Multi-Group Gorilla Troops Optimizer with Multi-Strategies for 3D Node Localization of Wireless Sensor Networks.

The localization problem of nodes in wireless sensor networks is often the focus of many researches. This paper proposes an opposition-based learning and parallel strategies Artificial Gorilla Troop Optimizer (OPGTO) for reducing the localization error. Opposition-based learning can expand the exploration space of the algorithm and significantly improve the global exploration ability of the algorithm. The parallel strategy divides the population into multiple groups for exploration, which effectively increases the diversity of the population. Based on this parallel strategy, we design communication strategies between groups for different types of optimization problems. To verify the optimized effect of the proposed OPGTO algorithm, it is tested on the CEC2013 benchmark function set and compared with Particle Swarm Optimization (PSO), Sine Cosine Algorithm (SCA), Whale Optimization Algorithm (WOA) and Artificial Gorilla Troops Optimizer (GTO). Experimental studies show that OPGTO has good optimization ability, especially on complex multimodal functions and combinatorial functions. Finally, we apply OPGTO algorithm to 3D localization of wireless sensor networks in the real terrain. Experimental results proved that OPGTO can effectively reduce the localization error based on Time Difference of Arrival (TDOA).

Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction Using Transosseous Sutures Versus Suture Anchors: A Prospective Nonrandomized Controlled Trial.

BACKGROUND: Patellar instability remains a challenging problem for orthopaedic surgeons. Recurrent patellar instability is traditionally treated with medial patellofemoral ligament (MPFL) reconstruction using a suture anchor or bone tunnel technique. Although the use of transosseous sutures was recently described for MPFL reconstruction, relevant clinical data have not been reported. PURPOSE/HYPOTHESIS: The purpose of this study was to compare a new transosseous suture fixation technique with the suture anchor technique for MPFL reconstruction. The hypothesis was that reconstruction with transosseous sutures would show similar clinical results to reconstruction with suture anchors. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: There were 65 patients with recurrent lateral patellar dislocations from January 2014 to December 2016 who were included in this prospective nonrandomized controlled trial. In total, 31 patients underwent MPFL reconstruction with suture anchors at the patella site (suture anchor group), while the other 34 patients underwent MPFL reconstruction with transosseous sutures (transosseous suture group). The main outcome variable (patellar redislocation) was recorded at follow-up (range, 25-60 months). The International Knee Documentation Committee (IKDC) score, Kujala score, range of motion, congruence angle, patellar tilt, redislocation rate, and complications were collected preoperatively and/or postoperatively. RESULTS: No recurrent dislocations or other complications were observed in any of the patients. No significant differences were found at follow-up between the suture anchor and transosseous suture groups for subjective IKDC score, Kujala score, congruence angle, patellar tilt, redislocation rate, or range of motion. CONCLUSION: This short-term study showed that after MPFL reconstruction (suture anchors or transosseous sutures), patellar stability could be restored. With the numbers available, no significant differences in outcome scores were observed between patients in the transosseous suture and suture anchor groups.

Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction With Suture Fixation of the Gracilis Tendon via Transosseous Tunnels.

BACKGROUND: Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. PURPOSE: To present a case series with a minimum 2-year follow-up of 29 patients with recurrent patellar dislocation who underwent a new transosseous suture fixation technique for MPFL reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From January 2014 through February 2016, a total of 29 patients with recurrent patellar dislocation for which the MPFL was reconstructed with transosseous suture patellar fixation were studied. All patients were available for follow-up (mean, 37.52 months; range, 26-48 months). The patellar attachment was fixed by transosseous patellar sutures. The International Knee Documentation Committee (IKDC) subjective knee score, Kujala score, Tegner score, range of motion, congruence angle, patellar tilt angle, and complications were assessed both pre- and postoperatively. RESULTS: No recurrent dislocation was observed in any of the 29 patients for a minimum of 2 years. All outcome scores improved significantly from preoperatively to postoperatively: the average IKDC subjective knee evaluation score from 53 to 87, Kujala from 54 to 90, Lysholm from 50 to 89, and Tegner from 3 to 5 (P < .001 for all). The congruence angle significantly decreased from 22° preoperatively to -3° postoperatively, and the patellar tilt angle (Merchant) decreased from 23° preoperatively to 5° postoperatively (P < .001 for both). In total, 25 patients (25/29; 86.21%) were completely pain-free when performing activities of daily living at the last follow-up, and 27 patients (93.1%) rated themselves as very satisfied or satisfied with the results. CONCLUSION: In patients with chronic recurrent patellar dislocation, transosseous patellar suture fixation for MPFL reconstruction can significantly improve patellar stability and achieve good results at short-term follow-up.

Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis.

To evaluate the application, safety and efficacy of the patients treated with intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal tibia fractures. Following the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines, we searched databases PubMed, Cochrane library, EMBASE and Web of Science from inception of the database up to 10 October 2018, using the keywords "distal tibia fractures", "plate", "intramedullary nailing" and "RCT" to identify randomized clinical trials about distal tibia fractures. The included studies were assessed by two researchers according to the Cochrane risk-of-bias criteria. The primary outcome of measurement included operation time, malunion rate, nonunion/delayed union rate, and wound complication. Data analysis was conducted with Review Manager 5.3 software. A total of 10 RCTs involving 911 patients fulfilled the inclusion criteria with 455 patients in the IMN group and 456 patients in the MIPO group. There were no significant differences in radiation time, nonunion or delayed union rate, union time and operation time between the two groups. Patients treated with MIPO had lower incidence of malunion compared with IMN (RR = 1.85, 95%CI: 1.21 to 2.83, P = 1.00), while IMN seemed to have lower surgical incision complications whether in closed or opening fractures (RR = 0.49, 95%CI 0.33 to 0.73, P = 0.43). But in patients classified as 43A, the result of subgroup analysis suggested that there was no significant inwound complication between the two groups. MIPO was superior in preventing malunion compared with IMN, and intramedullary nailing appeared to have lower wound complications. However, in patients with 43A distal tibial fractures, MIPO was more recommended for its prevention of malunion. No matter which method we choose, we should notice and prevent the associated complications.

KLF2 Protects against Osteoarthritis by Repressing Oxidative Response through Activation of Nrf2/ARE Signaling In Vitro and In Vivo.

Osteoarthritis (OA) is a multifactorial and inflammatory disease characterized by cartilage destruction that can cause disability among aging patients. There is currently no effective treatment that can arrest or reverse OA progression. Kruppel-like factor 2 (KLF2), a member of the zinc finger family, has emerged as a transcription factor involved in a wide variety of inflammatory diseases. Here, we identified that KLF2 expression is downregulated in IL-1ß-treated human chondrocytes and OA cartilage. Genetic and pharmacological overexpression of KLF2 suppressed IL-1ß-induced apoptosis and matrix degradation through the suppression of reactive oxygen species (ROS) production. In addition, KLF2 overexpression resulted in increased expression of heme oxygenase-1 (HO-1) and NAD(P)H dehydrogenase quinone 1 (NQO1) through the enhanced nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2). Further, Nrf2 inhibition abrogated the chondroprotective effects of KLF2. Safranin O/fast green and TUNEL staining demonstrated that adenovirus-mediated overexpression of KLF2 in joint cartilage protects rats against experimental OA by inhibiting cartilage degradation and chondrocyte apoptosis. Immunohistochemical staining revealed that KLF2 overexpression significantly decreases MMP13 expression caused by OA progression in vivo. This in vitro and in vivo study is the first to investigate the antioxidative effect and mechanisms of KLF2 in OA pathogenesis. Our results collectively provide new insights into OA pathogenesis regulated by KLF2 and a rationale for the development of effective OA intervention strategies.

Comparison of the accelerometer-based navigation system with conventional instruments for total knee arthroplasty: a propensity score-matched analysis.

BACKGROUND: The accelerometer-based navigation (ABN) system is an emerging navigation system for total knee arthroplasty (TKA). This study aimed to determine whether the ABN system could improve the accuracy of mechanical alignment, component positioning, and short-term clinical outcomes for TKA when compared to conventional instruments (CON). METHODS: A total of 204 patients were selected and divided into two groups (CON: 135, ABN: 69) after applying the inclusion and exclusion criteria. Then, 1:1 propensity score matching was performed for age, gender, body mass index, hip-knee-ankle angle (HKA), Knee Society Score (KSS), Western Ontario and McMaster Universities (WOMAC) score, and follow-up times. A total of 82 consecutive patients (82 knees) underwent total knee arthroplasty using ABN (n = 41) or CON (n = 41) were enrolled in this study. The postoperative HKA, frontal femoral component (FFC) angle, frontal tibial component (FTC) angle, lateral femoral flexion (LFF) angle, and lateral tibial component (LTC) angle were compared between the two groups to evaluate mechanical alignment and component positioning. Additional clinical parameters, including haemoglobin reduction, the KSS, and the WOMAC score, were assessed at the final follow-up (the mean follow-up period was 20.9 months in the CON group and 21.2 months in the ABN group). RESULTS: The ABN group had a significantly improved mean absolute deviation of HKA (P = 0.033), FFC (P = 0.004), FTC (P = 0.017), LFF (P = 0.023), and LTC (P = 0.031) compared to those of the CON group. The numbers of FFCs and LTCs within 3° were significantly different (P = 0.021, P = 0.023, respectively) between the two groups. However, no differences in the numbers of FTCs within 3° (P = 0.166) and LFF within 3° (P = 0.556) were found. The ABN group had a significantly higher KS function score (P = 0.032), and the pain and stiffness scores were significantly different (P = 0.034, P = 0.020, respectively) between the two groups. Moreover, the ABN system could reduce hidden blood loss postoperatively. However, no difference was found in the KS knee score and the total WOMAC score between the two groups. CONCLUSION: This study demonstrates that ABN system improved TKA mechanical alignment and component positioning and decreased the hidden blood loss postoperatively compared to conventional instruments. However, no significant differences were found in short-term clinical outcomes between ABN and conventional instruments at the final follow-up. However, whether this system contributes to revision rates and long-term clinical outcomes requires further study.

High concentration magnesium inhibits extracellular matrix calcification and protects articular cartilage via Erk/autophagy pathway.

The significant cytopathological changes of osteoarthritis are chondrocyte hypertrophy, proteoglycan loss, extracellular matrix (ECM) calcification, and terminally, the replacement of cartilage by bone. Meanwhile, magnesium ion (Mg2+ ), as the second most abundant divalent cation in the human body, has been proved to inhibit the ECM calcification of hBMSCs (human bone marrow stromal cells), hVSMCs (Human vascular smooth muscle cells), and TDSCs (tendon-derived stem cells) in vitro studies. The ATDC5 cell line, which holds chondrocyte characteristics, was used in this study as an in vitro subject. We found that Mg2+ can efficiently suppress the ECM calcification and downregulate both hypertrophy and matrix metalloproteinase-related genes. Meanwhile, Mg2+ inhibits the formation of autophagy by inhibiting Erk phosphorylation signaling and lowers the expression of LC3, and eventually effectively reduces the formation of ECM calcification in vitro. In this study, we also used destabilization of the medial meniscus (DMM)-induced osteoarthritis (OA) animal model to further confirm the protective effect of Mg2+ on articular cartilage. Compared with the control group (saline-injected), continuous intra-articular magnesium chloride (MgCl2 ) injection can significantly alleviate the severity of cartilage calcification in OA animal model. Immunofluorescence staining also revealed that saline-injected DMM group had a higher positive rate of LC3 expression in cartilage chondrocytes, compared with MgCl2 -injected DMM group. In general, Mg2+ can significantly downregulate the hypertrophic gene Runx2, MMP13, and Col10α1, upregulate the chondrogenic genes Sox9 and Col1α1, inhibit the Erk phosphorylation signaling, reduce the expression of autophagy protein LC3, and effectively inhibit the ECM calcification of ATDC5. In vivo study also proved that intra-articular injection of Mg2+ protected knee cartilage by inhibiting the autophagy formation.

[Effect of posterior oblique ligament repair on rotational stability of knee joint].

OBJECTIVE: To investigate effect of posterior oblique ligament (POL) repair on the rotational stability of the knee joint for the medial collateral ligament (MCL) combined with anterior cruciate ligament (ACL) ruptures. METHODS: The clinical data of 50 patients (50 knees) with grade-3 MCL-ACL combined injuries who met the selection criteria between January 2013 and December 2015 were retrospectively analyzed. All ACLs were reconstructed with autogenous tendon and the superficial and deep layers of MCLs were sutured; then, POLs were also sutured in 25 patients of repair group and only received conservation treatment postoperatively in 25 patients of conservation group. There was no significant difference in gender, age, disease duration, and preoperative KT-1000 measuring, medial joint space opening, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, and knee range of motion between the two groups ( P>0.05). RESULTS: All incisions of the two groups healed by first intention, no surgical related complications occurred. All patients were followed up, with follow-up time of 28-56 months (mean, 38.1 months) in repair group and 26-55 months (mean, 29.1 months) in conservation group. At last follow-up, the IKDC score, VAS score, KT-1000 measuring, medial joint space opening, and knee range of motion significantly improved in the two groups when compared with preoperative ones ( P<0.05); but there was no significant difference between the two groups ( P>0.05). The Slocum test showed that there was no instability of the anterior medial rotation in the two groups. CONCLUSION: The POL repair can't obtain more medial stability after ACL reconstruction and MCL repair (superficial and deep layers) for patients who have MCL-ACL combined injuries.

Influences of temperature and salinity on holistic network performability of multi-AUV cooperative systems.

This study proposes holistic network performability as a reliability index of multiple autonomous underwater vehicle (AUV) (multi-AUV) cooperative systems and deduces the reliability of communication links. Temperature and salinity vary in different areas of the sea. The influence mechanism of temperature and salinity on holistic network performability is discussed. An example is provided to show the influences of temperature and salinity on holistic network performability. Corresponding trends of holistic network performability with the influences of temperature and salinity can be obtained. The trends show that the holistic network performability of multi-AUV cooperative systems exhibit ladder-like increases with temperature and salinity. In each ladder, the value of holistic network performability changes rapidly at high salinity or low temperature. The study on the change of the reliability of multi-AUV cooperative systems under different temperatures and salinities provides a theoretical basis for the reliability research of multi-AUV cooperative systems and provides reference for future practical application of multi-AUV cooperative systems and other network systems.

Vitamin K2 stimulates MC3T3­E1 osteoblast differentiation and mineralization through autophagy induction.

Vitamin K2 likely exerts its protective effects during osteoporosis by promoting osteoblast differentiation and mineralization. However, the precise mechanism remains to be fully elucidated. Autophagy maintains cell homeostasis by breaking down and eliminating damaged proteins and organelles. Increasing evidence in recent years has implicated autophagy in the development of osteoporosis. The aim of the present study was to verify whether vitamin K2 (VK2) can induce autophagy during the differentiation and mineralization of osteoblasts. In the present study, MC3T3­E1 osteoblasts were treated with various doses of VK2 (10­8­10­3 M) for 1­5 days. The results revealed no cytotoxicity at concentrations below 10­5 M, but cell viability was reduced in a dose­dependent manner at concentrations above 10­5 M. Furthermore, MC3T3­E1 osteoblasts were seeded in 6­well plates in complete medium supplemented with dexamethasone, ß­glycerophosphate and vitamin C (VC) for osteogenic differentiation. MC3T3­E1 osteoblasts treated with different concentrations (10­5, 10­6 and 10­7 M) of VK2 for 24 h on days 1, 3, 5 and 7 of the differentiation protocol. It was confirmed that VK2 promoted osteoblast differentiation and mineralization by using alkaline phosphatase (ALP) and alizarin red staining. Using western blotting, immunofluorescence, monodansylcadaverine staining and reverse transcription­quantitative polymerase chain reaction, it was observed that VK2 induced autophagy in osteoblasts. The results revealed that VK2 (1 µM) significantly increased ALP activity and the conversion of microtubule associated protein 1 light chain 3­α (LC3)II to LC3I in MC3T3­E1 osteoblasts (P<0.05) at every time point. The number of fluorescent bodies and the intensity increased with VK2, and decreased following treatment with 3­MA+VK2. There was an increase in the mRNA expression levels of ALP, osteocalcin (OCN) and Runt­related transcription factor 2 in VK2­treated cells (P<0.01). The present study further confirmed the association between autophagy and osteoblast differentiation and mineralization through treatment with an autophagy inhibitor [3­methyladenine (3­MA)]. Osteoblasts treated with 3­MA exhibited significant inhibition of ALP activity and osteogenic differentiation (both P<0.05). In addition, ALP activity and osteogenesis in the VK2+3­MA group was lower compared with VK2­treated cells (P<0.05 for both). The present study confirmed that VK2 stimulated autophagy in MC3T3 cells to promote differentiation and mineralization, which may be a potential therapeutic target for osteoporosis.

The transcriptional coactivator YAP1 is overexpressed in osteoarthritis and promotes its progression by interacting with Beclin-1.

Osteoarthritis (OA) constitutes the most common disease of degenerative joints, with chondrocytes playing an important role in disease progression. However, the underlying pathobiological mechanisms have not been fully characterized. In this study, we investigated the role of Yes-associated protein 1 (YAP1)-regulated autophagy in chondrocyte proliferation, apoptosis, and differentiation. The data showed that YAP1, a transcriptional coactivator, was overexpressed in OA tissues from a murine model of OA, as analyzed by real time PCR and western blot. Overexpression of YAP1 significantly suppressed ATDC5 chondrogenic cell proliferation and decreased the expression of differentiation-related genes including Runx2, osteocalcin, and collagen I, and elevated cell apoptosis, whereas these cellular processes were reversed by knockdown of YAP1. Immunofluorescence analysis demonstrated that YAP1 co-localized with the autophagy regulator beclin1. Co-immunoprecipitation experiments indicated that this interaction was enhanced in OA tissues. In contrast, YAP1 lacking the internal WW domains failed to interact with beclin1 and was unable to inhibit beclin1 ubiquitination. This resulted in upregulated autophagy, which significantly improved OA by increasing chondrocyte proliferation and differentiation. Notably, YAP1 expression was significantly downregulated by various anti-OA drugs. Finally, the Yap1 promoter was activated by transcriptional factors AP2α and SP1, whereas its 3'UTR was targeted by miR-5624-5p, miR-33-3p, and miR-6918-5p. In conclusion, inhibition of YAP1 could facilitate beclin1-regulated autophagy in OA, suggesting a potential therapeutic approach to combat OA.

LPS promote Osteosarcoma invasion and migration through TLR4/HOTAIR.

OBJECTIVES: Osteosarcoma is one of common malignant tumors worldwide in the metaphysis of teenagers. The role of lncRNAs in Osteosarcoma has become an emerging area of research. MATERIALS AND METHODS: Cell migration and invasion were analyzed in Osteosarcoma cell following knockdown or overexpression by transfection with small interfering RNA (siRNA) or treated with LPS. Western blotting and Real-time RT-PCR methods were used to analyze the effects of LPS on EMT. RESULTS: We discovered that LPS could regulate cell migration and invasion and promote EMT. At the same time, LPS could regulate the expression of TLR4 and HOTAIR. In addition, knockdown of the expression of TLR4 partially reverses the promotion of cell invasion induced by LPS. CONCLUSIONS: Our results indicated that LPS coordinate the Osteosarcoma through TLR4/HOTAIR.

Autophagy protects bone marrow mesenchymal stem cells from palmitate­induced apoptosis through the ROS­JNK/p38 MAPK signaling pathways.

In recent years, the association between saturated fatty acids (FA) and bone cells has received a high level of attention. Previous studies have shown that palmitate (PA), a common saturated FA, can cause apoptosis in bone marrow mesenchymal stem cells (BMSCs). However, whether PA can induce autophagy, an important intracellular protection mechanism that is closely associated with apoptosis, in BMSCs is still unknown; the association between autophagy and apoptosis is also unclear. The aim of the present study was to determine whether PA can induce autophagy in BMSCs. When BMSCs were treated with PA for >18 h, p62 began to accumulate, indicating that autophagic flux was impaired by prolonged exposure to PA. In addition, the proportion of apoptotic cells was increased when autophagy was inhibited by the autophagy inhibitor 3­methyladenine. Furthermore, inducing autophagy by pretreating cells with rapamycin, a known inducer of autophagy, markedly reduced PA­induced apoptosis, suggesting that autophagy may serve a protective role in PA­induced apoptosis in BMSCs. PA also increased intracellular reactive oxygen species (ROS) production, which was decreased by the antioxidant N­Acetyl­cysteine, and promoted the activation of c­Jun N­terminal kinases (JNKs) and p38 mitogen­activated protein kinase (MAPK). The addition of JNK and p38 MAPK inhibitors substantially reduced autophagy. Therefore, the results indicated that PA can induce autophagy in BMSCs and protect cells from PA­induced apoptosis through the ROS­JNK/p38 MAPK signaling pathways. These results may improve the general understanding of the mechanisms through which BMSCs adapt to PA­induced apoptosis. The present study also provides a novel approach for the prevention and treatment of PA­induced lipotoxicity.

Low-dose dexamethasone affects osteoblast viability by inducing autophagy via intracellular ROS.

Glucocorticoids (GCs) are closely associated with the progression of GC­induced osteoporosis (GIOP) by inhibiting osteoblast viability. However, endogenous GCs are important for bone development. In addition, previous studies have demonstrated that GCs could induce autophagy, a cytoprotective process that is protective against various stressors. In the present study, the aim is to explore whether osteoblasts exhibited dose­dependent viability in the presence of GCs due to autophagy. hFOB 1.19 osteoblasts were treated with various doses of dexamethasone (DEX; 10­8­10­4 M) for 0, 24, 48 and 72 h. The results revealed a biphasic effect of DEX on the viability of hFOB 1.19 cells; a high dose of DEX (≥10­6 M) accelerated cell apoptosis, while a low dose of DEX (10­8 M) increased cell viability. Furthermore, significantly increased autophagy was observed in the low dose DEX treatment group, as indicated by the expression of the autophagy­associated proteins beclin 1 and microtubule­associated protein light chain 3, and the detection of autophagosomes. Another finding was that DEX upregulated intracellular reactive oxygen species (ROS), which was decreased by the autophagy agonist rapamycin. The increase in autophagy and cell viability associated with low­dose DEX (10­8 M) was suppressed by the ROS scavenger catalase and the autophagy inhibitor 3­methyladenine. In conclusion, the results revealed that GCs affected osteoblast viability in a dose­dependent manner. A low dose of GCs increased osteoblast viability by inducing autophagy via intracellular ROS. The results indicate that autophagy may be a novel mechanism by which osteoblasts survive GC exposure and provide a potential therapeutic target for treating GIOP.

MiR-338-5p Promotes Inflammatory Response of Fibroblast-Like Synoviocytes in Rheumatoid Arthritis via Targeting SPRY1.

Our purpose is to study the roles of microRNA-338-5p (miR-338-5p) on the proliferation, invasion, and inflammatory response of fibroblast-like synoviocytes (SFs) in rheumatoid arthritis patients by regulating SPRY1. The target relationship between miR-338-5p and SPRY1 was validated through luciferase reporter system. The expression of miR-338-5p and SPRY1 in synovial tissues and synovial cells were detected using RT-PCR and western blot. The mimics and inhibitors of miR-338-5p were transfected into SFs. MTT, Transwell, and ELISA assays were used to analyze cell proliferation, invasiveness, and the secreted extracellular pro-inflammatory cytokines (such as IL-1a, IL-6, COX2) levels of SFs. MiR-338-5p was highly expressed in rheumatoid arthritis tissues and cells, and directly down-regulated the expression of SPRY1 in the SFs of rheumatoid arthritis patients. Cell proliferation, invasiveness and the expression level of pro-inflammatory cytokines in synovial cells increased after the transfection of miR-338-5p mimics, while the proliferation, invasion and expression level of pro-inflammatory cytokines decreased after the transfection of miR-338-5p inhibitors. In conclusion,miR-338-5p promoted the proliferation, invasion and inflammatory reaction in SFs of rheumatoid arthritis by directly down-regulating SPRY1 expression. J. Cell. Biochem. 118: 2295-2301, 2017. © 2017 Wiley Periodicals, Inc.

[EFFICACY COMPARISON BETWEEN DEEP MEDIAL COLLATERAL LIGAMENT REPAIR AND CONSERVATIVE TREATMENT FOR COMPLETE MEDIAL COLLATERAL LIGAMENT RUPTURE].

OBJECTIVE: To compare the clinical efficacy between deep medial collateral ligament (dMCL) repair and conservative treatment for complete MCL rupture. METHODS: Between August 2009 and December 2013, 36 patients with grade 3 MCL rupture underwent superior MCL (sMCL) reconstruction with tibial Inlay technique. Of 36 cases, 19 received dMCL repair (repair group), and 17 received conservative treatment (conservation group) after sMCL reconstruction. There was no significant difference in gender, age, knee sides, type of injury, disease duration and preoperative medial joint opening, knee Lysholm scores, and International Knee Documentation Committee (IKDC) score between 2 groups (P > 0.05). The Lysholm and IKDC scores, medial joint opening, range of motion (ROM), visual analogue scale (VAS) scores, and complications were used to assess the knee joint function. RESULTS: All patients achieved primary incision healing without acute postoperative complications of incision infection and deep vein thrombosis in the lower limb. The patients were followed up 28-65 months (mean, 46.3 months) in the repair group, and 26-69 months (mean, 45.9 months) in the conservation group. No knee stiffness, vascular or nerve injury, and knee joint infection occurred in 2 groups. All the patients recovered medial stability at 2 years postoperatively. At 2 years after operation, no significant difference was shown in knee ROM between 2 groups (t = 0.26, P = 0.80); the VAS score of the repair group was significantly lower than that of the conservation group (t = 5.22, P = 0.00); medial joint opening, IKDC score, and Lysholm score were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but no significant difference was found between 2 groups (P > 0.05). CONCLUSION: Whether or not additional dMCL repair is performed can recover medial stability after sMCL reconstruction. However, the additional dMCL repair is better in relieving medial knee pain than the conservative treatment.

[TREATMENT OF SEVERE MEDIAL COLLATERAL LIGAMENT RUPTURE IN MULTI-LIGAMENT INJURY].

OBJECTIVE: To compare the clinical efficacy between medial collateral ligament (MCL) repair and MCL reconstruction in multi-ligament injury. METHODS: Thirty-one patients with MCL rupture and multi-ligament injury of knee joint were treated between August 2008 and August 2012, and the clinical data were retrospectively analyzed. Of 31 patients, 11 cases underwent MCL repair (repair group), and 20 cases underwent MCL reconstruction (reconstruction group). There was no significant difference in gender, age, body mass, injury side, injury cause, and preoperative knee Lyshlom score, International Knee Documentation Committee (IKDC) subjective score, range of motion, and medial joint opening between 2 groups (P>0.05). The postoperative knee subjective function and stability were compared between 2 groups. RESULTS: All incisions healed by first intention, and no postoperative complication occurred. All patients were followed up 2-4 years (mean, 3.2 years). At 2 years after operation, the IKDC subjective score, Lyshlom score, and range of motion were significantly increased in 2 groups when compared with preoperative ones (P<0.05). The range of motion of reconstruction group was significantly better than that of repair group (P<0.05). No significant difference was found in IKDC subjective score and Lyshlom score between 2 groups (P>0.05). The medial joint opening was significantly improved in 2 groups at 2 years after operation when compared with preoperative one (P<0.05), but no significant difference was found between 2 groups (P>0.05). CONCLUSIONS: Both the MCL reconstruction and MCL repair can restore medial stability in multi-ligament injury, but MCL reconstruction is better than MCL repair in range of motion.

[HEMIARTHROPLASTY COMBINED WITH GREATER TROCHANTER REATTACHMENT DEVICE FOR TREATING INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENTS].

OBJECTIVE: To evaluate the effectiveness of hemiarthroplasty combined with greater trochanter reattachment device for intertrochanteric fractures in elderly patients. METHODS: A retrospective analysis was made on the clinical data of 34 patients (35 hips) with intertrochanteric fractures underwent hemiarthroplasty combined with greater trochanter reattachment device between February 2010 and April 2013. Of 34 patients, 16 were males (16 hips) and 18 were females (19 hips), and the mean age was 85.6 years (range, 77-95 years). All fractures were caused by falling. The left hip was involved in 20 cases, the right hip in 13 cases, and the bilateral hips in 1 case. There were 33 cases (34 hips) of fresh fracture, and 1 case (1 hip) of old fracture. Fractures were rated as type III in 6 cases (6 hips), type IV in 11 cases (11 hips), and type V in 17 cases (18 hips) according to Evans-Jensen standard. All of the patients had different degree of osteoporosis and internal diseases. RESULTS: All patients underwent surgery successfully. The operation time was 70-90 minutes (mean, 76.6 minutes); the intraoperative blood loss was 260-400 mL (mean, 301.5 mL); the postoperative drainage was 80-530 mL (mean, 290.6 mL); and the hospitalization time was 10-12 days (mean, 11.7 days). Postoperative infection of incision occurred in 1 case, which was cured after dressing; primary healing of incision was obtained in the other patients. No lower extremity deep vein thrombosis or other complications was observed. Twenty-six cases (27 hips) were followed up 12-48 months (mean, 21.3 months). X-ray examination showed fracture healing, and the healing time was 2.5-3.5 months (mean, 2.8 months). There was no dislocation, prosthesis loosening, dislocation, loosening of titanium cable, periprosthetic osteolysis, or other complications during the follow-up period. According to Harris hip score, the results were excellent in 8 hips, good in 15 hips, fair in 4 hips, and the excellent and good rate was 85.2% at 1 year after operation. CONCLUSION: The hemiarthroplasty combined with greater trochanter reattachment device is a feasible and effective method to treat intertrochanteric fractures in the elderly patients. It can allow early ambulation and improve quality of life, but it is necessary to strictly control the indications, and perioperative management should be paid attention.

Surgical treatment of an osteopetrotic patient with postoperative fractures: lessons from siblings with osteopetrosis.

Osteopetrosis is a rare, inherited disease characterized by dense and brittle bones, and it is associated with an increased risk of femoral fractures. However, the surgical treatment of the fracture patients with osteopetrosis is a subject of controversy, because it is difficult to compare the treatment effects between surgical treatment and conservative treatment in part due to the rarity of siblings with osteopetrosis. In fact, the genetic background and the environmental factors, such as living conditions and daily work, may influence the prognosis of the fracture patients with osteopetrosis. Here we describe siblings with osteopetrosis, a 23-year-old female patient and her older brother, both of whom had suffered from bilateral femoral fractures at their childhood. They do not have other brothers or sisters, and their parents are healthy. The younger sister had undergone surgical treatment for femoral fractures at the age of 8 years and recovered very well. In contrast, her brother had received the conservative treatment for femoral fractures at the age of 6 years, and thereafter he is badly disabled due to the malunion of the fractured femurs. Apparently, the surgical treatment is superior to the conservative treatment for the fracture patient with osteopetrosis. Unfortunately, fifteen years later, the sister fractured again at both femurs and underwent another operation. She recovered quickly from the second operation, indicating that second operation should be considered in osteopetrosis patients with postoperative fractures. The present report provides valuable information for the choice of treatment of femoral fractures associated with osteopetrosis.