Functional knee phenotypes appear to be more suitable for the Chinese OA population compared with CPAK classification: A study based on 3D CT reconstruction models.

PURPOSE: The aim of this study was to investigate the distribution of coronal plane alignment of the knee (CPAK) classification and functional knee phenotypes in a Chinese osteoarthritis (OA) population and to compare different lower limb alignment targets according to the distribution characteristics to find suitable total knee arthroplasty (TKA) bone cut strategies for the Chinese OA patients. METHODS: The computed tomography (CT) images were retrospectively collected and the three-dimensional (3D) models were reconstructed from 434 Chinese OA patients, including 93 males and 341 females, with a mean age of 66.4 ± 9.3 years. Femoral mechanical angle (FMA), tibial mechanical angle (TMA) and mechanical hip-knee-ankle angle (mHKA) were measured on the 3D models. Arithmetic hip-knee-ankle angle (aHKA) was calculated using FMA plus TMA, and joint line obliquity was calculated as 180 + TMA-FMA. The CPAK according to MacDessi and the functional knee phenotypes according to Hirschmann were performed. In addition, the suitable TKA bone cut strategies were explored according to the phenotypes and based on the characteristics of different alignment targets, such as mechanical alignment, anatomic alignment (AA), kinematic alignment, restricted KA (rKA) and adjusted MA (aMA). Statistical differences were determined using the independent-samples t-test or the two independent-samples Wilcoxon test, with p < 0.05 considered statistically significant. RESULTS: The Chinese OA population showed a varus alignment tendency (mHKA = 172.1° ± 7.2°), to which the TMA was a major contributor (TMA = 84.7° ± 4.4° vs. FMA = 91.3° ± 3.2°). The mHKA was on average 3.9° more varus than the aHKA. A total of 140 functional knee phenotypes were found and 45.6% were concentrated in VARFMA3°-NEUFMA0° to VARTMA3°-NEUTMA0°. More than 70% of patients had different FMA and TMA phenotypes. There were 92.9% of CPAK distributed in types I to IV, with type I accounting for 53.9%. The FMA phenotypes were less changed if the aMA and rKA were chosen, and the TMA phenotypes were less changed if the AA and rKA were chosen. CONCLUSION: Compared with the CPAK, the functional knee phenotypes were more suitable for the Chinese OA population with a wide distribution and a varus tendency, and it seemed more appropriate to choose aMA and rKA as TKA alignment targets for resection. LEVEL OF EVIDENCE: Level Ⅲ.

[Effectiveness of Tang's arthroscopy approach for anterior and posterior ankle impingement syndrome].

OBJECTIVE: To investigate the effectiveness of Tang's arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome. METHODS: Between August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang's arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups ( P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement. RESULTS: Median operation time of group A was 50.5 minutes ï¼»95%CI (49.3, 54.6)ï¼½, which was significantly shorter than that of group B ï¼»88.5 minutes, 95%CI (76.5, 92.8)ï¼½ (Z=-4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups ( t=-0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ 2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones ( P<0.05), but there was no significant difference between the two groups ( P>0.05). The median subjective satisfaction score of group A was 2.0 ï¼»95%(1.4, 1.7)ï¼½, which was better than that of group B ï¼»2.0, 95%(1.6, 2.2)ï¼½ ( Z=-2.480, P=0.013). CONCLUSION: Arthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang's approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.

[Effectiveness of Extracorporeal Shockwave Therapy in Treating Superior Lateral Brachial Cutaneous Nerve Compression Syndrome].

Objective To evaluate the effectiveness of radial extracorporeal shockwave therapy(rESWT) for the treatment of superior lateral brachial cutaneous nerve(SLBCN) compression syndrome.Methods A total of 40 patients with SLBCN compression syndrome who were treated in our department from March 2013 to October 2015 were equally randomized into two groups according to random number table:rESWT group(treated with rESWT for 1 cycle) and control group(treated with local hormone injection for 1 cycle). Visual analogue scale(VAS) and Constant-Murley scale(CMS) were applied to evaluate the shoulder joint function before treatment and 1 month and 1 year after treatment. Results The average CMS scores were(66.7±0.9) and(65.7±1.1)scores in rESWT group and control group,respectively,before treatment(t=0.67,P=0.510) and were(86.9±1.0) and(86.4±1.1)scores one month after treatment(t=0.35,P=0.730);it increased to(89.7±0.7) scores in rESWT group one year later,which was significantly higher than that in control group[(85.3±0.8)scores](t=3.56,P=0.002). The improvement rate was 95% in rESWT group and only 75% in control group. Before treatment,the median VAS score in rESWT group and control group were 5.00(5.00,6.00) and 5.00(4.00,5.75)scores(u=1.13,P=0.29);one month after treatment,the median VAS score in these two groups were 2(1.00,2.75) and 2.00(1.00,2.00)scores(u=0.04,P=0.85);one year later,it was 1.00(0.00,1.00) scores in rESWT group,significantly lower than that in [2.00(1.00,2.00)scores] control group(u=5.09,P=0.02). Conclusion Compared with local hormone injection,rESWT can remarkably alleviate pain and restore shoulder joint function in patients with SLBCN compression syndrome after one year of treatment.

Downregulation of microRNA-9 increases matrix metalloproteinase-13 expression levels and facilitates osteoarthritis onset.

Matrix metalloproteinase-13 (MMP-13) degrades collagen and other matrix components, thus playing a critical role in the development of osteoarthritis (OA). The expression level of microRNA­9 (miR­9) is significantly depressed in cartilage tissues of OA patients. Furthermore, bioinformatics analysis demonstrated complementary binding sites between miR­9 and MMP­13. The current study, therefore, investigated whether miR­9 is involved in regulating MMP­13 expression levels and OA onset. Cartilage tissues from OA patients and healthy individuals were compared for miR­9, MMP­13 and collagen type II α1 chain (Col2A1) expression levels. A dual luciferase gene reporter assay was performed to evaluate the association between miR­9 and MMP­13. Sodium iodoacetate was injected into the knee joint cartilage tissues to generate the rat OA model. The expression levels of miR­9, MMP­13 and Col2A1 were compared between the model and control rats. In addition, the OA model rats received miR­9 agomir for further expressional assay. Cartilage tissue samples from the OA patients exhibited significantly lower miR­9 and Col2A1 expression levels when compared with the control rats, whilst the expression level of MMP­13 was upregulated. As the target gene of miR­9, MMP­13 is under the targeted regulation of miR­9. The injection of miR­9 agomir into the knee joint cavity significantly depressed MMP­13 expression in the cartilage tissues of OA rats, with reduced collagen degradation and enhanced COL2A1. OA cartilage tissues have lower miR­9 expression and higher MMP­13 expression levels. Thus, miR­9 inhibits the expression level of MMP­13, decreases its inhibitory effects on COL2A1, and therefore contributes to antagonizing OA.

[REVERSED ARTHROSC OPIC SUBACROMIAL DEC OMPRESSION FOR TREATMENT OF ROTATOR CUFF TEARS].

OBJECTIVE: To investigate the effectiveness of reversed arthroscopic subacromial decompression in the treatment of rotator cuff tears. METHODS: Between November 2012 and January 2015, 53 patients with rotator cuff tears were treated with reversed arthroscopic subacromial decompression and rotator cuff repair. Of 53 patients, 38 were male and 15 were female, with the age of 47-61 years (mean, 53.4 years). The injury was caused by falling in 36 cases and other in 17 cases without an obvious history of trauma. All patients had shoulder pain and limited shoulder movement before operation. Visual analogue scale (VAS) was 6.4±0.9, and University of California at Los Angeles (UCLA) score was 16.3±1.9. MRI showed that distal supraspinatus tear was observed in 41 cases and distal infraspinatus tear in 12 cases; partial-thickness rotator cuff tear was observed in 9 cases and full-thickness tear in 44 cases. And the tear size was from 1 to 3 cm (mean, 1.9 cm). Combined injuries included tendinitis of long head of biceps brachii in 31 cases, Bankart lesion in 5 cases, and superior labrum anterior and posterior lesion in 2 cases. RESULTS: Incision healed by first intention in all patients; no infection or nerve injury occurred. Forty-nine cases were followed up from 12 to 35 months (mean, 22.8 months). After operation, shoulder pain relief was achieved in 42 cases; 7 cases had anterior shoulder pain at 3 months after operation, which was relieved after symptomatic treatment. At last follow-up, VAS score was significantly decreased to 0.5±0.6 (t=40.565, P=0.000). UCLA score was significantly increased to 33.8±1.7 (t=-79.799, P=0.000). The results were excellent in 42 cases, good in 6 cases, and fair in 1 case; the excellent and good rate was 98.0%. CONCLUSIONS: Reversed arthroscopic subacromial decompression can avoid coracoacromial arch injury and achieve good recovery of joint function, so it can be used in rotator cuff tears procedure.

Correlation between anatomical parameters of intertubercular sulcus and retroversion angle of humeral head.

OBJECTIVE: To obtain anatomical data on intertubercular sulcus of humerus, evaluate the correlation between intertubercular sulcus and retroversion angle of humeral head, to guide the positioning of torsion angle of prosthesis during total shoulder arthroplasty and provide references for shoulder prosthesis design. METHODS: Using a Siemens Ultrahigh speed 64- rows multi-slices spiral CT scanner and 20 dried adult humeral specimens (intact specimen, no fractures or pathological damage), of these, left lateral in 10 cases, right lateral in 10 cases, male or female all inclusive, specimens are all provided by Anatomy Department of Weifang Medical College, scan ranged from the highest point of humeral head to the distal ends of trochlea. And scanned data were subjected to statistical analysis. RESULTS: There is a linear correlation between the distance from intertubercular sulcus to central axis line of humeral head, position angle of intertubercular sulcus and retroversion angle of humeral head at the beginning slice of intertubercular sulcus. There is a linear correlation between position angle of intertubercular sulcus and retroversion angle of humeral head at the slice of surgical neck. CONCLUSION: There is a linear correlation between position of intertubercular sulcus and retroversion angle of humeral head, in total shoulder arthroplasty, using intertubercular sulcus as anatomical landmark will help to accurately position torsion angle of individualized prosthesis. Position angle of intertubercular sulcus is an objective, flexible positioning indicator.

Arthroscopy-assisted reconstruction of coracoclavicular ligament by Endobutton fixation for treatment of acromioclavicular joint dislocation.

OBJECTIVE: The aim of this study was to evaluate the clinical outcomes of arthroscopy-assisted reconstruction of the coracoclavicular (CC) ligament using Endobutton for treating acromioclavicular (AC) joint dislocation. METHODS: From March 2012 to May 2013, a total of 22 patients with fresh AC joint dislocation (Rockwood type III and type V) were treated with arthroscopy-assisted Endobutton reconstruction of the CC ligament. The regular post-operation follow-up was performed. Shoulder joint function was assessed with Constant-Murley scores. Postoperative efficacy of the surgery was evaluated using the Karlsson criterion. RESULTS: The 22 patients were followed postoperatively for an average of 24 months (16-31 months). Among them, 20 patients achieved good functional recovery with no pain. Two patients had slight pain in the acromion during shoulder joint motion with limited abduction at 3 months, both of whom had recovered at 6 months. Radiography confirmed anatomical reduction of the AC joint in all patients. At 1 year, the Constant-Murley scores were 93.1 ± 2.4 points on the injured side versus 94.2 ± 2.7 points on the uninjured side. The difference did not reach statistical significance (P > 0.05). Postoperative Karlsson evaluation ranked 20 patients (90.9 %) as grade A and 2 as grade B (9.1 %) at the 3-month follow-up. All patients had become grade A at 6 months. None of the patients had brachial plexus or peripheral vascular injuries. CONCLUSION: Arthroscopy-assisted reconstruction of the coracoclavicular ligament by Endobutton fixation is a safe, easy method for treating AC joint dislocation. It provides reliable fixation, causes little trauma, and has a fast recovery.

Effect of recombinant human bone morphogenetic protein 2/poly-lactide-co-glycolic acid (rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis.

OBJECTIVE: To observe the effect of recombinant human bone morphogenetic protein 2/poly-lactide-co-glycolic acid (rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis. METHOD: Bilateral femoral head necrosis models of rabbit were established by steroid injection. A total of 48 rabbits (96 femoral head necrosis) were randomly divided into 4 groups: Group A, control group with12 rabbits, 24 femoral head necrosis; Group B, treated with rhBMP-2/PLGA implantation after core depression, with 12 rabbits, 24 femoral head necrosis; Group C, treated with rhBMP-2 implantation after core depression, with 12 rabbits, 24 femoral head necrosis; Group D treated with core depression group without implantation, with 12 rabbits, 24 femoral head necrosis. All animals were sacrificed after 12 weeks. The ability of repairing bone defect was evaluated by X-ray radiograph. Bone mineral density analysis of the defect regions were used to evaluate the level of ossification. The morphologic change and bone formation was assessed by HE staining. The angiogenesis was evaluated by VEGF immunohistochemistry. RESULTS: The osteogenetic ability and quality of femoral head necrosis in group B were better than those of other groups after 12 weeks by X-ray radiograph and morphologic investigation. And the angiogenesis in group B was better than other groups. Group C had similar osteogenetic quality of femoral head necrosis and angiogenesis with group D. CONCLUSION: The treatment of rhBMP-2/PLGA implantation after core depression can promote the repair of rabbit femoral head necrosis. It is a promising and efficient synthetic bone material to treat the femoral head necrosis.

[Arthroscopic surgery for severe elbow osteoarthritis and ankylosis].

OBJECTIVE: to investigate the clinical efficacy of arthroscopic debridement, shaping and soft tissue releasing in the treatment of severe elbow osteoarthritis and ankylosis. METHODS: arthroscopies were performed in 34 patients with severe elbow osteoarthritis. Among them, 13 were accompanied by ankylosis. In arthroscopic surgery, articular cavity was cleared. And loose bodies, osteophytes of coronoid process and olecranon of ulna were excised, the coracoid fossa and olecranon fossa shaped and joint capsules and collateral ligaments severely contracted properly released. Rehabilitation training was guided postoperatively. Arthralgia and range of motion of elbow were scored by Mayo's scoring criteria in contrast with that preoperatively. RESULTS: the pain and range of motion (ROM) of elbow improved obviously in 34 patients. Angle of extension postoperatively increased by 30° ± 16° and angle of flexion increased by 34° ± 19°. Postoperative ROM of elbow show significant difference with the preoperative status (P < 0.01). According to the Mayo's scoring criteria, the excellent and good rate was 85.3%. CONCLUSION: arthroscopic treatment of severe osteoarthritis and ankylosis of elbow is reliable. Trauma of arthroscopy is minimal and complications are rare.