Surgical treatment of subchondral osteonecrosis of the humeral head: A case report and literature review.

BACKGROUND: Osteonecrosis of the humeral head is an uncommon subchondral bone disease with many etiologies, and there is currently no definite evidence to support an optimal surgical treatment plan. We report a case of surgical treatment of left humeral head necrosis. To the best of our knowledge, this is the youngest patient with non-drug-induced humeral head necrosis and the largest collapsed area. CASE PRESENTATION: The case involved a 16-year-old male who injured his left shoulder 1 year ago. The patient was admitted to the hospital because of shoulder pain after activity in the year following the injury. During the physical examination, the left glenohumeral joint space was tender, the pain was obvious when the shoulder joint was rotated and squeezed, and the active and passive range of motion was normal. X-ray, magnetic resonance imaging, and computed tomography + 3D computed tomography scans all showed subchondral osteonecrosis of the left humeral head. Left humeral head lesion removal and autologous osteochondral transplantation were performed, and the patient was followed up. CONCLUSION: Non-drug-induced humeral head necrosis is rare. Autologous osteochondral transplantation is currently one of the most mature and effective treatment methods. The short-term curative effect in this patient is satisfactory, but the patient is young and has a large collapsed area, so long-term follow-up is worthwhile.

circRNA-ZCCHC14 affects the chondrogenic differentiation ability of peripheral blood-derived mesenchymal stem cells by regulating GREM1 through miR-181a.

circRNAs play an important role in the progression of osteoarthritis (OA). Therefore, we aimed to reveal the mechanism of action of circRNA-ZCCHC14 in OA. OA animal and cell models were constructed, and clinical samples were collected. The expression of circRNA-ZCCHC14 and miR-181a was detected by RT‒qPCR. The chondrogenic differentiation ability of peripheral blood-derived mesenchymal stem cells (PBMSCs) was detected by Alcian blue staining. The expression of chondrogenic differentiation-related proteins was detected by Western blotting. Double fluorescein experiments verified the targeting relationship of miR-181a with circRNA-ZCCHC14 and GREM1. Upregulation of circRNA-ZCCHC14 was observed in blood, in BMP-2- and TGF-ß3-treated PBMSCs from OA patients and in animal models. Knockdown of circRNA-ZCCHC14 promoted the chondrogenic differentiation ability of PBMSCs. circRNA-ZCCHC14 was found to bind to miR-181a and negatively regulate miR-181a expression. Inhibition of miR-181a reversed the promoting effect of circRNA-ZCCHC14 knockdown on the chondrogenic differentiation ability of PBMSCs. GREM1 was identified as a target of miR-181a. Overexpression and knockdown of GREM1 regulated the expression of BMP2, which in turn affected the chondrogenic differentiation ability of PBMSCs, indicating that GREM1 and BMP2 have antagonistic effects and that they jointly regulate the chondrogenic differentiation of PBMSCs. circRNA-ZCCHC14 may promote the chondrogenic differentiation ability of PBMSCs by regulating miR-181a and inhibiting the expression of GREM1.

Total marrow irradiation reduces organ damage and enhances tissue repair with the potential to increase the targeted dose of bone marrow in both young and old mice.

Total body irradiation (TBI) is a commonly used conditioning regimen for hematopoietic stem cell transplant (HCT), but dose heterogeneity and long-term organ toxicity pose significant challenges. Total marrow irradiation (TMI), an evolving radiation conditioning regimen for HCT can overcome the limitations of TBI by delivering the prescribed dose targeted to the bone marrow (BM) while sparing organs at risk. Recently, our group demonstrated that TMI up to 20 Gy in relapsed/refractory AML patients was feasible and efficacious, significantly improving 2-year overall survival compared to the standard treatment. Whether such dose escalation is feasible in elderly patients, and how the organ toxicity profile changes when switching to TMI in patients of all ages are critical questions that need to be addressed. We used our recently developed 3D image-guided preclinical TMI model and evaluated the radiation damage and its repair in key dose-limiting organs in young (~8 weeks) and old (~90 weeks) mice undergoing congenic bone marrow transplant (BMT). Engraftment was similar in both TMI and TBI-treated young and old mice. Dose escalation using TMI (12 to 16 Gy in two fractions) was well tolerated in mice of both age groups (90% survival ~12 Weeks post-BMT). In contrast, TBI at the higher dose of 16 Gy was particularly lethal in younger mice (0% survival ~2 weeks post-BMT) while old mice showed much more tolerance (75% survival ~13 weeks post-BMT) suggesting higher radio-resistance in aged organs. Histopathology confirmed worse acute and chronic organ damage in mice treated with TBI than TMI. As the damage was alleviated, the repair processes were augmented in the TMI-treated mice over TBI as measured by average villus height and a reduced ratio of relative mRNA levels of amphiregulin/epidermal growth factor (areg/egf). These findings suggest that organ sparing using TMI does not limit donor engraftment but significantly reduces normal tissue damage and preserves repair capacity with the potential for dose escalation in elderly patients.

Clinical outcomes of acute displaced posterior cruciate ligament tibial avulsion fracture: A retrospective comparative study between the arthroscopic suture and EndoButton fixation techniques.

BACKGROUND: Tibial avulsion fracture of the posterior cruciate ligament is not rare in the clinic. Arthroscopic treatment is increasingly accepted, but the choice of fixation has been debated. This study aims to compare the clinical outcomes of suture and EndoButton fixation under arthroscopy for acute displaced posterior cruciate ligament avulsion fractures. METHODS: A total 68 of 83 PCL tibial avulsion fracture cases from 2009 to 2016 were retrospectively reviewed. Some patients received arthroscopic suture initially, and later the others received arthroscopic EndoButton fixation. Associated lesions were treated if present. The Lysholm and International Knee Documentation Committee (IKDC) scores, KT-1000 arthrometry and plain radiography were evaluated at follow-up. The assessment data at two years of follow-up were used for comparing the two different fixation groups. RESULTS: The follow-up time of 63 patients was more than 2 years. In total, 32 of the 63 patients were in the suture group, and 31 were in the EndoButton group. At two years of follow-up, knee function according to the Lysholm score was a mean of 92.5 with a 95% confidence interval [CI] of 89.45 to 96.40 in the suture group and a mean of 93.5 with a 95% CI of 90.52 to 97.28 in the EndoButton group (P=.785). More than 90% of patients in both groups rated their knee function as normal or nearly normal on IKDC subjective evaluation. KT-1000 arthrometry showed that there was no difference between the two groups, with 0 to 3mm of laxity in 91% of the cases in the suture group versus 90% of cases in the EndoButton group. All patients achieved bony healing within 3 months. No significant complications were noted in the study. CONCLUSIONS: Both the arthroscopic suture and EndoButton fixation methods for acute displaced posterior cruciate ligament avulsion fractures resulted in comparably good clinical outcomes, radiologic healing, and stable knees at mid-term follow-up. LEVEL OF EVIDENCE: III; retrospective comparative study.

The outcomes of one-stage treatment for multiple knee ligament injuries combined with extensor apparatus rupture.

BACKGROUND: Multiple knee ligament injuries combined with extensor apparatus rupture are serious and complex knee injuries that are rare in clinical practice. The management is extremely challenging and controversial. The aim of this study is to describe a patient collective with multiple knee ligament injuries combined with extensor apparatus injuries in detail and to report the mid-term outcomes of a one-stage surgical treatment regarding subjective outcome scores, complications, knee instability, and ROM. METHODS: Eleven of 425 patients with multiple knee ligament injuries combined with extensor apparatus injuries admitted to our hospital were reviewed from July 2008 to May 2017. All patients underwent one-stage repair and reconstruction of multiple knee ligaments and extensor apparatus. The Lysholm knee score and the International Knee Documentation Committee (IKDC) score were adopted to evaluate the surgical effect preoperatively and at a minimum of 2 years' follow-up. Clinical data, including range of motion and knee stability, were also recorded at the final follow-up. RESULTS: Ten patients were followed up with a mean time of 40 (range, 24-60) months. At the last follow-up, 8 patients had joint flexion range of motion greater than or equal to120 degrees, 2 patients had joint flexion range of motion of 100-120 degrees, and 1 patient had active knee extension limitation of 5 degrees. Stress radiographs showed that the mean differences in posterior displacement were reduced from 10.8 ± 3.0 mm preoperatively to 2.0 ± 2.5 mm at the last follow-up. There were significant improvements in stress radiographs from pre- to postoperative states for all patients with multiple knee ligament injuries. The Lysholm score ranged from 85 to 96, with a mean of 92.1 (compared with 33 before surgery, P < 0.05). The final IKDC scores were A in 2 patients (20%), B in 7 (70%), and C in 1 (10%). Nine of the 10 patients (90%) returned to their former activity level. CONCLUSION: Multiple knee ligament injuries combined with extensor apparatus rupture are rare. Single-stage management of the repair and reconstruction of multiple knee ligaments and extensor apparatus with proper rehabilitation is an effective and reliable procedure to restore knee stability and function. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Open tibia plateau fracture with intra-osseous dislocation of the patella and quadriceps tendon rupture: a case report.

BACKGROUND: Both tibial plateau fractures and extensor apparatus injuries are serious injuries to the knee joint that generally do not occur in the same patient. We report a rare case of open tibial plateau fracture combined with quadriceps tendon rupture and complete displacement of the patella into the tibial plateau fracture. CASE PRESENTATION: The case involved a male who was 19 years old who had been in a motorcycle accident. The patient was admitted to our department with an open tibial plateau fracture 3 h post-injury. X-ray showed a tibial plateau fracture and complete displacement of the patella into the tibial plateau. CT showed an avulsion fracture in the patella and tibial intercondylar eminence. Concomitant quadriceps tendon injury and both anterior and posterior cruciate ligament tibial insertion avulsion fractures were considered. The operative findings of emergency surgery confirmed our preoperative diagnosis. Single-stage quadriceps tendon repair and ORIF for the tibial plateau fracture were performed. Satisfactory restoration of function was acquired at the last follow up. CONCLUSION: The most difficult aspect of this case was the determination of the cause of the intra-osseous dislocation of the patella into the tibial plateau. The most likely mechanism of the injury may be that the patient experienced transient posterior dislocation of the knee during the injury. Rupture of the quadriceps tendon should be considered with posterior dislocation of the knee, and the patella was pushed into the tibial plateau fracture by force after the rupture of the quadriceps tendon.

Correlations Between the Genetic Variations in the COL1A1, COL5A1, COL12A1, and ß-fibrinogen Genes and Anterior Cruciate Ligament Injury in Chinese Patientsa.

CONTEXT: A variety of factors have been linked to the occurrence of anterior cruciate ligament injury (ACLI), including sex, familial factors, and genetic variations. OBJECTIVE: To find the genetic loci associated with ACLI and explore the genetic mechanism of ACLI in order to provide a genetic basis for the diagnosis, prognosis, and treatment of patients with ACLI. DESIGN: Cross-sectional study. SETTING: Hospital. PATIENTS OR OTHER PARTICIPANTS: Data from 101 Chinese Yunnan Han patients with ACLI and 110 Yunnan Han individuals without ACLI (control group) were collected. MAIN OUTCOME MEASURE(S): The single nucleotide polymorphisms of COL1A1 rs1800012, COL5A1 rs12722 and rs13946, COL12A1 rs970547 and rs240736 and the rs1800787, rs1800788, rs1800789, rs1800790, rs1800791, and rs2227389 in the ß-fibrinogen (ß-fib) promoter region were analyzed using restriction fragment length polymorphism and DNA sequencing detection, and their genetic associations with ACLI were assessed. RESULTS: Single nucleotide polymorphisms of COL1A1 rs1800012, COL5A1 rs12722 and rs13946, and the rs1800789 and rs1800791 in the ß-fib promoter region showed no difference between patients with ACLI and control participants, but the changes of COL12A1 rs970547 and rs240736 and the rs1800787, rs1800788, rs1800790, and rs2227389 genotypes in the ß-fib promoter region were associated with ACLI. Furthermore, the rs970547 allele and genotype frequencies in male ACLI patients were different from the control group (P < .05): the frequencies of the rs970547 A and G alleles in the patients were 71.9% and 28.1%, respectively, and in the control group were 58.8% and 41.2%, respectively. The frequencies of AA, AG, and GG genotypes in the patients were 49.3%, 45.2%, and 5.5%, respectively, and in the control group were 27.5%, 62.7%, and 9.8%, respectively, suggesting that male carriers of rs970547 A and rs970547 AA were at high risk of ACLI. CONCLUSIONS: Males with the rs970547 A allele and rs970547 AA genotype of COL12A1 may be at high risk for ACLI. Low rs1800787 TT and high rs1800788 CT, rs1800790 AG, and rs2227389 CT frequencies as well as high TGA* of rs1800790, rs1800791, and rs2227389 in the ß-fib promoter region may be genetic risk factors related to ACLI.

Therapeutic effect and mechanism of action of quercetin in a rat model of osteoarthritis.

OBJECTIVE: To study the therapeutic effect and mechanism of action of quercetin in a rat model of osteoarthritis (OA). METHODS: The OA rat model was established by intra-articular injection of papain. Changes in knee diameter, toe volume and histopathology were measured. Levels of interleukin (IL)-ß and tumor necrosis factor (TNF)-α were assessed by ELISA. Relative expression of Toll-like receptor (TLR)-4 and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) was evaluated by western blotting. RESULTS: Compared with rats treated with papain alone, changes in knee diameter, toe volume and Makin' s score were less apparent in OA rats treated with quercetin. Levels of serum IL-1ß and TNF-α were also reduced in quercetin-treated OA rats. Expression of TLR-4 and NF-κB was significantly suppressed in a dose-dependent manner in quercetin-treated OA rats. CONCLUSION: Quercetin exhibited a therapeutic effect in OA rats, which may be related to inhibition of IL-1ß and TNF-α production via the TLR-4/NF-κB pathway.

Arthroscopically assisted treatment for nonconcentric reduction of hip posterior dislocation caused by acetabular labrum rim fracture: Medium-term clinical and radiological outcomes.

BACKGROUND: Nonconcentric reduction of hip posterior dislocation caused by the acetabular labrum rim fracture is rare. There has been very little study on the feasibility of arthroscopically treatment and medium and mid-term evaluation to this pathology. The objectives of the current study were: (1) Is the arthroscopically assisted technique feasible to this manage this injury? (2) What is the effectiveness of arthroscopic treatment for nonconcentric reduction of hip posterior dislocation caused by acetabular labrum rim fracture. HYPOTHESIS: Arthroscopically assisted procedure is an alternative treatment modality for nonconcentric reduction of hip posterior dislocation caused by acetabular labrum rim fracture. PATIENTS AND METHODS: Thirteen of 257 posterior hip dislocations who were admitted to our hospital from February 2008 to March 2017 were included: 9 males and 4 females, with an average age of 23.7 (15-36) years. All of them underwent hip posterior dislocation and nonconcentric reduction related to acetabular labrum rim fracture. All of them had arthroscopic reduction and fixation of the rim fracture. Visual Analogic Score (VAS) score, modified Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the last follow-up radiographs were analyzed respectively. Postoperative complication and the need for secondary operation were recorded during the process. RESULTS: The incidence rate of this pathology was nearly 5%. Twelve out of 13 patients were followed up for an average of 42 (range, 26-68) months. At the final follow-up, VAS score was decreased from 5.2±0.9 (range, 4.0-6.1) preoperatively to 0.5±0.5 (range, 0.0-1.0) (p<0.0001), modified Harris score and WOMAC score were increased statistically significant from 32±8 (range, 28-40) and 30±5 (range, 25-35) to 94±5 (range, 89-99) and 95±4 (range, 91-99) respectively (p<0.0001). All patients have had completely concentric reduction and returned to activities of daily life. There was not any hip arthroscopic complication such as sciatic nerve injury and intra-abdominal fluid extravasation. Besides, there were no aseptic necrosis and revision case. CONCLUSION: Arthroscopically assisted procedure is an alternative treatment modality for nonconcentric reduction of hip posterior dislocation caused by the acetabular labrum rim fracture without surgical dislocation procedure. Good clinical results can be achieved without any complications related to the surgical procedure. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

[Arthroscopic Twin Tail TightRope combined with distal joint capsule repair technique for acute acromioclavicular dislocation].

OBJECTIVE: To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. METHODS: The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups ( P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. RESULTS: The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation ( P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group ( P<0.05). CONCLUSION: Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.

[Arthroscopic treatment of irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions].

OBJECTIVE: To investigate the effectiveness of arthroscopic treatment for irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions. METHODS: Between February 2008 and August 2016, 11 patients with irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions, were treated with arthroscopic reduction and fixation of bony Bankart lesions. There were 7 males and 4 females, with an average age of 23.7 years (mean, 15-36 years). The injury was caused by traffic accident in 8 cases and falling from height in 3 cases. The interval between hip dislocation and the first manual reduction was 2-8 hours (mean, 5.3 hours) and between the first manual reduction and arthroscopic surgery was 6-31 days (mean, 12.8 days). The preoperative visual analogue scale (VAS) was 5.2±0.9, the modified Harris score was 32±8, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was 30±5. RESULTS: The operative time was 90-150 minutes (mean, 120.9 minutes), with no hip arthroscopic surgery related complications. All incisions healed by first intention. All patients were followed up 26-68 months (mean, 42.7 months). Postoperative X-ray films showed that all hip joints were reduction; CT showed that the reduction of posterior acetabular wall fracture was satisfactory. And all fractures healed at last follow-up with no avascular necrosis of the femoral head or osteoarthritis. At last follow-up, the VAS score was 0.5±0.5, the modified Harris score was 94±5, and the WOMAC score was 95±4. There were significant differences in those indexes between pre- and post-operation ( P<0.05). CONCLUSION: The irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions is rare. Arthroscopic therapy has the advantages of less trauma, quick recovery, and less complications.

Peripheral Blood Mesenchymal Stem Cells Combined with Modified Demineralized Bone Matrix Promote Pig Cartilage Defect Repair.

OBJECTIVE: To investigate the mobilization of peripheral blood mesenchymal stem cells (PBMSCs) and whether a combination of PBMSCs and modified demineralized bone matrix (DBM) promoted the repair of cartilage lesions in a pig model. METHODS: Pig PBMSCs were mobilized by the combined administration of granulocyte colony-stimulating factor (G-CSF) and the CXCR4 antagonist AMD3100. Colony formation was detected by the fibroblast colony-forming unit (CFU-F) count and the percentage of the CD45-CD90+ cell population by flow cytometry. The mobilized cells were identified as MSCs by their morphological characteristics, surface markers, and differentiation potentials. The composite scaffolds carrying BMP-2 and TGF-ß3 chitosan sustained-release microspheres/DBM were prepared by emulsion cross-linking and the Urist method, and scanning electron microscopy (SEM) observation was performed. The model of pig cartilage defect was prepared, and gross observation, histological examination, immunohistochemistry, and O'Driscoll scoring were performed 4, 8, and 12 weeks postoperation. RESULTS: After mobilization, the number of CFU-Fs in the peripheral blood in the experimental group (G-CSF + AMD3100) was significantly increased compared with the control group (p < 0.05). The proportion and total number of CD45-CD90+ cells were increased (p < 0.05). The mobilized stem cells had MSC characteristics. SEM of the new tissue-engineered cartilage showed that PBMSCs were evenly grown on the surface of the scaffold and microsphere morphology had no obvious change. Gross observation, histological examination, immunohistochemistry, and O'Driscoll score were better in the experimental group than in the other groups (p < 0.05). CONCLUSION: G-CSF + AMD3100 is an effective mobilization agent for PBMSCs. The new tissue-engineering cartilage constructed by two-factor sustained-release microspheres/DBM composite PBMSCs effected good repair of the cartilage defect in pigs.

MiR-181a regulates the chondrogenic differentiation in pig peripheral blood mesenchymal stem cells.

Articular cartilage injury and therapy are important clinical issues around the world. Mesenchymal stem cells (MSCs) have the ability to differentiate into chondrocytes, which makes MSCs good candidates for use in cartilage repairing. However the regulation and the mechanism of chondrogenesisin MSCs is still unclear. To clarify the factor and mechanism which contribute to the process of chondrogenic differentiation, we focus on miRNAs. Considering the role of miR-181a in chondrogenesis and osteoblast formation, we tested the expression of miR-181a in the induced chondrogenic differential pig PBMSCs by using qRT-PCR. And we identified miR-181a as an up-regulated miRNA in the TGF-ß3-induced pig PBMSCs chondrogenic differentiation from the early stages and maintained elevated throughout the whole process. After inhibition of the endogenesis miR-181a expression by transfecting the miR-181a inhibitor, the western-blot results and immunofluorescence results indicated that the expression of differentiation-related protein COL2A1, BMP2 were decreased, together with the Alcian blue assay, proving the process of differentiation was inhibited significantly. Taken together, our results demonstrated that miR-181a might be necessary in chondrogenesis of MSCs. Even so, the mechanism of miR-181a on regulating the chondrogenesis still needed to be investigated in future work. And our data would provide an experimental evidence for the research of tissue engineering.

Bone marrow-derived mesenchymal stem cells (BM-MSCs) inhibit apoptosis of spinal cord cells in a kaolin-induced syringomyelia-associated scoliosis rabbit model.

The mechanisms and causes of scoliosis are believed to be multifactorial. Syringomyelia can often be found in scoliosis patients but the relationship between the two remains obscure. In this study, based on a rabbit model of syringomyelia-associated scoliosis, the involved pathological mechanism was explored in an attempt to further understand the relationship. This will also be helpful in determining how scoliosis occurred. In this study, a syringomyelia-associated scoliosis rabbit model was established by kaolin-injection technique. Spinal cell apoptosis following scoliosis and syringomyelia induction were analyzed. Furthermore, the effect of bone marrow-mesenchymal stem cell (BM-MSCs) transplantation on spinal cell apoptosis and on incidence of scoliosis and syringomyelia were assessed. Most of the experimental animals injected with kaolin developed progressive scoliotic curves and syringomyelia. Syrinx and scoliosis were found in 64.7% and 58.8% of the experimental animals. Syringomyelia-associated scoliosis appeared in 41.2% of the animals. Syrinx size and scoliotic curves increased with time. Apoptosis was found on postoperative day 3 both in surgical segments and adjacent segments in the spinal cord, peaking at week 6. The number of apoptotic cells was significantly lower in BM-MSCs transplantation group compared with the saline-injection group. Fewer rabbits in the BM-MSCs injection group developed scoliosis or syringomyelia by the end of the experiment. Our findings indicate the potential value of kaolin-induced scoliotic animal models. For the first time, we studied features of apoptosis of spinal cells in a syringomyelia-associated scoliosis rabbit model. Our results demonstrate that BM-MSCs transplanted into the spinal cord decrease both apoptosis of spinal cells and incidence of scoliosis and syringomyelia.

The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia.

BACKGROUND: Habitual patellar dislocation is not common in clinical practice, but it has a deep impact on the patient's lifestyle and movement. There has been no large case-control study on habitual patellar dislocation, and the management of it is still controversial. The aim of this study was to observe the efficacy of the modified Fulkerson procedure on patients with habitual patellar dislocation with high-grade trochlear dysplasia without trochleoplasty and to evaluate the results of this procedure. METHODS: A total of 25 patients who were admitted to our hospital from April 2007 to October 2013 were included: 7 males and 18 females, aged 17-28 years old, with an average age of 21.5 years old, including 21 cases of unilateral dislocation and 4 cases of bilateral dislocation. The tibial tuberosity transfer procedure (internal rotation, medial transfer and elevation osteotomy) and medial patellofemoral ligament (MPFL) reconstruction were performed in all cases of habitual patellar dislocation that were accompanied by trochlea dysplasia. RESULTS: The mean follow-up duration was 36.8 months (range, 25-68 months). A CT scan was performed to compare the tibial tuberosity-trochlear groove distance (TT-TG), the patellar tilt angle (PTA), and the mean Kujala and Lysholm scores before surgery and at follow-up and to measure the angle of internal rotation of the tibial tubercle after surgery. The mean Kujala and Lysholm scores improved significantly (P < 0.05) from 55.65 ± 6.10 and 50.34 ± 6.54 preoperatively to89.24 ± 4.66 and 88.53 ± 4.75, respectively, at follow-up. The tibial tuberosity-trochlear groove distance (TT-TG) decreased significantly (P < 0.05) from 20.24 ± 2.80 mm to 10.50 ± 4.50 mm, and the patellar tilt angle (PTA) decreased significantly (P < 0.05) from28.58 ± 3.28to7.54 ± 5.56. No recurrence was observed, and only one patient had a mild skin infection after surgery. The mean angle of internal rotation of the tibial tubercle was 10 ± 4° after surgery. There were no cases of stiffness. CONCLUSIONS: The modified procedure of tibial tubercle transfer, especially the internal rotation, which can improve the patella stability and knee function, is an effective surgical procedure for the treatment of habitual patellar dislocation associated with high-grade trochlear dysplasia without trochleoplasty. LEVEL OF EVIDENCE: III.

[Arthroscopic treatment of both anterior and posterior cruciate ligament tibial insertion avulsion fractures with suture and absorbable screw double fixation].

OBJECTIVE: ?To evaluate the effectiveness of arthroscopic suture and absorbable screw double fixation for both anterior and posterior cruciate ligament avulsion fractures of tibial insertions. METHODS: ?Between June 2006 and September 2013, 8 patients with anterior and posterior cruciate ligament avulsion fractures of the tibial eminence underwent arthroscopic treatment with suture and absorbable screw double fixation. There were 5 males and 3 females, with a mean age of 28.9 years (range, 18-43 years). The causes of injury included traffic accident in 5 cases and falling from height in 3 cases. The time from injury to operation was 3-10 days (mean, 6.2 days). The Lysholm knee score, International Knee Documentation Committee (IKDC) score, and Tegner rating scales were used to evaluated the knee function. RESULTS: ?Primary healing of incision was obtained, without infection or deep vein thrombosis. The mean follow-up period was 42.4 months (range, 24 to 65 months). At 3 months after operation, X-ray films showed good reduction and healing of fracture. The anterior and posterior drawer tests were negative. The knee range of motion was normal (0-125°), and it recovered to preoperative level in 7 cases. The IKDC score, Tegner score, and Lysholm score were significantly improved to 90.4±5.2, 7.5±1.6, and 89.2±3.5 from preoperative 52.1±3.3, 3.3±1.0, and 51.9±3.5 respectively (t=-38.680, P=0.000; t=-39.520, P=0.000; t=-41.150, P=0.000). CONCLUSIONS: ?A combined injury of anterior and posterior cruciate ligament avulsion fractures of tibial insertions is rare. Arthroscopic treatment with suture and absorbable screw double fixation is a useful technique to restore tibial avulsion injuries with well-documented radiographic healing, good clinical outcomes, and low complication rates.

[ROLE OF TIBIAL TUBERCLE INTERNAL ROTATION TO TREAT RECURRENT PATELLAR DISLOCATION ASSOCIATED WITH TROCHLEAR DYSPLASIA].

OBJECTIVE: To introduce and analyze the role of tibial tubercle internal rotation to treat recurrent patellar dislocation associated with trochlear dysplasia. METHODS: Between February 2007 and April 2011, 28 patients with recurrent patellar dislocation underwent tibial tubercle translocation through medial transfer, rotation and elevation of the tibial tuberosity and the medial patellofemoral ligament (MPFL) reconstruction. There were 4 males and 24 females with an average age of 21.8 years (range, 17-28 years). The disease duration ranged from 6 months to 8 years (mean, 4 years). The patients suffered from 3-10 times patellar dislocation. The result of apprehension test was positive; Lysholm score was (51.64 ± 3.79); Kujala score was (56.89 ± 3.79). According to Dejour classification, 11 cases were rated as type B, 14 cases as type C, and 3 cases as type D; the tibial tuberosity-trocholear distance (TT-TG) was (20.53 ± 2.58) mm; and the patellar tilt angle (PTA) was (29.34 ± 2.54)°. RESULTS: Primary healing of incision was obtained in the others except 1 case of mild infection. Twenty-seven patients were followed up 41.8 months on average (range, 27-74 months). No recurrent dislocation was found, and the result of apprehension test was negative. The knee range of motion restored to normal totally. The postoperative Kujala score and Lysholm score were significantly improved to 88.97 ± 3.06 and 88.95 ± 2.98 (t = -42.005, P = 0.000; t = -43.122, P = 0.000) respectively. TT-TG and PTA restored to normal [(11.77 ± 2.24) mm and (7.99 ± 2.57)°], showing significant differences when compared with preoperative ones(t=13.032, P=0.000; t=29.533, P=0.000). CONCLUSION: The technique of tibial tubercle translocation and MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation associated with trochlear dysplasia. Especially, tibial tubercle internal rotation can improve the patella stability and knee function.

[Effectiveness of double-needle suture for mixed meniscus tear repair under arthroscope].

OBJECTIVE: To investigate the effectiveness of double-needle suture for mixed meniscus tear repair under arthroscope. METHODS: Between April 2006 and January 2011, 22 patients with mixed meniscus tear were treated with double-needle suture under arthroscope. There were 14 males and 8 females, aged 18-41 years (mean, 31.3 years). All injuries were caused by sports. The time between injury and admission ranged from 2 days to 4 years (median, 11 months). International Knee Documentation Committee (IKDC) score was 42.5 +/- 15.2, Lysholm score was 45.5 +/- 13.5, and Tegner score was 2.9 +/- 1.6. Seventeen cases complicated with anterior cruciate ligament injury. RESULTS: Healing of incision by first intention was achieved in all patients. No injury of nerve and blood occurred. The patients were followed up 12-48 months with an average of 27.6 months. According to Barrett et al. standard, 19 cases (86%) got clinical healing. The IKDC, Lysholm, and Tegner scores were improved to 77.1 +/- 8.9, 79.8 +/- 9.9, and 6.8 +/- 1.6 respectively at last follow-up, showing significant differences when compared with preoperative scores (P < 0.05). Co CONCLUSION: Arthroscopic meniscus repair using double-needle suture can provide good effectiveness because it has high firmness.

[Posterior deformity vertebra resection with pedicle instrumentation in treatment of congenital scoliosis or kyphoscoliosis in child and adolescent patients].

OBJECTIVE: To discuss operative strategies of posterior deformity vertebra resection and instrumentation fixation in the treatment of congenital scoliosis or kyphoscoliosis in child and adolescent patients, and to evaluate the surgical results. METHODS: From May 2003 to December 2007, 28 patients with congenital scoliosis or kyphoscoliosis were treated with one stage posterior deformity vertebra resection. There were 11 males and 17 females with an average age of 9.6 years (1.5-17.0 years). The locations were thoracic vertebra in 13 cases, thoracolumbar vertebra in 10 cases, and lumbar vertebra in 5 cases. All the patients underwent one stage posterior deformity vertebra resection, fusion and correction with pedicle instrumentation. According to different types of deformities, the patients underwent three different surgeries: hemivertebra resection (13 patients), hemivertebra resection combined contralateral unsegmental resection (7 patients), and total vertebral column resection (8 patients). Based on short or long segmental pedicle instrumentation, deformities were corrected and fixed, in 7 patients with short segmental fixation (group A), in 13 patients with long segmental fixation with hemivertebra resection or combined contralateral unsegmental resection (group B), and in 8 patients with long segmental fixation with total vertebral column resection (group C). The operative duration and the volume of blood loss were recorded, and the correction rate was calculated through measurement of Cobb angles of scoliosis and kyphosis before and after operation. RESULTS: The operation time of groups A, B, and C was (98 +/- 17), (234 +/- 42), and (383 +/- 67) minutes, respectively, and the blood loss during operation was (330 +/- 66), (1540 +/- 120), and (4760 +/- 135) mL, respectively; showing significant differences among three groups (P < 0.05). All patients achieved one-stage healing of incision. No deep infection, respiratory failure or deep vein thrombosis occurred. One patient had the signs of ischemical reperfusion injury of spinal cord 6 hours after operation and recovered after 2 weeks of relative therapy in group C; no neurological complication occurred in other patients. The mean follow-up period was 32.8 months (24-72 months). Intervertebral rigid fusion was identified from radiological data 6 months after operation according to contiguous callus crossed intervertebral gap and maintenance of correction results. No instrumentation failure occurred. There were significant differences in the Cobb angle between before and after operations (P < 0.01). There were significant differences in the corrective rate of scoliosis between groups A, B and group C (P < 0.05). Meanwhile, there were significant differences in the corrective rate of kyphosis between groups A, C and group B (P < 0.05). CONCLUSION: One-stage posterior deformity vertebra resection has a good capability of correcting congenital scoliosis or kyphoscoliosis on coronal and sagittal plane relied on removal deformity origin. It is important to select appropriated strategies on deformity resection and segmental fixation according to different ages and deformity situations of patient.

The DNA damaging agent etoposide activates a cell survival pathway involving alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate receptors and mitogen-activated protein kinases in hippocampal neurons.

Etoposide, an inhibitor of topoisomerase II that induces DNA damage and can trigger cell death, is used as a chemotherapeutic agent. Because chemotherapies can result in neurological complications and because DNA damage in neurons is implicated in the pathogenesis of several neurodegenerative disorders, we studied the effects of etoposide on cultured hippocampal neurons. We found that etoposide induces neuronal apoptosis and that, prior to the cell death commitment point, there is an increase in whole-cell alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA)-induced current but no change in N-methyl-D-aspartate (NMDA)-induced current. Associated with the increase in AMPA-induced current was an increase in the amounts of AMPA receptor subunits GluR1 and GluR4, whereas levels of the NMDA receptor subunit NR1 were unaffected by etoposide. AMPA receptor activation can result in excitotoxic cell death but can also activate signaling pathways that promote synaptic plasticity and cell survival. We found that etoposide increases the activation of p42 and p44 mitogen-activated protein (MAP) kinases, and that activation of the MAP kinases by etoposide requires AMPA receptor activation. Pharmacological blockade of AMPA receptors and p42/p44 MAP kinases, but not of NMDA receptors, exacerbated etoposide-induced cell death. These findings suggest that, although etoposide is neurotoxic, it also activates a cell survival pathway involving AMPA receptor-mediated activation of p42/p44 MAP kinases. Agents that selectively inhibit the cell life or death pathways triggered by DNA damage may prove useful in the settings of cancer and neurodegenerative disorders, respectively.