Objective To review the influencing factors of medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation. Methods The literature of MPFL reconstruction for patellar dislocation at home and abroad in recent years were summarized and analyzed. Results The influencing factors such as the location of the femoral insertion point, the tension and the fixed angle of the grafts, the dysplasia of the femoral trochlear before operation, the abnormal tuberositas tibiae-trochlear groove value, the high position of the patellar, and the tilting angle of the patellar, are all the factors affecting the effectiveness of MPLF reconstruction. Conclusion During MPFL reconstruction, the surgical techniques and elimination of other factors that caused patellar instability need to be focused in order to reduce the complications and operation failure.
ObjectiveTo summarize the regulatory effect of long non-coding RNA (lncRNA) on osteoarthritis (OA) cartilage injury.MethodsThe molecular functions and mechanisms of lncRNA were introduced and its regulatory effects on the pathological processes of OA were elaborated by referring to the relevant literature at domestic and abroad in recent years.ResultsThe pathological characteristics of OA are degeneration of articular cartilage and inflammation of synovial tissue, but its etiology and pathological mechanism have not been clarified. lncRNA is a kind of heterogeneous non-coding RNA, which plays a regulatory role in many inflammation-related diseases and exerts a wide range of biological functions. lncRNA is a regulator involved in the pathogenesis of OA, and is abnormally expressed in OA cartilage, leading to the degeneration of the extracellular matrix of cartilage.ConclusionAt present, there have been preliminary studies on the pathological effects of lncRNA in regulating OA and the biological functions of chondrocytes. However, the pathogenesis of lncRNA and its regulatory network in OA and the way in which it regulates inflammatory pathways are still unclear, and further exploration is needed.
ObjectiveTo review the research progress of location methods and the best femoral insertion position of medial patellofemoral ligament (MPFL) reconstruction of femoral tunnel, and provide reference for surgical treatment.MethodsThe literature about femoral insertion position of the MPFL reconstruction in recent years was extensively reviewed, and the anatomical and biomechanical characteristics of MPFL, as well as the advantages and disadvantages of femoral tunnel positioning methods were summarized.ResultsThe accurate establishment of the femoral anatomical tunnel is crucial to the success of MPFL reconstruction. At present, there are mainly two kinds of methods for femoral insertion: radiographic landmark positioning method and anatomical landmark positioning method. Radiographic landmark positioning method has such advantages as small incision and simple operation, but it can not be accurately positioned for patients with severe femoral trochlear dysplasia. It is suggested to combine with the anatomical landmark positioning method. These methods have their own advantages and disadvantages, and there is no unified positioning standard. In recent years, the use of three-dimensional design software can accurately assist in the MPFL reconstruction, which has become a new trend.ConclusionFemoral tunnel positioning of the MPFL reconstruction is very important. The current positioning methods have their own advantages and disadvantages. Personalized positioning is a new trend and has not been widely used in clinic, its effectiveness needs further research and clinical practice and verification.
Objective To review the research progress of internal tension relieving technique in assisting anterior cruciate ligament (ACL) reconstruction with tendon grafts. MethodsThe in vivo and in vitro biomechanical tests, animal experiments, and clinical studies on the use of internal tensioning relieving technique assisted ACL reconstruction in recent years were extensively reviewed, the impact of this technology on the biomechanics, histological changes of grafts, and the clinical effectiveness were analyzed and summarized. Results The internal tensioning relieving technique based on non-absorbable high-strength sutures can reduce the risk of relaxation and rupture by enhancing the biomechanical strength of tendon grafts in vitro and in vivo, it shows good biocompatibility and support for the ligamentation of the tendon grafts and the establishment of the direct tendon-bone interface in terms of histology. This technique improves postoperative initial joint stability, range of motion, and functional scores in clinical practic, when combining with the enhanced recovery after surgery can effectively promote patients to return to pre-injury exercise level without serious complications. Conclusion The preliminary research results have confirmed the efficacy and safety of the internal tension relieving technique on assisting ACL reconstruction, then showes some degree of significance and prospect, but more research is needed to further optimize tension-relieving devices and related surgical techniques, and clarify the specific effects of this technique on graft’s structure remodeling, biomechanical function, and long-term clinical results.
Objective To explore the secretion law of high mobility group box 1（HMGB1）in rat pancreatic acinar cells induced by trypsin activation peptide（TAP）and release of HMGB1 affected by ethyl pyruvate（EP）. Methods The experiment was performed in 12 SD rats. The pancreatic acinar cells of rats were taken out and then separated into three groups：control group， TAP group， and EP group. TAP was added into TAP group and EP group（keep TAP at a final concentration of 3 nmol/L）， respectively， but EP was added into EP group only （keep EP at a final concentration of 28 mmol/L）. The expressions of HMGB1 mRNA and protein were detected by using real-time quantitative reverse transcription polymerase chain reaction（RT-PCR）or Western blot at 3 h， 6 h， 12 h， and 24 h time point， respectively. The relationship between HMGB1 and TAP action time was explored by rank correlation. Results Compared with control group， the expressions of HMGB1 mRNA and protein were increased with prolongation of the TAP action in TAP group and EP group（P＜0.05）. Compared with TAP group， the expressions of HMGB1 mRNA and protein were decreased in EP group（P＜0.05）. The expressions of HMGB1 mRNA and protein were increased with prolongation of the TAP action（P＜0.05）， and were highest at 12 h time point（P＜0.01）in TAP group. There were positive correlation between the expressions of HMGB1 mRNA and protein and TAP action time（rs=0.971， P＜0.01；rs=0.966， P＜0.01）.Conclusions TAP can induce the release of HMGB1 in pancreatic acinar cells. There is positive relationship between TAP in early stage and HMGB1 in later period of acute pancreatitis. EP can inhibit the release of HMGB1.
Objective To systematically evaluate the clinical value of remote ischemic preconditioning (RIPC) in elective percutaneous coronary intervention (EPCI). Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015), WanFang Data, CBM and CNKI from inception to June 2016, to collect randomized controlled trials (RCTs) about RIPC in EPCI. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Nine RCTs involving 1 099 patients were included. The results of meta-analysis showed that: There were no significant difference in the level of troponin I and T between the RIPC group and the control group (SMD=–0.24, 95%CI –0.63 to 0.16,P=0.24). Sensitive analysis showed that with 3×5–min remote preconditioning protocol, there was still no significant difference in the level of troponin I and T between the two groups (SMD=–0.16, 95%CI –0.36 to 0.04,P=0.12). Another, RIPC could significantly reduce the incidence of peri–procedural myocardial infarctions (RD=–0.14, 95%CI –0.20 to –0.08,P<0.000 01) and the risk of ST-segment deviation in the elective PCI procedure (RD=–0.17, 95%CI –0.26 to –0.07,P=0.000 6), but there was no significant difference in postoperative eGFR between both groups (SMD=–0.03, 95%CI –0.18 to 0.12,P=0.71). Conclusion RIPC can significant reduce the incidence of peri-procedural myocardial infarctions, and the risk of ST-segment deviation in the elective PCI procedure. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To investigate the changes of knee joint kinematics after anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral positioner based on the apex of deep cartilage (ADC). Methods Between January 2021 and January 2022, a total of 40 patients with initial ACL rupture who met the selection criteria were randomly divided into the study group (using the personalized femoral positioner based on ADC design to assist ACL reconstruction) and the control group (not using the personalized femoral positioner to assist ACL reconstruction), with 20 patients in each group. Another 20 volunteers with normal knee were collected as a healthy group. There was no significant difference in gender, age, body mass index, and affected side between groups (P>0.05). Gait analysis was performed at 3, 6, and 12 months after operation using Opti _ Knee three-dimensional knee joint motion measurement and analysis system, and the 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, internal and external displacement) and motion cycle (maximum step length, minimum step length, and step frequency) of the knee joint were recorded. The patients’ data was compared to the data of healthy group. Results In the healthy group, the flexion and extension angle was (57.80±3.45)°, the varus and valgus angle was (10.54±1.05)°, the internal and external rotation angle was (13.02±1.66)°, and the anteroposterior displacement was (1.44±0.39) cm, the superior and inferior displacement was (0.86±0.20) cm, and the internal and external displacement was (1.38±0.39) cm. The maximum step length was (51.24±1.29) cm, the minimum step length was (45.69±2.28) cm, and the step frequency was (12.45±0.47) step/minute. Compared with the healthy group, the flexion and extension angles and internal and external rotation angles of the patients in the study group and the control group decreased at 3 months after operation, and the flexion and extension angles of the patients in the control group decreased at 6 months after operation, and the differences were significant (P<0.05); there was no significant difference in the other time points and other indicators when compared with healthy group (P>0.05). In the study group, the flexion and extension angles and internal and external rotation angles at 6 and 12 months after operation were significantly greater than those at 3 months after operation (P<0.05), while there was no significant difference in the other indicators at other time points (P>0.05). There was a significant difference in flexion and extension angle between the study group and the control group at 6 months after operation (P<0.05), but there was no significant difference of the indicators between the two groups at other time points (P>0.05).Conclusion Compared with conventional surgery, ACL reconstruction assisted by personalized femoral positioner based on ADC design can help patients achieve more satisfactory early postoperative kinematic results, and three-dimensional kinematic analysis can more objectively and dynamically evaluate the postoperative recovery of knee joint.
Objective To compare the effectiveness of I.D.E.A.L technique and transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction. Methods A clinical data of 60 patients with ACL injury, who were admitted and met the selection criteria between January 2020 and September 2022, was retrospectively analyzed. All patients underwent arthroscopic ACL reconstruction with autologous tendon. During operation, the femoral tunnel was prepared by using I.D.E.A.L technique in 30 cases (I.D.E.A.L group) and using TT technique in 30 cases (TT group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, injured side, interval from injury to operation, constituent ratio of combined cartilage and meniscus injury, and preoperative Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, anterior tibial translation difference, and Blumensaat angle between the two groups (P>0.05). The length of hospital stay and the occurrence of early and late complications were recorded. During follow-up, the Lysholm score, IKDC score, and VAS score were used to evaluate knee joint function and pain degree, and the anterior tibial translation difference was measured. MRI reexamination was performed to observe the healing of the graft, and the signal to noise quotient (SNQ) values of the femoral end, middle section, and tibial end of the graft, as well as the Blumensaat angle of the knee joint were measured. The differences in tibial anterior translation difference and Blumensaat angle before and after operation (change values) were calculated and compared between the two groups. Results The incisions in both groups healed by first intention after operation, and there was no significant difference in the length of hospital stay between the two groups (P>0.05). All patients were followed up 12-18 months, with an average of 14.9 months. The Lysholm score and IKDC score of the knee joint in both groups after operation increased when compared with those before operation, and the VAS score decreased. Compared to preoperative scores, except for the VAS score of the TT group at 1 week after operation (P>0.05), there were significant differences in all scores at different time points postoperatively in the two groups (P<0.05). The above scores in both groups showed a further improvement trend with the prolongation of time after operation. There were significant differences in Lysholm score and VAS score among 1 week, 1 month, 3 months, 6 months, and 12 months after operation in the two groups (P<0.05). The IKDC score of both groups at 1 month after operation was significantly different from that at 1 week after operation (P<0.05). At 1 week after operation, the Lysholm score and IKDC score in the I.D.E.A.L group were significantly higher than those in the TT group (P<0.05), and the VAS score was significantly lower (P<0.05); there was no significant difference between the two groups at 1, 3, 6, and 12 months after operation (P>0.05). At 12 months after operation, the anterior tibial translation differences in both groups were significantly lower than those before operation (P<0.05); and the change value in the I.D.E.A.L group was significantly higher than that in the TT group (P<0.05). The incidences of early and late complications in the I.D.E.A.L group were significantly lower than those in the TT group (P<0.05). At 12 months after operation, MRI examination showed that the grafts of the knee joint in both groups survived well, and the Blumensaat angles of both groups were significantly smaller than those before operation (P<0.05). The change value of the Blumensaat angle in the I.D.E.A.L group was significantly higher than that in the TT group (P<0.05). The SNQ values of the femoral end, middle section, and tibial end of the graft in the I.D.E.A.L group were significantly higher than those in the TT group (P<0.05). Conclusion The early effectiveness of ACL reconstruction by using the I.D.E.A.L technique is better, the knee joint is more stable, and the incidence of postoperative complication is lower. However, the maturity of the graft after reconstruction using the TT technique is higher.
Objective To study the feasibility of virtual intercondylar notchplasty by applying MRI two-dimensional (2D) images to reconstruct three-dimensional (3D) images and measure the size of intercondylar notch. Methods Thirty healthy volunteers who had no knee joint disease and surgery history were selected. There were 15 females and 15 males with an age range of 20-30 years, weight range of 45-74 kg, and height range of 150-185 cm. They were divided into male group and female group, and the knees of each group were divided into 2 subgroups (the left group and right group). MRI scan of the left and right knees was performed, and the 2D images of MRI were imported into Mimics10.01 medical image control system for 3D reconstruction. The related anatomical data as follows were measured from the 3D digital model and analyzed by statistical software: notch width (NW), condylar width (CW), and notch width index (NWI). Then the 3D knee images of patients with anterior cruciate ligament (ACL) injury were collected between January and March 2010, and 4 patients with narrow intercondylar notch (NWI≤0.2) were selected for reconstructing the 3D model of the knee and simulating the intercondylar notch plasty. Then, the volume of osteotomy in 3D model was calculated and applied in the ACL reconstruction surgery, and whether the graft had impingement with intercondylar notch or not was evaluated. Results There were significant differences in NW and CW between male group and female group (P≤lt;≤0.05), but no significant difference was found in the NWI (P≤gt;≤0.05). And there was no significant difference in NW, CW, and NWI between the left and right knees both in male group and female group (P≤gt;≤0.05). After ACL reconstruction and intercondylar notchplasty, the shape of intercondylar notch became normal (NWI≤gt;≤0.22), no impingement occurred between the graft and intercondylar notch under arthroscopy within 3-month follow-up. Conclusion The shape of intercondylar notch of 3D model based on MRI 2D images is similar to the real intercondylar notch. NWI is one of important indexes which can reflect the narrow level of intercondylar notch. The virtual intercondylar notchplasty may provide preoperative plan and guidence for ACL reconstruction operation to avoid the impingement between graft and intercondylar notch after surgery.
Objective To investigate the influence on matrix metalloproteinases (MMP) 3, 9, and 13 levels of human articular cartilage cells after blocking stromal cell derived factor 1 (SDF-1)/ chemokine receptor 4 (CXCR4) signaling pathway withAMD3100 and to define the function mechanism of AMD3100. Methods A total of 144 cartilage blocks from 12 osteoarthritis (OA) patients undergoing total knee arthroplasty (OA cartilage group) and 144 normal cartilage blocks (Mankin score of 0 or 1) from 12 patients undergoing traumatic amputation (normal cartilage group). OA cartilage group was further divided into subgroups A1, B1, and C1, and normal cartilage group into subgroups A2, B2, and C2. The cartilage tissues were cultured in DMEM solution containing 100 ng/mL SDF-1 and 1 000 nmol/L AMD3100 in subgroup A, 100 ng/mL SDF-1 and 1 000 nmol/L MAB310 in subgroup B, and 100 ng/mL SDF-1 in subgroup C, respectively. The levels of MMP-3, 9, and 13 were measured by ELISA; the expressions of MMP-3, 9, and 13mRNA were tested by RT-PCR. Results ELISA and RT-PCR results showed that the levels of MMP-3, 9, and 13 and the expressions of MMP-3, 9, and 13 mRNA were significantly lower in subgroup A than in subgroups B and C at the same time points (P lt; 0.05); the levels of MMP-3, 9, and 13 and the expressions of MMP-3, 9, and 13 mRNA were significantly higher in OA cartilage group than in normal cartilage group at the same time points (P lt; 0.05). Conclusion SDF-1 could induce overexpression and release of MMP-3, 9, and 13 in the articular cartilage through the SDF-1/CXCR4 signaling pathway; AMD3100 could reduce the mRNA expressions and secretion of MMP-3, 9, and 13 in OA cartilage by blocking the SDF-1/CXCR4 signaling pathway; but AMD3100 could not make the secretion of MMP-3, 9, and 13 return to normal levels in OA cartilage.