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Abstract Purpose The purpose of this study was to propose a surgical technique for arthroscopic medial patellofemoral ligament (MPFL) reconstruction with polyethylene suture combined with medial retinaculum plication and to evaluate the efficacy of this surgical technique in the treatment of acute patellar dislocation. Methods Clinical data of patients with acute patellar dislocations treated with arthroscopic MPFL reconstruction with polyethylene tape (FiberTape) combined with medial support band compression were analyzed retrospectively from January 2018 to January 2021. The mean age of the patients was 25.15 ± 4.66 years; the mean follow-up time was 27.5 (24–36) months. Clinical evaluation consisted of apprehension test results, patellar extrapolation test results, Lysholm score, Kujala score, and IKDC score, the Patellar lateral shift distance and patellar tilt angle (PTA) measured by CT scan. Results All patients had no recurrent patellar dislocation or subluxation after surgery, and the apprehension test was negative. In all patients, the Kujala score (36.0 ± 9.9 vs. 98.2 ± 3.1), the IKDC score (48.6 ± 7.0 vs. 90.6 ± 4.4) and the Lysholm score (32.8 ± 10.4 vs. 96.7 ± 3.1) had improved at the 24-month follow up (P

Degradable rotator cuff patches, followed over five years, have been observed to exhibit high re-tear rates exceeding 50%, which is attributed to the inability of degradable polymers alone to restore the post-rotator cuff tear (RCT) inflammatory niche. Herein, poly(ester-ferulic acid-urethane)urea (PEFUU) was developed, featuring prolonged anti-inflammatory functionality, achieved by the integration of ferulic acid (FA) into the polyurethane repeating units. PEFUU stably releases FA in vitro, reversing the inflammatory niche produced by M1 macrophages and restoring the directed differentiation of stem cells. Utilizing PEFUU, hierarchical composite nanofiber patch (HCNP) was fabricated, simulating the natural microstructure of the tendon-to-bone interface with an aligned-random alignment. The incorporation of enzymatic hydrolysate derived from decellularized Wharton jelly tissue into the random layer could further enhance cartilage regeneration at the tendon-to-bone interface. Via rat RCT repairing model, HCNP possessing prolonged anti-inflammatory properties uniquely facilitated physiological healing at the tendon-to-bone interface's microstructure. The alignment of fibers was restored, and histologically, the characteristic tripartite distribution of collagen I – collagen II - collagen I was achieved. This study offers a universal approach to the functionalization of degradable polymers and provides a foundational reference for their future applications in promoting the in vivo regeneration of musculoskeletal tissues.

Abstract The management of surgical instruments is related to the safety and efficiency of surgical operations, and a surgical instruments information management system (SIIMS) has been developed. The aim of the current study is to explore the application value of the SIIMS in sports medicine specialty. A set of self-developed SIIMS for sports medicine surgeries was applied to the study. The application value of the SIIMS was verified by comparing the safety and efficiency of instrument manipulation before and after its application, with instrument accidents, instrument repair rate, instrument scrap rate and instrument use efficiency as indicators. Through the application of the SIIMS, the incidence of surgical instrument accidents decreased from 3.7 times to 1.8 times (P = 0.02), the number of instrument repair decreased from 7.7 times to 2.9 times (P = 0.00), and the number of scrapped instruments decreased from 5.1 to 2.3 (P = 0.03), when referred to per thousand operations. Before and after the application of the SIIMS, the average instrument use efficiency was 74.0% ± 3.3% and 88.2% ± 4.4%, respectively, with statistically significant difference (P = 0.00). The application of the SIIMS in sports medicine specialty is helpful to the fine management of surgical instruments, improve surgical safety and instrument use efficiency.

Abstract Tissue engineering has demonstrated its efficacy in promoting tissue regeneration, and extensive research has explored its application in rotator cuff (RC) tears. However, there remains a paucity of research translating from bench to clinic. A key challenge in RC repair is the healing of tendon–bone interface (TBI), for which bioactive materials suitable for interface repair are still lacking. The umbilical cord (UC), which serves as a vital repository of bioactive components in nature, is emerging as an important source of tissue engineering materials. A minimally manipulated approach is used to fabricate UC scaffolds that retain a wealth of bioactive components and cytokines. The scaffold demonstrates the ability to modulate the TBI healing microenvironment by facilitating cell proliferation, migration, suppressing inflammation, and inducing chondrogenic differentiation. This foundation sets the stage for in vivo validation and clinical translation. Following implantation of UC scaffolds in the canine model, comprehensive assessments, including MRI and histological analysis confirm their efficacy in inducing TBI reconstruction. Encouraging short‐term clinical results further suggest the ability of UC scaffolds to effectively enhance RC repair. This investigation explores the mechanisms underlying the promotion of TBI repair by UC scaffolds, providing key insights for clinical application and translational research.

It has been reported that anterior cruciate ligament reconstruction (ACLR) with the Ligament Advanced Reinforcement System (LARS) could obtain similar clinical outcomes to ACLR with autograft. However, in most related reports, single-bundle ACLR was performed. Given that double-bundle ACLR is more favorable than single-bundle ACLR biomechanically, it is reasonable to try double-bundle ACLR with the LARS clinically. Thus, we introduce an anatomic double-bundle transtibial ACLR technique with the LARS, in which the most critical step is to create a shallow tibial tunnel for the anteromedial bundle to further create the corresponding femoral tunnel in a transtibial manner, as well as to fix both bundles in full extension of the knee.

The escalating prevalence of anterior cruciate ligament (ACL) injuries in sports necessitates innovative strategies for ACL reconstruction. In this study, we propose a multiphasic bone-ligament-bone (BLB) integrated scaffold as a potential solution. The BLB scaffold comprised two polylactic acid (PLA)/deferoxamine (DFO)@mesoporous hydroxyapatite (MHA) thermally induced phase separation (TIPS) scaffolds bridged by silk fibroin (SF)/connective tissue growth factor (CTGF)@Poly(l-lactide-co-ε-caprolactone) (PLCL) nanofiber yarn braided scaffold. This combination mimics the native architecture of the ACL tissue. The mechanical properties of the BLB scaffolds were determined to be compatible with the human ACL. In vitro experiments demonstrated that CTGF induced the expression of ligament-related genes, while TIPS scaffolds loaded with MHA and DFO enhanced the osteogenic-related gene expression of bone marrow stem cells (BMSCs) and promoted the migration and tubular formation of human umbilical vein endothelial cells (HUVECs). In rabbit models, the BLB scaffold efficiently facilitated ligamentization and graft-bone integration processes by providing bioactive substances. The double delivery of DFO and calcium ions by the BLB scaffold synergistically promoted bone regeneration, while CTGF improved collagen formation and ligament healing. Collectively, the findings indicate that the BLB scaffold exhibits substantial promise for ACL reconstruction. Additional investigation and advancement of this scaffold may yield enhanced results in the management of ACL injuries.

Surgical sutures are necessary for the rotator cuff (RC) repair to reconnect the torn and degenerating cuff tendon to its footprint. Early‐stage immunomodulation, angiogenesis, and the progressive mechanobiological response encourage complex healing processes involving micro‐nano dimensional reconstruction, including tendon‐bone interface integration and tendon remodeling. However, commercially available sutures with mismatched micrometer‐scale diameters resulted in mechanobiological and biological deficiencies, severely impeding RC regeneration. We developed a bionic functional surgical suture (SS) with helical and hierarchical micro‐nano structures using nano‐ and micro‐Poly (DL‐lactide‐co‐glycolide) (PLGA) yarns (ny), which was subsequently crosslinked in situ with a temporary chemotactic (TC) layer of physiological fibrin networks (TC‐nySS). The TC‐nySS has both mechanobiological and biological advantages: 1) biomimetic helical and hierarchical micro‐nano structures showed progressive degradation behavior, inducing the incremental mechanobiological response of the repaired tissues; 2) outer TC layer of biochemical modification by fibrin networks supplied dual‐functions of angiogenesis and immunomodulation at the early stage, subsequently resulting in timely vascularization and inflammatory regressions due to superior degradation behavior of the constructs. Consequently, TC‐nySS with structural and biochemical designs that elicit process‐matching mechanobiological and biological responses tailored to the RC regeneration successfully achieved the complex healing processes, including superior tendon‐bone interface integration and tendon remodelling.

Introduction: This study employed surgical robot to perform anatomic single-bundle reconstruction using the modified transtibial (TT) technique and anteromedial (AM) portal technique. The purpose was to directly compare tunnel and graft characteristics of the two techniques.Methods: Eight cadaveric knees without ligament injury were used in the study. The modified TT and AM portal technique were both conducted under surgical robotic system. Postoperative data acquisition of the tunnel and graft characteristics included tibial tunnel position, tunnel angle, tunnel length and femoral tunnel-graft angle.Results: The mean tibial tunnel length of the modified TT technique was significantly shorter than in the AM portal technique (p < 0.001). The mean length of the femoral tunnel was significantly longer for the modified TT technique than for the AM portal technique (p < 0.001). The mean coronal angle of the tibial tunnel was significantly lower for the modified TT technique than for the AM portal technique (p < 0.001). The mean coronal angle of the femoral tunnel was significantly lower for the AM portal technique than for the modified TT technique (p < 0.001). The AM portal technique resulted in a graft bending angle that was significantly more angulated in the coronal (p < 0.001) and the sagittal planes (p < 0.001) compared with the modified TT technique.Discussion: Comparison of the preoperative planning and postoperative femoral tunnel positions showed that the mean difference of the tunnel position was 1.8 ± 0.4 mm. It suggested that the surgical navigation robot could make predictable tunnel position with high accuracy. The findings may support that the modified TT technique has benefits on femoral tunnel length and obliquity compared with AM portal technique. The modified TT technique showed a larger femoral tunnel angle in the coronal plane than the AM portal technique. Compared with the modified TT technique, the more horizontal trajectory of the femoral tunnel in the AM portal technique creates a shorter femoral tunnel length and a more acute graft bending angle.

Abstract Background Discoid meniscus (DM) and femoral trochlear dysplasia (FTD) are common knee disorders. Both as congenital malformation, whether there is a connection between them is unclear and the research on their prevalence in the general population is inadequate. This study aimed to investigate the prevalence of FTD and DM in the general population through a large sample size, and to explore the relationship between them. Study design Retrospective study. Methods Patients undergoing knee magnetic resonance imaging (MRI) examinations at our outpatient clinic were screened and 1003 patients were enrolled in DM group with 989 patients in non-DM (NDM) group. The type of DM and FTD was classified with Watanabe classification and Dejour’s classification, respectively. The prevalence of FTD and DM in the general population and the relationship between them were evaluated. Results The prevalence of DM and FTD was 10.0% and 14.5%, respectively. The overall percentage of FTD was higher in DM group (P

Abstract Isoprenoids, a large kind of plant natural products, are synthesized by the mevalonate (MVA) pathway in the cytoplasm and the 2-C-methyl-d-erythritol 4-phosphate (MEP) pathway in plastids. As one of the rate-limiting enzymes in the MVA pathway of soybean (Glycine max), 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGR) is encoded by eight isogenes (GmHMGR1–GmHMGR8). To begin, we used lovastatin (LOV), a specific inhibitor of GmHMGR, to investigate their role in soybean development. To further investigate, we overexpressed the GmHMGR4 and GmHMGR6 genes in Arabidopsis thaliana. The growth of soybean seedlings, especially the development of lateral roots, was inhibited after LOV treatment, accompanied by a decrease in sterols content and GmHMGR gene expression. After the overexpression of GmHMGR4 and GmHMGR6 in A. thaliana, the primary root length was higher than the wild type, and total sterol and squalene contents were significantly increased. In addition, we detected a significant increase in the product tocopherol from the MEP pathway. These results further support the fact that GmHMGR1–GmHMGR8 play a key role in soybean development and isoprenoid biosynthesis.

Nodulation is the most efficient nitrate assimilation system in the ecosystem, while excessive fertilization has an increased nitrate inhibition effect; deciphering the nitrate signal transduction mechanism in the process is of the utmost importance. In this study, genome-wide analyses of the GmCEP genes were applied to identify nodulation-related CEP genes; 22 GmCEP family members were identified, while GmCEP6 was mainly expressed in nodules and significantly responded to nitrate treatment and rhizobium infection, especially in later stages. Overexpression and CRISPR-Cas9 were used to validate its role in nodulation. We found that GmCEP6 overexpression significantly increased the nodule number, while GmCEP6 knock-out significantly decreased the nodule number, which suggests that GmCEP6 functions as a positive regulator in soybean nodulation. qRT-PCR showed that alterations in the expression of GmCEP6 affected the expression of marker genes in the Nod factor signaling pathway. Lastly, the function of GmCEP6 in nitrate inhibition of nodulation was analyzed; nodule numbers in the GmCEP6-overexpressed roots significantly increased under nitrogen treatments, which suggests that GmCEP6 functions in the resistance to nitrate inhibition. The study helps us understand that GmCEP6 promotes nodulation and participates in the regulation of nitrate inhibition of nodulation, which is of great significance for high efficiency utilization of nitrogen in soybeans.

Facilitating regeneration of the tendon-to-bone interface can reduce the risk of postoperative retear after rotator cuff repair. Unfortunately, undesirable inflammatory responses following injury, difficulties in fibrocartilage regeneration, and bone loss in the surrounding area are major contributors to suboptimal tendon-bone healing. Thus, the development of biomaterials capable of regulating macrophage polarization to a favorable phenotype and promoting the synchronous regeneration of the tendon-to-bone interface is currently a top priority. Here, strontium-doped mesoporous bioglass nanoparticles (Sr-MBG) were synthesized through a modulated sol-gel method and Bi-lineage Inducible and Immunoregulatory Electrospun Fibers Scaffolds (BIIEFS) containing Sr-MBG were fabricated. The BIIEFS were biocompatible, showed sustained release of multiple types of bioactive ions, enhanced osteogenic and chondrogenic differentiation of mesenchymal stem cells (MSCs), and facilitated macrophage polarization towards the M2 phenotype in vitro. The implantation of BIIEFS at the torn rotator cuff resulted in greater numbers of M2 macrophages and the synchronous regeneration of tendon, fibrocartilage, and bone at the tendon-to-bone interface, leading to a significant improvement in the biomechanical strength of the supraspinatus tendon-humerus complexes. Our research offers a feasible strategy to fabricate immunoregulatory and multi-lineage inducible electrospun fibers scaffolds incorporating bioglass nanoparticles for the regeneration of soft-to-hard tissue interfaces.

Healing of an anterior cruciate ligament (ACL) autologous graft in a bone tunnel occurs through the formation of fibrovascular scar tissue, which is structurally and compositionally inferior to normal fibrocartilaginous insertion and thus may increase the reconstruction failure and the rate of failure recurrence. In this study, an injectable hydroxyapatite/type I collagen (HAp/Col Ⅰ) paste was developed to construct a suitable local microenvironment to accelerate the healing of bone-tendon interface. Physicochemical characterization demonstrated that the HAp/Col Ⅰ paste was injectable, uniform and stable. The in vitro cell culture illustrated that the paste could promote MC3T3-E1 cells proliferation and osteogenic expression. The results of a canine ACL reconstruction study showed that the reconstructive ACL had similar texture and color as the native ACL. The average width of the tunnel, total bone volume, bone volume/tissue volume and trabecular number acquired from micro-CT analysis suggested that the healing of tendon-bone interface in experimental group was better than that in control group. The biomechanical test showed the maximal loads in experimental group achieved approximately half of native ACL's maximal load at 24 weeks. According to histological examination, Sharpey fibers could be observed as early as 12 weeks postoperatively while a typical four-layer transitional structure of insertion site was regenerated at 48 weeks in the experimental group. The injectable HAp/Col Ⅰ paste provided a biomimetic scaffold and microenvironment for early cell attachment and proliferation, further osteogenic expression and extracellular matrix deposition, and in vivo structural and functional regeneration of the tendon-bone interface.

Electrospun fibers, with proven ability to promote tissue regeneration, are widely being explored for rotator cuff repairing. However, without post treatment, the microstructure of the electrospun scaffold is vastly different from that of natural extracellular matrix (ECM). Moreover, during mechanical loading, the nanofibers slip that hampers the proliferation and differentiation of migrating stem cells. Here, electrospun nanofiber scaffolds, with crimped nanofibers and welded joints to biomimic the intricate natural microstructure of tendon-to-bone insertion, were prepared using poly(ester-urethane)urea and gelatin via electrospinning and double crosslinking by a multi-bonding network densification strategy. The crimped nanofiber scaffold (CNS) features bionic tensile stress and induces chondrogenic differentiation, laying credible basis for in vivo experimentation. After repairing a rabbit massive rotator cuff tear using a CNS for 3 months, the continuous translational tendon-to-bone interface was fully regenerated, and fatty infiltration was simultaneously inhibited. Instead of micro-CT, μCT was employed to visualize the integrity and intricateness of the three-dimensional microstructure of the CNS-induced-healed tendon-to-bone interface at an ultra-high resolution of less than 1 μm. This study sheds light on the correlation between nanofiber post treatment and massive rotator cuff repair and provides a general strategy for crimped nanofiber preparation and tendon-to-bone interface imaging characterization.

Polyporaceae is an important fungal family that has been a source of natural products with a range of pharmaceutical activities in China. In our previous study, two polysaccharides, PCWPW and PCWPS, with significant antioxidant and antidepressant activity were obtained from Poria cocos. In this study, we evaluated their potential molecular mechanisms in the immunomodulation of macrophages. PCWPW and PCWPS were characterized by GC–MS analysis to contain 1,3-linked Glcp. ELISA assays results demonstrated that the secretion of TNF-α was significantly enhanced by PCWPW/PCWPS. RNA-seq data demonstrated that PCWPS treatment modulated the expression of immune-related genes in macrophages, which was further confirmed by RT-qPCR assays. The activation of TNF-α secretion was found to be mannose receptor (MR) dependent and suppressed by MR inhibitor pretreatment. Moreover, the amount of TNF-α cytokine secretion in PCWPW/PCWPS-induced RAW264.7 cells was decreased when pretreated with NF-κB or MAPK signaling pathway inhibitors. Collectively, our results suggested that PCWPW and PCWPS possessed immunomodulatory activity that regulates TNF-α expression through the NF-κB/MAPK signaling pathway by binding to mannose receptors. Therefore, PCWPW and PCWPS isolated from Poria cocos have potential as drug candidates for immune-related disease treatment.

Ligament regeneration is a complicated process that requires dynamic mechanical properties and allowable space to regulate collagen remodeling. Poor strength and limited space of currently available grafts hinder tissue regeneration, yielding a disappointing success rate in ligament reconstruction. Matching the scaffold retreat rate with the mechanical and spatial properties of the regeneration process remains challenging. Herein, a scaffold matching the regeneration process was designed via regulating the trajectories of fibers with different degradation rates to provide dynamic mechanical properties and spatial adaptability for collagen infiltration. This core-shell structured scaffold exhibited biomimetic fiber orientation, having tri-phasic mechanical behavior and excellent strength. Besides, by the sequential material degradation, the available space of the scaffold increased from day 6 and remained stable on day 24, consistent with the proliferation and deposition phase of the native ligament regeneration process. Furthermore, mature collagen infiltration and increased bone integration in vivo confirmed the promotion of tissue regeneration by the adaptive space, maintaining an excellent failure load of 67.65% of the native ligament at 16 weeks. This study proved the synergistic effects of dynamic strength and adaptive space. The scaffold matching the regeneration process is expected to open new approaches in ligament reconstruction.

Abstract Background Surgical treatment for recurrent patellar dislocation (RPD) could yield good outcomes. While, unsatisfactory recovery still exists in some cases. For all prognostic factors, serum biomarkers have rarely been investigated. This study aimed to evaluate the prognostic value of preoperative serum calcium level, a widely used serum biomarker, in surgical treatment for RPD. Study design Retrospective study. Methods Ninety-nine patients with RPD were enrolled in the study. Preoperative serum calcium was acquired from routinely tested blood 1 day prior to operation. Demographic data, characteristics of RPD, postoperative functional outcomes were obtained. The association between preoperative calcium and postoperative functional outcomes (Kujala, Lysholm, Tegner, IKDC and KOOS score) was determined by correlation analysis and multivariate linear regression analysis. Poor recovery was determined as Kujala score below 80. The receiver operating characteristic (ROC) curve was used to assess the prognostic value of preoperative calcium. Results Patients were followed up for a mean period of 2.45 ± 1.33 years. All clinical scores showed significant improvement at the latest follow-up. Correlation and multivariate linear analyses indicated that serum calcium level was an important factor related with the prognosis of surgical treatment for RPD. According to the ROC curve, the cut-off value for preoperative calcium was 2.225 mmol/L. The clinical outcomes of patients with a preoperative blood calcium

An alkali-extracted polysaccharide (PCAPS1) was isolated and purified from the Poria cocos. Our results proved that PCAPS1 was a neutral polysaccharide with a molecular weight of 11.5 kDa. The monosaccharide composition, methylation and NMR analysis results displayed that the polysaccharide was mostly comprised of β-1,3-glucan with 1,4 and 1,6 branches. The Immune activity and mechanism of PCAPS1 were evaluated in RAW264.7 cells. The enzyme-linked immunosorbent assay (ELISA) analysis revealed that PCAPS1 increased the tumor necrosis factor-α (TNF-α) secretion. RNA-sequencing data analysis suggested that PCAPS1 activated macrophages by the classic NF-κB pathway. Real-time quantitative polymerase chain reaction (RT-qPCR) analysis confirmed that PCAPS1 enhanced mRNA expression levels of TNF-α and nuclear factor κB (NF-κB) in RAW264.7 cells. Simultaneously, the fluorescence nuclear transport experiment showed that PCAPS1 activated RAW264.7 cells by inducing the NF-κB p65 translocation. Our results indicated that PCAPS1-induced TNF-α expression was mediated via the NF-κB signaling pathway.

Purpose: To determine whether rotator cuff tear (RCT) patterns and scapular morphologic characteristics are associated with acetabularization of the coracoacromial arch when the remaining rotator cuff cannot stabilize the humeral head centered on the glenoid. Methods: Thirty-two consecutive patients incapable of stabilizing the humeral head within the native glenoid were included and divided into 2 groups: unstable glenohumeral fulcrum kinematics (GHFK) group (n = 16; absence of acetabularization of the coracoacromial arch) and captured GHFK group (n = 16; the presence of acetabularization of the coracoacromial arch). Magnetic resonance imaging (MRI) analysis included tear locations, tear extensions (anterior, posterior, and global), and fatty infiltration of the rotator cuff muscles. Plain radiographic and computed tomography image measurements included acromiohumeral distance, critical shoulder angle, lateral acromial angle, acromial index, acromial tilt, acromial slope angle, anterior and posterior acromial coverage, and coracoacromial ligament coverage. Results: Patient demographic characteristics did not differ significantly (P > .05). No differences in tear patterns were found between patients with unstable GHFK and those with captured GHFK on MRI (P > .05). Scapular morphologic parameter measurements showed significant differences between the unstable and captured GHFK groups: anterior acromial coverage (–5.8 ± 13.8° vs. 13.8 ± 11.3°, P

Abstract Aim Our aim was to evaluate the literature investigating proprioception improvement after anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that ACL tibial remnant-preserving reconstruction (ACLR-R) is more beneficial than standard technique (ACLR-S) in terms of postoperative proprioceptive function with various reported tests, including joint position sense (JPS) and threshold to detect passive motion (TTDPM). Methods An online search was performed in Embase, MEDLINE/PubMed, Cochrane, SPORTDiscus, and Web of Science databases before 5 October 2020, on the basis of the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Key terms [(‘ACLR’ or ‘ACL-R’ or ‘anterior cruciate ligament reconstruction’) AND (‘remnant’ or ‘stump’) AND (‘proprioception’ or ‘proprioceptive’)] were used. The Oxford Centre for Evidence-Based Medicine and The McMaster Critical Review Form for Quantitative Studies were used for quality assessment. In total, four articles comparing proprioceptive functions between ACLR-R and ACLR-S were included, two of which were randomized clinical trials rated as level of evidence II, and two were retrospective cohort studies rated as level of evidence III. The outcomes were then compared. Evaluation of proprioception involved joint position sense (JPS) [reproduction of active positioning (RAP) and reproduction of passive positioning (RPP)] and threshold to detect passive motion (TTDPM) tests. Results Only four studies were included, with a total of 234 patients (119 ACLR-R patients and 115 ACLR-S patients). High heterogeneity in characteristics and outcome measurements was observed among the studies. Three studies performed sparing technique, and one performed tensioning technique. One study tested RAP and reported better results at an average of 7 months follow-up in ACLR-R (P

Based on the published animal studies, we systematically evaluated the outcomes of various materials for rotator cuff repair in animal models and the potentials of their clinical translation. 74 animal studies were finally included, of which naturally derived biomaterials were applied the most widely (50.0%), rats were the most commonly used animal model (47.0%), and autologous tissue demonstrated the best outcomes in all animal models. The biomechanical properties of naturally derived biomaterials (maximum failure load: WMD 18.68 [95%CI 7.71–29.66]; P = 0.001, and stiffness: WMD 1.30 [95%CI 0.01–2.60]; P = 0.048) was statistically significant in the rabbit model. The rabbit model showed better outcomes even though the injury was severer compared with the rat model.

Features of black phosphorous (BP) nano sheets such as enhancing mineralization and reducing cytotoxicity in bone regeneration field have been reported. Thermo-responsive FHE hydrogel (mainly composed of oxidized hyaluronic acid (OHA), poly-ε-L-lysine (ε-EPL) and F127) also showed a desired outcome in skin regeneration due to its stability and antibacterial benefits. This study investigated the application of BP-FHE hydrogel in anterior cruciate ligament reconstruction (ACLR) both in in vitro and in vivo, and addressed its effects on tendon and bone healing. This BP-FHE hydrogel is expected to bring the benefits of both components (thermo-sensitivity, induced osteogenesis and easy delivery) to optimize the clinical application of ACLR and enhance the recovery. Our in vitro results confirmed the potential role of BP-FHE via significantly increased rBMSC attachment, proliferation and osteogenic differentiation with ARS and PCR analysis. Moreover, In vivo results indicated that BP-FHE hydrogels can successfully optimize the recovery of ACLR through enhancing osteogenesis and improving the integration of tendon and bone interface. Further results of Biomechanical testing and Micro-CT analysis [bone tunnel area (mm2) and bone volume/total volume (%)] demonstrated that BP can indeed accelerate bone ingrowth. Additionally, histological staining (H&E, Masson and Safranin O/fast green) and immunohistochemical analysis (COL I, COL III and BMP-2) strongly supported the ability of BP to promote tendon-bone healing after ACLR in murine animal models.

Identification of the biological targets of a compound is of paramount importance for the exploration of the mechanism of action of drugs and for the development of novel drugs. A concept of the Connectivity Map (CMap) was previously proposed to connect genes, drugs, and disease states based on the common gene-expression signatures. For a new query compound, the CMap-based method can infer its potential targets by searching similar drugs with known targets (reference drugs) and measuring the similarities into their specific transcriptional responses between the query compound and those reference drugs. However, the available methods are often inefficient due to the requirement of the reference drugs as a medium to link the query agent and targets. Here, we developed a general procedure to extract target-induced consensus gene modules from the transcriptional profiles induced by the treatment of perturbagens of a target. A specific transcriptional gene module pair (GMP) was automatically identified for each target and could be used as a direct target signature. Based on the GMPs, we built the target network and identified some target gene clusters with similar biological mechanisms. Moreover, a gene module pair-based target identification (GMPTI) approach was proposed to predict novel compound–target interactions. Using this method, we have discovered novel inhibitors for three PI3K pathway proteins PI3Kα/β/δ, including PU-H71, alvespimycin, reversine, astemizole, raloxifene HCl, and tamoxifen.

BackgroundMusculoskeletal disorders (MSDs) are common occupational diseases. However, the influencing mechanisms were not clear in the new emerging takeaway rider occupation in the catering industry in China.MethodsA cross-sectional study was conducted using a takeaway rider sample from one of the largest e-platforms, the Mei Tuan Company in Shanghai. The chi-square test was used to compare the sex differences in MSDs according to various factors. Binary logistic regressions were then performed to explore the potential risk factors for the occurrence and severity of MSDs adjusted by age, sex and vehicle type. Crude odds ratios (CORs) and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) for predictors were reported.ResultsThe prevalence of MSDs was found to be 54.9% (n = 361). Shoulders (joint pain: 24.5%, n = 154/629 cases; muscle pain: 29.0%, n = 183/632 cases; muscle numbness: 31.7%, n = 120/379 cases) and neck (joint pain: 17.0%, n = 107/629 cases; muscle pain: 14.1%, n = 89/632 cases; muscle numbness: 15.3%, n = 58/379 cases) were the most affected regions. Irregular meals (often having regular meals: p = 0.03, AOR = 1.89, 95% CI: 1.05–3.39; sometimes: p < 0.01, AOR = 2.54, 95% CI: 1.49–4.34 and seldomly: p < 0.01, AOR = 4.24, 95% CI: 2.28–7.91) were positively associated with the occurrence of MSDs. Work-related factors, including working over 5 years (p = 0.02, AOR = 1.87, 95% CI: 1.10–3.17) and over 51 km of food delivery distance per day (51–75 km: p = 0.02, AOR = 2.13, 95CI%:1.13–4.01; ≥76 km: p < 0.01, AOR = 3.12, 95CI%: 1.44–6.77), were strongly associated with severity.ConclusionMSDs were common among takeaway riders. Personal lifestyles (meal irregularity) were found to predict the occurrence, while work-related factors (longer years of employment and prolonged food delivery distance) were positively associated with severity. Public health efforts should be made to prevent MSDs in this population.

Posterosuperior rotator cuff tear (PSRCT) is one of the most common shoulder disorders in elderly people’s daily life; however, the biomechanical relationship between PSRCT and shoulder abduction function is still controversial. In this study, a total of twelve freshly frozen cadaveric shoulders were included and tested in five conditions: intact rotator cuff, 1/3 PSRCT, 2/3 PSRCT, entire PSRCT, and global RCT. In each condition, extra load (0%, 45%, and 90% failure load) was sequentially added to the distal humerus, and the function of the remaining rotator cuff was mainly evaluated via the middle deltoid force (MDF) required for abduction. It is found that the peak MDF is required for abduction did not differ among the three PSRCT conditions (1/3 PSRCT: 29.30 ± 5.03 N, p = 0.96; 2/3 PSRCT: 29.13 ± 9.09 N, p = 0.98; entire PSRCT: 28.85 ± 7.12 N, p = 0.90) and the intact condition (29.18 ± 4.99 N). However, the peak MDF significantly differed between the global RCT (76.27 ± 4.94 N, p < 0.01) and all PSRCT and intact conditions. Under 45% failure load, the MDF of the entire PSRCT and global tear conditions were significantly increased compared with another status. With the 90% failure load, only the 1/3 PSRCT condition maintained the same shoulder function as the intact rotator cuff. These biomechanical testing jointly suggested that the weight-bearing ability of the shoulder significantly decreased as PSRCT progressed.

Black soybean (Glycine max (L.) merr), as an edible seed of the leguminous plant, possesses a high amount of proteins and carbohydrates. However, few studies have been conducted on the protein-polysaccharide polymer (proteoglycan) in Black soybean. Here, we aim to characterize the proteoglycan in Black soybean. Firstly, a crude extract from Black soybean was obtained by water extraction and alcohol precipitation. Then, DEAE-52 cellulose and Sephadex G-100 column chromatography were used to isolate proteoglycans in the crude extract, and a novel proteoglycan named BBWPS2 was obtained. Moreover, the chemical analysis showed that BBWPS2 was a proteoglycan of 2.02 × 105 Da, and composed of 7 kinds of monosaccharides and 16 kinds of amino acids. β-elimination reaction identified the carbohydrate chain was connected to peptide chain with O-glycosidic bonds. Finally, the immunomodulatory tests indicated that BBWPS2 can significantly promote the primary splenocyte proliferation and activate mouse peritoneal macrophages to produce TNF-α. Subsequent pathway studies revealed that BBWPS2 activated macrophages through the mannose receptor-mediated NF-κB/MAPK signaling pathway. Our work indicated that BBWPS2 from Black soybean could be explored as a promising natural immunopotentiator in food and pharmaceutical industries.

Biceps tenotomy (BT) is a common surgery used to address anterior shoulder pain and joint dysfunction in humans. Using animal models to simulate human conditions is an effective and essential research strategy to further understand histologic and biomechanical processes that occur after BT, including the pathology of the detached biceps, secondary tendinopathic conditions of the rotator cuffs, and glenohumeral functional changes. This Technical Note presents a comprehensive step-by-step description of an arthroscopic BT procedure in rabbits. This technique is particularly beneficial, as the mini-invasive arthroscopic technique in a rabbit model is similar to that performed in humans. which resulted in less scarring and injuries to other adjacent structures in comparison with open surgery.

Understanding the pathophysiology of rotator cuff tears (RCTs) in animal models is of great importance, as it helps in the development of repair strategies and therapeutic treatments for rotator cuff diseases in humans. This Technical Note describes a comprehensive step-by-step description of an arthroscopic-assisted minimally invasive RCT model in rabbits. This technique is beneficial because the rabbit has rotator cuffs anatomically similar to those of humans, and it has been widely used as a preclinical animal model in the basic science literature. Compared with other small animals (e.g., mice and rats), the advantage of the rabbit model is that it can test the effectiveness and healing process of new surgical repair techniques that require relatively larger anatomical structures. Moreover, it is more cost-effective compared with larger animal models, such as sheep and canines. This arthroscopic-assisted mini-invasive technique to create an RCT model may have a better effect on simulating the degenerative and chronic RCT state in humans than the commonly used open surgery, along with an earlier return to activities, less scarring and tissue adhesion, fewer injuries to the deltoid, and fewer complications.

Rhizoma Acori Tatarinowii is a traditional Chinese herb used to treat depression and coronary heart disease. Studies on its active components mainly focus on small molecular compounds such as asarone and other essential oil components, while the large molecular active components such as polysaccharides are ignored. In this study, we aimed to study the chemical structure and immune activation of polysaccharides from Rhizoma Acori Tatarinowii. In this study, a polysaccharide (RATAPW) was isolated and purified by DEAE-52 cellulose and Sephadex G-100 column chromatography from alkali extraction polysaccharide of Rhizoma Acori Tatarinowii. The average molecular weight of RATAPW was 2.51 × 104 Da, and the total carbohydrate contents of RATAPW were 98.23 ± 0.29%. The monosaccharide composition, methylation, and nuclear magnetic resonance (NMR) analysis results displayed that the polysaccharide was α-1,4-glucan with short α-1,6 branches. Immunofluorescence assay and inhibitor neutralization assay indicated that RATAPW could promote the TNF-α production of RAW264.7 macrophage through the nuclear factor kappa B (NF-κB) molecular signaling pathway. Treatment with 200 μg/ml of RATAPW enhanced a 38.77% rise in the proliferation rate of spleen lymphocytes. RATAPW also enhances ConA-induced T cells and lipopolysaccharide (LPS)-induced B cell proliferation in a dose-dependent effect. Our study lays a foundation for the discovery of natural polysaccharide immune modulators or functional food from Rhizoma Acori Tatarinowii.

Critical-sized bone defect repair in patients with diabetes mellitus remains a challenge in clinical treatment because of dysfunction of macrophage polarization and the inflammatory microenvironment in the bone defect region. Three-dimensional (3D) bioprinted scaffolds loaded with live cells and bioactive factors can improve cell viability and the inflammatory microenvironment and further accelerating bone repair. Here, we used modified bioinks comprising gelatin, gelatin methacryloyl (GelMA), and 4-arm poly (ethylene glycol) acrylate (PEG) to fabricate 3D bioprinted scaffolds containing BMSCs, RAW264.7 macrophages, and BMP-4-loaded mesoporous silica nanoparticles (MSNs). Addition of MSNs effectively improved the mechanical strength of GelMA/gelatin/PEG scaffolds. Moreover, MSNs sustainably released BMP-4 for long-term effectiveness. In 3D bioprinted scaffolds, BMP-4 promoted the polarization of RAW264.7 to M2 macrophages, which secrete anti-inflammatory factors and thereby reduce the levels of pro-inflammatory factors. BMP-4 released from MSNs and BMP-2 secreted from M2 macrophages collectively stimulated the osteogenic differentiation of BMSCs in the 3D bioprinted scaffolds. Furthermore, in calvarial critical-size defect models of diabetic rats, 3D bioprinted scaffolds loaded with MSNs/BMP-4 induced M2 macrophage polarization and improved the inflammatory microenvironment. And 3D bioprinted scaffolds with MSNs/BMP-4, BMSCs, and RAW264.7 cells significantly accelerated bone repair. In conclusion, our results indicated that implanting 3D bioprinted scaffolds containing MSNs/BMP-4, BMSCs, and RAW264.7 cells in bone defects may be an effective method for improving diabetic bone repair, owing to the direct effects of BMP-4 on promoting osteogenesis of BMSCs and regulating M2 type macrophage polarization to improve the inflammatory microenvironment and secrete BMP-2.

It is a big challenge to develop a polyethylene terephthalate (PET) artificial ligament with excellent osteogenetic activity to enhance graft-bone integration for ligament reconstruction. Herein, we evaluated the effect of biomineralization (BM) and electrodeposition (ED) method for depositing calcium-phosphate (CaP) on the PET artificial ligament in vitro and in vivo. Scanning electron microscopy and energy-dispersive X-Ray spectrometer mapping analysis revealed that the ED-CaP had more uniform particles and element distribution (Ca, P and O), and thermogravimetric analysis showed there were more CaP on the PET/ED-CaP than the PET/BM-CaP scaffold. Moreover, the hydrophilicity of PET scaffolds was significantly improved after CaP deposition. In vitro study showed that CaP coating via BM or ED method could improve the attachment and proliferation of MC3T3-E1 cells, and ED-CaP coating significantly increased osteogenic differentiation of the cells, in which the Wnt/β-catenin signaling pathway might be involved. In addition, radiological, histological and immunohistochemical results of in vivo study in a rabbit anterior cruciate ligament (ACL) reconstruction model demonstrated that the PET/BM-CaP and PET/ED-CaP scaffolds significantly improved graft-bone integration process compared to the PET scaffold. More importantly, larger areas of new bone ingrowth and the formation of fibrocartilage tissue were observed at 12 weeks in the PET/ED-CaP group, and the biomechanical tests showed increased ultimate failure load and stiffness in PET/ED-CaP group compared to PET/BM-CaP and PET group. Therefore, ED of CaP is an effective strategy for the modification of PET artificial ligament and can enhance graft-bone integration both in vitro and in vivo.

Regenerative sports medicine aims to address sports and aging-related conditions in the locomotor system using techniques that induce tissue regeneration. It also involves the treatment of meniscus and ligament injuries in the knee, Achilles’ tendon ruptures, rotator cuff tears, and cartilage and bone defects in various joints, as well as the regeneration of tendon–bone and cartilage–bone interfaces. There has been considerable progress in this field in recent years, resulting in promising steps toward the development of improved treatments as well as the identification of conundrums that require further targeted research. In this review the regeneration techniques currently considered optimal for each area of regenerative sports medicine have been reviewed and the time required for feasible clinical translation has been assessed. This review also provides insights into the direction of future efforts to minimize the gap between basic research and clinical applications.

Abstract Control over soft‐to‐hard tissue interfaces is attracting intensive worldwide research efforts. Herein, a bioactive film‐guided soft–hard interface design (SHID) for multi‐tissue integrative regeneration is shown. Briefly, a soft bioactive film with good elasticity matchable to native ligament tissue, is incorporated with bone‐mimic components (calcium phosphate cement, CPC) to partially endow the soft‐film with hard‐tissue mimicking feature. The hybrid film is elegantly compounded with a clinical artificial ligament to act as a buffer zone to bridge the soft (ligament) and hard tissues (bone). Moreover, the bioactive film‐decorated ligament can be rolled into a 3D bio‐instructive implant with spatial‐controllable distribution of CPC bioactive motifs. CPC then promotes the recruitment and differentiation of endogenous cells in to the implant inside part, which enables a vascularized bone growth into the implant, and forms a structure mimicking the biological ligament–bone interface, thereby significantly improving osteointegration and biomechanical property. Thus, this special design provides an effective SHID‐guided implant‐bioactivation strategy unreached by the traditional manufacturing methods, enlightening a promising technology to develop an ideal SHID for translational use in the future.

Glucocorticoid (GC) injections are commonly used in clinical practice to relieve pain and improve function in patients with multiple shoulder disabilities but cause detrimental effects on rotator cuff tendons. Adipose stem cell-derived exosomes (ASC-Exos) reportedly recover impaired tendon matrix metabolism by maintaining tissue homeostasis. However, it is unclear whether additional treatment with ASC-Exos overrides the detrimental effects of GCs without interfering with their anti-inflammatory effects. Thus, we aimed to investigate the anti-inflammatory effect of ASC-Exos with GCs and protective effect of ASC-Exos against GC-induced detriments. The present study comprised in vitro and in vivo studies. In vitro inflammatory analysis revealed that ASC-Exos exerted a synergic anti-inflammatory effect with GCs by significantly decreasing secretion of proinflammatory cytokines by RAW cells and increasing secretion of anti-inflammatory cytokines. In vitro cytoprotective analysis showed that ASC-Exos overrode GC-induced detrimental effects on tenocytes by significantly improving GC-suppressed cellular proliferation, migration, and transcription of tenocytic matrix molecules and degradative enzyme inhibitors and significantly decreasing GC-induced cell senescence, apoptosis, and transcription of ROS and tenocytic degradative enzymes. In vivo studies revealed that additional ASC-Exo injection restored impairments in histological and biomechanical properties owing to GC administration. Collectively, these results suggest that ASC-Exos exert a stronger anti-inflammatory effect in combination with GCs, overriding their detrimental effects on rotator cuff tendons.

A natural α-1,6-glucan named BBWPW was identified from black beans. Cell viability assay showed that BBWPW inhibited the proliferation of different cancer cells, especially HeLa cells. Flow cytometry analysis indicated that BBWPW suppressed the HeLa cell cycle in the G2/M phase. Consistently, RT-PCR experiments displayed that BBWPW significantly impacts the expression of four marker genes related to the G2/M phase, including p21, CDK1, Cyclin B1, and Survivin. To explore the molecular mechanism of BBWPW to induce cell cycle arrest, a transcriptome-based target inference approach was utilized to predict the potential upstream pathways of BBWPW and it was found that the PI3K-Akt and MAPK signal pathways had the potential to mediate the effects of BBWPW on the cell cycle. Further experimental tests confirmed that BBWPW increased the expression of BAD and AKT and decreased the expression of mTOR and MKK3. These results suggested that BBWPW could regulate the PI3K-Akt and MAPK pathways to induce cell cycle arrest and ultimately inhibit the proliferation of HeLa cells, providing the potential of the black bean glucan to be a natural anticancer drug.

The ultrasonic transmission detection method is used to investigate the applicability for the second-harmonic generation (SHG) technology of longitudinal wave to quantitatively assess carbonated concrete. The principal of this method is to use the piezoelectric lead zirconate titanate (PZT) patch to detect the second-harmonic of longitudinal waves during the concrete carbonation process and extract non-linear parameters from observed signals. Non-linear parameters of concretes with two water–cement ratios (CI (w/c=0.47), CII (w/c=0.53)), two moisture contents (CI 0%, CI-W 100%), and three ultrasonic incident frequencies (50 kHz, 75 kHz, 100 kHz) were measured in this study. Results of the experiment demonstrate that non-linear ultrasonic parameters of longitudinal ultrasonic waves with high frequencies (75 kHz, 100 kHz) exhibit a better resolution regarding changes in concrete microstructure. Moisture (CI 0%, CI-W 100%) has little effect on the rate (CI: 62.73%, CI-W: 60.25, carbonation depth: 15 mm) for the change in relative non-linear parameters in the same concrete. The carbonation depth of concrete (CI (w/c=0.47), CI-W (w/c=0.47), CII (w/c=0.53)) can be well reflected by the change in relative non-linear parameters. Furthermore, there exists a good fit between the relative non-linear parameters of longitudinal waves and the concrete carbonation process. The relative non-linear parameters of longitudinal waves demonstrate feasibility in the quantitative assessment of concrete carbonation.

In order to explore the monitoring technique of concrete carbonation in various temperatures, longitudinal ultrasonic nonlinear parameters of carbonated concrete are measured by using an embedded composite piezoelectric transducer (ECPT) and a surface-mounted transducer. The effect of temperature from −20 ∘C to 40 ∘C with a temperature interval of 5 ∘C and water–cement ratio on the measurements of ultrasonic parameters for carbonated concrete is investigated. The ultrasonic transmission detection method and the second harmonic generation (SHG) technique for longitudinal waves are used in the study. Results of the experiment demonstrate that ECPT is effective in the monitoring of the changes in ultrasonic parameters of carbonated concrete. At the temperature ranging from 15 ∘C to 40 ∘C, the increasing temperature slightly increases the relative nonlinear parameters of carbonated concrete. It decreases significantly that the relative nonlinear parameters of carbonated concrete measured at 0 ∘C compared with that at 10 ∘C. The configuration in this measurement is also appropriate for the assessment of carbonated concrete during carbonation time in low-temperature environments (below 0 ∘C). In the same carbonation time, the relative nonlinear parameters also increase slightly when the temperature is at −20 ∘C to 0 ∘C, but it does not change too much. Furthermore, there is a more significant variation of the nonlinear parameters in the same carbonation time for the specimens with a high water–cement ratio than that with a low one.

The tendon-to-bone interface is a special structure connecting the tendon and bone and is crucial for mechanical load transfer between dissimilar tissues. After an injury, fibrous scar tissues replace the native tendon-to-bone interface, creating a weak spot that needs to endure extra loading, significantly decreasing the mechanical properties of the motor system. Macrophages play a critical role in tendon-bone healing and can be divided into various phenotypes, according to their inducing stimuli and function. During the early stages of tendon-bone healing, M1 macrophages are predominant, while during the later stages, M2 macrophages replace the M1 macrophages. The two macrophage phenotypes play a significant, yet distinct, role in tendon-bone healing. Growing evidence shows that regulating the macrophage phenotypes is able to promote tendon-bone healing. This review aims to summarize the impact of different macrophages on tendon-bone healing and the current immunomodulatory biomaterials for regulating macrophages, which are used to promote tendon-bone healing. Although macrophages are a promising target for tendon-bone healing, the challenges and limitations of macrophages in tendon-bone healing research are discussed, along with directions for further research.

Lycopi Herba has been broadly used as a traditional medicinal herb in Asia due to its ability to strengthen immunity. However, it is still obscure for its material basis and underlying mechanisms. Polysaccharide, as one of the most important components of most natural herbs, usually contributes to the immunomodulatory ability of herbs. Here, we aimed to detect polysaccharides from Lycopi Herba and examine their potential immunomodulatory activity. A novel polysaccharide (LHPW) was extracted from Lycopi Herba and purified by DEAE-52 cellulose chromatography and G-100 sephadex. According to physicochemical methods and monosaccharide composition analysis, LHPW was mainly composed of galactose, glucose, fructose, and arabinose. NMR and methylation analyses indicated that LHPW was a neutral polysaccharide with a backbone containing →3,6)-β-D-Galp-(1→, →4)-β-D-Galp-(1→ and →4)-α-D-Glcp-(1→, with the branches of →1)-β-D-Fruf-(2→ and →6)-α-D-Galp-(1→. Immunological tests indicated that LHPW could activate macrophage RAW264.7 and promote splenocyte proliferation. This study discovered a novel polysaccharide from Lycopi Herba and showed it was a potential immunomodulator.

Abstract As a regular adoptable material for anterior cruciate ligament (ACL) reconstruction, free tendon allograft exhibits unsatisfactory outcomes, such as retarded ligamentization and tendon–bone integration. The application of bone marrow‐derived mesenchymal stem cells (BMSCs), as well as a decellularized free tendon allograft developed by our group, was proven to be effective in improving ACL reconstruction results. This study aimed to investigate the efficacy and feasibility of decellularized allogenic semitendinous tendon (ST) combined with autologous BMSCs used as a substitute to free tendon allograft in a rabbit model. This study finally shows that the decellularized allogenic ST combined with autologous BMSCs could significantly improve ACL reconstruction results compared with allograft. Stem Cells Translational Medicine 2019;8:971&982

Abstract Background Although the stenotic femoral intercondylar notch was associated with anterior cruciate ligament (ACL) injuries, the parameters for notch assessment were numerous. The present study aimed to compare the 2-dimensional (2D) femoral notch parameters, including the notch width (NW) and notch width index (NWI), with the 3-dimensional (3D) notch volume based on magnetic resonance imaging (MRI), to determine appropriate femoral parameters for ACL injuries. Methods Two hundred forty individuals were included in this study, including 120 patients with ACL ruptures and 120 age- and gender-matched individuals without ACL ruptures. The NWs and NWIs were measured at four sites (the popliteal groove, the notch inlet and outlet, and the ACL attachment), and the notch volumes were calculated. The Pearson correlation coefficients between the 2D and 3D parameters were calculated. A multivariate analysis of the ACL injuries was conducted with these parameters and the demographic data. Results The associations of the NW and NWI with the notch volume at each of the four locations of the femoral notch were poor in the subgroup analysis, with the exception of the NW in the male ACL-intact group (R = 0.307, 0.256, 0.404 and 0.387 at the popliteal groove, notch inlet and outlet, and ACL attachment, respectively). The multivariate analysis revealed that the notch volume (OR = 0.679, P

Abstract Background In anatomic medial patellofemoral ligament (MPFL) reconstruction, malpositioning of the MPFL femoral tunnel is common. A palpable sulcus reportedly exists at the anatomic femoral attachment of the MPFL. The present study aimed to investigate the accuracy of the sulcus localization method to establish the MPFL femoral tunnel. Methods A cadaveric study was first done on 12 knees to evaluate the accuracy of the sulcus localization method to establish the entry points of the MPFL femoral tunnel in comparison with the midpoint and fluoroscopic localization methods. The center of the native MPFL femoral attachment was served as the reference in the cadaveric study. A clinical study was then performed to further evaluate the accuracy of the sulcus localization method in 53 patients (60 knees). Schöttle’s point was served as the reference in the clinical study. Femoral tunnel placement was defined as accurate when it was less than 5 mm from Schöttle’s point. In both the cadaveric and clinical studies, MPFL femoral tunnel placement was assessed on postoperative reconstructed three-dimensional computed tomography images. In the cadaveric study, the accuracy of different localization methods was compared using analysis of variance. Results In the cadaveric study, the mean distances from the native MPFL attachment to the femoral tunnel entry point were 4.2 ± 1.0 mm (range 2.4–5.6 mm), 4.4 ± 1.4 mm (range 1.8–6.6 mm) and 2.9 ± 0.8 mm (range 1.9–4.4 mm) using the midpoint, fluoroscopic, and sulcus localization methods, respectively; this distance significantly differed between the midpoint and sulcus localization methods, and between the fluoroscopic and sulcus localization methods (p ≤ .05). While there were no significant differences between the midpoint and fluoroscopic localization methods (n.s.). In the clinical study, the mean distance between the femoral tunnel and Schöttle’s point was 3.5 ± 1.5 mm (range 0.4–6.1 mm), with accurate tunnel placement achieved in 49 of 60 cases (82%). Conclusion The sulcus localization method can accurately guide MPFL femoral tunnel placement. This method might be useful for orthopedic surgeons. Level of evidence IV

Various degree of remnant tissues exists following anterior cruciate ligament (ACL) injury. Making use of these tissues may be helpful for the reconstructed ACL from many aspects. There are many methods of remnant preservation and use, as well as many types of combined ACL reconstruction. However, the most effective methods of remnant reuse as well as ACL reconstruction are still being pursued. We introduce an anatomical double-bundle transtibial ACL reconstruction with in-between remnant preservation technique named sandwich-style ACL reconstruction. The indication of this technique is complete ACL tear with a large volume of connectable remnant. The main tricks of this technique are proper ligation of the remnant, proper location of the anteromedial-bundle tibial tunnels, and passing the anteromedial bundle through the shallow side of the remnant. We believe the introduction of this technique will provide more options for remnant preservation and ACL reconstruction.

Irreparable posterior rotator cuff tears pose challenges to orthopaedic surgeons, especially when the medial remaining rotator cuff is not reusable. Trapezius transfer is biomechanically favorable due to the similar vector of the transferred muscle to the native posterior superior rotator cuff. Regarding combined tendon grafting in trapezius transfer, onto-surface tendon attachment to the humerus was reported in most previous reports. For better tendon–humeral head connection, we introduce an humeral bone tunnel–based tendon grafting technique. In this technique, we use the hamstring tendons and the anterior half of the peroneus tendon to make 3 grafts. The most critical steps of this technique are the proper creation of the humeral tunnels and graft implantation. We consider the introduction of this technique will shed light in the field of trapezius transfer for Irreparable posterior rotator cuff tears.

Double-bundle anterior cruciate ligament (ACL) reconstruction (DBACLR) is a reasonable transition from single-bundle ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through a medial portal. However, in our clinical practice, we have found that anatomic DBACLR can be performed easily and exactly through transtibial tunnels just by positioning the tibial tunnels appropriately. Thus, we would like to introduce this anatomic double-bundle transtibial ACL reconstruction technique, in which the most critical step is to create a shallow tibial tunnel for the anteromedial bundle with a proximal projection to the anatomic location of the corresponding femoral tunnel. We believe this Technical Note will give an interesting view of anatomic DBACLR.

The surgical results of shoulder multidirectional instability are not satisfactory. To address the structural and biological factors that are related to the low success rate of surgical treatment, we developed a whole glenoid reconstruction technique, which includes mainly 270° glenoid bone grafting and capsule labrum reconstruction, and glenohumeral ligament reconstruction. Our clinical experience indicates that the application of this technique can result in optimal shoulder stability. We consider the introduction of this technique will shed light on the surgical treatment of shoulder multidirectional instability.

Irreparable posterior-superior rotator cuff tear is encountered quite often in clinical practice. Bridging the tendon defect with various materials is reasonable. However, optimal bridging structures and techniques are still being pursued. We introduce a rotator cuff bridging technique, rooting rotator cuff reconstruction. In this technique, autogenous tendon is used to make grafts. On the medial side, the graft tendons are suspended on the rotator cuff tendon. On the lateral side, the graft tendons are placed into tunnels through the tuberosities. The most critical steps of this technique are properly fabricating the humeral tunnels and suspending the graft tendons onto the rotator cuff tendon. We believe this technique will shed light on rotator cuff reconstruction.