Search

Posttraumatic osteoarthritis (PTOA) patients are often diagnosed by X-ray imaging at a middle-late stage when drug interventions are less effective. Early PTOA is characterized by overexpressed matrix metalloprotease 13 (MMP13). Herein, we constructed an integrated diagnosis and treatment micelle modified with MMP13 enzyme-detachable, cyanine 5 (Cy5)-containing PEG, black hole quencher-3 (BHQ3), and cRGD ligands and loaded with siRNA silencing MMP13 (siM13), namely ERMs@siM13. ERMs@siM13 could be cleaved by MMP13 in the diseased cartilage tissues to detach the PEG shell, causing cRGD exposure. Accordingly, the ligand exposure promoted micelle uptake by the diseased chondrocytes by binding to cell surface αvβ3 integrin, increasing intracellular siM13 delivery for on-demand MMP13 downregulation. Meanwhile, the Cy5 fluorescence was restored by detaching from the BHQ3-containing micelle, precisely reflecting the diseased cartilage state. In particular, the intensity of Cy5 fluorescence generated by ERMs@siM13 that hinged on the MMP13 levels could reflect the PTOA severity, enabling the physicians to adjust the therapeutic regimen. Finally, in the murine PTOA model, ERMs@siM13 could diagnose the early-stage PTOA, perform timely interventions, and monitor the OA progression level during treatment through a real-time detection of MMP13. Therefore, ERMs@siM13 represents an appealing approach for early-stage PTOA theranostics.

Segmental bone defects, stemming from trauma, infection, and tumors, pose formidable clinical challenges. Traditional bone repair materials, such as autologous and allogeneic bone grafts, grapple with limitations including source scarcity and immune rejection risks. The advent of nucleic acid nanotechnology, particularly the use of DNA hydrogels in tissue engineering, presents a promising solution, attributed to their biocompatibility, biodegradability, and programmability. However, these hydrogels, typically hindered by high gelation temperatures (∼46 °C) and high construction costs, limit cell encapsulation and broader application. Our research introduces a novel polymer-modified DNA hydrogel, developed using nucleic acid nanotechnology, which gels at a more biocompatible temperature of 37 °C and is cost-effective. This hydrogel then incorporates tetrahedral Framework Nucleic Acid (tFNA) to enhance osteogenic mineralization. Furthermore, considering the modifiability of tFNA, we modified its chains with Aptamer02 (Apt02), an aptamer known to foster angiogenesis. This dual approach significantly accelerates osteogenic differentiation in bone marrow stromal cells (BMSCs) and angiogenesis in human umbilical vein endothelial cells (HUVECs), with cell sequencing confirming their targeting efficacy, respectively. In vivo experiments in rats with critical-size cranial bone defects demonstrate their effectiveness in enhancing new bone formation. This innovation not only offers a viable solution for repairing segmental bone defects but also opens avenues for future advancements in bone organoids construction, marking a significant advancement in tissue engineering and regenerative medicine.

Minimally invasive surgery for hallux valgus correction, has been attracting great interests in the recent decades, due to the potential benefits of less pain, decreased recovery times, smaller scars with better cosmesis, and improved early post-operative range of motion. The most recent developments in minimally invasive surgery have evolved into the third generation with modifications of the chevron-type osteotomy. This evidence-based clinical guideline of the third generation minimally invasive surgery for hallux valgus is initiated and developed collectively by the Foot and Ankle Committee of Orthopedic Branch of Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Branch of Chinese Medical Doctor Association, and Foot and Ankle Expert Committee of Orthopedic Branch of the Chinese Association of the Integrative Medicine. This clinical guideline provides recommendations for indications, contraindications, operative planning and techniques, post-operative management, management of complications, and prognosis of the third generation minimally invasive surgery for hallux valgus.The Translational Potential of this Article This comprehensive guideline aims to establish standardized recommendations for the indications, contraindications, operative techniques, and post-operative management of the third generation minimally invasive surgery for hallux valgus. By adhering to this guideline, the success rate of the procedure could be maximized. This comprehensive guideline serves as a valuable reference for practitioners interested in or preparing to perform minimally invasive surgery for hallux valgus.

ABSTRACTIn bone tissue engineering, the search for improved repair methods is crucial, given the drawbacks of traditional strategies like donor site issues and immune rejection. Addressing these challenges, this paper introduces an innovative GelMA/Bentonite composite bioink for 3D bioprinting, designed to create scaffolds that closely emulate native bone tissue. GelMA is selected for its biocompatibility and modifiable mechanics, while Bentonite's mineral richness and ion exchange capacity are harnessed to enhance scaffold structure and promote an osteogenic microenvironment. This research marks the inaugural incorporation of Bentonite into a bioink, a significant stride forward given its established safety in pharmaceuticals and versatility across industries. This bioink formulation signifies a breakthrough in bone tissue engineering, aiming to improve the osteointegration and regeneration of bone tissue. Combining Bentonite with GelMA marks a key step in creating bioinks that enhance bone healing, potentially transforming scaffold-based bone regeneration and pioneering the use of natural nanomaterials in medicine.

Abstract Background and objective Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was

Osteoid osteoma of the cuneiform bone is an exceedingly rare and easily missed cause of foot pain. The uncharacteristic and nonspecific radiographs of such intra‐articular osteoid osteoma further increase difficulty in making the diagnosis. To date, there has been no description of intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration in any published literatures. We present a case of intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration, who underwent curettage, allograft bone graft, and navicular‐cuneiform arthrodesis. The patient presented with radiographic bone union, full motor function recovery and pain‐free at the 22‐month follow‐up. This report adds to the existing literature. Intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration is an exceedingly rare and easily missed cause of foot pain. It proves a complicated and challenging task to identify intra‐articular osteoid osteoma. Clinicians should be particularly careful not to exclude the possibility of arthritis and, thus, vigilant when choosing the surgical option.

Background: Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute LAS more effectively and efficiently, it is important to identify patients at substantial risk for developing CAI. This study identifies magnetic resonance imaging (MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients. Methods: All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1, 2017 to December 1, 2019 were identified. Data were collected using the Cumberland Ankle Instability Tool at final follow-up. Demographic and other related clinical variables, including age, sex, body mass index, and treatment were also recorded. Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS. Results: A total 131 out of 362 patients with a mean follow-up of 3.0 ± 0.6 years (mean ± SD; 2.0–4.1 years) developed CAI after first-episode LAS. According to multivariable regression, development of CAI after first-episode LAS was associated with 5 prognostic factors: age (odds ratio (OR) = 0.96, 95% confidence interval (95%CI): 0.93–1.00, p = 0.032); body mass index (OR = 1.09, 95%CI: 1.02–1.17, p = 0.009); posterior talofibular ligament injury (OR = 2.17, 95%CI: 1.05–4.48, p = 0.035); large bone marrow lesion of the talus (OR = 2.69, 95%CI: 1.30–5.58, p = 0.008), and Grade 2 effusion of the tibiotalar joint (OR = 2.61, 95%CI: 1.39–4.89, p = 0.003). When patients had at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, or inversion tilt test, they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI. Conclusion: MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.

Abstract Purpose The aim of this study was to evaluate the relation between anteromedial ankle osteophytes (AMAO) and anteromedial ankle impingement (AMAI) in chronic lateral ankle instability (CLAI) through visualization and quantification. Methods Forty-three patients with unilateral CLAI between September 2018 and March 2020 accepted arthroscopic repair of an anterior talofibular ligament (ATFL) and were split into two groups: AMAI (AMAI including intraoperative AMAO resection) and pure CLAI (with AMAO but without AMAI, no AMAO resection). The AMAO protrusion lengths in each direction were measured and compared after all of the ankles were reconstructed. All patients were assessed preoperatively and at 2-year follow-up with ankle dorsiflexion, the American Orthopedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, and visual analog scale (VAS) score. Results Intelligent analysis showed that a large extent of osteophytes was found at the dorsomedial surface of the talar neck in AMAI group. The upper and inner bound protrusion distances of AMAO in AMAI group were greater than in the pure CLAI group. There was no significant difference in anterior bound protrusion distance of AMAO between the two groups. Preoperatively, the ankle dorsiflexion of AMAI group (7.6 ± 1.4°) was considerably lower than that of pure CLAI group (22.4 ± 1.9°) (p

Abstract Background Lisfranc injuries mainly involve the tarsometatarsal joint complex and are commonly misdiagnosed or missed in clinical settings. Most medical institutions prefer to use conventional radiography. However, existing studies on conventional radiographs in Lisfranc injury lack a large population‐based sample, influencing the validity of the results. We aimed to determine the diagnostic validity and reliability of conventional radiography for Lisfranc injury and whether computed tomography can alter clinical decision‐making. Methods This retrospective study included 307 patients with, and 100 patients without, Lisfranc injury from January 2017 to December 2019. Diagnosis was confirmed using computed tomography. A senior and junior surgeon independently completed two assessments of the same set of anonymised conventional radiographs at least 3 months apart. The surgeons were then asked to suggest one of two treatment options (surgery or conservative treatment) for each case based on the radiographs and subsequently on the CT images. Results All inter‐ and intra‐observer reliabilities were moderate to very good (all κ coefficients > 0.4). The mean (range) true positive rate was 81.8% (73.9%–87.0%), true negative rate was 90.0% (85.0%–94.0%), false positive rate was 10.0% (6.0%–15.0%), false negative rate was 18.2% (13.0%–26.1%), positive predictive value was 96.1% (93.8%–97.8%), negative predictive value was 62.4% (51.5%–69.7%), classification accuracy was 83.8% (76.7%–88.2%), and balanced error rate was 14.1% (10.2%–20.5%). Three‐column injuries were most likely to be recognized (mean rate, 92.1%), followed by intermediate‐lateral‐column injuries (mean rate, 81.5%). Medial‐column injuries were relatively difficult to identify (mean rate, 60.7%). The diagnostic rate for non‐displaced injuries (mean rate, 76.7%) was lower than that for displaced injuries (mean rate, 95.5%). The typical examples are given. A significant difference between the two surgeons was found in the recognition rate of non‐displaced injuries (p = 0.005). The mean alteration rate was 21.9%; the senior surgeon tended to a lower rate (15.6%) than the junior one (28.3%) (p

ObjectiveThe study aims to investigate the functional outcome of the lateral approach for insertional Achilles tendinitis (IAT) with Haglund deformity.MethodsFrom January 2016 to September 2019, 14 cases of IAT with Haglund deformity that resisted conservative treatment received surgery in our department. A lateral approach was used to debride the bony and soft tissue and reattach the insertion of the Achilles tendon. The Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Score (AOFAS), and Victorian Institute of Sport Tendon Study Group-Achilles Tendinopathy score (VISA-A) were used to evaluate clinical outcomes.ResultThe mean patient age was 39.57 years at the time of surgery. The mean follow-up was 14.74 months. The mean VAS score significantly decreased from 4.86 ± 0.86 preoperatively to 1.21 ± 1.58 postoperatively (P

ObjectivesWith positive outcomes recorded, the mixed reality (MR) technology has lately become popular in orthopedic surgery. However, there are few studies that specifically address the utility of MR in talocalcaneal coalitions (TCC) resection. Our goal in this retrospective study is to assess certain data while examining the viability of using MR to treat TCC resection.MethodsSix consecutive patients with TCC diagnosed by computed tomography (CT) for which nonoperative therapy had failed and MR system assisted TCC resection were included in this study from March 2021 to December 2021. The feasibility and accuracy of TCC resection were assessed by post-operation radiography. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were used to assess the recovery condition and pain level pre- and post-operation.ResultsThe surgeon can accurately resect the TCC according to the preoperatively determined range by superimposing the holographic model with the actual anatomy of the TCC using an MR system. Additionally, no additional x-ray was necessary while operating. Mean follow-up was 10.3 months, with a minimum of 6 months. There is a significant difference between the preoperative AOFAS score of 53.4 ± 3.8 and the 6-month follow-up AOFAS score of 97.3 ± 2.2 (p

PurposeThe common disease hallux valgus results in foot discomfort and dysfunction. Less soft tissue damage and faster wound healing have made minimally invasive surgery (MIS) more popular. However, little research has compared the fixation results of minimally invasive chevron-akin (MICA) osteotomy thus far. In this study, the clinical and radiographic results of MICA with first metatarsal single- or dual-screw fixation are being examined.MethodsA total of 107 feet of 103 patients with mild to moderate symptomatic hallux valgus treated MICA from January 2018 to June 2020 were retrospective evaluated, with at least 12-months follow-up. 51 patients underwent single-screw fixation procedures and 52 patients received dual-screw fixation procedures. Patients were assessed preoperatively and at the final follow-up with radiographic measurements [hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA)] and clinical scores (american orthopaedic foot and ankle society (AOFAS) forefoot score, visual analog scale (VAS) and Manchester-Oxford Foot Questionnaire (MOxFQ) scores). The coughlin satisfaction scores were also obtained.ResultsBoth groups showed significantly improved HVA, IMA and DMAA at the final follow-up (P

Talar chondroblastoma, which is a benign tumor of immature cartilage cells, is an uncommon but easily missed diagnosis of foot pain. Arthroscopic treatment for this condition is a safe, powerful, and promising technique with definitive advantages of visualization and minimal invasion. Here, we report a case of a talar chondroblastoma treated by posterior ankle arthroscopic curettage, allograft bone graft, and platelet-rich plasma-fibrin glue (PRP-FG) application.Level of evidenceCase Report. Level IV.

BackgroundLong recovery time, large scar, postoperative swelling and pain are possible side effects of open reduction internal fixation (ORIF) for tarsal navicular fractures. Early exercise instruction is made possible by the use of an intraoperative robot-assisted percutaneous invasive closed reduction internal fixation. The goal of the trial was to determine whether percutaneous screw internal fixation with robot assistance might be used to treat navicular fractures.Methods27 patients with navicular fractures had surgical treatment between June 2019 and December 2021. Of those, 20 instances were treated with ORIF, while 7 cases had robot-assisted percutaneous screw internal fixation. At the final follow-up, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and the visual analogue scale (VAS) score were compared to determine outcomes and function.ResultsFollow-up was obtained in all 27 patients after surgery, with a mean follow-up time of 21.81 months, ranging from 15 to 29 months . In the 7 instances of robot-assisted group, percutaneous guide wire insertion and screw placement only needed one attempt and the depth and position of the implant were both satisfactory. In the ORIF group, there were two patients who sustained cutaneous nerve injuries. The AOFAS score and the VAS score of the group receiving robot-assisted navigation percutaneous screw fixation were 92.25 ± 2.22 and 0.75 ± 0.25 respectively at the last follow-up, while 82.25 ± 7.15 and 0.50 ± 0.29 were the respective values for the ORIF group.ConclusionIntraoperative robot-assisted percutaneous closed reduction internal fixation for tarsal navicular fractures can accomplish exact localization of fracture site, reduce soft tissue damage and operative time. According to current view, this method offers fewer complications, a faster recovery after surgery, and more patient satisfaction.

Background: Because of the rising prevalence of anterior talofibular ligament (ATFL) damage, there is a considerable interest in developing innovative techniques to improve the biological healing response of ATFL. Platelet-rich plasma (PRP) includes several growth factors linked to a favorable healing response, however none of the studies involved both quality evaluation and clinical results to evaluate this treatment.Purpose: To determine the clinical results of PRP injections into the ATFL in lateral ankle sprain (LAS) patients, as well as the quality of the ATFL based on radiographic outcomes.Methods: Patients with clinically confirmed grade II LAS for the first time (n = 83) were examined. The clinical outcomes of three types of injection methods were evaluated: none, once within 48 h after the sprain, and once more 4 weeks later after first injection. PRP was injected into the tear site of the ATFL using ultrasound guidance, and all ankles were immobilized for 2 weeks. The American Orthopedic Foot and Ankle Score (AOFAS) ankle-hindfoot scale and the Visual Analogue Scale (VAS) were used to assess the results at 2, 6, 8, 24, and 48 weeks of follow-up. The signal/noise ratio (SNR) value of Magnetic Resonance Imaging (MRI)-based ATFL signal intensity can disclose ATFL quality. The ATFL SNR results were then assessed 8, 24 and 48 weeks following the first injection to compare ATFL quality.Results: The PRP injection groups outperformed the control group in terms of clinical outcomes, and the two injections group outperformed other groups in terms of pain reduction and functional outcome at 8 weeks. The clinical results of all groups were comparable at 6 and 12 months follow-up. ATFL SNR findings improved significantly across all groups over time. At the same follow-up time, the PRP injection groups outperformed the control group, and the best SNR result showed in the two injections group at the final follow-up.Conclusion: PRP injection helped relieve early symptoms of LAS, although all patients saw a similar development after 6 months. The two PRP injections group produced considerably better clinical results and quality of the ATFL in short-term follow-up.

Tendon injury is one of the most serious orthopedic diseases often leading to disability of patients. Major shortages of tendon healing are due to its multiple comorbidities, uncertainty of therapeutic efficacy and insufficient of angiogenesis. With a deeper understanding of angiogenic mechanism of tendon healing, we investigated an innovative microneedle patch loaded with platelet derived growth factor (PDGF) to achieve a constant systemic administration of PDGF to enhance topical tendon healing. Rat achilles tendon injury model was performed as in vivo animal models. Histological staining showed an enhancement of tendon healing quality, especially angiogenesis. Biomechanical studies demonstrated an increase of tendon stiffness, maximum load and maximum stress with treatment of PDGF-loaded microneedles. Furthermore, MAPK/p38/Cyclin D1 pathway and angiogenesis were found to play an important role in tendon healing process by using a biological high throughput RNA-sequence method and bioinformatic analysis. The high throughput RNA-seq tendon healing results were confirmed by histochemical staining and western blot. These results suggest the novel therapeutic potential of PDGF-loaded microneedle patch in tendon surgery.

Osteoporotic fractures, also known as fragility fractures, are prevalent in the elderly and bring tremendous social burdens. Poor bone quality, weak repair capacity, instability, and high failure rate of internal fixation are main characteristics of osteoporotic fractures. Osteoporotic bone defects are common and need to be repaired by appropriate materials. Proximal humerus, distal radius, tibia plateau, calcaneus, and spine are common osteoporotic fractures with bone defect. Here, the consensus from the Osteoporosis Group of Chinese Orthopaedic Association concentrates on the epidemiology, characters, and management strategies of common osteoporotic fractures with bone defect to standardize clinical practice in bone repair of osteoporotic fractures.

Background: Osteoarthritis (OA) is a form of arthritis due to degradation of articular cartilage. OA is associated with stiffness, joint pain, and dysfunction, affecting adults worldwide. Galangin is a bioactive flavonoid that exerts several therapeutic and biological activities. Anti-hyperglycemic, anti-inflammatory, anti-cancer, and anti-apoptotic activities of galangin have been reported in several studies. In the present study, rats were divided into normal control, OA (control), galangin 10 mg/kg (low-dose), galangin 100 mg/kg (high-dose), and celecoxib 30 mg/kg (positive control) groups. All doses were administered orally for 14 consecutive days. The urinary type II collagen (µCTX-II) level as well as reactive oxygen species, tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6, superoxide dismutase, catalase, lipid peroxidation, reduced glutathione, and glutathione peroxidase levels were measured. In addition, the CTX-II mRNA and protein expression levels were measured. Results: Galangin supplementation significantly reduced the µCTX-II level compared with controls. Galangin treatment significantly reduced reactive oxygen species, lipid peroxidation, interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha levels, but increased catalase, superoxide dismutase, glutathione peroxidase, and reduced glutathione levels. Galangin treatment significantly reduced the CTX-II mRNA and protein expression levels. The low CTX-II level in tissue indicated the inhibition of cartilage degradation. Conclusions: In summary, supplementation with galangin was effective against OA. The identification of potential therapeutic agents that inhibit inflammation may be useful for the management and prevention of OA.How to cite: Su Y, Shen L, Xue J, et al. Therapeutic evaluation of galangin on cartilage protection and analgesic activity in a rat model of osteoarthritis. Electron J Biotechnol 2021;52. https://doi.org/10.1016/j.ejbt.2021.05.005

BackgroundThe high success rate, minimal invasion, and safety of subtalar arthroereisis (SA) have made it a primary mode of surgical management for pediatric flexible flatfoot. The HyProCure procedure is a new surgery for SA, However, very few available studies reported the therapeutic effects of the HyProCure procedure, especially in pediatric flexible flatfoot. The main aim of the present study was to investigate the clinical and radiological outcomes of the HyProCure procedure for pediatric flexible flatfoot and analyze the risk factors for therapeutic outcomes and sinus tarsi pain.MethodsIn this retrospective cohort study, 69 pediatric flexible flatfoot patients (107 feet) who underwent the HyProCure procedure were included between July 2015 and September 2020. All patients underwent the HyProCure procedure with or without gastrocnemius recession. The Maryland foot score (MFS), visual analog scale (VAS), radiographic data, and complications were assessed at a minimum 1-year follow-up and statistically analyzed.ResultsThe mean follow-up was 35.9 months (range, 13–73 months). At the last follow-up, VAS (0.64 ± 1.16) was significantly lower than the preoperative VAS (4.06 ± 1.43) (p < 0.001); MFS (90.39 ± 12.10) was significantly higher than the preoperative MFS (71.36 ± 10.25) (p < 0.001). The AP talar-second metatarsal angle (T2MT angle) significantly decreased from 17.0 ± 5.4° preoperatively to 11.4 ± 5.2° at the last follow-up (p < 0.001). The lateral talar-first metatarsal angle (Meary's angle) significantly decreased from 13.8 ± 6.4° preoperatively to 6.3 ± 5.0° at the last follow-up (p < 0.001). The calcaneal declination angle (Pitch angle) significantly increased from 13.5 ± 4.9° preoperatively to 14.8 ± 4.4° at the last follow-up (p < 0.001). Logistic regression analysis indicated that patients with a longer distance from the tail end of the implant exceeding the longitudinal talar bisection line had 275.8% greater odds of MFS < 90. Yet, no risk factors were found in connection with sinus tarsi pain.ConclusionsThe HyProCure procedure for pediatric flexible flatfoot achieved satisfactory curative effects with a low complication rate; implant depth was associated with unsatisfactory postoperative outcome.

Lisfranc injuries are a disruption of one or more of the tarsometatarsal joints and have an estimated incidence of 1/55 000 people. However, the total number of Lisfranc injuries could be underreported, because almost 20% of these injuries are initially missed. Because of the relative infrequency of these injuries, the current literature is inconsistent in regard to proper treatment. This article provides a review of Lisfranc complex injuries including relevant anatomy, diagnosis, treatment, classifications, operative approaches, and outcomes and complications. Based on existing evidence, it also proposes an algorithm the authors prefer for the evaluation and treatment of Lisfranc complex injuries.

Introduction: Synthetic fibrous membranes unveil a promising field in anti-adhesion of tendons. Meanwhile, oriented nanofiber structures have been widely studied and used in the application of biomedical engineering, particularly in repairing and strengthening effects. Methods: In this study, a bi-layer poly(L-lactic acid) (PLLA) electrospun membrane was fabricated, in which the inner oriented fibrous layer was designed to promote tendon healing while outer random aligned layer was designed to prevent peritendinous adhesion. Results: It was found that fibroblasts were aligned along the oriented fiber of membranes in vitro and in a Leghorn chicken model. In biomechanical tests of repaired tendons, no significant difference was found between oriented fibrous membrane and blank control in maximum tensile strength; both oriented fibrous membranes and random fibrous membranes showed lower work of flexion than blank control, which was consistent with gross assessment. Conclusion: It was practicable to promote tendon healing while preventing adhesion via bi-layer PLLA membranes with an inner-oriented-fiber fabricated structure.

Category: Midfoot/Forefoot Introduction/Purpose: To summarize and evaluate the treatment and clinical outcome of Lisfranc injury with cuneiform fracture retrospectively. Methods: From January 2014 to December 2017, totally 128 cases of Lisfranc injury with cuneiform fractures were treated in our department including 78 cases of male and 50 cases of female with an average of 42.2 ±10.5 years old . There were 60 left feet and 68 right feet, two of which were suffered from an open injury. From the CT scanning, The avulsion fracture of cuneiform was seen in 48 cases, while other 80 cases were cuneiform body fractures or comminuted fractures. An open reduction and internal fixation were undergone after the improvement of soft tissue condition. Final clinical outcome were evaluated by VAS score and AOFAS midfoot score. Complication were also recorded. Results: 9 cases suffered from an early stage of wound and soft tissue complication, who were cured by a dressing change. All cases were followed for a mean of 16.3 months (range: 6-36 months). The plain radiograph demonstrated that the bone union were achieved on the 12.8±1.3 weeks (range: 11-16 weeks) post-operatively on average. The VAS score at the final follow-up was 1.8±1.7 (range: 0-8), while the AOFAS midfoot score was 81.3±10.4 (range: 35-95). The excellent and good rate was 88.3%. 12 cases of post-traumatic arthritis of midfoot was manifested on the X-ray, five of which underwent a salvage arthrodesis in consequence of the severe symptom and disability. The implant of 49 cases were removed on an average of 13.5 month (9-24 months). Conclusion: The Lisfranc injury is always associated with cuneiform fractures, which should be attached importance to in clinical work. For the simple cuneiform fractures, screw fixation could be performed. The key of management is the restoration of intercunceiform joint. And an anatomical alignment and stable fixation of midfoot may facilitate an acceptable clinical outcome.

Category: Ankle Arthritis Introduction/Purpose: To summarize and evaluate the surgical technique and clinical outcome of ankle distraction arthroplasty with PRP injection for post-traumatic ankle arthritis. Methods: Totally 21 patients of post-traumatic ankle arthritis were treated at the department of orthopaedic surgery, Shanghai Sixth People’s Hospital. They were 13 males and 8 females with an average age of 32.5±6.2 years. The average course of disease were 14.0±2.8 months. After the failure of conservative management for at least 6 months, ankle distraction arthroplasty with PRP injection was performed in all patients. American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score system and Visual Analogue Scale (VAS) system were used to evaluate the final overall outcome. The range of motion (ROM) of ankle joint and complications were also recorded. Results: Pin tract infection was occurred in two patients, who were cured by alcohol care. 18 patients were followed for an average 36 months. The post-operative AOFAS ankle and hindfoot score was improved from 46.2±7.7 to 79.2±11.6 (t=-14.58, P ＜0.05), while the VAS score was decreased from 6.6±1.1 to 1.8±2.0 (t=16.424, P＜0.0001). The dorsal extension of ankle joint was increased from 1.3±9.3° to 8.1±5.5° (t=-4.675, P＜0.0001) and the plantar flexion was improved from 14.4±6.8° to 26.9±7.3°(t=-7.919, P＜0.05). The radiograph manifested the progressive course of ankle arthritis in four patients, two of which were cured by a salvage ankle arthrodesis by consequence of a failure of conservative treatment for persistent pain and functional limitation. Conclusion: The ankle distraction arthroplasty is an effective ankle preserving surgery, which could relieve symptoms, improve functions and delay the course of post-traumatic ankle arthritis

Category: Hindfoot Introduction/Purpose: To investigate the clinical effect of minimally invasive knotless-bridge suture technique combined with PRP augamentation for acute achilles tendon rupture. Methods: Totally 23 cases of acute achilles tendon rupture were treated from August 2016 to December 2016 including 21 cases of males and 2 cases of females with an average age of 42.1 years-old (from 29-51 years). Mini-invasive knotless-bridge suture technique was performed in all cases until the soft tissue condition improved. Ankle range of motion, calf circumference difference between two lower extrenities, number of repetions for single heel-rise in one minute, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Achilles Tendon Total Rupture Score(ATRS) and time to return to work were investigated at last follow-up, as well as complications during follow-up. Results: 23 cases were followed for an average of 28 months . At last follow-up, the average ankle ROM was 60.3±2.2°, calf circumference difference between two lower extrenities was 92.7±1.8%, number of repetions for single heel-rise in one minute was 25±2, AOFAS score was 91.5±2.2, ATRS score was 92.6±2.4, time to return to work ranged from 6 to 9 weeks, averaging 7 weeks.Wound was sutured in one stage and united in one stage.No skin necrosis, superficial infection, sural nerve injury occurred.No achilles tendon re-rupture was seen during follow-up. Conclusion: Minimally invasive knotless-bridge suture technique combined with PRP augamentation for acute achilles tendon rupture is operated easily and lesser-trama, enabling patients to return to work earlier and proved to be an effective treatment.

Category: Ankle Introduction/Purpose: There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm2 in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Methods: Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form36 (SF-36) score.The range of motion (ROM) of the ankle joint and complications also were recorded. Results: Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients.The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (all 𝑃 < 0.001) without obvious complications. Conclusion: We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.

Category: Ankle Introduction/Purpose: To evaluate the clinical outcomes of distal tibial osteotomy and alignment reconstruction for pilon fracture malunion. Methods: Between January 2010 and May 2012. 15 cases of pilon fracture malunion were treated with super-malleolar extra-articular osteotomy and alignment reconstruction. They were 12 males and 3 females with an average age of 30.8 years(from 24 to 39 years). The pre-operative X-ray and CT scan showed varus deformity in 9 cases anti valgus in 2 cases. There were 4 cases of anterior impact of the distal tibia and 4 cases of tibiotalar subluxation. All the patients complained about ankle pain, deformity, limited range of motion(ROM)and walking difficulty. X-ray was taken routinely to confirm the bone healing during post-operative follow-up. Scores of visual analogue scale(VAS), American Orthopaedic Foot & Ankle Society(AOFAS)and The Short Form-36(SF-36), ankle ROM and complications were also recorded. Results: 13 cases obtained all average follow-up of 23. 8 months (from 19 to 48 months)and 2 were lost to the follow-up. Bony union was achieved after an average of 3.8 months(from 3 to 7 months). The average VAS score declined significantly from 5.1±3.2 preoperatively to 1.4±0.8 postoperatively (P

Category: Ankle Arthritis, Trauma Introduction/Purpose: To evaluate the clinical outeonles of distal tibial osteotomy and alignment reconstruction for Pilon fracture malunion. Methods: Between January 2010 and May 2012, 15 cases of Pilon fracture malunion were treated with super-malleolar extra- articular or intra-articular osteotomy and alignment reconstruction.They were 12 males and 3 females with an average age of 30.8 years.The pre-operative X-ray and CT scan showed varus deformity in 9 cases and valgus in 6.All the patients complained about ankle pain, deformity, limited range of motion and walking difficulty. Results: 13 cases obtained an average final follow-up of 23.8 months.The average VAS score declined significantly from 5.1±3.2 preoperatively to 1.4±0.8 postoperatively (P

Category: Trauma Introduction/Purpose: The aim of this study was to assess the clinical outcomes of medial wall stabilization in sinus-tarsi approach to treat Sanders type II and III calcaneus fractures. Methods: In this retrospective study, a total of 38 patients (32 men and 6 women) with 38 displaced intra-articular calcaneal fractures were included. A modified sinus tarsi approach was used to reduce and stabilize the posterior facet using rafting technique with mini-fragment locking plate and multiple sagittal screws were added percutaneously to stabilize the calcaneal body and to control rotation. Preoperative and postoperative Böhler’s and Gissane angle were compared, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and SF-36 scores were used to evaluate the final outcomes, and the complications were also recorded. Results: The mean duration of follow-up was 17.4 months. The mean preoperative Böhler’s angle (13.4 ± 3.4°), Gissane angle (88.1 ± 7.6°) were significantly increased (P < 0.05) at final follow-up (25.5 ± 5.6°, 116.2 ± 7.5°, respectively). Complications included 9 cases of moderate subtalar joint stiffness. There were 2 cases with wound edge necrosis, but there was no superficial or deep infection, or nerve injury was observed in these patients. Conclusion: The application of minimally invasive rafting technique with medial wall stabilization is an effective option for displaced intra-articular calcaneal fractures.

Category: Ankle Introduction/Purpose: There is no consensus on treatment or prognosis for Hepple stage V Osteochondral lesion of talus (OLTs), especially for lesion more than 1.5 cm2. This research was to investigate surgical techniques and clinical outcomes of platelet-rich plasma (PRP) scaffold for Hepple stage V OLTs. Methods: 14 patients were treated by cancellous bone graft with PRP gel scaffold between 2013 and 2015 with average age of 38.9 years old and mean set of 23.5 months. Ankle X-ray and MRI were obtained at the final follow-up for evaluation. Functional outcomes were scored by the Visual Analog Scale (VAS) score, American Orthopaedics Foot and Ankle Society (AOFAS) ankle- hindfoot score and Short Form (36) Survey score (SF-36). Range of motion (ROM) of ankle joint and complications were also recorded. Results: 13 patients got the final follow-up with a mean duration of 18 months. MRI showed complete regeneration of subchondral bone and cartilage in all patients. The post-operative VAS, AOFAS ankle-hindfoot score and SF-36 score improved significantly (P