Wuhan Puai Hospital

Abstract Background : Graft bridging (GB) and superior capsular reconstruction (SCR) are utilized to treat massive rotator cuff tears (MRCTs), however they all have reported mixed results. In this study, we explore to combine the GB and SCR in one surgery. The aim of this study was to compare the effectiveness of surgeries that combing GB and SCR (in which autogenous fascia lata is used as the graft for GB while the long head of the biceps tendon [LHBT] is transposed for SCR) with partial repair in the treatment of MRCTs. Methods : This retrospective comparative study evaluated two surgical treatments for MRCTs (> 5 cm, ≥ 2 tendons involved, Hamada grade 1–3): partial repair (the partial repair group) versus autogenous fascia lata graft bridging combined with LHBT transposition (the combined surgery group). Patients were enrolled between January 2016 and June 2023. The clinical outcomes included active range of motion (forward flexion, external rotation, internal rotation) and the American Shoulder and Elbow Surgeons (ASES) score and the Constant Murley Score (CMS) assessed before surgery and at the final follow-up (> 2 years). Radiographic assessments were used to determine the acromiohumeral interval(AHI) and graft integrity at before surgery and at the final follow-up. Results : The study enrolled 53 patients with MRCTs, of whom 24 underwent partial repair and 29 received autogenous fascia lata graft bridging with LHBT transposition. Both groups demonstrated significantly improved ASES and CMS scores at the final follow-up (> 2 years), with superior outcomes in the combined surgery group (ASES: 88.6 vs. 84.0, P = 0.014; CMS: 83.4 vs. 77.4, P < 0.001). While both groups showed comparable improvements in the range of motion (both P < 0.001), the combined surgery group exhibited significantly greater restoration of AHI (7.4 mm vs. 5.4 mm, P < 0.001). MRI assessment revealed significantly lower retear rates (6.9% vs. 37.5%, P = 0.015) in the combined surgery group. Conclusion : This study suggests that autogenous fascia lata graft bridging combined with biceps transposition is associated with better ASES and CMS scores, increased acromiohumeral distance, and lower retear rates compared with partial repair alone at two-year follow-up.

While the induced membrane technique effectively addresses bone defect reconstruction, its reliance on autografts remains a significant limitation. Building upon the well-established osteogenic properties of platelet-rich plasma (PRP) and demineralized bone matrix (DBM), this study systematically investigated their combined potential as a functional alternative to autografts within the induced membrane microenvironment. PRP was extracted and DBM was prepared from New Zealand White rabbits. PRP gel and a composite gel incorporating DBM into PRP were subsequently formulated. The extract solutions derived from PRP, DBM, and PRP/DBM composites were, respectively, collected to induce osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Alkaline phosphatase (ALP) staining was performed on day 5, while mineralization was assessed via Alizarin red staining and osteogenic gene (OCN, OPN, Runx-2, and Col-1) mRNA expression was quantified by quantitative real-time polymerase chain reaction on Days 14 and 21. The rabbits (n =48) were randomly assigned into four experimental groups (n =12 per group): empty defect control (no graft material), PRP gel alone, DBM alone, and PRP/DBM composite gel graft. A 20-mm large segmental bone defect was surgically created in the bilateral radius of each animal, followed by initially filling with polymethyl methacrylate spacers to maintain the defect space. After an 8-week period, the spacers were removed, and the resulting membranous cavities were implanted with the respective graft materials according to group assignment. Bone regeneration was evaluated at 6 and 12weeks post-grafting through radiography, micro-CT imaging, fluorescence-labeled dynamic histomorphometry, histochemical staining, and immunofluorescence analysis. BMSCs treated with PRP/DBM composites demonstrated the most pronounced ALP activity and mineralization capacity, alongside the strongest upregulation of osteogenic genes. Minimal new bone formation, restricted primarily to the defect peripheries, was observed in both control and PRP groups at 6- and 12-week timepoints. In contrast, the DBM and PRP/DBM groups exhibited progressive, time-dependent osteogenic activity. Notably, the PRP/DBM group demonstrated superior bone regeneration, with compact trabeculae and well-organized collagen fully bridging the defect area, accompanied by robust vascularization. In comparison, the DBM group showed less mature bone formation, characterized by loose trabecular structures, immature collagen deposition, and sparse blood vessels. Furthermore, the PRP/DBM group displayed the highest mineral apposition rates and the most pronounced expression of the angiogenic marker CD31. Additionally, the PRP/DBM composite, mediated by the induced membrane, elicited stronger immunomodulatory effects within the local microenvironment and a more robust activation of the hypoxia-inducible factor/vascular endothelial growth factor pathway during bone repair compared to the other groups. Within the induced membrane microenvironment, PRP synergistically enhances the osteogenic capacity of DBM. The resulting PRP/DBM composite represents a highly promising autologous candidate for bone graft substitution.

Accurate screw placement is pivotal to the success of internal fixation of scaphoid fractures. However, no anatomically standardized reference currently exists for guiding entry-point selection and screw-axis orientation during percutaneous Herbert-screw fixation through the volar approach. Conventional techniques rely heavily on surgeon experience or intraoperative fluoroscopy, thereby increasing radiation exposure and compromising accuracy. This study proposes a novel reference method based on the angular relationship between the scaphoid screw axis and the first and second metacarpals, and to assess its anatomical consistency and potential clinical utility. A retrospective analysis was conducted on radiographs of healthy adults from 2021 to 2023, including anteroposterior and lateral wrist views. Two senior trainees and two experienced surgeons measured the imaging data. The measurements included the screw axis length, angles between the screw axis and metacarpal axes, skin thickness(the thickness beneath the skin of the scaphoid tubercle), and entry point distance(the vertical distance from the intersection of the extended screw axis with the palmar skin to the apex of the scaphoid tubercle). The influences of the thumb position, gender, and skin thickness on the screw axis orientation and entry point location were analyzed. A total of 151 adults were analyzed, including 87 females (57.6%) and 64 males (42.4%) with an average age of 43.2 ± 15.9 years. In the lateral view, the mean angle between the screw axis and the second metacarpal axis was 71.5° ± 6.7°, with minimal variance, indicating high consistency across individuals. In the PA view, the angle between the screw axis and the first metacarpal axis varied with the thumb position: 4.8° ± 2.8° in abduction versus 18.7° ± 5.7° at rest. In some cases, the axes were nearly parallel in abduction. The screw axis length measured in the lateral view was closely aligned with that reported in previous anatomical studies (male 2.5 ± 0.3 cm vs. female 2.2 ± 0.2 cm, p < 0.001). No significant correlation was found between subcutaneous thickness and entry point distance (r = 0.048, p = 0.559). Additionally, males had greater entry point distances (males 1.5 ± 0.3 cm vs females 1.3 ± 0.3 cm, p < 0.001). In this study, we find a defined anatomical relationship between the scaphoid screw axis and the axes of the first and second metacarpals. Additionally, the guidewire entry point on the skin should be located distal to the scaphoid tubercle, with the distance varying by gender. The second metacarpal is recommended as a lateral view guide because of its stability and consistency, whereas the first metacarpal can be used in the PA view, particularly when the thumb is in abduction. Further clinical validation through prospective studies is warranted.

Introduction Proximal humeral fractures are increasingly common, particularly among older people, whereas the prognosis of surgical treatments for these fractures remains substantially uncertain. In China, where the ageing population is rapidly growing, high-quality prospective data on surgical outcomes, complications and cost-effectiveness are lacking. To address this gap, we propose to initiate a prospective, multicentre cohort study on surgical treatment for proximal humeral fractures in China—Cohort of Acute Shoulder Trauma (CAST) study.Methods and analysisThe CAST is a multicentre, prospective cohort study enrolling patients with acute proximal humeral fractures undergoing surgical treatments at eight hospitals in China between May 2024 and December 2029. Patients can receive any of the surgical treatment methods which include percutaneous Kirschner wire fixation, external fixation, open reduction and internal fixation using locking plates or intramedullary nails, suture anchors and shoulder arthroplasty. We will collect patient-reported outcome measures (Quick Disabilities of the Arm, Shoulder and Hand), Constant-Murley, American Shoulder and Elbow Surgeons, EuroQol 5-Dimension and Visual Analogue Scale), physical examination results, imaging assessments (based on X-rays, ultrasound, CT and MRI scans), laboratory tests (including inflammatory cytokines) and data on medical costs. We will follow patients at 1 day, and at 1 month, 3 months, 6 months, 12 months and 24 months postoperatively. The planned sample size is 1500 patients.Ethics and disseminationThe study protocol has been approved by the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University (Approval No. 2024-ky-104(K)). Written informed consent will be obtained from all participants. Findings from the CAST study will be disseminated through peer-reviewed journals and academic conferences.Study registration numberChiCTR2500109651.

Abstract Objectives This study aims to explore the function of ADSCs-derived exosomes within a hyaluronic acid (HA) hydrogel on chondrocytes. Methods ADSCs-Exo were isolated and characterized through western blot analysis. An HA hydrogel encapsulating ADSCs-Exo (HA@ADSCs-Exo) was formulated. To simulate cartilage injury, an IL-1β-induced cell model was constructed. MTT assay, flow cytometry, ELISA, and RT-qPCR were used to detect the cell viability, apoptosis, as well as inflammatory factors, oxidative stress indexes, and the levels of degradation-related proteins and synthesis-related proteins in SW1353 chondrocytes. Results In comparison to IL-1β induction, the presence of HA@ADSCs-Exo improved cell viability and mitigated cell apoptosis. HA@ADSCs-Exo significantly restricted the production of TNF-α and IL-6 in the context of IL-1β stimulation. Moreover, the addition of HA@ADSCs-Exo inhibited the intracellular leakage of MDA and promoted the formation of SOD. Ultimately, HA@ADSCs-Exo effectively suppressed the expression of chondrocyte degradation markers (MMP-13 and ADAMTS-1), while simultaneously facilitating the upregulation of chondrocyte reconstruction marker (Aggrecan). Conclusions HA@ADSCs-Exo demonstrates remarkable efficacy in mitigating chondrocyte damage induced by IL-1β. This innovative drug delivery system, which intricately combines HA-hydrogels with exosomes derived from ADSCs, offers a novel approach to addressing cartilage injury and has exhibited promising potential for facilitating cartilage repair.

ObjectiveTo describe the surgical technique and evaluate the clinical efficacy of all-arthroscopic knotless anchor repair for talar-sided anterior talofibular ligament tears in the treatment of chronic lateral ankle instability.MethodsThis retrospective case series included 11 patients treated between February 2020 and October 2022. All patients presented with persistent lateral ankle pain and instability following an ankle sprain that did not respond to at least 6 months of conventional conservative management. Preoperative assessment included physical examination (positive anterior drawer and varus stress tests) and magnetic resonance imaging, which verified talar-sided anterior talofibular ligament insertion tears. The procedure was performed under complete arthroscopic visualization. Initially, the ankle joint was debrided to remove hyperplastic synovium and loose bodies. Then, the anterior talofibular ligament was tensioned using a suture tape passed through a two-wire loop sleeve. Finally, the ligament was secured with an absorbable knotless anchor implanted at the anatomical talar insertion site of the anterior talofibular ligament.ResultsAll 11 patients were followed up for a mean duration of 13.27 ± 2.41 months. At the final follow-up, significant clinical improvements were observed compared with the preoperative status: the American Orthopaedic Foot and Ankle Society Ankle–Hindfoot score increased from 42.62 ± 2.2 to 95.73 ± 1.43 (p < 0.001), and the pain score on a visual analog scale decreased from 6.47 ± 1.25 to 1.73 ± 1.26 (p < 0.001). No postoperative complications occurred, including wound infection, cutaneous nerve injury, or recurrent ankle instability. All patients reported improved ankle stability and returned to daily activities without significant limitation.ConclusionFor patients with chronic lateral ankle instability caused by talar-sided anterior talofibular ligament insertion tears, all-arthroscopic knotless anchor repair results in minimal surgical trauma, enables safe and reliable anatomical restoration of the ligament, and yields satisfactory short-term functional outcomes and pain relief. However, given the limitations of the retrospective case series design, including a small sample size and lack of a control group, further prospective studies with larger cohorts are needed to validate its long-term efficacy.

Background Stroke, a formidable global health issue, is characterized by high disability and mortality rates, thus necessitating advances in acute treatment strategies and preventative medical regimens. Ischemic stroke (IS), the most prevalent type, emerges due to the interruption of blood flow to the brain, resulting in a series of events that may induce irreparable cerebral damage. Purpose The present work was conducted to study the neuroprotective properties of matairesinol in in vivo and in vitro models. Materials and Methods The experimental rats were subjected to middle cerebral artery occlusion (MCAO) to induce ischemia/reperfusion (I/R) injury. Rats were pretreated orally with 25 and 50 mg/kg of matairesinol for 7 days earlier to the MCAO. The brain edema, neurological score, and infarction level of the rats were assessed. The concentrations of oxidative stress markers, inflammatory cytokines, and acetylcholinesterase (AChE) concentrations were assessed using kits. The levels of toll-like receptor 4 (TLR4) and NOD-like receptor protein 3 (NLRP3) were also studied using test kits. The in vitro studies were evaluated using oxygen-glucose deprivation/reoxygenation (OGD/R)-stimulated human neuroblastoma cell line (SH-SY5Y) cells. The effect of matairesinol on the viability and inflammatory markers was assessed in OGD/R-stimulated SH-SY5Y cells. Results The oral pretreatment of matairesinol significantly diminished the brain edema, neurological scores, and infarction level in the rats subjected to MCAO. The matairesinol treatment considerably diminished pro-inflammatory cytokine levels, enhanced anti-oxidant concentrations, and diminished the AChE in the brain tissues of MCAO-induced rats. Matairesinol treatment also effectively reduced the TLR4 and NLRP3 levels in the brains of MCAO-induced rats. The findings of in vitro studies evidenced that the matairesinol increased viability and reduced inflammatory markers in OGD/R-stimulated SH-SY5Y cells. Conclusion The research highlighted the neuroprotective property of matairesinol in rats with MCAO-induced cerebral I/R injury. These results may facilitate the advancement of matairesinol as a novel therapeutic agent to treat IS.