Journal of Orthopaedic Surgery and Research最新文献

Objective: To analyze changes in the expression of osteoporosis (OP)-related genes across different bone types based on transcriptome sequencing, and to identify the key molecules and mechanisms involved in the progression of OP in order to better understand this process.

Methods: Ten pairs of postmenopausal patients with osteoporosis (OP) and non-osteoporotic (non-OP) volunteers were included. Transcriptome sequencing was performed on six pairs of spongy and cortical bone tissues. The expression of FOXP1 was detected using quantitative real-time PCR (RT-qPCR) and receiver operating characteristic (ROC) curves. Magnetic-activated cell sorting was conducted, and the expression levels of AC003090.1, miR-203a-3p, and FOXP1 were measured using RT-qPCR. Human bone marrow stem cells (hBMSCs) were infected with a lentivirus carrying the AC003090.1 expression plasmid. The expression levels of Runx2, Opn, and Ocn in spongy and cortical bone samples, as well as in post-infection cells, were assessed through RT-qPCR. The expression levels of GSK-3β, β-catenin, and c-Myc were evaluated by performing RT-qPCR and Western blot analysis.

Result: A total of 2,102 out of 2,827 differentially expressed genes (DEGs) were identified between the cortical bone samples from patients with osteoporosis (OP) and the cortical/spongy bone samples of the control group. Among these, 1,482 were significantly up-regulated, and 620 were significantly down-regulated, while 1,146 were significantly up-regulated and 1,681 were significantly down-regulated. The expression of FOXP1 in tissue and bone tissue-derived mesenchymal stem cells (MSCs) from patients with OP was significantly lower than that in patients without OP. FOXP1 levels in bone tissue (cortical bone AUC = 0.825, P = 0.01405; spongy bone AUC = 0.800, P = 0.02338) could serve as predictors of OP. In addition, the overexpression of AC003090.1 significantly enhanced the transcription levels of Runx2, Opn, and Ocn; significantly upregulated the expression levels of β-catenin and c-Myc; and inhibited the expression of GSK-3β. Transfection with miR-203a-3p mimics and FOXP1 small interfering RNA reversed the effect of AC003090.1 on GSK-3β/β-catenin/c-Myc signaling.

Conclusion: FOXP1, as a molecular mediator of AC003090.1, affects the GSK-3β/β-catenin/c-Myc signaling pathway and promotes the osteogenic differentiation of hBMSCs, thus playing a key role in the progression of OP.

Background: Suture and knotless anchor onlay tenodesis are two common treatments for biceps lesions; however, there is a paucity of biomechanical studies evaluating the efficacy and structural integrity of these techniques.

Methods: Tendons were harvested from four lower extremity fresh cadaver specimens, including the extensor digitorum longus, peroneus longus, peroneus brevis, and anterior tibialis tendons. Each tendon diameter was recorded using a digital Vernier caliper. Sixteen 3D printed proximal humeri models were allocated to either the single lasso loop with suture anchor (SLL) group or the whipstitch with knotless suture anchor (WSA) group. Each tenodesis model was initially tested on an electrodynamic material testing instrument under a cyclic load ranging from 5 to 70 N at a speed of 1.25 mm/s. The force on the tendon was then returned to 5 N, which was pulled until the ultimate failure of the construct. Displacement during cyclic loading, ultimate failure load, stiffness, and failure modes were assessed.

Results: Fourteen tenodesis models were validated, and two models were discarded due to technical errors. No significant differences between the two groups were observed regarding tendon diameter, ultimate failure load, and displacement at ultimate failure load. However, the construct stiffness for the SLL group was lower than that of the WSA group (58.02 ± 5.62 N/mm vs. 72.24 ± 15.63 N/mm, P = 0.043).

Conclusion: The SLL group had a lower construct stiffness than the WSA group, whereas construct displacement and ultimate failure load were similar in both groups. Therefore, SLL biceps tenodesis may offer a convenient alternative, with lower tendon migration fixation, while performing an arthroscopic biceps tenodesis.

Level of evidence: Basic Science Study.

Background: Schatzker IV-VI tibial plateau fractures usually happen in the weight-bearing part of the knee joint. They are hard to fix with traditional methods because they damage soft tissues and make it hard to get back to normal activities. This study introduces a modified hockey-stick medial plate (mHSMP) designed to improve functional outcomes while reducing surgical complexity.

Methods: This retrospective study included 40 patients with Schatzker IV-VI tibial plateau fractures (20 in the experimental group treated with the mHSMP and 20 in the control group treated with a traditional medial plate) who were followed up for 12 months. Surgical time, intraoperative blood loss, fracture healing time, postoperative complications, and knee function, as assessed by the Hospital for Special Surgery (HSS) score, were compared between the two groups.

Results: Compared with the control group, the experimental group had significantly greater HSS scores at 3 days postsurgery (50.2 ± 1.7 vs. 43.6 ± 1.8, P < 0.001), 3 months (68.2 ± 1.8 vs. 61.7 ± 1.9, P < 0.001), and 6 months (83.2 ± 1.9 vs. 76.7 ± 2.1, P < 0.001). No significant differences were observed between the two groups in terms of surgical time, intraoperative blood loss, fracture healing time, or postoperative complications.

Conclusion: Compared with traditional fixation methods, the mHSMP results in superior early functional recovery with comparable safety, providing an effective alternative for treating Schatzker IV-VI tibial plateau fractures.

Background: Endothelium-derived exosomes has been reported to enhanced osteogenesis. However, the role of endothelial exosomes on osteoclastgenesis is still unknown.

Methods: Human umbilical vein endothelial cells (HUVECs) were used to isolate exosomes. PBS or HUVEC-Exos were used to treat RAW 264.7 cells. Then, the preconditioned RAW 264.7 cells were subjected to TRAP staining and RT-qPCR assays. In vivo, we constracted osteoporosis mice model. PBS or HUVEC-Exos were injected through tail vein after ovariectomy surgery. Bone mass was assessed by micro-CT and TRAP staining. Furthermore, we conducted RNA sequencing and found the genes that were differentially expressed.

Results: Osteoclast differentiation was inhibited by endothelium-derived exosomes in this study. Moreover, HUVEC-Exos demonstrated a specific action on bones to promote in vivo bone resorption. Furthermore, exosomal Manf promoted bone resorption via down-regulating NF-κB signaling, and HUVEC-Exos Manf inhibited osteoclast differentiation in vivo.

Conclusion: HUVEC-exosomal Manf suppressed osteoclastogenesis via down-regulating NF-κB signaling.

Background: This comprehensive meta-analysis aimed to elucidate the effects of anti-osteoporosis (OP) drugs in patients who experienced rotator cuff tears and underwent arthroscopic repair.

Methods: The PubMed, Embase, Web of Science, and Cochrane Central databases were searched to identify studies that examined the effects of anti-OP drugs among patients with rotator cuff tears who underwent arthroscopic rotator cuff repair. Specifically, studies that evaluated the retear rate and other subjective or objective outcomes were included in the analysis. The databases were searched from inception to January 13, 2025.

Results: Ultimately, 5 articles were included in this meta-analysis. Compared with the control group, the anti-OP drug group had a lower retear rate, higher American Shoulder and Elbow Surgeon scores and a greater internal rotation angle. The Simple Shoulder Test, University of California, Los Angeles shoulder score, Constant Shoulder score, and forward flexion angle were not markedly different between the two groups.

Conclusion: Anti-OP drugs markedly promoted bone-to-tendon healing and improved quality of life among patients who underwent arthroscopic rotator cuff repair, especially with respect to activities that involve internal rotation of the shoulder.

Background: Medial meniscus (MM) injuries are common and often contribute to knee osteoarthritis (KOA). While studies focus on joint degeneration, the role of extrinsic factors such as postural control remains underexplored. This study investigated how MM injuries affected postural control, particularly plantar pressure distribution, with an emphasis on lower limb alignment.

Methods: 83 participants were recruited: 29 healthy subjects, 29 MM patients with neutral alignment (-3°< hip-knee-ankle angle (HKA) ≤ 3°), and 25 MM patients with varus alignment (HKA > 3°). Plantar pressure was measured using a shoe-integrated detection system. Normalized peak force, center-of-pressure (COP), and time-to-boundary (TTB) were measured during walking and single-leg stance (SLS).

Results: During walking, compared to the healthy group, the varus alignment group showed lower peak force for the posterior heel (P = 0.012), lateral midfoot (P = 0.024) and hallux (P = 0.009). When the two sides were compared, the varus group exhibited a lower peak force in the anterior heel (P = 0.004) and hallux (P = 0.017) of the affected sides, the neutral (P = 0.043) and varus (P = 0.045) groups all showed higher medio-lateral COP of the unaffected sides, indicating the COP shifting laterally. In SLS test, the two MM groups demonstrated increased peak force of the third (P = 0.037) and fifth (P = 0.040) metatarsals compared to the healthy group, the peak force of the posterior heel were lower in the varus alignment group compared to the healthy group (P = 0.007) and the neutral alignment group (P = 0.008). And the TTB absolute value of medial-lateral direction of the two MM groups were lower than healthy controls (P = 0.029). The area under the receiver operating characteristic curve (AUC = 0.698, P = 0.016) suggested that peak force of posterior heel had good performance to discriminate varus alignment group from neutral alignment group.

Conclusion: MM injuries, especially with varus alignment, lead to significant changes in plantar pressure distribution and postural stability. These insights are clinically significant for designing early, biomechanically-informed rehabilitative strategies to optimize recovery and prevent further joint degeneration following MM injuries.

Purpose: To compare the efficacy of personalized osteotomies with that of standard osteotomies in treating medial unicompartmental knee osteoarthritis.

Methods: The clinical data of 96 patients who were diagnosed with unicompartmental knee osteoarthritis in our group between 2019 and 2023 were retrospectively analysed on the basis of preoperative and postoperative radiological measurements. The knee injury and osteoarthritis outcome score (KOOS), forgotten joint score (FJS), and Lysholm knee score scale (Lysholm) were used to assess the clinical outcome, and complications were observed and recorded.

Results: According to the relevant criteria, 84 of 96 patients were included in this study. All patients were followed for a mean of 31 (range 22-55) months. Fifty-one patients underwent personalized osteotomy procedures, and thirty-three underwent standard osteotomy procedures. The postoperative KOOS Pain (P < 0.0001), KOOS Symptoms (P < 0.0001), KOOS ADL (P < 0.0001), KOOS Sport (P = 0.0023), KOOS QoL (P < 0.0001), Lysholm (P < 0.0001) and FJS (P < 0.0001) scores were higher than those in the standard osteotomy group. Nevertheless, postoperative extension (P = 0.2636) and postoperative flexion (P = 0.3554) were not significantly different.

Conclusion: This was a single-centre, retrospective, short follow-up study with several limitations. However, on the basis of the results of the present study, we believe that the function of the knee after medial unicompartmental knee arthroplasty (mUKA) is affected by the direction of tibial osteotomy. We believe that better clinical results may be obtained when the tibial implant is placed near the preoperative tibial deformity.

Level of evidence: Level IV; retrospective case series.

Background: This study aimed to compare the clinical efficacy of Jingshang Gao in the treatment of lateral ankle sprains by observing the healing process with musculoskeletal ultrasound.

Methods: We enrolled 90 patients with lateral ankle sprains who were admitted to our hospital from July 1, 2022, to July 1, 2023. The average age was 36.21 years, and 35 patients were male (38.9%). Patients were divided into two groups based on different treatment methods: the control group received oral celecoxib capsules(200 mg once daily), and the research group received Jingshang Gao topical application. We compared the basic data between the two groups.

Results: In terms of pain score, both groups had lower VAS scores at T1-T4 than at T0, and the research group had significantly lower VAS scores than the control group at T3 and T4 (p < 0.01, Cohen's d = 0.82). In terms of functional score, both groups had higher Kaikkonen ankle injury function scores at T1-T4 than at T0, and the research group had significantly higher scores than the control group at T3 and T4 (p < 0.01, Cohen's d = 0.87). In terms of AOFAS score, the research group had significantly higher functional scores than the control group (94.307 ± 18.206 vs. 81.216 ± 17.22, p < 0.001, Cohen's d = 0.75). Musculoskeletal ultrasound showed that the healing rate of the ligament in the research group was 82.2% (95% CI: 71.1-93.3%), which was significantly higher than the control group's 57.8% (95% CI: 43.3-72.3%), p = 0.011. In terms of SF-36 score, the research group had a higher VT score than the control group (75.6 ± 9.2 vs. 68.4 ± 8.9, p = 0.024, Cohen's d = 0.79), and a lower MH score than the control group (60.2 ± 7.8 vs. 65.9 ± 8.2, p = 0.032, Cohen's d = 0.71). In terms of the thickness of the anterior talofibular ligament and calcaneofibular ligament, the research group had thinner ATFL (1.78 ± 0.21 vs. 2.05 ± 0.24 mm, p < 0.001, Cohen's d = 1.19) and CFL (1.32 ± 0.09 vs. 1.41 ± 0.08 mm, p < 0.001, Cohen's d = 1.06) than the control group.

Conclusion: Musculoskeletal ultrasound observation of Jingshang Gao treatment for lateral ankle sprains has shown promising results in relieving pain, improving function, and promoting ligament healing. These findings suggest potential benefits of this treatment approach, though randomized controlled trials are needed for definitive efficacy assessment.

Clinical trial number: Not applicable.

Background: Utilizing liposomal bupivacaine (LB) for postoperative analgesia post-total knee arthroplasty (TKA) is prevalent. However, its effectiveness in pain control, specifically in the parasacral ischial plane block (PIPB) post-TKA, remains unknown.

Methods: This single-center, double-blinded, randomized controlled trial recruited patients scheduled for unilateral TKA. Forty-five patients were randomly assigned in a 1:1 ratio to receive 133 mg (Group A) or 266 mg (Group B) LB using the block randomization method. The PIPB effectiveness was assessed by evaluating changes in sensory and motor functions. The primary outcome was the cumulative area under the curve (AUC) of the Numerical Rating Scale (NRS) at rest within 72 h postoperatively. All patients were included in the analyses of analgesic efficacy, rehabilitation quality, and adverse events.

Results: Between January 30, 2024, and May 1, 2024, 45 patients were enrolled and randomly assigned to Group A (n = 22) and Group B (n = 23). A significant between-group difference was observed in the NRS-AUC_0-72 h at rest postoperatively (132.3 ± 19.7 vs. 97.3 ± 19.1, p = 0.001), but none was observed in NRS-AUC_0-72 h during activity (p = 0.642). Kaplan-Meier survival analysis revealed significant between-group differences in the median onset times of sensory [60 vs. 35(min), p < 0.0001] and motor blocks [85 vs. 50(min), p < 0.0001]. The onset time of sensory block was notably shorter than that of motor block in both groups. No significant variance was observed in the median regression time for the sensory block. A significant between-group difference in the rescue analgesic dosage was observed on the first postoperative day [43.1 vs. 27.2(mg), p = 0.009], with no significant differences in the subsequent two days or the total amount. No significant between-group differences were found in adverse events or rehabilitation quality.

Conclusion: LB used in the PIPB was effective for analgesia at rest post-TKA, with 266 mg demonstrating superiority. Trial RegistrationThe randomized controlled trial was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/, No: ChiCTR2400079606).

Background: Severe rigid spinal deformities present significant challenges in correction surgery due to complexity and associated comorbidities. To mitigate the surgical risks, preoperative halo-pelvic traction (HPT) have been employed. This study aims to evaluate the effectiveness and safety of staged HPT combined with posterior spinal fusion (PSF) in the treatment of severe rigid spine deformity.

Methods: This is a prospective cohort study. From 2020 to 2022, 61 consecutive patients (mean age 26.2 years) with severe rigid spine deformity who underwent staged HPT combined with PSF with a minimum 24-month follow-up were recruited. Radiographic parameters, clinical information, pulmonary functions tests, and perioperative complications were recorded.

Results: The mean preoperative coronal Cobb angle was 114.2° ± 38°, and the mean MK was 105.8° ± 34.7°. Following the HPT ( mean duration 19.2 weeks), the mean coronal Cobb angle were corrected to 55.3° post-traction (50.6%) and 47.4° after PSF (58.3%); the mean MK angle were corrected to 52.6° post-traction (49.5%) and 38.1° after PSF (63.4%). The overall complication rate during HPT was 16.4%, while surgery-related complications were 18.0%, with no permanent neurological deficits observed.

Conclusion: Staged HPT combine with PSF is effective and safe for patients with severe rigid spine deformities. HPT could mitigate the severity of spine deformity, minimize the need for invasive three-column osteotomies, and reduce the risk of complications for correction surgery.