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Clinical guidelines for indications,techniques,and complications of autogenous bone grafting

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Chinese Medical Journal 2024年第1期137卷 5-7页

作者： Jianzheng Zhang Shaoguang Li Hongying He Li Han Simeng Zhang Lin Yang Wenxing Han Xiaowei Wang Jie Gao Jianwen Zhao Weidong Shi Zhuo Wu Hao Wang Zhicheng Zhang Licheng Zhang Wei Chen Qingtang Zhu Tiansheng Sun Peifu Tang Yingze Zhang Senior Department of orthopedics PLA General HospitalBeijing 100048China The National Clinical research Center for orthopedics Sports Medicine&RehabilitationBeijing 100048China The Trauma orthopedic Branch of Chinese orthopedic Association ShijiazhuangHebei 050051China Department of orthopedic Surgery The Third Hospital of Hebei Medical UniversityShijiazhuangHebei 050051China Department of Microsurgical Trauma The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdong 510080China

Autogenous bone grafts have long been considered the“gold standard”and most effective material in bone regeneration procedures.[1]Autogenous bone grafts are used to repair bone defects caused by nonunion,infection,tumor resection,and spinal and joint fusion.[2]It has been reported that more than 200,000 autologous bone grafts are performed in the United States each year.[3]Although there are no specific statistics on the annual number of bone grafts performed in China,autologous bone grafting is the most common surgical technique in orthopedics.The iliac crest remains the most common donor site,along with the fibula,ribs,tibial metaphysis,proximal humerus,distal radius,and greater trochanter.[4,5]Various bone-graft options provide different amounts and qualities of cortical,cancellous,and corticocancellous bone.[6,7]Autogenous bone graft is osteogenic,histocompatible,provides structural support.

关键词： grafting graft union

Mid-term outcomes of a kinematically designed cruciate retaining total knee arthroplasty

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World Journal of orthopedics 2024年第2期15卷 118-128页

作者： Jonathan L Katzman Akram A Habibi Muhammad A Haider Casey Cardillo Ivan Fernandez-Madrid Morteza Meftah Ran Schwarzkopf Department of orthopedic Surgery Division of Adult Reconstructive SurgeryNYU Langone Orthopedic HospitalNYU Langone HealthNew YorkNY 10010United States

BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rat

关键词： Total knee arthroplasty Cruciate retaining Kinematic design Survivorship Bearing material Prosthetic design Clinical outcomes Patient-reported outcome measures

Congenital absence of the lateral meniscus:A case report

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World Journal of orthopedics 2024年第5期15卷 477-482页

作者： Hamad Ali Alkhunayfir Abdulaziz Ali AlQahtani Abdulrahman Jalwi Korkoman Department of orthopedic Surgery Prince Muhammed bin Abdulaziz HospitalRiyadh 61422Saudi Arabia Department of orthopedic Surgery Prince Sultan Military Medical CityRiyadh 12233Saudi Arabia Department of orthopedic Surgery University of BishaBisha 67714Saudi Arabia

BACKGROUND Congenital absence of the menisci is a rare anatomical variation characterized by the absence or underdevelopment of one or both menisci in the knee joint.The menisci are crucial in load distribution,joint stability,and shock absorption.Understanding the clinical presentation,diagnosis,and management of this condition is important for optimal patient care.CASE SUMMARY A 27-year-old male with a long-standing history of knee pain underwent diagnostic arthroscopy,revealing a congenital absence of the meniscus.The patient's clinical findings,imaging results,surgical procedures,and pertinent images are detailed.This case presents a unique aspect with the congenital absence of the meniscus,contributing valuable insights to the literature on rare anatomical anomalies.CONCLUSION This case of congenital absence of the menisci highlights the diagnostic challenges posed by rare anomalies.The diagnostic arthroscopy played a crucial role in identifying the absence of the meniscus and providing an explanation for the patient's persistent knee pain.The case underscores the importance of individualized treatment approaches,including physical therapy,for optimal management of rare meniscal anomalies.Further research is warranted to explore effective management strategies for the aforementioned cases and to expand our knowledge of these rare conditions.

关键词： Lateral meniscus Arthroscopy Knee joint Menisci reformation Magnetic resonance imaging Case report

Regenerative medicine strategies for chronic complete spinal cord injury

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Neural Regeneration research 2024年第4期19卷 818-824页

作者： Shogo Hashimoto Narihito Nagoshi Masaya Nakamura Hideyuki Okano Department of orthopedic Surgery Keio University School of Medicine Department of Physiology Keio University School of Medicine

Spinal cord injury is a condition in which the parenchyma of the spinal cord is damaged by trauma or various diseases.While rapid progress has been made in regenerative medicine for spinal cord injury that was previously untreatable,most research in this field has focused on the early phase of incomplete injury.However,the majority of patients have chronic severe injuries;therefore,treatments for these situations are of fundamental importance.The reason why the treatment of complete spinal cord injury has not been studied is that,unlike in the early stage of incomplete spinal cord injury,there are various inhibitors of neural regeneration.Thus,we assumed that it is difficult to address all conditions with a single treatment in chronic complete spinal cord injury and that a combination of several treatments is essential to target severe pathologies.First,we established a combination therapy of cell transplantation and drug-releasing scaffolds,which contributes to functional recovery after chronic complete transection spinal cord injury,but we found that functional recovery was limited and still needs further investigation.Here,for the further development of the treatment of chronic complete spinal cord injury,we review the necessary approaches to the different pathologies based on our findings and the many studies that have been accumulated to date and discuss,with reference to the literature,which combination of treatments is most effective in achieving functional recovery.

关键词： cell transplantation chronic phase complete transection regenerative medicine spinal cord injury

Irreducible anteromedial radial head dislocation without fracture caused by transposed biceps tendon in an adult:A case report and literature review

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Chinese Journal of Traumatology 2024年第3期27卷 180-186页

作者： Ming-Fu Fu Hai-Ning Zuo Tao Sun Ming-Zhang Mu Zhi-Yong Zhou Department of orthopedic Surgery Yantaishan HospitalYantaiShandong Province264003China

Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful swelling and restricted movement of his right elbow due to strangulation injury by a fishing boat cable.On examination,the images of the right elbow reveals in a"semi-extended and pronated"elastic fixation position.Radiography and 3-dimensional reconstruction CT reveals an isolated anteromedial radial head dislocation with extreme protonation of the radius and the bicipital tuberosity towards the posterior aspect of the elbow joint,and MRI shows biceps tendon wrapping around the radial neck,similar to umbilical cord wrapping seen in newborns.The Henry approach was applied for the first time to reduce the biceps tendon.The patient achieved a good functional recovery at 26 months,which represents the first reported case of IARHD without fracture caused by biceps tendon in an adult.In treatment of IARHD,attention should be paid to the phenomenon of biceps tendon transposition.Careful clinical examination,comprehensive imaging modalities,and appropriate surgical approach are the keys to successful management.

关键词： Biceps tendon Henry approach Irreducible Anteromedial dislocation Radial head Elbow Adult

A new perspective on intervertebral disc calcification—from bench to bedside

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Bone research 2024年第1期12卷 50-61页

作者： Emanuel J.Novais Rajkishen Narayanan Jose A.Canseco Koen van de Wetering Christopher K.Kepler Alan S.Hilibrand Alexander R.Vaccaro Makarand V.Risbud Department of Orthopaedic Surgery Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPAUSA Unidade Local de Saúde do Litoral Alentejano Orthopedic DepartmentSantiago do CacémPortugal Rothman orthopedic Institute at Thomas Jefferson University PhiladelphiaPAUSA

Disc degeneration primarily contributes to chronic low back and neck pain.Consequently,there is an urgent need to understand the spectrum of disc degeneration phenotypes such as fibrosis,ectopic calcification,herniation,or mixed phenotypes.Amongst these phenotypes,disc calcification is the least studied.Ectopic calcification,by definition,is the pathological mineralization of soft tissues,widely studied in the context of conditions that afflict vasculature,skin,and cartilage.Clinically,disc calcification is associated with poor surgical outcomes and back pain refractory to conservative treatment.It is frequently seen as a consequence of disc aging and progressive degeneration but exhibits unique molecular and morphological characteristics:hypertrophic chondrocyte-like cell differentiation;TNAP,ENPP1,and ANK upregulation;cell death;altered Pi and PPi homeostasis;and local inflammation.Recent studies in mouse models have provided a better understanding of the mechanisms underlying this phenotype.It is essential to recognize that the presentation and nature of mineralization differ between AF,NP,and EP compartments.Moreover,the combination of anatomic location,genetics,and environmental stressors,such as aging or trauma,govern the predisposition to calcification.Lastly,the systemic regulation of calcium and Pi metabolism is less important than the local activity of PPi modulated by the ANK-ENPP1 axis,along with disc cell death and differentiation status.While there is limited understanding of this phenotype,understanding the molecular pathways governing local intervertebral disc calcification may lead to developing disease-modifying drugs and better clinical management of degeneration-related pathologies.

关键词： degeneration metabolism intervertebral

Extracellular vesicles for neural regeneration after spinal cord injury

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Neural Regeneration research 2024年第3期19卷 491-492页

作者： Young-Ju Lim Wook-Tae Park Gun Woo Lee Department of orthopedic Surgery Yeungnam University Medical CenterYeungnam University College of MedicineDaeguKorea

What is spinal cord injury:Spinal cord injury(SCI)is the damage to the structure of the bundles of cells and nerves that communicate signals from the brain to the body and extremities.The pathology of SCI includes both primary and secondary injuries(Morales et al.,2016).Physical forces such as compression,shearing,contusion,and tearing are major causes of primary injury in SCI.There are two main processes in primary injury:acute and subacute.The acute phase includes traumatic disruption of axons and hemorrhage of the blood vessels around the spinal cord.Hemorrhagic injury to the vessels can lead to increased edema within the neural and cord tissues,susceptibility to infiltration by microglia and astrocytes,excitotoxicity,and demyelination.Similarly,disruption of the blood-spinal cord barrier results in the release of inflammatory cytokines from specific cells and vessels.

关键词： acute injuries nerves

Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

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World Journal of orthopedics 2024年第3期15卷 257-265页

作者： Bryan Hamans Sheryl de Waard Sjoerd Kaarsemaker Esther R C Janssen Inger N Sierevelt Gino M M J Kerkhoffs Daniël Haverkamp Department of Orthopaedic Surgery Xpert ClinicAmsterdam 1101EANetherlands Department of orthopedic Surgery Amsterdam University Medical CenterAmsterdam 1105 AZNetherlands Esther R C Janssen Department of Orthopaedic SurgeryViecuri Medisch CentrumVenlo 5912 BLNetherlands Centre for Orthopaedic research Spaarne ZiekenhuisHoofddorp 2134 TMNetherlands Department of Orthopaedic Surgery and Sports Medicine Amsterdam UMC-Location AMCAmsterdam 1105 AZNetherlands Department of orthopedic Surgery Xpert Orthopedic Surgery ClinicAmsterdam 1101 EANetherlands

BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year f

关键词： Total hip arthroplasty Femoral stem Short stem Optimys Survival 5-year survival Revision PROMs

Piezo1 expression in chondrocytes controls endochondral ossification and osteoarthritis development

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Bone research 2024年第1期12卷 199-214页

作者： Laura J.Brylka Assil-Ramin Alimy Miriam E.A.Tschaffon-Müller Shan Jiang Tobias Malte Ballhause Anke Baranowsky Simon von Kroge Julian Delsmann Eva Pawlus Kian Eghbalian Klaus Püschel Astrid Schoppa Melanie Haffner-Luntzer David J.Beech Frank Timo Beil Michael Amling Johannes Keller Anita Ignatius Timur A.Yorgan Tim Rolvien Thorsten Schinke Department of Osteology and Biomechanics University Medical Center Hamburg-Eppendorf20246 HamburgGermany Department of Trauma and orthopedic Surgery University Medical Center Hamburg-Eppendorf20246 HamburgGermany Institute of orthopedic research and Biomechanics University Medical Center UlmBadenWürttemberg89081 UlmGermany Department Legal Medicine University Medical Center Hamburg-Eppendorf20246 HamburgGermany Leeds Institute of Cardiovascular and Metabolic Medicine School of MedicineUniversity of LeedsLS29JT LeedsUK

Piezo proteins are mechanically activated ion channels,which are required for mechanosensing functions in a variety of cell types.While we and others have previously demonstrated that the expression of Piezo1 in osteoblast lineage cells is essential for boneanabolic processes,there was only suggestive evidence indicating a role of Piezo1 and/or Piezo2 in cartilage.Here we addressed the question if and how chondrocyte expression of the mechanosensitive proteins Piezo1 or Piezo2 controls physiological endochondral ossification and pathological osteoarthritis(OA)development.Mice with chondrocyte-specific inactivation of Piezo1(Piezo1^(Col2a1Cre)),but not of Piezo2,developed a near absence of trabecular bone below the chondrogenic growth plate postnatally.Moreover,all Piezo1^(Col2a1Cre) animals displayed multiple fractures of rib bones at 7 days of age,which were located close to the growth plates.While skeletal growth was only mildly affected in these mice,OA pathologies were markedly less pronounced compared to littermate controls at 60 weeks of age.Likewise,when OA was induced by anterior cruciate ligament transection,only the chondrocyte inactivation of Piezo1,not of Piezo2,resulted in attenuated articular cartilage degeneration.Importantly,osteophyte formation and maturation were also reduced in Piezo1^(Col2a1Cre) mice.We further observed increased Piezo1 protein abundance in cartilaginous zones of human osteophytes.Finally,we identified Ptgs2 and Ccn2 as potentially relevant Piezo1 downstream genes in chondrocytes.Collectively,our data do not only demonstrate that Piezo1 is a critical regulator of physiological and pathological endochondral ossification processes,but also suggest that Piezo1 antagonists may be established as a novel approach to limit osteophyte formation in OA.

关键词： Piezo1 markedly ossification