Background:Osteochondral lesions of the talus (OLT) are common and clinically challenging conditions with no consensus on how to optimally treat them. This prospective single-arm study aimed to evaluate the clinical outcomes of autologous costal cartilage transplantation (ACCT) for OLT. Methods:A prospective single-arm study of patients who were diagnosed with medial OLT and underwent ACCT with 2 years of follow-up was performed. There were 28 patients enrolled at a single center. The primary outcome was changes in American Orthopaedic Foot and Ankle Society (AOFAS) scores from baseline. The secondary outcomes included results of the EuroQol 5-dimension 5-level questionnaire (EQ-5D-5L) for quality of life, the visual analog scale for pain, the Tegner score for sports activity, and magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for imaging evaluations. Results:All 28 enrolled patients (41.82 ± 11.98 years, 9 female and 19 male) completed the initial study and the 2 years of follow-up. The AOFAS score improved significantly from 58.89 ± 8.74 preoperatively to 86.5 ± 7.41 at 1 year and 90.53 ± 5.49 at 2 years (p < 0.01 for both). EQ-5D-5L index improved from 0.866 ± 0.042 at baseline to 0.976 ± 0.041 at 2 years postoperatively (p < 0.01). Tegner score increased by 1.96 ± 0.69 at 2 years (p < 0.01). Patients reported significant pain relief at 2 years postoperatively (VAS: from 3.89 ± 0.87 to 0.75 ± 0.58, p < 0.01; EQ VAS: from 63.75 ± 6.02 to 88.57 ± 6.21, p < 0.01). The mean MOCART scores were 81.07 ± 11.25 at 6 months, 83.57 ± 11.85 at 1 year, and 82.32 ± 10.92 at 2 years. Complete filling of the defect was observed in all 28 patients at 2 years, and complete integration of the graft with the bone was seen in 25 cases (89.29%). Conclusions:ACCT for OLT led to significant improvement in clinical outcomes and effectively repaired talar osteochondral lesions, with grafts maintaining stability and integrating well with the host tissue over time. This study introduces ACCT as a novel strategy for OLT. Level of evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Scarf osteotomy is a well-established procedure for hallux valgus, yet recurrence rates range from 3.6

ObjectivesSPARCL1 is a matricellular protein that mediates the cell–matrix interactions and participates in physiological processes such as cell adhesion, differentiation and proliferation. However, its role in chondrocyte and osteoarthritis (OA) progression has not been fully characterized. We aimed to evaluate the effects of SPARCL1 on OA through in vitro and in vivo experiments.MethodsExpression of SPARCL1 was examined in 55 paired human OA samples. Effects of Sparcl1 on chondrocytes were identified in vitro. Intra-articular injection was performed in an anterior cruciate ligament transection (ACLT) mouse model. Alterations of SPARCL1-mediated signaling pathway were identified by RNA-seq analysis. qPCR and western-blot were used to demonstrate the potential signaling pathway.ResultsSPARCL1 expression in the OA cartilage was increased compared with undamaged cartilage. Recombinant Sparcl1 protein induced extracellular matrix degradation in chondrocytes. Furthermore, intra-articular injection of recombinant Sparcl1 protein in ACLT mice could promote OA pathogenesis. Mechanistically, Sparcl1 activated TNF/NF-κB pathway and consequently led to increased transcription of inflammatory factors and catabolism genes of cartilage, which could be reversed by NF-κB inhibitor BAY 11–7082.ConclusionSPARCL1 could promote extracellular matrix degradation and inflammatory response to accelerate OA progression via TNF/NF-κB pathway.The translational potential of this articleThe current research could help to gain further insights into the underlying molecular mechanism in OA development, and provides a biological rationale for the use of SPARCL1 as a potential therapeutic target of OA.

Background:Glucocorticoid usage and alcohol abuse are the most widely accepted risk factors for nontraumatic osteonecrosis of femoral head (ONFH). Despite distinct etiologies between glucocorticoid-associated ONFH (GONFH) and alcohol-associated ONFH (AONFH), little is known about the differences of the microarchitectural and histomorphologic characteristics between these subtypes of ONFH.Purposes:To investigate bone microarchitecture, bone remodeling activity and histomorphology characteristics of different regions in femoral heads between GONFH and AONFH.Methods:From September 2015 to October 2020, 85 patients diagnosed with GONFH and AONFH were recruited. Femoral heads were obtained after total hip replacement. Femoral head specimens were obtained from 42 patients (50 hips) with GONFH and 43 patients (50 hips) with AONFH. Micro-CT was utilized to assess the microstructure of 9 regions of interest (ROIs) in the femoral head. Along the supero-inferior orientation, the femoral head was divided into necrotic region, reactive interface, and normal region; along the medio-lateral orientation, the femoral head was divided into medial region, central region and lateral region. Decalcified and undecalcified bone histology was subsequently performed to evaluate histopathological alterations and bone remodeling levels.Results:In the necrotic region, most of the microarchitectural parameters did not differ significantly between GONFH and AONFH, whereas both the reactive interface and normal region revealed a less sclerotic microarchitecture but a higher bone remodeling level in GONFH than AONFH. Despite similar necrotic pathological manifestations, subchondral trabecular microfracture in the necrotic region was more severe and vasculature of the reactive interface was more abundant in GONFH.Conclusions:GONFH and AONFH shared similar microarchitecture and histopathological features in the necrotic region, while GONFH exhibited a less sclerotic microarchitecture and a more active bone metabolic status in both the reactive interface and normal region. These differences between GONFH and AONFH in bone microarchitectural and histopathological characteristics might contribute to the development of disease-modifying prevention strategies and treatments for ONFH, taking into etiologies.

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.

Minimally invasive percutaneous plate osteosynthesis (MIPPO) was compared with traditional open reduction and internal fixation (ORIF) in treating distal tibial fractures. Patients diagnosed with displaced extraarticular distal tibial fractures during October 2005-June 2007 were randomly assigned to a closed (treated using MIPPO) and an open (treated using ORIF) group. Ninety-four patients with fractures were treated and followed up, of which 42 and 52 patients were enrolled in the open and closed groups, respectively. The 94 fracture cases were classified into three types: Type A, 52 (55.3%); Type B, 24 (25.5%); and Type C, 18 (19.1%). The average follow-up time was 15.6 and 16.2 months for the open and closed groups, respectively. In the open group, 35 fractures healed within six months. Delayed union was observed in three fractures and nonunion in four fractures. Two cases had superficial wound infection after operation. No malunion was observed. In the closed group, 47 fractures healed within six months. Delayed union was observed in four fractures. Locking plate was broken nine months after operation in one case. Malunion was observed in five cases: two rotational and three posterior angular deformities. No statistically significant differences were observed in the healing time of Types A and B between the open and closed groups (p > .05). The healing time of Type C in the open group was longer than that in the closed group (p < .05). The first choice for Type C fractures is MIPPO, whereas that for Type A is open reduction.