Growing data have indicated that the miR-17–92 cluster is implicated in inflammatory response and rheumatoid arthritis (RA). This study was aimed to investigate the effects of miR-92a on the proliferation and migration of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLSs). Our results showed that miR-92a was significantly down-regulated in RA synovial tissue and RA-FLSs, whereas the protein level of AKT2 is increased. Restoration of miR-92a suppressed the proliferation and migration of RA-FLSs. Down-regulation of miR-92a promotes proliferation and migration of normal human FLSs. Dual luciferase reporter gene assay showed that miR-92a could specifically bind with the 3′UTR of AKT2 and significantly repressed the luciferase activity. Down-regulation or up-regulation of miR-92a significantly increased or decreased the protein and phosphorylation levels of AKT2. siRNA-mediated down-regulation of AKT2 significantly prevented cell proliferation and migration of RA-FLSs, which were similar to the effects induced by overexpression of miR-92a. Moreover, AKT2 overexpression rescued miR-92a-mediated suppressive effect on proliferation and migration of RA-FLS. Thus, miR-92a could inhibit the proliferation and migration of RA-FLSs through regulation of AKT2 expression.

Osteoarthritis is a type of joint disease that may lead to other joint diseases. Previous research has demonstrated that tumor necrosis factor (TNF)‑α is associated with osteoarthritis activity and pathology. The possible mechanisms of the TNF‑α‑mediated signaling pathway have not been clearly elaborated in synovial fibroblasts. The present study aimed to investigate the potential mechanisms of TNF‑α in a mouse model of iodoacetate‑induced osteoarthritis. Reverse transcription‑quantitative polymerase chain reaction, ELISA, western blotting and immunohistochemistry were performed to evaluate the role of TNF‑α in the progression of osteoarthritis. The results revealed that the serum levels of TNF‑α, interleukin (IL)‑1β, IL‑4 and IL‑6 were significantly upregulated in a mouse model of iodoacetate‑induced osteoarthritis compared with healthy mice (P<0.01). TNF‑α, IL‑1β, IL‑4 and IL‑6 mRNA and protein levels were also significantly upregulated in synovial fibroblasts in the experimental mice (P<0.01). It was demonstrated that TNF‑α increased pro‑inflammation factors matrix metalloproteinase (MMP)‑3, MMP‑9, nuclear factor (NF)‑κB and receptor activator of NF‑κB ligand (RANKL) in synovial fibroblasts. It was also observed that the toll‑like receptor (TLR)‑3 was significantly upregulated and extracellular signal‑regulated kinase (ERK) and protein kinase B (AKT) were significantly downregulated in synovial fibroblasts in osteoarthritis mice (P<0.01). An in vitro assay demonstrated that TNF‑α inhibitor decreased mRNA and protein levels of IL‑1β, IL‑4 and IL‑6 in synovial fibroblasts. The knockdown of TLR‑3 abolished the TNF‑α upregulated mRNA and protein levels of IL‑1β, IL‑4 and IL‑6 in synovial fibroblasts. In addition, the knockdown of TLR‑3 also reversed TNF‑α‑upregulated ERK and AKT expression in synovial fibroblasts. In vivo assays demonstrated that TNF‑α inhibitor significantly decreased the deposition of IL‑1β, IL‑4 and IL‑6 as well as bone destruction and significantly increased the body weight and osteoarthritis score for osteoarthritic mice (P<0.01). TNF‑α inhibitor decreased TLR‑3 and significantly increased the expression and phosphorylation of ERK and AKT in articular cartilage (P<0.01). In conclusion the results of the present study indicate that TNF‑α serves an essential role in synovial fibroblasts in osteoarthritis, suggesting that inhibition of TNF‑α may decrease inflammation via the TLR‑3‑mediated ERK/AKT signaling pathway in a mouse model of monosodium iodoacetate‑induced osteoarthritis.

Objective To propose time-effect standards and standard treatment measures for battlefield extremity injuries.Methods By conducting retrospective analysis of battlefield extremity injuries in the militariy in different countries using literature retrieval and comparative analysis,time-effect standards and standard technical measures of battlefield extremity injuries were outlined.Results In wars of conventional weapons,extremity injuries are the most prevalent.Such treatment should give top priority to the timing of rescue and be implemented in conjunction with the injury classification.Conclusion Time-effect standards and standard treatment measures for battlefield extremity injuries are proposed to strengthen the time-effect treatment capacity of battlefield extremity injuries.

BACKGROUND:MicroRNAs (miRs) play an important role in osteoclastogenesis. However, no study has investigated the underlying molecular mechanisms of miR-145 in this process. The purpose of the present study was to investigate the role of miR-145 and its post-transcriptional mechanism in the progression of osteoclast differentiation. METHODS:Macrophage colony stimulating factor (M-CSF) and receptor activator of nuclear factor-kB ligand (RANKL) were used to induce osteoclastogenesis originated from bone marrow-derived macrophages (BMMs). Female C57BL/6J mice were divided into sham, OVX, OVX + NC-agomir and OVX + miR-145-agomir groups. Tartrate-resistant acid phosphatase (TRAP) staining was performed to identify osteoclasts in-vitro and in-vivo. The mRNA and protein levels in osteoclast and tibia were assayed by qRT-PCR and western blotting, respectively. RESULTS:miR-145 expression was inhibited in RANKL-induced osteoclastogenesis, whereas overexpression of miR-145 attenuated it. We further found that Smad3 is a direct target gene of miR-145 by binding with its 3'-UTR. Overexpression of miR-145 significantly suppressed Smad3 mRNA and protein expression. In-vivo, miR-145 agomir treatment inhibited osteoclast activity in OVX mice by inhibiting Smad3 expression. CONCLUSION:We provide the evidence that over-expression of miR-145 could inhibit osteoclast differentiation, at least partially, by decreasing Smad3 expression.

Background: Previous studies suggest that circRNAs abnormally function in the progression of osteoarthritis (OA). However, little is known about the diagnostic value of circRNAs in patients with OA. To assess potential applications of circRNAs as diagnostic tools in OA, expression profiles of circRNAs in synovial fluid from OA patients and healthy subjects were obtained. Methods: Microarray analysis was performed to profile the expression of circRNAs in an unbiased manner. CircRNA expression in synovial fluid was identified by real-time quantitative polymerase chain reaction (RT-qPCR). The diagnostic value was evaluated using receiver operating characteristics (ROC) curves and the area under the ROC curves (AUC). Spearman correlation analysis was performed to assess the correlation of circRNAs and clinical parameters. Results: We identified five circRNAs that were significantly elevated in synovial fluid from OA patients compared with those of the healthy controls. Among these five circRNAs, hsa_circ_0104873, hsa_circ_0104595, and hsa_circ_0101251 could effectively separate patients with OA from healthy controls with high AUC (0.683, 0.708 and 0.754, respectively). Furthermore, we found that three circRNAs were positively correlated with the degree of radiographic grading and symptomatic severity of OA patients. Conclusion: This study suggests that increased expression of hsa_circ_0104873, hsa_circ_0104595, and hsa_circ_0101251 in synovial fluid from OA patients may serve as potential biomarkers for OA screening.

The aims to evaluate the effectiveness of dislocated and unstable knee joint reconstruction using calcanei combined with an Achilles tendon allograft using one-stage arthroscopy. From January 2008 to January 2010, we treated 11 patients with knee-joint dislocation using calcanei combined with an Achilles tendon allograft using one-stage arthroscopy. A total of 9 males and 2 females aged 17 years to 45 years (average age of 22.3 years) were included in this study. All patients were treated with calcanei combined with an Achilles tendon allograft. The posterior cruciate, medial collateral, anterior cruciate and lateral collateral ligaments were reconstructed. All incisions healed at the first follow-up two weeks after operation. Ten of the patients were monitored for 24 months to 36 months (average of 30 months). Kneejoint function was evaluated using Lysholm and International Knee Documentation Committee scores. Significant differences were found between the pre- and post-operation Lysholm and IKDC scores (P<0.05), as well as between the pre- and post-operation movement ranges (P<0.05). The application of calcanei combined with an Achilles tendon allograft for the treatment of dislocated knee joints using one-stage arthroscopy recovered the stability and movement range of the knee joint. Therefore, the proposed method leads to satisfactory clinical effects.

Objective To evaluate the clinical results of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP)lesions in patients with recurrent shoulder dislocations.Methods Between May 2011 and January 2015,we reviewed 15 cases with combined Bankart and SLAP lesions with recurrent shoulder dislocations who underwent arthroscopic repair.Their average age during surgery was 24.2 years (ranging from 16 to 38 years).During the operation,we began by repairing the unstable SLAP lesion with absorbable suture anchors before we repaired Bankart lesion from the inferior to superior.Fifteen patients in the control group had isolated Bankart lesions without SLAP lesions and underwent arthroscopic repair.Their mean age was 24.6 years (ranging from 18 to 35 years).The preoperative and postoperative results were analyzed by Visual Analogue Scale (VAS)for pain,the range of motion,American Shoulder and Elbow Surgeon (ASES)and Rowe Shoulder Scores Systems.We compared the results with the isolated Bankart lesion. Results For patients who underwent arthroscopic repair of combined Bankart and SLAP lesions,the mean postoperative follow-up period was 15 months (ranging from 13 to 28 months),vs 22 months (ranging from 21 to 34 months)in the control group.VAS for pain was decreased from preoperative 4.9 to postoperative 1.9 (P <0.05).Mean ASES and Rowe Shoulder Scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1,respectively (P <0.05). Recurrent dislocation was not observed until the last follow-up and anterior instability in two groups was not noted during the physical examination.Compared with the isolated Bankart lesion group,no statistical significance was found in the ASES score,Rowe Shoulder Score,or VAS for pain (P >0.05 ).Anterior flexion,abduction,and internal rotation of the affected shoulder during the last follow-up were normal after surgery.Conclusion For recurrent dislocation of the shoulder with combined Bankart and SLAP lesion,arthroscopic repair using absorbable suture anchors can achieve favorable clinical results.It can effectively restore shoulder function.

目的:评价髓芯减压联合负压吸引术治疗早期股骨头坏死的疗效.方法:术前术后记录患者的Harris评分、VAS评分及检测其股骨头血管功能定量参数,以评价术前术后髋关节功能及股骨头微循环的变化情况.结果:术后经影像学检查未见股骨头发生塌陷或坏死区明显扩大.除术后1个月(P＞0.05)外,术后其余的VAS评分均低于术前(P＜0.05);术后的Harris评分均高于术前(P＜0.05).在ARCO Ⅰ期组坏死区Kep值于术后3、6个月均低于术前(P＜0.05);坏死区iAUC值于术后3个月低于术前(P＜0.05).在ARCOⅡ期组坏死区Ve值于术后1个月低于术前(P＜0.05).结论:这种新的手术方法在短期内可有效地改善髋关节功能,减轻疼痛症状,并具有延缓坏死股骨头塌陷的作用.可在一定程度上改善ARCOⅠ期股骨头坏死的微循环瘀滞问题,但对ARCOⅡ期股骨头坏死的改善情况不明显.

目的:通过对某部新入伍官兵训练中膝关节损伤发生原因、特点进行流行性病学调查和分析,为合理训练,预防损伤发生和治疗相关伤痛提供指导依据.方法:对某部2013年度450名新入伍官兵的训练伤发病情况进行统计分析,重点分析膝关节损伤发生率、伤病类型和致伤原因,并对其严重者进行关节镜治疗,观察和分析术后随访效果.结果:某部新兵的训练伤发生率为20.0％.以关节急性扭伤最为多见,占81.1％.其中膝关节损伤共发生32例,占训练伤发病率为7.1％,占训练伤发病率43.8％,其中膝关节周围肌肉损伤20例、交叉韧带损伤1例、半月板损伤9例、侧副韧带损伤2例.致伤率最高的前3位科目是5000米负重跑、跨越障碍训练、格斗训练,共27例,占膝关节训练伤总数的84.4％.所有受伤患者中,12例行手术治疗,20例给予石膏、支具固定、休息等保守治疗.经随访所有患者均得到较好的功能恢复.结论:对于新兵膝关节训练伤预防工作非常重要,避免致残;关节镜手术技术的进步对于膝关节军事训练伤治疗有良好的效果.

目的:了解表面肌电图(sEMG)评定髌股疼痛综合征(PFPS)患者手术治疗前后股内侧肌(VM)和股外侧肌(VL)动态平衡的变化.方法:分别对PFPS患者6例手术前后和健康者10例行sEMG测试、视觉模拟评分法(VAS)疼痛和Lysholm膝关节功能评分.结果:健康人、PFPS术前和术后3组间平均振幅右VM:VL比值分别为1.09±0.36、0.90±0.28和0.94±0.35,3组间的差异无显著性意义(P＞0.05);3组VM与VL达峰值时限的差值(△TBP)分别为-1.45±4.02、7.55±5.84和-1.82±2.93,差异有显著性意义(P＜0.01),PFPS者术后较术前明显改善(P＜0.01),恢复到健康人水平(P＞0.05).PFPS者VAS术后1.60±0.91较术前3.09±1.14减小(P＜0.01),Lysholm评分术后71.27±16.52较术前54.82±17.50明显提高(P＜0.01).结论:本研究sEMG标准化测试VM和VL的峰值时限,能敏感反映PFPS患者手术治疗前后髌骨在冠状面上动态平衡的变化.

Objective To study the effect of surface physical properties of different materials for the artificial joint pros -thesis interface on Mycobacterium tuberculosis adhesion .Methods The surface polishing coating , titanium coating and hydroxyapatite coating were chosen as the experimental materials to analyze the surface topography and measure the surface roughness, contact angle and surface energy .The M.tuberculosis strains were used by in vitro cultivation method and ob-served by scanning electron microscopy (SEM) to study the morphology of M.tuberculosis and the material surface adhe-sion.The influence of surface physical properties of the interface of the artificial joint prostheses on the proliferation and ad -hesion of bacteria was evaluatd .Results The titanium coating and hydroxyapatite coating materials were hydrophobic , while the surface polishing coating was hydrophilic .The contact angle and surface energy were significantly different ( P<0.05).In the process of bacterial culture of the three types of materials , there was no significant difference (P>0.05)in the OD value of bacterial solution .The titanium coating had the largest amount of interface adhesion for M.tuberculosis, fol-lowed by the hydroxyapatite coating and the polishing coating .The difference between various materials was statistically sig-nificant (P<0.05).Conclusion The adhesion of M.tuberculosis in the surface of artificial joint prosthesis materials is closely related to the surface physical properties .A adhesiveness improves with surface roughness .

OBJECTIVE:To study the clinical efficacy of double bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation.METHODS:From January 2007 to November 2011, 50 patients with PCL rupture met the inclusion criteria were divided into two groups: remnant preservation group (RP group) and remnant resection group (RR group). There were 19 males and 7 females in the RP group, ranging in age from 18 to 55 years, with a mean of (32.250 +/- 11.085) years old. The duration from injury to operation ranged from 2 to 66 months, with an average of (17.481 +/- 3.568) months. Among the RR group, 17 patients were male and 7 patients were female, ranging in age from 20 to 54 years old, with an average of (31.458 +/- 9.569) years. The duration from injury to operation ranged from 3 to 72 months, with a mean of (19.354 +/- 3.950) months. The patients in both groups suffered from instability of knee joint, got a positive result of posterior drawer test. In the RP group, the intercondylar notch remnant fiber, scar tissue and synovial were preserved in operation, only the free ligament in the intercondylar notch was resected. In the RR group, the remnant fiber, scar tissue and synovial tissue of adhesive parts were resected. In both groups, autologous semitendinosus and gracilis tendon double-bundle PCL reconstruction were carried out, the tibia was fixed with an absorbable interference screw with post-tie fixation, and the femur side was compositely fixed with absorbable interference screws and suspending fixation. Each patient received both subjective assessment (IKDC subjective evaluation, Lysholm scoring and Cincinnati rating) and objective clinical assessment (IKDC objective evaluation and Kneelax 3 tibia backward measurement) before operation and two years after operation.RESULTS:IKDC subjective evaluation: 92.167 +/- 4.177 in the RP group,which was higher than 87.542 +/- 5.687 in the RR group (P = 0.010). Lysholm scores: 90.917 +/- 4.413 in the RP group, which was higher than 87.083 +/- 5.149 in the RR group (P = 0.027). Cincinnati knee scores: 92.125 +/- 4.003 in the RP group, which was higher than 87.791 +/- 6.665 in the RR group (P = 0.027). IKDC objective evaluation:no significant statistical differences between RP group and RR group. Kneelax 3 assessment : tibia backward test with Kneelax 3 under 132 N showed no significant statistical difference between RP group and RR group, which were (3.958 +/- 0.693) mm and (4.029 +/- 0.846) mm respectively (P = 0.795).CONCLUSION:The study shows a significant advantage of remnant fiber preservation than remnant fiber resection in double-bundle PCL construction in terms of subjective knee function recovery after operation. There is no significant difference in postoperative knee stability.

Objective: To evaluate the effectiveness of calcanei combined achilles tendon allograftunder arthroscopy for the treatment of antero-medical rotary caused by the injuries of bothanterior cruciate ligament(ACL) and medial collateral ligament(MCL).Methods: From January 2007 to January 2010,27 patients with ACL combined MCL injuries in accordance with the inclusion criteria were treated.They were 18 male and 9 female,aged from 16 to 48 with average age of 32.5.Fifteen of them were injured in right knee and twelve injured in left knee.After surgical contraindications were excluded,all the patients were treated with calcanei combined achilles tendon allograft for the reconstruction of both ACL and MCL.The interval between injury and surgery was 7 to 14 days and the average interval was 10 days.Results: All the incisions healed by the first intention two weeks after operation.Ten of the patients were followed up 24 to 32 months,mean 26 months.Twenty-four months after operation,the function of the knee joint was measured by Lysholm and IKDC(International Knee Documentation Committee) scores.The average Lysholm score were raised from 32.10±4.35(pre-operation) to 86.25±4.12(post-operation).And the average IKDC scores of the patients were raised from 33.27±4.25(pre-operation) to 82.46±4.13(post-operation).There were significant differences between the two scores of pre-operation and post-operation(P0.05).Conclusion: The application of calcanei combined achilles tendon allograft for the treatment of antero-medical rotary caused by the injuries of both ACL and MCLunder arthroscopy at one-stage could recover the stability of knee joint,showing satisfactory clinical effects.

Objective To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction using achilles tendon allograft with attached calcaneus in promoting the tendon-bone healing through comparing with that of ACL reconstruction using simple tendon allograft under arthroscopy. Methods From January 2008 to December 2009, 41 patients with ACL injuries in accordance with the inclusion criteria were treated. They were randomly divided into 2 groups according to different treatment methods. In the trial group, ACL reconstruction using achilles tendon allograft with attached calcaneus was performed on 21 patients. In the control group, ACL reconstruction using simple tendon allograft was performed on 20 patients. There were no significant differences in such general data as the age, gender, cause of injury, disease duration, preoperative functional score and so on between the 2 groups (P>0.05), which were comparable. The single-bundle and single-tunnel ACL reconstruction was performed in both groups. Results All the incisions in both groups were healed by the first intention 2 weeks postoperatively. The patients were followed up for an average period of 26 months (range; 24-28 months) in the trial group, and 28 months (range; 24-30 months) in the control group. 2 years after the operation, 15 cases (71.4%) were negative in the Lachman test, and 16 cases (76.2%) were negative in the anterior drawer test in the trail group. In contrast, 14 cases (70.0%) and 15 cases (75.0%) were negative respectively in the control group. There were no significant differences in the Lysholm score and International Knee Documentation Committee (IKDC) score between the 2 groups 2 years after the operation (P>0.05). The CT exam showed the bone tunnel diameter was enlarged in different degrees in both groups 2 years after the operation, when compared with that 1 month postoperatively. However, the rate of bone tunnel enlargement in the trial group (4/21, 19.0%) was obviously less than that in the control group (8/20, 40.0%) (P<0.05). The knee joint laxity examination showed the displacement in the trial group (1.82±0.90) mm was obviously less than that in the control group (2.29±0.77) mm. Conclusions The ACL reconstruction using achilles tendon allograft with attached calcaneus can decrease the rate of bone tunnel enlargement to some degree and promote the tendon-bone healing, with better short-term clinical outcomes, when compared with the ACL reconstruction using simple tendon allograft.

Objective: To evaluate the effectiveness of dislocated and unstable knee joint reconstruction using calcanei combined achilles tendon allograft under arthroscopy at one-stage.Methods: From January 2008 to January 2010,we treated 11 patients of knee joint dislocation using calcanei combined achilles tendon allograft under arthroscopy at one-stage.There were 9 males and 2 females,aged from 17 to 45 with average age of 22.3.There were 6 patients in right knee and 5 patients in left knee.After surgical contraindications were excluded,all the patients were treated with a calcanei combined achilles tendon allograft.The posterior cruciate ligament(PCL),medial collateral ligament(MCL),anterior cruciate ligament(ACL) and lateral collateral ligament(LCL) were reconstructed respectively.Results: All the incisions healed by the first intention two weeks after operation.Ten of the patients were followed up for 24-36 months,average 30 months.The function of the knee joint was measured by Lysholm and IKDC scores.Pre-operation the average Lysholm score of the patients was 42.2±3.5,and 24 months post-operation the score raised to 84.5±6.2.And pre-operation the average IKDC scores of the patients were 41.7±6.5,and 24 months post-operation the score raised to 82.3±10.3.There were significant differences between the scores of pre-operation and post-operation(P0.05).There were significant differences between the movement ranges of pre-operation and post-operation(P0.05).Conclusions: The application of calcanei combined achilles tendon allograft for the treatment of dislocated knee joint under arthroscopy at one-stage could recover the stable and movement range of knee joint,showing satisfactory clinical effects.

Objective To evaluate the feasibility and clinical efficacy of one-stage focal debridement and total hip replacement (THR) in treatment of active tuberculosis of the hip.Methods A retrospective analysis was done for 28 cases of active hip tuberculosis who were treated with one-stage focal debridement and THR in our hospital from January 2007 to October 2010.There were 17 males and 11 females,with an average age of 36 years (range,18-72 years).Eight patients had abscess only inside the joint,while 20 also had periarticular abscess.All patients had acetabular and femoral head damage.The erythrocyte sedimentation rate (ESR) before operation averaged 52 mm/l h (range,28-102 mm/lh),and the C-reactive protein (CRP) averaged 38 mg/L (range,11 to 73 mg/L).The anti-tuberculous treatment before operation lasted 7 weeks in average (range,3-32 weeks).The abscess and acetabular sequestra around the joint were cleared in all operations.The removed femoral head and neck issue were cleared from focus,soaked in 75％ alcohol for 5 min,washed with saline,and used as implant in area of bone defect.Cementless THR was performed.All cases were confirmed as hip tuberculosis by pathological examination.Anti-tuberculous treatment was applied for 18 months after operation.Results All of 28 patients were followed up for an average of 37 months (range,24-56 months).All patients had first intention healing.ESR returned to normal in an average of 3.3 months (range,2-5 months),and CRP 2.1 months (range,1-3 months).The Harris hip score improved from 30.214±9.350 preoperatively to 90.535±6.746 postoperatively.One patient stopped anti-tuberculosis chemotherapy 13 months after operation at his own choice,and relapsed.He was able to walk 56 months after operation,and no loosening was observed in the hip stem or acetabular cup.The patient has the prosthesis retained and is under close follow-up.Conclusion It is reliable to use one-stage focal debridement and THR based on effective anti-tuberculous chemotherapy to treat active tuberculosis of the hip.

Objective To evaluate the technical characteristics and the clinical efficacy of unicondylar knee arthroplasty(UKA).Methods 62 patients with 85 knees( 39 patients of unilateral knee,23 patients of bilateral knees) who underwent UKA at our hospital from January 2005 to May 2009had been reviewed.There were eight males with 10 knees and 54 females with 75 knees.The sex ratio was7.5 females per male.Their age ranged from 44 to 78 years with an average of 63 years.There were 79cases of medial unicondylar knee arthroplasty and six lateral unicondylar knee arthroplasty cases.Unicompartmental prostheses from Waldemar Link GmbH & Co were used in all cases.The KSS knee scores and ranges of joint motion before operation and at the last review after operation were compared to evaluate the function of the knee joint.All patients underwent X-ray examination after operation to observe the prosthesis location and changes of non-replaced compartments.Results 62 patients with 85 knees were followed up for 65.8 months after operation( ranged from 48 to 99 months).Their KSS knee scores improved from( 58.22 ± 20.07) to( 81.24 ± 17.96)( P < 0.01).The range of knee motion averaged in( 126.73 ±7.53) degrees before operation and( 124.65 ± 8.65) at the last review after operation( P >0.05).The first and last time X-ray examinations after operation showed that the development of nonreplaced compartments was not obvious.Five patients with six knees had looseness in part of the tibial prosthesis between 11 to 42 months after operation.Three knees had total knee revision surgery; the other two patients with three knees took analgesics and were able to walk and do daily activities.They are under our follow-up at present.Conclusion Unicondylar knee arthroplasty achieves good joint functions and,to some extent,slows down the progression rate of knee degeneration.Nonetheless,the morbidity of prosthesis looseness in the tibia is noticeably high and must be paid attention to.

Objective To investigate whether arthroscopic remplissage with Bankart repair is an effective treatment for patients with Hill-Sachs defects.Methods Between 2007 and 2009,20 patients underwent arthroscopic Bankart repair with remplissage for the treatment of recurrent anterior glenohumeral instability and large Hill-Sachs defects.Preoperative imaging in all patients demonstrated both a Bankart lesion and a significant Hill-Sachs defect.Patients were followed up postoperatively with the Western Ontario Shoulder Instability score(WOSI),the American Shoulder and Elbow Surgeons score(ASES),and the Penn Shoulder Score.Recurrent dislocation was documented.Results The mean length of follow-up in this study was 25 months(range,18 to 32 months).At final follow-up,3 patients reported recurrence of instability.The mean American Shoulder and Elbow Surgeons score was 92.5.The mean Penn score was 90.The mean total Western Ontario Shoulder Instability score was 572.5.There was no statistical difference in ASES,Penn and WOSI shoulder scores for patients with concomitant injury.Conclusion For the Bankart lesions with Hill-Sachs defects,arthroscopic remplissage technique with Bankart repair can achieve satisfactory clinical results and effectively restore shoulder function.

Objective To explore the treatment of patelo-femoral ostarthritis through lateral patelloplasty under an arthroscope and to summarize the early clinical effectiveness.Methods Between Jan 2009 and Feb 2010,32 cases of patello-femoral ostarthritis( 59 knees) were treated by lateral patelloplasty under an arthroscope.There were 6 males( 8knees) and 26 females( 32 knees) aged 36 to 54( 45 years old on average).We started the operation by cleaning the articular cavity,performed arthrectomy on the lateral patella about 1 cm upward,followed by mechanical gouging on the disorder cartilage of patella and femoral trochlea.All the cases received a strictly-staged knee functional rehabilitation.Twenty-five cases( 48 knees) were followed up for 4- 16 months( mean 8 months).The results were evaluated according to the Lysholm knee score.Results The mean Lysholm knee score was improved from 54.6 ± 4.3 preoperatively to 87.6 ± 2.8 at the last follow-up( P 0.01).Conclusion Lateral patelloplasty under an arthroscope has the advantages of less injury,quick knee joint function recovery and good effect on patelo-femoral ostarthritis.

Objective To discuss the different treatments of adult osteochondritis dissecans of the femoral condyle. Methods A retrospective study was carried out. The inclusion criteria were as follows: the adults above 18 years old,who were diagnosed osteochondritis dissecans of the femoral condyle,and underwent surgical treatment,the follow-up time was more than 24 months. The exclusion criteria were as follows: the juvenile osteochondritis dissecans,nonoperative management,no follow-up after surgery. 32 cases of osteochondritis dissecans of the femoral condyle treated from January 2007 to July 2011 were reviewed. There were 23 male and 9 female cases,and the sex ratio was 2. 6∶ 1. Among the samples there were 10 cases of arthroscopic microfractures,12 cases of arthroscopic osteochondral piece fixed with a bioabsorbable nail composed of SR-PLLA( SmartNail; ConMed Linvatec,Largo,FL),eight cases of osteochondral piece fixed with cannulated screws and two cases of unicondylar replacements. Lysholm scores and IKDC subjective evaluation were used to assess the function of the knee joint before and after the surgery. Results The 32 patients were followed up for 35. 8 months in average( range: 24 ~ 52 months). The average Lysholm score was( 53. 77 ± 4. 48) before the operation and( 90. 89 ± 4. 42) after the operation( t =- 266. 01,P < 0. 01). The average IKDC objective evaluation was( 58. 50 ± 5. 99) preoperation and(92. 15 ± 4. 16) postoperation( t =- 87. 62,P < 0. 01). Conclusion Various treating options are available for osteochondritis dissecans of the femoral condyle of different types and stages. Appropriate treating methods will achieve good clinical efficacy,while the late-stage treatment will result in medical costs increase.