IntroductionOsteochondral lesion of the talus (OLT) is a common ankle injury that may disturb the biomechanical environment and contribute to progressive articular degeneration. However, in clinical practice, OLT is typically elliptical, whereas most biomechanical studies modeled OLTs as circular defects. This study aimed to compare circular and elliptical OLT defects of different sizes and locations using finite element analysis.MethodsA subject-specific ankle finite element model was reconstructed from CT data. Full-thickness circular and elliptical defects ranging from 25 to 200 mm2 were created in zones 4 and 6 and analyzed under three gait phases. Elliptical defects were defined with an anteroposterior-to-mediolateral axis ratio of 1.5:1. Peak von Mises stress, peak stress location, and regional stress distribution were analyzed.ResultsCompared with circular defects, elliptical defects generally produced higher peak stress and a more adverse redistribution pattern. In zone 4, differences between shapes became more evident in larger defects, and at 200 mm2, peak stress in circular defects was 3.77, 4.16, and 5.02 MPa, compared with 4.37, 4.85, and 5.85 MPa in elliptical defects across all gait phases. A similar pattern was observed in zone 6, with elliptical defects also producing higher peak stress than circular defects. These differences were more evident in zone 4 during midstance and push off and were consistently observed in zone 6 across all gait phases. In zone 4, elliptical defects caused the global peak stress to shift from zone 3 to zone 1 at a smaller defect size (150 vs. 175 mm2). Elliptical defects also showed a smaller distance between the local peak stress and defect edge than circular defects (2.10 vs. 2.24 mm). Stress redistribution favored the anterior-posterior direction in zone 4 for both shapes, whereas in zone 6 this directional pattern was less consistent, particularly in elliptical defects.ConclusionDefect shape substantially alters the biomechanical environment of OLT. Compared with circular defects, elliptical defects produce greater stress concentration, earlier stress redistribution, and a more unfavorable stress pattern, especially in larger lesions. These findings suggest that defect shape should be considered in biomechanical assessment and clinical evaluation.

BackgroundAlthough stem cell–based therapies show promise for promoting Achilles tendon regeneration, the current preclinical evidence is highly heterogeneous, and their overall efficacy and key modifying factors remain unclear.MethodsWe systematically searched PubMed, Web of Science, Embase, and Scopus for studies based on rat models of Achilles tendon rupture. Two investigators independently performed study selection, data extraction, and risk-of-bias assessment. Meta-analyses were conducted using R software.ResultsTwenty-seven studies were included. Pooled analyses showed that stem cell transplantation significantly improved ultimate load and histological scores of the Achilles tendon, with effects increasing over time. However, the impact of stem cell therapy on tendon stiffness was limited. For type I collagen, stem cell transplantation alone did not significantly enhance its expression, whereas combining stem cells with biomaterial scaffolds led to a marked increase. Subgroup analyses revealed a complex relationship between stem cell dose and treatment efficacy: for ultimate load, a moderate dose was effective at 2 weeks, while a high dose was more effective at 4 weeks; for histological scores, both low and moderate doses were effective at 2 weeks, whereas only moderate-to-high doses were effective at 4 weeks, indicating a nonlinear and time-dependent dose–response pattern. Overall, composite strategies using scaffold-loaded stem cells were generally more effective than scaffold treatment alone. Assessment of publication bias suggested potential bias in the primary outcomes, but trim-and-fill correction did not materially alter the conclusions. Risk-of-bias evaluation showed generally inadequate reporting in key methodological domains, including random sequence generation, allocation concealment, and blinding, indicating a potential risk of bias.ConclusionStem cell transplantation can effectively improve the biomechanical strength and histological architecture of the Achilles tendon after rupture, but its effects on stiffness restoration and type I collagen expression appear limited. Based on early healing data from rat models, scaffold-loaded stem cell therapy shows potential for enhancing Achilles tendon repair. However, the current preclinical literature is characterized by methodological shortcomings and marked heterogeneity in critical factors such as stem cell sources and scaffold materials. As a result, the findings primarily reflect overall trends rather than definitive effects, and clinical translation will require further standardized studies and validation in large animal models.

Charcot neuroarthropathy (CN) is a debilitating joint disorder that predominantly affects patients with neuropathy, particularly those with diabetic peripheral neuropathy (DPN). CN causes painless, rapid joint destruction and often leads to foot deformity, ulceration, osteomyelitis, and, in severe cases, amputation. Its pathogenesis involves repetitive microtrauma due to loss of protective sensation, triggering an inflammatory cascade that activates osteoclasts (OCs) disproportionately relative to osteoblasts (OBs) via the RANKL–RANK–OPG pathway, resulting in progressive bone loss and joint destruction. This systematic review and meta-analysis evaluated the efficacy of anti-resorptive agents in promoting bone remodeling and alleviating clinical symptoms in patients with active or stable CN. Following Cochrane Collaboration guidelines, we searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing anti-resorptive agents, such as bisphosphonates, denosumab, calcitonin, and parathyroid hormone analogues, with placebo or no treatment in patients with Charcot neuroarthropathy. Two independent reviewers performed data extraction and risk-of-bias assessment using the Cochrane RoB 2 tool. Primary outcomes were bone mineral density (BMD), bone turnover markers (BTMs), time to remission, change in foot temperature, and adverse events. Statistical analyses were conducted using Stata 18, with random-effects models used to pool results. We identified 936 records and nine reports describing seven RCTs met the inclusion criteria. The meta-analysis showed no significant difference in BMD between anti-resorptive agents and control groups. However, anti-resorptive therapy significantly reduced bone resorption markers. Clinical outcomes, including foot temperature change and time to remission, did not differ significantly between groups. Adverse events were similar between the intervention and control groups. Although anti-resorptive agents reduce bone resorption markers in patients with Charcot neuroarthropathy, current evidence does not support their efficacy in improving BMD or providing clinically meaningful symptom relief beyond standard offloading. High-quality clinical trials and mechanistic studies are needed to define the role of these agents in CN management.

PurposeThis study aimed to investigate the preoperative psychological status of adult patients with equinocavovarus foot deformity and to examine the association between preoperative anxiety/depressive symptoms and the clinical outcomes of corrective surgery in this population.MethodsA retrospective analysis was conducted on 103 adult patients who underwent corrective surgery for equinocavovarus foot at Xi’an Honghui Hospital between March 2014 and July 2023. Baseline data were collected. Patient psychological status, ankle-hindfoot function, pain, and quality of life were assessed preoperatively and at the final follow-up using the Hospital Anxiety and Depression Scale (HADS), the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the Visual Analog Scale (VAS), and the 36-Item Short Form Health Survey (SF-36). Based on preoperative HADS scores, patients were categorized into an anxiety/depression group (Group A) and a non-anxiety/depression group (Group B). The two groups were compared with respect to baseline characteristics (gender, age, disease duration, BMI, follow-up duration), clinical outcomes, and the degree of improvement in all assessment metrics.ResultsA total of 83 patients completed the follow-up, among whom 38 (45.78%) exhibited preoperative anxiety/depression symptoms. No significant differences were found in baseline characteristics between the two groups (all P > 0.05). At the final follow-up, both groups showed significant improvement in VAS, AOFAS, SF-36 (PCS/MCS), and HADS (A/D) scores compared to their preoperative baselines (all P < 0.001). Intergroup comparisons revealed that Group A had significantly lower AOFAS and SF-36 (PCS/MCS) scores, and significantly higher VAS and HADS (A/D) scores than Group B, both preoperatively and at the final follow-up (all P < 0.001). Regarding the degree of improvement, Group A demonstrated a smaller magnitude of improvement in VAS (P < 0.01), AOFAS (P < 0.01), and SF-36 PCS (P < 0.001) compared to Group B. Conversely, Group A showed a greater improvement in SF-36 MCS and HADS (A/D) scores (all P < 0.001).ConclusionsWhile surgery improved all outcomes, patients with preoperative anxiety/depression exhibited persistently worse clinical scores. Their improvement profile was distinct: smaller gains in pain and physical function but greater mental health improvement. Addressing preoperative psychological status may optimize comprehensive outcomes.

PurposeThe aim of this study is to investigate the psychological status of patients with end-stage ankle osteoarthritis (OA), and to evaluate the impact of ankle arthrodesis (AA) on the patients’ psychological condition, as well as the influence of preoperative anxiety and depression symptoms on the clinical outcomes after AA surgery.MethodsA retrospective observational study was conducted on 62 patients with end-stage ankle OA who underwent AA treatment at our hospital from January 2019 to December 2024. Based on the patients’ preoperative psychological status, they were divided into two groups: those with symptoms of anxiety/depression were included in Group A, and those without symptoms of anxiety/depression were included in Group B. The Hospital Anxiety and Depression Scale (HADS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Visual Analogue Scale (VAS) for pain were used to evaluate the patients before surgery and at the final follow-up. Independent sample t-tests and chi-square tests were used for between-group comparisons, and paired sample t-tests were used for within-group pre-post comparisons. P < 0.05 was considered statistically significant.ResultsOf the 62 patients with end-stage ankle OA who were fully followed up, 30 had symptoms of anxiety/depression before surgery, a prevalence rate of up to 48%. All evaluation indicators for patients in Groups A and B improved significantly after AA surgery compared to before surgery, but the overall prognosis for Group A was worse than Group B.ConclusionAA can effectively improve patients’ pain, functional activity, and psychological condition, and there is a significant correlation between the patients’ preoperative psychological status and the prognosis.

This study systematically compares the efficacy of different adjunctive therapies in enhancing microfracture (MF) treatment for osteochondral lesions of the talus (OLT) through a network meta-analysis, aiming to identify the optimal adjunctive therapy for microfracture. A systematic search of PubMed, Embase, Web of Science, Cochrane, and Scopus databases was conducted for relevant literature until October 1, 2024. Two researchers independently screened, extracted data, and assessed quality. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of six randomized controlled trials were included, comprising 295 OLT patients and involving four adjunctive therapies: MF combined with platelet-rich plasma (MF_PRP), hyaluronic acid (MF_HA), collagen scaffold (MF_CS), and pulsed electromagnetic fields (MF_PEMF). The results of the network meta-analysis indicated that while HA is the most commonly used adjunctive therapy, PRP-assisted MF demonstrated the best improvement in AOFAS and VAS scores for OLT. The surface under the cumulative ranking curve (SUCRA) predictions also revealed that PRP has the greatest potential among the four adjunctive therapies, followed by HA. Conversely, MF_PEMF showed the least effectiveness in improving AOFAS and VAS scores. Additionally, only one study reported complications associated with MF_PEMF and MF, with no statistically significant differences between the two. Among the MF adjunctive therapies validated by RCTs, HA is the most widely used; however, PRP-assisted MF provides the best outcomes for OLT patients, suggesting that its application should be emphasized in clinical practice. Registration No: CRD42024546984. Not applicable.

Bone implants play a critical role in the treatment of orthopedic diseases, however, conventional polymer or ceramic or metal implants possess various problems in enhancing bone repair and osteointegration. Recent years, the bioactive bone implants with biomimetic mechanical surface with natural extracellular matrix has shown promising role in reinforcing bone integration and regeneration. Biomedical hydrogels coating strategy has attracted much attention in bone implants modification, due to their adjustable surface biomechanics, bioactivities and drug release ability. Based on the principles of mechanical compatibility for biodegradable scaffold materials, it facilitates a "soft-hard synergy" in bone repair. This review provides an overview of recent advances in the field of hydrogel modification for bone implants, including the polysaccharide hydrogels (such as chitosan, alginate, and hyaluronic acid) and protein hydrogels (such as gelatin and collagen). Furthermore, this review explores the current understanding of the biomechanical mechanisms underlying bone formation in hydrogel-modified implants within the body, presents the challenges and future directions in this field. This study integrates engineering, developmental biology, and clinical perspectives, offering unique insights for the development of functional strategies for bone implants aimed at enhancing the treatment of orthopedic diseases.

ObjectiveThis study aims to analyze the impact of different surgical procedures on the prognosis and psychological state of patients with end-stage ankle arthritis (ESAA) by comparing two groups of patients with ESAA who have undergone total ankle replacement (TAR) and ankle arthrodesis (AA), and to investigate whether preoperative psychological status can alter the final clinical outcomes.MethodsThis study retrospectively collected data from 66 patients with ESAA who underwent AA surgery in the Foot and Ankle Surgery Department of Xi’an Honghui Hospital between 2016 and 2023. In July 2024, the final follow-up of patients was conducted via telephone or WeChat, with a follow-up duration of no less than 12 months. Before surgery and at the final follow-up, evaluations were conducted using the Chinese version of the Hospital Anxiety and Depression Scale (HADS), the Visual Analogue Scale (VAS) for pain (ranging from 0 to 100mm), and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score. The study compared differences in pain scores, functional scores, and psychological scores between patients in the TAR and AA groups before surgery and at the final follow-up. Additionally, patients who underwent TAR and AA were further subgrouped based on the severity of their preoperative psychological status, in order to analyze the impact of preoperative psychological conditions on surgical prognosis.ResultsA total of 66 patients with ESAA completed the follow-up. At the final follow-up, both the VAS and AOFAS scores in the TAR group and the AA group showed significant improvement compared to preoperative levels. Among them, the TAR group performed better in terms of AOFAS scores, but no significant difference was observed in VAS scores between the two groups. Additionally, there was no significant difference in HADS scores between the two groups at the final follow-up. Regardless of whether they belonged to the high-HADS group or the low-HADS group, patients showed significant improvement in clinical scores compared to preoperative levels. However, at the final follow-up, the clinical scores of the high-HADS group were significantly lower than those of the low-HADS group, and the incidence of complications in the high-HADS group was also higher.ConclusionThis study found that both TAR and AA significantly improved patients’ psychology, pain, and functional activities. Both surgical methods demonstrated similar improvements in terms of final psychological status and pain relief. However, patients in the TAR group showed better ankle function and mobility. Patients with poorer preoperative psychological status had worse clinical outcomes and faced a higher risk of complications. The study indicates that both TAR and AA are effective treatment options for patients with ESAA, but poor preoperative psychological status is one of the important risk factors for poor prognosis. Therefore, when selecting a treatment approach, the patient’s psychological state and needs should be fully considered, and necessary psychological interventions and postoperative rehabilitation plans should be implemented to enhance the patient’s treatment outcomes and quality of life.

PURPOSE:This study aims to assess the psychological health status of patients with Achilles tendon rupture (ATR) and explore the potential effect of preoperative psychological health on the prognosis of ATR surgical outcomes. By thoroughly analyzing the role of psychological factors in surgical recovery, this study seeks to provide a more comprehensive reference for clinical treatment. METHODS:This study included 71 patients with ATR who underwent open surgical treatment at the Department of Foot and Ankle Surgery at Xi'an Honghui Hospital from March 2018 to February 2022. Based on the presence of anxiety/depressive symptoms before surgery, patients were divided into two groups: group A, comprising patients with anxiety/depressive symptoms before surgery, and group B, comprising patients without anxiety/depressive symptoms before surgery. Preoperative and final follow-up evaluations were conducted using the Hospital Anxiety and Depression Scale, the Visual Analog Scale (0-100 mm), the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, and the Achilles Tendon Rupture Score. A comparative analysis of the clinical functional outcomes of the two groups was done, and changes in pain symptoms before and after surgery were compared between the two groups. RESULTS:A total of 71 patients with ATR were included in the study, with 34 patients (47.9%) exhibiting anxiety/depressive symptoms before surgery. After undergoing open surgical repair, both groups showed significant improvements in all evaluation indicators ( P < 0.05). Preoperatively, patients with anxiety/depressive symptoms reported significantly more severe pain compared with those without such symptoms ( P < 0.05); at the final follow-up, no significant differences were observed between the two groups in pain and depressive symptoms ( P > 0.05). However, patients with preoperative anxiety/depressive symptoms demonstrated significantly worse outcomes in anxiety symptoms and functional activities compared with those without such symptoms ( P < 0.05). No significant intergroup differences were detected in pain symptom progression from baseline to final follow-up ( P > 0.05). However, although postoperative pain changes did not differ markedly, patients with preoperative anxiety or depression demonstrated greater recovery challenges, especially in functional outcomes. CONCLUSIONS:Open surgical repair of ATR markedly improved patients' foot function. However, patients with preoperative anxiety/depressive symptoms experienced more severe pain and a slower functional recovery postoperatively. Although no notable differences were observed in the changes in pain symptoms before and after surgery between the two groups, preoperative psychological health status markedly influenced postoperative functional recovery. Future research should further investigate the use of psychological interventions to enhance postoperative recovery, particularly for patients with anxiety or depressive symptoms before surgery.

To investigate the impact of preoperative psychological factors on outcomes following metatarsophalangeal joint replacement surgery in patients with Freiberg’s infraction. This retrospective study included 127 patients diagnosed with Freiberg’s infraction who underwent metatarsophalangeal joint replacement surgery at Xi’an Honghui Hospital’s Department of Foot and Ankle Surgery between August 2013 and September 2023. Patients were stratified into two groups based on preoperative psychological status: Group A comprised patients with preoperative anxiety and/or depression symptoms, while Group B included patients without such symptoms. The Hospital Anxiety and Depression Scale (HADS) and visual analogue scale (VAS) were administered preoperatively and at final follow-up to assess psychological status and pain levels. Primary outcome measures included the 0–100 mm VAS for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) functional score. Of 127 patients, 91 (71.7

Polyether-ether-ketone (PEEK) has become a much-attracted biomedical implant material in orthopedic surgery, serving as a more biocompatible alternative to conventional metals. However, the inherent bioinert and mismatched mechanical surface of PEEK have limited their optimized bone fixation and repair. In this work, a PEEK implant is printed and a bioactive mechanical-adaptive surface via in situ chemical linking of photoluminescent elastomeric poly(citrate-silicon) (PCS) polymer (PEEK-PCS) is subsequently constructed, which could be used for real-time bioimaging and enhanced osseointegration. The PEEK-PCS surface exhibits viscoelastic properties, enabling it to conform to complex tissue geometries and effectively alleviate surface stress. Furthermore, PEEK-PCS modulates the inflammatory response by promoting macrophage M2 phenotypic polarization and reducing the expression of inflammatory factors. Additionally, PEEK-PCS promotes the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), significantly enhancing the osseointegration and osteogenesis ability of PEEK implants. Notably, PEEK-PCS demonstrates excellent autofluorescence properties both in vitro and in vivo, along with remarkable fluorescence stability over 14 d in vivo, suggesting real-time tracking potential of bioimaging. Compared to traditional coated implants, PEEK-PCS provides distinct advantages in surface adhesion, mechanical compatibility, real-time bioimaging, and osseointegration, representing a promising solution for implant-related bone repair.

OBJECTIVE:To explore the current research status and hotspots in the field of biomechanics of diabetic foot by bibliometric analysis methods. METHODS:Literatures related to biomechanics of diabetic foot published in the Web of Scienc Core Collection (WoSCC) from 1981 to 2024 were searched. CiteSpace software and R language bibliometrics plugin were used to conduct a visual analysis of annual publication volume of the literature, including publication volume of each country and region, the publication situation of authors and institutions, the citation situation of individual literature, and the co-occurrence network of keywords. RESULTS:Totally 996 literatures were included, and the number of published papers increased steadily. The United States (261 papers) and China (89 papers) were the top two countries in terms of the number of published papers. The mediating centrality of the United States was 0.94, and that of China was 0.01. Scholars such as Cavanagh and institutions like the Cleveland Clinic were at the core of research in this field. High-frequency keywords include plantar pressure (plantar pressure), diabetic foot (diabetic foot), ulceration (ulcer), etc. The research focuses on plantar pressure, ulcer formation and prevention, etc. CONCLUSION:Biomechanical research on diabetic foot mainly focuses on the pressure distribution on the sole of the foot, callus formation, mechanical analysis of soft tissues on the sole of the foot, and the study of plantar decompression caused by Achilles tendon elongation. The research trend has gradually shifted from focusing on joint range of motion to gait and the design of braces and assistive devices, and has begun to pay attention to muscle strength, gait imbalance and proprioception abnormalities.

PURPOSE:The aim of this study is to investigate the preoperative and postoperative psychological health status of patients with calcaneal fractures, and to explore the impact of preoperative psychological health status on the prognosis of surgical treatment for calcaneal fracture patients. METHODS:This study included 67 patients with calcaneal fractures who underwent surgical treatment in the Foot and Ankle Surgery Department of Honghui Hospital in Xi'an from November 2019 to September 2022. Patients were divided into two groups based on the presence of preoperative anxiety/depression symptoms, with patients exhibiting preoperative anxiety/depression symptoms assigned to Group A and those without such symptoms assigned to Group B. Preoperative and final follow-up assessments were conducted using the Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Score to evaluate patients. RESULTS:Among the 67 patients with complete follow-up for calcaneal fractures, 33 patients exhibited preoperative anxiety/depression symptoms (49.25%). Both Group A and Group B patients showed significant improvements in various evaluation indicators after calcaneal fracture surgery compared to preoperative assessments, but the overall prognosis of Group A was worse than that of Group B. CONCLUSIONS:The preoperative psychological health status of patients is related to postoperative clinical outcomes, and patients with poorer psychological health have a worse prognosis.

Analyzing the correlation between patients’ basic information, three-dimensional parameters after calcaneal fractures, and the prognosis of calcaneal fractures. A retrospective analysis was conducted on 43 patients with calcaneal fractures who underwent surgical treatment in the Foot and Ankle Surgery, Xi’an Honghui Hospital, from September 2019 to August 2022. Patient demographics including gender and age were collected, as well as the preoperative posterior articular surface collapse area, number of fracture fragments, length, width, height, and volume of the calcaneus obtained from preoperative three-dimensional imaging. Patients were followed up for VAS, AOFAS, and SF-36 scores. Correlation analysis was performed on the obtained data. All 43 included patients received complete follow-up, including 40 males and 3 females, with an average follow-up time of 35.37 ± 10.73 months, and an average age of 43.98 ± 12.08 years. All patients’ VAS, AOFAS, and SF-36 scores at the last follow-up showed no correlation with patient age, gender, or the area of posterior articular collapse, number of fracture fragments, length, width, height, or volume of the calcaneus. The prognosis of calcaneal fractures is unrelated to three-dimensional factors such as patient age, gender, length, width, height, volume of the calcaneus, area of the posterior joint, and number of fracture fragments.

This study aims to analyze the correlation between the prognosis of osteochondral lesions of the talus and patient age, gender, duration of illness, and injury location, surface area, depth, and volume. A retrospective analysis of 44 patients who underwent talus osteochondral transplantation in the Department of Foot and Ankle Surgery of our hospital between January 2017 and December 2020 was performed. The clinical medical records of the patients were collected, and the location of the osteochondral lesion of the talus was determined according to the nine-division method. The surface area, depth, and volume of the osteochondral lesion of the talus were measured using mimics software in all patients. The visual analog scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS), and the SF-36 quality of life questionnaire scores were evaluated before surgery and at the last follow-up, and correlation analysis was performed. Of 44 patients, 30 were followed up with a mean period of 24.33 ± 12.19 months. There were 18 men and 12 women, with an average age of 40.73 ± 10.57 years and an average disease duration of 28.30 ± 21.25 months. The VAS, AOFAS, and SF-36 scores of all patients at the last follow-up were significantly better than those before surgery. The degree of post-operative symptom improvement was not correlated with age, sex, duration of illness, and injury location, surface area, depth, and volume. The prognosis of osteochondral lesion of the talus is not related to patient age, gender, duration of disease, or injury location, surface area, depth, and volume.

Bioprinting is an advanced technology that allows for the precise placement of cells and biomaterials in a controlled manner, making significant contributions in regenerative medicine. Notably, bioprinting-enabled biomaterials have found extensive application as drug delivery systems (DDS) in the treatment of osteoarthritis (OA). Despite the widespread utilization of these biomaterials, there has been limited comprehensive research summarizing the recent advances in this area. Therefore, this review aims to explore the noteworthy developments and challenges associated with utilizing bioprinting-enabled biomaterials as effective DDS for the treatment of OA. To begin, we provide an overview of the complex pathophysiology of OA, highlighting the shortcomings of current treatment modalities. Following this, we conduct a detailed examination of various bioprinting technologies and discuss the wide range of biomaterials employed in DDS applications for OA therapy. Finally, by placing emphasis on their transformative potential, we discuss the incorporation of crucial cellular components such as chondrocytes and mesenchymal stem cells into bioprinted constructs, which play a pivotal role in promoting tissue regeneration and repair.

OBJECTIVE:To compare clinical efficacy of platelet-rich plasma (PRP) and extracorporeal shock wave in treating chronic insertional Achilles tendinopathy. METHODS:From February 2019 to August 2021, 42 patients with chronic insertional Achilles tendinopathy were selected and divided into PRP group(20 patients, 28 feet) and shock wave group (22 patients, 29 feet). In PRP group, there were 12 males and 8 females, aged 47.00(28.00, 50.75) years old, and the courses of disease ranged 7.00(6.00, 7.00) months;PRP injection was performed in the Achilles tendon stop area of the affected side. In shock wave group, there were 16 males and 6 females, aged 42.00(35.75, 47.25) years old;and the courses of disease was 7.00(6.00, 8.00) months;shock wave was performed in Achilles tendon stop area of the affected side and triceps surae area. Visual analogue scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) were applied to evaluate clnical effect before treatment, 1, 3 and 6 months after treatment, and satisfaction of patients was investigated. RESULTS:VAS and VISA-A score in both groups were significantly improved at 1, 3 and 6 months after treatment than before treatment (P<0.05), VAS and VISA-A score in PRP group at 6 months after treatment were significantly higher than those at 1 and 3 months after treatment, and VAS and VISA-A score in shock wave group were lower than those at 1 and 3 months after treatment (P<0.05). There was no significant difference in VAS and VISA-A score between two groups before treatment, 1 and 3 months after treatment(P>0.05), while VAS and VISA-A score in PRP group were better than those in shock wave group at 6 months after treatment(P<0.05), and the satisfaction survey in PRP group was better than that in shock wave group(P<0.05). CONCLUSION:PRP injection has a good clinical effect on chronic insertional Achilles tendinopathy with high patient satisfaction, and medium-and long-term effect of PRP injection for the treatment of chronic insertional Achilles tendinopathy is better than that of extracorporeal divergent shock wave.

目的 比较体外发散式冲击波与局部皮质类固醇(CS)药物注射治疗慢性跖筋膜炎的临床疗效.方法 选取2018年3月至2020年5月西安红会医院足踝外科门诊治疗的80例慢性跖筋膜炎患者,进行回顾性研究,以在足底区进行CS局部封闭注射治疗的40例为封闭组,以在足底区和同侧小腿三头肌进行冲击波治疗的40例为冲击波组,比较两组满意度、VAS及Maryland评分等指标.结果 两组治疗1、3、6个月时VAS及Maryland评分均较治疗前改善(P＜0.05);治疗1个月时封闭组VAS及Maryland评分优于冲击波组,但治疗6个月时冲击波组VAS及Maryland评分优于封闭组(P＜0.05).冲击波组治疗后各时间点的VAS及Maryland评分均较治疗前逐渐改善,除治疗后6个月与3个月比较外,其他时点间两两比较差异均有统计学意义(P＜0.05);相反封闭组从治疗1个月后逐渐出现恶化趋势,且治疗6个月时VAS及Maryland评分均较1个月时出现反弹,差异有统计学意义(P＜0.05).治疗6个月时,冲击波组满意度调查优于封闭组(P＜0.05).结论 两种治疗方法对于慢性跖筋膜炎均有效,局部CS注射短期内缓解疼痛、改善功能,但体外发散式冲击波的长期临床效果显著,患者满意度高.

Background This retrospective study aimed to introduce a novel method for simultaneous Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion and to evaluate the feasibility of this method. Methods We retrospectively analysed the clinical and imaging data of 11 patients with calcaneus malunion treated using Y -shape osteotomy and subtalar arthrodesis who were admitted to our hospital from June 2018 to October 2020. The patients included 9 males and 2 females aged from 24 to 69 years old, with an average age of 42.18 years. The clinical and radiological results were assessed with the Visual Analogue Scale (VAS) pain score and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. In addition, functional recovery and general quality of life were evaluated using the 12-Item Short-Form Survey (SF-12). Results All radiological parameters were significantly improved at the last follow-up, with increases of 14.37°, 9.18°, and 4.51 mm in the Böhler’s angle, calcaneal pitch angle, and talocalcaneal height, respectively, and decreases of 6.39 mm and 6.18° in the calcaneal width and Hindfoot alignment angle ( p < 0.05). The mean AOFAS and VAS scores at the last follow-up improved compared with those preoperatively, from 34.18 ± 9.53 to 84.18 ± 11.59 and from 6.90 ± 1.22 to 1.90 ± 1.13, respectively ( p < 0.05). The SF-12 physical and mental health scores were 49.65 ± 6.84 and 52.68 ± 7.88, respectively. Furthermore, the early postoperative complications included skin necrosis in one and sural neuralgia in one patient, and the late postoperative complication included ankle pain in one patient. No other complications, such as implant discomforts, malunion, nonunion and re-fracture, were presented. Conclusion These results indicate that Y-shape osteotomy combined with subtalar arthrodesis is an effective new method for the treatment of calcaneal malunion. Advantages include improvement of the anatomic shape of the calcaneus and union rates for subtalar arthrodesis.

目的 介绍踝关节前侧微创双切口行关节融合术的手术技术,并评估其临床疗效.方法 回顾性分析2016年12月至2018年12月西安交通大学附属红会医院足踝外科收治的终末期踝关节炎患者23例(23足),其中男9例,女14例;年龄37～68岁,平均(53.4±8.5)岁;左侧10例,右侧13例;根据Kellgren-Lawrence分期,Ⅲ期4例,Ⅳ期19例.所有患者均采用微创双切口行关节融合术治疗,通过对比术前与末次随访的美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分、视觉疼痛量表(visual analog scale,VAS)评分进行临床疗效评估.结果 本组23例患者的随访时间28～55个月,平均(44.75±9.42)个月.术后所有患者均获得骨性愈合,未出现严重的手术相关并发症.AOFAS评分、VAS评分较术前均有显著改善(P<0.001).结论 针对无明显内外翻畸形及骨缺损的踝关节炎患者,踝关节融合可获得满意的临床疗效,微创双切口技术创伤小、并发症少,中短期随访疗效肯定.