Objective:To review the research progress of pathological changes of glenohumeral capsule in patients with recurrent shoulder anterior dislocation (RSAD). Methods:The literature on shoulder capsules, both domestic and international, was reviewed. The anatomy, histology, and molecular biology characteristics of the glenohumeral capsule in RSAD patients were summarized. Results:Anatomically, the glenohumeral capsule is composed of four distinct parts: the upper, lower, anterior, and posterior sections. The thickness of these sections is uneven, and the stability of the capsule is further enhanced by the presence of the glenohumeral and coracohumeral ligaments. Histologically, the capsule tissue undergoes adaptive changes following RSAD, which improve its ability to withstand stretching and deformation. In the realm of molecular biology, genes associated with the regulation of structure formation, function, and extracellular matrix homeostasis of the shoulder capsule's collagen fibers exhibit varying degrees of expression changes. Specifically, the up-regulation of transforming growth factor β 1 (TGF-β 1), TGF-β receptor 1, lysyl oxidase, and procollagen-lysine, 2-oxoglutarate 5-dioxygenase 1 facilitates the repair of the joint capsule, thereby contributing to the maintenance of shoulder joint stability. Conversely, the up-regulation of collagen type Ⅰ alpha 1 (COL1A1), COL3A1, and COL5A1 is linked to the recurrence of shoulder anterior dislocation, as these changes reflect the joint capsule's response to dislocation. Additionally, the expressions of tenascin C and fibronectin 1 may play a role in the pathological processes occurring during the early stages of RSAD. Conclusion:Glenohumeral capsular laxity is both a consequence of RSAD and a significant factor contributing to its recurrence. While numerous studies have documented alterations in the shoulder capsule following RSAD, further research is necessary to confirm the specific pathological anatomy, histological, and molecular biological changes involved.

Objective:To investigate the morphological characteristics of the glenohumeral joint (including the glenoid and coracoid) in the Chinese population and determine the feasibility of designing coracoid osteotomy based on the preoperative glenoid defect arc length by constructing glenoid defect models and simulating suture button fixation Latarjet procedure. Methods:Twelve shoulder joint specimens from 6 adult cadavers donated voluntarily were harvested. First, whether the coracoacromial ligament and conjoint tendon connected was anatomically observed and their intersection point was identified. The vertical distance from the intersection point to the coracoid, the maximum allowable osteotomy length starting from the intersection point, and the maximum osteotomy angle were measured. Next, the anteroinferior glenoid defect models of different degrees were randomly constructed. The arc length and area of the glenoid defect were measured. Based on the arc length of the glenoid defect of the model, the size of coracoid oblique osteotomy was designed and the actual length and angle of the coracoid osteotomy were measured. A limited osteotomy suture button fixation Latarjet procedure with the coracoacromial ligament and pectoralis minor preservation was performed and the position of coracoid block was observed. Results:All shoulder joint specimens exhibited crossing fibers between the coracoacromial ligament and the conjoint tendon. The vertical distance from the tip of the coracoid to the coracoid return point was 24.8-32.2 mm (mean, 28.5 mm). The maximum allowable osteotomy length starting from the intersection point was 26.7-36.9 mm (mean, 32.0 mm). The maximum osteotomy angle was 58.8°-71.9° (mean, 63.5°). Based on the anteroinferior glenoid defect model, the arc length of the glenoid defect was 22.6-29.4 mm (mean, 26.0 mm); the ratio of glenoid defect was 20.8%-26.2% (mean, 23.7%). Based on the coracoid block, the length of the coracoid osteotomy was 23.5-31.4 mm (mean, 26.4 mm); the osteotomy angle was 51.3°-69.2° (mean, 57.1°). There was no significant difference between the arc length of the glenoid defect and the length of the coracoid osteotomy ( P>0.05). After simulating the suture button fixation Latarjet procedure, the highest points of the coracoid block (suture loop fixation position) in all models located below the optimal center point, with the bone block concentrated in the anteroinferior glenoid defect position. Conclusion:The size of the coracoid is generally sufficient to meet the needs of repairing larger glenoid defects. The oblique osteotomy with preserving the coracoacromial ligament may potentially replace the traditional Latarjet osteotomy method.

Objective:To evaluate the mid-term effectiveness of limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet) procedure in treatment of recurrent anterior shoulder dislocation. Methods:Between March 2017 and February 2019, 56 patients with recurrent shoulder dislocation were treated with arthroscopic LU-tarjet procedure. There were 44 males and 12 females with an average age of 26.3 years (range, 18-41 years). Shoulder joint dislocation occurred 2-16 times, with an average of 7.5 times. The time from the initial dislocation to operation ranged from 6 months to 13 years, with a median of 4.6 years. Preoperative shoulder joint fear test and re-reduction test were positive in all patients. The Beighton score of joint relaxation ranged from 1 to 7, with an average of 4.1. The shoulder Instability Severity Index Score (ISIS) ranged from 5 to 10, with an average of 7.8. The size of glenoid defects on the affected side ranged from 15% to 32% (mean, 22.4%). All patients had Hill-Sachs injuries of varying degrees. Six patients had re-dislocation after Bankart surgery. The operation time, incision healing, and postoperative complications were recorded. The range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation) of shoulder joint were compared between pre- and post-operation. The improvement of shoulder function was evaluated using the American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score. X-ray films and three-dimensional CT were used to analyze the location, healing, and remolding of bone graft, the repair of glenoid defect, and degenerative changes of the shoulder joint. Results:All operations were successfully completed. The operation time ranged from 42 to 98 minutes, with an average of 63 minutes. All incisions healed by first intention. All patients were followed up 5-7 years (mean, 6.3 years). During follow-up, 2 patients experienced shoulder subluxation within 1 year after operation and 1 patient experienced recurrent shoulder joint pain. The remaining patients had no related complications. At last follow-up, there was no significant difference between the two groups ( P>0.05) in range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation). The ASES score, Rowe score, and Walch-Duplay score of shoulder significantly improved when compared with those before operation ( P<0.05). Postoperative CT showed that 53 cases (94.64%) of coracoid bone masses were centered placed vertically, 2 cases (3.57%) were superior, and 1 case (1.79%) was inferior; 49 cases (87.50%) of the coracoid bone grafts were flush with the glenoid, 2 cases (3.57%) and 5 cases (8.93%) were medially and laterally positioned. The volume of coracoid bone graft decreased first and then increased, and the shape of the bone graft was continuously remodeling and gradually matched with the track of the humerus head (the optimal circle of the glenoid), all coracoid bone grafts healed. At last follow-up, the coverage rate of optimal glenoid circle was 89.6%-100%, with an average of 97.4%. The area of glenoid defect was 2.6%±1.3%, which significantly decreased when compared with preoperative (22.4%±5.4%) ( P<0.05). At last follow-up, no obvious degenerative changes of shoulder joint was observed. Conclusion:LU-tarjet procedure for recurrent anterior shoulder dislocation has good mid-term effectiveness with short operation time and few complications.

Arthroscopic techniques for anterior talofibular ligament (ATFL) reconstruction have been developed in recent years. Allograft tendons are often used in ATFL reconstruction, and surgical indications include an insufficiently strong ligament remnant, high-demand activities, repeated ankle sprains, and revision cases. We describe a socket-anchor technique for talar tunnel creation: A 10-mm-deep bone tunnel (socket) is created along a previously located guidewire at the ATFL talar footprint; an absorbable suture anchor is inserted into the end of the socket; and the graft is tied to the suture, pulled into the socket, and finally, secured using an arthroscopic knot pusher. This technique provides the advantages of being minimally invasive, ensuring a sufficient tendon-bone interface healing area of the graft, avoiding medial neurovascular bundle injury and the risk of talar neck fracture caused by screw fixation, and having no special restrictions on the direction of the anchor with blind tunnel creation. In addition, the procedure is easy to perform with high fault tolerance and no need for intraoperative fluoroscopy.

BACKGROUND:Although the implications of circular RNAs (circRNAs) with the progression of diverse pathological conditions have been reported, the circRNA players in osteoarthritis (OA) are barely studied.METHODS:In this study, twenty-five OA patients who received arthroplasty were recruited for cartilage tissue collection. Public circRNA microarray data from Gene Expression Omnibus was retrieved for circRNA identification. An in vitro cell model of OA-related damages was constructed by treating human chondrocytes (CHON-001 cell line) with IL-1β, and circSOD2 siRNA was used to silence circSOD2 expression to study its functional role in apoptosis, inflammatory responses, and extracellular matrix (ECM) degradation. Besides, we investigated the functional interactions among circSOD2, miR-224-5p, and peroxiredoxin 3 (PRDX3) by luciferase reporter assay, RNA-immunoprecipitation assay, and quantitative reverse transcription polymerase chain reaction.RESULTS:Our findings revealed the overexpression of circSOD2 in the OA cartilage and cell samples, and circSOD2 knockdown alleviated ECM degradation, inflammation, and apoptosis in CHON-001 cell model. In addition, our findings suggested the regulatory function of circSOD2 knockdown on miR-224-5p expression, while miR-224-5p was capable of downregulating PRDX3 expression. The co-transfection of miR-224-5p inhibitor or pcDNA-PRDX3 could prevent the effect of circSOD2 knockdown.CONCLUSION:Hence, our results demonstrated that knockdown of circSOD2 may serve as an intervention strategy to alleviate OA progression through modulating miR-224-5p/PRDX3 signaling axis.

Objective:To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting.Methods:A total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively.Results:In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane.Conclusion:In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.

Background: Graft impingement is one of the main concerns in double-bundle anterior cruciate ligament reconstruction (DB-ACLR). Impingement between the anteromedial (AM) and posterolateral (PL) bundles has been postulated to cause graft deterioration or rerupture, but this has not been thoroughly investigated, and the interbundle impingement pressure (IIP) has not been well researched. Purpose: To determine the IIP between the AM and PL bundles in the native anterior cruciate ligament (ACL) and in DB-ACLR with individualized and nonindividualized double-tunnel placement. Study Design: Controlled laboratory study. Methods: A total of 30 fresh-frozen, nonpaired, human cadaveric knees were randomly divided into 3 groups of 10 knees: native intact ACL (NI group), DB-ACLR tunnel placement using the preserved remnant procedure (individualized reconstruction) (PR group), and DB-ACLR tunnel placement using the bony landmark procedure (nonindividualized reconstruction) (BL group). Pressure sensors were inserted between the AM and PL bundles. The knee was moved passively from full extension to full flexion, and the IIP between the 2 ACL bundles was measured every 15°. Similarly, the impingement pressure was measured between the ACL and intercondylar roof and between the ACL and posterior cruciate ligament (PCL). Results: No significant differences were found in the maximum, mean, or minimum ACL-roof and ACL-PCL impingement pressures among the 3 groups. The IIP significantly increased when the knee joint was flexed >120° in all 3 groups ( P < .001). Compared with the other 2 groups, the BL group had significantly higher maximum and mean IIP throughout the range of knee movement ( P < .001) and from maximum extension to 120° of flexion ( P < .001). The BL group also had significantly higher minimum IIP than the other 2 groups when knee flexion was >120° ( P < .001). No significant differences were seen in maximum, minimum, or mean IIP between the NI and PR groups. Conclusion: The PR procedure (individualized DB-ACLR) was more consistent with the interbundle biomechanical conditions of the native ACL, whereas the BL procedure (nonindividualized DB-ACLR) had higher maximum and mean IIP. The IIP was higher than the ACL–intercondylar roof or ACL-PCL pressures, and it increased significantly when knee flexion was >120°. Clinical Relevance: These data suggest that surgeons can perform individualized DB-ACLR using preserved remnants for tunnel placement as impingement-free DB-ACLR.

OBJECTIVE:To investigate the mid-term effect of lateral placement of bone graft on shoulder joint degeneration after modified arthroscopic Latarjet surgery with elastic fixation for recurrent anterior shoulder dislocation with an anterior glenoid bone defect. METHODS:According to the inclusion and exclusion criteria, 18 patients with recurrent anterior shoulder dislocation and anterior glenoid bone defect who received the modified arthroscopic Latarjet surgery with elastic fixation between January 2015 and November 2016 were enrolled in this study. There were 12 males and 6 females with an average age of 26.2 years (range, 19-37 years). The number of shoulder dislocation ranged from 4 to 30 times (mean, 8.8 times). The disease duration was 8-49 months (mean, 23.8 months). The mean anterior glenoid bone defect was 25.2% of the glenoid surface (range, 20%-29%). The mean preoperative Instability Severity Index Score (ISIS) was 7.6 (range, 7-10). According to Samilson-Prieto classification, the shoulder joint degeneration was rated as grade 0 in 13 cases, grade Ⅰ in 3 cases, and grade Ⅱ in 2 cases. Before and after operation, the visual analogue scale (VAS) score, American Society of Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, Rowe score, and shoulder mobility were used to evaluate the effectiveness. Imaging examination was performed to observe the shoulder joint degeneration, the position of the bone graft, and the postoperative shaping of the scapular glenoid. RESULTS:All patients were followed up 55-62 months, with an average of 59.6 months. There was no neurovascular injuries, infections, fixation-related and bone graft-related complications. No re-dislocation and revision occurred. All patients returned to normal life, 17 of whom returned to sport. The VAS score was significantly decreased and ASES, Walch-Duplay, and Rowe scores were significantly improved at last follow-up ( P<0.05). No significant difference was found in range of motion of forward flexion, abduction, lateral rotation at 90° abduction, internal rotation at 90° abduction, or lateral rotation at 0° between pre- and post-operation ( P>0.05). Three-dimensional CT showed that the centers of all bone grafts were between 3∶30 and 4∶30 (right shoulder) or between 7∶40 and 8∶20 (left shoulder) and no bone grafts were positioned superiorly or inferiorly in the glenoid En-face view. All bone grafts were positioned lateral to the scapular glenoid with an average distance of 3.5 mm (range, 2.3-4.6 mm) in cross-sectional imaging by CT. Compared with the preoperative Samilson-Prieto classification results, all cases showed no progression of shoulder joint degeneration at 36, 48 months and last follow-up. All bone grafts remodeled to a steady state within 24 months after operation. The bone graft and glenoid finally remodeled analogous to the shape of the intact glenoid in the En-face view and became flush with the glenoid rim, remodeling to a curved shape congruent to the humeral head in cross-sectional imaging by CT. The shape of the remodeled glenoid at last follow-up was not significantly different from that at 24 months after operation. CONCLUSION:The lateral placement of the bone graft during modified arthroscopic Latarjet surgery with elastic fixation do not accelerate the imaging changes of shoulder joint degeneration.

目的 对比评估双骨道四袢与单骨道双袢固定修复急性肩锁关节RockwoodⅤ型脱位疗效.方法 回顾性分析2010年5月至2016年5月于深圳大学第一附属医院接受关节镜下双骨道四袢与单骨道双袢固定修复急性肩锁关节RockwoodⅤ型脱位的所有患者,其中入选82例手术患者,四袢双骨道组与双袢单骨道组各41例.术后2年内随访观察患者的视觉模拟评分(visual analogue scale,VAS)、患者恢复运动时间、恢复运动患者数量、Constant功能评分、Karlsson肩锁关节功能评分,并通过影像学观察评估喙锁关节和肩锁关节的间隙.结果 术后2年内末次随访X线片显示四袢双骨道组患侧平均喙锁关节和肩锁关节的间隙与双袢单骨道组对比明显减小,且差异具有统计学意义(P<0.05);双袢单骨道组患者健侧平均喙锁关节和肩锁关节的间隙与患侧对比明显减小,且差异具有统计学意义(P<0.05);然而四袢双骨道组患者健侧平均喙锁关节和肩锁关节的间隙与患侧对比差异无统计学意义(P>0.05).两组患者术后末次随访患肢疼痛均有明显减轻,术前与术后VAS评分对比差异具有统计学意义,两组组间对比差异无统计学意义.四袢双骨道组重返运动的时间较双袢单骨道组明显缩短,重返患者数目明显多于双袢单骨道组,且Constant功能评分、Karlsson肩锁关节功能评分均明显优于双袢单骨道组,差异均具有统计学意义(P<0.05).四袢双骨道组并发症明显少于双袢单骨道组.结论 采用关节镜下双骨道四袢固定治疗Rockwood V型脱位,方法固定可靠,并发症少,较双袢单骨道固定效果更佳,是治疗急性肩锁关节Rockwood V型脱位损伤较好的方法.

背景:类固醇具有强大的抗炎、止吐及镇痛作用而被广泛用于围术期镇痛,有研究表明膝关节置换后膝关节周围注射含类固醇的鸡尾酒镇痛疗法可缓解术后疼痛、改善膝关节活动度及减少相关并发症,但也有研究认为类固醇可增加术后感染、髌腱断裂等风险.因此膝关节周围注射含类固醇鸡尾酒疗法在膝关节置换后镇痛中的安全性和疗效尚存在争议.目的:通过荟萃分析系统评价膝关节置换后运用含类固醇鸡尾酒疗法镇痛的疗效和安全性.方法:检索PubMed/Medline、Cochrane Central Register of Controlled Trials、EMBASE数据库2019年4月前的文献,收集所有膝关节置换后局部运用类固醇镇痛的随机对照试验,筛选出符合条件的文献.由2名研究者分别单独使用Cochrane 5.0风险偏倚评估工具对文献方法学偏倚进行评价,提取文献数据并用Review Manager 5.2软件进行荟萃分析.结果 与结论:①共纳入1 0篇随机对照试验,820例患者;②Meta分析显示:类固醇组术后第1天的目测类比评分低于对照组[MD=-1.52,95％C/(-2.94,-0.10),P=0.04],术后第1,2,3,4,5天的关节活动度高于对照组[MD=1 1.57,95％C/(9.85,13.30),P＜0.000 01;MD=9.03,95％C/(6.67,11.38),P＜0.000 01;MD=5.73,95％CI(0.85,10.60),P=0.02;MD=5.53,95％C/(0.68,10.38),P=0.03;MD=5.90,95％C/(0.87,10.93),P=-0.02],吗啡使用量少于对照组[MD =-7.94,95％C/(-14.35,-1.53),P=-0.02],住院时间短于对照组[MD=-0.98,95％C/(-1.25,-0.71),P＜0.000 01],直腿抬高所需时间短于对照组[MD=0.65,95％C/(-0.86,0.44),P＜0.000 01],术后C-反应蛋白水平低于对照组[WMD=-4.82,95％C/(7.41,2.23),P=0.000 3];两组膝关节KSS评分、并发症发生率比较差异无显著性意义;③结果表明,膝关节置换后关节周围运用含类固醇的鸡尾酒疗法安全有效.

OBJECTIVE:To clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis. METHODS:Ten pairs of shoulder joints from 6-7 months old male pigs were selected. Each pair was randomly divided into screw group and endo-button group. A 25% glenoid defect model was created, and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body. The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group, respectively. The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block, respectively. Then fatigue test was performed to observe whether the graft or internal fixator would failed. During the test, the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison. Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared. RESULTS:There was no tendon tear, bone fracture, and other graft or internal fixation failure in the two groups during the fatigue test. The standard deviation of the relative displacement of the screw group was (0.007 87±0.001 44) mm, and that of the endo-button group was (0.034 88±0.011 10) mm, showing significant difference between the two groups ( t=7.682, P=0.000). The maximum failure load was (265±39) N in screw group and (275±52) N in endo-button group, showing no significant difference between the two groups ( t=1.386, P=0.199). There were 3 ways of failure: rupture at bone graft's tunnel (6/10 from screw group, 3/10 from endo-button group), tendon tear at the cramp (2/10 from screw group, 2/10 from endo-button group), and tendon tear at the internal fixator interface (2/10 from screw group, 5/10 from endo-button group), showing no significant difference between the two groups ( P=0.395). CONCLUSION:Although the endo-button fixation fails to achieve the same strong fixation stability as the screw fixation, its fixation stability can achieve the clinical requirements. The two fixation methods can provide similar fixation strength when being used in Latarjet procedure.

Dear Editor: We had the opportunity to read the article entitled “Arthroscopic Versus Open Broström-Gould Repair for Chronic Ankle Instability” by Woo et al5 and we did so with great interest. The authors compared the clinical outcomes of patients who underwent the arthroscopic versus the open Brostöm-Gould technique, which had also been reported by other investigators in previous studies.6 Moreover, their study stated that the anterior talofibular ligament (ATFL) repair using the arthroscopic BroströmGould technique produced better clinical outcomes than using the open repair technique for the treatment of chronic ankle instability. We appreciate the authors’ efforts. However, we would like to highlight a few points based on our clinical experience and literature search. First, chronic lateral ankle instability frequently coexists with various intra-articular pathological conditions, such as synovitis, impingement, osteophyte, os subfibulare, and osteochondral lesions of the talus (OLTs).3 Some lesions have no significant effect on the functional outcomes after lateral ankle reconstruction. However, OLT is regarded as a significant predictor for poor outcomes after operation.6 Though the authors noted that there was a higher portion of OLTs in the open group compared with the arthroscopic group, detailed characteristics of the OLTs, such as the location and lesion size and pathologic stage, were not reported in the study. In addition, different procedures for the treatment of intra-articular abnormalities may cause a substantial variation in perioperative pain. Therefore, the intraoperative procedures should also be matched and standardized for these patients, as this can significantly alter the studied outcomes. Second, regarding the suture anchors, the authors used 1 anchor for open ATFL repair and 2 anchors for arthroscopic ATFL repair. However, the reason for using 1 or 2 anchors for ligament fixation is not stated in this study. Previously, Feng et al1 and Li et al2 showed that 2-anchor repair of the ATFL produced better functional outcomes when compared with 1-anchor repair. We are wondering if the authors might have insight as to the differences in clinical outcomes between the use of 1 anchor and 2 anchors. Third, this study made a comparison between ATFL repair using open and arthroscopic techniques with respect to visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS), and 36-Item Short-Form Health Survey (SF-36) scores. However, the assessment of some aspects of important value is lacking. While the ankle stability examinations included the stress radiographic varus stress test and the anterior drawer test, the reinjury rate and sports abilities should also be assessed in order to make a more comprehensive comparison since the biomechanical strength of the 1-anchor repair appeared to be lower than that of the 2-anchor repair.4 We respect the great contributions of the authors and would welcome some comments to address the aforementioned issues. This would help to further substantiate the findings of this important clinical study.

BACKGROUND:Some studies have advocated the use of suture-button fixation during the Latarjet procedure to reduce complications associated with screw fixation. However, the sample size of these studies is relatively small, and their follow-up period is short.PURPOSE:To investigate the efficacy of the suture-button Latarjet procedure with at least 3 years of follow-up and remodeling of the coracoid graft.STUDY DESIGN:Case series; Level of evidence, 4.METHODS:A total of 152 patients who underwent the suture-button Latarjet procedure between February 2013 and February 2016 were selected, and 128 patients who met the inclusion criteria were enrolled in this study. Preoperative and postoperative clinical results were assessed. The position and healing condition of the coracoid graft and arthropathy of the glenoid and humeral head were also assessed using radiography and 3-dimensional computed tomography (CT).RESULTS:The mean follow-up time was 40.3 ± 5.8 months. There were 102 patients included in this study. The mean visual analog scale score for pain during motion, the American Shoulder and Elbow Surgeons score, the Rowe score, and the Walch-Duplay score were improved considerably. A total of 100 grafts achieved bone union. The overall absorption rate was 12.6% ± 4.3%. Graft absorption mostly occurred on the edge and outside the "best-fit" circle of the glenoid. A vertical position was achieved in 98 grafts (96% of all cases) immediately postoperatively, with the mean graft midline center at the 4 o'clock position. In the axial view, CT showed that 89 grafts were flush to the glenoid, whereas 2 and 11 grafts were fixed medially and laterally, respectively. In all cases, the bone graft and glenoid tended to extend toward each other to form concentric circles during the remodeling process. During follow-up observations, the height of the 11 grafts that were positioned laterally (ie, above the glenoid level) exhibited a wave-curved change. No arthropathy was observed in any patient.CONCLUSION:Patient outcomes were satisfactory after the modified arthroscopic suture-button Latarjet technique. Graft absorption mostly occurred on the edge and outside the "best-fit" circle of the glenoid. The graft exhibited the phenomenon of ectatic growing when it fused with the glenoid and finally remodeled to a new concentric circle with the humeral head analogous to the original glenoid. Grafts positioned laterally did not cause arthropathy of the joints within the period of the study.

Objective:To observe the changes in acromiaohumeral distance(AHD) in patients undergoing the modified arthroscopic double-button Latarjet procedure for recurrent anterior shoulder dislocation complicated with glenoid bone defect.Methods:A retrospective study was performed of the 52 patients who had undergone the modified arthroscopic double-button Latarjet procedure from October 2014 to October 2016 at Department of Sports Medicine, The First Affiliated Hospital to Shenzhen University for recurrent anterior shoulder dislocation complicated with glenoid bone defect. They were 33 males and 19 females, having 30 left and 22 right shoulders affected. Their ages ranged from 19 to 45 years(mean, 29.6 years). Their glenoid bone defects ranged from 17% to 30%(mean, 23.4%). CT scans were performed on the surgery side to observe the healing and reshaping of the bone grafts and to measure the AHDs of healthy shoulder, immediately, 6, 18 and 36 months after operation. Their American Shoulder and Elbow Surgeons(ASES), Rowe and Walch-Duplay scores were recorded before operation and at the final follow-up for comparison.Results:The follow-up time for this series ranged from 37 to 44 months (mean, 40.6 months). The AHDs at immediate postoperation(9.6 mm ± 0.7 mm), 6 months postoperation(8.6 mm ± 0.9 mm), 18 months postoperation (8.0 cm ± 0.8 cm) and 36 months postoperation(7.9 cm ± 0.8 cm) were significantly wider than the healthy side value (7.8 mm ± 0.8 mm)( P<0.05). The ASES, Rowe and Walch-Duplay scores at the final follow-up (93.9±3.2, 94.5±2.7 and 95.7±3.6) were significantly improved than the preoperative values (67.3±9.1, 40.1±4.2 and 63.5±9.0) ( P<0.05). The final follow-ups observed no symptoms or signs of chronic shoulder pain, rotator cuff injury or acromion impingement. Conclusion:As the AHD becomes wider rather than narrower after arthroscopic double-button Latarjet procedure for recurrent anterior shoulder dislocation complicated with glenoid bone defect, no subsequent rotator cuff injury may happen due to the uplift of the humeral head after the modified arthroscopic double-button Latarjet procedure.

OBJECTIVE:To investigate the effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament (ACL) reconstruction, and summarize the relevant rules to guide the clinic. METHODS:Between August 2016 and December 2016, forty patients underwent arthroscopic ACL reconstruction using hamstring tendon were randomly divided into isokinetic group and control group ( n=20). The two groups of patients underwent staged rehabilitation treatment. The isokinetic group replaced the traditional intervention with the corresponding isokinetic strength training from 3 to 6 months after operation, and the traditional rehabilitation intervention was used in the control group. Finally, 12 cases of isokinetic group and 12 cases of control group with complete follow-up were enrolled in study. There was no significant difference in gender, age, body mass index, side of injury, the interval between injury and operation, and preoperative International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The peak torque (PT) of knee extension and flexion and hamstring quadriceps ratio (H/Q) were measured at 3 months, 6 months, 12 months, and the second-look arthroscopy. The MRI examination was performed at the same time to evaluate graft remodeling. The shape, tension, and degree of vascularization of grafts were observed under arthroscopy. The grafts were harvested and observed by HE staining. RESULTS:The invertal between ACL reconstruction and the second-look arthroscopy was (23.57±3.23) months in isokinetic group and (23.22±3.56) months in control group, showing no significant difference between the two groups ( P>0.05). At the second-look arthroscopy, the IKDC score was 90.45±4.73 in isokinetic group and 89.32±4.54 in control group, showing significant differences when compared with preoperative scores in the two groups ( P<0.05). But there was no significant difference between the two groups ( t=0.868， P=0.404). At 3 months after operation, there was no significant difference in the PT of knee extension and flexion between the two groups ( P>0.05). At 6 months, 12 months, and the second-look arthroscopy, the PT of knee extension and flexion in isokinetic group were higher than those in control group ( P<0.05). The H/Q at 6 months and 12 months were higher in isokinetic group than in control group, and the differences were significant ( P<0.05). There was no significant difference in MRI score between the two groups at 3 months, 6 months, and the second-look arthroscopy ( P>0.05). The MRI score at 12 months was significantly higher in isokinetic group than in control group ( P<0.05). At the second-look arthroscopy, there was no significant difference in the arthroscopic score between the two groups ( P>0.05), and the histological score of the isokinetic group was superior to the control group ( P<0.05). CONCLUSION:On the basis of regular rehabilitation training, using the isokinetic training system to develop a suitable post-surgical isokinetic rehabilitation training program is helpful in early muscle strength recovery, early graft remodeling, and even long-term histological results after ACL reconstruction.

OBJECTIVE:To evaluate the correlation between the Mohawk (MKX) expression level and the collagen fiber diameter of autologous hamstring tendon graft during the stable graft remodeling phase after anterior cruciate ligament (ACL) reconstruction. METHODS:Between January 2018 and August 2018, patients who underwent arth-roscopic single-bundle anatomical ACL reconstruction with autologous hamstring tendons for at least 48 months and also underwent second-look arthroscopy were enrolled in study. During the second-look arthroscopic procedures, ACL graft biopsies were performed from the surface of central part of the ligament. MKX expressions of ACL grafts were analysed by real-time fluorescent quantitative PCR (qRT-PCR). The ultrastructure of collagen fibers of grafts were evaluated by transmission electron microscopy, which included average diameter of collagen fibers (D c), average diameter of large-diameter collagen fibers (D L), average diameter of small-diameter collagen fibers (D S), and large-small collagen fibers ratio (R L/S). The correlation between MKX expression level and graft collagen fiber diameter was calculated. RESULTS:Twenty-six patients met the selection criteria and their ACL graft specimens were enrolled in the study. The interval between ACL reconstruction and second-look arthroscopy was 52-128 months, with an average of 78.6 months. Arthroscopic graft remodeling score was 3-6 (mean, 4.8). There were 17 cases of excellent remodeling and 9 cases of fair remodeling. All ACL grafts showed typical bimodal distributions of both large-diameter collagen fibers and small-diameter collagen fibers, but the ultrastructural characteristics of the graft collagen fibers were different according to different remodeling status under arthroscopy. The D C, D L, D S, and R L/S of the graft specimens were (65.2±9.3) nm, (91.6±10.5) nm, (45.7±8.6) nm, and 0.73±0.12, respectively. The relative expression level of MKX was 1.42±0.11, which was positively linearly correlated with D C, D L, and R L/S, and the correlation coefficient was statistically significant ( r=0.809, P=0.000; r=0.861, P=0.000; r=0.942, P=0.000), while there was no significant correlation between D S and relative expression level of MKX ( r=0.147, P=0.238). Regression analysis showed that the relative expression level of MKX could predict the D C, D L, and R L/S results of the ACL graft specimens ( P<0.05). CONCLUSION:After autologous hamstring tendon grafts stepped into stabilized remodeling phase, MKX expression level could predict the diameter measurement results of collagen fibers and be used as an important evaluation basis for graft collagen anabolic metabolism.

BACKGROUND:As several neurologic and hardware complications have been reported with screw fixation. Suture buttons are used to serve as an alternative to screw fixation to obtain better outcome and to reduce the complication. The purpose of this study was to observe the clinical outcomes and make the radiologic assessment of a modified suture button (MSB) arthroscopic Latarjet procedure.METHODS:A total of ninty-one patients with recurrent shoulder joint dislocation who underwent MSB arthroscopic Latarjet procedure was retrospectively reviewed. Fifty cases identified from the chart review met the inclusion criteria. The clinical outcomes and position of the grafts, glenohumeral degeneration, and graft healing condition were assessed postoperatively in a follow-up with at least one and half of a year.RESULTS:All the fifty patients were satisfied with their clinical outcome. The overall complication rate was 4% in this study. The mean visual analog scale score, the affected shoulder active mobility in Ers(external rotation at the side), Era(external rotation in abduction) decreased significantly; the ASES score, Rowe score, Walch-Duplay score improved significantly. CT scans in the sagittal view showed that grafts in 88% of cases were in good position, grafts in 12% of cases were fixed too superiorly and inferiorly. In the axial view grafts in forty cases were flush with the glenoid rim, ten were considered as too lateral. The ten grafts became remodeled and were more flush with the glenoid rim in the follow-up.CONCLUSIONS:The MSB arthroscopic Latarjet procedure provides excellent outcome with few complications, and no degenerative changes were observed in the follow-up. Moreover, the graft fixed too laterally presented a phenomenon of remodeling and became flush with the glenoid rim over time.

Background During epileptic seizures,a series of injury caused by the fall event as a result of muscle spasms has always been the therapeutic difficulty in clinical practice.From the perspective of orthopaedic doctor,the instability of shoulder joint caused by fall damage is the focus of our attention.It has been reported in literature that the incidence of shoulder dislocation caused by seizures is approximately 0.6％.Considering that a large number of patientsare missed,we believe that the actual incidence rate is much higher than this value.It has been previously thought that the posterior shoulder dislocation caused by strong muscle contraction in the patient with epilepsy is more common.However,the truth is that the proportion of patient with anterior shoulder dislocation is not low,and it is even reported that the incidence rates of anterior and posterior shoulder dislocationsare 50％ and 50％ respectively.Currently,there are many surgical methods for the treatment of anterior shoulder dislocation including soft tissue repair surgery and bone repair surgery.Among them,the Latarjet procedure in bone repair surgery is the most widely applied technique.Objective To explore the clinical efficacy of modified arthroscopic double-Endobutton Latarjet procedure for the treatment of recurrent anterior shoulder dislocation in epileptics.Methods From October 2014 to October 2016,a total of 9 epileptics (9 shoulder joints) suffered from anterior shoulder dislocation with severe bone defect received the modified arthroscopic double-Endobutton Latarjet procedure in our hospital.The mean age was (26.3 ± 3.1) years old.All patients received anti-epileptic treatment for over half of a year before surgery,and the anti-epileptic treatment was continued for 1 year after operation.Immediate postoperative CT scan was performed to detect bone graft position.Then,CT scan was performed at the 3rd,6th,12th,and 24th months to evaluate the status ofbone graft absorption and union.The ASES score,Rowe score and Walch-Duplay score were recorded during each follow-up to assess patients' shoulder function.Results Eight patients were followed up for anaverage of (20.1 ± 4.2) months,while 1 patient ofright shoulder was lostfor follow-up.Three patients had recurrent epilepsy 2 months,6 months and 8 months after operation respectively due to absence of taking medicine.Among them,1 case was lost for follow-up atthe 6th postoperative month,and the remaining 2 patients with recurrence showed a significant displacement of bone graft and then healed again after conservative treatment.A total of 7 patients received complete follow-up,and the bone grafts healedduring the last followup.Six patients returned to competitive exercise,and 2 patients returned to normal life without complaint of shoulder joint instability.The CT scans showed significant difference of bone graft plasticity.The bone absorption rate in 4 cases was between 5％ and 75％.Three cases had the area expanded compared to the original state,and 1 case had no obvious change.Before operation and during the last followup:the mean ASES scoreswere (76.75 ± 7.41) points and (94.68 ± 5.02) points respectively (P ＜ 0.05);the mean Rowe scores were (43.75 ± 5.82) points and (93.13 ± 5.30) points respectively (P ＜ 0.05);the mean Walch-Duplay scores were (76.13 ± 6.98) points and (93.00 ± 2.00) points respectively (P ＜ 0.05).Conclusion The modified arthroscopic double-Endobutton Latarjet procedure has a good short-term clinical effect on epileptics with anterior shoulder dislocation,and this technique has the potential of reunion after recurrence.The patient satisfaction is high,and this technique is worth of promotion and application.However,weshould pay more attention to the postoperative control of epileptic seizure and the prevention of epilepsy recurrence to avoidoperation failure and recurrent shoulder dislocation.

目的 采用生物力学方法对比Ⅰ型及Ⅱ型距下关节制动器治疗Ⅱa期成人获得性平足(AAF)的效果差异.方法 收集1例Ⅱa期AAF志愿者中立位扫描CT数据,拍摄单足负重正侧位X线片,应用Mimics、Geomagic、Solidwork等软件建立具有韧带软组织的Ⅱa期AAF三维有限元模型,在Abaqus软件中分别将合适型号的Ⅰ型及Ⅱ型距下关节制动器植入跗骨窦,于小腿上端加载单倍体重,对比分析未植入及植入Ⅰ型、Ⅱ型制动器AAF负重模型足底、足内外侧柱各骨块和内侧韧带及软组织的应力分布,以及距骨第一跖骨角、跟骨倾斜角、距舟覆盖角及足弓高度等参数的变化.结果 未植入及植入Ⅰ型、Ⅱ型制动器模型足底应力最大值均出现在第一跖骨头下,分别为111.5、109.6和108.7 kPa.与未植入模型比较,植入制动器模型足内侧柱骨块最大应力值均有降低(Ⅱ型制动器植入模型降低更明显),第五跖骨应力峰值明显增加,内侧支撑韧带和软组织最大应力值下降;距骨第一跖骨角、跟骨倾斜角、距舟覆盖角有所改善,足弓高度明显恢复,其中Ⅱ型制动器矫正效果更好.结论 Ⅰ型及Ⅱ型距下关节制动器均可有效地将Ⅱa期AAF内侧跖列的压力转移至外侧并稳定足弓,Ⅱ型制动器矫形效果优于Ⅰ型.