The tendon-bone junction (TBJ), a critical transitional zone where tendons and bones connect, is particularly prone to injury due to the forces from muscle contractions and skeletal movements. Once tendon-bone injuries occur, the complex original tissue structure is difficult to restore, increasing the risk of re-tear. In this study, we initially established a rabbit model of tendon-bone injury and treated it using either interference screw or suture anchor. Biomechanical testing demonstrated the maximum tension and strength of TBJ with interference screw fixation were superior. However, histologic and immunohistochemical results showed more tissue regeneration and expression of cartilage markers at the site of injury with suture anchor fixation. Moreover, Gelatin Methacryloyl encapsulated with exosomes from mesenchymal stem cell (GelMA-exosomes) were prepared, showing a consistent and stable exosome release characteristic. The combined application of GelMA-exosomes with either interference screws or suture anchors further enhanced the healing of tendon-bone injuries, which may be achieved by promoting cellular proliferation as well as regulating the decreased expression of local pro-inflammatory factors IL-1β, IL-6 and TNF-α and increased expression of anti-inflammatory factors IL-10 and TGF-β. This provides a viable therapeutic strategy to enhance tendon-bone healing.

Purpose To compare the clinical efficacy and complication rates between the medial midline and anterolateral portals in ankle arthroscopy for treating medial osteochondral lesions of the talus (OLTs). Methods We retrospectively analyzed patients with medial OLTs who underwent either a dual medial approach (via the medial midline and anteromedial portal) or a traditional approach (via the anterolateral and anteromedial portal) between June 2017 and January 2023. The degree of injury was evaluated by radiographs, computed tomography, and magnetic resonance imaging. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The incidence of postoperative complications, including superficial peroneal nerve (SPN) injury, was evaluated in all patients. Results There were 39 patients in total; 16 patients underwent the dual medial approach, and 23 patients underwent the traditional approach. The mean age was 39.4 ± 9.0 years, and the mean follow-up duration was 18.7 ± 6.4 months. The clinical outcomes improved significantly in both groups (* P < 0.05), but there was no significant difference between the two groups ( P > 0.05). Postoperative complications were mainly SPN injury. The incidence of SPN injury was 13.0% in the traditional approach group and 0% in the dual medial approach group, with no significant difference between the two groups ( P > 0.05), but a trend of reduction in SPN injury was observed in the dual medial approach group. Conclusion The dual medial approach can also treat medial OLTs well, providing clear visualization and more convenient operation and reducing the possibility of injury to the SPN compared with the traditional approach. Therefore, we consider that the MM portal would be a good alternative to the anterolateral portal in treating medial OLTs.

Cartilage damage is a common orthopedic disease, which can be caused by sports injury, obesity, joint wear, and aging, and cannot be repaired by itself. Surgical autologous osteochondral grafting is often required in deep osteochondral lesions to avoid the later progression of osteoarthritis. In this study, we fabricated a gelatin methacryloyl-marrow mesenchymal stem cells (GelMA-MSCs) scaffold by three-dimensional (3D) bioprinting. This bioink is capable of fast gel photocuring and spontaneous covalent cross-linking, which can maintain high viability of MSCs and provide a benign microenvironment to promote the interaction, migration, and proliferation of cells. In vivo experiments, further, proved that the 3D bioprinting scaffold can promote the regeneration of cartilage collagen fibers and have a remarkable effect on cartilage repair of rabbit cartilage injury model, which may represent a general and versatile strategy for precise engineering of cartilage regeneration system.

In clinical studies, we discovered that when using headless cannulated compression screw fixation, many patients complain of heel pain and frequently need to have the screws removed, whereas this occurrence is uncommon with plate fixation. This study aims to compare the clinical outcome of a mini T-plate and headless cannulated compression screws in calcaneal osteotomy. We reviewed the medical records of patients who had calcaneal osteotomy performed by one senior chief surgeon in our hospital between January 2014 and May 2021. Thirty-nine patients met the selection criteria: 22 were fixed using a mini T-plate through a modified small “L” incision on the lateral aspect of the calcaneus and 17 were fixed using double screws through an oblique incision on the lateral aspect of the calcaneus. Then, we compared the patient demographics, surgical statistics, and postoperative complications in calcaneal osteotomy between a mini T-plate and double 6.5-mm headless cannulated compressed screws. Each patient attained radiographic union. The average age was 49.23±13.80 (range: 24–76) years and the average follow-up duration was 47.07±8.64 (range: 36–66) weeks. The average operation duration and times of intraoperative fluoroscopy were significantly lower in the mini T-plate group (P<0.05). There was a savings of $838.88 per patient when using double screws for fixation. The incidence of hardware-related pain and implant removal was lower in the mini T-plate group (P<0.05). There is no significant difference between the two groups in terms of delayed incision healing and clinical neurological complications (P>0.05). In calcaneal osteotomy, the operation duration, times of intraoperative fluoroscopy, hardware-related pain, and implant removal rate were lower with mini T-plate fixation than with double screws fixation. Therefore, we consider that the mini T-plate would be a good alternative to double screws in calcaneal osteotomy.

[目的]介绍改良外侧"L"切口锁定钢板固定跟骨截骨术的手术技术和初步临床效果.[方法]2019年1月-2021年10月对21例患者采用改良外侧"L"切口锁定钢板固定跟骨截骨术矫正跟骨内外翻畸形.于跟骨外侧做改良的"L"切口,切口拐角呈钝角,切口的垂直线和水平线分别位于外踝尖到跟腱外缘和跟骨下缘的2/3.显露跟骨外侧壁,行跟骨截骨,根据需要对跟骨进行推移,恢复下肢力线.摆锯磨平推移时产生的台阶,用锁定钢板进行固定.术后石膏固定3周,6周时开始下肢功能锻炼.[结果]所有患者均顺利完成手术,无严重并发症.截骨手术时间平均(15.0±2.7)min.随访时间平均(8.5±1.3)个月,跟骨截骨临床愈合时间平均(4.9±0.8)周.末次随访时,AOFAS评分较术前显著增加[(85.2±4.6)分vs(34.6±7.0)分,P＜0.05],VAS评分较术前显著减少[(2.1±1.0)分vs(7.9±0.9)分,P＜0.05].[结论]改良外侧"L"切口锁定钢板固定跟骨截骨术便于操作,临床效果满意.

跗骨联合是可引起足部疼痛及关节炎的疾病,最常见的类型为跟距联合及跟舟联合.病史的询问、详细的查体、全面的影像学检查相结合最有利于跗骨联合的诊断,保守治疗可有效缓解症状,保守治疗失败者可予以手术治疗.随着临床医生的重视和医疗技术的发展,诊断更加全面,治疗也逐渐追求精细化.本文从跗骨联合的病因、流行病学、临床表现、辅助检查、治疗方法的现状等方面进行总结综述,期望为后续诊断与治疗方案的选择提供参考.

目的 探讨跟骨前突骨折的诊断及治疗效果.方法 回顾性分析苏州大学附属第一医院2018年6月—2020年10月收治的12例跟骨前突骨折患者.对急性撕脱性跟骨前突骨折患者予以膝下短腿石膏固定4～6周,拆除石膏后适当负重,并逐渐进行康复训练;对于漏诊的负重时跗骨窦区域长期疼痛的跟骨前突骨折患者予以类固醇激素局部注射,保守治疗无效者予以手术治疗,手术治疗包括撕脱骨块切除、骨赘清理、关节面微骨折术或跟骰骨关节融合术;对于急性粉碎性跟骨前突骨折的患者行植骨、加压螺钉固定或微钢板内固定.采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分、视觉模拟评分(visual analogue scale,VAS)对治疗前后足部功能及疼痛情况进行评价.结果 12例均获得随访,随访时间为21.3(7～31)个月,所有保守治疗的患者无骨折不愈合发生,采取手术治疗的患者无畸形、内固定相关并发症和创伤性关节炎发生,AOFAS踝-后足评分由治疗前的(21.7±7.5)分提高至末次随访时的(88.5±7.0)分,VAS评分由治疗前的(7.9±0.9)分改善至末次随访时的(0.6±0.76)分.结论 完善的体格检查、合理的影像学资料及早期准确的诊断,可有效防止漏诊误诊,选择正确、合理的治疗方式是跟骨前突骨折患者获得满意疗效的关键,同时也要重视术后康复训练.