ObjectiveTo summarize the application status and progress of platelet-rich plasma (PRP) in clinical orthopedics. MethodsThe recent related literature concerning the application of PRP in clinical orthopedics was extensively reviewed and analyzed. ResultsRecently, a large number of clinical studies on PRP have been carried out, which are applied in bone defects or nonunion, spinal fusion, osteoarthritis and cartilage injuries, ligament reconstruction, muscle strain, tendon terminal diseases, and a variety of acute and chronic soft tissue injuries. Some results show certain effectiveness, while others demonstrate invalid. ConclusionEasily drawing, achieving autologous transplantation, and the biological repair potential of the musculoskeletal tissues make PRP to be widely used in clinical orthopedics. However, there are still no uniform standards accepted and reliable clinical guidelines about the application of PRP. Furthermore, a variety of PRP products and their respective indications are also different. The clinical evidences with the greater sample size and higher quality are still needed to further support the safety and effectiveness of PRP in clinical orthopedics.
ObjectiveTo review the research progress of the preparation and components of the platelet rich plasma (PRP). MethodsThe recent literature concerning the biological mechanism, preparation, and components of PRP was analyzed and summarized. ResultsThe biological function of PRP depends on a series of intricate cascade of cellular and molecular events. PRP contains different concentrations of platelets, which would release a large number of the activated molecules, and also contains a small amount of white blood cells and red blood cells. The preparation of PRP is based on platelet concentration. Different preparation techniques would lead to different platelet concentrations, recovery ratios, and components. ConclusionThere is no uniform standard for the preparation of PRP. Different preparation methods and technical parameters of PRP will get different components and different concentrations of PRP, which also provide a reference for cl inicians to select the most appropriate PRP for individual patient.
ObjectiveTo investigate the effectiveness of arthroscopic treatment of pigmented villonodular synovitis (PVNS) of the ankle. MethodsTwelve patients who were initially diagnosed as having PVNS of the ankle were treated between January 2005 and May 2012.There were 6 males and 6 females,aged 20-50 years (mean,35.4 years).Disease duration ranged from 6 months to 12 years (median,3.6 years).One case of recurrence was included.The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 55.5±7.6.According to degree and range of the PVNS lesions,4 cases of local PVNS were treated with arthroscopic debridement,and 8 cases of diffuse PVNS were treated with arthroscopically assisted arthrotomy;and local radiotherapy was given in all patients after operation. ResultsPrimary healing of incision was obtained in all patients.The mean follow-up time was 2.8 years (range,1-6 years).At 12 months after operation,no obvious pain,swelling,and limited range of motion of the ankle were observed.The AOFAS score was increased to 84.3±3.4 at 12 months,and it was significantly higher than that at preoperation (P<0.05) and at 3 months after operation (82.8±3.8)(P<0.05).There was no recurrence during follow-up. ConclusionArthroscopic arthrotomy combined with postoperative radiotherapy are recommended for PVNS of the ankle according to the PVNS lesion degree and range.And arthroscopically assisted surgery has many advantages of less traumas and hemorrhage,fast recovery,and less complications.
ObjectiveTo summarize the application status and progress of the strategies to augment tendon-to-bone healing. MethodsThe present researches focused on augmentation of tendon-to-bone healing were extensively reviewed. ResultsThe present strategies to augment healing of tendon-to-bone by enhancing the location environment, and increasing the cell numbers and relative growth factor. The mainly strategies include using calcium phosphate materials, biocompatible scaffolds and glue, growth factors, cell matrix, platelet-rich plasma, and periosteum. Although periosteum have been used in clinical and got some possitive effects, the others still not be used in clinical and needs further studies. ConclusionThere are many strategies to enhance the ability of tendon-to-bone healing, which got some positive results, but results of studies were varied. Thus, further fundamental research and clinical studies are required to achieve the best effects.
ObjectiveTo detect the metabolites of the serum and joint fluid from rabbits’ osteoarthritis model with 1H nuclear magnetic resonance spectroscopy (NMR) technique, study the metabolic differences and connections of serum, synovial and cartilage of rabbits after the articular cavity injection of sodium hyaluronate, and explore osteoarthritis and metabolic mechanism in the process of treating sodium hyaluronate using sodium hyaluronate, thus provide new ideas and basis of the specific mechanisms in the treatment of osteoarthritis via sodium hyaluronate.MethodsWe selected 30 healthy New Zealand white rabbits, 6 months old, and randomly divided them into three groups as follows: blank control group, model phosphate buffer saline (PBS) liquid injection group and model injection of sodium hyaluronate group, with 10 rabbits in each group. Ten weeks after surgery, all experimental animals were put to death and observed in correlation studies regarding general condition, imaging examination, and histological examination. Metabolites 1H NMR detection and data preprocessing were performed in the serum and joint fluid samples.ResultsThe results considering general condition, general sample observation, imaging examination and histology indicated advantages in sodium hyaluronate group over PBS group. Metabolomics analysis showed statistically significant changes of metabolites in the serum and joint fluid compared with the PBS group and the blank control group (P<0.05). According to the relevant ways of differences metabolites retrieval, analysis found that the effect of sodium hyaluronate on osteoarthritis might be related to protein biosynthesis, amino acid circulation, the metabolic process of pyruvic acid, gluconeogenesis and other metabolic pathways.ConclusionsBased on the research of 1H-NMR metabolomics, the results suggest that the effect of sodium hyaluronate on osteoarthritis is mainly related with the activation of protein metabolism, abnormal lipid and energy metabolic pathways. This study provides new ideas and basis on the concrete mechanism in the treatment of knee osteoarthritis using sodium hyaluronate.
ObjectiveTo review the current status and progress of sterilization and preservation for allograft in anterior cruciate ligament reconstruction.MethodsThe related literature about the sterilization and preservation of allografts in anterior cruciate ligament reconstruction was extensively reviewed and summarized.ResultsThere are many sterilization methods for allografts, the most commonly used method is γ-ray irradiation, but the optimal irradiation dose is still unclear. Electron beam irradiation is also available, but excessive dose is harmful to graft shaping. A combined sterilization method combining physics and chemistry methods is still being explored. Cryopreservation is the most commonly used method of preservation. In order to reduce the influence of crystals, the principle of " slow cooling and rapid rewarming” should be adhered to as far as possible.ConclusionThe processing methods of allograft can affect the effectiveness of anterior cruciate ligament reconstruction. The clinical doctors should consider the sterilization and preservation methods in practice.
ObjectiveTo systematically review the progress of different methods for femoral tunnel positioning in anterior cruciate ligament (ACL) reconstruction and provide a clinical reference for treatment of ACL rupture.MethodsThe literature about the femoral tunnel positioning in ACL reconstruction was widely reviewed. The advantages and disadvantages and the clinical results of each method were summarized.ResultsCurrently in ACL reconstruction, methods for femoral tunnel positioning include transtibial technique (TT), anteromedial technique (AM), outside-in (OI), modified TT (mTT), and computer assisted surgery. There is no significant difference in the postoperative effectiveness between TT technique and AM technique. Compared with the TT technique, the OI technique has higher rotational stability of knee, but there is no significant difference in clinical results. The femoral tunnel located by mTT technique is closer to the anatomical placement than that of TT technique, but mTT technique is not effective for systematically anatomic femoral tunnel positioning, and further research is needed to prove its advantages.ConclusionDifferent femoral tunnel positioning methods have their own advantages and disadvantages, and there is no definite evidence that one is superior than the rest.
ObjectiveTo summarize the diagnosis and treatment progress in the femoral insertion injury of the medial collateral ligament (MCL) of knee, and to provide a clinical reference for diagnosis and treatment. MethodsThe literature on the femoral insertion injury of the MCL of knee was widely reviewed. The incidence, mechanisms of injury and anatomy, the diagnosis and classification, and status of treatment were summarized. ResultsThe mechanism of the femoral insertion injury of the MCL of knee is related to its anatomical and histological characteristics, as well as the abnormal valgus of the knee joint, excessive external rotation of the tibial platform and it is classified according to the injury characteristics to guide the refined and individualized clinical treatment. ConclusionDue to different understanding of femoral insertion injury of MCL of knee, the treatment methods are different, and thus is the healing effect. Additional studies are still needed to promote the healing of insertion injuries.
ObjectiveTo investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction. Methods A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups (P>0.05). However, the proportion of female in the injured group was significantly higher than that of male (P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group (P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values. ResultsUnivariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury (P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury (P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] (χ2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years](χ2=302.479, P<0.001). ConclusionFemale and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.
ObjectiveTo review the bioactive strategies that enhance tendon graft healing after anterior cruciate ligament reconstruction (ACLR), and to provide insights for improving the therapeutic outcomes of ACLR. Methods The domestic and foreign literature related to the bioactive strategies for promoting the healing of tendon grafts after ACLR was extensively reviewed and summarized. ResultsAt present, there are several kinds of bioactive materials related to tendon graft healing after ACLR: growth factors, cells, biodegradable implants/tissue derivatives. By constructing a complex interface simulating the matrix, environment, and regulatory factors required for the growth of native anterior cruciate ligament (ACL), the growth of transplanted tendons is regulated at different levels, thus promoting the healing of tendon grafts. Although the effectiveness of ACLR has been significantly improved in most studies, most of them are still limited to the early stage of animal experiments, and there is still a long way to go from the real clinical promotion. In addition, limited by the current preparation technology, the bionics of the interface still stays at the micron and millimeter level, and tends to be morphological bionics, and the research on the signal mechanism pathway is still insufficient.ConclusionWith the further study of ACL anatomy, development, and the improvement of preparation technology, the research of bioactive strategies to promote the healing of tendon grafts after ACLR is expected to be further promoted.