BACKGROUND Anterior cruciate ligament(ACL)reconstruction using bone-patellar tendon-bone(BPTB)autografts remains the gold standard for young,active individuals due to its superior biomechanical strength and bone-to-bo...BACKGROUND Anterior cruciate ligament(ACL)reconstruction using bone-patellar tendon-bone(BPTB)autografts remains the gold standard for young,active individuals due to its superior biomechanical strength and bone-to-bone healing.However,donor site morbidity,particularly anterior knee pain(AKP),limits its utilization despite its advantages.Various techniques have been proposed to reduce AKP,but they show variable outcomes and several limitations.AIM To assess the incidence and severity of AKP following BPTB ACL reconstruction using an autologous bone grafting technique.METHODS We conducted a retrospective observational study of 24 patients aged 20-45 years,who had primary ACL reconstruction with BPTB grafts.During surgery,autologous cancellous bone generated from tunnel drilling was used to fill the patellar and tibial donor site voids after graft fixation.All patients were followed up for at least twelve months.Using the Kujala Anterior Knee Pain Score,clinical outcomes were evaluated,including the pain-specific subcomponent.RESULTS With scores ranging from 86 to 100,the average overall Kujala score was 95.67±4.01.No patient scored below 85.There was no complication such as patellar fracture,tibial tuberosity fracture,or infection.Grouped data showed 20.8%of patients scored 100,whereas 54.2%scored between 95 and 99,and 25%scored between 86 and 94.One patient(4.2%)had an 8/10 pain subcomponent,whereas 23 patients(95.8%)had a 10/10.CONCLUSION This procedure is easy to incorporate into routine surgical practice,cost-effective and reproducible without requiring extra incisions or raising the patient’s surgical expenses.Excellent short-term results back up this technique.展开更多
Mechanical stress modulates bone formation and organization of the extracellular matrix(ECM),the interaction of which affects heterotopic ossification(HO).However,the mechanically sensitive cell populations in HO and ...Mechanical stress modulates bone formation and organization of the extracellular matrix(ECM),the interaction of which affects heterotopic ossification(HO).However,the mechanically sensitive cell populations in HO and the underlying mechanism remain elusive.Here,we show that the mechanical protein Polysyctin-1(PC1,Pkd1)regulates CTSK lineage tendon-derived mesenchymal stem cell(TDMSC)fate and ECM organization,thus affecting HO progression.First,we revealed that CTSK lineage TDMSCs are the major source of osteoblasts and fibroblasts in HO and are responsive to mechanical cues via single-cell RNA sequencing analysis and experiments with a lineage tracing mouse model.Moreover,we showed that PC1 mediates the mechanosignal transduction of CTSK lineage TDMSCs to regulate osteogenic and fibrogenic differentiation and alters the ECM architecture by facilitating TAZ nuclear translocation.Conditional gene depletion of Pkd1 or Taz in CTSK lineage cells and pharmaceutical intervention in the PC1-TAZ axis disrupt osteogenesis,fibrogenesis and ECM organization,and consequently attenuate HO progression.These findings suggest that mechanically sensitive CTSK-lineage TDMSCs contribute to heterotopic ossification through PC1-TAZ signaling axis mediated cell fate determination and ECM organization.展开更多
BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of t...BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.展开更多
Tendon adhesion,a prevalent complication affecting over 30%of patients after a tendon injury or surgery,results in joint stiffness and impaired mobility.Although current treatments facilitate tendon repair,they are of...Tendon adhesion,a prevalent complication affecting over 30%of patients after a tendon injury or surgery,results in joint stiffness and impaired mobility.Although current treatments facilitate tendon repair,they are often insufficient in preventing adhesions and promoting optimal healing outcomes.To address these challenges,we developed an oriented cryostructured silk fibroin bandage(OCSFB)using the directional freeze-casting methodology.In vitro studies demonstrated that OCSFB provided a favorable microenvironment for cell viability,proliferation,and alignment,concurrently upregulating the expression of tendon-specific genes.In a rat Achilles tendon model,OCSFB significantly reduced adhesion formation and improved tendon healing.RNA-seq analysis further revealed modulation of cell adhesion molecules,substantiating its role in tissue regeneration.The integration of silk fibroin biocompatibility with a unique microstructure that facilitates cellular adhesion and proliferation renders OCSFB a promising approach for mitigating tendon adhesions and improving repair outcomes,establishing it as a robust candidate for clinical application.展开更多
BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during ...BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during transfer.However,median nerve neuropathy has not been reported yet.We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.CASE SUMMARY A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer.He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique.FPL function loss was due to adhesion resulting from repeated surgery of radius shaft.He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago.During surgery,FPL muscle was severely adhered and indistinguishable.However,tendon continuity remained intact.After tendon transfer,he experienced paresthesia along median nerve distribution upon movement of thumb.He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots.Exploration was then performed.The median nerve was irritated by suture knots of transferred tendon.Thus,knots were removed.Twelve months later,he demonstrated thumb flexion of 80°.Additionally,median nerve neuropathy symptoms fully resolved.CONCLUSION Median nerve neuropathy can occur after tendon transfer from irritation of suture knots.Covering knots using surrounding tissue is recommended.展开更多
This article offers additional clinical and biomechanical insights into using the peroneus longus tendon(PLT)autograft in posterior cruciate ligament recon-struction.While recent studies report favorable knee outcomes...This article offers additional clinical and biomechanical insights into using the peroneus longus tendon(PLT)autograft in posterior cruciate ligament recon-struction.While recent studies report favorable knee outcomes,concerns remain regarding donor site morbidity.The PLT plays a key role in foot biomechanics,and its harvesting may lead to subtle changes,as suggested by imaging and pe-dobarographic studies.Tendon regeneration may limit long-term morbidity,but further studies are needed.We recommend that future research include gait analysis,long-term follow-up,and insights from anterior cruciate ligament li-terature.展开更多
BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mi...BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mid-to-long-term clinical outcomes following the double-row repair method for massive rotator cuff tears.METHODS This retrospective analysis included data from 53 patients with massive rotator cuff tears treated at our hospital between 2020 and 2021.The patients were divided into the double-row repair group(conventional group)and the doublerow repair combined with the LHBT transposition group(transposition group).Postoperative pain was assessed using the visual analogue scale at one week,one year,and the final follow-up.Shoulder function was evaluated using the American Shoulder and Elbow Surgeons and Constant-Murley scores at one year and the final follow-up.Rotator cuff healing was assessed postoperatively for one year using the Sugaya classification,which categorizes tendon integrity based on magnetic resonance imaging findings.RESULTS No perioperative complications were observed in any of the patients at any time.There were no significant differences between the groups regarding operative time and intraoperative blood loss.The transposition group had significantly lower visual analogue scale scores than the conventional group at one week postoperatively;however,there were no significant differences between the groups at one year or the final follow-up.At one year postoperatively,the transposition group showed significantly higher American Shoulder and Elbow Surgeons and Constant-Murley scores than the conventional group;no significant differences were observed at the final followup.There were no significant differences in rotator cuff healing between the groups at one year postoperatively.CONCLUSION Compared to double-row repair alone,double-row repair combined with LHBT transposition for treating massive rotator cuff tears more effectively alleviates short-term postoperative pain and improves shoulder function within the first year.展开更多
Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent appr...Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent approaches favor early active mobilization with strong,multi-stranded core sutures to enhance outcomes.This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting.Methods:In this prospective study,143 tendons from 30 patients who underwent surgery were followed up.The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture,providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs,thereby reducing operative time without increasing bulk.Early active mobilization was initiated on postoperative day 2.The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group,which enabled real-time guidance and compliance monitoring.The outcomes were measured in terms of total active motion,grip strength,pinch strength,time to return to work,postoperative pain,and complications.Results:Of the 30 patients,28(93.3%)had fair-to-excellent outcomes,whereas only 2(6.7%)had poor outcomes.Most patients(93.3%)returned to work within 12 weeks postoperatively.Four(13.3%)patients had complications,such as wound infection and skin necrosis.The patients showed significant changes in grip strength(45.2%)and pinch strength(70.7%)between weeks 8 and 12.No tendon ruptures were observed.Conclusion:The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization,which began on the second day after surgery,resulting in fair-to-excellent outcomes.It supports digitally supervised physiotherapy through app-based monitoring,enhancing patient compliance,and reducing reliance on in-person therapy sessions.This combination led to excellent functional recovery with minimal complications.展开更多
The tension leg platform is a typical compliant platform that is connected to the seabed through tension leg tendons.However,it is hard to characterize tension leg tendons due to the complexity of their force and moti...The tension leg platform is a typical compliant platform that is connected to the seabed through tension leg tendons.However,it is hard to characterize tension leg tendons due to the complexity of their force and motions as well as the lack of full-scale test methods.We performed a finite element analysis and full-scale four-point bending fatigue tests on tension leg tendons and connectors to study the fatigue properties of the tension leg tendons(made using 36in-X70 steel pipes)used in the Gulf of Mexico.The maximum deflection and the maximum stress of samples under complex loading were estimated through finite element simulation to ensure the testing requirements,including load intensity,load method,load path,and frequency.The maximum equivalent strain and the corresponding position were then determined through testing,which were further compared with simulation results to verify their accuracy and applicability.The maximum strain amplitude from simulations was 761.42με,while the equivalent strain amplitude obtained through tests was 734.90με,which is close to the simulation result.In addition,when the number of fatigue cycles reached 1.055 million,sample damage did not occur.It confirms that the fatigue performance of the tendon steel pipe weld is better than the C1 curve value shown in the DNV RP C203 specification.The proposed full-scale approach to study the fatigue properties of tension leg tendons can provide a reference for domestic engineering design and manufacture of tension leg tendons as well as promote the localization of test equipment.展开更多
BACKGROUND Fibro-adipogenic progenitors(FAPs)are a group of mesenchymal stem cells that cause fibro-fatty degeneration in skeletal muscle in various chronic disease mode-ls.FAPs also play a role in preventing muscle d...BACKGROUND Fibro-adipogenic progenitors(FAPs)are a group of mesenchymal stem cells that cause fibro-fatty degeneration in skeletal muscle in various chronic disease mode-ls.FAPs also play a role in preventing muscle degeneration at acute stages during disease progression.However,few studies have reported the changes in and function of FAPs in the acute phase after tendon rupture.AIM To clarify the changes in the number of FAPs and their impact on skeletal muscle soon after tendon rupture to facilitate future studies targeting FAPs to treat muscle degeneration.METHODS We utilized Pdgfra-H2B::eGFP mice to trace and quantify FAPs in a tibialis anterior tenotomy(TAT)model at 0 and 3 days,1 week,2 weeks,3 weeks,4 weeks,5 weeks,and 6 weeks post-injury,and the results were further validated using fluorescence-activated cell sorting analysis with C57BL/6 mice at the same post-injury timepoints.We subsequently used PdgfraCreERT::RosaDTA mice,and evaluated the severity of post-TAT skeletal muscle degeneration with or without FAP-depletion.RESULTS The number of FAPs peaked at 1 week post-TAT before gradually declining to a level comparable to that pre-TAT.The change in the number of FAPs was potentially temporally correlated with the progression of skeletal muscle degeneration after TAT.FAP-depletion led to more severe degeneration early after TAT,indicating that FAPs potentially alleviate muscle degeneration after tendon rupture in the early post-injury phase.CONCLUSION FAPs potentially alleviate the degeneration of skeletal muscle in the acute stage after tendon rupture.展开更多
Bimodal pressure sensors capable of simultaneously detecting static and dynamic forces are essential to medical detection and bio-robotics.However,conventional pressure sensors typically integrate multiple operating m...Bimodal pressure sensors capable of simultaneously detecting static and dynamic forces are essential to medical detection and bio-robotics.However,conventional pressure sensors typically integrate multiple operating mechanisms to achieve bimodal detection,leading to complex device architectures and challenges in signal decoupling.In this work,we address these limitations by leveraging the unique piezotronic effect of Y-ion-doped ZnO to develop a bimodal piezotronic sensor(BPS)with a simplified structure and enhanced sensitivity.Through a combination of finite element simulations and experimental validation,we demonstrate that the BPS can effectively monitor both dynamic and static forces,achieving an on/off ratio of 1029,a gauge factor of 23,439 and a static force response duration of up to 600 s,significantly outperforming the performance of conventional piezoelectric sensors.As a proof-of-concept,the BPS demonstrates the continuous monitoring of Achilles tendon behavior under mixed dynamic and static loading conditions.Aided by deep learning algorithms,the system achieves 96%accuracy in identifying Achilles tendon movement patterns,thus enabling warnings for dangerous movements.This work provides a viable strategy for bimodal force monitoring,highlighting its potential in wearable electronics.展开更多
BACKGROUND Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior s...BACKGROUND Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare.Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.CASE SUMMARY A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident.He reported that he braced his fall with his right hand.Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss.Six days after the injury,the patient exhibited pseudoparalysis and active forward flexion limited to 10°.Two weeks after the injury,magnetic resonance imaging revealed complete tears of the supraspinatus,infraspinatus,and subscapularis muscles as well as dislocation of the long head of the biceps tendon.Arthroscopic rotator cuff repair was performed 6 weeks after injury.The tendon quality was acceptable with minimal fatty infiltration.At the 12-month surgical follow-up,the patient had recovered full strength and complete range of motion.CONCLUSION Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.展开更多
BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;ho...BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;however,the absence of the PCL results in abnormal knee kinematics,which may cause injuries to other ligaments.The ideal tendon source for PCL reconstruction is still a subject of debate.AIM To evaluate the results of employing the peroneus longus tendon(PLT)in PCL reconstruction.METHODS A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction.Studies published up to August 2024 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included five studies on PLT use for PCL reconstruction:(1)Four prospective studies with 104 patients;and(2)One retrospective study with 18 patients.Most studies followed up participants for 24 months,while one had a shorter follow-up of 18 months.Lysholm and modified cincinnati scores improved by pooled means of 32.2(95%CI:29.3-35.1,I2=0%)and 31.1(95%CI:27.98-34.22,I2=0%),respectively.Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5(I2=61.5%)and 94.5(I2=80.09%),respectively.Single-hop and triple-hop test scores averaged 95.5(95%CI:94.5-96.5)and 92.4(95%CI:91.9-92.9)respectively.No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.CONCLUSION Evidence supports PLT autografts for PCL reconstruction,improving knee function and patient outcomes.Larger randomized trials are needed to confirm efficacy and compare graft options.展开更多
Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early Achilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types of...Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early Achilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types of Achilles tendon rupture were selected and treated with internal fixation of steel-wire limited loop.The patients began to take exercise for their lower limbs through continous passive motion as early as possible after surgical repair,and the loops were removed after 3-5 months.Six months later,the condition of complications including Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis,cutaneous sensation in sural nerve dominance region,time back to preinjury work or learning as well as time to physical activities were observed.One year later,the therapeutic effect was evaluated,and the maximum circumferences of bilateral legs and raptured plane circumferences of Achilles tendon were measured.Results:The wound of all patients healed well,no complications like Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis occured,and the cutaneous sensation in sural nerve dominance region was normal.The mean time back to preinjury work or learning as well as to pysical activities of all patients were respectively 10 and 22 weeks.Seventy out of 76 patients(92.1%) achieved an excellent effect,and 6(7.9%) good effect.The excellent and good rate came up to 100%.The maximum circumference in the affected leg decreased to 2 mm averagely compared with the offside,while the ruptured plane circumferences of Achilles tendon in the affected side increased to 2.2 mm compared with the offside.Conclusions:Kor early Achilles tendon rupture,internal fixation of steel-wire limited loop can recover the ankle function better,return to the preinjury state in the shortest lime,and has few complications.展开更多
文摘BACKGROUND Anterior cruciate ligament(ACL)reconstruction using bone-patellar tendon-bone(BPTB)autografts remains the gold standard for young,active individuals due to its superior biomechanical strength and bone-to-bone healing.However,donor site morbidity,particularly anterior knee pain(AKP),limits its utilization despite its advantages.Various techniques have been proposed to reduce AKP,but they show variable outcomes and several limitations.AIM To assess the incidence and severity of AKP following BPTB ACL reconstruction using an autologous bone grafting technique.METHODS We conducted a retrospective observational study of 24 patients aged 20-45 years,who had primary ACL reconstruction with BPTB grafts.During surgery,autologous cancellous bone generated from tunnel drilling was used to fill the patellar and tibial donor site voids after graft fixation.All patients were followed up for at least twelve months.Using the Kujala Anterior Knee Pain Score,clinical outcomes were evaluated,including the pain-specific subcomponent.RESULTS With scores ranging from 86 to 100,the average overall Kujala score was 95.67±4.01.No patient scored below 85.There was no complication such as patellar fracture,tibial tuberosity fracture,or infection.Grouped data showed 20.8%of patients scored 100,whereas 54.2%scored between 95 and 99,and 25%scored between 86 and 94.One patient(4.2%)had an 8/10 pain subcomponent,whereas 23 patients(95.8%)had a 10/10.CONCLUSION This procedure is easy to incorporate into routine surgical practice,cost-effective and reproducible without requiring extra incisions or raising the patient’s surgical expenses.Excellent short-term results back up this technique.
基金National Natural Science Foundation of China(Grant Nos.82261160397,82272560)Central South University Research Programme of Advanced Interdisciplinary Studies(2023QYJC011)+4 种基金National Natural Science Foundation of China(Grant Nos.82472521,81922017)Hunan Provincial Science and Technology Department(2023JJ30896)Key Research and Development Program of Hunan Province(2022SK2023)Science and Technology Innovation Program of Hunan Province(2023RC1027)Major Basic Research Projects in Hunan Province(No.2024JC0004)。
文摘Mechanical stress modulates bone formation and organization of the extracellular matrix(ECM),the interaction of which affects heterotopic ossification(HO).However,the mechanically sensitive cell populations in HO and the underlying mechanism remain elusive.Here,we show that the mechanical protein Polysyctin-1(PC1,Pkd1)regulates CTSK lineage tendon-derived mesenchymal stem cell(TDMSC)fate and ECM organization,thus affecting HO progression.First,we revealed that CTSK lineage TDMSCs are the major source of osteoblasts and fibroblasts in HO and are responsive to mechanical cues via single-cell RNA sequencing analysis and experiments with a lineage tracing mouse model.Moreover,we showed that PC1 mediates the mechanosignal transduction of CTSK lineage TDMSCs to regulate osteogenic and fibrogenic differentiation and alters the ECM architecture by facilitating TAZ nuclear translocation.Conditional gene depletion of Pkd1 or Taz in CTSK lineage cells and pharmaceutical intervention in the PC1-TAZ axis disrupt osteogenesis,fibrogenesis and ECM organization,and consequently attenuate HO progression.These findings suggest that mechanically sensitive CTSK-lineage TDMSCs contribute to heterotopic ossification through PC1-TAZ signaling axis mediated cell fate determination and ECM organization.
文摘BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.
基金sponsored by the National Natural Science Foundation of China(Nos.52235007,T2121004,and 52325504)the Key R&D Program of Zhejiang(No.2024SSYS0027)+1 种基金the National Key Research and Development Program of China(Nos.2024YFB4607700 and 2024YFB4607703)the China National Postdoctoral Program for Innovative Talents(No.BX20240312)。
文摘Tendon adhesion,a prevalent complication affecting over 30%of patients after a tendon injury or surgery,results in joint stiffness and impaired mobility.Although current treatments facilitate tendon repair,they are often insufficient in preventing adhesions and promoting optimal healing outcomes.To address these challenges,we developed an oriented cryostructured silk fibroin bandage(OCSFB)using the directional freeze-casting methodology.In vitro studies demonstrated that OCSFB provided a favorable microenvironment for cell viability,proliferation,and alignment,concurrently upregulating the expression of tendon-specific genes.In a rat Achilles tendon model,OCSFB significantly reduced adhesion formation and improved tendon healing.RNA-seq analysis further revealed modulation of cell adhesion molecules,substantiating its role in tissue regeneration.The integration of silk fibroin biocompatibility with a unique microstructure that facilitates cellular adhesion and proliferation renders OCSFB a promising approach for mitigating tendon adhesions and improving repair outcomes,establishing it as a robust candidate for clinical application.
文摘BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during transfer.However,median nerve neuropathy has not been reported yet.We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.CASE SUMMARY A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer.He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique.FPL function loss was due to adhesion resulting from repeated surgery of radius shaft.He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago.During surgery,FPL muscle was severely adhered and indistinguishable.However,tendon continuity remained intact.After tendon transfer,he experienced paresthesia along median nerve distribution upon movement of thumb.He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots.Exploration was then performed.The median nerve was irritated by suture knots of transferred tendon.Thus,knots were removed.Twelve months later,he demonstrated thumb flexion of 80°.Additionally,median nerve neuropathy symptoms fully resolved.CONCLUSION Median nerve neuropathy can occur after tendon transfer from irritation of suture knots.Covering knots using surrounding tissue is recommended.
文摘This article offers additional clinical and biomechanical insights into using the peroneus longus tendon(PLT)autograft in posterior cruciate ligament recon-struction.While recent studies report favorable knee outcomes,concerns remain regarding donor site morbidity.The PLT plays a key role in foot biomechanics,and its harvesting may lead to subtle changes,as suggested by imaging and pe-dobarographic studies.Tendon regeneration may limit long-term morbidity,but further studies are needed.We recommend that future research include gait analysis,long-term follow-up,and insights from anterior cruciate ligament li-terature.
基金Supported by the General Program of the Hubei Provincial Natural Science Foundation of China Key Project,No.2021CFB520.
文摘BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mid-to-long-term clinical outcomes following the double-row repair method for massive rotator cuff tears.METHODS This retrospective analysis included data from 53 patients with massive rotator cuff tears treated at our hospital between 2020 and 2021.The patients were divided into the double-row repair group(conventional group)and the doublerow repair combined with the LHBT transposition group(transposition group).Postoperative pain was assessed using the visual analogue scale at one week,one year,and the final follow-up.Shoulder function was evaluated using the American Shoulder and Elbow Surgeons and Constant-Murley scores at one year and the final follow-up.Rotator cuff healing was assessed postoperatively for one year using the Sugaya classification,which categorizes tendon integrity based on magnetic resonance imaging findings.RESULTS No perioperative complications were observed in any of the patients at any time.There were no significant differences between the groups regarding operative time and intraoperative blood loss.The transposition group had significantly lower visual analogue scale scores than the conventional group at one week postoperatively;however,there were no significant differences between the groups at one year or the final follow-up.At one year postoperatively,the transposition group showed significantly higher American Shoulder and Elbow Surgeons and Constant-Murley scores than the conventional group;no significant differences were observed at the final followup.There were no significant differences in rotator cuff healing between the groups at one year postoperatively.CONCLUSION Compared to double-row repair alone,double-row repair combined with LHBT transposition for treating massive rotator cuff tears more effectively alleviates short-term postoperative pain and improves shoulder function within the first year.
文摘Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent approaches favor early active mobilization with strong,multi-stranded core sutures to enhance outcomes.This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting.Methods:In this prospective study,143 tendons from 30 patients who underwent surgery were followed up.The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture,providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs,thereby reducing operative time without increasing bulk.Early active mobilization was initiated on postoperative day 2.The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group,which enabled real-time guidance and compliance monitoring.The outcomes were measured in terms of total active motion,grip strength,pinch strength,time to return to work,postoperative pain,and complications.Results:Of the 30 patients,28(93.3%)had fair-to-excellent outcomes,whereas only 2(6.7%)had poor outcomes.Most patients(93.3%)returned to work within 12 weeks postoperatively.Four(13.3%)patients had complications,such as wound infection and skin necrosis.The patients showed significant changes in grip strength(45.2%)and pinch strength(70.7%)between weeks 8 and 12.No tendon ruptures were observed.Conclusion:The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization,which began on the second day after surgery,resulting in fair-to-excellent outcomes.It supports digitally supervised physiotherapy through app-based monitoring,enhancing patient compliance,and reducing reliance on in-person therapy sessions.This combination led to excellent functional recovery with minimal complications.
基金supported by the Innovation Capability Improvement Project of Scientific and Technological Small and Medium-sized Enterprises in Shandong Province,China(2021TSGC1415).
文摘The tension leg platform is a typical compliant platform that is connected to the seabed through tension leg tendons.However,it is hard to characterize tension leg tendons due to the complexity of their force and motions as well as the lack of full-scale test methods.We performed a finite element analysis and full-scale four-point bending fatigue tests on tension leg tendons and connectors to study the fatigue properties of the tension leg tendons(made using 36in-X70 steel pipes)used in the Gulf of Mexico.The maximum deflection and the maximum stress of samples under complex loading were estimated through finite element simulation to ensure the testing requirements,including load intensity,load method,load path,and frequency.The maximum equivalent strain and the corresponding position were then determined through testing,which were further compared with simulation results to verify their accuracy and applicability.The maximum strain amplitude from simulations was 761.42με,while the equivalent strain amplitude obtained through tests was 734.90με,which is close to the simulation result.In addition,when the number of fatigue cycles reached 1.055 million,sample damage did not occur.It confirms that the fatigue performance of the tendon steel pipe weld is better than the C1 curve value shown in the DNV RP C203 specification.The proposed full-scale approach to study the fatigue properties of tension leg tendons can provide a reference for domestic engineering design and manufacture of tension leg tendons as well as promote the localization of test equipment.
基金Supported by National Natural Science Foundation of China,No.82172509.
文摘BACKGROUND Fibro-adipogenic progenitors(FAPs)are a group of mesenchymal stem cells that cause fibro-fatty degeneration in skeletal muscle in various chronic disease mode-ls.FAPs also play a role in preventing muscle degeneration at acute stages during disease progression.However,few studies have reported the changes in and function of FAPs in the acute phase after tendon rupture.AIM To clarify the changes in the number of FAPs and their impact on skeletal muscle soon after tendon rupture to facilitate future studies targeting FAPs to treat muscle degeneration.METHODS We utilized Pdgfra-H2B::eGFP mice to trace and quantify FAPs in a tibialis anterior tenotomy(TAT)model at 0 and 3 days,1 week,2 weeks,3 weeks,4 weeks,5 weeks,and 6 weeks post-injury,and the results were further validated using fluorescence-activated cell sorting analysis with C57BL/6 mice at the same post-injury timepoints.We subsequently used PdgfraCreERT::RosaDTA mice,and evaluated the severity of post-TAT skeletal muscle degeneration with or without FAP-depletion.RESULTS The number of FAPs peaked at 1 week post-TAT before gradually declining to a level comparable to that pre-TAT.The change in the number of FAPs was potentially temporally correlated with the progression of skeletal muscle degeneration after TAT.FAP-depletion led to more severe degeneration early after TAT,indicating that FAPs potentially alleviate muscle degeneration after tendon rupture in the early post-injury phase.CONCLUSION FAPs potentially alleviate the degeneration of skeletal muscle in the acute stage after tendon rupture.
基金financially supported by the National Natural Science Foundation of China(No.U2330120)the Natural Science Foundation of Sichuan Province of China(No.2023NSFSC0313)the Basic Research Cultivation Project of Southwest Jiaotong University(No.2682023KJ024)。
文摘Bimodal pressure sensors capable of simultaneously detecting static and dynamic forces are essential to medical detection and bio-robotics.However,conventional pressure sensors typically integrate multiple operating mechanisms to achieve bimodal detection,leading to complex device architectures and challenges in signal decoupling.In this work,we address these limitations by leveraging the unique piezotronic effect of Y-ion-doped ZnO to develop a bimodal piezotronic sensor(BPS)with a simplified structure and enhanced sensitivity.Through a combination of finite element simulations and experimental validation,we demonstrate that the BPS can effectively monitor both dynamic and static forces,achieving an on/off ratio of 1029,a gauge factor of 23,439 and a static force response duration of up to 600 s,significantly outperforming the performance of conventional piezoelectric sensors.As a proof-of-concept,the BPS demonstrates the continuous monitoring of Achilles tendon behavior under mixed dynamic and static loading conditions.Aided by deep learning algorithms,the system achieves 96%accuracy in identifying Achilles tendon movement patterns,thus enabling warnings for dangerous movements.This work provides a viable strategy for bimodal force monitoring,highlighting its potential in wearable electronics.
文摘BACKGROUND Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare.Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.CASE SUMMARY A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident.He reported that he braced his fall with his right hand.Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss.Six days after the injury,the patient exhibited pseudoparalysis and active forward flexion limited to 10°.Two weeks after the injury,magnetic resonance imaging revealed complete tears of the supraspinatus,infraspinatus,and subscapularis muscles as well as dislocation of the long head of the biceps tendon.Arthroscopic rotator cuff repair was performed 6 weeks after injury.The tendon quality was acceptable with minimal fatty infiltration.At the 12-month surgical follow-up,the patient had recovered full strength and complete range of motion.CONCLUSION Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.
文摘BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;however,the absence of the PCL results in abnormal knee kinematics,which may cause injuries to other ligaments.The ideal tendon source for PCL reconstruction is still a subject of debate.AIM To evaluate the results of employing the peroneus longus tendon(PLT)in PCL reconstruction.METHODS A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction.Studies published up to August 2024 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included five studies on PLT use for PCL reconstruction:(1)Four prospective studies with 104 patients;and(2)One retrospective study with 18 patients.Most studies followed up participants for 24 months,while one had a shorter follow-up of 18 months.Lysholm and modified cincinnati scores improved by pooled means of 32.2(95%CI:29.3-35.1,I2=0%)and 31.1(95%CI:27.98-34.22,I2=0%),respectively.Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5(I2=61.5%)and 94.5(I2=80.09%),respectively.Single-hop and triple-hop test scores averaged 95.5(95%CI:94.5-96.5)and 92.4(95%CI:91.9-92.9)respectively.No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.CONCLUSION Evidence supports PLT autografts for PCL reconstruction,improving knee function and patient outcomes.Larger randomized trials are needed to confirm efficacy and compare graft options.
基金It is supported by Scientific Research Planned Project of Taizhou Science and Technology Bureau in Zhejiang:No.031212
文摘Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early Achilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types of Achilles tendon rupture were selected and treated with internal fixation of steel-wire limited loop.The patients began to take exercise for their lower limbs through continous passive motion as early as possible after surgical repair,and the loops were removed after 3-5 months.Six months later,the condition of complications including Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis,cutaneous sensation in sural nerve dominance region,time back to preinjury work or learning as well as time to physical activities were observed.One year later,the therapeutic effect was evaluated,and the maximum circumferences of bilateral legs and raptured plane circumferences of Achilles tendon were measured.Results:The wound of all patients healed well,no complications like Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis occured,and the cutaneous sensation in sural nerve dominance region was normal.The mean time back to preinjury work or learning as well as to pysical activities of all patients were respectively 10 and 22 weeks.Seventy out of 76 patients(92.1%) achieved an excellent effect,and 6(7.9%) good effect.The excellent and good rate came up to 100%.The maximum circumference in the affected leg decreased to 2 mm averagely compared with the offside,while the ruptured plane circumferences of Achilles tendon in the affected side increased to 2.2 mm compared with the offside.Conclusions:Kor early Achilles tendon rupture,internal fixation of steel-wire limited loop can recover the ankle function better,return to the preinjury state in the shortest lime,and has few complications.
