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
Platelet rich plasma(PRP)is an autologous blood product rich in platelets,showing promise in reducing inflammation and accelerating healing.While extensively utilized in plastic surgery,dermatology,and osteoarthritis ...Platelet rich plasma(PRP)is an autologous blood product rich in platelets,showing promise in reducing inflammation and accelerating healing.While extensively utilized in plastic surgery,dermatology,and osteoarthritis treatment,its application in anterior cruciate ligament(ACL)injuries is limited.This article examines PRP's potential in ACL reconstruction(ACLR),exploring its history,current usage,controversies and future directions.PRP has demonstrated significant early benefits in ligamentisation and vascularisation post-ACLR,though its long-term efficacy is inconsistent.Studies suggest that PRP may serve as both an adjunct therapy in ACLR to enhance initial healing and reduce postoperative complications,and as a non-surgical alternative for small ACL tears.Despite these promising findings,outcome variability necessitates further high-quality research to optimize PRP formulations and determine its most effective applications.The exploration of PRP as a treatment modality in ACLR offers promising but varied outcomes.PRP holds considerable promise as both an adjunct and alternative to traditional ACLR.This article underscores the need for targeted research to fully realize PRP's therapeutic potential in ACL treatment,aiming to inform future studies and clinical practices.By understanding PRP's mechanisms of efficacy and identifying the most beneficial patient populations,PRP could significantly impact orthopaedics and sports medicine,improving recovery pathways and patient outcomes.展开更多
BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes t...BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes them advantageous.However,complications such as breakage and intra-articular migration of screws can cause significant clinical issues,including joint pain,swelling,and cartilage damage.Early diagnosis and management are critical in such cases.CASE SUMMARY A 26-year-old male presented with knee pain and swelling one year after ACL reconstruction using a hamstring graft and bioabsorbable tibial interference screw.The patient had been engaged in rigorous physical activity as part of military training.Clinical examination revealed mild effusion without instability,and imaging showed screw breakage with intra-articular migration.Therapeutic arthroscopy confirmed intact graft tension,and broken screw fragments were removed successfully.The patient resumed normal activity two weeks after surgery.CONCLUSION This case highlights the potential complications associated with bioabsorbable screws,emphasizing the need for meticulous surgical technique,postoperative monitoring,and timely intervention.A comprehensive review of the literature illustrates the mechanisms,risk factors,and preventive strategies associated with screw-related complications.展开更多
The periodontal ligament(PDL)plays a crucial role in transmitting and dispersing occlusal force,acting as mechanoreceptor for muscle activity during chewing,as well as mediating orthodontic tooth movement.It transform...The periodontal ligament(PDL)plays a crucial role in transmitting and dispersing occlusal force,acting as mechanoreceptor for muscle activity during chewing,as well as mediating orthodontic tooth movement.It transforms mechanical stimuli into biological signals,influencing alveolar bone remodeling.Recent research has delved deeper into the biological and mechanical aspects of PDL,emphasizing the importance of understanding its structure and mechanical properties comprehensively.This review focuses on the latest findings concerning both macro-and micro-structural aspects of the PDL,highlighting its mechanical characteristics and factors that influence them.Moreover,it explores the mechanotransduction mechanisms of PDL cells under mechanical forces.Structure-mechanics-mechanotransduction interplay in PDL has been integrated ultimately.By providing an up-to-date overview of our understanding on PDL at various scales,this study lays the foundation for further exploration into PDL-related biomechanics and mechanobiology.展开更多
Anterior cruciate ligament(ACL)injuries are frequently caused by sports injuries and trauma.In cases involving complete tears,ACL reconstruction(ACLR)surgery is the only way to restore the ligament’s integrity.When s...Anterior cruciate ligament(ACL)injuries are frequently caused by sports injuries and trauma.In cases involving complete tears,ACL reconstruction(ACLR)surgery is the only way to restore the ligament’s integrity.When selecting a graft,both the potential complications and the mechanical properties and healing efficacies should be considered.Artificial ligaments have been widely applied in clinical ACLR,and most have exhibited satisfactory biocompatibility and short-term follow-up results.Compared with autografts and allografts,however,the lack of bioactivity of currently available artificial ligaments is a major disadvantage.In addition,some long-term follow-up results have revealed other drawbacks of artificial ligaments,such as graft failure and other complications.Here,we summarize attempts to enhance the bioactive performance of artificial ligaments,as such modifications may have good potential for clinical translation and could improve the long-term outcomes of existing products.展开更多
BACKGROUND Recovering from anterior cruciate ligament(ACL)reconstruction can be challenging.While standard rehabilitation helps restore knee function,many patients still face a slow or incomplete recovery.Extracorpore...BACKGROUND Recovering from anterior cruciate ligament(ACL)reconstruction can be challenging.While standard rehabilitation helps restore knee function,many patients still face a slow or incomplete recovery.Extracorporeal shockwave therapy(ESWT)has recently gained attention as a potential way to speed up healing and improve outcomes when added to traditional rehab.AIM To explore whether combining ESWT with standard postoperative rehabilitation truly leads to better recovery compared with rehab alone.METHODS A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,evaluating participant status following ACL reconstruction with standard rehabilitation and without augmented ESWT.This meta-analysis included six studies(five randomized controlled trials,one non-randomized clinical study).The outcome measures were the Lysholm score,International Knee Documentation Committee score,visual analog score,and KT-1000 measurements.To compare the control and intervention groups,the weighted mean differences were calculated along with the 95%confidence intervals.The heterogeneity of the studies and publication bias were analyzed.RESULTS ESWT modestly improved Lysholm scores(weighted mean difference:3.72;95%confidence interval:-0.27 to 7.71)with high heterogeneity(I2:96%,P<0.001)when compared with standard rehabilitation.Focused ESWT showed greater benefits compared with radial ESWT.No significant differences were found in the International Knee Documentation Committee scores,visual analog score,or KT-1000 measurements.Substantial variability and publication bias were noted.CONCLUSION ESWT improved Lysholm scores but did not show other significant benefits.Due to the limited evidence,further standardized,placebo-controlled trials are needed to confirm its effectiveness in ACL reconstruction.展开更多
The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial ...The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella.Despite this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion.The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial.This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.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
The present article reviews the emerging role of melatonin(MT)and the Hippo-Yes-associated protein signaling pathway in periodontal regeneration,high-lighting their potential to delay the aging process of periodontal ...The present article reviews the emerging role of melatonin(MT)and the Hippo-Yes-associated protein signaling pathway in periodontal regeneration,high-lighting their potential to delay the aging process of periodontal ligament stem cells(PDLSCs).Oxidative stress and cellular senescence are major obstacles in regenerative therapies,especially in an aging population.MT,a potent antioxidant,restores the morphology,proliferation,and osteogenic differentiation potential of PDLSCs under oxidative stress conditions.Recent research highlights how MT enhances PDLSC stemness by upregulating Yes-associated protein ex-pression,offering a promising therapeutic strategy to antagonize tissue dege-neration.In addition,the article discusses the growing interest in probiotics as a complementary approach to improve oral microbiota and support tissue regeneration.The integration of MT with traditional and novel therapeutic approaches may pave the way for innovative preventive or active treatments in periodontology,aimed at reducing oxidative stress.Future research needs to focus on translating these findings into clinical applications and promoting a deeper understanding of periodontal regeneration and cellular aging.展开更多
BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM ...BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.METHODS During March 2024,the PubMed,EMBASE,and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries.Data regarding patient demographics,pathological characteristics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.RESULTS Eight studies were included.In total,94 patients(94 feet)underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2±10.2 months.The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2±11.8 preoperatively to a post-operative score of 82.8±5.4.The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7±0.6 preoperatively to a post-operative score of 2.0±0.4.In total,100%of patients returned to sport at a mean time of 16.8 weeks.The complication rate was 5%,the most common complication of which was residual midfoot stiffness(3.0%).No failures nor secondary surgical procedures were recorded.CONCLUSION This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up.In addition,there was an excellent return-to-sport rate(100%)at a weighted mean time of 16.8 weeks.This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries;however,caution should be taken when evaluating this data in light of the lack of high quality,comparative studies,and short-term follow-up.展开更多
BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging ...BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging when they undergo degenerative changes because their clinical and radiological features often mimic those of ovarian tumors.We report a rare case of a giant broad ligament fibroid with cystic degeneration,which was initially mistaken for an ovarian mass.CASE SUMMARY A 49-year-old woman presented with mild abdominal distension and pain as the only symptoms.Upon abdominal examination,a large mass measuring approximately 30 cm and extending from the pelvic cavity to just below the xiphoid process was identified.Both transvaginal ultrasound and contrast-enhanced computed tomography suggested an ovarian origin of the mass.However,laparotomy confirmed that the mass originated from the right broad ligament.The mass was separated from the uterus and bilateral ovaries,with no involvement of the uterus or ovaries.The mass was completely resected with respecting the patient’s desire to retain her uterus and adnexa.Postoperative histopathological examination confirmed leiomyoma with cystic degeneration.CONCLUSION Broad ligament myomas mimic ovarian tumors;accurate diagnosis and careful operation are critical to avoid complications and ensure safety.展开更多
BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many pat...BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many patients.Trans-vaginal sacrospinous ligament suspension(VSSLS)involves securing the apex of the prolapsed vagina to the sacrospinous ligament to maintain the physiological axis of the vagina,help in repairing pelvic floor defects,and maintain the normal function of the pelvic floor,thereby alleviating patients’anxiety and depression.AIM To explore the effect of VSSLS in the treatment of POP and its influence on anxiety and depression among patients.METHODS Sixty patients with moderate to severe POP who underwent surgical treatment between January 2023 and June 2024 in Suzhou Ninth Hospital Affiliated to Soochow University were retrospectively enrolled in the study.According to treatment methods,they were divided into the control group(n=30,treated with vaginal hysterectomy alone)and observation group(n=30,treated with VSSLS combined with vaginal hysterectomy).The two groups were compared by baseline data,perioperative indicators,and postoperative pain intensity,prolapse distance before and after surgery,sexual function,pelvic function,anxiety,and depression.RESULTS No significant differences in baseline data,preoperative POP Quantification measurement value,Pelvic Floor Dysfunction Inventory 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)scores were found between the two groups.The obser vation group had longer operation time and more intraoperative blood loss than the control group,the Visual Analog Scale score on postoperative day 1 was slightly higher in than in the control group.On the reexamination 3 months postoperatively,the POP Quantification measurement values in the observation group were lower than those in the control group(P<0.05).Evaluation 6 months after surgery,the FSFI score was higher in the observation group than in the control group,the PFDI-20,PFIQ-7,SAS and SDS score scored were lower in than in the control group(P<0.05).The PFDI-20,PFIQ-7 scores positively correlated with the SAS and SDS scores.CONCLUSION VSSLS demonstrated a significant effect on the treatment of moderate and severe POP,as it can reduce the prolapse distance and PFDI-20 and PFIQ-7 scores and improve anxiety and depression among patients.展开更多
BACKGROUND Laparoscopic fenestration is a common treatment for hepatic cysts,but postoperative recurrence and complications remain concerns.AIM To evaluate suturing the liver’s round ligament to the cyst wall after l...BACKGROUND Laparoscopic fenestration is a common treatment for hepatic cysts,but postoperative recurrence and complications remain concerns.AIM To evaluate suturing the liver’s round ligament to the cyst wall after laparoscopic fenestration for hepatic cysts.METHODS This retrospective case series study involved patients who underwent the novel surgical technique at the Second People’s Hospital of Changzhou,affiliated with Nanjing Medical University,between December 2022 and March 2024.The perioperative indicators observed included operative duration,intraoperative blood loss,the occurrence of bile leakage or hemorrhage within the drainage fluid,and the duration of hospital confinement.RESULTS Fifteen patients were included.The surgeries were successfully completed laparoscopically,with a mean operative duration of 75.0±15.4 minutes and minimal intraoperative blood loss.No major complications,such as significant bleeding,bile leakage,or intra-abdominal infections,were reported.The follow-up period,ranging from 3 months to 12 months,revealed a cure rate of 40.0%and a total efficacy rate of 100%,with no cases deemed ineffective.CONCLUSION Suturing the free pedicled round ligament to the cyst wall after laparoscopic fenestration is feasible and effective,with promising cure rates.展开更多
Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased ri...Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased risk.The success of ACL reconstruction is multifactorial,relying on individualized graft selection,surgical precision,patient-specific characteristics,and optimized rehabilitation.Despite the availability of various graft options—hamstring tendon,bone-patellar tendon-bone,and quadriceps tendon—no single type has demonstrated clear superiority,reinforcing the need for patient-tailored approaches based on anatomical,functional,and age-related factors.Surgical techniques continue to evolve,with adaptations such as physeal-sparing methods for skeletally immature patients and minimally invasive procedures aimed at reducing morbidity and improving recovery.Rehabilitation is a critical determinant of functional out-comes.Current evidence supports immediate mobilization,early weight-bearing,and initiation of neuromuscular and strength training,while routine use of continuous passive motion and bracing is discouraged,except in multi-ligament injuries.Prehabilitation is recommended,though accelerated rehabilitation remains controversial.Implant choice and fixation strategy are also essential to long-term success.The use of materials that reduce the risk of chronic complic-ations and support biological integration is increasingly favored.Nevertheless,rare mechanical failures emphasize the need for accurate tunnel placement,appropriate implant selection,and vigilant postoperative monitoring.Outcomes are further influenced by patient-specific variables,including bone quality,metabolic status,and physical activity levels.Optimal ACL reconstruction results from a comprehensive,patient-centered strategy that integrates surgical accuracy,individualized rehabilitation,and continuous follow-up to minimize complications and enhance recovery.展开更多
BACKGROUND Periodontitis is an inflammatory disease caused by the host’s immune response and various interactions between pathogens,which lead to the loss of connective tissue and bone.In recent years,mesenchymal ste...BACKGROUND Periodontitis is an inflammatory disease caused by the host’s immune response and various interactions between pathogens,which lead to the loss of connective tissue and bone.In recent years,mesenchymal stem cell(SC)transplantation technology has become a research hotspot,which can form periodontal ligament,cementum,and alveolar bone through proliferation and differentiation.AIM To elucidate the regulatory effects of WD repeat-containing protein 36(WDR36)on the senescence,migration,and osteogenic differentiation of periodontal ligament SCs(PDLSCs).METHODS The migration and chemotaxis of PDLSCs were detected by the scratch-wound migration test and transwell chemotaxis test.Alkaline phosphatase(ALP)activity,Alizarin red staining,calcium content,and real-time reverse transcription polymerase chain reaction(RT-qPCR)of key transcription factors were used to detect the osteogenic differentiation function of PDLSCs.Cell senescence was determined by senescence-associatedβ-galactosidase staining.RESULTS The 24-hour and 48-hour scratch-wound migration test and 48-hour transwell chemotaxis test showed that overexpression of WDR36 inhibited the migration/chemotaxis of PDLSCs.Simultaneously,WDR36 depletion promoted the migration/chemotaxis of PDLSCs.The results of ALP activity,Alizarin red staining,calcium content,and RTqPCR showed that overexpression of WDR36 inhibited the osteogenic differentiation of PDLSCs,and WDR36 depletion promoted the osteogenic differentiation of PDLSCs.Senescence-associatedβ-galactosidase staining showed that 0.1μg/mL icariin(ICA)and overexpression of WDR36 inhibited the senescence of PDLSCs,and WDR36 depletion promoted the osteogenic differentiation of PDLSCs.CONCLUSION WDR36 inhibits the migration and chemotaxis,osteogenic differentiation,and senescence of PDLSCs;0.1μg/mL ICA inhibits the senescence of PDLSCs.Therefore,WDR36 might serve as a target for periodontal tissue regeneration and the treatment of periodontitis.展开更多
BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac arte...BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac artery by the median arcuate ligament(MAL),potentially leading to ischemia,aneurysm formation,and rupture.CASE SUMMARY Computed tomography revealed a retroperitoneal hematoma,celiac artery stenosis,and two aneurysms in the inferior pancreaticoduodenal artery.Hemo-stasis was achieved using transcatheter arterial embolization.However,15 days after embolization,the patient developed duodenal stenosis,manifesting as gastric distension and nausea without abdominal pain.Endoscopy revealed mucosal edema and luminal narrowing of the duodenum.Conservative treatment was ineffective,and the patient underwent MAL transection and gastrojejun-ostomy.She recovered uneventfully,and follow-up at 4 months showed complete resolution of duodenal stenosis and no recurrence.CONCLUSION This case highlights the importance of the early diagnosis and multidisciplinary management of MALS.展开更多
BACKGROUND The anterior talofibular ligament(ATFL)is the most commonly injured ligament in ankle sprains.While most individuals recover with conservative management,some patients develop persistent pain and instabilit...BACKGROUND The anterior talofibular ligament(ATFL)is the most commonly injured ligament in ankle sprains.While most individuals recover with conservative management,some patients develop persistent pain and instability from chronic ATFL tears.Surgical repair is often required,and minimally invasive techniques are gaining popularity.AIM To evaluate the clinical outcomes of a novel,totally percutaneous(TP)modified Broström repair(MBR)for chronic ATFL insufficiency in a cohort of patients who failed conservative treatment.METHODS This retrospective study analyzed 20 patients(14 males,6 females;mean age,28.7 years)who underwent TP-MBR between 2023 and 2024 at a tertiary trauma center.All patients had persistent pain and instability for at least 3 months despite conservative treatment.Diagnosis was confirmed by magnetic resonance imaging,arthroscopy,and stress testing.TP-MBR was performed using suture anchors and percutaneous ligament advancement.Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society score and Karlsson score at a mean follow-up of 1.5 years.RESULTS All procedures were completed successfully with no intraoperative complications.At a mean follow-up of 1.5 years,patients showed significant improvements in American Orthopaedic Foot and Ankle Society score(from 39.85 to 84.4;P<0.001)and Karlsson scores(from 43.8 to 87.4;P<0.001).All patients returned to pre-injury activity levels with resolution of instability.The technique resulted in minimal tissue trauma,reduced operative time,accelerated recovery,and excellent cosmetic outcomes.No recurrences or major complications occurred.CONCLUSION TP-MBR is a safe and effective alternative to open Broström repair for chronic ATFL tears.It offers the benefits of a minimally invasive approach,including less trauma and faster rehabilitation,making it a valuable option for appropriately selected patients.展开更多
BACKGROUND Thoracic ossification of the posterior longitudinal ligament(T-OPLL)is caused by the ossified posterior longitudinal ligament occupying space in the spinal canal,which causes compression of the thoracic spi...BACKGROUND Thoracic ossification of the posterior longitudinal ligament(T-OPLL)is caused by the ossified posterior longitudinal ligament occupying space in the spinal canal,which causes compression of the thoracic spinal cord.Surgical treatment is difficult,risky and complicated;thus,clinical treatment is difficult at present.CASE SUMMARY A case of severe multi-segmental T-OPLL treated with thoracic anterior controllable antedisplacement fusion(TACAF)is reported,including the surgical procedures and analysis of the clinical data.The modified-Japanese Orthopaedic Association score in this patient was 4 before surgery,and it was raised to 9 after the operation.The symptoms of spinal canal compression were subsequently relieved.Three months after surgery,digital radiography showed good healing and recovery of limb sensory function.CONCLUSION This case report suggests that TACAF is feasible for the treatment of long-segment T-OPLL,and has the advantages of low risk and reduced trauma.However,this operation still needs to be verified by clinical research with a larger sample size.展开更多
Background:The anterior talofibular ligament(ATFL)and the calcaneofibular ligament(CFL)are vulnerable to be torn or ruptured during lateral ankle sprain(LAS),especially in people with chronic ankle instability(CAI).Th...Background:The anterior talofibular ligament(ATFL)and the calcaneofibular ligament(CFL)are vulnerable to be torn or ruptured during lateral ankle sprain(LAS),especially in people with chronic ankle instability(CAI).This study aims to determine whether landing with a larger toe-out angle would influence ATFL and CFL strains in people with CAI,aiming to contribute to the development of effective landing strategies to reduce LAS risk.Methods:Thirty participants with CAI(22 males and 8 females,age:21.2±1.2 years,height:176.9±9.0 cm,body mass:70.6±12.1 kg,mean±SD)were recruited.Each participant landed on a specialized trap-door device with their unaffected limbs on a support platform and their affected limbs on a movable platform,which could be flipped 24°inward and 15°forward to mimic LAS conditions.Two landing conditions were tested—i.e.,natural landing(NL,with natural toe-out angle at landing)and toe-out landing(TL,with toe-out angle increased to over 150%of that under the NL conditions).Kinematic data were captured using a 12-camera motion analysis system,and ATFL and CFL strains were calculated using a 3D rigid-body foot model.Paired sample t tests and Pearson's correlations were used to analyze data.Results:Compared to NL conditions,ATFL strain decreased(p<0.001,d=2.42)while CFL strain remained unchanged(p=0.229,d=0.09)under TL conditions.The toe-out angle was negatively and strongly correlated with ATFL strain(r=-0.743,p<0.001)but not with CFL strain(r=0.153,p=0.251).Compared to NL conditions,participants exhibit a lower ankle inversion angle(p<0.001,d=0.494),a higher plantarflexion angle(p<0.001,d=1.101),and no significant difference in external rotation angle(p=0.571,d=0.133)under TL conditions.Conclusion:Toe-out landing may reduce ATFL strain while maintaining CFL strain in people with CAI,thereby reducing the risk of LAS.展开更多
Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recent...Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint.Numerous studies investigated the anatomy,function,and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability.However,controversies regarding its existence,prevalence,and femoral and tibial insertions need to be addressed.According to a recent consensus,ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint,with some anatomic variations.The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies.Generally,ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.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.
文摘Platelet rich plasma(PRP)is an autologous blood product rich in platelets,showing promise in reducing inflammation and accelerating healing.While extensively utilized in plastic surgery,dermatology,and osteoarthritis treatment,its application in anterior cruciate ligament(ACL)injuries is limited.This article examines PRP's potential in ACL reconstruction(ACLR),exploring its history,current usage,controversies and future directions.PRP has demonstrated significant early benefits in ligamentisation and vascularisation post-ACLR,though its long-term efficacy is inconsistent.Studies suggest that PRP may serve as both an adjunct therapy in ACLR to enhance initial healing and reduce postoperative complications,and as a non-surgical alternative for small ACL tears.Despite these promising findings,outcome variability necessitates further high-quality research to optimize PRP formulations and determine its most effective applications.The exploration of PRP as a treatment modality in ACLR offers promising but varied outcomes.PRP holds considerable promise as both an adjunct and alternative to traditional ACLR.This article underscores the need for targeted research to fully realize PRP's therapeutic potential in ACL treatment,aiming to inform future studies and clinical practices.By understanding PRP's mechanisms of efficacy and identifying the most beneficial patient populations,PRP could significantly impact orthopaedics and sports medicine,improving recovery pathways and patient outcomes.
文摘BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes them advantageous.However,complications such as breakage and intra-articular migration of screws can cause significant clinical issues,including joint pain,swelling,and cartilage damage.Early diagnosis and management are critical in such cases.CASE SUMMARY A 26-year-old male presented with knee pain and swelling one year after ACL reconstruction using a hamstring graft and bioabsorbable tibial interference screw.The patient had been engaged in rigorous physical activity as part of military training.Clinical examination revealed mild effusion without instability,and imaging showed screw breakage with intra-articular migration.Therapeutic arthroscopy confirmed intact graft tension,and broken screw fragments were removed successfully.The patient resumed normal activity two weeks after surgery.CONCLUSION This case highlights the potential complications associated with bioabsorbable screws,emphasizing the need for meticulous surgical technique,postoperative monitoring,and timely intervention.A comprehensive review of the literature illustrates the mechanisms,risk factors,and preventive strategies associated with screw-related complications.
基金supported by the National Natural Science Foundation of China(32271416)Sichuan Provincial Science and Technology program(2022YFQ0002).
文摘The periodontal ligament(PDL)plays a crucial role in transmitting and dispersing occlusal force,acting as mechanoreceptor for muscle activity during chewing,as well as mediating orthodontic tooth movement.It transforms mechanical stimuli into biological signals,influencing alveolar bone remodeling.Recent research has delved deeper into the biological and mechanical aspects of PDL,emphasizing the importance of understanding its structure and mechanical properties comprehensively.This review focuses on the latest findings concerning both macro-and micro-structural aspects of the PDL,highlighting its mechanical characteristics and factors that influence them.Moreover,it explores the mechanotransduction mechanisms of PDL cells under mechanical forces.Structure-mechanics-mechanotransduction interplay in PDL has been integrated ultimately.By providing an up-to-date overview of our understanding on PDL at various scales,this study lays the foundation for further exploration into PDL-related biomechanics and mechanobiology.
基金supported by the Areas of Excellence Scheme(AoE/M402/20)the Knowledge Transfer Project Fund(KPF24GWP05)+2 种基金the IdeaBooster Fund(IDBF24MED12)the HKSTP Ideation Fund(Ideation 23-0698)the ITC Technology Startup Support Scheme for Universities(TSU24MED05).
文摘Anterior cruciate ligament(ACL)injuries are frequently caused by sports injuries and trauma.In cases involving complete tears,ACL reconstruction(ACLR)surgery is the only way to restore the ligament’s integrity.When selecting a graft,both the potential complications and the mechanical properties and healing efficacies should be considered.Artificial ligaments have been widely applied in clinical ACLR,and most have exhibited satisfactory biocompatibility and short-term follow-up results.Compared with autografts and allografts,however,the lack of bioactivity of currently available artificial ligaments is a major disadvantage.In addition,some long-term follow-up results have revealed other drawbacks of artificial ligaments,such as graft failure and other complications.Here,we summarize attempts to enhance the bioactive performance of artificial ligaments,as such modifications may have good potential for clinical translation and could improve the long-term outcomes of existing products.
文摘BACKGROUND Recovering from anterior cruciate ligament(ACL)reconstruction can be challenging.While standard rehabilitation helps restore knee function,many patients still face a slow or incomplete recovery.Extracorporeal shockwave therapy(ESWT)has recently gained attention as a potential way to speed up healing and improve outcomes when added to traditional rehab.AIM To explore whether combining ESWT with standard postoperative rehabilitation truly leads to better recovery compared with rehab alone.METHODS A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,evaluating participant status following ACL reconstruction with standard rehabilitation and without augmented ESWT.This meta-analysis included six studies(five randomized controlled trials,one non-randomized clinical study).The outcome measures were the Lysholm score,International Knee Documentation Committee score,visual analog score,and KT-1000 measurements.To compare the control and intervention groups,the weighted mean differences were calculated along with the 95%confidence intervals.The heterogeneity of the studies and publication bias were analyzed.RESULTS ESWT modestly improved Lysholm scores(weighted mean difference:3.72;95%confidence interval:-0.27 to 7.71)with high heterogeneity(I2:96%,P<0.001)when compared with standard rehabilitation.Focused ESWT showed greater benefits compared with radial ESWT.No significant differences were found in the International Knee Documentation Committee scores,visual analog score,or KT-1000 measurements.Substantial variability and publication bias were noted.CONCLUSION ESWT improved Lysholm scores but did not show other significant benefits.Due to the limited evidence,further standardized,placebo-controlled trials are needed to confirm its effectiveness in ACL reconstruction.
文摘The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella.Despite this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion.The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial.This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.
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.
文摘The present article reviews the emerging role of melatonin(MT)and the Hippo-Yes-associated protein signaling pathway in periodontal regeneration,high-lighting their potential to delay the aging process of periodontal ligament stem cells(PDLSCs).Oxidative stress and cellular senescence are major obstacles in regenerative therapies,especially in an aging population.MT,a potent antioxidant,restores the morphology,proliferation,and osteogenic differentiation potential of PDLSCs under oxidative stress conditions.Recent research highlights how MT enhances PDLSC stemness by upregulating Yes-associated protein ex-pression,offering a promising therapeutic strategy to antagonize tissue dege-neration.In addition,the article discusses the growing interest in probiotics as a complementary approach to improve oral microbiota and support tissue regeneration.The integration of MT with traditional and novel therapeutic approaches may pave the way for innovative preventive or active treatments in periodontology,aimed at reducing oxidative stress.Future research needs to focus on translating these findings into clinical applications and promoting a deeper understanding of periodontal regeneration and cellular aging.
文摘BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.METHODS During March 2024,the PubMed,EMBASE,and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries.Data regarding patient demographics,pathological characteristics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.RESULTS Eight studies were included.In total,94 patients(94 feet)underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2±10.2 months.The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2±11.8 preoperatively to a post-operative score of 82.8±5.4.The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7±0.6 preoperatively to a post-operative score of 2.0±0.4.In total,100%of patients returned to sport at a mean time of 16.8 weeks.The complication rate was 5%,the most common complication of which was residual midfoot stiffness(3.0%).No failures nor secondary surgical procedures were recorded.CONCLUSION This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up.In addition,there was an excellent return-to-sport rate(100%)at a weighted mean time of 16.8 weeks.This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries;however,caution should be taken when evaluating this data in light of the lack of high quality,comparative studies,and short-term follow-up.
文摘BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging when they undergo degenerative changes because their clinical and radiological features often mimic those of ovarian tumors.We report a rare case of a giant broad ligament fibroid with cystic degeneration,which was initially mistaken for an ovarian mass.CASE SUMMARY A 49-year-old woman presented with mild abdominal distension and pain as the only symptoms.Upon abdominal examination,a large mass measuring approximately 30 cm and extending from the pelvic cavity to just below the xiphoid process was identified.Both transvaginal ultrasound and contrast-enhanced computed tomography suggested an ovarian origin of the mass.However,laparotomy confirmed that the mass originated from the right broad ligament.The mass was separated from the uterus and bilateral ovaries,with no involvement of the uterus or ovaries.The mass was completely resected with respecting the patient’s desire to retain her uterus and adnexa.Postoperative histopathological examination confirmed leiomyoma with cystic degeneration.CONCLUSION Broad ligament myomas mimic ovarian tumors;accurate diagnosis and careful operation are critical to avoid complications and ensure safety.
基金Supported by 2023 Academy Level Research Start-up Fund,No.YK2023332024 Academy Level Research Start-up Fund,No.YK202430+1 种基金Wujiang District,Suzhou City,“Promoting Health through Science and Education”Project,No.WWK202201Xuzhou Medical University Affiliated Hospital Development Fund Support Project,No.XYFY202423.
文摘BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many patients.Trans-vaginal sacrospinous ligament suspension(VSSLS)involves securing the apex of the prolapsed vagina to the sacrospinous ligament to maintain the physiological axis of the vagina,help in repairing pelvic floor defects,and maintain the normal function of the pelvic floor,thereby alleviating patients’anxiety and depression.AIM To explore the effect of VSSLS in the treatment of POP and its influence on anxiety and depression among patients.METHODS Sixty patients with moderate to severe POP who underwent surgical treatment between January 2023 and June 2024 in Suzhou Ninth Hospital Affiliated to Soochow University were retrospectively enrolled in the study.According to treatment methods,they were divided into the control group(n=30,treated with vaginal hysterectomy alone)and observation group(n=30,treated with VSSLS combined with vaginal hysterectomy).The two groups were compared by baseline data,perioperative indicators,and postoperative pain intensity,prolapse distance before and after surgery,sexual function,pelvic function,anxiety,and depression.RESULTS No significant differences in baseline data,preoperative POP Quantification measurement value,Pelvic Floor Dysfunction Inventory 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)scores were found between the two groups.The obser vation group had longer operation time and more intraoperative blood loss than the control group,the Visual Analog Scale score on postoperative day 1 was slightly higher in than in the control group.On the reexamination 3 months postoperatively,the POP Quantification measurement values in the observation group were lower than those in the control group(P<0.05).Evaluation 6 months after surgery,the FSFI score was higher in the observation group than in the control group,the PFDI-20,PFIQ-7,SAS and SDS score scored were lower in than in the control group(P<0.05).The PFDI-20,PFIQ-7 scores positively correlated with the SAS and SDS scores.CONCLUSION VSSLS demonstrated a significant effect on the treatment of moderate and severe POP,as it can reduce the prolapse distance and PFDI-20 and PFIQ-7 scores and improve anxiety and depression among patients.
文摘BACKGROUND Laparoscopic fenestration is a common treatment for hepatic cysts,but postoperative recurrence and complications remain concerns.AIM To evaluate suturing the liver’s round ligament to the cyst wall after laparoscopic fenestration for hepatic cysts.METHODS This retrospective case series study involved patients who underwent the novel surgical technique at the Second People’s Hospital of Changzhou,affiliated with Nanjing Medical University,between December 2022 and March 2024.The perioperative indicators observed included operative duration,intraoperative blood loss,the occurrence of bile leakage or hemorrhage within the drainage fluid,and the duration of hospital confinement.RESULTS Fifteen patients were included.The surgeries were successfully completed laparoscopically,with a mean operative duration of 75.0±15.4 minutes and minimal intraoperative blood loss.No major complications,such as significant bleeding,bile leakage,or intra-abdominal infections,were reported.The follow-up period,ranging from 3 months to 12 months,revealed a cure rate of 40.0%and a total efficacy rate of 100%,with no cases deemed ineffective.CONCLUSION Suturing the free pedicled round ligament to the cyst wall after laparoscopic fenestration is feasible and effective,with promising cure rates.
文摘Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased risk.The success of ACL reconstruction is multifactorial,relying on individualized graft selection,surgical precision,patient-specific characteristics,and optimized rehabilitation.Despite the availability of various graft options—hamstring tendon,bone-patellar tendon-bone,and quadriceps tendon—no single type has demonstrated clear superiority,reinforcing the need for patient-tailored approaches based on anatomical,functional,and age-related factors.Surgical techniques continue to evolve,with adaptations such as physeal-sparing methods for skeletally immature patients and minimally invasive procedures aimed at reducing morbidity and improving recovery.Rehabilitation is a critical determinant of functional out-comes.Current evidence supports immediate mobilization,early weight-bearing,and initiation of neuromuscular and strength training,while routine use of continuous passive motion and bracing is discouraged,except in multi-ligament injuries.Prehabilitation is recommended,though accelerated rehabilitation remains controversial.Implant choice and fixation strategy are also essential to long-term success.The use of materials that reduce the risk of chronic complic-ations and support biological integration is increasingly favored.Nevertheless,rare mechanical failures emphasize the need for accurate tunnel placement,appropriate implant selection,and vigilant postoperative monitoring.Outcomes are further influenced by patient-specific variables,including bone quality,metabolic status,and physical activity levels.Optimal ACL reconstruction results from a comprehensive,patient-centered strategy that integrates surgical accuracy,individualized rehabilitation,and continuous follow-up to minimize complications and enhance recovery.
文摘BACKGROUND Periodontitis is an inflammatory disease caused by the host’s immune response and various interactions between pathogens,which lead to the loss of connective tissue and bone.In recent years,mesenchymal stem cell(SC)transplantation technology has become a research hotspot,which can form periodontal ligament,cementum,and alveolar bone through proliferation and differentiation.AIM To elucidate the regulatory effects of WD repeat-containing protein 36(WDR36)on the senescence,migration,and osteogenic differentiation of periodontal ligament SCs(PDLSCs).METHODS The migration and chemotaxis of PDLSCs were detected by the scratch-wound migration test and transwell chemotaxis test.Alkaline phosphatase(ALP)activity,Alizarin red staining,calcium content,and real-time reverse transcription polymerase chain reaction(RT-qPCR)of key transcription factors were used to detect the osteogenic differentiation function of PDLSCs.Cell senescence was determined by senescence-associatedβ-galactosidase staining.RESULTS The 24-hour and 48-hour scratch-wound migration test and 48-hour transwell chemotaxis test showed that overexpression of WDR36 inhibited the migration/chemotaxis of PDLSCs.Simultaneously,WDR36 depletion promoted the migration/chemotaxis of PDLSCs.The results of ALP activity,Alizarin red staining,calcium content,and RTqPCR showed that overexpression of WDR36 inhibited the osteogenic differentiation of PDLSCs,and WDR36 depletion promoted the osteogenic differentiation of PDLSCs.Senescence-associatedβ-galactosidase staining showed that 0.1μg/mL icariin(ICA)and overexpression of WDR36 inhibited the senescence of PDLSCs,and WDR36 depletion promoted the osteogenic differentiation of PDLSCs.CONCLUSION WDR36 inhibits the migration and chemotaxis,osteogenic differentiation,and senescence of PDLSCs;0.1μg/mL ICA inhibits the senescence of PDLSCs.Therefore,WDR36 might serve as a target for periodontal tissue regeneration and the treatment of periodontitis.
文摘BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac artery by the median arcuate ligament(MAL),potentially leading to ischemia,aneurysm formation,and rupture.CASE SUMMARY Computed tomography revealed a retroperitoneal hematoma,celiac artery stenosis,and two aneurysms in the inferior pancreaticoduodenal artery.Hemo-stasis was achieved using transcatheter arterial embolization.However,15 days after embolization,the patient developed duodenal stenosis,manifesting as gastric distension and nausea without abdominal pain.Endoscopy revealed mucosal edema and luminal narrowing of the duodenum.Conservative treatment was ineffective,and the patient underwent MAL transection and gastrojejun-ostomy.She recovered uneventfully,and follow-up at 4 months showed complete resolution of duodenal stenosis and no recurrence.CONCLUSION This case highlights the importance of the early diagnosis and multidisciplinary management of MALS.
文摘BACKGROUND The anterior talofibular ligament(ATFL)is the most commonly injured ligament in ankle sprains.While most individuals recover with conservative management,some patients develop persistent pain and instability from chronic ATFL tears.Surgical repair is often required,and minimally invasive techniques are gaining popularity.AIM To evaluate the clinical outcomes of a novel,totally percutaneous(TP)modified Broström repair(MBR)for chronic ATFL insufficiency in a cohort of patients who failed conservative treatment.METHODS This retrospective study analyzed 20 patients(14 males,6 females;mean age,28.7 years)who underwent TP-MBR between 2023 and 2024 at a tertiary trauma center.All patients had persistent pain and instability for at least 3 months despite conservative treatment.Diagnosis was confirmed by magnetic resonance imaging,arthroscopy,and stress testing.TP-MBR was performed using suture anchors and percutaneous ligament advancement.Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society score and Karlsson score at a mean follow-up of 1.5 years.RESULTS All procedures were completed successfully with no intraoperative complications.At a mean follow-up of 1.5 years,patients showed significant improvements in American Orthopaedic Foot and Ankle Society score(from 39.85 to 84.4;P<0.001)and Karlsson scores(from 43.8 to 87.4;P<0.001).All patients returned to pre-injury activity levels with resolution of instability.The technique resulted in minimal tissue trauma,reduced operative time,accelerated recovery,and excellent cosmetic outcomes.No recurrences or major complications occurred.CONCLUSION TP-MBR is a safe and effective alternative to open Broström repair for chronic ATFL tears.It offers the benefits of a minimally invasive approach,including less trauma and faster rehabilitation,making it a valuable option for appropriately selected patients.
文摘BACKGROUND Thoracic ossification of the posterior longitudinal ligament(T-OPLL)is caused by the ossified posterior longitudinal ligament occupying space in the spinal canal,which causes compression of the thoracic spinal cord.Surgical treatment is difficult,risky and complicated;thus,clinical treatment is difficult at present.CASE SUMMARY A case of severe multi-segmental T-OPLL treated with thoracic anterior controllable antedisplacement fusion(TACAF)is reported,including the surgical procedures and analysis of the clinical data.The modified-Japanese Orthopaedic Association score in this patient was 4 before surgery,and it was raised to 9 after the operation.The symptoms of spinal canal compression were subsequently relieved.Three months after surgery,digital radiography showed good healing and recovery of limb sensory function.CONCLUSION This case report suggests that TACAF is feasible for the treatment of long-segment T-OPLL,and has the advantages of low risk and reduced trauma.However,this operation still needs to be verified by clinical research with a larger sample size.
基金supported by the General Administration of Sport of China(23QN009)the National Natural Science Foundation of China(12102235)。
文摘Background:The anterior talofibular ligament(ATFL)and the calcaneofibular ligament(CFL)are vulnerable to be torn or ruptured during lateral ankle sprain(LAS),especially in people with chronic ankle instability(CAI).This study aims to determine whether landing with a larger toe-out angle would influence ATFL and CFL strains in people with CAI,aiming to contribute to the development of effective landing strategies to reduce LAS risk.Methods:Thirty participants with CAI(22 males and 8 females,age:21.2±1.2 years,height:176.9±9.0 cm,body mass:70.6±12.1 kg,mean±SD)were recruited.Each participant landed on a specialized trap-door device with their unaffected limbs on a support platform and their affected limbs on a movable platform,which could be flipped 24°inward and 15°forward to mimic LAS conditions.Two landing conditions were tested—i.e.,natural landing(NL,with natural toe-out angle at landing)and toe-out landing(TL,with toe-out angle increased to over 150%of that under the NL conditions).Kinematic data were captured using a 12-camera motion analysis system,and ATFL and CFL strains were calculated using a 3D rigid-body foot model.Paired sample t tests and Pearson's correlations were used to analyze data.Results:Compared to NL conditions,ATFL strain decreased(p<0.001,d=2.42)while CFL strain remained unchanged(p=0.229,d=0.09)under TL conditions.The toe-out angle was negatively and strongly correlated with ATFL strain(r=-0.743,p<0.001)but not with CFL strain(r=0.153,p=0.251).Compared to NL conditions,participants exhibit a lower ankle inversion angle(p<0.001,d=0.494),a higher plantarflexion angle(p<0.001,d=1.101),and no significant difference in external rotation angle(p=0.571,d=0.133)under TL conditions.Conclusion:Toe-out landing may reduce ATFL strain while maintaining CFL strain in people with CAI,thereby reducing the risk of LAS.
基金Supported by a grant of Korea University Anam Hospital,Seoul,Republic of Korea,No.K2209741.
文摘Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint.Numerous studies investigated the anatomy,function,and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability.However,controversies regarding its existence,prevalence,and femoral and tibial insertions need to be addressed.According to a recent consensus,ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint,with some anatomic variations.The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies.Generally,ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.
