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 One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical out...BACKGROUND One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical outcomes and magnetic resonance image(MRI)evaluation after meniscus suture repair for longitudinal tears at a minimum 2-year-follow-up.METHODS We conducted a retrospective review of meniscal repairs between January 2004 and December 2018.All patients treated for longitudinal tears associated or not with an anterior cruciate ligament reconstruction(ACL-R)were included.Meniscal ramp lesions,radial and root tears,associated with multiligament injuries,tibial fracture and meniscal allograft transplants were excluded.Surgical details and failure rate,defined as symptomatic patients who underwent a revision surgery,were analyzed.As isolated bucket handle tears(BHTs)were usually associated with higher failure rates,we compared BHTs and not BHTs associated or not with an ACL-R.Since 2014,the inside-out technique using cannulas and suture needles with 2-0 Tycron began to predominate.In addition,the number of stitches per repair was increased.In view of differences in surgical technique,we compared two different cohorts:before and after 2014.We recorded the RTS according to the level achieved and the time to RTS.Lysholm and IKDC scores were recorded.Patients were studied with x-rays and MRI as standard postoperative control.RESULTS One hundred and nineteen patients were included with a mean follow up of 7 years(SD:4.08).Overall failure rate was 20.3%at a mean 20.1 mo.No statistically significant differences were found when comparing failure for medial and lateral meniscal repair(22.7%and 15.3%,P=0.36),BHTs and not BHTs(26%and 17.6%,P=0.27),isolated or associated with an ACL-R(22.9%and 18%,P=0.47),or when comparing only BHTs associated with an ACL-R(23%and 27.7%,P=0.9)or not.When comparing cohorts before and after 2014,we found a significant decrease in the overall failure rate from 26%to 11%(P<0.03).Isolated lesions presented a decrease from 28%to 6.6%(P=0.02),BHTs from 34%to 8%(P=0.09)and those associated with an ACL-R from 25%to 10%(P=0.09).Mean RTS time was 6.5 mo in isolated lesions and 8.64 mo when associated with an ACL-R.Overall,56%of patients returned to the same sport activity level.Mean pre and postoperative Lysholm scores were 64 and 85(P=0.02),and IKDC 58 and 70(P=0.03).Out of 84 asymptomatic patients evaluated with MRI,39%were classified as“not healed”and 61%as“healed”.CONCLUSION Even though the overall failure rate of our series was 20.3%,we found a statistically significant decrease from 26%to 11%,not only for isolated lesions,but also for BHT’s and those associated with an ACL-R when comparing our series in two different cohorts,most probably due to improvements in surgical technique.展开更多
Background: Intertrochanteric fractures are of intense interest globally. They are the most frequently operated fracture type, have the highest postoperative fatality rate of surgically treated fractures, and have bec...Background: Intertrochanteric fractures are of intense interest globally. They are the most frequently operated fracture type, have the highest postoperative fatality rate of surgically treated fractures, and have become a serious health resource issue due to the high cost of care required after injury. A number of problems exist when determining the best option for treatment for intertrochanteric fractures. The classification systems do not work well enough for preoperative planning and the reduction criteria have not been well defined. Methods: All patients who presented to Firoozgar Hospital, Tehran with intertrochanteric fracture, between March 20th 2013 and December 21st 2015, underwent DHS implementation, after 6-month follow-up period. Demographic data, preoperative radiographic fracture, bone quality typing (AO/OTA and Dorr classification), American Society of Anesthesiologists (ASA) score and evaluation of their correlation with the complication of fixation including nonunion and device failure were recorded and analyzed. Result: 101 patients including 54 males (53.5%) and 47 females (46.5%) underwent DHS implementation. Mean population age was 73.06 ± 16.36 years with an age range of 30 to 94 years;the most frequent age period was 76 - 85 years, injured by low-energy trauma mechanism and 23.8% patients were injured in a high-energy trauma. 56 patients completed the 6-month follow-up evaluation which ranged from 1 to 80 weeks. According to AO/OTA classification, the most common type among the patient population was A2, 27 patients (51.5%);while the most common group from Dorr classification turned to be group B (39.6%). Classification by ASA score revealed Class II to be most frequent among the patient population (56.4%). Nonunion was seen in eight of patients (14.3%). Three patients (5.4%) had device failure, two cases showed side plate breakage, and another one had screw cut out. There was no significant relationship between AO/OTA classification with the both complications i.e. the development of device failure (P = 0.85) and nonunion (P = 0.99). Non-significant correlation was found between Dorr classification with device failure (P = 0.06) and nonunion (P = 0.11). Conclusion: Regarding recent studies, more effective factor on the outcome is patient’s medical condition before surgery compared to the radiographic findings including AO/OTA and Dorr classification.展开更多
The articular osteochondral injury involves the repair of hyaline cartilage,subchondral bone plate,and cancellous bone.Due to the weak regeneration ability of chondrocytes and the complex structure of the bone-cartila...The articular osteochondral injury involves the repair of hyaline cartilage,subchondral bone plate,and cancellous bone.Due to the weak regeneration ability of chondrocytes and the complex structure of the bone-cartilage junction,there is currently no excellent repair method.The challenge of hyaline cartilage repair is to avoid fibrosis and hypertrophy,which has been solved to some extent after the advent of type II collagen scaffolds;the difficulty of the subchondral bone plate and cancellous bone repair lies in the repair of the complex transition structure of cartilage tidemark,calcified cartilage,subchondral bone plate,and cancellous bone.Inspired by developmental biology,the generation of this complex structure during development depends on endochondral ossification(ECO).ECO depends on some specific proteins,such as IHH,PTHrP,BMP,and WNT,and the receptors of these proteins.Studies have shown that polydopamine coating can promote the production of BMP and WNT proteins.We developed a type II collagen-based double-layer scaffold(Col II&Dopa-Col II)with type II collagen on the upper layer and polydopamine-coated type II collagen on the lower layer.Proteomics and RNA sequencing analysis have found that polydopamine coating can mobilize the proliferation and hy-pertrophy differentiation of chondrocytes,induce intra-chondral vascular nerve invasion,and promote ECO and bone remodeling by upregulating Parathyroid hormone signaling pathway,Hedgehog signaling pathway,VEGF signaling pathway,and Axon guidance.All the results indicate that Col II&Dopa-Col II can achieve hyaline cartilage and vascularized subchondral bone regeneration.展开更多
The natural ligament-bone interface features gradient changes in matrix composition,architecture and cell phenotype,which play critical roles in reliable ligament fixation and smooth loading transfer.Mimicking such or...The natural ligament-bone interface features gradient changes in matrix composition,architecture and cell phenotype,which play critical roles in reliable ligament fixation and smooth loading transfer.Mimicking such organisations in artificial composite tissue-engineering scaffolds is important for realising functional fixation between ligament implants and host bones.Here,the authors aim to provide a comprehensive review on the latest strategies to fabricate biomimetic composite scaffolds for the regeneration of ligament-to-bone interface.The biomimetic composite scaffolds are divided into stratified and gradient scaffolds,which are characterised as layer-specific and continuous changes,respectively,in scaffold materials and/or microstructures.Biofabrication strategies for different types of composite scaffolds are summarised.The effects of material/structural changes on cellular morphology,cell differentiation,in vivo osteointegration and multi-tissue interface regeneration are highlighted.Finally,the potential challenges and future perspectives in engineering biomimetic composite scaffolds for ligament-bone interface regeneration are discussed.展开更多
Macrophages play a key role in wound healing.Dysfunction of their MO polarization to M2 leads to disorders of the wound immune microenvironment and chronic inflammation,which affects wound healing.Regulating the polar...Macrophages play a key role in wound healing.Dysfunction of their MO polarization to M2 leads to disorders of the wound immune microenvironment and chronic inflammation,which affects wound healing.Regulating the polarization of Mo macrophages to M2 macro-phages is an effective strategy for treating wound healing.Mesenchymal stem cells(MsCs)deliver endogenous regulatory factors via paracrine extracellular vesicles,which may play a key role in wound healing,and previous studies have shown that apoptotic bodies(ABs)are closely associated with inflammation regression and macrophage polarization.However,the specific regulatory mechanisms involved in ABs remain unknown.In the present study,we de-signed an MSC-AB(MSC-derived AB)-loaded polycaprolactone(PCL)scaffold,evaluated the macrophage phenotype and skin wound inflammation in vivo and in vitro,and explored the ability of MSC-AB-loaded PCL scaffolds to promote wound healing.Our data suggest that the PCL scaffold regulates the expression of the CCL-1 gene by targeting the delivery of mmu-miR-21a-5p by local sustained-release MSC-ABs,and drives MO macrophages to program M2 macrophages to regulate inflammation and angiogenesis,thereby synergistically promoting wound healing.This study provides a promising therapeutic strategy and experimental basis for treating various diseases associated with imbalances in proinflammatory and anti-inflammatory immuneresponses.展开更多
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 One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical outcomes and magnetic resonance image(MRI)evaluation after meniscus suture repair for longitudinal tears at a minimum 2-year-follow-up.METHODS We conducted a retrospective review of meniscal repairs between January 2004 and December 2018.All patients treated for longitudinal tears associated or not with an anterior cruciate ligament reconstruction(ACL-R)were included.Meniscal ramp lesions,radial and root tears,associated with multiligament injuries,tibial fracture and meniscal allograft transplants were excluded.Surgical details and failure rate,defined as symptomatic patients who underwent a revision surgery,were analyzed.As isolated bucket handle tears(BHTs)were usually associated with higher failure rates,we compared BHTs and not BHTs associated or not with an ACL-R.Since 2014,the inside-out technique using cannulas and suture needles with 2-0 Tycron began to predominate.In addition,the number of stitches per repair was increased.In view of differences in surgical technique,we compared two different cohorts:before and after 2014.We recorded the RTS according to the level achieved and the time to RTS.Lysholm and IKDC scores were recorded.Patients were studied with x-rays and MRI as standard postoperative control.RESULTS One hundred and nineteen patients were included with a mean follow up of 7 years(SD:4.08).Overall failure rate was 20.3%at a mean 20.1 mo.No statistically significant differences were found when comparing failure for medial and lateral meniscal repair(22.7%and 15.3%,P=0.36),BHTs and not BHTs(26%and 17.6%,P=0.27),isolated or associated with an ACL-R(22.9%and 18%,P=0.47),or when comparing only BHTs associated with an ACL-R(23%and 27.7%,P=0.9)or not.When comparing cohorts before and after 2014,we found a significant decrease in the overall failure rate from 26%to 11%(P<0.03).Isolated lesions presented a decrease from 28%to 6.6%(P=0.02),BHTs from 34%to 8%(P=0.09)and those associated with an ACL-R from 25%to 10%(P=0.09).Mean RTS time was 6.5 mo in isolated lesions and 8.64 mo when associated with an ACL-R.Overall,56%of patients returned to the same sport activity level.Mean pre and postoperative Lysholm scores were 64 and 85(P=0.02),and IKDC 58 and 70(P=0.03).Out of 84 asymptomatic patients evaluated with MRI,39%were classified as“not healed”and 61%as“healed”.CONCLUSION Even though the overall failure rate of our series was 20.3%,we found a statistically significant decrease from 26%to 11%,not only for isolated lesions,but also for BHT’s and those associated with an ACL-R when comparing our series in two different cohorts,most probably due to improvements in surgical technique.
文摘Background: Intertrochanteric fractures are of intense interest globally. They are the most frequently operated fracture type, have the highest postoperative fatality rate of surgically treated fractures, and have become a serious health resource issue due to the high cost of care required after injury. A number of problems exist when determining the best option for treatment for intertrochanteric fractures. The classification systems do not work well enough for preoperative planning and the reduction criteria have not been well defined. Methods: All patients who presented to Firoozgar Hospital, Tehran with intertrochanteric fracture, between March 20th 2013 and December 21st 2015, underwent DHS implementation, after 6-month follow-up period. Demographic data, preoperative radiographic fracture, bone quality typing (AO/OTA and Dorr classification), American Society of Anesthesiologists (ASA) score and evaluation of their correlation with the complication of fixation including nonunion and device failure were recorded and analyzed. Result: 101 patients including 54 males (53.5%) and 47 females (46.5%) underwent DHS implementation. Mean population age was 73.06 ± 16.36 years with an age range of 30 to 94 years;the most frequent age period was 76 - 85 years, injured by low-energy trauma mechanism and 23.8% patients were injured in a high-energy trauma. 56 patients completed the 6-month follow-up evaluation which ranged from 1 to 80 weeks. According to AO/OTA classification, the most common type among the patient population was A2, 27 patients (51.5%);while the most common group from Dorr classification turned to be group B (39.6%). Classification by ASA score revealed Class II to be most frequent among the patient population (56.4%). Nonunion was seen in eight of patients (14.3%). Three patients (5.4%) had device failure, two cases showed side plate breakage, and another one had screw cut out. There was no significant relationship between AO/OTA classification with the both complications i.e. the development of device failure (P = 0.85) and nonunion (P = 0.99). Non-significant correlation was found between Dorr classification with device failure (P = 0.06) and nonunion (P = 0.11). Conclusion: Regarding recent studies, more effective factor on the outcome is patient’s medical condition before surgery compared to the radiographic findings including AO/OTA and Dorr classification.
基金General Research Fund (GRF) from the Research Grants Council (RGC) of the Hong Kong Special Administrative Region, China (CUHK11205324)Grant from Karolinska Institutet Ming Wai Lau Center of Reparative Medicine (CityUHK 9231486)Grant from Health@InnoHK: CNRM, Innovation and Technology Commission, Hong Kong SAR.
文摘The articular osteochondral injury involves the repair of hyaline cartilage,subchondral bone plate,and cancellous bone.Due to the weak regeneration ability of chondrocytes and the complex structure of the bone-cartilage junction,there is currently no excellent repair method.The challenge of hyaline cartilage repair is to avoid fibrosis and hypertrophy,which has been solved to some extent after the advent of type II collagen scaffolds;the difficulty of the subchondral bone plate and cancellous bone repair lies in the repair of the complex transition structure of cartilage tidemark,calcified cartilage,subchondral bone plate,and cancellous bone.Inspired by developmental biology,the generation of this complex structure during development depends on endochondral ossification(ECO).ECO depends on some specific proteins,such as IHH,PTHrP,BMP,and WNT,and the receptors of these proteins.Studies have shown that polydopamine coating can promote the production of BMP and WNT proteins.We developed a type II collagen-based double-layer scaffold(Col II&Dopa-Col II)with type II collagen on the upper layer and polydopamine-coated type II collagen on the lower layer.Proteomics and RNA sequencing analysis have found that polydopamine coating can mobilize the proliferation and hy-pertrophy differentiation of chondrocytes,induce intra-chondral vascular nerve invasion,and promote ECO and bone remodeling by upregulating Parathyroid hormone signaling pathway,Hedgehog signaling pathway,VEGF signaling pathway,and Axon guidance.All the results indicate that Col II&Dopa-Col II can achieve hyaline cartilage and vascularized subchondral bone regeneration.
基金The Youth Innovation Team of Shaanxi Universitiesthe National Key Research and Development Program of China,Grant/Award Number:2018YFA0703000+4 种基金the Fundamental Research Funds for the Central UniversitiesGuangdong Basic and Applied Basic Research Foundation,Grant/Award Number:2020B1515130002the Key Research Project of Shaanxi Province,Grant/Award Numbers:2020GXLH-Y-021,2021GXLH-Z-028the Basic Research Program of Natural Science in Shaanxi Province,Grant/Award Number:2021JQ-906the National Natural Science Foundation of China,Grant/Award Number:81601937。
文摘The natural ligament-bone interface features gradient changes in matrix composition,architecture and cell phenotype,which play critical roles in reliable ligament fixation and smooth loading transfer.Mimicking such organisations in artificial composite tissue-engineering scaffolds is important for realising functional fixation between ligament implants and host bones.Here,the authors aim to provide a comprehensive review on the latest strategies to fabricate biomimetic composite scaffolds for the regeneration of ligament-to-bone interface.The biomimetic composite scaffolds are divided into stratified and gradient scaffolds,which are characterised as layer-specific and continuous changes,respectively,in scaffold materials and/or microstructures.Biofabrication strategies for different types of composite scaffolds are summarised.The effects of material/structural changes on cellular morphology,cell differentiation,in vivo osteointegration and multi-tissue interface regeneration are highlighted.Finally,the potential challenges and future perspectives in engineering biomimetic composite scaffolds for ligament-bone interface regeneration are discussed.
基金supported by the National Natural Science Foundation of China (No.82072443,82372425)the Chongqing Outstanding Project of Overseas Chinese Entrepreneurship and Innovation Support Program (China) (No.CX2022032)+6 种基金the Articular Cartilage Tissue Engineering and Regenerative Medicine Team,Chongqing Medical University (No.W0080)the General Project of Natural Science Foundation of Chongqing,China (No.CSTB2023NSCQMSX0166)the"Tomorrow Cup"Teacher-Student Cocreation Teaching and Research Innovation Project of International Medical College of Chongqing Medical University (No.KY20220204)the Chengdu Medical Research Project (Sichuan,China) (No.2023191)the China Postdoctoral Science Foundation (No.2022M710557)the Natural Science Foundation of Chongqing,China (No.CSTB2023NSCQBHx0011)the Young Excellent Science and Technology Talent Project of the First Affiliated Hospital of Chongqing Medical University (No.ZYRC2022-05).
文摘Macrophages play a key role in wound healing.Dysfunction of their MO polarization to M2 leads to disorders of the wound immune microenvironment and chronic inflammation,which affects wound healing.Regulating the polarization of Mo macrophages to M2 macro-phages is an effective strategy for treating wound healing.Mesenchymal stem cells(MsCs)deliver endogenous regulatory factors via paracrine extracellular vesicles,which may play a key role in wound healing,and previous studies have shown that apoptotic bodies(ABs)are closely associated with inflammation regression and macrophage polarization.However,the specific regulatory mechanisms involved in ABs remain unknown.In the present study,we de-signed an MSC-AB(MSC-derived AB)-loaded polycaprolactone(PCL)scaffold,evaluated the macrophage phenotype and skin wound inflammation in vivo and in vitro,and explored the ability of MSC-AB-loaded PCL scaffolds to promote wound healing.Our data suggest that the PCL scaffold regulates the expression of the CCL-1 gene by targeting the delivery of mmu-miR-21a-5p by local sustained-release MSC-ABs,and drives MO macrophages to program M2 macrophages to regulate inflammation and angiogenesis,thereby synergistically promoting wound healing.This study provides a promising therapeutic strategy and experimental basis for treating various diseases associated with imbalances in proinflammatory and anti-inflammatory immuneresponses.
