Publications by authors named "Yuelin Hu"

19 Publications

  • Page 1 of 1

Midterm Outcomes of Talocalcaneal Coalition Arthroscopic Resection in Adults.

Foot Ankle Int 2022 Aug 26;43(8):1062-1069. Epub 2022 May 26.

Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.

Background: Arthroscopic resection of the talocalcaneal coalition (TCC) has been reported to be associated with good short-term outcomes. However, the midterm outcomes of this approach remain uncertain.

Methods: We performed a retrospective study of patients who underwent arthroscopic resection for symptomatic TCC. The patients were divided into 2 groups (group P, patients with isolated posterior facet coalition; and group MP, patients with both middle and posterior facet coalition). The preoperative and postoperative visual analog scale (VAS) scores for pain and American Orthopaedic Foot & Ankle Society (AOFAS) scale scores were calculated. The postoperative AOFAS and VAS scores between the 2 groups were analyzed. Patient satisfaction was also assessed.

Results: Thirty-two patients were included in this study. The mean age at the time of surgery was 26.0±8.5 years, and the mean follow-up period was 56.9±18.0 months. Thirteen (41%) patients were in group P, whereas 19 (59%) patients were in group MP. Postoperative VAS and AOFAS scores improved more significantly than preoperative scores. At the final follow-up, excellent and good subjective outcomes were attained in 26 patients (81%), fair and poor outcomes in 6 patients (19%). There were no statistical differences in the postoperative AOFAS (91.0±7.0 vs 85.8±10.8, = .532) and VAS score (2.1±1.7 vs 4.0±2.6, = .537) between patients with the ratio of coalition/posterior facet more than or less than 50%. There were no statistical differences in postoperative VAS score (1.8±1.3 vs 2.6±2.2, = .236) and AOFAS score (92.5±5.6 vs 89.2±8.7, = .297) between group P (n=13) and group MP (n=19), either. Three patients (9.4%) had complications, including these notable findings: 1 patient complained of restricted dorsal flexion, 1 with computed tomography-proven coalition recurrence, and 1 with partial tibial nerve injury.

Conclusion: We found that TCC arthroscopic resection was generally associated with reasonable outcomes at midterm follow-up.

Level Of Evidence: Level IV, case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/10711007221092756DOI Listing
August 2022

Distal insertion rupture of lateral ankle ligament as a predictor of weakened and delayed sports recovery after acute ligament repair: mid-term outcomes of 117 cases.

BMC Musculoskelet Disord 2022 Mar 28;23(1):294. Epub 2022 Mar 28.

Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.

Background: For lateral ankle ligament rupture, surgical repair has been considered for patients requiring return to high-demanding sports. However, there is a lack of systematic research regarding arthroscopic treatment followed by ligament repair for severe acute ankle sprain. The purpose of this study was to analyze the mid-term outcomes of arthroscopy followed by open anatomic lateral ankle ligament repair surgery for acute lateral ankle sprain and the impact of ligament rupture site on the outcomes.

Methods: Professional or amateur athletes with clinically- and radiologically-confirmed grade III acute lateral ankle ligament injuries undergoing ankle arthroscopy followed by open anatomic ligament repair between June 2007 and May 2017 were reviewed. Intra-articular lesions and the location of rupture were first examined under arthroscopy. Simple suture repair was performed for mid- substance ligament rupture (middle group), while suture repair with anchors were used for the ruptures near the ligament attachment site on the fibular (proximal group), talar or the calcaneal side (distal group). Outcomes were evaluated at final follow-up, including visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Tegner score, time to return to sports, resumption of pre-injury sports level, sprain recurrence and range of motion (ROM).

Results: A total of 117 patients were included for analysis, with a mean follow-up duration of 46.4 ± 16.1 months. There were 48 (41%) cases in the proximal group, 41 (35%) cases in the middle group and 28 (24%) cases in the distal group respectively. At final follow-up, all of the VAS score, AOFAS score and the Tegner score were significantly improved from the pre-operative level (p < 0.001). 12 (10%) patients complained of sprain recurrence during follow-up. 14 (12%) patients reported mild ROM restriction and 7 (6%) patients experienced transient skin numbness. The average time to return to pre-injury sports was 4.34 ± 1.11 months. The smallest proportion (86% ± 13%) of resumption of pre-injury sports level was reported from the distal group, compared with 93% ± 12% for the proximal group and 89% ± 14% for the middle group (p = 0.037). Time to return to sports was significantly longer for the distal group, with an average of 4.59 ± 1.27 months compared to 3.99 ± 1.09 months for the proximal group and 4.58 ± 0.90 months for the middle group (p = 0.009).

Conclusions: Ankle arthroscopy followed by open anatomic ligament repair is a reliable procedure for patients requiring return to high demanding sports after severe acute ankle sprains. Distal rupture near the talar or calcaneal end was associated with delayed return-to-sport and inferior performance in resuming pre-injury sports level.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12891-022-05260-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961918PMC
March 2022

Mussel-inspired extracellular matrix-mimicking hydrogel scaffold with high cell affinity and immunomodulation ability for growth factor-free cartilage regeneration.

J Orthop Translat 2022 Mar 10;33:120-131. Epub 2022 Mar 10.

Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, Sichuan, China.

Background: Injury to articular cartilage cause certain degree of disability due to poor self-repair ability of cartilage tissue. To promote cartilage regeneration, it is essential to develop a scaffold that properly mimics the native cartilage extracellular matrix (ECM) in the aspect of compositions and functions.

Methods: A mussel-inspired strategy was developed to construct an ECM-mimicking hydrogel scaffold by incorporating polydopamine-modified hyaluronic acid (PDA/HA) complex into a dual-crosslinked collagen (Col) matrix for growth factor-free cartilage regeneration. The adhesion, proliferation, and chondrogenic differentiation of cells on the scaffold were examined. A well-established full-thickness cartilage defect model of the knee in rabbits was used to evaluated the efficacy and functionality of the engineered Col/PDA/HA hydrogel scaffold.

Results: The PDA/HA complex incorporated-hydrogel scaffold with catechol moieties exhibited better cell affinity than bare negatively-charged HA incorporated hydrogel scaffold. In addition, the PDA/HA complex endowed the scaffold with immunomodulation ability, which suppressed the expression of inflammatory cytokines and effectively activated the polarization of macrophages toward M2 phenotypes. The in vivo results revealed that the mussel-inspired Col/PDA/HA hydrogel scaffold showed strong cartilage inducing ability to promote cartilage regeneration.

Conclusions: The PDA/HA complex-incorporated hydrogel scaffold overcame the cell repellency of negatively-charged polysaccharide-based scaffolds, which facilitated the adhesion and clustering of cells on the scaffold, and therefore enhanced cell-HA interactions for efficient chondrogenic differentiation. Moreover, the hydrogel scaffold modulated immune microenvironment, and created a regenerative microenvironment to enhance cartilage regeneration.

The Translational Potential Of This Article: This study gives insight into the mussel-inspired approach to construct the tissue-inducing hydrogel scaffold in a growth-factor-free manner, which show great advantage in the clinical treatment. The hydrogel scaffold composed of collagen and hyaluronic acid as the major component, providing cartilage ECM-mimicking environment, is promising for cartilage defect repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jot.2022.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914478PMC
March 2022

Comparison of Autologous Osteoperiosteal and Osteochondral Transplantation for the Treatment of Large, Medial Cystic Osteochondral Lesions of the Talus.

Am J Sports Med 2022 Mar 20;50(3):769-777. Epub 2022 Jan 20.

Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Haidian District, Beijing, China.

Background: Autologous osteoperiosteal transplantation (AOPT) using graft harvested from the iliac crest is used to treat large cystic osteochondral lesions of the talus (OLTs). However, no studies have compared clinical and radiologic outcomes between AOPT and autologous osteochondral transplantation (AOCT) using graft harvested from the nonweightbearing zone of the femoral condyle of the ipsilateral knee in patients with large cystic OLTs.

Purpose: To compare clinical and radiologic outcomes between patients undergoing AOPT and those undergoing AOCT for large cystic OLTs.

Study Design: Cohort study; Level of evidence, 3.

Methods: Between March 2015 and March 2018, patients who underwent AOCT and AOPT to treat medial large cystic OLTs (>10 mm) were retrospectively evaluated. For comparability, the 2 groups were matched 1:1 based on their characteristics, including sex, age, body mass index, side of injury, follow-up period, and the preoperative cyst volume. After propensity score matching, 23 patients were enrolled in each group for the analysis. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Tegner score. Donor-site morbidity was recorded according to the symptoms, including pain, stiffness, swelling, and discomfort. In addition, the Lysholm score was used to assess the most common knee donor-site morbidity. Radiologic outcomes were evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score, and the International Cartilage Regeneration & Joint Preservation Society (ICRS) score was obtained during second-look surgery.

Results: The mean follow-up period was about 48 months. There were no significant differences in patient characteristics and lesion volumes between groups. Postoperative ankle pain VAS score, AOFAS score, and Tegner score were not significantly different between groups at final follow-up. Total donor-site morbidity ( = .004) and discomfort morbidity ( = .009) were significantly lower in the AOPT group than in the AOCT group. However, the Lysholm score showed no significant difference between the donor knee and the opposite knee ( = .503) in the AOCT group. The MOCART and ICRS scores were not significantly different between groups.

Conclusion: Clinical and radiologic outcomes of patients who underwent AOPT from the iliac crest were found to be comparable with those of patients who underwent AOCT from the ipsilateral knee for the treatment of medial large cystic OLTs. These results may be helpful for orthopaedic surgeons to decide appropriate treatments for patients with large cystic OLTs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03635465211068529DOI Listing
March 2022

A new classification of talocalcaneal coalitions based on computed tomography for operative planning.

BMC Musculoskelet Disord 2021 Aug 11;22(1):678. Epub 2021 Aug 11.

Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China.

Background: Current classifications emphasize the morphology of the coalition, however, subtalar joint facets involved should also be emphasized.

Objective: The objective of this study was to develop a new classification system based on the articular facets involved to cover all coalitions and guide operative planning.

Methods: Patients were diagnosed with talocalcaneal coalition using a CT scan, between January 2009 and February 2021. The coalition was classified into four main types according to the shape and nature of the coalition: I, inferiorly overgrown talus or superiorly overgrown calcaneus; II, both talus and calcaneus overgrew; III, coalition with an accessory ossicle; IV, complete osseous coalition (I-III types are non-osseous coalition). Then each type was further divided into three subtypes according to the articular facets involved. A, the coalition involving the anterior facets; M, the coalition involving the middle facets, and P, the coalition involving the posterior facets. Interobserver reliability was measured at the main type (based on nature and shape) and subtype (articular facet involved) using weighted Kappa. Results There were 106 patients (108 ft) included in this study. Overall, 8 ft (7.5%) were classified as type I, 75 ft (69.4%) as type II, 7 ft (6.5%) as type III, and 18 ft (16.7%) as type IV. Twenty-nine coalitions (26.9%) involved the posterior facets only (subtype-P), 74 coalitions (68.5%) involved both the middle and posterior facets (subtype-MP), and five coalitions (4.6%) simultaneously involved the anterior, middle, and posterior facets (subtype-AMP). Type II-MP coalition was the most common. The value of weighted Kappa for the main type was 0.93 (95%CI 0.86-0.99) (p<0.001), and the value for the subtype was 0.78 (95%CI 0.66-0.91) (p<0.001).

Conclusion: A new classification system of the talocalcaneal coalition to facilitate operative planning was developed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12891-021-04567-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356385PMC
August 2021

Open Versus Endoscopic Osteotomy of Posterosuperior Calcaneal Tuberosity for Haglund Syndrome: A Retrospective Cohort Study.

Orthop J Sports Med 2021 Apr 19;9(4):23259671211001055. Epub 2021 Apr 19.

Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, People's Republic of China.

Background: Although endoscopic calcaneoplasty and retrocalcaneal debridement have been extensively applied to treat Haglund syndrome, evidence of the value of the endoscopic procedure remains to be fully established.

Purpose/hypothesis: The purpose of this study was to compare the postoperative outcomes and the amount of osteotomy between open and endoscopic surgery for the treatment of Haglund syndrome. It was hypothesized that endoscopic calcaneoplasty would lead to higher patient satisfaction and lower complication rates compared with open surgical techniques.

Study Design: Cohort study; Level of evidence, 3.

Methods: The following postoperative outcomes were compared between the open surgery group (n = 20) and the endoscopic surgery group (n = 27): visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index, Tegner score, Ankle Activity Score, and 36-Item Short Form Health Survey; postoperative complications; and duration of surgery. To determine the extent of resection, the authors compared the calcaneal height ratio, calcaneal resection ratio, calcaneal resection angle, pitch line, and Haglund deformity height between groups. The learning curve for endoscopic calcaneoplasty was also calculated.

Results: There were no significant differences between the open and endoscopic groups on any outcome score. Two patients in the open group reported temporary paresthesia around the incisional site, indicating sural nerve injuries; no complication was reported in the endoscopy group. None of the parameters for extent of resection were statistically significant between the groups. The duration of surgery was 44.90 ± 10.52 and 65.39 ± 11.12 minutes in the open and endoscopy groups, respectively ( = .001). Regarding the learning curve for endoscopic calcaneoplasty (6 surgeons; 27 follow-up patients; 9 patients lost to follow-up), the duration of surgery reached a steady point of 55.68 ± 4.19 minutes after the fourth operation.

Conclusion: The results of this study indicated that the endoscopy procedure was as effective as the open procedure. The endoscopic procedure required significantly more time than the open procedure, and the duration of the endoscopic procedure was shortened only after the fourth operation, suggesting that it requires high technical skills and familiarity with the anatomic relationships.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23259671211001055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058802PMC
April 2021

Calcaneoplasty coupled with an insertional Achilles tendon reattachment procedure for the prevention of secondary calcaneal impingement: a retrospective study.

Ther Adv Chronic Dis 2020 3;11:2040622320944793. Epub 2020 Aug 3.

Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, PR China.

Background: Posterior heel pain may occur after an Achilles insertional rupture reattachment procedure and could be attributed to an impingement between the calcaneal tuberosity and Achilles tendon, which could be observed using postoperative magnetic resonance imaging (MRI). Moreover, such impingement, which may be associated with postoperative pain symptoms, could be relieved by calcaneoplasty.

Methods: Postoperative Visual Analog Pain Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, Foot Function Index (FFI), Ankle Activity Score (AAS), and Tegner score were obtained and compared between 10 patients who underwent calcaneoplasty (calcaneoplasty group) and 11 patients who did not receive calcaneoplasty (non-calcaneoplasty group). Several signs of calcaneal tuberosity impingement identified in MRI were also compared between the two groups, which included retrocalcaneal bursitis, postoperative tendinopathy, tendon calcification, bone marrow edema, increased Achilles tendon diameter, and bony spurs.

Results: The VAS score was 2.00 ± 1.41 and 2.18 ± 1.83 ( = 0.803), the AOFAS score was 90.60 ± 4.22 and 81.82 ± 7.77 ( = 0.005), the FFI was 5.00 ± 2.86 and 17.18 ± 15.92 ( = 0.028), the AAS was 5.50 ± 2.55 and 5.82 ± 2.04 ( = 0.750), and the Tegner score was 4.30 ± 1.49 and 4.45 ± 1.21 ( = 0.797) in the calcaneoplasty and non-calcaneoplasty groups, respectively. The AOFAS score and FFI were significantly different between the groups. MRI findings revealed that the non-calcaneoplasty group had significant signs of calcaneal impingement compared with the calcaneoplasty group.

Conclusions: Secondary calcaneal impingement due to insertional tendon enlargement may occur, and prophylactic calcaneoplasty coupled with an insertional reattachment procedure could achieve promising postoperative outcomes for patients with insertional Achilles tendon rupture.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2040622320944793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8832320PMC
August 2020

Chinese Consensus on Insertional Achilles Tendinopathy.

Orthop J Sports Med 2019 Oct 11;7(10):2325967119879052. Epub 2019 Oct 11.

H.X. and H.L. contributed equally to this work.

Background: Insertional Achilles tendinopathy (IAT) is a common finding in the clinic. However, consensus on its mechanism, pathological process, diagnosis, treatment, and rehabilitation is lacking. Thus, the Chinese Society of Sports Medicine organized and invited experts representing the fields of ankle disease and tendinopathy to jointly develop an expert consensus on IAT.

Study Design: A consensus statement of the Chinese Society of Sports Medicine.

Methods: A total of 34 experts in the field of sports medicine and orthopaedics were invited to participate in the compilation of a consensus statement regarding IAT. Consensus was achieved according to the Delphi method. First, 10 working groups composed of 34 experts were established to compile draft statements about clinical problems related to IAT by reviewing and analyzing the available literature. An expert consensus meeting to discuss drafts was then arranged. Each statement was individually presented and discussed, followed by a secret vote. Consensus was reached when more than 50% of the experts voted in its favor. The strength of the proposed recommendation was classified based on the proportion of favorable votes: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimity, 100%.

Results: Of the 10 expert consensus statements on the clinical diagnosis and treatment of IAT, there was strong consensus for 8 statements and unanimity for 2 statements.

Conclusion: This expert consensus focused on the concepts, causes, pathological process, clinical diagnosis, and treatment of IAT. Accepted recommendations in these areas which will assist clinicians in carrying out standardized management of related diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2325967119879052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791038PMC
October 2019

Optimal Outcomes for Acute Avulsion Fracture of the Achilles Tendon Treated With the Insertional Reattachment Technique: A Case Series of 31 Cases With Over 2 Years of Follow-up.

Am J Sports Med 2019 10 3;47(12):2993-3001. Epub 2019 Sep 3.

Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China.

Background: Avulsion fracture of the Achilles tendon is a less common but debilitating disorder. There is a paucity of literature on this problem.

Purpose: To present a retrospective case series assessing the clinical outcomes of avulsion fracture of the Achilles tendon after a reattachment procedure and to identify potential factors predicting postoperative outcomes.

Study Design: Case series; Level of evidence, 4.

Methods: A consecutive case series of 35 patients with acute insertional rupture of the Achilles tendon who received a reattachment procedure between 2011 and 2017 were reviewed. All patients were measured and classified by magnetic resonance imaging (MRI) and surgical findings. Patient-reported outcomes were evaluated using the visual analog scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI), Tegner score, and Ankle Activity Score (AAS). The range of motion and single-legged heel raise test were also conducted for both ankles.

Results: Thirty-one out of 35 (88.57%) patients were followed up for an average of 43.65 months. The VAS pain score and AOFAS Ankle-Hindfoot score improved from 4.87 ± 1.61 preoperatively to 2.07 ± 1.57 postoperatively and from 58.32 ± 18.66 preoperatively to 87.32 ± 7.53 postoperatively, respectively (both < .001). The mean FFI, AAS, and Tegner scores after the operation were 11.84 ± 1.62, 5.71 ± 2.18, and 4.61 ± 1.31, respectively. Compared with the intact ankle, the mean deficit in dorsiflexion in the involved ankle was 9.54°± 6.25° (range, 0.59°-23.70°; < .001) and the mean deficit in plantarflexion in the involved ankle was 6.31°± 4.02° (range, 0.24°-14.92°; < .001). Thirty patients could perform the single-legged heel raise on the operative leg. A larger body mass index was associated with worse postoperative AOFAS and FFI outcomes. Longer follow-up predicted statistically significantly better FFI scores. Better postoperative dorsiflexion was associated with better postoperative FFI, AAS, and Tegner scores, and a statistically significant interaction was found between the VAS score and plantarflexion deficit. Age, preoperative insertional tenderness, Haglund deformity, and MRI classification showed little association with postoperative outcomes.

Conclusion: This study demonstrated that the reattachment procedure for acute avulsion fracture of the Achilles tendon can achieve firm fixation and promising outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546519869952DOI Listing
October 2019

Vascular Compromising Effect of Drilling for Osteochondral Lesions of the Talus: A Three-Dimensional Micro-Computed Tomography Study.

Arthroscopy 2019 10 19;35(10):2930-2937. Epub 2019 Aug 19.

Department of Human Anatomy and Histology and Embryology, Peking University, Beijing, P. R. China. Electronic address:

Purpose: To explore an optimal drilling depth and direction for osteochondral lesions of the talus based on a 3-dimensional vascular microarchitecture model constructed with micro-computed tomography (microCT).

Methods: Twelve tali were perfused with the contrast agent and then scanned with microCT. The talar dome was divided into 9 zones, and the vessel densities were measured at the subchondral depths of 0 to 5 mm, 5 to 10 mm and 10 to 15 mm in each zone. The anterolateral (AL) and posterolateral (PL) approaches of retrograde drilling were simulated and the vascular compromising effect was evaluated.

Results: The vessel density of the 0- to 5-mm depth was lower than that of the 5- to 10-mm (P = .001) and 10- to 15-mm (P = .007) depths, but no significant difference was found between the 5- to 10-mm and 10- to 15-mm depths (P > .9999). The vessel density in the 5- to 10-mm depth of medial talar dome was similar to that of the adjacent zones (P = .05). Vessel density in the 5- to 10-mm depth around the lateral talar dome was higher in the anterior and medial side. The anterolateral approach disturbed the main intraosseous vessels from the tarsal canal-tarsal sinus, causing extensive vascular compromise in the talus neck and body, whereas the posterolateral approach disturbed only the vessels near the tunnel.

Conclusions: The vessel density changed greatly from the subchondral 0- to 5-mm to the 5- to 10-mm depth. The vessel densities of the 5- to 10-mm depth around the medial talar dome were similar, whereas the anterior and medial side of the lateral talar dome was better vascularized. The posterolateral approach caused less vascular damage than the anterolateral approach.

Clinical Relevance: The anterograde drilling depth was preferable to the subchondral 5- to 10-mm depth. There was no preferred drilling direction for the osteochondral lesion in the medial talar dome, whereas it is preferable to drill anteriorly or medially in the lateral dome. The posterolateral approach might be a safer alternative for retrograde drilling.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2019.05.021DOI Listing
October 2019

Reattachment of the superior peroneal retinaculum versus the bone block procedure for the treatment of recurrent peroneal tendon dislocation: two safe and effective techniques.

Knee Surg Sports Traumatol Arthrosc 2019 Sep 22;27(9):2877-2883. Epub 2019 Mar 22.

Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.

Purpose: Clinical outcomes between reattachment of the superior peroneal retinaculum (SPR) and the bone block procedure were compared in this study to elucidate which procedure was safer and more effective.

Methods: From 2012 to 2016, 25 patients with recurrent peroneal tendon dislocation underwent the bone block procedure (group A), and another 22 patients underwent reattachment of the SPR (group B). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Activity Score (AAS), time to return to sports activity, rate of return to sports level, range of motion (ROM) of the ankle, rate of recurrence, and overall patient satisfaction were collected to evaluate outcomes between the two groups.

Results: In group A, 24 patients followed up at a mean period of 42.5 ± 16.7 months. The mean postoperative AOFAS score was 92.9 ± 3.9. The median time to return to sports activity was 6.0 months (IQR 4.3-6.0 months) with 19 patients (79.2%) returning to their previous sports level. Two patients experienced recurrent dislocation, and 22 patients (91.7%) were satisfied with the procedure. In group B, 20 patients followed up at a mean period of 35.8 ± 15.3 months. The mean postoperative AOFAS score was 95.0 ± 4.2. The median time to return to sports activity was 5.0 months (IQR 4.0-5.0 months) with 18 patients (90.0%) returning to their previous sports level. No recurrence was reported, and 18 patients (90.0%) were satisfied with the procedure. The time to return to sports activity in group B was significantly shorter than that in group A. There was no significant difference in complications or clinical outcomes between the two procedures.

Conclusion: Both procedures offered satisfactory results for recurrent peroneal tendon dislocation with low rates of recurrence and complications. However, the time to return to sports activity after the reattachment of the SPR was shorter than that after the bone block procedure.

Level Of Evidence: Retrospective Comparative Study, Level III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-019-05479-2DOI Listing
September 2019

Results and recurrence of pigmented villonodular synovitis of the ankle: does diffuse PVNS with extra-articular extension tend to recur more often?

Knee Surg Sports Traumatol Arthrosc 2018 Oct 7;26(10):3118-3123. Epub 2017 Apr 7.

Institute of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.

Purpose: The aim of this study was to provide the outcomes and to analyze the recurrence of Pigmented Villonodular Synovitis (PVNS) of the ankle joint treated by surgical synovectomy.

Methods: Thirty-one PVNS cases of the ankle, including 5 localized PVNS cases and 26 diffuse PVNS cases, were treated in our institute between 2004 and 2015. The median age was 35 (range 18-63) years. The 5 localized PVNS cases were treated with partial synovectomy (group I); 10 diffuse PVNS cases limited to intra-articular synovium received arthroscopic comprehensive synovectomy (group II); and 16 cases with diffuse PVNS spreading to extra-articular tendon sheaths underwent combined arthroscopic and open synovectomy (group III). Adjuvant radiotherapy was provided in groups II and III. The American Orthopaedic Foot and Ankle Society (AOFAS) score and subjective grading of procedure were used to evaluate the results.

Results: Twenty-seven patients were followed with a median of 54 (range 15-108) months. In the three groups, the average AOFAS score improved from 75 (in all three groups) points preoperatively to 100 (group I), 97 (group II), and 90 points (group III) postoperatively. The rate of good-to-excellent result was 100% in group I and II and 73.3% in group III. Only in group III, recurrence occurred in five cases.

Conclusions: Diffuse PVNS of the ankle can be successfully managed with surgical synovectomy and adjuvant radiotherapy. Radiotherapy is not needed for localized PVNS. The recurrence rate in PVNS patients with extra-articular extension is higher.

Level Of Evidence: IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-017-4488-8DOI Listing
October 2018

A novel mutation and a known mutation in the CLCN7 gene associated with relatively stable infantile malignant osteopetrosis in a Chinese patient.

Gene 2016 Jan 22;576(1 Pt 1):176-81. Epub 2015 Oct 22.

Xinhua College, Sun Yat-sen University, Guangzhou, China; Beijing Genomics Institute (BGI) in Shenzhen, China. Electronic address:

Osteopetrosis is a group of heterogeneous disorders caused by the dysfunction of osteoclasts. The CLCN7 and TCIRG1 genes are the major obligate genes responsible for infantile malignant osteopetrosis (IMO). IMO patients usually die in infancy or before three years of age. In this study, we report a patient who was diagnosed with IMO at seven months of age. The patient presented with classical radiological features of IMO. She also exhibited erythropenia, thrombocytopenia, hepatosplenomegaly and neurodegeneration. The parents discontinued any medical treatment for the patient. Surprisingly, the patient's condition did not deteriorate when she was admitted a second time at the age of four years and nine months, despite not receiving any medical support during the untreated period. We sequenced the CLCN7 and TCIRG1 genes of the patient and her parents and identified a novel c.285+1G>A (IVS3+1G>A) mutation and the known c.896C>T (p.Ala299Val) mutation. The novel c.285+1G>A mutation occurred on the splice donor of the third intron of CLCN7. This mutation was predicted to interfere with normal splicing between exons 3 and 4, thereby truncating 711 amino acids from the C terminus and resulting in the loss of all of the functional domains of the encoded protein. The c.896C>T (p.Ala299Val) mutation was a previously known pathogenic mutation. We did not find any pathogenic mutations in the TCIRG1 gene. CLCN7-related osteopetrosis is known to have a high phenotype heterogeneity. Our study demonstrates a wide heterogeneity in the progression of the phenotypes and expanded the mutational spectrum for the CLCN7 gene.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gene.2015.10.021DOI Listing
January 2016

C-reactive protein and erythrocyte sedimentation rate changes after arthroscopic anterior cruciate ligament reconstruction: guideline to diagnose and monitor postoperative infection.

Arthroscopy 2014 Sep 23;30(9):1110-5. Epub 2014 May 23.

Institute of Sports Medicine, Peking University Third Hospital, Beijing, China. Electronic address:

Purpose: The purposes of our study were to determine normative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values from a retrospective review of patients with and without infection after anterior cruciate ligament (ACL) reconstruction and to determine CRP and ESR threshold levels that can serve as diagnostic indicators of infection. We also tried to draw a curve of CRP and ESR value changes after treatment of ACL infection to evaluate the response to treatment of the infection.

Methods: A retrospective chart review was performed of arthroscopic ACL reconstruction patients from 2007 to 2008 (noninfection group) and all patients with postoperative intra-articular infection from 1997 to 2010 (infection group). We collected the CRP and ESR values on the third and fifth postoperative days in the noninfection group and before infection treatment and on the first, third, fifth, seventh, 10th, 14th, 21st, 28th, and 35th days after infection treatment in the infection group. Sensitivity, specificity, and Youden's index were calculated for different threshold values of CRP and ESR as predictors of infection. Receiver operator curves were obtained for CRP and ESR on the fifth postoperative day.

Results: Of 122 patients, 83 had normal joints and 39 had septic joints. The mean CRP and ESR values in patients with septic joints were 101.9 mg/L and 57.1 mm/h, respectively, which were significantly higher than those in the noninfection group (P < .01). A CRP value of 41 mg/L and ESR value of 32 mm/h were the optimal thresholds to predict an infection, which had the highest Youden's index of all calculated values and had sensitivity values of 94.1% and 91.2%, respectively, and specificity values of 97.6% and 80.5%, respectively. The peak CRP level after infection treatment occurred earlier than the peak ESR level (first day v third day) and returned to normal more quickly (21st day v 28th day).

Conclusions: Both CRP and ESR were helpful in determining the presence of a normal or septic joint. The threshold values of 41 mg/L for CRP and 32 mm/h for ESR had the most optimal sensitivity and specificity. The peak CRP level occurred earlier than the peak ESR level after treatment of postoperative infection and returned to normal more quickly. In this study CRP was more useful than ESR to evaluate the response of infection to treatment.

Level Of Evidence: Level IV, diagnostic study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2014.03.025DOI Listing
September 2014

Repair of articular cartilage defects in the knee with autologous iliac crest cartilage in a rabbit model.

Knee Surg Sports Traumatol Arthrosc 2015 Apr 27;23(4):1119-27. Epub 2014 Feb 27.

Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China.

Purpose: To demonstrate that iliac crest cartilage may be used to repair articular cartilage defects in the knees of rabbits.

Methods: Full-thickness cartilage defects were created in the medial femoral condyle on both knees of 36 New Zealand white rabbits. The 72 defects were randomly assigned to be repaired with ipsilateral iliac crest cartilage (Group I), osteochondral tissues removed at defect creation (Group II), or no treatment (negative control, Group III). Animals were killed at 6, 12, and 24 weeks post-operatively. The repaired tissues were harvested for magnetic resonance imaging (MRI), histological studies (haematoxylin and eosin and immunohistochemical staining), and mechanical testing.

Results: At 6 weeks, the iliac crest cartilage graft was not yet well integrated with the surrounding articular cartilage, but at 12 weeks, the graft deep zone had partial ossification. By 24 weeks, the hyaline cartilage-like tissue was completely integrated with the surrounding articular cartilage. Osteochondral autografts showed more rapid healing than Group I at 6 weeks and complete healing at 12 weeks. Untreated defects were concave or partly filled with fibrous tissue throughout the study. MRI showed that Group I had slower integration with surrounding normal cartilage compared with Group II. The mechanical properties of Group I were significantly lower than those of Group II at 12 weeks, but this difference was not significant at 24 weeks.

Conclusion: Iliac crest cartilage autografts were able to repair knee cartilage defects with hyaline cartilage and showed comparable results with osteochondral autografts in the rabbit model.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-014-2906-8DOI Listing
April 2015

Treatment of large cystic medial osteochondral lesions of the talus with autologous osteoperiosteal cylinder grafts.

Arthroscopy 2013 Aug;29(8):1372-9

Institute of Sports Medicine, Beijing, China.

Purpose: To investigate the clinical, radiologic, and second-look arthroscopic outcomes of autologous iliac crest osteoperiosteal cylinder graft transplantation for medial osteochondral lesions of the talus (OLTs) with large subchondral cysts.

Methods: Between January 2008 and December 2010, 17 consecutive cases of medial OLT with a subchondral cyst larger than 10 mm in diameter received transplantation of autologous osteoperiosteal cylinder graft, which was harvested from the ipsilateral iliac crest. The visual analog scale score for pain during daily activities, American Orthopaedic Foot & Ankle Society hindfoot and ankle scores, and subjective satisfaction survey rating were obtained. Plain radiographs and magnetic resonance imaging of the ankle were obtained before and after surgery. In 13 cases second-look arthroscopy was performed 12 months postoperatively and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society.

Results: Sixteen patients were available for follow-up at a mean of 32.6 months (range, 24 to 48 months). The mean visual analog scale score decreased from 5.51 ± 0.83 preoperatively to 0.98 ± 0.98 at the latest follow-up, and the median American Orthopaedic Foot & Ankle Society score improved from 75 preoperatively to 90 at the latest follow-up. Seven patients resumed sporting activities. Overall, 7 patients rated the result as excellent, 8 as good, and 1 as fair. The radiolucent area of the cysts disappeared on the plain radiographs in all cases. The mean Magnetic Resonance Observation of Cartilage Repair Tissue score was 60 ± 9.4 points, whereas subchondral bone edema persisted on the postoperative magnetic resonance images in 16 cases. The mean International Cartilage Repair Society arthroscopic score for cartilage repair at second-look arthroscopy was 9 ± 1.4 points.

Conclusions: Autologous iliac crest osteoperiosteal cylinder graft transplantation with supplemental bone grafting is a simple, safe, and effective procedure for treatment of large cystic medial OLT. It can successfully fill the subchondral cyst and repair the cartilage defect.

Level Of Evidence: Level IV, therapeutic case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2013.05.014DOI Listing
August 2013

Interosseous talocalcaneal ligament reconstruction with hamstring autograft under subtalar arthroscopy: case report.

Foot Ankle Int 2011 Nov;32(11):1089-94

Peking University Third Hospital, Institute of Sports Medicine, 49 North Garden Rd, Haidian District, Beijing 100191, China.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3113/FAI.2011.1089DOI Listing
November 2011

Novel mutation of TCIRG1 and clinical pictures of two infantile malignant osteopetrosis patients.

J Bone Miner Metab 2011 Mar 2;29(2):251-6. Epub 2010 Nov 2.

Department of Medical Genetics, Center for Genome Research, Zhongshan School of Medicine, Sun Yat-Sen University, 74 Zhongshan Road II, Guangzhou, 510080, People's Republic of China.

Infantile malignant osteopetrosis (IMO) (OMIM 259700) is a lethal autosomal recessive disease. The underlying gene in most IMO patients is TCIRG1. This codes for the TCIRG1 protein involved in the cellular proton pump, which is highly expressed on surfaces of osteoclasts. We have characterized a family comprising two affected siblings born to healthy parents. The sister and her younger brother both presented classical X-ray images of IMO at 17 h and 16 weeks, respectively, after birth, and both died after the appearance of fever and flu-like symptoms months later. Radiographs revealed normal bone density in both parents. Mutation detection of the TCIRG1 gene was performed in the boy and the parents. The novel mutation c.242delC (p.Pro81ArgfsX85) and the known mutation c.1114C>T (p.Gln372X) were both identified in the boy. Both mutations are predicted to introduce premature stop codons, with deletion of 666 amino acids from the C terminus of the TCIRG1 protein of one allele and 459 from the other. Both mutations involve loss of part or the whole of the ATPase V0-complex domain of the protein. The father carries the c.242delC (p.Pro81ArgfsX85) mutation and the mother the c.1114C>T (p.Gln372X). Our findings provide new data for pre- and post-natal genetic diagnosis and identification of heterozygous carriers of the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00774-010-0228-6DOI Listing
March 2011

Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause.

Arthroscopy 2009 Mar 18;25(3):243-9. Epub 2008 Dec 18.

Institute of Sports Medicine, Peking University Third Hospital, Beijing, China.

Purpose: The purpose of this report is to summarize our experience in the diagnosis and management of septic arthritis after anterior cruciate ligament (ACL) reconstruction.

Methods: A retrospective review was conducted of all the arthroscopic ACL reconstructions performed at our institution between 1997 and 2007. Postoperative septic arthritis occurred in 21 of 4,068 patients. The incidence, cause, presentation, laboratory results, and treatment of all infected patients were analyzed.

Results: The incidence of septic arthritis after ACL reconstruction was 0.52%. The most common symptoms of the infected patients were fever, swelling, severe pain, tenderness, and restricted motion. The erythrocyte sedimentation rate, C-reactive protein level, and fibrinogen level were markedly elevated. Microbiology showed that coagulase-negative Staphylococcus was the most common bacterium. Both conservative and operative treatments were effective, and no patient had the ACL graft removed. However, the conservative group had a longer recovery time and duration of intravenous antibiotic therapy.

Conclusions: Septic arthritis after arthroscopic ACL reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on clinical evaluation, laboratory tests, synovial fluid analysis, and bacterial culture. With early diagnosis and prompt treatment, the infection can be successfully eradicated. Our proposed treatment protocol is arthroscopic debridement and irrigation as quickly as possible, with retention of the ACL graft when it is still functional.

Level Of Evidence: Level IV, therapeutic case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2008.10.002DOI Listing
March 2009
-->