Anterolateral rotatory instability in vivo correlates tunnel position after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft

AIM To quantitatively assess rotatory and anterior-posterior instability in vivo after anterior cruciate ligament(ACL) reconstruction using bone-patellar tendon-bone(BTB) autografts, and to clarify the influence of tunnel positions on the knee stability.METHODS Single-bundle ACL reconstruction with BTB autograft was performed on 50 patients with a mean age of 28 years using the trans-tibial(TT)(n = 20) and trans-portal(TP)(n = 30) techniques. Femoral and tibial tunnel positions were identified from the high-resolution 3 D-CT bone models two weeks after surgery. Anterolateral rotatory translation was examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging(MRI) 1.0-1.5 years after surgery, by measuring anterior tibial translation at the medial and lateral compartments on its sagittal images. Anterior-posterior stability was evaluated with a Kneelax3 arthrometer.RESULTS A total of 40 patients(80%) were finally followed up. Femoral tunnel positions were shallower(P < 0.01) and higher(P < 0.001), and tibial tunnel positions were more posterior(P < 0.05) in the TT group compared with the TP group. Anterolateral rotatory translations in reconstructed knees were significantly correlated with the shallow femoral tunnel positions(R = 0.42, P < 0.01), and the rotatory translations were greater in the TT group(3.2 ± 1.6 mm) than in the TP group(2.0 ± 1.8 mm)(P < 0.05). Side-to-side differences of Kneelax3 arthrometer were 1.5 ± 1.3 mm in the TT, and 1.7 ± 1.6 mm in the TP group(N.S.). Lysholm scores, KOOS subscales and reinjury rate showed no difference between the two groups.CONCLUSION Anterolateral rotatory instability significantly correlated shallow femoral tunnel positions after ACL reconstruction using BTB autografts. Clinical outcomes, rotatory and anterior-posterior stability were overall satisfactory in both techniques, but the TT technique located femoral tunnels in shallower and higher positions, and tibial tunnels in more posterior positions than the TP technique, thus increased the anterolateral rotation. Anatomic ACL reconstruction with BTB autografts may restore knee function and stability.

Controlled-release hydrogel loaded with magnesium-based nanoflowers synergize immunomodulation and cartilage regeneration in tendon-bone healing

Tendon-bone interface injuries pose a significant challenge in tissue regeneration,necessitating innovative approaches.Hydrogels with integrated supportive features and controlled release of therapeutic agents have emerged as promising candidates for the treatment of such injuries.In this study,we aimed to develop a temperature-sensitive composite hydrogel capable of providing sustained release of magnesium ions(Mg^(2+)).We synthesized magnesium-Procyanidin coordinated metal polyphenol nanoparticles(Mg-PC)through a self-assembly process and integrated them into a two-component hydrogel.The hydrogel was composed of dopamine-modified hyaluronic acid(Dop-HA)and F127.To ensure controlled release and mitigate the“burst release”effect of Mg^(2+),we covalently crosslinked the Mg-PC nanoparticles through coordination bonds with the catechol moiety within the hydrogel.This crosslinking strategy extended the release window of Mg^(2+)concentrations for up to 56 days.The resulting hydrogel(Mg-PC@Dop-HA/F127)exhibited favorable properties,including injectability,thermosensitivity and shape adaptability,making it suitable for injection and adaptation to irregularly shaped supraspinatus implantation sites.Furthermore,the hydrogel sustained the release of Mg^(2+)and Procyanidins,which attracted mesenchymal stem and progenitor cells,alleviated inflammation,and promoted macrophage polarization towards the M2 phenotype.Additionally,it enhanced collagen synthesis and mineralization,facilitating the repair of the tendon-bone interface.By incorporating multilevel metal phenolic networks(MPN)to control ion release,these hybridized hydrogels can be customized for various biomedical applications.

Degradable magnesium alloy suture promotes fibrocartilaginous interface regeneration in a rat rotator cuff transosseous repair model

Despite transosseous rotator cuff tear repair using sutures is widely accepted for tendon-bone fixation,the fibrocartilaginous enthesis regeneration is still hardly achieved with the traditional sutures.In the present work,degradable magnesium(Mg)alloy wire was applied to suture supraspinatus tendon in a rat acute rotator cuff tear model with Vicryl Plus 4±0 absorbable suture as control.The shoulder joint humerus-supraspinatus tendon complex specimens were retrieved at 4,8,and 12 weeks after operation.The Mg alloy suture groups showed better biomechanical properties in terms of ultimate load to failure.Gross observation showed that hyperplastic response of the scar tissue at the tendon-bone interface is progressively alleviated over time in the both Mg alloy suture and Vicryl suture groups.In the histological analysis,for Mg alloy suture groups,chondrocytes appear to proliferate at 4 weeks postoperatively,and the tendon-bone interface showed an orderly structural transition zone at 8 weeks postoperatively.The collagenous fiber tended to be aligned and the tendon-bone interlocking structures apparently formed,where transitional structure from unmineralized fibrocartilage to mineralized fibrocartilage was closer to the native fibrocartilaginous enthesis.In vivo degradation of the magnesium alloy wire was completed within 12 weeks.The results indicated that Mg alloy wire was promising as degradable suture with the potential to promotes fibrocartilaginous interface regeneration in rotator cuff repair.

膝关节镜下自体髌韧带重建前交叉韧带手术探讨

目的 :报告关节镜下采用中 1 / 3骨 -髌韧带 -骨 (BPTB)等长重建前交叉韧带手术 1 0例 ,并对临床疗效进行分析讨论。方法 :经临床及关节镜检查确诊的前交叉韧带 (ACL)损伤患者 1 0例 ,平均年龄 2 2 .3岁 (1 7～2 6岁 ) ,取自体BPTB中 1 / 3 ,关节镜下重建其ACL。术后随访时间 1 6个月 (1 2～ 2 0个月 ) ,参照敖英芳临床判断标准及lysholm评分评价疗效。结果 :临床效果优者 3例 ,良 5例 ,中 1例 ,差 1例。Lysholm评分术前(2 3 .8± 8.53)分 ,术后 (88± 7.48)分 (P <0 .0 1 )。术后 3例合并膝前疼痛 ,其中 2例接受再次关节镜手术 ,再次镜检证实为脂肪垫挤压综合征 ,均于手术后恢复。结论 :膝关节镜下自体髌韧带重建前交叉韧带 ,近期疗效肯定 ,术后恢复快 。

自体腱重建膝内侧副韧带手术探讨

目的:探讨重度膝内侧副韧带断裂修复重建的手术方法及临床疗效。方法:对33例严重膝内侧副韧带断裂患者采取手术重建、修复方法治疗。全部患者损伤程度为III度,即内侧副韧带浅层及深层全部断裂,部分患者合并半月板损伤、胫骨平台骨折。手术方法采用在解剖修复内侧副韧带基础上游离移植自体半腱肌腱(semitendinous tendon,ST)或骨-髌韧带-骨(bone-patella tendon-bone,BPTB)重建内侧副韧带浅层。结果:33例患者得到随访,随访时间为43.1(3～71)月。术后症状明显改善,膝关节无明显不稳及疼痛者27例;仍感觉有内侧不稳定者1例,外翻应力位X线照片检查,患膝内侧间隙增宽大于5mm;膝关节仍感疼痛者5例,5例中膝关节屈伸功能未完全恢复者4例。术后Lysholm评分为81～91(87.42±3.78)分,与术前0～56(26.45±21.03)分相比较有统计学差异(P<0.01)。结论:游离肌腱移植重建膝内侧副韧带效果佳。BPTB及ST均是可供选择的移植物。

关节镜下自体骨-髌腱-骨重建前交叉韧带疗效分析

目的探讨自体骨-髌腱-骨（BPTB）在前交叉韧带（ACL）损伤移植重建的临床疗效。方法256例ACL断裂患者行自体BPTB重建,对获得随访患者的临床资料进行回顾性研究,采用Lysholm膝关节功能评分法和IKDC评分法评定膝关节功能恢复情况。结果193例获得随访,时间632（17±3）个月,患者膝不稳症状均消失,关节功能恢复良好。Lysholm膝评分平均积分由术前的（66.3±6.1）分提高到术后的（88.3±5.9）分,IKDC评分由术前的79%降低为术后的4%,P〈0.01。16例术后合并膝前疼痛,51例长期感觉伸膝乏力,2例膝关节松弛。结论BPTB重建ACL临床疗效满意,但仍有膝前疼痛和伸膝乏力的并发症。

关节镜下骨-髌腱-骨重建前交叉韧带5年以上随访分析

目的探讨骨-髌腱-骨(BPTB)在前交叉韧带(ACL)损伤重建后的的远期疗效。方法 1999年1月～2003年6月该院行自体或同种异体BPTB重建ACL韧带123例,采用Lysholm膝关节功能评分法、IKDC评分法及KT1000检测分别评定术后1个月、3个月、6个月、1年、2年及5年等不同时期膝关节功能情况。结果 98例得到5年以上随访,91例患者膝不稳症状消失,关节功能恢复良好。8例合并膝前疼痛,25例感觉伸膝乏力,7例在2年后感觉关节轻度不稳,8例关节功能受限。重建术后6个月Lysholm评分、IKDC评分与术后1个月相比差异有显著性,术后2年与术后6个月相比差异有显著性,但重建术后5年与重建术后2年相比差异无显著性,且术后5年的评分总体满意。结论自体与同种异体中1/3BPTB重建ACL远期临床疗效满意。

进展性下位髌骨综合征

目的 :报道临床所见的进展性下位髌骨综合征 ,探讨其病因、诊断 ,并介绍一种新的治疗方法。方法 :本组病人共 11例 ,均由膝关节手术或创伤引起。以膝关节僵硬和髌骨高度降低为主要特征。髌骨垂直高度系数 (Linclau法 )平均较对侧减少 5 0 .4% ,Lysholm膝关节功能评分平均 47.5分。采用健侧中 1/3骨—髌腱—骨移植延长髌腱。结果 :髌骨高度恢复正常 ,膝关节伸屈功能及Lysholm评分较术前显著改善。结论 :膝关节手术及创伤是引起该综合征的直接原因 ,髌骨垂直高度系数较对侧显著减少是诊断该病的主要依据。以中 1/3骨—髌腱—骨移植延长髌腱 ,可准确恢复髌骨原来高度 。

关节镜下自体与同种异体骨-髌腱-骨重建膝前交叉韧带的临床探讨

目的探讨关节镜下自体与同种异体骨-髌腱-骨(B-PT-B)移植重建膝前交叉韧带(ACL)的临床疗效。方法对术前MRI检查有前交叉韧带断裂且术中关节镜检证实为前交叉韧带断裂者25例,按病人要求,分别选择采用关节镜下自体(自体组)和同种异体(同种异体组)骨-髌腱-骨移植重建膝前交叉韧带进行治疗,观察并记录两组治疗前后的症状、体征变化及术后Lysholm膝关节功能评分。术后随访6～24个月,平均16.7个月。结果两组术后均未发生严重的并发症,关节失稳明显改善,客观指标正常。手术时间自体组为(80±10)min,同种异体组为(60±10)min。术后发热时间自体组为(2±1)d,同种异体组为(3±1)d。膝关节功能按Lysholm评分标准,自体组为(86.7±4.3)min,同种异体组为(85.8±4.4)min。按Lukiano评分标准,自体组优良率为92.5%,同种异体组为90.09%。两组病例膝关节活动范围均正常。结论采用关节镜下自体B-PT-B移植手术时间较同种异体B-PT-B移植时间长,而术后吸收热时间较短(P<0.01),但自体与异体B-PT-B移植住院时间、Lysholm评分和重建ACL临床疗效差异均无统计学意义(P>0.05)。同种异体移植重建无明显排斥反应,避免了自体B-PT-B重建时的自体组织损伤。同种异体B-PT-B是ACL重建的良好选择之一。

兔髌骨-髌腱结合部新骨形成与大小预测其愈合程度

目的探讨髌骨-髌腱结合部愈合中新骨形成量和力学指标之间的关系。方法15只雌性成年兔,在一侧后肢的髌骨远端1/3处横行截骨,切除远端1/3髌骨。将髌腱与髌骨断端连接。分别于术后第8和16周取材进行生物力学、组织学和新骨形成情况(X线摄片测量和骨密度测定)检测,进行对比研究。结果髌骨-髌腱结合部新骨面积、新骨长度及骨矿密度在第8和16周之间仍未达到显著性水平,但在第16周时的拉断载荷、极限拉应力和拉断能量均明显大于第8周;新骨面积与拉断载荷及极限拉应力呈显著性相关。结论新骨面积与拉断载荷及极限拉应力间显著相关,通过临床无创X线影像学对新骨面积的定量,可有效评估髌骨部分切除后髌骨-髌腱结合部愈合状况,为术后主动康复提供参考。

Anterior cruciate ligament reconstruction best practice: A review of graft choice

There is much literature about differing grafts used in anterior cruciate ligament(ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear "best" graft, there are clear differences between the differing graft choices. Surgeon's need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements.

Canine ACL reconstruction with an injectable hydroxyapatite/collagen paste for accelerated healing of tendon-bone interface

Healing of an anterior cruciate ligament(ACL)autologous graft in a bone tunnel occurs through the formation of fibrovascular scar tissue,which is structurally and compositionally inferior to normal fibrocartilaginous insertion and thus may increase the reconstruction failure and the rate of failure recurrence.In this study,an injectable hydroxyapatite/type I collagen(HAp/Col I)paste was developed to construct a suitable local microenvironment to accelerate the healing of bone-tendon interface.Physicochemical characterization demonstrated that the HAp/Col I paste was injectable,uniform and stable.The in vitro cell culture illustrated that the paste could promote MC3T3-E1 cells proliferation and osteogenic expression.The results of a canine ACL reconstruction study showed that the reconstructive ACL had similar texture and color as the native ACL.The average width of the tunnel,total bone volume,bone volume/tissue volume and trabecular number acquired from micro-CT analysis suggested that the healing of tendon-bone interface in experimental group was better than that in control group.The biomechanical test showed the maximal loads in experimental group achieved approximately half of native ACL’s maximal load at 24 weeks.According to histological examination,Sharpey fibers could be observed as early as 12 weeks postoperatively while a typical four-layer transitional structure of insertion site was regenerated at 48 weeks in the experimental group.The injectable HAp/Col I paste provided a biomimetic scaffold and microenvironment for early cell attachment and proliferation,further osteogenic expression and extracellular matrix deposition,and in vivo structural and functional regeneration of the tendon-bone interface.

Low-intensity pulsed ultrasound therapy: a potential strategy to stimulate tendon-bone junction healing

Incorporation of a tendon graft within the bone tunnel represents a challenging clinical problem. Successfulanterior cruciate ligament (ACL) reconstruction requires solid healing of the tendon graft in the bone tunnel. En-hancement of graft healing to bone is important to facilitate early aggressive rehabilitation and a rapid return topre-injury activity levels. No convenient, effective or inexpensive procedures exist to enhance tendon-bone (T-B)healing after surgery. Low-intensity pulsed ultrasound (LIPUS) improves local blood perfusion and angiogenesis,stimulates cartilage maturation, enhances differentiation and proliferation of osteoblasts, and motivates osteogenic differentiation of mesenchymal stem cells (MSCs), and therefore, appears to be a potential non-invasive tool for T-Bhealing in early stage of rehabilitation of ACL reconstruction. It is conceivable that LIPUS could be used to stimulateT-B tunnel healing in the home, with the aim of accelerating rehabilitation and an earlier return to normal activities inthe near future. The purpose of this review is to demonstrate how LIPUS stimulates T-B healing at the cellular andmolecular levels, describe studies in animal models, and provide a future direction for research.

Combination of graphene oxide and platelet-rich plasma improves tendon-bone healing in a rabbit model of supraspinatus tendon reconstruction

The treatment of rotator cuff tear is one of the major challenges for orthopedic surgeons.The key to treatment is the reconstruction of the tendon-bone interface(TBI).Autologous platelet-rich plasma(PRP)is used as a therapeutic agent to accelerate the healing of tendons,as it contains a variety of growth factors and is easy to prepare.Graphene oxide(GO)is known to improve the physical properties of biomaterials and promote tissue repair.In this study,PRP gels containing various concentrations of GO were prepared to promote TBI healing and supraspinatus tendon reconstruction in a rabbit model.The incorporation of GO improved the ultrastructure and mechanical properties of the PRP gels.The gels containing 0.5 mg/ml GO(0.5 GO/PRP)continuously released transforming growth factor-b1(TGF-b1)and platelet-derived growth factor(PDGF)-AB,and the released TGF-b1 and PDGF-AB were still at high concentrations,1063.451 pg/ml and814.217 pg/ml,respectively,on the 14th day.In vitro assays showed that the 0.5 GO/PRP gels had good biocompatibility and promoted bone marrow mesenchymal stem cells proliferation and osteogenic and chondrogenic differentiation.After 12 weeks of implantation,the magnetic resonance imaging,microcomputed tomography and histological results indicated that the newly regenerated tendons in the 0.5 GO/PRP group had a similar structure to natural tendons.Moreover,the biomechanical results showed that the newly formed tendons in the 0.5 GO/PRP group had better biomechanical properties compared to those in the other groups,and had more stable TBI tissue.Therefore,the combination of PRP and GO has the potential to be a powerful advancement in the treatment of rotator cuff injuries.

Nano-calcium silicate mineralized fish scale scaffolds for enhancing tendon-bone healing

Tendon-bone healing is essential for an effective rotator cuff tendon repair surgery,however,this remains a significant challenge due to the lack of biomaterials with high strength and bioactivity.Inspired by the high-performance exoskeleton of natural organisms,we set out to apply natural fish scale(FS)modified by calcium silicate nanoparticles(CS NPs)as a new biomaterial(CS-FS)to overcome the challenge.Benefit from its“Bouligand”microstructure,such FS-based scaffold maintained excellent tensile strength(125.05 MPa)and toughness(14.16 MJ/m^(3)),which are 1.93 and 2.72 times that of natural tendon respectively,allowing it to well meet the requirements for rotator cuff tendon repair.Additionally,CS-FS showed diverse bioactivities by stimulating the differentiation and phenotypic maintenance of multiple types of cells participated into the composition of tendon-bone junction,(e.g.bone marrow mesenchymal stem cells(BMSCs),chondrocyte,and tendon stem/progenitor cells(TSPCs)).In both rat and rabbit rotator cuff tear(RCT)models,CS-FS played a key role in the tendon-bone interface regeneration and biomechanical function,which may be achieved by activating BMP-2/Smad/Runx2 pathway in BMSCs.Therefore,natural fish scale-based biomaterials are the promising candidate for clinical tendon repair due to their outstanding strength and bioactivity.

Discussing tuina for atlantoaxial subluxation in adults based on the theory of‘tendon-bone balance’

According to Chinese medicine,the atlantoaxial joint is a composite joint composed of tendons and bones,and the stability of the joint depends on the‘tendon-bone balance’involving tendons,ligaments,atlas and axis.Multiple causes of‘tendon off-position,joint subluxation’will lead to joint‘tendon-bone imbalance’,which will evolve into atlantoaxial subluxation(AAS),endangering human health.Chinese therapeutic massage(tuina)is a very effective treatment for AAS in adults,but conventional manipulations are prone to ineffectiveness or accidents due to neglect of the causal relationship of the‘tendon-bone imbalance’and inappropriate manipulations.Compared with conventional manipulations,the rational choice of modified manipulations under the guidance of‘tendon-bone balance’theory is more effective and less risky,and more worthy of clinical promotion.From the‘tendon-bone balance’theory,we considered the shortcomings of conventional manipulations,and introduced several modified manipulations that have their own strengths in‘tendon smoothing’and‘bone setting’,in order to provide new ideas for treatment of AAS in adults.

Multi-functionalized nanofibers with reactive oxygen species scavenging capability and fibrocartilage inductivity for tendon-bone integration

The presence of excessive reactive oxygen species(ROS)after injuries to the enthesis could lead to cellular oxidative damage,high inflammatory response,chronic inflammation,and limited fibrochondral inductivity,making tissue repair and functional recovery difficult.Here,a multifunctional silk fibroin nanofiber modified with polydopamine and kartogenin was designed and fabricated to not only effectively reduce inflammation by scavenging ROS in the early stage of the enthesis healing but also enhance fibrocartilage formation with fibrochondrogenic induction in the later stages.The in vitro results confirmed the antioxidant capability and the fibrochondral inductivity of the functionalized nanofibers.In vivo studies showed that the multifunctional nanofiber can significantly improve the integration of tendon-bone and accelerate the regeneration of interface tissue,resulting in an excellent biomechanical property.Thus,the incorporation of antioxidant and bio-active molecules into extracellular matrix-like biomaterials in interface tissue engineering provides an integrative approach that facilitates damaged tissue regeneration and functional recovery,thereby improving the clinical outcome of the engineered tissue.

Biological approaches to the repair and regeneration of the rotator cuff tendon-bone enthesis:a literature review

Entheses are highly specialised organs connecting ligaments and tendons to bones,facilitating force transmission,and providing mechanical strengths to absorb forces encountered.Two types of entheses,fibrocartilaginous and fibrous,exist in interfaces.The gradual fibrocartilaginous type is in rotator cuff tendons and is more frequently injured due to the poor healing capacity that leads to loss of the original structural and biomechanical properties and is attributed to the high prevalence of retears.Fluctuating methodologies and outcomes of biological approaches are challenges to overcome for them to be routinely used in clinics.Therefore,stratifying the existing literature according to different categories(chronicity,extent of tear,and studied population)would effectively guide repair approaches.This literature review supports tissue engineering approaches to promote rotator cuff enthesis healing employing cells,growth factors,and scaffolds period.Outcomes suggest its promising role in animal studies as well as some clinical trials and that combination therapies are more beneficial than individualized ones.It then highlights the importance of tailoring interventions according to the tear extent,chronicity,and the population being treated.Contributing factors such as loading,deficiencies,and lifestyle habits should also be taken into consideration.Optimum results can be achieved if biological,mechanical,and environmental factors are approached.It is challenging to determine whether variations are due to the interventions themselves,the animal models,loading regimen,materials,or tear mechanisms.Future research should focus on tailoring interventions for different categories to formulate protocols,which would best guide regenerative medicine decision making.

Bone marrow mesenchymal stem cell-derived exosomal microRNAs target PI3K/Akt signaling pathway to promote the activation of fibroblasts

BACKGROUND Fibroblast plays a major role in tendon-bone healing.Exosomes derived from bone marrow mesenchymal stem cells(BMSCs)can activate fibroblasts and promote tendon-bone healing via the contained microRNAs(miRNAs).However,the underlying mechanism is not comprehensively understood.Herein,this study aimed to identify overlapped BMSC-derived exosomal miRNAs in three GSE datasets,and to verify their effects as well as mechanisms on fibroblasts.AIM To identify overlapped BMSC-derived exosomal miRNAs in three GSE datasets and verify their effects as well as mechanisms on fibroblasts.METHODS BMSC-derived exosomal miRNAs data(GSE71241,GSE153752,and GSE85341)were downloaded from the Gene Expression Omnibus(GEO)database.The candidate miRNAs were obtained by the intersection of three data sets.TargetScan was used to predict potential target genes for the candidate miRNAs.Functional and pathway analyses were conducted using the Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)databases,respectively,by processing data with the Metascape.Highly interconnected genes in the protein-protein interaction(PPI)network were analyzed using Cytoscape software.Bromodeoxyuridine,wound healing assay,collagen contraction assay and the expression of COL I andα-smooth muscle actin positive were applied to investigate the cell proliferation,migration and collagen synthesis.Quantitative real-time reverse transcription polymerase chain reaction was applied to determine the cell fibroblastic,tenogenic,and chondrogenic potential.RESULTS Bioinformatics analyses found two BMSC-derived exosomal miRNAs,has-miR-144-3p and hasmiR-23b-3p,were overlapped in three GSE datasets.PPI network analysis and functional enrichment analyses in the GO and KEGG databases indicated that both miRNAs regulated the PI3K/Akt signaling pathway by targeting phosphatase and tensin homolog(PTEN).In vitro experiments confirmed that miR-144-3p and miR-23b-3p stimulated proliferation,migration and collagen synthesis of NIH3T3 fibroblasts.Interfering with PTEN affected the phosphorylation of Akt and thus activated fibroblasts.Inhibition of PTEN also promoted the fibroblastic,tenogenic,and chondrogenic potential of NIH3T3 fibroblasts.CONCLUSION BMSC-derived exosomes promote fibroblast activation possibly through the PTEN and PI3K/Akt signaling pathways,which may serve as potential targets to further promote tendon-bone healing.

全膝关节置换术中髌骨轨迹不良的髌韧带止点重建

目的总结髌骨半脱位或脱位患者行人工膝关节置换术中髌股关节运行轨迹不良时,为纠正髌骨外脱位倾向所采用的髌韧带止点重建策略和康复效果。方法对12例13膝合并髌骨半脱位或脱位患者进行人工膝关节置换的同时,将髌韧带外侧1/2止点内移至髌韧带内侧,并重建止点,术后对膝关节不予固定制动,并根据关节情况进行早期康复训练;全部病例进行半年以上随访,随访内容包括KSS膝关节评分和功能评分。结果全部患者膝关节外翻畸形、髌骨半脱位或脱位获得矫正,康复过程重建的髌韧带未见出现撕裂或断裂现象。KSS膝关节评分由术前的平均33分提高到79分,功能评分由术前的平均39分提高到83分,膝关节总体情况较术前均有根本性的改变。结论膝关节长期的外翻畸形可继发引起胫骨外旋,二者均是导致髌骨半脱位或脱位的原因,行人工膝关节置换时为纠正髌骨的脱位倾向而进行的髌韧带止点重建,对膝关节的早期功能康复训练没有不利影响,对该类患者是一合理的手术治疗方法。