HepG2.2.15-derived exosomes facilitate the activation and fibrosis of hepatic stellate cells

BACKGROUND

The role of exosomes derived from HepG2.2.15 cells, which express hepatitis B virus (HBV)-related proteins, in triggering the activation of LX2 liver stellate cells and promoting liver fibrosis and cell proliferation remains elusive. The focus was on comprehending the relationship and influence of differentially expressed microRNAs (DE-miRNAs) within these exosomes.

AIM

To elucidate the effect of exosomes derived from HepG2.2.15 cells on the activation of hepatic stellate cell (HSC) LX2 and the progression of liver fibrosis.

METHODS

Exosomes from HepG2.2.15 cells, which express HBV-related proteins, were isolated from parental HepG2 and WRL68 cells. Western blotting was used to confirm the presence of the exosomal marker protein CD9. The activation of HSCs was assessed using oil red staining, whereas DiI staining facilitated the observation of exosomal uptake by LX2 cells. Additionally, we evaluated LX2 cell proliferation and fibrosis marker expression using 5-ethynyl-2′-deoxyuracil staining and western blotting, respectively. DE-miRNAs were analyzed using DESeq2. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were used to annotate the target genes of DE-miRNAs.

RESULTS

Exosomes from HepG2.2.15 cells were found to induced activation and enhanced proliferation and fibrosis in LX2 cells. A total of 27 miRNAs were differentially expressed in exosomes from HepG2.2.15 cells. GO analysis indicated that these DE-miRNA target genes were associated with cell differentiation, intracellular signal transduction, negative regulation of apoptosis, extracellular exosomes, and RNA binding. KEGG pathway analysis highlighted ubiquitin-mediated proteolysis, the MAPK signaling pathway, viral carcinogenesis, and the toll-like receptor signaling pathway, among others, as enriched in these targets.

CONCLUSION

These findings suggest that exosomes from HepG2.2.15 cells play a substantial role in the activation, proliferation, and fibrosis of LX2 cells and that DE-miRNAs within these exosomes contribute to the underlying mechanisms.

[Comparison of the clinical efficacy of all-inside arthroscopic lateral ligament augmentation procedure and Broström procedure for the treatment of chronic lateral rotational ankle instability]

Objective: To compare the clinical efficacy of patients with chronic lateral rotational ankle instability(CLRAI) after all-inside arthroscopic lateral ligament augmentation procedure and Broström procedure. Methods: This is a retrospective cohort study. The clinical and imaging data of 106 CLRAI patients were collected at the Xuzhou Central Hospital from January 2021 to December 2022. The patients included 55 males and 51 females with an age of (32.6±8.2) years (range: 16 to 50 years). All patients were treated under all-inside arthroscopic, and were divided into Broström-Gould surgery group (n=54) and Broström surgery group (n=52) according to different ligament repair methods. At 3, 6, and 12 months after surgery, ankle inversion stress tests and anterior drawer tests were used to examine the stability of the ankle joint and observe gait. The American Orthopedic Foot and Ankle Society ankle hindfoot scale (AOFAS-AH) and Karlsson ankle function score (KAFS) were used to assess ankle function; Tegner score was used to assess the patient's level of exercise; the foot and ankle outcome score(FAOS)(including score of symptoms,pain,function, daily living,function, sports and recreational activities (sport); quality of life (QOL)) was used to assess the patient's daily activity ability. Comparisons of data were made using independent sample t test, repeated measures analysis of variance, LSD multiple comparison method, χ2 test or Mann-Whitney U test. Results: All operations were successfully accomplished. All incisions healed by first intention, without evidence of postoperative complications of implant rejection, ligation reaction, and nerve and vessel injury. All patients were followed up at 3, 6, and 12 months after surgery. Ankle varus stress test and anterior drawer test were negative. No evidence supporting lateral ankle instability was obtained. All patients eventually regained normal gait. No patients underwent revision surgery. Repeated measurement analysis of variance showed that AOFAS-AH, Tegner, KAFS and FAOS scores in the Brostrom-Gould group and the Brostrom group were significantly higher than those before surgery (P<0.01). The change trends of Tegner score and FAOS-sport score were significantly different between the two groups (F=18.839, P<0.01; F=8.169, P=0.005). Multiple comparisons revealed that at 3-, 6-and 12-month follow-up, the Tegner scores ((3 months: 3.7±0.5 vs. 3.3±0.5, t=-3.980, P<0.01; 6 months: 4.4±0.6 vs. 3.8±0.7, t=-4.792,P<0.01;12 months: 5.8±0.9 vs. 5.1±1.0, t=-3.889,P<0.01)), sport scores ((3 months: 82.5±3.7 vs. 79.3±3.8, LSD-t=-4.316, P<0.01; 6 months: 88.5±4.9 vs. 85.7±3.8, LSD-t=-3.312,P=0.001;12 months: 90.1±4.3 vs. 88.2±5.1, LSD-t=-2.112,P=0.037)) in the Broström-Gould surgery group were higher than those in the Broström surgery group, with statistical significances. Conclusions: Both Broström-Gould and Broström procedures under all-inside arthroscopic can make ankle stability and improve ankle function in the treatment of CLRAI. However, the former maybe shorten the time to return to exercise and achieve higher motor function.

[The current status and challenges of surgical treatment for chronic Achilles tendon rupture]

With the growing demand for physical activity, an increasing number of individuals with chronic Achilles tendon ruptures are opting for surgical intervention. Surgical approaches encompass end-to end anastomosis, tendon flap techniques, tendon transfer procedures, and free tendon grafting, among others. When selecting the appropriate surgical method and determining the surgical indications, it is imperative to consider factors like the length of the Achilles tendon defect, patient age, aesthetic preferences, functional requirements, and local tissue conditions. As medical devices evolve and surgical techniques advance, the criteria for surgical intervention are also evolving. Drawing from existing literature evidence, it becomes crucial to define reasonable parameters for addressing Achilles tendon defects with each surgical technique, aligning more closely with clinical needs. Additionally, auxiliary technologies such as biologic therapy and innovative biomaterials have demonstrated promising results in laboratory or animal models. The focal point of advancing these auxiliary technologies lies in facilitating the translation of pertinent clinical outcomes in the future.

Surgical management of chronic Achilles tendon rupture: evidence-based guidelines

BACKGROUND

Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes.

METHODS

A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines.

RESULTS

Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol.

CONCLUSION

Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.

Effect of hip strategy-based motion control training on walking function restoration after ankle joint injury

OBJECTIVES

The study aimed to explore the effect of hip strategybased motion control training on the recovery of walking function after ankle injury and the optimization of the rehabilitation program.

PATIENTS AND METHODS

In the study, 62 patients with ankle injuries were randomly divided into the observation group (n=30; 24 males, 6 females; mean age: 41.9±8.5 years; range, 28 to 56 years) and the control group (n=32; 26 males, 6 females; mean age: 42.0±9.3 years; range, 27 to 55 years) between September 2021 and September 2022. Both groups were treated using routine rehabilitation training, including conventional drug and rehabilitation treatment. The observation group additionally received hip strategy-based motion control training, which included hip muscle strength training, hip joint stability control training, balance testing and training system training, and three-dimensional gait analysis system training for six weeks. All patients were evaluated before and after the treatment using the balance function parameters (motion length and motion ellipse area), Berg Balance Scale, the timed up-and-go test, and three-dimensional gait analysis system (step length and step frequency).

RESULTS

There was no significant difference in the evaluation indexes between the two groups before treatment (p>0.05). After treatment, the evaluation indexes of the two groups were significantly better than those before treatment (p<0.05), and all the indexes in the observation group were significantly better than those in the control group (p<0.05).

CONCLUSION

Hip strategy-based motion control training could significantly improve the recovery of walking function in patients with ankle injuries.

[Effect of hollow compression screw internal fixation in treating McCrory-Bladin type Ⅱ lateral process fracture of the talus: open versus arthroscopy surgery]

In order to explore the clinical efficacy of hollow compression screw internal fixation in the treatment of lateral process fracture of the talus under open surgery versus arthroscopy procedure, a retrospective cohort study was conducted to analyze the clinical data of 33 patients with lateral process fracture of the talus admitted to Xuzhou Central Hospital from January 2019 to December 2021. There were 19 males (19 feet) and 14 females (14 feet), aged 18 to 50 years, with an average age of (32.2±9.3) years. According to the modified McCrory-Bladin classification, all patients were classified as type Ⅱ. Based on the different surgical methods, the patients were divided into the arthroscopy group (21 cases, treated with double-tunnel subtalar arthroscopy combined with hollow compression screw internal fixation) and the open group (12 cases, treated with open reduction and internal fixation with hollow compression screw). The operation time was observed and the surgical effects were evaluated using the visual analogue scale (VAS) of pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the Foot Function Index (FFI), and the Foot and Ankle Ability Measure (FAAM), which includes the FAAM-ADL (activity of daily living subscale) and the FAAM-S (sport subscale). All the patients of the two groups achieved stage Ⅰ wound healing. On the first day after the operation, the mean VAS score of the arthroscopy group was 2.4±0.7, which was significantly lower than that of the open group (3.4±1.6) (P=0.020). No significant difference was observed in terms of the follow-up time, operation time and AOFAS score between the two groups (all P>0.05). The FFI score of the arthroscopy group was significantly lower than that of the open group, and the FAAM-ADL and FAAM-S scores were significantly higher than those in the open group (all P<0.05). Two cases of dorsal foot numbness occurred in the open group after the operation, and the incidence of complications was not significantly different from that of the arthroscopy group (P=0.054). For McCrory-Bladin type Ⅱ lateral process fracture of the talus, the use of compression screw internal fixation could achieve reliable results, however, compared to open surgery, arthroscopy procedure obtained mini trauma and better functions.

Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture

Background

Anatomic repair of anterior talofibular ligament (ATFL) is used to manage chronic lateral ankle instability (CLAI). However, the optimal suture configuration used to repair the ATFL is not yet determined. It remains unclear whether suture configuration affects clinical outcomes in such patients.

Purpose

To compare the functional outcomes of all-inside arthroscopic ATFL repair using either a loop suture and or a free-edge suture configuration in CLAI patients.

Study Design

Cohort study; Level of evidence, 3.

Methods

This retrospective cohort study included 71 patients with CLAI who had undergone an all-inside arthroscopic ATFL repair procedure with either loop suture (n = 36) or free-edge suture (n = 35) from February 2016 to July 2018. Comparable pre-operatively, the Visual analogy score (VAS), American Orthopedic Foot and Ankle Society scoring system (AOFAS), Karlsson Ankle Functional Score (KAFS) scoring system, Anterior Talar Translation (ATT) and Active Joint Position Sense (AJPS) were used to evaluate postoperative ankle function.

Results

There were no postoperative wound complications, implant reactions, or neurological or vascular injuries. Postoperative hospitalization, VAS, AOFAS, KAFS, AJPS and the time of return to sport were similar between the loop suture group and free-edge suture group. Requiring a longer procedure time, patients with loop suture configuration achieved better ATT.

Conclusion

All-inside arthroscopic ATFL repair procedure for CLAI treatment provides better ATT and comparable functional outcomes when a loop suture configuration is used instead of a free-edge suture configuration. A statistical difference in ATT was observed. Given the relatively short follow-up, it is questionable whether this will have any clinical relevance.

Evaluation of the protective efficacy of virus-like particles based on PCV 2b and 2d subtypes against mixed challenge in mice

Porcine circovirus type 2 (PCV2) is an economically important swine pathogen and, although small, it has the highest evolution rate among DNA viruses. Commercial PCV2 commercial vaccines are inactivated PCV2 isolates or a subunit vaccine based on the Cap protein of PCV2. Currently, PCV2 VLPs of individual subtype vaccines are available. Although the main prevalent genotype worldwide is PCV2b, the emerging subtype PCV2d subtype is also increasingly associated with PCV disease. The aim of the study was to evaluate the protective efficacy of VLP based on the PCV2b and 2d subtypes against the mixed challenge of two hypotype PCV2 in mice. Thirty-six female SPV Kunming mice were immunized twice with PCV2b and 2d VLPs, then challenged with PCV2b and PCV2d, to assess the immunogenicity and effectiveness of the VLPs. Vaccination of the mice with PCV2b and 2d VLPs elicited a robust antibody response specific for the PCV2. The virus load detected in the 2b and 2d spleen vaccine group was the lowest compared to other groups. Furthermore, there was no pathological damage in the HE stained sections of the 2b and 2d spleen vaccine, and no virus was detected in the immunohistochemical sections. Our data suggest that the mixed PCV2b and 2d VLP vaccine could protect mice from challenge with the mixed infection of PCV2b and PCV2d..

[All-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ]

Objective: To investigate the surgical technology and clinical efficacy of using the all-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ. Methods: The clinical data of 33 patients (33 feet) with intra-articular displaced calcaneal fractures treated by modified all-inside arthroscopic from March 2017 to March 2019 at Department of Orthopedics,Xuzhou Central Hospital were retrospectively analyzed.There were 19 male patients,and 14 female patients,aged (32.6±11.3) years(range:20 to 55 years). According to the Sanders classification,there were 12 cases of type Ⅱ and 21 cases of type Ⅲ. The duration from injury to surgery was (101.2±32.1) hours(range:6 to 140 hours).The preoperative visual analogue scale (VAS) was 6.4±2.9 (range: 4 to 8); The preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the SF-36 score was 63.3±11.8 (range:50 to 75) and 94.8±9.1 (range:70 to 105) respectively.All the patients were managed with the all-side subtalar arthroscopy through three portals combined with rafting screws technique.The incision healing,reduction of fracture,and fracture healing were recorded.The VAS,AOFAS ankle-hindfoot scale,and SF-36 score were used to assess the pain and functional outcomes.Repeated-measurement was used to compare the scores before and after surgery. Results: The time of operation was (69.7±10.4) minutes (range:40 to 110 minutes). All patients did not undergo bone grafting.The incision healed in one stage without complications of skin sensory and peroneal tendon injury.All patients were followed up for 24 months.At the last follow-up,all the patients were satisfied with the hindfoot alignment,function,and hindfoot appearance.Postoperative calcaneal imaging indicators (calcaneal length,calcaneal width,calcaneal height,Bohler angle and Gissane angle) were significantly improved compared with those before surgery (P<0.01).There was no statistically significant difference in the imaging indexes of calcaneus at 1 day,1 year and 2 years after surgery,indicating no loss of fracture reduction (all P>0.05).The VAS,AOFAS ankle-hindfoot scale,and SF-36 score were 1.5±0.4 (range: 0 to 2),94.0±6.5 (range:90 to 100),and 119.1±7.2 (range:105 to 130),respectively,which were better than those before surgery (all P>0.05).According to the AOFAS scoring system,27 cases were excellent,4 cases were good, 2 cases were fair,and the excellent and good rate was 94.0%. Conclusion: All-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ provides precise reduction,reliable fixation,satisfactory function and limited complications,which is an alternative method.

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

Background

The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients.

Methods

This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups.

Results

Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups.

Conclusion

In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome.

Level of Evidence

Level III, a retrospective comparative study.

First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes

Background

The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves.

Methods

This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared.

Results

All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05).

Conclusion

There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap.

Level of evidence: Level III, retrospective comparative study.

Flexor Hallucis Longus Tendon Impingement Syndrome: All-inside Arthroscopic Treatment and Long-term Follow-up

This study aimed to evaluate the surgical technique and long-term clinical outcomes of all-inside arthroscopic treatment for flexor hallucis longus (FHL) tendon impingement syndrome. We retrospectively evaluated 34 FHL tendon impingement syndrome patients with complete follow-up data who were admitted from June 2015 to August 2018 and underwent the all-inside arthroscopy technique. The subjects consisted of 20 (58.82%) males and 14 (41.18%) females, with a mean age of 32.7 ± 10.2 (range 21-52) years. The cases consisted of 19 (55.88%) right and 15 (44.12%) left feet. The mean disease duration was 18.5 ± 9.1 (range 10-43) months. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS), Karlsson Ankle Functional Score (KAFS), and 36-item Short Form Health Survey questionnaire (SF-36) scores for pain were 3.6 ± 1.2, 84.1 ± 9.6, 86.3 ± 10.7, and 94.7 ± 9.3, respectively. All patients were treated with all-inside posterior arthroscopy for the debridement of the FHL tendon sheath combined with partial muscle belly resection. Post-operative follow-up and observation of the patients' pain and ankle movement were evaluated using VAS, AOFAS, KAFS, and SF-36. All incisions were healed in the first stage, and no complications such as nerve, blood vessel, or tendon injuries occurred. The hospital stays were 3 to 5 days, with a mean of 3.7 ± 1.3 days. All patients were followed up for 12 to 36 months, with a mean follow-up time of 25.4 ± 8.5 months. By the last follow-up, the ankle joint and hallux movement were normal and returned to the pre-pain state for these patients. The VAS score decreased to 0.2 ± 0.1, while the AOFAS, KAFS, and SF-36 scores increased to 97.7 ± 8.5, 97.9 ± 8.2, and 118.2 ± 8.4, respectively. Advantages of all-inside posterior arthroscopic partial muscle belly resection for the treatment of FHL tendon impingement syndrome include small surgical trauma, fast functional recovery, and reliable outcomes. This procedure is therefore worthy of clinical attention and promotion.

Endoscopic Partial Plantar Fasciotomy via 2 Medial Portals vs Mini-Open Procedure for Refractory Plantar Fasciitis

BACKGROUND

The treatment of plantar fasciitis may require surgical intervention in patients with ineffective response to conservative treatment. There is a lack of evidence regarding the differences in clinical outcomes between the endoscopic and the mini-open procedures. The purpose of this study was to compare the clinical outcomes of the endoscopic partial plantar fasciotomy via 2 medial portals with mini-open partial plantar fasciotomy for treating refractory plantar fasciitis.

METHODS

A retrospective analysis was carried out on 62 patients with refractory plantar fasciitis from January 2015 to July 2017. Thirty-three patients received endoscopic partial plantar fasciotomy, while the other 29 received mini-open procedure by patient preference. Two medial portals were used in the endoscopic group while single mini-medial method was used in the open group. All patients were followed up for 24 months. The pain visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, the calcaneodynia score (CS), and the 36-item Short Form Health Survey questionnaire (SF-36) were employed to evaluate the clinical outcomes of the 2 groups.

RESULTS

There was increase in the functional scores (eg, VAS, AOFAS, CS, and SF-36) in both groups recorded at 3 months, 6 months, 1 year, and 2 years after surgery. The patients in the endoscopic group had better VAS, AOFAS, CS, and SF-36 scores at 3 months after the surgery compared with those of the open group. During the 6-month follow-up, although the 2 groups showed similar VAS and AOFAS, the CS and SF-36 scores of the endoscopic group were significantly higher than those of the open group. During the 1-year and 2-year follow-ups, the endoscopic group gained equivalent VAS, AOFAS, CS, and SF-36 scores compared with those of the open group. The recurrence rate was similar in both groups. Moreover, the patients in the endoscopic group achieved earlier recovery in comparison to those in the open group.

CONCLUSION

For refractory plantar fasciitis, endoscopic partial plantar fasciotomy via 2 medial portals produced better short-term and equivalent long-term subjective outcomes than the mini-open surgery.

LEVEL OF EVIDENCE

Level II, comparative study.

Long-term functional outcomes of all-inside arthroscopic repair of anterior talofibular ligament avulsion fracture

BACKGROUND

The main purpose of this study was to describe the all-inside arthroscopic technique for repairing anterior talofibular ligament (ATFL) avulsion fractures at the attachment points of the fibula and talus, and to evaluate the functional outcomes during long-term follow-up.

METHODS

The data of 78 patients with ATFL avulsion fracture treated in our hospital from August 2013 to November 2016 were analyzed retrospectively. All patients underwent surgery. Patients were divided into two groups according to whether they had undergone all-inside arthroscopic treatment or open treatment. The American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Foot and Ankle Outcome Score (FAOS) and a 36-item Short Form Health Survey questionnaire (SF-36) were used to evaluate functional outcomes.

RESULTS

The postoperative follow-up period was 24-48 months. All patients reported subjective improvements to ankle stability without any nerve, blood vessel or tendon complications. At the final follow-up, there was no significant difference in the AOFAS, SF-36 or sport participation rate between the arthroscopic group and the open group; however, the KAFS and FAOS were significantly higher in the arthroscopic group than in the open group.

CONCLUSIONS

For ATFL avulsion fractures, the all-inside ankle arthroscopic procedure produced better outcomes than did the open procedure. The all-inside ankle arthroscopic procedure provides a minimally invasive technique with acceptable long-term functional outcomes.

All-inside arthroscopic modified Broström-Gould procedure for chronic lateral ankle instability with and without anterior talofibular ligament remnant repair produced similar functional results

PURPOSE

The Broström-Gould procedure, with the repair of the anterior talofibular ligament (ATFL) combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI). Lateral ligament reconstruction is considered if the ATFL remnant quality is poor or the ATFL has been damaged beyond the ability to suture it. It remains unclear whether not repairing the ATFL remnant produces comparable functional outcomes to the classical Broström-Gould procedure.

METHODS

This retrospective cohort study included 84 patients with CLAI undergoing either repair or non-repair of the ATFL remnant using an all-inside arthroscopic Broström-Gould procedure from 2015 to 2018. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups.

RESULTS

All the functional scores (VAS, AOFAS, KAFS, ATT, AJPS) significantly improved in both groups at 1 and 2 years after surgery. At all the follow-up time points, the VAS, AOFAS, KAFS, ATT, AJPS, and the rate of return to sport scores were comparable between the repair and non-repair group.

CONCLUSION

There are no statistically significant differences in postoperative outcomes between ATFL remnant repair and non-repair for the management of CLAI using the all-inside arthroscopic Broström-Gould procedure. From the clinical viewpoint, the present study shows that the potential differences in clinical outcomes between ATFL remnant repair and non-repair are likely not relevant when performing an all-inside arthroscopic Broström-Gould procedure for CLAI.

LEVEL OF EVIDENCE

III.

Functional Comparison of Horizontal Mattress Suture Versus Free-Edge Suture in the All-Inside Arthroscopic Broström-Gould Procedure for Chronic Lateral Ankle Instability

Objective

To compare the clinical outcomes of horizontal mattress suture vs free‐edge suture in the all‐inside arthroscopic Broström–Gould procedure.

Methods

This retrospective cohort study included 68 chronic lateral ankle instability (CLAI) patients who underwent either a horizontal mattress suture or a free‐edge suture all‐inside arthroscopic Broström–Gould procedure from January 2014 to January 2017. Patients were divided into two groups based on the suture fashion during the all‐inside arthroscopic Broström–Gould procedure. In the horizontal mattress suture group (n = 31), anchor sutures were used to suture the ATFL, capsule, and inferior extensor retinaculum in horizontal mattress suture fashion. In the free‐edge suture group (n = 37), anchor sutures were used to suture the ATFL, capsule, and inferior extensor retinaculum in free‐edge suture fashion. The Visual Analogue Scale (VAS) score, the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), the rate of return to sports, and ankle proprioceptive recovery were compared in both groups.

Results

The operative times and duration of hospitalization between the two groups were comparable (all P > 0.05). The VAS, AOFAS, ATT, the rate of return to sports, and ankle proprioceptive recovery were comparable between the horizontal mattress suture and free‐edge suture groups at 1 and 2 years after surgery. Patients of the free‐edge suture group achieved better KAFS 1 and 2 years after the surgery compared with those of the horizontal mattress suture group. In both groups, incisions were healed by first intention, and complications such as infection, implant reactions, tendon injury, and nervous or vascular injuries were not observed. The ankle proprioceptive recovery in horizontal mattress suture and free‐edge suture groups showed no significant differences at 1 and 2 years after surgery. The mean time of the return to full activity for patients in the horizontal mattress suture group was 10.38 ± 2.02 (range 8 to 12) weeks vs 8.63 ± 2.31 (range 8 to 12) weeks for those in the free‐edge suture group (P = 0.001, power = 0.907). The exercise participation rates were comparable between groups (P > 0.05). At the 2‐year follow‐up, all patients regained normal activities and ankle stability, and no recurrence of CLAI or revision surgery was recorded.

Conclusion

All‐inside arthroscopic Broström–Gould surgery for the treatment of CLAI ensures a better functional effect (KAFS) and better recovery time when free‐edge suture is used instead of horizontal mattress suture.

Arthroscopic Remnant-Preserving Anterior Talofibular Ligament Reconstruction does not Improve Mid-term Function in Chronic Ankle Instability

BACKGROUND

Anterior talofibular ligament (ATFL) reconstruction is routinely undertaken to manage chronic lateral ankle instability (CLAI). This study evaluated the effects on clinical outcome of preserving or not preserving the ATFL remnant when reconstructing the ATFL.

METHODS

From January 2015 to July 2017, 53 CLAI patients with ATFL injury were randomized to undergo either a remnant-preserving (preservation of ATFL) or a non-preserving (no preservation of ATFL) anatomic reconstruction of the ATFL using an ipsilateral free semitendinosus tendon autograft. The Visual Analogue Scale (VAS) score, the American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), and ankle proprioceptive recovery in both groups were compared.

RESULTS

All patients were followed up for at least 2 years, VAS, AOFAS, KAFS, ATT and ankle proprioception between two the groups were not statistically significant different.

CONCLUSION

There are no differences at 2.5 years in postoperative ankle function, stability and proprioceptive recovery when an ipsilateral free semitendinosus tendon autograft is used to manage CLAI regardless of preservation of the remnant ATFL.

Functional Results of All-Inside Arthroscopic Broström-Gould Surgery With 2 Anchors Versus Single Anchor

BACKGROUND

The all-inside arthroscopic Broström-Gould technique gained particular attention among clinicians and researchers due to its high rate of satisfactory results. Thus far, there is a lack of evidence regarding the differences in clinical outcomes between the use of 1 anchor and 2 anchors. The purpose of this study was to compare the differences in clinical function and activity levels in patients treated with 1 or 2 anchors in all-inside arthroscopic Broström-Gould surgery for chronic lateral ankle instability (CLAI).

METHODS

The data of 75 patients with CLAI (unilateral) admitted from May 2013 to July 2016 were retrospectively analyzed. All patients were treated with all-inside arthroscopic Broström-Gould surgery. The patients were divided into a single-anchor group (n = 36) and double-anchor group (n = 39) according to the number of anchors used. There was no statistical difference in general characteristics between the 2 groups before surgery. After 36 to 72 months of follow-up, the pain visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Foot and Ankle Outcome Score (FAOS) were used to evaluate and compare the clinical function results between the 2 groups.

RESULTS

The incidence of wound complications; reaction to the suture; injury to the nerve, blood vessel, or tendon; and length of postoperative hospitalization were similar between the 2 groups. At the last follow-up, there was no significant difference in the VAS and AOFAS scores between single- and double-anchor groups, but the KAFS and FAOS in the double-anchor group were significantly higher than in the single-anchor group. Additionally, more patients in the double-anchor group returned to preinjury sports activities.

CONCLUSION

All-inside arthroscopic Broström-Gould surgery for the treatment of CLAI yielded a better functional effect and better recovery to preinjury mobility when 2 anchors were used instead of a single anchor.

LEVEL OF EVIDENCE

Level III, comparative study.

Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium- and Long-Term Functional Follow-Up

Objective

To evaluate the functional outcomes of arthroscopic anatomical repair of anterior talofibular ligament (ATFL) in the treatment of chronic lateral ankle instability (CLAI) during medium‐ and long‐term follow‐up.

Methods

From September 2014 to August 2017, the data of 37 patients (23 males, 14 females; 12 left ankles, 25 right ankles) aged between 21 and 56 years, with an average age of 32.17 ± 6.35 years, presenting with CLAI, was retrospectively analyzed. Among them, 32 injuries were caused by sprain and five injuries were caused by car accidents. The course of the disease lasted for 12 to 60 months, with an average of 26.07 ± 13.29 months. All patients had intact skin around the ankle and no skin lesions. All patients underwent arthroscopic anatomical repair of ATFL, with the fixation of one to two anchors. Pre‐ and post‐operative visual analogue scales (VAS), the American Orthopaedic Foot and Ankle Society Ankle‐Hindfoot Score (AOFAS), and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation.

Results

The operation was successful in all 37 cases. The operation time ranged from 40 to 75 min, with an average of 51.25 ± 11.49 min. After surgery, all incisions healed in stage I and there were no complications such as nerve, blood vessel and tendon injury, implant rejection, or suture rejection. Hospital stays of postoperative patients were 3 to 5 days, with an average of 3.77 ± 1.36 days. All patients were followed for 24 to 45 months, averaging 33.16 ± 10.58 months. For three patients with CLAI combined with mild limitation of subjective ankle movement, joint activity was normal after rehabilitation function exercise and proprioceptive function training for 2 months. At the final follow‐up, ankle pain had disappeared completely. The ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and all patients returned to normal gait. The mean VAS score decreased to 1.12 ± 0.13, the AOFAS score increased to 92.53 ± 4.87, and the KAFS score increased to 93.36 ± 6.15. All the follow‐up indexes were significantly different from those before surgery.

Conclusion

Arthroscopic anatomical repair of ATFL for CLAI is precise, with less surgical trauma and reliable medium‐ and long‐term effect.

[Arthroscopy-assisted percutaneous reduction and screw fixation for displaced intra-articular calcaneal fractures]

Objective: To investigate the surgical technology and clinical efficacy of using the all-inside arthroscopic treatment of intra-articular displaced calcaneal fracture. Methods: A retrospective analysis was made of 46 patients (46 feet) with intra-articular displaced calcaneal fractures treated by modified all-inside arthroscopic from December 2015 to December 2017 in Xuzhou Central Hospital. Twenty-eight cases (28 feet) were male and 18 cases (18 feet) were female, aged from 19 to 60 years (mean (39±13) years). The time from injury to operation was 1 to 10 days (mean (4.5±2.2) days). The pre-operative visual analogue scale (VAS) of pain ranged from 4 to 8 points, mean (6.3±1.8) points. No other combined injuries were found in the affected feet in all patients. All patients were treated with anterolateral, lateral and posterolateral approaches of arthroscopically assisted reduction for calcaneal fractures, and fixed with hollow screw. Main outcome measures included the pain, foot appearance, and the scores of the American Orthopedic Foot & Ankle Society (AOFAS) Scale and the Maryland Scale. Paired t test was used when the data before and after the operation were compared. Results: All incisions healed in one stage without postoperative complications such as nerve, vessel and tendon injury. The mean follow-up period ranged from 12 to 36 months, mean (21±9) months. Postoperatively X-ray showed complete fracture healing time was 8 to 12 weeks, mean (10.4±2.3) weeks. At the last follow-up, the ankle and talocalcaneal joints movement and appearance were ideal, and no traumatic arthritis was found. The VAS score of talocalcaneal joint was 0. AOFAS score increased from 58±13 to 96±9 and Maryland score increased from 72±11 to 98±8 after the operation, the differences were all significant (t=15.958, 12.496, both P<0.05). Conclusion: The all-inside arthroscopic treatment of the intra-articular displaced calcaneal fracture is an effective and precise method, with accurately outcomes, precise reduction and minimally postoperative complications.

[Analysis of the effect of two medial portals for the all-inside endoscopic treatment of recalcitrant plantar fasciitis]

Objective: To examine the clinical effect of all-inside endoscopic treatment of recalcitrant plantar fasciitis through two medial portals. Methods: The recalcitrant plantar fasciitis data of 67 cases (79 feet) that underwent two medial portals all-inside endoscopic treatment at Department of Hand and Foot Microsurgery, Xuzhou Central Hospital from October 2016 to June 2018 were retrospectively analyzed.There were 24 males (30 feet) and 43 females (49 feet) aged 44.3 years old(range:24-76 years).The mean disease duration from the specialist doctor intervention to operation was (23.7±11.0) months (range: 12-60 months). All the patients were treated with the two medial portals all-inside endoscopic procedure when the 6 months conservative treatment had failed.The endoscopic procedure including debridement and partial plantar fasciotomy.The clinical results,including pain,activity,gait and foot health quality,were scored using visual analogue pain scale (VAS),American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale (AOFAS) and SF-36. Results: All the patients were followed up for (15.2±6.7) months (range: 12-24 months). All cases achieved primarily healing of the wound without postoperative complications of nerve,vessel and tendon.At the last follow-up,the VAS decreased from (5.3±2.0) preoperative to 0 prooperative (t=21.60, P=0.000), AOFAS increased from (72.6±9.4) to (97.3±4.6)(t=19.43,P=0.000),SF-36 increased from (93.6±8.4) to (119.1±7.3) (t=18.78, P=0.000), non-recurrent calcaneal spur, normal foot and ankle activity was recorded. Conclusion: The two medial portals all-inside endoscopic procedure is effective for the treatment of recalcitrant plantar fasciitis.

[Clinical analysis of ankle arthroscopy technique for treatment of tarsal tunnel syndrome]

Objective: To explore the effects of ankle arthroscopy technique in treating the tarsal tunnel syndrome. Methods: From May 2014 to May 2016, the ankle arthroscopy technique was used for surgical treatment of tarsal tunnel syndrome in the Department of Hand and Foot Microsurgery in Xuzhou Central Hospital. Twenty-two patients with 24 feet with tarsal tunnel syndrome were hospitalized for treatment, with 10 left feet and 14 right feet, aged 26-57 years. The disease duration ranged from 4 to 15 months (mean 8.3 months). The dual-portals ankle arthroscopic neurolysis and fiber membrane resection were performed. The Pfeiffer scoring system was used to evaluate the post-operative outcomes. Results: Primarily healing of the wound was achieved in all the patients. No postoperative infection was found during the follow-up. The postoperative hospitalization time was 2 to 5 days (mean 3.7 days). All patients were followed up for 12 to 24 months. At the final follow-up, all the patients had significant improvement in numbness and pain. According to the Pfeiffer scoring system, the results were excellent in 16 feet, good in 8 feet, with an excellent and good rate of 100%. Conclusion: The ankle arthroscopic neurolysis is a safe and easy treatment option for the tarsal tunnel syndrome and provides satisfactory results.

[Arthroscopic treatment of avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury]

Objective: To analyze the clinical effects of all-inside arthroscopic treatment for the patients of avulsion fracture of tibial origin withⅠdegree supination and external rotation injury according to the Lauge-Hansen classification. Methods: A retrospective analysis of 34 patients (34 feet) who had underwent all-inside arthroscopic for avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury from September 2015 to September 2017 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital. There were 20 males and 14 females, aged (24.7±11.3)years (range:14-43 years). The duration from injury to operation was (4.3±2.5) d (range: 6 h-7 d). The pro-operation visual analogue scale(VAS) of pain was 6.8±1.4(range: 4-8). All the patients were treated with the all-inside arthroscopic procedure by using the anterolateral and near-anterolateral portals and the fractures were fixed with cannulated screws. Main outcome measures included the pain, foot appearance, and patients were scored using the American Orthopaedic Foot & Ankle Society Lesser Toe Metatarsophalangeal-Interphalangeal Scale(AOFAS). Results: Primarily healing of the wound was achieved in all cases without postoperative complications of nerve, vessel and tendon injury. The follow-up period was (16.9±6.6)months(range: 8-24 months). Postoperatively X-ray films showed complete fracture healing at (11.2±2.1)weeks after surgery.At the last follow-up, the ankle movement and appearance were good, and no ankle joint traumatic arthritis were found. The VAS and AOFAS was 0 and 95.7±9.4 respectively. Conclusion: The all-inside arthroscopic treatment of Lauge-Hansen type avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury is an effective and precise method, with accurately outcomes, precise reduction and minimally postoperative complications.

"All-Inside" Arthroscopic Treatment of Tillaux-Chaput Fractures: Clinical Experience and Outcomes Analysis

We investigated all-inside ankle arthroscopy for Tillaux-Chaput fractures. We retrospectively evaluated 19 patients (12 males [63.2%] and 7 [36.8%] females; 11 right [57.9%] and 8 left [42.1%] ankles) treated from May 2013 to January 2016. Their mean age was 28.1 (range 10 to 55) years. Sixteen (84.2%) had single Tillaux-Chaput fractures and 3 (15.8%) had combined proximal fibular fractures; 17 (89.5%) were diagnosed radiographically and 2 (10.5%) by computed tomography. Anterolateral and anteromedial ankle arthroscopy was used for closed reduction and internal fixation with 1 or 2 Herbert screws. Joint function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. All 19 patients healed by first intention without nerve, vessel, or tendon injuries. The follow-up was 19.0 (range 12 to 25) months; fracture union was achieved by 23.5 (range 12 to 36) weeks. At the last follow-up, the 19 patients had no restrictions in ankle function and range of motion, with no ankle or walking pain. The AOFAS score changed from 52.8 to 91.7 points, with an excellent/good rate of 100%. These results suggest that anterolateral and anteromedial all-inside ankle arthroscopy is a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures.

The modified coughlin osteotomy for surgical treatment of high-grade tailor’s bunion

Category:

Lesser Toes

Introduction/Purpose:

To explore the surgical method of using the modified coughlin osteotomy for surgical treatment of high-grade tailor’s bunion and report the clinical outcomes

Methods:

From March 2013 to April 2015, the modified coughlin osteotomy was used for surgical treatment of high-grade tailor’s bunion. Twenty-two patients with 31 feet high-grade tailor’s bunion were hospitalized for treament in Xuzhou Central Hospital. There were 3 male (3 feet) and 19 female (28 feet) cases, aged 26 -78 years (mean 45.3y) old. The mean course of the painful bunionette disease was 6.7 years (range, 2 to 38 y). The average 4-5 intermetatarsal angle, fifth metatarsophalangeal angle and lateral deviation of the fifth metatarsal angle were 16.3°±5.1°, 10.7°±3.5° and 5.8°±2.6°, respectively. Main outcome measures included the 4-5 intermetatarsal angle, the fifth metatarsophalangeal angle, pain and appearance. Patients were scored using the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale.

Results:

All operations were performed with no complications. Primarily healing of the wound was achieved in all cases. All the patients were followed up for a mean time of 17.8 months (range, 6 to 30 months). The mean fracture healing time was 11.6 weeks(range, 6 to 14 weeks), X-ray photograph proved fracture healing with a good positoin.All the patients had satisfactory appearance and sensory function witout callosum and metastatic metatarsalgiaat the final follow-up. The preoperatively average 4- 5 intermetatarsal angle, fifth metatarsophalangeal angle and lateral deviation of the fifth metatarsal angle were 5.9°±1.6°, 6.1°±2.3° and 2.2°±1.2°, respectively. The mean AOFAS score was 89.0±8.4.

Conclusion:

The modified coughlin osteotomy is a safe and easy treatment option for the high-grade tailor’s bunion deformity and provides patient satisfaction results

Aesthetic Treatment of Tillaux-Chaput fractures

Category:

Arthroscopy

Introduction/Purpose:

This study aim to investigate the clinical result of treating Tillaux-Chaput fractures using the all-inside ankle arthroscopy technique.

Methods:

We retrospectively evaluated 23 Tillaux-Chaput fractures patients who underwent all-inside ankle arthroscopy technique and were follow-up from May 2013 to June 2016. There were 15 males and 8 females, with the mean age of 30.4 years (range, 10-57 years). Right ankle was involved in 15 patients and left ankle in 8 patients. Eighteen patients had single Tillaux-Chaput fractures and 5 patients had combined proximal fibular fractures. While 20 cases were diagnosed by X-rays and 3 cases by CT. Ankle arthroscopy was used through the anterolateral and anteriormedal approaches for closed reduction and internal fixation using Herbert screw(s). The joints function was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale score.

Results:

Operative incisions of 23 cases were primary healing without complications of nerve, vessel and tendon injuries. The period of follow-up was 19.6 months (range, 12-25 months) and the time of Fracture union was 23.3 weeks (range, 12-36 weeks). At the time of last follow-up, none of the patients had any restriction in the ankle function and range of motion, with the ankle pain and weight-bearing walking pain. AOFAS score was changed from preoperative 53.3 points to 92.1 points, with the excellent-good rate of 100%.

Conclusion:

All-arthroscopy teatment by the anterolateral and anteriormedal approaches is a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures and deserves clinical application.

A Novel Approach for Reconstruction of Finger Neurocutaneous Defect: A Sensory Reverse Dorsal Digital Artery Flap from the Neighboring Digit

OBJECTIVE

Providing soft tissue coverage for finger neurocutaneous defects presents aesthetic and sensory challenges. A common source for reconstruction of soft tissue defects of the fingers is the same finger. However, when the donor areas are damaged by concomitant injuries, this option is not available. The present study aims to reconstruct finger neurocutaneous defects using a sensory reverse dorsal digital artery flap from the neighboring digit and to evaluate the efficacy of this technique.

METHODS

The study included 16 patients, with an average age of 34.9 years (range, 20-53 years) at the time of surgery, from May 2010 to June 2013. The sensory reverse dorsal digital artery flap was used in all 16 patients, who had a combination of soft tissue and digital nerve defects. The mean size of the soft tissue defects was 3.1 cm × 2.0 cm, and the mean flap size was 3.3 cm × 2.2 cm. The length of the nerve defects ranged from 1.3 to 2.5 cm (mean, 2.0 cm), which were reconstructed with dorsal branches of the proper digital nerve transfer. The active motion of the fingers (injured and donor) and the flap sensibility (static two-point discrimination) were measured. The appearance and functional recovery of the injured finger and the donor site were assessed using the Michigan Hand Outcomes Questionnaire.

RESULTS

All flaps survived completely. No complications were reported, and no further flap debulking procedure was required. At the mean follow-up period of 24 months (range, 18-30 months), the mean static two-point discrimination was 6.5 mm (range, 5-10 mm) of the reconstructed area; the mean ranges of motions of the injured finger and the opposite finger at the proximal interphalangeal and distal interphalangeal joints were 102.2° and 103.5°, and 70.3° and 76.5°, respectively. The average ranges of motions of the metacarpophalangeal and proximal interphalangeal joints of the donor fingers were 90° and 103.4°, respectively. Based on the Michigan Hand Outcomes Questionnaire, 10 patients were strongly satisfied and 6 were satisfied with the functional recovery of the injured finger; however, 13 patients were strongly satisfied and 3 were satisfied with the appearance of the injured finger.

CONCLUSION

The sensory reverse dorsal digital artery flap from the neighboring digit, based on the dorsal branch of the digital artery, is an effective and additional option for finger neurocutaneous defect reconstruction when use of the local and regional flaps is not feasible.

[Modified Chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity]

OBJECTIVE

To explore the surgical method of using the modified chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity.

METHODS

From June 2013 to June 2015, the modified chevron osteotomy combined distal soft tissue reconstruction was used for surgical treatment of high-grade bunionette deformity in the Department of Hand and Foot Microsurgery in Xuzhou Central Hospital.Twenty-six patients with 28 feet high-grade bunionette deformity were hospitalized for treatment, with 3 male (3 feet) and 23 female (25 feet) cases, aged 22-73 (mean 47.1) years old.The average fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were measured on the pre-and post- operative anterior to posterior weight-beating X rays of treated feet.The American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale was used to evaluate the post-operative outcomes.

RESULTS

All of 26 patients were followed, with a mean 15.7 months (range 8-25 months). Primarily healing of the wound was achieved in all cases.No postoperative infection and nonunion on the osteotomy site was found during the follow-up time.The fracture healing time was 6-15 (mean 12.2) weeks.All the patients had satisfactory appearance and sensory function without callosum and metastatic metatarsalgia at the final follow-up.The post-operative fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were significantly lesser than the pre-operative at the 6th week after operation, respectively [(5.5±1.7)°, (2.1±0.8)°, (5.7±2.6)°vs (16.4±4.2)°, (6.0±2.2)°, (10.5±7.4)°; all P<0.01]. The post-operative AOFAS score was significantly greater than the pre-operative [(87.1±6.7) vs (62.3±9.8) points, P<0.001].

CONCLUSION

The modified chevron osteotomy combined distal soft tissue reconstruction is a safe and easy treatment option for the high-grade bunionette deformity and provides patient satisfaction results.

Aesthetic and sensory reconstruction of finger pulp defects using free toe flaps

BACKGROUND

This study illustrates aesthetic and sensory reconstruction of finger pulp defects with free toe flaps from the lateral aspect of the great toe or the medial aspect of the second toe.

METHODS

Between August 2007 and July 2010, free toe flaps were harvested and used for 21 fingers of 21 patients. The average patient age was 34.5 years (range 19-62 years). The soft tissue defects were found in the thumb of 6 patients, the index finger of 7 patients, the middle finger of 5 patients, and the ring finger of 3 patients. The donor site was the great toe for 9 patients and the second toe for 12 patients. The average flap size was 2.8 × 2.0 cm (range 1.7 × 1.7 to 3.5 × 3.0 cm). Restoration of the sensitivity, aesthetic appearance, and mobility of the injured fingers compared with the opposite side was assessed using appropriate tools during the follow-up time.

RESULTS

All the flaps in this series survived completely, with a high survival rate of 100 %. No urgent operative revision necessitated by postoperative thrombosis of the vessels was performed during the follow-up period. During a mean follow-up period of 18.4 months (range 12-24 months), the average static two-point discrimination score for the injured finger pulp was 4.8 mm (range 3-7 mm), and the Michigan Hand Outcome Questionnaire score was 4.9 mm. The mean range of motion of the distal interphalangeal joint in the injured finger was 69.7°.

CONCLUSION

Transplantation of free microvascular flaps from the great toe or the second toe is a useful and reliable technique for finger pulp defect reconstruction.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of distal fingertip degloving injuries using a cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx

This study reports our experience with reconstruction of distal fingertip degloving injuries using a single cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx. From January 2009 to October 2011, 18 patients (18 fingers) presented with distal fingertip degloving injuries and were treated with this technique. The mean size of the soft tissue defects was 4.5 cm in length and 2.0 cm in width. The mean size of the cross-finger flaps was 4.7 × 2.1 cm. In the series, all flaps survived completely. No complication was reported, and no further flap debunking procedure was required. At the mean follow-up period of 20.5 months (range, 12-48 mo), the mean static two-point discrimination was 6.3 mm (range, 5-9 mm) of the reconstructed finger pulp. The total range of active motion of the proximal and the distal interphalangeal joints of the donor fingers were 105 and 77.4 degrees, respectively. The cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx is a reliable and simple method in reconstruction of distal degloving injuries of the finger.

HCPTPA, a protein tyrosine phosphatase that regulates vascular endothelial growth factor receptor-mediated signal transduction and biological activity

Angiogenesis is a tightly controlled process in which signaling by the receptors for vascular endothelial growth factor (VEGF) plays a key role. In order to define signaling pathways downstream of VEGF receptors (VEGFR), the kinase domain of VEGFR2 (Flk-1) was used as a bait to screen a human fetal heart library in the yeast two-hybrid system. One of the signaling molecules identified in this effort was HCPTPA, a low molecular weight, cytoplasmic protein tyrosine phosphatase. Although HCPTPA possesses no identifiable phosphotyrosine binding domains (i.e. SH2 or phosphotyrosine binding domains), it bound specifically to active, autophosphorylated VEGFR2 but not to a mutated, kinase-inactive VEGFR2. Recombinant VEGFR2 and endogenous VEGFR2 were substrates for recombinant HCPTPA, and HCPTPA was co-expressed with VEGFR2 in endothelial cell lines, suggesting that HCPTPA may be a negative regulator of VEGFR2 signal transduction. To pursue this possibility, an adenovirus directing the expression of HCPTPA was constructed. When used to infect cultured endothelial cells, this adenovirus directed high level expression of HCPTPA that resulted in impairment of VEGF-mediated VEGFR2 autophosphorylation and mitogen-activated protein kinase activation. Adenovirus-mediated overexpression of HCPTPA also inhibited VEGF-induced cellular responses (endothelial cell migration and proliferation) and inhibited angiogenesis in the rat aortic ring assay. Taken together, these findings indicate that HCPTPA may be an important regulator of VEGF-mediated signaling and biological activity. Potential interactions with other signaling pathways and possible therapeutic implications are discussed.

PGE receptor characteristics on porcine luteal cells during the estrous cycle and early pregnancy

This study examined the affinities and concentrations of prostaglandin E (PGE) receptors on porcine luteal cells during the estrous cycle and early pregnancy. Corpora lutea (CL) were obtained from nonpregnant gilts at days 9 (n = 4), 12 (n = 3), and 14 (n = 6); three gilts possessed red, vascular CL and three gilts had white nonvascular CL) of the estrous cycle, and days 9 (n = 4), 12 (n = 3), 14 (n = 5), and 30 (n = 5) of pregnancy. The CL were dissociated enzymatically to disperse single cells and the red blood cells were removed by elutriation. The luteal cells were assayed for specific PGE binding by displacement analysis with use of [3H] PGE2 and varying concentrations of unlabeled PGE2. The specific binding of [3H] PGE2 to luteal cells decreased (p < 0.05) from days 9 to 14 of the estrous cycle, but only decreased (p < 0.05) from days 9 to 12 of pregnancy. Specific binding was higher (p < 0.05) on day 14 of pregnancy than the comparable stage of the estrous cycle. The affinities of PGE receptors decreased (p < 0.05) only on the luteal cells dissociated from red, vascular CL of day 14 nonpregnant gilts compared with those of other days of the estrous cycle and pregnancy. The number of PGE receptors on porcine luteal cells was similar (p > 0.05) in pregnant and nonpregnant gilts, but decreased (p < 0.05) on days 12-14 postestrus. During early pregnancy, it was evident that high affinity PGE receptors are sustained on porcine luteal cells; however, the role of the PGE receptors in maternal recognition of pregnancy remains speculative.

Effects of LH, prostaglandin E2, 8-bromo-cyclic AMP and forskolin on progesterone secretion by pig luteal cells

The present study examined the effects of LH, prostaglandin E2 (PGE2), 8-bromo-cyclic AMP (cAMP) and forskolin on progesterone secretion by small and large pig luteal cells. Corpora lutea were isolated from gilts (n > or = 3 per day) on days 9, 12 and 14 of the oestrous cycle and days 9, 12, 14 and 30 of pregnancy. After enzymatic dissociation of the corpora lutea, small and large luteal cells were obtained by elutriation. Culture plates (24-well) were then seeded with 150,000 small luteal cells or 30,000 large luteal cells per well in 1 ml M199 medium in the absence or presence of LH, PGE2, LH plus PGE2, 8-bromo-cAMP or forskolin. After 12 h of incubation, culture plates were centrifuged, and the supernatant collected and frozen for subsequent assay of progesterone. Differences within day were not detected between cyclic and pregnant gilts, and thus, results were combined for days 9, 12 and 14. Basal progesterone secretion by small luteal cells was less (P < 0.05) on days 14 and 30 than days 9 and 12. Treatment with LH, PGE2, 8-bromo-cAMP or forskolin increased (P < 0.05) progesterone secretion by small luteal cells on days 9 and 12; however, treatments had no effect on days 14 and 30. Basal progesterone production by large luteal cells was less (P < 0.05) on day 30 compared with other days. PGE2 stimulated (P < 0.001) progesterone production by large luteal cells at all days. In contrast, 8-bromo-cAMP and forskolin inhibited progesterone production by large luteal cells on day 12 (P < 0.05), and day 14 (P < 0.001). These data show that pregnancy status does not alter luteal cell response to the aforementioned secretagogues. However, regulation of progesterone secretion differs between small and large luteal cells, and the age of the corpora lutea. Also, it is unlikely that the stimulatory actions of PGE2 involve increased cAMP production in pig large luteal cells.

Identification and distribution of prostaglandin E receptors on porcine luteal cells

This study examined whether pig luteal cells contain specific prostaglandin (PG) E receptors. Corpora lutea, from PG 600R -induced cycling prepubertal gilts or naturally cycling gilts, were dissociated enzymatically, and large, small, and mixed cells were obtained by elutriation. Preliminary experiments demonstrated that optimal [3H]PGE2 binding to mixed cells was obtained after incubation at 22 degrees C for 2 h in binding buffer containing 1% BSA at pH 7.38. In addition, [3H]PGE2 binding was displaced by prostaglandins in the order of PGE2 approximately or = to PGE1 > PGF2a > > PGI2. The mixed, large, and small cells were assayed for specific PGE2 binding by displacement analysis with [3H]PGE2 and varying concentrations of unlabeled PGE2. Each gilt was assigned to group A (n = 6) or group B (n = 3) on the basis of whether the serum progesterone concentrations in that pig had increased or decreased, respectively, from 2 days before ovary collection to the time of ovary collection. Luteal cells from PG 600R -induced cycling prepubertal gilts had similar (p > 0.1) affinities and numbers of PGE receptors. In group A, the mixed cells contained a PGE binding site with a Kd of 21.1 +/- 1.1 nM and a concentration of 5.0 x 10(5) sites per large cell. Affinities of PGE receptors were similar (p > 0.1) regardless of cell types and functional status. PGE receptor concentrations were higher on large cells than on small cells (p > 0.05) and in group A than in group B (p = 0.006). These data demonstrated that PGE receptors primarily exist on porcine large luteal cells and that the concentration of PGE receptors appeared to be related to corpus luteum functional status.