Zhenxing Shao

Background: Bone grafting is a common and effective treatment for anterior shoulder instability. Graft healing is critical for the success of this procedure; however, few studies have investigated methods to enhance the healing process. Furthermore, suitable animal models are scarce for this type of surgery. Purpose: To (1) establish an animal model of anterior shoulder instability, and (2) evaluate whether a surgical modification based on an inlay structure (creating a groove on the glenoid and shaping the graft to match it) along with postoperative administration of the bone anabolic agent parathyroid hormone 1-34 (PTH1-34) could accelerate graft healing. Study Design: Controlled laboratory study. Methods: A rabbit model of anterior shoulder instability was established, and autologous iliac bone grafting was performed. Gross morphological observation, micro–computed tomography imaging and analysis, and histological staining and evaluation were employed to assess whether the inlay-based surgical modification and postoperative intermittent subcutaneous injection of PTH1-34 could enhance graft healing. Results: The modified inlay technique increased the expression of Runx2 and type I collagen within the graft, accelerated graft integration with the glenoid, promoted more rapid callus remodeling and maturation, and reduced graft resorption. Additionally, for both the modified inlay and classic onlay bone grafting procedures, postoperative intermittent subcutaneous injection of PTH1-34 enhanced osteogenic capacity of the autograft and glenoid, increased new bone volume, and shortened the graft healing time. Conclusion: We successfully developed an animal model of autologous bone grafting for anterior shoulder instability. Using this model, we demonstrated that the modified inlay bone grafting procedure improves osteogenic ability, shortens healing time, and promotes callus maturation. Intermittent subcutaneous administration of PTH1-34 after surgery further enhanced graft-glenoid healing. Clinical Relevance: The modified inlay technique and postoperative intermittent PTH1-34 administration may improve graft healing rates after bone grafting procedures for anterior shoulder instability.

Background: Young athletes who undergo surgery for a rotator cuff tear (RCT) are expected to return to sports (RTS) at the preinjury level. Purpose: To determine the rate and level of RTS and associated factors after RCT surgery in young athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed in PubMed, Embase, and Cochrane Library the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were studies in English evaluating RTS after surgical treatment of RCTs in athletes <40 years. Study quality was evaluated according to the Methodological Index for Nonrandomized Studies scores. Fixed-effects and random-effects meta-analyses were conducted to investigate the overall RTS rate and the ability to RTS at the preinjury level and explore the heterogeneity of the studies. Results: Of 168 studies initially identified, 13 studies (332 athletes; 270 competitive and 62 recreational) were included. The mean age of the athletes was 26.1 years (range, 13.2-39 years). Eleven studies (289 athletes) reported the type of sports; the most common sports were baseball (n = 195), football (n = 47), and tennis (n = 13). A total of 25 athletes were lost to follow-up, leaving 307 athletes with postoperative RTS data for meta-analysis. The combined rate of RTS according to the fixed-effects model was 84% (95% CI, 80%-88%). The level of RTS was evaluated in 11 studies (251 athletes), and according to the random-effects models, the combined rate of RTS at the preinjury level was 63% (95% CI, 49%-77%). In a subgroup analysis, the rate of RTS at the preinjury level was significantly different between competitive athletes (61% [95% CI, 46%-76%]) and recreational athletes (89% [95% CI, 78%-99%]) ( P = .004). Conclusion: Results of this review indicated that most young athletes were able to RTS after RCT surgery, and more than half were able to RTS at the preinjury level. Compared with competitive athletes, a higher proportion of recreational athletes were able to RTS at the preinjury level after surgery.

Background: This study aimed to investigate the short-term complications (minimum 1-year follow-up) after either an arthroscopic Bristow or Latarjet procedure for anterior shoulder instability utilizing screw or suture-button fixation. Methods: Patients undergoing arthroscopic Bristow or Latarjet procedures between November 2016 and April 2021 were enrolled. Data were collected at baseline, 3 months, 6 months, and every year after surgery. Risks of postoperative complications and unplanned reoperations were assessed. A multivariable regression model was used to identify risk factors for complications and to determine the association of complications with patient-reported outcomes. Results: A total of 412 patients (425 shoulders) undergoing arthroscopic Bristow or Latarjet procedures performed by a single surgeon between November 2016 and April 2021 were reviewed. Two hundred and ninety-nine patients (308 shoulders, 76.2% of 404 eligible) with a mean follow-up of 22.3 ± 4.2 months were included for analysis. Two hundred and sixty-nine shoulders (87.3%) underwent a Bristow procedure (165 with screw and 104 with suture-button fixation), while 39 (12.7%) underwent a Latarjet procedure (18 with screw and 21 with suture-button fixation). Eighty-two patients (83 shoulders) reported a total of 85 complications within 2 years after surgery, with an overall complication rate of 26.9%. The rates of recurrent dislocation or subluxation and infection were 1.9% and 0.6%, respectively, while a total of 4 (1.3%) of the shoulders had unplanned reoperations. The most common complications were graft-related (11.7%), followed by complications involving neurologic symptoms (10.7%). The overall, graft, and neurologic complication rates following Bristow or Latarjet procedures were 27.1% versus 25.6%, 12.3% versus 7.7%, and 10.0% versus 15.4%, respectively. Compared with the Bristow technique with screw fixation, Bristow with suture-button fixation yielded a lower risk of any complications (odds ratio [OR], 0.55; p = 0.04). Paying with rural insurance and poor sleep quality prior to surgery were associated with increased risk of any complications. Conclusions: Compared with arthroscopic Bristow procedures with screw fixation, Bristow procedures with suture-button fixation resulted in a lower overall complication risk. Both patient demographic and implant-specific factors were associated with the development of a complication. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Treatment of articular cartilage remains a great challenge due to its limited self-repair capability. In tissue engineering, a scaffold with both mechanical strength and regenerative capacity has been highly desired. This study developed a double-network scaffold based on natural biomaterials of silk fibroin (SF) and methacrylated hyaluronic acid (MAHA) using three-dimensional (3D) printing technology. Structural and mechanical characteristics of the scaffold was first investigated. To enhance its ability of recruiting endogenous bone marrow mesenchymal stem cells (BMSCs), the scaffold was conjugated with a proven BMSC-specific-affinity peptide E7, and its biocompatibility and capacity of cell recruitment were assessed in vitro. Animal experiments were conducted to evaluate cartilage regeneration after transplantation of the described scaffolds. The SF/HA scaffolds exhibited a hierarchical macro-microporous structure with ideal mechanical properties, and offered a 3D spatial microenvironment for cell migration and proliferation. In vitro experiments demonstrated excellent biocompatibility of the scaffolds to support BMSCs proliferation, differentiation, and extracellular matrix production. In vivo, superior capacity of cartilage regeneration was displayed by the SF/MAHA + E7 scaffold as compared with microfracture and unconjugated SF/MAHA scaffold based on macroscopic, histologic and imaging evaluation. In conclusion, this structurally and functionally optimized SF/MAHA + E7 scaffold may provide a promising approach to repair articular cartilage lesions in situ.

Sarcopenia is a common complication of diabetes. Nevertheless, precise evaluation of sarcopenia risk among patients with diabetes is still a big challenge. The objective of this study was to develop a nomogram model which could serve as a practical tool to diagnose sarcopenia in patients with diabetes. A total of 783 participants with diabetes from China Health and Retirement Longitudinal Study (CHARLS) 2015 were included in this study. After oversampling process, 1,000 samples were randomly divided into the training set and internal validation set. To mitigate the overfitting effect caused by oversampling, data of CHARLS 2011 were utilized as the external validation set. Least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis were employed to explore predictors. Subsequently, a nomogram was developed based on the 9 selected predictors. The model was assessed by area under receiver operating characteristic (ROC) curves (AUC) for discrimination, calibration curves for calibration, and decision curve analysis (DCA) for clinical efficacy. In addition, machine learning models were constructed to enhance the robustness of our findings and evaluate the importance of the predictors. 9 factors were selected as predictors of sarcopenia for patients with diabetes. The nomogram model exhibited good discrimination in training, internal validation and external validation sets, with AUC of 0.808, 0.811 and 0.794. machine learning models revealed that age and hemoglobin were the most significant predictors. Calibration curves and DCA illustrated excellent calibration and clinical applicability of this model. This comprehensive nomogram presented high clinical predictability, which was a promising tool to evaluate the risk of sarcopenia in patients with diabetes.

Background: The Chinese unique inlay Bristow (Cuistow) procedure is a modified Bristow surgery in which an inlay (mortise-and-tenon) structure is added to the contact surface between the coracoid tip and the glenoid. Patients who have undergone the Cuistow procedure have had satisfying clinical performance and excellent postoperative bone healing rates (96.1%). Purpose: To compare the clinical and radiographic outcomes after the arthroscopic Cuistow procedure and the arthroscopic Bristow procedure. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 91 patients who underwent either the Cuistow or Bristow procedure between January 2017 and March 2018 were selected, and 69 patients (70 shoulders; 35 in the Cuistow group and 35 in the Bristow group) were included. Clinical assessment at minimum 24 months postoperatively, including the visual analog scale for pain and instability, American Shoulder and Elbow Surgeons score, Rowe score, subjective shoulder value score, and active range of motion, was completed by independent observers and compared with values collected preoperatively. Assessment with 3-dimensional computed tomography scans was performed preoperatively; immediately after the operation; at 3, 6, and 12 months postoperatively; and at the final follow-up. Results: A total of 69 patients (70 shoulders) were included, with a mean follow-up duration of 34.41 ± 5.99 months (range, 24-50 months). Both groups saw significant improvement in visual analog scale for pain and instability, American Shoulder and Elbow Surgeons, Rowe, and subjective shoulder value scores at the final follow-up compared with the preoperative values ( P < .001 for all), with no significant between-group differences on any clinical outcomes at the final follow-up. The 3-month postoperative graft union rate on computed tomography was significantly higher in the Cuistow group compared with the Bristow group (82.9% vs 51.4%, respectively, P = .003), although the graft union rate at the final follow-up was not significantly different (94.3% vs 85.7%, respectively; P = .449). Conclusion: Patients receiving the Cuistow procedure had equivalent clinical outcomes and a significantly higher bone union rate at 3 months postoperatively than those in the Bristow group. The inlay structure used in the Cuistow procedure was found to be associated with accelerated bone union.

Objectives: Bankart lesion is one of the most common lesions of the glenohumeral joint. Several double‐row suture methods were reported for Bankart repair, which could provide more stability, yet more motion limitation and complications. Therefore, we introduced a new double‐row Bankart repair technique, key point double‐row suture which used one anchor in the medial line. The purpose of this article is to investigate the clinical outcomes of this new method and to compare it with single‐row suture.Methods: Seventy‐eight patients receiving key point double‐row suture or single‐row suture from October 2010 to June 2014 were collected retrospectively. The basic information including gender, age, dominant arm, and number of episodes of instability was collected. Before surgery, the glenoid bone loss was measured from the CT scan. The visual analogue scale, American shoulder and elbow surgeons, the University of California at Los Angeles shoulder scale, and subjective shoulder value were valued before surgery and at the last follow‐up.Results: Forty‐four patients (24 patients receiving single‐row suture and 20 patients receiving key point double‐row suture) were followed up successfully. The follow‐up period was 9.2 ± 1.1 years (range, 7.8–11.4 years). At the last follow‐up, no significant differences were detected for any of the clinical scores. The recurrence rate was 12.5% for the single‐row group and 10% for the double‐row group, respectively (p = 0.795) 14 patients (31.8%) in the single‐row group and nine patients (26.5%) in the double‐row group were tested for active range of motion. A statistically significant difference was found only for the internal rotation at 90° abduction (48.9° for single‐row and 76.7° for key point double‐row, p = 0.033).Conclusion: The key point double‐row sutures for Bankart lesions could achieve similar long‐term outcomes compared with single‐row suture, and one medial anchor did not result in a limited range of motion. The low recurrence rate and previous biomechanical results also indicate the key point double‐row suture is a reliable method.

Osteoarthritis (OA) is a common degenerative disease. Although some biomarkers and drug targets of OA have been discovered and employed, limitations and challenges still exist in the targeted therapy of OA. Mendelian randomization (MR) analysis has been regarded as a reliable analytic method to identify effective therapeutic targets. Thus, we aimed to identify novel therapeutic targets for OA and investigate their potential side effects based on MR analysis. In this study, two-sample MR, colocalization analysis, summary-data-based Mendelian randomization (SMR) and Mendelian randomization phenome-wide association study (MR-PheWAS) were conducted. We firstly analyzed data from 4907 plasma proteins to identify potential therapeutic targets associated with OA. In addition, blood expression quantitative trait loci (eQTLs) data sources were used to perform additional validation. A protein–protein interaction (PPI) network was also constructed to delve into the interactions among identified proteins. Then, MR-PheWASs were utilized to assess the potential side effects of core therapeutic targets. After MR analysis and FDR correction, we identified twelve proteins as potential therapeutic targets for knee OA or hip OA. Colocalization analysis and additional validation supported our findings, and PPI networks revealed the interactions among identified proteins. Finally, we identified MAPK3 (OR = 0.855, 95% CI: 0.791–0.923, p = 6.88 × 10⁻⁵) and GZMK (OR = 1.278, 95% CI: 1.131–1.444, p = 8.58 × 10⁻⁵) as the core therapeutic targets for knee OA, and ITIH1 (OR = 0.847, 95% CI: 0.784–0.915, p = 2.44 × 10⁻⁵) for hip OA. A further MR phenome-wide association study revealed the potential side effects of treatments targeting MAPK3, GZMK, and ITIH1. This comprehensive study indicates twelve plasma proteins with potential roles in knee and hip OA as therapeutic targets. This advancement holds promise for the progression of OA drug development, and paves the way for more efficacious treatments of OA.