Huige Hou

Chronic ankle instability often requires surgical intervention, with arthroscopic anterior talofibular ligament repair being a preferred technique; however, outcomes in cases with poor ligament quality remain challenging. This study introduces a “modified suture augmentation” technique, which uses an individualized portal placement and arthroscopic lasso‐loop suturing, followed by a flexible “turn‐back” reinforcement of the anterior talofibular ligament using the suture limbs. This all‐inside, suture‐based augmentation method aims to provide anatomic reconstruction and enhanced stability while potentially avoiding the risk of joint stiffness associated with rigid internal bracing.

Background: There are difficulties in clinically diagnosing avulsion fractures of the distal fibula, although arthroscopic examination is an effective diagnostic method. To propose a novel classification scheme for avulsion fractures of the distal fibula, and further provide guidance for surgical and rehabilitation strategies. Methods: Data from 152 patients diagnosed with avulsion fractures of the distal fibula between February 1, 2019, and April 30, 2023, were included in this study. The characteristics of avulsion fractures of the distal fibula according to arthroscopic observations were identified, and concomitant intra-articular pathology was described and recorded. Results: Forty-five females and 107 males were enrolled. According to the size and relationship between the bone fragments and the ligaments, avulsion fractures were classified into the following types: A1 ( n = 9 [6.0%]); A2 ( n = 31 [20.3%]); B1 ( n = 62 [40.8%]); B2 ( n = 33 [21.7%]); C1 ( n = 13 [8.6%]); and C2 ( n = 4 [2.6%]). To further accurately locate avulsion fractures, fracture position was divided into anterior, junctional, and posterior areas. Most avulsion fractures occurred in the anterior and junctional areas (82.9%). Additionally, there was an association between the incidence of pathological soft tissue occupying the anterior compartment ( p < 0.001), osteochondral defect ( p = 0.035), and the type of avulsion fracture. Conclusion: This study established a new classification system for avulsion fractures of the distal fibula. Based on this classification system, we have proposed a serial management for different types of avulsion fractures, which provides certain reference value for clinical treatment.

Background: To evaluate the efficacy and safety of an all-inside, all-suture meniscal repair device for arthroscopic meniscal repair (AMR). Materials and methods: Patients with vertical longitudinal full-thickness meniscus tears undergoing AMR were randomly assigned to the intervention group (all-inside, all-suture meniscal repair device) or the control group (all-inside meniscal repair system). The primary efficacy endpoint was the Lysholm Knee Score (LKS) at 6 months postoperatively. Secondary efficacy endpoints included: (1) the immediate device success rate at intraoperatively; (2) LKS at 3 and 12 months postoperatively; (3) Tegner activity score (TAS) and visual analogue scale (VAS) of pain at 3, 6, and 12 months postoperatively; (5) Meniscus repair status evaluated by magnetic resonance imaging (MRI) at 6 and 12 months postoperatively. Adverse events (AEs) and device deficiencies were recorded to assess safety. Final follow-up for 12 months was completed in April 2024. Results: A total of 94 patients from 5 tier-A centers in China were randomized (intervention group: n = 48; control group: n = 46). Primary outcome analysis included 91 patients (intervention group: n = 45; control group: n = 46). LKS improved significantly from baseline in both groups at 6 months (both P < 0.001), with no between-group difference in absolute scores (mean ± standard deviation: 90.85 ± 8.70 vs 90.96 ± 11.52, P = 0.503). However, covariance analysis revealed greater LKS improvements in the intervention group (mean ± standard deviation: 30.17 ± 1.65 vs 23.87 ± 1.93, P = 0.015). Safety analysis showed no significant difference in the incidence of surgery-related AEs between the groups (17.02% vs 17.39%, P = 1.000). Conclusion: The all-inside, all-suture meniscal repair device demonstrated comparable efficacy and safety to the controlled all-inside meniscal repair device for arthroscopic repair of vertical longitudinal full-thickness meniscus tears over 12 months. Moreover, it showed superior early improvement in knee function recovery and can be considered an alternative for AMR.

Chronic ankle instability (CAI) often requires surgical intervention, but the optimal suturing repair technique remains unclear. This study aimed to compare the clinical efficacy of modified trans augmentation (MTA) suturing repair and trans augmentation (TA) suturing repair to provide a feasible option for patients with CAI and their surgeons. This single-center retrospective study included 73 patients with CAI who treated between February 2019 and January 2021. Patients were assigned to MTA or TA groups based on ligament condition. Clinical outcomes were assessed using the American Orthopedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), anterior drawer test, patient satisfaction, and postoperative complications. Postoperative AOFAS scores were significantly higher in the MTA group (91.0 ± 7.1) compared to the TA group (83.3 ± 9.4, P < 0.001). Similarly, patient satisfaction was higher in the MTA group (8.6 ± 0.9 vs. 8.1 ± 1.0, P = 0.02), whereas VAS scores were lower (1.2 ± 0.4 vs. 1.4 ± 0.5, P = 0.01). There were no significant differences in anterior drawer test results between the groups (P = 0.32). MTA suturing repair demonstrates superior clinical outcomes compared to TA suturing repair, providing a feasible for patients with CAI. These findings highlight the potential of MTA repair to improve patient satisfaction and functional recovery.

At present, the modified suture augmentation (MSA) repair and the InternalBrace™ (IB) reconstruction techniques are commonly used for the treatment of chronic ankle instability (CAI). This study aimed to evaluate and compare the clinical efficacy of the MSA repair and IB reconstruction techniques, providing a reference for clinical practice. After propensity score matching, 50 patients with CAI between May 2021 and May 2022 were included in this retrospective study. Of these, 26 underwent IB reconstruction surgery and 24 underwent MSA repair surgery. The American Orthopedic Foot and Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, anterior drawer tests, and patient satisfaction were used for clinical efficacy evaluation. The postoperative AOFAS scores in the MSA group (88.8 ± 3.0) were significantly higher than those in the IB group (84.3 ± 5.4, P = 0.001). However, the patient satisfaction scores in the IB group (7.3 ± 0.8) were higher than those in the MSA group (6.7 ± 0.8, P = 0.02). There were no significant differences between the two groups in the anterior drawer test results and VAS scores (P < 0.05). In addition, regarding postoperative complications, only one patient (4.2%) in the MSA group had joint laxity. MSA repair was superior to IB reconstruction in terms of AOFAS scores. However, IB reconstruction was superior in terms of patient satisfaction. These findings highlight the potential of MSA repair and IB reconstruction techniques for the treatment of CAI.

Objectives: Currently, there are various surgical options for the treatment of lateral ankle sprains, and deciding which surgical option to use is a question worth considering. Furthermore, there is a relative scarcity of mechanical research comparing suture anchor repair (SAR) and suture tape augmentation (STA) internal brace for the repair of the anterior talofibular ligament (ATFL). Therefore, this study aimed to compare the efficacy of arthroscopically all‐inside ATFL SAR and STA for reconstruction to treat lateral ankle sprains through biomechanical testing.Methods: Eighteen fresh‐frozen cadaver ankles were used for the study and divided into one of three groups: (1) intact ATFL group, (2) arthroscopically reconstructed with suture tape augmentation internal brace of the ATFL (STA group), and (3) arthroscopically repaired ATFL with suture anchors (SAR group). We used custom fixtures to test the specimens for loading to ultimate failure and stiffness.Results: The mean load to failure of the STA group (311.20 ± 52.56 N) was significantly higher than that of the intact ATFL group (157.37 ± 63.87 N; p = 0.0016) and the SAR group (165.27 ± 66.81 N; p = 0.0025). The mean stiffness of the STA group (30.10 ± 5.10 N/mm) was significantly higher than that of the intact ATFL (14.17 ± 6.35 N/mm; p = 0.0012) and the SAR group (15.15 ± 6.89 N/mm; p = 0.0021). The suture anchor repair withstood failure loads and stiffness similar to the intact ATFL.Conclusions: In terms of failure load and stiffness, the reconstructive outcome of ATFL reconstruction with STA is markedly superior to that of SAR reconstruction of the ATFL and the intact ATFL. Additionally, the novel technique of the SAR was a reliable technique that offered biomechanical properties similar to intact ATFL.

A coracoid process fracture combined with an acromioclavicular (AC) joint dislocation is an uncommon injury that typically causes significant pain and limits shoulder movement. Open reduction and internal fixation have been the traditional treatment approach. However, arthroscopic techniques are emerging as a promising alternative for managing these injuries. A 35-year-old woman presented with right shoulder pain following an accidental fall. Imaging studies revealed a coracoid process fracture along with an AC joint dislocation. The fracture was classified as an Eyres Type IIIA, which warranted surgical intervention. Our team performed arthroscopic coracoid fracture reduction and internal fixation surgery, as well as AC joint dislocation repair using Kirschner wires. Six months after surgery, the patient demonstrated a satisfactory functional outcome with complete bone healing. This case report highlights the potential of arthroscopic reduction and fixation as a novel treatment option for fractures of the coracoid base.

Background: To compare the clinical efficacies of arthroscopic anterior talofibular ligament suture augmentation repair and modified suture augmentation repair in patients with chronic ankle instability (CAI). Methods: From October 2019 to August 2020, 100 patients with CAI were enrolled after propensity score matching analysis and observed for two years. Among them, 50 underwent modified suture augmentation repair and the other 50 underwent suture augmentation repair. The clinical efficacies of CAI treatments were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating scale, visual analog scale (VAS), and anterior drawer test scores. Results: The postoperative AOFAS score of the modified suture augmentation repair group (83.8 ± 11.3) was significantly higher than that of the suture augmentation repair group (76.3 ± 11.3; P = 0.001). The VAS (P = 0.863) and anterior drawer test (P = 0.617) scores were not significantly different between the two treatment groups. Conclusion: Both the modified suture augmentation repair and suture augmentation repair demonstrated good clinical efficacies. The AOFAS score of the modified suture augmentation repair group was superior to that of the conventional suture augmentation repair group. Thus, modified suture augmentation repair is a feasible and practical surgical technique for CAI treatment.

Tendon‐derived stem cells (TDSCs) play a vital role in repair of rotator cuff tear injuries by secreting paracrine proteins that regulate resident cell functions. Secreted exosomes may play a role in tendon injury repair by mediating intercellular communication; however, the detailed mechanisms by which TDSC‐derived exosomes affect tenocyte development remain unknown. Here, we examined the effects of exosomes isolated from conditioned medium of TDSCs on tenocyte differentiation, migration, and transition to a fibroblastic phenotype in vitro. Successful isolation of exosomes from TDSCs was confirmed by high expression levels of CD81, CD63, CD9, and TSG101. Treatment with TDSC‐derived exosomes promoted the growth and migration of cultured rat tenocytes, and increased the levels of the fibrosis markers collagen I, collagen III, scleraxis, tenascin C, and α‐smooth muscle actin. Furthermore, vascular endothelial growth factor A (VEGFA) expression was higher in TDSC‐derived exosomes than in TDSCs, and genetic knockdown of VEGFA suppressed the stimulatory effect of TDSC‐derived exosomes on tenocyte development. Overall, these results demonstrate that VEGFA‐enriched exosomes isolated from TDSCs promote differentiation and migration of cultured tenocytes and their transition to a fibroblastic phenotype. These data provide a new potential clinical treatment strategy for tendon injury.