BACKGROUND: The improvement in production technology of new materials including artificial ligament reduces material rupture caused by fatigue and histocompatibility-related synovitis and other complications, leading to a wide application of artificial ligament. OBJECTIVE: To evaluate the histocompatibility and clinical curative effects of reconstruction of the anterior cruciate ligament (ACL) of the knee with ligament advanced reinforcement system (LARS) artificial ligament using arthroscopy. DESIGN: A completely randomized clinical design. SETTING: Department of Orthopedics, Second Affiliated Hospital of Soochow University. PARTICIPANTS: Thirty-two cases of ACL injury received LARS artificial ligament in the Department of Orthopedics, Second Affiliated Hospital of Soochow University From June 2005 to June 2006 and were recruited for this study. The 32 patients averaged 21 years old and were injured in sports. Prior to surgery, MRI showed injury to ACL and semilunar valve in all patients. Written informed consent for therapeutic contents was obtained from each patient. METHODS: Thirty-two patients with injury to ACL of the knee underwent arthroscopic ACL reconstruction. LARS was used to reconstruct the ACL. The LARS was produced by Laboratoire d'Application et de Recherche Scientifique, France (Certification No. CE0459, 1SO9002-EN46002). Artificial ligament was made of polyethylene terephthalate, which had the material type L021201 (left knee) and L021202 (right knee). Artificial ligament was designed to imitate the anatomic structure and biomechanical principle of artificial ligament with specification No. AC120 2BL(left knee) and No. AC120 2BR(right knee). The lot number for artificial ligament in China [import 03460468 (in 2004)]. All reconstructions were performed by a group of physicians who have worked for more than 10 years in the Department of Orthopedics, Second Affiliated Hospital of Soochow University and directed by a physician titled with doctor's tutor and chief physician. All included physicians were qualified to perform the surgery. The protocol of treatment was approved by the hospital's Ethics Committee. MAIN OUTCOME MEASURES: Biocompatibility of LARS artificial ligament was observed. Patients were followed up for 24 months on average to score knee function by Lysholm test and subjective satisfaction by Tegner test. RESULTS: All of 32 cases were followed up. The follow-up periods were 18 months (3 cases), 20 months (7 cases), 24 months (8 cases), 28 months (12 cases) and 30 months (2 cases). No complications, such as acute or chronic synovitis, LARS artificial ligament rupture, or limited range of motion were found. The knee joint function was ideal with the range of motion [0° to (128±11.56)°]. The postoperative scores with 85.6 ± 2.24 were significandy higher than the preoperative scores with 45.3±1.31 according to the Lysholm knee joint function evaluation system (P < 0.05). The instability of every knee disappeared with anterior drawer sign negative. Tegner's scores were also increased. CONCLUSION: The biocompatibility of LARS is optimal. LARS artificial ligament reconstruction showed excellent knee joint function and subjective satisfaction degree.

BACKGROUND: Of the many growth factors that can enhance bone formation, the bone morphogenic proteins (BMPs) are probably the most effective and most widely studied for applications requiring new bone growth. To analyze the effects, the gold standard is patient randomized control trials, however, only BMP-2 and BMP-7 have reached this level of investigation. OBJECTIVE: In this meta analysis the recent findings concerning the application of recombinant human bone morphogenic protein-2 (rhBMP-2) in tissue engineering and gene therapy, the options of its transfer means, as well as the ideal time of delivery is discussed. RETRIEVAL STRATEGY: The relevant articles published between January 1997 and December 2006 were searched for in Pubmed database by researcher of this article with the key words "recombinant human bone morphogenic proteins (rhBMPs), tissue engineering, gene therapy" in English. A total of 81 articles were selected and reviewed by the standards of: ① Having close relations with the application of rhBMP-2 in tissue engineering and gene therapy; ②The most recently published articles and articles in authority journals were chosen in the same field. Exclusion criteria: repetitive studies. LITERATURE EVALUATION: The main sources of literature are the application of rhBMP-2 in tissue engineering and gene therapy. Among the 52 selected articles, 12 are reviews or meeting reports, others are clinical or elementary experimental studies. DATA SYNTHESIS: BMPs are members of the TGF- β superfamily, which are released by osteoprogenitor cells and typically improve bone growth. The use of scaffolds, cells, and growth factors for bone regeneration is called bone tissue engineering. The application of rhBMP-2 in tissue engineering holds great promise for the augmentation and manipulation of bone and soft tissue repair. One potential alternative to direct rhBMP-2 delivery is to develop a biologic cellular delivery vehicle via gene therapy to enhance bone formation. The application of rhBMP-2 in gene therapy holds great promise for the augmentation and manipulation of bone and soft tissue repair. The research indicated that the dosing, time, and transfer mode of rhBMP-2 to the desired targets remain a facing challenge. Further studies should focus on the ideal dosing, time and method of delivery, which should be easily and reliably displayed, cost effective, and clearly controlled. CONCLUSION: The future of bone and soft tissue repair will likely be based on biologic augmentation of healing and tissue regeneration. The use of rhBMP-2 holds great promise for the augmentation and manipulation in tissue engineering and gene therapy.

Articular cartilage injuries are always difficult to repair, but g ene-enhanced cartilage tissue-engineering has proved to be a better alternativ e treatment. Tissue engineering consists of 3 elements; germ cells, signal facto rs (cytokine or growth factor) and biological materials (scaffolds). This paper highlights research on the gene transduction with signal factors into germ cells .

Objective To discuss the repair methods for the cartilage defects of the knee joint. Methods The cylindrical osteochondral grafts were harvested from the non-weight-bearing area of the knee joint and then transplanted to the cartilage defects in 6 patients with cartilage defects of the knee joint. Results The clinical symptoms of all the patients followed up for 2-24 months disappeared and the joint mobility recovered to normal. A follow-up MRI showed consistent cartilage coverage and the excellent position of the cylindrical osteochondral grafts. Conclusions The osteochondral autograft is a practical surgical method because it is characterized by less trauma, simple performance and good maintenance of the curvature of the articular surface.

Objective To explore the characteristics of chondrocyte apoptosis following acute osteochondral injury and the effect of intra-articular sodium hyaluronate injection in prevention of chondrocyte apoptosig. Methods Acute osteochondral injuries were created by drilling holes in knees at both sides of 28 rabbits according to Costouros' method. The experimental and control sides were randomized in each animal. Another four rabbits served as a normal control which received dissection of knee joint capsule without osteochondral injury. The experimental knee was injected with 1 % sodium hyaluronate at the end of the operation and then every week postoperatively. TUNEL and fluorescence-activated cell sorter (FACS) were applied to study the injured femoral condyles obtained at different intervals following the drilling injury. Results From day 4 after injury, the injured cartilage specimens displayed a statistically significant increase in overall level of apoptosis. Chondrocyte apoptosis was significantly reduced in the experiment knees compared with the injured ones. Conclusions Chondrocyte apoptosis may contribute to the subsequent development of post-traumatic arthritis. Intra-articular sodium hyaluronate injection just after acute osteochondral injury can suppress chondrocyte apoptosis, and thus help prevent the knee from post-traumatic arthritis.

BACKGROUND:Interlocking intramedullary nailing exhibits unique superiority in treatment of multi-segment radial fracture,bone nonunion,and osteoporotic fracture. However,distal interlocking screw placement would injury the deep branch of radial nerves. OBJECTIVE:To analyze the anatomical characteristics of the deep branch of radial nerves during radial interlocking intramedullary nailing. DESIGN,TIME AND SETTING:An observational measurement was performed at the laboratory of Department of Orthopedics,Second Affiliated Hospital of Soochow University between November and December 2002. MATERIALS:A total of 44 pieces of fresh adult cadaver forearm specimens were provided by Department of Anatomy,Soochow University,China. A vernier caliper was purchased from Henan Yuanyang Zhenhua Instrument Factory,China. METHODS:The deep branches of radial nerve of 44 fresh forearm specimens were exposed. The lateral epicondyle of humerus was joined to the Lister tubercle of radius. The line passed through 6 horizontal planes,which were as follows in sequence:0,1.0,1.5,and 2.0 cm lower than the articular surface of radial head respectively,the horizontal planes of the deep branch of radial nerve entering the supinator and winding across the radius. The crossed points were named points A,B,C,D,E,and F accordingly. MAIN OUTCOME MEASURES:The distance between the deep branch of radial nerve and fixed points B,C,and D was measured separately when the forearm was kept in pronation,neutral and supination positions. RESULTS:The distance between the deep branch of radial nerve and fixed points B,C,D became nearer and nearer in the sequence of B,C,and D. With the forearm in pronation,neutral and supination positions in sequence,each fixed point became farther and farther from the deep branch of radial nerve. CONCLUSION:When interlocking intremedullary nailing is used to fix radius,it is relatively safe to keep the forearm in neutral and flexion positions,and drilling and insertion of distal interlocking screw at 1.5 cm lower the articular surface of radial head from the posterolateral to anteromedial approach should be selected.

Objective To observe angiogenic effect of platelet-released growth factors (PRGF) from platelet-rich plasma (PRP) on mierovessel formation at early stage after anterior crueiate ligament (ACL) reconstruction by freeze-dried Achilles tendon. Methods The study involved 14 rabbits, of which 12 rabbits were used as experiment group and the other 2 as control group. In the experiment group, after two sides of rabbit ACL were removed, freeze-dried Achilles tendon treated by PRGF was transplanted into random one side of the knee to substitute the original ACL (PRGF group), while the other side was transplanted with freeze-dried Achilles tendon treated only by normal saline (NS group). Only one side of the knee was removed in the control group. The grafts were observed by HE and immuno- histeehemical staining 2, 4 and 6 weeks after operation. Microvessel density (MVD) was measured by Weidner method. Results Compared with NS group, MVD in PRGF group was significant higher at 2,4 and 6 weeks after operation (P<0.05). MVD of NS group at 2,4 and 6 weeks after operation was 2.52±0.45, 3.41±0.44 and 2.57±0.51 respectively, but that of PRGF group at 2,4 and 6 weeks af- ter operation was 3.56±0.81,4.91±0.46 and 3.01±0.75 respectively (P<0.05). The time of neo- vascular formation and the depth of vascular penetration into the grafts of the PRGF group were superior to those of NS group. Conclusion PRGF can significantly promote microvessel formation at early stage after ACL reconstruction with freeze-dried Achilles tendon.

Objective To observe the effect of platelet-rich plasma(PRP)gel on tendon-bone healing following tendon allograft reconstruction of anterior cruciate ligament(ACL).Methods Bilateral ACL reconstructions using Achilles tendon allografts were performed in 24 New Zealand white rabbits matured skeletally.One knee joint was pretreated with the allograft PRP gel(served as experimental group),while the contralateral knee joint was free from treatment with PRP(served as control group).The reconstructions were assessed histologically,immunohistochemically and biomechanically at 2,6 and 12 weeks.Results At 2 and 6 weeks,Burak scores of experimental group were higher than control group.At 12 weeks,the grafts showed a mature zone of fibrocartilage in experimental group but mature scar tissues on the tendon-bone surface.Immunohistochemistry demonstrated early higher expression of VEGF in experimental group than control group and continually higher expression of TGF-β1 in experimental than control group.In contrast,the grafts of the controls group revealed the development of mature scar tissue resembling Sharpey fibers spanning the tendon-bone interface.At 2 and 6 weeks,the biomechanical analysis revealed the limit load of(15.3±2.9)N and(33.2±6.9)N respectively in experimental group,which were significantly higher than(7.9±1.4)N and(23.7±4.9)N in control group (P ＜ 0.05).Conclusion Application of PRP is the potential means to enhance the earlier healing of the allograft tendon-bone.

Objective To propose prevention and management of vascular crisis according to cause analysis, and improve the survival rate of digital replantation. Methods The vascular crisis of 132 digits of 98 cases were observed during intraoperative. The replantation was performed under different time and different conditions. The causes of vascular crisis, and propose effective prevention and management of vascular crisis were restrospective analysis. Results From March 2006 to June 2007, 35 amputated digits occurred vascular crisis during intraoperative, 19 amputated digits occurred during postoperative. After using warm physiological saline and injecting the papaverine partly, we proceed operations research with regard to the non-catabatic amputated digits. As result 58 digits survived, the achievement ratio was 89.2%. From July 2007 to March 2009, 10 amputated digits occurred vascular crisis during intraoperative,5 amputated digits occurred during postoperative. After non-surgical treatment, we performed operations research regard to the non-catabatic amputated digits. After blood supply recover, we imbed PCA pump into flex tendinous sheath to avoid the occurrence of vascular crisis postoperative. As result 66 digits survived, the achievement ratio was 98.5%. postoperative 9 cases out of fullow-up, 89 cases follow up ranged from 6 to 8 months. Recovery of the hand function was good. Conclusion Good and adequate anesthetic and an appropriate ambient temperature during operation are important factors to prevent occurrence of vascular crisis in digital replantation. Paying enough attention to these factors can effectively improve the survival rate of replantatian.

[Objective]To explore the operating methods and rudimental clinical effects of reconstruction of anterior cruciate ligament(ACL) with the ligament advancement reinforcement system(LARS) artificial ligaments under arthroscope.[Method]Since June of 2006,15 patients(11 males and 4 females,with an average age of 26.8 years)with acute ACL rupture have been treated with the LARS artificial ligaments.The results of preoperative Arto-scan of all patients suggested discontinuation of ACL.The average score of Lysholm on knee joint was 50 points.The operations were completed under arthroscope.Bone tunnels of the femur were located at the central point of arc on the medial surface of ectocondyle of 140 degree.Bone tunnels of tibia were located between the medial and lateral condyle on the tibial plateau、2-4 mm to summit line of fossa intercondylica.The diameter of the bone tunnels was 7.5 mm while that of LARS ligament and hollow crushing screw were 8 mm.[Result]All 15 patients were available for follow-up with an average of 18 months.No postoperative complications such as infection,ligament rupture,ligament loosening occurred.The clinical results were graded as being excellent in 8 patients,good in 5 and fair in 2 according to the Lysholm's classification.The excellent and good rate was 86.6%.[Conclusion]The anatomical reconstruction and the stability of the knee joint can be obtained after ACL reconstruction with LARS artificial ligaments.The operation under arthroscope has advantages of less-injury,rapid recovery and satisfactory curative effect.