Level of Evidence: Level V, expert opinion

GJH was not a contraindication for the modified Broström procedure if the contralateral uninjured ankle showed a normal varus talar tilt and a normal anterior talar translation on stress tests. Further studies are needed to better define GJH affecting the ankle.

Osteoarthritis (OA) is a common joint disease with high morbidity, but there is still no definitive treatment for it. Long noncoding RNAs (lncRNAs) have been confirmed to play key roles in OA progression. This work was done to investigate the roles and action mechanism of lncRNA TNFSF10 in OA. The messenger RNA levels of TNFSF10 in articular cartilage samples from patients or chondrocytes were detected by Quantitative real-time PCR assay (qRT-PCR).The effects of TNFSF10 on chondrocytes were evaluated on the basis of cell growth, apoptosis, and inflammation. Then, the interaction between TNFSF10 and miR-376-3p was explored by dual-luciferase reporter test, RNA-binding protein immunoprecipitation, and RNA pull-down assay. Finally, various cell experiments, Western blot analysis, and qRT-PCR were performed to study the interaction among TNFSF10, miR-376-3p, and fibroblast growth factor receptor 1 (FGFR1). It was found that TNFSF10 was upregulated in OA cartilages and stimulated cell proliferation, antiapoptosis, and inflammation for chondrocytes.In addition, TNFSF10 acted as a competing endogenous RNA to downregulate miR-376-3p, and the influence of TNFSF10 on chondrocytes was partly reversed by miR-376-3p. Moreover, FGFR1, as a target of miR-376-3p, had reversal functions on the outcomes mediated by miR-376-3p. The further analysis displayed that there was a negative relationship between TNFSF10 and miR-376-3p as well as miR-376-3p and FGFR1, while FGFR1 was positively related with TNFSF10. Altogether, TNFSF10 overexpression probably stimulated proliferation and inflammation, and inhibited apoptosis by regulating the miR-376-3p/FGFR1 axis, implying that its increase contributed to OA progression. Our study provided a new potential biomarker or therapeutic target-TNFSF10, which was helpful to develop an efficient approach to cure OA. K E Y W O R D Schondrocytes., FGFR1, long noncoding TNFSF10, miR-376-3p, osteoarthritis

Rationale: Upper pole sleeve fractures of the patella are rare in adolescents; however, they are serious injuries that require early diagnosis and treatment. Patient concerns: We present a rare case of a 15-year-old girl who suffered a sleeve fracture at the superior pole of the right patella. The patient had a history of dislocation of the patella 2 weeks ago. Physical examination showed tenderness on palpation over the upper pole of the patella and absence of active movement of the knee accompanied by swelling and joint effusion. A plain radiograph showed an avulsed fragment of the superior pole of the patella. Diagnoses: Magnetic resonance imaging showed a superior pole patellar avulsion fracture and dysfunction of the knee extensor mechanism. Interventions: Under general anesthesia, the patient underwent open surgery for reduction of the patellar fracture and reconstruction of the knee extension apparatus through an anterior approach. Outcomes: Six months after the operation, the knee function was fully restored, there was absence of pain and swelling, and the patient was able to return to sports. Lessons: Upper pole sleeve fracture of the patella is usually serious and it needs to be diagnosed and treated as soon as possible, the sports medicine practitioner must be aware of this type of injury.

Rationale: Coracoid processes (CPs) fracture with acromioclavicular (AC) joint dislocation are extremely rare. This combined injury has brought many challenges to surgeons, and the mechanism underlying the injury is still not fully understood. There is no clear consensus on its treatment. Patient concerns: Here, we describe a CP fracture with AC joint dislocation in a middle-aged manual worker. Diagnosis: Radiographs showed a fracture of the base of the CP and a third-degree AC joint separation. Interventions: The patient was treated surgically with open reduction and internal fixation of the AC joint by LCP clavicle hook plate, and the CP was fixed with a 3.5 mm diameter cannulated screw. Outcomes: Three months after the operation, shoulder function was completely restored, and the affected shoulder had full mobility with no tenderness. Plain film radiography showed anatomical indications of the healing of these combined injuries. Lessons: Although AC joint dislocation with CP fractures is extremely rare in adults, it is important to remind and remember that this possibility exists. In unclear cases, special radiographic films and CT are necessary. Surgical treatment of AC joint dislocation with CP fractures can provide solid stability and restore normal shoulder function with an excellent prognosis.

Rationale: Medial collateral ligament (MCL) injury is a common sports injury. The damage mainly occurs in ligament fibers, but MCL avulsion fracture is extremely rare and only a few reports have been published.Patient concerns: Herein, we present a healthy 21-year-old man with an avulsion fracture of the MCL of the right knee sustained during snowboarding.Diagnosis: Clinical and radiographic findings confirmed the presence of an avulsion fracture at the proximal attachment of the MCL, combined with complete anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) rupture. Interventions:The patient underwent single-stage ACL, PCL reconstruction, and MCL repair.Outcomes: Two weeks after the surgery, the patient developed heterotopic ossification (HO) at the medial side of the knee, HO tended to be stable and mature at the 3-month follow-up examination. One year after the operation, the patient's knee was fully functional, stable, and pain free.Lessons: Femoral attachment avulsion fracture of the MCL is in contrast to common isolated MCL injuries. Early surgical repair is advocated for the greatest benefit. Orthopedic surgeons should keep the potential complication HO in mind and develop rational strategies for HO prevention and treatment.Abbreviations: ACL = anterior cruciate ligament, HO = heterotopic ossification, MCL = medial collateral ligament, MRI = magnetic resonance imaging, PCL = posterior cruciate ligament.

Rationale: Widely applied in the treatment of severe ankle arthritis (AA), ankle distraction arthroplasty (ADA) can avoid not only the ankle range of motion loss but also ankle fusion. However, the clinical outcomes of ADA for severe AA are poorly understood. This study aims to present our clinical outcomes of severe AA treated by ADA. Patient concerns: A 53-year-old man suffered right ankle sprain 10 years ago, endured right ankle pain and limited movement for 6 years. Diagnosis: The patient was diagnosed as severe AA. Interventions: He received ankle distraction arthroplasty. No adjuvant procedures were performed. The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the short-form (SF)-36 physical component summary (PCS) score and ankle activity score (AAS) were recorded to access the clinical outcomes pre- and postoperatively. Moreover, ankle joint space distance was evaluated on weight-bearing radiographs. Outcomes: The patient derived effective pain relief and restored a satisfactory range of movement. There was a 13-month follow-up period after frame removal. The AOFAS score improved from 56 preoperatively to 71 postoperatively. The VAS score decreased from 6 prior to surgery to 1 after surgery. The SF-36 PCS was 47.2 and 71.8 pre- and postoperative, respectively. The AAS scores were improved from 3.4 preoperatively to 7.3 postoperatively. Lessons: ADA is reliable to achieve pain relief, functional recovery, and serve AA resolution. Besides, it is an alternative to ankle arthrodesis or total ankle arthroplasty in selected patients with severe AA.

No abstract