CARTILAGE最新文献

ObjectiveTo determine whether there are differences in MACI (matrix-induced autologous chondrocyte implantation) treatment in the United States, by comparing cartilage defects and patient characteristics between the initial 1,000 patients treated with the next 5,000MethodsFollowing initial analysis of the first 1,000 consecutive patients treated with MACI, data were collected and analyzed for the subsequent 5,000. Patients were identified by MACI lot number and surgery date. Adverse events were summarized with descriptive statistics. Group differences were assessed with t-tests and chi-square, with significance set at P < 0.05.ResultsFive thousand adults (5,198 knees) were implanted with MACI by 1,130 surgeons. Patient sex (male 49.2%) was evenly split, and the mean age was 33.6 years. Most patients had a single cartilage defect treated, and the mean defect size was 4.4 cm². The patella was the most treated surface (38.4%), followed by the medial femoral condyle (25.7%). Most patients (85.5%) had concomitant surgical procedures at the time of cartilage biopsy procurement. There were statistically significant differences in the number of patella (P < 0.001), medial femoral condyle (P < 0.001), and "not specified" (P = 0.008) between groups. Mean defect size and mean total defect size were both larger (P < 0.001 and P = 0.009, respectively) in the subsequent 5,000 patients.ConclusionThe utilization of MACI has remained consistent. Patient demographics and concomitant surgical procedures between the first 1,000 MACI patients and subsequent 5,000 MACI patients were comparable. Patellofemoral defects were the most treated in both subsets, and an overall low rate of adverse events was observed.

ObjectiveThe goal of our study was to assess the prevalence of osteoarthritis in the knee joint of active male professional soccer players by means of the semi-quantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS).DesignMagnetic resonance imagings (MRIs) of both knees were performed on 85 male professional soccer players during their "medicals" (age = 24 ± 4 years). All baseline data (age, playing position) were obtained. Based on the WORMS, the status of the cartilage and bone in the medial and lateral femoro-tibial joint (MFTJ and LFTJ), as well as the patellofemoral joint was assessed. Menisci and ligaments were evaluated separately. The final score was the sum of all regional scores.ResultsThe mean WORMS of the 170 knee joints was 13.3 ± 13.5 points (range = 0-111, achievable scores: 0-290). Cartilage changes were the most common pathologies, observed in 141 of the 170 knee joints. Structural cartilage lesions (WORMS ≥ 2) were observed in 54% of the studied knees. Pathologies of the medial meniscus were associated with cartilage damage of the corresponding MFTJ (r = 0.424, P < 0.0001). The same effect was observed for the lateral meniscus and the corresponding LFTJ (r = 0.553, P < 0.0001). However, lateral meniscal lesions could be correlated with more other joint pathologies compared to medial meniscal lesions. Total WORMS correlated significantly with increasing age (r = 0.386, P = 0.001).ConclusionThe provided data show the high incidence of knee joint damage in professional football players. In particular, the lateral meniscus appears to play a critical role.

Objective: Viscosupplementation (VS) by intra-articular injections of hyaluronic acid (HA) is a commonly used treatment of knee osteoarthritis. However, there are no clear recommendations for its use in clinical situations not usually addressed in therapeutic guidelines.

Design: Members of the European Viscosupplementation Consensus Group (EUROVISCO), made up of rheumatologists, orthopedic surgeons, and rehabilitation physicians from seven European countries, were asked to make a therapeutic decision on 30 clinical scenarios based on their clinical experience and data from the literature, using the Delphi method. For each scenario, the strength of agreement and the level of consensus were calculated by the chairman of the group.

Results: The expert panel reached consensus on 18 of the 30 clinical scenarios proposed. According to the experts, the factors that most influence the decision to use VS with HA to treat knee osteoarthritis are the nature and severity of symptoms, the presence of comorbidity, the absence of therapeutic alternatives, and the patient's refusal to undergo knee arthroplasty. Obesity and an advanced radiological degree of osteoarthritis have been identified as the two main factors for poor response to VS with HA and should be considered before any decision is made to viscosupplement.

Conclusion: This set of recommendations, based on common clinical scenarios, is intended to help practitioners make decisions about HA VS in patients with osteoarthritis of the knee.

ObjectiveTo investigate whether insurance coverage criteria for meniscal allograft transplantation (MAT) are sufficiently supported in the policy documentation and whether these criteria represent current research and expert consensus on indications for the procedure.DesignThe top 11 United States (US)-based national commercial health insurance payers for MAT were identified. A Google search was performed to identify payer coverage policies. Cited references within policy documents were classified by type of reference and reviewed for level of evidence (LOE). Specific coverage criteria for each individual payer were then extracted and compared to assess for similarities among commercial payers. Finally, all references cited were examined to determine whether they supported the coverage criteria stated by policies for each specific payer.ResultsSeven of the 11 payers had accessible coverage policies. This study found that the majority of cited references were primary journal articles (20, 57.1%) and that the vast majority of references cited (27, 77.1%) were level IV evidence. Of the seven payers, only two (Cigna = 8, HCSC = 19) cited more than six sources. There was a high degree of homogeneity in coverage criteria among payers. The sources cited did not consistently support specific payer coverage criteria. Payer criteria also tended to be arbitrary and poorly supported by current evidence on MAT.ConclusionThis study demonstrates that insurance coverage policies for MAT frequently use outdated references or cite references inappropriately. In addition, these policies fail to reflect current research and consensus on indications for the procedure.

ObjectiveTo develop and validate an in vivo image acquisition protocol for assessment of cartilage degeneration in an osteoarthritis (OA) mouse model using contrast-enhanced micro-computed tomography (CECT).DesignThree-, four-, seven-, and 10-month-old male STR/ort OA (n = 8) and healthy control CBA/1 (n = 8) mice were imaged using synchrotron-radiation micro-computed tomography. Mean attenuation of cartilage and mean attenuation difference between cartilage and contrast agent (mean Δ attenuation), to control for flux, were calculated and correlated to previously published cartilage parameters measured in the same mice. In a second experiment, C57Bl/6 mice underwent destabilization of medial meniscus (DMM) surgery or sham surgery. At 0 (n = 8 DMM), and 4 weeks (n = 10 DMM, n = 6 sham) post-surgery, mice were imaged using CECT. Mean attenuation and Osteoarthritis Research Society International (OARSI) score of cartilage were calculated, and mean attenuation and OARSI score were correlated.ResultsMean Δ attenuation of medial cartilage was lower in STR/ort OA mice compared to healthy control CBA/1 at 3-, 4-, 7-, and 10-months of age. Medial mean Δ attenuation was positively correlated to cartilage volume and thickness and negatively correlated with surface-to-volume ratio and Collins score. The mean attenuation and OARSI score of cartilage in DMM OA mice was higher than in sham controls in the medial tibia. Mean attenuation was positively correlated with OARSI score in the medial tibia.ConclusionsAn in vivo CECT imaging method was developed and validated. Mean attenuation is sensitive to cartilage degeneration in OA mouse models when imaged against a contrast agent as a background and using in vivo compatible image acquisition parameters.

ObjectiveTo evaluate perioperative changes in anatomical parameters related to patellofemoral biomechanics, as well as cartilage repair outcomes following additional arthroscopic marrow stimulation for full-thickness trochlear cartilage defects (TCDs) during medial open-wedge high tibial osteotomy (MOWHTO).DesignA total of 38 patients (38 knees) who underwent arthroscopic marrow stimulation (microfracture or microdrilling) for TCDs combined with MOWHTO were retrospectively reviewed. The mean follow-up period was 27.0 months. Three-dimensional measurements of parameters associated with patellar biomechanics were performed. Magnetic resonance imaging and second-look arthroscopy were used to assess repaired cartilage, using Magnetic Resonance Observation of Cartilage Repaired Tissue (MOCART) knee score and International Cartilage Repair Society Cartilage repair assessment (ICRS CRA).ResultsIn 3-dimensional measurements, the tibial tubercle-trochlear groove (TT-TG) distance was maintained (mean difference: -0.6 mm, P = 0.227), whereas the modified Q-angle significantly decreased (mean difference: -1.9°, P = 0.002). The distal femur-distal tibial rotation (DF-DTR) decreased, indicating internal rotation of the distal tibial segment (mean difference: -5.3°, P < 0.001). TT-TG distance was associated with DF-DTR (r = 0.583, P = 0.001). Arthroscopic marrow stimulation for TCDs showed favorable cartilage repaired tissue, especially for the microdrilling group (median MOCART score, 70; ICRS CRA grade 1-2, 82.8%).ConclusionThe 3-dimensionally measured TT-TG distance was maintained after MOWHTO and was associated with internal rotation of the distal tibial segment below the osteotomy site. Arthroscopic marrow stimulation for TCDs in patients undergoing MOWHTO achieved favorable cartilage repaired tissue in short term.

ObjectiveMeanwhile, the association between osteoarthritis (OA) and type 2 diabetes mellitus (T2DM) is well known. However, it remains unclear whether vitamin K2 (vit.K2) could exert chondroprotective effects. Hence, this study investigates the interrelation between OA and T2DM under the influence of vit.K2 in chondrocytes.MethodsUsing an in vitro OA/T2DM model, articular chondrocytes were harvested from adult male Zucker diabetic fatty (ZDF) Leptfa/Crl rats, categorized as non-diabetic (heterozygous: fa/+) or diabetic (homozygous: fa/fa). Based on vit.K2 supplementation of the rats, four groups arose: control without or with vit.K2 and diabetic without or with vit.K2 supplementation. Inflammatory conditions simulating OA were induced by exposing chondrocytes to tumor necrosis factor alpha (TNFα) and C5a. Chondrocyte response was analyzed using proliferation, metabolic and wound healing assays, immunolabeling, as well as gene expression analyses.ResultsThe proliferation of chondrocytes from control rats with vit.K2 supplementation was significantly higher than those without vit.K2 feeding, under both normoglycemic (NG) and hyperglycemic (HG) conditions. The wound closure ability of chondrocytes was significantly higher in the non-diabetic compared with the diabetic chondrocyte donor group. TNFα and C5a exerted catabolic effects under HG conditions by significantly inducing Tnfα gene activity in chondrocytes of control rats without vit.K2 supplementation and a significant reduction of collagen type 2 gene expression in those cells of control rats with vit.K2 supplementation.ConclusionsThe response of chondrocytes derived from non-diabetic and diabetic donors differed. The vit.K2 supply of chondrocyte donor rats exerted anabolic effects on chondrocytes.

ObjectiveThis study aimed to identify genes and signaling pathways associated with acute cartilage injury using RNA sequencing (RNA-seq).MethodsKnee joint cartilage samples were collected from normal mice and 2 models of acute cartilage injury (non-invasive and groove models) within an 8-hour time limit. RNA-seq revealed differential gene expression between the injury models and controls, with subsequent validation using real-time quantitative polymerase chain reaction (RT-qPCR) for 9 representative genes.ResultsCompared to controls, the non-invasive model showed 36 differentially expressed genes (DEGs) (13 up-regulated, 23 down-regulated), with Gm14648 and Gm35438 showing the most significant upregulation and downregulation, respectively. The groove model exhibited 255 DEGs (13 up-regulated, 23 down-regulated), with Gm14648 and Gm35438 showing the (222 up-regulated, 33 down-regulated). Six overlapping genes were identified between the non-invasive and groove models, including up-regulated genes (Igfn1, Muc6, Hmox1) and down-regulated genes (Pthlh, Cyp1a1, Gm13490), validated by RT-qPCR. Gene ontology (GO) analysis highlighted involvement in environmental information processing and cartilage organ system function, while Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis implicated the JAK-STAT signaling pathway. RT-qPCR and immunohistochemistry confirmed downregulation of Fhl1 in the non-invasive model, supported by Western blotting of p-JAK2/t-JAK2 levels.ConclusionsThis study identifies DEGs (13 up-regulated, 23 down-regulated), with Gm14648 and Gm35438 showing the in acute cartilage injury, suggesting potential therapeutic targets. The role of Fhl1 in cartilage protection via the JAK-STAT pathway warrants further investigation in acute cartilage injury research.

ObjectiveTo analyze and synthesize the information available from five pivotal, large-scale, multicenter, observational studies (CHECK, OAI, FNIH Biomarkers Consortium, IMI-APPROACH, and MOST) focusing on knee osteoarthritis (OA), which can be used to elucidate disease progression, risk factors, and the effectiveness of potential interventions.DesignFor this narrative review, a comprehensive literature search and data extraction from official web pages and scientific databases were conducted to compare methodologies, in- and exclusion criteria, outcomes, and cohort characteristics across the studies. Thematic, comparative, and qualitative analyses were employed to identify trends, commonalities, and disparities among the findings.ResultsThe studies collectively enhanced understanding of the onset and progression of knee OA, and in several of the studies, hip OA, emphasizing the importance of both systemic and local risk factors. Advanced imaging and biomarkers are important components in all the cohorts, with the goal of aiding early diagnosis and tracking disease progression. All cohorts evaluated unique markers generally not available in the other cohorts, while other factors overlap, suggesting possibilities for combining or cross-validating between cohorts.ConclusionsThe collaborative efforts of major OA research significantly advance our understanding of knee OA. These studies highlight the importance of a multifaceted approach, integrating advanced imaging, biomarkers, and longitudinal data to tackle the complexities of OA. By synthesizing findings and addressing knowledge gaps such as heterogeneity of patients and used measurements, and use of novel pain measures, future research can develop more effective diagnostic tools and treatments, ultimately enhancing the quality of life for OA patients.

IntroductionAutologous conditioned plasma (ACP) is a single-spin, leukocyte-poor platelet-rich plasma (PRP) that provides a plasma with a platelet concentration 2 to 3 times the blood platelet concentration. The objective of this study was to investigate the clinical effectiveness of ACP intra-articular injection in patients with knee osteoarthritis (OA) and to identify any demographic, disease-associated, or biological predictors of outcome.MethodsA prospective cohort study was conducted between 2022 and 2023 in a single high-volume tertiary center, including 42 patients (54 knees) who consented to be enrolled. Patients underwent a series of 3 injections of ACP at weekly intervals, prepared using the Arthrex ACP Double-Syringe System. Lysholm scores were collected at baseline, 3-months, and 6-months post-injection.ResultsForty patients (49 knees) completed the follow-up and were included in the final analysis. The mean age was 53.8 ± 10.16 years (range 35-76 years), and the median body mass index (BMI) was 29 (interquartile range [IQR]: 27-34). There were 22 females and 18 males. Treatment failure occurred in 12 out of 49 cases (24.49%). The mean platelet concentration in the ACP was 588.5 ± 183.2 × 10⁶/ml, with a mean platelet fold increase of 2.14 ± 0.71 compared to the baseline. Multi-linear regression modeling showed that older age and higher mean platelet concentration were predictors of higher post-injection Lysholm scores, with beta coefficients of 0.34 and 0.28, respectively, and p values of 0.013 and 0.036, respectively.ConclusionAutologous conditioned plasma provided clinical benefits in this cohort study of knee OA patients for at least 6 months post-injection. Older age and a higher mean platelet concentration in the ACP were identified as predictors of a higher Lysholm score.