CARTILAGE最新文献

Introduction: Distal femoral cartilage lesions can be treated using osteochondral autograft transfer (OAT). When impacting plugs into a recipient site, the cartilage may fracture. This study aimed to analyze OAT donor regions and impaction energies to identify characteristics that lead to fracture.

Methods: Fifteen cadaver femurs were used with OAT plugs harvested from the following regions: lateral and medial trochlea (LT and MT), lateral and medial intercondylar notch (LIN and MIN). Plugs were impacted into a bone surrogate block using a custom anvil-type system with pre-determined impact heights; 30, 50, 70, and 90 mm. Each plug's cartilage was examined and determined to be intact or fractured. Chi-square was used to compare the rate of chondral fracture for each region.

Results: In all, 221 plugs were included. The overall rate of chondral fracture was 45.7%. There was a significant difference in the rate of fracture between regions, with LIN, MIN, LT, and MT, having a fracture rate of 46.6%, 62.7%, 25.0%, and 51.9%, respectively (P = 0.001). An impact height of 30 mm resulted in a fracture rate of 17.7%. Increasing the impact height from 30 to 50 mm resulted in significantly increased chondral fracture risk (P = 0.001).

Conclusion: Different donor regions have varying rates of chondral fracture during OAT plug impaction, with the lateral and medial trochlea being the most resistant to chondral fracture at lower forces. Increased impact energy increases risk of chondral fracture. Surgeons should maintain caution and utilize lower impact energy when inserting OAT plugs.

Objective: The primary aim of this study is to examine the prevalence of ankle osteoarthritis in patients with achondroplasia and to assess the impact of surgical correction of lower limb alignment on this prevalence. The secondary aim is to identify radiographic parameters associated with ankle osteoarthritis.

Design: This retrospective cohort study included 134 patients (268 ankles) who visited our institution between March 2014 and February 2023. Lower limb alignment was assessed using the mechanical axis deviation, lateral distal tibial angle, anterior distal tibial angle, and talar tilt angle. Ankle osteoarthritis was evaluated using the Van Dijk Osteoarthritis score and modified Kellgren-Lawrence (K-L) scale by 2 experienced orthopedic surgeons.

Results: The prevalence of ankle osteoarthritis in our study cohort was 29%, and that of advanced ankle osteoarthritis defined by Van Dijk Osteoarthritis scale III or modified K-L grade 4 was 0.8% (aged <40 years, 22%, and 0%; aged ≥40 years, 42% and 2%, respectively). Talar tilt angle was the only radiographic parameter that showed a significant correlation with the degree of ankle osteoarthritis (Van Dijk Osteoarthritis score, r_s = 0.403, P < 0.001; modified K-L grade, r_s = 0.385, P < 0.001).

Discussion: The prevalence of ankle osteoarthritis in achondroplasia is moderate, but the progression to advanced stages is uncommon. Ankle osteoarthritis in achondroplasia is strongly associated with increased talar tilt angle. This finding emphasizes caution regarding ankle osteoarthritis in achondroplasia with a nonparallel tibiotalar articular surface. Clinicians should, therefore, consider regularly assessing the talar tilt angle in patients with achondroplasia.

Objective: To synthesize the literature concerning return to sport (RTS) and related outcomes after cartilage restoration surgery of the knee in professional athletes.

Design: Cochrane, PubMed, and OVID/Medline databases were queried for data pertaining to RTS after knee cartilage surgery in professional athletes. Demographic information, cartilage lesion characteristics, and RTS-specific information were extracted. Freeman-Tukey Double-Arscine Transformations with Dersimonian-Laerd random-effects estimators were constructed to quantitatively describe the cumulative incidence of RTS, while heterogeneous data described narratively.

Results: Eleven studies (476 athletes; mean age 27.5 ± 2.1 years; 96.6% male) were included. Nine (81.8%) studies investigated a form of microfracture as treatment, with 6 (54.5%) performing isolated microfracture. The remaining studies investigated osteochondral allograft transplantation and mosaicplasty. More than half (n = 6; 54.5%) did not report cartilage lesion location or size. The pooled RTS rate was 84.3% (95% CI: 75.4%-91.8%) at a mean 39.9 (range, 12-104) weeks postoperatively. In 6 studies reporting competition level, a trend toward returning to a lower than pre-injury level was observed. The definition of RTS was only provided in 6 (54.5%) studies, while the criteria for RTS was only reported in 2 (18.2%) studies, suggesting limited transparency. One study reported an objective imaging assessment of reparative tissue, while none reported formal RTS testing protocols or minimum RTS timeline.

Conclusion: Although the majority of professional athletes are reported to achieve a successful RTS after cartilage restoration surgery of the knee, the literature predominantly reflects microfracture treatment. Current limitations in this literature include a substantial lack of female representation and infrequent reporting of cartilage lesion characteristics, rehabilitation and RTS criteria, and objective imaging assessments of reparative tissue.

Objective: The purpose of this prospective study was to evaluate the quality of the reparative cartilage during second-look needle arthroscopy following talar osteoperiostic grafting from the iliac crest (TOPIC) or autologous osteochondral transplantation (AOT) procedure for the management of large osteochondral lesions (OCLs) of the talus.

Design: Prospective case series.

Methods: Patients who underwent second-look needle arthroscopy following either TOPIC or AOT procedure were prospectively recruited when they needed a second look. The primary outcome was the assessment of the quality of the reparative cartilage via second-look needle arthroscopy scored by the International Cartilage Repair Society (ICRS) score. The secondary outcomes were the number and nature of needle arthroscopy interventions and complications associated with these interventions.

Results: Five patients underwent second-look needle arthroscopy following TOPIC procedure and 11 patients underwent second-look in-office needle arthroscopy following AOT. The mean ICRS in the TOPIC cohort was 9.4 ± 1.0 at a mean time of 24.4 months following the index procedure. The mean ICRS in the AOT cohort was 10.6 ± 1.3 at a mean time of 58.8 months following the index procedure. No complications were observed in either cohort.

Conclusion: This study demonstrated that TOPIC and AOT lead to adequate-looking quality reparative cartilage at short-term to mid-term follow-ups. However, further studies with larger patient cohorts and longer follow-ups are warranted. Furthermore, second-look needle arthroscopy is a safe and viable minimally invasive procedure that can effectively evaluate the quality of reparative cartilage following surgical intervention for OCLs of the talus.

Objective: A gold standard surgical treatment for osteochondral lesions (OCLs) of the talus still needs to be established. Still, autologous matrix-induced chondrogenesis (AMIC) is a commonly applied 1-stage procedure that has achieved good short- and mid-term results. The present cohort study aimed to assess whether the long-term, 10-year results can confirm the previous findings.

Design: All patients underwent an open AMIC procedure using a collagen type I/III bilayer matrix for a talar OCL. General demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1, 5, and 10 years as well as European Foot and Ankle Society (EFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores at 10 years after surgery were analyzed. The primary outcome variable was the procedure's longitudinal effect, and several variables' influence on the outcome was tested.

Results: Of 47 consecutive patients, 18 (38%) were included. Of the 18 patients, 6 (33%) were female, and 12 (67%) were male, with a mean age of 39 ± 15 (range = 15-62) and an average body mass index (BMI) of 26 ± 5 (range = 20-38) kg/m². The mean defect size was 1.4 ± 0.9 (range = 0.2-4) cm². The FFI-D total score showed a significant decrease from preoperatively to 1 year postoperatively (56 ± 19 to 34 ± 27; P = 0.001) with a further nonsignificant decrease to the 5-year (34 ± 27 to 21 ± 20; P = 0.16) and 10-year follow-up (21 ± 20 to 15 ± 13; P = 1.00). All the single items decreased significantly from preoperatively to the 5- and 10-year mark. Although not significant, most items improved from 5 to 10 years postoperatively. Age positively correlated with the preoperative, 5-year, and 10-year follow-up FFI-D total score.

Conclusions: AMIC, as a single-step surgical intervention, is a viable long-term treatment option. Patient selection regarding symptoms and findings is vital to achieve satisfying results.

Objective: The genomic effects of biomechanical loading on human growth plate cartilage are unknown so far. To address this, we used rare human growth plate biopsies obtained from children undergoing epiphysiodesis and exposed them to precisely controlled mechanical loading using a microloading device. The biopsies were cultured 24 hours after mechanical loading, followed by RNA-sequencing analyses to decipher the genomic regulation.

Design: We conducted RNA-seq analysis of human growth plate cartilage obtained from three patients cultured ex vivo and subjected to cyclical mechanical loading with peak 0.4 N with frequency 0.77 Hz during a 30-second duration, using a specialized microloading device.

Results: Gene ontology analysis revealed novel data showing three significantly upregulated signaling pathways, including notch, oxytocin, and tight junction, and three significantly downregulated signaling pathways, including lysosome, sphingolipid metabolism, and peroxisome proliferator-activated receptor (PPAR) in human growth plate cartilage. Moreover, we found 15 significantly regulated genes within these signaling pathways from all three patients. These genes included PSEN2, HEY1, and NCOR2 from the notch signaling; CACNB1 and PPP3R2 from the oxytocin signaling; ACTR3C, WHAMM, and ARHGEF18 from the tight junction signaling; ARSA, SMPD1, and CD68 from the lysosome signaling; ARSA and SMPD1 from the sphingolipid metabolism signaling; and SLC27A4 and AQP7 from the PPAR signaling pathway. In addition, 20 significantly upregulated genes and six significantly downregulated genes shared between two patient samples were identified.

Conclusion: Our study provides the first-ever transcriptomic data of mechanical loading of human growth plate cartilage. These findings can potentially provide genetic targets for future investigations in physiological and pathological bone growth conditions.

Purpose/aim: This study aimed to assess the effectiveness of joint lavage in managing knee osteoarthritis (OA) by evaluating its effect on pain relief, inflammatory markers, cartilage-degrading enzymes, and oxidative stress.

Methods: Seventy patients with Kellgren-Lawrence grade 2 or 3 knee OA were selected for this single-center study. Joint lavage was performed, and pain and function were measured using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline and 24 weeks postintervention. Synovial fluid samples were collected at baseline, before lavage, and 24 weeks postintervention. Samples were stored at -80°C and analyzed in batches to minimize variability. At the time of analysis, the samples were thawed and evaluated for levels of proinflammatory cytokines, interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α), matrix metalloproteinase-3 (MMP-3), and total oxidant status (TOS), and oxidative stress index (OSI).

Results: Postintervention, VAS, and WOMAC scores significantly decreased (P < 0.001), with 100% achieving the minimal clinically important difference (MCID). Patient acceptable symptom state (PASS) rates varied: VAS (80%), WOMAC pain (50%), function (81.4%), and total (84.3%). Cytokine levels (IL-1β, IL-6, TNF-α) and MMP-3 significantly decreased (P < 0.001), along with TOS and OSI. Baseline TNF-α, IL-6, and IL-1β levels were significantly correlated with improvements in VAS and WOMAC scores. Moderate correlations were observed between reductions in IL-6/TNF-α and improvements in VAS/WOMAC. No significant associations were found between confounders and outcomes.

Conclusions: Joint lavage resulted in marked pain relief and functional improvement while significantly reducing inflammatory markers, cartilage-degrading enzymes, and oxidative stress.

Objective: This study aimed to investigate the relationship between clinical findings and the trabecular microstructure of the subchondral bone in patients with hip osteoarthritis (OA) due to developmental dysplasia of the hip (DDH) using multidetector row computed tomography (MDCT).

Design: A total of 63 patients (69 hips) with OA due to DDH were retrospectively reviewed, with 12 healthy controls being included for comparison. Clinical evaluation was performed using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). The trabecular bone microstructure was analyzed using MDCT. Regions of interest in the subchondral trabecular bones of the acetabulum and femoral head were defined in the coronal view, and various trabecular microstructural parameters were evaluated.

Results: Bone volume fraction (BV/TV) and trabecular thickness (Tb.Th) exhibited a significant positive correlation with the OA stage, whereas trabecular separation (Tb.Sp) showed a negative correlation. In addition, BV/TV and Tb.Th were negatively correlated with the JHEQ total and pain scores, whereas Tb.Sp was positively correlated with the pain score in all regions.

Conclusions: This is the first study to evaluate the bone microstructure and its relationship with clinical findings in patients with hip OA due to DDH. Our findings suggest that as OA progresses, osteosclerotic changes increase in the acetabulum and femoral head; these changes are associated with worsening clinical symptoms, particularly pain. Targeting the subchondral bone may emerge as a novel treatment strategy for patients with OA due to DDH; nevertheless, further comprehensive studies are required.

Objective: The purpose of this study was to determine the M1/M2 macrophage ratio in concentrated bone marrow aspirate (cBMA) in patients undergoing surgical intervention augmented with cBMA for osteochondral lesions of the talus (OLTs).

Design: Samples of peripheral blood (PB), bone marrow aspirate (BMA), and cBMA were collected during the procedure. The samples were analyzed by automated cell counting and multicolor fluorescence-activated cell sorting with specific antibodies recognizing monocytes (CD14+ CD16+) and the M1 (CD86+) and M2 (CD163+CD206+) populations within that monocyte population. Cytokine concentrations within the samples were evaluated with enzyme-linked immunosorbent assay (ELISA). The composition of cBMA was compared between 2 commercially available BMA concentration systems.

Results: Thirty-eight patients with a mean age of 43.2 ± 10.1 years old undergoing a surgical procedure for the treatment of OLTs involving the use of cBMA were included. cBMA had a mean fold increase of 4.7 for all white blood cells, 6.1 for monocytes, 7.9 for lymphocytes, 2.4 for neutrophils, and 9.6 for platelets when compared to BMA. The mean M1/M2 ratio for PB, BMA, and cBMA was 15.2 ± 12.0, 20.8 ± 13.3, and 22.1 ± 16.0, respectively. There was a statistically significant higher concentration of interleukin-1 receptor antagonist (IL-1Ra) in the cBMA sample (8243.3 ± 14,837.4 pg/mL) compared to both BMA (3143.0 ± 2218.5 pg/mL) and PB (1847.5 ± 1520.4 pg/mL) samples. The IL-1Ra/IL-1β ratio for PB, BMA, and cBMA was 790.6 ± 581.9, 764.7 ± 675.2, and 235.7 ± 192.1, respectively. There was no difference in the cBMA M1/M2 ratio (19.0 ± 11.1 vs 24.0 ± 18.3) between the Magellan (Isto Biologics, Hopkinton, Massachusetts) and Angel systems (Arthrex Inc, Naples, Florida).

Conclusion: This prospective study found that the M1/M2 ratio in cBMA was 22.1 ± 16.0, with significant patient to patient variation observed. Overall, there was no statistically significant difference in the M1/M2 ratio across PB, BMA, and cBMA samples. This is the first study to characterize the macrophage subpopulation within cBMA, which may have significant clinical implications in future studies.

Objective: Medial meniscus tear (MMT) is a common method to induce osteoarthritis in rats, but mimics secondary osteoarthritis. A novel method of carrying out a medial wedge closing tibial osteotomy (TO) has been recently developed to induce primary osteoarthritis. This study aims to validate it, compared to MMT.

Methods: Twenty rats were divided equally into 2 groups. Outcome measures such as histology graded according to Osteoarthritis Research Society International (OARSI) guidelines and computed tomography (CT) scans were analyzed at 6 weeks post-operatively. Observational gait analysis and serum biomarkers such as C-terminal cross-linked telopeptides of type II collagen (CTX-II) and interleukin-1 beta (IL-1β) were collected at 2-weekly intervals up to 6 weeks post-operatively.

Results: Serum CTX-II and IL-1β levels did not reveal a statistically significant difference across all time points between the 2 groups. CT grading was significantly more severe (2.80 ± 1.10 vs 1.40 ± 0.548, P = 0.0389) in the MMT group compared to the TO group. In addition, histological gradings such as calcified cartilage score (2.10 ± 1.91 vs 0.00 ± 0.00, P < 0.01) and cartilage degeneration score (4.80 ± 5.18 vs 0.00 ± 0.00, P < 0.01) revealed significantly more severe osteoarthritis in the MMT compared to TO group. Synovial membrane score did not reveal a statistically significant difference (1.10 ± 0.994 vs 1.00 ± 0.00, P = 1.00).

Conclusion: TO is a novel method in inducing primary osteoarthritis in the rat model compared to MMT between the 6 and 12 weeks' time frame.