Objective: Supply-demand mismatch of medial femoral condyle (MFC) osteochondral allografts (OCAs) remains a rate-limiting factor in the treatment of osteochondral defects of the femoral condyle. Surface contour mapping was used to determine whether a contralateral lateral femoral condyle (LFC) versus ipsilateral MFC OCA differs in the alignment of donor:native subchondral bone for large osteochondral defects of the MFC.
Design: Thirty fresh-frozen human femoral condyles were matched by tibial width into 10 groups of 3 condyles (MFC recipient, MFC donor, and LFC donor) each for 3 cartilage surgeons (90 condyles). The recipient MFC was imaged using nano-computed tomography scan. Donor oval grafts were harvested from each matched condyle and transplanted into a 17 mm × 36 mm defect created in the recipient condyle. Following the first transplant, the recipient condyle was imaged and superimposed on the native condyle nano-CT scan. The donor plug was removed and the process repeated for the other donor. Surface height deviation and circumferential step-off height deviation were compared between native and donor subchondral bone surfaces for each transplant.
Results: There was no statistically significant difference in mean subchondral bone surface deviation (LFC = 0.87 mm, MFC = 0.76 mm, P = 0.07) nor circumferential step-off height (LFC = 0.93 mm, MFC = 0.85 mm, P = 0.09) between the LFC and MFC plugs. There were no significant differences in outcomes between surgeons.
Conclusions: There were no significant differences in subchondral bone circumferential step-off or surface deviation between ipsilateral MFC and contralateral LFC oval-shaped OCAs for 17 mm × 36 mm defects of the MFC.
{"title":"Subchondral Bone Alignment in Osteochondral Allograft Transplants for Large Oval Defects of the Medial Femoral Condyle: Comparison of Lateral versus Medial Femoral Condyle Donors.","authors":"Kelly M R Taylor, Conor S Locke, Timothy S Mologne, William D Bugbee, John A Grant","doi":"10.1177/19476035231226218","DOIUrl":"10.1177/19476035231226218","url":null,"abstract":"<p><strong>Objective: </strong>Supply-demand mismatch of medial femoral condyle (MFC) osteochondral allografts (OCAs) remains a rate-limiting factor in the treatment of osteochondral defects of the femoral condyle. Surface contour mapping was used to determine whether a contralateral lateral femoral condyle (LFC) versus ipsilateral MFC OCA differs in the alignment of donor:native subchondral bone for large osteochondral defects of the MFC.</p><p><strong>Design: </strong>Thirty fresh-frozen human femoral condyles were matched by tibial width into 10 groups of 3 condyles (MFC recipient, MFC donor, and LFC donor) each for 3 cartilage surgeons (90 condyles). The recipient MFC was imaged using nano-computed tomography scan. Donor oval grafts were harvested from each matched condyle and transplanted into a 17 mm × 36 mm defect created in the recipient condyle. Following the first transplant, the recipient condyle was imaged and superimposed on the native condyle nano-CT scan. The donor plug was removed and the process repeated for the other donor. Surface height deviation and circumferential step-off height deviation were compared between native and donor subchondral bone surfaces for each transplant.</p><p><strong>Results: </strong>There was no statistically significant difference in mean subchondral bone surface deviation (LFC = 0.87 mm, MFC = 0.76 mm, <i>P</i> = 0.07) nor circumferential step-off height (LFC = 0.93 mm, MFC = 0.85 mm, <i>P</i> = 0.09) between the LFC and MFC plugs. There were no significant differences in outcomes between surgeons.</p><p><strong>Conclusions: </strong>There were no significant differences in subchondral bone circumferential step-off or surface deviation between ipsilateral MFC and contralateral LFC oval-shaped OCAs for 17 mm × 36 mm defects of the MFC.</p>","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"240-249"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139572516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The hip joint can be affected by extraspinal diffuse idiopathic skeletal hyperostosis (DISH). This study aimed to compare the clinical characteristics of hips with DISH to those with mixed-type femoroacetabular impingement symptoms (FAIS). In addition, patient-reported outcome (PRO) scores were reported among patients with DISH involving the hip joint who underwent arthroscopic treatment.
Methods: A retrospective analysis was performed using data from patients who underwent hip arthroscopy between 2017 and 2021. Patients who had a preoperative diagnosis of extraspinal DISH of the hip joint and postoperative Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SSS), International Hip Outcome Tool 12-component form (iHOT-12), modified Harris Hip Score (mHHS) and visual analog scale (VAS) for pain scores were enrolled in the study. The patients' characteristics were compared with those of a control group (1:2) consisting of mixed-type patients with FAIS. The control group was matched in terms of age, sex, body mass index (BMI), and symptom duration.
Results: Eleven hips (0.87%) with extraspinal DISH (study group) were matched to 22 FAIS hips (control group). All the patients were male. The mean age of patients was 42.0 ± 8.0 in the study group. The study group was characterized by a larger preoperative alpha angle (79.1 ± 6.8 vs 64.8 ± 9.7, P < .001), lateral center-edge angle (LCEA) (49.7 ± 6.0 vs 40.7 ± 3.2, P < .001), and postoperative LCEA (36.6 ± 3.0 vs 34.2 ± 2.0, P = .013). In addition, a higher proportion of acetabular (81.8% vs 31.8%, P = .007) and femoral head chondral lesions (45.5% vs 9.1%, P = .016). Cartilage damage has the potential to affect the prognosis of arthroscopic treatment. Nevertheless, at the final follow-up, patients with DISH experienced a significant increase in range of motion (ROM), notable enhancements in all PROs, and favorable rates of minimal clinically important difference (MCID) for the PROs.
Conclusion: The occurrence of DISH in the hip joint is considerably infrequent, characterized by hip pain and limited ROM. Despite increased alpha angle and LCEA, and more acetabular and femoral head chondral damage noted at the time hip arthroscopy, patients with DISH observed a significant improvement in ROM, notable enhancements in all PROs, and favorable rates of MCID for the PROs.
目的:髋关节可能受到脊柱外弥漫性特发性骨骼增生症(DISH)的影响。本研究旨在比较患有 DISH 的髋关节与患有混合型股骨髋臼撞击症状(FAIS)的髋关节的临床特征。此外,还报告了接受关节镜治疗的髋关节DISH患者的患者报告结果(PRO)评分:利用2017年至2021年期间接受髋关节镜手术的患者数据进行了回顾性分析。研究对象包括术前诊断为髋关节脊柱外DISH的患者,以及术后髋关节结果评分-日常生活活动(HOS-ADL)、髋关节结果评分-运动分量表(HOS-SSS)、国际髋关节结果工具12分量表(iHOT-12)、改良哈里斯髋关节评分(mHHS)和疼痛视觉模拟量表(VAS)评分的患者。这些患者的特征与由混合型 FAIS 患者组成的对照组(1:2)的特征进行了比较。对照组在年龄、性别、体重指数(BMI)和症状持续时间等方面均匹配:11个髋关节(0.87%)患有脊柱外DISH(研究组),22个髋关节患有FAIS(对照组)。所有患者均为男性。研究组患者的平均年龄为(42.0 ± 8.0)岁。研究组的特点是术前α角(79.1 ± 6.8 vs 64.8 ± 9.7,P < .001)、外侧中心边缘角(LCEA)(49.7 ± 6.0 vs 40.7 ± 3.2,P < .001)和术后 LCEA(36.6 ± 3.0 vs 34.2 ± 2.0,P = .013)较大。此外,髋臼(81.8% vs 31.8%,P = .007)和股骨头软骨损伤的比例更高(45.5% vs 9.1%,P = .016)。软骨损伤可能会影响关节镜治疗的预后。尽管如此,在最后的随访中,DISH 患者的活动范围(ROM)显著增加,所有PRO指标均有明显改善,PRO指标的最小临床重要差异(MCID)率良好:结论:髋关节 DISH 的发生率相当低,其特点是髋关节疼痛和活动度受限。尽管在髋关节镜检查时发现α角和LCEA增大,髋臼和股骨头软骨损伤增多,但DISH患者的ROM明显改善,所有PRO指标显著提高,PRO指标的最小临床重要差异(MCID)率良好。
{"title":"Clinical Outcomes After Arthroscopic Treatment of Extraspinal Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Hip Joint.","authors":"Fan Yang, Zhiyu Zhang, Hongjie Huang, Yan Xu, Jianquan Wang, Xiaodong Ju","doi":"10.1177/19476035231226215","DOIUrl":"10.1177/19476035231226215","url":null,"abstract":"<p><strong>Objective: </strong>The hip joint can be affected by extraspinal diffuse idiopathic skeletal hyperostosis (DISH). This study aimed to compare the clinical characteristics of hips with DISH to those with mixed-type femoroacetabular impingement symptoms (FAIS). In addition, patient-reported outcome (PRO) scores were reported among patients with DISH involving the hip joint who underwent arthroscopic treatment.</p><p><strong>Methods: </strong>A retrospective analysis was performed using data from patients who underwent hip arthroscopy between 2017 and 2021. Patients who had a preoperative diagnosis of extraspinal DISH of the hip joint and postoperative Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SSS), International Hip Outcome Tool 12-component form (iHOT-12), modified Harris Hip Score (mHHS) and visual analog scale (VAS) for pain scores were enrolled in the study. The patients' characteristics were compared with those of a control group (1:2) consisting of mixed-type patients with FAIS. The control group was matched in terms of age, sex, body mass index (BMI), and symptom duration.</p><p><strong>Results: </strong>Eleven hips (0.87%) with extraspinal DISH (study group) were matched to 22 FAIS hips (control group). All the patients were male. The mean age of patients was 42.0 ± 8.0 in the study group. The study group was characterized by a larger preoperative alpha angle (79.1 ± 6.8 vs 64.8 ± 9.7, <i>P</i> < .001), lateral center-edge angle (LCEA) (49.7 ± 6.0 vs 40.7 ± 3.2, <i>P</i> < .001), and postoperative LCEA (36.6 ± 3.0 vs 34.2 ± 2.0, <i>P</i> = .013). In addition, a higher proportion of acetabular (81.8% vs 31.8%, <i>P</i> = .007) and femoral head chondral lesions (45.5% vs 9.1%, <i>P</i> = .016). Cartilage damage has the potential to affect the prognosis of arthroscopic treatment. Nevertheless, at the final follow-up, patients with DISH experienced a significant increase in range of motion (ROM), notable enhancements in all PROs, and favorable rates of minimal clinically important difference (MCID) for the PROs.</p><p><strong>Conclusion: </strong>The occurrence of DISH in the hip joint is considerably infrequent, characterized by hip pain and limited ROM. Despite increased alpha angle and LCEA, and more acetabular and femoral head chondral damage noted at the time hip arthroscopy, patients with DISH observed a significant improvement in ROM, notable enhancements in all PROs, and favorable rates of MCID for the PROs.</p>","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"259-267"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139484503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Protein kinase C-delta (PKC-δ) is involved in apoptosis. This study aimed to establish whether PKC-δ can further promote IL-1β-induced chondrocyte apoptosis by mediating the phosphorylation of the JNK and p38 mitogen-activated protein kinase (MAPK) signaling pathways In osteoarthritis (OA).
Methods: We employed chondrocyte staining to determine the extent of cartilage degeneration. PKC-δ and p38 signal expressions were used in the immunohistochemical (IHC) test and apoptosis was assayed at the TUNEL test in human osteoarthritic and controls. We stimulated rat cartilage cells using IL-1β (10 ng/ml)/rottlerin (10 μM) or lentivirus. To determine the apoptosis rate, we employed flow cytometry. The mRNA of both BCL2-related X (BAX) and cysteine aspartate protease 3 (caspase-3) could be measured via qRT-PCR. Western blot measured the protein levels of BAX, caspase-3, PKC-δ, p-JNK/JNK and p-p38/p38.
Results: The positive rate of PKC-δ and the apoptotic rate of chondrocytes in OA were higher than controls. The manifestation of PKC-δ was positively related to the degree of cartilage degeneration, p38 protein expression, and apoptosis rate. IL-1β exposure upregulated PKC-δ expression in chondrocytes in a dose-dependent manner. Decreasing PKC-δ expression and its phosphorylation in OA can inhibit MAPK signaling pathway activation (phosphorylation) by downregulating JNK and p38 protein phosphorylation and expression. This inhibition decreases caspase-3 and BAX levels, consequently lowering the apoptosis rate in chondrocytes.
Conclusion: PKC-δ activation by IL-1β in OA promotes chondrocyte apoptosis via activation of the JNK and p38 MAPK signal pathways, thereby promoting the OA progression.
{"title":"PKC-δ Promotes IL-1β-Induced Apoptosis of Rat Chondrocytes and Via Activating JNK and P38 MAPK Pathways.","authors":"Jinfeng Lu, Miao Yu, Jia Li","doi":"10.1177/19476035231181446","DOIUrl":"10.1177/19476035231181446","url":null,"abstract":"<p><strong>Objective: </strong>Protein kinase C-delta (PKC-δ) is involved in apoptosis. This study aimed to establish whether PKC-δ can further promote IL-1β-induced chondrocyte apoptosis by mediating the phosphorylation of the JNK and p38 mitogen-activated protein kinase (MAPK) signaling pathways In osteoarthritis (OA).</p><p><strong>Methods: </strong>We employed chondrocyte staining to determine the extent of cartilage degeneration. PKC-δ and p38 signal expressions were used in the immunohistochemical (IHC) test and apoptosis was assayed at the TUNEL test in human osteoarthritic and controls. We stimulated rat cartilage cells using IL-1β (10 ng/ml)/rottlerin (10 μM) or lentivirus. To determine the apoptosis rate, we employed flow cytometry. The mRNA of both BCL2-related X (BAX) and cysteine aspartate protease 3 (caspase-3) could be measured via qRT-PCR. Western blot measured the protein levels of BAX, caspase-3, PKC-δ, p-JNK/JNK and p-p38/p38.</p><p><strong>Results: </strong>The positive rate of PKC-δ and the apoptotic rate of chondrocytes in OA were higher than controls. The manifestation of PKC-δ was positively related to the degree of cartilage degeneration, p38 protein expression, and apoptosis rate. IL-1β exposure upregulated PKC-δ expression in chondrocytes in a dose-dependent manner. Decreasing PKC-δ expression and its phosphorylation in OA can inhibit MAPK signaling pathway activation (phosphorylation) by downregulating JNK and p38 protein phosphorylation and expression. This inhibition decreases caspase-3 and BAX levels, consequently lowering the apoptosis rate in chondrocytes.</p><p><strong>Conclusion: </strong>PKC-δ activation by IL-1β in OA promotes chondrocyte apoptosis via activation of the JNK and p38 MAPK signal pathways, thereby promoting the OA progression.</p>","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"315-327"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9870577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Disintegrin and Metalloproteinase with Thrombospondin Motifs-4 Levels in Chondrocytes of Different Morphology within Nondegenerate and Early Osteoarthritic Human Femoral Head Cartilage.","authors":"Arthur O F Herren, Anish K Amin, Andrew C Hall","doi":"10.1177/19476035231176532","DOIUrl":"10.1177/19476035231176532","url":null,"abstract":"","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"278-282"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9627435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Osteoarthritis (OA) is the most common joint disease. The occurrence and progression of OA are regulated by epigenetics. A large number of studies have shown the important regulatory role of noncoding RNAs in joint diseases. As the largest class of noncoding small RNAs, the importance of piRNAs in many diseases, especially cancer, has been increasingly recognized. However, few studies have explored the role of piRNAs in OA. Our study showed that hsa_piR_019914 decreased significantly in OA. This study aimed to demonstrate the role of hsa_piR_019914 as a potential biological target of OA in chondrocytes.
Design: The GEO database and bioinformatics analysis were used for a series of screenings, and the OA model using human articular chondrocytes (C28/I2 cells), SW1353 cells under inflammatory factor stimulation was used to determine that hsa_piR_019914 was significantly downregulated in OA. Overexpression or inhibition of hsa_piR_019914 in C28/I2 cells was achieved by transfecting mimics or inhibitors. The effect of hsa_piR_019914 on the biological function of chondrocytes was verified by qPCR, flow cytometry, and colony formation assays in vitro. The target gene of hsa_piR_019914, lactate dehydrogenase A (LDHA), was screened by small RNA sequencing and quantitative polymerase chain reaction (qPCR), LDHA was knocked out in C28/I2 cells by the transfection of siRNA LDHA, and the relationship between hsa_piR_019914, LDHA, and reactive oxygen species (ROS) production was verified by flow cytometry.
Results: The piRNA hsa-piR-019914 was significantly downregulated in osteoarthritis (OA). Hsa-piR-019914 reduced inflammation-mediated chondrocyte apoptosis and maintained cell proliferation and clone formation in vitro. Hsa-piR-019914 reduced the production of LDHA-dependent ROS through targeted regulation of LDHA expression, maintained chondrocyte-specific gene expression of ACAN and COL2, and inhibited the gene expression of MMP3 and MMP13.
Conclusions: Collectively, this study showed that hsa_piR_019914 was negatively correlated with the expression of LDHA, which mediates ROS production. Under the stimulation of inflammatory factors, overexpression of hsa_piR_019914 had a protective effect on chondrocytes in vitro, and the absence of hsa_piR_019914 exacerbated the negative effect of inflammation on chondrocytes. Studies on piRNAs provide new therapeutic interventions for OA.
{"title":"PiRNA hsa_piR_019914 Promoted Chondrocyte Anabolic Metabolism By Inhibiting LDHA-Dependent ROS Production.","authors":"YuXuan Gao, Wen Yan, Liangye Sun, XiaoLing Zhang","doi":"10.1177/19476035231181094","DOIUrl":"10.1177/19476035231181094","url":null,"abstract":"<p><strong>Objectives: </strong>Osteoarthritis (OA) is the most common joint disease. The occurrence and progression of OA are regulated by epigenetics. A large number of studies have shown the important regulatory role of noncoding RNAs in joint diseases. As the largest class of noncoding small RNAs, the importance of piRNAs in many diseases, especially cancer, has been increasingly recognized. However, few studies have explored the role of piRNAs in OA. Our study showed that hsa_piR_019914 decreased significantly in OA. This study aimed to demonstrate the role of hsa_piR_019914 as a potential biological target of OA in chondrocytes.</p><p><strong>Design: </strong>The GEO database and bioinformatics analysis were used for a series of screenings, and the OA model using human articular chondrocytes (C28/I2 cells), SW1353 cells under inflammatory factor stimulation was used to determine that hsa_piR_019914 was significantly downregulated in OA. Overexpression or inhibition of hsa_piR_019914 in C28/I2 cells was achieved by transfecting mimics or inhibitors. The effect of hsa_piR_019914 on the biological function of chondrocytes was verified by qPCR, flow cytometry, and colony formation assays in vitro. The target gene of hsa_piR_019914, lactate dehydrogenase A (LDHA), was screened by small RNA sequencing and quantitative polymerase chain reaction (qPCR), LDHA was knocked out in C28/I2 cells by the transfection of siRNA LDHA, and the relationship between hsa_piR_019914, LDHA, and reactive oxygen species (ROS) production was verified by flow cytometry.</p><p><strong>Results: </strong>The piRNA hsa-piR-019914 was significantly downregulated in osteoarthritis (OA). Hsa-piR-019914 reduced inflammation-mediated chondrocyte apoptosis and maintained cell proliferation and clone formation in vitro. Hsa-piR-019914 reduced the production of LDHA-dependent ROS through targeted regulation of LDHA expression, maintained chondrocyte-specific gene expression of ACAN and COL2, and inhibited the gene expression of MMP3 and MMP13.</p><p><strong>Conclusions: </strong>Collectively, this study showed that hsa_piR_019914 was negatively correlated with the expression of LDHA, which mediates ROS production. Under the stimulation of inflammatory factors, overexpression of hsa_piR_019914 had a protective effect on chondrocytes in vitro, and the absence of hsa_piR_019914 exacerbated the negative effect of inflammation on chondrocytes. Studies on piRNAs provide new therapeutic interventions for OA.</p>","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"303-314"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9823341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To assess the economic burden of moderate to severe osteoarthritis (OA) management for patients and the health care system in Greece.
Design: A noninterventional, cross-sectional, prospective, epidemiological analysis of data from the medical records of patients with moderate to severe OA, recruited in a single visit from 9 sites in Greece. Outcomes included health care resource use (direct/indirect costs) associated with this patient population.
Results: A total of 164 patients were included in the analysis: mean age was 70.5 years, and the majority of participants were females (78.7%). The presence of comorbidities was reported by 87.2% of patients, with hypertension being the most frequently reported (53.7%). Paracetamol was the most commonly used analgesic treatment (96%), followed by systemic nonsteroidal anti-inflammatory drugs (NSAIDs) (75%) and opioids (50%). The mean overall annual direct costs per patient was estimated at 1,675.3€, with approximately half incurred by the National Health Insurance Fund, whereas the mean overall annual indirect cost (absenteeism of patients and informal caregivers) was estimated at 3,501.4€. Joint replacement (JR) procedures and paid care were the major drivers of annual direct costs in this patient population (4,326.3€ and 9,360.0€, respectively).
Conclusions: This real-world analysis of direct and indirect costs confirmed the substantial economic burden imposed by moderate to severe OA to the health care system and the patients. Our findings emphasize the need for interventions to enhance disease management, to improve patients' health outcomes and reduce the global burden of OA on society.
目的:评估希腊中重度骨关节炎(OA)治疗对患者和医疗系统造成的经济负担:评估希腊中重度骨关节炎(OA)治疗给患者和医疗系统带来的经济负担:设计:对希腊 9 个医疗机构一次性招募的中重度骨关节炎患者的病历数据进行非干预性、横断面、前瞻性、流行病学分析。结果包括与该患者群体相关的医疗资源使用情况(直接/间接成本):共有 164 名患者参与分析:平均年龄为 70.5 岁,大多数参与者为女性(78.7%)。87.2%的患者报告患有合并症,其中高血压患者最多(53.7%)。最常用的镇痛疗法是扑热息痛(96%),其次是全身性非甾体抗炎药(75%)和阿片类药物(50%)。每位患者每年的平均直接费用约为 1,675.3 欧元,其中约一半由国家医疗保险基金承担,而每年的平均间接费用(患者和非正式护理人员的缺勤)约为 3,501.4 欧元。关节置换(JR)手术和有偿护理是这一患者群体每年直接费用的主要驱动因素(分别为 4326.3 欧元和 9360.0 欧元):这项对直接和间接成本的实际分析证实,中重度 OA 给医疗系统和患者带来了巨大的经济负担。我们的研究结果表明,有必要采取干预措施,加强疾病管理,改善患者的健康状况,减轻 OA 给全球社会造成的负担。
{"title":"Moderate to Severe Osteoarthritis: What is the Economic Burden for Patients and the Health Care System? Insights from the \"PONOS\" Study.","authors":"P Savvari, I Skiadas, M Barmpouni, S A Papadakis, V Psychogios, A P Pastroudis, G A Skarpas, A Tsoutsanis, A Garofalakis, G Katsifis, O D Argyropoulou, D Boumpas, D Menegas","doi":"10.1177/19476035231196524","DOIUrl":"10.1177/19476035231196524","url":null,"abstract":"<p><strong>Objective: </strong>To assess the economic burden of moderate to severe osteoarthritis (OA) management for patients and the health care system in Greece.</p><p><strong>Design: </strong>A noninterventional, cross-sectional, prospective, epidemiological analysis of data from the medical records of patients with moderate to severe OA, recruited in a single visit from 9 sites in Greece. Outcomes included health care resource use (direct/indirect costs) associated with this patient population.</p><p><strong>Results: </strong>A total of 164 patients were included in the analysis: mean age was 70.5 years, and the majority of participants were females (78.7%). The presence of comorbidities was reported by 87.2% of patients, with hypertension being the most frequently reported (53.7%). Paracetamol was the most commonly used analgesic treatment (96%), followed by systemic nonsteroidal anti-inflammatory drugs (NSAIDs) (75%) and opioids (50%). The mean overall annual direct costs per patient was estimated at 1,675.3€, with approximately half incurred by the National Health Insurance Fund, whereas the mean overall annual indirect cost (absenteeism of patients and informal caregivers) was estimated at 3,501.4€. Joint replacement (JR) procedures and paid care were the major drivers of annual direct costs in this patient population (4,326.3€ and 9,360.0€, respectively).</p><p><strong>Conclusions: </strong>This real-world analysis of direct and indirect costs confirmed the substantial economic burden imposed by moderate to severe OA to the health care system and the patients. Our findings emphasize the need for interventions to enhance disease management, to improve patients' health outcomes and reduce the global burden of OA on society.</p>","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"268-277"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138798451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To assess the current treatment of osteochondral lesions of the ankle (OCLA) by German-speaking foot and ankle surgeons, focusing on the management of postoperative care and rehabilitation.
Results: A total of 60 participants returned the questionnaire. The main results are as follows: regarding the frequency of surgical procedures for OCLA, refixation of the fragment, retrograde drilling, and bone marrow stimulation with or without using a matrix were performed by at least 75% of the surgeons and was considered a strong tendency. There was a strong tendency to stabilize the ankle (76.7%) and perform corrective osteotomies (51.7%). In total, 75.5% and 75% of the surgeons performed bone marrow stimulation with and without using a matrix, respectively. Corrective osteotomy and ankle stabilization were performed in 64.5% and 65.2% cases, respectively. Most participants included published recommendations on postoperative rehabilitation and the return to sports activities in their postoperative management. The main surgical procedures were considered the most critical factor in influencing the postoperative management by 81% of the participants (strong tendency). Adjunct surgical procedures such as corrective osteotomy and stabilization of the ankle were considered important by 67.8% of the respondents (tendency).
Conclusions: The management of OCLA varies among German-speaking foot and ankle surgeons. Therefore, guidelines remain essential to standardize the management of OCLA, to achieve improved and stable results. This survey will assist clinicians and patients with rehabilitation to return to sports after treating the ankle's cartilage injury.
Purpose: To evaluate the clinical characteristics and global trends in the surgical treatment of articular cartilage defects.
Methods: Studies in English published between January 1, 2001 and December 31, 2020 were retrieved from MEDLINE, WOS, INSPEC, SCIELO, KJD, and RSCI on the "Web of Science." Patient data were extracted, including age, sex, defect location and laterality, duration of follow-up and symptoms, and body mass index (BMI). Data were further stratified according to the surgical method, lesion location, procedural type and geographical area, and time period. A comparative analysis was performed.
Results: Overall, 443 studies involving 26,854 patients (mean age, 35.25 years; men, 60.5%) were included. The mean lesion size and patient BMI were 3.51 cm2 and 25.61 kg/m2, respectively. Cartilage defects at the knees, talus, and hips affected 20,850 (77.64%), 3,983 (14.83%), and 1,425 (5.31%) patients, respectively. The numbers of patients who underwent autologous chondrocyte implantation, arthroscopic debridement/chondroplasty, osteochondral allograft (OCA), osteochondral autologous transplantation, and microfracture were 7,114 (26.49%), 5,056 (18.83%), 3,942 (14.68%), 3,766 (14.02%), and 2,835 (10.56%), respectively. European patients were the most numerous and youngest. North American patients had the largest defects. The number of patients increased from 305 in 2001 to 3,017 in 2020. In the last 5 years, the frequency of OCAs showed a greatly increasing trend.
Conclusion: Clinical characteristics and global trends in the surgical treatment of articular cartilage defects were revealed. The choice of operation should be based on the patient characteristics and defect location, size, and shape, as well as the patient's preference.
{"title":"Treatment of Articular Cartilage Defects: A Descriptive Analysis of Clinical Characteristics and Global Trends Reported from 2001 to 2020.","authors":"Zhiyuan Ren, Yang Liu, Yongsheng Ma, Lingan Huang, Xueding Wang, Qitai Lin, Yugang Xing, Wenming Yang, Wangping Duan, Xiaochun Wei","doi":"10.1177/19476035231205695","DOIUrl":"10.1177/19476035231205695","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical characteristics and global trends in the surgical treatment of articular cartilage defects.</p><p><strong>Methods: </strong>Studies in English published between January 1, 2001 and December 31, 2020 were retrieved from MEDLINE, WOS, INSPEC, SCIELO, KJD, and RSCI on the \"Web of Science.\" Patient data were extracted, including age, sex, defect location and laterality, duration of follow-up and symptoms, and body mass index (BMI). Data were further stratified according to the surgical method, lesion location, procedural type and geographical area, and time period. A comparative analysis was performed.</p><p><strong>Results: </strong>Overall, 443 studies involving 26,854 patients (mean age, 35.25 years; men, 60.5%) were included. The mean lesion size and patient BMI were 3.51 cm<sup>2</sup> and 25.61 kg/m<sup>2</sup>, respectively. Cartilage defects at the knees, talus, and hips affected 20,850 (77.64%), 3,983 (14.83%), and 1,425 (5.31%) patients, respectively. The numbers of patients who underwent autologous chondrocyte implantation, arthroscopic debridement/chondroplasty, osteochondral allograft (OCA), osteochondral autologous transplantation, and microfracture were 7,114 (26.49%), 5,056 (18.83%), 3,942 (14.68%), 3,766 (14.02%), and 2,835 (10.56%), respectively. European patients were the most numerous and youngest. North American patients had the largest defects. The number of patients increased from 305 in 2001 to 3,017 in 2020. In the last 5 years, the frequency of OCAs showed a greatly increasing trend.</p><p><strong>Conclusion: </strong>Clinical characteristics and global trends in the surgical treatment of articular cartilage defects were revealed. The choice of operation should be based on the patient characteristics and defect location, size, and shape, as well as the patient's preference.</p>","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"209-218"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49674666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: This study aimed to conduct arthroscopic evaluation of cartilage electromechanical properties and establish their correlation with International Cartilage Repair Society (ICRS) grading scores.
Methods: In 18 patients, quantitative parameter (QP) measurements were taken on the weight-bearing surface of the medial femoral condyle. Adjacently, the same site was graded using ICRS scores (0-4). Electromechanical QPs for ICRS grades 0 to 3 were obtained during arthroscopy, while complete grade 4 injuries were assessed using femur cartilage-bone blocks from knee arthroplasty. The QP values for ICRS grades 0 to 2 were compared with grades 3 and 4 using Welch t test. The corresponding QP values were assigned to ICRS grades 0 to 4 and compared using Welch ANOVA (analysis of variance). Pearson's coefficient evaluated QP-ICRS grade relationship.
Results: Healthy grade 0 cartilage displayed a mean QP value of 10.5 (±2.8 SD, n = 4). The ICRS grade 1 and grade 2 injuries were associated with QP values of 12 (±0.7, n = 2) and 13.25 (±1.77, n = 2), respectively. The grade 3 defects had QP values of 20.43 (±4.84, n = 4), whereas complete grade 4 defects showed electromechanical values of 30.17 (±2.19, n = 6). Significant differences in QP values were observed between ICRS grades 0 to 2 (mean QP 11.56 ± 2.3, n = 8) and grades 3 and 4 (26.27 ± 6, n = 10; P < 0.0001). Pearson's correlation coefficient of 0.9 indicated a strong association between higher ICRS cartilage injury grades and elevated QP values (P < 0.0001).
Conclusion: Arthroscopic electromechanical QP assessment robustly correlates with ICRS scores. The QP values for ICRS grades 0 to 2 are significantly lower, compared with grades 3 and 4.
{"title":"Arthroscopic Electromechanical Assessment of Human Articular Cartilage Injury Correlates with ICRS Scores.","authors":"Augustinas Rimkunas, Rimtautas Gudas, Tomas Mickevicius, Justinas Maciulaitis, Mantas Malinauskas, Alfredas Smailys, Mantas Staskunas, Arvydas Usas","doi":"10.1177/19476035231216439","DOIUrl":"10.1177/19476035231216439","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to conduct arthroscopic evaluation of cartilage electromechanical properties and establish their correlation with International Cartilage Repair Society (ICRS) grading scores.</p><p><strong>Methods: </strong>In 18 patients, quantitative parameter (QP) measurements were taken on the weight-bearing surface of the medial femoral condyle. Adjacently, the same site was graded using ICRS scores (0-4). Electromechanical QPs for ICRS grades 0 to 3 were obtained during arthroscopy, while complete grade 4 injuries were assessed using femur cartilage-bone blocks from knee arthroplasty. The QP values for ICRS grades 0 to 2 were compared with grades 3 and 4 using Welch <i>t</i> test. The corresponding QP values were assigned to ICRS grades 0 to 4 and compared using Welch ANOVA (analysis of variance). Pearson's coefficient evaluated QP-ICRS grade relationship.</p><p><strong>Results: </strong>Healthy grade 0 cartilage displayed a mean QP value of 10.5 (±2.8 SD, <i>n</i> = 4). The ICRS grade 1 and grade 2 injuries were associated with QP values of 12 (±0.7, <i>n</i> = 2) and 13.25 (±1.77, <i>n</i> = 2), respectively. The grade 3 defects had QP values of 20.43 (±4.84, <i>n</i> = 4), whereas complete grade 4 defects showed electromechanical values of 30.17 (±2.19, <i>n</i> = 6). Significant differences in QP values were observed between ICRS grades 0 to 2 (mean QP 11.56 ± 2.3, <i>n</i> = 8) and grades 3 and 4 (26.27 ± 6, <i>n</i> = 10; <i>P</i> < 0.0001). Pearson's correlation coefficient of 0.9 indicated a strong association between higher ICRS cartilage injury grades and elevated QP values (<i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>Arthroscopic electromechanical QP assessment robustly correlates with ICRS scores. The QP values for ICRS grades 0 to 2 are significantly lower, compared with grades 3 and 4.</p>","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"250-258"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138486818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1177/19476035241276859
Amir Fathi, Jacob L Kotlier, Sahil S Telang, Vishal S Patel, Ioanna K Bolia, Brett M Biedermann, Christian A Cruz, Eric H Lin, Frank A Petrigliano, Joseph N Liu
Objective: The purpose of this study is to analyze how the largest insurance companies support their medical necessity policies regarding osteochondral allograft transplantation (OCA) and to determine whether the literature they cite in their policies is of a high level of evidence (LOE).
Design: The 10 largest national health insurance companies were identified. Each payer was contacted via phone or email to obtain their coverage policy regarding OCA. For each policy, the medical necessity criteria were recorded, and all cited references were screened. For all references applicable to OCA, the LOE was recorded, and each reference was screened to determine whether they mentioned the specific criteria reported in the policies.
Results: The medical policies for 6 of the 10 national health insurance companies were identified. These 6 policies cited a collective total of 102 applicable references. Most of these studies were an LOE of IV (n = 58, 56.9%) and an LOE of V (n = 18, 17.6%). There were similarities amongst the medical necessity criteria between different commercial payers; however, most criteria were poorly supported by the cited literature.
Conclusions: Our results demonstrate that commercial insurance companies utilize studies that are of a low LOE when justifying their medical necessity criteria. Moreover, these cited studies infrequently support or mention the commercial payers' criteria. Future studies should continue to explore how well-supported insurance policies are with the goal of potentially increasing access and authorization for well-supported treatment modalities.
{"title":"The Literature that Commercial Insurance Payers Use to Substantiate Knee Osteochondral Allograft Policies Are of a Low Level of Evidence.","authors":"Amir Fathi, Jacob L Kotlier, Sahil S Telang, Vishal S Patel, Ioanna K Bolia, Brett M Biedermann, Christian A Cruz, Eric H Lin, Frank A Petrigliano, Joseph N Liu","doi":"10.1177/19476035241276859","DOIUrl":"10.1177/19476035241276859","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study is to analyze how the largest insurance companies support their medical necessity policies regarding osteochondral allograft transplantation (OCA) and to determine whether the literature they cite in their policies is of a high level of evidence (LOE).</p><p><strong>Design: </strong>The 10 largest national health insurance companies were identified. Each payer was contacted via phone or email to obtain their coverage policy regarding OCA. For each policy, the medical necessity criteria were recorded, and all cited references were screened. For all references applicable to OCA, the LOE was recorded, and each reference was screened to determine whether they mentioned the specific criteria reported in the policies.</p><p><strong>Results: </strong>The medical policies for 6 of the 10 national health insurance companies were identified. These 6 policies cited a collective total of 102 applicable references. Most of these studies were an LOE of IV (<i>n</i> = 58, 56.9%) and an LOE of V (<i>n</i> = 18, 17.6%). There were similarities amongst the medical necessity criteria between different commercial payers; however, most criteria were poorly supported by the cited literature.</p><p><strong>Conclusions: </strong>Our results demonstrate that commercial insurance companies utilize studies that are of a low LOE when justifying their medical necessity criteria. Moreover, these cited studies infrequently support or mention the commercial payers' criteria. Future studies should continue to explore how well-supported insurance policies are with the goal of potentially increasing access and authorization for well-supported treatment modalities.</p>","PeriodicalId":9626,"journal":{"name":"CARTILAGE","volume":" ","pages":"19476035241276859"},"PeriodicalIF":2.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}