Cartilage Loss Research Articles

Adult Stem Cell Therapy as an Alternative Treatment in Knee Osteoarthritis

Objective: Osteoarthritis (OA) of the knee, also known as degenerative joint disease of the knee because of progressive loss of articular cartilage, is the most common disabling conditions of the knee joint, which often presents with pain and stiffness and progresses to affect activity of daily living. The prevalence of knee OA will continue to rise due to factors like obesity and increased life expectancy. Roughly 13% of women and 10% of men 60 years and older have symptomatic knee osteoarthritis. Among those older than 70 years of age, the prevalence rises to as high as 40%. Our aim is to evaluate the importance of adult stem cell therapy (ADSC) as an alternative treatment in knee osteoarthritis. Patient, Materials and Methods: A case of an elderly patient with early right knee osteoarthritis (grade 2). Right knee severity was assessed using the Western Ontario and McMaster universities osteoarthritis index (WOMAC) scale. Radiologic studies (X-ray and MRI) were done. Patient had a session of autologous adult stem cell therapy - Mesenchymal stem cells retrieved from the fat and bone marrow along with platelet rich plasma (PRP) from blood which was administered intra-articularly via ultrasound guidance. Procedure was done on an outpatient basis and was well tolerated with no complications. Results: Patient was observed in the first 6 months under the instructions of no physiotherapy to preserve new maturing cells. The WOMAC assessed on the 0 and 6 months showed quality improvement from an initial score of 48/96 to a score of 8/96. Post procedure X-ray of the Right knee on the sixth month showed marked progressive changes. Conclusion: Adult stem cell therapy is promising to be an effective alternative treatment in knee osteoarthritis. It is minimally invasive, safe with no major treatment related adverse effect. Case study showed a positive outcome according to all the grading systems used in this study for the initial 6 months.

Management of Osteoarthritis of Both Knee Joints with Causticum, Law of Palliation- A Case Report

Osteoarthritis is a degenerative joint disease characterized by focal loss of hyaline cartilage with proliferation of new bone and remodelling of joint contour. It is one of the leading causes of disability. OA primarily affects articular cartilage, bone, synovial membrane, capsule and ligaments. It is more common in women than in men and the prevalence increases with age. This article illustrates the clinical application of homoeopathic law of palliation. The law of similars is the fundamental law of palliation. This is a case of a 52-year-old male patient who presented with complaints of tearing pain in both knee joints, especially of left knee with severe burning sensation in knees. On thorough case taking and analysing the case, the homoeopathic medicine Causticum was prescribed in 200th potency orally, as dry dose. The remedy was selected based on totality of symptoms and symptom similarity. The severity of the symptoms was assessed using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS), both before and after the treatment. The scores got reduced after administering our medicine and the patient was symptomatically relieved. Even though Osteoarthritis cannot be cured, it is possible to prevent the progression of pathology, and avert further deformities through our medicines by following the homoeopathic law of palliation.

Exploring the influence of physical activity on the efficacy of chondroprotective agents for osteoarthritis: The role of diffusion conditions

Osteoarthritis is a common and debilitating joint disease that primarily affects the knee and hip joints, resulting in a significant loss of articular cartilage. While non-steroidal anti-inflammatory drugs are often used to treat pain in osteoarthritis, they are not a suitable long-term solution because of their associated adverse events. Slow-acting symptom-modifying or structure/disease-modifying osteoarthritis drugs have demonstrated safety with minimal side effects, but their efficacy remains controversial. We hypothesize that differences in physical activity patterns among patients with knee or hip osteoarthritis could partly explain the large heterogeneity in response to oral glucosamine/chondroitin. Our hypothesis suggests that stagnant synovial fluid may restrict the diffusion of these drugs into the joint cartilage cells, leading to variable clinical outcomes. In this study, we provide evidence to support this hypothesis and propose a simple post-intake physical therapy procedure to enhance the effectiveness of chondroprotective agents. If validated, this approach could be a valuable addition to non-operative osteoarthritis management, potentially leading to remarkable improvements in patient outcomes.

Comparative evaluation of macro- and microscopic changes in rabbit, cattle, and pig auricular cartilage following exhumation after different postmortem intervals

The study evaluated and compared macro- and microscopic changes in the auricular cartilage of rabbits, cattle, and pigs following exhumation at different postmortem intervals (PMI). Eight samples corresponding to 0, 5, 10, 15, 20, 25, 30, and 150 days after exhumation were obtained from all rabbit ears, and twelve samples corresponding to 0, 5, 10, 15, 20, 25, 30, 35, 40, 50, 60, and 150 days after exhumation were obtained from all cattle and pig ears. The weight loss of the rabbit ear samples remained higher than that of the cattle and pig ear samples at all PMIs. At 60 days, the average weight loss of cattle and pig ear samples did not differ significantly (p>0.05). The loss of area of the samples was similar among the three species at most PMIs (p>0.05). At 150 days, all cattle samples were completely decomposed, unlike the pig and rabbit samples. Microscopic analysis of the cartilage tinctorial affinity and loss of chondrocyte nuclei and tissue architecture demonstrated the worsening of postmortem changes over time, regardless of the animal species. Colonization by fungi and bacteria occurred earlier in the cattle and pig samples. The correlation of time with sample weight loss and cartilage thickness was strong, indicating the potential of these variables as parameters for PMI estimation. Therefore, postmortem examination of auricular cartilage can be used to estimate PMI.

Blocking TXNIP reduced IL-1β Induced chondrocyte cell inflammation.

Osteoarthritis (OA) is the most common joint disease in the elderly and is characterized by progressive and irreversible degeneration of articular cartilage, particularly cartilage loss and callus formation. This study would like to investigate the important role and the molecular mechanism of OA progression following interleukin 1β (IL-1β)-induced chondrocyte injury regulated by TXNIP. In this study, high-purity mouse chondrocytes were obtained by enzymatic two-step digestion for primary culture. Toluidine blue staining and type II collagen immunofluorescence were used to identify cells through histochemical staining after slide mounting. The relative expression of TXNIP was detected by immunohistochemical staining and qRT-PCR.Aiming at the shRNA sequence of the TXNIP gene, the shRNA expression vector was constructed and packaged with lentivirus to form the lentiviral vector shTXNIP. After inhibiting the expression of TXNIP by transfecting shTXNIP into normal mouse chondrocytes, the CCK-8 kit was used for detecting its effect on cell proliferation after transfection, and the effect on chondrocyte apoptosis was detected by flow cytometry. The staining kit was used to detect the effect of TXNIP knockout on chondrocyte aging, and the differential expression of TNF, IL-6, MMP3, MMP13, ADAMTS-5 and type II collagen genes in chondrocytes was detected by RT-PCR and Western-bolt. Western blot was used to detect the expression of upstream-related protein P-ERK, downstream-related protein NLRP3 and Caspase1 after inflammatory injury of mouse articular chondrocytes. Results showed that the expression level of TXNIP in chondrocytes induced by different concentrations of il-1β was proportional to the concentration. After silencing TXNIP by shRNA, cell proliferation increased, chondrocyte apoptosis was weakened, and chondrocyte aging was weakened. The differential expression of genes such as TNF, IL-6, MMP3, MMP13, ADAMTS-5 and type II collagen and the differential expression of protein levels were relatively decreased. In addition, the expression of the upstream-related protein P-ERK did not change much when TXNIP was silenced, and the expression levels of the downstream-related proteins NLRP3 and Caspase1 were slightly reduced. In conclusion, silencing TXNIP can inhibit il-1β-induced chondrocyte apoptosis and aging, and has a positive effect on cell proliferation. However, this study has not clarified the molecular mechanism involved in TXNIP and the process of its signaling expression pathway.

Nutritional Strategies for Rheumatoid Arthritis: Exploring Pathways to Better Management

Rheumatoid arthritis (RA) is an autoimmune illness that affects the entire body, with the involvement of the joints and gradual bone and cartilage loss. Environmental and genetic factors contribute to the susceptibility to RA. A growing body of research in recent years has indicated that nutrition plays a major impact in both the risk and course of disease. Notably, environmental factors like dust, pollution, infections, and smoking are identified as potential contributors to systemic autoimmunity preceding symptom onset. Amidst this complexity, the role of nutrition emerges as a significant area of interest, with studies indicating potential links between dietary habits and the onset of RA. The article thoroughly investigates the impact of dietary choices on inflammation, drawing attention to the dichotomy of foods with either pro-inflammatory or anti-inflammatory effects. The Western diet, characterized by its high intake of red meat, saturated fats, and refined carbohydrates, is implicated in elevating inflammation, insulin resistance, and obesity, potentially increasing the risk of RA. Further, the intricate relationship between nutrition and inflammatory diseases is explored, emphasizing the impact of specific nutrients on inflammatory processes. Omega-3 and omega-6 fatty acids, crucial for cellular membranes and inflammatory regulation, emerge as potential therapeutic supplements for RA management. Additionally, calorie restriction and antioxidants are identified as influential factors in mitigating inflammation and disease activity in RA patients. The manuscript also examines the effects of various dietary components such as flavonoids, gluten, fasting, vitamin D, and probiotics on RA. Overall, the manuscript presents a comprehensive overview of the intricate relationship between diet and RA, shedding light on the potential avenues for leveraging nutrition as a tool for managing and potentially mitigating the impact of this complex autoimmune condition. Keywords: Inflammation, Rheumatoid Arthritis, Nutritional Therapy, Omega-3 fatty acids, Joint pains, Antioxidants

Astragalus polysaccharides ameliorate osteoarthritis via inhibiting apoptosis by regulating ROS-mediated ASK1/p38 MAPK signaling pathway targeting on TXN

This research aims to explore the potential of astragalus polysaccharides (APS) in treating osteoarthritis. The primary component of APS extracted in this study was glucose, and noticeably it had a relatively high content of glucuronic acids. In vitro, APS reduced ROS levels, protected chondrocytes from apoptosis, and promoted collagen II expression by regulating ASK1 (apoptosis-signal-regulating kinase1)/p38 cell apoptosis pathway. Further co-immunoprecipitation and immunofluorescence localization experiments demonstrated that the thioredoxin (TXN) antioxidant system was responsible for its bioactivity. Moreover, TXN silencing remarkably blocked the protective effects of APS, indicating that APS inhibited chondrocyte apoptosis by targeting TXN. In vivo, APS effectively mitigated cartilage loss and chondrocyte apoptosis and decreased expressions of p-ASK1 and p-p38. Collectively, this research first demonstrated that APS could ameliorate osteoarthritis by ASK1/p38 signaling pathway through regulating thioredoxin. In conclusion, APS holds promise as a nutraceutical supplement for osteoarthritis in future drug development.

Structural and Molecular Changes of Human Chondrocytes Exposed to the Rotating Wall Vessel Bioreactor.

Over the last 30 years, the prevalence of osteoarthritis (OA), a disease characterized by a loss of articular cartilage, has more than doubled worldwide. Patients suffer from pain and progressive loss of joint function. Cartilage is an avascular tissue mostly consisting of extracellular matrix with embedded chondrocytes. As such, it does not regenerate naturally, which makes an early onset of OA prevention and treatment a necessity to sustain the patients' quality of life. In recent years, tissue engineering strategies for the regeneration of cartilage lesions have gained more and more momentum. In this study, we aimed to investigate the scaffold-free 3D cartilage tissue formation under simulated microgravity in the NASA-developed rotating wall vessel (RWV) bioreactor. For this purpose, we cultured both primary human chondrocytes as well as cells from the immortalized line C28/I2 for up to 14 days on the RWV and analyzed tissue morphology, development of apoptosis, and expression of cartilage-specific proteins and genes by histological staining, TUNEL-assays, immunohistochemical detection of collagen species, and quantitative real-time PCR, respectively. We observed spheroid formation in both cell types starting on day 3. After 14 days, constructs from C28/I2 cells had diameters of up to 5 mm, while primary chondrocyte spheroids were slightly smaller with 3 mm. Further inspection of the 14-day-old C28/I2 spheroids revealed a characteristic cartilage morphology with collagen-type 1, -type 2, and -type 10 positivity. Interestingly, these tissues were less susceptible to RWV-induced differential gene expression than those formed from primary chondrocytes, which showed significant changes in the regulation of IL6, ACTB, TUBB, VIM, COL1A1, COL10A1, MMP1, MMP3, MMP13, ITGB1, LAMA1, RUNX3, SOX9, and CASP3 gene expression. These diverging findings might reflect the differences between primary and immortalized cells. Taken together, this study shows that simulated microgravity using the RWV bioreactor is suitable to engineer dense 3D cartilage-like tissue without addition of scaffolds or any other artificial materials. Both primary articular cells and the stable chondrocyte cell line C28/I2 formed 3D neocartilage when exposed for 14 days to an RWV.

Quercetin- herbal bioactive nanotechnology for osteoarthritis & elderly health

Quercetin is rapidly emerging “bioactive” in the western world in the form of food supplement or healthy ingredient to address several lifestyle issues such as cardiovascular, hypertension and diabetes issues, obesity and cancer. It is a flavanoid found common in some healthy fruits and vegetables/ spices such as Red Onion, Coriander, Pomegranate, Asparagus, Green Tea, Coffee etc. It is highly anti-inflammatory and sold as over the counter food supplement in the western world to address cardiovascular, hypertension and diabetes issues. Osteoarthritis, an auto-immune disease prevails among the musco-skeletal diseases that comprise 4th most disabling conditions among elders globally but no proven drug yet (Shen et al, . Quercetin has shown to attenuate it in vivo, in vitro and even limited human trials by scavenging free radicals that and preventing the loss of bone/ cartilage/ muscle. However, quercetin bioabsorption is low so we propose its conjugation with non-polar amino acid viz. Glycine for multiplier effect. Glycine is a key component of Glutathione, the natural antioxidant in the human body. Glycine alone shown to improve collagen synthesis by articular chondrocytes in vitro and its deficiency may cause osteoarthritis, vide literature. So its conjugate with Quercetin boost the Glutathione level & improve body’s own antioxidant system , to reduce the cartilage loss and prevent osteoarthritis.

Idiopathic chondrolysis of hip: A case report with literature review

Idiopathic chondrolysis of the hip (ICH) is a rare debilitating disease that results in articular cartilage loss in proximal femoral epiphysis and acetabulum; in the absence of a history of trauma, slipped capital femoral epiphysis, Perthe’s disease, prolonged immobilization, and infective/inflammatory joint diseases or malignancies. The diagnosis of chondrolysis of the hip is usually delayed due to the gradual onset of symptoms, initial normal radiographs, and the absence of specific diagnostic laboratory tests. Magnetic resonance imaging is the gold standard for the early diagnosis and grading of disease. ICH is often reversible with non-surgical management such as rest, alleviation of pain, and avoidance of weight-bearing. The clinical details and imaging appearance of this uncommon disease are discussed here.

Association of Knee Osteoarthritis and Flexion Contracture With Localized Tibial Articular Cartilage Loss: Data From the Osteoarthritis Initiative.

To evaluate whether a knee flexion contracture (FC) was associated with localized tibial articular cartilage loss over a 1-year period using Osteoarthritis Initiative quantitative data. Five hundred seventy-eight participants from a previously established nested case-control study of people with radiographic knee OA with or without progression, based on radiographs and symptoms, had their knee range of extension measured at baseline and received magnetic resonance imaging (MRI) at baseline and 1 year. The tibial articular cartilage of the medial and lateral condyles was segmented into anterior, center, and posterior regions. We tested for associations between knee FC (defined as lack of extension to 0°), and localized changes in tibial articular cartilage thickness or percent of denuded bone (0 mm thickness) after 1 year relative to baseline using ANOVA, controlling for baseline MRI outcomes and clinical factors. Knee FC was associated with denuded bone in the medial condyle center (β 0.44, 95% CI 0.02-0.86) and preserved cartilage thickness in the medial condyle posterior (β 0.01, 95% CI 0.002-0.03) regions. Knee FC unloading the tibial center region and loading the posterior region was associated with localized articular cartilage loss centrally and preserved articular cartilage posteriorly. These findings are consistent with knee FC negatively affecting unloaded tibial articular cartilage.

Comparative Effects of High and Low Intensity Progress Resisted Exercises on Pain, Range of Motion and Functional Disability in Knee Osteoarthritis Patients with Sarcopenia: A Randomized Controlled Trial

Background: Osteoarthritis is the most common kind of arthritis, affecting millions of people. It develops because of the slow loss of the protective cartilage that cushions the ends of the bones over time. Although osteoarthritis may affect any joint, it is most often connected with joints in the hands, knees, hips, and spine. Objective: To compare the effects of high and low intensity progressive resisted exercises on pain, range of motion and functional disability in knee osteoarthritis patients with sarcopenia. Methods: It was a Randomized Controlled Trial. Data was collected from University of Lahore Teaching Hospital, physical therapy department. Group A- High Intensity Program and Group B- Low Intensity Program each had 42 patients in them. They were all male and female, between the ages of 35 and 65, and had osteoarthritis of different grades, according to Kallgren and Lawrence. The SARC-F questionnaire was used to find out if people had sarcopenia. The outcome measures were pain, functional disability, as well as range of motion. Results: Group A had a mean age of 58.47 years (SD = 4.22) and a mean symptom duration of 3.47 (SD = 1.82). In contrast, Group B had a slightly higher mean age of 58.8 years (SD = 3.11) and a mean symptom duration of 3.04 (SD = 1.68). At baseline, no significant differences were seen between Group A and Group B in terms of knee range of motion, KOOS pain, KOOS function, and KOOS quality of life. However, after 8 weeks, all variables showed significant differences (p>0.05) except for knee flexion (p>0.05). Conclusion: Low-intensity exercises showed greater improvements in pain, functional disability, quality of life, and range of motion compared to the high-intensity group among knee osteoarthritis patients with sarcopenia. Notably, knee flexion exhibited superior enhancement within the high-intensity exercise regimen.

Pathological progress and remission strategies of osteoarthritic lesions caused by long-term joint immobilization

ObjectiveWhile joint immobilization is a useful repair method for intra-articular ligament injury and periarticular fracture, prolonged joint immobilization can cause multiple complications. A better understanding how joint immobilization and remobilization impact joint function and homeostasis will help clinicians develop novel strategies to reduce complications.DesignWe first determined the effects of long-term immobilization on joint pain and osteophyte formation in patients after an extraarticular fracture or ligament injury. We then developed a mouse model of joint immobilization and harvested the knee joint samples at 2, 4, and 8 weeks. We further determined the effects of remobilization on recovery of the osteoarthritis (OA) lesions induced by immobilization in mice.ResultsWe found that the long-term (6 weeks) joint immobilization caused significant joint pain and osteophytes in patients. In mice, 2-week immobilization already induced moderate sensory innervation and increased pain sensitivity and infiltration in synovium without inducing marked osteophyte formation and cartilage loss. Long-term immobilization (4 and 8 weeks) induced more severe sensory innervation and inflammatory infiltration in synovium, massive osteophyte formation on both sides of the femoral condyle, and the edge of the tibial plateau and significant loss of the articular cartilage in mice. Remobilization, which ameliorates normal joint load and activity, restored to certain extent some of the OA lesions and joint function in mice.ConclusionsJoint immobilization caused multiple OA-like lesions in both mice and humans. Joint immobilization induced progressive sensory innervation, synovitis, osteophyte formation, and cartilage loss in mice, which can be partially ameliorated by remobilization.

Knee cartilage change on magnetic resonance imaging: Should we lump or split topographical regions? A 2-year study of data from the osteoarthritis initiative.

We challenge the paradigm that a simplistic approach evaluating anatomic regions (e.g., medial femur or tibia) is ideal for assessing articular cartilage loss on magnetic resonance (MR) imaging. We used a data-driven approach to explore whether specific topographical locations of knee cartilage loss may identify novel patterns of cartilage loss over time that current assessment strategies miss. We assessed 60 location-specific measures of articular cartilage on a sample of 99 knees with baseline and 24-month MR images from the Osteoarthritis Initiative, selected as a group with a high likelihood to change. We performed factor analyses of the change in these measures in two ways: (1) summing the measures to create one measure for each of the six anatomically regional-based summary (anatomic regions; e.g., medial tibia) and (2) treating each location separately for a total of 60 measures (location-specific measures). The first analysis produced three factors accounting for 66% of the variation in the articular cartilage changes that occur over 24 months of follow-up: (1) medial tibiofemoral, (2) medial and lateral patellar, and (3) lateral tibiofemoral. The second produced 20 factors accounting for 75% of the variance in cartilage changes. Twelve factors only involved one anatomic region. Five factors included locations from adjoining regions (defined by the first analysis; e.g., medial tibiofemoral). Three factors included articular cartilage loss from disparate locations. Novel patterns of cartilage loss occur within each anatomic region and across these regions, including in disparate regions. The traditional anatomic regional approach is simpler to implement and interpret but may obscure meaningful patterns of change.

Ankylosing spondylitis impact on knee cartilage thickness: correlation with demographic data and clinical characteristics

BackgroundAnkylosing spondylitis (AS) is a progressive inflammatory disease involving cartilaginous structures in the spine and peripheral joints. However, the number of the studies assessing knee cartilage thickness in AS and its correlations with parameters of disease activity/severity is even less. We aimed to assess the impact of AS on knee cartilage thickness using musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI).MethodsTwenty-five AS patients and 25 healthy individuals (15 served for MSUS assessment, and 10 served for MRI assessment) were included. By employing MRI “using a 1.5-T machine” and MSUS “with a 10–18-MHz linear probe,” respectively, the thickness of the femorotibial cartilage and femoral cartilage was assessed.ResultsCompared to healthy controls, AS patients showed statistically significantly thinner cartilage thickness (P < 0.05) at all femorotibial cartilage subdivisions and the medial femoral condyle and intercondylar area on both sides. Femoral cartilage thickness measurements either assessed by MSUS or MRI were negatively correlated with age, measures of disease activity, and Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s) (P < 0.05). However, MRI tibial cartilage thickness was negatively correlated with disease duration and measures of spinal mobility, functional limitation, and BASRI-s (P < 0.05). MRI total cartilage thickness measurements at the femoral condyle were negatively correlated with Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Disease Activity Score-erythrocyte sedimentation rate (ASDAS ESR) (P = 0.04 and P = 0.03, respectively). A positive correlation was found between MSUS and MRI total femoral cartilage thickness (P = 0.02).ConclusionsThe knee cartilage thickness of AS patients was thinner than that of healthy controls. The correlations between cartilage thickness and patient variables demonstrate MSUS and MRI's utility in identifying knee cartilage loss areas in AS patients.

Level of Inflammation and its Association with Pain, Physical Functioning and KL-Grade in Patients With Knee Osteoarthritis

Background: Knee osteoarthritis (OA), also known as degenerative arthritis, causes a progressive loss of articular cartilage. In recent years, there has been a shift in the understanding of OA from a “wear and tear” disease to an “inflammatory” condition. Aims and Objectives: The objective of this study was to assess the level of inflammation and to evaluate the relationship between inflammation, pain, physical functioning, and Kellgren Lawrence (KL)-grade in patients with knee OA. Materials and Methods: Sixty patients with radiographic evidence of knee OA (KL Grade I/II/III) were cross-sectionally analyzed. Data about their anthropometry, inflammatory markers high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate-(ESR), pain, and physical functioning were collected. Results: The mean hsCRP among the patient population was 4.6 ± 4.0 mg/L and the mean ESR was 40.4 ± 21.8 mm/h. There was a strong significant association of visual analog scale (VAS) pain score with hsCRP (r = 0.353; P = 0.005) and ESR (r = 0.269; P = 0.036). There was a strong significant association of Western Ontario and McMaster Universities OA Index score with hsCRP (r = 0.415; P = 0.001) and ESR (r = 0.413, P = 0.001). However, there was no significant difference in hsCRP or ESR when classified according to KL-grade (P &gt; 0.05). Conclusion: The level of inflammation is high in knee OA patients. Inflammation is significantly associated with pain intensity and physical functioning in knee OA patients. However, there is no significant difference in hsCRP, ESR, and VAS when classified according to KL-grade. This emphasizes the need to study inflammatory markers in addition to radiographic evidence for informed clinical decision-making.

Short-Term Outcomes After Bipolar Osteochondral Allograft Transplantation (OCAT) in the Ankle

Treatment options for symptomatic cartilage loss in the ankle are not consistently effective. This study documents initial outcomes for patients undergoing bipolar OCAT in the ankle after advances in tissue preservation, transplantation techniques, and patient management strategies were implemented. Patients were prospectively enrolled into a registry designed to follow outcomes after OCAT in the ankle. Fourteen patients were included for analyses (12 primary OCAT, 2 revision OCAT). Four patients underwent Bipolar OCAT (tibia, talus) and 10 Bipolar+ OCAT (tibia, talus, fibula). Short-term (median follow-up = 43, range =13-73 months) success was documented for thirteen patients. Radiographic assessments indicated OCA integration and maintenance of joint space in twelve patients. Statistically significant (p<0.030) and clinically meaningful improvements in AAOS and VAS pain scores were noted at 3 months, 6 months, 1 year and 2 years following OCA transplantation when compared to preoperative measures. For patients that were non-adherent to postoperative restriction and rehabilitation protocols, all 1-year postoperative PROs were significantly lower (p<0.050) than for patients who were adherent. The successful outcomes documented in thirteen of fourteen patients in conjunction with significant and clinically meaningful improvements in patient-reported measures of pain and function support OCA transplantation as an appropriate treatment option in indicated patients. These improvements in outcomes were associated with advances in OCA preservation, pre-implantation treatment, transplantation techniques, and patient management strategies, suggesting this shift in practice be considered for OCA transplantation in the ankle. Level of Evidence: IV - Case series.

CartiMorph: A framework for automated knee articular cartilage morphometrics

We introduce CartiMorph, a framework for automated knee articular cartilage morphometrics. It takes an image as input and generates quantitative metrics for cartilage subregions, including the percentage of full-thickness cartilage loss (FCL), mean thickness, surface area, and volume. CartiMorph leverages the power of deep learning models for hierarchical image feature representation. Deep learning models were trained and validated for tissue segmentation, template construction, and template-to-image registration. We established methods for surface-normal-based cartilage thickness mapping, FCL estimation, and rule-based cartilage parcellation. Our cartilage thickness map showed less error in thin and peripheral regions. We evaluated the effectiveness of the adopted segmentation model by comparing the quantitative metrics obtained from model segmentation and those from manual segmentation. The root-mean-squared deviation of the FCL measurements was less than 8%, and strong correlations were observed for the mean thickness (Pearson’s correlation coefficient ρ∈[0.82,0.97]), surface area (ρ∈[0.82,0.98]) and volume (ρ∈[0.89,0.98]) measurements. We compared our FCL measurements with those from a previous study and found that our measurements deviated less from the ground truths. We observed superior performance of the proposed rule-based cartilage parcellation method compared with the atlas-based approach. CartiMorph has the potential to promote imaging biomarkers discovery for knee osteoarthritis.

Diagnostic Value of the HEAD-US-C Scale for the Knees of Severe Hemophilia A Patients.

This study aimed to assess the reliability of the Hemophilia Early Arthropathy Detection with Ultrasound in China (HEAD-US-C) scale for the knees of severe hemophilia A (SHA) patients and to determine its diagnostic accuracy for assessments of knee-joint lesions in comparison with magnetic resonance imaging (MRI). We collected data from 32 knee joints of 21 patients diagnosed with SHA. The knees were evaluated based on the HEAD-US-C scale and the results were compared with the International Prevention Study Group (IPSG) scale. The HEAD-US-C scale was applied independently by two trained ultrasonographers blinded to the MRI results. The IPSG scale was applied independently by two radiologists blinded to the clinical data and ultrasound (US) results. The IPSG and HEAD-US-C scales exhibited good to excellent inter-rater reliability. Additionally, there was good to excellent agreement between the US and MRI results for the detection of knee lesions in SHA patients. The sensitivities of US for joint effusion, synovial hyperplasia, cartilage loss, and bone-surface irregularities in the knees of patients were 92.59, 100, 95.45, and 87.50%, respectively. The HEAD-US-C scale was positively correlated with the IPSG scale. US is important for evaluating knee lesions in patients with SHA and may potentially replace MRI.

Clinical Outcomes of Adolescents With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions Compared With Isolated Bankart Lesions.

Glenolabral articular disruption (GLAD) lesions may occur in adolescents with anterior shoulder instability, resulting in articular cartilage loss and reduced functional glenoid surface area. To compare failure rates and patient-reported outcomes (PROs) between adolescents with versus without GLAD lesions who were treated for anterior shoulder instability with arthroscopic stabilization. It was hypothesized that the comparison would yield no significant differences. Cohort study; Level of evidence, 3. Patients aged ≤18 years who were treated for anterior shoulder instability with arthroscopic stabilization between 2010 and 2021 were retrospectively identified. Those patients with a GLAD lesion identified at the time of surgery were compared with patients with >2 years of retrospective follow-up who were matched to the no-GLAD cohort according to pathology and management. Demographic and patient characteristics including recurrent instability, complications, and reoperations were recorded. All patients in the GLAD cohort were contacted to obtain PRO data, including the Single Assessment Numeric Evaluation; the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the Pediatric Adolescent Shoulder Survey. Patients were also asked about recurrent instability and additional shoulder problems. Of 35 included patients (mean age, 15.4 ± 1.6 years; 80% male), 15 patients (43%) with GLAD lesions and 26 patients without GLAD lesions were identified. Both cohorts had similar patient characteristics, number of anchors, and anchor constructs; the mean follow-up period was significantly different (GLAD vs no-GLAD, 6.9 ± 3.3 vs 3.4 ± 1.2 years, respectively; P < .001). Seven of 15 GLAD patients (46.7%) underwent loose body removal; 4 of 15 GLAD patients (26.6%) and 9 of 26 no-GLAD patients (34.6%) had recurrent subjective instability (P = .7). No significant group differences were found in PRO scores, reoperation rates (15% no-GLAD vs 20% GLAD), or percentage of patients with recurrent instability between cohorts (P > .05). Adolescent patients with and without GLAD lesions treated arthroscopically for anterior shoulder instability had similar PROs and failure rates at intermediate duration of follow-up. GLAD lesions may be managed in a similar surgical manner as isolated Bankart tears in teenagers, with expectations of similar outcomes.