OA Changes Research Articles

The collagenase-induced osteoarthritis (CIOA) model: Where mechanical damage meets inflammation

ObjectiveTo characterize inflammatory and mechanical changes in the collagenase-induced OA (CIOA) model in rats. DesignSkeletally mature, 6-month-old Wistar rats received unilateral intraarticular injections of saline, 500 U or 1000 U of collagenase on days 0 and 2 of the study. Joint tissues were harvested on either day 4 or 70 to evaluate the acute and long-term changes. Blood biomarkers, gait asymmetry and mechanical hyperalgesia were assessed repeatedly up until day 70. ResultsThe intraarticular injection of collagenase triggered an increase in cartilage degeneration and bone resorption over time, particularly for 1000 U. Similarly, mild synovitis was observed on day 70 with an increased number of synovial lining cells, increased fibrosis, and infiltration of peripheral macrophages. Mechanistically, these findings were linked to a dose-related mechanical weakening of the anterior cruciate ligament (ACL), which caused persistent joint destabilization throughout the study. Furthermore, the collagenase injection triggered acute inflammation and swelling of the synovium on day 4 and an acute systemic inflammatory response with increased cytokine and peripheral blood immune cell levels. While mild synovitis persisted until day 70, the systemic inflammatory response returned to control levels after 8 days. Similarly, the observed acute changes in gait and mechanical hyperalgesia also returned to baseline after 21 days. ConclusionBy evaluating inflammatory and mechanical factors at different doses and timepoints, our characterization enables a more targeted study design and increases the clinical relevance of future studies involving the CIOA model.

Osteoarthritis year in review 2024: Biomechanics

ObjectiveWe aimed to systematically review and summarize the literature of the past year on OA and biomechanics, to highlight gaps and challenges, and to present some promising approaches and developments. Methods.A systematic literature search was conducted using Pubmed and the Web of Science Core Collection. We included original articles and systematic reviews on OA and biomechanics in human subjects published between April 2023 and April 2024. Results.Of the 155 studies that met the inclusion criteria, 9 were systematic reviews and 146 were original (mostly cross-sectional) studies that included a total of 6488 patients and 1921 controls with a mean age of 57.5 and 44.7 years, respectively. Promising advances have been made in medical imaging of affected soft tissue structures, the relationship between soft tissue properties and biomechanical changes in OA, new technologies to facilitate easier assessment of ambulatory biomechanics, and personalized physics-based models that also include complex chemical and mechanobiological mechanisms, all of which are relevant to gaining mechanistic insights into the pathophysiology of OA. ConclusionsThere is still an unmet need for larger longitudinal data sets that combine clinical, radiological, and biomechanical outcomes to characterize the biomechanical fingerprint that underlies the trajectory of functional decline and biomechanical phenotypes of OA. In addition, criteria and guidelines for control groups, as well as methods and standards for model verification allowing for comparisons between studies are needed.

The role of osteoarthritis severity, BMI and age on clinical efficacy of bone marrow aspirate concentrate in the treatment of knee osteoarthritis.

Aim: The aim of this study was to assess whether BMI, severity of knee osteoarthritis, age and gender have any influence on the final clinical results of bone marrow aspirate concentrate injection. Method: A total of 111 study participants with painful knee osteoarthritis and different characteristics concerning before mentioned factors underwent bone marrow aspirate concentrate (BMAC) therapy and were followed up for 1 year. Result: Significant pain and functional improvement were observed in all participant groups. Participants' age and BMI did not influence the clinical outcome, but there was an influence of OA severity, especially among older patients. Conclusion: This study shows that BMAC therapy is effective. Younger patients with milder OA changes could be better candidates for long-lasting and more efficient BMAC therapy. Clinical Trial Registration: NCT03825133 (ClinicalTrials.gov).

YY1/miR-140-5p/Jagged1/Notch axis mediates cartilage progenitor/stem cells fate reprogramming in knee osteoarthritis.

Osteoarthritis is a multifactorial disease characterized by cartilage degeneration, while cartilage progenitor/stem cells (CPCs) are responsible for endogenous cartilage repair. However, the relevant regulatory mechanisms of CPCs fate reprogramming in OA are rarely reported. Recently, we observed fate disorders in OA CPCs and found that microRNA-140-5p (miR-140-5p) protects CPCs from fate changes in OA. This study further mechanistically investigated the upstream regulator and downstream effectors of miR-140-5p in OA CPCs fate reprogramming. As a result, luciferase reporter assay and validation assays revealed that miR-140-5p targets Jagged1 and inhibits Notch signaling in human CPCs, and the loss-/gain-of-function experiments and rescue assays discovered that miR-140-5p improves OA CPCs fate, but this effect can be counteracted by Jagged1. Moreover, increased transcription factor Ying Yang 1 (YY1) was associated with OA progression, and YY1 could disturb CPCs fate via transcriptionally repressing miR-140-5p and enhancing the Jagged1/Notch signaling. Finally, the relevant changes and mechanisms of YY1, miR-140-5p, and Jagged1/Notch signaling in OA CPCs fate reprogramming were validated in rats. Conclusively, this study identified a novel YY1/miR-140-5p/Jagged1/Notch signaling axis that mediates OA CPCs fate reprogramming, wherein YY1 and Jagged1/Notch signaling exhibits an OA-stimulative role, and miR-140-5p plays an OA-protective effect, providing attractive targets for OA therapeutics.

Understanding of Tempormandibular joint osteoarthritis: pathophysiology, epidemiology and diagnosis

Temporomandibular joint Osteoarthritis (TMJ OA) is a subtype of temporomandibular disorders (TMDs) andrefers to a debilitating degenerative disorder involving inflammatory conditions accompanying bone changes of the TMJ. Once the physical load exceeds physiologic resistance of TMJ, gradual damage to the cartilage layer occurs and leads to bone destruction with various signs and symptoms related to the defect of adjacent tissues.TMJ OA is a relatively common phenomenon, not only in patients complaining of TMJ symptoms, but also found incidentally through radiographs taken for any other dental treatments. TMJ OA is known to be more common in women and related to age closely, but the results of the studies are inconsistent.Deformity of the TMJ condyle due to OA can be easily confirmed with radiography and diagnosis is becom-ing more effective with the development of imaging modalities such as computed tomography. Also, as osseous changes of TMJ OA cause dysfunction of TMJ due to pain and/or restriction of motion and eventually can lead to irreversible changes in occlusion and facial morphology, accurate and in-depth understanding based on sci-entific evidence is essential for dentists. Therefore, this review on the basis of the documents published so far will describe the pathophysiologic mechanisms, epidemiology and diagnosis of TMJ OA.

Anatomic Double-Bundle and Single-Bundle Reconstructions Yield Similar Outcomes Following Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-analysis

To evaluate outcomes of arthroscopic single-bundle (SB) versus anatomic double-bundle (ADB) anterior cruciate ligament reconstruction (ACLR) in adults through a synthesis of randomized controlled trials (RCTs). We hypothesized that SB and ADB methods would lead to similar outcomes after reconstruction of ACL rupture. The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist guided our reporting. To identify RCTs that compared SB and ADB reconstructions, a thorough literature search was conducted of PubMed, Embase, Cochrane library, and Web of Science. The methodologic quality of each included study was independently assessed by 2 authors using the Cochrane Collaboration's risk of bias tool. The Anatomic ACL Reconstruction Scoring Checklist (AARSC) was used to screen the eligibility of each study's operative approaches. Twelve clinical outcomes were investigated through pooled analyses conducted using Review Manager 5.3. This meta-analysis synthesized 13 RCTs comparing postoperative outcomes between ADB and SB reconstructions of ACLs. After a minimum follow-up of 12 months, ADB and SB technique resulted in similar subjective clinical outcomes, including the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score sports subscale. Similarly, no statistically significant outcomes were found for objective outcomes such as International Knee Documentation Committee objective grade, pivot-shift test, Lachman test, side-to-side difference, extension deficit, flexion deficit, and osteoarthritis change. However, patients who underwent SB reconstruction had significantly greater complication rates than those that underwent ADB reconstruction. When an ACLR approach meets a minimal total AARSC score of 8, ADB and SB techniques may result in similar subjective and objective outcomes, but the ADB technique may lead to lower complication rates following surgery. We recommend that surgeons favor ADB ACLR, as guided by the AARSC. Level I, systematic review and meta-analysis of Level I randomized controlled trials.

Receptor-interacting protein 1 inhibition prevents mechanical stress-induced temporomandibular joint osteoarthritis by regulating apoptosis and later-stage necroptosis of chondrocytes

ObjectivesTemporomandibular joint osteoarthritis (TMJ OA) is a common degenerative joint disease that has multiple causes. The abnormal stress distribution is known to be an important trigger of TMJ OA. This article explored the pathological changes of the condylar cartilage under 60 g mechanical force and whether the inhibition of Receptor-interacting protein 1 (RIP1) can protect stress-induced TMJ OA. Material and methodsWe used a compressive mechanical force-induced-TMJ OA model and Lenti-virus targeting RIP1 to perform this study. A total of 72 male rats were used in the animal experiment. Each rat was injected with a negative control Lenti-shRNA in the right TMJ and Lenti-siRIP1 in the left TMJ and euthanized after 4 and 7 days, respectively. Quantitative real-time PCR, immunohistochemistry, Tunnel staining and Micro-CT were used to detect cartilage pathological changes and one way ANOVA with LSD analysis was used to determine statistical significance between groups. ResultsThe results identified the characteristics of the spatio-temporal changes in stress-induced TMJ OA. Under mechanical force, inflammation and apoptosis, which occur in the whole layer of mandibular cartilage, appear on the 4th day and persist till the 7th day. Necroptosis arises in the later stage of mechanical force and is mainly located in the transition layer. RIP1 inhibition through Lenti-virus could protect stress-induced mandibular cartilage thinning by inhibiting persisted apoptosis and later-stage necroptosis in the transition layer. ConclusionsRIP1 plays an essential role in the destruction of mandibular cartilage under mechanical force. RIP1 inhibition through Lenti-virus could protect mechanical stress-induced TMJ OA.

Temporomandibular Joint Osteoarthritis: Pathogenic Mechanisms Involving the Cartilage and Subchondral Bone, and Potential Therapeutic Strategies for Joint Regeneration

The temporomandibular joint (TMJ) is a specialized synovial joint that is crucial for the movement and function of the jaw. TMJ osteoarthritis (TMJ OA) is the result of disc dislocation, trauma, functional overburden, and developmental anomalies. TMJ OA affects all joint structures, including the articular cartilage, synovium, subchondral bone, capsule, ligaments, periarticular muscles, and sensory nerves that innervate the tissues. The present review aimed to illustrate the main pathomechanisms involving cartilage and bone changes in TMJ OA and some therapeutic options that have shown potential restorative properties regarding these joint structures in vivo. Chondrocyte loss, extracellular matrix (ECM) degradation, and subchondral bone remodeling are important factors in TMJ OA. The subchondral bone actively participates in TMJ OA through an abnormal bone remodeling initially characterized by a loss of bone mass, followed by reparative mechanisms that lead to stiffness and thickening of the condylar osteochondral interface. In recent years, such therapies as intraarticular platelet-rich plasma (PRP), hyaluronic acid (HA), and mesenchymal stem cell-based treatment (MSCs) have shown promising results with respect to the regeneration of joint structures or the protection against further damage in TMJ OA. Nevertheless, PRP and MSCs are more frequently associated with cartilage and/or bone repair than HA. According to recent findings, the latter could enhance the restorative potential of other therapies (PRP, MSCs) when used in combination, rather than repair TMJ structures by itself. TMJ OA is a complex disease in which degenerative changes in the cartilage and bone develop through intricate mechanisms. The regenerative potential of such therapies as PRP, MSCs, and HA regarding the cartilage and subchondral bone (alone or in various combinations) in TMJ OA remains a matter of further research, with studies sometimes obtaining discrepant results.

Ameliorative Effect of Curcumin Nanoparticles against Monosodium Iodoacetate-Induced Knee Osteoarthritis in Rats.

This study is aimed at evaluating the use of curcumin-loaded polylactic-co-glycolic acid nanoparticles (CUR-loaded PLGA NPs) as a treatment against monosodium iodoacetate- (MIA-) induced knee OA. Eighteen rats were assigned to three groups (n = 6), namely, normal control group that received intra-articular injections (IAIs) of saline, an OA control group that received an IAIs of MIA (2 mg/50 μL), and a treatment group (MIA+CUR-loaded PLGA NPs) that received IAIs of CUR-loaded PLGA NPs (200 mg/kg b.wt). The CUR NP treatment against knee OA alleviated radiographic alternations and histopathological changes and inhibited the upregulation in the serum levels of interleukin-1β, tumor necrosis factor-α, interleukin-6, and transforming growth factor-beta and the downregulation in interleukin-10. CUR NP-treated joints also decreased the mRNA expression of nuclear factor-kappa B and inducible nitric oxide synthase and the protein expression of matrix metalloproteinase-13 and caspase-3. Finally, CUR-loaded PLGA NP treatment mitigated the loss of type II collagen, which resulted in a significant reduction in malondialdehyde level and increased the glutathione content and superoxide dismutase activity compared with that of the OA group. This study demonstrated that the administration of CUR NPs could provide effective protection against MIA-induced OA and knee joint histological deteriorated changes due to its anti-inflammatory, antioxidant, and antiapoptotic properties.

Retrofit assessment of automobile air conditioners using hydrocarbon refrigerants

• R600a and HR12 were selected as alternative refrigerants for the R134a MAC. • Optimal charging amount of HR12 was 45% of that for R134a. • R600a was not suitable to directly replace R134a in the MAC. • Q c and DH were better than those of R134a at T oa of 30 to 40 °C. • T oa of 40 °C could cause a substantial decrease in the EER of HR12. In this study, hydrocarbons (R600a and HR12) were selected as alternative refrigerants to evaluate their performance and feasibility as direct replacements for the R134a used in automobile air conditioners (MACs). The MAC performance tests were performed under fixed indoor conditions (27 °C, 50% RH) and outdoor ambient temperatures ( T oa , 35 °C) to determine the optimum charging amount and availability of hydrocarbons. The results showed that the optimal charging amount of HR12 (247.5 g) was 45% of that for R134a, and its cooling capacity ( Q c ), dehumidification capacity ( DH ), and energy efficiency ratio (EER) were significantly better than those of R134a and R600a. Therefore, HR12 was more suitable for replacing R134a than R600a. In terms of the influence of T oa changes on MAC performance, the Q c , DH , and EER of HR12 used in MACs at a T oa of 30 °C were 5.96%, 6.62%, and 81.02% higher than those of R134a, respectively. The differences of the Q c , DH , and EER between the HR12 and R134a used in the MAC at a T oa of 40 °C were 1.02%, 7.59%, and −9.79%, respectively. The results showed that a T oa of 40 °C could cause a substantial decrease in the EER of HR12, mainly due to the increase in power consumption of MACs. However, in the T oa range (30–40 °C) of this study, the Q c and DH of HR12 were still higher than those of R134a, indicating that HR12 was suitable as a direct replacement for R134a in MACs.

Metformin alleviates osteoarthritis in mice by inhibiting chondrocyte ferroptosis and improving subchondral osteosclerosis and angiogenesis

BackgroundOsteoarthritis (OA) is the most common musculoskeletal disease, and it has a complex pathology and unknown pathogenesis. Chondrocyte ferroptosis is closely associated with the development of OA. As a common drug administered for the treatment of type 2 diabetes, metformin (Met) is known to inhibit the development of ferroptosis. However, its therapeutic effect in OA remains unknown. The present study aimed to explore the effects of Met on cartilage and subchondral bone in a mouse OA model and to explore the potential underlying mechanisms.MethodsA mouse OA model was induced using destabilization of the medial meniscus (DMM) surgery, chondrocyte ferroptosis was induced using an intra-articular injection of Erastin, and Met (200 mg/kg/day) was intragastrically administered for 8 weeks after surgery. H&E and Safranin O‑fast green staining were used to evaluate cartilage degeneration, and μ‑computed tomography was used to evaluate changes in subchondral bone microarchitecture. Moreover, immunohistochemical staining was performed to detect mechanistic metalloproteinases 13, type II collagen, glutathione peroxidase 4, acyl-CoA synthetase long-chain family member 4, solute carrier family 7 member 11 and p53. Runt-associated transcription factor 2 and CD31 were detected using immunofluorescent staining.ResultsMet protected articular cartilage and reversed the abnormal expression of ferroptosis-related proteins in the chondrocytes of DMM mice. Moreover, intra-articular injection of Erastin induced ferroptosis in mouse chondrocytes, and Met eliminated the ferroptosis effects induced by Erastin and protected articular cartilage. In addition, the results of the present study demonstrated that Met alleviated the microstructural changes of subchondral osteosclerosis and reduced heterotypic angiogenesis in DMM mice.ConclusionMet alleviates the pathological changes of OA by inhibiting ferroptosis in OA chondrocytes, alleviating subchondral sclerosis and reducing abnormal angiogenesis in subchondral bone in advanced OA.

Radiological changes in shoulder osteoarthritis and pain sensation correlate with patients’ age

PurposeOsteoarthritis (OA) is one of the most common musculoskeletal disorders in the aging population. The correlation of radiographic OA severity, disability and pain is variable and inconsistent for the different joints. This study aims to elucidate the relationship between histological and radiological signs of shoulder OA with pain sensation and functional impairment to potentially adapt the recommendation for surgical treatment for primary total shoulder arthroplasty (TSA).MethodsForty-four patients with shoulder OA undergoing TSA using an anatomic stemless implant were included in this study. The radiological OA severity was scored pre-operatively on true ap X-rays according to the Kellgren–Lawrence score (KL-Score). Acromial types according to Bigliani were defined by pre-operative radiological images. The histological OA severity was determined according to the OARSI-Score using bone–cartilage sections from loaded areas of the humeral head. Pain was quantified using the visual analog scale (VAS). The functional status was assessed by the items “mobility” and “strength” out of the Constant–Murley score (CS Score). Demographic data including BMI, age, gender, diabetes mellitus and smoking were recorded.ResultsThere was no correlation between radiographic and histological severity in shoulder OA. However, a correlation of age and the severity of radiological changes was observed. Further, pain did not correlate with histological or radiological scores, whereas it correlated with age and the presence of diabetes mellitus. The functional shoulder status (mobility, strength) correlated with the severity of radiological changes, but not with the histologic scoring, which correlated with nicotine abuse.ConclusionThis study shows that increased age is the main determinant of radiological changes in shoulder OA, as well as pain. Therefore, age and pain sensation should be considered as important parameters for the recommendation for TSA.

A COMPARISON OF ULTRASOUND-DETECTED PATHOLOGIES IN PERSONS WITH AND WITHOUT KNEE OSTEOARTHRITIS AND THE ASSOCIATIONS WITH PAIN

Purpose: Ultrasound can be performed to evaluate the degree of osteophytes and synovitis in persons with knee OA bedside to patients, without any side effects or contraindications. Few studies have looked at the associations between ultrasound findings and pain, and there is limited knowledge regarding ultrasound as a valid examination to assess OA pathology of the knee. Hence, we aimed to compare the degree of OA changes by ultrasound among people with and without knee OA according to established classification criteria and study the associations between ultrasound findings and pain.

Meniscal anterior and posterior horn heights are associated with MRI-defined knee structural abnormalities in middle-aged and elderly patients with symptomatic knee osteoarthritis

BackgroundMeniscal morphological changes are associated with knee OA. However, the correlation of meniscal height and OA-related knee structural abnormalities is still not well understood. The purpose of present study is to investigate whether and how meniscal anterior and posterior horn heights are associated with structural abnormalities in knees with symptomatic OA.MethodsOur sample consisted of 106 patients (61 female, aged 40–73 years) with symptomatic knee OA. Kellgren-Lawrence system was used for radiographic evaluation. On sagittal sequence, medial meniscal posterior horn height (MPH), lateral meniscal anterior horn height (LAH) and lateral meniscal posterior horn height (LPH) were measured on the middle slice through the medial/lateral compartment. Knee structural abnormalities were assessed using the modified whole-organ magnetic resonance imaging score (WORMS). Associations between meniscal anterior and posterior horn heights and knee structural abnormalities were assessed using linear regression analysis.ResultsHigher MPH was significantly associated with higher WORMS score for medial meniscal anterior horn lesion (P = 0.016) but did not have a statistical association with other WORMS parameters. Increased LAH was statistically correlated with decreased WORMS scores for lateral compartmental cartilage lesions (P = 0.001–0.004) and lateral compartmental bone marrow edema patterns (BMEPs) (P = 0.021–0.027). Moreover, LPH was negatively associated with WORMS scores for lateral compartmental cartilage lesions (P = 0.007–0.041) and lateral compartmental BMEPs (P = 0.022–0.044). Additionally, higher MPH was statistically associated with lower trochlea cartilage WORMS score and higher LAH was significantly correlated with higher WORMS score for trochlea subarticular cysts.ConclusionsChanges of LAH and LPH were inversely associated with the severity of lateral compartmental cartilage lesions and BMEPs, while higher MPH was only significantly correlated with more severe medial meniscal anterior horn lesions. Besides, MPH and LAH were also significantly associated with patellofemoral structural abnormalities. The present study provided novel information for understanding the role of meniscal morphological changes in knee OA, which would be helpful in identifying and evaluating knees with or at risks for OA.

Role of global femoral cartilage in assessing severity of primary knee osteoarthritis

Background/objectiveOsteoarthritis is a degenerative joint disease marked by structural changes in the joint. Radiological evaluation can be used to assess structural changes. Pain, inflammation, and stiffness are common clinical symptoms, leading to limitations in daily activities. Ultrasound, unlike traditional radiography, allows for a direct examination of changes in soft tissues. In addition, it is sensitive in detecting osteophytes as well as identifying early OA changes in femoral cartilage associated with clinical manifestations and function.ResultsA cross- sectional study of 40 patients with primary KOA diagnosed according to the American College of Rheumatology (ACR) criteria. After radiographic evaluation using Kellgren-Lawrence (K-L) scale and US examination assessing global femoral hyaline cartilage (GFC), osteophytes, meniscal extrusion, effusion, and Baker’s cyst of the most symptomatic knee, there was significant correlation between (K-L) grading and (GFC) ultrasonographic grading (p = < 0.001). After assessment of pain and functional disability using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, there was significant correlation between KL and GFC grading with age (p = < 0.001 for both), disease duration (p = < 0.001 for both) as well as WOMAC total scores (p = < 0.001 for both). GFC grading was the only independent predictor relative to other ultrasonographic variables for WOMAC total score (p = < 0.001).ConclusionsUS is a valid tool to evaluate knee joint space and is well correlated with radiographic images. KOA severity assessed by KL grading and GFC ultrasonographic grading showed good correlation with age, duration of the disease, pain intensity, and functional disability.

The difference in joint instability affects the onset of cartilage degeneration or subchondral bone changes

It has been debated whether the onset of knee osteoarthritis is initiated in cartilage or subchondral bone. The purpose of this study was to clarify the effects of increasing or decreasing joint instability on cartilage degeneration and subchondral bone changes in knee OA by comparing different models of joint instability. We used the anterior cruciate ligament transection (ACL-T) model and the destabilization of the medial meniscus (DMM) model. In addition, we created a controlled abnormal tibial translation (CATT) model and a controlled abnormal tibial rotation (CATR) model. We performed joint instability analysis, micro-computed tomography analysis, histological and immunohistological analysis in 4 and 6 weeks. The CATT group suppressed joint instability in the ACL-T group (6 weeks; P=0.032), and the CATR group suppressed joint instability in the DMM group (6 weeks; P=0.032). Chondrocyte hypertrophy in the ACL-T and DMM groups was increased compared to the Sham group (6 weeks; [ACL-T vs Sham], P=0.002, 95%CI [5.983-33.025]; [DMM vs Sham], P=0.022, 95%CI [1.691-28.733]). In the subchondral bone, the BV/TV in the DMM and CATR groups was increased compared to the ACL-T and CATT groups (6 weeks; [DMM vs ACL-T], P=0.002, 95%CI [7.404-37.582]; [DMM vs CATT], P=0.014, 95%CI [2.881-33.059]; [CATR vs ACL-T], P=0.006, 95%CI [4.615-34.793]; [CATR vs CATT], P=0.048, 95%CI [0.092-30.270]). This study showed that joint instability promotes chondrocyte hypertrophy, but subchondral bone changes were influenced by differences in ACL and meniscus function.

Facteurs de pronostic pour les résultats fonctionnels faibles dans les luxations du genou traitées par reconstruction ligamentaire

Knee dislocation (KD) remains a therapeutic challenge. Current literature promotes multi ligament reconstructions (MLR) rather than repairs. However, little is known on their mid-term functional outcomes and especially their prognostic factors. The purpose of this study is to identify prognostic factors for Patient Reported Outcomes (PROMs), Return to Sport (RTS) and Return to Work (RTW) in knee dislocations treated by MLR. Patients with knee dislocations treated by MLR between 2013 and 2019 were identified in our registry. They all received a similar procedure: all complete ligament ruptures were reconstructed, starting with the PCL and extensor mechanism if involved. Postoperative functional outcomes were assessed with PROMs (IKDC, ACL-RSI, KOOS), Return To Sport (RTS) and Return To Work (RTW) questionnaires. We hypothesized the following factors as possible determinants of poor outcomes: KD severity according Schenck classification, postero medial (PMC) and lateral (PLC) corner injury, age, BMI, gender, OA changes, and ligament reconstruction failure confirmed under dynamic radiographs. Fifty-two consecutive patients were assessed at 3.6 ± 1.7 years following MLR. Demographics: sex ratio: 3, BMI: 25.7 ± 4.5 kg/m 2 , age: 35 ± 10.9 years. According Schenck, knee dislocations were classified KD I (40.4%), KD III (40.4%), KD IV (9.6%) and KD V (9.6%). 76.9% of these dislocations sustained either complete PMC ( n = 27) or PLC ( n = 13) injury. In Schenck classification, only KD V (intra articular fracture) was associated with lower IKDC (51.9; p = 0.007) and KOOS (49.7; p = 0.004) scores. In dislocation patterns involving PLC injury (encountered in KD I L and III L), we observed lower IKDC (63.0; p = 0.04) and ACL-RSI (43.2; p = 0.02), as well as more frequent need for professional reorientation (30.7%, p = 0.05). Early medial compartment OA led to lower ACL RSI (47.3; p = 0,04), IKDC (62.5; p = 0,03), total KOOS (67.1; p = 0,03). Failure to RTS increased with severity of dislocation (KD I: 28.6%, KD III: 47.6%; KD IV: 60%; KD V 80%) but differences did not reach significance ( p = 0.151) Simultaneous intra articular fracture, dislocation with PLC injuries and early medial compartment OA were identified as poor prognostic factors after knee dislocation treated by MLR.

Comparative study of functional outcome of unilateral locking plate and dual plating in the treatment of bicondylar proximal tibia fractures

Background: Proximal Tibia Fracture (PTF) includes different fracture patterns with varied degrees of articular depression and displacement. Many kinds of fixators, including newly designed plate with locking screws were applied to treat these complicated fractures. We intended to follow up the surgical outcomes of 1. Unilateral locking plate and 2.Classic dual plates. Materials and Methods We retrospectively reviewed 66 patients with PTF, Schatzker types V and VI, who we operated in our institute. Excluding patients who expired due to other medical conditions and without complete follow-up. e scheme of surgical intervention was designed by visiting staff, and 15 patients, as Group I, were treated with unilateral locking plate. e other 19 patients, as Group II, were treated with classic dualplates (one lateral approach locking compression plate (LCP)+medial anti-gliding plate). All patients were under periodic follow up at about 6 weeks interval for at least 18 months postoperatively. Results: In Group I, 11 cases achieved solid bony union without obvious traumatic OA change, limitation of ROM, or malalignment. In Group II, 17 patients reached the same goal, respectively. By analysis of the recorded parameters with statistical software (SPSS 12.0), there were five parameters with significant difference, including Schatzker classification, Operation time, Staged treatment done or not done, Period of hospitalization and Hardware impingement. Conclusion: Our study shows Dual plating provides better stability and outcome than unilateral plate fixation for Schatzker type V and type VI fractures. On clinical follow up one should keep a close eye.

Association of serum levels of inflammatory markers and adipokines with joint symptoms and structures in participants with knee osteoarthritis.

To investigate the longitudinal associations of serum inflammatory markers and adipokines with joint symptoms and structures in participants with knee OA. Two hundred participants (46.5% female, mean age 63.1 years, mean BMI 29.5 kg/m2) from Tasmania, part of the VIDEO (Vitamin D Effect on OA) study, were randomly selected in the current study. Serum levels of 19 biomarkers, scores of WOMAC and MRI-assessed knee structures were evaluated at baseline and month 24. The patterns of biomarkers were derived from principal component analysis and their association with knee symptoms and structures were examined using adjusted generalized estimating equations. Five components explained 78% of the total variance. IL-1β, -2, -4, -6, -8, -17 A, -17 F, -21, -22 and -23 loaded the highest on the first component, which was associated with increased bone marrow lesions (BMLs) and WOMAC dysfunction score. IL-10, -12 and GM-CSF loaded on the second component, which was associated with increased cartilage volume, and decreased effusion synovitis and WOMAC scores. Leptin, adipsin and CRP loaded on the third component, which was positively associated with WOMAC scores. Resistin loaded on the fourth component, which was associated with increased BMLs and cartilage defects. Apelin-36 and adiponectin loaded on the fifth component, which was associated with increased BMLs. Various inflammatory and metabolic components were associated differently with joint symptoms and structural changes in knee OA, suggesting a complex inflammatory and metabolic interrelationship in the pathogenesis of knee OA.

Walking speed is associated with MRI-detected structural changes of the knee osteoarthritis in healthy elderlies -the bunkyo health study

Purpose: Walking speed is one of the health indicators and a predictor of lifespan in elderlies (JAMA 2011). The prevalence of knee osteoarthritis (knee OA) increases with age, and >80% of women over 80 years of age showed knee OA in Japan. However, knee OA was evaluated using radiography in this case. It has been recently shown that when MRI was used under the concept of “early-stage of knee OA”, OA changes were initiated much earlier than those evaluated using radiography. A population based observational study, in which 710 people aged >50 years of age (62.3 years of age in average) who had no radiographic evidence of knee OA [Kellgren-Lawrence (KL) grade 0] and underwent MRI of the knee, showed that the prevalence of any abnormality on MRI was 89% overall (BMJ 2012).