Development Of Early Osteoarthritis Research Articles

Search for molecular markers of joint hypermobility

Background: Joint hypermobility (JH) is a condition that can be either benign or accompanied by pain and early development of osteoarthritis. For early verification of the risk of complications, it is necessary to study the molecular pathogenesis of various JH variants. The aim of the study: The aim of this study was to search for candidate genes involved in connective tissue metabolism and causing joint hypermobility in a form isolated or combined with connective tissue dysplasia (CTD). Materials and methods: The study involved young (21,86±0,22 y.o.) people (n=181). A clinical study was conducted for the presence of signs of JH (Beighton scale) and CTD (tables Kadurina T.I.). Further, a molecular genetic study was carried out and the search for associations of polymorphic variants of genes (vitamin D receptor (VDR), lumican (LUM), tenascin (TNXB), growth/differentiation factor 5 (GDF5), magnesium ion channel TRPM6), bone morphogenetic protein type 5 (BMP5)) and JH, CTD in isolated and combined forms. Statistical data processing was carried out by comparing qualitative features using the χ2 test, Fisher's exact test, and the χ2 test with Yates' correction for contingency tables 2x2. The strength of associations was assessed in terms of the odds ratio (Odds Ratio, OR, at p<0.05), the correction for multiple comparisons was carried out using the FDR method (Benjamin- Hochberg). Quantitative data were evaluated in pairs using the Student's t-test, the normality of distribution according to the Kolmogorov-Smirnov test. Results: Associations of the G allele and the GG genotype of the rs3734444 locus of the BMP5 gene with the presence of JH (OR=3.70 and OR=5.10), the A allele of the rs1470527 locus of the BMP5 gene and the presence of JH+CTD- (OR=8.00), the T allele and the TT genotype of the rs11144134 locus of the TRPM6 gene with JH in isolated (OR=3.00 and OR =10.19) and in the forms combined with CTD (OR=3.17 and OR=11.28), the TT genotype was also associated with the isolated form of CTD (OR=3.74). The GT genotype of the rs73611720 locus of the GDF5 gene was associated with isolated CTD (OR=4.15). No statistically significant associations were found for polymorphic variants rs11540149 (VDR), rs2268578 and rs3759222 (LUM), rs3130342 (TNXB). Conclusion: The G allele of locus rs3734444 of the BMP5 gene is a potential risk marker for JH in general, the A allele of locus rs1470527 is an isolated JH, the GT genotype of locus rs73611720 of the GDF5 gene is a marker for isolated CTD, the T allele of locus rs11144134 of the TRPM6 gene is a marker for JH combined with CTD.

Estimation of Atraumatic Hip Microinstability Among Long Distance Truck Drivers in Western Maharashtra : A Cross-Sectional Study

Introduction: Hip micro-instability is an upcoming concern and is gaining acceptance as an important contributing factor for hip joint dysfunction among adults and is a major risk factor for the development of early osteoarthritis. Around 20-25% of people at the age of 50 suffer hip pain and knee pain because of chronic wear and tear of joint articular cartilage. is typically described as painful extra-physiologic hip movements, either alone or in combination with symptoms of unstable hip joints. Truck drivers travel long routes for an extensive duration of time with their hips in an ergonomically compromised position. Occupational stress can cause pain which is an effect of vibrational forces and postural stress. Investigation suggests that hip musculoskeletal pain as a whole is one of the main causes of hip micro-instability. Hence, it is important to evaluate the presence of hip micro-instability among long-distance truck drivers. Methods: A cross-sectional study was conducted from 4 May 2023 in a rural tertiary care hospital in Karad for about 6 months. Wherein a total of 103 long-distance truck drivers were randomly selected based on the inclusion criteria which included truck drivers by occupation within the age group of 35-45 years, working for more than 12 hours in a day and for 5 days/week with no history of trauma. They were assessed by using the Anterior Apprehension Test, Prone Apprehension Test, and AB-HEER test. The data was then analyzed using statistical procedures, and the results were obtained. Results: The present study shows that over 12% of participants showed positive results for hip micro-instability. A significant positive correlation was observed between the number of years of driving in relation to pain (P value < 0.0001). On assessment, there was an increase in flexion, adduction, and internal rotation ranges which hence revealed anterior hip micro-instability (P value = 0.0121) as compared to extension, abduction and external rotation ranges which revealed posterior instability. Conclusion: The study concluded that over 12% of participants showed positive results for hip micro-instability. Also, anterior hip micro-instability was more as compared to posterior hip micro-instability amongst the truck drivers due to capsular relaxation which was affected due to prolonged hours of poor ergonomics. This study also showed the existence of micro-instability despite the presence or absence of ligamentous laxity.

Infiltration therapy in the context of cartilage surgery.

Guideline-based surgical cartilage therapy for focal cartilage damage offers highly effective possibilities to sustainably reduce patients' complaints and to prevent or at least delay the development of early osteoarthritis. In the knee joint, it has the potential to reduce almost a quarter of the arthroses requiring joint replacement caused by cartilage damage. Biologically effective injection therapies could further improve these results. Based on the currently available literature and preclinical studies, intra- and postoperative injectables may have a positive effect of platelet-rich plasma/fibrin (PRP/PRF) and hyaluronic acid (HA) on cartilage regeneration and, in the case of HA injections, also on the clinical outcome can be assumed. The role of a combination therapy with use of intra-articular corticosteroids is lacking in the absence of adequate study data and cannot be defined yet. With regard to adipose tissue-based cell therapy, the current scientific data do not yet justify any recommendation for its use. Further studies also regarding application intervals, timing and differences in different joints are required.

IDENTIFICATION OF PATIENT-SPECIFIC RISK FACTORS AFTER ARTHROSCOPIC PARTIAL MENISCECTOMY: TOWARDS THE DEVELOPMENT OF AN INDIVIDUALIZED TREATMENT ALGORITHM

Partial meniscectomy patients have a greater likelihood for the development of early osteoarthritis (OA). To prevent the onset of early OA, patient-specific treatment algorithms need to be created that predict patient risk to early OA after meniscectomy. The aim of this work was to identify patient-specific risk factors in partial meniscectomy patients that could potentially lead to early OA.Partial meniscectomy patients operated between 01/2017 and 12/2019 were evaluated in the study (n=317). Exclusion criteria were other pathologies or surgeries for the evaluated knee and meniscus (n = 114). Following informed consent, an online questionnaire containing demographics and the “Knee Injury and Osteoarthritis Outcome Score” (KOOS) questionnaire was sent to the patient. Based on the KOOS pain score, patients were classified into “low” (> 75) and “high” (< 75) risk patients, indicating risk to symptomatic OA. The “high risk” patients also underwent a follow-up including an MRI scan to understand whether they have developed early OA.From 203 participants, 96 patients responded to the questionnaire (116 did not respond) with 61 patients considered “low-risk” and 35 “high-risk” patients. Groups that showed a significant increased risk for OA were patients aged > 40 years, females, overweight (BMI >25 kg/m2 ≤ 30 kg/m2), and smokers (*p < 0.05). The “high-risk”-follow-up revealed a progression of early osteoarthritic cartilage changes in seven patients, with the remaining nineteen patients showing no changes in cartilage status or pain since time of operation. Additionally, eighteen patients in the high-risk group showed a varus or valgus axis deviation.Patient-specific factors for worse postoperative outcomes after partial meniscectomy and indicators for an “early OA” development were identified, providing the basis for a patient-specific treatment approach. Further analysis in a multicentre study and computational analysis of MRI scans is ongoing to develop a patient-specific treatment algorithm for meniscectomy patients.

Gait Variability Structure Linked to Worse Cartilage Composition Post-ACL Reconstruction.

Aberrant gait variability has been observed after anterior cruciate ligament reconstruction (ACLR), yet it remains unknown if gait variability is associated with early changes in cartilage composition linked to osteoarthritis development. Our purpose was to determine the association between femoral articular cartilage T1ρ magnetic resonance imaging relaxation times and gait variability. T1ρ magnetic resonance imaging and gait kinematics were collected in 22 ACLR participants (13 women; 21 ± 4 yr old; 7.52 ± 1.43 months post-ACLR). Femoral articular cartilage from the ACLR and uninjured limbs were segmented into anterior, central, and posterior regions from the weight-bearing portions of the medial and lateral condyles. Mean T1ρ relaxation times were extracted from each region and interlimb ratios (ILR) were calculated (i.e., ACLR/uninjured limb). Greater T1ρ ILR values were interpreted as less proteoglycan density (worse cartilage composition) in the injured limb compared with the uninjured limb. Knee kinematics were collected at a self-selected comfortable walking speed on a treadmill with an eight-camera three-dimensional motion capture system. Frontal and sagittal plane kinematics were extracted, and sample entropy was used to calculate kinematic variability structure (KV structure ). Pearson's product-moment correlations were conducted to determine the associations between T1ρ and KV structure variables. Lesser frontal plane KV structure was associated with greater mean T1ρ ILR in the anterior lateral ( r = - 0.44, P = 0.04) and anterior medial condyles ( r = - 0.47, P = 0 .03). Lesser sagittal plane KV structure was associated with greater mean T1ρ ILR in the anterior lateral condyle ( r = - 0.47, P = 0.03). The association between less KV structure and worse femoral articular cartilage proteoglycan density suggests a link between less variable knee kinematics and deleterious changes joint tissue changes. The findings suggest that less knee kinematic variability structure is a mechanism linking aberrant gait to early osteoarthritis development.

Interlimb differences in T1ρ MRI relaxation times linked with symptomatic knee osteoarthritis following anterior cruciate ligament reconstruction

BackgroundLower proteoglycan density, as estimated by greater T1ρ magnetic resonance imaging (MRI) relaxation times, may be an indicator of early osteoarthritis development. We examined associations between femoral cartilage inter-limb T1ρ MRI relaxation time ratios and clinically relevant knee symptoms at 12 months following anterior crucial ligament reconstruction (ACLR). MethodsTwenty-nine individuals completed the Knee Osteoarthritis Outcome Score (KOOS) and underwent MRI 12 months following ACLR for this cross-sectional study. Participants were categorized as symptomatic or asymptomatic for clinically relevant knee symptoms consistent with osteoarthritis based on a standard KOOS classification. T1ρ MRI relaxation times were segmented in the weightbearing regions of lateral and medial femoral condyle (LFC and MFC). Inter-limb T1ρ MRI relaxation time ratios were calculated by normalizing the ACLR to the uninjured knee. T-tests were used to compare LFC and MFC interlimb T1ρ relaxation time ratios between individuals with and without knee symptoms. A Receiver Operating Characteristic (ROC) Curve analysis was used to determine a critical inter-limb T1ρ relaxation time ratio identifying symptomatic patients. Odds ratios (OR) and 95% confidence intervals (CI) estimated the association between the critical value and clinically relevant knee symptoms. ResultsSymptomatic individuals had significantly higher LFC inter-limb T1ρ MRI relaxation time ratios compared to asymptomatic individuals (p = 0.04). Individuals with an LFC inter-limb T1ρ MRI relaxation time ratio >1.11 were more likely to have symptoms (OR 8.5; 95%CI = 1.25–57.93). ConclusionIndividuals with greater inter-limb LFC T1ρ MRI relaxation time ratios 12 months post-ACLR may be more likely to exhibit symptoms consistent with knee OA.

Clinical Evaluation of the Knee Arthritis Patient

The evaluation of a patient with knee osteoarthritis (OA) has 3 main components: clinical history, physical examination, and radiographic imaging. The clinician should assess for inciting and aggravating factors for the knee pain as well as for the presence of any mechanical symptoms. A history of prior knee injury or surgery can suggest the development of early osteoarthritis. A thorough physical examination of the knee should be performed. Some features of OA include limited range of motion, crepitus in the patellofemoral compartment, and joint line tenderness. Depending on the severity of OA varus or valgus alignment can develop. Special tests such as the McMurray for meniscal tears may cause increased pain as patients with OA will often have degenerative meniscal tears. Weight bearing radiographs can confirm the diagnosis of OA. Several scales exist to grade the severity of OA with the Kellgren-Lawrence being one that is often used. Radiographic features of OA include joint space narrowing, osteophytes, sclerosis of bone and bone end deformities. If after the above evaluation the diagnosis is still unclear, advanced imaging or laboratory testing can be performed to evaluate for alternative diagnoses.

The Speed of Pathogen Eradication May Prevent the Early Development of Cartilage Destruction: Case Series of Long-Term Follow-Up of Septic Arthritis (SA) after Anterior Cruciate Ligament Reconstruction (ACL-R) and Literature Review

Late diagnosis and treatment of septic arthritis (SA) after anterior cruciate ligament reconstruction (ACL-R) can lead to graft and cartilage damage. Pathogen eradication time may be the key to preventing the development of osteoarthritis. The purpose of this study was to evaluate the effect of the proposed management of SA after ACL-R on knee function, pathogen eradication time and knee cartilage status on MRI. Five patients with acute knee SA after ACL-R were included in this study. All five patients underwent knee arthroscopic debridement with lavage and flow drainage with physiological saline with vancomycin. All five patients underwent clinical assessment, isokinetic examinations and MRI quantitative cartilage thickness evaluation at two follow-up points: at a mean of 10.9 years and at a mean of 18.1 years. Slight statistical differences in cartilage thickness on the medial femoral condyle were observed between the SA and control groups (2.077 mm and 2.237 mm, respectively; p = 0.021). There were no significant differences in cartilage thickness between the first and last follow-ups in the SA knees. The proposed treatment could lead to a faster eradication of infection, and thus protect against the early development of osteoarthritis. The quadriceps peak torque deficit may persist afterwards at a mean of 18.1 years follow-up.

Radiographic incidence of femoral acetabular impingement in young adults

After Ganz’s first work in 2003 on femoral acetabular impingement (FAI), the interest in this pathology has steadily increased. Several treatments have been proposed and many parameters have been evaluated to reach a diagnosis as accurate as possible. In fact, the resulting cartilage lesions are often associated with early development of osteoarthritis in symptomatic patients. Although there is a considerable percentage of elderly patients who meet radiographic criteria for FAI but are asymptomatic, this disease is commonly underestimated in young adults with coxalgia. The purpose of our study was to investigate these signs in radiographic images in patients under the age of 60 years who have undergone hip replacement surgery to see if FAI criteria were present. We found such signs in most of the patients examined. The most frequent type was mixed impingement. Diagnosis of FAI in symptomatic young adults, in the light of radiographic data, is likely to be underestimated. Early diagnosis and treatment therefore play a non-secondary role.

More Regular Gait Patterns Associate With Worse Femoral Cartilage Composition Following Anterior Cruciate Ligament Reconstruction

Individuals with anterior cruciate ligament reconstruction (ACLR) exhibit more regular gait patterns, resulting in more rigid movements compared to controls. Aberrant joint loading post-ACLR is linked to worse T1ρ magnetic resonance imaging (MRI) relaxation times, an outcome associated with osteoarthritis development. Yet, it remains unknown if knee movement regularity during gait associates with knee cartilage composition in individuals with ACLR. PURPOSE: Determine the association between femoral articular cartilage T1ρ MRI relaxation times and knee joint movement regularity during gait. METHODS: T1ρ MRI and gait kinematics were collected in 20 participants with ACLR (13 Females; 21 ± 4 years old; 8 ± 1 months post-ACLR). Femoral articular cartilage from the ACLR and uninjured limbs was segmented into anterior, central, and posterior regions from the weightbearing portions of the medial and lateral condyles. Mean T1ρ relaxation times were extracted from the cartilage in each region and interlimb ratios were calculated (i.e., ACLR / uninjured limb). Greater interlimb T1ρ ratios were interpreted as lesser proteoglycan density (worse cartilage composition) in the injured limb compared to the uninjured limb. Knee kinematics were collected at a self-selected gait speed on a treadmill with an 8-camera 3D motion capture system. Frontal and sagittal plane knee kinematics were extracted, and sample entropy was used to calculate the degree of movement regularity (i.e., lower values reflect more regularity). Pearson’s product-moment correlations were conducted to determine the association between T1ρ and movement regularity variables. RESULTS: Greater frontal plane knee movement regularity associated with greater mean T1ρ interlimb ratios in the anterior portions of the lateral (r = -0.44, p = .04) and medial condyles (r = -0.47, p = .03). Greater sagittal plane kinematic regularity associated with greater mean T1ρ interlimb ratios in the anterior portion of the lateral condyle (r = -0.47, p = .03). CONCLUSION: Greater movement regularity was associated with less femoral articular cartilage proteoglycan density which is linked to early osteoarthritis development. We hypothesize that greater movement regularity contributes to less adaptable gait and more concentrated cartilage loading.

Short-term radiological results after spheroid-based autologous chondrocyte implantation in the knee are independent of defect localisation.

Lesions of articular cartilage represent a crucial risk factor for the early development of osteoarthritis. Autologous chondrocyte implantation (ACI) is a well-established procedure in therapy of those lesions in the knee. The aim of the presented study is to detect differences in short-term radiological outcome depending on defect localization (femoral condyle vs. retropatellar) after spheroid-based ACI. This study aimed to demonstrate that radiological outcome after spheroid-based ACI in the knee is independent of defect localization. MRI-scans after retropatellar ACI and ACI of the medial/lateral femoral condyle, with a preoperative Outerbridge grade of III or IV were evaluated regarding MOCART 2.0. The mean defect-size was 5.0 ± 1.8 cm2, with a minimum size of 2 cm2 and a maximum size of 9 cm2. Scans were performed 7.7 months (± 3.1 months) postoperatively. The mean MOCART 2.0 score was 78.5 ± 15.6. No statistically significant influence neither of the localization (p= 0.159), the gender (p= 0.124) nor defect size (< 5 cm2 vs. ⩾ 5 cm2; p= 0.201) could be observed. The presented data demonstrate good to excellent radiological short-term results after spheroid-based ACI. Data indicates, that at least radiological results are independent of gender, defect-size and defect-localization.

Arthroscopic Repair of Posterior Root Tears of the Lateral Meniscus with All-Suture Anchor

Meniscus root tears are increasingly being recognized and treated because of improved awareness and diagnostics. These injuries commonly occur in combination with knee ligament injuries. Untreated posterior meniscus root teats have been demonstrated to increase contact pressure and decrease contact area, ultimately leading to unfavorable joint loading and development of early osteoarthritis. Posterior lateral meniscus root tears (PLMRTs) also have been reported to increase anterior tibial translation and pivot shift in anterior cruciate ligament–deficient knees. Therefore, it is crucial to repair meniscal root tears when possible to restore knee joint loading and kinematics. Several techniques for repair of the PLMRT have been described. In this Technical Note, we describe our preferred technique for repair of PLMRT using an all-suture anchor. This technique is reproducible, does not need a tunnel, mitigates bungee effect of transtibial technique, and the anchor can easily be inserted on the footprint without a need for a guide.

Large lateral tibial slope and lateral-to-medial slope difference are risk factors for poorer clinical outcomes after posterolateral meniscus root tear repair in anterior cruciate ligament reconstruction

BackgroundMeniscus root tear is an uncommon but detrimental injury of the knee. Hoop stress is lost during meniscus root tear, which can lead to excessive tibiofemoral contact pressure and early development of osteoarthritis. Posterolateral meniscus root tears (PLRT) are more commonly associated with anterior cruciate ligament (ACL) tears. As the lateral compartment is less congruent than the medial compartment, it is more susceptible to a shearing force, which is increased in the ACL-deficient knee. In accordance with the compressive axial load, the increase in the tibial slope would generate a greater shearing force. The additional lateral compartment mobility caused by ACL tear should be reduced after ACL reconstruction (ACLR). However, there is a lack of evidence to conclude that ACLR can sufficiently limit the effect of large tibial slope (LTS) on the healing after PLRT repair. This study aimed to evaluate whether a steep LTS would be a risk factor for poorer clinical outcomes after PLRT repair concomitant with ACLR.MethodsIn this retrospective study, a chart review was conducted to identify patients with concomitant unilateral primary ACLR and PLRT repair. Patients with a partial tear or healed tear were excluded. Postoperative MRI and clinical assessments were performed at a mean follow up of 35 months. MRI data was used to measure the LTS, medial tibial slope (MTS), coronal tibial slope (CTS), the lateral-to-medial slope difference (LTS-MTS) and meniscus healing and extrusion. Functional outcomes were evaluated by patient-reported outcomes (International Knee Documentation Committee [IKDC], Lysholm and Tegner scores) and KT-1000 arthrometer assessment. Interobserver reproducibility was assessed by two reviewers.ResultsTwenty-five patients were identified for the analysis. Patients with larger LTS and larger LTS-MTS differences were shown to be correlated with poorer IKDC scores after surgery (R = -0.472, p = 0.017 and R = -0.429, p = 0.032, respectively). Herein, patients with LTS ≥ 6° or LTS-MTS ≥ 3° demonstrated poorer IKDC scores.ConclusionA large LTS (≥ 6°) and a large difference of LTS-MTS (≥ 3°) were shown to be risk factors for poorer functional and radiological outcomes for PLRT repair in patients after ACLR. Clinically, closer monitoring and a more stringent rehabilitation plan for patients with LTS ≥ 6° or LTS-MTS ≥ 3° would be recommended.

The evaluation of hip joint pathologies in pediatric age group with MRI

Diagnosis of hip pathologies in the pediatric age group has difficulties. This study aimed to evaluate the hip diseases and prevalences detected by magnetic resonance imaging (MRI) in patients presenting with a preliminary diagnosis of hip pain. The MRI scans of pediatric patients who underwent hip MRI were re-evaluated retrospectively. Clinical and laboratory findings, pathology reports, operation and follow-up notes from the hospital information system, and MRI findings were re-evaluated as a whole and noted. It was examined whether there was a correlation between the prevalence of pathologies and the demographic data, such as age and gender. A total of 101 pediatric patients with hip pain were included in the study. The mean age was 12.29±3.35. Of these patients, 36 (35.6%) were female, and 65 (64.4%) were male. There was right hip involvement in 29 (28.7%), left hip in 47 (46.5%), and bilateral hip involvement in 25 (24.8%) patients. Legg-Calvé Perthes (LCP) disease was the most common final diagnosis seen significantly more frequently in males (p=0.016). Ischiofemoral impingement was significantly more common in girls (p=0.004). Avulsion fractures were significantly more commonly detected by patients over 10 years of age (p=0.019). Similarly, ischiofemoral impingement was more common in patients over 10 years of age (p=0.040). On the contrary, LCP disease was significantly more common in patients under 10 years of age (p&lt;0.001). We observed that hip pathologies in children show significant differences between different age groups and genders. Because wrong and delayed diagnosis can cause irreversible joint destruction and early development of osteoarthritis, a fast and accurate diagnosis of hip pathologies in children is critical. Therefore, MRI plays a crucial role in the differential diagnosis of hip diseases, determining the correct treatment methods, and postoperative follow-up.

Повреждения корня мениска: распространенность и современные аспекты диагностики и лечении

Among the variety of different pathologies of the intra-articular structures of the knee, tearing of the root of the medial meniscus is one of the least studied and at the same time the most formidable injuries. Biomechanically, this type of injury is comparable to a total meniscectomy, which leads to a decrease in the area of tibiofemoral contact and an increase in contact pressure in the affected area. These changes are detrimental to the articular cartilage and ultimately lead to the development of early osteoarthritis. Surgery is the treatment of choice in patients without significant osteoarthritis (grade 1 or 2).According to many authors, posterior meniscus root repair improves clinical outcomes, reduces meniscus extrusion and delays the onset of degenerative changes.This article is intended to expand the general knowledge base on the issue for doctors who may encounter this problem.Keywords: meniscus root tear, prevalence, diagnosis, suture techniques, osteoarthrosis

A Comprehensive Framework to Evaluate the Effects of Anterior Cruciate Ligament Injury and Reconstruction on Graft and Cartilage Status through the Analysis of MRI T2 Relaxation Time and Knee Laxity: A Pilot Study.

Background: Anterior cruciate ligament (ACL) tear represents a common orthopedic traumatic issue that often leads to an early development of osteoarthritis. To improve the diagnostic and prognostic techniques involved in the assessment of the joint after the trauma and during the healing process, the present work proposes a multi-parametric approach that aims to investigate the relationship between joint function and soft tissue status before and after ACL reconstruction. Methods: Thirteen consecutive patients who underwent ACL reconstruction were preliminarily enrolled in this study. Joint laxity assessment as well as magnetic resonance imaging with T2 mapping were performed in the pre-operative stage, at four and 18 months after surgery to acquire objective information to correlate knee function and soft tissue condition. Results: Correlations were found between graft and cartilage T2 signal, suggesting an interplay between these tissues within the knee joint. Moreover, graft maturation resulted in being connected to joint laxity, as underlined by the correlation between the graft T2 signal and the temporal evolution of knee function. Conclusions: This preliminary study represents a step forward in assessing the effects of ACL graft maturation on knee biomechanics, and vice versa. The presented integrated framework underlines the possibility to quantitatively assess the impact of ACL reconstruction on trauma recovery and cartilage homeostasis. Moreover, the reported findings—despite the preliminary nature of the clinical impacts—evidence the possibility of monitoring the surgery outcomes using a multi-parametric prognostic investigation tool.

Accelerated osteoarthritis in women with polycystic ovary syndrome: a prospective nationwide registry-based cohort study

BackgroundOsteoarthritis (OA) is the most common form of arthritis with multiple risk factors implicated including female sex and obesity. Metabolic dysregulation associated with obesity leading to metabolic syndrome is a proposed component of that association. Polycystic ovary syndrome (PCOS) commonly affects women of reproductive age and these women are at higher risk of developing metabolic syndrome and thus likely to represent a high-risk group for early OA development. There are no published studies exploring the epidemiology of knee, hip and hand OA in women diagnosed with PCOS.Study aimTo assess the prevalence and incidence of knee, hip and hand osteoarthritis (OA) in women with polycystic ovary syndrome (PCOS) when compared with age-matched controls.MethodsProspective Danish national registry-based cohort study. The prevalence of OA in 2015 and incidence rates of OA over 11.1 years were calculated and compared in more than 75,000 Danish women with either a documented diagnosis of PCOS ± hirsutism (during the period of 1995 to 2012) or age-matched females without those diagnoses randomly drawn from the same population register.ResultsIn 2015, the prevalence of hospital treated knee, hip and hand OA was 5.2% in women with PCOS diagnosis. It was 73% higher than that seen in age-matched controls. Significantly higher incidence rates were observed in the PCOS cohort compared with the age-matched controls during the follow-up period (up to 20 years), with the following hazard ratios (HR): 1.9 (95% CI 1.7 to 2.1) for knee, 1.8 (95% CI 1.3–2.4) for hand and 1.3 (95% CI 1.1 to 1.6) for hip OA. After excluding women with obesity, similar associations were observed for knee and hand OA. However, risk of developing hip OA was no longer significant.ConclusionsIn this large prospective study, women with PCOS diagnosis had higher prevalence and accelerated onset of OA of both weight and non-weight bearing joints, when compared with age-matched controls. Further studies are needed to understand the relative effect of metabolic and hormonal changes linked with PCOS and their role in promoting development of OA.

Common Biochemical and Magnetic Resonance Imaging Biomarkers of Early Knee Osteoarthritis and of Exercise/Training in Athletes: A Narrative Review

Knee osteoarthritis (OA) is the most common joint disease of the world population. Although considered a disease of old age, OA also affects young individuals and, more specifically among them, those practicing knee-joint-loading sports. Predicting OA at an early stage is crucial but remains a challenge. Biomarkers that can predict early OA development will help in the design of specific therapeutic strategies for individuals and, for athletes, to avoid adverse outcomes due to exercising/training regimens. This review summarizes and compares the current knowledge of fluid and magnetic resonance imaging (MRI) biomarkers common to early knee OA and exercise/training in athletes. A variety of fluid biochemical markers have been proposed to detect knee OA at an early stage; however, few have shown similar behavior between the two studied groups. Moreover, in endurance athletes, they are often contingent on the sport involved. MRI has also demonstrated its ability for early detection of joint structural alterations in both groups. It is currently suggested that for optimal forecasting of early knee structural alterations, both fluid and MRI biomarkers should be analyzed as a panel and/or combined, rather than individually.

Equine synovial fluid small non-coding RNA signatures in early osteoarthritis

BackgroundOsteoarthritis remains one of the greatest causes of morbidity and mortality in the equine population. The inability to detect pre-clinical changes in osteoarthritis has been a significant impediment to the development of effective therapies against this disease. Synovial fluid represents a potential source of disease-specific small non-coding RNAs (sncRNAs) that could aid in the understanding of the pathogenesis of osteoarthritis. We hypothesised that early stages of osteoarthritis would alter the expression of sncRNAs, facilitating the understanding of the underlying pathogenesis and potentially provide early biomarkers.MethodsSmall RNA sequencing was performed using synovial fluid from the metacarpophalangeal joints of both control and early osteoarthritic horses. A group of differentially expressed sncRNAs was selected for further validation through qRT-PCR using an independent cohort of synovial fluid samples from control and early osteoarthritic horses. Bioinformatic analysis was performed in order to identify putative targets of the differentially expressed microRNAs and to explore potential associations with specific biological processes.ResultsResults revealed 22 differentially expressed sncRNAs including 13 microRNAs; miR-10a, miR-223, let7a, miR-99a, miR-23b, miR-378, miR-143 (and six novel microRNAs), four small nuclear RNAs; U2, U5, U11, U12, three small nucleolar RNAs; U13, snoR38, snord96, and one small cajal body-specific RNA; scarna3. Five sncRNAs were validated; miR-223 was significantly reduced in early osteoarthritis and miR-23b, let-7a-2, snord96A and snord13 were significantly upregulated. Significant cellular actions deduced by the differentially expressed microRNAs included apoptosis (P < 0.0003), necrosis (P < 0.0009), autophagy (P < 0.0007) and inflammation (P < 0.00001). A conservatively filtered list of 57 messenger RNA targets was obtained; the top biological processes associated were regulation of cell population proliferation (P < 0.000001), cellular response to chemical stimulus (P < 0.000001) and cell surface receptor signalling pathway (P < 0.000001).ConclusionsSynovial fluid sncRNAs may be used as molecular biomarkers for early disease in equine osteoarthritic joints. The biological processes they regulate may play an important role in understanding early osteoarthritis pathogenesis. Characterising these dynamic molecular changes could provide novel insights on the process and mechanism of early osteoarthritis development and is critical for the development of new therapeutic approaches.

The Problems of Meniscal Root Tears

Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony root avulsion. This injury is biomechanically comparable to a total meniscectomy, leading to compromised hoop stresses resulting in decreased tibiofemoral contact area and increased contact pressures in the involved compartment. These changes are detrimental to the articular cartilage and ultimately lead to the development of early osteoarthritis. Surgical repair is the treatment of choice in patients without significant osteoarthritis (Outerbridge grades 3 or 4). Root repairs have been reported to improve clinical outcomes, decrease meniscal extrusion and slow the onset of degenerative changes. In this article, we describe the anatomy, biomechanics, clinical evaluation, treatment methods, outcomes, and post-operative rehabilitation for posterior meniscal root tears.