Intra-articular Tissue Research Articles

TMJ synovial chondromatosis - an evaluation of 37 patients.

The authors evaluated a cohort of 37 patients with histologically verified synovial chondromatosis (SC) between 2013 and 2022. The cohort consisted of 37 patients (26 women, 11 men). 36 patients had unilateral involvement, while one patient had bilateral involvement. The average age of the patients was 54.77 years. The authors used the Milgram histopathological classification. They evaluated SC localisation, clinical symptoms, diagnostics and treatment (including recurrence incidence) in this cohort. In 31 patients (83.7%) SC affected only the upper joint space in one patient (2.7%) the lower space, and in five patients (13.6%) both spaces. 12 patients (32%) were Milgram Stage 1 (presence of synovial metaplasia without loose bodies), eight patients (22%) were Stage 2 (presence of synovial changes, loose bodies), and 17 patients (46%) were Stage 3 (presence of loose bodies, no synovial changes). Pain was the dominant clinical symptom (32 patients, 86.4%). Treatment consisted of arthroscopy and open surgery. Two patients underwent primary reconstruction and total TMJ replacement. Treatment was successful in 89.2% of cases (33 patients), with four (10.8%) patients suffering recurrence. As this patient cohort shows, pain was the dominant symptom in patients with SC. Magnetic resonance imaging is fundamental in the diagnosis of SC, demonstrating pathological findings even in patients for whom an initial X-ray was negative. These were mainly patients with Milgram Stages 1 and 2 without calcification, loose bodies or pathological changes of the bone structures. This is why the authors recommend MRI for any patient experiencing pain for more than three months, and if this reveals an effusion, joint distension or intraarticular soft tissue mass, they will always indicate arthroscopy. Thorough follow-up of patients is recommended, although SC recurrence is not very frequent. The authors recommend follow-up one, three and six months after surgery, and then annually for the first five years after surgery. They recommend follow-up MRI one, two and five years after surgery.

A comparison of MRI and arthroscopic findings of intraarticular soft tissue injury of the knee at Kenyatta National Hospital, Kenya

A comparison of MRI and arthroscopic findings of intraarticular soft tissue injury of the knee at Kenyatta National Hospital, Kenya

Adipose-Derived Mesenchymal Stem Cells from Arthritis Patients: Differential Modulation of CD4⁺ T Cell Activation and Cytokine Production.

BACKGROUND Adipose-derived stem cells (ASCs) from intra-articular adipose tissue of osteoarthritis (OA) and rheumatoid arthritis (RA) patients similarly regulate the proliferation of activated CD4⁺ T lymphocytes and exhibit comparable differentiation potential. This study aimed to assess the impact of ASCs from RA patients on CD4⁺ T cell activation and differentiation into Th17 and T regulatory (Treg) cells. MATERIAL AND METHODS Intra-articular adipose tissue samples were obtained from patients with RA and OA, who underwent knee replacement surgery. ASCs were isolated and cultured either with isolated CD4⁺ cells or with peripheral blood mononuclear cells. After culture, CD4⁺ T cell phenotype was evaluated by flow cytometry, and cytokine concentrations in culture supernatants were analyzed via ELISA. Blocking experiments were conducted to identify the soluble agents responsible for the immunomodulatory effects of ASCs. RESULTS RA- and OA-derived ASCs effectively modulated CD25 and CD69 expression on CD4⁺ cells. RA-derived ASCs failed to induce Tregs, decreased HLA-DR expression, and increased IL-35 production. RA- and OA-derived ASCs reduced TNF and IFN-γ production but increased IL-17 production. The immunomodulatory activities of ASCs were linked to the kynurenine pathway and prostaglandin E2. CONCLUSIONS This study indicates that ASCs modulate the phenotype of CD4⁺ T cells and influence the production of both pro-inflammatory and anti-inflammatory cytokines. However, ASCs from RA patients appear to have impaired immunomodulatory abilities, raising concerns about their therapeutic potential. Further research is needed to enhance our understanding of ASCs biology and their therapeutic utility.

Clarifying the relation between the marrow contusion pattern around the knee and the types of concomitant intra-articular soft tissue injuries

BackgroundAcute knee injuries represent a prevalent cause of morbidity among athletes and, if overlooked, could potentially lead to the development of chronic functional limitations. This study aimed to identify marrow contusion patterns around the knee and find the relation between each pattern and the intra- and extra-articular soft tissue injuries. This was a retrospective cross-sectional study carried out on 109 patients who presented to the hospital where the study was held with recent knee joint injury, for which magnetic resonance imaging was requested from January 2017 to January 2019.ResultsThe entire patient population under investigation had a mean age of 30.2 ± 9.7 years. Regarding gender distribution, the study comprised 90 males (82.6%) and 19 females (17.4%). Regarding bone marrow contusion patterns in all studied patients, it was pivot shift in 58 patients (53.2%), clip injury in 11 patients (10.1%), dashboard injury in 7 patients (6.4%), hyperextension injury in 3 patients (2.8%), lateral patellar dislocation in 15 patients (13.8%), and others in 15 patients (13.8%). In the pivot shift pattern group, anterior cruciate ligament (ACL), medial meniscus, and medial collateral ligament (MCL) injuries were most commonly seen in 94.8, 50, and 44.8% of patients, respectively. Among the clip pattern group, MCL, ACL, and medial meniscus injuries were most common in 90.9, 36.4, and 36.4%, respectively. Regarding the dashboard injury group, posterior cruciate ligament (PCL), ACL, and medial and lateral menisci were the most common injury structures (100, 57.1, 42.9, and 42.9%, respectively). Despite the hyperextension pattern being found in a small number of patients, it shows 100% medial meniscal and 66.7% PCL injuries. Within the group of lateral patellar dislocation patterns, 100% of cases exhibited injuries to the medial patellofemoral ligament.ConclusionsPrecise localization of the marrow contusion around the knee and defining its pattern help to anticipate the most probable associated soft tissue injuries and, thus, can increase our sensitivity in their detection. This can have a better impact on patients' management outcomes.

Disentangling the detrimental effects of local from systemic adipose tissue dysfunction on articular cartilage in the knee

ObjectiveObesity increases osteoarthritis (OA) risk due to adipose tissue dysfunction with associated metabolic syndrome and excess weight. Lipodystrophy syndromes exhibit systemic metabolic and inflammatory abnormalities similar to obesity without biomechanical overloading. Here, we used lipodystrophy mouse models to investigate the effects of systemic versus intra-articular adipose tissue dysfunction on the knee. MethodsIntra-articular adipose tissue development was studied using reporter mice. Mice with selective lipodystrophy of intra-articular adipose tissue were generated by conditional knockout (cKO) of Bscl2 in Gdf5-lineage cells, and compared with congenital Bscl2 KO mice with generalised lipodystrophy and associated systemic metabolic dysfunction. OA was induced by surgically destabilising the medial meniscus (DMM) and obesity by high-fat diet (HFD). Gene expression was analysed by quantitative RT-PCR and tissues were analysed histologically. ResultsThe infrapatellar fat pad (IFP), in contrast to overlying subcutaneous adipose tissue, developed from a template established from the Gdf5-expressing joint interzone during late embryogenesis, and was populated shortly after birth by adipocytes stochastically arising from Pdgfrα+ Gdf5-lineage progenitors. While female Bscl2 KO mice with generalised lipodystrophy developed spontaneous knee cartilage damage, Bscl2 cKO mice with intra-articular lipodystrophy did not, despite synovial hyperplasia and inflammation of the residual IFP. Furthermore, male Bscl2 cKO mice showed no worse cartilage damage after DMM. However, female Bscl2 cKO mice with intra-articular lipodystrophy showed increased susceptibility to the cartilage damaging effects of HFD-induced obesity. ConclusionOur findings emphasise the prevalent role of systemic metabolic and inflammatory effects in impairing cartilage homeostasis, with a modulatory role for intra-articular adipose tissue.

The Intra-articular Tendinous Graft Diameter of 10-mm Bone-Patellar Tendon-Bone Autografts in Adolescent Patients: An MRI Analysis of 100 Patients.

Bone-patellar tendon-bone (BPTB) autograft size may be one modifiable predictor of anterior cruciate ligament (ACL) reconstruction postoperative success, as smaller graft diameter has been associated with higher rates of rupture requiring revision. However, measuring the true intra-articular tendinous graft diameter of the soft tissue portion of a BPTB graft with standard intraoperative methods is difficult while keeping the graft intact. The purpose of the study was to use 3-dimensional magnetic resonance imaging (MRI) measurements to determine the cross-sectional area of the soft tissue, tendinous portion of a standard BPTB autograft with 10-mm diameter bone plugs, and, by calculation, the collagen graft size (ie, graft diameter), as would typically be reported in ACL reconstruction studies that consider soft tissue graft size. It was hypothesized that the calculated collagen graft diameter of 10-mm BPTB autografts would be significantly smaller than 10 mm. Cross-sectional study; Level of evidence, 3. A total of 100 patients (10 girls and 10 boys at each age from 13 to 17 years) who underwent a knee MRI at a single academic orthopaedic center without documented extensor mechanism pathology were identified. The central 10-mm width of the patellar tendon that would be harvested for BPTB autograft was measured. The region of interest area tool was then used to measure the cross-sectional area of a 10-mm BPTB graft with subsequent soft tissue autograft diameter calculation. The mean calculated tendinous graft diameter of a 10 mm-wide BPTB graft was 6.3 ± 0.5 mm and was significantly smaller than a 10-mm reference (P≤ .001). There was no significant association between age and cross-sectional area or graft diameter. Modern 3-dimensional imaging-based measurement techniques demonstrated that the true intra-articular tendinous soft tissue portion of 10-mm BPTB autografts shows substantial variation and is significantly smaller in diameter than the tunnels typically reamed to accommodate the bone plug portions of these grafts. Moreover, as graft size is a predictor of rupture rate, preoperative MRI-based evaluation may be an important tool when considering BPTB autograft for ACL reconstruction. Future comparative clinical research utilizing graft size as a study variable should consider quantifying and utilizing the diameter of the soft tissue component of BPTB autografts.

What Have We Learned in the Wrist Joint of Distal Radius Fracture through Wrist Arthroscopy?

Abstract Background Wrist arthroscopy is an efficient tool for the surgical treatment of distal radius fracture (DRF). It could show us the various conditions of the radiocarpal joint, its effectiveness seems to overwhelm that of fluoroscopy. Methods Since July 2005, we have performed wrist arthroscopy and plate presetting arthroscopic reduction technique (PART) for 141 extra-articular and 559 intra-articular DRFs and investigated various kinds of intra-articular conditions and advantages of wrist arthroscopy. Results The pathological conditions clarified and the advantages of PART in the surgical treatment of DRF are: (1) accurate reduction of intra-articular fragments is possible compared with fluoroscopic reduction, (2) intra-articular fragments (free body) undetected with radiograph and CT can be recognized, (3) screw protrusion into joint surface can be monitored, (4) intra-articular soft tissue injury associated with fracture can be evaluated and treated, and (5) debridement of joint hematoma can be performed. Severe complications such as tendon rupture, major neurovascular injury or compartment syndrome from arthroscopy were never encountered. Conclusions The volar locking plate fixation and simultaneous arthroscopic intervention is problematic because vertical traction must be applied and released during surgery. PART can overcome these difficulties and achieved good clinical results.

Morphological Changes and Concentricity of the Hip Joint During Gradual Reduction in Infants with Late-Detected Developmental Dysplasia of the Hip: A Retrospective Study.

The relationship between hip morphological changes and joint concentricity in infants with late-detected developmental dysplasia of the hip (DDH) treated with gradual reduction remains unclear. Therefore, we investigated hip morphological changes and concentricity in infants with late-detected unilateral DDH using magnetic resonance imaging (MRI) during gradual reduction. We enrolled 20 infants aged ≥ 12months with unilateral DDH. Treatment comprised continuous traction, a hip-spica cast, and an abduction brace. MRI was performed before treatment, immediately after hip-spica cast placement, after cast removal, and at the end of the brace. We evaluated the acetabulum and femoral head morphology and joint concentricity. The mean age was 25months, and female sex and the left side were predominant. Before treatment, the acetabulum was small and shallow and the femoral head was spherically flat on the affected side. Immediately after the continuous traction, the affected acetabulum and femoral head were still smaller than the healthy/contralateral one. However, they improved to a deeper acetabulum and round femoral head. Intra-articular soft tissue (IAST) and femoral-acetabular distance (FAD) continuously decreased, indicating gradual improvement in joint concentricity. Deeper formation of the acetabulum and round shaping of the femoral head had occurred even in non-concentric reduction. The shape and concentricity of the hip joint improved after treatment; however, the acetabulum and femoral head remained small. The deeper acetabulum and round femoral head were observed the non-concentric reduction before the concentric reduction was achieved. The continuous decrease in IAST and FAD indicates effective post-traction therapy.

Comparative Assessment of Surgical Treatment Results of Patients with Early-Stage Avascular Necrosis of the Femoral Head

Background. The observed sharp increase in patients with avascular necrosis of the femoral head (ANFH) associated with a new COVID-19 infection determines the need to find some new effective strategies for surgical treatment to achieve long-term positive results.
 Aim of the study is to make a comparative assessment of surgical treatment results of patients with early-stage avascular necrosis of the femoral head using different techniques of core decompression and autogenous bone grafting of the femoral head.
 Methods. We performed a comparative analysis of the treatment results of patients with early stages of ANFH. The patients were divided by the treatment method into two groups: control and main. Surgical treatment in the control group (n = 19) consisted of an open decompression and autogenous bone grafting of the femoral head using the Rosenwasser’s “light bulb” technique. The main group (n = 17) included the patients who had undergone the developed combined impaction autografting of the femoral head. Clinical and functional assessment of the treatment results was performed using the Harris Hip Score (HHS) questionnaire and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score. Assessment was performed preoperatively and at 3, 6, and 12 months postoperatively.
 Results. The performed comparative analysis showed statistically significant difference in clinical and functional results after operative treatment in patients of the control and the main groups at all follow-ups. Change of the HHS values presented as Me (Q1;Q3) in patients of both groups at 3, 6 and 12 months was 77.0 (68.0;84.0) and 82.0 (75.0;91.0), p = 0.001; 79.0 (69.0;85.0) and 88.0 (79.0;95.0), p0.001; 81.0 (71.0;86.0) and 90.0 (85.0;92.0), p0.001, respectively. According to the WOMAC, the following dynamics was revealed for the same values: 30.0 (25.0;35.0) and 25.0 (21.0;32.0), p = 0.002; 27.0 (22.0;33.0) and 20.0 (17.0;27.0), p0.001; 24.0 (17.0;30.0) and 15.0 (13.0;24.0), p0.001.
 Conclusion. Comparative assessment of efficacy of the open core decompression with autogenous bone grafting of the femoral head defect using the light bulb technique and closed intralesional resection of necrosis focus with combined impaction grafting of the femoral head showed that the minimal damage to para- and intraarticular tissues when performing the approach to the area of the pathological focus and the main stages of the operation allows to achieve the best clinical and functional results and create optimal conditions for bone remodeling in the grafting area.

Contrast arthrography of the equine temporomandibular joint.

Disorders of the equine temporomandibular joint (TMJ) cause clinical problems and detailed investigations of this joint are becoming more common. Specialist radiographic projections have the potential to highlight osseous abnormalities; however, the ability to assess the intra-articular soft tissue structures is currently limited to computed tomography (with, or without contrast enhancement) or magnetic resonance imaging. Both modalities are expensive and not readily accessible. To develop a technique of contrast arthrography of both compartments of the equine TMJ in cadavers and then perform the refined technique in three living horses as a proof-of-principle. A descriptive, experimental, study. Contrast arthrography of the discomandibular and discotemporal joint compartments of both TMJs was performed in 12 cadaveric equine heads using needles placed in the caudal pouches of the respective joint compartments. Radiographs were taken using previously published techniques, repeated with the mouth open and after air had been injected into the joints, to perform a double-contrast study. The TMJs of three healthy horses were subsequently examined to determine the validity of the procedure in live animals. Single and double-contrast arthrography allowed delineation of the dorsal and ventral surfaces of the intra-articular disc in addition to filling the rostral and caudal joint pouches of the independent joint compartments. Contrast extravasation was common, and in two instances iatrogenic disc penetration resulted in the false diagnosis of pathologic disc perforation. The techniques were well tolerated in all three live horses. Low number of horses. Contrast arthrography allows interpretation of intra-articular soft tissue structures, but caution is advised in diagnosing intra-articular disc perforation. Even with experience, accessing the discomandibular joint can be challenging.

Synovium and infrapatellar fat pad share common mesenchymal progenitors and undergo coordinated changes in osteoarthritis.

Osteoarthritis (OA) affects multiple tissues in the knee joint, including the synovium and intra-articular adipose tissue (IAAT) that are attached to each other. However, whether these two tissues share the same progenitor cells and hence function as a single unit in joint homeostasis and diseases is largely unknown. Single-cell transcriptomic profiling of synovium and infrapatellar fat pad (IFP), the largest IAAT, from control and OA mice revealed five mesenchymal clusters and predicted mesenchymal progenitor cells (MPCs) as the common progenitors for other cells: synovial lining fibroblasts (SLFs), myofibroblasts (MFs), and preadipocytes 1 and 2. Histologic examination of joints in reporter mice having Dpp4-CreER and Prg4-CreER that label MPCs and SLFs, respectively, demonstrated that Dpp4+ MPCs reside in the synovial sublining layer and give rise to Prg4+ SLFs and Perilipin+ adipocytes during growth and OA progression. After OA injury, both MPCs and SLFs gave rise to MFs, which remained in the thickened synovium at later stages of OA. In culture, Dpp4+ MPCs possessed mesenchymal progenitor properties, such as proliferation and multilineage differentiation. In contrast, Prg4+ SLFs did not contribute to adipocytes in IFP and Prg4+ cells barely grew in vitro. Taken together, we demonstrate that the synovium and joint fat pad are one integrated functional tissue sharing common mesenchymal progenitors and undergoing coordinated changes during OA progression.

Operative Management of Lateral Ankle Instability: Examination Under Anesthesia, Ankle Arthroscopy and Stabilization Technique

Background: Ankle sprains are common injuries that can result in chronic ankle instability. Indications: Indications for surgical management include recurrent instability, failed conservative management for 3 to 6 months, and inability to return to play or activity. Technique Description: The patient’s ankle is initially examined under anesthesia with anterior drawer testing to confirm the diagnosis of ankle instability. Ankle arthroscopy is then preformed to identify and treat additional intra-articular pathology prior to modified Broström repair. During arthroscopy, care is taken to protect the superficial peroneal nerve. Routinely we perform a “drive-through sign” to assess syndesmotic stability and also debride pathologic intra-articular tissue such as hypertrophied synovium. Following the completion of arthroscopy, an incision is made directly over the fibula. The anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and distal fibular periosteum are dissected off the fibula. Two 3.0-mm suture anchors are placed at the origin of the CFL ligament and the ATFL ligament, and previously dissected tissue is incorporated for repair. We reinforce the CFL and ATFL tissues with incorporation of the distal fibular periosteum. Suture tape augmentation is considered for patients at high risk of recurrence, such as those with ligamentous laxity. After completion of our repair, the ankle is again examined under anesthesia with satisfactory confirmation of improved ankle stability. Results: Outcomes of our technique are promising, with improvement in patient-reported outcome measures, restoration of range of motion, return to sport as high as 94%, and low failure rates. Discussion: For patients with chronic instability, our described technique for sequential examination under anesthesia, ankle arthroscopy, and our modified Broström result in satisfactory improvement in ankle stability and patient symptoms. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

FUNCTIONAL OUTCOME OF FIXATION OF TIBIA SCHATZKER TYPE II AND TYPE III FRACTURES UNDER ARTHROSCOPIC GUIDANCE

The tibial plateau fracture is a common type of orthopaedic fracture. An alternative to open reduction and internal fixation (ORIF) is arthroscopic-assisted reduction and internal fixation, which provides direct visualisation of the articular surface of the plateau, evaluation of the reduction of the articular surface, and management of any intra-articular pathology that may be associated with the reduction of the articular surface. This study aimed to determine the functional outcome of patients who received tibial fixation under arthroscopic supervision for Schatzker's Type II and III tibial fractures. The research was conducted over six months in the Orthopaedic Surgical Department at Jinnah Hospital in Lahore from November 17, 2022, to May 17, 2023. Sixty patients met the inclusion criteria were recruited after obtaining written informed permission. A clinical and historical examination of each patient's knees was conducted, followed by arthroscopy-guided internal reduction and repair of the tibial fracture under general anaesthesia. All patients received a post-operative rehabilitation regimen. At the three-month follow-up, standing AP radiographs were taken to examine the general alignment of the limbs, and Rasmussen score results were recorded. The average age of the patients was 46 years, and 63.3% were men and 36.7% were women. Schatzker grades II and III tibial plateau fractures were present in 53.3% and 46.7% of the patients, respectively. The mean Rasmussen clinical score was 27.33, indicating that 50 out of 60 patients had excellent recovery, nine out of 60 patients had good recovery, and one out of 60 patients had fair recovery. The mean Rasmussen radiological score was 7.36, indicating that 48 out of 60 patients had outstanding recovery, 11 out of 60 patients had good recovery, and one out of 60 patients had fair recovery. In conclusion, arthroscopic-assisted reduction and internal fixation is a good technique for treating young patients with Schatzker grades II-III tibial plateau fractures, and it enables control of co-existing injuries of intra-articular soft tissues, leading to faster recovery and greater patient satisfaction. However, having expertise in trauma and arthroscopic methods is important to carry out the procedure correctly.

Epigenomic profiling of the infrapatellar fat pad in osteoarthritis.

Osteoarthritis is a prevalent, complex disease of the joints, and affects multiple intra-articular tissues. Here, we have examined genome-wide DNA methylation profiles of primary infrapatellar fat pad and matched blood samples from 70 osteoarthritis patients undergoing total knee replacement surgery. Comparing the DNA methylation profiles between these tissues reveal widespread epigenetic differences. We produce the first genome-wide methylation quantitative trait locus (mQTL) map of fat pad, and make the resource available to the wider community. Using two-sample Mendelian randomization and colocalization analyses, we resolve osteoarthritis GWAS signals and provide insights into the molecular mechanisms underpinning disease aetiopathology. Our findings provide the first view of the epigenetic landscape of infrapatellar fat pad primary tissue in osteoarthritis.

Continuous detrimental activity of intra-articular fibrous scar tissue in correlation with posttraumatic ankle osteoarthritis

Posttraumatic osteoarthritis is primarily characterized by articular cartilage destruction secondary to trauma or fracture events. Even while intra-articular scar tissue can be observed following ankle fractures, little is known about its nature and molecular events linking its biological activity and cartilage deterioration. Here, we investigated scar tissue's histological and molecular characteristics, and its relationship with localized articular cartilage alterations consistent with early osteoarthritic degeneration. Intra-articular scar tissues from sixty-two patients who underwent open reduction internal fixation for ankle fracture were obtained at hardware removal time (6–44 months after fracture). Histological analysis demonstrated that scar tissue has the nature of fibrosis with fibrous tissue hyperplasia, fibroblast proliferation, and chondrometaplasia. These fibrous scar tissues showed overexpressed pro-inflammatory cytokines and high mRNA expression levels of osteoarthritis-related markers (cytokines, chemokines, and enzymes) compared to the normal synovium. Furthermore, those transcriptional levels were significantly correlated with the grade of talar chondral degeneration. Our findings suggest that following an ankle fracture, the intra-articular fibrous scar tissue exhibits high catabolic and inflammatory activity, which has a long-lasting negative impact correlated to cartilage deterioration in the development of posttraumatic osteoarthritis.

Intravenous Tranexamic Acid Improves Visual Clarity During Synovectomy in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Double-Blind, Randomized Controlled Study

PurposeTo assess the effects of intravenous tranexamic acid (TXA) on visual clarity at various surgical stages and the correlation between severity of synovitis and bursitis and visual clarity in patients undergoing arthroscopic shoulder surgery under an interscalene brachial plexus block. MethodsThis double-blind, randomized controlled study included patients undergoing arthroscopic rotator cuff repair. The TXA group was injected 1000 mg of TXA intravenously, and the control group was administered the same volume in normal saline 10 min preoperatively. Visual clarity was rated according to a three-grade visual clarity scoring system from grade 1 (clear) to grade 3 (poor) at four surgical stages (I, intra-articular soft tissue procedure including synovectomy; II, acromioplasty; III, bursectomy; and IV, greater tuberoplasty). The primary outcome was arthroscopic visual clarity. The secondary outcomes were medications administered for hemodynamic stability, length of hospital stay, and thromboembolic events. ResultsAltogether, 63 patients were included in the study and they were divided into the TXA group comprising 32 patients and the control group comprising 31 patients. The TXA group showed significantly better visual clarity than the control group (1(1–2) vs 2(1–2), p=0.027) during stage I, but not during stages II–IV. Spearman correlation analysis revealed a significant correlation between synovitis and visual clarity grade during synovectomy (correlation coefficient, 0.393; p=0.001), but not between bursitis and visual clarity grade during bursectomy. Deep vein thrombosis and pulmonary embolism did not occur in either group. ConclusionsIntravenous TXA can improve visual clarity during intra-articular soft tissue procedures, including synovectomy. However, it does not have a significant effect during acromioplasty, bursectomy, and greater tuberoplasty. TXA can be used to improve visual clarity in patients with suspected severe synovitis. Level of EvidenceLevel I, randomized controlled trial

The infrapatellar fat pad contributes to spontaneous healing after complete anterior cruciate ligament injury.

Anterior cruciate ligament (ACL) injuries have a very low healing capacity but have recently been shown to heal spontaneously with conservative treatment. This study examined the mechanism of spontaneous ACL healing by focusing on the intra-articular tissues of the knee joint. Skeletally mature Wistar rats (n = 70) were randomly assigned to two groups: the controlled abnormal movement (CAM) and anterior cruciate ligament transection (ACLT) groups. The ACL was completely transected at the mid-portion in both groups. Only the CAM group underwent extra-articular braking to control for abnormal tibial translation. The animals were allowed full cage activity until sacrifice for histological, and molecular biology analyses. The results showed that the behavior of the stump after ACL injury differed between models 12 h after injury. The femoral stump in the ACLT group retreated posteriorly and upwardly. Macrophage polarity analysis revealed that the stump immune response in the CAM group was more activated than that in the ACLT group 6 h after injury. Microarray analysis of the ACL parenchyma and infrapatellar fat pads suggested the involvement of nuclear factor kappa B (NF-κB) signaling. Real-time polymerase chain reaction (PCR) analysis showed that NF-κB gene expression in the infrapatellar fat pad was significantly increased in the CAM group than in the ACLT group. However, there was no difference in the gene expression levels in the ACL parenchyma between models. In conclusion, the healing response of the ACL was activated within 12 h of injury, resulting in differences in the healing response between the models. It has been suggested that infrapatellar fat pads are involved in the healing process and that angiogenesis and antiapoptotic effects through NF-κB signaling may contribute to this mechanism.

Mesenchymal stem cells in synovial fluid increase in number in response to synovitis and display more tissue-reparative phenotypes in osteoarthritis

BackgroundSynovial fluid mesenchymal stem cells (SF-MSCs) originate in the synovium and contribute to the endogenous repair of damaged intra-articular tissues. Here, we clarified the relationship between their numbers and joint structural changes during osteoarthritis (OA) progression and investigated whether SF-MSCs had phenotypes favorable for tissue repair, even in an OA environment.MethodsPartial medial meniscectomy (pMx) and sham surgery were performed on both knees of rats. SF and knee joints were collected from intact rats and from rats at 2, 4, and 6 weeks after surgery. SF was cultured for 1 week to calculate the numbers of colony-forming cells and colony areas. Joint structural changes were evaluated histologically to investigate their correlation with the numbers and areas of colonies. RNA sequencing was performed for SF-MSCs from intact knees and knees 4 weeks after the pMx and sham surgery.ResultsColony-forming cell numbers and colony areas were greater in the pMx group than in the intact and sham groups and peaked at 2 and 4 weeks, respectively. Synovitis scores showed the strongest correlation with colony numbers (R = 0.583) and areas (R = 0.456). RNA sequencing revealed higher expression of genes related to extracellular matrix binding, TGF-β signaling, and superoxide dismutase activity in SF-MSCs in the pMx group than in the sham group.ConclusionThe number of SF-MSCs was most closely correlated with the severity of synovitis in this rat OA model. Tissue-reparative gene expression patterns were observed in SF-MSCs from OA knees, but not from knees without intra-articular tissue damage.

Efficacy and Long-Term Outcomes of Intra-Articular Autologous Micro-Fragmented Adipose Tissue in Individuals with Glenohumeral Osteoarthritis: A 36-Month Follow-Up Study.

Glenohumeral osteoarthritis (GOA) is associated with disabling shoulder pain that affects everyday life. Its management comprises various treatment approaches, both conservative and surgical. Regenerative medicine has gained a major role in the conservative treatment of osteoarthritis. Intra-articular injection of adipose-derived mesenchymal stem cells (ADMSCs) is a widely used regenerative medicine approach. The aim of this retrospective study was to report the safety and clinical outcomes of intra-articular injection of ADMSCs in patients with GOA over 36-months. This retrospective observational study involved patients with chronic shoulder pain resistant to standard conservative treatment and a diagnosis of concentric GOA, who received an intra-articular injection of autologous micro-fragmented adipose tissue (μFAT). The values of the Constant-Murley score (CMS), the visual analog scale (VAS), and the simple shoulder test (SST), collected at baseline and at 12, 24, and 36 months, were analyzed to assess treatment efficacy. The single assessment numeric evaluation (SANE) was used to rate patient satisfaction. The Friedman test was used to compare observations of CMS, VAS, and SST values repeated on the same subjects. The significance threshold was set at 0.05. The participants were 65 patients with a mean age of 54.19 years and a nearly equal gender distribution. Most had mild concentric GOA classified as Samilson-Prieto grade 1. The mean follow-up duration was 44.25 months. The postoperative clinical scores showed significant improvement. At 36 months, the CMS was 84.60, the VAS score was 3.34, and the SST score was 10.15 (all p < 0.0001). The SANE score at 36 months indicated that 54 patients (83.08%) were completely satisfied with the treatment. ADMSC treatment exerted favorable effects on the clinical outcomes of patients with GOA, providing pain relief and improving shoulder function. Our data support its use as a conservative treatment option for osteoarthritis.

Efficacy and Duration of Intra-Articular Autologous Micro-Fragmented Adipose Tissue in Athletes with Ankle Osteoarthritis: A 36-Month Follow-Up Study

Introduction: The intra-articular injection of autologous micro-fragmented adipose tissue (MAT) is increasingly used to manage pain and dysfunction in subjects with osteoarthritis (OA). The purpose of this retrospective study was to report the safety and clinical outcomes of intra-articular MAT in athletes with ankle OA. Methods: Participants were 21 symptomatic athletes aged 18–30 years suffering from mild-to-moderate ankle OA, who received 7 mL autologous MAT after failure of six-month conservative treatment. Clinical evaluation was performed before the procedure and at 6, 12, 24, and 36 months using the visual analog scale for pain, the American Orthopedic Foot and Ankle Society score and the Foot and Ankle Disability Index score. Patient satisfaction was assessed at 36 months. Results: The clinical scores documented a significant or marked improvement throughout the follow-up (p &lt; 0.05). However, at 36 months, they were significantly lower compared with the 24-month time point (p &lt; 0.05), although they were still significantly better than the baseline scores. There were no intraoperative or postoperative complications. Altogether, 81% of patients were very satisfied and 19% were satisfied. Conclusions: Intra-articular MAT injection appears to be a safe and effective treatment for ankle OA. In particular, it offers athletes wishing a fast return to their sports a new, minimally invasive therapeutic option.