Intra-articular Tissue Research Articles

Surgical treatment of gunshot penetrated wounds of elbow joint

Treatment of patients with gunshot penetrated wounds of elbow joint — is complicate problem. In case of combination of soft tissues and bone structure defeat in this area, the risk of complications increase, it can lead to negative results.Objective: to optimize the basic elements of surgical treatment of patients with gunshot penetrated polistructural wounds of elbow joint in order to get appropriate anatomic and functional result.Methods: we analyzed results of treatment of 31 patients with polistructural wounds of elbow joint. Patients were treated with the system ASES. During the first week after trauma 24 patients were hospitalized (the 1st group), in 1–6 months — 7 patients (the 2nd g roup).Results: in 2 4,4 % have got poli­structural wounds of elbow joint, among them 67,7 % — had the III–IV degree. In the 1st group reconstructive surgeries were made in early terms (in average in (21,0 ± 3,2) days). At the same time we made surgeries on the reason of severe intraarticular fractures, damages and soft tissues defects. We have got excellent (3 patients), good (11) and satisfactory (10) results. In the 2nd group infection complications were revealed such as sinus tracts, rough scars because of unvascularised types of grafts application in the elbow region, restriction or absence of joint movements. Reconstructive-plastic surgeries were made in (73,0 ± 6,5) days after trauma. We have got good (1 patient), satisfactory (4) and unsatisfactory (2) results.Conclusions: the key moment in the treatment of patients with polistructural penetrated wounds of elbow joint of the III–IV degree is soft tissues restoration. Expediently is to combine the stages of reconstructive surgeries.

Celecoxib modulates release of different prostanoid subtypes by intra-articular tissues: towards celecoxib based intra-articular treatment for OA modulation?

Purpose: Celecoxib is currently used as an analgesic in knee osteoarthritis (OA) patients with proven efficacy. Besides solely being a drug with analgesic properties, evidence on the OA disease modifying properties of celecoxib is accumulating. On the other hand, other studies do not confirm OA disease modifying properties of celecoxib. However, these studies evaluated effects of orally administered celecoxib, which not surprisingly will result in lower local concentrations of celecoxib in the knee joint. In this study we hypothesized that celecoxib can be used as an OA-modulatory drug when injected intra-articularly in the knee joint. Since intra-articular administration of celecoxib means that the drug will interact with different intra-articular tissues such as the cartilage, synovium, Hoffa's Fat Pad (HFP) and meniscus we first evaluated the ability of celecoxib to modulate prostanoid release from these intra-articular tissues. Furthermore, we investigated whether prostanoid-reducing actions of celecoxib on different intra-articular tissues is accompanied by a modulation of the expression of aggrecanases, which are important proteolytic enzymes involved in OA pathophysiology. Finally, we sought to determine potential chondroprotective effects of a single intra-articular celecoxib bolus injection in the rat ACLT/pMMx model for OA. Methods: Upon medical ethical approval, cartilage, synovium, HFP and meniscus were obtained after total knee replacement from nine patients with knee OA. Explants were generated and cultured at a ratio of 100 mg tissue per mL culture medium for 24 hours in the presence or absence of 10 μM celecoxib. Presence of prostaglandin subtypes PGE2, PGF2α, PGD2 and (thromboxane B2) TXB2 was determined quantitatively by specific ELISAs. Gene expression levels of ADAMTS4 and ADAMTS5 was evaluated in the intra-articular tissues by means of RT-qPCR. For in vivo experiments OA was induced by performing anterior cruciate ligament transection (ACLT) + partial medial menisectomy (pMMx) in the right knees of 14 male Lewis rats (12-weeks old). Four weeks after OA induction, both the OA-induced and contralateral healthy knees were injected with 25 μL of 0.9 % NaCl or 9.7 nM celecoxib (92.25 ng celecoxib). Twelve weeks after injection, rats were sacrificed and OA severity was assesed by two blinded observers using the OARSI histopathology initiative for the rat (n = 7 per experimental group). Results: Average concentration ranges for the different prostanoids were 26216-385039 pg/mL for PGE2, 5496-69,574 pg/mL for PGF2α, 3848-43830 for PGD2 and 388-9102 pg/mL for TXB2. Celecoxib, at a dose of 10 μM, was able to significantly reduce PGE2, PGF2α, PGD2 and TXB2 release in cartilage, synovium, HFP and meniscus. Average fold reduction in prostanoid release for different intra-articular tissues tested ranged from 25- to 62-fold for PGE2, 9-fold to 20-fold for PGF2α, 8-fold to 23-fold for PGD2 and 2- to 5-fold for TXB2. Celecoxib significantly reduced gene expression levels of both ADAMTS4 and ADAMTS5 in cartilage, synovium, HFP and meniscus. OA levels based upon OARSI scoring were significantly reduced in OA-induced knees treated with bolus celecoxib (P = 0.009 by observer 1 and P = 0.032 by observer 2) compared to OA-induced knees injected with 0.9% NaCl (Fig. 1). Conclusions: Different intra-articular tissues secrete various prostanoid subtypes. These prostanoid subtypes are involved in catabolic processes and celecoxib is able to reduce the release of these prostanoids from cartilage, synovium, HFP and meniscus, but is also able to reduce the expression of aggrecanases which are important enzymes involved in cartilage matrix degradation. A single bolus injection with celecoxib protects against OA progression in vivo and therefore this study reinforces the potential of celecoxib as a potential OA disease-modifying drug when used intra-articularly.

Characteristics and usefulness of synovial fluid-derived stem cells compared with synovium-derived stem cells

Purpose: Recent progresses in the field of mesenchymal stem cells (MSCs) have brought us to apply them for clinical applications. In the autologous MSC transplantation therapy, the selection of donor tissues for the isolation of MSCs is quite important to obtain better clinical outcomes and to reduce patient's physical burden. We have started clinical trials to regenerate intra-articular cartilagenous tissues using MSCs derived from autologous synovial membrane (Syn-MSCs). In these trials, patients must suffer synovial biopsy to prepare autologous MSCs before transplantation. We considered that synovial fluid can be another good supplier for autologous MSCs for cartilage regeneration therapy since arthrocentesis is usually performed during the normal medical examinations in the consultation rooms. We have isolated MSCs from synovial fluid (SF-MSCs) and reported that these cells also have great potential to differentiate into chondrocytic lineage in vitro. However, it is still unrevealed whether SF-MSCs have comparable potential in cartilagenous tissue regeneration with those of Syn-MSCs. This study was aimed to compare proliferation and differentiation capacity of SF-MSCs and Syn-MSCs from the same patient. Methods: Synovial membrane (Syn) and synovial fluid (SF) were harvested from the same patient who underwent total knee arthroplasty at our hospital with approval and permission (n = 14, male = 1, female = 13, average 73.0 year-old). Isolated cells were maintained upto passage 10 to compare their proliferation ability. In vitro differentiation assay was performed using passage 3 cells. Flowcytometric analyses were performed to detect distinct surface antigen expression profiles between Syn- and SF-MSCs (FACS Verse, BD Bioscience). In order to compare the cartilage repair ability of SF-MSCs and Syn-MSCs, MSCs from the same patient were transplanted to osteochondral defects created in the trochlear groove of the femur of 10-week-old Lewis Rat, and histological assessments were performed at 4 weeks and 8 weeks. Results: Proliferation rate of SF-MSCs was much slower than that of Syn-MSC, however, they continued proliferating by 70 days in culture and needed for almost 3 weeks (passage 3) to become 1 × 107 cells, which is currently required for clinical application. In vitro differentiation assays indicated that there were subtle differences in chondrogenic-, osteogenic-, and adipogenic- differentiation ability between SF- and Syn-MSCs. Flowcytometric analyses indicated that the expression of MSC-related surface antigens (CD73, CD90, and CD105) was comparable between the groups. In contrast, expressions of certain sets of cell adhesion molecules (CD51/61) and growth factor receptors (CD140a) tended to decrease in SF-MSCs. In in vivo study, there was no significant difference in ICRS score (respectively SF 3.4, Syn 3.4 at 4weeks (P = 1.0), SF 6.8, Syn 5.4 at 8weeks (P = 0.798). Both MSCs groups showed good cartilage repair and there was no significant difference in histological grading scale modified from that of Pineda et al, and Wakitani et al(respectively SF 9.8, Syn 10.2 at 4weeks (P = 0.854), SF 7.4, Syn 7.4 at 8weeks (P = 0.446)). Conclusions: In this study, we showed that SF-MSCs could be the replacement of Syn-MSCs for cartilagenous tissue regeneration therapy. Surface antigen expression analyses and in vitro differentiation assays indicated that phenotypes of SF-MSCs are quite similar with those of Syn-MSCs and have characteristics of MSCs. However, proliferation rate was lower in SF-MSCs if compared to that of Syn-MSCs (n = 12). We consider that the down-regulation of cell adhesion molecules (CD51/61; Integrin alpha v/beta 3) and a growth factor receptor (CD140a/PDGFR alpha) might be possible reasons for that (n = 2). In spite of the less proliferation ability in vitro, cartilagenous tissue regeneration ability was quite comparable between SF-MSCs and Syn-MSCs. Since arthrocentesis is less invasive than synovial biopsy, it is much advantageous to reduce patient's physical burden in transplantation therapy.

E26 UK Rheumatologist in Training Network: results from first national multi-site audit: documentation and consent for intra-articular and soft tissue injection (IAI)

e26 UK Rheumatologist in Training Network: results from first national multi-site audit: documentation and consent for intra-articular and soft tissue injection (IAI)

The Unexplored Role of Intra-articular Adipose Tissue in the Homeostasis and Pathology of Articular Joints.

Intra-articular adipose tissue deposits known as articular fat pads (AFPs) are described to exist within synovial joints. Their assumed role in normal joint biomechanics is increasingly objectivized by means of advanced methods of functional imaging. AFPs possess structural similarity with body subcutaneous white adipose tissue (WAT), however, seems to be regulated by independent metabolic loops. AFP dimension are conserved during extreme WAT states: obesity, metabolic syndrome, lipodystrophy, and cachexia. Hoffa fat pad (HFP) in the knee is increasingly recognized as a major player in pathological joint states such as anterior knee pain and osteoarthritis. HFP contains numerous population of mesenchymal and endothelial progenitors; however, the possible role of mature adipocytes in the maintenance of stem cell niche is unknown. We propose that AFP is an active component of the joint organ with multifunctional roles in the maintenance of joint homeostasis. Endowed with a rich network of sensitive nervous fibbers, AFPs may act as a proprioceptive organ. Adipokines and growth factors released by AFP-resident mature adipocytes could participate in the maintenance of progenitor stem cell niche as well as in local immune regulation. AFP metabolism may be locally controlled, correlated with but independent of WAT homeostasis. The identification of AFP role in normal joint turnover and its possible implication in pathological states could deliver diagnostic and therapeutic targets. Drug and/or cell therapies that restore AFP structure and function could become the next step in the design of disease modifying therapies for disabling joint conditions such as osteoarthritis and inflammatory arthritis.

Celecoxib-mediated reduction of prostanoid release in Hoffa's fat pad from donors with cartilage pathology results in an attenuated inflammatory phenotype

The Hoffa's fat pad (HFP) is an intra-articular adipose tissue which is situated under and behind the patella. It contains immune cells next to adipocytes and secretes inflammatory factors during osteoarthritis (OA). In this study, we compared the release profile of prostanoids, which are involved in inflammation, of HFP from OA patients vs patients with a focal cartilage defect (CD) without evidence for OA on MRI and investigated the prostanoid modulatory anti-inflammatory action of celecoxib on HFP. Prostanoid release was analyzed in conditioned medium of HFP explant cultures from 17 osteoarthritic patients and 12 CD patients, in the presence or absence of celecoxib. Furthermore, gene expression of COX enzymes and expression of genes indicative of a pro-inflammatory or anti-inflammatory phenotype of HFP was analyzed. Prostanoid release by HFP from knee OA patients clustered in two subgroups with high and low prostanoid producers. HFP from high prostanoid producers released higher amounts of PGE2, PGF2α and PGD2 compared to HFP from CD patients. PGE2 release by OA HFP was positively associated with expression of genes known to be expressed by M1 macrophages, indicating a role for macrophages. Celecoxib modulated prostanoid release by HFP, and also modulated the inflammation ratio towards a more favorable anti-inflammatory M2 phenotype, most effectively in patients with higher prostanoid release profiles. In knee OA patients with inflamed HFP's, celecoxib may exert positive effects in the knee joint via decreasing the release of prostanoids produced by the HFP and by favorably modulating the anti-inflammatory marker expression in HFP.

Frequency distribution of osteochondral fragmentation of the dorsoproximal articular surface of the proximal phalanx in racing Thoroughbreds in the UK.

Osteochondral fragmentation of the dorsoproximal margin of the proximal phalanx is commonly recognised in racing Thoroughbreds. Frequency distribution has been documented in racing Thoroughbreds and Quarter Horses in the USA and in European Warmbloods but no data have been published from the UK. Concurrent intra-articular soft tissue lesions and radiographic accuracy of fragment distribution in racing Thoroughbreds have not previously been reported. To document frequency distribution of dorsoproximal fragmentation of the proximal phalanx in a UK population of racing Thoroughbreds and to compare this with published data. To document concurrent intra-articular lesions identified arthroscopically and radiographic accuracy of fragment distribution. A retrospective single centre-based, observational study. Surgical reports and radiographs of all racing Thoroughbreds that underwent arthroscopic surgery for removal of fragmentation from the dorsoproximal margin of the proximal phalanx at Newmarket Equine Hospital between 2011 and 2015 were reviewed. Two hundred and forty-two (85.8%) horses were in or being prepared for flat racing. Osteochondral fragmentation of the dorsoproximal aspect of the proximal phalanx was present in 428 fetlock joints of 282 horses, consisting of 194 (45.3%) left and 188 (43.9%) right metacarpophalangeal joints, and 20 (4.7%) left and 26 (6.1%) right metatarsophalangeal joints. Fragmentation was located dorsomedially in 316 (73.8%), dorsolaterally in 32 (7.5%) and biaxially in 80 (18.7%) joints. Concurrent soft tissue lesions were identified in 168 (39.3%) joints. Radiographic evidence of fragmentation was visible in 320 joints (74.8%). Limited numbers preclude conclusions with respect to yearlings and horses in jump race training. Dorsoproximal fragmentation of the proximal phalanx occurred most frequently medially and in the forelimbs. Sidedness was not demonstrated. Although similar to previously reported data, variance in limb distribution is evident. Further research is required to determine whether concurrent intra-articular soft tissue lesions are aetiopathogenic or an additional result of the pathological changes leading to fragmentation. Fragmentation site was not always accurately identified radiographically. The Summary is available in Spanish - see Supporting information.

Advanced Hemophilic Arthropathy: Sensitivity of Soft Tissue Discrimination With Musculoskeletal Ultrasound.

Point-of-care musculoskeletal ultrasound (US) is increasingly used by hemophilia providers to guide management; however, pathologic tissue differentiation with US is uncertain. We sought to determine the extent to which point-of-care musculoskeletal US can identify and discriminate pathologic soft tissue changes in hemophilic arthropathy. Thirty-six adult patients with hemophilia A/B were prospectively enrolled. Point-of-care musculoskeletal US examinations were performed on arthropathic joints (16 knees, 10 ankles, and 10 elbows) using standard views by a musculoskeletal US-trained and certified hematologist, who recorded abnormal intra-articular soft tissue accumulation. Within 3 days, magnetic resonance imaging was performed using conventional and multiecho ultrashort echo time sequences. Soft tissue identification (synovial proliferation with or without hemosiderin, fat, and/or blood products) was performed by a musculoskeletal radiologist. Findings obtained with both imaging modalities were compared and correlated in a blinded fashion. There was perfect agreement between the modalities on the presence of abnormal soft tissue (34 of 36 cases). However, musculoskeletal US was unable to discriminate between coagulated blood, synovium, intrasynovial or extrasynovial fat tissue, or hemosiderin deposits because of wide variations in echogenicity. Musculoskeletal US is valuable for point-of-care imaging to determine the presence of soft tissue accumulation in discrete areas. However, because of limitations of musculoskeletal US in discriminating the nature of pathologic soft tissues and detecting hemosiderin, magnetic resonance imaging will be required if such discrimination is clinically important.

Cost Calculation Methodology Exacerbates Site-of-Service Differentials by 10- to 18-Fold for Soft Tissue and Joint Injections in Hospital Outpatient Departments

In recent years, physicians and facilities have faced a multitude of reforms, regulations, and payment models to reduce health care costs, and to improve access and quality. Despite these measures, total health care cost increased to $3.3 trillion in 2016, up 4.3% from 2015. An aging population and an increase in cost are two of the factors that account for most of the increase in costs. Price intensity from physicians and facilities are influenced by Medicare rate-setting methodology with site-of-service differentials. Site-of-service differentials for payments are increasingly being recognized as a topic that requires discussion. Intraarticular and soft tissue injections are performed in physician offices (90%), ambulatory surgery centers (ASCs) (1%), and hospital outpatient departments (HOPDs) (9%), however, the payment rates differ 10- to 18-fold among these settings with 63% of total payments to HOPDs, 2% to ASCs, and 37% to offices. In this manuscript, we describe significant payment differentials, based on cost calculation methodology that indicate a potential substantial savings of more than $125 million per year if HOPDs are reimbursed at the same rate as ASCS, utilizing any of the formulas, even if the current ASC rate is doubled. This effort would also save significantly when it comes to copayments, which are 27% by patients, instead of the 20% in offices and ASCs. The addition of Medicare Advantage recipients, which constitutes approximately 30% of the overall Medicare population will increase these estimations by 30%. In conclusion, utilizing accurate payment rate calculations for intraarticular and soft tissue injections will result in substantial changes in the payment rates. In fact, just the differences in the copay itself would make the copay $66.06 (which is 27% of $244.68). This rate is 3- to 5-fold higher than the current Medicare rates for office payment or even 2-fold higher than the ASC payment. Key words: Medicare, physician payment schedules, HOPD and ASC payment schedule, site-of-service differentials, soft tissue injections, intraarticular injections

Arthroscopic Lysis of Adhesions for Treatment of Post-traumatic Arthrofibrosis of the Knee Joint

Normal knee range of motion varies slightly between individuals and measures approximately 0° to −5° of extension to 140° of flexion. A full arc of motion is required for normal gait and knee function. Loss of normal joint range of motion may occur after a traumatic knee injury and may contribute to increased pain, lower functional outcome scores, and decreased patient satisfaction. Although multiple factors may contribute to the development of motion loss, the occurrence of intra-articular scar tissue adhesions, or post-traumatic arthrofibrosis, may limit the patient's knee motion in the early postoperative period. Once motion loss has been identified, it can be a challenging complication to manage. Arthroscopic lysis of adhesions with manipulation under anesthesia is a reliable surgical technique that can improve range of motion in patients with knee stiffness due to post-traumatic arthrofibrosis.

Randomized Prospective Analysis of Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: 1 Year Follow-up

Objectives:Biceps pathology typically includes pain in the anterior shoulder that is reproduced with provocative maneuvers. However, optimal treatment of patient with this diagnosis is not clear and can include tenotomy or various forms of tenodesis. As tenotomy can lead to cosmetic deformity and anterior humeral discomfort from spasms, many surgeons perform tenodesis. Technique for tenodesis includes intra-articular soft tissue fixation or osseous fixation, suprapectoral osseous fixation, and subpectoral osseous fixation. Focusing on the later two, it is unclear if there is a clinical or surgical benefit of performing an open subpectoral biceps tenodesis (OBT) versus arthroscopic suprapectoral biceps tenodesis (ABT). We therefore designed this randomized clinical trial to assess these two techniques.Methods:Patients diagnosed with biceps tendinopathy meeting the inclusion and exclusion criteria were randomized into the arthroscopic and mini-open biceps tenodesis groups. Prior to surgery, patients were asked a series of questions regarding their anterior shoulder pain and underwent a subsequent shoulder exam. Follow-up was d at 3 months, 6 months, and 1 year time points, during which the shoulder exam and patient questionnaires were also d.Results:A total of 38 patients were enrolled with a mean age of 43.5 ± 10.5 years and a mean BMI of 28.3 ± 5.4. All patients had arthroscopic evidence of biceps pathology and underwent either an ABT (18) or an OBT (20). All patients underwent a concomitant arthroscopic subacromial decompression. The surgical time for the ABT group, 17.2 ± 3.7 minutes, was significantly greater than the OBT group, 11.7 ± 6.1 (p<0.01). One patient was converted from the ABT group to the OBT group due to sheering of a severely attenuated tendon preventing an ABT. One patient in the OBT group required a revision tenodesis. No significant difference (p > 0.05) was found in strength or anterior shoulder pain at 3 months, 6 months, and 1 year. Additionally, no significant difference (p > 0.05) was found in clinical outcome scores (ASES, Constant subjective, WORC, KJOC) between the two groups.Conclusion:This randomized clinical trial suggests there is no clinical difference between the two techniques. Additionally, while the arthroscopic procedure requires more surgical time, the revision rates are not different. Besides the cosmetic concern for an additional scar, we recommend decisions to be made based on surgeon preference and experience.

Intra-articular angiofibroma of soft tissue of the knee: A case report.

Angiofibroma of soft tissue (AFST) is an extremely rare soft tissue neoplasm that typically presents as a slow-growing, painless mass in the extremities. The present study reports an unusual case of an intra-articular AFST occurring in the left knee of a 23-year-old female. Physical examination revealed a 3-cm, relatively mobile, elastic-hard, non-tender mass. Magnetic resonance imaging detected an intra-articular soft tissue mass with iso-signal intensity relative to skeletal muscle on T1-weighted sequences and heterogeneous high signal intensity on T2-weighted sequences. Contrast-enhanced fat-suppressed T1-weighted sequences demonstrated strong peripheral enhancement of the mass. An arthroscopic excision of the mass was performed. Histologically, the tumor was composed of spindle- or oval-shaped cells in a fibromyxoid stroma with a prominent vascular pattern. Immunohistochemically, the tumor cells were diffusely positive for vimentin and CD163 and focally positive for CD68, desmin and estrogen receptor. Based on these findings, the tumor was diagnosed as an AFST. The patient had no evidence of local recurrence within 9 months of follow-up. To the best of our knowledge, this is the first case of intra-articular AFST managed successfully with arthroscopic excision.

Intraoperative arthroscopy of the TMJ during surgical management of condylar head fractures: A preliminary report

PurposeThe purpose of this preliminary study was to evaluate intraarticular soft tissues of the temporomandibular joint (TMJ) using intraoperative arthroscopy during open reduction and internal fixation (ORIF) of condylar head fractures (CHF). Materials and methods26 patients (29 joints) were diagnosed in period of 5 years (2011–2015) with CHF, 5 patients had concomitant mandibular fracture. Fractures were diagnosed on basis of conventional orthopantomogram (OPG) and computed tomography (CT). ResultsIntraoperative arthroscopy revealed hyperemia and hypervascularity in all 29 joints, anterior disc dislocation in 26 joints, cartilage erosion in 21 joints and hemorrhagic clots were present in 10 joints. Major hemarthrosis or tear of the posterior band, as often described in MRI, could not be shown in our patients. Data from the study further the understanding of intraarticular pathology of the TMJ after acute trauma in a group with CHF. ConclusionIntraoperative arthroscopy is useful for direct evaluation and accurate diagnosis of the extent of soft tissue damage to TMJ in CHF. Larger and more long-term studies including comparison to MRI findings should be helpful to refine the treatment and postoperative management of patients after CHF.

Variance in infra-patellar fat pad volume: Does the body mass index matter?—Data from osteoarthritis initiative participants without symptoms or signs of knee disease

The infra-patellar fat pad (IPFP) has been proposed to represent an endocrine link between obesity and knee osteoarthritis (OA). The purpose of the current study has been to explore the extent to which IPFP volume is related to body mass index (BMI).A total of 152 participants (age 56±7 years) without knee OA were studied. These consisted of 19 men and 19 women of normal weight (BMI 18.5–25), 19/19 pre-obese (BMI 25–30), 19/19 obese class I (BMI 30–35) and 19/19 obese class II (BMI 35–40), who were matched 1:1 for age and height. The IPFP volume was manually segmented from sagittal fat-suppressed magnetic resonance images (MRI). An ANOVA of repeated measures was used to assess whether IPFP volume was related to BMI.The IPFP volume differed significantly between the BMI strata (ANOVA: p=0.001): It was 27.1±6.7cm3 (mean±SD) in normal weight, 29.3±6.9cm3 in pre-obese, 31.0±6.9cm3 in obese class I, and 30.4±6.6cm3 in obese class II participants; the difference in IPFP volume (and body weight) relative to normal weight subjects was 10% (18%) in pre-obese, 17% (39%) in obese class I, and 15% (59%) in obese class II participants. Stratification by sex showed similar results.In conclusion, IPFP volume is shown to be related to BMI, albeit the relative increase (compared with normal weight) does not appear to be proportional to that in body weight. Nonetheless, these findings support the hypothesis that the IPFP may represent a potential endocrine link between obesity and OA, with more intra-articular adipose tissue potentially releasing greater amounts of adipokines.

Pseudomonas Infection of the Temporomandibular Joint (TMJ) Health and Public Health Issues

Abstract The authors describe a case of a rare infectious disease of intra-articular tissues of the temporomandibular joint caused mainly by Pseudomonas aeruginosa. In scientific literature, under the heading invasive (malignant) external otitis, we can find cases of an infectious disease of the external acoustic meatus caused by a microbial agent of Pseudomonas aeruginosa which can subsequently penetrate into structures. However, a primary affliction of the abovementioned structures has not been described. Localisation and severity of the infection requires long-term and massive treatment with antibiotics.

Knee stiffness and viscosity: New implementation and perspectives in prosthesis development.

The pendulum test is a method applied to measure passive resistance of the knee. A new and simple pendulum test with instrumentation based on infrared camera was used to evaluate knee stiffness and viscosity on a female human cadaver. The stiffness and viscosity were calculated based on the kinetic data. During the measurements, the periarticular and intraarticular soft tissue of the knee was gradually removed to determine the stiffness and viscosity as a function of the tissue removal rate. The measurements showed that the removal of tissue around the joint reduces the damping of leg oscillation, and therefore decreases the stiffness and viscosity. The contribution to knee joint damping was 10% for the skin, 20% for ligaments, and 40% for muscles and tendons. Tissue removal has a very large impact on the knee stiffness and viscosity.

Osteoarthritis: Inflammation and fibrosis in adipose tissue of osteoarthritic joints.

The infrapatellar fat pad and other adipose tissues in close proximity to the joint have been linked with osteoarthritis (OA), but the nature of this relationship is unclear. Two new studies elucidate the features of intra-articular adipose tissues in OA and raise important questions for future investigations.

Tenosynovial Giant Cell Tumor of the thigh

Tenosynovial giant cell tumors (TGCT) are a group of generally benign intra-articular and soft tissue tumors with common histological features. TGCT is also known as pigmented villonodular synovitis. There are localized and diffuse forms. Localized types include giant cell tumors of tendon sheath and localized pigmented villonodular synovitis, whereas diffuse types encompass conventional pigmented villonodular synovitis and diffuse type giant cell tumor. Localized tumors are generally indolent, whereas diffuse tumors are locally aggressive.&#x0D; In this article, we report the case of a diffuse-type extra-articular TGCT found in the left thigh of a 73-year-old woman who presented with a painless but gradually progressive swelling in the left thigh since eighteen months. On examination, there was a soft cystic swelling measuring 22 cm. The swelling was fixed to the underlying soft tissues. She had a Computed Tomography scan of the left thigh showing a mass of fluid density, well encapsulated between the muscles of the thigh, measuring 20x10 cm of major axes, compressing the femoral vessels without invading them. The patient had a complete marginal resection of the tumor. The immune-histopathological findings were consistent with those of a diffuse type of Giant Cell Tenosynovial Tumor. At 18 months follow-up, the patient is asymptomatic with no evidence of disease recurrence.&#x0D; The extra-articular diffuse type TGCT is more aggressive than the localized type. Although these tumors are benign in the majority of cases, malignant transformation has been reported. Therefore, close follow-up is recommended after tumor excision.

Knee and hip intra-articular adipose tissues (IAATs) compared with autologous subcutaneous adipose tissue: a specific phenotype for a central player in osteoarthritis

ObjectivesCompared with subcutaneous adipose tissue (SCAT), infrapatellar fat pad (IFP), the main knee intra-articular adipose tissue (IAAT), has an inflammatory phenotype in patients with osteoarthritis (OA). We phenotyped suprapatellar fat...

Impact of Diet and/or Exercise Intervention on Infrapatellar Fat Pad Morphology: Secondary Analysis from the Intensive Diet and Exercise for Arthritis (IDEA) Trial

Objectives: The infrapatellar fat pad (IPFP) represents intra-articular adipose tissue that may contribute to intra-articular inflammation and pain by secretion of proinflammatory cytokines. Here we examined the impact of weight loss by diet and/or exercise interventions on the IPFP volume. Methods: Intensive Diet and Exercise for Arthritis (IDEA) was a single-blinded, single-center, 18-month, prospective, randomized controlled trial that enrolled 454 overweight and obese older adults with knee pain and radiographic osteoarthritis. Participants were randomized to 1 of 3 groups: exercise-only control (E), diet-induced weight loss (D), and diet-induced weight loss + exercise (D+E). In a subsample (n = 106; E: n = 36, D: n = 35, and D+E: n = 35), magnetic resonance images were acquired at baseline and at the 18-month follow-up, from which we analyzed IPFP volume, surface areas, and thickness in this secondary analysis. Results: The average weight loss amounted to 1.0% in the E group, 10.5% in the D group, and 13.0% in the D+E group. A significant (p < 0.01) reduction in IPFP volume was observed in the E (2.1%), D (4.0%), and D+E (5.2%) groups. The IPFP volume loss in the D+E group was significantly greater than that in the E group (p < 0.05) when not adjusting for parallel comparisons. Across intervention groups, there were significant correlations between IPFP volume change, individual weight loss (r = 0.40), and change in total body fat mass (dual-energy X-ray absorptiometry; r = 0.44, n = 88) and in subcutaneous thigh fat area (computed tomography; r = 0.32, n = 82). Conclusions: As a potential link between obesity and knee osteoarthritis, the IPFP was sensitive to intervention by diet and/or exercise, and its reduction was correlated with changes in weight and body fat.