Compartment Of Joint Research Articles

Research progress in Oxford unicompartmental knee arthroplasty for partial thickness cartilage loss in medial compartment of knee joint

To summarize the research progress of Oxford unicompartmental knee arthroplasty (UKA) in treating partial thickness cartilage loss (PTCL) in the medial compartment of the knee joint, aiming to further clarify the indications and optimize the effectiveness of Oxford UKA. A comprehensive review of recent domestic and international literature on Oxford UKA for PTCL in the medial compartment of the knee joint was conducted to summarize its application and research advancements. Based on current researches, the main indication for Oxford UKA is full thinckness cartilage loss in the medial compartment of the knee joint. Although it has shown certain effectiveness in treating PTCL in the medial compartment of the knee joint, there are also reports of opposite conclusions. Therefore, there is still controversy over whether Oxford UKA can be chosen for PTCL, and the large-sample and multi-center studies are needed to further clarify the controversy. Studies indicate that accurate preoperative assessment of cartilage damage severity is crucial for selecting appropriate candidates for Oxford UKA to optimize postoperative effectiveness. Oxford UKA may represent an effective treatment for patients with PTCL in the medial compartment of the knee joint. However, strict patient selection and precise preoperative evaluation are essential to ensure surgical success and long-term effectiveness.

Effect of anterior cruciate ligament integrity on the short- and mid-term effectiveness of mobile-bearing medial unicompartmental knee arthroplasty

To investigate the effect of anterior cruciate ligament (ACL) integrity on the short- and mid-term effectiveness of mobile-bearing medial unicompartmental knee arthroplasty (UKA). The clinical data of 128 patients with anteromedial osteoarthritis who underwent mobile-bearing medial UKA between June 2019 and June 2021 was retrospectively analyzed. According to the integrity of ACL structure under direct vision during operation, the patients were divided into normal group (30 cases), synovial defect group (53 cases), and longitudinal split group (45 cases). There was no significant difference in gender, age, body mass index, preoperative knee range of motion (ROM), hip-knee-ankle angle (HKA), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and other baseline data among the 3 groups ( P>0.05). The knee ROM, KSS score (including clinical and functional scores), WOMAC score (including pain, stiffness, and function scores) before operation and at last follow-up, the Lysholm score, International Knee Documentation Committee (IKDC) score, and Forgetting Joint Score (FJS-12) at last follow-up were recorded and compared among the 3 groups. Imaging examination was performed to evaluate the wear of cartilage in the lateral tibiofemoral compartment and patellofemoral compartment of the knee joint. HKA and posterior tibial slope (PTS) were measured at last follow-up. All the patients of 3 groups were followed up 22-56 months (mean, 40.4 months). There was no significant difference in follow-up time among the 3 groups ( P>0.05). At last follow-up, imaging examination showed no obvious cartilage wear progression of the lateral tibiofemoral compartment and patellofemoral compartment, and no adverse events such as aseptic loosening of the prosthesis, dislocation of the removable pad, or infection occurred during the follow-up. At last follow-up, knee ROM, HKA, KSS scores, and WOMAC scores of the 3 groups significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the changes of the above indicators before and after operation, and also the Lysholm score, IKDC score, FJS-12 score, and PTS among the 3 groups ( P>0.05). The integrity of ACL has no significant effect on the short- and mid-term effectiveness of mobile-bearing medial UKA.

Anteromedial knee osteoarthritis (AMOA) evaluated with magnetic resonance imaging (MRI): a cohort study of 100 patients.

Magnetic resonance imaging (MRI) scans are increasingly used for knee osteoarthritis evaluation and preoperative planning before unicompartmental knee arthroplasty (UKA), and often patients already have MRI scans before their initial surgeon consultation. This highlights the need for surgeons to understand anteromedial osteoarthritis (AMOA) patterns on MRI. Hence, we aim to describe MRI findings in patients with AMOA meeting current indications for medial UKA. We analysed MRI scans from 100 knees evaluated for UKA between 2006 and 2013. Inclusion criteria comprised full-thickness medial compartment loss and intact lateral compartment joint space on preoperative radiographs. Assessment included cartilage lesions, osteophytes, meniscal damage, and anterior-cruciate ligament (ACL) status on tibial and femoral surfaces. Final decision to proceed with UKA relied on intraoperative findings, independent of MRI. Complete anteromedial tibial and femoral cartilage loss preserved posterior cartilage rims was evident in all cases. Cartilage thinning occurred in the lateral compartment in 34% of cases. While 62% displayed lateral osteophytes, only 6 exhibited small areas of full-thickness cartilage loss. ACL abnormalities varied: 27% normal, 3% ruptured, and 70% had intrasubstance high signal. Larger osteophytes in the medial (p = 0.012) and lateral (p = 0.002) intercondylar notch correlated significantly with ACL damage. All underwent medial UKA, with no evidence of areas with full lateral compartment cartilage loss intraoperatively. The MRI findings confirmed the radiographic diagnosis of bone-on-bone medial disease but highlights a range of findings in the ACL, lateral compartment, and patellofemoral joint compartment for patients who met the current x-ray and intraoperative indication for UKA. Further research is required to understand if these MRI changes will affect long-term outcomes.

Decision-making in unicompartmental knee arthroplasty using radiological parameters in South Asian populations

Background: Many patients who visit orthopedic surgeons mainly complained of knee pain, which is often diagnosed as osteoarthritis affecting the medial compartment, whereas the lateral compartment and patello-femoral joint remain relatively unaffected. AIM: This study aimed to establish criteria for patient selection and validate an evidence-based approach for selecting candidates for unicompartmental knee arthroplasty (UKA). Key considerations in patient selection for UKA include identifying the presence of bone-on-bone osteoarthritis in the medial compartment, ensuring a functionally normal anterior cruciate ligament, maintaining full-thickness cartilage in the lateral compartment, verifying a functionally normal medial collateral ligament, and confirming the absence of severe damage lateral to the patello-femoral joint. MATERIALS AND METHODS: From a consecutive cohort of 390 patients with medial knee pain, preoperative radiographs of bilateral knee including anteroposterior/lateral/Rosenberg/20° valgus stress views were collected, and results were tabulated. Patients were categorized into appropriate groups. The suitability for UKA was determined based on the Oxford radiological decision aid, history, examination, and radiographic assessment including stress radiographs. RESULTS: The Oxford radiological decision aid demonstrated 92% sensitivity and 88% specificity. According to the radiographic assessment, 49% of the knees were considered suitable for Oxford UKA (OUKA), whereas 51% were deemed unsuitable. Among the 51 knees identified as unsuitable for OUKA, 40% did not meet one radiographic criterion, 38% did not meet two criteria, 22% did not meet three criteria, and 1% did not meet four criteria. CONCLUSION: The Oxford radiographic decision aid safely and reliably identifies the appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of this radiological decision aid should improve the results of UKA.

Ultrasound-Guided Single Puncture Technique to Simultaneously Reach the Upper and Lower Temporomandibular Joint Compartments for Arthrocentesis or Injections Purposes: A Technical Note

TMJ arthrocentesis is a widely described and effective technique that promotes lysis and lavage of TMJ compartments, improving pain and mandibular range of motion. Mostly, this technique has been used to reach the upper TMJ compartment, besides effusion may be present also in lower compartment, that, in the absence of disc perforation, may also need to be assessed. Here, we propose an adaptation of arthrocentesis technique aiming to access both upper and lower compartments of the temporomandibular joint with a single needle puncture and guided by ultrasound real-time images. The technique was initially established in fresh cadavers and later replicated in 2 patients. Technique modification proved to be efficient and reproducible, reducing the number of perforations and, consequently, possible adverse events. The proposed technique can be applied to arthrocentesis and/or intra-articular injections through the combination of two previously validated techniques, to improve its safety and efficacy.

Biomechanics of Bruxism Potentially Determine the Sites of Severe TMJ Osteoarthritis

The objective of this study was to assess the osteoarthritis (OA) disease severity in 47 temporomandibular joints (TMJs) using a validated scale for gross signs of OA while noting the specific sites for profound disease on the donor condyle and fossa. A disease severity score of Grade 0–4, representing absent to severe disease, was awarded to each specimen’s condyle and fossa by two blinded investigators who have demonstrated interrater reliability. The mandibular fossa was more pathological compared to the mandibular condyle (* p = 0.001). When the deepest focal lesions were qualitatively assessed, it was demonstrated that the mandibular fossa was more severely degenerated than the articular eminence in 58% of donors. In this subpopulation, 74% of the severe mandibular fossa pathology was seen on the deep articular surface. When the articular eminence was the most severely degenerated region of the fossa, it was equivalently likely to see severe focal lesions on the lateral eminence (35%) or equally distributed across the entire eminence (35%). The greatest disease severity was discovered in sites of overloading, which may be associated with paranormal mandibular movements and potentially bruxism. Patients with bruxism produce significant translational movements (grinding) in the upper joint compartment and heavy vertical loading (clenching). Theoretically, this amplifies pressure and inflammation on the lateral articular surfaces and in the deep fossa.

Clearing-enabled light sheet microscopy as a novel method for three-dimensional mapping of the sensory innervation of the mouse knee.

A major barrier that hampers our understanding of the precise anatomic distribution of pain sensing nerves in and around the joint is the limited view obtained from traditional two dimensional (D) histological approaches. Therefore, our objective was to develop a workflow that allows examination of the innervation of the intact mouse knee joint in 3D by employing clearing-enabled light sheet microscopy. We first surveyed existing clearing protocols (SUMIC, PEGASOS, and DISCO) to determine their ability to clear the whole mouse knee joint, and discovered that a DISCO protocol provided the most optimal transparency for light sheet microscopy imaging. We then modified the DISCO protocol to enhance binding and penetration of antibodies used for labeling nerves. Using the pan-neuronal PGP9.5 antibody, our protocol allowed 3D visualization of innervation in and around the mouse knee joint. We then implemented the workflow in mice intra-articularly injected with nerve growth factor (NGF) to determine whether changes in the nerve density can be observed. Both 3D and 2D analytical approaches of the light sheet microscopy images demonstrated quantifiable changes in midjoint nerve density following 4 weeks of NGF injection in the medial but not in the lateral joint compartment. We provide, for the first time, a comprehensive workflow that allows detailed and quantifiable examination of mouse knee joint innervation in 3D.

STUDY ON THE ULTRASONOGRAPHIC AND RADIOGRAPHIC FINDINGS OF KNEE OSTEOARTHRITIS PATIENTS AT CAN THO UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL IN 2022-2023

Background: Knee osteoarthritis is a common disease in the group of bone and joint diseases. The incidence of the disease increases with age, commonly occurs in elderly patients or can also occur in young people. Diagnosis of knee osteoarthritis is mainly based on clinical symptoms combined with radiographs. Currently, ultrasound can be used to examine the damage that occurs in early-stage knee osteoarthritis. In addition, it has the ability to evaluate joint cartilage thickness, detect synovitis, joint effusion,... and abnormal features in other joint diseases of the knee, especially when there are no clinical manifestations or no damage on X-ray images. Objectives: To describe and compare ultrasonographic and radiographic findings in osteoarthritis-affected knee joints. Materials and Methods: A cross-sectional study was conducted on 50 patients and 62 knee joints diagnosed with osteoarthritis according to the American College of Rheumatology (ACR) 1991 criteria. General characteristics, radiographic findings, and ultrasonographic findings in osteoarthritis-affected knee joints of participants were collected at Can Tho University of Medicine and Pharmacy from May 2022 to April 2023. Results: Radiographs showed the most common finding was grade 1 osteophytes. The most common feature found on ultrasound was also grade 1 osteophytes. Medial condyle osteophytes and lateral condyle osteophytes: Grade 1 was the most common finding, with 53.2% and 58.1%. Medial tibial plateau osteophytes and lateral tibial plateau osteophytes: Grade 1 was the most common finding, with 54.8% and 50.0%. Medial compartment joint space narrowing: grade 1 was the most common (41.9%). Lateral compartment joint space narrowing was not found (grade 0) in 64.5%. In addition, ultrasound detected synovitis in patients with knee osteoarthritis, accounting for a fairly high rate of 87.1%. There was moderate agreement between osteophyte and joint space narrowing grading on ultrasound and radiographs. Conclusion: There was moderate agreement between osteophyte and joint space narrowing grading on ultrasound and radiographs. Ultrasound can also detect and evaluate synovitis that may not be seen on radiographs. We recommend using the ultrasonography atlas created for knee osteophyte detection in routine knee ultrasound.

Development and Validation of an Examination Protocol for Arthroscopic Evaluation of the Temporomandibular Joint in Dogs.

Due to the previously limited intra-articular diagnostic possibilities of the canine temporomandibular joint, an examination protocol for the canine temporomandibular joint (TMJ) was developed and tested in this study using a needle arthroscope. In total, the discotemporal (DTJ) and discomandibular (DMJ) joint compartments of 32 animals (64 TMJs) were examined arthroscopically. During the examinations, 15 anatomical landmarks per joint side were evaluated in regard to their visibility and accessibility. All arthroscopies were performed by the same examiner and the same assistant to ensure standard methods were applied. The examination procedure which was developed here proved to be a reliable tool for examining this joint. The 15 anatomical landmarks that were to be examined could be reliably visualised and assessed in all TMJs with a certainty of 86% to 100% by both observers. This tool provides clinicians with a reliable examination aid for everyday practice and ensures the comparability of results. In the future, this could provide an opportunity to better diagnose and treat TMJ pathologies.

Dual-energy X-ray absorptiometry derived knee shape may provide a useful imaging biomarker for predicting total knee replacement: Findings from a study of 37,843 people in UK Biobank

ObjectiveWe aimed to create an imaging biomarker for knee shape using knee dual-energy x-ray absorptiometry (DXA) scans and investigate its potential association with subsequent total knee replacement (TKR), independently of radiographic features of knee osteoarthritis and established risk factors. MethodsUsing a 129-point statistical shape model, knee shape (expressed as a B-score) and minimum joint space width (mJSW) of the medial joint compartment (binarized as above or below the first quartile) were derived. Osteophytes were manually graded in a subset of images and an overall score was assigned. Cox proportional hazards models were used to examine the associations of B-score, mJSW and osteophyte score with TKR risk, adjusting for age, sex, height and weight. ResultsThe analysis included 37,843 individuals (mean age 63.7 years). In adjusted models, B-score was associated with TKR: each unit increase in B-score, reflecting one standard deviation from the mean healthy shape, corresponded to a hazard ratio (HR) of 2.25 (2.08, 2.43), while a lower mJSW had a HR of 2.28 (1.88, 2.77). Among the 6719 images scored for osteophytes, mJSW was replaced by osteophyte score in the most strongly predictive model for TKR. In ROC analyses, a model combining B-score, osteophyte score, and demographics outperformed a model including demographics alone (AUC ​= ​0.87 vs 0.73). ConclusionsUsing statistical shape modelling, we derived a DXA-based imaging biomarker for knee shape that was associated with kOA progression. When combined with osteophytes and demographic data, this biomarker may help identify individuals at high risk of TKR, facilitating targeted interventions.

No correlation found between palpation and ultrasound for evaluation of effusion in the medial femorotibial and femoropatellar joint compartments of horses.

To compare palpation and ultrasound scores of effusion of the medial femorotibial and femoropatellar joints of horses. 40 horses (80 stifles) were evaluated over a 12-week period. Horses > 1 year of age without history of stifle disease were enrolled from September to December 2022. Palpation of right and left medial femorotibial and femoropatellar joint compartments was performed. Amount of effusion was scored by a board-certified large animal surgeon, a third-year large animal surgery resident, and an equine sports medicine intern. Effusion of right and left medial femorotibial and femoropatellar joints was quantified with ultrasound by a board-certified equine sports medicine and rehabilitation clinician. Amount of effusion on palpation and ultrasound was graded as none-mild (1), moderate (2), or severe (3). A 2-way intraclass correlation coefficient evaluated interrater reliability of palpation scores. The Spearman rank correlation determined association between palpation and ultrasound scores. Interrater reliability for palpation of effusion was poor between all observers for all joint compartments. No significant correlation was identified between palpation and ultrasound scores for any joint compartment for any observer. Clinicians often rely on palpation of joint effusion as an indication of stifle pathology. We found interrater reliability to be poor for palpation scores, indicating low agreement for palpation of joint effusion between clinicians within our group. No correlation was found between palpation and ultrasound scores for joint effusion, indicating that clinicians should not rely on palpation alone to quantify joint effusion of the medial femorotibial and femoropatellar joints.

Change of joint line convergence angle and other coronal alignments after total hip arthroplasty

BackgroundThe purpose of this study was to determine the unloading effect of total hip arthroplasty (THA) on the ipsilateral knee joint through the joint line convergence angle (JLCA) change and determine the changes in other coronal radiographic parameters after THA, and evaluate the sensitivity of JLCA. Patients and methodsWe retrospectively assessed 70 patients who underwent unilateral THA. Hip parameters such as neck shaft angle (NSA), neck length, and femoral offset and coronal alignment parameters of the lower extremity such as hip–knee–ankle angle (HKA), femur length, mechanical lateral distal femoral angle (mLDFA), JLCA, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), and plafond talus angle (PTA) were measured in the operative and non-operative sides. We compared all hip and coronal alignment parameters between before and 1 year after THA, and the amount of standardized changes (Δ) between all hip and coronal alignment parameters on the operative side, respectively. ResultsAll mean hip and coronal alignment parameters on the operative side changed significantly 1-year after THA; however, those on the non-operative side did not. On the operative side, mean JLCA and PTA changed in the direction of closing the joint lateral space, from 1.81° and 0.47° to 1.22° and 0.11°, respectively (p<0.001 and 0.046, respectively). Mean NSA, HKA, and mLDFA changed in the valgus direction, from 129.39°, 2.62°, and 86.69° to 133.54°, 1.53°, and 85.91°, respectively (p<0.001). Mean femoral offset, neck length, and femur length increased from 36.45mm, 47.83mm, and 429.20mm to 39.85mm, 55.06mm, and 436.33mm, respectively (p<0.001). Mean MPTA and LDTA increased from 85.43° and 87.50° to 86.73° and 90.38, respectively (p<0.001). JLCA was more vulnerable to change than HKA, femur length, mLDFA, MPTA, and PTA (p<0.05). DiscussionJLCA change on the operative side was more sensitive than changes of other coronal alignments after THA. According to the cohort, THA might have an unloading effect on the medial compartment of the knee joint. Level of evidenceIV; retrospective case-control and cohort studies.

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.

Pulsed Electromagnetic Field Stimulation in Bone Healing and Joint Preservation: A Narrative Review of the Literature

Background: Biophysical stimulation therapy, Pulsed Electromagnetic Fields (PEMFs) and Capacitively Coupled Electric Fields (CCEFs) have significantly increased in the last twenty years. Due to this, it is necessary to have clear information regarding their efficacy, therapeutic indications and expected objectives. Application fields: There is a unanimous opinion regarding the usefulness of applying biophysical therapy on the bone compartment both in terms of the tissue-healing process and the symptoms associated with this situation. Differently, but no less important, positive results were observed in the joint compartment, especially with regard to the inhibition of the inflammatory process. Good results for chondroprotection were obtained in vitro and after a surgical procedure. New studies have shown the effectiveness also in cases of osteoporosis. Conclusions: The effectiveness of PEMFs and CCEFs on the bone-healing process and on joint preservation in the orthopedic and traumatology fields has consolidated evidence in the literature. We have also found positive results for symptoms and patient compliance with rehabilitation therapies. Therefore, their notable applications can be envisaged in the fields of prosthetic surgery and sports medicine.

Osteoarthritic Tibiofemoral Joint Contact Characteristics During Weightbearing With Arch-Supported and Standalone Lateral Wedge Insoles.

Imbalanced joint load distribution across the tibiofemoral surface is a risk factor for osteoarthritic changes to this joint. Lateral wedge insoles, with and without arch support, are a form of biomechanical intervention that can redistribute tibiofemoral joint load, as estimated by external measures of knee load. The objective of this study was to examine the effect of these insoles on the internal joint contact characteristics of osteoarthritic knees during weightbearing. Fifteen adults with tibiofemoral osteoarthritis underwent magnetic resonance imaging of the affected knee, while standing under 3 insole conditions: flat control, lateral wedge alone, and lateral wedge with arch support. Images were processed, and the surface area and centroid location of joint contact were quantified separately for the medial and lateral tibiofemoral compartments. Medial contact surface area was increased with the 2 lateral wedge conditions compared with the control (P ≤ .012). A more anterior contact centroid was observed in the medial compartment in the lateral wedge with arch support compared with the lateral wedge alone (P = .009). Significant changes in lateral compartment joint contact outcomes were not observed. These findings represent early insights into how loading at the tibiofemoral interface may be altered by lateral wedge insoles as a potential intervention for knee osteoarthritis.

Elevated secretion of pro-collagen I-alpha and vascular endothelial growth factor as biomarkers of acetabular labrum degeneration and calcification in hip osteoarthritis: An explant study

BackgroundHip osteoarthritis (OA) involves structural degeneration of different joint compartments, including femoral head cartilage, periarticular ligaments and the acetabular labrum. However, the molecular mechanisms underlying labrum degeneration in hip OA remain poorly understood. AimTo assess secretion of putative biomarkers for OA from explanted human labrum tissues under basal and inflammatory conditions and to determine whether these could differentiate between OA and calcification status compared to fracture controls. MethodsIntact labrum specimens were collected from patients undergoing joint arthroplasty for primary hip OA (n ​= ​15, mean age 70) or non-OA femoral neck fracture (n ​= ​5, mean age 64). Tissues were dissected in equal-sized samples and explanted for one week. To mimic activation of inflammatory signaling by endogenous damage-associated molecular patterns (DAMP) tissue were stimulated with a toll-like receptor 4 (TLR4) agonist (1 ​μg/mL LPS). The involvement of transforming growth factor-beta (TGF-beta) signaling was evaluated by treatment with a TGF-beta type 1 receptor inhibitor (10 ​μM SB-505124). Secretion of aggrecan (ACAN), pro-collagen-I alpha (Pro-Col-Iα), cartilage oligomeric matrix protein (COMP), interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) was assessed by enzyme-linked immunosorbent assay (ELISA). Labrum calcification was evaluated by 3D whole mount fluorescent microscopy of ethyl cinnamate-based optically cleared tissues stained with Alcian blue/Alizarin red. ResultsWhole mount microscopy revealed non-OA fracture controls were non-calcified, whereas six OA labra (40%) were partially calcified or ossified. Basal secretion of Pro-Col-Iα and VEGF was increased four-fold in OA versus non-OA labra. Pro-Col-Iα levels were correlated with those of VEGF (r ​= ​0.65) and COMP (r ​= ​0.54). Stimulation of DAMP signaling through TLR4 affected secretion of IL-6, VEGF, COMP and Pro-Col-Iα, with distinct responses between non-OA and OA tissues. Inhibition of TGF-beta signaling specifically reduced elevated secretion of Pro-Col- Iα and VEGF in calcified OA labrum. ConclusionsSecretion of the putative OA biomarkers Pro-Col-Iα and VEGF is elevated in degenerated human acetabular labrum and may serve as indicators of OA and calcification status. Secretion of both factors was partially regulated by TGF-beta signaling in calcified OA labrum tissues.The Translational potential of this article:Our findings suggest that a biomarker panel consisting of Pro-Col-Iα/VEGF/COMP may be valuable for assessing subradiographic labrum degeneration and calcification in hip OA. Targeting TGF-beta signaling may offer a means to reduce vascular invasion and fibrosis in acetabular labrum tissue.

THE MECHANICAL REGULATION OF SEMA3A IN PATIENT SYNOVIAL FLUID WITH CHRONIC KNEE VARUS MALALIGNMENT

AbstractOBJECTIVEKnee varus malalignment increases medial knee compartment loading and is associated with knee osteoarthritis (OA) progression and severity1. Altered biomechanical loading and dysregulation of joint tissue biology drive OA progression, but mechanistic links between these factors are lacking. Subchondral bone structural changes are biomechanically driven, involve bone resorption, immune cell influx, angiogenesis, and sensory nerve invasion, and contribute to joint destruction and pain2. We have investigated mechanisms underlying this involving RANKL and alkaline phosphatase (ALP), which reflect bone resorption and mineralisation respectively3 and the axonal guidance factor Sema3A. Sema3A is osteotropic, expressed by mechanically sensitive osteocytes, and an inhibitor of sensory nerve, blood vessel and immune cell invasion4. Sema3A is also differentially expressed in human OA bone5.HYPOTHESIS: Medial knee compartment overloading in varus knee malalignment patients causes dysregulation of bone derived Sema3A signalling directly linking joint biomechanics to pathology and pain.METHODSSynovial fluid obtained from 30 subjects with medial knee OA (KL grade II-IV) undergoing high tibial osteotomy surgery (HTO) was analysed by mesoscale discovery and ELISA analysis for inflammatory, neural and bone turnover markers. 11 of these patients had been previously analysed in a published patient-specific musculoskeletal model6 of gait estimating joint contact location, pressure, forces, and medial-lateral condyle load distribution in a published data set included in analyses. Data analysis was performed using Pearson's correlation matrices and principal component analyses. Principal Components (PCs) with eigenvalues greater than 1 were analysed.RESULTSPC1 (32.94% of variation) and PC2 (25.79% of variation) from PCA analysis and correlation matrices separated patients according to correlated clusters of established inflammatory markers of OA pain and progression (IL6/IL8, r=0.754, p&lt;0.001) and anti-inflammatory mediators (IL4/IL10, r=0.469, p=0.005). Bone turnover marker ALP was positively associated with KL grade (r=0.815, p=0.002) and negatively associated with IL10 (r=−0.402, p=0.018) and first peak knee loading pressures (r=−0.688, p=0.019). RANKL was positively associated with IL4 (r=0.489, p=0.003). Synovial fluid Sema3A concentrations showed separate clustering from all OA progression markers and was inversely correlated with TNF-α (r=−0.423, p=0.022) in HTO patients. Sema3A was significantly inversely correlated with total predicted force in the medial joint compartment (r=−0.621, p=0.041), mean (r=−0.63, p=0.038) and maximum (r=−0.613, p=0.045) calculated medial compartment joint pressures during the first phase and mean (r=−0.618, p=0.043) and maximum (r=−0.641, p=0.034) medial compartment joint pressures during midstance outputs of patient-specific musculoskeletal model.CONCLUSIONSThis study shows joint inflammatory status and mechanical overloading influence subchondral bone-remodelling. Synovial Sema3A concentrations are inversely correlated to patient-specific musculoskeletal model estimations of pathological medial overloading. This study reveals Sema3A as a biological mediator with capacity to induce OA pain and disease progression that is directly regulated by gait mechanical loading.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Chondrogen™ Injection for Knee Osteoarthritis using Stem Cells from Wharton's Jelly

Knee osteoarthritis constitutes a prominent source of pain and functional impairment, with its prevalence showing a consistent yearly increase. Current therapeutic strategies primarily revolve around addressing symptoms and, in severe cases, resorting to prosthetic joint replacement, yet they fail to target the underlying pathophysiological mechanisms driving degeneration. In this context, there is a growing interest in investigating mesenchymal stem cell (MSC) therapy as a potential remedy for osteoarthritis. Among the various MSC types under scrutiny, using Wharton's Jelly-derived mesenchymal stem cells (WJ-MSCs) has garnered relatively scant attention. The present study represents a Phase I clinical trial of an open-label, single-arm design within this context. Its principal aim is to assess the safety and efficacy of administering mesenchymal stem cells derived from Wharton's Jelly via intra-articular injection for patients diagnosed with knee osteoarthritis. Throughout six months, this investigation discerned a statistically significant overall improvement in clinical presentation relative to baseline. This improvement manifested as reduced analgesic consumption, diminished Visual Analog Scale (VAS) scores (19.5 to 18.7 mm, p = .00), and augmented functional assessment scores, including the IKDC Score (enhanced from 62.2 to 100, p = .00), KOOS Symptoms and Stiffness subscales (elevated from 76.8% to 10.6%, p = .00), as well as KOOS Pain subscale (upgraded from 74.4% to 10.1%, p = .00). The study encouragingly reported no significant adverse effects during the observation period. However, upon radiographic evaluation, no significant alterations were observed in terms of deformity angle (p = 0.957) or medial (p = 0.871) and lateral (p = 0.520) compartment joint space widths. To further elucidate the comparative efficacy of this treatment, it is prudent to contemplate a randomised controlled trial comparing it against the conventional hyaluronic acid regimen, thereby contributing to an enriched understanding of its therapeutic potential.

Achieving Correct Balance in Total Knee Arthroplasty with Fixed Varus Deformity.

Varus knee deformity is one of the most common deformities presenting for total knee arthroplasty (TKA). When present, a varus knee deformity contributes to overload of the medial joint compartment during gait, leading to increased medial compartment forces as well as lateral soft tissue lengthening. Additionally, a fixed varus deformity is associated with medial soft tissue contractures of the deep and superficial medial collateral ligament (MCL) and posteromedial capsule. With a fixed varus deformity, soft tissue releases may be necessary to create equivalent and rectangular flexion and extension gaps. There may also be anteromedial tibial bone defects, medial femoral condyle defects, and occasionally flexion contractures, especially in more severe cases. In cases of severe varus deformity with medial tibial bone loss, bone defects must be addressed to ensure adequate implant support. In many cases, a primary knee implant can be utilized in cases of varus knee deformity, but occasionally prostheses with higher levels of constraint may be required to balance and stabilize the knee. TKA has had a successful track record, with high levels of long-term implant survivorship even in cases of severe varus. Iatrogenic MCL instability and tibial aseptic loosening are complications associated with TKA in cases of severe varus, and multiple methods to avoid complications are presented here.

Analysis of the correlation between media meniscus displacement index and medial tibiofemoral articular cartilage damage

To investigate the correlation between the medial meniscal indentation index (MDI) and medial tibiofemoral articular cartilage damage more than 3 degrees in patients aged 40 to 60 years old with suspected or complicated knee osteoarthritis at non-weight-bearing position, and to determine the predictive threshold. From June 2016 to June 2020, a total of 308 patients who underwent initial knee arthroscopic exploration for chronic knee pain were collected. The age ranged from 36 to 71 years old with an average of(56.40±1.82) years old, including 105 males and 203 females. And patients with extra-articular malformations (abnormal force lines), a history of trauma, inflammatory arthritis and other specific arthritis were excluded. Finally, 89 eligible cases were obtained, aged from 42 to 60 years old with an average of (59.50±0.71) years old, including 45 males and 44 females. The degree of cartilage damage in the medial compartment of the knee joint was recorded, which was divided into two groups(≥degree 3 and<degree 3) according to Outer-Bridge classification system. The possible risk factors were determined by univariate analysis in the age, gender, affected sides, body mass index (BMI), synovial thickening grade, meniscus injury and MDI of 2 groups. Then, the independent risk factors for cartilage injury of more than grade 3 were determined by further binary Logistic regression analysis. If MDI was taken as an independent risk factor, receiver operating characteristic (ROC) analysis was performed to confirm whether it had diagnostic value for cartilage damage of above degree 3 and calculate the critical value of MDI. A total of 89 eligible patients were obtained. Univariate analysis showed age, BMI, MDI and meniscus injury may be the independent risk factors for cartilage damage of more than 3 degrees, further binary Logistic regression analysis confirmed that MDI[OR=1.66, 95%CI(1.64, 1.69), P=0.01]and BMI [OR=1.58, 95%CI(1.17, 2.15), P=0.03] were independent risk factors for cartilage injury of more than degree 3 in enrolled patients. ROC analysis showed that MDI had more diagnostic value than BMI, and the critical value was 0.355 with a sensitivity of 89.1% and a specificity of 88.2%. In doubt or accompanied by 40 to 60 years old patients with knee osteoarthritis, the MDI measured by non-weight-bearing knee MRI has predictive value for cartilage injury of more than degree 3 in medial tibiofemoral joint, and the critical value for diagnosis of cartilage injury of more than degree 3 is 0.355.