Lawrence Classification Research Articles

Association of knee osteoarthritis grade with one-leg standing balance and quadriceps strength in male independent ambulators aged ≥80 years

BackgroundOne-leg standing (OLS) balance is an important predictor of falls in people of advanced age. In this population, muscle weakness and knee osteoarthritis also contribute to falls and resultant fractures and thereby affect mortality rates. The Kellgren–Lawrence (KL) classification is widely used in the radiographic evaluation of knee osteoarthritis. This study was performed to evaluate OLS balance and the quadriceps strength (QS) for each KL grade and to clarify the impact of the knee osteoarthritis grade on OLS balance and QS. HypothesisOLS balance shows results compatible with those of previous reports when independent walking is possible because of maintenance of QS regardless of the OA grade. MethodsThis single-center prospective cross-sectional study included data on 106 male orthopedic patients (106 knees) aged ≥80 years who could walk independently. OLS balance with eyes open was assessed using the patient's preferred leg. A handheld dynamometer was used to measure QS. The ratio of muscle strength to body weight (QS/BW ratio) was used to evaluate outcomes. Weight-bearing standing knee radiographs were evaluated using the KL classification. OLS balance and the QS/BW ratio were evaluated for each KL grade, and the correlations of the KL grade with OLS balance and the QS/BW ratio were assessed simultaneously. ResultsFor each KL grade, the number of participants (n), median OLS balance (seconds), and QS/BW ratio (N/kg) were as follows: grade I: 24, 12, and 4.9; grade II: 51, 14, and 5.2; grade III: 22, 14, and 4.9; and grade IV: 9, 26, and 5.7, respectively. There were no significant differences in either OLS balance or the QS/BW ratio among the four grades. ConclusionsParticipants exhibited good OLS balance and QS/BW ratio regardless of their KL grade. This study demonstrated an absence of correlations of the KL grade with OLS balance and the QS/BW ratio, as was previously reported for the KL grade and pain. Level of evidenceLevel II prospective study.

Dorsal Capsule Interpositional Arthroplasty of the Metacarpophalangeal Joint.

Background: Current recommendations for osteoarthritis of the metacarpophalangeal joint (MCPJ) are confined to implant arthroplasty to preserve joint motion and provide pain relief. This study documents the median 2-year results of a novel soft tissue arthroplasty technique that interposes the dorsal capsule. Methods: A retrospective review of 10 MCPJ dorsal capsule interposition arthroplasties in 8 patients was conducted. Physical evaluation assessed MCPJ range of motion (ROM), grip strength, and pain. Outcome tests used were the Michigan Hand Outcome Score, Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Kellgren and Lawrence Classification assessed severity of MCPJ osteoarthritis on preoperative radiographs. Results: The mean follow-up was 29 months from surgery. Average VAS was 2/10 postoperatively and average postoperative ROM improved 7 degrees. Average postoperative grip strength of the surgical hand was 30 kg. The QuickDASH average score was 24. Average Michigan Hand Questionnaire final score was 70. Patients with Kellgren Grades 2 or 3 osteoarthritis had the best QuickDASH and Michigan Hand Outcome scores. All patients working before surgery returned to work. No patient required a second surgery. Conclusion: This technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years. Pain relief was most reliably provided in patients with less severe radiograph findings. The advantages of this procedure include preservation of bony anatomy, collateral ligaments, and volar plate to not preclude later implant arthroplasty.

Knee Osteoarthritis Grade does not Correlate with Quadriceps Muscle Strength or Bone Properties of the Calcaneus in Men Aged 80 Years or More who Can Walk independently.

Purpose: Muscle weakness and bone deterioration in the elderly are related to falls and fractures, resulting in decreased mobility. Knee osteoarthritis also may contribute to falls and fractures and thereby affect mortality rates. The Kellgren–Lawrence (KL) classification is widely used in the radiographic evaluation of knee osteoarthritis. Aims: This study aimed to evaluate the quadriceps strength and bone properties of the calcaneus for each KL grade, and to clarify the impact of knee osteoarthritis grade on quadriceps strength and bone properties. Methods: This prospective cross-sectional study included data on 108 male patients (213 knees), aged ≥80 years, who could walk independently. A handheld dynamometer was used to measure quadriceps strength. Bone properties were evaluated using broadband ultrasound attenuation with a portable bone densitometer. Weight-bearing standing knee radiographs were evaluated using KL classification. Quadriceps strength and bone properties were evaluated for each KL grade and the correlations between the grade and quadriceps strength and bone properties were assessed simultaneously. Results: The numbers of participants in KL grades I–IV were 46, 102, 45, and 20, respectively. There were no differences among grades for either quadriceps strength or bone properties. Conclusions: Participants exhibited good quadriceps strength and bone properties regardless of their KL grade. Relatively high mechanical loading of muscle and bone incurred while walking independently, likely explaining this result. Clinically, this study demonstrated the absence of correlations between KL grade and quadriceps strength and bone properties, as was previously reported in studies showing the absence of a correlation between KL grade and pain.

Comparative clinical and economic analysis of using SYSADOA drugs containing chondroitin sulphate or influencing its biosynthesis in the treatment of patients with stage II knee osteoarthritis

Aim : to conduct a comparative clinical and economic analysis of using three SYSADOA drugs containing chondroitin sulfate or modifying its biosynthesis in patients with stage II knee osteoarthritis in an outpatient setting. Material and methods . This was a retrospective comparative study, with the inclusion of data from medical records of outpatients with stage II knee arthritis according to the Kellgren & Lawrence classification. We calculated the cost-effectiveness from the direct costs and treatment efficiency based on the dynamics of pain, functional ability of the joint according to the Lequesne index, as well as the VAS index, the WOMAC index, ultrasound results and quality of life according to the EuroQol-5D questionnaire. The medical records of patients (n = 90) with stage II knee osteoarthritis are systematized according to inclusion / exclusion criteria. All patients were divided into 3 groups: group 1 (n = 30) received chondroitin sulfate, 100 mg in 1 ml (Chondroguard ® , Sotex, Russia), i /m, every other day, the first 3 injections of 100 mg each with good tolerance starting from the 4th injection of 200 mg, the course of treatment was 25 injections over 50 days; group 2 (n = 30) received an active substance-glycosaminoglycan-peptide complex (Romania), on the 1st day – 0.3 ml, on the 2nd day – 0.5 ml and then 3 times a week for 1 ml, the course of treatment – 20 injections per 44 days; group 3 (n = 30) received the active substance – bioactive concentrate from small sea fish (Romania), 1 ml per day, course of treatment – 20 injections, 20 days. Results . It is shown that the treatment of stage II osteoarthritis of the knee with Chondroguard ® is the most economically feasible in terms of the cost-effectiveness ratio (CER=9182). Conclusion . The study results are recommended for decision making on the use of SYSADOA at the level of doctors and health care providers.

CT controlled results of direct reduction and fixation of posterior malleolus in ankle fractures.

The aim of this study was to present outcomes of operative treatment of the posterior malleolus fractures of type four of the Bartoníček/Rammelt classification. In 19 patients, direct reduction and fixation of the posterior malleolus was performed from the posterolateral or posteromedial approaches. The accuracy of reduction was assessed with the use of postoperative CT scans. The mean size of the avulsed articular surface carried by posterior malleolus amounted to 36%. Reduction of the posterior malleolus fracture was assessed as anatomical in 14 cases and as satisfactory in five cases. Position of the distal fibula was assessed as anatomical in 15 cases. The mean AOFAS score was 89.4 points. All nine patients with anatomical reduction of all lesions achieved the mean AOFAS score of 93.1 points, five patients with malposition of posterior malleolus 89.1 points and five patients with malposition of the fibula in the fibular notch 87.8 points. A total of six patients developed osteoarthritic changes of grades one and two according to the Kellgren and Lawrence classification. Outcomes of the study demonstrated good mid-term results in type four fractures of the posterior malleolus treated by direct reduction from posterior approaches. Postoperative CT examination allowed evaluation of the accuracy of reduction of all fractures and reduction of the distal fibula into the fibular notch. Based on postoperative CT examination, it will be possible to assess the effect of reduction of individual lesions on the functional results.

Is the Association of Platelet Rich Plasma and Hyaluronic Acid Useful for Severe Knee Arthrosis?

Background: Evaluate the effectiveness of intra-articular injections of platelet rich plasma associated with hyaluronic acid, in severe knee osteoarthritis in elderly patients. By comparing the results of mild and moderate osteoarthritis group (younger) with the severe osteoarthritis group (older). Methods: The treatment was based on a technique which consisted of a superolateral knee injection of 2 mL of xylocaine (1% without constrictor vessel) followed by an injection of 2 mL of hyaluronic acid and an injection of 4 mL of platelet rich plasma. All injections were guided by ultrasound and given in the same site. Comparative analysis of pre and post treatment was performed. Results: No significant difference were obtained between the groups (p value > 0.05), showing that despite having a different Kellgren and Lawrence classification, the two groups showed a similar improvement result. Conclusion: The association of platelet rich plasma and hyaluronic acid in the treatment of knee arthrosis is useful for the improvement of the WOMAC total score, as well as of its subscores (pain, function, and stiffness). Similar results were obtained for patients with severe arthrosis and those with mild and moderate arthrosis.

Intramedullary screw fixation for proximal fifth metatarsal zone II and III fractures on athlete population: a systematic review

Introduction: Metatarsal fractures are the most common fractures in foot with an incidence of 6.7 per 10.000 persons. Fifth metatarsal fractures account for 70% of metatarsal fractures. Proximal 5th metatarsal zone II and III fractures have minimal vascularization, known as a ‘watershed area’, with delayed to non-union rate up to 50%. This study will review clinical and functional effectiveness from intramedullary screw fixation for proximal 5th metatarsal zone II and III fractures. Methods: Publications from 2010-2020 in PubMed and Scopus databases were systematically reviewed using PRISMA guideline within the searching period from the 1st of June to the 10th of July 2020. Inclusion criteria for this study were published journal from the last 10 years, athlete population, undergone intramedullary screw fixation, assessed for time to bone union or return to sport duration, acute fractures, clearly stated followed-up period, and reported complications. All data were statistically analyzed using SPSS version 23. Results: Data from 2010 to 2020 were systematically searched, there were 146 cases of proximal 5th metatarsal zone II and III fractures which undergone intramedullary screw fixation with a mean follow up of 5.6 + 3.1 years. Time to bone union was 8.5 weeks on average. Return to sport was 8.7 weeks, the average reported midfoot AOFAS functional score was 98.4. Complications in the form of diaphyseal stress fracture, thermal necrosis of the skin, irritation of soft tissue, non-union, and refracture were reported. Conclusion: The current study demonstrates the effectiveness of intramedullary screw fixation as the management of proximal 5th metatarsal zone II and III (Lawrence and Botte classification) fractures. We recommend this treatment modality as one of the techniques that provide optimal outcomes.

Enhanced Serum miR-153-3p Promotes the Development of Knee Osteoarthritis by Targeting SOST.

The current study aims to identify the expression of serum miR-153-3p in knee osteoarthritis (KOA) patients, thereby evaluating its diagnostic value in clinic. The KOA group was divided into mild group, moderate group, and severe group according to the Kellgren Lawrence (K-L) classification. RT-PCR was used to determine the level of serum miR-153-3p. The relationship between serum miR-153-3p level and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) was analyzed by Pearson's correlation assay. The possible target gene of miR-153-3p was predicted by TargetScan and validated using dual-luciferase reporter assay. The serum miR-153-3p levels of KOA patients in mild, moderate, and severe groups were significantly higher than those in the control group. A positive correlation was found between the serum miR-153-3p level and ESR/CRP levels. ROC analysis showed that serum miR-153-3p could differentiate KOA patients from controls. Based on TargetScan, a conserved binding site was identified in the 3'UTR of SOST and miR-153-3p significantly suppressed the relative luciferase activity of pmirGLO-SOST-3'UTR. Further study showed that the serum SOST levels of patients with KOA were significantly lower than that of the control group. Pearson's correlation assay showed a negative correlation between serum miR-153-3p and serum SOST levels. Collectively, enhanced serum miR-153-3p level promoted the progression of KOA by suppressing SOST. Hence, serum miR-153-3p may be a useful biomarker and therapeutic target in patients with KOA.

Can body mass index influence the fracture zone in the fifth metatarsal base? A retrospective review

BackgroundFifth metatarsal base fracture are a common occurrence in the orthopaedic practice. Literature on the epidemiology of such fractures is scarce. The aim of this analysis was to study the relationship between Body Mass Index (BMI) and the zone of the fifth metatarsal base involved by the fracture.MethodsData on adult patients who have been diagnosed with isolated fifth metatarsal base fracture were gathered at our Institution (blinded for review). Age, sex, height, weight and injury mechanism were collected from electronic medical records. Fractures were classified according to the Lawrence and Botte classification (Zone 1, 2 and 3) by three independent reviewers.ResultsFrom March 2016 to December 2018, 149 patients (109 women and 40 men) have been diagnosed with fifth metatarsal base fracture. Average age and BMI at the time of injury were 51.9 (SD 17.1, range 18–84) and 24.0 (SD 3.8, range 16.4–36.7) respectively. Fracture distribution was 63.8% in zone 1, 23.5% in zone 2, 12.7% in zone 3. 12.1% of patients had a BMI < 20 kg/m2, 57.7% between 20 and 24.9 kg/m2, 22.2% between 25 and 29.9 kg/m2 and 8.0% over 30 kg/m2. No statistically significant differences attributable to sex (p = 0.774) or age (p = 0.379) were found between different zones of fracture. Average BMI was found to be higher in the zone 3 (26.1 ± 4.7 kg/m2) fracture group than in zone 1 (23.7 ± 2.9 kg/m2) (p = 0.031).ConclusionThe prevalence of proximal diaphysis (zone 3) fractures rises proportionally with BMI in our sample study. BMI appears to have an impact on fifth metatarsal base fractures pattern.

Early screw fixation versus casting in the treatment of acute Jones fracture

Purpose There is considerable variability in the literature in treatment of Jones fracture. The purpose of this study is to compare between the outcomes of cast immobilization and intramedullary screw fixation in treatment of acute Jones fracture type II and type III. Our results concluded that treatment of Jones fracture by early intramedullary screw fixation showed early union and return to previous activity in shorter time than the conservative treatment. Patients and methods In this prospective study, 40 patients were selected from Kasr El Ainy from October 2014 to May 2015. Radiographs were assessed for displacement. Dameron, Lawrence, and Quill classification was used to determine type of fracture. A total of 20 patients were treated conservatively by below-knee cast, and the average duration for cast application was 7 weeks. A total of 20 patients underwent operative management in the sort of percutaneous fixation by cannulated screw. We only used compression bandage after the operation; however, slab was used if there were any associated ipsilateral injuries. We followed up the patients with radiograph for union and by American Orthopedic Foot and Ankle Society Score to evaluate the function. Results All the surgical group patients achieved union, with an average clinical union of 7.5 weeks, and the cast group had an average union of 12.5 weeks, with highly significant difference (P Conclusion Early screw fixation in the treatment of acute Jones fracture is preferable than conservative treatment in patients with high-demand physical activity who want to return early to their work, where we have to take in consideration the financial cost of the operation versus the cast application. So, tailoring of the management plan to the patient activity and financial capability is of utmost importance.

Efficacy of intra-articular injection of methylprednisolone in patients with osteoarthritis of the knee in southern district of India

Background: Osteoarthritis (OA) is a most common form of arthritis wherein chronic progressive degenerative changes occur in the articular cartilage of the joint which leads to restriction of joint function and poor life quality and it is globally prevalent causing pain and functional disability. Intra-articular corticosteroids are usually administered to candidates who do not show symptomatic relief to conservative line of management. Aims and Objectives: The objective of the study is to assess the efficacy of intra-articular injection of methylprednisolone acetate in patients with OA of the knee. Materials and Methods: Patients of all age and gender diagnosed with primary OA of knee with visual analog scale (VAS) pain score seven and more than seven with X-ray evidence of osteoarthropathy of knee with Kellgren Lawrence classification one-three, patients not satisfied with anti-inflammatory drugs and physiotherapy were included in the study. Study participants were asked for self-assessment of pain and mark on the VAS and interpretation of scoring was statistically analyzed. Results: Thirty study participants were enrolled for the study among them, the male and female were 56.67% and 43.33%, respectively. The mean age of the study participants was 59.2 ± 11.79 years. The mean VAS pain score before intra-articular methylprednisolone acetate was 9.37 ± 0.81 and there was gradual decrease in pain score after intra-articular injection over time in 2, 4, 8, 12, and 24 weeks. Conclusion: Intra-articular methylprednisolone acetate had revealed good efficacy in patients with OA knee with chronic pain without adverse effects.

Radiographic diagnosis of erosive hand osteoarthritis

Osteoarthritis (OA) is one of the most common diseases of the musculoskeletal system in the world. Some researchers call the small joints of the hands as being one of the most common sites of involvement in OA. Its most severe phenotype is considered to be inflammatory, or erosive, OA (EOA). Nevertheless, the radiographic pattern of this disease has not yet been sufficiently studied, and whether EOA is an independent form of OA, a regular later stage of the disease or an individual nosological entity, has not yet been resolved. Objective : to assess the location, frequency, and severity of radiographic symptoms and pain in patients with EOA and non-erosive OA (NEOA), to study the involvement of carpometacarpal (CMC), wrist, metacarpophalangeal (MCP) and radiocarpal (RC) joints in the pathological process in patients with EOA and NEOA of the hands. Subjects and methods . The investigation enrolled 64 women with hand OA who met the American College of Rheumatology (ACR) OA criteria. Hand joint images in the anteroposterior projection were first performed in all the patients. Each patient completed the AUSCAN questionnaire. The images were described according to the Kellgren and Lawrence classification. The mean age of the patients was 65.28+6.82 years; the age at onset of the disease was 48.81+7.73 years; its median OA duration was 15.0 [10.0; 19.5] years. According to the presence of erosions in the interphalangeal joints (IPJ) of the hand, the patients were divided into two groups: 1) EOA (n=23); 2) NEOA (n=37). Both groups were matched for age and disease duration (the mean age of patients with EOA was 68+6.15 years, the mean disease duration was 18.34+7.11 years; these in the NEOA group were 65.13+5.43 and 16.56+8.4 years, respectively). For age matching, 4 patients were excluded from Group 2. Results and discussion . Kellgren and Lawrence Stage II hand OA was detected most frequently (49%) and the most common radiographic symptoms of OA in the distal IPJ (DIPJ), proximal IPJ (PIPJ) and MCP joints were joint space narrowing (JSN) (100%, 100%, and 95%, respectively) and osteophytes (OPs) (88%, 70%, and 45% respectively). The least common conditions were subchondral osteosclerosis (SCOS) (5%), erosions (8%), and subluxations (3%) in the MCP joints, as well as subluxations in the PIPJ (6%). In the wrist, the most frequent sites of involvement was first CMCJ and scaphoid-trapezium-trapezoid joint (STTJ); their JSN was identified in 86 and 69% of patients, respectively; OPs were found respectively in 81 and 50% of cases. Changes in the RC joint (RCJ) were least common. EOA of the DIPJ and PIPJ was found in 15 (23%) patients with radiographic changes corresponding to Stages III—IV OA of the hand and in 8 (12%) patients with Stage II according to the Kellgren and Lawrence classification. The DIPJ in EOA versus NEOA showed significantly higher frequency of OPs (100 and 78%), SCOS (74 and 11%), cysts (61 and 24%), and subluxations (43 and 14%); the PIPJ — SCOS (43 and 5%), cysts (52 and 27%), and subluxations (17 and 0%; p <0.05); the first CMCJ — JSN (96 and 68%), SCOS (61 and 22%), erosions (26 and 3%), and subluxations (39 and 14%), the STTJ, — SCOS (22 and 3%) and erosions (62 and 16%, respectively; p <0.05). According to the AUSCAN questionnaire, a significantly greater pain severity was recorded in patients with EOA than in those with NEOA (65 and 30%; p=0.008). Conclusion. DIPJs are most frequently affected by hand OA. The most common radiographic symptoms are JSN and OPs. In the wrists, first CMCJ and STTJ are most often involved; there are practically no changes in the RCJ. In EOA versus in NEOA, there are significantly more common OPs, cysts, SCOS, and subluxations in the DIPJs, SCOS, cysts, and subluxations in the PIPJs; first CMCJ and STTJ are significantly more often involved in the pathological process. EOA compared with NEOA is characterized by more severe pain, as evidenced by the AUSCAN questionnaire.

Clinical and radiological features of lumbar degenerative spondylolisthesis who complicates osteoarthritis of the knee

Background dataCorrelation between lumbar degenerative disease and degenerative disorders of the knee joint have often been reported, however, detailed research concerning lumbar degenerative spondylolisthesis (DS) who complicates osteoarthritis of the knee (KOA) are scarce. MethodsA total of 184 consecutive surgically treated DS patients were identified, and divided into two groups: DS patients who complicate KOA (KOA group) and DS patients without KOA (non-KOA group). DS was defined as grade 1 or more, according to Meyerding's classification, and KOA was defined as grade 3 or more according to Kellgren–Lawrence classification. Clinical and the radiological differences of DS patients between KOA group and non-KOA group were investigated in order to clarify the features of DS patients who complicate KOA. Statistical significance using student's t-test and multivariate logistic regression analysis was performed to identify independent predictors of complicating KOA in DS. ResultsKOA group and non-KOA group consisted of 57 and 127 patients, respectively, with both group predominantly of female patients. Clinical features of KOA group were significantly high in age and body mass index (BMI), and more likely to complicate circulatory system disorders than non-KOA group. Radiological features of KOA group were significantly high in frequency of double adjacent level spondylolisthesis, Pelvic incidence (PI), Pelvic tilt (PT), and PI–LL. Multivariate logistic regression analysis identified coexistence of circulatory system disorders (OR 2.251, p = 0.024) and PI–LL (OR 1.04, p < 0.001) to be an independent predictors of complicating KOA in DS patients. ConclusionsOlder age and overweighted female patients coexistence of circulatory system disorders, containing double adjacent level spondylolisthesis with high PI, PT, and PI–LL were the characteristics of DS patients who complicate KOA, particularly coexistence of circulatory system disorders and significantly high lumbo-pelvic sagittal mismatch were the most significant factors above all.

Long-term clinical and radiological outcomes after multiligament knee injury using a delayed ligament reconstruction approach: A single-center experience

PurposeTo present long-term clinical and radiological results of patients treated with delayed reconstruction of multiligament knee injuries. MethodsClinical data from 26 patients (21 men, five women, mean age 27.44 years) were retrospectively reviewed. Patients were evaluated at final follow-up with the use of: The International Knee Documentation Committee score (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity level, Lysholm Knee Scoring Scale, EuroQol subjective knee evaluation form, and KT-2000 arthrometer. Mean follow-up time was 105.38 months. Both knees were radiographically evaluated for osteoarthritis according to the Kellgren–Lawrence classification. ResultsNo patient required mobilization under anesthesia for adhesion lysis at the immediate or later postoperative duration. There was no statistically significant difference in range of motion between the healthy and operated sides (P = 0.713). Mean time to final range of motion regain was 2.1 ± 0.4 months. Average KT-2000 side-to-side (operated vs. normal) difference was 2.03 ± 1.1 mm, and the difference was statistically significant (P = 0.007). The mean IKDC, KOOS, Lysholm, Tegner, and Euroqol-5D postoperative scores were 82.13 ± 17.5, 84.59 ± 16.8, 90.6 ± 6.4, 4.3 ± 1.3, and 80 ± 11.74, respectively. Multiple regression analysis showed that age and follow-up time had significant effects on each clinical score, except for the Lysholm and Tegner scores. Progression of osteoarthritic changes of the reconstructed knee and its contralateral side was significantly different (P = 0.003). ConclusionExcellent clinical results were reported from this center's long-term experience with delayed ligament reconstruction, and osteoarthritic changes of reconstructed knees were recorded.

Association between cytokines and exosomes in synovial fluid of individuals with knee osteoarthritis

Background: Cytokines in synovial fluid (SF) play a crucial role in knee osteoarthritis (KOA). Exosomes are nanovesicles that are abundant in SF and carry a large quantity of signaling molecules. The purpose of this study was to evaluate the cytokine profiles of SF-derived exosomes and try to explore its biological function.Methods: Twenty-four KOA patients who were scheduled for their first intra-articular injection or knee replacement surgery were enrolled and divided into the KL1–2 group and the KL3–4 group according to the Kellgren and Lawrence (KL) classification. SF was collected from the patient’s knee for the isolation of exosomes. A multiplex cytokine assay was performed to detect the 21 cytokines in the exosomes. The SF derived-exosomes were exposed to PBMCs and chondrocytes to assess their immunomodulatory potential.Results: Exosomes were successfully extracted from the SF, with an average diameter of 92 nm. Most cytokines were detectable in the SF-derived exosomes. Twelve inflammatory cytokines and eight chemokines were elevated in the exosomes of the KL3–4 group compared to that of the KL1–2 group (p < .05). A higher number of PBMCs were chemo attracted and the proliferation of chondrocytes was restrained by the SF-derived exosomes from the KL3–4 group in comparison with the KL1–2 group (p < .05).Conclusion: Our data indicated that most cytokines in SF are not only in a free form but also associated with and enriched in exosomes. Exosomes from end-stage KOA patients have a higher level of cytokines, especially chemokines, in comparison with the cytokine profiles of the soluble SF. SF-derived exosomes recruit inflammatory cells and inhibit cartilage proliferation, thus promoting joint degeneration. These data provide a new perspective for understanding the changes in the inner environment of KOA.

Synovial fluid and plasma levels of milk fat globule-epidermal growth factor 8 are inversely correlated with radiographic severity of knee osteoarthritis.

ObjectiveMounting evidence demonstrates that inflammation plays an important role in the pathogenesis of osteoarthritis (OA). Milk fat globule–epidermal growth factor 8 (MFG-E8) is an important glycoprotein that is involved in anti-inflammatory responses. The present study was performed to assess the MFG-E8 levels in plasma and synovial fluid and explore the association between radiographic severity and MFG-E8 levels in patients with knee OA.MethodsThis study involved 138 healthy controls and 142 patients with knee OA. The MFG-E8 levels in plasma and synovial fluid were evaluated by enzyme-linked immunosorbent assay. The Kellgren and Lawrence classification was used for OA grading.ResultsThe plasma MFG-E8 level was significantly lower in patients with knee OA than in healthy controls. The synovial fluid MFG-E8 level was significantly lower than the plasma level in patients with knee OA. More importantly, the MFG-E8 levels in synovial fluid and plasma were significantly and inversely associated with radiographic severity among patients with knee OA.ConclusionsThese results demonstrate that the levels of MFG-E8 in synovial fluid and plasma are inversely correlated with the radiographic severity of knee OA.

Features of the connective tissue metabolism, the content of adipokines and cytokeratin-18 in patients with non-alcoholic steatohepatitis combined with osteoarthritis and obesity

Aim. To determine the indices of connective tissue metabolism, adipokines and cytokeratin-18 in non-alcoholic steatohepatitis patients with osteoarthritis and obesity comorbidities.Materials and methods. 90 patients were examined and divided into three groups: group 1 (n = 30) included patients suffering from OA grade II–III according to Kellgren and Lawrence classification with normal body mass (BMI = 21–25 kg/m2), group 2 (n = 30) – patients with NASH and OB without OA (BMI &gt; 30 kg/m2), group 3 (n = 30) – patients with OA with NASH and OB (BMI more than 30 kg/m2). The control group consisted of 30 age-matched practically healthy persons (PHP). The average age of patients was 62.3 ± 5.7 years.Results. In NASH patients with OB and OA, there is a significant increase in the synthesis of collagen and glycosaminoglycans which is accompanied by ineffective resorption of newly formed collagen due to inhibition of the collagenolytic activity of blood plasma in NASH arising from activation of proteinase inhibitors (α2-MG), a significant imbalance in the metabolic system of connective tissue, which, particularly in OA and OB comorbidities, leads to progressive fibrosis of the liver and its functions impairment. It has been established that blood adipokines level not only depends on body weight, but also reflects the risk for occurrence of nosologies associated withOB.Conclusions. In patients with NASH and morbidOB, a significant increase in collagen and glycosaminoglycans synthesis was observed. Adipokine deficiency, found in the work, can play a significant pathogenetic role in the development and progression of NASH as well asOB and OA. Adipokines leptin and adiponectin and also cytokeratin-18 may serve as sensitive risk markers for comorbid diseases development and could be candidates for their measurements inclusion in the diagnostic algorithm for NASH, OA,OB and their combination.

Medium- and long-term results of high tibial osteotomy in patients with primary and secondary knee osteoarthritis with varus deformity

The most common operation for knee osteoarthritis (OA) is total knee arthroplasty (TKA); however, the latter is associated with the development of severe complications. This was the reason for the revival of the interest of orthopedic traumatologists in high tibial osteotomy (HTO), the essence of which is to transfer the load away from the affected medial part of the knee joint (KJ) to the intact lateral one.Objective: to evaluate the medium- and long-term results of open-wedge (OW) HTO in primary and secondary I–III stage knee OA.Patients and methods. The Laboratory of Orthopedic Rheumatology and Rehabilitation, V.A. Nasonova Research Institute of Rheumatology, performed 10 OW HTOs in 9 patients in 2005 to 2009 and 21 more OW HTOs in 19 patients in 2014 to 2018 (a total of 31 operations). The male/female ratio was 2.5:1. The mean age of the patients was 57.6±12.5 years; the body mass index (BMI) was 28.5±3.6 kg/m2 ; the correction angle was 11.7±2.5°. Preoperative planning was performed using the Miniaci method; the X-ray stage of knee OA was evaluated according to the Kellgren–Lawrence classification. OW HTO was carried out. For assessment of its results, the investigators determined the degree of pain using a visual analogue scale (VAS) and the KJ status by the Knee Society Score (KSS) scale. The results were assessed at one (n=31), 3.5±0.6 (n=28), and 8.5±1.3 (n=10) years.Results and discussion. There was a tendency to worsen surgical results over time. The mean VAS values for pain at 1, 3.5, and 8.5 years were as follows: 9.8±10.3; 21.2±16.2 and 38±15.5 mm, respectively. In the same periods, the KSS functional scores were 83.6±14.8, 85.2±12.6, and 80.5±14.2; the objective scores were 80.7±8.5, 75.2±12.7, and 67.8±16.3. There was a strong correlation between the severity of pain and the functional and objective KSS scores (-0.78, -0.81 years, and -0.91 at 1, 3.5, and 8.5 years, respectively; p&lt;0.05). At 3.5±0.6 years, the survival rate after OW HTO was 96.6%. None of the patients examined at 8.5±1.3 years after OW HTO needed TKA. The surgical result was studied in 2 patients at 14 years; one patient underwent TKA, the other refused surgical intervention, the result was satisfactory.Conclusion. OW HTO has limited indications for use. However, in patients who are allowed to undergo this operation, pain syndrome can be relieved, by maintaining and/or improving KJ function; in most cases, TKA can be delayed for more than 10 years.

Early Results of High Tibial Osteotomy for Osteoarthritis in Mongolia

Objectives: The objectives of this study were to examine the reproducibility of the surgical correction and pain relief following high tibial osteotomy for osteoarthritis. Methods: Twenty-seven patients who underwent high tibial osteotomy at The First Central Hospital of Mongolia were included. Patients divided into three groups based on their osteoarthritis grade using the Kellgren Lawrence classification. The weight-bearing line and medial proximal tibial angle were used for preoperative planning to assess postoperative correction. Oxford knee scores were used to assess knee pain and function. Results: The weight-bearing line and medial proximal tibial angle measurements at both postoperative time intervals were significantly different from the preoperative values (p&lt;.001) but were not significantly different from each other. The Oxford knee scores were 31.54±6.3 preoperatively, 34.82±4.3 at two months after the surgery and improved to 40.89±2.7 six months after the surgery. Statistically significant successive improvements in scores were observed at each time interval (p&lt;.001). Conclusion: High tibial osteotomy can be done with rigid internal fixation and can improve function and reduce pain in Mongolian patients with early arthritis without affecting joint range of motion.

Diagnosis and treatment of proximal fifth metatarsal fracture

As one of the most common fractures of the foot, the blood supply characteristics and unique anatomy of proximal fifth metatarsal fracture makes a high risk of delayed union or non-union of fractures occurring at the junction of the diaphyseal-metaphyseal. At present, the classification system of proximal fifth metatarsal fracture is complicated and not yet unified, and Lawrence and Botte classification is more recommended. The system divides proximal fifth metatarsal fracture into three types:avulsion fractures of tuberosity(Zone I), fractures at the metaphysis-diaphysis junction, which extend into the fourth-fifth intermetatarsal facet (Zone II) and the proximal diaphyseal fractures(Zone III). Based on the classification system, each type of fracture has a corresponding treatment plan and prognosis. There are a variety of surgical methods for proximal fifth metatarsal fracture. For the fracture of Zone II and Zone III, percutaneous intramedullary screw is the first choice. In addition, clinicians should also have a thorough understanding of common complications of fracture and associated disposal methods.