Cartilage Lesions Research Articles

TLR4 antagonism provides short-term but not long-term clinical benefit in a full-depth cartilage defect mouse model

ABSTRACT Purpose/Aim Cartilage injury and subsequent osteoarthritis (OA) are debilitating conditions affecting millions worldwide. As there are no cures for these ailments, novel therapies are needed to suppress disease pathogenesis. Given that joint injuries are known to produce damage-associated molecular patterns (DAMPs), our central premise is that the Toll-like receptor 4 (TLR4) pathway is a principal driver in the early response to cartilage damage and subsequent pathology. We postulate that TLR4 activation is initiated/perpetuated by DAMPs released following joint damage. Thus, antagonism of the TLR4 pathway immediately after injury may suppress the development of joint surface defects. Materials and Methods Two groups were utilized: (1) 8-week-old, male C57BL6 mice treated systemically with a known TLR4 antagonist and (2) mice injected with vehicle control. A full-depth cartilage lesion on the midline of the patellofemoral groove was created in the right knee of each mouse. The left knee was used as a sham surgery control. Gait changes were evaluated over 4 weeks using a quantitative gait analysis system. At harvest, knee joints were processed for pathologic assessment, Nanostring® transcript expression, and immunohistochemistry (IHC). Results Short-term treatment with a TLR4 antagonist at 14-days significantly improved relevant gait parameters; improved cartilage metrics and modified Mankin scores were also seen. Additionally, mRNA expression and IHC showed reduced expression of inflammatory mediators in animals treated with the TLR4 antagonist. Conclusions Collectively, this work demonstrates that systemic treatment with a TLR4 antagonist is protective to further cartilage damage 14-days post-injury in a murine model of induced disease.

Postoperative quadriceps weakness and male sex are risk factors for patellofemoral articular cartilage lesions after anatomical anterior cruciate ligament reconstruction

PurposePatellofemoral (PF) compartment cartilage lesions are a frequent problem after anterior cruciate ligament (ACL) reconstruction. This study aimed to determine the factors that influence PF cartilage lesions after anatomical ACL reconstruction.MethodsThis study enrolled a total of 114 patients who did not manifest PF compartment cartilage lesions during anatomical ACL reconstruction and underwent second-look arthroscopy 18 months postoperatively. Arthroscopy using the International Cartilage Repair Society (ICRS) classification was used to assess cartilage lesions. The correlation between surgical findings, radiographic factors, and clinical factors and change of ICRS grade was analysed. Multivariate regression analysis was conducted to reveal the independent risk factors for PF cartilage lesions among patients’ demographic data and parameters that correlated with the change of ICRS grade in the correlation analyses.ResultsICRS grade changes in PF cartilage were significantly correlated with age, sex, quadriceps strength at 1 year postoperatively, hamstrings strength at pre- and 1 year postoperatively, and single leg hop test at 1 year postoperatively. However, no significant correlation was found between the time between injury and surgery, posterior tibial slope angle, pre- and postoperative Tegner activity scale, graft type, initial graft tension, meniscus injury, meniscus injury treatment, pre- and postoperative range of motion, anteroposterior laxity and preoperative quadriceps strength, and the change in ICRS grade. Multivariate regression analysis revealed male (P = 0.019) and quadriceps strength weakness at 1 year postoperatively (P = 0.009) as independent risk factors for PF cartilage lesions.ConclusionsQuadriceps strength weakness 1 year after ACL reconstruction and males were correlated with a new PF cartilage lesion after anatomical ACL reconstruction, with no significant correlation between bone-patellar tendon-bone autograft, initial graft tension, or extension deficit and new PF cartilage lesion. Rehabilitation that focuses on quadriceps strength after ACL reconstruction is recommended to prevent new PF cartilage lesions.Level of evidenceLevel IV.

Proprioception and Mechanoreceptors in Osteoarthritis: A Systematic Literature Review.

Osteoarthritis (OA) is one of the most common chronic diseases in the world. It is frequently accompanied by high levels of persistent pain, as well as substantial impairments in function and functional capacity. This review aims to systematically analyze the changes in proprioception and related mechanoreceptors in OA patients. Studies from September 2013 to September 2023 were identified by conducting searches on the PubMed, Web of Science, and Scopus electronic databases following the PRISMA statement. One reviewer independently assessed and screened the literature, extracted the data, and graded the studies. The body of evidence underwent an evaluation and grading process using the ROBINS-I tool, which was specifically designed to assess the risk of bias in non-randomized studies of interventions. Results were summarized using descriptive methods. A search through 37 studies yielded 14 clinical studies that were ultimately included. The primary focus of the studies was on the knee joint, particularly the posterior cruciate ligament (PCL). The studies found that PCL in OA patients had impaired proprioceptive accuracy, possibly due to changes in mechanoreceptors (Ruffini, Pacini, and Golgi Mazzoni corpuscles). This suggests that dysfunctional articular mechanoreceptors, especially in severe cases of OA, may contribute to reduced proprioception. Dynamic stabilometry also identified significant proprioceptive deficits in patients with knee articular cartilage lesions, underscoring the impact of such lesions on knee proprioception. Literature data have shown that proprioceptive accuracy may play an important role in OA, particularly in the knee PCL and cartilage. However, the role of proprioception and related mechanoreceptors needs to be further clarified. Future studies focusing on the relationship between proprioception, OA disease, and symptoms, considering age and gender differences, and exploring OA joints other than the knee should be conducted to improve clinical and surgical outcomes in cases where proprioception and mechanoreceptors are impaired in OA patients.

Outcomes of Osteochondral Allograft Transplantation: A Comparative Study of BioUni and Snowman Techniques for Ovoid Lesions.

Treatment of large articular cartilage lesions of the knee includes surgical options one of which includes cartilage replacement therapies. Among these therapies include osteochondral allograft (OCA) transplantation, which can be performed utilizing a BioUni® (Arthrex BioUni® Instrumentation System; Arthrex, Naples, FL) replacement and a 'snowman' technique of repair. To compare clinical and radiographic outcomes in patients who have undergone multiplug OCA transplantations utilizing a BioUni® replacement and a 'snowman' technique of repair. Patients who underwent OCA transplantation utilizing a snowman technique or BioUni® replacement between January 1st, 2012 and December 31st, 2018, and who had a minimum 1-year follow-up at the same institution were identified for inclusion in this study via current procedural terminology (CPT) codes. Charts of included patients were reviewed for injury and treatment details as well as demographic information. Imaging studies and operative reports were reviewed and pre and postoperative subjective and objective outcome measures were recorded. Twenty-eight patients underwent OCA transplantation with either BioUni® replacement (n=5) or with snowman technique repair (n=23). Defects in both groups had similar characteristics including size, area, location, and classifications. Patient-reported outcomes using the Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR), International Knee Documentation Committee (IKDC), and Physical Health Composite Score (PCS-12) were similar at baseline and increased post-operatively for both groups with no significant differences between techniques after a mean follow-up of 2.77 ± 0.83. Although it did not reach significance, the snowman group had higher rates of knee-related complications (13%) and need for revision surgery (22%) when compared to BioUni® (0% and 0%, respectively). The use of both BioUni® and snowman techniques for large, unicondylar articular cartilage lesions of the femoral condyle demonstrate improved patient-reported outcomes at short-term follow-up. The use of the snowman technique presents relatively higher rates of revision similar to previous studies with no statistical difference in patient-reported outcomes when compared to those of a single plug OCA using a BioUni® system.

Highly accelerated knee magnetic resonance imaging using deep neural network (DNN)–based reconstruction: prospective, multi-reader, multi-vendor study

In this prospective, multi-reader, multi-vendor study, we evaluated the performance of a commercially available deep neural network (DNN)–based MR image reconstruction in enabling accelerated 2D fast spin-echo (FSE) knee imaging. Forty-five subjects were prospectively enrolled and randomly divided into three 3T MRIs. Conventional 2D FSE and accelerated 2D FSE sequences were acquired for each subject, and the accelerated FSE images were reconstructed and enhanced with DNN–based reconstruction software (FSE-DNN). Quantitative assessments and diagnostic performances were independently evaluated by three musculoskeletal radiologists. For statistical analyses, paired t-tests, and Pearson’s correlation were used for image quality comparison and inter-reader agreements. Accelerated FSE-DNN reduced scan times by 41.0% on average. FSE-DNN showed better SNR and CNR (p < 0.001). Overall image quality of FSE-DNN was comparable (p > 0.05), and diagnostic performances of FSE-DNN showed comparable lesion detection. Two of cartilage lesions were under-graded or over-graded (n = 2) while there was no significant difference in other image sets (n = 43). Overall inter-reader agreement between FSE-conventional and FSE-DNN showed good agreement (R2 = 0.76; p < 0.001). In conclusion, DNN-based reconstruction can be applied to accelerated knee imaging in multi-vendor MRI scanners, with reduced scan time and comparable image quality. This study suggests the potential for DNN-accelerated knee MRI in clinical practice.

Knee Cartilage Lesion Management-Current Trends in Clinical Practice.

Many patients, particularly those aged above 40, experience knee joint pain, which hampers both sports activities and daily living. Treating isolated chondral and osteochondral defects in the knee poses a significant clinical challenge, particularly in younger patients who are not typically recommended partial or total knee arthroplasty as alternatives. Several surgical approaches have been developed to address focal cartilage defects. The treatment strategies are characterized as palliation (e.g., chondroplasty and debridement), repair (e.g., drilling and microfracture), or restoration (e.g., autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft). This review offers an overview of the commonly employed clinical methods for treating articular cartilage defects, with a specific focus on the clinical trials conducted in the last decade. Our study reveals that, currently, no single technology fully meets the essential requirements for effective cartilage healing while remaining easily applicable during surgical procedures. Nevertheless, numerous methods are available, and the choice of treatment should consider factors such as the location and size of the cartilage lesion, patient preferences, and whether it is chondral or osteochondral in nature. Promising directions for the future include tissue engineering, stem cell therapies, and the development of pre-formed scaffolds from hyaline cartilage, offering hope for improved outcomes.

Impact of humid climate on rheumatoid arthritis faecal microbiome and metabolites

Studies have shown that high humidity is a condition that aggravates the pain of rheumatoid arthritis (RA), but the relevant mechanism is controversial. Currently, there is a lack of experimental animal studies on high humidity as an adverse factor related to the pathogenesis of RA. We used healthy SD rats and collagen-induced arthritis (CIA) rats to investigate the effects of high humidity on arthritis. Integrated metabolomics analyses of faeces and 16S rRNA sequencing of the faecal microbiota were performed to comprehensively assess the diversity of the faecal microbiota and metabolites in healthy and CIA rats. In this study, high humidity aggravated arthritis in CIA rats, which manifested as articular cartilage lesions, increased arthritis scores, and an increase in proinflammatory cytokines. High humidity had a certain effect on the articular cartilage extent, arthritis score and proinflammatory cytokines of healthy rats as well. Furthermore, high humidity caused significant changes in faecal microbes and metabolites in both healthy and CIA rats. 16S rRNA sequencing of faecal samples showed that high humidity increased the amount of inflammation-related bacteria in healthy and CIA rats. Faecal metabolomics results showed that high humidity significantly altered the level of faecal metabolites in healthy rats and CIA rats, and the changes in biological functions were mainly related to the inflammatory response and oxidative stress. Combined analysis showed that there was a strong correlation between the faecal microbiota and faecal metabolites. High humidity is an adverse factor for the onset and development of RA, and its mechanism is related to the inflammatory response and oxidative stress. However, the question of how high humidity impacts RA pathogenesis needs to be further investigated.

New-Generation 0.55 T MRI of the Knee-Initial Clinical Experience and Comparison With 3 T MRI.

The aim of this study was to compare the detection rate of and reader confidence in 0.55 T knee magnetic resonance imaging (MRI) findings with 3 T knee MRI in patients with acute trauma and knee pain. In this prospective study, 0.55 T and 3 T knee MRI of 25 symptomatic patients (11 women; median age, 38 years) with suspected internal derangement of the knee was obtained in 1 setting. On the 0.55 T system, a commercially available deep learning image reconstruction algorithm was used (Deep Resolve Gain and Deep Resolve Sharp; Siemens Healthineers), which was not available on the 3 T system. Two board-certified radiologists reviewed all images independently and graded image quality parameters, noted MRI findings and their respective reporting confidence level for the presence or absence, as well as graded the bone, cartilage, meniscus, ligament, and tendon lesions. Image quality and reader confidence levels were compared ( P < 0.05 = significant), and clinical findings were correlated between 0.55 T and 3 T MRI by calculation of the intraclass correlation coefficient (ICC). Image quality was rated higher at 3 T compared with 0.55 T studies (each P ≤ 0.017). Agreement between 0.55 T and 3 T MRI for the detection and grading of bone marrow edema and fractures, ligament and tendon lesions, high-grade meniscus and cartilage lesions, Baker cysts, and joint effusions was perfect for both readers. Overall identification and grading of cartilage and meniscal lesions showed good agreement between high- and low-field MRI (each ICC > 0.76), with lower agreement for low-grade cartilage (ICC = 0.77) and meniscus lesions (ICC = 0.49). There was no difference in readers' confidence levels for reporting lesions of bone, ligaments, tendons, Baker cysts, and joint effusions between 0.55 T and 3 T (each P > 0.157). Reader reporting confidence was higher for cartilage and meniscal lesions at 3 T (each P < 0.041). New-generation 0.55 T knee MRI, with deep learning-aided image reconstruction, allows for reliable detection and grading of joint lesions in symptomatic patients, but it showed limited accuracy and reader confidence for low-grade cartilage and meniscal lesions in comparison with 3 T MRI.

In situ observation of cartilage matrix based on two-photon fluorescence microscopy

Articular cartilage lesions remain a major challenge for clinicians and researchers. Several techniques, such as histological scoring, magnetic resonance imaging, and tissue section staining, are available for detecting cartilage degeneration and lesions and evaluating cartilage repairs. Nevertheless, these methods are complex and have numerous influencing factors, which may present obstacles to efficient communication between studies. In this study, we developed a fluorescence observation system that integrated a two-photon laser scanning confocal microscope (TPLSCM) with the second-harmonic generation (SHG) of a cartilage matrix. The observation system enabled the detection of autofluorescence emitted by the cartilage matrix without species specificity, facilitating both qualitative and quantitative analyses of the cartilage matrix. Notably, this observation could be applied three-dimensionally to a fresh specimen in situ up to a depth of 300 μm, obviating the need for traditional histological fixation, slicing, or staining. Furthermore, using this observation system, we reconstructed a three-dimensional (3D) image and a 3D model of the cartilage matrix. The utilization of the 3D fluorescence model may serve as a dependable option for the fabrication of cartilage matrix biomimetic scaffolds in future studies.

Retrograde Drilling for Hepple-V Subchondral Lesion of Talus using 3D Image-based Navigation Assisted Endoscopic Technique

Category: Ankle; Arthroscopy Introduction/Purpose: Retrograde drilling remains technically challenging, due to the difficulty of identifying the accurate location of cysts on fluoroscopic images or matching the tip of the drill guide under arthroscopic visualization. This studies aim was to evaluate the 3-dimentional(3D) image-based surgical navigation system assisted endoscopic retrograde drilling technique for subchondral lesions of the talus. Methods: From Mar 2018 to Jun 2020, 21 cases with Hepple-V type subchondral lesions of the talus were treated with 3D image- based surgical navigation system assisted endoscopic retrograde drilling technique. Arthroscopic views were categorized per Pritsch’s classifications. The American Orthopaedic Foot and Ankle Society (AOFAS) scores and Visual Analog Scale (VAS) scores were evaluated at the preoperative and final follow-up appointments. All complications were also recorded. Results: The average follow-up time was 29.2 ± 9.4 months (range, 24 – 48). Only 9 cases (42.9%) showed intact and normal cartilage surfaces (grade 0, group A), 12 cases (57.1%) had intact, soft cartilage surfaces (grade I, group B). At the final follow-up, the average of the AOFAS scores and VAS scores were 89.0 ± 2.1 vs 88.3 ± 2.0 and 0.8 ± 0.2 vs 0.8 ± 0.3, respectively. There were no significant differences between both groups. In group B, however, two patients were documented with signs of recurrence after 2 years postoperative. Also, an additional overlying cartilage lesion was noticed in another patient. Finally, two patients were given revised surgery. Conclusion: The 3D image-based surgical navigation system assisted endoscopic retrograde drilling technique is accurate, effective and safe for the subchondral lesions of the talus. The ideal indication is subchondral cysts with intact and normal cartilage surfaces. However, these patients are uncommon.

Radial Planes in Hip Magnetic Resonance Imaging: Techniques, Applications, and Perspectives.

The hip cartilage and labrum, as the main targets of femoroacetabular impingement, sports-related or traumatic damage, as well as congenital and developmental abnormalities, have attracted increasing attention with the development of magnetic resonance imaging (MRI) and hip arthroscopy. MRI is a commonly used imaging modality to noninvasively visualize the hip cartilage and labral lesions. However, conventional orthogonal MRI planes encounter unique challenges given the ball-and-socket configuration of the hip joint, its anatomically abducted and anteverted orientation, and the thin, closely apposed cartilage enveloping the femoral head and acetabulum. Advancements in hip MRI's radial plane, which is acquired through the center of the hip joint, offer a solution. This technology provides true cross-sectional images of the cartilage and labrum perpendicular to the curvature of the joint, thereby mitigating the partial-volume-averaging effects. The integration of 3.0-Tesla high field strength and three-dimensional (3D) acquisition techniques further enhances the capabilities of the radial plane. This combination yields a high signal-to-noise ratio, high spatial resolution, high contrast between intraarticular structures, while minimizing partial-volume-averaging effects. Such improvements potentially facilitate the comprehensive detection of even minor chondral and labral lesions. The capability for multiplanar reconstruction from a single 3D volumetric acquisition further strengthens the usefulness of the radial plane by aiding in precise localization of hip cartilage and labral lesions, in line with hip arthroscopy findings. These advancements have the potential to standardize MRI evaluations and radiographic reporting systems for hip cartilage and labrum, offering precise guidance for hip arthroscopy. This article presents a comprehensive review of radial plane technology applied to the hip MRI, and discusses the morphological assessment and localization of hip cartilage and labral lesions utilizing this advanced imaging technique. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 2.

Osteomodulin downregulation is associated with osteoarthritis development

Abnormal subchondral bone remodeling leading to sclerosis is a main feature of osteoarthritis (OA), and osteomodulin (OMD), a proteoglycan involved in extracellular matrix mineralization, is associated with the sclerotic phenotype. However, the functions of OMD remain poorly understood, specifically in vivo. We used Omd knockout and overexpressing male mice and mutant zebrafish to study its roles in bone and cartilage metabolism and in the development of OA. The expression of Omd is deeply correlated with bone and cartilage microarchitectures affecting the bone volume and the onset of subchondral bone sclerosis and spontaneous cartilage lesions. Mechanistically, OMD binds to RANKL and inhibits osteoclastogenesis, thus controlling the balance of bone remodeling. In conclusion, OMD is a key factor in subchondral bone sclerosis associated with OA. It participates in bone and cartilage homeostasis by acting on the regulation of osteoclastogenesis. Targeting OMD may be a promising new and personalized approach for OA.

Evaluation of the anti-inflammatory activity of fisetin-loaded nanoparticles in an in vitro model of osteoarthritis

Cartilage lesions, especially osteoarthritis (OA), are a common health problem, causing pain and disability in various age groups, principally in older adults and athletes. One of the main challenges to be considered in cartilage tissue repair is the regeneration of cartilage tissue in an active inflammatory environment. Fisetin has various biological effects including anti-inflammatory, antioxidant, apoptotic, and antiproliferative activities. The only disadvantages of fisetin in the pharmaceutical field are its instability and low solubility in aqueous media. This study is aimed at preparing chitosan (CS)-based nanoparticles to yield fisetin with improved bioavailability features. Then, the effect of fisetin-loaded nanoparticles (FNPs) on inflammatory responses in interleukin-1β (IL-1β) pretreated human chondrocytes has also been investigated. FNPs presented an average size of 363.1 ± 17.2 nm and a zeta potential of + 17.7 ± 0.1 mV with encapsulation efficiency (EE) and loading capacity (LC) of 78.79 ± 7.7% and 37.46 ± 6.6%, respectively. The viability of human chondrocytes was not affected by blank nanoparticles (BNPs) up to a concentration of 2000 μg/mL. In addition, the hemolysis results clearly showed that FNPs did not damage the red blood cells (RBCs) and had good hemocompatibility within the range investigated. FNPs, similar to fisetin, were able to inhibit the inflammatory responses induced by IL-1β such as the expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) while increasing the production of an anti-inflammatory cytokine such as interleukin-10 (IL-10). Overall, the in vitro evaluation results of the anti-inflammatory activity showed that FNPs can serve as delivery systems to transfer fisetin to treat inflammation in OA.

Simvastatin retards cartilage degradation and subchondral bone deterioration induced by a high-fat diet in mice

ABSTRACT To evaluate the effects of simvastatin on the degeneration of cartilage and subchondral bone in a mice model of osteoarthritis (OA) induced by obesity. Thirty male 3-month-old C57BL/6J mice were randomized into three groups: mice with normal diet + vehicle (distilled water) (Control), mice with High-fat diet + vehicle (HFD), mice with HFD + Simvastatin (HFD+S). HFD+S group were treated with simvastatin (10 mg/kg/day) for 12 weeks. The pathology of OA was assessed by histomorphology analyses, immunohistochemistry, micro-computed tomography, and enzyme-linked immunosorbent assay. Histomorphological analysis revealed that OA was significantly exacerbated by the HFD-induced obesity and markedly alleviated by the simvastatin intervention. In details, simvastatin ameliorated the abnormal metabolic status and cartilage lesions, significantly increased aggrecan and collagen-II expression and decreased the expression of MMP-13 and leptin in cartilage. Furthermore, the results of micro-CT analysis revealed that the HFD+S group exhibited higher BMD, BV/TV, and Tb.N values but a lower Tb.Sp value than that of the HFD group. Serum glucose, leptin, and IL-1β concentrations were significantly correlated with the OARSI score. Histomorphological analysis revealed that OA was significantly exacerbated by the HFD-induced obesity and markedly alleviated by the simvastatin intervention. In details, simvastatin ameliorated the abnormal metabolic status and cartilage lesions, significantly increased aggrecan and collagen-II expression and decreased the expression of MMP-13 and leptin in cartilage. Furthermore, the results of micro-CT analysis revealed that the HFD+S group exhibited higher BMD, BV/TV, and Tb.N values but a lower Tb.Sp value than that of the HFD group. Serum glucose, leptin, and IL-1β concentrations were significantly correlated with the OARSI score. The HFD-induced obesity aggravates articular degeneration and deterioration in subchondral bone, which could be improved by the intervention of simvastatin, suggesting that simvastatin may be a potential candidate for amelioration of the progression of obesity induced-OA.

Teknik Pemeriksaan MRI Genu Dengan Penambahan Sequence Axial 3D Spoiled Gradient Recalled Echo

Magnetic Resonance Imaging (MRI) is a medical diagnostic imaging technique that works on the principle of nuclear magnetic resonance. MRI aircraft can produce diagnostic images of the inside of the human body in both sagittal, coronal, and transverse cuts, Magnetic resonance imaging (MRI) is a widely accepted non-invasive technique for the evaluation of cartilage lesions. The femur, tibia, fibula, and patella are united into one complex group by ligaments. According to Moeller, Genu Examination uses STIR Sequence, Sagital T2 Weighted Fat saturated, Sagittal 3D GRE, Proton Density weighted fat saturated T1 Coronal. The author's purpose in conducting this study is because Genu Examination at one of the Jakarta Hospital in the Case of Soft Tissue Tumor, Meniscus Tear and Oesteoarthritis added the Axial 3D SPGR sequence. The research method used is descriptive research with an observational approach. Data collection was carried out on June 5 to August 31 using Mri GE aircraft with a power of 1.5 Tesla. The patient samples used in this study were three patients with clinical Soft Tissue Tumor, Meniscus Tear, and Osteoarthritis. Data collection was carried out through observation, interviews and Genu Examination Documentation with the addition of Axial 3D SPGR. The examination is carried out using Quad Knee Coil, the patient's position is supine, feet first. The sequences used in the examination at one of the Jakarta hospitals are Axial Proton Density Fat saturated, Sagital Proton Density Fat saturated, Sagital T2, Coronal Proton Density Fat saturated, Coronal STIR. The role of the Axial 3D SPGR sequence is to evaluate articular cartilage due to its clear depiction of cartilage morphology and high signal to noise ratio (SNR) images.

Comparing and predicting the outcome of anterior cruciate ligament reconstruction performed within one year and one year after injury

Background: The anterior cruciate ligament reconstruction (ACLR) should not be delay too long to get a good outcome but how long delay could be considered acceptable is not known. The objective of this study was to assess the outcome of surgery performed within and after a year of injury. We also predicted the operative outcome if the surgery is further delayed and several associated factors were also evaluated if they could influence the outcome. Methodology: Thirty-six patients were recruited in the early group where surgery is performed within a year of injury and thirty were in the delayed group where surgery was after a year of injury. Age, sex, body mass index, Tegner activity level and duration from the time of injury to surgery were evaluated. Surgical outcomes were measured at one year follow up after surgery were Lysholm score and limb symmetry index (LSI). Results: Mean time from injury to surgery for early and delayed groups were eight months and 18 months. Timing from injury to surgery affects the outcome parameters. Both groups showed good outcomes but the early group showed better LSI and Lysholm scores (p&lt;0.5). LSI was better in predicting the outcome of surgery compared to Lysholm score (67% vs 43%). Conclusions: Early ACLR showed better outcome but the late ACLR still demonstrate acceptable result in the absent of high grade cartilage lesion. LSI is better at predicting the outcome of surgery. Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 876-881

Expression Profiles of Long Non-Coding RNAs in the Articular Cartilage of Rats Exposed to T-2 Toxin.

T-2 toxin could induce bone damage. But there is no specific mechanism about the long non-coding RNAs (lncRNAs) involved in T-2 toxin-induced articular cartilage injury. In this study, 24 SD rats were randomly divided into a control group and a T-2 group, which were administered 4% absolute ethanol and 100 ng/g · bw/day of T-2 toxin, respectively. After treatment for 4 weeks, safranin O/fast green staining identified the pathological changes in the articular cartilage of rats, and immunofluorescence verified the autophagy level increase in the T-2 group. Total RNA was isolated, and high-throughput sequencing was performed. A total of 620 differentially expressed lncRNAs (DE-lncRNAs) were identified, and 326 target genes were predicted. Enrichment analyses showed that the target genes of DE-lncRNAs were enriched in the autophagy-related biological processes and pathways. According to the autophagy database, a total of 23 autophagy-related genes were identified, and five hub genes (Foxo3, Foxo1, Stk11, Hdac4, and Rela) were screened using the Maximal Clique Centrality algorithm. The Human Protein Atlas database indicated that Rela and Hdac4 proteins were highly expressed in the bone marrow tissue, while Foxo3, Foxo1, and Stk11 proteins were reduced. According to Enrichr, etoposide and diatrizoic acid were identified as the key drugs. The real-time quantitative PCR results were consistent with the RNA sequencing (RNA-Seq) results. These results suggested that autophagy was involved in the rat articular cartilage lesions induced by T-2 toxin. The lncRNAs of NONRATG014223.2, NONRATG012484.2, NONRATG021591.2, NONRATG024691.2, and NONRATG002808.2, and their target genes of Foxo3, Foxo1, Stk11, Hdac4, and Rela, respectively, were the key regulator factors of autophagy.

Knee lesions with anterior cruciate ligament (ACL) tear in Iraqi adult males: arthroscopic findings.

This cross-sectional study aimed at exploring the frequency and extent of knee joint lesions associated with delayed treatment of anterior cruciate ligament (ACL) injury. It enrolled 300 patients from 2020 to 2022 who were subjected to arthroscopy for anterior cruciate ligament reconstruction. The sample was comprised of Iraqi adult male patients from different regions of Iraq, and the surgical procedure was carried out in Al-Diwaniyah Teaching Hospital. The findings were recorded by Karl Storz's camera system. Dissection and arthroscopy were done under general anesthesia using an anterolateral portal technique. The study employed a visualization of the anterior cruciate ligament probing the meniscus and reaching the posteromedial space for the ramp lesion. The mean age of patients was 28.05±6.92 years, ranging from 19 to 35 years and the mean duration from onset of injury to the time of operation was 3.69±1.07 years, ranging from 6 months to 10 years. The arthroscopic examination revealed medial meniscus tear in 80% of the cases, lateral meniscus tear in 40% of the cases, cartilage lesion in 40% of the cases, and meniscus ramp lesions in 10% of the cases. Most cases of ACL tear are associated with a meniscus injury, cartilage defect, and collateral ligament tear. These serious lesions, such as complex meniscus tears or full articular cartilage defects, are a direct consequence of delayed treatment. Consequently, it is crucial to inform the patients about the significant issues that can arise due to treatment delays.

Added Value of MRI Knee Cartigram in Assessment of Anterior Knee Pain in Comparison to Conventional Standard MRI

Background Osteoarthritis (OA) is a multi-tissue, multi-factorial disease and worldwide a major cause of disability resulting from reduced joint mobility and function. Progressive loss of hyaline cartilage is one of the hallmark features of osteoarthritis, initiated by a loss of proteoglycans and an increase in water content, followed by a loss of type II collagen and a change in collagen fiber orientation. Objective To evaluate the role of T2 mapping in detection of degenerative changes in articular cartilage of knee joint as compared to standard clinical magnetic resonance imaging (MRI) at 1.5T. Patients and Methods From April 2020 to November 2020, this prospective Study was done to use T2 mapping to visualize the articular cartilage of the knee on 1.5 T MR Scanner using special software to evaluate the efficiency Of T2 mapping to detect cartilage lesions. The material of this study included 380 patients. The study includes all of them come complaining of knee pain and 2 of them had previous minor knee trauma, each patient had a single MRI exanimation including conventional MRI routine protocol and added a single complementary T2 mapping. Results there were significant differences between T2 mapping and conventional MRI sequence in the ability to detect cartilage degeneration as T2 mapping was capable of detecting all lesions that were visible on the clinical MRI. Moreover, T2 mapping showed more cartilage lesions than clinical MRI T2 mapping showed more cartilage lesions than clinical MRI, and in T2 maps the lesions appeared generally wider. This proposes that T2 mapping is feasible in the clinical setting and may reveal cartilage lesions not seen on the standard knee MRI. Conclusion Our results suggest that T2 mapping is an interesting MRI sequence for the exploration of patients articular cartilage in and should be included in the routine protocol if cartilage pathology is suspecting as it may improve the diagnostic accuracy of MRI for focal chondral lesions, and should help decide whether and MR-arthrography or CT-arthrography is necessary.

Comparison of a Routine Magnetic Resonance Imaging &amp; T2* Mapping of Articular Cartilage in Knee Osteoarthritis

Purpose To detect the knee articular cartilage lesions in T2* mapping as compared to a routine standard magnetic resonance imaging (MRI) at 3T. Material and Methods Twenty-five patients, complaining of knee pain and trauma, underwent knee MRI and were imaged with a standard knee MRI protocol (proton-density-weighted Fat Sat sagittal and axial series, T2weighted sagittal and axial series, and T1-weighted coronal series) and Proton density 3D sagittal and axial sequences are added, then images of T2* relaxation time is generated with color-coded mapping representing the relaxation time. The detected lesions were evaluated for lesion width (mm), lesion depth (1/3, 2/3, or 3/3 of cartilage thickness), and T2 values (20–40 ms, 40–60 ms, or 60– 80 ms). Results The study was conducted on 25 patients (13 female &amp; 12 male with a mean of 44.92 ± 11.74 years). 87 lesions were detected both on MRI and T2 maps, while 41 lesions were visible only on T2* maps. The cartilage lesions’ width and depth measurements showed no statistically significant difference on T2 maps as compared to standard knee MRI. Many lesions (45) had moderately (T2 40–60 ms) increased T2 values, while 29 lesions had slightly (T2 20–40 ms) and 13 lesions with remarkably (T2 60– 80 ms) increased T2 relaxation times. Conclusion T2 mapping of articular cartilage is efficient in cartilage evaluation and may reveal early cartilage lesions not visible on standard clinical MRI.