Periarticular Osteophytes Research Articles

Spectrum of computed tomographic findings in 58 canine elbows with fragmentation of the medial coronoid process

To describe in detail the computed tomographic findings in elbows of dogs with fragmentation of the medial coronoid process of the ulna. Retrospective review of computed tomographic images of 58 elbows that had displaced medial coronoid process fragment(s), non-displaced medial coronoid process fragment or a stable fissure in the articular cartilage of the medial coronoid process at arthroscopy. Bone fragments were observed in 85 per cent elbows with a displaced fragment at arthroscopy, in 18 per cent elbows with a non-displaced fragment and in 29 per cent elbows with a stable fissure. Fissures in the subchondral bone were observed in computed tomographic images of 43 per cent elbows that had a stable fissure at arthroscopy. Abnormal shape, sclerosis and lucency affecting the medial coronoid process, subchondral sclerosis of the ulna and humerus, irregular radial incisure of the ulna and periarticular osteophytes were observed in a similar proportion in dogs regardless of the arthroscopic findings. Kissing lesions affecting the medial aspect of the humeral condyle were mainly associated with displaced fragments. Signs of joint incongruity were observed in dorsal and sagittal reconstructed computed tomographic images in 24 per cent elbows. A wide range of abnormalities may be observed in computed tomographic images of dogs with fragmented medial coronoid process. Computed tomographic is moderately sensitive for detection of fragments.

Effects of long-term estrogen replacement therapy on bone turnover in periarticular tibial osteophytes in surgically postmenopausal cynomolgus monkeys

The aims of the present study were to assess the effects of long-term estrogen replacement therapy (ERT) on size and indices of bone turnover in periarticular osteophytes in ovariectomized cynomolgus monkeys and to compare dynamic indices of bone turnover in osteophyte bone with those of subchondral bone (SCB) and epiphyseal/metaphyseal cancellous (EMC) bone. One hundred sixty-five adult female cynomolgus macaques were bilaterally ovariectomized and randomly divided into three age- and weight-matched treatment groups for a 36-month treatment period. Group 1 (OVX control) received no treatment, Group 2 (SPE) received soy phytoestrogens, and Group 3 (ERT) received conjugated equine estrogens in the diet; all monkeys were labeled with calcein before necropsy. A midcoronal, plastic-embedded section of the right proximal tibia from 20 randomly selected animals per treatment group was examined histologically. Forty-nine of the sections (OVX control, n = 16; SPE, n = 16; ERT, n = 17) contained lateral abaxial osteophytes, and static and dynamic histomorphometry measurements were taken from osteophyte bone, SCB from the lateral tibial plateau, and EMC bone. Data were analyzed using the ANOVA and Kruskal–Wallis test, correlation and regression methods, and the Friedman and Wilcoxon signed rank test. There was no significant effect of long-term ERT on osteophyte area or on any static or dynamic histomorphometry parameters. The bone volume, trabecular number, and trabecular thickness in osteophyte bone were considerably higher than in EMC bone; whereas, trabecular separation was considerably lower in osteophyte bone. In all three treatment groups, BS/BV was significantly lower in osteophyte bone vs. EMC bone and significantly higher in osteophyte bone vs. lateral SCB. We conclude that osteophyte area and static and dynamic histomorphometry parameters within periarticular tibial osteophytes in ovariectomized cynomolgus monkeys are not significantly influenced by long-term ERT, but that site differences in static and dynamic bone histomorphometry parameters exist, particularly between EMC and osteophyte bone.

DIGITOS-Fingermittelgelenkprothese - Langzeitergebnisse

Most important methods for the surgical treatment of painful arthritis of the proximal interphalangeal joint are the joint fusion or the implantation of a prosthesis. There are a lot of different models for joint replacement. Sixteen patients received 19 middle joint replacements performed with the DIGITOS-prosthesis between 1996 and 1999. Over a period of seven years, 14 patients with 17 prostheses have been observed prospectively. In the 7-year follow-up, a minimal radiolucent line at the bone-cement junction and huge periarticular osteophytes could be found in every case. No cortical penetration, luxation, or implant fractures were recorded. The preoperative median range of motion was 50 degrees. Postoperatively, there was an improvement to 60 degrees. The range of motion decreased to 50 degrees after one year and to as little as 30 degrees after seven years. Preoperatively, eleven patients had pain with activity and three had pain without activity. During the whole follow-up period there were only two patients who had pain at work. All patients were satisfied with the results of the operation throughout the control period and would choose the same treatment again.

Ulnocarpal arthrodesis and limb lengthening for the management of radial agenesis in a dog

Radial agenesis was diagnosed in a nine-week-old boxer. An ulnocarpal arthrodesis was performed when six months of age to improve limb alignment and enable weight bearing. When the dog was 10 months old, a hinged circular fixator was applied to the limb to gradually lengthen the ulna and correct angular and rotational deformity. The fixator was removed at 16 months of age. At this time, there was 1.7 cm (6 per cent) shortening of the affected antebrachium-metacarpus and 2.6 cm (15 per cent) compensatory overgrowth of the humerus compared with the contralateral limb. Inability to extend the digits was a complication that improved with physiotherapy. Follow-up at 23 months of age showed good limb use when walking and running. Radiographs of the elbow showed periarticular osteophytes and subcoronoid sclerosis of the ulna.

Effects of long-term estrogen replacement therapy on the prevalence and area of periarticular tibial osteophytes in surgically postmenopausal cynomolgus monkeys

Osteoarthritis (OA) occurs naturally in cynomolgus macaques. The purposes of the present study were to: 1) develop histological measurement schemes to measure the cross-sectional area of axial and abaxial osteophytes in the proximal tibia; 2) determine the effects of long-term estrogen replacement therapy (ERT) on osteophyte prevalence and area; and 3) assess relationships between osteophyte size and risk factors of OA (age and body weight) and concurrent bone and cartilage lesions. Adult female cynomolgus macaques ( n = 180) were bilaterally ovariectomized (OVX) and were treated for 3 years with ERT, soy phytoestrogens (SPE), or no hormones (OVX controls). At necropsy, the prevalence and cross-sectional area of periarticular tibial osteophytes were evaluated histologically. Treatment effects on osteophyte prevalence and area were evaluated using Chi-square analyses and Kruskal–Wallis test, respectively; other comparisons were evaluated using regression analyses. The prevalence of abaxial osteophytes in the medial tibial plateau was not significantly affected by treatment group; however, the prevalence of abaxial osteophytes in the lateral tibial plateau was significantly lower in ERT group than SPE group ( p < 0.01). The total number of abaxial osteophytes (sum of lateral and medial) was significantly lower in ERT group compared to OVX and SPE groups. Neither the prevalence of axial osteophytes nor the sum of lateral and medial axial osteophytes was significantly affected by treatment in either tibial plateau. There were no significant treatment effects on axial or abaxial osteophyte cross-sectional area in either tibial plateau. There was a significant positive correlation between abaxial osteophyte area and SCB thickness in the medial tibial plateau ( p = 0.048); however, there were no significant correlations between abaxial osteophyte area ( medial or lateral) and age or body weight. In this model of naturally occurring OA, long-term ERT does not consistently reduce the prevalence, and has no significant effects on cross-sectional area, of periarticular tibial osteophytes.

The ultrastructure of the peri-articular osteophytes - an evaluation by scanning electron microscopy

Osteophytes are intra-articular osteochondral tissues, which are usually found at the margins of degenerating synovial joints. The aetiology or pathogenesis of this tissue has been a subject of protracted debate. The aim of this study was to offer a possible aetiology and or pathogenesis of this expendable yet important osteochondral tissue using the scanning electron microscopy to evaluate the structure of the cartilage mantle of osteophytes and the relationship of this mantle with that of the adjoining normal articular cartilage. Sections of periarticular osteophytes and osteophyte-normal articular cartilage composite tissues were obtained during total knee replacement for osteoarthritis (OA). These sections were routinely processed and examined using the scanning electron microscope with emphasis on the osteophytic cartilage mantle and the merger of the osteophyte and the adjoining normal articular cartilage. The cartilage mantle of osteophytes was found to be thinner but continuous with that of the adjoining normal articular cartilage. However, a longitudinal bar of acellular tissue was found to separate the subchondral bones of both tissues. The cellular (chondrocyte) arrangement in the osteophytic cartilage was similar to that of the adjoining normal articular cartilage. In addition, in the superficial layer, there was looping of collagen fibres between the normal articular cartilage mantle and that of the osteophytic tissues. The continuity between the cartilage mantle of osteophytes and the adjoining normal articular cartilage may suggest that in the formation of osteophytes, the chondrocytes from the adjoining normal articular cartilage greatly influence the mesenchymal tissue precursor of osteophyte to differentiate along a chondrocytic pathway initially. With subsequent vascular invasion probably from the periosteum, the neocartilage develops a bony core with a completely separate blood supply from that of the adjoining subchondral bone.

P314 Effects of long-term estrogen replacement therapy on bone turnover in periarticular tibial osteophytes in surgically postmenopausal cynomolgus monkeys

P314 Effects of long-term estrogen replacement therapy on bone turnover in periarticular tibial osteophytes in surgically postmenopausal cynomolgus monkeys

Oncogene expression in the peri-articular osteophytes

The aim of this study was to ascertain the proliferative and probably reparative potentials of the periarticular osteophytes by evaluating the sites of expression of c-myc, c-jun and c-fos oncogenes in this neoplastic repair tissue. Sections of osteophytes were obtained from knees of patients undergoing total knee arthroplasty for osteoarthritis. Decalcified sections of osteophytes were stained for c-myc and c-jun oncogenes using the avidin HRP technique. Sections of breast carcinoma were used as positive controls. Undecalcified or frozen sections of osteophytes were stained for c-fos oncogene using the avidin alkaline phosphatase technique. Sections of the human skin were used as positive control. For both techniques, sections of normal articular cartilage were used as negative controls. The chondrocytes of the entire cartilage mantle of the peri-articular osteophyte had positive staining for c-myc oncogene but no staining for c-jun oncogene. The basal chondrocytes of the deep layer of the cartilage mantle of the peri-articular osteophyte had positive staining for c-fos oncogene. The normal articular cartilage sections had no staining for any of the oncogenes evaluated. The expression of c-myc oncogene in the osteophytic chondrocytes suggests that these cells are actively proliferating. However, c-fos expression in the basal chondrocytes implies that these cells are capable of transformation. This result confirms the proliferative ability of the peri-articular osteophytes and this may suggest that this osteochondral repair tissue, which is apparently wrongly sited, may be a source of tissue for osteochondral grafting for full thickness articular cartilage defects.

Hallux rigidus

Hallux rigidus is a common problem of the first metatarsophalangeal joint and is particularly common in the 31–69 year old age group. Loss of articular cartilage narrowing of joint space and formation of periarticular osteophytes are present and increase over time, often leading to palpable osteophyte formation. The authors suggest that a diagnosis of hallux rigidus be made if at least 4 of the following are present at the big toe: pain, stiffness, palpable exostosis, positive X-ray findings, positive axial grind test, occasional synovitis, decreased motion on motion palpation (particularly dorsiflexion). This case study follows a 36-year-old male professional tennis player over a 7 year period under various forms of management including orthopaedic, physical therapy and chiropractic care. Initial surgery provided some relief, subsequent physiotherapy did not significantly reduce the patient's pain while chiropractic manipulation and mobilization on two separate occasions provided marked reduction in pain scores. NSAID usage and “punching out” his shoes also provided some relief. There is a reasonable possibility that general foot and big toe mobilization and the Brantingham “protective” big toe manipulation may reduce the pain of hallux rigidus. A randomized-controlled study should be done to ascertain the efficacy of such a treatment protocol.

T lymphocytes are not required for the spontaneous development of entheseal ossification leading to marginal ankylosis in the DBA/1 mouse.

Male mice of the DBA/1 inbred strain spontaneously develop polyarthritis and toe stiffness when they are > or =4 months old. The arthritis affects predominantly the proximal interphalangeal joints and the ankle of the hind limbs. The current study was aimed at determining the importance of T lymphocytes in this disease. Histologic sections of hindpaws from arthritic DBA/1 mice were examined. The role of T lymphocytes was studied by using mice lacking either alpha/beta or gamma/delta T cells due to a deletion in T cell receptor beta (TCRbeta) or TCRdelta genes. Arthritis was associated with a massive proliferation of connective tissue (fibroblasts) in synovium and adjacent tissues. Chondroid and bone tissue outgrowth at the entheses generated periarticular osteophytes (enthesophytes) which were deposited on the unchanged margins of the preexisting bone. In some cases, the enthesophytes enlarged enough to bridge and fuse the bones by marginal ankylosis. Articular cartilage was essentially unaffected. Abnormal chondroid tissue formation was common in stiffened toes, suggesting that the same pathology may underlie both joint stiffness and arthritis. Dividing chondrocytes were commonly seen in tendons, but without correlation with arthritis or toe stiffness. Mice lacking alpha/beta or gamma/delta T cells developed arthritis at the same incidence as control littermates. The naturally occurring arthritis in male DBA/1 mice is a T cell-independent enthesopathy characterized by periarticular hyperostosis and marginal ankylosis. This suggests that the ossification leading to peripheral ankylosis of the joints in human enthesopathies, such as diffuse idiopathic skeletal hyperostosis and seronegative spondylarthropathies, is a T cell-independent process.

Evaluation of different projections for radiographic detection of tarsal degenerative joint disease in Icelandic horses.

Radiographs from 196 tarsi in 98 Icelandic horses were evaluated to compare the accuracy of four different projections in detecting radiographic signs of degenerative joint disease in the distal tarsus. The extent and localization of tarsal degenerative joint disease found in one projection when reading all four projections of the same tarsus together was compared with the combined findings from all four projections. The results of reading individual radiographic projections without knowledge of the other three projections was also evaluated. Degenerative joint disease was detected most frequently in the plantarolateral-dorsomedial oblique (P1L-DMO) projection. The location with the highest relative frequency of radiographic findings was the dorsolateral aspect of the centrodistal and tarsometatarsal joints respectively. Radiographic signs of active bone remodelling was detected in 30 (33%) and periarticular osteophytes in 51 (56%) of 91 tarsi with degenerative joint disease.

A Comparison of the Compressive and Shear Stiffness of Periarticular Osteophytes, Hypertrophic Femoral Intercondylar Notch and Normal Articular Cartilage

The compressive and shear stiffness of periarticular osteophytes, hypertrophic femoral intercondylar notch and normal articular cartilage were compared by obtaining force-indentation curves and applying a shear force to the cartilage/bone interface. The primary stiffness (at 0–100N load) was similar for osteophytes (391N/mm), intercondylar notch (400N/mm) and normal articular cartilage (401N/mm). By contrast, the secondary stiffness (at 100–500N load) was much higher for the intercondylar notch (493N/mm) compared to the osteophytes (410N/mm). There were two varieties of osteophytes, "pink" and "white". Compared with "pink" osteophytes, "white" osteophytes exhibited features similar to a progressively hardening material and appear to be a more mechanically suitable material as an osteochondral graft for full thickness articular cartilage defect. The shear characteristics of all the samples were similar.

Hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint.

Hallux rigidus is characterized by restriction of motion at the first metatarsophalangeal joint8,11. It is a common disorder that has been reported to affect one in forty-five individuals who are more than fifty years of age19. There is a generalized decrease in motion with particular limitation of dorsiflexion8,27,35,51. Hallux rigidus is often associated with a mechanical block to dorsiflexion caused by periarticular osteophytes, with an impingement exostosis of the first metatarsal head against an osteophyte at the base of the proximal phalanx13,15,16,37,41. The natural course of this disorder is typical of degenerative processes, with progression of the osteoarthrotic changes leading to limitation of motion and interference with function of the metatarsophalangeal joint3,13,27,41. Other terms that have been used to describe this clinical entity include hallux limitus5,22,32,66, dorsal bunion37,41, and localized arthrosis32. When there is a large dorsal osteophyte, the great toe is in a position of flexion, which has led to use of the term hallux flexus43. As the position of the great toe becomes even more plantar, the metatarsal becomes elevated, which has led to use of the term metatarsus elevatus50. Hallux rigidus has been attributed to various causes, including trauma2,11,15,41,66, metabolic disorders4,15,16,35, and congenital disorders3,4,9,15,27,28,35,42,51. These disease processes result in degenerative changes within the joint, including loss of articular cartilage, narrowing of …

Diffuse idiopathic skeletal hyperostosis

Objective: To describe the axial and appendicular skeleton findings of diffuse idiopathic skeletal hyperostosis. To analyze the role of conventional radiography, computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of this condition. To discuss the differential diagnosis and diagnostic pitfalls of this disease. Material and methods: The involvement of vertebral and extravertebral sites including the pelvis, calcaneum, ulnar olecranon, and patella is frequently found in the literature. The lesions described are the anterior and lateral ossification of the spine, hyperostosis at sites of tendon and ligament insertion, ligamentous ossification, and periarticular osteophytes. The criteria for the diagnosis of diffuse idiopathic skeletal hyperostosis involving the spine are: flowing ossification along the anterior and anterolateral aspects of at least four contiguous vertebrae, preserved intervertebral disc height, no bony ankylosis of the posterior spinal facet joints, and finally no erosion, sclerosis or bony ankylosis of the sacroiliac joints. Results: The disease has about the same frequency in men (65%) and women (35%); it is most common in the thoracic spine and occurs less frequently in the lumbar and cervical spine. The disease most commonly presents in the sixth and seventh decades of life and its estimated frequency in the elderly is 5–15%. Signs and symptoms include stiffness and pain in the back, dysphagia due to direct esophageal compression/distorsion, pain related to associated tendinitis, myelopathy related to core compression associated to the ossification of the posterior longitudinal ligament, and pain related to vertebral complications—e.g. fracture/subluxation. Conclusion: While conventional radiography clearly confirms the diagnosis of diffuse idiopathic skeletal hyperostosis, CT and MRI better detect associated findings (e.g. ossification of the posterior longitudinal ligament) and complications (e.g. spinal cord compressive myelomalacia).

The arthroscopic managementof cartilage lesions, loose bodies, and synovial lesions of the elbow

Since elbow arthroscopy first graduated from a purely diagnostic procedure, the management of cartilage and synovial lesions has remained the most frequent therapy. The most common indications for elbow arthroscopy in the athletic population are the removal of loose bodies and the debridement of periarticular osteophytes, and for these mechanical disorders the procedure has clearly shown its value. The success in treating pathologic conditions in the elbow is substantially dependent on the ability of the arthroscopist. The high degree of congruency of the articular surfaces and the relatively small capsular volume demand a thorough knowledge of arthroscopic elbow anatomy and the relationships of the articulating surfaces. Skills in portal placement, instrument triangulation, and safely maneuvering the arthroscope to obtain optimal views are essential. To the degree that these necessities are met, gratifying results can be achieved in the arthroscopic management of loose bodies, chondromalacia, osteochondritis dissecans, synovitis, synovial osteochondromatosis, and lateral synovial plicas.

A study of 118 cases of navicular disease: radiological features.

Dorsoproximal-palmarodistal oblique, lateromedial and palmaroproximal-palmarodistal oblique radiographic projections were used with standard techniques to examine 118 horses with clinical signs of navicular disease. All radiological features which have previously been reported as significant changes in the navicular bones of horses with navicular disease were recorded. Comparisons were made between these features in lame limbs and sound limbs in unilaterally lame horses and most lame limbs and least lame limbs in bilateral but asymmetrically lame animals. Their relationship to the degree of lameness was also analysed. No relationships were identified between the characteristics of distal border synovial invaginations, flattening and/or thinning of the flexor cortex and limb distribution or severity of lameness. Defects in the flexor cortex, proximal border remodelling, medullary trabecular disruption and medullary sclerosis appeared to be related to limb affliction and severity of lameness while proximal border enthesophytes, and poor flexor corticomedullary demarcation presented evidence of a relationship to the grade of lameness. Poor flexor corticomedullary demarcation and fragmentation of the distal border were related to the severity of lameness in bilateral but asymmetrically affected horses. The presence of peri-articular osteophytes and mineralisation of the flexor digitorum profundus were too infrequently recognised to permit meaningful data evaluation.

Traumatic Coxofemoral Luxation In Dogs Results of Repair

The medical records of 171 dogs with traumatic hip luxations were examined. German shepherds, mixed breeds, and poodles were significantly overrepresented. The mean age of the patients at the time of diagnosis was 4.4 years (range 5 months to 14 years). Vehicular trauma caused 83% of the 133 luxations where the etiology was known; 53% had at least one other diagnosed traumatic injury. Long‐term results were obtained from owner questionnaires (25 dogs) or clinical and radiographic examinations (11 hip joints). The short‐term recurrence rate after closed reduction (47.3%) was higher than that after surgical reduction using any of the three surgical techniques most frequently used here (9.5, 12.5, and 14.3%), even when the operation was performed after failure of a closed reduction (11.8%). Excluding dogs that had a femoral head ostectomy, 68% (17 of 25) of the dogs had a normal gait, 16% had only a mild lameness, and 16% had more severe lameness when evaluated on an average of 31 months after repair. Of 11 hip joints radiographed on an average of 25 months following repair, five had no radio‐graphic abnormalities related to the luxation and six showed one or more of the following: periosteal new bone formation, femoral head subluxation, partial resorption of the femoral head, periarticular osteophytes, and subchondral bone erosion. Closed reduction should be the initial treatment of choice in uncomplicated luxations even though the rate of reluxation is high, because it avoids the need for surgery in approximately one half of affected dogs and does not increase the recurrence rate following subsequent surgical reduction.

Development of periarticular osteophytes in experimentally induced osteoarthritis in the dog. A study using microradiographic, microangiographic, and fluorescent bone-labelling techniques.

(1) The development of periarticular osteophytes in experimental osteoarthritis in the dog degins as early as 3 days after induction of the disease process. (2) Development of the osteophytes is still proceeding 48 weeks after induction. (3) The common site for development of the osteophyte is at the marginal zone where synovial membrane merges with fibrocartilage. (4) At this site the osteophyte begins as a deposition of outside the existing femoral bone cortex. (5) Further deposition of new bone and resorption lead to a remodelling which ultimately produces a mature osteophyte having a trabecular bone structure and free communication with the bone marrow spaces of the femur. (6) In some dogs there is also hyperplasia of bone with remodelling which takes place beneath the cartilage of the nonarticulating face of the trochlear ridge. This develops a mature trabecular structure later in the disease process and may become confluent with the osteophyte at the marginal zone. (7) The bone changes are not confined to development of the osteophyte. The whole distal end of the femur appears to have a marked increase in bone turnover, and there is also evidence of increased bone metabolism in the contralateral limb. (8) Dye injection techniques have shown that an increase in vascularity is associated with this development of new bone, and it is suggested that the results indicate the possible importance of a vascular component in the pathogenesis of osteoarthritis.