Periarticular Tissues Research Articles

No adverse effects on periarticular tissue by intra-articular vitamin D analogue calcipotriol in a reduced-dose zymosan-induced arthritis model in rats.

Calcipotriol, a vitamin D analogue, is an antiproliferative and anti-inflammatory drug currently used in psoriasis. Here, our aim was to analyse the safety of calcipotriol for cartilage and bone in alleviated-dose (0.1 mg instead of usual ≥1mg dose) zymosan-induced arthritis in rats. Theoretically, high doses of vitamin D or analogues could have detrimental effects on bone or cartilage. The rats were divided into four groups: vehicle (n = 9), dexamethasone 0.1 mg/kg (n = 9), calcipotriol 0.1 mg/kg (n = 8) and negative control (n = 10) with no injections. Arthritic rats were given phosphate-buffered saline (PBS) injections to left knees as a control. After euthanasia on day 8, all knees were imaged with micro-computed tomography for surface lesions and decalcified for histological analyses. Contrary to our expectations, no significant changes could be observed in the tomography data and histological scores among the three treatment groups or between the vehicle-treated and non-arthritic group. Calcipotriol did not cause adverse effects on cartilage or subchondral bone within a week, suggesting that it could be safely used in local treatment of arthritis. The alleviated model caused synovitis with local and systemic inflammatory response without cartilage erosions, which might be useful in studying self-limiting synovitis where cartilage or bone effects are not of primary interest.

Tophaceous Gout in Adults: Case Report and Review of the Literature

Gout is a microcrystalline arthropathy resulting from the deposition of sodium urate microcrystals in the articular and periarticular tissues, and even in the extra-articular tissues. It affects mainly men and its mechanism is at the origin of a delay in diagnosis, and consequently its severe forms can occur. We report a case of tophaceous gout in a 59 year old adult, with no family history of gout. Gout, whose first attack was at the age of 40, was polyarticular and affected the left wrist, elbows, knees, ankles and the left big toe. The diagnosis was based on clinical signs (tophi at the elbows, ankles, hands, and auricles) and paraclinical signs ( hyperuricemia at 620 ʯmol/l With normal at150-360 ʯmol/l in women and 310-420 ʯmol/l in men, presence of sodium urate cristals in the puncture fluid of the right knee, double- contour image on ultrasonography) by the ACR/Eular classification criteria. The background treatment was based on 120mg of Febuxostat per day with a favorable follow-up marked by the regression of signs.

Myositis ossificans of hip: A case report

Introduction: Myositis ossificans is a benign condition in which there is an increased activity of periarticular tissues resulting in intramuscular bone formation. In most of the cases trauma is the leading etiology.
 Case presentation: A 25 year old male with a history of pain and restricted range of motion of the left hip was admitted for further management. His hip motions were restricted with fixed flexion and abduction. There was a history of highway car accident with severe head injury and associated mid shaft comminuted fracture of left humerus. He was given ICU care for a period of two months. The imaging of left hip revealed mature myositis ossificans. The mass was removed surgically and post operatively the patient was rehabilitated with physiotherapy.
 Conclusion: Myositis ossificans is a benign heterotrophic ossification of the muscle tissue. It has a prevalence of less than 1 per 1 million. Trauma is the most frequent etiological factor seen in almost 60 -75% of the cases. Non-traumatic myositis ossificans is very rare. Combination of surgical excision with radiotherapy in the treatment of the myositis ossificans may give satisfactory results.

Hyaluronic acid in rheumatic disorders of the periarticular soft tissues: a brief descriptive review

Periarticular soft tissue disorders (PSTD) are typical manifestation of immunoinflammatory rheumatic diseases, primarily spondyloarthritis. However, in real clinical practice, physicians involved in the management of patients with musculoskeletal diseases often have to deal with "non-systemic" PSTD resulting from trauma, physical exertion, or degenerative processes associated with endocrine, metabolic, and cardiovascular diseases. PSTD causes acute and chronic pain, significant impairment of function and deterioration in the quality of life. The treatment of this pathology is complex and includes non-drug methods, painkillers and local injection therapy. Hyaluronic acid (HA) drugs occupy an important place in this treatment. Their use is pathogenetically justified, because when the tendon and enthesis are involved, the internal environment (intercellular matrix) change, and its basis is natural hyaluronate, which provides the viscoelastic properties of biological structures, as well as regulates metabolism, proliferative and immune processes. A relatively low molecular weight HA drug (530–730 kDa) has favorable rheological parameters, anti-inflammatory and anabolic potential, which makes it the drug of choice for local injection therapy of PSTD. This review briefly presents data on the pathogenesis of PSTD and the advisability of HA drugs use for its therapy, as well as the evidence base for the use of HA (530–730 kDa) in various types of ligamentous apparatus lesions.

PRIMARY NORMO-PHOSPHATEMIC TUMORAL CALCINOSIS - A RARE ENTITY

Tumoral calcinosis is a rare benign condition, characterized by massive deposition of calcium salts into peri-articular soft tissues. Majority are secondary to underlying chronic disorders like chronic renal failure. Primary Normo-phosphatemicTumoral Calcinosis is a rare entity. I hereby, report a case of primary normo-phosphatemictumoral calcinosis in a 11 years old female patient, managed by complete surgical excision.

Sequential Ultrasound Assessment of Peri-Articular Soft Tissue in Adhesive Capsulitis of the Shoulder: Correlations with Clinical Impairments-Sequential Ultrasound in Adhesive Capsulitis.

Recently, ultrasound measurements of the shoulder such as thickening of the rotator interval (RI) and the axillary recess (AR) are suggested as specific indicators of adhesive capsulitis. Herein, we evaluated the sequential changes in ultrasound parameters and clinical impairments and the correlation between the two in the case of adhesive capsulitis through a prospective observational study of 56 patients with adhesive capsulitis. Clinical assessments and ultrasound parameters, including the thicknesses of the RI and AR, were surveyed at baseline and after 1, 3, and 6 months. In 56 patients with adhesive capsulitis, the thickness of the AR significantly decreased at each follow-up evaluation, but the thickness of the RI showed a significant decrease only between the baseline and 1-month evaluation. In repeated analyses of correlation, the thickness of the AR was strongly correlated with all clinical impairments except the pain at rest and range of internal rotation in the affected shoulder. The thickness of AR was correlated with clinical impairments in patients with adhesive capsulitis during the 6 months follow up and could be useful as a surrogate marker in patients with adhesive capsulitis.

Osteoarthritis

Extreme interest in the problem of osteoarthritis (osteoarthrosis, OA) is due to the significant spread of this form of joint pathology. Research in recent years has made it possible to revise our ideas about the pathogenesis of this process with confirmation of the leading role of inflammation in the development of functional and structural damage in the specified pathology. The review article discusses the features of the pathogenesis of OA. It is noted that OA is a complex disease that affects not only cartilage tissue, but also intra-articular and peri-articular tissues. Clinical classification of OA, classification criteria for OA of hand, knee and hip joints are presented. Considered phenotypes of pain in OA, methods of pain assessment. It is noted that the diagnosis of OA of the knee and hand joints in the practice of the doctor is based mainly on the data of the clinical picture; an exception is OA of the hip joints. Presented Consensus for the development of criteria for primary care physicians for the diagnosis of OA using the methodology of red flags, which allows the examination to identify exactly those patients who should be immediately referred to narrow specialists.

Tumoral calcinosis in the periarticular soft tissue of the left shoulder joint secondary to end‑stage renal disease.

Tumoral calcinosis in the periarticular soft tissue of the left shoulder joint secondary to end‑stage renal disease.

Immunofluorescence analysis of sensory nerve endings in the periarticular tissue of the human elbow joint.

To investigate the dynamic aspects of elbow stability, we aimed to analyze sensory nerve endings in the ligaments and the capsule of elbow joints. The capsule with its anterior (AJC) and posterior (PJC) parts, the radial collateral ligament (RCL), the annular ligament (AL), and the ulnar collateral ligament with its posterior (PUCL), transverse (TUCL) and anterior parts (AUCL) were dissected from eleven human cadaver elbow joints. Sensory nerve endings were analyzed in two levels per specimen as total cell amount/ cm2 after immunofluorescence staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, S-100 protein and 4',6-Diamidin-2-phenylindol, Carbonic anhydrase II and choline acetyltransferase on an Apotome microscope according to Freeman and Wyke's classification. Free nerve endings were the predominant mechanoreceptor in all seven structures followed by Ruffini, unclassifiable, Golgi-like, and Pacini corpuscles (p ≤ 0.00001, respectively). Free nerve endings were observed significant more often in the AJC than in the RCL (p < 0.00002). A higher density of Ruffini endings than Golgi-like endings was observed in the PJC (p = 0.004). The RCL contained significant more Ruffini endings than Pacini corpuscles (p = 0.004). Carbonic anhydrase II was significantly more frequently positively immunoreactive than choline acetyltransferase in all sensory nerve endings (p < 0.05). Sensory nerve endings were significant more often epifascicular distributed in all structures (p < 0.006, respectively) except for the AJC, which had a pronounced equal distribution (p < 0.00005). The high density of free nerve endings in the joint capsule indicates that it has pronounced nociceptive functions. Joint position sense is mainly detected by the RCL, AUCL, PUCL, and the PJC. Proprioceptive control of the elbow joint is mainly monitored by the joint capsule and the UCL, respectively. However, the extreme range of motion is primarily controlled by the RCL mediated by Golgi-like endings.

Update on Current Imaging of Systemic Lupus Erythematous in Adults and Juveniles.

Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organs and organ systems. Musculoskeletal (MSK) involvement is one of the most frequent and the earliest locations of disease. This disease affects joints and periarticular soft tissues, tendon sheaths and tendons, bones, and muscles. Multimodality imaging, including radiography, ultrasound (US), and magnetic resonance imaging (MRI), plays a significant role in the initial evaluation and treatment follow up of MSK manifestations of the SLE. In this paper, we illustrate MSK imaging features in three clinical forms of SLE, including nondeforming nonerosive arthritis, deforming nonerosive arthropathy, and erosive arthropathy, as well as the other complications and features of SLE within the MSK system in adults and juveniles. Advances in imaging are included. Conventional radiography primarily shows late skeletal lesions, whereas the US and MRI are valuable in the diagnosis of the early inflammatory changes of the soft tissues and bone marrow, as well as late skeletal manifestations. In nondeforming nonerosive arthritis, US and MRI show effusions, synovial and/or tenosynovial hypertrophy, and vascularity, whereas radiographs are normal. Deforming arthritis clinically resembles that observed in rheumatoid arthritis, but it is reversible, and US and MRI show features of inflammation of periarticular soft tissues (capsule, ligaments, and tendons) without the pannus and destruction classically observed in RA. Erosions are rarely seen, and this form of disease is called rhupus syndrome.

Incisional and Surrounding Periarticular Soft Tissue Management With Negative Pressure Therapy.

Periarticular injuries of the lower extremity are known for wound healing and infection complications. The role for incisional negative pressure wound therapy for lower extremity periarticular fractures has expanded over the last 10 years in hopes of minimizing complications. To date, there is no standardized published protocol of how negative pressure wound therapy is best used in lower extremity periarticular fractures. A review of strategies to decrease complications associated with the operative management of lower extremity periarticular fractures to include the use of incisional negative pressure wound therapy is presented.

Beyond the Hip Labrum: A Pictorial Review.

Magnetic resonance arthrography and 3T magnetic resonance imaging of the hip are a technique commonly performed in young, physically active patients presenting with pain relating to the hip, with the focus on assessing for the presence of labral tears and femoroacetabular impingement. Abnormal signal within the labrum can be misleading, however, as labral tears are a frequent incidental finding and have been identified in a large proportion of the asymptomatic population. A range of extralabral conditions can cause hip-related pain in young patients, including pathology related to the bones, joints, and periarticular soft tissues. It is vital that the radiologist is aware for these pathologies and examines for them even in the presence of a confirmed labral tear. In this article, we review a range of common extralabral pathologies responsible for hip pain and highlight review areas that aid in their diagnosis.

A new mouse model of post-traumatic joint injury allows to identify the contribution of Gli1+ mesenchymal progenitors in arthrofibrosis and acquired heterotopic endochondral ossification.

Complex injury and open reconstructive surgeries of the knee often lead to joint dysfunction that may alter the normal biomechanics of the joint. Two major complications that often arise are excessive deposition of fibrotic tissue and acquired heterotopic endochondral ossification. Knee arthrofibrosis is a fibrotic joint disorder where aberrant buildup of scar tissue and adhesions develop around the joint. Heterotopic ossification is ectopic bone formation around the periarticular tissues. Even though arthrofibrosis and heterotopic ossification pose an immense clinical problem, limited studies focus on their cellular and molecular mechanisms. Effective cell-targeted therapeutics are needed, but the cellular origin of both knee disorders remains elusive. Moreover, all the current animal models of knee arthrofibrosis and stiffness are developed in rats and rabbits, limiting genetic experiments that would allow us to explore the contribution of specific cellular targets to these knee pathologies. Here, we present a novel mouse model where surgically induced injury and hyperextension of the knee lead to excessive deposition of disorganized collagen in the meniscus, synovium, and joint capsule in addition to formation of extra-skeletal bone in muscle and soft tissues within the joint capsule. As a functional outcome, arthrofibrosis and acquired heterotopic endochondral ossification coupled with a significant increase in total joint stiffness were observed. By employing this injury model and genetic lineage tracing, we also demonstrate that Gli1+ mesenchymal progenitors proliferate after joint injury and contribute to the pool of fibrotic cells in the synovium and ectopic osteoblasts within the joint capsule. These findings demonstrate that Gli1+ cells are a major cellular contributor to knee arthrofibrosis and acquired heterotopic ossification that manifest after knee injury. Our data demonstrate that genetic manipulation of Gli1+ cells in mice may offer a platform for identification of novel therapeutic targets to prevent knee joint dysfunction after chronic injury.

Ligament mechanics of ageing and osteoarthritic human knees.

Knee joint ligaments provide stability to the joint by preventing excessive movement. There has been no systematic effort to study the effect of OA and ageing on the mechanical properties of the four major human knee ligaments. This study aims to collate data on the material properties of the anterior (ACL) and posterior (PCL) cruciate ligaments, medial (MCL) and lateral (LCL) collateral ligaments. Bone-ligament-bone specimens from twelve cadaveric human knee joints were extracted for this study. The cadaveric knee joints were previously collected to study ageing and OA on bone and cartilage material properties; therefore, combining our previous bone and cartilage data with the new ligament data from this study will facilitate subject-specific whole-joint modelling studies. The bone-ligament-bone specimens were tested under tensile loading to failure, determining material parameters including yield and ultimate (failure) stress and strain, secant modulus, tangent modulus, and stiffness. There were significant negative correlations between age and ACL yield stress (p = 0.03), ACL failure stress (p = 0.02), PCL secant (p = 0.02) and tangent (p = 0.02) modulus, and LCL stiffness (p = 0.046). Significant negative correlations were also found between OA grades and ACL yield stress (p = 0.02) and strain (p = 0.03), and LCL failure stress (p = 0.048). However, changes in age or OA grade did not show a statistically significant correlation with the MCL tensile parameters. Due to the small sample size, the combined effect of age and the presence of OA could not be statistically derived. This research is the first to report tensile properties of the four major human knee ligaments from a diverse demographic. When combined with our previous findings on bone and cartilage for the same twelve knee cadavers, the current ligament study supports the conceptualisation of OA as a whole-joint disease that impairs the integrity of many peri-articular tissues within the knee. The subject-specific data pool consisting of the material properties of the four major knee ligaments, subchondral and trabecular bones and articular cartilage will advance knee joint finite element models.

9. Novel murine model of heterotopic ossification induced by spinal cord injury

<h3>BACKGROUND CONTEXT</h3> Heterotopic ossification (HO) is a painful and debilitating condition causing abnormal bone formation in the soft tissues reported in up to 50% of polytrauma patients with spinal cord injury (SCI) and limb damage. In the absence of knowledge regarding the pathogenesis of HO, prophylactic treatment with NSAIDs, bisphosphonates, and radiation therapy do little to relieve the chronic pain and joint contractures resulting from HO or prevent its recurrence after surgical intervention to remove ectopic bone. A lack of clinically relevant animal models has been a major obstacle to understanding the pathogenesis of SCI-induced HO. <h3>PURPOSE</h3> The goal of this research is to characterize a clinically relevant mouse model of SCI-induced HO based on the hypothesis that simultaneous SCI and musculotendinous injury (MTI) can cause HO. <h3>METHODS</h3> Four-week-old C57BL/6J wild type mice were subjected to spinal cord transection between T10 and T11 using a pair of spring scissors via posterior open incision. The quadriceps were then crushed using a surgical clamp and a No. 15 surgical blade used to induce a 2mm MTI at the quadriceps insertion into patella in the LEFT hindlimb. The RIGHT hindlimb remained intact as internal procedural control. During the postoperative course, urine was expelled from the paraplegic using twice daily bladder massage. Soft food and water were placed in petri dishes on the bottom of the cages. Buprenorphine SR at 1mg/kg was administered subcutaneously on Day 0 and Day 4 to provide postoperative analgesia. All mice were euthanized at postoperative Day 21 when both hindlegs were dis-articulated at hip and ankle and fixed in formaldehyde overnight. High resolution micro-CT scans of the specimens were captured at the spatial resolution of 8µm. The volume of ectopic bone around the knee joint was quantified in a 3D reconstructed model. Undecalcified samples were then dehydrated, infiltrated, and embedded in low temperature MMA, and sectioned at 5µm. Consecutive sections were assessed by Von Kossa and Toluidine Blue staining to show ossification of peri-articular soft tissues, alkaline phosphatase (ALP) staining for osteoblasts, and tartrate-resistant acid phosphatase (TRAP) staining for osteoclasts. Mann-Whitney U test was used for statistical analysis of ectopic bone volumes. <h3>RESULTS</h3> Of the seven mice euthanized at three weeks post SCI/MTI, two sustained patellar dislocation in the LEFT knee and were excluded from analyses. Quantitative microCT analysis of the remaining five revealed ectopic bone deposits in the peri-articular region of all LEFT knees but none in the RIGHT knees. The HO volume of the LEFT hindlimb was consistently higher than that of RIGHT hindlimb of each mouse (25th - 75th percentile 0.02 - 0.34 vs 0.00 - 0.00, P=0.09). Histological evaluation confirmed ectopic bone deposited in the peri-articular soft tissues of the LEFT knees while the musculotendinous tissue was intact on the RIGHT side. <h3>CONCLUSIONS</h3> This mouse model represents a novel, reproducible and clinically relevant preclinical model of SCI-induced HO that will facilitate investigation of pathogenic mechanisms and assessment of novel therapeutics for this condition. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Effectiveness of Prophylactic Interventions in Neurogenic Heterotopic Ossification (NHO): A Systematic Review.

Neurogenic heterotopic ossification (NHO) is the formation of mature lamellar bone in peri-articular tissues following a neurological insult, most commonly traumatic brain injury (TBI) or spinal cord injury (SCI). NHO is a debilitating condition associated with significant morbidity and reduced quality of life. However, its pathophysiology remains poorly understood. While surgery is the mainstay of treatment once NHO has been diagnosed, prophylactic options are limited and not well studied. This review aimed to determine the efficacy of various interventions used in the primary prevention of NHO. We conducted an electronic literature search using five databases (PubMed, Embase, ScienceDirect, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) for records published until April 10, 2022. We identified 2,610 potentially eligible records across all databases. Nine reports met our eligibility criteria and were included in this review. Four were clinical trials (three randomized control trials, one nonrandomized trial), four were observational studies, and one was a systematic review/meta-analysis. The medications/interventions used included: warfarin, pulse low-intensity electromagnetic field therapy (PLIMF), bisphosphonates, and nonsteroidal anti-inflammatory drugs (NSAIDs). We did not find conclusive evidence to recommend the use of bisphosphonates and warfarin in the prevention of NHO. On the contrary, we found NSAIDs and PLIMF as effective prophylactic options based on the results of high-quality randomized control trials. Further prospective randomized studies with prolonged follow-ups are needed to confirm the long-term efficacy of these preventive interventions.

Postoperative imaging of the hip

To assess postoperative imaging of the hip joint regarding possible complications, it is indispensable to have in-depth knowledge of commonly used surgical techniques, access routes, and the implanted materials. While radiography is used to evaluate the position of foreign material and to rule out periprosthetic fractures that have occurred intraoperatively, follow-up examinations might show signs of material failure, aseptic loosening, prosthesis infections, or the occurrence of heterotopic ossifications. If radiographic findings are ambiguous, computed tomography (CT) may be used to clarify findings, whereas magnetic resonance imaging (MRI) is helpful to identify intra- and periarticular soft tissue pathologies such as surgery-associated cartilage and ligament damage, muscle insufficiency, or metallosis. To guide clinical decision making in common postoperative complications, various classification systems are available, e.g., for periprosthetic fractures, aseptic loosening, or heterotopic ossification. However, the differentiation between aseptic material loosening and septic endoprosthesis infection remains challenging if based on imaging alone. The assessment of postoperative hip imaging should be closely linked to the respective surgical technique and the implanted foreign material, whereby different probabilities of specific complications can be derived.

Massive and progressive multifocal periarticular soft tissue calcinosis

Massive and progressive multifocal periarticular soft tissue calcinosis

Physical Activity and Ecological Means of Transport-Functional Assessment Methodology.

Medical developments have led to lower mortality rates but have increased the proportion of people with disabilities or mobility dysfunctions. A higher level of awareness of the general need to perform physical activity, in different spheres of life and at any age, is necessary. A device produced in response to the growing need of supporting active participation in activities of daily life is the Torqway. The aim of this research conducted at the Faculty of Transport, Warsaw University of Technology, was to evaluate the kinematic of users’ upper and lower body muscles motion while riding the tested device. The research was carried out using the MyoMotion system on a stand designed for the purpose of the experiment. Analysis of the results showed a high level of activity in the muscles of the upper limbs, demonstrating that the device can be used to train muscle strength and mass, prevent muscle atrophy, improve the elasticity of periarticular soft tissues and improve the action of the muscle pump (increasing blood flow to the muscles and, with it, the flow of oxygen and nutrients, which promotes the development and subsequent regeneration of muscles). The device can not only serve as a form of recreation but also be used to promote convalescence.

Osteoarthritis: management strategies depending on the location of lesions

Osteoarthritis (OA) is a multifactorial disease that can be caused by genetic factors, obesity, joint microtrauma, and excessive physical exercises. The key features of OA include gradual loss of articular cartilage, bone tissue remodeling, development of osteophytes, and subchondral sclerosis. The pathogenesis of OA is based on the loss of glycosaminoglycans, collagen disorganization, and inflammation mediated by a cytokine cascade. OA is a complex disease affecting not only cartilage, but also intraarticular and periarticular tissues. Together, these changes compromise joint function and cause chronic pain. Considerable attention has beer recently paid to OA phenotyping in order to introduce a tailored approach into patient management. Phenotypes are applicable to the three most common peripheral OA locations: gonarthrosis, coxarthrosis, and hand OA. An international group of experts of primary care has developed algorithms for OA patient management, including diagnostic criteria, treatment options, and criteria for referring the patient to a specialist (rheumatologist). Current guidelines recommend non-drug therapy, pharmacotherapy, and surgery. There is a growing interest in phytopharmaceuticals, a heterogeneous group of molecules with a high capacity of suppressing inflammation, oxidative stress, and pain, as well as improving joint function. Mucosate® in capsules (DIAMED-pharma, Russia) is one of currently available complex products with phytocompounds. It contains the NEM® complex (natural eggshell membrane), Harpagophytum root extract, glucosamine sulfate, chondroitin sulfate, and manganese sulfate monohydrate.