Synovial Reaction Research Articles

Synovial Lipomatosis: Histopathologic Features in a Series of Five Cases.

Synovial lipomatosis is a controversial entity of uncommon intraarticular joint lesions. Most studies focused on radiological findings and surgical resection modalities. Pathologic findings were limited to case reports. Detailed descriptions of the histopathologic features are lacking. We aim to highlight the salient histopathologic features of synovial lipomatosis. We performed a retrospective review study over 15 years retrieving cases of synovial lipomatosis. We found 5 patients (age range: 8-78, average age: 50 years, male to female ratio: 4:1) demonstrating unilateral synovial lipomatosis out of 241 (2.0%) patients with knee joint lesions. Four patients had osteoarthritis. One patient was obese. The resected specimens showed synovial hyperplasia, surface fibrin, hemosiderin pigment, microcalcifications, lymphoplasmacytic infiltrates, lymphoid aggregates, stromal fibrotic, degenerative, and metaplastic alterations shared by other synovitis related changes. Consistent features included abundant adipocytic components, surface adipocytes, prominent large vessel vasculatures, plasma cells, and dense perivascular lymphocytic cuff-like infiltrates. One patient demonstrated superimposed sarcoid-type epithelioid granulomas. A distinct fibrous band separated the lesional tissue from the underlying normal fatty tissue. Synovial lipomatosis predominates in older males with degenerative joint conditions with a second peak in children and adolescents. Obesity is not a risk factor. Some histopathologic features help distinguish synovial lipomatosis from look-alike joint lesions. The findings may suggest an angiolipomatous hamartomatous growth or an exaggerated synovial reaction inducing florid subsynovial stromal proliferative, metaplastic, and degenerative changes. Regardless of its etiopathogenesis, pathologists have a role in confirming the diagnosis and ensuring a complete arthroscopic synovectomy by assessing the presence of the fibrous septa.

Mechanism of electroacupuncture penetration needling for relieving synovial inflammation of knee osteoarthritis through TLR4/MyD88/NF-κB signal pathway

To observe the effects of electroacupuncture (EA) penetration needling on Toll-like receptors 4/myeloid differentiation factor 88/nuclear factor-kappa B (TLR4/MyD88/NF-κB) signaling pathway in rat synovium and the serum-related inflammatory factors, so as to explore the mechanism of EA penetration needling on synovial inflammation in rats with knee osteoarthritis (KOA). SD male rats were randomly divided into sham-operation group, model group, EA+penetration needling group, and conventional EA group, with 16 rats in each group. The rats model was prepared by anterior cruciate ligment transection and these rats were forced to exercise for 8 weeks after operation. After successful modeling, in the EA+penetration needling group, the needles were inserted at "Dubi" (ST35) "Neixiyan" (EX-LE4), and at "Xuehai"(SP10) "Liangqiu"(ST34) on the right hind limb, towards each other, 5-8 mm in depth, respectively. In the conventional EA group, the needles were inserted at ST35 and EX-LE4 on the right hind limb, obliquely, at 30° angle to the skin, 3-5 mm in depth; and were inserted at SP10 and ST34 on the right hind limb perpendicularly, 3-5 mm in depth. In these two groups, electric stimulation was operated with dense-disperse wave, 2 Hz/10 Hz in frequency and 0.5-1.5 mA in intensity, retained for 20 min in each treatment. The treatment was given once daily, 10 days as 1 course of treatment, and 2 courses were required at the interval of 2 days. After the intervention, the knee joint effusion was observed by musculoskeletal ultrasound; the contents of IL-1β, IL-6 and TNF-α in serum were determined by ELISA; the morphological changes in the synovium were observed after H.E. staining; the positive expression of NF-κB p65 in the synovial membrane was detected by immunohistochemical method; the expression levels of TLR4, MyD88, TRAF-6 and NF-κB p65 proteins in the synovial membrane were determined by Western blot. Compared with the sham-operation group, in the model group, the knee joint effusion was obviously increased, the synovial lining cells were distributed irregularly, the cells were disarranged, the pannus was formed largely, and a great number of the inflammatory cells were infiltrated; the contents of serum IL-1β, IL-6 and TNF-α, the positive expression of NF-κB p65, the protein expression levels of TLR4, MyD88, TRAF-6 and NF-κB p65 in the synovial tissue were increased (P<0.05). Compared with the model group, the knee joint effusion was reduced, the synovial lining cells were proliferated, a small number of the inflammatory cells were infiltrated, and the pannus was formed lightly; the contents of serum IL-1β, IL-6 and TNF-α, the positive expression of NF-κB p65, the protein expression levels of TLR4, MyD88, TRAF-6 and NF-κB p65 in the synovial tissue were lower (P<0.05) in the EA+penetration needling group and the conventional EA group. In the conventional EA group, the knee joint effusion was increased, the synovial lining cells were proliferated, the inflammatory cells were infiltrated largely, and the pannus was formed increasingly; the contents of serum IL-1β, IL-6 and TNF-α, and the protein expression levels of TLR4, MyD88 and NF-κB p65 in the synovial tissue were increased when compared with the EA+penetration needling group (P<0.05). The EA+penetration needling can significantly relieve the synovial inflammatory reaction and the knee joint effusion in KOA rats. The mechanism is probably related to down-regulating the downstream inflammatory cascade through inhibiting the transduction of TLR4/MyD88/NF-κB signaling pathway.

GLX351322, a Novel NADPH Oxidase 4 Inhibitor, Attenuates TMJ Osteoarthritis by Inhibiting the ROS/MAPK/NF-κB Signaling Pathways.

As a degenerative disease in joints, temporomandibular joint osteoarthritis (TMJOA) is characterized by progressive cartilage degradation, subchondral bone remodeling, and chronic synovitis, severely undermining functions and quality of life in patients. NADPH oxidase 4 (NOX4) contributes to reactive oxygen species (ROS) production and inflammatory pathway activation in osteoarthritis, which has attracted increasing attention in research in recent years. GLX351322 (GLX), a novel NOX4 inhibitor, exerts a protective effect on chondrocytes. However, whether it has a therapeutic effect on ROS production and inflammatory responses in synovial macrophages remains to be evaluated. In this study, we examined the effect of GLX on LPS-induced ROS production and inflammatory responses in vitro and on complete Freund's adjuvant (CFA)-induced TMJ inflammation in vivo. We found that GLX could depress LPS-induced intracellular ROS production and inflammatory response without cytotoxicity by inhibiting the ROS/MAPK/NF-κB signaling pathways. In line with in vitro observations, GLX markedly attenuated the synovial inflammatory reaction in the TMJ, thus protecting the condylar structure from severe damage. Taken together, our results suggest that GLX intervention or NOX4 inhibition is a promising curative strategy for TMJOA and other inflammatory diseases.

Diffusion-weighted MRI of total hip arthroplasty for classification of synovial reactions: A pilot study

BackgroundConventional quantitative diffusion-weighted imaging (DWI) is sensitive to changes in tissue microstructure, but its application to evaluating patients with orthopaedic hardware has generally been limited due to metallic susceptibility artifacts. The apparent diffusion coefficient (ADC) and T2-values from a multi-spectral imaging (MSI) DWI combined with 2D multi-spectral imaging with a 2D periodically rotated overlapping parallel lines with enhanced reconstruction (2D-MSI PROPELLER DWI) based sequence and a MAVRIC based T2 mapping sequence, respectively, may mitigate the artifact and provide additional quantitative information on synovial reactions in individuals with total hip arthroplasty (THA). The aim of this pilot study is to utilize a 2D-MSI PROPELLER DWI and a MAVRIC-based T2 mapping to evaluate ADC and T2-values of synovial reactions in patients with THA. MethodsCoronal morphologic MRIs from THA patients underwent evaluation of the synovium and were assigned a synovial classification of ‘normal’, or ‘grouped abnormal’ (consisting of sub-groups ‘infection’, ‘polymeric’, ‘metallosis’, ‘adverse local tissue reaction’ [ALTR], or ‘non-specific’) and type of synovial reaction present (fluid-like, solid-like, or mixed). Regions of interest (ROIs) were placed in synovial reactions for measurement of ADC and T2-values, obtained from the 2D-MSI PROPELLER DWI and T2-MAVRIC sequences, respectively. A one-way analysis of variance (ANOVA) and Kruskal-Wallis rank sum tests were used to compare the differences in ADC and T2-values across the different synovial reaction classifications. A Kruskal-Wallis test was used to compare the ROI areas for the ADC and T2-values. A principal component analysis (PCA) was performed to evaluate the possible effects of ADC values, size of the ADC ROI, T2-values, and size of the T2 ROI with respect to synovial reaction classification. ResultsDifferences of ADC and T2 among the individual synovial reactions were not found. A difference of ADC between ‘normal’ and ‘grouped abnormal’ synovial reactions was also not detected even as the ADC area of ‘grouped abnormal’ synovial reactions were significantly larger (p = 0.02). The ‘grouped abnormal’ synovial reactions had significantly shorter T2-values than ‘normal’ synovial reactions (p = 0.02), and that the T2 area of ‘grouped abnormal’ synovial reactions were significantly larger (p = 0.01). A larger ROI area on the T2-maps was observed in the mixed synovial reaction type as compared to the fluid-like reaction type area (p = 0.01). Heterogeneity was noted in calculated ADC and T2 maps. PCA analysis revealed obvious clustering by the ‘normal’ and ‘grouped abnormal’ classifications. Conclusions2D-MSI PROPELLER DWI and MAVRIC-T2 generate quantitative images of periprosthetic tissues within clinically feasible scan times. The combination of derived ADC and T2-values with area of synovial reaction may aid in differentiating normal from abnormal synovial reactions between types of synovial reactions in patients with THA.

28 Osteoarticular manifestations simulating JIA in acute leukemia: case report and literature review

BackgroundThe osteoarticular manifestations are proven during hematological malignancies in children, they can be the revealing symptom of the disease, and they may simulate a full clinical picture of Juvenile Idiopathic Arthritis (JIA), especially if no blasts are found in blood smear. Some therapies are common to both diseases, which commonly delay diagnosis for a couple of months and worsens the prognosis of these malignancies. We report three observations of patients treated for JIA which turned out to be acute leukaemia.Clinical caisesThe first patient is a 7-year-old male followed in pediatric rheumatology consultation for a monoarticular onset JIA. Since the patient did not respond to indomethacin, a bone marrow examination (BME) was performed before corticosteroid therapy (CST), no blasts were found. The patient received 01 month of CST which led to the amendment of clinical and biological signs, however, joint pain and bicytopenia reappeared after we started CST reduction. Blood and blood marrow smear were performed, leading to the diagnosis of acute B-lymphoblastic leukaemia.The second patient is a 4 years old male admitted for exploration of polyarthritis with cervical lymphadenopathy, the initial assessment allowed the diagnosis of JIA with polyarticular onset. Indomethacin is prescribed, without any improvement. Radiological assessment was performed, as well as a complete blood count (CBC) which found neutropenia with lymphopenia, and blasts were discovered in the second BME.The third patient is a 6-year-old female admitted for exploration of arthralgia and pathological fractures. Radiological signs in favor of leukaemia and normochromic aregenerative normocytic anaemia were revealed, allowing the diagnosis of ALL B to be made after several consultations in rheumatology.DiscussionJoint damage during leukaemia, called leukaemic arthritis, is frequent, complicating 12% to65% of pediatric leukaemia, most often ALL. It is linked to specific damage by leukaemic infiltration of the synovium or less likely to a synovial reaction to adjacent periosteal or capsular infiltration. In JIA there are incomplete or atypical forms, the differential diagnoses to be sought are numerous and depend on age, personal and family anamnesis and clinical, biological, hematological and radiological signs. The dread of a haematological malignancy must constantly be sought and excluded before the use of CST, which is one of the therapeutic weapons in ALL, thus causing the blasts to disappear and delaying the diagnosis.ConclusionThe diagnosis of JIA must be made with caution, raise the possibility of haematological malignancy in children in the absence of response to usual treatments, in the presence of systemic signs such as fever or a persistent biological syndrome or atypical radiological lesions, hence the correct analysis of the CBC and the blood and marrow smears is clearly important.

Progress of researches on acupuncture-moxibustion treatment of cartilage damage of osteoarthritis

Cartilage damage is the key pathological mechanism in the progressive development of osteoarthritis(OA). Slowing down cartilage damage and accelerating cartilage repair are strategies for effective treatment of OA. Acupuncture and moxibustion therapies are widely used in relieving symptoms of OA and have a protective effect on cartilage. In this paper, we reviewed the mechanisms of acupuncture and moxibustion underlying relieving cartilage damage from three aspects: 1) promoting chondrocyte homeostasis by inhibiting apoptosis and improving cellular autophagy, 2) regulating extracellular matrix (ECM) metabolism (inhibiting decomposition and promoting synthesis) by suppressing the release of inflammatory factors and the activity of proteolytic enzymes, and 3) improving OA microenvironment by reducing the number of macrophagocyte 1 (M1) and increasing the ratio of M2/M1 in the local inflammatory locus. In addition, most studies on the mechanisms of acupuncture and moxibustion underlying remission of OA focus on the improvement of pathological changes, such as joint histopathology, cartilage morphology, synovial inflammatory reaction and infiltration, subchondral bone remodeling, etc., thus, the exact functions of acupuncture and moxibustion in ameliorating cartilage injury remain unknown. In view of the important role of mitochondrial dysfunction in promoting OA development and cartilage damage and the current use of tissue engineering methods of chondrocytes and mesenchymal stem cells to repair articular cartilage injury, it is highly recommended that future studies should pay more attention to these aspects.

Validating the accuracy of multispectral metal artifact suppressed diffusion-weighted imaging.

Diffusion-weighted imaging (DWI) provides quantitative measurement of random water displacement in tissue as calculated by the apparent diffusion coefficient (ADC). While heavily utilized in stroke and oncology applications, DWI is a promising tool to map microstructural changes in musculoskeletal applications including evaluation of synovial reactions resulting from total hip arthroplasty (THA). One major challenge facing the application of DWI in THA is the significant artifacts related to the conventional echo-planar imaging (EPI) readout used. Multispectral imaging (MSI) techniques, including the multiacquisition with variable resonance image combination (MAVRIC), have been shown to effectively reduce metallic susceptibility artifacts around total joint replacements to render clinically useful images. Recently, a 2D periodically rotated overlapping parallel line with enhanced reconstruction (PROPELLER) FSE acquisition that incorporates a diffusion preparation pulse with 2D-MAVRIC has been developed to mitigate both distortion and dropout artifacts. While there have been some preliminary assessments of DWI-MAVRIC, the repeatability of DWI-MAVRIC and the effects of key parameters, such as the number of spectral bins, are unknown. To evaluate the quantitative accuracy of DWI-MAVRIC as compared to conventional diffusion sequences. A diffusion phantom with different reference diffusivities (ADC = 113-1123 μm2 /s) was used. Scans were performed on two 1.5T MRI scanners. DWI-EPI and DWI-MAVRIC were acquired in both the axial and coronal planes. Three spatial offsets (0 cm, 10 cm left, and 10 cm right off iso-center) were used to evaluate effects of off-isocenter positioning. To assess intraday and interday repeatability, DWI-EPI and DWI-MAVRIC acquisitions were repeated on one scanner at same-day and 9-month intervals. To assess inter-scanner repeatability, DWI-EPI and DWI-MAVRIC acquisitions were compared between two scanners. ADC maps were generated with and without gradient nonlinearity correction (GNC). Linear regression, correlation, and error statistics were determined between calculated and reference ADC values. Bland-Altman plots were generated to evaluate intraday, interday, and interscanner repeatability. DWI-MAVRIC had excellent correlation to reference values but at reduced linearity (r = 1.00, slope = 0.91-0.94) as compared to DWI-EPI (r = 1.00, slope = 0.99-1.01). A greater than 5% ADC bias was observed at the lowest ADC values, predominantly in the DWI-MAVRIC scans. ADC values did not vary with DWI-MAVRIC parameters. DWI-EPI acquisitions had intraday, interday, and interscanner repeatability of 3.18 μm2 /s, 19.2 μm2 /s, and 20.2 μm2 /s, respectively. DWI-MAVRIC acquisitions had inferior intraday, interday, and interscanner repeatability of 13.3 μm2 /s, 44.7 μm2 /s, 110 μm2 /s, respectively. Lower ADC errors were found at isocenter, as compared to the left and right positions. GNC reduced the absolute error by 0.31% ± 0.89%, 3.6% ± 1.4%, 0.65% ± 2.4% for the center, left, and right positions, respectively. DWI-MAVRIC provides good linearity with respect to reference values and good intra- and interday repeatability.

Magnetic Resonance Imaging Synovial Classification Is Associated With Revision Indication and Polyethylene Insert Damage.

Patients with total knee arthroplasty (TKA) stiffness are commonly presumed to have arthrofibrosis though no specific test exists. In patients undergoing revision TKA, we asked the following question: (1) Do patients who are revised for stiffness display a synovial reaction on MRI that is different than patients revised for other reasons? (2) Do these patients have a different magnitude of polyethylene insert damage than patients revised for other reasons? and (3) Is the MRI synovial classification associated with polyethylene insert damage? Patients undergoing revision TKA for stiffness had a preoperative MRI performed, and the synovium was classified on MRI in a blinded fashion as arthrofibrosis, focal scarring, polymeric reaction, infection, or abnormal. At surgery, the polyethylene inserts were removed, and graded by 2 reviewers for total surface damage. Revision indication and MRI synovial classification were associated (P < .0001), with a greater proportion of patients assigned an MRI classification of arthrofibrosis revised for arthrofibrosis and a greater proportion of patients assigned a polymeric classification revised for aseptic loosening. Patients assigned an MRI synovial classification of polymeric had the greatest damage to the tibial insert (P < .0001), and patients revised for the clinical indication of aseptic loosening had the greatest damage to the tibial insert (P < .0001). Synovial grading on MRI is strongly associated with revision indication and polyethylene insert damage. In patients with stiffness in the absence of another complication, MRI can be a helpful diagnostic adjuvant in confirming the diagnosis of stiffness.

An Insight Into Lyme Prosthetic Joint Infection in Knee Arthroplasty: A Literature Review.

Lyme prosthetic joint infection (PJI) is a rare event, but it is imperative to include Lyme disease as a possible cause of PJI in a Lyme-endemic region. The purpose of this article was to review the reported cases of Lyme PJIs in knee arthroplasty and to initiate the development of a treatment strategy. We found five cases of Lyme PJI in the literature. All patients lived in the northeastern region of the United States. Four patients were successfully treated with surgical intervention and postoperative antibiotics. One patient was successfully treated with intravenous and oral antibiotics for 6 weeks, without surgical intervention. Synovial fluid Lyme polymerase chain reaction and serological tests were positive in all patients. On follow-up visits, after completion of their treatment, all patients were asymptomatic with a painless functional knee. We recommend considering Lyme disease as a cause of culture-negative PJIs in endemic regions. Additional research is needed to clearly define a treatment algorithm. Based on our literature review, we cannot recommend a single best treatment modality for the treatment of Lyme PJI. However, early irrigation and débridement with administration of postoperative antibiotics may improve early clinical outcomes.

Meta-analysis of synovial fluid polymerase chain reaction for diagnosing periprosthetic hip and knee infection

Background and objectiveThe purpose of this study was to estimate the diagnostic performance of synovial fluid polymerase chain reaction (PCR) in periprosthetic hip and knee infection, and whether synovial fluid PCR has greater diagnostic significance than conventional methods.MethodsThe literature databases PubMed, Scopus, and the Web of Science were searched for English articles describing periprosthetic joint infection (PJI) diagnosis by synovial fluid PCR. Articles were limited to the period between January 1990 and December 2019. Subsequently, conventional methods that were used on at least two occasions were included for further analysis. Data analysis was performed using the Meta-DiSc and Stata software.ResultsEleven studies with 1360 cases were included in the meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of synovial fluid PCR were 0.70 (95% CI 0.66–0.74), 0.92 (95% CI 0.90–0.93), and 37.4 (95% CI 17.77–78.74), respectively.ConclusionsSynovial fluid PCR provides an effective tool for rapid diagnosis of PJI, and also in the early stages of culture-negative bacterial infections.

Fascin1 mediated release of pro-inflammatory cytokines and invasion/migration in rheumatoid arthritis via the STAT3 pathway

ABSTRACT Rheumatoid arthritis (RA) is a chronic, multi-factorial disease characterized by Synovial hyperplasia, chronic inflammation, and autoimmune reaction. Fascin1 overexpression has been implicated in cancer, immune, and inflammatory diseases. However, the relationship between Fascin1 and rheumatoid arthritis (RA) has not yet been determined. We investigated whether Fascin1 could modulate pro-inflammatory cytokine secretion and the proliferation, apoptosis, and invasion/migration of fibroblast-like synoviocytes (RA-FLSs). Fascin 1 was suppressed with a short interfering (si)RNA approach. Functional analysis contained MTT assay, flow cytometry,Transwell™ assays, wound healing, Quantitative polymerase chain reaction and western blotting were used to detect cell proliferation,apoptosis ratio, invasion/ migration, the mRNA and protein expression of the realted markers, respectively. Overexpression of fascin1 was observed in RA-FLSs group compared with control group. Fascin1 expression positively correlated with changes in the expression of RA disease activity markers (RF, CRP, and DAB28, respectively). We also observed a significant positive correlation between Fascin1 and STAT3 mRNA levels in RA- FLSs.Fascin1 silencing attenuated the expression of pro-inflammatory cytokines; reduced FLS proliferation in vitro; and increased apoptosis ratio and bax, cleaved PARP, and caspase-3 expression. si- Fascin1 transfection delayed RA-FLS invasion/migration and reversed the epithelial- mesenchymal transition. These data suggest that Fascin1 exerts positive effects on the proliferation, cell cycle, and invasion/migration of RA-FLSs by activating signal transducer and activator of transcription 3 signaling.After all, Fascin1 contributed to RA development.

Clinical Feasibility of Multi-Acquisition Variable-Resonance Image Combination-Based T2 Mapping near Hip Arthroplasty.

Background: Hip arthroplasty is increasingly prevalent, and early detection of complications can improve outcomes. Quantitative magnetic resonance imaging (qMRI) methods using multi-acquisition variable-resonance image combination (MAVRIC) may allow for the assessment of soft tissues in close proximity to hip arthroplasty devices. Question/Purposes: We sought to determine the clinical feasibility of MAVRIC-based T2 mapping as a qMRI approach for assessing synovial reactions in patients with a hip arthroplasty device. We hypothesized that there would be differences in T2 metrics by synovial type, clinical impression, and clinical findings related to synovitis. Methods: We conducted a cross-sectional study of 141 subjects with 171 hip arthroplasties with greater than 1 year post-implantation. We enrolled subjects who had had a primary total hip arthroplasty or hip resurfacing arthroplasty between May 2019 and March 2020, excluding those with a revision hip arthroplasty and those with standard safety contraindications for receiving an MRI. Institutional standard 2D fast spin echo (FSE), short-tau inversion recovery (STIR), and susceptibility-reduced MAVRIC morphological MR images were acquired for each hip and followed by a dual-echo acquisition MAVRIC T2 mapping sequence. Results: While 131 subjects (81%) were classified as having a "normal" synovial reaction, significantly longer T2 values were found for fluid synovial reactions compared with mixed reactions. In addition, subjects with synovial dehiscence and decompression present had T2 prolongation. Larger synovial volumes were found in subjects with low-signal intensity deposits. Conclusions: MAVRIC-based T2 mapping is clinically feasible and there are significant quantitative differences based on type of synovial reaction. Patients undergoing hip arthroscopy revision surgery will warrant comparison of T2 values with direct histologic assessment of a tissue sample obtained intraoperatively. The approach used in this study may be used for a quantitative evaluation and monitoring of soft tissues around metal implants.

Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs.

Animal experimental model. To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs. We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed. The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis. Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed.

Extensor digitorum tendon rupture after anterior ankle arthroscopy

Aim: The aim of this paper is to increase awareness of orthopaedic surgeons about an uncommon yet possible complication of ankle arthroscopy – iatrogenic extensor digitorum rupture. Ankle arthroscopy is becoming more widespread and according to the literature, the complication rate varies from 9% up to 17%. Case report: We are presenting a case of 32-year old police officer who recreationally plays soccer. The patient presented with clear signs of anterior ankle impingement confirmed by X-ray and the MRI. During ankle arthroscopy massive tibial and talar bone spurs were found with significant synovial reaction, nearly 10 loose intraarticular bodies and syndesmotic ossification. The patient was placed in a walking boot and early postoperative recovery went as planned. Physical therapy started 14 days after the procedure. Five weeks after the surgery while dorsiflexing his fingers patient felt a "snap" over his ankle followed by swelling. He couldn't dorsiflex his fingers afterwards. MRI showed a rupture of the common extensor digitorum tendon. The patient was treated with open reconstruction of the tendon and lower leg immobilisation for 6 weeks followed by physical therapy and partial weight bearing. The patient made a full recovery. Conclusion: It is of the utmost importance to keep in mind that ankle arthroscopy alongside it's obvious benefits is not void of complications. Iatrogenic tendon lesion is always possible and should be suspected with any loss of movement in foot and ankle after the procedure. Urgent MRI and immediate reconstruction showed good results in our case.

Effect of Tongluo Zhitong (, TLZT) gel preparation on p53 /miR-502-5p /NF-κBp65 in synovial tissue of knee osteoarthritis

To observe effects of Tongluo Zhitong (, TLZT) gel preparation on p53, miR-502-5p, NF-κBp65 in synovial tissue of knee osteoarthritis (KOA), and to explore mechanism of TLZT gel preparation in treating KOA. Thirthy-six Wistar rats aged 8 weeks and weighed 200 to 220 g (meaned 208 g) were randomly divided into normal group, model group and traditional Chinese medicine (TCM) group, 12 rats in each group. KOA model was established by modified Hulth method. After 4 weeks of modeling, TCM group treated with TLZT gel preparation for external use, 3 times daily for 2 weeks;normal group and model group were fed normally without intervention. After treatment, morphological changes of specimens in each group were observed, changes of miR-502-5p in synovial tissue were detected by qPCR, and contents of p53, NF-κBp65, IL-1β, TNF-α, MMP-13 in synovial tissue were detected by qPCR and Western Blot respectively. (1)Morphological observation of specimens showed that the articular cartilage in model group was hyaline and uneven, the synovial membranes were hypertrophic and proliferative with a large number of inflammatory cells infiltrating, the joint fluid was thicker in texture;the articular cartilage in TCM group was more transparent and smooth, synovial hyperplasia was mild with a small amount of inflammatory cell infiltration, the texture of articular fluid was clear and sparse. (2) Compared with normal group, content of miR-502-5p of synovial tissue in model and TCM group were increased, mRNA and expression of p53 decreased, expression of NF-κBp65, IL-1β, TNF-α, MMP-13 increased. (3)Compared with model group, content of miR-502-5p in synovial tissue of TCM group decreased (P<0.05), mRNA and protein expression of p53 increased (P<0.05), mRNA and protein expression of NF-κBp65, IL-1β, TNF-α, MMP-13 decreased (P<0.05). Expression of p53, miR-502 -5p, NF -κBp65 in synovial tissue is closely related to synovial hyperplasia and inflammatory reaction, TLZT gel preparation may reduce proliferation and inflammatory reaction of KOA synovium by regulating the expression of p53, miR- 502-5p, NF-κBp65 in synovial tissues.

Boosting the Intra-Articular Efficacy of Low Dose Corticosteroid through a Biopolymeric Matrix: An In Vivo Model of Osteoarthritis.

The purpose of this study was to verify the efficacy of a single intra-articular (i.a.) injection of a hyaluronic acid-chitlac (HY-CTL) enriched with two low dosages of triamcinolone acetonide (TA, 2.0 mg/mL and 4.5 mg/mL), in comparison with HY-CTL alone, with a clinical control (TA 40 mg/mL) and with saline solution (NaCl) in an in vivo osteoarthritis (OA) model. Seven days after chemical induction of OA, 80 Sprague Dawley male rats were grouped into five arms (n = 16) and received a single i.a. injection of: 40 mg/mL TA, HY-CTL alone, HY-CTL with 2.0 mg/mL TA (RV2), HY-CTL with 4.5 mg/mL TA (RV4.5) and 0.9% NaCl. Pain sensitivity and Catwalk were performed at baseline and at 7, 14 and 21 days after the i.a. treatments. The histopathology of the joint, meniscus and synovial reaction, type II collagen expression and aggrecan expression were assessed 21 days after treatments. RV4.5 improved the local pain sensitivity in comparison with TA and NaCl. RV4.5 and TA exerted similar beneficial effects in all gait parameters. Histopathological analyses, measured by Osteoarthritis Research Society International (OARSI) and Kumar scores and by immunohistochemistry, evidenced that RV4.5 and TA reduced OA features in the same manner and showed a stronger type II collagen and aggrecan expression; both treatments reduced synovitis, as measured by Krenn score and, at the meniscus level, RV4.5 improved degenerative signs as evaluated by Pauli score. TA or RV4.5 treatments limited the local articular cartilage deterioration in knee OA with an improvement of the physical structure of articular cartilage, gait parameters, the sensitivity to local pain and a reduction of the synovial inflammation.

Shea Nut Oil Extracts Enhance the Intra-Articular Sodium Hyaluronate Effectiveness on Surgically Induced OA Progression in Rats.

Osteoarthritis (OA) progression is associated with joint pain and stiffness. Intra-articular hyaluronic acid (IAHA) injection in knee OA restores the viscoelasticity of the joint and prevents cartilage damage. Shea nut oil extract (SNO) was shown to provide chondroprotection on surgically-induced OA progression in rats. Here we aim to examine IAHA injection supplemented with SNO diet for a synergetic evaluation on the disease progression in OA rats. We employed an anterior cruciate ligament transection plus medial meniscectomy-induced knee OA rat model with up to 12 weeks of sign/behavior observation (knee width, weight-bearing) and histological assessments of joint damage. We found both IAHA and SNO alone significantly attenuated histological changes of cartilage degeneration and synovial reactions in these knee OA rats. Nonetheless, oral SNO alone mitigated OA pain and inflammation while IAHA alone had no significant impact on the weight-bearing test and knee joint swelling. Moreover, with IAHA-treated rats fed with oral SNO diet, additional anti-inflammatory and anti-nociceptive effects were found, which further enhanced and maintained IAHA protection. Given the differential phenotype of oral SNO vs. IAHA, a regimen of IAHA coupled with SNO supplement provides a long-term effect of IAHA treatment. Taken together, the SNO supplement can be safely used as an adjuvant diet for chronic symptomatic relief of OA coupled with IAHA management.

Evolution of the imaging features of osteoid osteoma treated with RFA or MRgFUS during a long-term follow-up: a pictorial review with clinical correlations.

Interventional radiology is today considered the first-line treatment for osteoid osteoma both in the form of needle-guided technique of ablation (Radiofrequency) and of needleless technique (magnetic resonance-guided focused ultrasound surgery). The follow-up study of the procedures is mainly clinical, since the disappearance of pain is consistent with the success of the procedure. However, due to the minimally invasive and innovative nature of the approach, interpretation of the follow-up imaging could be ambiguous and misleading. Aim of our review was to define the main findings on the imaging that can best describe the regular evolution of these types of treatment. In particular, four findings were considered: (1) bone marrow oedema; (2) reactive phenomena (perilesional inflammatory reaction for extra-articular lesions or synovial reaction for intra-articular lesions); (3) bone remodelling (disappearance of the nidus and bone healing); (4) ring sign (considered as the granulation tissue around the nidus treated). These findings were evaluated using MRI and CT with a follow-up study that lasted up to 24months.

Long-term Evaluation of Meniscal Tissue Formation in 3-dimensional–Printed Scaffolds With Sequential Release of Connective Tissue Growth Factor and TGF-β3 in an Ovine Model

Background: Artificial meniscal scaffolds are being developed to prevent development of osteoarthritis after meniscectomy. Previously, it was reported that 3-dimensional (3D) anatomic scaffolds loaded with connective tissue growth factor (CTGF) and transforming growth factor β3 (TGF-β3) achieved meniscal regeneration in an ovine model. This was a relatively short-term study (3 months postoperative), and outcome analyses did not include magnetic resonance imaging (MRI). Purpose: To evaluate long-term outcome of meniscal replacement with growth factor–laden poly-ε-caprolactone (PCL) scaffolds. Study Design: Controlled laboratory study. Methods: Anatomically shaped ovine meniscal scaffolds were fabricated from PCL with a 3D printer based on MRI data. Skeletally mature sheep (N = 34) were randomly allocated to 3 groups: scaffold without growth factor (0-µg group), scaffold with CTGF microspheres (µS) (5 µg) + TGF-β3 µS (5 µg) (5-µg group), and scaffold with CTGF µS (10 µg) + TGF-β3 µS (10 µg) (10-µg group). Unilateral medial meniscal replacement was performed. Animals were euthanized at 6 or 12 months. Regenerated meniscus, articular cartilage status, and synovial reaction were evaluated quantitatively with gross inspection, histology, and MRI. Kruskal-Wallis and Dunn tests were used to compare the 3 groups. Results: Remnants of the PCL scaffold were evident in the 6-month specimens and were decreased but still present at 12 months in most animals. There were no significant differences among groups in gross inspection, histology, or MRI for either meniscal regeneration or articular cartilage protection. All experimental groups exhibited articular cartilage degeneration as compared with control (nonoperated). In terms of synovitis, there were no clear differences among groups, suggesting that growth factors did not increase inflammation and fibrosis. MRI revealed that meniscal extrusion was observed in most animals (82.7%). Conclusion: Previously, the combination of CTGF and TGF-β3 was shown to stimulate mesenchymal stem cells into a fibrochondrocyte lineage. CTGF and TGF-β3 did not aggravate synovitis, suggesting no adverse response to the combination of 3D-printed PCL scaffold combined with CTGF and TGF-β3. Further work will be required to improve scaffold fixation to avoid meniscal extrusion. Clinical Relevance: A significant advantage of this technique is the ability to print custom-fit scaffolds from MRI-generated templates. In addition, average-size menisci could be printed and available for off-the-shelf applications. Based on the 1-year duration of the study, the approach appears to be promising for meniscal regeneration in humans.

Synovitis as a concomitant disease in shoulder pathologies.

Shoulder pathologies are often accompanied by rotator interval synovitis. This phenomenon is poorly described in the literature so far. The aim of the study was to analyze the occurrence of macroscopically visible synovial reaction in the rotator interval in patients with chronic shoulder pathologies and to perform a histopathological evaluation. In this prospective cohort study, 167 consecutive patients undergoing arthroscopic shoulder surgery for chronic shoulder pathology were included (♀ = 45, ♂ = 122; [Formula: see text]54.5years ± 12.8). Included patients were divided into subgroups according to the encountered chronic shoulder pathology: (1) impingement syndrome with or without bursal sided partial rotator cuff tear (RCT); (2) articular sided partial RCT; (3) full-thickness RCT; (4) RCT that involves at least two tendons; (5) shoulder instability; and (6) cartilage damage. Standardized soft tissue biopsies from the rotator interval were taken. The synovitis score of Krenn/Morawietz was used for histopathological examination. Extraarticular pathology (group 1) showed significantly decreased synovitis scores compared to all the other groups. Increased size of rotator cuff tears (group 4), as well as cartilage damage (group 6) showed significantly higher synovitis scores than group 3 (p < 0.05). Moreover, the synovitis score was significantly increased in patients with concomitant pathologies of the long head of the biceps (p = 0.001). This study suggests that chronic intra- and extraarticular shoulder diseases are very often accompanied by a histopathologically verifiable low-grade synovitis. Intraarticular pathologies seem to induce increased levels of synovitis. Furthermore, the increased size of rotator cuff tears is accompanied by a higher degree of synovitis. Cohort study, level of evidence, 2b.