Traumatic Joint Injury Research Articles

Study on evalution of post traumatic knee joint injuries

Background: The knee being the largest joint in the human body withstands complex forces which are exerted during various activities, rendering it prone to a number of acute and chronic injuries. It is also one of the most frequently injured joints, whether as an isolated injury or as a component in a multiple trauma patient. Aim and. Objectives: The objective of the present study was to evaluate the incidence of various ligamentous and meniscal injuries of post-traumatic knee joint. Materials and Methods: Once a patient fulfilled the inclusion criteria for this study he / she was administered the predesigned / pretested proforma. Demographic characteristics of the study population such as age, sex were obtained through an interview. The patients were then briefed about the procedure i.e. about the noise of the gradient coils and need to control the body movements for successful image acquisitions. The patient is asked to lie in supine position with the knee in close relation to the knee coil. The knee is then externally rotated 15-20° and is also minimally flexed 5-10°. Statistical Analysis: The data obtained was coded and entered into Microsoft Excel Worksheet. The categorical data was expressed as rates, ratios, proportions and percentages.

Bio-orthogonal Click Chemistry Methods to Evaluate the Metabolism of Inflammatory Challenged Cartilage after Traumatic Overloading.

During traumatic joint injuries, impact overloading can cause mechanical damage to the cartilage. In the following inflammation phase, excessive inflammatory cytokines (e.g., interleukin-1β (IL-1β)) can act on chondrocytes, causing over-proliferation, apoptosis, and extracellular matrix (ECM) degradation that can lead to osteoarthritis. This study investigated the combined effects of traumatic overloading and IL-1β challenge on the metabolic activities of chondrocytes. Bovine cartilage explants underwent impact overloading followed by IL-1β exposure at a physiologically relevant dosage (1 ng/mL). New click chemistry-based methods were developed to visualize and quantify the proliferation of in situ chondrocytes in a nondestructive manner without the involvement of histological sectioning or antibodies. Click chemistry-based methods were also employed to measure the ECM synthesis and degradation in cartilage explants. As the click reactions are copper-free and bio-orthogonal, i.e., with negligible cellular toxicity, cartilage ECM was cultured and studied for 6 weeks. Traumatic overloading induced significant cell death, mainly in the superficial zone. The high number of dead cells reduced the overall proliferation of chondrocytes as well as the synthesis of glycosaminoglycan (GAG) and collagen contents, but overloading alone had no effects on ECM degradation. IL-1β challenge had little effect on cell viability, proliferation, or protein synthesis but induced over 40% GAG loss in 10 days and 61% collagen loss in 6 weeks. For the overloaded samples, IL-1β induced greater degrees of degradation, with 68% GAG loss in 10 days and 80% collagen loss in 6 weeks. The results imply a necessary immediate ease of inflammation after joint injuries when trauma damage on cartilage is present. The new click chemistry methods could benefit many cellular and tissue engineering studies, providing convenient and sensitive assays of metabolic activities of cells in native three-dimensional (3D) environments.

Protein N-glycosylation aberrations and glycoproteomic network alterations in osteoarthritis and osteoarthritis with type 2 diabetes

Whether the relationship between type 2 diabetes mellitus (T2DM) and osteoarthritis (OA) can be solely attributed to the shared risk factors, such as obesity, remains controversial. Several studies have revealed the critical role of abnormal glycosylation in the pathogenesis of OA and T2DM. Therefore, we speculate that T2DM may contribute to the pathogenesis of OA through the intrinsic mechanisms of N-glycosylation aberrations. Using N-glycoproteomics, we compared the changes in N-glycosylated protein abundance in cartilage samples from patients with OA without and with T2DM (DM-OA), and from patients with traumatic joint injury (NC) as controls. We identified 847 N-glycosylation sites corresponding to 729 peptides fragments from 374 proteins. The number of N-glycosylated proteins in the DM-OA group tended to decrease compared with that in the OA and NC groups. We identified 22 upregulated and 1 down-regulated N-glycosylated peptides in the OA group compared to the NC group, while only fibronectin 1 (FN1) at position N1007, cartilage intermediate layer protein 1 (CILP) at N346, and collagen type VI alpha 1 chain (COL6A1) at N804, were also identified in the DM-OA group. Compared to the OA group, the downregulation of secreted protein acidic and rich in cysteine (SPARC) at N116, collagen type VI alpha 1 chain (COL6A2) at N785, and asporin (ASPN) at N282, and the upregulation of complement component C8 alpha chain (C8α) at N437, were the most remarkable alterations in the DM-OA group. The differentially expressed N-glycosylated proteins between the OA and DM-OA groups were mainly located extracellularly and enriched in the KEGG pathways involving PI3K/Akt signaling, focal adhesion, and ECM-receptor interaction. Their predicted protein–protein interactions were also depicted. We were thus able to show the general characteristics of N-glycosylation aberrations in OA and DM-OA. Moreover, the upregulated glycosylated complement C8α in the DM-OA group might augment membrane attack complex activity, thereby exacerbating cartilage destruction. Although further confirmation is required, our hypothesis proposes a possible explanation for the deduction that T2DM is an independent risk factor for OA.

Epigenetic Regulation of Chondrocytes and Subchondral Bone in Osteoarthritis.

The aim of this review is to provide an updated review of the epigenetic factors involved in the onset and development of osteoarthritis (OA). OA is a prevalent degenerative joint disease characterized by chronic inflammation, ectopic bone formation within the joint, and physical and proteolytic cartilage degradation which result in chronic pain and loss of mobility. At present, no disease-modifying therapeutics exist for the prevention or treatment of the disease. Research has identified several OA risk factors including mechanical stressors, physical activity, obesity, traumatic joint injury, genetic predisposition, and age. Recently, there has been increased interest in identifying epigenetic factors involved in the pathogenesis of OA. In this review, we detail several of these epigenetic modifications with known functions in the onset and progression of the disease. We also review current therapeutics targeting aberrant epigenetic regulation as potential options for preventive or therapeutic treatment.

Nonoperative Management of Traumatic Acromioclavicular Joint Injury: A Clinical Commentary with Clinical Practice Considerations.

Traumatic injuries of the acromioclavicular joint result in pain and potentially long-term alterations in scapulohumeral rhythm that occurs due to disruption of the clavicular strut function which is integral to scapular kinematics. Nonoperative treatment remains a valid option in most acromioclavicular joint injuries with the potential of minimizing pain and restoring scapulohumeral rhythm. However, few studies have provided nonoperative treatment details. Therefore, the purpose of this clinical commentary is to discuss the rationale, indications, and techniques of nonoperative treatment and present an organized approach for evaluating and managing such patients based on the best available evidence. Attention will be focused on identifying the treatment methods employed and the results/outcomes of such treatments.Level of Evidence5

IS MUSCLE QUALITY IMPAIRED AFTER TRAUMATIC KNEE INJURIES? - A MATCHED CLUSTER ANALYSIS

Purpose: Neuromuscular deficits persist following knee injury and may contribute to early-onset osteoarthritis. Clinical presentation of reduced muscle strength is reported years after anterior cruciate ligament (ACL) injury or surgery, while presence of less evident factors, such as neural inhibition and muscle denervation, altered mechanics, pro-inflammatory cytokines, and imbalance of muscle protein synthesis can drive muscle atrophy after a traumatic joint injury. These changes can implicate recovery despite muscle strengthening exercises and even cause deficits in the uninjured limb.

Traumatic acromioclavicular joint injury in a child: A case report

Traumatic acromioclavicular joint injury in a child: A case report

Traumatic sternoclavicular joint dislocation - A case series and discussion of methods of management

Traumatic sternoclavicular (SC) joint injuries account for <3% of all traumatic joint injuries. Instability of the SC joint (SCJ) is a difficult problem to treat and can present with gross limitations in activities. Prompt diagnosis and intervention are imperative in the management of these fracture dislocations. We present three cases of posttraumatic SCJ dislocation treated conservatively and two cases treated with open reduction and internal fixation with reconstruction plate and its functional outcome and discuss the various modes of management of these dislocations.

Risk factors for infectious complications after total elbow arthroplasty

INTRODUCTION. Total elbow arthroplasty (TEA) is a good alternative surgical solution for many patients with severe traumatic and inflammatory joint injuries. However, this surgical procedure is characterized by a rather high incidence of periprosthetic joint infection (PJI): from 3 to 8 %. At present, the issue of the influence of various factors on the risk of PJI is relevant.The OBJECTIVE of the study was to identify risk factors for the development of PJI after primary TEA.METHODS AND MATERIALS. In a retrospective study, the data of 485 patients who underwent primary and revision TEA from 2003 to 2019 were analyzed. The total number of studied patients was divided into 2 groups. The main group consisted of 51 patients who underwent revision TEA for PJI. The control group included 434 patients who underwent primary TEA.RESULTS. Evaluation of the effect of the primary diagnosis on the risk of PJI development showed a statistically significant relationship only in patients with gunshot wounds of the elbow joint (p=0.01). In the study of possible anamnestic factors, the following were significant: a history of previous interventions on elbow joint (p=0.004), previous infection (p &lt;0.001) and open fracture of the elbow (p=0.009).CONCLUSION. In the course of the study, we proved the influence of anamnestic factors in the occurrence of PJI. Performing a two-stage revision allows stopping the infectious process with high efficiency in most cases.

Traumatic Hip Joint and Thigh Injuries - an Analysis of NHF Reporting Data from 2016-2019 Using the NHF Statistics API.

The hip joint is one of the most important joints in the human body. Although its multiaxial movements account for many benefits, they also render the hip one of the most hard-working joints. Injuries to the hip joint and thigh often occur as a result of a fall. According to epidemiologic data, such falls are most frequent in the elderly, particularly in osteoporosis sufferers. The "Services" component of the Statistics API version 1.0 provided by the National Health Fund (NHF) was used in order to evaluate the number of hospitalizations due to hip joint and thigh injuries. Information on the number of patients was obtained in a number of stages. The first stage involved determination of hip and thigh injuries as the main diagnosis. Then, the billing products which made possible settlement for hospitalization of patients with the selected diagnoses were chosen. The last stage consisted in the extraction of relevant medical data sets from the "Services" component of the NHF Sta-tistics API, which made possible this analysis. According to the NHF reporting data, over the four-year period of interest there were approx. 42,000 hospitalizations per year. The most frequent causes of hospitalization were fractures of the neck of the femur (S72.0) and trochanteric fractures (S72.1), accounting for approx. 48% and 36% of all hospital stays, respectively. 1. Hip injuries constitute a significant health problem in Poland (approx. 42,000 hospitalizations per year). 2. The most frequent causes of hospitalization are injuries in the form of fractures of the neck of the femur or trochanteric fractures (corresponding to the ICD-10 codes S72.0 and S72.1, respectively). 3. It appears advisable to develop a tool to enable medical service providers to adjust their services to patients' changing needs. This tool could em-ploy open-access data on injuries published in the NHF Statistics API.

The history of the development of elbow arthroplasty

Total elbow arthroplasty is a good alternative surgical solution for many patients with severe traumatic and inflammatory joint injuries. In case of bones multiple fractures of the elbow joint, arthroplasty can restore the stability of the joint and provide early mobilization of the limb, which is not always possible when performing osteosynthesis. This literature review provides information on the design features of foreign and domestic endoprostheses of the elbow joint, long-term results of operations. The turbulent history of the development of elbow arthroplasty goes back over 60 years. At the same time, due to insufficient understanding of the biomechanics of the joint, the first attempts at its arthroplasty failed. Only in the early 70s, in connection with the improvement of the endoprostheses design and the operation technique, publications on the successful results of total elbow arthroplasty appear in the literature. In the 80s of the XX century implants with a semi-connected design and cemented placement technique have been developed, which still demonstrate better long-term results in comparison with implants with anatomical design. The analysis of publications on the topic of total elbow arthroplasty showed that significant achievements were observed only in the early 1990s, which is largely due to a better understanding of the biomechanics of the elbow joint, as a result, to the improvement of implant design and surgical technique.

BANDHANA WITH MANJISHTADI LEPA IN THE MANAGEMENT OF ANKLE SPRAIN – A CASE REPORT

The ankle joint is the most common site for a ligament injury in the body. Some ankle joint injuries are minor and heal with some rest from activities, but some are serious and require immediate medical attention. An ankle sprain refers to ligament injuries of the ankle. In classics, there is no direct reference regarding sprain and its manage- ment. In Susrutha Samhitha Chikitsa Sthana 3rdchapter, Bhagna Chikitsitham, Acharya Susruta has mentioned the application of Manjishtadi Lepa for traumatic joint injuries. In the present case study, a 22 years old male pa- tient visited the OPD with severe pain and swelling of the right ankle following a twisting injury of the foot. He was diagnosed with a grade 1 ankle sprain and was bandaged with Manjishtadi Lepa. Management with Man- jishtadi Lepa has shown significant relief in pain and swelling as well as in the restoration of normal movements. Keywords: Ankle sprain, Manjishtadi Lepa

Anti-inflammatory effects of tibial axial loading on knee articular cartilage post traumatic injury

Early therapeutic intervention to mitigate inflammatory responses following joint injury may offer a potential strategy to prevent post-traumatic osteoarthritis (PTOA). In-vitro studies have demonstrated uniaxial dynamic compression mitigates the catabolic and apoptotic responses of articular cartilage (AC) in response to mechanical injury. The objectives of this study were (1) to develop a custom device that can apply dynamic tibial axial loading (TAL) to knee AC by mimicking therapeutic, in-vitro loading conditions and (2) to investigate the potential of TAL to reduce the inflammatory response of AC post traumatic acute joint injury using an ex-vivo porcine model. A TAL device was fabricated to apply dynamic compressive loading to knee AC by combining tibial axial compressive loading with continuous passive motion. Computational analyses demonstrated that the loading condition applied to the knee by the TAL device closely simulate uniaxial dynamic compression reported in previous in-vitro studies. Following single impact injury, injured porcine knees were subjected to TAL with a magnitude of 1/4 body weight at a frequency of 1 Hz for 30 min. AC samples were harvested 8 h post injury for analysis of pro-inflammatory cytokine expression (IL-1β and TNF-α). Expression of both cytokines was upregulated following injury; however, the change was notably mitigated in the specimens subjected to TAL. Thus, TAL may be an effective and potentially, practical-to-administer early intervention strategy to mitigate rapidly occurring detrimental events following acute AC injury, potentially slowing down progression to PTOA.

Changes in anterior femoral articular cartilage structure in collegiate rugby athletes with and without a history of traumatic knee joint injury following a five-month competitive season

This study aimed to examine anterior femoral cartilage morphology before (pre-season) and after (post-season) a 5-month competitive season in collegiate ruby players with and without a previous history of traumatic injury to ligamentous, meniscus, and/or cartilage structures at the knee joint. Using a prospective cohort design, 42 male collegiate rugby players with a previous history of traumatic intracapsular knee joint injury and 124 players without knee injury history were included in this study. Ultrasonography assessments of anterior femoral cartilage were performed before (pre-season) and following a 5-month athletic season (post-season). Rugby players with a history of traumatic knee joint injury had greater lateral condylar thickness (2.37 ± 0.35 mm, p = 0.03), intercondylar thickness (2.51 ± 0.47 mm, p = 0.03), and partial area (44.67 ± 7.28mm2, p = 0.02) compared to control players (lateral = 2.23 ± 0.35 mm, intercondylar = 2.32 ± 0.47 mm, partial area = 41.60 ± 7.26 mm2), regardless of pre-and post-season assessment time points. Pre-season ultrasonography assessment of lateral condylar thickness (2.34 ± 0.47 mm, p = 0.02), medial condylar thickness (2.05 ± 0.43 mm, p = 0.03), and partial area (44.10 ± 9.23 mm2, p = 0.001) were significantly greater than the post-season ultrasonography assessment time point (lateral = 2.26 ± 0.43 mm, medial = 1.98 ± 0.43 mm, partial area = 42.17 ± 8.82 mm2), regardless of group membership. Rugby players with a history of intracapsular knee joint injury displayed altered anterior femoral cartilage size via ultrasonography assessments. Regardless of a presence of injury history, collegiate rugby players showed a decrease in cartilage thickness and partial area following a 5-month competitive season.

Radiographic evaluation of reactive osteitis in traumatic injury of sacroiliac joints

ObjectivesAfter traumatic Sacroiliac (SI) joint injury, follow up radiographic imaging can demonstrate subchondral bone resorption resembling inflammatory sacroiliitis. No studies have described the incidence of marginal SI post-traumatic osteitis, the probable temporal relationship to the initial traumatic injury, or the possible effect of unilateral hardware fixation on the contralateral SI joint. MethodsA Level 1 trauma center imaging database was queried to identify patients with pelvic bony trauma between 2005 and 2017 with CT baseline preserved SI cortication and unilateral/bilateral traumatic SI diastasis. Serial radiographs were retrospectively evaluated by 2 musculoskeletal-trained radiologists at initial, 6 weeks, 3 months and 6 months following trauma, with documentation of diastasis, subchondral resorption, and operative fixation. Results206 SI joints in 106 total patients met inclusion criteria. There was a statistically significant association between injury and presence of resorption at 6 weeks post-trauma for the right SI joint only. There was no other statistically significant relationship between injury and presence of resorption at any other post-trauma evaluation. There was no statistical relationship between resorption and surgical fixation. There was a statistically significant increased incidence of resorption in the post-traumatic population when compared to an atraumatic population undergoing CT pelvis study for non-SI related indications as well as compared to the incidence of inflammatory sacroiliitis in a general population. ConclusionsThis study confirms an incidence of sub-acute subchondral bone resorption following traumatic joint injury above that expected for a general, non-traumatic population. Accurate interpretation of this traumatic finding minimizes inappropriate consultation and intervention for inflammatory sacroiliitis.

A single dose of P188 prevents cell death in meniscal explants following impact injury

ObjectiveTo determine the efficacy of single and multiple administrations of Poloxamer 188 (P188) in saving meniscal cells following an injurious impact. MethodsMeniscal explants were harvested from both the lateral and medial menisci of Flemish Giant rabbits. After a 24-h incubation period, explants were subjected to 50% impact strain to simulate traumatic joint injury, and the explants were then placed in media with or without supplemented P188. Temporal administrations of P188 over a 14-day period were given based on one of 6 different treatments regimes. Over the 14-day period, explants were cyclically loaded to 10% strain at 1 Hz for 1 h per day, five days a week. Cell viability was assessed on day 14, with the remainder of the tissue being fixed to determine cell apoptosis levels and proteoglycan changes via histology. ResultsThe injurious impact proved to produce significant levels of cell death in meniscal explants. The ability of P188 to prevent cell death was not affected by the number of P188 doses (single versus multiple). P188 treatment proved to maintain cell viability levels comparable to those from unimpacted explants. There were no significant changes in cell apoptosis or proteoglycan coverage in the tissues over a 14-day period for any group, all treatment groups were statistically similar to the unimpacted explants. ConclusionA single dose of P188 following impact is all that is necessary to inhibit cell death in the meniscus following a traumatic impact. Thus, orthopaedic surgeons may choose to administer P188 in addition to treating any other acute damage due to a traumatic load to the knee, such as anterior cruciate ligament rupture, although more in depth in vivo studies are necessary.

Hyaluronic Acid-Based Shape-Memory Cryogel Scaffolds for Focal Cartilage Defect Repair

Traumatic joint injuries can result in significant cartilage defects, which can greatly increase the risk of osteoarthritis development. Due to the limited self-healing capacity of avascular cartilage, tissue engineering approaches are required for filling defects and promoting cartilage regeneration. Current approaches utilize invasive surgical procedures for extraction and implantation of autologous chondrocytes; therefore, injectable biomaterials have gained interest to minimize the risk of infection as well as patient pain and discomfort. In this study, we engineered biomimetic, hyaluronic acid (HA)-based cryogel scaffolds that possess shape-memory properties as they contract and regain their shape after syringe injection to noninvasively fill cartilage defects. The cryogels, fabricated with HA and glycidyl methacrylate at -20°C, resulted in an elastic, macroporous, and highly interconnected network that provided a conducive microenvironment for chondrocytes to remain viable and metabolically active after injection through a syringe needle. Chondrocytes seeded within cryogels and cultured for 15 days exhibited enhanced cell proliferation, metabolism, and production of cartilage extracellular matrix glycosaminoglycans compared with HA-based hydrogels. Furthermore, immunohistochemical staining revealed production of collagen type II from chondrocyte-seeded cryogels, indicating the maintenance of cell phenotype. These results demonstrate the potential of chondrocyte-seeded, HA-based, injectable cryogel scaffolds to promote regeneration of cartilage tissue for nonsurgically invasive defect repair. Impact statement Hyaluronic acid-based shape-memory cryogels provide a conducive microenvironment for chondrocyte adhesion, proliferation, and matrix biosynthesis for use in repair of cartilage defects. Due to their sponge-like elastic properties, cryogels can fully recover their original shape back after injection while not impacting metabolism or viability of encapsulated cells. Clinically, they provide an opportunity for filling focal cartilage defects by using a single, minimally invasive injection of a cell encapsulating biocompatible three-dimensional scaffold that can return to its original structure to fit the defect geometry and enable matrix regeneration.

High Prevalence of Hip and Knee Arthroplasty in Former Professional American Style Football Players: A Call to Action.

High Prevalence of Hip and Knee Arthroplasty in Former Professional American Style Football Players: A Call to Action.

Projected Metabolic Consequences of Post-Traumatic Osteoarthritis and the Aging Population

Osteoarthritis (OA) affects a large percentage of older adults. Prevalence of OA in younger adults is growing due to traumatic joint injuries occurring through sport participation. The purpose of this review is to summarize the recent literature linking lower extremity musculoskeletal injuries to post-traumatic osteoarthritis (PTOA), summarize the biomechanical and movement strategy consequences of these injuries, and link these consequences with known metabolic risk factors associated with general OA specifically in the aging population. Approximately 30% of younger adults have radiographic OA within one year after traumatic knee injury. An estimated 50% of individuals with chronic ankle instability will suffer from PTOA. Injuries to lower limb joints can lead to alterations in movement patterns, which may result in detrimental joint loading. This may be contributing to this accelerated development of PTOA. Older age, independent of OA, is also associated with gait alterations as well as greater metabolic cost of movement and greater fatigability. It is hypothesized that individuals suffering from PTOA as younger adults may be at a greater risk for these metabolic consequences due to the accelerated timeframe of OA onset and associated functional declines of older age. The potential consequences of PTOA in lower limb joints paired with advancing age may include gait abnormalities, greater metabolic cost of movement, greater fatigability, and reduced physical activity. Collectively, these factors may contribute to greater cardiometabolic risk and weight gain, and reduced quality of life with older age. Strategies to alleviate and/or delay the progression of OA in younger and middle-aged adults are necessary to help reduce this risk.

Traumatic joint injury induces acute catabolic bone turnover concurrent with articular cartilage damage in a rat model of posttraumatic osteoarthritis.

Assess acute alterations in bone turnover, microstructure, and histomorphometry following noninvasive anterior cruciate ligament rupture (ACLR). Twelve female Lewis rats were randomized to receive noninvasive ACLR or Sham loading (n = 6/group). In vivo μCT was performed at 3, 7, 10, and 14 days postinjury to quantify compartment-dependent subchondral (SCB) and epiphyseal trabecular bone remodeling. Near-infrared (NIR) molecular imaging was used to measure in vivo bone anabolism (800 CW BoneTag) and catabolism (Cat K 680 FAST). Metaphyseal bone remodeling and articular cartilage morphology was quantified using ex vivo μCT and contrast-enhanced µCT, respectively. Calcein-based dynamic histomorphometry was used to quantify bone formation. OARSI scoring was used to assess joint degeneration, and osteoclast number was quantified on TRAP stained-sections. ACLR induced acute catabolic bone remodeling in subchondral, epiphyseal, and metaphyseal compartments. Thinning of medial femoral condyle (MFC) SCB was observed as early as 7 days postinjury, while lateral femoral condyles (LFCs) exhibited SCB gains. Trabecular thinning was observed in MFC epiphyseal bone, with minimal changes to LFC. NIR imaging demonstrated immediate and sustained reduction of bone anabolism (~15%-20%), and a ~32% increase in bone catabolism at 14 days, compared to contralateral limbs. These findings were corroborated by reduced bone formation rate and increased osteoclast numbers, observed histologically. ACLR-injured femora had significantly elevated OARSI score, cartilage thickness, and cartilage surface deviation. ACL rupture induces immediate and sustained reduction of bone anabolism and overactivation of bone catabolism, with mild-to-moderate articular cartilage damage at 14 days postinjury.