Modified Mesenchymal stem cell, platelet-rich plasma, and hyaluronic acid intervention in early stage osteoarthritis: A systematic review, meta-analysis, and meta-regression of arthroscopic-guided intra-articular approaches.

BACKGROUND: Mesenchymal stem cells (MSCs) hold promise for osteoarthritis (OA) treatment, potentially enhanced by combining them with platelet-rich plasma (PRP) and hyaluronic acid (HA). This study aimed to assess the synergy of MSCs, PRP, and varying HA doses, and determine optimal MSC sources to treat early-stage OA in the perspective of Lysholm score, VAS Score, KSS score, and WOMAC score. METHOD: Original articles from 2013 to 2023 were screened from four databases, focusing on clinical trials and randomized controlled trials. The Risk of Bias in Non-randomized Studies-of Interventions (ROB-2) tool evaluated bias, and a PICOS criteria table guided result construction. Revman 5.4 analyzed outcomes such as Lysholm score, VAS score, KSS, WOMAC score, cartilage volume, and defect size using MRI. This systematic review adhered to PRISMA guidelines. RESULT: Nine studies met the final inclusion criteria. Meta-analysis revealed a significant improvement in Lysholm score (MD: 17.89; 95% CI: 16.01, 19.77; I2 = 0%, P = 0.56), a notable reduction in VAS score (MD: -2.62; 95% CI: -2.83, -2.41; I2 = 99%, P < 0.00001), elevated KSS (MD: 29.59; 95% CI: 27.66, 31.52; I2 = 95%, P < 0.0001), and reduced WOMAC score (MD: -12.38; 95% CI: -13.75, -11.01; I2 = 99%, P < 0.0001). CONCLUSIONS: Arthroscopic guided high-dose subchondral application of primary cultured synovial MSCs in popliteal PRP media with HA effectively regenerates cartilage defects and improves clinical outcomes in early-stage osteoarthritis. Clarification of MSC sources and quantities enhances the understanding of this promising treatment modality.

Application of green mussel (Perna viridis) shells hydroxyapatite on osteocalcin levels and osteoblast cells in rabbit femur bone defect.

Background: Bovine hydroxyapatite (HA) used for bone grafts is relatively expensive, necessitating the development of alternative sources. Alternative HA materials derived from green mussel shells with smaller molecular sizes are inexpensive and abundantly available throughout Indonesian waters. The purpose of this study is to investigate the effect of green mussel shells HA on bone healing. Methods: This post-test-only experimental research used male rabbits with femoral defects divided into three groups randomly: K (no treatment), P1 (bovine HA treatment), and P2 (green mussel shell HA treatment). The osteocalcin level was assessed biochemically while osteoblast cells were histopathologically at the second, fourth, and sixth weeks. Statistic tests were used to assess differences between groups and periods with statistical significance P<0.05. Results: Nine rabbits in each group showed significant differences between groups K, P1, and P2 in term osteocalcin levels at week 2 (2.60, 4.53±0.12, 4.47±0.23; P=0.046), week 4 (5.13±0.12, 8.53±0.12, 7.47±0.12; P=0.025), and week 6 (8.20, 11.93±0.23, 10.93±0.31, P=0.023), while in term osteoblast cells only at week 6 (16.33±3.46, 26.10±3.52, 30.40±3.29; P=0.006). The osteocalcin level and osteoblast increased significantly between groups K and P1/P2 from the initial trial until the last week. Osteoblast cells in the groups P1/P2 increased significantly, especially at week 6. Conclusion: Green mussel shell HA has the biochemical effectiveness of osteocalcin and can increase osteoblast cells comparable to bovine HA, which can enhance bone healing.

Fibrodysplasia Ossificans Progressiva: Difficulty in Diagnosis and Management A case report and literature review.

INTRODUCTION: Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant genetic disorder and characterized by postnatal progressive heterotopic ossification of the connective tissue. There are difficulties in diagnosing FOP, thus delayed or misdiagnosis and mismanagement is common. 3D printers have now become widely available and inexpensive, and can be used to rapidly produce life-size models based on CT scans of an individual patient. The availability of patient specific, accurate and detailed models of complex acetabular fractures can aid planning of surgical management on a patient specific basis. CASE REPORT: We present the diagnosis and surgical management of a 9-year old Indonesian girl with FOP. She presented with extensive involvement of cervical spine and both shoulders. Total excision of occipito-cervico-lumbar and paravertebral ossification and also exostoses at bilateral shoulder was done. At three years follow up, she had local recurrence with similar range of movement of the shoulder and cervical spine. CONCLUSION: FOP is an extremely rare case. It is difficult to diagnose and manage FOP, therefore delayed or misdiagnosis and also inappropriate management is common.