Reduction of knee joint load suppresses cartilage degeneration, osteophyte formation, and synovitis in early-stage osteoarthritis using a post-traumatic rat model.

The purpose of this study was to clarify the histological effect of reducing the loading to knee on cartilage degeneration, osteophyte formation, and synovitis in early-stage osteoarthritis (OA) using a post-traumatic rat model. Ten male rats were randomly allocated into two experimental groups: OA induction by surgical destabilization of medial meniscus (DMM, OA group) and hindlimb suspension after OA induction by DMM (OAHS group). The articular cartilage, osteophyte formation, and synovial membrane in the medial tibiofemoral joint were analyzed histologically and histomorphometrically at 2 and 4 weeks after surgery. The histological scores and changes in articular cartilage and osteophyte formation were significantly milder and slower in the OAHS group than in the OA group. At 2 and 4 weeks, there were no significant differences in cartilage thickness and matrix staining intensity between both the groups, but chondrocytes density was significantly lower in the OA group. Synovitis was milder in OAHS group than in OA group at 2 weeks. Reducing knee joint loading inhibited histological OA changes in articular cartilage, osteophyte formation, and synovial inflammation. This result supports the latest clinical guidelines for OA treatment. Further studies using biochemical and mechanical analyses are necessary to elucidate the mechanism underlying delayed OA progression caused by joint-load reduction.

Renal Artery Dissection in a Patient With Degenerative Scoliosis: A Rare Complication Caused by Lumbar Vertebra Osteophyte.

Isolated spontaneous renal artery dissection (RAD) without known trauma is rare, and its etiology has not been determined. However, notable risk factors including hypertension, strenuous exercise, connective tissue disorders, atherosclerosis, extracorporeal shock wave lithotripsy, and cocaine abuse have been reported. To the best of our knowledge, isolated RAD caused by lumbar vertebra osteophytes in patients with degenerative lumbar scoliosis has not been reported in the literature. In this article, we present a case of RAD caused by lumbar vertebra osteophyte in a patient with degenerative scoliosis and discuss the management of the disease.

Structural effects of intra-articular TGF-ß1 in moderate to advanced knee osteoarthritis: MRI-based assessment in a randomized controlled trial.

BACKGROUND: To determine effects of allogeneic human chondrocytes expressing TGF-ß1 (TG-C) on structural progression of MRI features of knee osteoarthritis over a 1 year period. METHODS: This phase II randomized controlled trial of TG-C included patients with moderate to advanced osteoarthritis. Patients were randomized to receive an intraarticular 3:1 mixture of non-transduced allogeneic human chondrocytes and TG-C or placebo. 3 T MRI was acquired for all patients at baseline and follow-up (3, 6 and 12 months). MRIs were assessed using the WORMS system including cartilage damage, bone marrow lesions (BMLs), meniscal damage/extrusion, Hoffa-, effusion-synovitis, and osteophytes. Analyses were performed on a whole knee level, compartmental level, and subregional level. Binary logistic regression with Generalized Estimating Equation was used to compare risks of progression, adjusting for baseline age and gender. Mann - Whitney - Wilcoxon tests were used to assess differences for continuous variables. RESULTS: Fifty-seven Patients were included in the TG-C group and 29 in the placebo group. At 12 months, knees in the TG-C group showed less progression of cartilage damage compared to placebo on a whole knee level (34.6% vs. 47.9%; adjusted RR 0.7, 95%CI [0.5-1.1], p = 0.077). Less progression of Hoffa-synovitis and effusion-synovitis was observed in the TG-C group compared to placebo (9.6% vs. 21.1%, adjusted RR 0.5, 95%CI [0.2,1.2], p = 0.115). No statistically significant differences were seen for BMLs, meniscal damage and osteophytes. CONCLUSIONS: Intraarticular treatment with TG-C showed fewer patients in the treated group with progression in structural OA features and other MRI-defined inflammatory markers such as Hoffa-synovitis and effusion-synovitis. However, no differences were observed in regard to progression of BMLs and meniscal damage, or hypertrophic osteophyte formation. TRIAL REGISTRATION: NCT01221441 .Registered 13th October, 2010.

Review Article: Osteophytes.

An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor ß plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.

Symptomatic Osseous Abnormalities at the Posteromedial Tubercle of the Talus: Magnetic Resonance Imaging Features.

Osseous alterations adjacent to the posteromedial tubercle of the talus that lead to posterior ankle impingement and their imaging findings have been much less well described than alterations of the posterolateral tubercle. We present 5 cases of osseous abnormalities at the posteromedial tubercle of the talus depicted on magnetic resonance imaging in subjects with chronic symptoms at this location, with no history of local trauma, who had presented with posteromedial mechanical pain and/or tarsal tunnel syndrome. The symptoms were related to mechanical changes of the bony and soft tissue structures, leading to posterior impingement, and to neurovascular bundle entrapment at the tarsal tunnel, leading to tarsal tunnel syndrome.

A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

Anterior knee pain associated with an anterior superior patellar bony spur: a case report.

Anterior knee pain is a common presentation in Orthopaedic out patient practice. However anterior superior patellar spur is an uncommon cause.This case presentation is to highlight an anterior superior patellar spur with quadriceps tendonitis. The patient is a 52 year old man who presented with a recurrent anterior knee pain. The radiographic study revealed an anterio-superior patellar spur. The patient had a depo steroid injection as an adjunct therapy to physiotherapy and has been pain free.

Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study.

BACKGROUND: Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years. HYPOTHESIS: Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing. PATIENTS AND METHODS: Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain. RESULTS: Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group. DISCUSSION: Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing. LEVEL OF EVIDENCE: Level II: low-powered prospective randomized trial.

Dorsal wrist mass: the carpal boss.

The carpal boss is an osseous overgrowth that is occasionally mistaken for a ganglion cyst. This report highlights the case a 36-year-old patient who was originally diagnosed by his primary care physician with a ganglion cyst and was sent to an orthopaedist for aspiration. Upon further evaluation with a plain radiograph, the dorsal wrist mass was found to be a carpal boss. The patient was treated with rest and a wrist brace, and was informed that a corticosteroid injection or surgical excision would be necessary if conservative treatment failed. The patient was asymptomatic on follow-up and invasive procedures were not necessary.

Valgus extension overload: diagnosis and treatment.

Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the overhead athlete. Athletes in many sports may experience VEO and other common pathologies related to the high repetitive stresses generated by the overhead throwing motion. VEO is characterized by reproducible pain that is elicited by repeatedly forcing the elbow into terminal extension while applying a valgus stress to the elbow. Pain at the posteromedial tip of the olecranon process is pathognomonic of the condition. Olecranon stress fractures are rare, but can cause significant discomfort and, if unrecognized or untreated, can lead to significant pain and dysfunction. Both of these conditions are treated initially with rest from throwing, followed by gradual return to throwing through an interval throwing program. When conservative measures fail, minimally invasive or arthroscopic surgical procedures can be used to address the problem. Successful return to competitive overhead sports is expected at all levels of competition with these conditions.

Extensor hood syndrome--osteophytic irritation of digital extensor tendons in rock climbers.

OBJECTIVE: Injuries to the flexor tendons and flexor tendon pulleys are frequently reported in rock climbers. Osteoarthritic changes with bone spurs are also well known. We report on the less commonly described extensor tendon irritation caused by such osteophytes. METHODS: Thirteen high-level rock climbers (12 men, 1 woman; average age 33.8 years [range 17-55]; average years of climbing experience 19 [range 5-30]; average climbing level 10.2) with extensor hood irritation caused by dorsally located osteophytes of proximal interphalangeal (n = 10) or distal interphalangeal joints (n = 3) were evaluated and managed. Twelve climbers received conservative therapy and 1 climber was treated surgically. RESULTS: Before treatment, the climbers were unable to achieve their normal climbing ability due to extensor tendon irritations with resultant effusion noted in the ultrasound examinations. After conservative treatment, and in 1 case surgery, all patients achieved their previous climbing ability. CONCLUSION: While all climbers were able to achieve their former climbing level after treatment, the condition is progressive and the osteoarthritic changes will likely cause further problems for these individuals in the future. Extensor hood irritation must be considered in the differential diagnosis of finger pain in rock climbers.

[Observation on therapeutic effect of acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy for treatment of calcaneus spur].

OBJECTIVE: To compare therapeutic effects of acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy and common acupuncture on calcaneus spur. METHODS: A single-blind, randomized and controlled trial was adopted. Sixty-six cases were randomly divided into an observation group (n=34) and a common acupuncture group (n=32). The observation group was treated with acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy and the common acupuncture group with common acupuncture, Yanglingquan (GB 34), Kunlun (BL 60) etc. selected. The markedly effective rate and the changes of heel pain scores, heel swelling scores, heel burning sensation scores, and walking function scores were compared between the two groups before and after treatment. RESULTS: The markedly effective rate of 64.7% (22/34) in the observation group was higher than 37.5% (12/32) in the common acupuncture group (P<0.05). After treatment, all the scores in the two groups were significantly improved as compared with before treatment (all P<0.05), and the observation group was better than the common acupuncture group (all P<0.05). CONCLUSION: The therapeutic effect of acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy on calcaneus spur is superior to that of common acupuncture.

Changes in knee adduction moment, pain, and functionality with a variable-stiffness walking shoe after 6 months.

This study tested the effects of variable-stiffness shoes on knee adduction moment, pain, and function in subjects with symptoms of medial compartment knee osteoarthritis over 6 months. Patients were randomly and blindly assigned to a variable-stiffness intervention or constant-stiffness control shoe. The Western Ontario and McMaster Universities (WOMAC) score served as the primary outcome measure. Joint loading, the secondary outcome measure, was assessed using the external knee adduction moment. Peak external knee adduction moment, total WOMAC, and WOMAC pain scores were assessed at baseline and after 6 months. The total WOMAC and WOMAC pain scores for the intervention group were reduced from baseline to 6 months (p = 0.017 and p = 0.002, respectively), with no significant reductions for the control group. There was no difference between groups in magnitude of the reduction in total WOMAC (p = 0.50) or WOMAC pain scores (p = 0.31). The proportion of patients achieving a clinically important improvement in pain was greater in the intervention group than in the control group (p = 0.012). The variable-stiffness shoes reduced the peak knee adduction moment (-6.6% vs. control, p < 0.001) in the 34 intervention subjects at 6 months. The adduction moment reduction significantly improved (p = 0.03) from the baseline reduction. The constant-stiffness control shoe increased the peak knee adduction moment (+6.3% vs. personal, p = 0.004) in the 26 control subjects at 6 months. The results of this study showed that wearing the variable-stiffness shoe lowered the adduction moment, reduced pain, and improved functionality after 6 months of wear. The lower adduction moment associated with wearing this shoe may slow the rate of progression of osteoarthritis after long-term use.