Tenosynovial giant cell tumor in the foot and ankle.

BACKGROUND: Tenosynovial giant cell tumor (TSGCT) originates from the synovial cells of the tendon sheath and is the most common soft tissue tumor of the foot and ankle. Due to the lack of clinical data about TSGCT in the foot and ankle, this study was performed with the aim of investigating the clinical characteristics, and surgical outcomes that might predict the likelihood of recurrence. METHODS: Clinical data, obtained from the pathology records and the clinic files, along with the tumor subtype, local recurrence, and patient functional status among 26 cases of TSGCT were evaluated with the mean 73 months follow-up period. RESULTS: There were 26 patients including 16 males and 10 females with a mean age of 40 years, who underwent surgery. There were 15 localised TSGCT and 11 diffuse TSGCT. The diffuse TSGCT was more likely to be in the hindfoot dorsum (54,5%, 6/11). The localised TSGCT was mostly located in the forefoot (80%, 12/15). The recurrence rate in the diffuse TSGCT was 27,3% (3/11). In the localised TSGCT, recurrence was seen in 6,6% of patients (1/15). The mean AOFAS score was 79. CONCLUSION: Diffuse TSGCT is more likely to occur in the hindfoot and localised TSGCT is more common in the forefoot. Excision with clear margins is an effective treatment for TSGCT, with good oncological and clinical outcomes. But the orthopaedic surgeons should consider the equilibrium between surgical margins and the functional status of the patient.

A skin tumor from an orthopedic oncology perspective: Pilomatrixoma in extremities (11 years experience with 108 cases).

Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a benign skin neoplasm originating from hair follicle matrix cells. Pilomatrixoma is a common skin neoplasm that is often misdiagnosed as another type of skin condition. The aim of our study is to review 11 years' worth of experience in examining clinical and histopathological presentations, imaging findings, management approaches, and treatment outcomes of pilomatrixoma at a tertiary hospital. A review of the pathology database revealed that 108 extremity pilomatrixomas were excised between 2007 and 2018. Hospital charts, and pathology and orthopedic clinic records, were reviewed for patient data such as age, gender, clinical and histopathological presentations, preoperative diagnosis and imaging results, management approach, recurrence, and treatment outcomes. The main presenting symptom was a hard, subcutaneous, slowly growing mass. The preoperative diagnosis was accurate and consistent with the pathological diagnosis of pilomatrixoma in only 35 cases (32%). The optimal diagnostic tool for pilomatrixoma seems to be ultrasound imaging of superficial tissue, and the optimal first-line treatment might be surgical excision with clear margins. However, pilomatrixoma is a benign tumor, with atypical forms, and there no tumor-specific diagnostic tool is available other than careful histopathological examination.

Fifty top-cited classic papers in orthopaedic oncology: a bibliometric analysis.

INTRODUCTION: Citation analysis has been used to evaluate the impact of papers in medicine. There has been multitude of orthopaedic oncology-related papers in literature, to our knowledge no citation analysis of orthopaedic oncology papers has been performed. We identified the 50 most-cited orthopaedic oncology papers and evaluated these papers in terms of their time of publication, source journals, countries, institutions, authors, and main topics. MATERIALS AND METHODS: Science citation index expanded was searched in April 2018 for citations of papers published in 77 selected journals since the beginning of the database. The 50 most-cited orthopaedic oncology papers were identified and evaluated. RESULTS: The number of citations for the top 50 papers ranged from 168 to 1162 (mean 308). These papers were published between 1957 and 2010. 1990s was the most productive decade, with 19 papers of the list. All papers were written in English and they were published in a total of 6 journals. The Journal of Bone and Joint Surgery-Am published the largest number of papers with 31, followed by Clinical Orthopaedics and Related Research with 8. The top 50 papers were created mainly from US and Japan, respectively, with 33 and 5. CONCLUSIONS: It is difficult to define the exact impact of a single paper in the literature. In doing citation analysis, it provides us perspective in the history and progress of orthopaedic oncology.

Learning Curve for Surgical Treatment of Acetabular Fractures: A Retrospective Clinical Study of a Practical and Theoretical Training Course.

BACKGROUND Surgical treatment of acetabular fracture and the anatomic reconstruction of the hip joint are difficult to achieve due to the complex pelvic anatomy, and surgical training requires a prolonged and steep learning curve. The aim of this study was to evaluate the effects of an applied training course, including cadaveric dissection, for the surgical treatment of acetabular fractures. MATERIAL AND METHODS This retrospective study included 35 patients who underwent surgical treatment for acetabulum fractures between 2012-2016. Patients were divided into three groups during two training courses, for the first two years and second two years. The surgical treatment was performed through single or combined standard approaches, according to the fracture pattern. The radiological outcome was evaluated using Matta's criteria to grade postoperative reduction and final radiological outcome and the restoration of the hip joint center (HJC). The clinical outcome was evaluated using the modified the Merle d'Aubigné-Postel (DAP) hip score. RESULTS Both post-course groups had statistically better functional and radiological outcomes compared with the pre-course group. Depending on the learning curve, the mean duration of surgery decreased from 153 minutes to 82.3 minutes. Although there was no statistical difference between groups in the vertical shift of the HJC, there was a statistically significant in the amount of horizontal shift of the HJC in the second two years of training, compared with the other groups. CONCLUSIONS Functional and radiological outcome of surgical treatment of acetabular fracture may be improved with increased training, depending on the learning curve.

The association of vitamin D with inflammatory cytokines in diabetic peripheral neuropathy.

[Purpose] The effects of vitamin D on the circulating levels of IL-17 and IL-13 were investigated in patients with diabetic peripheral neuropathy, patients with diabetes mellitus type 2 without neuropathy, and healthy controls. [Subjects and Methods] A single-blind controlled clinical study was performed, including70 type 2 diabetic patients with or without diabetic peripheral neuropathy and 33 healthy volunteer controls. The 25(OH)D levels were evaluated using ultra-performance liquid chromatography, and IL-17 and IL-13 levels were assessed using enzyme-linked immunosorbent assays. [Results] The 25(OH) vitamin D concentration was lower in diabetic peripheral neuropathy patients than in diabetes mellitus patients without neuropathy and healthy controls. Similarly, 25(OH)D levels were lower in diabetes mellitus patients than healthy controls. IL-17 and IL-13 levels were higher in diabetes mellitus patients than in controls. Additionally, IL-13 levels were higher in diabetic peripheral neuropathy patients than in diabetes mellitus patients without neuropathy. These differences were statistically significant. There was a significant positive correlation between 25(OH)D and IL-13,and a negative correlation between 25(OH)D andIL-17 in the diabetic and diabetic neuropathy groups. [Conclusion] Vitamin D is a potential modifiable risk factor for diabetic peripheral neuropathy and may regulate inflammatory mediators, e.g., IL-17 and IL-13.

Similar effectiveness of the open versus endoscopic technique for carpal tunnel syndrome: a prospective randomized trial.

This prospective randomized study aims at evaluating the electrophysiological results of endoscopic and open carpal ligament release in patients with carpal tunnel syndrome. Included in the study were 41 patients diagnosed with carpal tunnel syndrome (21 hands in the endoscopic group and 20 hands in the open group). The Boston questionnaire was administered preoperatively and postoperatively to the patients, and their functional capacities and symptom severities were recorded. Physical examination was carried out preoperatively and in the postoperative sixth month. Demographic data and preoperative Boston symptomatic and functional scores were similar between both groups. A significant improvement was obtained in the Boston symptomatic and functional scores of both groups, but no significant difference was found between the groups in terms of improvement in the symptomatic and the functional scores. A significant shortening in median nerve motor distal latency and an increase in the velocity of sensory conductions were determined in both groups in the postoperative electromyography, but no difference was found between them in terms of improvement in the electromyography values. It was shown both clinically and electrophysiologically that endoscopic carpal tunnel surgery was as effective as open surgery as a treatment method for carpal tunnel syndrome.

Traumatic Hip Dislocations in Patients Younger Than 16 Years Old: A Single Center Experience with Mean Follow-Up of 10.4 Years.

Introduction: Traumatic hip dislocation in childhood is a rare injury. The aim of this study was to present the experience of a single center for traumatic hip dislocation in the pediatric and adolescent age group. Materials and Methods: The orthopedic trauma database of a single center was retrospectively searched for patients who had sustained a traumatic hip dislocation between 2004 and 2019. Data related to age, mechanism of injury, additional fractures, presence of any open fracture or neurovascular injury, and dislocation side were retrieved from the patient files. Functional outcome was evaluated using the Harris Hip Scoring system. Results: The mean age of 13 patients at the time of injury was 7.7 years and the mean follow-up time was 124.5 months (10.4 years). All traumatic hip dislocations were posterior dislocations. The mean Harris Hip score was 95.7 points (range 55-100 points) with 12 patients scored as excellent and 1 as poor results. Ten complications including limb length inequality, avascular necrosis and hip arthritis were determined in seven patients. Conclusion: Traumatic hip dislocation is a rare injury in the pediatric age group. Early diagnosis and concentric reduction of the femoral head is essential for better functional results and to avoid complications. Limb length inequality is a frequently seen complication, which has not been reported in previous studies.

The efficiency and safety of intravenous tranexamic acid administration in open reduction and internal fixation of pelvic and acetabular fractures.

PURPOSE: This study aimed to investigate the efficiency and safety of tranexamic acid use in open reduction and internal fixation of pelvis and acetabulum fractures. MATERIALS AND METHODS: 73 consecutive patients were included. 1000 mg TXA was administered intravenously to all patients before surgery. The patients were evaluated on the basis of preoperative, postoperative first and third day hemoglobin-hematocrit values, amount of drainage collected, total blood loss, transfusion rates and complications. RESULTS: Mean operative time was 120.1 min. Average decrease in hematocrit levels between preoperative and postoperative first day was 2.1 g/dL. Average collected blood from the drain was 177 mL. Mean total blood loss was 1137 mL. Transfusion rate of the patients was 21%. Mean transfused units was 0.9 units. Three patients died within 3 weeks after the operation due to myocardial infarction, acute kidney failure and pneumonia. There were no cases of symptomatic venous or pulmonary thromboembolism during the 90 days of follow-up. CONCLUSION: Use of TXA in pelvic and acetabular fractures was found to be effective in reducing total blood loss, hemoglobin drop and transfusion rates without increasing venous and pulmonary thromboembolism in our series.

Lumbopelvic Fixation with Bridged Distal Iliac Screws for Vertically Unstable Sacral Fractures.

Purpose: The purpose of this study is to evaluate preliminary outcomes of vertically unstable sacral fractures treated by lumbopelvic fixation (LPF) augmented transiliac bridged screws. Methods: From April 2017 to December 2019, fifteen consecutive patients with vertically unstable sacral fractures who had undergone LPF augmented transiliac bridged screws were enrolled. The radiological assessment included standard lumbopelvic x-rays and pelvic computed tomography (CT) to evaluate the lumbosacral angle (LSA), sacral kyphosis angle (SKA), lumbar lordosis angles (LLA) and Matta's reduction criterias (MRC). Clinical and neurologic impairment outcomes were evaluated by the Majeed grading scale (MGS) and Gibbons criterias, respectively. Results: All patients were followed for an average of 18 months (range, 14-25). All sacral fractures eventually healed and implant failure did not occur in any patient, though there were two patients with a loss of reduction (< 5 mm) during the follow-up period. According to the MRC, the results were excellent on 14 sides, good on five sides, and fair on one side. The MGS mean score was 82 points (range, 49-98 points); the results were excellent in nine cases, good in four cases, and fair in two cases. There was no statistically significant difference in SKA and LLA in preoperative and postoperative final controls. The preoperative and postoperative LSA were 72 ± 13.9 and 44.1 ± 11.3, respectively, and a statistically significant improvement was observed (p = 0.01). Conclusion: In vertically unstable sacrum fractures, we believe that LPF augmented with transiliac bridging technique may expedite the reduction of vertical sacrum fracture and offers a reinforced fixation choice.

An Epidemiological Study of Primary Bone Tumors of the Fibula.

BACKGROUND: Relatively low incidence has led to an under-rating of fibula tumors. This study aimed to evaluate fibula tumors as a whole and to give detailed information based on histological types according to the anatomic location of the tumors in the fibula. METHODS: Evaluation was made of all the primary bone tumors of the fibula recorded in our bone tumor registry and institute of pathology from 2007 to 2018. Of these, 62 cases were identified. Analysis included assessment of age, gender, tumor localization, the presenting symptoms, the duration of symptoms, and treatment methods. RESULTS: There were 48 (77.4%%) benign and 14 (22.6%) malignant tumors. The most commonly found benign tumors were non-ossifying fibroma (12/48; 25%) and aneurysmal bone cyst (12/48; 25%), and the malignant tumors were chondrosarcoma (3/14; 21.4%) and chondroblastic osteosarcoma (3/14; 21.4%). The most common location for both benign and malignant tumors (58.3%, 71.4%) are the proximal fibula, followed by the distal fibula (27.1%, 28.6%) and the diaphysis (14.6%, 0%). Six (9.7%) patients presented with pathological fibula fractures. CONCLUSION: Fibular tumors are rarely encountered in clinical practice but are mostly benign, with malignancy determined in approximately a quarter of patients. However, as most benign tumors are asymptomatic, and therefore remain undetected, the actual proportion of malignant tumors will be much lower.

Glomus tumors of the upper extremity.

BACKGROUND: Glomus tumors are uncommon and painful benign perivascular neoplasms. They usually occur in the subungual region of phalanx, and present with a classic clinical triad of localized tenderness, cold hypersensitivity, and excruciating paroxysmal pain. The aim of this study was to review 45 cases of glomus tumor according to the clinical, radiological and therapeutic characteristics, and the clinical and functional outcomes of surgical treatment. MATERIALS AND METHODS: A retrospective review was made of 45 glomus tumors of the upper extremity operated on between June 2005 and January 2019. Data were collected of demographic characteristics and the diagnostic, immunohistochemical, therapeutic and postoperative clinical findings. RESULTS: The patients comprised 69 % females and 31 % males with a median age of 41 years at the time of surgery. The most commonly affected anatomic location was the digits (87 %). Of the 39 cases with an affected digit, there was a predominance of the middle finger in 28 % and the peri-subungual area in 51 %. There was no recurrence or need for secondary surgical intervention in any patient in this study. The mean QuickDASH score was 1.47 at mean 66 months follow-up. CONCLUSIONS: Glomus tumor, which is usually seen in the middle finger of middle-aged women, presents with excruciating paroxysmal pain out of proportion to the tumor size. The long-term outcomes after surgical loupe-assisted surgery with a transungual approach were seen to be good, without local recurrence and an acceptable rate of postoperative nail dystrophy.

Tenosynovial Giant Cell Tumor in the Hand: Experience with 173 Cases.

Background: Tenosynovial giant cell tumor (TSGCT) is the second most common benign tumor of the hand. Even though it is a benign lesion there is still a high incidence of local recurrence (range, 7%-44%) according to data in published papers. In this study, the clinical and epidemiological features of 173 patients who underwent excision of localized TSGCT, the recurrence rates and possible reasons for recurrence were examined in the light of current literature. Methods: Medical records of 173 patients with TSGCT were reviewed. Data on demographic characteristics as well as clinical and intraoperative findings were collected. Patients were asked about the recurrence of the TSGCT and the QuickDASH scoring was applied at the final clinical evaluation after mean follow-up of 81 months. Results: Females were predominantly involved (73%). Patients aged mean 44 years at the time of surgery. There were 93 tumors in flexor zones and 80 tumors in extensor zones of the hand. Of the tumors with flexor zone localization, zone II was most predominantly involved with 46 tumors, and 18 of these were on the index finger. The extensor zones III and IV were mostly involved with 9 tumors each on the middle and ring fingers. A total of 12 recurrences (6.9 %) were determined over the mean follow-up period of 81 months. Conclusions: The characteristics of our patients identified were similar to the previous studies. Surgical excision provides good outcomes in the treatment of TSGCT especially when clear margins are obtained.

Is high level of hemoglobin A1C an indicator for extended period of antibiotherapy in diabetic foot ulcers?

OBJECTIVE: Diabetic foot ulcers are the most common cause of hospitalization among the diabetic complications. Hemoglobin A1C (HbA1C) has a critical role in medical follow-up of diabetic patients. In fact, the role of HbA1C and related clinical parameters has been investigated in literature there are only a few studies investigating the relationship between HbA1C and the prolonged antibiotherapy. We aim to reveal the reciprocal relationship between this two parameters. METHODS: The clinical data of 139 patients who admitted with diabetic foot ulcers are analyzed retrospectively. Besides the demographic information, the levels of HbA1C wound localizations, the degree of the wounds regarding the Wagner classification, culture antibiogram, and the duration of the antibiotic agents. The data have been analyzed with IBM SPSS Statistics (IBM Statistical Package for the Social Sciences) for Windows 22.0. RESULTS: The clinical data of the 139 diabetic foot patients are retrospectively assessed. The mean age was 56.50 (±4.12). There were 81 male (58.27%) and 58 (41.73%) female patients. The distal type diabetic foot ulcers were found to be the most frequent type (n=83, 59.71% [±3.12]). The mean HbA1C level was 9.60 (±1.10). The "7-15%" subgroups of HbA1C level patients showed statistically significant prolongation of the antibiotherapy time (p<0.01). CONCLUSION: The results showed that the higher levels of HbA1C have a significant effect on treatment duration and formation of deeper and larger wounds with advanced stages of Wagner classification. This result may reveal the importance of the exact starting time of the treatment besides the proper glycemic control. Lager scaled studies may clarify the credited parameters related to diabetic foot ulcers for a reinterpretation of the issue.

Surgically treated Hoffa Fractures with poor long-term functional results.

INTRODUCTION: Hoffa fractures are rare injuries and usually involve the lateral condyle. There are few published studies of large series of isolated coronal plane fractures of the femoral condyle. The aim of the study to determine the long-term functional outcomes and complications in surgically treated Hoffa fractures. PATIENTS AND METHODS: A retrospective review was made of 13 consecutive patients who were treated surgically for an isolated coronal plane fracture of the distal femur posterior condyle. The patients were evaluated with physical examination, PA and lateral radiographs and CT at the final follow-up examination. Functional outcome was evaluated with the OXFORD knee scoring system and Knee Society Score (KSS). Pain at rest and in activity was assessed using a Visual Analog Scale (VAS). RESULTS: The patients comprised 11 males and 2 females with an average age at surgery of 27.5 years. The mean follow-up period was 93 months (range, 62-134 months). Mean time to fracture healing was 10 weeks (range, 8-12 weeks). The mean ROM was determined as 110°, mean KSS 78,4 and mean Oxford knee score 38,2. The mean KSS was 66,5 for medial Hoffa fracture patients and it was 83,8 for lateral Hoffa fracture patients. The mean Oxford knee score was 33,2 for medial Hoffa fracture patients and it was 40,4 for lateral Hoffa fracture patients. The mean VAS at rest and in activity was 1,1 and 2,9, respectively. Osteoarthritis was seen in 7 (54%) patients and avascular necrosis in 2 (15.4%). Varus instability was determined in 1 patient and valgus instability in 1 patient. CONCLUSION: Hoffa fractures may easily be overlooked if the radiological examination is not made carefully. Screw fixation was seen to provide enough biomechanical stability until the fracture healed. Arthrosis is a frequent long-term complication which worsens the functional results. Medial Hoffa fractures tend to have worse functional results than lateral Hoffa fractures. LEVEL OF EVIDENCE: Therapeutic Level IV retrospective case series.

Surgical treatment of type III acromioclavicular dislocation: Bosworth technique versus hook plating.

OBJECTIVE: In this study, it was compared the clinical results of the Bosworth technique and hook plating in acromioclavicular (AC) dislocations. METHODS: 44 patients are retrospectively evaluated in this study whom diagnosed as type III AC dislocations and treated by two different surgical methods in two different clinics. The patients were 30 males and 14 females with a mean age of 44 years (range, 18-80 years). The patients were divided into 2 groups according to the applied surgical technique. Group I comprised 25 patients to whom coracoclavicular fixation was applied by using the Bosworth technique. Group II comprised 19 patients to whom acromioclavicular fixation was applied by using hook plate. All patients are evaulated by The University of California at Los Angeles Shoulder Score (UCLA) and The disabilities of the arm, shoulder and hand (DASH) scoring system. RESULTS: The mean follow-up period was 23 months (range, 12-42 months). A statistically significant diffference was determined between the surgical groups in respect of the modified UCLA scale (p=0.012) and Quick DASH score (p=0.008). Hook plating group had better clinical results according to Bosworth group in terms of both UCLA and DASH score. A statistically highly significant negative correlation was determined between the UCLA and DASH scores (r=0.677, p=0.000). CONCLUSION: Although hook plating had better clinic outcomes compared to Bosworth technique, there is not seen difference between two groups in terms of the time of return to work. Treatment of the AC dislocation should perform early reconstruction for better reduction, fewer complications and higher levels of patient satisfaction.

Cystic tuberculosis osteomyelitis of the distal tibia in infancy.

One-third of tuberculosis cases affect the musculoskeletal system. Solitary bone tuberculosis is a rare condition in infancy, has non-specific findings, and can be misdiagnosed easily. Cystic form tuberculosis may mimic many other pathologic conditions. In our case report, we present tuberculosis osteomyelitis of the distal tibia in a baby aged ten months who visited our outpatient department with swelling and pain in their left ankle. Curettage and debridement was performed twice for the lesion. An under-knee splint was applied for 3 months and anti-tuberculosis treatment was given for 12 months. There was no relapse during a five-year follow-up period. There was no epiphysis injury and deformity. In this case report, we discuss that bone tuberculosis, as a rare condition, must be considered in lytic lesions of the distal tibia metaphysis in infancy.

The effect of sodium hyaluronate-chondroitin sulfate combined solution on cartilage formation in osteochondral defects of the rabbit knee: an experimental study.

OBJECTIVE: In focal cartilage lesions, multipotent mesenchymal stem cells in bone marrow are aimed to be moved into the defect area using subchondral drilling or microfracture method. However, repaired tissue insufficiently fills the defect area or cannot meet natural hyaline tissue functions, due to fibrous structure. We investigated the effect of a combined solution of sodium hyaluronate + chondroitin sulfate (HA+CS) administered intra-articularly after subchondral drilling on newly formed cartilage in rabbits with focal osteochondral defects. MATERIALS AND METHODS: A total of 32 New Zealand White mature rabbits, whose weights ranged from 2.5 to 3 kg, were randomly divided into four groups. Full-thickness osteochondral defect was formed in the left-knee medial femur condyles of all rabbits. Subchondral drilling was then performed. The following treatment protocol was administered intra-articularly on knee joints on days 7, 14, and 21 after surgery: group 1, 0.3 mL combined solution of HA+CS (20 mg CS combined with 16 mg HA/mL); group 2, 0.3 mL HA (16 mg/mL); group 3, 0.3 mL CS (20 mg/mL); and group 4 (control group), 0.3 mL saline solution. In the sixth week, all animals were killed and then evaluated histopathologically and biochemically. RESULTS: There was significant articular cartilage formation in the HA+CS group compared to the HA, CS, and control groups. Hyaline cartilage formation was observed only in the HA+CS group. Cartilage-surface continuity and smoothness were significantly higher in the HA+CS and HA groups compared to the other groups. Normal cartilage mineralization was found to be significantly higher in the HA+CS group compared to the other groups. Increased levels of VEGFA and IL-1ß in synovial fluid were observed in the HA+CS group. CONCLUSION: After subchondral drilling, intra-articular HA-CS combination therapy is a good choice to promote better quality new cartilage-tissue formation in the treatment of focal osteochondral defects.

Are We Using Slow-Acting Symptomatic Chondroprotective Drugs Conscious Enough?

BACKGROUND: Osteochondral injuries constitute an entity that is widespread and can be seen in patients of all ages. Actual treatment modalities aim to relieve pain, obtain full range of movement of the joint, and improve the quality of life. There are many slow-acting chondroprotective agents prevalently used in the United States that are classified as nutritional support but not as medicines . This study presents the importance of clinical adverse effect profiles as well as the pharmacological mechanism of action and application of combinations of drugs that are widely prescribed and not subjected to control. METHODS: Electronic databases were searched with keywords about the chondroprotective drugs without any language restriction. Evaluations of the descriptive statistics were represented via Microsoft Office Excel 2010 lists in the form of a mean±standard deviation or frequency (%). The first evaluation showed that 1502 studies were potentially relevant. Following exclusion of the 1277 studies which were not clinical, full versions of the remaining 225 studies were subjected to further evaluation. No controlled, blinded, randomized and/or comparative studies met the inclusion criteria of the study, and no studies evaluated the comparative clinical results of the hyaluronan of different molecular weights. RESULTS: The findings of this study concluded that especially when prescribing drugs with ingredients like GS and CS, many patients' pre-existing conditions must be considered, such as whether the patient has a glucose intolerance or not. Additionally, mineral toxication should be considered since the drugs contain minerals, and after the application of injected hyaluronan, complications should be considered. CONCLUSION: Clinical, controlled and comparative studies about the use of chondroprotective drugs must be performed to define the benefits of these drugs, if any, in order to determine the most suitable time for operative intervention.

Can a Biodegradable Implanted Bilayered Drug Delivery System Loaded with BMP-2/BMP-12 Take an Effective Role in the Biological Repair Process of Bone-Tendon Injuries? A Preliminary Report.

BACKGROUND: Use of biodegradable and biocompatible materials in the orthopedic surgery is gaining popularity. In this research, the rate of controlled release of a bilayered prototype biomaterial designed to promote osteoblastic and tenoblastic activity was calculated using pharmacochemical methods. METHODS: The first part of the design, composed of a sodium tetraborate, polyvinyl alcohol, and starch based hydrogel, was loaded with bone morphogenic protein-2. The second part which was composed of a sodium tetraborate, polyvinyl alcohol, and chitosan based hydrogel was loaded with bone morphogenic protein-12. Osteochondral and tendon tissue specimens were obtained from patients with a diagnosis of gonarthrosis and primary bone cells and tendon cells cultures were prepared following treatment with collagenase enzyme. Cell samples were collected from the groups by means of an invert light microscope and environmental scanning electron microscope underwent at the 1st and 21st days. The level of osteogenic differentiation was measured by the activity of alkaline phosphatase. For the statistical evaluation of the obtained data, groups were compared with post hoc Tukey test following analysis of variance. Level of significance was accepted to be <0,01. RESULTS: Both osteogenic and tenogenic stimulation were observed in the cultured specimens. In comparison to the control groups, the rate of proliferation of healthy cells was found to be higher in the groups to which the design was added (p < 0.01). CONCLUSIONS: Our research is a preliminary report that describes a study conducted in an in vitro experimental setting. We believe that such prototype systems may be pioneers in targeted drug therapies after reconstructional surgeries.

Iopromide- and gadopentetic acid-derived preparates used in MR arthrography may be harmful to chondrocytes.

BACKGROUND: Magnetic resonance arthrography, a procedure through which contrast agents containing gadolinium and/or iopromide are administered intra-articularly, has become a useful tool in musculoskeletal diagnosis. Nevertheless, despite being considered safe for systemic use, certain tissue toxicities have been identified for both drugs. In this study, the effects of short-term exposure of human primary chondrocyte cell cultures to gadolinium and/or iopromide contrast agents were examined by assaying for stage-specific embryonic antigen-1 (SSEA-1) protein expression (a chondrogenic differentiation marker), cell viability, toxicity, and proliferation. METHODS: Human articular chondrocytes were grown in monolayer culture and were exposed to iopromide and/or gadolinium diethylenetriamine-pentaacetate (Gd-DPT) for 2 and 6 h. Cell cultures with no drug exposure were used as the control group. Cell differentiation status was assessed according to SSEA-1 protein expression. Contrast agent effects on cell viability and proliferation were analyzed using MTT analysis. Further, changes in cell morphology in relation to the control group were evaluated using inverted light microscopy, environmental scanning electron microscopy (ESEM), and 3-tesla magnetic resonance imaging. The obtained data were statistically compared. RESULTS: When compared with the control group, both SSEA-1 protein expression and cell proliferation were lowest in the Gd-DPT group (P = 0.000). There was a statistically significant correlation between SSEA-1 expression and MTT results (rho = 0.351; P = 0.003). CONCLUSIONS: Nevertheless, the data obtained from in vitro experiments may not directly correspond to clinical applications. However, the mere fact that a drug used solely for diagnostic purposes may repress chondrocyte cell proliferation should be carefully considered by clinicians.