Comparison of Clinical Outcomes of Platelet-Rich Plasma for Epicondylitis, Elbow: Simultaneous Lateral and Medial Versus Lateral Versus Medial.

OBJECTIVE: Lateral and medial epicondylitis are relatively common diseases, but they do not improve quickly and are known to reduce patients' quality of life. Much research has been done on Platelet-Rich Plasma (PRP) as a treatment for lateral epicondylitis, but research on medial epicondylitis is lacking. The purpose of this study is to compare: (i) the pain intensity; and (ii) the functional outcome between the simultaneous treatment of medial and lateral epicondylitis and the treatment of only lateral or medial epicondylitis using PRP. METHODS: In this retrospective study, 209 patients treated with PRP on epicondylitis between March 2018 and December 2021 were enrolled. Simultaneous treatment was underwent 68 patients (group I). Seventy patients were treated for lateral epicondylitis (group II). The remaining 71 patients were treated for medial epicondylitis (group III). The visual analogue scale for pain (VAS) and the Mayo elbow performance score (MEPS) were evaluated for clinical outcomes at the initial visit and 6 months after injection. RESULTS: VAS for pain and MEPS showed significant improvement in all three groups compared to before treatment. There was no significant difference between three groups on -ΔVAS (P > 0.05). However, in case of ΔMEPS, group III showed significantly lower compared to groups II and III (P < 0.05). No patients showed worsening of symptoms or complications during the treatment. CONCLUSION: PRP injection for the patient with elbow medial and lateral epicondylitis can be treated effectively simultaneously in terms of pain. From a functional point of view, the effect of simultaneous treatment may be lessened than in the case of only lateral and medial treatment.

Real-time in vivo imaging of metastatic bone tumors with a targeted near-infrared fluorophore.

Tumors of the prostate or breast are particularly likely to metastasize to the bone, and early diagnosis of metastatic bone tumors is important for designing an effective treatment strategy. Imaging modalities for the detection of bone metastasis are limited, and radiation-based techniques are commonly used. Here, we investigated the efficacy of selective near-infrared (NIR) fluorescence detection of metastatic bone tumors and its role in the detection of bone metastasis in prostate and breast cancer cell lines and in a xenograft mouse model. A targeted NIR fluorophore was used to monitor metastatic bone tumors using a NIR fluorescence imaging system in real time, enabling the diagnosis of bone metastasis in vivo by providing the location of the metastatic bone tumor. The NIR fluorescence imaging technique using targeted NIR contrast agents is a potential tool for the early diagnosis of bone tumors.

Ectopic overexpression of CD133 in HNSCC makes it resistant to commonly used chemotherapeutics.

Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancers in the world. Resistance to cytotoxic chemotherapy is a major cause of mortality in patients with HNSCC. A small subset of cancer cells called cancer stem cells (CSCs) may be key contributors to drug resistance and tumor recurrence in HNSCC. The aim of this study was to determine whether CD133, which maintains properties of CSCs, promotes chemoresistance by arresting cell cycle transition and reducing apoptosis in HNSCC cells. CD133 overexpression was examined in KB cells, and colony forming and aldehyde dehydrogenase activity assays were performed. To investigate the role of CD133 in chemoresistance, cell death was analyzed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), Diff-Quick, flow cytometry, and western blot of apoptosis-related protein expression in fluorouracil (5-FU)- or cisplatin-treated cells. In addition, microarray and related protein expression assessments were performed to investigate the mechanism of chemoresistance against 5-FU and cisplatin in KB cells. Moreover, chemoresistance against 5-FU or cisplatin in a KB-inoculated mouse model was analyzed by hematoxylin and eosin staining, immunohistochemical study of CD133, and immunofluorescence of tumor tissue. In this study, we demonstrate that ectopic overexpression of CD133 significantly promotes properties of stemness in KB cell lines. Furthermore, CD133 promotes chemoresistance by arresting transition of the cell cycle and reducing apoptosis, which results in inhibition of tumor growth in 5-FU- or cisplatin-injected mouse tumor model. Taken together, our findings show that elevated levels of CD133 lead to HNSCC chemoresistance through increased stemness and cell cycle arrest.

Comparison of the alendronate and irradiation with a light-emitting diode (LED) on murine osteoclastogenesis.

Photomodulation therapy (PBMT) using light-emitting diode (LED) has been proposed as an alternative to conventional osteoporosis therapies. Our aim was to determine the effect of irradiation with a light-emitting diode on receptor activator of NF-κB ligand (RANKL)-mediated differentiation of mouse bone marrow macrophages into osteoclasts and compare it to alendronate treatment. The cells were irradiated with LED at 635±10 nm, 9-cm spot size, 5 mW/cm2, and 18 J for 60 min/day in a CO2 incubator. The differentiation of irradiated and untreated RANKL-stimulated bone marrow macrophages into osteoclasts was evaluated by tartrate-resistant acid phosphatase (TRAP) staining and by molecular methods. These included assessing messenger RNA (mRNA) expression of osteoclastic markers such as TRAP, c-Fos, Atp6v0d2, DC-STAMP, NFATc1, cathepsin K, MMP9 and OSCAR; phosphorylation of various MAPKs, including extracellular signal-regulated kinase ERK1/2, P38, and JNK; NF-κB translocation; and resorption pit formation. Results were compared to those obtained with sodium alendronate. Production of reactive oxygen species was measured by a 2',7'-dihydrodichlorofluorescein diacetate assay. LED irradiation and alendronate inhibited mRNA expression of osteoclast-related genes, such as TRAP, c-Fos, and NFATc1, and reduced the osteoclast activity of RANKL-stimulated bone marrow macrophages. LED irradiation, but not alendronate, also inhibited the production of reactive oxygen species (ROS); phosphorylation of ERK, P38, and IκB; and NF-κB translocation. These findings suggest that LED irradiation downregulates osteoclastogenesis by ROS production; this effect could lead to reduced bone loss and may offer a new therapeutic tool for managing osteoporosis.

Effects of light-emitting diode irradiation on RANKL-induced osteoclastogenesis.

BACKGROUND AND OBJECTIVE: Bone homeostasis is maintained by a balance between osteoblastic bone formation and osteoclastic bone resorption, where intracellular reactive oxygen species (ROS) are crucial mediators of osteoclastogenesis. Recently, low-level light therapy (LLLT), a form of laser medicine used in various clinical fields, was shown to alleviate oxidative stress by scavenging intracellular ROS. The present study aimed to investigate the impact of 635 nm irradiation from a light-emitting diode (LED) on osteoclastogenesis from receptor activator of nuclear factor kappa-B (NF-κB) ligand (RANKL)-stimulated mouse bone marrow-derived macrophages (BMMs). STUDY DESIGN/MATERIALS AND METHODS: The effects of LED irradiation on osteoclastogenesis were assessed in tartrate-resistant acid phosphatase (TRAP), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), cell viability, and resorption pit formation, respectively. Quantitative real-time polymerase chain reaction (qPCR) and Western blot analyses were also performed to assess mRNA expression of osteoclastogenesis-related genes and phosphorylation of extracellular signal-regulated kinase 1/2 (ERK 1/2), p38, and c-Jun-N-terminal kinase (JNK). NF-κB activity was assayed by luciferase reporter assay and Intracellular ROS generation was investigated by the 2',7'-dichlorodihydrofluorescein diacetate (H2 DCF-DA) detection method. RESULTS: LED irradiation significantly inhibited RANKL-mediated osteoclast differentiation from BMMs and mRNA expression of TRAP, osteoclast-associated immunoglobulin-like receptor (OSCAR), and dendrocyte-expressed seven-transmembrane protein (DC-STAMP). Exposure to LED light likewise significantly decreased RANKL-facilitated NF-κB activity, p38 and ERK phosphorylation and intracellular ROS generation, and increased gene expression of nuclear factor E2-related factor 2 (Nrf2). CONCLUSIONS: Taken together, the results presented herein show that LED irradiation downregulates osteoclastogenesis by reducing ROS production. Therefore, LED irradiation/LLLT might be useful as an alternative, conservative approach to osteoporosis management.

Bilateral arthroscopic rotator cuff repair using a single-stage procedure.

Bilateral rotator cuff tears requiring repair are not uncommon. Typically, these tears have been treated with staged surgeries. However, in appropriately selected cases, single-stage repair is preferable because it reduces costs, the number of admissions, total hospitalization, and rehabilitation time. It can also reduce patient suffering by providing relief with a single procedure. The authors compared 10 patients with a mean age of 55 years who had bilateral symptomatic rotator cuff tear and underwent single-stage bilateral arthroscopic cuff repair (group A) with 17 patients with a mean age of 55 years who had unilateral symptomatic rotator cuff tear and underwent unilateral arthroscopic cuff repair (group B). Clinical assessment was performed preoperatively and at 3, 6, and 12 months postoperatively with the visual analog scale, the University of California Los Angeles (UCLA) score, and the Korean shoulder score. Overall function, pain, and strength were improved significantly in both groups. Although the difference in visual analog scale score between both groups decreased during follow-up, this score was significantly lower in group B (P=.026). At initial follow-up, the UCLA score was higher in group A. However, at the last follow-up, this score was significantly higher in group B (P<.001). The Korean shoulder score was significantly higher in group A at all follow-up times (P<.001). The study findings showed that single-stage bilateral rotator cuff repair is a preferable option in appropriately selected patients. It can provide satisfactory results without additional complications, and it does not lead to longer hospitalization or rehabilitation than unilateral repair.

Expression of cancer stem cell marker during 4-nitroquinoline 1-oxide-induced rat tongue carcinogenesis.

One of the theories regarding oral carcinogenesis is that the tumor growth is initiated from cancer stem cells (CSCs) that self-renew and give rise to differentiated tumor cells, like stem cells do in normal tissues. The most common methods of CSC identification are based on CSC marker expression in carcinogenesis. This study examined the expression of CD133 and CD44, the most commonly used CSC biomarkers in oral squamous cell sarcoma (SCC), with the goal of identifying molecular biomarkers whose expression is associated with the multistep oral carcinogenesis. The expression of CD133, CD44, proliferating cell nuclear antigen (PCNA), and Cytokeratin (CK) was examined by Western blot analysis and confirmed by immunohistochemistry in a 4-nitroquinoline 1-oxide-induced rat tongue carcinogenesis model. Also, the expression of aldehyde dehydrogenase 1 (ALDH1), OCT-4 and Nanog were investigated for alteration of cancer cell stemness by Western blot. Along with the progress of multistep carcinogenesis, there were slight increases of CD133 and CD44 expression in the dysplasia group compared with normal rats. However, CD133 protein level was significantly overexpressed in SCC. The expression of PCNA and CK were low in normal group, but sequentially increased in SCC. ALDH1, Nanog and OCT-4 expression were significantly increased according to SCC grade during carcinogenesis. The findings indicate that CD133 is useful in identifying oral CSCs, which suggests that CD133 may serve as a predictor to identify CSCs with a high risk of oral cancer development.

Arthroscopic management of stiff elbow.

Elbow stiffness is a common problem encountered by orthopedic surgeons. Various management options have been described in the literature, including conservative measures and open and arthroscopic surgery. Arthroscopic management of stiff elbow remains controversial. The purpose of this study was to evaluate the functional results of arthroscopic management of stiff elbow.Thirty patients with stiff elbow underwent arthroscopic release surgery and were followed up for an average of 27.3 months. Surgery included anterior and posterior capsular release, coronoid process debridement, bony spur excision, and loose body removal. Postoperative outcome was assessed using the Mayo Elbow Performance Score and range of motion at the elbow. Mayo Elbow Performance Score increased from a mean 64.5 preoperatively to a mean 83.17 postoperatively. Range of motion also improved, from a mean preoperative extension and flexion of 22.83° and 96.83°, respectively, vs a mean 10.83° and 120.84°, respectively, at final follow-up. No intra- or postoperative complication was seen in any case. Underlying etiology and timing of surgery influenced the end result, with better results seen in patients with traumatic etiology and those with a shorter duration of symptoms.Arthroscopic release allows good visualization and rectification of intra-articular pathology and is a safe and effective tool for the management of stiff elbow.

Arthroscopic rotator interval closure by purse string suture for symptomatic inferior shoulder instability.

Multidirectional instability of the shoulder is a complex condition that can be difficult to diagnose and treat. Clinically, it is characterized by symptomatic global laxity of the glenohumeral joint and may present either traumatically or atraumatically, unilaterally or bilaterally, and with or without generalized joint laxity. Capsular plication is a primary treatment option in these patients and is used to tension the redundant or lax capsule. We evaluated the role of rotator interval closure in restoring stability as a primary procedure in patients with multidirectional instability and a positive and painful sulcus sign.Twenty adult patients (16 men and 4 women) presenting with multidirectional instability were evaluated clinically and radiologically to assess the degree and direction of instability, were treated by arthroscopic rotator interval closure and inferior capsular plication, and were followed up for a minimum of 2 years. Clinical and functional results were excellent at 2-year follow-up. The results of the study indicate that the closure of the rotator interval in patients with symptomatic inferior instability will have a long-lasting effect on the stability and function of the shoulder, as the closure improves not only the static restraints but also the dynamic restraints of the shoulder through the improved proprioception secondary to restoration of the rotator interval structures.

Evaluation of shoulder disorders by 2-[F-18]-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography.

BACKGROUND: Although fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) has a limitation for localizing anatomical structures, combining it with computed tomography (CT) has made it more efficient for overcoming such limitations. This study aims to evaluate the efficacy of PET/CT for evaluating diseases of the shoulder. METHODS: Retrospective examination was performed on 25 patients who underwent FDG-PET/CT scanning. All the patients were over 60 years of age, and they were evaluated both clinically and radiologically for shoulder pain. The study period was from May, 2006 to May, 2008. One of the patients had metastatic lesion in a shoulder and this patient was excluded from the study, so the total number of subjects in the study was finally 24 patients. RESULTS: PET/CT showed 67% sensitivity, 73% specificity, a positive predictive value of 60%, a negative predictive value of 79%, 27% false positivity and 33% false negativity concerning shoulder pain. PET/CT showed negative finding in 4 cases that were successfully treated by operative treatment (rotator cuff tear [RCT], 3 cases; impingement syndrome, 1 case). Negative findings were also noted in 6 cases in which the pain subsided after conservative treatment (RCT, 1 case; suspected RCT, 2 cases; impingement syndrome, 3 cases). All the patients with osteoarthritis and rheumatoid arthritis had positive findings on PET/CT scanning. CONCLUSIONS: PET/CT is a useful adjunct to the existing imaging modalities to assess functional and pathophysiologic processes and at a very early stage, and so PET/CT can help physicians make better preoperative and postoperative decisions on treatment.

Sonographic probe induced tenderness for lateral epicondylitis: an accurate technique to confirm the location of the lesion.

The purpose of this study is to evaluate the hypothesis that ultrasonographic probe-induced tenderness is a useful adjunct to the simple sonography in confirming the location of the pathology within the extensor carpi radialis brevis tendon in patients with lateral epicondylitis of the elbow. We conducted a case controlled study by evaluating 27 consecutive patients in the age group of 37-59 years (median 44) who had typical symptoms of lateral epicondylitis and a visual analogue score of more than 4 and evaluating a same number of asymptomatic healthy volunteers in the age group of 37-59 years (median 43) by means of ultrasound examination of the lateral elbow in a period of 5 months from 2007 to 2008. When we identified sonographic anechoic or hypoechoic lesions within the common extensor tendon we compressed it with the ultrasound probe to elicit tenderness so as to confirm the site of lesion within the affected tendon. We observed that the abnormal lesion detected by ultrasonography corresponded to the point of maximal tenderness when compressed by the probe in all the symptomatic patients. We therefore conclude that as it is essential to accurately detect the lesion within the extensor carpi radialis brevis for the purpose of diagnosis and treatment of lateral epicondylitis of elbow the technique of inducing tenderness at site of abnormal shadow on ultrasound within the extensor carpi radialis brevis tendon improves the accuracy of identifying the site of lesion, prevents the misinterpretation of anisotropy as pathological lesion and also can be useful to maximize the efficacy of interventions aimed in treating the lateral epicondylitis.

Upper airway compromise by extravasated fluid: a rare complication after arthroscopic repair of atrophic cuff tear.

During arthroscopic procedures, leakage of irrigation fluid into surrounding tissue planes is a frequently noticed phenomenon usually clinically asymptomatic and resolving within 12 hours postoperatively. Although rare, this fluid may produce life-threatening complications such as airway compromise. This article describes a case of upper airway obstruction in a 60-year-old man undergoing arthroscopic repair for an atrophic rotator cuff tear. The patient presented with a 6-month history of pain and weakness in the left shoulder. Magnetic resonance imaging studies revealed a massive rotator cuff tear with significant retraction and fatty degeneration of cuff musculature. Perioperatively, all vital cardiorespiratory parameters were within normal limits. Postoperatively, immediately on extubation, he was dyspneic, and examination revealed a diffuse swelling extending from the left shoulder up to the neck and face. He was reintubated and sent to the recovery room, where he recovered 12 hours later. This article highlights the possibility of respiratory compromise due to the extravasation of irrigation fluid into the neck and chest during arthroscopic repair of massive and atrophied cuff tears, even with shorter surgical time as is this case. The widened suprascapular space will offer less resistance to the spread of fluid into the neck and chest from the shoulder. We advocate monitoring the patient continuously to prevent this serious complication from becoming life-threatening.

Bilateral and simultaneous triceps avulsions in a patient with chronic renal failure receiving long-term peritoneal dialysis.

Simultaneous bilateral triceps tendon avulsions are extremely rare; only 4 cases have been reported in the international literature. This article describes a case of a 32-year-old woman with bilateral and simultaneous avulsions of the triceps tendons. She suffers from chronic renal failure and undergoes peritoneal dialysis every day. The patient presented with ecchymosis and swelling at the posterior aspect of both elbows. While climbing stairs a few hours earlier, she had fallen back on both outstretched arms, experienced moderate pain, and heard a sudden popping sound in her right elbow, followed by similar pain in the left elbow. On examination, she revealed intact extensor mechanism. Radiographs revealed a small osseous flake just proximal to the olecranon in both arms and the absence of associated fractures. During surgery, both triceps tendons appeared normal, other than being avulsed at their tendo-osseous junction. The patient obtained a successful result and full range of motion bilaterally within 3 months postoperatively. A high index of suspicion is needed and careful attention should be paid to elbow pain after minor trauma so that triceps injuries, especially in chronic kidney disease cases, are not missed.

Autologous bone marrow plasma injection after arthroscopic debridement for elbow tendinosis.

INTRODUCTION: The treatment of tendinosis of elbow can be challenging, yet rewarding. Nevertheless, for the patients who failed conservative management and develop persistent recalcitrant symptoms, surgical intervention should be considered. The hypothesis of this study is iliac bone marrow plasma injection after arthroscopic debridement of degenerative tissue will bring along biological cure. Thus, it will not only reduce pain but also improve function in patients with resistant elbow tendonitis. MATERIALS AND METHODS: Twenty-four patients (26 elbows) with significant persistent pain for a mean of 15 months, despite of standard rehabilitation protocol and a variety of other nonsurgical modalities were treated arthroscopically. We applied autologous iliac bone marrow plasma injection following arthroscopic debridement. This material is produced by centrifugation of iliac bone marrow blood at 1,800 rpm for 20 to 30 minutes. Patients were allowed full range of motion (ROM) exercise after 2 to 3 days. Cytokine analyses for this injective material were done. Outcome was rated by postoperative sonography, visual analog pain scores (VAS) and Mayo elbow performance scores (MEPS) at 8 weeks and 6 months follow-up. Informed consent had been obtained from the subjects, and the study protocol was approved by the ethics committee of Chosun University Hospital, Korea. RESULTS: All patients in this study noted improvement both in their VAS and MEPS. No complication occurred in any patient. Evidence of tendon healing was observed in postoperative sonographic examination. Predominant cytokines of this study were interleukin-12 (IL-12), interferon-gamma-inducible protein-10 (IP-10) and RANTES. CONCLUSION: Biologic treatments in orthopaedics are just beginning to evolve. In the present investigation, the injection of iliac bone marrow plasma after arthroscopic debridement in severe elbow tendinosis demonstrated early recovery of daily activities and clear improvement.

Bursoscopic evaluation for degree of rotator cuff tear using an air-infusion method.

This article presents a method of bursoscopic examination with use of a glenohumeral air-infusion technique for the detection of full-thickness tears hidden by bursal tissue. We inflated the glenohumeral joint with 50 to 60 mL of air while simultaneously observing the joint with bursoscopy for the detection of air bubble leakage. The air-infusion technique is valuable in detecting full-thickness tears and useful for evaluating the patency of repair.