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1.
Medicine (Baltimore) ; 99(19): e20141, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384496

RESUMO

OBJECTIVE: Femoroacetabular impingement (FAI) is a common cause of hip pain and even tearing of the acetabular labrum in young adults and athletes. Either arthroscopic labral debridement (LD) or labral repair (LR) technique for FAI patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic LD versus LR intervention. METHODS: The five studies were acquired from PubMed, Medline, Embase, and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias. RESULTS: Four observational studies and one prospective randomized study were assessed. The methodological quality of the trials indicated a low to moderate risk of bias. The pooled results of Non-Arthritic Hip Score (NAHS), failure rate of surgeries and complications showed that the differences were not statistically significant between the two interventions. The difference of modified Harris Hip Score (mHHS), the Visual Analogue Scale (VAS) score and satisfaction rate was statistically significant between LD and LR intervention, and LR treatment was more effective. Sensitivity analysis proved the stability of the pooled results and there were too less included articles to verify the publication bias. CONCLUSIONS: Hip arthroscopy with either LR or LD is an effective treatment for symptomatic FAI. The difference of mHHS, VAS score, and satisfaction rate was statistically significant between LD and LR intervention, and arthroscopic LR could re-create suction-seal effect, potentially reduce microinstability, which demonstrated a trend toward better clinical efficacy and comparable safety compared with LD. The arthroscopic LR technique is recommended as the optical choice for acetabular labrum tear with FAI.


Assuntos
Artroscopia/métodos , Desbridamento/métodos , Impacto Femoroacetabular/cirurgia , Fibrocartilagem/cirurgia , Adulto , Artroscopia/efeitos adversos , Desbridamento/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia
2.
Vet Radiol Ultrasound ; 61(1): 48-57, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31825150

RESUMO

Magnetic resonance imaging and the correlation to histopathological findings of the equine palmar foot of lame horses have been described previously, using 0.27 and 1.5 T systems. Compared to these, 3 T systems provide superior spatial resolution and imaging contrast. The aim of our prospective anatomic study was to characterize the imaging anatomy of the navicular region on 3 T MRI in comparison to histopathological findings. We hypothesized that 3 T MRI allows a good visualization of the entire navicular apparatus and reliable measurements of navicular cartilage and cortical bone thickness. Twenty front feet of sound horses were examined using a 3 T MRI system. For histopathological examination, sagittal tissue sections of the navicular bones and adjacent ligaments were prepared. Alterations in magnetic resonance signal were graded for each region and compared to corresponding histological slices. Overall, there was good visualization of the anatomical detail and a very good agreement between MRI and histology for compact bone and spongiosa, good agreement for the fibrocartilage and the distal sesamoidean impar ligament, but only moderate agreement for the hyaline cartilage and the collateral sesamoidean ligament. A comparative measurement of cartilage and cortical bone thickness on magnetic resonance images and histological sections was performed. In MRI, the hyaline cartilage of the articular surface appeared significantly thinner and the fibrocartilage of the flexor surface appeared significantly thicker compared to histology. Findings indicated that MRI at a field strength of 3 T allows reliable depiction of anatomic details of the navicular apparatus.


Assuntos
Cavalos/anatomia & histologia , Imagem por Ressonância Magnética/veterinária , Ossos do Tarso/anatomia & histologia , Ossos do Tarso/diagnóstico por imagem , Animais , Osso Cortical/diagnóstico por imagem , Fibrocartilagem/diagnóstico por imagem , Cartilagem Hialina/diagnóstico por imagem , Estudos Prospectivos
3.
J Am Podiatr Med Assoc ; 109(5): 407-411, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31599672

RESUMO

BACKGROUND: The spring ligament fibrocartilage complex (SLFC) is an important static foot stabilizer comprising the superomedial ligament (SML) and the inferior ligament, with anatomical variations (third ligament). The aim of this study was to describe the patterns of the lesions found during SLFC surgery, to allow direct comparison between the results with various surgical techniques. METHODS: Fourteen consecutive patients with SLFC lesions were analyzed during surgical treatment. The mean patient age was 37.3 years, and the mean time from injury was 6.9 months. Intraoperative assessments and anatomical descriptions of the lesions were collected. RESULTS: Three types of lesion were found. In 13 of 14 cases, only the superomedial ligament was involved: five superomedial ligament distentions and eight superomedial ligament ruptures. In one case, total SLFC (superomedial and inferior ligaments) rupture was observed. CONCLUSIONS: The first classification of SLFC lesions is presented, which is simple, consistent, and based on anatomical description.


Assuntos
Fibrocartilagem/patologia , Pé Chato/cirurgia , Ligamentos Articulares/patologia , Adulto , Feminino , Fibrocartilagem/diagnóstico por imagem , Fibrocartilagem/cirurgia , Pé Chato/patologia , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ruptura/cirurgia , Ultrassonografia , Adulto Jovem
4.
J Bone Joint Surg Am ; 101(17): 1554-1562, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483398

RESUMO

BACKGROUND: Despite the fact that many surgeons perform partial capsular detachment from the anterosuperior aspect of the acetabulum to correct acetabular deformities during hip arthroscopy, few studies have focused on whether these detachments influence hip joint stability. The aim of this study was to investigate the capsular attachment on the anterosuperior aspect of the acetabulum. We hypothesized that the attachment on the inferior aspect of the anterior inferior iliac spine (AIIS) is wide and fibrocartilaginous and might have a substantial role in hip joint stability. METHODS: Fifteen hips from 9 cadavers of Japanese donors were analyzed. Eleven hips were analyzed macroscopically, and the other 4 were analyzed histologically. In all specimens, the 3-dimensional morphology of the acetabulum and AIIS was examined using micro-computed tomography (micro-CT). RESULTS: Macroscopic analysis showed that the widths of the capsular attachments varied according to the location, and the attachment width on the inferior edge of the AIIS was significantly larger than that on the anterosuperior aspect of the acetabulum. Moreover, the capsular attachment on the inferior edge of the AIIS corresponded with the impression, which was identified by micro-CT. Histological analysis revealed that the hip joint capsule on the inferior edge of the AIIS attached to the acetabulum adjacent to the proximal margin of the labrum. In addition, the hip joint capsule attached to the inferior edge of the AIIS via the fibrocartilage. CONCLUSIONS: The capsular attachment on the inferior edge of the AIIS was characterized by an osseous impression, large attachment width, and distributed fibrocartilage. CLINICAL RELEVANCE: It appeared that the capsular attachment on the inferior edge of the AIIS was highly adaptive to mechanical stress, on the basis of its osseous impression, attachment width, and histological features. Anatomical knowledge of the capsular attachment on the inferior edge of the AIIS provides a better understanding of the pathological condition of hip joint instability.


Assuntos
Acetábulo/anatomia & histologia , Articulação do Quadril/anatomia & histologia , Acetábulo/diagnóstico por imagem , Idoso de 80 Anos ou mais , Cadáver , Feminino , Impacto Femoroacetabular/patologia , Fibrocartilagem/anatomia & histologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Instabilidade Articular/patologia , Masculino , Microtomografia por Raio-X
5.
Arthroscopy ; 35(9): 2591-2597, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31416655

RESUMO

PURPOSE: To investigate diagnostic value of ultrasound in acetabular labral tears compared with magnetic resonance (MR) imaging, using arthroscopic surgery as the gold standard in a relatively large sample size. METHODS: We retrospectively evaluated patients who attended the sports medicine clinic of our department and underwent arthroscopic surgery for the diagnosis of an anterosuperior acetabular labral tear between June 2014 and April 2018. All the patients received hip joint ultrasound examination and MR imaging evaluation before arthroscopic surgery. The sensitivity, specificity, and accuracy of ultrasound and MR imaging were calculated and compared. RESULTS: A total of 195 patients were enrolled in this study. Of these, 184 had arthroscopically confirmed anterosuperior acetabular labral tear. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy by ultrasound were, respectively, 68.5%, 81.8%, 98 4%, 13.4%, and 69.2%, retrospectively. For MR imaging, the sensitivity, specificity, PPV, negative predictive value, and accuracy were 84.8%, 63.6%, 97.5%, 20.0%, and 83.6%, respectively. CONCLUSIONS: Although ultrasound had a slightly lower sensitivity for detecting anterosuperior acetabular labral tear, it had a higher specificity and PPV than MR imaging. With the advantages of being inexpensive, relatively quick, noninvasive, and having dynamic evaluation, ultrasound could be used as a feasible method to evaluate anterosuperior acetabular labral tear. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Acetábulo/diagnóstico por imagem , Fibrocartilagem/lesões , Lesões do Quadril/diagnóstico por imagem , Acetábulo/cirurgia , Adolescente , Adulto , Artroscopia , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/cirurgia , Feminino , Fibrocartilagem/diagnóstico por imagem , Fibrocartilagem/cirurgia , Lesões do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia/métodos , Adulto Jovem
6.
Am J Sports Med ; 47(10): 2308-2315, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31246493

RESUMO

BACKGROUND: The repair of porcine articular cartilage defects by using particulated juvenile allograft cartilage (PJAC) has demonstrated good short-term clinical efficacy, but the repair process and mechanism have not been fully elucidated. PURPOSE: To study the efficacy of PJAC in repairing full-thickness cartilage defects and to provide an experimental basis for its clinical application. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty Guizhou minipigs were randomly divided into an experimental group and control group. An 8-mm cylindrical full-thickness cartilage defect was created in the femoral trochlea of either knee in all minipigs. The experimental group received the PJAC transplantation (PJAC group; n = 15) and the control group received autologous cartilage chips (ACC group; n = 15). Five minipigs were euthanized at 1, 3, and 6 months in each group to obtain samples, which were evaluated by general view of the knee joint and histomorphometry of the chondral defect area (hematoxylin and eosin, safranin O). International Cartilage Repair Society (ICRS) II semiquantitative evaluation and collagen type II staining immunohistochemistry were also performed. RESULTS: All 30 Guizhou minipigs were followed; there was no infection or incision healing disorder after the operation. At 1 month postoperatively, more hyaline cartilage was found in the ACC group (29.4%) compared with the PJAC group (20.1%) (P < .05); there was no statistical difference between the 2 groups at 3 and 6 months after operation. The fibrocartilage content in the ACC group was significantly more than that in the PJAC group at 1 and 3 months postoperatively (27.4% vs 18.2% and 49.9% vs 41.1%, respectively; P < .05); significant differences disappeared at 6 months postoperatively. The PJAC group produced more fibrous tissue than the ACC group at 1 and 3 months postoperatively (60.1% vs 40.6% and 38.8% vs 24.4%, respectively; P < .05) but showed no statistical difference at 6 months postoperatively. Regarding the ICRS II scores, those of the ACC group were significantly better than the scores of the PJAC group in some subclasses at 3 and 6 months postoperatively. The positive rates of immunohistochemical staining in the ACC group were higher at 1 and 3 months postoperatively than those in the PJAC group (54.2% vs 37.8% and 46.4% vs 34.4%, respectively; P < .05). The difference was not statistically significant between the 2 groups at 6 months postoperatively. CONCLUSION: Both PJAC and ACC can produce a good repair effect on cartilage defects. At 1 and 3 months postoperatively, ACC resulted in better outcomes than PJAC, but there was no statistical difference in the repair effect between the 2 techniques at 6 months postoperatively. CLINICAL RELEVANCE: Based on this animal experiment, further clinical studies are needed to investigate PJAC as a possible alternative first-line treatment for cartilage defects.


Assuntos
Artroplastia/métodos , Cartilagem Articular/transplante , Aloenxertos/estatística & dados numéricos , Animais , Artroplastia/estatística & dados numéricos , Colágeno Tipo II , Feminino , Fêmur , Fibrocartilagem , Cartilagem Hialina , Masculino , Distribuição Aleatória , Suínos , Porco Miniatura , Transplante Homólogo/estatística & dados numéricos , Resultado do Tratamento
7.
Am J Sports Med ; 47(8): 1964-1974, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31150275

RESUMO

BACKGROUND: Tendon-bone interface (TBI) injuries are common in sports activities. Owing to the limited regenerative ability of the TBI, its functional healing remains a difficulty in clinical practice. Icariin (ICA) provides strong stimulation for osteogenesis. Platelet-rich plasma (PRP) can be used as a carrier for bioactive molecules, although its ability to provide sustained release for such molecules needs improvement. HYPOTHESIS: Freeze-dried PRP (FD-PRP) as a carrier for ICA can provide sustained release of ICA into the tendon-bone (T-B) healing site, thus accelerating T-B healing. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 84 New Zealand rabbits with partial patellectomy in the hindlimb were randomly allocated into 3 different treatments: ICA incorporated with FD-PRP (ICA/FD-PRP), FD-PRP alone (FD-PRP), or saline control (CTL). The rabbit patella-patellar tendon (PP) interfaces were postoperatively harvested at postoperative week 8 or 16 for gross, radiological, histological, and mechanical evaluations. RESULTS: Our results showed that FD-PRP can act as a carrier for sustained release of ICA into the T-B healing site. Macroscopically, no signs of infection or osteoarthritis were shown in the regenerated PP interfaces, and the area of cartilaginous metaplasia in the FD-PRP and ICA/FD-PRP groups at postoperative week 16 was significantly larger than that of the CTL group (P < .05 for all). Radiologically, micro-computed tomography showed that new bone which formed at the healing site in the ICA/FD-PRP group was significantly increased, remodeled, and mineralized in comparison with the CTL group (P < .05 for all). Histologically, the ICA/FD-PRP group exhibited a significant native PP interface, as shown by the enlargement and remodeling of new bone, well-organized collagen fibers, and robust production of proteoglycans in the regenerated fibrocartilage. The mechanical strength of the regenerated PP interface was significantly improved in the ICA/FD-PRP group. Significantly higher failure load and stiffness were shown in the ICA/FD-PRP group compared with the CTL and FD-PRP groups, respectively (P < .05 for all). CONCLUSION: FD-PRP is a suitable sustained-release carrier for ICA, and ICA/FD-PRP can provide sustained release of ICA into the T-B healing site, thus effectively accelerating T-B healing. CLINICAL RELEVANCE: Findings of this study demonstrate the feasibility of using FD-PRP as a carrier for ICA to improve T-B healing and provide a foundation for future clinical application.


Assuntos
Osso e Ossos/metabolismo , Flavonoides/administração & dosagem , Ligamento Patelar/metabolismo , Plasma Rico em Plaquetas , Animais , Fibrocartilagem/fisiologia , Masculino , Osteogênese/fisiologia , Coelhos , Regeneração/fisiologia , Traumatismos dos Tendões/patologia , Microtomografia por Raio-X
8.
Arthroscopy ; 35(5): 1411-1412, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31054720

RESUMO

The major factor separating a good from a poor outcome in any study is appropriate indications. We don't operate on x-rays, magnetic resonance images, or computed tomography scans alone; we operate on clinical symptoms. With proper patient selection, we can achieve good outcomes from hip arthroscopic surgery in many older patients. There is no controversy involved in performing hip arthroscopy for an older patient. The key is to prospectively identify the proper candidates.


Assuntos
Cartilagem Articular , Articulação do Quadril , Artroscopia , Estudos de Casos e Controles , Fibrocartilagem , Humanos
9.
Contrast Media Mol Imaging ; 2019: 2834273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31049042

RESUMO

Purpose: To confirm the interest of 3-dimensional ultrashort echo-time (3D-UTE) sequences to assess morphologic aspects in normal and pathological Achilles entheses in a rat model of spondyloarthropathy (SpA) with histological correlations, in comparison with conventional RARE T2 Fat-Sat sequences, and, furthermore, to evaluate the feasibility of a 3D multiecho UTE sequence performed before and after the intravenous injection of ultrasmall superparamagnetic iron oxide (USPIO) particles to assess macrophagic involvement in the Achilles enthesis in the same rat model of SpA. Materials and Methods: Fourteen rats underwent in vivo MRI of the ankle at 4.7 T, including a 3D RARE T2 Fat-Sat sequence and a 3D ultrashort echo-time (UTE) sequence for morphologic assessment at baseline and day 3 after induction of an SpA model, leading to Achilles enthesopathy in the left paw (right paw serving as a control). A 3D multiecho UTE sequence was also performed at day 3 before and then 24 (4 rats) and 48 (2 rats) hours after intravenous injection of USPIO. Visual analysis and signal intensity measurements of all images were performed at different locations of the Achilles enthesis and preinsertional area. Visual analysis and T2∗ measurements were performed before and after USPIO injection, on the 3D multiecho UTE sequence in the same locations. Normal and pathological values were compared by Wilcoxon signed-rank tests. MR findings were compared against histological data. Results: 3D-UTE sequences enabled morphologic identification of the anterior fibrocartilage and posterior collagenic areas of the Achilles enthesis. Visual analysis and signal intensity measurements distinguished SpA-affected entheses from healthy ones at day 3 (P=0.02). After administration of USPIO, no differences in signals were detected. Similarly, both visual analysis and signal T2∗ measurements in the enthesis were unable to distinguish the SpA-affected tendons from healthy ones (P=0.914). Neither the normal anatomy of the enthesis nor its pathological pattern could be distinguished using the standard RARE sequence. Histology confirmed the absence of USPIO in Achilles entheses, despite marked signs of inflammation. Conclusion: Unlike conventional RARE T2 Fat-Sat sequences, 3D-UTE sequences enable morphologic assessment of normal enthesis anatomy and early detection of abnormalities in pathological conditions. However, 3D multiecho UTE sequences combined with USPIO injections with T2∗ measurements were unable to detect macrophagic involvement in these pathological conditions.


Assuntos
Tendão do Calcâneo/patologia , Imageamento Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Espondiloartropatias/diagnóstico por imagem , Animais , Tornozelo/diagnóstico por imagem , Colágeno/análise , Modelos Animais de Doenças , Compostos Férricos/análise , Fibrocartilagem/diagnóstico por imagem , Inflamação , Macrófagos/patologia , Tamanho da Partícula , Ratos , Espondiloartropatias/patologia , Fatores de Tempo
10.
Invest Radiol ; 54(9): 565-571, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31107700

RESUMO

OBJECTIVES: The goal of this study was to demonstrate feasibility of measuring extracellular pH in cartilage and meniscus using acidoCEST technique with a 3-dimensional ultrashort echo time readout (acidoCEST-UTE) magnetic resonance imaging (MRI). MATERIALS AND METHODS: Magnetization transfer ratio asymmetry, radiofrequency (RF) power mismatch, and relative saturation transfer were evaluated in liquid phantoms for iopromide, iopamidol, and iohexol over a pH range of 6.2 to 7.8, at various agent concentrations, temperatures, and buffer concentrations. Tissue phantoms containing cartilage and meniscus were evaluated with the same considerations for iopamidol and iohexol. Phantoms were imaged with the acidoCEST-UTE MRI sequence at 3 T. Correlation coefficients and coefficients of variations were calculated. Paired Wilcoxon rank-sum tests were used to evaluate for statistically significant differences. RESULTS: The RF power mismatch and relative saturation transfer analyses of liquid phantoms showed iopamidol and iohexol to be the most promising agents for this study. Both these agents appeared to be concentration independent and feasible for use with or without buffer and at physiologic temperature over a pH range of 6.2 to 7.8. Ultimately, RF power mismatch fitting of iohexol showed the strongest correlation coefficients between cartilage, meniscus, and fluid. In addition, ratiometric values for iohexol are similar among liquid as well as different tissue types. CONCLUSIONS: Measuring extracellular pH in cartilage and meniscus using acidoCEST-UTE MRI is feasible.


Assuntos
Fibrocartilagem/química , Aumento da Imagem/métodos , Imageamento Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Algoritmos , Estudos de Viabilidade , Humanos , Concentração de Íons de Hidrogênio , Iohexol/análogos & derivados , Iopamidol , Menisco/química , Imagens de Fantasmas
11.
BMC Musculoskelet Disord ; 20(1): 233, 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31103035

RESUMO

BACKGROUND: A detailed evaluation focusing on the fibrocartilage layers in the anterior cruciate ligament (ACL) insertion is necessary to consider regeneration of the insertion. This study examined the development of the fibrocartilage layers in the ACL tibial insertion in rabbits by quantitative morphometric evaluations based on histological and immunohistochemical analyses. METHODS: Male Japanese white rabbits were used because of their history of use for histomorphometric analyses of the ACL insertion and to eliminate the influence of female hormones on the ACL. Six animals were euthanized at each age (1 day and 1, 2, 4, 6, 8, 12, and 24 weeks); in total, 48 animals were used. Proliferation rate, apoptosis rate, Sox9-positive rate, and chondrocyte number were evaluated. Safranin O-stained glycosaminoglycan (GAG) areas, tidemark length, ACL insertion width, and ACL length were also evaluated. All parameters were compared with those at age 24 weeks of age. RESULTS: High levels of chondrocyte proliferation and Sox9 expression continued until 4 and 8 weeks of age, respectively, and then gradually decreased. Chondrocyte apoptosis increased up to 8 weeks. The chondrocyte number, ACL insertion width, ACL length, safranin O-stained GAG areas, and tidemark length gradually increased up to 12 weeks. CONCLUSION: Chondrocytes that displayed chondrocyte proliferation and Sox9 expression increased until 12 weeks of age, in accordance with development of the ACL length and its insertion width. The GAG production and tidemark length also increased until 12 weeks of age. The development of fibrocartilage layers in the ACL insertion was complete at 12 weeks of age.


Assuntos
Ligamento Cruzado Anterior/fisiologia , Condrócitos/fisiologia , Fibrocartilagem/fisiologia , Regeneração , Animais , Ligamento Cruzado Anterior/transplante , Lesões do Ligamento Cruzado Anterior/cirurgia , Apoptose/fisiologia , Proliferação de Células/fisiologia , Fibrocartilagem/citologia , Masculino , Modelos Animais , Coelhos , Fatores de Transcrição SOX9/metabolismo
12.
Arthroscopy ; 35(5): 1486-1497, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30979627

RESUMO

PURPOSE: To investigate platelet-rich plasma (PRP) combined with gelatin sponge (GS) to improve tendon-bone interface healing and structure formation. METHODS: Characterization of the GS scaffold was performed with a scanning electron microscope, and the release curve after loading with PRP was evaluated. A real-time reverse transcription quantitative polymerase chain reaction assay was performed to test the levels of tendon-to-bone healing-related gene expression. Finally, 18 New Zealand white rabbits were randomly divided into 3 groups and underwent semitendinosus autograft anterior cruciate ligament reconstruction: autograft group without PRP, PRP group, and PRP-GS group. All rabbits were killed 8 weeks after the operation. Magnetic resonance imaging scans, biomechanical testing, and histologic evaluation were performed. RESULTS: An enzyme-linked immunosorbent assay and cell counting kit-8 assay showed that the GS could control the release of PRP and prolong its bioactivity time, as well as promote bone marrow mesenchymal stem cell proliferation. In the PRP-GS group, the levels of related genes were upregulated compared with the PRP group (P < .05). Lower signal in the magnetic resonance images indicated fibrocartilage formation in the 2 groups with PRP. In addition, histologic staining showed that the tendon-bone connection had a greater fibrocartilaginous transition region in the PRP-GS group, and the histologic scores were higher (vs the PRP group, P = .039). The maximum failure load and stiffness were higher in the PRP-GS group than in the other 2 groups. CONCLUSIONS: GS loading with PRP could prolong the bioactivity time of PRP and promote bone marrow mesenchymal stem cell proliferation and osteogenic gene expression in vitro. It also promoted the early healing process at the tendon-bone junction in a rabbit anterior cruciate ligament reconstruction model. CLINICAL RELEVANCE: GS is a natural material and offers satisfactory biocompatibility. Using GS as a scaffold to control the release of bioactive factors in bone tunnels may be useful, but additional studies in human subjects will be necessary to evaluate its clinical prospects.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/instrumentação , Reconstrução do Ligamento Cruzado Anterior/métodos , Gelatina , Plasma Rico em Plaquetas , Tendões/transplante , Engenharia Tecidual/métodos , Animais , Fenômenos Biomecânicos , Osso e Ossos , Fibrocartilagem , Masculino , Coelhos , Distribuição Aleatória , Transplante Autólogo , Cicatrização
13.
Orthop Traumatol Surg Res ; 105(4): 683-690, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31006645

RESUMO

INTRODUCTION: Implantation of autogenous meniscal fragments wrapped with a fascia sheath significantly enhances fibrocartilage regeneration in vivo in defect cases at 12 weeks after implantation. The specific effects of the implanted autologous living chondrocytes and meniscal matrix have not been elucidated, however. The aim of this study was to clarify the role of autologous living chondrocytes contained in the meniscal matrix in in vivo meniscus regeneration induced by in situ meniscus fragment implantation. HYPOTHESIS: Implantation of meniscus fragments containing autologous living chondrocytes may result in significant in vivo meniscus regeneration. MATERIALS AND METHODS: Seventy-five rabbits were used in this study. A partial meniscectomy of the anterior one-third of the medial meniscus including the part of the anterior horn was performed. The rabbits were divided into 3 groups. In Group I, no treatment was applied to the defect. In Group II, the autogenous meniscal fragments devitalized by freeze-thaw treatment were reimplanted into the defect. In Group III, the autogenous meniscal fragments were reimplanted. In each group, the defect was covered with a fascia. Five rabbits from each group were subjected to morphologic and histologic evaluations at 3, 6, and 12 weeks, and 5 rabbits from each group were subjected to biomechanical evaluations at 6 and 12 weeks. RESULTS: Histologically, no cells were seen in the grafted meniscal fragments at 3 weeks in Group II, whereas chondrocytes in the grafted meniscal fragments were alive at 3 weeks in Group III. Histologic and biomechanical data for Group II were slightly but significantly better than those of Group I at 12 weeks after implantation (p=0.007 and p=0.002, respectively), whereas the data for Group III were significantly superior to those of Groups I and II at 12 weeks (p<0.0014 and p<0.0029, respectively). DISCUSSIONS: Grafted autologous living chondrocytes contained in the meniscal matrix play an important role in in vivo meniscus regeneration induced by in situ meniscus fragment implantation. STUDY DESIGN: II, Controlled laboratory study.


Assuntos
Condrócitos/fisiologia , Fibrocartilagem/fisiologia , Meniscectomia/métodos , Meniscos Tibiais/cirurgia , Regeneração , Reimplante/métodos , Lesões do Menisco Tibial/fisiopatologia , Lesões do Menisco Tibial/cirurgia , Animais , Feminino , Coelhos , Transplante Autólogo
14.
Cells ; 8(4)2019 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-30959928

RESUMO

The aim of this study was to review aspects of the pathobiology of the meniscus in health and disease and show how degeneration of the meniscus can contribute to deleterious changes in other knee joint components. The menisci, distinctive semilunar weight bearing fibrocartilages, provide knee joint stability, co-ordinating functional contributions from articular cartilage, ligaments/tendons, synovium, subchondral bone and infra-patellar fat pad during knee joint articulation. The meniscus contains metabolically active cell populations responsive to growth factors, chemokines and inflammatory cytokines such as interleukin-1 and tumour necrosis factor-alpha, resulting in the synthesis of matrix metalloproteases and A Disintegrin and Metalloprotease with ThromboSpondin type 1 repeats (ADAMTS)-4 and 5 which can degrade structural glycoproteins and proteoglycans leading to function-limiting changes in meniscal and other knee joint tissues. Such degradative changes are hall-marks of osteoarthritis (OA). No drugs are currently approved that change the natural course of OA and translate to long-term, clinically relevant benefits. For any pharmaceutical therapeutic intervention in OA to be effective, disease modifying drugs will have to be developed which actively modulate the many different cell types present in the knee to provide a global therapeutic. Many individual and combinatorial approaches are being developed to treat or replace degenerate menisci using 3D printing, bioscaffolds and hydrogel delivery systems for therapeutic drugs, growth factors and replacement progenitor cell populations recognising the central role the menisci play in knee joint health.


Assuntos
Fibrocartilagem/fisiologia , Articulação do Joelho/fisiologia , Menisco/fisiologia , Humanos , Transcriptoma/genética , Suporte de Carga , Cicatrização
15.
J Orthop Res ; 37(8): 1709-1722, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30977542

RESUMO

Bone-tendon (B-T) healing is a clinical challenge due to its limited regeneration capability. Fibrocartilage regeneration and bone formation at the healing site are two critical factors for B-T healing. Promoting fibrocartilage regeneration and bone formation by tissue-engineering may be a promising treatment strategy. In this study, we innovatively fabricated two kinds of acellular scaffolds from bone or fibrocartilage tissues, namely the book-type the acellular bone scaffold (BABS) and the book-type acellular fibrocartilage scaffold (BAFS). Histologically, the two scaffolds well preserved the native extracellular matrix (ECM) structure without cellular components. In vitro studies showed BABS is superior in osteogenic inducibility, while BAFS has good chondrogenic inducibility. To comparatively investigate the efficacy on B-T healing, the BABS or BAFS were, respectively, implanted into a rabbit partial patellectomy model. Macroscopically, a regenerated bone-tendon insertion (BTI) was bridging the residual patella and patellar-tendon with no signs of infection and osteoarthritis. Radiologically, more new bone was formed at the healing interface in the BABS group as compared with the BAFS or control (CTL) groups (p < 0.05). Histologically, at postoperative week 16, histological scores were significantly better for regenerated fibrocartilage in the BAFS group or BABS group compared with the CTL group, but the BAFS group showed a significantly larger score than the BABS groups (p < 0.05). Biomechanical evaluation indicated a higher failure load and stiffness were shown in the BAFS group than those in the BABS or CTL groups at week 16 (p < 0.05). This study indicated that the BAFS is a more promising scaffold for B-T healing in comparison with the BABS. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1709-1722, 2019.


Assuntos
Osso e Ossos , Fibrocartilagem , Traumatismos dos Tendões/terapia , Tecidos Suporte , Animais , Masculino , Coelhos
16.
Am J Sports Med ; 47(4): 942-953, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30870031

RESUMO

BACKGROUND: Low-intensity pulsed ultrasound (LIPUS), as a safe biophysiotherapy, can enhance bone-tendon (B-T) healing in vivo and induce osteogenic or chondrogenic differentiation of mesenchymal stromal cells in vitro. This study aimed to determine whether LIPUS can improve the efficacy of transplanted mesenchymal stromal cells on B-T healing. HYPOTHESIS: LIPUS can induce lineage-specific differentiation of transplanted adipose-derived stromal cells (ASCs) at the B-T healing site, thus resulting in superior healing quality when compared with LIPUS or ASCs alone. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 112 mature rabbits with partial patellectomy in the hindlimb were randomly assigned into mock sonication without ASCs (control), ultrasonication without ASCs (LIPUS), mock sonication with ASCs (ASCs), and ultrasonication with ASCs (LIPUS + ASCs). The treatment time of the mock sonication or ultrasonication was 20 minutes per day. Autologous ASCs were transplanted to the healing site by fibrin glue during the operation, and LIPUS was delivered daily starting at postoperative day 3 until euthanasia. The patella-patellar tendon junctions were postoperatively harvested at 8 and 16 weeks for radiological, histological, and mechanical evaluations. Additionally, 9 animals were used for ASC tracking with mCherry protein. RESULTS: Radiologically, there was more new bone formation and remodeling in the LIPUS + ASCs group as compared with the other groups. Synchrotron radiation micro-computed tomography showed that the LIPUS + ASCs group significantly increased bone volume fraction, trabecular thickness, and trabecular number at the healing site as compared with the other groups at postoperative 8 weeks ( P < .05 for all). Histologically, immunohistochemical staining confirmed that the transplanted mCherry-ASCs can differentiate into osteoblasts and fibrochondrocytic-like cells. Meanwhile, as compared with the other groups, the LIPUS + ASCs group showed more formation and maturity of the fibrocartilage layer and new bone at postoperative weeks 8 and 16 ( P < .05 for all). Biomechanically, the LIPUS + ASCs group showed significantly higher failure load and stiffness versus the other groups at postoperative weeks 8 and 16 ( P < .05 for all). CONCLUSION: Autologous ASC transplantation stimulated with LIPUS can result in superior B-T healing quality when compared with LIPUS or ASCs alone. CLINICAL RELEVANCE: This study demonstrates the effectiveness of using ASC transplantation stimulated with LIPUS for B-T healing and provides a foundation for future clinical studies.


Assuntos
Transplante de Células-Tronco Mesenquimais , Patela/fisiologia , Patela/cirurgia , Ligamento Patelar/fisiologia , Ligamento Patelar/cirurgia , Terapia por Ultrassom/métodos , Cicatrização/fisiologia , Tecido Adiposo/citologia , Animais , Condrogênese , Fibrocartilagem/fisiologia , Masculino , Modelos Animais , Osteogênese , Patela/diagnóstico por imagem , Ligamento Patelar/diagnóstico por imagem , Coelhos , Distribuição Aleatória , Transplante Autólogo , Microtomografia por Raio-X
17.
Knee Surg Sports Traumatol Arthrosc ; 27(11): 3543-3551, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30877317

RESUMO

PURPOSE: The purpose of this study was to evaluate whether a flattened bone tunnel has a positive effect on the tendon-bone healing (TBH) process in the early period after anterior cruciate ligament (ACL) reconstruction. METHODS: Seventy-two New Zealand White rabbits were randomly allocated into two groups, the flattened tunnel (FT) group and the conventional round tunnel (RT) group. We compared the cross-sectional areas and diameters of the bone tunnels between the two groups through computed tomography (CT) scanning. TBH results between the two groups were assessed by histological analysis, micro-CT scanning and biomechanical tests at 4 weeks, 8 weeks and 12 weeks after operation. RESULTS: The cross-sectional areas of the bone tunnels between the two groups were almost the same. However, the shape of bone tunnels in the FT group was more flattened. A faster cellular and collagen remoulding process were found in the FT group. Semiquantitative histological analysis of Safranin O staining showed that there was more fibrocartilage formation in the interface region in the FT group (P < 0.05). Sirius Red staining showed that the tissues in the interface areas were more intense in the FT group. Micro-CT scanning showed that more new bone formation could be found in the interface region in the FT group. The biomechanical tests also showed that FT ACL reconstruction will result in a stronger regenerated tendon-bone interface. CONCLUSIONS: Our study found that a flattened bone tunnel accelerated TBH in the early period after ACL reconstruction surgery in a rabbit model, which lays the groundwork for further clinical practice of this ACL reconstruction method.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Osso e Ossos/fisiologia , Osso e Ossos/cirurgia , Tendões/fisiologia , Tendões/cirurgia , Cicatrização , Animais , Ligamento Cruzado Anterior/cirurgia , Colágeno/biossíntese , Fibrocartilagem/fisiologia , Masculino , Modelos Animais , Coelhos , Distribuição Aleatória
18.
Biomed Mater ; 14(3): 035016, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30844776

RESUMO

Electrospun fibers offer tremendous potential for tendon and ligament tissue engineering, yet developing porous scaffolds mimicking the size, stiffness and strength of human tissues remains a challenge. Previous studies have rolled, braided, or stacked electrospun sheets to produce three-dimensional (3D) scaffolds with tailored sizes and mechanical properties. A common limitation with such approaches is the development of low porosity scaffolds that impede cellular infiltration into the body of the implant, thereby limiting their regenerative potential. Here, we demonstrate how varying the rotational speed of the collecting mandrel during the electrospinning of poly(ε-caprolactone) (PCL) can be used to limit inter-fiber fusion (or fiber welding). Increasing the fraction of unfused fibers reduced the flexural rigidity of the electrospun sheets, which in turn allowed us to bundle the fibers into 3D scaffolds with similar dimensions to the human anterior cruciate ligament (ACL). These unfused fibers allowed for higher levels of porosity (up to 95%) that facilitated the rapid migration of mesenchymal stem cells (MSCs) into the body of the scaffolds. Mechanical testing demonstrated that the fiber-bundles possessed a Young's modulus approaching that of the native human ACL. The scaffolds were also capable of supporting the differentiation of MSCs towards either the fibrocartilage or ligament/tendon lineage. This novel electrospinning strategy could be used to produce mechanically functional, yet porous, scaffolds for a wide range of biomedical applications.


Assuntos
Ligamento Cruzado Anterior/crescimento & desenvolvimento , Ligamentos/crescimento & desenvolvimento , Tendões/crescimento & desenvolvimento , Engenharia Tecidual/métodos , Tecidos Suporte/química , Animais , Materiais Biocompatíveis/química , Materiais Biomiméticos , Células da Medula Óssea/citologia , Movimento Celular , Sobrevivência Celular , Módulo de Elasticidade , Fibrocartilagem/crescimento & desenvolvimento , Humanos , Poliésteres/química , Porosidade , Estresse Mecânico , Suínos
19.
Kaohsiung J Med Sci ; 35(3): 175-182, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30887723

RESUMO

Bone tendon junction injury is hard to cure because of its special anatomical structure, and the treatment applied for bone-tendon junction injury cannot result in the perfect vascular regeneration and restoration of the fibrocartilage zone. In this article, we aim to explore the effect of caveolin-1 as a slow-release material on bone-tendon junction healing. Seventy-two New Zealand rabbits were randomly selected and assigned into the experimental, sham-operated and control groups (n = 24). Caveolin-1 microspheres and microcapsule were developed as drug delivery system. At the 4th, 8th, and 12th weeks after surgery, quadriceps muscle patella-patellar tendon (QMPPT) was obtained from each rabbit to observe the tendon-to-bone tunnel healing, and X-ray examination, histological examination and biomechanical testing were applied for evaluating new bone formation. As the X-ray showed, caveolin-1 increased the new bone area at each time point. At the 4th and 8th weeks after surgery, the rabbit treated with caveolin-1 slow release material showed repair of fibrocartilage. According to the biomechanical results, the cross-sectional area, breaking load and ultimate tensile strength were increased along with time. At the same time point, caveolin-1 increased the ultimate tensile strength. Our study demonstrates that caveolin-1 as a slow-release material could accelerate bone-tendon junction healing by promoting the formation of the transition zone.


Assuntos
Osso e Ossos/metabolismo , Osso e Ossos/patologia , Caveolina 1/farmacologia , Tendões/metabolismo , Tendões/patologia , Cicatrização , Animais , Fenômenos Biomecânicos/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Quitosana/química , Preparações de Ação Retardada/farmacologia , Feminino , Fibrocartilagem/efeitos dos fármacos , Cinética , Masculino , Microesferas , Músculos/efeitos dos fármacos , Tamanho da Partícula , Patela/efeitos dos fármacos , Coelhos , Tendões/efeitos dos fármacos , Cicatrização/efeitos dos fármacos
20.
Development ; 146(4)2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30745426

RESUMO

Sesamoid bones are small auxiliary bones that form near joints and contribute to their stability and function. Thus far, providing a comprehensive developmental model or classification system for this highly diverse group of bones has been challenging. Here, we compare our previously reported mechanisms of patella development in the mouse with those of two anatomically different sesamoids, namely lateral fabella and digit sesamoids. We show that all three types of sesamoid bones originate from Sox9+ /Scx+ progenitors under the regulation of TGFß and independently of mechanical stimuli from muscles. Whereas BMP2 regulates the growth of all examined sesamoids, the differentiation of lateral fabella or digit sesamoids is regulated redundantly by BMP4 and BMP2. Next, we show that whereas patella and digit sesamoids initially form in juxtaposition to long bones, lateral fabella forms independently and at a distance. Finally, our evidence suggests that, unlike the synovial joint that separates patella from femur, digit sesamoids detach from the phalanx by formation of a fibrocartilaginous joint. These findings highlight both common and divergent molecular and mechanical features of sesamoid bone development, which underscores their evolutionary plasticity.


Assuntos
Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Músculos/embriologia , Fatores de Transcrição SOX9/genética , Ossos Sesamoides/embriologia , Ossos Sesamoides/crescimento & desenvolvimento , Fator de Crescimento Transformador beta/metabolismo , Animais , Evolução Biológica , Proteína Morfogenética Óssea 2/metabolismo , Proteína Morfogenética Óssea 4/metabolismo , Cartilagem/metabolismo , Linhagem da Célula , Feminino , Fêmur/metabolismo , Fibrocartilagem/metabolismo , Heterozigoto , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Músculos/metabolismo , Patela/embriologia , Patela/crescimento & desenvolvimento , Ossos Sesamoides/citologia , Transdução de Sinais , Estresse Mecânico , Líquido Sinovial/metabolismo
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