Algorithm-Guided Treatment of Ulna Impaction Syndrome: A 10-Year Follow-Up Study of Ulna Shortening Osteotomy and Wafer Procedure.

Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative management fails. This study assessed an algorithm-guided treatment of UIS over a period of 10 years. Methods: This prospective observational study compared the outcome of 54 patients who underwent either USO or AWP for UIS based on a predefined treatment algorithm. The mean follow-up period was 10 years. Primary outcome parameters were the visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), whereas secondary outcome parameters were grip and pinch strength and range of motion. Results: The median preoperative ulnar variance was 2.6 mm in the USO group and 2.0 mm in the AWP group. The postoperative average ulnar variance was 0 mm in both groups. The preoperative pain at rest was 3.4 in the USO group and 2.3 in the AWP group. One year after surgery, there was a significant reduction to VAS 0.7 and 0.2, respectively. These results persisted to the 10-year follow-up (VAS 0.9 and 0.2). The pain in motion also decreased significantly in the first year (from 6.8 and 6.7 to 2.2 and 2.1), as well as after 10 years (2.4 and 1.0). The preoperative DASH score averaged 31.3 in the USO group and 35.8 in the AWP group. At the 10-year follow-up, the DASH of both groups decreased significantly to 4.35 in the AWP group compared to 12.7 in the USO group. Conclusions: Our data show that, when using our algorithm, both USO and AWP, two common operative treatment options of UIS, reliably reduce pain and significantly reduce the DASH score over at least a period of ten years. The results after 10 years differ from short-term results in so far as after one year, the USO group showed to some degree similar outcome parameters compared to AWP, whereas at the 10-year follow-up, AWP reached slightly better primary outcome parameters. The algorithm presented, thus, produced excellent short- and long-term outcomes. Our findings and the applied algorithm can assist in decision-making and patient education.

[Perioperative Use of Antibiotics as Infection Prophylaxis in Elective Wrist Arthroscopy: A Nationwide Survey]. / Einsatz von Antibiotikum zur perioperativen Infektprophylaxe in der elektiven Handgelenksarthroskopie: Eine deutschlandweite Befragung.

BACKGROUND: Wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist conditions. While perioperative antibiotic prophylaxis (PAP) is not generally recommended for elective hand surgery, there is no official standard for elective wrist arthroscopy. This study aimed to determine the actual clinical use of PAP in elective wrist arthroscopy in Germany and relate it to the structural conditions of clinics performing this procedure. MATERIAL AND METHODS: We conducted a systematic search of all facilities in Germany offering wrist arthroscopy. Among these, we performed an online survey using the SoSci Survey online tool via email. RESULTS: PAP is more frequently administered in cases involving simultaneous bone procedures. Cephalosporins are the most commonly used antibiotics in cases of PAP administration. Hospitals administer PAP more frequently than outpatient settings, with most surveyed institutions following facility-specific internal standards for antibiotic administration. The number of arthroscopies performed in the surveyed centres does not influence antibiotic administration. CONCLUSIONS: The use of PAP in wrist arthroscopies in Germany is inconsistent. The increased use in arthroscopies with bone involvement corresponds to AWMF guidelines, but a general recommendation for wrist arthroscopies, including soft tissue arthroscopies, is necessary to provide physicians with medical and legal certainty.

Postoperative Benefits of Soft Tissue Wrist Arthroscopy: Retro- and Prospective Analyses of Outcome Measures.

Background: Elective soft-tissue-only wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist pain. A number of pathologies can be treated arthroscopically, with the aim of pain reduction and improved wrist mobility. A postinterventional evaluation of the treatment using objective and patient-reported outcome measures (PROMs) allows for an evidence-based statement about the benefits of soft-tissue-only wrist arthroscopy. Methods: A dual-center study combining retro- and prospective clinical analyses of patient outcomes after soft-tissue-only wrist arthroscopies was performed. The data were collected at two hospitals with departments specializing in hand surgery. The outcome was measured by assessing the range of motion of the wrist and its manual strength, as well as PROMs, including Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: A total of 154 soft interventions met the study criteria and could be included. Seven months after the elective soft-tissue-only wrist arthroscopies, mobility improved significantly for active extension and flexion, as well as the ulnar and radial abduction of the wrist. The grip strength also improved significantly, by an average of 6 kg, during this period. The DASH score improved significantly, from 35 points to 14 points. Additionally, wrist pain at rest was reduced significantly. Conclusions: After elective soft-tissue-only wrist arthroscopy, patients showed an overall functional improvement in their wrist, with a significant reduction in pain and improvement of mobility and grip strength. This study emphasizes the importance of wrist arthroscopy as a successful treatment option for soft tissue pathologies of the wrist.

RNA-seq unravels distinct expression profiles of keloids and Dupuytren's disease.

Keloid scars and Dupuytren's disease are two common, chronic, and incurable fibroproliferative disorders that, among other shared clinical features, may induce joint contractures. We employed bulk RNA sequencing to discern potential shared gene expression patterns and underlying pathological pathways between these two conditions. Our aim was to uncover potential molecular targets that could pave the way for novel therapeutic strategies. Differentially expressed genes (DEGs) were functionally annotated using Gene Ontology (GO) terms and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways with the Database for Annotation, Visualization, and Integrated Discovery (DAVID). The protein-protein-interaction (PPI) networks were constructed by using the Search Tool for the Retrieval of Interacting Genes (STRING) and Cytoscape. The Molecular Complex Detection (MCODE) plugin was used for downstream analysis of the PPI networks. A total of 1922 DEGs were identified within Dupuytren's and keloid samples, yet no overlapping gene expression profiles were detected. Significantly enriched GO terms were related to skin development and tendon formation in keloid scars and Dupuytren's disease, respectively. The PPI network analysis revealed 10 genes and the module analysis provided six protein networks, which might play an integral part in disease development. These genes, including CDH1, ERBB2, CASP3 and RPS27A, may serve as new targets for future research to develop biomarkers and/or therapeutic agents.

Systematic review of molecular pathways in burn wound healing.

Depending on extent and depth, burn injuries and resulting scars may be challenging and expensive to treat and above all heavily impact the patients' lives. This systematic review represents the current state of knowledge on molecular pathways activated during burn wound healing. All currently known molecular information about gene expression and molecular interactions in mammals has been summarized. An ample interaction of regenerative cytokines, growth factors, ECM-regenerative molecules and proinflammatory immune response became apparent. We identified three molecules to be most often involved in the pathways: TGFB1, ACTA1 and COL1A1. Yet, other factors including FLII, AKT1 and miR-145 were shown to play pivotal roles in burn wound healing as well. This systematic review helps to explain the fundamental molecular proceedings participating in burn wound healing. A number of new molecular interactions and functional connections were identified yielding intriguing new research targets. An interactive version of the first network about molecular pathways and interactions during burn wound healing is provided in the online edition and on WikiPathways.

[Current Trends in Flexor Tendon Surgery: Results of a National Online Survey]. / Aktuelle Trends in der Beugesehnenchirurgie ­ Ergebnisse einer nationalen Online-Umfrage.

Within the last 50 years, there has been a change in trend in flexor tendon surgery. After the introduction of the 2-strand technique, the 4-strand technique was propagated in the 1990s. In order to obtain a status quo of which technique is used in Germany and if the gold standard of the 4-strand suture has changed in favour of a 6-strand suture, we conducted an online survey among members of the DGH ("Deutsche Gesellschaft für Handchirurgie", German Society for Hand Surgery) on the suture technique of flexor tendon injuries zone 2. MATERIAL AND METHODS: An online survey was conducted and sent out by email to all DGH members. The questionnaire included 7 questions. Participants accessed the survey via a link. RESULTS: 155 hand surgeons from Germany participated in the survey. All of them answered the questionnaire in full and all questionnaires were included in the evaluation. The main question of how many strands are currently used for core suturing was answered as follows: 21% (n=32) of the 155 participants (TN) stated that they use a 2-strand suture, 53% used (n=82) a 4-strand suture and 10% used a 6-strand suture. Regarding techniques, 81 TN used the Kirchmayr-Kessler technique or a modification of it, 9 TN used the M-Tang technique, and 15 TN indicated "other technique". The question about the application of an epitendinous suture was overwhelmingly answered with "yes". Here, 98.2% agreed. Only with regard to the suture material, different opinions were found. 68% (n=106) use an absorbable monofilament suture (such as PDS). Just under a quarter (23%, n=36) use a non-absorbable monofilament suture (such as Prolene). CONCLUSION: Flexor tendon surgery has changed considerably due to intensive advances in research during the last decades. It was interesting to note in our survey that German hand surgeons have adapted their suture technique within the last years based on the results of the literature. Our results clearly show that convincing scientific data has an influence on the choice of surgical technique and that discussions about new techniques, e. g. in the context of annual meetings, may well stimulate the auditorium to rethink.

Efficacy of perioperative antibiotic prophylaxis in elective soft-tissue-only wrist arthroscopy.

Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy. A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained. The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms. We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results.

Detailed analysis of surgically treated hand trauma patients in a regional German trauma centre.

Hand and forearm injuries are the most frequent reason for consultations in German emergency departments. Therefore, full recovery has a high social and economic relevance. In this study, data on surgically treated hand injuries in a regional German trauma centre between 01.01.2019 and 31.01.2021 were collected using the new German HandTraumaRegister of the German Society for Hand Surgery. These data were retrospectively analysed and correlated with mobility data of the Bavarian population, the 7-day incidence of Covid-19 infections in Germany and the number of elective hand surgeries. We found that a fall from standing height with consecutive distal radius fracture was the most common injury in women, whereas mechanism of injury and diagnosis were more diverse in men. The populations' mobility correlated well with the number of accidents, which in turn was reciprocal to the 7-day-incidence of Covid-19 infections. The number of elective hand surgeries expectedly dropped significantly during the state-imposed lockdowns. Knowing that mainly young men and elderly women suffer from hand injuries, tailored prevention measures may be elaborated. In order to reduce socioeconomic burden, care for hand injuries and elective hand surgeries must be guaranteed according to the frequency of their occurrence.

Patients With Dupuytren Disease Use Excessive Grip Force When Lifting and Holding Small Objects, Independent of the Degree of Contracture.

OBJECTIVE: To identify the extent and quality of fine motor skill alteration in patients with Dupuytren disease (DD) using an instrumented device measuring grip forces, beyond the commonly used measurement of contracture. DESIGN: Case-control study. SETTING: University outpatient clinic. PARTICIPANTS: Patients with DD (N=27) and a contracture >45° (Tubiana stage II, III, and IV) were included and compared with age-matched healthy control patients (N=27). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES(S): All individuals were subjected to a set of specific tests using a new instrumented device ("manipulandum"). These included lifting, grasping, and then holding the "manipulandum" with 4 different object characteristics (light and heavy weight, rough and smooth surface) along with a measurement of the precision grip strength. Standard measurements including the Nine-Hole Peg Test, a two-point discrimination, and the Disability of Arm, Shoulder and Hand score were evaluated in comparison. RESULTS: Although the measurements of precision grip, two-point discrimination, Nine-Hole Peg Test, and Disability of Arm, Shoulder and Hand score showed no statistically significant differences between both groups, patients with DD applied significantly greater forces when tested with the different subtests using the "manipulandum." Analysis of the 2-phase movement (lifting and holding the "manipulandum") revealed highly significant differences between the groups. CONCLUSIONS: Patients with DD use excessive grip forces when lifting and holding the "manipulandum" when compared with healthy control patients, independent of the degree of contracture. As no differences in precision grip strength were seen, the presented approach is useful to obtain additional important information about fine motor function in diseased hands.

Hypoxic pre-conditioned adipose-derived stem/progenitor cells embedded in fibrin conduits promote peripheral nerve regeneration in a sciatic nerve graft model.

Recent results emphasize the supportive effects of adipose-derived multipotent stem/progenitor cells (ADSPCs) in peripheral nerve recovery. Cultivation under hypoxia is considered to enhance the release of the regenerative potential of ADSPCs. This study aimed to examine whether peripheral nerve regeneration in a rat model of autologous sciatic nerve graft benefits from an additional custom-made fibrin conduit seeded with hypoxic pre-conditioned (2% oxygen for 72 hours) autologous ADSPCs (n = 9). This treatment mode was compared with three others: fibrin conduit seeded with ADSPCs cultivated under normoxic conditions (n = 9); non-cell-carrying conduit (n = 9); and nerve autograft only (n = 9). A 16-week follow-up included functional testing (sciatic functional index and static sciatic index) as well as postmortem muscle mass analyses and morphometric nerve evaluations (histology, g-ratio, axon density, and diameter). At 8 weeks, the hypoxic pre-conditioned group achieved significantly higher sciatic functional index/static sciatic index scores than the other three groups, indicating faster functional regeneration. Furthermore, histologic evaluation showed significantly increased axon outgrowth/branching, axon density, remyelination, and a reduced relative connective tissue area. Hypoxic pre-conditioned ADSPCs seeded in fibrin conduits are a promising adjunct to current nerve autografts. Further studies are needed to understand the underlying cellular mechanism and to investigate a potential application in clinical practice.

Keloids are transcriptionally distinct from normal and hypertrophic scars.

Wound healing and skin regeneration after injury are complex biological processes, and deep injuries with a high degree of tissue destruction may result in severe scar formation. Clinically, scars can be classified into normal, hypertrophic and keloid scars. However, the molecular signature of each scar type is currently not known. The aim of this study was to reveal the transcriptional landscape of normal, hypertrophic and keloid skin scars following hand and plastic surgery based on total RNA sequencing. Eighteen skin scar samples from hand and plastic surgeries of human donors were minced directly after removal and stored in TRIzol (Thermo Fisher, USA). Samples were then subjected to RNA isolation, cDNA library preparation, bulk RNA sequencing and bioinformatics analysis. We show that keloid scars transcriptionally differed from normal and hypertrophic scars. Normal and hypertrophic scars presented overlapping clustering, and eight genes were shown to be commonly expressed between hypertrophic and normal scars. No genes were specifically expressed at a higher level in keloid and normal scars. Based on gene ontology pathway analysis, genes with a higher level of expression in keloid scars lead to increased (extra-) cellular matrix proliferation and cell interaction. Moreover, tumour-like genes were more highly expressed in keloid scars, supporting the clinical impression of strong and diffuse growth. This study furthers our understanding of the classification of differential scar types based on molecular signature, which may shed light on new diagnostic and therapeutic strategies for keloid scars in the future.

Differences in the Inflammatory Response of White Adipose Tissue and Adipose-Derived Stem Cells.

The application of liposuctioned white adipose tissue (L-WAT) and adipose-derived stem cells (ADSCs) as a novel immunomodulatory treatment option is the currently subject of various clinical trials. Because it is crucial to understand the underlying therapeutic mechanisms, the latest studies focused on the immunomodulatory functions of L-WAT or ADSCs. However, studies that examine the specific transcriptional adaptation of these treatment options to an extrinsic inflammatory stimulus in an unbiased manner are scarce. The aim of this study was to compare the gene expression profile of L-WAT and ADSCs, when subjected to tumor necrosis factor alpha (TNFα), and to identify key factors that might be therapeutically relevant when using L-WAT or ADSCs as an immuno-modulator. Fat tissue was harvested by liposuction from five human donors. ADSCs were isolated from the same donors and shortly subjected to expansion culture. L-WAT and ADSCs were treated with human recombinant TNFα, to trigger a strong inflammatory response. Subsequently, an mRNA deep nextgeneration sequencing was performed to evaluate the different inflammatory responses of L-WAT and ADSCs. We found significant gene expression changes in both experimental groups after TNFα incubation. However, ADSCs showed a more homogenous gene expression profile by predominantly expressing genes involved in immunomodulatory processes such as CCL19, CCL5, TNFSF15 and IL1b when compared to L-WAT, which reacted rather heterogeneously. As RNA sequencing between L-WAT and ADSCS treated with TNFα revealed that L-WAT responded very heterogeneously to TNFα treatment, we therefore conclude that ADSCs are more reliable and predictable when used therapeutically. Our study furthermore yields insight into potential biological processes regarding immune system response, inflammatory response, and cell activation. Our results can help to better understand the different immunomodulatory effects of L-WAT and ADSCs.

Adipose-derived stem/progenitor cells from lipoaspirates: A comparison between the Lipivage200-5 liposuction system and the Body-Jet liposuction system.

BACKGROUND: Adipose-derived stem/progenitor cells (ADSPCs) are under investigation in many clinical applications for their regenerative potential in a variety of autoimmune, degenerative, and inflammatory diseases. Adipose tissue, which is mainly harvested by manual liposuction, is the main source of these ADSPCs. OBJECTIVE: In the past years, a variety of different liposuction devices have been commercialized. To ensure a high quality of obtained ADSPCs, it is crucial to show the advantages and disadvantages of frequently used liposuction methods. For this reason, the objective of this study was to compare ADSPCs harvested by either the suction-assisted LipiVage200-5 or the water-assisted Body-Jet system. METHODS: The proliferation potential of ADSPCs, harvested from 20 patients, was assessed by cumulative population doublings (cumPD), population doubling time (PDT), colony-forming units (CFU), and cell metabolism assays. To prove the multipotency of the primary isolated cells, ADSPCs were induced to differentiate into adipogenic, osteogenic, and chondrogenic lineages. RESULTS: Our data show a significantly higher cumPD, as well as a significantly lower PDT for cells obtained by the Body-Jet system. No significant differences were found regarding the CFU efficiency and the cell metabolism. Furthermore, we showed that the adipogenic, osteogenic, and chondrogenic potential of ADSPCs is similar in both groups. DISCUSSION/CONCLUSION: In our study, we provide evidence that the cell characteristics and the functional properties of ADSPCs isolated after liposuction with different techniques are largely similar. However, we observed a significantly higher cumPD and a slightly higher adipogenic potential in cells isolated after liposuction with the Body-Jet system. Different cannula sizes and sheer stresses in the used methods might play a role here.

One-Year Outcomes of Intraarticular Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis: Case Review of 99 Joints.

BACKGROUND: This study aims to present a new therapeutic option for the treatment of thumb carpometacarpal joint osteoarthritis. Knowing that autologous fat may be beneficial for osteoarthritis through antiinflammatory and chondroprotective effects, the authors transplanted autologous adipose fat into the thumb carpometacarpal joint with the objective of postponing definite resection arthroplasty surgery. METHODS: In this pilot study, the authors performed surgery on 99 joints. The study population consisted of patients with symptomatic and radiologically confirmed osteoarthritis of the thumb carpometacarpal joint. After harvesting abdominal adipose tissue, 1 to 2 ml of fat without physical or enzymatic manipulation were transplanted into the thumb carpometacarpal joint. Surgical outcome was quantified by use of the Michigan Hand Outcomes Questionnaire in addition to strength and pain measurements during a 12-month follow-up consultation. We conducted Friedman's analysis of variance to gauge the differences over time regarding Michigan Hand Outcomes Questionnaire and pain under stress. RESULTS: From 2 weeks on, there was pain relief, both under stress and at rest. Friedman's analysis of variance revealed a significant change in pain under stress [chi-square (5) = 68.52; p < 0.001]. Postoperative Michigan Hand Outcomes Questionnaire Scores improved significantly over 12 months [chi-square (5) = 90.56; p < 0.001]. CONCLUSION: The authors' preliminary findings suggest that intraarticular autologous fat transplantation is a promising alternative treatment of carpometacarpal joint osteoarthritis of the thumb. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Fibrin glue displays promising in vitro characteristics as a potential carrier of adipose progenitor cells for tissue regeneration.

Adipose-derived multipotent stem/progenitor cells (ASPCs) were shown to be ideal candidates for cell-based regenerative therapies. Yet, despite their huge potential, successful clinical applications are still rare. It was suggested that the efficacy of ASPCs at the recipient site depends on the vehicle of cell delivery. In this study, for preparation of a murine critical-size nerve defect model, we assessed the commercially available fibrin gel (ARTISS) as a potential cell carrier. In a thorough in vitro analysis, we investigated cell-fibrin interactions and analyzed the distribution and the long-term behavior of ASPCs cultivated in fibrin gel under normoxic and hypoxic conditions. ASPCs attached to the surface of a thin fibrin layer (two-dimensional condition) and spread with the abundant formation of actin stress fibers. Cells cultured within a fibrin matrix (three-dimensional condition) displayed a uniform distribution and formed interconnected networks while exhibiting strong cell-matrix interactions. Using time-lapse analysis, cells were found to migrate out of the gel and subsequently proliferated robustly both under hypoxic and normoxic conditions. During 14 days of culture in fibrin gel, ASPCs showed high viability, metabolic, and remodeling activities. At the end of the culture period, the fibrin matrix was degraded entirely accompanied by an upregulation of matrix metalloproteinases. In conclusion, fibrin gel stands out as a valuable biomaterial for delivering vital and active cells to damaged tissues. As a direct proof, ASPCs carried in a fibrin matrix will be evaluated in a murine critically sized peripheral nerve repair model.

Validation of a novel animal model for sciatic nerve repair with an adipose-derived stem cell loaded fibrin conduit.

Despite the regenerative capabilities of peripheral nerves, severe injuries or neuronal trauma of critical size impose immense hurdles for proper restoration of neuro-muscular circuitry. Autologous nerve grafts improve re-establishment of connectivity, but also comprise substantial donor site morbidity. We developed a rat model which allows the testing of different cell applications, i.e., mesenchymal stem cells, to improve nerve regeneration in vivo. To mimic inaccurate alignment of autologous nerve grafts with the injured nerve, a 20 mm portion of the sciatic nerve was excised, and sutured back in place in reversed direction. To validate the feasibility of our novel model, a fibrin gel conduit containing autologous undifferentiated adipose-derived stem cells was applied around the coaptation sites and compared to autologous nerve grafts. After evaluating sciatic nerve function for 16 weeks postoperatively, animals were sacrificed, and gastrocnemius muscle weight was determined along with morphological parameters (g-ratio, axon density & diameter) of regenerating axons. Interestingly, the addition of undifferentiated adipose-derived stem cells resulted in a significantly improved re-myelination, axon ingrowth and functional outcome, when compared to animals without a cell seeded conduit. The presented model thus displays several intriguing features: it imitates a certain mismatch in size, distribution and orientation of axons within the nerve coaptation site. The fibrin conduit itself allows for an easy application of cells and, as a true critical-size defect model, any observed improvement relates directly to the performed intervention. Since fibrin and adipose-derived stem cells have been approved for human applications, the technique can theoretically be performed on humans. Thus, we suggest that the model is a powerful tool to investigate cell mediated assistance of peripheral nerve regeneration.

Tenomodulin is essential for prevention of adipocyte accumulation and fibrovascular scar formation during early tendon healing.

Tenomodulin (Tnmd) is the best-known mature marker for tendon and ligament lineage cells. It is important for tendon maturation, running performance and has key implications for the resident tendon stem/progenitor cells (TSPCs). However, its exact functions during the tendon repair process still remain elusive. Here, we established an Achilles tendon injury model in a Tnmd knockout (Tnmd-/-) mouse line. Detailed analyses showed not only a very different scar organization with a clearly reduced cell proliferation and expression of certain tendon-related genes, but also increased cell apoptosis, adipocyte and blood vessel accumulation in the early phase of tendon healing compared with their wild-type (WT) littermates. In addition, Tnmd-/- tendon scar tissue contained augmented matrix deposition of biglycan, cartilage oligomeric matrix protein (Comp) and fibronectin, altered macrophage profile and reduced numbers of CD146-positive cells. In vitro analysis revealed that Tnmd-/- TSPCs exhibited significantly reduced migration and proliferation potential compared with that of WT TSPCs. Furthermore, Tnmd-/- TSPCs had accelerated adipogenic differentiation accompanied with significantly increased peroxisome proliferator-activated receptor gamma (Pparγ) and lipoprotein lipase (Lpl) mRNA levels. Thus, our results demonstrate that Tnmd is required for prevention of adipocyte accumulation and fibrovascular scar formation during early tendon healing.

[Pilot study on the effects and benefits of autologous fat grafting in osteoarthritis of the CMC-1 joint compared to intraarticular cortisone injection: results after 3 months]. / Pilotstudie über die Wirkung und den Nutzen von autologen Fettgewebstransplantaten bei Rhizarthrose verglichen mit einer Kortisoninjektion ­ 3 Monatsergebnisse.

Background/Aim Preliminary data suggest that an intraarticular autologous fat transplant may be useful in osteoarthritis (OA) of the CMC-1 joint. This prospective, non-randomised pilot study investigates this new method with a view to clinical outcomes compared with intraarticular corticosteroid injection. Patients and Methods 17 women and 7 men with an average age of 63.3 (47-75) years with symptomatic OA were included in the study. In 12 patients, a radiologically guided injection of 1-1.5 ml of adipose tissue was carried out after transumbilical liposuction of 10 ml of abdominal fat. Prior to that, the fat was homogenised using two Luer-Lock Syringes, but not centrifuged. Postoperatively, the thumb was immobilised for one week. The patients from the cortisone control group received an intraarticular injection of 10 mg (1 ml) of Triamcinolon® under sterile conditions without subsequent immobilisation. Preoperatively as well as 2, 6 and 12 weeks postoperatively, the QuickDASH and the Michigan-Hand-Questionnaire (MHQ) were analysed, the pain was measured by means of the visual analogue scale (VAS), and strength and grip force were measured. Results Both the cortisone group and the autologous fat group showed a significant reduction in stress pain after two weeks. Both methods had no significant effect on force. The evaluation of quality of life by means of QuickDASH and MHQ after cortisone treatment initially demonstrated an improvement in quality of life, which, however, fell below the previous level after 6 weeks. After autologous fat transplantation, quality of life increased continuously. Conclusion In contrast to cortisone injection treatment, a persistent pain reduction was achieved in the fat injection group in the 3-month follow-up period, whereas cortisone injection only resulted in a short-term reduction of pain lasting about 6 weeks. Long-term follow-up is required now to show how long the effect of autologous fat transplantation in OA can be sustained.

[Treatment of Dupuytren's disease with collagenase injections in Germany: efficacy and adverse effects in 110 treated joints]. / Therapie des Morbus Dupuytren mit Injektion von Kollagenase in Deutschland ­ Ergebnisse und Komplikationen an 110 Gelenken.

Background Since 2011, a new minimally-invasive treatment for Dupuytren's disease has been available in the form of injectable collagenase (Xiapex®, Pfizer). Purpose Our aim is to report about the results and adverse effects of injectable collagenase for the treatment of Dupuytren's disease in Germany. Patients and Methods We treated 78 patients (61 male, 17 female) with 87 injections in 87 digits (little finger n = 40, ring finger n = 37, middle finger n = 8 and index n = 2). We documented the range of motion before treatment, after 6 weeks and after 6 months. We were able to include 39 patients (32 male, 7 female) in the 6-month follow-up. Results The initial correction in MCP joints (n = 26) was from an average 51° to 0° (p < 0.05). After 6 months there was an average reduction of contracture in MCP joints (n = 16) from 52° to 0° (p < 0.05). The initial correction in PIP joints (n = 28) was from an average of 63° to 15° (p < 0.05). After 6 months, PIP joints (n = 12) exhibited an average correction from 70° auf 40° (p < 0.05). In combined contractures of MCP und PIP joints (n = 33), there was a mean reduction from 96° to 13° (p < 0.05). In the 6-month follow-up, the correction of combined contractures (n = 16) was from 91° to 61° (p < 0.05). Common adverse effects were local oedema (n = 36), followed by haematoma (n = 25), temporary livid discolouration (n = 17) and skin tears (n=16). There were no severe complications such as tendon ruptures, vessel or nerve injuries. The most severe complications comprised 4 little skin defects that healed with conservative wound care. Conclusion Our results are comparable with previous international studies. Very good success has been achieved with single injection treatment for high-grade preoperative contractures in MCP joints, while treatment success for combined contractures of MCP and PIP joints has been satisfactory. There have been no severe complications. Common adverse effects have been similar to previous studies. In our opinion, collagenase injection is a safe and efficient treatment for Dupuytren's disease. Further studies are needed to compare long-term efficacy with percutaneous needle aponeurotomy und partial fasciectomy.