[Systematic evaluation of the incidence of the knee donor area after autobone cartilage mosaic xentoplasty].

OBJECTIVE: To provide an overview of the incidence of knee donor -site morbidity after autologous osteochondral mosaicplasty. METHODS: A comprehensive search was conducted in PubMed, EMbase, Wanfang Medical Network, and CNKI databases from January 2010 to April 20, 2021. Relevant literature was selected based on predefined inclusion and exclusion criteria, and data were evaluated and extracted. The correlation between the number and size of transplanted osteochondral columns and donor-site morbidity was analyzed. RESULTS: A total of 13 literatures were included, comprising a total of 661 patients. Statistical analysis revealed an incidence of knee donor-site morbidity at 8.6% (57/661), with knee pain being the most common complaint, accounting for 4.2%(28/661). There was no significant correlation between the number of osteochondral columns and postoperative donor-site incidence (P=0.424, N=10), nor between the diameter size of osteochondral columns and postoperative donor-site incidence(P=0.699, N=7). CONCLUSION: Autologous osteochondral mosaicplasty is associated with a considerable incidence of knee donor-site morbidity, with knee pain being the most frequent complaint. There is no apparent correlation between donor-site incidence and the number and size of transplanted osteochondral columns. Donors should be informed about the potential risks.

[Clinical effects of arthroscopy-assisted anterior cruciate ligament tibial eminence avulsion fracture compared with traditional open surgery:a Meta-analysis].

OBJECTIVE: To systematically evaluate the clinical efficacy of arthroscopy and traditional incision in the treatment of tibial avulsion fracture of anterior cruciate ligament (ACL). METHODS: From July 2010 to July 2020, clinical comparative trial about arthroscopy and traditional incision in the treatment of ACL tibial avulsion fracture was conducted by using computer-based databases, including Embase, Pubmed, Central, Cinahl, PQDT, CNKI, Weipu, Wanfang, Cochrane Library, CBM. Literature screening and data extraction were carried out according to the inclusion and exclusion criteria, and the quality of the included literature was evaluated by improved Jadad score and Ottawa Newcastle scale (NOS). The operation time, hospital stay, fracture healing time, knee range of motion, postoperative excellent and good rate, complication rate, Lysholm score, International Knee Documentation Committee (IKDC) score and Tegner score were statistically analyzed by Review Manager 5.3 software. RESULTS: Finally, 16 literatures were included, including 1 randomized controlled trial and 15 non randomized controlled trials, with a total of 822 patients (405 in arthroscopy group and 417 in traditional incision group). Meta analysis showed that the operation time [MD=-9.03, 95% CI(-14.36, -3.70), P<0.001], hospital stay [MD=-5.81, 95%CI(-9.32, -2.31), P=0.001] and fracture healing time [MD=-14.61, 95% CI(-17.93, -11.28), P<0.001] in the arthroscopy group were better than those in the traditional incision group. The incidence of complications in arthroscopy group was lower than that in traditional incision group[OR=0.15, 95%CI(0.07, 0.33), P<0.001]. The postoperative excellent and good rate[OR=4.39, 95%CI (1.96, 9.82), P<0.001], knee mobility[MD=6.78, 95%CI(2.79, 10.77), P<0.001], Lysholm score[MD=11.63, 95%CI(4.91, 18.36), P<0.001], IKDC score[MD=7.83, 95%CI(6.09, 9.57), P<0.001] and Tegner score[MD=0.60, 95%CI(0.31, 0.89), P<0.001] in the arthroscopic group were higher than those in the traditional incision group. CONCLUSION: Compared with the traditional open reduction and internal fixation, arthroscopic surgery in patients with ACL tibial avulsion fracture can shorten the operation time, hospital stay and fracture healing time, reduce the incidence of postoperative complications, and obtain good postoperative knee function. It can be recommended as one of the first choice for patients with ACL tibial avulsion fracture.

Studies of Articular Cartilage Repair from 2009 to 2018: A Bibliometric Analysis of Articles.

OBJECTIVE: To perform a bibliometric analysis of research on articular cartilage repair published in Chinese and English over the past decade. Fundamental and clinical research topics of high interest were further comparatively analyzed. METHODS: Relevant studies published from 1 January 2009 to 31 December 2018 (10 years) were retrieved from the Wanfang database (Chinese articles) and six databases, including MEDLINE, WOS, INSPEC, SCIELO, KJD, and RSCI on the website "Web of Science" (English articles), using key words: "articular cartilage" AND "injury" AND "repair". The articles were categorized according to research focuses for a comparative analysis between those published in Chinese vs English, and further grouped according to publication date (before and after 2014). A comparative analysis was performed on research focus to characterize the variation in research trends between two 5-year time spans. Moreover, articles were classified as basic and clinical research studies. RESULTS: Overall, 5762 articles were retrieved, including 2748 in domestic Chinese journals and 3014 in international English journals. A total of 4937 articles focused on the top 10 research topics, with the top 3 being stem cells (32.1%), tissue-engineered scaffold (22.8%), and molecular mechanisms (16.4%). Differences between the numbers of Chinese and English papers were observed for 3 topics: chondrocyte implantation (104 vs 316), osteochondral allograft (27 vs 86), and microfracture (127 vs 293). The following topics gained more research interest in the second 5-year time span compared with the first: microfracture, osteochondral allograft, osteochondral autograft, stem cells, and tissue-engineered scaffold. Articles with a focus on three-dimensional-printing technology have shown the fastest increase in publication numbers. Among 5613 research articles, basic research studies accounted for the majority (4429), with clinical studies described in only 1184 articles. The top 7 research topics of clinical studies were: chondrocyte implantation (28.7%), stem cells (21.9%), microfracture (19.2%), tissue scaffold (10.6%), osteochondral autograft (10.5%), osteochondral allograft (6.3%), and periosteal transplantation (2.8%). CONCLUSION: Studies focused on stem cells and tissue-engineered scaffolds led the field of damaged articular cartilage repair. International researchers studied allograft-related implantation approaches more often than Chinese researchers. Traditional surgical techniques, such as microfracture and osteochondral transplantation, gained high research interest over the past decade.

[A short term clinical study of fibular osteotomy for knee osteoarthritis].

OBJECTIVE: To study clinical effects of fibular osteotomy for the treatment of knee osteoarthritis. METHODS: From January 2015, 12 patients (15 knees) with knee osteoarthritis were treated with fibular osteotomy. The main symptom was interval inside pain. All the patients were female with an average age of 61.3 years old. Early postoperative ambulation of joints was carried out after surgery, and the corresponding radiographic assessment before and after operations were performed with record. Finally, the following indicators were analyzed:VAS, KSS, HSS, respectively before, 2 days and 2 months after the operation. RESULTS: The average hospitalization time was (6.0±2.4) days, and the time of unilateral operation was (33.3±8.4) minutes without significant bleeding. There were no obvious complications such as wound infection, delayed healing and nerve damage. All the patients could walk around 1 day after operations with a chief complaint of the obvious reduction or disappear of the interval medial knee pain. The VAS score, HSS score and KSS clinical score were significantly improved 2 days after surgery compared to the scores before operation. These above scores and functional score were significantly improved 2 months after operation compared to the scores before operation. X ray films of the weight bearing knees were taken 2 days after surgery, showing increased height of medial joint space to some extent compared to that before operation. CONCLUSIONS: A fibular osteotomy has been proved to significantly reduce the postoperative pain and facilitate the good recovery of joint function with the advantages of simple surgical procedures and slighttrauma. Therefore, it is an effective method for the treatment of knee osteoarthritis with varus deformity.

[Research on pericellular matrix properties for chondrcytes].

Pericellular matrix (PCM) is a narrow tissue region surrounding chondrocytes, which "chondron" with its enclosed cells. A number of studies suggested that PCM is rich in proteoglycans, collagen and fibronectin, and plays an important role in regulating microenvironment of chondrocytes. Direct measures of PCM properties through micropipette aspiration technique showed that PCM was different from mechanical property of chondrocytes and nature extracellular matrix. However, the function of PCM is not clear, and need further study.

Normal age-related viscoelastic properties of chondrons and chondrocytes isolated from rabbit knee.

BACKGROUND: The mechanical microenvironment of the chondrocytes plays an important role in cartilage homeostasis and in the health of the joint. The pericellular matrix, cellular membrane of the chondrocytes, and their cytoskeletal structures are key elements in the mechanical environment. The aims of this study are to measure the viscoelastic properties of isolated chondrons and chondrocytes from rabbit knee cartilage using micropipette aspiration and to determine the effect of aging on these properties. METHODS: Three age groups of rabbit knees were evaluated: (1) young (2 months, n = 10); (2) adult (8 months, n = 10); and (3) old (31 months, n = 10). Chondrocytes were isolated from the right knee cartilage and chondrons were isolated from left knees using enzymatic methods. Micropipette aspiration combined with a standard linear viscoelastic solid model was used to quantify changes in the viscoelastic properties of chondrons and chondrocytes within 2 hours of isolation. The morphology and structure of isolated chondrons were evaluated by optical microscope using hematoxylin and eosin staining and collagen-6 immunofluorescence staining. RESULTS: In response to an applied constant 0.3 - 0.4 kPa of negative pressure, all chondrocytes exhibited standard linear viscoelastic solid properties. Model predictions of the creep data showed that the average equilibrium modulus (E(∞)), instantaneous modulus (E(0)), and apparent viscosity (m) of old chondrocytes was significantly lower than the young and adult chondrocytes (P < 0.001); however, no difference was found between young and adult chondrocytes (P > 0.05). The adult and old chondrons generally possessed a thicker pericellular matrix (PCM) with more enclosed cells. The young and adult chondrons exhibited the same viscoelastic creep behavior under a greater applied pressure (1.0 - 1.1 kPa) without the deformation seen in the old chondrons. The viscoelastic properties (E(∞), E(0), and m) of young and adult chondrons were significantly greater than that observed in young and adult cells, respectively (P < 0.001). The adult chondrons were stiffer than the young chondrons under micropipette aspiration (P < 0.001). CONCLUSIONS: Our findings provide a theoretical model to measure the viscoelastic properties of the chondrons as a whole unit by micropipette aspiration, and further suggest that the properties of the chondrocytes and PCM have an important influence on the biomechanical microenvironment of the knee joint cartilage degeneration that occurs with aging.

[Disassembly of tubulin cytoskeleton disrupts the homeostasis of articular cartilage chondrocytes].

OBJECTIVE: To investigate the influence of tubulin disassembly on the in vitro metabolism of articular chondrocytes. METHODS: Eight New Zealand rabbits aged 2 months were sacrificed by air embolism. The full-thickness cartilages were harvested from both knees under sterile conditions. Then 0.4% pronase and 0.025% II collagenase were used to digest for primary chondrocytes. The cells were cultured for 3 days after attachment and then divided into the control and experimental groups. The control group continued culturing with primary medium and the experimental group with colchicine, a tubulin destructive agent, at a final concentration of 0.1 µmol/L. At Days 1 & 2, the early apoptosis of two cell groups was assayed with phosphatidylserine (Annexin V). At Day 6, the morphological changes of cells were observed by hematoxylin and eosin staining. At Days 3, 6 & 9, the expression levels of type II collagen, proteoglycan and MMP (matrix metalloproteinase)-13 mRNA were measured by real time quantitative fluorescent reverse transcription-polymerase chain reaction (real time RT-PCR). Meanwhile at Days 3, 6 & 9, the cultured supernatant of each group was obtained to detect the contents of type II collagen and proteoglycan by the methods of ELISA (enzyme-linked immunosorbent assay) and Alcian blue. RESULTS: At Day 2, the early cell apoptosis rate of the experimental group was higher than that of the control group (P < 0.05). At Day 6 post-dosing, the experimental cell morphology was found to be irregular and polygonal. Hyperchromatic nucleus and division phase increased while matrix cell decreased. At Days 3, 6 & 9, the expressions of collagen and proteoglycan mRNA in the experimental group decreased versus those in the control group (P < 0.05). The level of MMP-13 mRNA showed no significant changes in the control group at Day 3. And it significantly increased at Days 6 & 9 (P < 0.01). Meanwhile, type II collagen and glycosaminoglycan were significantly lower in the experimental group at Days 3, 6 & 9 than those in the control group (P < 0.05). CONCLUSION: A disassembly of tubulin can induce early apoptosis of chondrocytes. The synthesis and secretion of type II collagen and proteoglycan decrease while there is an elevated expression of MMP-13. The degeneration of cartilage cells and their disrupted synthesis and catabolism result in a serious decline in biological functions.

[Case-control study on the relationship between body mass index and lower limb alignment of patients with knee osteoarthritis].

OBJECTIVE: To investigate the relationship between body mass index and lower limb alignment of patients with knee osteoarthritis. METHODS: From July 2008 to June 2010, 78 patients who suffered from severe knee osteoarthritis were treated with total knee replacement, including 17 males and 61 females, ranging from 41 to 85 years old, with an average age of 68.1 years. The Chinese average adult body mass index (BMI) classification standard was used to classify the patients into three groups: normal group, BMI<24.0, including 3 males and 11 females, totalized 14 patients (28 knees), with the mean age of (69.5 +/- 4.7); overweight group, 24.0 < or = BMI<28.0, including 4 males and 25 females, totalized 29 patients (58 knees), with the mean age of (66.4 +/- 7.9) years; and obese group, BMI > or = 28.0, including 10 males and 25 females, totalized 35 patients(70 knees), with the mean age of (69.1 +/- 8.3) years. The limb X-ray film measuring system was used to measure the lower limb alignment at the supine and weight-bearing position. RESULTS: There were no statistical significances between the normal group and the overweight group in the knee varus angle at the supine and weight-bearing position (P>0.05). However, keen varus angle of the overweight group increased compared with the other two groups at the supine position,and the angle of the weight-bearing position increased nearly 2 degrees, but no statistical significance. There was no statistical significance between supine and weight-bearing position in the three groups of BMI, but the knee varus angle at the supine position was more than the weight -bearing position in the three groups. CONCLUSION: The knee varus angle of obese patients with osteoarthritis in the weight-bearing position increases obviously. It indicates that obesity is an important factor increasing the angle of lower limb alignment.