Editorial Commentary: Isolated Patellofemoral Osteoarthritis May Be Treated Arthroscopically: Arthroscopic Partial Lateral Facetectomy Is a Good Alternative to More Aggressive Techniques.

Isolated patellofemoral osteoarthritis is not uncommon, and treatment remains controversial. Several surgical procedures have been performed to treat this condition. The success of surgery highly depends on the technique and the patient selection. The surgeon can choose between a relatively extreme total knee replacement, with predictable results, or operations demanding less surgical dissection and resection, but offering less certainty. Partial lateral facetectomy is a minimally invasive procedure that is simple and effective enough in selected patients with up to 10 years follow-up. An even less aggressive technique, the arthroscopic partial lateral facetectomy in combination with lateral retinacular release, has been shown to be safe, practical, reproducible, and with a low rate of complications and revision surgery at mid-term follow-up. Benefits of arthroscopic techniques include decreased bleeding, less postoperative pain, ability to treat concomitant pathology, and better cosmesis.

Cellular and molecular meniscal changes in the degenerative knee: a review.

BACKGROUND: The important role of knee menisci to maintain adequate knee function is frequently impaired since early stages of knee joint degeneration. A better understanding of meniscal impairment may help the orthopaedic surgeon to orient the treatment of the degenerative knee. This review focuses on changes in meniscal cells and matrix when degeneration is in progress. MAIN BODY: Differences in the meniscal structure and metabolism have been investigated in the degenerative knee, both in experimental animal models and in surgical specimens. Cell population reduction, extracellular matrix disorganization, disturbances in collagen and non-collagen protein synthesis and/or expression have been found in menisci along with knee degeneration. These changes are considered disease-specific, different from those due to aging. CONCLUSION: Significant cellular and matrix differences are found in menisci during knee degeneration. These investigations may help to further progress in the understanding of knee degeneration and in the search of more biological treatments.

Meniscal degeneration in human knee osteoarthritis: in situ hybridization and immunohistochemistry study.

OBJECTIVE: Meniscus injury is one of the causes of secondary osteoarthritis (OA). However, the role of meniscus is still unclear. Human meniscal distribution of cells and cartilage oligomeric matrix protein (COMP) and their changes in advanced OA were analyzed. PATIENTS AND METHODS: Thirty-one medial menisci from patients with knee OA that underwent a total knee arthroplasty were studied. Normal meniscal tissue was obtained from partial arthroscopic meniscectomy. Meniscal samples were processed for histology, immunohistochemistry and in situ hybridization, for cell assessment including density, active divisions, apoptosis, COMP distribution and proteoglycan content. RESULTS: Osteoarthritic menisci demonstrated areas of cell depletion and significant decrease in COMP immunostaining. Actively dividing cells were only found in the meniscectomy group, but not in the osteoarthritic group. Proteoglycan staining was less prominent in menisci from the osteoarthritis group. CONCLUSIONS: Our results show a decreased cell population, with low COMP and altered matrix organization in osteoarthritis menisci that suggest an altered meniscal scaffold and potential impairment of meniscal function. These meniscal changes may be associated with the development of knee osteoarthritis.

An experimental study of COMP (cartilage oligomeric matrix protein) in the rabbit menisci.

INTRODUCTION: Secondary knee osteoarthritis (OA) is currently associated with meniscal injuries, but the pathogenesis is unclear. We analyzed the distribution of cells and cartilage oligomeric matrix protein (COMP) and its changes in the early stages of degeneration in meniscus. METHOD: Ten New Zealand rabbits underwent anterior cruciate ligament (ACL)-transection of the right knee-joint. Left knee-joints were used as controls. The animals were killed at 4 and 12 weeks. Gross injuries in meniscus and articular cartilage were scored. Meniscal tissues were immunostained with a specific antibody against COMP, with Ki-67, using TUNEL-assay and alcian blue stain. The number of cells was counted. RESULTS: At 4 weeks post-ACL-transection, 2/5 of the operated knees showed articular damages and medial menisci tears. Menisci showed a weak increase of cells, higher in cells under division and an increase of apoptosis, COMP and proteoglycans. At 12 weeks, 5/5 of the medial menisci and 2/5 of lateral menisci presented tears, and osteoarthritic changes were seen in the cartilage of all the operated knees. Meniscal cells reverted to normal number, while active cell division decreased below normal, apoptotic events were still high, COMP remained elevated, and glycosaminoglycans were even more elevated. CONCLUSION: Extracellular matrix changes and altered cell distribution occur early in the degenerative meniscus. There is a close relationship between changes in the articular cartilage and the menisci at the onset of secondary OA.

Multicentric myxoid liposarcoma: report of two cases.

BACKGROUND: Multicentric myxoid liposarcoma is a rather infrequent tumour that tends to behave aggressively. CASE PRESENTATION: We herein report two further cases of this tumour that have been managed in our Hospital. Both were young men with multiple sites of involvement at the moment of diagnosis and both have shown a bad prognosis with frequent recurrences after treatment and rapid death in one case. CONCLUSION: We comment on the diagnosis of this entity and on the therapeutic options available for these patients.

Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury.

The management of acute acromioclavicular joint dislocations is controversial. The purpose of this study was to compare the incidence of posttraumatic anatomic alterations after surgical or conservative treatment of type III injuries and to analyze their effect on the outcome. Forty-three patients were evaluated retrospectively, clinically and radiographically, at a 12-month minimum follow-up. Thirty-two were treated surgically, using the Phemister technique, and 11 had conservative treatment. A comparison of the overall clinical results in both groups showed no statistically significant differences. The acromioclavicular joint was anatomically reduced in only half of the surgical patients. Those shoulders treated surgically showed a significantly higher incidence of osteoarthritis and coracoclavicular ligament ossification. Differences in clavicular deformity or osteolysis were not significant. None of these abnormalities had any influence on the clinical result. Because operative and conservative treatments achieve equally good clinical results and surgery carries a higher risk of osteoarthritis, we recommend managing this injury conservatively.

Legg-perthes disease and heritable thrombophilia.

The etiology of Perthes' disease is unclear. Recent reports have suggested that inheritable thrombophilic disorders may be one of its pathogenetic causes. The G20210A prothrombin gene, factor V Leiden, and MTHFR C677T mutations have been identified as predisposing genetic factors for thrombosis. Ninety children diagnosed with Perthes' disease were studied. A family history of thrombosis and any other personal thromboembolic events were researched. PCR and endonuclease digestion were used to analyze factor V Leiden, prothrombin G20210A, and MTHFR C677T. Two hundred healthy donors were included as a control group. No patient had a family or personal history of early thrombotic events. Four children with Perthes' disease (4.4%) were heterozygous for G20210A polymorphism compared with controls (odds ratio: 2.07; 95% confidence interval: 0.40-8.46). No association between factor V Leiden and Perthes' disease was observed. Three patients (3.33%) were heterozygous for factor V Leiden (odds ratio: 1.36; 95% confidence interval: 0.32-5.84). The prevalence of different genotypes of C677T MTHFR did not show statistical differences compared with controls. Eleven patients were homozygous for this polymorphism (odds ratio: 1.02; 95% confidence interval: 0.42-2.44). This study does not support the screening of this group of polymorphism in patients with Perthes' disease.