Effect of ascending and descending medial open wedge high tibial osteotomy on patella height and functional outcomes-a retrospective study.

BACKGROUND: High tibial osteotomy (HTO) is a popular joint-preserving option for medial compartmental osteoarthritis. However, this is associated with alterations in the patellar height (PH) and tibial slope (TS). This study aims to compare the effect of ascending (AMHTO) and descending medial opening wedge HTO (DMHTO) on patella height, posterior tibial slope and functional outcomes. MATERIAL AND METHODS: A retrospective study was conducted between February 2018 and July 2021. Patients with medial compartment osteoarthritis, varus alignment, and complete pre- and postoperative lateral and full-length anteroposterior radiographs were included. Pre- and postoperative radiological measurements include the Caton-Deschamps index (CDI), the mechanical axis deviation (MAD), and the posterior tibial slope. The functional outcomes were measured using the Oxford Knee Score (OKS), Lysholm Knee Score (LKS), and Tegner Activity Scale (TAS). The osteotomy union was checked with serial X-rays every 6 weeks till a satisfactory union was achieved. RESULTS: Fifty-eight patients were included in the study. Thirty-four (58%) patients received AMHTO, and 24 (42%) received DMHTO. There was no baseline difference in the demographic variables or functional scores between the two groups. The preoperative mean MAD of - 9.65° ± 3.67° was corrected significantly to + 0.08 ± 2.80° (varus -, valgus + , P = 0.034). A significant difference in preoperative and postoperative CDI of 0.93 ± 0.45 and 0.83 ± 0.27, respectively, was noted (P = 0.023). In the AMHTO group, a statistically significant decrease in PH from preoperative 1.03 ± 0.77 to 0.84 ± 0.12 was noted (P = 0.003). There was a significant improvement in functional outcomes between baseline and 9-month follow-up in both groups. There was no significant difference between the functional outcomes of the two groups at 9-month follow-up. CONCLUSION: The study confirmed our hypothesis that descending HTO caused less alteration in the patella height compared to ascending HTO. There is no significant difference in the functional outcomes between the groups. However, in patients with PFOA, and when attempting higher degree of correction through AMHTO, the possibility of worsening of symptoms due to change in PH must be considered.

Managing Chondral Lesions: A Literature Review and Evidence-Based Clinical Guidelines.

BACKGROUND: Articular cartilage lesions are becoming increasingly common. Optimum diagnosis and management of chondral defects cause a lot of dilemma. A number of surgical methods have been reported in the literature for treating focal cartilage defects. There is a lack of consensus on the most effective management strategy, with newer surgical and cell-based treatments being advocated regularly. STUDY DESIGN AND METHODS: A clinical review is constructed by appraising the published literature about clinical evaluation and diagnostic modalities for articular cartilage defects and subsequent surgical procedures, management strategies employed for such lesions. Prominent available databases (PUBMED, EMBASE, Cochrane) were also searched for trials comparing functional outcomes following cartilage procedures. Synthesis of a practical management guideline is then attempted based on the evidence assessed. RESULTS: Systematic examination and optimal use of diagnostic imaging are an important facet of cartilage defect management. Patient and lesion factors greatly influence the outcome of cartilage procedures and must be considered while planning management. Smaller lesions < 2 cm2 respond well to all treatment modalities. Autologous osteochondral transplants (OATs) are effective in high activity individuals with intermediate lesions. For larger lesions > 4 cm2, newer generation autologous chondrocyte implantation (ACI) has shown promising and durable results. Stem cells with scaffolds may provide an alternate option. Orthobiologics are a useful adjunct to the surgical procedures, but need further evaluation. CONCLUSIONS: Most treatment modalities have their role in appropriate cases and management needs to be individualized for patients. The search for the perfect cartilage restoration procedure continues.

Electrospun PCL nanofibers blended with Wattakaka volubilis active phytochemicals for bone and cartilage tissue engineering.

In the present study, the polycaprolactone (PCL) nanofibers were investigated as a carrier to deliver phytochemicals for bone and cartilage tissue engineering. The PCL nanofibers was blended with phytochemicals hexadecanoic acid, octadecanoic acid and N,N-diisopropyl (2,2,3,3,3-pentafluoropropyl) amine isolated from a medicinal plant, Wattakaka volubilis. The scaffolds were characterized using scanning electron microscope (SEM) and Fourier transform infrared (FTIR) spectroscopy. The average diameter of control and phytochemical loaded nanofiber was 208 ±â€¯9.6 nm and 316 ±â€¯7.0 nm respectively. Biodegradation rate of nanofibers, impact of nanofiber on meniscus and osteoblast cell growth was analyzed using 3-(4,5-dimethyl thiazolyl-2)-2,5-diphenyl tetrazolium bromide (MTT) assay, DNA content and extra cellular matrix secretion. Hoechst stain and SEM images were used to visualize and monitor the cell growth on PCL scaffold. The phytochemicals incorporated PCL nanofibers enhanced the growth and proliferation of primary human meniscus and osteoblast like cells and hence may be suitable scaffold for bone and cartilage tissue engineering applications.

In vitro evaluation of phytochemical loaded electrospun gelatin nanofibers for application in bone and cartilage tissue engineering.

Wattakaka volubilis, a medicinal plant, is known to exhibit various potential health benefits and has traditionally been used in Ayurveda for various medicinal applications. In the present study, phytochemicals hexadecanoic acid, octadecanoic acid and N,N-Diisopropyl(2,2,3,3,3-pentafluoropropyl)amine isolated from W. volubilis leaf extract were co-electrospun with gelatin nanofibers for meniscus and osteoblast cell attachment and proliferation. The electrospun nanofibers were characterized using suitable techniques such as a scanning electron microscope and Fourier transform infrared spectroscopy. The mechanical property of electrospun gelatin nanofibers and phytochemicals incorporated gelatin nanofibers were tensile tested. Both the control and phytochemical loaded nanofiber exhibited a similar stress-strain trend. The average diameter of the control and phytocompound loaded gelatin nanofiber was found to be 300 ± 5.5 nm and 483 ± 12 nm, respectively. The rate of biodegradation of the control and phytochemical loaded nanofiber was analyzed in a simulated body fluid. The cell attachment and proliferation were monitored using a fluorescence microscope after appropriate staining. The cell viability, DNA content, extracellular secretion confirmed that the phytocompound loaded gelatin nanofibers were non-toxic and enhanced the meniscus and osteoblast cell growth and proliferation. This phytocompound loaded gelatin matrix may be used as a potential scaffold for cartilage and bone tissue engineering applications.

Synergistic effect of electrical conductivity and biomolecules on human meniscal cell attachment, growth, and proliferation in poly-ε-caprolactone nanocomposite scaffolds.

Poly-ε-caprolactone (PCL)-based nanocomposite scaffolds with different concentrations of carbon nanofillers (carbon nanofibers (CNFs), nanographite, and exfoliated graphite) have been studied to investigate the effect of electrical conductivity and biomolecule supplementation for enhanced human meniscal cell attachment, growth, and proliferation. The incorporation of carbon nanofillers was found to improve the mechanical and electrical properties. CNF-based nanocomposite scaffolds showed the highest electrical conductivity with significant improvements in mechanical properties (more than 50% tensile strength increase than PCL with 10% (w/w) CNF). All nanocomposite scaffolds were subjected to cytotoxicity studies using primary meniscus cells. The nanocomposite scaffolds showing higher cell viability were selected and tested for meniscal cell attachment and proliferation assays such as total deoxyribonucleic acid content, extracellular matrix secretion, nuclear staining, and cell attachment studies using a scanning electron microscope. When an optimized combination of biomolecules is supplemented in the cell culture medium, a synergistic effect of the electrical conductivity and biomolecule combination is observed, especially in the case of highly conducting CNF (7.5% and 10% (w/w))-based nanocomposite scaffolds. Our findings suggest that electrically conductive scaffolds with optimized biomolecules in cell culture medium can potentially be used for successful human meniscal tissue engineering applications.

A combination of biomolecules enhances expression of E-cadherin and peroxisome proliferator-activated receptor gene leading to increased cell proliferation in primary human meniscal cells: an in vitro study.

The present study investigates the impact of biomolecules (biotin, glucose, chondroitin sulphate, proline) as supplement, (individual and in combination) on primary human meniscus cell proliferation. Primary human meniscus cells isolated from patients undergoing meniscectomy were maintained in Dulbecco's Modified Eagle's Medium (DMEM). The isolated cells were treated with above mentioned biomolecules as individual (0-100 µg/ml) and in combinations, as a supplement to DMEM. Based on the individual biomolecule study, a unique combination of biomolecules (UCM) was finalized using one way ANOVA analysis. With the addition of UCM as supplement to DMEM, meniscal cells reached 100 % confluency within 4 days in 60 mm culture plate; whereas the cells in medium devoid of UCM, required 36 days for reaching confluency. The impact of UCM on cell viability, doubling time, histology, gene expression, biomarkers expression, extra cellular matrix synthesis, meniscus cell proliferation with respect to passages and donor's age were investigated. The gene expression studies for E-cadherin and peroxisome proliferator-activated receptor (PPAR∆) using RT-qPCR and immunohistochemical analysis for Ki67, CD34 and Vimentin confirmed that UCM has significant impact on cell proliferation. The extracellular collagen and glycosaminoglycan secretion in cells supplemented with UCM were found to increase by 31 and 37 fold respectively, when compared to control on the 4th day. The cell doubling time was reduced significantly when supplemented with UCM. The addition of UCM showed positive influence on different passages and age groups. Hence, this optimized UCM can be used as an effective supplement for meniscal tissue engineering.