The effect of tranexamic acid in open reduction and internal fixation of pelvic and acetabular fracture: A systematic review and meta-analysis.

BACKGROUND: Pelvic bone fractures may cause extensive bleeding; however, the efficacy of tranexamic acid (TXA) usage in pelvic fracture surgery remains unclear. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of TXA in open reduction and internal fixation surgery for pelvic and acetabular fracture. METHODS: MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 22, 2020, that investigated the effect of TXA in the treatment of pelvic and acetabular fracture with open reduction and internal fixation. A pooled analysis was used to identify the differences between a TXA usage group and a control group in terms of estimated blood loss (EBL), transfusion rates, and postoperative complications. RESULTS: We included 6 studies involving 764 patients, comprising 293 patients who received TXA (TXA group) and 471 patients who did not (control group). The pooled analysis showed no differences in EBL between the groups (mean difference -64.67, 95% confidence interval [CI] -185.27 to -55.93, P = .29). The study period transfusion rate showed no significant difference between the groups (odds ratio [OR] 0.77, 95% CI 0.19-3.14, P = .71, I2 = 82%), nor in venous thromboembolism incidence (OR 1.53, 95% CI 0.44-5.25, P = .50, I2 = 0%) or postoperative infection rates (OR 1.15, 95% CI 0.13-9.98, P = .90, I2 = 48%). CONCLUSIONS: Despite several studies having recommended TXA administration in orthopedic surgery, our study did not find TXA usage to be more effective than not using TXA in pelvic and acetabular fracture surgery, especially in terms of EBL reduction, transfusion rates, and the risk of postoperative complications.

Allogenic Pure Platelet-Rich Plasma Therapy for Adhesive Capsulitis: A Bed-to-Bench Study With Propensity Score Matching Using a Corticosteroid Control Group.

BACKGROUND: While platelet-rich plasma (PRP) has been widely studied for musculoskeletal disorders, few studies to date have reported its use for adhesive capsulitis (AC). Fully characterized and standardized allogenic PRP may provide clues to solve the underlying mechanism of PRP with respect to synovial inflammation and thus may clarify its clinical indications. PURPOSE: To clinically evaluate the safety and efficacy of a fully characterized pure PRP injection in patients with AC and to assess the effects of pure PRP on synoviocytes with or without inflammation in vitro. STUDY DESIGN: Controlled laboratory study and cohort study; Level of evidence, 3. METHODS: For the clinical analysis, a total of 15 patients with AC received an ultrasonography-guided intra-articular PRP injection and were observed for 6 months. Pain, range of motion (ROM), muscle strength, shoulder function, and overall satisfaction in the patients were evaluated using questionnaires at 1 week as well as at 1, 3, and 6 months after the PRP injection and results were compared with the results of a propensity score-matched control group that received a corticosteroid injection (40 mg triamcinolone acetonide). For the in vitro analysis, synoviocytes were cultured with or without interleukin-1ß (IL-1ß) and PRP. The gene expression of proinflammatory and anti-inflammatory cytokines as well as matrix enzymes and their inhibitors was evaluated. RESULTS: At 6-month follow-up, pure PRP significantly decreased pain and improved ROM, muscle strength, and shoulder function to levels comparable with those after a corticosteroid injection. All pain values, strength measurements, and functional scores significantly improved up to 6 months in the PRP group, but these measures improved up to 3 months and then were decreased at 6 months in the corticosteroid group. ROM was significantly improved in the 2 groups at 6 months compared with baseline. Allogenic PRP did not cause adverse events. For the in vitro findings, PRP induced inflammation but significantly improved the IL 1ß-induced synovial inflammatory condition by decreasing proinflammatory cytokines such as IL-1ß, tumor necrosis factor-α, IL-6, cyclooxygenase-2, and microsomal prostaglandin E synthase-1 and decreased matrix enzymes (matrix metalloproteinase-1, -3, and -13 as well as a disintegrin and metalloproteinase with thrombospondin motifs-4 and -5) and further increasing anti-inflammatory cytokines such as vasoactive intestinal peptide. CONCLUSION: This study showed that PRP decreased pain and improved shoulder ROM and function to an extent comparable with that of a corticosteroid in patients with AC. Allogenic pure PRP acted in a pleiotropic manner and decreased proinflammatory cytokines only in the inflammatory condition. CLINICAL RELEVANCE: Allogenic PRP could be a treatment option for the inflammatory stage of AC.

Culture-Expanded Autologous Adipose-Derived Mesenchymal Stem Cell Treatment for Osteonecrosis of the Femoral Head.

BACKGROUD: Outcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH. METHODS: Eighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint. RESULTS: Preoperatively, the necrotic lesion extent was 63.0% (38.4%-96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI. However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2). CONCLUSIONS: Our outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.

Effects of corticosteroids and platelet-rich plasma on synoviocytes in IL-1ß-induced inflammatory condition.

AIMS: Corticosteroid injections are used to treat shoulder pain. Platelet-rich plasma (PRP) is known to have anti-inflammatory and anabolic effects, as well as cytoprotective effects against corticosteroids. Thus, this study was to investigate the effects of co-treatment of corticosteroid and PRP on anti-inflammatory and matrix homeostasis of synoviocytes in IL-1ß-induced inflammatory conditions. MATERIALS AND METHODS: Synoviocytes were cultured with 1 ng/mL IL-1ß, 1 µM dexamethasone, and 10% (vol/vol) Platelet-poor plasma (PPP), PRP200, PRP1000, and PRP4000 X 103/µL. Gene expressions of pro-inflammatory and anti-inflammatory cytokines, degradative enzymes, and their inhibitors were evaluated and protein synthesis of degradative enzymes and their inhibitors were also examined. RESULTS: Corticosteroid modulated anti-inflammatory and pro-inflammatory cytokines, and subsequent PRP treatment did not interfere with the effect of a corticosteroid and modulated the gene expressions of cytokines such as TNF-α and IL-4, which were not regulated by the corticosteroid alone. Gene expressions and protein expressions of degradative enzymes and their inhibitors were suppressed by corticosteroid. Additional PRPs did not alter the gene expression and protein regulated by the corticosteroid and inhibited the gene expression of ADAMTS-5 and protein synthesis of MMP-9 and ADAMTS-5, which were not modulated by the corticosteroid alone. CONCLUSION: Corticosteroid regulated the inflammation and synovial homeostasis. When PRP and the corticosteroid were used together, it exhibited synergistic effects on synoviocytes by regulating the parts that were not controlled by corticosteroid alone while not interfering with the effects of the corticosteroid in an inflammatory condition.

Two-stage total hip arthroplasty following skeletal traction after extensive soft tissue release for severe limb-length discrepancy.

INTRODUCTION: To maximise limb-length discrepancy (LLD) resolution during total hip arthroplasty (THA) for untreated developmental hip dysplasia or septic hip sequelae, THA following limb lengthening was introduced using different methods. We aimed to evaluate 2-stage THA results following limb lengthening via skeletal traction after extensive soft tissue release. METHOD: In total, 24 hips with severe LLD in 10 men and 14 women (mean age, 49.6 ± 15.2 years) underwent 2-stage THA and were followed thereafter (mean 6.3 ± 3.7 years). The entire abductor muscle origin was subperiosteally released from the ilium, and the soft tissue around the hip joint, including the psoas tendon, short external rotator, joint capsule, and adductor tendon, was extensively released. 2-stage THA was performed after 2-week skeletal traction using proximal tibial pins. During the final THA, 7 hips necessitated subtrochanteric shortening osteotomy (STO) for hip joint reduction. We evaluated the clinical and radiological results and especially focused on LLD and neurological complications. RESULTS: The Harris Hip Score improved from 57.1 ± 9.6 to 88.3 ± 6.3 points. No patients showed worse abductor power. LLD improved from 5.0 ± 2.0 to 1.4 ± 1.0 cm. No permanent neurological complications occurred except for 1 transient peroneal nerve palsy during traction, which resolved fully after cessation of traction. There were 2 hips with STO nonunion treated with osteosynthesis and stem revision. CONCLUSION: 2-stage THA following skeletal traction after extensive soft tissue release showed favourable results in terms of neurologic complication prevention and LLD resolution. However, a large proportion of patients still necessitated shortening osteotomy with a risk for nonunion at the osteotomy site. Though surgical procedures might be complicated and necessitate longer hospital stays, 2-stage THA with extensive soft tissue release might be an alternative treatment option for patients with severe LLD willing to resolve their limb length discrepancy.

Outcome of Ceramic-on-Ceramic Total Hip Arthroplasty with 4th Generation 36 mm Head Compared to that with 3rd Generation 28 mm Head by Propensity Score Matching.

BACKGROUND: With the development of 4th generation ceramic bearing, the large ceramic head is available for ceramic-on-ceramic total hip arthroplasty (THA). This retrospective study aimed to compare the outcomes of ceramic-on-ceramic THA with 4th generation 36 mm head to those with 3rd generation 28 mm head using propensity score matching. METHODS: We retrospectively reviewed the results of 133 ceramic-on-ceramic THAs with 4th generation 36 mm ceramic head in 129 patients and 133 ceramic-on-ceramic THAs identified from 405 ceramic-on-ceramic THAs with 3rd generation 28 mm head by propensity score matching. There were 83 males and 50 females in both groups with a mean age of 55 years. There was no significant difference in other demographic features except for follow-up period (4.2 years in the 36 mm group and 6.4 years in the 28 mm group, p < 0.001). Clinical and radiological results and occurrence of complication were compared between the two groups. RESULTS: Harris Hip Score was increased significantly from 46.4 to 92.1 in the 36 mm group and from 46.7 to 93.6 in the 28 mm group. No loosening or osteolysis was observed in the 36 mm group. However, one hip showed radiologic sign of loosening in the 28 mm group. As for complication, postoperative dislocation was more frequent in the 28 mm group (6 in the 28 mm group vs. 0 in the 36 mm group, p = 0.03). Otherwise, there was no significant difference in other results including inguinal pain, squeaking or ceramic fracture. CONCLUSION: Ceramic-on-ceramic THA with 4th generation 36 mm head significantly reduced postoperative dislocation rate without increasing the rate of inguinal pain, squeaking, or ceramic fracture compared to that with 3rd generation 28 mm head.

Allogeneic Platelet-Rich Plasma Versus Corticosteroid Injection for the Treatment of Rotator Cuff Disease: A Randomized Controlled Trial.

BACKGROUND: The use of platelet-rich plasma (PRP) for the treatment of rotator cuff disease is still controversial. The purpose of the present study was to investigate the safety and efficacy of a fully characterized allogeneic pure PRP injection into the subacromial space of patients with rotator cuff disease in comparison with corticosteroid injection. METHODS: A 2-group, parallel, assessor-blinded, randomized controlled trial was conducted. A total of 60 patients with clinically and structurally diagnosed rotator cuff disease were randomly assigned to receive a subacromial injection of either 4 mL of allogeneic pure PRP or a 4-mL mixture of 1 mL of 40-mg/mL triamcinolone acetonide and 3 mL of 2% lidocaine under ultrasonographic guidance. The primary outcomes were safety and the Constant score at 1 month. The secondary outcomes were pain, range of motion, muscle strength, functional scores, and overall satisfaction and function. RESULTS: There were no treatment-related adverse events. The Constant score at 1 month did not significantly differ between the PRP and corticosteroid groups. At 6 months, the DASH (Disabilities of the Arm, Shoulder and Hand) score, overall function, and external rotation were significantly better in the PRP group than in the corticosteroid group, and the other clinical outcomes did not show significant differences. All pain measurements, the strength of the supraspinatus and infraspinatus, and 5 functional scores also improved slowly and steadily after injection, becoming significantly better at 6 months compared with those before the injection, whereas those in the corticosteroid group responded promptly but did not further improve. CONCLUSIONS: Allogeneic PRP injections for the treatment of rotator cuff disease are safe but are not definitely superior to corticosteroid injections with respect to pain relief and functional improvement during 6 months. The DASH score, overall function, and external rotation were significantly better in the PRP group than in the steroid group at 6 months. Generally, PRP slowly but steadily reduced pain and improved function of the shoulder until 6 months, whereas corticosteroid did not. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Identification and Biotechnical Potential of a Gcn5-Related N-Acetyltransferase Gene in Enhancing Microalgal Biomass and Starch Production.

Microalgae are promising feedstocks for starch production, which are precursors for bioenergy and chemicals manufacturing. Though starch biosynthesis has been intensively studied in the green alga Chlamydomonas reinhardtii, regulatory mechanisms governing starch metabolism in this model species have remained largely unknown to date. We proposed that altering triacylglycerol (TAG) biosynthesis may trigger intrinsic regulatory pathways governing starch metabolism. In accordance with the hypothesis, it was observed in this study that overexpression of the plastidial lysophosphatidic acid acyltransferase gene (i.e. LPAAT1) in C. reinhardtii significantly enhanced TAG biosynthesis under nitrogen (N)-replete conditions, whereas the starch biosynthesis was enhanced in turn under N depletion. By the exploitation of transcriptomics analysis, a putative regulatory gene coding Gcn5-related N-acetyltransferase (GNAT19) was identified, which was up-regulated by 11-12 times in the CrLPAAT1 OE lines. Overexpression of the cloned full-length CrGNAT19 cDNA led to significant increase in the starch content of C. reinhardtii cells grown under both N-replete and N-depleted conditions, which was up to 4 times and 26.7% higher than that of the empty vector control, respectively. Moreover, the biomass yield of the CrGNAT19 OE lines reached 1.5 g L-1 after 2 days under N-depleted conditions, 72% higher than that of the empty vector control (0.87 g L-1). Overall, the yield of starch increased by 118.5% in CrGNAT19 OE lines compared to that of the control. This study revealed the great biotechnical potentials of an unprecedented GNAT19 gene in enhancing microalgal starch and biomass production.

Unique Form of Atypical Subtrochanteric Femoral Fracture at the Medial Cortex: A Report of 3 Cases.

CASE: Three women with unique subtrochanteric femoral fracture occurring at the medial cortex of the femur are presented. One patient had been on drug holiday for the past 2 years after 3 years of risedronate use; the other patients had been taking alendronate for osteoporosis for 4 years and 20 years without drug holiday. CONCLUSION: The fractures met all major criteria for the revised case definition of atypical femoral fracture (AFF) provided by the American Society of Bone and Mineral Research task force except for the location. Hence, we report 3 cases of AFFs developing in the subtrochanteric medial femoral cortex.

The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study.

BACKGROUNDS: One of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head. METHODS: A total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient's contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio). RESULTS: Twenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3, 75.0, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85-1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28-0.38). In contrast, the ratio was 1.30 (95% CI: 1.03-1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio (P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-to-acetabulum uptake ratio between the two groups (P <  0.001). CONCLUSIONS: SPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.

Intratendinous Injection of Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A 2-Year Follow-Up Study.

PURPOSE: To assess the mid-term safety and efficacy of an intratendinous injection of autologous adipose tissue-derived mesenchymal stem cells (AD MSCs) for rotator cuff disease at 2-year follow-up. METHODS: The first part of the study consisted of 3 dose-escalation groups, with 3 patients each, for the evaluation of safety: low-dose (1.0 × 107 cells), mid-dose (5.0 × 107), and high-dose (1.0 × 108) groups. For the second part, we planned to include 9 patients receiving the high dose for the evaluation of exploratory efficacy. Clinical outcomes were assessed according to pain, range of motion, muscle strength, functional scores, overall satisfaction and function, and presence of failure. Structural outcomes included changes in volume of tendon defects measured using magnetic resonance imaging. RESULTS: This study enrolled 19 patients (9 for the first part and 10 for the second part) with partial-thickness rotator cuff tears. There were no treatment-related adverse events at minimum 2-year follow-up. Intratendinous injection of AD MSCs reduced shoulder pain by approximately 90% at 1 and 2 years in the mid- and high-dose groups. The strength of the supraspinatus, infraspinatus, and teres minor significantly increased by greater than 50% at 2 years in the high-dose group. Shoulder function measured with 6 commonly used scores improved for up to 2 years in all dose groups. Structural outcomes evaluated with magnetic resonance imaging showed that the volume of bursal-sided defects in the high-dose group nearly disappeared at 1 year and did not recur at up to 2 years. No failures-defined as the performance of any kind of shoulder surgery or return of the Shoulder Pain and Disability Index score to the preinjection level-occurred during follow-up. CONCLUSIONS: This study showed continued safety and efficacy of an intratendinous injection of AD MSCs for the treatment of partial-thickness rotator cuff tears over a 2-year period through regeneration of tendon defects. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Postoperative delirium after hip surgery is a potential risk factor for incident dementia: A systematic review and meta-analysis of prospective studies.

BACKGROUND: Although a few trials have explored the relationship between postoperative delirium (POD) and incident dementia in patients with hip surgery, the numbers of participants in each study are relatively small. Thus, we performed a meta-analysis to examine whether POD after hip surgery is a risk factor for incident dementia. METHODS: Six prospective cohort studies investigating the development of incident dementia in patients with POD after hip surgery were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- and random- effect models. RESULTS: POD significantly increased the risk of incident dementia and cognitive decline (overall odds ratio [ORs] = 8.957; 95 % confidence interval [CI], 5.444-14.737; P <  0.001 in fixed-effects model; overall ORs = 8.962; 95 % CI, 5.344-15.029; P <  0.001 in random-effects model). A publication bias was not evident in this study. CONCLUSIONS: Our meta-analysis revealed that POD after hip surgery is a risk factor for incident dementia. Early identification of cognitive function should be needed after surgery and appropriate prevention and treatment for dementia will be required, especially in cases with POD.

Incidence of a stem sitting proud of a proximally coated cementless tapered wedge stem.

BACKGROUND/OBJECTIVE: A stem sitting proud (SP) or that above the final rasp position remains in some patients who undergo hip replacement using proximally coated tapered wedge stems. Surgeons may face challenges providing the best fit because of unpredictable SP of proximally coated tapered wedge stems. Zimmer Inc. introduced a new rasp to solve this issue but the clinical results of this rasp have not yet been published. Therefore, our aim was to address the following: (1) What is the stem SP incidence using a proximally coated cementless tapered wedge stem? (2) Does the new rasp system (0-mm rasp) improve seating height? and (3) What are the risk factors of stem SP? METHODS: We performed a retrospective study with 338 hips, in which Tri-Lock Bone Preservation Stem (BPS) was used in 181 hips and M/L Taper stem was used in 157 hips (82 hips before and 75 hips after 0-mm rasp use). A positive stem SP was defined as a stem proud height of >2 mm. We analysed and compared SP incidence in two stems and M/L Taper stems before and after the 0-mm rasp use. RESULTS: An incidence of stem SP was 13% in the Tri-Lock BPS and 15% in the M/L Taper stem before the 0-mm rasp use. Stem SP incidence in the M/L Taper stem substantially decreased after the 0-mm rasp use (4%). The significant risk factor for stem SP was use of the high offset option in Tri-Lock BPS. CONCLUSION: The proximally coated tapered wedge stems present potential problems related to stem SP. The new rasp of the M/L Taper stem showed significant improvement in initial seating height. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: This study was conducted to understand "stem sitting proud" in proximally coated tapered wedge stem as one of the most popular designs nowadays in adult hip joint arthroplasty field. In this study, we aimed to address the incidence of stem proud, investigated the risk factor and introduced the effect of new rasp system which improve stem seating height.

Characterization of Tendon-Specific Markers in Various Human Tissues, Tenocytes and Mesenchymal Stem Cells.

Background: Unlike bone, cartilage, or muscle, tendon-specific markers are not well established. The purpose of the study was to investigate expression pattern and level of 6 well-known tendon-specific markers, in various human musculoskeletal tissues, tenocytes, and mesenchymal stem cells (MSCs). Methods: Musculoskeletal tissue samples of tendon, bone, cartilage, nerve, muscle, and fat were obtained from patients undergoing orthopedic surgery. Tenocytes, MSCs from bone marrow, adipose tissue, and umbilical cord were isolated from each tissue and cultured. Six tendon-specific markers, scleraxis (Scx), tenomodulin (TNMD), thrombospondin-4 (TSP-4), tenascin-C (TNC), type I collagen (Col I), and type III collagen (Col III) were investigated in tendon tissue, tenocytes, and MSCs. Results: mRNA levels of 6 tendon-specific markers were significantly higher in tendon tissue that in other connective tissues levels of Scx, TNMD, TSP-4, and Col III immediately decreased after plating tenocytes in culture dishes whereas those of TNC and Col I did not. In comparison with tendon tissue, mRNA levels pattern of Scx, TNMD, and TSP-4 in tenocytes were significantly higher than that in MSCs, but lower than in tendon tissue whereas expression pattern of TNC, Col I and III showed different pattern with each other. Conclusion: This study demonstrated that 6 commonly used tendon-specific markers were mainly expressed in tendon tissue, but that expression level and pattern of the tendon-specific markers with respect to kinds of tissues, culture duration of tenocytes and sources of MSCs.

Favorable Functional Recovery and Stem Stability after Hip Arthroplasty with a Short Metaphyseal Stem in Elderly Patients with Osteoporotic Femoral Neck Fractures.

PURPOSE: Short stems have recently become widely used; however, concerns about the initial secure fixation of a short stem in osteoporotic bone remain. The aim of this study was to evaluate the short-term clinical and radiological results of using a short cementless metaphyseal stabilizing tapered stem for senile osteoporotic femoral neck fractures. MATERIALS AND METHODS: Thirty-eight arthroplasties (31 bipolar hemiarthroplasties and 7 total hip arthroplasties) were performed for osteoporotic femoral neck fractures in patients older than 65 years (10 males and 28 females). The mean age was 76.1 years and the mean follow-up was 2.9 years. We retrospectively evaluated clinical results, focusing on walking performance, thigh pain, and radiologic results, with special regard to signs of stem stability and osteointegration. RESULTS: Mean Harris hip score was 84.3 points and 68.4% of patients regained their preoperative walking performance. No patients complained about thigh pain. No osteolysis or loosening was observed during the follow-up, and all but 1 stem showed signs of stable bone ingrowth. CONCLUSION: Short, metaphyseal stabilizing tapered stems could be a reliable treatment option for osteoporotic femoral neck fractures.

Allogenic Pure Platelet-Rich Plasma Therapy for Rotator Cuff Disease: A Bench and Bed Study.

BACKGROUND: Although platelet-rich plasma (PRP) is a popular option for rotator cuff disease, the underlying mechanism of PRP and its clinical indications are unclear. Further, some kinds of PRP might be detrimental to patients. Allogenic PRP prepared through a standardized process and fully characterized could eliminate variations in PRP as well as uncertainties regarding its use in each patient, which could provide clues about its mechanism of action and indications for its use. PURPOSE: To assess the effects of pure PRP on tenocytes with or without inflammation in an in vitro study and to evaluate the safety and efficacy of a fully characterized pure PRP injection in patients with rotator cuff disease in a clinical study. STUDY DESIGN: Controlled laboratory study and cohort study; Level of evidence, 3. METHODS: For the in vitro study, tenocytes were enzymatically isolated and cultured from patients with rotator cuff tear and treated with or without interleukin 1ß (IL-1ß) and PRP. Gene expression and protein synthesis of pro- and anti-inflammatory cytokines, enzymes and their inhibitors, matrix synthesis, and cell viability were evaluated. For the clinical study, a total of 17 patients with rotator cuff disease received ultrasonography-guided subacromial PRP injection and were followed for 6 months. Pain, range of motion, muscle strength, shoulder function, and overall satisfaction in patients were compared with the results in a propensity score-matched control group who received corticosteroid (triamcinolone acetonide 40 mg). RESULTS: PRP induced inflammation in the absence of inflammation and ameliorated inflammation in IL-1ß-induced tendinopathic conditions by regulation of cytokines such as IL-1ß, cyclooxygenase 2, microsomal prostaglandin E synthase 1, vasoactive intestinal peptide, and downstream matrix metalloproteinases. No general or local adverse events were noted with regard to allogenic PRP injection. Whereas steroid injection showed earlier improvement in some kinds of pain and functional scores, PRP generally showed comparable effects with steroid injection in all clinical outcomes at 6 months. CONCLUSION: This study showed that allogenic pure PRP had pleiotropic effects on tenocytes depending on inflammation and that it did not cause adverse events but rather decreased pain and improved shoulder function to a degree comparable with steroid injection in patients with rotator cuff disease. CLINICAL RELEVANCE: Allogenic PRP could be a treatment option for rotator cuff disease.

Intratendinous Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A First-In-Human Trial.

Despite relatively good results of current symptomatic treatments for rotator cuff disease, there has been an unmet need for fundamental treatments to halt or reverse the progress of disease. The purpose of this study was to assess the safety and efficacy of intratendinous injection of autologous adipose tissue-derived mesenchymal stem cells (AD MSCs) in patients with rotator cuff disease. The first part of the study consists of three dose-escalation cohorts; the low- (1.0 × 107 cells), mid- (5.0 × 107 ), and high-dose (1.0 × 108 ) groups with three patients each for the evaluation of the safety and tolerability. The second part included nine patients receiving the high-dose for the evaluation of the exploratory efficacy. The primary outcomes were the safety and the shoulder pain and disability index (SPADI). Secondary outcomes included clinical, radiological, and arthroscopic evaluations. Twenty patients were enrolled in the study, and two patients were excluded. Intratendinous injection of AD MSCs was not associated with adverse events. It significantly decreased the SPADI scores by 80% and 77% in the mid- and high-dose groups, respectively. Shoulder pain was significantly alleviated by 71% in the high-dose group. Magnetic resonance imaging examination showed that volume of the bursal-side defect significantly decreased by 90% in the high-dose group. Arthroscopic examination demonstrated that volume of the articular- and bursal-side defects decreased by 83% and 90% in the mid- and high-dose groups, respectively. Intratendinous injection of autologous AD MSCs in patient with a partial-thickness rotator cuff tear did not cause adverse events, but improved shoulder function, and relieved pain through regeneration of rotator cuff tendon. Stem Cells 2018;36:1441-1450.

Comparative Analysis of Platelet-rich Plasma Effect on Tenocytes from Normal Human Rotator Cuff Tendon and Human Rotator Cuff Tendon with Degenerative Tears.

BACKGROUND: Platelet-rich plasma (PRP) stimulates cell proliferation and enhances matrix gene expression and synthesis. However, there have been no comparative study of the PRP effect on the normal and degenerative tenocytes. The purpose of this study was to compare the effect of PRP on tenocytes from normal and degenerative tendon. METHODS: Tendon tissues were obtained from patients undergoing arthroscopic repair (n=9) and from healthy donors (n=3). Tenocytes were cultured with 10% (vol/vol) platelet-poor plasma, PRP activated with calcium, and PRP activated with calcium and thrombin. The total cell number was assessed at days 7 and 14. The expressions of type I and III collagen, decorin, tenascin-C, and scleraxis were evaluated by quantitative real-time reverse transcriptase polymerase chain reaction. The total collagen and glycosaminoglycan (GAG) synthesis was evaluated at days 7 and 14. RESULTS: No differences were observed between the groups at day 7, but cell proliferation was remarkably increased in tenocytes from the degenerative tendon at day 14. In both tenocyte groups, the gene expressions of type I and III collagen were up-regulated. GAG synthesis was greater in the normal tendon, whereas the expressions of decorin and tenascin-C were increased in tenocytes from the degenerative tendon. Tenocytes from the degenerative tendon had higher fold-change of GAG synthesis and a lower collagen III/I ratio than normal tenocytes. CONCLUSIONS: PRP promoted the cell proliferation and enhanced the synthesis of tendon matrix in both groups. PRP has a greater positive effect on cell proliferation, matrix gene expression and synthesis in tenocytes from degenerative tendon.

Arthroscopic treatment of psoas abscess concurrent with septic arthritis of the hip joint.

PURPOSE: To describe the outcomes of 7 cases of psoas abscess concurrent with septic arthritis of the hip treated by hip arthroscopy alone. METHODS: We retrospectively collected the data of patients who underwent arthroscopic drainage of psoas abscess concurrent with septic arthritis of the hip. Arthroscopic debridement was performed in both the central and peripheral hip joint compartments. In all cases, the iliopsoas compartment was accessed from the peripheral compartment through an anterior capsulotomy without limb traction. After debridement and drainage of the iliopsoas compartment, a suction drain tube was placed in the iliopsoas compartment through an enlarged anterior capsulotomy and another tube in the peripheral compartment. Postoperative intravenous antibiotics were administered on the basis of culture results; in cases with no positive culture, empirical antibiotics were administered for 4 to 6 weeks after surgery. RESULTS: 7 patients underwent arthroscopic debridement and drainage for a psoas abscess concurrent with hip joint septic arthritis. Laboratory tests were normalized within 4 weeks after hip arthroscopy in all patients. At a median follow-up of 16 months (range, 13-30 months) after surgery, infection recurrence was absent in all patients. CONCLUSIONS: Arthroscopic debridement alone could be an effective treatment alternative to open surgery for psoas abscess concurrent with hip joint septic arthritis.

Clinical Outcomes of an Initial 3-month Trial of Conservative Treatment for Femoroacetabular Impingement.

BACKGROUND: Femoroacetabular impingement (FAI) can be managed either conservatively or by a surgical correction of the deformity causing impingement. However, there is insufficient evidence to justify an immediate surgical treatment in all symptomatic patients, and the role of a nonoperative treatment is unclear. This study evaluates the role of conservative treatment for FAI. MATERIALS AND METHODS: 87 patients (102 hips) diagnosed as FAI between January 2011 and May 2012 were included in this retrospective study. All patients underwent an initial 3-month conservative treatment followed by arthroscopic hip surgery if symptoms did not improve. Clinical outcome scores (modified Harris Hip Score, nonarthritic hip score, and Western Ontario and McMaster Universities Arthritis Index) were evaluated at baseline and at the end of followup, and scores were compared between the nonsurgical and surgical groups. RESULTS: The final analysis included 83 patients (55 men, 28 women; 97 hips) because four patients were lost to followup. The average age was 45.1 years and 14 patients had bilateral symptomatic FAI. After an initial conservative treatment averaging 27.5 months (range 24-36 months), 53 hips (54.6%) could perform normal daily activities. The nonsurgical group had significant improvements in all clinical scores at the end of followup (P < 0.001). Forty four hips (45.4%) were unresponsive to conservative treatment and underwent arthroscopic hip surgery with subsequent significant improvements in clinical scores (P < 0.001). At the end of followup, there were no significant differences in clinical scores between the two groups. CONCLUSION: An initial trial of conservative treatment of sufficient length should be considered for FAI patients before surgical intervention.