Association between High HbA1c Levels and Mast Cell Phenotype in the Infrapatellar Fat Pad of Patients with Knee Osteoarthritis.

Diabetes mellitus (DM) has been suggested as a potential risk factor for knee osteoarthritis (KOA), and its underlying mechanisms remain unclear. The infrapatellar fat pad (IPFP) contributes to OA through inflammatory mediator secretion. Mast cells' (MCs) role in diabetic IPFP pathology is unclear. In 156 KOA patients, hemoglobin A1c (HbA1c) was stratified (HbA1c ≥ 6.5, n = 28; HbA1c < 6.5, n = 128). MC markers (TPSB2, CPA3) in IPFP were studied. Propensity-matched cohorts (n = 27 each) addressed demographic differences. MC-rich fraction (MC-RF) and MC-poor fraction (MC-PF) were isolated, comparing MC markers and genes elevated in diabetic skin-derived MC (PAXIP1, ARG1, HAS1, IL3RA). TPSB2 and CPA3 expression were significantly higher in HbA1c ≥ 6.5 vs. <6.5, both before and after matching. MC-RF showed higher TPSB2 and CPA3 expression than MC-PF in both groups. In the HbA1c ≥ 6.5 group, PAXIP1 and ARG1 expression were significantly higher in the MC-RF than MC-PF. However, no statistical difference in the evaluated genes was detected between the High and Normal groups in the MC-RF. Elevated TPSB2 and CPA3 levels in the IPFP of high HbA1c patients likely reflect higher numbers of MCs in the IPFP, though no difference was found in MC-specific markers on a cell-to-cell basis, as shown in the MC-RF comparison. These findings deepen our understanding of the intricate interplay between diabetes and KOA, guiding targeted therapeutic interventions.

A Modified Sliding-Lengthening Approach to Tendon Lengthening with a Locking Mechanism Suture: A Technical Note.

There are various techniques used for tendon lengthening, of which Z-lengthening and sliding-lengthening are the most frequently performed. In patients with cerebral palsy, tendon lengthening may often be necessary at multiple sites. However, they can cause various complications, such as inaccurate extension, overextension, and a lack of tendon continuity. We modified the sliding-lengthening technique with a locking mechanism to address these issues. This technical note aims to describe the surgical technique and pitfalls associated with the modified sliding-lengthening approach and suture locking mechanism. The tendon was exposed and stabilized using sterilized spitz tubes and was then threaded so that each loop length was equivalent to the amount of tendon extension. Symmetrical hemisection of both ends of the tendon was performed, and the tendon was carefully extended to create a tense loop. The modified sliding-lengthening technique with the locking suture mechanism may be an advantageous method that accurately addresses extension volume, prevents hyperextension, and maintains tendon continuity, even when smaller incisions are used.

Using allogenous structural bone graft for uncontained tibial bone defects ≥ 10 mm in depth in primary total knee arthroplasty.

BACKGROUND: In primary total knee arthroplasty (TKA), tibial bone defects ≥ 10 mm in depth often become uncontained defects, a condition most surgeons find challenging to treat. Although the allogenous bone graft is a useful method, complications such as infection and nonunion are likely to occur. There are several reports on the use of allogenous bone graft in revision TKA; however, few studies have investigated its use in primary TKA. We performed primary TKA using the allogenous bone graft as a structural bone graft to treat uncontained defects ≥ 10 mm in depth. This study aimed to assess the clinical and radiographical results after primary TKA with allogenous structural bone graft (ASBG). METHODS: Seventeen patients (mean age, 69.2 years) with a follow-up period of at least 7 years, were retrospectively reviewed. All cases had been treated for medial bone defects using the ipsilateral medial tibial allogenous bone. Clinical evaluation included the assessment of the knee and function scores and knee angle, and the hip-knee-ankle (HKA) angle, bone union, and radiolucent line (RL) were assessed radiologically. RESULTS: The mean depth of the medial tibial defects after tibia cutting was 16.8 mm. Nonunion occurred in one case, and RL occurred in another. We observed a significant difference when the preoperative knee score and HKA angle of patients was compared with that at 1 year postoperatively and the final evaluation. No major complications were observed. CONCLUSION: The ASBG technique produced favorable surgical outcomes and may be an acceptable procedure for managing uncontained tibial bone defects ≥ 10 mm in depth in primary TKA.

Femoral varus derotational osteotomy without pelvic osteotomy in nonambulatory children with cerebral palsy: Minimum 5 years follow-up.

ABSTRACT: Whether femoral varus derotational osteotomy (VDRO) alone or a combination of femoral and pelvic osteotomies should be performed for hip dislocation in nonambulatory children with cerebral palsy (CP) remains controversial. Few studies have reported radiographical results after the surgical treatment in nonambulatory children with CP. This study aimed to assess the results and determine predictors indicating progressive hip subluxation and redislocation after VDRO without pelvic osteotomy. We retrospectively analyzed 22 hips in 15 nonambulatory children with CP. All patients underwent VDRO without pelvic osteotomy and were followed up for at least 5 years. The mean follow-up period was 7.3 ±â€Š1.9 years. In radiological assessments, we investigated migration percentage (MP), center-edge angle, neck-shaft angle, teardrop distance, break in Shenton's line (SL), sharp's angle, acetabular ridge angle (ARA), and the change ratio of MP (Change MP). We classified patients with an MP of <40% at final follow-up in the Good group and those with an MP of ≥40% in the Poor group. The Good group included 10 children (14 hips), and the Poor group included 8 children (8 hips). No preoperative differences were found in the means of all the radiographical parameters. However, MP was significantly different between the groups from 1 year postoperatively. ARA showed improvement 5 years after surgery in the Good group. Change MP in the Good group was maintained from immediately after surgery to the final follow-up. Multivariate logistic regression analyses revealed that preoperative break in SL and Change MP immediately after surgery were parameters to predict MP at the final follow-up. In the receiver operating characteristic analysis, the cut-off values were estimated to be 19.2 mm for preoperative SL and 79.0% for Change MP immediately after surgery. Within 7.3 years of follow-up, 63.6% of the patients who underwent VDRO without pelvic osteotomy had good results. Preoperative SL and postoperative Change MP can be considered as predictors of postoperative subluxation and/or dislocation.

Hip Dislocation After Correction for Scoliosis in an Adolescent with Angelman Syndrome: A Case Report.

CASE: Although scoliosis is common in Angelman syndrome (AS), there are no reports of hip dislocation as a complication of scoliosis surgery. We experienced a case of hip dislocation after posterior spinal instrumentation and fusion from T4 to L5 because of scoliosis progression in an adolescent girl with AS. Postoperatively, posterior dislocation of the left hip occurred; after closed reduction, instability remained. Thus, periacetabular osteotomy was performed (left hip), with good clinical outcomes. CONCLUSION: Especially in cases of abnormal muscle tone, a loss of spinal flexibility because of extensive spinal fixation may result in secondary pathologies of the hip joint.

Bilateral Solitary Osteochondroma of the Bicipital Tuberosity Accompanied with Painful Clicking: A Case Report and Literature Review.

Although osteochondroma is a benign bone tumor often observed in daily practice, solitary osteochondroma of the bicipital tuberosity is rarely observed. Herein, we report a case of bilateral solitary osteochondroma of the bicipital tuberosity. A 76-year-old woman experienced crackling and painful clicking bilaterally in her proximal forearms during pronation-supination. X-ray imaging, computed tomography, and magnetic resonance imaging revealed that the symptom was caused by bilateral solitary osteochondroma of the bicipital tuberosity. Bone tumor resection was performed on both sides. After surgery, the symptoms improved. X-ray imaging performed 2 years after surgery revealed no tumor recurrence. When painful clicking occurs around the elbow joint, a solitary osteochondroma of the bicipital tuberosity should be suspected; this symptom should be examined, and the surgeon should consider surgery positively. Exposed subchondral bone may rub against, collide with, or impinge upon the ulna during forearm pronation-supination and induce pain.

In Vivo Evaluation of the Mechanical Strength of a Slide Lengthening Technique With a Locking Mechanism Using a Rabbit Model.

Background There are many reports of Achilles tendon lengthening procedures for equinus deformity of the ankle. We previously modified an Achilles tendon lengthening to prevent overextension with a locking mechanism suture before performing a sliding lengthening. The purpose of this study was to compare the biomechanical properties of the locking mechanism suture with sliding lengthening (L-SL) and Z-lengthening (ZL) using a rabbit model. Methods Thirty-six male Japanese white rabbits were assigned to two groups - half undergoing the L-SL technique and half undergoing the ZL technique on the flexor hallucis longus (FHL) tendon. Six rabbits in each group were sacrificed at one week, three weeks, and six weeks postoperatively and evaluated, while five rabbits underwent radiographical and biomechanical evaluation and one underwent histological evaluation. Results In extension length, L-SL was significantly lower than ZL one week postoperatively. In the L-SL group, elongation one week postoperatively was significantly lower than that three and six weeks postoperatively. In the ultimate failure load, L-SL was significantly higher than ZL one and three weeks after lengthening. In the L-SL group, the ultimate failure load one week postoperatively was significantly lower than that three and six weeks postoperatively. In the ZL group, there were significant differences at all time points. Conclusion  L-SL had higher mechanical property in vivo.