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1.
Medicine (Baltimore) ; 99(35): e21437, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871866

RESUMO

RATIONALE: Osteochondritis dissecans (OCD) lesions involve disruption of the osteochondral unit along articular surfaces, with significant potential for joint deterioration if not managed appropriately. PATIENT CONCERNS: A 15-year-old male presented with persistent and insidious right knee pain, which had worsened following a collision with another player during a basketball game, resulting in episodes of locking. DIAGNOSES: Magnetic resonance imaging revealed a lateral trochlear OCD extending into the anterior lateral femoral condyle. INTERVENTIONS: Chondral fraying was observed along the margins of the OCD. Retrograde drilling ensued with use of a 0.045-inch Kirschner wire throughout the lesion to a depth that would allow for penetration of healthy underlying subchondral bone to create an influx of healing factors. Three resorbable pegs were arthroscopically placed through an accessory portal overlying the lesion to stabilize the fracture and compress the gapped cartilage mantle to reduce flow of synovial fluid behind the lesion. Bipolar radiofrequency coblation was used to stabilize the chondral fraying and seal the gap along the periphery of the lesion. OUTCOMES: The patient was put on a nonweight bearing protocol for 6 weeks, after which crutches and brace were discontinued, but therapy persisted. Repeat imaging at 3 months demonstrated excellent interval healing. The patient was released to slowly engage impact activities. Although he returned at approximately 8 months postoperatively with a contralateral anterior cruciate ligament tear, he reported the operative knee with the OCD was doing extremely well. LESSONS: Radiofrequency coblation appears to be a viable strategy as an adjunct to management for OCD in children.


Assuntos
Articulação do Joelho/patologia , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/terapia , Dor/etiologia , Terapia por Radiofrequência/métodos , Adolescente , Assistência ao Convalescente , Artroscopia/métodos , Cartilagem Articular/patologia , Terapia Combinada , Humanos , Traumatismos do Joelho/complicações , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Resultado do Tratamento
3.
Nat Commun ; 11(1): 3427, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32647171

RESUMO

The contribution of inflammation to the chronic joint disease osteoarthritis (OA) is unclear, and this lack of clarity is detrimental to efforts to identify therapeutic targets. Here we show that chondrocytes under inflammatory conditions undergo a metabolic shift that is regulated by NF-κB activation, leading to reprogramming of cell metabolism towards glycolysis and lactate dehydrogenase A (LDHA). Inflammation and metabolism can reciprocally modulate each other to regulate cartilage degradation. LDHA binds to NADH and promotes reactive oxygen species (ROS) to induce catabolic changes through stabilization of IκB-ζ, a critical pro-inflammatory mediator in chondrocytes. IκB-ζ is regulated bi-modally at the stages of transcription and protein degradation. Overall, this work highlights the function of NF-κB activity in the OA joint as well as a ROS promoting function for LDHA and identifies LDHA as a potential therapeutic target for OA treatment.


Assuntos
Condrócitos/metabolismo , Lactato Desidrogenase 5/metabolismo , Terapia de Alvo Molecular , Osteoartrite/tratamento farmacológico , Espécies Reativas de Oxigênio/metabolismo , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Aerobiose , Animais , Cartilagem Articular/patologia , Células Cultivadas , Condrócitos/efeitos dos fármacos , Condrócitos/patologia , Citoproteção/efeitos dos fármacos , Deleção de Genes , Regulação da Expressão Gênica/efeitos dos fármacos , Glicólise/efeitos dos fármacos , Humanos , Inflamação/metabolismo , Inflamação/patologia , Interleucina-1beta/farmacologia , Articulação do Joelho/patologia , Meniscos Tibiais/cirurgia , Redes e Vias Metabólicas/efeitos dos fármacos , Camundongos Endogâmicos C57BL , NAD/metabolismo , NF-kappa B/metabolismo , Osteoartrite/genética , Osteoartrite/patologia
4.
Orthopade ; 49(7): 617-624, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32494904

RESUMO

BACKGROUND: Despite the growing clinical evidence "pro" kinematic alignment (KA) in primary total knee arthroplasty, the idea of this individualized implant positioning has not (yet) become established throughout the community. Many surgeons have concerns about the safety of the method and the universality of its application. Interestingly, comparative studies with unlimited indications for KA showed only little or no advantage over standard mechanical alignment in contrast to studies with strict indications showing a significant benefit. QUESTION AND METHODOLOGY: This results in a discussion about possible indication limits for KA. The aim of this article is to summarize the current evidence and theoretical considerations regarding ideal and possibly non-ideal patients. Furthermore, the paper describes the "lessons learned" of the past years as a recommendation for safe use of the method. RESULTS AND DISCUSSION: Based on current evidence, primary varus osteoarthritis appears to be a good indication for KA. A limitation, however, is extra-articular deformities that lead to a pathologically joint line angle. Instabilities of the collateral ligaments are to be considered as a contraindication. In contrast to varus type osteoarthritis, valgus deformities appear to be more critical for KA. Even though there is yet only limited evidence, especially the accompanying extra-articular pathologies of the hip and ankle pose an increased risk of failure. In our opinion, a restricted KA with an individualized component position but neutral overall limb alignment makes sense here. To analyze the suitability of KA and estimate the post-operative component position, weight-bearing long-leg x­rays are recommended. Additional stress radiography is helpful in certain cases, as is the three-dimensional analysis of the anatomy by CT or MRI scans.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Articulação do Tornozelo/patologia , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/patologia , Osteoartrite do Joelho/fisiopatologia , Suporte de Carga
5.
Am J Pathol ; 190(9): 1909-1920, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32533926

RESUMO

Perivascular mural cells surround capillaries and microvessels and have diverse regenerative or fibrotic functions after tissue injury. Subsynovial fibrosis is a well-known pathologic feature of osteoarthritis, yet transgenic animals for use in visualizing perivascular cell contribution to fibrosis during arthritic changes have not been developed. Here, inducible Pdgfra-CreERT2 reporter mice were subjected to joint-destabilization surgery to induce arthritic changes, and cell lineage was traced over an 8-week period with a focus on the joint-associated fat pad. Results showed that, at baseline, inducible Pdgfra reporter activity highlighted adventitial and, to a lesser extent, pericytic cells within the infrapatellar fat pad. Joint-destabilization surgery was associated with marked fibrosis of the infrapatellar fat pad, accompanied by an expansion of perivascular Pdgfra-expressing cellular descendants, many of which adopted α-smooth muscle actin expression. Gene expression analysis of microdissected infrapatellar fat pad confirmed enrichment in membrane-bound green fluorescent protein/Pdgfra-expressing cells, along with a gene signature that corresponded with injury-associated fibro-adipogenic progenitors. Our results highlight dynamic changes in joint-associated perivascular fibro-adipogenic progenitors during osteoarthritis.


Assuntos
Adipócitos/patologia , Fibroblastos/patologia , Osteoartrite/patologia , Tecido Adiposo/patologia , Animais , Linhagem da Célula , Articulação do Joelho/patologia , Camundongos , Camundongos Transgênicos , Células-Tronco
6.
AJR Am J Roentgenol ; 215(2): 458-464, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32507014

RESUMO

OBJECTIVE. The purpose of this study is to assess the use of cross-sectional imaging to qualitatively and quantitatively categorize trochlear dysplasia as low grade (type A) or high grade (types B-D) according to the Dejour classification. MATERIALS AND METHODS. A retrospective review of CT and MRI knee examinations performed before patients underwent deepening trochleoplasty was independently conducted by two musculoskeletal radiologists. Each case of trochlear dysplasia was qualitatively assigned a Dejour type. Subsequently, quantitative measurements of the sulcus angle, distance from the tibial tubercle to the trochlear groove, trochlear depth, lateral trochlear inclination, trochlear facet asymmetry, and degree of patellar lateralization were performed. RESULTS. A total of 35 patients (29 female patients and six male patients; mean age, 21.1 years) with 39 affected knees (17 right knees and 22 left knees) were included. Readers had exact qualitative agreement using Dejour classification for 30 of 39 knees (77% [κ = 0.77; 95% CI, 0.62-0.91]) and agreement on classification of low-grade versus high-grade dysplasia for 36 of 39 knees (92%). For these 36 knees, the mean differences in measurements of low- versus high-grade dysplasia, respectively, were as follows: for sulcus angle, 153° versus 168° (p < 0.001); for trochlear depth, 4 versus 1 mm (p < 0.001); for lateral trochlear inclination, 12 versus 7 mm (p < 0.02); and for decreased trochlear facet asymmetry, 13% versus 92% (p < 0.001). Trochlear depth, lateral trochlear inclination, and trochlear facet asymmetry were also different in comparisons of knees with Dejour type B and C trochlear dysplasia versus those with Dejour types B and D (all p < 0.05). No quantitative measurement differentiated between trochlear dysplasia of Dejour types C and D. The distance from the tibial tubercle to the trochlear groove and the degree of patellar lateralization were not statistically different between low- and high-grade dysplasia. CONCLUSION. Qualitative use of the Dejour classification accurately categorizes trochlear dysplasia as low grade or high grade in 92% of cases, with exact agreement reached in 77% of cases. Furthermore, the trochlear depth, lateral trochlear inclination, trochlear facet asymmetry, and sulcus angle can differentiate between low-grade and high-grade dysplasia, with trochlear depth, lateral trochlear inclination, and trochlear facet asymmetry useful for differentiating between Dejour types B and C and Dejour types B and D.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Fêmur/diagnóstico por imagem , Fêmur/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imagem por Ressonância Magnética , Patela/diagnóstico por imagem , Patela/patologia , Tomografia Computadorizada por Raios X , Adolescente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
7.
Ann Rheum Dis ; 79(8): 1105-1110, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32381567

RESUMO

OBJECTIVES: Although treatment development in osteoarthritis (OA) focuses on chondroprotection, it is unclear how much preventing cartilage loss reduces joint pain. It is also unclear how nociceptive tissues may be involved. METHODS: Using data from the Osteoarthritis Initiative, we quantified the relation between cartilage loss and worsening knee pain after adjusting for bone marrow lesions (BMLs) and synovitis, and examined how much these factors mediated this association. 600 knee MRIs were scored at baseline, 12 months and 24 months for quantitative and semiquantitative measures of OA structural features. We focused on change in medial cartilage thickness using an amount similar to that seen in recent trials. Linear models calculated mean change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score with cartilage loss, adjusted for baseline BMLs, synovitis and covariates. Mediation analysis tested whether change in synovitis or BMLs mediated the cartilage loss-pain association. We carried out a subanalysis for knees with non-zero baseline WOMAC pain scores and another for non-valgus knees. RESULTS: Cartilage thickness loss was significantly associated with a small degree of worsening in pain over 24 months. For example, a loss of 0.1 mm of cartilage thickness over 2 years was associated with a 0.32 increase in WOMAC pain (scale 0-20). The association of cartilage thickness loss with pain was mediated by synovitis change but not by BML change. Subanalysis results were similar. CONCLUSIONS: Cartilage thickness loss is associated with only a small amount of worsening knee pain, an association mediated in part by worsening synovitis. Demonstrating that chondroprotection reduces knee pain will be extremely challenging and is perhaps unachievable.


Assuntos
Artralgia/etiologia , Cartilagem Articular/patologia , Osteoartrite do Joelho/patologia , Idoso , Feminino , Humanos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações
8.
J Vis Exp ; (159)2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32449702

RESUMO

One of the most prevalent joint disorders in the United States, osteoarthritis (OA) is characterized by progressive degeneration of articular cartilage, primarily in the hip and knee joints, which results in significant impacts on patient mobility and quality of life. To date, there are no existing curative therapies for OA able to slow down or inhibit cartilage degeneration. Presently, there is an extensive body of ongoing research to understand OA pathology and discover novel therapeutic approaches or agents that can efficiently slow down, stop, or even reverse OA. Thus, it is crucial to have a quantitative and reproducible approach to accurately evaluate OA-associated pathological changes in the joint cartilage, synovium, and subchondral bone. Currently, OA severity and progression are primarily assessed using the Osteoarthritis Research Society International (OARSI) or Mankin scoring systems. In spite of the importance of these scoring systems, they are semiquantitative and can be influenced by user subjectivity. More importantly, they fail to accurately evaluate subtle, yet important, changes in the cartilage during the early disease states or early treatment phases. The protocol we describe here uses a computerized and semiautomated histomorphometric software system to establish a standardized, rigorous, and reproducible quantitative methodology for the evaluation of joint changes in OA. This protocol presents a powerful addition to the existing systems and allows for more efficient detection of pathological changes in the joint.


Assuntos
Osteoartrite/patologia , Osteoartrite/cirurgia , Animais , Medula Óssea/patologia , Calibragem , Cartilagem Articular/patologia , Contagem de Células , Condrócitos/patologia , Modelos Animais de Doenças , Articulação do Joelho/patologia , Masculino , Camundongos Endogâmicos C57BL , Fenótipo , Qualidade de Vida , Padrões de Referência , Software , Coloração e Rotulagem , Membrana Sinovial/patologia , Tíbia/patologia
9.
Trop Doct ; 50(3): 254-257, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32437295

RESUMO

Burkholderia pseudomallei is an important cause of sepsis in certain parts of Asia and northern Australia. It usually causes abscess in the lungs, liver, spleen, skeletal muscle and parotids, especially in patients who are immunocompromised. In India, musculoskeletal melioidosis has rarely been reported. We report such a case with septic arthritis of the knee, diagnosed on the basis of a positive pus culture. After being treated by arthrotomy and surgical debridement followed by a combination of intravenous ceftazidime (acute phase = three weeks) and oral doxycycline and co-trimoxazole (eradication phase = five weeks) for two months, the patient recovered completely with no recurrence.


Assuntos
Artrite Infecciosa/diagnóstico , Burkholderia pseudomallei/isolamento & purificação , Articulação do Joelho/microbiologia , Melioidose/diagnóstico , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/cirurgia , Humanos , Índia , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Masculino , Melioidose/tratamento farmacológico , Melioidose/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(14): e19646, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243395

RESUMO

Discoid lateral meniscus is one of the most common knee problems in clinical practice. Several radiographic findings have been reported to screen discoid lateral meniscus, but the diagnostic value of those signs varies.We introduce a new method of measurement on plain radiograph for initial screening discoid lateral meniscus and describe its efficacy and correlation to symptomatic discoid lateral meniscus.This is a retrospective case-control study.Seventy-eight arthroscopic proven symptomatic discoid lateral meniscus adult patients plus 73 patients of matched control group were retrospectively reviewed at our institution between 2012 and 2017. We studied their standardized non-weight-bearing knee radiograph anterior-posterior view and measured the following parameters: lateral joint space height, lateral tibia spine height, fibular head height, lateral tibia plateau obliquity (LTPO), and lateral condyle convex angle (LCCA).Significant statistical differences were found in the lateral joint space height, lateral tibia spine height, fibular head height, LTPO and LCCA measurements between the 2 groups (P < .05). Also, we found the phenomenon that angle parameters such as LTPO and LCCA had high sensitivities with relatively low specificities compared with height parameters.We propose that LCCA is a new measurement which is statistically larger in discoid meniscus patients. Furthermore, it can be useful for screening discoid lateral meniscus on plain radiograph with its relative high sensitivity.Level of Evidence: Level III, Case-control study.


Assuntos
Programas de Rastreamento/métodos , Meniscos Tibiais/diagnóstico por imagem , Radiografia/métodos , Lesões do Menisco Tibial/diagnóstico por imagem , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Fíbula/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Tíbia/diagnóstico por imagem , Lesões do Menisco Tibial/patologia , Adulto Jovem
11.
PLoS One ; 15(4): e0231240, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32287299

RESUMO

OBJECTIVE: REG-O3 is a 24-aminoacid chimeric peptide combining a sequence derived from growth hormone (GH) and an analog of somatostatin (SST), molecules displaying cartilage repair and anti-inflammatory properties, respectively. This study aimed to investigate the disease-modifying osteoarthritis drug (DMOAD) potential of REG-O3 by analyzing its effect on pain, joint function and structure, upon injection into osteoarthritic rat knee joint. DESIGN: Osteoarthritis was induced in the right knee of mature male Lewis rats (n = 12/group) by surgical transection of the anterior cruciate ligament (ACLT) combined with partial medial meniscectomy (pMMx). Treatments were administered intra-articularly from fourteen days after surgery through three consecutive injections one week apart. The effect of REG-O3, solubilized in a liposomal solution and injected at either 5, 25 or 50 µg/50 µL, was compared to liposomal (LIP), dexamethasone and hyaluronic acid (HA) solutions. The study endpoints were the pain/function measured once a week throughout the entire study, and the joint structure evaluated eight weeks after surgery using OARSI score. RESULTS: ACLT/pMMx surgery induced a significant modification of weight bearing in all groups. When compared to liposomal solution, REG-O3 was able to significantly improve weight bearing as efficiently as dexamethasone and HA. REG-O3 (25 µg) was also able to significantly decrease OARSI histological global score as well as degeneration of both cartilage and matrix while the other treatments did not. CONCLUSION: This study provides evidence of a remarkable protecting effect of REG-O3 on pain/knee joint function and cartilage/matrix degradation in ACLT/pMMx model of rat osteoarthritis. REG-O3 thus displays an interesting profile as a DMOAD.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Anti-Inflamatórios não Esteroides/uso terapêutico , Cartilagem Articular/efeitos dos fármacos , Hormônio do Crescimento/uso terapêutico , Articulação do Joelho/efeitos dos fármacos , Osteoartrite do Joelho/tratamento farmacológico , Proteínas Recombinantes de Fusão/uso terapêutico , Somatostatina/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Cartilagem Articular/patologia , Modelos Animais de Doenças , Hormônio do Crescimento/farmacologia , Articulação do Joelho/patologia , Masculino , Osteoartrite do Joelho/etiologia , Ratos , Ratos Endogâmicos Lew , Proteínas Recombinantes de Fusão/farmacologia , Somatostatina/análogos & derivados , Somatostatina/farmacologia
12.
Qual Life Res ; 29(9): 2395-2402, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32314125

RESUMO

PURPOSE: To evaluate the health-related quality of life (HRQoL) of knee osteoarthritis (KOA) patients in China, compare their HRQoL with norm population, and examine the associations between the potential influencing factors and HRQoL. METHODS: A cross-sectional study was conducted in 912 KOA patients from 4 provinces between March and November 2017. All participants were diagnosed according to the National Institute for Health and Care Excellence (NICE)'s criterion or the Chinese Medical Association (CMA)'s criterion. Recruited patients were surveyed for HRQoL using the 12-item Short Form (SF-12) and sociodemographic, disease-related factors. We assessed the associations between potential influencing factors and HRQoL using multiple linear regression models. RESULTS: Among the KOA patients, the mean physical component summary (PCS) of HRQoL was 40.91 ± 11.62, lower than norm (P < 0.001). And the mean mental component summary (MCS) was 50.25 ± 11.99, similar to the norm. Patients who were older (ß = - 0.155, P = 0.001), women (ß = - 4.589, P < 0.001), had ever been treated (ß = - 2.426, P = 0.006), had longer course of KOA (ß = - 0.164, P = 0.012), and were in early stage (ß = - 2.968, P = 0.001) or progressive/late stage (ß = - 7.636, P < 0.001) showed lower scores of PCS. Patients who lived in Hunan (ß = 4.988, P < 0.001) and had education levels of junior high school (ß = 3.134, P = 0.012) or senior high school and above (ß = 3.050, P = 0.010) had better mental status. Those suffered from non-knee pains (ß = - 2.308, P = 0.027) and with progressive or late KOA (ß = - 4.690, P = 0.016) had lower MCS scores. CONCLUSION: KOA patients had worse physical condition. The mental and physical health of patients were affected by different factors. Targeted management measures should be taken to improve their HRQoL.


Assuntos
Nível de Saúde , Osteoartrite do Joelho/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , China , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/patologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteoartrite do Joelho/patologia , Inquéritos e Questionários
13.
JAMA ; 323(15): 1456-1466, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32315057

RESUMO

Importance: A proof-of-principle study suggested that intravenous zoledronic acid may reduce knee pain and the size of bone marrow lesions in people with knee osteoarthritis, but data from large trials are lacking. Objective: To determine the effects of intravenous zoledronic acid on knee cartilage volume loss in patients with symptomatic knee osteoarthritis and bone marrow lesions. Design, Setting, and Participants: A 24-month multicenter, double-blind placebo-controlled randomized clinical trial conducted at 4 sites in Australia (1 research center and 3 hospitals). Adults aged 50 years or older with symptomatic knee osteoarthritis and subchondral bone marrow lesions detected by magnetic resonance imaging (MRI) were enrolled from November 2013 through September 2015. The final date of follow-up was October 9, 2017. Interventions: Intravenous infusion with either 5 mg of zoledronic acid in a 100-mL saline solution (n = 113) or a placebo saline solution (n = 110) at baseline and 12 months. Main Outcomes and Measures: The primary outcome was absolute change in tibiofemoral cartilage volume assessed using MRI over 24 months (the minimum clinically important difference [MCID] has not been established). Three prespecified secondary outcomes were change in knee pain assessed by a visual analog scale (0 [no pain] to 100 [unbearable pain]; MCID, 15) and the Western Ontario and McMaster Universities Osteoarthritis Index (0 [no pain] to 500 [unbearable pain]; MCID, 75) over 3, 6, 12, 18, and 24 months and change in bone marrow lesion size over 6 and 24 months (the MCID has not been established). Results: Of 223 participants enrolled (mean age, 62.0 years [SD, 8.0 years]; 52% were female), 190 (85%) completed the trial. Change in tibiofemoral cartilage volume was not significantly different between the zoledronic acid group and the placebo group over 24 months (-878 mm3 vs -919 mm3; between-group difference, 41 mm3 [95% CI, -79 to 161 mm3]; P = .50). No significant between-group differences were found for any of the prespecified secondary outcomes, including changes in knee pain assessed by a visual analog scale (-11.5 in the zoledronic acid group vs -16.8 in the placebo group; between-group difference, 5.2 [95% CI, -2.3 to 12.8]; P = .17), changes in knee pain assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (-37.5 vs -58.0, respectively; between-group difference, 20.5 [95% CI, -11.2 to 52.2]; P = .21), and changes in bone marrow lesion size (-33 mm2 vs -6 mm2; between-group difference, -27 mm2 [95% CI, -127 to 73 mm2]; P = .60) over 24 months. Adverse events were more common with zoledronic acid than with placebo (96% vs 83%, respectively) and consisted mainly of acute reactions (defined as symptoms within 3 days of administration of infusion; 87% vs 56%). Conclusions and Relevance: Among patients with symptomatic knee osteoarthritis and bone marrow lesions, yearly zoledronic acid infusions, compared with placebo, did not significantly reduce cartilage volume loss over 24 months. These findings do not support the use of zoledronic acid in the treatment of knee osteoarthritis. Trial Registration: anzctr.org.au Identifier: ACTRN12613000039785.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Doenças da Medula Óssea/tratamento farmacológico , Cartilagem Articular/efeitos dos fármacos , Osteoartrite do Joelho/tratamento farmacológico , Ácido Zoledrônico/uso terapêutico , Idoso , Conservadores da Densidade Óssea/administração & dosagem , Medula Óssea/patologia , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/patologia , Falha de Tratamento , Ácido Zoledrônico/administração & dosagem
14.
Medicine (Baltimore) ; 99(14): e19455, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243364

RESUMO

The aim of this study is to compare the distal femoral cartilage thickness of patients with type II diabetes mellitus with those of healthy subjects using ultrasonography. The study comprised 34 patients and 36 healthy subjects. Demographic characteristics of all the participants were recorded. The thickness of the femoral articular cartilage was measured using a 5-18MHzlinearprobe.Measurements were performed bilaterally from three points (intercondylar area, medial condyle, and lateral condyle). No significant difference could be found between patients and healthy subjects. Two demographic characteristics correlated positively with diabetic patients.


Assuntos
Cartilagem Articular/patologia , Diabetes Mellitus Tipo 2/patologia , Fêmur/patologia , Articulação do Joelho/patologia , Adulto , Idoso , Índice de Massa Corporal , Cartilagem Articular/diagnóstico por imagem , Estudos Transversais , Feminino , Fêmur/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Ultrassonografia
15.
Pathologe ; 41(3): 271-280, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32215684

RESUMO

Orthopedic and trauma surgery are currently confronted with significant changes in their interventional and therapeutic strategies, especially in knee surgery. Minimally invasive and reconstructive techniques lead not only to modifications of the repertoire of interventional methods but also of the indications and questions for histopathological diagnostics. The classical problems in knee surgery remain important issues, which are traumatic, degenerative, and infectious lesions. In addition, questions regarding regeneration and integration of cell-material constructs will become more and more important in the future. Furthermore, questions regarding the regenerative potential of an implantation site for such constructs and the morphological quality of harvested tissue for the in vitro cell expansion of autologous cells are becoming increasingly important. The autologous chondrocyte transplantation is a good example of the relevance of the histopathological re-evaluation of the regenerated tissue for a better understanding of the pathophysiology of reconstructive therapies. It becomes clear that for specific aims based on reconstructive therapies, new scoring systems should be established for the histopathological routine diagnostic service. Furthermore, there is need for the definition of further histopathological criteria, which will help to optimize the differential application of reconstructive strategies via tissue engineering. The present report gives a short overview of the modifying requirements on the histopathological diagnostics in specimens from knee-surgery but does not claim to be exhaustive.


Assuntos
Cartilagem Articular/patologia , Condrócitos/transplante , Articulação do Joelho/patologia , Procedimentos Ortopédicos , Humanos , Regeneração , Engenharia Tecidual , Transplante Autólogo
16.
Artigo em Inglês | MEDLINE | ID: mdl-32151036

RESUMO

Purpose: Muscle weakness and bone deterioration in the elderly are related to falls and fractures, resulting in decreased mobility. Knee osteoarthritis also may contribute to falls and fractures and thereby affect mortality rates. The Kellgren-Lawrence (KL) classification is widely used in the radiographic evaluation of knee osteoarthritis. Aims: This study aimed to evaluate the quadriceps strength and bone properties of the calcaneus for each KL grade, and to clarify the impact of knee osteoarthritis grade on quadriceps strength and bone properties. Methods: This prospective cross-sectional study included data on 108 male patients (213 knees), aged ≥80 years, who could walk independently. A handheld dynamometer was used to measure quadriceps strength. Bone properties were evaluated using broadband ultrasound attenuation with a portable bone densitometer. Weight-bearing standing knee radiographs were evaluated using KL classification. Quadriceps strength and bone properties were evaluated for each KL grade and the correlations between the grade and quadriceps strength and bone properties were assessed simultaneously. Results: The numbers of participants in KL grades I-IV were 46, 102, 45, and 20, respectively. There were no differences among grades for either quadriceps strength or bone properties. Conclusions: Participants exhibited good quadriceps strength and bone properties regardless of their KL grade. Relatively high mechanical loading of muscle and bone incurred while walking independently, likely explaining this result. Clinically, this study demonstrated the absence of correlations between KL grade and quadriceps strength and bone properties, as was previously reported in studies showing the absence of a correlation between KL grade and pain.


Assuntos
Calcâneo , Força Muscular , Osteoartrite do Joelho , Músculo Quadríceps , Caminhada , Idoso de 80 Anos ou mais , Calcâneo/fisiologia , Estudos Transversais , Humanos , Articulação do Joelho/patologia , Masculino , Força Muscular/fisiologia , Osteoartrite do Joelho/classificação , Osteoartrite do Joelho/patologia , Estudos Prospectivos , Músculo Quadríceps/fisiologia
17.
Bone Joint J ; 102-B(3): 329-335, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114807

RESUMO

AIMS: Biopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how often the bacteria identified in the tissue analysis differed between samples obtained from preoperative biopsy and intraoperative revision surgery in cases of late PJI; and whether there was a therapeutic consequence. METHODS: A total of 508 patients who required revision surgery of total hip arthroplasty (THA) (n = 231) or total knee arthroplasty (TKA) (n = 277) because of component loosening underwent biopsy before revision surgery. The tissue samples collected at biopsy and during revision surgery were analyzed according to the criteria of the Musculoskeletal Infection Society (MSIS). RESULTS: In total, 178 (113 THA, 65 TKA) were classified as infected. The biopsy procedure had a sensitivity of 93.8%, a specificity of 97.3%, a positive predictive value (PPV) of 94.9%, a negative predictive value (NPV) of 96.7%, and an accuracy of 96.1%. Of the 178 infected patients, 26 showed a difference in the detected bacteria from the biopsy and the revision surgery (14.6%). This difference required a change to antibiotic therapy in only two cases (1.1%). CONCLUSION: Biopsy is a useful tool to diagnose PJI, but there may be a difference in the detected bacteria between the biopsy and revision surgery. However, this did not affect the choice of antibiotic therapy in most cases, rendering the clinical relevance of this phenomenon as low. Cite this article: Bone Joint J 2020;102-B(3):329-335.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Biópsia/métodos , Diagnóstico Tardio , Infecções Relacionadas à Prótese/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/isolamento & purificação , Feminino , Seguimentos , Articulação do Quadril/microbiologia , Articulação do Quadril/patologia , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Prótese de Quadril/microbiologia , Humanos , Articulação do Joelho/microbiologia , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Prótese do Joelho/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/microbiologia , Reprodutibilidade dos Testes
18.
Medicine (Baltimore) ; 99(12): e19576, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195969

RESUMO

RATIONALE: Tension band wiring is the most widely accepted technique for the treatment of patellar fractures but the technique is associated with common complications like wire migration, prominence, and breakage. To reduce these complications, we developed and propose a modified technique that has a superior biomechanical strength and a potential to reduce such postoperative complications. PATIENT CONCERNS: The patient presented with pain and mild swelling in his left knee after he slipped on the floor and fell on his left knee. He has no significant past medical or surgical history. The patient took the tension band wiring as the first choice because of the wide acceptance. But he worried about the complications. DIAGNOSES: X-ray showed a transverse fracture of the left patella with an inferior pole occult fracture. INTERVENTIONS: The patient was operated with a modified technique of the classic tension band wiring for patellar fractures. In our 4-step procedure, double tension cerclage wires were wrapped under the exposed ends of the Kirschner wires (K-wires) and the tendons in figure-of-8 fashion. The aim was to increase the biomechanical strength so that when one of the tension wires fail, the other one can hold the fragments together. OUTCOMES: The patient recovered very well and without any complications. The patient was followed-up for 1 year and the fracture has united very well, with satisfying knee range of motion. LESSONS: From this case study, we can detect the biomechanical advantages of our technique which can increase the stability of the fracture and that allows early functional exercise and additionally the micromotion at the fracture site has a beneficial effect of fracture union. Based on the perfect outcomes, our technique is worthy of clinical application.


Assuntos
Fios Ortopédicos/normas , Traumatismos do Joelho/cirurgia , Patela/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Fios Ortopédicos/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Humanos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Patela/diagnóstico por imagem , Patela/patologia , Radiografia/métodos , Resultado do Tratamento
19.
Indian J Pathol Microbiol ; 63(1): 128-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32031142

RESUMO

Acquired perforating dermatosis is a group of disease characterized by transepidermal elimination of altered dermal constituents of unknown pathogenesis. The giant variant was first described in 2006, as an emerging entity with seven reported cases to date. Here is an 83-year-old male presented with a 4-year history of gradually enlarging soft tisssue mass with ulcerartions at the left knee joint. Imaging revealed an extra-articular, single, heterogeneous, multinodular mass, suspicious for a soft tissue sarcoma. Wide local excision of the mass showed fleshy, hemorrhagic nodules communicating with epidermal ulcers. Microscopy showed cystic spaces straddling dermis and subcutis, containing eosinophilic, amorphous, granular material extruding through epidermal craters, surrounded by exuberant myofibroblastic proliferation. Trichrome and van-Gieson stains confirmed that the extruded material is collagen and the histology was compatible with the giant variant of acquired perforating collagenosis. Awareness of histological appearance prevents misdiagnosis and overtreatment of this entity, masquerading as a sarcoma clinically.


Assuntos
Sarcoma/diagnóstico , Sarcoma/patologia , Dermatopatias/classificação , Dermatopatias/patologia , Idoso de 80 Anos ou mais , Técnicas Histológicas , Humanos , Articulação do Joelho/patologia , Masculino , Coloração e Rotulagem
20.
Am J Sports Med ; 48(3): 642-646, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32004085

RESUMO

BACKGROUND: Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tubercle caused by repetitive strain and chronic avulsion from the patellar tendon. No widely accepted anatomic risk factors have been associated with OSD. PURPOSE: To determine if OSD is associated with increased posterior tibial slope (PTS). STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Forty knees with OSD and 32 control knees examined by the senior author between 2008 and 2019 were included. Patients 10 to 15 years of age with a clinical diagnosis of OSD and available lateral radiograph and magnetic resonance imaging (MRI) were eligible. Age- and sex-matched patients with a history of knee pain but no evidence of OSD on clinical examination and without significant pathology on lateral radiograph and MRI were included in the control group. PTS was defined as the angle between a reference line perpendicular to the proximal anatomic axis and a line drawn tangent to the uppermost anterior and posterior edges of the medial tibial plateau. Measurements were carried out in duplicate on true lateral radiographs by 2 blinded investigators. Interrater reliability of PTS measurements was evaluated using intraclass correlation coefficient (ICC). The independent samples t test was used to compare PTS between the OSD and control knees. RESULTS: The mean age was 12.6 ± 1.6 years and 51% (37/72) of the knees were from male youth. There were no differences in age, sex, and laterality of knees between the OSD and control groups. The mean PTS was significantly higher in the OSD group (12.23°± 3.58°) compared with the control group (8.82°± 2.76°; P < .001). The ICC was 0.931 (95% CI, 0.890-0.957), indicating almost perfect interrater reliability. CONCLUSION: This study identifies an association between OSD and increased PTS. The clinical implications of this finding have not yet been elucidated. It may be speculated that in patients with OSD, stress from the extensor mechanism through the patellar tendon loads the anterior portion of the tibia disproportionately to the posterior segment, thereby resulting in asymmetric growth and an increased PTS.


Assuntos
Articulação do Joelho/patologia , Osteocondrose/fisiopatologia , Tíbia/patologia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Dor/etiologia , Ligamento Patelar , Radiografia , Reprodutibilidade dos Testes
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