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1.
Eklem Hastalik Cerrahisi ; 30(2): 177-81, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291869

RESUMO

Pigmented villonodular synovitis (PVNS) is a benign tumorous condition commonly found in tendon sheathes, bursa, or joint synovium. Unlike the diffuse type which invades the entire synovium of the affected joint, synovium of localized PVNS shows relatively normal appearance. It presents nonspecific symptoms and typically progresses for a long time but acute locking phenomenon or internal derangement of knee symptoms suddenly commence in early stage. In this article, we present a 48-year-old female patient with well-capsulated localized PVNS with intra-capsular hemorrhage occurring from the junction of the mid-body of lateral meniscus and the lateral joint capsule in the knee. It expanded and then moved to the lateral joint space, which caused pain, limitation of knee flexion and locking spontaneously. Arthroscopic complete excision, biopsy, and focal synovectomy were performed with punch and motorized shaver. Full weight-bearing with full knee range of motion was allowed at one day post-surgery. The mechanical symptom of locking and severe pain disappeared. At the clinical follow-up one month post-surgery, the symptoms were no longer present.


Assuntos
Doenças das Cartilagens/etiologia , Hemorragia/etiologia , Sinovite Pigmentada Vilonodular/complicações , Sinovite Pigmentada Vilonodular/cirurgia , Artroscopia , Biópsia , Feminino , Humanos , Cápsula Articular , Articulação do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Sinovectomia , Membrana Sinovial/patologia , Sinovite Pigmentada Vilonodular/diagnóstico por imagem , Sinovite Pigmentada Vilonodular/patologia
2.
Radiologe ; 59(8): 684-691, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31168772

RESUMO

CLINICAL ISSUE: Today's advanced MRI imaging allows for a precise diagnosis and thus better treatment planning of cartilage damage. The phrase "depending on intraoperative findings" is therefore slowly becoming a thing of the past. However, this also increases the demand for an exact interpretation of the imaging, from clinicians and patients alike. This article highlights the importance of a radiologist's role in different constellations. PRACTICAL RECOMMENDATIONS: In the case of acute injuries, it is crucial to recognize osteochondral flakes, cartilage delamination, subchondral bone bruising and fractures as well as concomitant injuries. These findings must be instantly communicated to the practitioner. In the case of chronic cartilage damage, grading the extent and size of the damage is decisive in choosing the appropriate therapy method. Possible causes and accompanying injuries must also be analyzed and, if necessary, addressed. Direct communication with the clinical colleague is also useful in correlating the clinical and radiological findings.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Fraturas Ósseas , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/fisiopatologia , Cartilagem Articular/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Radiologistas
3.
Radiologe ; 59(8): 742-749, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31187160

RESUMO

BACKGROUND: Cartilage imaging using magnetic resonance imaging (MRI) is increasingly used for early detection of cartilage damage. Biochemical MR methods to assess cartilage damage are essential for optimal treatment planning. PURPOSE: The aim of this review is to provide an update on advanced cartilage imaging based on biochemical MR techniques. The clinical applications and additional benefits compared to conventional MRI are presented. MATERIALS AND METHODS: A literature search of PubMed regarding the clinical applications of various biochemical MR methods and morphological MR imaging was performed. RESULTS: While T2 mapping can be easily implemented on clinical routine MR scanners, the T1rho method is technically more demanding and is not available on all MR scanners. dGEMRIC, which can be performed with all field strengths, is now severely restricted due to the recent decision of the European Medical Agency (EMA) to withdraw linear gadolinium contrast agents from the market because of proven gadolinium deposition in the brain. Sodium imaging is the most sensitive MRI method for glycosaminoglycan (GAG), but is limited to 7 T. In addition to early diagnosis of cartilage degeneration before morphological changes are visible, biochemical MRI offers predictive markers, e.g., effect of lifestyle changes or assessing results of cartilage repair surgery. CONCLUSION: Cartilage imaging based on biochemical MRI allows a shift from qualitative to quantitative MRI. Biochemical MRI plays an increasingly important role in the early diagnosis of cartilage degeneration for monitoring of disease-modifying drugs and as predictive imaging biomarker in clinical diagnostics. In cartilage repair, monitoring of the efficacy of different cartilage repair surgery techniques to develop hyaline-like cartilage can be performed with biochemical MRI.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Doenças das Cartilagens/diagnóstico por imagem , Meios de Contraste/química , Gadolínio/química , Humanos , Imagem por Ressonância Magnética
4.
Radiologe ; 59(8): 692-699, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31240354

RESUMO

BACKGROUND: In order to answer clinical therapy-oriented questions, reliable and consistent depiction of articular cartilage across technical platforms is necessary. MATERIALS AND METHODS: Technical standards and developments in cartilage imaging are summarized based on current literature and experience from clinical daily routine. RESULTS: Clinical questions that need to be answered relate to cross-sectional extent, depth, differentiating cartilaginous from bony components of a lesion and to the lesion's location within the compartment. If present, displaced fragments, concomitant meniscal, ligamentous and/or degenerative lesions should be identified. To date, magnetic resonance imaging (MRI) is the workhorse of cartilage imaging and is largely based on moderately T2-weighted and also proton-density (PD)-weighted fat-suppressed turbo-spin-echo sequences. Direct MR- and CT-arthrography are the gold standard to evaluate thin cartilage layers. Recent advances in coil and MR sequence design, increased availability of 3T-MR scanners and more and more sophisticated acceleration techniques allow for better spatial resolution and more robust image contrast at acceptable scan times. DISCUSSION: As abundant as current developments in clinical routine cartilage imaging may be, the radiologist must carefully select the approach best suited to answering the clinical questions.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Artrografia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/fisiopatologia , Cartilagem Articular/diagnóstico por imagem , Estudos Transversais , Humanos , Imagem por Ressonância Magnética
5.
Acta Vet Scand ; 61(1): 24, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146775

RESUMO

BACKGROUND: Inflammatory and degenerative activity inside the joint can be studied in vivo by analysis of synovial fluid biomarkers. In addition to pro-inflammatory mediators, several anabolic and anti-inflammatory substances are produced during the disease process. They counteract the catabolic effects of the pro-inflammatory cytokines and thus diminish the cartilage damage. The response of synovial fluid biomarkers after intra-articular hyaluronan injection, alone or in combination with other substances, has been examined only in a few equine studies. The effects of hyaluronan on some pro-inflammatory mediators, such as prostaglandin E2, have been documented but especially the effects on synovial fluid anti-inflammatory mediators are less studied. In animal models hyaluronan has been demonstrated to reduce pain via protecting nociceptive nerve endings and by blocking pain receptor channels. However, the results obtained for pain-relief of human osteoarthritis are contradictory. The aim of the study was to measure the synovial fluid IL-1ra, PDGF-BB, TGF-ß1 and TNF-α concentrations before and after surgically induced cartilage defect, and following intra-articular hyaluronan injection in horses. Eight Standardbred horses underwent bilateral arthroscopic surgeries of their intercarpal joints under general anaesthesia, and cartilage defect was created on the dorsal edge of the third carpal bone of one randomly selected intercarpal joint of each horse. Five days post-surgery, one randomly selected intercarpal joint was injected intra-articular with 3 mL HA (20 mg/mL). RESULTS: Operation type had no significant effect on the synovial fluid IL-1ra, PDGF-BB, TGF-ß1 and TNF-α concentrations but compared with baseline, synovial fluid IL-1ra and TNF-α concentrations increased. Intra-articular hyaluronan had no significant effect on the biomarker concentrations but a trend of mild improvement in the clinical signs of intra-articular inflammation was seen. CONCLUSIONS: Creation of the cartilage defect and sham-operation lead to an increase of synovial fluid IL-1ra and TNF-α concentrations but changes in concentrations of anabolic growth factors TGF-ß1 and PDGF-BB could not be documented 5 days after the arthroscopy. Intra-articular hyaluronan was well tolerated. Further research is needed to document possible treatment effects of intra-articular hyaluronan on the synovial fluid biomarkers of inflammation and cartilage metabolism.


Assuntos
Biomarcadores/análise , Articulações do Carpo/efeitos dos fármacos , Doenças das Cartilagens/diagnóstico , Doenças dos Cavalos/diagnóstico , Ácido Hialurônico/farmacologia , Líquido Sinovial/química , Animais , Biomarcadores/metabolismo , Articulações do Carpo/patologia , Articulações do Carpo/cirurgia , Doenças das Cartilagens/patologia , Doenças dos Cavalos/patologia , Cavalos , Proteína Antagonista do Receptor de Interleucina 1/análise , Fator de Necrose Tumoral alfa/análise
6.
Int J Mol Sci ; 20(9)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31052252

RESUMO

Ectopic mineralization disorders comprise a broad spectrum of inherited or acquired diseases characterized by aberrant deposition of calcium crystals in multiple organs, such as the skin, eyes, kidneys, and blood vessels. Although the precise mechanisms leading to ectopic calcification are still incompletely known to date, various molecular targets leading to a disturbed balance between pro- and anti-mineralizing pathways have been identified in recent years. Vitamin K and its related compounds, mainly those post-translationally activated by vitamin K-dependent carboxylation, may play an important role in the pathogenesis of ectopic mineralization as has been demonstrated in studies on rare Mendelian diseases, but also on highly prevalent disorders, like vascular calcification. This narrative review compiles and summarizes the current knowledge regarding the role of vitamin K, its metabolism, and associated compounds in the pathophysiology of both monogenic ectopic mineralization disorders, like pseudoxanthoma elasticum or Keutel syndrome, as well as acquired multifactorial diseases, like chronic kidney disease. Clinical and molecular aspects of the various disorders are discussed according to the state-of-the-art, followed by a comprehensive literature review regarding the role of vitamin K in molecular pathophysiology and as a therapeutic target in both human and animal models of ectopic mineralization disorders.


Assuntos
Calcinose/metabolismo , Doenças Genéticas Inatas/metabolismo , Vitamina K/metabolismo , Anormalidades Múltiplas , Animais , Calcinose/genética , Doenças das Cartilagens , Doenças Genéticas Inatas/genética , Deformidades Congênitas da Mão , Humanos , Estenose da Valva Pulmonar , Vitamina K/genética
7.
Radiologe ; 59(8): 732-741, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30953080

RESUMO

BACKGROUND: Cartilage imaging of small joints is increasingly of interest, as early detection of cartilage damage may be relevant regarding individualized surgical therapies and long-term outcomes. PURPOSE: The aim of this review is to explain modern cartilage imaging of small joints with emphasis on MRI and to discuss the role of methods such as CT arthrography as well as compositional and high-field MRI. MATERIALS AND METHODS: A PubMed literature search was performed for the years 2008-2018. RESULTS: Clinically relevant cartilage imaging to detect chondral damage in small joints remains challenging. Conventional MRI at 3 T can still be considered as a reference for cartilage imaging in clinical routine. In terms of sensitivity, MR arthrography (MR-A) and computed tomography arthrography (CT-A) are superior to non-arthrographic MRI at 1.5 T in the detection of chondral damage. Advanced degenerative changes of the fingers and toes are usually sufficiently characterized by conventional radiography. MRI at field strengths of 3 T and ultrahigh-field imaging at 7 T can provide additional quantifiable, functional and metabolic information. CONCLUSION: Standardized cartilage imaging plays an important role in clinical diagnostics in the ankle joint due to the availability of different and individualized therapeutic concepts. In contrast, cartilage imaging of other small joints as commonly performed in clinical studies has not yet become standard of care in daily clinical routine. Although individual study results are promising, additional studies with large patient collectives are needed to validate these techniques. With rapid development of new treatment concepts radiological diagnostics will play a more significant role in the diagnosis of cartilage lesions of small joints.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Artrografia , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
8.
Biomed Res Int ; 2019: 2761241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31016187

RESUMO

The aim of the present study was to investigate the effects of phosphorylatable nucleus localization signal linked nucleic kinase substrate short peptide (pNNS)-conjugated chitosan (pNNS-CS) mediated miR-140 and IGF-1 in both rabbit chondrocytes and cartilage defects model. pNNS-CS was combined with pBudCE4.1-IGF-1, pBudCE4.1-miR-140, and negative control pBudCE4.1 to form pDNA/pNNS-CS complexes. Then these complexes were transfected into chondrocytes or injected intra-articularly into the knee joints. High levels of IGF-1 and miR-140 expression were detected both in vitro and in vivo. Compared with pBudCE4.1 group, in vitro, the transgenic groups significantly promoted chondrocyte proliferation, increased glycosaminoglycan (GAG) synthesis, and ACAN, COL2A1, and TIMP-1 levels, and reduced the levels of nitric oxide (NO), MMP-13, and ADAMTS-5. In vivo, the exogenous genes enhanced COL2A1, ACAN, and TIMP-1 expression in cartilage and reduced cartilage Mankin score and the contents of NO, IL-1ß, TNF-α, and GAG contents in synovial fluid of rabbits, MMP-13, ADAMTS-5, COL1A2, and COL10A1 levels in cartilage. Double gene combination showed better results than single gene. This study indicate that pNNS-CS is a better gene delivery vehicle in gene therapy for cartilage defects and that miR-140 combination IGF-1 transfection has better biologic effects on cartilage defects.


Assuntos
Doenças das Cartilagens/tratamento farmacológico , Cartilagem Articular/efeitos dos fármacos , Quitosana/farmacologia , Condrócitos/efeitos dos fármacos , Fator de Crescimento Insulin-Like I/metabolismo , MicroRNAs/metabolismo , Peptídeos/farmacologia , Animais , Doenças das Cartilagens/metabolismo , Cartilagem Articular/metabolismo , Condrócitos/metabolismo , Técnicas de Transferência de Genes , Humanos , Articulação do Joelho/metabolismo , Metaloproteinase 13 da Matriz/metabolismo , Óxido Nítrico/metabolismo , Coelhos , Líquido Sinovial/efeitos dos fármacos , Líquido Sinovial/metabolismo , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Transfecção/métodos
9.
Eur J Radiol ; 113: 32-38, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927957

RESUMO

PURPOSE: We described patellofemoral alignment and trochlear morphology at one and five years after anterior cruciate ligament reconstruction (ACLR), and evaluated the associations between alignment and trochlear morphology (at one year) and worsening patellofemoral osteoarthritis (OA) features by five years. We also evaluated the associations between alignment and morphology to self-reported pain and function (Knee injury and Osteoarthritis Outcome Score, KOOS) at five years. MATERIALS AND METHODS: In this longitudinal observational study, we followed 73 participants (mean age 29[9] years, 40% women) from one- to five-years after ACLR. Using MRI, we measured alignment and morphology, and scored cartilage and bone marrow lesions at both time points. We used mixed effects and linear regression models to achieve our stated aims. RESULTS: Greater lateral patella displacement increased risk of cartilage worsening (Odds Ratio [95% CI]: 1.09 [1.01, 1.16]); while less lateral tilt (0.91 [0.83, 0.99]) and greater trochlear angle (0.88 [0.77, 1.00]) were protective. Greater medial trochlear inclination increased risk of bone marrow lesion worsening (1.12 [1.04, 1.19]); while greater trochlear angle was protective (0.80 [0.67, 0.96]). Greater lateral displacement was associated with worse self-reported KOOS sport and recreation scores (ß [95% CI]: -11.0 [-20.9, -1.2]) and quality of life scores (-10.5 [-20.4, -0.7]). CONCLUSIONS: Lateral displacement, lateral tilt, and morphology at 1 year post-ACLR altered the risk of worsening patellofemoral OA features four years later. Lateral displacement was the only measure associated with worse self-reported symptoms at five years. These findings may lead to novel treatment strategies for secondary prevention after ACLR.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Mau Alinhamento Ósseo/patologia , Osteoartrite do Joelho/patologia , Adulto , Lesões do Ligamento Cruzado Anterior/patologia , Doenças das Cartilagens/patologia , Criança , Feminino , Humanos , Traumatismos do Joelho/patologia , Estudos Longitudinais , Imagem por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade , Patela/patologia , Complicações Pós-Operatórias/patologia , Prognóstico , Qualidade de Vida , Adulto Jovem
10.
J Stroke Cerebrovasc Dis ; 28(6): e66-e67, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30930242

RESUMO

Fibrocartilaginous embolism (FCE) is an uncommon cause of spinal cord infarction often misdiagnosed as transverse myelitis. The mechanism of ischemia is suspected to be due to retrograde embolization of nucleus pulposus material originating from Schmorl's nodes to the spinal vessels following acute disk herniation. We describe the clinical and imaging findings of FCE in 3 healthy young women with history of trivial spinal cord trauma, and recommend that FCE should be considered in the differential diagnosis of acute myelopathy.


Assuntos
Doenças das Cartilagens/complicações , Embolia/complicações , Infarto/etiologia , Extremidade Inferior/inervação , Isquemia do Cordão Espinal/etiologia , Medula Espinal/irrigação sanguínea , Extremidade Superior/inervação , Adolescente , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/terapia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Embolia/diagnóstico por imagem , Embolia/terapia , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/fisiopatologia , Infarto/terapia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/fisiopatologia , Isquemia do Cordão Espinal/terapia , Resultado do Tratamento , Adulto Jovem
12.
Knee ; 26(3): 673-678, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904326

RESUMO

BACKGROUND: This study aimed to demonstrate the characteristics of the chondral lesion at the medial femoral condyle (MFC) in patients with medial meniscal posterior root tear (MMPRT), and to compare the progression rate of accompanying chondral disease in MMPRT with that in degenerative non-radial tear. METHODS: Thirty-one patients who underwent arthroscopic surgery for MMPRT and 31 controls who underwent arthroscopic surgery for degenerative medial meniscus posterior horn horizontal tear (MMPHT) were included. Accompanying chondral lesions in the MFC were evaluated by magnetic resonance imaging (MRI) at initial diagnosis and from video taken at arthroscopic surgery using the International Cartilage Repair Society (ICRS) classification system. The difference in severity and extent of the chondral lesion between initial diagnosis and surgery was measured. RESULTS: Twenty-five patients with MMPRT (80.6%) and 29 patients (93.5%) with MMPHT had ICRS grade ≥2 chondral injuries at MFC. In the MMPRT and MMPHT groups, the most severely injured areas of the MFC were the far medial compartment (52%) and central compartment (51%), respectively. Comparing MRI and arthroscopy, 12 patients (39%) in the MMPRT group showed progression of chondral disease after a mean of 3.5 months, whereas only three patients (10%) in the MMPHT group showed progression after a mean of 3.1 months. CONCLUSIONS: MFC lesions accompanying MMPRT were located more medially and progressed faster than those with non-root horizontal tear. Earlier intervention such as repair of MMPRT or high tibial osteotomy, if malalignment is present, may be considered in order to prevent the progression of chondral lesion.


Assuntos
Doenças das Cartilagens/etiologia , Cartilagem Articular/lesões , Lesões do Menisco Tibial/cirurgia , Adulto , Artroscopia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
13.
J Orthop Surg Res ; 14(1): 87, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30902098

RESUMO

BACKGROUND: Recently, the AMADEUS (Area Measurement And DEpth Underlying Structures) grading system has been introduced to evaluate and grade osteochondral lesions prior to cartilage surgery. The AMADEUS score has not been connected to clinical data in order to test a potential clincial impact. PURPOSE: To examine the correlation between the AMADEUS score and preoperative patient-reported outcome measurements (PROMs). STUDY DESIGN: Case series METHODS: Patients treated with matrix-induced autologous chondrocyte implantation (MACI) were included in the study, unless exclusion criteria like BMI > 35, prior extensive meniscectomy or ongoing inflammatory arthritis were present. Preoperative magnetic resonance (MR) examinations were graded according to the standardized AMADEUS protocol. The final AMADEUS score was correlated with preoperative patient-reported outcome measurements (PROMs), including the IKDC (International Knee Documentation Committee), the Lysholm score, the Short-Form-12 (SF-12) score, and the Core Outcome Measures Index (COMI) score. RESULTS: A total of 50 patients with a mean age of 33.6 ± 11.5 years, a mean BMI of 25.1 ± 4.9, and a mean defect size of 2.3 ± 1.5 cm2 were included in the study. More severe cartilage defects, indicated by the AMADEUS grade (R = 0.35, p = 0.01) and the AMADEUS score (R = - 0.36, p = 0.01) as well as larger chondral defects (R = 0.32, p = 0.03) show a moderate correlation with the higher COMI scores. No correlative capacity was demonstrated for the AMADEUS score and the IKDC, Lysholm, and Tegner activity scores as well as for its subscales. CONCLUSION: There is a moderate correlation of the COMI and the AMADEUS score in patients treated with matrix-induced autologous chondrocyte implantation (MACI). All other patient-reported outcome measurement scores (PROMs) show no evidence of an association to the magnetic resonance-based AMADEUS score. CLINICAL RELEVANCE: The clinical and scientific implication of the COMI score as a PROM tool can be recommended when working with the AMADEUS score and patients undergoing MACI.


Assuntos
Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/cirurgia , Condrócitos/transplante , Medidas de Resultados Relatados pelo Paciente , Cuidados Pré-Operatórios/métodos , Índice de Gravidade de Doença , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/tendências , Transplante Autólogo/tendências , Resultado do Tratamento
14.
Orthopedics ; 42(2): 66-73, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30889253

RESUMO

Individuals with osteoarthritis have a diminished quality of life, and the condition is a major cause of disability. Newer biologic treatments have been developed that are believed to modify disease progression. These predominantly include hyaluronic acid, platelet-rich plasma, bone marrow aspirate concentrate, and adipose-derived mesenchymal stem cells. There is conflicting evidence regarding the use of orthobiologics for osteoarthritis and for focal chondral defects, although most studies indicate that injections of biologics are safe and without significant adverse effects. [Orthopedics. 2019; 42(2):66-73.].


Assuntos
Doenças das Cartilagens/terapia , Osteoartrite/terapia , Transplante de Medula Óssea , Humanos , Ácido Hialurônico/farmacologia , Ácido Hialurônico/uso terapêutico , Transplante de Células-Tronco Mesenquimais , Plasma Rico em Plaquetas , Viscossuplementos/farmacologia , Viscossuplementos/uso terapêutico
15.
Bone Joint J ; 101-B(3): 325-330, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30813785

RESUMO

AIMS: The aim of this study was to evaluate cartilaginous patellotrochlear congruence and patellofemoral alignment parameters after deepening trochleoplasty in severe trochlear dysplasia. PATIENTS AND METHODS: The study group comprised 20 patients (two male, 18 female; mean age 24 years (16 to 39)) who underwent deepening trochleoplasty and medial patellofemoral ligament (MPFL) reconstruction for the treatment of recurrent lateral patellar dislocation due to severe trochlear dysplasia (Dejour type B to D). Pre- and postoperative MRI investigations of the study group were compared with MRI data of 20 age- and gender-matched control patients (two male, 18 female; mean age 27 years (18 to 44)) regarding the patellotrochlear contact ratio, patellotrochlear contact area, posterior patellar edge-trochlear groove ratio, and patellar tilt. RESULTS: Preoperatively, all parameters in the study group indicated significant patellar malalignment, including a reduced patellotrochlear contact ratio (mean 0.38 (0.13 to 0.59) vs mean 0.67 (0.48 to 0.88); p < 0.001), reduced contact area (mean 128 mm2 (87 to 190) vs mean 183 mm2 (155 to 227); p < 0.001), increased patellar lateralization (mean 0.82 (0.55 to 1.0) vs mean 0.99 (0.93 to 1.1); p < 0.001) and increased patellar tilt (mean 25.8° (8.1° to 43.0°) vs mean 9.1° (0.5° to 16.8°); p < 0.001). Postoperatively, all parameters in the study group improved significantly and reached normal values compared with the control group. The patellotrochlear contact ratio increased to a mean of 0.63 (0.38 to 0.85) (p < 0.001), the contact area increased to a mean of 187 mm2 (101 to 255) (p < 0.001), the posterior patellar edge-trochlear groove ratio improved to a mean of 0.96 (0.83 to 0.91) (p < 0.001), and the patellar tilt decreased to a mean of 13.9° (8.1° to 22.1°) (p < 0.001) postoperatively. CONCLUSION: Deepening trochleoplasty and MPFL reconstruction normalized the patellotrochlear congruence and patellofemoral alignment parameters. Modifying the dysplastic trochlea involves approximating the trochlear morphology to the shape of the patella rather than inducing a patella and trochlea mismatch. Cite this article: Bone Joint J 2019;101-B:325-330.


Assuntos
Doenças das Cartilagens/cirurgia , Fêmur/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Adolescente , Adulto , Doenças das Cartilagens/diagnóstico por imagem , Feminino , Fêmur/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Masculino , Procedimentos Ortopédicos , Luxação Patelar/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos , Recidiva , Adulto Jovem
18.
Z Orthop Unfall ; 157(5): 515-523, 2019 Oct.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-30736086

RESUMO

PURPOSE: This study was aimed to determine the impact of bioregenerative operations in case of degenerative cartilage lesions within the media knee compartment. MATERIAL AND METHODS: The CartilageRegistry DGOU was founded in 2013. At the deadline August 2016 a total of 1847 patients were included. A total of 23.3% (n = 432) was suffering from a degenerative cartilage lesion in the medial compartment. Follow-up was performed after 6, 12, and 24 months (online evaluation). The patients were asked for their subject feeling as well as the KOOS (Knee injury and Osteoarthritis Outcome Score) was determined. RESULTS: Most of the patients (n = 358) suffered from a single femoral lesion. In 25 cases single tibial and in 49 cases combined defects ("kissing lesions") were addressed by different treatment options: 39.9% autologous chondrocyte transplantation, in 8.1% in combination with a spongiosa plasty. Other treatments were drilling, microfracturing with or without matrix. In 17.9% the surgeons had chosen combined methods. The bioregenerative treatment was combined with a concomitant operation in 39.7% in patients with medial, in 56.0% in patients with a tibial, and in 67.9% in patients with combined defects. The mostly performed additional operations were osteotomies. There were no gender differences at baseline or during follow-up. The history of patients with femoral defects was shorter than in the other groups. The patients with medial defects judged the subjective outcome significant more frequently better after 6, 12, or 24 months compared with the other groups. The KOOS raised from baseline (median 52 points) to a median of 75 after 6, to 78 points after 12, and to 80 points after 24 months. Patients with femoral defects had a better KOOS-outcome in tendency. Revision operations were required in 7.1%. CONCLUSIONS: The treatment of degenerative cartilage lesions (respective early OA) by bioregenerative procedures are well-established measures. These treatments are sufficient to produce high patients' satisfaction and acceptable short/midterm results.


Assuntos
Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Adolescente , Adulto , Idoso , Doenças das Cartilagens/fisiopatologia , Cartilagem Articular/patologia , Cartilagem Articular/fisiologia , Feminino , Fêmur/fisiopatologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Regeneração , Sistema de Registros , Tíbia/fisiopatologia , Tíbia/cirurgia , Adulto Jovem
19.
Arch Orthop Trauma Surg ; 139(6): 819-841, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30758661

RESUMO

INTRODUCTION: The purpose of this systematic review and meta-analysis was to analyze and compare the rate of secondary meniscus and cartilage lesions diagnosed at different time points of ACL reconstruction. MATERIALS AND METHODS: A systematic search for articles comparing the rate of secondary meniscus and cartilage lesions diagnosed at different time points of ACL reconstruction was performed. PubMed central was the database used for the literature review. RESULTS: Forty articles out of 1836 were included. In 35 trials (88%), there was evidence of a positive correlation between the rate of meniscus and/or cartilage lesions and the time since ACL injury. This correlation was more evident for the medial meniscus in comparison with the lateral meniscus. In particular, a delay of more than 6 months was critical for secondary medial meniscus injuries [risk ratio 0.58 (95% CI 0.44-0.79)] and a delay of more than 12 months was critical for cartilage injuries [risk ratio 0.42 (95% CI 0.29-0.59)]. Additionally, there is evidence that the chance for meniscal repair decreases as the time since ACL rupture increases. CONCLUSION: Chronic instability in the ACL-deficient knee is associated with a significant increase of medial meniscus injuries after 6 months followed by a significant increase of cartilage lesions after 12 months.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Doenças das Cartilagens/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Lesões do Menisco Tibial/epidemiologia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Humanos , Meniscos Tibiais/cirurgia , Prevalência
20.
Int J Mol Sci ; 20(3)2019 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-30717402

RESUMO

Despite advances in cartilage repair strategies, treatment of focal chondral lesions remains an important challenge to prevent osteoarthritis. Articular cartilage is organized into several layers and lack of zonal organization of current grafts is held responsible for insufficient biomechanical and biochemical quality of repair-tissue. The aim was to develop a zonal approach for cartilage regeneration to determine whether the outcome can be improved compared to a non-zonal strategy. Hydrogel-filled polycaprolactone (PCL)-constructs with a chondrocyte-seeded upper-layer deemed to induce hyaline cartilage and a mesenchymal stromal cell (MSC)-containing bottom-layer deemed to induce calcified cartilage were compared to chondrocyte-based non-zonal grafts in a minipig model. Grafts showed comparable hardness at implantation and did not cause visible signs of inflammation. After 6 months, X-ray microtomography (µCT)-analysis revealed significant bone-loss in both treatment groups compared to empty controls. PCL-enforcement and some hydrogel-remnants were retained in all defects, but most implants were pressed into the subchondral bone. Despite important heterogeneities, both treatments reached a significantly lower modified O'Driscoll-score compared to empty controls. Thus, PCL may have induced bone-erosion during joint loading and misplacement of grafts in vivo precluding adequate permanent orientation of zones compared to surrounding native cartilage.


Assuntos
Regeneração Óssea , Condrócitos/citologia , Condrócitos/metabolismo , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Cicatrização , Animais , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/etiologia , Doenças das Cartilagens/patologia , Doenças das Cartilagens/terapia , Cartilagem Articular/metabolismo , Cartilagem Articular/patologia , Diferenciação Celular , Condrogênese , Modelos Animais de Doenças , Hidrogéis , Suínos , Engenharia Tecidual , Tecidos Suporte , Microtomografia por Raio-X
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