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1.
Clin Orthop Surg ; 11(3): 282-290, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475048

RESUMO

Background: Although microfracture is widely accepted as an effective treatment option for knee chondral lesions, little is known about the deterioration of clinical outcomes and radiological progression in middle-aged patients. Therefore, this study was conducted to evaluate the clinical and radiological changes after microfracture of knee chondral lesions in middle-aged Asian patients. Methods: A total of 71 patients were included in the study. They were between the ages of 40 and 60 years and underwent arthroscopic microfracture for localized full-thickness cartilage defects of the knee from January 2000 to September 2015. The recovery status of chondral lesions was assessed by using the magnetic resonance observation of cartilage repair tissue (MOCART) score in postoperative magnetic resonance imaging (MRI). Clinical and radiological results were reviewed, and survival rate with conversion to arthroplasty or osteotomy as an end point was evaluated. Results: The mean age of the patients at surgery was 51.3 ± 4.7 years (range, 40 to 60 years), and the mean follow-up period was 7.2 ± 2.6 years (range, 1.0 to 17.4 years). The MOCART scores of 32 patients at mean postoperative 2.1 years showed three cases (9%) of full recovery, two cases (7%) of hyperplastic recovery, 23 cases (70%) with more than 50% filling, and four cases (14%) with less than 50% filling. Clinical scores improved significantly at 1 year after surgery (p < 0.05); however, the scores deteriorated over time after postoperative 1 year, and the mean values reached preoperative levels at postoperative 10 years. Significant radiological progression of arthritis (Kellgren-Lawrence grade) was observed at 5 years after surgery. Four patients underwent total knee arthroplasty during follow-up. Conclusions: Most patients showed more than 50% of defect filling at 2 years after surgery on MRI. Clinical results of microfracture of knee chondral lesion showed the best improvement at postoperative 1 year but gradually worsened thereafter until postoperative 10 years. Radiological progression of arthritis was observed from 5 years after surgery.


Assuntos
Artroplastia Subcondral , Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Adulto , Grupo com Ancestrais do Continente Asiático , Doenças das Cartilagens/diagnóstico , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/etnologia , Cartilagem Articular/diagnóstico por imagem , Progressão da Doença , Humanos , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem
2.
Eur J Radiol ; 118: 161-168, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439236

RESUMO

PURPOSE: To evaluate whether baseline MRI-defined structural abnormalities are associated with subsequent change in laminar femorotibial cartilage transverse relaxation time (T2) of participants without radiographic signs, symptoms or risk factors for knee osteoarthritis (OA). METHOD: We studied all right knees with longitudinal MRI data of the refined Osteoarthritis Initiative Healthy Reference cohort. Baseline osteophytes, effusion-synovitis, Hoffa-synovitis, bone marrow lesions, cartilage lesions, and meniscus morphology and - extrusion were scored semiquantitatively from MR images by an expert reader. Deep and superficial layer cartilage T2 was computed in the medial and lateral femorotibial compartment (MFTC/LFTC) at baseline and at 1- and 4-year follow-up from multi-echo spin-echo MR images. Statistical analyses were performed using UNIANOVA. RESULTS: 82 participants (age 54.1 ±â€¯7.2y, BMI 24.2 ±â€¯3.0 kg/m²; 61% women, bilateral Kellgren-Lawrence 0) were studied. Number of baseline MRI pathologies was not significantly associated with longitudinal change in MFTC or LFTC cartilage T2 over 1 or 4 years. Feature-specific analyses suggested that presence of baseline MFTC osteophytes may be associated with prolongation in superficial MFTC cartilage T2 over one (0.8 vs. 0.0 ms, p = 0.02) and four years (2.3 vs. 0.9 ms, p = 0.01), and that MFTC meniscal damage or extrusion may be associated with prolongation in deep layer T2 times over the first year (0.7 vs. 2.1 ms, p = 0.02). CONCLUSIONS: Our study does not provide evidence that, in knees without radiographic OA, baseline structural MRI abnormalities are strongly related to compositional progression during normal aging and/or the potentially earliest phases of the disease as measured by cartilage T2.


Assuntos
Doenças das Cartilagens/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imagem por Ressonância Magnética/métodos , Doenças das Cartilagens/patologia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Artropatias/patologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho , Medição de Risco , Fatores de Risco , Tempo
4.
Acta Clin Croat ; 58(1): 103-106, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363331

RESUMO

The aim of the study was to investigate knee cartilage thickness in polycystic ovary syndrome (PCOS) patients using ultrasonography and to assess the effects of sex steroids on osteoarthritis development. A total of 90 female patients were enrolled in the study, including 47 patients diagnosed with PCOS as study group and 43 patients admitted to our hospital for any other complaints as control group. Ultrasonographic evaluation of both knees was performed in all patients. The knee cartilage thickness was measured at lateral condyle, intercondylar area and medial condyle. The measurements were averaged for each region. The mean femoral cartilage thickness was greater in the study group compared with control group in all regions, with a statistically significant difference (p<0.005). In conclusion, we found PCOS patients to have greater mean cartilage thickness, supporting the possible effects of sex steroids on osteoarthritis development.


Assuntos
Doenças das Cartilagens/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Síndrome do Ovário Policístico/fisiopatologia , Adulto , Doenças das Cartilagens/etiologia , Estudos Transversais , Feminino , Fêmur/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
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
6.
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
7.
BMC Musculoskelet Disord ; 20(1): 267, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153367

RESUMO

BACKGROUND: It is unclear whether postoperative outcomes are associated with the cartilage regeneration after open wedge high tibial osteotomy (OWHTO) combined with microfracture. The purpose of this study was to evaluate the regeneration of the articular cartilage, radiologic, and clinical outcomes after OWHTO with and without microfracture. METHODS: Eighty-seven patients who underwent OWHTO from 2014 to 2015 were retrospectively included in this study. Fifty-seven OWHTOs with microfracture on medial femoral condyle (MFC) (group 1) and 30 OWHTOs without microfracture (group 2) were compared at a mean 2-year follow-up. The regeneration of the articular cartilage was evaluated using International Cartilage Repair Society (ICRS) grade on the second-look arthroscopy and the magnetic resonance observation of cartilage repair tissue (MOCART) score on magnetic resonance imaging (MRI). The weight-bearing line (WBL) ratio, hip-knee-ankle (HKA) angle, joint line convergence angle (JLCA) and Ahlbäck grade were evaluated. The clinical outcomes were evaluated using the Western Ontario and McMaster University (WOMAC) scores and the Knee Society (KS). RESULTS: The articular cartilage in the MFC were regenerated in 67.8% of group 1 (43/57) and 58.6% of group 2 (16/30), respectively (p = 0.014). However, change of the ICRS grades of the medial tibial plateau, lateral and patellofemoral compartments showed no statistical difference between the groups. Total MOCART score in group 1 was superior to that in the group 2 at postoperative 2 years (41.8 ± 18.6 vs. 31.8 ± 19.8, p = 0.023). Regarding MOCART score, microfracture was only effective in the defect filling and integration to the border zone of the MFC (p < 0.001 and p = 0.035, respectively). Other radiologic and clinical outcomes showed no statistical differences between the groups. CONCLUSION: Microfracture of the MFC during OWHTO only helped the filling of the degenerative cartilage defect and the integration of the cartilage with adjacent cartilage. However, the clinical and radiologic outcome could not be improved by mircrofracture in the OWHTO.


Assuntos
Artroplastia Subcondral/métodos , Doenças das Cartilagens/cirurgia , Cartilagem Articular/patologia , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Assistência ao Convalescente , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/patologia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/patologia , Regeneração , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/cirurgia , Resultado do Tratamento
8.
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
9.
Turk J Med Sci ; 49(3): 844-853, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31121997

RESUMO

Background/aim: Evaluating the relationship of patellar chondromalacia with obesity, infrapatellar fat pad (IFP) volume and popliteal artery intima-media thickness (IMT). Materials and methods: A total of203 patients with different degree of patellar chondromalacia (103 male, 100 female) and 52 control subjects (19 male, 33 female) were included and grouped according to sex, age, body surface area (BSA), body mass index (BMI) and patellar chondromalacia classification. All measurements were completed with 3T magnetic resonance imaging (MRI). Articular cartilage and IFP volume were measured in saggital plane using double echo steady state (DESS) and DIXON sequences, respectively. Patellar cartilage damage was graded using modified outerbridge classification, and the relations among cartilage volume and BMI, BSA, IFP, IMT were statistically assessed. Results: Popliteal artery IMT showed an independent association with the prevalence of cartilage defects and IFP volumes (P ˂ 0.001). There was an association between BMI and IFP volumes (P ˂ 0.001). However, no differences were observed between IFP volume and different chondromalacia groups. When IFP measurements were corrected using individual BMI and BSA values, a positive correlation was found between control and advanced chondromalacia groups (P ˂ 0.001). Conclusion: This study demonstrates the relationship among obesity, IMT and chondromalacia and highlights this potential circle to develop effective treatments and inhibit the progression of chondromalacia.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Índice de Massa Corporal , Doenças das Cartilagens , Patela , Artéria Poplítea/diagnóstico por imagem , Adulto , Idoso , Doenças das Cartilagens/complicações , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/fisiopatologia , Técnicas de Diagnóstico Cardiovascular , Feminino , Humanos , Joelho/diagnóstico por imagem , Joelho/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Patela/diagnóstico por imagem , Patela/fisiopatologia , Artéria Poplítea/fisiologia , Adulto Jovem
10.
J Am Acad Orthop Surg ; 27(20): 752-759, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30964755

RESUMO

Bone marrow lesions of the knee in patients with osteoarthritis (OA-BML) are an important clinical entity that may explain progressive pain, decreased quality of life, and impaired function. MRI of OA-BMLs demonstrates a region of subchondral bone with hyperintense marrow signal on T2-weighted images. Histopathology retrieval studies have demonstrated that these lesions correlate with microdamage of the trabecular bone, and subsequently, this leads to a vicious cycle of subchondral bone attrition, attempts at repair, pain, and progressive deformity. These lesions have also been linked to accelerated loss of adjacent articular cartilage and increases in the severity of knee pain, prompting patients to seek musculoskeletal care and treatment. Multiple studies have also correlated the presence of an OA-BML with an increased probability of seeking knee arthroplasty. Knowledge of these lesions is important in the context that knee OA is both a cartilage-based and bone-based disease. Further study of OA-BMLs may provide opportunities for early intervention and OA disease-modifying treatments.


Assuntos
Doenças da Medula Óssea/patologia , Doenças das Cartilagens/patologia , Osteoartrite do Joelho/patologia , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/cirurgia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/cirurgia , Humanos , Imagem por Ressonância Magnética , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos
11.
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.
J Vet Med Sci ; 81(5): 747-749, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-30867352

RESUMO

A 9-year-old castrated male cat presented with sudden onset of paralysis in four limbs. Magnetic resonance imaging revealed an intramedullary lesion at C3, and lesions in the vermis and right hemisphere of the cerebellum, which were hyperintense on T2-weighted imaging. The cat was euthanized, and postmortem examination was performed. Grossly, transverse sectioning of the spinal cord revealed areas of malacia within the gray matter extending from C2 to C3. Histologically, the ventral spinal artery, the spinal intramedullary arteries and the arterioles of arachnoid in the cerebellum contained fibrocartilaginous emboli confirmed by metachromatic staining with toluidine blue. To our knowledge, this is the first report of fibrocartilaginous embolism involving both the cerebellum and cervical spinal cord in a cat.


Assuntos
Doenças das Cartilagens/veterinária , Doenças do Gato/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Embolia/veterinária , Medula Espinal/diagnóstico por imagem , Animais , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/patologia , Doenças do Gato/patologia , Gatos , Cerebelo/patologia , Embolia/diagnóstico por imagem , Embolia/patologia , Imagem por Ressonância Magnética/veterinária , Masculino , Paralisia/etiologia , Paralisia/veterinária , Medula Espinal/patologia
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.
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
15.
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
16.
Rheumatology (Oxford) ; 58(7): 1206-1213, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30690561

RESUMO

OBJECTIVES: To determine the prevalence and distribution of US-detected qualitative cartilage damage at metacarpal heads of patients with RA and hand OA. METHODS: Fifty-two RA patients and 34 patients with hand OA were enrolled. US examination of the metacarpal head cartilage from the II to V finger of both hands was performed. A total of 414 MCP joints in RA and 266 MCP joints in OA patients were scanned with a linear probe up to 22 MHz. Qualitative assessments using a previously described scoring system for cartilage damage were performed. The prevalence and distribution of cartilage damage were analysed. Multivariate regression analysis was used to determine the predictive value of age, gender, BMI, disease duration and the presence of RF and anti-CCP antibodies for US-detected cartilage damage. RESULTS: The metacarpal head cartilage was positive for cartilage damage in 35.7% (148/414) of MCP joints in RA and in 43.6% (116/266) of MCP joints in OA patients. In RA, the hyaline cartilage of the II and III metacarpal heads (bilaterally) was the most frequently affected. In OA, cartilage damage was more homogeneously distributed in all MCP joints. Multivariate regression analysis showed that age and disease duration, but not gender, BMI or autoantibody status, were independent predictors of US-detected cartilage damage in RA. CONCLUSION: Cartilage damage was found in more than one-third of the MCP joints in both RA and OA patients, and in RA patients, the II and III MCP joints were the most damaged.


Assuntos
Artrite Reumatoide/complicações , Doenças das Cartilagens/etiologia , Articulação Metacarpofalângica/diagnóstico por imagem , Osteoartrite/complicações , Adulto , Fatores Etários , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Autoanticorpos/sangue , Doenças das Cartilagens/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/tratamento farmacológico , Radiografia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores Sexuais , Ultrassonografia
17.
Rheumatol Int ; 39(4): 751-755, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30612148

RESUMO

Idiopathic hip chondrolysis is a rare disorder, the pathophysiology of which has not been fully elucidated. Several theories have been proposed regarding the cause of the disease with some of them involving autoimmune-mediated cartilage destruction. There are several similar features between idiopathic hip chondrolysis and rheumatologic diseases such as juvenile idiopathic arthritis, so whether these two disorders are different or not is still debatable. This case report aims to help comprehending this complex disorder by presenting a case of idiopathic hip chondrolysis with apparent risk factors, such as repetitive microtrauma and presence of HLA-B27 antigens. A 15-year-old HLA-B27 positive male presented with idiopathic hip chondrolysis after excessive walking. Initial treatment consisted of medications including corticosteroids, protected weight bearing and surgical soft tissue release. After failure of all these modalities in restoring the decreased range of motion of the hip, a course of a TNF-inhibitor, etanercept was tried. Alleviation of pain achieved early in the treatment period, but range of motion remained mainly unchanged. Although there was a brief improvement of stiffness for a short period after surgery which lasted for about 3 months, stiffness came back afterwards. Administration of a TNF inhibitor in the following period significantly improved his range of motion. The presence of laboratory findings indicating an autoimmune tendency in this patient supports the hypothesis of susceptibility of these patients to autoimmune reactions, while excessive walking was an apparent trigger factor. In future, traditional treatments may be abandoned in favor of novel medications targeting immunologic pathways.


Assuntos
Doenças das Cartilagens/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Refugiados , Caminhada , Adolescente , Artrite Juvenil/diagnóstico , Artroscopia , Doenças das Cartilagens/genética , Doenças das Cartilagens/patologia , Doenças das Cartilagens/terapia , Cartilagem Articular/patologia , Diagnóstico Diferencial , Etanercepte/uso terapêutico , Grupo com Ancestrais do Continente Europeu , Antígeno HLA-B27/genética , Articulação do Quadril/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Modalidades de Fisioterapia , Radiografia , /uso terapêutico
18.
Skeletal Radiol ; 48(6): 931-937, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30357459

RESUMO

OBJECTIVE: To determine if radiographic medial tibiofemoral offset (MTFO) is associated with: (1) magnetic resonance imaging (MRI) pathology of cartilage, meniscus, and ligament; and (2) a distinct pattern of lateral cartilage degeneration on MRI. MATERIALS AND METHODS: Three hundred consecutive adult knee MRIs with anteroposterior (AP) radiographs were retrospectively reviewed, and 145 studies were included. MTFO was defined as a medial extension of the medial femoral condyle beyond the articular surface of the medial tibial plateau on weight-bearing AP radiographs. The patients were then divided into the MTFO (n = 61) or no-offset (n = 84) groups. On MRI data obtained on a 1.5-Tesla system, articular cartilage of the femoral condyle and tibial plateau were graded using a modified Outerbridge classification (36 sub-regions similar to whole-organ MRI Score (WORMS) system). In addition, MR pathology of the ACL, MCL, LCL, medial and lateral menisci, were determined. RESULTS: Significantly increased (ANOVA p < 0.007) MR grade of the ligaments, menisci, and cartilage in the MTFO group (ranging from 0.3 to 2.5) compared to the control group (0.2 to 1.1). Color maps of the cartilage grades suggested a marked difference in both severity of degeneration and regional variations between the groups. MTFO group exhibited focally increased cartilage grades in the central, non-weight regions of lateral compartment (region p = 0.07 to 0.12, interaction p = 0.05 to 0.1). CONCLUSIONS: MTFO is associated with overall degeneration of the knee and features a distinct lateral cartilage degeneration pattern, which may reflect non-physiologic contact of the cartilage between the lateral tibial eminence and lateral central femoral condyle.


Assuntos
Doenças das Cartilagens/patologia , Cartilagem Articular/patologia , Fêmur/anormalidades , Articulação do Joelho/patologia , Imagem por Ressonância Magnética , Meniscos Tibiais/patologia , Tíbia/anormalidades , Doenças das Cartilagens/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Feminino , Fêmur/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia/diagnóstico por imagem
19.
Ultrasound Med Biol ; 45(1): 148-159, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30322672

RESUMO

The purpose of this study was to evaluate the effect of low-intensity ultrasound on articular cartilage and subchondral bone alterations in joints under normal and functional disuse conditions during osteoarthritis (OA) progression. Total of thirty 5-mo-old female Sprague-Dawley rats were randomly assigned to six groups (n = 5/group): age-matched group, OA group, OA + ultrasound (US) group, hindlimb suspension (HLS) group, HLS + OA group and HLS + OA + US group. The surgical anterior cruciate ligament was used to induce OA in the right knee joints. After 2 wk of OA induction, low-intensity ultrasound generated with a 3-MHz transducer with 20% pulse duty cycle and 30 mW/cm2 acoustic intensity was delivered to the right knee joints for 20 min a day, 5 d a week for a total of 6 wk. Then, the right tibias were harvested for micro-computed tomography, histologic and mechanical analysis. Micro-computed tomography results indicated that the thickness and sulfated glycosaminoglycan content of cartilage decreased, but the thickness of the subchondral cortical bone plate and the formation of subchondral trabecular bone increased in the OA group under the normal joint use condition. Furthermore, histologic results revealed that chondrocyte density and arrangement in cartilage corrupted and the underlying subchondral bone increased during OA progression. These changes were accompanied by reductions in mechanical parameters in OA cartilage. However, fewer OA symptoms were observed in the HLS + OA group under the joint disuse condition. The cartilage degeneration and subchondral bone sclerosis were alleviated in the US treatment group, especially under normal joint use condition. In conclusion, low-intensity ultrasound could improve cartilage degeneration and subchondral sclerosis during OA progression. Also, it could provide a promising strategy for future clinical treatment for OA patients.


Assuntos
Doenças das Cartilagens/complicações , Cartilagem Articular/patologia , Osteoartrite/complicações , Tíbia/patologia , Ondas Ultrassônicas , Animais , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/patologia , Cartilagem Articular/diagnóstico por imagem , Modelos Animais de Doenças , Feminino , Osteoartrite/diagnóstico por imagem , Osteoartrite/patologia , Ratos , Ratos Sprague-Dawley , Esclerose , Tíbia/diagnóstico por imagem , Microtomografia por Raio-X
20.
J Pediatr Orthop B ; 28(2): 127-131, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30444750

RESUMO

Focal fibrocartilaginous dysplasia (FFCD) is a rare developmental disorder frequently leading to angular deformities in young children. It most commonly affects the proximal tibia followed by distal femur. There are totally 22 reported cases of FFCD of femur. We report a case of FFCD of distal femur as a cause of varus deformity that was managed nonoperatively. The deformity resolved spontaneously over a period of 8 years. This is the second reported case of spontaneous resolution of angular deformity secondary to FFCD of distal femur. We strongly recommend to observe the behavior of deformity over a period of 24 months before any surgical intervention is planned.


Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/terapia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/terapia , Fêmur/diagnóstico por imagem , Pré-Escolar , Fêmur/anormalidades , Humanos , Masculino , Remissão Espontânea
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