OBJECTIVE To present a simple and reliable method for the reconstruction of metacarpophalangeal joint by the cartilage transplantation of metatarsophalangeal joint. METHODS From 1990, nine cases (11 sides) with traumatic metacarpophalangeal joint defect were treated by the autogenous cartilage transplantation of metatarsophalangeal joint followed by modified treatment. Appropriate biological mechanics was provided by internal fixation and collateral ligament repair. RESULTS Followed up 6 months to 7 years, the range of joint motion was increased 35.1 degrees. The fusion of donor phalanges was fine, and the range of joint motion was decreased, even ankylosis after plastic operation, but no pain and no effect on walk. CONCLUSION The key to successful operation is better matching of cartilage, reliable internal fixation, ligament reconstruction, thin cartilage and little bone of the donor, appropriate biological mechanical surroundings.
Objective To establ ish a porcine model of articular full-thickness cartilage defect characterized byremaining cartilage calcified zone on femoral trochlea, so as to provide a considerable and comparative control group forinvestigating repair effects of tissue engineered scaffolds in articular cartilage defects with cartilage calcified zone remaining.Methods The full-thickness cartilage column defects (6 mm in diameter, 0.2-0.5 mm in depth) without damage on calcifiedcartilage zone were made on the femoral trochlea in 9 clean-grade 6-month-old Guizhou mini pigs by standard cartilage-defectmakingsuites. Microscopical observation was performed after modeling. Scanning were made by 3.0T MRI at 4 weeks. Thengeneral observation, stereomicroscope, and histological staining were used to observe cartilage repair. Results All animals wereal ive. No infection of incisions or patellar dislocations occurred; they were able to walk with partial weight-bearing immediatelyafter surgery and could move freely without limp at 1 week. Obvious signal discontinuity in trochlea and subchondral bone couldbe observed in MRI, without deep signal change in defects surrounding. Microscopical observation showed a few repair tissueand petechia at base of the defect with clear boundary. Nearly intact calcified zone of cartilage and zonal collapse of subchondralbone in defects could be observed with stereomicroscope. Under common microscope, no chondrocytes was found in defects,as well as negative staining of fast green-safranin O and alcian blue. Under polarized microscope, the bottom of defects werefilled with a l ittle of fibrous tissue presenting continuous and b l ight-refraction by sirius red staining. Conclusion Theanimal model of articular full-thickness cartilage defect on femoral trochlea by standard cartilage-defect-making suites can beapplied for the research of cartilage disease in early human osteoarthritis and function of calcified cartilage zone in pig.
Objective To explore the effect of arthroscopy on diagnosing and treating suppurative arthritis of knee joint. Methods The clinical data of 22 patients with suppurative arthritis of knee joint diagnosed between January 2012 and December 2013 were analyzed retrospectively, including 13 males and 9 females with the age of 7-56 years (average 28.5 years). The duration of disease history was from 7 days to 4.5 months with the average of 2.8 months. All of the patients had swelling, pain, and limitation of motion of the knee joint in different degrees. Among them, 20 patients were diagnosed definitely and remaining 2 were osteoarthritis with atypical infections. Patients were investigated by Lysholm questionnaires during the follow-up period. Results All of the 22 patients were followed up for 3-10 months with the average of 8.5 months. The diagnosis was confirmed by pathological and arthroscopic examination after the surgery, and no recurrence was found. Lysholm score ranged from 77 to 99 with the average of 92.8. Only 1 patient had the motion range of 10-40°of the knee joint after several treatment. Conclusion Early arthroscopic treatment for suppurative arthritis of knee joint with continuous postoperati ve lavage and irrigation combined with comprehensive physiotherapy and rehabilitation has the advantages of high efficacy, maximum recovery of knee function, and quick recovery, which should be promoted in the clinical application
ObjectiveTo summarize the active changes of Wnt signaling pathway in osteoarthritis (OA) as well as the influence and mechanism of dual-targeted regulation on cartilage and subchondral bone and the role of crosstalk between them on OA process.MethodsThe relevant literature concerning the articular cartilage, subchondral bone, and crosstalk between them in OA and non-OA states by Wnt signaling pathway in vivo and vitro experimental studies and clinical studies in recent years was reviewed, and the mechanism was analyzed and summarized.ResultsWnt signaling can regulate the differentiation and function of chondrocytes and osteoblasts through the classic β-catenin-dependent or non-classical β-catenin-independent Wnt signaling pathway and its cross-linking with other signaling pathways, thereby affecting the cartilage and bone metabolism. Moreover, Wnt signaling pathway can activate the downstream protein Wnt1-inducible-signaling pathway protein 1 to regulate the progress of OA and it also can be established gap junctions between different cells in cartilage and subchondral bone to communicate molecules directly to regulate OA occurrence and development. Intra-articular injection of Wnt signaling inhibitor SM04690 can inhibit the progress of OA, and overexpression of Wnt signaling pathway inhibitor Dickkopf in osteoblasts can antagonize the role of vascular endothelial growth factor work on chondrocytes and inhibit the catabolism of its matrix.ConclusionThe regulation of metabolism and function of cartilage and subchondral bone and crosstalk between them is through interactions among Wnt signaling pathway and molecules of other signaling. Therefore, it plays an vital role in the occurrence and development of OA and is expected to become a new target of OA treatment through intervention and regulation of Wnt signaling pathway.
Objective To summarize the best evidence for improving adherence to exercise therapy in non-surgical patients with knee osteoarthritis (KOA), so as to provide an evidence-based basis and reference for healthcare professionals, managers, patients, and caregivers. Methods Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses Association of Ontario, National Guideline Clearinghouse, American College of Rheumatology, Osteoarthritis Research Society International, Turkish League Against Rheumatism, European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, System for Information on Grey Literature in Europe, Cochrane Library, PubMed, Joanna Briggs Library, www.guide.medlive.cn, China National Knowledge Infrastructure, and WanFang Data were searched by computer for literature about improving exercise therapy compliance in non-surgical patients with KOA. The retrieval time limit was from January 1, 2017 to April 20, 2022. The quality of the included literature was evaluated by 2 researchers with evidence-based training, and ultimately evidence was extracted from the literature that met the quality evaluation criteria. Results A total of 12 publications were included, including 5 guidelines, 4 systematic reviews, and 3 expert consensuses, covering 6 aspects of multidisciplinary teamwork, development of individualized exercise plans, external support, interventions, health education, and follow-up management. A total of 18 best evidences for improving exercise therapy compliance in non-surgical patients with KOA were summarized, with 8 A-level recommendations and 10 B-level recommendations. Conclusions When applying the evidence, clinical staff should fully assess and develop exercise plans with individual patients, strengthen multidisciplinary communication and writing, make full use of external support resources and do health education and full follow-up management. Through comprehensive consideration and selection of the best evidence for implementation, the compliance of KOA non-surgical patients with exercise therapy can be improved.
【Abstract】 Objective To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty,to observe the cl inical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy inthe treatment of osteoarthritis of knee with varum. Methods From June 2004 to February 2006, 8 patients with osteoarthritisof knee with varum(10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellarplastyand high tibial osteotomy. There were 2 males with 3 knees, and 6 females with 7 knees,with an average age of 50 years(42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients hadknee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibialjoint，especially in the medial. The gap between patella and femur narrowed or disappeared，especially in the medial femurtibialjoint. The femoral tibial angel (FTA) was 185-200°(mean 190°). The HSS score of knee was 55-75(mean 60). The history ofknee ache was 1-12 years(mean 5 years). Results All patients were followed up for 7-24 months (mean 15 months). All theincisions healed by first intention, no early compl ication occurred. The cl inical bone heal ing time was 8-11 weeks(mean 9 weeks).Rectification of FTA was 15-30°(mean 20°). Normal weight-loading al ignment was recovered. The valgus angle of knee was 10°.The range of motion of knee was 100-120° after operation, increasing by 5-20° (mean 10°) when compared with preoperation.The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakageoccurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation. Conclusion Mosaicplastyof femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can rel ieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading al ignment. The curative effect is good withthe combined methods.
Objective To evaluate the short-term results of reconstruction of stiff elbow under arthroscopy technique in patients with elbow osteoarthritis. Methods Between March 2006 and March 2009, 38 cases of elbow osteoarthritis with contracture were treated under arthroscopy technique. There were 26 males and 12 females with an average age of 47.8 years (range, 26-66 years). Unilateral side was affected in all cases, including 13 cases at the left side and 25 at the right side with 30 patients on the dominant side. The disease duration was more than 6 months. X-ray examination showed that 31 patients had free body, and 28 had osteophytosis. Seven patients had ulnar neuritis. The arthroscopy functional reconstruction was performed including synovectomy, free body removal, and osteocapsular arthroplasty. Results All incisions healed by first intention. All patients were followed up 6-10 months (mean, 8 months). Transient radial nerve injury occurred in 1 case, re-adhesion of elbow joint in 1 case, and heterotopic ossification of brachial ulnar joint in 1 case at 6 months after operation. In 1 patient compl icated by ulnar neuritis, the disorder of ulnar nerve was not improved, nervous symptoms disappeared after the re-operation of ulnar nerve relaxation after 2 months. The range of motion, Mayo Elbow Performance Score (MEPS), and visual analogue scale (VAS) for pain at 3 and 6 months had significant differences when compared with those before operation (P lt; 0.05), but had no significant difference between two time points after operation (P gt; 0.05). According to MEPS functional criteria, the results were classified as excellent in 20 cases, good in 15 cases, fair in 2 cases, and poor in 1 case at 6 months after operation, and the excellent and good rate was 92.1%. No new free body or osteophytosis occurred after operation by X-ray examination. Conclusion The arthroscopy is an effective technique to reconstruct the function of stiff elbow, which can obviously improve the range of motion and the function of elbow joint, and has good short-term results.
Objective To access the protective effects of glucosamine hydrochloride capsules (OTL) on articular cartilage in osteoarthritis of rabbit. Methods Thirty-six New Zealand white rabbits were divided randomly into three groups (n=12): sham group (group A), anterior cruciate l igament transection (ACLT)/normal sal ine group (group B), and ACLT/ OTL group (group C). Rabbits in groups B, C received ACLT on the right knee. Rabbits in group A were not given ACLT ascontrol. Group C received a daily administration of OTL at a dose of 150 mg/kg of body weight for 12 weeks; in contrast, group B received normal sal ine at the same dose. All rabbits were sacrificed after 12 weeks. The right femoral condyle were removed and observed at pathologic changes with HE staining and graded by Mankin’s scale, the expression level of transforming growth factor β1 (TGF-β1) and interleukin 1β (IL-1β) were detected by immunohistochemical staining. Results All rabbits survived at the end of experiment and incision healed well. The gross observation showed that joint synovia increased and articular surface was smooth and integrity in group A; that ulcer was observed on the articular surface of group B; and that articular surface was smooth and integrity in group C. There were sigificant differences in articular cartilage scores between 3 groups (P lt; 0.05). The histological observation showed that the articular cartilage had normal structure and the cells arranged regularly in group A; that the articular cartilage became thin and the cells arranged irregularly in group B; and that the cells arranged with a clear layer and had regular shape in group C. The Mankin scores were 1.04 ± 0.13, 7.97 ± 0.12, and 2.81 ± 0.36 in groups A, B, and C, respectively; showing significant difference between 3 groups (P lt; 0.05). The result of immunohistochemistry showed that the expressions of TGF-β1 were 50.62 ± 1.51, 24.81 ± 1.28, and 41.57 ± 1.69 and the expressions of IL-1β were 13.12 ± 1.21, 62.53 ±2.37, and 30.67 ± 1.28; showing significant differences between 3 groups (P lt; 0.05). Conclusion A daily administration ofOTL at a dose of 150 mg/kg for 12 weeks can partially decrease the expression levels of IL-1β and increase the expression levels of TGF-β1, which delays the development of osteoarthritis.
Objective To compare the effectiveness and complications of various surgical techniques in the treatment of the osteoarthritis of the trapeziometacarpal joint. Methods We searched MEDLINE (1966 to 2005), Cochrane Controlled Trials Register (Issue 3, 2005) and CBM (1978 to 2005), and handsearched the references of relevant studies. Only randomized controlled trials were included. We assessed the methodological quality of the included studies, extracted data, and performed quantitative and qualitative analyses. Results Seven studies were included, and all had some methodological shortcomings. There was b evidence that in the short term, ligamentous reconstruction, tendon interposition (LRTI) and trapeziectomy alone provide similar results with regard to pain relief, grip and pinch strength, range of thumb motion, hand function and overall satisfaction of patients, but more complications occur with LRTI than with trapeziectomy alone. Conflicting evidence was found about whether LRTI resulted in less subsidence of the first metacarpal bone than trapeziectomy alone. There was moderate evidence that LRTI and ligament reconstruction without tendon interposition (LR) did not have significant differences in thumb strength, patient satisfaction and subsidence of the first metacarpal bone. Limited evidence showed that LR produced better functional scores than LRTI and similar results in pain relief to LRTI. Conflicting evidence supported that LR resulted in greater motion range of thumb than LRTI. Only limited evidence showed that effectiveness was similar between LRTI and Swanson implant. We did not find randomized controlled trials about other surgical techniques. Conclusion Not enough evidence supports superiority of one technique over another. More high quality randomized controlled trials and long term follow-up are necessary.
Objective To review the recent research progress on relationshi p between subchondral bone and cartilage degeneration in osteoarthritis (OA), and to predict future research directions. Methods Recent l iteratures about the pathological changes of subchondral bone in OA were reviewed and analyzed in terms of biomechanics, bone remodel ingand biological factors. Results Subchondral bone sclerosis or softening was the result of osteoarthritis and also closely related to the occurrence and development of OA. Inhibiting the bone metabol ism of subchondral bone could slow the degeneration of articular cartilage. Conclusion For the treatment of OA, it is necessary to pay close attention to cartilage changes and the prevention of subchondral bone degeneration.