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Seminars in Musculoskeletal Radiology Jun 2024The posteromedial corner (PMC) of the knee is an anatomical region formed by ligamentous structures (medial collateral ligament, posterior oblique ligament, oblique... (Review)
Review
The posteromedial corner (PMC) of the knee is an anatomical region formed by ligamentous structures (medial collateral ligament, posterior oblique ligament, oblique popliteal ligament), the semimembranosus tendon and its expansions, the posteromedial joint capsule, and the posterior horn of the medial meniscus. Injuries to the structures of the PMC frequently occur in acute knee trauma in association with other ligamentous or meniscal tears. The correct assessment of PMC injuries is crucial because the deficiency of these supporting structures can lead to anteromedial rotation instability or the failure of cruciate ligaments grafts. This article reviews the anatomy and biomechanics of the PMC to aid radiologists in identifying injuries potentially involving PMC components.
Topics: Humans; Knee Injuries; Ligaments, Articular; Magnetic Resonance Imaging; Knee Joint; Biomechanical Phenomena
PubMed: 38768596
DOI: 10.1055/s-0044-1779718 -
Scandinavian Journal of Clinical and... May 2024PsoP27 is an antigen expressed in psoriatic lesions. It plays an inflammatory role in psoriasis. This study objective was to characterize antibodies (Abs) against PsoP27...
PsoP27 is an antigen expressed in psoriatic lesions. It plays an inflammatory role in psoriasis. This study objective was to characterize antibodies (Abs) against PsoP27 in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Levels of Abs against native and citrullinated PsoP27 in PsA and RA patients' synovial fluid (SF) and sera were determined by ELISA. SF of osteoarthritis (OA) patients and sera of healthy donors were used as controls. Levels of Abs against PsoP27 were correlated with disease activity scores. Abs against native and citrullinated PsoP27 levels in SF of PsA ( = 48; 0.38 ± 0.03 and 0.44 ± 0.04, respectively) and RA ( = 22; 0.57 ± 0.1 and 0.62 ± 0.09, respectively) were significantly higher than in OA patients ( = 23; 0.14 ± 0.01 and 0.15 ± 0.01, respectively) ( < .0001). For both Abs, there were no significant differences between their level in PsA and RA patients. There was no difference in the level of Abs against citrullinated PsoP27 in SF of seronegative versus seropositive RA patients. Levels of Abs against both native and citrullinated PsoP27 in the SF and level of systemic C-reactive protein in PsA correlated positively, while in RA there were no significant correlations with disease activity scores. No differences in level of Abs against PsoP27 were found in the sera of all three study groups. Abs against native and citrullinated PsoP27 are present in PsA and RA SF but not in those of OA patients, suggesting a potential role of those Abs in inflammatory joint diseases.
Topics: Humans; Arthritis, Psoriatic; Arthritis, Rheumatoid; Synovial Fluid; Autoantibodies; Male; Middle Aged; Female; Adult; Aged; Case-Control Studies; Osteoarthritis; Enzyme-Linked Immunosorbent Assay
PubMed: 38767606
DOI: 10.1080/00365513.2024.2352844 -
Cureus Apr 2024Cerclage wiring and tension band wiring are commonly utilized in orthopedic surgeries for patellar fractures, but wire breakage is a recognized complication. This report...
Challenging Open Extraction of Intraarticular Intracapsular Broken Patellar Cerclage Wire Adjacent to the Medial Femoral Condyle Following Unsuccessful Arthroscopic Removal.
Cerclage wiring and tension band wiring are commonly utilized in orthopedic surgeries for patellar fractures, but wire breakage is a recognized complication. This report presents a rare case where a broken cerclage wire exhibited intraarticular intracapsular migration, prompting open removal adjacent to the medial femoral condyle after unsuccessful attempts at arthroscopic extraction. A 50-year-old male with a history of patellar fracture fixation using cerclage and tension band wiring, presented with persistent knee pain and restricted motion. Radiographs revealed a united patellar fracture with a broken cerclage wire, and 3D CT pinpointed the wire fragment in the posterior knee compartment. Arthroscopic removal attempts through standard portals were ineffective, leading to a subsequent open removal via a Burk and Schaffer approach. Intraoperative fluoroscopy guided the thorough dissection, exposing the broken wire deep within the joint capsule, proximal to the intercondylar notch and adjacent to the medial femoral condyle. Meticulous extraction mitigated potential risks of cartilage and neurovascular damage. Follow-up imaging confirmed successful wire removal, and the patient experienced satisfactory functional recovery without significant complications. This case highlights the rare occurrence of intraarticular intracapsular migration of a broken cerclage wire and underscores the importance of timely removal to mitigate risks of cartilage and neurovascular damage. While arthroscopic removal is generally successful, cases of failure may necessitate open extraction, particularly when the wire is located posteriorly. The described approach, assisted by intraoperative fluoroscopy, proved effective in safely removing the broken wire and ensuring optimal patient outcomes.
PubMed: 38765375
DOI: 10.7759/cureus.58455 -
Journal of Orthopaedics and... May 2024Total joint arthroplasty is the recommended treatment for patients with end-stage osteoarthritis, as it reduces disability and pain and restores joint function. However,... (Review)
Review
Total joint arthroplasty is the recommended treatment for patients with end-stage osteoarthritis, as it reduces disability and pain and restores joint function. However, prosthetic joint infection is a serious complication of this procedure, with the two-stage exchange being the most common treatment method. While there is consensus on diagnosing prosthetic joint infection, there is a lack of agreement on the parameters that can guide the surgeon in performing definitive reimplantation in a two-stage procedure. One approach that has been suggested to improve the accuracy of microbiologic investigations before definitive reimplantation is to observe a holiday period from antibiotic therapy to improve the accuracy of cultures from periprosthetic tissues, but these cultures report some degree of aspecificity. Therefore, several pieces of evidence highlight that performing reimplantation using continuous antibiotic therapy should be considered a safe and effective approach, leading to higher cure rates and a shorter period of disability. Dosage of C-reactive protein (CRP), erythrocyte sedimentation rate (ERS) and D-dimer are helpful in diagnosing prosthetic joint infection, but only D-dimer has shown sufficient accuracy in predicting the risk of infection recurrence after a two-stage procedure. Synovial fluid analysis before reimplantation has been shown to be the most accurate in predicting recurrence, and new cutoff values for leukocyte count and neutrophil percentage have shown a useful predictive rule to identify patients at risk of unfavourable outcome. A new scoring system based on a numerical score calculated from the beta coefficient derived through multivariate analysis of D-dimer levels, synovial fluid leukocytes and relative neutrophils percentage has demonstrated high accuracy when it comes to guiding the second step of two-stage procedure. In conclusion, reimplantation may be a suitable option for patients who are on continuous therapy without local symptoms, and with CRP and ERS within the normal range, with low synovial fluid leukocytes (< 952/mL) and a low relative neutrophil percentage (< 52%) and D-dimer below 1100 µg/mL. A numerical score derived from analysing these three parameters can serve as a valuable tool in determining the feasibility of reimplantation in these patients.
Topics: Humans; Prosthesis-Related Infections; Reoperation; Anti-Bacterial Agents; Arthroplasty, Replacement; C-Reactive Protein; Fibrin Fibrinogen Degradation Products; Blood Sedimentation; Synovial Fluid
PubMed: 38761247
DOI: 10.1186/s10195-024-00767-1 -
Clinical Rheumatology Jul 2024
Topics: Humans; Arthritis, Rheumatoid; Synovial Fluid; Cytokines; T Follicular Helper Cells; T-Lymphocytes, Helper-Inducer
PubMed: 38761245
DOI: 10.1007/s10067-024-07006-2 -
Graefe's Archive For Clinical and... May 2024To investigate the performance of 10 MHz ultrasonography in detecting posterior lens capsule defects before traumatic cataract surgery.
PURPOSE
To investigate the performance of 10 MHz ultrasonography in detecting posterior lens capsule defects before traumatic cataract surgery.
METHODS
This retrospective analysis includes patients with traumatic cataracts who underwent cataract surgery. Preoperative 10 MHz ultrasonography was performed to evaluate whether the posterior lens capsule was defective or intact, and the results were compared to the intraoperative findings. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa were calculated.
RESULTS
The study included 140 eyes of 140 patients. There were 68 eyes with closed-globe injuries and 72 eyes with open-globe injuries. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa of 10 MHz ultrasonography was 86.76%, 90.28%, 89.39%, 87.84%, 88.57% and 0.771, respectively. The accuracy was 86.11% and 91.18% in open-globe and closed-globe injury groups, respectively.
CONCLUSION
The accuracy of 10 MHz ultrasonography in evaluating the posterior lens capsule in traumatic cataracts is high. Preoperative 10 MHz ultrasonography would help to make an appropriate surgical plan.
PubMed: 38758375
DOI: 10.1007/s00417-024-06523-9 -
Folia Morphologica May 2024The plantaris is a small muscle of the superficial posterior compartment of the leg. It originates at the lateral supracondylar line of the femur and the knee joint...
The plantaris is a small muscle of the superficial posterior compartment of the leg. It originates at the lateral supracondylar line of the femur and the knee joint capsule, from where it continues distally, forming a long and slender tendon distally attached to the calcaneal tuberosity. During standard anatomical dissection four-headed plantaris muscle was found and all of its heads connected to each other as a single muscle belly passing into tendinous structure which was distally attached as a standard plantaris muscle. The first head originated from the popliteal surface of the femur. The second one was originated from distal Kaplan fiber. In turn, the third and fourth heads were proximally attached to the lateral femoral epicondyle. Knowledge about morphological variations is necessary because of its potential clinical significance, which means not only neurovascular compressions, but also surgical procedures.
PubMed: 38757503
DOI: 10.5603/fm.98753 -
Redox Biology Jul 2024Our previous studies have shown that lipoxin A (LXA) can serve as a potential biomarker for assessing the efficacy of exercise therapy in knee osteoarthritis (KOA), and...
Lipoxin A ameliorates knee osteoarthritis progression in rats by antagonizing ferroptosis through activation of the ESR2/LPAR3/Nrf2 axis in synovial fibroblast-like synoviocytes.
BACKGROUND
Our previous studies have shown that lipoxin A (LXA) can serve as a potential biomarker for assessing the efficacy of exercise therapy in knee osteoarthritis (KOA), and fibroblast-like synoviocytes (FLSs) may play a crucial role in KOA pain as well as in the progression of the pathology.
OBJECTIVE
By analyzing the GSE29746 dataset and collecting synovial samples from patients with different Kellgren-Lawrence (KL) grades for validation, we focused on exploring the potential effect of LXA on ferroptosis in FLSs through the ESR2/LPAR3/Nrf2 axis to alleviate pain and pathological advancement in KOA.
METHODS
The association between FLSs ferroptosis and chondrocyte matrix degradation was explored by cell co-culture. We overexpressed and knocked down LPAR3 in vitro to explore its potential mechanism in FLSs. A rat model of monosodium iodoacetate (MIA)-induced KOA was constructed and intervened with moderate-intensity treadmill exercise and intraperitoneal injection of PHTPP to investigate the effects of the LXA intracellular receptor ESR2 on exercise therapy.
RESULTS
ESR2, LPAR3, and GPX4 levels in the synovium decreased with increasing KL grade. After LXA intervention in the co-culture system, GPX4, LPAR3, and ESR2 were upregulated in FLSs, collagen II was upregulated in chondrocytes, and MMP3 and ADAM9 were downregulated. LPAR3 overexpression upregulated the expression of GPX4, Nrf2, and SOD1 in FLSs, while downregulating the expression of MMP13 and MMP3; LPAR3 knockdown reversed these changes. Moderate-intensity platform training improved the behavioral manifestations of pain in KOA rats, whereas PHTPP treatment partially reversed the improvement in synovial and cartilage pathologies induced by platform training.
CONCLUSION
LXA inhibited FLSs ferroptosis by activating the ESR2/LPAR3/Nrf2 axis, thereby alleviating the pain and pathological progression of KOA. This study brings a new target for the treatment of KOA and also leads to a deeper understanding of the potential mechanisms of exercise therapy for KOA.
Topics: Animals; Osteoarthritis, Knee; Rats; Ferroptosis; Lipoxins; NF-E2-Related Factor 2; Synoviocytes; Humans; Male; Disease Models, Animal; Fibroblasts; Signal Transduction; Rats, Sprague-Dawley; Synovial Membrane; Disease Progression
PubMed: 38754271
DOI: 10.1016/j.redox.2024.103143 -
PloS One 2024The deficiency of clinically specific biomarkers has made it difficult to achieve an accurate diagnosis of temporomandibular joint osteoarthritis (TMJ-OA) and the...
The deficiency of clinically specific biomarkers has made it difficult to achieve an accurate diagnosis of temporomandibular joint osteoarthritis (TMJ-OA) and the insufficient comprehension of the pathogenesis of the pathogenesis of TMJ-OA has posed challenges in advancing therapeutic measures. The combined use of metabolomics and transcriptomics technologies presents a highly effective method for identifying vital metabolic pathways and key genes in TMJ-OA patients. In this study, an analysis of synovial fluid untargeted metabolomics of 6 TMJ-OA groups and 6 temporomandibular joint reducible anterior disc displacement (TMJ-DD) groups was conducted using liquid and gas chromatography mass spectrometry (LC/GC-MS). The differential metabolites (DMs) between TMJ-OA and TMJ-DD groups were analyzed through multivariate analysis. Meanwhile, a transcriptomic dataset (GSE205389) was obtained from the GEO database to analyze the differential metabolism-related genes (DE-MTGs) between TMJ-OA and TMJ-DD groups. Finally, an integrated analysis of DMs and DE-MTGs was carried out to investigate the molecular mechanisms associated with TMJ-OA. The analysis revealed significant differences in the levels of 46 DMs between TMJ-OA and TMJ-DD groups, of which 3 metabolites (L-carnitine, taurine, and adenosine) were identified as potential biomarkers for TMJ-OA. Collectively, differential expression analysis identified 20 DE-MTGs. Furthermore, the integration of metabolomics and transcriptomics analysis revealed that the tricarboxylic acid (TCA) cycle, alanine, aspartate and glutamate metabolism, ferroptosis were significantly enriched. This study provides valuable insights into the metabolic abnormalities and associated pathogenic mechanisms, improving our understanding of TMJOA etiopathogenesis and facilitating potential target screening for therapeutic intervention.
Topics: Humans; Osteoarthritis; Metabolomics; Male; Female; Temporomandibular Joint Disorders; Adult; Transcriptome; Temporomandibular Joint; Gene Expression Profiling; Biomarkers; Synovial Fluid; Gas Chromatography-Mass Spectrometry; Middle Aged
PubMed: 38753666
DOI: 10.1371/journal.pone.0301341 -
PloS One 2024Periprosthetic joint infection (PJI) is one of the most serious and debilitating complications that can occur after total joint arthroplasty. Therefore, early diagnosis...
BACKGROUND
Periprosthetic joint infection (PJI) is one of the most serious and debilitating complications that can occur after total joint arthroplasty. Therefore, early diagnosis and appropriate treatment are important for a good prognosis. Recently, molecular diagnostic methods have been widely used to detect the causative microorganisms of PJI sensitively and rapidly. The Multiplex Loop-Mediated Isothermal Amplification (LAMP) method eliminates the complex temperature cycling and delays caused by temperature transitions seen in polymerase chain reaction (PCR) methods, making it faster and easier to perform compared to PCR-based assays. Therefore, this study developed a multiplex LAMP assay for diagnosing bacterial PJI using LAMP technology and evaluated its analytical and clinical performance.
METHODS
We developed a multiplex LAMP assay for the detection of five bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, Pseudomonas aeruginosa, and Escherichia coli, frequently observed to be the causative agents of PJI. The method of analytical sensitivity and cross-reactivity were determined by spiking standard strains into the joint synovial fluid. The analytical sensitivity of the multiplex LAMP assay was compared with that of a quantitative real-time PCR (qPCR) assay. Clinical performance was evaluated using 20 joint synovial fluid samples collected from patients suspected of having bacterial PJI.
RESULTS
The analytical sensitivity of the gram-positive bacterial multiplex LAMP assay and qPCR were 105/104 CFU/mL, 103/103 CFU/mL, and 105/104 CFU/mL against S. agalactiae, S. epidermidis, and S. aureus, respectively. For P. aeruginosa and E. coli, the analytical sensitivity of the multiplex LAMP and qPCR assays were 105/104 and 106/104 CFU/mL, respectively. The multiplex LAMP assay detects target bacteria without cross-reacting with other bacteria, and exhibited 100% sensitivity and specificity in clinical performance evaluation.
CONCLUSIONS
This multiplex LAMP assay can rapidly detect five high-prevalence bacterial species causing bacterial PJI, with excellent sensitivity and specificity, in less than 1 h, and it may be useful for the early diagnosis of PJI.
Topics: Humans; Nucleic Acid Amplification Techniques; Prosthesis-Related Infections; Molecular Diagnostic Techniques; Sensitivity and Specificity; Staphylococcus epidermidis; Synovial Fluid; Bacterial Infections; Staphylococcus aureus
PubMed: 38753660
DOI: 10.1371/journal.pone.0302783