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Medicine Jun 2024Baker's cysts (BCs) are known to be associated with intra-articular pathologies. BCs can be classified into 2 types: simple and complicated. Although some studies have... (Comparative Study)
Comparative Study
Baker's cysts (BCs) are known to be associated with intra-articular pathologies. BCs can be classified into 2 types: simple and complicated. Although some studies have focused on BC using magnetic resonance imaging (MRI), which is the gold standard examination, no study has compared knee MRI features in patients with simple and complicated BCs. To assess the relationship between the type of BC (simple vs complicated) and other knee pathologies using MRI. Seventy patients who underwent knee MRI examination due to symptomatic knee were retrospectively recruited from April 2011 to April 2021 at a single hospital. In the knee MRI images, the following were assessed: type (simple or complicated), morphology, volume of BCs, thickness of the suprapatellar recess, presence of synovial proliferation of the suprapatellar recess, grade of knee joint effusion, presence of meniscal tear, and extent of meniscal extrusion. The patients were classified into 2 groups according to the type of BC: simple BC and complicated BC. The differences between the 2 groups were evaluated for all variables. Finally, 52 patients were included in this study, 15 were classified as "simple BC" group and 37 as "complicated BC" group. The volume of complicated BC (median: 4.6, interquartile range - IQR: 1.6-12.4) was significantly greater than that of simple BC (median: 0.7, IQR: 0.3-3.7; P = .007). The presence of synovial proliferation in the suprapatellar recess was significantly higher in complicated BC (91.9%) than that in simple BC (46.7%; P = .001). The thickness of the suprapatellar recess was significantly greater in complicated BC (median: 7.5, IQR: 5.8-10.7) than that in simple BC (median: 4.3, IQR: 2.3-7.6; P = .020). The medial meniscus extrusion was greater in complicated BC (median: 4.1, IQR: 2.8-5.1) than that in simple BC (median: 2.5, IQR: 1.8-4.4; P = .037). After adjusting these P-values using the Holm method, only the presence of synovial proliferation in the suprapatellar recess remained significant (P = .010). Using knee MRI images, we demonstrated that complicated BCs are more associated with intra-articular pathologies than simple BCs; such as cyst volume, amount of the knee joint effusion, synovial proliferation and medial meniscal extrusion. Among them, the presence of synovial proliferation was the most significant factor associated with complicated BCs.
Topics: Humans; Popliteal Cyst; Male; Female; Magnetic Resonance Imaging; Retrospective Studies; Middle Aged; Knee Joint; Adult; Aged
PubMed: 38847688
DOI: 10.1097/MD.0000000000038407 -
Orthopaedic Journal of Sports Medicine Jun 2024Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and...
BACKGROUND
Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and lead to impaired fixation and treatment failure.
PURPOSE/HYPOTHESIS
The purpose of this study was to determine optimal socket-tunnel drilling parameters for medial and lateral MAT with concurrent ACLR using artificial tibias and computed tomography (CT) scans for 3-dimensional (3D) modeling. It was hypothesized that clinically relevant socket tunnels could be created to allow for concurrent medial or lateral MAT and ACLR without significant risk for overlap at varying tunnel guide angles.
STUDY DESIGN
Descriptive laboratory study.
METHODS
A total of 27 artificial right tibias (3 per subgroup) were allocated to 9 experimental groups based on the inclination of the socket tunnels (55°, 60°, and 65°) created for simulating medial and lateral MAT and ACLR. Five standardized socket tunnels were created for each tibia using arthroscopic guides: one for the ACL tibial insertion and one for each meniscus root insertion. CT scans were performed for all specimens and sequentially processed using computer software to produce 3D models for quantitative assessment of socket-tunnel overlap risk. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney tests.
RESULTS
No subgroup consistently presented significantly safer distances than other subgroups for all distances measured. Three cases (11%) and 24 cases (~90%) of tunnel overlap occurred between the ACL tunnel and tunnels for medial and lateral MAT, respectively. Most socket-tunnel overlap (25 of 27; 92.6%) occurred between sockets at depths ranging between 6.3 and 10 mm from the articular surface. For ACLR and posterior root of the lateral meniscus setting, the guide set at 65° increased socket-tunnel distances.
CONCLUSION
When combined ACLR and MAT using socket tunnels for graft fixation is performed, the highest risk for tibial socket-tunnel overlap involves the ACLR tibial socket and the lateral meniscus anterior root socket at a depth of 6 to 10 mm from the tibial articular surface.
CLINICAL RELEVANCE
Setting tibial guides at 65° to the tibial articular surface with the tunnel entry point anteromedial and socket aperture location within the designated anatomic "footprint" will minimize the risk for socket-tunnel overlap.
PubMed: 38845611
DOI: 10.1177/23259671241246277 -
Transosseous Repair of Isolated Posterior Medial Meniscal Root Injuries in Children and Adolescents.Arthroscopy Techniques May 2024The meniscal roots are critically important for maintaining knee stability, functional load distribution, and proper knee kinematics. Although adult meniscal root...
The meniscal roots are critically important for maintaining knee stability, functional load distribution, and proper knee kinematics. Although adult meniscal root injuries have been a topic of increasing research, medial meniscus injuries also occur in pediatric and adolescent patients, with up to 2% of meniscal injuries involving root attachments. The purpose of this Technical Note is to demonstrate the transosseous repair of isolated posterior medial meniscal root injuries in children and adolescents, including tear visualization on magnetic resonance imaging and during arthroscopy, operative technique, and postoperative management.
PubMed: 38835467
DOI: 10.1016/j.eats.2024.102951 -
Arthroscopy Techniques May 2024This report describes the arthroscopic transtibial pullout repair technique using multiple simple stitch (MSS), which was used to treat a medial meniscus posterior root...
This report describes the arthroscopic transtibial pullout repair technique using multiple simple stitch (MSS), which was used to treat a medial meniscus posterior root tear (MMPRT) of the knee. The most commonly used technique to address this type of MMPRT is currently arthroscopic transtibial pullout repair. MSS pullout repair technique can provide excellent pullout strength and large tissue-bone contact area, which facilitates successful healing potential. This MSS pullout repair technique may be suggested as another useful option that can be used in the treatment of MMPRT.
PubMed: 38835464
DOI: 10.1016/j.eats.2024.102952 -
Arthroscopy Techniques May 2024The integrity of the posterior meniscus root attachment is vital for the preservation of knee joint biomechanics. Meniscus root tears treated nonoperatively or with...
The integrity of the posterior meniscus root attachment is vital for the preservation of knee joint biomechanics. Meniscus root tears treated nonoperatively or with meniscectomy lead to poor functional outcomes and progressive knee degeneration. Repair returns knee biomechanics back to the intact state and has an established record of positive mid-term to long-term results. Although transtibial pullout repair has been the gold standard, innovation is needed to overcome the limitations inherent to traditional approaches. The latest generation of transtibial pullout repair devices is adjustable, permits suture anchor placement directly into the root footprint, and has demonstrated encouraging early results in biomechanical analysis. This Technical Note describes an arthroscopic technique for medial meniscus posterior root repair that uses a knotless adjustable implant (SutureLoc; Arthrex) for aperture fixation via a transtibial approach with intratunnel soft anchor direct fixation and rip-stop suture configuration.
PubMed: 38835457
DOI: 10.1016/j.eats.2024.102934 -
Reverse Ramp Lesion Repair in Patients With Meniscotibial Ligament Avulsion Injury: The Hidden AMRI.Arthroscopy Techniques May 2024Lesions of the meniscocapsular junction and the meniscotibial ligament (MTL) of the posterior horn of the medial meniscus are common with knee ligamentous injuries and...
Lesions of the meniscocapsular junction and the meniscotibial ligament (MTL) of the posterior horn of the medial meniscus are common with knee ligamentous injuries and associated with residual rotational instability if left untreated. MTL avulsion from its tibial attachment has never been described among different types of meniscocapsular disruptions so far. Both diagnosis and treatment of such an injury can be challenging. This article describes a detailed technique and proposes an algorithm to appropriate management of this rare injury.
PubMed: 38835443
DOI: 10.1016/j.eats.2024.102930 -
Arthroscopy Techniques May 2024As an important structure for maintaining the hoop tension of the medial meniscus of the knee joint, the posterior root is receiving increasing attention. Medial...
As an important structure for maintaining the hoop tension of the medial meniscus of the knee joint, the posterior root is receiving increasing attention. Medial meniscus posterior root tear is an important reason for the occurrence, development, and kinematics changes of knee osteoarthritis. It is necessary to repair the posterior root of meniscus for restoring joint kinematics and improving clinical efficacy. This Technical Note reports a medial meniscus posterior root tear repair technique using arthroscopic transtibial pullout repair (ATPR) combined with tibial condylar valgus osteotomy. The aim of this technique is to repair the posterior root of the medial meniscus while correcting the force line through osteotomy, opening the joint gap, improving the joint surface fit, providing a good mechanical environment for meniscus repair, thereby improving the healing rate of the posterior root of the meniscus and reducing the risk of retear. Although clinical evidence is currently limited, we believe that this technology may have more clinical advantages compared with ATPR alone or ATPR combined with high tibial osteotomy.
PubMed: 38835442
DOI: 10.1016/j.eats.2024.102966 -
Naunyn-Schmiedeberg's Archives of... Jun 2024Osteoarthritis (OA) is a common degenerative joint disease that cause pain and disability in adults. Chondrocyte ferroptosis is found to be involved in OA progression....
Osteoarthritis (OA) is a common degenerative joint disease that cause pain and disability in adults. Chondrocyte ferroptosis is found to be involved in OA progression. Sappanone A has been found as an anti-inflammatory and antioxidative agent in several diseases. This study aims to investigate the effects of sappanone A on OA progression and chondrocyte ferroptosis. IL-1β-induced chondrocytes and destabilization of the medial meniscus (DMM)-induced rats were respectively used as the OA model in vitro and in vivo. The effects of sappanone A on inflammation, extracellular matrix (ECM) metabolism, and ferroptosis were determined. Our results showed that in IL-1β-induced chondrocytes, sappanone A suppressed the production of NO, PGE2, TNF-α, IL-6, iNOS, and COX2. Sappanone A also inhibited the expression of MMP3, MMP13, and ADAMTS5, while increasing collagen II expression. Moreover, sappanone A alleviated cytotoxicity and decreased the levels of intracellular ROS, lipid ROS, MDA, and iron, while increasing GSH levels. Additionally, sappanone A increased the protein expression of SLC7A11 and GPX4. Administration of ferroptosis activator reversed the inhibitory effects of sappanone A on IL-1β-induced inflammation and ECM degradation. More importantly, Sappanone A activated the Nrf2 signaling by targeting SIRT1. The inhibition of sappanone A on ferroptosis was greatly eliminated due to the addition of SIRT1 inhibitor. Furthermore, intra-articular injection of sappanone A mitigated cartilage destruction and ferroptosis in DMM-induced OA rats. In conclusion, sappanone A protects against inflammation and ECM degradation in OA via decreasing chondrocyte ferroptosis by activating the SIRT1/Nrf2 signaling. These findings deepen our understanding of chondrocyte ferroptosis in OA and highlight the therapeutic potential of sappanone A for OA.
PubMed: 38832987
DOI: 10.1007/s00210-024-03179-4 -
Bioactive Materials Sep 2024Osteoarthritis (OA) is a major clinical challenge, and effective disease-modifying drugs for OA are still lacking due to the complicated pathology and scattered...
Osteoarthritis (OA) is a major clinical challenge, and effective disease-modifying drugs for OA are still lacking due to the complicated pathology and scattered treatment targets. Effective early treatments are urgently needed to prevent OA progression. The excessive amount of transforming growth factor β (TGFβ) is one of the major causes of synovial fibrosis and subchondral bone sclerosis, and such pathogenic changes in early OA precede cartilage damage. Herein we report a novel strategy of intra-articular sustained-release of pirfenidone (PFD), a clinically-approved TGFβ inhibitor, to achieve disease-modifying effects on early OA joints. We found that PFD effectively restored the mineralization in the presence of excessive amount of TGFβ1 (as those levels found in patients' synovial fluid). A monthly injection strategy was then designed of using poly lactic--glycolic acid (PLGA) microparticles and hyaluronic acid (HA) solution to enable a sustained release of PFD (the "PLGA-PFD + HA" strategy). This strategy effectively regulated OA progression in destabilization of the medial meniscus (DMM)- induced OA mice model, including preventing subchondral bone loss in early OA and subchondral bone sclerosis in late OA, and reduced synovitis and pain with cartilage preservation effects. This finding suggests the promising clinical application of PFD as a novel disease-modifying OA drug.
PubMed: 38832304
DOI: 10.1016/j.bioactmat.2024.05.028 -
Molecular Medicine (Cambridge, Mass.) Jun 2024Osteoarthritis (OA) is a degenerative joint disease characterized by cartilage destruction and inflammation. CC chemokine receptor 1 (CCR1), a member of the chemokine...
BACKGROUND
Osteoarthritis (OA) is a degenerative joint disease characterized by cartilage destruction and inflammation. CC chemokine receptor 1 (CCR1), a member of the chemokine family and its receptor family, plays a role in the autoimmune response. The impact of BX471, a specific small molecule inhibitor of CCR1, on CCR1 expression in cartilage and its effects on OA remain underexplored.
METHODS
This study used immunohistochemistry (IHC) to assess CCR1 expression in IL-1β-induced mouse chondrocytes and a medial meniscus mouse model of destabilization of the medial meniscus (DMM). Chondrocytes treated with varying concentrations of BX471 for 24 h were subjected to IL-1β (10 ng/ml) treatment. The levels of the aging-related genes P16INK4a and P21CIP1 were analyzed via western blotting, and senescence-associated β-galactosidase (SA-β-gal) activity was measured. The expression levels of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), aggrecan (AGG), and the transcription factor SOX9 were determined through western blotting and RT‒qPCR. Collagen II, matrix metalloproteinase 13 (MMP13), and peroxisome proliferator-activated receptor (PPAR)-γ expression was analyzed via western blot, RT‒qPCR, and immunofluorescence. The impact of BX471 on inflammatory metabolism-related proteins under PPAR-γ inhibition conditions (using GW-9662) was examined through western blotting. The expression of MAPK signaling pathway-related molecules was assessed through western blotting. In vivo, various concentrations of BX471 or an equivalent medium were injected into DMM model joints. Cartilage destruction was evaluated through Safranin O/Fast green and hematoxylin-eosin (H&E) staining.
RESULTS
This study revealed that inhibiting CCR1 mitigates IL-1β-induced aging, downregulates the expression of iNOS, COX-2, and MMP13, and alleviates the IL-1β-induced decrease in anabolic indices. Mechanistically, the MAPK signaling pathway and PPAR-γ may be involved in inhibiting the protective effect of CCR1 on chondrocytes. In vivo, BX471 protected cartilage in a DMM model.
CONCLUSION
This study demonstrated the expression of CCR1 in chondrocytes. Inhibiting CCR1 reduced the inflammatory response, alleviated cartilage aging, and retarded degeneration through the MAPK signaling pathway and PPAR-γ, suggesting its potential therapeutic value for OA.
Topics: Animals; Mice; Osteoarthritis; PPAR gamma; Chondrocytes; Disease Models, Animal; Receptors, CCR1; Male; Interleukin-1beta; Mice, Inbred C57BL; Cyclooxygenase 2; Nitric Oxide Synthase Type II
PubMed: 38831316
DOI: 10.1186/s10020-024-00823-w