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Arthroscopy : the Journal of... May 2024To compare the patient-reported outcomes and radiological outcomes of the patients with medial- and lateral-cystic osteochondral lesions of the talus (OLTs) following...
Medial cystic osteochondral lesions of the talus exhibited lower sports levels, higher cyst-presence rate, and inferior radiological outcomes compared with lateral lesions following arthroscopic bone marrow stimulation.
PURPOSE
To compare the patient-reported outcomes and radiological outcomes of the patients with medial- and lateral-cystic osteochondral lesions of the talus (OLTs) following bone marrow stimulation (BMS).
METHODS
Patients with cystic OLTs who underwent BMS between January 2016 and February 2021 were retrospectively analyzed, and the minimum follow-up time was more than 24 months. Patients were paired in a 1:1 ratio (medial-: lateral-cystic OLT; MC-OLT: LC-OLT) based on the OLT area within 30mm, follow-up within 1 year, age within 5 years, and ligament surgery (Yes/No). The Visual analog scale, Foot and Ankle Ability Measure (FAAM)-Activities of Daily Life and Sports scores were assessed preoperatively and postoperatively. The magnetic resonance observation of cartilage repair tissue (MOCART) scores, and presence of cysts after BMS were also evaluated. Additionally, the receiver operating characteristic curve was performed.
RESULTS
The matched patients were divided into the MC-OLT(n=31, 43.35±12.32 months) and LC-OLT groups (n=31, 43.32±14.88 months, P=.986). Thirty patients of each group achieved a power of 80% and an α = 0.05 in this study. The MC-OLT group showed significantly less improvement in FAAM-ADL and sports scores (P = .034, P <0.001, respectively), lower MOCART scores (80.80±11.91 vs. 86.00±8.50, P = .010), and higher presence-rate of cyst after BMS (45.16% vs. 16.12%, P = .013). Regarding FAAM sports scores, the LC-OLT group had significantly more patients exceeding the MCID (80.64% vs. 51.61%, P = .031). Furthermore, an OLT depth of 7.23mm (sensitivity: 78.6%; specificity: 70.6%) might serve as a cut-off value for predicting the presence of cysts in medial-cystic OLTs following BMS.
CONCLUSION
Medial cystic OLTs exhibited markedly lower sports levels, higher cyst-presence rate, and inferior radiological outcomes following BMS than lateral counterparts. Additionally, an OLT depth of 7.23mm could be the cut-off value for predicting the presence of cysts regarding medial-cystic OLTs after BMS.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
PubMed: 38797503
DOI: 10.1016/j.arthro.2024.05.011 -
Knee Surgery, Sports Traumatology,... May 2024The purpose of the present study is to assess the gender-specific differences in the presentation and outcomes following Talar OsteoPeriostic grafting from the Iliac...
PURPOSE
The purpose of the present study is to assess the gender-specific differences in the presentation and outcomes following Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) between male and female patients.
METHODS
A prospective comparative analysis was performed comparing consecutive female and male patients having been treated by the press-fit TOPIC procedure. Clinical comparative assessment preoperatively and at 12 months of follow-up included determination of the Numeric Rating Scale (NRS) scores for pain during walking (primary outcome), at rest and during stair-climbing. The Foot and Ankle Outcome Score (FAOS) was also assessed. A computed tomography (CT) scan was performed for lesion size, morphology and localization determination preoperatively as well as 10-12 weeks postoperatively to assess the union of the osteotomy site and at 1 year postoperatively to assess consolidation of the graft as well as intra-graft cyst development.
RESULTS
A total of 48 patients (30 women, 18 men) were eligible for inclusion. Both men and women demonstrated significant functional improvements postoperatively concerning the clinical outcomes with no significant differences between men and women (n.s.) except for a significantly greater improvement in postoperative FAOS pain scores in women. Men presented with OLTs significantly larger in both surface area (208 mm for males versus 155 mm for females, p < 0.05) as well as lesion volume (3.0 cm for males versus 1.8 cm for females, p < 0.05). At 1-year postoperatively, all patients showed graft consolidation. Cyst formation was present in 11 females (37% of the group) and 10 males (59% of the group), respectively (n.s.).
CONCLUSION
Both males and females showed clinically relevant improvements in the clinical outcomes after undergoing the TOPIC procedure with significant differences in preoperative lesion size. The TOPIC procedure is a good treatment strategy for large OLTs in both men and women.
LEVEL OF EVIDENCE
Level III, comparative prospective clinical cohort.
PubMed: 38796727
DOI: 10.1002/ksa.12257 -
Scientific Reports May 2024Physiochemical tissue inducers and mechanical stimulation are both efficient variables in cartilage tissue fabrication and regeneration. In the presence of biomolecules,...
Physiochemical tissue inducers and mechanical stimulation are both efficient variables in cartilage tissue fabrication and regeneration. In the presence of biomolecules, decellularized extracellular matrix (ECM) may trigger and enhance stem cell proliferation and differentiation. Here, we investigated the controlled release of transforming growth factor beta (TGF-β1) as an active mediator of mesenchymal stromal cells (MSCs) in a biocompatible scaffold and mechanical stimulation for cartilage tissue engineering. ECM-derived hydrogel with TGF-β1-loaded alginate-based microspheres (MSs) was created to promote human MSC chondrogenic development. Ex vivo explants and a complicated multiaxial loading bioreactor replicated the physiological conditions. Hydrogels with/without MSs and TGF-β1 were highly cytocompatible. MSCs in ECM-derived hydrogel containing TGF-β1/MSs showed comparable chondrogenic gene expression levels as those hydrogels with TGF-β1 added in culture media or those without TGF-β1. However, constructs with TGF-β1 directly added within the hydrogel had inferior properties under unloaded conditions. The ECM-derived hydrogel group including TGF-β1/MSs under loading circumstances formed better cartilage matrix in an ex vivo osteochondral defect than control settings. This study demonstrates that controlled local delivery of TGF-β1 using MSs and mechanical loading is essential for neocartilage formation by MSCs and that further optimization is needed to prevent MSC differentiation towards hypertrophy.
Topics: Alginates; Microspheres; Tissue Engineering; Humans; Bioreactors; Hydrogels; Mesenchymal Stem Cells; Chondrogenesis; Animals; Cartilage; Tissue Scaffolds; Decellularized Extracellular Matrix; Transforming Growth Factor beta1; Cell Differentiation; Cells, Cultured; Transforming Growth Factor beta; Extracellular Matrix
PubMed: 38796487
DOI: 10.1038/s41598-024-62474-5 -
Journal of ISAKOS : Joint Disorders &... May 2024Patellofemoral instability is usually initially treated non-operatively. Surgery is considered in patients with recurrent patellar dislocation and after a first-time... (Review)
Review
Patellofemoral instability is usually initially treated non-operatively. Surgery is considered in patients with recurrent patellar dislocation and after a first-time patellar dislocation in the presence of either an associated osteochondral fracture or high risk of recurrence. Stratifying the risk of recurrence includes evaluating risk factors such as age, trochlear dysplasia, contralateral dislocation, and patellar height. Surgery with soft tissue procedures includes restoring the medial patellar restraints and balancing the lateral side of the joint. Reconstruction of the medial patellofemoral ligament is the most frequent way of addressing the medial soft tissues in patients with patellofemoral instability. Meanwhile, lateral tightness can be achieved by lateral retinaculum lengthening or release. Approaching patellofemoral instability in a patient-specific approach, combined with a shared decision-making process with the patient/family, will guide surgeons to the deliver optimal care for the patellar instability patient.
PubMed: 38795864
DOI: 10.1016/j.jisako.2024.05.013 -
Biomedicines May 2024This pilot study examined the long-term structural changes in the osteochondral unit of 20 patients with knee osteoarthritis (KOA) who underwent high tibial osteotomy...
Long-Term Structural Changes in the Osteochondral Unit in Patients with Osteoarthritis Undergoing Corrective Osteotomy with Platelet-Rich Plasma or Stromal Vascular Fraction Post-Treatment.
This pilot study examined the long-term structural changes in the osteochondral unit of 20 patients with knee osteoarthritis (KOA) who underwent high tibial osteotomy (HTO) and received post-treatment with either platelet-rich plasma (PRP) or stromal vascular fraction (SVF). Ten patients were injected with autologous PRP (PRP subgroup), while another ten patients received autologous SVF (SVF subgroup) six weeks after surgery and were monitored for 18 months. Histological samples of bone and cartilage (2 mm in diameter and 2 cm long) were taken from tibial and femoral sites during surgery and 18-month post-HTO, and morphometric analyses were conducted using Mega-Morf12 software. Both post-treatment resulted in an increase in articular cartilage height at both sites ( < 0.001 in the tibia and femur), indicating positive outcomes. Significant improvements in subchondral and trabecular bone architecture were also observed, with SVF injection showing higher reparative capacity in terms of bone volume ( < 0.001 for the tibia and = 0.004 for the femur), subchondral bone height ( < 0.001 for the tibia and = 0.014 for the femur), trabecular bone volume ( < 0.001 for the femur), and intertrabecular space ( = 0.009 for the tibia and = 0.007 for the femur). This pilot study, for the first time, demonstrates that HTO surgery combined with PRP and SVF post-treatments can lead to significant enhancements in knee articular cartilage and bone architecture in KOA patients, with SVF showing higher regenerative potential. These findings may contribute to improving treatment strategies for better clinical outcomes in HTO therapy for patients with KOA.
PubMed: 38791006
DOI: 10.3390/biomedicines12051044 -
Bioengineering (Basel, Switzerland) May 2024This study explores an approach to design and prepare a multilayer scaffold mimicking interstratified natural tissue. This multilayer construct, composed of chitosan...
This study explores an approach to design and prepare a multilayer scaffold mimicking interstratified natural tissue. This multilayer construct, composed of chitosan matrices with graded nanohydroxyapatite concentrations, was achieved through an in situ biomineralization process applied to individual layers. Three distinct precursor concentrations were considered, resulting in 10, 20, and 30 wt% nanohydroxyapatite content in each layer. The resulting chitosan/nanohydroxyapatite (Cs/n-HAp) scaffolds, created via freeze-drying, exhibited nanohydroxyapatite nucleation, homogeneous distribution, improved mechanical properties, and good cytocompatibility. The cytocompatibility analysis revealed that the Cs/n-HAp layers presented cell proliferation similar to the control in pure Cs for the samples with 10% n-HAp, indicating good cytocompatibility at this concentration, while no induction of apoptotic death pathways was demonstrated up to a 20 wt% n-Hap concentration. Successful multilayer assembly of Cs and Cs/n-HAp layers highlighted that the proposed approach represents a promising strategy for mimicking multifaceted tissues, such as osteochondral ones.
PubMed: 38790339
DOI: 10.3390/bioengineering11050471 -
Bioengineering (Basel, Switzerland) Apr 2024To address the limitations of alginate and gelatin as separate hydrogels, partially oxidized alginate, alginate dialdehyde (ADA), is usually combined with gelatin to...
To address the limitations of alginate and gelatin as separate hydrogels, partially oxidized alginate, alginate dialdehyde (ADA), is usually combined with gelatin to prepare ADA-GEL hydrogels. These hydrogels offer tunable properties, controllable degradation, and suitable stiffness for 3D bioprinting and tissue engineering applications. Several processing variables affect the final properties of the hydrogel, including degree of oxidation, gelatin content and type of crosslinking agent. In addition, in 3D-printed structures, pore size and the possible addition of a filler to make a hydrogel composite also affect the final physical and biological properties. This study utilized datasets from 13 research papers, encompassing 33 unique combinations of ADA concentration, gelatin concentration, CaCl and microbial transglutaminase (mTG) concentrations (as crosslinkers), pore size, bioactive glass (BG) filler content, and one identified target property of the hydrogels, stiffness, utilizing the Extreme Boost (XGB) machine learning algorithm to create a predictive model for understanding the combined influence of these parameters on hydrogel stiffness. The stiffness of ADA-GEL hydrogels is notably affected by the ADA to GEL ratio, and higher gelatin content for different ADA gel concentrations weakens the scaffold, likely due to the presence of unbound gelatin. Pore size and the inclusion of a BG particulate filler also have a significant impact on stiffness; smaller pore sizes and higher BG content lead to increased stiffness. The optimization of ADA-GEL composition and the inclusion of BG fillers are key determinants to tailor the stiffness of these 3D printed hydrogels, as found by the analysis of the available data.
PubMed: 38790283
DOI: 10.3390/bioengineering11050415 -
Medical Engineering & Physics Jun 2024Mass transport properties within three-dimensional (3D) scaffold are essential for tissue regeneration, such as various fluid environmental cues influence mesenchymal...
Mass transport properties within three-dimensional (3D) scaffold are essential for tissue regeneration, such as various fluid environmental cues influence mesenchymal stem cells differentiation. Recently, 3D printing has been emerging as a new technology for scaffold fabrication by controlling the scaffold pore geometry to affect cell growth environment. In this study, the flow field within scaffolds in a perfusion system was investigated with uniform structures, single gradient structures and complex gradient structures using computational fluid dynamics (CFD) method. The CFD results from those uniform structures indicate the fluid velocity and fluid shear stress within the scaffold structure increased as the filament diameter increasing, pore width decreasing, pore shape decreased from 90° to 15°, and layer configuration changing from lattice to stagger structure. By assembling those uniform structure as single gradient structures, it is noted that the fluid dynamic characterisation within the scaffold remains the same as the corresponding uniform structures. A complex gradient structure was designed to mimic natural osteochondral tissue by assembly the uniform structures of filament diameter, pore width, pore shape and layer configuration. The results show that the fluid velocity and fluid shear stress within the complex gradient structure distribute gradually increasing and their maximum magnitude were from 1.15 to 3.20 mm/s, and from 12 to 39 mPa, respectively. CFD technique allows the prediction of velocity and fluid shear stress within the designed 3D gradient scaffolds, which would be beneficial for the tissue scaffold development for interfacial tissue engineering in the future.
Topics: Hydrodynamics; Printing, Three-Dimensional; Tissue Engineering; Tissue Scaffolds; Porosity; Stress, Mechanical; Computer Simulation
PubMed: 38789213
DOI: 10.1016/j.medengphy.2024.104173 -
Clinics in Podiatric Medicine and... Jul 2024Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is... (Review)
Review
Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is composed primarily of hyaline cartilage, the regenerative capacity of these injuries is limited. Therefore, several open and arthroscopic techniques have been described to treat osteochondral injuries of the talus and underlying bone marrow lesions. Throughout this review, these treatment options are discussed along with their indications and currently reported outcomes. A commentary on the authors' preferences among these techniques is also provided.
Topics: Humans; Talus; Arthroscopy; Cartilage, Articular; Ankle Injuries; Male; Female
PubMed: 38789163
DOI: 10.1016/j.cpm.2024.01.004 -
Medicine May 2024Osteochondral lesions on the lateral process of the talus involving the subtalar joint are rare; the optimal surgical treatment remains to be clarified as there are few...
RATIONALE
Osteochondral lesions on the lateral process of the talus involving the subtalar joint are rare; the optimal surgical treatment remains to be clarified as there are few reports. Additionally, bilateral cases are extremely rare. Therefore, the clinical outcomes of the surgical treatment for bilateral osteochondral lesions on the lateral process of the talus involving the subtalar joint have not been fully elucidated.
PATIENT CONCERNS
A 16-year-old boy who played soccer presented to our hospital with bilateral hindfoot pain. The symptoms persisted even after 3 months of conservative treatment. The patient and family requested surgical treatment to relieve the symptoms.
DIAGNOSES
The patient was diagnosed with bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint based on computed tomography and magnetic resonance imaging findings.
INTERVENTIONS
Arthroscopic debridement and microfracture were performed bilaterally.
OUTCOMES
Postoperative computed tomography and magnetic resonance imaging of both feet revealed remodeling of the subchondral bone. The patient returned to play at the pre-injury level with no pain.
LESSONS
This report describes a case of bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint. Arthroscopic debridement and microfracture were effective in relieving symptoms and the subchondral bone remodeling. To the best of our knowledge, this is the first report of arthroscopic treatment of osteochondral lesions of the lateral process of the talus involving the subtalar joint.
Topics: Humans; Male; Adolescent; Debridement; Talus; Subtalar Joint; Arthroscopy; Magnetic Resonance Imaging; Soccer; Tomography, X-Ray Computed; Arthroplasty, Subchondral
PubMed: 38787984
DOI: 10.1097/MD.0000000000038302