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Owoeye OBA, Whittaker JL, Toomey CM, Räisänen AM, Jaremko JL, Carlesso LC, Manske SL, Emery CA. Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold? Foot Ankle Int 2022; 43:21-31. [PMID: 34353138 DOI: 10.1177/10711007211033543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study examined the association between youth sport-related ankle sprain injury and health-related outcomes, 3-15 years postinjury. METHODS A historical cohort study in which uninjured controls were cluster-matched with injured cases. The primary outcome was self-reported Foot and Ankle Outcome Score (FAOS). Secondary outcomes included measures of adiposity, validated questionnaires for physical activity, athletic identity, fear of pain, and tests of strength, balance, and function. RESULTS We recruited 86 participants (median age of 23 years; 77% female); 50 with a time-loss ankle sprain, median of 8 years postinjury, and 36 uninjured controls cluster-matched by sex and sport. Based on mixed effects multivariable regression models, previously injured participants demonstrated poorer outcomes than controls on all 5 FAOS subscales regardless of sex and time since injury, with the largest differences observed in symptoms (-20.9, 99% CI: -29.5 to -12.3) and ankle-related quality of life (-25.3, 99% CI: -34.7 to -15.9) subscales. Injured participants also had poorer unipedal dynamic balance (-1.9, 99% CI: 3.5 to -0.2) and greater fear of pain (7.2, 99% CI: 0.9-13.4) compared with controls. No statistically significant differences were found for other secondary outcomes. CONCLUSION At 3-15 years following time-loss ankle sprain injury in youth sport, previously injured participants had more pain and symptoms, poorer self-reported function, ankle-related quality of life, reduced sport participation, balance, and greater fear of pain than controls. This underlines the need to promote the primary prevention of ankle sprains and secondary prevention of potential health consequences, including posttraumatic osteoarthritis. LEVEL OF EVIDENCE Level III, historical cohort study.
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Affiliation(s)
- Oluwatoyosi B A Owoeye
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St Louis, MO, USA.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Clodagh M Toomey
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| | - Anu M Räisänen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Therapy Education, College of Health Sciences, Western University of Health Sciences, Lebanon, OR, USA
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa C Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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52
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Gorbachova T, Melenevsky YV, Latt LD, Weaver JS, Taljanovic MS. Imaging and Treatment of Posttraumatic Ankle and Hindfoot Osteoarthritis. J Clin Med 2021; 10:jcm10245848. [PMID: 34945144 PMCID: PMC8703616 DOI: 10.3390/jcm10245848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022] Open
Abstract
Posttraumatic osteoarthritis of the ankle and hindfoot is a common and frequently debilitating disorder. 70% to 90% of ankle osteoarthritis is related to prior trauma that encompasses a spectrum of disorders including fractures and ligamentous injuries that either disrupt the articular surface or result in instability of the joint. In addition to clinical evaluation, imaging plays a substantial role in the treatment planning of posttraumatic ankle and hindfoot osteoarthritis. Imaging evaluation must be tailored to specific clinical scenarios and includes weight bearing radiography that utilizes standard and specialty views, computed tomography which can be performed with a standard or a weight bearing technique, magnetic resonance imaging, and ultrasound evaluation. This review article aims to familiarize the reader with treatment rationale, to provide a brief review of surgical techniques and to illustrate expected imaging appearances of common operative procedures performed in the setting of posttraumatic ankle and hindfoot osteoarthritis, such as joint-preserving procedures, ankle fusion, subtalar fusion, tibiotalarcalcaneal fusion and ankle arthroplasty. Preoperative findings will be discussed along with the expected postoperative appearance of various procedures in order to improve detection of their complications on imaging and to provide optimal patient care.
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Affiliation(s)
- Tetyana Gorbachova
- Einstein Medical Center, Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19141, USA
- Correspondence:
| | - Yulia V. Melenevsky
- Department of Radiology, UAB Medical Center, University of Alabama at Birmingham, Birmingham, AL 35249, USA;
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85724, USA;
| | - Jennifer S. Weaver
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Mihra S. Taljanovic
- Department of Radiology, University of New Mexico Health Sciences, Albuquerque, NM 87131, USA;
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85724, USA
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53
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Godoy-Santos AL, Fonseca LF, de Cesar Netto C, Giordano V, Valderrabano V, Rammelt S. Ankle Osteoarthritis. Rev Bras Ortop 2021; 56:689-696. [PMID: 34900095 PMCID: PMC8651441 DOI: 10.1055/s-0040-1709733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
Abstract
Osteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing post-traumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Laboratório Prof Manlio Mario Marco Napoli, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Programa Aparelho Locomotor, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, United States
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, SP, Brasil
| | | | - Stefan Rammelt
- Universitäts Centrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Alemanha
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54
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Sinclair J, Brooks D, Taylor PJ, Liles N. Effects of toe-in/ out toe-in gait and lateral wedge orthoses on lower extremity joint kinetics; an exploration using musculoskeletal simulation and Bayesian contrasts. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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55
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Keller LE, Tait Wojno ED, Begum L, Fortier LA. Regulatory T cells provide chondroprotection through increased TIMP1, IL-10 and IL-4, but cannot mitigate the catabolic effects of IL-1β and IL-6 in a tri-culture model of osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100193. [PMID: 36474817 PMCID: PMC9718146 DOI: 10.1016/j.ocarto.2021.100193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 01/19/2023] Open
Abstract
Objective To gain insight into Treg interactions with synovial tissues in early OA, an equine tri-culture model of OA was used to test the hypothesis that Tregs, in the absence of T Helper 17 cells, are sufficient to resolve inflammation elicited by IL-1β. Methods To model normal and OA joints, synoviocytes were co-cultured with chondrocytes in a transwell system and ± stimulated with IL-1β. Tregs were activated and enriched, then added to co-cultures, creating tri-cultures. At culture end, synoviocytes and chondrocytes were analyzed for gene expression, Treg Foxp3 expression was reexamined by flow cytometry, and conditioned media were evaluated by ELISA. Results Tregs increased IL-10 and IL-4 in tri-culture media and increased TIMP1 gene expression in synoviocytes and chondrocytes. Tregs increased IL-6 in conditioned media and Il6 gene expression in synoviocytes, which was additive with IL-1β. In chondrocytes, addition of Tregs decreased Col2b gene expression while Acan gene expression was decreased by IL-1β and addition of Tregs. IL-17A was detected in tri-cultures. CCL2 and CCL5 were increased in tri-cultures. Conclusions In a tri-culture model of OA, addition of Tregs resulted in conditions conducive to chondroprotection including increased concentration of IL-10 and IL-4 in conditioned media and increased gene expression of TIMP1 in both chondrocytes and synoviocytes. However, there was increased concentration of the catabolic cytokine IL-6, and decreased gene expression of Col2b and Acan in IL-1β-stimulated chondrocytes. These results suggest that blocking IL-6 could enhance Treg function in mitigating OA progression.
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Affiliation(s)
- Laura E. Keller
- Cornell University, College of Veterinary Medicine, Department of Clinical Sciences, USA
| | | | - Laila Begum
- Cornell University, College of Veterinary Medicine, Department of Clinical Sciences, USA
| | - Lisa A. Fortier
- Cornell University, College of Veterinary Medicine, Department of Clinical Sciences, USA
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56
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Teo BJX, Gatot C, Cheng DZC, Koo K. Location of Talar Osteochondral Defects in Chronic Lateral Ankle Instability in an Asian Population. J Foot Ankle Surg 2021; 60:689-691. [PMID: 33546989 DOI: 10.1053/j.jfas.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/20/2020] [Accepted: 01/13/2021] [Indexed: 02/03/2023]
Abstract
Osteochondral defect of the talus is traditionally described to involve the anterolateral and posteromedial portion of the talar dome in patients with chronic lateral ankle instability. Recent studies challenged this notion with advances in preoperative imaging and arthroscopy. Since Asian patients are more prone to ligamentous laxity, we postulate that the morphology and severity of osteochondral defects may be different in this population. Intraoperative records of 272 patients undergoing modified Broström-Gould procedure were reviewed for arthroscopic evidence of osteochondral defects. We characterized the morphology according to an anatomical 9-grid classification. Talar osteochondral defects were seen in 52 (19.1%) patients with a double lesion present in 1 patient. Medial-sided lesions account for nearly 3-quarters (n = 38, 73.1%) of all lesions and tend to be larger (79.4 ± 55.7 mm2 vs 51.0 ± 28.6 mm2, p =.08). There was no osteochondral defect seen in the central zones. There was no significant gender or age differences between patients with medial and lateral lesions. The most commonly performed procedure was microfracture. Osteochondral defects are commonly encountered in our Asian patients undergoing surgery for chronic lateral ankle instability. Contrary to published data, medial lesions are prevalent with no central lesions seen.
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Affiliation(s)
- Bryon J X Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Daryl Z C Cheng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore; The Bone and Joint Centre, Mount Elizabeth Hospital, Singapore
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57
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Lan T, McCarthy HS, Hulme CH, Wright KT, Makwana N. The management of talar osteochondral lesions - Current concepts. JOURNAL OF ARTHROSCOPY AND JOINT SURGERY 2021; 8:231-237. [PMID: 34337329 PMCID: PMC8312263 DOI: 10.1016/j.jajs.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Diagnosis of OLTs requires a combination of clinical assessment and imaging and despite many different treatment options, there is no generalised consensus regarding which option is the most effective. Left untreated, OLTs risk progressing to osteoarthritis. Acute non-displaced OLTs can be treated non-operatively. However, OLTs refractory to non-surgical care for three to six months may be suitable for surgical care. In these cases, conservative treatments are often unsuccessful, particularly for larger and more severe defects and so the majority require surgical intervention. Although bone marrow stimulation techniques remain the "gold standard" for lesions <150 mm2, there still requires a need for better long term clinical data and cost-benefit analyses compared with other treatment options. Biological attempts at either regenerating or replacing the articular cartilage are however demonstrating some promising results, but each with their own advantages and disadvantages. In this review, we summarise the clinical management of OLTs and present the current concepts of different treatment regimes.
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Affiliation(s)
- Tian Lan
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
| | - Helen S. McCarthy
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
| | - Charlotte H. Hulme
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
| | - Karina T. Wright
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
| | - Nilesh Makwana
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
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58
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Chen X, Lim JA, Zhou A, Thahir A. Currents concepts of the perioperative management of closed ankle fractures. J Perioper Pract 2021; 32:295-300. [PMID: 34190640 PMCID: PMC9619258 DOI: 10.1177/17504589211006018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ankle fractures are common injuries that can result in substantial morbidity in the population. This review discusses the management of closed ankle fractures and outlines the recent evidence and guidelines on perioperative management. In general, a detailed history should be undertaken, followed by examination and imaging of the affected limb. Fixation is based on the AO principles of fracture management that aims towards restoring stability of the joint and reducing the risk of long-term complications. A multidisciplinary approach towards perioperative management is recommended in view of the increasing proportion of aging patients with significant comorbidities.
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Affiliation(s)
- Xiaoyu Chen
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jiang An Lim
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Andrew Zhou
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK
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59
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Yeo ED, Park SB, Lee SW, Cho WJ, Kim HK, Cheon SH, Lee YK. Knotless All-Inside Arthroscopic Modified Broström Procedure for Lateral Ankle Instability. J Foot Ankle Surg 2021; 60:541-547. [PMID: 33549425 DOI: 10.1053/j.jfas.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/07/2020] [Accepted: 11/30/2020] [Indexed: 02/03/2023]
Abstract
One reported complication of the arthroscopic modified Broström operation is pain caused by the suture anchoring knot. We hypothesized that a knotless technique could reduce such pain. Therefore, in this study we evaluated the clinical and radiological outcomes after knotless all-inside arthroscopic modified Broström operation for lateral ankle instability. From July 2017 to November 2017, 28 patients were treated. Clinical and radiological features were evaluated preoperatively and 3, 6, and 12 months postoperatively using the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale score, visual analogue scale score for pain, anterior talar drawer test, and talar tilt angle. The mean age of the 28 patients (14 men, 14 women) was 41.71 ± 17.19 years. Three (10.7%) complications, but no knot-associated pain, occurred. The clinical and radiological outcomes were significantly improved 12 months postoperatively compared with preoperative outcomes (all p < .05). Knotless all-inside arthroscopic modified Broström operation for lateral ankle instability avoided knot-associated pain and improved not only patient satisfaction but also clinical and radiological outcomes.
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Affiliation(s)
- Eui Dong Yeo
- Department of Orthopedic Surgery, VHS medical center, South Korea
| | - Sung Bum Park
- Department of Orthopaedic Surgery, Lee Chun Tek Hospital, South Korea
| | - Sang Woo Lee
- Department of Orthopaedic Surgery, Yonsei The Bareun Hospital, South Korea
| | - Whi Je Cho
- Departments of Orthopedic Surgery, Soonchunhyang University, Bucheon Hospital, South Korea
| | - Hyun Kwon Kim
- Departments of Orthopedic Surgery, Soonchunhyang University, Bucheon Hospital, South Korea
| | - Seung Hee Cheon
- Department of Orthopedic Surgery, VHS medical center, South Korea
| | - Young Koo Lee
- Departments of Orthopedic Surgery, Soonchunhyang University, Bucheon Hospital, South Korea.
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60
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A four-experiment examination of ankle kinetics, kinematics and lateral ligament strains during different conditions: an examination using musculoskeletal simulation. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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61
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Pogliacomi F, De Filippo M, Casalini D, Longhi A, Tacci F, Perotta R, Pagnini F, Tocco S, Ceccarelli F. Acute syndesmotic injuries in ankle fractures: From diagnosis to treatment and current concepts. World J Orthop 2021; 12:270-291. [PMID: 34055585 PMCID: PMC8152437 DOI: 10.5312/wjo.v12.i5.270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship, and it is essential for normal motion of the ankle joint. The disruption of this joint is frequently accompanied by rotational ankle fracture, such as pronation-external rotation, and rarely occurs without ankle fracture. The diagnosis is not simple, and ideal management of the various presentations of syndesmotic injury remains controversial to this day. Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes. In such an injury, including inadequately treated, misdiagnosed and correctly diagnosed cases, a chronic pattern characterized by persistent ankle pain, function disability and early osteoarthritis can result. This paper reviews anatomical and biomechanical characteristics of this syndesmosis, the mechanism of its acute injury associated to fractures, radiological and arthroscopic diagnosis and surgical treatment.
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Affiliation(s)
| | - Massimo De Filippo
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Daniele Casalini
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Alberto Longhi
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Fabrizio Tacci
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Rocco Perotta
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Francesco Pagnini
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Silvio Tocco
- Centro Riabilitativo della Mano e Arto Superiore, Parma 43121, Italy
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Comparisons of initial outcomes and cost-effectiveness after total ankle arthroplasty versus bipolar osteochondral allograft transplantation in the ankle: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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63
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The ankle cartilage cascade: incremental cartilage damage in the ankle joint. Knee Surg Sports Traumatol Arthrosc 2021; 29:3503-3507. [PMID: 34609539 PMCID: PMC8514360 DOI: 10.1007/s00167-021-06755-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/20/2021] [Indexed: 10/27/2022]
Abstract
Level of evidence Editorial, Level V.
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64
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Pathophysiological Perspective of Osteoarthritis. ACTA ACUST UNITED AC 2020; 56:medicina56110614. [PMID: 33207632 PMCID: PMC7696673 DOI: 10.3390/medicina56110614] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022]
Abstract
Osteoarthritis (OA) is the most well-known degenerative disease among the geriatric and is a main cause of significant disability in daily living. It has a multifactorial etiology and is characterized by pathological changes in the knee joint structure including cartilage erosion, synovial inflammation, and subchondral sclerosis with osteophyte formation. To date, no efficient treatment is capable of altering the pathological progression of OA, and current therapy is broadly divided into pharmacological and nonpharmacological measures prior to surgical intervention. In this review, the significant risk factors and mediators, such as cytokines, proteolytic enzymes, and nitric oxide, that trigger the loss of the normal homeostasis and structural changes in the articular cartilage during the progression of OA are described. As the understanding of the mechanisms underlying OA improves, treatments are being developed that target specific mediators thought to promote the cartilage destruction that results from imbalanced catabolic and anabolic activity in the joint.
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65
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Zhang L, Peng H, Feng M, Zhang W, Li Y. Yeast microcapsule-mediated oral delivery of IL-1β shRNA for post-traumatic osteoarthritis therapy. MOLECULAR THERAPY. NUCLEIC ACIDS 2020; 23:336-346. [PMID: 33425491 PMCID: PMC7779538 DOI: 10.1016/j.omtn.2020.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
Post-traumatic osteoarthritis is a prevalent debilitating joint disease. However, there is no FDA-approved disease-modifying osteoarthritis drug currently. Gene therapy can improve disease progression but lacks an effective delivery system. Here, we constructed an oral drug delivery system by non-virus-mediated interleukin-1β (IL-1β) short hairpin RNA (shRNA) and non-pathogenic yeast to evaluate its effect on osteoarthritis therapy. After recombinant IL-1β shRNA/yeast therapy, yeast microcapsule-mediated oral delivery of IL-1β shRNA greatly reduced the IL-1β expression in intestine macrophage, bone marrow macrophage, and articular cartilage, systematically regulate the inflammatory response. The degeneration of articular cartilage was significantly inhibited in the medial femoral condyle and medial tibial plateau of the knee joint. And the expression of osteoarthritis markers Col X and MMP13 was reduced in the knee joint. Thus, yeast microcapsule-mediated oral delivery of IL-1β shRNA may serve as a novel gene therapy strategy for treating joint degeneration through immunomodulation of the mononuclear phagocyte system from the intestine to subchondral bone marrow and ultimately preserving the articular cartilage joint.
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Affiliation(s)
- Long Zhang
- Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi 710054, PR China
| | - Hang Peng
- Health Science Center of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China.,The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China
| | - Meng Feng
- Health Science Center of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China.,The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China
| | - Wan Zhang
- Health Science Center of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China.,The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China
| | - Yankun Li
- Health Science Center of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China.,The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China
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Abstract
PURPOSE OF REVIEW Lateral ankle ligament sprains are one of the most commonly reported injuries in high-level athletes and the general population. Unfortunately, up to 40% of these can go on to develop chronic lateral ankle instability which in the right circumstances requires surgical intervention. The purpose of this review is to present the gold standard surgical treatment for chronic lateral instability with anatomic ligament repair and to highlight the techniques, outcomes, and importance of anatomy when considering surgical treatment. RECENT FINDINGS Recent and remote literature agrees that the initial treatment for chronic ankle instability is non-operative rehabilitation. In the cases where this fails, the gold standard of surgical treatment is open anatomic repair using the Brostrom-Gould technique which stands out as having very good results over the course of time. Recent studies have shown equally good outcomes with arthroscopy as well as with internal brace devices, and both techniques show potential for earlier rehabilitation. In those with contraindications for anatomic repair including innate soft tissue laxity, high BMI, and in the revision setting, anatomic ligament reconstruction is an appropriate surgical option. Open modified Brostrom lateral ligament repair continues to be the preferred method of surgical treatment for chronic lateral ligament instability. In the setting of new modifications and techniques, long-term outcome studies are necessary to identify both their usefulness in long term and to compare them to the open surgery outcomes. It would be useful to standardize rehabilitation protocols as well as return to sport metrics in order to better evaluate outcomes moving forward.
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Bechert RE. Treatment of Posttraumatic Osteoarthritis Secondary to a Chronic Plafond Fracture: A Case Report. J Chiropr Med 2020; 18:219-224. [PMID: 32874162 DOI: 10.1016/j.jcm.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 01/26/2019] [Accepted: 02/05/2019] [Indexed: 12/30/2022] Open
Abstract
Objective The purpose of this case report is to describe the treatment of a 3-year-old plafond fracture that developed posttraumatic osteoarthritis in a patient with chronic left ankle pain. Clinical Features A 65-year-old woman presented with daily anterior, posterior, medial, and lateral left ankle pain. Her initial pain level was 7 of 10 on weight bearing. She had trouble working and walking. She was previously treated with a walking boot, crutches, exercises, nonsteroidal anti-inflammatory drugs, and a steroid injection. She consulted our office approximately 3 years post-injury, at which point her initial disability score was 55 of 104 on the Foot and Ankle Disability Index. Interventions and Outcome The patient was subsequently treated with low-level laser, kinesio taping, exercise, and toggle board manipulation of the ankle. After a total of 6 visits, she was able to return to work and was walking with marked reduction of pain. Her pain level was 1 of 10 on weight bearing 1.5 years after her last treatment. Conclusion In this case report, a patient presented with 3-year-old ankle pain with an original etiology of plafond fracture. Her pain and disability resolved with a combination of low-level laser, exercises, kinesio taping, and toggle board manipulation. Her disability score after 6 visits was 18 of 104 on the Foot and Ankle Disability Index. This is a possible treatment option for posttraumatic osteoarthritis secondary to plafond fractures.
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Estimating tissue-level properties of porcine talar subchondral bone. J Mech Behav Biomed Mater 2020; 110:103931. [PMID: 32805501 DOI: 10.1016/j.jmbbm.2020.103931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/21/2022]
Abstract
Tissue-level properties of bone play an important role when characterising apparent-level bone biomechanical behaviour and yet little is known about its effect at this hierarchical level. In combination with trabecular morphological data these properties can be used to predict bone strength, which becomes an invaluable tool for clinicians in patient treatment planning. This study developed specimen-specific micro-finite element (μFE) models using validated continuum-level models, containing grayscale-derived material properties, to indirectly establish tissue-level properties of porcine talar subchondral bone. Specimen-specific continuum finite element (hFE) models of subchondral trabecular bone were setup using μCT data of ten cylindrical specimens extracted from juvenile porcine tali. The models were validated using quasi-static uniaxial compression testing. Validated hFE models were used to calibrate the tissue modulus of corresponding μFE models by minimising the difference between the μFE and hFE stiffness values. Key trabecular morphological indices (BV/TV, DA, Conn.D, Tb.Th, EF) were evaluated. Good agreement was observed between hFE models and experiment (CCC = 0.66). Calibrated Etiss was 504 ± 37.65 MPa. Average BV/TV and DA for μFE specimens were 0.37 ± 0.05 and 0.68 ± 0.11, respectively. BV/TV (r2 = 0.667) correlated highly with μFE stiffness. The small intra-specimen variation to tissue-level properties suggests that variations to apparent-level stiffness originate from variations to microarchitecture rather than tissue mechanical properties.
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69
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Suo H, Fu L, Liang H, Wang Z, Men J, Feng W. End-stage Ankle Arthritis Treated by Ankle Arthrodesis with Screw Fixation Through the Transfibular Approach: A Retrospective Analysis. Orthop Surg 2020; 12:1108-1119. [PMID: 32558333 PMCID: PMC7454153 DOI: 10.1111/os.12707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate the clinical outcome of ankle arthrodesis with screw fixation through the transfibular approach for end-stage ankle arthritis. METHODS Data of 22 patients (28 ankles) with end-stage ankle arthritis admitted to the Department of Orthopedics and Surgery of the First Hospital of Jilin University from May 2015 to December 2018 were analyzed retrospectively. The study included 9 men and 13 women, with a mean age of 56.86 ± 11.27 years (range, 37-75 years). The mean duration of the disease was 11.36 ± 12.80 years (range, 3 months-50 years). A total of 16 patients had posttraumatic arthritis, 5 patients had osteoarthritis, and 1 patient had rheumatoid arthritis. There were 12 cases of the left ankle and 16 cases of the right ankle; 16 cases were unilateral and 6 were bilateral. The same surgical procedure was applied to all patients. Collected data included the operation time, intraoperative and postoperative blood loss, hospitalization time, bone union rate, time to bone union, and complications. The American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score and the visual analogue scale (VAS) were used to evaluate the preoperative status and the postoperative outcome at the last follow up. RESULTS The mean follow-up period was 26.14 ± 10.99 months. The mean operation time was 101.82 ± 33.33 min. The mean blood loss was 116.78 ± 68.86 mL during the procedure and 111.07 ± 52.18 mL after the procedure. The mean hospitalization time was 14.22 ± 5.42 days. Bone union of the ankle joint was achieved in all patients. The mean time to bone union was 14.83 ± 2.14 weeks. There was significant difference in the operation time between the patients undergoing unilateral and bilateral ankle arthrodesis. The AOFAS ankle hindfoot score increased from the preoperative value of 43.46 ± 4.39 points to 80.39 ± 5.37 points at the last follow up. During the same interval, the VAS score improved from 6.14 ± 0.80 points to 1.64 ± 0.73 points. The AOFAS ankle hindfoot score of patients who underwent unilateral ankle arthrodesis improved from the preoperative 43.19 ± 3.95 points to 81.75 ± 5.23 points at the last follow up, and the VAS score improved from 6.19 ± 0.83 points to 1.69 ± 0.70 points. The AOFAS ankle hindfoot score of patients undergoing bilateral ankle arthrodesis improved from the preoperative value of 43.83 ± 5.08 points to 78.67 ± 5.05 points at the last follow up, while the VAS score improved from 6.08 ± 0.82 points to 1.58 ± 0.79 points. There was significant difference in the maximum walking distance and walking on any surface between the patients undergoing unilateral and bilateral ankle arthrodesis. One patient developed superficial peroneal nerve palsy, which resolved within 1 year after the operation. In another patient, healing of the incision skin was delayed. During the follow-up period, none of the patients developed an infection of the incision or local skin necrosis; screw loosening, withdrawal, or breakage did not occur in any patient. CONCLUSION The ankle arthrodesis with screw fixation through the transfibular approach provides satisfactory clinical outcomes for end-stage ankle arthritis.
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Affiliation(s)
- Haiqiang Suo
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
| | - Li Fu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Hanguang Liang
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
| | - Zhiwei Wang
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
| | - Jie Men
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
| | - Wei Feng
- Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China
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Passias BJ, Korpi FP, Chu AK, Myers DM, Grenier G, Galos DK, Taylor B. Safety of Early Weight Bearing Following Fixation of Bimalleolar Ankle Fractures. Cureus 2020; 12:e7557. [PMID: 32382461 PMCID: PMC7202576 DOI: 10.7759/cureus.7557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Ankle fractures are common orthopedic injuries. Although operative indications and subsequent stabilization of these fractures have not significantly changed, postoperative protocols remain highly variable. Effects of early weight bearing (EWB) on fracture characteristics in operatively stabilized bimalleolar and bimalleolar equivalent ankle fractures remain poorly publicized. This study seeks to clarify postoperative fracture union rates, rates of hardware loosening or failure, and radiographic medial clear space changes when comparing EWB to late weight bearing (LWB) following open reduction and internal fixation (ORIF). A total of 95 patients with either bimalleolar (66%) or bimalleolar equivalent (34%) fractures who underwent ORIF were retrospectively reviewed. Weight bearing was allowed at three weeks in the EWB group and when signs of radiographic union were noted in the LWB group. Postoperatively, patients were evaluated at regular intervals for fracture union, signs of implant failure, and evidence of medial clear space widening radiographically. There were 38 patients (40%) in the EWB group and 57 patients (60%) comprising the LWB cohort. There were no significant demographic differences between groups. The EWB group on average began to weight bear at 3.1 + 1.4 weeks postoperatively, whereas the LWB group began at 7.2 + 2.1 weeks postoperatively (p<0.01). Union rate (p=0.51), time to union (p=0.23), and implant failure (p>0.1 at all time intervals) were not notably different between groups. No differences in medial clear space were detected at any postoperative interval between groups (p>0.1 at all time intervals). This study suggests that EWB at three weeks postoperatively does not increase markers of radiographic failure compared to six weeks of non-weight bearing (NWB), which has been regarded as the gold standard of treatment to allow for healing; this may represent an improvement to rehabilitation protocols after bimalleolar ankle ORIF of unstable ankle fractures.
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Affiliation(s)
| | | | - Anson K Chu
- Foot and Ankle Surgery, OhioHealth, Columbus, USA
| | | | | | - David K Galos
- Orthopedic Trauma, Nassau University Medical Center, Great Neck, USA
| | - Benjamin Taylor
- Orthopedic Trauma, OhioHealth Grant Medical Center, Columbus, USA
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Dabash S, Buksbaum JR, Fragomen A, Rozbruch SR. Distraction arthroplasty in osteoarthritis of the foot and ankle. World J Orthop 2020; 11:145-157. [PMID: 32280604 PMCID: PMC7138864 DOI: 10.5312/wjo.v11.i3.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/08/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023] Open
Abstract
Post-traumatic osteoarthritis (PTOA) is a complex and painful problem in the foot and ankle. Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic. PTOA can affect any of the 33 joints in the foot and the ankle. Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented. The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle, subtalar, first metatarsophalangeal, and second tarsometatarsal joints, and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty. Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle. Additionally, the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint, and can prolong the need for further, more aggressive surgical interventions such as fusion or arthroplasty.
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Affiliation(s)
- Sherif Dabash
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
| | - Joshua R Buksbaum
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York, NY 11226, United States
| | - Austin Fragomen
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
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72
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Delco ML, Goodale M, Talts JF, Pownder SL, Koff MF, Miller AD, Nixon B, Bonassar LJ, Lundgren-Åkerlund E, Fortier LA. Integrin α10β1-Selected Mesenchymal Stem Cells Mitigate the Progression of Osteoarthritis in an Equine Talar Impact Model. Am J Sports Med 2020; 48:612-623. [PMID: 32004077 DOI: 10.1177/0363546519899087] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Early intervention with mesenchymal stem cells (MSCs) after articular trauma has the potential to limit progression of focal lesions and prevent ongoing cartilage degeneration by modulating the joint environment and/or contributing to repair. Integrin α10β1 is the main collagen type II binding receptor on chondrocytes, and MSCs that are selected for high expression of the α10 subunit have improved chondrogenic potential. The ability of α10β1-selected (integrin α10high) MSCs to protect cartilage after injury has not been investigated. PURPOSE To investigate integrin α10high MSCs to prevent posttraumatic osteoarthritis in an equine model of impact-induced talar injury. STUDY DESIGN Controlled laboratory study. METHODS Focal cartilage injuries were created on the tali of horses (2-5 years, n = 8) by using an impacting device equipped to measure impact stress. Joints were treated with 20 × 106 allogenic adipose-derived α10high MSCs or saline vehicle (control) 4 days after injury. Synovial fluid was collected serially and analyzed for protein content, cell counts, markers of inflammation (prostaglandin E2, tumor necrosis factor α) and collagen homeostasis (procollagen II C-propeptide, collagen type II cleavage product), and glycosaminoglycan content. Second-look arthroscopy was performed at 6 weeks, and horses were euthanized at 6 months. Joints were imaged with radiographs and quantitative 3-T magnetic resonance imaging. Postmortem examinations were performed, and India ink was applied to the talar articular surface to identify areas of cartilage fibrillation. Synovial membrane and osteochondral histology was performed, and immunohistochemistry was used to assess type I and II collagen and lubricin. A mixed effect model with Tukey post hoc and linear contrasts or paired t tests were used, as appropriate. RESULTS Integrin α10high MSC-treated joints had less subchondral bone sclerosis on radiographs (P = .04) and histology (P = .006) and less cartilage fibrillation (P = .04) as compared with control joints. On gross pathology, less India ink adhered to impact sites in treated joints than in controls, which may be explained by the finding of more prominent lubricin immunostaining in treated joints. Prostaglandin E2 concentration in synovial fluid and mononuclear cell synovial infiltrate were increased in treated joints, suggesting possible immunomodulation by integrin α10high MSCs. CONCLUSION Intra-articular administration of integrin α10high MSCs is safe, and evidence suggests that the cells mitigate the effects of joint trauma. CLINICAL RELEVANCE This preclinical study indicates that intra-articular therapy with integrin α10high MSCs after joint trauma may be protective against posttraumatic osteoarthritis.
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73
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Abstract
Foot and ankle pathology is common in the pediatric population. Common issues may be traumatic in nature, congenital, or age dependent. This article reviews common problems and pathology found in the pediatric foot and ankle.
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Affiliation(s)
- Aron Green
- Seaview Orthopedic & Medical Associates, 1200 Eagle Avenue, Ocean, NJ 07712, USA.
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74
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Physical Therapy as a Force Multiplier: Population Health Perspectives to Address Short-Term Readiness and Long-Term Health of Military Service Members. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000129] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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75
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Nwankwo EC, Labaran LA, Athas V, Olson S, Adams SB. Pathogenesis of Posttraumatic Osteoarthritis of the Ankle. Orthop Clin North Am 2019; 50:529-537. [PMID: 31466668 DOI: 10.1016/j.ocl.2019.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ankle osteoarthritis affects a significant portion of the global adult population. Unlike other joints, arthritis of the ankle often develops as a response to traumatic injury (intra-articular fracture) of the ankle joints. The full mechanism leading to posttraumatic osteoarthritis of the ankle (PTOAA) is poorly understood. These deficits in knowledge pose challenges in the management of the disease. Adequate surgical reduction of fractured ankle joints remains the gold standard in prevention. The purpose of this review is to thoroughly delineate the known pathogenesis of PTOAA, and provide critical updates on this pathology and new avenues to provide therapeutic management of the disease.
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Affiliation(s)
- Eugene C Nwankwo
- Department of Orthopedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC 27703, USA; Texas Tech University School of Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, USA
| | - Lawal A Labaran
- University of Illinois College of Medicine, 1200 Harrison Street, Chicago, IL 60607, USA
| | - Vincent Athas
- Texas Tech University School of Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, USA
| | - Steve Olson
- Department of Orthopedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC 27703, USA
| | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC 27703, USA.
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76
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Zou YC, Li HH, Yang GG, Yin HD, Cai DZ, Liu G. Attenuated levels of ghrelin in synovial fluid is related to the disease severity of ankle post-traumatic osteoarthritis. Biofactors 2019; 45:463-470. [PMID: 30697843 DOI: 10.1002/biof.1490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 12/24/2022]
Abstract
Post-traumatic osteoarthritis (PTOA) of ankle joints results in pain and reduced joint function. Ghrelin, a 28-amino-acid polypeptide, has been previously identified as the first cognate natural ligand that binds to the growth hormone secretagogue receptor. In the present study, ghrelin has been validated to exert cartilage-protective and anti-inflammatory effects. The current study was aimed at investigating the potential role of the levels of serum and synovial fluid (SF) ghrelin on the severity of disease in patients suffering from ankle PTOA. Ninety-seven patients with ankle osteoarthritis who received an arthroscopical examination and debridement or replacement of the ankle joint were included in the study cohort. Meanwhile, 95 healthy individuals (whose age and sex were matched) who received periodic body checkups were enrolled as healthy controls. Enzyme-linked immunosorbent assay (ELISA) was used to analyze the ghrelin levels in serum and SF. SF was also probed for cartilage degradation enzyme matrix metalloproteinases-3 (MMP-3) and tumor necrosis factor alpha (TNF-α), which is a known pro-inflammatory cytokine. The clinical evaluation was carried out using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot rating scale and visual analogue scale (VAS). The radiographic severity was evaluated using the modified Kellgren-Lawrence (K-L) grading system. We scored for the modified Mankin's score to depict histopathological changes due to cartilage lesions. The diagnostic relevance of the ghrelin concentrations in the prediction of the radiographic grading (in comparison with MMP-3 and TNF-α) was evaluated by calculating the area under the curve of the receiver operating characteristic (ROC) curve. The serum abundance of ghrelin was not significantly altered between ankle PTOA patients and healthy controls. SF ghrelin was negatively correlated with radiographic progression determined by modified ankle K-L grades. In addition SF ghrelin concentrations were negatively related to VAS scores, and positively associated with AOFAS ankle-hindfoot rating. Moreover, SF ghrelin was inversely proportional to the expressions of MMP-3 and TNF-α. ROC analysis curve demonstrated that ghrelin serves as a favorable marker for the diagnosis of radiographic severity by modified ankle K-L grade. The ghrelin concentration in SF is negatively proportional to disease progression in patients suffering from ankle PTOA. Local administration of ghrelin may function as a decent adjuvant therapy to delay the progress of ankle PTOA. © 2019 BioFactors, 45(3):463-470, 2019.
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Affiliation(s)
- Yu-Cong Zou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hai-Hong Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Guang-Gang Yang
- Department of Orthopedics, Guangzhou Orthopedics Hospital, Guangzhou, Guangdong Province, China
| | - Hai-Dong Yin
- Shunde Hospital of Southern Medical University, Foshan, China
| | - Dao-Zhang Cai
- Department of Joint Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Gang Liu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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A pragmatic approach to prevent post-traumatic osteoarthritis after sport or exercise-related joint injury. Best Pract Res Clin Rheumatol 2019; 33:158-171. [PMID: 31431269 DOI: 10.1016/j.berh.2019.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lower extremity musculoskeletal injuries are common in sport and exercise, and associated with increased risk of obesity and post-traumatic osteoarthritis (PTOA). Unlike other forms of osteoarthritis, PTOA is common at a younger age and associated with more rapid progression, which may impact career choices, long-term general health and reduce quality of life. Individuals who suffer an activity-related joint injury and present with abnormal joint morphology, elevated adiposity, weak musculature, or become physically inactive are at increased risk of PTOA. Insufficient exercise therapy or incomplete rehabilitation, premature return-to-sport and re-injury, unrealistic expectations, or poor nutrition may further elevate this risk. Delay in surgical interventions in lieu of exercise therapy to optimize muscle strength and neuromuscular control while addressing fear of movement to guarantee resumption of physical activity, completeness of rehabilitation before return-to-sport, education that promotes realistic expectations and self-management, and nutritional counseling are the best approaches for delaying or preventing PTOA.
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78
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Ewalefo SO, Dombrowski M, Hirase T, Rocha JL, Weaver M, Kline A, Carney D, Hogan MV. Management of Posttraumatic Ankle Arthritis: Literature Review. Curr Rev Musculoskelet Med 2018; 11:546-557. [PMID: 30327933 PMCID: PMC6220012 DOI: 10.1007/s12178-018-9525-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications. RECENT FINDINGS Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint. Regarding surgical management of posttraumatic ankle arthritis, osteochondral allograft transplantation of the talus, and supramalleolar osteotomies have demonstrated promising results. Additionally, the outpatient setting was found to be appropriate for managing pain following total ankle arthroplasty, associated with low complication rates and no readmission. Management for posttraumatic ankle arthritis is generally progressive. Initial treatment entails nonpharmacologic options with surgery reserved for posttraumatic ankle arthritis refractory to conservative treatment. Patient demographics and lifestyles should be carefully considered when formulating a management strategy, as outcomes are dependent upon the satisfaction of each set of respective criteria. Ultimately, the management of posttraumatic ankle arthritis should be individualized to satisfy the needs and desires, which are specific to each patient.
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Affiliation(s)
- Samuel O Ewalefo
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
| | - Malcolm Dombrowski
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Takashi Hirase
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Jorge L Rocha
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mitchell Weaver
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Kline
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dwayne Carney
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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79
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O'Neill TW, McCabe PS, McBeth J. Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best Pract Res Clin Rheumatol 2018; 32:312-326. [PMID: 30527434 DOI: 10.1016/j.berh.2018.10.007] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis and a leading cause of pain and disability worldwide. OA can affect any synovial joint, although the hip, knee, hand, foot and spine are the most commonly affected sites. Knowledge about the occurrence and risk factors for OA is important to define the clinical and public health burden of the disease to understand mechanisms of disease occurrence and may also help to inform the development of population-wide prevention strategies. In this article, we review the occurrence and risk factors for OA and also consider patient-reported outcome measures that have been used for the assessment of the disease.
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Affiliation(s)
- Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul S McCabe
- Royal Oldham Hospital, Pennine Acute NHS Trust, Rochdale Rd, Oldham OL1 2JH, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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80
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Leech RD, Eyles J, Batt ME, Hunter DJ. Lower extremity osteoarthritis: optimising musculoskeletal health is a growing global concern: a narrative review. Br J Sports Med 2018; 53:806-811. [PMID: 30030282 DOI: 10.1136/bjsports-2017-098051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 11/03/2022]
Abstract
The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.
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Affiliation(s)
- Richard D Leech
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jillian Eyles
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Mark E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.,Centre for Sports Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Rothrauff BB, Murawski CD, Angthong C, Becher C, Nehrer S, Niemeyer P, Sullivan M, Valderrabano V, Walther M, Ferkel RD, Adams SB, Andrews CL, Batista JP, Baur OL, Bayer S, Berlet GC, Boakye LAT, Brown AJ, Buda R, Calder JD, Canata GL, Carreira DS, Clanton TO, Dahmen J, D’Hooghe P, DiGiovanni CW, Dombrowski ME, Drakos MC, Ferrao PNF, Fortier LA, Glazebrook M, Giza E, Gomaa M, Görtz S, Haleem AM, Hamid KS, Hangody L, Hannon CP, Haverkamp D, Hertel J, Hintermann B, Hogan MV, Hunt KJ, Hurley ET, Karlsson J, Kearns SR, Kennedy JG, Kerkhoffs GMMJ, Kim HJ, Kong SW, Labib SA, Lambers KTA, Lee JW, Lee KB, Ling JS, Longo UG, Marangon A, McCollum G, Mitchell AW, Mittwede PN, Nunley JA, O’Malley MJ, Osei-Hwedieh DO, Paul J, Pearce CJ, Pereira H, Popchak A, Prado MP, Raikin SM, Reilingh ML, Schon LC, Shimozono Y, Simpson H, Smyth NA, Sofka CM, Spennacchio P, Stone JW, Takao M, Tanaka Y, Thordarson DB, Tuan R, van Bergen CJ, van Dijk CN, van Dijk PA, Vannini F, Vaseenon T, Wiewiorski M, Xu X, Yasui Y, Yinghui H, Yoshimura I, Younger ASE, Zhang Z. Scaffold-Based Therapies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:41S-47S. [PMID: 30215312 DOI: 10.1177/1071100718781864] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Scaffold-Based Therapies" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 9 statements on scaffold-based therapies reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, 8 reached strong consensus (greater than 75% agreement), and 1 was removed because of redundancy in the information provided. All statements reached at least 80% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with applying scaffold-based therapies as a treatment strategy for osteochondral lesions of the talus. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Benjamin B Rothrauff
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher D Murawski
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chayanin Angthong
- 2 Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Christoph Becher
- 3 Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Stefan Nehrer
- 4 Orthopedic Foot & Ankle Center, Westerville, OH, USA
| | - Philipp Niemeyer
- 5 Centre for Regenerative Medicine and Orthopedics, Danube University Krems, Krems an der Donau, Austria
| | | | - Victor Valderrabano
- 7 Orthopaedic Department, Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland
| | - Markus Walther
- 8 Center of Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
| | - Richard D Ferkel
- 9 Southern California Orthopedic Institute, Los Angeles, CA, USA
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Delco ML, Bonnevie ED, Bonassar LJ, Fortier LA. Mitochondrial dysfunction is an acute response of articular chondrocytes to mechanical injury. J Orthop Res 2018; 36:739-750. [PMID: 28696002 PMCID: PMC5764818 DOI: 10.1002/jor.23651] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/23/2017] [Indexed: 02/04/2023]
Abstract
UNLABELLED Mitochondrial (MT) dysfunction is known to occur in chondrocytes isolated from end-stage osteoarthritis (OA) patients, but the role of MT dysfunction in the initiation and early pathogenesis of post-traumatic OA (PTOA) remains unclear. The objective of this study was to investigate chondrocyte MT function immediately following mechanical injury in cartilage, and to determine if the response to injury differed between a weight bearing region (medial femoral condyle; MFC) and a non-weight bearing region (distal patellofemoral groove; PFG) of the same joint. Cartilage was harvested from the MFC and PFG of 10 neonatal bovids, and subjected to injurious compression at varying magnitudes (5-17 MPa, 5-34 GPa/s) using a rapid single-impact model. Chondrocyte MT respiratory function, MT membrane polarity, chondrocyte viability, and cell membrane damage were assessed in situ. Cartilage impact resulted in MT depolarization and impaired MT respiratory function within 2 h of injury. Cartilage from a non-weight bearing region of the joint (PFG) was more sensitive to impact-induced MT dysfunction and chondrocyte death than cartilage from a weight-bearing surface (MFC). Our findings suggest that MT dysfunction is an acute response of chondrocytes to cartilage injury, and that MT may play a key mechanobiological role in the initiation and early pathogenesis of PTOA. CLINICAL SIGNIFICANCE Direct therapeutic targeting of MT function in the early post-injury time frame may provide a strategy to block perpetuation of tissue damage and prevent the development of PTOA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:739-750, 2018.
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Affiliation(s)
- Michelle L. Delco
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Edward D. Bonnevie
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
| | - Lawrence J. Bonassar
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York,Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Lisa A. Fortier
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
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83
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Sandell L. Journal of Orthopaedic Research® update, January 2018. J Orthop Res 2018; 36:9. [PMID: 29425400 DOI: 10.1002/jor.23852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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84
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Liang D, Sun J, Wei F, Zhang J, Li P, Xu Y, Shang X, Deng J, Zhao T, Wei L. Establishment of rat ankle post-traumatic osteoarthritis model induced by malleolus fracture. BMC Musculoskelet Disord 2017; 18:464. [PMID: 29149841 PMCID: PMC5693506 DOI: 10.1186/s12891-017-1821-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malleolar fracture, which is present in 37-53% of human ankle osteoarthritis (OA), is the most common type of fracture in the ankle joint. In spite of this, no rat animal model has been developed for this type of injury to date. Here, we established a rat ankle post-traumatic OA (PTOA) model induced by malleolar fracture; this model will be useful in ankle OA research. METHODS Two-month-old male Sprague Dawley (SD) rats were randomized into 2 groups (n = 19 per group): 1) malleolus articular fracture, dislocation, and immediate reduction on the right joints and 2) malleolus articular fracture on the right ankle. The contralateral ankle joints were used as controls. The fracture and healing processes were confirmed and monitored by radiography. Changes in inflammation were monitored in vivo by fluorescence molecular tomography (FMT). Cartilage damage and changes in expression of OA-related genes were analyzed by histology, immunohistochemistry, Real-time quantitative PCR (qPCR) and enzyme-linked immunosorbent assay (ELISA) at 8 weeks post-surgery. RESULTS X-rays showed that all fractures were healed at 8 weeks post-surgery. A reproducible, mild to moderate degree of OA cartilage damage with reduced aggrecan was detected by histology in all animals in both groups but there was no significant difference between the two groups. Decreased Col-II and increased Col-X and MMP-13 levels were detected by qPCR, immunohistochemistry, ELISA and FMT from both groups cartilage. CONCLUSIONS Malleolus articular fracture alone induces ankle OA with lesions on the central weight bearing area of the tibiotalar joint in rats. This model will provide a reproducible and useful tool for researchers to study ankle OA.
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Affiliation(s)
- Dawei Liang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian Sun
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Fangyuan Wei
- Foot and Ankle Orthopaedic Surgery Center, Beijing Tongren Hospital, Beijing, China
| | - Jianzhong Zhang
- Foot and Ankle Orthopaedic Surgery Center, Beijing Tongren Hospital, Beijing, China
| | - Pengcui Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yingke Xu
- School of Community Health Science, Nevada Institute of Personalized Medicine, University of Nevada, Las Vegas, Nevada USA
| | - Xianwen Shang
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jin Deng
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ting Zhao
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI USA
| | - Lei Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI USA
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Adams SB, Reilly RM, Huebner JL, Kraus VB, Nettles DL. Time-Dependent Effects on Synovial Fluid Composition During the Acute Phase of Human Intra-articular Ankle Fracture. Foot Ankle Int 2017; 38:1055-1063. [PMID: 28891711 DOI: 10.1177/1071100717728234] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The study objective was to examine the effect of time and fracture severity on the undiluted synovial fluid (SF) microenvironment during the acute phase following intra-articular fracture (IAF) of the human ankle. METHODS Ankle SF from 54 patients with an acute IAF was analyzed for concentrations of 10 cytokines, 5 matrix metalloproteinases, 2 products of cartilage catabolism, and combined products of heme metabolism. All analytes were correlated with time from fracture and further analyzed for an effect of 3 time subgroups (0-2 days, 3-9 days, and ≥10 days) corresponding to timepoints for clinical ankle fracture interventions. The effect of fracture severity was determined by grouping SF according to the number of radiographic intra-articular fracture lines. RESULTS Fifteen of 18 analytes were significantly correlated with time. Temporal grouping of SF revealed an initial (0-2 days) spike of pro-inflammatory (IL-12p70, IL-1β, IL-6) and anti-inflammatory (IL-10 and IL-4) cytokines, matrix metalloproteinases (MMP) MMP-9, and sGAG, followed immediately (3-9 days) by products of heme metabolism and an unchallenged surge in mediators and products of cartilage catabolism (MMP-1, MMP-2, MMP-3, MMP-10, and CTX-II). After 10 days, there was a decrease in pro- and anti-inflammatory cytokines but a persistence of mediators of ECM catabolism. There was no clear relationship between the number of fracture lines and SF levels of analytes. CONCLUSIONS This study demonstrated acute temporal fluctuations following ankle IAF resulting in an overall catabolic environment by 10 days post-fracture and supports consideration of an early evacuation of the joint space to reduce the intra-articular inflammatory burden. Clinical Relavence: This study contributes to the understanding of the intra-articular events that potentially contribute to the development of posttraumatic osteoarthritis acutely following IAF in the ankle.
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Affiliation(s)
| | | | - Janet L Huebner
- 1 Duke University Medical Center, Durham, NC, USA.,3 Duke Molecular Physiology Institute, Durham, NC, USA
| | - Virginia B Kraus
- 1 Duke University Medical Center, Durham, NC, USA.,2 Department of Medicine, Division of Rheumatology and Immunology, Duke University, Durham, NC, USA.,3 Duke Molecular Physiology Institute, Durham, NC, USA
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