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Engineering complex orthopaedic tissues via strategic biomimicry. Ann Biomed Eng 2014; 43:697-717. [PMID: 25465616 DOI: 10.1007/s10439-014-1190-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/13/2014] [Indexed: 12/13/2022]
Abstract
The primary current challenge in regenerative engineering resides in the simultaneous formation of more than one type of tissue, as well as their functional assembly into complex tissues or organ systems. Tissue-tissue synchrony is especially important in the musculoskeletal system, wherein overall organ function is enabled by the seamless integration of bone with soft tissues such as ligament, tendon, or cartilage, as well as the integration of muscle with tendon. Therefore, in lieu of a traditional single-tissue system (e.g., bone, ligament), composite tissue scaffold designs for the regeneration of functional connective tissue units (e.g., bone-ligament-bone) are being actively investigated. Closely related is the effort to re-establish tissue-tissue interfaces, which is essential for joining these tissue building blocks and facilitating host integration. Much of the research at the forefront of the field has centered on bioinspired stratified or gradient scaffold designs which aim to recapitulate the structural and compositional inhomogeneity inherent across distinct tissue regions. As such, given the complexity of these musculoskeletal tissue units, the key question is how to identify the most relevant parameters for recapitulating the native structure-function relationships in the scaffold design. Therefore, the focus of this review, in addition to presenting the state-of-the-art in complex scaffold design, is to explore how strategic biomimicry can be applied in engineering tissue connectivity. The objective of strategic biomimicry is to avoid over-engineering by establishing what needs to be learned from nature and defining the essential matrix characteristics that must be reproduced in scaffold design. Application of this engineering strategy for the regeneration of the most common musculoskeletal tissue units (e.g., bone-ligament-bone, muscle-tendon-bone, cartilage-bone) will be discussed in this review. It is anticipated that these exciting efforts will enable integrative and functional repair of soft tissue injuries, and moreover, lay the foundation for the development of composite tissue systems and ultimately, total limb or joint regeneration.
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302
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Goodman SM, Ravi B, Hawker G. Outcomes in rheumatoid arthritis patients undergoing total joint arthroplasty. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/ijr.14.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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303
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Liu Y, Schwartz AG, Birman V, Thomopoulos S, Genin GM. Stress amplification during development of the tendon-to-bone attachment. Biomech Model Mechanobiol 2014; 13:973-83. [PMID: 24370852 PMCID: PMC4074273 DOI: 10.1007/s10237-013-0548-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
Mechanical stress is necessary to sustain the mineral content of bone in adults. However, in a developing neonatal mouse, the mineralization of soft tissues progresses despite greatly reduced average mechanical stresses. In adults, these reduced loads would likely lead to bone loss. Although biochemical factors may partly explain these different responses, it is unclear how mineralization is initiated in low load environments. We present here the effect of morphometric data and initial modeling supporting a hypothesis that mechanical factors across several length scales amplify stresses, and we suggest that these stresses are of a level adequate to contribute to mechanical signaling for initiation of mineralization at the developing tendon-to-bone enthesis. A mineral gradient is evident across the insertion from the onset of mineralization. This grading maintains a constant size from early postnatal time points to adulthood. At the tissue level, this grading contributes to reduced stresses in an adult animal and to a minor elevation of stresses in a neonatal animal. At the cellular level, stress concentrations around mineralizing chondrocytes are enhanced in neonatal animals compared with adult animals. The enhancement of stresses around cells at early time points may serve to amplify and transduce low loads in order to initiate mineralization.
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Affiliation(s)
- Yanxin Liu
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, 63130, USA
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304
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Prosenz J, Hirtler L. Rovsing sign revisited-effects of an erroneous translation on medical teaching and research. JOURNAL OF SURGICAL EDUCATION 2014; 71:738-742. [PMID: 24776856 DOI: 10.1016/j.jsurg.2014.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/27/2014] [Accepted: 03/04/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate whether Rovsing sign in the diagnosis of appendicitis is described and applied inaccurately in the current literature, scientific papers, and books; quantify the problem; and investigate the cause of this error. BACKGROUND The method of eliciting Rovsing sign is not described uniformly throughout the literature. METHODS PubMed, MEDLINE, and Embase searches were conducted, and 1178 individual studies were searched for the use of Rovsing sign. A total of 57 studies were included in this study; of these, 14 described the way that the sign was executed. Additionally, 3 current English (text)books on surgery, 3 German (text)books on surgery, and 3 German books on anatomy were analyzed. The descriptions in studies and books were compared with the original publication by Niels Thorkild Rovsing in 1907. RESULTS No included study that described the method of eliciting Rovsing sign provided a correct description. None of the 3 English (text)books on surgery described the sign accurately, but all 6 German (text)books provided a correct description. CONCLUSION Rovsing sign is used erroneously in clinical practice and medical research and is most likely already taught incorrectly to most medical students. All statistical data available on this sign must be questioned and reinvestigated in future well-designed studies to assess the actual value of Rovsing sign in the diagnosis of appendicitis.
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Affiliation(s)
- Julian Prosenz
- Department of Systematic Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Department of Systematic Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
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305
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Morphologic and morphometric features of the calcaneal insertions of the superficial digital flexor tendon in the horse. Vet Comp Orthop Traumatol 2014; 27:366-71. [PMID: 25088706 DOI: 10.3415/vcot-14-03-0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 07/11/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Accurate description of the calcaneal insertions of the superficial digital flexor tendon (SDFT) is lacking and inconsistent. The aim of this study was to undertake morphologic and morphometic evaluations of these structures to assist in elucidating their functional and pathogenic roles in displacement of the SDFT from the calcaneal tuber. METHOD Dissections were performed on 10 normal cadaveric hindlimbs. The anatomy was photographed to allow measurements at repeatable locations and differences in SDFT dimensions at the various locations were compared using a paired student t-test. RESULTS This study demonstrated that the calcaneal insertions of the SDFT are independent from the overlying tarsal insertions of the biceps femoris and semitendinosus, which blend into the plantar surface of the fibrocartilaginous cap (FCC) of the SDFT before inserting dorsal to the insertion of the SDFT on the calcaneal tuber. The lateral insertion of the SDFT is larger in cross-sectional area (median: 219 mm²) at its origin from the FCC than its medial counterpart (median: 159 mm², p = 0.004) and has a more complex fibre alignment. The lateral site of attachment of the SDFT on the calcaneal tuber is dorsolateral to the insertion of the gastrocnemius tendon and is larger (median: 525 mm²) than the medial insertion (median: 428 mm², p = 0.036), which inserts distal to the insertion of the gastrocnemius tendon. CONCLUSION The features identified in this study suggest that the calcaneal insertions of the SDFT are complex and their morphological and morphometric differences are likely to contribute to clinical lesions identified at this site.
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306
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Kumai T, Muneta T, Tsuchiya A, Shiraishi M, Ishizaki Y, Sugimoto K, Samoto N, Isomoto S, Tanaka Y, Takakura Y. The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study. J Orthop Sci 2014; 19:603-11. [PMID: 24817495 DOI: 10.1007/s00776-014-0579-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 03/30/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hyaluronic acid (HA) with a high molecular weight of 2700 kDa is approved in Japan to treat osteoarthritis of the knee, periarthritis scapulohumeralis, and knee pain associated with rheumatoid arthritis. The purpose of this preliminary study was to investigate the short-term efficacy, safety, and injectable volume of HA in the treatment of enthesopathies. METHODS A total of 61 patients (16 with lateral epicondylitis, 14 with patellar tendinopathy, 15 with insertional Achilles tendinopathy, and 16 with plantar fasciitis) were each administered a single injection of HA (up to 2.5 ml). Efficacy and safety were assessed by comparing the visual analog scale (VAS) for pain and local symptoms before injection (baseline) and at 1 week after injection. We also investigated the injectable volume by means of the difference in syringe weight before and after injection and by the judgment of the administering investigator. RESULTS The injection of HA resulted in a change in VAS (mean ± SD) of -2.20 ± 2.26 cm for the four sites overall and -2.55 ± 2.43 cm for lateral epicondylitis, -2.01 ± 2.16 cm for patellar tendinopathy, -1.80 ± 1.91 cm for insertional Achilles tendinopathy, and -2.38 ± 2.61 cm for plantar fasciitis. The injection of HA also improved local symptoms in each site. It was also determined that 2.5 ml of HA can be injected in each of the four sites. CONCLUSION A single injection of HA resulted in similar improvements of pain in each of the four enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis). These results suggest that HA could be clinically effective in the treatment of enthesopathies.
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Affiliation(s)
- Tsukasa Kumai
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan,
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307
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Samim M, Smitaman E, Lawrence D, Moukaddam H. MRI of anterior knee pain. Skeletal Radiol 2014; 43:875-93. [PMID: 24473994 DOI: 10.1007/s00256-014-1816-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/05/2013] [Accepted: 01/01/2014] [Indexed: 02/02/2023]
Abstract
Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.
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Affiliation(s)
- Mohammad Samim
- Department of Radiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
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308
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Bunker DLJ, Ilie V, Ilie V, Nicklin S. Tendon to bone healing and its implications for surgery. Muscles Ligaments Tendons J 2014; 4:343-350. [PMID: 25489553 PMCID: PMC4241426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Entheses are complex structures which act to reduce stress concentrations between tendon and skeleton tissues. Understanding the development and function of the enthesis organ has implications for surgical repair, particularly in regards to healing and the regulation of tendon to bone engraftment. In this paper we review the development and function of entheses as well as the enthesis organ concept. Next we examine the process of tendon to bone healing and how this can be regulated, before addressing implications for surgical repair and post-operative care.
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Affiliation(s)
| | | | | | - Sean Nicklin
- Consultant Plastic & Hand Surgeon, Prince of Wales, Sydney Childrens and Sydney Hospitals, Australia
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309
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Heathcote GM, Bromage TG, Sava VJ, Hanson DB, Anderson BE. Enigmatic cranial superstructures among Chamorro ancestors from the Mariana Islands: gross anatomy and microanatomy. Anat Rec (Hoboken) 2014; 297:1009-21. [PMID: 24753475 PMCID: PMC4078988 DOI: 10.1002/ar.22920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/04/2014] [Accepted: 02/19/2014] [Indexed: 11/09/2022]
Abstract
This study focuses on the gross anatomy, anatomic relations, microanatomy, and the meaning of three enigmatic, geographically patterned, and quasi-continuous superstructures of the posterior cranium. Collectively known as occipital superstructures (OSSs), these traits are the occipital torus tubercle (TOT), retromastoid process (PR), and posterior supramastoid tubercle (TSP). When present, TOT, PR, and TSP develop at posterior cranial attachment sites of the upper trapezius, superior oblique, and sternocleidomastoid muscles, respectively. Marked expression and co-occurrence of these OSSs are virtually circumscribed within Oceania and reach highest recorded frequencies in protohistoric Chamorros (CHamoru) of the Mariana Islands. Prior to undertaking scanning electron microscopy (SEM) work, our working multifactorial model for OSS development was that early-onset, long-term, and chronic activity-related microtrauma at enthesis sites led to exuberant reactive or reparative responses in a substantial minority of genetically predisposed (and mostly male) individuals. SEM imaging, however, reveals topographic patterning that questions, but does not negate, activity induction of these superstructures. Although OSSs appear macroscopically as relatively large and discrete phenomena, SEM findings reveal a unique, widespread, and seemingly systemic distribution of structures over the occipital surface that have the appearance of OSS microforms. Nevertheless, apparent genetic underpinnings, anatomic relationships with muscle entheses, and positive correlation of OSS development with humeral robusticity continue to suggest that these superstructures have potential to at once bear witness to Chamorro population history and inform osteobiographical constructions of chronic activity patterns in individuals bearing them. Further work is outlined that would illuminate the proximate and ultimate meanings of OSS.
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Affiliation(s)
- Gary M Heathcote
- Department of Anthropology, St. Thomas University, Fredericton, New Brunswick, Canada
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310
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Abstract
Tendon–bone junctions (TBJs) are frequently injured, especially in athletic settings. Healing of TBJ injuries is slow and is often repaired with scar tissue formation that compromises normal function. This study explored the feasibility of using kartogenin (KGN), a biocompound, to enhance the healing of injured TBJs. We first determined the effects of KGN on the proliferation and chondrogenic differentiation of rabbit bone marrow stromal cells (BMSCs) and patellar tendon stem/progenitor cells (PTSCs) in vitro. KGN enhanced cell proliferation in both cell types in a concentration-dependent manner and induced chondrogenic differentiation of stem cells, as demonstrated by high expression levels of chondrogenic markers aggrecan, collagen II and Sox-9. Besides, KGN induced the formation of cartilage-like tissues in cell cultures, as observed through the staining of abundant proteoglycans, collagen II and osteocalcin. When injected into intact rat patellar tendons in vivo, KGN induced cartilage-like tissue formation in the injected area. Similarly, when KGN was injected into experimentally injured rat Achilles TBJs, wound healing in the TBJs was enhanced, as evidenced by the formation of extensive cartilage-like tissues. These results suggest that KGN may be used as an effective cell-free clinical therapy to enhance the healing of injured TBJs.
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311
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Han M, Larson PEZ, Liu J, Krug R. Depiction of achilles tendon microstructure in vivo using high-resolution 3-dimensional ultrashort echo-time magnetic resonance imaging at 7 T. Invest Radiol 2014; 49:339-45. [PMID: 24500089 PMCID: PMC4143127 DOI: 10.1097/rli.0000000000000025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The objective of this study was to demonstrate the feasibility of depicting the internal structure of the Achilles tendon in vivo using high-resolution 3-dimensional ultrashort echo-time (UTE) magnetic resonance imaging at 7 T. MATERIALS AND METHODS For our UTE imaging, a minimum-phase radiofrequency pulse and an anisotropic field-of-view 3-dimensional radial acquisition were used to minimize the echo time and scan time. A fat saturation pulse was applied every 8 spoke acquisitions to reduce blurring and chemical shift artifacts from fat and to improve the dynamic range of the tendon signal. Five healthy volunteers and 1 patient were scanned with an isotropic spatial resolution of up to 0.6 mm. Fat-suppressed UTE images were qualitatively evaluated and compared with non-fat-suppressed UTE images and longer echo-time images. RESULTS High-resolution UTE imaging was able to visualize the microstructure of the Achilles tendon. Fat suppression substantially improved the depiction of the internal structure. The UTE images revealed a fascicular pattern in the Achilles tendon and fibrocartilage at the tendon insertion. In a patient who had tendon elongation surgery after birth, there was a clear depiction of disrupted tendon structure. CONCLUSIONS High-resolution fat-suppressed 3-dimensional UTE imaging at 7 T allows for the evaluation of the Achilles tendon microstructure in vivo.
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Affiliation(s)
- Misung Han
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Peder E. Z. Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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312
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The urethral rhabdosphincter, levator ani muscle, and perineal membrane: a review. BIOMED RESEARCH INTERNATIONAL 2014; 2014:906921. [PMID: 24877147 PMCID: PMC4022307 DOI: 10.1155/2014/906921] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 01/31/2023]
Abstract
Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter.
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313
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Wang M, VanHouten JN, Nasiri AR, Tommasini SM, Broadus AE. Periosteal PTHrP regulates cortical bone modeling during linear growth in mice. J Anat 2014; 225:71-82. [PMID: 24762197 DOI: 10.1111/joa.12184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 11/29/2022] Open
Abstract
The modeling of long bone surfaces during linear growth is a key developmental process, but its regulation is poorly understood. We report here that parathyroid hormone-related peptide (PTHrP) expressed in the fibrous layer of the periosteum (PO) drives the osteoclastic (OC) resorption that models the metaphyseal-diaphyseal junction (MDJ) in the proximal tibia and fibula during linear growth. PTHrP was conditionally deleted (cKO) in the PO via Scleraxis gene targeting (Scx-Cre). In the lateral tibia, cKO of PTHrP led to a failure of modeling, such that the normal concave MDJ was replaced by a mound-like deformity. This was accompanied by a failure to induce receptor activator of NF-kB ligand (RANKL) and a 75% reduction in OC number (P ≤ 0.001) on the cortical surface. The MDJ also displayed a curious threefold increase in endocortical osteoblast mineral apposition rate (P ≤ 0.001) and a thickened cortex, suggesting some form of coupling of endocortical bone formation to events on the PO surface. Because it fuses distally, the fibula is modeled only proximally and does so at an extraordinary rate, with an anteromedial cortex in CD-1 mice that was so moth-eaten that a clear PO surface could not be identified. The cKO fibula displayed a remarkable phenotype, with a misshapen club-like metaphysis and an enlargement in the 3D size of the entire bone, manifest as a 40-45% increase in the PO circumference at the MDJ (P ≤ 0.001) as well as the mid-diaphysis (P ≤ 0.001). These tibial and fibular phenotypes were reproduced in a Scx-Cre-driven RANKL cKO mouse. We conclude that PTHrP in the fibrous PO mediates the modeling of the MDJ of long bones during linear growth, and that in a highly susceptible system such as the fibula this surface modeling defines the size and shape of the entire bone.
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Affiliation(s)
- Meina Wang
- Endocrine Section, Department of Internal Medicine, Yale University, New Haven, CT, USA
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314
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Yang G, Rothrauff BB, Tuan RS. Tendon and ligament regeneration and repair: clinical relevance and developmental paradigm. ACTA ACUST UNITED AC 2014; 99:203-222. [PMID: 24078497 DOI: 10.1002/bdrc.21041] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 07/27/2013] [Accepted: 07/27/2013] [Indexed: 12/18/2022]
Abstract
As dense connective tissues connecting bone to muscle and bone to bone, respectively, tendon and ligament (T/L) arise from the somitic mesoderm, originating in a recently discovered somitic compartment, the syndetome. Inductive signals from the adjacent sclerotome and myotome upregulate expression of Scleraxis, a key transcription factor for tenogenic and ligamentogenic differentiation. Understanding T/L development is critical to establishing a knowledge base for improving the healing and repair of T/L injuries, a high-burden disease due to the intrinsically poor natural healing response. Current treatment of the three most common tendon injuries-tearing of the rotator cuff of the shoulder, flexor tendon of the hand, and Achilles tendon-include mostly surgical repair and/or conservative approaches, including biophysical modalities such as rehabilitation and cryotherapy. Unfortunately, the fibrovascular scar formed during healing possesses inferior mechanical and biochemical properties, resulting in compromised tissue functionality. Regenerative approaches have sought to augment the injured tissue with cells, scaffolds, bioactive agents, and mechanical stimulation to improve the natural healing response. The key challenges in restoring full T/L function following injury include optimal combination of these biological agents as well as their delivery to the injury site. A greater understanding of the molecular mechanisms involved in T/L development and natural healing, coupled with the capability of producing complex biomaterials to deliver multiple biofactors with high spatiotemporal resolution and specificity, should lead to regenerative procedures that more closely recapitulate T/L morphogenesis, thereby offering future patients the prospect of T/L regeneration, as opposed to simple tissue repair.
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Affiliation(s)
- Guang Yang
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
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315
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Masi AT. Might axial myofascial properties and biomechanical mechanisms be relevant to ankylosing spondylitis and axial spondyloarthritis? Arthritis Res Ther 2014; 16:107. [PMID: 25166000 PMCID: PMC4060468 DOI: 10.1186/ar4532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Ankylosing spondylitis and axial spondyloarthropathy have characteristic age- and sex-specific onset patterns, typical entheseal lesions, and marked heritability, but the integrative mechanisms causing the pathophysiological and structural alterations remain largely undefined. Myofascial tissues are integrated in the body into webs and networks which permit transmission of passive and active tensional forces that provide stabilizing support and help to control movements. Axial myofascial hypertonicity was hypothesized as a potential excessive polymorphic trait which could contribute to chronic biomechanical overloading and exaggerated stresses at entheseal sites. Such a mechanism may help to integrate many of the characteristic host, pathological, and structural features of ankylosing spondylitis and axial spondyloarthritis. Biomechanical stress and strain were recently documented to correlate with peripheral entheseal inflammation and new bone formation in a murine model of spondyloarthritis. Ankylosing spondylitis has traditionally been classified by the modified New York criteria, which require the presence of definite radiographic sacroiliac joint lesions. New classification criteria for axial spondyloarthritis now include patients who do not fulfill the modified New York criteria. The male-to-female sex ratios clearly differed between the two patient categories - 2:1 or 3:1 in ankylosing spondylitis and 1:1 in non-radiographic axial spondyloarthritis - and this suggests a spectral concept of disease and, among females, milder structural alterations. Magnetic resonance imaging of active and chronic lesions in ankylosing spondylitis and axial spondyloarthritis reveals complex patterns, usually interpreted as inflammatory reactions, but shows similarities to acute degenerative disc disease, which attributed to edema formation following mechanical stresses and micro-damage. A basic question is whether mechanically induced microinjury and immunologically mediated inflammatory mechanisms operate in both ankylosing spondylitis and degenerative disc disease but differ in relative degrees. The hypothesized biomechanical properties raised in this commentary require documentation of their association with the onset risk and course of ankylosing spondylitis and axial spondyloarthritis. If particular subsets of ankylosing spondylitis and axial spondyloarthritis patients are confirmed to have altered axial myofascial properties, their biological basis and underlying biomechanical mechanisms promise to become clarified. Understanding how biomechanical and physical properties can affect symptomatic and structural manifestations of these disorders could also improve their management.
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316
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Lottering N, Reynolds MS, MacGregor DM, Meredith M, Gregory LS. Morphometric modelling of ageing in the human pubic symphysis: Sexual dimorphism in an Australian population. Forensic Sci Int 2014; 236:195.e1-11. [DOI: 10.1016/j.forsciint.2013.12.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 12/26/2013] [Accepted: 12/30/2013] [Indexed: 12/21/2022]
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317
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Yammine K. The prevalence of the sesamoid bones of the hand: a systematic review and meta-analysis. Clin Anat 2014; 27:1291-303. [PMID: 24615762 DOI: 10.1002/ca.22378] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/30/2013] [Accepted: 01/12/2014] [Indexed: 11/07/2022]
Abstract
The literature contains various estimates of the prevalence and distribution of the sesamoid bones in the hands. The aims of this systematic review are to provide a better estimate of the frequency of hand sesamoids and its association with variables such as ancestry, gender, and side. Nineteen studies met the inclusion criteria. The pooled rates of the sensitive meta-analyses from large-sample studies in adults showed: (a) true overall rates of 99.9% for the metacarpophalangeal (MCP) joint of the thumb (MCP-I), 53% for the interphalangeal joint (IP-I), 43.4% for the MCP of the index (MCP-II), 1.47% for the MCP of the medius finger (MCP-III), 0.6% for the MCP of the ring finger (MCP-IV), and 67.7% for the MCP of the auricular finger (MCP-V); (b) true radiological rates of 99.9% for the radial thumb sesamoid, 99.6% for the ulnar thumb sesamoid, 47.8% for IP-I, 40% for MCP-II, 1.3% for MCP-III, 0.8% for MCP-VI, and 62.8% for MCP-V. Black, Middle Eastern, and European ancestries conferred significantly higher sesamoid frequencies at IP-I, MCP-II, and MCP-V, respectively. There was a significant association with female gender at MCP-II, MCP-IV, and MCP-V, with ORs of 1.53, 4, and 1.3, respectively, and a nonsignificant "female" trend for the other locations. There was no significant association with hand side. The pooled rates of hand sesamoids in children aged 10-17 years were 92.7, 42.2, 33.8, 0.5, 0.3, and 36.5% for MCP-I, IP-I, MCP-II, MCP-III, MCP-IV, and MCP-V, respectively. The findings of this evidence-based anatomical review provide quantitative evidence that the incidence of sesamoid bones in human hands depends on genetic rather than functional factors.
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Affiliation(s)
- Kaissar Yammine
- The Foot and Hand Clinic and the Center for Evidence-Based Sport & Orthopedic Research, Emirates Hospital, Jumeirah Beach Road, P.O. Box 73663, Dubai, UAE
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318
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Ravi B, Croxford R, Austin PC, Hollands S, Paterson JM, Bogoch E, Kreder H, Hawker GA. Increased Surgeon Experience With Rheumatoid Arthritis Reduces the Risk of Complications Following Total Joint Arthroplasty. Arthritis Rheumatol 2014; 66:488-96. [DOI: 10.1002/art.38205] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/19/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Bheeshma Ravi
- University of Toronto and Women's College Hospital; Toronto, Ontario Canada
| | - Ruth Croxford
- Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Peter C. Austin
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Simon Hollands
- Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - J. Michael Paterson
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Earl Bogoch
- University of Toronto and St. Michael's Hospital; Toronto, Ontario Canada
| | - Hans Kreder
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Gillian A. Hawker
- University of Toronto, Institute for Clinical Evaluative Sciences, and Women's College Hospital; Toronto, Ontario Canada
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319
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Fearon AM, Twin J, Dahlstrom JE, Cook JL, Cormick W, Smith PN, Scott A. Increased substance P expression in the trochanteric bursa of patients with greater trochanteric pain syndrome. Rheumatol Int 2014; 34:1441-8. [PMID: 24563019 DOI: 10.1007/s00296-014-2957-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 01/29/2014] [Indexed: 11/26/2022]
Abstract
Greater trochanteric pain syndrome (GTPS) is a pathology that can involve the trochanteric bursa or the tendons which attach to the greater trochanter. To clarify the potential importance of bursa versus tendon pathology and of substance P (SP) in contributing to pain in this condition tendon and bursa tissue biopsies were obtained from 34 patients with GTPS and 29 control subjects. Specimens were evaluated via light microscopy for histopathological and morphological differences, as well as using immunohistochemistry for macrophages (CD68), inflammatory cells (CD45) and SP. Bursa [stroma score, mean (SD): 4.18 (1.65) vs. 2.53 (1.61), p = 0.051] and tendon [Bonar score, mean (SD): GTPS mean (SD) 12.65 (2.0), control (10.43 (4.84), p = 0.04] from subjects with GTPS demonstrated more extensive signs of pathology than specimens from control subjects. There was a significantly greater presence of SP in the bursa (frequency: 9/12 vs. 6/16, p = 0.047), but not in the tendon (8/12 vs. 8/15, p = 0.484) of subjects with GTPS compared to controls. An increased presence of SP in the trochanteric bursa may be related to the pain associated with GTPS.
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320
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Metabolic syndrome associated to non-inflammatory Achilles enthesopathy. Clin Rheumatol 2014; 33:1517-22. [DOI: 10.1007/s10067-014-2524-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 01/27/2014] [Accepted: 02/01/2014] [Indexed: 10/25/2022]
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321
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Abraham A, Pauly H, Donahue TH. Deleterious effects of osteoarthritis on the structure and function of the meniscal enthesis. Osteoarthritis Cartilage 2014; 22:275-83. [PMID: 24316288 PMCID: PMC3923977 DOI: 10.1016/j.joca.2013.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/23/2013] [Accepted: 11/26/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The ability of menisci to prevent osteoarthritis (OA) is dependent on the integrity of the complex meniscal entheses, the attachments of the menisci to the underlying subchondral bone (SB). The goal of this study was to determine mechanical and structural changes in meniscal entheses after the onset of OA. DESIGN Healthy and osteoarthritic meniscal entheses were evaluated for changes in histomorphological characteristics, mineralization, and mechanical properties. Glycosaminoglycans (GAG) and calcium in the insertion were evaluated with histological staining techniques. The extent of calcium deposition was assessed and tidemark (TM) integrity was quantified. Changes in the mineralized zone of the insertion were examined using micro-computed tomography (μCT) to determine bone mineral density, cortical zone thickness, and mineralization gradient. Mechanical properties of the entheses were measured using nano-indentation techniques to obtain material properties based on viscoelastic analysis. RESULTS GAG thickness in the calcified fibrocartilage (CFC) zone and calcium content were significantly greater in osteoarthritic anterior meniscal entheses. TM integrity was significantly decreased in OA tissue, particularly in the medial anterior (MA) enthesis. The mineralized zone of osteoarthritic meniscal entheses was significantly thicker than in healthy entheses and showed decreased bone mineral density. Fitting of mineralization data to a sigmoidal Gompertz function revealed a lower rate of increase in mineralization in osteoarthritic tissue. Analysis of viscoelastic mechanical properties revealed increased compliance in osteoarthritic tissue. CONCLUSIONS These data suggest that significant changes occur at meniscal enthesis sites with the onset of OA. Mechanical and structural changes in meniscal entheses may contribute to meniscal extrusion, which has been shown to increase the progression of OA.
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Affiliation(s)
- A.C. Abraham
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - H.M. Pauly
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - T.L. Haut Donahue
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA,Address correspondence and reprint requests to: T.L. Haut Donahue, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
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322
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Zhu Z, Yu A, Hou M, Xie X, Li P. Effects of Sox9 gene therapy on the healing of bone-tendon junction: An experimental study. Indian J Orthop 2014; 48:88-95. [PMID: 24600069 PMCID: PMC3931159 DOI: 10.4103/0019-5413.125521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sox9 is an operon that positively regulates the transcription of type II collagen. The generation of type II collagen plays a critical role in the healing process of the bone-tendon junction (BTJ). MATERIALS AND METHODS Sox9 was injected into an established bone-tendon healing model in order to observe its effect on the healing by determining the biomechanical properties of the BTJ. In addition, the recombinant adenovirus Sox9 was used to transduce the animal model samples and in vivo observations of the effect of the adenovirus-mediated Sox9 transduction as well as its promotion of the healing properties were made. RESULTS Sox9 was not only able to promote the healing, but also increased the biomechanical strength. The recombinant Sox9 delivered by adenoviral vector can be expressed at a high level in the damaged tissues of the bone-tendon junction, which can stimulate the production of type II collagen and improve the healing of the BTJ. CONCLUSIONS Based on the results of this study, we considered that gene therapy may be applicable in the healing process of the bone-tendon junction.
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Affiliation(s)
- Zhiqi Zhu
- Department of Orthopaedics, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China,Department of Orthopaedics, People's Hospital of Longgang District, Shenzhen, China
| | - Aixi Yu
- Department of Orthopaedics, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China,Address for correspondence: Dr. Aixi Yu, Department of Orthopaedics, Wuhan University Zhongnan Hospital, No. 169 Donghu Road, Wuhan, Hubei Province, China - 430030. E-mail:
| | - Ming Hou
- Department of Orthopaedics, People's Hospital of Longgang District, Shenzhen, China
| | - Xiaoqing Xie
- Department of Orthopaedics, People's Hospital of Longgang District, Shenzhen, China
| | - Peng Li
- Department of Orthopaedics, People's Hospital of Longgang District, Shenzhen, China
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323
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Sasaki H, Hinata N, Kurokawa T, Murakami G. Supportive tissues of the vagina with special reference to a fibrous skeleton in the perineum: A review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojog.2014.43025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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324
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Mata Arnaiz MC, de Miguel Mendieta E. Usefulness of ultrasonography in the assessment of peripheral enthesis in spondyloarthritis. ACTA ACUST UNITED AC 2013; 10:113-9. [PMID: 24360900 DOI: 10.1016/j.reuma.2013.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/11/2013] [Indexed: 12/01/2022]
Abstract
Enthesitis is one of the characteristic etiopathogenic manifestations of spondyloarthritis. However, in clinical practice, its presence often goes unnoticed because of the lack of precision and sensitivity of physical examination to detect it. Viable, valid and reliable imaging tests are needed for early diagnosis, as well as a good sensitivity to change to monitor therapeutic response. In this paper we review the most relevant aspects of current knowledge of the enthesis and discusses the validity of ultrasound for assessing enthesitis in spondyloarthritis and its sensitivity to change to monitor therapeutic response.
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325
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Abstract
The intrasynovial bone-tendon interface is a gradual transition from soft tissue to bone, with two intervening zones of uncalcified and calcified fibrocartilage. Following injury, the native anatomy is not restored, resulting in inferior mechanical properties and an increased risk of re-injury. Recent in vivo studies provide evidence of improved healing when surgical repair of the bone-tendon interface is augmented with cells capable of undergoing chondrogenesis. In particular, cellular therapy in bone-tendon healing can promote fibrocartilage formation and associated improvements in mechanical properties. Despite these promising results in animal models, cellular therapy in human patients remains largely unexplored. This review highlights the development and structure-function relationship of normal bone-tendon insertions. The natural healing response to injury is discussed, with subsequent review of recent research on cellular approaches for improved healing. Finally, opportunities for translating in vivo findings into clinical practice are identified.
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Affiliation(s)
- Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering; Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh, PA USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering; Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh, PA USA
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326
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Wang M, Nasiri A, VanHouten JN, Tommasini SM, Broadus AE. The remarkable migration of the medial collateral ligament. J Anat 2013; 224:490-8. [PMID: 24266550 DOI: 10.1111/joa.12145] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2013] [Indexed: 01/06/2023] Open
Abstract
The developing cortical surfaces of long bones are sculpted and modeled by periosteal osteoclasts and osteoblasts. These surfaces also receive the insertions of tendons and ligaments, and these insertion sites too are modeled to form the root systems that anchor them into the cortical bone. The regulatory molecules that control modeling are poorly understood, but recent evidence suggests that parathyroid hormone-related protein (PTHrP) participates in this process. PTHrP functions principally as a paracrine regulatory molecule, and is known to be induced by mechanical loading in a number of sites. The most curious example of developmental modeling of the cortex is the migration of insertion sites such as that of the medial collateral ligament (MCL) along the bone surface during long-bone growth. We report here the mechanisms that mediate MCL migration using a combination of genetic, imaging and histological techniques. We describe a MCL migratory complex that comprises two components. The first is the MCL insertion site itself, which is a prototypical fibrous insertion site with coupled osteoclast and osteoblast activities, and its key feature is that it is anchored early in development, well before initiation of the long-bone growth spurt. Above the insertion site the periosteum is excavated by osteoclasts to form a migratory tract; this is mediated by wholly uncoupled osteoclastic bone resorption and remains as an unmineralized canal on the cortical surface in the adult. Load-induction of PTHrP appears to regulate the osteoclastic activity in both the insertion site and migratory tract.
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Affiliation(s)
- Meina Wang
- Endocrine Section, Department of Internal Medicine, Yale University, New Haven, CT, USA
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327
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Massoud EIE. Healing of subcutaneous tendons: Influence of the mechanical environment at the suture line on the healing process. World J Orthop 2013; 4:229-240. [PMID: 24147258 PMCID: PMC3801242 DOI: 10.5312/wjo.v4.i4.229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023] Open
Abstract
Tendon ruptures remain a significant musculoskeletal injury. Despite advances in surgical techniques and procedures, traditional repair techniques maintain a high incidence of rerupture or tendon elongation. Mechanical loading and biochemical signaling both control tissue healing. This has led some researchers to consider using a technique based on tension regulation at the suture line for obtaining good healing. However, it is unknown how they interact and to what extent mechanics control biochemistry. This review will open the way for understanding the interplay between mechanical loading and the process of tendon healing.
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328
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Bannerman A, Paxton JZ, Grover LM. Imaging the hard/soft tissue interface. Biotechnol Lett 2013; 36:403-15. [PMID: 24129952 DOI: 10.1007/s10529-013-1374-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 09/25/2013] [Indexed: 12/15/2022]
Abstract
Interfaces between different tissues play an essential role in the biomechanics of native tissues and their recapitulation is now recognized as critical to function. As a consequence, imaging the hard/soft tissue interface has become increasingly important in the area of tissue engineering. Particularly as several biotechnology based products have made it onto the market or are close to human trials and an understanding of their function and development is essential. A range of imaging modalities have been developed that allow a wealth of information on the morphological and physical properties of samples to be obtained non-destructively in vivo or via destructive means. This review summarizes the use of a selection of imaging modalities on interfaces to date considering the strengths and weaknesses of each. We will also consider techniques which have not yet been utilized to their full potential or are likely to play a role in future work in the area.
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Affiliation(s)
- Alistair Bannerman
- School of Chemical Engineering, University of Birmingham, Birmingham, UK,
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329
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Shwartz Y, Blitz E, Zelzer E. One load to rule them all: Mechanical control of the musculoskeletal system in development and aging. Differentiation 2013; 86:104-11. [DOI: 10.1016/j.diff.2013.07.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/01/2013] [Accepted: 07/12/2013] [Indexed: 12/24/2022]
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330
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Noldner LK, Edgar HJ. 3D representation and analysis of enthesis morphology. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2013; 152:417-24. [DOI: 10.1002/ajpa.22367] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/19/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Lara K. Noldner
- Anthropology Department and Maxwell Museum of Anthropology; University of New Mexico; Albuquerque; NM 87131
| | - Heather J.H. Edgar
- Anthropology Department and Maxwell Museum of Anthropology; University of New Mexico; Albuquerque; NM 87131
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331
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de Bakker E, Gielen I, Kromhout K, van Bree H, Van Ryssen B. Magnetic resonance imaging of primary and concomitant flexor enthesopathy in the canine elbow. Vet Radiol Ultrasound 2013; 55:56-62. [PMID: 24033814 DOI: 10.1111/vru.12090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 06/10/2013] [Indexed: 11/30/2022] Open
Abstract
Flexor enthesopathy is a recently recognized elbow disorder in dogs and considered to be an important differential diagnosis for elbow lameness. Primary and concomitant forms of the disease have been previously described and treatments differ for the two forms. The goal of this prospective study was to compare magnetic resonance imaging (MRI) findings for dogs with primary flexor enthesopathy (n = 17), concomitant flexor enthesopathy (n = 23), elbow dysplasia alone (n = 13), and normal elbows (n = 7). Each elbow joint underwent MRI using the same low-field scanner. Sequences included transverse and sagittal T1-weighted (before and after IV contrast), transverse and sagittal T2-weighted, and dorsal STIR. For each elbow, MRI lesions were recorded based on a consensus of two observers unaware of group status. Magnetic resonance imaging lesions involving flexor tendons were found in 100% of clinically affected joints with primary flexor enthesopathy and 96% of clinically affected joints with concomitant flexor enthesopathy. Thickened flexor muscles were the most common lesions, followed by hyperintense tendon signal and contrast enhancement. Irregular, thickened medial humeral epicondyle, edema, and calcified body lesions were less frequently observed. Magnetic resonance imaging characteristics of flexor enthesopathy were not found in normal joints or those affected by elbow dysplasia alone. No significant differences in frequencies and details of individual MRI characteristics were found between primary and concomitant flexor enthesopathy groups. Findings indicated that MRI is a sensitive technique for detection of flexor enthesopathy lesions in dogs, however, MRI characteristics do not allow differentiation of primary versus concomitant forms of the disease.
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Affiliation(s)
- Evelien de Bakker
- Department of Medical Imaging and Small Animal Orthopaedics, Ghent University, Merelbeke, Belgium
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332
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de Bakker E, Gielen I, van Caelenberg A, van Bree H, van Ryssen B. Computed tomography of canine elbow joints affected by primary and concomitant flexor enthesopathy. Vet Radiol Ultrasound 2013; 55:45-55. [PMID: 24033837 DOI: 10.1111/vru.12091] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 06/10/2013] [Indexed: 12/01/2022] Open
Abstract
Flexor enthesopathy is an important differential diagnosis for elbow lameness in dogs. The disorder can be a primary cause of elbow lameness or concomitant with other elbow pathology. Since treatment differs for primary and concomitant forms of flexor enthesopathy, a noninvasive method for distinguishing between them is needed. In the current prospective study, computed tomographic (CT) examination was performed before and after IV injection of contrast in 17 dogs with primary flexor enthesopathy, 24 dogs with concomitant flexor enthesopathy, 13 dogs with elbow dysplasia, and seven normal dogs. Dogs were assigned to groups based on results of clinical examination and at least three other imaging modalities. Computed tomographic lesions consistent with flexor enthesopathy were found in all clinically affected joints with primary flexor enthesopathy and in 29 of the 30 clinically affected joints with concomitant flexor enthesopathy. Those lesions were not found in sound elbows or joints affected by elbow dysplasia. Flexor lesions detected in dogs with primary flexor enthesopathy were not significantly different from those detected in dogs with the concomitant form. Findings indicated that CT can be applied to detect flexor enthesopathy, but a distinction between the primary and concomitant forms was not always possible. Authors recommend the use of multiple diagnostic techniques for treatment planning in affected dogs.
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Affiliation(s)
- Evelien de Bakker
- Department of Medical Imaging and Small Animal Orthopaedics, Ghent University, Merelbeke, Belgium
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333
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Song N, Armstrong AD, Li F, Ouyang H, Niyibizi C. Multipotent mesenchymal stem cells from human subacromial bursa: potential for cell based tendon tissue engineering. Tissue Eng Part A 2013; 20:239-49. [PMID: 23865619 DOI: 10.1089/ten.tea.2013.0197] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Rotator cuff injuries are a common clinical problem either as a result of overuse or aging. Biological approaches to tendon repair that involve use of scaffolding materials or cell-based approaches are currently being investigated. The cell-based approaches are focused on applying multipotent mesenchymal stem cells (MSCs) mostly harvested from bone marrow. In the present study, we focused on characterizing cells harvested from tissues associated with rotator cuff tendons based on an assumption that these cells would be more appropriate for tendon repair. We isolated MSCs from bursa tissue associated with rotator cuff tendons and characterized them for multilineage differentiation in vitro and in vivo. Human bursa was obtained from patients undergoing rotator cuff surgery and cells within were isolated using collagenase and dispase digestion. The cells isolated from the tissues were characterized for osteoblastic, adipogenic, chondrogenic, and tenogenic differentiation in vitro and in vivo. The results showed that the cells isolated from bursa tissue exhibited MSCs characteristics as evidenced by the expression of putative cell surface markers attributed to MSCs. The cells exhibited high proliferative capacity and differentiated toward cells of mesenchymal lineages with high efficiency. Bursa-derived cells expressed markers of tenocytes when treated with bone morphogenetic protein-12 (BMP-12) and assumed aligned morphology in culture. Bursa cells pretreated with BMP-12 and seeded in ceramic scaffolds formed extensive bone, as well as tendon-like tissue in vivo. Bone formation was demonstrated by histological analysis and immunofluorescence for DMP-1 in tissue sections made from the scaffolds seeded with the cells. Tendon-like tissue formed in vivo consisted of parallel collagen fibres typical of tendon tissues. Bursa-derived cells also formed a fibrocartilagenous tissue in the ceramic scaffolds. Taken together, the results demonstrate a new source of MSCs with a high potential for application in tendon repair.
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Affiliation(s)
- Na Song
- 1 College of Animal Sciences, Jilin University , Changchun, China
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334
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Eivazi MG, Selfe J. Infrapatellar fat pad lesions: theoretical considerations and practical implications. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x251993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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335
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Ozkan F, Bakan B, Fatih Inci M, Kocturk F, Yildirim Cetin G, Yuksel M, Sayarlioglu M. Avaliação de entesopatia em pacientes com fibromialgia por meio do novo índice ultrassonográfico de entesite. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000400004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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336
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Wang L, Su YX, Zheng GS, Liao GQ, Zhang WH. Healing masseter entheses of mandibular reconstruction with autograft—Raman spectroscopic and histological study. Int J Oral Maxillofac Surg 2013; 42:915-22. [DOI: 10.1016/j.ijom.2012.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 11/13/2012] [Accepted: 12/12/2012] [Indexed: 01/18/2023]
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337
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Zhang Q, Zhou J, Ge H, Cheng B. Tgif1 and SnoN modified chondrocytes or stem cells for tendon-bone insertion regeneration. Med Hypotheses 2013; 81:163-6. [PMID: 23747175 DOI: 10.1016/j.mehy.2013.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 05/02/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
Tendon-bone insertion injuries are a common occurrence but rarely heal, despite the many strategies that have been employed. The tendon-bone insertion consists of four types of tissues: tendon, fibrocartilage, mineral fibrocartilage and bone, making it hard to regenerate. The key to reconstructing the tendon enthesis is to rebuild the gradations of cell type, collagen type, mineral content and collagen fiber orientation. Chondrocytes were found to be able to differentiate into tendon and bone tissues upon special stimulation, which offers promise for tendon enthesis regeneration. Tgif1 is a key factor that represses the expression of the cartilage master gene Sox9, which is induced by TGFβs, and changes the expression rate of Sox9 versus Scx, eventually promoting fibrogenesis. SnoN is a key factor that is induced by TGFβs to inhibit the hypertrophy of chondrocytes and therefore bone formation. It appears that the induction of Tgif1 and the repression of SnoN can cause chondrocytes to differentiate into tendon and bone tissues. Moreover, a gradation of the expression levels of Tgif1 and SnoN in chondrocytes may create a gradation of the tissue from tendon to fibrocartilage to bone. Consequently, we propose that a gradation of gene-modified chondrocytes (Tgif1-inducing cells, primary cells, SnoN-repressing cells) or stem cells that arise from a gradation of stimulation (Tgif1 induction and SnoN repression) will aid in the regeneration of the tendon-bone insertion.
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Affiliation(s)
- Qiang Zhang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medcine, Shanghai, China
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Walther M, Kratschmer B, Verschl J, Volkering C, Altenberger S, Kriegelstein S, Hilgers M. Effect of different orthotic concepts as first line treatment of plantar fasciitis. Foot Ankle Surg 2013; 19:103-7. [PMID: 23548451 DOI: 10.1016/j.fas.2012.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/02/2012] [Accepted: 12/11/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evaluation of the effectiveness of three different types of prefabricated foot orthotics in the treatment of plantar fasciitis. METHODS Prospective, randomized head-to-head trial in 30 adults (21 women, 9 men) with plantar fasciitis without any anatomic alterations. Three different prefabricated orthotics were tested (thin, non supportive orthotic (NO); soft supportive foam orthotic (FO); foam covered rigid self-supporting plastic orthotic (PO)). The follow up was 3 weeks. Main outcome measures were maximum and average pain (VAS), duration of pain per day, walking distance and subjective comfort. RESULTS There was no significant effect of NO on maximal pain and average pain. FO and PO had a significant effect on pain levels (p<0.05) whereas PO was superior concerning pain reduction and the time until the onset of effect (p<0.05). CONCLUSIONS PO are superior regarding pain reduction and pain free time when compared to FO. NO did not demonstrate a significant effect in the test setup used.
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Affiliation(s)
- Markus Walther
- Department of Foot and Ankle Surgery, Schoen Klinik Munich Harlaching, Harlachinger Strasse 51, 81547 Munich, Germany.
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339
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Abraham AC, Donahue TLH. From meniscus to bone: a quantitative evaluation of structure and function of the human meniscal attachments. Acta Biomater 2013; 9:6322-9. [PMID: 23385217 DOI: 10.1016/j.actbio.2013.01.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/16/2013] [Accepted: 01/28/2013] [Indexed: 12/01/2022]
Abstract
Meniscus efficacy at promoting joint congruity and preventing osteoarthritis hinges on enthesis integrity. Gross-scale tensile testing, histomorphometry and magnetic resonance imaging reveal significant differences between the four attachments, implying that each must endure a unique mechanical environment, which dictates their structure. However, little data exists to elucidate how these interfaces have adapted to their complex loading environment, particularly on a relevant scale, as the enthesis transitions through several unique zones in less than a millimeter. In our study we leveraged nanoindentation to determine viscoelastic material properties through the transition zones. Additionally, we employed histological techniques to evaluate the enthesis structure, including collagen organization and interdigitation morphometry. Mechanical evaluation revealed the medial posterior insertion site to be significantly more compliant than others. Collagen fiber orientation and dispersion as well as interdigitation morphometry were significantly different between attachments sites. These findings are clinically relevant as a disproportionate amount of enthesis failure occurs in the medial posterior attachment. Also, meniscal enthesis structure and function will need to be considered in future reparative and replacement strategies in order to recreate native meniscus mechanics and prevent osteoarthritis propagation.
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Affiliation(s)
- Adam C Abraham
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
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340
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Kupczynska M, Barszcz K, Janczyk P, Wasowicz M, Czubaj N. Morphology of the transverse ligament of the atlas and the alar ligaments in the silver fox (Vulpes vulpes var). BMC Vet Res 2013; 9:64. [PMID: 23557095 PMCID: PMC3622594 DOI: 10.1186/1746-6148-9-64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 03/27/2013] [Indexed: 11/27/2022] Open
Abstract
Background Recent new anatomical and histological features of craniocervical junction in dogs and cats were described providing evidence of differences between the carnivore species. No information on these structures in foxes exists. Results Two parts of the alar ligaments were found. A longer one aroused from dens of axis to the internal (medial) surface of the occipital condyles and was called apical part. A shorter part originated from the entire length of the lateral edge of the dens of axis and terminated on the internal wall of the vertebral foramen of atlas and thus was called the lateral part. The transverse ligament of the atlas was widened in the mid region, above the dens of axis, and thickened at enthesis. Periosteal fibrocartilage was detected in the transverse ligament of the atlas at the enthesis, and sesamoid fibrocartilage was present on periphery in the middle of the ligament. Conclusions The craniocervical junction in foxes differs in part from other carnivores such as dogs and cats but resembles that of mesaticephalic dogs. The sesamoid and periosteal fibrocartilage supports the transverse ligament of the atlas whereas the alar ligaments have no cartilage.
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Affiliation(s)
- Marta Kupczynska
- Department of Morphological Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences - SGGW, Nowoursynowska 159, Warsaw, 02-776, Poland
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341
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Ma L, Meng Q, Chen Y, Zhang Z, Sun H, Deng D. Preliminary use of a double-echo pulse sequence with 3D ultrashort echo time in the MRI of bones and joints. Exp Ther Med 2013; 5:1471-1475. [PMID: 23737901 PMCID: PMC3671832 DOI: 10.3892/etm.2013.993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/08/2013] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to investigate the application of a double-echo pulse sequence with 3D ultrashort echo time (UTE) in the magnetic resonance imaging (MRI) of bones and joints. In total, 7 healthy volunteers and 1 volunteer with a suspected tear of the lateral meniscus of the left knee joint underwent MRI with a double-echo pulse sequence and 3D UTE. The imaging was performed on the tibial diaphysis, knee joint and ankle of the volunteers and on a segment of porcine fibula in vitro. The echo time of echo 1 (TE1) of the UTE images for the achilles tendon of the ankle joint were set as 0.08, 0.16, 0.24 and 0.35 msec. The maximum intensity projection (MIP) of the difference images created from the primary double-echo images with a TE1 of 0.08 msec were performed on the tendons of the ankle to display their 3D structure. The data were analyzed with a one-way ANOVA and paired-sample t-test. The 3D distribution of the tendons was displayed through MIPs of the difference images created from the primary double-echo images. The cortical bones, periosteum, tendons and menisci of the 8 volunteers appeared as high signal intensities in the UTE pulse sequence. Multiplanar reconstruction followed by subtraction of the primary double-echo images raised the image signal-to-noise (S/N) ratio from 2.80±0.75 to 3.76±0.88 (t=−4.851, P<0.01). The artifacts appeared more marked as the TE1 was prolonged. A double pulse sequence MRI with 3D UTE may display the short T2 components which are not displayed with a conventional clinical MRI sequence, therefore creating a basis for the further quantification of these tissues.
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Affiliation(s)
- Liheng Ma
- The Medical Diagnostic Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080
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342
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Wang M, VanHouten JN, Nasiri AR, Johnson RL, Broadus AE. PTHrP regulates the modeling of cortical bone surfaces at fibrous insertion sites during growth. J Bone Miner Res 2013; 28:598-607. [PMID: 23109045 PMCID: PMC3574208 DOI: 10.1002/jbmr.1801] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/24/2012] [Accepted: 10/08/2012] [Indexed: 11/06/2022]
Abstract
The sites that receive ligament and tendon insertions (entheses) on the cortical surfaces of long bones are poorly understood, particularly regarding modeling and regulation. Entheses are classified as either fibrocartilaginous or fibrous based on their structures. Fibrous entheses typically insert into the metaphysis or diaphysis of a long bone, bear a periosteal component, and are modeled during long-bone growth. This modeling forms a root system by which the insertions attach to the cortical surface. In the case of the medial collateral ligament, modeling drives actual migration of the ligament along the cortical surface in order to accommodate linear growth, whereas in other sites modeling may excavate a deep cortical root system (eg, the teres major insertion) or a shallow root system with a large footprint (eg, the latissimus dorsi insertion). We report here that conditionally deleting parathyroid hormone-related protein (PTHrP) in fibrous entheses via Scleraxis-Cre targeting causes modeling to fail in these three iterations of osteoclast-driven enthesis excavation or migration. These iterations appear to represent formes frustes of a common modeling strategy, presumably differing from each other as a consequence of differences in biomechanical control. In sites in which PTHrP is not induced, either physiologically or because of conditional deletion, modeling does not take place and fibrocartilage is induced. These findings represent the initial genetic evidence that PTHrP regulates periosteal/intramembranous bone cell activity on cortical bone surfaces and indicate that PTHrP serves as a load-induced modeling tool in fibrous insertion sites during linear growth.
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Affiliation(s)
- Meina Wang
- Department of Internal Medicine, Yale University, New Haven, CT 06511
| | | | - Ali R. Nasiri
- Department of Internal Medicine, Yale University, New Haven, CT 06511
| | - Randy L. Johnson
- Department of Biochemistry and Molecular Biology, University of Texas, MD Anderson Cancer Center, Houston, TX 77030
| | - Arthur E. Broadus
- Department of Internal Medicine, Yale University, New Haven, CT 06511
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343
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Hoppe S, Alini M, Benneker LM, Milz S, Boileau P, Zumstein MA. Tenocytes of chronic rotator cuff tendon tears can be stimulated by platelet-released growth factors. J Shoulder Elbow Surg 2013; 22:340-9. [PMID: 22521394 DOI: 10.1016/j.jse.2012.01.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 01/11/2012] [Accepted: 01/15/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bone-to-tendon healing after rotator cuff repairs is mainly impaired by poor tissue quality. The tenocytes of chronic rotator cuff tendon tears are not able to synthesize normal fibrocartilaginous extracellular matrix (ECM). We hypothesized that in the presence of platelet-released growth factors (PRGF), tenocytes from chronically retracted rotator cuff tendons proliferate and synthesize the appropriate ECM proteins. MATERIALS AND METHODS Tenocytes from 8 patients with chronic rotator cuff tears were cultured for 4 weeks in 2 different media: standard medium (Iscove's Modified Dulbecco's Media + 10% fetal calf serum + 1% nonessential amino acids + 0.5 μg/mL ascorbic acid) and media with an additional 10% PRGF. Cell proliferation was assessed at 7, 14, 21, and 28 days. Messenger (m)RNA levels of collagens I, II, and X, decorin, biglycan, and aggrecan were analyzed using real time reverse-transcription polymerase chain reaction. Immunocytochemistry was also performed. RESULTS The proliferation rate of tenocytes was significantly higher at all time points when cultured with PRGF. At 21 days, the mRNA levels for collagens I, II, and X, decorin, aggrecan, and biglycan were significantly higher in the PRGF group. The mRNA data were confirmed at protein level by immunocytochemistry. CONCLUSIONS PRGFs enhance tenocyte proliferation in vitro and promote synthesis of ECM to levels similar to those found with insertion of the normal human rotator cuffs. CLINICAL RELEVANCE Biologic augmentation of repaired rotator cuffs with PRGF may enhance the properties of the repair tissue. However, further studies are needed to determine if application of PRGF remains safe and effective in long-term clinical studies. LEVEL OF EVIDENCE Basic Science Study, Cell Biology.
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Affiliation(s)
- Sven Hoppe
- Orthopedic Sports Medicine, Department of Orthopedic Surgery and Traumatology, University of Bern, Inselspital, CH- 3010 Bern, Switzerland
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344
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Askling CM, Koulouris G, Saartok T, Werner S, Best TM. Total proximal hamstring ruptures: clinical and MRI aspects including guidelines for postoperative rehabilitation. Knee Surg Sports Traumatol Arthrosc 2013; 21:515-33. [PMID: 23229384 DOI: 10.1007/s00167-012-2311-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 11/19/2012] [Indexed: 11/26/2022]
Abstract
The aim of this article is to provide a state-of-the-art review for treatment of acute, total proximal hamstring tendon ruptures. For total proximal hamstring tendon ruptures, early (<2-3 w) surgical refixation minimizes muscle atrophy and facilitates a somewhat predictable time course for healing and rehabilitation. A postoperative rehabilitation program is detailed that has been used by one physical therapist for the past 7 years on over 200 patients with surgical repair for total proximal hamstring tendon rupture. One re-rupture has occurred, 7 months after surgery, following the rehabilitation program described herein. The rehabilitation program, including avoidance of postoperative bracing, appears effective for total proximal hamstring ruptures. Early surgery together with a specific rehabilitation program appears to be the treatment of choice for timely and safe return to sport and an active lifestyle. Level of evidence V.
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Affiliation(s)
- Carl M Askling
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
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345
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Sanchez S, Dupret V, Tafforeau P, Trinajstic KM, Ryll B, Gouttenoire PJ, Wretman L, Zylberberg L, Peyrin F, Ahlberg PE. 3D microstructural architecture of muscle attachments in extant and fossil vertebrates revealed by synchrotron microtomography. PLoS One 2013; 8:e56992. [PMID: 23468901 PMCID: PMC3582629 DOI: 10.1371/journal.pone.0056992] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/16/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Firm attachments binding muscles to skeleton are crucial mechanical components of the vertebrate body. These attachments (entheses) are complex three-dimensional structures, containing distinctive arrangements of cells and fibre systems embedded in the bone, which can be modified during ontogeny. Until recently it has only been possible to obtain 2D surface and thin section images of entheses, leaving their 3D histology largely unstudied except by extrapolation from 2D data. Entheses are frequently preserved in fossil bones, but sectioning is inappropriate for rare or unique fossil material. METHODOLOGY/PRINCIPAL FINDINGS Here we present the first non-destructive 3D investigation, by propagation phase contrast synchrotron microtomography (PPC-SRµCT), of enthesis histology in extant and fossil vertebrates. We are able to identify entheses in the humerus of the salamander Desmognathus from the organization of bone-cell lacunae and extrinsic fibres. Statistical analysis of the lacunae differentiates types of attachments, and the orientation of the fibres, reflect the approximate alignment of the muscle. Similar histological structures, including ontogenetically related pattern changes, are perfectly preserved in two 380 million year old fossil vertebrates, the placoderm Compagopiscis croucheri and the sarcopterygian fish Eusthenopteron foordi. CONCLUSIONS/SIGNIFICANCE We are able to determine the position of entheses in fossil vertebrates, the approximate orientation of the attached muscles, and aspects of their ontogenetic histories, from PPC-SRµCT data. Sub-micron microtomography thus provides a powerful tool for studying the structure, development, evolution and palaeobiology of muscle attachments.
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Affiliation(s)
- Sophie Sanchez
- European Synchrotron Radiation Facility, Grenoble, France
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Vincent Dupret
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Paul Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France
| | - Katherine M. Trinajstic
- Department of Chemistry, Curtin University, Perth, Australia
- Department of Earth and Planetary Sciences, Western Australian Museum, Perth, Australia
| | - Bettina Ryll
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Pierre-Jean Gouttenoire
- European Synchrotron Radiation Facility, Grenoble, France
- Unité mixte de recherche 5220, Centre national de la recherche scientifique, Institut national de la santé et de la recherche médicale U1044, Universtité de Lyon, Lyon, France
| | - Lovisa Wretman
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Louise Zylberberg
- Unité mixte de recherche 7193, Centre national de la recherche scientifique, Université Pierre et Marie Curie, Institut des sciences de la Terre de Paris, Paris, France
| | - Françoise Peyrin
- European Synchrotron Radiation Facility, Grenoble, France
- Unité mixte de recherche 5220, Centre national de la recherche scientifique, Institut national de la santé et de la recherche médicale U1044, Universtité de Lyon, Lyon, France
| | - Per E. Ahlberg
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
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346
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Lovric V, Ledger M, Goldberg J, Harper W, Bertollo N, Pelletier MH, Oliver RA, Yu Y, Walsh WR. The effects of low-intensity pulsed ultrasound on tendon-bone healing in a transosseous-equivalent sheep rotator cuff model. Knee Surg Sports Traumatol Arthrosc 2013; 21:466-75. [PMID: 22466014 DOI: 10.1007/s00167-012-1972-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 03/15/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to examine the effects Low-intensity Pulsed Ultrasound has on initial tendon-bone healing in a clinically relevant extra-articular transosseous-equivalent ovine rotator cuff model. METHODS Eight skeletally mature wethers, randomly allocated to either control group (n = 4) or treatment group (n = 4), underwent rotator cuff surgery following injury to the infraspinatus tendon. All animals were killed 28 days post surgery to allow examination of early effects of Low-intensity Pulsed Ultrasound treatment. RESULTS General improvement in histological appearance of tendon-bone integration was noted in the treatment group. Newly formed woven bone with increased osteoblast activity along the bone surface was evident. A continuum was observed between the tendon and bone in an interdigitated fashion with Sharpey's fibres noted in the treatment group. Low-intensity Pulsed Ultrasound treatment also increased bone mineral density at the tendon-bone interface (p < 0.01), while immunohistochemistry results revealed an increase in the protein expression patterns of VEGF (p = 0.038), RUNX2 (p = 0.02) and Smad4 (p = 0.05). CONCLUSIONS The results of this study indicate that Low-intensity Pulsed Ultrasound may aid in the initial phase of tendon-bone healing process in patients who have undergone rotator cuff repair. This treatment may also be beneficial following other types of reconstructive surgeries involving the tendon-bone interface.
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Affiliation(s)
- Vedran Lovric
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2031, Australia
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347
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Tufan A, Mercan R, Tezcan ME, Kaya A, Bitik B, Ozturk MA, Haznedaroglu S, Goker B. Enthesopathy in patients with familial Mediterranean fever: increased prevalence in M694 V variant. Rheumatol Int 2013; 33:1933-7. [PMID: 23334425 DOI: 10.1007/s00296-013-2669-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 01/04/2013] [Indexed: 01/03/2023]
Abstract
Enthesopathy is pathology of bony insertions of tendons, ligaments or joint capsules. It is a frequent finding in rheumatic diseases, like ankylosing spondylitis (AS) and Behçet's disease. Musculoskeletal complaints are common in patients with familial Mediterranean fever (FMF), and these could be a clinical manifestation of enthesopathy. Hence, we investigated the possible association between FMF and enthesopathy. Fifty-six patients with FMF and 11 patients with FMF-associated spondyloarthropathy (FMFS) were enrolled. Forty-seven healthy individuals and 36 patients with AS formed the healthy and diseased control groups. Musculoskeletal complaints were meticulously questioned, and all patients underwent a detailed physical and ultrasonographic (US) examination of the lower limbs. US scorings of enthesopathy was performed according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Demographic data, disease characteristics, MEFV genotypes and HLA B27 results were retrieved from the medical records. Patient-reported pain and physical examination findings consistent with enthesopathy were frequent in all groups with the highest prevalence in the FMFS group. Heel was the most common region affected in all patient groups. FMF patients harboring M694 V variant had higher GUESS scores compared to patients with other variants (2.78 ± 2.43 vs. 1.37 ± 1.67, p = 0.026). There was no statistically significant difference in the mean ± SD GUESS scores between healthy subjects and those FMF patients with genetic variants other than M694 V (1.38 ± 1.42 vs. 1.37 ± 1.67, p > 0.05). Enthesopathy may not be a feature of general FMF population; rather, it might be specifically associated with the presence of M694 V variant. Our results further support the previous evidence regarding M694 V mutation and spondyloarthropathy association.
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Affiliation(s)
- Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
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348
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Woodburn J, Hyslop E, Barn R, McInnes IB, Turner DE. Achilles tendon biomechanics in psoriatic arthritis patients with ultrasound proven enthesitis. Scand J Rheumatol 2013; 42:299-302. [PMID: 23286761 DOI: 10.3109/03009742.2012.747626] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate Achilles tendon (AT) biomechanics in psoriatic arthritis (PsA) patients with ultrasound confirmed features of enthesitis. METHOD PsA patients and healthy control subjects underwent three-dimensional (3D) gait analysis to measure walking speed, rotational joint motion and the moments, power, and AT force at the ankle-subtalar joint complex. The Glasgow Ultrasound Enthesitis Scoring System (GUESS) was used to score the presence of enthesophytes, erosions, retrocalcaneal bursitis, and tendon thickening. Power Doppler ultrasound signal (PDUS) was used to detect active disease. Peripheral joint arthritis, acute-phase reactants, global health, disability, and foot impairments were recorded. A core set of biomechanical variables that influence the insertion of the AT and indirect estimates of tendon loading were compared between PsA patients and control subjects with and without enthesitis. RESULTS Forty-two PsA patients with a mean disease duration of 10.6 (SD 9.4) years and 29 control subjects were studied. Seventeen (40%) PsA patients had clinically detectable AT entheseal pain. Twenty-eight (67%) PsA patients and nine (31%) control subjects had one or more GUESS enthesitis features, predominantly enthesophytes. PsA patients with enthesitis walked significantly more slowly than control subjects (p = 0.019) and generated lower peak ankle joint moments (p = 0.006), power (p = 0.001), and AT force (p = 0.003). Ankle-subtalar joint complex motion was comparable and no between-group differences were found for peak dorsiflexion (p = 0.59), eversion (p = 0.05), and internal rotation (p = 0.19). CONCLUSIONS In this group of PsA patients, the AT insertional angle was not influenced by ankle-subtalar joint motion in those with and without enthesitis. Moreover, the PsA patients with enthesitis had significantly lower AT loading.
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Affiliation(s)
- J Woodburn
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK.
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349
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Elastic discontinuity due to ectopic calcification in a human fibrous joint. Acta Biomater 2013; 9:4787-95. [PMID: 22917805 DOI: 10.1016/j.actbio.2012.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 07/23/2012] [Accepted: 08/14/2012] [Indexed: 01/13/2023]
Abstract
Disease can alter natural ramp-like elastic gradients to steeper step-like profiles at soft-hard tissue interfaces. Prolonged function can further mediate mechanochemical events that alter biomechanical response within diseased organs. In this study, a human bone-tooth fibrous joint was chosen as a model system, in which the effects of bacterial-induced disease, i.e. periodontitis, on natural elastic gradients were investigated. Specifically, the effects of ectopic biomineral, i.e. calculus, on innate chemical and elastic gradients within the cementum-dentin complex, both of which are fundamental parameters to load-bearing tissues, are investigated through comparisons with a healthy complex. Complementary techniques for mapping changes in physicochemical properties as a result of disease included micro X-ray computed tomography, microprobe micro X-ray fluorescence imaging, transmission electron and atomic force microscopy (AFM) techniques, and AFM-based nanoindentation. Results demonstrated primary effects as derivatives of ectopic mineralization within the diseased fibrous joint. Ectopic mineralization with no cementum resorption, but altered cementum physicochemical properties with increasing X-ray attenuation, exhibited stratified concretion with increasing X-ray fluorescence counts of calcium and phosphorus elements in the extracellular matrix in correlation with decreased hygroscopicity, indenter displacement, and apparent strain-relieving characteristics. Disease progression, identified as concretion through the periodontal ligament (PDL)-cementum enthesis, and sometimes the originally hygroscopic cementum-dentin junction, resulted in a significantly increased indentation elastic modulus (3.16±1.19 GPa) and a shift towards a discontinuous interface compared with healthy conditions (1.54±0.83 GPa) (Student's t-test, P<0.05). The observed primary effects could result in secondary downstream effects, such as compromised mechanobiology at the mechanically active PDL-cementum enthesis that can catalyze progression of disease.
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350
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Foot tendinopathies in rheumatic diseases: etiopathogenesis, clinical manifestations and therapeutic options. Clin Rheumatol 2012; 32:547-55. [DOI: 10.1007/s10067-012-2158-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
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