Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A. 2017;114:9332-9336. [PMID: 28808025 DOI: 10.1073/pnas.1703856114]

Comparative effectiveness of Tuina therapy versus manual physical therapy for knee osteoarthritis: a randomized controlled trial

BACKGROUND

Tuina therapy (Tuina) is commonly utilized for managing knee osteoarthritis (KOA), yet the available evidence is limited. This study aimed to evaluate the effectiveness of Tuina compared to widely accepted manual physical therapy (mPT) for patients with KOA.

METHODS

Between Oct 2019 and Oct 2021, patients with KOA (Kellgren-Lawrence score II or III) were randomly assigned in a 1:1 ratio to receive Tuina or mPT, with eight 20-min sessions over 3 weeks. Assessments were performed at baseline, week 4, 8, and 16. The primary outcome was the change of total Western Ontario and McMaster University Osteoarthritis Index (WOMAC) from baseline to week 4. Secondary outcomes included WOMAC subscales, knee pain measures, performance-based tests, quality-of-life measures, and safety assessments. Patients, evaluators, and statisticians were blinded to treatment group assignment. All main analyses were by intention-to-treat.

RESULTS

Of the 140 patients allocated to Tuina or mPT, 127 completed the treatment. There was significant intervention × time interaction observed in the WOMAC-total (F(2, 266) = 3.87, P = 0.02), there was no statistically significant between groups at week 4 (between-group difference: -1.00, 95%CI: -5.33 to 3.33, P = 0.79, Bonferroni correction). By week 8, Tuina showed significantly consistent improvement compared to mPT (between-group difference: -4.33, 95%CI: -8.34 to -0.31, P = 0.03, Bonferroni correction), whereas there were no statistically significant differences between groups at week 16 (between-group difference: 0.74, 95%CI: -3.67 to 5.15, P = 0.37, Bonferroni correction). Most secondary outcomes showed no significant between-group differences, except for the Timed Up and Go Test Time favoring mPT (0.94, 95%CI: 0.03 to 1.85, P = 0.04). No serious adverse events occurred. One patient in the mPT group took the medication and no patients received other therapies for KOA.

CONCLUSIONS

Tuina produced beneficial effectiveness similar to mPT in treating KOA.

TRIAL REGISTRATION

NCT03966248, Registered on 29/05/2019, ClinicalTrials.gov.

Stem cell injections for osteoarthritis of the knee

BACKGROUND

Stem cells are specialised precursor cells that can replace aged or damaged cells and thereby maintain healthy tissue function. Stem cell therapy is increasingly used as a treatment for knee osteoarthritis, despite the lack of clarity around the mechanism by which stem cell therapy may slow down disease progression in osteoarthritis, and uncertainty regarding its benefits and harms.

OBJECTIVES

To assess the benefits and harms of stem cell injections for people with osteoarthritis of the knee. A secondary objective is to maintain the currency of the evidence, using a living systematic review approach.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase on 15 September 2023, unrestricted by date or language of publication. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) for relevant trial protocols and ongoing trials.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), or trials using quasi-randomised methods of participant allocation, comparing stem cell injection with placebo injection, no treatment or usual care, glucocorticoid injection, other injections, exercise, drug therapy, surgical interventions, and supplements and complementary therapies in people with knee osteoarthritis.

DATA COLLECTION AND ANALYSIS

Two review authors selected studies for inclusion, extracted trial characteristics and outcome data, assessed risk of bias and assessed the certainty of evidence using the GRADE approach. The primary comparison was stem cell injection compared with placebo injection. The primary time point for pain, function and quality of life was three to six months, and the end of the trial period for participant-reported success, joint structure changes and adverse event outcomes. Major outcomes were pain, function, quality of life, global assessment of success, radiographic joint progression, withdrawals due to adverse events and serious adverse events.

MAIN RESULTS

We found 25 randomised trials (1341 participants) comparing stem cell injections with placebo injection (eight trials), no treatment or usual care (analgesia, weight loss and exercise) (two trials), glucocorticoid injection (one trial), hyaluronic acid injection (seven trials), platelet-rich plasma injections (two trials), oral acetaminophen (paracetamol) (one trial), non-steroidal anti-inflammatory drugs plus physical therapy plus hyaluronic acid injection (one trial) and stem cell injection plus intra-articular co-intervention versus co-intervention alone (three trials) in people with osteoarthritis of the knee. Trials were predominantly small, with sample sizes ranging from 6 to 252 participants, with only two trials having more than 100 participants. The average age of participants across trials ranged from 51 to 66 years, and symptom duration varied from one to 10 years. Placebo-controlled trials were largely free from bias, while most trials without a placebo control were susceptible to performance and detection biases. Here, we limit reporting to the main comparison, stem cell injection versus placebo injection. Compared with placebo injection, stem cell injection may slightly improve pain and function up to six months after treatment. Mean pain (0 to 10 scale, 0 no pain) was 4.5 out of 10 points with placebo injection and 1.2 points better (2.5 points better to 0 points better) with stem cell injection (I2 = 80%; 7 studies, 445 participants). Mean function (0 to 100 scale, 0 best function) was 46.3 points with placebo injection and 14.2 points better (25.3 points better to 3.1 points better) with stem cell injection (I2 = 82%; 7 studies, 432 participants). We are uncertain whether stem cell injections improve quality of life or increase the number of people who report treatment success compared to placebo injection, because the certainty of the evidence was very low. Mean quality of life was 45.3 points with placebo injection and 22.8 points better (18.0 points worse to 63.7 points better) with stem cell injection (I2 = 96%; 2 studies, 288 participants) at up to six months follow-up. At the end of follow-up, 89/168 participants (530 per 1000) in the placebo injection group reported treatment success compared with 126/180 participants (683 per 1000) in the stem cell injection group (risk ratio (RR) 1.29, 95% CI 1.10 to 1.53; I2 = 0%; 4 trials, 348 participants). We downgraded the evidence to low certainty for pain and function due to indirectness (as the source, method of preparation and dose of stem cells varied across studies), and suspected publication bias (up to three larger RCTs have been conducted but withdrawn prior to reporting of results). For quality of life and treatment success, we further downgraded the evidence to very low certainty due to imprecision in addition to indirectness and suspected publication bias. We are uncertain of the potential harms associated with stem cell injection, as there were very low event rates for serious adverse events. At the end of follow-up, 5/219 participants (23 per 1000) in the placebo injection group experienced serious adverse events compared with 4/242 participants (16 per 1000) in the stem cell injection group (RR 0.72, 95% CI 0.20 to 2.64; I2 = 0%; 7 trials, 461 participants) and there were no reported withdrawals due to adverse events. We downgraded the evidence to very low certainty due to indirectness, suspected publication bias and imprecision. Radiographic progression was not assessed in any of the included studies.

AUTHORS' CONCLUSIONS

Compared with placebo injections and based upon low-certainty evidence, stem cell injections for people with knee osteoarthritis may slightly improve pain and function. We are uncertain of the effects of stem cell injections on quality of life or the number who report treatment success. Although the putative benefits of stem cell therapies for osteoarthritis include potential regenerative effects on damaged tissues, particularly articular cartilage, we remain uncertain of the effect of stem cell injections on structural progression in the knee (measured by radiographic appearance). There is also uncertainty regarding the safety of stem cell injections. Serious adverse events were infrequently reported, although all invasive joint procedures (including injections) carry a small risk of septic arthritis. The risk of other important harms, including potential concerns related to the use of a therapy with the theoretical capacity to promote cell growth, or to the use of allogeneic cells, remains unknown.

Gait improvements in the early post-surgery rehabilitation phase in subjects receiving a total knee or hip arthroplasty: A prospective study

BACKGROUND

Rehabilitation after total knee arthroplasty (TKA) and total hip arthroplasty (THA) is fundamental for reducing pain and recovering strength, range of motion, and walking ability. Gait analysis (GA) is rarely included in the rehabilitation path. This study assesses how inpatient rehabilitation influences clinical outcomes and gait analysis (GA) parameters in TKA and THA patients, comparing these with age- and speed-matched healthy subjects (HS).

METHODS

A prospective observational study included 80 subjects (50 TKA, 30 THA) and 20 aged-matched HS. Assessments occurred at admission and discharge post inpatient rehabilitation, using clinical outcome scales (e.g., Modified Barthel Index, Knee Society Score), GA spatiotemporal parameters, and gait summary measures (e.g., Gait Profile Score, Gait Deviation Index). Statistical analyses determined the significance of improvements.

RESULTS

Post-rehabilitation, significant improvements were observed in clinical outcomes and some key spatio-temporal gait parameters (p ≤ 0.01). However, gait summary measures showed no changes. Interestingly, gait summary measures did not correlate with clinical outcome scales. Moreover, TKA and THA patients showed no differences compared with slow-walking HS.

CONCLUSION

Inpatient rehabilitation significantly enhanced clinical outcomes and spatio-temporal parameters. Additionally, no differences were observed between spatiotemporal and gait summary measures of slow-walking HS and patients at discharge, indicating that rehabilitation restored gait quality. However, gait speed remains impaired, in both TKA and THA populations. Future research should explore personalized rehabilitation protocols to address these limitations and improve gait outcomes.

TRIAL REGISTRATION NUMBER

NCT04803578.

Gonarthrosis related changes in quadriceps muscle architecture and physical function outcomes in women

This study aimed to assess the effects of gonarthrosis on quadriceps muscle architecture and fatigue, physical function, and postural balance in women compared with healthy controls. Eighty-one females diagnosed with gonarthrosis (n = 40) and healthy control group (n = 41) aged between 47 and 77 years participated in the study. After demographic data were collected, right and left rectus femoris (RF), vastus intermedius (VI), vastus lateralis (VL) thicknesses and RF pennation angle (PA) were determined using a 2D real-time ultrasound device (USG). RF and VI depths and RF cross-sectional area (CSA) were obtained using ultrasound with the probe positioned in a transverse orientation to the muscle. In addition, the participants underwent the timed up and go test (TUG), 30-sec sit-and-up test (SU30s), and completed the Fatigue Severity Scale (FSS). The relationship between functional tests and right and left quadriceps muscle architecture parameters was also analyzed. In our study, the right CSA (p < .001, t=- 8.609, ES = 1.92), left VL (p = .020, t= - 2.365, ES = 0.052), and left CSA (p < .001, t=- 10.164, ES = 2.26) were significantly higher in the healthy group. Conversely, TUG (p < .001, t = 4.882, ES = 1.08) and FSS (p < .001, t = 10.362, ES = 2.29) were significantly higher in the gonarthrosis group, while SU30s values were higher in the control group (p < .001, t = - 12.262, ES = 2.73). Additionally, a negative correlation was observed between SU30s and CSA, whereas TUG and FSS showed a positive correlation with CSA (p < .001). According to the results of our study, some morphological losses were observed in the quadriceps muscle architecture of participants with gonarthrosis. Decreases in CSA affect functional performance. Determination of quadriceps muscle architecture in patients with gonarthrosis can be used to predict functional loss.

Comparison of hyaluronic acid and platelet-rich plasma in knee osteoarthritis: a systematic review

BACKGROUND

Knee osteoarthritis (KOA) is a common joint disorder, and intra-articular injections of hyaluronic acid (HA) or platelet-rich plasma (PRP) are frequently employed therapeutic interventions. However, there remains controversy regarding their efficacy. This systematic review aims to compare the effectiveness and safety of HA and PRP through a meta-analysis, with the objective of identifying the optimal treatment protocol for KOA and enhancing its management.

METHODS

Randomized controlled trials evaluating the clinical outcomes of patients receiving intra-articular injections of either HA or PRP were included as eligible studies. Two independent investigators assessed the selected studies and evaluated their risk of bias. Primary outcome measures included the Visual Analog Scale (VAS) score, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and other relevant assessment indices. Dichotomous variables were analyzed using risk ratios (RR) with 95% confidence intervals (CI). Data analysis was conducted using RevMan software (version 5.3).

RESULTS

A total of forty-two randomized controlled trials were included in this meta-analysis. No significant differences were observed between the patient populations in the two groups. The analysis demonstrated that PRP resulted in lower VAS and WOMAC scores compared to HA. Additionally, PRP exhibited superior performance across other evaluation indices. Notably, the incidence of adverse events was higher in the PRP group; however, all reported complications were mild.

CONCLUSIONS

Based on the current evidence, intra-articular injection of PRP appears to be more effective than HA for the treatment of KOA, as indicated by the analysis of VAS, WOMAC scores, and other evaluation indices.

TRIAL REGISTRATION

Retrospectively registered.

RANKL-mediated osteoclastic subchondral bone loss at a very early stage precedes subsequent cartilage degeneration and uncoupled bone remodeling in a mouse knee osteoarthritis model

INTRODUCTION

Uncoupled bone remodeling in the subchondral bone (SB) has recently been considered as an important process in the progression of knee osteoarthritis (KOA). In this study, we aimed to investigate changes in SB and articular cartilage using a mouse model of destabilization of the medial meniscus (DMM) and determine the effects of bone metabolism on KOA progression.

METHODS

DMM or sham surgery was performed on the left knees of 40-week-old male wild-type (WT) mice and Tsukuba hypertensive mice (THM), which exhibit high-turnover bone metabolism. Bone volume/tissue volume (BV/TV) and bone mineral density (BMD) in the medial tibial SB were measured longitudinally in vivo using μCT at 0 (immediately after surgery), 1, 2, 4, 8, and 12 weeks postoperatively. Concurrently, histological evaluations of the articular cartilage in the medial tibial plateau were conducted. Furthermore, the number of endo-periosteal tartrate-resistant acid phosphatase-positive osteoclasts, trabecular RANKL-positive osteocytes, and osteocytes in the trabeculae were measured at 0, 1, 2, and 4 weeks.

RESULTS

In the WT + DMM group, BV/TV and BMD in the SB significantly decreased with time, whereas cartilage degeneration significantly increased. In the THM + DMM group, these changes in BMD and cartilage degeneration were significantly pronounced. Interestingly, in the THM + DMM group, BV/TV significantly decreased up to 4 weeks but then began to increase, although BMD continued to decrease until the 12-week mark. The number of osteoclasts and the percentage of RANKL-positive osteocytes per total number of osteocytes within the total trabecular bone area (%) in the WT + DMM group significantly increased with time, with a significant difference between the WT + DMM and WT + sham groups at 4 weeks. The number of osteocytes in the WT + DMM group significantly decreased with time, and the difference between the WT + DMM and WT + sham groups was significant at 4 weeks postoperatively. These histological changes were significantly enhanced in the THM + DMM group.

CONCLUSIONS

The results indicate that early-stage osteocyte death in the SB and RANKL-mediated osteoclastic SB loss precede histological cartilage degeneration and contribute to uncoupled bone remodeling at the later stage. Acceleration of disease processes in the THM + DMM group suggests that high-turnover bone metabolism is a potential risk factor for KOA. Maintaining SB integrity and avoiding continuous SB overload may be key strategies for mitigating disease progression.

Corticosteroids, hyaluronic acid, platelet-rich plasma, and cell-based therapies for knee osteoarthritis - literature trends are shifting in the injectable treatments' evidence: a systematic review and expert opinion

INTRODUCTION

The aim of this systematic review was to quantify the data available on corticosteroids (CS), hyaluronic acid, (HA), platelet-rich plasma (PRP), and cell-based therapies for knee osteoarthritis (OA) treatment.

METHODS

A literature search was conducted on PubMed, Cochrane, WebofScience according to the PRISMA guidelines. Inclusion criteria: clinical studies of any level of evidence, written in English, evaluating the intra-articular use of CS, HA, PRP, or cell-based therapies for knee OA treatment.

RESULTS

The initial search identified 17,415 records. A total of 766 studies from 1959 were included. Of these, 401 were randomized controlled trials, 110 comparative studies, and 255 case series, for a total of 75,834 patients. (11,245 treated with CS 40,862 with HA 16,174 with PRP, 7,553 with cell-based therapies).

CONCLUSIONS

The evidence on injective knee OA treatments is increasing at different speeds with a more rapidly growing literature focusing on orthobiologics. Currently, HA has the largest evidence, followed by PRP that recently surpassed the number of studies evaluating CS. Cell-based therapies are also growing rapidly, although the number of studies is still lower. The rapid literature shift toward orthobiologics urges an update in societies' guidelines to align with the new body of evidence on knee OA treatments.

PROTOCOL REGISTRATION

www.crd.york.ac.uk/prospero identifier is CRD42024592972.

Rethinking Osteoarthritis Management: Synergistic Effects of Chronoexercise, Circadian Rhythm, and Chondroprotective Agents

Osteoarthritis (OA) is a chronic and debilitating joint disease characterized by progressive cartilage degeneration for which no definitive cure exists. Conventional management approaches often rely on fragmented and poorly coordinated pharmacological and non-pharmacological interventions that are inconsistently applied throughout the disease course. Persistent controversies regarding the clinical efficacy of chondroprotective agents, frequently highlighted by pharmacovigilance agencies, underscore the need for a structured evidence-based approach. Emerging evidence suggests that synchronizing pharmacotherapy and exercise regimens with circadian biology may optimize therapeutic outcomes by addressing early pathological processes, including low-grade inflammation, oxidative stress, and matrix degradation. Recognizing the influence of the chondrocyte clock on these processes, this study proposes a 'prototype' for a novel framework that leverages the circadian rhythm-aligned administration of traditional chondroprotective agents along with tailored, accessible exercise protocols to mitigate cartilage breakdown and support joint function. In addition, this model-based framework emphasizes the interdependence between cartilage chronobiology and time-of-day-dependent responses to exercise, where strategically timed joint activity enhances nutrient and waste exchange, mitigates mitochondrial dysfunction, supports cellular metabolism, and promotes tissue maintenance, whereas nighttime rest promotes cartilage rehydration and repair. This time-sensitive, comprehensive approach aims to slow OA progression, reduce structural damage, and delay invasive procedures, particularly in weight-bearing joints such as the knee and hip. However, significant challenges remain, including inter-individual variability in circadian rhythms, a lack of reliable biomarkers for pharmacotherapeutic monitoring, and limited clinical evidence supporting chronoexercise protocols. Future large-scale, longitudinal trials are critical to evaluate the efficacy and scalability of this rational integrative strategy, paving the way for a new era in OA management.

Anti-inflammatory effect of multi-dose tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Tranexamic acid (TXA) is considered a potential therapeutic approach to mitigate postoperative inflammatory responses; however, its anti-inflammatory effects remain controversial. This study conducts a systematic review and meta-analysis of randomized controlled trials aiming to investigate the efficacy of multi-dose TXA in exerting anti-inflammatory effects in hip and knee arthroplasty.

METHODS

We identified potential relevant literature evaluating the anti-inflammatory effects of TXA in patients undergoing hip and knee arthroplasty from PubMed, Embase, and the Cochrane Library. Meta-analysis was performed using RevMan 5.3.

RESULTS

Nine randomized controlled studies met the inclusion criteria. Meta-analysis results indicated that, compared with lower doses of TXA, multi-dose TXA significantly reduced the inflammatory markers IL-6 and CRP in patients undergoing hip and knee arthroplasty and shortened the length of hospital stay, with statistically significant results. Nonsignificant differences were found in the incidence of thromboembolic events.

CONCLUSION

Based on the current evidence, our results indicate that multi-dose TXA effectively reduces postoperative inflammatory responses in patients undergoing hip and knee arthroplasty. This anti-inflammatory effect is dose-dependent and is accompanied by a reduction in the length of hospital stay. Nonetheless, further high-quality, multicenter, large-sample-size randomized controlled trials are needed to confirm the anti-inflammatory effects of TXA.

Examining Planar Contributions to Knee Total Joint Moment Between Women and Men During Loaded Gait Tasks

Background

Military personnel in combat roles observe a high prevalence of knee osteoarthritis. Knee total joint moment (KTJM) and the knee adduction moment percentage contribution (KAM%) of KTJM have been linked to knee osteoarthritis. It is postulated that sex, load carriage, and imposed locomotion patterns such as forced marching (FM) alter mechanics of the knee. The purpose of this study was to determine the effects of "military-relevant" load magnitudes, locomotion patterns, and sex on KTJM and its planar percentage contributions in recruit-aged adults during short-duration gait tasks.

Hypothesis

The greatest load magnitude and FM will significantly increase KAM contribution to KTJM compared with lower magnitudes or no load. Additionally, women will exhibit greater KAM contribution to KTJM compared with men regardless of experimental condition.

Study Design

Controlled laboratory study.

Methods

Twenty healthy recruit-aged (18-35 years) adults (10 male, 10 female) executed trials of running and FM with no load (BW), an additional load of 45% of BW, and an additional load of 55% of BW. KTJM was calculated along with each plane of motion percentage contribution: knee flexion moment (KFM%), KAM%, and knee rotation moment (KRM%). A 3 × 2 × 2 mixed model analysis of variance was used to evaluate the effects of load carriage, locomotion pattern, and sex on KTJM, KFM%, KAM%, and KRM% at multiple gait events of stance phase.

Results

FM exhibited a greater (P < .001) KTJM than running at heel strike. Running had greater KAM% (P = .01) and KRM% (P < .001) compared with FM. At midstance, running exhibited greater (P < .001) KTJM than FM for each load condition; however, FM had greater KAM% (P < .001) and KRM% (P = .002) compared with running at peak vertical ground reaction force and midstance. Men exhibited greater KAM% at heel strike (P = .02) independent of locomotion pattern and at midstance (P = .04) for FM.

Conclusion

Load carriage increases KAM% to a magnitude similarly observed in populations with knee osteoarthritis, especially when executing FM. Interestingly, men exhibited greater KAM% than women, suggesting differing strategies to motor execution with relative load carriage.

Clinical Relevance

Screening recruits for greater KAM% during loaded gait tasks may identify individuals in need of specialized training to reduce the risk of knee osteoarthritis development.

PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Platelet-rich plasma (PRP) has emerged as a promising therapeutic intervention for knee osteoarthritis (OA), attracting substantial clinical and research attention. However, the clinical relevance of the treatment benefit remains controversial.

PURPOSE

To evaluate the effectiveness of PRP compared with placebo in patients with knee OA in terms of minimal clinically important difference (MCID) and to investigate the possible influence of platelet concentration on the clinical outcome.

STUDY DESIGN

Meta-analysis. Level of evidence 1.

METHODS

The search was conducted on 5 databases (PubMed, Cochrane Library, Scopus, Embase, Web of Science) using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were randomized controlled trials comparing PRP and placebo injections to treat knee OA, written in the English language, with no time limitation. The effects were quantified at 1-, 3-, 6-, and 12-month follow-up points. Visual analog scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used, with subanalyses based on platelet concentration performed using a 1,000,000 ± 20% platelets/µL cutoff. The MCID values (VAS, 1.37; WOMAC, 6.4) were used to interpret clinical improvement. The articles' quality was assessed using the Revised Tool for Risk of Bias in Randomized Trials and the Grading of Recommendations Assessment, Development and Evaluation guidelines.

RESULTS

Among the 5499 articles retrieved, 18 randomized controlled trials (1995 patients) were included. PRP presented statistically superior improvements in VAS and WOMAC scores compared with placebo at all follow-up points, exceeding the MCID at 3- and 6-month follow-up points for VAS and at all follow-up points for WOMAC. The subanalysis based on platelet concentration showed that high-platelet PRP provided clinically significant pain relief with the improvement exceeding the MCID compared with placebo at 3-, 6-, and 12-month follow-up points. In contrast, low-platelet PRP failed to offer a clinically perceivable benefit in terms of VAS score. WOMAC results showed that both products provided a clinically significant improvement at 3 and 6 months of follow-up. This benefit was maintained up to the 12-month follow-up in the high-platelet group but not in the low-platelet group, where the improvement compared with placebo did not reach statistical significance.

CONCLUSION

This meta-analysis showed that PRP offered clinically relevant functional improvement at 1-, 3-, 6-, and 12-month follow-up points and pain relief at 3- and 6-month follow-up points compared with placebo for the treatment of knee OA. Platelet concentration was found to influence treatment efficacy, with high-platelet PRP providing superior pain relief and more durable functional improvement compared with low-platelet PRP.

Mechanism of action and new developments in the study of curcumin in the treatment of osteoarthritis: a narrative review

Osteoarthritis is a degenerative joint disease that affects the aging population worldwide. It has an underlying inflammatory cause that leads to loss of chondrocytes, reducing the cartilage layer at the affected joints. Compounds with anti-inflammatory properties are potential therapeutic agents for osteoarthritis. Curcumin, derived from species of the Curcuma, is an anti-inflammatory compound. The purpose of this review is to summarize the anti-osteoarthritic effects of curcumin from clinical and preclinical studies. Many clinical trials have been conducted to determine curcumin's effectiveness in osteoarthritis patients. Available studies have shown that curcumin prevents chondrocyte apoptosis and inhibits the release of proteoglycans and metalloproteinases as well as the expression of cyclooxygenase, prostaglandin E-2, and inflammatory cytokines in chondrocytes. The mechanism of action of curcumin also involves multiple cell signaling pathways, including Nuclear factor kappa-B(NF-κB), Mitogen-activated protein kinase (MAPK), Wnt/β-catenin pathway (Wnt/β-catenin), The Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3), Nuclear factor erythroid 2-related factor 2/antioxidant response elements/heme oxygenase-1(Nrf2/ARE/HO-1), and Phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathways. Curcumin further reduced the release of inflammatory factors and apoptosis by inhibiting the activation of NF-κB. In addition, curcumin modulates the MAPK, Nrf2/ARE/HO-1, and PI3K/Akt/mTOR signaling pathways and affects cell proliferation and apoptosis processes, a series of effects that together promote the healthy state of chondrocytes. In conclusion, curcumin, as a natural plant compound, exhibits significant anti-inflammatory potential by modulating inflammatory factors associated with articular osteoarthritis through multiple mechanisms. Its protective effects on articular cartilage and synovium make it a promising candidate for the treatment of OA. Future studies should further explore the mechanism of action of curcumin and its optimal dosage and therapeutic regimen in clinical applications, to provide more effective therapeutic options for osteoarthritis patients.

Red Algae Alters Expression of Inflammatory Pathways in an Osteoarthritis In Vitro Co-Culture

Background/Objectives: Osteoarthritis (OA) is one of the most prevalent chronic conditions and significantly contributes to local and global disease burden. Common pharmaceuticals that are used to treat OA cause significant side effects, thus non-pharmaceutical bioactive alternatives have been developed that can impact OA symptoms without severe side-effects. One such alternative is the Red Algae Lithothamnion species (Litho). However, there is little mechanistic knowledge of its potential to effect OA gene expression, and a human in vitro model using commercially available cell lines to test its effectiveness has yet to be developed. Methods: Human osteoblast (hFOB 1.19. CRL-11372) and chondrocyte (C28/I2) cell lines were co-cultured indirectly using transwells. IL1-β was used to induce an inflammatory state and gene expression profiles following treatment were the primary outcome. Conclusions: Results indicated that the model was physiologically relevant, remained viable over at least seven days, untreated or following induction of an inflammatory state while maintaining hFOB 1.19. and C28/I2 cell phenotypic characteristics. Following treatment, Litho reduced the expression of inflammatory and pain associated genes, most notably IL-1β, IL-6, PTGS2 (COX-2) and C1qTNF2 (CTRP2). Confirmatory analysis with droplet digital PCR (ddPCR) revealed that Il-1β induced a significant reduction in C1qTNF2 at 7 days which was ameliorated with Litho treatment. These data present a novel and replicable co-culture model of inflammatory OA that can be used to investigate bioactive nutraceuticals. For the first time, this model demonstrated a reduction in C1qTNF2 expression that was mitigated by Red Algae Lithothamnion species.

Perioperative Geriatrician Assessment Is Associated with a Lower Risk of Emergency Department Visits After Total Joint Arthroplasty

BACKGROUND

Previous research has underscored the benefits of geriatrician consultation in improving outcomes for older patients undergoing hip fracture repair, highlighting enhanced functional outcomes and reduced morbidity. However, the impact of geriatrician care in outcomes for patients undergoing elective total joint arthroplasty (TJA) has yet to be described. We aimed to determine whether preoperative or postoperative geriatrician involvement was associated with differences in the length of hospital stay and emergency department (ED) visits after TJA.

METHODS

This retrospective cohort study screened the medical records of patients ≥65 years of age undergoing primary elective TJA in a network of tertiary hospitals. Geriatrician consultations occurring within a period spanning 90 days before to 90 days after TJA were recorded. Bivariate analysis and multivariable regression models were used to assess the relationship between receiving these consultations and changes in the length of stay and ED visits.

RESULTS

A total of 16,076 patients undergoing primary TJA were included. Of these surgical procedures, 9,677 (60.2%) were total knee arthroplasties and 6,087 (37.9%) were total hip arthroplasties; 1,416 (8.8%) of cases had geriatrician visits. Patients had lower odds of requiring postoperative ED visits when they had at least 1 geriatrician appointment within the week preceding an arthroplasty (odds ratio [OR], 0.97 [95% confidence interval (CI), 0.68 to 0.99]; p = 0.005). This effect was most notable for 65-year-old patients (OR, 0.66 [95% CI, 0.45 to 0.98]).

CONCLUSION

This study reports promising evidence supporting the benefits of perioperative geriatrician visits on TJA outcomes. Preoperative visits were shown to be associated with decreased odds of ED visits after TJA in patients for up to 90 days postoperatively. Thus, geriatrician involvement in elective TJAs has the potential to improve outcomes and reduce morbidity and costs for patients and reduce costs for surgeons and institutions.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

The Mediating Role of Anger and Anxiety in the Association of Social Support with Mobility Among Middle-Age and Older Adults with Knee Osteoarthritis

INTRODUCTION

Osteoarthritis (OA) is one of the leading causes of chronic disability in older adults, often causing significant impairment of mobility. OA symptoms have been linked to mental functioning, including depression, anxiety, and negative affect.

METHOD

To examine whether anger and anxiety mediate the relationship between social support and mobility among older adults with knee osteoarthritis, data from the Everyday Quality of Life in Older Blacks and Whites with Osteoarthritis (EQUAL) study (N = 336) were analyzed using Hayes' PROCESS model in SPSS to test the direct effect of social support on mobility as well as mediation by anxiety and anger.

RESULTS

While univariate models for both anxiety and anger were significant, only anxiety mediated the relationship between social support and mobility.

CONCLUSION

Although limited by their cross-sectional nature, the findings suggest that at least part of the association of social support with mobility may be explained by the role of support in alleviating anxiety.

Design of novel graded bone scaffolds based on triply periodic minimal surfaces with multi-functional pores

Background

Various mechanical and biological requirements on bone scaffolds were proposed due to the clinical demands of human bone implants, which remains a challenge when designing appropriate bone scaffolds.

Methods

In this study, novel bone scaffolds were developed by introducing graded multi-functional pores onto Triply Periodic Minimal Surface (TPMS) structures through topology optimization of unit cell. The performance of these scaffolds was evaluated using finite element (FE) analysis and computational fluid dynamics (CFD) method.

Results

The results from FE analysis indicated that the novel scaffold exhibited a lower elastic modulus, potentially mitigating the issue of stress shielding. Additionally, the results from CFD demonstrated that the mass transport capacity of the novel scaffold was significantly improved compared to conventional TPMS scaffolds.

Conclusion

In summary, the novel TPMS scaffolds with graded multi-functional pores presented in this paper exhibited enhanced mechanical properties and mass transport capacity, making them ideal candidates for bone repair. A new design framework was provided for the development of high-performance bone scaffolds.

Fork in the road: therapeutic and pathological actions for fibro-adipogenic progenitors following musculoskeletal injury

Musculoskeletal injuries are a substantial source of global disability through weakness and loss of function, which can be attributable, in part, to deficits in skeletal muscle quality. Poor muscle quality, resulting from fibrotic pathology or fatty infiltration, strongly predicts lower rates of patient recovery following injury and higher rates of re-injury. The cellular sources of fibrosis and fatty infiltration within skeletal muscle are mesenchymal fibro-adipogenic progenitors (FAPs), which are central effectors to support muscle homeostasis, regeneration and growth. However, following acute or chronic musculoskeletal injury, FAPs can promote fibro/fatty pathology within muscle that is likely to limit recovery and repair. Given their indispensable role within skeletal muscle, FAPs have emerged as a compelling cellular target to promote tissue recovery following acute and chronic injury. This review provides insight into the aetiology of FAP activity following various musculoskeletal injuries, in addition to signalling components that effect FAP differentiation. Contrasting pathology with therapeutic potential, insight into disease- and injury-specific FAP activation further cements their role as crucial effectors to improve muscle function and enhance patient outcomes.

Knee loading and joint pain during daily activities in people with knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND

Knee loading is associated with the severity and progression of knee osteoarthritis, while knee pain contributes to reduced functional ability and quality of life. In this systematic review, we quantified knee loading and knee pain during different daily activities in people with knee osteoarthritis and explored methodological reasons for differences between studies.

METHODS

PubMed, Web of Science, Scopus, and manual searches were performed up to July 2024, to retrieve studies measuring knee loading and knee pain in walking, sit-to-stand and stair climbing of people with knee osteoarthritis. Descriptive data synthesis and meta-analysis were performed using a mixed-effect model.

FINDINGS

183 studies were included. Walking led to the greatest knee loading, followed by stair climbing and finally sit-to-stand, although only sit-to-stand was significantly lower than the others (p < 0.001). Stair ascent had the greatest knee pain, followed by walking, stair descent and then sit-to-stand. In addition, our results show a strong negative correlation between knee loading and pain during walking (r = -0.507).

INTERPRETATION

The trend of knee loading across activities, while non-significant, is consistent with our previous experimental study. The differences compared to other studies are likely be due to the high heterogeneity in the tested population and differences in methodology. Additionally, there were a substantial number of studies only examining a single activity (primarily walking), which could bias the results. Therefore, future studies should detail participant characteristic and experiment design. In addition, inclusion of a control group is recommended to account for knee loading offsets when comparing results across studies.

The Implications of Brain-Derived Neurotrophic Factor in the Biological Activities of Platelet-Rich Plasma

Platelet-rich plasma (PRP) is a biological blood-derived therapeutic obtained from whole blood that contains higher levels of platelets. PRP has been primarily used to mitigate joint degeneration and chronic pain in osteoarthritis (OA). This clinical applicability is based mechanistically on the release of several proteins by platelets that can restore joint homeostasis. Platelets are the primary source of brain-derived neurotrophic factor (BDNF) outside the central nervous system. Interestingly, BDNF and PRP share key biological activities with clinical applicability for OA management, such as anti-inflammatory, anti-apoptotic, and antioxidant. However, the role of BDNF in PRP therapeutic activities is still unknown. Thus, this work aimed to investigate the implications of BDNF in therapeutic outcomes provided by PRP therapy in vitro and in-vivo, using the MIA-OA animal model in male Wistar rats. Initially, the PRP was characterized, obtaining a leukocyte-poor-platelet-rich plasma (LP-PRP). Our assays indicated that platelets activated by Calcium release BDNF, and suppression of M1 macrophage polarization induced by LP-PRP depends on BDNF full-length receptor, Tropomyosin Kinase-B (TrkB). OA animals were given LP-PRP intra-articular and showed functional recovery in gait, joint pain, inflammation, and tissue damage caused by MIA. Immunohistochemistry for activating transcriptional factor-3 (ATF-3) on L4/L5 dorsal root ganglia showed the LP-PRP decreased the nerve injury induced by MIA. All these LP-PRP therapeutic activities were reversed in the presence of TrkB receptor antagonist. Our results suggest that the therapeutic effects of LP-PRP in alleviating OA symptoms in rats depend on BDNF/TrkB activity.

Improved Pain and Function With Triamcinolone Acetonide Extended-Release and Cryoneurolysis for Knee Osteoarthritis: Use of a New Real-World Registry

BACKGROUND

Knee osteoarthritis (OA) affects 19% of American adults aged more than 45 years and costs $27+ billion annually. A wide range of nonoperative treatment options are available. This study compared 6 treatments: cryoneurolysis with deep genicular nerve block (Cryo-Deep/Both), cryoneurolysis with superficial nerve block (Cryo-Superficial), intra-articular hyaluronic acid (IA-HA) injections, nonsteroidal anti-inflammatory drug injections (IA-NSAIDs), IA-corticosteroids (IA-CS) injections, or IA-triamcinolone extended release (IA-TA-ER) injections over 4 months for: (1) pain severity and analgesic use; and (2) physical function (from Knee Injury and Osteoarthritis Outcome Score for Joint Replacement).

METHODS

Patients who had unilateral knee OA and received nonoperative intervention were enrolled in the Innovations in Genicular Outcomes Research registry, a novel, multicenter real-world registry, between September 2021 and February 2024. A total of 480 patients were enrolled. Both pain and functional outcomes were assessed at baseline, weekly, and monthly, which were analyzed by overall trend, magnitude changes pretreatment to post-treatment, and distribution-based minimally clinically important difference (MCID) score. Multivariate linear regressions with adjustments for 7 confounding factors were used to compare follow-up outcomes among 6 treatment groups.

RESULTS

Use of IA-TA-ER injections was associated with the lowest pain, greatest pain reduction, and highest prevalence of patients achieving MCID relative to other treatments (P < .001). Deep/Both-Cryo and IA-CS were associated with a higher prevalence of achieving MCID than IA-HA, IA-NSAIDs, and Cryo-Superficial (P ≤ .001). Use of IA-TA-ER was also associated with the greatest functional score, improvement from baseline, and highest prevalence of patients achieving MCID than other treatments (P ≤ .003).

CONCLUSIONS

The IA-TA-ER appears to outperform other treatments in terms of pain relief and functional improvement for up to 4 months following treatment. In addition, outcomes in the novel cryoneurolysis and conventional IA-CS were similar to one another and better than those in IA-HA and IA-NSAIDs.

Health-related quality of life, lifestyle habits and chronic pain in individuals with knee pain - a 2-year follow-up study

INTRODUCTION

Knee pain increases the risk of developing chronic widespread pain (CWP) and knee osteoarthritis (KOA). The prevalence of CWP and KOA has increased, and there is a need for early prevention. Therefore, the aim was to examine the associations of health-related quality of life (HRQoL) and lifestyle habits with chronic pain at a two-year follow-up in individuals with knee pain.

METHODS

A two-year longitudinal cohort study including 251 individuals aged 30-60 years reporting knee pain at baseline. HRQoL was measured via the Short-Form General Health Survey (SF-36), and lifestyle habits included questions on overweight, physical activity, diet, alcohol and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time in groups with unchanged no chronic pain (NCP), transitioned to less and more pain, and unchanged CWP were analysed using Wilcoxon's, McNemar's and Friedman's tests. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up.

RESULTS

Reporting better HRQoL across various SF-36 concepts and normal weight at baseline was associated with reporting NCP after two years. A few changes were made regarding HRQoL and lifestyle habits over the course of two years, but an increase in general health was associated with transitioning to less pain.

CONCLUSIONS

During primary care visits for knee pain with a combination of overweight or lower HRQoL, individuals should receive comprehensive attention to prevent the development of CWP. Future studies should investigate the associations further.

Return to work after primary total knee replacement in patients under 55 years of age: a retrospective study of 129 cases

INTRODUCTION

Primary total knee arthroplasty (TKA) has shown excellent results in the treatment of osteoarthritis, and its indications have now been extended to younger patients of working age. Few articles in the literature have studied the return to work of young subjects, and no specific studies have been conducted in France. Therefore, we carried out a retrospective study to 1) investigate the rate and delay of return to work after primary TKA in a population under 55 years of age and 2) identify factors influencing early return to work before 3 months, the period usually used as the duration of initial work stoppage (TS).

HYPOTHESIS

The hypothesis of this study was that the rate and time to return to work were similar to those of other Western studies.

MATERIALS AND METHODS

This was a single-center retrospective study including all patients under 55 years of age who underwent primary TKA between 2010 and 2019, regardless of their professional status. A questionnaire collected all socioeconomic and medical information, time to return to work, and factors influencing it. Our population consisted of 223 TKAs (201 patients), with a participation rate of 64%. Among 129 patients, with a mean age of 50.3 ± 4.6 years [29-55], 109 were working (84%).

RESULTS

Ninety-four of 109 patients (86.2%) returned to work after surgery at a mean time of 17.3 ± 10.6 weeks [12-24]. Previous hip or knee prosthetic surgery had a significant negative influence on the rate of return to work (OR 0.08; 95% CI [0.008; 0.7] [p = 0.027]). Manual workers returned to work significantly earlier (OR 8.2; 95% CI [1.6; 51.4] [p = 0.017]). A total of 56 patients (43.4%) were off work preoperatively, for a mean time of 16.7 ± 17.8 weeks [4,13-24], and 49 of these patients returned to work (87.5%) at a mean time of 18.7 ± 11 weeks [12-24] compared with patients who did not receive a preoperative work stoppage (WK) (p = 0.7).

CONCLUSION

The hypothesis was only partially confirmed. Compared with patients in other Western countries, French patients under 55 years of age who underwent primary TKA surgery appeared to return to work at the same rate but with a longer delay. Patients on WT prior to surgery were more likely to return to work after the operation, although this difference did not reach the significance threshold.

LEVEL OF EVIDENCE IV

Retrospective observational study.

A Randomized, Double-Blind, Placebo-Controlled Study Investigating the Safety and Efficacy of a Herbal Formulation on Knee Joint Function in Adults with Knee Osteoarthritis

Background: Current treatments for osteoarthritis (OA) pain and stiffness have limitations, including adverse effects. Therefore, effective and safe complementary or alternative therapies are needed. Dietary supplement GJ 191, comprising Epimedium, Dioscorea, and Salvia miltiorrhiza extracts, may address this need. Methods: This randomized, double-blind, placebo-controlled study investigated GJ 191 supplementation on knee OA symptoms. Seventy-two adults (40-75 years) with mild to moderate knee OA and mild to moderate knee pain were enrolled. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Pain Visual Analog Scale (VAS), Quality of Life questionnaire, knee joint range of motion, serum C-reactive protein, and rescue medication use were assessed. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores were computed using KOOS scores. Results: Decreases in WOMAC pain scores were reported by both GJ 191 and placebo groups after 6 (-1.78 ± 2.71 and -1.34 ± 1.93, respectively; p < 0.01) and 12 (-2.31 ± 2.83 and -1.59 ± 2.69, respectively; p < 0.01) weeks, with no significant difference between groups. There were decreases in WOMAC stiffness scores for participants supplemented with GJ 191 by 0.53 ± 1.22 and 0.72 ± 1.46 (p ≤0.02) after 6 and 12 weeks, respectively, with respective decreases of 0.81 ± 1.51 and 0.75 ± 1.85 (p ≤0.03) for those on placebo. Significant improvements in current pain, as assessed by the Pain VAS, and bodily pain were reported by the GJ 191 group after 6 and 12 weeks, while the placebo group only reported significant improvements in these measures after 12 weeks. GJ 191 supplementation was safe and well tolerated. Conclusion: There was no significant difference in pain and stiffness scores between GJ 191 and placebo over the 12 weeks. While both groups reported improvements in WOMAC pain from baseline, improvements in current and bodily pain were experienced sooner with GJ 191 than placebo and were sustained over the study period. GJ 191 supplementation was safe and well tolerated. (CTR#: NCT04395547).

The structure, process and outcomes of interprofessional care among knee osteoarthritis patients: a scoping review

Knee osteoarthritis (OA) is a common chronic condition that leads to joint pain and disability among older adults. An interprofessional collaborative approach has nowadays been widely advocated in knee OA management although little is known about the characteristics of care, roles and responsibilities of healthcare providers and how they collaborate as a team to optimise treatment outcomes. The Donabedian structure-process-outcome framework was used in the review. Six databases were searched from February 2013 to March 2023. A total of 26 articles that met our inclusion criteria were reported. All studies (n = 26) identified the physiotherapist as a critical member of the interprofessional team. Several studies (n = 5) have offered training to healthcare providers in the management of knee OA. The intervention components in most studies included disease-based education (n = 21) and exercise therapy (n = 16). A comprehensive understanding of the existing interprofessional knee OA care in this review could potentially assist the government and healthcare organisations in developing interprofessional practice guidelines and designing intervention programmes that maximise their benefits.

Glucosamine sulfate-loaded nanofiber reinforced carboxymethyl chitosan sponge for articular cartilage restoration

Cartilage is severely limited in self-repair after damage, and tissue engineering scaffold transplantation is considered the most promising strategy for cartilage regeneration. However, scaffolds without cells and growth factors, which can effectively avoid long cell culture times, high risk of infection, and susceptibility to contamination, remain scarce. Hence, we developed a cell- and growth factor-dual free hierarchically structured nanofibrous sponge to mimic the extracellular matrix, in which the encapsulated core-shell nanofibers served both as mechanical supports and as long-lasting carriers for bioactive biomass molecules (glucosamine sulfate). Under the protection of the nanofibers in this designed sponge, glucosamine sulfate could be released continuously for at least 30 days, which significantly accelerated the repair of cartilage tissue in a rat cartilage defect model. Moreover, the nanofibrous sponge based on carboxymethyl chitosan as the framework could effectively fill irregular cartilage defects, adapt to the dynamic changes during cartilage movement, and maintain almost 100 % elasticity even after multiple compression cycles. This strategy, which combines fiber freeze-shaping technology with a controlled-release method for encapsulating bioactivity, allows for the assembly of porous bionic scaffolds with hierarchical nanofiber structure, providing a novel and safe approach to tissue repair.

Manual Tibial Distraction in Seated Position for Identification of Intra-articular Knee Joint Lesions: A Case Report Presenting a Novel Clinical Special Test

The meniscus is a weight-bearing, intra-articular, fibrocartilaginous structure that is frequently injured. Traditional special tests for diagnosis of intra-articular lesions of the knee involve provocative tests with compressive or torsional components, often leading to increased pain. With this case study, we aim to introduce the Tibial Distraction Test (TDT), a novel clinical special test for the assessment of intra-articular knee joint lesions, including meniscus injury and osteoarthritis (OA), without provoking pain. A 30-year-old man presented to the clinic with right knee pain and swelling of two months duration following a forceful extension and internal rotation motion which led to a catch then audible pop and discomfort. The patient's initial assessment included McMurray's test, joint line palpation, and Apley's compression tests with positive results for each test. A second examiner, blinded to the initial examination, assessed the patient using the proposed TDT. The patient reported pain relief, indicating a positive result. Subsequent magnetic resonance imaging (MRI) confirmed the diagnosis of a medial meniscus tear. Arthroscopy showed a full-thickness meniscal tear and debridement was performed. At one month's follow-up, the patient returned to baseline function with resolution of symptoms. Diagnosing intra-articular lesions of the knee requires a thorough history and examination, frequently including painful provocative clinical special tests in a patient already presenting with pain as a primary complaint. Our case presents a novel manual clinical special test in a seated position which appears to be a pain-relieving test that may be used to assess for intra-articular knee joint lesions.

The use of autologous chondrocyte transplantation for the treatment of osteoarthritis: a systematic review of clinical trials

Tissue engineering and cartilage transplantation constitute an evolving field in the treatment of osteoarthritis, with therapeutic and clinical promise shown in autologous chondrocyte implantation. The aim of this systematic review is to explore current clinical trials that utilized autologous chondrocyte transplantation (ACT) and assess its efficacy in the treatment of osteoarthritis. PubMed, Ovid MEDLINE, and Google-Scholar (pages 1-20) were searched up until February 2023. Inclusion criteria consisted of clinical trials that involve autologous cartilage transplantation for the treatment of osteoarthritis. Clinical, imaging, arthroscopic, and histologic outcomes were assessed. A total of 15 clinical trials, involving 851 participants, were included in the study. All trials utilized ACT in the treatment of knee osteoarthritis through varying scaffolds: collagen-based (10 trials), polymer-based (2 trials), hyaluronic-acid based (2 trials), and spheroid technology (1 trial). Clinical improvement of patients undergoing ACT was noted in 14 trials; five showed superior clinical outcomes compared to the control group, while one showed inferiority compared to mesenchymal stem cells. Postoperative imaging was utilized to assess the degree of cartilage regeneration in 11 trials. Ten trials showed signs of cartilage recovery with ACT, four trials showed no difference, and two showed worse outcomes when compared to controls. Second-look-arthroscopy was performed in three trials, which reported varying degrees of improvement in cartilage regeneration. Histologic analysis was performed in four trials and generally showed promising results. While improved clinical outcomes were demonstrated, conflicting findings in postoperative outcome analysis raise questions about the unequivocal utility of ACT. Additional research with control groups, randomization, and appropriate blinding is required.

Evaluation of the Timed Up and Go Test in Patients with Knee Osteoarthritis Using Inertial Sensors

Background: There has been a growing interest in using inertial sensors to explore the temporal aspects of the Timed Up and Go (TUG) test. The current study aimed to analyze the spatiotemporal parameters and phases of the TUG test in patients with knee osteoarthritis (KOA) and compare the results with those of non-arthritic individuals. Methods: This study included 20 patients with KOA and 60 non-arthritic individuals aged 65 to 84 years. All participants performed the TUG test, and 17 spatiotemporal parameters and phase data were collected wirelessly using the BTS G-Walk inertial sensor. Results: Significant mobility impairments were observed in KOA patients, including slower gait speed, impaired sit-to-stand transitions, and reduced turning efficiency. These findings highlight functional deficits in individuals with KOA compared to their non-arthritic counterparts. Conclusions: The results emphasize the need for targeted physiotherapy interventions, such as quadriceps strengthening, balance training, and gait retraining, to address these deficits. However, the study is limited by its small sample size, gender imbalance, and limited validation of the BTS G-Walk device. Future research should include larger, more balanced cohorts, validate sensor reliability, and conduct longitudinal studies. Despite these limitations, the findings align with previous research and underscore the potential of inertial sensors in tailoring rehabilitation strategies and monitoring progress in KOA patients.

Direct Scaffold-Coupled Electrical Stimulation of Chondrogenic Progenitor Cells through Graphene Foam Bioscaffolds to Control Mechanical Properties of Graphene Foam - Cell Composites

Osteoarthritis, a major global cause of pain and disability, is driven by the irreversible degradation of hyaline cartilage in joints. Cartilage tissue engineering presents a promising therapeutic avenue, but success hinges on replicating the native physiological environment to guide cellular behavior and generate tissue constructs that mimic natural cartilage. Although electrical stimulation has been shown to enhance chondrogenesis and extracellular matrix production in 2D cultures, the mechanisms underlying these effects remain poorly understood, particularly in 3D models. Here, we report that direct scaffold-coupled electrical stimulation applied to 3D graphene foam bioscaffolds significantly enhances the mechanical properties of the resulting graphene foam - cell constructs. Using custom 3D-printed electrical stimulus chambers, we applied biphasic square impulses (20, 40, 60 mVpp at 1 kHz) for 5 minutes daily over 7 days. Stimulation at 60 mVpp increased the steady-state energy dissipation and equilibrium modulus by approximately 65% and 25%, respectively, compared to unstimulated controls, while also yielding the highest cell density among stimulated samples. In addition, our custom chambers facilitated full submersion of the hydrophobic graphene foam in media, leading to enhanced cell attachment and integration across the scaffold surface and within its hollow branches. To assess this cellular integration, we employed co-localized confocal fluorescence microscopy and X-ray microCT imaging enabled by colloidal gold nanoparticle and fluorophore staining, which allowed visualization of cell distribution within the opaque scaffold's internal structure. These findings highlight the potential of direct scaffold-coupled electrical stimulus to modulate the mechanical properties of engineered tissues and offer new insights into the emergent behavior of cells within conductive 3D bioscaffolds.

The Effects of High-Intensity Laser Therapy vs. Low-Level Laser Therapy on Functional Ability and Quadriceps Architecture in Patients with Knee Osteoarthritis: A Single-Blinded Randomized Clinical Trial

Introduction: This study aimed to compare the effects of high-intensity laser therapy (HILT) and low-level laser therapy (LLLT) on the disability and architecture of the quadriceps in patients with knee osteoarthritis (OA). Methods: Ninety-eight patients with knee OA (KOA) were selected by convenience sampling and then divided into three groups: control, LLLT and HILT. Disability was determined using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Quadriceps structures including thickness, fascicle length and pennate angle of the vastus lateralis (VL) and thickness, volume and fiber angle of vastus medialis obliquus (VMO) muscles were assessed using ultrasonography. All evaluations were performed before interventions, immediately after interventions, and one month later. Between-group data were analyzed with two-way ANOVA and paired-samples t-test. Results: The within-group comparisons of WOMAC scores before, after and at a one-month follow-up showed significant differences between the groups (P<0.001). The VMO thickness revealed significant increases after the treatment in both HILT (P<0.001) and LLLT (P=00.03) groups. The between-group comparison revealed a significantly lower score of WOMAC in the HILT group compared to the other groups after a one-month follow-up (P=00.03). VMO thickness showed a significant increase in the HILT group after the treatment (P=0.002). The VL structures and VMO fiber angle and volume did not exhibit significant changes in within-group and between-group comparisons (P>00.05). Conclusion: Both HILT and LLLT may improve functional ability and VMO thickness in patients with knee osteoarthritis. After a one-month follow-up, functional ability was greater in the HILT group.

Development and validation of a three-dimensional nomogram prediction model for knee osteoarthritis in middle-aged population

OBJECTIVES

This study aims to identify predictors of knee osteoarthritis (KOA) risk in middle-aged population, construct and validate a nomogram for KOA in this demographic.

METHODS

From June to December 2020, we conducted a cross-sectional survey on 5,527 middle-aged individuals from Changsha and Zhangjiajie cities in Hunan Province, selected using a stratified multi-stage random sampling method. Data collection involved a structured questionnaire encompassing general demographic, physical condition, and lifestyle behaviors dimensions. The dataset was randomly split into a training set (n = 3868) and a validation set (n = 1659) at a 7:3 ratio via computerized randomization. We analyzed the prevalence of self-reported KOA and identified its influencing factors using logistic regression. A nomogram was constructed based on these "three-dimensional" factors. Subsequent validation was conducted, and the nomogram's performance was further evaluated through ROC curves, C-index, Hosmer-Lemeshow test, and calibration curves.

RESULTS

The self-reported prevalence of KOA in the middle-aged population was 11.4% (632/5527). The risk factor with the greatest impact is: diagnosed with osteoporosis(95% CI 2.269-3.568, OR = 2.845), followed by age between 51 to 60 years (95% CI 2.176-3.151, OR = 2.619), diagnosed with hypertension(95% CI 1.633-2.499, OR = 2.02), diagnosed with diabetes (OR = 1.689), ethnic Han Chinese (OR = 1.673), exercise according to physical condition (OR = 1.643), pay attention to keeping the knee joint warm (OR = 1.535), eating habits are mainly light vegetables (OR = 1.374), male gender (OR = 1.343), drink occasionally in small amounts (OR = 1.286); a higher level of education (OR = 0.477) and frequently or always apply an external or plaster to relieve symptoms after knee discomfort (OR = 0.377; OR = 0.385) are protective factors. The C-index of the training set model was 0.8107 (95% CI: 0.8102-0.8111), with a statistically significant area under the ROC curve (AUC = 0.818), and the calibration curve showed a good fit. The C-index for the validation set was 0.8124 (95% CI: 0.8109-0.8140), with an AUC of 0.812. The Hosmer-Lemeshow test resulted in a P-value of 0.46 (P ≥ 0.05)indicating good calibration of the model.

CONCLUSION

The three dimensions nomogram generated in this study was a valid and easy-to-use tool for assessing the risk of KOA in middle-aged population, and helped healthcare professionals to screen the high-risk population.

Developing the new diagnostic model by integrating bioinformatics and machine learning for osteoarthritis

BACKGROUND

Osteoarthritis (OA) is a common cause of disability among the elderly, profoundly affecting quality of life. This study aims to leverage bioinformatics and machine learning to develop an artificial neural network (ANN) model for diagnosing OA, providing new avenues for early diagnosis and treatment.

METHODS

From the Gene Expression Omnibus (GEO) database, we first obtained OA synovial tissue microarray datasets. Differentially expressed genes (DEGs) associated with OA were identified through utilization of the Limma package and weighted gene co-expression network analysis (WGCNA). Subsequently, protein-protein interaction (PPI) network analysis and machine learning were employed to identify the most relevant potential feature genes of OA, and ANN diagnostic model and receiver operating characteristic (ROC) curve were constructed to evaluate the diagnostic performance of the model. In addition, the expression levels of the feature genes were verified using real-time quantitative polymerase chain reaction (qRT-PCR). Finally, immune cell infiltration analysis was performed using CIBERSORT algorithm to explore the correlation between feature genes and immune cells.

RESULTS

The Limma package and WGCNA identified a total of 72 DEGs related to OA, of which 12 were up-regulated and 60 were down-regulated. Then, the PPI network analysis identified 21 hub genes, and three machine learning algorithms finally screened four feature genes (BTG2, CALML4, DUSP5, and GADD45B). The ANN diagnostic model was constructed based on these four feature genes. The AUC of the training set was 0.942, and the AUC of the validation set was 0.850. In addition, the qRT-PCR validation results demonstrated a significant downregulation of BTG2, DUSP5, and GADD45 mRNA expression levels in OA samples compared to normal samples, while CALML4 mRNA expression level exhibited an upregulation. Immune cell infiltration analysis revealed B cells memory, T cells gamma delta, B cells naive, Plasma cells, T cells CD4 memory resting, and NK cells The abnormal infiltration of activated cells may be related to the progression of OA.

CONCLUSIONS

BTG2, CALML4, DUSP5, and GADD45B were identified as potential feature genes for OA, and an ANN diagnostic model with good diagnostic performance was developed, providing a new perspective for the early diagnosis and personalized treatment of OA.

Physical activity and joint health: Implications for knee osteoarthritis disease pathophysiology and mechanics

Knee osteoarthritis is experienced by hundreds of millions of people worldwide and is a major cause of disability. Although enhancing physical activity levels and the participation in exercise programmes has been proved to improve the debilitating illness of osteoarthritis, many do not engage in recommended levels of physical activity. One of the reported barriers to exercise engagement is the perception that physical activity can damage joint health and is attributed to the incorrect perception of 'wear and tear'. We posit that these perceptions arise from uncertainty and ambiguity generated from conflicting research findings. In this review, we explore the complex relationship between knee osteoarthritis and physical activity. We demonstrate how factors contribute to the uncertainty around the effects of physical activity on joint tissue metabolism, structure and function. The aim of this review is to demonstrate how a nuanced approach to the relationship between physical activity and knee osteoarthritis can help to dispel misconceptions, leading to better management strategies and improved quality of life for patients.

Cellular and molecular mechanisms underlying obesity in degenerative spine and joint diseases

Degenerative spine and joint diseases, including intervertebral disc degeneration (IDD), ossification of the spinal ligaments (OSL), and osteoarthritis (OA), are common musculoskeletal diseases that cause pain or disability to the patients. However, the pathogenesis of these musculoskeletal disorders is complex and has not been elucidated clearly to date. As a matter of fact, the spine and joints are not independent of other organs and tissues. Recently, accumulating evidence demonstrates the association between obesity and degenerative musculoskeletal diseases. Obesity is a common metabolic disease characterized by excessive adipose tissue or abnormal adipose distribution in the body. Excessive mechanical stress is regarded as a critical risk factor for obesity-related pathology. Additionally, obesity-related factors, mainly including lipid metabolism disorder, dysregulated pro-inflammatory adipokines and cytokines, are reported as plausible links between obesity and various human diseases. Importantly, these obesity-related factors are deeply involved in the regulation of cell phenotypes and cell fates, extracellular matrix (ECM) metabolism, and inflammation in the pathophysiological processes of degenerative spine and joint diseases. In this study, we systematically discuss the potential cellular and molecular mechanisms underlying obesity in these degenerative musculoskeletal diseases, and hope to provide novel insights for developing targeted therapeutic strategies.

Comparative Efficacy of Glucosamine-Based Combination Therapies in Alleviating Knee Osteoarthritis Pain: A Systematic Review and Network Meta-Analysis

Background: The lack of definitive scientific evidence sustains uncertainty about the efficacy of glucosamine and its combination therapies for knee osteoarthritis (KOA), contributing to an ongoing debate among clinical practice guidelines and healthcare practitioners. This systematic review and network meta-analysis (NMA) aimed to identify the most effective glucosamine combination therapy for KOA patients. Methods: Frequentist random-effects models were employed for this NMA, with standardized mean differences (SMDs) and 95% confidence intervals (CIs) calculated for primary outcomes. We incorporated an SMD value of 0.40 as a minimum clinically important difference (MCID) to interpret the pain outcome. Confidence in evidence was evaluated using CINeMA. Results: Thirty randomized controlled trials (RCTs) covering 5265 patients were included. Glucosamine with omega-3 (G + omega-3, SMD -2.59 [95% CI -4.42 to -0.75], moderate quality) and glucosamine with ibuprofen (G + ibuprofen, SMD -2.27 [95% CI -3.73 to -0.82], moderate quality) significantly reduced overall pain compared to placebo. Similarly, glucosamine + chondroitin sulfate + methylsulfonylmethane showed effectiveness in pain reduction (SMD -2.25 [95% CI -3.84 to -0.67], low-quality). None of the other interventions met the MCID threshold for overall pain reduction. Moreover, clustered ranking results showed that glucosamine with omega-3 interventions was more effective than others in reducing overall pain and adverse events. Conclusions: For KOA, combining glucosamine with omega-3 and ibuprofen effectively reduces pain and may lower NSAID side effects, improving treatment guidelines and decision-making for better patient care.

The association of vitamin D with knee osteoarthritis pain: an analysis from the Osteoarthritis Initiative database

Knee osteoarthritis (KOA) is a major cause of disability in the elderly, with its pain primarily driving medical consultations. Despite numerous studies, the role of Vitamin D in managing KOA pain remains inconclusive. This study seeks to explore the association between serum Vitamin D levels and WOMAC pain scores, providing new insights into potential treatment strategies for KOA. Utilizing data from the Osteoarthritis Initiative (OAI) database, we conducted a cross-sectional analysis involving 524 participants. Serum levels of 25-hydroxyvitamin D were measured using liquid chromatography-tandem mass spectrometry. WOMAC pain scores served as the dependent variable. Multivariable linear regression models and restricted cubic splines were employed to assess the relationship between Vitamin D levels and KOA pain, with subgroup analyses stratified by sex. Higher Vitamin D levels were significantly associated with lower WOMAC pain scores in males across all models. For females, no significant associations were observed. The analysis suggests a nonlinear relationship between Vitamin D levels and KOA pain in the general cohort, which becomes non-significant after adjustment for covariates. Our findings indicate that Vitamin D is associated with reduced pain in male patients with KOA, highlighting a potential sex-specific therapeutic approach. The results warrant further investigation through longitudinal studies and randomized controlled trials to substantiate Vitamin D supplementation as a viable treatment for reducing KOA pain in males.

Can blood flow restriction therapy improve quality of life and function in dissatisfied knee arthroplasty patients?

Aims

Approximately 10% to 20% of knee arthroplasty patients are not satisfied with the result, while a clear indication for revision surgery might not be present. Therapeutic options for these patients, who often lack adequate quadriceps strength, are limited. Therefore, the primary aim of this study was to evaluate the clinical effect of a novel rehabilitation protocol that combines low-load resistance training (LL-RT) with blood flow restriction (BFR).

Methods

Between May 2022 and March 2024, we enrolled 45 dissatisfied knee arthroplasty patients who lacked any clear indication for revision to this prospective cohort study. All patients were at least six months post-surgery and had undergone conventional physiotherapy previously. The patients participated in a supervised LL-RT combined with BFR in 18 sessions. Primary assessments included the following patient-reported outcome measures (PROMs): Knee injury and Osteoarthritis Outcome Score (KOOS); Knee Society Score: satisfaction (KSSs); the EuroQol five-dimension five-level questionnaire (EQ-5D-5L); and the pain catastrophizing scale (PCS). Functionality was assessed using the six-minute walk Test (6MWT) and the 30-second chair stand test (30CST). Follow-up timepoints were at baseline, six weeks, three months, and six months after the start.

Results

Six weeks of BFR with LL-RT improved all the PROMs except the sports subscale of the KOOS compared to baseline. Highest improvements after six weeks were found for quality of life (QoL) (mean 28.2 (SD 17.2) vs 19 (SD 14.7); p = 0.002), activities of daily living (mean 54.7 (SD 18.7) vs 42.9 (SD 17.3); p < 0.001), and KSSs (mean 17.1 (SD 8.8) vs 12.8 (SD 6.7); p < 0.001). PROMs improvements continued to be present at three-month and six-month follow-up compared to baseline. However, no significant differences were observed in the paired comparisons of the six-week, three-month, and six-month follow-up. The same trends are observed for the 6MWT and 30CST.

Conclusion

The reported regime demonstrates improved QoL and function of dissatisfied knee arthroplasty patients. In light of this, the pathway described may provide a valuable and safe treatment option for dissatisfied knee arthroplasty patients for whom therapeutic options are limited.

Endoplasmic reticulum stress-mediated apoptosis and autophagy in osteoarthritis: From molecular mechanisms to therapeutic applications

Osteoarthritis (OA) is characterized primarily by the degeneration of articular cartilage, with a high prevalence and disability rate. The functional phenotype of chondrocytes, as the sole cell type within cartilage, is vital for OA progression. Due to the avascular nature of cartilage and its limited regenerative capacity, repair following injury poses significant challenges. Various cellular stressors, including hypoxia, nutrient deprivation, oxidative stress, and collagen mutations, can lead to the accumulation of misfolded proteins in the endoplasmic reticulum (ER), resulting in ER stress (ERS). In response to restore ER homeostasis as well as cellular vitality and function, a series of adaptive mechanisms are triggered, including the unfolded protein response, ER-associated degradation, and ER-phagy. Prolonged or severe ERS may exceed the adaptive capacity of cells, leading to dysregulation in apoptosis and autophagy-key pathogenic factors contributing to chondrocyte damage and OA progression. This review examines the relationship between ERS in OA chondrocytes and both apoptosis and autophagy in order to identify potential therapeutic targets and strategies for prevention and treatment of OA.

The epithelial barrier theory and its associated diseases

The prevalence of many chronic noncommunicable diseases has been steadily rising over the past six decades. During this time, over 350,000 new chemical substances have been introduced to the lives of humans. In recent years, the epithelial barrier theory came to light explaining the growing prevalence and exacerbations of these diseases worldwide. It attributes their onset to a functionally impaired epithelial barrier triggered by the toxicity of the exposed substances, associated with microbial dysbiosis, immune system activation, and inflammation. Diseases encompassed by the epithelial barrier theory share common features such as an increased prevalence after the 1960s or 2000s that cannot (solely) be accounted for by the emergence of improved diagnostic methods. Other common traits include epithelial barrier defects, microbial dysbiosis with loss of commensals and colonization of opportunistic pathogens, and circulating inflammatory cells and cytokines. In addition, practically unrelated diseases that fulfill these criteria have started to emerge as multimorbidities during the last decades. Here, we provide a comprehensive overview of diseases encompassed by the epithelial barrier theory and discuss evidence and similarities for their epidemiology, genetic susceptibility, epithelial barrier dysfunction, microbial dysbiosis, and tissue inflammation.

Novel drug discovery approaches for MMP-13 inhibitors in the treatment of osteoarthritis

Recently, the key role of matrix metalloproteinase-13 (MMP-13) in a variety of diseases has attracted much attention. In the field of osteoarthritis (OA) treatment, the study of MMP-13 inhibitors has become a hotspot, and the development of selective MMP-13 inhibitors is a key direction of OA treatment strategies. This paper aims to summarize the latest research progress on MMP-13 inhibitors in drug design and delivery systems in OA treatment, in order to provide new ideas and strategies for the development of MMP-13 inhibitors. In the context of drug design, researchers have utilized innovative drug discovery strategies to developed a number of potential MMP-13 inhibitors by accurately simulating the active site and analyzing the structure of known inhibitors. With regard to delivery systems, nanotechnology has been extensively employed to enhance the targeting and bioavailability of MMP-13 inhibitors, effectively improving therapeutic efficacy through precise delivery to the lesion site. The latest research developments not only reveal the significant potential of MMP-13 inhibitors in disease treatment, but also provide new directions and challenges for future research.

Functional and radiological outcomes of total knee arthroplasty using posterior-stabilized U2 knee system: A retrospective study in 560 cases at five years of follow-up

PURPOSE

The purpose of this study was to assess clinical and functional outcomes as well as the prosthesis survival rates of the U2 Knee system in primary total knee arthroplasty (TKA) with a minimum follow-up of four years.

METHODS

We retrospectively analyzed 560 consecutively primary TKA performed between 2015 and 2019 due to osteoarthritis with a mean follow-up of 5.4 ± 1.1 years. The clinical outcomes were assessed using the knee society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic outcomes were assessed using the American knee society's roentgenographic evaluation system. Prosthetic survival was calculated using the Kaplan-Meier method.

RESULTS

Postoperative KSS showed significant improvement at one year (Clinical: 37.4 ± 4.1 vs. 91.9 ± 3.7; p < 0.01; Functional: 41.2 ± 3.3 vs. 90.6 ± 4.8; p =  < 0.01), with these improvements maintained throughout the follow-up period. The WOMAC score improved from 60 ± 10.1 preoperatively to 10.9 ± 8.3 (p = 0.02) at the end of the follow-up. There were 20 (3.7%) knees with radiolucent lines around the implant (< 2 mm), and none showed evidence of loosening. There were six (1.1%) revisions-four due to prosthetic joint infections and two due to periprosthetic femur fracture. The prosthetic survival was 97.8% at the study closure.

CONCLUSION

The U2 knee system demonstrates effective and safe performance for primary TKA with significant improvements in functional scores, patient-reported outcomes, and a promising prosthesis survival rate at mid-term follow-up. We will continue with the series analysis to assess the long-term outcomes.

Contemporary small-scale subsistence populations offer unique insights into human musculoskeletal health and aging

Human foragers avoid noncommunicable diseases that are leading causes of mortality, partly because physically active lifestyles promote healthy aging. High activity levels also promote tissue damage accumulation from wear-and-tear, increase risk of injury and disability which compromise productivity, and reduce energetic investments in somatic maintenance given constrained energy expenditure. Constraints intensify when nutrient supply is limited and surplus energy is directed toward pathogen defense and reproduction, as occurred throughout hominin evolution. This paper reviews evidence linking exposomes to musculoskeletal health in subsistence populations, focusing on effects of physical activity, pathogens, diet, and reproduction. Chronic musculoskeletal conditions are common for humans and possibly prehistoric hominins but rarer in quadrupedal apes. We propose that transition to bipedalism ~6 to 8 million years ago constituted an early "mismatch scenario," increasing hominin susceptibility to musculoskeletal conditions vis-à-vis quadrupedal apes due to changes in mechanical loading environments. Mismatched musculoskeletal traits were not targets of selection because of trade-offs favoring bipedal extractive foraging and higher fertility.

The antimicrobial properties of exogenous copper in human synovial fluid against Staphylococcus aureus

Aims

The mechanism by which synovial fluid (SF) kills bacteria has not yet been elucidated, and a better understanding is needed. We sought to analyze the antimicrobial properties of exogenous copper in human SF against Staphylococcus aureus.

Methods

We performed in vitro growth and viability assays to determine the capability of S. aureus to survive in SF with the addition of 10 µM of copper. We determined the minimum bactericidal concentration of copper (MBC-Cu) and evaluated its sensitivity to killing, comparing wild type (WT) and CopAZB-deficient USA300 strains.

Results

UAMS-1 demonstrated a greater sensitivity to SF compared to USA300 WT at 12 hours (p = 0.001) and 24 hours (p = 0.027). UAMS-1 died in statistically significant quantities at 24 hours (p = 0.017), and USA300 WT survived at 24 hours. UAMS-1 was more susceptible to the addition of copper at four (p = 0.001), 12 (p = 0.005), and 24 hours (p = 0.006). We confirmed a high sensitivity to killing with the addition of exogenous copper on both strains at four (p = 0.011), 12 (p = 0.011), and 24 hours (p = 0.011). WT and CopAZB-deficient USA300 strains significantly died in SF, demonstrating a MBC-Cu of 50 µM against USA300 WT (p = 0.011).

Conclusion

SF has antimicrobial properties against S. aureus, and UAMS-1 was more sensitive than USA300 WT. Adding 10 µM of copper was highly toxic, confirming its bactericidal effect. We found CopAZB proteins to be involved in copper effluxion by demonstrating the high sensitivity of mutant strains to lower copper concentrations. Thus, we propose CopAZB proteins as potential targets and use exogenous copper as a treatment alternative against S. aureus.

Navigating the Global Landscape of Exercise Interventions for Knee Osteoarthritis: Exploring Evolving Trends and Emerging Frontiers From a Bibliometric and Visualization Analysis Perspective (2011-2022)

OBJECTIVES

This study utilizes visual analysis methods to retrospectively examine the evolution and trends in exercise interventions for knee osteoarthritis (KOA) research from 2011 to 2022.

DESIGN

Bibliometric and visualization analysis review.

SETTING AND PARTICIPANTS

Using the Web of Science database, the literature search range is from January 1, 2011, to December 31, 2022, with the language specified as English and document type set to Article.

METHODS

Visual analysis was used to analyze literature in the field of exercise interventions for KOA, with KOA and exercise interventions as the key search terms. Visualization maps for countries/regions were created using Tableau and Scimago Graphica software. Institutional, author, and keyword visualization maps were drawn using CiteSpace and VOSviewer software.

RESULTS

In total, 3137 articles were included in the visual analysis. The United States emerged as the leading country in terms of publication volume and contribution. Moreover, developed countries such as the United States, Australia, United Kingdom, and Canada have established close and stable cooperative relationships. The University of Melbourne stood out as the institution with both the highest publication volume and centrality. At the forefront of research output in this field was Bennell K.L. from the University of Melbourne. The journal with the highest co-citation frequency was Osteoarthritis and Cartilage. The keyword clustering map highlighted an evolution in the field of exercise interventions for KOA, emphasizing 8 key research themes spanning knee osteoarthritis, serum cartilage, osteoarthritis initiative, patellofemoral pain, total knee arthroplasty, exercise-induced hypoalgesia, isometric exercise, and anterior cruciate ligament reconstruction. Burst analysis revealed that older adult was the earliest and most prominent keyword, with contemporary topics such as patellofemoral pain, safety, musculoskeletal disorder, and neuromuscular exercise considered as research hotspots and future directions in this field.

CONCLUSIONS AND IMPLICATIONS

The global attention on exercise interventions for KOA research is expanding, emphasizing the importance of strengthened connections among developing countries and collaborative author groups. Recent trends have shifted toward topics such as neuromuscular training, treatment safety, and musculoskeletal disorders, whereas research interest in patellofemoral pain remains unabated. Neuromuscular training for KOA represents the current frontier in this field. Future research should delve into the effects of diverse types of exercise interventions for KOA on neuromuscular injury and recovery, exploring feasibility and safety to formulate personalized exercise plans for patients with KOA.

Targeted Therapy of Osteoarthritis via Intra-Articular Delivery of Lipid-Nanoparticle-Encapsulated Recombinant Human FGF18 mRNA

Fibroblast growth factor 18 (FGF18) emerges as a promising therapeutic target for osteoarthritis (OA). In this study, a novel articular cavity-localized lipid nanoparticle (LNP) named WG-PL14 is developed. This optimized formulation has a nearly 30-fold increase in mRNA expression as well as better articular cavity enrichment compared to commercial lipids MC3 when performing intra-articular injection. Then, a mRNA sequence encoding recombinant human FGF18 (rhFGF18) for potential mRNA therapy in OA is optimized. In vitro assays confirm the translation of rhFGF18 mRNA into functional proteins within rat and human chondrocytes, promoting cell proliferation and extracellular matrix (ECM) synthesis. Subsequently, the therapeutic efficacy of the LNP-rhFGF18 mRNA complex is systematically assessed in a mouse OA model. The administration exhibits several positive outcomes, including an improved pain response, upregulation of ECM-related genes (e.g., AGRN and HAS2), and remodeling of subchondral bone homeostasis compared to a control group. Taken together, these findings underscore the potential of localized LNP-rhFGF18 mRNA therapy in promoting the regeneration of cartilage tissue and mitigating the progression of OA.

Return to work policies and practices after total hip or knee arthroplasty in Denmark, Germany, and the Netherlands: an exploratory study

PURPOSE

To explore return-to-work (RTW) policies and practices for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients in three European countries.

MATERIALS AND METHODS

An exploratory study in Denmark, Germany, and the Netherlands consisting of three aspects: (1) description of the healthcare and social security systems; (2) identification of national RTW guidelines; (3) a survey to gain insight into RTW practices and perceptions of orthopaedic surgeons, including barriers, facilitators, and needs.

RESULTS

Healthcare and social security systems differed (e.g. fast-track vs longer postoperative stay; coverage of rehabilitation costs). National guidelines were available in Germany (THA, TKA) and the Netherlands (TKA), containing limited RTW information. The survey was completed by 168 orthopaedic surgeons (Denmark n = 51; Germany n = 39; the Netherlands n = 78). Overall, orthopaedic surgeons reported being in need of more knowledge and better collaboration with other healthcare practitioners.

CONCLUSION

We found considerable variation in healthcare and social security systems. When available, national guidelines contained limited information. In all three countries surgeons need more knowledge and better collaboration with other healthcare practitioners. We advise that RTW multidisciplinary recommendations post THA/TKA be established by the national associations of the healthcare practitioners involved.

Safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in knee osteoarthritis: a randomized, triple-blind, placebo-controlled clinical trial

BACKGROUND

Knee osteoarthritis causes pain and disability in many people worldwide, for which no definitive treatment has yet been proposed. In this study, we investigated the safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in patients with knee osteoarthritis.

METHODS

This triple-blind, randomized clinical trial included patients suffering from bilateral knee osteoarthritis with grade 2 or 3. The knees of each patient were randomized to intervention and control. For the intervention knee, 5 cc of placental mesenchymal stromal cells-derived extracellular vesicles were injected, and for the control knee, 5 cc of normal saline was injected. The patients' symptoms were evaluated before the intervention and 2 and 6 months after the intervention using VAS, WOMAC questionnaire, and Lequesne index. MRI was performed before the intervention and 6 months after the intervention to evaluate retropatellar and tibiofemoral cartilage volume, medial and lateral meniscal disintegrity, ACL injury, and effusion-synovitis.

RESULTS

62 knees (31 patients) were enrolled in this study. There were 31 knees as intervention and 31 knees as control. Finally, the data of 58 knees (29 patients) were analyzed, including 28 women and 1 man. The mean age of the patients was 55.38 ± 6.07 years. No statistically significant difference was detected between the two groups in clinical outcomes (including VAS, WOMAC, and Lequesne scores) before treatment and 2 and 6 months after treatment. Also, no statistically significant difference was detected between the two groups in MRI findings before treatment and 6 months after treatment. No systemic complications or severe local reactions occurred in the patients.

CONCLUSION

A single intra-articular injection of placental mesenchymal stromal cells-derived extracellular vesicles (5 cc, 7 × 109 particles/cc) is safe, but does not improve clinical symptoms or MRI findings in knee osteoarthritis beyond placebo. The protocol of this study was approved on 11 May 2022 with registration number IRCT20210423051054N1.

The Outcomes at 3 Years in 82 Knees with Kellgren and Lawrence 2-3 Osteoarthritis Treated with an Autologous Protein Fluid Concentrate Produced with a Fluid Volume Reducer

INTRODUCTION

Knee osteoarthritis (OA) is a highly prevalent and debilitating condition with significant emotional and economic impacts. Current treatment options may only provide temporary pain relief and are not regenerative, thus the progression of knee OA is not deterred and total knee arthroplasty is inevitable. Injection therapies with orthobiologics possess regenerative potential and are an emerging treatment option. We present a prospective study aimed at examining patients with knee OA who had received an autologous platelet concentrate fluid (APCF) injection produced through a fluid volume reducer.

METHODS

This was an observational review of the results following an APCF injection in a cohort of patients at a single site. Patients were included in the study if they were diagnosed with K/L grade 2-3 knee OA and treated with an APCF knee injection. Patients were excluded if they had obtained an orthobiologic injection in the three months prior to study enrollment or if baseline data were unavailable. Knee score and function score were used to assess patients at the baseline and post-injection follow-ups.

RESULTS

Improvements for knee score were statistically significant for the follow-ups at three months, six months, one year, and three years. Function score improved, with statistically significant changes for the three month and three year follow-ups.

CONCLUSIONS

Our study demonstrates that there is some utility in using APCF injection for knee OA, with improvements that may be sustained up to three years in some patients.