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Hedlundh U, Karlsson J, Sernert N, Haag L, Movin T, Papadogiannakis N, Kartus J. Periprosthetic joint infection after total hip arthroplasty induces histological degeneration of the gluteus medius tendon. Bone Jt Open 2023; 4:628-635. [PMID: 37604496 PMCID: PMC10442177 DOI: 10.1302/2633-1462.48.bjo-2023-0074.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Aims A revision for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) has a major effect on the patient's quality of life, including walking capacity. The objective of this case control study was to investigate the histological and ultrastructural changes to the gluteus medius tendon (GMED) in patients revised due to a PJI, and to compare it with revision THAs without infection performed using the same lateral approach. Methods A group of eight patients revised due to a PJI with a previous lateral approach was compared with a group of 21 revised THAs without infection, performed using the same approach. The primary variables of the study were the fibril diameter, as seen in transmission electron microscopy (TEM), and the total degeneration score (TDS), as seen under the light microscope. An analysis of bacteriology, classification of infection, and antibiotic treatment was also performed. Results Biopsy samples from the GMED from infected patients revealed a larger fibril diameter than control patients, as seen in the TEM (p < 0.001). Uninfected patients were slightly older and had their revisions performed significantly later than the infected patients. Histologically, samples from infected patients revealed significantly more vascularity (p < 0.001), the presence of glycosaminoglycans (p < 0.001), and a higher TDS (p = 0.003) than the control patients. The majority of patients had staphylococcal infections of various species. Conclusion More histological degeneration in the GMED was found in patients undergoing THA revision surgery due to PJI than in patients undergoing THA revision surgery due to other reasons.
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Affiliation(s)
- Urban Hedlundh
- Orthopaedic Department NU Hospital Group, Uddevalla, Sweden
| | - Johanna Karlsson
- Department of Infectious Diseases NU Hospital Group, Trollhattan, Sweden
- Department of Infectious Diseases, University of Gothenburg Institute of Biomedicine, Goteborg, Sweden
| | - Ninni Sernert
- University of Gothenburg Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
- Director Department of Research and Development, NU Hospital Group, Trollhattan, Sweden
| | - Lars Haag
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute, Stockholm, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute, Stockholm, Sweden
| | - Jüri Kartus
- University of Gothenburg Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
- Head Department of Research and Development, NU Hospital Group, Trollhattan, Sweden
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2
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Geary MB, Orner CA, Shammas H, Reuter JM, Loiselle AE, Giordano BD, Wu CL. The surgical destabilization of the abductor muscle leads to development of instability-associated hip osteoarthritis in mice. J Hip Preserv Surg 2023; 10:158-165. [PMID: 38162262 PMCID: PMC10757407 DOI: 10.1093/jhps/hnad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/07/2023] [Accepted: 05/24/2023] [Indexed: 01/03/2024] Open
Abstract
Osteoarthritis (OA) of the hip is a common and debilitating painful joint disease. However, there is paucity of surgically induced hip OA models in small animals that allow scientists to study the onset and progression of the disease. A growing body of evidence indicates a positive association between periarticular myotendinous pathology and the development of hip OA. Thus, in the current study, we aimed to establish a novel mouse instability-associated hip OA model via selective injury of the abductor complex around the hip joint. C57BL6/J mice were randomized to sham surgery or abductor injury, in which the myotendinous insertion at the third trochanter and greater trochanter were surgically detached. Mice were allowed free active movement until they were sacrificed at either 3 weeks or 20 weeks post-injury. Histologic analyses and immunohistochemical staining of the femoral head articular cartilage were performed, along with microCT (µCT) analysis to assess subchondral bone remodeling. We observed that mice receiving abductor injury exhibited significantly increased instability-associated OA severity with loss of proteoglycan and type II collagen staining compared to sham control mice at 20 weeks post-surgery, while comparable matrix metalloproteinase 13 expression was observed between injury and sham groups. No significant differences in subchondral bone remodeling were found after 3 or 20 weeks following injury. Our study further supports the link between abductor dysfunction and the development of instability-associated hip OA. Importantly, this novel surgically induced hip OA mouse model may provide a valuable tool for future investigations into the pathogenesis and treatment of hip OA.
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Affiliation(s)
- Michael B Geary
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood, Avenue, Box 665, Rochester, NY 14642, USA
| | - Caitlin A Orner
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood, Avenue, Box 665, Rochester, NY 14642, USA
| | - Helen Shammas
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood, Avenue, Box 665, Rochester, NY 14642, USA
- Department of Biomedical Engineering, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
| | - John M Reuter
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood, Avenue, Box 665, Rochester, NY 14642, USA
| | - Alayna E Loiselle
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood, Avenue, Box 665, Rochester, NY 14642, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
| | - Brian D Giordano
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood, Avenue, Box 665, Rochester, NY 14642, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
| | - Chia-Lung Wu
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood, Avenue, Box 665, Rochester, NY 14642, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
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3
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Mechanisms of skeletal muscle-tendon development and regeneration/healing as potential therapeutic targets. Pharmacol Ther 2023; 243:108357. [PMID: 36764462 DOI: 10.1016/j.pharmthera.2023.108357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Skeletal muscle contraction is essential for the movement of our musculoskeletal system. Tendons and ligaments that connect the skeletal muscles to bones in the correct position at the appropriate time during development are also required for movement to occur. Since the musculoskeletal system is essential for maintaining basic bodily functions as well as enabling interactions with the environment, dysfunctions of these tissues due to disease can significantly reduce quality of life. Unfortunately, as people live longer, skeletal muscle and tendon/ligament diseases are becoming more common. Sarcopenia, a disease in which skeletal muscle function declines, and tendinopathy, which involves chronic tendon dysfunction, are particularly troublesome because there have been no significant advances in their treatment. In this review, we will summarize previous reports on the development and regeneration/healing of skeletal muscle and tendon tissues, including a discussion of the molecular and cellular mechanisms involved that may be used as potential therapeutic targets.
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4
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Chatterjee M, Muljadi PM, Andarawis-Puri N. The role of the tendon ECM in mechanotransduction: disruption and repair following overuse. Connect Tissue Res 2022; 63:28-42. [PMID: 34030531 DOI: 10.1080/03008207.2021.1925663] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Tendon overuse injuries are prevalent conditions with limited therapeutic options to halt disease progression. The specialized extracellular matrix (ECM) both enables joint function and mediates mechanical signals to tendon cells, driving biological responses to exercise or injury. With overuse, tendon ECM composition and structure changes at multiple scales, disrupting mechanotransduction and resulting in inadequate repair and disease progression. This review highlights the multiscale ECM changes that occur with tendon overuse and corresponding effects on cell-matrix interactions and cellular response to load.Results: Different functional joint requirements and tendon types experience a wide range of loading profiles, creating varied downstream mechanical stimuli. Distinct ECM structure and mechanical properties within the fascicle matrix, interfascicle matrix, and enthesis and their varied disruption with overuse are considered. The pericellular matrix (PCM) comprising the microscale tendon cell environment has a unique composition that changes with overuse injury and exercise, suggesting an important role in mechanotransduction and promoting repair. Cell-matrix interactions are mediated by structures including cilia, integrins, connexins and cytoskeleton that signal downstream homeostasis, adaptation, or repair. ECM disruption with tendon overuse may cause altered mechanical loading and cell-matrix interactions, resulting in mechanobiological understimulation, apoptosis, and ineffective repair. Current interventions to promote repair of tendon overuse injuries including exercise, targeting cell signaling, and modulating inflammation are considered.Conclusion: Future therapeutics should be assessed with regard of their effects on multiscale mechanotransduction in addition to joint function, with consideration of the central role of ECM.
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Affiliation(s)
- Monideepa Chatterjee
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Patrick M Muljadi
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Nelly Andarawis-Puri
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA.,Hospital for Special Surgery, New York, New York, USA
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5
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Bicket L, Cooke J, Knott I, Fearon A. The natural history of greater trochanteric pain syndrome: an 11-year follow-up study. BMC Musculoskelet Disord 2021; 22:1048. [PMID: 34930192 PMCID: PMC8691027 DOI: 10.1186/s12891-021-04935-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background Greater trochanteric pain syndrome (GTPS) is a musculoskeletal condition which can cause disability and reduce quality of life. However, limited evidence is available on the long-term outcomes of people with GTPS. Our aims were to determine the long-term prevalence of GTPS; to calculate the proportion of people with GTPS who had developed hip osteoarthritis (OA); and to determine the level of function and quality of life, 11-years after initial GTPS diagnosis. Methods A prospective 11-year natural history study. Two groups [GTPS group (n = 24), asymptomatic control (ASC) group (n = 20)] were evaluated at baseline, 12-months and 11-years. At 11-years all participants completed the modified Harris Hip Score (mHHS), Oswestry Disability Index (ODI) and Assessment of Quality-of-Life questionnaire. At 11-year follow-up 20/24 GTPS and 19/20 ASC participants were clinically assessed for GTPS and hip OA, completed the 10 metre-walk-test, timed up and go, and hip abduction and external rotation strength testing. Results At 11-year follow-up 45.0% of GTPS participants had GTPS compared to 5.3% of ASC participants (p = 0.008), OR [95% CI]: 10.19 [1.95, 104.3], and 35.0% of GTPS participants were clinically diagnosed with hip OA compared to none of the ASC participants (p = 0.002), OR [95% CI]: 21.6, [2.3, 2898.0]. GTPS participants reported more pain and disability than ASC participants via the ODI, mean difference [95% CI]: 6.1 [0.7, 11.6] but not the modified Harris Hip Score, mean difference [95% CI]: -3.3 [-10.3, 3.7]. Both groups had similar levels of quality of life and measures of function. Conclusions GTPS is a chronic condition: people with GTPS at baseline had twice the odds of being clinically diagnosed with GTPS or hip OA than the control group at 11-years. Further, there appears to be a temporal relationship between GTPS and the development of hip OA. This finding highlights the need to identify effective treatments that address the underlying impairments associated with GTPS. Pain and function results varied depending on the assessment tools used. Between group differences in quality of life seen at baseline are not found at the 11-year follow-up. The small sample size means the results must be considered with caution. Level of Evidence Level II Natural history Study. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04935-w.
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Affiliation(s)
- Luke Bicket
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia
| | - Julie Cooke
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia.,Research Institute for Sport and Exercise, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia
| | - Isaac Knott
- Canberra Health Services, 20 Guraguma St, Bruce, 2617, Australia
| | - Angie Fearon
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia. .,Research Institute for Sport and Exercise, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia. .,Trauma and Orthopaedic Research Centre at the Canberra Hospital, Garren, ACT, 2606, Australia.
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6
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Ibrahim M, Hedlundh U, Sernert N, Meknas K, Haag L, Movin T, Papadogiannakis N, Kartus JT. Histological and ultrastructural degenerative findings in the gluteus medius tendon after hip arthroplasty. J Orthop Surg Res 2021; 16:339. [PMID: 34039378 PMCID: PMC8152320 DOI: 10.1186/s13018-021-02434-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite gluteus medius (GMED) tendinosis being relatively common, its presence in association with hip osteoarthritis (OA) or total hip arthroplasty (THA) is not well studied. It was hypothesized that more tendon degeneration would be found in patients with OA of the hip and in those that had undergone THA than that in a control group. Methods One hundred patients were included between 2016 and 2019 and were included into 4 groups; the patients were undergoing revision surgery in two groups and primary THA in the other two groups; 22 patients had previously undergone primary THA through a direct lateral approach (involving sectioning of the GMED tendon), 24 patients had previously undergone primary THA through a posterior approach (leaving the GMED tendon intact), 29 patients had primary hip OA, and 25 patients who suffered a femoral neck fracture served as controls. Biopsies from the GMED tendon were obtained at the time of the primary THA or the hip revision surgery. The tendon biopsies were examined ultrastructurally and histologically. Results Ultrastructurally, the direct lateral and posterior revision groups had statistically significantly more collagen fibrils with smaller diameters compared with the fracture and primary THA groups. Moreover, the direct lateral revision group had more collagen fibrils with smaller diameters compared with the posterior revision group. Histologically, the direct lateral revision group had a higher total degeneration score (TDS) compared with the primary hip OA group. Conclusions The GMED tendon shows more ultrastructural degeneration in patients who undergo hip revision arthroplasty than in patients with primary OA of the hip and control patients, who had suffered a femoral neck fracture. Furthermore, patients who had previously undergone primary THA through a direct lateral approach revealed more histological GMED tendon degeneration than patients who suffer primary hip OA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02434-1.
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Affiliation(s)
- Mustafa Ibrahim
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden. .,University of Gothenburg, Gothenburg, Sweden.
| | - Urban Hedlundh
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden
| | - Ninni Sernert
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden.,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Khaled Meknas
- Department of Orthopedics, University Hospital North Norway, N-9038, Tromsø, Norway.,Orthopedics Research Group, Institute of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Lars Haag
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden.,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Research and Development, NU Hospital Group, Trollhättan / Uddevalla, Sweden
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7
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Sohn R, Rösch G, Junker M, Meurer A, Zaucke F, Jenei-Lanzl Z. Adrenergic signalling in osteoarthritis. Cell Signal 2021; 82:109948. [PMID: 33571663 DOI: 10.1016/j.cellsig.2021.109948] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
Adrenoceptors (ARs) mediate the effects of the sympathetic neurotransmitters norepinephrine (NE) and epinephrine (E) in the human body and play a central role in physiologic and pathologic processes. Therefore, ARs have long been recognized as targets for therapeutic agents, especially in the field of cardiovascular medicine. During the past decades, the contribution of the sympathetic nervous system (SNS) and particularly of its major peripheral catecholamine NE to the pathogenesis of osteoarthritis (OA) attracted growing interest. OA is the most common degenerative joint disorder worldwide and a disease of the whole joint. It is characterized by progressive degradation of articular cartilage, synovial inflammation, osteophyte formation, and subchondral bone sclerosis mostly resulting in chronic pain. The subchondral bone marrow, the periosteum, the synovium, the vascular meniscus and numerous tendons and ligaments are innervated by tyrosine hydroxylase-positive (TH+) sympathetic nerve fibers that release NE into the synovial fluid and cells of all abovementioned joint tissues express at least one out of nine AR subtypes. During the past decades, several in vitro studies explored the AR-mediated effects of NE on different cell types in the joint. So far, only a few studies used animal OA models to investigate the contribution of distinct AR subtypes to OA pathogenesis in vivo. This narrative review shortly summarizes the current background knowledge about ARs and their signalling pathways at first. In the second part, we focus on recent findings in the field of NE-induced AR-mediated signalling in different joint tissues during OA pathogenesis and at the end, we will delineate the potential of targeting the adrenergic signalling for OA prevention or treatment. We used the PubMed bibliographic database to search for keywords such as 'joint' or 'cartilage' or 'synovium' or 'bone' and 'osteoarthritis' and/or 'trauma' and 'sympathetic nerve fibers' and/or 'norepinephrine' and 'adrenergic receptors / adrenoceptors' as well as 'adrenergic therapy'.
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Affiliation(s)
- Rebecca Sohn
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt / Main, Germany
| | - Gundula Rösch
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt / Main, Germany
| | - Marius Junker
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt / Main, Germany
| | - Andrea Meurer
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt / Main, Germany
| | - Frank Zaucke
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt / Main, Germany
| | - Zsuzsa Jenei-Lanzl
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt / Main, Germany.
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8
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Ibrahim M, Meknas K, Steigen SE, Olsen R, Sernert N, Ejerhed L, Kartus JT. No significant histological or ultrastructural tendinosis changes in the hamstring tendon in patients with mild to moderate osteoarthritis of the knee? Knee Surg Sports Traumatol Arthrosc 2021; 29:1067-1074. [PMID: 32504157 PMCID: PMC7973588 DOI: 10.1007/s00167-020-06066-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the periarticular degenerative changes of the knee joint in association with osteoarthritis (OA). More tendinosis was expected to be found in the semitendinosus tendon in patients with knee OA than in patients without knee OA. METHODS Samples from 41 patients were included between January 2016 and October 2017. Twenty-one patients median age 53 (33-63) years with mild to moderate OA underwent high tibial osteotomy (HTO) and 20 patients median age 38 (31-57) years without OA underwent anterior cruciate ligament reconstruction (ACLR). Biopsies from the semitendinosus tendon were obtained at the time of surgery and examined histologically, morphologically and ultrastructurally using light and electron microscope. RESULTS The histological evaluation of the semitendinosus tendon revealed the presence of more hemosiderin in the ACLR group. No significant morphological or ultrastructural differences were shown between patients in the HTO and ACLR group. CONCLUSION Patients with mild and moderate medial compartment knee OA displayed no more degenerative changes in their semitendinosus tendon than patients without OA, as seen in both the light and the electron microscope. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mustafa Ibrahim
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden. .,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Khaled Meknas
- Department of Orthopedics, University Hospital North Norway, Tromsø, Norway ,Orthopedics Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Sonja E. Steigen
- Diagnostic Clinic-Clinical Pathology, University Hospital of Northern Norway, Tromsø, Norway ,Institute of Medical Biology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Randi Olsen
- Advanced Microscopy Core Facility, Institute of Medical Biology, UIT-The Arctic University of Norway, Tromsø, Norway
| | - Ninni Sernert
- Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
| | - Lars Ejerhed
- Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden ,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
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9
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Gielis WP, de Jong PA, Bartstra JW, Foppen W, Spiering W, den Harder AM. Osteoarthritis in Pseudoxanthoma Elasticum Patients: An Explorative Imaging Study. J Clin Med 2020; 9:E3898. [PMID: 33271791 PMCID: PMC7760162 DOI: 10.3390/jcm9123898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 11/16/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a systemic disease affecting the skin, eyes, and cardiovascular system of patients. Cardiovascular disease is associated with osteoarthritis (OA), which is the most common cause of joint pain. There is a lack of systematic investigations on joint manifestations in PXE in the literature. In this explorative study, we aimed to investigate whether patients with PXE are more at risk for developing osseous signs of OA. Patients with PXE and hospital controls with whole-body low-dose CT examinations available were included. OA was assessed using the OsteoArthritis Computed Tomography (OACT)-score, which is a 4-point Likert scale, in the acromioclavicular (AC), glenohumeral (GH), facet, hip, knee, and ankle joints. Additionally, intervertebral disc degeneration was scored. Data were analyzed using ordinal logistic regression adjusted for age, body mass index (BMI), and smoking status. In total, 106 PXE patients (age 56 (48-64), 42% males, BMI 25.3 (22.7-28.2)) and 87 hospital controls (age 55 (43-67), 46% males, BMI 26.0 (22.5-29.2)) were included. PXE patients were more likely to have a higher OA score for the AC joints (OR 2.00 (1.12-3.61)), tibiofemoral joint (OR 2.63 (1.40-5.07)), and patellofemoral joint (2.22 (1.18-4.24)). For the other joints, the prevalence and severity of OA did not differ significantly. This study suggests that patients with PXE are more likely to have structural OA of the knee and AC joints, which needs clinical confirmation in larger groups and further investigation into the mechanism.
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Affiliation(s)
- Willem Paul Gielis
- University Medical Center Utrecht, Department of Orthopaedics, Utrecht University, 3584 CX Utrecht, The Netherlands
- University Medical Center Utrecht, Department of Radiology, Utrecht University, 3584 CX Utrecht, The Netherlands; (P.A.d.J.); (J.W.B.); (W.F.); (A.M.d.H.)
| | - Pim A. de Jong
- University Medical Center Utrecht, Department of Radiology, Utrecht University, 3584 CX Utrecht, The Netherlands; (P.A.d.J.); (J.W.B.); (W.F.); (A.M.d.H.)
| | - Jonas W. Bartstra
- University Medical Center Utrecht, Department of Radiology, Utrecht University, 3584 CX Utrecht, The Netherlands; (P.A.d.J.); (J.W.B.); (W.F.); (A.M.d.H.)
| | - Wouter Foppen
- University Medical Center Utrecht, Department of Radiology, Utrecht University, 3584 CX Utrecht, The Netherlands; (P.A.d.J.); (J.W.B.); (W.F.); (A.M.d.H.)
| | - Wilko Spiering
- University Medical Center Utrecht, Department of Vascular Medicine, Utrecht University, 3584 CX Utrecht, The Netherlands;
| | - Annemarie M. den Harder
- University Medical Center Utrecht, Department of Radiology, Utrecht University, 3584 CX Utrecht, The Netherlands; (P.A.d.J.); (J.W.B.); (W.F.); (A.M.d.H.)
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10
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Stangl-Correa P, Stangl-Herrera W, Correa-Valderrama A, Ron-Translateur T, Cantor EJ, Palacio-Villegas JC. Postoperative Failure Frequency of Short External Rotator and Posterior Capsule With Successful Reinsertion After Primary Total Hip Arthroplasty: An Ultrasound Assessment. J Arthroplasty 2020; 35:3607-3612. [PMID: 32684400 DOI: 10.1016/j.arth.2020.06.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The reinsertion of the short external rotators and posterior capsule to the greater trochanter in the posterolateral approach has been considered an effective strategy to reduce the risk of dislocation. However, during clinical practice, no verification and monitoring of the status of such reinsertions is carried out. The objective of this study is to estimate the frequency of postoperative failure with successful reinsertion of the short external rotator and posterior capsule of the hip through ultrasound after primary total hip arthroplasty (THA) using the posterolateral approach. METHODS A prospective observational study was conducted involving patients with primary total hip arthroplasty via posterolateral approach in which reinsertion of hip's short external rotators and posterior capsule were successful reinserted during surgery from January to December 2019. The status of the reinsertion was assessed with an ultrasound between the 6 and 8 weeks after surgery. Reinsertion failure was considered when the reinserted structures were not fully visualized in the ultrasound during internal and external rotation. RESULTS Sixty-eight patients were included in this study (mean age: 58.7 ± 13.8 years; 44.1% (30) women). The incidence of failure of the reinsertion of short external rotators and posterior capsule was 16.2% (n = 11) (95% confidence interval 9.3-26.7). A postoperative increased femoral offset was found more frequently in cases with failure (36.4% vs 17.5%); a similar trend was observed in the leg length discrepancy (36.4% vs 22.8%). However, these differences were not statistically significant (P > .05). CONCLUSION Between the 6th and 8th postoperative week, approximately 2 of the 10 short external rotator and posterior capsule reinsertions fail in cases with successful intraoperative repair using absorbable suture. This estimate is comparable and even lower than previous reports. EVIDENCE LEVEL II, Prospective Observational Study.
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Affiliation(s)
- Paul Stangl-Correa
- Joint Replacement Group, Institute of Osteoarticular Disease, Centro Médico Imbanaco, Cali, Colombia; Faculty of Medicine, Universidad Javeriana, Javeriana, Bogotá, Colombia
| | - Willy Stangl-Herrera
- Joint Replacement Group, Institute of Osteoarticular Disease, Centro Médico Imbanaco, Cali, Colombia; Surgical Clinics Department, Pontificia Universidad Javeriana, Cali, Colombia
| | - Andrés Correa-Valderrama
- Joint Replacement Group, Institute of Osteoarticular Disease, Centro Médico Imbanaco, Cali, Colombia; Surgical Clinics Department, Pontificia Universidad Javeriana, Cali, Colombia
| | - Tamy Ron-Translateur
- Joint Replacement Group, Institute of Osteoarticular Disease, Centro Médico Imbanaco, Cali, Colombia
| | - Erika J Cantor
- Institute of Statistics, Universidad de Valparaiso, Valparaiso, Chile
| | - Julio C Palacio-Villegas
- Joint Replacement Group, Institute of Osteoarticular Disease, Centro Médico Imbanaco, Cali, Colombia; Surgical Clinics Department, Pontificia Universidad Javeriana, Cali, Colombia
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Ni Z, Zhou S, Li S, Kuang L, Chen H, Luo X, Ouyang J, He M, Du X, Chen L. Exosomes: roles and therapeutic potential in osteoarthritis. Bone Res 2020; 8:25. [PMID: 32596023 PMCID: PMC7305215 DOI: 10.1038/s41413-020-0100-9] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022] Open
Abstract
Exosomes participate in many physiological and pathological processes by regulating cell-cell communication, which are involved in numerous diseases, including osteoarthritis (OA). Exosomes are detectable in the human articular cavity and were observed to change with OA progression. Several joint cells, including chondrocytes, synovial fibroblasts, osteoblasts, and tenocytes, can produce and secrete exosomes that influence the biological effects of targeted cells. In addition, exosomes from stem cells can protect the OA joint from damage by promoting cartilage repair, inhibiting synovitis, and mediating subchondral bone remodeling. This review summarizes the roles and therapeutic potential of exosomes in OA and discusses the perspectives and challenges related to exosome-based treatment for OA patients in the future.
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Affiliation(s)
- Zhenhong Ni
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Siru Zhou
- State Key Laboratory of Trauma, Burns and Combined Injury; Medical Cformation of H-type vessel in subchondral enter of Trauma and War Injury; Daping Hospital, Army Medical University of PLA, Chongqing, China
| | - Song Li
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
- Eleven Squadron Three Brigade, School of Basic Medical Science, Army Medical University, Chongqing, China
| | - Liang Kuang
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Hangang Chen
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoqing Luo
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Junjie Ouyang
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Mei He
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaolan Du
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Lin Chen
- Department of Wound Repair and Rehabilitation Medicine, Center of Bone Metabolism and Repair, Laboratory for Prevention and Rehabilitation of Training Injuries, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
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More tendon degeneration in patients with shoulder osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2019; 27:267-275. [PMID: 30284007 DOI: 10.1007/s00167-018-5186-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Tendon disorders are a major problem in the general population. It is known that rotator cuff tendinopathy contributes to osteoarthritis (OA) of the shoulder. The aim of the study was to analyse the presence of tendinopathy in patients with shoulder OA and an intact rotator cuff, using a multimodal approach. METHODS Thirteen consecutive patients median age 67 (52-84) years, with OA of the shoulder, and 13 consecutive control patients, with a fracture of the proximal humerus, median age 70 (51-84) years, underwent an open biopsy procedure from the biceps and subscapularis tendon in conjunction with shoulder arthroplasty. In addition to a macroscopic evaluation, the samples underwent histologic, morphologic and ultrastructural analyses in light and transmission electron microscopy. RESULTS Macroscopic degeneration was found in 15 of 26 specimen in the OA group but in seven of 25 in the control group (p = 0.048). The histologic analysis revealed a non-significant difference for the total degeneration score (TDS) between the study groups. The morphologic evaluation of the samples revealed that the OA group had significantly more samples with non-homogeneous extracellular matrix (ECM), (p = 0.048). Ultrastructurally, the OA group revealed a significantly larger fibril diameter in the biceps tendon (p < 0.0001) but not in the subscapularis tendon compared with the control group. CONCLUSION A significantly worse macroscopic appearance and significantly more morphologically inhomogeneous ECM, indicating more tendon degeneration, were found in the OA group compared with the control group. This indicates that it could be beneficial to treat the tendinosis in an early stage to decrease symptoms from the OA. STUDY DESIGN Level of evidence, III.
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Farfaras S, Ejerhed LE, Hallström EK, Hultenby K, Meknas K, Movin T, Papadogiannakis N, Kartus JT. More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement. Knee Surg Sports Traumatol Arthrosc 2018; 26:79-87. [PMID: 28255657 PMCID: PMC5754398 DOI: 10.1007/s00167-017-4442-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability. METHODS Male patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope. RESULTS Eight patients, median age 53 (45-74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22-48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001). CONCLUSION Male patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability. CLINICAL RELEVANCE It appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stefanos Farfaras
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451, Uddevalla, Sweden. .,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden.
| | - Lars Erik Ejerhed
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden
| | - Erling K. Hallström
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden ,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden
| | - Kjell Hultenby
- Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Khaled Meknas
- Bone and Joint Research Group, Department of Orthopedics, Institute of Clinical Medicine, University Hospital North Norway, The Arctic University of Norway, Tromsø, Norway
| | - Tomas Movin
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden ,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden
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Islam A, Romijn EI, Lilledahl MB, Martinez-Zubiaurre I. Non-linear optical microscopy as a novel quantitative and label-free imaging modality to improve the assessment of tissue-engineered cartilage. Osteoarthritis Cartilage 2017; 25:1729-1737. [PMID: 28668541 DOI: 10.1016/j.joca.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 05/22/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Current systems to evaluate outcomes from tissue-engineered cartilage (TEC) are sub-optimal. The main purpose of our study was to demonstrate the use of second harmonic generation (SHG) microscopy as a novel quantitative approach to assess collagen deposition in laboratory made cartilage constructs. METHODS Scaffold-free cartilage constructs were obtained by condensation of in vitro expanded Hoffa's fat pad derived stromal cells (HFPSCs), incubated in the presence or absence of chondrogenic growth factors (GF) during a period of 21 d. Cartilage-like features in constructs were assessed by Alcian blue staining, transmission electron microscopy (TEM), SHG and two-photon excited fluorescence microscopy. A new scoring system, using second harmonic generation microscopy (SHGM) index for collagen density and distribution, was adapted to the existing "Bern score" in order to evaluate in vitro TEC. RESULTS Spheroids with GF gave a relative high Bern score value due to appropriate cell morphology, cell density, tissue-like features and proteoglycan content, whereas spheroids without GF did not. However, both TEM and SHGM revealed striking differences between the collagen framework in the spheroids and native cartilage. Spheroids required a four-fold increase in laser power to visualize the collagen matrix by SHGM compared to native cartilage. Additionally, collagen distribution, determined as the area of tissue generating SHG signal, was higher in spheroids with GF than without GF, but lower than in native cartilage. CONCLUSION SHG represents a reliable quantitative approach to assess collagen deposition in laboratory engineered cartilage, and may be applied to improve currently established scoring systems.
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Affiliation(s)
- A Islam
- Institute of Clinical Medicine, University of Tromsø, Norway.
| | - E I Romijn
- Department of Physics, Norwegian University of Science and Technology, Norway.
| | - M B Lilledahl
- Department of Physics, Norwegian University of Science and Technology, Norway.
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15
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Robinson L. A superior gemellus tear in a degenerative hip: Is it relevant? SONOGRAPHY 2017. [DOI: 10.1002/sono.12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Luke Robinson
- Canberra Imaging Group; Australia
- Central Queensland University; Australia
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16
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Katsma MS, Patel SH, Eldon E, Corbell KA, Shimkus KL, Fluckey JD, Carroll CC. The influence of chronic IL-6 exposure, in vivo, on rat Achilles tendon extracellular matrix. Cytokine 2017; 93:10-14. [PMID: 28412025 DOI: 10.1016/j.cyto.2017.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022]
Abstract
When compared to placebo, acetaminophen (APAP) reduces tendon stiffness and collagen cross-linking. APAP also enhances the exercise-induced increase in peritendinous levels of IL-6. Elevated levels of IL-6 are associated with tendinopathy, thus we hypothesized that chronic, elevated peritendinous IL-6 would alter tendon extracellular matrix (ECM). IL-6 (∼3000pgml-1) was injected (3dwk-1 for 8-wks) into the Achilles peritendinous region of male Wistar rats (n=16) with the opposite leg serving as a sham. Fractional synthesis rates (FSR) were determined using deuterium oxide. Collagen (hydroxyproline) and hydroxylysl pyridinoline (HP) cross-linking were analyzed by HPLC. ECM and IL-6 related genes were evaluated using qRT-PCR. Relative to sham, collagen (Col) 1a1 but not Col3a1 expression was suppressed (47%) in tendons exposed to IL-6 (p<0.05). Lysyl oxidase (LOX) and MMP-1 expression were also reduced (37%) in IL-6 treated tendons (p<0.05). Relative to sham the expression of MMP-2, -3, -9, and TIMP-1 were not altered by IL-6 treatment (p>0.05). Interleukin-6 receptor subunit beta precursor (IL6st) was lower (16%) in IL-6 treated tendons when compared to sham (p<0.05). Suppressor of cytokine signaling 3 (Socs3), signal transducer and activator of transcription 3 (STAT3), and protein inhibitor of activated STAT 1 (Pias1) were not altered by IL-6 exposure (p>0.05). Neither collagen nor cross-linking content were altered by IL-6 (p>0.05). Additionally, IL-6 treatment did not alter tendon FSR. Chronic treatment with physiologically relevant levels of IL-6 suppresses expression of Col1a1 and LOX while also altering expression of select MMPs but does not alter Achilles tendon collagen synthesis.
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Affiliation(s)
- Mark S Katsma
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Shivam H Patel
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Erica Eldon
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Kathryn A Corbell
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | | | | | - Chad C Carroll
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA; Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA.
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Bessette MC, Olsen JR, Mann TR, Giordano BD. Intra-articular hip injections for lateral hip pain. J Hip Preserv Surg 2014; 1:71-6. [PMID: 27011805 PMCID: PMC4765286 DOI: 10.1093/jhps/hnu012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/07/2014] [Accepted: 08/20/2014] [Indexed: 11/12/2022] Open
Abstract
Occult intra-articular hip pathology is commonly found in patients with greater trochanteric pain syndrome, and may be a possible pain generator in patients with recalcitrant lateral hip pain. We investigated the effect of intra-articular hip injections in patients with recalcitrant lateral hip pain. Between September 2012 and May 2013, patients over the age of 18 with a history lateral hip pain who had received prior treatment with non-steroidal anti-inflammatory medications, physical therapy and peritrochanteric corticostroid injections were enrolled. Treatment consisted of an ultrasound guided intra-articular corticosteroid injection followed by a course of directed physical therapy and a non-steroidal anti-inflammatory medication. Patients performed GaitRite analysis at baseline and 12 weeks following the injection. In addition, the Modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Scores (HOS), Short Form 36 (SF-36) and a visual analogue pain score (VAS) were collected at baseline, 1, 6 and 12 weeks.A total of 16 patients were studied. Patients experienced significant improvements from their baseline mHHS at 1 and 12 weeks (P = 0.03, P = 0.04). The minimal clinically important difference (MCID) was exceeded at multiple timepoints on various clinical outcome surveys. Velocity and stride length were not significantly improved at 12 weeks. Intra-articular hip injections may decrease pain and improve function in patients with recalcitrant lateral hip pain, and occult intra-articular hip pathology should be considered in the etiology of lateral hip pain. Though low enrollment numbers left this study underpowered, MCID comparisons demonstrated potential benefit from this treatment.
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Affiliation(s)
- Matthew C Bessette
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Joshua R Olsen
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Tobias R Mann
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Brian D Giordano
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
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Åhlén M, Lidén M, Movin T, Papadogiannakis N, Rostgård-Christensen L, Kartus J. Histological Evaluation of Regenerated Semitendinosus Tendon a Minimum of 6 Years After Harvest for Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2014; 2:2325967114550274. [PMID: 26535362 PMCID: PMC4555632 DOI: 10.1177/2325967114550274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Semitendinosus (ST) and/or gracilis (G) autografts are the most used grafts for anterior cruciate ligament (ACL) surgery. The tendons have been shown to be able to regenerate but with focal areas of scar tissue in the short term. There are no long-term histological studies of the regenerated tendons. Hypothesis: In the long term, the regenerated ST tendon normalizes and has a similar histology as the contralateral nonharvested tendon. Study Design: Case-control study; Level of evidence, 3. Methods: Eighteen patients (8 female, 10 male) who underwent ACL surgery using ipsilateral ST/G tendon autografts were included in this study. Percutaneous specimens were obtained from the regenerated ST tendon and the contralateral nonharvested ST tendon under ultrasonographic guidance at a median of 8.4 years (100.5 months; range, 77-129 months) after the harvest procedure. Specimens from the nonoperated side served as controls. The histology and presence of glycosaminoglycans (GAGs) were assessed using a light microscope and a semiquantitative grading system. Results: Thirty-six biopsies were obtained (2 biopsies from each patient). In 5 biopsies, the amount of tissue was too small to analyze in the light microscope, and 1 patient had been operated on bilaterally and was therefore excluded. In total, 24 biopsies were included in the histological analysis. In overall terms, there were no significant differences between the regenerated and nonharvested ST tendon in terms of fiber structure, cellularity, vascularity, and level of GAGs a minimum 6 years after harvest of the ST tendon. However, 3 of the regenerated tendons displayed a loss of fiber structure. Conclusion: The ST tendon regenerates and may regain a histological appearance similar to that of the nonharvested contralateral tendon, as seen in this study a median of 8.4 years after harvesting. However, in some tendons, loss of fiber structure was found.
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Affiliation(s)
- Martina Åhlén
- Department of Orthopedics, NU-Hospital Organization, Trollhättan/Uddevalla, Sweden. ; University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Sahlgrenska University Hospital, Sahlgrenska, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Jüri Kartus
- Department of Research and Development NU-Hospital Organization, Trollhättan/Uddevalla, Sweden
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Zhang J, Wang JHC. Prostaglandin E2 (PGE2) exerts biphasic effects on human tendon stem cells. PLoS One 2014; 9:e87706. [PMID: 24504456 PMCID: PMC3913640 DOI: 10.1371/journal.pone.0087706] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023] Open
Abstract
Prostaglandin E2 (PGE2) has been reported to exert different effects on tissues at low and high levels. In the present study, cell culture experiments were performed to determine the potential biphasic effects of PGE2 on human tendon stem/progenitor cells (hTSCs). After treatment with PGE2, hTSC proliferation, stemness, and differentiation were analyzed. We found that high concentrations of PGE2 (>1 ng/ml) decreased cell proliferation and induced non-tenocyte differentiation. However, at lower concentrations (<1 ng/ml), PGE2 markedly enhanced hTSC proliferation. The expression levels of stem cell marker genes, specifically SSEA-4 and Stro-1, were more extensive in hTSCs treated with low concentrations of PGE2 than in cells treated with high levels of PGE2. Moreover, high levels of PGE2 induced hTSCs to differentiate aberrantly into non-tenocytes, which was evident by the high levels of PPARγ, collagen type II, and osteocalcin expression in hTSCs treated with PGE2 at concentrations >1 ng/ml. The findings of this study reveal that PGE2 can exhibit biphasic effects on hTSCs, indicating that while high PGE2 concentrations may be detrimental to tendons, low levels of PGE2 may play a vital role in the maintenance of tendon homeostasis in vivo.
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Affiliation(s)
- Jianying Zhang
- MechanoBiology Laboratory, Departments of Orthopaedic Surgery, Bioengineering, Mechanical Engineering and Materials Science, and Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - James H-C. Wang
- MechanoBiology Laboratory, Departments of Orthopaedic Surgery, Bioengineering, Mechanical Engineering and Materials Science, and Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Abraham A, Pauly H, Donahue TH. Deleterious effects of osteoarthritis on the structure and function of the meniscal enthesis. Osteoarthritis Cartilage 2014; 22:275-83. [PMID: 24316288 PMCID: PMC3923977 DOI: 10.1016/j.joca.2013.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/23/2013] [Accepted: 11/26/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The ability of menisci to prevent osteoarthritis (OA) is dependent on the integrity of the complex meniscal entheses, the attachments of the menisci to the underlying subchondral bone (SB). The goal of this study was to determine mechanical and structural changes in meniscal entheses after the onset of OA. DESIGN Healthy and osteoarthritic meniscal entheses were evaluated for changes in histomorphological characteristics, mineralization, and mechanical properties. Glycosaminoglycans (GAG) and calcium in the insertion were evaluated with histological staining techniques. The extent of calcium deposition was assessed and tidemark (TM) integrity was quantified. Changes in the mineralized zone of the insertion were examined using micro-computed tomography (μCT) to determine bone mineral density, cortical zone thickness, and mineralization gradient. Mechanical properties of the entheses were measured using nano-indentation techniques to obtain material properties based on viscoelastic analysis. RESULTS GAG thickness in the calcified fibrocartilage (CFC) zone and calcium content were significantly greater in osteoarthritic anterior meniscal entheses. TM integrity was significantly decreased in OA tissue, particularly in the medial anterior (MA) enthesis. The mineralized zone of osteoarthritic meniscal entheses was significantly thicker than in healthy entheses and showed decreased bone mineral density. Fitting of mineralization data to a sigmoidal Gompertz function revealed a lower rate of increase in mineralization in osteoarthritic tissue. Analysis of viscoelastic mechanical properties revealed increased compliance in osteoarthritic tissue. CONCLUSIONS These data suggest that significant changes occur at meniscal enthesis sites with the onset of OA. Mechanical and structural changes in meniscal entheses may contribute to meniscal extrusion, which has been shown to increase the progression of OA.
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Affiliation(s)
- A.C. Abraham
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - H.M. Pauly
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - T.L. Haut Donahue
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA,Address correspondence and reprint requests to: T.L. Haut Donahue, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
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Domb BG, Botser I, Giordano BD. Outcomes of endoscopic gluteus medius repair with minimum 2-year follow-up. Am J Sports Med 2013; 41:988-97. [PMID: 23524152 DOI: 10.1177/0363546513481575] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gluteus medius tears may be present in as many as 25% of late middle-aged women and 10% of middle-aged men, and they are often misdiagnosed. Outcomes of endoscopic repair of gluteus medius tears have seldom been reported. PURPOSE To report the early outcomes of endoscopic repair of partial- and full-thickness gluteus medius tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between April 2009 and January 2010, data were prospectively collected for all patients undergoing endoscopic gluteus medius repair by one of the authors. Inclusion criteria for the study were patients undergoing repair for either high-grade, partial-, or full-thickness tears. Only patients with endoscopic evidence of a gluteus medius tear were treated surgically. In the case of an articular-side tear, a transtendinous repair technique was used, whereas in the presence of a full-thickness tear, the tendon was refixated to the bone directly. RESULTS A total of 15 patients met the inclusion criteria. The cohort included 14 women and 1 man, with an average age of 58 years (range, 44-74 years). Endoscopically, 6 cases were found to be partial-thickness tears. Nine were either full-thickness tears or near-full-thickness tears, which were completed for the repair. Follow-up was obtained on all patients at an average of 27.9 months postoperatively (range, 24-37 months). Fourteen of the 15 patients showed postoperative improvement in all 4 hip-specific scores used to assess outcome, with an average improvement of more than 30 points for all scores. Satisfaction with the surgery results was reported to be from good to excellent (scores of 7-10 out of 10) in 14 of 15 patients. CONCLUSION This study demonstrates that endoscopic surgical repair, whether performed through a transtendinous or full-thickness technique, can be an effective treatment of gluteus medius tears at a minimum follow-up of 2 years. Longer term follow-up studies are necessary to determine whether these therapeutic and functional gains are maintained.
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Meknas K, Johansen O, Kartus J. Retro-trochanteric sciatica-like pain: current concept. Knee Surg Sports Traumatol Arthrosc 2011; 19:1971-85. [PMID: 21678093 PMCID: PMC3195768 DOI: 10.1007/s00167-011-1573-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 05/31/2011] [Indexed: 12/05/2022]
Abstract
The aim of this manuscript is to review the current knowledge in terms of retro-trochanteric pain syndrome, make recommendations for diagnosis and differential diagnosis and offer suggestions for treatment options. The terminology in the literature is confusing and these symptoms can be referred to as 'greater trochanteric pain syndrome', 'trochanteric bursitis' and 'trochanteritis', among other denominations. The authors focus on a special type of sciatica, i.e. retro-trochanteric pain radiating down to the lower extremity. The impact of different radiographic assessments is discussed. The authors recommend excluding pathology in the spine and pelvic area before following their suggested treatment algorithm for sciatica-like retro-trochanteric pain.
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Affiliation(s)
- Khaled Meknas
- Department of Orthopaedics, University Hospital of North Norway, 9038 Tromsø, Norway.
| | - Oddmund Johansen
- Department of Orthopaedics, University Hospital of North Norway, 9038 Tromsø, Norway ,Institute of Clinical Medicine, Faculty of Medicine, University of Tromsø, Tromsø, Norway
| | - Jüri Kartus
- Department of Orthopaedics, NU-Hospital Organization, Trollhättan, Uddevalla, Sweden
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