Effect of high tibial osteotomy on upper tibial venous drainage: study by intraosseous phlebography in primary osteoarthritis of knee joint

Mesenchymal stem cells for subchondral bone marrow lesions: From bench to bedside

Subchondral bone marrow lesions (BMLs) are areas of disease within subchondral bone that appear as T1 hypointense and T2 hyperintense ill-defined areas of bone marrow on magnetic resonance imaging. The most common bone marrow lesions include subchondral lesions related to osteoarthritis, osteochondral defects, and avascular necrosis. Emerging therapies include autologous biologic therapeutics, in particular mesenchymal stem cells (MSCs), to maintain and improve cartilage health; MSCs have become a potential treatment option for BMLs given the unmet need for disease modification. Active areas in the preclinical research of bone marrow lesions include the paracrine function of MSCs in pathways of angiogenesis and inflammation, and the use of bioactive scaffolds to optimize the environment for implanted MSCs by facilitating chondrogenesis and higher bone volumes. A review of the clinical data demonstrates improvements in pain and functional outcomes when patients with knee osteoarthritis were treated with MSCs, suggesting that BM-MSCs can be a safe and effective treatment for patients with painful knee osteoarthritis with or without bone marrow lesions. Preliminary data examining MSCs in osteochondral defects suggest they can be beneficial as a subchondral injection alone, or as a surgical augmentation. In patients with hip avascular necrosis, those with earlier stage disease have improved outcomes when core decompression is augmented with MSCs, whereas patients in later stages post-collapse have equivalent outcomes with or without MSC treatment. While the evidence for the use of MSCs in conditions with associated bone marrow lesions seems promising, there remains a need for continued investigation into this treatment as a viable treatment option.

•

Common BMLs include osteoarthritis, osteochondral defects, and avascular necrosis.

•

Patients with knee osteoarthritis treated with MSCs show improved pain and function.

•

MSCs used as subchondral injection or surgical augmentation in osteochondral defects

•

Improved outcomes of early hip avascular necrosis after core decompression with MSCs

•

Additional preclinical and clinical evidence of MSCs as treatment for BMLs is needed.

High valgus tibial osteotomy for osteoarthritis of the knee

We report a statistical analysis of the results of 65 tibial osteotomies for primary osteoarthritis of the knee followed up at 3 and 5 years. Preoperative walking ability and the severity of pain are the factors with which the long term prognosis can best be correlated. The preoperative range of motion and mild subluxation become important at 5 years, but these factors were not important at 3 years. Mild instability did not have any influence. The severity of the osteoarthritis in radiographs and the postoperative femoro-tibial angle did not have any important association with the result. The results are therefore best predicted by preoperative pain and activity. The degree of correction did not affect the result.