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Yue S, Zhai G, Zhao S, Liang X, Liu Y, Zheng J, Chen X, Dong Y. The biphasic role of the infrapatellar fat pad in osteoarthritis. Biomed Pharmacother 2024; 179:117364. [PMID: 39226725 DOI: 10.1016/j.biopha.2024.117364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024] Open
Abstract
Osteoarthritis (OA) is a progressive degenerative disease resulting in joint deterioration. It is a whole organ disease characterized by cartilage degeneration and varying degrees of synovitis, involving pathological changes in all joint tissues, such as cartilage, subchondral bone, ligaments, meniscus, synovium, and infrapatellar fat pad (IPFP). IPFP is the largest adipose tissue structure in the knee joint and is composed of fat cells, immune cells and blood vessels. Moreover, IPFP is located close to the cartilage and bone surface so that it may reduce the impact of loading and absorb forces generated through the knee joint, and may have a protective role in joint health. IPFP has been shown to release various cytokines and adipokines that play pro-inflammatory and pro-catabolic roles in cartilage, promoting OA progression. Intra-articular injections of IPFP-derived mesenchymal stem cells and exosomes have been shown to reduce pain and prevent OA progression in patients with knee OA. Previous studies have shown that IPFP has a biphasic effect on OA progression. This article reviews the latest research progress of IPFP, discusses the role and mechanism of IPFP in OA, provide new intervention strategies for the treatment of OA. This article will also discuss the handling of IPFP during the procedure of total knee arthroplasty.
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Affiliation(s)
- Songkai Yue
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Ganggang Zhai
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Siyu Zhao
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Xiaming Liang
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Yunke Liu
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Jia Zheng
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Xiaoyang Chen
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Yonghui Dong
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China.
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Kawada T, Shinohara Y, Kurihara T, Satake H, Itokawa K, Fukuyoshi M, Hayashi N, Sugimoto K. Anatomical evaluations of the adipose tissue surrounding the flexor hallucis longus tendon. Sci Rep 2024; 14:16903. [PMID: 39043789 PMCID: PMC11266517 DOI: 10.1038/s41598-024-67831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024] Open
Abstract
This study aimed to evaluate the presence of adipose tissue surrounding the flexor hallucis longus (FHL) tendon through gross dissection and magnetic resonance imaging (MRI). Grossly, we observed the FHL tendon and surrounding tissues in nine cadavers. Using MRI, we quantitatively evaluated each tissue from the horizontal plane in 40 healthy ankles. Macroscopic autopsy revealed the presence of adipose tissue behind the ankle joint between the FHL and fibula, and horizontal cross-sections showed an oval-shaped adipose tissue surrounding the tendon. The cross-sectional area on MRI was 14.4 mm2 (11.7-16.7) for the FHL tendon and 120.5 mm2 (100.3-149.4) for the adipose tissue. Additionally, the volume of the adipose tissue was 963.3 mm3 (896.2-1115.6). There is an adipose tissue around FHL tendon and maybe this close anatomical relationship might influence the function of the tendon and be involved in its pathologies.
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Affiliation(s)
- Tatsuhito Kawada
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga, Japan
- Department of Rehabilitation, Nagoya Sports Medicine & Orthopedic Clinic, Aichi, Japan
| | - Yasushi Shinohara
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan.
| | - Toshiyuki Kurihara
- Research Organization of Science and Technology, Ritsumeikan University, Shiga, Japan
| | - Hayato Satake
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga, Japan
| | - Kana Itokawa
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga, Japan
| | - Masaki Fukuyoshi
- Department of Rehabilitation, Nagoya Sports Medicine & Orthopedic Clinic, Aichi, Japan
| | - Norio Hayashi
- Musculoskeletal Functional Anatomy Research Institute, Gifu, Japan
| | - Katsumasa Sugimoto
- Department of Orthopedic Surgery, Nagoya Sports Medicine & Orthopedic Clinic, Aichi, Japan
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Obara S, Oishi R, Nakano Y, Kurosawa S, Inoue S. Anterior knee pain post-multiple surgeries for tibia fracture effectively managed with infrapatellar fat pad injection: a case report. JA Clin Rep 2022; 8:82. [PMID: 36214990 PMCID: PMC9551149 DOI: 10.1186/s40981-022-00573-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The anterior knee compartment is filled by the infrapatellar fat pad (IFP) and has been emphasized as a source of anterior knee pain (AKP). CASE PRESENTATION A 51-year-old woman sustained a right tibial plateau and open diaphyseal fracture 2 years earlier. She remained with chronic AKP after undergoing bone fixations. Increased anterior portion of the IFP brightness and decreased adipose tissue gliding with flexion and extension compared to the unaffected side was shown on ultrasonography. An injection of 0.2% lidocaine between the patellar tendon and IFP, and into the IFP under ultrasound guidance, immediately relieved the pain. The pain kept recurring although injections were effective for a while; thus, surgery was scheduled. Scar tissue on the IFP surface was endoscopically excised and her pain dramatically reduced. CONCLUSION This is the first report in which the detection of increased brightness on ultrasound of IFP and the injections into the IFP triggered an additional surgical intervention. Ultrasound evaluation and injection may be beneficial in pain clinic patients presenting with AKP and may provide an opportunity for diagnosis.
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Affiliation(s)
- Shinju Obara
- grid.411582.b0000 0001 1017 9540Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295 Japan ,grid.471467.70000 0004 0449 2946Center for Pain Management, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Fukushima 960-1295 Japan
| | - Rieko Oishi
- grid.411582.b0000 0001 1017 9540Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295 Japan
| | - Yuko Nakano
- grid.411582.b0000 0001 1017 9540Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295 Japan
| | - Shin Kurosawa
- grid.411582.b0000 0001 1017 9540Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295 Japan
| | - Satoki Inoue
- grid.411582.b0000 0001 1017 9540Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295 Japan
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Mills MK, Allen H. Knee Plical Pathology and Impingement Syndromes. Magn Reson Imaging Clin N Am 2022; 30:293-305. [DOI: 10.1016/j.mric.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kitagawa T, Ozaki N, Aoki Y. Effect of physical therapy on the flexibility of the infrapatellar fat pad: A single-blind randomised controlled trial. PLoS One 2022; 17:e0265333. [PMID: 35298522 PMCID: PMC8929552 DOI: 10.1371/journal.pone.0265333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022] Open
Abstract
The infrapatellar fat pad plays a biomechanical role in the knee joint. After knee injury or surgery, its dynamics decrease because of an inflammatory response. Physical therapy might be one of the valuable treatments for the recovery of knee joint mobility. This study aimed to evaluate the immediate effect of physical therapy on the dynamics of the infrapatellar fat pad in healthy participants using ultrasonography. In this prospective, single-blind, randomised controlled trial, 64 healthy young participants were enrolled and randomly assigned to one of the following three interventions: manual therapy, hot pack treatment, and control. Ultrasound images of the infrapatellar fat pad were obtained before and after the intervention. The thickness change ratio of the infrapatellar fat pad was calculated to compare the changes between and within groups before and after the intervention. No significant inter-group differences were observed. The effect sizes were relatively small. Manual therapy or hot pack intervention might not have an immediate effect on infrapatellar fat pad flexibility in healthy participants. Thus, it is necessary to consider more intensive treatments to change the dynamics of the infrapatellar fat pad.
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Affiliation(s)
- Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Japan
- * E-mail:
| | - Natsumi Ozaki
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Japan
| | - Yuma Aoki
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Japan
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Takeda K, Takeshima E, Kojima S, Watanabe M, Matsuzaki T, Hoso M. Daily and short-term application of joint movement for the prevention of infrapatellar fat pad atrophy due to immobilization. J Phys Ther Sci 2019; 31:873-877. [PMID: 31871369 PMCID: PMC6879406 DOI: 10.1589/jpts.31.873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 08/01/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To mobilize the knee joint during cast fixation and to determine whether infrapatellar fat pad changes can be prevented. [Materials and Methods] We randomly allocated Wistar rats into 3 groups as follows: normal group, raised in normal conditions (n=5); contracture group, immobilized with cast fixation (n=5); and prevention group, treated with joint movement during immobilization (n=5). We immobilized the right hindlimb using cast fixation. Joint movement in the prevention group was accomplished by repeatedly pulling the right hindlimb caudally and then returning the leg to the bent position for 10 minutes every day for 2 weeks. We used a metronome to maintain a constant speed, with one set lasting 2 seconds (1-second traction and 1-second return). [Results] The contracture group had adipose cells of various sizes and fibrosis in the infrapatellar fat pad. These changes were also found in milder forms in the prevention group. We found significant differences in the cross section of adipose cells and in knee extension restriction between the groups. [Conclusion] Promoting joint movement may not only have a therapeutic effect on adipose cells but also a preventative effect.
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Affiliation(s)
- Keisuke Takeda
- Graduate School of Medical Science, Kanazawa University: 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan.,Department of Rehabilitation, Kanazawa University Hospital, Japan
| | | | - Satoshi Kojima
- Graduate School of Rehabilitation, Kinjo University, Japan
| | | | - Taro Matsuzaki
- Graduate School of Medical Science, Kanazawa University: 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
| | - Masahiro Hoso
- Graduate School of Medical Science, Kanazawa University: 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
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Abstract
The anterior and posterior cruciate ligaments are important stabilizers of the knee joint function. Although they are both similar in their native appearance, they possess slightly different properties and complement each other's function. The imaging findings differ between the anterior and posterior cruciate ligaments. While MRI is the main imaging modality, radiographs and CT have a role in pre- and post-operative imaging. The aim of this review is to present pre-and post-operative imaging findings of injured cruciate ligaments. A special emphasis will be placed on the potential pitfalls in cruciate ligament imaging.
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