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Hwang S, Lee YJ, Song MH, Cho TJ, Choi IH, Shin CH. Incidence and Clinical Characteristics of Slipped Capital Femoral Epiphysis in Patients with Endocrinopathy: A Population-Based Cohort Study. J Bone Joint Surg Am 2024; 106:381-388. [PMID: 38079482 DOI: 10.2106/jbjs.23.00790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Endocrinopathy is a risk factor for slipped capital femoral epiphysis (SCFE). We aimed to determine (1) the incidence of endocrinopathy-associated SCFE compared with that of non-endocrinopathy-associated SCFE, (2) whether the incidence of SCFE increases with the number of deficient hormones, and (3) the clinical characteristics of endocrinopathy-associated SCFE. METHODS We conducted a population-based cohort study using a nationwide database in South Korea. All new diagnoses of endocrinopathy or SCFE between 2002 and 2019 in children born between 2002 and 2005 were identified. The incidence of SCFE was calculated for each type of endocrinopathy. The trend of the incidence of SCFE relative to the number of deficient hormones was analyzed. The male:female ratio was compared between endocrinopathy-associated SCFE and non-endocrinopathy-associated SCFE. For endocrinopathy-associated SCFE, the time between the diagnoses of SCFE and endocrinopathy was evaluated. RESULTS The incidence of SCFE was higher in children with endocrinopathy than in those without endocrinopathy (37.1/100,000 versus 9.0/100,000 children) (relative risk, 4.1 [95% confidence interval, 2.8-6.1]). Among various endocrinopathies, growth hormone deficiency showed the highest incidence of SCFE (583.8/100,000 children). The Cochran-Armitage test showed a linear trend, with an increased number of deficient hormones being associated with a higher incidence of SCFE (p < 0.001). Male sex was dominant in the non-endocrinopathy-associated SCFE group (73%; 117 of 161), whereas female sex was dominant in the endocrinopathy-associated SCFE group (53%; 16 of 30) (p = 0.009). Twenty-two of the 30 cases of endocrinopathy-associated SCFE were diagnosed after the diagnosis of endocrinopathy, with a median time of 3.6 years between the diagnoses. Six (27%) of these 22 children developed SCFE >5 years after the diagnosis of endocrinopathy. CONCLUSIONS The incidence of SCFE was approximately 4 times higher in children with endocrinopathy than in those without endocrinopathy. The risk of SCFE increased with an increased number of deficient hormones. Long-term monitoring of SCFE occurrence in children with endocrinopathies is strongly recommended. LEVEL OF EVIDENCE Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sunghyun Hwang
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Mi Hyun Song
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Ho Choi
- Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Ho Shin
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Tang T, Landis W, Raguin E, Werner P, Bertinetti L, Dean M, Wagermaier W, Fratzl P. A 3D Network of Nanochannels for Possible Ion and Molecule Transit in Mineralizing Bone and Cartilage. ADVANCED NANOBIOMED RESEARCH 2022. [DOI: 10.1002/anbr.202100162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Tengteng Tang
- Department of Biomaterials Max Planck Institute of Colloids and Interfaces Am Mühlenberg 1 14476 Potsdam Germany
| | - William Landis
- Department of Preventive and Restorative Dental Sciences University of California at San Francisco 707 Parnassus Avenue San Francisco CA 94143 USA
| | - Emeline Raguin
- Department of Biomaterials Max Planck Institute of Colloids and Interfaces Am Mühlenberg 1 14476 Potsdam Germany
| | - Peter Werner
- Department of Biomaterials Max Planck Institute of Colloids and Interfaces Am Mühlenberg 1 14476 Potsdam Germany
| | - Luca Bertinetti
- Center for Molecular Bioengineering TU Dresden Tatzberg 41 01307 Dresden Germany
| | - Mason Dean
- Department of Infectious Diseases and Public Health City University of Hong Kong 31 To Yuen Street, Tat Chee Avenue Kowloon Hong Kong
| | - Wolfgang Wagermaier
- Department of Biomaterials Max Planck Institute of Colloids and Interfaces Am Mühlenberg 1 14476 Potsdam Germany
| | - Peter Fratzl
- Department of Biomaterials Max Planck Institute of Colloids and Interfaces Am Mühlenberg 1 14476 Potsdam Germany
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Egiazaryan KA, Grigoriev AV, Ratyev AP. ETIOLOGY, PATHOGENESIS, DIAGNOSIS AND PRINCIPLES OF TREATMENT OF SLIPPED CAPITAL FEMORAL EPIPHYSIS. LITERATURE REVIEW. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-1-38-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim: to describe the epidemiology, possible causes and predisposing factors for the development of slipped capital femoral epiphysis. To follow the evolution of classifications. Analyze indications for surgical treatment, as well as types of surgical treatment. Materials and methods: this review article analyzes the data of Russian and foreign literature on the etiology, pathogenesis, diagnosis and treatment of slipped capital femoral epiphysis. Results: in view of the frequent distribution in the population, high risks of disability in pediatric patients, the issue of treatment of slipped capital femoral epiphysis remains very relevant. Many methods of surgical treatment have been proposed depending on the stage of the disease, however, they have their own advantages and disadvantages. Conclusions: Conservative treatment in the long term did not show good results, generally accepted, according to most sources of literature, surgical treatment is considered. The gold standard in the surgical treatment of the disease does not exist today, and the methods and tactics of treatment are being improved.
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Affiliation(s)
- K. A. Egiazaryan
- Russian National Research Medical University named after N.I. Pirogov
| | - A. V. Grigoriev
- State Budget Health Institution of the Moscow Region «Moscow Regional Clinical Traumatology and Orthopedic Hospital»
| | - A. P. Ratyev
- Russian National Research Medical University named after N.I. Pirogov
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Pflug EM, Herrero C, Zhong JR, Castañeda P. Modified Oxford Bone Scores Are Reduced in Patients With Slipped Capital Femoral Epiphysis Compared With Healthy Controls. J Pediatr Orthop 2021; 41:e624-e627. [PMID: 34091558 DOI: 10.1097/bpo.0000000000001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The etiology and pathogenesis of slipped capital femoral epiphysis (SCFE) are attributable to abnormalities of the proximal femoral epiphysis. This study aimed to examine if there is a difference in the bone age of patients diagnosed with SCFE compared with patients without hip pathology. METHODS We identified a consecutive series of patients treated for SCFE between December 2012 and December 2019 from a departmental database. Retrospective chart review was performed to collect demographic information and patient medical history. We then obtained a control group of statistically similar patients based on age and sex. These patients did not have hip pathology or medical comorbidities that could alter their bone age. The modified Oxford bone score (mOBS) was calculated for both groups by 3 blinded reviewers. We excluded patients with unstable slips, endocrine disorders, and inadequate imaging. RESULTS We identified 60 patients with stable idiopathic SCFE during the study period; 45 met inclusion criteria and were included in the final analysis. There were 27 males and 18 females. The average age of patients with SCFE was higher in males than females (12.6 vs. 11.1, P<0.01). Patients in the comparison cohort did not differ significantly from the SCFE cohort in terms of age (11.6 vs. 12.0, P=0.06) or sex (P=0.52). The comparison group's median mOBS was significantly higher than the SCFE group (22.5 vs. 20.5, P<0.01). The difference in the mOBS between male and female patients in the SCFE group approached significance (20.0 vs. 21.0, P=0.05). The weighted κ coefficient was 0.93. CONCLUSIONS Patients with SCFE have a decreased bone age compared with patients without hip pathology. Male patients with SCFE were more likely to be older compared with female patients. LEVEL OF EVIDENCE Level IV-retrospective study.
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Affiliation(s)
- Emily M Pflug
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
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Abstract
The most common pediatric orthopedic conditions of the hip and pelvis involve abnormal architecture of the joint leading to pain and dysfunction. Developmental dysplasia of the hip and femoroacetabular impingement are 2 common and distinct forms of structural pathology in the pediatric hip. The authors also discuss 2 of the more common, and often questioned, pediatric hip disorders-slipped capital femoral epiphysis and Legg-Calvé-Perthes disease. Future investigations are aimed at identifying risk factors to provide pediatric orthopedists tools to risk stratify their patients and understand when conservative approaches such as close observation versus surgical interventions are more appropriate.
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Affiliation(s)
- Bertrand W Parcells
- Seaview Orthopaedic & Medical Associates, 1200 Eagle Avenue, Ocean, NJ 07712, USA.
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6
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Widmer S, Steiner RP, Morscher MA, Shasti M, Weiner DS, Adamczyk MJ, Childs RD, Landis WJ. An investigation to validate the equivalence of physes obtained from different anatomic regions in a single animal species: Implications for choosing experimental controls in clinical studies. Bone Rep 2019; 10:100209. [PMID: 31194098 PMCID: PMC6551382 DOI: 10.1016/j.bonr.2019.100209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/02/2019] [Indexed: 11/23/2022] Open
Abstract
Control tissue in studies of various orthopedic pathologies is difficult to obtain and presumably equivalent biopsies from other anatomic sites have been utilized in its place. However, for growth plates, different anatomic regions are subject to dissimilar mechanical forces and produce disproportionate longitudinal growth. The purpose of this study was to compare gene expression and structure in normal physes from different anatomic regions within a single animal species to determine whether such physes were equivalent. Thirteen female New Zealand white rabbits (five 15-week-old and eight 19-week-old animals) were euthanized and physes harvested from their proximal and distal femurs and proximal tibiae. Harvested physes were divided into groups for histological, immunohistochemical (IHC), and reverse transcription-quantitative polymerase chain reaction analyses. All physes analyzed demonstrated no apparent differences in morphology or proteoglycan staining intensity on histological examination or in type II collagen presence determined by IHC study. Histomorphometric measures of physeal height as well as gene expression of type II collagen and aggrecan were found to be statistically significantly equivalent (p < 0.05) among the three different bones from the total number of rabbits. Summary data suggest that the structural similarities and statistical equivalence determined among the various physes investigated in the rabbit validate these tissues in this species for use as surrogate controls by which physeal abnormalities may be compared and characterized in the absence of otherwise normal control tissues. Other species may exhibit the same similarities and equivalence among different physes so that such tissues may serve in like manner as controls for assessing a variety of orthopedic conditions, including those occurring in humans.
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Affiliation(s)
- Steven Widmer
- Wooster Orthopaedics and Sports Medicine Center, Wooster, OH, USA
| | | | | | - Mark Shasti
- Norton Leatherman Spine Center, Louisville, KY, USA
| | | | | | - Robin DiFeo Childs
- The University of Akron, Akron, OH, USA
- Akron Children's Hospital, Akron, OH, USA
| | - William J. Landis
- The University of Akron, Akron, OH, USA
- University of California, San Francisco, San Francisco, CA, USA
- Corresponding author at: Department of Preventive and Restorative Dental Sciences, Health Sciences Building, West, Room 812, School of Dentistry, University of California, San Francisco, 707 Parnassus Avenue, San Francisco, CA 94158, USA.
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Chen L, Childs RD, Landis WJ. Correlations between gene expression and mineralization in the avian leg tendon. Bone 2019; 121:42-59. [PMID: 30419319 DOI: 10.1016/j.bone.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
Certain avian tendons have been studied previously as a model system for normal mineralization of vertebrates in general. In this regard, the gastrocnemius tendon in the legs of turkeys mineralizes in a well defined temporal and spatial manner such that changes in the initial and subsequent events of mineral formation can be associated with time and specific locations in the tissue. In the present investigation, these parameters and mineral deposition have been correlated with the expression of several genes and the synthesis and secretion of their related extracellular matrix proteins by the composite tenocytes of the tendon. Quantitative polymerase chain reaction analysis demonstrates that mRNA expression of the non-collagenous genes of bone sialoprotein, osteopontin, and osteocalcin corresponds well with the temporal and spatial onset and progression of mineralization. Immunolocalization separately confirms the synthesis and secretion of these matrix molecules. The expression of other non-collagenous genes such as decorin does not show strong correlation with turkey leg tendon mineralization, and expression of vimentin, a cytoskeletal component which may be regulated by biomechanical factors in the tendon, may lead to inhibition of osteocalcin expression during the development and mineralization of the tissue. The overall results of this work provide insight into direct temporal and spatial relations between the genes and proteins of interest as well as the formation and deposition of mineral in the avian tendon model.
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Affiliation(s)
- Ling Chen
- Department of Polymer Science, University of Akron, Akron, OH, USA
| | | | - William J Landis
- Department of Polymer Science, University of Akron, Akron, OH, USA.
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Brylka LJ, Köppert S, Babler A, Kratz B, Denecke B, Yorgan TA, Etich J, Costa IG, Brachvogel B, Boor P, Schinke T, Jahnen-Dechent W. Post-weaning epiphysiolysis causes distal femur dysplasia and foreshortened hindlimbs in fetuin-A-deficient mice. PLoS One 2017; 12:e0187030. [PMID: 29088242 PMCID: PMC5663435 DOI: 10.1371/journal.pone.0187030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/12/2017] [Indexed: 01/01/2023] Open
Abstract
Fetuin-A / α2-Heremans-Schmid-glycoprotein (gene name Ahsg) is a systemic inhibitor of ectopic calcification. Due to its high affinity for calcium phosphate, fetuin-A is highly abundant in mineralized bone matrix. Foreshortened femora in fetuin-A-deficient Ahsg-/- mice indicated a role for fetuin-A in bone formation. We studied early postnatal bone development in fetuin-A-deficient mice and discovered that femora from Ahsg-/- mice exhibited severely displaced distal epiphyses and deformed growth plates, similar to the human disease slipped capital femoral epiphysis (SCFE). The growth plate slippage occurred in 70% of Ahsg-/- mice of both sexes around three weeks postnatal. At this time point, mice weaned and rapidly gained weight and mobility. Epiphysis slippage never occurred in wildtype and heterozygous Ahsg+/- mice. Homozygous fetuin-A-deficient Ahsg-/- mice and, to a lesser degree, heterozygous Ahsg+/- mice showed lesions separating the proliferative zone from the hypertrophic zone of the growth plate. The hypertrophic growth plate cartilage in long bones from Ahsg-/- mice was significantly elongated and V-shaped until three weeks of age and thus prior to the slippage. Genome-wide transcriptome analysis of laser-dissected distal femoral growth plates from 13-day-old Ahsg-/- mice revealed a JAK-STAT-mediated inflammatory response including a 550-fold induction of the chemokine Cxcl9. At this stage, vascularization of the elongated growth plates was impaired, which was visualized by immunofluorescence staining. Thus, fetuin-A-deficient mice may serve as a rodent model of growth plate pathologies including SCFE and inflammatory cartilage degradation.
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Affiliation(s)
- Laura J. Brylka
- Biointerface Laboratory, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University Hospital, Aachen, Germany
| | - Sina Köppert
- Biointerface Laboratory, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University Hospital, Aachen, Germany
| | - Anne Babler
- Biointerface Laboratory, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University Hospital, Aachen, Germany
| | - Beate Kratz
- IZKF Genomics Facility, Interdisciplinary Center for Clinical Research, RWTH Aachen University Hospital, Aachen, Germany
| | - Bernd Denecke
- IZKF Genomics Facility, Interdisciplinary Center for Clinical Research, RWTH Aachen University Hospital, Aachen, Germany
| | - Timur A. Yorgan
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Etich
- Department of Pediatrics and Adolescent Medicine, Experimental Neonatology, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ivan G. Costa
- IZKF Research Group Computational Biology and Bioinformatics, Interdisciplinary Center for Clinical Research, RWTH Aachen University Hospital, Aachen, Germany
| | - Bent Brachvogel
- Department of Pediatrics and Adolescent Medicine, Experimental Neonatology, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Peter Boor
- Department of Pathology & Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Willi Jahnen-Dechent
- Biointerface Laboratory, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University Hospital, Aachen, Germany
- * E-mail:
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Halverson SJ, Warhoover T, Mencio GA, Lovejoy SA, Martus JE, Schoenecker JG. Leptin Elevation as a Risk Factor for Slipped Capital Femoral Epiphysis Independent of Obesity Status. J Bone Joint Surg Am 2017; 99:865-872. [PMID: 28509827 PMCID: PMC5426400 DOI: 10.2106/jbjs.16.00718] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) is strongly associated with childhood obesity, yet the prevalence of obesity is orders of magnitude greater than the prevalence of SCFE. Therefore, it is hypothesized that obesity is not, by itself, a sufficient condition for SCFE, but rather one component of a multifactorial process requiring preexisting physeal pathology. Leptin elevation is seen to varying degrees in patients with obesity, and as leptin has been shown to cause physeal pathology similar to the changes seen in SCFE, we propose that leptin may be a factor distinguishing between patients with SCFE and equally obese children without hip abnormalities. METHODS Serum leptin levels were obtained from 40 patients with SCFE and 30 control patients with approximate body mass index (BMI) matching. BMI percentiles were calculated according to Centers for Disease Control and Prevention population data by patient age and sex. Patients were compared by demographic characteristics, leptin levels, odds of leptin elevation, and odds of SCFE. RESULTS The odds of developing SCFE was increased by an odds ratio of 4.9 (95% confidence interval [CI], 1.31 to 18.48; p < 0.02) in patients with elevated leptin levels, regardless of obesity status, sex, and race. When grouping patients by their obesity status, non-obese patients with SCFE showed elevated median leptin levels at 5.8 ng/mL compared with non-obese controls at 1.7 ng/mL (p = 0.006). Similarly, obese patients with SCFE showed elevated median leptin levels at 17.9 ng/mL compared with equally obese controls at 10.5 ng/mL (p = 0.039). Serum leptin levels increased in association with obesity (p < 0.001), with an increase in leptin of 0.17 ng/mL (95% CI, 0.07 to 0.27 ng/mL) per BMI percentile point. CONCLUSIONS To our knowledge, this study is the first to clinically demonstrate an association between elevated serum leptin levels and SCFE, regardless of BMI. This adds to existing literature suggesting that SCFE is a multifactorial process and that leptin levels may have profound physiological effects on the development of various disease states. Despite a strong association with adiposity, leptin levels vary between patients of equal BMI and may be a vital resource in prognostication of future obesity-related comorbidities. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Schuyler J. Halverson
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Tracy Warhoover
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Gregory A. Mencio
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Steven A. Lovejoy
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Jeffrey E. Martus
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Jonathan G. Schoenecker
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee,E-mail address for J.G. Schoenecker:
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Tresoldi I, Modesti A, Dragoni M, Potenza V, Ippolito E. Histological, histochemical and ultrastructural study of slipped capital femoral epiphysis. J Child Orthop 2017; 11:87-92. [PMID: 28529654 PMCID: PMC5421349 DOI: 10.1302/1863-2548-11-170023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of our study was to investigate the histological, histochemical and ultrastructural aspects of the proximal femoral growth plate in slipped capital femoral epiphysis (SCFE). METHODS Eight core biopsies of the proximal femoral growth plate were performed during in situ epiphysiodesis in patients with SCFE that was at the pre-slipping stage in two cases and at the mild slipping stage (Southwick angle < 30°) in six cases. After fixation, the specimens were processed for either histological or histochemical or ultrastructural studies. RESULTS The proximal femoral growth plate was thicker than normal in the SCFE cases, and the 3:1 ratio between the thickness of the resting zone and the other zones of the plate was reversed. Chondrocytes of the proliferating, maturation, hypertrophic and degenerating zones were arranged in large clusters rather than in columns, which were separated by loose fibrillary septae that appeared moderately alcian blue positive and metachromatic. The collagen fibrils of the longitudinal septae were uniformly thin, measuring about 200 Å, whereas in the normal plate collagen fibrils were in the range of 300 to 1200 Å in thickness. Chondrocytes were elongated and smaller than normal, with a dark cytoplasm. In the degenerating zone, mineralisation of the longitudinal and transversal septae was scanty and enchondral ossification was impaired, with a few small osteoblasts forming thin bone trabeculae on the cartilage septae of the degenerating zone. CONCLUSION In SCFE, the proximal femoral growth plate undergoes several histological, histochemical and ultrastructural changes that precede slipping of the epiphysis since they are already present at a pre-slipping stage of the disease. The loss of solidity of the extracellular matrix and the disarrangement of the normal architecture of the physis very likely cause the consequent slipping of the proximal femoral epiphysis. SCFE aetiology remains unknown.
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Affiliation(s)
- I. Tresoldi
- Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, Via Montpellier 12, Rome, 00133, Italy
| | - A. Modesti
- Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, Via Montpellier 12, Rome, 00133, Italy
| | - M. Dragoni
- Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, Via Montpellier 12, Rome, 00133, Italy
| | - V. Potenza
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Viale Oxford 81, Rome, 00133, Italy
| | - E. Ippolito
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Viale Oxford 81, Rome, 00133, Italy,Correspondence should be sent to: Dr E. Ippolito, Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Viale Oxford 81, Rome, 00133, Italy. E-mail:
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11
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Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) and tibia vara (Blount disease) are associated with childhood obesity. However, the majority of obese children do not develop SCFE or tibia vara. Therefore, it is hypothesized that other obesity-related biological changes to the physis, in addition to increased biomechanical stress, potentiate the occurrence of SCFE and tibia vara. Considering that hypertension can impose pathologic changes in the physis similar to those observed in these obesity-related diseases we set out to determine the prevalence of hypertension in patients with SCFE and tibia vara. METHODS Blood pressure measurements were obtained in 44 patients with tibia vara and 127 patients with SCFE. Body mass index and blood pressure were adjusted for age, sex, and height percentiles utilizing normative distribution data from the CDC. These cohorts were compared with age-matched and sex-matched cohorts derived from an obesity clinic who did not have either bone disease. A multivariable proportional odds model was used to determine association. RESULTS The prevalence of prehypertension/hypertension was significantly higher in the tibia vara (64%) and SCFE cohort (64%) compared with respective controls (43%). Patients diagnosed with either SCFE or tibia vara had 2.5-fold higher odds of having high blood pressure compared with age-matched and sex-matched obese patients without bone disease. Sex, age, and race did not have a significant effect on a patient's blood pressure. CONCLUSIONS This is the first study to establish that the obesity-related bone diseases, SCFE and tibia vara, are significantly associated with high blood pressure. These data have immediate clinical impact as they demonstrate that children with obesity-related developmental bone disease have increased prevalence of undiagnosed and untreated hypertension. Furthermore, this prevalence study supports the hypothesis that hypertension in conjunction with increased biomechanical forces together potentiate the occurrence of SCFE and tibia vara. If proven true, it is plausible that hypertension may represent a modifiable risk factor for obesity-related bone disease. LEVEL OF EVIDENCE Level III-case-control study.
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Johnson JS, Weiner DS, Jacquet R, Adamczyk MJ, Morscher MA, Landis WJ. Microarray analysis of slipped capital femoral epiphysis growth plates. J Pediatr Endocrinol Metab 2016; 29:971-8. [PMID: 27390878 DOI: 10.1515/jpem-2016-0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/09/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Microarray technology has been used to analyze gene expression in patients with and without slipped capital femoral epiphysis (SCFE). METHODS Proximal femoral physis core biopsies from two patients with SCFE were compared with two control specimens from age-matched patients without SCFE. Extracted RNA from frozen ground samples was subjected to microarray analysis with data tests for statistical significance between SCFE and control tissues. RESULTS Compared to controls, SCFE samples demonstrated significant up-regulation in gene expression pathways involving physiological defense and inflammatory responses and significant down-regulation in the regulation of cellular physiologic processes, cellular metabolic pathways, and skeletal development pathways including expression of aggrecan and type II collagen, genes affecting physeal structure and integrity. CONCLUSIONS Up-regulation of inflammatory and immune response pathways in SCFE compared to controls relates to physeal mechanical displacement in SCFE. Globalized down-regulation of several other pathways suggests growth plate weakening. These novel microarray findings further define SCFE etiology.
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Landis WJ, Chubinskaya S, Tokui T, Wada Y, Isogai N, Jacquet R. Tissue engineering a human phalanx. J Tissue Eng Regen Med 2016; 11:2373-2387. [PMID: 26999523 DOI: 10.1002/term.2137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/11/2015] [Accepted: 12/10/2015] [Indexed: 12/31/2022]
Abstract
A principal purpose of tissue engineering is the augmentation, repair or replacement of diseased or injured human tissue. This study was undertaken to determine whether human biopsies as a cell source could be utilized for successful engineering of human phalanges consisting of both bone and cartilage. This paper reports the use of cadaveric human chondrocytes and periosteum as a model for the development of phalanx constructs. Two factors, osteogenic protein-1 [OP-1/bone morphogenetic protein-7 (BMP7)], alone or combined with insulin-like growth factor (IGF-1), were examined for their potential enhancement of chondrocytes and their secreted extracellular matrices. Design of the study included culture of chondrocytes and periosteum on biodegradable polyglycolic acid (PGA) and poly-l-lactic acid (PLLA)-poly-ε-caprolactone (PCL) scaffolds and subsequent implantation in athymic nu/nu (nude) mice for 5, 20, 40 and 60 weeks. Engineered constructs retrieved from mice were characterized with regard to genotype and phenotype as a function of developmental (implantation) time. Assessments included gross observation, X-ray radiography or microcomputed tomography, histology and gene expression. The resulting data showed that human cell-scaffold constructs could be successfully developed over 60 weeks, despite variability in donor age. Cartilage formation of the distal phalanx models enhanced with both OP-1 and IGF-1 yielded more cells and extracellular matrix (collagen and proteoglycans) than control chondrocytes without added factors. Summary data demonstrated that human distal phalanx models utilizing cadaveric chondrocytes and periosteum were successfully fabricated and OP-1 and OP-1/IGF-1 accelerated construct development and mineralization. The results suggest that similar engineering and transplantation of human autologous tissues in patients are clinically feasible. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- W J Landis
- Goodyear Polymer Center, Department of Polymer Science, University of Akron, Akron, OH, USA
| | - S Chubinskaya
- Departments of Biochemistry, Orthopaedic Surgery and Medicine, Rush University Medical Center, Chicago, IL, USA
| | - T Tokui
- Department of Plastic and Reconstructive Surgery, Kinki University Medical School, Osaka-Sayama, Japan
| | - Y Wada
- Department of Plastic and Reconstructive Surgery, Kinki University Medical School, Osaka-Sayama, Japan
| | - N Isogai
- Department of Plastic and Reconstructive Surgery, Kinki University Medical School, Osaka-Sayama, Japan
| | - R Jacquet
- Goodyear Polymer Center, Department of Polymer Science, University of Akron, Akron, OH, USA
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Johnson JS, Morscher MA, Jones KC, Moen SM, Klonk CJ, Jacquet R, Landis WJ. Gene expression differences between ruptured anterior cruciate ligaments in young male and female subjects. J Bone Joint Surg Am 2015; 97:71-9. [PMID: 25568397 DOI: 10.2106/jbjs.n.00246] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries is two to eightfold greater in female compared with male athletes. Anatomic, hormonal, and neuromuscular factors have been associated with this disparity. This study compared gene expression and structural features in ruptured but otherwise normal ACL tissue from young female and male athletes. METHODS A biopsy sample of ruptured ACL tissue (which would normally have been discarded) was obtained intraoperatively from seven female and seven male athletes (12.7 to 22.6 years old). Each sample was divided into portions for histological and gene expression analyses. Specimens for gene analysis were frozen and ground, and RNA was extracted and purified. Microarray analysis was performed on RNA isolated from four female and three male study participants (13.9 to 18.5 years old) who had a noncontact injury. Genes with an expression level that differed significantly between these female and male athletes were grouped into functionally associated networks with use of IPA software (Qiagen). Three genes of interest were chosen for further validation by RT-qPCR (reverse transcription-quantitative polymerase chain reaction) analysis of the samples from all fourteen patients. Several statistical methods were used to examine sex-related differences. RESULTS Microarray analysis of the RNA isolated from the ruptured ACL tissue from the female and male athletes identified thirty-two genes with significant differential expression. Fourteen of these genes were not linked to the X or Y chromosome. IPA analysis grouped these genes into pathways involving development and function of skeletal muscle and growth, maintenance, and proliferation of cells. RT-qPCR confirmed significant differences in expression of three selected genes: ACAN (aggrecan) and FMOD (fibromodulin) were upregulated in female compared with male study participants, and WISP2 (WNT1 inducible signaling pathway protein 2) was downregulated. No morphological differences among the ruptured tissue from the various participants were apparent on histological examination. CONCLUSIONS The genes identified in this study as differing distinctly according to sex produce major molecules in the ACL extracellular matrix. Significant upregulation of ACAN and FMOD (which regulate the matrix) and downregulation of WISP2 (which is involved in collagen turnover and production) may account for the weaker ACLs in female compared with male individuals.
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Affiliation(s)
- Jeffrey S Johnson
- Department of Orthopaedic Surgery, Summa Health System, 444 North Main Street, Akron, OH 44310
| | - Melanie A Morscher
- Departments of Pediatric Orthopaedic Surgery (M.A.M. and K.C.J.) and Pathology (C.J.K.), Akron Children's Hospital, One Perkins Square, Akron, OH 44308
| | - Kerwyn C Jones
- Departments of Pediatric Orthopaedic Surgery (M.A.M. and K.C.J.) and Pathology (C.J.K.), Akron Children's Hospital, One Perkins Square, Akron, OH 44308
| | - Susan M Moen
- Department of Orthopaedic Surgery, Summa Health System, 444 North Main Street, Akron, OH 44310
| | - Christopher J Klonk
- Departments of Pediatric Orthopaedic Surgery (M.A.M. and K.C.J.) and Pathology (C.J.K.), Akron Children's Hospital, One Perkins Square, Akron, OH 44308
| | - Robin Jacquet
- Department of Polymer Science, The University of Akron, Goodyear Polymer Center, 170 University Avenue, Akron, OH 44325. E-mail address for W.J. Landis:
| | - William J Landis
- Department of Polymer Science, The University of Akron, Goodyear Polymer Center, 170 University Avenue, Akron, OH 44325. E-mail address for W.J. Landis:
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Shasti M, Jacquet R, McClellan P, Yang J, Matsushima S, Isogai N, Murthy A, Landis WJ. Effects of FGF-2 and OP-1 in vitro on donor source cartilage for auricular reconstruction tissue engineering. Int J Pediatr Otorhinolaryngol 2014; 78:416-22. [PMID: 24439635 DOI: 10.1016/j.ijporl.2013.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/20/2013] [Accepted: 11/21/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Microtia is a congenital partial or total loss of the external ear with current treatment approaches involving autologous construction from costal cartilage. Alternatively, tissue engineering provides possible use of normal or microtia auricular chondrocytes harvested from patients. This study investigated effects in vitro of basic fibroblast growth factor (FGF-2) and osteogenic protein 1 (OP-1) on human pediatric normal and microtia auricular chondrocytes and their potential proliferation and differentiation for cellular expansion. A working hypothesis was that FGF-2 promotes proliferation and OP-1 maintains an auricular phenotype of these cells. METHODS Two patients, one undergoing otoplasty and one an ear construction, yielded normal and microtia auricular chondrocytes, respectively. The two donor sets of isolated chondrocytes were equally divided into four experimental cell groups. These were controls without added growth factors and cells supplemented with FGF-2, OP-1 or FGF-2/OP-1 combined. Cells were cultured 3, 5, 7, and 10 days (3 replicates/time point), counted and assayed by RT-qPCR to determine elastin and types II and III collagen gene expression. RESULTS Compared to control counterparts, normal and microtia chondrocytes with OP-1 alone were similar in numbers and varied in elastin and types II and III collagen expression over all culture times. Compared to respective controls and chondrocyte groups with OP-1 alone, normal and microtia cell groups with FGF-2 had statistically significant (p<0.05) enhanced proliferation and statistically significant (p<0.05) decreased elastin and types II and III collagen expression over 10 days of culture. CONCLUSIONS FGF-2 effects on normal and microtia chondrocytes support its use for increasing cell numbers while OP-1 maintains a chondrocyte phenotype, otherwise marked by increasing type III collagen expression and cellular dedifferentiation to fibroblasts in culture.
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Affiliation(s)
- Mark Shasti
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Robin Jacquet
- Department of Polymer Science, University of Akron, Akron, OH, United States
| | - Phillip McClellan
- Department of Polymer Science, University of Akron, Akron, OH, United States
| | - Julianne Yang
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Seika Matsushima
- Department of Plastic and Reconstructive Surgery, Kinki University Medical School, Osaka-sayama, Osaka, Japan
| | - Noritaka Isogai
- Department of Plastic and Reconstructive Surgery, Kinki University Medical School, Osaka-sayama, Osaka, Japan
| | - Ananth Murthy
- Division of Plastic and Reconstructive Surgery, Children's Hospital Medical Center, Akron, OH, United States
| | - William J Landis
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, United States; Department of Polymer Science, University of Akron, Akron, OH, United States.
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Tank JC, Weiner DS, Jacquet R, Childs D, Ritzman TF, Horne WI, Steiner R, Morscher MA, Landis WJ. The effects of hypothyroidism on the proximal femoral physis in miniature swine. J Orthop Res 2013; 31:1986-91. [PMID: 24038610 DOI: 10.1002/jor.22467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 07/19/2013] [Indexed: 02/04/2023]
Abstract
As a potential means of comparing hypothyroidism in humans, this work intended to establish a defined hypothyroid state in immature miniature swine and evaluate specific molecular, cellular, and extracellular responses of their growth plates. Two male, 11-week-old Sinclair miniature swine were given 6-propyl-2-thiouracil (PTU) in their water and two other like animals (controls) were provided water without PTU. Blood levels of thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxin (T4) were monitored weekly. At 25 weeks of age, the hind limb proximal femoral physes were harvested and divided into portions for histology and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis. Compared to controls, swine administered PTU exhibited increased TSH and decreased T3 and T4 serum levels during the study period, features consistent with a hypothyroid state. Compared to controls, hypothyroid swine exhibited structurally altered physes and demonstrated significantly decreased gene expression of aggrecan (p < 0.05) and type X collagen (p ≤ 0.1). This is the first hypothyroid model established in miniature swine and represents a potentially important advance for understanding the condition in humans, in which, like this swine model, there are changes critical to growth plate molecular biology, biochemistry and structure.
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Witbreuk M, van Kemenade FJ, van der Sluijs JA, Jansma EP, Rotteveel J, van Royen BJ. Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: a systematic review of the literature. J Child Orthop 2013; 7:213-23. [PMID: 24432080 PMCID: PMC3672463 DOI: 10.1007/s11832-013-0493-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/25/2013] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Puberty, obesity, endocrine and chronic systemic diseases are known to be associated with slipped capital femoral epiphysis (SCFE). The mechanical insufficiency of the physis in SCFE is thought to be the result of an abnormal weakening of the physis. However, the mechanism at the cellular level has not been unravelled up to now. METHODS To understand the pathophysiology of endocrine and metabolic factors acting on the physis, we performed a systematic review focussing on published studies reporting on hormonal, morphological and cellular abnormalities of the physis in children with SCFE. In addition, we looked for studies of the effects of endocrinopathies on the human physis which can lead to cause SCFE and focussed in detail on hormonal signalling, hormone receptor expression and extracellular matrix (ECM) composition of the physis. We searched in the PubMed, EMBASE.com and The Cochrane Library (via Wiley) databases from inception to 11th September 2012. The search generated a total of 689 references: 382 in PubMed, 232 in EMBASE.com and 75 in The Cochrane Library. After removing duplicate papers, 525 papers remained. Of these, 119 were selected based on titles and abstracts. After excluding 63 papers not related to the human physis, 56 papers were included in this review. RESULTS Activation of the gonadal axis and the subsequent augmentation of the activity of the growth hormone-insulin-like growth factor 1 (GH-IGF-1) axis are important for the pubertal growth spurt, as well as for cessation of the physis at the end of puberty. The effects of leptin, thyroid hormone and corticosteroids on linear growth and on the physis are also discussed. Children with chronic diseases suffer from inflammation, acidosis and malnutrition. These consequences of chronic diseases affect the GH-IGF-1 axis, thereby, increasing the risk of the development of SCFE. The risk of SCFE and avascular necrosis in children with chronic renal insufficiency, growth hormone treatment and renal osteodystrophy remains equivocal. CONCLUSIONS SCFE is most likely the result of a multi-factorial event during adolescence when height and weight increase dramatically and the delicate balance between the various hormonal equilibria can be disturbed. Up to now, there are no screening or diagnostic tests available to predict patients at risk.
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Affiliation(s)
- M. Witbreuk
- />Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
| | - F. J. van Kemenade
- />Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - J. A. van der Sluijs
- />Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
| | - E. P. Jansma
- />Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - J. Rotteveel
- />Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
| | - B. J. van Royen
- />Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
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[Slipped capital femoral epiphysis]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 56:506-14. [PMID: 23594949 DOI: 10.1016/j.recot.2012.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 06/26/2012] [Accepted: 07/19/2012] [Indexed: 12/15/2022] Open
Abstract
Slipped capital femoral epiphysis (SCFE) is characterized by displacement of the capital femoral epiphysis from the metaphysis through the physis. The term is confusing, because the metaphysis moves upward and outward while the epiphysis remains in the acetabulum. The SCFE is considered stable when the child is able to walk with or without crutches, and it is considered unstable when the child cannot walk with or without crutches. Patients with SCFE present with pain in the groin, knee and limp. The current treatment of stable SCFE is in situ stabilization with a single screw.
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Slipped capital femoral epiphysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bries AD, Weiner DS, Jacquet R, Adamczyk MJ, Morscher MA, Lowder E, Askew MJ, Steiner RP, Horne WI, Landis WJ. A study in vivo of the effects of a static compressive load on the proximal tibial physis in rabbits. J Bone Joint Surg Am 2012; 94:e1111-10. [PMID: 22855000 DOI: 10.2106/jbjs.k.00340] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effect of compression on the physis is generally defined by the Hueter-Volkmann principle, in which decreased linear growth of the physis results from increased compression. This investigation examined whether mechanically induced compression of rabbit physes causes changes in gene expression, cells, and extracellular components that promote physeal resilience and strength (type-II collagen and aggrecan) and cartilage hypertrophy (type-X collagen and matrix metalloprotease-13). METHODS Static compressive loads (10 N or 30 N) were applied for two or six weeks across one hind limb proximal tibial physis of thirteen-week-old female New Zealand White rabbits (n = 18). The contralateral hind limb in all rabbits underwent sham surgery with no load to serve as an internal control. Harvested physes were divided into portions for histological, immunohistochemical, and quantitative reverse transcription-polymerase chain reaction analysis. Gene expression was statistically analyzed by means of comparisons between loaded samples and unloaded shams with use of analysis of variance and a Tukey post hoc test. RESULTS Compared with unloaded shams, physes loaded at 10 N or 30 N for two weeks and at 10 N for six weeks showed histological changes in cells and matrices. Physes loaded at 30 N for six weeks were decreased in thickness and had structurally disorganized chondrocyte columns, a decreased extracellular matrix, and less intense type-II and X collagen immunohistochemical staining. Quantitative reverse transcription-polymerase chain reaction analysis of loaded samples compared with unloaded shams yielded a significantly (p ≤ 0.05) decreased gene expression of aggrecan and type-II and X collagen and no significant (p > 0.05) changes in the matrix metalloprotease-13 gene expression with increasing load. CONCLUSIONS Compressed rabbit physes generate biochemical changes in collagens, proteoglycan, and cellular and tissue matrix architecture. Changes potentially weaken overall physeal strength, consistent with the Hueter-Volkmann principle, and lend understanding of the causes of pathological conditions of the physis.
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Affiliation(s)
- Andrew D Bries
- Department of Orthopaedic Surgery, Summa Health System, Akron, OH 44310, USA
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:470-80. [PMID: 19858911 DOI: 10.1097/med.0b013e3283339a46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wada Y, Enjo M, Isogai N, Jacquet R, Lowder E, Landis WJ. Development of bone and cartilage in tissue-engineered human middle phalanx models. Tissue Eng Part A 2009; 15:3765-78. [PMID: 19527181 PMCID: PMC2792075 DOI: 10.1089/ten.tea.2009.0078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 06/15/2009] [Indexed: 11/13/2022] Open
Abstract
Human middle phalanges were tissue-engineered with midshaft scaffolds of poly(L-lactide-epsilon-caprolactone) [P(LA-CL)], hydroxyapatite-P(LA-CL), or beta-tricalcium phosphate-P(LA-CL) and end plate scaffolds of bovine chondrocyte-seeded polyglycolic acid. Midshafts were either wrapped with bovine periosteum or left uncovered. Constructs implanted in nude mice for up to 20 weeks were examined for cartilage and bone development as well as gene expression and protein secretion, which are important in extracellular matrix (ECM) formation and mineralization. Harvested 10- and 20-week constructs without periosteum maintained end plate cartilage but no growth plate formation. They also consisted of chondrocytes secreting type II collagen and proteoglycan, and they were composed of midshaft regions devoid of bone. In all periosteum-wrapped constructs at like times, end plate scaffolds held chondrocytes elaborating type II collagen and proteoglycan and cartilage growth plates resembling normal tissue. Chondrocyte gene expression of type II collagen, aggrecan, and bone sialoprotein varied depending on midshaft composition, presence of periosteum, and length of implantation time. Periosteum produced additional cells, ECM, and mineral formation within the different midshaft scaffolds. Periosteum thus induces midshaft development and mediates chondrocyte gene expression and growth plate formation in cartilage regions of phalanges. This work is important for understanding developmental principles of tissue-engineered phalanges and by extension those of normal growth plate cartilage and bone.
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Affiliation(s)
- Yoshitaka Wada
- Department of Integrative Medical Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio
- Department of Plastic and Reconstructive Surgery, Kinki University Medical School, Osaka, Japan
| | - Mitsuhiro Enjo
- Department of Integrative Medical Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio
- Department of Plastic and Reconstructive Surgery, Kinki University Medical School, Osaka, Japan
| | - Noritaka Isogai
- Department of Integrative Medical Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio
- Department of Plastic and Reconstructive Surgery, Kinki University Medical School, Osaka, Japan
| | - Robin Jacquet
- Department of Integrative Medical Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio
| | - Elizabeth Lowder
- Department of Integrative Medical Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio
| | - William J. Landis
- Department of Integrative Medical Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio
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