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Chou LS, Zhang J, Jildeh TR. Metabolic Functions of the Infrapatellar Fat Pad: Implications for Knee Health and Pathology. JBJS Rev 2024; 12:01874474-202410000-00001. [PMID: 39361777 DOI: 10.2106/jbjs.rvw.24.00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
» Despite being historically viewed as a vestigial structure, the infrapatellar fat pad (IPFP) is now recognized as a metabolically active structure, influencing knee health through cytokine production and metabolic pathways.» With distinct anatomical regions, the IPFP contains diverse cell types including adipocytes, fibroblasts, and immune cells, influencing its functional roles, pathology, and contributions to knee disorders.» The IPFP acts as an endocrine organ by releasing adipokines such as adiponectin, leptin, and tumor necrosis factor α, regulating energy balance, immune responses, and tissue remodelling, with implications for knee joint health.» The IPFP's metabolic interactions with neighboring tissues influence joint health, clinical conditions such as knee pain, osteoarthritis, postoperative complications, and ganglion cysts, highlighting its therapeutic potential and clinical relevance.» Understanding the multifaceted metabolic role of the IPFP opens avenues for collaborative approaches that integrate orthopaedics, endocrinology, and immunology to develop innovative therapeutic strategies targeting the intricate connections between adipokines, joint health, and immune responses.
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Affiliation(s)
- Lee S Chou
- Department of Orthopaedic Surgery, Michigan State University, East Lansing, Michigan
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Wang Z, Lu J, Li Z, Wang Y, Ge H, Zhang M, Wang R, Gu Y, Ding L, Ren W, Shen Z, Du G, Wu Y, Zhan H. Qualitative and Quantitative Measures in the Infrapatellar Fat Pad in Older Adults: Associations with Knee Pain, Radiographic Osteoarthritis, Kinematics, and Kinetics of the Knee. Acad Radiol 2024; 31:3315-3326. [PMID: 38413312 DOI: 10.1016/j.acra.2024.02.013] [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: 12/30/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to delineate cross-sectional associations between qualitative and quantitative measures of the infrapatellar fat pad (IPFP) and knee symptoms, structure, kinematics, and kinetics in older adults. METHODS Ninety eligible subjects (90 knees, mean age 54.0 years, 68.9% female) were examined at our center. We used T2-weighted fat-suppressed magnetic resonance imaging (MRI) to evaluate signal intensity alteration, maximum sagittal area, and depth of the IPFP. Symptomatic osteoarthritis (SOA) was a pain subscale score greater than 0 on the Western Ontario McMaster Osteoarthritis Index. A Kellgren-Lawrence grade ≥ 2 identified incident radiographic osteoarthritis (iROA). Three-dimensional gait data were employed to analyze knee joint kinematics and kinetics. Correlation and regression analyzes assessed associations between IPFP measurements and SOA, iROA, kinematics, and kinetics. RESULTS There were strong and positive associations between IPFP signal intensity alteration and both SOA and iROA in multivariable regression analyzes [OR (95% CI): 2.849 (1.440 to 5.636), 2.356 (1.236 to 4.492), respectively]. Conversely, a significant negative correlation was observed between IPFP maximum area and flexion angle [B (95%CI): - 1.557 (-2.549 to -0.564)]. Moreover, adjusting for covariates did not reveal any significant correlation between IPFP parameters and other indicators (P > 0.05, respectively). CONCLUSION IPFP signal intensity alteration and area were associated with knee clinical symptoms, structural abnormalities, and flexion angle in adults over 40, respectively. These findings suggest that IPFP may be a crucial imaging biomarker in early and middle knee osteoarthritis.
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Affiliation(s)
- Zhengming Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jiehang Lu
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Zhengyan Li
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yuanyuan Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haiya Ge
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Min Zhang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Rui Wang
- Guanghua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Yong Gu
- Translational Medical Innovation Center, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Lipeng Ding
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Woxing Ren
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Zhibi Shen
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Guoqing Du
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yufeng Wu
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Hongsheng Zhan
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.
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Okinaka R, Ishii Y, Nakashima Y, Okamoto S, Hashizume T, Zhu K, Xu C, Iwamoto Y, Adachi N, Takahashi M. Morphological Changes in the Infrapatellar Fat Pad During Walking Detected by Dynamic Ultrasound in Healthy Volunteers. Cureus 2024; 16:e66738. [PMID: 39268287 PMCID: PMC11392513 DOI: 10.7759/cureus.66738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2024] [Indexed: 09/15/2024] Open
Abstract
Aim This study aimed to verify specific morphological changes in the infrapatellar fat pad (IFP) during walking in healthy young participants. Methods A total of 17 healthy young participants (mean age, 22.8 ± 0.9 years) were recruited in this cross-sectional study. The IFP was evaluated using ultrasonography in three conditions: supine, standing, and walking. The IFP value was described as the thickness of the distal section of the IFP. Additionally, in the walking condition, the IFP was captured in video mode on ultrasonography, and its dynamics were recorded. The waveform of the IFP was produced using the sequence of the IFP thickness on each image. The morphological change of IFP (ΔIFP) was calculated in the IFP waveform and was shown as the difference in IFP thickness between the maximum and minimum at the beginning of the early stance phase. Moreover, kinematics and kinetic data were evaluated using a three-dimensional motion system, and the knee flexion angle (KFA) and knee flexion moment (KFM) were obtained. Results The thickness of the IFP during walking was significantly greater than that during the supine and standing conditions (p < 0.001 for both). The IFP waveform during walking showed a gradual increase during the stance phase and a decrease during the swing phase of the gait cycle. ΔIFP was 1.35 ± 0.42 mm and significantly correlated with the KFM (r = 0.59, p = 0.007). Conclusions Dynamic ultrasonography revealed a specific morphological change in the IFP during walking, which correlated with the KFM.
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Affiliation(s)
- Riko Okinaka
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Yosuke Ishii
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Yuko Nakashima
- Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, JPN
| | - Saeko Okamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Takato Hashizume
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Kexin Zhu
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Chen Xu
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Yoshitaka Iwamoto
- Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, JPN
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Makoto Takahashi
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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Huo Z, Xu C, Li S, Niu Y, Wang F. The thickness change ratio and preservation ratio of the infrapatellar fat pad are related to anterior knee pain in patients following medial patellofemoral ligament reconstruction. J Orthop Surg Res 2024; 19:375. [PMID: 38918867 PMCID: PMC11197376 DOI: 10.1186/s13018-024-04853-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The infrapatellar fat pad (IPFP) lies extrasynovial and intracapsular, preserving the joint cavity and serving as a biochemical regulator of inflammatory reactions. However, there is a lack of research on the relationship between anterior knee pain (AKP) and the IPFP after medial patellofemoral ligament reconstruction (MPFLR). Pinpointing the source of pain enables clinicians to promptly manage and intervene, facilitating personalized rehabilitation and improving patient prognosis. METHODS A total of 181 patients were included in the study. These patients were divided into the AKP group (n = 37) and the control group (n = 144). Clinical outcomes included three pain-related scores, Tegner activity score, patient satisfaction, etc. Imaging outcomes included the IPFP thickness, IPFP fibrosis, and the IPFP thickness change and preservation ratio. Multivariate analysis was used to determine the independent factors associated with AKP. Finally, the correlation between independent factors and three pain-related scores was analyzed to verify the results. RESULTS The control group had better postoperative pain-related scores and Tegner activity score than the AKP group (P < 0.01). The AKP group had lower IPFP thickness change ratio and preservation ratio (P < 0.001), and smaller IPFP thickness (P < 0.05). The multivariate analysis revealed that the IPFP thickness change ratio [OR = 0.895, P < 0.001] and the IPFP preservation ratio [OR = 0.389, P < 0.001] were independent factors related to AKP, with a significant correlation between these factors and pain-related scores [|r| > 0.50, P < 0.01]. CONCLUSIONS This study showed the lower IPFP change ratio and preservation ratio may be independent factors associated with AKP after MPFLR. Early detection and targeted intervention of the underlying pain sources can pave the way for tailored rehabilitation programs and improved surgical outcomes. LEVEL OF EVIDENCE LEVEL III.
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Affiliation(s)
- Zhenhui Huo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chenyue Xu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Sibo Li
- School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, 050200, Hebei, China
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Zhou Z, Liu J, Xiong T, Liu Y, Tuan RS, Li ZA. Engineering Innervated Musculoskeletal Tissues for Regenerative Orthopedics and Disease Modeling. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2310614. [PMID: 38200684 DOI: 10.1002/smll.202310614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/28/2023] [Indexed: 01/12/2024]
Abstract
Musculoskeletal (MSK) disorders significantly burden patients and society, resulting in high healthcare costs and productivity loss. These disorders are the leading cause of physical disability, and their prevalence is expected to increase as sedentary lifestyles become common and the global population of the elderly increases. Proper innervation is critical to maintaining MSK function, and nerve damage or dysfunction underlies various MSK disorders, underscoring the potential of restoring nerve function in MSK disorder treatment. However, most MSK tissue engineering strategies have overlooked the significance of innervation. This review first expounds upon innervation in the MSK system and its importance in maintaining MSK homeostasis and functions. This will be followed by strategies for engineering MSK tissues that induce post-implantation in situ innervation or are pre-innervated. Subsequently, research progress in modeling MSK disorders using innervated MSK organoids and organs-on-chips (OoCs) is analyzed. Finally, the future development of engineering innervated MSK tissues to treat MSK disorders and recapitulate disease mechanisms is discussed. This review provides valuable insights into the underlying principles, engineering methods, and applications of innervated MSK tissues, paving the way for the development of targeted, efficacious therapies for various MSK conditions.
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Affiliation(s)
- Zhilong Zhou
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
| | - Jun Liu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Shatin, NT, Hong Kong SAR, P. R. China
| | - Tiandi Xiong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Shatin, NT, Hong Kong SAR, P. R. China
| | - Yuwei Liu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, 518000, P. R. China
| | - Rocky S Tuan
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Shatin, NT, Hong Kong SAR, P. R. China
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
| | - Zhong Alan Li
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Shatin, NT, Hong Kong SAR, P. R. China
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
- Key Laboratory of Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518057, P. R. China
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Du X, Fan R, Kong J. What improvements do general exercise training and traditional Chinese exercises have on knee osteoarthritis? A narrative review based on biological mechanisms and clinical efficacy. Front Med (Lausanne) 2024; 11:1395375. [PMID: 38841568 PMCID: PMC11150680 DOI: 10.3389/fmed.2024.1395375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Background Knee osteoarthritis (KOA) is a disease that significantly affects the quality of life of patients, with a complex pathophysiology that includes degeneration of cartilage and subchondral bone, synovitis, and associations with mechanical load, inflammation, metabolic factors, hormonal changes, and aging. Objective This article aims to comprehensively review the biological mechanisms and clinical effects of general exercise training and traditional Chinese exercises (such as Tai Chi and Qigong) on the treatment of KOA, providing references for the development of clinical exercise prescriptions. Methods A systematic search of databases including PubMed, Web of Science, Google Scholar, and China National Knowledge Infrastructure (CNKI) was conducted, reviewing studies including randomized controlled trials (RCTs), observational studies, systematic reviews, and meta-analyses. Keywords included "knee osteoarthritis," "exercise therapy," "physical activity," and "traditional Chinese exercise." Results and conclusion General exercise training positively affects KOA by mechanisms such as promoting blood circulation, improving the metabolism of inflammatory factors, enhancing the expression of anti-inflammatory cytokines, and reducing cartilage cell aging. Traditional Chinese exercises, like Tai Chi and Qigong, benefit the improvement of KOA symptoms and tissue repair by regulating immune function and alleviating joint inflammation. Clinical studies have shown that both types of exercise can improve physical function, quality of life, and pain relief in patients with KOA. Both general exercise training and traditional Chinese exercises are non-pharmacological treatment options for KOA that can effectively improve patients' physiological function and quality of life. Future research should further explore the long-term effects and biological mechanisms of these exercise interventions and develop personalized exercise programs based on the specific needs of patients.
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Affiliation(s)
- Xingbin Du
- Shandong Huayu University of Technology, Dezhou, China
- Faculty of Education, Qufu Normal University, Qufu, China
| | - Rao Fan
- College of Sports Science, Qufu Normal University, Qufu, China
| | - Jianda Kong
- College of Sports Science, Qufu Normal University, Qufu, China
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Kanak M, Pawłuś N, Mostowy M, Piwnik M, Domżalski M, Lesman J. Sonographic Characterization of the Pericruciate Fat Pad with the Use of Compression Elastography-A Cross-Sectional Study among Healthy and Post-Injured Patients. J Clin Med 2024; 13:2578. [PMID: 38731107 PMCID: PMC11084231 DOI: 10.3390/jcm13092578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/03/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The pericruciate fat pad (PCFP) in the knee joint is still insufficiently studied despite its potential role in knee pathologies. This is the first reported study which aimed to clarify the characteristics of the PCFP in healthy individuals and contrast them with cases of post-traumatic injuries. Methods: Conducted as a retrospective cross-sectional study (n = 110 knees each) following STROBE guidelines, it employed grayscale ultrasound with echogenicity measurement, compression elastography with elasticity measurement, and Color Doppler for blood flow assessment. Results: PCFP showed a homogenic and hyperechoic echostructure. The echogenicity of the PCFP was higher than that of the posterior cruciate ligament (PCL) (p < 0.001, z-score = 8.97) and of the medial head of gastrocnemius (MHG) (p = 0.007, z-score = 2.72) in healthy knees, but lower than subcutaneous fat (SCF) (p < 0.001, z-score = -6.52). Post-injury/surgery, PCFP echogenicity surpassed other structures (p < 0.001; z-score for PCL 12.2; for MHG 11.65 and for SCF 12.36) and notably exceeded the control group (p < 0.001, z-score = 8.78). PCFP elasticity was lower than MHG and SCF in both groups, with significantly reduced elasticity in post-traumatic knees (ratio SCF/PCFP 15.52 ± 17.87 in case group vs. 2.26 ± 2.4 in control group; p < 0.001; z-score = 9.65). Blood flow was detected in 71% of healthy PCFPs with three main patterns. Conclusions: The main findings, indicating increased echogenicity and reduced elasticity of PCFP post-trauma, potentially related to fat pad fibrosis, suggest potential applications of echogenicity and elasticity measurements in detecting and monitoring diverse knee pathologies. The description of vascularity variations supplying the PCFP adds additional value to the study by emphasizing the clinically important role of PCFP as a bridge for the middle genicular artery on its way to the inside of the knee joint.
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Affiliation(s)
- Michał Kanak
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
| | - Natalia Pawłuś
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
| | - Marcin Mostowy
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
| | | | - Marcin Domżalski
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
| | - Jędrzej Lesman
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
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Feuerriegel GC, Marth AA, Fröhlich S, Scherr J, Spörri J, Sutter R. Superolateral Hoffa fat pad edema in adolescent competitive alpine skiers: temporal evolution over 4 years and risk factors. Insights Imaging 2024; 15:52. [PMID: 38365902 PMCID: PMC10873258 DOI: 10.1186/s13244-024-01633-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES To longitudinally assess and correlate the prevalence of superolateral Hoffa fat pad (SHFP) edema with changes in features of the knee extensor mechanism in adolescent competitive alpine skiers over 48 months. METHODS Competitive alpine skiers were prospectively enrolled in 2018 and underwent bilateral knee MRI at baseline and after 48 months. MRI was assessed for the prevalence of SHFP edema. Features of the knee extensor mechanism were assessed by measuring the trochlear sulcus angle and depth, lateral and medial trochlear inclination, trochlear angle, patella tilt, Insall‒Salvati ratio (ISR), and patellar ligament to lateral trochlear facet (PL-T) distance. Separate logistic regression models were used to calculate the odds ratios between each measurement and the presence of SHFP edema at both time points. RESULTS Sixty-three athletes were included in the study (mean age 15.3 ± 1.3 years, 25 women). At baseline, 23 knees had SHFP edema, increasing to 34 knees at the 48-month follow-up. At baseline, knees with measurements in the highest quartile for ISR and lowest quartile for trochlear depth and PL-T were 9.3, 5.1, and 7.7 times more likely to show SHFP edema, respectively. At follow-up, these correlations were confirmed and additionally, knees with measurements in the highest quartile for trochlear sulcus angle and the lowest quartile for lateral trochlear inclination were 4.1 and 3.4 times more likely to show SHFP edema. CONCLUSION An increased prevalence of SHFP edema in competitive alpine skiers during adolescence was associated with persistent high-riding patella, reduced patellar ligament to trochlear distance, and flattened lateral trochlear facet. CRITICAL RELEVANCE STATEMENT In clinical routine, assessment of the mechanical properties of the knee extensor mechanism, together with anatomical developments during adolescence, may improve the understanding and management of patellofemoral instability. KEY POINTS • Superolateral Hoffa fat pad (SHFP) edema is a frequent cause of anterolateral knee pain but the role of predisposing factors is still debated. • A higher prevalence of SHFP edema was associated with high-riding patella, reduced patellar ligament to trochlear distance, and flattened lateral trochlear facet. • Understanding of the mechanical interaction and the anatomical development of the knee during adolescence provides further insight into the development of SHFP edema.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Faculty of Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Adrian A Marth
- Department of Radiology, Faculty of Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland
| | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Johannes Scherr
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Faculty of Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Yang J, Wang X, Zeng X, Wang R, Ma Y, Fu Z, Wan Z, Wang Z, Yang L, Chen G, Gong X. One-step stromal vascular fraction therapy in osteoarthritis with tropoelastin-enhanced autologous stromal vascular fraction gel. Front Bioeng Biotechnol 2024; 12:1359212. [PMID: 38410163 PMCID: PMC10895027 DOI: 10.3389/fbioe.2024.1359212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
Background: Osteoarthritis (OA) is a debilitating degenerative joint disease, leading to significant pain and disability. Despite advancements, current regenerative therapies, such as mesenchymal stem cells (MSCs), face challenges in clinical efficacy and ethical considerations. This study aimed to evaluate the therapeutic potential of stromal vascular fraction gel (SVF-gel) in comparison to available treatments like hyaluronic acid (HA) and adipose-derived stem cells (ADSCs) and to assess the enhancement of this potential by incorporating tropoelastin (TE). Methods: We conducted a comparative laboratory study, establishing an indirect co-culture system using a Transwell assay to test the effects of HA, ADSCs, SVF-gel, and TE-SVF-gel on osteoarthritic articular chondrocytes (OACs). Chondrogenic and hypertrophic markers were assessed after a 72-hour co-culture. SVF-gel was harvested from rat subcutaneous abdominal adipose tissue, with its mechanical properties characterized. Cell viability was specifically analyzed for SVF-gel and TE-SVF-gel. The in vivo therapeutic effectiveness was further investigated in a rat model of OA, examining MSCs tracking, effects on cartilage matrix synthesis, osteophyte formation, and muscle weight changes. Results: Cell viability assays revealed that TE-SVF-gel maintained higher cell survival rates than SVF-gel. In comparison to the control, HA, and ADSCs groups, SVF-gel and TE-SVF-gel significantly upregulated the expression of chondrogenic markers COL 2, SOX-9, and ACAN and downregulated the hypertrophic marker COL 10 in OACs. The TE-SVF-gel showed further improved expression of chondrogenic markers and a greater decrease in COL 10 expression compared to SVF-gel alone. Notably, the TE-SVF-gel treated group in the in vivo OA model exhibited the most MSCs on the synovial surface, superior cartilage matrix synthesis, increased COL 2 expression, and better muscle weight recovery, despite the presence of fewer stem cells than other treatments. Discussion: The findings suggest that SVF-gel, particularly when combined with TE, provides a more effective regenerative treatment for OA by enhancing the therapeutic potential of MSCs. This combination could represent an innovative strategy that overcomes limitations of current therapies, offering a new avenue for patient treatment. Further research is warranted to explore the long-term benefits and potential clinical applications of this combined approach.
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Affiliation(s)
- Junjun Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Key Laboratory of Biorheological Science and Technology, Ministry of Education College of Bioengineering, Chongqing University, Chongqing, China
| | - Xin Wang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - XueBao Zeng
- Chongqing Yan Yu Medical Beauty Clinic, Chongqing, China
| | - Rong Wang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yanming Ma
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhenlan Fu
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zu Wan
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhi Wang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Guangxing Chen
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaoyuan Gong
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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10
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Neubauer M, Otahal A, Kuten O, Sherman SL, Moser L, Kramer K, DeLuna A, Neugebauer J, Dammerer D, Muellner T, Nehrer S. Infra-patellar fat pad-derived mesenchymal stem cells maintain their chondrogenic differentiation potential after arthroscopic harvest with blood-product supplementation. INTERNATIONAL ORTHOPAEDICS 2024; 48:279-290. [PMID: 37646823 PMCID: PMC10766657 DOI: 10.1007/s00264-023-05930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Mesenchymal stem cells/medicinal signaling cells (MSCs) possess therapeutic potential and are used in regenerative orthopaedics. The infra-patellar fat pad (IFP) is partially resected during knee arthroscopy (KASC) and contains MSCs. Heat, irrigation, and mechanical stress during KASC may decrease MSC's therapeutic potential. This study assessed MSCs' regenerative potential after arthroscopic IFP harvest and potential effects of two blood products (BP) (platelet-rich plasma (PRP), hyperacute serum (HAS)) on MSCs' viability and chondrogenic differentiation capacity. METHODS IFP was arthroscopically harvested, isolated, and counted (n = 5). Flow cytometry was used to assess cell viability via staining with annexin V/7-AAD and stemness markers via staining for CD90, CD73, and CD105. MSCs were incubated with blood products, and metabolic activity was determined via an XTT assay. Deposition of cartilage extracellular matrix was determined in histologic sections of chondrogenically differentiated 3D pellet cultures via staining with Alcian Blue. Expression of cartilage-specific genes (SOX9, MMP3/13, ACAN, COL1/2) was analyzed via quantitative PCR. RESULTS MSC isolation from IFP yielded 2.66*106 ± 1.49*106 viable cells from 2.7 (0.748) g of tissue. MSC markers (CD 90/105/73) were successfully detected and annexin V staining showed 81.5% viable cells. XTT showed increased metabolic activity. Within the BP groups, this increase was significant (days 0-14, p < 0.05). PCR showed expression of cartilage-specific genes in each group. COL2 (p < 0.01) as well as ACAN (p < 0.001) expression levels were significantly higher in the HAS group. Histology showed successful differentiation. CONCLUSION Arthroscopic harvest of IFP-MSCs yields sufficient cells with maintained regenerative potential and viability. Blood products further enhance MSCs' viability.
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Affiliation(s)
- Markus Neubauer
- Center for Regenerative Medicine and Orthopaedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria
- Division of Orthopaedics and Traumatology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Alexander Otahal
- Center for Regenerative Medicine and Orthopaedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria
| | - Olga Kuten
- Ortho Sera GmbH, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria
| | | | - Lukas Moser
- Center for Regenerative Medicine and Orthopaedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria
- Division of Orthopaedics and Traumatology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Karina Kramer
- Center for Regenerative Medicine and Orthopaedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria
| | - Andrea DeLuna
- Center for Regenerative Medicine and Orthopaedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria
| | - Johannes Neugebauer
- Division of Orthopaedics and Traumatology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Dietmar Dammerer
- Center for Regenerative Medicine and Orthopaedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria
- Division of Orthopaedics and Traumatology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Thomas Muellner
- Center for Regenerative Medicine and Orthopaedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria
- Department of Orthopaedics and Traumatology, Evangelic Hospital Vienna, Hans-Sachs-Gasse 10-12, 1180, Vienna, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopaedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Austria.
- Division of Orthopaedics and Traumatology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria.
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11
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Xiao J, Gong X, Fu Z, Song X, Ma Q, Miao J, Cai R, Yan Z, Wang S, Li Q, Chen Y, Yang L, Bian X, Chen Y. The influence of inflammation on the characteristics of adipose-derived mesenchymal stem cells (ADMSCs) and tissue repair capability in a hepatic injury mouse model. Stem Cell Res Ther 2023; 14:334. [PMID: 37981679 PMCID: PMC10659042 DOI: 10.1186/s13287-023-03532-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Mesenchymal stem cells (MSCs) are adult stem cells with self-renewal and multi-directional differentiation potential and possess the functions of immunomodulation, regulation of cell growth, and repair of damage. Over recent years, MSCs have been found to regulate the secretion of inflammatory factors and to exert regulatory effects on various lymphocytes in inflammatory states, and on the subsequent repair of tissue damage caused by inflammation. In the present study, we analyzed the effects of tissue inflammation on the characteristics of MSCs. METHODS Human fat derived from the infrapatellar fat pad (IPFP) of knees with differing degrees of inflammation was extracted from specimens derived from total knee arthroplasties. HE and immunohistochemical staining was performed to directly observe the evidence and degree of inflammation in human infrapatellar fat pad tissue in order to classify MSCs cells, by their origin, into highly inflamed and lowly inflamed groups, and to study the effect of tissue inflammation on cell acquisition rates via cellular counting data. Flow cytometry assays were performed to investigate the effect of tissue inflammation on MSC surface marker expression. Trilineage differentiation, including osteogenesis, adipogenesis, and chondrogenesis, was performed to assess the effect of tissue inflammation on the ability of MSCs to undergo directed differentiation. The effect of tissue inflammation on the ability of MSCs to proliferate was investigated via clone formation studies. RNA-sequencing was performed to evaluate the transcriptomes of MSCs derived from different areas of inflammation. The effect of tissue inflammation on tissue repair capacity and safety of MSCs was investigated via a murine model of acute liver injury. RESULTS The results of cell count data indicate that a high degree of tissue inflammation significantly decreases the acquisition rate of MSCs, and the proportion of CD34+ and CD146+ cells. The results of our trilineage differentiation assay show that a higher degree of inflammation decreases osteogenic differentiation and enhances adipogenic and chondrogenic differentiation of MSCs. However, these differences were not statistically significant. Clone formation assays indicate that the degree of tissue inflammation at the MSC source does not significantly affect the proliferative capacity of MSCs. The transcriptomes of MSCs remain relatively stable in fat pad tissues derived from both highly and lowly inflamed samples. The results of acute liver injury investigations in mice indicate that MSCs of high and low inflammatory tissue origin have no significant difference in their tissue repair capability. CONCLUSIONS High tissue inflammation at the source of MSCs reduces the acquisition rate of MSCs and the percentage of CD34+ and CD146+ cells acquisition. However, source tissue inflammation may not significantly affect trilineage differentiation potential and proliferative capacity of MSCs. Also, MSCs obtained from differing source degrees of inflammation retain stable and similar transcriptomic profile and are both safe and efficacious for tissue repair/regeneration without detectable differences.
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Affiliation(s)
- Jingfang Xiao
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xiaoyuan Gong
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Zhenlan Fu
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xiongbo Song
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Qinghua Ma
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Jingya Miao
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ruili Cai
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Zexuan Yan
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Shuai Wang
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Qian Li
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Yaokai Chen
- Biobank and Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, People's Republic of China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China.
| | - Xiuwu Bian
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China.
| | - Yemiao Chen
- Biobank and Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, People's Republic of China.
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Munday CE, Patel SU, Jain N, Hikmat D, Armstrong T. A rare cause of Hoffa's fat pad impingement: the crossed-doubled patellar tendon. BJR Case Rep 2023; 9:20220049. [PMID: 37928710 PMCID: PMC10621588 DOI: 10.1259/bjrcr.20220049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 11/07/2023] Open
Abstract
We present an unusual case of Hoffa's fat pad impingement syndrome and chondromalacia patellae in the presence of a rare congenital crossed doubled patellar tendon. The crossed-doubled patellar tendon is exceedingly rare. It's relationship to other conditions involved in anterior knee pain is unclear; however, this case highlights potential pathological associations.
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Affiliation(s)
- Charlotte E Munday
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Shreena U Patel
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Neel Jain
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Dina Hikmat
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Thomas Armstrong
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
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13
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Tan H, Kang W, Fan Q, Wang B, Yu Y, Yu N, Duan H, Yuan P, Wang S, Chen Q, Jin C. Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging Findings of Infrapatellar Fat Pad Signal Abnormalities: Comparison Between Symptomatic and Asymptomatic Knee Osteoarthritis. Acad Radiol 2023; 30:1374-1383. [PMID: 36609030 DOI: 10.1016/j.acra.2022.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/26/2022] [Accepted: 11/12/2022] [Indexed: 01/06/2023]
Abstract
RATIONALE AND OBJECTIVES Infrapatellar fat pad (IPFP) proton density-weighted images (PdWI) hyperintense regions on MRI are an important imaging feature of knee osteoarthritis (KOA) and are thought to represent inflammation which may induce knee pain. The aim of the study was to compare the intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) findings of PdWI hyperintense regions of IPFP between symptomatic and asymptomatic KOA and to determine whether IVIM-DWI parameters can be used as an objective biomarker for symptomatic KOA. MATERIALS AND METHODS In total, 84 patients with symptomatic KOA, 43 asymptomatic KOA persons, and 30 healthy controls with MRI were retrospectively reviewed. Demographic, IPFP-synovitis, Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain sub-score, IPFP volume and depth and quantitative parameters of IVIM-DWI were collected. The chi-square test, Binary logistic regression and receiver operating characteristic curve (ROC) analysis were used for diagnostic performance comparison. RESULTS The IPFP volume and depth were statistically significant differences between the non-KOA and sKOA groups (p<0.05). The IPFP PdWI hyperintense regions demonstrated significantly higher values of D and D* in the symptomatic KOA compared to those in the asymptomatic KOA (1.51±0.47 vs. 1.73±0.40 for D and 19.24±6.44 vs. 27.09±9.75 for D*) (both p<0.05). Multivariate logistic regression analyses showed that Higher D and D* values of IPFP hyperintense region were significantly associated with higher risks of knee pain (OR: 1.97; 95% CI: 1.21-3.19; p=0.006 for D and OR: 1.24; 95% CI: 1.09-1.41; p=0.001 for D*). Sensitivity and specificity of D value for symptomatic KOA were 80.28% and 83.33%, with an AUC of 0.78 (0.68-0.86). D* value had the sensitivity with 92.96% and a specificity of 58.33%, with an AUC of 0.82 (0.73-0.89) for symptomatic KOA. CONCLUSION IVIM-DWI can be used as an additional functional imaging technique to study IPFP with signal abnormalities on PdWI, and the D and D* values may have potential value to predict the symptom in mild-to-moderate KOA patients.
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Affiliation(s)
- Hui Tan
- From the department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China; Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Wulin Kang
- Department of Orthopedics, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Qiuju Fan
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Bin Wang
- Institute of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Yong Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Haifeng Duan
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Puwei Yuan
- Department of Orthopedics, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Shaoyu Wang
- MR senior scientific marketing specialist, Siemens Healthineers, Shanghai, People's Republic of China
| | - Qing Chen
- Institute of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Chenwang Jin
- From the department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
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Abelleyra Lastoria DA, Benny CK, Hing CB. Predisposing factors for Hoffa's fat pad syndrome: a systematic review. Knee Surg Relat Res 2023; 35:17. [PMID: 37296488 PMCID: PMC10251569 DOI: 10.1186/s43019-023-00192-4] [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] [Received: 02/02/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hoffa's fat pad syndrome has been defined as impingement of Hoffa's fat pad, leading to oedema and fibrosis. The primary aim of this systematic review was to identify morphological differences in Hoffa's fat pad between patients with and without Hoffa's fat pad syndrome, evaluating them as risk factors predisposing to its development. The secondary aim was to summarize and evaluate current evidence pertaining to the management of Hoffa's fat pad syndrome. MATERIALS AND METHODS The protocol for this review was prospectively registered (PROSPERO registration: CRD42022357036). Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. All studies evaluating differences in Hoffa's fat pad anatomy under imaging between patients with and without Hoffa's fat pad syndrome were included, as well as those exploring epidemiological factors predisposing to its development (ethnicity, employment status, sex, age and BMI), and studies reporting on the effect of treatment on Hoffa's fat pad morphology. RESULTS A total of 3871 records were screened. Twenty one articles satisfied the inclusion criteria, evaluating 3603 knees of 3518 patients. Patella alta, increased tibial tubercle-tibial groove distance, and increased trochlear angle were found to predispose the development of Hoffa's fat pad syndrome. Trochlear inclination, sulcus angle, patient age and BMI were not associated with this condition. The link between Hoffa's fat pad syndrome and ethnicity, employment, patellar alignment, Hoffa's fat pad composition, physical activity and other pathological processes cannot be established due to lack of evidence. No studies reporting on treatment for Hoffa's fat pad syndrome were identified. Though weight loss and gene therapy may provide symptomatic relief, further research is required to corroborate these claims. CONCLUSION Current evidence suggests that high patellar height, TT-TG distance, and trochlear angle predispose the development of Hoffa's fat pad syndrome. In addition, trochlear inclination, sulcus angle, patient age and BMI do not seem to be associated with this condition. Further research should explore the link between Hoffa's fat pad syndrome and sport as well as other conditions pertaining to the knee. In addition, further study evaluating treatment approaches for Hoffa's fat pad syndrome is required.
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Affiliation(s)
| | | | - Caroline Blanca Hing
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
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15
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Rajbhandari A, Banskota B, Bhusal R, Banskota AK. Effect of Infrapatellar Fat Pad Preservation vs Resection on Clinical Outcomes After Total Knee Arthroplasty in Patient with End-Stage Osteoarthritis. Indian J Orthop 2023; 57:863-867. [PMID: 37214378 PMCID: PMC10192471 DOI: 10.1007/s43465-023-00865-y] [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] [Received: 09/07/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
Purpose The management of infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) is the subject of ongoing debate. There is conflicting evidence whether IPFP should be preserved or resected during TKA to improve clinical outcomes. This study sought to establish if there is a benefit of one over another in terms of clinical function & patient satisfaction. Material & Methods Total of 67 patients (96 knees), 11 males & 56 females with a mean age of 66.29 years, who underwent TKA between 2016 and 2020 were included in the study. The planning for IPFP preservation (IPFP-P) on right side (50 knees) & IPFP resection (IPFP-R) on left side (46 knees) was done prospectively. We prospectively evaluated clinical outcomes post-TKA, comparing the right knee to the left knee in terms of IPFP-P vs IPFP-R using the oxford knee scoring (OKS) system. The SF-12 was used to evaluate and compare patient satisfaction between the two groups. Results The mean OKS in the IPFP-P group was 42.86 ± 2.63 & in the IPFP-R group was 44.22 ± 2.40. The OKS differed significantly between the two groups (p < 0.05). Patient with IPFP-R group had significantly better OKS. The mean Sf-12 (physical & mental component) in the IPFP-P was 51.05 ± 4.15 & 59.29 ± 2.53 & in IPFP-R was 51.23 ± 4.74 & 59.24 ± 2.78, showing no significant differences. Conclusion Our study shows that IPFP-R gave marginally better patient-reported functional outcome scores (OKS), but there was no difference in patient satisfaction (SF-12 scores) between the two groups.
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Affiliation(s)
| | - Bibek Banskota
- Department of Orthopaedics, B&B Hospital, Gwarko, Lalitpur, Nepal
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16
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Sacher SE, Neri JP, Gao MA, Argentieri EC, Potter HG, Koch KM, Koff MF. MAVRIC based T2 mapping assessment of infrapatellar fat pad scarring in patients with total knee arthroplasty. J Orthop Res 2023; 41:1299-1309. [PMID: 36262013 PMCID: PMC10113607 DOI: 10.1002/jor.25472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
The infrapatellar fat pad (IPFP) has been implicated as a source of postoperative knee pain. Imaging the IPFP is challenging in patients with total knee arthroplasty (TKA) due to metallic susceptibility artifact. Multi-Acquisition Variable-Resonance Image Combination (MAVRIC)-based T2 Mapping has been developed to mitigate this artifact and can generate quantitative T2 data. Objectives of this study were to (1) measure T2 values of the IPFP in patients with TKAs using a MAVRIC based T2 mapping technique and (2) determine if IPFP T2 values are related to the degree of fat pad scarring or clinical magnetic resonance imaging (MRI) findings. Twenty-eight subjects (10 males, 18 females, Age: 66 + 7.2 years [Mean ± standard deviations]) undergoing clinical MRIs were sequentially recruited. Morphological imaging and quantitative T2 mapping sequences were performed on a clinical 1.5 T scanner. The morphologic images were graded for the presence and severity of fat pad scarring and clinical outcomes. T2 values were calculated in the total fat pad volume, a normal regions of interest (ROI), and an abnormal ROI. T2 values were shortened in the total IPFP volume (p = 0.001) and within abnormal regions (p = 0.003) in subjects with more severe IPFP scarring. The difference between T2 values in normal-abnormal regions was greater in subjects with severe versus no scarring (+1426.1%, p = 0.008). T2 values were elevated in patients with MRI findings of osteolysis (+32.3%, p = 0.02). These findings indicate that MAVRIC-based T2 Mapping may be used as a quantitative biomarker of postoperative IPFP scarring in individuals following TKA.
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Affiliation(s)
- Sara E. Sacher
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
| | - John P. Neri
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
| | - Madeleine A. Gao
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
| | | | - Hollis G. Potter
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
| | | | - Matthew F. Koff
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
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Jardon M, Miller TT. Diagnostic ultrasound and ultrasound-guided injections for peri-articular pain after knee replacement. Skeletal Radiol 2023; 52:1023-1031. [PMID: 36136116 DOI: 10.1007/s00256-022-04189-0] [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] [Received: 06/29/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this technical report is to review the sonographic spectrum of abnormalities accounting for peri-articular pain after knee replacement surgery, as well as to demonstrate the clinical utility of ultrasound in the diagnosis and treatment of this subset of patients. MATERIALS AND METHODS Utilizing an imaging report database, we performed a search for ultrasound examinations performed by a single radiologist for knee pain after knee arthroplasty at our institution over a 10-year period. The search yielded 63 patients, whom we have categorized by causative pathology, with representative diagnostic and procedural ultrasound images selected for inclusion. RESULTS Our search yielded multiple causes of peri-articular knee pain after arthroplasty, including medial and lateral retinacular impingement and scarring, iliotibial band or conjoined tendon irritation, popliteus tendon impingement, medial collateral ligament impingement, pes anserine bursitis, and scarring of Hoffa's fat pad. CONCLUSION While knee arthroplasty is an often-successful procedure, it can be complicated by post-operative peri-articular knee pain. Ultrasound provides a valuable tool for the diagnosis of painful peri-articular knee pathology, as it allows for both static and dynamic evaluation, as well as direct correlation with patient symptoms, and is not confounded by the metal components. In addition to its diagnostic utility, ultrasound can also guide diagnostic and/or therapeutic injections of anesthetic and corticosteroid. Given these advantages, ultrasound is an important tool in managing the painful post-arthroplasty knee.
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Affiliation(s)
- Meghan Jardon
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
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Martel-Pelletier J, Paiement P, Pelletier JP. Magnetic resonance imaging assessments for knee segmentation and their use in combination with machine/deep learning as predictors of early osteoarthritis diagnosis and prognosis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231165560. [PMID: 37151912 PMCID: PMC10155034 DOI: 10.1177/1759720x231165560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/23/2023] [Indexed: 05/09/2023] Open
Abstract
Knee osteoarthritis (OA) is a prevalent and disabling disease that can develop over decades. This disease is heterogeneous and involves structural changes in the whole joint, encompassing multiple tissue types. Detecting OA before the onset of irreversible changes is crucial for early management, and this could be achieved by allowing knee tissue visualization and quantifying their changes over time. Although some imaging modalities are available for knee structure assessment, magnetic resonance imaging (MRI) is preferred. This narrative review looks at existing literature, first on MRI-developed approaches for evaluating knee articular tissues, and second on prediction using machine/deep-learning-based methodologies and MRI as input or outcome for early OA diagnosis and prognosis. A substantial number of MRI methodologies have been developed to assess several knee tissues in a semi-quantitative and quantitative fashion using manual, semi-automated and fully automated systems. This dynamic field has grown substantially since the advent of machine/deep learning. Another active area is predictive modelling using machine/deep-learning methodologies enabling robust early OA diagnosis/prognosis. Moreover, incorporating MRI markers as input/outcome in such predictive models is important for a more accurate OA structural diagnosis/prognosis. The main limitation of their usage is the ability to move them in rheumatology practice. In conclusion, MRI knee tissue determination and quantification provide early indicators for individuals at high risk of developing this disease or for patient prognosis. Such assessment of knee tissues, combined with the development of models/tools from machine/deep learning using, in addition to other parameters, MRI markers for early diagnosis/prognosis, will maximize opportunities for individualized risk assessment for use in clinical practice permitting precision medicine. Future efforts should be made to integrate such prediction models into open access, allowing early disease management to prevent or delay the OA outcome.
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Affiliation(s)
- Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412B,
Montreal, QC H2X 0A9, Canada
| | - Patrice Paiement
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
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19
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Jardim M, Santos I, da Silva MG. Electromyographic analysis of the three subdivisions of gluteus medius during two different exercises: Wall press exercise and figure-of-four position. J Back Musculoskelet Rehabil 2023; 36:721-729. [PMID: 36776038 DOI: 10.3233/bmr-220188] [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: 02/10/2023]
Abstract
BACKGROUND Gluteus medius (GM) is a segmented muscle involving three muscular subdivisions. Rehabilitation exercises has been suggested to strengthen specific subdivisions. OBJECTIVE This study aimed to evaluate muscular activation of the anterior, middle, and posterior subdivisions of the GM during two different exercises. METHODS A total of 28 healthy active subjects participated in this study. Muscle activity using surface electromyography was recorded for the three GM subdivisions during figure-of-four position (FFP) and wall press (WP). Non-parametric Kruskal-Wallis test was used to detect differences between GM subdivisions on each exercise and the Mann-Whitney U test was used to compare muscular activation across exercises. RESULTS There were statistically significant differences (P< 0.001) in all GM subdivision during FFP and WP exercises. Both exercises showed greater activation of the posterior subdivision than the middle and anterior subdivisions, with the WP causing highest activation of the posterior subdivision. CONCLUSION In line with the WP exercise, the FFP produces sufficient activity to provide potential strength gains on the posterior subdivision and could be a viable option to include in the early stages of the rehabilitation process. Clinicians may use this information to make more informed decisions about exercise selection for strengthening specific GM subdivision.
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Affiliation(s)
- Marco Jardim
- Department of Physiotherapy, School of Health Polytechnic Institute of Setubal, Setubal, Portugal.,Centre for Interdisciplinary Applied Research in Health, Polytechnic Institute of Setubal, Setubal, Portugal
| | - Inês Santos
- Department of Physiotherapy, School of Health Polytechnic Institute of Setubal, Setubal, Portugal
| | - Madalena Gomes da Silva
- Department of Physiotherapy, School of Health Polytechnic Institute of Setubal, Setubal, Portugal.,Centre for Interdisciplinary Applied Research in Health, Polytechnic Institute of Setubal, Setubal, Portugal
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20
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Neubauer M, Kramer K, Neugebauer J, Moser L, Moser A, Dammerer D, Nehrer S. Isolation and Cultivation of Adipose-Derived Mesenchymal Stem Cells Originating from the Infrapatellar Fat Pad Differentiated with Blood Products: Method and Protocol. Methods Protoc 2022; 6:mps6010003. [PMID: 36648952 PMCID: PMC9844469 DOI: 10.3390/mps6010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Adipose-derived mesenchymal stem cells (ASCs) are a promising source for clinical application in regenerative orthopedics. ASCs derived from the infra-patellar fat pad (IFP)-a distinct adipose structure in the knee-show superior regenerative potential compared to subcutaneous-fat-derived cells. Furthermore, it has been shown that blood products enhance ASCs' viability. A major challenge for clinical translation of both ASCs and blood products is the low comparability of obtained data due to non-standardized harvesting, isolation and preparation methods. The aim of this method-paper is to provide reproducible protocols to help standardize basic research in the field to build a sound basis for clinical translation with an emphasize on practicability. The presented protocols include (i) ASC isolation from the IFP, (ii) blood product preparation and (iii) ASC incubation with blood products.
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Affiliation(s)
- Markus Neubauer
- Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Department of Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Karina Kramer
- Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
| | - Johannes Neugebauer
- Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Department of Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Lukas Moser
- Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Department of Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Anna Moser
- Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Department of Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Dietmar Dammerer
- Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Department of Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Department of Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
- Correspondence: ; Tel.: +43-2732-893-2608
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21
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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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22
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Hellmund C, Hepp P, Steinke H. The subpopliteal fat body. Ann Anat 2022; 245:151995. [PMID: 36182003 DOI: 10.1016/j.aanat.2022.151995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The knee is likely to get hurt due to its excessive weight-bearing, for which it is surrounded by strongly tensioned ligaments, connectives and muscles. These highly active structures are imbedded in fatty tissue. The Fatty and loose connective tissue of the knee recently gained a renaissance in research. While the Hoffa fat body in the ventral knee attracted attention over the last years, we have investigated a smaller, dorsal fat body, ventral to the popliteus muscle. This fat body has not been described before. MATERIALS AND METHODS 11 knees of 11 fresh specimens were investigated. All muscles but the popliteus muscle were removed. The popliteus was released from its tibial origin and dissected towards its tendinous insertion. Thereby, a subpopliteal fat body (SFB) was shown. The related vessels and nerves were evaluated. The size of the body was measured. Examples of histological slices were stained with HE and immunostained against neurofilament. RESULTS The SFB lies ventral of the popliteus muscle at the concave posterior tibia and attaches to the periosteum and the popliteus muscle. It is not attached to the posterior cruciate ligament. It is separated from the subpopliteal recess by a lamella deriving from the fibular head. Arterial and venous vessels are seen entering the SFB, deriving from the popliteal artery or the anterior tibial artery. A subbranch of the tibial nerve was seen to reach the SFB. The SFB could be identified in MRI scans and in plastinations. DISCUSSION Primarily, the SFB provides a gliding space for the mobile part of the popliteus muscle over the tibia. The SFB lies within the tibial concavity, ventral to the popliteus muscle. This is exactly where embryologically, the popliteal artery passes through, before its involution in later stages. Therefore, the SFB may show the former perivascular autonomic nerves which encompass the embryologically created arteries, from which we have seen the arterial remnants. The nerves seen here form neurovascular bundles which could be a source of pain, when compressed. This anatomy may explain the autonomic component of pain in the deep lateral region of the knee. The SFB is functional fat, comparable to the Hoffa's fat pad in the ventral knee.
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Affiliation(s)
- Christoph Hellmund
- Institut für Anatomie, Universität Leipzig, Liebigstr. 13, 04103 Leipzig.
| | - Pierre Hepp
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie.
| | - Hanno Steinke
- Institut für Anatomie, Universität Leipzig, Liebigstr. 13, 04103 Leipzig.
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23
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Li J, Fu S, Gong Z, Zhu Z, Zeng D, Cao P, Lin T, Chen T, Wang X, Lartey R, Kwoh CK, Guermazi A, Roemer FW, Hunter DJ, Ma J, Ding C. MRI-based Texture Analysis of Infrapatellar Fat Pad to Predict Knee Osteoarthritis Incidence. Radiology 2022; 304:611-621. [PMID: 35638929 PMCID: PMC9434820 DOI: 10.1148/radiol.212009] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/24/2022] [Accepted: 04/14/2022] [Indexed: 11/11/2022]
Abstract
Background Infrapatellar fat pad (IPFP) quality has been implicated as a marker for predicting knee osteoarthritis (KOA); however, no valid quantification for subtle IPFP abnormalities has been established. Purpose To investigate whether MRI-based three-dimensional texture analysis of IPFP abnormalities could help predict incident radiographic KOA. Materials and Methods In this prospective nested case-control study, 690 participants whose knees were at risk for KOA were included from the Pivotal Osteoarthritis Initiative MRI Analyses incident osteoarthritis cohort. All knees had a Kellgren-Lawrence grade of 1 or less at baseline. During the 4-year follow-up, case participants were matched 1:1 to control participants, with incident radiographic KOA as the outcome. MRI scans were segmented at the incident time point of KOA (hereafter, P0), 1 year before P0 (hereafter, P-1), and baseline. MRI-based three-dimensional texture analysis was performed to extract IPFP texture features. Least absolute shrinkage and selection operator and multivariable logistic regressions were applied in the development cohort and evaluated in the test cohort. The area under the receiver operating characteristic curve (AUC) was used to evaluate the discriminative value of the clinical score, IPFP texture score, and MRI Osteoarthritis Knee Score. Results Participants were allocated to development (n = 500, 340 women; mean age, 60 years) and test (n = 190, 120 women; mean age, 61 years) cohorts. In both cohorts, IPFP texture scores (AUC ≥0.75 for all) showed greater discrimination than clinical scores (AUC ≤0.69 for all) at baseline, P-1, and P0, with significant differences in pairwise comparisons (P ≤ .002 for all). Greater predictive and concurrent validities of IPFP texture scores (AUC ≥0.75 for all) compared with MRI Osteoarthritis Knee Scores (AUC ≤0.66 for all) were also demonstrated (P < .001 for all). Conclusion MRI-based three-dimensional texture of the infrapatellar fat pad was associated with future development of knee osteoarthritis. ClinicalTrials.gov registration no.: NCT00080171 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Fischer in this issue.
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Affiliation(s)
| | | | - Ze Gong
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Zhaohua Zhu
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Dong Zeng
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Peihua Cao
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Ting Lin
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Tianyu Chen
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Xiaoshuai Wang
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Richard Lartey
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - C. Kent Kwoh
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Ali Guermazi
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Frank W. Roemer
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - David J. Hunter
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Jianhua Ma
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
| | - Changhai Ding
- From the Clinical Research Centre, Zhujiang Hospital, Southern
Medical University, Guangzhou, Guangdong, China (J.L., Z.Z., P.C., T.C., X.W.,
D.J.H., C.D.); Department of Orthopedics, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong, China (J.L.); School of Biomedical
Engineering, Southern Medical University, Guangzhou, China (S.F., D.Z., J.M.);
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical
University, Guangzhou, China (Z.G.); School of Rehabilitation Medicine, Southern
Medical University, Guangzhou, China (Z.G.); Department of Radiology, Zhujiang
Hospital, Southern Medical University, Guangzhou, China (T.L.); Department of
Orthopedics, The Third Affiliated Hospital of Southern Medical University,
Guangzhou, China (T.C.); Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio (R.L.); University of Arizona
College of Medicine, Tucson, Ariz (C.K.K.); University of Pittsburgh Graduate
School of Public Health, Pittsburgh, Pa (C.K.K.); Department of Radiology, VA
Boston Healthcare System, Boston University School of Medicine, Boston, Mass
(A.G., F.W.R.); Department of Radiology, University of Erlangen-Nuremberg,
Erlangen, Germany (F.W.R.); Department of Rheumatology, Royal North Shore
Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of
Sydney, Australia (D.J.H.); and Menzies Institute for Medical Research,
University of Tasmania, Hobart, Australia (C.D.)
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24
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Zhou S, Maleitzke T, Geissler S, Hildebrandt A, Fleckenstein FN, Niemann M, Fischer H, Perka C, Duda GN, Winkler T. Source and hub of inflammation: The infrapatellar fat pad and its interactions with articular tissues during knee osteoarthritis. J Orthop Res 2022; 40:1492-1504. [PMID: 35451170 DOI: 10.1002/jor.25347] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/28/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Knee osteoarthritis, the most prevalent degenerative joint disorder worldwide, is driven by chronic low-grade inflammation and subsequent cartilage degradation. Clinical data on the role of the Hoffa or infrapatellar fat pad in knee osteoarthritis are, however, scarce. The infrapatellar fat pad is a richly innervated intracapsular, extrasynovial adipose tissue, and an abundant source of adipokines and proinflammatory and catabolic cytokines, which may contribute to chronic synovial inflammation, cartilage destruction, and subchondral bone remodeling during knee osteoarthritis. How the infrapatellar fat pad interacts with neighboring tissues is poorly understood. Here, we review available literature with regard to the infrapatellar fat pad's interactions with cartilage, synovium, bone, menisci, ligaments, and nervous tissue during the development and progression of knee osteoarthritis. Signaling cascades are described with a focus on immune cell populations, pro- and anti-inflammatory cytokines, adipokines, mesenchymal stromal cells, and molecules derived from conditioned media from the infrapatellar fat pad. Understanding the complex interplay between the infrapatellar fat pad and its neighboring articular tissues may help to better understand and treat the multifactorial pathogenesis of osteoarthritis.
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Affiliation(s)
- Sijia Zhou
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Tazio Maleitzke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Sven Geissler
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Alexander Hildebrandt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Florian Nima Fleckenstein
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Berlin, Germany
| | - Marcel Niemann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Heilwig Fischer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Carsten Perka
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Tobias Winkler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
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25
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Chen TR, Chang CW, Tai TW, Wang B. Anterior knee pain associated with Hoffa’s disease alleviated with genicular artery embolization: A case study. J Vasc Interv Radiol 2022; 33:1123-1126.e4. [DOI: 10.1016/j.jvir.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/18/2022] [Accepted: 05/29/2022] [Indexed: 11/17/2022] Open
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26
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Braun S, Zaucke F, Brenneis M, Rapp AE, Pollinger P, Sohn R, Jenei-Lanzl Z, Meurer A. The Corpus Adiposum Infrapatellare (Hoffa's Fat Pad)-The Role of the Infrapatellar Fat Pad in Osteoarthritis Pathogenesis. Biomedicines 2022; 10:1071. [PMID: 35625808 PMCID: PMC9138316 DOI: 10.3390/biomedicines10051071] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, the infrapatellar fat pad (IFP) has gained increasing research interest. The contribution of the IFP to the development and progression of knee osteoarthritis (OA) through extensive interactions with the synovium, articular cartilage, and subchondral bone is being considered. As part of the initiation process of OA, IFP secretes abundant pro-inflammatory mediators among many other factors. Today, the IFP is (partially) resected in most total knee arthroplasties (TKA) allowing better visualization during surgical procedures. Currently, there is no clear guideline providing evidence in favor of or against IFP resection. With increasing numbers of TKAs, there is a focus on preventing adverse postoperative outcomes. Therefore, anatomic features, role in the development of knee OA, and consequences of resecting versus preserving the IFP during TKA are reviewed in the following article.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (M.B.); (A.M.)
| | - Frank Zaucke
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (F.Z.); (A.E.R.); (P.P.); (R.S.); (Z.J.-L.)
| | - Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (M.B.); (A.M.)
| | - Anna E. Rapp
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (F.Z.); (A.E.R.); (P.P.); (R.S.); (Z.J.-L.)
| | - Patrizia Pollinger
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (F.Z.); (A.E.R.); (P.P.); (R.S.); (Z.J.-L.)
| | - Rebecca Sohn
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (F.Z.); (A.E.R.); (P.P.); (R.S.); (Z.J.-L.)
| | - Zsuzsa Jenei-Lanzl
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (F.Z.); (A.E.R.); (P.P.); (R.S.); (Z.J.-L.)
| | - Andrea Meurer
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (M.B.); (A.M.)
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27
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He J, Ba H, Feng J, Peng C, Liao Y, Li L, Cao X, Wang Z, Shen M, Wu S. Increased signal intensity, not volume variation of infrapatellar fat pad in knee osteoarthritis: A cross-sectional study based on high-resolution magnetic resonance imaging. J Orthop Surg (Hong Kong) 2022; 30:10225536221092215. [PMID: 35422165 DOI: 10.1177/10225536221092215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infrapatellar fat pad (IPFP) is regarded as an essential knee tissue involved in osteoarthritis (OA) for its potential structural-related or metabolism-related function. This cross-sectional study aims to identify which part is more related to OA. METHODS Patients with knee OA (n = 53) and healthy controls (n = 54) were prospectively recruited. Based on high-resolution magnetic resonance imaging with a slice thickness of only 0.35 mm, IPFP structural-related parameters (volume and maximal area), metabolism-related parameter (signal), degeneration indicators, and patellar maltracking indicators (patellar translation, patellofemoral angle, and Insall-Salvati ratio) were measured. IPFP volume (maximal area, and signal) was compared between healthy controls and OA patients. The level of significance for all comparisons was set as .05. RESULTS OA patients had higher IPFP signal (672.9 ± 136.9 vs 567.3 ± 63.6, p = .009), but no significant difference in IPFP volume or maximal area compared with healthy controls. In healthy controls, IPFP signal was positively associated with age (β = 1.481; 95% CI: 0.286-2.676; p = .018); IPFP maximal area was positively related to Insall-Salvati ratio (β = 0.001; 95% CI: 0.0003-0.0017; p = .039), but not associated with patellar translation and patellofemoral angle. In OA patients, IPFP signal was positively associated with cartilage loss (β = 0.005; 95% CI: 0.003-0.007; p = .013); no correlation between knee pain and IPFP volume or maximal area was observed. CONCLUSIONS The metabolism-related function of IPFP, which can be reflected by the IPFP signal, might play a more critical role in OA progression than its structural function.
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Affiliation(s)
- Jinshen He
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Hongliang Ba
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Jing Feng
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Cheng Peng
- Department of Burns, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Yunjie Liao
- Department of Radiology, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Lifeng Li
- Department of Radiology, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Xu Cao
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Zili Wang
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Minren Shen
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Song Wu
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
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28
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Pharis H, Kong A, Robbins M, Waranch C, Wissman R. Friction Syndromes of the Knee. J Knee Surg 2022; 35:491-497. [PMID: 35189665 DOI: 10.1055/s-0042-1743222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The knee is a complex joint with many fascial and ligamentous interactions. The movement in multiple planes makes the knee a prime site for friction syndromes, especially in active individuals. The most common friction syndrome is the iliotibial band friction syndrome. This occurs commonly in runners and cyclists and can be diagnosed clinically in a patient with lateral knee pain during activity. The anterior fat pads of the knee can also be the site of friction syndromes, most often in the Hoffa fat pad. Edema here can be located in the superolateral aspect of the fat pad when associated with patellar abnormalities, or diffusely when impingement is due to other causes. Edema of the quadriceps or prefemoral fat pad may also cause anterior knee pain and may be diagnosed with magnetic resonance imaging. The posteromedial friction syndrome and medial tibial crest syndrome are rare causes of medial knee pain highly active individuals.
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Affiliation(s)
- Hunter Pharis
- Department of Medical Education, Heritage College of Osteopathic Medicine, Ohio University, Dublin, Ohio
| | - Andrew Kong
- Department of Radiology, University of Missouri System, Columbia, Missouri
| | - Mike Robbins
- Department of Radiology, University of Missouri System, Columbia, Missouri
| | - Christy Waranch
- Department of Radiology, University of Missouri System, Columbia, Missouri
| | - Robert Wissman
- Department of Radiology, University of Missouri System, Columbia, Missouri
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29
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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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30
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Martel-Pelletier J, Tardif G, Pelletier JP. An Open Debate on the Morphological Measurement Methodologies of the Infrapatellar Fat Pad to Determine Its Association with the Osteoarthritis Process. Curr Rheumatol Rep 2022; 24:76-80. [PMID: 35235164 DOI: 10.1007/s11926-022-01057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Knee osteoarthritis (OA) is a disease affecting all the neighboring articular tissues including the infrapatellar fat pad (IPFP). Although not yet as widely studied as other tissues in the knee, the IPFP has been recognized to have important metabolic activities and is a key player in OA. METHODS In this commentary, we will briefly describe the different methodologies employed for the MRI morphological measurement of this tissue and depict the findings in regard to OA. RESULTS The morphology of this tissue, monitored mainly with the use of magnetic resonance imaging (MRI), demonstrates changes during OA. However, studies of the IPFP morphological alterations and their association with the OA process have shown conflicting results, including a detrimental or beneficial role or no role at all. Although many reasons could explain such mixed findings, one might be the different methodologies used for the MRI measurement of area, volume, or signal intensity. In addition, several techniques are also employed for measuring the volume and signal intensity. An additional level of complexity is related to the presence within the IPFP of two different types of signal intensities, hyper-intensity, and hypo-intensity. CONCLUSION A consensus of a procedure to measure the morphology of the IPFP is urgently needed to fully appreciate the role of this tissue in the pathology of OA, as well as its uses for clinical decision-making.
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Affiliation(s)
- Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, Pavilion R, Room R11.412, Montreal, Quebec, H2X 0A9, Canada.
| | - Ginette Tardif
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, Pavilion R, Room R11.412, Montreal, Quebec, H2X 0A9, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, Pavilion R, Room R11.412, Montreal, Quebec, H2X 0A9, Canada
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31
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Effect of Korean Medicine Treatments for Fat Pad Syndrome of Knee Joint: A Case Report. JOURNAL OF ACUPUNCTURE RESEARCH 2022. [DOI: 10.13045/jar.2021.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fat pad syndrome is a knee joint condition/disease where acute or chronic inflammation occurs in the fat pad of the knee joint, and it is a cause of anterior knee pain. Fat pad syndrome usually occurs concurrently with other conditions/diseases to collectively cause anterior knee pain. No study to date has reported the treatment of anterior knee pain solely due to fat pad syndrome. Here, we report a case of fat pad syndrome of the knee joint as the sole cause of anterior knee pain in a 49-year-old woman who received integrated Korean medicine treatments (pharmacopuncture, acupuncture, herbal medicine, deep fascial meridian therapy, and chuna). Using patient-reported pain scale scores, the level of the patient’s pain was relieved, and her mobility improved. Integrated Korean medicine treatments could be effective for patients who have fat pad syndrome of the knee joint.
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32
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High glucose stimulating ECM remodeling and an inflammatory phenotype in the IPFP via upregulation of MFAP5 expression. Biochem Biophys Res Commun 2022; 601:93-100. [PMID: 35240498 DOI: 10.1016/j.bbrc.2022.02.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 01/16/2023]
Abstract
Extracellular matrix (ECM) remodeling and inflammation in the infrapatellar fat pad (IPFP) are associated with cartilage degeneration and the severity of osteoarthritis (OA). Diabetes is associated with the progression of OA. However, it is still unclear whether diabetes can promote osteoarthritis by targeting the IPFP. In this study, we established a high-fat diet/streptozotocin (HFD/STZ)-induced diabetes mouse model. We found that fibrosis and inflammation were more severe in the IPFP in diabetic mice. Transcriptomic profiling showed that MFAP5 expression was upregulated in IPFPs collected from diabetic mice compared to IPFPs collected from normal mice. We identified that Pdgfrα(+) progenitors were the primary source of MFAP5 in the IPFP under diabetic conditions. In addition, high glucose promoted the expression of MFAP5 in Pdgfrα(+) progenitors by stimulating the translocation of Yap1. Overexpression of MFAP5 in Pdgfrα(+) progenitors promoted fibrogenic differentiation and the production of IL-6. Knocking down the expression of MFAP5 efficiently prevented fibrosis and decreased the level of IL-6 in the IPFP and attenuated cartilage degeneration. Together, these results suggest that MFAP5 may be a potential novel therapeutic target for the treatment of diabetes-induced OA.
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33
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Kanak M, Mostowy M, Domżalski M, Lesman J. Pericruciate fat pad (PCFP) – A scoping systematic review of anatomy, histology, imaging, and clinical importance. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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34
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Wallace KG, Pfeiffer SJ, Pietrosimone LS, Harkey MS, Zong X, Nissman D, Kamath GM, Creighton RA, Spang JT, Blackburn JT, Pietrosimone B. Changes in Infrapatellar Fat Pad Volume 6 to 12 Months After Anterior Cruciate Ligament Reconstruction and Associations With Patient-Reported Knee Function. J Athl Train 2021; 56:1173-1179. [PMID: 33787883 PMCID: PMC8582630 DOI: 10.4085/1062-6050-0458.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Hypertrophy of the infrapatellar fat pad (IFP) in idiopathic knee osteoarthritis has been linked to deleterious synovial changes and joint pain related to mechanical tissue impingement. Yet little is known regarding the IFP's volumetric changes after anterior cruciate ligament reconstruction (ACLR). OBJECTIVES To examine changes in IFP volume between 6 and 12 months after ACLR and determine associations between patient-reported outcomes and IFP volume at each time point as well as the volume change over time. In a subset of individuals, we examined interlimb IFP volume differences 12 months post-ACLR. STUDY DESIGN Prospective cohort study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS We studied 26 participants (13 women, 13 men, age = 21.88 ± 3.58 years, body mass index = 23.82 ± 2.21 kg/m2) for our primary aims and 13 of those participants (8 women, 5 men, age = 21.15 ± 3.85 years, body mass index = 23.01 ± 2.01 kg/m2) for our exploratory aim. MAIN OUTCOME MEASURE(S) Using magnetic resonance imaging, we evaluated the IFP volume change between 6 and 12 months post-ACLR in the ACLR limb and between-limbs differences at 12 months in a subset of participants. International Knee Documentation Committee subjective knee evaluation (IKDC) scores were collected at 6-month and 12-month follow-ups, and associations between IFP volume and patient-reported outcomes were determined. RESULTS The IFP volume in the ACLR limb increased from 6 months (19.67 ± 6.30 cm3) to 12 months (21.26 ± 6.91 cm3) post-ACLR. Greater increases of IFP volume between 6 and 12 months were significantly associated with better 6-month IKDC scores (r = .44, P = .03). The IFP volume was greater in the uninjured limb (22.71 ± 7.87 cm3) than in the ACLR limb (20.75 ± 9.03 cm3) 12 months post-ACLR. CONCLUSIONS The IFP volume increased between 6 and 12 months post-ACLR; however, the IFP volume of the ACLR limb remained smaller than that of the uninjured limb at 12 months. In addition, those with better knee function 6 months post-ACLR demonstrated greater increases in IFP volume between 6 and 12 months post-ACLR. This suggests that greater IFP volumes may play a role in long-term joint health after ACLR.
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Affiliation(s)
- Kyle G Wallace
- Georgetown University School of Medicine, Washington, DC
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Steven J Pfeiffer
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens
- School of Applied Health Sciences and Wellness, Ohio University, Athens
| | - Laura S Pietrosimone
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC
| | - Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | - Xiaopeng Zong
- Department of Radiology, University of North Carolina at Chapel Hill
- Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill
| | - Ganesh M Kamath
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | | | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - J Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
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Vahedi P, Moghaddamshahabi R, Webster TJ, Calikoglu Koyuncu AC, Ahmadian E, Khan WS, Jimale Mohamed A, Eftekhari A. The Use of Infrapatellar Fat Pad-Derived Mesenchymal Stem Cells in Articular Cartilage Regeneration: A Review. Int J Mol Sci 2021; 22:ijms22179215. [PMID: 34502123 PMCID: PMC8431575 DOI: 10.3390/ijms22179215] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Cartilage is frequently damaged with a limited capacity for repair. Current treatment strategies are insufficient as they form fibrocartilage as opposed to hyaline cartilage, and do not prevent the progression of degenerative changes. There is increasing interest in the use of autologous mesenchymal stem cells (MSC) for tissue regeneration. MSCs that are used to treat articular cartilage defects must not only present a robust cartilaginous production capacity, but they also must not cause morbidity at the harvest site. In addition, they should be easy to isolate from the tissue and expand in culture without terminal differentiation. The source of MSCs is one of the most important factors that may affect treatment. The infrapatellar fat pad (IPFP) acts as an important reservoir for MSC and is located in the anterior compartment of the knee joint in the extra-synovial area. The IPFP is a rich source of MSCs, and in this review, we discuss studies that demonstrate that these cells have shown many advantages over other tissues in terms of ease of isolation, expansion, and chondrogenic differentiation. Future studies in articular cartilage repair strategies and suitable extraction as well as cell culture methods will extend the therapeutical application of IPFP-derived MSCs into additional orthopedic fields, such as osteoarthritis. This review provides the latest research concerning the use of IPFP-derived MSCs in the treatment of articular cartilage damage, providing critical information for the field to grow.
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Affiliation(s)
- Parviz Vahedi
- Department of Anatomical Sciences, Maragheh University of Medical Sciences, Maragheh 78151-55158, Iran;
| | - Rana Moghaddamshahabi
- Faculty of Pharmacy, Eastern Mediterranean University, Famagusta 99628, North Cyprus, Turkey;
| | - Thomas J. Webster
- Department of Chemical Engineering, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA;
| | - Ayse Ceren Calikoglu Koyuncu
- Materials and Metallurgical Engineering Department, Faculty of Technology, Marmara University, Istanbul 34722, Turkey;
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, Istanbul 34722, Turkey
| | - Elham Ahmadian
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz 51666-15731, Iran;
| | - Wasim S. Khan
- Division of Trauma & Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
- Correspondence: (W.S.K.); (A.E.)
| | - Ali Jimale Mohamed
- Department of Pharmacology, Faculty of Medicine, Somali National University, Mogadishu 801, Somalia;
| | - Aziz Eftekhari
- Department of Toxicology and Pharmacology, Maragheh University of Medical Sciences, Maragheh 78151-55158, Iran
- Department of Synthesis and Characterization of Polymers, Polymer Institute, Slovak Academy of Sciences (SAS), Dúbravská cesta, 9, 845 41 Bratislava, Slovakia
- Correspondence: (W.S.K.); (A.E.)
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Li Z, Huang Z, Bai L. Cell Interplay in Osteoarthritis. Front Cell Dev Biol 2021; 9:720477. [PMID: 34414194 PMCID: PMC8369508 DOI: 10.3389/fcell.2021.720477] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/14/2021] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis (OA) is a common chronic disease and a significant health concern that needs to be urgently solved. OA affects the cartilage and entire joint tissues, including the subchondral bone, synovium, and infrapatellar fat pads. The physiological and pathological changes in these tissues affect the occurrence and development of OA. Understanding complex crosstalk among different joint tissues and their roles in OA initiation and progression is critical in elucidating the pathogenic mechanism of OA. In this review, we begin with an overview of the role of chondrocytes, synovial cells (synovial fibroblasts and macrophages), mast cells, osteoblasts, osteoclasts, various stem cells, and engineered cells (induced pluripotent stem cells) in OA pathogenesis. Then, we discuss the various mechanisms by which these cells communicate, including paracrine signaling, local microenvironment, co-culture, extracellular vesicles (exosomes), and cell tissue engineering. We particularly focus on the therapeutic potential and clinical applications of stem cell-derived extracellular vesicles, which serve as modulators of cell-to-cell communication, in the field of regenerative medicine, such as cartilage repair. Finally, the challenges and limitations related to exosome-based treatment for OA are discussed. This article provides a comprehensive summary of key cells that might be targets of future therapies for OA.
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Affiliation(s)
- Zihao Li
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziyu Huang
- Foreign Languages College, Shanghai Normal University, Shanghai, China
| | - Lunhao Bai
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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Difference in Movement between Superficial and Deep Parts of the Infrapatellar Fat Pad during Knee Extension. J Funct Morphol Kinesiol 2021; 6:jfmk6030068. [PMID: 34449659 PMCID: PMC8395910 DOI: 10.3390/jfmk6030068] [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: 07/22/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023] Open
Abstract
(1): The superficial and deep parts of the infrapatellar fat pat (IFP) have different morphological and functional characteristics. Knee pain often occurs during movement, and it is important to clarify the movement of the IFP during knee joint movement. The purpose of this study is to clarify that the movement of the superficial and deep parts of the IFP are different during knee extension in vivo using ultrasonography (US). (2): US was performed on 15 knees of 15 healthy adults. The probe was placed longitudinally at the center of the patellar tendon and the IFP was imaged. Measurements were taken during active extension of the knee from 90 degrees to 10 degrees of knee flexion at a rate of 30 times/min. The captured US videos were analyzed using Flow particle image velocimetry (Flow PIV) fluid measurement software. The region-of-interest (ROI) was set at the superficial part and the deep part of the IFP, and the flow velocity was calculated for each. (3): The flow velocity of the deep part (1.37 ± 0.13 cm/s) of the IFP was significantly faster than that of the superficial part (0.80 ± 0.23 cm/s). (4): Our results show that the flow velocity of the IFP is different between the superficial and deep parts and that US may be a better assessment tool for the movement of the IFP.
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Sweeney E, Rodenberg R, MacDonald J. Overuse Knee Pain in the Pediatric and Adolescent Athlete. Curr Sports Med Rep 2021; 19:479-485. [PMID: 33156034 DOI: 10.1249/jsr.0000000000000773] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Overuse knee pain is common in young athletes. There are many potential overuse injuries which present with insidious onset of pain that can challenge sports medicine providers, including Osgood-Schlatter's disease, patellofemoral syndrome, osteochondritis dissecans, and stress fractures. The differential diagnosis of insidious onset knee pain also includes malignancies, infections, and rheumatologic issues. A thorough history and physical examination can guide the treating provider in making a diagnosis and appropriate treatment plan. Although not always necessary, imaging is often helpful in overuse knee pain, and laboratory workup may be necessary. Conservative treatment is often the first recommendation in the management of overuse knee pain in young athletes, and this may include activity modification, ice, anti-inflammatory medications, bracing, and physical therapy. This review summarizes common overuse knee injuries seen in pediatric and adolescent athletes.
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Narrative: Review of Anterior Knee Pain Differential Diagnosis (Other than Patellofemoral Pain). Curr Rev Musculoskelet Med 2021; 14:232-238. [PMID: 33818700 DOI: 10.1007/s12178-021-09704-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW This review presents a framework for constructing a differential diagnosis for chronic anterior knee pain associated with overuse other than patellofemoral pain. Traumatic, systemic, and pediatric injuries will not be covered. RECENT FINDINGS From superficial to deep, the anterior knee can be conceptually organized into four layers: (1) soft tissue, (2) extensor mechanism, (3) intracapsular/extrasynovial, and (4) intra-articular. From superficial to deep, diagnoses to consider include bursitis, patellar and quadriceps tendinosis, fat pad impingement, and plica syndromes.
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Genc E, Duymaz T. Functional effects of kinesiology taping for medial plica syndrome: a prospective randomized controlled trial. Physiother Theory Pract 2021; 38:1581-1590. [PMID: 33567953 DOI: 10.1080/09593985.2021.1885089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Medial plica syndrome (MPS) is a common yet overlooked cause of anterior knee pain. The treatment options for MPS include a variety of conservative approaches, however, the effect of kinesiology taping (KT), which is a feasible and effective treatment choice for musculoskeletal pathologies, has not been studied.Objectives: We investigated the efficacy of KT in addition to exercise in terms of pain severity, pain threshold, functional muscle strength of lower extremity, dynamic balance, functional status, and quality of life in patients with MPS.Methods: Eighty participants with MPS were randomly and equally divided into two groups: 1) the KT group, which received KT in addition to a 6-week exercise program; and 2) the control group, which received the 6-week exercise program alone. The following evaluations were conducted before and after the treatment; pain threshold, pain severity, disability level, functional strength and dynamic balance of the lower extremity, and quality of life.Results: Pain intensity decreased during activity, at rest, and night (KT group p < .001; control group p ≤ 0.013), and pain thresholds increased (KT group p < .001; control group p = .008) in both groups, however, the after treatment measures were better in the KT group (p ≤ 0.012). The time taken to complete the stairs up and down test decreased in both groups (KT group p < .001, control group p = .007) with a better outcome in the KT group (p = .024). Disability scores improved significantly in the KT only (p < .001). The quality of life improved in both groups (KT group p < .001; control group p = .005).Conclusions: While exercise therapy is beneficial in MPS treatment for functionality and pain relief; KT, in addition to exercise, improved symptoms and decreased impairment more efficiently than exercise alone in patients with MPS in our study, and it is thus a favorable treatment option for MPS.
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Affiliation(s)
- Erdinc Genc
- Department of Orthopaedics and Traumatology Clinic, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul Bilgi University, Istanbul, Turkey
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Kouroupis D, Willman MA, Best TM, Kaplan LD, Correa D. Infrapatellar fat pad-derived mesenchymal stem cell-based spheroids enhance their therapeutic efficacy to reverse synovitis and fat pad fibrosis. Stem Cell Res Ther 2021; 12:44. [PMID: 33413649 PMCID: PMC7792122 DOI: 10.1186/s13287-020-02107-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background To investigate the in vitro and in vivo anti-inflammatory/anti-fibrotic capacity of IFP-MSC manufactured as 3D spheroids. Our hypothesis is that IFP-MSC do not require prior cell priming to acquire a robust immunomodulatory phenotype in vitro in order to efficiently reverse synovitis and IFP fibrosis, and secondarily delay articular cartilage damage in vivo. Methods Human IFP-MSC immunophenotype, tripotentiality, and transcriptional profiles were assessed in 3D settings. Multiplex secretomes were assessed in IFP-MSC spheroids [Crude (non-immunoselected), CD146+ or CD146− immunoselected cells] and compared with 2D cultures with and without prior inflammatory/fibrotic cell priming. Functionally, IFP-MSC spheroids were assessed for their immunopotency on human PBMC proliferation and their effect on stimulated synoviocytes with inflammation and fibrotic cues. The anti-inflammatory and anti-fibrotic spheroid properties were further evaluated in vivo in a rat model of acute synovitis/fat pad fibrosis. Results Spheroids enhanced IFP-MSC phenotypic, transcriptional, and secretory immunomodulatory profiles compared to 2D cultures. Further, CD146+ IFP-MSC spheroids showed enhanced secretory and transcriptional profiles; however, these attributes were not reflected in a superior capacity to suppress activated PBMC. This suggests that 3D culturing settings are sufficient to induce an enhanced immunomodulatory phenotype in both Crude and CD146-immunoselected IFP-MSC. Crude IFP-MSC spheroids modulated the molecular response of synoviocytes previously exposed to inflammatory cues. Therapeutically, IFP-MSC spheroids retained substance P degradation potential in vivo, while effectively inducing resolution of inflammation/fibrosis of the synovium and fat pad. Furthermore, their presence resulted in arrest of articular cartilage degradation in a rat model of progressive synovitis and fat pad fibrosis. Conclusions 3D spheroids confer IFP-MSC a reproducible and enhanced immunomodulatory effect in vitro and in vivo, circumventing the requirement of non-compliant cell priming or selection before administration and thereby streamlining cell products manufacturing protocols.
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Affiliation(s)
- Dimitrios Kouroupis
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami, Miller School of Medicine, 1450 NW 10th Ave (3014), Miami, FL, 33136, USA.,Diabetes Research Institute & Cell Transplantation Center, University of Miami, Miller School of Medicine, 1450 NW 10th Ave (3014), Miami, FL, 33136, USA
| | - Melissa A Willman
- Diabetes Research Institute & Cell Transplantation Center, University of Miami, Miller School of Medicine, 1450 NW 10th Ave (3014), Miami, FL, 33136, USA
| | - Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami, Miller School of Medicine, 1450 NW 10th Ave (3014), Miami, FL, 33136, USA
| | - Lee D Kaplan
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami, Miller School of Medicine, 1450 NW 10th Ave (3014), Miami, FL, 33136, USA
| | - Diego Correa
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami, Miller School of Medicine, 1450 NW 10th Ave (3014), Miami, FL, 33136, USA. .,Diabetes Research Institute & Cell Transplantation Center, University of Miami, Miller School of Medicine, 1450 NW 10th Ave (3014), Miami, FL, 33136, USA.
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van der Heijden RA, de Vries BA, Poot DHJ, van Middelkoop M, Bierma-Zeinstra SMA, Krestin GP, Oei EHG. Quantitative volume and dynamic contrast-enhanced MRI derived perfusion of the infrapatellar fat pad in patellofemoral pain. Quant Imaging Med Surg 2021; 11:133-142. [PMID: 33392017 DOI: 10.21037/qims-20-441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Patellofemoral pain (PFP) is a common knee condition and possible precursor of knee osteoarthritis (OA). Inflammation, leading to an increased perfusion, or increased volume of the infrapatellar fat pad (IPFP) may induce knee pain. The aim of the study was to compare quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters, as imaging biomarkers of inflammation, and volume of the IPFP between patients with PFP and controls and between patients with and without IPFP edema or joint effusion. Methods Patients with PFP and healthy controls were included and underwent non-fat suppressed 3D fast-spoiled gradient-echo (FSPGR) and DCE-MRI. Image registration was applied to correct for motion. The IPFP was delineated on FSPGR using Horos software. Volume was calculated and quantitative perfusion parameters were extracted by fitting extended Tofts' pharmacokinetic model. Differences in volume and DCE-MRI parameters between patients and controls were tested by linear regression analyses. IPFP edema and effusion were analyzed identically. Results Forty-three controls and 35 PFP patients were included. Mean IPFP volume was 26.04 (4.18) mL in control subjects and 27.52 (5.37) mL in patients. Median Ktrans was 0.017 (0.016) min-1 in control subjects and 0.016 (0.020) min-1 in patients. None of the differences in volume and perfusion parameters were statistically significant. Knees with effusion showed a higher perfusion of the IPFP compared to knees without effusion in patients only. Conclusions The IPFP has been implicated as source of knee pain, but higher DCE-MR blood perfusion, an imaging biomarker of inflammation, and larger volume are not associated with PFP. Patient's knees with effusion showed a higher perfusion, pointing towards inflammation.
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Affiliation(s)
| | - Bas A de Vries
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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Rim YA, Ju JH. The Role of Fibrosis in Osteoarthritis Progression. Life (Basel) 2020; 11:life11010003. [PMID: 33374529 PMCID: PMC7822172 DOI: 10.3390/life11010003] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a chronic degenerative joint disease where the main characteristics include cartilage degeneration and synovial membrane inflammation. These changes in the knee joint eventually dampen the function of the joint and restrict joint movement, which eventually leads to a stage where total joint replacement is the only treatment option. While much is still unknown about the pathogenesis and progression mechanism of OA, joint fibrosis can be a critical issue for better understanding this disease. Synovial fibrosis and the generation of fibrocartilage are the two main fibrosis-related characteristics that can be found in OA. However, these two processes remain mostly misunderstood. In this review, we focus on the fibrosis process in OA, especially in the cartilage and the synovium tissue, which are the main tissues involved in OA.
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Affiliation(s)
- Yeri Alice Rim
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Ji Hyeon Ju
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2258-6895
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Ford B, Halaki M, Diong J, Ginn KA. Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review. Scand J Pain 2020; 21:217-237. [PMID: 34387953 DOI: 10.1515/sjpain-2020-0076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/16/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Experimental pain is a commonly used method to draw conclusions about the motor response to clinical musculoskeletal pain. A systematic review was performed to determine if current models of acute experimental pain validly replicate the clinical experience of appendicular musculoskeletal pain with respect to the distribution and quality of pain and the pain response to provocation testing. METHODS A structured search of Medline, Scopus and Embase databases was conducted from database inception to August 2020 using the following key terms: "experimental muscle pain" OR "experimental pain" OR "pain induced" OR "induced pain" OR "muscle hyperalgesia" OR ("Pain model" AND "muscle"). Studies in English were included if investigators induced experimental musculoskeletal pain into a limb (including the sacroiliac joint) in humans, and if they measured and reported the distribution of pain, quality of pain or response to a provocation manoeuvre performed passively or actively. Studies were excluded if they involved prolonged or delayed experimental pain, if temporomandibular, orofacial, lumbar, thoracic or cervical spine pain were investigated, if a full text of the study was not available or if they were systematic reviews. Two investigators independently screened each title and abstract and each full text paper to determine inclusion in the review. Disagreements were resolved by consensus with a third investigator. RESULTS Data from 57 experimental pain studies were included in this review. Forty-six of these studies reported pain distribution, 41 reported pain quality and six detailed the pain response to provocation testing. Hypertonic saline injection was the most common mechanism used to induce pain with 43 studies employing this method. The next most common methods were capsaicin injection (5 studies) and electrical stimulation, injection of acidic solution and ischaemia with three studies each. The distribution of experimental pain was similar to the area of pain reported in clinical appendicular musculoskeletal conditions. The quality of appendicular musculoskeletal pain was not replicated with the affective component of the McGill Pain Questionnaire consistently lower than that typically reported by musculoskeletal pain patients. The response to provocation testing was rarely investigated following experimental pain induction. Based on the limited available data, the increase in pain experienced in clinical populations during provocative maneuvers was not consistently replicated. CONCLUSIONS Current acute experimental pain models replicate the distribution but not the quality of chronic clinical appendicular musculoskeletal pain. Limited evidence also indicates that experimentally induced acute pain does not consistently increase with tests known to provoke pain in patients with appendicular musculoskeletal pain. The results of this review question the validity of conclusions drawn from acute experimental pain studies regarding changes in muscle behaviour in response to pain in the clinical setting.
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Affiliation(s)
- Brendon Ford
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
| | - Mark Halaki
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSWAustralia
| | - Joanna Diong
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
| | - Karen A Ginn
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
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Asai K, Nakase J, Oshima T, Shimozaki K, Yoshimizu R, Tsuchiya H. Partial resection of the infrapatellar fat pad during anterior cruciate ligament reconstruction has no effect on clinical outcomes including anterior knee pain. Arch Orthop Trauma Surg 2020; 140:1751-1757. [PMID: 32566980 DOI: 10.1007/s00402-020-03520-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Anterior knee pain (AKP) is a major complication that occurs after anterior cruciate ligament reconstruction (ACLR), even when hamstring tendon (HT) grafts are used. Damage to the infrapatellar fat pad (IPFP) during arthroscopy can cause AKP. The purpose of this study was to evaluate the influence of IPFP preservation on clinical outcomes, including AKP, in patients who underwent ACLR with HT autografts using the inside-out technique. METHODS Forty-two patients who underwent primary ACLR with HT autografts were prospectively assessed for 2 years after surgery. They were randomly selected to undergo treatment with as much intercondylar IPFP preservation as possible or with intercondylar IPFP resection to confirm the ACL origin on the femoral and tibial sides, especially the femoral footprint in deep flexion of the knee joint. The total IPFP volume was calculated using sagittal MR images before and 6 months after surgery. The patients completed a subjective knee score questionnaire and were assessed for patellar tendon tenderness and pain with the half-squat test or single-leg hop test at 6 months and 2 years postoperatively. RESULTS There were no differences in the patient characteristics, including age, sex, BMI, time from injury to surgery, and meniscus tear. The difference in the total size of the IPFP preserved was significant (P = 0.004). However, there were no significant differences in the subjective knee scores. Moreover, there were no differences in the clinical assessment parameters between the IPFP preservation and resection groups. CONCLUSIONS The size of the IPFP decreased more in the resection group than in the preservation group at 6 months after surgery. However, partial IPFP resection, which was used to better visualize the origin of the ACL, had no effect on the clinical outcomes, including AKP. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Takeshi Oshima
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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46
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Zhao G, Liu C, Chen K, Chen F, Lyu J, Chen J, Shi J, Huang G, Wei Y, Wang S, Xia J. Predictive value of adipose to muscle area ratio based on MRI at knee joint for postoperative functional outcomes in elderly osteoarthritis patients following total knee arthroplasty. J Orthop Surg Res 2020; 15:494. [PMID: 33109259 PMCID: PMC7590798 DOI: 10.1186/s13018-020-02014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current research used a new index-adipose to muscle area ratio (AMR)-to measure fatness compared with body mass index (BMI) in elderly osteoarthritis (OA) patients following total knee arthroplasty. Our study aimed to test the relationship between the two indexes (AMR and BMI) and to examine whether AMR was a predictive factor of patient-reported outcome measures (PROMS) for elderly OA patients following total knee arthroplasty (TKA). METHODS The retrospective data of 78 OA patients (older than 60 years) following TKA was included in our study. Clinical features of patients included age, BMI, sex, AMR, side of the implant, time of follow-up, complications, the Knee Society Score (KSS score), and the Hospital for Special Surgery knee score (HSS score). The area of adipose tissue and muscle tissue was measured on the cross section (supra-patella, midline of the patella, joint line of the knee) of the knee magnetic resonance imaging (MRI). AMR was calculated as the average of adipose to muscle area ratio at the three levels. The Pearson correlation analysis, simple linear regression, and multiple linear regression were used to study the relationship between BMI, AMR, and PROMS (KSS total-post score and HSS-post score) in the study. RESULTS Of all patients, the mean (± standard deviations (SD)) of age was 67.78 ± 4.91 years. For BMI and AMR, the mean (± SD) were 26.90 ± 2.11 and 2.36 ± 0.69, respectively. In Pearson correlation analysis, BMI had a good correlation with AMR (r = 0.56, p = 0.000), and AMR (r = - 0.37, p = 0.001, HSS-post score; r = - 0.43, p = 0.000, KSS total-post score) had better correlations with PROMS postoperatively compared with BMI (r = - 0.27, p = 0.019, HSS-post score; r = - 0.33, p = 0.003, KSS total-post score). In multivariate linear regression analysis, AMR was negatively correlated with KSS total-post score as well as HSS-post score, while BMI was not. As for patients with complications, AMR values were between the 3rd quartile and 4th quartile of the AMR value in the entire study cohort. CONCLUSIONS In this study, the new obesity evaluation indicator-AMR, which was well related with BMI, was found to be a predictor of PROMS (KSS total-post score and HSS-post score) in elderly OA patients following TKA.
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Affiliation(s)
- Guanglei Zhao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Changquan Liu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Kangming Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Feiyan Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jinyang Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jie Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jingsheng Shi
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Gangyong Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Yibing Wei
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Siqun Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jun Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
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Zeng N, Yan ZP, Chen XY, Ni GX. Infrapatellar Fat Pad and Knee Osteoarthritis. Aging Dis 2020; 11:1317-1328. [PMID: 33014539 PMCID: PMC7505265 DOI: 10.14336/ad.2019.1116] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/16/2019] [Indexed: 02/05/2023] Open
Abstract
Osteoarthritis is the most prevalent arthritis typically characterized by degradation of cartilage. However, its pathogenesis is not fully understood. Currently, osteoarthritis is best considered a disease of the whole "joint organ". Infrapatellar fat pad (IFP), an adipose tissue near synovium, is now attaching importance to researchers for its inflammatory phenotype. In this narrative review, a large body of evidence has been gathered for the involvement of IFP in the development of knee osteoarthritis. Additionally, the underlying mechanisms of how IFP can be involved in this process have been proposed. However, further investigations are needed to better understand its precise role in this process and its underlying mechanism, and beyond that, to develop new strategies to slow down the degenerative process and explore an effective and timely diagnosis of the disease.
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Affiliation(s)
- Ni Zeng
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Peng Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xin-Yuan Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- Correspondence should be addressed to: Dr. Guo-Xin Ni, School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
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48
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Sun C, Zhang X, Lee WG, Tu Y, Li H, Cai X, Yang H. Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2020; 15:297. [PMID: 32758250 PMCID: PMC7409474 DOI: 10.1186/s13018-020-01823-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The infrapatellar fat pad (IPFP) or Hoffa's fat pad is often resected during total knee arthroplasty in order to improve visibility. However, the management of the IPFP during total knee arthroplasty (TKA) is the subject of an ongoing debate that has no clear consensus. The purpose of this review was to appraise if resection of the IPFP affects clinical outcomes. METHODS We conducted a meta-analysis to identify relevant randomized controlled trials involving infrapatellar fat pad resection and infrapatellar fat pad preservation during total knee arthroplasty in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database, up to March 2020. RESULTS Nine randomized controlled trials, involving 783 TKAs (722 patients), were included in the systematic review. Outcome measures included patellar tendon length (PTL), Insall-Salvati ratio (ISR), rate of anterior knee pain, Knee Society Scores (KSS), and knee range of motion. The meta-analysis identified a trend toward the shortening of the patellar tendon with IPFP resection at 6 months (P = 0.0001) and 1 year (P = 0.001). We found no statistical difference in ISR (P = 0.87), rate of anterior knee pain within 6 months (p = 0.45) and 1 year (p = 0.38), KSS at 1 year (p = 0.77), and knee range of motion within 6 months (p = 0.61) and 1 year (0.46). CONCLUSION Based on the available level I evidence, we were unable to conclude that one surgical technique of IPFP can definitively be considered superior over the other. More adequately powered and better-designed randomized controlled trial (RCT) studies with long-term follow-up are required to produce evidence-based guidelines regarding IPFP resection.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Woo Guan Lee
- Department of Orthopedic, Kuching Specialist Hospital, Tabuan Stutong Commercial Centre, 93350, Kuching, Sarawak, Malaysia
| | - Yan Tu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Huimin Li
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
| | - Huadong Yang
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
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49
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Kim YM, Joo YB, Lee WY, Park IY, Park YC. Patella-patellar tendon angle decreases in patients with infrapatellar fat pad syndrome and medial patellar plica syndrome. Knee Surg Sports Traumatol Arthrosc 2020; 28:2609-2618. [PMID: 32125441 DOI: 10.1007/s00167-020-05892-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Infrapatellar fat pad (IPFP) syndrome and medial patellar plica (MPP) syndrome are two recognized causes of anterior knee pain. However, diagnosing these syndromes is challenging without arthroscopic examination. The aim of this study was to evaluate sagittal patellar tilt in patients with IPFP syndrome or MPP syndrome by measuring the patella-patellar tendon angle (PPTA) in affected patients. METHODS Eighty-three patients with anterior knee pain who underwent diagnostic arthroscopy that confirmed isolated IPFP or MPP syndrome from 2011 to 2016 were included in this retrospective study. Patients were divided into Group A (IPFP syndrome, n = 44) and Group B (MPP syndrome, n = 39). The control group included 78 patients without knee pathology who underwent magnetic resonance imaging (MRI) of the knee during the study period. Radiographic measurements, including PPTA, IPFP area, patellar height, axial patellar alignment, patellar tilt, sulcus angle, and lateral trochlear inclination, were made on MRI images by two experienced sports medicine orthopedists. RESULTS The mean PPTA in each knee-pathology group was significantly smaller than that in the control group (Group A: 137.3° ± 4.9°; Group B: 138.1° ± 3.2°; control group, 141.4° ± 2.9°). There was no significant difference between groups for any other radiographic parameter evaluated. CONCLUSION The PPTA was significantly smaller in patients with IPFP syndrome or MPP syndrome than in healthy controls. Therefore, sagittal patellar tilt should be included in the routine evaluation of patients with anterior knee pain. Evaluation of PPTA may help to diagnose IPFP syndrome or MPP syndrome. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Young Mo Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
| | - Yong Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea.
| | - Woo Yong Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
| | - Il Young Park
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
| | - Young Cheol Park
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
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50
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Greif DN, Kouroupis D, Murdock CJ, Griswold AJ, Kaplan LD, Best TM, Correa D. Infrapatellar Fat Pad/Synovium Complex in Early-Stage Knee Osteoarthritis: Potential New Target and Source of Therapeutic Mesenchymal Stem/Stromal Cells. Front Bioeng Biotechnol 2020; 8:860. [PMID: 32850724 PMCID: PMC7399076 DOI: 10.3389/fbioe.2020.00860] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022] Open
Abstract
The infrapatellar fat pad (IFP) has until recently been viewed as a densely vascular and innervated intracapsular/extrasynovial tissue with biomechanical roles in the anterior compartment of the knee. Over the last decade, secondary to the proposition that the IFP and synovium function as a single unit, its recognized tight molecular crosstalk with emerging roles in the pathophysiology of joint disease, and the characterization of immune-related resident cells with varying phenotypes (e.g., pro and anti-inflammatory macrophages), this structural complex has gained increasing attention as a potential therapeutic target in patients with various knee pathologies including osteoarthritis (KOA). Furthermore, the description of the presence of mesenchymal stem/stromal cells (MSC) as perivascular cells within the IFP (IFP-MSC), exhibiting immunomodulatory, anti-fibrotic and neutralizing activities over key local mediators, has promoted the IFP as an alternative source of MSC for cell-based therapy protocols. These complementary concepts have supported the growing notion of immune and inflammatory events participating in the pathogenesis of KOA, with the IFP/synovium complex engaging not only in amplifying local pathological responses, but also as a reservoir of potential therapeutic cell-based products. Consequently, the aim of this review is to outline the latest discoveries related with the IFP/synovium complex as both an active participant during KOA initiation and progression thus emerging as a potential target, and a source of therapeutic IFP-MSCs. Finally, we discuss how these notions may help the design of novel treatments for KOA through modulation of local cellular and molecular cascades that ultimately lead to joint destruction.
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Affiliation(s)
- Dylan N Greif
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Dimitrios Kouroupis
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Christopher J Murdock
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Anthony J Griswold
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Lee D Kaplan
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Diego Correa
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States.,Diabetes Research Institute and Cell Transplant Center, Miller School of Medicine, University of Miami, Miami, FL, United States
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