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Weninger P, Feichtinger X, Steffel C, Kerschbaumer C, Duscher D. Arthroscopy with Lipoaspirate and Plasma Infiltration Using Adipose-Derived Stem Cells Plus Platelet-Rich Plasma: Harvesting and Injection for Arthroscopic Treatment of Cartilage Defects of the Knee. Arthrosc Tech 2023; 12:e2265-e2271. [PMID: 38196888 PMCID: PMC10773146 DOI: 10.1016/j.eats.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/30/2023] [Indexed: 01/11/2024] Open
Abstract
Osteoarthritis, predominantly of the knee, is a highly prevalent disease leading to pain, reduced quality of life, and significantly reduced ability to work. With autologous orthobiologic options, new regenerative treatment methods have emerged, offering an alternative to early surgical intervention. Supercharged Liparthroplasty combines arthroscopy with lipoaspirate and plasma infiltration of the joint. Lipoaspirate contains high levels of adipose-derived stem cells, which show chondroprotective and anti-inflammatory qualities. Intra-articular injection, combined with platelet-rich plasma administration for accelerated cartilage metabolism, thus provides an optional approach in osteoarthritis treatment. This article aims to provide in detail our regimen for Supercharged Liparthroplasty, including tissue harvesting and preparation of the injectables, therefore enabling physicians to adopt this point-of-care technique.
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Affiliation(s)
- Patrick Weninger
- Sports Medical Center, Vienna, Austria
- Academic Stem Cell Center Vienna, Vienna, Austria
| | | | - Caterina Steffel
- Sports Medical Center, Vienna, Austria
- Academic Stem Cell Center Vienna, Vienna, Austria
| | | | - Dominik Duscher
- The Face and Longevity Center Munich, Munich, Germany
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, Tübingen, Germany
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Feichtinger X, Muji E, Domej MA, Pauzenberger L, Baierl A, Kocijan R, Loho G, Brandl G. Combined press-fit and extracortical fixation in patellar tendon anterior cruciate ligament reconstruction results in reliable graft fixation and early bone block incorporation. Knee 2023; 43:18-27. [PMID: 37210858 DOI: 10.1016/j.knee.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/19/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction with bone-patellar-tendon-bone (BPTB) autograft has the potential biological advantage of direct bone-to-bone healing over soft tissue grafts. The primary aim of this study was to investigate possible graft slippage and therefore fixation strength in a modified BPTB autograft technique with suspensory fixation on both sides for primary ACL reconstruction until bony integration takes place. METHODS Twenty-one patients undergoing primary ACL reconstruction with a modified BPTB autograft (bone-on-bone (BOB) technique) between August 2017 and August 2019 were included in this prospective study. A computed tomography (CT) scan of the affected knee was performed directly postoperatively, as well as 3 months postoperatively. Examiner-blinded parameters for graft slippage, early tunnel widening, bony incorporation, as well as remodeling of the autologous refilled patellar harvest site were investigated. RESULTS A series of 21 patients treated with a BPTB autograft with this technique underwent two CT investigations. Comparison of CT scans showed no bone block displacement and therefore no graft slippage in the patient cohort. Only one patient showed signs of early tunnel enlargement. Radiological bone block incorporation took place showing bony bridging of the graft to the tunnel wall in 90% of all patients. Furthermore, 90% showed less than 1 mm bone resorption of the refilled harvest site at the patella. CONCLUSIONS Our findings suggest graft fixation stability and reliability of anatomic BPTB ACL reconstruction with a combined press-fit and suspensory fixation technique by absence of graft slippage within the first 3 months postoperatively.
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Affiliation(s)
- Xaver Feichtinger
- Department of Orthopedic Surgery II, Herz-Jesu Hospital Vienna, Austria.
| | - Edin Muji
- Department of Orthopedic Surgery II, Herz-Jesu Hospital Vienna, Austria
| | - Marija Ana Domej
- Department of Orthopedic Surgery II, Herz-Jesu Hospital Vienna, Austria
| | - Leo Pauzenberger
- Department of Orthopedic Surgery II, Herz-Jesu Hospital Vienna, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, The University of Vienna, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology, 1st Medical Department at Hanusch Hospital, Vienna, Austria
| | - Gerald Loho
- Department of Orthopedic Surgery II, Herz-Jesu Hospital Vienna, Austria
| | - Georg Brandl
- Department of Orthopedic Surgery II, Herz-Jesu Hospital Vienna, Austria
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Weninger P, Thallinger C, Chytilek M, Hanel Y, Steffel C, Karimi R, Feichtinger X. Extracorporeal Shockwave Therapy Improves Outcome after Primary Anterior Cruciate Ligament Reconstruction with Hamstring Tendons. J Clin Med 2023; 12:jcm12103350. [PMID: 37240456 DOI: 10.3390/jcm12103350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE The decision regarding the timepoint of a return to sports after anterior cruciate ligament (ACL) reconstruction is complex and depends on many factors, including objectively tested physical and psychological readiness as well as biological healing. The aim of this study was to investigate the influence of repetitive extracorporeal shockwave therapy (ESWT) on return-to-sports duration, clinical results and MRI results after ACL reconstruction with hamstring tendons (HT). MATERIAL AND METHODS In this prospective controlled study, all patients with acute ACL ruptures were treated by ACL reconstruction with HT. Patients were randomized into two groups (Group A: ESWT group; Group B: control group). Patients in the ESWT group received focused shockwave therapy 4, 5 and 6 weeks after ACL surgery. Follow-up investigations including IKDC score, Lysholm score, VAS and evaluation regarding return-to-sports timepoints that were conducted 3-, 6-, 9- and 12-months post-operation. An MRI investigation was performed 12-months post-operation and graft maturation (signal intensity ratio (SIR)) as well as femoral and tibial tunnel characteristics (bone marrow oedema, tunnel fluid effusion) were assessed. RESULTS In total, 65 patients (27.65 ± 7.07 years; 35 male/30 female) were included in this study. The mean timepoint for "return-to-pivoting-sports" was 27.92 weeks (±2.99) in the ESWT group as well as 42.64 weeks (±5.18) in the control group (p < 0.001). In the ESWT group 31 patients (vs. CONTROL GROUP n = 6) attained the "pre-injury activity level", whereas 6 patients (vs. CONTROL GROUP n = 22) did not reach this level within 12 months post-operation. The IKDC score, Lysholm score, and VAS showed significant improvement in the ESWT group compared with the control group for all time-points (p < 0.001). The mean SIR in the ESWT group revealed 1.81 (±0.88), whereas the control group showed a mean SIR of 2.68 (±1.04) (p < 0.01). DISCUSSION In conclusion, this is the first study investigating the effect of repetitive ESWT on ACL reconstruction with clinical outcome measurements, including the duration of return-to-sports activity and an MRI follow-up examination. Return-to-sports parameters, clinical scores and graft maturation were significantly improved in the ESWT group. This study may support an earlier return-to-sports timepoint by ESWT and is of high clinical relevance as ESWT is a cost-effective treatment option with no relevant side effects.
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Affiliation(s)
- Patrick Weninger
- Sports Medical Center, Am Hof 11/9, 1010 Vienna, Austria
- Döbling Private Clinic, Heiligenstädter Straße 55-63, 1190 Vienna, Austria
| | | | | | - Yannis Hanel
- Sports Medical Center, Am Hof 11/9, 1010 Vienna, Austria
| | | | - Ramin Karimi
- Döbling Private Clinic, Heiligenstädter Straße 55-63, 1190 Vienna, Austria
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Weninger P, Steffel C, Rabel S, Karimi R, Feichtinger X. Anterior Cruciate Ligament Reconstruction Using a Fascia Lata Graft With FiberTape Augmentation. Arthrosc Tech 2022; 12:e127-e133. [PMID: 36814977 PMCID: PMC9939742 DOI: 10.1016/j.eats.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Reconstruction of the anterior cruciate ligament (ACL) is one of the most popular orthopedic surgical procedures. To date, numerous studies are available focusing on different reconstruction techniques using established autografts, such as hamstrings, bone patellar-tendon bone (BPTB), quadriceps tendon, or allograft tendons. In the present article, we describe a minimally invasive ACL reconstruction technique using a fascia lata autograft in combination with FiberTape (Arthrex, Naples, FL) augmentation using the TightRope II (Arthrex). The minimally invasive harvesting procedure is performed by using the new QuadPro Tendon Harvester (Arthrex). This technique is recommended for acute and chronic complete ACL ruptures or bundle ruptures in athletes or patients with high physical activity. The technique might allow early full weight bearing due to less donor site morbidity, early free range of motion, and early active rehabilitation due to the use of FiberTape as a augmentation device to reinforce the autograft. Clinical studies are necessary to prove the principle.
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Affiliation(s)
- Patrick Weninger
- Sports Medical Center, Vienna, Austria,Döbling Private Hospital, Vienna, Austria,Address correspondence to Patrick Weninger, M.D., Am Hof 11/9, 1010 Vienna, Austria.
| | | | | | - Ramin Karimi
- Sports Medical Center, Vienna, Austria,Döbling Private Hospital, Vienna, Austria
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Schanda JE, Heher P, Weigl M, Drechsler S, Schädl B, Prueller J, Kocijan R, Heuberer PR, Hackl M, Muschitz C, Grillari J, Redl H, Feichtinger X, Fialka C, Mittermayr R. Muscle-Specific Micro-Ribonucleic Acids miR-1-3p, miR-133a-3p, and miR-133b Reflect Muscle Regeneration After Single-Dose Zoledronic Acid Following Rotator Cuff Repair in a Rodent Chronic Defect Model. Am J Sports Med 2022; 50:3355-3367. [PMID: 36053026 DOI: 10.1177/03635465221119507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Zoledronic acid improves bone microarchitecture and biomechanical properties after chronic rotator cuff repair (RCR) in rats. Besides the positive effects of zoledronic acid on bone mineral density and bone microarchitecture, bisphosphonates have positive effects on skeletal muscle function. PURPOSES/HYPOTHESIS The purposes of this study were to (1) longitudinally evaluate circulating bone- and muscle-specific serum micro-ribonucleic acids (miRNAs) and (2) investigate supraspinatus muscle tissue after tenotomy and delayed RCR in a rat model. It was hypothesized that zoledronic acid would improve muscle regeneration after chronic RCR in rats. STUDY DESIGN Controlled laboratory study. METHODS A total of 34 male Sprague-Dawley rats underwent unilateral (left) supraspinatus tenotomy (time point 1) with delayed transosseous RCR after 3 weeks (time point 2). All rats were sacrificed 8 weeks after RCR (time point 3). Animals were randomly assigned to 2 groups. One day after RCR, the control group was given 1 mL of subcutaneous saline solution, and the intervention group was treated with a subcutaneous single-dose of 100 µg/kg body weight of zoledronic acid. All 34 study animals underwent miRNA analysis at all 3 time points. In 4 animals of each group, histological analyses as well as gene expression analyses were conducted. RESULTS Circulating miRNAs showed significantly different expressions between both study groups. In the control group, a significant downregulation was observed for muscle-specific miR-1-3p (P = .004), miR-133a-3p (P < .001), and miR-133b (P < .001). Histological analyses showed significantly higher rates of regenerating myofibers on the operated side (left) of both study groups compared with the nonoperated side (right; P = .002). On the nonoperated side, significantly higher rates of regenerating myofibers were observed in the intervention group compared with the control group (P = .031). The myofiber cross-sectional area revealed significantly smaller myofibers on both sides within the intervention group compared with both sides of the control group (P < .001). Within the intervention group, significantly higher expression levels of muscle development/regeneration marker genes embryonal Myosin heavy chain (P = .017) and neonatal Myosin heavy chain (P = .016) were observed on the nonoperated side compared with the operated side. CONCLUSION An adjuvant single-dose of zoledronic acid after RCR in a chronic defect model in rats led to significant differences in bone- and muscle-specific miRNA levels. Therefore, miR-1-3p, miR-133a-3p, and miR-133b might be used as biomarkers for muscle regeneration after RCR. CLINICAL RELEVANCE Adjuvant treatment with zoledronic acid may improve muscle regeneration after chronic RCR in humans, thus counteracting fatty muscle infiltration and atrophy.
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Affiliation(s)
- Jakob E Schanda
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria; Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Philipp Heher
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; King's College London, Randall Centre for Cell and Molecular Biophysics, London, United Kingdom
| | - Moritz Weigl
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; TAmiRNA GmbH, Vienna, Austria
| | - Susanne Drechsler
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Barbara Schädl
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; Medical University of Vienna, University Clinic of Dentistry, Vienna, Austria
| | - Johanna Prueller
- King's College London, Randall Centre for Cell and Molecular Biophysics, London, United Kingdom
| | - Roland Kocijan
- Hanusch Hospital Vienna, Medical Department I, Vienna, Austria; Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria; Sigmund Freud University Vienna, Faculty for Medicine, Metabolic Bone Diseases Unit, Vienna, Austria
| | | | | | - Christian Muschitz
- St. Vincent Hospital Vienna, Medical Department II, VINFORCE, Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; University of Natural Resources and Life Science [BOKU], Institute of Molecular Biotechnology, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Xaver Feichtinger
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria; Sigmund Freud University Vienna, Faculty for Medicine, Department for Traumatology, Vienna, Austria
| | - Rainer Mittermayr
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria; Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Investigation performed at the Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria
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Feichtinger X, Heimel P, Tangl S, Keibl C, Nürnberger S, Schanda JE, Hercher D, Kocijan R, Redl H, Grillari J, Fialka C, Mittermayr R. Improved biomechanics in experimental chronic rotator cuff repair after shockwaves is not reflected by bone microarchitecture. PLoS One 2022; 17:e0262294. [PMID: 34986173 PMCID: PMC8730430 DOI: 10.1371/journal.pone.0262294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of this study was to investigate the effect of extracorporeal shockwave therapy (ESWT) on bone microstructure as well as the bone-tendon-interface and the musculo-tendinous transition zone to explain the previously shown improved biomechanics in a degenerative rotator cuff tear animal model. This study hypothesized that biomechanical improvements related to ESWT are a result of improved bone microstructure and muscle tendon properties. Methods In this controlled laboratory study unilateral supraspinatus (SSP) tendon detachment was performed in 48 male Sprague-Dawley rats. After a degeneration period of three weeks, SSP tendon was reconstructed transosseously. Rats were randomly assigned into three groups (n = 16 per group): control (noSW); intraoperative shockwave treatment (IntraSW); intra- and postoperative shockwave treatment (IntraPostSW). Eight weeks after SSP repair, all rats were sacrificed and underwent bone microstructure analysis as well as histological and immunohistochemical analyses. Results With exception of cortical porosity at the tendon area, bone microstructure analyses revealed no significant differences between the three study groups regarding cortical and trabecular bone parameters. Cortical Porosity at the Tendon Area was lowest in the IntraPostSW (p≤0.05) group. Histological analyses showed well-regenerated muscle and tendon structures in all groups. Immunohistochemistry detected augmented angiogenesis at the musculo-tendinous transition zone in both shockwave groups indicated by CD31 positive stained blood vessels. Conclusion In conclusion, bone microarchitecture changes are not responsible for previously described improved biomechanical results after shockwave treatment in rotator cuff repair in rodents. Immunohistochemical analysis showed neovascularization at the musculo-tendinous transition zone within ESWT-treated animals. Further studies focusing on neovascularization at the musculo-tendinous transition zone are necessary to explain the enhanced biomechanical and functional properties observed previously. Clinical relevance In patients treated with a double-row SSP tendon repair, an improvement in healing through ESWT, especially in this area, could prevent a failure of the medial row, which is considered a constantly observed tear pattern.
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Affiliation(s)
- Xaver Feichtinger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- AUVA Trauma Center Vienna—Meidling, Vienna, Austria
- Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- * E-mail:
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Stefan Tangl
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Sylvia Nürnberger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Division of Trauma-Surgery, Department of Orthopaedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Emanuel Schanda
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- AUVA Trauma Center Vienna—Meidling, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - David Hercher
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology, 1st Medical Department at Hanusch Hospital, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna—Meidling, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- AUVA Trauma Center Vienna—Meidling, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
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Dahm F, Feichtinger X, Vallant SM, Haffner N, Schaden W, Fialka C, Mittermayr R. High-energy extracorporeal shockwave therapy in humeral delayed and non-unions. Eur J Trauma Emerg Surg 2021; 48:3043-3049. [PMID: 34515810 DOI: 10.1007/s00068-021-01782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Within the last few decades, focused high-energy extracorporeal shockwave therapy (ESWT) has proven to be an effective alternative to standard of care revision surgery in delayed healing fractures or manifest non-unions in various anatomical regions. MATERIALS AND METHODS A retrospective multi-variant analysis of an open prospective, single-armed clinical study was conducted. Patients receiving focused high-energy ESWT for a delayed healing or an apparent non-union of a humeral fracture between January 1999 and December 2015 at a single trauma center were included in the study. Bony healing was defined as cortical continuity in three of four cortices and pain-free force loading and evaluated using CT scans and clinical examination at three- and six-month follow-ups after ESWT. RESULTS A total of 236 patients were included. N = 93 (43.8%) showed bony consolidation three months after ESWT and n = 105 (52.5%) after six months. Sub-group analysis showed significantly better healing for the proximal metaphyseal humerus (66.7% after six months, n = 42) compared to the diaphyseal region (48.1%, n = 133) and distal metaphyseal humerus (48.1%, n = 25). Regression analysis indicated significantly increased healing rates for patients of younger ages (p = 0.001) and a fracture diastasis of less than 5 mm (p = 0.002). CONCLUSION The findings of this study indicate that ESWT can be considered as a treatment option for a well-selected patient population despite the lower healing rates compared to other anatomical regions.
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Affiliation(s)
- Falko Dahm
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria. .,Women's College Hospital, University of Toronto Orthopaedics Sports Medicine, Toronto, Canada.
| | - Xaver Feichtinger
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | | | - Nicolas Haffner
- Department for Orthopedics and Trauma Surgery, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Wolfgang Schaden
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Feichtinger X, Dahm F, Schallmayer D, Boesmueller S, Fialka C, Mittermayr R. Surgery improves the clinical and radiological outcome in Rockwood type IV dislocations, whereas Rockwood type III dislocations benefit from conservative treatment. Knee Surg Sports Traumatol Arthrosc 2021; 29:2735-2736. [PMID: 33420808 DOI: 10.1007/s00167-020-06423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Xaver Feichtinger
- AUVA Trauma Center Vienna - Meidling, Kundratstrasse 37, Vienna, Austria.
| | - Falko Dahm
- AUVA Trauma Center Vienna - Meidling, Kundratstrasse 37, Vienna, Austria
| | - Daniel Schallmayer
- AUVA Trauma Center Vienna - Meidling, Kundratstrasse 37, Vienna, Austria
| | - Sandra Boesmueller
- AUVA Trauma Center Vienna - Meidling, Kundratstrasse 37, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna - Meidling, Kundratstrasse 37, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- AUVA Trauma Center Vienna - Meidling, Kundratstrasse 37, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
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Feichtinger X, Dahm F, Schallmayer D, Boesmueller S, Fialka C, Mittermayr R. Surgery improves the clinical and radiological outcome in Rockwood type IV dislocations, whereas Rockwood type III dislocations benefit from conservative treatment. Knee Surg Sports Traumatol Arthrosc 2021; 29:2143-2151. [PMID: 32748232 DOI: 10.1007/s00167-020-06193-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Despite the available classifications, diagnostics and treatment of acute acromioclavicular joint (ACJ) injuries are still vague and challenging for trauma and shoulder surgeons. This study aimed to evaluate the dynamic radiographic as well as clinical outcome of operatively and conservatively treated Rockwood (RW) type III and IV ACJ dislocations. MATERIALS AND METHODS All patients with RW type III and IV ACJ dislocations between 2009 and 2016 (n = 226) were included in this retrospective data analysis with a prospective follow-up examination. According to their injury classification, patients were subdivided in an operative and conservative treatment group. Examiner blinded clinical evaluation including the constant score (CS), American shoulder and elbow surgery (ASES) score, the acromioclavicular joint instability (ACJI) score, visual analog scale (VAS), bilateral force measurements, and posttraumatic/postsurgical sequelae were assessed. Fluoroscopic evaluations including dynamic stability assessment with functional axillary views were performed for every patient. RESULTS For follow-up examination (mean 4.8 years ± 0.3 SEM) 56 patients (29 RW type III, 27 RW type IV) were available. In patients with RW type III ACJ dislocations [operative (n = 10); conservative (n = 19)] prolonged duration of treatment was seen in operatively treated patients (p < 0.05). Clear improvement could be shown for the ACJI score (p < 0.05) and coracoclavicular (CC) and acromioclavicular (AC) distance (p < 0.05) in the operative group. In patients with RW type IV ACJ dislocations [operative (n = 18); conservative (n = 9)] superior clinical results were found in operated patients with highly significant differences for the ACJI score (p < 0.001). Radiographic dynamic horizontal analysis showed nearly normalized anteroposterior translation in operated patients (p < 0.05). No differences were found regarding arthroscopic or open procedures. CONCLUSION Accurate diagnostics including sufficient dynamic stability assessment with functional axillary views are strongly advised for patients with ACJ dislocations. Conservative treatment should be recommended for patients with RW type III ACJ dislocations, due to shorter duration of treatment with good clinical results but lacking operative risks. In patients with RW type IV ACJ dislocations, surgical treatment is recommended because of superior clinical and radiological results. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Xaver Feichtinger
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria.
| | - F Dahm
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - D Schallmayer
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - S Boesmueller
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - C Fialka
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - R Mittermayr
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
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10
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Weigl M, Kocijan R, Ferguson J, Leinfellner G, Heimel P, Feichtinger X, Pietschmann P, Grillari J, Zwerina J, Redl H, Hackl M. Longitudinal Changes of Circulating miRNAs During Bisphosphonate and Teriparatide Treatment in an Animal Model of Postmenopausal Osteoporosis. J Bone Miner Res 2021; 36:1131-1144. [PMID: 33598975 PMCID: PMC8252367 DOI: 10.1002/jbmr.4276] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 12/16/2022]
Abstract
MicroRNAs regulate bone homeostasis, and circulating microRNAs have been proposed as novel bone biomarkers. The effect of anti-osteoporotic treatment on circulating microRNAs has not been described in detail. Therefore, we performed a comprehensive analysis of microRNA serum levels in ovariectomized (OVX) and sham-operated (SHAM) rats over 12 weeks of antiresorptive or osteoanabolic treatment. Forty-two Sprague Dawley rats underwent SHAM surgery (n = 10) or ovariectomy (n = 32). After 8 weeks, OVX rats were randomized to antiresorptive treatment with zoledronate (n = 11), osteoanabolic treatment with teriparatide (n = 11), or vehicle treatment (n = 10). Serum samples were collected at weeks 8, 12, 16, and 20 after surgery. A total of 91 microRNAs were analyzed by RT-qPCR in serum samples collected at week 20. Based on the results, 29 microRNAs were selected for longitudinal analysis at all four study time points. Changes in bone mineral density and microstructure were followed up by in vivo micro-CT and ex vivo nano-CT. Ovariectomy resulted in the loss of trabecular bone, which was reversed by osteoanabolic and antiresorptive treatment. Differential expression analysis identified 11 circulating miRNAs that were significantly regulated after treatment. For example, miR-107 and miR-31-5p increased in vehicle-treated OVX animals, whereas they decreased during teriparatide treatment. Additional miRNAs were identified that showed significant correlations to bone microstructure or bone miRNA expression, including miR-203a-3p, which exhibited a significant negative correlation to vertebral and tibial trabecular bone volume fraction (%). Longitudinal analysis confirmed eight microRNAs with significant changes in serum over time that were prevented by teriparatide and zoledronate treatment (miR-34a-5p, miR-31-5p, miR-30d-3p, miR-378a-5p) or teriparatide treatment only (miR-375-3p, miR-183-5p, miR-203a-3p, miR-203b-3p). Gene target network analysis identified WNT and Notch signaling as the main signaling pathways controlled by these miRNAs. Thus, ovariectomy results in time-dependent deregulation of circulating miRNAs compared with SHAM animals. Anti-osteoporotic treatments can rescue this effect, showing that bone-related miRNAs might act as novel biomarkers for treatment monitoring. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Moritz Weigl
- TAmiRNA GmbHViennaAustria
- Austrian Cluster for Tissue RegenerationViennaAustria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre MeidlingViennaAustria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research CenterViennaAustria
- Medical Faculty of Bone DiseasesSigmund Freud UniversityViennaAustria
| | - James Ferguson
- Austrian Cluster for Tissue RegenerationViennaAustria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research CenterViennaAustria
| | - Gabriele Leinfellner
- Austrian Cluster for Tissue RegenerationViennaAustria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research CenterViennaAustria
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research CenterViennaAustria
- Karl Donath Laboratory for Hard Tissue and Biomaterial ResearchUniversity Clinic of Dentistry, Medical University of ViennaViennaAustria
| | - Xaver Feichtinger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research CenterViennaAustria
| | - Peter Pietschmann
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Johannes Grillari
- Austrian Cluster for Tissue RegenerationViennaAustria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research CenterViennaAustria
- Institute of Molecular Biotechnology, Department of BiotechnologyBOKU ‐ University of Natural Resources and Life Sciences ViennaViennaAustria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre MeidlingViennaAustria
| | - Heinz Redl
- Austrian Cluster for Tissue RegenerationViennaAustria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research CenterViennaAustria
| | - Matthias Hackl
- TAmiRNA GmbHViennaAustria
- Austrian Cluster for Tissue RegenerationViennaAustria
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11
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Mittermayr R, Haffner N, Feichtinger X, Schaden W. The role of shockwaves in the enhancement of bone repair - from basic principles to clinical application. Injury 2021; 52 Suppl 2:S84-S90. [PMID: 33714550 DOI: 10.1016/j.injury.2021.02.081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
Extracorporeal shockwave therapy is a treatment modality, originally introduced into the clinic as lithotripsie, which has also been successfully used in the last two decades in the non-invasive treatment of delayed or non-healing fractures. Initially, the mechanism of action was attributed to microfracture-induced repair, but intensive basic research has now shown that the shockwave generates its effect in tissue via mechanotransduction. Numerous signal transduction pathways have already been demonstrated, which in their entirety trigger an endogenous regeneration process via cell proliferation, migration and differentiation. Clinically, these shockwave-conveyed biological signals support healing of acute, delayed and non-union fractures. The attainable outcome is comparable to surgery but avoiding an open approach with associated potential complications. These advantageous properties with a clearly positive cost-benefit ratio make shockwave therapy a first line treatment in delayed and non-union fractures.
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Affiliation(s)
- Rainer Mittermayr
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; AUVA Trauma Center Meidling, Vienna, Austria; AUVA trauma research center, Vienna, Austria; Austrian Cluster for Tissue Engineering, Vienna, Austria.
| | - Nicolas Haffner
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; Clinic Floridsdorf, Orthopedic and Traumatology Department, Vienna, Austria
| | | | - Wolfgang Schaden
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; AUVA trauma research center, Vienna, Austria; Austrian Cluster for Tissue Engineering, Vienna, Austria; AUVA Medical Board, Vienna, Austria
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12
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Feichtinger X, Heimel P, Keibl C, Hercher D, Schanda JE, Kocijan R, Redl H, Grillari J, Fialka C, Mittermayr R. Lugol's solution but not formaldehyde affects bone microstructure and bone mineral density parameters at the insertion site of the rotator cuff in rats. J Orthop Surg Res 2021; 16:254. [PMID: 33849592 PMCID: PMC8045387 DOI: 10.1186/s13018-021-02394-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/05/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study aimed to investigate whether rodent shoulder specimens fixed in formaldehyde for histological and histomorphometric investigations and specimens stained using Lugol's solution for soft tissue visualization by micro-computed tomography (microCT) are still eligible to be used for bone architecture analysis by microCT. METHODS In this controlled laboratory study, 11 male Sprague-Dawley rats were used. After sacrifice and exarticulation both shoulders of healthy rats were assigned into three groups: (A) control group (n = 2); (B) formaldehyde group (n = 4); (C) Lugol group (n = 5). Half of the specimens of groups B and C were placed in a 4% buffered formaldehyde or Lugol's solution for 24 h, whereas the contralateral sides and all specimens of group A were stored without any additives. MicroCT of both sides performed in all specimens focused on bone mineral density (BMD) and bone microstructure parameters. RESULTS BMD measurements revealed higher values in specimens after placement in Lugol's solution (p < 0.05). Bone microstructure analyses showed increased BV/TV and Tb.Th values in group C (p < 0.05). Specimens of group C resulted in clearly decreased Tb.Sp values (p < 0.05) in comparison to the control group. Formaldehyde fixation showed minimally altered BMD and bone microstructure measurements without reaching any significance. CONCLUSIONS MicroCT scans of bone structures are recommended to be conducted natively and immediately after euthanizing rats. MicroCT scans of formaldehyde-fixed specimens must be performed with caution due to a possible slight shift of absolute values of BMD and bone microstructure. Bone analysis of specimens stained by Lugol's solution cannot be recommended.
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Affiliation(s)
- Xaver Feichtinger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
- AUVA Trauma Center Vienna - Meidling, Vienna, Austria.
- Department of Orthopedic Surgery II, Herz-Jesu Hospital, Vienna, Austria.
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - David Hercher
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Jakob Emanuel Schanda
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- AUVA Trauma Center Vienna - Meidling, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology, 1st Medical Department at Hanusch Hospital, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna - Meidling, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- AUVA Trauma Center Vienna - Meidling, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
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13
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Schanda JE, Keibl C, Heimel P, Monforte X, Tangl S, Feichtinger X, Teuschl AH, Baierl A, Muschitz C, Redl H, Fialka C, Mittermayr R. Zoledronic Acid Substantially Improves Bone Microarchitecture and Biomechanical Properties After Rotator Cuff Repair in a Rodent Chronic Defect Model. Am J Sports Med 2020; 48:2151-2160. [PMID: 32543880 DOI: 10.1177/0363546520926471] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone mineral density at the humeral head is reduced in patients with chronic rotator cuff tears. Bone loss in the humeral head is associated with repair failure after rotator cuff reconstruction. Bisphosphonates (eg, zoledronic acid) increase bone mineral density. HYPOTHESIS Zoledronic acid improves bone mineral density of the humeral head and biomechanical properties of the enthesis after reconstruction of chronic rotator cuff tears in rats. STUDY DESIGN Controlled laboratory study. METHODS A total of 32 male Sprague-Dawley rats underwent unilateral (left) supraspinatus tenotomy with delayed transosseous rotator cuff reconstruction after 3 weeks. All rats were sacrificed 8 weeks after rotator cuff repair. Animals were randomly assigned to 1 of 2 groups. At 1 day after rotator cuff reconstruction, the intervention group was treated with a single subcutaneous dose of zoledronic acid at 100 µg/kg bodyweight, and the control group received 1 mL of subcutaneous saline solution. In 12 animals of each group, micro-computed tomography scans of both shoulders were performed as well as biomechanical testing of the supraspinatus enthesis of both sides. In 4 animals of each group, histological analyses were conducted. RESULTS In the intervention group, bone volume fraction (bone volume/total volume [BV/TV]) of the operated side was higher at the lateral humeral head (P = .005) and the medial humeral head (P = .010) compared with the control group. Trabecular number on the operated side was higher at the lateral humeral head (P = .004) and the medial humeral head (P = .001) in the intervention group. Maximum load to failure rates on the operated side were higher in the intervention group (P < .001). Cortical thickness positively correlated with higher maximum load to failure rates in the intervention group (r = 0.69; P = .026). Histological assessment revealed increased bone formation in the intervention group. CONCLUSION Single-dose therapy of zoledronic acid provided an improvement of bone microarchitecture at the humeral head as well as an increase of maximum load to failure rates after transosseous reconstruction of chronic rotator cuff lesions in rats. CLINICAL RELEVANCE Zoledronic acid improves bone microarchitecture as well as biomechanical properties after reconstruction of chronic rotator cuff tears in rodents. These results need to be verified in clinical investigations.
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Affiliation(s)
- Jakob E Schanda
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Medical University of Vienna, Department of Oral Surgery, Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Vienna, Austria
| | - Xavier Monforte
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,University of Applied Sciences Technikum Wien, Department of Life Science Engineering, Vienna, Austria
| | - Stefan Tangl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Medical University of Vienna, Department of Oral Surgery, Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Vienna, Austria
| | - Xaver Feichtinger
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas H Teuschl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,University of Applied Sciences Technikum Wien, Department of Life Science Engineering, Vienna, Austria
| | - Andreas Baierl
- University of Vienna, Department of Statistics and Operations Research, Vienna, Austria
| | - Christian Muschitz
- St Vincent Hospital Vienna, II. Medical Department, Metabolic Bone Disease Unit, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria.,Sigmund Freud University, Medical Faculty, Center for the Musculoskeletal System, Vienna, Austria
| | - Rainer Mittermayr
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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14
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Wakolbinger R, Muschitz C, Wallwitz J, Bodlaj G, Feichtinger X, Schanda JE, Resch H, Baierl A, Pietschmann P. Correction to: Serum levels of sclerostin reflect altered bone microarchitecture in patients with hepatic cirrhosis. Wien Klin Wochenschr 2020; 132:216. [PMID: 32016509 DOI: 10.1007/s00508-020-01613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Correction to: Wien Klin Wochenschr 2019 https://doi.org/10.1007/s00508-019-01595-8 The original version of this article unfortunately contained a mistake. The last sentence should read: Patients with ALD had significantly lower sclerostin levels, compared to controls. The authors apologize for the ….
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Affiliation(s)
- Robert Wakolbinger
- Department of Physical and Rehabilitation Medicine, Danube Hospital - Social Medical Center East, Academic Teaching Hospital of the Medical University of Vienna, Langobardenstraße 122, 1220, Vienna, Austria.,Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - Christian Muschitz
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.
| | - Jacqueline Wallwitz
- The Antibody Lab, Divischgasse 4, 1210, Vienna, Austria.,Division of Pharmacology, Department of Pharmacology, Physiology and Microbiology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Gerd Bodlaj
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - Xaver Feichtinger
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.,AUVA Trauma Center Meidling, Kundratstraße 37, 1120, Vienna, Austria
| | - Jakob E Schanda
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.,AUVA Trauma Center Meidling, Kundratstraße 37, 1120, Vienna, Austria
| | - Heinrich Resch
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.,Karl Landsteiner Institute for Gastroenterology and Rheumatology, Stumpergasse 13, 1060, Vienna, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Oskar-Morgenstern-Platz 1, 1090, Vienna, Austria
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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15
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Wakolbinger R, Muschitz C, Wallwitz J, Bodlaj G, Feichtinger X, Schanda JE, Resch H, Baierl A, Pietschmann P. Serum levels of sclerostin reflect altered bone microarchitecture in patients with hepatic cirrhosis. Wien Klin Wochenschr 2020; 132:19-26. [PMID: 31912287 PMCID: PMC6978289 DOI: 10.1007/s00508-019-01595-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
Background Patients with hepatic cirrhosis are at increased risk of bone loss. Recent work on areal bone mineral density has reported contradictory findings. As the assessment of bone microarchitecture is complex, a search was made for correlations with new serum markers of bone turnover. Current data on serum sclerostin levels in patients with increased fracture risk are divergent and to date only one study has examined patients with hepatic cirrhosis. Therefore, the aim of this study was to evaluate serum sclerostin levels and to test for correlations with microarchitecture. Methods This study was performed in 32 patients with recently diagnosed hepatic cirrhosis and 32 controls. The parameters of bone microarchitecture were assessed by high-resolution peripheral quantitative computed tomography. Sclerostin was detected via a new ELISA that detects the active receptor interaction site at loop 2 of the sclerostin core region. Results Sclerostin levels were slightly, but not significantly lower in the patient group, compared to controls. In contrast, patients with alcoholic liver cirrhosis had significantly lower levels than the controls. A significant correlation with areal bone mineral density (BMD) and trabecular microarchitecture was observed in the patient group. However, there was hardly any correlation between sclerostin and bone microarchitecture in the controls. Conclusion In hepatic cirrhosis, sclerostin is related to altered bone microarchitecture and lower areal BMD. In alcoholic liver disease, low sclerostin concentrations were seen.
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Affiliation(s)
- Robert Wakolbinger
- Department of Physical and Rehabilitation Medicine, Danube Hospital - Social Medical Center East, Academic Teaching Hospital of the Medical University of Vienna, Langobardenstraße 122, 1220, Vienna, Austria
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - Christian Muschitz
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.
| | - Jacqueline Wallwitz
- The Antibody Lab, Divischgasse 4, 1210, Vienna, Austria
- Division of Pharmacology, Department of Pharmacology, Physiology and Microbiology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Gerd Bodlaj
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - Xaver Feichtinger
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
- AUVA Trauma Center Meidling, Kundratstraße 37, 1120, Vienna, Austria
| | - Jakob E Schanda
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
- AUVA Trauma Center Meidling, Kundratstraße 37, 1120, Vienna, Austria
| | - Heinrich Resch
- Medical Department II - The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
- Karl Landsteiner Institute for Gastroenterology and Rheumatology, Stumpergasse 13, 1060, Vienna, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Oskar-Morgenstern-Platz 1, 1090, Vienna, Austria
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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16
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Schanda JE, Kocijan R, Resch H, Baierl A, Feichtinger X, Mittermayr R, Plachel F, Wakolbinger R, Wolff K, Fialka C, Gruther W, Muschitz C. Bone Stress Injuries Are Associated With Differences in Bone Microarchitecture in Male Professional Soldiers. J Orthop Res 2019; 37:2516-2523. [PMID: 31410876 DOI: 10.1002/jor.24442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/07/2019] [Indexed: 02/04/2023]
Abstract
Bone stress injuries are commonly due to repetitive loading, as often described in competitive athletes or military recruits. The underlying pathophysiology of bone stress injuries is multifactorial. The present cross-sectional study investigated (i) cortical and trabecular bone microstructure as well as volumetric bone mineral density in subjects with bone stress injuries at the tibial diaphysis, measured at the distal tibia and the distal radius by means of high-resolution peripheral quantitative computed tomography (CT), (ii) areal bone mineral density using dual-energy X-ray absorptiometry as well as calcaneal dual X-ray absorptiometry and laser, and (iii) the influence on bone turnover markers of formation and resorption at the early phase after injury. A total of 26 Caucasian male professional soldiers with post-training bone stress injury at the tibial diaphysis were included (case group). A total of 50 male, Caucasian professional soldiers from the same military institution served as controls (control group). High-resolution peripheral quantitative CT revealed a higher total area at the radius within the case group. Cortical bone mineral density was reduced at the radius and tibia within the case group. The trabecular number and trabecular thickness were reduced at the tibia in the case group. The trabecular network was more inhomogeneous at the radius and tibia within the case group. Calcaneal dual X-ray absorptiometry and laser was significantly reduced in the case group. This study quantified differences in bone microstructure among otherwise healthy individuals. Differences in bone microarchitecture may impair the biomechanical properties by increasing the susceptibility to sustain bone stress injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2516-2523, 2019.
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Affiliation(s)
- Jakob E Schanda
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Roland Kocijan
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria
| | - Heinrich Resch
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria.,Karl Landsteiner Institute for Gastroenterology, Rheumatology, and Osteology, Stumpergasse 13, Vienna, A-1060, Austria.,Medical Faculty, Bone Diseases Unit, Sigmund Freud University, Freudplatz 1, Vienna, A-1020, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Oskar-Morgenstern-Platz 1, Vienna, A-1090, Austria
| | - Xaver Feichtinger
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Rainer Mittermayr
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Fabian Plachel
- Charité-Universitätsmedizin Berlin, Campus Virchow, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, D-13353, Germany
| | - Robert Wakolbinger
- Department of Physical Medicine and Rehabilitation, Danube Hospital-Social Medical Center East, Langobardenstrasse 122, Vienna, A-1220, Austria
| | - Klaus Wolff
- Department of Surgery, Austrian Armed Forces, Military Medical Cluster East, Bruenner Strasse 238, Vienna, A-1210, Austria
| | - Christian Fialka
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria.,Medical Faculty, Traumatology Unit, Sigmund Freund University, Freudplatz 1, Vienna, A-1020, Austria
| | - Wolfgang Gruther
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Christian Muschitz
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria
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Feichtinger X, Monforte X, Keibl C, Hercher D, Schanda J, Teuschl AH, Muschitz C, Redl H, Fialka C, Mittermayr R. Substantial Biomechanical Improvement by Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears. Am J Sports Med 2019; 47:2158-2166. [PMID: 31206305 DOI: 10.1177/0363546519854760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Characteristics of chronic rotator cuff tears include continuous loss of tendon structure as well as tendon elasticity, followed by a high failure rate after surgical reconstruction. Several studies have already shown the beneficial effect of extracorporeal shockwave therapy (ESWT) on tissue regeneration in tendon pathologies. HYPOTHESIS ESWT improves biomechanical tendon properties as well as functional shoulder outcomes in chronic rotator cuff reconstruction in rodents. STUDY DESIGN Controlled laboratory study. METHODS After tendon detachment and 3 weeks of degeneration, a subsequent transosseous reattachment of the supraspinatus tendon was performed in 48 adult male Sprague-Dawley rats (n = 16 per group). Rodents were randomly assigned to 3 study groups: no ESWT/control group, intraoperative ESWT (IntraESWT), and intra- and postoperative ESWT (IntraPostESWT). Shoulder joint function, as determined by gait analysis, was assessed repeatedly during the observation period. Eight weeks after tendon reconstruction, the rats were euthanized, and biomechanical and gene expression analyses were performed. RESULTS Macroscopically, all repairs were intact at the time of euthanasia, with no ruptures detectable. Biomechanical analyses showed significantly improved load-to-failure testing results in both ESWT groups in comparison with the control group (control, 0.629; IntraESWT, 1.102; IntraPostESWT, 0.924; IntraESWT vs control, P≤ .001; IntraPostESWT vs control, P≤ .05). Furthermore, functional gait analyses showed a significant enhancement in intensity measurements for the IntraPostESWT group in comparison with the control group (P≤ .05). Gene expression analysis revealed no significant differences among the 3 groups. CONCLUSION Clearly improved biomechanical results were shown in the single-application and repetitive ESWT groups. Furthermore, functional evaluation showed significantly improved intensity measurements for the repetitive ESWT group. CLINICAL RELEVANCE This study underpins a new additional treatment possibility to prevent healing failure. Improved biomechanical stability and functionality may enable faster remobilization as well as an accelerated return to work and sports activities. Furthermore, as shockwave therapy is a noninvasive, easy-to-perform, cost-effective treatment tool with no undesired side effects, this study is of high clinical relevance in orthopaedic surgery. Based on these study results, a clinical study has already been initiated to clinically confirm the improved functionality by ESWT.
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Affiliation(s)
- Xaver Feichtinger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Vienna, Austria
| | - Xavier Monforte
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Life Science Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - David Hercher
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Jakob Schanda
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas H Teuschl
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Life Science Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria
| | | | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Wakolbinger R, Muschitz C, Scheriau G, Bodlaj G, Kocijan R, Feichtinger X, Schanda JE, Haschka J, Resch H, Pietschmann P. Bone microarchitecture and bone turnover in hepatic cirrhosis. Osteoporos Int 2019; 30:1195-1204. [PMID: 30788527 PMCID: PMC6546655 DOI: 10.1007/s00198-019-04870-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/21/2019] [Indexed: 02/06/2023]
Abstract
UNLABELLED Liver cirrhosis leads to bone loss. To date, information on bone quality (three-dimensional microarchitecture) and, thus, bone strength is scarce. We observed decreased bone quality at both assessed sites, independent of disease severity. Therefore, all patients should undergo early-stage screening for osteoporosis. INTRODUCTION Recent studies found low bone mineral density in cirrhosis, but data on bone microstructure are scarce. This study assessed weight-bearing and non-weight-bearing bones in patients with cirrhosis and healthy controls. The primary objective was to evaluate trabecular and cortical microarchitecture. METHODS This was a single-center study in patients with recently diagnosed hepatic cirrhosis. Thirty-two patients and 32 controls participated in this study. After determining the type of cirrhosis, the parameters of bone microarchitecture were assessed by high-resolution peripheral quantitative computed tomography. RESULTS Both cortical and trabecular microarchitectures showed significant alterations. At the radius, trabecular bone volume fraction was 17% lower (corrected p = 0.028), and, at the tibia, differences were slightly more pronounced. Trabecular bone volume fraction was 19% lower (p = 0.024), cortical bone mineral density 7% (p = 0.007), and cortical thickness 28% (p = 0.001), while cortical porosity was 32% higher (p = 0.023), compared to controls. Areal bone mineral density was lower (lumbar spine - 13%, total hip - 11%, total body - 9%, radius - 17%, and calcaneus - 26%). There was no correlation between disease severity and microarchitecture. Areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA) correlated well with parameters of cortical and trabecular microarchitecture. CONCLUSIONS Hepatic cirrhosis deteriorates both trabecular and cortical microarchitecture, regardless of disease severity. Areal bone mineral density is diminished at all sites as a sign of generalized affection. In patients with hepatic cirrhosis, regardless of its origin or disease severity, aBMD measurements are an appropriate tool for osteologic screening.
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Affiliation(s)
- R Wakolbinger
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria
- Department of Physical Medicine and Rehabilitation, Danube Hospital-Social Medical Center East, Academic Teaching Hospital of the Medical University of Vienna, Langobardenstraße 122, A-1220, Vienna, Austria
| | - C Muschitz
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria.
| | - G Scheriau
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria
| | - G Bodlaj
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria
| | - R Kocijan
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria
| | - X Feichtinger
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria
- AUVA Trauma Center Meidling, Kundratstraße 37, A-1120, Vienna, Austria
| | - J E Schanda
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria
- AUVA Trauma Center Meidling, Kundratstraße 37, A-1120, Vienna, Austria
| | - J Haschka
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria
| | - H Resch
- Medical Department II-The VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, A-1060, Vienna, Austria
| | - P Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
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19
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Feichtinger X, Kolbitsch P, Kocijan R, Baierl A, Giurea A. How Accurate is Intraoperative Alignment Measurement with a Navigation System in Primary Total Knee Arthroplasty? J Knee Surg 2018; 31:467-471. [PMID: 28701006 DOI: 10.1055/s-0037-1604149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The primary objective was to compare the intraoperative data assessed by OrthoPilot (Aesculap AG, Tuttlingen, Germany) with postoperative coronal and sagittal long-leg standing radiographs. The secondary objective was to evaluate the influence of sex and body mass index (BMI) on the accuracy and effectiveness of the implantation of the knee prosthesis by OrthoPilot. We included 75 patients in our investigation. Participants received an e.motion (Aesculap AG) knee prosthesis using the OrthoPilot navigation system. Postoperative long-leg standing anteroposterior and lateral radiographs were performed. We compared the intraoperative navigational data with postoperative determined angles of knee geometry. We also compared the sex and BMI of participants to their difference between intraoperative and postoperative measurements to test for an association. We found a difference between intraoperative data and radiographs of 1.8 degrees for the hip-knee-ankle angle. The intraoperative lateral distal femoral angle and medial proximal tibial angle differed from the radiological analysis by 1.2 degrees, respectively. The lateral views revealed a difference of 1.6 degrees for femur lateral and 1.4 degrees for the tibia lateral. There was no significant (p > 0.05) influence of the parameters BMI and sex of the patients on these values. Our results showed that the implemented intraoperative navigation system is reliable. It does not differ on average from postoperative radiographs by more than 1.8 degrees. The findings of our study suggest that a correct postoperative alignment can be achieved in both high and low BMI participants if a precise range is maintained during the surgery.
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Affiliation(s)
- Xaver Feichtinger
- Department of Orthopedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Paul Kolbitsch
- Department of Orthopedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Roland Kocijan
- Metabolic Bone Diseases Unit, The VINFORCE Study Group, St. Vincent Hospital, Vienna, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, The University of Vienna, Vienna, Austria
| | - Alexander Giurea
- Department of Orthopedic Surgery, Medical University of Vienna, Vienna, Austria
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20
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Feichtinger X, Muschitz C, Heimel P, Baierl A, Fahrleitner-Pammer A, Redl H, Resch H, Geiger E, Skalicky S, Dormann R, Plachel F, Pietschmann P, Grillari J, Hackl M, Kocijan R. Bone-related Circulating MicroRNAs miR-29b-3p, miR-550a-3p, and miR-324-3p and their Association to Bone Microstructure and Histomorphometry. Sci Rep 2018; 8:4867. [PMID: 29559644 PMCID: PMC5861059 DOI: 10.1038/s41598-018-22844-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/01/2018] [Indexed: 12/27/2022] Open
Abstract
The assessment of bone quality and the prediction of fracture risk in idiopathic osteoporosis (IOP) are complex prospects as bone mineral density (BMD) and bone turnover markers (BTM) do not indicate fracture-risk. MicroRNAs (miRNAs) are promising new biomarkers for bone diseases, but the current understanding of the biological information contained in the variability of miRNAs is limited. Here, we investigated the association between serum-levels of 19 miRNA biomarkers of idiopathic osteoporosis to bone microstructure and bone histomorphometry based upon bone biopsies and µCT (9.3 μm) scans from 36 patients. Four miRNAs were found to be correlated to bone microarchitecture and seven miRNAs to dynamic histomorphometry (p < 0.05). Three miRNAs, namely, miR-29b-3p, miR-324-3p, and miR-550a-3p showed significant correlations to histomorphometric parameters of bone formation as well as microstructure parameters. miR-29b-3p and miR-324-p were found to be reduced in patients undergoing anti-resorptive therapy. This is the first study to report that serum levels of bone-related miRNAs might be surrogates of dynamic histomorphometry and potentially reveal changes in bone microstructure. Although these findings enhance the potential value of circulating miRNAs as bone biomarkers, further experimental studies are required to qualify the clinical utility of miRNAs to reflect dynamic changes in bone formation and microstructure.
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Affiliation(s)
- Xaver Feichtinger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,St. Vincent Hospital - Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.,AUVA Trauma Center Meidling, Vienna, Austria
| | - Christian Muschitz
- St. Vincent Hospital - Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria Department of Traumatology, Medical University of Vienna, Vienna, Austria.,Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Vienna, Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Heinrich Resch
- St. Vincent Hospital - Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.,Medical Faculty of Bone Diseases, Sigmund Freud University, Vienna, Austria
| | | | | | - Rainer Dormann
- St. Vincent Hospital - Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria
| | - Fabian Plachel
- St. Vincent Hospital - Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Johannes Grillari
- TAmiRNA GmbH, Vienna, Austria.,Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology, BOKU - University of Natural Resources and Life Sciences Vienna, Vienna, Austria
| | | | - Roland Kocijan
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,St. Vincent Hospital - Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria
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21
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Muschitz C, Kocijan R, Baierl A, Dormann R, Feichtinger X, Haschka J, Szivak M, Muschitz GK, Schanda J, Pietschmann P, Resch H, Dimai HP. Preceding and subsequent high- and low-trauma fracture patterns-a 13-year epidemiological study in females and males in Austria. Osteoporos Int 2017; 28:1609-1618. [PMID: 28138718 DOI: 10.1007/s00198-017-3925-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/12/2017] [Indexed: 12/17/2022]
Abstract
UNLABELLED This study investigated the implication of a preceding high-trauma fracture on subsequent high- and low-trauma fractures at different skeletal sites in postmenopausal women and similarly aged men at an age range of 54 to 70 years. A preceding high-trauma fracture increases the risk of future low-trauma non-vertebral fractures including hip. INTRODUCTION Little is known about the impact of the skeletal fracture site in conjunction with the severity of a past fracture (high- or low-trauma preceding fracture) and its effect on future fracture risk. METHODS Patients with de novo high- and low-trauma fractures admitted to seven large trauma centers across Austria between 2000 and 2012 were stratified into sex and different age groups. Kaplan-Meier estimates, Cox proportional hazards regression models (HR), and likelihood calculations estimated effects of age, sex, and the anatomic region on the probability of a subsequent fracture in the same patient. RESULTS Included in the study were 433,499 female and male patients at an age range of 0 to 100 years with 575,772 de novo high- and low-trauma fractures. In the age range of 54-70 years, subsequent fractures were observed in 16% of females and 12.1% of males. A preceding high-trauma fracture was associated with 12.9% of subsequent fractures, thereof 6.5% of high- and 6.4% of low-trauma in origin, usually at the hip, humerus, or pelvis. The highest effect sizes were observed for femur, humerus, and thorax fractures with hazard ratios (HR) of 1.26, 1.18, and 1.14. After splitting into high-trauma preceding and subsequent low-trauma fractures, the femoral neck (HR = 1.59), the female sex (HR = 2.02), and age (HR = 1.03) were discriminators for increased future fracture risk. CONCLUSIONS Preceding high-trauma fractures increase the risk of future low-trauma non-vertebral fractures including hip. For each patient with a fracture, regardless of the severity of the trauma, osteoporosis should be taken into clinical consideration.
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Affiliation(s)
- C Muschitz
- St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.
| | - R Kocijan
- St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - A Baierl
- Department of Statistics and Operations Research, The University of Vienna, Oskar-Morgenstern-Platz 1, 1090, Vienna, Austria
| | - R Dormann
- St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - X Feichtinger
- St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
- AUVA Trauma Center Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - J Haschka
- St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - M Szivak
- Austrian Trauma Insurance Agency (AUVA), Adalbert-Stifter-Strasse 65, 1200, Vienna, Austria
| | - G K Muschitz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - J Schanda
- AUVA Trauma Center Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - P Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, The Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - H Resch
- St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
- Karl Landsteiner Institute for Gastroenterology and Rheumatology, Stumpergasse 13, 1060, Vienna, Austria
- Bone Diseases Unit-Medical Faculty, Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Metabolism, The Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
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Kocijan R, Muschitz C, Geiger E, Skalicky S, Baierl A, Dormann R, Plachel F, Feichtinger X, Heimel P, Fahrleitner-Pammer A, Grillari J, Redl H, Resch H, Hackl M. Circulating microRNA Signatures in Patients With Idiopathic and Postmenopausal Osteoporosis and Fragility Fractures. J Clin Endocrinol Metab 2016; 101:4125-4134. [PMID: 27552543 DOI: 10.1210/jc.2016-2365] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT Established bone turnover markers do not reflect fracture risk in idiopathic male and premenopausal osteoporosis and the role of microRNAs (miRNAs) in these patients is currently unclear. miRNAs are a class of small non-coding RNAs that regulate gene expression and bone tissue homeostasis. They are considered a new class of endocrine regulators with promising potential as biomarkers. OBJECTIVE Evaluation of circulating miRNA signatures in male and female subjects with idiopathic and postmenopausal osteoporotic low-traumatic fractures. DESIGN, SETTING, AND PATIENTS This was a case-control study of cross-sectional design of 36 patients with prevalent low-traumatic fractures and 39 control subjects Main Outcome Measures: One hundred eighty-seven miRNAs were quantified in serum by qPCR, compared between groups and correlated with established bone turnover markers. RESULTS Significant differences in serum levels of circulating miRNAs were identified in all three subgroups (46 in premenopausal, 52 in postmenopausal, 55 in male). A set of 19 miRNAs was consistently regulated in all three subgroups. Eight miRNAs [miR-152-3p, miR-30e-5p, miR-140-5p, miR-324-3p, miR-19b-3p, miR-335-5p, miR-19a-3p, miR-550a-3p] were excellent discriminators of patients with low-traumatic fractures, regardless of age and sex, with area under the curve values > 0.9. The 11 remaining miRNAs showed area under the curve values between 0.81 and 0.89. Correlation analysis identified significant correlations between miR-29b-3p and P1NP, and miR-365-5p and iPTH, TRAP5b, P1NP and Osteocalcin, as well as BMDL1-L4 and miR-19b-3p, miR-324-3p, miR-532-5p, and miR-93-5p. CONCLUSIONS Specific serum miRNA profiles are strongly related to bone pathologies. Therefore miRNAs might be directly linked to bone tissue homeostasis. In particular, miR-29b-3p has previously been reported as regulator of osteogenic differentiation and could serve as a novel marker of bone turnover in osteoporotic patients as a member of a miRNA signature.
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Affiliation(s)
- Roland Kocijan
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Christian Muschitz
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Elisabeth Geiger
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Susanna Skalicky
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Andreas Baierl
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Rainer Dormann
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Fabian Plachel
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Xaver Feichtinger
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Patrick Heimel
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Astrid Fahrleitner-Pammer
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Johannes Grillari
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Heinz Redl
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Heinrich Resch
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
| | - Matthias Hackl
- St. Vincent Hospital-Medical Department II (R.K., C.M., R.D., F.P., X.F., H.Res.), The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, 1090 Vienna, Austria; TAmiRNA, GmbH (E.G., S.S, M.H..), 1190 Vienna, Austria; Department of Statistics and Operations Research (A.B.), University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (R.K., P.H., H.Red.), 1200 Vienna, Austria; Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery (P.H.), Medical University of Vienna, 1090 Vienna, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetes (A.F.-P.), Medical University of Graz, 8010 Graz, Austria; Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology (J.G.), University of Natural Resources and Life Sciences Vienna, 1180 Viena, Austria; Austrian Cluster for Tissue Regeneration (H.Red., J.G.), Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria; and Medical Faculty of Bone Diseases (H.Red.), Sigmund Freud University-Vienna, 1020 Vienna, Austria
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