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Aim: Periodontal disease is driven by oral pathogens, including Porphyromonas gingivalis, and the release of inflammatory cytokines. These cytokines (e.g., TNF) or their receptors (e.g., IL-1R) are substrates of a disintegrin and metalloproteinases (ADAMs). In this study, we aimed to determine the effects of ADAMs on periodontal disease phenotypes., Materials and Methods: Western blot and FRET-based activity measurements of the gingival crevicular fluid (GCF) of patients were compared with those of infected (P. gingivalis) or cytokine-stimulated oral keratinocytes and primary human neutrophils, respectively. This was accompanied by an analysis of the released extracellular vesicles and MMP9 activity., Results: In the GCF of patients, ADAM8 protein expression and activity were correlated with disease stage, whereas ADAM10 protein expression was inversely correlated with disease stage. Infection and the resulting cytokine release orchestrated the release of soluble ADAM8 by oral keratinocytes and primary neutrophils as soluble ectodomain and on exosomes, respectively. Furthermore, ADAM8 regulated the release of ADAM10 and MMP9., Conclusion: Dysregulation of cell-associated and extracellular ADAM proteolytic activity may be an essential regulatory element in the progression of periodontal disease driven by ADAM8. The influence of ADAM8 on disease onset and the evaluation of targeting ADAM8 as a potential and novel local treatment option should be addressed in future translational in vivo studies., (© 2024 The Author(s). Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Introduction & Importance: Parosteal osteosarcoma is an uncommon, low-grade, well differentiated malignant bone neoplasm with a more favorable prognosis compared to other types of osteosarcoma. Dedifferentiation is a well-known phenomenon, observed in 16-24.6 % of cases, leads to a combination of low-grade fibroblastic osteosarcoma and high-grade sarcoma. The dedifferentiated component is typically high-grade conventional osteosarcoma, although unusual variants such as spindle cell sarcoma, telangiectatic osteosarcoma, and rhabdomyosarcomatous dedifferentiation may arise. This case report contributes significant information to the sparse literature on dedifferentiated parosteal osteosarcoma due to its distinctive characteristics., Case Presentation: We describe a rare presentation of dedifferentiated parosteal osteosarcoma in a 44-year-old male with a lesion in the left femur. The dedifferentiated component included low-grade leiomyosarcoma alongside high-grade conventional osteosarcoma, presenting a diagnostic challenge, particularly with limited biopsy material. Diagnosis was confirmed using fluorescence in situ hybridization (FISH) for MDM2 gene amplification, emphasizing the importance of molecular diagnostic testing in such complex cases., Clinical Discussion: This case highlights a rare presentation of dedifferentiated parosteal osteosarcoma (DPO) with low-grade leiomyosarcomatous and high-grade osteosarcomatous components, posing significant diagnostic challenges. Accurate diagnosis required a multidisciplinary approach, including imaging, histopathology, and MDM2 gene amplification testing, especially given the limitations of initial biopsy samples. Early recognition of dedifferentiation is critical due to its impact on metastasis risk and treatment planning. The case underscores the need for personalized treatment strategies and vigilant long-term follow-up in managing rare bone tumors like DPO., Conclusion: This case presenting a distinctive pattern of dedifferentiation is, to our knowledge, the first documented case of low-grade leiomyosarcoma occurring in parosteal osteosarcoma. As it enhances the clinical understanding by broadening the range of dedifferentiated components identified in parosteal osteosarcoma and highlights the diagnostic difficulties associated with these uncommon bone tumors., Competing Interests: Conflict of interest statement The authors declare that they have no conflict of interest. The case report was written following the SCARE Guidelines [26]., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Bacterial biofilms represent a prominent biological barrier against physical and chemical attacks. Disturbing the anaerobic microenvironment within biofilms by co-delivery of oxygen appears as a promising strategy to enhance the activity of an antibiotic. Here, we report the effect of oxygen-producing calcium peroxide nanoparticles (CaO 2 NP) in combination with tobramycin sulfate (Tob). On Pseudomonas aeruginosa PAO1 biofilms in vitro, the additive effect of CaO 2 NP towards Tob activity enhanced biofilm eradication by 2 log compared to Tob alone. For natural biofilms grown in the oral cavity of human volunteers in situ, treatment by CaO 2 NP alone slightly increased the fraction of dead bacteria from 44% in various controls, including Tob alone, to 57%. However, the combination of CaO 2 NP with Tob further increased the fraction of dead bacteria to 69%. These data confirm the intrinsic antimicrobial and antibiotic-potentiating effect of CaO 2 NP also in a clinically relevant setting., (© 2024. The Author(s).)

Objectives This study aimed to investigate the relationship between ankle ligamentous injuries and osteochondral defects (OCDs) and to determine the incidence of these conditions within the Saudi Arabian population. Methods This retrospective cohort study included 215 patients (110 males and 105 females) who sought medical advice for an ankle injury at our institute from January 2017 to August 2022. The patients were divided according to age, sex, presence and type of ligamentous injury, and status of OCDs. Patients' ages were categorized into three groups: younger than 30 years (48 patients), 30-60 years (145 patients), and older than 60 years (22 patients). The patients were assessed for ligamentous ankle sprains, tears, and OCDs by reviewing their magnetic resonance imaging reports from radiology records. The exclusion criteria included ankle fracture, ankle surgery, osteoarthritis of the ankle joint, inflammatory arthritis, and congenital deformity of the ankle. The data were collected using a simple questionnaire created via Google Forms. Results Of the 24 patients with OCD, 23 had OCD of the talus. Anterior talofibular ligament (ATFL) injury was the most common injury (75 patients), whereas posterior talofibular ligament (PTFL) injury was the least common. The only significant relationship between ligamentous injury and OCD was observed between PTFL injury and OCD of the talus (P = 0.041). Conclusions In patients with an ankle injury, the most common OCDs occur at the talus, whereas the most injured ligament is the ATFL. Nevertheless, a significant relationship was observed between PTFL injury and OCD of the talus. The findings underscore the importance of considering specific ligament injuries when diagnosing and managing OCDs, especially in patients with chronic ankle pain., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Biomedical Ethics Research Committee of King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia issued approval 526-22. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Reda et al.)

Total knee arthroplasty is one of the most common orthopedic procedures. Simultaneous bilateral knee arthroplasty involves performing total knee arthroplasty on both knees in a single anesthetic session. This systematic review and meta-analysis followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. A primary search was performed using PubMed, EBSCO, Scopus, Web of Science, Clarivate, and Google Scholar databases. Quantitative data synthesis was performed using MedCalc® Statistical Software version 20.115 to determine the pooled prevalence of the infection among patients who underwent simultaneous bilateral knee arthroplasty. The Newcastle-Ottawa Scale was used to assess study quality. We included 30 studies in our quantitative data synthesis, with a total population of 118,502 patients (237,004 knees). The pooled prevalence of superficial infection, deep infection, and unspecified surgical site infection was estimated to be 0.86% (95% confidence interval: 0.62-1.13%), 0.84% (95% confidence interval: 0.64-1.05%), and 1.18% (95% confidence interval: 0.45-2.27%), respectively. There was significant heterogeneity (I2 >50%) in all analyses, and inspection of funnel plots revealed a symmetrical distribution of plotted data. We found that the infection rates following simultaneous bilateral knee arthroplasty were relatively low but heterogeneous, as the data showed marked variability. Superficial infections were more common than deep infections; however, there was a small difference in their prevalence. Furthermore, the reliability of our findings was limited owing to significant heterogeneity., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Reda et al.)

Objectives: To compare the cytotoxicity of octenidine dihydrochloride and chlorhexidine gluconate at different concentrations on primary human articular chondrocytes and cartilage., Materials and Methods: Primary cultures of human normal adult articular chondrocytes were exposed to octenidine dihydrochloride (0.001562%, 0.003125%, 0.00625%, 0.0125%, 0.025%, 0.05%, and 0.1%), chlorhexidine gluconate (0.003125%, 0.00625%, 0.0125%, 0.025%, 0.05%, 0.1%, and 0.2%), and control (Dulbecco's modified Eagle medium or phosphate-buffered saline) for 30 s. Normal human articular cartilage explants were exposed to octenidine dihydrochloride (0.1% versus control) and chlorhexidine gluconate (0.1% versus control) for 30 s. The viability of human articular chondrocytes was measured by Trypan blue staining, Cell Proliferation Reagent WST-1, and Live/Dead staining. The proliferation of human chondrocytes was measured using the Cell Proliferation Reagent WST-1. The viability of human articular cartilage explants was measured by using Live/Dead staining., Results: Octenidine dihydrochloride and chlorhexidine gluconate exposure decreased cell viability and proliferation in a dose-dependent manner in primary human articular chondrocytes. Octenidine dihydrochloride and chlorhexidine gluconate exposure decreased cell viability in human articular cartilage explant cultures., Conclusion: The degree of toxicity varied between octenidine dihydrochloride and chlorhexidine gluconate, with chlorhexidine gluconate being less toxic than octenidine dihydrochloride at the same concentration. Additionally, both octenidine dihydrochloride and chlorhexidine gluconate evaluation had cytotoxic effects on human articular cartilage. Therefore, dosing for the antimicrobial mouthwash ingredients administration would ideally be determined to remain below IC50., Clinical Relevance: These data support the in vitro safety of antimicrobial mouthwashes on primary adult human articular chondrocytes., (© 2023. The Author(s).)

Hereditary sensory and autonomic neuropathies (HSANs) include hereditary disorders that cause congenital insensitivity to pain. Moreover, patients diagnosed with such disorders are known to have genetic mutations that alter their deep pain sensation, making them more prone to developing bone and joint complications such as repetitive fractures, joint swelling, and Charcot arthropathy. Neuropathic arthropathy (Charcot joint) is a rare and relatively poorly understood condition; it is suggested to be caused by autonomic dysfunction and repetitive microtrauma and characterized by instability and joint destruction. Diagnosing the idiopathic Charcot joint is challenging and is considered to be a diagnosis of exclusion. In addition, there are limited cases of Charcot knees managed by arthroplasty. Patients with Charcot knees are commonly characterized by profound bone loss, diffuse synovitis, and instability in the knee joint. In this article, we report the case of a 13-year-old patient with known NTRK1 gene mutation who presented with recurrent knee joint swelling episodes and instability without pain. She was diagnosed with Charcot knee joint and underwent right hinged total knee replacement. At one-year follow-up, she continued to have good knee stability and an overall functional gait. Our findings suggest that managing Charcot knee joint with total knee replacement in patients with HSAN may show improvement in terms of stability, swelling, and overall gait., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alghamdi et al.)

Objectives: This in situ study aimed to determine and compare the chlorhexidine (CHX) retention in the oral cavity after the application of different CHX pharmaceutical regimens., Methods: Five volunteers used different CHX treatment regimens including mouth rinses, dental spray and toothpaste gel. After the application of the different CHX regimens, 2-μl samples were taken from saliva and buccal mucosa pellicle as well as the dental pellicle samples formed on standardized enamel surfaces. Sample collection was conducted at six time points within 12 h. Retention of CHX was measured using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry., Results: CHX retention values in the oral mucosa pellicle were significantly higher than those in saliva. CHX remained in the mucosal pellicle at microgrammes per millilitre levels for 12 h after mouth rinsing, 10 h after spray application and 2 h after using the toothpaste. CHX was detected in the dental pellicle for at least 12 h after application of mouth rinsing and spray. Retention of CHX after mouth rinsing or spray application was significantly higher than the retention after using toothpaste., Conclusions: Oral mucosa was the favourable site for CHX retention. Higher mouth rinse concentration and longer rinsing time produced a slight increase in CHX retention. CHX spray provided considerable retention values, whereas toothpaste gel delivered the lowest retention after application. MALDI-TOF was a sensitive method with excellent limits of quantification for CHX detection., (© 2021. The Author(s).)

Background: Simulation provides low-risk opportunities for surgical trainees to learn and practice fundamental skills. One simulation tool for orthopaedics is the Arthroscopic Knot (ArK) Trainer, which has been validated as an effective simulation tool across multiple methodologies. Previous studies have investigated the ArK Trainer in its basic form using clear plexiglass, which allows direct visualization of tissue anchors., Purpose: Using a mixed-methods approach, we assessed and compared junior and senior trainees' Seoul Medical Center (SMC) knot-tying performance under direct and indirect visualization., Study Design: Cross-sectional study., Methods: Fourteen orthopaedic surgery postgraduate trainees at a single medical school were recruited to participate. Trainees tied SMC knots using the Ark Trainer under direct and indirect visualization. A mixed-methods approach was used to evaluate knot-tying proficiency and characterize participants' approach to knot-tying. Knot-tying proficiency was evaluated using validated tools: a task-specific checklist (TSC), a global rating scale (GRS), and a proficiency scale (PS). Participants' approach to knot-tying was characterized using Likert-type questionnaires and semistructured interviews. An α level of .10 was set a priori owing to the small pool of trainees., Results: The 14 participants included 7 junior residents (postgraduate years [PGYs] 1 and 2) and 7 senior residents (PGY ≥3), of whom 3 were fellows (PGY 6). Senior trainees outperformed junior trainees on both versions of the ArK Trainer: clear (GRS, P = .055; PS, P = .075) and covered (TSC, P = .05). Overall, participants performed better under direct visualization conditions (GRS, P = .05). In semistructured interviews, significantly more senior trainees discussed relying on haptic cues while tying knots under direct visualization ( P = .021). The majority of trainees agreed that both versions of the ArK Trainer were realistic and appropriate practice formats for their level of training., Conclusion: Senior trainees were significantly more experienced than were junior trainees in arthroscopic skill and outperformed them on both configurations: direct (PS and GRS) and indirect (TSC) visualization. Experienced trainees were significantly more likely to report using tactile cues to aid knot-tying under indirect visualization. It is likely that inexperienced trainees rely more heavily on direct visualization and that the use of tactile cues may be an indicator of knot-tying proficiency. Trainees recommended progression from direct to indirect visualization configurations for inexperienced learners., Competing Interests: The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

In saliva and gingival crevicular fluid (GCF) soluble factors such as cytokines, chemokines and growth factors have shown a great potential serving as biomarkers for early detection and/or diagnosis of oral and systemic diseases. However, GCF and saliva, which one is a better source is still under debate. This study aimed to gain an overview of cytokines, chemokines and growth factors in saliva and GCF to pave the way for selecting suitable oral fluids for oral and systemic diseases. Multiplex cytokine assay was conducted to determine concentrations of cytokines, chemokines and growth factors in saliva and GCF samples from healthy subjects. The protocol for sample collection was carefully optimized. Stabilization, repeatability, and donor variation of the profiles were analyzed. We found that for different donors, cytokine and chemokine profiles showed unique patterns in saliva but similar patterns in GCF. In terms of growth factors, the profiles were individualized in saliva and GCF. All profiles stayed stable for the same healthy individual. In saliva, profiles of cytokines, chemokines and growth factors are individualized for different donors. In GCF, profiles of cytokines and chemokines are similar. Other factors, such as growth factors and T helper-related cytokines, are highly variable in donors. Profiles of soluble factors are not correlated in saliva and GCF. The comprehensive cytokine profiles in saliva and GCF reported in this work would serve as a good base for choosing promising cytokines for developing biomarkers in oral fluids., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: This in situ study aims to evaluate the effects of chlorhexidine (CHX) mouth rinsing on biofilm formation and moreover on the disruption of existing mature dental biofilms., Methods: Biofilms were formed in situ by five volunteers on bovine enamel specimens fixed to individual acrylic splints. For biofilm formation analysis, the volunteers intraorally exposed the splint for 48 h. Mouth rinsing using 10 ml of 0.2% CHX or water as control was performed for 30 s every 12 h. For analysis of biofilm disruption, the biofilm was formed on enamel specimens for 48 h. Then, the first CHX rinse was carried out. A second rinse followed after an additional 12 h, again for 30 s using 10 ml of 0.2% CHX. Biofilm vitality was imaged by fluorescence microscopy after vital fluorescence staining. Additionally, the ultrastructure of the biofilm was examined by transmission electron microscopy., Results: Rinses with 0.2% CHX significantly reduced biofilm formation on enamel. Both biofilm colonization and vitality were dramatically impaired. Moreover, a considerable biofilm disruption induced by the CHX rinses was observed. Remarkably, a single application of CHX to a 48-h mature biofilm causes biofilm ultrastructure alterations and induces a substantial reduction in biofilm thickness and bacterial vitality., Conclusions: CHX mouth rinses induced a significant inhibition of biofilm formation on native enamel. Furthermore, an important biofilm disrupting effect under in situ conditions was detected., Clinical Relevance: CHX rinses could be used as a short-term treatment protocol for biofilm management focused on patients unable to reach adequate oral hygiene.

Objective: The aim of this study was to determine chlorhexidine retention in different oral sites after a one-time 30 s mouth rinsing., Design: Five volunteers were asked to rinse their mouth with 10 ml of 0.2 % chlorhexidine digluconate for 30 s. After rinsing, samples were collected from the interdental area, buccal dental pellicle, anterior labial and posterior buccal mucosa, and saliva with a microbrush at five-time points within 24 h. Retention of chlorhexidine was measured using matrix-assisted laser desorption/ionization-time of flight mass spectrometry with a quantification limit of 15 ng/ml., Results: Chlorhexidine remained in the oral cavity at micrograms per milliliter levels for 11 h after mouth rinsing and was even detected 24 h after application. The results showed a distinct decline of intraoral chlorhexidine levels during the first 6 h after rinsing and it was then retained at low concentrations for at least 24 h., Conclusions: The dental pellicle and oral mucosa were favorable sites for chlorhexidine retention. The novel method used for chlorhexidine determination offered excellent quantification limits and readily permitted quantification of chlorhexidine., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Bone tumors are relatively rare in the foot and ankle region. Many of them present as cystic lesions on plain films. Due to the relative rarity of these lesions and the complex anatomy of the foot and ankle region, identification of such lesions is often delayed or they get misdiagnosed and mismanaged. This review discusses the most common cystic tumors of the foot and ankle including their radiographic features and principles of management., (© 2018 Wiley Periodicals, Inc.)

Background: Hip arthroscopic surgery is a rapidly growing procedure that requires distraction of the leg to access the joint. A frequently reported complication of this procedure is postoperative numbness, with rates between 1% and 20% reported in the literature., Purpose/hypothesis: The purpose of this study was to determine the factors contributing to the development and effect of numbness on functional outcomes. We hypothesized that this complication is underreported and that its prevalence is higher than what has been described in the literature., Study Design: Case series; Level of evidence, 4., Methods: Patients who had undergone hip arthroscopic surgery between 2012 and 2016 were included, and a telephone survey was conducted to collect data. Data related to the procedure and outcome scores were collected via a systematic chart review for the included patients. Data analysis was conducted for means, SDs, frequencies, and percentages. For comparative statistics, t tests and multiple logistic regression models were used., Results: A total of 221 patients (113 male, 108 female; mean age, 39.8 ± 13.34 years) completed the survey out of 362 eligible patients. Overall, 37% (n = 82) of patients reported having experienced some form of numbness after surgery. Approximately 43% (35/82) of the patients reported resolution by 6 weeks postoperatively, and 68% (56/82) of numbness was reported to have completely resolved by 6 months. The duration of surgery was a significant factor for the development of postoperative numbness ( P = .010; odds ratio, 2.18) when comparing procedures longer than 50 minutes with procedures shorter than 50 minutes (first incision until closure). Postoperative numbness was associated with a negative effect on the International Hip Outcome Tool-33 (iHOT-33) score that reached statistical significance at the 1-year (numbness, 60.19; no numbness, 74.21; P = .006) and 2-year time points (numbness, 52.04; no numbness, 72.69; P = .01)., Conclusion: This study confirmed our hypothesis that postoperative numbness is more common in our patient population than the incidence reported in the literature. This adverse event was also shown to be associated with decreased postoperative functional outcomes, as measured by the iHOT-33 at 1 and 2 years postoperatively., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

A revision rotator cuff repair is a technically challenging surgical procedure. This can be further complicated by the presence of poor quality of the cuff tissue, as well as a large greater tuberosity cyst, typically located at the rotator cuff footprint. This Technical Note discusses the surgical approach to deal with a revision rotator cuff tear with a large humeral head cyst. This described arthroscopic technique is performed in a single-stage procedure using a human dermal allograft (GraftJacket) for augmentation. This technique was specifically designed to (1) address the limited area for anchor placement, (2) use a bone graft, demineralized bone matrix, for repairing the bone cyst, and (3) optimize the biology for healing by augmenting the reconstruction with GraftJacket.