Search

Background Hamstring tendons are a popular choice for autografts in anterior cruciate ligament (ACL) reconstruction. However, there is increasing evidence that hamstring tendon autografts carry a high risk of revision and residual instability in young patients. To elucidate the reasons for the inferior outcome of the reconstructed ACL with hamstring tendon autografts in young patients, we investigated the Young’s modulus and the extent of cyclic loading-induced slackening of the semitendinosus tendon used for ACL reconstruction across a broad range of ages. Methods Twenty-six male patients (aged 17–53 years), who were scheduled for ACL reconstruction surgery using the semitendinosus tendon autograft, participated in this study. The distal portion of the harvested semitendinosus tendon, which was not used to construct the autograft, was used for cyclic tensile testing to calculate the Young’s modulus and the extent of slackening (i.e., increase in slack length). Results Spearman correlation analysis revealed that the Young’s modulus of the semitendinosus tendon was positively correlated with the patient’s age (ρ = 0.559, P = 0.003). In contrast, the extent of tendon slackening did not correlate with the patient’s age. Conclusions We demonstrated that the Young’s modulus of the semitendinosus tendon increases with age, indicating that the semitendinosus tendon used for ACL reconstruction is compliant in young patients.

Osteoarthritis of the knee (knee OA) induces pain, loss of mobility and diminished activities of daily living (ADL). Although an understanding of the pathophysiology of early stage knee OA has been developed, the structural changes associated with disability for ADL in early stage knee OA are still unclear. The aim of the present study was to examine magnetic resonance imaging (MRI)-detected changes associated with disability for ADL in patients with early stage knee OA. One hundred and thirty-two patients with early stage medial knee OA (Kellgren–Lawrence grade ≤ 2) who first visited the outpatient clinic at our university hospital were included. They were also examined by 3.0-Tesla knee MRI. The OA-associated structural changes were scored using the Whole-Organ Magnetic Resonance Imaging Score (WORMS), and clinical manifestations were evaluated by the Japanese Knee Osteoarthritis Measure (JKOM). Median quartile regression was used for the analysis. Cartilage lesion, subchondral bone attrition and osteophytes were observed in all patients. Bone marrow lesions (BMLs) and synovitis were observed in 60% and 55% of the patients, respectively. Subchondral cysts and ligament changes were observed in 6% and 17% of the patients, respectively. Pain severity of the patients was associated with medial cartilage lesions (coefficient 2.50, 95% confidence interval 0.61–4.40, p

When children around 2 years of age show leg bowing and diseases are ruled out based on radiographic findings without conducting blood tests, they are classified as "physiologic" genu varum. Since whether or not physiologic genu varum is associated with bone metabolism is unclear, this study was conducted to clarify the association between genu varum and bone metabolism in children. Thirty-five pediatric patients with genu varm who visited our out-patient clinic were enrolled. While two of the 35 children had nutritional rickets, showing abnormalities on both blood test (ALP, ≥1000 IU/L; iPTH, >65 pg/mL and 25(OH)D, ≤20 ng/mL) and radiographs (such as cupping, fraying or splaying), five of 35 children showed abnormalities on blood tests but not radiographs. While metaphyseal-diaphyseal angle (MDA) correlated with serum 25-hydroxy vitamin D (r = -0.35, p = 0.04) and magnesium (r = -0.36, p = 0.04), MDA and femorotibial angle (FTA) correlated with alkaline phosphatase (r = 0.43, p = 0.01 and r = 0.51, p = 0.006, respectively). A ridge regression analysis adjusted for age and body mass index indicated that ALP was associated with MDA and FTA. A logistic regression analysis adjusted for age and BMI indicated that higher ALP influenced an MDA >11°, which indicates the risk for the progression of genu varum (odds ratio 1.002, 95% confidence interval 1.0003-1.003, p = 0.021). The higher ALP (+100 IU), the higher risk of an MDA >11° (odds ratio 1.22). In conclusion, genu varum is associated with the alkaline phosphatase level regardless of the presence of radiographic abnormalities in the growth plate in children.

We previously reported that perlecan, a heparan-sulfate proteoglycan (Hspg2), expressed in the synovium at the cartilage-synovial junction, is required for osteophyte formation in knee osteoarthritis. To examine the mechanism underlying this process, we examined the role of perlecan in the proliferation and differentiation of synovial mesenchymal cells (SMCs), using a recently established mouse synovial cell culture method. Primary SMCs isolated from Hspg2-/- -Tg (Hspg2-/- ;Col2a1-Hspg2Tg/- ) mice, in which the perlecan-knockout was rescued from perinatal lethality, lack perlecan. The chondrogenic-, osteogenic-, and adipogenic-potentials were examined in the Hspg2-/- -Tg SMCs compared to the control SMCs prepared from wild-type Hspg2+/+ -Tg (Hspg2+/+ ;Col2a1-Hspg2Tg/- ) littermates. In a culture condition permitting proliferation, both control and Hspg2-/- -Tg SMCs showed similar rates of proliferation and expression of cell surface markers. However, in micromass cultures, the cartilage matrix production and Sox9 and Col2a1 mRNA levels were significantly reduced in Hspg2-/- -Tg SMCs, compared with control SMCs. The reduced level of Sox9 mRNA was restored by the supplementation with exogenous perlecan protein. There was no difference in osteogenic differentiation between the control and Hspg2-/- -Tg SMCs, as measured by the levels of Runx2 and Col1a1 mRNA. The adipogenic induction and PPARγ mRNA levels were significantly reduced in Hspg2-/- -Tg SMCs compared to control SMCs. The reduction of PPARγ mRNA levels in Hspg2-/- -Tg SMCs was restored by supplementation of perlecan. Perlecan is required for the chondrogenic and adipogenic differentiation from SMCs via its regulation of the Sox9 and PPARγ gene expression, but not for osteogenic differentiation via Runx2. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:837-846, 2017.

“Locomotive syndrome” is defined as a condition associated with restriction in one’s ability to walk or lead a normal life due to a dysfunction in one or more of the parts of the locomotion system, including the muscles, bones, joints, cartilage or intervertebral discs. This syndrome especially refers to individuals who have come to need nursing care services because of problems with the locomotive organs, or those who have conditions which may require them to need such services in the near future. Recent epidemiological studies revealed that the one-fourth of elderly individuals who require special assistance or nursing care have locomotive disorders in Japan. Osteoarthritis of the knee (knee OA) and hip (hip OA), and osteoporosis and spinal canal stenosis due to spondylosis are three major locomotive disorders that cause elderly individuals require special assistance or nursing care. In this review, we focus on the effects of knee and hip OA on the lives of elderly individuals and the recent advantages in clinical research on the pathophysiology and management of these diseases.

Summary Objective The aim of this study was to examine the osteoarthritis (OA)-related structural changes associated with histological synovitis in end-stage knee OA patients. Methods Forty end-stage knee OA patients (female: 88%, mean age: 71.8 y) were enrolled. All participants underwent 3.0-T MRI. The structural changes, such as cartilage morphology, subchondral bone marrow lesion (BML), subchondral bone cyst (SBC), subchondral bone attrition (SBA), osteophytes, meniscal lesion and synovitis, were scored using the whole-organ MRI scoring (WORMS) method. Synovial samples were obtained from five regions of interest (ROIs) of the knee joint during total joint replacement surgery. The associations between the histological synovitis score (HSS) and WORMS or the synovial expression levels of cyclooxygenase (COX)-2, interleukin (IL)-1β, IL-6 and transforming growth factor (TGF)–β were examined using Spearman's correlation coefficient. Results Among the seven OA-related structural changes, the BML, SBC, SBA and synovitis were significantly associated with the HSS ( r = 0.33, 0.35, 0.48 and 0.36, respectively), while other morphological changes were not. Although synovial COX-2, IL-1β or IL-6 expression levels were not associated with the HSS, the synovial TGF-β expression levels were associated with the HSS. Conclusion The presence of BML, SBC and SBA was associated with histological synovitis in end-stage knee OA patients.

SummaryObjectiveThe aim of the present study was to examine whether the degenerative and morphological changes of articular cartilage in early stage knee osteoarthritis (OA) occurred equally for both femoral- and tibial- or patellar- articular cartilage using magnetic resonance imaging (MRI)-based analyses.DesignThis cross-sectional study was approved by the ethics committee of our university. Fifty patients with early stage painful knee OA were enrolled. The patients underwent 3.0 T MRI on the affected knee joint. Healthy volunteers who did not show MRI-based OA changes were also recruited as controls (n = 19). The degenerative changes of the articular cartilage were quantified by a T2 mapping analysis, and any structural changes were conducted using Whole Organ Magnetic Resonance Imaging Score (WORMS) technique.ResultsAll patients showed MRI-detected OA morphological changes. The T2 values of femoral condyle (FC) (P

s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S439 To explore this, the aim of this study was to evaluate the impact of a FR program on the variation in muscle/lean mass and fat mass in patients with chronic low back pain. Patients and methods: Design: longitudinal uncontrolled French monocentric prospective study. Patients: All patients with chronic low back pain who participated in the FR program between January 2010 and March 2013 where included. Intervention: The FR program was carried out over a period of 4 weeks, 5 days aweek and included 3 hours per day of intensive physical training as well as patient education, relaxation etc through a multidisciplinary approach. Assessment: DXA was performed at baseline, at 1 month (end of the FR program) and at 6 months. The primary endpoint was the absolute variation in the muscle mass (or lean mass) calculated by DXA between baseline and 6 months. Variations in fat mass and variations as 1 month were also analysed. Statistical analysis: parametric paired tests (student’s t) and nonparametric paired test (Wilcoxon) in the total population and based on the body mass index (BMI) at inclusion : normal weight versus overweight or obesity (BMI>25kg /m2). Only patients with DXA available at baseline and 6 months were included in the analyses (no imputation of missing data). Results: In all, 95 patients were included, 40 men and 55 women: mean age 41 ( 8.4) years, mean BMI 26.6kg/m2, 38 (60%) where overweight or obese. At 1 month, there was an increase in lean mass (mean change þ1.3kg) and a decrease in fat mass (mean change -0.6kg) in the total population and in the subgroups according to BMI (p all

Conclusions: Our preliminary results suggest that CTa can accurately measure sGAG content of articular cartilage in human knee joints invivo. The coefficient of determination, however, is only moderate and therefore CTa outcomes are likely to be also influenced by other composites of cartilage, e.g. collagen. Despite the use of intra-articular contrast agent and ionizing radiation, CTa might become a cheap and fast alternative to MRI based techniques to quantitative measure cartilage composition in patients with contra-indications to undergo MRI. 482 DEGENERATION AND DESTRUCTION FOR FEMORAL ARTICULAR CARTILAGE IS PRECEDED THAN THOSE FOR CONFRONTING TIBIAL AND PATELLAR ARTICULAR CARTILAGE IN EARLY STAGE OF KNEE OSTEOARTHRITIS: A CROSS-SECTIONAL STUDY S. Hada y, H. Kaneko y, R. Sadatsuki y, L. Liz yz, A. Yusup y, M. Kinoshita y, I. Futami y, Y. Shimura x, M. Tsuchiya x, Y. Saita y, Y. Takazawa y, H. Ikeda y, K. Kaneko yz, M. Ishijima yz. yDept. of Med. for Orthopaedics and Motor Organ, Juntendo Univ. Graduate Sch. of Med., Tokyo, Japan; z Sportology Ctr., Juntendo Univ. Graduate Sch. of Med., Tokyo, Japan; xDept. of Orthopedics, Juntendo Tokyo Koto Geriatric Med. Ctr., Tokyo, Japan, Tokyo, Japan

in 84 knees and rheumatoid arthritis in 6 knees. The pre-operative mechanical alignment of the lower limbwas in 13.4 6.3 (0-30) varus. The knees were randomized in 1:1:1 ratio into one of the three groups conventional instruments (CON), computer navigation (NAV) and patient specific instruments (PSI). They were also randomized with regard to the 3 surgeons. Each surgeon performed 10 CON, 10 NAV and 10 PSI TKA. The three groups were matched, except there were more male patients in the PSI group. The prostheses and surgical routines were standardized. Post-operative standing long films of the entire lower limbs were taken.We recorded the tourniquet time and the operative time (skin-to-skin). We measured the femoral and tibial component positions in the coronal and axial planes and the overall lower limb alignment of the lower limb after TKA. Results: The mean tourniquet times were 49.2 12.7 minutes for CON, 68.6 14.8 minutes for NAV and 49.1 15.3 minutes for PSI groups (p < 0.001, Oneway ANOVA). Conventional instrument was more likely to result in an excessively flexed femoral component (p 1⁄4 0.001, Oneway ANOVA). Number of outliers in postoperative lower limb alignment, and other components positions in the coronal and sagittal plane showed no statistically significant difference. Conclusion: We found that the tourniquet time and operation time of using patient specific instrument in TKA were similar to that of conventional instrument, and shorten than computer navigation. The postoperative lower limb alignment and individual component positions were similar in all 3 groups except in sagittal plane where conventional instrument resulted in a significantly flexed femoral component. Although statistical significance was not achieved, the incidence of outliers was the highest in the conventional instrument group, followed by patient specific instrument and finally computer navigation. The current studied identifiedmarginal benefit of PSI in isolated component position compared to conventional instrument. A prospective study with a larger sample size and better post-op imaging modality (e.g. CT or MRI) may be needed to prove the efficacy of PSI. 860 MRI-DETECTED OSTEOPHYTE IS A PREDICTOR FOR RECEIVING TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH END-STAGE KNEE OSTEOARTHRITIS L. Liu y,z, H. Kaneko y, R. Sadatsuki y, S. Hada y, A. Yusup y, M. Kinoshita y, I. Futami y, Y. Shimura x, H. Kurosawa x, Y. Saita y, Y. Takazawa y, H. Ikeda y, K. Kaneko y,z, M. Ishijima y,z. yDept. of Med. for Orthopaedics and Motor Organ, Juntendo Univ. Graduate Sch. of Med., Tokyo, Japan; z Sportology Ctr., Juntendo Univ. Graduate Sch. of Med., Tokyo, Japan; xDept. of Orthopaedic Surgery, Juntendo Tokyo Metropolitan Koto Geriatric Med. Ctr., Tokyo, Japan