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To compare three-dimensional (3D) nasal forms after definitive correction of unilateral cleft lip (UCL)-nose using an extended spreader cartilage graft with/without a cross-lap joint cartilage graft technique. Twenty-four patients with UCL who underwent definitive nose correction using an extended spreader cartilage graft with a cross-lap joint technique (CLJ group) and fifteen patients with UCL who underwent nose correction without a cross-lap joint technique (non-CLJ group) were enrolled in this study. Pre- and postoperative 3D nasal forms were compared between the two groups. The CLJ group demonstrated more successful recovery of the nasal tip and anterior nasal ridge in the center of the face (P 0.01), and the higher nasal tip was maintained for more than 1 year (P = 0.008). The differences in the cephalo-caudal heights of the nasal alar groove and curvatures of the alar groove arch were successfully improved in both CLJ and non-CLJ groups. The nasal angles on lateral profiles did not change in either group. An extended spreader cartilage graft with a cross-lap joint technique facilitates satisfactory recovery of the nasal tip in the center of the face and a higher nasal tip, avoiding over-projection in the definitive correction of UCL-nose.

We present two cases of patients with immature skeleton and intra-articular fracture of the proximal radius, treated conservatively in the acute phase and that presented later on with severe chondral degeneration that required surgical treatment. Clinical outcome at 3 years follow-up is reported. This report underlines the association between intra-articular proximal radius fracture in skeletally immature patients and poor clinical outcome. We suggest the need for a high index of suspicion regarding chondral lesions in minimally or non-displaced proximal radius intra-articular fractures in patients with open physis, and more advanced imaging studies are advocated in these cases.

Objectives: Different materials are currently being used experimentally to accelerate cartilage healing and to obtain hyaline cartilage. We aimed to investigate the effect of platelet-rich fibrin on joint cartilage healing. Methods: Twenty rats were used in this study. platelet-rich fibrin was obtained from 4 rats, and the remaining 16 rats were randomly divided into two groups (4 and 8 weeks). Both knee joints were prepared, and an osteochondral defect was created at the femoral condyle in all rats. platelet-rich fibrin was placed into the osteochondral defect of the right knee, while the left knee joint was used as a control. Groups were sacrificed after 4 and 8 weeks, respectively. Results: According to the O'Driscoll score, there were no significant differences between the right and left knee scores in group 4 weeks (p = 0.820). However, the right knee scores were significantly different than the left knee scores in group 8 weeks (p < 0.001). Defects were completely filled with cartilage tissue after 8 weeks in the platelet-rich fibrin group. Conclusions: Similar to its role in various tissues, platelet-rich fibrin is an effective biomaterial that enhances the healing of osteochondral defects.

Degenerative Joint Disease (DJD), also known as Osteoarthritis (OA), is a chronic disease of progressive degeneration for which there is no cure, which can occur in one or more joints in the body, usually caused by overweight of the animal, longevity, instability, incongruence or by injury to the articular cartilage itself. Adult and senile dogs may be affected by this disease as a result of obesity, hormonal disease, natural wear of the joints. In this case, the most affected joint processes are in the pelvic limbs, in the knees and in the hip joint, in the thoracic limbs and in the elbow joints. This work aims to describe the Low Intensity Laser (LIL) efficacy of treatments associated with kinesiotherapy and chondroprotective drugs, performed on a female canine dog affected by this disease in her hip joint and to evaluate this methodology as one of the therapeutic choices more appropriate and less aggressive for the treatment of this disease. La enfermedad degenerativa de las articulaciones (EDA), también conocida como osteoartritis (OA), es una enfermedad crónica de degeneración progresiva para la que no existe cura, que puede ocurrir en una o más articulaciones del cuerpo, generalmente causada por el sobrepeso del animal, la longevidad, inestabilidad, incongruencia o por lesión del propio cartílago articular. Los perros adultos y seniles pueden verse afectados por esta enfermedad como consecuencia de la obesidad, enfermedad hormonal, desgaste natural de las articulaciones. En este caso, los procesos articulares más afectados se encuentran en las extremidades pélvicas, en las rodillas y en la articulación de la cadera, en las extremidades torácicas y en las articulaciones del codo. Este trabajo tiene como objetivo describir la eficacia del Láser de Baja Intensidad (LBI) de los tratamientos asociados a la kinesioterapia y los condroprotectores, realizados en una canina afectada por esta enfermedad en la articulación de la cadera y evaluar esta metodología como una de las opciones terapéuticas más adecuadas y adecuadas menos agresivo para el tratamiento de esta enfermedad. A Doença Articular Degenerativa (DAD), também conhecida como Osteoartrite (OA), é uma doença crônica de degeneração progressiva para a qual não há cura, que pode ocorrer em uma ou mais articulações do corpo, geralmente causada pelo excesso de peso do animal, longevidade, instabilidade, incongruência ou por lesão da própria cartilagem articular. Cães adultos e senis podem ser afetados por esta doença como resultado de obesidade, doenças hormonais, desgaste natural das articulações. Nesse caso, os processos articulares mais afetados estão nos membros pélvicos, nos joelhos e na articulação do quadril, nos membros torácicos nas articulações do cotovelo. Este trabalho tem como objetivo descrever a eficácia do Laser de Baixa Intensidade (LBI) como tratamento associados à cinesioterapia e condroprotetores, realizados em uma fêmea canina acometida por esta doença na articulação do quadril e avaliar esta metodologia como uma das opções terapêuticas mais adequadas e menos agressivo para o tratamento desta doença.

Joint cartilage lesions are seen as a major musculoskeletal system problem that have a negative effect on quality of life and are observed at increasing rates [1]. In a prospective examination of 1000 knee arthroscopies by Hijelle et al., chondral and osteochondral lesions were determined incidentally at the rate of 61%. In a similar series, grade III–IV lesions at least 1 cm2 in size were determined in 5.3% of patients aged ≤40 years [2]. According to this, it can be said that focal symptomatic cartilage lesions are frequently seen in young patients.

Symptomatic osteochondral lesions of the talus (OLT) often require surgical treatment. Surgical interventions can be broadly divided into reparative procedures and replacement procedures. Reparative techniques include bone marrow stimulation, autologous chondrocyte implantation, and matrix-induced autologous chondrocyte implantation, while replacement techniques include osteochondral autograft and allograft transplantation. More recently, biological adjuncts and scaffolds have been shown to have promising evidence and may be utilized alongside surgery to improve healing potential. This chapter reviews the current evidence for surgical management and use of biological adjuncts for the treatment of OLT.

BACKGROUND: BoneXpert is an automated method to calculate bone maturation and bone health index (BHI) in children with juvenile idiopathic arthritis (JIA). Cartilage thickness can also be seen as an indicator for bone health and arthritis damage. The objective of this study was to evaluate the relation between cartilage thickness, bone maturation and bone health in patients with JIA.METHODS: Patients with JIA diagnosed according ILAR criteria included in a previous ultrasonography (US) study were eligible if hand radiographs were taken at the same time as the US examination. Of the 95 patients 67 met the inclusion criteria.RESULTS: Decreased cartilage thickness was seen in 27% of the examined joints. Decreased BHI was seen in half of the JIA patient, and delayed bone maturation was seen in 33% of patients. A combination of decreased BHI and bone age was seen in 1 out of 5 JIA patients. Decreased cartilage thickness in the knee, wrist and MCP joint was negatively correlated with delayed bone maturation but not with bone health index.CONCLUSION: Delayed bone maturation and decreased BHI were not related to a thinner cartilage, but a thicker cartilage. No relation with JADAS 10 was found. The rheumatologist should remain aware of delayed bone maturation and BHI in JIA patients with cartilage changes, even in the biologic era.

Some of the most pressing health problems of the industrial society are the damage and degeneration of articular cartilage associated with the limited capacity of tissues to regenerate. The review describes the existing and developing technologies for the recovery and replacement of damaged joint cartilage tissue. The results obtained are analyzed covering two major areas: the stimulation of regeneration of damaged cartilage tissue and the growing of cartilage tissue elements in bioreactors.

Objective To identify if the time of day and pre-imaging exercise matter while performing T2* mapping of hip joint cartilage at 3 T. Design Nine asymptomatic healthy volunteers (mean age 27.4 ± 4.0 years) with no obvious morphological evidence of cartilage damage were enrolled. The MRI protocol included a double-echo steady state (DESS) sequence for morphological cartilage assessment and a multi-echo data image combination sequence for the T2* measurement. T2* values were obtained between 8 and 11 a.m., between 3 and 6 p.m., and after 50 knee-bends at several time points of each measurement (0, 15, 30, 45, 60 minutes). Results We observed no differences ( P = 0.47) between the T2* values obtained in the morning (T2* = 22.9 ± 3.0 ms) and those measured in the afternoon (T2* = 23.2 ± 3.2 ms). We also observed no statistically significant differences between the T2* values at different time points ( P = 0.67) or after 50 knee-bends ( P = 0.43). Conclusions Timing of the scan and pre-imaging exercise clearly did not matter in this modality. This study consolidates the value of T2* imaging in hip joint cartilage that seems to be independent of diurnal effects and physical activity prior to MRI.

Introduction: Hyalofast grafting with microfracture is a new minimally invasive treatment method being proposed for joint cartilage defects. This study was done to measure the clinical efficacy of Hyalofast grafting after microfractures. Methods: Forty-six patients were assessed for knee function using knee injury and osteoarthritis outcome score (KOOS) after undergoing microfracture and Hyalofast grafting surgery. We further divided the 46 patients into a group of 10 patients who had no associated procedures done with the microfracture and Hyalofast grafting surgery. All patients had magnetic resonance imaging (MRI) of the affected knee pre-surgery and two patients had MRI done post-surgery. Due to another unrelated injury, we were also able to obtain further arthroscopic findings of another patient’s knee 18 months after microfracture and Hyalofast grafting. Results: There was a statistically significant improvement in all categories of the KOOS (symptoms, pain, daily living, sports and quality of life) compared between years 1, 2 and 3 against pre-surgery. For the subgroup of Hyalofast only, there was a statistically significant improvement in symptoms, pain and daily living categories of the KOOS compared between years 1, 2 and 3 against pre-surgery. Conclusions: Our study shows that Hyalofast grafting after microfracture is a viable alternative to treatment for patients with grade 4 cartilage ulcers.

Penyakit Osteochondral Lesion of the Talus (OLT) adalah kelainan pada tulang talus di lapisan subchondral yang berupa lesi osteochondral pada talar dome dengan konsekuensi abnormalitas pada tulang rawan sendi talar. Pasien biasanya datang berobat ke tenaga kesehatan dengan keluhan yang tidak spesifik dan dengan gejala seperti nyeri pada pergelangan kaki, bengkak serta berkurangnya berkurangnya ruang gerak. Penegakan diagnosis bisa dilakukan dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang sederhana seperti foto X-ray maupun pemeriksaan penunjang canggih seperti CT-Scan dan MRI. Tatalaksana OLT bervariasi. Tatalaksana pada OLT tergantung dari tahapan lesi, kronisitasnya, dan keluhan simtomatis yang menyertainya. Pasien dengan keluhan simtomatis yang akut dan non-displaced sering diberikan terapi nonoperatif biasanya berupa terapi konservatif dengan imobilisasi. Lesi yang tidak berhasil atau tidak menunjukkan perbaikan dalam keluhan simtomatisnya setelah 3 sampai 6 bulan, serta lesi dengan displacement dapat direncanakan untuk terapi operatif. Ada beberapa macam tehnik operatif yang dapat dilakukan untuk menyembuhkan OLT. Tehnik operatif ini dapat dikategorikan menjadi cartilage repair , cartilage regeneration dan cartilage replacement techniques. Kata kunci: osteochondral lesion of the talus , patofisiologi, tatalaksana ABSTRACT Osteochondral Lesion of the Talus (OLT) is an abnormality in the talus bone in the subchondral layer in the form of osteochondral lesions in the talar dome with consequent abnormalities in the talar joint cartilage. Patients usually come to a health care provider with nonspecific complaints and with symptoms such as pain in the ankles, swelling and reduced space for movement. The diagnosis can be made with a history, physical examination and simple investigations such as X-rays and sophisticated investigations such as CT-Scan and MRI. The management of OLT varies. The management of OLT depends on the stage of the lesion, its chronicity, and the accompanying symptomatic complaints. Patients with acute and non-displaced symptomatic complaints are often given nonoperative therapy usually in the form of conservative therapy with immobilization. Lesions that are unsuccessful or show no improvement in symptomatic complaints after 3 to 6 months, and lesions with displacement can be planned for operative therapy. There are several types of operative techniques that can be done to cure OLT. These operative techniques can be categorized into cartilage repair, cartilage regeneration and cartilage replacement techniques . Keywords: osteochondral lesion of the talus , patophysiology, treatment

Hyaline cartilage covers joint surfaces and plays an important role in reducing friction and mechanical loading on synovial joints such as the knee. This tissue is not supplied with blood vessels, nerves or lymphatic circulation, which may be one of the reasons why joint cartilage has such poor capacity for healing. Chondral lesions that reach the subchondral bone (osteochondral lesions) do not heal and may progress to arthrosis with the passage of time. In young patients, treatment of chondral defects of the knee is still a challenge, especially in lesions larger than 4 cm. One option for treating these patients is autologous chondrocyte transplantation/implantation. Because this treatment does not violate the subchondral bone and repairs the defect with tissue similar to hyaline cartilage, it has the theoretical advantage of being more biological, and mechanically superior, compared with other techniques. In this paper, we describe our experience with autologous chondrocyte transplantation/implantation at the Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of Sâo Paulo, through a report on three cases.

ResumoObjetivoAnalisar os níveis séricos sanguíneos de CTX‐II em atletas profissionais de futebol de salão, em três momentos distintos durante uma temporada: no início da pré‐temporada, quatro meses após (período que marca o meio da temporada) e no fim da temporada.MétodosForam incluídos 14 atletas do gênero masculino e média de idade de 19 anos. Foram coletados 3 mL de sangue de cada indivíduo. As amostras foram analisadas pelo teste do tipo Elisa.ResultadosHouve aumento significativo dos níveis séricos de CTX‐II nos atletas de futebol de salão, comparando‐se o início e o fim de uma temporada (p

Background and purpose — Unloading alters the thickness of joint cartilage. It is unknown, however, to what extent unloading leads to a loss of glycosaminoglycans (GAGs) in the cartilage tissue. We hypothesized that muscle forces, in addition to axial loading, are necessary to maintain the joint cartilage GAG content of the knee and the upper and lower ankle.Patients and methods — The HEPHAISTOS orthosis was worn unilaterally by 11 men (mean age 31 (23–50) years old) for 56 days. The orthosis reduces activation and force production of the calf muscles while it permits full gravitational loading of the lower leg. MRI measurements of the knee and ankle were taken before the intervention, during the intervention (on day 49), and 14 days after the end of the intervention. Cartilage segmentation was conducted semiautomatically for the knee joint (4 segments) and for the upper (tibio-talar) and lower (subtalar) ankle joints (2 segments each). Linear mixed-effects (LME) models were used for statistical analysis....

The limited natural capacity for articular cartilage to regenerate has led to a continuously broadening array of surgical interventions. Used once patients' symptoms are not relieved by nonoperative management, these share the goals of joint preservation and restoration. Techniques include bone marrow stimulation, whole-tissue transplantation, and cell-based strategies, each with its own variations. Many of these interventions are performed arthroscopically or with extended-portal techniques. Indications, operative techniques, unique benefits, and limitations are presented.

Background: A focal full thickness cartilage lesion of knee joint is one of the commonly seen intraarticular pathologies among the joint cartilage problems. Osteochondral autograft transfer mosaicplasty is a method which has satisfactory outcomes among the treatment preferences of cartilage defects. In spite of the favorable clinical results there are some pitfalls of mosaicplasty treatment especially in cases of large defects. One of the major problems of the classical OAT mosaicplasty is the gap spaces between the plugs. The objective of the present study is to report the early clinical and radiological outcomes and to evaluate the clinical application of a new hexagonal osteochondral graft system (HOGS) with the hypothesis of improvement of the OAT mosaicplasty method with the use of hexagonally shaped plugs. The study has intended to answer two questions. (1) Does mosaicplasty with the new HOGS has favorable early clinical outcomes? (2) Is it possible to arrange the osteochondral autografts without leaving gap spaces by using hexagonal pattern in OAT mosaicplasty? Patients and methods: We designed a retrospective study to report analysis of early outcomes of the initial case series of OAT mosaicplasty by using a new HOGS. Six male individuals with the diagnosis of osteochondral defect and treated with HOGS and reached sixth month follow-up formed the basis of the study. The clinical status of the patients were evaluated with IKDC score. The radiological evaluations were carried out with direct X-rays and magnetic resonance imaging (MRI) studies. The mosaicplasty procedures were carried out via standard surgical method of classical OAT mosaicplasty by using the HOGS following a diagnostic arthroscopy in the same session. The inclusion criteria was a full thickness osteochondral lesion of femoral condyle between 1.5 and 6 cm(2) and completion of 6 month follow-ups. The patients having deformities around the knee or major ligament lesions were excluded. MOCART scoring system was used for the evaluation of follow-up MRI findings. The clinical status of the patients were evaluated with IKDC scores. Results: The mean age of the patients was 40.8 (+/- 5.2) years and the mean duration of the symptoms on presentation was 16 (+/- 4.3) months. On the initial MRI studies mean defect area was measured 3.7 cm(2) (+/- 0.9) which was compatible with arthroscopic findings. During the surgical procedures it was possible to fill the defect area completely. The mean number of plugs in this series was 4.8 (+/- 1.1). We did not faced with insufficient donor reserve problem in any of the cases. On the sixth month follow-up physical examination there was no limitation of the knee joint range of motion in the cases. All patients were able to bear weight on to their operated extremities without pain. The mean postoperative IKDC score improvement was 70.2 (+/- 3.5) which shows significant improvement compared to preoperative scores. On the control MRI studies the bone integration of the hexagonal plugs were complete the cartilage continuity of the articular surfaces were intact and the grafts were well incorporated in all cases. The mean MOCART score on the 6th month MRI studies was 65.8 (+/- 4.1). Conclusion: The early outcomes of OAT mosaicplasty with HOGS are comparable to studies on the classical mosaicplasty. According to our observations in this study we can say that the gap space left between the cylindrical plugs can be solved by using hexagonal prism shaped plugs.

Objective To analyse the changes in synovial fluid (SF) in the most common knees joint diseases, and to establish a relationship according to its concentration. Material and methods A total of 62 synovial fluids were analysed from knees with, meniscus disease (32), anterior cruciate ligament (ACL) (17) and isolated chondral injury (13). A quantitative and quality study was performed on each sample, which included cytokines IL-1, IL-2, IL-6, IL-10, TNF-α, and growth factors (IGF-1 and TGF-β). Results The SF environment in the ACL injury was mainly anabolic and inflammatory, with increased levels of IL1, IL6, significant levels of TGF-β ( P = .02 and P = .004), IL-10 ( P = .046 and P = .047) and significantly decreased levels of TNF-α ( P = .02 and P = .004). There was mainly a catabolic environment in chondral and meniscal disease, with a significant increase in TNF-α and a significant decrease in TGF-β ( P = .02 and P = .004). The differences were greater in the case of isolated chondral injury. Conclusion The changes observed show that, as well as the biomechanical changes, the SF has a negative effect on joint homeostasis, leaving its composition varying depending upon the type of pathology.

This is a case report using a new technique designed to allow passage of a screw through a joint while simultaneously preserving the joint cartilage. A 58-year-old woman with diabetes with midfoot Charcot neuro-arthropathy underwent reconstruction, which included a medial column rodding. A headless 8.0-mm screw was inserted into the first metatarsal head coursing along the entire medial column after temporary removal of a portion of the osteochondral surface. This allowed the screw to be positioned perpendicular to the medial column joints. Serial radiographs were collected to evaluate alignment, stability, and osteochondral graft incorporation. The patient showed preservation of joint motion and function with complete osteochondral graft incorporation without evidence of joint degeneration or pain after 45 months of follow-up. This is the first study to present the use of a local osteochondral graft to allow passage of a large diameter screw in the foot. Although graft incorporation was complete, the situation regarding joint preservation remains unclear, but midterm follow-up shows promise. Levels of Evidence: Therapeutic, Level IV, retrospective case study

INTRODUCTIONOchronosis is a rare disorder which is defined as the deposition of metabolites of oxidation and polymerization of homogentisic acid, which have high affinity to collogen, in the connective tissues. It is a clinical condition characterized with ochronotic pigmentation of tissues, degenerative arthropathy of especially large joints and black discoloration of urine. In this paper we present a case of ochronosis diagnosed with biopsy and additional tests when a black discoloration of menisci and joint cartilage were detected during arthroscopic intervention for a degenerative meniscus tear.PRESENTATION OF CASEA forty two year-old male patient was operated for lateral meniscus tear of his right knee. The arthroscopic examination of right knee revealed black colored synovial hypertrophy and torn lateral meniscus. Partial meniscectomy was performed. The diagnosis of ochronosis was made after histopathologic examination.DISCUSSIONOchronotic pigment can accumulate in hyaline cartilage, tendon, skin, teeth, nail, sclera, tympanic membrane, heart valves, renal tubular cells, duramater, pancreas and walls of large arteries. In ochronosis the most frequently involved joints are knee and hip. In ochronotic arthropathy, articular cartilage become more sensitive to mechanical stresses. Our patient had meniscal tear, cartilage damage and black discoloration of synovial tissues and meniscus.CONCLUSIONArthroscopy may be helpful in diagnosis of ochronotic arthropathy.

Zusammenfassung Es wird uber zwei Falle von Polyarthritis beim Rothirsch (Cervus elaphus L.) berichtet. Die Veranderungen in Form von sero-fibrinoser Synovialitis, fibroser Verdickung der Gelenkkapseln, Knorpelusuren und Knochenappositionen an den Gelenkrandern betrafen die Gelenke der Gliedmasen und des Rumpfes. Bei einem Hirsch wurde auserdem eine exsudativ-granulomatose Tendovaginitis beobachtet. In einem Fall wurden in den veranderten Gelenkkapseln histologisch adulte Nematoden nachgewiesen, bei denen es sich vermutlich um Filarien der Gattung Onchocerca oder Wehrdikmansi handelte. Eine durch Filarien verursachte Arthritis der Zehengelenke wird als Ursache fur ein pathologisches Hornwachstum der Zehenendorgane angenommen. Summary Polyarthritis of red deer (Cervus elaphus L.) caused by Filaria Two cases of polyarthritis in red deer are reported. The changes comprising sero-fibrinous synovitis, fibrous thickening of the articular capsule, ulceration of joint cartilage and areas of bone overgrowth at the edges of joints, affected the joints of the limbs and trunk. In one deer there was also an exudative-granulomatous tendovaginitis. In one case adult nematodes were found within the affected joint capsule and the helminth was provisionally identified as belonging to Onchocerca or to Wehrdikmansi. Arthritis of the foot joints is considered to have been the cause of the pathological horn growth at the end of the toes. Resume A propos d'une polyarthrite due a des filaires chez le cerf Deux cas de polyarthrite chez le cerf (Cervus elaphus L.) sont decrits. Les lesions sont apparues sous la forme de synovite sero-fibrineuse, d'un epaississement fibreux de la capsule articulaire, d'usures du cartilage et d'apposition osseuse sur les bords de l'articulation et concernaient les articulations des membres et du tronc. Une tendovaginite exsudative et granulomateuse a ete en outre observee chez un cerf. Des nematodes ont ete mis en evidence histologiquement dans un cas dans les capsules articulaires lesees. Il s'agit probablement de filaires de l'espece Onchocerca ou Wehrdikmansi. Une arthrite des articulations des onglons due a des filaires est consideree comme la cause d'une croissance pathologique de la corne des onglons. Resumen Sobre una poliartritis en un venado ocasionada por filarias Se informa sobre dos casos de poliartritis en venados (Cervus elaphus L.). Las modificaciones en forma de sinovialitis serofibrinosa, engrosamiento fibroso de las capsulas articulares, desgastes cartilaginosos y aposiciones oseas en los margenes articulares afectaron las articulaciones de las extremidades y del tronco. En un ciervo se observo ademas una tendovaginitis exudativo-granulomatosa. En un caso se identificaron histopatologicamente nematodos adultos en las capsulas articulares modificadas, tratandose probablemente de filarias del genero Onchocerca o Wehrdikmansi. Una artritis de las articulaciones digitales ocasionada por filarias se admite como etiologia de un crecimiento corneo patologico en los organos digitales terminales.

To determine if the application of low intensity pulsed ultrasound (LIPUS) therapy has a positive effect over the cartilage repair, functional status and reduction of pain in patients with grade 2 or 3 osteoarthrosis of the knee.This trial was an observational, before and after study without a control group, in which 10 patients (eleven knees) were studied. We applied LIPUS therapy with an intensity of 0.3W/cm(2), duty cycle of 50%, giving a total of 36J/cm(2) per session during 36 sessions (three months). The clinical measures were obtained before the first session and at the end of the 36th session, and were: cartilage thickness by the analysis of magnetic resonance images (MRI) measured by two rheumatologists and a radiology specialist, pain by a visual analog scale (1-10cm) and function/severity by the Lequesne index. We used the non parametric tests of Wilcoxon for comparing medians and the Spearmans rho for the correlation of the inter observer cartilage thickness measurements defining a p value of0.05 as significant.We observed an effect on pain (VAS mean before 7.09+-2.54 mean after 4.18+-2.22 p 0.005) and on the function/severity index (Lequesne mean before 10.55+-5.42 mean after 5+-4.45 p 0.008). There was poor consistency regarding the cartilage thickness measures by resonance imaging between the three observers (2 rheumatologists and 1 radiologist) so we were not able to define the presence or absence of effect on cartilage thickness augmentation.LIPUS has a benefic effect over pain and functionality/severity in patients with Kellgren and Lawrence grade 2 and 3 osteoarthritis of the knee. Unfortunately in this study we did not count with a reliable measure method to conclude on its effect over cartilage thickness measured by MRI.

SummaryWe describe the creation of a cranial instrument portal for shoulder joint arthroscopy in the dog using a target device that has been successfully employed for the caudal access. We compared the method with a conventional triangulation technique. The shoulder joints of 60 dog cadavers were investigated by arthroscopy and the two methods were compared on the basis of pre-defined parameters of outcome. Time, the number of trials, success, damage to cartilage and the accessibility of intra-articular structures were assessed. The anatomical localisation of the working cannula in muscles was also documented. In general, the new method permitted more successful insertion of the working cannula. This was achieved in a shorter period of time and was associated with fewer insertion attempts as well as less damage to joint cartilage. Intra-articular structures could be readily approached through the working cannula with both methods. Predetermined, clinically relevant points were comparatively more accessible with the new technique. Independent of the method, in only a few cases, the working cannula perforated neither muscles nor tendons when accessing the joint. It may be concluded that the new method using a target device is simpler and safer and offers a standardised technique to establish a cranial instrument port.

The elasticity of the joint surface was measured at defined points on a freshly removed patella which had no macroscopically apparent degenerative changes. The chondrocyte volume density of the stressed points was determined planimetrically. A correlation was found between the cell volume density and the viscoelastic properties of the joint cartilage, indicative of an increase in elasticity where the cell volume density was reduced. The mean chondrocyte volume under a defined joint surface was found to be almost constant, with varying cartilage thickness.

The article explains the fundamental problems in therapeutic studies of the primary and secondary processes in arthrosis. Many drugs are on the market for treating the secondary phenomena; however, such phenomena can often be assessed only on the basis of "soft" action criteria (verbal information given by the patients). Biochemical examinations of the synovial fluid and methods to assess joint morphology, are particularly suitable for evaluating the primary changes taking place in the joint cartilage. An assessment of the "joint noises" is known in literature as a non-invasive method. An improved method of recording and evaluating these joint noises is suggested. It is characterized by the following features: - registration of signals with defined joint load - classification of the noise phenomena with reference to the joint position, i.e. to joint areas - by separation of the signal into movement cycles elimination of artificial noise producers - evaluation of those signal periods only which are disease-specific. The article shows examples by quoting signals with the respective frequencies for healthy and diseased persons, and explains the suitability of the method in therapy control by describing two examples of surgical treatment.

SUMMARY Purpose: We reviewed 71 patients diagnosed with anterior cruciate ligament (ACL) injury on 72 knees. The incidence of associated injuries (meniscal and joint cartilage injuries) were evaluated according to the time elapsed until ACL reconstruction. Study design: Retrospective case series. Methods: Statistical analysis of the relationship between the time elapsed until surgery and the increase of associated lesions. Results: There was no statistically significant difference on the incidence of joint-cartilage and meniscal injuries assessed for the periods within 2-3 months, 4-6 months, 7-12 months, 13-24 months and above 24 months. Conclusion: Although a trend towards a higher number of meniscal injuries after 6 months, and of joint-cartilage injuries after 12 months since the primary anterior cruciate ligament injury, such fact showed no statistical significance.

Purpose: This study was designed to comprehensively compare the mechanical properties of 4 types of braided polyblend sutures with widely used braided polyester and monofilament polydioxanone sutures. Methods: Polyblend polyethylene sutures (FiberWire [Arthrex, Naples, FL], Herculine [Linvatec, Largo, FL], Orthocord [DePuy Mitek, Raynham, MA], and Ultrabraid [Smith & Nephew Endoscopy, Andover, MA]), a braided polyester suture (Ethibond; Ethicon, Somerville, NJ), and an absorbable monofilament polydioxanone suture (PDS II; Ethicon), all USP No. 2, were mechanically tested. Fraying resistance was tested on eyelets of metallic and absorbable suture anchors. Cartilage abrasion caused by an intra-articularly placed suture knot was simulated by fraying on distal porcine femora. Results: All polyblend sutures were stronger than Ethibond or PDS II sutures by at least a factor of 2, with or without a knot. When knotted, Herculine (261 ± 44 N) was strongest, followed by Ultrabraid (244 ± 3 N). FiberWire was most resistant against fraying on metallic anchors. Orthocord was by far least abrasive with absorbable anchors. Resistance to fraying was 100- to 500-fold (absorbable anchors) and 6- to 30-fold (metallic anchor) better for all polyblend sutures than for Ethibond. All braided sutures caused a similar amount of abrasion of joint cartilage, but they caused significantly more abrasion (>20-fold) than the monofilament degradable suture. Conclusions: The ultimate strength of polyblend suture material was 2- to 2.5-fold greater than that of polyester or polydioxanone sutures, but the resistance to fraying was up to 500-fold greater than that of polyester or polydioxanone sutures. With regard to strength, this makes polyblend sutures particularly advantageous for use with metallic edges of anchors or prostheses or with absorbable anchor eyelets. Clinical Relevance: With a high resistance to fraying against metallic edges or a decrease in cutting of absorbable suture eyelets being up to 500-fold greater than with polyester or polydioxanone sutures, the new polyblend sutures appear to fill a void in the armamentarium of the surgeon, provided that at least 2 throws more than with conventional sutures are used for knot tying.

We report our preliminary experience with the use of hyaluronic acid (Synvisc®) in 29 joints from 25 different haemophilic patients (17 knees, six shoulders, four ankles, one elbow and one hip). All the joints were grade III of our classification, characterized by synovial thickening, axial deformities and muscle atrophy (chronic arthropathy). In view of the very satisfactory results obtained with this procedure, we have substituted Synvisc® for the previous use of intra-articular long-standing corticosteroids that we had been used for some years. This method is theoretically more physiological and does not destroy the joint cartilage further, as corticosteroids can.

The structure and composition of articular cartilage provides unique mechanical properties which effectively dampen and distribute loads during weightbearing. Acute traumatic damage to the articular cartilage destroys the original structure and composition of the articular cartilage and impairs its function. Lesions in articular cartilage can cause patients severe disabling symptoms from the affected joint. These symptoms also run the risk of developing into degenerative osteoarthrosis with time. Unfortunately, articular cartilage does not have any real ability to heal itself after injury. Different treatment methods have been developed in an attempt to restore the function of the injured joint and to prevent further deterioration in the articular cartilage. Some of these methods have produced promising results in clinical studies, but further research is necessary to establish their efficacy and indications for treatment. Today, no controlled studies that compare these different methods are available.

Ochronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis. © OMSB, 2013.

The degenerative osteoarticular processes are an inherent consequence of the lower limb amputation. The use of exoprosthesis generates changes in the stimuli received by the healthy and the amputated bones producing disorders in their structures. To establish the effects of a frequent use of the exoprosthesis over the articular cartilage volume in individuals with lower limb amputation, a preliminary study was made to compare volumetric percentage between healthy and amputated side. commas.

The effects of insulin-like growth factor (IGF)-I, IGF-II, and platelet-derived growth factor (PDGF) were examined in cultured chondrocytes derived from rabbit joint cartilage. In addition, the expression of IGF-I receptors on the cultured chondrocytes was detected with anti-IGF-I receptor antibody. IGF-I acted as a growth stimulant, but IGF-II had no effect on cell growth. Increasing the dose of IGF-I beyond 50 ng/ml resulted in decreased growth stimulation. The expression of IGF-I receptors was detected continuously during the culture period. The results also showed that PDGF acted as a growth inhibitor, in contrast to the results of other studies. Further studies are necessary to clarify the precise mechanism of the action of PDGF and the role played by different homo- or heterodimers of PDGF in the proliferation of articular chondrocytes.

Summary Implantation of non-articular (heterotopic) chondrocyte-based implants might be an alternative approach to articular cartilage repair. This strategy could be helpful in cases in which there are no or too few articular chondrocytes available. Therefore, this study was undertaken to compare joint cartilage defect healing in the minipig model after implantation of heterotopic auricular and orthotopic articular chondrocytes. Poly-glycolic acid (PGA) associated three-dimensional (3D) constructs were prepared culturing autologous minipig-derived articular and auricular chondrocytes for 7 days in a dynamic culture system. Chondrocyte PGA constructs were implanted into 8 mm diameter and ∼1.1 mm deep chondral defects within the medial and lateral condyles of the minipig knee joints. Empty defects served as controls for assessment of the intrinsic healing response. Defect healing was monitored 6 months post implantation using a macroscopic and microscopic score system and biomechanical analysis. Neo-cartilage formation could be observed in the PGA constructs seeded with articular and auricular chondrocytes in vivo. The defect healing did not significantly differ at the macroscopic and histological level in response to implantation of either autologous articular or auricular chondrocytes seeded constructs compared with the empty defects. Although the differences were not significant, the auricular chondrocytes-based implants led to a slightly inferior repair quality at the macroscopic level, but a histologically superior healing response when compared with the empty defect group. However, biomechanical analysis revealed a higher stiffness in repair tissues produced by auricular chondrocyte implantation compared with the other groups. Deduced from these results, articular chondrocytes represent the preferable cell source for implantation.

Following an application from Roxlor Nutra LLC, submitted pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Belgium, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to Cynatine® and maintenance of normal joint mobility. The Panel considers that Cynatine®, which is a keratin powder extracted from sheep wool, is sufficiently characterised. The claimed effect proposed by the applicant refers to “joint flexibility”. The Panel considers that maintenance of normal joint mobility is a beneficial physiological effect. The applicant presented one unpublished human intervention study as being pertinent to the health claim. The Panel notes that the study was specifically designed to identify patients with clinical diagnosis of osteoarthritis, and considers that normal cells and tissues are genetically (gene expression) and functionally different from osteoarthritic cells and tissues, and therefore may respond differently to interventions with exogenous substances. In addition, the mechanisms involved in the onset and/or progression of osteoarthritis are largely unknown. It would have to be established, therefore, that an intervention which has an effect on the progression of the disease (in patients with osteoarthritis) would also have an effect on its onset (subjects without the disease). The Panel considers that no conclusions can be drawn from this study for the scientific substantiation of the claim. The Panel concludes that a cause and effect relationship has not been established between the consumption of Cynatine® and maintenance of normal joint mobility.

Platelet gel (PG) includes concentrated dose of growth factors which plays role in physiological processes of healing. The goal of this study is to evaluate repairing effects of intra-articular injection of PG use in a rat model of knee osteoarthritis (OA). A total of 20 rats were randomly distributed into a PG group and a control group. Both the groups were induced OA in knee joints with intra-articular formaline injection. The rats in the PG group and the control group were injected in the knee joint with PG and 0.9% NaCl solution, respectively. Two weeks after last injections, all rats were sacrificed by ether asphyxiation. Tissue samples were obtained from the knee joints and were examined histopathologically. No statistically significant differences were found between the groups regarding cartilage healing ( P > .05). We were unable to determine any beneficial or harmful effects of PG on joint cartilage healing in OA.

RESUMENIn­tro­duc­ción:­ una vez detenida la progresión del deslizamiento, las caderas experimentan un fenómeno complejo de remodelación. Mientras tanto, el choque femoro-acetabular provoca daño irreversible del cartílago articular. El propósito del trabajo es determinar si la remodelación es suficiente para impedir el deterioro articular en el corto plazo. Materiales ­y ­Métodos: se diseñó un estudio de cohorte retrospectivo de pacientes con deslizamientos moderados y graves, que recibieron como tratamiento la fijación in situ. Se evaluó la capacidad de remodelación con el ángulo de Southwick y el ángulo alfa. El deterioro funcional se evaluó con el puntaje de Harris y el radiológico, con la escala de Tonnis. Seguimiento mínimo: 4 años. Resultados:­ diecisiete pacientes, mediana de seguimiento: 63 meses (RI 55-81). El ángulo de Southwick prequirúrgico 57º (RI 50-72) versus el posquirúrgico 48º (RI 45-74) disminuyó significativamente (p 0,023). Lo mismo ocurrió con el ángulo alfa complementario. El deterioro radiológico evaluado con la escala de Tonnis fue estadísticamente significativo (p 0,012). Los resultados funcionales, cuantificados con el puntaje de Harris no mostraron diferencias estadísticamente significativas (p 0,49). Conclusiones: en esta serie, las epifisiólisis moderadas y graves fijadas in situ presentaron deterioro radiológico en 63 meses de seguimiento promedio. Sin embargo, la funcionalidad no se deterioró con la misma rapidez.

Background Joint cartilage degradation is resulted by ensuing chronic inflammation in juvenile idiopathic arthritis (JIA). Since the primary goals of treatment are to prevent joint destruction sensitive methods are needed to evaluate cartilage thickness (CTh). Ultrasonography (US) is a reliable tool in the assessment of joint cartilage in rheumatic disease. Previously, we have shown that CTh, in healthy children between 7 and 16 years, is significantly influenced by age and gender.

Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage.

With the increasing advances in hip joint preservation surgery, accurate diagnosis and assessment of femoral head and acetabular cartilage status is becoming increasingly important. Magnetic resonance imaging (MRI) of the hip does present technical difficulties. The fairly thin cartilage lining necessitates high image resolution and high contrast-to-noise ratio (CNR). With MR arthrography (MRA) using intraarticular injected gadolinium, labral tears and cartilage clefts may be better identified through the contrast medium filling into the clefts. However, the ability of MRA to detect varying grades of cartilage damage is fairly limited and early histological and biochemical changes in the beginning of osteoarthritis (OA) cannot be accurately delineated. Traditional MRI thus lacks the ability to analyze the biological status of cartilage degeneration. The technique of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is sensitive to the charge density of cartilage contributed by glycosaminoglycans (GAGs), which are lost early in the process of OA. Therefore, the dGEMRIC technique has a potential to detect early cartilage damage that is obviously critical for decision-making regarding time and extent of intervention for joint-preservation. In the last decade, cartilage imaging with dGEMRIC has been established as an accurate and reliable tool for assessment of cartilage status in the knee and hip joint. This review outlines the current status of dGEMRIC for assessment of hip joint cartilage. Practical modifications of the standard technique including three-dimensional (3D) dGEMRIC and dGEMRIC after intra-articular gadolinium instead of iv-dGEMRIC will also be addressed.

One hundred and fifty crossbred pigs (Camborough × Canabrid, equal numbers of gilts and barrows) at an average live weight of 64.2 kg were randomly assigned to diets containing 17 or 20% crude protein (with 0.8 or 1.1% lysine, respectively) and 0 or 20 ppm ractopamine. Pigs were slaughtered at an average live weight of 102.2 kg. Supplementation of ractopamine in pig diets significantly increased average daily gain (P

The result of intraarticular injection of high molecular weight sodium hyaluronate in the knee joint were reviewed. Twelve knees in 12 patients were divided into two groups: Group A consisted of 10 patients with osteoarthritis in the medial compartment of the knee and arthroscopic medial partial meniscectomy had been performed. Group B consisted of 2 patients who had osteoarthritis in the medial compartment of the knee and lateral partial meniscectomy had been performed. After meniscectomy all patients received intraarticular injection of high molecular weight sodium hyaluronate into the knee joint for at least 5 months. After this therapy all knees were arthroscoped again. Improvement was obserbed in both groups.These results suggest that high molecular weight sodium hyaluronate is effective for improvement of degenerative joint cartilage.

Anterolateral Instability of the Proximal Tibiofibular Joint - An Operation Technique. Instability of the proximal ti-biofibular joint is a rare injury in sportsmedicine [1]. J. A. Odgen subdivides 4 different types of instability [7]. We report on a 19-year-old female high performance alpine ski athlete suffering from a left anterolateral instability of the tibiofibular joint after ski trauma. We describe an operation technique for reconstructing anterior stability with free iliotibial tract graft avoiding joint cartilage damage. Six months after operation the patient is pain free and able to performs ski sport.

Die Atiologie der Chondromalazia patellae, insbesondere die Bedeutung des subchondralen Raumes, ist noch immer nicht geklart. Aus der Klinik (z. B. Patellafrakturen, osteochondrale Frakturen etc.) gibt es jedoch Hinweise auf einen Zusammenhang zwischen degenerativen Veranderungen des Gelenkknorpels und dem Einflus des subchondralen Raumes. In unserem Experiment fuhrten wir eine operative Ischamie der Patella mit Unterbrechung des Gefaszu- und -abflusses bei 40 ausgewachsenen Kaninchen fur genau definierte Zeitraume durch (2 Wochen, 6 Wochen, 3 Monate, 6 Monate). Die Untersuchungen wurden mit Hilfe der Plastinationsmethode, der Histologie, der Transmissionselektronenmikroskopie und der Rasterelektronenmikroskopie durchgefuhrt. Deutliche Veranderungen sind ab dem 3. Monat zu erkennen mit einem Verschwinden der Tidemark, Knorpelzelldegeneration (Clusterbildung) sowie beginnender Pannusbildung. Diese degenerativen Veranderungen schreiten bei den 6-Monats-Tieren fort. Die Ergebnisse deuten darauf hin, das der Umbau der Tidemark eine wesentliche Rolle spielt bei der Entstehung von degenerativen Veranderungen des Knorpels. Eine Chondromalazia patellae kann somit durch subchondrale Vaskularisationsstorungen hervorgerufen werden. - Hiermit liegt ein neues Konzept zur Atiopathogenese der Chondromalazia patellae vor. Das Krankheitsbild der Chondromalazia patellae hat eine grose Bedeutung im sportorthopadischen Bereich. The aetiology of chondromalacia patellae and especially the importance of the subchondral space have not been clarified to date. However, clinical findings yielded pointers to a connection between degenerative changes of the articular cartilage and an influence exercised by the subchondral space. In our experiments we performed an operative ischaemia of the patella with interruption of the vascular inflow and outflow on 40 adult rabbits for exactly defined times (2 weeks, 6 weeks, 3 months, 6 months). The examinations were carried out using the plastination method, histology, transmission electron microscopy, and scanning electron microscopy. Marked changes can be seen from the third month onwards: disappearance of the tidemark, degeneration of the cartilaginous cells (formation of clusters) and onset of trachomatous keratitis. These degenerative changes progress further in the animals of 6 months of age. The results indicate that metaplasia of the tidemark plays a signifikant part in the pathogenesis of degenerative changes of the cartilage. Hence, chondromalacia patellae can be caused by subchondral vascularisation disorders. - This is, therefore, a new concept for the aetiopathogenesis of chondromalacia patellae, a disease pattern that is of great importance in sports orthopaedics.

Auricular pain, redness, and swelling are usually the result of infectious cellulitis. However, relapsing polychondritis is another cause of this symptom complex and is the result of an autoimmune phenomenon. It presents with inflammation and destruction of both articular and nonarticular cartilage, with the external ear and joint cartilage most often involved. Although usually indolent with multiple acute exacerbations, relapsing polychondritis can be rapidly fatal if the airway or cardiovascular system is involved. We present a case of relapsing polychondritis initially mistaken for auricular cellulitis. The clinical manifestations and course of relapsing polychondritis are reviewed, along with the emergency department management.

Summary Objective The purpose of this study was to evaluate the effects of impact exercise on the joint cartilage of rats with osteoarthritis (OA) induced by monosodium iodoacetate (MIA). Methods Eighteen male rats were divided into three groups of six animals each: control, OA, and OA plus exercise (OAE). The OAE group trained on a treadmill for 8 weeks. Afterward, the right joints of the animals were washed with saline solution and joint lavage was used for biochemical analyses of myeloperoxidase (MPO) and enzyme superoxide dismutase (SOD) activities and total thiol content. The same limb provided samples of the articular capsule for analyses of MPO activity and total thiol content. The left joint was used for histological analysis. Results Our results indicate that MPO activity was increased in both OA groups in the lavage as well as the articular capsule, regardless of exercise status. SOD activity was increased in animals with OA, especially in the animals that had run on the treadmill. On the other hand, thiol content in the articular capsule and joint lavage decreased in the OA group, while the OAE group had values similar to those of the control group. The histological data indicate that animals that were submitted to running exercise showed a higher preservation rate of proteoglycan content in the superficial and intermediate areas of the joint cartilage. Conclusion Our results show that physical training contributes to the preservation of joint cartilage in animals with OA and to increase the defense mechanism against oxidative stress.

Arthritis, in one form or another, is one of the most common disorders that affect man. Whether the etiology is systemic, neurologic, or traumatic, the one common finding is the destruction of joint cartilage. Although there have been massive amounts of literature concerning osteoarthritis, little has been written about arthritis of the ankle joint. Current concepts in the pathology, terminology, symptomatology, and treatment of the arthritic ankle are discussed.

OBJECTIVE Arthroscopy is "the gold standard" for the diagnosis of knee cartilage lesions. However, it is invasive and expensive, and displays all the potential complications of an open surgical procedure. Ultra-high-field MRI now offers good opportunities for the indirect assessment of the integrity and structural changes of joint cartilage of the knee. The goal of the present study is to determine the site of early cartilaginous lesions in adults with non-traumatic knee pain. METHODS 3-T MRI examinations of 200 asymptomatic knees with standard and three-dimensional double-echo steady-state (3D-DESS) cartilage-specific sequences were prospectively studied for early degenerative lesions of the tibiofemoral joint. Lesions were classified and mapped using the modified Outerbridge and modified International Cartilage Repair Society classifications. RESULTS A total of 1437 lesions were detected: 56.1% grade I, 33.5% grade II, 7.2% grade III and 3.3% grade IV. Cartographically, grade I lesions were most common in the anteromedial tibial areas; grade II lesions in the anteromedial L5 femoral areas; and grade III in the centromedial M2 femoral areas. CONCLUSION 3-T MRI with standard and 3D-DESS cartilage-specific sequences demonstrated that areas predisposed to early osteoarthritis are the central, lateral and ventromedial tibial plateau, as well as the central and medial femoral condyle. ADVANCES IN KNOWLEDGE In contrast with previous studies reporting early cartilaginous lesions in the medial tibial compartment and/or in the medial femoral condyle, this study demonstrates that, regardless of grade, lesions preferentially occur at the L5 and M4 tibial and L5 and L2 femoral areas of the knee joint.