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In 1999 we have introduced a new approach for treatment of spine diseases based on the mechanical effect of nondestructive laser radiation on the nucleus pulposus of the intervertebral disc. Laser reconstruction of spine discs (LRD) involves puncture of the disc and non-destructive laser irradiation of the nucleus pulposus to activate reparative processes in the disc tissues. In vivo animal study has shown that LRD allows activate the growth of hyaline type cartilage in laser affected zone. The paper considers physical processes and mechanisms of laser regeneration, presents results of investigations aimed to optimize laser settings and to develop feedback control system for laser reparation in cartilages of spine and joints. The results of laser reconstruction of intervertebral discs for 510 patients have shown substantial relief of back pain for 90% of patients. Laser technology has been experimentally tested for reparation of traumatic and degenerative diseases in joint cartilage of 20 minipigs. It is shown that laser regeneration of cartilage allows feeling large (more than 5 mm) defects which usually never repair on one's own. Optical techniques have been used to promote safety and efficacy of the laser procedures.

As reported by the ASME Center for Education Task Force [1], human health will be one of the major areas in which mechanical engineers will take the leadership position to develop innovative technologies in the future. To adapt to the transforming role of the mechanical engineering profession, undergraduate education of mechanical engineering needs to guide students to apply engineering principles in this area. In this paper, the development of an undergraduate biomedical course in a mechanical engineering major is introduced. Several course projects developed by mechanical engineering undergraduate students are described. These projects focused on the study of biomedical problems using engineering problem solving skills. The projects were started with the analysis of injuries or diseases of patients. Then, injuries and/or possible treatments were analyzed from the viewpoint of a mechanical engineer. All of these students’ projects are summarized in this paper and a few projects discussed in detail. Among these projects, the flow and pressure distributions of different types of heart valves were calculated using computational fluid dynamics; the consequence of injuries of joint cartilage was analyzed with bearing design theory; the treatment of a muscle hernia was calculated using the finite element method. These projects encouraged students to appreciate engineering applications in fields other than traditional fields such as automobile and aircraft design. The results of the projects are also useful in practice. The course model is applicable for engineering programs in other small teaching universities.Copyright © 2011 by ASME

In this chapter, we describe our renewed attempts at phalangeal regeneration by applying an osteoinductive biodegradable three-dimensional (3D) copolymer of P(LA-CL) with hydroxyapatite particles, shaped into a human phalanx. By combining a high-performance biodegradable copolymer with periosteum, we sought to achieve a better induction of phalangeal regeneration. Maintenance of joint cartilage after cartilage formation is functionally important. Periosteum has been suggested to play an important role in the regulation of joint cartilage, although the mechanism is not precisely known. An analytical study of the interaction between the periosteum and the joint cartilage in our model was undertaken. Periosteum was attached circumferentially around one half of a phalanx-molded biodegradable copolymer and the regenerative ability of bone between the periosteal and nonperiosteal sides was compared with respect to tissue-forming properties and 3D-maintained shape. Thus, our study was designed from both functional (human phalanx shape) and analytical viewpoints. A basic knowledge and understanding of the developmental processes that occur in phalangeal regeneration are clearly necessary for future clinical applications.

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.

52 knee and ankle joints of hemophiliacs were examined by MRI using FLASH and FISP-3-D sequences; and the degree of synovial hypertrophy and of cartilage destruction were assessed. Findings of synovial hypertrophy varied between thin membranes and tumorous tissue destroying the joint cartilage. Degree of cartilage destruction varied between focal signal decrease and total loss. In spite of recurrent joint bleedings no synovial or cartilaginous changes were seen in 31% and 29% of joints, respectively. Changes were more frequently seen and degree was more marked in the ankle than in the knee joints. With the exception of cysts, osseous destruction was more obvious with radiographs. MRI is suitable for the investigation of joints of hemophiliacs showing no osseous destruction.

20 patients who suffered from osteochondrosis dissecans in the knee were examined by x-ray and MRI. Afterwards all joints were evaluated by arthroscopy. On plain x-ray the judgement of joint cartilage is not possible. With the use of MRI, the hyaline cartilage can be documented. Even without any visible changes on x-ray, MRI clearly reveals pathologic bone patterns. Comparing areas of sclerosis on x-ray with MRI changes, the real diameter of osteochondrosis dissecans can only be seen on MRI.

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.

A Monte Carlo simulation on Geant4 was carried out to calculate the Re-186 absorbed dose factors in radiation synovectomy procedures. In simulation was used a joint model based on a series of thin slabs of bone, joint cartilage, synovial fluid and synovium. Two groups of runs were carried out: considering all particles emitted from Re-186 decay, and considering beta emission alone. Results show that absorbed dose factors are the same in target tissues but they are higher in surrounding tissues considering beta emission alone, reaching differences up 8.0%. In bone tissue absorbed dose factors are lower with beta emission alone because of gamma en X-ray emission by considering all particles emitted from Re-186.

The purpose of the current study was to determine the effect of pulse electromagnetic fields (PEMFs) on joint cartilage thickness of the distal femoral metaphysis in the rat. Twelve female 84 days old Wistar rats from the same litter, were randomly assigned into two groups: the first group received focused PEMF’s (30 mT/1 Hz/ 30 min/20 days) on the knee (MS). The second, the control group (Non-MS), was managed similarly, except magnetical stimulation was applied. All the animals were sacrificed for histological joint tissue evaluation; 6 μm bone longitudinal sections of the knee were obtained and stained with a hematoxiline-eosine technique. These sections were analyzed in a light clear field microscope. The joint surface thickness was measured. Statistically significant differences were found in joint cartilage thickness when compared MS with Non-MS (p=0.001). Our results evidenced that in vivo PEMF’s stimulation increases the knee joint cartilage thickness in healthy young adult rats.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:50Z No. of bitstreams: 1 S1413-78522009000400011.pdf: 698392 bytes, checksum: e2c2bc376d0c064ee17dea6df08437d2 (MD5) Made available in DSpace on 2013-08-22T19:03:50Z (GMT). No. of bitstreams: 1 S1413-78522009000400011.pdf: 698392 bytes, checksum: e2c2bc376d0c064ee17dea6df08437d2 (MD5) Previous issue date: 2009-01-01 Made available in DSpace on 2013-09-30T20:06:11Z (GMT). No. of bitstreams: 2 S1413-78522009000400011.pdf: 698392 bytes, checksum: e2c2bc376d0c064ee17dea6df08437d2 (MD5) S1413-78522009000400011.pdf.txt: 23096 bytes, checksum: 2d9ca931d656ea65870c8cb659ead8ab (MD5) Previous issue date: 2009-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:23Z No. of bitstreams: 2 S1413-78522009000400011.pdf: 698392 bytes, checksum: e2c2bc376d0c064ee17dea6df08437d2 (MD5) S1413-78522009000400011.pdf.txt: 23096 bytes, checksum: 2d9ca931d656ea65870c8cb659ead8ab (MD5) Made available in DSpace on 2014-05-20T13:32:23Z (GMT). No. of bitstreams: 2 S1413-78522009000400011.pdf: 698392 bytes, checksum: e2c2bc376d0c064ee17dea6df08437d2 (MD5) S1413-78522009000400011.pdf.txt: 23096 bytes, checksum: 2d9ca931d656ea65870c8cb659ead8ab (MD5) Previous issue date: 2009-01-01 OBJETIVOS: O presente estudo teve como objetivo cultivar condrócitos retirados da articulação do joelho de coelhos encapsulados em hidrogel de alginato (HA) e caracterizar a produção de matriz extracelular (ECM). MÉTODOS: A cartilagem articular foi removida do joelho de coelhos, com três a seis meses, fragmentada em pedaços de 1mm e submetida à digestão enzimática. Uma concentração de 1x106 céls/mL foram ressuspensas em uma solução de alginato de sódio a 1,5% (w/v), em seguida fez-se o processo de gelatinização em CaCl2 (102 mM), permitindo a formação do HA e cultivo em meio DMEM-F12 durante quatro semanas. A distribuição das células e a ECM foram acessadas através das secções histológicas coradas com e azul de toluidina hematoxilina e eosina (HE). RESULTADOS: Houve um aumento no número e na viabilidade dos condrócitos durante as quatro semanas de cultura. Através das análises histológicas dos HAs corados com azul de toluidina e HE foi possível observar a distribuição definida dos condrócitos no hidrogel, assemelhando-se a grupos isógenos e formação de matriz territorial. CONCLUSÃO: Este estudo demonstrou a eficiência do HA como arcabouço para ser usado na cultura de condrócitos, constituindo uma alternativa no reparo de lesões na cartilagem articular. OBJECTIVES: The aim of this study was to culture chondrocytes from knee joint cartilage of rabbits encapsulated in alginate hydrogel (HA) and to characterize the production of extracelular matrix (ECM). METHODS: Joint cartilage was obtained from rabbits' knees, three to six months old, fragmented into 1-mm pieces and submitted to enzymatic digestion. A concentration of 1x106 cells/mL were re-suspended into a 1.5% (w/v) sodium alginate solution, followed by gel formation process with CaCl2 (102 mM), allowing HA to build for culturing it into a DMEM-F12 medium for four weeks. The distribution of cells and ECM were assessed from histological slices stained toluidine blue and hematoxyline-eosin (HE). RESULTS: There was an increase of the number and viability of the chondrocytes during the four weeks of culture. By assessing the histological sections stained with toluidine blue and HE, we could note the definitive distribution of chondrocytes in the hydrogel, similarly to isogenous groups and territorial matrix formation. CONCLUSION: In this study, the alginate was shown to be an effective scaffold for use in chondrocytes culture, constituting an alternative for repairing joint cartilage defects. UNESP Faculdade de Medicina de Botucatu UNESP Instituto de Biociências UNESP Faculdade de Medicina de Botucatu UNESP Instituto de Biociências

Investigation of joint cartilage properties is of prime importance due to facilitation of its routine diagnostics and artificial tissue engineering. This experiment is based on our previous work in which we have developed new technique for dynamic testing of cartilage tissue biomechanical properties using blunt impact approach. Obtained data are confronted with ICRS histological classification of examined knee cartilage samples.

The biotribological properties of natural swine joint cartilage under various load, velocity and lubrications were investigated by a pin-on-disk tribometer. The experimental results show that the friction coefficients and wear rates of the cartilage under various lubrications are difference, the lowest friction and the lowest wear was obtained under calf serum lubrication. Under the same experiment conditions, the friction coefficients of various position of the cartilage are difference and friction coefficient of top area of the swine joint cartilage was the lowest and the far away from the area, the high friction coefficient was obtained.

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.

The present study aimed to describe the ultrastructural localization of alkaline phosphatase (AP) activity in articular-epiphyseal growth cartilage of the commercial pig and the minipig of wild hog ancestry, comparing areas with a normal endochondral ossification with those where the calcification of the matrix is insufficient, as in osteochondrotic cartilage. Intense AP activity was primarily present in the cytoplasm, the plasmalemmae the long cellular processes and the matrix vesicles budding off from proliferative and hypertrophic chondrocytes in those areas of cartilage where normal calcification appeared. In the osteochondrotic cartilage, the only detectable AP activity was restricted to a few morphologically viable hypertrophic cells in the surroundings of the lesion. The lack of AP activity could partially explain the insufficient calcification of the osteochondrotic cartilage.

A thousand radiographs of the hip joints in adults were evaluated quantitatively and the following statistical conclusions were drawn: the normal forms of the supercilium acetabuli are either parallel or convex. Wedge-shaped supercilia indicate increased stress on the cartilage only in cases with hip dysplasia. A supercilium of more than 4mm raises the suspicion of increased stress on the cartilage. Normally, the joint space as shown on a radiograph does not fall short of 3mm. Eight formulas have been defined which can be used after planimetry of the supercilium and the articular surface in order to indicate increased stress on the cartilage and a risk of developing an arthrosis of the hip. These formulae are of practical value if the radiographs appear normal to visual inspection.

Osteoarthrosis (OA) is the most common musculoskeletal alteration in the general human adult population(1). It is a non inflammatory, deforming, degenerative disease characterized by joint cartilage damage.

Chronic inflammation during rheumatoid arthritis and degenerative processes during osteoarthritis eventually result in joint destruction. Anti-inflammatory therapies facilitate the inhibition or delay of progressing joint cartilage and bone loss, but do not regenerate these tissues. Surgical procedures are quite unsatisfactory in long-term evaluation and often lead to endoprothetic joint replacement. Present tissue engineering technologies offer new strategies for the treatment of cartilage and bone defects. Here, beyond implantation of cell suspensions, biomaterials combined with tissue-specific cells or mesenchymal stem cells are clinically applied. This review focusses on state-of-the-art and future in situ mesenchymal stem cell-based tissue engineering approaches for joint repair in patients with rheumatic diseases.

Background Loss of joint cartilage is a feature of destructive disease in JIA. The cartilage of most joints can be visualized with ultrasonography (US). Our present study focuses on discriminant validity of US in children. We studied reproducibility between and within a skilled and a non-skilled investigator of US assessment of cartilage thickness in small and large joints in healthy children. Methods and results In 11 healthy children (5 girls/6 boys), aged 9.6 years (9.3–10 years), 110 joints were examined. Cartilage thickness of the right and left hip, knee, ankle, 2nd metacarpophalangeal (MCP), and 2nd proximal interphalangeal (PIP) joint independently. The joints were examined twice, two days apart by a skilled and a non-skilled investigator. Mean cartilage thickness in the five joints was: hip 2.59 ± 0.41, knee 3.67 ± 0.64, ankle 1.08 ± 0.31, MCP 1.52 ± 0.27 and PIP 0.73 ± 0.15 mm. We found the same mean differences in CTh of 0.6 mm in the inter-observer part with regard of the PIP joint. Within investigators (intra-observer), the smallest mean difference of CTh was found in the MCP joint with -0.004 (skilled) and 0.013 mm (non-skilled). Conclusion We found the level of agreement between observers within a 95% Confidence Interval in assessment of cartilage thickness in hip-, knee-, ankle-, MCP-, and PIP joints in healthy children. Observer variability seems not to relate to joint size but to the positioning of the joints and the transducer. These factors seem to be of major importance for reproducible US measurements. The smallest difference in measurement of cartilage thickness between observers was found in the PIP joint, and within observers in the MCP joint and it seems that using EULAR standard US guidelines is feasible for a pediatric setting. The use of US in children is promising. Studies on larger groups of children are needed to confirm the validation and variability of US in children as well as determining the smallest detectable difference of US measures.

The ability of an acoustic microscope in the investigation of biological objects with irregular surface, layered structure, different physical and acoustical properties has been estimated. Acoustic images and the results of tissue layers thickness measurements have been analyzed with 3 objects: extracted human tooth, cats’ knee joint in vitro and human nail in vivo. It has been demonstrated, that unlike metal or polymeric samples the biological objects of a ball or cylindrical shape due to the fine surface irregularities can produce acoustic images of their internal structures, which are in a good correspondence with the real microanatomical parameters. Morphological resemblance of the biological objects shape in acoustical and optical images provides precise measuring of separate tissue layers in a noninvasive mode that can not be performed with any other method

PROPOSTA: Revisamos 71 pacientes com diagnóstico de lesão do ligamento cruzado anterior em 72 joelhos. Foi avaliado a incidência de lesões associadas (meniscais ou condrais) de acordo com o tempo até a cirurgia de reconstrução do ligamento. TIPO DE ESTUDO: Estudo retrospectivo de série de casos. MÉTODOS: Realizado análise estatística do efeito do tempo até a cirurgia com o aumento de lesões associadas. RESULTADOS: Não houve alteração, estatisticamente significante, da incidência de lesões condrais e meniscais avaliadas nos períodos 2 a 3 meses, 4 a 6 meses, 7 a 12 meses, 13 a 24 meses e mais que 24 meses. CONCLUSÕES: Embora haja uma tendência de aumento de lesões meniscais após 6 meses e de lesões condrais após 12 meses da lesão do ligamento cruzado anterior, tal fato não mostrou significância estatistica. 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.

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.

Osteoarthritis (OA) is a group of overlapping disorders, which may have different aetiology but similar biological, morphologic and clinical outcome. In osteoarthritis, process will not encompass the joint cartilage only, but the entire joint, including sub-hondral bone, ligaments, capsule, and sinovial membrane and surrounding muscles. Osteoarthritis is a multi-factor disorder of sinovial joints, which occurs as result of mechanical and biological factors, which destabilise normal hondrocyte function, partitioning of cartilage, extra-cellular matrix and sub-hondral bone. The earliest changes, which are restricted to the joint cartilage surface only, do not cause any subjective feeling. The pain in arthrosis occurs (or re-occurs) a bit later, Diagnosis will be determined based on clinical exam as well as signs and symptoms present. Symptomatic and functional treatment of osteoarthritis as one of rheumatic disorders must be taken throughout years, sometimes throughout a lifetime. It encompasses application of many medications and physical therapy procedures.

Diffraction Enhanced Imaging (DEI) is an X-ray imaging method to provide additional contrast and diminish untoward image signals by reducing scattering. Previous reports demonstrated its applicability in soft and hard tissue imaging. Here we provide further evidence for the improved overall image quality and for the option to discriminate various tissue-specific properties, such as collagen fiber elements or mineralization. Comparative ex vivo data to medical MRI and to medical ultrasound are shown, utilizing human ankle and hip specimens.

Osteochondrosis and trauma are major causes of lameness in pigs, especially in breeding stock. However, less is known about the effects of trauma in joint cartilage than about osteochondrosis. This report describes the incidence and consequences of trauma in the elbow joints of growing swine. We suggest that lesions caused by trauma involve compression, twisting and plowing in the joint. Key words: Cartilage, bone, trauma, elbow joint, swine

Osteoarthritis is characterized mainly by degenerative changes in joint cartilage, ultimately resulting in loss of cartilage, and alterations in the subchondral bone. Osteoarthritis osteoblasts show a number of metabolic alterations that may interfere with normal cell metabolism and signaling, possibly leading to altered extracellular matrix composition. This review examines the role of eicosanoids in this structural degradation.Prostaglandins exert diverse modulatory roles in osteoarthritis, with prostaglandin E2 known to play an important role in inflammation. Prostaglandins and leukotriene B4 have been shown to regulate proinflammatory cytokine and interstitial collagenase synthesis in human osteoarthritis synovial membrane explants. Human osteoarthritis osteoblasts produce variable levels of prostaglandin E2 and leukotriene B4 compared with normal osteoblasts. Prostaglandin E2 levels can distinguish two types of patients with osteoarthritis: osteoblasts from one group produce low levels of prostaglandin E2 and interleukin-6, and the other shows an increase in production. In contrast, osteoarthritis osteoblasts that produce high levels of prostaglandin E2 produce low levels of leukotriene B4 and vice versa. This observation could be explained by the selective metabolism of arachidonic acid via the 5-lipoxygenase or cyclooxygenase pathways in osteoarthritis osteoblasts.Prostaglandins play a significant role not only in joint physiology, but also in the pathogenesis of joint disorders. In addition, it has been identified that osteoarthritis subchondral osteoblasts can synthesize leukotriene B4, indicating a role of leukotrienes in bone remodeling associated with osteoarthritis. A therapeutic intervention that blocks lipoxygenase/cyclooxygenase pathways, thereby inhibiting production of prostaglandins and leukotrienes, may therefore be very attractive for the treatment of osteoarthritis patients.

This study was undertaken to determine the concentrations of collagen and glycosaminoglycan (GAG) in different layers of joint cartilage of pigs. Effects of recombinant porcine somatotropin (rpST) treatment of pigs on cartilage composition was also examined. The results demonstrated that the concentrations of GAG uronic acid and collagen (measured as hydroxyproline) varied (P

Keratan sulphate (KS) concentration in sera from resting horses and horses training daily on a racetrack was measured by an inhibition enzyme-linked immunosorbent assay (ELISA) using anti-equine KS antibody 1/14/16H9. For the in-training horses, serum KS concentrations in 2-year-old-horses was significantly higher than 3- or 4-year-old-horses. A higher concentration of serum KS was found in the in-training group than in the long-term resting group in 2-year-old-horses. Serum KS concentration increased remarkably immediately after training in healthy horses, and at 1, 5, 9 and 24 h after training remained at similar levels to the pre-training concentration. The results suggest that serum KS concentration could represent the situation of joint loading, induced by daily racetrack training, affecting the metabolic activities in joint cartilage.

There is no reliable animal model of the early stages of osteonecrosis of the femoral head (ONFH) for the evaluation of new therapeutic approaches. In this study, we propose a new animal model of femoral head osteonecrosis. Pure ethanol was injected into the centre of the femoral head in adult Merino sheep under fluoroscopic control. After 3, 6 and 12 weeks the animals were killed and the femoral heads were harvested. Microradiographic and histological changes were analysed and recorded. Partial necrosis was documented over a period of 12 weeks in all animals. The appearance of necrosis in combination with intact macrotexture, macrocirculation and joint cartilage is similar to the features described in early ONFH in humans. Due to its efficacy and its similarity to the early stages of ONFH in humans, this model may be suitable to evaluate new therapeutic techniques in the treatment of ONFH.

The article describes modern methods of treatment for early stages of knee osteoarthritis on the basis of results of researches, carried out by Ukrainian and foreign authors. The necessity of rational approach to conservative therapy of early stages of osteoarthritis is shown. This therapy includes use of anti-inflammatory and chondroprotective drugs with compulsory combination of physiotherapeutic treatment and local laser influence on the involved joint and its adjacent tissues in a certain sequence in order to improve the effect of pharmaceutical drugs on metabolism in the joint cartilage.

Osteonecrosis of rat femoral heads was induced by stripping the periosteum of the neck and cutting the ligamentum teres. The epiphyseal marrow and bone were necrotic on the 5th postoperative day. Specimens obtained 18 and 36 days postoperatively showed fibrous and hematopoietic-fatty tissue in the intertrabecular spaces, osteoclastic bone resorption, osteogenesis, and degeneration of the joint cartilage. Morphometrically, the means of the height-to-length ratios of the control, 6-day, 18-day, and 36-day femoral heads were 0.26, 0.28, 0.48, and 0.29, respectively. The shape factor of the femoral heads of the control rats was higher than 0.81 in 80% of the cases, while those of rats killed on the 6th, 18th, and 36th postoperative day were higher than 0.81 in 65, 60, and 50% of cases, respectively. Statistically, the means of the height-to-length ratios and the values of the shape factors of the femoral heads of the rats killed 18 days postoperatively differed significantly from those of the other three groups of rats. The quantitatively gauged data of the remodeled epiphyses negate the authors' subjective impression concerning early flattening of the femoral heads after surgically produced osteonecrosis.

The application of extracorporeal shock waves has become a new mode of treatment for affections of the locomotor apparatus such as calcifying tendinitis, epicondylitis humeri radialis, calcaneodynia and pseudarthrosis. The treatment often takes place in the vicinity of joints. Up to now no systematic data have been published about possible side-effects on joint cartilage. In an in vivo study the effect of extracorporeal shock waves on joint cartilage was evaluated in 24 immature New Zealand White rabbits. The left lateral femoral condyle of each animal was treated with 2000 shock waves of 1.2 mJ/mm2; the right condyle served as control. Macroscopical, radiological and histological analysis at 0, 3, 12 and 24 weeks after treatment showed no pathological changes in the joint cartilage. We conclude that extracorporeal shock wave treatment does not cause damage to the joint cartilage of growing rabbits.

The functional deterioration and failure of joint cartilage in osteoarthritis results from changes in its cells and matrix. Significant changes occur in both synthesis, degradation and structure of matrix molecules of cartilage and other joint tissues during the different phases of development of OA.

Rationale and objectives After intraarticular application of gadolinium (Gd)-DTPA the visualization cartilage surface roughness is limited because of diffusion into the cartilage. To improve the sensitivity of magnetic resonance (MR) arthrography to diagnose cartilage surface abnormalities, the authors have tested liposome-entrapped contrast agents. Methods Using paramagnetic contrast agents (Gd-DTPA and manganese chloride) free and entrapped in liposomes, respectively, high resolution MR imaging investigations were performed at 7.1 tesla on intact pig temporomandibular and rabbit knee joints. Results After intraarticular injection of the liposome-entrapped contrast agents an excellent contrast between cartilage surface and joint space was achieved. Diffusion of the contrast agent into the cartilage layer was prevented and the visualization of the cartilage surface was improved markedly. Small mechanically and enzymatically induced cartilage lesions could be assessed reliably. Conclusions Intraarticular injection of liposome-entrapped contrast agents can improve the potential of MR arthrography concerning the detection of early osteoarthritic cartilage changes.

Background Since usage of biologic agents, treatment strategy of Rheumatoid Arthritis (RA) is now being a new target. In T2T principle, our first goal to achieve is clinical remission. Biologic agents are strong tool for the target. For the evaluation of disease activity, some indices such as SDAI, CDAI and Boolean are proposed. And some of biomarkers such as ESR, CRP are proposed and put to practice as a supportive tool for evaluation. Objectives We have investigated relationship between MMP-3 and clinical indices, such as SDAI, CDAI, Boolean, DAS28 and each component of these indices in order to clarify if MMP-3 could be supportive biomarker for evaluation of treatment effectiveness. Methods 968 RA patients who have attended to our institute were picked up for this study. The patients had been taken interview and calculated SDAI, DAS28, HAQ, and measured CRP, ESR, and MMP-3 every 3 months. The relationship between DAS28 and MMP-3, and SDAI and MMP-3 were evaluated statistically. Average MMP-3 at measured time when SDAI remission achieved and not achieved were also compared statistically. Linear regression among SJC, TJC, PtGA, PhGA, and CRP on MMP-3 was evaluated statistically. Patients who have been treated with biologics were also investigated. Their DAS28, SDAI and MMP-3 were measured every 3 months, and the relationship between DAS28 and MMP-3, and between SDAI and MMP-3 were also evaluated statistically. For the patients who were treated with biologic agents, MMP-3 measurement is arranged. Because normal range of MMP-3 is different by gender, MMP-3 improvement ratio (MIR) was calculated. That is MMP-3 value divided by what of last MMP-3 before biologics started. The relationship between DAS28 improvement (DAS-I), what is calculated as difference from the last DAS28 value before biologics started, and MIR and SDAI improvement value compared to last time before biologics (SDAI-I) and MIR were also evaluated statistically. Results In 2067 times of calculated DAS28 and MMP-3 and 962 times of SDAI and MMP-3, the relationship between the two demonstrated significantly correlated (p Average MIR in patients with biologics is significantly correlated with DAS-I, and SDAI-I (p Conclusions These results show that MMP-3 value closely correlates with disease activity. In treatment of RA, we are taking care of management of inflammation as first priority. MMP-3 can be an applicable marker for inflammation of joint cartilage. And at the same time, MMP-3 improvement reflects treatment effectiveness. In measuring MMP-3 and in comparing MMP-3 value relative to primary value, the effectiveness of treatment protocol can be evaluated. This evaluation method is more useful for biologics treatment to evaluate. We should include MMP-3 for both of evaluation of RA disease activity and of treatment effectiveness. Disclosure of Interest None Declared

The ablation of joint cartilage by Holmium laser radiation is followed by the creation of an unexpected large avital cell area below of the irradiated spot. To examine the reasons for the tissue destruction the effect of shockwaves as well as the temporal development of temperature due to the laser absorption was investigated. The temperature raise was observed by an infrared-camera. The creation of cell destroying temperatures below the irradiated area is explained by the absorption of the Holmium laser light and the spread out of heat from the absorption area, whereby the effects due to shockwave seem to be neglible. To reduce the development of high temperatures a method is presented that allows a local coding of the irradiated area.

Hypothesis of regulation of proteosynthetic activity of chondrocytes is suggested. A deformation of the cartilage caused by contact hip joint stress and consequent deformation of the chondrocytes are considered as main factors that could influence the metabolism of the cartilage.

The objective of this study was to examine the reliability of an intraoperative evaluation tool for assessing cartilage degeneration of the first metatarsophalangeal joint in hallux valgus surgery. During hallux valgus reconstruction, 2 examiners documented the location, depth, and surface area of cartilage lesions affecting the first MTPJ in 20 females aged 17 to 69 (mean 50.9 ± 13.5) years. Depth of cartilage lesions was assessed using the 5-level International Cartilage Repair Society (ICRS) scale and a 3-level scale (normal, partial thickness, full thickness). Interexaminer reliability of lesion location and depth was assessed using absolute percentage agreement and kappa (κ) statistics, and interexaminer reliability of lesion surface area was assessed using intraclass correlation coefficients (ICCs) and 95% limits of agreement (LOAs). For lesion location, percentage agreement ranged from 90% to 100% and κ values ranged from 0.78 to 1.00, reflecting substantial to excellent levels of agreement. For lesion depth using the ICRS and 3-level scale, percentage agreement ranged from 33% to 100% and weighted κ values ranged from 0 to 1.00, reflecting poor to excellent levels of agreement. For lesion surface area, the ICC was 0.98 (95% confidence interval = 0.97 to 0.99) and 95% LOA was 0.74 to 1.41, indicating excellent reliability. The results of this study demonstrate a generally high degree of reliability between examiners for the intraoperative use of the first metatarsophalangeal joint cartilage evaluation tool, and the tool may have some value in predicting surgical outcomes associated with hallux valgus.

Originally, the investigators of limb-salvage operations were mainly concerned with postoperative function. This objective has been realized not only by the progress of prosthetic design, but by the various efforts intended to minimize the resection area [1–5]. The next concern concentrated on two goals: to extend the yardsticks for the indication of the prosthetic replacement for the growing, younger patients and to improve the design of the prosthesis for long-term application, because most of the patients who undergo this type of operation are relatively young. In addition, the loss of bone stock around the prosthesis after longterm use would make any revision surgery more difficult. Several kinds of extending prostheses and temporary resection-arthrodesis were attempted for attaining the first goal [6–9]. Operations employing prostheses with porous-coated stems and anti-micromotion blades, prostheses with porous-coated segments for bone grafts and cement-fixed stems, long-stem prostheses with allografted segments, and ceramic prostheses were performed for achieving the second objective [10–18]. On the other hand, allograft, reimplantation of affected bone with both extracorporeal and intracorporeal irradiation were also carried out because these bones can be permanently used if they could be revascularized and reconstructed with normal bone tissue [19–22]. These methods have another advantage in that they preserve joint cartilage and the attachment of muscle or ligament because these tissues are more resistant against irradiation. However, these methods bear the problem of a high rate of complications, such as infection, fracture, or necrosis [23].