Objective To investigate the rotational mismatch of total kneereplacement with medial 1/3 of tibial tuberosity as bony landmark in osteoarthritic patients with varus or valgus deformity. Methods Axial images on computed tomography of 62 knees (including 55 varus deformities and 7 valgus deformities) in 32 Chinese osteoarthritic patients who had total knee arthroplasty were analyzed, compared with that of 10 healthy knees. On images of the distal femur, the angle between the lines of surgical epicondylar axis(SEA) and posterior condylar axis was measured as posterior condylar angle (PCA), and on images of the proximal tibia, a baseline for the anteriorposterior axis of each component was drawn based on the SEA for the femur and the medial 1/3 of the tibial tuberosity for the tibia. The angle between these lines (Angle α) was defined as therotational mismatch between the components when they were aligned to the anatomic landmarks of each bone. Results The sulcus of medial epicondyle of femur could be identified on CT images of over 80% osteoarthritic knees; the median value of PCA was +2.36°, with an individual variation of 0° to +7.5°. Angle α was +6.45±3.68°(range, 0° to +11.8°) in 10 healthy knees, which increased significantly to +10.85±10.47°(range, 0° to +28.1°)in 55 varus knees (P＜0.05), which also increased significantly to +11.6±7.3°(range, -6.5° to +26.8°) in 7 valgus knees (P＜ 0.05). Conclusion With the medial 1/3 of the tibial tuberosity as the rotational landmark for the tibial component, there was a tendency to align the tibial component in external rotational position relative to the femoral component in knees with normal alignment, the rotational mismatch increased in Chinese osteoarthritic knees with varus and valgus deformity.
Surgical management of osteoarthritis of the knee: evidence based guideline contains 38 recommendations pertaining to the preoperative, perioperative, and postoperative care of patients with knee osteoarthritis (KOA) who are considering surgical treatment. Compared with the domestic consensus on diagnosis and treatment for KOA, this clinical practice guideline (CPG) prepared by the American Academy of Orthopedic Surgeons (AAOS) has some advantages in terms of methodology selection and recommendation. Therefore, it is necessary for us to interpret this CPG to speed up the understanding and dissemination of the CPG. The ultimate aims are to: ① strengthen the standardization and understanding of surgical treatment of KOA; ② enhance the understanding of clinicians for this CPG in treating KOA; ③ speed up the development of guideline development methodologies in China; ④ provide methodological guidance for the development of CPG based on the current situation in China.
Objective To investigate the influence on matrix metalloproteinases (MMP) 3, 9, and 13 levels of human articular cartilage cells after blocking stromal cell derived factor 1 (SDF-1)/ chemokine receptor 4 (CXCR4) signaling pathway withAMD3100 and to define the function mechanism of AMD3100. Methods A total of 144 cartilage blocks from 12 osteoarthritis (OA) patients undergoing total knee arthroplasty (OA cartilage group) and 144 normal cartilage blocks (Mankin score of 0 or 1) from 12 patients undergoing traumatic amputation (normal cartilage group). OA cartilage group was further divided into subgroups A1, B1, and C1, and normal cartilage group into subgroups A2, B2, and C2. The cartilage tissues were cultured in DMEM solution containing 100 ng/mL SDF-1 and 1 000 nmol/L AMD3100 in subgroup A, 100 ng/mL SDF-1 and 1 000 nmol/L MAB310 in subgroup B, and 100 ng/mL SDF-1 in subgroup C, respectively. The levels of MMP-3, 9, and 13 were measured by ELISA; the expressions of MMP-3, 9, and 13mRNA were tested by RT-PCR. Results ELISA and RT-PCR results showed that the levels of MMP-3, 9, and 13 and the expressions of MMP-3, 9, and 13 mRNA were significantly lower in subgroup A than in subgroups B and C at the same time points (P lt; 0.05); the levels of MMP-3, 9, and 13 and the expressions of MMP-3, 9, and 13 mRNA were significantly higher in OA cartilage group than in normal cartilage group at the same time points (P lt; 0.05). Conclusion SDF-1 could induce overexpression and release of MMP-3, 9, and 13 in the articular cartilage through the SDF-1/CXCR4 signaling pathway; AMD3100 could reduce the mRNA expressions and secretion of MMP-3, 9, and 13 in OA cartilage by blocking the SDF-1/CXCR4 signaling pathway; but AMD3100 could not make the secretion of MMP-3, 9, and 13 return to normal levels in OA cartilage.
Objective The changes of the aquaporins 1 (AQP-1) expression may be related to the chondrocyte apoptosis. To explore the correlation between the expression of AQP-1 and chondrocyte apoptosis by observing the expression of the AQP-1 and the Caspase-3, so as to provide experimental evidence for the further study in the pathogenesis of osteoarthritis (OA). Methods Seventy-two 8-week-old clean grade male Sprague Dawley rats, weighing 286-320 g (mean, 300 g), were randomly divided into the operated group (n=24), the sham-operated group (n=24), and the control group (n=24).OA models were made by amputating the anterior cruciate l igament and medial collateral l igament, and partial excision of medial meniscus in operated group; the articular cavity was exposed only in sham-operated group; and no treatment was given in control group. The general condition of the rat was observed after model was establ ished. At 1, 2, 4, and 8 weeks, the specimens of knee joints were harvested to perform the gross and histological observations; the mRNA expressions of AQP-1 and Caspase-3 were determined by real-time fluorescent quantitative PCR; and the activity of the Caspase-3 protease was detected. The correlations between the expression of AQP-1 mRNA and the expressions of Caspase-3 mRNA and protease were analyzed. Results Totally 6 rats died after operation, and the rats were suppl ied immediately; the other rats survived to the end of experiment. The appearance and structure of knee articular cartilage were normal in control group and sham-operated group. While in operated group, the cartilage had a rough surface with fissure and vegetation, and fibrosis and irregular cell arrangement were seen on the surface of cartilage. There were significant differences in the Mankin score between the operated group and sham-operated group, control group at 2, 4, and 8 weeks (P lt; 0.05). There was no significant difference in expressions of the AQP-1 mRNA and Caspase-3 mRNA, and the activity of the Caspase-3 protease among 3 groups at 1 week after operation (P gt; 0.05); while the expressions of the AQP-1 mRNA, Caspase-3 mRNA, and the activity of the Caspase-3 protease in operated group were significantly higher than those in sham-operated group and control group at 2, 4, and 8 weeks after operation (P lt; 0.05), andthere was an increased trend over time. There was significantly positive correlation (r=0.817, P=0.000) between the expressions of AQP-1 mRNA and Caspase-3 mRNA, and the regression equation was y=0.426 7x2+0.051 5x; meanwhile, there was also significantly positive correlation (r=0.945, P=0.000) between the expression of AQP-1 mRNA and the activity of Caspase-3 protease, and the regression equation was y=15.423 0x+4.392 8. Conclusion The up-regulation of AQP-1 expression in OA cartilage may be related to the chondrocyte apoptosis, and the changes of AQP-1 expression may involve in the pathogenesis of OA.
ObjectiveTo review the advances in utilizing paracrine effect of stem cells in knee osteoarthritis (OA) treatment.MethodsThe researches in applying stem cells derived conditioned medium, extracellular matrix, exosomes, and microvesicles in knee OA treatment and cartilage repair were reviewed and analyzed.ResultsThe satisfying outcomes of using different products of stem cells paracrine effect in knee OA condition as well as cartilage defect is revealed in studies in vitro and in vivo. The mechanism including suppressing the intraarticular inflammation, the apoptosis of chondrocytes, and the degradation of cartilage matrix, while enhancing the synthesis of cartilage matrix, the differentiation of in-situ stem cells into chondrocytes and the migration to the affected area. The effectiveness can be further improved supplemented with the tissue engineering methods or gene modification.ConclusionCompared with the traditional stem cell therapy, applying the products from paracrine effect of stem cells in knee OA treatment is more economical and safer, presenting great potential in clinical practice.
Chinese guideline for diagnosis and treatment of osteoarthritis (2021 edition) was published in the Chinese Journal of Orthopaedics, providing abundant recommendations on osteoarthritis (OA) issues. In this paper, the methodological and reporting qualities of the guideline were explained and assessed by using quality appraisal tools, such as appraisal of guidelines research and evaluation-China (AGREE-China), Institute of Medicine Committee (IOM), and reporting items for practice guidelines in healthcare (RIGHT). It also aimed to provide personalized treatments for specific patients, support readers in understanding the principle of OA treatment, and standardize OA treatment strategies. In addition, this study would contribute to the clinical promotion of the current guidelines and provide the necessary references for clinical practice guidelines in treating OA in the future.
Objective To establ ish a porcine model of articular full-thickness cartilage defect characterized byremaining cartilage calcified zone on femoral trochlea, so as to provide a considerable and comparative control group forinvestigating repair effects of tissue engineered scaffolds in articular cartilage defects with cartilage calcified zone remaining.Methods The full-thickness cartilage column defects (6 mm in diameter, 0.2-0.5 mm in depth) without damage on calcifiedcartilage zone were made on the femoral trochlea in 9 clean-grade 6-month-old Guizhou mini pigs by standard cartilage-defectmakingsuites. Microscopical observation was performed after modeling. Scanning were made by 3.0T MRI at 4 weeks. Thengeneral observation, stereomicroscope, and histological staining were used to observe cartilage repair. Results All animals wereal ive. No infection of incisions or patellar dislocations occurred; they were able to walk with partial weight-bearing immediatelyafter surgery and could move freely without limp at 1 week. Obvious signal discontinuity in trochlea and subchondral bone couldbe observed in MRI, without deep signal change in defects surrounding. Microscopical observation showed a few repair tissueand petechia at base of the defect with clear boundary. Nearly intact calcified zone of cartilage and zonal collapse of subchondralbone in defects could be observed with stereomicroscope. Under common microscope, no chondrocytes was found in defects,as well as negative staining of fast green-safranin O and alcian blue. Under polarized microscope, the bottom of defects werefilled with a l ittle of fibrous tissue presenting continuous and b l ight-refraction by sirius red staining. Conclusion Theanimal model of articular full-thickness cartilage defect on femoral trochlea by standard cartilage-defect-making suites can beapplied for the research of cartilage disease in early human osteoarthritis and function of calcified cartilage zone in pig.
Objective To evaluate the influence of patellar non-resurfacing on the effectiveness after total knee arthroplasty (TKA). Methods Between April 2008 and April 2011, 163 patients with degenerative osteoarthritis of the knee underwent TKA without patellar resurfacing, and the clinical data were retrospectively analyzed. There were 65 males and 98 females, with a mean age of 63 years (range, 54-78 years). According to Outerbridge classification for cartilage degeneration, 22 cases were classified as grade I, 38 cases as grade II, 64 cases as grade III, and 39 cases as grade IV. There was no significant difference in gender, age, and sides among patients at 4 grades (P gt; 0.05). The intraoperative tourniquet-using time and postoperative complications were recorded; the knee society score (KSS), patella score (PS), patients’ satisfaction, and anterior knee pain [using visual analogue scale (VAS)] were used to evaluate the knee function. X-ray films were routinely taken to observe the position of the prosthesis and the patella. Results The mean tourniquet-using time was 125 minutes (range, 90-150 minutes). All incisions obtained healing by first intention, and no early postoperative complication occurred. All patients were followed up 2-5 years (mean, 3.6 years). The KSS and PS scores were significantly improved at 6 months and last follow-up when compared with preoperative scores (P lt; 0.05), but no significant difference between at 6 months and last follow-up (P gt; 0.05). Significant differences in KSS and PS scores were found among patients with different grades of cartilage degeneration at preoperation (P lt; 0.05), but no significant difference at last follow-up (P gt; 0.05). At last follow-up, 7 patients experienced anterior knee pain (mild pain in 5, moderate pain in 2). The results of satisfaction were very satisfied in 90 cases, satisfied in 66 cases, not certain in 5 cases, and not satisfied in 2 cases. No significant difference was found in satisfaction and anterior knee pain among patients with different grades of cartilage degeneration (P gt; 0.05). Conclusion Patellar non-resurfacing has no effect on the effectiveness after TKA.
Objective Melatonin (MLT) can increase the expression of cartilage-derived growth factor and stimulate the synthesis of cartilage matrix. To investigate the prevention and treatment effects of MLT on damaged cartilage through observing the expressions of bone morphogenetic protein 2 (BMP-2) and interleukin 1β (IL-1β) in articular cartilage of the rats with osteoarthritis (OA). Methods Forty SPF 4-week-old male SD rats (weighing 120-150 g) were randomly divided into 4 groups (n=10): normal control group (group A), OA group (group B), OA/pinealectomy group (group C), and OA/ pinealectomy/MLT group (group D). The rats of group A served as a control without treatment. The rats of groups B, C, andD underwent left knee joint injection of 0.2 mL 4% papain solution 1 time every other day for 2 weeks for establ ishing OAmodel. Two weeks after papain injection, the rats of groups C and D were exposed to continuous l ight for 24 hours (intensity of illumination: 500 lx) for creating pinealectomy models. And at the next day after pinealectomy model establ ishing, the rats of group D were treated with intra-articular injections of 0.2 mL 20 mg/mL MLT solution 4 times a week for 4 weeks. At 1 week after last MLT injection, the venous blood samples were taken in groups A, B, and C to test the level of serum MLT by ELISA, respectively, and then the specimens of left cartilage of femoral condyle were harvested for macroscopic, histological, and immunohistochemical examinations in 4 groups. Results The OA and pinealectomy models of rats were successfully establ ished, and all rats survived. There were significant differences in the serum MLT level among groups A, B, and C, and among different time points at the same group (P lt; 0.05). In group A, articular cartilage surface was smooth and elastic, and chondrocytes arranged regularly. In groups B and C, articular cartilage surface was rough, cartilage defects and subchondral bone exposure were observed in some areas, and chondrocytes arranged irregularly. In group D, cartilage surface was more smooth than that in groups B and C, and the degrees of cartilage defect and subchondral bone exposure decreased with regular arrangment of chondrocytes. There were significant differences in Mankin scores and integral absorbance values among 4 groups (P lt; 0.05). Conclusion Exposure to continuous l ight can accelerate degeneration process of articular cartilage of OA rats. Injections of 0.2 mL MLT solution (20 mg/mL) by intra-articular for 4 weeks can inhibit the progress of cartilage defects. Upregulationof anabol ic factor of BMP-2 as well as down-regulation of catabol ic factors of IL-1β is associated with cartilage repairin the pathological features of OA.
Objective To investigate the effect of sodium hyaluronate (SH) intra-articular injection on the treatment of knee osteoarthritis (OA), andto compare the contents of free radicals and inflammatory factors in joint fluids of pre-and pro-treatment as to explore the treatment mechanism of SH. Methods Ninety-two patients (111 knees) with mild(51)，moderate(35) and serious(25) knee OA were treated with intra-articular injections of SH (20 mg once a week for 5 weeks). According to Lysholm scoring, clinical signs such aspain, swelling,and the ability to walk, squat, run, go upstairs and downstairs were assessed before and after the treatment, and the contents of nitric oxide (NO), superoxide dismutase(SOD), malonic dialdehyde(MDA) and IL-1β、TNF-α in joint fluids from the OA joints before 1st,2nd, and 5th injection and 3 months after each injection were observed. Results All cases were followed up for 3 months. The improvements in the signs and function of knees were excellent in 42 knees, good in 38 knees, fair in 21 knees and poor in 10 knees, with 72.1% excellent and good results. The lighter the illness was, the better the improvement was: the rate of the excellent and good was 92.1% in mild group, 68.6% in moderate group and 42.9% in serious group. The contents of oxygen free radicals and IL-1β、TNF-α of the patients with mild and moderate OA decreasedmarkedly after being treated with SH（Plt;0.05）, but these decreased lightlyin serious OA group（Pgt;0.05）. SH had mild effect on the contents of NO. Three months after treatment, only in mild OA group the contents of NO significantly decreased（Plt;0.05）, and no significant change in moderate and serious groups was observed（Pgt;0.05）. Conclusion SH intraarticular injection has a positive effect on the relief of clinical symptoms and on the improvement of articular function of knee OA. The therapeutical effect of SH on OA is achieved possibly by decreasing the contents of free radicals especially oxygen free radicals and inflammatory factors in joint fluids.