Expert consensus on platelet-rich plasma treatment for osteochondral lesion of talus (version 2023) / 中华创伤杂志

Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.

Efficacy of osteochondral fragment fixation using bioabsorbable pins for Hepple Ⅱ osteochondral lesions of the talus in adolescents / 国际外科学杂志

Objective:To investigate the efficacy of osteochondral fragment fixation using bioabsorbable pins for Hepple Ⅱ osteochondral lesions of the talus (OLT) in adolescents.Methods:Retrospective case analysis was used. The clinical data and follow-up results of 13 adolescent patients (13 feet) with Hepple Ⅱ OLT were all treated with osteochondral fragment fixation using bioabsorbable pins admitted to Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to December 2021 were retrospectively analyzed. There were 7 males and 6 females, with 13 right feet. The age was (14.85±2.23) years old, ranged from 12 to 18 years old. According to the American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) and SF-36 score before operation and at the last follow-up were used to evaluate the efficacy and function of the patients. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; The mearsurement data with skewness distribution were expressed by M( Q1, Q3), and rank-sum test was used for inter-group comparison. Results:Thirteen adolescent patients (13 feet) with Hepple Ⅱ OLT underwent surgery successfully and were followed up for (25.54±9.95) months. All wounds healed by first intention, and no complications such as wound infection and delayed healing occurred. Preoperative AOFAS ankle-posterior foot score, VAS and SF-36 score were 58.62±3.55, 7.00 (6.50, 8.00) and 68.38±4.81, respectively. At the last follow-up, the scores were 97.38±2.73, 1.00 (0.00, 1.00), 91.15±4.28, respectively, and the results were significantly improved at the last follow-up, with the difference between the two groups statistically significant( P<0.05). Conclusion:Osteochondral fragment fixation using bioabsorbable pins which can promote cartilage repair, significantly improve symptoms, and achieve better clinical satisfaction with fewer complications, is a safe and effective surgical treatment option for Hepple Ⅱ OLT in adolescents with satisfactory short-term clinical outcomes.

Parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement / Lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular

Abstract Objective: To describe cases of parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement, correlating the clinical and imaging data. Materials and Methods: This was a retrospective descriptive case series of parafoveal chondral lesion of the femoral head in 21 patients who underwent computed tomography and magnetic resonance arthrography scans of the hip, having then received an imaging-based diagnosis of femoroacetabular impingement. Results: Of the 21 patients evaluated, 15 (71%) had cam-type femoroacetabular impingement, whereas five (24%) had mixed-type impingement, and one (5%) had pincer-type impingement. Twelve patients (57%) had a low frequency of physical activity, which was significantly associated with the presence of cam-type impingement (p = 0.015). Although the extent of the lesion correlated significantly with the acetabular coverage angle (p = 0.04), it did not correlate significantly with the alpha angle or femoral head-neck offset value (p = 0.08 and p = 0.06, respectively). We also found no correlation between the extent of the lesion and the other main parameters that define the femoroacetabular impingement types. Conclusion: This was one of the largest case series of parafoveal chondral lesion of the femoral head in patients with imaging findings of femoroacetabular impingement. The extent of such lesions does not appear to correlate with the parameters of femoroacetabular impingement, with the exception of the acetabular coverage angle.

Resumo Objetivo: Descrever casos de lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular, correlacionando dados clínicos e de imagem. Materiais e Métodos: Esta foi uma série de casos descritiva retrospectiva de lesão condral parafoveal da cabeça femoral em 21 pacientes submetidos a tomografia computadorizada e artrorressonância magnética do quadril e que receberam diagnóstico por imagem de impacto femoroacetabular. Resultados: Dos 21 pacientes avaliados, 15 (71%) tiveram impacto femoroacetabular do tipo cam, enquanto cinco (24%) tiveram impacto do tipo misto e um (5%) teve impacto do tipo pincer. Doze pacientes (57%) apresentaram baixa frequência de atividade física, sendo esta significativamente associada a impacto do tipo cam (p = 0,015). Houve correlação significativa entre a extensão da lesão e o ângulo de cobertura acetabular (p = 0,04), porém, não se correlacionou significativamente com o ângulo alfa ou com o valor do deslocamento cabeça-colo femoral (p = 0,08 e p = 0,06, respectivamente). Também não encontramos correlação entre a extensão da lesão e os outros principais parâmetros que definem os tipos de impacto femoroacetabular. Conclusão: Esta foi uma das maiores casuísticas de lesão condral parafoveal da cabeça femoral em pacientes com achados de imagem de impacto femoroacetabular. A extensão dessas lesões não parece se correlacionar com os parâmetros do impacto femoroacetabular, com exceção do ângulo de cobertura acetabular.

Use of Exogenous Hyaluronic Acid for the Treatment of Patellar Chondropathy- A Six-Month Randomized Controlled Trial / Uso do ácido hialurônico exógeno no tratamento da condropatia patelar - Ensaio clínico randomizado com acompanhamento de seis meses

Abstract Objective To evaluate the clinical and radiological benefits of intra-articular exogenous hyaluronic acid for the treatment of chondral patellar injury. Method Randomized clinical trial with 70 patients divided into 2 groups: those submitted to physical therapy for 3 months, and those submitted to physical therapy associated with the intra-articular administration of 2 mL of hyaluronic acid for the same period, who had anterior knee pain and patellar cartilage injury of grades II or III with no significant bone abnormalities. The functional scores and the characteristics of the physical and imaging exams were evaluated before and 3 and 6 months after the treatment. Result The average age of the patients was 32 ± 7.6 years. Patients from the hyaluronic acid group had better Kujala et al and Lysholm scores, and lower pain scores after 3 and 6 months of treatment when compared to the control group. The incidence of positive Clarke maneuver was lower in the treated group, but there was no difference in the magnetic resonance imaging classification. Conclusion Patients with patellar chondropathy of grades II or III treated with hyaluronic acid and physical therapy had less pain (visual analogue scale, VAS), and better functional results in the Lysholm and Kujala et al questionnaires after 3 and 6 months of treatment compared to patients undergoing physical therapy alone. In addition, the number of cases with a negative Clarke maneuver was larger in the treated group after 6 months of treatment.

Resumo Objetivo Avaliar os benefícios clínicos e radiológicos do uso do ácido hialurônico exógeno intra-articular para o tratamento da lesão condral da patela. Método Ensaio clínico randomizado com 70 pacientes divididos em dois grupos: o de tratamento fisioterápico por 3 meses, e o de tratamento fisioterápico associado à aplicação de 2 ml de ácido hialurônico intra-articular pelo mesmo período, composto por pacientes com dor na região anterior do joelho e lesão de graus II ou III da cartilagem da patela, sem anormalidades ósseas significativas. Foram avaliados os escores funcionais e as características do exame físico e de imagem antes, e após 3 e 6 meses de tratamento. Resultado A idade média dos pacientes foi de 32 ± 7,6 anos. Os pacientes do grupo submetido à aplicação de acido hialurônico apresentaram melhores escores de Kujala et al e de Lysholm, e menor pontuação de dor após 3 e 6 meses de tratamento quando comparados ao grupo controle. A manobra de Clarke positiva foi menor no grupo em que foi feita a aplicação do ácido, mas não houve diferença na classificação da imagem obtida pela ressonância magnética. Conclusão Pacientes com condropatia patelar de graus II ou III do joelho tratados com ácido hialurônico e fisioterapia apresentaram menos dor (escala visual analógica, EVA), e melhores resultados funcionais nos questionários de Lysholm e de Kujala et al após 3 e 6 meses de tratamento quando comparados com os pacientes submetidos apenas à fisioterapia. Além disso, estes pacientes apresentaram manobra de Clarke negativa em maior número após 6 meses de tratamento.

Reliability of the Arthroscopic Classifications of Hip Chondral Lesions* / Confiabilidade das classificações artroscópicas das lesões condrais do quadril*

Abstract Objective To evaluate the inter- and intraobserver reliability of the Outerbridge, Beck, and Haddad classifications for acetabular joint cartilage lesions through the arthroscopic procedure. Methods A total of 60 hip arthroscopy videos were evaluated twice by 4 surgeons at 2 different times to assess the inter- and intraobserver reproducibility of the classifications, and the data was analyzed by means of the weighted Cohen Kappa index. Results The mean weighted Kappa values in the interobserver assessment of the Outerbridge, Beck, and Haddad classifications were, respectively, 0.72, 0.78, and 0.68. The three classifications were considered as presenting good interobserver agreement. Regarding the intraobserver assessment of the Outerbridge, Beck, and Haddad classifications, the weighted Kappa values were, respectively, 0.9, 0.9, and 0.93. The three classifications were considered as presenting excellent intraobserver agreement. Conclusion In the present series, the Outerbridge, Beck, and Haddad classifications presented good interobserver reproducibility and excellent intraobserver reproducibility when evaluating acetabular chondral lesions by the arthroscopic approach.

Resumo Objetivo Avaliar a confiabilidade inter- e intraobservador das classificações de Outerbridge, Beck e Haddad para lesões da cartilagem articular acetabular com o uso da via artroscópica. Métodos Foram avaliados 60 vídeos de artroscopias do quadril por 4 cirurgiões em 2 momentos para avaliar a reprodutibilidade inter- e intraobservador das classificações. Os dados foram analisados a partir do cálculo do índice Kappa de Cohen ponderado. Resultados Os valores do Kappa ponderado médio na avaliação interobservador das classificações de Outerbridge, Beck e Haddad foram, respectivamente, 0,72, 0,78 e 0,68. As três classificações foram consideradas como de boa concordância interobservador. Comrelação à avaliação intraobservador das classificações de Outerbridge, Beck e Haddad, os valores Kappa foram, respectivamente, 0,9, 0,9 e 0,93. As três classificações foram consideradas excelentes na comparação intraobservador. Conclusão Na presente série, as classificações de Outerbridge, Beck e Haddad apresentaram boa reprodutibilidade interobservador e excelente reprodutibilidade intraobservador ao avaliar lesões condrais acetabulares por via artroscópica.

Evaluation of different commercial hyaluronic acids as a vehicle for injection of human adipose-derived mesenchymal stem cells / Avaliação de diferentes ácidos hialurônicos comerciais como veículo de injeção para células mesenquimais humanas derivadas do tecido adiposo

ABSTRACT Objective: The main purpose of this study is to evaluate, in vitro, the cytotoxicity of different commercial brands of hyaluronic acids to be used as a vehicle for injection of human adipose-derived mesenchymal stem cells (AD-MSCs). Methods: AD-MSCs were divided into seven groups: one control group where AD-MSCs were cultivated with phosphate-buffered saline (PBS) and six other groups where AD-MSCs were cultivated with different commercial brands of hyaluronic acid. AD-MSC viability analysis was performed after 4, 24, and 48 h in contact with each treatment, using the trypan staining method on a Countess automated cell counter (Thermo Fisher Scientific). Results: The results clearly demonstrated a significant difference in cell viability when AD-MSCs were exposed to different hyaluronic acids when compared with the control group. Conclusion: These data suggest that hyaluronic acid can be used as a vehicle for injection of human AD-MSCs, but caution is needed to choose the best product, aiming at its future therapeutic application.

RESUMO Objetivo: Avaliar in vitro, de forma direta, a citotoxicidade de ácidos hialurônicos como veículo de injeção para linhagens de células-tronco mesenquimais (CTMs) obtidas de tecido adiposo humano. Métodos: As CTMs foram divididas em sete grupos, os quais foram expostos ao ácido hialurônico de seis marcas comerciais, além do contato com tampão fosfato-salino PBS (grupo controle). Após quatro, 24 e 48 horas, foi feita a análise da viabilidade celular através do contador Countess pelo método de coloração com Trypan Blue (Thermo Fisher Scientific). Resultados: Os resultados demonstraram uma diferença significativa na viabilidade celular quando essas linhagens de CTMs foram expostas aos diferentes ácidos hialurônicos em comparação com o grupo controle. Conclusão: Os dados sugerem que o ácido hialurônico pode ser usado como veículo de injeção para CTMs, porém é necessária cautela na escolha do melhor produto para aplicação terapêutica futura.

The experimental research of calcium alginate gel loaded transforming growth factor beta 3 and compounded with adipose mesenchymal stem cells to repair rabbit articular cartilage defect / 中国医师杂志

Objective To investigate the effect of tissue engineered cartilage on the repair of artic ular cartilage defects in rabbits with calcium alginate gel (CAG) loaded transforming growth factor beta 3 (TGF-β3) and compounded with adipose mesenchymal stem cells (ADSCs).Methods The ADSCs were separated and cultured in subcutaneous fat of New Zealand white rabbits.The full-thickness articular cartilage defect model was made at the patellar groove by exposure of the femoral ankle joint.ADSCs were implanted into calcium alginate scaffolds loaded with TGF-β3 to construct tissue-engineered cartilage and transplanted into rabbit articular cartilage defects.The animals were divided into four groups:control group (injected with sterile isotonic saline),CAG group (injected with CAG),ADSCs + CAG group (injected with CAG loaded with ADSCs),TGF-β3 + CAG group (injected with CAG loaded with TGF-β3) and TGF-β3 + ADSCs + CAG group (injected with CAG loaded with TGF-β3 and ADSCs).At the end of 12 weeks,the repair of articular cartilage defects was observed by gross observation,hematoxylin-eosin (HE) staining,immunohistochemical staining of safranin-O and type Ⅱ] collagen,and the scoring method developed by In ternational Association of Cartilage Repair (ICRS) Histological score.Results The cartilage repair effect of TGF-β3 + ADSCs + CAG group was better than that of other groups,not only the neonatal tissue and the surrounding normal tissue closely,but also the secretion of extracellular matrix and normal tissue similar.The ICRS scores of each group were (7.06 ±+ 0.18) score,(7.15 + 0.23) score,(7.45 + 0.25) score,(7.47 + 0.24) score and (15.78 ±+ 0.24) score.That of TGF-β3 + ADSCs + CAG group was better than that of other groups,the difference was significant (P ＜ 0.05).Conclusions CAG loaded with TGF-β3 and combined with ADSCs has a good effect in repairing articular cartilage defects in rabbits,and is a structural repair.

Research progress and clinical application of Tantalum in therepair of cartilage / 国际外科学杂志

Cartilage injury is very common in clinical,which can be caused by multiple factors,such as trauma,degenerative change and chronic strain.The clinical application of cartilage injury treatment includs conservative treatment,surgical treatment,and chondrocytes implant with cell scaffold,but all these methods are still unable to achieve a very satisfactory effect.Therefore,new explorations have been made in the field of cartilage repair,and the metal and other inorganic substances with better human compatibility have made great progress.Tantalum,a kind of transitional element,which has excellent chemical and physical properties and biocompatibility,is becoming more and more concerned in cartilage repair.This paper will review the research progress of tantalumin the repair of cartilage in recent years.

Mosaicoplastia / Mosaicplasty

movimiento articular. El tratamiento de esta afección es variado, de estas modalidades la mosaicoplastia es muy empleada por sus diferentes ventajas. Objetivo: actualizar los conocimientos sobre el injerto osteocondral autólogo en la modalidad de mosaicoplastia. Métodos: la búsqueda de la información se realizó en el mes de octubre de 2016, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 654 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 52 citas seleccionadas para realizar la revisión, 47 de ellas de los últimos cinco años, donde se incluyeron cuatro libros. Desarrollo: se describen los elementos necesarios para el diagnóstico clínico e imaginológico, en relación a estos últimos se hace énfasis en la imagen de resonancia magnética y la artroscopia. Se hace referencia a la clasificación de la sociedad internacional para la reparación de los cartílagos. Se describen las indicaciones quirúrgicas generales de las lesiones de cartílago y las específicas de la mosaicoplastia con sus principales ventajas y desventajas. Se plasman las principales complicaciones relacionadas con el procedimiento y los resultados de un grupo de investigaciones. Conclusiones: la mosaicoplastia es una variedad de injerto autólogo osteocondral empleada con buenos resultados en la actualidad, tiene ventajas, desventajas e indicaciones específicas.

Background: cartilage lesions are common nowadays. Their main symptoms and signs are pain and limited joint range of motion. There are many ways to treat them. Mosaicplasty is very used because of its several advantages. Objective: to update knowledge of autogenous osteochondral transplantation in mosaicplasty modality. Methods: a search in the databases PubMed, Hinari, SciELO and Medline was conducted through the information locator EndNote in October 2016. From the information obtained, a bibliographic review was carried out with 654 articles. Among them, 52 citations were used and 47 of them from the last five years, including four books. Development: fundamental elements for clinical and imaging diagnosis were described. With regard to the latter, it is emphasized on magnetic resonance imaging and arthroscopy. The international cartilage repair society classification system was pointed out. General surgical indications for cartilage lesions were described as well as specific ones for mosaicplasty and its main advantages and disadvantages. Complications were highlighted as well as the results of a group of researchers. Conclusions: mosaicplasty is a modality of autogenous osteochondral transplantation with good results because of its many advantages and disadvantages and specific indications to do it.

Hydrogen sulfide in cartilage and its inhibitory effect on matrix metalloproteinase 13 expression in chondrocytes induced by interlukin-1β / 北京大学学报(医学版)

Objective:To investigate whether endogenous hydrogen sulfide (H2 S)was involved in the pathogenesis of osteoarthritis (OA)and its underlying mechanism,to detect H2 S and its synthases ex-pression in knee cartilage in patients diagnosed with different severity of OA,and to explore the transcrip-tion and expression of gene MMP-13 in chondrocytes treated with IL-1βor H2S.Methods:Synovial fluids of the in-patients with different severity of OA hospitalized in Peking University First Hospital were collected for measurement of H2 S content using methylene blue assay.Articular cartilages of the patients who underwent knee arthroplasty were collected for the cell culture of relatively normal chondrocytes.The chondrocytes were cultured to the P3 generation and H2 S molecular probes were used for detection of endogenous H2 S generation in the chondrocytes.Immunocytochemistry was used to detect the localization of H2 S synthases including cystathionine β-synthase (CBS),cystathionine-γ-lyase (CSE),and mercap-topyruvate sulfurtransferase (MPST)in OA chondrocytes.Western blot was used to quantify the protein expressions of CSE,MPST,and CBS in cartilage tissues of the patients who were diagnosed with OA and underwent knee arthroplasty.The relatively normal human chondrocytes were cultured to passage 3 and then divided into 4 groups for different treatments:(1 )the normal control group,no reagent was added;(2)the IL-1βgroup,5 μg/L of IL-1βwas added;(3)the IL-1β+H2S group,200 μmol/L of NaHS was added 30 min before adding 5 μg/L of IL-1β;(4)the H2 S group,200 μmol/L of NaHS was added. The transcription and expression of gene MMP-13 in chondrocytes of each group were determined with Real-time PCR and Western blot,respectively.And the total NF-κB p65 and phosphorylated NF-κB p65 in chondrocytes were detected with Western blot.Results:The content of H2 S in the synovial fluid of degenerative knee was (14.3 ±3.3)μmol/L.Expressions of endogenous H2 S and its synthases including CBS,CSE and MPST were present in the cytoplasm of chondrocytes.CSE protein expression in Grade 3 (defined by outerbridge grading)cartilage tissues was significantly increased as compared with that of Grade 1 cartilage tissues (1.67 ±0.09 vs.1.26 ±0.11,P<0.05).However,no significant difference of CBS or MPST expression among the different groups was observed.The expression of MMP-13 protein in the IL-1βgroup was significantly higher than that in the normal chondrocytes (1 .87 ±0.67 vs.0.22 ± 0.10,P<0.05 ),and that in the IL-1β+H2 S group was significantly decreased than that in the IL-1βgroup (0.55 ±0.11 vs.1.87 ±0.67,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.The transcription of MMP-13 protein in the IL-1βgroup was significantly higher than that in the normal chondrocytes (31.40 ±0.31 vs.1.00 ±0.00,P<0.05), and that in the IL-1β+H2 S group was significantly decreased than that in the IL-1βgroup (24.41 ± 1.28 vs.31.40 ±0.31,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.The total NF-κB p65 in the IL-1βgroup was significantly higher than that in the normal chondrocytes (2.13 ±0.08 vs.0.73 ±0.08,P<0.05),and that in the IL-1β+H2S group was significantly decreased than that in the IL-1βgroup (1 .24 ±0.13 vs.2.13 ±0.08,P<0.05 ),and that in the H2 S group had no significant difference compared with that in the normal control group.The phosphorylated NF-κB p65 in IL-1βgroup was significantly higher than that in the normal chondrocytes (1.30 ±0.13 vs.0.19 ±0.04,P<0.05),and that in IL-1β+H2S group was significantly decreased than that in the IL-1βgroup (0.92 ±0.26 vs.1.30 ±0.13,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.Conclusion:H2 S affected the cartilage degeneration by partly inhibiting the degradation of extracellular matrix.

Bilateral Idiopathic Chondrolysis of the Hip in an Adult: A Case Report and Review of the Literature / 대한고관절학회지

Idiopathic chondrolysis of the hip usually develops in adolescents and is a disease characterized by gradual degenerative changes of the hyaline cartilage surrounding the head of the femur. It eventually decreases the hip joint space and causes limitations in the hip joint range of motion due to pain. The authors had experienced an unusual case of bilateral idiopathic chondrolysis of the hip in an 54 year-old male; thus, we report the treatment results and literature reviews in this case report.

Articular cartilage repair using mesenchymal stem cells-derived microvesicles and induced pluripotent stem cells / 中国组织工程研究

BACKGROUND:Induced pluripotent stem cels and mesenchymal stem cels-derived microvesicles have been confirmed in various tissue repairs, which are expected to become more effective and safe therapy for articular cartilage repair. OBJECTIVE:To overal understand the research progress in the use of induced pluripotent stem cels and mesenchymal stem cels-derived microvesicles in articular cartilage repair. METHODS: A computer-based search of PubMed and CNKI was performed by the first author for articles related to stem cel treatment of osteoarthritis published from 2003 to 2015. The keywords were “articular cartilage injury, bone marrow mesenchymal stem cels” in English and Chinese, respectively. In the same field, articles published recently or in authorized journals were preferred. RESULTS AND CONCLUSION:Articular cartilage injury is stil a difficulty in the orthopedics. Many repair methods have been reported, but they al have limitations. Induced pluripotent stem cels and mesenchymal stem cels-derived microvesicles bring a new hope for patients with articular cartilage injury. However, there are stil many problems to be solved, such as extracting and purifying a large amount of cels, proliferation and differentiation potentials, and mechanism underlying cartilage repair.

Comportamiento de pacientes con lesión de menisco / Behavior of patients with lesions of meniscus

Fundamento: las lesiones de los meniscos de la rodilla constituyen una enfermedad muy frecuente en la actualidad, su comportamiento varía de acuerdo a la causa que la produce. Objetivo: mostrar el comportamiento de pacientes con lesiones de los meniscos de la rodilla. Método: se realizó un estudio observacional descriptivo en 42 pacientes con el diagnóstico clínico y artroscópico de lesión de menisco que fueron asistidos en el Hospital Universitario Manuel Ascunce Domenech de Camagüey entre el 1ro de octubre de 2012 hasta el 31 de marzo de 2013. Resultados: predominaron las lesiones de tipo degenerativa de los meniscos. La edad promedio de las lesiones traumáticas fue de 32,6 años y la de los pacientes de causa degenerativa fue de 54,2 años. El tipo de desgarro más encontrado fue el degenerativo. La meniscectomía de tipo parcial fue la más realizada. Conclusiones: el comportamiento de pacientes con lesión de menisco es variable según la causa que lo provoca.

Background: lesions of the meniscus of the knee are a very frequent disease nowadays. The disease varies according to the cause that produces it. Objective: to show the behavior of patients with lesions of the meniscus of the knee. Method: a descriptive, observational study was conducted in 42 patients with the clinical and arthroscopic diagnosis of lesion of meniscus. The patients were treated at the Manuel Ascunce Domenech University Hospital in Camaguey between October 1st and March 31th, 2013. Results: the degenerative lesions of meniscus predominated. The average age of the patients with traumatic lesions was of 32.6 years and the average age of the patients with a degenerative cause was of 54.2 years. The most frequent type of tear was the degenerative one. Partial meniscectomy was the most practiced technique. Conclusions: the behavior of patients with lesions of meniscus is variable according to the cause that provokes it.

Lesiones del cartílago de la rodilla / Lesions of the cartilage of the knee

Fundamento: las lesiones del cartílago de la rodilla producen en los enfermos dolor y pérdida de la capacidad funcional de manera progresiva. El tratamiento de esta enfermedad es difícil, debido a la poca capacidad biológica de los cartílagos para su cicatrización. Desarrollo: se revisaron más de 300 artículos sobre el tema, de ellos 44 de los últimos cinco años. Se discutieron los aspectos relacionados con las características propias de los enfermos que presentan lesiones del cartílago y cómo decidir o sugerir las variantes de tratamientos según los factores propios de la lesión y del enfermo. Se abordaron técnicas tales como: el desbridamiento artroscópico, el injerto autólogo de condrocitos asociados a andamios y matrices sintéticas, en cada caso se analizaron las ventajas y desventajas, así como las indicaciones específicas de cada procedimiento, basado en los reportes de la literatura internacional. Conclusiones: el tratamiento de pacientes con lesiones del cartílago depende de varios factores, entre los que se conjugan los propios del enfermo y la preparación del médico. La intervención oportuna y efectiva en pacientes con esta enfermedad disminuye los síntomas y signos, además de la necesidad de utilizar técnicas quirúrgicas más complejas.

Background: lesions of the cartilage of the knee cause pain and progressive loss of the functional capacity of the joint. The treatment for the disease is difficult because of the poor biological capacity of cartilages to heal. Development: we looked through more than 300 articles related to the topic, 44 of which are from the last five years. Aspects related to the common characteristics of the patients that have lesions of the cartilage were discussed, and how to decide and suggest the different treatments according to the common factors of the lesion and of the patient as well. Techniques such as: arthroscopic debridement, autologous transplantation of chondrocytes associated to scaffolds and synthetic arrays were tackled. In each case, the advantages and disadvantages were analyzed, as well as the specific indications to each procedure based on reports from the international literature. Conclusions: the treatment of patients with lesions of the cartilage of the knee depends on some factors that combine those related to the common characteristics of the patient and the training of the doctor. Timely and effective operation in patients with the disease reduces the symptoms and the need to use more complex surgical techniques.

Trapezoidal osteochondral autologous plug singleblock graft for treating chondral lesions of the knee: clinical and functional medium-term results in an observational study

OBJECTIVE: To evaluate the clinical and functional results of autologous trapezoidal plug single-block grafts fixed with absorbable chondral darts in patients with osteochondral knee lesions of varying sizes. METHODS: Twenty-five patients underwent surgery from February 2000 to June 2008. Seventy-two percent of the patients were male, and the mean age was 29 years. RESULTS: The right side (56%) and the medial condyle (92%) were most affected. The lesions had an average area of 5.28 cm², and the mean follow-up was 59 months. All of the variables other than instability showed significant improvements (p<0.05), as shown by the increase in the mean Lysholm score from 55 points preoperatively to 92 points (p<0.001) postoperatively. There was no loosening or collapse of the osteochondral graft. All of the patients had patellofemoral crepitation and pain for an average of six months. CONCLUSION: Autologous trapezoidal plug single-block grafts are a therapeutic option for defects of varying sizes and provide good clinical results and low morbidity at the donor site in the medium term.

Atualização no diagnóstico e tratamento das lesões condrais do joelho / Updating on diagnosis and treatment of chondral lesion of the knee

O tratamento das lesões condrais no joelho ainda permanece um desafio para o cirurgião ortopédico, principalmente pelas próprias características da cartilagem, que promovem um baixo potencial de regeneração. As lesões condrais podem ser causadas por estímulos metabólicos, genéticos, vasculares e traumáticos e são classificadas de acordo com o tamanho e espessura da cartilagem acometida. O diagnóstico clínico pode ser difícil, principalmente pela sintomatologia insidiosa, sendo necessário o uso de exames complementares, em especial, a ressonância magnética. O tratamento dessas lesões é, em geral, iniciado de forma conservadora, ficando o tratamento cirúrgico reservado para pacientes com fragmentos condrais destacados, com bloqueio do arco de movimento, ou pacientes refratários ao tratamento clínico. As técnicas cirúrgicas mais usadas para o tratamento dos defeitos de espessura parcial são o desbridamento e a ablação por radiofrequência. Essas técnicas têm o objetivo de melhorar os sintomas, já que não restauram a estrutura e a função normal da cartilagem. Para os defeitos de espessura total (lesão osteocondral), os tratamentos disponíveis são a abrasão, drilling, microfratura, transplante osteocondral autólogo e alógeno e técnicas biológicas como o uso de transplante autólogo de condrócitos, técnica da cartilagem picada (minced cartilage) e o transplante de células-tronco.

The treatment of chondral knee injuries remains a challenge for the orthopedic surgeon, mainly owing to the characteristics of the cartilage tissue, which promote low potential for regeneration. Chondral lesions can be caused by metabolic stimulation, or by genetic, vascular and traumatic events, and are classified according to the size and thickness of the affected cartilage. Clinical diagnosis can be difficult, especially due to insidious symptoms. Additional tests, as Magnetic Resonance Imaging (MRI), may be needed. The treatment of these lesions usually starts with non-operative management. Surgery should be reserved for patients with detached chondral fragments, blocked range of motion, or the failure of non-operative treatment. The surgical techniques used for the treatment of partial thickness defects are Debridement and Ablation. These techniques aim to improve symptoms, since they do not restore normal structure and function of the cartilage. For full-thickness defects (osteochondral lesion), available treatments are Abrasion, Drilling, Microfracture, Osteochondral Autologous and Allogeneic Transplantation, and biological techniques such as the use of Autologous Chondrocyte Transplantation, Minced Cartilage and stem cells.

Tratamento cirúrgico das lesões osteocondrais do joelho com mosaicoplastia / Surgical treatment of osteochondral lesions of the knee with mosaicplasty

OBJETIVO: Avaliação dos resultados funcionais da técnica de mosaicoplastia em joelhos de pacientes com lesão osteocondral. MÉTODOS: No período de agosto de 1999 a março de 2005, 27 pacientes foram submetidos à mosaicoplastia do joelho. Vinte e um eram do sexo masculino e seis, do feminino. A idade variou de 16 a 64 anos (média de 38,1 anos). Dezessete lesões eram do lado direito e 10, do esquerdo. Em relação à localização da lesão, quatro (15 por cento) situaram-se no côndilo femoral lateral, 18 (66,5 por cento) no côndilo femoral medial e 5 (18,5 por cento) na patela. O tamanho das lesões variou de 1 a 8cm² (média de 2,7cm²). Os pacientes operados foram avaliados no pré e pós-operatórios pela escala funcional de Lysholm, com seguimento médio de 2,5 anos. RESULTADOS: O pré-operatório teve uma média de 62,7 pontos e o pós-operatório uma média de 95,4 pontos. Os pacientes submetidos à mosaicoplastia no côndilo femoral lateral apresentaram, no pré-operatório, a média de pontos de 51,5 pontos e, no pós-operatório, média de 100 pontos. No côndilo femoral medial a média no pré-operatório foi de 64,1 pontos e, no pós-operatório, de 95,4 pontos. Com relação à patela, a média do pré-operatório foi de 66,4 pontos e, do pós-operatório, de 92 pontos. CONCLUSÃO: A mosaicoplastia mostrou-se uma boa alternativa no tratamento das lesões osteocondrais do joelho. Entretanto, apresentou melhor evolução nas lesões dos côndilos femorais em relação às localizadas na patela.

OBJECTIVE: To evaluate the functional results of mosaicplasty in knees of patients with osteochondral lesion. METHODS: Between August 1999 and March 2005, twenty-seven patients were submitted to mosaicplasty on the knee. Twenty-one were male and six female. The patients' ages ranged from 16 to 64 years (average 38.1 years). Seventeen lesions were located on the right knee and ten on the left one. The lesion was located on the lateral condyle in 4 patients (15 percent), on the medial condyle in 18 patients (66.5 percent) and on the patella in 5 patients (18.5 percent). The lesion sizes varied from 1 to 8 cm² (average 2.7 cm²). The patients operated on were evaluated before and after surgery by the functional Lysholm scale, with an average follow-up of 2.5 years. RESULTS: In the preoperative evaluation, the average was 62.7 points, evolving to 95.4 points in the postoperative evaluation. The patients submitted to mosaicplasty in the lateral condyle presented an average of 51.5 points before surgery, evolving to 100 points after surgery. The patients submitted to mosaicplasty in the medial condyle had presented average of 64.1 points before surgery, evolving to 95.4 points after surgery. The patients submitted to mosaicplasty on the patella presented average of 66.4 points before surgery, evolving to 92 points in the postoperative evaluation. CONCLUSION: Mosaicplasty proved to be a good alternative for the treatment of chondral and osteochondral lesions of the knee, showing better evolution in lesions located on the femoral condyles than in lesions located on the patella.

MR diffusion weighted imaging experimental study on early stages of articular cartilage degeneration of knee / 中华放射学杂志

Objective To study the appearance of MR diffusion weighted imaging in early stages of cartilage degeneration and to detect its values. Methods In 20 goat left knees, intra- articular injection of 5 units of papain was performed causing a loss of cartilage proteoglycan. Twenty right knees were used as control group. MR diffusion weighted imaging was performed at 24 hours after intra-articular injection of papain. ADC of each part of articular cartilage was measured and compared with each other. The proteoglycan content was measured biochemically and histochemicaUy. Routine MRI and DWI were performed in 100 patients with osteoarthritis and 20 healthy people. The ADC of each interested part of articular cartilage was measured and compared with each other. Results In experimental control group, the ADCav of articular cartilage was (14.2±2.3)×10-4 mm2/s. In early stages of cartilage degeneration group, the ADCav of articular cartilage was (17.5±4.2) × 10-4 mm2/s. The ADCav of the control group was lower than that of the early stages of cartilage degeneration group (t = 2.709 ; P = 0.016) . The proteloglyean content of articular cartilage was 4.22×10<'6> μg/kg in control group, and 0.82×10<'6>μg/kg in experimental group at 24 hours after injection of papain. The difference between control group and experimental group was significant (t = 2.705, P = 0.018). In healthy people, the ADCav of articular cartilage was (7.6±2. 2) × 10-4 mm2/s. In osteoarthritis group, the ADCav of articular cartilage was (10.3±4. 2) × 10-4 mm2/s. The ADCav in the healthy group was significantly lower than that in the osteoarthritis group (t = 2.609, P = 0.014). Conclusion DWI is an useful method in detecting early stages of cartilage degeneration which can not be showed on routine sequences.

Treatment of Pectus Carinatum with a Compressive Brace / 대한흉부외과학회지

BACKGROUND: Patients suffering with pectus carinatum complain of cosmetic problems when they stand and this in spite of wearing cloths. The standard surgical treatment of pectus carinatum is resection of the deformed cartilages, but the wide operative scar, post-operative pain and complications related with such an operation can occur. Therefore, we have performed compressive brace therapy as a non-operative treatment for pectus carinatum and we observed the effects and the efficiency of this treatment. MATERIAL AND METHOD: From January, 2001 to December, 2006, 109 patients wore the compressive brace for all day. The degree of satisfaction was evaluated after 6~9 months of wearing the compressive brace. The degree of satisfaction was evaluated by a score of from 1~4. A score of 1 was assigned when the status was worse, 2 when it was the same, 3 when there was partial improvement and 4 when remarkable improvement was observed. The degree of satisfaction was assessed subjectively by the parent if the patient was a child younger than middle school age, and the patients older than middle school age assessed the score themselves. RESULT: The mean score of the overall degree of satisfaction was 3.93+/-0.33. Recurrence of pectus carinatum after removal of compressive brace occurred in 6 patients (5.5%) of the total 109 patients. But 4 patients of the total 6 recurred patients stopped wearing of compressive brace against our advice. The 6 recurred patients were re-corrected by re-wearing the compressive brace within 3 months after they originally removed the compressive brace. The complications were discomfort with initially wearing the compressive brace, which occurred in all patients, skin rash due to the compressive brace for 76 patients (69.7%) and skin discolorization with excessive compression for 16 patients (5.5%). The skin rash and discolorization returned to normal within a few months after removal of the compressive brace. CONCLUSION: This study demonstrated that non-surgical treatment with using the compressive brace for patients with pectus carinatum was effective, and especially for children and teenagers. Non-surgical treatment with using a compressive brace would be helpful for the patients suffering with pectus carinatum and who dislike surgical operations because of their fear about general anesthesia and operation-related complications. Yet long-term follow up is necessary to accurately evaluate the effectiveness of this compressive brace and the recurrences after removal of the compressive brace.

Cartilage degeneration sign and diognosis of knee osteoarthritis / 中华风湿病学杂志

Objective To get new more sensitive signs reflecting cartilage degeneration,which were added to the present ARA differential criteria of knee osteoarthritis and to compare the sensitivity and specificity before and after new items.Methods Through review analysis of the clinical feature,radiography and operative presentation of 115 adult patients,the new signs reflecting cartilage degeneration as items were found,which were added to the present ARA differential criteria of knee osteoarthritis as new criteria.Then the 112 patients who have received either knee joint replacement or arthroscopy were re diagnosed with both the present ARA criteria and the new criteria.Sensitivity and specificity were calculated and compared.Results "Extensive knee joint tenderness" with cartilage degradation and "lockage on motion or a positive Apler test" were significantly related to the meniscus degradation.A 39 7% sensitivity of these patients was obtained using the present ARA clinical criteria,while it reached 70 6% using the new clinical criteria ( P 0 05).Conclusion The two new items added to the present ARA criteria help to increase the sensitivity for diagnosis of knee osteoarthritis without influence on the specificity.