Effects of a graphene oxide-alginate sheet scaffold on rotator cuff tendon healing in a rat model.

BACKGROUND: Natural polymer scaffolds used to promote rotator cuff healing have limitations in terms of their mechanical and biochemical properties. This animal study aimed to investigate the effects of combined graphene oxide (GO) and alginate scaffold and the toxicity of GO on rotator cuff healing in a rat model. METHODS: First, the mechanical properties of a GO/alginate scaffold and a pure alginate scaffold were compared. The in vitro cytotoxicity of and proliferation of human tenocytes with the GO/alginate scaffold were evaluated by CCK-8 assay. For the in vivo experiment, 20 male rats were randomly divided into two groups (n = 10 each), and supraspinatus repair was performed: group 1 underwent supraspinatus repair alone, and group 2 underwent supraspinatus repair with the GO/alginate scaffold. Biomechanical and histological analyses were performed to evaluate the quality of tendon-to-bone healing 8 weeks after rotator cuff repair. RESULTS: The GO/alginate scaffold exhibited an increased maximum load (p = .001) and tensile strength (p = .001). In the cytotoxicity test, the cell survival rate with the GO/alginate scaffold was 102.08%. The proliferation rate of human tenocytes was no significant difference between the GO/alginate and alginate groups for 1, 3, 5, and 7 days. Biomechanically, group 2 exhibited a significantly greater ultimate failure load (p < .001), ultimate stress (p < .001), and stiffness (p < .001) than group 1. The histological analysis revealed that the tendon-to-bone interface in group 2 showed more collagen fibers bridging, tendon-to-bone integration, longitudinally oriented collagen fibers, and fibrocartilage formation than in group 1. CONCLUSION: A small amount of GO added to alginate improved the mechanical properties of the scaffold without evidence of cytotoxicity. At 8 weeks after rotator cuff repair, the GO/alginate scaffold improved tendon-to-bone healing without causing any signs of toxicity in a rat model.

Increased interleukin-6 and TP53 levels in rotator cuff tendon repair patients with hypercholesterolemia.

BACKGROUND: A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. METHODS: Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, Western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. RESULTS: Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05). CONCLUSIONS: We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.

Comparison of the Characteristics of Rotator Cuff Tissue in a Diabetic Rat Model.

This study evaluated the biomechanical and histologic characteristics of the rotator cuff tendon and muscle tissue with rat models with diabetes mellitus (DM) (group 1) and 30 male rats without DM (group 2). We conducted a time zero study without any additional procedures or external variables at 9 weeks after induction of the diabetic rat model. Thereafter, quantitative evaluation of advanced glycation end products (AGEs) was accomplished via enzyme-linked immunosorbent assay and immunohistochemistry (IHC). Fatty infiltration was investigated with Oil Red O staining, and the peroxisome proliferator activated receptor-gamma (PPAR-gamma) value was studied with IHC. Grossly, the supraspinatus tendons of the group 1 rats were more friable and discolored (yellowish) than those of group 2. In the biomechanical analysis, group 1 rats showed significantly inferior ultimate failure load (P=.001) and ultimate stress (P=.02). Group 1 was significantly inferior to group 2 in terms of total histologic scoring (P<.001). Mean AGE levels were significantly higher in group 1 (P<.001), as determined by IHC. In evaluating fatty infiltration, the degree of Oil Red O staining was significantly higher in group 1 (P<.001), but there was no significant difference in PPAR-gamma value between the 2 groups (P=.14). The intact rotator cuffs of rats with DM were associated with inferior biomechanics in association with AGE accumulation and increased fatty infiltration, as confirmed by histologic examination The hyperglycemic state caused by DM is associated with rotator cuff tendon degeneration. [Orthopedics. 2022;45(3):e154-e161.].

Prenatal serum sFlt-1/PlGF ratio predicts the adverse neonatal outcomes among small-for-gestational-age fetuses in normotensive pregnant women: A prospective cohort study.

ABSTRACT: We investigated the predictive value of the soluble fms-like tyrosine kinase-1 (sFlt-1)-to-placental growth factor (PlGF) ratio for poor neonatal outcomes of SGA neonates in the absence of preeclampsia.This prospective cohort study included 530 singleton pregnant women who attended a prenatal screening program at a single institution. The sFlt-1/PlGF values at 24 to 28+6 weeks and 29 to 36+6 weeks of gestation were analyzed and compared between control and SGA group (subdivided as with normal neonatal outcomes and with poor neonatal outcomes).After 22 preeclampsia cases were excluded, 47 SGA neonates and 461 control neonates were included. In the SGA group, 17 neonates had adverse neonatal outcomes (36.1%, 17/47). The mean (±D) sFlt-1/PlGF ratio of early third trimester was significantly higher in SGA with averse neonatal outcome group than in the control group (14.42 ±â€Š23.8 vs 109.12 3.96, P = .041) and the ratio retained an independent and significant association with SGA with adverse neonatal outcomes (odds ratio = 1.017, P = .01). A sFlt-1/PlGF ratio cut-off of 28.15 at 29 to 36+6 weeks significantly predicted adverse outcomes among SGA neonates (sensitivity = 76.9%, specificity = 88%).In this study, sFlt-1/PlGF ratio at 29 to 36 + 6wks of SGA with adverse neonatal outcome group was significantly higher than control group. This study suggests the feasibility of the sFlt-1/PlGF ratio as helpful objective measurement for predicting the adverse SGA neonatal outcome by providing sFlt-1/PlGF cut-off value.

Clinical outcome of rotator cuff repair in patients with mild to moderate glenohumeral osteoarthritis.

PURPOSE: Osteoarthritis (OA) in the glenohumeral joint is a concomitant lesion with rotator cuff tear that commonly occurs in older patients. The authors aimed to evaluate the effect of associated OA on the treatment outcome of rotator cuff repair. METHODS: A total of three hundred and forty-eight patients who underwent full-thickness arthroscopic rotator cuff repair were retrospectively reviewed, and the data were prospectively collected. The severity of OA was evaluated using the Samilson and Prieto method preoperatively and the Outerbridge classification intraoperatively. The patients were divided into the small-to-medium group and large-to-massive group according to rotator cuff tear size and were evaluated for presence or absence of OA. The postoperative clinical outcomes were assessed using the visual analog scale for pain, simple shoulder test (SST), University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons (ASES) scoring systems at baseline and at final follow-up. RESULTS: Forty-five patients were diagnosed with glenohumeral OA (12.9%). Overall, no significant differences were observed in demographic and baseline data between the two groups according to the presence or absence of OA. The clinical symptoms of both groups significantly improved at the final follow-up. At the final follow-up, no significant differences were found in the VAS for pain, SST, UCLA, Constant, and ASES scores between the two groups. In the large-to-massive tear group, patients with OA had significantly inferior clinical results compared with those without OA. CONCLUSION: The clinical outcome scores improved after rotator cuff repair regardless of the presence of concomitant OA. However, glenohumeral OA should be considered as a potential negative prognostic factor in patients with large-to-massive rotator cuff tears. LEVEL OF EVIDENCE: III.

Concomitant Coracoid Process Fracture with Bony Bankart Lesion Treated with the Latarjet Procedure.

Bony lesions of the glenoid and Hill-Sachs lesions are the most common injuries after a first-time traumatic shoulder dislocation. However, fracture of the coracoid process after traumatic shoulder dislocation is rare. A single, open surgical procedure could be performed by a Latarjet procedure using a fractured fragment of the coracoid process. If a fracture of the coracoid process is associated with a traumatic anterior shoulder dislocation, the Latarjet procedure may be the most appropriate surgical option.

The anti-Mullerian hormone as a predictor of early pregnancy loss in subfertile women.

The aim of this study was to evaluate the predictive value of the anti-Mullerian hormone (AMH) level for early pregnancy loss and to compare the significance of AMH level to age as prognostic factors of pregnancy loss in subfertile women. The outcome of 848 subfertile patients confirmed with intrauterine pregnancies by ultrasound within 1 year of measuring serum AMH level were retrospectively analyzed. Among 848 patients, 206 women were diagnosed with early pregnancy loss. The mean age of the 848 patients was 35.66 ± 3.61 years (range: 26-46 years), and the mean AMH level was 2.95 ± 1.89 (range: 0.14-8.82 ng/mL). There were no significant differences in gravidity, parity, body mass index (BMI), and previous abortion history depending on early pregnancy loss. However, multivariable logistic regression analysis confirmed that the probability of early pregnancy loss is significantly affected by age (odd ratio, 1.079: 1.025-1.135, P = 0.004) and AMH (odd ratio, 0.885: 0.797-0.982, p = 0.022). According to this study, AMH level and age are both powerful predictors of early pregnancy loss. While chronological age is already well known as a factor related to early pregnancy loss, AMH was also considered when individualizing risk prediction for early pregnancy loss.

Effect of thoracic and pelvic anteroposterior diameters on spinal sagittal alignment.

PURPOSE: This study aimed to analyze the effect of the thoracic anteroposterior diameter (TAPD) and pelvic anteroposterior diameter (PAPD) on global sagittal alignment in asymptomatic patients with normal sagittal alignment. PATIENT SAMPLE: The study investigated 2042 adult patients who initially presented at our hospital with a hip and knee problem without history of symptoms related to the entire spine. Only 57 patients with normal global sagittal alignment (C2-7 sagittal vertical axis (SVA) and C7-S1 SVA of <10 mm) were considered. METHODS: The whole-spine standing lateral radiographs were obtained to analyze the following parameters: pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic inlet angle (TIA), T1 slope, cervical spinal parameters (angle of C0-2, C2-7, and C0-7), TAPD, and PAPD. Statistical analysis was performed using Pearson correlation coefficients and multiple regression analyses. RESULTS: All the parameters showed a normal distribution. TAPD had a significant relationship with thoracic kyphosis (TK; r = 0.458), TIA (r = 0.677), and C0-2 angle (r = 0.294) but no significant relationship with T1 slope and other cervical parameters. PAPD had a significant relationship with PI (r = 0.309) and PT (r = 0.463) but no significant relationship with LL, SS, and TK. The multiple regression analysis showed that TIA = 21.974 + 0.405 (TK) + 0.188 (TAPD) (p < 0.0001). CONCLUSIONS: TAPD and PAPD are associated with TIA, TK, C0-2 angle, PI, and PT, all of which act as key factors in spinal sagittal alignment. Although they did not directly correlate with other cervical parameters, T1 slope, and LL, TAPD and PAPD might have indirect effects on cervical and lumbar spinal sagittal alignment through their relationships with TIA, TK, and PI.

Mechanical Augmentation With Absorbable Alginate Sheet Enhances Healing of the Rotator Cuff.

For anatomical restoration of a repaired rotator cuff, mechanical augmentation of the repaired structure is essential. Using histological and biomechanical evaluation in a rat model, the authors sought to determine the efficacy of an absorbable alginate sheet at the supraspinatus tendon-to-bone repair site for healing of the rotator cuff tear. Forty adult (12 weeks old) male Sprague- Dawley wild-type rats were used in this study. The animals were randomly separated into 2 groups: group 1, conventional supraspinatus repair with acute repair; or group 2, supraspinatus repair with absorbable alginate sheet. Biomechanical and histological analyses were performed at 6 and 12 weeks after index rotator cuff surgery. Compared with group 1, group 2 exhibited a significantly greater mean ultimate failure load (group 1, 23.70±3.87 N; group 2, 61.44±43.67 N; P=.023) and mean ultimate stress (group 1, 2.83±0.50 MPa; group 2, 7.36±2.87 MPa; P=.020). However, 6-week outcomes were not significantly different. On histological scoring, compared with group 1, group 2 exhibited a significantly greater mean 6-week score (group 1, 4.10±1.72 points; group 2, 7.80±1.47 points; P<.001) and mean 12-week score (group 1, 3.50±1.00 points; group 2, 5.25±2.62 points; P=.020). Mechanical augmentation with absorbable alginate may improve tendon healing after surgical repair of the rotator cuff. [Orthopedics. 2019; 42(1):e104-e110.].

Preoperative planning using the picture archiving and communication system technique in high tibial osteotomy.

PURPOSE: This study aimed to evaluate the accuracy of the picture archiving and communication system (PACS) method in order to select the correction angle and gap in open-wedge high tibial osteotomy (HTO) and clinical results of the patients. MATERIAL AND METHODS: This retrospective study analyzed 27 consecutive patients (30 knees) underwent open-wedge HTO using the PACS method between April 2013 and March 2015. Full-length lower limb radiographs obtained preoperatively and at the final follow-up were used to the percentages of crossing points of the weight-bearing line and tibial plateau with respect to the medial border and mechanical femur-tibia angle. Preoperatively predicted and postoperatively measured wedge angles and gaps were compared. The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee score and the Knee Society score. RESULTS: At the 20.5 months (12-26.5) follow-up, the weight-bearing line on the tibial plateau was corrected from 17.3% to 61.3%, and the mechanical femur-tibia angle was corrected from 7.3° varus to 3.1° valgus. No significant difference in preoperative and postoperative measured values was observed ( p = 0.440 and p = 0.505). The mean HSS score increased from 66.7 to 88.8 ( p < 0.001). The knee score and function score of Knee Society increased from 62.0 to 88.7 ( p < 0.001) and from 60.2 to 91.7 ( p < 0.001), respectively. CONCLUSION: In open-wedge HTO, correction of angular deformity based on the PACS method could be an accurate correction method and the good clinical results could be obtained.

Evaluation of Infection after Anterior Cruciate Ligament Reconstruction during a Short Period.

PURPOSE: We encountered 7 cases (7.1%) of infection (5 deep and 2 superficial) in 98 cases of anterior cruciate ligament (ACL) reconstruction using hamstring autografts in a 17-month period. The aim of this study was to analyze the causes of infection and to introduce our treatment strategy. MATERIALS AND METHODS: We investigated the shelf-life of the fixation implants, the order of surgery, previous knee surgery, infectious pathogen, treatment of infection, and results of treatment. RESULTS: There was no problem with the expiration date of the fixation implants. The order of surgery was either the last or second to the last of all those performed on the same day. One patient had undergone knee surgery 8 months previously. The treatment after infection included aggressive debridement in all cases. Revision ACL reconstruction with graft removal was performed in 1 case of persistent infection with methicillin-resistant Staphylococcus aureus. All cases had satisfactory clinical results without recurrence during a mean 24.9 months of follow-up. CONCLUSIONS: We could not verify the exact cause of the high incidence of infection during the 17-month period. However, preventive measures are important to decrease the incidence of infection after ACL reconstruction.

Total knee arthroplasty conversion after open-wedge high tibial osteotomy: A report of three cases.

BACKGROUND: The changes in the anatomy that occur due to a high tibial osteotomy (HTO), including the ligament release, can affect the clinical results after a subsequent total knee arthroplasty (TKA). We present three cases in which patients underwent conversion to a TKA after an open-wedge HTO. Of particular interest is the medial instability that was noted during the TKA procedures. METHODS: Three patients underwent conversion to a TKA after an open-wedge HTO. RESULTS: One case was converted to a TKA using a conventional posterior-stabilized type implant, and the other case was converted to a TKA using varus-valgus constraint-type implants due to the medial instability. The final case was converted to TKA using a conventional posterior-stabilized type implant, but a revision TKA using constrained-type implant was performed due to neglected medial instability. CONCLUSION: Conversion to a TKA after open-wedge HTO requires careful preparation and a constrained-type implant should be prepared to address the medial structure release. Furthermore, medial structures should be repaired during open-wedge HTO, in case the patient requires a future TKA conversion.

Clinical outcomes of vitrified-thawed embryo transfer using a pull and cut straw method.

OBJECTIVE: To compare the clinical outcomes of patients with vitrified-thawed embryos transferred using either the 0.25 mL straw method and the pull and cut straw (PNC) method. To evaluate the clinical outcomes of patients with transferred embryos that underwent assisted hatching at the cleaved embryo (day 3) or the blastocyst (day 5) stage. METHODS: The study population consisted of women who underwent vitrified-warmed embryo transfer between May 2000 and December 2011 and assisted hatching was performed after warming of embryos. Cycles of thawing between assisted hatching treated and non treated groups were compared for survival and pregnancy rates. RESULTS: The PNC vitrification method improved survival and pregnancy rates in partial lysed embryos. While assisted hatching did not affect the developmental and clinical pregnancy rates of the vitrified-warmed blastocyst group, it did increase the pregnancy rate of poor quality vitrified-warmed cleaved embryos. CONCLUSION: These results suggest that PNC may increase the number of clinical pregnancies via the vitrification of both cleaved embryos and blastocysts. In addition, selective assisted hatching treatment of embryos that show a poor prognosis after warming may increase the rate of clinical pregnancy.