Application of CT-MRI Fusion-Based Three-Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament.

OBJECTIVE: During PCL reconstruction surgery, precise and personalized positioning of the graft tunnel is very important. In order to obtain patient-specific anatomical data, we established a three-dimensional knee joint fusion model to provide a unified imaging strategy, as well as anatomical information, for individualized and accurate posterior cruciate ligament (PCL) reconstruction. METHODS: This is an exploration study. From January 2019 to January 2020, 20 healthy adults randomly were enrolled and assessed via CT and MRI imaging. A three-dimensional fusion model of the knee joint was generated using the modified MIMIMICS and image fusion software. On the fused image, the areas of the femoral and tibial PCL footprint of both knees were measured. The anatomical center of the PCL footprint was measured at the femoral and tibial ends. The relevant bony landmarks surrounding the PCL femoral and tibial attachment were also measured. Paired t-tests were employed for all statistical analyzes, and p < 0.05 was considered as statistically significant. RESULTS: All 20 subjects achieved successful image fusion modeling and measurement, with an average duration of 12 h. The lengths of the LF1-LF3 were 32.1 ± 1.8, 6.8 ± 2.5, and 23.3 ± 2.1 mm, respectively. The lengths of the LT1-LT3 were 37.3 ± 3.3, 45.6 ± 5.3, and 6.0 ± 1.2 mm, respectively. The distances between the tibial PCL center of the left knee to the medial groove, champagne-glass drop-off, and the apex of the medial intercondylar were 8.4 ± 2.4, 9.2 ± 1.8, and 15.3 ± 1.4 mm, respectively, and the corresponding distances from the right knee were 8.0 ± 2.0, 9.4 ± 2.2, and 16.1 ± 1.8 mm, respectively. We observed no difference between the bilateral sides, in terms of the distance from the PCL center to the PCL attachment-related landmark, under arthroscopic guidance. The area of the femoral and tibial PCL footprints on the left knee were 115.3 ± 33.5 and 146.6 ± 24.4 mm2 , respectively, and the corresponding areas on the right knee were 121.8 ± 35.6 and 142.8 ± 19.5 mm2 , respectively. There was no difference between the bilateral sides in terms of the PCL footprint areas. CONCLUSION: In the fusion image, the PCL attachment center and relevant bony landmarks which can be easily identified under arthroscopy can be accurately measured. The model can also obtain personalized anatomical data of the PCL on the unaffected side of the patient, which can guide clinical PCL reconstruction.

Hypoxia-Preconditioned Extracellular Vesicles from Mesenchymal Stem Cells Improve Cartilage Repair in Osteoarthritis.

In the past decade, mesenchymal stem cells (MSCs) have been widely used for the treatment of osteoarthritis (OA), and extracellular vesicles (EVs) may play a major role in the efficacy of this treatment. Hypoxia can change the cargo and biological functions of MSC-derived EVs (MSC-EVs). The aim of the present study was to determine whether the effects of hypoxia-preconditioned MSC-EVs on OA cartilage repair are superior to normoxia-preconditioned MSC-EVs. By using in vitro and in vivo OA models, we verified that hypoxia-preconditioned MSC-EVs improved chondrocyte proliferation and migration and suppressed chondrocyte apoptosis to a greater extent than normoxia-preconditioned MSC-EVs. Furthermore, we found that hypoxia altered the microRNA expression in MSC-EVs and identified four differentially expressed microRNAs: hsa-miR-181c-5p, hsa-miR-18a-3p, hsa-miR-376a-5p, and hsa-miR-337-5p. Bioinformatics analysis revealed that hypoxic pretreatment may promote cartilage repair by stimulating chondrocyte proliferation and migration and suppressing chondrocyte apoptosis through the miRNA-18-3P/JAK/STAT or miRNA-181c-5p/MAPK signaling pathway. Therefore, hypoxia-preconditioned EVs may be a novel treatment for OA.

Relative Efficacy and Safety of Tanezumab for Osteoarthritis: A Systematic Review and Meta-analysis of Randomized-Controlled Trials.

OBJECTIVES: The aim of this meta-analysis was to evaluate the efficacy and safety of tanezumab for the treatment of patients with knee or hip osteoarthritis (OA). METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to July 2020. Randomized-controlled trials comparing tanezumab with placebo or nonsteroidal anti-inflammatory drugs in patients with OA. Two investigators identified studies and independently extracted data, and conventional meta-analyses were conducted with Review Manager 5.3. The outcomes were pain relief, functional improvement, and risk of adverse events (AEs). RESULTS: A total of 8 articles, comprising 9 randomized-controlled trials, were included. Overall, tanezumab was superior to placebo for relieving pain and improving function, as well as in the patient's global assessment. Tanezumab also had significant advantages over nonsteroidal anti-inflammatory drugs for relieving pain and improving function, as well as in the patient's global assessment. Significantly more patients discontinued treatment because of AEs after treatment with tanezumab. However, the differences in serious AEs and total joint replacement were not significant. Moreover, tanezumab-treated patients experienced significantly more rapid progression of osteoarthritis. DISCUSSION: Tanezumab can alleviate pain and improve function for patients with OA of the hip or knee. Although tanezumab does not cause serious AEs, rapid progression of OA occurred in a small number of participants, so more clinical trials are needed to explore its safety.

Efficacy of extracellular vesicles from mesenchymal stem cells on osteoarthritis in animal models: a systematic review and meta-analysis.

Background: Some studies have reported results from the use of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) to treat osteoarthritis (OA). Objective: To evaluate the efficacy of MSC-EVs as a treatment for OA. Data sources: Databases were searched using the terms 'mesenchymal stem cells', 'osteoarthritis' and 'extracellular vesicles.' Study eligibility criteria: Studies performed in animal models utilizing MSC-EVs to treat OA that described the macroscopic evaluation or histological evaluation were included. Study appraisal: The quality of the studies was examined using the CAMARADES quality checklist. Results: MSC-EVs were superior to the placebo in the macroscopic evaluation and histological evaluation. MSC-EVs were more effective in the early stage of OA and once a week was better than multiple times a week. Limitations: The included studies were highly heterogeneous. Conclusion: MSC-EVs may improve the results of macroscopic and histological evaluations of OA.

The backward traction test: a new and effective test for diagnosis of biceps and pulley lesions.

BACKGROUND: The value of physical examination for diagnosis of lesions of the long head of the biceps (LHB) and the pulley remains unsatisfactory. The purpose of this study was to describe a new diagnostic test, the backward traction (BT) test, to detect lesions of the LHB and the biceps pulley. METHODS: A prospective study of 143 patients was performed to evaluate the diagnostic value of the BT test and 2 traditional clinical tests (Speed and Yergason tests). Shoulder arthroscopy was used as the "gold standard." RESULTS: For the detection of LHB injury, the BT test was the most sensitive (74%) and accurate (68%). The BT test had a higher diagnostic value for pulley lesions, with a high sensitivity of 81% and an accuracy of 71%. No significant differences in terms of specificity for LHB and pulley lesions were observed between tests. Regarding pulley lesions, the internally rotated and externally rotated BT test positions had high specificity for the diagnosis of specific anteromedial and posterolateral pulley lesions (79% and 73%, respectively). The BT test had a high κ coefficient of 0.768-0.811. CONCLUSION: The BT test is more sensitive and accurate as a new test for LHB and pulley lesions and also specific to distinguish the medial sling and lateral sling lesions of the pulley.

Elevated levels of interleukin-1ß, interleukin-6, tumor necrosis factor-α and vascular endothelial growth factor in patients with knee articular cartilage injury.

BACKGROUND: Inflammatory cytokines play a vital role in the occurrence of osteoarticular injury and inflammation. Whether inflammation-associated factors interleukin-1ß (IL-1ß), IL-6, tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) are involved in the pathogenesis of keen articular cartilage injury remains poorly understood. AIM: To measure the levels of inflammatory factors [IL-1ß, IL-6, TNF-α and VEGF] in patients with knee articular cartilage injury. METHODS: Fifty-five patients with knee articular cartilage injury were selected as patient groups, who were divided into three grades [mild (n = 20), moderate (n = 19) and severe (n = 16)] according to disease severity and X-ray examinations. Meanwhile, 30 healthy individuals who underwent physical examination were selected as the control group. The levels of IL-1ß, IL-6, TNF-α and VEGF were measured by ELISA and immunohistochemical staining. RESULTS: Compared with the control group, patient groups displayed significantly higher levels of IL-1ß, IL-6, TNF-α and VEGF, and the extent of increase was directly proportional to the severity of injury (P < 0.05). In addition, the number of cells with positive staining of IL-1ß, IL-6, TNF-α and VEGF in the synovial membrane were significantly increased, along with increased disease severity (P < 0.05). After treatment, the scores of visual analogue scale and the Western Ontario and McMaster University of Orthopaedic Index in patient groups were 2.26 ± 1.13 and 15.56 ± 7.12 points, respectively, which were significantly lower than those before treatment (6.98 ± 1.32 and 49.48 ± 8.96). Correlation analysis suggested that IL-1ß and TNF-α were positively correlated with VEGF. CONCLUSION: IL-1ß, IL-6, TNF-α and VEGF levels are increased in patients with knee articular cartilage injury, and are associated with the disease severity, indicating they might play an important role in the occurrence and development of knee articular cartilage injury. Furthermore, therapeutically targeting them might be a novel approach for the treatment of keen articular cartilage injury.

Single-tunnel anatomic double-bundle anterior cruciate ligament reconstruction has the same effectiveness as double femoral, double tibial tunnel: A prospective randomized study.

PURPOSE: To investigate whether single femoral, single tibial tunnel anatomic double-bundle anterior cruciate ligament (ACL) reconstruction is equal to or superior to double femoral, double tibial tunnel ACL double-bundle anatomic reconstruction in terms of restoring the stability and functions of the knee joint. METHODS: A prospective clinical study was performed to compare 30 cases of single-tunnel ACL double-bundle anatomic reconstruction to 28 cases of double-tunnel ACL double-bundle anatomic reconstruction, with average follow-up of 36 months. All graft tendons were hamstring tendon autografts. Tunnel placements in all the cases were made anatomically. Clinical results were collected after reconstruction. Graft appearance, meniscus status and cartilage state under arthroscopy were compared and analyzed. RESULTS: Tunnel placements were in the anatomic positions in both groups. On the lateral pivot-shift test performed at 36 months postoperatively, there was no significant difference between groups. Clinical results such as International Knee Documentation Committee score, Tegner activity scale, and range of motion showed no significant differences between the groups. The mean thickness of anteromedial graft was reduced by 10.3% and that of the posterolateral graft was reduced by 11.1% from the original graft thickness evaluated by magnetic resonance imaging. No new meniscal tears were found either group; however, cartilage damage occurred in the double-tunnel group at 39.3%, and this rate was significantly higher than that in the single-tunnel group (10.0%). CONCLUSION: Single femoral, single tibial tunnel anatomic double-bundle ACL reconstruction has the same effectiveness as the double femoral, double tibial tunnel in restoring the knee's stability and functions.

Elevated visceral obesity quantified by CT is associated with adverse postoperative outcome of laparoscopic radical nephrectomy for renal clear cell carcinoma patients.

PURPOSE: To examine the association between CT measures of visceral obesity and short-term postoperative outcomes in renal clear cell carcinoma (RCCC) patients. METHODS: In this retrospective study, 76 patients treated with unilateral laparoscopic radical nephrectomy for stage I-III renal cancer were classified as obese or non-obese by preoperative CT-based measures of adiposity [obese: visceral fat area (VFA) > 100 cm2, BMI ≥ 28 kg/m2]. Clinical variables, Fuhrman grade, operation time, estimated blood loss (EBL), postoperative complications, postoperative stay, drainage time and hospitalization expenses were compared between the two groups. RESULTS: Viscerally obese patients significantly had higher Fuhrman grade than the non-obese (p = 0.018). The operation time of obese patients by VFA or BMI was more than the non-obese (171.6 ± 68.9 vs. 140.8 ± 35.5 min, p = 0.012 and 197.2 ± 67.2 vs. 153.2 ± 57.7 min, p = 0.013, respectively). And obese patients by VFA or BMI tended to have more EBL than non-obese (132.0 ± 120.7 vs. 83.8 ± 53.4 ml, p = 0.018 and 215.3 ± 165.0 vs. 92.5 ± 68.8 ml, p = 0.013, respectively). Viscerally obese patients by VFA (not BMI) were more likely to develop postoperative complications as compared to patients classified as non-obese: VFA (26.9 vs. 4.2%, p = 0.045) and BMI (33.3 vs. 16.4%, p =0.265). Furthermore, obese patients by VFA (not BMI) were more likely to have longer postoperative stay: VFA (8.7 ± 2.5 vs. 7.5 ± 1.4 dollars, p = 0.013) and BMI (9.1 ± 2.9 vs. 8.1 ± 2.1 dollars, p = 0.209). Obese patients expensed more than non-obese: VFA (7570.9 ± 2674.3 vs. 6368.8 ± 1289.8 dollars, p = 0.040) and BMI (8390.8 ± 2929.7 vs. 6896.3 ± 2159.1 dollars, p = 0.029). CONCLUSIONS: Elevated visceral obesity by VFA is associated with increased surgical complexity, postoperative morbidity, postoperative stay and hospitalization expenses for RCCC patients and may be superior to BMI for renal cancer outcome assessment. VFA may be a useful index for the evaluation and calculation of RCCC aggressiveness.