ABSTRACT
OBJECTIVES: The metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints may be involved in juvenile idiopathic arthritis. Our goal was to describe their normal sonoanatomy in healthy children, according to age and gender. METHODS: We studied 41 consecutive healthy children (20 girls, 21 boys; age 2-15 years) divided into four age groups: 2-4 years (n=9), 5-7 years (n=11), 8-12 years (n=12), and 13-15 years (n=9). Longitudinal ultrasound axis of the MCP and MTP joints were obtained. The evolution of the cartilage thickness and vascularisation of these joints were studied according to age and gender. The MCP or MTP joints were the statistical unit. RESULTS: At all sites, on B-mode images, cartilage thickness was associated with age (p<0.0001). Cartilage thickness at different sites was significantly greater in boys than in girls (p≤0.05). Blood vessels were seen within the cartilage, with differences across age groups. CONCLUSIONS: This study provides children's age- and gender-specific sonoanatomy data of MCP and MTP and confirms the importance of using colour Doppler or Power Doppler to study cartilage vascularisation.
Subject(s)
Cartilage, Articular/blood supply , Cartilage, Articular/diagnostic imaging , Metacarpophalangeal Joint/blood supply , Metacarpophalangeal Joint/diagnostic imaging , Metatarsophalangeal Joint/blood supply , Metatarsophalangeal Joint/diagnostic imaging , Neovascularization, Physiologic , Ultrasonography, Doppler , Adolescent , Adolescent Development , Age Factors , Cartilage, Articular/growth & development , Child , Child Development , Child, Preschool , Female , Humans , Male , Metacarpophalangeal Joint/growth & development , Metatarsophalangeal Joint/growth & development , Predictive Value of Tests , Reference Values , Retrospective Studies , Sex FactorsABSTRACT
Toe-to-hand vascularized joint transfers in four children were reviewed 6 to 8 years after operation (average, 6.6 years). Two children had vascularized metatarsophalangeal (MTP) joints. Both children have near normal active range of motion. The transferred epiphyses have provided a major contribution to digital growth. The other two children had second toe proximal interphalangeal (PIP) joints transferred to damaged hand joints. Active PIP joint extension has been disappointing, and the overall growth contribution of the transferred epiphysis has been small. We conclude that MTP to metacarpophalangeal vascularized joint transfer can provide painless, functional, stable motion, with near normal growth potential, and the usefulness of toe PIP to hand PIP joint transfer is limited by the inability to achieve good active extension and limited growth potential.
Subject(s)
Hand/surgery , Metatarsophalangeal Joint/transplantation , Toe Joint/transplantation , Child , Child, Preschool , Epiphyses/transplantation , Female , Follow-Up Studies , Humans , Male , Metatarsophalangeal Joint/blood supply , Metatarsophalangeal Joint/growth & development , Toe Joint/growth & development , Toe Joint/surgeryABSTRACT
Study of pre- and postnatal development of the metatarsophalangeal joint of the mouse shows that the synovial cavity (SC) forms before any differentiation of the synovial mesenchyme. The primitive cleft results from degradation of a thin vascular mesenchymal layer in direct contact with the chondrogenic layers. Differentiation of the synovial membrane coincides with clarification of the SC (3rd to 6th day of postnatal life). When dilatation of the SC occurs (6th to 8th day), the two intimal cells types (A- and B-cells) are well identified. The B-cells already show typical features at day 6; their content of typical dense secretory vesicles is comparable to that of the adult B-cells at day 13. The specific secretory function of B-cells could be correlated with the particular structure of the intimal interstitial tissue and could account for the origin of some protein(s) of the synovial fluid.