Anterior cruciate ligament intactness in osteoarthritic patients indicated for total knee arthroplasty: a systematic literature review and meta-analysis.

Bi-cruciate retaining total knee arthroplasty (BCR TKA) is thought to result in more natural knee kinematics compared to conventional TKA designs. This may lead to a reduction in dissatisfied patients after TKA. An intact anterior cruciate ligament (ACL) is a prerequisite for implantation of a BCR TKA but the frequency of an intact ACL in patients indicated for TKA is not well known. The objective of this systematic literature review was to determine the presence of an intact ACL in patients undergoing TKA by intraoperative macroscopic or MRI assessment. A systematic literature review was conducted using PubMed™ and EMBASE™ in June 2020. The ACL of patients with knee osteoarthritis (OA) undergoing TKA was classified as present (including intact and degenerated) vs. absent, and as intact vs. not fully intact. Proportional meta-analyses were performed. 2840 articles were identified and screened. 135 full texts were analyzed and 18 studies met the inclusion criteria for subsequent qualitative and quantitative meta-analysis. Analysis of the status of the ACL when assessed intraoperatively during TKA showed that the ligament was present in 79.4% of patients (CI: 73.5-84.3%), from 14 studies with 2067 cases studied. The ACL was determined to be intact in 55.0% of patients (CI: 45.3-64.4%), from 14 studies with 1916 cases. Preoperative ACL assessment using MRI (2 studies) revealed it was present in 82.9% of 193 cases (CI: 76.9-87.6%), and intact in 56.8% of 176 cases (CI: 8.2-94.7%). This systematic literature review shows that the ACL is macroscopically intact in more than half of patients with knee OA undergoing TKA, based on intraoperative assessment of the ligament. The results suggest BCR TKA may be considered as an alternative to traditional TKA in a large number of TKA patients. More high-quality studies are needed to better understand the functional status of the ACL in TKA patients.Level of evidence III.

Gene expression and metabolic response of bovine oviduct epithelial cells to the early embryo.

During its journey through the oviduct, the bovine embryo may induce transcriptomic and metabolic responses, via direct or indirect contact, from bovine oviduct epithelial cells (BOECs). An in vitro model using polyester mesh was established, allowing the study of the local contact during 48 h between a BOEC monolayer and early embryos (2- or 8-cell stage) or their respective conditioned media (CM). The transcriptomic response of BOEC to early embryos was assessed by analyzing the transcript abundance of SMAD6, TDGF1, ROCK1, ROCK2, SOCS3, PRELP and AGR3 selected from previous in vivo studies and GPX4, NFE2L2, SCN9A, EPSTI1 and IGFBP3 selected from in vitro studies. Moreover, metabolic analyses were performed on the media obtained from the co-culture. Results revealed that presence of early embryos or their CM altered the BOEC expression of NFE2L2, GPX4, SMAD6, IGFBP3, ROCK2 and SCN9A. However, the response of BOEC to two-cell embryos or their CM was different from that observed to eight-cell embryos or their CM. Analysis of energy substrates and amino acids revealed that BOEC metabolism was not affected by the presence of early embryos or by their CM. Interestingly, embryo metabolism before embryo genome activation (EGA) seems to be independent of exogenous sources of energy. In conclusion, this study confirms that early embryos affect BOEC transcriptome and BOEC response was embryo stage specific. Moreover, embryo affects BOEC via a direct contact or via its secretions. However transcriptomic response of BOEC to the embryo did not manifest as an observable metabolic response.