Background and objectiveThe treatment for symptomatic meniscus-deficient knees with cartilage defects remains challenging on account of insufficient meniscal substitutes. One solution for this might ...involve combining meniscal allograft transplantation (MAT) and cartilage repair. In this study, we aimed to analyze the effectiveness and safety of MAT concomitant with cartilage repair for symptomatic lateral meniscus-deficient knees in a setting with limited availability of meniscal transplants in Japan.MethodsNine patients who underwent MAT concomitant with osteochondral transplantation (five) and/or autologous chondrocyte implantations (seven) were followed up for at least two years (mean: 51.2 months, range: 24-84 months). Their demographic data and other characteristics were as follows - mean age: 51.7 years, range: 36-67 years; men/women: 4/5; cause: trauma/discoid meniscus: 8/1; cartilage defect size: mean: 6.7 cm2/knee, range: 1.0-11.3. The effectiveness and safety were evaluated clinically by using the Lysholm Knee Scoring Scale (LKSS) and Japanese Orthopaedic Association (JOA) knee score, physical examination, X-rays, and MRI preoperatively and at one, 12, and 24 months after the implantation. Differences between the variables were analyzed using the Friedman test and Scheffe's multiple comparisons.ResultsThe median LKSS and JOA scores significantly improved from 70 points (range: 21-80) and 35 (25-45) preoperatively to 86.5 (65-98) and 87.5 (80-95) at 24 months after surgery, respectively (p<0.001, p=0.0013). The range of motion (ROM), femorotibial angle, and the lateral joint space showed no significant changes. However, lateral meniscal extrusions (LMEs) increased by 3.0 mm (range: 0-6.3 mm) at one month postoperatively and remained unchanged until two years postoperatively. Treatment failure occurred in one case, which was revised by total knee arthroplasty (TKA) at 18 months postoperatively. Additional surgeries were needed in some cases: lateral meniscal tear (three cases), contracture (two cases), and patellar instability (one case). However, neither infection nor allergic reaction was observed in the blood exams.ConclusionsAlthough MAT concomitant with cartilage repair showed good clinical outcomes, half of the cases needed additional surgeries. Based on our findings, this technique should be adopted only in select cases and performed by a handful of highly experienced surgeons.
We present a ‘Windswept deformity’ in patient who had osteoarthritis with a mild varus and very severe valgus with ipsilateral permanent patellar dislocation. An 83-year-old woman could not walk for ...the past a few years due to bilateral knee pain. The femorotibial angle was 196° in the right knee pre-operatively and 134° in the left knee with permanent patellar dislocation. She underwent a staged total knee arthroplasty (TKA) for the right knee, and a semi-constrained TKA for the left knee with medial patellofemoral ligament (MPFL) augmentation using a Leeds-Keio (LK) ligament. At the final follow-up three years after surgery, bilateral knee pain and the extension lag had disappeared and range of motion (ROM) was 0° in extension and 130° in flexion for both knees without patellar re-dislocation. This clinical case indicates that the unconstrained and semi-constrained type of TKA combined with the MPFL augmentation using an LK ligament is effective to treat a ‘Windswept deformity’.
Sarcopenia is a common skeletal muscle disease in older people. Lower limb muscle strength is a good predictive value for sarcopenia; however, little is known about its genetic components. Here, we ...conducted a genome-wide association study (GWAS) for knee extension strength in a total of 3452 Japanese aged 60 years or older from two independent cohorts. We identified a significant locus, rs10749438 which is an intronic variant in TACC2 (transforming acidic coiled-coil-containing 2) (P = 4.2 × 10
). TACC2, encoding a cytoskeleton-related protein, is highly expressed in skeletal muscle, and is reported as a target of myotonic dystrophy 1-associated splicing alterations. These suggest that changes in TACC2 expression are associated with variations in muscle strength in older people. The association was consistently observed in young and middle-aged subjects. Our findings would shed light on genetic components of lower limb muscle strength and indicate TACC2 as a potential therapeutic target for sarcopenia.
Vertebral spondylitis is difficult to diagnose and is often treated as fever of unknown origin. We encountered a 46-year-old man with complaints of fever and back pain. He had costovertebral angle ...tenderness on percussion and elevated inflammatory markers on blood biochemistry; he was suspected to have urinary tract infection. A likely cause of fever, such as pyelonephritis, was elusive on non-contrast chest/abdomen/pelvis computed tomography and subsequent contrast computed tomography and magnetic resonance imaging. Specialist radiology review was suggestive of vertebral spondylitis. Physical reexamination revealed numbness and muscle weakness consistent with the location of the lesions. Conservative antibiotic treatment was initiated. Septic right knee joint was also suspected, and arthroscopic washout with debridement was urgently performed. Inflammatory markers improved on conservative antibiotic treatment. In emergency settings, thorough physical examination and coordination between medical specialists is crucial.
The optimal surgical procedure to address both anterior cruciate ligament (ACL) deficiency and medial compartment osteoarthritis (OA) has been controversial.
A 49-year-old woman with a 30-year ...history of chronic anterior cruciate ligament (ACL) deficiency, medial compartment osteoarthritis, and varus deformity presented with medial knee pain and apprehension with walking and playing soccer. Her preoperative range of motion was from 0° of extension to 135° of flexion. The anterior drawer sign (1+), Lachman test (1+), and pivot shift test (glide) were positive before surgery, as measured by the International Knee Documentation Committee knee examination form. The patient underwent simultaneous arthroscopic ACL single-socket and single-bundle reconstruction using hamstring tendons, dome-shaped high tibial osteotomy using the TomoFix fixation device, and mosaicplasty to the medial condyle. The standing femorotibial angle changed from 185° preoperatively to 172° postoperatively. Range of motion exercises were started 1 week after surgery, and partial weight bearing was allowed 2 weeks after surgery. The patient returned to her baseline physical level 2 years after the operation. Range of motion was –10° of extension and 130° of flexion, and the anterior drawer sign, Lachman test, and pivot shift test were all negative at the final 3-year follow-up.
An ACL reconstruction combined with a dome-shaped high tibial osteotomy using a locking plate is one option for treating an aged athlete with ACL deficiency and severe medial compartment osteoarthritis, and can allow the athlete to return to sports activity.
Osteoarthritis affects over 300 million people worldwide. Here, we conduct a genome-wide association study meta-analysis across 826,690 individuals (177,517 with osteoarthritis) and identify 100 ...independently associated risk variants across 11 osteoarthritis phenotypes, 52 of which have not been associated with the disease before. We report thumb and spine osteoarthritis risk variants and identify differences in genetic effects between weight-bearing and non-weight-bearing joints. We identify sex-specific and early age-at-onset osteoarthritis risk loci. We integrate functional genomics data from primary patient tissues (including articular cartilage, subchondral bone, and osteophytic cartilage) and identify high-confidence effector genes. We provide evidence for genetic correlation with phenotypes related to pain, the main disease symptom, and identify likely causal genes linked to neuronal processes. Our results provide insights into key molecular players in disease processes and highlight attractive drug targets to accelerate translation.
Display omitted
•A multicohort study identifies 52 previously unknown osteoarthritis genetic risk variants•Similarities and differences in osteoarthritis genetic risk depend on joint sites•Osteoarthritis genetic components are associated with pain-related phenotypes•High-confidence effector genes highlight potential targets for drug intervention
A multicohort genome-wide association meta-analysis of osteoarthritis highlights the impact of joint site types on the features of genetic risk variants and the link between osteoarthritis genetics and pain-related phenotypes, pointing toward potential targets for therapeutic intervention.
BACKGROUND:Longitudinal changes in patellar stiffness following reconstruction of the medial patellofemoral ligament for recurrent patellar dislocation at full extension are unknown.
METHODS:Fifteen ...consecutive patients (three men and twelve women, with a mean age of twenty-two years) with seventeen knees were matched by sex and age to thirty-two reference subjects in this prospective study. The follow-up period was a minimum of twenty-four months. The medial patellofemoral ligament reconstruction used an autograft semitendinosus tendon and an interference screw system with or without lateral release under 10 N of laterally directed force. The medial patellar stiffness and lateral patellar stiffness were measured in 0° of knee extension using the Patella Stability Tester preoperatively; postoperatively at three, six, twelve, and eighteen months; and at the time of the latest follow-up. Before and after the surgical procedure, patients were evaluated for apprehension and Kujala and Lysholm scores; radiographic examinations were performed to evaluate changes, including osteoarthritic changes.
RESULTS:The medial stiffness of the affected side before the surgical procedure was significantly lower than the lateral stiffness (p = 0.004) and the stiffness for healthy reference knees (p = 0.004). Medial stiffness three months after the surgical procedure was significantly elevated compared with lateral values (p = 0.027), preoperative values (p < 0.001), and reference group values (p = 0.002); reached the reference level by six months; and was maintained for up to two years. Furthermore, medial stiffness and lateral stiffness were well balanced after six months and this balance was sustained for up to two years postoperatively. No recurrent dislocation occurred during the follow-up period; one patient experienced apprehension. Postoperative radiographic findings and clinical scores were significantly improved at the time of the latest follow-up (p < 0.05). One knee progressed to patellofemoral osteoarthritis.
CONCLUSIONS:The value for medial stiffness was significantly improved three months after medial patellofemoral ligament reconstruction compared with the preoperative and lateral values and returned to the reference level by six months. Medial stiffness and lateral stiffness of the patella were well balanced by six months and retained that balance for up to two years, with good clinical results.
LEVEL OF EVIDENCE:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
A 70-year-old woman had suffered from right knee pain without any history of trauma or infection for 30 years. The pseudoanterior drawer sign was positive, as were posterior sagging and the posterior ...drawer sign. Radiographic findings identified the Kellgren-Lawrence grade as 4. We performed total knee arthroplasty (TKA) under the method of first using the cutting guide to make a posterior condylar cut, the size of which was bigger than that of the implant. This technique was very useful to cut the tibia side in this case because the neurovascular bundle was very close to the posterior tibial margin. Good clinical and radiographic outcomes were observed without any complications at one year after TKA. INTRODUCTION Although total knee arthroplasty (TKA) has become a common procedure in treating knee joint diseases, there are some trouble cases undergoing severely deformity1, 2. In addition, posterior tibial sagging case with osteoarthritis treated by TKA was rare. Here we present this case treated by TKA regarding the technical tips. We obtained the informed consent from the patient before publication this case. CASE REPORT The patient was a 70-year-old woman who had suffered from right knee pain for 30 years.
PDF
