Objective To evaluate the effect of weight-bearing time on micro-fracture therapy for small sized osteochondral lesion of the talus (OLT) by comparing early weight-bearing and postponed weight-bearing. Methods Between March 2010 and September 2011, 43 patients with small sized OLT (lt; 2 cm2) scheduled for arthroscopic micro-fracture therapy were randomly divided into early weight-bearing group (n=22) and postponed weight-bearing group (n=21). There was no significant difference in gender, age, body mass index, disease duration, disease cause, preoperative visual analogue scale (VAS) score, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score between 2 groups (P gt; 0.05). All patients of 2 groups received micro-fracture treatment under arthroscopy. Full weight bearing began under the protection of “8” figure shaped splint at immediately after operation in early weight-bearing group, and weight bearing began at 6 weeks after operation in postponed weight-bearing group. Results The size of cartilage injury was (1.24 ± 0.35) cm2 in early weight-bearing group and was (1.25 ± 0.42) cm2 in postponed weight-bearing group by arthroscopy measurement, showing no significant difference between 2 groups (t=0.09, P=0.93); and there was no significant difference in cartilage injury grading between 2 groups (Z= — 1.45, P=0.15). The follow-up time was 12-18 months (mean, 14.5 months) in 2 groups. VAS and AOFAS scores of each group at each time point after operation were all significantly improved when compared with preoperative scores (P lt; 0.05), but no significant difference was found between 2 groups at 3, 6, and 12 months after operation (P gt; 0.05). The time of returning to work in early weight-bearing group [(6.35 ± 1.93) months] was significantly shorter than that in postponed weight-bearing group [(8.75 ± 1.48) months] (t= — 4.10, P=0.00). Conclusion For patients with small sized OLT, early weight-bearing and postponed weight-bearing after micro-fracture therapy under arthroscopy have similar short-term results. But patients undergoing early weight-bearing can earlier return to work than patients undergoing postponed weight-bearing.
Objective To observe the outcome of arthroscopic meniscal plasty and suture repair to treat torn discoid lateral meniscus involving popl iteal hiatus. Methods Between January 2008 and May 2009, 21 cases of torn discoid lateral meniscus involving popl iteal hiatus were treated by arthroscopic surgery. There were 9 males and 12 females with an average ageof 22.5 years (range, 12-45 years), including 12 left knees and 9 right knees. Seven cases had the history of injury and other 14 cases had uncertain trauma. The average disease duration was 6.4 months (range, 3 months to 2 years). All patients complained knee pain or locking with positive McMurray test and mill ing test before surgery. All cases had torn discoid lateral meniscus, and the tear extended to the popl iteal hiatus, including 17 cases of complete type and 4 cases of incomplete type according to the Watanabe classification. After meniscal plasty, suture repair of torn popl iteal lateral hiatus was performed. The anterior part to hiatus was repaired by the outside-in technique, and the posterior part underwent repair of all inside technique by FasTFix. Results All wounds healed by first intention with no compl ications such as infection, stiffness of knee, or injury of common peroneal nerve. All patients were followed up 12-28 months with an average of 18 months. The symptoms of knee pain or locking disappeared postoperatively with negative McMurray test and mill ing test in all patients. The Lysholm score was improved from 54.0 ± 13.4 to 90.0 ± 6.6 at 12 months postoperatively, showing significant difference (t=— 12.00, P=0.00). Based on the improved Lysholm classification standard, the results were excellent in 14 cases, good in 5, and fair in 2; the excellent and good rate was 90.5%. Conclusion For torn discoid lateral meniscus involving popl iteal hiatus, based on meniscal plasty, suture repair of the popl iteal hiatus would contribute to preserve the peripheral part and restore its stabil ity.
Objective To study the effect of chitosan (CS) mediated insul in-l ike growth factor 1 gene (igf-1) transfection on the repair of articular cartilage defect. Methods Twelve 3-month-old healthy male rabbits weighting 2.0-2.5 kg were randomly divided into 2 primary groups, control and intervention groups (n=6 per group). Control group was further divided into normal control (left knee) and normal saline (NS) control (right knee) groups. While, intervention group was divided into CS (left knee) and CS/igf-1 intervention (right knee) groups. Cartilage defects were created in the knee joints except normalcontrol. Intra-articular injections of CS/igf-1 complex was administrated 2 times a week for 4 weeks in CS/igf-1 interventiongroup, 0.5 mL CS in CS intervention group, and 0.5 mL sal ine solution in normal control and sal ine control groups. At 28days after treatments, the cartilage samples were collected for histological observation and collagen type II and aggrecan mRNA evaluation. Results HE staining and toluidine blue staining revealed that CS/igf-1 and CS intervention could significantly stimulated cartilage regeneration accompanied with fibrosis and inflammatory cell infiltration, however, CS/igf-1 treatment resulted in the best repair of cartilage defect. In contrast, sal ine control group only showed fibrous tissue prol iferation and inflammatory cell infiltration without significant cartilage repairing. In terms of collagen type II and aggrecan gene expression, significant differences were observed in each pairwised comparison among 4 groups in the order of CS/igf-1 gt; CS gt; NS gt; normal control (P lt; 0.05). Conclusion In situ CS/ifg-1 complex transfection can enhance the formation of mesochondrium by upregulating collagen type II or aggrecan expression, which might enhance the repair of articular cartilage defect.
ObjectiveTo investigate the clinical efficacy of glucosamine hydrochloride tablets in treating knee cartilage injury resulting from rheumatoid arthritis. MethodsWe selected 200 knee cartilage injury patients with rheumatoid arthritis treated in our hospital from January 2011 to January 2015 as the research subjects. They were divided into control group (n=98) and observation group (n=102) according to the time of admission. The control group was treated with conventional disease modifying anti-rheumatic drugs (DMARDs), while the observation group was treated with glucosamine hydrochloride tablets on the basis of DMARDs. The treatment effect was evaluated and compared between the two groups of patients 18, 36 and 54 weeks after the treatment. ResultsFifty-four weeks later, knee pain score of the observation group was better than that of the control group, and the difference was statistically significant (P ＜ 0.05) . The observation group had a lower Noyes evaluation level than the control group, and the difference was statistically significant (P ＜ 0.05) . Adverse reaction in the observation group was 3.92% and it was 3.06% in the control group, and the difference between the two groups was not statistically significant (P ＞ 0.05) . ConclusionGlucosamine hydrochloride tablets combined with conventional anti-rheumatic treatment is effective for knee cartilage injury caused by rheumatoid arthritis, which can promote cartilage repair, and it is worthy of clinical application.
ObjectiveTo observe and study the clinical effect of glucosamine in the treatment of patients with knee articular cartilage injury caused by rheumatoid arthritis. MethodsForty-six patients with knee articular cartilage injury caused by rheumatoid arthritis treated from January 2013 to June 2015 were selected as the research subjects, and they were randomly divided into control group (conventional treatment group, n=23) and observation group (conventional and glucosamine treatment group, n=23) . Then the Noyes classification and serum articular cartilage injury related indexes [cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-1, MMP-3 and mouse tissue inhibitors of metalloproteinase (TIMP)-1], inflammatory indexes [tumor necrosis factor (TNF)-α, interleukin (IL)- 17 and IL-33] of the two groups before and after treatment were compared. ResultsIn the observation group, after treatment for 4, 8 and 12 weeks, Noyes grade was better than that in the control group, but with no statistical significance (P ＞ 0.05) . In the observation group, after treatment for 4, 8 and 12 weeks, serum inflammatory markers serum COMP, MMP-1, MMP-3 and TIMP-1 and other related indicators of cartilage damage and serum TNF-α, IL-17 and IL-33 were all significantly lower than those in the control group (P ＜ 0.05) . ConclusionIn the treatment of patients with knee articular cartilage injury caused by rheumatoid arthritis, glucosamine has active role for the improvement of articular cartilage injury and inflammatory stress state of patients.
ObjectiveTo review the current treatment status of osteochondral defects (OCD) of the knee joint. MethodsRecent literature concerning treatment of OCD of the knee joint was extensively reviewed and summarized. ResultsOCD affect both the articular cartilage and the underlying subchondral bone, whereas OCD caused by different etiologies require various treatments. OCD repair is available by conventional clinical methods or the advanced tissue engineering strategies. Current clinical treatment outcomes remain uncertain; tissue engineering has emerged as a potential option as it can be efficiently applied to regenerate bone, cartilage, and the bone-cartilage interface, as well as effectively restore normal function and mechanical properties of the cartilage and subchondral bone. ConclusionOCD management and repair remain a great challenge in orthopedic surgery, thus cartilage and subchondral bone should be promoted as an interdependent functional unit considering treatment strategies to provide the best solution for the treatment of osteochondral defects.
ObjectiveTo investigate the effectiveness of arthroscopic bipolar radiofrequency energy (bRFE) and lateral partial meniscectomy for lateral meniscus tear and cartilage lesion. MethodsBetween January 2011 and December 2012, 40 eligible patients with lateral meniscus tear and cartilage injury in the lateral knee compartment underwent arthroscopic treatment, and the clinical data were analysed retrospectively. There were 21 males and 19 females, aged 15-65 years (mean, 42.1 years). The left knee was involved in 22 cases and the right knee in 18 cases. The causes of injury included sport injuries in 5 cases and sprain of knee joints in 8 cases, the remaining patients had no history of trauma. The disease duration ranged from 1 month to 10 years (median, 10 months). The Lysholm score and Japanese Orthopaedic Association (JOA) score of the knee were 59.9±8.2 and 69.6±5.3. According to the Outerbridge classification, 2 cases were rated as grade I, 21 cases as grade II, 17 cases as grade III, and 10 cases as grade IV. The scores described by Noyes were 1-16 (mean, 6.52). The Noyes scores were from 1 to 6 points in 20 patients (group A) and 7 to 16 points in 20 patients (group B). During surgery, all patients underwent partial meniscectomy, and radiofrequency-based chondroplasty was used. Knee joint function was assessed using the Lysholm score and JOA score of the knee, and the clinical outcomes between different degrees of cartilage lesions were also compared. ResultsAll incisions healed primarily without complication. All the patients were followed up 8-31 months (mean, 18.1 months). The Lysholm and JOA scores of the knee at last follow-up (92.2±7.2 and 92.9±7.9, respectively) were significantly higher than those at preoperation (P<0.05). There was no significant difference in preoperative Lysholm and JOA scores of the knee between groups A and B (P>0.05), but significance difference was found between 2 groups at last follow-up (P<0.05). ConclusionArthroscopic bRFE and lateral partial meniscectomy have good effectiveness in treating lateral meniscus tear and cartilage lesion. The effectiveness is better in patients with mild cartilage lesion than in patients with severe cartilage lesion.
ObjectiveTo investigate the effect of phosphorylatable short peptide (pSP) conjugated chitosan (CS) (pSP-CS) mediated insul in-l ike growth factor 1 (IGF-1) gene and human interleukin 1 receptor antagonist (IL-1Ra) gene local transfection on the repair of articular cartilage defect. MethodsCo-expression plasmid pBudCE4.1-IL-1Ra+IGF-1, single gene expression plasmid pBudCE4.1-IL-1Ra and pBudCE4.1-IGF-1 were constructed and combined with pSP-CS to form pSP-CS/ pDNA complexes. Thirty 3-month-old healthy male New Zealand white rabbits, weighing 2.0-2.5 kg, double legs were randomly divided into 5 groups (n=12). Lateral femoral condyle articular surface was only exposed in sham-operated group (group A); full-thickness cartilage defects were created in the articular surface of the lateral femoral condyle of the knee in 4 intervention groups: pSP-CS/pBudCE4.1 (group B), pSP-CS/pBudCE4.1-IL-1Ra (group C), pSP-CS/pBudCE4.1-IGF-1(group D), and pSPCS/ pBudCE4.1-IL-1Ra+IGF-1 (group E). At 1 week after operation, intra-articular injection of pSP-CS/pDNA complexes was administrated 2 times a week for 7 weeks in each intervention group, the same volume normal sal ine in group A. The general condition of animal was observed after operation, and rabbits were sacrificed at 8 weeks. Knee joint synovial fluid was collected to measure the concentrations of the IL-1Ra and IGF-1 by ELISA; mRNA expressions of Aggrecan, matrix metalloproteinase 3 (MMP-3), and MMP inhibitor 1 (TIMP-1) were detected by real-time fluorescent quantitative PCR; the chondrogenic phenotype of nascent cells in the damage zone was identified by alcian blue-periodic acid/schiff (AB-PAS) histochemistry and Aggrecan immunohistochemistry staining. ResultsThirty experimental rabbits all survived to the end of experiment, without infection and death. Large amounts of exogenous proteins of IGF-1 and IL-1Ra were detected in the synovial fluid of 4 intervention groups. There were significant differences between groups D, E and group A in IGF-1 protein expression, and between goups C, E and group A in IL-1Ra protein expression (P < 0.05). Aggrecan and TIMP-1 mRNA expressions were significantly up-regulated in group E, simultaneously MMP-3 mRNA expression was significantly down-regulated when compared with groups C and D (P < 0.05). Varying degrees of cartilage repair appeared in groups C, D, and E, showing positive staining of AB-PAS and Aggrecan, and group E had better results than groups C and D (P < 0.05); inflammatory cell infiltration and fibrous tissue prol iferation were seen in the defect region of group B, without significant cartilage repairing. ConclusionpSP-CS is an ideal gene del ivery system for cartilage defect gene therapy; IL-1Ra and IGF-1 double gene transfection has better biologic effect on cartilage defect repair.
ObjectiveTo compare the incidence of chondral injury using Rigidfix femoral fixation device via the anteromedial approach and the tibial tunnel approach during anterior cruciate ligament (ACL) reconstruction. MethodsEighteen adult cadaver knees were divided randomly into 2 groups, 9 knees in each group. Femoral tunnel drilling and cross-pin guide insertions were performed using the Rigidfix femoral fixation device through the anteromedial approach (group A) and the tibial tunnel approach (group B). ACL reconstruction simulation was performed at 0, 10, 20, 30, 45, 60, 70, 80, and 90°in the horizontal position. The correlation between incidence of chondral injury and slope angles was analyzed, and then the incidence was compared between the 2 groups. ResultsThe correlation analysis indicated that the chondral injury incidence increased with the increasing of the slope angle (r=0.611, P=0.000; r=0.852, P=0.000). The incidence of chondral injury was 69.1% (56/81) and 48.1% (39/81) in groups A and B respectively, showing significant difference (χ2=7.356, P=0.007). The sublevel analysis showed that the chondral injury incidence of group A (36.1%, 13/36) was significantly higher than that of group B (0) at 0-30°(χ2=15.864, P=0.000), but no significant difference was found between group A (95.6%, 43/45) and group B (86.7%, 39/45) at 45-90°(P=0.267). ConclusionIt has more risk of chondral injury to use Rigidfix femoral fixation device via the anteromedial approach than the tibial tunnel approach to reconstruct ACL.