Improvement of clinical and radiological outcomes of root repair patients with advanced articular cartilage degeneration and osteoarthritis

Abstract Purpose The main purpose of this study was to investigate clinical and radiological outcomes of medial meniscus posterior root tear (MMPRT) repair in knees with advanced articular cartilage degeneration and osteoarthritis compared to those with minimal degenerative change. Methods Thirty-three knees underwent MMPRT repair using an arthroscopic pullout repair tibial tunnel technique. Clinical scores including Lysholm Score, International Knee Documentation Committee (IKDC) Score and Knee injury and Osteoarthritis Outcome (KOOS) Score were collected preoperatively and sequentially at 6 months, 12 months and mean final follow-up of 39.4 months. Kellgren-Lawrence (K-L) osteoarthritis grade, Outerbridge classification of cartilage degeneration and the presence of bone marrow oedema on MRI were also evaluated. Results All clinical scores improved at final follow-up for knees with K-L grade ≥ 2 osteoarthritis (p < 0.001), with no significant difference compared to K-L 0/1. Patients with Outerbridge class 3/4 cartilage degeneration also reported improvements in clinical scores, albeit lower than those with class 2 degeneration (p < 0.05). During recovery, the majority of patients reported clinical improvements by 6 months, and six patients further improved by at least 15 points in IKDC score between 6 and 12 months. Osteoarthritis progressed in 10 of 31 knees (32%), with an overall mean pre-operative K-L grade of 1.6 ± 0.9 compared to 2.0 ± 0.9 at final follow-up (n.s.). No knees progressed to K-L 4 or underwent re-operation. Pre-operative bone marrow oedema was present in 17 knees (52%), all of which had signal localised to the medial tibia or femur. Oedema had resolved in all but 5 knees post-operatively (p < 0.01). Conclusion Arthroscopic repair of medial meniscus posterior root tears is associated with improved outcomes in knees with advanced cartilage degeneration and osteoarthritis. Meaningful improvements in clinical outcomes can be achieved beyond 6 months, thus success of the operation is best determined at the 12-month mark. Oedema signal significantly improved post-operatively, however a relatively high proportion of knees had K-L progression. Level of evidence IV – Case Series.

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Comparison of Clinical Efficacy Between Arthroscopically Assisted Gracilis Autograft With Suture Reinforcement Technique and Transtibial Pull-out Technique in Treating Medial Meniscus Posterior Root Tears

10.21203/rs.3.rs-942318/v1 ◽

2021 ◽

Author(s):

Si Si Nie ◽

Hongbo Li ◽

Jianyin He ◽

Guanxiang Liao ◽

Xuelei Ke ◽

...

Keyword(s):

Medial Meniscus ◽

Lysholm Score ◽

Reconstruction Technique ◽

Posterior Root ◽

Vas Score ◽

Pull Out ◽

Meniscal Root ◽

Meniscus Healing ◽

Ikdc Score

Abstract Background: To compare the short-term efficacy of the transtibial pull-out technique and gracilis autograft with suture reinforcement technique in the treatment of medial meniscus posterior root tears. Methods: A total of 64 patients with medial meniscus posterior root tears received reconstruction of the posterior root of the meniscus attachment point through the tibial tunnel between June 2018 and April 2019 were included in this study, patients were divided into 2 groups (transtibial pull-out technique group: 35 cases; gracilis autograft with suture reinforcement technique group: 29 cases) according to the different posterior meniscus root tear repair methods. Clinical outcomes were evaluated by the visual analogue scale (VAS) and Lysholm score and IKDC score, and the demographics and functional recovery of the knee were compared between the two groups.Results: Intraoperative and postsurgical complications such as infection were not found in the two groups, and there was a statistically significant improvement in the Lysholm score，IKDC score and VAS score (P<0.001; respectively). All the patients were very satisfied with the function of their knee at the last follow-up. However, compared with the transtibial pull-out repair group, the reinforced medial meniscal root reconstruction technique with gracilis autograft group were significant improvement in the meniscus healing rates and Lysholm score, IKDC score and VAS score at the end of follow-up (P<0.05; respectively).Conclusions: Compared with the transtibial pull-out technique, the reinforced medial meniscal root reconstruction technique with gracilis autograft is advantageous for treating these patients because it is a minimally invasive procedure with superior clinical outcome and meniscus healing rates.Levels of Evidence: Ⅲ, Case-control study Retrospective comparative study

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The Effect of Total Meniscectomy versus Caudal Pole Hemimeniscectomy on the Stifle Joint of the Sheep

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632463 ◽

1999 ◽

Vol 12 (02) ◽

pp. 56-63 ◽

Cited By ~ 5

Author(s):

C. R. Bellenger ◽

P. Ghosh ◽

Y. Numata ◽

C. Little ◽

D. S. Simpson

Keyword(s):

Tissue Culture ◽

Articular Cartilage ◽

Fibrous Tissue ◽

Cartilage Degeneration ◽

Medial Compartment ◽

Proteoglycan Synthesis ◽

Stifle Joint ◽

Medial Meniscectomy ◽

Tibial Condyle ◽

Articular Cartilage Degeneration

SummaryTotal medial meniscectomy and caudal pole hemimeniscectomy were performed on the stifle joints of twelve sheep. The two forms of meniscectomy produced a comparable degree of postoperative lameness that resolved within two weeks of the operations. After six months the sheep were euthanatised and the stifle joints examined. Fibrous tissue that replaced the excised meniscus in the total meniscectomy group did not cover as much of the medial tibial condyle as the residual cranial pole and caudal fibrous tissue observed following hemimeniscectomy. The articular cartilage from different regions within the joints was examined for gross and histological evidence of degeneration. Analyses of the articular cartilage for water content, glycosaminoglycan composition and DNA content were performed. The proteoglycan synthesis and release from explanted articular cartilage samples in tissue culture were also measured. There were significant pathological changes in the medial compartment of all meniscectomised joints. The degree of articular cartilage degeneration that was observed following total meniscectomy and caudal pole meniscectomy was similar. Caudal pole hemimeniscectomy, involving transection of the meniscus, causes the same degree of degeneration of the stifle joint that occurs following total meniscectomy.The effect of total medial meniscectomy versus caudal pole hemimeniscectomy on the stifle joint of sheep was studied experimentally. Six months after the operations gross pathology, histopathology, cartilage biochemical analysis and the rate of proteoglycan synthesis in tissue culture were used to compare the articular cartilage harvested from the meniscectomised joints. Degeneration of the articular cartilage from the medial compartment of the joints was present in both of the groups. Caudal pole hemimeniscectomy induces a comparable degree of articular cartilage degeneration to total medial meniscectomy in the sheep stifle joint.

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Comment on Medial Meniscus Scaffold Implantation in Combination with Concentrated Bone Marrow Aspirate Injection: Minimum 3-Year Follow-Up

The Journal of Knee Surgery ◽

10.1055/s-0040-1721037 ◽

2020 ◽

Author(s):

Mingjin Zhong ◽

Wei Lu ◽

Weimin Zhu

Keyword(s):

Bone Marrow ◽

Medial Meniscus ◽

Bone Marrow Aspirate ◽

Concentrated Bone Marrow

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MOLECULAR CONTROL OF ARTICULAR CARTILAGE DEGENERATION BY TRANSFORMING GROWTH FACTOR ALPHA

Clinical & Investigative Medicine ◽

10.25011/cim.v31i4.4787 ◽

2008 ◽

Vol 31 (4) ◽

pp. 2

Author(s):

Tom Appleton ◽

Shirine Usmani ◽

John Mort ◽

Frank Beier

Keyword(s):

Gene Expression ◽

Articular Cartilage ◽

Growth Factor ◽

P38 Mapk ◽

Transforming Growth Factor ◽

Cartilage Degeneration ◽

Signalling Pathways ◽

Transforming Growth Factor Alpha ◽

Factor Alpha ◽

Articular Cartilage Degeneration

Background: Articular cartilage degeneration is a hallmark of osteoarthritis (OA). We previously identified increased expression of transforming growth factor alpha (TGF?) and chemokine (C-C motif) ligand 2 (CCL2) in articular cartilage from a rat modelof OA (1,2). We subsequently reported that TGF? signalling modified chondrocyte cytoskeletal organization, increased catabolic and decreased anabolic gene expression and suppressed Sox9. Due to other roles in chondrocytes, we hypothesized that the effects ofTGF? on chondrocytes are mediated by Rho/ROCK and MEK/ERK signaling pathways. Methods: Primary cultures of chondrocytes and articularosteochondral explants were treated with pharmacological inhibitors of MEK1/2(U0126), ROCK (Y27632), Rho (C3), p38 MAPK (SB202190) and PI3K (LY294002) to elucidate pathway involvement. Results: Using G-LISA we determined that stimulation of primary chondrocytes with TGF? activates RhoA. Reciprocally, inhibition of RhoA/ROCK but not other signalling pathways prevents modification of the actin cytoskeleton in responseto TGF?. Inhibition of MEK/ERKsignaling rescued suppression of anabolic gene expression by TGF? including SOX9 mRNA and protein levels. Inhibition of MEK/ERK, Rho/ROCK, p38 MAPK and PI3K signalling pathways differentially controlled the induction of MMP13 and TNF? gene expression. TGF? also induced expression of CCL2 specifically through MEK/ERK activation. In turn, CCL2 treatment induced the expression of MMP3 and TNF?. Finally, we assessed cartilage degradation by immunohistochemical detection of type II collagen cleavage fragments generated by MMPs. Blockade of RhoA/ROCK and MEK/ERK signalling pathways reduced the generation of type IIcollagen cleavage fragments in response to TGF? stimulation. Conclusions: Rho/ROCK signalling mediates TGF?-induced changes inchondrocyte morphology, while MEK/ERK signalling mediates the suppression ofSox9 and its target genes, and CCL2 expression. CCL2, in turn, induces the expression of MMP3 and TNF?, two potent catabolic factors known to be involved in OA. These pathways may represent strategic targets for interventional approaches to treating cartilage degeneration in osteoarthritis. References: 1. Appleton CTG et al. Arthritis Rheum 2007;56:1854-68. 2. Appleton CTG et al. Arthritis Rheum 2007; 56:3693-705.

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Senolytic Drugs Attenuate Osteoarthritis-Related Articular Cartilage Degeneration: A Clinical Trial

Case Medical Research ◽

10.31525/ct1-nct04210986 ◽

2019 ◽

Author(s):

Keyword(s):

Clinical Trial ◽

Articular Cartilage ◽

Cartilage Degeneration ◽

Articular Cartilage Degeneration

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Faculty Opinions recommendation of Articular cartilage degeneration following the treatment of focal cartilage defects with ceramic metal implants and compared with microfracture.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1162289.622777 ◽

2009 ◽

Author(s):

Anthony Ratcliffe

Keyword(s):

Articular Cartilage ◽

Cartilage Degeneration ◽

Cartilage Defects ◽

Metal Implants ◽

Articular Cartilage Degeneration

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Early patellofemoral articular cartilage degeneration in a rat model of patellar instability is associated with activation of the NF-κB signaling pathway

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03965-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Wei Lin ◽

Huijun Kang ◽

Yike Dai ◽

Yingzhen Niu ◽

Guangmin Yang ◽

...

Keyword(s):

Articular Cartilage ◽

Signaling Pathway ◽

Subchondral Bone ◽

Patellofemoral Joint ◽

Patellar Instability ◽

Cartilage Degeneration ◽

Control Group ◽

And Control ◽

Articular Cartilage Degeneration ◽

And Cartilage

Abstract Background Patellar instability (PI) often increases the possibility of lateral patellar dislocation and early osteoarthritis. The molecular mechanism of early articular cartilage degeneration during patellofemoral osteoarthritis (PFOA) still requires further investigation. However, it is known that the NF-κB signaling pathway plays an important role in articular cartilage degeneration. The aim of this study was to investigate the relationship between the NF-κB signaling pathway and patellofemoral joint cartilage degeneration. Methods We established a rat model of PI-induced PFOA. Female 4-week-old Sprague-Dawley rats (n = 120) were randomly divided into two groups: the PI (n = 60) and control group (n = 60). The distal femurs of the PI and control group were isolated and compared 4, 8, and 12 weeks after surgery. The morphological structure of the trochlear cartilage and subchondral bone were evaluated by micro-computed tomography and histology. The expression of NF-κB, matrix metalloproteinase (MMP)-13, collagen X, and TNF-ɑ were evaluated by immunohistochemistry and quantitative polymerase chain reaction. Results In the PI group, subchondral bone loss and cartilage degeneration were found 4 weeks after surgery. Compared with the control group, the protein and mRNA expression of NF-κB and TNF-ɑ were significantly increased 4, 8, and 12 weeks after surgery in the PI group. In addition, the markers of cartilage degeneration MMP-13 and collagen X were more highly expressed in the PI group compared with the control group at different time points after surgery. Conclusions This study has demonstrated that early patellofemoral joint cartilage degeneration can be caused by PI in growing rats, accompanied by significant subchondral bone loss and cartilage degeneration. In addition, the degeneration of articular cartilage may be associated with the activation of the NF-κB signaling pathway and can deteriorate with time as a result of PI.

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Effect of Remnant-Preserving Reconstruction of Acute Anterior Cruciate Ligament Injuries in a Rabbit Model: Histological and Biomechanical Analysis

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2022.2992 ◽

2022 ◽

Vol 12 (5) ◽

pp. 897-906

Author(s):

XiaoChen Ju ◽

Hao Chai ◽

Sasirekha Krishnan ◽

Abinaya Jaisankar ◽

Murugan Ramalingam ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Articular Cartilage ◽

Acl Reconstruction ◽

Bone Healing ◽

Cruciate Ligament ◽

Cartilage Degeneration ◽

Remnant Preservation ◽

Model Animal ◽

Anterior Cruciate ◽

Articular Cartilage Degeneration

Acute anterior cruciate ligament (ACL) is a key structure that stabilizes knee joints. The objective of this research is to investigate the influence of ligament remnants preserved on the tendon-bone healing following ACL reconstruction and to examine postoperative articular cartilage degeneration in rabbit as a model animal. Sixty New Zealand rabbits are randomly divided into an ACL reconstruction without remnant preservation group (Group A; n = 30) or ACL reconstruction with remnant preservation group (Group B; n = 30). The expression of HIF-1α, VEGF, and micro vessel density (MVD) in the transplanted tendon was detected by immunohistochemical staining at week 6 and 12 after the operation. The signal intensity of the transplanted tendon was observed by MRI scanning, and the width of the bone tunnel was measured by CT scanning at week 6 and 12 after the operation. The graft biomechanics was tested 12 weeks after the operation. The JNK and MMP-13 expression levels were compared to analyze the cartilage degeneration of the knee at week 12 after the operation. The experimental results were analyzed and showed that the remnant-preserving ACL reconstruction is beneficial for bone healing of the tendon in rabbits, but ACL reconstruction with or without ligament remnants preserved will not affect knee articular cartilage degeneration post-surgery.

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