Subchondral Bone Microarchitectural and Mineral Properties and Expression of Key Degradative Proteinases by Chondrocytes in Human Hip Osteoarthritis

Background: The purpose of this study was to investigate the relationship between the expression of key degradative enzymes by chondrocytes and the microarchitectural and mineral properties of subchondral bone across different stages of cartilage degradation in human hip osteoarthritis (OA). Methods: Osteochondral samples at different stages of cartilage degradation were collected from 16 femoral heads with OA. Osteochondral samples with normal cartilage were collected from seven femoral heads with osteoporosis. Microcomputed tomography was used for the investigation of subchondral bone microarchitecture and mineral densities. Immunohistochemistry was used to study the expression and distribution of MMP13 and ADAMTS4 in cartilage. Results: The microarchitecture and mineral properties of the subchondral plate and trabecular bone in OA varied with the severity of the degradation of the overlying cartilage. Chondrocytes expressing MMP13 and ADAMTS4 are mainly located in the upper zone(s) of cartilage regardless of the histopathological grades. The zonal expression of these enzymes in OA (i.e., the percentage of positive cells in the superficial, middle, and deep zones), rather than their overall expression (the percentage of positive cells in the full thickness of the cartilage), exhibited significant variation in relation to the severity of cartilage degradation. The associations between the subchondral bone properties and zonal and overall expression of these enzymes in the cartilage were generally weak or nonsignificant. Conclusions: Phenotypic changes in chondrocytes and remodelling of subchondral bone proceed at different rates throughout the process of cartilage degradation. Biological influences are more important for cartilage degradation at early stages, while biomechanical damage to the compromised tissue may outrun the phenotypic change of chondrocytes and is critical in the advanced stages.

OPTIMIZATION OF DIAGNOSIS OF EARLY STAGES OF LEGG-CALVE-PERTHES DISEASE IN CHILDREN

Aim. Optimization of the diagnosis of the initial stages of Legg-Calve-Perthes disease in children of 4-7 years old using biochemical and ultrasound methods. Materials and Methods. Patients aged 4-9 years (15 boys, 10 girls) complaining of morning pain in walking, contracture in the hip joint, lameness, were examined. The duration of the disease ranged from several days to 2-3 months. The control was a group of healthy children aged 4-9 years (n=22, 12 boys, 10 girls). Ultrasound of the hip joints was performed on Hitachi scanner (Japan) using a linear sensor with 7.5 MHz frequency. In the blood serum of patients, the follow-ing markers of resorption of the organic matrix of bone tissue were determined: the amount of sulfate sulfur, hexuronic acids (HAC), hexoses, hexosamines, sialic acids with calculation of their ratios: hexoses/hexuronic acids, hexoses/sulfate, sulfate/hexuronic acids, hexuronic ac-ids/hexosamines. Besides, concentration of electrolytes was determined in serum: total calcium and chloride ions and inorganic phosphate. On the basis of these fata, the system index of elec-trolytes SIE=ССа.CCl/CPO4 was calculated. The concentrations of parameters obtained in the ex-amination of 25 healthy children of 4 to 7 years of age were taken for norm. Results. In children with duration of the disease from several days to several weeks, an ultra-sound scan along the neck of the femur revealed thickening of the joint capsule to 0.73 (0.7:0.77) mm. With the progression of the pathological process, separate lumpy formations were visualized in the region of the subchondral plate of the femoral head in the position of abduction of the limb and internal/external rotation, which indicated the appearance of initial destructive changes in the region of the subchondral plate of the femoral head. Using biochemical methods, besides increase in the concentration of organic matrix degradation markers, there were also determined increase in the extent of sulphatation of the organic matrix and insignificant alterations of the content of separate electrolytes. Conclusions. The use of biochemical and ultrasound research methods allows optimization of the diagnosis of the initial stages of Legg-Calve-Perthes disease.

Outcomes of talar osteochondral and transchondral lesions using an evidence-based algorithmic approach based on size, location and subchondral plate integrity: a 10-year study on 204 lesions

Objectives: Treatments outcomes for articular lesions of the talus are variable based on size. MRI has been used to assess size and location, and base treatment. We prospectively analyzed talar lesions and the outcomes of surgical procedures based on lesion size, which are typically measured two-dimensionally, intact cartilage/subchondral plate and activity level. We propose following a treatment algorithm will yield favorable results and outcomes. Methods: Over a ten-year period, transchondral and osteochondral lesions of the talus were measured tri-dimensionally on pre-operative MRI, location noted based on a nine-region grid pattern of the talar dome, and patients’ activity level documented. Procedures were performed based on lesion size, integrity of cartilage and lesion location. They were assessed with pre- and post-operative AOFAS scores, post-operative Roles Maudsley score and time to return to activity. Lesions below 125 mm³ were treated with microfracture or retrograde drilling, lesions less than 1500 mm³ were treated with autogenous bone graft, and larger lesions were treated with fresh allograft. Results: 204 talar lesions were analyzed. The following surgeries were performed: arthroscopy with microfracture or retrograde drilling (with or without bone graft) N =159, arthrotomy (with or without osteotomy) with autogenous bone graft N = 60, and fresh allograft with osteotomy N =7. The average follow-up post-index surgery was 82.53± 34.62 (range 24-132) months for the entire cohort. The average time to return to activity was 7.93 ± 5.00 (range 2-36) months. The average pre-AOFAS score was 76.44 ± 10.98 (range 52-86) and average post-AOFAS score was 96.12 ± 3.46 (range 81-100), P=.0001. Post-surgery RM score was 1.28 ± 0.49 (range 1-3). There were no differences in outcomes based on lesion size. Conclusion: Similar outcomes were able to be achieved regardless of talar lesion size using the treatment algorithm.Clinicians should consider using three-dimensional measurements when determining the best treatment approach to talar lesions.Microfracture, while successful for certain talar lesions, may not have a role for larger lesions. Other techniques such as retrograde drilling, autogenous bone grafting and allograft can yield good results, along with microfracture when used appropriately based on lesion size.

4-5 Year Results Following AMIC Procedure with Collagen Matrix in Cartilage Reconstruction of the Talus

Category: Ankle, Arthroscopy Introduction/Purpose: In recent years, the autologous matrix-induced chondrogenesis (AMIC) has established itself in the treatment of cartilage defects of the talus. In this prospective study, the 4-5 year results following arthroscopic AMIC technique at the Talus will be presented. Methods: 97 patients has been treated with this method from August 2009 until September. 48 patients (26 F, 22 M) with a mean age of 36.5 ± 3.9 years (15-69) and a BMI of 24.8 ± 3.9 (19.1 to 39.6) met the inclusion criteria. The Hannover scoring system (HSS) and VAS score for pain, function and satisfaction at baseline and 1 year (FU1), 2 years (FU2) and 4.4 years (FU3) postoperatively have been evaluated. Following arthroscopic exploration to control the inclusion criteria, the cartilage defect was debrided thoroughly. Subsequently, microfracturing has been performed with a special swan neck awls and then PRP was injected over the subchondral plate. Afterwards, covering of the defect area was carried out with the collagen matrix (AMIC) which was impregnated with PRP, which was then fixed with fibrin glue. Results: The HSS improved from 55.6 ± 12.18 baseline to 82.3 FU1 ± 15.64 (p <0.05 compared to baseline.), FU2 88.8 ± 7,43 (p <0,05 see to baseline) and FU3 89.7 ± 8.3 (p <0.05 compared to baseline) with a significant improvement over the entire period of p = 0.008. VAS for pain was 4 ± 2.74 at the Baseline and improved at FU1 to 7.8 ± 2.73 (p <0.05, compared to baseline.), FU2 8.9 ± 1.01 (p <0.05) and FU3 9.3 ± 1.26 (p <0.05) with a significant improvement over the entire period of p = 0.001. Similar results were observed in the VAS scores for function and satisfaction. There were no infections or surgical complications. Conclusion: The arthroscopic AMIC procedure also shows good mid-term results in treatment of cartilage defects of the talus. It is a promising and safe procedure in the cartilage therapy with a low complication rate through an arthroscopic surgery.

Arthroscopic Surgical Technique for an Acute Talar Dome Osteochondral Lesion in a Professional Rugby League Player

Background. Talar osteochondral lesions represent challenging clinical entities, particularly in high-demand athletes. Surgical treatment of large lesions often requires a 2-step procedure, or the use of osteotomy in the case of autologous osteochondral transfer, which can delay return to sport. Methods. A professional rugby league player underwent surgery for a complex injury to the ankle. A talar osteochondral lesion with a maximal diameter of 15 mm was treated in an arthroscopic fashion using the cartilage taken from the completely displaced osteochondral fragment. Cartilage was cut into chips and combined with bone graft product containing platelet-derived growth factor and a porous collagen scaffold. Autologous cartilage was then reimplanted arthroscopically. The patient was allowed full ankle motion from 2 weeks postoperatively, and weightbearing was commenced at 6 weeks. Follow-up imaging and functional outcomes, including return to sport, were assessed at regular intervals. Results. The patient was able to return to professional rugby league by 23 weeks postoperatively. Magnetic resonance imaging at 16 months postoperatively showed restoration of the subchondral plate and osseous infill. At final follow-up, the patient remained pain free and was playing at preinjury level. Conclusion. This report describes good outcomes using a novel, 1-step cartilage repair technique to treat a large talar osteochondral lesion in a professional athlete. Levels of Evidence: Level V: Expert opinion