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Lyu SR, Hsu CC, Hung JP, Chou LC, Chen YR, Lin CW. Arthroscopic cartilage regeneration facilitating procedure: A decompressing arthroplasty for knee osteoarthritis. Medicine (Baltimore) 2022; 101:e30895. [PMID: 36181017 PMCID: PMC9524980 DOI: 10.1097/md.0000000000030895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has always been a subject of debate. This study presents an innovative concept for the arthroscopic management of knee OA and investigates its clinical outcomes. An arthroscopic cartilage regeneration facilitating procedure (ACRFP) was performed on 693 knees of 411 patients with knee OA, with a mean age of 60 years (34-90 years), to eliminate the medial abrasion phenomenon (MAP) and decompress the patellofemoral joints. The Knee Society Score (KSS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to determine the subjective outcome. Roentgenographic changes in all cases and magnetic resonance imaging (MRI) variations in 20 randomly selected cases were evaluated for objective outcomes. We evaluated 634 knees in 369 patients (93.7%) with more than 3 years of follow-up (mean, 40 months; SD, 9) and found that the overall subjective satisfaction rate was 91.1%. Scores for KSS and all KOOS subscales improved statistically. Reversal of cartilage degeneration was observed in 80.1% of the entire series (radiographic outcome study) and 72.2% of the 18 randomly selected cases (1-year MRI outcome study). We found significant association between gender and OA severity, with regards to the subjective outcomes. Age, body mass index, pre-operative hyaluronic acid injection, OA severity, and type and severity of the medial plica were found to be important predictors of radiographic outcomes. An analysis of failed cases reaffirmed the need for early ACRFP and skilled post-operative care. ACRFP is an effective treatment for knee OA. It can benefit most patients and modify their degeneration processes if performed in time. However, further investigations are needed to confirm our concept of treatment.
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Affiliation(s)
- Shaw-Ruey Lyu
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Tzu Chi University, Hualien, Taiwan
- *Correspondence: Shaw-Ruey Lyu, Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan ()
| | - Chia-Chen Hsu
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Jung-Pin Hung
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Li-Chan Chou
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Yu-Ruei Chen
- Department of Medical Imaging, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Chih-Wen Lin
- Tzu Chi University, Hualien, Taiwan
- Department of Medical Imaging, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
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Paczesny L, Zabrzynski J, Kentzer R, Gryckiewicz S, Lewandowski B, Szwedowski D, Kruczynski J. A 10-Year Follow-up on Arthroscopic Medial Plica Syndrome Treatments with Special Reference to Related Cartilage Injuries. Cartilage 2021; 13:974S-983S. [PMID: 31810387 PMCID: PMC8808933 DOI: 10.1177/1947603519892310] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the factors that can affect long-term results of arthroscopic resection of medial synovial plica of the knee. DESIGN A total of 52 knees in 50 consecutive patients with medial plica syndrome (MPS) were enrolled to prospective study. Preoperatively the age, gender, level of activity, symptoms' duration, Lysholm knee scoring scale (LKSS), Q angle, range of motion (ROM), and quadriceps output torque (QOT) were recorded. The plica was then arthroscopically excised while plica morphological type and cartilage lesions (International Cartilage Repair Society [ICRS] classification) were registered. The postoperative evaluation was done after 1 month, 3 months, 6 months, 3 years, and 10 years. The final assessment after 10 years covered LKSS, ROM, QOT, and was enriched with functional tests: the single leg squat test (SLS), the modified Ober test (MO), and the manual palpation of the vastus medialis obliquus (VMO). RESULTS The mean LKSS increased from 52 (15-85, SD 16.479) preoperative to 80 (48-100, SD 15.711) at final follow-up examination. A significant negative correlation was found between LKSS and the patients' age. Cartilage lesions higher than ICRS 1 significantly decreased the final LKSS. Results were significantly better in the subgroups with normal outcome of functional tests. CONCLUSIONS Clinical results of arthroscopic plica resection are better in patients without coexisting cartilage lesions. Poor neuromuscular control may contribute to abnormal patella tracking, leading to both medial plica irritation and further cartilage deterioration.
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Affiliation(s)
- Lukasz Paczesny
- Orvit Clinic, Citomed Healthcare Center,
Torun, Poland,Lukasz Paczesny, Orvit Clinic, Citomed
Healthcare Center, Sklodowskiej 73, Torun, 87-100, Poland.
| | - Jan Zabrzynski
- Orvit Clinic, Citomed Healthcare Center,
Torun, Poland,Department of Orthopedic Surgery,
Multidisciplinary Hospital, Inowroclaw, Poland
| | | | | | | | - Dawid Szwedowski
- Orthopaedic Arthroscopic Surgery
International (OASI) Bioresearch Foundation, Milan, Italy,Department of Orthopaedics and Trauma
Surgery, Provincial Polyclinical Hospital, Torun, Poland
| | - Jacek Kruczynski
- Department of General Orthopaedics,
Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, Poznan,
Poland
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Schuster R, Rockel JS, Kapoor M, Hinz B. The inflammatory speech of fibroblasts. Immunol Rev 2021; 302:126-146. [PMID: 33987902 DOI: 10.1111/imr.12971] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/18/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023]
Abstract
Activation of fibroblasts is a key event during normal tissue repair after injury and the dysregulated repair processes that result in organ fibrosis. To most researchers, fibroblasts are rather unremarkable spindle-shaped cells embedded in the fibrous collagen matrix of connective tissues and/or deemed useful to perform mechanistic studies with adherent cells in culture. For more than a century, fibroblasts escaped thorough classification due to the lack of specific markers and were treated as the leftovers after all other cells have been identified from a tissue sample. With novel cell lineage tracing and single cell transcriptomics tools, bona fide fibroblasts emerge as only one heterogeneous sub-population of a much larger group of partly overlapping cell types, including mesenchymal stromal cells, fibro-adipogenic progenitor cells, pericytes, and/or perivascular cells. All these cells are activated to contribute to tissue repair after injury and/or chronic inflammation. "Activation" can entail various functions, such as enhanced proliferation, migration, instruction of inflammatory cells, secretion of extracellular matrix proteins and organizing enzymes, and acquisition of a contractile myofibroblast phenotype. We provide our view on the fibroblastic cell types and activation states playing a role during physiological and pathological repair and their crosstalk with inflammatory macrophages. Inflammation and fibrosis of the articular synovium during rheumatoid arthritis and osteoarthritis are used as specific examples to discuss inflammatory fibroblast phenotypes. Ultimately, delineating the precursors and functional roles of activated fibroblastic cells will contribute to better and more specific intervention strategies to treat fibroproliferative and fibrocontractive disorders.
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Affiliation(s)
- Ronen Schuster
- Laboratory of Tissue Repair and Regeneration, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,PhenomicAI, MaRS Centre, Toronto, ON, Canada
| | - Jason S Rockel
- Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Mohit Kapoor
- Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Boris Hinz
- Laboratory of Tissue Repair and Regeneration, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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Hufeland M, Treder L, Kubo HK, Verde PE, Krauspe R, Patzer T. Symptomatic medial synovial plica of the knee joint: an underestimated pathology in young patients. Arch Orthop Trauma Surg 2019; 139:1625-1631. [PMID: 31432206 DOI: 10.1007/s00402-019-03249-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION To prospectively evaluate the outcome of arthroscopic resection of a symptomatic medial plica in patients under 30 years with evaluating the influence of sports, knee trauma and plica type. METHODS 35 consecutive patients (38 knees), mean age 16.2 ± 4.7 years (9-26 years), 28 females (73.7%) were prospectively included. Patients with any additional surgical procedures or cartilage lesions > ICRS grade I were excluded. The influence of trauma to the knee, level of sport and the morphologic plica type on the outcome was evaluated in addition to standard knee scores before and 20.1 ± 9.3 months (12-44 months) after surgery. RESULTS The Knee Injury and Osteoarthritis Outcome Score improved significantly from 50.2 ± 19.1% (12.5-94.6) to 80.7 ± 15.3% (48.2-100; p < 0.001). The Tegner Activity Scale improved significantly from 2.2 ± 1.5 (0-6) to 4.9 ± 1.7 (3-10; p < 0.001) and the Kujala Anterior Knee Pain Scale improved significantly from 52.6 ± 16.6 (16-86) to 80.7 ± 16.5 (46-100; p < 0.001). The level of pain in the knee decreased from 7.9 ± 2.0 (1-10) to 3.1 ± 2.6 (0-9; p < 0.001) at follow-up on a numeric rating scale (0-10). Neither trauma to the knee, high impact sport, cartilage lesions to the medial femoral condyle nor the plica type or associated ICRS grade I cartilage lesion to the medial femoral condyle had a significant effect on the outcome parameters. CONCLUSION Arthroscopic resection of a symptomatic medial plica provides excellent clinical results in young patients. Trauma, high impact sports, ICRS grade I cartilage lesions to the medial femoral condyle or the plica type are not associated with a poorer outcome. LEVEL OF EVIDENCE Level IV, prospective case series with no control group.
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Affiliation(s)
- Martin Hufeland
- Klinik für Orthopädie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinik Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany.
| | - Loren Treder
- Klinik für Orthopädie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinik Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
| | - Hannes Kenji Kubo
- Klinik für Orthopädie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinik Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
| | - Pablo Emilio Verde
- Heinrich-Heine-Universität Düsseldorf, Koordinierungszentrum für Klinische Studien (KKS), Düsseldorf, Germany
| | - Rüdiger Krauspe
- Klinik für Orthopädie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinik Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
| | - Thilo Patzer
- Klinik für Orthopädie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinik Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany.,Schön-Klinik Düsseldorf, Fachzentrum für Schulter, Ellenbogen, Knie und Sportorthopädie, Düsseldorf, Germany
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Suprapatellar plica classification and suprapatellar plica syndrome. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2019; 17:10-15. [PMID: 31044135 PMCID: PMC6477514 DOI: 10.1016/j.asmart.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 12/02/2022]
Abstract
Background Plicae around the knee are anatomically normal structures that are remnants of embryonic membranes and are generally asymptomatic. Synovial plica syndrome is known to cause knee symptoms; however, its pathological contribution has been rarely reported. This study aimed to investigate the clinical significance of suprapatellar plicae as well as the morphological characteristics of suprapatellar plicae in patients with knee symptoms who required arthroscopic treatment. Methods Of 223 arthroscopic knee surgeries, 125 patients undergoing primary arthroscopy for various diseases were eligible for inclusion in this study. All affected knees were preoperatively examined by two skilled physicians in a routine manner. Each patient was diagnosed with one primary disease entity based on clinical examinations and arthroscopic findings. At least two skilled orthopedic physicians watched the surgical videos together and defined the type of plicae based on the Dandy classification (Dandy DJ. 1990) as follows: (A) absent, (B) the plica was up to one-quarter of the width of the suprapatellar pouch, (C) the plica was between one-quarter and one-third of the width of the suprapatellar pouch, (D) the plica was between one-third and two-thirds of the width of the suprapatellar pouch, (E) the plica was more than two-thirds of the width of the suprapatellar pouch, (F) the plica had a complete membrane, (G) the plica was perforated, (H) arch, (I) pillar, or (J) lateral. Suprapatellar plica syndrome was considered when (1) the patient complained of anterior knee pain and had localized tenderness above the suprapatellar pouch, (2) magnetic resonance imaging revealed suprapatellar plica structures, and (3) other suspicious pathologies accounting for knee symptoms were excluded. We investigated primary disease type, type of plica, and the relationships between them. Results The results revealed that meniscus injuries and anterior cruciate ligament injuries caused the majority of primary diseases (approximately 80%). Regarding plica forms, 23 knees were classified as having absent (type A) plicae, 14 knees as having a complete septum (type F), and 88 knees were classified as “other.” There were no significant relationships between disease type and the morphological characteristics of the plicae (chi-squared test, p = 0.35). Suprapatellar pain was observed in five cases, of which two patients were diagnosed with intra-articular free body, one patient with synovitis combined osteoarthritis, and two patients with suprapatellar plica syndrome with a complete septum. The latter two cases experienced knee symptom resolution soon after arthroscopic resection of the plica. Conclusions Although the results did not show any relationship between forms of plica remnants and primary disease type, all patients diagnosed with suprapatellar plica syndrome showed complete septum type suprapatellar plicae. A large population study is required in the future.
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Treatment of medial compartment knee osteoarthritis by arthroscopic 'L' medial release procedure. INTERNATIONAL ORTHOPAEDICS 2017; 41:2025-2035. [PMID: 28600698 DOI: 10.1007/s00264-017-3508-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 05/07/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of an arthroscopic 'L' medial release (ALMR) procedure for the treatment of medial compartment knee osteoarthritis (MCKOA). METHODS Between January 2012 and December 2013, 372 patients with MCKOA of Kellgren's radiographic grade I-III were diagnosed. Among them, 252 patients with MCKOA received ALMR performed by a single surgeon. The other 120 patients received supportive treatment and were regarded as the control group. The Knee Society Score (KSS) at baseline and 2 years, and the subjective visual analogue scale (VAS) at baseline and 1st, 2nd, 6th, 12th, and 24th months were used for outcome studies. RESULTS There were 286 patients available for follow-up for more than 2 years and the mean follow-up period was 28 months. There were 202 patients with unilateral MCKOA in the ALMR group and 84 in the control group. The mean subjective VAS showed a statistically significant improvement after 6 months, and then remained relatively stable between the 6th and 24th month. The mean KSS for pain and function improved statistically at 2 years of follow-up. CONCLUSIONS This ALMR appears to be an effective and safe treatment for mild and moderate MCKOA.
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Lee PYF, Nixion A, Chandratreya A, Murray JM. Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain. Surg J (N Y) 2017; 3:e9-e16. [PMID: 28825013 PMCID: PMC5553487 DOI: 10.1055/s-0037-1598047] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/06/2016] [Indexed: 11/25/2022] Open
Abstract
Synovial plica syndrome (SPS) occurs in the knee, when an otherwise normal structure becomes a source of pain due to injury or overuse. Patients may present to general practitioners, physiotherapists, or surgeons with anterior knee pain with or without mechanical symptoms, and the diagnosis can sometimes be difficult. Several studies have examined the epidemiology, diagnosis, and treatment of SPS. We review these resources to provide an evidence-based guide to the diagnosis and treatment of SPS of the knee.
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Affiliation(s)
- Paul Yuh Feng Lee
- South Wales Orthopaedic Research Network, WelshBone, Cardiff, Wales, United Kingdom
| | - Amy Nixion
- South Wales Orthopaedic Research Network, WelshBone, Cardiff, Wales, United Kingdom
| | - Amit Chandratreya
- Department of Orthopaedic Surgery, ABMU LHB, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | - Judith M Murray
- Department of Orthopaedic Surgery, Royal Glamorgan Hospital, Llantrisant, Wales, United Kingdom
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Jonathan GZW, Bin Abd Razak HR, Amit Kanta M. Cartilage Delamination Flap Mimicking a Torn Medial Meniscus. Case Rep Orthop 2016; 2016:7062129. [PMID: 28070434 PMCID: PMC5187486 DOI: 10.1155/2016/7062129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/29/2016] [Accepted: 11/17/2016] [Indexed: 12/30/2022] Open
Abstract
We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis.
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Naghibi Beidokhti H, Janssen D, Khoshgoftar M, Sprengers A, Perdahcioglu ES, Van den Boogaard T, Verdonschot N. A comparison between dynamic implicit and explicit finite element simulations of the native knee joint. Med Eng Phys 2016; 38:1123-30. [DOI: 10.1016/j.medengphy.2016.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 05/09/2016] [Accepted: 06/03/2016] [Indexed: 01/28/2023]
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