Autologous chondrocyte transplantation in the treatment of thumb CMC joint osteoarthritis

Targeted partial arthroscopic trapeziectomy with temporary distraction: a retrospective study with 5-year follow-up

Targeted partial arthroscopic trapeziectomy with temporary distraction is a minimally invasive treatment for trapeziometacarpal osteoarthritis. We performed a retrospective single centre study from March 2011 to May 2022 and included patients with at least 5 years of follow-up. A failure was defined as a patient requiring a second procedure. Of the 28 patients with at least 5 years of follow-up, 23 were reviewed. Five of the 23 patients underwent revision surgery with a 5-year survival rate of 78%. There was a significant improvement in pain and the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score. There were three postoperative complications, one with complex regional pain syndrome, and two with hyperesthesia in the distribution of the sensory branch of the radial nerve. Targeted partial arthroscopic trapeziectomy with temporary distraction is a feasible temporary solution for early stage trapeziometacarpal joint osteoarthritis. However, there remains a 20% risk of failure.Level of evidence: IV.

Regenerative Therapies for Basal Thumb Arthritis-A Systematic Review

Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local steroid injections and/or surgery. Yet, therapeutic data on long-term improvement and even cartilage repair are scarce. This review aims to present the currently available literature on novel therapies for basal thumb arthritis, including platelet-rich plasma (PRP), fat grafting and phototherapy, and investigate their potential efficacy. The entire OVID database and PubMed were searched for studies containing the topics PRP injection, lipofilling, laser treatment and regenerative treatment for carpometacarpal arthritis. Seven studies on the effect of fat tissue on basal thumb arthritis were found. Four authors reported on PRP injections, one RCT examined a combinational treatment of PRP and fat grafting, another phototherapy for the thumb joint and one prospective trial on chondrocyte transplantation was found. Pain improvement and decreased impairment were reported in the majority of PRP and/or fat grafting studies as well as after chondrocyte implantation. Phototherapy did not significantly improve the condition. This review revealed that only limited data on regenerative therapies for carpometacarpal arthritis are currently available, yet PRP and lipofilling show promising results and merit further investigation.

Targeted Partial Arthroscopic Trapeziectomy and Temporary K-Wire Distraction for Basal Joint Arthritis in Young Patients: A Retrospective Study of 39 Thumbs

Purpose  There is a real need to find less invasive therapeutic options for young patients suffering from osteoarthritis of the first carpometacarpal joint. We wanted to assess the effectiveness of targeted partial arthroscopic trapeziectomy with distraction of the trapeziometacarpal (TM) joint with Kirschner wires (K-wires) in 39 thumbs impacted by TM osteoarthritis. Methods  We conducted a retrospective study in which preoperative and postoperative data on pinch strength, grip strength, and pain on a visual analogue scale were collected. Subgroup analysis was performed based on two different K-wire distraction techniques. Only patients suffering from primary osteoarthritis and younger than 70 years were included. Second, we compared the frequency of complications relative to the position of the pins. Results  We found a significant improvement in pain ( p  = 0.005) and grip strength ( p  = 0.0021) as well as an improvement in pinch strength ( p  = 0.5704). There was reduction in pain for all Badia levels, which was significant for stages 2 ( p  = 0.002) and 3 ( p  = 0.032) as well as an overall improvement in grip strength and pinch strength for all Badia levels. Conclusion  Partial trapeziectomy with K-wire distraction in young patients suffering from TM osteoarthritis is a simple technique that requires minimal equipment and yields satisfactory outcomes. Conversion to another surgical treatment is still possible if this less invasive technique is unsuccessful. Level of Evidence  This is a Level IV study.

Targeted Partial Arthroscopic Trapeziectomy and Distraction: Surgical Technique

Basal joint osteoarthritis is a real public health problem, yet there is no consensus on its treatment. Although total trapeziectomy, as well as arthroplasty, provides long-lasting efficacy, it does not seem to be adapted to a young population with complications that are often very difficult to manage. In the era of minimally invasive surgery, there is a real interest in finding conservative therapeutic alternatives for young subjects that allow them to "pass a painful milestone" and, thus, postpone the least conservative interventions. This article details the surgical technique of an arthroscopic and conservative technique: The Targeted Partial Arthroscopic Trapeziectomy and Distraction based on two goals: targeted resection of painful arthritic lesions and distraction of the joint to restore ligament tension and hopefully regrow fibrocartilage on resected lesions.

Thumb basal joint arthritis: new classification, diagnostic and therapeutic algorithm

The assessment of thumb basal joint arthritis requires a radiographic evaluation and a classification of the lesions to guide the treatment choice. Arthritis of the thumb basal joint is not limited to trapeziometacarpal arthritis. The radiographic assessment must consider the scaphotrapeziotrapezoid joint, the entire carpus and the rest of the thumb column, in particular the metacarpophalangeal joint. There is currently no classification that captures all these items. This article reviews the existing classifications, proposes a new classification system that takes into account the entire thumb column and sets out the therapeutic options.

MiR-539-3p inhibited chondrogenic differentiation in human adipose stem cells by targeting Sox9

Background

Mesenchymal stem cells (MSCs) have emerged as the attractive candidates for cell therapy for cartilage repair in clinical therapy of osteoarthritis (OA). MiR-539-3p was reported to differentially express during chondrogenic differentiation of adipose stem cells (ASCs) by miRNA microarrays. The aim of the study was to investigate the effects and underlying mechanisms of miR-539-3p on chondrogenic differentiation of ASCs.

Methods

Human ASCs (hASCs) were obtained from liposuction and transfected with miR-539-3p mimic or inhibitor. Then, the cells were cultured in chondrogenic differentiation medium including transforming growth factor-β1 (TGF-β1).

Results

Our results found that miR-539-3p was gradually down-regulated during chondrogenic differentiation of hASCs. MiR-539-3p overexpression inhibited TGF-β1-induced chondrogenic differentiation of hASCs, as supported by reducing the gene and protein expression of chondrogenic differentiation markers type II collagen alpha 1 (COL2A1), aggrecan (ACAN), and type II collagen. In contrast, miR-539-3p inhibitor significantly promoted the chondrogenic differentiation of hASCs. Dual luciferase reporter assay demonstrated that Sox9 was a direct target gene of miR-539-3p. The expression of SRY-box transcription factor 9 (Sox9) was up-regulated progressively over time during chondrogenic differentiation of hASCs. Additionally, Sox9 overexpression notably reversed chondrogenic differentiation of hASCs inhibited by miR-539-3p mimic, as demonstrated by the decreased expression of COL2A1, ACAN, and type II collagen.

Conclusions

Altogether, miR-539-3p inhibited chondrogenic differentiation of hASCs by targeting Sox9. MiR-539-3p may have significant clinical applications for use as a targeted therapy of OA.