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Yan X, Ye Y, Wang L, Xue J, Shen N, Li T. Platelet-rich plasma alleviates neuropathic pain in osteoarthritis by downregulating microglial activation. BMC Musculoskelet Disord 2024; 25:331. [PMID: 38725009 PMCID: PMC11080143 DOI: 10.1186/s12891-024-07437-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The development of neuropathic pain (NP) is one of the reasons why the pain is difficult to treat, and microglial activation plays an important role in NP. Recently, platelet-rich plasma (PRP) has emerged as a novel therapeutic method for knee osteoarthritis (KOA). However, it's unclarified whether PRP has analgesic effects on NP induced by KOA and the underlying mechanisms unknown. PURPOSE To observe the analgesic effects of PRP on NP induced by KOA and explore the potential mechanisms of PRP in alleviating NP. METHODS KOA was induced in male rats with intra-articular injections of monosodium iodoacetate (MIA) on day 0. The rats received PRP or NS (normal saline) treatment at days 15, 17, and 19 after modeling. The Von Frey and Hargreaves tests were applied to assess the pain-related behaviors at different time points. After euthanizing the rats with deep anesthesia at days 28 and 42, the corresponding tissues were taken for subsequent experiments. The expression of activating transcription factor 3 (ATF3) in dorsal root ganglia (DRG) and ionized-calcium-binding adapter molecule-1(Iba-1) in the spinal dorsal horn (SDH) was detected by immunohistochemical staining. In addition, the knee histological assessment was performed by hematoxylin-eosin (HE) staining. RESULTS The results indicated that injection of MIA induced mechanical allodynia and thermal hyperalgesia, which could be reversed by PRP treatment. PRP downregulated the expression of ATF3 within the DRG and Iba-1 within the SDH. Furthermore, an inhibitory effect on cartilage degeneration was observed in the MIA + PRP group only on day 28. CONCLUSION These results indicate that PRP intra-articular injection therapy may be a potential therapeutic agent for relieving NP induced by KOA. This effect could be attributed to downregulation of microglial activation and reduction in nerve injury.
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Affiliation(s)
- Xiao Yan
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Yinshuang Ye
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Lin Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Junqiang Xue
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Nana Shen
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Tieshan Li
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China.
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Sandström A, Torrado-Carvajal A, Morrissey EJ, Kim M, Alshelh Z, Zhu Y, Li MD, Chang CY, Jarraya M, Akeju O, Schrepf A, Harris RE, Kwon YM, Bedair H, Chen AF, Mercaldo ND, Kettner N, Napadow V, Toschi N, Edwards RR, Loggia ML. [ 11 C]-PBR28 positron emission tomography signal as an imaging marker of joint inflammation in knee osteoarthritis. Pain 2024; 165:1121-1130. [PMID: 38015622 DOI: 10.1097/j.pain.0000000000003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
ABSTRACT Although inflammation is known to play a role in knee osteoarthritis (KOA), inflammation-specific imaging is not routinely performed. In this article, we evaluate the role of joint inflammation, measured using [ 11 C]-PBR28, a radioligand for the inflammatory marker 18-kDa translocator protein (TSPO), in KOA. Twenty-one KOA patients and 11 healthy controls (HC) underwent positron emission tomography/magnetic resonance imaging (PET/MRI) knee imaging with the TSPO ligand [ 11 C]-PBR28. Standardized uptake values were extracted from regions-of-interest (ROIs) semiautomatically segmented from MRI data, and compared across groups (HC, KOA) and subgroups (unilateral/bilateral KOA symptoms), across knees (most vs least painful), and against clinical variables (eg, pain and Kellgren-Lawrence [KL] grades). Overall, KOA patients demonstrated elevated [ 11 C]-PBR28 binding across all knee ROIs, compared with HC (all P 's < 0.005). Specifically, PET signal was significantly elevated in both knees in patients with bilateral KOA symptoms (both P 's < 0.01), and in the symptomatic knee ( P < 0.05), but not the asymptomatic knee ( P = 0.95) of patients with unilateral KOA symptoms. Positron emission tomography signal was higher in the most vs least painful knee ( P < 0.001), and the difference in pain ratings across knees was proportional to the difference in PET signal ( r = 0.74, P < 0.001). Kellgren-Lawrence grades neither correlated with PET signal (left knee r = 0.32, P = 0.19; right knee r = 0.18, P = 0.45) nor pain ( r = 0.39, P = 0.07). The current results support further exploration of [ 11 C]-PBR28 PET signal as an imaging marker candidate for KOA and a link between joint inflammation and osteoarthritis-related pain severity.
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Affiliation(s)
- Angelica Sandström
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Erin J Morrissey
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Minhae Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Zeynab Alshelh
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Yehui Zhu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew D Li
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Connie Y Chang
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Richard E Harris
- Susan Samueli Integrative Health Institute, School of Medicine, University of California at Irvine, Irvine CA, United States
- Department of Anesthesiology and Perioperative Care, School of Medicine, University of California at Irvine, Irvine CA, United States
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Hany Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Nathaniel D Mercaldo
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Norman Kettner
- Department of Radiology, Logan University, Chesterfield, MO, United States
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Nicola Toschi
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Biomedicine and Prevention, University of Rome, "Tor Vergata," Rome, Italy
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Marco L Loggia
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Mickle AM, Staud R, Garvan CS, Kusko DA, Sambuco N, Addison BR, Vincent KR, Redden DT, Goodin BR, Fillingim RB, Sibille KT. Dispositional traits help explain individual differences in relationships between a radiographic knee osteoarthritis measure, pain, and physical function. Ther Adv Musculoskelet Dis 2024; 16:1759720X241235805. [PMID: 38516228 PMCID: PMC10956141 DOI: 10.1177/1759720x241235805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/02/2024] [Indexed: 03/23/2024] Open
Abstract
Background The concordance between radiograph-derived Kellgren-Lawrence (KL) scores for knee osteoarthritis (KOA) and experimental and clinical pain and KOA-related physical function is conflicting. Objectives We investigate whether the inclusion of dispositional traits reduces variability between KOA radiographic findings, experimental pain, clinical pain, and function in individuals with knee pain. Design This study is a cross-sectional, secondary analysis of data collected from the UPLOAD-II study. Methods Adults aged 45-85 years with and without knee pain were enrolled. Data collected included sociodemographics, knee radiographs, experimental pain, clinical pain and function, and trait affect. Vulnerable and protective dispositional traits were classified from combined positive and negative trait affect measures. KL scores were determined from the knee radiographs. Unadjusted and adjusted (age, sex, comorbidities, and body mass index) regression analyses were completed with SAS version 9.4 (Cary, NC, USA). Results The study included 218 individuals with a mean age of 58 years, 63.6% women, and 48.2% non-Hispanic black adults. Dispositional traits were associated with the experimental pain measures. No association between radiographic KOA and experimental pain was observed. In a combined and adjusted analysis, dispositional traits were predictive of knee punctate pain temporal summation (p = 0.0382). Both dispositional traits and radiographic KOA scores independently and combined were predictive of Graded Chronic Pain Scale pain and function, and Western Ontario and McMaster University pain and function (ps ⩽ 0.01). Improvements in R2 were noted across all models with the inclusion of dispositional traits. Conclusion Consideration of dispositional traits reduces the variability between radiographic KOA and pain and function. Non-pathological and associated pain-related psychological factors and dispositional traits might serve as parsimonious proxy tools to improve clinical assessments. Registration N/A.
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Affiliation(s)
- Angela M. Mickle
- Department of Physical Medicine & Rehabilitation, University of Florida, Campus Box 100242, 2004 Mowry Road, Gainesville, FL 32610, USA
- Department of Community Dentistry, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Cynthia S. Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Daniel A. Kusko
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicola Sambuco
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Brittany R. Addison
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin R. Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - David T. Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Anesthesiology, Washington University, St. Louis, MO, USA
| | - Roger B. Fillingim
- Department of Community Dentistry, University of Florida, Gainesville, FL, USA
- Pain Research Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Kimberly T. Sibille
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
- Pain Research Center of Excellence, University of Florida, Gainesville, FL, USA
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Ma J, Yu P, Ma S, Li J, Wang Z, Hu K, Su X, Zhang B, Cheng S, Wang S. Bioinformatics and Integrative Experimental Method to Identifying and Validating Co-Expressed Ferroptosis-Related Genes in OA Articular Cartilage and Synovium. J Inflamm Res 2024; 17:957-980. [PMID: 38370466 PMCID: PMC10871044 DOI: 10.2147/jir.s434226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/13/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose Osteoarthritis (OA) is the most common joint disease worldwide and is the primary cause of disability and chronic pain in older adults.Ferroptosis is a type of programmed cell death characterized by aberrant iron metabolism and reactive oxygen species accumulation; however, its role in OA is not known. Methods To identify ferroptosis markers co-expressed in articular cartilage and synovium samples from patients with OA, in silico analysis was performed.Signature genes were analyzed and the results were evaluated using a ROC curve prediction model.The biological function, correlation between Signature genes, immune cell infiltration, and ceRNA network analyses were performed. Signature genes and ferroptosis phenotypes were verified through in vivo animal experiments and clinical samples. The expression levels of non-coding RNAs in samples from patients with OA were determined using qRT-PCR. ceRNA network analysis results were confirmed using dual-luciferase assays. Results JUN, ATF3, and CDKN1A were identified as OA- and ferroptosis-associated signature genes. GSEA analysis demonstrated an enrichment of these genes in immune and inflammatory responses, and amino acid metabolism. The CIBERSORT algorithm showed a negative correlation between T cells and these signature genes in the cartilage, and a positive correlation in the synovium. Moreover, RP5-894D12.5 and FAM95B1 regulated the expression of JUN, ATF3, and CDKN1A by competitively binding to miR-1972, miR-665, and miR-181a-2-3p. In vivo, GPX4 was downregulated in both OA cartilage and synovium; however, GPX4 and GSH were downregulated, while ferrous ions were upregulated in patient OA cartilage and synovium samples, indicating that ferroptosis was involved in the pathogenesis of OA. Furthermore, JUN, ATF3, and CDKN1A expression was downregulated in both mouse and human OA synovial and cartilage tissues. qRT-PCR demonstrated that miR-1972, RP5-894D12.5, and FAM95B1 were differentially expressed in OA tissues. Targeted interactions between miR-1972 and JUN, and a ceRNA regulatory mechanism between RP5-894D12.5, miR-1972, and JUN were confirmed by dual-luciferase assays. Conclusion This study identified JUN, ATF3, and CDKN1A as possible diagnostic biomarkers and therapeutic targets for joint synovitis and OA. Furthermore, our finding indicated that RP5-894D12.5/miR-1972/JUN was a potential ceRNA regulatory axis in OA, providing an insight into the connection between ferroptosis and OA.
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Affiliation(s)
- Jinxin Ma
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Peng Yu
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Shang Ma
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Jinjin Li
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Zhen Wang
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Kunpeng Hu
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Xinzhe Su
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Bei Zhang
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Shao Cheng
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
- Department of Arthropathy, Henan Province Hospital of Chinese Medicine (The Second Affiliated Hospital of Henan University of Chinese Medicine), Zhengzhou, People’s Republic of China
- School of Osteopathy, Henan Province Engineering Research Center of Basic and Clinical Research of Bone and Joint Repair in Chinese Medicine, Zhengzhou, People’s Republic of China
| | - Shangzeng Wang
- School of Osteopathy, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China
- Department of Arthropathy, Henan Province Hospital of Chinese Medicine (The Second Affiliated Hospital of Henan University of Chinese Medicine), Zhengzhou, People’s Republic of China
- School of Osteopathy, Henan Province Engineering Research Center of Basic and Clinical Research of Bone and Joint Repair in Chinese Medicine, Zhengzhou, People’s Republic of China
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Dawson ZE, Beaumont AJ, Carter SE. A Systematic Review of Physical Activity and Sedentary Behavior Patterns in an Osteoarthritic Population. J Phys Act Health 2024; 21:115-133. [PMID: 38086351 DOI: 10.1123/jpah.2023-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To explore physical activity (PA) and sedentary behaviors (SB) in individuals with lower limb (LL) Osteoarthritis (OA) and the influence of age, sex, and body mass index (BMI) on these behaviors. DESIGN Systematic review search: PubMed, Cochrane Library, ScienceDirect, and CINAHL databases were searched from inception until July 2023. Study criteria: Studies that reported quantifiable device-based or self-reported data for PA and SB variables in adults clinically diagnosed with LL OA were included. DATA SYNTHESIS A synthesis of PA and SB levels for those diagnosed with LL OA and the influence age, sex, and BMI have on these behaviors. RESULTS From the 1930 studies identified through the electronic search process, 48 met the inclusion criteria. PA guidelines were met by 33% of the sample population that measured moderate and moderate to vigorous PA. No studies reported 75 minutes per week or more of vigorous PA. Additionally, 58% of the population reporting SB were sedentary for 8 hours per day or more. Also, increasing age, BMI, and the female sex were identified as negative influences on PA levels. There were numerous methodological inconsistencies in how data were collected and reported, such as various activity monitor cut points for PA and SB bout duration. CONCLUSION Adults with LL OA may be at an increased risk of noncommunicable diseases due to low PA and high SB levels. It is important to consider age, sex, and BMI when investigating behavior patterns in those with LL OA.
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Affiliation(s)
- Zoe E Dawson
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Alexander J Beaumont
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Sophie E Carter
- School of Science, Technology and Health, York St John University, York, United Kingdom
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Condemi S, Panuel M, Chaumoitre K, Belcastro MG, Pietrobelli A, Voisin JL. A pathological Neandertal thumb phalanx from Moula-Guercy (France). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 42:14-17. [PMID: 37354658 DOI: 10.1016/j.ijpp.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/17/2023] [Accepted: 06/18/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To discuss a Neandertal pathological adult first pollical proximal phalanx (I2-104) from the Baume de Moula-Guercy (Ardèche, France) and evaluate the possible causes of this pathology. METHODS Macroscopic analyses of external features, as well as CT imaging, were used in the analysis RESULTS: The presence of asymmetric eburnation on the distal epiphysis associated with an osteophyte on the palmar surface, as well as the absence of periosteal bone reaction visible on CT images, is consistent with osteoarthritis. CONCLUSION Osteoarthritis (OA) can have different origins and the cause is difficult to identify. The pathology of the Moula-Guercy I2-104 phalanx may be due to a genetic predisposition for OA known in Neandertals and associated with short limb bones. The OA could have been aggravated by the age of this individual and by an inflammatory reaction caused by repeated movements and intense vibrations provoked by high-frequency knapping or by other use of the hands SIGNIFICANCE: The I2-104 phalanx is the first Neandertal pollical phalanx known to display OA, although joints of this bone are frequently affected by this pathology in modern humans. Thus, greater insight into the presence and consequences of Neandertal behaviors is offered LIMITATION: It is impossible to give a definitive conclusion on the cause(s) of the OA in this case. SUGGESTIONS FOR FURTHER RESEARCH More data is needed concerning OA within Neandertals and its relationship with behavior and genetics.
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Affiliation(s)
- Silvana Condemi
- UMR 7268 ADES, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine - La Timone, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France.
| | - Michel Panuel
- UMR 7268 ADES, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine - La Timone, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Kathia Chaumoitre
- UMR 7268 ADES, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine - La Timone, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Maria Giovanna Belcastro
- Dipartimento di Scienze Biologiche, Geologiche e Ambientali, Alma Mater Studiorum Università di Bologna, Via Selmi 3, Bologna, Italy
| | - Annalisa Pietrobelli
- Dipartimento di Scienze Biologiche, Geologiche e Ambientali, Alma Mater Studiorum Università di Bologna, Via Selmi 3, Bologna, Italy
| | - Jean-Luc Voisin
- UMR 7268 ADES, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine - La Timone, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France.
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Innmann MM, Lunz A, Fröhlich L, Bruckner T, Merle C, Reiner T, Schiltenwolf M. What Is the Correlation between Clinical and Radiographic Findings in Patients with Advanced Osteoarthritis of the Knee? J Clin Med 2023; 12:5420. [PMID: 37629462 PMCID: PMC10455573 DOI: 10.3390/jcm12165420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Knee range of motion and patient-reported outcome measures (PROMs) are often used as screening tools to assess the severity of knee osteoarthritis and guide the decision to refer patients to an arthroplasty clinic. However, there is little understanding regarding the correlation between these factors. Thus, the purpose of this study was to determine the correlation between patient-reported clinical function measured with the Oxford Knee Score (OKS), pain assessed using the visual analog scale (VAS), knee range of motion (ROM), and characteristic radiographic features in patients with advanced osteoarthritis of the knee. A prospective analysis of a consecutive series of 138 patients with advanced unilateral osteoarthritis (OA) of the knee was performed. The severity of radiographic OA was classified according to the most commonly used Kellgren and Lawrence classification (K&L). Spearman's rank correlation analysis and multiple linear regression analysis were performed. The OKS was used as a dependent variable and was adjusted for pain, ROM, and nine standardized radiographic parameters on multiple views of the tibiofemoral and patellofemoral joint. OKS and pain correlated weakly with the K&L grade (r = -0.289; p = 0.001; r = 0.258; p = 0.002). K&L grade and the degree of patellofemoral joint space narrowing were identified as independent factors being associated with a poorer OKS (coefficient -4.528, p = 0.021; coefficient -2.211, p = 0.038). Slightly worse results were identified for OKS and pain in patients with K&L grade 4 osteoarthritis compared to patients with K&L grade 3 osteoarthritis (∆OKS 5.5 points, p < 0.001; ∆VAS 1.7 points, p = 0.003). There was no significant difference for passive range of motion between patients with K&L grade 3 or 4. When counseling patients with advanced knee osteoarthritis who may be eligible for knee arthroplasty, it is essential to give primary consideration to pain levels and self-reported limitations experienced during daily activities. Relying solely on knee ROM and PROMs is not an effective screening method for guiding the decision to refer patients to an arthroplasty clinic.
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Affiliation(s)
- Moritz M. Innmann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Andre Lunz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Larissa Fröhlich
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Christian Merle
- Diakonie Klinikum Stuttgart, Rosenbergstraße 38, 70176 Stuttgart, Germany
| | - Tobias Reiner
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Marcus Schiltenwolf
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
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Brenneis M, Junker M, Sohn R, Braun S, Ehnert M, Zaucke F, Jenei-Lanzl Z, Meurer A. Patellar malalignment correlates with increased pain and increased synovial stress hormone levels-A cross-sectional study. PLoS One 2023; 18:e0289298. [PMID: 37498905 PMCID: PMC10374142 DOI: 10.1371/journal.pone.0289298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Risk factors for the development of pain in the context of knee osteoarthritis (KOA) remain unclear. Radiological findings often do not correlate with clinical findings, so other pathomechanisms in the development and perception of pain must play a role. The purpose of this study is to investigate the correlation of increased sympathetic nervous system (SNS) activity (measured by subjective and objective chronic stress parameters) with KOA severity, patellofemoral malalignment, and pain. METHODS 47 patients with KOA were assessed. Radiological measurements of tibiofemoral and patellofemoral parameters (Kellgren-Lawrence-score, patellar tilt (PT), Caton-Deschamps-Index and Hepp´s classification) were performed and correlated with knee-specific questionnaires (WOMAC®, KSS©) and chronic stress questionnaires (PSQ-20). Additionally, parameters associated with chronic stress were quantified in synovial fluid and serum samples from patients. RESULTS PT correlated significantly with Caton-Deschamps-Index (r = 0.394,p = 0.006) and with medial patellofemoral joint space (r = 0.516,p<0.001). In addition, asymmetric trochlear groove (Hepp's classification > II) was associated with significantly higher PT values (p = 0.014). A negative correlation between PT and KSS©-symptoms subgroup was found (r = -0.340,p = 0.024). Patients with PT<5° had significantly higher scores in the Knee Society Score©-symptoms subgroup (p = 0.038). A positive and significant correlation between synovial aldosterone levels and PT was observed (r = 0.548,p = 0.042). CONCLUSION The results of this study indicate that patellar malalignment might correlate with increased pain. The previous specification of standard PT values must be reconsidered as even low PT values seem to play a role in the occurrence of patellofemoral osteoarthritis symptoms. Lower PT values might lead to aggravated symptoms in patients with KOA due to a narrow medial patellofemoral joint space. In addition, PT might induce the release of synovial stress biomarkers and thus contribute to the progression of KOA.
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Affiliation(s)
- Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marius Junker
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
- Department of Orthopedics, Tabea Hospital Hamburg, Hamburg, Germany
| | - Rebecca Sohn
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Markus Ehnert
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Frank Zaucke
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Zsuzsa Jenei-Lanzl
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Andrea Meurer
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
- Medical Park St. Hubertus Klinik, Bad Wiessee, Germany
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9
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Altamirano S, Jansen MP, Oberski DL, Eijkemans MJC, Mastbergen SC, Lafeber FPJG, van Spil WE, Welsing PMJ. Identifying multivariate disease trajectories and potential phenotypes of early knee osteoarthritis in the CHECK cohort. PLoS One 2023; 18:e0283717. [PMID: 37450467 PMCID: PMC10348540 DOI: 10.1371/journal.pone.0283717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/15/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To gain better understanding of osteoarthritis (OA) heterogeneity and its predictors for distinguishing OA phenotypes. This could provide the opportunity to tailor prevention and treatment strategies and thus improve care. DESIGN Ten year follow-up data from CHECK (1002 early-OA subjects with first general practitioner visit for complaints ≤6 months before inclusion) was used. Data were collected on WOMAC (pain, function, stiffness), quantitative radiographic tibiofemoral (TF) OA characteristics, and semi-quantitative radiographic patellofemoral (PF) OA characteristics. Using functional data analysis, distinctive sets of trajectories were identified for WOMAC, TF and PF characteristics, based on model fit and clinical interpretation. The probabilities of knee membership to each trajectory were used in hierarchical cluster analyses to derive knee OA phenotypes. The number and composition of potential phenotypes was selected again based on model fit (silhouette score) and clinical interpretation. RESULTS Five trajectories representing different constant levels or changing WOMAC scores were identified. For TF and PF OA, eight and six trajectories respectively were identified based on (changes in) joint space narrowing, osteophytes and sclerosis. Combining the probabilities of knees belonging to these different trajectories resulted in six clusters ('phenotypes') of knees with different degrees of functional (WOMAC) and radiographic (PF) parameters; TF parameters were found not to significantly contribute to clustering. Including baseline characteristics as well resulted in eight clusters of knees, dominated by sex, menopausal status and WOMAC scores, with only limited contribution of PF features. CONCLUSIONS Several stable and progressive trajectories of OA symptoms and radiographic features were identified, resulting in phenotypes with relatively independent symptomatic and radiographic features. Sex and menopausal status may be especially important when phenotyping knee OA patients, while radiographic features contributed less. Possible phenotypes were identified that, after validation, could aid personalized treatments and patients selection.
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Affiliation(s)
- Sara Altamirano
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniel L Oberski
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Data Science and Biostatistics, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marinus J C Eijkemans
- Department of Data Science and Biostatistics, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem E van Spil
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Rheumatology, Dijklander Hospital, Hoorn, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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10
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Goldoni ES, Bittencourt JV, do Espirito Santo LR, Sousa EBD, Faria JLRD, Alexandre DJDA, Nogueira LAC. Neuropathic-like symptoms and central sensitization related signs and symptoms negatively affect the functional performance of patients with knee osteoarthritis – a cross-sectional study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100358. [PMID: 37122842 PMCID: PMC10133749 DOI: 10.1016/j.ocarto.2023.100358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023] Open
Abstract
Objective This study aimed to compare the functional performance among participants with a neuropathic-like symptoms (NS) and central sensitization related signs and symptoms (CS), and their knee osteoarthritis (OA) counterparts. Methods A cross-sectional observational study was conducted with 125 participants with knee OA (94 females, mean age 63.1 ± 7.4 years). Participants completed a self-reported questionnaire with personal and clinical features and musculoskeletal pain characteristics, including NS (PainDETECT), CS (Central Sensitization Inventory, CSI), and conditioned pain modulation. Self-reported functional disability (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC) and functional mobility (Timed Up and Go, TUG) were compared among patients with NS, CS, and their knee OA counterparts using the one-way analysis of variance (ANOVA). Results Thirty-three (26.4%) participants had NS and CS, eighteen (14.4%) had NS, twenty-seven (21.6%) participants had CS, and 47 (37.6%) had knee OA with no NS or CS. A one-way ANOVA revealed greater functional limitation in the group with NS and CS (mean = 67.5 ± 12.0) or NS (mean = 56.7 ± 17.5) than the group without these symptoms (mean = 32.0 ± 20.7) with a statistical significance difference [F(3, 121) = 29.434, p < 0.001] in the WOMAC Total score. The group with NS and CS (mean = 19.2 ± 7.4) or NS (mean = 16.3 ± 6.3) had slower velocity than the group without these symptoms (mean = 11.6 ± 3.5) with a statistical significance difference [F(3,121) = 10.045, p < 0.001] in the TUG test. Conclusion Participants with knee osteoarthritis and NS or CS pain phenotype have greater functional limitations than their counterparts.
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Affiliation(s)
- Enrico Seixas Goldoni
- Rehabilitation Science Postgraduate Programme at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduate Programme at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Corresponding author. Centro Universitário Augusto Motta (UNISUAM), Avenida Paris, 84, Bonsucesso, CEP 21041-020, Rio de Janeiro, RJ, Brazil.
| | | | - Eduardo Branco de Sousa
- Physiotherapy Department at Jamil Haddad National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - José Leonardo Rocha de Faria
- Physiotherapy Department at Jamil Haddad National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | | | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduate Programme at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department at Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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11
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Giorgino R, Albano D, Fusco S, Peretti GM, Mangiavini L, Messina C. Knee Osteoarthritis: Epidemiology, Pathogenesis, and Mesenchymal Stem Cells: What Else Is New? An Update. Int J Mol Sci 2023; 24:ijms24076405. [PMID: 37047377 PMCID: PMC10094836 DOI: 10.3390/ijms24076405] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Osteoarthritis (OA) is a chronic disease and the most common orthopedic disorder. A vast majority of the social OA burden is related to hips and knees. The prevalence of knee OA varied across studies and such differences are reflected by the heterogeneity of data reported by studies conducted worldwide. A complete understanding of the pathogenetic mechanisms underlying this pathology is essential. The OA inflammatory process starts in the synovial membrane with the activation of the immune system, involving both humoral and cellular mediators. A crucial role in this process is played by the so-called “damage-associated molecular patterns” (DAMPs). Mesenchymal stem cells (MSCs) may be a promising option among all possible therapeutic options. However, many issues are still debated, such as the best cell source, their nature, and the right amount. Further studies are needed to clarify the remaining doubts. This review provides an overview of the most recent and relevant data on the molecular mechanism of cartilage damage in knee OA, including current therapeutic approaches in regenerative medicine.
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12
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Alahmed SK, Mohyeldin AM, Alshammari A, Alshammari ZF, Alhamdi RA, Alghaslan SA, Alshammari HF, Alshamry FF, Alshammari AH, Alhamdi MS. Knowledge and Awareness Regarding Osteoarthritis and Its Factors in Hail Region, Saudi Arabia. Cureus 2023; 15:e36557. [PMID: 37095817 PMCID: PMC10122111 DOI: 10.7759/cureus.36557] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
Objectives Osteoarthritis (OA) is a common chronic degenerative joint disease linked to age, joint overuse abnormalities, and previous trauma. This research aims to assess the awareness levels, as well as the knowledge gap and misconceptions, about OA and its risk factors among the general population in Hail, Saudi Arabia. Methods The research adopted an observational cross-sectional method. Participants from Hail, Saudi Arabia, were recruited and then interviewed between 1 April and 15 July 2022. Adult males and females aged 18 or more were recruited via an online questionnaire using a Google Form link, inviting them to take part in a study concerning their knowledge of OA. The questionnaire was split into three sections. The first section covered demographic data, the second section contained general knowledge regarding OA, and the third section was made up of a 20-item quiz. The collected data was reviewed and then analyzed using the Statistical Package for Social Sciences (SPSS) Version 21 (IBM Corp., Armonk, NY, USA). The statistical methods employed were all two-tailed, with an alpha level of 0.05 considered significant if the P value was less than, or equal to, 0.05. Results Nine hundred six (906) eligible respondents completed the questionnaire. Participants ranged from 18 to 65 in age. More than 66% were female, while 77.5% had a university level of education or above. 13.6% had been diagnosed with OA. Overall, 40.9% of the study participants demonstrated a good knowledge level regarding OA, while 59.1% showed a poor knowledge level. Conclusion The study revealed that the awareness and knowledge levels of the general population in Hail about OA are unsatisfactory. Efforts are recommended to increase the awareness and knowledge of the population through public education, which in turn can lead to a reduction in risk factors and improved early detection of the disease.
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Affiliation(s)
- Shog K Alahmed
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | - Ahmed M Mohyeldin
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | - Areeb Alshammari
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | - Ziyad F Alshammari
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | - Ruba A Alhamdi
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | | | - Hamad F Alshammari
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | - Fahad F Alshamry
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
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13
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Korhonen RK, Eskelinen ASA, Orozco GA, Esrafilian A, Florea C, Tanska P. Multiscale In Silico Modeling of Cartilage Injuries. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1402:45-56. [PMID: 37052845 DOI: 10.1007/978-3-031-25588-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Injurious loading of the joint can be accompanied by articular cartilage damage and trigger inflammation. However, it is not well-known which mechanism controls further cartilage degradation, ultimately leading to post-traumatic osteoarthritis. For personalized prognostics, there should also be a method that can predict tissue alterations following joint and cartilage injury. This chapter gives an overview of experimental and computational methods to characterize and predict cartilage degradation following joint injury. Two mechanisms for cartilage degradation are proposed. In (1) biomechanically driven cartilage degradation, it is assumed that excessive levels of strain or stress of the fibrillar or non-fibrillar matrix lead to proteoglycan loss or collagen damage and degradation. In (2) biochemically driven cartilage degradation, it is assumed that diffusion of inflammatory cytokines leads to degradation of the extracellular matrix. When implementing these two mechanisms in a computational in silico modeling workflow, supplemented by in vitro and in vivo experiments, it is shown that biomechanically driven cartilage degradation is concentrated on the damage environment, while inflammation via synovial fluid affects all free cartilage surfaces. It is also proposed how the presented in silico modeling methodology may be used in the future for personalized prognostics and treatment planning of patients with a joint injury.
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Affiliation(s)
- Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Atte S A Eskelinen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Gustavo A Orozco
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Amir Esrafilian
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Cristina Florea
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Petri Tanska
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
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14
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Kuppa SS, Kim HK, Kang JY, Lee SC, Seon JK. Role of Mesenchymal Stem Cells and Their Paracrine Mediators in Macrophage Polarization: An Approach to Reduce Inflammation in Osteoarthritis. Int J Mol Sci 2022; 23:13016. [PMID: 36361805 PMCID: PMC9658630 DOI: 10.3390/ijms232113016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022] Open
Abstract
Osteoarthritis (OA) is a low-grade inflammatory disorder of the joints that causes deterioration of the cartilage, bone remodeling, formation of osteophytes, meniscal damage, and synovial inflammation (synovitis). The synovium is the primary site of inflammation in OA and is frequently characterized by hyperplasia of the synovial lining and infiltration of inflammatory cells, primarily macrophages. Macrophages play a crucial role in the early inflammatory response through the production of several inflammatory cytokines, chemokines, growth factors, and proteinases. These pro-inflammatory mediators are activators of numerous signaling pathways that trigger other cytokines to further recruit more macrophages to the joint, ultimately leading to pain and disease progression. Very few therapeutic alternatives are available for treating inflammation in OA due to the condition's low self-healing capacity and the lack of clear diagnostic biomarkers. In this review, we opted to explore the immunomodulatory properties of mesenchymal stem cells (MSCs) and their paracrine mediators-dependent as a therapeutic intervention for OA, with a primary focus on the practicality of polarizing macrophages as suppression of M1 macrophages and enhancement of M2 macrophages can significantly reduce OA symptoms.
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Affiliation(s)
- Sree Samanvitha Kuppa
- Department of Biomedical Sciences, Chonnam National University Medical School, Hwasun 58128, Korea
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea
| | - Hyung Keun Kim
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea
| | - Ju Yeon Kang
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea
| | - Seok Cheol Lee
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea
| | - Jong Keun Seon
- Department of Biomedical Sciences, Chonnam National University Medical School, Hwasun 58128, Korea
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea
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15
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Bensalma F, Hagemeister N, Cagnin A, Ouakrim Y, Bureau NJ, Choinière M, Mezghani N. Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial. BMC Musculoskelet Disord 2022; 23:896. [PMID: 36199051 PMCID: PMC9533576 DOI: 10.1186/s12891-022-05845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Conventional radiography is commonly used to diagnose knee osteoarthritis (OA), but also to guide clinical decision-making, despite a well-established discordance between radiographic severity and patient symptoms. The incidence and progression of OA is driven, in part, by biomechanical markers. Therefore, these dynamic markers may be a good metric of functional status and actionable targets for clinicians when developing conservative treatment plans. The aim of this study was to assess the associations between biomechanical markers and self-reported knee function compared to radiographic severity. Methods This was a secondary analysis of data from a randomized controlled trial (RCT) conducted in primary care clinics with knee OA participants. Correlation coefficients (canonical (ρ) and structural (Corr)) were assessed between the Knee Injury and Osteoarthritis Outcome Score (KOOS) and both, radiographic OA severity using the Kellgren-Lawrence grade, and three-dimensional biomechanical markers quantified by a knee kinesiography exam. Significant differences between coefficients were assessed using Fischer’s z-transformation method to compare correlations from dependent samples. Results KOOS and biomechanical data were significantly more associated than KOOS and X-ray grading (ρ: 0.41 vs 0.20; p < 0.001). Structural correlation (Corr) between KOOS and X-ray grade was 0.202 (4% of variance explained), while individual biomechanical markers, such as the flexion during loading, explained up to 14% of KOOS variance (i.e., Corr2). Biomechanical markers showed the strongest associations with Pain and Activity of Daily Living KOOS subscales (both > 36% variance explained), while X-ray grading was most associated with Symptoms subscale (21% explained; all p ≤ 0.001). Conclusions Knee biomechanical markers are associated with patient-reported knee function to a greater extent than X-ray grading, but both provide complementary information in the assessment of OA patients. Understanding how dynamic markers relate to function compared to radiographic severity is a valuable step towards precision medicine, allowing clinicians to refine and tailor therapeutic measures by prioritizing and targeting modifiable biomechanical markers linked to pain and function. Trial registration Original RCT was approved by the Research Ethics Boards of École de technologie supérieure (H20150505) and Centre hospitalier de l’Université de Montréal (CHUM-CE.14.339), first registered at https://www.isrctn.com/ (ID-ISRCTN16152290) on May 27, 2015.
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Affiliation(s)
- Fatima Bensalma
- Université TÉLUQ, Centre de Recherche LICEF, 5800 Saint-Denis Str., #1105, Montreal, QC, H2S 3L4, Canada
| | - Nicola Hagemeister
- École de Technologie Supérieure, Laboratoire de Recherche en Imagerie Et Orthopédie, 900 Saint-Denis Str., R11-430, Montreal, QC, H2X 0A9, Canada
| | - Alix Cagnin
- École de Technologie Supérieure, Laboratoire de Recherche en Imagerie Et Orthopédie, 900 Saint-Denis Str., R11-430, Montreal, QC, H2X 0A9, Canada
| | - Youssef Ouakrim
- Université TÉLUQ, Centre de Recherche LICEF, 5800 Saint-Denis Str., #1105, Montreal, QC, H2S 3L4, Canada
| | - Nathalie J Bureau
- Centre Hospitalier de L'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Manon Choinière
- Centre Hospitalier de L'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Neila Mezghani
- Université TÉLUQ, Centre de Recherche LICEF, 5800 Saint-Denis Str., #1105, Montreal, QC, H2S 3L4, Canada.
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16
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Baria M, Pedroza A, Kaeding C, Durgam S, Duerr R, Flanigan D, Borchers J, Magnussen R. Platelet-Rich Plasma Versus Microfragmented Adipose Tissue for Knee Osteoarthritis: A Randomized Controlled Trial. Orthop J Sports Med 2022; 10:23259671221120678. [PMID: 36147791 PMCID: PMC9486262 DOI: 10.1177/23259671221120678] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Platelet-rich plasma (PRP) has been established as safe and effective for
knee osteoarthritis (OA). Another orthobiologic therapy, microfragmented
adipose tissue (MFAT), has gained attention because of its heterogeneous
cell population (including mesenchymal stem cells). However, prospective
comparative data on MFAT are lacking. Because of the safety, efficacy, and
simplicity of PRP, new therapeutics such as MFAT should be compared directly
with PRP. Purpose: To compare patient-reported outcomes of a single injection of PRP versus MFAT
for knee OA. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 58 patients with symptomatic knee OA (Kellgren-Lawrence grades
1-4) were randomized to receive a single injection of either leukocyte-rich
PRP or MFAT under ultrasound guidance. PRP was created by processing 156 mL
of whole blood. MFAT was created by harvesting 30 mL of adipose tissue via
standard lipoaspiration. Scores for the Knee injury and Osteoarthritis
Outcome Score (KOOS) subscales and visual analog scale for pain with
Activities of Daily Living (VAS-ADL) were recorded at baseline and at 1, 3,
and 6 months after the injection. The primary outcome was the KOOS–Pain
subscore at 6 months after the injection. Results: The PRP group (n = 30) had a mean volume of 5.12 ± 1.12 mL injected. This
consisted of a mean platelet count of 2673.72 ± 1139.04 × 103/µL
and mean leukocyte count of 25.36 ± 13.27 × 103/µL (67.81%
lymphocytes, 18.66% monocytes, and 12.33% neutrophils). The MFAT group (n =
28) had a mean volume of 7.92 ± 3.87 mL injected. The mean total nucleated
cell count was 3.56 ± 4.62 million/mL. In both groups, KOOS subscale and
VAS-ADL scores improved from baseline, and there was no significant
difference between the PRP and MFAT groups in the final KOOS–Pain subscore
(80.38 ± 16.07 vs 81.61 ± 16.37, respectively; P = .67) or
any other outcome score. Conclusion: A single injection of either PRP or MFAT resulted in a clinically meaningful
improvement for patients with knee OA at 6 months, with no difference
between treatment groups. Registration: NCT04351087 (ClinicalTrials.gov
identifier).
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Affiliation(s)
- Michael Baria
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Angela Pedroza
- Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | | | - Sushmitha Durgam
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Robert Duerr
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - David Flanigan
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - James Borchers
- Department of Family and Community Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Robert Magnussen
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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Kim HA. Osteoarthritis - Insights From Recent Research. JOURNAL OF RHEUMATIC DISEASES 2022; 29:132-139. [PMID: 37475969 PMCID: PMC10324928 DOI: 10.4078/jrd.2022.29.3.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 07/22/2023]
Abstract
Osteoarthritis (OA) is the most common form of arthritis and is a growing public health concern in the aging society. In rapidly aging societies such as in Korea, the increasing prevalence of OA may present serious new health issues. There is no treatment for OA that can either prevent or slow the progression of joint damage. For the development of effective therapeutics, precise understating of its pathogenesis is important. In this review, the current evidence of etiopathogenesis of OA is discussed. First, while epidemiologic study of OA are still dominated by reports from Western countries, findings from Korean epidemiologic studies are highlighted. Then, recent progresses in genetics, especially in the field of genome wide association study and mendelian randomization studies, are reviewed with focus on Asian population. Lastly, sex difference in pain etopathogenesis is reviewed. Studies of OA pathogenesis including epidemiology, genetics, animal model and pain signaling will aid in progress towards treatment of OA.
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Affiliation(s)
- Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Institute for Skeletal Aging, Hallym University, Chuncheon, Korea
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Rabey M, Moloney N. "I Don't Know Why I've Got this Pain!" Allostasis as a Possible Explanatory Model. Phys Ther 2022; 102:6535131. [PMID: 35202474 DOI: 10.1093/ptj/pzac017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/05/2021] [Accepted: 02/18/2022] [Indexed: 11/14/2022]
Abstract
UNLABELLED Explaining the onset and maintenance of pain can be challenging in many clinical presentations. Allostasis encompasses the mechanisms through which humans adapt to stressors to maintain physiological stability. Due to related neuro-endocrine-immune system effects, allostasis and allostatic load (the cumulative effects on the brain and body that develop through the maintenance of physiological stability) offer the potential to explain the development and maintenance of musculoskeletal pain in certain cases. This paper outlines the concept of allostatic load, highlights the evidence for allostatic load in musculoskeletal pain conditions to date, and discusses mechanisms through which allostatic load influences pain, with particular focus on hypothalamic-pituitary-adrenal axis and sympathetic nervous system function and central, brain-driven governance of these systems. Finally, through case examples, consideration is given as to how allostatic load can be integrated into clinical reasoning and how it can be used to help explain pain to individuals and guide clinical decision-making. IMPACT Awareness of the concept of allostatic load, and subsequent assessment of physical and psychological stressors potentially contributing to allostatic load, may facilitate a broader understanding of the multidimensional presentations of many people with pain, both acute and persistent. This may facilitate discussion between clinicians and their patients regarding broader influences on their presentations and drive more targeted and inclusive pain management strategies.
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Affiliation(s)
- Martin Rabey
- THRIVE Physiotherapy, St Martins, Guernsey, UK.,School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Niamh Moloney
- THRIVE Physiotherapy, St Martins, Guernsey, UK.,Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
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Factors Influencing Quality of Life Among Older Persons Living With Osteoarthritis Using 3 Different Definitions. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Berenbaum F, Schnitzer T, Kivitz A, Viktrup L, Johnston E, Yang R, Whalen E, Tive L, Semel D. Gender, age, disease severity, body mass index and diabetes may not affect response to subcutaneous tanezumab in patients with osteoarthritis after 16 weeks of treatment. A subgroup analysis of placebo-controlled trials. Int J Clin Pract 2021; 75:e14975. [PMID: 34626502 PMCID: PMC9285028 DOI: 10.1111/ijcp.14975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/23/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
AIM To assess the impact of pre-specified patient characteristics on efficacy and safety of subcutaneous tanezumab in patients with osteoarthritis (OA). METHODS Data were pooled from two (efficacy; N = 1545) or three (safety; N = 1754) phase 3 placebo-controlled trials. Change from baseline to week 16 in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, WOMAC Physical Function and patient global assessment of OA (PGA-OA) scores was compared between tanezumab (2.5 and 5 mg) and placebo groups via analysis of covariance. Treatment-emergent adverse events (TEAEs) were summarised descriptively. Analyses were done in patient subgroups (men or women; age <65, ≥65, or ≥75 years; body mass index [BMI] <25, 25 to <30, 30 to <35 or ≥35 kg/m2 ; diabetes or no diabetes; baseline WOMAC Pain score <7 or ≥7; and Kellgren-Lawrence [KL] grades 2, 3 or 4 in the index joint) and the overall population. RESULTS In all subgroups, improvements in WOMAC Pain were numerically greater and often statistically significant (P < .05) for both tanezumab groups compared with placebo. Results were similar for WOMAC Physical Function and PGA-OA. TEAE profiles were generally consistent across subgroups and similar to the overall population (ie slightly higher rates of TEAEs, serious TEAEs and severe TEAEs with tanezumab relative to placebo) with a few exceptions. Exceptions included women reporting slightly more TEAEs with tanezumab than men, and patients with diabetes reporting slightly more severe TEAEs with tanezumab than patients without diabetes. Additionally, TEAEs were more frequent with tanezumab than placebo in the age ≥65 and ≥75 years, but not the age <65 years, subgroups. CONCLUSIONS Efficacy and safety/tolerability of tanezumab may not be meaningfully impacted by gender, age, BMI, diabetes status, baseline pain severity or KL grade in the index joint. Conclusions are limited by low patient number in some subgroups. Clinicaltrials.gov: NCT02697773, NCT02709486, NCT01089725.
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Affiliation(s)
| | - Thomas Schnitzer
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Alan Kivitz
- Altoona Center for Clinical ResearchDuncansvillePennsylvaniaUSA
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Ulstein S, Årøen A, Engebretsen L, Forssblad M, Røtterud JH. Effect of Concomitant Meniscal Lesions and Meniscal Surgery in ACL Reconstruction With 5-Year Follow-Up: A Nationwide Prospective Cohort Study From Norway and Sweden of 8408 Patients. Orthop J Sports Med 2021; 9:23259671211038375. [PMID: 34722785 PMCID: PMC8549477 DOI: 10.1177/23259671211038375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background Increased knowledge of the factors predicting outcome after anterior cruciate ligament reconstruction (ACLR) is needed. Purpose To determine the effect of concomitant meniscal lesions, and the surgical management thereof, on patient-reported outcomes 5 years after ACLR. Study Design Prospective cohort study; Level of evidence, 2. Methods A total of 15,706 patients who underwent primary unilateral ACLR between 2005 and 2008 were enrolled prospectively and evaluated longitudinally. All patients were part of the Norwegian and Swedish national knee ligament registries. Outcomes at 5-year follow-up were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS). A multivariable linear regression model was used to assess possible effects on prognosis, as measured by KOOS, of a concomitant meniscal lesion and its associated surgical treatment. Results At a mean follow-up of 5.1 ± 0.2 years, KOOS data were available from 8408 patients: 4774 (57%) patients with no and 3634 (43%) patients with concomitant meniscal lesions (mean patient age, 33.8 ± 10.7 years). Patients with concomitant meniscal lesions reported equal crude mean scores compared with patients without meniscal lesions in all KOOS subscales 5 years after ACLR. The mean improvement in scores from preoperative to the 5-year follow-up was greater for patients with a concomitant meniscal lesion for the KOOS Pain, Activities of Daily Living (ADL), and Sport and Recreation subscales. In the adjusted regression analyses, using patients without concomitant meniscal lesions as the reference, neither no treatment nor resection or repair of medial meniscal lesions were significantly associated with KOOS scores 5 years after ACLR. Except for the ADL subscale, in which a repaired lateral meniscal lesion was associated with better outcome, no significant associations between any of the lateral meniscal lesion treatment categories and KOOS outcome at 5-year follow-up were identified. Conclusion Concomitant meniscal lesions at the time of ACLR conferred no negative effects on patient-reported outcomes 5 years after ACLR. The improvement in selected KOOS subscales from preoperative to the 5-year follow-up was significantly greater for patients with concomitant meniscal lesions than for patients without such lesions.
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Affiliation(s)
- Svend Ulstein
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway
| | - Asbjørn Årøen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Forssblad
- Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway
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