Validity and reliability of the Thai version of the Achilles tendon total rupture score

PURPOSE

The purpose of this study was to translate and cross-culturally adapt the Achilles Tendon Total Rupture Score (ATRS), a patient-reported outcome measurement (PROM) designed specifically to assess outcomes in patients with Achilles tendon rupture, into the Thai language and then determine its validity and reliability.

METHODS

The ATRS was translated into the Thai version (Thai-ATRS) according to internationally recognized guidelines. The study included 50 patients with Achilles tendon rupture from 2003 to 2017. The web-based online assessments were conducted two weeks apart. Construction validity was determined by assessing the correlation between the Thai-ATRS and the Thai version of the Foot and Ankle Outcome Score (Thai-FAOS). Reliability was determined with Cronbach's alpha and intraclass correlation coefficients (ICC).

RESULTS

The validity test displayed a strong correlation between the Thai-ATRS and the Thai-FAOS (r = 0.87). The reliability test showed good internal consistency with a Cronbach's alpha of 0.95 and excellent internal consistency with an ICC of 0.95, which represented excellent test-retest reliability. The MDC was 10.7 at the individual level and 1.5 at the group level.

CONCLUSION

The Thai-ATRS was demonstrated to be valid and reliable for assessing functional outcomes in Thai patients with Achilles tendon rupture.

LEVEL OF EVIDENCE

II.

A novel gelatin/chitooligosaccharide/demineralized bone matrix composite scaffold and periosteum-derived mesenchymal stem cells for bone tissue engineering

Background

A novel biodegradable scaffold including gelatin (G), chitooligosaccharide (COS), and demineralized bone matrix (DBM) could play a significant part in bone tissue engineering. The present study aimed to investigate the biological characteristics of composite scaffolds in combination of G, COS, and DBM for in vitro cell culture and in vivo animal bioassays.

Methods

Three-dimensional scaffolds from the mixture of G, COS, and DBM were fabricated into 3 groups, namely, G, GC, and GCD using a lyophilization technique. The scaffolds were cultured with mesenchymal stem cells (MSCs) for 4 weeks to determine biological responses such as cell attachment and cell proliferation, alkaline phosphatase (ALP) activity, calcium deposition, cell morphology, and cell surface elemental composition. For the in vivo bioassay, G, GC, and GCD, acellular scaffolds were implanted subcutaneously in 8-week-old male Wistar rats for 4 weeks and 8 weeks. The explants were assessed for new bone formation using hematoxylin and eosin (H&E) staining and von Kossa staining.

Results

The MSCs could attach and proliferate on all three groups of scaffolds. Interestingly, the ALP activity of MSCs reached the greatest value on day 7 after cultured on the scaffolds, whereas the calcium assay displayed the highest level of calcium in MSCs on day 28. Furthermore, weight percentages of calcium and phosphorus on the surface of MSCs after cultivation on the GCD scaffolds increased when compared to those on other scaffolds. The scanning electron microscopy images showed that MSCs attached and proliferated on the scaffold surface thoroughly over the cultivation time. Mineral crystal aggregation was evident in GC and greatly in GCD scaffolds. H&E staining illustrated that G, GC, and GCD scaffolds displayed osteoid after 4 weeks of implantation and von Kossa staining confirmed the mineralization at 8 weeks in G, GC, and GCD scaffolds.

Conclusion

The MSCs cultured in GCD scaffolds revealed greater osteogenic differentiation than those cultured in G and GC scaffolds. Additionally, the G, GC, and GCD scaffolds could promote in vivo ectopic bone formation in rat model. The GCD scaffolds exhibited maximum osteoinductive capability compared with others and may be potentially used for bone regeneration.

Clinical outcomes of chronic Achilles tendon rupture treated with flexor hallucis longus grafting and flexor hallucis longus grafting plus additional augmentation: A meta-analysis

BACKGROUND

The treatment of chronic Achilles tendon rupture is still controversial. Many surgical procedures have been proposed and claim to have good post-operative clinical outcomes. These techniques include direct repair, V-Y flap, turndown flap, peroneus brevis tendon graft, flexor digitorum longus graft, FHL graft, semitendinosus graft, gracilis tendon graft or synthetic material. The two surgical techniques that are widely used include FHL grafting and the combination of FHL grafting plus additional augmentation. This meta-analysis was conducted with the purpose of comparing clinical outcomes of flexor hallucis longus (FHL) grafting and the combination of FHL grafting with additional augmentation techniques in the treatment of chronic Achilles tendon rupture.

METHODS

Systematic literature searches were conducted on Medline, Embase and Scopus from their inception to April 4, 2019, and proceedings of reference list and scientific meetings were also searched. Relevant clinical studies (e.g., observational, cross-sectional, cohort or randomized controlled trial (RCT)) that reported AOFAS (American Orthopedic Foot Ankle Score) and postoperative complications of either technique were identified.

RESULTS

Six studies (N = 68) were included for the analysis of FHL, and six studies (N = 124) were included for analysis of FHL with augmentation. A pooling of mean and standard deviation of preoperative and postoperative AOFAS were 57.09 (3.63), 92.97 (22.67) in FHL group and 66.92 (3.16), 95.25 (4.71) in FHL with additional augmentation group respectively. The pooled UMD of AOFAS in FHL with additional augmentation were 2.28 (-1.86, 6.42) scores higher when compared to the FHL group. The prevalence of complications in FHL and FHL with additional augmentation were 14 (N = 120) and 10 (N = 63) patients. The chance of having complications of FHL with additional augmentation group was 0.74 (95% CI: 0.35, 1.56) lower than FHL group. However, there is no statistically significant difference.

CONCLUSIONS

FHL with additional augmentation group has higher foot function scores (AOFAS) and lower complications when compared to the FHL group. However this did not reach to statistically significant. Further research that assesses a larger sample size of RCTs is necessary to further evaluate FHL with additional augmentation and FHL in the treatment of chronic Achilles tendon rupture.

New aspect of morphometric study of the superior peroneal retinaculum: pertinent data for surgical repair and reconstruction

BACKGROUND

This study was conducted to investigate characteristics, attachments and morphometric parameters of the superior peroneal retinaculum (SPR).

MATERIALS AND METHODS

Morphology and morphometric details including width, length, thickness and angle of alignment of SPR in 109 embalmed cadaveric legs were investigated. The occurrence of peroneal tendon tear was also noted.

RESULTS

Most of SPR originated from the fibrocartilaginous ridge of the lateral malleolus. The SPR might be a single band or split into proximal and distal bands inserted on the posterior intermuscular septum and lateral wall of calcaneus, respectively. Based on the characteristics and insertion patterns, the SPR could be divided into 3 types: type I (double band with subtype Ia and Ib), type II (single band) and type III (single band) with the prevalence of 56.88% (12.84%, 44.04%), 1.83%, and 41.28%, respectively. The average coordinate (X, Y axis) of the midpoint of width at origin measured from the tip of fibula in all types was 7.26±3.15 and 10.45±4.52 mm. The average coordinate of the midpoint at insertion on the posterior intermuscular septum was 24.06±4.94 and 13.35±5.18, and those inserted on the lateral wall of calcaneus was 21.45±7.88 and 13.59±6.73 mm. Prevalence of peroneus brevis (PB) tendon tear was 12.84% (14 cases) and was associated with SPR type Ib with statistical significance.

CONCLUSIONS

Precise information of the characteristics, morphometric data and coordinates of attachment sites of SPR are essential for surgical procedures and reconstruction.

Osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells encapsulated in Thai silk fibroin/collagen hydrogel: a pilot study in vitro

Background

Silk fibroin (SF) can be processed into a hydrogel. SF/collagen hydrogel may be a suitable biomaterial for bone tissue engineering.

Objectives

To investigate in vitro biocompatibility and osteogenic potential of encapsulated rat bone marrow-derived mesenchymal stem cells (rat MSCs) in an injectable Thai SF/collagen hydrogel induced by oleic acid–poloxamer 188 surfactant mixture in an in vitro pilot study.

Methods

Rat MSCs were encapsulated in 3 groups of hydrogel scaffolds (SF, SF with 0.05% collagen [SF/0.05C], and SF with 0.1% collagen [SF/0.1C]) and cultured in a growth medium and an osteogenic induction medium. DNA, alkaline phosphatase (ALP) activity, and calcium were assayed at periodically for up to 5 weeks. After 6 weeks of culture the cells were analyzed by scanning electron microscopy and energy dispersive spectroscopy.

Results

Although SF hydrogel with collagen seems to have less efficiency to encapsulate rat MSCs, their plateau phase growth in all hydrogels was comparable. Inability to maintain cell viability as cell populations declined over 1–5 days was observed. Cell numbers then plateaued and were maintained until day 14 of culture. ALP activity and calcium content of rat MSCs in SF/collagen hydrogels were highest at day 21. An enhancing effect of collagen combined with the hydrogel was observed for proliferation and matrix formation; however, benefits of the combination on osteogenic differentiation and biomineralization are as yet unclear.

Conclusion

Rat MSCs in SF and SF/collagen hydrogels showed osteogenic differentiation. Accordingly, these hydrogels may serve as promising scaffolds for bone tissue engineering.

Unusual accessory peroneal muscles, peroneus quartus, peroneus digiti quinti, and their association with peroneus brevis tendon tear

Background

Anatomic variation and supernumerary contents in the superior peroneal tunnel, and the prominence of the retrotrochlear eminence and peroneal tubercle are related to peroneal tendon disorders.

Objectives

To investigate the prevalence, origin, and insertion of accessory peroneal muscles, the prominence of the retrotrochlear eminence and peroneal tubercle, and their association with peroneal tendon tears.

Methods

We examined 109 formalin-embalmed legs of cadavers from Thai donors. Accessory peroneal muscles and peroneal tendon tears were noted. Associations with peroneal tendon tears were evaluated using a χ2 test.

Results

We found 48 accessory peroneal muscles comprising 13 peroneus quartus (PQ), 33 peroneus digiti quinti (PDQ), and 2 unusual muscles. All PDQ originated from the PB tendon and inserted on various parts of the 5th toe. The PQ originated mostly from the PB muscle belly and less from the tendinous part with various insertions on the retrotrochlear eminence, peroneal tubercle, cuboid, and dorsolateral surface of the 5th metatarsal base. Two unusual accessory muscles were identified, 1 coexisting with the PQ. A PB tendon tear was found in 13% of specimens. We found no association between the peroneal tendon tears and the accessory peroneal muscles, or prominence of the retrotrochlear eminence or peroneal tubercle.

Conclusions

The prevalence of PQ, PDQ, and unusual accessory peroneal muscles was concordant with previous findings. We noted a new type of unusual accessory peroneal muscle coexisting with the PQ. No association was found between peroneal tendon tears and the PQ, PDQ, or prominence of the retrotrochlear eminence or peroneal tubercle.

Morphometric study of inferior peroneal retinaculum and contents of inferior peroneal tunnel

BACKGROUND

The aims of this study are to investigate the inferior peroneal retinaculum (IPR) regarding morphometric parameters, and contents in the inferior peroneal tunnel (IPT).

MATERIALS AND METHODS

One hundred and nine embalmed cadaveric legs were dissected in prone position.

RESULTS

The extension band of the IPR was found in 31.19% of cases. The mean of length, width at the origin, width at the middle part, width at the insertion, and thickness of the IPR [mm] were 23.42 ± 3.54 (17.05-33.68), 13.29 ± 2.56 (5.83-20.92), 14.50 ± 2.37 (6.68-21.34), 10.10 ± 2.63 (4.59-19.17) and 0.48 ± 0.16 (0.20-0.87), respectively. The angle of the IPR to the horizontal axis was 38.51 ± 7.07 (11.67-54.00) degrees. The IPT was divided into the upper and lower tunnels. The normal contents were the tendons of peroneus brevis and peroneus longus in the upper and lower tunnels, respectively. However, additional contents were found in the upper tunnel in 2 cases. One was the tendon of peroneus digiti quinti, and peroneus quartus in the other one. Moreover, an unusual accessory peroneal muscle coursed into the lower tunnel and inserted on the peroneal tubercle. Tears of the peroneus brevis tendon were observed in 2 cases.

CONCLUSIONS

These morphometric data might be beneficial in surgical repair for IPR injury.

Functional and T Cell Receptor Repertoire Analyses of Peripheral Blood and Infrapatellar Fat Pad T Cells in Knee Osteoarthritis

Objective.

Osteoarthritis (OA) is a condition that features inflammation and immune responses of innate and adaptive immunity. The role of T cells in knee OA pathogenesis is still unclear. Our aim was to characterize T cell functions and their clonality in patients with knee OA in peripheral blood (PB) and infrapatellar fat pads (IPFP).

Methods.

We isolated T cells from PB and IPFP of patients with knee OA and PB of healthy individuals and determined soluble mediators produced from these cells. In addition, we performed a clonal analysis of activated CD8+ T cells and compared the T cell receptor β-variable gene chain (TRBV) usages between T cells in PB and IPFP of patients with knee OA.

Results.

Our results suggest that in patients with knee OA, circulating T cells possess a more “cytotoxic” profile or rather impaired cytokine production, but the knee microenvironment allows for these T cells to produce proinflammatory cytokines [interleukin (IL)-1β, IL-6, tumor necrosis factor], IL-17, and interferon-γ within IPFP. Activated CD8+ IPFP T cells carry different repertoire distribution from those present in PB of patients with knee OA. Shared TRBV usage of activated CD8+ IPFP T cells among the 3 patients with knee OA was also observed.

Conclusion.

Our study describes the nature of T cells in knee OA that may be due to “unhealthy” aging or other factors that drive healthy aging T cells into a state of imbalance, thus contributing to the pathogenesis of knee OA.