The Leptin Level in Development of Knee Osteoarthritis Disease

Subject: Knee Osteoarthritis (HOA) is known as degenerative cartilage cell disease in joint association with generation various inflammatory responses. This disease is more common in geriatrics and affected by many factors such as obesity. Leptin is hormones secreted by fatty tissue involve as a mediator in many pathophysiology processes, and supports inflammation at the cartilage of the knee joint. The objective of the Study: Role of the leptin concentration level in the progression of knee Osteoarthritis. Materials and Methods: This study was done on 60 patients with KOA disease and 60 healthy persons (control ), the all subject’s age within this study was more than 60 years of both genders. After obtained serum, immediately used quantity method (immunoassay) for the measured level of leptin concentration. Results: This study shows elevation of serum leptin concentration level in the KOA group compared with the healthy control group. Conclusion: This study confirms that serum leptin concentration level can act as support KOA disease progression.

Use of hyaluronic acid injection after arthroscopic release in lateral patellar compression syndrome with degenerative cartilage changes: randomized control trial

Background Degenerative cartilage changes can be seen, in cases of lateral patellar compression syndrome, involving the patellofemoral joint. Hyaluronic acid is a natural component of the synovial fluid and responsible for its elastic features and function of articular surfaces. The aim of this study is to show the effect of intra-articular injection of Hyaluronic acid, after arthroscopic lateral release in lateral patellar compression syndrome, on the functional outcome and knee pain in those patients with degenerative cartilage changes. Method Ninety patients age (30–50) years with lateral patellar compression syndrome and degenerative cartilage changes were divided randomly into 2 groups. Group A was treated by arthroscopic lateral release and received intraarticular injection of Hyaluronic acid 2 weeks after surgery. Group B was treated by arthroscopic lateral release only. Both groups were assessed by Kujala score and visual analogue scale for knee pain preoperatively and re-assessed postoperatively at 3 months, 6 months, 12 months and 24 months. Results There was significant improvement in Kujala score and Visual analogue scale post-operatively in both groups (P-value< 0.001) with better improvement in Kujala score in group A after intra-articular injection of Hyaluronic acid up to 2 year of follow up (P-value = 0.006) as well as better improvement in visual analogue score at 6 months post-operatively (P-value = 0.035). Conclusion Intra-articular injection of Hyaluronic acid after arthroscopic release, in patients with lateral patellar compression syndrome and degenerative cartilage changes, can result in better improvement of knee pain and functional outcome up to 2 years of follow up. Trial registration NCT, NCT04134611. Registered 18 October 2019 -Retrospectively registered.

Biological Properties and Pathological Stages of Chondrocyte Colony-Like Clusters in Human Osteoarthritic Cartilage Tissue

During the development of knee osteoarthritis(OA), chondrocyte colony-like clusters occur in cartilage tissue. However, the significance of chondrocyte colony-like cluster formation in cartilage tissue remains unclear. In these studies,we investigated the timing and location of chondrocyte colony-like clusters in cartilage tissue during the development of human knee OA,and explored the biological properties of chondrocytes in colony-like clusters and their significance for degenerative cartilage tissue. The resulte showed that chondrocyte colony-like clusters mainly formed in the OARSI grades 3 and 4 cartilage tissue,which could divide into four stages according to the quantity and biological properties of the chondrocytes inside the cluster.The chondrocyte colony-like clusters in cartilage tissue could cause the cartilage tissue to become looser and more porous, with more severe cartilage degeneration. To understand this, we further clarified the development of this disease and provided a new direction for the treatment of knee OA.

The menisci and articular cartilage: a life-long fascination

The menisci and articular cartilage of the knee have a close embryological, anatomical and functional relationship, which explains why often a pathology of one also affects the other. Traumatic meniscus tears should be repaired, when possible, to protect the articular cartilage. Traumatic articular cartilage lesions can be treated with success using biological treatment options such as microfracture or microdrilling, autologous chondrocyte transplantation (ACT), or osteochondral transplantation (OCT) depending on the depth and area of the lesion. Degenerative cartilage and meniscus lesions often occur together, and osteoarthritis is already present or impending. Most degenerative meniscus lesions should be treated first conservatively and, after failed conservative treatment, should undergo arthroscopic partial meniscus resection. Degenerative cartilage lesions should also be treated conservatively initially and then surgically; thereby treating the cartilage defect itself and also maintaining the axis of the leg if necessary. Tears of the meniscus roots are devastating injuries to the knee and should be repaired e.g. by transtibial re-fixation. The clinical role of ‘ramp’ lesions of the meniscus is still under investigation. Cite this article: EFORT Open Rev 2020;5:652-662. DOI: 10.1302/2058-5241.5.200016

Use of Hyaluronic Acid Injection after Arthroscopic Release in Lateral Patellar Compression Syndrome with Degenerative Cartilage Changes: Randomized Control Trial

BackgroundDegenerative cartilage changes can be seen, in cases of lateral patellar compression syndrome, involving the patellofemoral joint. Hyaluronic acid is a natural component of the synovial fluid and responsible for its elastic features and function of articular surfaces. The aim of this study is to show the effect of intra-articular injection of Hyaluronic acid, after arthroscopic lateral release in lateral patellar compression syndrome, on the functional outcome and knee pain in those patients with degenerative cartilage changes. MethodNinety patients age (30-50) years with lateral patellar compression syndrome and degenerative cartilage changes were divided randomly into 2 groups. Group A was treated by arthroscopic lateral release and received intrarticular injection of Hyaluronic acid 2 weeks after surgery. Group B was treated by arthroscopic lateral release only. Both groups were assessed by Kujala score and visual analogue scale for knee pain preoperatively and re-assessed postoperatively at 3 months, 6 months, 12 months and 24 months.ResultsThere was significant improvement in Kujala score and Visual analogue scale post-operatively in both groups (P-value<0.001) with better improvement in Kujala score in group A after intra-articular injection of Hyaluronic acid up to 2 year of follow up (P-value=0.006) as well as better improvement in visual analogue score at 6 months post-operatively (P-value=0.035)ConclusionIntra-articular injection of Hyaluronic acid after arthroscopic release, in patients with lateral patellar compression syndrome and degenerative cartilage changes, can result in better improvement of knee pain and functional outcome up to 2 years of follow up.Trial registration: NCT, NCT04134611. Registered 18 October 2019 -Retrospectively registered, https://www.clinicaltrials.gov/NCT04134611

Comparative Study OCT versus MRI T2 in Diagnosis of Degenerative Cartilage Lesions

BackgroundWhen diagnosed early, degenerative cartilage lesions are reversible if the appropriate therapeutical measures are applied. Currently available diagnostic methods (radiography, MRI and arthroscopic examination) do not provide the accuracy needed in the early diagnosis of these lesions.MethodsThe aim of the study is to analyse, in an ex vivo study on osteochondral fragments taken from patients undergoing total knee arthroplasty, weather the OCT technique is effective in detecting these lesions. The results will be compared to the preoperative MRI images (especially T2 mapping technique).ResultsThe percentage of the agreement between the two reviewers was 89% (8 out of 9 cases) during the OCT examination process.ConclusionOCT is a new technique potentially useful in the diagnosis of cartilage lesions. The possibility of performing it through minimally invasive techniques currently (arthroscopic surgery) further increases the value of this technique. OCT is a non-destructive diagnosing technique in degenerative cartilage lesions whose efficiency is comparable to MRI T2 technique and superior to conventional MRI.

Degenerative Cartilage Lesions of the Medial Knee Compartment. Associated Factors, Operative Options, and Preliminary Results from the CartilageRegistry DGOU

ZusammenfassungDegenerativ bedingte Knorpelschäden im medialen Kniekompartiment. Assoziierte Faktoren, operative Optionen und präliminäre Ergebnisse. Ergebnisse aus dem KnorpelRegister (DGOU). Zielsetzung Ziel dieser Untersuchung war es, den Stellenwert der knorpelregenerativen Behandlungen bei Patienten mit degenerativ bedingten Knorpelschäden des Kniegelenkes, vor allem bei Vorliegen von kombinierten Defekten, unter dem Aspekt der Versorgungsforschung anhand der Daten aus dem KnorpelRegister in Deutschland zu untersuchen. Material und Methode Das KnorpelRegister (DGOU) besteht seit dem Jahre 2013. Bis August 2016 wurden im Kniemodul des Registers insgesamt 1847 Behandlungsfälle erfasst, von denen 432 Patienten (23,3%) degenerativ bedingte Knorpelschäden im Bereich des medialen Kompartiments aufwiesen. Entsprechend den Präferenzen der verschiedenen an der Erfassung beteiligten Einrichtungen wurden bei diesen Patienten verschiedene Verfahren der knorpelregenerativen Therapie angewandt. Die Kontrolluntersuchungen ([Online-]Evaluation) erfolgte nach 6, 12 und 24 Monaten durch Befragung der subjektiven Patientenzufriedenheit und Bestimmung des KOOS (Knee injury and Osteoarthritis Outcome Score). Ergebnisse Insgesamt hatten 358 Patienten isolierte Defekte im Bereich des medialen Kondylus, 25 Patienten isolierte tibiale Defekte und bei den restlichen 49 Patienten lagen kombinierte Defekte (kissing lesions) vor. Unterschiede zwischen Männern und Frauen in Bezug auf die Defektpathologie gab es nicht, Patienten mit isolierten femoralen bzw. tibialen Defekten waren signifikant jünger als Patienten mit kombinierten Defekten. Tendenziell hatten Patienten mit einem tibialen Defekt eine kürzere Anamnesedauer. Als Therapie kam in 20,1% der Fälle die Knochenmarkstimulation, in 39,9% die autologe Knorpeltransplantation allein bzw. in 8,1% der Fälle die Knorpeltransplantation in Kombination mit einer Spongiosaplastik zur Anwendung. Sonstige Therapieverfahren waren Bohrung, osteochondrale Transplantationen, matrixassoziierte Mikrofrakturierung, Débridement. In 17,9% der Fälle erfolgten kombinierte Verfahren. Begleiteingriffe wurden bei 39,7% der Patienten mit einem isolierten femoralen, bei 56,0% der Patienten mit einem tibialen und in 67,6% bei kombinierten Defekten durchgeführt. Hierbei handelte es sich in den meisten Fällen um zusätzliche Tibiakopfosteotomien. Subjektiv waren Patienten mit einem femoralen Defekt signifikant häufiger sehr zufrieden/zufrieden, gefolgt von Patienten mit isoliertem Tibiadefekt. Am schlechtesten schlossen Patienten mit kombinierten Defekten ab. Der KOOS betrug zur Eingangsuntersuchung im Median 52 Punkte und stieg nach 6 Monaten auf 75, nach 12 Monaten auf 78 und nach 24 Monaten auf 80 Punkte an. Dabei zeigten Patienten mit einem isolierten femoralen Defekt tendenziell bessere Ergebnisse als die übrigen Patienten. Die Gesamtrevisionsrate betrug 7,1%. Schlussfolgerungen Die Daten zeigen, dass bei der Behandlung degenerativer Knorpelschäden des medialen Gelenkkompartiments des Kniegelenkes (Früharthrosen) durch knorpelregenerative Verfahren in solchen Fällen kurz- und mittelfristig akzeptable Ergebnisse erzielt werden können.