Enhanced articular cartilage regeneration with SIRT1-activated MSCs using gelatin-based hydrogel.

To investigate the functional effects of resveratrol (RSV) on mesenchymal stem cells (MSCs), we treated MSCs with RSV continuously during ex vivo expansion. MSCs were continuously treated with RSV from passage (P) 0 to P5. A proliferative capacity of RSV-treated MSCs was higher than that of non-treated MSCs and similar with P1-MSCs. Continuous treatment of RSV on MSCs increased the stemness and inhibited the senescence. During chondrogenic differentiation in vitro, RSV-treated MSCs had higher differentiation potential and reduced hypertrophic maturation, which are limitations for hyaline cartilage formation. The histological analysis of micromass demonstrated increased chondrogenic differentiation potential. We further explored the therapeutic effectiveness of this method in a rabbit osteochondral defect model. A rabbit osteochondral defect model was established to investigate the hyaline cartilage regeneration potential of RSV-treated MSCs. Moreover, the cartilage regeneration potential of RSV-treated MSCs was greater than that of untreated MSCs. The expression levels of chondrogenic markers increased and those of hypertrophic markers decreased in RSV-treated MSCs compared with untreated MSCs. Sustained treatment of RSV on MSCs during ex vivo expansion resulted in the maintenance of stemness and enhanced chondrogenic differentiation potential. Consequentially, highly efficient MSCs promoted superior hyaline cartilage regeneration in vivo. This novel treatment method provides a basis for cell-based tissue engineering.ope

Intra-articular Injections of Hyaluronic Acid on Osteochondral Lesions of the Talus After Failed Arthroscopic Bone Marrow Stimulation

Background: The purpose of the study was to compare clinical and functional outcomes before and after hyaluronic acid (HA) injections in patients with osteochondral lesions of the talus who experienced a failure of their primary treatment with arthroscopic microfracture surgery. Methods: A total of 40 patients were included in the final study. These patients had received microfracture surgery but continued to experience postoperative pain over an average of 13.0 months (range, 0-81 months) and were available for investigation with a mean follow-up for 29.1 months (SD 14.7; range 2.6-79.6 months). All patients received intra-articular injections of HA once per week for 3 weeks. We assessed clinical and functional outcomes before and after injection using the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Short Form Health Survey (SF-36), the visual analog scale (VAS) for pain, and the Alexander subjective scale. Results: The AOFAS score significantly increased from 50.7 ± 13.8 to 79.9 ± 13.8 and the FAOS scores for symptom, pain, daily living, and sports were significantly higher postinjection compared to preinjection (all P <.001). Similarly, the mean VAS for pain was significantly decreased after 6 weeks following injection and continued to decrease over the follow-up period; the mean VAS was significantly lower postinjection compared to preinjection at 12 months (P <.001). Conclusion: Intra-articular HA injections on average significantly improved clinical and functional scores after failed primary operative treatment. HA injections may provide an alternative to secondary operative treatment and provide better clinical outcomes than other conservative treatments. Level of Evidence: Level II, prospective observational cohort study. © The Author(s) 2020

Prospective Randomized Controlled Study of Hemostatic Efficacy with Kaolin-Impregnated Dressings in Diabetic Foot Ulcers Taking Anticoagulants Undergoing Debridement in an Outpatient Clinic

Background. The effective hemostasis after minor debridement in an outpatient clinic is important and essential. This study is aimed at evaluating the hemostatic efficacy and safety of the kaolin-impregnated dressing for diabetic foot ulcer patient who take an anticoagulant. Methods. A prospective, randomized, clinical trial study was performed in twenty-six patients with diabetic foot ulcers who take an anticoagulant requiring minor debridement in an outpatient clinic. Minor debridement and removal of break down skin were performed by one orthopedic surgeon. Hemostasis on wound bed was achieved using kaolin-impregnated gauze (study group) and standard sterilized dry gauze (control group). Two randomized groups were compared for hemostatic efficacy and side effect. Results. For the purpose of this study, the presence or absence of hemostasis was assessed at 5 and 10 minutes after the application of dressing material. Treatment was evaluated as successful if bleeding was ceased adequately, and no extra hemostatic measures were required within 10 minutes. At 5 minutes, 80% of patients using the kaolin-impregnated gauze successfully achieved complete hemostasis versus 40% in the control group that controlled bleeding partially. With kaolin-impregnated gauze, 100% of patients show complete hemostasis at 10 minutes versus 58.3% in the standard gauze (P<.001). An adverse effect was not noted in all patients. Conclusions. The use of kaolin-impregnated gauze appears to be a safe and feasible option in managing bleeding after debridement of diabetic foot ulcers, and merits to patient who had a bleeding tendency is high. This trial is registered with CRIS registration number KCT0003894

Detection of the Tram Track Lesion in the Ankle Joint: Comparing 3.0-Tesla Magnetic Resonance Imaging and Arthroscopy

PURPOSE: To show the effectiveness of magnetic resonance imaging (MRI) for the detection of tram track lesions in the ankle compared with ankle arthroscopy. METHODS: We retrospectively assessed all patients who underwent arthroscopic ankle surgery between January 2013 and July 2015. Patients with anterior impingement spurs were included, but those with an osteochondral lesion or arthritis were excluded. Anterior ankle bony spurs on preoperative weight-bearing radiographs were scored using an impingement classification system. The 3.0-tesla MRIs were reviewed for tram track lesions (defined as focal high signal intensity along the talar dome cartilage surface on coronal views) and compared with arthroscopic findings. The cartilage defect grade at arthroscopy was stratified according to the International Cartilage Repair Society (ICRS) grading system. RESULTS: Overall, 175 ankles in 170 patients were evaluated. Tram track lesions were identified on MRI in 14 ankles (8.0%) and at arthroscopy in 16 ankles (9.1%). The overall sensitivity of MRI for the detection of tram track lesions was 87.5% and the specificity was 100%. On plain weight-bearing radiographs, of the 16 patients with confirmed tram track lesions on arthroscopy, 4 patients had grade 1, 2 had grade 2, and 10 had grade 3 impingement spurs. Under the ICRS grading system, 4 patients had grade II, 4 had grade III, and 8 had grade IV cartilage defects at arthroscopy. On MRI, 2 patients had grade II (50% of arthroscopy), 4 had grade III (100% of arthroscopy), and 8 had grade IV defects (100% of arthroscopy). The impingement spur grade showed no significant correlation with the arthroscopic ICRS grade of the tram track lesion (P = .609). CONCLUSION: Tram track lesions can be confidently detected on MRI with high sensitivity and specificity. The impingement spur grade did not correlate with the severity of cartilage injury of the talar dome. LEVEL OF EVIDENCE: Level III, diagnostic evaluation study.restrictio

Short-term Clinical and Radiographic Results of the Salto Mobile Total Ankle Prosthesis

BACKGROUND: The mobile-bearing Salto total ankle prosthesis has been reported to have promising outcomes. However, clinical reports on this prosthesis are few, and most have been published by the inventors and disclosed consultants. METHODS: We retrospectively reviewed 59 patients who received Salto prosthesis unilaterally. The average follow-up was 35.9 (range, 6-56) months. Clinical and radiologic results were evaluated. Clinical results were evaluated according to visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS) pain and disability score, and ankle range of motion (ROM) in dorsiflexion/plantarflexion. In the radiographic evaluation, we measured the tibial angle (TA), talar angle (TAL), tibial slope, and talocalcaneal angle (TCA) on weightbearing radiographs. RESULTS: By the last follow-up, 7 of 59 patients (11.9%) had undergone reoperation, and 3 of 59 implants (5.1%) had been removed. The prosthesis survival was 94.9% (95% CI, 89.1%-100%). With any reoperation as the endpoint of follow-up, the clinical success rate was 88.1% (95% CI, 79.4%-96.9%). The mean postoperative visual analog scale score, AOFAS ankle-hindfoot score, and Ankle Osteoarthritis Scale pain and disability score improved significantly ( P < .001). The ankle range of motion also improved from preoperative 33.4 +/- 16.6 to 40.3 +/- 15.5 postoperatively ( P < .001); however, there was no statistically significant change in plantarflexion ( P = .243). Radiolucent areas and osteolysis were found in 28 (47.5%) and 27 (45.8%) patients, respectively. Heterotopic ossification was observed in 13 patients (22.0%). CONCLUSIONS: In this series, early clinical and radiographic outcomes of this prosthesis were promising. We believe the early radiolucent lines were probably due to the gap at the implant and bone interface, and they disappeared at the time of osseous integration. However, longer follow-up is necessary to determine the long-term durability and survivorship of this implant, particularly given the high incidence of postoperative osteolysis. LEVEL OF EVIDENCE: Level IV, case series.restrictio

Primary Versus Secondary Osteochondral Autograft Transplantation for the Treatment of Large Osteochondral Lesions of the Talus

BACKGROUND: Recent studies have reported promising clinical results after osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the talus (OLT). However, no study has yet compared clinical outcomes between primary and secondary OAT for large OLT. PURPOSE: To compare clinical outcomes among patients with large OLT who receive primary OAT versus those who receive secondary OAT after failure of marrow stimulation and to identify factors associated with clinical failure. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From 2005 to 2014, 46 patients with large OLT (>/=150 mm(2)) underwent OAT: 18 underwent OAT as initial surgical management (primary OAT group), and 28 patients underwent secondary OAT after failure of previous arthroscopic marrow stimulation (secondary OAT group). In both groups, OAT procedures included arthroscopic inspection and debridement of concomitant soft tissue injuries. Clinical outcomes were assessed using pain visual analog scale (VAS), the Roles and Maudsley score, Foot and Ankle Outcome Scores (FAOS), and revisional surgery rates. Factors associated with clinical failures were evaluated using bivariate and logistic regression analyses. Survival outcomes were compared using Kaplan-Meier analysis. RESULTS: Mean follow-up time was 6 years (range, 2-10.8 years). Mean lesion size was 194.9 mm(2) (range, 151.7-296.3 mm(2)). There were no significant differences between groups in patient demographics and preoperative findings. Postoperative pain VAS, Roles and Maudsley score, FAOS, and revisional surgery rates were not significantly different at last follow-up. Prior marrow stimulation was not significantly associated with clinical failure on bivariate analysis. Lesion size greater than 225 mm(2) on preoperative magnetic resonance imaging was significantly associated with clinical failure. Survival probabilities from Kaplan-Meier plots were not significantly different between the primary and secondary OAT groups ( P = .947). CONCLUSION: Clinical outcomes of patients with large OLT treated with secondary OAT after failed marrow stimulation were found to be comparable with those who were treated with primary OAT. These results may be helpful to orthopaedic surgeons deciding appropriate surgical options for patients with large OLT.restrictio