Latest CORR Articles - Orthopaedia

Devoted to disseminating new and important orthopaedic knowledge,Clinical Orthopaedics and Related Research (CORR) is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons. CORR brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. Learn more about CORR.

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Femoral Shortening During Hip Arthroplasty Through a Modified Lateral Approach Abstract We describe a modification of the direct lateral approach to the hip that provides excellent femoral and acetabular exposure and an easy way to shorten the proximal femur and equalize leg length. The approach also is useful for lower extremity elongation while preserving muscle continuity and minimizing postoperative complications. The exact amount of shortening can be calculated and planned preoperatively and measured and corrected intraoperatively if necessary. It avoids the necessity for osteotomies of the trochanter and transverse cuts or detachment of abductor muscles. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. Content Type Journal Article Category Multimedia Article DOI 10.1007/s11999-008-0292-6 Authors Domagoj Delimar, University of Zagreb, Clinical Hospital Centre Zagreb Department of Orthopaedic Surgery, School of Medicine Salata 7 10000 Zagreb Croatia Goran Bicanic, University of Zagreb, Clinical Hospital Centre Zagreb Department of Orthopaedic Surgery, School of Medicine Salata 7 10000 Zagreb Croatia Kresimir Korzinek, University of Zagreb, Clinical Hospital Centre Zagreb Department of Orthopaedic Surgery, School of Medicine Salata 7 10000 Zagreb Croatia Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
The Basic Science of Tendinopathy Abstract Tendinopathy is a common clinical problem with athletes and in many occupational settings. Tendinopathy can occur in any tendon, often near its insertion or enthesis where there is an area of stress concentration, and is directly related to the volume of repetitive load to which the tendon is exposed. Recent studies indicate tendinopathy is more likely to occur in situations that increase the “dose” of load to the tendon enthesis – including increased activity, weight, advancing age, and genetic factors. The cells in tendinopathic tendon are rounder, more numerous, and show evidence of oxidative damage and more apoptosis. These cells also produce a matrix that is thicker and weaker with more water, more immature and cartilage-like matrix proteins, and less organization. There is now evidence of a population of regenerating stem cells within tendon. These studies suggest prevention of tendinopathy should be directed at reducing the volume of repetitive loads to below that which induces oxidative-induced apoptosis and cartilage-like genes. The management strategies might involve agents or cells that induce tendon stem cell proliferation, repair and restoration of matrix integrity. Content Type Journal Article Category Symposium: Molecular and Clinical Developments in Tendinopathy DOI 10.1007/s11999-008-0286-4 Authors Yinghua Xu, University of New South Wales Orthopaedic Research Institute, The St. George Hospital Level 2, 4-10 South Street, Kogarah Sydney NSW 2217 Australia George A. C. Murrell, University of New South Wales Orthopaedic Research Institute, The St. George Hospital Level 2, 4-10 South Street, Kogarah Sydney NSW 2217 Australia Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Risk factors for Periprosthetic Fractures of the Hip: A Survivorship Analysis Abstract Periprosthetic fracture is an uncommon but typically complex complication of cemented THA usually treated operatively. It is a source of reduced function, subsequent morbidity, and increased mortality. Previous studies may have underestimated the incidence of fracture through loss to followup or failure to use survivorship methodologies. The primary aim of this study was to use survivorship methodology to investigate the incidence of, and risk factors for fracture following primary arthroplasty. We examined a cohort of 6458 primary cemented femoral prostheses implanted during a 17-year period. One hundred twenty-four patients sustained fractures at the tip or below the femoral prosthesis. The incidence of fracture was 0.8% at 5 years and 3.5% at 10 years after primary implant. Patients older than 70 years had a 2.9 times greater risk of sustaining a subsequent fracture. There was no association between fracture and gender or implant type. These rates are higher than those reported for cemented arthroplasties. Older patients should be counseled regarding their higher risk of periprosthetic fracture, and additional research is required to elucidate the biologic mechanisms involved. Level of Evidence: Level II, retrospective prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. Content Type Journal Article Category Original Article DOI 10.1007/s11999-008-0289-1 Authors R. E. Cook, Royal Infirmary of Edinburgh Elective Arthroplasty Unit and the Orthopaedic Trauma Unit Old Dalkeith Road Edinburgh EH16 4SU Scotland, UK P. J. Jenkins, Royal Infirmary of Edinburgh Elective Arthroplasty Unit and the Orthopaedic Trauma Unit Old Dalkeith Road Edinburgh EH16 4SU Scotland, UK P. J. Walmsley, Royal Infirmary of Edinburgh Elective Arthroplasty Unit and the Orthopaedic Trauma Unit Old Dalkeith Road Edinburgh EH16 4SU Scotland, UK J. T. Patton, Royal Infirmary of Edinburgh Elective Arthroplasty Unit and the Orthopaedic Trauma Unit Old Dalkeith Road Edinburgh EH16 4SU Scotland, UK C. M. Robinson, Royal Infirmary of Edinburgh Elective Arthroplasty Unit and the Orthopaedic Trauma Unit Old Dalkeith Road Edinburgh EH16 4SU Scotland, UK Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Coordinate Regulation of IL-1β and MMP-13 in Rat Tendons Following Subrupture Fatigue Damage Abstract Mechanical overloading is a major causative factor of tendinopathy; however, its underlying mechanisms are unclear. We hypothesized mechanical overloading would damage tendons and alter genes associated with tendinopathy in a load-dependent manner. To test this hypothesis, we fatigue loaded rat patellar tendons in vivo and measured expression of the matrix-degrading enzyme MMP-13 and the inflammatory cytokine IL-1β. We also examined these responses in cultured tenocytes exposed to intermittent hydrostatic pressure in vitro. Additionally, we hypothesized load-induced changes in tenocyte MMP-13 expression would be dependent on expression of IL-1β. In vivo fatigue loading at 1.7% strain caused overt microstructural damage and upregulated expression of MMP-13 and IL-1β, while 0.6% strain produced only minor changes in matrix microstructure and downregulated expression of both MMP-13 and IL-1β. Loading of cultured tenocytes at 2.5 and 7.5 MPa produced comparable changes in expression to those of in vivo tendon loading. Blocking IL-1β expression with siRNA suppressed load-induced both MMP-13 mRNA expression and activity. The data suggest fatigue loading alters expression of MMP-13 and IL-1β in tendons in vivo and tenocytes in vitro in a load-dependent manner. The data also suggest MMP-13 is regulated by both IL-1β-dependent and IL-1β-independent pathways. Content Type Journal Article Category Symposium: Molecular and Clinical Developments in Tendinopathy DOI 10.1007/s11999-008-0278-4 Authors Hui B. Sun, Mount Sinai School of Medicine Leni and Peter May Department of Orthopaedics 5 East 98th Street, 9th Floor New York NY 10029 USA Yonghui Li, Mount Sinai School of Medicine Leni and Peter May Department of Orthopaedics 5 East 98th Street, 9th Floor New York NY 10029 USA David T. Fung, Mount Sinai School of Medicine Leni and Peter May Department of Orthopaedics 5 East 98th Street, 9th Floor New York NY 10029 USA Robert J. Majeska, Mount Sinai School of Medicine Leni and Peter May Department of Orthopaedics 5 East 98th Street, 9th Floor New York NY 10029 USA Mitchell B. Schaffler, Mount Sinai School of Medicine Leni and Peter May Department of Orthopaedics 5 East 98th Street, 9th Floor New York NY 10029 USA Evan L. Flatow, Mount Sinai School of Medicine Leni and Peter May Department of Orthopaedics 5 East 98th Street, 9th Floor New York NY 10029 USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Fresh Osteochondral Allografts for Posttraumatic Knee Defects: Long-term Followup Abstract Fresh osteochondral allograft transplantation has been an effective treatment option with promising long-term clinical outcomes for focal posttraumatic defects in the knee for young, active individuals. We examined histologic features of 35 fresh osteochondral allograft specimens retrieved at the time of subsequent graft revision, osteotomy, or TKA. Graft survival time ranged from 1 to 25 years based on their time to reoperation. Histologic features of early graft failures were lack of chondrocyte viability and loss of matrix cationic staining. Histologic features of late graft failures were fracture through the graft, active and incomplete remodeling of the graft bone by the host bone, and resorption of the graft tissue by synovial inflammatory activity at graft edges. Histologic features associated with long-term allograft survival included viable chondrocytes, functional preservation of matrix, and complete replacement of the graft bone with the host bone. Given chondrocyte viability, long-term allograft survival depends on graft stability by rigid fixation of host bone to graft bone. With the stable osseous graft base, the hyaline cartilage portion of the allograft can survive and function for 25 years or more. Content Type Journal Article Category Symposium: New Approaches to Allograft Transplantation DOI 10.1007/s11999-008-0282-8 Authors A. E. Gross, Pathology and Laboratory Medicine Division of Orthopaedic Surgery, Mount Sinai Hospital Suite 476A, 600 University Ave. Toronto ON Canada M5G 1X5 W. Kim, Pathology and Laboratory Medicine Division of Orthopaedic Surgery, Mount Sinai Hospital Suite 476A, 600 University Ave. Toronto ON Canada M5G 1X5 F. Las Heras, Pathology and Laboratory Medicine Division of Orthopaedic Surgery, Mount Sinai Hospital Suite 476A, 600 University Ave. Toronto ON Canada M5G 1X5 D. Backstein, Pathology and Laboratory Medicine Division of Orthopaedic Surgery, Mount Sinai Hospital Suite 476A, 600 University Ave. Toronto ON Canada M5G 1X5 O. Safir, Pathology and Laboratory Medicine Division of Orthopaedic Surgery, Mount Sinai Hospital Suite 476A, 600 University Ave. Toronto ON Canada M5G 1X5 K. P. H. Pritzker, Pathology and Laboratory Medicine Division of Orthopaedic Surgery, Mount Sinai Hospital Suite 476A, 600 University Ave. Toronto ON Canada M5G 1X5 Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Extraarticular Fractures after Periacetabular Osteotomy Abstract Extraarticular fractures of the pelvic ring after periacetabular osteotomy could impair stability of the acetabular fragment and cause poor clinical and radiographic outcomes. We evaluated 17 patients (17 hips) with fractures of either the ipsilateral os pubis (n = 12) or os ischium (n = 5) during the postoperative period after periacetabular osteotomy. Ischial fractures seemed more debilitating with two of five resulting in painful nonunions for which additional surgery was performed. In contrast, only one patient with pubic fracture had additional surgery. Ischial fractures took almost twice as long to achieve resolution of symptoms compared with pubic fractures, and when left untreated, asymptomatic nonunions developed in three of five. However, we observed no effect on acetabular fragment positioning or long-term clinical outcome. It is essential to be aware of this potential complication and realize it could be accompanied by substantial morbidity for patients during the rehabilitation period after periacetabular osteotomy, but does not seem to influence the longer-term outcome. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. Content Type Journal Article Category Original Article DOI 10.1007/s11999-008-0280-x Authors Norman Espinosa, University of Zurich Department of Orthopaedics Zurich Switzerland Joshua Strassberg, Children’s Hospital Department of Orthopaedic Surgery Hunnewell Bldg, 2nd Floor, 300 Longwood Avenue Boston MA 02115 USA Etienne L. Belzile, Centre Hospitalier Universitaire de Quebec Division of Orthopaedic Surgery, Department of Surgery Quebec City Canada Michael B. Millis, Children’s Hospital Department of Orthopaedic Surgery Hunnewell Bldg, 2nd Floor, 300 Longwood Avenue Boston MA 02115 USA Young-Jo Kim, Children’s Hospital Department of Orthopaedic Surgery Hunnewell Bldg, 2nd Floor, 300 Longwood Avenue Boston MA 02115 USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Surgery for Retrocalcaneal Bursitis: A Tendon-splitting versus a Lateral Approach Abstract For patients with refractory retrocalcaneal bursitis (Haglund’s syndrome), the most effective surgical approach has not been defined. We asked whether patients undergoing the tendon-splitting approach and the lateral approach would have comparably effective relief of pain for both types of calcaneal ostectomies. We retrospectively reviewed 30 patients (31 feet) who underwent the tendon-splitting approach and compared their results with 32 previous patients (35 feet) who had a lateral incision. Minimum followup was 12 months (mean, 16 months; range, 12–23 months) for the tendon-splitting group and 15 months (mean, 51 months; range, 15–109 months) for the lateral group. The mean American Orthopaedic Foot and Ankle Society score improved from 43 points preoperatively to 81 points (range, 8–100 points) postoperatively in the tendon-splitting group and from 54 points to 86 points (range, 55–100 points) in the lateral group. The mean physical component score of the Short Form-36, version 2, at followup was 52 (range, 22–61) in the tendon-splitting group and 49 (range, 34–63) in the lateral group. The median return to normal function was 4.1 months (range, 3–13 months) in the tendon-splitting group and 6.4 months (range, 4–20 months) in the lateral group. Both approaches to calcaneal ostectomy provided symptomatic pain relief. However, patients in the tendon-splitting group returned to normal function quicker than patients in the lateral group. Level of Evidence: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence. Content Type Journal Article Category Original Article DOI 10.1007/s11999-008-0281-9 Authors John A. Anderson, Hospital for Special Surgery Department of Foot and Ankle Surgery 523 East 72nd Street New York NY 10021 USA Eduardo Suero, Hospital for Special Surgery Department of Foot and Ankle Surgery 523 East 72nd Street New York NY 10021 USA Padhraig F. O’Loughlin, Hospital for Special Surgery Department of Foot and Ankle Surgery 523 East 72nd Street New York NY 10021 USA John G. Kennedy, Hospital for Special Surgery Department of Foot and Ankle Surgery 523 East 72nd Street New York NY 10021 USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Early Outcome of TKA with a Medial Pivot Fixed-bearing Prosthesis is Worse than with a PFC Mobile-bearing Prosthesis Abstract Although the design features of the Medial Pivot fixed-bearing prosthesis reportedly improve kinematics compared with TKAs using fixed-bearings, clinical improvements have not been reported. We asked whether the clinical and radiographic outcomes, ranges of motion of the knee, patient satisfaction, and complication rates would be better in knees with a Medial Pivot fixed-bearing prosthesis than in those with a PFC Sigma mobile-bearing prosthesis. We compared the results of 92 patients who had a Medial Pivot fixed-bearing prosthesis implanted in one knee and a PFC Sigma mobile-bearing prosthesis implanted in the other. There were 85 women and seven men with a mean age of 69.5 years (range, 55–81 years). The minimum followup was 2 years (mean, 2.6 years; range, 2–3 years). The patients were assessed clinically and radiographically using the rating systems of the Hospital for Special Surgery and the Knee Society at 3 months, 1 year, and annually thereafter. Contrary to expectations, we found worse early clinical outcomes, smaller ranges of knee motion, less patient satisfaction, and a higher complication rate for the Medial Pivot fixed-bearing prosthesis than for the PFC Sigma mobile-bearing prosthesis. Level of Evidence: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. Content Type Journal Article Category Original Article DOI 10.1007/s11999-008-0221-8 Authors Young-Hoo Kim, Ewha Womens University DongDaeMun Hospital The Joint Replacement Center of Korea 70, ChongRo 6-Ga, ChongRo-Gu Seoul 110-783 Korea Sung-Hwan Yoon, Ewha Womens University DongDaeMun Hospital The Joint Replacement Center of Korea 70, ChongRo 6-Ga, ChongRo-Gu Seoul 110-783 Korea Jun-Shik Kim, Ewha Womens University DongDaeMun Hospital The Joint Replacement Center of Korea 70, ChongRo 6-Ga, ChongRo-Gu Seoul 110-783 Korea Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Case Reports: Thumb Reconstruction Using Amputated Fingers Abstract Reconstruction of an irreparably amputated thumb in multiple digit amputations using amputated fingers can considerably improve hand function and allows creation of a newly transplanted thumb with acceptable cosmetic and functional attributes. However, the surgery is challenging and rarely reported. We report six cases using this procedure in patients with crushed thumbs unsuitable for replantation. In four of the patients, the remnant of the index finger was replanted on the thumb stump and in another two patients, an amputated middle finger and ring finger were used. The patients had a minimum followup of 12 months (mean, 18 months; range, 12–45 months). All newly transplanted thumbs survived resulting in the patients having satisfactory postoperative hand function and appearance. Content Type Journal Article Category Case Reports DOI 10.1007/s11999-008-0227-2 Authors Nguyen T. Hoang, Central University Hospital 108 Department of Hand Surgery and Microsurgery, Institute of Trauma and Orthopaedics Hanoi Vietnam R. Staudenmaier, University Hospital “rechts der Isar,” Technical University of Munich ENT Department Munich Germany C. Hoehnke, University Hospital “rechts der Isar,” Technical University of Munich Department of Plastic and Reconstructive Surgery Munich Germany Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation? Abstract This study was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized using a sliding hip screw or an intramedullary nail. A 20% sample of Part A and B entitled Medicare beneficiaries 65 years or older was used to generate a cohort of patients who sustained intertrochanteric femur fractures between 1999 and 2001. Two fracture implant groups, intramedullary nail and sliding hip screw, were identified using Current Procedural Terminology and International Classification of Diseases, 9th Revision codes. The cohort consisted of 43,659 patients. Patients treated with an intramedullary nail had higher rates of revision surgery during the first year than those treated with a sliding hip screw (7.2% intramedullary nail versus 5.5% sliding hip screw). Mortality rates at 30 days (14.2% intramedullary nail versus 15.8% sliding hip screw) and 1 year (30.7% intramedullary nail versus 32.5% sliding hip screw) were similar. Adjusted secondary outcome measures showed significant increases in the intramedullary nail group relative to the sliding hip screw group for index hospital length of stay, days of rehabilitation services in the first 6 months after discharge, and total expenditures for doctor and hospital services. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. Content Type Journal Article Category Original Article DOI 10.1007/s11999-008-0285-5 Authors Brian Aros, Multidisciplinary Clinical Research Center in Musculoskeletal Diseases Lebanon NH USA Anna N. A. Tosteson, Multidisciplinary Clinical Research Center in Musculoskeletal Diseases Lebanon NH USA Daniel J. Gottlieb, The Dartmouth Institute for Health Policy and Clinical Practice Lebanon NH USA Kenneth J. Koval, Multidisciplinary Clinical Research Center in Musculoskeletal Diseases Lebanon NH USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Acetabular Changes in Coxa Vara Abstract The purpose of this study was to define the acetabular changes associated with coxa vara and determine how these acetabuli differ from those of a normal hip. Charts and radiographs of 33 patients with coxa vara with a mean age of 6 years (range, 2–15 years) were retrospectively reviewed. The diagnosis was developmental coxa vara in 21 patients and congenital femoral deficiency in 12. Radiographic measurements, including acetabular index, sourcil slope, center edge angle, migration index, and medial joint space, were compared with those of 29 hips in the control group. The inclination of the acetabulum or acetabular slope (as measured by the acetabular index and sourcil slope) was significantly increased in the hips with coxa vara as compared with those in the control group. Both parameters have a statistically significant inverse correlation with the degree of varus, ie, the greater the varus of the proximal femur, the greater the upsloping of the acetabulum. Joint subluxation, as measured by the center edge angle, migration index, and medial joint space, showed little difference from that of control subjects. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. Content Type Journal Article Category Original Article DOI 10.1007/s11999-008-0223-6 Authors Ashish Ranade, Shriners Hospitals for Children, Philadelphia Philadelphia PA USA James J. McCarthy, University of Wisconsin School of Medicine and Public Health Department of Orthopaedics and Rehabilitation K4/7 Clinical Science Center, 600 Highland Avenue Madison WI 53792-7375 USA Richard S. Davidson, Children’s Hospital of Philadelphia Philadelphia PA USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Registry Outcomes of Unicompartmental Knee Arthroplasty Revisions Abstract Perceptions of the difficulty and outcome of unicompartmental knee arthroplasty revision (rev-UKA) vary. We analyzed differences in the complexity, cost, and survival of rev-UKAs compared with revision TKAs (rev-TKA). One hundred eighty knee arthroplasty revisions (68 rev-UKAs/112 rev-TKAs), defined as a minimum of tibial or femoral component revision, were identified from a community joint registry of 7587 knee implants performed between 1991 and 2005. Four of 68 rev-UKAs (5.9%) were revised a second time, whereas seven of 112 rev-TKAs (6.3%) were rerevised. Rev-TKA was predictably more complex than rev-UKA based on the proxies of operative time, use of modular augmentation and stems, and polyethylene liner thickness. Thirty-nine of 68 rev-UKAs (57%) had no form of augmentation and were revised as primary TKAs. There were more rev-TKAs than rev-UKAs with an implant cost greater than $5200 (42% versus 12%) and hospital charges greater than $33,000 (48% versus 25%). We found no difference in survival between the groups. Although rev-UKAs had less surgical complexity and bone loss at the time of revision compared with rev-TKAs, we were unable to show improved survival of rev-UKAs compared with rev-TKAs. Rev-UKAs were associated with lower implant costs and hospital charges compared with rev-TKAs. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. Content Type Journal Article Category Original Article DOI 10.1007/s11999-008-0279-3 Authors Thomas E. Dudley, University of Minnesota Department of Orthopaedic Surgery Minneapolis MN USA Terence J. Gioe, University of Minnesota Department of Orthopaedic Surgery Minneapolis MN USA Penny Sinner, HealthEast Research Department St Paul MN USA Susan Mehle, HealthEast Research Department St Paul MN USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Photodynamic Therapy with ATX-S10·Na(II) Inhibits Synovial Sarcoma Cell Growth Abstract Photodynamic therapy (PDT) is an effective cancer treatment modality that allows selective destruction of malignant tumor cells. We asked whether PDT could inhibit in vivo and in vitro growth of synovial sarcoma cells. We analyzed PDT using ATX-S10·Na(II) and a diode laser for a synovial sarcoma cell line (SYO-1). Photodynamic therapy with ATX-S10·Na(II) showed an in vitro cytotoxic effect on the cultured SYO-1 cells. The in vitro effect of PDT depended on the treatment concentration of ATX-S10·Na(II) and the laser dose of irradiation. ATX-S10·Na(II) was detected in the tumor tissue specimens that were excised from nude mice bearing SYO-1 within 6 hours after intravenous injection, but it was eliminated from the tumor 12 hours after injection. Photodynamic therapy suppressed the tumor growth of nude mice bearing SYO-1, and high-dose irradiation induced no viable tumor cells in histologic specimens. Photodynamic therapy performed after marginal resection of the tumor of nude mice bearing SYO-1 reduced the rate of local recurrence of the tumor. Our results suggest PDT using ATX-S10·Na(II) and laser irradiation may be a potentially useful treatment for synovial sarcoma, especially to reduce the surgical margin and preserve critical anatomic structures adjacent to the tumor. Content Type Journal Article Category Original Article DOI 10.1007/s11999-008-0284-6 Authors Ken Takeda, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction Okayama Japan Toshiyuki Kunisada, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Department of Medical Materials for Musculoskeletal Reconstruction 2-5-1, Shikata-cho Okayama 700-8558 Japan Shinichi Miyazawa, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction Okayama Japan Yoshinori Nakae, Photochemical Co, Ltd Okayama Japan Toshifumi Ozaki, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction Okayama Japan Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Addition of Nitric Oxide Through Nitric Oxide-paracetamol Enhances Healing Rat Achilles Tendon Abstract Nitric oxide is an important messenger molecule in many physiological processes. The addition of NO via NO-flurbiprofen enhances the material properties of healing tendon, however, flurbiprofen has a detrimental effect on healing. We asked if NO delivered by a cyclooxygenase 3 inhibitor (paracetamol/acetaminophen) would enhance healing in a rat Achilles tendon healing model. Rats were injected subcutaneously daily with NO-paracetamol, paracetamol or vehicle from two days before surgery to the day of tissue harvesting. Paracetamol had no effect on tendon healing compared with vehicle alone. NO-paracetamol did not change the failure load, but did decrease the water content, enhance the collagen content, reduce the cross-sectional area and improve the ultimate stress of healing tendon compared with paracetamol and vehicle. The collagen organization of the healing tendon in the NO-paracetamol group, as determined by polarized light microscopy, was enhanced. Our data suggests NO-paracetamol increases the total collagen content and enhances organization while decreasing the cross-sectional area of healing rat Achilles tendon and is consistent with human clinical trials where NO has improved the symptoms and signs of tendinopathy. Content Type Journal Article Category Symposium: Molecular and Clinical Developments in Tendinopathy DOI 10.1007/s11999-008-0271-y Authors George A. C. Murrell, St George Hospital, Research & Education Centre, University of New South Wales Orthopaedic Research Institute Level 2, 4-10 South Street, Kogarah Sydney NSW 2217 Australia Gongyao Tang, St George Hospital, Research & Education Centre, University of New South Wales Orthopaedic Research Institute Level 2, 4-10 South Street, Kogarah Sydney NSW 2217 Australia Richard C. Appleyard, St George Hospital, Research & Education Centre, University of New South Wales Orthopaedic Research Institute Level 2, 4-10 South Street, Kogarah Sydney NSW 2217 Australia Piero del Soldato, NicOx SA Sophia Antipolis France Min-Xia Wang, St George Hospital, Research & Education Centre, University of New South Wales Orthopaedic Research Institute Level 2, 4-10 South Street, Kogarah Sydney NSW 2217 Australia Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Journal Scan: Journal of Hand Surgery Journal Scan: Journal of Hand Surgery Content Type Journal Article Category Journal Scan DOI 10.1007/s11999-008-0276-6 Authors Orrin I. Franko, Beth Israel Deaconess Medical Center Harvard Medical School, Department of Orthopaedic Surgery 330 Brookline Avenue, Stoneman 10 Boston MA 02215 USA Tamara D. Rozental, Beth Israel Deaconess Medical Center Harvard Medical School, Department of Orthopaedic Surgery 330 Brookline Avenue, Stoneman 10 Boston MA 02215 USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Gene Expression in Rat Supraspinatus Tendon Recovers From Overuse With Rest Abstract Rest is a common treatment for overuse injuries, but its effectiveness on gene expression has not been systematically evaluated under controlled experimental conditions. We asked whether genes regulated in the supraspinatus tendon as a result of overuse would return to normal levels after 2 or 4 weeks of rest. We used a rat model of tendon overuse that generates reproducible changes in the histology, geometry, gene expression, and mechanical properties consistent with an overuse injury. Animals were subjected to the overuse protocol for 2 or 4 weeks followed by either 2 or 4 weeks of rest. Microarray analysis was used to measure global changes in gene expression after the overuse plus rest protocol. Genes upregulated as a result of the overuse returned to near normal levels after rest in most animals. The biochemical composition of the tendon was similar to normal after the imposed rest period, except for slightly lower collagen content. These results suggest as little as 2 weeks of rest is often sufficient to recover from the molecular and biochemical effects of 2 and 4 weeks of overuse in this rat model. Content Type Journal Article Category Symposium: Molecular and Clinical Developments in Tendinopathy DOI 10.1007/s11999-008-0270-z Authors Scott A. Jelinsky, Wyeth Discovery Research 87 Cambridge Park Drive Cambridge MA 02140 USA Spencer P. Lake, University of Pennsylvania McKay Orthopedic Research Laboratory Philadelphia PA USA Joanne M. Archambault, Wyeth Discovery Research 87 Cambridge Park Drive Cambridge MA 02140 USA Louis J. Soslowsky, University of Pennsylvania McKay Orthopedic Research Laboratory Philadelphia PA USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
VEGF Expression in Patellar Tendinopathy: A Preliminary Study Abstract Vascular function and angiogenesis are regulated by vascular endothelial growth factor-A (VEGF). The purpose of this preliminary study was to address the following questions: Is VEGF expression in the patellar tendon more prevalent in patients with patellar tendinopathy than in individuals with normal, pain-free patellar tendons? Which cell populations express VEGF in normal and tendinopathic tendon? Is there a difference in symptom duration between VEGF+ and VEGF− tendons? We collected patellar tendon tissue from 22 patients undergoing open débridement of the patellar tendon and from 10 patients undergoing intramedullary nailing of the tibia. VEGF expression was assessed immunohistochemically. Relevant inflammatory and repair cell types were immunolabeled. VEGF expression was absent from control tendons, but was present in a subset of patients with histopathological evidence of angiofibroblastic tendinosis. VEGF was expressed in the intimal layer of tendon vessels, but was absent in other cell types. Patients demonstrating VEGF expression in the patellar tendon had a shorter symptom duration (12 ± 7.8 months) than patients with no detectable VEGF (32.8 ± 23.5 months). VEGF may contribute to the vascular hyperplasia that is a cardinal feature of symptomatic tendinosis, particularly in cases with more recent onset. Content Type Journal Article Category Symposium: Molecular and Clinical Developments in Tendinopathy DOI 10.1007/s11999-008-0272-x Authors Alexander Scott, University of British Columbia Vancouver Coastal Health Research Institute, Centre for Hip Health and Department of Medicine 2660 Oak Street Vancouver BC Canada V6H 3Z6 Øystein Lian, Norwegian School of Sport Sciences Department of Sports Medicine, Oslo Sport Trauma Research Center Oslo Norway Roald Bahr, Norwegian School of Sport Sciences Department of Sports Medicine, Oslo Sport Trauma Research Center Oslo Norway David A. Hart, University of Calgary McCaig Center for Joint Injury and Arthritis Research, Faculty of Medicine Calgary Alberta Canada Vincent Duronio, University of British Columbia Vancouver Coastal Health Research Institute, Centre for Hip Health and Department of Medicine 2660 Oak Street Vancouver BC Canada V6H 3Z6 Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Loss of Homeostatic Strain Alters Mechanostat “Set Point” of Tendon Cells In Vitro Abstract Tendon cells respond to mechanical loads. The character (anabolic or catabolic) and sensitivity of this response is determined by the mechanostat set point of the cell, which is governed by the cytoskeleton and its interaction with the extracellular matrix. To determine if loss of cytoskeletal tension following stress deprivation decreases the mechanoresponsiveness of tendon cells, we cultured rat tail tendons under stress-deprived conditions for 48 hours and then cyclically loaded them for 24 hours at 1%, 3%, or 6% strain at 0.17 Hz. Stress deprivation upregulated MMP-13 mRNA expression and caused progressive loss of cell-matrix contact compared to fresh controls. The application of 1% strain to fresh tendons for 24 hours inhibited MMP-13 mRNA expression compared to stress-deprived tendons over the same period. However, when tendons were stress-deprived for 48 hours and then subjected to the same loading regime, the inhibition of MMP-13 mRNA expression was decreased. In stress-deprived tendons, it was necessary to increase the strain magnitude to 3% to achieve the same level of MMP-13 mRNA inhibition seen in fresh tendons exercised at 1% strain. The data suggest loss of cytoskeletal tension alters the mechanostat set point and decreases the mechanoresponsiveness of tendon cells. Content Type Journal Article Category Symposium: Molecular and Clinical Developments in Tendinopathy DOI 10.1007/s11999-008-0264-x Authors Steven P. Arnoczky, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI USA Michael Lavagnino, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI USA Monika Egerbacher, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI USA Oscar Caballero, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI USA Keri Gardner, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI USA Marisa A. Shender, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Loss of Homeostatic Tension Induces Apoptosis in Tendon Cells: An In Vitro Study Abstract Apoptosis (programmed cell death) has been identified as a histopathologic feature of tendinopathy. While the precise mechanism(s) that triggers the apoptotic cascade in tendon cells has not been identified, it has been theorized that loss of cellular homeostatic tension following microscopic damage to individual tendon fibrils could be the stimulus for initiating the pathologic events associated with tendinopathy. To determine if loss of homeostatic tension following stress deprivation could induce apoptosis in tendon cells, rat tail tendons were stress-deprived or cyclically loaded (3% strain at 0.17 Hz) for 24 hours under tissue culture conditions. Caspase-3 (an upstream mediator of apoptosis) mRNA expression was evaluated using quantitative polymerase chain reaction and caspase-3 protein synthesis was identified using immunohistochemistry. Apoptotic cells were identified histologically using an antibody for single-stranded DNA. Stress deprivation for 24 hours resulted in an increase in caspase-3 mRNA expression when compared to fresh controls or cyclically loaded tendons. Stress deprivation also increased the percentage of apoptotic cells (10.59% ± 2.80) compared to controls (1.87% ± 1.07) or cyclically loaded tendons (3.73% ± 0.87). These data suggest loss of homeostatic tension following stress deprivation induces apoptosis in rat tail tendon cells. Content Type Journal Article Category Symposium: Molecular and Clinical Developments in Tendinopathy DOI 10.1007/s11999-008-0274-8 Authors Monika Egerbacher, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI 48824 USA Steven P. Arnoczky, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI 48824 USA Oscar Caballero, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI 48824 USA Michael Lavagnino, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI 48824 USA Keri L. Gardner, Michigan State University Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, G-387 East Lansing MI 48824 USA Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X
Molecular and Clinical Developments in Tendinopathy: Editorial Comment Molecular and Clinical Developments in Tendinopathy: Editorial Comment Content Type Journal Article Category Symposium: Molecular and Clinical Developments in Tendinopathy DOI 10.1007/s11999-008-0267-7 Authors Brett M. Andres, Orthopedic & Fracture Clinic 11782 SW Barnes Road, Suite 300 Portland OR 97225 USA George A. Murrell, St. George Hospital Department of Orthopaedic Surgery Sydney Australia Journal Clinical Orthopaedics and Related Research Online ISSN 1528-1132 Print ISSN 0009-921X

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