Clinical outcome in MPFL reconstruction with and without tuberositas transposition

There are several surgical options for recurrent patella dislocations. As the reconstruction of the medial patellofemoral ligament (MPFL) has been proven to restore stability, it has become more accepted. Aim of this study was to investigate the clinical outcome after MPFL reconstruction as an isolated procedure or in association with a transposition of the tibial tubercle (in case of patella alta or an excessive TT-TG) in a large prospective cohort study. Additionally, the effect on patellar height was analysed radiographically using the Caton-Deschamps index. In a large prospective cohort study of 129 knees in 124 patients (81 females, 48 males, mean age 22.8 +/- 7.7 years), 91 knees received primary MPFL reconstruction (group 1) and 38 were a combination with a transposition of the tibial tubercle (group 2). The clinical follow-up was evaluated using KOOS and Kujala scores preoperatively and 1 year postoperatively. Patient satisfaction, complications and revision surgery were recorded. Overall, Kujala improved significantly from 53.5 (SD 22.7) preoperatively to 74.7 (SD 20.5) postoperatively (p < 0.01). All KOOS subdomains improved significantly (p < 0.01). No significant difference for Kujala score between groups was noticed. Revision rate was (5/129) 3.9 %. Reconstruction was supplemented with a transfer of the tibial tuberosity in (38/129) 29.4 % of the cases and shows a comparable outcome. MPFL reconstruction is a viable treatment option for episodic patellar dislocation. A concomitant tuberositas transposition is useful in selected patients

The Crystal Structure of Thermotoga maritima Class III Ribonucleotide Reductase Lacks a Radical Cysteine Pre-Positioned in the Active Site

Ribonucleotide reductases (RNRs) catalyze the reduction of ribonucleotides to deoxyribonucleotides, the building blocks for DNA synthesis, and are found in all but a few organisms. RNRs use radical chemistry to catalyze the reduction reaction. Despite RNR having evolved several mechanisms for generation of different kinds of essential radicals across a large evolutionary time frame, this initial radical is normally always channelled to a strictly conserved cysteine residue directly adjacent to the substrate for initiation of substrate reduction, and this cysteine has been found in the structures of all RNRs solved to date. We present the crystal structure of an anaerobic RNR from the extreme thermophile Thermotoga maritima (tmNrdD), alone and in several complexes, including with the allosteric effector dATP and its cognate substrate CTP. In the crystal structure of the enzyme as purified, tmNrdD lacks a cysteine for radical transfer to the substrate pre-positioned in the active site. Nevertheless activity assays using anaerobic cell extracts from T. maritima demonstrate that the class III RNR is enzymatically active. Other genetic and microbiological evidence is summarized indicating that the enzyme is important for T. maritima. Mutation of either of two cysteine residues in a disordered loop far from the active site results in inactive enzyme. We discuss the possible mechanisms for radical initiation of substrate reduction given the collected evidence from the crystal structure, our activity assays and other published work. Taken together, the results suggest either that initiation of substrate reduction may involve unprecedented conformational changes in the enzyme to bring one of these cysteine residues to the expected position, or that alternative routes for initiation of the RNR reduction reaction may exist. Finally, we present a phylogenetic analysis showing that the structure of tmNrdD is representative of a new RNR subclass IIIh, present in all Thermotoga species plus a wider group of bacteria from the distantly related phyla Firmicutes, Bacteroidetes and Proteobacteria

The Crystal Structure of <i>Thermotoga maritima - Fig 1 </i> Class III Ribonucleotide Reductase Lacks a Radical Cysteine Pre-Positioned in the Active Site

<p>a) The radical generation and transfer pathways of all three classes of RNR are thought to converge on a completely conserved cysteine residue that transfers it to the substrate. The class I, II and III enzymes are coloured mauve, pink and gold respectively. The finger loops of all three classes and the C-terminal loop of the class III RNRs, as exemplified by the enzyme from bacteriophage T4, are shown in cartoon representation. The position of the glycyl radical in class III is marked by a sphere. The two hydrogen-bonded Tyr residues that end the proton-coupled electron transfer chain (PCET) in class I are shown in mauve, with the terminal oxygen atom shown as a sphere. The 5’-deoxyadenosine moiety generated by cleavage of the C-Co bond in AdoCbl by class II RNRs is shown with the 5’-C atom shown as a pink sphere. The GDP substrate bound to the class II enzyme is shown as sticks with the C3’ atom marked with a gray sphere. b) Overall structure of the tmNrdD dimer. The left-hand monomer is coloured grey while the right-hand monomer is coloured as a spectrum from deep blue at the N-terminus to deep red at the C-terminus. The allosteric effector dATP and the substrate CTP are shown in space-filling representation. c) Comparison of the structures of tmNrdD and the previously determined structure of NrdD from bacteriophage T4 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0128199#pone.0128199.ref009" target="_blank">9</a>]. The T4 structure is coloured dark blue and tmNrdD is coloured red. d) Depiction of the active site area where the tips of the finger loop (blue) and the C-terminal loop (orange) meet. The position of the glycyl radical is marked by an orange sphere and Ile359 at the tip of the finger loop by a blue sphere. The substrate CTP is shown in stick representation. The Zn-binding domain is shown in yellow.</p

Position of the SCCR motif in relation to the active site in tmNrdD.

<p>The C-terminal domain and glycyl radical loop are shown in orange and the finger loop in light blue, with the Gly and Ile residues at their respective tips shown as spheres. The two residues Ser and Cys at the beginning of the SCCR motif are also pinpointed by spheres. The preceding <b>β</b>-strand <b>β</b>E is drawn in yellow and the approximate location of a disordered 20-residue segment following the SCCR motif is sketched. For clarity several <b>α</b>-helices on the front of the barrel have been removed.</p

Schematic of key distances between the Cα atom of Gly621, atoms in Ile359 and the H3’ atom of the substrate CTP.

<p>Distances between key atoms are shown in Å.</p