Patellar tracking in primary total knee arthroplasty

This is a review of the recent literature of the various factors that affect patellar tracking following total knee arthroplasty (TKA). Patellar tracking principally depends on the pre-existing patellar tracking and the rotational alignment of the femoral and tibial implants, but the detailed movements depend on the patellar shape. The latter means that the patellar kinematics of any implanted TKA does not return to normal. Laboratory cadaveric studies use normal knees and non-activity-based testing conditions and so may not translate into clinical findings. The recent literature has not added anything significant to change established clinical practice in achieving satisfactory patellar tracking following TKA

A survey of orthopaedic journal editors determining the criteria of manuscript selection for publication

Background: To investigate the characteristics of editors and criteria used by orthopaedic journal editors in assessing submitted manuscripts. Methods: Between 2008 to 2009 all 70 editors of Medline listed orthopaedic journals were approached prospectively with a questionnaire to determine the criteria used in assessing manuscripts for publication. Results: There was a 42% response rate. There was 1 female editor and the rest were male with 57% greater than 60 years of age. 67% of the editors worked in university teaching hospitals and 90% of publications were in English.The review process differed between journals with 59% using a review proforma, 52% reviewing an anonymised manuscript, 76% using a routine statistical review and 59% of journals used 2 reviewers routinely. In 89% of the editors surveyed, the editor was able to overrule the final decision of the reviewers.Important design factors considered for manuscript acceptance were that the study conclusions were justified (80%), that the statistical analysis was appropriate (76%), that the findings could change practice (72%). The level of evidence (70%) and type of study (62%) were deemed less important. When asked what factors were important in the manuscript influencing acceptance, 73% cited an understandable manuscript, 53% cited a well written manuscript and 50% a thorough literature review as very important factors. Conclusions: The editorial and review process in orthopaedic journals uses different approaches. There may be a risk of language bias among editors of orthopaedic journals with under-representation of non-English publications in the orthopaedic literature

Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty

Purpose: Around 10–30 % of patients are dissatisfied with the results of their total knee arthroplasty (TKA). This review aimed to identify and evaluate the predictors of outcome measured by the three domains of health-related quality of life (pain, stiffness and function). The focus was on pre-operative psychological factors as related to other patient-related variables. Methods: A systematic search was performed using the following databases: MEDLINE, PubMed, AMED, CINAHL, PsychINFO, SciFinder, Scopus, EMBASE, Cochrane, Lilacs, Web of Science and ScienceDirect. The quality of identified studies was assessed using the Critical Appraisal Skills Programme Cohort checklist. Results: Ten studies met the eligibility criteria. From these, nine patient-related predictors of outcome were identified (depression, anxiety, age at surgery, gender (being female), medical co-morbidities, BMI, level of education, pre-operative pain severity and pre-operative knee function). Greater anxiety, pre-operative pain and function were the most significant factors to predict a poorer outcome of a TKA. The results of depression, gender (female), medical co-morbidities, BMI and level of education were variable among the included studies. There was very little evidence to support older age at operation as a predictor of poorer outcome. Conclusion: Patients experiencing high levels of pain before surgery should be informed of the chances of improvement by having a TKA. A validated psychological screening tool that separates depression and anxiety is recommended as part of the pre-operative assessment stage. Patients presenting with symptoms of depression and anxiety should be identified and consulted before a TKA

A clinical, biological, and biomaterials perspective into tendon injuries and regeneration

Tendon injury is common and debilitating, and it is associated with long-term pain and ineffective healing. It is estimated to afflict 25% of the adult population and is often a career-ending disease in athletes and racehorses. Tendon injury is associated with high morbidity, pain, and long-term suffering for the patient. Due to the low cellularity and vascularity of tendon tissue, once damage has occurred, the repair process is slow and inefficient, resulting in mechanically, structurally, and functionally inferior tissue. Current treatment options focus on pain management, often being palliative and temporary and ending in reduced function. Most treatments available do not address the underlying cause of the disease and, as such, are often ineffective with variable results. The need for an advanced therapeutic that addresses the underlying pathology is evident. Tissue engineering and regenerative medicine is an emerging field that is aimed at stimulating the body's own repair system to produce de novo tissue through the use of factors such as cells, proteins, and genes that are delivered by a biomaterial scaffold. Successful tissue engineering strategies for tendon regeneration should be built on a foundation of understanding of the molecular and cellular composition of healthy compared with damaged tendon, and the inherent differences seen in the tissue after disease. This article presents a comprehensive clinical, biological, and biomaterials insight into tendon tissue engineering and regeneration toward more advanced therapeutics

The potential for dietary factors to prevent or treat osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease for which there are no disease-modifying drugs. It is a leading cause of disability in the UK. Increasing age and obesity are both major risk factors for OA and the health and economic burden of this disease will increase in the future. Focusing on compounds from the habitual diet that may prevent the onset or slow the progression of OA is a strategy that has been under-investigated to date. An approach that relies on dietary modification is clearly attractive in terms of risk/benefit and more likely to be implementable at the population level. However, before undertaking a full clinical trial to examine potential efficacy, detailed molecular studies are required in order to optimise the design. This review focuses on potential dietary factors that may reduce the risk or progression of OA, including micronutrients, fatty acids, flavonoids and other phytochemicals. It therefore ignores data coming from classical inflammatory arthritides and nutraceuticals such as glucosamine and chondroitin. In conclusion, diet offers a route by which the health of the joint can be protected and OA incidence or progression decreased. In a chronic disease, with risk factors increasing in the population and with no pharmaceutical cure, an understanding of this will be crucial

An electrochemical study of acrylate bone adhesive permeability and selectivity change during in vitro ageing: a model approach to the study of biomaterials and membrane barriers

This study assessed the solute permeability of a family of UV and moisture cured acrylates-based adhesives during in vitro ageing in pH 7.4 buffer. Acrylates have a potential role in bone fracture fixation, but their inability to allow microsolute exchange between the fractured bone surfaces may contribute to ineffective healing. Cyclic voltammetry and chronoamperometry were used to determine the diffusion coefficients for various electrochemically active probe molecules (O2, H2O2, acetaminophen, catechol, uric acid and ascorbic acid) at proprietary acrylic, urethane – acrylate and cyanoacrylate adhesives. All adhesives proved to be impermeable for up to 9 days ageing, following which a near-exponential increase in permeability resulted for all solutes. At 18 days, the diffusion coefficients were in the range of 10-5 cm2s-1 for O2 and H2O2 and 10-6 cm2s-1 for the organic solutes; no transport selectivity was seen between the latter. Adhesive joint strength showed a direct, inverse, correlation with permeability, with the more hydrophilic cyanoacrylates showing the greatest loss of strength. Adhesive permeabilisation does not appear to be compatible with the retention of bonding strength, but it serves as a new non-destructive predictor of adhesion strength change during ageing and practical use

Patient reported outcome measures in meniscal tears and arthroscopic meniscectomy: The value of outcome score prediction

Background: There are several clinical outcome scores relating to meniscal injuries reported in the literature. However, the result of one scoring system is often different from that of the others even when assessing the same group of patients. This makes the comparison of results of studies who have used different outcome measures restrictive and difficult.  Hypothesis: Statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with meniscal tears before and after arthroscopic meniscectomy.  Patients and methods: Thirty-four patients with meniscal tears were evaluated using nine clinical outcome scores. These included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score, Tapper and Hoover Meniscal Grading Score, IKDC Subjective Knee Score, Knee Outcome Survey–Activities of Daily Living Scale, Short Form-12 Item Health Survey (SF-12) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine patients underwent an arthroscopic meniscectomy and were reassessed 3 months post-operatively.  Results: There were considerable differences between the mean total of each of the nine outcome measures. Significant correlations and regressions were found between most of the outcome scores and were stronger following surgery. The strongest correlation was found between IKDC Subjective and SF-12 Physical Component Summary sub-score (r = 0.94, P < 0.001). The strongest regression formula was found between IKDC Subjective and KOOS (R 2 = 0.93, P < 0.001).  Discussion: The outcome of one knee score can be predicted when the results of the other are known through formulae calculations produced from this study. This could facilitate the conduct of systematic reviews and meta-analysis in research pertaining to meniscal injuries by allowing the pooling of substantially more data. Level of evidence: II; prospective non-randomized trial

Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction: The significance of outcome score prediction

BACKGROUND Numerous anterior cruciate ligament (ACL) clinical outcome measures exist. However, the result of one score does not equate to the findings of another even when evaluating the same patient group. AIM To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction. METHODS Fifty patients with ACL rupture were evaluated using nine clinical outcome measures. These included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score, Tapper and Hoover Meniscal Grading Score, IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score. Thirty-four patients underwent an ACL reconstruction and were reassessed post-operatively. RESULTS The mean total of each of the nine outcome scores appreciably differed from each other. Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively. The strongest correlation was found between Cincinnati and KOS-ADLS (r = 0.91, P < 0.001). The strongest regression formula was also found between Cincinnati and KOS-ADLS (R2 = 0.84, P < 0.001). CONCLUSION The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known. These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data. Al-Dadah O, Shepstone L, Donell ST. Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction: The significance of outcome score prediction. World J Clin Cases 2022; 10(30): 10939-10955 [PMID: 36338237 DOI: 10.12998/wjcc.v10.i30.10939

Dino Buzzati’s 50th death anniversary: An appraisal of medicine and infectivology’s influence on his literary production

Background and aim: This paper, in the 50th anniversary of the author’s death, examines the overall impact and influence of medicine, in particular of infectious diseases, on the literary production of Italian writer and novelist Dino Buzzati (1906-1972). Methods: Analysis of literary sources and historical study. Results and conclusions: Buzzati’s literary world is great fun for the reader, being both intriguing and anxiety forming at the same time. One finishes reading his books only to discover the one truth which overturns everything that seemed to be true. In particular, in his short stories, which stem mostly from episodes taken from everyday life, the plot suddenly comes to life. The atmosphere becomes surreal, and in a moment the incredible happens. Behind the apparent lightness of the fairytale narrative there lies hidden the important issues addressed by the author. He uses the hospital as a metaphor for a categorised life, in which we are at risk of no longer being masters of ourselves, in which we suffer a continuous steady drip that makes us head downwards day after day, floor after floor. We will come back up, but not today, tomorrow perhaps, or at the latest, the day after tomorrow. Corte on the second floor hopes, and screams to give strength to his hope, that he will soon return to the top, towards the seventh floor. (www.actabiomedica.it)

A direct comparison of linear and star-shaped poly(dimethylaminoethyl acrylate) polymers for polyplexation with DNA and cytotoxicity in cultured cell lines

Poly[2-(Dimethylamino) ethyl acrylate] (PDMAEA) based polymers have been studied as potential gene delivery system. However, few reports emerging in literature suggesting that star-shaped PDMAEA based polymers are performing better in polyplexation with DNA, cytotoxicity and transfection, as compared to linear counterparts. Nonetheless, little evidences exist on direct comparison between the linear and star-shaped polymer structures. To address this, a series of new star-shaped PDMAEA polymers with linear counterparts were synthesised and directly compared their polyplexation with DNA and cytotoxicity in culture cell lines. The star-shaped PDMAEA polymers were synthesised using pentaerythritol tetrakis [2-(dodecylthiocarbonothioylthio)-2-methylpropionate] (4-arm DDMAT) RAFT agent in a “core-first” approach, whereas 2-(dodecylthiocarbonothioylthio)-2-methylpropionate was used to synthesise linear PDMAEA polymers. In order to investigate the effect of molar mass, both star-shaped and linear PDMAEA were synthesised in low (10kDa) and high (20kDa) molar mass. It must be noted here that the overall molar mass of the star-shaped polymer was equal to that of the linear counterparts. Interestingly, we found that the star-shaped polymer has slightly smaller hydrodynamic diameter (more compact) relative to linear counterparts, and importantly, star-shaped PDMAEA binds to DNA at much lower nitrogen to phosphate ratio (N/P ratio). However, the cytotoxicity studies in cultured 3T3 murine cell lines demonstrated that both star-shaped and linear counterparts have no toxicity at low 10kDa, but significantly toxic at higher 20kDa molar mass, this finding confirmed that the molar mass of PDMAEA play a key role in cytotoxicity effect, not variable polymer structures. Taken together, star-shaped PDMAEA binds more effectively to DNA than linear counterparts and showed no toxicity at 10kDa molar mass at variable polymer concentrations