A bony bridge within the suprascapular notch. Anatomic study and clinical relevance

Purpose of the present study was to document the incidence, morphology, origin and clinical significance of the existence of a bony bridge within the suprascapular notch, below the level of the superior transverse scapular ligament. The study was carried out by visual observation on 204 dried scapulas. In only two scapulas (0.98%), there was a bony bridge within the suprascapular notch. The direction of this bony bridge was almost transverse to the notch and as a result there was a bony foramen beneath the bony bridge and a notch above it. There were bony prominences at the superior corners of both suprascapular notches and the bony bridges were both thicker at their attachments and thinner at their middle points, such as a ligament. These bony bridges seem to be the result of the complete ossification of an accessory band of the superior transverse scapular ligament and occur in about 1% of the population. A bony bridge within the suprascapular notch narrowed the notch enough to be considered as a potential risk factor for the suprascapular nerve entrapment syndrome. Radiologists, neurosurgeons and orthopaedic surgeons should keep this abnormality in mind, because they should identify it during the preoperative radiological assessment or intraoperatively, since its existence modifies the surgical technique during open and arthroscopic decompression of the suprascapular nerve

Crystallization Study and Comparative in Vitro–in Vivo Hydrolysis of PLA Reinforcement Ligament

In the present work, the crystallization behavior and in vitro–in vivo hydrolysis rates of PLA absorbable reinforcement ligaments used in orthopaedics for the repair and reinforcement of articulation instabilities were studied. Tensile strength tests showed that this reinforcement ligament has similar mechanical properties to Fascia Latta, which is an allograft sourced from the ilio-tibial band of the human body. The PLA reinforcement ligament is a semicrystalline material with a glass transition temperature around 61 °C and a melting point of ~178 °C. Dynamic crystallization revealed that, although the crystallization rates of the material are slow, they are faster than the often-reported PLA crystallization rates. Mass loss and molecular weight reduction measurements showed that in vitro hydrolysis at 50 °C initially takes place at a slow rate, which gets progressively higher after 30–40 days. As found from SEM micrographs, deterioration of the PLA fibers begins during this time. Furthermore, as found from in vivo hydrolysis in the human body, the PLA reinforcement ligament is fully biocompatible and after 6 months of implantation is completely covered with flesh. However, the observed hydrolysis rate from in vivo studies was slow due to high molecular weight and degree of crystallinity

Sonovial changes in patients suffering from degenerative osteoarthritis of the knee: light and electron microscopy study

Twenty- nine patients, 16 women and 13 men, with knee osteοarthritisparticipated in the present study. Patients with grade 3 of severity ofosteoarthritis, interjoint cortisone or enzymes injections or high grade of limitationof motion were excluded from the study. All patients underwent kneearthroscopy, during which the macroscopical findings were evaluated andbiopsies were taken from the lateral and medial part of the knee. Arthroscopywas performed using a 30° angle arthroscοpe. Synovial biopsies obtained duringarthroscopy were processed for :a) Light microscopy : tissues were fixed in formaldeyde 10%, dehydraded ingraded ethanol series, xylol and embedded in paraffin, and were stained withhaematoxylin- eosin, Gomori and Masson.b) Transmission electron microscopy. The classical method of tissue processingfor transmission electron microscopy was used.The macroscopical changes included thickening of the synovium in all patientswhich was significantly excessive in 10/29 patients ( 34.3%). Degenerativechanges of grade 2 were noted in 10/29 patients and in the remaining theseverity was of grade 1. Meniscus tear was found in 23/29 patients.Light microscopy revealed a moderate hypertrophy of synovial cells with apartial villous appearance of the synovium. Oedema, hypertrophy of vessel wallsand hypertrophy of endothelial cells in many capillaries were also seen. Therewas a slight inflammatory infiltration with lymphocytes and a few plasma cells.Significant increase in fibrosis with presence of collagen fibers was only found in3 cases.Electron microscopy revealed :1) Oedema within the synovial cells and hyperplasia mainly of type B cells.These cells often presented an intracellular oedema, thickening of their villiand processes which extended to the apical portion of the cells and several ofthem projected in the joint cavity or were loose in it. Processes were eitherempty of organelles or had areas of dense accumulation of intermediatefillaments. Microtubules were observed interspersed between theintermediate filaments and were increased in type A cells.2) Gap junctions were observed between cell processes, mainly between type Bcells. Punctuate adherens were abundant along any point of cell membranecontact.3) Many centromeres were observed mainly in type B cells as well as incytoplasmic processes.4) Mitochondria appeared swollen and showed various degree of degenerationwith cristernae lysis and distortion and their matrix had lost its normal density.Myelin figures were found inside the mitochondria.5) Abundant collagen fibers were observed intercellularly and around vessels,the quantity and density of which were related to the degree of synovial celldegeneration. A distinct perivascular fibrosis was also noted. The increase incollagen concentration could possibly contribute to the impairment of varioussubstances diffusion from the cells to the capillaries and vice versa.6) The nuclei were basically euchromatic and in a few of them a nucleolus couldbe seen. Nuclear fibrous bodies surrounded by a clear zone were observed inall types of cells.7) The dilation of rough endoplasmic reticulum combined with the affectedswollen mitochondria are indicating cell degeneration. A dilation of Golgicomplexes was also present. These findings may represent cell hyperplasiaas a “repair response”.8) Infiltration with neutrophils, plasma cells and natural killer cells was alsoobserved. Giant cells were also seen. A fatty degeneration of cells was noted.In conclusion, these findings show that certain significant ultrastructuralchanges occur in the synovium in osteoarthritis. These changes mainly consist ofa) oedema and cell hyperplasia, b) inversion of the predominant cell type from Ato B, c) excessive mitochondria alterations, d) presence of abumdant collagenfibers and fibrosis mainly perivascularly, e) changes in the rough endoplasmicreticulum and Golgi complexes and f) inflammatory cell infiltration and giant cellconcentration.These changes are possibly directly or undirectly related to thepathogenesis of osteoarthritisΣτην παρούσα μελέτη συμμετείχαν 29 ασθενείς, 16 γυναίκες και 13άνδρες, οι οποίοι έπασχαν από οστεοαρθρίτιδα γόνατος. Από τη μελέτηαποκλείσθηκαν ασθενείς με 3ου βαθμού αλλοιώσεις, όσοι είχαν υποβληθεί σεενδαρθρική ένεση κορτιζόνης ή ενζύμων και όσοι εμφάνιζαν μεγάλου βαθμούπεριορισμό της κινητικότητας της άρθρωσης. Οι ασθενείς υποβλήθηκαν σεαρθροσκόπηση του γόνατος , κατά την οποία αξιολογήθηκαν τα μακροσκοπικάευρήματα και πραγματοποιήθηκαν βιοψίες του αρθρικού υμένα από το έσω καιέξω διαμέρισμα του γόνατος. Η αρθροσκόπηση διενεργήθηκε με αρθροσκόπιογωνίας απόκλισης 30°.Τα οστεοτεμάχια που λαμβάνονταν διαχωρίστηκαν :Α) Για μελέτη στο οπτικό μικροσκόπιο : τα τεμάχια μονιμοποιήθηκαν σε διάλυμαφορμαλδεύδης 10%, αφυδατώθηκαν σε οινόπνευμα διαφόρων βαθμών,διαφανοποιήθηκαν με ξυλόλη και εμποτίστηκαν με παραφίνη. Χρησιμοποιήθηκανοι χρώσεις αιματοξυλίνης- εωσίνης και οι ειδικές ιστοχημικές χρώσεις Gomori καιMasson.Β) Για μελέτη στο ηλεκτρονικό μικροσκόπιο : η μέθοδος παρασκευής καιεπεξεργασίας των ιστοτεμαχίων έγινε σύμφωνα με την κλασσική μέθοδοπροετοιμασίας ιστών για παρατήρηση με ΗΜ διερχόμενης δέσμης.Οσον αφορά τα μακροσκοπικά ευρήματα διαπιστώθηκε πάχυνση τουαρθρικού υμένα σε όλους τους ασθενείς, η οποία ήταν ιδιαίτερα αυξημένη σε10/29 ασθενείς ( 34.3%). Σε 10/29 ασθενείς παρατηρήθηκαν εκφυλιστικέςαλλοιώσεις 2ου βαθμού ενώ στους υπόλοιπους 1ου βαθμού. Σε 23/29 ασθενείςπαρατηρήθηκε ρήξη μηνίσκου.Με το οπτικό μικροσκόπιο διαπιστώθηκε μέτρια υπερπλασία τωνσυνοβιακών κυττάρων με μερική θηλώδη διαμόρφωση του αρθρικού υμένα. Στουπόστρωμα παρατηρήθηκε οίδημα, πολλά τριχοειδή με υπερπλασία τωνενδοθηλιακών κυττάρων και πάχυνση του τοιχώματος των αγγείων. Ηφλεγμονώδης διήθηση ήταν ήπια και αποτελούνταν από λεμφοκύτταρα και λίγαπλασματοκύτταρα. Μόνον σε 3 περιπτώσεις παρατηρήθηκε σημαντική αύξησητου ινώδους συνδετικού ιστού με παρουσία κολλαγόνων ινών.Οσον αφορά τα ευρήματα του ηλεκτρονικού μικροσκοπίου διαπιστώθηκαντα εξής :1) Οίδημα μεταξύ των κυττάρων και υπερπλασία κυρίως των τύπου Β κυττάρων.Τα κύτταρα παρουσίαζαν ενίοτε ενδοκυττάριο οίδημα, πάχυνση τωνψευδοποδίων και προσεκβολές που εκτείνονταν στο άνω άκρο της στιβάδαςτων κυττάρων και ορισμένες κατέληγαν ως προβολή στο μεσάρθριο χώρο ήεμφανίζονταν ελεύθερες μέσα σε αυτόν. Οι προσεκβολές άλλοτε ήταν κενές ήπαρουσίαζαν πυκνή συσσώρευση διάμεσων ινιδίων. Ανάμεσα στα διάμεσαινίδια υπήρχαν μικροσωληνάρια τα οποία ήταν αυξημένα στα κύτταρα τύπουΑ.2) Χασματοσυνδέσεις διαπιστώθηκαν μεταξύ των κυτταρικών προσεκβολών καικυρίως μεταξύ των κυττάρων τύπου Β. Πολυάριθμες στικτές προσκολλήσεις(punctate adherens) κατά μήκος οποιουδήποτε σημείου επαφής τηςκυτταρικής μεμβράνης ήταν επίσης ορατές.3) Παρατηρήθηκαν πολλά κεντροσωμάτια, κυρίως στα κύτταρα τύπου Β, όπωςκαι σε κυτταροπλασματικές προσεκβολές.4) Τα μιτοχόνδρια ήταν διατεταμένα και παρουσίαζαν διαφόρου βαθμού λύσηκαι ρήξη των ακρολοφιών, με τη θεμέλια ουσία να έχει χάσει την φυσιολογικήτης πυκνότητα. Μέσα στα μιτοχόνδρια βρέθηκαν μυελινικοί σχηματισμοί. Οιαλλοιώσεις αυτές φαίνεται ότι χαρακτηρίζουν την ΟΑ.5) Παρατηρήθηκαν άφθονες κολλαγόνες ίνες μεταξύ των κυττάρων και τωντριχοειδών, η ποσότητα και πυκνότητα των οποίων ήταν ανάλογη με τοβαθμό εκφύλισης των κυττάρων του αρθρικού υμένα. Παρατηρήθηκεχαρακτηριστική περιαγγειακή ίνωση. Η αύξηση των κολλαγόνων ινώνπιθανόν συμμετέχει στη διαταραχή της διάχυσης ουσιών από τα κύτταρα στατριχοειδή και αντίστροφα.6) Οι πυρήνες ήταν βασικά ευχρωματικοί και σε ελάχιστους ήταν εμφανές τοπυρήνιο. Σε όλους τους τύπους κυττάρων εμφανίζονταν πυρηνικά ινώδησωμάτια τα οποία περιβάλλονταν από διαφανή ζώνη. Οι πυρήνες ενίοτεεμφάνιζαν κυτταροπλασματικές προσεκβολές.7) Παρατηρήθηκε διάταση του τραχέως ενδοπλασματικού δικτύου, η οποία μαζίμε τη διάταση των μιτοχονδρίων συνηγορεί με κενοτοπιώδη εκφύλιση τωνκυττάρων. Παράλληλα υπήρχε διάταση της συσκευής Golgi. Τα παραπάνωευρήματα υποδηλώνουν την προσπάθεια αντισταθμιστικής υπερτροφίας τωνκυττάρων.8) Παρατηρήθηκαν στις περισσότερες περιπτώσεις ουδετερόφιλα,πλασματοκύτταρα, φονικά κύτταρα και γιγαντοκύτταρα. Επίσηςπαρατηρήθηκε λιπώδης εκφύλιση των κυττάρων.Συμπερασματικά φαίνεται ότι σε επίπεδο λεπτής υφής παρατηρούνταιορισμένες σημαντικές αλλοιώσεις στον αρθρικό υμένα στην ΟΑ σε σύγκριση μετον φυσιολογικό αρθρικό υμένα. Αυτές κυρίως συνίστανται σε α) οίδημα καιυπερπλασία των κυττάρων, β) σε αναστροφή του τύπου των κυττάρων πουεπικρατούν, από Α σε Β, γ) σημαντικές αλλοιώσεις των μιτοχονδρίων, δ)παρουσία αφθόνων κολλαγόνων ινών και ίνωσης κυρίως περιαγγειακής, ε)αλλοιώσεις στο τραχύ ενδοπλασματικό δίκτυο και τη συσκευή Golgi και στ) στηνπαρουσία φλεγμονωδών κυττάρων και γιγαντοκυττάρων.Οι αλλοιώσεις αυτές είναι πιθανόν να σχετίζονται άμεσα ή έμμεσα με τηνπαθογένεση της οστεοαρθρίτιδα

A Giant Scapular Aneurysmal Bone Cyst in a Child

Aneurysmal bone cysts (ABCs) are rare benign bone tumours. Scapula is a very rare location, and the relative literature is sparse. The purpose of this study is to present a case of a giant aggressive scapular aneurysmal bone cyst in a child. A 7-year-old boy presented to our hospital with pain and a palpated mass on the right scapula. Imaging studies (radiographs computed tomography scintigraphy) were indicative of aneurysmal bone cyst. We performed curettage and bone grafting after the diagnosis was set by pathological examination through a posterior shoulder approach. Five years later, the patient has only residual signs of the lesion on radiographic control without signs of recurrence

Genu Recurvatum Deformity in a Child due to Salter Harris Type V Fracture of the Proximal Tibial Physis Treated with High Tibial Dome Osteotomy

Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2 cm) as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture) and, secondly, provides an alternative method of treatment for genu recurvatum deformity

Stem cells for the treatment of early to moderate osteoarthritis of the knee: a systematic review

Abstract Purpose Mesenchymal stem cells (MSCs) present a valuable treatment option for knee osteoarthritis with promising results. The purpose of the present study was to systematically review the clinical and functional outcomes following mesenchymal stem cell application focusing on early to moderate knee osteoarthritis. Methods A systematic search was done using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines in Pubmed, Scopus, Web of Science, and Cochrane Library databases. All Studies published between 2017 and March 2023 on patients treated with single mesenchymal stem cell injection for Kellgren‐Lawrence grade I—III knee osteoarthritis reported on clinical and functional outcomes were included. Results Twelve articles comprising 539 patients and 576 knees treated with a single intraarticular injection of MSCs for knee osteoarthritis were included in the current systematic review. In eligible studies, the reported outcomes were improved concerning patient‐reported outcomes measures, knee function, pain relief, and quality of patient's life. Conclusion Based on high‐level evidence studies, single intraarticular injection of MSCs is a safe, reliable, and effective treatment option for Kellgren‐Lawrence grade I—III knee osteoarthritis. However, the lack of homogeneity in the included studies and the variance in MSCs sources and preparations should be noted. Level of evidence III

Stem cells for the treatment of early to moderate osteoarthritis of the knee: a systematic review

Purpose: Mesenchymal stem cells (MSCs) present a valuable treatment option for knee osteoarthritis with promising results. The purpose of the present study was to systematically review the clinical and functional outcomes following mesenchymal stem cell application focusing on early to moderate knee osteoarthritis. Methods: A systematic search was done using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in Pubmed, Scopus, Web of Science, and Cochrane Library databases. All Studies published between 2017 and March 2023 on patients treated with single mesenchymal stem cell injection for Kellgren-Lawrence grade I—III knee osteoarthritis reported on clinical and functional outcomes were included. Results: Twelve articles comprising 539 patients and 576 knees treated with a single intraarticular injection of MSCs for knee osteoarthritis were included in the current systematic review. In eligible studies, the reported outcomes were improved concerning patient-reported outcomes measures, knee function, pain relief, and quality of patient's life. Conclusion: Based on high-level evidence studies, single intraarticular injection of MSCs is a safe, reliable, and effective treatment option for Kellgren-Lawrence grade I—III knee osteoarthritis. However, the lack of homogeneity in the included studies and the variance in MSCs sources and preparations should be noted. Level of evidence: III.SCOPUS: re.jinfo:eu-repo/semantics/publishe