The Management of Talar Osteochondral Lesions - Current Concepts

Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Diagnosis of OLTs requires a combination of clinical assessment and imaging and despite many different treatment options, there is no generalised consensus regarding which option is the most effective. Left untreated, OLTs risk progressing to osteoarthritis. Acute non-displaced OLTs can be treated non-operatively. However, OLTs refractory to non-surgical care for three to six months may be suitable for surgical care. In these cases, conservative treatments are often unsuccessful, particularly for larger and more severe defects and so the majority require surgical intervention. Although bone marrow stimulation techniques remain the “gold standard” for lesions <150 mm2, there still requires a need for better long term clinical data and cost-benefit analyses compared with other treatment options. Biological attempts at either regenerating or replacing the articular cartilage are however demonstrating some promising results, but each with their own advantages and disadvantages. In this review, we summarise the clinical management of OLTs and present the current concepts of different treatment regimes

The effects of driver fatigue, gender, and distracted driving on perceived and observed aggressive driving behavior: A correlated grouped random parameters bivariate probit approach.

Previous research has shown that the determinants of perceived and observed aggressive driving behavior may differ. However, the consideration of major sources of aggressive patterns may introduce additional variations in the effect of such determinants. This study aims to provide further insights in the variations of these two behavioral components arising from driver’s fatigue, gender as well as internal and external distractions (such as, rushing to destination, listening to music and solving logical problems) during the driving task. To identify how the factors determining perceived and observed aggressive behavior may vary across groups of drivers associated with such sources of aggressive driving, survey and simulation data are statistically analyzed. Separate models of perceived and observed aggressive driving behavior are estimated for fatigued and non-fatigued, distracted and non-distracted, male and female drivers. To address various aspects of unobserved heterogeneity, associated with the unobserved variations that are commonly shared among the behavioral components and participants, as well as their unobserved interactions, the correlated grouped random parameters bivariate probit modeling framework is employed. The results of the empirical analysis showed that the effect of the socio-demographic and behavioral factors on perceived and aggressive driving behavior may vary across the aforementioned groups of drivers, in terms of magnitude and directional effect. In addition, the identification of correlation among the unobserved characteristics further illustrates the complexities of the driving decision mechanism, especially when fundamental sources of aggressive driving are evident

Routinely measured haematological markers can help to predict AIS scores following spinal cord injury.

Neurological outcomes following spinal cord injury (SCI) are currently difficult to predict. Whilst the initial American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade can give an estimate of outcome, the high remaining degree of uncertainty has stoked recent interest in biomarkers for SCI. This study aimed to assess the prognostic value of routinely measured blood biomarkers by developing prognostic models of AIS scores at discharge and 12-months post-injury. Routine blood and clinical data were collected from SCI patients (n=427) and blood measures that had been assessed in less than 50% of patients were excluded. Outcome neurology was obtained from AIS and Spinal cord independence measure III (SCIM-III) scores at discharge and 12-months post-injury, with motor (AIS) and sensory (AIS, touch and prick) abilities being assessed individually. Linear regression models with and without elastic net penalisation were created for all outcome measures. Blood measures associated with liver function such as alanine transaminase were found to add value to predictions of SCIM-III at discharge and 12-months post-injury. Furthermore, components of a total blood count including haemoglobin were found to add value to predictions of AIS motor and sensory scores at discharge and 12-month post-injury. These findings corroborate the results of our previous preliminary study and thus provide further evidence that routine blood measures can add prognostic value in SCI, and that markers of liver function are of particular interest

The synovial fluid from patients with focal cartilage defects contains mesenchymal stem/stromal cells and macrophages with pro- and anti-inflammatory phenotypes

Objective The synovial fluid (SF) of patients with focal cartilage defects contains a population of poorly characterised cells that could have pathophysiological implications in early osteoarthritis and joint tissue repair. We have examined the cells within SF of such joints by determining their chondrogenic capacity following culture expansion and establishing the phenotypes of the macrophage subsets in non-cultured cells. Design Knee SF cells were obtained from 21 patients receiving cell therapy to treat a focal cartilage defect. Cell surface immunoprofiling for stem cell and putative chondrogenic markers, and the expression analysis of key chondrogenic and hypertrophic genes were conducted on culture-expanded SF cells prior to chondrogenesis. Flow cytometry was also used to determine the macrophage subsets in freshly isolated SF cells. Results Immunoprofiling revealed positivity for the monocyte/macrophage marker (CD14), the haematopoietic/endothelial cell marker (CD34) and mesenchymal stem/stromal cell markers (CD73, CD90, CD105) on culture expanded cells. We found strong correlations between the presence of CD14 and the vascular cell adhesion marker, CD106 (r=0.81, p=0.003). Collagen type II expression after culture expansion positively correlated with GAG production (r=0.73, p=0.006), whereas CD90 (r=-0.6, p=0.03) and CD105 (r=-0.55, p=0.04) immunopositivity were inversely related to GAG production. Freshly isolated SF cells were positive for both pro- (CD86) and anti-inflammatory markers (CD163 and CD206). Conclusions The cellular content of the SF from patients with focal cartilage injuries is comprised of a heterogeneous population of reparative and inflammatory cells. Additional investigations are needed to understand the role played by these cells in the attempted repair and inflammatory process in diseased joints