Molecular and Cellular Mechanisms of Delayed Fracture Healing in Mmp10 (Stromelysin 2) Knockout Mice

The remodeling of the extracellular matrix is a central function in endochondral ossification and bone homeostasis. During secondary fracture healing, vascular invasion and bone growth requires the removal of the cartilage intermediate and the coordinate action of the collagenase matrix metalloproteinase (MMP)-13, produced by hypertrophic chondrocytes, and the gelatinase MMP-9, produced by cells of hematopoietic lineage. Interfering with these MMP activities results in impaired fracture healing characterized by cartilage accumulation and delayed vascularization. MMP-10, Stromelysin 2, a matrix metalloproteinase with high homology to MMP-3 (Stromelysin 1), presents a wide range of putative substrates identified in vitro, but its targets and functions in vivo and especially during fracture healing and bone homeostasis are not well defined. Here, we investigated the role of MMP-10 through bone regeneration in C57BL/6 mice. During secondary fracture healing, MMP-10 is expressed by hematopoietic cells and its maximum expression peak is associated with cartilage resorption at 14 days post fracture (dpf). In accordance with this expression pattern, when Mmp10 is globally silenced, we observed an impaired fracture-healing phenotype at 14 dpf, characterized by delayed cartilage resorption and TRAP-positive cell accumulation. This phenotype can be rescued by a non-competitive transplant of wild-type bone marrow, indicating that MMP-10 functions are required only in cells of hematopoietic linage. In addition, we found that this phenotype is a consequence of reduced gelatinase activity and the lack of proMMP-9 processing in macrophages. Our data provide evidence of the in vivo function of MMP-10 during endochondral ossification and defines the macrophages as the lead cell population in cartilage removal and vascular invasio

Influencia del calzado en los ángulos del hallux y presencia de exóstosis en su falange distal

Antecedentes La parte anterior del zapato, donde se alojan los dedos, tiene muy comúnmente una forma que puede ser constrictiva y provoca presión sobre los dedos, dando lugar a alteraciones en el antepié. Sin embargo, queda en el aire si los zapatos de punta constrictiva únicamente producen dolor en los puntos de presión o si pueden causar también cambios permanentes en la morfología del hallux. El objetivo de este estudio es comparar la morfología del hallux en 3 grupos de personas clasificadas de acuerdo con su uso de zapatos de punta constrictiva o abierta. Materiales y método 424 pacientes fueron incluidos en el estudio y se clasificaron en 3 grupos: el Grupo A utilizaba sólo zapatos de punta abierta diariamente; El Grupo B utiliza zapatos de punta abierta y constrictiva indistintamente según el día; El grupo C utiliza zapatos de punta cerrada diariamente. Se utilizaron radiografías dorso-plantares para analizar los ángulos del hallux, la presencia de exóstosis y la forma de la falange distal (F2). Resultados Los pacientes que usaron zapatos con punta abierta (grupo A) presentaban un AIM, AMTF, DASA, PASA, AIF, AF1, AF2, DA de 10º (DE: 2), 8º (DE: 6), 5º (DE: 3), 4º (DE: 3), 9º (DE: 4), 3º (DE: 2), 5º (DE: 3), 3º (DE: 2) respectivamente. Los pacientes que utilizaban zapatos de punta abierta y constrictiva indistintamente (grupo B) presentaban un AIM, AMTF, DASA, PASA, AIF, AF1, AF2, DA de 10º (DE: 14), 10º (DE: 2), 4º (DE: 3), 4º (DE: 4), 12º (DE: 6), 3º (DE: 3), 8º (DE: 4), 1º (DE: 2) respectivamente. Los pacientes que usaban zapatos con punta constrictiva (grupo C) presentaban un ángulo intermetatarsal (AIM), ángulo metatarsofalángico (AMTF), DASA, PASA, ángulo interfalángico (AIF), ángulo de oblicuidad (AF1), ángulo de asimetría (AF2) y desviación de la articulación ángulo (DA) de 9º (DE: 4), 19º (DE: 11), 5º(DE: 3), 6º (DE: 4), 12º (DE: 5), 2º (DE: 2), 8º (SD ): 4), 2º (DE: 2) respectivamente. La prevalencia de exóstosis tibial en F2 fue de 22, 29 y 36% en los grupos A, B y C, respectivamente. En nuestra serie encontramos distribuciones similares en las diferentes formas de F2 (longitudinal, piramidal y clásica). Conclusiones El uso de zapatos de punta constrictiva provoca un aumento de los AMTF, AIF y AF2, incluso cuando su uso es solo ocasional. El uso de zapatos con punta constrictiva se asocia a una mayor prevalencia de exóstosis en el lado tibial en la F2 del 1er radio, incluso aunque el uso sea solo ocasional. Sin embargo, el tipo de zapatos no parece influir en la forma de F2

Influencia del calzado en los ángulos del hallux y presencia de exóstosis en su falange distal

Antecedentes La parte anterior del zapato, donde se alojan los dedos, tiene muy comúnmente una forma que puede ser constrictiva y provoca presión sobre los dedos, dando lugar a alteraciones en el antepié. Sin embargo, queda en el aire si los zapatos de punta constrictiva únicamente producen dolor en los puntos de presión o si pueden causar también cambios permanentes en la morfología del hallux. El objetivo de este estudio es comparar la morfología del hallux en 3 grupos de personas clasificadas de acuerdo con su uso de zapatos de punta constrictiva o abierta. Materiales y método 424 pacientes fueron incluidos en el estudio y se clasificaron en 3 grupos: el Grupo A utilizaba sólo zapatos de punta abierta diariamente; El Grupo B utiliza zapatos de punta abierta y constrictiva indistintamente según el día; El grupo C utiliza zapatos de punta cerrada diariamente. Se utilizaron radiografías dorso-plantares para analizar los ángulos del hallux, la presencia de exóstosis y la forma de la falange distal (F2). Resultados Los pacientes que usaron zapatos con punta abierta (grupo A) presentaban un AIM, AMTF, DASA, PASA, AIF, AF1, AF2, DA de 10º (DE: 2), 8º (DE: 6), 5º (DE: 3), 4º (DE: 3), 9º (DE: 4), 3º (DE: 2), 5º (DE: 3), 3º (DE: 2) respectivamente. Los pacientes que utilizaban zapatos de punta abierta y constrictiva indistintamente (grupo B) presentaban un AIM, AMTF, DASA, PASA, AIF, AF1, AF2, DA de 10º (DE: 14), 10º (DE: 2), 4º (DE: 3), 4º (DE: 4), 12º (DE: 6), 3º (DE: 3), 8º (DE: 4), 1º (DE: 2) respectivamente. Los pacientes que usaban zapatos con punta constrictiva (grupo C) presentaban un ángulo intermetatarsal (AIM), ángulo metatarsofalángico (AMTF), DASA, PASA, ángulo interfalángico (AIF), ángulo de oblicuidad (AF1), ángulo de asimetría (AF2) y desviación de la articulación ángulo (DA) de 9º (DE: 4), 19º (DE: 11), 5º(DE: 3), 6º (DE: 4), 12º (DE: 5), 2º (DE: 2), 8º (SD ): 4), 2º (DE: 2) respectivamente. La prevalencia de exóstosis tibial en F2 fue de 22, 29 y 36% en los grupos A, B y C, respectivamente. En nuestra serie encontramos distribuciones similares en las diferentes formas de F2 (longitudinal, piramidal y clásica). Conclusiones El uso de zapatos de punta constrictiva provoca un aumento de los AMTF, AIF y AF2, incluso cuando su uso es solo ocasional. El uso de zapatos con punta constrictiva se asocia a una mayor prevalencia de exóstosis en el lado tibial en la F2 del 1er radio, incluso aunque el uso sea solo ocasional. Sin embargo, el tipo de zapatos no parece influir en la forma de F2

Medial and lateral exostoses of the distal phalanx of the hallux: A potentially painful bunion-like structure. Part 1: Incidence and clinical application

Background Exostoses at the base of the distal phalanx of the great toe are usually asymptomatic. The literature has not generally considered them as the origin of a possible problem resulting from a pressure conflict between hallux and shoe (medial aspect) or second toe (lateral aspect) nor a potential complication of surgical correction of hallux valgus deformity. No studies, to our knowledge, have evaluated its possible correlation with other foot disorders. When one of these neglected exostoses became painful after surgical correction of hallux valgus, we decided to start a study to determine their possible origin, prevalence in daily practice and histo-pathological morphology. Methods Two hundred and fifty-four feet of patients (average age 41.7 y.) were enrolled in the study from January 2007 to June 2009. Dorsoplantar weight-bearing radiographs were used to analyze the presence of exostoses and their correlation with the distal phalanx morphology, metatarsal formula (or transverse plane orientation of the metatarsal heads parabola) and hallux valgus angles. Patients were classified according to their age and main symptom for consultation. Four exostoses removed from cadaver feet were also analyzed microscopically. Results Osseous excrescences arising on the medial or lateral aspect at the proximal part of the terminal phalanx of the hallux were observed in 132 feet (51.9%). Thirty-five feet out of these 132 (13.7%) had exostoses on both sides of the phalanx.A statistically significant positive correlation was found between the presence of a medial exostosis of the phalanx and the severity of HVA. Patients with higher IPH and asymmetry angles have a lower prevalence of medial exostoses (p < 0.05). Amongst the different morphologies of the second phalanx, exostoses were most likely found in the standard form. Conclusions Prevalence of exostoses at the base of the distal phalanx is high (51.9% of the studied feet). Histological findings would suggest that these exostoses could be considered a mechanical reactive process, produced by a chronic irritation by shoes. We encourage surgeons to be aware of its potential clinical implications. Direct resection is very simple and the most appropriate treatment for symptomatic cases

Proximal tibiofibular joint changes after closed-wedge high tibial osteotomy. Are they relevant?

Background: There is some controversy about how the proximal tibiofibular joint (PTFJ) capsulotomy changes PTFJ anatomy in closed-wedge high tibial osteotomy (CW-HTO) and about how this affects ankle and knee mobility and the onset of lateral knee pain. The aim of this study is to evaluate changes in PTFJ after CW-HTO, and its possible clinical significance. Methods: This study includes 50 patients who underwent CW-HTO with tibiofibular capsulotomy from 2000 to 2018 in our hospital. A clinical evaluation was conducted to evaluate pain location. The degrees of osteoarthritis and the proximal fibular subluxation were evaluated on radiographs. A dynamic analysis of the PTFJ was also performed comparing proximal fibular head subluxation on anteroposterior knee radiographs with the ankle placed in neutral position and dorsiflexed. Results: The clinical evaluation revealed that two patients had a sore scar, five had pain on the PTFJ with manual compression, and none referred lateral compartment pain. The radiological analysis revealed an average proximal subluxation of the fibular head after the osteotomy of 9.64 (range: 0–29) mm, which was greater in oblique PTFJ (p < 0.05). After the surgery, all the patients developed some degree of PTFJ arthritis. There was no correlation between lateral pain and proximal fibular subluxation, tibiofibular arthritis, or lateral compartment arthritis. The dynamic analysis revealed no significant changes. Conclusions: After CW-HTO all the patients developed proximal subluxation of the fibular head and a variable degree of PTFJ osteoarthritis, but these changes seem to be unrelated with lateral knee pain

Akin osteotomy: Is the type of staple fixation relevant?

Background Although different fixation techniques for the Akin osteotomy have been described in the literature, there are no many studies trying to analyze the differences between the types of fixation available. The aim of this study is to analyze if there are any differences between three types of staple fixation available in the market. Method We present a retrospective study of 145 cases in which an Akin osteotomy was performed and fixed with three different kinds of implants staple A (28%), staple B (45%), and staple C (27%). Staple A is made out of stainless steel, and the surgeon mechanically controls the compression applied. Staple B increases the compression when heat is applied to it. Staple C has an intrinsic elastic memory that closes the osteotomy. In all cases, distal articular set angle, interphalangeal joint obliquity angle, and metatarsophalangeal angle were measured pre-operatively and 1.5 months post-operatively on dorsoplantar weight-bearing radiographs. Other details such as post-operative complications, implant migration, osteolysis, or fracture of the lateral cortex during surgery were also recorded. Results Clinical and radiological results show no relevant differences between the three types of fixation. The mean angular corrections of DASA, interphalangeal joint obliquity angle, and metatarsophalangeal angle were 5, 12, and 21, respectively, for staple A; 4, 10, and 19, respectively, for staple B; and 7, 10, and 23, respectively, for staple C. The rates of intra-operative and post-operative complications were similar for all groups. There was one case of infection per group. We had five cases of delayed union two with staple A and three with staple C. In four cases, there was a loss of correction, two of them fixed with staple A and two with staple C. Seven cases developed a Südeck’s syndrome, four of them fixed with staple A and three with staple C. Fifteen patients suffered an uncontrolled fracture of the lateral cortex of the phalanx when performing the osteotomy (3, 8, and 4 cases fixed with staples A, B, and C, respectively), and 87.5% of the patients that developed a plantar displacement of the osteotomy had an uncontrolled fracture of the lateral cortex (p < 0.05). All three staples achieved a rigid internal fixation and minimal periosteum damage and provided a good bone-bone contact. Conclusions According to our results, the radiological differences are minimal, and although the thermal compression staple had less complication, clinical differences were also not statistically significant. This means the choice of implant could be left to the surgeon’s preferences or made according to cos

Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft

The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p = 0.897; sidewalk invasions, p = 0.749; pedestrian impact, p = 0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right-left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries

The vancomycin soaking technique: no differences in autograft re-rupture rate. A comparative study

Purpose The main aim of this study was to evaluate the re-rupture risk after an anterior cruciate ligament reconstruction (ACL-R) using the vancomycin soaking technique and to compare it with the re-rupture risk in patients on whom this technique was not utilized. The secondary purpose was to compare the functional outcomes of those two subsets of patients operated on for ACL-R. The hypotheses are that the vancomycin soaking technique does not affect the re-rupture risk or the functional outcomes. Material and methods A retrospective historical cohort study was conducted. Two groups were compared in terms of the re-rupture rate (traumatic or atraumatic) and functional outcomes (International Knee Documentation Committee (IKDC), Tegner, and Lysholm). Group 1 consisted of patients that received pre-operative IV antibiotics. In group 2, the patients received pre-operative IV antibiotics along with a graft that had been presoaked in a vancomycin solution. A minimum follow-up of five years was required. Results There were 17 patients that suffered a re-rupture in group 1 (4.7%) and 15 in group 2 (3.9%) (n.s.). IKDC was 82.0 in group 1 and 83.9 in group 2 (p = 0.049); Tegner scored 4 in both groups (n.s.) and Lysholm was 90.3 in group 1 and 92.0 in group 2 (p = 0.015). Conclusion The vancomycin soaking technique for ACL autografts is a safe procedure for the daily clinical practice, in terms of re-ruptures. Moreover, it does not impair functional outcomes after an ACL-R

Validation of the concavity-convexity quotient as a new method to measure the magnitude of scoliosis.

Objectives: We propose a novel and simple method to determine the magnitude of the curve in scoliosis and its correlation with the Cobb angle. Methods: Using multiple rounds of nominal group technique and an established consensus‑building methodology, a multidisciplinary research group identified a simple method to value the curve deformity based on the vertebral pedicles. Measurements: A mathematical study was performed to determine the relationship between the Cobb angle and the concavity–convexity quotient (CCQ). To evaluate the clinical correlation between the Cobb angle and CCQ, spine surgeons measured 48 curves (before and after follow‑up) of congenital scoliosis. Results: This quotient reflects the ratio between the distance from the upper end of the most inclined upper vertebra to the lower end of the most inclined lower vertebra on the concave side (A‑distance) and the corresponding distance on the convex side of the curve (B‑distance). The existing mathematical relationship is based on changing the explicit coordinates to polar coordinates. Finally, the clinical correlation between the Cobb angle and CCQ was statistically significant (r = −0.688; P < 0.001 in first measure and r = −0.789; P < 0.001 in the second measure). Conclusions: Our study provides Level III evidence that CCQ represents a promising alternative or a complementary method to the traditional Cobb angle due to its simple and reliable ability to measure the magnitude of the curve

Do we really improve life quality after total knee arthroplasty in patients with Parkinson’s disease?

Introduction The knee in Parkinson’s disease (PD) patients is a problematic joint due to pain, stifness and gait instability. The aim of this study is to evaluate the functional outcome and degree of pain relief achieved after total knee arthroplasty (TKA) in PD patients. Materials and methods This is a retrospective review of 26 PD patients (32 knees) with osteoarthritis who underwent a TKA between 1994 and 2013. Comorbidities, anesthetic procedures and complications were recorded. Patient functional status was assessed with the Knee Society Function Score (KFS) and the Knee Society Score (KSS). PD stage was classifed with the Hoehn and Yahr Scale. Results The mean follow-up was 3.5 years (range 2–9). The mean age was 71 years (range 61–83) with a mean time since PD diagnosis of 11.8 years (range 4–24). PD severity on the Hoehn and Yahr Scale was 1.5 points before surgery and 2 points postoperatively. Pain on the visual analogic scale improved from 8 points preoperatively to 5 points at 1-year follow-up; function improved from 32 (range 20–45) to 71 (range 50–81) and from 34 (range 28–52) to 59 (range 25–76) on the KSS and KFS, respectively. The mean postoperative hospital stay was 9.8 days (range 5–21). Confusion and fexion contracture were the most frequent perioperative complications. Conclusion TKA successfully provided pain relief in PD patients. However, the functional outcome is related to disease progression and, therefore, variable. Perioperative complications are difcult to avoid and manage