Lezije koštane srži: koncept dvaju stupova

A common magnetic resonance imaging pattern of bone marrow lesion has been described in numerous pathological entities. However, despite intensive research, its etiopathological pathways and repercussions on disease progression remain controversial. From our current knowledge, subchondral bone represents an active site of remodelling fulfilling both mechanical and biological joint requirements. Alteration of bone remodelling activity, as one of the major characteristics of bone marrow lesions, can potentially lead to biological and structural impairment of the affected tissue and consequently the entire joint. The discovered close connection between subchondral bone biology and its structural changes together with parallel changes in overlying cartilage is setting the scene for a potentially new concept. In this “Two Pillar“ concept both structure and biology of subchondral bone (and its biomechanical and biochemical interference with the layer above) represent the foundations of the structure and function of articular cartilage. In light of the proposed concept, we will review current knowledge on aetiology, pathogenesis, and clinical presentation of BML and correlate it to existing and emerging treatment options.Uobičajeni prikaz lezija koštane srži na magnetskoj rezonanciji opisan je u brojnim patološkim entitetima. Međutim, unatoč intenzivnim istraživanjima, njegovi etiopatološki putevi i posljedice na progresiju bolesti ostaju kontroverzni. Prema našim trenutnim spoznajama, subhondralna kost predstavlja aktivno mjesto remodeliranja s važnom mehaničkom i biološkom ulogom u održavanju homeostaze zglobova. Promjene remodeliranja kosti, kao jedna od glavnih karakteristika lezije koštane srži, može potencijalno dovesti do biološkog i strukturnog oštećenja zahvaćenog tkiva i posljedično cijelog zgloba. Otkrivena bliska veza između biologije subhondralne kosti i njezinih strukturnih promjena, zajedno s paralelnim promjena ma u hrskavici koja se nalazi iznad, postavljaju scenu za potencijalno novi koncept. U ovom konceptu “Dva nosiva stupa” i struktura i biologija subhondralne kosti (i njezina biomehanička i biokemijska interferencija sa slojem iznad) predstavljaju temelje strukture i funkcije zglobne hrskavice. U svjetlu predloženog koncepta osvrnuti ćemo se na trenutne spoznaje o etiologiji, patogenezi i kliničkoj prezentaciji lezija koštane srže te ih povezati s postojećim i novim mogućnostima liječenja

Intraoperacijska navigacija detekcijskom gama sondom kod resekcije osteoidnog osteoma – prikaz dvaju slučajeva

Two cases of osteoid osteoma tumor (OO ) are presented and our early experience with intraoperative gamma probing to localize OO during surgery is reported. The concept of radioguided surgery was developed 60 years ago and the gamma detection probe technology for radioguided biopsy and/or resection of bone lesions has been applied since the early 1980s. Bone scintigraphy is very important for initial diagnosis of OO with almost 100% sensitivity. The bone scan finding is specific, with so called double density appearance, very intense accumulation of radiopharmaceutical in the nidus and therefore great difference between the nidus and the surrounding healthy bone, thus making possible to treat this lesion with probe guided surgery. Three phase bone scintigraphy and single photon emission computed tomography were conducted in our patients for initial diagnosis of OO . A second bone scintigraphy was performed before surgery. The surgery followed 12-15 hours later by intraoperative nidus detection with a hand-held gamma probe. Gamma hand-held probe is a system that detects gamma photons. The count rate in the nidus area on the day of surgery was 3 to 4 times higher than in the healthy bone area. Drilling was performed until the counts decreased to the level of the surrounding bone counts, thereby confirming complete excision. This is the method of choice for minimizing bone resection, the risk of pathologic fracture, the need of bone grafting, and reducing the period of convalescence. Evidence for the treatment efficiency is pain disappearance after the surgery.U radu se prikazuju dva klinička slučaja kod kojih smo koristili detekcijsku gama sondu za intraoperacijsku navigaciju prilikom kiretaže tumora osteoidnog osteoma (OO ). Zahvati su izvršeni na Klinici za traumatologiju Kliničkog bolničkog centra “Sestre milosrdnice”. Koncept radionavigacije u kirurgiji razvijao se zadnjih 60 godina, a primjena tehnologije gama detekcijske sonde za biopsiju ili resekciju koštanih lezija datira od ranih osamdesetih. Uz RTG te kompjutoriziranu tomografiju scintigrafija kosti je jedna od najvažnijih metoda u dijagnostici OO , s gotovo 100%-tnom osjetljivošću. Za početnu dijagnozu učinjena je trofazna scintigrafija kosti i SPE CT – jednofotonska emisijska kompjutorizirana tomografija. Druga scintigrafija kosti učinjena je prije zahvata. Operacija je uslijedila 12-15 sati kasnije uz intraoperacijsko otkrivanje gnijezda ručnom gama sondom. Na dan operacije brojčana vrijednost bila je 3-4 puta viša na mjestu lezije u odnosu na zdravu kost. Kiretaža tumora provođena je sve dok brojčana vrijednost nije pala na razinu vrijednosti okolne kosti, na taj način potvrđujući potpuno uklanjanje lezije. Ovo je jedna od metoda izbora liječenja OO , jer na najmanju mjeru svodi resekciju kosti te time smanjuje rizik od mogućih patoloških prijeloma i skraćuje razdoblje rekonvalescencije. Dokaz uspješnosti kirurškog zahvata bio je nestanak boli u operiranih bolesnika

Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective

Aim: To identify modes of venous thromboembolism (VTE) prophylaxis in patients undergoing elective major orthopaedic surgery (total hip or knee arthroplasty, THA/TKA) at a single university-associated hospital in Croatia. ----- Methods: A retrospective analysis of consecutive patients subjected to THA or TKA over a two-year period (2014-2015) with a focus on anticoagulation during the first 15 post-surgical days (period of highest VTE risk). ----- Results: Of 603 identified patients three (0.5%) were not anticoagulated (haemophilia) and others received perioperative doses of low molecular weight heparins (LMWH). Overall, 228 (37.8%) patients received prophylaxis not involving warfarin, and 372 continued with short-term LMWH with switching to warfarin. They contributed a total of 1218 international normalized ratio (INR) values (median=3, range=1-8). These were consistently below the target INR range across the observed period. Between post-surgical days 6 and 15 (after the initial titration), 438 values were taken in patients treated with LMWH+warfarin and 92.7% were below, and only 6.8% within the target range; 580 values were taken in patients already switched to warfarin, 74% were below and only 25% within the range. ----- Conclusion: The prevailing mode of VTE prophylaxis was in a clear contrast to (then) actual professional guidelines, with inadequate monitoring and poor anticoagulation. There is no reason to expect a substantially different situation at other institutions across the country. The prevailing practice of VTE prophylaxis in major orthopaedic surgery in Croatia should be promptly abandoned and up-dated in agreement with the current state of the art

NEW TECHNIQUES AND PROSPECTS IN INVASIVE TREATMENT IN VERTEBROLOGY

U članku su obrađene novosti i perspektive u invazivnom liječenju u vertebrologiji s naglaskom na interventne i poluinvazivne postupke te minimalno invazivnu kirurgiju u liječenju hernije intervertebralnog diska slabinske kralježnice. Osim toga opisane su novosti u neuroablativnim postupcima u liječenju križobolje, fiksaciji kralježnice i operativnom liječenju skolioza. Članak se osvrće i na metode koje se još ne primjenjuju kod nas, a koje dosta obećavaju kao što su rekonstrukcije nukleusa pulpozusa transplantacijom autolognih hondrocita, a prikazane su najnovije spoznaje u kirurgiji vratne kralježnice. Upozoreno je na uspješnost svake pojedine kirurške metode liječenja. Osim što je informativan, zajedno s odgovarajućim člankom o patofiziologiji spinalne boli, magnetskoj rezonanciji i konzervativnom liječenju ovaj tematski članak o najnovijim spoznajama u tom području može pomoći u pristupu bolesnicima.In this article authors outline new techniques and prospects in invasive treatment in vertebrology with emphasis on interventional and semi invasive procedures and minimally invasive surgery for lumbar disc herniation. They describe new approaches in neuroablative procedures for back pain treatment, in spinal fixation and in surgical treatment of scoliosis. Authors also report methods of great expectations which are not yet in use in our clinical practice but are promising like reconstruction of nucleus pulposus by autologous chondrocytes transplantation. New methods in cervical spine surgery are also discussed. The efficacy of each surgical method is pointed out. Apart from being informative, together with the corresponding article on patophysiology, magnetic resonance imaging and conservative treatment, these articles considering recent developments can be used as an aid in decision making when approaching these patients

Evaluation of intraarticular inflammatory markers in sheep’s knee following cartilage reconstruction with autologous osteochondral graaft engineered in a perfusion bioreactor

Opći cilj ovog istraživanja bio je analizirati upalne promjene u subhondralnoj kosti i okolnoj sinoviji koje se dešavaju tijekom procesa cijeljenja, integracije i remodeliranja implantiranog autolognog koštano-hrskavičnog presatka uzgojenog u perfuzijskom bioreaktoru. Istraživanje je provedeno na velikom animalnom modelu ovce koji predstavlja odgovarajući model za ispitivanje koštano-hrskavičnog oštećenja koljenskog zgloba. Ukupno su provedene dvije studije u koje je bilo uključeno 38 ovaca. U prvu studiju (kronični model koštano-hrskavičnog oštećenja / idiopatski OA) su bile uključene 24 životinje, dok je u drugoj studiji (akutni model hrskavičnog oštećenja / posttraumatski OA) bilo 14 životinja. U prvoj studiji životinje su podjeljene u 4 grupe, u učinjena su dva zahvata u razmaku od 6 tjedana (razdoblje kronifikacije). U prvom operativnom zahvatu, na medijalnom i lateralnom kondilu femura desnog koljena ovaca napravljeno je oštećenje zglobne hrskavice. Nakon 6 tjedana kronifikacije, u prvoj grupi je načinjeno samo koštano-hrskavično oštećenje (CTR), drugoj grupi je ugrađen samo nosač bez stanica (CFS), trećoj grupi je ugrađen presadak načinjen od stanica zglobne hrskavice (AC), a četvrtoj grupi je ugrađen presadak načinjen od stanica nosne hrskavice (NC). Po dvije životinje iz svake grupe su žrtvovane 6 tjedana, 3 mjeseca i 12 mjeseci nakon zahvata. Prikupljeni uzorci sinovijalne membrane i subhondralne kosti su analizirani molekularnim i imunohistokemijskim metodama na prisutstvo upale. U drugoj studiji (akutni model) je 14 životinja bilo podijeljeno u 2 skupine. Prva skupina (NC) je liječena implantacijom presatka načinjenog od stanica nosne hrskavice (6 životinja), a druga skupina (CFS) implantacijom nosača bez stanica (8 životinja). Polovica životinja iz svake skupine je žrtvovana 3 mjeseca nakon zahvata, a polovica 12 mjeseci nakon zahvata. Uzorci su analizirani na isti način kao i u prvoj studiji. Temeljem molekularne i imunohistokemijske analize upalnih parametara, izvjesno je da stvaranje koštano-hrskavične lezije potiče određene promjene koje su sukladne (predmnijevanoj) indukciji upalne reakcije (početno) nakon koje slijedi cijeljenje i smirivanje upale. Nema dokaza da bi transplantacija nosača na mjesto lezije, ili pak presadaka građenih od zglobnih (AC) ili nosnih hondrocita (NC), imala nepovoljan učinak u smislu intenziviranja produkcije i aktivnosti analiziranih proteina. Također nisu nađeni dokazi da bi presatci na bilo koji način pozitivno djelovali na smanjenje parametara upale u samome zglobu ili na mjestu oštećenja.The aim of this study was to analyze the changes that occur in subchondral bone and surrounding synovium during the healing process, integration and remodeling of osteochondral graft grown in the bioreactor. The research was conducted on a large animal model of sheep which represents and appropriate model of a knee articular osteochondral defect. A total of two studies were conducted involving 38 sheep. The first study (chronic model of a osteochondral defect / idiopathic OA) included 24 animals, while second study (acute model of osteochondral defect / posttraumatic OA) included 14 animals. In the first study, the animals we divided into 4 groups, and two procedures were performed at 6-week intervals (chronification period). In the first procedure, osteochondral defects were made on the medial and lateral femoral condyle of the right knee of the sheep. After 6 weeks of chronfication, empty defect was created in the first groups (CTR), cell-free scaffold was implanted in the second group (CFS), a graft made of articular cartilage (AC) was implanted in the third group, and the fourth group was treated with a graft made from nasal chondrocytes (NC). 2 animals from each group were sacrificed after 6 weeks, next 2 after 3 months and the rest after 12 months postoperatively. Collected samples of subchondral bone and synovium were analyzed by molecular and immunohistochemichal methods for the presence of inflammatory mediators. In the second study (acute model) 14 sheep were divided into two groups. The first groups (NC) was treated by implantation of the graft made of nasal chondrocytes (NC), and the cell-free scaffold was implanted in the second group (CFS). Half of the animals from each grup were sacrified after 3 months and half of the animals after 12 months. The collected samples were analyzed in the same fashion as in the first study

Evaluation of intraarticular inflammatory markers in sheep’s knee following cartilage reconstruction with autologous osteochondral graaft engineered in a perfusion bioreactor

Opći cilj ovog istraživanja bio je analizirati upalne promjene u subhondralnoj kosti i okolnoj sinoviji koje se dešavaju tijekom procesa cijeljenja, integracije i remodeliranja implantiranog autolognog koštano-hrskavičnog presatka uzgojenog u perfuzijskom bioreaktoru. Istraživanje je provedeno na velikom animalnom modelu ovce koji predstavlja odgovarajući model za ispitivanje koštano-hrskavičnog oštećenja koljenskog zgloba. Ukupno su provedene dvije studije u koje je bilo uključeno 38 ovaca. U prvu studiju (kronični model koštano-hrskavičnog oštećenja / idiopatski OA) su bile uključene 24 životinje, dok je u drugoj studiji (akutni model hrskavičnog oštećenja / posttraumatski OA) bilo 14 životinja. U prvoj studiji životinje su podjeljene u 4 grupe, u učinjena su dva zahvata u razmaku od 6 tjedana (razdoblje kronifikacije). U prvom operativnom zahvatu, na medijalnom i lateralnom kondilu femura desnog koljena ovaca napravljeno je oštećenje zglobne hrskavice. Nakon 6 tjedana kronifikacije, u prvoj grupi je načinjeno samo koštano-hrskavično oštećenje (CTR), drugoj grupi je ugrađen samo nosač bez stanica (CFS), trećoj grupi je ugrađen presadak načinjen od stanica zglobne hrskavice (AC), a četvrtoj grupi je ugrađen presadak načinjen od stanica nosne hrskavice (NC). Po dvije životinje iz svake grupe su žrtvovane 6 tjedana, 3 mjeseca i 12 mjeseci nakon zahvata. Prikupljeni uzorci sinovijalne membrane i subhondralne kosti su analizirani molekularnim i imunohistokemijskim metodama na prisutstvo upale. U drugoj studiji (akutni model) je 14 životinja bilo podijeljeno u 2 skupine. Prva skupina (NC) je liječena implantacijom presatka načinjenog od stanica nosne hrskavice (6 životinja), a druga skupina (CFS) implantacijom nosača bez stanica (8 životinja). Polovica životinja iz svake skupine je žrtvovana 3 mjeseca nakon zahvata, a polovica 12 mjeseci nakon zahvata. Uzorci su analizirani na isti način kao i u prvoj studiji. Temeljem molekularne i imunohistokemijske analize upalnih parametara, izvjesno je da stvaranje koštano-hrskavične lezije potiče određene promjene koje su sukladne (predmnijevanoj) indukciji upalne reakcije (početno) nakon koje slijedi cijeljenje i smirivanje upale. Nema dokaza da bi transplantacija nosača na mjesto lezije, ili pak presadaka građenih od zglobnih (AC) ili nosnih hondrocita (NC), imala nepovoljan učinak u smislu intenziviranja produkcije i aktivnosti analiziranih proteina. Također nisu nađeni dokazi da bi presatci na bilo koji način pozitivno djelovali na smanjenje parametara upale u samome zglobu ili na mjestu oštećenja.The aim of this study was to analyze the changes that occur in subchondral bone and surrounding synovium during the healing process, integration and remodeling of osteochondral graft grown in the bioreactor. The research was conducted on a large animal model of sheep which represents and appropriate model of a knee articular osteochondral defect. A total of two studies were conducted involving 38 sheep. The first study (chronic model of a osteochondral defect / idiopathic OA) included 24 animals, while second study (acute model of osteochondral defect / posttraumatic OA) included 14 animals. In the first study, the animals we divided into 4 groups, and two procedures were performed at 6-week intervals (chronification period). In the first procedure, osteochondral defects were made on the medial and lateral femoral condyle of the right knee of the sheep. After 6 weeks of chronfication, empty defect was created in the first groups (CTR), cell-free scaffold was implanted in the second group (CFS), a graft made of articular cartilage (AC) was implanted in the third group, and the fourth group was treated with a graft made from nasal chondrocytes (NC). 2 animals from each group were sacrificed after 6 weeks, next 2 after 3 months and the rest after 12 months postoperatively. Collected samples of subchondral bone and synovium were analyzed by molecular and immunohistochemichal methods for the presence of inflammatory mediators. In the second study (acute model) 14 sheep were divided into two groups. The first groups (NC) was treated by implantation of the graft made of nasal chondrocytes (NC), and the cell-free scaffold was implanted in the second group (CFS). Half of the animals from each grup were sacrified after 3 months and half of the animals after 12 months. The collected samples were analyzed in the same fashion as in the first study

Evaluation of intraarticular inflammatory markers in sheep’s knee following cartilage reconstruction with autologous osteochondral graaft engineered in a perfusion bioreactor

Opći cilj ovog istraživanja bio je analizirati upalne promjene u subhondralnoj kosti i okolnoj sinoviji koje se dešavaju tijekom procesa cijeljenja, integracije i remodeliranja implantiranog autolognog koštano-hrskavičnog presatka uzgojenog u perfuzijskom bioreaktoru. Istraživanje je provedeno na velikom animalnom modelu ovce koji predstavlja odgovarajući model za ispitivanje koštano-hrskavičnog oštećenja koljenskog zgloba. Ukupno su provedene dvije studije u koje je bilo uključeno 38 ovaca. U prvu studiju (kronični model koštano-hrskavičnog oštećenja / idiopatski OA) su bile uključene 24 životinje, dok je u drugoj studiji (akutni model hrskavičnog oštećenja / posttraumatski OA) bilo 14 životinja. U prvoj studiji životinje su podjeljene u 4 grupe, u učinjena su dva zahvata u razmaku od 6 tjedana (razdoblje kronifikacije). U prvom operativnom zahvatu, na medijalnom i lateralnom kondilu femura desnog koljena ovaca napravljeno je oštećenje zglobne hrskavice. Nakon 6 tjedana kronifikacije, u prvoj grupi je načinjeno samo koštano-hrskavično oštećenje (CTR), drugoj grupi je ugrađen samo nosač bez stanica (CFS), trećoj grupi je ugrađen presadak načinjen od stanica zglobne hrskavice (AC), a četvrtoj grupi je ugrađen presadak načinjen od stanica nosne hrskavice (NC). Po dvije životinje iz svake grupe su žrtvovane 6 tjedana, 3 mjeseca i 12 mjeseci nakon zahvata. Prikupljeni uzorci sinovijalne membrane i subhondralne kosti su analizirani molekularnim i imunohistokemijskim metodama na prisutstvo upale. U drugoj studiji (akutni model) je 14 životinja bilo podijeljeno u 2 skupine. Prva skupina (NC) je liječena implantacijom presatka načinjenog od stanica nosne hrskavice (6 životinja), a druga skupina (CFS) implantacijom nosača bez stanica (8 životinja). Polovica životinja iz svake skupine je žrtvovana 3 mjeseca nakon zahvata, a polovica 12 mjeseci nakon zahvata. Uzorci su analizirani na isti način kao i u prvoj studiji. Temeljem molekularne i imunohistokemijske analize upalnih parametara, izvjesno je da stvaranje koštano-hrskavične lezije potiče određene promjene koje su sukladne (predmnijevanoj) indukciji upalne reakcije (početno) nakon koje slijedi cijeljenje i smirivanje upale. Nema dokaza da bi transplantacija nosača na mjesto lezije, ili pak presadaka građenih od zglobnih (AC) ili nosnih hondrocita (NC), imala nepovoljan učinak u smislu intenziviranja produkcije i aktivnosti analiziranih proteina. Također nisu nađeni dokazi da bi presatci na bilo koji način pozitivno djelovali na smanjenje parametara upale u samome zglobu ili na mjestu oštećenja.The aim of this study was to analyze the changes that occur in subchondral bone and surrounding synovium during the healing process, integration and remodeling of osteochondral graft grown in the bioreactor. The research was conducted on a large animal model of sheep which represents and appropriate model of a knee articular osteochondral defect. A total of two studies were conducted involving 38 sheep. The first study (chronic model of a osteochondral defect / idiopathic OA) included 24 animals, while second study (acute model of osteochondral defect / posttraumatic OA) included 14 animals. In the first study, the animals we divided into 4 groups, and two procedures were performed at 6-week intervals (chronification period). In the first procedure, osteochondral defects were made on the medial and lateral femoral condyle of the right knee of the sheep. After 6 weeks of chronfication, empty defect was created in the first groups (CTR), cell-free scaffold was implanted in the second group (CFS), a graft made of articular cartilage (AC) was implanted in the third group, and the fourth group was treated with a graft made from nasal chondrocytes (NC). 2 animals from each group were sacrificed after 6 weeks, next 2 after 3 months and the rest after 12 months postoperatively. Collected samples of subchondral bone and synovium were analyzed by molecular and immunohistochemichal methods for the presence of inflammatory mediators. In the second study (acute model) 14 sheep were divided into two groups. The first groups (NC) was treated by implantation of the graft made of nasal chondrocytes (NC), and the cell-free scaffold was implanted in the second group (CFS). Half of the animals from each grup were sacrified after 3 months and half of the animals after 12 months. The collected samples were analyzed in the same fashion as in the first study

Whole-Body Vibration Effects on Flexibility in Artistic Gymnastics—A Systematic Review

It is well documented that whole body-vibration training has effects on muscle strength and flexibility, blood circulation, decreases pain perception and strengthens bone and tendon. Although whole body-vibration has benefits in athletes’ flexibility, we are not sure what its actual effects are in artistic gymnastics (since they already have stunning flexibility). Hence, the aim of this study was to analyse the studies on whole-body vibration in artistic gymnastics and to present the effects on flexibility. The search and analysis were carried out in accordance with PRISMA guidelines. The databases search (PubMed, Scopus, Google Scholar, Cochrane Library, ProQuest, EBSCOhost and Science Direct) yielded 18,057 potential studies. By the given inclusion criteria (studies from 2005 to 2022; full-text published in English; the study included male and female gymnasts as samples, and that participants were tested for evaluation of flexibility by whole-body vibration method), a total of 9 full-text studies were included, with a total of 210 participants, both male and female. As far as the measured flexibility tests conducted, front split, sit and reach and bridge were evaluated, while obtained results were 9.1–39.1%, 2.79–6.7%, 6.43–7.45%, respectively. All studies have conducted same vibration frequency (30 Hz) with same amplitude of displacements (2 mm), except for the one study who did not show the information of implemented amplitude. After analysing the obtained results, it can be concluded that the usage of whole-body vibration platform shows flexibility improvements in artistic gymnasts, both male and female. In addition, a combination of whole-body vibration and traditional static stretching may enhance the flexibility in artistic gymnasts. However, these results should be taken with caution. Since this review did not reveal the optimal vibrational protocol, it is necessary to invest time during the implementation of various vibrational experimental protocols, so future research is required

Cytokines and Chemokines Involved in Osteoarthritis Pathogenesis

Osteoarthritis is a common cause of disability worldwide. Although commonly referred to as a disease of the joint cartilage, osteoarthritis affects all joint tissues equally. The pathogenesis of this degenerative process is not completely understood; however, a low-grade inflammation leading to an imbalance between anabolic and katabolic processes is a well-established factor. The complex network of cytokines regulating these processes and cell communication has a central role in the development and progression of osteoarthritis. Concentrations of both proinflammatory and anti-inflammatory cytokines were found to be altered depending on the osteoarthritis stage and activity. In this review, we analyzed individual cytokines involved in the immune processes with an emphasis on their function in osteoarthritis