Search Results (101)

Whole-leg radiographs (WLRs) are widely used to assess coronal alignment before total knee arthroplasty (TKA), but may be inaccurate in patients with atypical morphotypes or malrotation. This study evaluated the discrepancy between WLR and 3D computed tomography (CT) scans across coronal plane alignment of the knee (CPAK) morphotypes and introduced a novel projection index—the femoral notch projection ratio (FNPR). In CPAK III knees, 19% of cases exceeded a clinically relevant threshold (>3° difference), prompting investigation of underlying projection factors. In 187 knees, coronal angles—including the medial distal femoral angle (MDFA°), medial proximal tibial angle (MPTA°), femoral mechanical angle (FMA°), and arithmetic hip–knee–ankle angle (aHKA°)—were measured using WLR and CT. Rotational positioning on WLR was assessed using FNPR and the patellar projection ratio (PPR). CPAK classification was applied. WLR systematically underestimated alignment, with the greatest bias in CPAK III (MDFA° + 1.5° ± 2.0°, p < 0.001). FNPR was significantly higher in CPAK III and VI (+1.9° vs. −0.3°, p < 0.001), indicating a tendency toward internally rotated limb positioning during imaging. The PPR–FNPR mismatch peaked in CPAK III (4.1°, p < 0.001), suggesting patellar-based centering may mask rotational malprojection. Projection artifacts from anterior osteophytes contributed to outlier measurements but were correctable. Valgus morphotypes with oblique joint lines (CPAK III) were especially prone to projection error. FNPR more accurately reflected rotational malposition than PPR in morphotypes prone to patellar subluxation. A 3D method (e.g., CT) or repeated imaging may be considered in CPAK III to improve surgical planning. Full article

Current osteoarthritis (OA) therapies fail to yield long-term clinical benefits, due in part to the lack of a mechanism for the targeted and confined delivery of therapeutics to OA joints. This study evaluates if M2 macrophages are effective cell vehicles for the targeted and confined delivery of therapeutic genes to OA joints. CT bioluminescence in vivo cell tracing and fluorescent microscopy reveal that intraarticularly injected M2 macrophages were recruited to and retained at inflamed synovia. The feasibility of an M2 macrophage-based adoptive gene transfer strategy for OA was assessed using IL-1Ra as the therapeutic gene in a mouse tibial plateau injury model. Mouse M2 macrophages were transduced with lentiviral vectors expressing IL-1Ra or GFP. The transduced macrophages were intraarticularly injected into injured joints at 7 days post-injury and OA progression was monitored with plasma COMP and histology at 4 weeks. The IL-1Ra-expressing M2 macrophage treatment reduced plasma COMP, increased the area and width of the articular cartilage layer, decreased synovium thickness, and reduced the OARSI OA score without affecting the osteophyte maturity and meniscus scores when compared to the GFP-expressing M2 macrophage-treated or PBS-treated controls. When the treatment was given at 5 weeks post-injury, at which time OA should have developed, the IL-1Ra-M2 macrophage treatment also reduced plasma COMP, had a greater articular cartilage area and width, decreased synovial thickness, and reduced the OARSI OA score without an effect on the meniscus and osteophyte maturity scores at 8 weeks post-injury. In conclusion, the IL-1Ra-M2 macrophage treatment, given before or after OA was developed, delayed OA progression, indicating that the M2 macrophage-based adoptive gene transfer strategy for OA is tenable. Full article

This study described, assessed and correlated ultrasonographic, computed tomographic, and histological findings in the sacroiliac joints of adult Warmblood horse cadavers. In total, 25 joints from 15 horses were examined post-mortem using transrectal ultrasonography and helical computed tomography. Findings on computed tomography were graded in the caudal joint third (caudally) and for the entire joint as mild, moderate, or severe. In total, 11 joints from nine horses were evaluated histologically. All joints (100%) showed abnormalities on computed tomography, and 92% (23/25) displayed abnormal ultrasonographic findings. The most common ultrasonographic findings were osteophytes (92%), joint effusion (76%), and sacral/iliac bone modeling (76%). Computed tomography revealed osteophytes (92% caudally, 100% overall), sclerosis (72% caudally, 88% overall), subchondral bone lesions (60% caudally, 88% overall), and enthesophytes (60% caudally, 68% overall). The most severe CT findings occurred caudally (44%), whereas 24% occurred cranially,16% in the mid portion of the SIJ, and 16% were multifocally present in the SIJ Histological analysis showed degenerative changes in the cartilage, subchondral bone, and the joint capsule. Horses with more pronounced imaging abnormalities also showed corresponding histological degeneration. Significant correlations were found between computed tomographic findings caudally and in the entire joint (r_s = 0.915, p < 0.001, n = 25), and between imaging and histological findings (computed tomography: r_s = 0.731, p = 0.011, n = 11; ultrasonography: r_s = 0.67, p = 0.024, n = 11). Non-significant correlations were observed between mean ultrasonographic and computed-tomographic grades (r_s = 0.35, p = 0.087, n = 25). Findings suggest these structural changes may reflect adaptation to joint loading. Transrectal ultrasonography appears suitable as a first-line diagnostic tool. However, future studies are essential to compare the diagnostic imaging findings of SIJs in asymptomatic and symptomatic horses to elucidate their clinical relevance. Full article

Background/Objectives: Diffuse idiopathic skeleton hyperostosis (DISH) is also known as Forestier–Rotes-Querol syndrome. The etiology of DISH is unknown. DISH is characterized by ossification of the anterior longitudinal ligaments of the spine. The area most frequently involved in the disease is the thoracic region of the spine. DISH in most cases is asymptomatic. If the cervical spine is involved, the most common symptoms are dysphagia and dyspnea. The ossifications in the cervical region of the spine are localized most frequently in its lower segments. Case presentation: The authors present the case of a 92-year-old cachectic female patient (body mass index (BMI) of 17; lost 13% of her body weight within the last 6 months). The patient underwent resection of the anterior osteophytes C2-T1. Results: At one-year follow up, the patient had gained weight (BMI—20) and regained her ability to consume solid products. To our knowledge, this is the oldest patient treated surgically for DISH. Conclusions: If dysphagia or dyspnea appears among elderly patients, cervical spine inspection should be conducted. If DISH is diagnosed safe, effective surgical treatment should be considered. Full article

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

Degenerative joint disease remains a leading cause of global disability, with early diagnosis posing a significant clinical challenge due to its gradual onset and symptom overlap with other musculoskeletal disorders. This review focuses on emerging diagnostic strategies by synthesizing evidence specifically from studies that integrate biochemical biomarkers, advanced imaging techniques, and machine learning models relevant to osteoarthritis. We evaluate the diagnostic utility of cartilage degradation markers (e.g., CTX-II, COMP), inflammatory cytokines (e.g., IL-1β, TNF-α), and synovial fluid microRNA profiles, and how they correlate with quantitative imaging readouts from T2-mapping MRI, ultrasound elastography, and dual-energy CT. Furthermore, we highlight recent developments in radiomics and AI-driven image interpretation to assess joint space narrowing, osteophyte formation, and subchondral bone changes with high fidelity. The integration of these datasets using multimodal learning approaches offers novel diagnostic phenotypes that stratify patients by disease stage and risk of progression. Finally, we explore the implementation of these tools in point-of-care diagnostics, including portable imaging devices and rapid biomarker assays, particularly in aging and underserved populations. By presenting a unified diagnostic pipeline, this article advances the future of early detection and personalized monitoring in joint degeneration. Full article

Objectives: The objective of this study was to evaluate the relationship between interleukin-17 (IL-17) serum levels, musculoskeletal ultrasound (MSUS) observations, and clinical disease activity in patients with rheumatoid arthritis (RA) and hand osteoarthritis (OA). Methods: This case–control study involved 120 participants, with 40 individuals assigned to each of the three groups: RA, OA, and control. IL-17 serum levels were quantified in all participants. MSUS of the hand joints was performed on all RA and OA patients. Disease activity in patients with RA was assessed using the Clinical Disease Activity Score (CDAS). Both RA and OA patients completed a Visual Analog Scale (VAS) to evaluate pain intensity. Functional status was evaluated using the Health Assessment Questionnaire (HAQ) for RA patients, while the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index was utilized for OA patients. Results: Serum levels of IL-17 were significantly higher in both the RA and OA groups compared to the control group. Among RA patients, a positive correlation was identified between the CDAS and the VAS for pain. In OA patients, a significant correlation was observed between VAS scores and serum IL-17 levels. Additionally, serum IL-17 levels were associated with the presence of synovitis in both RA and OA groups; however, no significant association was found between IL-17 levels and bony changes such as erosions or osteophytes. In terms of functional evaluation, serum IL-17 levels correlated with HAQ in the RA group, but not with AUSCAN in the OA group. Conclusions: Elevated IL-17 serum levels are linked to inflammatory changes identified by MSUS but not to bony changes. These findings suggest that the rise in IL-17 levels in both OA and RA is primarily driven by underlying inflammatory processes, positioning IL-17 as a potential therapeutic target for both conditions. Full article

Degenerative changes are characterized by the formation of vertebral osteophytes, the hypertrophy of facet joints, and narrowing of the intervertebral space. This study aimed to investigate the concentrations of trace elements (Al, As, Se, Zn, Fe, Mo, Cu) in spinal tissues (intervertebral discs, muscle, and bone) of patients with degenerative lumbar spine disease (DLSD) and their potential associations with the disease. The research involved 13 patients undergoing surgery for symptomatic degenerative spine disease. The trace element concentrations were analyzed using chemical and radiographic assessments, with a statistical analysis performed through a Mann–Whitney U-test, Spearman’s rank correlation test, principal component analysis (PCA), and canonical discriminant analysis (CDA). The results showed significant variations and correlations among the trace elements across different spinal tissues, suggesting their roles in metabolic and oxidative processes and the pathology of spinal degeneration. Full article

Objectives: This paper evaluates the potential of using deep learning approaches for the detection of degenerative bone changes in the mandibular condyle. The aim of this study is to enable the detection and diagnosis of mandibular condyle degenerations, which are difficult to observe and diagnose on panoramic radiographs, using deep learning methods. Methods: A total of 3875 condylar images were obtained from panoramic radiographs. Condylar bone changes were represented by flattening, osteophyte, and erosion, and images in which two or more of these changes were observed were labeled as “other”. Due to the limited number of images containing osteophytes and erosion, two approaches were used. In the first approach, images containing osteophytes and erosion were combined into the “other” group, resulting in three groups: normal, flattening, and deformation (“deformation” encompasses the “other” group, together with osteophyte and erosion). In the second approach, images containing osteophytes and erosion were completely excluded, resulting in three groups: normal, flattening, and other. The study utilizes a range of advanced deep learning algorithms, including Dense Networks, Residual Networks, VGG Networks, and Google Networks, which are pre-trained with transfer learning techniques. Model performance was evaluated using datasets with different distributions, specifically 70:30 and 80:20 training-test splits. Results: The GoogleNet architecture achieved the highest accuracy. Specifically, with the 80:20 split of the normal-flattening-deformation dataset and the Adamax optimizer, an accuracy of 95.23% was achieved. The results demonstrate that CNN-based methods are highly successful in determining mandibular condyle bone changes. Conclusions: This study demonstrates the potential of deep learning, particularly CNNs, for the accurate and efficient detection of TMJ-related condylar bone changes from panoramic radiographs. This approach could assist clinicians in identifying patients requiring further intervention. Future research may involve using cross-sectional imaging methods and training the right and left condyles together to potentially increase the success rate. This approach has the potential to improve the early detection of TMJ-related condylar bone changes, enabling timely referrals and potentially preventing disease progression. Full article

Post-traumatic osteoarthritis (PTOA) is a common cause of lameness in the horse. There is no cure, therefore treatments are aimed at reducing pain and improving the joint environment by modifying inflammatory pathways or by viscosupplementation. Here, we report the safety and efficacy of the biolubricant (poly(2-methacryloyloxyethyl phosphorylcholine; pMPC) to mitigate the physical, gross, histological, and biochemical effects of arthritis. We created an osteochondral fragment in the middle carpal joint of one limb in 16 horses to induce PTOA; the contralateral limb served as a sham-operated joint. Two weeks postoperative, half (n = 8) of the horses received a single injection of pMPC in the PTOA joint, while the other half received saline. All sham-operated joints (n = 16) received saline. We conducted clinical evaluations weekly while synovial fluid biomarkers were measured biweekly during the 70-day study period. Subsequently, we performed postmortem gross and histologic analyses. Horses in which PTOA joints were treated with pMPC exhibited mild increases in clinical data, including lameness, effusion, and flexion scores. Similarly, synovial cell count, total protein, and prostaglandin E₂ values were higher for pMPC-treated joints. Radiographic changes included significantly higher osteophyte scores in pMPC-treated joints at the terminal timepoint. The biolubricant may demonstrate some chondroprotective effects with lower total erosion scores and higher cartilage glycosaminoglycan content. In summary, when pMPC is administered to PTOA joints, the biolubricant induces a mild inflammatory response but may offer some chondroprotective effects in horses. Full article

Extracellular vesicles (EVs), particularly exosomes (EXOs) of various skeletal and stem cells, were shown to delay osteoarthritis (OA) progression, and apoptotic bodies (ABs), another EV subtype, of osteoclasts showed osteoanabolic actions and were involved in the osteoclastic-regulation of local bone formation. Moreover, this study demonstrates that microvesicles (MVs) released by osteoclasts displayed potent pro-chondrogenic, pro-osteogenic, and anti-inflammatory activities. These activities were unique to osteoclastic MVs and were not shared by osteoclastic ABs and EXOs or MVs of other cell types. Because chronic synovial inflammation, progressive articular cartilage erosion, abnormal subchondral bone remodeling, and inability to regenerate articular cartilage are key etiologies of OA, we postulate that the foregoing activities of osteoclastic MVs could simultaneously target multiple etiologies of OA and could thereby be an effective therapy for OA. Accordingly, this study sought to assess the feasibility of an osteoclastic MV-based strategy for OA with a mouse tibial plateau injury model of OA. Briefly, tibial plateau injuries were created on the right knees of adult C57BL/6J mice, MVs were intraarticularly injected into the injured joints biweekly, and the OA progression was monitored histologically at five weeks post-injury. The MV treatment reduced the OA-induced losses of articular cartilage area and thickness, decreased irregularity in the articular cartilage surface, reduced loss of gliding/intermediate zone of articular cartilage, reduced osteophyte formation, suppressed synovial inflammation, and decreased the OARSI OA score. In summary, treatment with osteoclastic MVs delayed or reversed OA progression. Thus, this study supports the feasibility of an osteoclastic MV-based therapy for OA. Full article

Background: The accurate diagnosis of degenerative joint diseases (DJDs) of the temporomandibular joint (TMJ) presents a significant clinical challenge due to their progressive nature and the complexity of associated structural changes. These conditions, characterized by cartilage degradation, subchondral bone remodeling, and eventual joint dysfunction, necessitate reliable and efficient imaging techniques for early detection and effective management. Cone-beam computed tomography (CBCT) is widely regarded as the gold standard for evaluating osseous changes in the TMJ, offering detailed visualization of bony structures. However, ultrasonography (US) has emerged as a promising alternative, offering a non-invasive and radiation-free option for assessing TMJ disorders. This study aims to evaluate the diagnostic accuracy of US in identifying degenerative changes in the TMJ, with CBCT serving as the definitive diagnostic reference. By analyzing the sensitivity, specificity, and predictive values of US in detecting key degenerative markers—such as subchondral erosion, osteophytes, and joint space narrowing—this investigation seeks to assess its utility as a screening tool and its potential integration into clinical workflows. Methods: Forty adult patients presenting temporomandibular joint disorders were included in our cross-sectional study. Each patient underwent a clinical examination and was subjected to cone-beam computed tomography (CBCT) and ultrasonography (US). A statistical analysis was performed to compare the imaging results from CBCT and US. Results: The results are summarized in three tables. The first table presents a comparative analysis of radiological outcomes in patients with temporomandibular joint disorders using different imaging techniques. CBCT demonstrated higher sensitivity in detecting osteophytes in the right mandibular head (27.50% vs. 7.50%, p = 0.027) and higher detection rates for erosions, though without a significant advantage over US. The second table analyzes the consistency of diagnostic results between CBCT and US. A moderate agreement was observed for detecting normal bone structures, with AC1 values of 0.58 for the right and 0.68 for the left mandibular head (p < 0.001). The third table evaluates the diagnostic accuracy of US compared to CBCT. US demonstrated a positive predictive value (PPV) of 90% for detecting normal conditions, indicating its high reliability as a screening tool for normal findings. US demonstrates higher effectiveness in ruling out certain issues due to its high specificity and negative predictive value. However, its lower sensitivity in detecting abnormalities may lead to both false-positive and false-negative results. Conclusions: US holds significant promise as a screening modality for detecting normal anatomical features of the temporomandibular joint, its limitations in identifying more complex degenerative changes necessitate a cautious and integrated approach to TMJ diagnostics. Full article

Knee osteoarthritis (OA) is a chronic articular disease characterized by the progressive degeneration of cartilage and bone tissue, leading to the appearance of subchondral cysts, osteophyte formation, and synovial inflammation. Conventional treatments consist of non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, and glucocorticoids. However, the prolonged use of these drugs causes adverse effects. NSAIDs, for instance, are known to be nephrotoxic, increasing the damage to articular cartilage. New therapies capable of accelerating the process of tissue regeneration and repair are being discussed, such as the use of orthobiologics that are naturally found in the body and obtained through minimally invasive collection and/or laboratory manipulations. Bone marrow aspirate (BMA) and bone marrow aspirate concentrate (BMAC) are both rich in hematopoietic stem cells, mesenchymal stem cells (MSCs), and growth factors (GFs) that can be used in the healing process due to their anabolic and anti-inflammatory effects. The aim of this literature review is to assess the efficacy of BMA and BMAC in the treatment of knee OA based on the favorable results that researchers have obtained with the use of both orthobiologics envisaging an accelerated healing process and the prevention of OA progression. Full article

A 65-year-old woman was admitted to the neurology department with a suspected demyelinating disease due to complaints of progressive pain and weakness in both upper and lower limbs, as well as urinary incontinence. MRI of the spine revealed complex disc osteophyte with compression of the spinal cord in the cervical and lumbar spine at several vertebral levels, and localized enhancement in the cervical spine at the site of maximal spinal canal stenosis. During her hospitalization, the patient underwent extensive evaluation to rule out any systematic inflammatory diseases, infections, and malignancy. Chest CT revealed bilateral mediastinal lymphadenopathy. Transbronchial mediastinal lymph node biopsy showed numerous non-necrotizing granulomas without evidence of malignancy. After a thorough and careful exclusion of a demyelinating, infectious, and paraneoplastic myelopathies, and based on clinical, radiographic, and pathological findings, the patient was diagnosed with both neurosarcoidosis and spondylotic myelopathy. She was then treated for neurosarcoidosis, including glucocorticosteroids, azathioprine, and a biosimilar of the anti-TNF alpha agent infliximab, resulting in both clinical and radiographic improvement. Intramedullary spinal neurosarcoidosis is very rare and may present with clinical features of spondylotic myelopathy, with typical imaging findings occurring only in areas of spinal canal stenosis. Full article

Osteoarthritis of the knee (OAK), a progressive degenerative disease affecting quality of life, is characterized by cartilage degeneration, synovial inflammation, and osteophyte formation causing pain and disability. Platelet-rich plasma (PRP) is an autologous blood product effective in reducing OAK-associated pain. PRP compositions depend on their purification. In clinical practice, PRP is typically administered immediately after purification, while cryopreserved PRP is used in research. Platelets are activated by freezing followed by release of their humoral factors. Therefore, PRP without any manipulation after purification (utPRP) and freeze–thawed PRP (fPRP) may differ in their properties. We purified leukocyte-poor PRP (LPPRP) and autologous protein solution (APS) to compare the properties of utPRPs and fPRPs and their effects on OAK target cells. We found significant differences in platelet activation and humoral factor content between utPRPs and fPRPs in both LPPRP and APS. Freeze–thawing affected the anti-inflammatory properties of LPPRP and APS in chondrocytes and synovial cells differed. Both utPRPs and fPRPs inhibited polarization toward M1 macrophages while promoting polarization toward M2 macrophages. Freeze–thawing specifically affected humoral factor production in macrophages, suggesting that evaluating the efficacy of PRPs requires considering PRP purification methods, properties, and conditions. Understanding these variations may enhance therapeutic application of PRPs in OAK. Full article