Introduction: Incomplete removal of calcified cartilage appears to be associated with suboptimal repair tissue attachment. Furthermore, histologic evaluation of arthroscopically debrided chondral lesions demonstrated that removal of calcified cartilage was not obvious using standard arthroscopic equipment. The purpose of this study was to compare chondral healing with and without removal of calcified cartilage in experimentally created chondral defects. Methods: Twelve mature horses underwent bilateral arthroscopy of the femorotibial joints. A 1cm2 chondral lesion was made on the weight bearing surface of both medial femoral condyles. Randomly, in each horse one lesion had complete removal of the calcified cartilage layer (CCL) using curettes, and the CCL was left intact on the contralateral side. All defects were subjected to subchondral bone microfracture. At 12 months, all horses were euthanized and all femorotibial joints were harvested. MR imaging was performed in a 1.5 Tesla clinical MRI scanner. Analysis of variance was to analyze data. Results: Gross and histomorphometric observations confirmed significantly (p Conclusions: Based on gross, MRI and histologic findings, this study suggests that care should be taken in debridement of clinical cartilage lesions to assure complete removal of calcified cartilage. Summary: Removal of the calcified cartilage layer significantly improves the healing of chondral defects.

Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses

Instructive cartilage regeneration modalities with advanced therapeutic implantations under abnormal conditions.

Chondral defects of the knee are common and their treatment is challenging.PubMed, Google scholar, Embase and Scopus databases.Both autologous matrix-induced chondrogenesis (AMIC) and membrane-induced autologous chondrocyte implantation (mACI) have been used to manage chondral defects of the knee.It is debated whether AMIC and mACI provide equivalent outcomes for the management of chondral defects in the knee at midterm follow-up. Despite the large number of clinical studies, the optimal treatment is still controversial.To investigate whether AMIC provide superior outcomes than mACI at midterm follow-up.AMIC may provide better outcomes than mACI for chondral defects of the knee. Further studies are required to verify these results in a clinical setting. 

OUP accepted manuscript

Adolescent idiopathic scoliosis (AIS) is a complex, three dimensional deformity of the spine that commonly occurs in pubescent girls. Abnormal osteogenic differentiation of mesenchymal stem cells (MSCs) is implicated in the pathogenesis of AIS. However, the biological roles of long noncoding RNAs (lncRNAs) in the regulation of osteogenic differentiation of MSCs are unknown. Through microarray analyses of bone marrow (BM) MSCs from healthy donors and AIS patients, we identified 1483 differentially expressed lncRNAs in AIS BM-MSCs. We defined a novel lncAIS (gene symbol: ENST00000453347) is dramatically downregulated in AIS BM-MSCs. In normal BM-MSCs, lncAIS interacts with NF90 to promote HOXD8 mRNA stability that enhances RUNX2 transcription in BM-MSCs, leading to osteogenic differentiation of normal BM-MSCs. By contrast, lncAIS downregualtion in AIS BM-MSCs cannot recruit NF90 and abrogates HOXD8 mRNA stability, which impedes RUNX2 transcription for osteogenic differentiation. Thereby lncAIS downregualtion in BM-MSCs suppresses osteogenic differentiation that is implicated in the pathogenesis of AIS.

Long noncoding RNA lncAIS downregulation in mesenchymal stem cells is implicated in the pathogenesis of adolescent idiopathic scoliosis.

It is a great challenge to cure symptomatic lesions and considerable defects of hyaline cartilage due to its complex structure and poor self-repair capacity. If left untreated, unmatured degeneration will cause significant complications. Surgical intervention to repair cartilage may prevent progressive joint degeneration. A series of surgical techniques, including biological augmentation, microfracture and bone marrow stimulation, autologous chondrocyte implantation (ACI), and allogenic and autogenic chondral/osteochondral transplantation, have been used for various indications. However, the limited repairing capacity and the potential pitfalls of these techniques cannot be ignored. Increasing evidence has shown promising outcomes from ACI and cartilage transplantation. Nevertheless, the morbidity of autologous donor sites and limited resource of allogeneic bone have considerably restricted the wide application of these surgical techniques. Costal cartilage, which preserves permanent chondrocytes and the natural osteochondral junction, is an ideal candidate for the restoration of cartilage defects. Several in vitro and in vivo studies have shown good performance of costal cartilage transplantation. Although costal cartilage is a classic donor in plastic and cosmetic surgery, it is rarely used in skeletal cartilage restoration. In this review, we introduce the fundamental properties of costal cartilage and summarize costa-derived chondrocyte implantation and costal chondral/osteochondral transplantation. We will also discuss the pitfalls and pearls of costal cartilage transplantation. Costal chondral/osteochondral transplantation and costa-based chondrocytotherapy might be up-and-coming surgical techniques for recalcitrant cartilage lesions.

https://journals.sagepub.com/doi/pdf/10.1177/1759720X19877131

Autologous costal chondral transplantation and costa-derived chondrocyte implantation: emerging surgical techniques.

BACKGROUND Supracondylar fracture of the humerus is one of the most common elbow injuries in children. It represents 60% elbow fractures and 16% all pediatric fractures. Extension-type fracture is the most frequent mechanism of this injury. MATERIAL/METHODS The aim of our study was to analyse early vascular and neurological complications of supracondylar humerus fractures in 122 children hospitalized in the Department of Orthopaedics and Traumatology, determine fracture types and duration of symptoms, as well as to establish methods of early diagnosis and treatment. The study covered cases of patients treated in the years 2004-2010. RESULTS Acute neurovascular complications occurred in 15% patients with supracondylar fractures (18 children). Nerve damage was found in 11% patients with displaced fractures (12 children). The average duration of symptoms was 49 days (ranging from 2 days to 5 months). Symptoms of vascular injury occurred in 8% children with displaced fractures (8 children) and were characterized by absent or weak pulse of the radial artery. CONCLUSIONS 1. Fracture reduction is a priority procedure in the cases of displaced supracondylar fracture, while further diagnostic steps and treatment of possible complications should only be applied afterwards. 2. The incidence of vascular and neurological complications positively correlates with fracture progression according to Gartland classification.

Analysis of early vascular and neurological complications of supracondylar humerus fractures in children.

The treatment of articular cartilage damage is a major clinical problem. More often, this clinical issue affects children, which forces doctors to find the best treatment method. The aim of this experimental study on 2-month-old Landrace pigs was to compare the results of two cartilage defect treatments: (1) filling the cartilage defect with a scaffold incubated with bone marrow aspirate supplemented with growth plate chondrocytes (the CELLS group) and (2) filling the cartilage defect with an empty scaffold implanted after drilling the subchondral bone (the CTRL group). The treatment outcomes were assessed macroscopically and microscopically. Based on the macroscopic evaluation, all animals showed a nearly normal morphology, with an average of 9.66/12 points (CTRL) and 10.44/12 points (CELLS). Based on the microscopic evaluation, 1 very good result and 8 good results were obtained in the CTRL group, with an average of 70.44%, while 5 very good results and 4 good results were obtained in the CELLS group, with an average of 79.61%. (1) Growth plate chondrocytes have high chondrogenic potential and thus offer new possibilities for cartilage cell therapy. (2) The implantation of a scaffold loaded with bone marrow-derived MSCs (mesenchymal stem cells) and growth plate chondrocytes into a cartilage defect is a good therapeutic method in immature patients. (3) Cartilage repair based on a scaffold with bone marrow aspirate-derived cells supplemented with autologous growth plate chondrocytes achieves better results than repair with marrow stimulation and a hyaluronic acid-based scaffold (overall microscopic rating). (4) Chondrocyte clustering is a manifestation of the cartilage repair process but requires further observation.

/pdf/enhancement-of-cartilage-repair-through-the-addition-of-m5sor97hyd.pdf

Enhancement of cartilage repair through the addition of growth plate chondrocytes in an immature skeleton animal model

Material and methods An analysis of pre-operational 82 CT in children with the pectus excavatum deformity was made. Patients were divided into two groups depending on the chest deformation ; the first one consisted of patients with symmetric pectus excavatum, there were 48 patients (9 girls, 39 boys), the mean age was 12,8 years (4-16), the average Haller index was 3,6 (2,2-7,1); in the second group with dissymmetric pectus excavatum there were 35 patients (8 girls, 27 boys), the mean age was 11,8 years (7-17), the average Haller index was 2,9 (2,4-5,8).

/pdf/radiological-evaluation-of-the-eighth-thoracic-vertebra-2s524cs79m.pdf

Radiological evaluation of the eighth thoracic vertebra rotation in the pectus excavatum

Background
Intramedullary nailing has become the treatment of choice for closed femoral shaft fractures in children and adolescents. Immediate intramedullary nailing of open fractures of femur in children remains controversial, with most surgeons preferring to treat grade II or III open fractures either by debridement and traction or external fixation.

Results of the treatment of the open femoral shaft fractures in children.

BACKGROUND Treatment of unstable pelvic fractures in children is a serious surgical problem. Despite similarities between the epidemiology, diagnosis and treatment of pelvic fractures in children and adults, this article attempts to demonstrate age-specific differences in patient management. MATERIAL AND METHODS In a group of 46 children with pelvic fractures hospitalized in the years 2001-2009, 18 patients required surgical treatment. The fractures were classified according to Tile as type B1 fractures (11% of the patients operated on), type B2 (28%), B3 (22%), and C (39%). Surgical treatment was based on Gordon's classification. RESULTS Patients were evaluated at 3, 6, and 12 months after surgery. All patients achieved radiological bone union by 3 months after surgery. The length of the lower limbs assessed at 12 months after surgery was the same in all patients. No patients demonstrated an oblique pelvic position. None of the patients had resting pain, but in one case there was slight pain in the sacro-iliac joint region due to incomplete reduction of sacro-iliac subluxation, but repeat surgery was not necessary. In one patient, there was a difference of approximately 15˚ in internal rotation of the hip joints caused by asymmetrical reduction of the pelvic fracture. One patient developed inflammation, which resolved after antibiotic therapy. CONCLUSIONS Operative treatment of pelvic fractures in children over 8 years of age should be based on the principles of stable fixation and early rehabilitation, as it is in adults. Surgical treatment of unstable pelvic fractures with osteosynthesis in children is a challenge and needs expertise and a well-prepared multi-specialty team.

Operative treatment of pediatric pelvic fractures--our experience

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