Despite widespread use, the benefit of knee arthroscopy for symptomatic osteoarthritis (OA) remains controversial. The theoretical benefit of removal of particulate debris and washout of inflammatory cytokines has not been supported by strong evidence. Arguments exist for its short term benefit in well selected patients. We sought to determine if arthroscopy provided any short term symptomatic relief in patients with a clinical diagnosis of OA in our unit. A total of 20 patients were listed for routine arthroscopy over a one year period for OA. Mean age was 60 (range 48–74) years and 3 in 5 patients were female. 9 patients were listed by registrars, 6 by locum consultants and 5 by substantive consultants. One procedure was cancelled on the day of surgery due to lack of indication, with 19 knees proceeding to surgery. There was evidence of significant arthritis in 17 knees, 6 of which had associated degenerate meniscus tears. Two knees had meniscus tears without significant arthritis. All patients had washout and debridement and in addition, 8 partial menisectomies were carried out together with 3 loose body removals. Patients were followed up after an average of 12 weeks. The 2 patients (both male, mean age 52) with meniscus tears in the absence of significant arthritis fully recovered. Both had symptoms of true locking. 2 patients with loose bodies also fully recovered. With the exception of 2 patients with partial relief, the remainder had no symptomatic relief. One reported a worsening of symptoms and progressed to total knee arthroplasty. These results suggest that arthroscopic debridement and washout plays a limited role in the short term symptomatic relief of OA. Surgeons should limit its use to younger patients with mild radiographic disease and true mechanical symptoms who are otherwise unsuitable for arthroplasty and not keen on undergoing joint conserving surgery

Summary Statement. Pincer deformities are involved in the genesis of femoro-acetabular impingement (FAI). Radiographic patterns suggestive of pincer deformities are common among general population. Prevalence of the pincer deformities among general population may be overestimated if only plain radiographs are considered. Background. Pincer deformities (coxa profunda, protrusio acetabuli, global retroversion, isolated cranial over-coverage) have been advocated as a cause of femoro-acetabular impingement (FAI) and early hip osteoarthritis (OA). Different radiographic patterns may advocate the presence of a pincer deformity. The prevalence of these radiographic patterns among general adult population, as their role in early hip OA, is poorly defined. Methods. From a database of 40.351 pelvic radiograms and CT collected at our institution between 2005 and 2010, we selected 118 caucasian individuals (56 females, 62 males), aged between 15 and 60 years, who underwent both plain radiographs and CT of the pelvis. A series of exclusion criteria were strictly applied to achieve a sample of adult general population as more representative as possible. In particular patients with presence of any disease involving hip joint, including: advanced hip OA (grade II or III of Tonnis scale), head necrosis, fractures, heterotopic ossifications, bone and soft tissue tumors, rheumatic pathologies, classic hip dysplasia with lateral center-edge angle (L-CEA) less than 20°, clinical diagnosis of FAI or hip pain, were excluded from the present study. We also excluded patients in which open growth plates, osteopenia, hardware or evidence of prior surgery were present. Radiographs were investigated for pelvic tilt, signs of retroversion, lateral center-edge angle (L-CEA), presence of coxa profunda or protrusio acetabuli. EAV was measured on CT scans at the equatorial plane of the acetabulum passing by the 3 o'clock position, while CAV was calculated at a more cranial level corresponding to the 1 o'clock position EAV and CAV were obtained in the axial plane by measuring the angle made by a line connecting the anterior and posterior rims of the acetabulum and a line perpendicular to the line connecting the ischial spines. A new parameter, Acetabular torsion (AT), has been introduced in order to discriminate between global retroversion and isolated cranial over-coverage. AT was defined as the difference between EAV and CAV. Cam deformity was assessed by calculating the alpha angle on the femoral side; an alpha angle > 55° was considered abnormal and suggestive of cam deformity. Radiological signs of chondrolabral degeneration were noticed. Results. Mean EAV and mean CAV were higher in females, mean AA was higher in males. L-CEA, EAV and CAV increased with age. Mean AT was 8.8±6.3. AT was inversely related to CAV (r=−0.799; p<0.0005) but independent from EAV (r=−0.076; p=0.244). EAV≤10.2° was defined as the marker of global retroversion, while AT≥21.2° was defined as the marker of isolated cranial over-coverage. Overall prevalence of pincer deformities was 21.6% (> females; p=0.02). Early OA changes were related to age (p<0.0005) and AA (p<0.0005), but not to pincer deformities (p=0.96). Radiological signs of retroversion showed good or excellent negative predictability but poor positive predictability. Conclusions. Radiographic patterns of pincer deformities are common among general population. Relationship with radiological signs of chondrolabral degeneration is poor. CT allows to discriminate between global retroversion and isolated cranial over-coverage. Prevalence of the pincer deformities among general population may be overestimated if only plain radiographs are considered

Meniscal tears commonly occur after a traumatic twisting injury to the knee (acute) or can form over time (degenerate). Symptoms include pain, swelling, and ‘locking’ of the knee. These symptoms are also commonly associated with osteoarthritis (OA). In some cases of OA, degenerative meniscal tears can also be present making it difficult to determine the cause of symptoms. Furthermore, acute meniscal lesions may be associated with early stage OA but often no radiological signs are evident. Many metabolites associated with joint disorders are released into the synovial fluid providing a real-time snap shot of joint pathology. The ability to examine concentrations of specific metabolites within synovial fluid could provide invaluable clinical information about the cause and stage of joint pathology. We have tested the hypothesis that ‘high resolution 1H-NMR can discriminate between osteoarthritic and meniscal tear-related metabolites within human synovial fluids and aid in clinical diagnosis.’. Method. Synovial fluid samples have been obtained during arthroscopy or knee replacement from patients with varying degrees of joint pathology (cartilage graded 0-4; meniscal tears classified as acute or degenerative). Samples were also taken from patients undergoing Anterior Cruciate Ligament (ACL) reconstruction with no additional pathology. Samples were analysed using 500 MHz 1H NMR spectroscopy. Chemical shifts were referenced to known concentration NMR internal standard (TSP), peaks identified by reference to published synovial fluid NMR spectra (1) and peak integrals measured using the Bruker software Topspin 2.0. Results. Spectroscopy revealed a number of differences in metabolites between OA, meniscal tear and ACL pathologies. These included significantly increased concentrations of glutamate, n-acetyl glycoprotein and β-hydroxybutyrate in OA (n=10) and acute meniscal tears (n=6) compared to ACL samples (p<0.05, T-test, n=6). Specific metabolites were also able to discriminate between OA with no meniscal tear and OA with meniscal tear synovial fluids. For example, concentrations of n-acetyl glycoproteins, glutamate and CH3 lipids were significantly increased in OA without tears (n=10) compared to OA plus meniscal tears (n=12); conversely ceramide concentrations were significantly increased in OA plus tears compared to OA only samples (p<0.05, T-test). Discussion. Our preliminary data indicate that the metabolic profiles of synovial fluid differ between OA, OA plus meniscal tear and ACL injuries. OA samples have increased concentrations of n-acetyl glycoproteins which can be indicative of degradative products from cartilage matrix such as hyaluronic acid. The increased concentrations of glutamate in OA may reflect activation of nociceptive, degradative and inflammatory processes (2). These metabolite concentrations were also increased in acute meniscal tear synovial fluids, which may reflect early signs of cartilage pathology. The differing levels of metabolites seen in OA alone compared to OA with meniscal tears may ultimately be a useful indicator of whether cartilage or meniscal pathology predominates within the joint

Objectives

To determine the pattern of mutations of the WISP3 gene in clinically identified progressive pseudorheumatoid dysplasia (PPD) in an Indian population.

Objectives

Acetabular retractors have been implicated in damage to the femoral and obturator nerves during total hip replacement. The aim of this study was to determine the anatomical relationship between retractor placement and these nerves.

This review is aimed at clinicians appraising preclinical trauma studies and researchers investigating compromised bone healing or novel treatments for fractures. It categorises the clinical scenarios of poor healing of fractures and attempts to match them with the appropriate animal models in the literature.

We performed an extensive literature search of animal models of long bone fracture repair/nonunion and grouped the resulting studies according to the clinical scenario they were attempting to reflect; we then scrutinised them for their reliability and accuracy in reproducing that clinical scenario.

Models for normal fracture repair (primary and secondary), delayed union, nonunion (atrophic and hypertrophic), segmental defects and fractures at risk of impaired healing were identified. Their accuracy in reflecting the clinical scenario ranged greatly and the reliability of reproducing the scenario ranged from 100% to 40%.

It is vital to know the limitations and success of each model when considering its application.