The cam-type deformity - what is it: SCFE, osteophyte, or a new disease?

Cam-type deformity of the proximal femur is a risk factor for the development of cam-type femoroacetabular impingement and a prearthrotic condition of the hip. The etiology of cam-type deformity remains unclear. There are a number of causes of cam-type deformity including sequellae of slipped capital femoral epiphysis, Legg-Calvé-Perthes disease or Perthes-like deformities, postinfectious, and traumatic. However, the majority of cam-type deformities arise without any apparent preexisting hip disease. These "idiopathic" cam-type deformities likely represent a majority of cases, and show clear racial and sex differences, as well as developmental and genetic influences. Idiopathic cam-type deformity also seems to be a distinct entity from residual or silent slipped capital femoral epiphysis, as well as osteoarthritis-induced osteophytes. In this paper we examine the different pathogenetic aspects of the proximal femur that contribute to cam-type deformity and/or symptomatic cam-type femoroacetabular impingement.

EVIDENCE FOR MECHANICAL STRAINS INFLUENCE IN OSTEOPHYTE DEVELOPMENT

Purpose: Osteophytes are osteo-cartilaginous metaplastic tissue outgrowths of bone capped by cartilage usually found in degenerative and inflammatory joint disease. The presence and degree of maturity of osteophytes, along with joint space narrowing, are the main radiographic criteria for diagnosis and grading osteoarthritis (OA). Although osteophytes are known for being anatomic signs of advanced OA, they can occur in non-symptomatic joints, in joints with no other observable alterations, and in early stage OA. It remains unclear if they develop from molecular, physiological and/or mechanical stimuli. We hypothesized that mechanical strains play a role in osteophyte development. The overall objective of this thesis was to find evidence that osteophytes are influenced by mechanical strains. Methods: The first project was to develop a mechanically-induced osteophyte animal model. One single impact load that was reported to induce moderate joint damage was applied to the periosteum of the rat knee. Animals were sacrificed at four time points to characterize the evolution of damaged tissue and the joint by histology. A second study using human mature hip osteophytes was conducted to evaluate if mature osteophyte presented histological signs of proliferating and developmental processes. The histological characterization of mature osteophyte was used to compare findings of the mechanically-induced osteophyte in the animal model to validate the use of this rodent model in studying some aspect of osteophyte development of human. Lastly, a detailed three-dimensional (3D) radiological morphometric analysis was performed on microscopic computed tomography (µCT) scanned femoral heads collected from total hip arthroplasty patients presenting mature hip osteophytes. Quantitative morphometric measures of osteophytes internal structure was compared to three regions of the femoral head of known quality of organisation and mechanical constraint. Results and Conclusion: Osteophyte can be mechanically induced by a single load impact to the joint periosteum, indicating that a moderate trauma to the periosteal layer of the joint may play a role in osteophyte development. Mature osteophytes have proliferation, developing and remodelling zones and have trabecular structures. Mechanically-induced osteophytes and mature osteophytes presented similar histological composition. Mature osteophytes have organized internal structure. These results provide evidence that mechanical strain can influence osteophyte development.

Juvenile idiopathic arthritis with involvement of the temporomandibular joint: the role of image examinations

PURPOSE: Juvenile idiopathic arthritis (JIA) has unknown etiology, and the involvement of the temporomandibular joint (TMJ) is rare in the early phase of the disease. The present article describes the use of computed tomography (CT) and magnetic resonance (MRI) images for the diagnosis of affected TMJ in JIA. CASE DESCRIPTION: A 12-year-old, female, Caucasian patient, with systemic rheumathoid arthritis and involvement of multiple joints was referred to the Imaging Center for TMJ assessment. The patient reported TMJ pain and limited opening of the mouth. The helical CT examination of the TMJ region showed asymmetric mandibular condyles, erosion of the right condyle and osteophyte-like formation. The MRI examination showed erosion of the right mandibular condyle, osteophytes, displacement without reduction and disruption of the articular disc. CONCLUSION: The disorders of the TMJ as a consequence of JIA must be carefully assessed by modern imaging methods such as CT and MRI. CT is very useful for the evaluation of discrete bone changes, which are not identified by conventional radiographs in the early phase of JIA. MRI allows the evaluation of soft tissues, the identification of acute articular inflammation and the differentiation between pannus and synovial hypertrophy.

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy.

PURPOSE: To determine whether motion preservation following oblique cervical corpectomy (OCC) for cervical spondylotic myelopathy (CSM) persists with serial follow-up. METHODS: We included 28 patients with preoperative and at least two serial follow-up neutral and dynamic cervical spine radiographs who underwent OCC for CSM. Patients with an ossified posterior longitudinal ligament (OPLL) were excluded. Changes in sagittal curvature, segmental and whole spine range of motion (ROM) were measured. Nathan's system graded anterior osteophyte formation. Neurological function was measured by Nurick's grade and modified Japanese Orthopedic Association (JOA) scores. RESULTS: The majority (23 patients) had a single or 2-level corpectomy. The average duration of follow-up was 45 months. The Nurick's grade and the JOA scores showed statistically significant improvements after surgery (p < 0.001). 17% of patients with preoperative lordotic spines had a loss of lordosis at last follow-up, but with no clinical worsening. 77% of the whole spine ROM and 62% of segmental ROM was preserved at last follow-up. The whole spine and segmental ROM decreased by 11.2° and 10.9°, respectively (p ≤ 0.001). Patients with a greater range of segmental movement preoperatively had a statistically greater range of movement at follow-up. The analysis of serial radiographs indicated that the range of movement of the whole spine and the range of movement at the segmental spine levels significantly reduced during the follow-up period. Nathan's grade showed increase in osteophytosis in more than two-thirds of the patients (p ≤ 0.01). The whole spine range of movement at follow-up significantly correlated with Nathan's grade. CONCLUSIONS: Although the OCC preserves segmental and whole spine ROM, serial measurements show a progressive decrease in ROM albeit without clinical worsening. The reduction in this ROM is probably related to degenerative ossification of spinal ligaments.

The shunt from the cyclooxygenase to lipoxygenase pathway in human osteoarthritic subchondral osteoblasts is linked with a variable expression of the 5-lipoxygenase-activating protein

Affiliation: Unité de recherche en Arthrose, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame

Étude comparative de l'imagerie dans l'évaluation de l'ostéoarthrose du grasset chez le cheval

Les objectifs de cette étude étaient (1) de décrire la localisation et la sévérité des lésions d’ostéoarthrose (OA) chroniques acquises naturellement au niveau du grasset équin grâce à l’échographie (US), la radiographie (XR), la tomodensitométrie (CT) et l’évaluation macroscopique (ME), (2) de comparer la performance diagnostique de chacune des modalities d’imagerie avec ME et (3) d’évaluer quantitativement la densité osseuse sous-chondrale lors d’OA du grasset chez le cheval à la tomodensitométrie. Des évaluations post mortem radiographique, tomodensitométrique et échographique ont été réalisées sur 23 grassets cadavériques et comparées à l’évaluation macroscopique. Des associations significatives ont été notées entre le «osteophytes global score» de toutes les modalités (US, p=0.04; XR, p=0.005; CT, p˂0.0001) et ME. De plus, la tomodensitométrie a démontré la plus forte association. Les ostéophytes étaient principalement localisés au niveau de l’articulation fémorotibiale médiale et cette articulation présentait également les scores d’ostéophytes les plus sévères. Un patron spécifique d’ostéophytes associé à l’insertion de la capsule articulaire sur le condyle fémoral médial a été mis en évidence. La nouvelle projection radiographique (Ca10Pr5L-CrDiMO) a été utile dans la détection des ostéophytes de la région intercondylaire. Les grades d’ostéophytes (0-3) ne différaient pas significativement selon la modalité dans la majorité des sites. La faible sensibilité/spécificité a indiqué que la sclérose de l’os sous-chondral et l’applatissement des condyles fémoraux ne semblent pas être des indicateurs fiables d’OA du grasset équin. L’OA du grasset équin est associée à une réduction de la densité osseuse sous-chondrale et des sites spécifiques de résorption/kystes sous-chondraux ont été notés chez certains spécimens.

The Role of ULK1 in the Pathophysiology of Osteoarthritis

L'arthrose est la maladie musculo-squelettique la plus commune dans le monde. Elle est l'une des principales causes de douleur et d’incapacité chez les adultes, et elle représente un fardeau considérable sur le système de soins de santé. L'arthrose est une maladie de l’articulation entière, impliquant non seulement le cartilage articulaire, mais aussi la synoviale, les ligaments et l’os sous-chondral. L’arthrose est caractérisée par la dégénérescence progressive du cartilage articulaire, la formation d’ostéophytes, le remodelage de l'os sous-chondral, la détérioration des tendons et des ligaments et l'inflammation de la membrane synoviale. Les traitements actuels aident seulement à soulager les symptômes précoces de la maladie, c’est pour cette raison que l'arthrose est caractérisée par une progression presque inévitable vers la phase terminale de la maladie. La pathogénie exacte de l'arthrose est encore inconnue, mais on sait que l'événement clé est la dégradation du cartilage articulaire. Le cartilage articulaire est composé uniquement des chondrocytes; les cellules responsables de la synthèse de la matrice extracellulaire et du maintien de l'homéostasie du cartilage articulaire. Les chondrocytes maintiennent la matrice du cartilage en remplaçant les macromolécules dégradées et en répondant aux lésions du cartilage et aux dégénérescences focales en augmentant l'activité de synthèse locale. Les chondrocytes ont un taux faible de renouvellement, c’est pour cette raison qu’ils utilisent des mécanismes endogènes tels que l'autophagie (un processus de survie cellulaire et d’adaptation) pour enlever les organelles et les macromolécules endommagés et pour maintenir l'homéostasie du cartilage articulaire. i L'autophagie est une voie de dégradation lysosomale qui est essentielle pour la survie, la différenciation, le développement et l’homéostasie. Elle régule la maturation et favorise la survie des chondrocytes matures sous le stress et des conditions hypoxiques. Des études effectuées par nous et d'autres ont montré qu’un dérèglement de l’autophagie est associé à une diminution de la chondroprotection, à l'augmentation de la mort cellulaire et à la dégénérescence du cartilage articulaire. Carames et al ont montré que l'autophagie est constitutivement exprimée dans le cartilage articulaire humain normal. Toutefois, l'expression des inducteurs principaux de l'autophagie est réduite dans le vieux cartilage. Nos études précédentes ont également identifié des principaux gènes de l’autophagie qui sont exprimés à des niveaux plus faibles dans le cartilage humain atteint de l'arthrose. Les mêmes résultats ont été montrés dans le cartilage articulaire provenant des modèles de l’arthrose expérimentaux chez la souris et le chien. Plus précisément, nous avons remarqué que l'expression d’Unc-51 like kinase-1 (ULK1) est faible dans cartilage humain atteint de l'arthrose et des modèles expérimentaux de l’arthrose. ULK1 est la sérine / thréonine protéine kinase et elle est l’inducteur principal de l’autophagie. La perte de l’expression de ULK1 se traduit par un niveau d’autophagie faible. Etant donné qu’une signalisation adéquate de l'autophagie est nécessaire pour maintenir la chondroprotection ainsi que l'homéostasie du cartilage articulaire, nous avons proposé l’hypothèse suivante : une expression adéquate de ULK1 est requise pour l’induction de l’autophagie dans le cartilage articulaire et une perte de cette expression se traduira par une diminution de la chondroprotection, et une augmentation de la mort des chondrocytes ce qui conduit à la dégénérescence du cartilage articulaire. Le rôle exact de ULK1 dans la pathogénie de l'arthrose est inconnue, j’ai alors créé pour la première fois, des souris KO ULK1spécifiquement dans le cartilage en utilisant la technologie Cre-Lox et j’ai ensuite soumis ces souris à la déstabilisation du ménisque médial (DMM), un modèle de l'arthrose de la souris pour élucider le rôle spécifique in vivo de ULK1 dans pathogenèse de l'arthrose. Mes résultats montrent que ULK1 est essentielle pour le maintien de l'homéostasie du cartilage articulaire. Plus précisément, je montre que la perte de ULK1 dans le cartilage articulaire a causé un phénotype de l’arthrose accéléré, associé à la dégénérescence accélérée du cartilage, l’augmentation de la mort cellulaire des chondrocytes, et l’augmentation de l'expression des facteurs cataboliques. En utilisant des chondrocytes provenant des patients atteints de l’arthrose et qui ont été transfectées avec le plasmide d'expression ULK1, je montre qu’ULK1 est capable de réduire l’expression de la protéine mTOR (principal régulateur négatif de l’autophagie) et de diminuer l’expression des facteurs cataboliques comme MMP-13 et ADAMTS-5 et COX-2. Mes résultats jusqu'à présent indiquent que ULK1 est une cible thérapeutique potentielle pour maintenir l'homéostasie du cartilage articulaire.

Estimating age of mature adults from the degeneration of the sternal end of the clavicle

The sternal end of the clavicle has been illustrated to be useful in aging young adults, however, no studies have investigated what age-related changes occur to the sternal end post epiphyseal fusion. In this study, three morphological features (i.e., surface topography, porosity, and osteophyte formation) were examined and scored using 564 clavicles of individuals of European ancestry (n = 318 males; n = 246 females), with known ages of 40+ years, from four documented skeletal collections: Hamann-Todd, Pretoria, St. Bride's, and Coimbra. An ordinal scoring method was developed for each of the three traits. Surface topography showed the strongest correlation with age, and composite scores (formed by summing the three separate trait scores) indicated progressive degeneration of the surface with increasing chronological age. Linear regression analyses were performed on the trait scores to produce pooled-sample age estimation equations. Blind tests of the composite score method and regression formulae on 56 individuals, aged 40+ years, from Christ Church Spitalfields, suggest accuracies of 96.4% for both methods. These preliminary results display the first evidence of the utility of the sternal end of the clavicle in aging older adult individuals. However, in the current format, these criteria should only be applied to individuals already identified as over 40 years in order to refine the age ranges used for advanced age. These findings do suggest the sternal end of the clavicle has potential to aid age estimates beyond the traditional "mature adult" age category (i.e., 46+ years), and provides several suggestions for future research.

Avaliação radiográfica e ultrassonográfica do aparato podotroclear de cavalos Quarto de Milha diagnosticados com síndrome do navicular

O objetivo deste estudo foi avaliar as alterações do aparato podotroclear de 22 cavalos da raça Quarto de Milha acometidos pela síndrome do navicular utilizando o acesso transcuneal. Esses equinos foram submetidos ao exame radiográfico e ultrassonográfico. No exame radiográfico foi observado a presença de invaginação sinovial de diferentes tipos, além de calcificação da bursa podotroclear e tendão flexor digital profundo, entesiófitos, osteófitos e alteração do limite córtico-medular. No exame ultrassonográfico observou-se alterações da bursa podotroclear, aderência e irregularidades nos bordos do tendão flexor digital profundo, diminuição do coxim digital, calcificação do ligamento sesamóide distal ímpar e irregularidade da superfície flexora do osso sesamóide distal. Todos os equinos que apresentavam alterações radiográficas também apresentaram alterações no exame ultrassonográfico compatíveis com a síndrome do navicular. O exame ultrassonográfico utilizando o acesso transcuneal foi um método prático e eficiente para avaliação das lesões do aparato podotroclear dos eqüinos, sendo um método complementar ao exame radiográfico.

Caracterização de alterações radiográficas na articulação metacarpofalângia de cavalos de três tambores

Pós-graduação em Medicina Veterinária - FMVZ

Imagem por ressonância magnética das articulações temporomandibulares: avaliação da confiabilidade e da validade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A influência da prática de atividade regular na composição corporal de pacientes com osteoartrite

Introduction: Osteoarthritis, osteoarthrosis or degenerative joint disease characterized by progressive loss of articular cartilage, pain, changes in subchondral bone, osteophyte formation and proliferation. Age, bone mineral density, joint instability, excess weight among others, are risk factors. Methods: To check the influence os physical exercise in patients with the disease were evaluated 39 patients over 50 years, both genders, with clinical and / or radiographic osteoarthritis were divided into experimental group (EG) and control group (CG). EG performed regular physical activity (aerobics) three times a week for four months, while CG was submitted to physical therapy painkiller in the same period. We analyzed demographics, BMI, basal metabolic rate and percentage of fat mass. Results: The results showed that regular physical activity reduced the body fat, but because of their characteristics and low-impact aerobics was not observed consistent benefits in muscle component. However, compared with the CG demonstrated a positive impact on other parameters of body composition.

Factors affecting bony impingement in hip arthroplasty

Computer modeling of 10 patients' computed tomographic scans was used to study the variables affecting hip arthroplasty range of motion before bony impingement (ROMBI) including acetabular offset and height, femoral offset, height and anteversion, and osteophyte removal. The ROMBI was compared with the ROM before component impingement and the native hip ROM. The ROMBI decreased with decreased total offset and limb shortening. Acetabular offset and height had a greater effect on ROMBI than femoral offset and height. The ROMBI lost with decreased acetabular offset was not fully recoverable with an increase in femoral offset or osteophyte removal. Bony impingement increased and component impingement decreased with decreased acetabular offset and increased head diameter.

Groin pain after open FAI surgery: the role of intraarticular adhesions

Femoroacetabular impingement (FAI) is an established cause of osteoarthrosis of the hip. Surgery is intended to remove the cause of impingement with hip dislocation and resection of osseous prominences of the acetabular rim and of the femoral head-neck junction. Using the Merle d'Aubigné score and qualitative categories, recent studies suggest good to excellent outcomes in 75% to 80% of patients after open surgery with dislocation of the femoral head. Unsatisfactory outcome is mainly related to pain, located either in the area of the greater trochanter or in the groin. There are several reasons for persisting groin pain. Joint degeneration with joint space narrowing and/or osteophyte formation, insufficient correction of the acetabula, and femoral pathology are known factors for unsatisfactory outcome. Recently, intraarticular adhesions between the femoral neck and joint capsule have been identified as an additional cause of postoperative groin pain. The adhesions form between the joint capsule and the resected area on the femoral neck and may lead to soft tissue impingement. MR-arthrography is used for diagnosis and the adhesions can be treated successfully by arthroscopy. While arthroscopic resection improves outcome it is technically demanding. Avoiding the formation of adhesions is important and is perhaps best accomplished by passive motion exercises after the initial surgery.