双极射频治疗山羊膝关节软骨损伤的实验研究

目的 探讨双极射频在治疗关节软骨损伤中的价值.方法 采用前交叉韧带切断和内侧半月板切除的方法制造16只山羊股骨软骨继发性损伤的动物模型.3个月后采用双极射频对右膝的损伤软骨进行治疗,左膝为对照侧.观察双极射频对损伤软骨的即刻效应和后期效应.结果 造模手术造成以股骨内侧髁软骨Outerbridge Ⅱ级和Ⅲ级为主的损伤.即刻观察显示射频处理后的软骨表面光整,小的裂隙被融合.浅层的少量软骨细胞死亡,深层细胞受到的影响比较小.3个月后发现治疗侧股骨髁软骨表面仍光滑,改良Mankin's软骨评分结果显示治疗侧(12±4)分,对照侧(14±5)分(P＜0.01),治疗侧软骨损伤比对照侧轻.流式细胞学检测发现治疗侧软骨细胞死亡率(24±10)%,对照侧(12±1)%,两组比较差异无统计学意义(P＞0.05).结论 一个能级的双极射频不会对软骨细胞造成明显损害,软骨成形术是治疗软骨损伤的有效方法之一.     

髌骨倾斜对兔髌骨关节软骨损害的实验研究

目的建立兔髌骨倾斜的模型并观察髌股关节软骨损害的变化,为临床治疗髌股关节疾病提供实验依据。方法新西兰大白兔24只,随机分3组,每组8只,行右膝髌骨内侧支持带松解和外侧支持带紧缩术,术后不固定右膝关节。左膝髌骨为对照组。分别于术后第2周、4周、8周处死取材,分别进行髌骨倾斜角CT测量、髌骨关节面软骨大体观察、软骨组织Mankin评分。结果（1）实验侧髌骨倾斜角明显大于对照侧;（2）术后4周可见关节软骨软化,色泽晦暗,裂隙形成;术后8周关节软骨粗糙,有大的裂隙且色泽晦暗;对照组无软骨退变;（3）HE染色光镜下观察关节软骨,术后4周时,关节软骨轻度变性,可见软骨细胞变扁,表面不规则,术后8周时,软骨明显变性,可见软骨细胞增殖,排列紊乱,基质减少,潮线不完整。根据软骨Mankin评分,术后4、8周时右膝实验组得分明显高于左膝空白对照组,相比较有显著的统计学意义（P〈0.05）。结论兔髌骨倾斜后4周,髌骨外侧关节面软骨出现软骨软化,随着时间的延长软骨退变进一步加重,为治疗髌股关节软骨疾病提供实验依据。     

中老年人胫骨结节-股骨滑车沟距离与髌股关节软骨退变之间的关系研究

目的：利用膝关节核磁共振成像（MRI）扫描探讨中老年人髌股关节软骨退变程度与胫骨结节-股骨滑车沟间距（TT-TG）之间的关系。方法：选取2020年9月—2022年12月在我院行膝关节MRI扫描的中老年患者515例。由两名从事骨科相关的影像科医生对髌股关节软骨退变分级进行客观评价。并利用GE工作站使用膝关节轴位图像后处理,进行TT-TG距离测量。比较髌骨侧软骨退变及股骨滑车侧软骨退变各组间TT-TG间距,采用Logistic回归分析TT-TG间距是否是关节软骨退变的影响因素,并绘制受试者特征曲线（ROC）进行分析。结果：髌骨侧软骨退变及股骨滑车侧软骨退变各组间TT-TG间距存在统计学意义（P <0.05）。髌骨侧关节软骨退变分级与TT-TG间距存在相关性（P=0.021）;股骨滑车侧关节软骨退变分级与TT-TG间距不存在相关性（P=0.737）。TT-TG间距对评估髌骨侧关节软骨退变存在诊断意义（AUC=0.583）,但诊断能力较低;而对股骨滑车侧关节软骨退变则不存在诊断意义（AUC=0.487）。结论：TT-TG间距对于髌骨侧关节软骨退变分级有一定的预测作用,但是无法准确预测股骨...     

髌股关节疾患及其治疗(文献综述)

髌股关节疾患是常见病,多因髌骨畸形、高位、偏斜、髌股关节负荷加重和外伤等所致。现就髌股关节常见的几种疾患及其治疗分别加以叙述。髌股关节疾患的病因和种类【病因】髌股关节疾患主要有髌骨脱位、半脱位、髌骨软化症和髌股关节退变。根据病因可分类为:(1)关节软骨的变性软化;(2)关节位置异常;(3)关节间隙狭窄。这三种原因可单独存在,也可重叠出现。髌骨软化症以软骨肿大软化为特征,多发于青少年,中老年多为关节软骨退变。髌骨的位置异常有髌骨的外方偏移和倾斜,也是髌骨半脱位的原因。     

胫骨结节前内移治疗髌骨半脱位合并髌股关节骨关节病的预后因素分析

目的 :探讨胫骨结节前内移术治疗髌骨半脱位合并髌股关节骨关节病的临床效果及影响因素。方法 :对 1995年 6月～ 2 0 0 2年 11月 43例 ( 5 7膝 )诊断为髌骨半脱位合并髌股关节骨关节病的患者采用“胫骨结节前内移位 ,外侧支持带松解 ,清理钻孔术”治疗 ,并对术前和术后的主观症状、X线、改良Lysholm髌股关节功能评分进行比较。结果 :随访时间平均 3 5个月 ,主观优良率为 84%。平均改良Lysholm评分从术前 49分上升到术后 83分 ,提高了 3 4分 ,客观优良率为 81%。性别、侧别、年龄、随访时间及是否合并高位髌骨对治疗结果无明显影响。髌骨形态为WibergⅡ型与合并髌骨倾斜的患者治疗结果虽有更好的趋势 ,但无统计学差异。髌骨全关节面软骨磨损、伴有胫股关节软骨退变以及病程超过 10年的患者手术效果差。结论 :胫骨结节前内移术治疗髌骨半脱位合并髌股关节骨关节病可以获得比较满意的效果。髌骨全关节面软骨磨损 ,伴有胫股关节软骨退变以及病程超过 10年为预后差的危险因素。     

手法治疗髌股关节紊乱

髌股关节紊乱（髌骨倾斜、髌骨半脱位）是髌骨不稳定的常见原因，而髌骨排列和运动轨迹异常及由此形成的应力分布异常所造成的关节软骨损伤，是髌股关节疼痛的主要原因，是髌股关节常见病。表现为膝前疼痛、髌骨轨迹异常和髌股关节软骨损伤。随着人们对以软骨退变为主要特征的膝关节骨关节病研究的不断深入，发现髌股关节紊乱在膝关节骨关节病中占有很高比例，其治疗的成功与否直接关系着膝关节骨关节病的疗效：2005年12月至2007年4月完成病例治疗观察，报告如下。     

膝关节镜下治疗髌股关节退行性变的方法探讨

目的：探讨膝关节镜下治疗髌股关节退行性变的方法．方法：327例患者，采用关节镜下手术治疗。对单纯髌骨软骨剥脱的病损行滑膜切除、髌骨软骨损伤区减压，对髌股关节四周有应力性劳损骨赘形成的病例行髌股关节四周应力区减压。结果：本组随访6个月～5年3个月。髌前疼痛缓解或消失298例。结论：膝关节镜下清理减压是治疗髌股关节退行性变的有效方法。     

膝关节镜下治疗髌股关节退行性变的方法探讨

目的:探讨膝关节镜下治疗髌股关节退行性变的方法.方法:327例患者,采用关节镜下手术治疗.对单纯髌骨软骨剥脱的病损行滑膜切除、髌骨软骨损伤区减压,对髌股关节四周有应力性劳损骨赘形成的病例行髌股关节四周应力区减压.结果:本组随访6个月～5年3个月.髌前疼痛缓解或消失298例.结论:膝关节镜下清理减压是治疗髌股关节退行性变的有效方法.     

髌股关节退变对Oxford内侧单髁置换疗效的影响

目的本研究对因膝关节前内侧关节炎进行Oxford单髁置换的中国患者前瞻性收集数据和术中观察髌股关节情况,并探讨这一结论的正确性。方法研究包括本单位从2009年8月至2011年5月连续进行的50例（45例患者）单髁置换病例。术前记录膝关节疼痛的部位,放射学检查发现的髌股关节退变用Ahlback系统分级。对于术中观察到的股骨滑车软骨磨损情况用Weidow5级分级系统记录,其将软骨状况从无磨损到全层磨损分为0至Ⅳ级。在术后1年随访是用Hospitalfor Special Surgery膝关节评分系统和自我满意度评分对临床疗效进行评定。结果术前放射学检查发现17膝（34％）存在髌股关节退变。术中观察发现27膝（54％）存在股骨滑车软骨面磨损,其中19例（38％）位于滑车沟偏内侧,6例（12％）位于滑车沟中央,1例（2％）位于滑车沟偏外侧,共有3例（6％）全层软骨磨损,2例（4％）位于滑车沟偏内侧,1例（2％）位于滑车沟偏外侧。不论是放射学发现的髌股关节退变还是术中发现软骨磨损病例与髌股关节相对正常病例相比,临床疗效没有显著性差异。结论术前放射学发现的髌股关节退变和术中发现髌股关节软骨磨损均不能作为Oxford内侧单髁置换的反指征。因外侧髌股关节退变的相关数据较少,对这类患者选择单髁置换时应慎重。     

关节镜下射频汽化仪治疗髌股关节紊乱症

目的 探讨关节镜下应用射频汽化仪治疗髌股关节紊乱症的方法与疗效.方法 2004年6月-2007年6月,收治86例98膝髌股关节紊乱症患者.男30例34膝,女56例64膝;年龄15～68岁,中位年龄40岁.左膝42例,右膝32例,双膝12例.病程3个月～6年,平均30.5个月.静力性髌骨外侧倾斜28膝,外侧半脱位10膝;动力性髌骨外侧倾斜45膝,外侧半脱位15膝.术前Lysholm膝关节功能评分(57.72±8.86)分.术中采用关节镜下射频汽化仪行外侧支持带松解术或辅以内侧支持带紧缩术,同时对病变软骨行双极射频软骨成形术.结果 髌股关节面软骨病变按Outerbridge分级:Ⅰ级18膝,Ⅱ级36膝,Ⅲ级32膝,Ⅳ级12膝.术后患者切口均Ⅰ期愈合,无关节内积血及关节腔感染等并发症发生.75例82膝获随访,随访时间为8～37个月,平均20.6个月.术后1个月患者膝前痛症状明显缓解,关节活动度良好,动力位及静力位髌骨轴位X线片未见髌骨外侧倾斜或半脱位.术后6个月Lysholm评分为(69.95±5.42)分,与术前比较差异有统计学意义(P<0.05).按照软骨分级进行Lysholm评分,除Ⅳ级与术前比较差异无统计学意义(P>0.05),Ⅰ、Ⅱ、Ⅲ级患膝与术前比较差异均有统计学意义(P<0.05).结论 关节镜下采用射频汽化仪行软组织平衡术和软骨成形术具有操作简便、创伤小、出血少、术后反应轻等优点,是一种治疗髌股关节紊乱症的有效方法.     

Thermometric determination of cartilage matrix temperatures during thermal chondroplasty: Comparison of bipolar and monopolar radiofrequency devices

Purpose: To compare cartilage matrix temperatures between monopolar radiofrequency energy (mRFE) and bipolar RFE (bRFE) at 3 depths under the articular surface during thermal chondroplasty. We hypothesized that cartilage temperatures would be higher at all cartilage depths for the bRFE device than for the mRFE device. Type of Study: Randomized trial using bovine cartilage. Methods: Sixty osteochondral sections from the femoropatellar joint of 15 adult cattle were used for this study. Using a custom jig, fluoroptic thermometry probes were placed at one of the following depths under the articular surface: 200 μm, 500 μm, or 2,000 μm. RF treatment was performed either with fluid flow (F) (120 mL/min) or without fluid flow (NF) (n = 5/depth/RFE device/flow; total specimens, 60). Irrigation fluid temperature was room temperature (22°C). Thermometry data were acquired at 4 Hz for 5 seconds with the RF probe off, for 20 seconds with the RF probe on, and then for 15 seconds with the RF probe off. During RF treatment, a 0.79-cm² area (1.0-cm diameter) of the articular surface centered over the thermometry probe was treated in a paintbrush manner in noncontact (bRFE) or light contact (mRFE). Results: Thermal chondroplasty with bRFE resulted in higher cartilage matrix temperatures compared with mRFE for all depths and regardless of fluid flow. Bipolar RFE resulted in temperatures of 95°C to 100°C at 200 μm and 500 μm under the surface, with temperatures of 75°C to 78°C at 2,000 μm. Fluid flow during bRFE application had no effect at 200 μm. Monopolar RFE resulted in temperatures of 61°C to 68°C at 200 μm, 54°C to 70°C at 500 μm under the surface, and 28°C to 30°C at 2,000 μm below the surface. A significant effect of fluid flow during mRFE application occurred at 200 μm (NF, 61°C; F, 63°C) and 500 μm (NF, 53°C; F, 68°C). Conclusions: In this study, we found significant differences between bRFE and a temperature-controlled mRFE device with regard to depth of thermal heating of cartilage in vitro. Bipolar RFE resulted in matrix temperatures high enough (>70°C) to kill cells as deep as 2,000 μm under the articular surface. Fluid flow during thermal chondroplasty had the effect of significantly increasing cartilage matrix temperatures at 200 and 500 μm with the mRFE device. During thermal chondroplasty, bRFE creates greater matrix temperature elevations at equivalent depths and treatment duration than does mRFE. Excessive temperatures generated deep within the cartilage matrix could cause full-thickness chondrocyte death, in vivo.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 4 (April), 2002: pp 339–346     

胶原酶在髌骨软骨软化中的作用

２４只新西兰兔，随机分４组。右膝髌骨手术方法造成髌骨倾斜状态为实验侧，左膝实施假手术为对照侧，定期处死动物后进行髌骨软骨面接触压力测量、软骨组织病理观察以及胶原酶免疫组化（ＬＡＢ法）定位。结果：实验膝髌骨倾斜后导致髌内侧面软骨接触压力降低，而髌外侧面软骨接触压力无明显变化；组织病理显示：髌内侧面软骨中层至深层明显变性、软化，髌骨外侧面软骨变性不明显；免疫组化染色显示：髌内侧面软骨中层、深层软骨细胞浆与周围软骨基质胶原酶明显增多，且自软骨下骨长入钙化层或深层的血管内皮细胞以及软骨裂隙边缘处胶原酶强阳性。而髌外侧面软骨胶原酶含量无明显增多。表明：软骨胶原酶增多部位与髌骨软骨软化发生部位及其程度相一致。作者认为，胶原酶对髌骨倾斜导致髌软骨软化过程中软骨基质的破坏起重要作用。     

Radiofrequency energy-induced heating of bovine articular cartilage: evaluation of a new temperature-controlled,bipolar radiofrequency system used at different settings

This in vitro investigation determined temperature changes associated with radiofrequency energy-induced heating of bovine articular cartilage using a newly developed, temperature-controlled, bipolar radiofrequency system at different settings. Cartilage tissue samples were placed in a saline bath maintained at room temperature. Radiofrequency energy was applied using a temperature-controlled, bipolar radiofrequency system at four different settings. Fluoroptic thermometry recorded temperatures at the radiofrequency electrode-tissue interface at 1-second intervals before, during delivery (1-5 seconds), and after delivery (1-3 seconds) of radiofrequency energy. Ten data acquisitions were obtained at each equipment setting. There were statistically significant (P<.05) increases in cartilage tissue temperatures associated with the different temperature settings. The temperature at the radiofrequency electrode-tissue interface was relatively close to the equipment's set temperature. These data provide basic information for the temperature-controlled, bipolar radiofrequency system applied to articular cartilage and may be useful in guiding electrosurgical equipment for thermal-assisted chondroplasty.     

How severe must repetitive loading be to kill chondrocytes in articular cartilage?

OBJECTIVE: Little is known about the effects of severe repetitive loading on articular cartilage chondrocytes, even though epidemiological studies associate this type of loading with osteoarthritis. We hypothesize that repetitive loading can kill cartilage chondrocytes in a dose-related manner. DESIGN: Large cartilage-on-bone specimens were cut from the patella groove of bovine knees obtained directly from a slaughterhouse. Cartilage was loaded using a flat impermeable indenter in such a manner that the loaded region was supported naturally by surrounding cartilage and subchondral bone. Specimens received 3600 cycles of compressive loading at 1 Hz, with the peak load lying in the range 1-70% of the force required to damage cartilage in a single loading cycle (35 MPa). Cell viability was assessed in thick sections of loaded and control cartilage using a paravital staining method: fluorescein diacetate stained live cells green, and propidium iodide stained dead cells red. The assay was validated on cartilage which had been subjected to repeated freeze-thaw cycles to kill the chondrocytes. RESULTS: Paravital staining revealed 100% cell death after one freeze-thaw cycle at -196 degrees C and three cycles at -20 degrees C. Baseline chondrocyte viability was 80% in unloaded cartilage, and viability decreased when applied compressive loading exceeded 6 MPa. Above this threshold, cell viability was inversely proportional to applied stress. When gross damage to the cartilage surface first became evident, above 14 MPa, 40% of cells remained viable. Load-induced chondrocyte death was greatest in the surface zone, and extended beyond the loaded area. Electron micrographs indicated that some cells were dying by apoptosis. CONCLUSIONS: Some chondrocytes are much more vulnerable to repetitive mechanical loading than others, suggesting that vigorous activity may lead to cell death in articular cartilage.     

Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on cartilage compressive stiffness, permeability, cell synthesis, and extracellular matrix composition

The cellular, biochemical, biomechanical, and histologic effects of radiofrequency-generated heat on osteoarthritic cartilage were assessed. Articular cartilage explants (n=240) from 26 patients undergoing total knee arthroplasty were divided based on Outerbridge grade (I or II/III) and randomly assigned to receive no treatment (controls) or monopolar or bipolar radiofrequency at 15 or 30 W. Both potentially beneficial and harmful effects of radiofrequency treatment of articular cartilage were noted. It will be vital to correlate data from in vitro and in vivo study of radiofrequency thermal chondroplasty to determine the clinical usefulness of this technique.     

Factors affecting the efficacy of bovine chondrocyte transplantation in vitro.

Current therapies for osteoarthritis have been primarily directed at symptom relief rather than disease modification or cure. Improved understanding of cartilage biology and metabolism has permitted exploration of disease-modifying treatments for OA. Chondrocyte transplantation is one approach to disease modification that has received increasing attention. To date, most chondrocyte transplantation has focused on surgical implantation into isolated chondral defects.Our hypothesis is that cultured chondrocytes will preferentially transplant to hyaline cartilage after intraarticular injection. The purpose of this study was to quantify chondrocyte adherence to cartilage in an in-vitro bovine explant model under differing culture conditions. The effect on chondrocyte transplantation of time, of alginate vs. monolayer culture techniques, and of differing origin of tissue explants within the knee joint were assessed. The effect on transplantation of physically modifying the explant surface was also assessed. In addition to quantification of transplantation adherence, the morphology of transplanted chondrocytes was assessed with confocal and electron microscopy.Maximal adherence occurred by 24 h post-transplantation. Baseline transplant densities exceeding 1 x 10(6) cells/cm(2)were observed on unmodified cartilage surfaces. No significant differences in binding density were noted between cartilage explants obtained from the patella, femoral condyles, tibial plateaus or the trochlear groove. In addition, no differences in chondrocyte adherence were noted in cells cultured in monolayer or alginate beads. Transplanted chondrocytes were noted to be spherical irrespective of the culture methods employed. Notably, chondrocytes demonstrated significantly improved adherence to cartilage surfaces after the superficial layer was removed as compared to normal intact cartilage surfaces (increase of 26%, P< 0. 01). This suggests that chondrocytes may preferentially adhere to cartilage surfaces where the superficial layer has been damaged, as is the case in isolated chondral lesions, or with diffuse cartilage degeneration.     

Transplantation of free tibial periosteal grafts for the repair of articular cartilage defect: An experimental study

Background:

Articular chondrocytes have got a long lifespan but rarely divides after maturity. Thus, an articular cartilage has a limited capacity for repair. Periosteal grafts have chondrogenic potential and have been used to repair defects in the articular cartilage. The purpose of the present study is to investigate the differentiation of free periosteal grafts in the patellofemoral joint where the cambium layer faces the subchondral bone and to investigate the applicability of periosteal grafts in the reconstruction of articular surfaces.

Materials and Methods:

The study was carried out over a period of 1 year on 25 adult, male Indian rabbits after obtaining permission from the institutional animal ethical committee. A full-thickness osteochondral defect was created by shaving off the whole articular cartilage of the patella of the left knee. The defect thus created was grafted with free periosteal graft. The patella of the right knee was taken as a control where no grafting was done after shaving off the articular cartilage. The first animal was used to study the normal histology of the patellar articular cartilage and periosteum obtained from the medial surface of tibial condyle. Rest 24 animals were subjected to patellectomy, 4 each at serial intervals of 2, 4, 8, 16, 32 and 48 weeks and the patellar articular surfaces were examined macroscopically and histologically.

Results:

The grafts got adherent to the underlying patellar articular surface at the end of 4 weeks. Microscopically, graft incorporation could be appreciated at 4 weeks. Mesenchymal cells of the cambium layer were seen differentiating into chondrocytes by the end of 4 weeks in four grafts (100%) and they were arranged in a haphazard manner. Till the end of 8 weeks, the cellular arrangement was mostly wooly. At 16 weeks, one graft (25%) had wooly arrangement of chondrocytes and three grafts (75%) had columnar formation of cells. Same percentage was maintained at 32 weeks. Four grafts (100%) at 48 weeks showed columnar orientation. The control side showed no changes over the shaved off articular surface in all the rabbits. One rabbit at 4 weeks had a dislocation of the patella on the control side. None of the rabbits developed any infection or wound dehiscence.

Conclusion:

Autologous periosteal graft transplantation can be a promising substitute for articular cartilaginous defects.     

First successful autologous chondrocyte implantation in Pakistan

Osteochondritis dissecans entails a hyaline cartilage defect of the articular surface causing pain and functional restriction in young adults, sometimes resulting in early degenerative arthritis. Conventional treatment methods such as abrasion chondroplasty and mosaicplasty have limitations in terms of quality of the resultant cartilage and donor site morbidity. A more recent technique, autologous chondrocyte implantation (ACI) results in hyaline cartilage formation and gives good long-term outcome, but requires a high-level cell culture facility and two surgical procedures. The patient was a young female with knee pain, intermittent locking and feeling of "joint mouse". MRI scan and arthroscopy showed a 2 x 2 cm full thickness osteochondral defect in the medial femoral condyle. A free fragment of articular cartilage was found, which was extracted arthroscopically, and chondrocytes were cultured from it in the Juma laboratory. Subsequently, patient underwent surgery whereby the chondrocytes were injected under a periosteal patch sewn over the defect. Over six months, patient's symptoms completely resolved and she returned to full function. A repeat arthroscopy after one year revealed complete filling of the previous defect with normal appearing cartilage indicating success of the procedure. This technology can be utilized for treating patients with a variety of conditions affecting hyaline cartilage of joints.