Anterior knee pain following total knee replacement correlates with the OARSI score of the cartilage of the patella

Background

Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP.

Patients and methods

We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP.

Results

57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6–20) and that of patients with AKP was 15 (6–20) (p = 0.04). Patients with OARSI scores of 13–24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0–2.3) than patients with OARSI scores of 0–12.

Interpretation

The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement.Patellar cartilage degeneration may be one cause of anterior knee pain (AKP) following total knee replacement. However, so far, attempts to relate intraoperatively assessed patellar cartilage involvement to postsurgical AKP have yielded conflicting results (van Jonbergen et al. 2012). There have been studies both affirming (Picetti 3rd et al. 1990, Rodríguez-Merchán and Gómez-Cardero 2010) and refuting (Barrac et al. 1997, 2001, Wood et al. 2002, Burnett et al. 2004, Campbell et al. 2006, Pilling et al. 2012) a relationship between the state of the patellar cartilage at the time of arthroplasty and postoperative AKP. The original Outerbridge classification (Outerbridge 1961) and its modification by Beguin and Locker (1983) have been used in most studies for grading of cartilage degeneration.Previous research of AKP has focused on the macroscopic cartilage changes. However, the disease process may be quite advanced at the histological level before any macroscopic changes become visible (Agha and Webb 2006, Bentley and Hill 2007).To our knowledge, the relationship between histological changes in the cartilage of the patella at the time of arthroplasty and postsurgical AKP has not been investigated. The Osteoarthritis Research Society International (OARSI) has developed a system for grading of the cartilage pathology, which is based on combined assessment of the depth of the lesion and the extent of the arthritic changes over the joint surface (Pritzker et al. 2006). We hypothesized that there is a correlation between OARSI score and AKP following total knee replacement with unresurfaced patella.The aims of the study were (1) to estimate the prevalence of AKP following total knee replacement with unresurfaced patella, and (2) to determine whether there is a correlation between the condition of the cartilage of the unresurfaced patella at the time of knee replacement, as assessed by the OARSI score, and postsurgical AKP.     

Genetic variations in vascular endothelial growth factor but not in angiotensin I-converting enzyme genes are associated with endometriosis in Estonian women

Objective

To determine plausible associations between endometriosis and vascular endothelial growth factor gene (VEGF −2578 A/C, −1154 G/A, −634 G/C and 936 C/T), also angiotensin I-converting enzyme gene (ACE −240 A/T and 2350 A/G) single nucleotide polymorphisms (SNPs), as well as their respective haplotypes.

Study design

PCR-based restriction fragment length polymorphism analysis was used to detect SNPs in VEGF and ACE genes in 150 Estonian women with endometriosis and 199 control subjects.

Results

The CC genotype of the VEGF −2578 A/C SNP was correlated with a decreased risk of endometriosis (OR = 0.40, 95% CI 0.20-0.78). Other VEGF and ACE SNPs and haplotypes were not associated with endometriosis.

Conclusion

This case-control study demonstrated that the VEGF −2578 A/C SNP may influence susceptibility to endometriosis in the Estonian population, while associations between endometriosis and other VEGF and ACE SNPs, as well as the respective haplotypes are unlikely.     

PNPLA3 Gene Polymorphisms in HCV/HIV-Coinfected Individuals

Background and Aims

The patatin-like phospholipase domain-containing 3 (PNPLA3) gene has been associated with the development of alcoholic and nonalcoholic steatohepatitis. Using a newly developed and validated assay for PNPLA3, we explored the prevalence of gene polymorphisms in a cohort of HCV/HIV-coinfected individuals to determine whether there was an association with insulin resistance or hepatic fibrosis.

Methods

A high-resolution melting point (HRM) assay was developed and validated. The assay was used to evaluate samples obtained in the context of a clinical trial performed at ACTG sites across the USA in HIV-infected patients. Clinical features and treatment outcomes were assessed in relation to the PNPLA3 genotype.

Results

The HRM methodology demonstrated 100% concordance with results obtained by Sanger sequencing. Among 241 participants tested, 66.0% had the wild-type allele (CC) and the remainder had the aberrant PNPLA3 gene polymorphism in the homozygotic (GG) or heterozygotic (CG) form. Race and ethnicity were associated with PNPLA3 genotype but fibrosis stage, Homeostatic Model Assessment of Insulin Resistance, and HCV treatment outcome were not.

Conclusion

The HRM method is an effective, rapid technique for characterizing PNPLA3 genotype. In those with HCV/HIV infection, nearly 40% carry gene polymorphisms associated with the development of NASH or ASH. Prospective studies should focus on this group to determine whether they represent a subset of HIV-infected persons at increased risk of fibrotic progression.

     

VNTR I/I genotype of insulin gene is associated with the increase of follicle number independent from polycystic ovary syndrome

BACKGROUND: Polycystic ovary syndrome (PCOS) is accompanied by selective insulin resistance and enhanced ovarian steroidogenic effects of insulin. We analysed the minisatellite variations of the insulin gene (INS VNTR) with regard to the clinical features of PCOS. METHODS: Retrospective, adjusted association study. Infertile patients with PCOS (n=30) and tubal factor (n=75) were screened for anthropometrical, clinical and ovarian morphology parameters, as well as hormonal values. INS VNTR was genotyped by its surrogate marker at -23 HphI locus. RESULTS: INS VNTR genotype distribution was similar in PCOS and tubal infertility group. The mean ovarian follicle number was higher in VNTR I/I individuals compared to VNTR I/III and III/III individuals (adjusted OR=1.28, p=0.03), independent from the cause of infertility, the age, the follicle stimulating hormone level on day 3-5 of menstrual cycle, BMI and the previous surgical ovarian tissue removal. In addition, higher level of the luteinising hormone in VNTR I/I individuals was associated with the increase in follicle number. CONCLUSIONS: We suggest that INS VNTR genotypes are not associated with PCOS in general, but could have a certain influence on the phenotypic spectrum of the syndrome.