Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients

Introduction : Referred pain in the anterior knee joint is the most common symptom in hip disease patients. The development of referred pain is considered to be related to dichotomizing peripheral sensory fibers. However, no gross anatomical findings identify any dichotomizing fibers innervating both the hip and knee joints. We dissected the femoral and obturator nerves in human cadavers to investigate the distribution of the articular branches in the hip and knee joints. Fourteen embalmed left lower limbs from 14 Japanese adult cadavers (five from females, nine from males, average age 73.8 ± 14.1 years) were observed macroscopically. The articular branches of the femoral and obturator nerves were dissected at the anterior margin of the groin toward the thigh region. After dissections of the articular nerves of the hip joints, the femoral and obturator nerves were exposed from proximally to distally to identify the articular nerves of the knee joints. The branching pattern of the articular branches in the hip and knee joints was recorded. In six of 14 limbs (42.9%), the femoral nerve supplied articular branches to the anteromedial aspect of both the hip and knee joints. These articular branches were derived from the same bundle of femoral nerve. These gross anatomical findings suggested that dichotomizing peripheral sensory fibers innervate the hip and knee joints and these could relate to the referred pain confirmed in the anterior knee joints of patients with hip disease. Clin. Anat. 31:705–709, 2018. © 2018 Wiley Periodicals, Inc.     

Outcomes of treatment for intracapsular fractures of the mandibular condyle: recommendation for a new classification

We know of no universally accepted classification for intracapsular condylar fractures. We propose here a new classification based on the concept of a “disc-condyle” unit, and validate the classification based on outcomes of treatment. From 1 January 2010 - 31 December 2014, 55 patients with unilateral intracapsular condylar fractures were classified into three types: type A has no reduction in mandibular height or displacement of the disc (n = 7); type B has displacement of the disc with no reduction in mandibular height (n = 17); and type C has reduced mandibular height with or without displacement of the disc (n = 31). We treated types B and C by open reduction and fixation, while type A fractures were managed non-surgically. At six month follow-up, we found no significant differences in the vertical height of the ramus, mandibular deviation, protrusion, or lateral protrusion between the fractured and healthy sides. All patients had normal occlusion postoperatively and only one patient (type C) reported pain. Magnetic resonance imaging and computed tomography showed good osseous healing and disc-condylar relations in all cases. Our results show that this new classification of intracapsular condylar fractures is a safe and easy way to obtain satisfactory outcomes of treatment. However, it needs further independent validation.     

Age Related Changes in the Synthesis of Connective Tissues in the Rabbit

The synthesis of collagen and non-collagen proteins was studied in rapidly growing male New Zealand rabbits. Animals were divided into sexually immature (i.e. 4 and 8 week old) and mature (i.e. 15 and 26 week old) groups. Comparisons of aorta, lung, and liver protein synthesis and accumulation were made to determine the effect of aging on both collagen and non-collagen proteins. In all tissues there appeared to be an age-related decrease in the relative percent of collagen synthesized. In the lung and liver the relative decrease in percent collagen synthesis resulted from an age-related increase in the synthesis rate of non-collagen proteins In the aorta the decrease in percent collagen synthesis was primarily a result of a decrease in collagen synthesis These data therefore suggest that the rate of accumulation of tissue proteins correlates more directly with the growth and degree of differentiation of a tissue than with direct animal age.     

The effects of elevated fibroblast growth factor 23 on mandibular growth in rats

ObjectiveThe aim of this study is to elucidate the local effects of fibroblast growth factor 23 (FGF23) in on mandibular condylar growth in growing rats.DesignGrowing Sprague–Dawley rats received intra-temporomandibular joint injections of phosphate buffer solution (PBS), adenovirus-mediated green fluorescent protein (Ad-GFP) or adenovirus-mediated fibroblast growth factor 23 (Ad-FGF23), which were marked as groups A, B, and C, respectively. In vitro, we treated rat mandibular cartilage chondrocytes with PBS, Ad-GFP, and Ad-FGF23.ResultsThe mandibular condyles in group C grew smaller sizes than those in the other control groups due to significant differences among the experimental and control groups with the value of C–D, Q–R (P ≤ 0.05), accompanied by diminished bone mass of sub-cartilage condyles via micro CT analysis. Histologically, the length of the hypertrophic zone was diminished and was associated with decreasing chondrocyte proliferation in group C. Quantitative real-time PCR indicated significant decreases in the expression of chondrogenesis marker genes, including Type X collagen (Col X) and SRY-type box 9 (Sox 9). Moreover, elevated Ad-FGF23 suppressed chondrocyte proliferation and the expression of the chondrogenic differentiation markers Col X and Sox 9 of in vitro.ConclusionsLocal injection of FGF23 suppressed the development and decreased the bone mass of condyles through the decreasing the formation of condylar cartilage, specifically by regulating condylar cartilage cell viability and chondrogenesis expression.     

Studies on the Circulatory Pathophysiology of Trauma: I. Effect of Acute Soft Tissue Injury on Nutritional and Non-nutritional Shunt Flow Through the Hindleg of the Dog

Antigen induced arthritis (AIA) was elicited in 28 adult rabbits using ovalbumin. All animals developed an intensive monarthritis manifested by local heat and swelling. Two, 7 and 21 days later, respectively, 0.3 ml of 1 per cent OsO₄ was injected into the arthritic knees of three groups of 9 rabbits. The rabbits were killed 1, 3 and 6 months later. No modifying influence on the severe to complete cartilage destruction was evident. One group of 8 rabbits received only OsO₄ and the cartilage of these animals remained intact after 6 months.     

可注射性生物复合材料修复老年膝关节软骨损伤的应用分析

目的探讨可注射性生物复合材料修复老年膝关节软骨损伤的应用。方法采用前瞻性研究方法,选择2015年1月至2016年2月在我院诊治的老年膝关节软骨损伤24例,根据信封随机抽取法分为观察组与对照组,每组12例,两组都给予关节镜下手术治疗,对照组注射骨水泥进行修复,观察组使用纳米晶磷酸钙/胶原基骨材料进行修复,观察手术前后疼痛与膝关节功能情况。结果术后3个月,观察组和对照组的疗效优良率分别为91.7%与66.7%,观察组明显高于对照组(P<0.05);观察组和对照组疼痛评分分别为(2.11±1.54)、(3.61±1.44)分,明显低于术前的(4.94±2.61)、(4.84±2.53)分(P<0.05),且观察组的术后评分明显低于对照组(P<0.05);观察组与对照组术后Lysholm膝关节功能评分均明显高于术前(P<0.05),且观察组的术后评分明显高于对照组(P<0.05)。观察组与对照组术后3个月的血栓栓塞、肺部感染、下肢肿胀等并发症发生率分别为16.7%、58.3%,观察组明显低于对照组(P<0.05)。结论可注射性生物复合材料-纳米晶磷酸钙/胶原基骨材料修复老年膝关节软骨损伤具有很好的疗效,能减少并发症的发生,其作用机制可能与有效缓解及改善膝关节功能有关。     

Limited Use of Antiseptics in Septic Surgery

ABSTRACT

In septic joint surgery, treatment with antiseptics is a standard procedure. Postinfectious degeneration of cartilage often results in early arthritis that necessitates joint replacement, even in young patients. It is still unclear whether antiseptics have only a toxic effect on chondrocytes or also induce late cell death through apoptosis. We hypothesized that commonly used antiseptics (polyhexanide, hydrogen peroxide, and chlorhexidine) induce different stages of apoptosis on human chondrocytes. Human chondrocytes were isolated and cultured. Polyhexanide, hydrogen peroxide, and chlorhexidine were added to the monolayer cultures. Early and late apoptotic cells were analyzed using flow cytometric detection of Annexin V, active caspases, and 7AAD, and fluorescence microscopy using Annexin V and propidium iodide staining. Flow cytometric analysis revealed an increase of Annexin V and active caspases expression of human chondrocytes after incubation with polyhexanide, hydrogen peroxide, and chlorhexidine. Fluorescence microscopy demonstrated a high number of apoptotic cells. Our data show that polyhexanide and chlorhexidine only promote the early stages of apoptosis without any differences in toxicity. Conversely, hydrogen peroxide induces early and later stages of apoptosis on primary human chondrocytes in vitro.     

Cellular proliferation in the nasal septal cartilage of juvenile minipigs

The growth of the nasal septal cartilage is believed to be a driving force of midfacial growth. Cellular proliferation is an important contributor to growth of the cartilage, but this factor has been rarely investigated. The current study was undertaken to assess the proliferation and cellular density in the septal cartilage of fast-growing juvenile minipigs. Six minipigs averaging 4.4 ± 1 months old were injected with 5′-bromo-2′-deoxyuridine (BrdU), a thymidine analog, 24 h before death. The septal cartilage was sectioned in the coronal plane and reacted for BrdU. The proliferative index (number of BrdU-positive chondrocytes/total number of chondrocytes) and cellular density (number of cells mm⁻²) of various locations of the septum were measured and compared in order to determine overall proliferation rate and whether regional variations in proliferative activity and cellular density are present. To provide a time perspective to the problem of midfacial growth, the lengths of the nasal bone and the palate were measured in a collection of 61 dry skulls of minipigs aged 1–8 months. Results showed that the septal chondrocytes were proliferating at a surprisingly high rate (∼21%). The proliferative index was higher in the ventral and middle compared with the dorsal locations, and in the central cartilage compared with the perichondrium. No difference in proliferative index was found between the anterior and posterior parts of the septum. Cellular density was higher in the perichondrium than in the central cartilage. Within the central cartilage there was a trend for higher cellular density anteriorly. In conclusion, the rapidly growing midface of juvenile minipigs is associated with a high rate of septal proliferation, especially in the ventral half of the cartilage.