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      Ossification post-traumatique du ligament collatéral médial du genou: à propos d’un cas Translated title: Post-traumatic ossification of the medial collateral ligament of the knee: about a case

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          Abstract

          L’ossification hétérotopique est une ossification pathologique des parties molles. C’est une affection bénigne, récidivante et de survenue imprévisible. On décrit le cas d’un patient, traité pour une fracture du plateau tibial gauche avec mise en place d’une plaque vissée. A deux mois de l’opération, le patient a présenté une raideur du genou gauche. Le bilan radiologique standard a révélé une ossification du ligament latéral interne (LLI), confirmée par la tomodensitométrie. On ne sait pas actuellement les facteurs déterminant l’ossification des ligaments et tendons. Bien que les cliniciens prescrivent souvent des médicaments prophylactiques tels que les anti-inflammatoires et des séances de radiothérapie pour prévenir l’ossification hétérotopique des parties molles; la physiopathologie de l’ossification hétérotopique est peu connue.

          Translated abstract

          Heterotopic ossification is a pathological ossification of soft tissues. It is a benign, recurring disease with an unpredictable onset. We here report the case of a patient treated for a fracture of the left tibial tray with installation of a screwed plate. Two months after surgery the patient had a stiff left knee. Standard radiological examination showed ossification of the medial collateral ligament (MCL) confirmed by tomodensitometry. We do not currently know which factors determine the presence of tendon and ligamentous ossification. Although clinicians often prescribe prophylactic drugs, such as anti-inflammatory drugs and radiotherapy sessions to prevent heterotopic ossification in soft tissues, the physiopathology of heterotopic ossification is little known.

          Most cited references15

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          Heterotopic ossification.

          Heterotopic ossification, the formation of bone in soft tissue, requires inductive signaling pathways, inducible osteoprogenitor cells, and a heterotopic environment conducive to osteogenesis. Little is known about the molecular pathogenesis of this condition. Research into two rare heritable and developmental forms, fibrodysplasia ossificans progressiva and progressive osseous heteroplasia, has provided clinical, pathologic, and genetic insights. In fibrodysplasia ossificans progressiva, overexpression of bone morphogenetic protein 4 and underexpression of multiple antagonists of this protein highlight the potential role of a potent morphogenetic gradient. Research on fibrodysplasia ossificans progressiva also has led to the identification of the genetic cause of progressive osseous heteroplasia: inactivating mutations in the alpha subunit of the gene coding for the stimulatory G protein of adenylyl cyclase. Better understanding of the complex developmental and molecular pathology of these disorders may lead to more effective strategies to prevent and treat other, more common forms of heterotopic ossification.
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            Isolation and characterization of multipotent stem cells from human cruciate ligaments.

            Mesenchymal stem cells have great potential for tissue regeneration, and these cells can be harvested from a variety of tissues; however, up to now it has not been clear whether stem cells could be isolated from cruciate ligaments of the knee joint. The aim of our study was to isolate and characterize stem cells from both anterior and posterior cruciate ligaments (ACL and PCL) of humans. Cruciate ligaments were obtained from patients receiving total knee arthroplasty for advanced osteoarthritis and plastic-adherent cells were serially passaged. In vitro chondrogenic, osteogenic and adipogenic abilities of the cells were evaluated by reverse transcriptase-polymerase chain reaction and histological study. Karyotyping and surface immunophenotyping of the cells were performed. It was found that a population of ligament-derived cells could be expanded and subcultured extensively. These cells were able to differentiate into osteoblasts, chondrocytes and adipocytes under appropriate inductions. Their phenotypic characteristics were similar to those of bone marrow mesenchymal stem cells. Karyotyping was normal after serial passage. In summary, our study demonstrates that human multipotent stem cells can be isolated and expanded from human ACL and PCL, which are easily obtained from patients following total knee or cruciate ligament reconstructive surgery. Self-renewal and mesodermal differentiation potential of these cells make them a viable alternative source for use in regenerative medicine.
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              The incidence of heterotopic ossification after total knee arthroplasty.

              Five hundred consecutive patients undergoing primary cemented knee arthroplasties were prospectively followed up and evaluated for the presence of heterotopic ossification. Of the patients studied, 95% had osteoarthritis and 5% had inflammation. A radiographic grading system was devised based on the size and location of the heterotopic bone. The overall incidence of heterotopic ossification in this group was 15%. The patients who developed HO tended to be heavier than the average and were more likely to be men. This is the most comprehensive prospective study of the incidence of HO in primary cemented knee arthroplasty. Other than a small subset of the patients (4 of 500), HO does not appear to have a major influence on the outcome of knee arthroplasty.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                19 July 2016
                2016
                : 24
                : 254
                Affiliations
                [1 ]Equipe de Recherche Clinique et Epidémiologique de la Pathologie Ostéo-articulaire, UCH Mohammed VI, Faculty of Medicine and Pharmacy Marrakech, Cadi AAyad University, Maroc
                [2 ]Service de Traumato-orthopédie, Hôpital Militaire Avicenne Marrakech, CHU Mohamed VI, Faculté de Médecine et de Pharmacie Marrakech, Université Kadi Ayad, Maroc
                Author notes
                [& ]Corresponding author: Hafid Arabi, Equipe de Recherche Clinique et Epidémiologique de la Pathologie Ostéo-articulaire, UCH Mohammed VI, Faculty of Medicine and Pharmacy Marrakech, Cadi AAyad University, Maroc
                Article
                PAMJ-24-254
                10.11604/pamj.2016.24.254.9723
                5075481
                642a4eeb-e540-4ec4-8c0e-f2d4983913d5
                © Hafid Arabi et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 April 2016
                : 23 May 2016
                Categories
                Case Report

                Medicine
                ossification hétérotopique,ligament collatéral médial,heterotopic ossification,medial collateral ligament,morocco (à enlever)

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