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      Reconstruction of finger joints using autologous rib perichondrium – an observational study at a single Centre with a median follow-up of 37 years

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          Abstract

          Background

          Gratifying long-term results are difficult to achieve when reconstructing osteoarthritic finger joints. Implant surgery is the most commonly used method to restore function and dexterity. However, all types of implant have disadvantages and may be a less favorable option in some cases, especially in young patients with a long expected lifetime and high demands on manual load. Implant related complications as loosening, instability, subsidence and stiffness are the main concerns. In this context, joint reconstruction using rib perichondrium might be a reasonable alternative in selected cases. The aim of the study was to evaluate the long-term results of finger joint reconstruction using rib perichondrial transplantation.

          Methods

          The study group ( n = 11) consisted of eight individuals reconstructed in the proximal interphalangeal (PIP) joints and three reconstructed in the metacarpophalangeal (MCP) joints during 1974–1981. All patients were evaluated at clinical visits (median: 37 years after perichondrial transplantation, range: 34–41 years) using radiographs, disability in arm-shoulder-hand (DASH) score, Visual Analog Scale (VAS), range-of-motion (ROM) and manual strength (JAMAR).

          Results

          None of the 11 patients had undergone additional surgery. All of the PIP-joints ( n = 8) were almost pain-free at activity (VAS 0,6) (range 0–4), had an average range-of-motion of 41 degrees (range 5–80) and a mean DASH-score of 8,3 (range 1–51). The mean strength was 41 kg compared to 44 kg in the contralateral hand (93%). The three MCP joints were almost pain-free at activity (VAS 0,7), (range 0–1). The ROM was on average 80 degrees (range 70–90) and the mean DASH-score was 2 (range 1–3). The mean strength was 43 kg compared to 53 kg in the contralateral hand (81%).

          Conclusions

          Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. Additional studies are needed to evaluate long-term results in comparison to modern implants and to better describe the factors that determine the outcome of these procedures.

          Level of evidence

          Level IV, Therapeutic Study.

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          Most cited references44

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          Distinguishing the contributions of the perichondrium, cartilage, and vascular endothelium to skeletal development.

          During the initiation of endochondral ossification three events occur that are inextricably linked in time and space: chondrocytes undergo terminal differentiation and cell death, the skeletal vascular endothelium invades the hypertrophic cartilage matrix, and osteoblasts differentiate and begin to deposit a bony matrix. These developmental programs implicate three tissues, the cartilage, the perichondrium, and the vascular endothelium. Due to their intimate associations, the interactions among these three tissues are exceedingly difficult to distinguish and elucidate. We developed an ex vivo system to unlink the processes initiating endochondral ossification and establish more precisely the cellular and molecular contributions of the three tissues involved. In this ex vivo system, the renal capsule of adult mice was used as a host environment to grow skeletal elements. We first used a genetic strategy to follow the fate of cells derived from the perichondrium and from the vasculature. We found that the perichondrium, but not the host vasculature, is the source of both trabecular and cortical osteoblasts. Endothelial cells residing within the perichondrium are the first cells to participate in the invasion of the hypertrophic cartilage matrix, followed by endothelial cells derived from the host environment. We then combined these lineage analyses with a series of tissue manipulations to address how the absence of the perichondrium or the vascular endothelium affected skeletal development. We show that although the perichondrium influences the rate of chondrocytes maturation and hypertrophy, it is not essential for chondrocytes to undergo late hypertrophy. The perichondrium is crucial for the proper invasion of blood vessels into the hypertrophic cartilage and both the perichondrium and the vasculature are essential for endochondral ossification. Collectively, these studies clarify further the contributions of the cartilage, perichondrium, and vascular endothelium to long bone development.
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            Return to Sport After Articular Cartilage Repair in Athletes' Knees: A Systematic Review.

            To perform a systematic review of cartilage repair in athletes' knees to (1) determine which (if any) of the most commonly implemented surgical techniques help athletes return to competition, (2) identify which patient- or defect-specific characteristics significantly affect return to sport, and (3) evaluate the methodologic quality of available literature.
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              Restoration of Injured or Degenerated Articular Cartilage.

              Intra-articular fractures, ligamentous and meniscal injuries, and articular cartilage breakdown are major causes of degenerative joint disease. Lesions on the articular surface seem to have a limited capacity for repair and often progress inexorably toward osteoarthritis. Recent studies on joint immobilization and cartilage atrophy, however, have shown that repair and remodeling of articular cartilage may be possible. Currently used clinical methods of stimulating cartilage repair and remodeling include alteration of the loading on degenerated joints (primarily by using osteotomies), introduction of new cartilage-forming cells by perforation of subchondral bone, and soft-tissue arthroplasty. These procedures provide temporary relief in selected patients, but they often do not predictably restore long-term joint function. Experimentally, cartilage repair has been stimulated successfully with the use of allografts of periosteum and perichondrium, which serve as sources of cells with chondrogenic potential; introduction of cells grown in culture (stem cells or chondrocytes); stimulation by fibrin clot formation; artificial collagen matrices combined with cell transplants; and chondrogenic growth factors. The long-term success of all these methods has not been explored thoroughly, even in animal studies. Nevertheless, some research results are sufficiently encouraging to suggest that repair of the degenerating articular cartilage may be possible in the future.
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                Author and article information

                Contributors
                torbjorn.vedung@surgsci.uu.se
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                29 April 2020
                29 April 2020
                2020
                : 21
                : 278
                Affiliations
                [1 ]GRID grid.412354.5, ISNI 0000 0001 2351 3333, Department of Surgical Sciences/Orthopedics & Hand Surgery, , Uppsala University Hospital, ; Entrence 70 1 floor, 751 85 Uppsala, Sweden
                [2 ]GRID grid.414744.6, ISNI 0000 0004 0624 1040, Department of Orthopedics, Falu Lasarett, ; Lasarettsvägen 10, 791 82 Falun, Sweden
                [3 ]GRID grid.15895.30, ISNI 0000 0001 0738 8966, School of Medical Sciences, , Örebro University and University Hospital, ; Örebro, Sweden
                [4 ]GRID grid.24381.3c, ISNI 0000 0000 9241 5705, Division of Pediatric Endocrinology and Center of Molecular Medicine, Department of Women’s and Children’s Health, , Karolinska Institutet and University Hospital, ; Stockholm, Sweden
                [5 ]Elisabeth Hospital Aleris, Geijersgatan 20, 752 26 Uppsala, Sweden
                Author information
                http://orcid.org/0000-0003-3458-5302
                Article
                3310
                10.1186/s12891-020-03310-5
                7191712
                32349740
                e7128297-7915-4160-9ca2-857a549ba285
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 28 March 2020
                : 22 April 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100009230, Landstinget i Uppsala län;
                Funded by: Swedish Research Council
                Award ID: K2015–54X-22 736–01–4, 2015-02227
                Award Recipient :
                Funded by: Swedish Governmental Agency for Innovation Systems (Vinnova)
                Award ID: 2014-01438
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100011898, Marianne and Marcus Wallenberg Foundation;
                Funded by: FundRef http://dx.doi.org/10.13039/501100004348, Stockholms Läns Landsting;
                Funded by: Byggmästare Olle Enkvist Stiftelse
                Funded by: Swedish Society of Medicine
                Funded by: Novo nordisk Foundation
                Funded by: Erik och Edith Fernström Foundation for Medical Research
                Funded by: HKH Kronprinsessan Lovisas förening för barnasjukvård
                Funded by: Sällskapet Barnavård
                Funded by: FundRef http://dx.doi.org/10.13039/501100006741, Stiftelsen Frimurare Barnhuset i Stockholm;
                Funded by: Örebro University, Örebro, Sweden
                Funded by: Nyckelfonden
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Orthopedics
                articular cartilage,perichondrium,transplantation,joint reconstruction
                Orthopedics
                articular cartilage, perichondrium, transplantation, joint reconstruction

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