The purpose of this study was to analyze the relationship between postsurgical tibial translation (TT) and tibial rotation (TR) with cartilage matrix changes using quantitative magnetic resonance imaging, specifically voxel-based relaxometry with T1ρ and T2 mapping sequences. Knee magnetic resonance imaging's (MRI's) of 51 patients with unilateral anterior cruciate ligament injury, no concomitant ligamentous injury, history of osteoarthritis (OA), and previous knee surgery were scanned prior to surgery. Thirty-four patients completed follow-up MRI scans at 6-month, 1-and 2-year postreconstruction and were included in this study. Knee biomechanics, T1ρ, and T2 were calculated using an in-house Matlab program. Compared to the contralateral knee, the injured knee demonstrated significantly increased anterior TT at baseline (P < .001), 6-month (P < .001), 1-(P = .001), and 2-year (P < .001). Furthermore, patients were divided into groups based on TT at 6-month. When compared to patients with normal TT, those with increased anterior TT at 6-month displayed significantly longer T1ρ and T2 relaxation times in 10.4% and 7.4% of the voxels in the injured medial tibia at 1-year, respectively, as well as 12.4% and 9.8% of the voxels in the injured medial tibia at 2-year, respectively. Our results demonstrate an association between abnormal tibiofemoral position and early degradative changes to the articular cartilage matrix of the injured knee. Clinical significance: These findings suggest that altered tibiofemoral position following ACL reconstruction is associated with early degeneration of knee cartilage. Future prospective studies employing longer follow-up times are warranted to evaluate the relationship between abnormal tibiofemoral position and the early onset of posttraumatic OA.
Purpose: There is growing evidence that endoplasmic reticulum (ER) stress plays a role in osteoarthritis (OA). In order to evaluate the role of ER stress in idiopathic adult-onset OA, we utilized ER stress as an OA inducer in a mouse model. Methods: In this system, ER stress is induced by expression of mutant cartilage oligomeric matrix protein (COMP) in the chondrocytes of adult mice between the ages of 16 to 20 weeks. Mutant COMP expression is dependent on presence of doxycycline (Tet-On system) and is restricted to chondrocytes by a type II collagen promoter. Results: We have preciously shown that mutant COMP causes ER and oxidative stress and inflammation in growth plate and articular chondrocytes. Our data further shows additional characteristics of OA including reduction in proteoglycans and glycosaminoglycans, presence of inflammatory markers and thinning of the articular cartilage in adult mice. We are now assessing classic OA markers in the articular cartilage, evaluating articular cartilage health using the OARSI scoring system, gait as a measure of limb function and pain. Conclusions: The strengths of this new model system of OA are the ability to induce ER stress at different time points and a system to investigate and define the role that ER stress plays in OA. This inducible model of adult-onset idiopathic OA will be used to assess recovery of the joint after damage, the contribution of multiple OA risk factors, identify early markers of OA and evaluate new treatments directed at dampening ER stress.
Background:
Preoperative optimization in patients undergoing posterior spinal fusion is essential to limit the number and severity of postoperative complications. Here, we, additionally, evaluated the impact of hypoalbuminemia on morbidity and mortality after posterior spinal fusion surgery.
Methods:
This retrospective analysis was performed using data from a prospective multicentric database (ACSNSQIP:2015–2020) regarding patients undergoing posterior spinal fusions. Factors studied included; baseline demographics and 30-day postoperative complications (i.e., reoperations, readmissions, and mortality rates).
Results:
There were 6805 patients who met the inclusion criteria. They averaged 62 years of age and had an average BMI of 30.2. Within the 30-day postoperative period, 634 (9.3%) sustained complications; 467 (6.9%) were readmitted, 263 (3.9%) required reoperations, and 37 (0.5%) expired. Although multiple preoperative risk factors were analyzed, hypoalbuminemia, severe hypoalbuminemia, and dialysis were the strongest independent risk factors associated with complications (i.e., reoperations, readmissions, and mortality).
Conclusion:
Hypoalbuminemia, severe hypoalbuminemia, and dialysis were significant predictors for morbidity and mortality after posterior spinal fusion surgery.
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