Background:Failure rates of up to 20% have been reported after fasciotomy for chronic exertional compartment syndrome (CECS). There is some evidence that postoperative failure and complication rates are higher in the posterior compartments of the lower leg than the anterolateral compartments. Isolated compartment surgery may put patients at risk of requiring revision surgery because of the risk of developing posterior compartment disease.Hypothesis:Isolated anterolateral fasciotomy for CECS, in the absence of posterior compartment symptoms, produces satisfactory functional outcomes.Study Design:Case series; Level of evidence, 4.Methods:Between 2006 and 2012, patients who had positive intracompartment pressure-testing findings and who underwent isolated anterolateral fasciotomy release for CECS were given a self-administered questionnaire. The minimum follow-up was 3 years. The questionnaire addressed time to return to sport and ongoing symptoms. A visual analog scale was used to assess pain during exercise before and after surgery (score: 0, no pain; 10, worst pain imaginable); overall satisfaction with the procedure was assessed as well. Of 31 eligible patients, 20 patients (36 legs operated on) were assessed.Results:Postoperatively, 90% of participants returned to the same or higher level of sport. The mean pain score during exercise before surgery was 8.17, whereas it was 1.74 after surgery. The overall mean patient satisfaction score was 8.64. Only 1 leg (2.8%) went on to develop posterior compartment syndrome.Conclusion:Isolated anterolateral fasciotomy for CECS produced excellent functional outcomes. Our rate of recurrence was low compared with those found in the literature, and 90% of participants returned to their same or higher level of sport postoperatively.

To determine if a high-fat diet (HF) from weaning would result in a pro-inflammatory state and affect joint cartilage, we fed male rats either HF or Chow diet post-weaning, and voluntary wheel exercise (EX) or cage only activity (SED) after 9 weeks of age. At 17 weeks body composition, plasma biomarkers and histomorphology scores of femoro-tibial cartilages of HF-SED, HF-EX, Chow-SED and Chow-EX groups were compared. Food intake and activity were not significantly different between groups. HF diet resulted in significantly higher weight gain, %fat, fat:lean ratio, and plasma leptin, insulin and TNFα concentrations, with significant interactions between diet and exercise. No abnormal features were detected in the hyaline articular cartilage or in the metaphyseal growth plate in all four groups. However, collagen type X- positive regions of retained epiphyseal growth cartilage (EGC) was present in all HF-fed animals and significantly greater than that observed in Chow-fed sedentary rats. Most lesions were located in the lateral posterior aspect of the tibia and/or femur. The severity of lesions was greater in HF-fed animals. Although exercise had a significantly greater effect in reducing adiposity and associated systemic inflammation in HF-fed rats, it had no effect on lesion incidence or severity. Lesion incidence was also significantly associated with indices of obesity and plasma markers of chronic inflammation. Clinically, EGC lesions induced by HF feeding in rats from very early in life, and possibly by insufficient activity, is typical of osteochondrosis in animals. Such lesions may be the precursor of juvenile osteochondritis dissecans requiring surgery in children/adolescents, conservative management of which could benefit from improved understanding of early changes in cellular and gene expression.

inhibitors or SHAM operated animals do not demonstrate these changes in behaviour post-surgery. Preliminary OARSI scoring indicate differences in subchondral bone and cartilage damage between inhibitor treated and vehicle treated rats post-surgery, indicating a possible chondroprotective role of PPARdelta inhibition. Microarray analyses identified targets of PPARdelta, such as those involved in lipid oxidation, transport, and metabolism (PDK4, ABCA1, CPT1A, ANGLPTL4) which is further supported by genetic and protein validation through qPCR and immunohistochemistry, as well as decreased cell triglyceride accumulation.Conclusions: This study provides strong evidence for a protective role of PPARdelta inhibition in post-traumatic OA and suggests that pharmacological inhibition of PPARdelta is a promising therapeutic strategy. It also suggests that changes in the metabolic activity of chondrocytes, particularly through increased fatty acid oxidation, can mediate the progression of OA. EARLY CELLULAR RESPONSES DEGRADE CARTILAGE MECHANICAL PROPERTIES AFTER JOINT INJURYPurpose: To determine the contribution of cellular response gene activation to the loss of cartilage mechanical properties after traumatic joint injury, using an in-vivo murine model and atomic force microscopy (AFM)-based nanoindentation. Methods: Mouse joint injury was by non-surgical ACL rupture using a single mechanical overload, applied to the knee joint such that there is anterior-posterior translation of the tibia to the point of ACL failure. Cellular responses to injury were attenuated by preventing the transcriptional elongation of primary response genes, accomplished by intraperitoneal injection of cyclin dependent kinase 9 (Cdk9) inhibitor flavopiridol (2.5mg/kg) and Bromodomain containing protein 4 (Brd4) inhibitor JQ1 (17mg/kg) daily for 3 days after injury. Cdk9/Brd4 inhibition prevents phosphorylation of RNA Polymerase II by Cdk9, which is the rate-limiting step for the transcriptional elongation of primary response genes. Control groups included uninjured naïve mice, injured mice without drug treatment, and drug-treated mice without injury. After 7 days, knee joints were dissected, then subjected to mechanical testing. AFM-based nanoindentation (Dimension Icon, BrukerNano) was performed on the surfaces of condyle articular cartilage using a microspherical tip (R z 5 mm, nominal k z 8.9 N/m). For each condyle, both the lateral and medial sides were tested. On each side, at least 10 different locations were tested up to an indentation depth of~1 mm at 10 mm/s rate. Effective indentation modulus, Eind (MPa), was calculated

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Research honours degrees provide potential pathways into Masters and Doctorate degrees. Essential to their success is that they provide a sound grounding for novice researchers without taxing supervisors unduly. Our case study is a Bachelor Health Science (BHSc) (Hons) degree at the University of Auckland, New Zealand, a postgraduate degree aimed at attracting high-achieving BHSc graduates to study at an advanced level. This particular programme is not practice focused, but is a training ground for research. Therefore assessing whether the honours programme is a good investment for students meeting their needs and in preparing them for future study, and is a viable undertaking for often already over-committed supervisors is important. The overarching aim of this case study is to explore how to evaluate whether an honours programme provides a sound grounding for further research based postgraduate study. Graduates of the BHSc (Hons) programme (completed 2010 – 2014) and academics at the University of Auckland were invited to take part in online anonymous cross-sectional surveys. A total of 26 graduates and 23 academics completed the surveys. Overall graduates reported they were satisfied with the quality of the honours programme (73%; 19/26), found the programme to be intellectually stimulating (92%; 24/26), motivating (73%; 19/26) and overall worthwhile (85%; 22/26). Academics agreed that the programme was worthwhile (78%; 18/23), and that the programme adequately prepared graduates for future postgraduate study (65%; 15/23). This case study has found that the BHSc (Hons) programme is an effective launching pad for future postgraduate study; however, the findings have highlighted directions for future improvement in curriculum design. The study gave insights into the challenges, benefits and limitations perceived by academics involved in supervision and graduates completing the programme. Those designing postgraduate honours degrees as researcher training grounds may find this paper useful.