Objective To explore the effectivness of arthroscopic synovectomy in the treatment of pigmented villonodular synovitis (PVNS) of the knee. Methods A retrospective analysis was conducted on 13 patients with PVNS of the knee treated with arthroscopic synovectomy between June 2008 and December 2011, including 8 left knees and 5 right knees. There were 9 males and 4 females, aged 25-45 years (mean, 33 years). Of 13 patients, 5 had a history of trauma, and 8 had no history of trauma. The disease duration ranged from 4 months to 80 months (mean, 44 months). The preoperative Lysholm score was 45.3 ± 4.2, and International Knee Documentation Committee (IKDC) 2000 score was 46.8 ± 4.9. All patients underwent arthroscopic synovectomy and postoperative radiotherapy. Results The pathological examination proved PVNS in all cases. All incisions obtained healing by first intention after operation. There was no neurovascular injury or knee infection. The average follow-up period was 21.8 months (range, 12-30 months). The Lysholm score was 90.2 ± 7.4, and IKDC2000 score was 87.8 ± 3.8 at last follow-up, showing significant differences when compared with preoperative scores (t=22.64, P=0.00; t=24.32, P=0.00). No recurrence was observed during follow-up. Conclusion Arthroscopic synovectomy can be effective in the treatment of PVNS of the knee, and it has the merits of minimal invasion, rapid function recovery of the knee joint, and satisfactory results. So it is a safe, promising, and minimal invasive procedure in treatment of PVNS.
Objective To investigate the feasibility of rabbit synovial-derived mesenchymal stem cells (SMSCs) differentiating into fibrocartilage cells by the recombinant adenovirus vector mediated by bone morphogenetic protein 2/7 (BMP-2/7) genes in vitro. Methods SMSCs were isolated and purified from 3-month-old New Zealand white rabbits [male or female, weighing (2.1 ± 0.3) kg]; the morphology was observed; the cells were identified with immunocytological fluorescent staining, flow cytometry, and cell cycles. The adipogenic, osteogenic, and chondrogenic differentiations were detected. The recombinant plasmid of pAdTrack-BMP-2-internal ribosome entry site (IRES)-BMP-7 was constructed and then was used to infect SMSCs. The cell DNA content and the oncogenicity were tested to determine the safety. Then infected SMSCs were cultured in incomplete chondrogenic medium in vitro. Chondrogenic differentiation of infected SMSCs was detected by RT-PCR, immunofluorescent staining, and toluidine blue staining. Results SMSCs expressed surface markers of stem cells, and had multi-directional potential. The transfection efficiency of SMSCs infected by recombinant plasmid of pAdTrack-BMP-2-IRES-BMP-7 was about 70%. The safety results showed that infected SMSCs had normal double time, normal chromosome number, and normal DNA content and had no oncogenicity. At 21 days after cultured in incomplete chondrocyte medium, RT-PCR results showed SMSCs had increased expressions of collegan type I and collegan type II, particularly collegan type II; the expressions of RhoA and Sox-9 increased obviously. Immunofluorescent staining and toluidine blue staining showed differentiation of SMSCs into fibrocartilage cells. Conclusion It is safe to use pAdTrack-BMP-2-IRES-BMP-7 for infecting SMSCs. SMSCs infected by pAdTrack-BMP-2-IRES-BMP-7 can differentiate into fibrocartilage cells spontaneously in vitro.
Objective To investigate the method and the effectiveness of arthroscopy and/or arthrotomy combinedwith postoperative radiotherapy for diffuse pigmented villonodular synovitis (PVNS) of the knee. Methods BetweenSeptember 2000 and August 2010, 97 patients with diffuse PVNS of the knee were treated. There were 38 males and 59 femaleswith a median age of 33 years (range, 8-75 years). The disease duration ranged from 1 week to 30 years, including 52 left kneesand 45 right knees. There were 10 recurrent cases. The extention and flexion of the knee joint were (1.9 ± 2.3)° and (122.9 ± 5.6)°,respectively; the Lysholm score was 43.2 ± 6.7; and the International Knee Documentation Committee (IKDC) score was53.2 ± 5.7, preoperatively. According to the scope and degree of the knee joint lesions, simultaneous anterior and posteriorsynovectomy was performed under arthroscopy in 82 cases, synovectomy under arthroscopy and removal of posterior extraarticularlesion by arthrotomy in 3 cases, synovectomy and the soft tissue lesions resection under arthroscopy in 9 cases, andstaging resection and bone graft in 3 cases. After operation, 76 patients received postoperative radiotherapy. Results Poplitealartery was injuryed in 1 case and the branch of popl iteal veins were injuryed in 3 cases during operation. Intra-articularhemorrhage occurred in 1 case at 3 days after operation. The other patients achieved heal ing of incision by first intentionwithout nerve damage and other complications. All patients were followed up 1 year and 3 months to 11 years and 2 months(median, 61 months) postoperatively. During follow-up, 89 cases had no relapse. At 15 months after operation, the extentionand flexion of the knee joint were (0.2 ± 1.3)° and (135.9 ± 6.6)°, respectively; the Lysholm score was 89.8 ± 5.8; and the IKDCscore was 87.8 ± 5.8. All indexes were significantly improved when compared with the preoperative ones (P lt; 0.05). At 6 monthsto 8 years postoperatively, 8 cases had occurrence, and they had sl ight limitation of the range of motion but had no pain andswelling of the knees after reoperation. Conclusion According to the scope and degree of the knee joint lesions, arthroscopyand/or arthrotomy combined with postoperative radiotherapy should be chosen for diffuse PVNS of the knee so as to obtain good effectiveness. Radiotherapy and enough total radiation dose are important factors to insure no recurrence.
Objective To explore the technique of arthroscopic treatment of synovial chondromatosis of the hip and to evaluate its effectiveness. Methods Between July 2009 and June 2011, 15 patients with synovial chondromatosis of the hip underwent arthroscopic synovectomy and removal of loose bodier. Of 15 patients, 11 were male and 4 were female, aged from 21 to 45 years with an average of 33.1 years. The location was the left side in 6 cases and the right side in 9 cases. The disease duration was 12-43 months (mean, 23 months) Pain and functional motion limitation were the main clinical symptoms. The visual analogue scale (VAS) score was 5.8 ± 1.1; the range of motion (ROM) of the hip was (149.8 ± 27.5)°; the Harris hip score was 54.5 ± 13.3. Results All incisions healed by first intention. All the patients were followed up 6 months to 2 years (mean, 17.4 months). At last follow-up, the VAS score was 2.0 ± 1.2; the ROM of the hip was (258.3 ± 35.4)°; the Harris hip score was 93.0 ± 18.7; and the above indexes were significantly improved when compared with preoperative values (P lt; 0.05). No recurrence was found on postoperative MRI. Conclusion Arthroscopic treatment of synovial chondromatosis of the hip has the advantages of minimal invasion, quick recovery, and best recovery of hip function and ROM.
Objective To review the research appl ication and advance of synovium-derived mesenchymal stem cells (SMSCs) in tissue engineering. Methods The recent related l iterature was reviewed, concerning isolation method, characteristics of SMSCs, and its appl ication in tissue engineering. Results SMSCs are multi potent cell population with characteristics of easy isolation and high prol iferation, which have been appl icated in the cartilage, tendon, l igament, and bone tissue engineering. Conclusion SMSCs is a new member of mesenchymal stem cells family. It appears to be promising seedcells for tissue engineering, but further research is needed.
Objective Platelet-rich plasma (PRP) can promote the repair of soft tissue, wound, and bone defect. To investigate the effect of PRP on synovitis by establ ishing papain-induced osteoarthritis model of rabbit knee and interfering withPRP. Methods Twenty healthy 6-month-old rabbits (male or female, weighing 2.5-3.5 kg) were randomly divided into theexperimental group (n=10) and the control group (n=10). The whole blood (10 mL) was extracted from the central aural artery and PRP was prepared with the Landesberg’s method. Meanwhile, the platelet derived growth factor (PDGF), transforming growth factor (TGF), and vascular endothel ial growth factor (VEGF) concentrations in the circulating blood and PRP were measured. The 4% papain solution (0.3 mL) was injected into the knee joint cavity to establ ish the osteoarthritis model. After that, PRP (0.3 mL) was injected into the knee joints every week for 10 weeks in the experimental group, while normal sal ine of the same volume in the control group. At 2nd, 4th, 6th, 8th, and 10th weeks after the first injection, the erythrocyte sedimentation rate (ESR) and interleukin 1β (IL-1β) concentrations in the whole blood were tested, and the histological changes of the synovium were observed by HE staining and the Mankin scores were made. Results The blood cell counting showed that the platelet concentration of PRP was 6.8 times as that of the circulating blood. PDGF, TGF-β, and VEGF were 5, 8, and 7 times as those of the circulating blood, showing significant differences (P lt; 0.05). All animals survived to the end of experiment. There were significant differences in the ESR at 2nd, 6th, 8th, and 10th weeks and in the IL-1β at 4th, 6th, 8th, and 10th weeks between 2 groups (P lt; 0.05). In the control group, the synovium was edematous and thickened with fibrous effusion and pannus on surface; in the experimental group, the effusion of the synovium was decreased and less congestion and edema were observed at the 2nd week; the synovium was observed to be a bit thickened without obvious edema, with sl ight amount of yellowish joint fluid on surface and no conglutination at the 10th weeks. There were significant differences in the Mankin score at 4th, 6th, 8th,and 10th weeks (P lt; 0.05) between 2 groups. Conclusion PRP is beneficial to the alleviation of synovitis induced by papain according to restoring the damaged tissue and depressing the inflammatory factors.
Objective To explore the method and outcome of knee resurfacing arthroplasty in treating late-staged diffuse pigmented villonodular synovitis (PVNS). Methods Between November 2002 and May 2009, 11 cases of late-staged diffuse PVNS were treated, including 3 males and 8 females with an average age of 51.2 years (range, 42-63 years). The diseaseduration was 2.5-10.0 years (mean, 5.2 years). Unilateral knee was involved in all patients, including 7 left knees and 4 right knees. Nine patients had a history of trauma and 2 cases had no obvious inducing factors. The range of motion was (90.1 ± 17.2)° and Hospital for Special Surgery Knee Score (HSS) was 68.9 ± 8.7. After synovectomy, knee resurfacing arthroplasty was performed in all patients. Results Superficial infection of the incision occurred in 1 case at 6 days postoperatively and was cured after debridement; other incisions healed by first intention. Limited flexion and extension, incomplete palsy of common peroneal nerve, and deep venous thrombosis occurred in 1 case respectively, and were cured or improved after symptomatic treatment. All the 11 cases were followed up 38 months on median (range, 13 to 102 months). Two cases developed chronic pain and were not given treatment. Recurrence occurred in 1 case 12 months postoperatively and recovered after synovectomy again. X-ray films showed no signs of loosening, sinking, and bone destruction. At last follow-up, the range of motion was (109.1 ± 18.6)° and HSS score was 86.7 ± 9.3, showing significant differences when compared with those before operation (P lt; 0.05). According to the HSS score system, the results were excellent in 6 cases, good in 3, fair in 1, bad in 1, and the excellent and good rate was 81.8%. Conclusion A combination of knee resurfacing arthroplasty and synovectomy for the treatment of late-staged diffuse PVNS is able to get a good cl inical results in restoration of function, improvememt of the l ife quality, and decrease of recurrence rate.
To study the method of isolating and culturing synovium-derived MSCs (SMSCs), and to investigate its multiple differentiation potential in vitro. Methods Three 2-month-old Changfeng hybrid swines weighing 8-10 kg (male and female) were used. SMSCs were harvested from the synovium of swine knee joints and cultured in vitro. When the SMSCs at passage 3 reached confluence, basic culture medium was removed, and the multi ple differentiationpotential of SMSCs was demonstrated in specific induction media (experimental group). The cells at passage 3 cultured with basic culture medium served as control group. After 21 days of chondrogenic differentiation, the cells underwent toluidine blue staining, immunohistochemistry staining and real-time fluorescence quantitative PCR detection. After 10 and 21 days of osteogenic differentiation, the cells underwent ALP staining and Al izarin red staining, respectively. After 21 days of adipogenic differentiation, the cells underwent Oil red O staining. Results SMSCs displayed long and thin or polygonal morphology 24 hours after culture. They prol iferated fast 48 hours after culture and presented large number of spindle-shaped cells with few globular cells 72 hours after culture. For the experimental group 21 days after chondrogenic induction, the cells were positive for toluidine blue staining with the formation of Aggrecan outside the cells; the immunohistochemistry staining revealed the expression of Col II; the real-time fluorescence quantitative PCR detection showed that the expressions of Col II A1, Aggrecan and SOX9 mRNA of the experimental group were greater than that of control group (P lt; 0.05). The cells were positive for ALP staining 10 days after osteogenic induction, and positive for Al izarin red staining 21 days after osteogenic induction, with the formation of calcium nodules. Oil red O staining displayed the formation of l i pid droplets inside the cells 21 days after adi pogenic induction. For the control group, the results of all the staining assays were negative except the ALP staining presenting with sl ight positive result. Conclusion SMSCs can be isolated from knee joint of swine and proliferate and differentiate into osteogenic, adi pogenic and chondrogenic cells in vitro. SMSCs may be a promising source of seed cells for tissue engineering.
Objective To explore the technique of arthroscopic treatment of local ized pigmented villonodular synovitis of the knee and to evaluate its cl inical results. Methods From February to December 2006, 22 cases of local ized pigmented villonodular synovitis of the knee were treated by arthroscopic excision of the focus and partial synovectomy. There were 8 males and 14 females, with an average age of 24 years old (16 to 35 years old). Eight patients had a trauma history, the others had no obvious inducement. The disease course was from 1 month to 30 months with an average of 10 months. The Lysholm score was 68.5 ± 8.2, and the International Knee Documentation Committee (IKDC) score was 72.7 ± 5.2 before operation. MRI showed that 20 knees had definite focuses and 2 had no ones. In all the cases, routine arthroscopic approach combined with assistant approach adjacent to the focus was used. Results All the patients were diagnosed as having local ized pigmented villonodular synovitis of the knee by pathological examination. The incisions healed at stage I. No compl ications occurred after operation. All patients were followed up 18-28 months (average 22 months). The angle of genuflex was less than 90° in 2 cases after 6 weeks, and the range of motion of the knee was recovery after manipulation release. At last followup, MRI showed no recurrence was found in 19 patients. The IKDC score was 92.8 ± 2.4, and the Lysholm score was 94.5 ± 3.5, respectively, indicating significant differences when compered with before operation (P lt; 0.01). Conclusion Local ized pigmented villonodular synovitis of the knee can be effectively treated by arthroscopic excision of the focus along with a rim of surrounding healthy synovium with most minimal invasive and best knee function.
Objective To study the effects of the periosteum，synovium andcartilage tissues on the gene expressions of proteoglycan, collagen Ⅱ, andnuclear factor kappa B (NF-κB) and to investigate the different effects of these tissues on cartilage regeneration. Methods In 20 New Zealand white rabbits, 20 cartilage explants were taken from the knee joints in each rabbit, the sizeof which was 4 mm×4 mm×4 mm. All the cartilages were divided into the following 4 groups and cultured for 7 days: Group A, with 5 pieces (2 mm×2 mm) of the synovium of theknee joints in each dish; Group B, with 5 pieces (2 mm×2 mm) of the periosteum ineach dish; Group C, with 5 pieces (2 mm×2 mm×2 mm) of the cartilage in each dish; and Group D, with no addition of other tissues (control group). RNA was extracted from the cells of the cartilage explants (4 mm×4 mm×4 mm) in all the dishes. Thegene expressions of proteoglycan, collagen Ⅱ and NF-κB were defected by a reversetranscription-polymerase chain reaction (RT-PCR).Results In group A, the gene expression of proteoglycan was significantly decreased. The relative density of this gene expression had a significant difference when compared with that in group D (1.09±0.21 vs. 1.25±0.25, Plt;0.05); the gene expressions of collagen Ⅱ and NF-κB were also decreased, but they had no significant differences when compared with those in group D (Pgt;0.05). In groupB, the gene expressions of proteoglycan, collagen Ⅱ, and NF-κB were significantly increased. The relative densities of these gene expressions were 1.60±0.26, 1.57±0.24, and 4.20±2.22, respectively, which had significant differences when compared with those in group D (Plt;0.05). In group C, the relative density of the gene expression of collagen Ⅱ was 1.43±0.28, which had a significant difference when compared with that in group D (Plt;0.05), but therelative densities of the gene expressions of proteoglycan and NF-κB had no significant differences when compared with those in group D (Pgt;0.05). Conclusion The results indicate that the periosteum can up-regulate the gene expressions of proteoglycan, collagen Ⅱ and NF-κB. The NF-κB is likely to be an important nuclear transcription factor related to cartilage regeneration. The results also suggest that the periosteum maybe better in facilitating the cartilage repair and regeneration in clinical practice.