Hee-Soo Kyung

Background: This study aims to evaluate the clinical and arthroscopic results of medial meniscus posterior tear (MMPRT) repair using an all-inside meniscal repair device combined with high tibial osteotomy (HTO), compared with HTO performed without MMPRT repair. Methods: Overall, 38 patients who underwent open-wedge HTO using a locking plate were examined. Preoperative magnetic resonance imaging (MRI) and intraoperative arthroscopic evaluation confirmed MMPRT. During HTO, meniscal repair with an all-inside meniscal repair device was performed in 24 cases, while partial meniscectomy of the movable torn meniscus was conducted in 14 cases with MMPRT. At 2 years postoperatively, arthroscopic meniscus healing, clinical results, and radiologic results were compared. Results: Arthroscopic evaluation showed improvement in the condition of the medial compartment cartilage after HTO in both groups. In the repair group, meniscus root healing was observed in 22 of 24 cases (92%), whereas in the no-repair group, healing was observed in 10 of 14 cases (71%); however, the difference was not statistically significant. Medial joint space increased in both groups (from 2.4 to 3.2 mm and 2.6 to 3.2 mm, respectively), and clinical scores also improved after HTO, with no significant differences between groups. Osteoarthritis progression, as assessed by K-L grade, progressed after HTO in both groups, without significant differences. Conclusions: No significant differences were observed in arthroscopic, clinical, or radiographic results after HTO, regardless of MMPRT repair with the all-inside meniscal suture device. These findings suggest that MMPRT repair with the all-inside meniscal repair device may not be necessary during HTO.

Background: Lateral hinge fracture (LHF) is a known complication of open-wedge high tibial osteotomy (OWHTO), potentially resulting in postoperative instability, displacement, loss of correction, malunion, and non-union. This study tested the hypothesis that patients who develop LHF after OWHTO can achieve clinical outcomes comparable to those without LHF, without requiring additional surgical intervention. Methods: This retrospective study included 96 patients who underwent OWHTO with a locking plate between 2019 and 2021. Postoperative radiographs and computed tomography (CT) scans identified LHF in 24 patients (25%). Lower limb alignment was assessed using whole-leg standing radiographs at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) score, Knee Society Knee Score (KS), and Function Score (FS). Results: In patients with LHF, the mechanical axis was 59.0 ± 7.4% at 6 weeks, 57.7 ± 7.8% at 3 months, 55.9 ± 9.5% at 6 months, and 53.9 ± 12.2% at 12 months. In patients without LHF, the corresponding values were 58.5 ± 6.1%, 57.8 ± 6.7%, 56.7 ± 7.0%, and 55.6 ± 7.4%, respectively. Although the mechanical axis decreased by 5.2% in the LHF group and 2.9% in the non-LHF group by 12 months, the difference was not statistically significant ( p = .219). Similarly, the longitudinal change in alignment did not differ significantly between groups ( p = .743). Postoperative clinical scores improved in all patients, with no significant differences between groups regardless of LHF status. Conclusion: Patients who experienced LHF following OWHTO demonstrated comparable clinical outcomes and alignment correction to those without LHF, suggesting that LHF does not adversely affect postoperative results.

Background: Bone marrow aspiration concentrate (BMAC) has garnered increasing interest due to its potential for healing musculoskeletal injuries. While the iliac crest remains a common harvest site, the aspiration technique’s efficacy in offering the highest yield and prevalence of mesenchymal stem cells (MSCs) is controversial. This study aimed to compare two different techniques of bone marrow aspiration over the anterior iliac crest from a single level versus multiple levels. Methods: Anterior iliac crests were selected in seven adult patients (aged between 31 and 59 years old). Aspiration was achieved using an 11-gauge needle (length: 100 mm; diameter: 2.3 mm) specifically manufactured for bone marrow collection (BD, Becton, Franklin Lakes, NJ, USA) connected to a 10 mL syringe. On one side, 4cc of bone marrow was aspirated at a single level to a depth of 7 cm without changing the needle direction. On the other side, over the same portion of the iliac crest, 1 cc of bone marrow was obtained from multiple levels of different depths during needle retrieval, maintaining a distance of 1 cm and changing the tip direction. The samples were blindly sent to the laboratory without indicating whether they came from an single level or multiple levels. Fluorescence-activated cell sorting (FACS) and osteoblast differentiation were analyzed and compared. Results: In the FACS analysis, the single level resulted in a higher population of MSCs that were positive for CD105, CD73, and CD90 and negative for CD34, compared to the multiple-level method. In the process of osteoblast differentiation, it was observed that MSCs exhibited more advanced features of enhanced osteoblastic abilities in the single-level method rather than the multiple-level method. Conclusions: A single-level aspiration technique at the anterior iliac crest may produce a high-quality bone marrow aspirate. This technique may help obtain specific populations of MSCs with the desired characteristics for use in regenerative therapies for musculoskeletal injuries.

Background: Bone marrow aspiration concentrate (BMAC) has garnered increasing interest due to its potential for healing musculoskeletal injuries. While the iliac crest remains a common harvest site, the aspiration technique’s efficacy in offering the highest yield and prevalence of mesen-chymal stem cells (MSCs) is controversial. This study aimed to compare two different techniques of bone marrow aspiration over the anterior iliac crest from a single level (SL) versus multiple level (ML). Methods: Anterior iliac crests were selected in 9 adult patients (aged between 31 and 59 years old). Aspiration was achieved using an 11-gauge needle (length: 100 mm; diameter: 2.3 mm) specifically manufactured for bone marrow collection (BD, Becton, US) connected to a 10-mL syringe. On one side, 4cc of bone marrow was aspirated at an SL to a depth of 7cm without changing the needle direction. On the other side, over the same portion of the iliac crest, 1 cc of bone marrow was obtained from ML of different depths during needle retrieval, maintaining a distance of 1cm and changing the tip direction. The samples were blindly sent to the laboratory without indicating whether they came from an SL or ML. Fluorescence-activated cell sorting (FACS) and osteoblast differentiation were analyzed and compared. Results: In the FACS analysis, the SL resulted in a higher population of MSCs that were positive for CD105, CD73, and CD90 and negative for CD34, compared to the ML method. In the process of osteoblast differentiation, it was observed that MSCs exhibited more advanced features of en-hanced osteoblastic abilities in the SL method rather than the ML method. Conclusion: An SL aspiration technique at the anterior iliac crest may produce a high-quality bone marrow aspirate. This technique may help obtain specific populations of MSCs with the desired characteristics for use in regenerative therapies for musculoskeletal injuries.

Purpose: The aim of this study is to evaluate the results of high tibial osteotomy (HTO) in patients with bone marrow edema (BME) and assess the effect of factors on the subsequent results. Methods: A total of 138 patients who underwent medial open-wedge HTO using locking plate were included in this study. BME was observed in 108 patients using preoperative magnetic resonance imaging. Clinical results were evaluated before HTO and postoperatively at 12 months. Moreover, we evaluated the factors affecting the clinical results. Results: The clinical scores were all significantly improved regardless of the presence of BME. There were no differences in improvement of clinical scores between patients with BME and without BME. Patients with BME showed higher postoperative Western Ontario and McMaster Universities Arthritis Index (WOMAC) stiffness scores than patients without BME. Furthermore, patients with BME on both the femur and tibia showed lower Knee Society function scores than patients with BME on either the femur or the tibia. Patients with large BME lesions exhibited a lower Hospital for Special Surgery score and WOMAC pain scores, postoperatively. In patients with BME, patients with undercorrection showed significantly lower improvement in WOMAC pain scores compared with patients with acceptable correction. Conclusions: The clinical improvement after HTO in patients with varus and medial osteoarthritis was not different regardless of the presence or absence of BME. However, accurate alignment should be considered essential for achieving better clinical outcomes in patients with preoperative BME.

TGF-β signaling is a vital regulator for maintaining articular cartilage homeostasis. Runx transcription factors, downstream targets of TGF-β signaling, have been studied in the context of osteoarthritis (OA). Although Runx partner core binding factor β (Cbfβ) is known to play a pivotal role in chondrocyte and osteoblast differentiation, the role of Cbfβ in maintaining articular cartilage integrity remains obscure. This study investigated Cbfβ as a novel anabolic modulator of TGF-β signaling and determined its role in articular cartilage homeostasis. Cbfβ significantly decreased in aged mouse articular cartilage and human OA cartilage. Articular chondrocyte-specific Cbfb-deficient mice (Cbfb^△ac/△ac) exhibited early cartilage degeneration at 20 weeks of age and developed OA at 12 months. Cbfb^△ac/△ac mice showed enhanced OA progression under the surgically induced OA model in mice. Mechanistically, forced expression of Cbfβ rescued Type II collagen (Col2α1) and Runx1 expression in Cbfβ-deficient chondrocytes. TGF-β1-mediated Col2α1 expression failed despite the p-Smad3 activation under TGF-β1 treatment in Cbfβ-deficient chondrocytes. Cbfβ protected Runx1 from proteasomal degradation through Cbfβ/Runx1 complex formation. These results indicate that Cbfβ is a novel anabolic regulator for cartilage homeostasis, suggesting that Cbfβ could protect OA development by maintaining the integrity of the TGF-β signaling pathway in articular cartilage.

TGF-ꞵ signaling is a vital regulator for maintaining articular cartilage homeostasis. Runx transcription factors, downstream targets of TGF-ꞵ signaling, have been studied in the context of osteoarthritis (OA). Although Runx partner core binding factor β (Cbfβ) is known to play a pivotal role in chondrocyte and osteoblast differentiation, the role of Cbfβ in maintaining articular cartilage remains obscure. This study investigated Cbfβ as a novel anabolic modulator of TGF-ꞵsignaling and determined its role in articular cartilage homeostasis. Cbfβ significantly decreased in aged mouse articular cartilage and human OA cartilage. Articular chondrocyte-specific Cbfb-deficient mice (Cbfb△ac/△ac) exhibited early cartilage degeneration at 20 weeks old and developed OA at 12 months old. Cbfb△ac/△ac mice showed enhanced OA progression under the surgical-induced mice OA model. Mechanistically, forced expression of Cbfβ rescued Col2α1 and Runx1 expression in Cbfβ-deficient chondrocytes. TGF-ꞵ1-mediated Col2α1 expression failed despite the pSmad3 activation under TGF-ꞵ1 treatment in Cbfβ-deficient chondrocytes. Cbfβ protected Runx1 from proteasomal degradation through Cbfβ/Runx1 complex formation. These results indicate that Cbfβ is a novel anabolic regulator for cartilage homeostasis, suggesting that Cbfβ could protect OA development by maintaining the integrity of the TGF-ꞵ1 signaling pathway in articular cartilage.

정승호, et al. J Korean Orthop Assoc. 2023 Aug;58(4):348-354. https://doi.org/10.4055/jkoa.2023.58.4.348

Kim HJ, et al. Clin Orthop Surg. 2022 Jun;14:e32. https://doi.org/10.4055/cios21093