| 1. |
- Dou, Zelong, et al.
(författare)
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Optimized protocols for in situ hybridization, immunohistochemistry, and immunofluorescence on skeletal tissue
- 2021
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Ingår i: Acta Histochemica. - : Elsevier. - 0065-1281 .- 1618-0372. ; 123:5
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Tidskriftsartikel (refereegranskat)abstract
- Assessment of gene and protein expression in tissue sections is instrumental in medical research. However, this is often challenging to perform on skeletal tissues that require prolonged decalcification and have poor adhesion to slides. In this study, we optimized selected steps of in situ hybridization (ISH), immunohistochemistry (IHC), and immunofluorescence (IF) for formalin fixed and decalcified skeletal tissues. Sections from distal femur of 6-, 8- and 14-week-old rats injected with BrdU with or without a hemizygous eGFP transgene expressed under the control of a ubiquitous promotor were used. We report that proteinase K digestion is critical for the sensitivity of ISH, as concentrations that were too strong and too mild both resulted in loss of signal. In addition, intensified RNase A digestion removed nonspecific riboprobe-mRNA hybrids. Furthermore, enzymatic antigen retrieval using proteinase K provided more consistent results in IHC and can therefore be a useful alternative to heat induced epitope retrieval (HIER) for skeletal tissues where such treatment often damages the morphology. A mild proteinase K digestion also improved IF detection of GFP and worked well for double labeling IF of GFP and osteocalcin on frozen sections of formalin fixed and decalcified rat bones while maintaining morphology. In summary, this study provides strategies to improve protocols for enzymatic digestion in ISH, IHC, and IF for skeletal tissues and also demonstrates the importance of careful optimization and validation with the use of these techniques.
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| 2. |
- Dou, Zelong, et al.
(författare)
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Rat perichondrium transplanted to articular cartilage defects forms articular-like, hyaline cartilage
- 2021
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Ingår i: Bone. - : Elsevier. - 8756-3282 .- 1873-2763. ; 151
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Perichondrium autotransplants have been used to reconstruct articular surfaces destroyed by infection or trauma. However, the role of the transplanted perichondrium in the healing of resurfaced joints have not been investigated.DESIGN: Perichondrial and periosteal tissues were harvested from rats hemizygous for a ubiquitously expressed enhanced green fluorescent protein (EGFP) transgene and transplanted into full-thickness articular cartilage defects at the trochlear groove of distal femur in wild-type littermates. As an additional control, cartilage defects were left without a transplant (no transplant control). Distal femurs were collected 3, 14, 56, 112 days after surgery.RESULTS: Tracing of transplanted cells showed that both perichondrium and periosteum transplant-derived cells made up the large majority of the cells in the regenerated joint surfaces. Perichondrium transplants contained SOX9 positive cells and with time differentiated into a hyaline cartilage that expanded and filled out the defects with Col2a1-positive and Col1a1-negative chondrocytes and a matrix rich in proteoglycans. At later timepoints the cartilaginous perichondrium transplants were actively remodeled into bone at the transplant-bone interface and at post-surgery day 112 EGFP-positive perichondrium cells at the articular surface were positive for Prg4. Periosteum transplants initially lacked SOX9 expression and despite a transient increase in SOX9 expression and chondrogenic differentiation, remained Col1a1 positive, and were continuously thinning as periosteum-derived cells were incorporated into the subchondral compartment.CONCLUSIONS: Perichondrium and periosteum transplanted to articular cartilage defects did not just stimulate regeneration but were themselves transformed into cartilaginous articular surfaces. Perichondrium transplants developed into an articular-like, hyaline cartilage, whereas periosteum transplants appeared to produce a less resilient fibro-cartilage.
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| 3. |
- Jann, David, et al.
(författare)
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Interosseous-lumbrical adhesions - a rare condition? : A series of five cases
- 2021
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Taylor & Francis. - 2000-656X .- 2000-6764. ; 55:6, s. 368-372
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Tidskriftsartikel (refereegranskat)abstract
- Adhesions between the interosseous and lumbrical muscles involving the deep transverse metacarpal ligament (dTML) can be a cause of chronic pain and reduced range of motion. New reports on this condition are rare. We identified five patients experiencing pain, swelling and decreased range of motion in the metacarpophalangeal (MCP) joints during manual load. The condition was caused by a direct trauma. After not responding to conservative treatment, patients underwent surgery. Time between trauma and surgery was on average 16 months and the mean postoperative follow-up was 8 months. The lumbrical-interosseus junction was exposed by volar or dorsal incision, adhesions were widely released and the distal third of the dTML was resected. This resulted in normal passive excursion of the muscles and the tendon junction. At the mean follow-up time 8.2 months (3-18) after surgery, all patients were pain-free and had gained near normal range of motion in the MCP joints. Interosseous-lumbrical adhesions may be more common than reflected by the literature. Hand surgeons should keep this condition in mind in cases with chronic inter-metacarpal pain after trauma or infection. Surgical exploration is relatively straight forward and tends to lead to gratifying results. Level of Evidence: IV (therapeutic)
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| 4. |
- Muder, Daniel
(författare)
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Finger Joint Reconstruction with Rib Perichondrium
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Difficulties in repairing and reconstructing articular cartilage damaged by trauma or disease remain unsolved and are one of the major challenges confronting orthopedic and hand surgeons in their clinical work. Relevant research has not adequately described the long-term clinical results, nor has it made a direct comparison to implant surgery after finger joint reconstruction with rib perichondrium. The role of the transplanted perichondrium and the resulting tissue's quality after transplantation have not been detailed with methods investigating gene and protein expression. Therefore, the overall aim of this thesis was to investigate the role and suitability of perichondrium transplants for finger joint reconstruction of cartilage defects and its potential for the field of tissue engineering.Study I is a longitudinal cohort study to evaluate the long-term clinical outcome of finger joint reconstruction with perichondrium transplants. The study cohort included all 11 traceable and alive patients after a median follow-up of 37 (range 34-41) years. The clinical results regarding range of motion, grip strength, pain and scores on the disability of the arm, shoulder, and hand (DASH) were good to excellent without any donor site morbidity. Study II is a retrospective cohort study evaluating 163 joints in 124 patients, divided into 138 surface replacement (SR) implants in 102 patients and 25 perichondrium transplants in 22 patients. The median follow-up was 6 years for the SR group and 26 years for the transplant group. Revision rates and 10-year survival favored patients treated with perichondrium transplants, but below the threshold of statistical significance. Study III is an in vitro study to develop highly sensitive and specific protocols for immunohistochemistry, immunofluorescence, and in situ hybridization on bone tissue. The protocol modifications in this study represent critical steps that can empower highly sensitive and specific mRNA and protein localization in formalin-fixed and decalcified skeletal tissues needed for study IV. In Study IV, an experimental animal study, perichondrium transplants from enhanced green fluorescent protein (EGFP) positive rats were transplanted to wild type recipients. The reconstructed cartilage's cellular contribution and quality were assessed by immunohistochemistry, immunofluorescence, confocal microscopy and in situ hybridization at different times after surgery. The study showed that perichondrium transplants differentiated into a cartilage structure that filled out the defects with chondrocytes expressing elevated levels of Col2a1 and producing a matrix rich in proteoglycans. Study V is a case series of four patients with a mean age of 40 (range 37-47) years with osteoarthritis in the distal radioulnar joint. Our retrospective clinical follow-up is presented and discussed in relation to more traditional techniques. Pain, range of motion, strength, and patient-rated outcome measures improved and were stable at the mid-term follow-up 7.5 years after surgery.In conclusion, perichondrium seems to be a suitable tissue for joint reconstruction and tissue engineering.
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| 5. |
- Muder, Daniel, et al.
(författare)
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Interosseous-lumbrical adhesions secondary to an infection : a case report
- 2014
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Ingår i: Journal of Medical Case Reports. - : Springer Science and Business Media LLC. - 1752-1947. ; 8, s. 301-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Adhesions between the tendons to the interosseous muscles, the lumbrical muscles and occasionally the deep transverse metacarpal ligament can be symptomatic and cause chronic discomfort in the distal part of the hand. Reports about the condition are rare and the causal factors in previous publications are in principle limited to crush injuries and contusion from a direct blow to the hand. We present a case with typical clinic findings secondary to an infection after a cat bite. To the best of our knowledge symptomatic interosseus-lumbrical adhesions caused by an infection has never been described previously.CASE PRESENTATION: Our case report describes a 25-year-old Caucasian woman with chronic pain and swelling between her second and third metacarpal heads. Symptoms occurred especially under stress and developed secondary to an infection after a cat bite. Surgical exploration revealed localized adhesions between her second lumbrical muscle, her first palmar interosseous muscle and her deep transverse metacarpal ligament. The symptoms were completely relieved by surgical release of the adhesions, partial resection of the deep transverse metacarpal ligament and immediate postoperative physiotherapy.CONCLUSIONS: Physicians involved in hand surgery should be aware of the condition and look for it in patients complaining about distal intermetacarpal pain. The major causal factors for developing symptomatic interosseous-lumbrical adhesions are crush injuries or contusion to the distal part of the hand but it may also occur after an infection.
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| 6. |
- Muder, Daniel, et al.
(författare)
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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
- 2020
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Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 21:1
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Tidskriftsartikel (refereegranskat)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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| 7. |
- Muder, Daniel, et al.
(författare)
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Reconstruction of the distal radioulnar joint with rib perichondrium - midterm follow-up
- 2022
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Nature. - 1471-2474. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reconstruction of an osteoarthritic distal radioulnar joint (DRUJ) in patients with high physical demands and a long lifetime expectancy is challenging. A variety of methods like implant surgery and salvage procedures as partial or total ulnar head resection and the Sauve-Kapandji procedure are reasonable options in the elderly patient but not in young individuals since it often compromises manual power and stability and may cause impingement problems. Reconstruction of the DRUJ with rib perichondrium is a new treatment option with promising short-term outcome. The aim the present study was to investigate if the outcome is consistent over time.Methods: Four female patients with a mean age of 40.5 years suffered severe unilateral osteoarthritis in the DRUJ. They underwent reconstruction of the joint with rib perichondrium transplants. Preoperatively, mean pain under manual load was 8.5 (range 7-10) and 4.2 (range 2-5) at rest, using the visual analogue scale (VAS). Range of motion (ROM) in forearm rotation was on average 118 degrees and grip strength was 86% in comparison to the contralateral hand. The outcome was assessed at a clinical follow-up in 2016, measuring ROM, grip-strength, pain at rest and under manual load and DASH-score. Radiological examination was performed. An additional follow-up by letter was performed in 2021 using a patient-reported-outcome survey (PROS). The patients were asked to grade the ROM and grip-strength as changed or unchanged in comparison to the clinical follow-up in 2016.Results: At clinical follow-up at a mean of 3.1 years (range 1-5) after surgery, pain level had decreased to VAS 1.5 (0-5) under load and all patients were pain free at rest. Forearm rotation was on average 156 degrees (range 100-180) and grip strength was 97% of the unoperated hand. The mean DASH-score was 14.4 (0-45). An additional follow-up by letter was conducted at a mean of 7.5 years (5.5-9.5) after surgery. ROM and grip strength were reported as unchanged by all patients in relation to the previous clinical follow-up. No additional surgery or complications were reported.Conclusion: Reconstruction of the osteoarthritic DRU-joint with rib perichondrium transplantation can provide good clinical outcome with perseverance over time.
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| 8. |
- Muder, Daniel, et al.
(författare)
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Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints : a retrospective cohort study with a mean follow-up time of 6 respectively 26years
- 2020
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Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints.MethodsWe evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint.ResultsThe median follow-up time was 6years (0-21) for the SR implants and 26years (1-37) for the perichondrium transplants. Median age at index surgery was 64years (24-82) for SR implants and 45years (18-61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4-100.0) than in the SR implant group (75%; CI 53.8-96.1), but not statistically significantly so (p=0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55-100) than in the SR implant group (74.7%; CI 66.6-82.7), but below the threshold of statistical significance (p=0.8).ConclusionIn conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants.Level of evidenceIII (Therapeutic).
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| 9. |
- Peyronson, Fredrik, et al.
(författare)
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Nonoperative Versus Operative Treatment for Displaced Finger Metacarpal Shaft Fractures : A Prospective, Noninferiority, Randomized Controlled Trial
- 2023
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : Wolters Kluwer. - 0021-9355 .- 1535-1386. ; 105:2, s. 98-106
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Finger metacarpal fractures represent up to 31% of all hand fractures, and most can be treated nonoperatively. Whether operative treatment is superior to nonoperative treatment for oblique and/or spiral finger metacarpal shaft fractures (MSFs) is unknown.METHODS: Forty-two patients with displaced oblique and/or spiral finger MSFs were randomized to either nonoperative treatment with unrestricted mobilization or operative treatment with screw fixation. The primary outcome was grip strength in the injured hand compared with the uninjured hand at the 1-year follow-up. Secondary outcomes were the Disabilities of the Arm, Shoulder and Hand score, range of motion, metacarpal shortening, complications, sick leave duration, patient satisfaction, and costs.RESULTS: All patients attended the 1-year follow-up. Mean grip strength relative to that in the contralateral hand was 104% (95% confidence interval [CI], 89% to 120%) in the nonoperative group and 96% (95% CI, 89% to 103%) in the operative group (p = 0.34). Mean metacarpal shortening was 5.3 mm (95% CI, 4.2 to 6.4 mm) in the nonoperative group and 2.3 mm (95% CI, 0.8 to 3.9 mm) in the operative group. In the nonoperative group, 1 minor complication was observed; in the operative group, there were 4 minor complications and 3 reoperations. The costs were estimated at 1,347 U.S. dollars (USD) for nonoperative treatment compared with 3,834 USD for operative treatment. Sick leave duration was significantly shorter in the nonoperative group (12 days [95% CI, 5 to 21 days] versus 35 days [95% CI, 20 to 54 days]) (p = 0.008).CONCLUSIONS: When treated with unrestricted mobilization, patients with a single displaced spiral and/or oblique finger MSF have outcomes comparable to those treated operatively, despite metacarpal shortening. Costs are substantially higher (2.8 times) and sick leave is significantly higher in the operative group.LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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| 10. |
- Schliemann, Benedikt, et al.
(författare)
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Locked posterior shoulder dislocation : treatment options and clinical outcomes.
- 2011
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - : Springer Science and Business Media LLC. - 0936-8051 .- 1434-3916. ; 131:8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Posterior dislocation of the shoulder is a rare injury and often misdiagnosed during the initial presentation to a physician. Misdiagnosis is due to a lack of clear clinical signs compared to anterior dislocation and inappropriate radiographs. In contrast to anterior dislocations, the humeral head defect accounts for recurrent instability. Depending on the size of the defect and the duration of dislocation, different treatment options include elevation of the defect, bone grafting, McLaughlin procedure, rotation osteotomy or arthroplasty.METHODS: We reviewed 35 patients who presented to our institution with a locked posterior dislocation of the shoulder between January 1999 and August 2009. In 6 patients, the shoulder remained stable after closed reduction, so the treatment was conservative; 29 patients underwent surgery.RESULTS: The mean follow-up was 55 months (range 11-132 months). The interval between trauma and the diagnosis of posterior shoulder dislocation was 66 days (min. 0, max. 365). Patients treated conservatively achieved a Constant Score of 85 points; patients who underwent operative treatment had a slightly worse outcome with an average Constant Score of 79 points. There was a high correlation between the time to the correct diagnosis and the outcome.CONCLUSION: Although locked posterior shoulder dislocation is uncommon and often initially misdiagnosed, satisfying results can be achieved by different surgical treatment options. Early diagnosis by detailed clinical examination and sufficient radiographic evaluation with true anterior-posterior and axillary views is essential to improve clinical results. Levl of evidence: IV.
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