In two cases of partial closure of an epiphysial plate causing angular deformity, one of a finger and one of the lower end of a femur, the deformities were corrected by growth after resection of a small peripheral bone bridge and its replacement with a free transplant of fat. This procedure has a firm basis on experimental work. Thus, when part of a growth plate in the rabbit is destroyed but the formation of a bone bridge uniting epiphysis and metaphysis is prevented, the destroyed part is replaced by regeneration of cartilage from the adjacent parts of the plate. Moreover, it has been proved in rabbits that when a bone bridge is induced and later resected and replaced with fat, recurrence of the bridge can be prevented and subsequent growth may correct the deformity

1. A comparative study has been made of the major transplantation antigens present on the chondrocyte isolated from articular cartilage of the sheep and lymphocytes from the cartilage donors. 2. It has been shown that the chondrocyte possesses antigens of the major histocompatibility system in common with the lymphocyte. 3. In order to demonstrate the similarity between the antigen structure of the chondrocyte and the lymphocyte it was necessary to treat cartilage cells with papain after isolation in order to remove the matrix more completely. Failure to do this led to an apparent deficit of antigens on the chondrocyte. 4. It was found that lysis of cells by antibodies was slower when chondrocytes were the target cells than when lymphocytes were used. It is concluded that this is due to a protective role of remaining cartilage matrix

1. The epiphyses of the metatarsal heads of 250-gramme rabbits were separated at the zone of cell columns, stripped of perichondrium, labelled with tritiated thymidine and transplanted into the back muscles of the same animals. 2. Endochondral ossification started in the grafts at four days, was well established by seven days and progressed until fourteen days, the end of the study. 3. Progressive passage of the label down the zone of cell columns and into the hypertrophic zone was observed. 4. The tritiated-. 3. H thymidine label had disappeared from the cartilage cells by ten days. No labelling was observed in the bone cells at any stage. 5. It was not possible to demonstrate from the experiment that growth plate chondrocytes are precursors of osteoblasts in the process of endochondral ossification in rabbits

1. A series of experiments on adult rabbits was carried out in which a tendon was transplanted and embedded in a bony tunnel and traversed a joint after the manner of a tenodesis. 2. Histological observations were made on the reaction of surrounding bone and tendon at intervals over a period of 307 days. 3. The findings suggest that the buried tendon undergoes a process of progressive degeneration, and that host cells issuing from the adjacent bone marrow infiltrate and ultimately replace it by new tendon tissue. 4. The invading cells are believed to be derived, as a result of the provocative stimuli provided by the experiment, from primitive reticular cells of the haemopoietic tissue. 5. The tunnelled bone undergoes considerable remodelling and associated with this is the presence of a considerable number of osteoblasts and osteoclasts

Aims

The French registry for complex bone and joint infections (C-BJIs) was created in 2012 in order to facilitate a homogeneous management of patients presented for multidisciplinary advice in referral centres for C-BJI, to monitor their activity and to produce epidemiological data. We aimed here to present the genesis and characteristics of this national registry and provide the analysis of its data quality.

1. Attention is drawn to that type of rigid congenital flat foot in which the talus lies vertically instead of horizontally. 2. This deformity is rare, but if not treated successfully leads to an ugly, painful foot in adolescence. 3. The experience of five patients forms the basis of the present preliminary account. One adolescent and two young children under the age of five were treated unsuccessfully by both conservative and operative measures. More recently in two children with bilateral deformity open operation has been successful in restoring the shape of the foot. 4. The operation is essentially a reduction of a subluxation at the talo-navicular and subtalar joints. It entails freeing the head of the talus sufficiently to allow it to be lifted dorsally and laterally. The talus is then anchored in position by transplanting the distal end of the peroneus brevis tendon through the neck of the bone

MicroRNAs (miRNAs) are a class of small non-coding RNAs that have emerged as potential predictive, prognostic, and therapeutic biomarkers, relevant to many pathophysiological conditions including limb immobilization, osteoarthritis, sarcopenia, and cachexia. Impaired musculoskeletal homeostasis leads to distinct muscle atrophies. Understanding miRNA involvement in the molecular mechanisms underpinning conditions such as muscle wasting may be critical to developing new strategies to improve patient management. MicroRNAs are powerful post-transcriptional regulators of gene expression in muscle and, importantly, are also detectable in the circulation. MicroRNAs are established modulators of muscle satellite stem cell activation, proliferation, and differentiation, however, there have been limited human studies that investigate miRNAs in muscle wasting. This narrative review summarizes the current knowledge as to the role of miRNAs in the skeletal muscle differentiation and atrophy, synthesizing the findings of published data.

Cite this article: Bone Joint Res 2020;9(11):798–807.

We have reviewed 11 patients with congenital absence of the thumb, treated by pollicisation of the index finger, after follow-up for 20 to 38 years. Seven of the hands also had an associated radial club-hand deformity. Function as assessed by the Percival score was excellent in six, good in three, fair in two and poor in four; three of the poor results were in patients with radial club hand. Ten of the 15 transfers were used as normal thumbs, but in five hands function required trick movements. Of the seven unilateral cases, two transplants were used as the dominant hand, and in another two thumb strength was more than 50% of that on the opposite side. For patients with isolated congenital absence of the thumb, pollicisation of the index finger gives good functional and cosmetic results which are maintained. The results are less reliable for those with radial club hand

Aims

The purpose of our study was to determine whether mesenchymal stem cells (MSCs) are an effective and safe therapeutic agent for the treatment of knee osteoarthritis (OA), owing to their cartilage regeneration potential.

Aims

To describe the incidence of adverse clinical outcomes related to COVID-19 infection following corticosteroid injections (CSI) during the COVID-19 pandemic. To describe the incidence of positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) testing, positive SARS-COV2 IgG antibody testing or positive imaging findings following CSI at our institution during the COVID-19 pandemic.

Treatment with corticosteroids is a risk factor for non-traumatic avascular necrosis of the femoral head, but the pathological mechanism is poorly understood. Short-term treatment with high doses of methylprednisolone is used in severe neurotrauma and after kidney and heart transplantation. We investigated the effect of such treatment on the pattern of perfusion of the femoral head and of bone in general in the pig. We allocated 15 immature pigs to treatment with high-dose methylprednisolone (20 mg/kg per day intramuscularly for three days, followed by 10 mg/kg intramuscularly for a further 11 days) and 15 to a control group. Perfusion of the systematically subdivided femoral head, proximal femur, acetabulum, humerus, and soft tissues was determined by the microsphere technique. Blood flow in bone was severely reduced in the steroid-treated group. The reduction of flow affected all the segments and the entire epiphysis of the femoral head. No changes in flow were found in non-osseous tissue. Short-term treatment with high-dose methylprednisolone causes reduction of osseous blood flow which may be the pathogenetic factor in the early stage of steroid-induced osteonecrosis

We used MRI to examine the hips of 32 asymptomatic patients at 9 to 21 months after renal transplantation covered by high-dose corticosteroids. Five hips in three patients showed changes which indicate avascular necrosis, although radiographs, CT scans and isotope scans were normal. These patients had repeat MRI scans after another two years and three years. One patient with bilateral MRI changes developed symptoms and abnormal radiographs and CT and isotope scans in one hip nine months after the abnormal MRI. Intraosseous pressure was found to be raised in both hips, and core biopsies revealed necrotic bone on both sides. The other three hips have remained asymptomatic with unchanged MRI appearances three years after the initial MRI. It seems that idiopathic avascular necrosis does not always progress to bone collapse in the medium term

We performed eight osteochondral autologous transplantations from the knee joint to the shoulder. All patients (six men, two women; mean age 43.1 years) were documented prospectively. In each patient the stage of the osteochondral lesion was Outerbridge grade IV with a mean size of the affected area of 150 mm. 2. All patients were assessed by using the Constant score for the shoulder and the Lysholm score for the knee. Standard radiographs, magnetic resonance imaging and second-look arthroscopy were used to assess the presence of glenohumeral osteoarthritis and the integrity of the grafts. After a mean of 32.6 months (8 to 47), the mean Constant score increased significantly. Magnetic resonance imaging revealed good osseointegration of the osteochondral plugs and congruent articular cartilage at the transplantation site in all but one patient. Second-look arthroscopy performed in two cases revealed a macroscopically good integration of the autograft with an intact articular surface. Osteochondral autologous transplantation in the shoulder appears to offer good clinical results for treating full-thickness osteochondral lesions of the glenohumeral joint. However, our study suggests that the development of osteoarthritis and the progression of pre-existing osteoarthritic changes cannot be altered by this technique

Allografts of intact cartilage, isolated chondrocytes and cultured chondrocytes taken from the epiphysial growth-plate and from the articular surface of immature rabbits were inserted into full thickness defects in the tibial articular surface of 160 mature rabbits. In the contralateral knees, which were used as controls, similar defects were made but no grafts were inserted. Grafts were followed up for periods of up to one year after transplantation. Both intact articular and intact growth-plate grafts produced significantly better repair than that seen in control ungrafted defects in normal joints (P less than 0.01 and P less than 0.05 respectively) and in arthritic joints (P less than 0.01). Cultured chondrocytes cut to a precise fit also produced significantly better repair than ungrafted defects in arthritic joints (P less than 0.05)

Allografts of immature joint cartilage from the knees of lambs were transferred heterotopically into an intramuscular site in animals which had been presensitised by two sets of skin grafts from the same donors. All of these grafts were found to be largely destroyed by the immune response as early as four weeks after transfer. Similar grafts transferred orthotopically into the knees of the recipients, on the other hand, were found to be thriving even after twelve weeks and evoked a minimal response. Heterotopic autografts also provoked a mild though non-specific inflammatory reaction which the orthotopic grafts did not. It is concluded that cartilage matrix is capable of protecting grafts to a remarkable degree even from a severe immunological assault but only when the nutrition is adequate. It is suggested that the conflicting results of similar previous experiments may be explained by variations in the nutritional state of the graft which may be affected by the technique of transplantation used

1. Recurrence of deformity after operations for drop foot is often associated with opening of the front of the ankle joint: this has previously been regarded as a complication of the operation. 2. This study of sixty paralytic drop feet treated conservatively reveals that this laxity was in fact present in no less than 43 per cent. 3. The laxity is most commonly found when the calf muscle is strong and it can occur within a year of the onset of the paralysis. It is not always prevented by wearing a toe-raising spring. 4. Such anterior laxity may well be a common cause of failure of many of the standard operations for drop foot. 5. Before operation for drop foot is undertaken a lateral radiograph of the ankle should be taken in forced plantar-flexiori. If this demonstrates anterior laxity any standard operation is unlikely to succeed unless the anterior fibres of the collateral ligaments are protected from strain by simultaneous tendon transplantation or unless the ankle is included in the arthrodesis

Autologous chondrocyte implantation (ACI) is a technique used for the treatment of symptomatic osteochondral defects of the knee. A variation of the original periosteum membrane technique is the matrix-induced autologous chondrocyte implantation (MACI) technique. The MACI membrane consists of a porcine type-I/III collagen bilayer seeded with chondrocytes. Osteochondral defects deeper than 8 to 10 mm usually require bone grafting either before or at the time of transplantation of cartilage. We have used a variation of Peterson’s ACI-periosteum sandwich technique using two MACI membranes with bone graft which avoids periosteal harvesting. The procedure is suture-free and requires less operating time and surgical exposure. We performed this MACI-sandwich technique on eight patients, five of whom were assessed at six months and one year post-operatively using the modified Cincinnati knee, the Stanmore functional rating and the visual analogue pain scores. All patients improved within six months with further improvement at one year. The clinical outcome was good or excellent in four after six months and one year. No significant graft-associated complications were observed. Our early results of the MACI-sandwich technique are encouraging although larger medium-term studies are required before there is widespread adoption of the technique

We describe a new method of biological repair of osteochondral defects. In rabbit knees an osteochondral defect was reconstructed with a callo-osseous graft made of a superficial sheet of medullary fracture callus attached to a base of cancellous bone. This was taken from the iliac bone of the same animal which had been osteotomised ten days earlier. The reparative tissues were evaluated for 24 weeks by quantitative histology, biochemical analysis of the uronic acid content, and immunohistochemical staining of collagen constituents. The callo-osseous graft provided significantly faster and better repair of the articular surface than an untreated defect or a callo-osseous graft in which the cells had been devitalised by irradiation before transplantation. Our findings indicate that the callo-osseous graft contributes to the repair process by providing both favourable extracellular matrices and pluripotential mesenchymal cells. Our study tested the hypothesis that early medullary callus generates hyaline cartilage instead of bone after transfer to an articular surface

Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided. We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. It combines aspects of approaches which have been reported previously and consists of an anterior dislocation through a posterior approach with a ‘trochanteric flip’ osteotomy. The external rotator muscles are not divided and the medial femoral circumflex artery is protected by the intact obturator externus. We report our experience using this approach in 213 hips over a period of seven years and include 19 patients who underwent simultaneous intertrochanteric osteotomy. The perfusion of the femoral head was verified intraoperatively and, to date, none has subsequently developed avascular necrosis. There is little morbidity associated with the technique and it allows the treatment of a variety of conditions, which may not respond well to other methods including arthroscopy. Surgical dislocation gives new insight into the pathogenesis of some hip disorders and the possibility of preserving the hip with techniques such as transplantation of cartilage

Children with a mucopolysaccharidosis or mucolipidosis suffer progressive disability of the hands, particularly in relation to dysfunction of the median nerve. This is an increasing problem because bone-marrow transplantation has dramatically improved survival without apparently changing the musculoskeletal manifestations. We have reviewed 48 children with these syndromes who required carpal tunnel decompression, recording symptoms, signs, radiological, electrophysiological and operative findings, histology and upper-limb function. In these children the carpal tunnel syndrome differs from that seen in adults. Symptoms are rare but signs such as decreased sweating, pulp atrophy, thenar wasting and manual clumsiness are much more common. At operation, the flexor retinaculum was thickened and a mass of white tenosynovium engulfed the flexor tendons. Most patients had some definite nerve constriction with a thickened epineurium. Functional improvement was seen after early decompression, with some benefit from simultaneous tendon release. Regular physiotherapy helped to maintain increased hand movement. We describe our assessment protocol, the physiotherapy and operative regime and the standard functional review which helps to maximise function in the hands and upper limbs of these children