J. Brand

Lokalisation von TGF-β und PDGF und deren Bedeutung für die Pathogenese der Arthrofibrose

Arthrofibrosis is a disabling complication after knee trauma and surgery and is characterised clinically by joint stiffness. Due to an immune response, the proliferation of fibroblasts and synthesis of extracellular matrix proteins are increased. The cytokines transforming growth factor beta (TGF-beta) and platelet-derived growth factor (PDGF) are critical players in tissue fibrosis, stimulating cell proliferation and the production of various extracellular matrix proteins. Tissue samples from the infrapatellar fat pad and intercondylar synovia of seven patients (age 18-49 years) suffering from arthrofibrosis were taken at surgery. The mean interval between trauma and arthrolysis was 14.3 months. All samples were stained with haematoxylin and eosin, and monoclonal and polyclonal antibodies were applied for immunohistological localisation of TGF-beta and PDGF. The percentage of both cytokines was then analysed using an image analysis system. Tissue samples with no macroscopic pathology of the synovial tissue from eight patients for anterior cruciate ligament replacement served as controls. Immunostaining for TGF-beta and PDGF was found to be increased in arthrofibrotic tissue. Both cytokines could be detected subsynovially around inflammatory cells. The profibrotic cytokines TGF-beta and PDGF play an important role in the pathogenesis of arthrofibrosis. Both cytokines are key mediators of tissue fibrosis.

[Localisation of TGF-beta and PDGF and their relevance for the pathogenesis of arthrofibrosis].

Arthrofibrosis is a disabling complication after knee trauma and surgery and is characterised clinically by joint stiffness. Due to an immune response, the proliferation of fibroblasts and synthesis of extracellular matrix proteins are increased. The cytokines transforming growth factor beta (TGF-beta) and platelet-derived growth factor (PDGF) are critical players in tissue fibrosis, stimulating cell proliferation and the production of various extracellular matrix proteins. Tissue samples from the infrapatellar fat pad and intercondylar synovia of seven patients (age 18-49 years) suffering from arthrofibrosis were taken at surgery. The mean interval between trauma and arthrolysis was 14.3 months. All samples were stained with haematoxylin and eosin, and monoclonal and polyclonal antibodies were applied for immunohistological localisation of TGF-beta and PDGF. The percentage of both cytokines was then analysed using an image analysis system. Tissue samples with no macroscopic pathology of the synovial tissue from eight patients for anterior cruciate ligament replacement served as controls. Immunostaining for TGF-beta and PDGF was found to be increased in arthrofibrotic tissue. Both cytokines could be detected subsynovially around inflammatory cells. The profibrotic cytokines TGF-beta and PDGF play an important role in the pathogenesis of arthrofibrosis. Both cytokines are key mediators of tissue fibrosis.

Knieendoprothetik beim Unterschenkelamputierten

We present the case of a 62-year-old man with posttraumatic osteoarthritis after a tibial head fracture. A below-knee amputation of the same limb had been performed years ago because of a chronic diabetic foot ulcus. The patient underwent total knee replacement, and the 2-year postoperative clinical outcome was very good. The problem of how to address missing anatomic reference points for the implantation of the tibial component in below-knee amputees and the question whether navigation offers a potential benefit in this situation are discussed.

[Total knee replacement in a below-knee amputee. Technical reference points and possible solutions].

We present the case of a 62-year-old man with posttraumatic osteoarthritis after a tibial head fracture. A below-knee amputation of the same limb had been performed years ago because of a chronic diabetic foot ulcus. The patient underwent total knee replacement, and the 2-year postoperative clinical outcome was very good. The problem of how to address missing anatomic reference points for the implantation of the tibial component in below-knee amputees and the question whether navigation offers a potential benefit in this situation are discussed.

Knochen im (Über-)Fluss: das seltene Krankheitsbild der Melorheostose

ZusammenfassungDie Melorheostose (MEL) ist eine seltene, gutartige und sporadisch auftretende Osteosklerose ungeklärter Ursache. Die Erkrankung beginnt oft im jungen Erwachsenenalter, verläuft fast immer progressiv auf eine Körperhälfte beschränkt und betrifft beide Geschlechter gleichermaßen. Die Sklerosierungszonen gehen meistens von der Kortikalis der langen Röhrenknochen der unteren, seltener auch der oberen Extremitäten aus. Die Sklerosierungen beziehen oft die Weichteile um die betroffenen Knochen ein und können zu Bewegungseinschränkungen, Kontrakturen, Deformitäten und Schmerzen führen. Die Diagnose erfolgt anhand eines Röntgenbildes. Die Therapie hat die Schmerzbeseitigung und die Wiedererlangung der Bewegungsfreiheit zum Ziel. Nicht immer ist ein befriedigendes Therapieergebnis zu erreichen und Rezidive kommen häufig vor.AbstractMelorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.Melorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.

[(Over-)flowing bone: the rare disease of melorheostosis: clinical presentation and therapeutic concepts demonstrated by three cases].

ZusammenfassungDie Melorheostose (MEL) ist eine seltene, gutartige und sporadisch auftretende Osteosklerose ungeklärter Ursache. Die Erkrankung beginnt oft im jungen Erwachsenenalter, verläuft fast immer progressiv auf eine Körperhälfte beschränkt und betrifft beide Geschlechter gleichermaßen. Die Sklerosierungszonen gehen meistens von der Kortikalis der langen Röhrenknochen der unteren, seltener auch der oberen Extremitäten aus. Die Sklerosierungen beziehen oft die Weichteile um die betroffenen Knochen ein und können zu Bewegungseinschränkungen, Kontrakturen, Deformitäten und Schmerzen führen. Die Diagnose erfolgt anhand eines Röntgenbildes. Die Therapie hat die Schmerzbeseitigung und die Wiedererlangung der Bewegungsfreiheit zum Ziel. Nicht immer ist ein befriedigendes Therapieergebnis zu erreichen und Rezidive kommen häufig vor.AbstractMelorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.Melorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.

Knochen im (Über-)Fluss: das seltene Krankheitsbild der Melorheostose(Over-)flowing bone: the rare disease of melorheostosis

ZusammenfassungDie Melorheostose (MEL) ist eine seltene, gutartige und sporadisch auftretende Osteosklerose ungeklärter Ursache. Die Erkrankung beginnt oft im jungen Erwachsenenalter, verläuft fast immer progressiv auf eine Körperhälfte beschränkt und betrifft beide Geschlechter gleichermaßen. Die Sklerosierungszonen gehen meistens von der Kortikalis der langen Röhrenknochen der unteren, seltener auch der oberen Extremitäten aus. Die Sklerosierungen beziehen oft die Weichteile um die betroffenen Knochen ein und können zu Bewegungseinschränkungen, Kontrakturen, Deformitäten und Schmerzen führen. Die Diagnose erfolgt anhand eines Röntgenbildes. Die Therapie hat die Schmerzbeseitigung und die Wiedererlangung der Bewegungsfreiheit zum Ziel. Nicht immer ist ein befriedigendes Therapieergebnis zu erreichen und Rezidive kommen häufig vor.AbstractMelorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.Melorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.

Knochen im (Über-)Fluss: das seltene Krankheitsbild der Melorheostose@@@(Over-)flowing bone: the rare disease of melorheostosis: Klinische Präsentation und Behandlungskonzepte am Beispiel von 3 Fällen@@@Clinical presentation and therapeutic concepts demonstrated by three cases

ZusammenfassungDie Melorheostose (MEL) ist eine seltene, gutartige und sporadisch auftretende Osteosklerose ungeklärter Ursache. Die Erkrankung beginnt oft im jungen Erwachsenenalter, verläuft fast immer progressiv auf eine Körperhälfte beschränkt und betrifft beide Geschlechter gleichermaßen. Die Sklerosierungszonen gehen meistens von der Kortikalis der langen Röhrenknochen der unteren, seltener auch der oberen Extremitäten aus. Die Sklerosierungen beziehen oft die Weichteile um die betroffenen Knochen ein und können zu Bewegungseinschränkungen, Kontrakturen, Deformitäten und Schmerzen führen. Die Diagnose erfolgt anhand eines Röntgenbildes. Die Therapie hat die Schmerzbeseitigung und die Wiedererlangung der Bewegungsfreiheit zum Ziel. Nicht immer ist ein befriedigendes Therapieergebnis zu erreichen und Rezidive kommen häufig vor.AbstractMelorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.Melorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.

Knieendoprothetik beim Unterschenkelamputierten@@@Total knee replacement in a below-knee amputee: Technische Besonderheiten der Referenzierung und Lösungsoptionen@@@Technical reference points and possible solutions

We present the case of a 62-year-old man with posttraumatic osteoarthritis after a tibial head fracture. A below-knee amputation of the same limb had been performed years ago because of a chronic diabetic foot ulcus. The patient underwent total knee replacement, and the 2-year postoperative clinical outcome was very good. The problem of how to address missing anatomic reference points for the implantation of the tibial component in below-knee amputees and the question whether navigation offers a potential benefit in this situation are discussed.

Lokalisation von TGF-β und PDGF und deren Bedeutung für die Pathogenese der Arthrofibrose@@@Localisation of TGF-β and PDGF and their relevance for the pathogenesis of arthrofibrosis

Arthrofibrosis is a disabling complication after knee trauma and surgery and is characterised clinically by joint stiffness. Due to an immune response, the proliferation of fibroblasts and synthesis of extracellular matrix proteins are increased. The cytokines transforming growth factor beta (TGF-beta) and platelet-derived growth factor (PDGF) are critical players in tissue fibrosis, stimulating cell proliferation and the production of various extracellular matrix proteins. Tissue samples from the infrapatellar fat pad and intercondylar synovia of seven patients (age 18-49 years) suffering from arthrofibrosis were taken at surgery. The mean interval between trauma and arthrolysis was 14.3 months. All samples were stained with haematoxylin and eosin, and monoclonal and polyclonal antibodies were applied for immunohistological localisation of TGF-beta and PDGF. The percentage of both cytokines was then analysed using an image analysis system. Tissue samples with no macroscopic pathology of the synovial tissue from eight patients for anterior cruciate ligament replacement served as controls. Immunostaining for TGF-beta and PDGF was found to be increased in arthrofibrotic tissue. Both cytokines could be detected subsynovially around inflammatory cells. The profibrotic cytokines TGF-beta and PDGF play an important role in the pathogenesis of arthrofibrosis. Both cytokines are key mediators of tissue fibrosis.