Editorial

3 pages, 195 KiB

Open AccessEditorial

Personalized Medicine for Orthopaedic Disorders

by Nan Jiang

J. Pers. Med. 2023, 13(11), 1553; https://doi.org/10.3390/jpm13111553 - 30 Oct 2023

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Orthopaedic disorders, also known as musculoskeletal disorders (MSDs), refer to diseases or injuries of the bone, joint, cartilage, muscle, tendon, nerve, and spinal disc [...] Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

Research

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9 pages, 240 KiB

Open AccessCommunication

Bacterial Contamination of Open Fractures: Pathogens and Antibiotic Resistance Patterns in East China

by Wanrun Zhong, Yanmao Wang, Hongshu Wang, Pei Han, Yi Sun, Yimin Chai, Shengdi Lu and Chengfang Hu

J. Pers. Med. 2023, 13(5), 735; https://doi.org/10.3390/jpm13050735 - 26 Apr 2023

Cited by 1 | Viewed by 817

Abstract

Bacterial contamination of soft tissue in open fractures leads to high infection rates. Pathogens and their resistance against therapeutic agents change with time and vary in different regions. The purpose of this study was to characterize the bacterial spectrum present in open fractures [...] Read more.

Bacterial contamination of soft tissue in open fractures leads to high infection rates. Pathogens and their resistance against therapeutic agents change with time and vary in different regions. The purpose of this study was to characterize the bacterial spectrum present in open fractures and analyze the bacterial resistance to antibiotic agents based on five trauma centers in East China. A retrospective multicenter cohort study was conducted in six major trauma centers in East China from January 2015 to December 2017. Patients who sustained open fractures of the lower extremities were included. The data collected included the mechanism of injury, the Gustilo-Anderson classification, the isolated pathogens and their resistance against therapeutic agents, as well as the prophylactic antibiotics administered. In total, 1348 patients were included in our study, all of whom received antibiotic prophylaxis (cefotiam or cefuroxime) during the first debridement at the emergency room. Wound cultures were taken in 1187 patients (85.8%); the results showed that the positive rate of open fracture was 54.8% (651/1187), and 59% of the bacterial detections occurred in grade III fractures. Most pathogens (72.7%) were sensitive to prophylactic antibiotics, according to the EAST guideline. Quinolones and cotrimoxazole showed the lowest rates of resistance. The updated EAST guidelines for antibiotic prophylaxis in open fracture (2011) have been proven to be adequate for a large portion of patients, and we would like to suggest additional Gram-negative coverage for patients with grade II open fractures based on the results obtained in this setting in East China. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

12 pages, 1733 KiB

Open AccessArticle

Intra-Articular Injection of Autologous Micro-Fragmented Adipose Tissue for the Treatment of Knee Osteoarthritis: A Prospective Interventional Study

by Yang Yu, Qunshan Lu, Songlin Li, Mingxing Liu, Houyi Sun, Lei Li, Kaifei Han and Peilai Liu

J. Pers. Med. 2023, 13(3), 504; https://doi.org/10.3390/jpm13030504 - 10 Mar 2023

Cited by 4 | Viewed by 2582

Abstract

Background: To investigate the efficacy and safety of autologous micro-fragmented adipose tissue (MF-AT) for improving joint function and cartilage repair in patients with knee osteoarthritis. Methods: From March 2019 to December 2020, 20 subjects (40 knees) between 50 and 65 years old suffering [...] Read more.

Background: To investigate the efficacy and safety of autologous micro-fragmented adipose tissue (MF-AT) for improving joint function and cartilage repair in patients with knee osteoarthritis. Methods: From March 2019 to December 2020, 20 subjects (40 knees) between 50 and 65 years old suffering from knee osteoarthritis were enrolled in the study and administered a single injection of autologous MF-A. The data of all patients were prospectively collected. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee society score (KSS), hospital for special surgery (HSS) score, visual analogue score (VAS) pain score, changes in cartilage Recht grade on magnetic resonance imaging (MRI) and adverse events were analyzed before and 3, 6, 9, 12 and 18 months after injection. Results: The WOMAC, VAS, KSS and HSS scores at 3, 6, 9, 12 and 18 months after injection were improved compared with those before injection (p < 0.05). There was no significant difference in WOMAC scores between 9 and 12 months after injection (p > 0.05), but the WOMAC score 18 months after injection was worse than that at the last follow-up (p < 0.05). The VAS, KSS and HSS scores 9, 12 and 18 months after injection were worse than those at the last follow-up (p < 0.05). The Recht score improvement rate was 25%. No adverse events occurred during the follow-up. Conclusions: Autologous MF-AT improves knee function and relieves pain with no adverse events. However, the improved knee function was not sustained, with the best results occurring 9–12 months after injection and the cartilage regeneration remaining to be investigated. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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13 pages, 10345 KiB

Open AccessArticle

Identification of Immune-Related Risk Genes in Osteoarthritis Based on Bioinformatics Analysis and Machine Learning

by Jintao Xu, Kai Chen, Yaohui Yu, Yishu Wang, Yi Zhu, Xiangjie Zou and Yiqiu Jiang

J. Pers. Med. 2023, 13(2), 367; https://doi.org/10.3390/jpm13020367 - 19 Feb 2023

Cited by 2 | Viewed by 1524

Abstract

In this research, we aimed to perform a comprehensive bioinformatic analysis of immune cell infiltration in osteoarthritic cartilage and synovium and identify potential risk genes. Datasets were downloaded from the Gene Expression Omnibus database. We integrated the datasets, removed the batch effects and [...] Read more.

In this research, we aimed to perform a comprehensive bioinformatic analysis of immune cell infiltration in osteoarthritic cartilage and synovium and identify potential risk genes. Datasets were downloaded from the Gene Expression Omnibus database. We integrated the datasets, removed the batch effects and analyzed immune cell infiltration along with differentially expressed genes (DEGs). Weighted gene co-expression network analysis (WGCNA) was used to identify the positively correlated gene modules. LASSO (least absolute shrinkage and selection operator)-cox regression analysis was performed to screen the characteristic genes. The intersection of the DEGs, characteristic genes and module genes was identified as the risk genes. The WGCNA analysis demonstrates that the blue module was highly correlated and statistically significant as well as enriched in immune-related signaling pathways and biological functions in the KEGG and GO enrichment. LASSO-cox regression analysis screened 11 characteristic genes from the hub genes of the blue module. After the DEG, characteristic gene and immune-related gene datasets were intersected, three genes, PTGS1, HLA-DMB and GPR137B, were identified as the risk genes in this research. In this research, we identified three risk genes related to the immune system in osteoarthritis and provide a feasible approach to drug development in the future. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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15 pages, 4219 KiB

Open AccessEditor’s ChoiceArticle

Advancing Osteoporosis Evaluation Procedures: Detailed Computational Analysis of Regional Structural Vulnerabilities in Osteoporotic Bone

by Matthew A. Wysocki and Scott T. Doyle

J. Pers. Med. 2023, 13(2), 321; https://doi.org/10.3390/jpm13020321 - 13 Feb 2023

Cited by 3 | Viewed by 1487

Abstract

Osteoporotic fractures of the femur are associated with poor healing, disability, reduced quality of life, and high mortality rates within 1 year. Moreover, osteoporotic fractures of the femur are still considered to be an unsolved problem in orthopedic surgery. In order to more [...] Read more.

Osteoporotic fractures of the femur are associated with poor healing, disability, reduced quality of life, and high mortality rates within 1 year. Moreover, osteoporotic fractures of the femur are still considered to be an unsolved problem in orthopedic surgery. In order to more effectively identify osteoporosis-related fracture risk and develop advanced treatment approaches for femur fractures, it is necessary to acquire a greater understanding of how osteoporosis alters the diaphyseal structure and biomechanical characteristics. The current investigation uses computational analyses to comprehensively examine how femur structure and its associated properties differ between healthy and osteoporotic bones. The results indicate statistically significant differences in multiple geometric properties between healthy femurs and osteoporotic femurs. Additionally, localized disparities in the geometric properties are evident. Overall, this approach will be beneficial in the development of new diagnostic procedures for highly detailed patient-specific detection of fracture risk, for establishing novel injury prevention treatments, and for informing advanced surgical solutions. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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15 pages, 3617 KiB

Open AccessCommunication

Results of Treating Mild to Moderate Knee Osteoarthritis with Autologous Conditioned Adipose Tissue and Leukocyte-Poor Platelet-Rich Plasma

by Vilim Molnar, Eduard Pavelić, Željko Jeleč, Petar Brlek, Vid Matišić, Igor Borić, Damir Hudetz, Eduard Rod, Dinko Vidović, Neven Starčević, Martin Čemerin, David C. Karli and Dragan Primorac

J. Pers. Med. 2023, 13(1), 47; https://doi.org/10.3390/jpm13010047 - 26 Dec 2022

Cited by 2 | Viewed by 2353

Abstract

Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders. Much progress has been made in regenerative medicine for the symptomatic treatment of KOA, including products containing stromal vascular fraction (SVF) and platelet-rich plasma (PRP). The aim of this study was to [...] Read more.

Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders. Much progress has been made in regenerative medicine for the symptomatic treatment of KOA, including products containing stromal vascular fraction (SVF) and platelet-rich plasma (PRP). The aim of this study was to evaluate clinical and radiological findings after the application of autologous conditioned adipose tissue (ACA) and leukocyte-poor PRP (LP-PRP) in patients with mild to moderate KOA. A total of 16 patients (eight male and eight female) with changes related to KOA on the magnetic resonance imaging (MRI), but without severe osteophytosis, full-thickness cartilage loss, or subchondral bone involvement were included in this study. Patients received an intraarticular, ultrasound-guided injection of ACA and LP-PRP. Clinical scores, including a visual analog scale for pain (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated at baseline and at the three and six month follow-ups showing a statistically significant improvements at three and six months post-intervention. Furthermore, the delayed gadolinium-enhanced MRI of the cartilage (dGEMRIC) indices were evaluated at baseline and at the three and six month follow-ups showing no significant changes after treatment with ACA and LP-PRP, which were actually equal to the dGEMRIC indices measured in the control group (hyaluronic acid applied in contralateral knees without osteoarthritis). ACA with LP-PRP presents a viable minimally invasive therapeutic option for the clinical improvement of mild to moderate KOA. However, MFAT produced by different systems is likely to differ in cellular content, which can directly affect the paracrine effect (cytokine secretion) of mesenchymal stem cells and consequently the regeneration process. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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11 pages, 2356 KiB

Open AccessArticle

Devascularized Bone Surface Culture: A Novel Strategy for Identifying Osteomyelitis-Related Pathogens

by Peng Chen, Qing-rong Lin, Mou-Zhang Huang, Xin Zhang, Yan-jun Hu, Jing Chen, Nan Jiang and Bin Yu

J. Pers. Med. 2022, 12(12), 2050; https://doi.org/10.3390/jpm12122050 - 12 Dec 2022

Cited by 7 | Viewed by 1294

Abstract

The gold standard for identifying pathogens causing osteomyelitis (OM) is intraoperative tissue sampling culture (TSC). However, its positive rate remains inadequate. Here, we evaluated the efficiency of a novel strategy, known as devitalized bone surface culture (BSC), for detecting OM-related microorganisms and compared [...] Read more.

The gold standard for identifying pathogens causing osteomyelitis (OM) is intraoperative tissue sampling culture (TSC). However, its positive rate remains inadequate. Here, we evaluated the efficiency of a novel strategy, known as devitalized bone surface culture (BSC), for detecting OM-related microorganisms and compared it to TSC. Between December 2021 and July 2022, patients diagnosed with OM and received both methods for bacterial identification were screened for analysis. In total, 51 cases were finally recruited for analysis. The mean age was 43.6 years, with the tibia as the top infection site. The positive rate of BSC was relatively higher than that of TSC (74.5% vs. 58.8%, p = 0.093), though no statistical difference was achieved. Both BSC and TSC detected definite pathogens in 29 patients, and their results were in accordance with each other. The most frequent microorganism identified by the BSC method was Staphylococcus aureus. Moreover, BSC took a significantly shorter median culture time than TSC (1.0 days vs. 3.0 days, p < 0.001). In summary, BSC may be superior to TSC for identifying OM-associated pathogens, with a higher detectable rate and a shorter culture time. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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10 pages, 1430 KiB

Open AccessArticle

Which Is Better in Clinical and Radiological Outcomes for Lumbar Degenerative Disease of Two Segments: MIS-TLIF or OPEN-TLIF?

by Weiran Hu, Guang Yang, Hongqiang Wang, Xiaonan Wu, Haohao Ma, Kai Zhang and Yanzheng Gao

J. Pers. Med. 2022, 12(12), 1977; https://doi.org/10.3390/jpm12121977 - 30 Nov 2022

Cited by 3 | Viewed by 1223

Abstract

Objective: To compare the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional open transforaminal lumbar interbody fusion (OPEN-TLIF) in the treatment of two-level lumbar degenerative diseases. Methods: The clinical data of 112 patients were retrospectively analyzed, and [...] Read more.

Objective: To compare the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional open transforaminal lumbar interbody fusion (OPEN-TLIF) in the treatment of two-level lumbar degenerative diseases. Methods: The clinical data of 112 patients were retrospectively analyzed, and were divided into an MIS-TLIF group and OPEN-TLIF group. The operative time, intraoperative fluoroscopy, blood loss, postoperative drainage volume, bed rest time, the content of creatine kinase(CK) and complications, were recorded. VAS score and ODI index were used to evaluate clinical efficacy. Bridwell grading was used to evaluate postoperative interbody fusion. Screw position was evaluated by Rao grading. Results: Compared with the OPEN-TLIF group, the MIS-TLIF group had longer operation times, more intraoperative fluoroscopy times, but shorter postoperative bed times (p < 0.05). There were no significant differences in blood loss, postoperative drainage and postoperative CK content between the two groups (p > 0.05). There was no difference in VAS score and ODI index during the follow-up (p > 0.05). There was no significant difference in the interbody fusion rate between the two groups (p > 0.05). There was no significant difference in the distribution of type A screws, but the type B screw in the MIS-TLIF group was higher (p < 0.05). There was no difference in the incidence of complications between the two groups (p > 0.05). Conclusion: The postoperative quality of life score and radiological outcomes of the two types of surgery in two-level lumbar degenerative diseases was similar, and there was no significant difference in muscle injury and complications, but the operation time and intraoperative radiation exposurewere higher than in the OPEN-TLIF group, and the pedicle screws were more likely to deviate laterally out of the vertebral body. Therefore, OPEN-TLIF is recommended for patients with lumbar degenerative diseases of two segments. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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12 pages, 1063 KiB

Open AccessArticle

Local Infiltrations in Patients with Radiculopathy or Chronic Low Back Pain Due to Segment Degeneration—Only A Diagnostic Value?

by Chris Lindemann, Timo Zippelius, Felix Hochberger, Alexander Hölzl, Sabrina Böhle and Patrick Strube

J. Pers. Med. 2022, 12(11), 1791; https://doi.org/10.3390/jpm12111791 - 30 Oct 2022

Cited by 2 | Viewed by 1316

Abstract

The purpose of this study was to investigate the differences in the therapeutic effectiveness of CT-assisted infiltration of a local anesthetic + corticosteroid between nerve root and facet joint capsule in patients with chronic complaints. In this prospective trial with a 12-month follow-up, [...] Read more.

The purpose of this study was to investigate the differences in the therapeutic effectiveness of CT-assisted infiltration of a local anesthetic + corticosteroid between nerve root and facet joint capsule in patients with chronic complaints. In this prospective trial with a 12-month follow-up, a total of 250 patients with chronic low back pain and radiculopathy were assigned to two groups. In the first group, patients with specific lumbar pain due to spondyloarthritis received periarticular facet joint capsule infiltration (FJI). In the second group, patients with monoradicular pain received periradicular infiltration (PRI) via an extraforaminal selective nerve block. Clinical improvement after FJI and PRI regarding pain (NRS), function (ODI), satisfaction (McNab), and health related quality of life (SF-36) were compared. Minimally clinically important difference (MCID) served as the threshold for therapeutic effectiveness evaluation. A total of 196 patients were available for final analysis. With respect to the pain reduction and functional improvement (ODI, NRSoverall, and NRSback), the PRI group performed significantly better (ptreatment < 0.001) and longer over time (ptreatment × time 0.001) than the FJI group. Regarding pain and function, only PRI demonstrated a durable improvement larger than MCID. A significant and durable therapeutic value was found only after receiving PRI but not after FJI in patients with chronic pain. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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14 pages, 305 KiB

Open AccessProtocol

Efficacy of Personalized Foot Orthoses in Children with Flexible Flat Foot: Protocol for a Randomized Controlled Trial

by Cristina Molina-García, Andrés Reinoso-Cobo, Jonathan Cortés-Martín, Eva Lopezosa-Reca, Ana Marchena-Rodriguez, George Banwell and Laura Ramos-Petersen

J. Pers. Med. 2023, 13(8), 1269; https://doi.org/10.3390/jpm13081269 - 17 Aug 2023

Cited by 1 | Viewed by 1230

Abstract

Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being [...] Read more.

Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being the most used treatment. The evidence supporting FO is very thin. It is not clearly known what the effect of these is, nor when it is convenient to recommend them. The main objective of this protocol is to design a randomized controlled trial to determine if personalized FO, together with a specific exercise regimen, produce the same or better results regarding the signs and symptoms of PFF, compared to only specific exercises. In order to respond to the stated objectives, we have proposed a randomized controlled clinical trial, in which we intend to evaluate the efficacy of FO together with strengthening exercises, compared to a control group in which placebos will be implanted as FO treatment along with the same exercises as the experimental group. For this, four measurements will be taken throughout 18 months (pre-treatment, two during treatment and finally another post-treatment measurement). The combination of FO plus exercise is expected to improve the signs and symptoms (if present) of PFF compared to exercise alone and the placebo FO group. In addition, it is expected that in both conditions the biomechanics of the foot will improve compared to the initial measurements. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

12 pages, 2737 KiB

Open AccessPerspective

Framing Patellar Instability: From Diagnosis to the Treatment of the First Episode

by Davide Maria Maggioni, Riccardo Giorgino, Carmelo Messina, Domenico Albano, Giuseppe Michele Peretti and Laura Mangiavini

J. Pers. Med. 2023, 13(8), 1225; https://doi.org/10.3390/jpm13081225 - 02 Aug 2023

Cited by 1 | Viewed by 1045

Abstract

The patellofemoral joint (PFJ) is a complex articulation between the patella and the femur which is involved in the extensor mechanism of the knee. Patellofemoral disorders can be classified into objective patellar instability, potential patellar instability, and patellofemoral pain syndrome. Anatomical factors such [...] Read more.

The patellofemoral joint (PFJ) is a complex articulation between the patella and the femur which is involved in the extensor mechanism of the knee. Patellofemoral disorders can be classified into objective patellar instability, potential patellar instability, and patellofemoral pain syndrome. Anatomical factors such as trochlear dysplasia, patella alta, and the tibial tuberosity–trochlear groove (TT-TG) distance contribute to instability. Patellofemoral instability can result in various types of dislocations, and the frequency of dislocation can be categorized as recurrent, habitual, or permanent. Primary patellar dislocation requires diagnostic framing, including physical examination and imaging. Magnetic resonance imaging (MRI) is essential for assessing the extent of damage, such as bone bruises, osteochondral fractures, and medial patellofemoral ligament (MPFL) rupture. Treatment options for primary dislocation include urgent surgery for osteochondral fragments or conservative treatment for cases without lesions. Follow-up after treatment involves imaging screening and assessing principal and secondary factors of instability. Detecting and addressing these factors is crucial for preventing recurrent dislocations and optimizing patient outcomes. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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8 pages, 565 KiB

Open AccessStudy Protocol

A Longitudinal Analysis of the Internal Rotation and Shift (IRO/Shift) Test Following Arthroscopic Repair of Superior Rotator Cuff Lesions

by René Schwesig, George Fieseler, Jakob Cornelius, Julia Sendler, Stephan Schulze, Souhail Hermassi, Karl-Stefan Delank and Kevin Laudner

J. Pers. Med. 2022, 12(12), 2018; https://doi.org/10.3390/jpm12122018 - 07 Dec 2022

Cited by 1 | Viewed by 967

Abstract

Although the use of clinical tests to diagnose superior rotator cuff pathology is common, there is paucity in the research regarding the accuracy of such tests following arthroscopic repair. The aim of this study was to determine the accuracy of the IRO/Shift test [...] Read more.

Although the use of clinical tests to diagnose superior rotator cuff pathology is common, there is paucity in the research regarding the accuracy of such tests following arthroscopic repair. The aim of this study was to determine the accuracy of the IRO/Shift test compared to the Jobe test at 3 months and 6 months post-surgery for superior rotator cuff repair. Arthroscopic repair was conducted on 51 patients who were subsequently seen for clinical evaluation at 3 and 6 months following surgery. At 3 months post-surgery only 27% of the patients had a negative IRO/Shift test and 18% had a negative Jobe test. However, at 6 months 88% of the patients presented with a negative IRO/Shift test and 61% a negative Jobe test. When compared to each other, the IRO/Shift test and the Jobe test had 90% agreement pre-operatively, 71% agreement at 3 months post-surgery, and 67% agreement at 6 months. These results demonstrate that the accuracy of the IRO/Shift test and the Jobe test improved between 3 and 6 months following arthroscopic surgery of the superior rotator cuff, with the IRO/Shift test having better accuracy. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

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