Joint Preserving Surgery for Osteonecrosis and Osteochondral Defects after Chemotherapy in Childhood

doi:10.1055/s-2003-45495

Cited by 33 publications

(8 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these, 17 were clinical articles while 3 articles used animal models and were excluded. From the clinical articles found, 5 were prospective studies, 9 , 10 , 17 , 31 , 32 2 were retrospective, 2 , 34 4 were case reports, 7 , 14 , 15 , 23 4 were case series, 3 , 4 , 9 , 12 1 was a surgical technique description, 26 and 1 was a systematic review. 5 We excluded the systematic review of treatment of chondral defects because it was specifically on the use of MSCs and not specific for BMAC nor the knee joint.…”

Section: Resultsmentioning

confidence: 99%

Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee

Chahla

Dean

Moatshe

et al. 2016

Orthopaedic Journal of Sports Medicine

202

165

View full text Add to dashboard Cite

Background:Bone marrow aspirate concentrate (BMAC) has emerged as a novel treatment for pathology of the knee. Despite containing a limited number of stem cells, BMAC serves as a source of growth factors that are thought to play an important role as a result of their anabolic and anti-inflammatory effects. To our knowledge, there is no systematic review regarding the outcomes of bone marrow aspirate concentrate used for the treatment of chondral defects and osteoarthritis of the knee.Purpose:To perform a systematic review on the outcomes of bone marrow aspirate concentrate for the treatment of chondral defects and osteoarthritis of the knee.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from 1980 to present. Inclusion criteria were as follows: use of BMAC for treatment of chondral defects and osteoarthritis of the knee, English language, and human studies. We excluded cadaveric studies, animal studies, basic science articles, editorial articles, surveys, and studies that did not include the knee. After applying inclusion and exclusion criteria, studies were evaluated for efficacy and safety of BMAC for treatment of articular cartilage knee pathologies.Results:Eleven studies were considered. Of these, 5 were prospective studies, 1 was a retrospective study, 2 were case series, and 3 were case reports. Three comparative studies (2 with level 2 evidence, 1 with level 3 evidence) were found in our search; none of them were randomized. Three studies investigated the clinical efficacy of BMAC in the treatment of osteoarthritis, and 8 studies evaluated the efficacy of BMAC on focal cartilage injuries. All 3 studies regarding osteoarthritis and all 8 studies regarding focal chondral defects reported good to excellent overall outcomes with the use of BMAC.Conclusion:Although a growing interest for biological alternatives of treating knee pathology has been observed in the past few years, there still remains a paucity of high-quality studies. The studies included in this systematic review reported varying degrees of beneficial results with the use of BMAC with and without an additional procedure for the treatment of chondral defects and early stages of osteoarthritis. Most articles present the use of BMAC as a safe procedure and report good results.

show abstract

Section: Resultsmentioning

confidence: 99%

Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee

Chahla

Dean

Moatshe

et al. 2016

Orthopaedic Journal of Sports Medicine

202

165

View full text Add to dashboard Cite

show abstract

“…ONFH is a disease characterized by necrosis of one or more parts of the femoral head. ONFH can cause severe joint pain and limited physical activity, and some severe cases even require surgical intervention to restore normal function (Werner et al 2003). Steroids are widely used in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Combination Analysis of NR3C1, MTHFR and IGFBP3 Gene Polymorphisms and DNA Methylation With Steroid-induced Osteonecrosis of the Femoral Head Risk in Chinese Han Population 

Huang¹,

Zhan²,

Hu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Although the precise etiology of osteonecrosis of the femoral head (ONFH) has yet to be fully elucidated, it is known that nuclear receptor subfamily3, group C, member 1 (NR3C1), 5, 10-methylenetetrahydrofolate reductase (MTHFR) and insulin-like growth factor-binding protein 3 (IGFBP3) are related to the pathophysiology of steroid-induced osteonecrosis of the femoral head (SONFH). The expression of NR3C1, MTHFR and IGFBP3 are regulated by epigenetics and genetic profiles. Objective: The primary objective of this study was to investigated the association between NR3C1, MTHFR and IGFBP3 gene polymorphisms and DNA methylation status and SONFH.Methods: This case-control study included 79 patients with SONFH and 114 patients who took steroids but did not develop SONFH. We evaluated 5 single-nucleotide polymorphisms (SNPs) out of 3 genes in Chinese Han population. These SNPs were genotyped by improved multiplex ligation detection reaction (iMLDR). Methyltarget was used to test the methylation level of positive sites, the interaction between SNPs and DNA methylation level was analyzed using eQTLD technique.Results: We identified rs3110697 in the IGFBP3 gene that was potentially associated with a reduced risk of SONFH in the genotype (P=0.008; odds ratio [OR]: 0.741; 95% confidence intervals [CI]: 0.456–1.205) and in the recessive model (P=0.003; OR: NA; 95% CI: NA–NA). Furthermore, CpG sites with significant differences in methylation levels were screened as follows: IGFBP3_2-143, MTHFR_1-36, MTHFR_1-77, MTHFR_1-139, MTHFR_2-42, NR3C1_2-163, NR3C1_4-47, and the differences were statistically significant compared with the control group (p<0.05). A total of 10 pairs of linear regression tests of SNP and methylation sites were statistically significant (p<0.05).Conclusions: SONFH is a polygenic disorder in which a wide range of interactions between SNPs and DNA methylation levels may dominate the course of the disease.

show abstract

“…8, 17, 20 While there is some data to suggest earlier intervention is more efficacious, no large scale studies have examined this. 1, 7, 8, 17, 20 Joint-preserving surgeries could potentially halt the progression of disease and improve quality of life, but such interventions are only possible before joint collapse. As surgical intervention appears safe, efficacy trials are warranted.…”

Section: Discussionmentioning

confidence: 99%

“…1 When conservative ON management fails, surgery may decrease pain and improve mobility. 7 Research from adults with ON suggests that joint decompression may be effective at preventing subsequent joint collapse, thereby preserving the native joint and decreasing pain. 8 Arthroscopic repair, core decompression and bone grafting have all been used as attempts to prevent joint collapse.…”

Section: Introduction1mentioning

confidence: 99%

Treatment of Osteonecrosis in Children and Adolescents With Acute Lymphoblastic Leukemia

Heneghan

Rheingold

et al. 2016

Clinical Lymphoma Myeloma and Leukemia

View full text Add to dashboard Cite

Background Cure rates for acute lymphoblastic leukemia (ALL) have improved, but as therapy has intensified, the burden of osteonecrosis (ON) has increased. Limited data exist regarding surgical interventions for pediatric ALL patients with ON. Materials and Methods A multi-center cohort of children with newly diagnosed ALL was established with Pediatric Health Information System (PHIS) data from 43 freestanding children's hospitals from 1999-2011. Patients with ON identified by ICD-9 code were followed for up to 5 years after index ALL admission for the presence of ON-associated orthopedic surgical procedures. Results A cohort of 10,729 ALL patients was assembled, of which 242(2.33%) were identified with an ICD-9 code for ON within 5 years of ALL diagnosis. Fifty-five patients (22.7%) with ON underwent orthopedic surgical intervention aimed at joint preservation (82%) or replacement (18%) with substantial practice variation by hospital in both the rate and type of surgical intervention. The majority of patients had surgical procedures while receiving Maintenance therapy. None of the patients undergoing surgical intervention required ICU-level care within 14 days of surgery, and there was no associated in-hospital mortality. Conclusions No standard of care exists for treatment of ALL-associated ON. While considerable practice variation exists, surgical intervention appears relatively safe.

show abstract

Joint Preserving Surgery for Osteonecrosis and Osteochondral Defects after Chemotherapy in Childhood

Abstract: The aim of surgery for ON and OCD after chemotherapy should be the reduction of pain and preservation of the joint to bypass the risks of joint replacement in young patients, although total joint replacement may become indicated in endstage degeneration of the involved joint.

Cited by 33 publications

References 34 publications

Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee

Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee

Combination Analysis of NR3C1, MTHFR and IGFBP3 Gene Polymorphisms and DNA Methylation With Steroid-induced Osteonecrosis of the Femoral Head Risk in Chinese Han Population

Treatment of Osteonecrosis in Children and Adolescents With Acute Lymphoblastic Leukemia

Contact Info

Product

Resources

About

Joint Preserving Surgery for Osteonecrosis and Osteochondral Defects after Chemotherapy in Childhood

Abstract: The aim of surgery for ON and OCD after chemotherapy should be the reduction of pain and preservation of the joint to bypass the risks of joint replacement in young patients, although total joint replacement may become indicated in endstage degeneration of the involved joint.

Cited by 33 publications

References 34 publications

Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee

Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee

Combination Analysis of NR3C1, MTHFR&nbsp;and IGFBP3&nbsp;Gene Polymorphisms and DNA&nbsp;Methylation With Steroid-induced Osteonecrosis of the Femoral Head Risk in Chinese Han Population&nbsp;

Treatment of Osteonecrosis in Children and Adolescents With Acute Lymphoblastic Leukemia

Contact Info

Product

Resources

About

Combination Analysis of NR3C1, MTHFR and IGFBP3 Gene Polymorphisms and DNA Methylation With Steroid-induced Osteonecrosis of the Femoral Head Risk in Chinese Han Population