SARS-CoV-2 in the knee joint: a cadaver study

Grassi, Miriam; Giorgi, Valeria; Nebuloni, Manuela; Zerbi, Pietro; Gismondo, Maria Rita; Salaffi, Fausto; Sarzi‐Puttini, Piercarlo; Rimoldi, Sara Giordana; Manzotti, Alfonso

doi:10.55563/clinexprheumatol/t1m4y2

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…The authors associated the complication primarily with the in ammatory and prothrombotic response associated with COVID-19. The post-mortem analysis did not isolate the virus in the knee joint environment in positive patients [37]. We described six cases of knee ON after COVID-19.…”

Section: Discussionmentioning

confidence: 91%

Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review

Zà

Papalia

Russo

et al. 2023

Preprint

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Background: SARS-CoV-2 is the virus responsible for COVID-19. Patients with Covid-19 manifested symptoms mainly related to the respiratory system, but also the musculoskeletal system can be involved. Covid-19 has been described as a possible cause of knee osteonecrosis (ON). We performed a systematic review to investigate the hypothetical correlation between Covid-19 and knee ON. Methods: Inclusion criteria were all articles reporting cases of knee ON after a diagnosis of SARS-CoV-2 infection. Considering that Covid-19 is an emerging disease, we included all levels of evidence studies. Results: We finally included 2 case series and 2 case reports. We extracted data regarding demographic and clinical characteristics, details of magnetic resonance imaging (MRI), use of corticosteroids (CCS), temporal correlation between ON and Covid-19, treatment of the lesion and its outcomes. A total of 6 cases of post-Covid knee ON have been described. Knee pain arose on average 8 weeks after the diagnosis of Covid-19. All patients had knee MRI showing osteonecrosis. CCS were used to treat COVID-19-related symptoms in 3 cases. The medial femoral condyle was always involved by ON. Conservative treatment was successful in 4 patients. Conclusions: It is unclear the correlation between COVID-19 and ON. Probably post Covid-19 osteonecrosis has a multifactorial origin in which factors related to the patient, consequences of Covid-19 and CCS therapy add up to cause a reduction of blood supply and bone vitality until ON is triggered. A greater number of patients is needed to clarify the role of Covid-19 in the etiopathogenesis of knee ON.

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Section: Discussionmentioning

confidence: 91%

Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review

Zà

Papalia

Russo

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Grassi et al searched for viral RNA within synovial fluid and bone tissue samples taken post-mortem in patients who died of SARS-CoV-2 respiratory complications. Again, the results were negative [ 15 ]. To the best of our knowledge, this study is the first one searching for viral nucleic acid in vivo within bone tissue samples.…”

Section: Discussionmentioning

confidence: 99%

Detection of SARS-CoV-2 in Cancellous Bone of Patients with COVID-19 Disease Undergoing Orthopedic Surgery: Laboratory Findings and Clinical Applications

Guazzoni

Castelli

Polizzi

et al. 2022

IJERPH

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An emerging issue for orthopedic surgeons is how to manage patients with active or previous COVID-19 disease, avoiding any major risks for the surgeons and the O.R. personnel. This monocentric prospective observational study aims to assess the prevalence of SARS-CoV-2 viral RT-PCR RNA in cancellous bone samples in patients with active or previous COVID-19 disease. We collected data about 30 consecutive patients from our institution from January 2021 to March 2021 with active or previous COVID-19 disease. The presence of SARS-CoV-2 in the samples was determined using two different PCR-based assays. Eighteen of the thirty patients included in the study had a positive nasopharyngeal swab at the time of surgery. Twelve patients had a negative nasopharyngeal swab with a mean days since negativization of 138 ± 104 days, ranging from 23 to 331 days. Mean days of positivity to the nasal swab were 17 ± 17. Twenty-nine out of thirty (96.7%) samples were negative for the presence of SARS-CoV-2 RNA. In one sample, low SARS-CoV-2 load (Cycle threshold (Ct) 36.6.) was detected but not confirmed using an additional confirmatory assay. The conducted study demonstrates the absence of the viral genome within the analyzed cancellous bone. We think that the use of personal protection equipment (PPE) to only protect from aerosol produced during surgery, both in active and recovered patients, is not strictly necessary. We think that the use of PPE should not be employed by surgeons and the O.R. personnel to protect themselves from aerosols produced from the respiratory tract. Moreover, we think that our results could represent a valid basis for further studies related to the possibility of bone donation in patients that suffered and recovered from COVID-19.

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“…Despite significant research efforts to learn more about the pathogenesis of COVID-19, musculoskeletal involvement is understudied. However, there is scientific evidence [11,12], which report that RNA of SARS-CoV-2 was not detected in any of the knee joint samples: synovial fluid, synovial membrane and bone tissue, as well as in myocytes of muscle tissue, despite a positive result in samples of other tissues (sputum, nasopharyngeal secretions, blood and feces). During the past few months there have been isolated reports [13,14] about of cases SARS-CoV-2 RNA detection in the synovial fluid, which is associated with the development of arthritis on the background of a viral infection.…”

Section: Potential Cellular Targets Of the Musculoskeletal System For...mentioning

confidence: 99%

View of the Pathogenetic Mechanisms of Joint Damage in Coronavirus Disease 2019

Borodin¹,

Tuharov²,

Ostapchenko³

et al. 2022

BTSNUKSB

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The Сoronavirus disease 2019 (COVID-19) pandemic has had an extremely serious impact on the livelihoods of people worldwide. Despite the mainly respiratory manifestations of SARS-CoV-2 infection, its consequences can affect the functioning of most systems of organism, including the musculoskeletal, dysfunction of which is a leading factor in disability of the population. Diseases of the joints are one of the most common pathologie of modernity, which in the last decade are increasingly found in young people and even children. The musculoskeletal symptoms can be observed as isolated clinical signs and expressed regardless of the severity of the viral disease. Chronic fatigue, myalgia, swelling and joint pain may occur during the acute phase of COVID-19 and as short-term or long-term complications, but their prevalence has not been systematically studied. Considering the wide range of clinical manifestations of SARS-CoV-2 infection and the complexity of their pathogenesis, the mechanisms underlying lesions of musculoskeletal system and rheumatological complications remain unclear. Today, the main research in this direction is focused mainly on a complete understanding of the regulatory pathways of immune dysregulation and inflammation. Excessive secretion of pro-inflammatory cytokines, disruption of signal transduction and immune response are the result of the severe impact of SARS-CoV-2 infection on most organs, including joints, as well as the use of corticosteroids for the treatment of patients with COVID-19. The presented review highlights generalized information on the main pathophysiological processes that can occur in the joints as a manifestation of the impact of SARS-CoV-2 infection, and possible key mechanisms which contribute to the progression of pathological changes.

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SARS-CoV-2 in the knee joint: a cadaver study

Cited by 6 publications

References 20 publications

Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review

Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review

Detection of SARS-CoV-2 in Cancellous Bone of Patients with COVID-19 Disease Undergoing Orthopedic Surgery: Laboratory Findings and Clinical Applications

View of the Pathogenetic Mechanisms of Joint Damage in Coronavirus Disease 2019

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