Background: Regenerative medicine has been an increasing trend in the management of articular cartilage defects in recent years. Untreated chondral lesions in young adults invariably progress to degenerative joint disorders. Reparative techniques such as bone marrow stimulation, and autologous chondrocyte implantation (ACI) are being used with certainly proven drawbacks. To overcome the disadvantages, recent research and our experimental study proposed to grow cultured chondrocytes in a biodegradable scaffold (matrix-assisted autologous chondrocyte implantation-mACI) to provide good stability and chondrogenic potential to the construct.
Methods: We have tested a novel 3-dimensional biological scaffold composed of chitosan, chondroitin sulfate, and silk biopolymers impregnated with autologous cultured chondrocytes and it is further enhanced using platelet-rich plasma (PRP) is recommended proportion on the animal experimental model. 3x3x2.5mm chondral defect was created in the articular surface of the distal femur.9 test rabbits were implanted with this cell-seeded PRP enriched scaffold, in 3 control rabbits defect area was filled with a cell-free scaffold (right knee) and remained void with defect (left knee). They were sacrificed at regular intervals(12,20&32weeks), then studied grossly, histologically, and radiologically using microCT was used to compare the outcome statistically.
Results: The results showed better quality of cartilage tissue, scaffold-chondrocyte interaction, scaffold anchorage, less fibrotic growth, better amalgamation with the surrounding epithelium, uptake at the bed, and regular proliferative growth at serial intervals.
Conclusion: Usage of non-synthetic chondrogenic biodegradable scaffolds coupled with growth-enhancing platelet-rich plasma may be a step ahead in the matrix-assisted autologous chondrocyte implantation technique with promising better results.

Introduction: Both pro-inflammatory and anti-inflammatory cytokines play a leading role in progression as well as control of infection by Mycobaceterium tuberculosis (Mtb). The distinctive biology of osseous tissue and the local tissue microenvironment in spinal tuberculosis lesions mandates that TB pathogens acclimatize to these alternate anatomical sites. Understanding and unravelling the interactions between host tissue and Mtb can have potential implications in diagnostics in terms of being a ground for development of immune-based assays. We hypothesized that Mtb remodels inflammatory cytokine response in osteoclasts to potentiate their function - clinical Mtb strains reproportionate TNF-/IL-10 axis to dictate cellular fate for presentation of extra-pulmonary tuberculosis in spinal tuberculosis. Methods: This collaborative study was carried out in two phases: Phase-I was an experimental animal study, and Phase II was a prospective cohort clinical study. For animal experiments, age- and sex-matched KO (knock-out) mice and co-housed wild type animals between 6-8 weeks of age were used. Precursor macrophage cells isolated from mice were infected with Mtb H37Rv-Gfp/AdosR strain. This was followed by quantification of the cytokine response and microarray analysis of the Mtb infected cells. Based on the results of the Phase I study - in the Phase II clinical study, we measured the serum levels of TNF-α, IFN-γ, IL-10, IL-4, IL 12p70, IL-17A, IL-8, IL-6, IL-2 in patients with spinal tuberculosis, pulmonary tuberculosis, pyogenic osteomyelitis, and healthy subjects. Comparisons between groups were done using appropriate statistical tests. Results: Mtb infected mononuclear cells actively fused with MNCs resulting in the formation of larger osteoclasts after infection. Mtb could substantially alter cellular programming to produce large osteoclast and the initial trigger of lineage commitment through RANKL was sufficient to produce mature bone resorbing cells. Analysis of TNF- and hypoxia regulatory genes showed upregulation of approximately 90% genes in the pathway at either one or multiple time-points during infection. Mtb manifested its osteoclast potentiating function by diminishing RANK signaling and simultaneously activating TLR2-dependant MyD88 regulated TNF- pathway via TNFR1 receptor. In our Phase II study, we noted that barring IL-6 and IFN-γ, the extent of increase in the levels of the other 7 biomarkers (IL-2, IL-8, TNF-α, IL-10, MMP2, MMP-9 and TRAP) was much more in patients with spinal tuberculosis, when compared to patients with pulmonary tuberculosis and non-tubercular, osteoarticular infection. Conclusion: Our studies reveal an interactive network consisting of TNF--HIF-1-IL-10-RANK which may be a central axis operative in Mtb infected osteoclasts during spinal tuberculosis. Tissue-specific immune pathogenesis of spinal tuberculosis can help identify host serum biomarkers with potential diagnostic implications.

Purpose: Arthroscopic capsular release (ACR) & Manipulation under anaesthesia (MUA) have been widely used in the treatment of frozen shoulder (FS). However, there is only limited Level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a randomised trial comparing ACR versus MUA to assess the difference in outcome, complications and cost-effectiveness of both procedures. Methods: From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR(n=44) and MUA(n=41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement(ROM), pain grading using visual analogue scale(VAS), functional scores- UCLA, CONSTANT & EuroQol-5D scores were measured pre-operatively & postoperatively. MRI was done at 3 weeks postoperatively for screening complications of either procedure. Quality-adjusted life years (QALY)was used for cost-analysis. Results: Postoperatively patients had significant improvement in pain, ROM & functional scores in both groups(P<0.001) with no significant difference between groups at 24 weeks follow up. Diabetic patients had inferior outcomes in terms of improvement in ROM & constant scores when compared to non-diabetic patients. Labral tears in MUA group & bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD. Conclusion: Both ACR & MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique & better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.

Introduction: Highly crosslinked polyethylene (HXLPE) has been used with great clinical success in total hip arthroplasty (THA) since its debut in the late 1990’s. However, reports regarding this bearing couple near the end of its second decade of service are still scant. The aim of this study was to 1. Determine the long term clinical and radiological results and 2. Investigate what factors affect wear rates using a metal-on-HXLPE bearing articulation. Patients and methods: 55 THAs using a single brand of highly crosslinked liner, cementless cup and 28mm hip ball were performed in 44 patients. Age, sex, Charlson Comorbidity Index (CCI) and need for revision surgery were recorded. Linear and volumetric wear was determined using the Martell method. Results: Mean age at operation was 51.2 (29-73 +/- 12.1) years. Mean duration of follow-up was 16.9 years (range 15.0-20.1 +/- 1.1 years). Osteolysis was not present in the latest follow-up radiographs. Median linear and volumetric wear rate was 0.038mm/year (95% CI 0.032-0.047) and 7.115mm3/year (95% CI 6.92-17.25) respectively. Acetabular component position was not found to be related to both linear and volumetric wear. No significant difference was found in the linear and volumetric wear rates of thinner and thicker liners (8mm or below and > 8mm) (p=0.849 and p=0.64 respectively). Conclusion: Metal-on-HXLPE is associated with low linear and volumetric wear rates which has virtually obviated osteolysis and has translated to excellent survivorship even at long term follow up. In-vivo oxidation does not appear to be of clinical concern at this point.

Giant cell tumors (GCT) of the spine are aggressive benign primary bone neoplasms, GCTs of the spine reportedly account for 2.7-6.5% of all GCTs in bone. Early-stage resection is the best strategy for GCT treatment with a low recurrence rate. Denosumab chemotherapy can effectively shrinkage tumors. Conventionally, curettage or piecemeal excision of vertebral tumors has been commonly practiced for GCT excision but it may lead to incomplete resection of GCT and high local recurrence. This surgical technique note reports the case of middle thoracic vertebra GCT which causes collapse of vertebral body and treatment with total en bloc resection. A 14-year-old-girl presented with gradual middle back pain with paraparesis. MRI demonstrated T5 vertebra plana, CT guided biopsy suggest of GCT. Following three-month neoadjuvant denosumab therapy, total en bloc GCT resection, fusion, and posterior stabilization were performed. Postoperatively the patient was completely recovered. At two year follow-up CT-scan shows complete fusion at the operative level without recurrence. Total en bloc GCT resection is not feasible in most cases. Despite the location and close contact of the lesion with the spinal cord, en bloc GCT resection was successful for our case. Neoadjuvant denosumab can be effective and it reduces the complexity of tumor.