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Table 3 Summary of key data and findings of assessed studies

From: Musculoskeletal pathology as an early warning sign of systemic amyloidosis: a systematic review of amyloid deposition and orthopedic surgery

Authors Total Subjects Male/ Female Mean Age (years) Orthopedic Pathology Biopsy location Key Findings
Akasaki et al. [35] 36 16/20 60.8 knee OA cartilage Young normal cartilage: 0% amyloid deposits, 0% TTR detected; Aged normal cartilage: 58% amyloid deposits, 83% TTR detected; OA cartilage: 100% amyloid deposits, 100% TTR detected
aus dem Siepen et al. [36] 466 373/93 63.7 CTS and LSS none Latency between CTR and diagnosis of systemic amyloidosis was significantly longer in ATTRwt compared to ATTRm (117 ± 179 months vs 66 ± 73 months; p=0.02)
Bishop et al. [15] 82 55/27 70.5 CTS none CTS associated with a longer delay in diagnosis (OR: 2.13; 95% CI 1.49–3.03) in 82 patients with AL or ATTR cardiomyopathy
Fernandez Fuertes et al. [37] 147 31/116 58 CTS TCL, FTS 29 of 147 (19.7%) of patients undergoing CTR had amyloid positive biopsies; 4 patients later developed systemic amyloidosis
Geller et al. [38] 151 137/14 74.7 Distal biceps rupture none 33.3% [95% CI, 24.7–42.9%] of 111 patients with ATTRwt cardiomyopathy had ruptured distal biceps tendon on exam
Gies et al. [39] 100 60/40 NS LSS LF 12 of 100 specimens from LSS and LDH patients contained amyloid; 5 contained very strong TTR presence
Gioeva et al. [14] 1020 351/669 61.8 CTS TCL 98 biopsies contained TTR amyloid;
70 of 81 patients with DNA sequencing had wildtype TTR gene
Gu et al. [23] 36 16/20 66.4 knee OA knee synovium 9 of 36 knee OA patients had amyloid positive biopsies;
8 contained TTR amyloid and 1 contained light-chain amyloid
Kyle et al. [40] 35 23/12 71 CTS TCL, FTS 33 of 35 had TTR amyloid; 2 developed systemic amyloidosis
Nakamichi et al. [41] 108 5/103 56 CTS TCL, FTS 10 of 108 patients had amyloid deposits, 6 contained TTR amyloid
Niggemeyer et al. [42] 50 14/36 68.4 Hip OA synovium, cartilage 17 of 50 consecutive patients had amyloid deposits, all contained TTR amyloid
Rubin et al. [27] 313 234/79 66.6 knee and hip OA, rotator cuff none THA and TKA significantly more common among ATTR patients with cardiomyopathy (THA: RR 5.61, 95% CI 2.25–4.64; TKA: RR 3.32, 95% CI 2.25–4.64)
Samões et al. [43] 16 3/13 46.1 CTS TCL In 16 patients with known ATTRm, 15 patients had CTS that preceded amyloidosis and 14 had amyloid positive biopsies
Scott et al. [44] 35 16/19 72 recurrent CTS FTS 9 of 35 patients (26%) with recurrent CTS had an amyloid positive biopsy, 7 of which contained TTR
Sekijima et al. [18] 132 40/92 71.8 CTS FTS 34 of 100 patients with idiopathic CTS had TTR amyloid deposits versus 7 of 32 autopsy controls (OR, 15.8; 95% CI, 3.3–75.7)
Sperry et al. [45] 98 51/47 68.5 CTS FTS 10 of 98 patients undergoing CTR had an amyloid positive biopsy (7 TTR, 2 light chain); 3 diagnosed with systemic amyloidosis
Stein et al. [46] 108 NS NS CTS TCL Amyloid deposits were found in 23 of 108 (21%) patients with idiopathic CTS; TTR was identified in 14 of these 23 patients
Sueyoshi et al. [13] 111 56/55 62 CTS, LSS, rotator cuff FTS, LF, RCT 39 of 111 specimens contained TTR amyloid deposits
Takanashi et al. [25] 232 31/201 73 knee OA synovium 21 of 232 knee OA patients (9%) had TTR amyloid deposits
Uchihara et al. [47] 25 NS NS NS periarticular F&A 3 of 25 specimens contained TTR amyloid
Westermark et al. [20] 26 13/13 66.5 LSS LF, bone fragments 21 of 26 specimens contained amyloid deposits; 5 of 15 specimens suitable for immunohistochemistry contained TTR amyloid
Yanagisawa et al. [21] 95 68/27 70.7 LSS LF All 95 LF specimens resected from LSS patients contained amyloid deposits; 43 contained TTR amyloid
Yanagisawa et al. [26] 52 17/35 66.6 knee OA periarticular knee TTR amyloid deposits were found in specimens from: 18 of 51 menisci, 8 of 27 articular cartilage, and 6 of 34 synovium
Zegri-Reiriz et al. [48] 101 32/69 69 CTS none, myocardial Prevalence of cardiac amyloidosis in the cohort was 1.2% (3/233) and 5.5% (3/55) for patients with LVH and bilateral CTS
  1. CI confidence interval, CTS carpal tunnel syndrome, DNA deoxyribonucleic acid, F&A foot and ankle, FTS flexor tenosynovium, LF ligamentum flavum, LDH lumbar disc herniation, LSS lumbar spinal stenosis, LVH left ventricular hypertrophy, NS not specified, OA osteoarthritis, OR odds ratio, RCT rotator cuff tendon, RR relative risk, TCL transverse carpal ligament, THA total hip arthroplasty, TKA total knee arthroplasty