Comparison of 2-octyl cyanoacrylate with polyester mesh with standard suture and staples in total knee and hip arthroplasty.

OBJECTIVE: The use of 2-octyl cyanoacrylate with polyester mesh (OCA-M) has become common in total hip and knee arthroplasty (THA, TKA). We aimed to compare the safety and cosmetic outcomes between OCA-M and standard suture techniques and staples, and determine whether OCA-M can safely be used for TKA. METHOD: Inclusion criteria were patients who underwent THA or TKA from January 2010 to October 2011 (Suture group), November 2011 to August 2013 (Staple group), March 2017 to September 2018 (OCA-M group). Exclusion criteria was loss of imaging data. Complications during hospitalisation (early complication) and after discharge (late complication) were compared in groups. Plastic and orthopaedic surgeons performed cosmetic evaluations with the modified Vancouver Scar Scale (VSS) and Likert scale at three and six months postoperatively and compared in groups. RESULTS: A total of 249 arthroplasties (suture group=88 patients; staple group=94 patients; OCA-M group=67 patients) were included in the study. The OCA-M group had a significantly lower early complication rate than the suture group (p=0.015). For THA, the OCA-M group had a significantly lower total complication rate than the suture group (p=0.048). For TKA, there was no significant difference among the three groups. The complication rate in the OCA-M group showed no significant difference between THA/TKA. With regards to the VSS, the OCA-M group was significantly better for cosmetic qualities than the suture group (p=<0.001, p=0.021 at three and six months, respectively). For the Likert scale, the OCA-M group was also significantly better for cosmetic qualities than the suture group and staple group (suture-OCA-M, p=0.003 (three months), p=<0.001 (six months); staple-OCA-M, p=0.027 (three months)). CONCLUSION: In this study, the OCA-M complication rate was low compared to suturing and similar to stapling. Moreover, better cosmetic outcomes were achieved compared to suturing and stapling.

Intrameniscal Gouty Tophi in the Knee: A Case Report.

CASE: We report a case of recurrent acute arthritis and restricted range of motion in the knee joint, with magnetic resonance imaging subsequently detecting a nodular lesion within the lateral meniscus. Knee arthroscopy and histology revealed that the lesion was intrameniscal gouty tophi. After arthroscopic synovectomy and excision of the tophi, the symptoms resolved and the patient remained symptom-free at two years of follow-up. CONCLUSION: Surgeons should be aware of the presence of such pathology and consider arthroscopic surgery if the mechanical symptoms persist.

Bony Landmarks of the Anterior Cruciate Ligament Tibial Footprint: A Detailed Analysis Comparing 3-Dimensional Computed Tomography Images to Visual and Histological Evaluations.

BACKGROUND: Although the importance of tibial tunnel position for achieving stability after anterior cruciate ligament (ACL) reconstruction was recently recognized, there are fewer detailed reports of the anatomy of the tibial topographic footprint compared with the femoral side. HYPOTHESIS: The ACL tibial footprint has a relationship to bony prominences and surrounding bony landmarks. STUDY DESIGN: Descriptive laboratory study. METHODS: This study consisted of 2 anatomic procedures for the identification of bony prominences that correspond to the ACL tibial footprint and 3 surrounding landmarks: the anterior ridge, lateral groove, and intertubercular fossa. In the first procedure, after computed tomography (CT) was performed on 12 paired, embalmed cadaveric knees, 12 knees were visually observed, while their contralateral knees were histologically observed. Comparisons were made between macroscopic and microscopic findings and 3-dimensional (3D) CT images of these bony landmarks. In the second procedure, the shape of the bony prominence and incidence of their bony landmarks were evaluated from the preoperative CT data of 60 knee joints. RESULTS: In the first procedure, we were able to confirm a bony prominence and all 3 surrounding landmarks by CT in all cases. Visual evaluation confirmed a small bony eminence at the anterior boundary of the ACL. The lateral groove was not confirmed macroscopically. The ACL was not attached to the lateral intercondylar tubercle, ACL tibial ridge, and intertubercular space at the posterior boundary. Histological evaluation confirmed that the anterior ridge and lateral groove were positioned at the anterior and lateral boundaries, respectively. There was no ligament tissue on the intercondylar space corresponding to the intercondylar fossa. In the second investigation, the bony prominence showed 2 morphological patterns: an oval type (58.3%) and a triangular type (41.6%). The 3 bony landmarks, including the anterior ridge, lateral groove, and intertubercular fossa, existed in 96.6%, 100.0%, and 96.6% of the cases, respectively. CONCLUSION: There is a bony prominence corresponding to the ACL footprint and bony landmarks on the anterior, posterior, and lateral boundaries. CLINICAL RELEVANCE: The study results may help create an accurate and reproducible tunnel, which is essential for successful ACL reconstruction surgery.

Early Postoperative Intratunnel Migration of an EndoButton After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Report.

CASE: We report a rare case of early postoperative migration of an EndoButton following anatomic double-bundle anterior cruciate ligament reconstruction with use of the EndoButton for femoral fixation. Although secure fixation of the EndoButton was confirmed during the operation, one-week postoperative radiographs revealed an intratunnel displacement of the posterolateral EndoButton. We performed a reoperation and refixed the EndoButton to the surface of the femoral cortex; we also hooked and tied both ends of the sutures to make a knot in order to prevent remigration. CONCLUSION: Orthopaedic surgeons should be aware that EndoButton displacement and migration could arise at an early postoperative stage.

A comparative study of induced pluripotent stem cells generated from frozen, stocked bone marrow- and adipose tissue-derived mesenchymal stem cells.

Bone marrow-derived mesenchymal stem cells (BMSCs) and adipose tissue-derived mesenchymal stem cells (AMSCs) have been used clinically for tissue regeneration; however, their proliferation/differentiation potentials are limited. Recently, induced pluripotent stem cells (iPSCs), known to have nearly unlimited potential to proliferate and differentiate into cells of all three germ layers, have gained wide interest in regenerative medicine. Here, we generated iPSCs from frozen-stocked AMSCs and BMSCs and examined their biological characteristics by comparative analyses. Although the iPSCs were more challenging to generate from the BMSCs than the AMSCs, both iPSC populations expressed pluripotent markers, such as stage-specific embryonic antigen (SSEA)-3, SSEA-4, tumour-related antigens (TRAs) TRA-1-60 and TRA-1-81, OCT3/4 and NANOG. Furthermore, both cell populations differentiated well into three germ layer-derived cells, both in vitro and in vivo. These results indicate that iPSCs derived from frozen AMSCs/BMSCs exhibit equally acceptable iPSC characteristics and have potential in clinical applications as an alternative source of autogenous stem cells.

Autofluorescence assessment of extracellular matrices of a cartilage-like tissue construct using a fluorescent image analyser.

For the assessment of tissue-engineered cartilage, easy and precise evaluation methods are anticipated. We have investigated the use of a fluorescent image analyser and the application of fluorescence intensity measurements to describe and evaluate a tissue-engineered cartilage-like tissue construct. We evaluated the matrix production of a tissue-engineered cartilage-like tissue (TCL) construct in vitro using the image analyser. The autofluorescence intensity of the TCL construct was determined using the image analyser driven by a software program after 1, 2, 3 and 4 weeks of culture. The autofluorescence intensity of the TCL construct gradually increased with increasing culture time. However, there was very little change in the autofluorescence intensity of gels without articular chondrocytes as controls. The relationship between the autofluorescence intensity of the TCL construct and the hydroxyproline content, reflecting the collagen content, was investigated. There was a significant correlation between the two items. Our findings demonstrate the ability of a commercial fluorescent image analyser to evaluate the matrix production of the TCL construct in vitro on the basis of objective data, such as the autofluorescence intensity. Therefore, the image analyser can be used to judge the success or failure of the in vitro culture process of TCL construct without a biopsy. Copyright © 2010 John Wiley & Sons, Ltd.

Generation of induced pluripotent stem cells from human adipose-derived stem cells without c-MYC.

Human adipose-derived stem cells (hASCs) are ubiquitous, plentiful, and easily/safely obtainable cells derived from adipose tissue, regardless of the age and sex of the donor. However, the hASCs have limited proliferative and differentiation capabilities. In this study, we examined whether induced pluripotent stem cells (iPSCs) could be generated from hASCs. We transduced hASCs with three human transcription factors (OCT3/4, SOX2, and KLF4), and found that they formed human embryonic stem cell (ESC)-like colonies. Importantly, we did not transduce c-MYC, which is usually utilized to generate iPSCs but is considered an oncogene. These colonies expressed human ESC-specific surface antigens (stage-specific embryonic antigens SSEA-3 and SSEA-4, and tumor-related antigens TRA-1-60 and TRA-1-81), endogenous transcription factors (OCT3/4, NANOG, and SOX2), and undifferentiated human ESC marker genes (REX1, UTF1, GDF3, DPPA2, DPPA4, and DPPA5). Further, the colonies were able to differentiate into the three germ layers both in vitro and in vivo. These results show that human iPSCs can be generated by the transduction of three factors (OCT3/4, SOX2, and KLF4) into hASCs.