Microfractures Versus a Porcine-Derived Collagen-Augmented Chondrogenesis Technique for Treating Knee Cartilage Defects: A Multicenter Randomized Controlled Trial.

PURPOSE: The purpose of this study was to evaluate the clinical efficacy and safety of treating patients with a cartilage defect of the knee with microfractures and porcine-derived collagen-augmented chondrogenesis technique (C-ACT). METHODS: One hundred participants were randomly assigned to the control group (n = 48, microfracture) or the investigational group (n = 52, C-ACT). Clinical and magnetic resonance imaging (MRI) outcomes were assessed 12 and 24 months postoperatively for efficacy and adverse events. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) assessment was used to analyze cartilage tissue repair. MRI outcomes for 50% defect filling and repaired tissue/reference cartilage (RT/RC) ratio were quantified using T2 mapping. Clinical outcomes were assessed using the visual analogue scale (VAS) for pain and 20% improvement, minimal clinically important difference (MCID), and patient acceptable symptom state for Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee score. RESULTS: MOCART scores in the investigation group showed improved defect repair and filling (P = .0201), integration with the border zone (P = .0062), and effusion (P = .0079). MRI outcomes showed that the odds ratio (OR) for ≥50% defect filling at 12 months was statistically higher in the investigation group (OR 3.984, P = .0377). Moreover, the likelihood of the RT/RC OR becoming ≥1 was significantly higher (OR 11.37, P = .0126) in the investigation group. At 24 months postoperatively, the OR for the VAS 20% improvement rate was significantly higher in the investigational group (OR 2.808, P = .047). Twenty-three patients (52.3%) in the control group and 35 (77.8%) in the investigation group demonstrated more than the MCID of KOOS pain from baseline to 1 year postoperatively, with a significant difference between groups (P = .0116). CONCLUSION: In this multicenter randomized trial, the addition of C-ACT resulted in better filling of cartilage defect of the knee joint. LEVEL OF EVIDENCE: Level Ⅰ, Multicenter Randomized Controlled Trial.

Early experience of lateral hinge fracture during medial opening-wedge high tibial osteotomy: incidence and clinical outcomes.

PURPOSE: Lateral hinge fracture (LHF) during a medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be the main cause of instability, further displacement, loss of correction, malunion, and nonunion. The purposes of this study were to evaluate whether the incidence of LHFs during MOWHTOs has decreased as the number of cases performed over time has increased, and whether the radiographic and clinical outcomes of patients with LHFs were worse than those of patients without LHFs. MATERIALS AND METHODS: During the period of July 2013 to January 2017, 132 MOWHTOs were performed by a single surgeon using a locking plate (TomoFix®, DePuySynthes, Solothurn, Switzerland) for the treatment of medial compartment osteoarthritis, with LHFs postoperatively detected in 32 knees (24.2%). To evaluate trends in the incidence of LHFs occurring during MOWHTOs over time, all 132 cases were divided chronologically into four groups of 33 cases and compared. The time for bony union and loss of correction were compared between the LHF group and the non-LHF group using an osteotomy filling index, hip-knee-ankle (HKA) angles, medial proximal tibial angles (MPTA), weight-bearing line (WBL) ratios, and posterior tibial slope (PTS) angles on radiographs. Clinical outcomes were also compared using the Knee Society Scores (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores 1 year post-surgery. RESULTS: The incidence of LHFs in each group of 33 cases did not decrease over time (21.2%, 27.3%, 24.2%, and 24.2%, respectively, p = 0.954). The time to union was significantly different between the non-LHF group (5.0 months) and the LHF group (7.3 months) (p < 0.001). However, there were no immediate or 1-year postoperative differences in the HKA angles, MPTAs, WBL ratios, or PTS angles between the non-LHF and LHF groups (all p > 0.05). The KSS and WOMAC scores were significantly improved in both groups (all p < 0.001) 1 year post-surgery, without any differences between the groups (p = 0.997 and p = 0.122, respectively). CONCLUSIONS: LHFs during MOWHTO procedures occurred consistently, with a similar incidence over time. Although patients with LHFs required more time to bony union, they showed similarly favorable radiographic and clinical results as the patients without LHFs 1 year after surgery.

Patients undergoing total knee arthroplasty using a contemporary patella-friendly implant are unaware of any differences due to patellar resurfacing.

PURPOSE: Anterior knee pain after total knee arthroplasty (TKA) is often unexplained, spurring ongoing debates on the need for patellar resurfacing. It was hypothesized that a contemporary patella-friendly implant would restore patellofemoral kinematics more physiologically than outdated implants and that there would be no perceived or clinically demonstrable differences due to resurfacing of patella (RP). METHODS: This prospective bilateral randomized study was undertaken in 49 patients scheduled for the same-day bilateral TKAs. One knee was subjected at random to RP while withholding RP on the opposing side (non-RP). A recently approved single-radius femoral prosthesis featuring a deep, elongate trochlear groove with lateral tilt and a high lateral flange was implanted bilaterally in all patients. Mean follow-up duration was 5 years. Group comparisons were based on patient-reported outcomes [anterior knee pain, Forgotten Joint Score (FJS), and side preference], physician-rated results [Feller patellofemoral (PF) score], radiographic patellar position, patella-related complications, and need for reoperation. RESULTS: There were no differences in midterm rates of anterior knee pain (RP 8%; non-RP 4%; n.s.), FJS (all n.s.), or side preference (RP 47%; non-RP 45%; n.s.), nor did the groups differ by Feller PF score (all n.s.) or radiographic patellar position (all n.s.). No secondary resurfacings of non-RP or RP revisions were required. CONCLUSIONS: Patients were incapable of distinguishing whether RP was done, casting doubt on its benefits. Surgeons may thus forego RP during TKA when using contemporary patella-friendly TKA implants. LEVEL OF EVIDENCE: Therapeutic study, Level I.

Enhancement of Healing of Long Tubular Bone Defects in Rabbits Using a Mixture of Atelocollagen Gel and Bone Marrow Aspirate Concentrate.

We evaluated the bone-forming potential of a mixture of atelocollagen and bone marrow aspirate concentrate which was transplanted into bone defects. Radial shaft defects of about 10 mm in size were created in 30 New Zealand white rabbits. Ten rabbits in the control group were not treated further, 10 rabbits in the first experimental group (E1) received an atelocollagen injection, and 10 rabbits in the second experimental group (E2) received an injection of a mixture of atelocollagen and bone marrow aspirate concentrate. The groups were compared radiologically at 8 weeks. Osteogenesis in group E2 progressed more rapidly than that in the other groups, and osteogenesis in group E1 progressed faster than that in the control group. Thus, the administration of a mixture of atelocollagen and bone marrow aspirate concentrate in bone defects was found to enhance bone defect healing.

Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study.

BACKGROUND: Failure after total knee arthroplasty (TKA) may be related to emerging technologies, surgical techniques, and changing patient demographics. Over the past decade, TKA use in Korea has increased substantially, and demographic trends have diverged from those of Western countries, but failure mechanisms in Korea have not been well studied. QUESTIONS/PURPOSES: We determined the causes of failure after TKA, the risk factors for failure, and the trends in revision TKAs in Korea over the last 5 years. METHODS: We retrospectively reviewed 634 revision TKAs and 20,234 primary TKAs performed at 19 institutes affiliated with the Kleos Korea Research Group from 2008 to 2012. We recorded the causes of failure after TKA using 11 complications from the standardized complication list of The Knee Society, patient demographics, information on index and revision of TKAs, and indications for index TKA. The influences of patient demographics and indications for index TKA on the risk of TKA failure were evaluated using multivariate regression analysis. The trends in revision procedures and demographic features of the patients undergoing revision TKA over the last 5 years were assessed. RESULTS: The most common cumulative cause of TKA failure was infection (38%) followed by loosening (33%), wear (13%), instability (7%), and stiffness (3%). However, the incidence of infections has declined over the past 5 years, whereas that of loosening has increased and exceeds that of infection in the more recent 3 years. Young age (odds ratio [OR] per 10 years of age increase, 0.41; 95% confidence interval [CI], 0.37-0.49) and male sex (OR, 1.88; 95% CI, 1.42-2.49) were associated with an increased risk of failure. The percentage of revision TKAs in all primary and revision TKAs remained at approximately 3%, but the annual numbers of revision TKAs in the more recent 3 years increased from that of 2008 by more than 23%. CONCLUSIONS: Despite a recent remarkable increase in TKA use and differences in demographic features, the causes and risk factors for failures in Korea were similar to those of Western countries. Infection was the most common cause of failure, but loosening has emerged as the most common cause in more recent years, which would prompt us to scrutinize the cause and solution to reduce it.

Autologous collagen-induced chondrogenesis using fibrin and atelocollagen mixture.

For articular cartilage defect treatment, many treatment modalities have been developed. We evaluate the cartilage repair potential of an atelocollagen and fibrin mixture transplanted to cartilage defects. A circular, articular cartilage defect 4 mm in diameter was made in the trochlear region in each of 20 New Zealand white rabbits. The 10 rabbits in the control group were kept without treatment and the 10 rabbits in the experimental group underwent injection of atelocollagen mixed with fibrin. At week 12 following surgery the cartilage was observed and histologically compared in both groups. The surface of the newly generated cartilage was very smooth and even, and we also noted that the entire area was completely regenerated in the experimental group. The control group showed incomplete and irregular cartilage formation in the defect. Regarding the histological scoring, comparison of the two groups differed significantly (p < 0.001). Injection of a mixture of atelocollagen and fibrin used to treat articular cartilage defects of the knee appears to be an effective method for cartilage regeneration.

Treatment of osteonecrosis in the knee joint of a rabbit using autologous cultured osteoblasts.

BACKGROUND: [corrected] To develop a successful treatment modality for osteonecrosis, an appropriate animal model is essential. We have proposed a new osteonecrosis model that shows the total amount of necrosis and in which we observed new bone formation after transplanting autologous cultured osteoblasts. MATERIALS AND METHODS: The femoral condyles of the right knees of New Zealand white rabbits were exposed after dissecting the ligaments surrounding the distal femur. After which, the metaphyseal-diaphyseal junction was cut using a saw, and the entire femoral condyle was isolated. After three liquid nitrogen treatments, the isolated femoral condyle was internally fixated to the femoral shaft using two or three Kirschner wires. Bone marrow isolated from the iliac crest was cultivated to differentiate it into osteoblasts, and the cultured cells were then injected into the necrotic bone. RESULTS: Viable osteocytes with well-stained nuclei were not present in the necrotic areas at any stage of the development of the osteonecrosis model within 24 wk after osteonecrosis induction. However, new bone formation with osteocytes and blood vessels was observed in the necrotic bone 12 wk after transplanting the autologous cultured osteoblasts. CONCLUSIONS: The distal femoral condyle of the rabbit is an appropriate model for demonstrating osteonecrosis and treatment evaluation owing to its easy reproducibility and treatment interpretation. Therefore, autologous cultured osteoblast treatment would seem to be a potentially successful treatment modality for osteonecrosis.

Biomechanical comparison of three techniques for fixation of tibial avulsion fractures of the anterior cruciate ligament.

PURPOSE: To evaluate the initial stability of a suture anchor fixation and to compare this with a screw fixation and pull-out suture fixation for anterior cruciate ligament tibial avulsion fracture. METHODS: The initial fixation strength of 3 different fixation techniques, antegrade cannulated screw fixation, pull-out suture fixation with Ethibond and bioabsorbable knotless suture anchor fixation, was evaluated. Using 14 fresh cadavers (28 knees), the strength to failure, initial displacement and mode of failure were measured. RESULTS: The strength to failure of the suture anchor fixation was not significantly different from that of the screw fixation and was higher than that of the pull-out suture fixation. The initial displacement of the suture anchor fixation was lower than that of the screw fixation and the pull-out suture fixation. The majority of the suture anchor fixations and the screw fixations were failed by pull-out from the bone. Eight of the 56 suture anchor fixations failed by pull-out of the suture from the ligament proper. And, one of the 7 screw fixations failed due to fracture of the avulsed bony fragment. All of the pull-out suture fixations failed by suture material rupture. CONCLUSIONS: These biomechanical results suggest that the initial fixation strength of suture anchor fixation was not less than that of screw fixation or pull-out suture fixation. And, the initial displacement of suture anchor fixation was lower than that of screw fixation or pull-out suture fixation. The suture anchor fixation appears to be a good alternative fixation technique for repair of anterior cruciate ligament tibial avulsion fracture.

Gel-type autologous chondrocyte (Chondron) implantation for treatment of articular cartilage defects of the knee.

BACKGROUND: Gel-type autologous chondrocyte (Chondron) implantations have been used for several years without using periosteum or membrane. This study involves evaluations of the clinical results of Chondron at many clinical centers at various time points during the postoperative patient follow-up. METHODS: Data from 98 patients with articular cartilage injury of the knee joint and who underwent Chondron implantation at ten Korean hospitals between January 2005 and November 2008, were included and were divided into two groups based on the patient follow-up period, i.e. 13~24-month follow-up and greater than 25-month follow-up. The telephone Knee Society Score obtained during telephone interviews with patients, was used as the evaluation tool. RESULTS: On the tKSS-A (telephone Knee Society Score-A), the score improved from 43.52 +/- 20.20 to 89.71 +/- 13.69 (P < 0.05), and on the tKSS-B (telephone Knee Society Score-B), the score improved from 50.66 +/- 20.05 to 89.38 +/- 15.76 (P < 0.05). The total improvement was from 94.18 +/- 31.43 to 179.10 +/- 24.69 (P < 0.05). CONCLUSION: Gel-type autologous chondrocyte implantation for chondral knee defects appears to be a safe and effective method for both decreasing pain and improving knee function.

Usefulness of multi-detector CT in Boyd-Griffin type 2 intertrochanteric fractures with clinical correlation.

OBJECTIVE: To investigate the usefulness of multi-detector computed tomography (MDCT) in three-part intertrochanteric fractures of proximal femur. MATERIALS AND METHODS: Twenty-six patients with Boyd-Griffin type 2 intertrochanteric fractures with MDCT (group 1) and 36 patients of the same type fracture without MDCT (group 2) were compared. Lesser trochanter (LT)/greater trochanter (GT) volume ratio above 0.5 or the volumetric proportion of GT in total volume of proximal femur below 25% was considered an unstable fracture. The fractures were fixed with dynamic compression hip screws (DCS). Additional greater trochanter stabilizing (GTS) plate or bone cement augmentation of the femoral head was performed in unstable fractures. Clinical outcome between the two groups by fixation failure and radiological results was compared. RESULTS: The volume ratio of the LT/GT was 0.33 (range, 0.13-0.73). The volume of the LT was inversely correlated with that of the GT (p < 0.001). The volume of the GT was significantly correlated with the LT/GT ratio or the head and neck (HN)/GT ratio (p < 0.001). Seven cases were regarded as unstable fractures in group 1. Fixation failures happened in one case in group 1 and five cases in group 2. There was significantly lower failure rate in group 1 than group 2 (p = 0.03). Neck-shaft angle at last follow-up was 134.8 degrees +/- 5.3 in group 1 and 131.3 degrees +/- 5.1 in group 2 (p = 0.01). The sliding length of lag screws were 5.6 degrees +/- 2.9 mm in group 1 and 8.3 degrees +/- 3.2 in group 2 (p = 0.03). CONCLUSION: Preoperative use of MDCT provides useful information about the fracture pattern and the geometry of the proximal femur in unstable intertrochanteric fractures and helps surgical planning. The ratio of the LT to the GT is inversely correlated with fracture stability.

Effect of total knee arthroplasty on metabolic syndrome.

The purpose of this study was to evaluate the effect of changing activity after total knee arthroplasty (TKA) on metabolic syndrome with a follow-up period of 2 years. Two hundred consecutive patients who were to undergo TKA were prospectively enrolled. The patients' blood pressure, fasting plasma glucose level, the lipid profile, the waist circumference, the Knee Society score, and the Lower Extremity Activity Scale were measured preoperatively and at the 2-year follow-up visit. The data from 169 patients were finally collected and reviewed. Two years after primary TKA, there was no change in the prevalence of metabolic syndrome, despite that the patients had a significant increase of their physical activity.

Agreements between different methods of gap balance estimation in cruciate-retaining total knee arthroplasty.

The authors investigated the agreements between three different methods of estimating gap balance in cruciate-retaining (CR) total knee arthroplasty (TKA) with the use of a subvastus approach. One hundred consecutive CR TKAs were prospectively included in this study. After completing soft tissue release and bone cutting for CR TKA, flexion-extension gap balance was assessed using a distractor, spacer blocks, and trial components. Levels of agreement between the estimation techniques used were substantial. All three techniques were reliable in the assessment of gap balance. But, observations made during this study suggest that if more than one estimation technique is applied during CR TKA, the incidence of undetected gap imbalance can be reduced.

Factors affecting flexion gap tightness in cruciate-retaining total knee arthroplasty.

With the exception of flexion gap tightness, which is common in cruciate-retaining (CR) total knee arthroplasty (TKA), the risk factors of flexion gap tightness have not been described. This retrospective study characterized factors that are associated with flexion gap tightness in CR TKA. Data on 203 consecutive knees that underwent CR TKA were reviewed. The prevalence rate of flexion gap tightness was 21.1%. By logistic regression analysis after adjusting for age, preoperative flexion contracture, and referencing method used for femoral sizing, insufficient tibial slope remained a significant independent risk factor of flexion gap tightness. Although excessive tibial slope should be avoided, the findings of the present study demonstrate that the risk of flexion gap tightness can be reduced by increasing the tibial slope in CR TKA.

Predictive factors for satisfaction after contemporary unicompartmental knee arthroplasty and high tibial osteotomy in isolated medial femorotibial osteoarthritis.

INTRODUCTION: Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are viable treatment options for early osteoarthritis (OA). Although a substantial proportion of the patient selection criteria for HTO and UKA are now shared, the factors related to satisfaction following each procedure remain unclear. HYPOTHESIS: We hypothesized that patient factors associated with satisfaction following contemporary HTO and UKA would be different. MATERIAL AND METHODS: We retrospectively reviewed the records of consecutively enrolled medial opening-wedge HTOs (n=123) and Oxford mobile-bearing UKAs (n=118) with satisfactory postoperative alignment. Preoperative demographics, physical activity levels, varus deformity status, and degree of OA were recorded. Postoperative radiographs, frequency of combined procedures and patient-reported outcomes (PROs) including pain, Western Ontario and McMaster Universities Osteoarthritis Index score, and patient satisfaction were assessed. RESULTS: Severe OA (p<0.01) was associated with an increased risk of dissatisfaction following HTO, whereas young age (p<0.01) and severe varus deformity (p=0.045) were related to dissatisfaction after UKA. In addition, patient satisfaction following UKA was higher than that following HTO in individuals with highly physically demanding activity. All UKA PROs were superior to those of the HTO group, except pain level. CONCLUSION: Despite the shared patient selection criteria for contemporary HTO and UKA, severe OA was associated with dissatisfaction following HTO, whereas young age and varus deformity were associated with dissatisfaction following UKA. Age, varus deformity and OA severity should be considered when deciding whether to perform HTO or UKA. TYPE OF STUDY AND LEVEL OF PROOF: Retrospective cohort study, Level III.

Duloxetine Reduces Pain and Improves Quality of Recovery Following Total Knee Arthroplasty in Centrally Sensitized Patients: A Prospective, Randomized Controlled Study.

BACKGROUND: Unexplained postoperative pain is one of the most feared complications of total knee arthroplasty (TKA). A persistent noxious peripheral stimulus, such as the pain of chronic knee osteoarthritis, can cause central sensitization in which the central nervous system becomes hyperexcitable, resulting in hypersensitivity to both noxious and non-noxious stimuli. Patients with central sensitization may be more susceptible to unexplained pain after TKA. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor (SNRI), can ameliorate the pain associated with central sensitization, and we aimed to determine whether it could reduce postoperative pain and improve quality of recovery after TKA in patients with central sensitization. METHODS: Patients undergoing TKA were screened for central sensitization preoperatively with use of the Central Sensitization Inventory (CSI). Among 464 patients with primary osteoarthritis who were scheduled for primary unilateral TKA, 80 were identified as being centrally sensitized and were included in the study. Forty patients were randomly assigned to the duloxetine group (30 mg 1 day before surgery and for 6 weeks after surgery), and 40 were randomized to the control group (no duloxetine). Pain and quality of recovery were assessed with use of the Brief Pain Inventory (BPI), the Short Form-36 (SF-36), the Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP), and the Hamilton Depression Scale. The prevalence of adverse medication effects was also noted. RESULTS: The patients in the duloxetine group had better performance across pain metrics during the initial 2 to 12-week postoperative period (p < 0.05). The duloxetine group also had a superior quality of recovery 2 weeks after TKA, as indicated by emotional and physical functioning (all p < 0.05). There was no difference between groups in the prevalence of adverse events. CONCLUSIONS: A substantial number of patients are centrally sensitized before TKA. Surgeons should consider selective incorporation of duloxetine into the multimodal postoperative analgesic protocol, according to the severity of central sensitization, to minimize the possibility of persistent pain following TKA. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Preliminary results of high fibular osteotomy (HFO) and cartilage regeneration procedure for medial compartment osteoarthritis of knee with varus deformity.

PURPOSE: High fibular osteotomy (HFO) is a simple surgical technique to reduce pain and improve function in patients with osteoarthritis via fibular osteotomy. We report short-term results of HFO and mesenchymal cell induced chondrogenesis (MCIC) for the treatment of osteoarthritis of knee with varus deformity. PATIENTS AND METHODS: 45 symptomatic patients with 14 males and 31 females age ranging from 40 to 75 years were treated by HFO and MCIC. Main lesions involved medial compartment of knee and lateral compartment with normal to mild lesions of lateral meniscus and articular cartilage, amenable to treatment via partial meniscectomy or observation. RESULTS: Knee injury and Osteoarthritis Outcome score and Lysholm showed a statistically significant increase and VAS, varus angle in X-ray showed a statistically significant decrease. A statistically significant difference between preoperative and postoperative scores was detected in male and female patients without any sexual differences. CONCLUSION: High fibular osteotomy and mesenchymal cell induced chondrogenesis can be considered as a good treatment option for medial compartment osteoarthritis of knee with varus deformity.

Arthroscopic posterior cruciate ligament augmentation using an autogenous hamstring tendon graft and the posterior-posterior triangulation technique.

We describe a modification of the currently practiced arthroscopic posterior cruciate ligament (PCL) reconstruction techniques. We augmented the injured PCL with quadrupled autogenous hamstring tendon grafts using the arthroscopic posterior-posterior triangulation method and a single-incision transtibial approach. The tibial drill guide was introduced through the anteromedial portal and positioned onto the fossa for the PCL on the tibia under arthroscopic guidance from the posterolateral portal. The femoral tunnel was made 10 mm posterior to the articular cartilage of the medial femoral condyle by use of the anterior cruciate ligament Beath pin (Arthrex, Naples, FL) introduced through the far-inferior anterolateral portal. The tendon graft was positioned in the knee joint by use of the tibial and femoral double-folded silk loops that traversed the bony tunnels. The graft was fixed by use of bioabsorbable Intrafix screw systems (DePuy Mitek, Raynham, MA) at both the ends. The arthroscopic posterior-posterior triangulation method provides adequate exposure of the posterior knee compartment; this allows for convenient instrumentation and safe and accurate placement of the bony tunnels with preservation of the PCL remnants. We believe that retention of the remnant PCL fibers is biologic and contributes to earlier healing and strengthening of the tendon graft.

Posterior "Double Cannular Sliding Technique" for Resection of Posterior Septum of the Knee Joint.

We introduce the posterior double cannular sliding technique, which is an easy, fast, safe, and reproducible method for posterior septum resection of the knee joint. Several posterior compartment procedures have been developed. Procedures with anterior-posterior approaches (transnotch approach) and posterior-posterior approaches have become possible for arthroscopic total synovectomy and loose body removal. For resection of the posterior septum with posterior-posterior approaches, several authors have used various methods. However, although previous studies reported posterior septum resection in the posterior portal, or perforation of the posterior septum by blind vision or transnotch approach, specific postperforation techniques to resect the posterior septum have not been reported. Furthermore, methods of posterior septum resection remain difficult to perform using posterior portal arthroscopy, with difficulties in the approach and in achieving reproducible outcomes. Thus, we introduce the posterior double cannular sliding technique, which is a reproducible method that uses 2 transparent cannulas and a switching stick under direct visualization control with a transnotch approach, thereby minimizing the risk of potential neurovascular or posterior cruciate ligament injury for all procedures in posterior septum resection.

Atelocollagen Enhances the Healing of Rotator Cuff Tendon in Rabbit Model.

BACKGROUND: Failure of rotator cuff healing is a common complication despite the rapid development of surgical repair techniques for the torn rotator cuff. PURPOSE: To verify the effect of atelocollagen on tendon-to-bone healing in the rabbit supraspinatus tendon compared with conventional cuff repair. STUDY DESIGN: Controlled laboratory study. METHODS: A tear of the supraspinatus tendon was created and repaired in 46 New Zealand White rabbits. They were then randomly allocated into 2 groups (23 rabbits per group; 15 for histological and 8 for biomechanical test). In the experimental group, patch-type atelocollagen was implanted between bone and tendon during repair; in the control group, the torn tendon was repaired without atelocollagen. Each opposite shoulder served as a sham (tendon was exposed only). Histological evaluation was performed at 4, 8, and 12 weeks. Biomechanical tensile strength was tested 12 weeks after surgery. RESULTS: Histological evaluation scores of the experimental group (4.0 ± 1.0) were significantly superior to those of the control group (7.7 ± 2.7) at 12 weeks ( P = .005). The load to failure was significantly higher in the experimental group (51.4 ± 3.9 N) than in the control group (36.4 ± 5.9 N) ( P = .001). CONCLUSION: Histological and biomechanical studies demonstrated better results in the experimental group using atelocollagen in a rabbit model of the supraspinatus tendon tear. CLINICAL RELEVANCE: Atelocollagen patch could be used in the cuff repair site to enhance healing.

Autologous bone marrow mesenchymal cell induced chondrogenesis for the treatment of osteoarthritis of knee.

Healthy and high quality of life has become the main issue with increasing human life span. Many biological treatments for osteoarthritis of the knee have been tried with limited success. We compared data from 7 patients who underwent total knee arthroplasty and 46 patients who underwent autologous bone-marrow mesenchymal cell induced chondrogenesis (MCIC) for osteoarthritis of grade IV of the Kellgren-Lawrence classification and grade IV of modified Outerbridge classification from 50 to 65 years of age. Clinical evaluation of the 2 groups showed significant improvement in the mean telephone Knee Society Scoring system (tKSS)-A (pain) and tKSS-B (function) scores throughout the postoperative follow-up period. There was no difference in the patients' satisfaction between the 2 groups. MCIC is a treatment option at least for delaying disease progression of osteoarthritis of the knee. ELECTRONIC SUPPLEMENTARY MATERIAL: Supplementary material is available for this article at 10.1007/s13770-016-9125-y and is accessible for authorized users.