RESUMEN
PURPOSE: The quadrant method is used to evaluate the bone tunnel position with the grid based on the Blumensaat's line in anterior cruciate ligament (ACL) reconstruction. This study aimed to clarify the influence of variation in the Blumensaat's line on the accuracy of the quadrant method measurements. METHODS: A retrospective review of the radiological records of patients aged 18-30 years who underwent computed tomography (CT) scanning of the knee joint was conducted. The Blumensaat's line inclination angle (BIA), along with the most posterior point of the posterior condyle (point P) position using the quadrant method and morphology of the Blumensaat's line were measured on true lateral transparent three-dimensional CT images of the distal femoral condyle in 147 patients. Statistical analysis was conducted to determine associations among these measurements. RESULTS: BIA was 37.5° (standard deviation 4.2°; range 27°-48°). The point P position was significantly correlated with BIA in the high/low (R2 = 0.590, P < 0.0001) and deep/shallow (R2 = 0.461, P < 0.0001) directions. The morphology of the Blumensaat's line was straight in 35 knees (23.8%); whereas, the remaining 112 knees (76.2%) were not straight but had some hill on the Blumensaat's line. No significant difference among the morphological variation of the Blumensaat's line was observed in BIA and the point P position. CONCLUSION: There was a strong correlation between BIA and the point P measured using the quadrant method, suggesting the influence of the Blumensaat's line on the accuracy of the quadrant method measurements in ACL reconstruction. As for the clinical relevance, surgeons should be careful in application of the quadrant method for ACL reconstruction, because the variation of the Blumensaat's line inclination influences the accuracy of this method.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Fémur/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Adolescente , Adulto , Femenino , Fémur/cirugía , Humanos , Imagenología Tridimensional , Articulación de la Rodilla/cirugía , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
PURPOSE: To determine the in vivo effects of multiple local anesthetic injections of 0.5% bupivacaine on normal and osteoarthritic articular cartilage. METHODS: Rats with normal knee joints received an intra-articular injection of 0.9% saline solution or 0.5% bupivacaine in their right knees joint once a week for 5 consecutive weeks, starting 4 weeks after the beginning of the experiment. Rats were humanely killed at 8, 16, and 24 weeks. In a parallel experiment, rats underwent anterior cruciate ligament transection to induce osteoarthritic changes. These rats were subjected to the same protocol as those with normal knee joints, starting 4 weeks after the procedure. Static weight-bearing tests were performed on both hind limbs to evaluate changes in weight-bearing ability throughout the experiments. Rats were humanely killed at 8 and 16 weeks. Cell viability was assessed with confocal microscopy, using samples from the distal femur. Histologic assessment of osteoarthritis was performed using samples from the tibial plateau based on the Osteoarthritis Research Society International (OARSI) cartilage histopathology assessment system (i.e., OARSI score). RESULTS: Static weight-bearing tests showed no significant changes after intra-articular injection of saline solution or bupivacaine, and bupivacaine injection did not increase weight bearing compared with saline solution injection, regardless of whether there were osteoarthritic changes. There were also no significant differences in cell viability, cell density, or OARSI scores between the saline solution and bupivacaine groups at each time point, regardless of whether osteoarthritic changes were induced. CONCLUSIONS: This study suggested that single or intermittent intra-articular bupivacaine injections might not have deleterious effects on either osteoarthritic or normal joints. CLINICAL RELEVANCE: There is no strong evidence that intra-articular bupivacaine injection induces degenerative changes in articular cartilage. Therefore, these results may apply to normal and osteoarthritic joints.
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Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Articulación de la Rodilla/patología , Osteoartritis de la Rodilla/patología , Animales , Cartílago Articular/patología , Recuento de Células , Supervivencia Celular/fisiología , Condrocitos/fisiología , Inyecciones Intraarticulares , Articulación de la Rodilla/fisiología , Osteoartritis de la Rodilla/fisiopatología , Ratas Sprague-Dawley , Soporte de Peso/fisiologíaRESUMEN
PURPOSE: The purpose of this study was to investigate the relationship between patellofemoral (PF) contact stress in vivo and the alignment of the femoral component in patients after total knee arthroplasty (TKA). METHODS: Thirty knees with medial compartment osteoarthritis that underwent mobile-bearing TKA with modified gap technique were evaluated. Surgery was performed using a subvastus approach to eliminate the effect of the approach to muscle balance, with a computed tomography-based navigation system (Vector Vision 1.61; Brain Lab, Heimstetten, Germany). PF contact stress was measured by a Flexiforce pressure sensor (Nitta Co., Ltd., Osaka, Japan) intraoperatively, and the results were compared with the alignment of the femoral component after TKA. RESULTS: The PF contact stress was not correlated with sagittal and coronal alignment of the femoral component and patellar tracking, whereas rotational alignment of the femoral component was negatively correlated with PF contact stress (r = -0.718, p < 0.01). CONCLUSIONS: Regarding the alignment of the femoral component, only the rotational alignment of the femoral component was correlated with PF contact stress. PF contact stress decreased more as the femoral component rotated more externally. LEVEL OF EVIDENCE: Case control study, Level III.
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Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Ajuste de Prótesis , Estrés Mecánico , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , RotaciónRESUMEN
The aim of this study was to evaluate the relationship between clinical results including patient-reported outcomes and intraoperative knee kinematic patterns after total knee arthroplasty (TKA). A cross-sectional survey of forty consecutive medial osteoarthritis patients who had a primary TKA using a CT-based navigation system was conducted. Subjects were divided into two groups based on intraoperative kinematic patterns: a medial pivot group (n = 20) and a non-medial pivot group (n = 20). Subjective outcomes with the new Knee Society Score and clinical outcomes were evaluated. The functional activities, patient satisfaction and the knee flexion angle of the medial pivot group were significantly better than those of the non-medial pivot group. An intraoperative medial pivot pattern positively influences deep knee flexion and patient-reported outcomes.
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Artroplastia de Reemplazo de Rodilla/métodos , Articulación de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Rango del Movimiento Articular , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Femenino , Humanos , Periodo Intraoperatorio , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Autoinforme , Cirugía Asistida por Computador , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The aim of this study is to evaluate the relationship between patellofemoral contact stress and intraoperative knee kinematic patterns after mobile bearing total knee arthroplasty (TKA). Medial osteoarthritic knees of forty-six posterior-stabilized total knee prostheses were evaluated using a computed tomography-guided navigation system. Subjects were divided into two groups based on intraoperative knee kinematic patterns: the medial pivot group (n=19) and the non-medial pivot group (n=27). Mean intraoperative patello-femoral contact stress was significantly lower in the medial pivot group than in the non-medial pivot group (1.7MPa vs. 3.2MPa, P<0.05). An intraoperative medial pivot pattern results in reduced patello-femoral contact stress.
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Artroplastia de Reemplazo de Rodilla/métodos , Fémur/fisiopatología , Articulación de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/fisiopatología , Rótula/fisiopatología , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Femenino , Fémur/cirugía , Humanos , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Rótula/cirugía , Presión , Diseño de Prótesis , Rango del Movimiento ArticularRESUMEN
BACKGROUND: There is limited information regarding the cause of revision TKA in Asia, especially Japan. Owing to differences in patient backgrounds and lifestyles, the modes of TKA failures in Asia may differ from those in Western countries. QUESTIONS/PURPOSES: We therefore determined (1) causes of revision TKA in a cohort of Japanese patients with revision TKA and (2) whether patient demographic features and underlying diagnosis of primary TKA are associated with the causes of revision TKA. METHODS: We assessed all revision TKA procedures performed at five major centers in Hokkaido from 2006 to 2011 for the causes of failures. Demographic data and underlying diagnosis for index primary TKA of the revision cases were compared to those of randomly selected primary TKAs during the same period. RESULTS: One hundred forty revision TKAs and 4047 primary TKAs were performed at the five centers, indicating a revision burden of 3.3%. The most common cause of revision TKA was mechanical loosening (40%) followed by infection (24%), wear/osteolysis (9%), instability (9%), implant failure (6%), periprosthetic fracture (4%), and other reasons (8%). The mean age of patients with periprosthetic fracture was older (77 versus 72 years) and the male proportion in patients with infection was higher (33% versus 19%) than those of patients in the primary TKA group. There was no difference in BMI between primary TKAs and any type of revision TKA except other causes. CONCLUSIONS: The revision burden at the five referral centers in Hokkaido was 3.3%, and the most common cause of revision TKA was mechanical loosening followed by infection. Demographic data such as age and sex might be associated with particular causes of revision TKA.
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Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Pueblo Asiatico , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Complicaciones Posoperatorias/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Distribución de Chi-Cuadrado , Femenino , Fracturas Óseas/etnología , Fracturas Óseas/cirugía , Humanos , Japón/epidemiología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Estilo de Vida/etnología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Osteólisis/etnología , Osteólisis/cirugía , Complicaciones Posoperatorias/etnología , Falla de Prótesis , Infecciones Relacionadas con Prótesis/etnología , Infecciones Relacionadas con Prótesis/cirugía , Radiografía , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
The aim of this study was to clarify the risk of knee flexion contracture associated with a posterior femoral condylar offset after total knee replacement (TKR). Radiographs from 100 healthy Japanese volunteers were included in the study. We evaluated femoral component posterior offset in various implants and compared them with the normal Japanese knee. Posterior offset of the femoral condyle is up to a maximum of 4.7 times greater than that of the healthy Japanese knee in all knee implants. Excess posterior offset of the femoral condyle in TKR prostheses may cause knee joint flexion contracture due to the relative shortening of the posterior soft tissue.
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Artroplastia de Reemplazo de Rodilla/métodos , Contractura/prevención & control , Fémur/cirugía , Prótesis de la Rodilla , Complicaciones Posoperatorias/prevención & control , Adulto , Fenómenos Biomecánicos , Contractura/diagnóstico por imagen , Femenino , Fémur/diagnóstico por imagen , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Diseño de Prótesis , Radiografía , Rango del Movimiento Articular , Factores de Riesgo , Resultado del TratamientoRESUMEN
The present study assessed the midterm results of reconstruction for rheumatoid forefoot deformity with arthrodesis of the first metatarsophalangeal (MTP) joint, scarf osteotomy, resection arthroplasty of the metatarsal head of the lesser toes, and surgical repair of hammertoe deformity (arthrodesis of the proximal interphalangeal joint). Special focus was placed on the sagittal alignment of the first metatarsophalangeal joint after arthrodesis. We retrospectively evaluated the postoperative clinical outcomes and radiographic findings for 16 consecutive female patients (20 feet) with symptomatic rheumatoid forefoot deformities. The mean duration of follow-up was 7.9 (range 4 to 13) years. All first MTP joints and first metatarsal bones were fused successfully. The mean value of the American Orthopaedic Foot and Ankle Society and Japanese Society for Foot Surgery clinical scores significantly improved overall, except for 2 patients (10%), who complained of first toe pain at the final follow-up visit owing to sagittal misalignment of the fused first MTP joint. Sagittal alignment of the first metatarsal varies greatly because of the rheumatoid midfoot and hindfoot deformities. Therefore, inclination of the first metatarsal should be considered when determining the first MTP joint sagittal fusion angle.
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Deformidades Adquiridas del Pie/cirugía , Antepié Humano/cirugía , Articulación Metatarsofalángica/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/complicaciones , Artrodesis , Artroplastia , Femenino , Deformidades Adquiridas del Pie/diagnóstico por imagen , Deformidades Adquiridas del Pie/etiología , Antepié Humano/diagnóstico por imagen , Síndrome del Dedo del Pie en Martillo/cirugía , Humanos , Articulación Metatarsofalángica/diagnóstico por imagen , Persona de Mediana Edad , Osteotomía , Radiografía , Estudios RetrospectivosRESUMEN
OBJECTIVES: Non-steroidal anti-inflammatory drugs play a major role in the management of osteoarthritis (OA). However, it remains unknown whether these drugs affect cartilage and synovial metabolism in osteoarthritic joints. The aim of this study was to evaluate the effects of a selective cyclooxygenase (COX)-2 inhibitor, celecoxib, on synovial fluids and tissues in severely osteoarthritic knees. METHODS: Patients were randomized into three groups and medicated two weeks prior to total knee arthroplasty with celecoxib, diclofenac sodium, or no medication (control). We checked for the presence of matrix metalloproteinase-3 (MMP-3), tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and hyaluronic acid (HA) in the synovial fluids of all three groups. RESULTS: MMP-3 significantly decreased in the celecoxib-treated patients (p = 0.0031). On the other hand, there were no significant differences among the three groups in their TNF-α and IL-1ß levels. HA in the joint fluid was significantly increased in the diclofenac-treated group, while HA was not changed in the celecoxib-treated patients. CONCLUSIONS: Our study suggests that celecoxib did not affect the level of HA in the joint fluid in the knee in severe OA, in contrast to the effect of the dual COX inhibitor.
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Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Ácido Hialurónico/metabolismo , Articulación de la Rodilla/efectos de los fármacos , Osteoartritis de la Rodilla/tratamiento farmacológico , Pirazoles/uso terapéutico , Sulfonamidas/uso terapéutico , Anciano , Anciano de 80 o más Años , Cartílago Articular/efectos de los fármacos , Cartílago Articular/metabolismo , Celecoxib , Inhibidores de la Ciclooxigenasa 2/farmacología , Diclofenaco/farmacología , Diclofenaco/uso terapéutico , Femenino , Humanos , Interleucina-1beta/metabolismo , Articulación de la Rodilla/metabolismo , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/metabolismo , Pirazoles/farmacología , Sulfonamidas/farmacología , Líquido Sinovial/metabolismo , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
Background: The advantages of remnant tissue preservation in anterior cruciate ligament (ACL) reconstruction (ACLR) remain controversial. Hypothesis: It was hypothesized that a large amount of remnant tissue, especially if anatomically positioned, would improve patient-reported outcomes and second-look graft appearance after preserved double-bundle ACLR (DB-ACLR). Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 89 consecutive patients who underwent unilateral remnant-preserving DB-ACLR using 2 hamstring tendon autografts. The authors categorized the arthroscopic findings into 3 groups according to the location and volume of the ACL remnant tissue in the femoral notch: (1) anatomical attachment (group AA; n = 34); (2) nonanatomical attachment (group NA; n = 33); and (3) no remnant (group NR; n = 22). Based on second-look arthroscopy, the reconstructed graft was graded as excellent, fair, or poor. Patient-reported outcomes were evaluated at 2 years after surgery using the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Japanese Anterior Cruciate Ligament Questionnaire-25 (JACL-25). Results: The AA and NA groups had a significantly shorter time from injury to surgery compared with the NR group (P = .0165). Considering the second-look arthroscopic findings, the authors found a significant difference in synovial coverage of the grafts between the 3 groups (P = .0018). There were no significant differences in the overall KOOS and JACL-25 score among the 3 groups; however, the KOOS-Sport and Recreation and KOOS-Quality of Life subscale scores were significantly higher in the AA group compared with the NA and NR groups (P = .0014 and .0039, respectively). The JACL-25 score for middle- to high-speed flexion and extension was significantly better in the AA group versus the NR group (P = .0261). Conclusion: This study showed that preserving anatomically positioned and adequate remnant tissue during DB-ACLR improved second-look graft appearance and KOOS-Sport and Recreation and KOOS-Quality of Life scores.
RESUMEN
The aim of this randomized prospective study was to clarify risks associated with a drain-clamping method using tranexamic acid and carbazochrome sodium sulfonate hydrate after total knee arthroplasty (TKA). Subjects comprised 100 patients scheduled to undergo TKA, randomized into 2 groups: 50 patients received the drain-clamping method using tranexamic acid and carbazochrome sodium sulfonate hydrate and 50 patients received drain-clamping with saline. Although bleeding volume was significantly lower in the group with tranexamic acid and carbazochrome sodium sulfonate hydrate, risk of asymptomatic deep venous thrombosis as detected by ultrasonography was comparable between groups. Tranexamic acid and carbazochrome sodium sulfonate hydrate in the drain-clamping method help reduce bleeding after TKA without increasing the risk of deep venous thrombosis.
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Adrenocromo/análogos & derivados , Antifibrinolíticos/efectos adversos , Artroplastia de Reemplazo de Rodilla , Hemostáticos/efectos adversos , Ácido Tranexámico/efectos adversos , Trombosis de la Vena/inducido químicamente , Trombosis de la Vena/epidemiología , Adrenocromo/efectos adversos , Anciano , Constricción , Femenino , Humanos , Masculino , Estudios Prospectivos , Medición de RiesgoRESUMEN
BACKGROUND: Both transfibular ankle arthrodesis with fibular onlay grafting and ankle arthrodesis using the Ilizarov apparatus have resulted in acceptable fusion rates. This study analyzed outcomes in the authors' practice for all patients who underwent transfibular ankle arthrodesis with fibular onlay grafting using the Ilizarov apparatus. MATERIALS AND METHODS: A retrospective review was conducted of all patients who experienced severe ankle pain associated with osteoarthritis, rheumatoid arthritis, talar osteonecrosis, or septic arthritis and underwent transfibular ankle arthrodesis with an Ilizarov apparatus between 1995 and 2010. Postoperative clinical outcomes were evaluated for 42 consecutive patients (43 feet) who received primary or revision ankle arthrodesis using the Ilizarov technique at two centers. Mean duration of follow-up was 4.1 (range, 1.5 to 13) years. Outcomes were assessed using the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society. RESULTS: All ankles fused successfully. Mean clinical outcome improved significantly from 36.2 (range, 8 to 64) preoperatively to 77.4 (range, 0 to 86; p < .05) postoperatively. CONCLUSION: Transfibular ankle arthrodesis using the Ilizarov external fixation system and fibular onlay strut grafting can achieve a very high rate of bony union and lead to general improvements in clinical outcome. Forefoot stabilization with a forefoot ring achieved rigid stabilization resulting in a shorter duration of external fixation.
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Articulación del Tobillo/cirugía , Artrodesis/métodos , Técnica de Ilizarov , Adolescente , Adulto , Anciano , Artritis/cirugía , Femenino , Peroné/cirugía , Estudios de Seguimiento , Humanos , Ilion/trasplante , Masculino , Persona de Mediana Edad , Osteonecrosis/cirugía , Osteotomía , Complicaciones Posoperatorias , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: The stress distribution of an ankle under various physiological conditions is important for long-term survival of total ankle arthroplasty. The aim of this study was to measure subchondral bone density across the distal tibial joint surface in patients with malalignment/instability of the lower limb. METHODS: We evaluated subchondral bone density across the distal tibial joint in patients with malalignment/instability of the knee by computed tomography (CT) osteoabsorptiometry from ten ankles as controls and from 27 ankles with varus deformity/instability of the knee. The quantitative analysis focused on the location of the high-density area at the articular surface, to determine the resultant long-term stress on the ankle joint. RESULTS: The area of maximum density of subchondral bone was located in the medial part in all subjects. The pattern of maximum density in the anterolateral area showed stepwise increases with the development of varus deformity/instability of the knee. CONCLUSIONS: Our results should prove helpful for designing new prostheses and determining clinical indications for total ankle arthroplasty.
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Absorciometría de Fotón/métodos , Articulación del Tobillo/diagnóstico por imagen , Desviación Ósea/diagnóstico por imagen , Coxa Vara/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Articulación del Tobillo/metabolismo , Articulación del Tobillo/fisiopatología , Artroplastia/métodos , Densidad Ósea/fisiología , Desviación Ósea/metabolismo , Desviación Ósea/fisiopatología , Coxa Vara/metabolismo , Coxa Vara/fisiopatología , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/metabolismo , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/metabolismo , Articulación de la Rodilla/fisiopatología , Diseño de Prótesis , Estrés Mecánico , Tibia/diagnóstico por imagen , Tibia/metabolismo , Soporte de PesoRESUMEN
It is difficult to precisely identify the locations of tunnels after double-bundle anterior cruciate ligament (ACL) reconstruction postoperatively. Using our novel transparent 3-dimensional computed tomography (T-3DCT), we evaluated intra-articular outlet locations and the angles of the anteromedial (AM) and posterolateral (PL) tunnels after anatomic double-bundle ACL reconstruction using the trans-tibial technique. A prospective study was performed with 123 consecutive patients. Tunnel outlet locations were identified on T-3DCT images showing the true lateral view of the femur and indicated by our originally defined X, Y coordinates. We also determined the angles between the tunnel axis and a joint surface line in the coronal plane, the long axis of the femur in the sagittal plane, and the posterior condyle line in the axial plane of both the femur and the tibia. The mean X, Y coordinates of the AM and PL tunnel outlets were 21, 43% and 0, 33%, respectively. In the coronal, sagittal, and axial planes, the mean AM femoral tunnel angles were 63 degrees, 48 degrees, and 55 degrees, respectively; the mean AM tibial tunnel angles in the tibia were 63 degrees, 49 degrees, and 71 degrees, respectively; the mean PL femoral tunnel angles were 38 degrees, 58 degrees, and 43 degrees, respectively; and the mean PL tibial tunnel angles were 46 degrees, 53 degrees, and 45 degrees, respectively. The AM and PL tunnel outlets and angles could be detailed precisely in three dimensions by using T-3DCT. This imaging technique may be useful to confirm surgical techniques and to improve clinical outcomes.
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Ligamento Cruzado Anterior/diagnóstico por imagen , Artroscopía/métodos , Fémur/diagnóstico por imagen , Radiografía Intervencional/métodos , Tibia/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Ligamento Cruzado Anterior/anatomía & histología , Ligamento Cruzado Anterior/cirugía , Femenino , Fémur/anatomía & histología , Humanos , Articulación de la Rodilla/anatomía & histología , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tendones/trasplante , Tibia/anatomía & histología , Tibia/cirugía , Adulto JovenRESUMEN
BACKGROUND: The aim of this study was to clarify the objective therapeutic effects of an acellular technique by ultrapurified alginate (UPAL) gel implantation in canine osteochondral defect models. METHODS: Two osteochondral defects (diameters: 3.0 and 5.0 mm) were created on each patellar groove in both knees of 10 dogs. Defects were divided into four groups (n = 10 each): Group 1, untreated 3.0-mm defect; Group 2, 3.0-mm defect with UPAL gel; Group 3, untreated 5.0-mm defect; and Group 4, 5.0-mm defect with UPAL gel. All surgical procedures were performed by individuals unfamiliar with the technique at an independent institution. Articular surfaces were evaluated grossly and histologically at 27 weeks after operation. RESULTS: UPAL gel-treated osteochondral defects showed significantly improved gross appearance in Group 4 and histological appearance in Groups 2 and 4. Reparative tissues in the 3.0-mm defect with UPAL gel were replaced by hyaline-like cartilage tissue. The 5.0-mm defects with UPAL gel were mostly covered with fibrocartilaginous tissue, whereas UPAL gel-untreated defects mostly remained uncovered by any tissue. CONCLUSIONS: Although an acellular technique using UPAL gel implantation significantly enhanced osteochondral repair in canines, reparative tissues of the large defect with alginate gel comprised of fibrocartilaginous tissue. This surgical technique is effective, especially for small cartilage injuries. Further improvements are required before clinical application in cases of severe osteochondral defects in humans.
RESUMEN
In this study, we successfully developed three-dimensional scaffolds fabricated from the chitosan-based hyaluronic acid hybrid polymer fibers, which can control the porous structure. To determine the adequate pore size for enhancing the chondrogenesis of cultured cells, we compared the behaviors of rabbit chondrocytes in scaffolds comprising different pore sizes (100, 200, and 400 microm pore size). Regarding the cell proliferation, there was no significant difference among the three groups. On the other hand, glycosaminoglycan contents in the 400 microm group significantly increased during the culture period, compared with those in the other groups. The ratio of type II to type I collagen mRNA level was also significantly higher in the 400 microm group than in the other groups. These results indicate that our scaffold with 400 microm pore size significantly enhances the extracellular matrix synthesis by chondrocytes. Additionally, the current scaffolds showed high mechanical properties, compared with liquid and gel materials. The data derived from this study suggest great promise for the future of a novel fabricated material with relatively large pore size as a scaffold for cartilage regeneration. The biological and mechanical advantages presented here will make it possible to apply our scaffold to relatively wide cartilaginous lesions.
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Biopolímeros/metabolismo , Cartílago/citología , Quitosano/metabolismo , Condrogénesis , Ácido Hialurónico/metabolismo , Animales , Biopolímeros/química , Adhesión Celular , Proliferación Celular , Células Cultivadas , Condrocitos/citología , ADN/análisis , Proteínas de la Matriz Extracelular/genética , Proteínas de la Matriz Extracelular/metabolismo , Regulación de la Expresión Génica , Ácido Hialurónico/química , Porosidad , ARN Mensajero/genética , ARN Mensajero/metabolismo , ConejosRESUMEN
BACKGROUND: The purpose of this study was to evaluate the relationship between the preoperative knee deformity/kinematic pattern and the postoperative knee kinematic pattern in posterior cruciate ligament substituting (PS)-total knee arthroplasty (TKA). METHODS: This study involved 39 patients with medial osteoarthritis who underwent a primary PS-TKA using a computed-tomography-based navigation system. All the operations were performed by a single surgeon using a subvastus approach, modified gap technique and the same PS type of prosthesis (Genesis II™ total knee system, Smith & Nephew, Memphis, TN, USA). Knee deformity, kinematic pattern after capsule incision (preoperative knee kinematics), and kinematic pattern after implantation (postoperative knee kinematics) in PS-TKA were measured. Kinematic patterns were divided into two groups: a medial pivot group and a non-medial pivot group. RESULTS: Preoperative varus knee deformity was significantly larger in the non-medial pivot group than in the medial pivot group (femorotibial angle: 184.7±6.4° vs. 180.8±3.9°, P<0.05). In addition, preoperative knee kinematics were conserved postoperatively, at a rate of 82% (P<0.01). CONCLUSIONS: The severity of varus knee deformity and the preoperative knee kinematic pattern might have affected the postoperative knee kinematics in PS-TKA. This must be confirmed with a randomized controlled trial on a large population study. LEVEL OF EVIDENCE: case control study, Level III.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Deformidades Adquiridas de la Articulación/cirugía , Articulación de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Estudios de Casos y Controles , Femenino , Humanos , Deformidades Adquiridas de la Articulación/fisiopatología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Ligamento Cruzado Posterior/cirugía , Periodo Posoperatorio , Rango del Movimiento Articular , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Ultrasonography is among the valid methods to assess articular cartilage in the foot. This study aimed to evaluate the validity of ultrasonographic grading to assess metatarsal head articular cartilage for rheumatoid forefoot deformity in vivo and to compare the findings with in vitro ultrasonographic and histologic gradings. METHODS: Participants were 15 patients scheduled to undergo resection arthroplasty of the metatarsal heads of the lesser toes because of rheumatoid arthritis of the metatarsophalangeal joints. Ultrasonographic examination was performed in vivo the day before surgery. Specimens of the second to fifth metatarsal heads taken intraoperatively were graded from in vitro ultrasonographic and histologic evaluations. Correlations among in vivo ultrasonographic, in vitro ultrasonographic, and histologic gradings were analyzed. RESULTS: In 46 metatarsal heads, the distribution of grading ranged from grade 1 to 6 for in vivo ultrasonographic examinations and from grade 1 to 4 for histologic examinations. In vivo ultrasonographic grading showed significant correlation to both in vitro ultrasonographic grading (P < .001, R = 0.74) and histologic grading (P < .001, R = 0.67). CONCLUSIONS: The significant correlations between in vivo ultrasonographic and histologic gradings suggest that a semiquantitative in vivo ultrasonographic assessment of forefoot deformity in rheumatoid arthritis may be possible. Ultrasonographic grading may prove useful for pre- and postoperative evaluation of remaining joint function in rheumatoid forefoot deformity. An ultrasonographic grading system for remaining joint surfaces might be helpful in selecting surgical procedures such as joint-sparing osteotomy and metatarsal head resection. LEVEL OF EVIDENCE: Level IV, case series.
Asunto(s)
Artritis Reumatoide/diagnóstico , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patología , Deformidades Adquiridas del Pie/diagnóstico , Antepié Humano/anomalías , Huesos Metatarsianos/diagnóstico por imagen , Huesos Metatarsianos/patología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
OBJECTIVE: This study aimed to elucidate the therapeutic effects of intra-articular administration of ultra-purified low endotoxin alginate (UPLE-alginate) on osteoarthritis (OA) using a canine anterior cruciate ligament transection (ACLT) model. DESIGN: We used 20 beagle dogs. ACLT was performed on the left knee of each dog and a sham operation was performed on the right knee as a control. All animals were randomly divided into the control (saline) and therapeutic (UPLE-alginate) groups. Animals in the control and therapeutic groups received weekly injections with 0.7 mL normal saline or 0.7 mL 0.5% UPLE-alginate, respectively, from 0 to 3 weeks after ACLT or sham operation. At 9 weeks after ACLT, the knee joints of all animals were observed using arthroscopy. All animals were euthanized at 14 weeks after ACLT and evaluated using morphologic assessment, histologic assessment, and biomechanical testing. RESULTS: Arthroscopic findings showed intact cartilage surface in both groups. Morphologic findings in the therapeutic group showed milder degeneration compared with those of the control group, but there were no significant differences between groups. Histologic scores of the medial femoral condyle (MFC) and lateral femoral condyle (LFC) were better in the therapeutic group than the control group (MFC: p = 0.009, LFC: p = 0.009). Joint lubrication did not differ significantly between groups. CONCLUSION: Intra-articular administration of UPLE-alginate in the early stage of OA slowed disease progression in canines. UPLE-alginate may have potential as a therapeutic agent for OA patients and reduce the number of patients who need to undergo total joint arthroplasty.
Asunto(s)
Alginatos/administración & dosificación , Alginatos/uso terapéutico , Endotoxinas/administración & dosificación , Endotoxinas/uso terapéutico , Osteoartritis/tratamiento farmacológico , Alginatos/farmacología , Animales , Ligamento Cruzado Anterior/diagnóstico por imagen , Ligamento Cruzado Anterior/cirugía , Artroscopía , Cartílago Articular/efectos de los fármacos , Cartílago Articular/patología , Modelos Animales de Enfermedad , Perros , Endotoxinas/farmacología , Fémur/efectos de los fármacos , Fémur/cirugía , Fricción , Ácido Glucurónico/administración & dosificación , Ácido Glucurónico/farmacología , Ácido Glucurónico/uso terapéutico , Ácidos Hexurónicos/administración & dosificación , Ácidos Hexurónicos/farmacología , Ácidos Hexurónicos/uso terapéutico , Inyecciones Intraarticulares , Articulaciones/efectos de los fármacos , Lubrificación , Osteoartritis/patología , Osteoartritis/cirugía , RadiografíaRESUMEN
BACKGROUND: Boiogito (Japanese herbal medicine, Tsumura Co. Tokyo, Japan) contains sinomenin which inhibits inflammatory reactions. Since sinomenine is a principle component of the Boiogito, there is a possibility of it being effective on osteoarthritis (OA) of the knee with joint effusion. However, there is no report concerning the effectiveness of Boiogito on knee OA. The objective of the present study is to investigate the therapeutic effect of Boiogito on OA of the knee associated with joint effusion in a comparative study among randomly assigned groups. METHODS: Study was performed using 50 patients who were diagnosed with primary osteoarthritis of the knee with joint effusion. The patients were randomly assigned to two groups: one group (25 patients) using both loxoprofen (2-{4-[(2-oxocyclopentyl) methyl]} propanoic acid) and Boiogito and the other group (25 patients) using loxoprofen, and were evaluated during a 12 week observation period. The assessment parameters including knee scores in the Knee Society Rating System including Knee score and Functional scores, amount of joint effusion by joint puncture in clinically detected cases, the 36-items short form of the Medical Outcome Study Questionnaire (SF-36) as a measurement of health related quality of life were used. RESULTS: The knee scores based on the Knee Society Rating System were improved in both groups. The staircase climbing up and down ability in the Knee society rating system functional score was significantly improved in the group using Boiogito and loxoprofen compared to the loxoprofen group. In the evaluation using SF-36, significant improvements were found in the scores in both groups in physical functioning after 12 weeks. The amount of joint fluid was significantly decreased at 4, 8 and 12 weeks compared to pre-administration baseline in the group using Boiogito and loxoprofen. A side effect of Boiogito, dry mouth, was found in one case. The symptom was mild and improved immediately after discontinuation of administration. CONCLUSION: The results indicated that Boiogito have a possibility for a treatment modality for joint effusion with osteoarthritis of the knee.