Palmaris longus tendon graft versus modified Weaver-Dunn procedure via dynamic button system for acromioclavicular joint reconstruction in chronic cases.

BACKGROUND: The hypothesis of this clinical study was that coracoclavicular (CC) reconstruction using autogenic palmaris longus graft through the GraftRope (PLG) system (Arthrex, Inc., Naples, FL, USA) would provide superior clinical and radiologic results compared with modified Weaver-Dunn procedure with the dynamic TightRope (Arthrex, Inc.) system (WDT). METHODS: Between 2008 and 2013, 32 patients (average age, 39.7 years; range, 22-60 years) underwent surgical reconstruction of chronic acromioclavicular (AC) joint dislocation. A modified WDT procedure was performed in 16 patients and autogenous PLG was performed in the other 16 patients. Patient data were collected retrospectively, with a final follow-up of 44.9 months (range, 29-60 months). The degree of AC joint displacement was evaluated by measuring the CC distance on the anteroposterior and axillary view. Clinical and functional outcomes were compared by American Shoulder and Elbow Surgeons and the Constant scores at final follow-up. RESULTS: Comparison between the WDT and PLG groups showed a significantly better outcome in the American Shoulder and Elbow Surgeons and the Constant scores (P < .01), in favor of the PLG group. Both groups showed an increased CC distance compared with the uninjured side, with a mean difference of 1.1 mm for the PLG and 3.3 mm for the WDT groups. A tolerable loss of reduction within the follow-up time was observed. Reduction loss was higher with the WDT group (P < .05). CONCLUSION: CC palmaris longus tendon graft reconstruction with GraftRope system was associated with functional and radiologic benefits. The palmaris longus graft with GraftRope system could be used in chronic cases.

Anatomic locking plate and coracoclavicular stabilization with suture endo-button technique is superior in the treatment of Neer Type II distal clavicle fractures.

INTRODUCTION: The purpose of this retrospective study was to compare the clinical results of three different fixation techniques for the treatment of Neer Type IIb fractures. We hypothesized that anatomic locking plate and coracoclavicular stabilization with suture endo-button technique provides more stable and biomechanically superior fixation among others with low complication rates. METHODS: Thirty six patients with Neer Type IIb fractures treated were evaluated. Patients were divided into three groups according to surgical choice that was performed: tension band and coracoclavicular suture stabilization with k-wires was defined as Group 1, anatomic locking plate and coracoclavicular stabilization with screw was defined as Group 2, and anatomic locking plate and coracoclavicular stabilization with suture endo-button (LPES) was defined as group 3. Mean age was 36.1 years, and mean follow-up period was 32.4 months. Radiological follow-ups and constant were recorded and compared at 3, 6, 12 and 24 months. RESULTS: At 3rd and 12th month follow-up in the LPES group, mean constant scores were statistically higher than other two groups (p < 0.01). The difference between other two groups was insignificant (p > 0.05). At 6th month follow-up, mean constant scores in LPES group were higher than other groups; there was less statistical significance than other time zones (p < 0.05). CONCLUSION: Anatomic locking plate combined with suture endo-button for CC ligament reinforcement is a reliable method to achieve osteosynthesis and stabilization for Neer Type IIb distal clavicle fractures without compromising physiology of shoulder.

The effect of environmental pH change on bovine articular cartilage metabolism: implications for the use of buffered solution during arthroscopy?

PURPOSE: The purpose of this study is to determine the immediate effects of pH change on the metabolism of bovine chondrocytes. METHODS: Bovine osteochondral explants were pre-cultured and placed in Ringer's lactate solution. Thirty explants were randomly divided into 3 groups. Buffered Ringer's lactate, pH 7.2, was used in Group I; buffered Ringer's lactate, pH 7.4 (normal bovine knee joint pH), was used in Group II; and this group was also set as the control group. Buffered Ringer's lactate, pH 7.6, was used in Group III. All specimens were soaked for 2 h. RNA yield analyses were performed to evaluate the changes in cartilage metabolism at different pH levels. RESULTS: Mean RNA yields of (hypoxia-induced factor) 1α that were immersed at pH 7.2 and 7.6 were 10.5- and 9.9-fold from base, respectively, which were lower compared to explants at pH 7.4 which was found as 15.2-fold. Mean RNA yields of aggrecan that were immersed at pH 7.2 and 7.6 were 12.2- and 13.6-fold from base, respectively, which were lower compared to explants at pH 7.4 which was found as 20-fold. RNA yields of collagen type II at pH 7.2 and 7.6 were 16.1- and 16.6-fold from base, respectively, which were lower compared to explants immersed at pH 7.4 which was found as 22.1-fold. CONCLUSION: The findings of the presented study suggest that short-term exposures to both acidic and basic pH may have effects on chondrocyte function. Our findings also indicate that exposures to solutions with a pH different from normal by only 0.2 unit could suppress chondrocyte metabolism and RNA synthesis. CLINICAL RELEVANCE: Using buffered irrigation solutions with a pH closer to the normal joint pH could be more physiologic and causes less ultra-structural damage than regular irrigation solutions. LEVEL OF EVIDENCE: II.

Comparative study of the closed reduction percutaneous cannulated screw fixation and open reduction palmar locking plate fixation in the treatment of AO type A2 distal radius fractures.

INTRODUCTION: The present study was designed to demonstrate the efficacy of standard 4.0 mm cannulated screw fixation by comparing it with palmar locking plate fixation in the treatment of acute, unstable, simple extra-articular distal radius fractures. MATERIALS AND METHODS: We prospectively collected and retrospectively analyzed outcomes data for 65 patients aged between 18 and 60 with AO type A2 fractures treated with closed reduction, percutaneous cannulated screw fixation (CRPCS n = 34) or open reduction palmar locking plate fixation (ORPLP n = 31). Range of motion, grip strength, Gartland-Werley and QuickDASH scores were compared at 2 months after surgery, and final follow-up (mean 32 months, range 12-90). Deterioration in radiographic parameters were measured and compared. Operative time and return to preinjury activity were evaluated. RESULTS: Parameters did not differ significantly between the groups at either time point with respect to grip strength or range of motion, except pronation and supination; they were better in the CRPCS group (p = 0.005 and 0.025, respectively) at 2 month follow-up. The Gartland-Werley and QuickDASH scores obtained at final follow-up were similar for each group and lacked statistical significance. Group comparison for the deterioration of radiologic parameters showed no significant difference. CRPCS group had significantly shorter operative time (p = 0.001) and there was no significant differences between the groups regarding the return to preinjury activity (p = 0.129). CONCLUSIONS: CRPCS group was found to be as successful as ORPLP group and it may be suitable in the case of young, active individuals with AO type A2 distal radius fractures.

Percutaneous cannulated screw fixation in the treatment of distal radius fractures.

PURPOSE: The aim of this study was to determine the results of closed reduction and percutaneous fixation of distal radial fractures with standard 4.0-mm cannulated screw. METHODS: We collected prospective outcomes data for 20 patients between 18 and 60 years of age (mean 39) with acute, displaced, extraarticular and unstable fractures of the distal radius treated with closed reduction, percutaneous cannulated screw fixation and early mobilization. The visits at months 2, 6 and 12 were specified as index follow-up visits and assessments of motion, grip strength and standard radiographs were performed. The Gartland Werley functional scores and the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were recorded. RESULTS: Mean values of flexion, extension, pronation and supination on the injured side were up to 70 % of those on the uninjured side at 2 months postoperatively. By 12 months, range of motion values on the injured side showed continuous and significant improvement and flexion, extension, pronation, supination and ulnar deviation reached up to 90 % of those on the uninjured side. A large and significant improvement was seen from 2 to 6 months in the QuickDASH score. A smaller improvement was seen from 6 to 12 months, which was judged not to be significant. Radiographic values were close to anatomic parameters, and the alignment was maintained at 12 months follow-up. No complications occurred. CONCLUSIONS: Cannulated screw fixation appears to be an effective means of allowing immediate range of motion of the wrist, resulting in a rapid and comfortable functional recovery while maintaining alignment to bone healing.

Comparison of headless screws used in the treatment of proximal nonunion of scaphoid bone.

Screws with different levels of compression force are available for scaphoid fixation and it is known that the Acutrak screw generates greater compression than the Herbert screw. We retrospectively compared two types of headless compression screw for their effectiveness in the repair of scaphoid nonunion. Twenty-nine cases of proximal scaphoid nonunion were surgically treated with non-vascularised bone graft: the Acutrak screw was used in 17 patients and the cannulated Herbert screw in 12 patients. Wrist range of motion, Mayo wrist score, grip strength and QuickDASH scores were indicators used for the functional evaluation. Radiographic findings were assessed for consolidation of nonunion and signs of arthrosis. The mean follow-up time was 49.2 months (range 12-96). Statistically, there was no significant difference between the Acutrak and Herbert screw types in terms of functional evaluation and time required for consolidation. Greater compression did not influence the functional outcome, consolidation rate or time to consolidation. The need for greater compression in the treatment of proximal scaphoid nonunions is thus questionable because it may increase the risk of proximal fragment communition.

Capitellar cartilage injuries concomitant with radial head fractures.

PURPOSE: To evaluate the incidence and types of capitellar cartilage injuries associated with higher-grade radial head fractures. METHODS: Fifty-one consecutive patients with operatively treated, unstable, displaced Mason type II to III radial head fractures were identified. Ten of 51 patients had capitellar cartilage injuries concomitant with these fractures. All cartilage injuries were identified at the time of surgery except in 1 patient whose injury was determined via computed tomography. There were 8 men and 2 women with an average age of 33 years (range, 24-39 years). Lesions were seen with direct inspection and recorded by location, size, and thickness. RESULTS: The incidence of capitellar chondral lesions concomitant with operatively treated Mason type II to III radial head fractures appeared in 10 of 51 patients. The average size was 5 x 5 mm (range, 2 x 2 mm to 10 x 10 mm). Four patients had Mason type II and 6 had Mason type III radial head fractures. The average surface of the cartilage injury was 6 x 7 mm (range, 3 x 6 mm to 10 x 10 mm) for Mason type II fractures and 4 x 4 mm (range, 2 x 2 mm to 5 x 10 mm) for Mason type III fractures. Two Mason type III fractures had full-thickness cartilage lesions, and 4 Mason type III fractures had partial-thickness cartilage lesions. Two Mason type II fractures had full-thickness cartilage lesions and the other 2 had partial-thickness cartilage lesions. CONCLUSIONS: Capitellar cartilage lesions frequently occurred concomitantly with higher-grade radial head fractures. The incidence of these lesions increased with greater severity of radial head fractures. Low-grade radial head fractures created higher-grade cartilage lesions as the intact radial head can cause more damage to the capitellum. Careful evaluation of the joint should be performed for these subtle injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

[Comparison between fixation with dorsal T plate and palmar locking plate in the treatment of unstable displaced distal radius fractures]. / Deplase ve instabil radius distal uç kiriklarinda dorsal T plak ile kilitli palmar plak yöntemlerinin karsilastirilmasi.

OBJECTIVES: We compared the results of fixation with dorsal T plate and palmar locking plate in the treatment of unstable displaced distal radius fractures. METHODS: Sixty-three patients (64 radii) with distal radius fractures were treated with dorsal T plate (n=41) or palmar locking plate (n=23). The mean age was 46+/-14 years (range 21 to 82 years) in the dorsal and 47+/-14 years (range 18 to 69 years) in the palmar plate groups. The fractures were classified according to the AO/ASIF system. Objective and subjective functional assessments were made using the Gartland-Werley and Quick-DASH scales, respectively. The mean follow-up was 78+/-19 months (range 12 to 101 months) and 18+/-5 months (range 12 to 28 months) with dorsal and palmar plating, respectively. RESULTS: The mean Gartland-Werley and Quick-DASH scores were 2.3+/-2.1 (range 0 to 9) and 2.0+/-2.2 (range 0 to 9) with dorsal plating, and 2.0+/-2.1 (range 0 to 6) and 1.9+/-2.7 (range 0 to 9) with palmar plating, respectively. The two groups did not differ with respect to the Gartland-Werley and Quick-DASH scores (p>0.05). Time to return to work or daily activities was also similar (1.9+/-0.3 months vs 1.8+/-0.4 months). However, patients treated with dorsal plating exhibited significantly greater values in the following parameters measured on early and late postoperative radiograms: loss of palmar tilt (p=0.001), radial height (p=0.001), radial inclination (p=0.049), and change in ulnar variance (p=0.049). Moreover, complications were seen in eight patients (19.5%) with dorsal plating, whereas no complications occurred with palmar locking plate (p=0.024). CONCLUSION: Although the two fixation methods do not differ with respect to functional results, palmar locking plating seems to provide a more rigid fixation resulting in significantly reduced collapse and a very low complication rate.

[Surgical treatment of acute coronoid process fractures]. / Akut koronoid kiriklarinin cerrahi tedavisi.

OBJECTIVES: This study was designed to assess the results of surgical treatment for type 2-3 coronoid process fractures and to identify factors that might influence the outcome. METHODS: Thirteen male patients (mean age 35 years; range 17 to 53 years) were treated with open reduction and internal fixation for displaced coronoid fractures. According to the Regan-Morrey classification, the fractures were type 2 in nine patients (69.2%), and type 3 in four patients (30.8%). Nine patients had associated injuries (elbow dislocation, radial head or olecranon fractures, and/or ligamentous injuries). The mean duration to treatment was 2.3 days (range 1 to 7 days). Functional results were assessed according to the Mayo elbow performance score (MEPS), and signs of arthritis were assessed according to the Broberg-Morrey criteria. The mean follow-up was 41.1 months (range 12 to 96 months). RESULTS: A functional range of motion of the elbow joint was achieved in 10 patients (76.9%). The mean elbow range of motion was 110.7 degrees (range 85 degrees to 130 degrees ) and the mean forearm rotation was 134.2 degrees (range 120 degrees to 155 degrees ). Three patients who had comminuted fractures and associated elbow injuries had decreased range of motion. None of the patients exhibited signs of instability. The mean MEPS was 86.5 (range 75 to 100). The results were excellent in four patients (30.8%; the mean MEPS 98.8) having isolated or noncomminuted coronoid fractures, and good in nine patients (69.2%) with comminuted fractures and/or associated bone or ligament injuries. Post-traumatic arthritis was detected in seven patients (53.9%) whose mean MEPS was 81.4. Patients with an excellent functional result did not develop arthritis. All the patients returned to preinjury activity levels. CONCLUSION: Coronoid fractures are the most important component of complex elbow injuries. The presence of comminuted fractures, associated bone and ligament injuries, and post-traumatic arthritis affect the outcome adversely.

Evaluation of absorbable and nonabsorbable sutures for repair of achilles tendon rupture with a suture-guiding device.

BACKGROUND: The purpose of this study was to compare the functional and clinical results of Achilles tendon repairs with an Achilles tendon suture-guiding device using nonabsorbable versus absorbable sutures. We hypothesized that the absorbable suture would have clinical results comparable to those of the nonabsorbable suture for Achilles tendon repair with an Achilles tendon suture-guiding system. METHODS: From January 2010 to September 2013, 48 consecutive patients who had sustained a spontaneous rupture of the Achilles tendon underwent operative repair with an Achilles tendon suture-guiding device using 2 different suture types. All ruptures were acute. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The average age of the patients was 38 years (range, 28-50 years). Functional outcome scores and complications were evaluated. RESULTS: All patients had an intact Achilles repair after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot clinical outcome scores were 98 (range, 90-100) in the nonabsorbable suture group and 96.8 (range, 87-100) in the absorbable suture group. All patients returned to their previous work. The absorbable suture group had fewer postoperative complications (0%) than the nonabsorbable suture group (12.5%) (P < .05). CONCLUSION: Use of an absorbable suture in the treatment of Achilles tendon repair by an Achilles tendon suture-guiding system was associated with a lower incidence of suture reaction; however, functionally the results were not notably different from those using a traditional nonabsorbable suture. We conclude that repair with absorbable sutures is appropriate for Achilles tendon ruptures. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Fracture-dislocations of the proximal ulna.

OBJECTIVE: To investigate the relationship between injury patterns, complications, and the functional outcomes of patients with proximal-ulna fracture-dislocations. METHODS: Retrospective analysis of 15 patients (10 men, 5 women; mean age, 49.1 years; mean follow-up 49 months) with 6 anterior and 9 posterior fracture-dislocations of the proximal ulna. The proximal ulna was reconstructed with plates and screws in 13 patients and tension-band wiring in 2 patients. At the final follow-up, elbow range of motion (ROM) was measured and Mayo elbow scores (MEPS) were recorded. Broberg-Morrey criteria were used for osteoarthritis staging. RESULTS: Concomitant radial-head fracture was seen in all posterior fracture-dislocations. Four ligamentous injuries occurred in this group. All anterior dislocations had trochlear-notch fractures without associated injuries. Mean flexion ROM was 130.6° (100°-140°) and mean loss of extension ROM was 12.6° (0°-30°) in the study group. The mean MEPS score was 92.3 (70-100). Patients with posterior fracture-dislocations showed lower ROM and MEPS and higher level of osteoarthritis than patients with anterior fracture-dislocations. Recurrent dislocations occurred in 2 patients who had ulna fractures fixed with tension-band wiring. CONCLUSION: Radial-head fracture and ligamentous injury are specific components of posterior fracture-dislocations. The injury is limited to the trochlear notch in anterior fracture-dislocations. Posterior fracture-dislocations have lower functional outcomes. Proximal-ulna fractures should be fixed with rigid internal fixation (plate and screw) even if the fracture is a simple 2-part fracture.

[Intramedullary nailing of adult femoral fractures]. / Eriskin femur cisim kiriklarinin intramedüller çivilerle tedavisi.

OBJECTIVES: We evaluated the results of treatment of adult femoral fractures treated by intramedullary nails. METHODS: Sixty-two patients (15 females, 48 males; mean age 29 years; range 16 to 62 years) with 64 femoral fractures were treated by intramedullary nailing. Eighty-three percent of the fractures was closed and 17% was open. According to the Winquist (W) classification, there were 16 (25%) W0, 22 (34%) W1, nine (14%) W2, nine (14%) W3, and eight (13%) W4 fractures. The mean duration between trauma and surgery was 18 days (range 4 to 130 days), and the mean hospital stay was 25 days (range 11 to 142 days). Open and closed techniques were employed in 62 (97%) and two (3%) fractures, respectively. Nine fractures were unlocked; dynamic and static locking were performed in 39 and 16 fractures, respectively. In the open technique, secondary procedures involved grafting in 14 cases, cerclage in eight cases, grafting and cerclage in 10 cases, and grafting and screw fixation in one case. The results were assessed according to the criteria by Thoresen et al. The mean follow-up was 28 months (range 7 to 62 months). RESULTS: Fifty-one patients (80%) had satisfactory, 13 patients (20%) had poor outcome. All proximal locking screws (n=20) were successfully inserted, whereas 23 (24%) of 95 distal screws missed the nail holes. Complications included superficial infection (n=3), osteomyelitis (n=4), trochanteric bursitis (n=1), irritation of the skin by the distal screws (n=4), heterotopic ossification (n=6), shortening more than 1 cm (n=8), rotational malalignment greater than 10 degrees (n=2), migration of the nail through the knee joint (n=2), drill breakage while preparing the distal holes (n=2), knee range of motion below 100 degrees (n=6), and delayed union (n=2). CONCLUSION: Intramedullary nailing should be the primary indication for stable and unstable femoral fractures.

Comparison of palmar locking plate and K-wire augmented external fixation for intra-articular and comminuted distal radius fractures.

OBJECTIVES: This study was designed to compare the results of palmar locking plate and K-wire augmented external fixation in the treatment of intra-articular comminuted distal radius fractures. METHODS: The study included 30 patients with intra-articular comminuted distal radius fractures. Sixteen patients (11 men, 5 women; mean age 49 ± 16 years) underwent open reduction and palmar locking plate fixation, and 14 patients (11 men, 3 women; mean age 35 ± 10 years) underwent closed reduction and K-wire augmented external fixation. In both groups, eight patients had accompanying injuries. According to the AO/ASIF classification, there were four C1, 10 C2, and two C3 fractures in the locking plate group, and three C1, eight C2, and three C3 fractures in the external fixation group. For functional assessment, joint range of motion and grip strength were measured. The patients were assessed using the Gartland-Werley scale. Subjective functional assessment was made using the QuickDASH scale. On final radiographs, the presence of osteoarthrosis in the radiocarpal joint was assessed according to the Broberg-Morrey criteria. The follow-up period was at least 12 months (26.1 ± 6.1 months in the locking plate group, and 62.7 ± 16.8 months in the external fixation group). RESULTS: Wrist flexion (p=0.012) and supination (p=0.003) degrees at final follow-up were significantly greater in the locking plate group. Other range of motion parameters were similar in the two groups. On final radiographic measurements, there were no significant differences between the two groups with respect to losses in palmar angulation, radial length, and radial inclination, and change in ulnar variance. The mean Gartland-Werley scores did not differ significantly (2.4 ± 2.4 with plate fixation, and 2.0 ± 2.8 with external fixation; p>0.05). The results were excellent in 11 patients (68.8%) and good in five patients (31.3%) with plate fixation. The results of external fixation were excellent in 11 patients (78.6%), good in two patients (14.3%), and moderate in one patient (7.1%). The mean QuickDASH scores and time to return to work were similar in patients treated with a locking plate and external fixator (QuickDASH score 2.4 ± 3.0 and 2.9 ± 5.4; 1.9 ± 0.5 months and 2.1 ± 0.7 months, respectively; p>0.05). The mean loss of strength compared to the healthy side at final follow-up was 3% in the locking plate group, and 5% in the external fixation group. Radiographic findings of stage 1 osteoarthrosis were observed in four patients (25%) in the plate group, and in 11 patients (78.6%) in the external fixation group. There were no complications in the locking plate group. In the external fixation group, two patients (14.3%) had regional pain syndrome, three patients (21.4%) had superficial pin and wire tract infections, and one patient complained of adherence at entry sites of the fixator. Overall, nine patients (64.3%) expressed dissatisfaction with the external fixator. CONCLUSION: Our results showed no superiority between the two treatment methods with respect to objective and subjective tools of evaluation. Palmar locking plate fixation was associated with full patient satisfaction. K-wire augmented external fixation can be used as a safe method in selected cases in which the severity of distal radius fracture would not allow palmar locking plate fixation.

[Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures]. / Falanks kiriklarinda açik düzeltme ve mini plak ve/veya vida ile tespit yönteminin yeri.

OBJECTIVES: We evaluated the functional results and the effectiveness of open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures. METHODS: The study included 17 patients (5 women, 12 men; mean age 33 + or - 10 years; range 17 to 48 years) with closed, nonarticular phalangeal fractures. One patient had two phalangeal fractures. There were 14 proximal and four mid phalangeal fractures, including seven oblique, four spiral, one transverse, and six comminuted fractures. The mean duration from injury to surgery was 2.6 + or - 2.9 days (range 0 to 11 days). Following open reduction, seven fractures were treated with a mini plate and screws, and 11 fractures with mini screws. For functional evaluations, total active motion (TARM) and grip strength were measured and the Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) questionnaire was administered. The mean follow-up was 35 + or - 20 months (range 12 to 75 months). RESULTS: Union was obtained in all the patients in a mean of 4.5 months. At final assessments, TARM ranged from 160 degrees to 260 degrees (mean 200 + or - 39.5 degrees ), showing excellent, good, and moderate results in six fingers (33.3%), five fingers (27.8%), and seven fingers (38.9%), respectively. An excellent or good TARM was obtained in eight fingers (72.2%) treated with mini screws, and in three fingers (42.9%) treated with plate-screw fixation. The mean grip strength decreased by 7.5% (range 0 to 20%) on the affected side. The mean Q-DASH score was 3.4 + or - 4.4. According to the classification of complications proposed by Page and Stern, seven major (38.9%) and six minor (33.3%) complications were seen. Two patients (11.1%) had delayed union. CONCLUSION: Our findings do not justify open reduction and low-profile plate and/or screw fixation as the first choice in the treatment of phalangeal fractures. If plate and screw fixation is necessary, the most minimally invasive method such as screw fixation should be preferred.

Oxygen radicals and nitric oxide levels in chondral or meniscal lesions or both.

The pathophysiologic mechanism of osteoarthritis is not well known. The importance of reactive oxygen species and nitric oxide in the pathogenesis of osteoarthritis in patients with chondral or meniscal lesions or both and a search for their source were investigated. Synovial fluid samples obtained from 44 patients with osteoarthritis (16 had meniscal lesions, 12 had chondral lesions, and 16 had meniscal plus chondral lesions) were analyzed. Ten control subjects also were included. Reactive species, nitric oxide, and peroxynitrite were measured by the chemiluminescence technique. Patients with chondral lesions had significantly increased levels of O when compared with patients with meniscal lesions and the control group. However, patients with chondral or meniscal plus chondral lesions had significantly higher levels of other reactive oxygen species when compared with the control group. For the patients with meniscal plus chondral lesions, the contribution of nitrogen containing reactive species was evident. Although patients with chondral lesions had a significant increase in nitric oxide, the increase in patients with meniscal plus chondral lesions was more pronounced in peroxynitrite concentration. These reactive species will lead to tissue damage along with the mechanical damage caused by meniscal or chondral lesions or both.(2-)