Inflammatory foreign-body reaction to an arthroscopic bioabsorbable meniscal arrow repair.

Various arthroscopic meniscal repair techniques have been developed in recent years to preserve meniscal function. We report the case of a patient with a failed arthroscopic meniscal repair demonstrating an inflammatory foreign-body reaction to bioabsorbable meniscal arrows.

The treatment of isolated articular cartilage lesions in the young individual.

The treatment of isolated articular cartilage defects is an evolving field in orthopaedic surgery today. We have summarized the basic science and clinical date on the treatment of isolated articular cartilage defects. Further long-term controlled studies are required in order to compare definitively the efficacy of treatments in this difficult clinical area. In future studies, inclusion/exclusion criteria must be detailed, and classification systems need to be standardized Comparative analysis can then be performed to assess the efficacy of various techniques.

A comparison of abrasion burr arthroplasty and subchondral drilling in the treatment of full-thickness cartilage lesions in the rabbit.

The purpose of this study was to observe the difference in healing of full-thickness articular cartilage defects treated with burr arthroplasty versus subchondral drilling. Cartilage was shaved off the medial femoral condyles of 39 rabbits without penetrating the subchondral plate. In left knees, two 2.0-mm holes were drilled into the condyle until bleeding was obtained. Right knees underwent a burr arthroplasty until punctate bleeding was observed. Animals were sacrificed at 6, 12, and 24 weeks postoperatively. Joint resurfacing and degenerative changes were evaluated grossly and histologically. Degenerative changes in the cartilage surface were observed with both treatments. Rabbits undergoing subchondral drilling had increased fibrocartilaginous healing with time, with a slight increase in degenerative changes. With burr arthroplasty, there was significant decrease in cartilaginous coverage of the exposed surface as well as progressive increase in degenerative changes. Although both techniques were suboptimal, histological evidence at 6 months suggests that subchondral drilling may result in a longer-lived repair than abrasion arthroplasty in the treatment of full-thickness lesions.

Use of the "blue dot" in femoral bone plug of bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction.

The advancement of the femoral bone plug, with proper orientation through the femoral tunnel is often one of the most difficult maneuvers in the reconstruction of the anterior cruciate ligament using a bone-patellar tendon-bone graft. The authors describe a modification to the procedure featuring the use of methylene blue marker (to make a ¿blue dot¿) to highlight the site of drill holes as well as the anterior bone-tendon junction. The ¿blue dot¿ aids the localization of the drill hole with a probe and thus the advancement of the femoral plug through the femoral tunnel.

The effect of low-level Nd:YAG laser energy on adult articular cartilage in vitro.

Reports of laser energy applied to soft tissues in vitro and in vivo suggest both stimulation and inhibition of specific metabolic processes, depending on the type of laser, the energy density (ED) used, the mode of delivery, and type of tissue studied. An earlier in vitro study of Nd:YAG laser irradiation of articular cartilage indicated stimulation of both matrix and DNA synthesis for 6 days following laser exposure. In vivo reports on the ability of Nd:YAG laser energy to stimulate the healing of partial-thickness cartilage defects are conflicting. In the present study, a noncontact continuous-wave Nd:YAG laser beam of varying EDs was applied to full-thickness adult articular cartilage explants maintained in organ culture; the metabolic processes of chondrocyte DNA synthesis and matrix synthesis were followed over 2 weeks. For both canine and bovine cartilage, low-levels of laser energy (ED 51-127 J/cm2) stimulated matrix synthesis at 6-7 days following laser exposure, with a concomitant decrease in baseline DNA synthesis. By 12-14 days, however, these dose-dependent effects were no longer seen, with no significant differences from control noted for any of the laser energies studied. Histologic analysis of the cartilage explants following laser exposure showed no significant differences in cell number or morphology between sample and control groups; however, a decrease in matrix proteoglycan staining was seen in the highest laser energy group at all time points. These findings indicate that exposure to low-level noncontact Nd:YAG laser energy promotes a significant stimulation of cartilage matrix synthesis. However, a single exposure may not be sufficient to promote a sustained upregulation of cartilage metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)