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1.
J Orthop Sci ; 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34535382

RESUMO

BACKGROUND: Different methods are available to assess the healing status of repaired root for medial meniscus posterior root tears (MMPRT) using second-look arthroscopy. However, few studies are comparing them or validating their usefulness. Therefore, it was hypothesized that the semi-quantitative arthroscopic score might correlate more with 1-year clinical outcomes in patients with MMPRT than the qualitative evaluation. METHODS: Data of 61 patients who underwent MMPRT pullout repair and second-look arthroscopy were retrospectively evaluated. The semi-quantitative arthroscopic scoring system was divided into three evaluation criteria: scores from 0 to 10 points include the width of the bridging tissue, stability of the repaired root, and synovial coverage. The qualitative evaluation was classified into 4 status; complete healing, lax healing, scar tissue healing, and failed healing according to the stability and mobility of the repaired root. Multivariate linear regression analyses were used to identify predictors of 1-year postoperative clinical outcomes, including Knee Injury and Osteoarthritis Outcome, Lysholm, or International Knee Documentation Committee scores. Spearman's correlation analysis was used to analyze the correlation between second-look arthroscopic score/qualitative evaluation and 1-year postoperative clinical outcomes. In addition, the optimal cutoff point of semi-quantitative arthroscopic score was determined by receiver operating characteristic (ROC) curve. The Mann-Whitney U test was used to compare clinical outcomes between patients with semi-quantitative arthroscopic scores ≥8 and scores <8. RESULTS: All clinical scores significantly improved at 1 year postoperatively. A good correlation was observed between the semi-quantitative score and clinical scores, but none between qualitative evaluation and clinical scores. The optimal cutoff point of semi-quantitative second-look arthroscopic score was 8 points. Significantly, better clinical outcomes were observed in patients with semi-quantitative scores ≥8 points. CONCLUSIONS: All 1-year postoperative clinical scores were significantly improved. The semi-quantitative arthroscopic scores correlate more with 1-year clinical outcomes in patients with MMPRT than the qualitative evaluation. LEVEL OF EVIDENCE: IV case series study.

2.
Acta Med Okayama ; 75(4): 423-430, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34511608

RESUMO

The treatment of medial meniscus posterior root tears (MMPRTs) has evolved to include a variety of repair strategies. This study investigated the location of the articular cartilage degeneration during second-look arthroscopy after transtibial pullout repair with a modified Mason-Allen suture using FasT-Fix (F-MMA) in 22 patients with MMPRTs. Second-look arthroscopy was performed approximately 1 year postoperatively to eval-uate the healing status of the medial meniscus (MM). Articular cartilage degeneration was assessed using the International Cartilage Repair Society grade at primary surgery and again at second-look arthroscopy. Articular surfaces of the medial/lateral femoral condyles, the medial/lateral tibial plateaus, the patella and the trochlea were divided into several subcompartments (MF 1-9, LF 1-9, MT 1-5, LT 1-5, P 1-9, T 1-3). Clinical evaluations used the Japanese Knee Injury and Osteoarthritis Outcome, Lysholm, and International Knee Documentation Committee scores. Second-look arthroscopic findings showed complete healing of the MM posterior root in all patients. Significant differences between pullout repair and second-look arthroscopy were observed for MF 2 and 4, LF 7, and P 7. All clinical outcomes were improved. Our results indicate that this technique improves clinical outcomes postoperatively and may prevent the progression of cartilage degenera-tion on the loading surface of the medial knee compartment.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34137941

RESUMO

PURPOSE: Transtibial pullout repairs using two simple stitches (TSS) and a combination of TSS with posteromedial pullout repair (TSS + PMP) using an all-inside meniscal repair device have been reported previously for the treatment of medial meniscus (MM) posterior root tears. This study aimed to investigate the postoperative clinical outcomes of these techniques including MM extrusion (MME). METHODS: Fifty-two patients who underwent transtibial pullout repair were investigated and divided into TSS (n = 27) and TSS + PMP (n = 25) groups. The clinical outcomes were assessed using the Lysholm knee score and Knee Injury and Osteoarthritis Outcome Score 1 year postoperatively and compared between two groups. MME was measured using magnetic resonance imaging at 1 year postoperatively and compared between two groups. RESULTS: A significant improvement in each clinical score was observed in both groups, and no significant difference was seen in clinical outcomes. Moreover, no significant difference in postoperative MME was observed in both groups (TSS and TSS + PMP: 3.5 mm and 3.8 mm, respectively). Though no significant progression of MME was observed in TSS group, a significant progression of it was observed in TSS + PMP group postoperatively. CONCLUSIONS: This study demonstrated that both techniques improved clinical outcomes in the short-term postoperative period. However, MME was progressed significantly in TSS + PMP group 1 year postoperatively, which indicated that PMP might not be a useful additional procedure for reducing the postoperative MME.

4.
Connect Tissue Res ; : 1-10, 2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33974473

RESUMO

Purpose/Aim of the study: Previous studies have noted distinctions between medial meniscus posterior root and horn cells. However, the characteristics of root remnant cells have not been explored in detail. The purpose of this study was to evaluate the gene expression levels, proliferation, and resistance to mechanical stress of remnant and horn cells.Materials and Methods: Medial meniscus tissue samples were obtained from patients who underwent total or uni-compartmental knee arthroplasty. Cellular morphology, sry-type HMG box 9, type II collagen, and chondromodulin-I gene expression levels were analyzed. Collagen synthesis was assessed by immunofluorescence staining. Proliferation analysis after 4 h-cyclic tensile strain was performed.Results: Horn cells displayed triangular morphology, whereas root remnant cells appeared fibroblast-like. sry-type HMG box 9 mRNA expression levels were similar in both cells, but type II collagen and chondromodulin-I mRNA expressions were observed only in horn cells. The ratio of type II collagen-positive cells in horn cells was about 10-fold higher than that in root remnant cells, whereas the ratio of sry-type HMG box 9-positive cells was similar. A significant increase in proliferation was observed in root remnant cells compared to that in horn cells. Further, under cyclic tensile strain, the survival rate was higher in root remnant cells than in horn cells.Conclusions: Medial meniscus root remnant cells showed higher proliferation and resistant properties to cyclic tensile strain than horn cells and showed no chondromodulin-I expression. Preserving the medial meniscus posterior root remnant during pullout repair surgery might maintain mechanical stress-resistant tissue and support healing.

5.
JBJS Case Connect ; 11(2)2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33826555

RESUMO

CASE: A 49-year-old woman injured her anterior cruciate ligament (ACL) as a high-school student. Double-bundle ACL reconstruction (DBACLR) using hamstring tendon grafts was performed because of recurrent instability. Eleven years after DBACLR, total knee arthroplasty was performed because of osteoarthritis progression. Histologic analysis was completed to observe the osteointegration of the tendon in the obtained proximal tibia. The tibial tunnel showed Sharpey-like fibers anteriorly, connecting the tendon graft and lamellar bone, whereas the intraarticular exit revealed well-aligned chondrocytes posteriorly, indicating chondral metaplasia of the tendon graft. CONCLUSION: Tendon-bone healing can regenerate both fibrous insertion and chondral metaplasia in DBACLR.

6.
Plants (Basel) ; 10(2)2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33669646

RESUMO

This study aimed to obtain information from several embryogenic cell (EC) genotypes analyzing the factors that affect somatic embryogenesis (SE) initiation in sugi (Cryptomeria japonica, Cupressaceae) to apply them in the improvement of protocols for efficient induction of embryogenic cell lines (ECLs). The results of several years of experiments including studies on the influence of initial explant, seed collection time, and explant genotype as the main factors affecting SE initiation from male-fertile, male-sterile, and polycross-pollinated-derived seeds are described. Initiation frequencies depending on the plant genotype varied from 1.35 to 57.06%. The best induction efficiency was achieved when seeds were collected on mid-July using the entire megagametophyte as initial explants. The extrusion of ECs started approximately after 2 weeks of culture, and the establishment of ECLs was observed mostly 4 weeks after extrusion on media with or without plant growth regulators (PGRs). Subsequently, induced ECLs were maintained and proliferated on media with PGRs by 2-3-week-interval subculture routines. Although, the initial explant, collection time, and culture condition played important roles in ECL induction, the genotype of the plant material of sugi was the most influential factor in SE initiation.

7.
Knee Surg Sports Traumatol Arthrosc ; 29(9): 3001-3009, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33112966

RESUMO

PURPOSE: To assess the effects of transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) among patients with early osteoarthritis of the knee as measured by the meniscus healing score and to determine whether the meniscus healing score correlates with the International Cartilage Repair Society (ICRS) grade progression. METHODS: Forty-seven patients with mild osteoarthritic knees (Kellgren-Lawrence grade ≤ 2 and varus alignment < 5°) who underwent transtibial pullout repair less than 3 months after MMPRT onset were assessed. The association between meniscus healing scores at 1 year postoperatively and cartilage damage of the medial compartment (medial femoral condyle [MFC] and medial tibial plateau [MTP]) were evaluated. The MFC was divided into six zones (A to F) and the MTP into two zones (G and H). The mean ICRS grade for each zone was compared between the primary surgery and second-look arthroscopy. The correlation between cartilage damage and meniscus healing status at the time of second-look arthroscopy in each zone was analysed. RESULTS: The mean time interval from injury to surgery was 63 days, and all clinical scores showed significant improvement. There were no significant differences in the extent of cartilage damage in areas B, C, E, or F (n.s.) for MFC or in areas G and H (n.s.) for MTP. The meniscus healing score and cartilage damage were correlated in the loading areas (B, C, E, and H; - 0.53, - 0.45, - 0.33, and - 0.38, respectively; p < 0.05). CONCLUSION: Transtibial pullout repair of MMPRTs among patients with mild osteoarthritic knees improved the clinical outcomes and showed a negative correlation between high meniscus healing scores and ICRS grades in the medial compartment loading area. This study suggests that early surgery should be undertaken for patients with mild osteoarthritic knee who develop MMPRTs. LEVEL OF EVIDENCE: Level IV.


Assuntos
Menisco , Osteoartrite do Joelho , Lesões do Menisco Tibial , Artroscopia , Humanos , Articulação do Joelho , Meniscos Tibiais/cirurgia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia
8.
Knee Surg Sports Traumatol Arthrosc ; 29(4): 1025-1034, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32451621

RESUMO

PURPOSE: The purpose of this study was to evaluate the influence of tibial tunnel position in pullout repair for a medial meniscus (MM) posterior root tear (MMPRT) on postoperative MM extrusion. METHODS: Thirty patients (median age 63 years, range 35-72 years) who underwent transtibial pullout repairs for MMPRTs were included. Three-dimensional computed tomography images of the tibial surface were evaluated using a rectangular measurement grid for assessment of tibial tunnel position and MM posterior root attachment. Preoperative and postoperative MM medial extrusion (MMME) and posterior extrusion (MMPE) at 10° and 90° knee flexion were measured using open magnetic resonance imaging. RESULTS: Tibial tunnel centers were located more anteriorly and more medially than the anatomic center (median distance 5.8 mm, range 0-9.3 mm). The postoperative MMPE at 90° knee flexion was significantly reduced after pullout repair, although there was no significant reduction in MMME or MMPE at 10° knee flexion after surgery. In the correlation analysis of the displacement between the anatomic center to the tibial tunnel center and improvements in MMME, and MMPE at 10° and 90° knee flexion, there was a significant positive correlation between percentage distance and improvement of MMPE at 90° knee flexion. CONCLUSION: This study demonstrated that the nearer the tibial tunnel position to the anatomic attachment of the MM posterior root, the more effective the reduction in MMPE at 90° knee flexion. Our results emphasize that an anatomic tibial tunnel should be created in the MM posterior root to improve the postoperative MMPE and protect the articular cartilage in a knee flexion position. Placement of an anatomic tibial tunnel significantly improves the MMPE at 90° of knee flexion after MM posterior root pullout repair. LEVEL OF EVIDENCE: IV.


Assuntos
Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Lesões do Menisco Tibial/cirurgia , Adulto , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Imageamento Tridimensional/métodos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Período Pós-Operatório , Amplitude de Movimento Articular , Ruptura/cirurgia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
9.
Planta ; 253(1): 3, 2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33346890

RESUMO

MAIN CONCLUSION: Eucalyptus camaldulensis EcDQD/SDH2 and 3 combine gallate formation, dehydroquinate dehydratase, and shikimate dehydrogenase activities. They are candidates for providing the essential gallate for the biosynthesis of the aluminum-detoxifying metabolite oenothein B. The tree species Eucalyptus camaldulensis shows exceptionally high tolerance against aluminum, a widespread toxic metal in acidic soils. In the roots of E. camaldulensis, aluminum is detoxified via the complexation with oenothein B, a hydrolyzable tannin. In our approach to elucidate the biosynthesis of oenothein B, we here report on the identification of E. camaldulensis enzymes that catalyze the formation of gallate, which is the phenolic constituent of hydrolyzable tannins. By systematical screening of E. camaldulensis dehydroquinate dehydratase/shikimate dehydrogenases (EcDQD/SDHs), we found two enzymes, EcDQD/SDH2 and 3, catalyzing the NADP+-dependent oxidation of 3-dehydroshikimate to produce gallate. Based on extensive in vitro assays using recombinant EcDQD/SDH2 and 3 enzymes, we present for the first time a detailed characterization of the enzymatic gallate formation activity, including the cofactor preferences, pH optima, and kinetic constants. Sequence analyses and structure modeling suggest the gallate formation activity of EcDQD/SDHs is based on the reorientation of 3-dehydroshikimate in the catalytic center, which facilitates the proton abstraction from the C5 position. Additionally, EcDQD/SDH2 and 3 maintain DQD and SDH activities, resulting in a 3-dehydroshikimate supply for gallate formation. In E. camaldulensis, EcDQD/SDH2 and 3 are co-expressed with UGT84A25a/b and UGT84A26a/b involved in hydrolyzable tannin biosynthesis. We further identified EcDQD/SDH1 as a "classical" bifunctional plant shikimate pathway enzyme and EcDQD/SDH4a/b as functional quinate dehydrogenases of the NAD+/NADH-dependent clade. Our data indicate that in E. camaldulensis the enzymes EcDQD/SDH2 and 3 provide the essential gallate for the biosynthesis of the aluminum-detoxifying metabolite oenothein B.


Assuntos
Oxirredutases do Álcool , Eucalyptus , Ácido Gálico , Oxirredutases do Álcool/metabolismo , Alumínio/toxicidade , Vias Biossintéticas/fisiologia , Eucalyptus/efeitos dos fármacos , Eucalyptus/enzimologia , Eucalyptus/genética , Ácido Gálico/metabolismo , Hidroliases/metabolismo
10.
Skeletal Radiol ; 49(11): 1781-1788, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32488335

RESUMO

OBJECTIVES: To identify the diagnostic performance of magnetic resonance imaging (MRI) in the knee-flexed position for the detection of meniscal ramp lesions in patients with anterior cruciate ligament tears. MATERIALS AND METHODS: Forty-three patients (mean age 24.5 ± 9.5 years; 21 males, 22 females) with an arthroscopically proven anterior cruciate ligament tear were included in this retrospective study. The presence of the following two important features on MRI was recorded: irregularity of the medial meniscus at the posterior margin, and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin. Findings obtained in arthroscopy served as the reference standard. The diagnostic sensitivity, specificity, and inter-observer agreement were calculated. RESULTS: Sixteen ramp lesions were noted on arthroscopy (37.2%). With an irregularity of the medial meniscus at the posterior margin on MRI, the sensitivity and specificity were 87.5 and 59.3% at 10° knee flexion and 93.8 and 85.2% at 90° flexion, respectively. The complete fluid filling sign on MRI showed sensitivity and specificity of 31.3 and 100% at 10° knee flexion and 87.5 and 100% at 90° flexion, respectively. The concordance between the two observers for the two MRI features was very good (k = 0.70-0.88). CONCLUSION: MRI with the knee in the flexed position improves the diagnostic performance of the detection of meniscal ramp lesions compared with MRI with the knee in the extended position.


Assuntos
Lesões do Ligamento Cruzado Anterior , Imageamento por Ressonância Magnética , Meniscos Tibiais , Lesões do Menisco Tibial , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Feminino , Humanos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Estudos Retrospectivos , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Adulto Jovem
11.
Knee ; 27(3): 701-708, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563426

RESUMO

BACKGROUND: Transtibial pullout repair of a medial meniscus posterior root tear (MMPRT) is a commonly used procedure, and several techniques have been reported. We hypothesised that pull-out repairs using two simple stitches (TSS) would have similar postoperative outcomes as those using the modified Mason-Allen suture with FasT-Fix (F-MMA). We aimed to investigate the clinical outcomes of these techniques, including the meniscal healing status and osteoarthritic change. METHODS: The data of 68 patients who underwent transtibial pull-out repair were retrospectively investigated. The patients were divided into two groups of 41 and 27 patients using F-MMA and TSS, respectively. The clinical outcomes were assessed preoperatively and at second-look arthroscopy (the mean period from surgery was one year) using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status, evaluated at second-look arthroscopy, was compared between the two groups. The cartilage damage was graded as per the classification of the International Cartilage Repair Society and compared at the primary surgery and second-look arthroscopy. RESULTS: Both groups showed significant improvement in each clinical score. No significant difference was seen in the clinical outcome scores and the meniscal healing status between the two groups at second-look arthroscopy. Moreover, no significant progression of cartilage damage was observed in both groups. Fourteen patients in the F-MMA group developed a complication of suture bar failures postoperatively; however, there were no complications in the TSS group. CONCLUSIONS: The TSS and F-MMA techniques showed favourable clinical outcomes and would be established as clinically useful techniques for the MMPRT treatment.


Assuntos
Artroscopia/métodos , Meniscos Tibiais/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Ruptura , Cirurgia de Second-Look , Lesões do Menisco Tibial/diagnóstico
12.
Knee ; 27(3): 899-905, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32249020

RESUMO

BACKGROUND: To investigate the relationship between tibial tunnel aperture location and postoperative meniscal healing. METHODS: We enrolled 25 patients (20 women and five men, mean age: 62.5 years) who underwent transtibial pullout repair for medial meniscus (MM) posterior root repair. The expected MM posterior root attachment center (AC) and tibial tunnel center (TC) were identified using three-dimensional computed tomography, and the minimum AC-TC distance was calculated. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period: 15 months) using a previously reported scoring system (meniscal healing score; range: 0-10). The association between AC-TC distance and meniscal healing score was investigated using univariate linear regression models. The optimal AC-TC distance cut-off for improved MM healing score (≥7) was determined using receiver operating characteristic analysis. RESULTS: The AC-TC distance and meniscal healing score were significantly associated (y = -0.42x + 9.48, R2 = 0.342; P = 0.002), with the optimum AC-TC distance being 5.8 mm. This cut-off had a sensitivity of 100% and specificity of 53%. CONCLUSIONS: This study demonstrates that AC-TC distance is significantly correlated with postoperative meniscal healing. Anatomical repair within 5.8 mm of the AC may result in improved meniscal healing.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Artroscopia , Feminino , Humanos , Imageamento Tridimensional , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Dispositivos de Fixação Ortopédica , Estudos Retrospectivos , Cirurgia de Second-Look , Técnicas de Sutura
13.
Orthop Traumatol Surg Res ; 106(3): 469-473, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32278734

RESUMO

BACKGROUND: Lateral meniscus (LM) posterior root tear (PRT) is often associated with anterior cruciate ligament (ACL) injury and can result in rotational instability, joint overloading, and degenerative changes in the knee. Improved rotational stability and kinematics have been reported after LMPRT repair. However, it is unclear what repair technique can achieve the greatest reduction in LM extrusion (LME). HYPOTHESIS: We hypothesized that transtibial pullout repair would decrease LME to a greater extent than other repair techniques. PATIENTS AND METHODS: Seventeen patients with ACL injury and complete LMPRT were evaluated. Nine underwent ACL reconstruction (ACLR) and transtibial pullout repair, and eight underwent ACLR and other repairs such as inside-out suturing. Double-bundle ACLR was performed using hamstring tendons, and LMPRT pullout repair was performed through the bone tunnel for the posterolateral bundle. Magnetic resonance imaging was performed immediately preoperatively and at>6 months postoperatively, and LME was measured from coronal images only. RESULTS: A significantly greater decrease in the value of LME from pre- to postoperative measurement was observed in the transtibial pullout repair group (-0.5±0.7mm) than in the other-repair group (1.0±0.9mm, p<0.01). Pre- and postoperative LME measurements were not significantly different between the two groups. DISCUSSION: The most important finding of this study was that transtibial pullout repair resulted in a greater decrease in LME than other repair techniques in patients with ACL injury and LMPRT. This technique might be useful for restoring hoop tension by decreasing LME. LEVEL OF EVIDENCE: III, comparative retrospective study.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Menisco Tibial , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia
14.
Artigo em Inglês | MEDLINE | ID: mdl-32042596

RESUMO

Background: Meniscal tears are commonly observed in patients with anterior cruciate ligament (ACL) injuries. Meniscal repair has become a common procedure for the injured meniscus, and good clinical outcomes have been reported in such cases when used concurrently with ACL reconstruction. However, it is unclear whether early chondral damage progression can be prevented following meniscal repair with ACL reconstruction, as meniscal damage is a potential risk factor for the development of osteoarthritis. The purpose of this study was to evaluate the zone-specific chondral damage that occurs after arthroscopic meniscal repair with concomitant ACL reconstruction. Our hypothesis was that meniscal repair with ACL reconstruction would not decrease the rate of progression of chondral damage compared to that observed in isolated ACL reconstruction with intact menisci. Methods: This study included 40 patients who underwent anatomic double-bundle ACL reconstruction. We divided the patients into the following two groups: Group A with an intact meniscus (20 knees) and Group M requiring meniscal repair (20 knees). Chondral damage was evaluated arthroscopically in six compartments and 40 sub-compartments, and these features were graded using the International Cartilage Repair Society lesion classification. The cartilage damage in each sub-compartment and compartment was compared between the two groups both at reconstruction and at second-look arthroscopy (average 16 months postoperatively). At the latest follow-up examination (average 37 months postoperatively), the International Knee Documentation Committee (IKDC) score was compared between the two groups. Results: Group M had a significantly worse cartilage status than Group A in five sub-compartments (mainly in the medial compartment) at reconstruction and in nine sub-compartments (mainly in the bilateral compartments) at second-look arthroscopy. The mean IKDC score was better in Group A than in Group M (Group A; 90 vs. Group M; 86). The overall success rate of meniscal repairs was 92% (23 of 25 menisci) at second-look arthroscopy. Conclusion: The progression of post-traumatic chondral damage may occur at a faster rate in patients who require ACL reconstruction and meniscal repair than in patients with intact menisci.

15.
J Plant Res ; 133(2): 205-215, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32048093

RESUMO

Rubisco specificity factor (Sc/o), a measure of the relative capacities of an enzyme to catalyze carboxylation and oxygenation of ribulose-1,5-bisphosphate, determines the extent of photosynthetic CO2 assimilation and photorespiratory CO2 release. The current model of C3 photosynthesis, the Farquhar-von Caemmerer-Berry (FvCB) model, requires a species-specific Sc/o. However, Sc/o values have never been reported in conifers, likely because in vitro kinetic analysis of conifer Rubisco presents difficulties. To estimate the Sc/o of conifers and compare it with angiosperm Sc/o, we measured changes in leaf CO2 compensation points (Γ) in response to O2 partial pressure for a variety of leaves, with different rates of day respiration (Rday) and maximum Rubisco carboxylation (Vcmax) in gymnosperms (Ginkgo biloba), conifers (Metasequoia glyptostroboides and Cryptomeria japonica), and angiosperms (Nicotiana tabacum and Phaseolus vulgaris). As predicted by the FvCB model, the slope of a linear function of Γ vs O2 partial pressure, d, increased alongside increasing Rday/Vcmax. The Sc/o was obtainable from this relationship between d and Rday/Vcmax, because the d values at Rday/Vcmax = 0 corresponded to α/Sc/o, where α was the photorespiratory CO2 release rate per Rubisco oxygenation rate (generally assumed to be 0.5). The calculated Sc/o values of N. tabacum and P. vulgaris exhibited good agreement with those reported by in vitro studies. The Sc/o values of both conifers were similar to those of the two angiosperm species. In contrast, the Sc/o value of G. biloba was significantly lower than those of the other four studied species. These results suggest that our new method for Sc/o estimation is applicable to C3 plants, including those for which in vitro kinetic analysis is difficult. Furthermore, results also suggest that conifer Sc/o does not differ significantly from that of C3 angiosperms, assuming α remains unchanged.


Assuntos
Dióxido de Carbono/fisiologia , Cycadopsida/enzimologia , Magnoliopsida/enzimologia , Oxigênio/fisiologia , Ribulose-Bifosfato Carboxilase/fisiologia , Traqueófitas/enzimologia , Cinética , Fotossíntese , Folhas de Planta
16.
Knee Surg Sports Traumatol Arthrosc ; 28(5): 1419-1424, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31025058

RESUMO

PURPOSE: In total knee arthroplasty (TKA), it is important to obtain an appropriate flexion-extension gap. The extension gap is expanded by posteromedial vertical capsulotomy (PMVC). This study aimed to evaluate the increase in the extension gap by PMVC using a navigation system. METHODS: In posterior stabilized (PS)-type TKA, PMVC was performed in 37 knees. The medial extension gap at 0° and flexion gap at 90° flexion of the knee joint using the navigation system before and after PMVC were measured. RESULTS: The extension gap before the PMVC was 5.3 ± 2.9 mm. After PMVC, the extension gap had significantly increased to 8.0 ± 2.8 mm (p < 0.001). In addition, the flexion gap was 8.1 ± 2.7 mm before the PMVC, but it was 8.7 ± 2.8 mm after the PMVC, and the flexion gap was not enlarged (n.s.). CONCLUSION: In PS-type TKA, it is possible to obtain selective expansion of about 2.7 mm of the extension gap by PMVC. Therefore, gap balance can be acquired by soft-tissue treatment while preserving the bone. The PMVC was a useful method for acquiring gap balance and preserving the bone stock. LEVEL OF EVIDENCE: IV.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Amplitude de Movimento Articular
17.
Connect Tissue Res ; 61(6): 546-553, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-31181971

RESUMO

Purpose/Aim of the study: Posterior root injury of the medial meniscus often leads to articular cartilage degeneration due to altered biomechanics. To avoid dysfunction, the attachment must be repaired using the transtibial pullout technique. To guide appropriate placement of the tibial tunnel, additional details on the normal anatomy of the meniscus insertion are needed. Therefore, we performed a histological analysis of a tibial bone slice with the medial meniscus posterior insertion obtained during total knee arthroplasty surgery. Materials and methods: Horizontal slices of the proximal tibia were obtained from 7 patients with osteoarthritis who underwent total knee arthroplasty. After decalcification, the region of the posterior horn was cut out and segmented into four pieces (2.0 mm thickness; medial to lateral). Sagittal sections were evaluated by safranin O staining or immunohistochemistry with anti-type collagen antibody. Results: Safranin O staining showed that the insertion of the posterior root consisted primarily of fibrocartilaginous layers in segment 2. Anatomically, segment 2 corresponded to the sagittal plane passing through the peak of the medial intercondylar tubercle. In this section, safranin O staining and immunohistochemistry revealed that the anterior one-third of the posterior root insertion was richer in proteoglycans and type II collagen than the central and posterior one-third. Conclusions: Anatomical insertion of the posterior root of the medial meniscus was located at the sagittal plane passing through the peak of the medial intercondylar tubercle. The structure of the medial meniscus posterior insertion was mainly localized in the anterior one-third.


Assuntos
Meniscos Tibiais/patologia , Tíbia/patologia , Idoso , Idoso de 80 Anos ou mais , Colágeno Tipo II/metabolismo , Feminino , Humanos , Masculino , Meniscos Tibiais/metabolismo , Coloração e Rotulagem , Tíbia/metabolismo
18.
Knee ; 27(1): 132-139, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31882388

RESUMO

BACKGROUND: Medial meniscus (MM) medial extrusion in the coronal plane does not always improve, even after repair. This study aimed to determine the extent of posteromedial extrusion of the MM during knee flexion before and after MM pullout repair using three-dimensional magnetic resonance imaging (MRI). METHODS: Data from 14 patients (mean age, 63.4 years; 86% female) who had undergone MM pullout repair at the current institution between August 2017 and October 2018 were retrospectively reviewed. The MRIs were performed pre-operatively and ≥3 months postoperatively. Three-dimensional MRIs of the tibial surface and MM were evaluated using Tsukada's measurement method before and after pullout repair. The expected center of MM posterior root attachment (point A), the point on the extruded edge of the MM farthest away from point A (point E), and the point of intersection of a line through the posteromedial corner of the medial tibial plateau and a line connecting points A and E (point I) were identified. Subsequently, the pre-operative and postoperative AE and IE distances were calculated and compared. RESULTS: Point E was laterally shifted by the pullout repair, whereas point I showed no significant change. The postoperative IE distance (6.7 mm) was significantly shorter than the pre-operative one (9.1 mm, P < 0.01). The postoperative AE distance (29.3 mm) was significantly shorter than the pre-operative one (31.5 mm, P < 0.01). CONCLUSIONS: The AE and IE distances significantly decreased after MM posterior root repair, suggesting that transtibial pullout repair may be useful in reducing posteromedial extrusion of the MM.


Assuntos
Articulação do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Imageamento Tridimensional , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Lesões do Menisco Tibial/classificação , Lesões do Menisco Tibial/diagnóstico por imagem
19.
Knee Surg Sports Traumatol Arthrosc ; 28(11): 3416-3425, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31781798

RESUMO

PURPOSE: To investigate changes in meniscal extrusion during knee flexion before and after pullout fixation for medial meniscus posterior root tear (MMPRT) and determine whether these changes correlate with articular cartilage degeneration and short-term clinical outcomes. METHODS: Twenty-two patients (mean age 58.4 ± 8.2 years) diagnosed with type II MMPRT underwent open magnetic resonance imaging preoperatively, 3 months after transtibial fixation and at 12 months after surgery, when second-look arthroscopy was also performed. The medial meniscus medial extrusion (MMME) and the medial meniscus posterior extrusion (MMPE) were measured at knee 10° and 90° flexion at which medial meniscus (MM) posterior translation was also calculated. Articular cartilage degeneration was assessed using International Cartilage Research Society grade at primary surgery and second-look arthroscopy. Clinical evaluations included Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee subjective knee evaluation form, Lysholm score, Tegner activity level scale, and pain visual analogue scale. RESULTS: MMPE at 10° knee flexion was higher 12 months postoperatively than preoperatively (4.8 ± 1.5 vs. 3.5 ± 1.2, p = 0.01). MMPE at 90° knee flexion and MM posterior translation were smaller 12 months postoperatively than preoperatively (3.5 ± 1.1 vs. 4.6 ± 1.3, 7.2 ± 1.7 vs. 8.9 ± 2.0, p < 0.01). Articular cartilage degeneration of medial femoral condyle correlated with MMME in knee extension (r = 0.5, p = 0.04). All clinical scores significantly improved 12 months postoperatively. However, correlations of all clinical scores against decreased MMPE and increased MMME were not detected. CONCLUSIONS: MMPRT transtibial fixation suppressed the progression of MMPE and cartilage degeneration and progressed MMME minimally in knee flexion position at 1 year. However, in the knee extension position, MMME progressed and correlated with cartilage degeneration of medial femoral condyle. MMPRT transtibial fixation contributes to the dynamic stability of the MM in the knee flexion position. LEVEL OF EVIDENCE: IV.


Assuntos
Traumatismos do Joelho/cirurgia , Meniscos Tibiais/fisiopatologia , Lesões do Menisco Tibial/cirurgia , Idoso , Artroscopia/métodos , Doenças das Cartilagens/fisiopatologia , Doenças das Cartilagens/cirurgia , Feminino , Humanos , Traumatismos do Joelho/complicações , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/cirurgia , Período Pós-Operatório , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Ruptura/cirurgia , Cirurgia de Second-Look/métodos , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/fisiopatologia
20.
Cureus ; 12(12): e12405, 2020 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-33532163

RESUMO

Postoperative scarring is one of the complications after arthroscopic knee surgery, which is usually treated with manual therapy or arthroscopic debridement. The incidence of symptomatic scarring requiring surgery within six months postoperatively has been reported to be approximately 0.06-6.00%. We treated a patient after arthroscopic surgery with a new "ultrasound-guided hydrorelease" procedure and we describe it. A 50-year-old woman with a history of arthroscopic anterior cruciate ligament reconstruction of the right knee presented to our clinic 10 months ago with a complaint of right anterior knee pain. Ultrasound imaging showed an infrapatellar fat pad (IPFP) scarring and sliding defects. The pre-treatment Kujala scale was 62 points and the visual analogue scale was 72. The inferolateral side of the patella was palpated to identify the scarring after arthroscopy at the IPFP area. An ultrasound probe was applied vertically to identify the site of adhesion of interest. Ultrasound-guided hydrorelease was performed using 7.0mL saline injected by needle (22G, 60mm) directed at the site with hypoechoic changes in the IPFP. After the procedure, the normalization of the IPFP sliding was confirmed by an ultrasound image. Four weeks after this procedure, the patient improved, with a Kujala scale of 82 points and a visual analogue scale of 28. The most important finding from this patient's course is that her chief complaint of anterior knee pain improved by ultrasound-guided hydrorelease into the IPFP scarring after arthroscopic knee surgery. The procedure should be considered as a treatment for scarring after arthroscopic knee surgery.

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