The clinical outcomes and the ability to sit straight in the Japanese style following high tibial osteotomy combined with osteochondral autologous transfer for osteonecrosis of the medial femoral condyle.

BACKGROUND: There have been some reports of high tibial osteotomy combined with osteochondral autograft transfer for osteonecrosis of the medial femoral condyle of the knee. However, few of them have focused on the deep knee flexion needed to sit straight in the Japanese style. PURPOSE: To evaluate the clinical outcomes and the knee flexion of HTO combined with OAT for osteonecrosis of the medial femoral condyle of the knee, especially the ability to sit straight in the Japanese style. METHODS: Between 1998 and 2012, valgus HTO combined with OAT was performed in 23 patients for stage IV osteonecrosis according to Koshino's radiological classification of the medial femoral condyle. The follow-up period was more than 2 years in all cases. The mean age at the time of the surgery was 65.8 years, and the mean follow-up period was 72.2 months. The function of the knee and the ability to sitting straight in the Japanese style were examined. Twenty-one knees were examined with second-look arthroscopy to assess the recipient and donor sites. RESULTS: The JOA scale and IKDC subjective scores were significantly improved. Twelve patients were able to sit straight in the Japanese style after the surgery, compared to 3 patients who were able to do so before surgery. On second-look arthroscopy of 21 knees, the average ICRS score was 10.5 points. No patient needed additional surgery except for removal of the implants. CONCLUSION: Valgus HTO combined with OAT is one treatment option for osteonecrosis of the medial femoral condyle with osteoarthritis. In the present study, many of the patients regained good knee function, and 50% of the patients were able to sit straight in the Japanese style after surgery, which is a higher rate than after total knee arthroplasty and unilateral knee arthroplasty.

Short-term effects of highly-bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study.

BACKGROUND: We previously developed a surface-controlled water-dispersible form of curcumin and named it Theracurmin(®) (Theracurmin; Theravalues, Tokyo, Japan). The area under the blood concentration-time curve of Theracurmin in humans was 27-fold higher than that of curcumin powder. We determined the clinical effects of orally administered Theracurmin in patients with knee osteoarthritis during 8 weeks of treatment. METHODS: Fifty patients with knee osteoarthritis of Kellgren-Lawrence grade II or III and who were aged more than 40 years were enrolled in this randomized, double-blind, placebo-controlled, prospective clinical study. Placebo or Theracurmin containing 180 mg/day of curcumin was administered orally every day for 8 weeks. To monitor adverse events, blood biochemistry analyses were performed before and after 8 weeks of each intervention. The patients' knee symptoms were evaluated at 0, 2, 4, 6, and 8 weeks by the Japanese Knee Osteoarthritis Measure, the knee pain visual analog scale (VAS), the knee scoring system of the Japanese Orthopedic Association, and the need for nonsteroidal anti-inflammatory drugs. RESULTS: At 8 weeks after treatment initiation, knee pain VAS scores were significantly lower in the Theracurmin group than in the placebo group, except in the patients with initial VAS scores of 0.15 or less. Theracurmin lowered the celecoxib dependence significantly more than placebo. No major side effects were observed with Theracurmin treatment. CONCLUSION: Theracurmin shows modest potential for the treatment of human knee osteoarthritis.

Serial Changes of the Cartilage in Recipient Sites and Their Mirror Sites on Second-Look Imaging After Mosaicplasty.

BACKGROUND: It has been reported that the short-term results of mosaicplasty are good, but there have been no reports of the serial cartilage changes in the recipient sites and their mirror sites for mosaicplasty. PURPOSE: To examine the serial changes in cartilage in the recipient sites and their mirror sites using second-look imaging. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 33 patients (37 knees, 40 sites) underwent mosaicplasty and second-look arthroscopy at a single institution over a 7-year period. There were 14 men and 19 women (12 right knees and 25 left knees). The recipient sites were the patella (n = 3), trochlea (n = 7), medial femoral condyle (n = 21), and lateral femoral condyle (n = 9). The mean patient age at surgery was 38.3 years; the mean period from mosaicplasty to second-look arthroscopy was 15.4 months; and the mean follow-up period was 34.9 months (range, 24-65 months). The results of second-look arthroscopy at the recipient site were categorized as cartilage with a smooth surface (group S) and fibrillation or an irregular surface (group I), and results of second-look arthroscopy at the mirror site were categorized as worse (group W), improved (group E), and unchanged (group U). RESULTS: There were 30 sites in group S, 10 sites in group I, 3 sites in group W, 4 sites in group E, and 33 sites in group U. The age at operation was significantly greater in group S than in group I. There was a significant correlation between group S and groups E and U. The clinical outcome was significantly worse in group W when compared with groups E and U. CONCLUSION: If a smooth surface was seen in the recipient site during second-look arthroscopy, the cartilage degeneration in its mirror site did not become worse after mosaicplasty.

Osteochondral autograft transfer for post-traumatic osteochondral defects of the anterolateral surface of the distal tibial plafond.

Post-traumatic osteochondral defects of the distal tibial plafond may be a more common cause of pain and osteoarthritis than previously recognized. However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. This case report presents the operative technique and clinical outcome of osteochondral autograft transfer for an osteochondral defect on the anterolateral surface of the distal tibial plafond. A case of transfer of osteochondral autograft plugs to repair the anterolateral surface of the distal tibial plafond and prevent progression of forward displacement of the talus in a 25-year-old man who presented with pain in his right ankle, following a history of trauma.

Cartilage Degeneration and Alignment in Severe Varus Knee Osteoarthritis.

OBJECTIVES: The aim of this study was to examine the relationship between cartilage, ligament, and meniscus degeneration and radiographic alignment in severe varus knee osteoarthritis in order to understand the development of varus knee osteoarthritis. DESIGN: Fifty-three patients (71 knees) with primary varus knee osteoarthritis and who underwent total knee arthroplasty were selected for this study. There were 6 men and 47 women, with 40 right knees and 31 left knees studied; their mean age at operation was 73.5 years. The ligament, meniscus, degeneration of joint cartilage, and radiographic alignments were examined visually. RESULTS: The tibial plateau-tibial shaft angle was larger if the condition of the cartilage in the lateral femoral condyle was worse. The femorotibial angle and tibial plateau-tibial shaft angle were larger if the conditions of the lateral meniscus or the cartilage in the lateral tibial plateau were worse. CONCLUSION: Based on the results of this study, progression of varus knee osteoarthritis may occur in the following manner: medial knee osteoarthritis starts in the central portion of the medial tibial plateau, and accompanied by medial meniscal extrusion and anterior cruciate ligament rupture, cartilage degeneration expands from the anterior to the posterior in the medial tibial plateau. Bone attrition occurs in the medial tibial plateau, and the femoro-tibial angle and tibial plateau-tibial shaft angle increase. Therefore, the lateral intercondylar eminence injures the cartilage of the lateral femoral condyle in the longitudinal fissure type. Thereafter, the cartilage degeneration expands in the whole of the knee joints.