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ABSTRACT: OBJECTIVE: To characterize the quantitative changes of patella cartilage over time after total knee arthroplasty (TKA) by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping at 3.0T. METHOD: Twenty-six knees of 26 patients (23 women and three men, mean age, 75 years) with primary osteoarthritis and osteonecrosis of the knee underwent TKA with a zirconia ceramic implant in this prospective study. Twelve patients without patella resurfacing (NR group) and 14 patients with patella resurfacing (R group) had TKA with cemented fixation. The implant position was examined by radiograph, CT and MRI. The clinical scores were checked pre-operatively, one year post-operatively and at the final follow-up. Patella cartilage and its thickness were evaluated pre-operatively and one year after TKA by dGEMRIC and T2 mapping in the NR group only. Patella cartilage was divided into eight regions of interest: the deep and superficial layers of the outer lateral and medial half, and the inner lateral and medial half from the central ridge. RESULTS: The implant position was appropriate in all cases and clinical scores were not significantly different between the two groups. The post-operative dGEMRIC value of the outer medial half superficial zone in the NR group was significantly decreased compared with the pre-operation value (P<0.05), whereas T2 mapping was not significantly changed in all zones. The cartilage thickness of the outer zone was significantly thinner postoperatively (P<0.05). CONCLUSIONS: These findings indicate that osteoarthritic changes in the outer zone of patella cartilage occurred one year after TKA.
Osteoarthritis and Cartilage 10/2012; · 3.90 Impact Factor
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Journal of Orthopaedic Science 09/2012; · 0.84 Impact Factor
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ABSTRACT: BACKGROUND: To compare the patient-reported outcomes and arthroscopic findings between drilling and autologous osteochondral grafting (AOG) for the treatment of articular cartilage defects combined with anterior cruciate ligament (ACL) injuries. METHODS: The subjects were 40 patients who had articular cartilage defects in the weight-bearing part of the medial and lateral femur condyle combined with ACL injuries that were treated by drilling (20 patients) or AOG (20 patients) at the same time as ACL reconstruction was performed. In the drilling group patients, lesions were penetrated with multiple 1.2-mm Kirschner wires, and in the AOG group patients, grafts were made to cartilage defects from one to three osteochondral pegs harvested from the less-weight-bearing periphery of the articular surface of the femoral condyle. The patient-reported outcomes were assessed using the International Knee Documentation Committee (IKDC) subjective knee examination score. Second-look arthroscopy was performed to evaluate the repaired cartilage macroscopically. RESULTS: The median follow-up duration was 25 (range, 12-42) months. The IKDC scores were significantly improved from 64.4 to 95.4 points in the drilling group and from 52.3 to 94.3 points in the AOG group, with no difference between the two groups, although there was a difference in the repaired cartilage findings of arthroscopy. CONCLUSION: In this study, no differences in IKDC scores were found in patients with a concomitant ACL rupture and an osteochondral lesion treated by drilling or AOG at a minimum follow-up of 1year, regardless of the differences at arthroscopic grading of the ICRS classification. LEVEL OF EVIDENCE: Case-control study (LEVEL III).
The Knee 08/2012; · 1.74 Impact Factor
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Kobun Takazawa,
Nobuo Adachi,
Masataka Deie,
Goki Kamei,
Yuji Uchio,
Junji Iwasa,
Nobuyuki Kumahashi,
Taku Tadenuma, Suguru Kuwata,
Kazunori Yasuda,
Harukazu Tohyama,
Akio Minami,
Takeshi Muneta,
Shigeo Takahashi,
Mitsuo Ochi
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ABSTRACT: Autologous chondrocyte implantation (ACI) is an important procedure when repairing cartilage defects of the knee. We previously reported several basic studies on tissue-engineered cartilage, and conducted a multicenter clinical study in 2009. In this clinical study, we evaluated the patients' clinical scores and MRI findings before and after tissue-engineered cartilage implantation, and compared the data obtained at 1 year and approximately 6 years post-implantation.
Fourteen patients who underwent implantation of tissue-engineered cartilage to repair cartilage defects of the knee were evaluated. Tissue-engineered cartilage was produced by culturing autologous chondrocytes three dimensionally in atelocollagen gel. The patients were evaluated clinically using the Lysholm score, and the original knee-function score at pre-implantation and at 1 year and approximately 6 years post-implantation. MRI scans were obtained at the same observation periods. A modified magnetic resonance observation of cartilage repair tissue (MOCART) system was used to quantify clinical efficacy based on the MRI findings.
In approximately 6 years of follow-up, none of the 14 patients reported any subjective symptoms of concern. The mean Lysholm score and the original knee-function score (63.0 ± 10.1, 59.9 ± 5.7) significantly improved at 1 year after implantation (86.4 ± 11.8, 94.1 ± 9.2), and were maintained until 6 years after implantation (89.8 ± 6.2, 89.9 ± 11.2), although some patients showed deterioration of Lysholm and original knee scores between 1 year post-implantation and the final follow-up. The mean MOCART score was 13.2 ± 12.0 pre-implantation, and 62.5 ± 24.7 at 1 year and 70.7 ± 22.7 at approximately 6 years post-implantation. The MOCART scores at 1 year and 6 years were significantly higher than the pre-implantation score, but there was no significant difference between the scores at 1 and 6 years, indicating that the MRI results at 1 year after implantation were maintained for the next 5 years.
The clinical scores and MRI findings after implantation of tissue-engineered cartilage were improved at 1 year after implantation and were maintained until 6 years after implantation.
Journal of Orthopaedic Science 05/2012; 17(4):413-24. · 0.84 Impact Factor
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ABSTRACT: No standard surgical procedure for medial patellofemoral ligament (MPFL) reconstruction exists in skeletally immature patients with patellar instability. This study aimed to evaluate the clinical effectiveness of a novel reconstruction technique for the MPFL in patients with patellar instability because of non-closure of the epiphyseal line.
The "sandwich" method was fixation of the patella between a double-stranded semitendinosus tendon through the posterior third of the femoral insertion of the medial collateral ligament (MCL) as a pulley with a titanium interference screw in a single patellar tunnel. Five knees in five patients were studied: four with recurrent and one with habitual patellar dislocations. Subjects underwent MPFL reconstruction with or without lateral release. Patients were evaluated using pre-operative and post-operative physical and radiographic examinations, including apprehension testing, assessment of tilting and congruence angles, medial and lateral shift ratios under stress measured using X-ray imaging, and Kujala and Lysholm scores.
No patient experienced recurrent post-operative episodes of dislocation or subluxation. By the final follow-up, patellar apprehension had disappeared in all patients. In addition, all patients showed significant improvement in the following: tilting angle, congruence angle, lateral shift ratio, Kujala score, and Lysholm score.
The MPFL reconstruction methods, using a double-stranded semitendinosus autograft and sparing the femoral physeal line in non-closure of the epiphyseal line, provide acceptable short-term results for the treatment of patellar instability.
Archives of Orthopaedic and Trauma Surgery 05/2012; 132(8):1077-83. · 1.37 Impact Factor
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The Foot and Ankle Online Journal 10/2011; 32(10):1012-5. · 1.22 Impact Factor
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ABSTRACT: To evaluate the effectiveness and limitations of autologous osteochondral grafting for the treatment of articular cartilage defects in the knee.
The subjects were 40 patients who had undergone autologous osteochondral grafting. Fifteen knees had cartilage defects combined with anterior cruciate ligament tears (ACL group), 15 knees had cartilage defects combined with osteoarthritis (OA group), and 10 knees had cartilage defects combined with osteochondral dissecans (OCD group). From one to five osteochondral pegs were harvested from the less-weight-bearing periphery of the articular surface of the femoral condyle and grafted to cartilage defects. The clinical results were assessed based on the Lysholm score and radiographic and magnetic resonance imaging (MRI) image assessment.
The median follow-up duration was 24 months (range from 12 to 41 months). The mean Lysholm score following treatment was improved in all groups. The patients who had cartilage defects combined with OA had a significantly poorer prognosis than did those with cartilage defects combined with ACL or OCD. In the OA group, advanced stage and an alignment abnormality were correlated with poor prognosis. Advanced age was correlated with poor prognosis. Other parameters showed no significant difference in prognosis.
Autologous osteochondral grafting was found to be an effective technique for treating relatively young patients who had cartilage defects combined with ACL injury or OCD, but this technique showed limited results in treating cartilage defects based on advanced patient age and degenerative changes in the cartilage.
Diagnostic studies-investigating a diagnostic test, Level III.
Knee Surgery Sports Traumatology Arthroscopy 07/2011; 20(1):160-5. · 2.21 Impact Factor
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ABSTRACT: We sought to determine whether a clinical association exists between osteoarthritis (OA)-associated knee pain and adenosine triphosphate (ATP) levels in synovial fluid (SF). A total of 28 patients with 28 primary OA knees were included. They routinely received intra-articular injection of high-molecular-weight hyaluronic acid (HA) once weekly for 5 weeks (treated group). Eight patients without knee pain who had undergone an operation for anterior or posterior cruciate ligament reconstruction 2 years ago were also examined (control group). SF and blood ATP concentrations, total amount of ATP, total SF volume, and Visual Analogue Scale (VAS) scores in all patients were measured and we compared pre-treatment values with those 1 week after the final treatment. We evaluated the correlation of change in total ATP (ΔATP) and change in VAS score (ΔVAS), ΔVAS and change in SF volume (ΔSF), and ATP concentration in SF and blood. In the treated group, SF ATP concentration, total amount of ATP, SF volume, and VAS score were all significantly lower post-treatment than pre-treatment (p = 0.0005, 0.0003, 0.0022, and < 0.0001, respectively). In treated group, ΔVAS was significantly associated with ΔATP (r = 0.56, p = 0.0032), ΔSF was significantly associated with ΔVAS (r = 0.78, p < 0.0001), and total amount of SF ATP and SF volume at pre-treatment were significantly higher than the control group (p < 0.0001, p < 0.0001) We demonstrated an association between SF ATP level changes and OA knee pain, which should facilitate a further understanding of OA pain mechanisms.
The Knee 06/2011; 18(3):160-4. · 1.74 Impact Factor
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ABSTRACT: We report a successful in situ fixation procedure for the medial condyle in juvenile osteochondritis dissecans (OCD) of the knee after arthroscopic retroarticular drilling failed. Our patient was a 13-year-old boy who felt right knee pain for six months while playing baseball. Plain radiographs and computed tomography (CT) showed a 20 mm ´ 25 mm radiolucent zone in his medial condyle and magnetic resonance imaging (MRI) showed abnormal intensity in the same region. We diagnosed OCD and no separation from cartilage was seen under arthroscopy following retroarticular drilling with K-wire, after conservative treatment for six months had failed. After transient disappearance of the knee pain, it persisted for eight months after the first drilling. Plain radiographs and CT showed a discrepancy in a fragment from the subchondral bone. No separation was identified arthroscopically and an 8.5 mm osteochondral graft was harvested from the center of the lesion and reimplanted in its original position after drilling sclerotic bone marrow. The patient’s knee pain disappeared in two months and union was attained one year after the second surgery. This case shows the limitation of retroarticular drilling for large lesions and in situ fixation of stable osteochondral lesions without any other osteochondral harvest as an effective treatment option
Journal of Orthopaedics. 01/2009;
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ABSTRACT: Early mobilization after tendon repair decreases adhesion formation and improves repair-site strength. We investigated whether the two-strand side-locking loop technique would tolerate aggressive active mobilization immediately after surgery.
Twelve flexor digitorum profundus tendons of the porcine forelimbs were sutured by the two-strand side-locking loop technique with a cross-stitch epitendinous repair (Group A), and by the 8-strand repair method with a simple running suture (Group B). Gaps and residual tensile strength after cyclic loadings of 3-50 N (for 10,000 rounds) were measured.
Gaps after cyclic loading in Group A were 0.5+/-0.3 and 1.2+/-0.8 mm while those in Group B were 3.5+/-0.8 and 5.2+/-1.2 mm at 3 and 50 N, respectively. In addition, the respective residual tensile strength of Groups A and B were 207.1+/-15.2 and 84.2+/-18.3N.
A combination of the two-strand side-locking loop technique with cross-stitch epitendinous repair served as the optimum suture method in establishing safe and early active mobilization without the aid of a specialized rehabilitation staff.
Clinical Biomechanics 01/2008; 22(10):1083-7. · 2.07 Impact Factor
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ABSTRACT: To reveal whether neuropeptides and cytokines affect the pathogenesis of tennis elbow, expressions of substance P, calcitonin gene-related peptide, interleukin 1 alpha, and transforming growth factor beta1 at the origin of the extensor carpi radialis brevis muscle were investigated in patients with tennis elbow (n = 10). Innervation in the origin was determined with use of the protein gene product 9.5. Substance P-like immunoreactivity and calcitonin gene-related peptide-like immunoreactivity were observed in the nerve fibers around small vessels without apparent infiltration of inflammatory cells. Cells showing positive interleukin 1 alpha or transforming growth factor beta1 immunoreactivity were noted in small vessels and the dense collagen meshwork in 5 of 10 cases. The results suggested that these neuropeptides and cytokines might promote inflammation and stimulate proliferation and matrix synthesis of fibroblasts, contributing to the pathology of tennis elbow.
Journal of Shoulder and Elbow Surgery 11(6):570-5. · 2.75 Impact Factor
