Mesenchymal Stem Cells Decrease Tunnel Widening of Anterior Cruciate Ligament Reconstruction in Rabbit Model

BACKGROUND AND OBJECTIVES: The study investigated the effect of mesenchymal stem cells (MSCs) or fibrin glue on tunnel widening after anterior cruciate ligament (ACL) reconstruction compared with biologic free control without any biologic agents in the rabbit model. METHODS AND RESULTS: ACL reconstructions were performed in 18 New Zealand white rabbits. All animals were divided into 3 groups according to the following reconstruction conditions and euthanized 12 weeks postoperatively for radiologic and histologic analyses. Thirty-two knees (control group=10; fibrin group=11; MSCs group=11) were finally evaluated. On micro-CT scan, mean femoral tunnel widening on oblique-sagittal image was 0.7±0.4 mm in the control group, 0.22±0.1 mm in the fibrin group and 0.25±0.1 mm in the MSCs group (p=0.001). Fibrin group and MSCs group showed significant differences compared with control group (p=0.002, 0.002). Mean tibial tunnel widening on oblique-sagittal image was 0.76±0.5 mm, 0.27±0.1 mm and 0.29±0.2 mm in the control, fibrin and MSCs group. Fibrin and MSCs group showed significant differences compared with control group (p=0.017, 0.014). Hounsfield Units (HU) were not significantly different between 3 groups (p>0.05). Histological analysis revealed that the architecture of graft in the MSCs group featured hypercellularity and compact collagen deposit. CONCLUSION: ACL reconstruction using MSCs seemed decrease tunnel widening in rabbit model. Further study with large animals is required to confirm efficacy on decreasing tunnel widening.

Comparative Study of the In Vivo Stability between a Stable Knee and an Anterior Cruciate Ligament Injured Knee with Using a Navigation System

PURPOSE: We compared the anteroposterior translation and the internal-external rotation of the tibia in stable knees without an anterior cruciate ligament (ACL) injury with those of ACL injured knees by using a navigation system and we report the objective data. MATERIALS AND METHODS: Forty-four patients who were treated for a meniscal tear without ACL injury were allocated to the stable group, and 41 patients were allocated to the ACL injury group. The anteroposterior displacement and the rotation of the knees were measured in 0, 30, 60 and 90 degrees of flexion with using the Orthopilot(R) navigation system. RESULTS: The mean total rotation values were 18.8degrees+/-4.5degrees, 31.4degrees+/-4.2degrees, 30.1degrees+/-5.1degrees and 29.2degrees+/-5.9degrees at 0, 30, 60 and 90 degrees of flexion, respectively, in the stable group and 22.7degrees+/-6.9degrees, 37.6degrees+/-5.8degrees, 34.0degrees+/-9.4degrees and 31.8degrees+/-8.8degrees at 0, 30, 60 and 90 degrees of flexion, respectively, in the ACL injury group. CONCLUSION: The quantitative values for anteroposterior translation and rotations of stable and ACL injured knee were obtained using a navigation system.

Minimally Invasive Two-Incision Total Hip Arthroplasty for Treating Acute Displaced Femoral Neck Fractures in Active Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the short term follow-up results of minimally invasive (MI) two-incision total hip arthroplasty (THA) for treating acute displaced femoral neck fractures in active elderly patients. MATERIALS AND METHODS: We performed a retrospective review of 39 cases (average age: 72 years old, range: 60 years and above) of elderly patients who underwent MI two-incision THA within 30 days of their injury for treating displaced acute femoral neck fractures. They were followed up for a minimum of 12 months. Clinical evaluation was done by comparing the pre-injury and postoperative daily activities, the Harris Hip score (HSS) and the Western Ontario and McMaster University (WOMAC) score. The radiographs were checked to evaluate for implant alignment and periprosthetic abnormalities. The postoperative complications were analyzed. RESULTS: The average postoperative HSS was 88.3 and the average WOMAC score was 28.8. All the patients were able to walk without any assistive device. One patient had a HHS of less than 70. There were 2 dislocations but there was no recurrence. Radiographically, there was no case with a limb length discrepancy of more than 5mm. The femoral stems did not reveal any subsidence of more than 5mm. Other complications such as osteolysis, infection, neurologic injury and intraoperative periprosthetic fracture were not noted. Especially, no patient complained of any groin pain, which often occurs after bipolar hemiarthroplasty. CONCLUSION: The short term follow-up results were good for MI two-incision THA to treat acute displaced femoral neck fractures in active elderly patients, and these procedures were done by an experienced hip surgeon.

Availability of D-dimer Test for the Diagnosis ofDeep Vein Thrombosis after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To investigate the prevalence of deep vein thrombosis (DVT) after Total knee arthroplasty (TKA) and evaluate the availability of D-dimer test for the diagnosis of DVT after TKA. MATERIALS AND METHODS: From April 2006 to July 2006, 140 consecutive patients, who had degenerative osteoarthritic knees and underwent primary total knee arthroplasty, were enrolled in this study. General and hematological risk factors were compared between DVT positive and negative patients. D-dimer level was checked preoperatively, and at 1, 7 and 14 days after surgery. A diagnosis of DVT was established by computed tomography venography. RESULTS: DVT was found in 48 (34%) patients and only 5 (10.4%) showed symptoms of DVT. Regarding the risk factors, only obesity was significantly associated with an increased incidence of DVT (p=0.049). Seven days after surgery, the average D-dimer level in the DVT positive and negative patients was 4.90 mg/L and 3.12 mg/L, respectively (p=0.000). CONCLUSION: In our study patients, the incidence of symptomatic DVT was lower than in the Western population. We recommend obesity, clinical symptoms and D-dimer value at 7 days after surgery as a valuable screening tests for detecting DVT.

Pathoanatomical Factors Responsible for Femoral Shortening in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to determine the relative contributions made by pathoanatomical factors responsible for femoral shortening in Legg-Calve-Perthes disease (LCPD), and to devise a method of reducing the amount of residual shortening based on a better understanding of its pathoanatomy and developmental pattern in LCPD. MATERIALS AND METHODS: We measured shortening of three anatomical components, namely, the femoral epiphysis, neck, and diaphysis on the teleoroentgenograms of 106 LCPD patients, comprised of 35 children with active disease, 24 in the healing stage, and 47 at skeletal maturity. RESULTS: The proportional contributions made by these 3 anatomical components to residual shortening at skeletal maturity were; 20% by the epiphysis (epiphyseal flattening), 53% by the neck (physeal growth retardation), and 27% by the diaphysis (underuse atrophy). These contributions differed according to disease stage and shortening severity. Mean diaphyseal shortening was 3.9 mm at skeletal maturity, but this increased to 5.8 mm when only patients with severe shortening (20 mm or more) were included. CONCLUSION: Our findings suggest that diaphyseal shortening is likely to be minimized by the implementation of limb exercise programs.

Radiographic Changes in Forefoot Geometry with Weightbearing: Hallux Valgus Angle, Intermetatarsal Angle, and Medial Sesamoid / 대한족부족관절학회지

PURPOSE: To determine the radiographic changes in forefoot geometry with weight-bearing. MATERIALS AND METHODS: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. RESULTS: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle 1~2 was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle 1~5 was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. CONCLUSION: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

Radiographic Changes in Forefoot Geometry with Weightbearing: Hallux Valgus Angle, Intermetatarsal Angle, and Medial Sesamoid / 대한족부족관절학회지

PURPOSE: To determine the radiographic changes in forefoot geometry with weight-bearing. MATERIALS AND METHODS: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. RESULTS: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle 1~2 was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle 1~5 was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. CONCLUSION: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

Rising Incidence of Hip Fracture in Gwangju City and Chonnam Province, Korea

The purpose of study was to determine the incidence of hip fracture in 2001, to compare this with that of 1991, and to identify possible causes of change. Patients aged 50 yr or more living in Gwangju City and Chonnam Province, Korea, and who sustained a fracture of the hip during 2001 were investigated. Only patients who were admitted to hospitals for primary treatment of the first hip fracture were selected. There were 1,152 patients. A comparison of fracture incidences for 1991 and 2001 showed considerable increase during the 10-yr period. The total annual number of hip fractures rose from 247 in 1991 to 1,152 in 2001 and the fracture incidence also increased remarkably from 3.3 persons per 10,000 population in 1991 to 13.3 in 2001, representing a 4-fold increase over 10-yr. The reasons for this rising trend of hip fracture were not fully explained. However, an increase in the elderly population, an increase in osteoporosis, and an increase in injurious falls could partly account for the observed increase.

Simultaneous Occurrence of Bilateral Legg-Calve-Perthes Disease in Identical Twins / 대한정형외과학회잡지

This report describes simultaneous bilateral Legg-Calve-Perthes disease (LCPD) development in four-year-old identical male twins. Moreover, the twins showed head involvement patterns with mirror symmetry. We included a review of the literature on this rare condition and discussed the genetic risks associated with LCPD.