Resected femoral anthropometry for design of the femoral component of the total knee prosthesis in a Korean population / 대한해부학회지

We measured the mediolateral (ML) and anteroposterior (AP) length, height and widths of the anterior, posterior and inferior section of the resected distal femurs using three dimensional computer tomographic measurements in 200 knees from 100 cadavers. We also calculated the aspect ratio (ML/AP) and compared the measured parameters with that of six conventionally used total knee femoral prostheses. We found that the average ML (70.2+/-5.5 mm) and AP (53.9+/-3.8 mm) dimensions from our study were lower than those reported from Western populations. The aspect ratio showed a progressive decline with an increasing antero-posterior dimension. All of the compared designs showed undersizing for the mediolateral dimension distally and for the widths of the resected medial and lateral posterior femoral condyles. But some of the compared designs showed oversizing for the height of the resected medial and lateral posterior femoral condyles. This study provides guidelines for designing a suitable femoral component for total knee prostheses that fit Asian populations.

Tibial intramedullary canal axis and its influence on the intramedullary alignment system entry point in Koreans / 대한해부학회지

Using computerized tomographic data and three dimensional model, we studied the influence of tibial intramedullary canal axis and other morphologic factors of the tibia on the entry point for tibial intramedullary alignment guides. Various anatomical parameters including tibial anteroposterior dimensions (AP), mediolateral dimensions (ML), aspect ratio (ML/AP), bowing and the intramedullary canal axis were studied. In addition, the entry point for the intramedullary alignment guide for primary and revision total knee arthroplasty were studied. The averaged entry point at the level of the tibial plateau was 5.7+/-2.2 mm anterior and 4.3+/-2.0 mm lateral to the classical entry point (P<.001). Furthermore, this entry point was more anterolateral in females when compared to males (P<.001). At a depth 10 mm below the tibial plateau, the entry point was on average 8.8+/-1.9 mm anterior and 2.9+/-1.9 mm lateral to the center of the cut surface. With increasing tibial varus the entry point tended to shift laterally at both levels (r=0.49) (P<.001). In Korean, the entry point for tibial intramedullary alignment systems is anterolateral to the classically described entry point. Moreover, the increment of tibial varus necessitates more lateral placement of the entry point. Intraoperatively, the entry point can be localized during primary knee arthroplasty to a point 15.9+/-2.8 mm anterior to and 1.2+/-2.8 mm lateral to the lateral tibial spine. For revision knee arthroplasty the point is on average 8.8+/-1.9 mm anterior and 2.9+/-1.9 mm lateral to the center of the cut surface of the tibia at a depth of 10 mm from the articular surface.

Morphometry of the Cut Surface of the Proximal Tibia for Total Knee Arthroplasty in Korea / 대한정형외과연구학회지

PURPOSE: To provide the morphometric data about the Korean proximal tibia to design a total knee prosthesis for Korean population. MATERIALS AND METHODS: We measured morphologic data from the proximal part of the tibia from 60 knees of 30 male and 30 female cadavers. The 3D images were reconstructed from the data obtained by computed tomography scanning from femoral head to ankle joint. These image were processed as a ideal tibial resection surface which was made during a total knee arthroplasty operation. Then, antero-posterior lengths, medio-lateral lengths and aspect ratios of the cut surface were measured. Measurements were analyzed and compared with those of five popular total knee prosthesis models. RESULTS: The average medio-lateral length, lateral antero-posterior length, aspect ratio of male was 79.4 +/- 3.8 mm, 39.6 +/- 5.0 mm, 49.8 +/- 5.1% respectively. And that of female was 70.4 +/- 3.7 mm, 34.3 +/- 3.6 mm, 48.8 +/- 4.7% respectively. Component size of medio-lateral length of 65~85 mm and lateral antero-posterior length of 30~45 mm, would be required for the Korean population. Aspect ratios were correlated to antero-posterior lengths positively (p < 0.05). CONCLUSION: No prostheses had fulfilled all the requirements for Korean knees in this study. These data could be used for design the optimal components for Korean.

Morphometry of the Cut Surface of the Proximal Tibia for Total Knee Arthroplasty in Korea / 대한정형외과연구학회지

PURPOSE: To provide the morphometric data about the Korean proximal tibia to design a total knee prosthesis for Korean population. MATERIALS AND METHODS: We measured morphologic data from the proximal part of the tibia from 60 knees of 30 male and 30 female cadavers. The 3D images were reconstructed from the data obtained by computed tomography scanning from femoral head to ankle joint. These image were processed as a ideal tibial resection surface which was made during a total knee arthroplasty operation. Then, antero-posterior lengths, medio-lateral lengths and aspect ratios of the cut surface were measured. Measurements were analyzed and compared with those of five popular total knee prosthesis models. RESULTS: The average medio-lateral length, lateral antero-posterior length, aspect ratio of male was 79.4 +/- 3.8 mm, 39.6 +/- 5.0 mm, 49.8 +/- 5.1% respectively. And that of female was 70.4 +/- 3.7 mm, 34.3 +/- 3.6 mm, 48.8 +/- 4.7% respectively. Component size of medio-lateral length of 65~85 mm and lateral antero-posterior length of 30~45 mm, would be required for the Korean population. Aspect ratios were correlated to antero-posterior lengths positively (p < 0.05). CONCLUSION: No prostheses had fulfilled all the requirements for Korean knees in this study. These data could be used for design the optimal components for Korean.

Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of arthroscopic synovectomy through the direct posterior-posterior approach in pigmented villonodular synovitis (PVNS) of the knee. MATERIALS AND METHODS: Between January 1997 and May 2004, twenty-one patients underwent an arthroscopic synovectomy for PVNS of knee. The mean follow-up period was 35 months. The arthroscopic and MRI findings revealed the localized form of PVNS in six patients and the diffuse form in fifteen patients. All patients underwent an arthroscopic examination and synovectomy through the direct posterior-posterior approach. The clinical results were evaluated by the range of motion, Lysholm knee score, and the knee pain score using the visual analogue scale (minimum 0-maximum 10). RESULTS: Among the fifteen cases with the diffuse form, three cases (14%) recurred and had secondary arthroscopic total synovectomy. One cases recurred again. Therefore, radiation therapy was performed. The Lysholm knee score improved from 62.5 to 87.3, and the VAS score improved from 5.9 to 1.8. Three patients had a mild limitation in knee motion. However, the others had full range of motion of the knee at the last follow-up. CONCLUSION: Arthroscopic synovectomy through the direct posterior-posterior approach could be a useful method for the treatment of PVNS of the knee, and can be used as an effective therapeutic tool particularly in posteromedial or posterolateral lesions.

Testicular Necrosis after Ilioinguinal Approach for Pelvic Nonunion: A Case Report

Pelvic nonunion is very difficult to treat. According to the nonunion site, anterior or posterior surgical approach should be used selectively. And if the nonunion site is located in both anterior and posterior, both anterior and posterior surgical approach should be used. We report a case of testicular necrosis after ilioinguinal approach used as a anterior approach to pelvis to treat pelvic nonunion developed as a result of unstable pelvic ring injury.

Human Muscle Derived Stem Cell Differentiate into Neurons / 대한정형외과연구학회지

PURPOSE: To evaluate the possibility that human muscle derived stem cells (hMDSCs) can be differentiated into neurons in vitro. MATERIAL AND METHODS: Muscle derived stem cells were isolated from the hamstring muscles during the anterior cruciate ligament reconstruction by preplate technique. For the characterization of these cells, desmin staining, CD 34, Sca-1, CD 29 using the Flow cytometry were performed. In the experimental group, neuronal induction media was added to differentiate hMDSCs to neuronal cells. These cells were evaluated by neuronal markers such as neuron-specific enolase (NSE), neurofilament (NF), TrkA using immunocytochemistry. For the control group, no induction media was added. Statstical analyses were performed by use of Kruskal-Wallis H test and Student-Newman-Keuls test (P<0.01). RESULT: Desmin staining was positive in 92.3+/-6%. Flow cytometry was negative for CD 34 and Sca-1. However it was positive for CD 29. (69.4+/-10%). The immunocytochemical result revealed NSE, NF and TrkA positive with 63.2+/-2.3%, 59.2+/-2.5%, 55+/-2.4% respectively. However, these were negative in the control group. CONCLUSION: Our observations indicate that hMDSCs have the capacity to differentiate into neurons in a specialized culture media.

Chondrogenic Differentiation of Human Bone Marrow-Derived Mesenchymal Stem Cells in PGA Polymeric Scaffolds / 대한정형외과연구학회지

PURPOSE: To characterize the chondrogenic potential of human mesenchymal stem cells (MSCs) in porous polymeric scaffolds by poly (glycolic acid) (PGA) as three-dimensional constructs to facilitate chondrogenic differentiation. METHODS: Human MSCs were isolated by percoll gradient method and adherent cell cultures were obtained. Isolated MSCs were characterized with CD 34 and Sca-1 antibodies using flow cytometry. MSCs were seeded in the PGA polymeric scaffolds for 28 days in a specialized defined medium. The control group was examined without the specialized defined medium. The chondrogenesis of MSCs-seeded polymer scaffolds culture was assessed by histology, RT-PCR and 35S-sulfate incorporation. RESULTS: Flow cytometry result showed that CD 34 was negative and Sca-1 was 93+/-10% positive. By the histological analysis from Safranin-O staining, it was confirmed that the chondrogenic differentiated human MSCs expressed chondrocyte-like morphologies. We also observed that type II collagen was expressed by RT-PCR. The degree of proteoglycan synthesis was higher in the experimental group than the control group. CONCLUSION: We have demonstrated that the biodegradable porous polymeric scaffolds and the specialized defined medium is able to provide three-dimensional constructs for inducing chondrogenic differentiation of human MSCs.

Comparison of the Activities of NF-kappa B and I kappa B alpha in Patients with Rheumatoid Arthritis and Osteoarthritis / 대한정형외과연구학회지

PURPOSE: The nuclear factor-kappa B (NF-kappa B) has been known to regulate the inflammatory and immune process by transcription of inflammatory intermediates. The purpose of the present study is to show the difference in activity of NF-kappa B and its inhibitory factor-I kappa B alpha in patients with rheumatoid arthritis, osteoarthritis and normal control subjects. MATERIALS AND METHODS: Synovial membrane samples were obtained at the time of orthopedic surgery from the knees of 7 patients with RA and 7 patients with OA. Two control samples were obtained from an amputee with no history of arthritis. We designed the primer of the subunit p65 of NF-kappa B and I kappa B alpha, measured the activity of them by RT-PCR, and analyzed the expression of NF-kappa B by immunohistochemical staining. RESULTS: From the results of RT-PCR, the expression levels of NF-kappa B was found to be higher in synovial tissues obtained from patients with RA than from synovial tissue obtained from patients with OA, and the least from the control group. The expression levels of I kappa B alpha were not different statistically among the three groups. Immunohistochemical staining for the NF-kappa B was dominant in synovial tissue from patients with RA. The result of immunohistochemical staining was similar to the results of RT-PCR for NF-kappa B. The localization of the staining was predominantly nuclear. CONCLUSION: In this study, activity of NF-kappa B of rheumatoid arthritis was higher than the other group, but expressions of I kappa B alpha were no different between the diseases. Further studies about specific inhibitors of NF-kappa B will benefit the development of rheumatoid arthritis regimens with greater efficacy.

Expression of Vascular Endothelial Growth Factor in Diabetic Frozen shoulder / 대한정형외과연구학회지

PURPOSE: To investigate the expression of Vascular Endothelial Growth Factor (VEGF) in diabetic frozen shoulders. MATERIALS AND METHODS: We preformed arthroscopic adhesiolysis on 9 diabetic frozen shoulder patients, and observed the arthroscopic findings. Also, we examined the potential role of VEGF by using samples of synovial tissues from 5 patients, and 2 normal synovial tissues. Immunohistochemical staining and Western blotting were performed using polyclonal antibodies against VEGF. RESULTS: There was hyperemic synovitis in the 9 diabetic frozen shoulder patients. In the 5 patients' tissue samples, there was strong immunostaining and expression to VEGF, but there was little staining and expression in the control group. CONCLUSION: We postulate that VEGF is synthesized and secreted in the synovium of diabetic frozen shoulders and that secreted VEGF binds specific receptors on the endothelial cells of nearby small blood vessels, and leads to the subsequent development of frozen shoulders in diabetic patients.

Optical Coherence Tomography Analysis of the Rabbit Articular Cartilage after Chondrocyte Transplantation / 대한정형외과연구학회지

PURPOSE: To evaluate the ability of optical coherence tomography (OCT) to provide real-time, high-resolution structural analysis of the full thickness rabbit articular repair tissue following chondrocyte transplantation. MATERIALS AND METHODS: Full thickness articular cartilage defects were created in the patellar grooves of the distal femur of 30 adult rabbit knee joints. Allogenic cultured chondrocytes embedded in collagen gels were implanted into the surgical defects. Six animals per time point were sacrificed at 2, 4, 8, 12 and 24 weeks after surgery. The repair tissues were sequentially analyzed by arthroscopic surface imaging, OCT, and histology. RESULTS: OCT was able to identify the bone and cartilage interface in normal rabbit articular cartilage and regenerated cartilage at 24 weeks post chondrocyte implantation. OCT was able to identify fine surface fibrillations at 24 weeks. More importantly, OCT was able to detect the embedded gaps between the repair tissue and surrounding cartilage. CONCLUSION: OCT provides a minimal invasive means to obtain an instant "optical biopsy" of the rabbit articular repair tissue without damaging the specimen.

Viability of Refrigerated Human Articular Cartilage / 대한정형외과연구학회지

PURPOSE: To determine the viability of human chondrocytes within refrigerated articular cartilage stored under conditions currently used clinically. MATERIALS AND METHODS: Osteochondral sections of human ankle taluses were stored at 4 degrees C in DMEM media for 1 to 42 days. Articular cartilage was harvested and evaluated for histologic changes and proteoglycan synthesis. RESULTS: By day 7, markedly decreased proteoglycan synthesis was observed. After 21 days, synthetic activity was virtually undetectable. Histologic specimens demonstrated chondrocyte death of a half of the cells from the superficial layer at day 7. Within 21 days, significant chondrocyte death was seen. CONCLUSION: These results suggest that proteoglycan synthetic activity and chondrocyte viability are markedly decreased in articular cartilage after cold storage for longer than 7 days.

Role of Vascular Endothelial Growth Factor in Diabetic Frozen Shoulder / 대한정형외과학회잡지

PURPOSE: To investigate the role of VEGF (vascular endothelial growth factor) and macrophage cells in the pathogenesis of diabetic frozen shoulders. MATERIALS AND METHODS: Five diabetic frozen shoulders which were resistant to conservative treatment were involved in this study. Synovial tissue was obtained during arthroscopic adhesiolysis. The synovial tissue of the shoulders from cadava dominators who had no history of shoulder joint disease was used for the control study. Immunohistochemical staining was performed with polyclonal antibodies against VEGF and CD68 macrophage/synovial antigen. RESULTS: Injection and hypertrophy of the synovium and thickening of the capsule were noted in all diabetic frozen shoulders. Strong immunostaining to VEGF and CD68 was observed in all diabetic frozen shoulders, whereas the control specimens showed little staining. CONCLUSION: From these results it would be postulated that the VEGF, synthesized and secreted by macrophage/synovial cells of the diabetic frozen shoulders stimulate regional angiogenesis which leads to synovitis and fibrosis could be one of the leading factors in the pathogenesis of frozen shoulders in diabetic patients.

Dissociation Between Polyethylene and Inner Prosthetic Ball Head During Closed Reduction of a Dislocated Bipolar Hip Hemiarthroplasty: A Report of 3 Cases / 대한정형외과학회잡지

Closed reduction of a dislocated bipolar hemiarthroplasty may induce dissociation between polyethylene and inner prosthetic ball head. This rare complication should be treated by open reduction. If dislocation of the bipolar hemiarthroplasty occurs, gentle closed reduction techniques with satisfactory anesthesia and muscle relaxation are recommended. We report our experience of 3 cases.

Mutations of the p53 tumor suppressor gene in rheumatoid arthritis synovium / 대한정형외과학회잡지

PURPOSE: To analyse the expression of the p53 tumour suppressor gene in the synovial tissue from rheumatoid patients. Material and Methods : Synovial membranes were obtained from 13 patients diagnosed as having RA, and 9 osteoarthritis (OA) patients. We studied p53 expression by immunohistochemical analysis and p53 DNA sequence using direct DNA preparation method. RESULT: In immunohistological studies, the Do-1 monoclonal antibody stained at 6 specimens out of the 13 rheumatoid arthritis tissue biopsies analysed. There was no p53 mutation in osteoarthritis samples, but there were 4 p53 mutations from the 13 rheumatoid arthritis samples. p53 mutations were found at the codon 177 (CTG to CTA, GA), 277 (TGT to TGC, TC), and, two patients at the codon 237 (CAT to TAT, CT). CONCLUSION: The predicted amino acid substitutions in p53 were similar to those commonly observed in a variety of tumors and might influence growth and survival of rheumatoid synoviocytes.

Gene Transfer Into Human Chondrocyte Derived Cells Using A Liposome Mediated Transfection System / 대한정형외과학회잡지

PURPOSE: To introduce the CMV promoter driven luciferase and -galactosidase marker gene into previously permeabilized human chondrial cells. MATERIALS AND METHODS: The cultured chondrocyte cells were transfected with a liposome/DNA mixture (pCMV-Luc or pSV40-lacZ). Cultured cells not transfected by liposome/DNA were used as a control. After forty-eight hours of incubation, the cells were used for reporter gene assays and the polymerase chain reaction (PCR). RESULTS: Fifteen percent of the chondrocyte cells treated with liposome/ pSV40-lacZ DNA were positive for -gal staining. Chondrocyte cells transfected with pCMV-Luc yielded a 70-fold increase in luciferase activity over that of the control cells. A PCR product corresponding to the luciferase gene appeared only in the transfected chondrocyte cells. These results indicate that the human chondrocyte cells can be transfected with pCMV-Luc and pSV40-lacZ. CONCLUSION: This system is particularly suitable for gene therapy, as well as for the use of genetically modified cartilage cells for resurfacing full thickness articular cartilage defects.

Bilateral Simultaneous Quadriceps Tendon Rupture in a Patient with Secondary Hyperparathyroidism: A Case Report

Simultaneous bilateral rupture of the quadriceps tendon without a significant history of trauma may occur in association with chronic metabolic disorders such as chronic renal failure and secondary hyperparathyroidism, though has rarely been reported. We describe a case of spontaneous bilateral quadriceps tendon rupture in a 36-year-old female patient with secondary hyperparathyroidism.

Neurobiology of Anxiety

The current understanding of the neurobioloby of anxiety is generally based on experimental animal model, empirical effective psychopharmacological agents, chemical and naturalistic challenge paradigms, and psychoendocinological assessment. This article focuses on reviewing neuroanantomical, neuroendocinological and neurofunctional research of anxiety disorder. In the decade ahead, we anticipate that extension of current research and the new integrated approach promise novel insight into mechanism of anxiety.

Arthroscopic Removal of Loose Bodies from the posterior Knee Compartment using Direct Posterior - Posterior Triangulation

PURPOSE: To report the advantages and the results of arthroscopic removal of loose bodies by posteri-or-posterior triangulation, using the posteromedial and posteroleteral portal. MATERIALS AND METHODS: Sixteen cases in this study had loose bodies in the posterior compartment of the knee joint; nine cases in the posteromediaI, three cases in the posterolateral and four cases in the both compartments. Under the supine position, the knee is flexed to a 90 angle, and an obturator was inserted in the posterolateral compartment through the fat areolar tissue eliminating the loose bodies in the posterior compartment. RESULT: In sixteen cases we eliminated all loose bodies under arthroscopy which were in the posterior compartment of the knee joint and there was no complication such as saphenous nerve palsy, common peroneal nerve palsy, or the rupture of popliteal artery. CONCLUSION: Arthroscopic removal of loose body in the posterior compartment of the knee joint using posterior-posterior triangulation was considered as one of the useful methods in terms of safety and good visualization.

Synovial Hemangioma of the Knee: A Case Report

A hemangioma in the knee joint of a 13-year-old girl was diagnosed by magnetic resonance imaging. There was pain and a tender localized swelling around to the patellar tendon. Arthroscopy verified the diagnosis but did not allow visualization of the full extent of the tumor. After arthroscopic excision of the associated hypertrophic medial plica, a miniarthrotomy was done. The tumor was attached to the periph-ery of the anterior horn of the medial meniscus, the anterior tibial plateau, and the fat pad. Its origin was from the venous plexus just below the anterior lip of the central tibial plateau. The patient was asympto-matic one and a half years after surgery. If the case is not amenable to arthroscopic surgery, open excision through miniarthrotomy ensures complete removal of the hemangiomas without recurrence.