The Effect of Platelet Rich Plasma from Bone Marrow Aspirate with Added Bone Morphogenetic Protein-2 on the Achilles Tendon-Bone Junction in Rabbits

BACKGROUND: To determine if exogenously injected bone marrow derived platelet-rich plasma (PRP) plus bone morphogenetic protein (BMP)-2 could accelerate the healing of bone-tendon junction injuries and increase the junction holding strength during the early regeneration period. METHODS: A direct injury model of the bone-tendon junction was made using an Achilles tendon-calcaneus bone junction in a rabbit. In the PRP/BMP-2/fibrin group, 0.05 mL of bone marrow derived PRP and 100 ng/mL of BMP-2 both incorporated into 0.1 mL of fibrin glue were injected into Achilles tendon-calcaneus bone junctions. The effect of the intervention was tested by comparing the results of an intervention group to a control group. The results of biomechanical testing, and histological and gross analyses were compared between the 2 groups at the following time points after surgery: 2 weeks, 4 weeks, and 8 weeks. RESULTS: Histologic examinations showed that woven bone developed in tendon-bone junctions at 2 weeks after surgery in the PRP/BMP-2/fibrin group. Mechanical test results showed no significant difference between the PRP/BMP-2/fibrin and control groups at 2 and 4 weeks after surgery, but the mean maximal load in the PRP/BMP-2/fibrin group was significantly higher than in the control group (p < 0.05) at 8 weeks after surgery. CONCLUSIONS: Bone marrow derived PRP and BMP-2 in fibrin glue accelerated healing in a rabbit model of tendon-bone junction injury.

Inferior Subluxation of Humeral of Head after Surgery for Fracture of Proximal Humerus

PURPOSE: To study the development of inferior shoulder subluxation after surgery for proximal humerus fractures. To analyze the mechanism development of such subluxation and the association between different types of proximal humerus fractures, quality of reduction achieved the method of operation performed. MATERIALS AND METHODS: A retrospective analysis of 45 proximal humerus fractures that were treated by surgery between March 1997 and July 2002 was done. All patients had a minimum of 12 months of postoperative follow up. Preoperative radiographs were classified by the Neer's classification. Different operative treatment methods, post reduction alignment and the degree of postoperative subluxation if present, were analysed. In order to evaluate effect of loss of negative intraarticular pressure, we compared this series with 15 cases of recurrent shoulder dislocation treated by open Bankart operation. RESULTS: 13 patients out of 45 (29%) developed immediate postoperative inferior shoulder subluxation. 3-part fractures of the proximal humerus showed a higher incidence of the same than the 2-part types. The better reduced fractures had lesser rates of subluxation. Open reduction (39%, 11 patients) results in an increased incidence of inferior subluxation than closed methods of reduction (13%, 2 patients). CONCLUSION: Inferior subluxation of the humeral head after surgery for the proximal humerus fracture can occur and persist till postoperative period of 2 months. Deltoid muscle tone affected by shortening of humeral neck plays an important role. Early active exercise for restoration deltoid tone may be effective in prevention of inferior subluxation.

The Residual Forefoot Adduction after Clubfoot-Surgery / 대한정형외과학회잡지

PURPOSE: To analyze the incidence and influencing factors of residual forefoot adduction after clubfoot-surgery. MATERIALS AND METHOD: A total of 133 clubfeet of 94 patients that had been surgically treated more than 3 years ago were followed up. For comparison purposes, we divided them into 3 groups. The first group was treated using a one-stage posteromedial release (PMR, 84 feet), the second group by posterolateral release (PLR, 34 feet), and the third group by medial release and lateral column shortening (Lichtblau, 34 feet). The forefoot adduction was characterized by Bleck's method and the effects of influencing factors, such as sex, laterality, methods of operation, and age at the time of operation were examined. Preoperative and postoperative calcaneocuboidal angles were also measured. RESULT: 40.2% of residual forefoot adduction was observed. Persistent grade 2 calcaneocuboidal malalignment showed 81.4% residual forefoot adduction. Forefoot adduction was unlikely to persist following posteromedial release procedure in the 1 to 2 year old age group. CONCLUSION: Age at the time of operation and the correction of calcaneocuboidal malalignment were significant factors for the development of residual forefoot adduction.