A Quantitative Analysis of Collagen Fibril Diameters of Transverse Carpal Ligament in Patients with Carpal Tunnel Syndrome / 대한정형외과연구학회지

No Abstract Available.

ACL Reconstruction with Quadrupled Hamstring Tendon: Study of Fixation Method and Rehabilitation

PURPOSE: To evaluate appropriate rehabilitation program after ACL reconstruction using double- looped semitendonosus and gracilis graft. MATERIAL AND METHOD: ACL reconstruction using double-looped semitendinosus and gracilis tendon was performed in thirty patients from March 1997 to February 1999, and the patients were evaluated with K-T 2000 arthrometer, Lachman test, pivot shift test, mid-thigh circumference and Lysholm score. We divided the patients into three group; in group A, conservative rehabilitation after bio-absorbable screw fixation was done, in group B, aggressive rehabilitation after bioabsorbable screw fixation was done, in group C, aggressive rehabilitation after Semi-Fix fixation was done. RESULTS: Average K-T 2000 maximum manual side-to-side difference was 0.73mm in group A, 3.66mm in group B, 0.91mm in group C at 6 weeks after the operation. The difference was greater in group B than group A and C. There was no difference in mid thigh circumference and Lysholm score at one year post- operatively. Positive signs in Lachman test and pivot shift test were increased in group B than group A and group C. CONCLUSION: Rehabilitation after bioabsorbable screw fixation of double-looped hamstring tendon should be performed conservatively, because aggressive rehabilitation might increase joint laxity.

Clinical Study After Reconstruction of the Posterior Cruciate Ligament: Factors on Posterior Stability

The goals of treatment in the injuries of posterior cruciate ligament(PCL) are restoration of normal tibiofemoral stability and reduction of long term osteoarthrosis of the knee. The purpose of this study is to analyze the factors on posterior stability and functional result after PCL reconstruction. From March 1996 to April 1997, twenty operation on PCL reconstruction were carried out in our hospital. The functional results according to the criteria of the Lysholm knee score and stress radiograph for posterior stability were evaluated. The average functional results evaluated by Lysholm knee score was 87. There was no significant difference in functional result according to selected grafted material, combined knee injury, type of injury and arthrotomy, etc. Difference in posterior tibial translation on average were 2.8mm in acute and 7.7mm in chronic injury. In posterolateral combined injury, average posterior tibial translation in pos- terolateral repair was 3.2mm and in posterolateral reconstruction was 9.4mm. In PCL reconstruction using hamstring with repair of PCL remnant was 2mm. In conclusion, to obtain the good result on posterior sta- bility, early PCL reconstruction using hamstring with repair of PCL remnant, and appropriate treatment on combined posterolateral injury were recommended.

Transplantation of Cultured Allogenic Chondrocyte-Collagen Gel Composite into the Articular Cartilage Defect of Rats / 대한정형외과연구학회지

As one of many cell-many cell-based cartilage repairing methods, transplantation of chondrocyte-embedded-collagen gels in cartilage defect was performed for more satisfactory regeneration of cartilage. The authors performed this study to investigate whether the TGF-beta1 treatment of chondrocytes can do some additional synergistic effect on the transplantation of chondrocyte-embedded-collagen gels for crtilage repair. Chondrocytes were isolated from the articular cartilage of newborn Sprague-Dawley rats. Chondrocytes cultured for 10 days in monolayer were embedded in the 0.45% type I collagen gel. Full-thickness cartilage defect was made in the patellar groove of adult Sprague-Dawley rats. Chondrocytes culdefect was made in the patellar groove of adult Sprague-Dawley rats. The cartilage defects were treated with the following methods in a total of 200 animals, which were assigned to 5 different groups of 40 rats. In the control group, the deffect was left without any treatment, in group I, the defect was filled with collagen gel only, in group II, with collagen gel coontaining 10 ng/ml concentration of TGF-beta1, in group III, with collagen gel containing chondrocytes, and in group IV, with collagen gel containing chondrocytes and TGF-beta1. At 1, 2, 4, 8, 12 weeks after the operation, eight rats of each group were sacrificed, and their distal femurs were harvested for the histologic and biomechanical tests. The section s were stained with hematoxilin and eosin. Alcian-blue, and Safranin-O. Regenerated cartilage was analyzed by the semiquantitative histological grading system. Point indentation test was performed as a biomechanical evaluation, and the stiffness was calculated. The results of the histological grading system revealed that the scores gradually increased with time in all groups, and the scores of group III and IV were higher than those of control, group I and II. The biomechanical study showed that the stiffness gradually increased to reach a plateau level in each group. In control, group I and II, the stiffness increased up to the eighth week and remained around the increased level at the twelfth week, and did not show any statistically significant difference between the groups. In group III and IV, the stiffness was higher than in control group, and increased markedly at the fourth week and the increased level was maintained onwards. The results of this study showed that the transplantation of chondrocyte-embedded-collagen gels enhanced the healing process, and the treatment of TGF-beta1 demonstrated at least partially significant improvement.

In Vivo Transfection of Rabbit Synovium using the Particle Bombardment Method / 대한정형외과연구학회지

Treatment of arthritis with the gene-transfering technique is one of tile important applications of gene therapy in orthopedics. The synovium can be transfected with the genes producing therapeutic proteins. Among the numerous methods of transfering genes, particle bombardment or gene gun is one of the most versatile tools and has the advantage of easy accessibility and efficiency. The authors planed to transfer the reporter gene into the synovium in vivo and confirm the expression of the gene. Cold particle microcarriers to deliver the DNA were coated with plasmids containing human placental alkali no phosphatase cDNA as a marker gene. The microcarriers were projected with the aid of the hand-held gene gun system into the rabbit knee synovium. After three days, the synovium was harvested and frozen sections of the tissue were made. The expression of the reporter gene in the synovium was confirmed with alkaline phoshatase staining. In summary, the authors have shown that the reporter gene was successfully delivered into the rabbit knee synovium in vivo with particle bombardment method and transient expression of the gene was confirmed with special staining. Our study suggest that in vivo transfection of the synovium using tile gene gun can be applied as a novel method for treating arthritis.

Patellofemoral Complications Following Total Knee Arthroplasty: Comparative Study between the Group with Lateral Retinacular Release and the Group without Lateral Retinacular Release / 대한정형외과학회잡지

Results of 170 total knee arthroplasties(TKAs) performed from 1986 to 1995, followed up for at least one year, were reviewed. Lateral retinacular release was performed in 76 knees(45%) and not performed in 94 knees(55%). We compared the results of TKAs combined with lateral retinacular release with those without lateral retinacular release. The clinical results of TKAs were evaluated by the Knee Scoring System of Hospital for Special Surgery(HSS). The average follow-up period was 34 months. The clinical results assessed by HSS score, pain score and range of motion improved postoperatively in both groups, but there was no significant difference between the two groups. There were 8(4.7%) with patellar subluxations in 170 TKAs, one(1.3%) in the group with lateral retinacular release and 7(7.5%) in the group without lateral retinacular release(t-test; p<0.05). Analysis of lateral tilt of patella on roentgenographs also showed a significant difference between the two groups. 7 knees(9.2%) with lateral tilt were observed in the group with lateral retinacular release and 22 knees(23.4%) with lateral tilt in the group without lateral retinacular release(t-test; p<0.05). There was no osteonecrosis or fracture of patella in either group. In summary, lateral retinacular release might improve the patellar tracking and lower the incidence of patellar subluxation and lateral tilt of patella. Lateral retinacular release alone did not seem to cause patellar osteonecrosis and subsequent patellar fracture which were detectable in plain roentgenographs. So, we suggest that lateral retinacular release can be performed without great risk of potential patellar complications in TKAs requiring lateral retinacular release for proper patellar tracking.

Relations of CD44 Expression with Metastasis and Prognosis in Osteosarcoma / 대한정형외과연구학회지

CD44 is a cell surface glycoprotein, which not only functions as a receptor to hyaluronan and other extracelluar matrix ligands but also is implicated in tumorigenesis, growth, invasion and metastasis in several kinds of human malignacies. There has not been any report concerning the relation of CD44 to metastasis or prognostic value in osteosarcoma. In the current study, we evaluated the expression of CD44 standard and CD44v5 and 0D44v6 isoforms immunohistochemically in osteosarcoma and assessed the prognostic value of these cell surface proteins. Formalin-fixed, paraffin-embedded archival pathologic tissues from fifty osteosarcoma patients were collected. Thirty-seven cases were osteoblastic, three chondroblastic, six fibroblastic, three telangiectatic and one mixed type. The immunohistochemical procedures were performed using a biotin-streptavidin detection system with diaminobenzidine chromogen. According to the proportion of stained cells, scores were semiquantitatively graded into three categories; '-', negative; '+', intermediate; and '11' high (more than 50 percent positive cells). We regarded overexpression of CD44 protein in case of 'high' score. Patterns of CD44 immnostaining were mainly membranous with a minor component of cytoplasmic pattern. Overexpression of CD44s was observed in 169o (8/50), that of v5 in 20% (10/50) and that of v5, in 46% (23/50) of osteosarcomas. Among the CD44 isoforms, overexpression of CD44v5 isoform was significantly correlated with metastasis (P=0.004). Survival of CD44v5 positive (overexpressed) group was significantly shorter than CD44v5 negative group(P=0.006). In conclusion, any isoform of CD44s, v5, v6 was not an independent predictor of overall survival, however, overexpression of CD44v5 may be considered one of predictors of poor survival in osteosarcoma as regards with metastasis. Further study is required to confirm its prognostic significance in osteosarcoma with relation to other biological tumor markers.

Changes of Length and Active Force of the Soleus Muscle According to the Position of Ankle Joint in Rabbit / 대한정형외과연구학회지

The dynamic performance of a skeletal muscle depends on the length-force and force-velocity relationships. The length-force relationship of muscle was described by Blix for the first time. The contractile elements of muscles produce the active length-force curve. The objective of this study is to determine the length-force relationship of the rabbit's soleus muscle and changes of tetanic force according to the position of ankle joint. The amount of excursion of the soleus muscle for full range of motion of the ankle joint was 25 mm. The ratio of excursion compared to the length of neutral position was 24%. That means that the soleus muscle has large amount of excursion that is responsible for producing active force throughout the whole range of ankle motion. The length at which active force of the muscle is maximal is called optimum length(Lo). The ratio of the optimum length compared to the length of neutral position was 98%. This means that the active force of the soleus muscle was maximal at the position of slight plantarflexion(about 2 degrees of plantarflexion). The value of the tetanic force was 3.1kg/cm2 in average, and the active length-force curve showed asymmetrical shape. The effective range is a length change from minimal point of zero active force to maximal point of zero active force. In this study, the minimal point of zero active force was 11mm shorter and maximal point of zero active force was 13mm longer than optimum length. Therefore, the effective range was 24mm. Active force increased abruptly at which muscle length was 90% of neutral length. At that point, active force was less than 20% of maximal tetanic force.

Immunohistochemical Study of the Expression of Transglutaminase Isoenzymes in the Healing Process of Rat's Articular Cartilage Defect / 대한정형외과연구학회지

Injury to the articular cartilage is clinically troublesome because its regeneration is limited, but until now no treatment method was proved to be satisfactory. Transglutaminases(TGase) are a group of enzymes which catalyze intermolecular crosslinking reaction to contribute to the structural stability of the tissue, and several authors suggested their use as potential biological glue. However there have been few studies on the expression of TGase and the roles of any specific subtype in the healing process of cartilge injury. So the authors observed the expression of tissue TGase(TGase C) and prostate TGase(TGase P) in the healing process of rat's articular cartilge defect. Into the knee articular cartilage of 5 month-old Sprague-Dawley rat, a defect was made with diameter 1.2mm drill bit. At 1, 3, 5, 7 days and 2, 4, 6, 8 weeks after the operation, the animals were sacrificed and their distal femurs were harvested for the histological studies. The sections were stained with HandE, alcian-blue and Safranin-O. Immunohistochemical study for the expression of TGase C and TGase P was done with the sections. Between 4 and 6 weeks after the operation, the articular cartilage defect was regenerated to the level of intact portion, but histologically it was regenerated not with hyaline catilage but with fibrocartilage. TGase C was expressed in fibroblasts, osteoblasts and fibrous matrix in the early healing phase, but after 4 weeks, it was expressed in chondrocytes and chondroid matrix. TGase P was not expressed in any of the normal articular cartilage, subchondral bone and reparative cells and tissue of the defect. As one of the new methods for the treatment of articular cartilage defect, chondrocytes were incorporated with biodegradable carriers and grafted into the injured site. To maximize the condition of the graft, addition of any specific material into these chondrocyte-carrier composite graft can be considered. In this study, TGase was found to be expressed in the healing process of articular cartilage defect. So, TGase might be supposed to play an important role in the healing process of cartilage injury, and could be tried as one of the additives for the chondrocyte graft.

Expression of Exon 2 of Type II Procollagen mRNA in Primary Culture of Rat Chondrocyte / 대한정형외과연구학회지

Type II procollagen mRNA exists in two forms, type II A and II B, by alternative splicing of exon 2. Type II A procollagen mRNA has been known to be expressed in chondroprogenitor, periosteal and perichondrial cells, whereas type II B procollagen mRNA in chondrocytes. Previous reports indicate that both types of procollagen mRNA exist in primary culture of rat chondrocyte. In this study, the time-dependent change in the type II A and II B mRNA expression in the primarily cultured rat chondrocytes was analyzed using reverse transcription polymerase chain reaction (RT-PCR) and Northern hybridization. Most chondrocytes in the early stage of primary cell culture were oval or polygonal in their shape. However, since 2 to 3 weeks of primary cell culture, most cells changed their shapes into fibroblast-like or ameboid cells. RT-PCR revealed that until 1 week of culture, the expression of the type II B mRNA was greater than that of the type II A. After 2 weeks of culture, the expression of the type II A mRNA became greater. Northern blot analysis showed a gradual decrease in the expression of the total type II procollagen mRNA with time of culture. On the other hand, the expression of the type II A procollagen mRNA increased significantly at 2 weeks and the increased level was maintained thereafter. This study confirmed that in primary culture of chondrocyte, the cells changed their morphological and molecular characteristics at the relatively early stage. This study implicates that in order to delineate the changes of phenotypes of chondrocytes, quantitative analysis of both type II A and II B procollagen mRNA is necessary instead of performing analysis of total type II procollagen mRNA.

Dose-Dependent Effects of Transforming Growth Factor-beta1 on Cell Proliferation and Matrix Synthesis in Relation to the Degree of Chondrocyte Dedifferentiation in Monolayer Culture / 대한정형외과연구학회지

Transforming growth factor-beta1(TGF-beta1) has been suggested to be a useful growth facto. that could maintain the phenotypic characteristics of cultured chondrocytes. We performed this study to investigate the dose-dependent effects of TGF-beta1 on cell proliferation and matrix synthesis in relation to the degree of chondrocyte dedifferentiation in monolayer culture. Chondrocytes were isolated from the articular cartilage of distal femur of neonatal Sprague-Dawley rats and were cultured in monolayer. When the cell population reached 70-80% of confluence, the cells were subcultured successively for 6 weeks for the following studies. Every weak, the dose dependent effects of rhTGF-beta1 (0ng/ml ,1ng/ml, 5ng/ml, 10ng/ml, 20ng/m1) on DNA synthesis, proteoglycan synthesis and collagen synthesis were evaluated by 3H-thymidine incorporation, 35S-sulfate incorporation and 3H-proline incorporation respectively. The DNA synthesis decreased with time of culture. The DNA synthesis was significantly decreased by the addition of rhTGF-beta1 at all concentrations. The dose-dependent inhibitory action was most prominent at initial 3 weeks. Proteoglycan synthesis was in the highest level at the second week and markedly decreased after 2 weeks. At 2 weeks, TGF-beta1 treatment increased the proteoglycan synthesis at all concentrations and this stimulatory effect was prominent at the concentrations of 5ng/ml and 10ng/ml. There was no significant difference in the level of collagen synthesis during the whole experimental period. TGF- beta1 treatment increased collagen synthesis at all concentrations and this stimulatory effect was prominent at the concentrations at 5ng/ml and 10ng/ml. The results of this study suggest that if the cultured chondrocytes treated by TGF-beta 1 are used for transplantation, the time for TGF-beta1 treatment and transplantation to be recommended is before 3 weeks and the beneficial concentration of TGF-beta1 is 5ng/ml to 10 ng/ml for the maintenance of the phenotypic properties.

Joint Line Change in Total Knee Replacement Arthroplasty / 대한정형외과학회잡지

It has been reported that the maintenance of proper ligament balance around the knee joint and the proper location of tibio-femoral joint line position are very important factors for obtaining good knee joint function after the total knee replacement arthroplasty. but, yet the exact effect of the change of joint line on the result of total knee replacement arthroplasty has not been elucidated. The purpose of this study is to evaluate the effect of the change of joint line on the patellar position and the postoperative knee joint function as well as the effect of antero-posterior offset of tibial component on the clinical result. The authors performed the clinical and radiological analysis of 85 knees, in which total knee replacement arthroplasty was performed and followed over 1 year. Tibio-femoral joint line changed from -7mm to +6.8mm (average -0.07) and in this range, the change of joint line did not influence the clinical result and the patellar position. As tibio-femoral joint line migrated proximally, the patella migrated distally and as tibio-femoral joint line migrated distally, the patella migrated proximally. Postoperative pain decreased as the patella and patellar articular surface moved proximally. As the patellar bone height from tibial tuberosity decreased postoperatively. The range of motion decreased. Antero-ppsterior offset of tibial component distributed from -4.2mm to +4.5mm (average 0.62mm) and no effect on cllinical result in this range. In conclusion, it may be suggested that the change of joint line in total knee replacement arthroplasty must be changed as little as possible for the good postoperative range of motion and relief of pain.

The Effect of Estradiol on the Osteoporosis Induced by Oophorectomy in the Rat / 대한정형외과학회잡지

Post-menopausal osteoporosis is known to be related to estrogen deficiency. The purpose of this experimental study is to investigate whether or not estrogen administration can prevent or retard the process of osteoporosis induced by oophorectomy in rats. Fifty-two Sprague-Dawley rats, aged five months, were separated into three groups. Group 1 (4 rats) was control group that had sham operation without oophorectomy. Goup 2 (32 rats) was another control group that had bilateral oophorectomy alone. Group 3 (16 rats) was experimental group that had estradiol administration from the fourth week through the eighth week after bilateral oophorectomy. In group 1, all the rats were killed at the fourth week after sham operation. In group 2 and group 3, four rats in each group were killed weekly until the eighth week after oophorectomy. All the animals were subjected to radiological, histological studies on the tibia, ilium, skull, and the sixth lumbar vertebra. Also, histomorphometric measurements were 1. Osteoporotic changes were evident from the fifth week after oophorectomy and increased with time on the radiologic examination in group 2. In contrast, osteoporotic changes were evident from the second week after oophorectomy and progressed with time on the histological and histomorphometric studies in group 2. 2. After administration of estradiol, osteoporotic changes which include thinning of the cortex, decrease of the amount of trabeculae were partially restored on the radiological, histological studies in group 3. 3. Histomorphometric study revealed that the trabecular area percent (the proportion of total area of the trabeculae from the whole metaphyseal area), decreased progressively through the eight week after oophorectomy in gorup 2. Whereas the trabecular area percents of group 3 were higher than those of group 2, but still lower than initial value before oophorectomy. Based on the above observations, estradiol administration appeared to delay the progression of the osteoporotic changes induced by oophorectomy in rats.

Arthroscopic synovectomy of the knee in chronic proliferative synovitis / 대한정형외과학회잡지

No abstract available.

Magnetic resonance imaging in Legg-Calve-Perthes' disease / 대한정형외과학회잡지

No abstract available.

A clinical review of femoral abduction osteotomy in Legg-CalvePerthes disease / 대한정형외과학회잡지

No abstract available.

Treatment of Displaced Extension type Supracondylar Fractures of the Humerus in Children by Percutaneous Pining or Open Reduction / 대한정형외과학회잡지

The treatment of supracondylar fracture of humerus in children has so many pitfalls as to be once called "supracondylar dilemma". The authors analyzed the follow-up results of fifty-six displaced extension type supracondylar fractures treated by percutaneous pinning and by open reduction from 1982 to 1989. The mean age was 7.6 years, ranging from three years to fifteen years. Forty three fractures were treated by percutaneous pinning and thirteen by open reduction. According to the modified Flynn's criteria, the results of the treatment by percutaneous pinning were excellent 36%, good 32%, fair 25% and poor 7%, while those of open reduction were 8%, 42%, 8% and 42% , respectively, on average follow up of 1.4 years. Post-operative complications were found in seven cases (16.7%) of percutaneous pinning, and in five cases(38.5%) of open reduction. Poorly chosen surgical approach for open reduction was appeared to be related with unsatisfactory results. We believe that percutaneous pinning was a simple, effective method for treatment of displaced supracondylar fractures of the humerus. We agree, however, that open reduction is still indicated if manipulative reduction before pinning is unacceptable, or if the fracture is complicated by neurovascular or open injury.