Comparison of a Cryopneumatic Compression Device and Ice Packs for Cryotherapy Following Anterior Cruciate Ligament Reconstruction

Background@#The purpose of the current study was to evaluate and compare the effectiveness of a cryopneumatic compression device with that of standard ice packs following arthroscopic anterior cruciate ligament (ACL) reconstruction, with a primary focus on early postoperative pain. @*Methods@#Participants were divided into two groups: cryopneumatic compression device group (CC group) and standard ice pack group (IP group). Patients in the CC Group (28 patients) received a cryopneumatic compression device (CTC-7, Daesung Maref) treatment, while patients in the IP group (28 patients) received standard ice pack cryotherapy postoperatively. All cryotherapy was applied three times (every 8 hours) per day for 20 minutes until discharge (postoperative day 7). Pain scores were assessed preoperatively and at 4, 7, and 14 days after surgery, and the primary outcome for analysis was pain at postoperative day 4 assessed using a visual analog scale (VAS). Other variables were opioid and rescue medication use, knee and thigh circumferences, postoperative drainage, and joint effusion quantified by a three-dimensional magnetic resonance imaging (MRI) reconstruction model. @*Results@#The mean pain VAS score and difference in VAS relative to the preoperative measurements for postoperative day 4 were significantly lower in the CC group than in the IP group (p = 0.001 and p = 0.007, respectively). The sum of postoperative drainage and effusion quantified by MRI showed a significant reduction of postoperative effusion in the CC group compared to the IP group (p = 0.015). The average total rescue medication consumption was comparable between the two groups. Circumferential measurements at days 7 and 14 postoperatively relative to those at day 4 (index day) demonstrated no significant differences between the groups. @*Conclusions@#Compared to standard ice packs, application of cryopneumatic compression was associated with a significant reduction in VAS pain scores and joint effusion during the early postoperative period following ACL reconstruction.

Biomechanical function of the anterolateral ligament of the knee: a systematic review

Background@#It has been suggested that the anterolateral ligament (ALL) is an important anterolateral stabilizer of the knee joint which functions to prevent anterolateral subluxation and anterior subluxation at certain flexion angles in the knee. Purpose: To analyze and systematically interpret the biomechanical function of the ALL. @*Methods@#An online search was conducted for human cadaveric biomechanical studies that tested function of the ALL in resisting anterolateral subluxation and anterior subluxation of the knee. Two reviewers independently searched Medline, Embase, and the Cochrane Database of Systematic Reviews for studies up to 25 September 2018. Biomechanical studies not reporting the magnitude of anterior tibial translation or tibial internal rotation in relation to the function of the ALL were excluded. @*Results@#Twelve biomechanical studies using human cadavers evaluating parameters including anterior tibial translation and/or internal tibial rotation in anterior cruciate ligament (ACL)-sectioned and ALL-sectioned knees were included in the review. Five studies reported a minor increase or no significant increase in anterior tibial translation and internal tibial rotation with further sectioning of the ALL in ACL-deficient knees. Five studies reported a significant increase in knee laxity in tibial internal rotation or pivot shift with addition of sectioning the ALL in ACL-deficient knees. Two studies reported a significant increase in both anterior tibial translation and internal tibial rotation during application of the anterior-drawer and pivot-shift tests after ALL sectioning. @*Conclusion@#There was inconsistency in the biomechanical characteristics of the ALL of the knee in resisting anterolateral and anterior subluxation of the tibia.

Tunnel Position for Anatomical Reconstruction of the Anterior Cruciate Ligament / 대한정형외과학회잡지

The review provides updated concepts regard to the anatomy of the anterior cruciate ligament (ACL) footprints. The concept of anatomicalACL reconstruction, in which the graft is placed in the native ACL insertion area, has been introduced. However, there is still no consensuson the anatomical positioning of the femoral and tibial tunnel. In this study, authors review and update the literature regarding the tunnelposition for anatomical ACL reconstruction.

Usefulness of the Korean Knee Score for Evaluation of the Results of Total Knee Arthroplasty

PURPOSE: The Korean Knee score (KKS) was designed to reflect the floor-sitting lifestyle that necessitates high knee flexion. The purpose of this study is to assess whether the KKS reflects the floor-sitting lifestyle more accurately than the previously developed Knee Society clinical rating system. In addition, the presence of ceiling effects was compared between the two rating systems. MATERIALS AND METHODS: Eighty-one consecutive patients (120 knees) who were assessed regularly after total knee arthroplasty (TKA) on an outpatient basis between January 2012 and December 2012 were enrolled. All patients were asked to complete a questionnaire to assess the Knee Society Knee score (KSKS), Knee Society Function score (KSFS), and KKS. RESULTS: At the final follow-up, the mean KSKS, KSFS, and KKS were 91.2, 86.0, and 70.1, respectively, and the scores were similar between the > or =125degrees maximum flexion group and 125degrees maximum flexion group (15.13 vs. 11.24, p=0.001). The number of cases with the highest possible score was 24 (20%) for the KSKS and 47 (39%) for the KSFS, whereas none of the cases obtained the highest possible KKS. According to the standard deviation method, more substantial ceiling effects were present in the KSKS (83 cases, 69.1%) and KSFS (67 cases, 55.8%) than in the KKS (23 cases, 19.2%). CONCLUSIONS: Although, the KKS was effective in reducing the ceiling effect, it demonstrated limited improvement in assessing the ability to perform high knee flexion after TKA. However, the 'floor life' subdomain of KSS appeared to be valid for evaluating high flexion of the knee.

Flexion Gap Measured in 45 Degrees and 90 Degrees of Hip Flexion Positions during Total Knee Arthroplasty: Measurement by Navigation System

PURPOSE: To evaluate the influence of thigh weight in different hip flexion positions on the knee flexion gap in total knee arthroplasty (TKA). MATERIALS AND METHODS: We evaluated 20 patients (25 knees) with osteoarthritis of the knee that underwent TKA using a navigation system from May 2010 to April 2011. After posterior cruciate ligament sacrificing, complete soft tissue balancing, and fixation of all components with cement, the flexion gaps were measured with the patello-femoral joint reduced. Medial and lateral flexion gaps were measured separately in both the 90degrees-90degrees and 45degrees-90degrees flexion positions of the hip-knee joints. RESULTS: The medial and lateral flexion gaps in the 45degrees-90degrees flexion position of the hip-knee joints were 13.02+/-2.17 mm and 13.12+/-2.21 mm, respectively. The medial and lateral flexion gaps in the 90degrees-90degrees flexion position were 12.92+/-2.03 mm and 13.08+/-2.29 mm, respectively. The flexion gaps showed no significant (p>0.05) differences between the two different hip flexion positions. CONCLUSIONS: Flexion gaps in TKA were not influenced by hip flexion positions (45degrees or 90degrees of flexion). Therefore, soft tissue balancing and polyethylene thickness should not be affected by hip flexion positions during TKA.

Treatment for Bilateral Congenital Dislocation of the Patella Using Stanisavljevic Procedure / 대한정형외과학회잡지

Congenital dislocation of the patella is a rare clinical entity and is considered to result from a failure in internal rotation when the myotome develops, which forms the femur, the quadriceps muscle, and the extensor mechanism. Several authors have suggested various treatment methods, but there has been no consensus on treatment. A 12-year-old boy complained of knee pain and presented with a deformity due to bilateral congenital dislocation of the patella. The patient was treated with surgical management using the Stanisavljevic procedure. We report this case of congenital dislocation of the patella treated with this procedure that achieved a stable patellofemoral joint and satisfactory clinical results over 6.5 years of follow-up. In addition, we have included a review of the relevant medical literature.

A novel mycotoxin purification system using magnetic nanoparticles for the recovery of aflatoxin B1 and zearalenone from feed

In this study, we developed a novel tool for purifying two mycotoxins, aflatoxin B1 (AFB1) and zearalenone (ZEN), in feed. This system utilized monoclonal antibodies (mAbs) against AFB1 and ZEN, and magnetic nanoparticles (MNPs). Among ten MNPs with different diameters and functional groups, a 100-nm diameter MNP (fMA) conjugated to an amine group (-NH2) was found to be optimum for coupling with mAbs. The optimal mAb concentrations for coupling to the fMA along with mycotoxin purification capacities of the fMA-mAb conjugates (fMA-AFB1 and fMA-ZEN) were determined. A comparison of mean recovery rates (from corn and product X feed) between the fMA-mAb conjugates and immunoaffinity columns (IAC-AFB1 and IAC-ZEN) showed that the rate for fMA-AFB1 (90~92% and 81~88%) was higher (p > 0.05) than that of IAC-AFB1 (81~84% and 72~78%) for AFB1 (5, 10, 15 ng/mL), and the rate for fMA-ZEN (99~100% and 92~94%) was significantly higher (p 30 min). This study suggests that the novel purification system we developed would be a useful tool for monitoring and regulating mycotoxin contamination in feed, and replace IAC methods.

The Effectiveness of C-Reactive Protein Surveillance as a Method to Monitor the Post-Operative Antibiotics Administration after Total Knee Replacement Arthroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of using C-reactive protein (CRP) surveillance as a method to monitor the effect of postoperative antibiotics for the prevention of early infection after total knee replacement arthroplasty (TKRA). MATERIALS AND METHODS: A prospective study was performed in 115 primary TKRAs. We examined the values of CRP of all cases on the 3rd, 5th, 7th, 10th and 14th days post-operatively. Some patients were administrated additional antibiotics under certain specific situations based on the pattern of CRP. The patients were divided into two groups: group I with planned period of administration and group II with administration longer than the planned period. RESULTS: No acute infection after TKRA due to CRP surveillance was observed. The mean duration of antibiotics administration was 5.9 days in all cases, 5 days in group I and 13.3 days in group II. Twelve cases (10.4%) were included in group II. The CRP was increased on the 5th and 10th days after operation in group II. CONCLUSION: The surveillance of CRP was thought to be helpful in monitoring the effects of post-operative antibiotics and prevention of early infection after TKRA.

The Prophylaxis of Venous Thromboembolism in Korean Patients with Total Knee Replacement Arthroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the effects and problems of venous thromboembolism (VTE) prophylaxis with a reduced dosage and administration period in Korean total knee arthroplasty (TKA) patients. MATERIALS AND METHODS: We analyzed 135 consecutive TKA patients with three different VTE prophylaxis regimens. Group dalteparin-aspirin (DA) injected dalteparin for the first 2 days, followed by taking aspirin for the next 5 days, Group aspirin (A) was on aspirin and Group dalteparin (D) on dalteparin 7 days postoperatively. We evaluated the incidence of VTE and safety among the 3 groups. RESULTS: Symptomatic deep vein thrombosis was detected in 4 cases (Group DA: 2, Group A: 1, Group D: 1). Pulmonary embolism (PE) was found in 1 case in each group with no fatal PE. Although no major bleeding complications were seen, minor bleeding incidents were detected in 14 cases (Group DA: 2, Group A: 1, Group D: 11), which was significant in Group D. No significant differences were observed in perioperative blood loss, effusion in the knee joint, thigh swelling or oozing on the wound area among the groups except thigh bruising, which developed more frequently in group D. CONCLUSION: The reduced dosage and administration period of VTE prophylactic medicine combined with mechanical prophylaxis for Korean TKA patients showed no fatal PE, but some minor bleeding incidents frequently developed with 7 days of dalteparin injections. We need to adjust the dosage and duration of prophylactic medication deliberately for Korean TKA patients, considering prophylaxis effectiveness and bleeding complication risks.

Total Knee Arthroplasty in Rheumatoid Arthritis

The course of rheumatoid arthritis varies from mild disease to severe joint destructive variant that progresses rapidly, eventually leading to unremitting pain and joint deformity. In advanced disease, total knee arthroplasty has proven to be the most successful intervention that reduces knee pain and improves physical function in rheumatoid arthritis patients. However, as rheumatoid arthritis patients carry additional potential for late complications, many important considerations regarding preoperative evaluation and surgical technique must be taken into account in order to improve the results of total knee arthroplasty in this subgroup of patients.

Septic Knee Arthritis Caused by Group B Salmonella Species in a Patient with Systemic Lupus Erythematosus / 대한정형외과학회잡지

Infection is a leading cause of death in patients with systemic lupus erythematosus (SLE). Insufficiency of the reticuloendothelial system, immunosuppressive therapy and inadequate opsonization are the main predisposing factors for infection. Salmonella infection is one of the most common opportunistic bacterial infections in patients with SLE and it can provoke a bacteremia or a localized infection. We report here on a rare case of septic knee arthritis caused by Group B Salmonella in a SLE patient, and this was treated with arthroscopic irrigation and antibiotics.

Dual-Modal Nanoprobes for Imaging of Mesenchymal Stem Cell Transplant by MRI and Fluorescence Imaging

OBJECTIVE: To determine the feasibility of labeling human mesenchymal stem cells (hMSCs) with bifunctional nanoparticles and assessing their potential as imaging probes in the monitoring of hMSC transplantation. MATERIALS AND METHODS: The T1 and T2 relaxivities of the nanoparticles (MNP@SiO2[RITC]-PEG) were measured at 1.5T and 3T magnetic resonance scanner. Using hMSCs and the nanoparticles, labeling efficiency, toxicity, and proliferation were assessed. Confocal laser scanning microscopy and transmission electron microscopy were used to specify the intracellular localization of the endocytosed iron nanoparticles. We also observed in vitro and in vivo visualization of the labeled hMSCs with a 3T MR scanner and optical imaging. RESULTS: MNP@SiO2(RITC)-PEG showed both superparamagnetic and fluorescent properties. The r1 and r2 relaxivity values of the MNP@SiO2(RITC)-PEG were 0.33 and 398 mM-1 s-1 at 1.5T, respectively, and 0.29 and 453 mM-1 s-1 at 3T, respectively. The effective internalization of MNP@SiO2(RITC)-PEG into hMSCs was observed by confocal laser scanning fluorescence microscopy. The transmission electron microscopy images showed that MNP@SiO2(RITC)-PEG was internalized into the cells and mainly resided in the cytoplasm. The viability and proliferation of MNP@SiO2(RITC)-PEG-labeled hMSCs were not significantly different from the control cells. MNP@SiO2(RITC)-PEG-labeled hMSCs were observed in vitro and in vivo with optical and MR imaging. CONCLUSION: MNP@SiO2(RITC)-PEG can be a useful contrast agent for stem cell imaging, which is suitable for a bimodal detection by MRI and optical imaging.

Cellular uptake of magnetic nanoparticle is mediated through energydependent endocytosis in A549 cells

Biocompatible silica-overcoated magnetic nanoparticles containing an organic fluorescence dye, rhodamine B isothiocyanate (RITC), within a silica shell [50 nm size, MNP@SiO2(RITC)s] were synthesized. For future application of the MNP@SiO2(RITC)s into diverse areas of research such as drug or gene delivery, bioimaging, and biosensors, detailed information of the cellular uptake process of the nanoparticles is essential. Thus, this study was performed to elucidate the precise mechanism by which the lung cancer cells uptake the magnetic nanoparticles. Lung cells were chosen for this study because inhalation is the most likely route of exposure and lung cancer cells were also found to uptake magnetic nanoparticles rapidly in preliminary experiments. The lung cells were pretreated with different metabolic inhibitors. Our results revealed that low temperature disturbed the uptake of magnetic nanoparticles into the cells. Metabolic inhibitors also prevented the delivery of the materials into cells. Use of TEM clearly demonstrated that uptake of the nanoparticles was mediated through endosomes. Taken together, our results demonstrate that magnetic nanoparticles can be internalized into the cells through an energy-dependent endosomal-lysosomal mechanism.

The association between indicators of central obesity and bone mineral density in women

BACKGROUND: Obesity is a protective factor of osteoporosis, which is one of the important health problems in the elderly. The purpose of this study was to determine the association between indicators of central obesity and bone mineral density (BMD) in women. METHODS: Among the healthy people who visited a tertiary hospital in Pusan for health exam from January to May 1999, we selected 303 women. We measured body mass index (BMI), waist, waist to hip ratio (WHR), menopausal period, and BMD. The SPSS statistical program was used for statistical analysis and the following test used: correlation and partial correlation adjusted for age and menopausal period. RESULTS: The total subjects consisted of 162 premenopausal and 141 postmenopausal women. In all subjects, BMI and WHR were positively correlated with spinal BMDs, but after controlling for age and menopausal period, BMI (r=0.322, p<0.01) and waist (r=0.220, p<0.01) were related to spinal BMDs. In the premenopausal group, spinal BMDs were correlated with BMI, waist, but after controlling for age, they were related to BMI (r=0.270, p<0.01) and waist (r=0.193, p<0.05). In the postmenopausal group, BMI, waist, and menopausal period wrer correlated with spinal BMDs, and after controlling for age and menopausal period, BMI (r=0.365, p<0.01) and waist (r=0.251, p<0.01) remained related to spinal BMDs. In women of BMI below 25 kg/m2, spinal BMDs were correlated with waist(r=0.163, P=0.02)and not WHR. CONCLUSION: These results suggest that waist, not WHR was associated with spinal BMDs in women.