Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration / 대한척추외과학회지

STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To determine the relationship between lumbar disc degeneration and back muscle degeneration. SUMMARY OF LITERATURE REVIEW: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles. MATERIALS AND METHODS: In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed. RESULTS: The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant. CONCLUSIONS: There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

Correlation between a Rupture of the Hypovascular Zone and Early Single Heel Raising after Achilles Tendon Repair / 대한족부족관절학회지

PURPOSE: To analyze the correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. MATERIALS AND METHODS: From January 2012 to August 2015, 68 patients, who underwent surgical treatment for a Achilles tendon rupture using Krackow method, were analyzed retrospectively. The patients were divided into two groups according to possibility of single heel raises within 3 months postoperatively. During the periodic outpatient observations, the visual analogue scale, Achilles tendon total rupture score (ATRS), and timing capable single heel raises were evaluated. In addition, the preoperative defect size and distance between the calcaneal osteotendinous junction and the rupture site were measured by ultrasound in all cases. RESULTS: Twenty-three patients could perform a single heel raise within 3 months after surgery (early single heel raise group), and forty-five patients could perform a single heel raise after 3 month postoperatively. The age, gender, body mass index, smoking, and operation delay were similar in the two groups. In addition, the defect size and distance between the calcaneal osteotendinous junction and rupture site as measured by preoperative ultrasound were similar (p=0.379 and p=0.631, respectively). On the other hand, when the rupture site was divided into the hypovascular zone (4~7 cm from calcaneal osteotendinous junction) and non-hypovascular zone, the hypovascular zone rupture rate was significantly lower in the early single heel raise group (60.9%, 14/23; 91.1%, 41/45; p=0.003). In logistic regression analysis, the odds of the hypovascular zone rupture group being capable of early single heel raise were 0.189 (p=0.017). The ATRS score at 3 months and 1 year after surgery were significantly higher in the early single heel raise group (p < 0.001). CONCLUSION: Achilles tendon rupture at the hypovascular zone is a poor prognostic factor for early single heel raise and might affect the prognosis significantly after an Achilles tendon rupture operation.

Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration

OBJECTIVES@#To determine the relationship between lumbar disc degeneration and back muscle degeneration.SUMMARY OF LITERATURE REVIEW: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles.@*MATERIALS AND METHODS@#In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed.@*RESULTS@#The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant.@*CONCLUSIONS@#There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

Loss of podocalyxin causes a novel syndromic type of congenital nephrotic syndrome

Many cellular structures directly imply specific biological functions. For example, normal slit diaphragm structures that extend from podocyte foot processes ensure the filtering function of renal glomeruli. These slits are covered by a number of surface proteins, such as nephrin, podocin, podocalyxin and CD2AP. Here we report a human patient presenting with congenital nephrotic syndrome, omphalocele and microcoria due to two loss-of-function mutations in PODXL, which encodes podocalyxin, inherited from each parent. This set of symptoms strikingly mimics previously reported mouse Podxl(−/−) embryos, emphasizing the essential function of PODXL in mammalian kidney development and highlighting this patient as a human PODXL-null model. The results underscore the utility of current genomics approaches to provide insights into the genetic mechanisms of human disease traits through molecular diagnosis.

Redomicrofracture as a Treatment for Osteochondral Lesion of Talus after the Failure of Arthroscopic Microfracture / 대한족부족관절학회지

Arthroscopic treatment has been reported to provide effective improvement of ankle function when used in treatment of small osteochondral lesion of talus; however, favorable long-term results have been less predictable for large osteochondral lesion of talus. In cases in which primary arthroscopic treatment fails, the decision regarding which subsequent technique to choose has become increasingly difficult, as good clinical outcomes may be unlikely for such patients irrespective of the surgical technique used. Redomicrofracture should be used judiciously for treatment of osteochondral lesion of talus in which arthroscopic treatment has failed.

Comparison of Efficiency of Self-renewal and Differentiation Potential in Tendon-derived Mesenchymal Stem Cells Isolated by Magnetic-activated Cell Sorting Method or Colony Picking Method / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the efficacy of mesenchymal stem cell (MSC) isolation by the magnetic-activated cell sorting (MACS) method in tendon tissue-derived cells compared to the colony picking method for isolation of MSCs by picking colonyforming cells. MATERIALS AND METHODS: Human tendon-derived cells were isolated by enzyme digestion using normal tendon tissues from three donors. We used the magnetic kit and well-known MSC markers (CD90 or CD105) to isolate MSCs in tendon-derived cells using MACS. Cloning cylinders were used to isolate colony-forming cells having MSC characteristics in tendon-derived cells. Colony-forming unitfibroblast (CFU-F) assay was used to evaluate the self-renewal capacity of cells isolated using the colony picking method or MACS. For comparison of differentiation potentials into osteogenic or adipogenic lineage between two groups, alizarin red S and oil red O staining were performed at 14 days after induction of differentiation in vitro. RESULTS: Flow cytometry results showed that early passage tendon-derived cells expressed CD44 in 99.13%, CD90 in 56.51%, and CD105 in 86.19%. In the CFU-F assay, CD90+ or CD105+ cells isolated with MACS showed larger colony formation in size than cells isolated using the colony picking method. We also observed that CD90+ or CD105+ cells were constantly differentiated into both osteogenic and adipogenic lineages in cells from all donors, whereas cells isolated using the colony picking method were heterogeneous in differentiation potentials to the osteogenic and adipogenic lineages. CONCLUSION: CD90+ or CD105+ cells isolated using MACS showed superior MSC characteristics in the self-renewal and multi-differentiation capacities compared with cells isolated using the colony picking method.

Review of Literatures for Development of Clinical Trial Guideline for Total Ankle Arthroplasty / 대한족부족관절학회지

PURPOSE: The purpose of this study is to develop guidelines for clinical trial of the total ankle replacement system for premarket approval. MATERIALS AND METHODS: We selected and analyzed nine peer-reviewed articles whose quality had been proven in a previous phase. Two investigators extracted parameters for guideline criteria, including number of cases, patient age, follow-up period, failure rate, radiographic osteolysis rate, residual pain rate, and percentage of satisfaction. In addition, the inclusion and exclusion criteria were analyzed and developed. RESULTS: Eight level IV studies and one level II study were included. The average number of cases was 159 cases and the mean patient age was 63.5 years. The mean follow-up period was 4.2 years, ranging from two to nine. The average failure rate of total ankle replacement in mid- to long-term follow-up was approximately 13% (2%~32.3%). The rate of osteolysis was approximately 18%. Residual pain was common (21.4%~46%), but overall patient satisfaction was approximately 85.6% (67.5%~97%). CONCLUSION: The results could be used as criteria for designing the clinical studies, such as number of cases, patient age (over 60 years), and follow-up period (minimum two years). The clinical scoring system and 36-item short form health survey (SF-36) was the most commonly used method for clinical evaluation for total ankle arthroplasty. In addition, the overall results, including failure rate, osteolysis rate, and patient satisfaction, could be used as a parameter of guidelines for premarket approval.

Outcomes of Diffuse-Type Pigmented Villonodular Synovitis (PVNS) after Open Total Synovectomy / 대한골관절종양학회지

PURPOSE: Pigmented villonodular synovitis (PVNS) is a rare soft tissue tumor, which usually arises in larger joints, such as the knee. It has a high recurrence rate after surgical treatment. The purpose of this study is to evaluate and analyze the clinical results of diffuse-type pigmented villonodular synovitis cases that were treated with open total synovectomy. MATERIALS AND METHODS: Between 1994 and 2006, 21 patients who had diffuse-type pigmented villonodular synovitis were selectively reviewed. Among the 21 cases studied, 14 patients presented at the knee, 5 at the ankle, and 2 at the shoulder and elbow. The mean follow up period was 5.5 years (range, 36-157 months). The average age of the patients was 34 years consist of 7 men and 14 women. Clinical outcomes were analyzed retrospectively, including range of motion and complications. RESULTS: Open total synovectomy and adjuvant electrocautrization were done in all cases except one. During the regular follow-up period after the surgery, two patients showed symptoms of recurrence. After re-operation, only one case was pathologically confirmed as a recurrence. The patient who had partial synovectomy and the other patient who had second operation due to recur rence received additional radiation therapy. Clinical outcome scores were improved in every aspect (p<0.0001). 2 out of 14 Patients who had pigmented villonodular synovitis at the knee developed stiff knee after the surgery. CONCLUSION: After the open total synovectomy with electrocautrization, a low recurrence rate and satisfactory clinical outcome was achieved, observed in a minimum of 3 years of follow-up.

Removal of a Broken Intramedullary Nail with a Narrow Hollow Using a Bulb-tipped Guide Wire and Kirschner Wire: A Case Report

To report the unusual failure of proximal femoral nail antirotation (PFNA) at the level of lag screw hole and introduce a simple technique for removal of a broken intramedullary nail with a narrow hollow using a bulb-tipped guide wire and Kirschner wire.