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Enlargement of lateral ventricle is most striking feature after sixth decade of life. Regression of brain is normalageing process. But there are marked individual variations in this process. Lateral ventricular contours arerelatively constant, except for the occipital horns. Two major changes that may occur in elderly individualwithout neurologic deficits is enlargement of ventricles and cortical atrophy. This study is focusing on thechanges in posterior horn of lateral ventricle in different age groups. Aim of this study is to statistically analysethe length of the posterior horn of lateral ventricle in human and to correlate the changes in relation to age andside. Method: The CT images of 150 adult individuals (age group 20-80yrs) was studied in both males andfemales. Length of posterior horn of lateral ventricle was measured using dicomworks software. Result: Meanvalue of length of the posterior horn increases on both sides as the age increases. Values are larger in 61-80years. In relation to the side, the length of posterior horn is greater on the left side as compared to the right side.
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Objective To investigate the clinical features of hidden horizontal tears of the posterior horn of the medial meniscus and clinical efficacy of arthroscopic partical meniscectomy. Methods A total of 14 cases of hidden horizontal tears of posterior horn of the medial meniscus from May 2011 to May 2013 were enrolled.The knee arthroscopy was carried out through anteromedial and anterolateral approaches.The lesion of tears was exposed after the inner edge of posterior horn of the meniscus was bitten away.The bottom of the posterior horn of meniscus was found instable during the operation, which was then removed to conduct a partial meniscectomy.Afterwards the arthroscopic meniscus plasty of the posterior horn was performed. Results Arthroscopic photographs showed normal appearance in 6 cases and tears underside meniscus in 8 cases, all of which were confirmed to be horizontal medial meniscus posterior horn tear during operation.The mean time of operation was 32 min (range, 26-40 min), and the mean hospitalization time was 6 days ( range, 3-8 d) .There was no complications, such as infections or stiffnesses.All the patients were followed up for 2 -3 years.Subjective symptoms improved significantly after arthroscopic partial meniscectomy.According to the Lysholm knee scoring scale, the scores were (71.1 ±6.6) points preoperatively and (92.0 ±3.4) points postoperatively, with significant difference (t=10.530, P=0.000). Conclusion Diagnosis of hidden horizontal tears of the medial meniscus posterior horn is often difficult, because most patients have osteoarthritic knees.Careful physical examination and MRI are critical for making a correct diagnosis.Arthroscopic partial meniscectomy can help patients obtain better results.
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Objective To evaluate the role of transient receptor potential ion channel 1 (TRPA1) in the spinal dorsal horn neurons in maintenance of neuropathic pain in rats.Methods Fifty-six adult male SpragueDawley rats,weighing 200-250 g,were randomly divided into 4 groups (n =14 each):sham operation group (group S); chronic compression of dorsal root ganglia (CCD) group; CCD + dimethyl sulfoxide group (group D); and CCD + TRPA1 blocker HC-030031 group (group H).CCD was produced by infiltrating the L5 intervertebral foramen with 50 μl of a hemostatic matrix (SURGIFLO) in anesthetized rats in CCD,D and H groups.In D and H groups,10％ dimethyl sulfoxide 20 μl and HC-030031 50 μg were injected intrathecally at 7 days after CCD operation,respectively.Paw withdrawal threshold to mechanical stimulation (PWMT) was measured at 1 day before operation (T0),at 1 h before intrathecal administration (T1),and at 1,2,4,6,8,and 24 h after intrathecal administration (T2-7).Six rats in each group were sacrificed at T4 and T7,the L3-5 segments of the spinal cord were obtained for determination of TRPA1 expression in the spinal cord by Western blot.Results Compared with group S,PWMT was significantly decreased at T1-7,the expression of TRPA1 in the spinal cord was up-regulated at T4 and T7 in CCD and D groups,and the PWMT was decreased at T1 and T5-7 and the expression of TRPA1 was up-regulated at T7 in H group (P ＜ 0.05).Compared with CCD group,the PWMT was significantly increased at T2-5 and the expression of TRPA1 was down-regulated at T4 in H group (P ＜ 0.05).Conclusion TRPA1 in the spinal dorsal horn neurons is involved in the maintenance of neuropathic pain in rats.
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PURPOSE: To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings. MATERIALS AND METHODS: From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. RESULTS: There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2. CONCLUSIONS: We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.
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Animals , Humans , Arthroscopy , Axis, Cervical Vertebra , Cicatrix , Follow-Up Studies , Horns , Knee , Knee Joint , Menisci, Tibial , Retrospective Studies , SuturesABSTRACT
Objective To evaluate the role of transient receptor potential ankyrin 1 (TRPA1) in the dorsal root ganglion neurons in the development of diabetic neuropathic pain (DNP) in rats.Methods Twenty-four Sprague-Dawley rats with DNP were randomly divided into 3 groups (n-=8 each) using a random number table:DNP group,TRPA1-specific siRNA group (siRNA group) and TRPA1-negative siRNA group (NC group).Another 8 Sprague-Dawley rats with normal blood glucose served as control group (C group).In siRNA group,TRPA1-specific siRNA 45 μl was injected intrathecally.In NC group,TRPA1-negative siRNA 45 μl was injected intrathecally.In DNP and C groups,normal saline 45 μl was injected intrathecally.On 2nd day after intrathecal administration,the lumbar segment (L4-6) of the dorsal root ganglions was removed for determination of the expression of TRPA1 mRNA.On 7,14,21 and 28 days after intrathecal administration (T1-4),MWT was measured.Results Compared with DNP group,TRPA1 mRNA expression was down-regulated in siRNA and C groups.Compared with DNP group,and MWT was significantly decreased at T1.2 in siRNA group,MWT was decreased at T1-3 in NC group,MWT was increased at T1-4 in group C.Compared with siRNA group,MWT was significantly increased at T1-4 in group C.MWT was significantly higher at T1~ in group C than in NC group.Conclusion TRPA1 in the dorsal root ganglion neurons is involved in the development of DNP in rats.
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Objective To evaluate the role of phosphatidylinositol 3-kinase (PI3K) p110β in spinal dorsal horn neurons in the development of arthritic pain (AP) in rats and the relationship with transient receptor potential vanilloid 1 (TRPV1) and acid-sensing ion channel (ASIC)1 a.Methods Forty adult female Sprague-Dawley rats in which intrathecal catheters were successfully placed,aged 3 months,weighing 250-300 g,were randomly divided into 4 groups (n =10 each):control group (group C),group AP,AP + PI3K p110β missense oligo-deoxynucleotide group (group MS) and AP + PI3K p110β antisense oligo-deoxynucleotide group (group AS).AP was induced by injecting complete Freund's adjuvant into the ankle joint cavity of right hindpaw.Normal saline 20 μl,missense oligo-deoxynucleotide 15 μg (20μl) and antisense oligo-deoxynucleotide 15 μg (20 μl) were administered intrathecally once a day for 6 consecutive days starting from the time immediately after arthritis was induced in groups AP,MS and AS,respectively.Mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured 1 day before operation (T0) and on days 4,7,10 after operation (T1-3).The rats were then sacrificed after the last measurement of pain threshold at T3.L4-6 segment of the spinal cord was removed for detection of expression of PI3K p110β (by Western blot),and TRPV1 and ASICla (by immunohistochemistry)in spinal dorsal horn neurons.Results Compared with group C,MWT and TWL were significantly decreased atT1-3,and the expression of PI3K p110β,TRPV1 and ASIC1a was up-regulated in the other 3 groups(P＜ 0.01).MWT and TWL were significantly higher at T1-3,and the expression of PI3K p110β,TRPV1 and ASIC1a was lower in group AS than in groups AP and MS (P ＜ 0.01).Conclusion PI3K p110β in spinal dorsal horn neurons is involved in the development of AP in rats,and the mechanism is related to up-regulation of TRPV1 and ASIC1a expression in spinal dorsal horn neurons.
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Objective To investigate the changes in the number of microglias and astrocytes in the spinal dorsal born in a rat model of phantom limb pain.Methods Eleven healthy adult SD rats of both sexes weighing 290-300 g were randomly divided into 2 groups:sham operation group (group S,n =5 ) and unilateral sciatic nerve transection group (group SNT,n =6).Phantom limb pain model was induced by resection of a 0.5 cm segment of unilateral sciatic nerve in group SNT.In group S unilateral sciatic nerve was exposed but not transected.The animals were observed for autotomy and scored (0 =no autotomy,13 =the worst autotomy) after operation and were sacrificed on the 28th day after operation.The L5 segment of the spinal cord was removed for determination of the number of microglials (by iba-1 immuno-histochemistry) and astrocytes (by GFAP immuno-histochemistry).Results In group S no animal developed autotomy.In group SNT autotomy started from the 2nd day after operation and the score reached 9-11.Compared with group S,the number of the microglias and astrocytes in the spinal dorsal horn was significantly decreased in the operated side in group SNT ( P ＜ 0.05 ).Conclusion The number of microglias and astrocytes in the spinal dorsal horn is decreased in animals with phantom limb pain.
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Objective To investigate the effects of dexmedetomidine (Dex) on the neuronal apoptosis in spinal dorsal horn in a rat model of chronic neuropathic pain.Methods Seventy-two adult male SD rats weighing 180-220 g were randomly divided into 3 groups ( n =24 each):sham operation group (group S) ; chronic constrictive injury (CCI) group; Dex + CCI group (group D).Two ligatures were placed on right sciatic nerve at 1 mm intervals with 4-0 silk thread in groups CCI and D.In group D Dex 50 μg/kg was injected intraperitoneally once a day starting from the end of operation until the animals were sacrificed.Paw withdrawal threshold to mechanical stimulation with yon Frey filament (PWT) and paw withdrawal latency to thermal stimulation (PWL) were measured at one day before (T0,baseline) and on the 3rd,7th and 14th day after operation (T1,2,3).Six animals were sacrificed at each time points (T1,2,3) after the measurement of PWT and PWL.Their lumbar segments (L4,5)were removed for examination with transmission electron microscope and detection of Bcl-2 and caspase-3 expression (by immune-histochemistry).Results CCI significantly decreased PWT and PWL,increased Bcl-2 and caspase-3 expression at T1,2,3 and induced apoptosis in spinal dorsal horn neurons in group CCI as compared with group S.Intraperitoneal Dex significantly attenuated CCI-induced mechanical and thermal hyperalgesia and neuronal apoptosis in group D as compared with group CCI.Dex injected intraperitoneally further increased Bcl-2 expression but decreased caspase-3 expression in group D as compared with group CCI.Conclusion Reduction in neuronal apoptosis in spinal dorsal horn is involved in the attenuation of neuropathic pain by Dex.
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In cases with root tear of the medial meniscus posterior horn, the meniscus usually can be repaired by a pull out suture technique. However, there is difficulty in manipulating a suture hook via the anteromedial portal and looking through the arthroscopic camera via anterolateral portal in the narrow medial joint space at the same time. This article describes a modified simple pull out suture technique for root tear of the medial meniscus posterior horn using a posteromedial portal that provides a safe and easy handling of the suture hook. Our indications of this technique used in patients with Outerbridge 1-2 arthritic change and minimal varus axis change. Benefits of this technique are simple, less invasive, and reduced operation time by simultaneous suture with a hook via posteromedial portal and pulling of a string with grasper. It may reduce the possibility of an additional chondral or meniscal injury.
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Animals , Humans , Axis, Cervical Vertebra , Handling, Psychological , Horns , Joints , Menisci, Tibial , Suture Techniques , SuturesABSTRACT
BACKGROUND: The clinical and radiologic features of radial tears of the medial meniscus posterior horn were compared with those of horizontal tears. METHODS: From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Among these, 91 were radial tears in the medial meniscus posterior horn, and 95 were horizontal tears in the posterior segment of the medial meniscus. The patients' data (age, gender, duration of symptom, body mass index, and injury history), radiographic findings (Kellgren and Lawrence score, posterior tibial slope, and femorotibial angle), and chondral lesions were recorded. RESULTS: The patient factors of age, gender, and body mass index were related to radial tears of the medial meniscus posterior horn. Radial tears were significantly correlated with Kellgren and Lawrence score, varus alignment, posterior tibial slope, and severity of the chondral lesion. CONCLUSIONS: Radial tears of the medial meniscus posterior horn are a unique clinical entity that are associated with older age, females and obesity, and are strongly associated with an increased incidence and severity of cartilage degeneration compared to horizontal tears.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Age Factors , Arthroscopy , Body Mass Index , Knee Injuries/pathology , Menisci, Tibial/injuries , Retrospective Studies , Sex FactorsABSTRACT
Objective To investigate the changes in the number of synapses and neurons in the spinal dorsal horn in a rat model of phantom limb pain. Methods Eleven healthy adult SD rats of both sexes weighing 209-300 g were randomly divided into 2 groups: sham operation group (group S, n = 5) and phantom limb pain group (group P, n = 6). Phantom limb pain was induced by resection of a 0.5 cm segment of unilateral sciatic nerve in group P. In group S unilateral sciatic nerve was exposed but not transected. The animals were observed for autotomy and scored (0 = no autotomy, 13 = the worst autotomy) after operation and were sacrificed on the 28th day after operation. The L3-6 segment of the spinal cord was removed for determination of the number of neurons (by Nissl's staining) and synapses (by synaptophysin immuno-histochemistry).Results In group S no animal developed autotomy. In group P autotomy started from the 2nd day after operation and the score reached 9-11. The number of the neurons in the spinal dorsal horn in all 4 segments and the number of synapses in L3 and 16 segments were comparable between the two sides and the 2 groups. The number of synapses in the spinal dorsal horn of L4and L5 segment was significantly larger in the operated side than in the contralateral side in group P. Conclusion The number of synapses in the spinal dorsal horn significantly increases in animals with plantom limb pain which induces no increase in the number of neurons in the spinal dorsal horn.
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PURPOSE: To evaluate the clinical results of arthroscopic inside-out repair leaving posterior horn tear. MATERIALS AND METHODS: Among the patients taken arthroscopic meniscal repair due to meniscus longitudinal tear from Jan. 1999 to Dec. 2004, total 32 patients were evaluated, and followed at minimum of two years(mean 32 months). Meniscal repair was done as maximum 3mm interval. The length of unrepaired posterior horn was mean 7.5mm. RESULTS: Preoperative Lysholm score was mean 62.5 and postoperative improved to 91.0. Twenty eight cases(87.5%) showed excellent or good results by Tapper and Hoover criteria. In 4 cases, symptoms recurred at 4 to 12 months after repair and 2 cases were combined with ACL deficiency. Second look arthroscopy was performed in 10 cases, 4 cases for recurred symptom and 6 cases for determining whether healing of untreated posterior horn occurred or not. We observed complete healing of 4 cases and incomplete healing of 2 cases on the acquisition of stability. CONCLUSION: It was suggested that meniscal repair leaving posterior horn tear may be healed if both stabilities of the torn area and the knee joint were maintained.
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Animals , Humans , Arthroscopy , Horns , Knee JointABSTRACT
PURPOSE: To evaluate the clinical findings of a complete radial rupture of the meniscal root ligament of the medial meniscus posterior horn. MATERIALS AND METHODS: From April, 2004 to December, 2004, nineteen patients (mean age, 56.5 years old) who were diagnosed with a medial root ligament rupture of the medial meniscus posterior horn during an arthroscopic treatment were enrolled in this study. The clinical findings, physical examinations, and the radiological and arthroscopic findings were analyzed retrospectively. RESULTS: Thirteen out of the nineteen cases had tenderness of the knee without specific trauma. The preoperative physical examination revealed posteromedial joint line tenderness in fifteen cases. A medial joint line protrusion with direct tenderness was observed in six cases (31.5%) and a positive McMurray test was observed in seventeen cases (89.5%). MRI was carried out in sixteen patients. All sixteen patients were diagnosed with a rupture of the meniscal root ligament using the author's diagnostic MRI criteria. CONCLUSION: Non-traumatic pain and posteromedial joint line tenderness in patients in their sixth decade are indications of a rupture of the meniscal root ligament of the medial meniscus posterior horn. Confirmation using MRI and arthroscopy is important for making a diagnosis.
Subject(s)
Animals , Humans , Arthroscopy , Diagnosis , Horns , Joints , Knee , Knee Joint , Ligaments , Magnetic Resonance Imaging , Menisci, Tibial , Physical Examination , Retrospective Studies , RuptureABSTRACT
PURPOSE: To evaluate the clinical results of arthroscopic all-inside suture using 2 posteromedial portals for medial meniscus posterior horn (MMPH) tears by second-look arthroscopy in patients received concurrent anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: From May 1997 to June 2001, 78 MMPH tears were treated with arthroscopic all-inside sutures with concurrent anterior cruciate ligament (ACL) reconstruction. Among these 39 patients were availablefor follow-up evaluation by second-look arthroscopy. All MMPH tears were repaired using the arthroscopic all-inside suture technique using 2 posteromedial portals. Second-look arthroscopy was performed on average 19 months (range 6 to 40 month) after the ACL reconstruction and meniscal repair. Meniscus healing status was defined and classified. According to the Henning classification, they were divided into complete healing, incomplete healing, and failure. Tear size, type and location were analyzed and compared with healing category. We determined clinical criterias for success in meniscal status as; (1) no positive among 4 clinical objective parameters: joint line pain and tenderness, locking or catching, recurrent effusions, and positive McMurry test; and (2) complete healing of all-inside sutured meniscus during second-look arthroscopy. RESULTS: Of 39 knees assessed by second-look arthroscopy, 32 (82.1%) showed complete healing, 6 (15.4%) incomplete healing without any positive findings of clinical symptoms. Furthermore, all in the incompletely healed group showed complete healing of the posterior horn, which was sutured by allinside suture, whereas incomplete healing was observed at the junctional areas between all-inside and inside-out sutures, mainly at the posteromedial corner. So the overall success rate was 97.4% (38/39) for all-inside suture healing. The one (2.6%) patient with clinical failure revealed a retear of the repaired site, and subsequent subtotal menisectomy was performed. KT-2000 arthrometry showed that sagittal knee laxity was less than 2 mm (Average 1.5 mm, SD 0.72) in all reconstructed knees. The average knee scores, Lysholm knee score and HSS score, at final follow up were 95.5 and 96.5, respectively. As expected, small, longitudinal, and more peripheral (red-red zone) tears resulted in a higher healing outcome. CONCLUSION: Accurate repair with arthroscopic all-inside vertical suture using a suture hook, resulted in a high healing rate even in large and complex vertical tears. Arthroscopic all-inside meniscal suturing may be an optimal treatment for medial meniscus posterior horn tear greater than 1 cm during concurrent anterior cruciate ligament reconstruction.
Subject(s)
Animals , Humans , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament , Arthroscopy , Classification , Follow-Up Studies , Horns , Joints , Knee , Menisci, Tibial , Suture Techniques , SuturesABSTRACT
We reported a new technique to repair of the posterior horn tear near the root of the medial meniscus. The radial posterior horn tear near the root showed total loss of the circumferential hoop tension and was similar to the total meniscectomized state. Efforts should be made to restore the circumferential hoop ten-sion and maintain stable bony insertion. We introduced a pull-out repair technique using ACL guide, suture repair set and two PDS No.1. This technique showed stable fixation and good hoop tension of the meniscus. Pull-out repair into the posterior root seems to be a useful method in the posterior horn tear near the root of the medial meniscus.
Subject(s)
Animals , Horns , Menisci, Tibial , SuturesABSTRACT
PURPOSE: To evaluate the efficiency and clinical result of all-inside repair using 2 posteromedial portals for medial meniscus posterior horn tear. MATERIALS AND METHODS: We evaluated 63 knees with m 'al meniscus posterior horn tear, which were repaired by all-inside method using 2 posteromedial portals between March 1997 and March 1999. They were assessed by variable parameters such as pain, joint line tenderness, effusion and McMurray testing. Of these, 30 knees were assessed by the second-look arthroscopy or MRI and the results were graded as healed, incompletely healed or failed. The healing rates were calculated and the effect of tear location, type of tear, the number of sutures used, ACL reconstruction and the repair technique was analyzed. RESULTS: Overall, asymptomatic healing occurred in 96.9/o of knees. At second-look arthroscopy or MRI, the healing rate was 93.3% with 83.3% healed and 10.0% incompletely healed, The failure rate was 6.7%(2 cases). There was no complication at follow up. Th rate of healing increased when tears were longitudinal in the peripheral site, the numbers of suture were smaller, when the repair was combined with the ACL reconstruction and when all-inside technique was performed independently. CONCLUSION: All-inside method using 2 posteromedial portals has a high healing rate and is an improved technique due to its safety, ease than Morgan's method and rigid fixation with vertical suture.
Subject(s)
Animals , Arthralgia , Arthroscopy , Follow-Up Studies , Horns , Knee , Magnetic Resonance Imaging , Menisci, Tibial , SuturesABSTRACT
Visceral afferent nerve fibers containing substance P or calcitonin gene-related peptide (CGRP) are distributed in the bladder wall, and are known to be stimulated by and then desensitized by capsaicin. Recently, there have been some reports on the effectiveness of intravesical capsaicin administration for the treatment of hypersensitive lower urinary tract disorder or neurogenic bladder. In this study, the effects of intravesical capsaicin on the substance P or CGRP immunoreactivities in the spinal dorsal horn were investigated and the mechanism of capsaicin treatment for bladder disorders was revealed. After intravesical administration of capsaicin, the substance P and CGRP immunoreactive areas were measured at the dorsal horn of L4 and S1 spinal cord. Before capsaicin treatment, the substance P immuno- reactive area was 2.61+/-0.78 x 105 mm2 in L4 and 1.66+/-0.49 x 105 mm2 in S1. The substance P immunoreactivity was markedly reduced 1~2 weeks after capsaicin treatment in both L4 and S1 spinal cord. The CGRP immunoreactive area was 1.74+/-0.52 x 105 mm2 in L4 and 1.14+/-0.69 x 105 mm2 in S1, but was not reduced after capsaicin treatment. Therefore, capsaicin administered intravesically desensitizes nerve fibers containing substance P and consequently suppresses pain and voiding reflex.