Results of Microfracture in the Osteoarthritic Knee with Focal Full-Thickness Articular Cartilage Defects and Concomitant Medial Meniscal Tears

PURPOSE: To evaluate the efficacy of arthroscopic microfracture in patients with focal full-thickness cartilage defects in the osteoarthritic knee. MATERIALS AND METHODS: Seventy-six patients were enrolled in this study. They were divided into group I (n=38) who underwent microfracture plus meniscectomy and group II (n=38) who underwent only meniscectomy. Clinical and radiological evaluations were performed. RESULTS: At the time of the three-year follow-up, a total of five failures (6.6%) were reported: four patients in group I and one in group II. The two groups showed no significant difference in the Lysholm score, the Tegner activity score and the visual analog pain scale score at three years after surgery. However, at the time of the three-month follow-up, group II showed significantly more improvement in the Tegner activity and the visual analog pain score compared with group I. CONCLUSIONS: In the osteoarthritic knee, additional microfracture did not confer any additional benefit to meniscectomy.

Fixation of Olecranon Fractures Using Plating System

PURPOSE: To evaluate the clinical and radiological outcomes of plate fixation for olecranon fractures which was difficult to be fixed firmly with tension band wiring alone. MATERIALS AND METHODS: From 1995 through 2008, 20 patients who underwent plate fixation of an olecranon fracture were included in this retrospective study. According to the Mayo classification, there were 3 type IIA fracture, 7 type IIB, and 10 type IIIB fractures. Clinical evaluation was done based on radiographic union of olecranon and measurements of range of motion at last follow-up. Disability of the arm, shoulder and hand (DASH) score and Mayo Elbow Performance score was used for evaluation of functional recovery. RESULTS: Union was achieved in 18 (90%) at an average of 5.6 months. The mean arc of elbow motion was 123degrees and the mean rotation arc was 81degrees. According to the MEPS, sixteen of twenty patients had a good or excellent outcome. The mean DASH score was 16.3. Most common complication was hardware irritation in 3 patients. CONCLUSION: Plate fixation is an effective treatment option for severe olecranon fracture pattern like comminuted fractures, Monteggia equivalent with unstable elbows and nonunions.

Medial Meniscal Tears in Anterior Cruciate Ligament-Deficient Knees: Effects of Posterior Tibial Slope on Medial Meniscal Tear

PURPOSE: To evaluate the incidence of meniscal tears in patients with chronic anterior cruciate ligament (ACL)-deficient knees, and to determine the influence of posterior tibial slope (PTS) on medial meniscal tears in ACL-deficient knees. MATERIALS AND METHODS: We reviewed 174 patients (174 knees) with a mean age of 30.7 years who underwent ACL reconstruction for chronic ACL tears. We divided the patients into two groups: low group (135 knees with a PTS or =13degrees). RESULTS: The incidence of medial meniscus tears was 44% (77/174), and that of lateral meniscus tears was 35% (61/174). The mean PTS in patients with medial meniscal tears was 11.4degrees+/-3.0degrees, whereas that in patients without medial meniscal tears was 9.8degrees+/-2.4degrees. The incidence of meniscal tears was 57.8% (78/135) in the low group and 89.7% (35/39) in the high group (p or =13degrees is a risk factor for secondary medial meniscal tears in ACL-deficient knees. So, we suggest that PTS is one of the considerations for determining early ACL reconstruction to prevent secondary meniscal tears.

Ligament Reconstruction in Congenital Absence of the Anterior Cruciate Ligament: A Case Report

Congenital absence of the cruciate ligament is an extremely rare condition that was first reported in Giorgi's radiographic study in 1956. The authors report on a case of anterior cruciate ligament reconstruction performed on a 21-year-old female patient with congenital anterior cruciate ligament absence. We also discuss radiographic evidence that could provide clues to the congenital absence and possible difficulties that may be encountered during surgery with a review of the relevant literature.

Surgical Treatment of Pathologic Humeral Fracture

PURPOSE: To evaluate and analyze the radiographic and clinical outcomes after the surgical treatments of pathologic humeral fractures. MATERIALS AND METHODS: From October 1993 to September 2007, a retrospective investigation was conducted with a total of 13 patients who underwent operations for pathologic humeral fractures. The methods of surgical treatment were as follows-four cases of open reduction and internal fixation; eight cases of closed reduction and internal fixation with intramedullary nailing; and one of radical excision and hemiarthroplasty. RESULTS: Of nine patients with metastatic bone lesions, three were diagnosed with primary cancer after the incidence of pathologic humeral fracture. The mean period between the diagnosis of primary cancer and pathologic fracture in the latter six cases was 36.7 (2~144) months and the mean survival period after the surgical treatments was 22.8 (12~35) weeks in all patients with bone metastasis. Fracture unions were noted in all four cases of primary humeral bone lesion but none in metastatic cases. Pain relief and functional recovery were noted in eleven patients of this study. CONCLUSION: Satisfactory clinical outcomes with sustained pain relief and functional recovery were observed after the surgical treatments of pathologic humeral fracture. Benign bone lesions require more active and early treatments in order to facilitate the functional recovery of upper extremities and fracture union. With pathologic humeral fractures originated from metastasis, palliative treatments were preferred to fracture union method for planning long-term pain relief and functional recovery.

Symmetrical Peripheral Gangrene after Pulmonary Hemorrhage / 대한정형외과학회잡지

Symmetrical peripheral gangrene (SPG) is characterized by distal ischemic damage in two or more extremities without a large vessel obstruction. This syndrome is associated with low cardiac output, sepsis, malignancy, disseminated intravascular coagulation (DIC) and the administration of vasoactive drugs. We report a case of SPG in a patient with pulmonary hemorrhage, sepsis and DIC who had been administered dopamine.

Isolation of ethanol-induced genes in pancreatic beta-cells by representational difference analysis (RDA)

Recent epidemiological studies suggest that alcohol consumption is one of the risk factors leading to type 2 diabetes, but the direct effect of ethanol on beta-cell gene expression is not known. Here, using cDNA RDA method, we isolated 43 ethanol-induced genes in pancreatic beta-cells, and confirmed their differential expression by Northern blot or semi-quantitative RT-PCR. These genes were further categorized by the functional criteria based on the published data; Translation, Transcription, Metabolism, Signal transduction, Transport, Structure, Cytoskeleton, Regulation, or Putative/Unknown genes. The effects of each gene on beta-cell function need to be further investigated, however, the present data strongly suggest that these genes might be related to the metabolic alterations caused by ethanol as indicated in earlier study. In particular, RPS3 gene expression was increased by ethanol, glucosamine, and cytokines, implying that ethanol might decrease the metabolic activity by oxidative stress in beta-cells. Therefore, cloning of these genes in full-length and the detailed studies of each gene on beta-cell functions might provide clues on the pathophysiology of type 2 diabetes caused by alcohol.

The effects of various hormones and growth factors on the growth of human insulin-producing cell line in serum-free medium

An insulin-producing cell line, HE, was derived from immortalized human pancreatic p-cells transformed by SV40 DNA, To make serum free medium specific for the cells, it was necessary to select basal medium, hormones, growth factors and coating materials. First of all, human insulin-producing cell line was adapted serially to the culture medium containing minimum required (1%) fetal calf serum (HB-1) from 10% fetal calf serum, The cells had a tendency to attach to the culture dishes coated with collagen or gelatin in the serum-free medium and showed a stronger attachment to collagen than to gelatin, For the basal medium selection, medium containing an equal mixture of RPMI 1640, Dulbecco's modified Eagle's medium, and Ham's F-12 (RDF) was shown to be the most suitable for the cells among 7 differently mixed basal media, The cells exhibited highly positive response to 7 factors including insulin-transferrin-selenium (ITS)complex in the basal medium. In addition, other 16 factors also influenced the cell growth positively, In contrast, 4 factors including aldosterone inhibited the cell growth, Cell growth was enhanced remarkably when the cells were cultured in the serum-free medium supplemented with all the seven positive factors, compared with in RDF serum-free medium. ITS and linoleic acid-BSA were found to be essential for the cell growth. The growth was much higher in the medium containing 6 strong positive factors without either dexamethasone, glucagon, or thyrocalcitonin than in the medium containing all the 7 strong positive factors, It is suggested that the interaction between the individual positive factors must be considered in choosing the factors with which the serum-free medium is supplemented.