Lateral Closing Wedge Osteotomy of Tibia for Degenerative Arthritis / 대한정형외과학회잡지

Proximal tibial osteotomy is an effective, well-established treatment for unicompartmental arthritic knee with varus or valgus deformity. Four basic types are commonly described: lateral closing wedge osteotomy, medial open wedge osteotomy, dome osteotomy, and medial opening hemicallotasis. The objective of this procedure is to realign the weight-bearing axis through the knee by redistributing the forces of weight to the less involved compartment of the knee. With thorough preoperative planning and careful selection of patients, optimal outcome can be expected with preservation of the patient's joint. In this article, we reviewed selection of patients, surgical planning, surgical technique, complications, pre- and post-operative change in mechanics, and long term surgical outcome of closing wedge osteotomy. Optimal outcome is expected in patients with young age (younger than 60), stable knee, medially confined osteoarthritis, and good range of motion. According to the literature, average 10-year survival rate is expected to be 60% to 90%. Closing wedge osteotomy allows for rapid bone healing, early weight bearing, rehabilitation, and low rates of correction loss. Surgeons should keep in mind that optimal indication, preoperative planning, and use of safe operative technique are essential to achievement of best results.

Prevalence of Osteoporosis in Female Patients with Advanced Knee Osteoarthritis Undergoing Total Knee Arthroplasty

This study sought to demonstrate bone mineral density (BMD) conditions in elderly female patients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). In addition, we sought to determine whether their BMD conditions differ from those of community-based females without knee OA. Finally we sought to determine whether clinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 female patients undergoing TKA and 273 community-based females were evaluated. Additionally, comparative analyses of BMD between age and body mass index-matched knee OA groups (n=212) and the control groups (n=212) were performed. In the pre-matched knee OA group, regression analyses were performed to determine whether preoperative clinical statuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%) was found in the pre-matched knee OA patients undergoing TKA. We found no significant differences of the BMD T-scores and the prevalence of osteoporosis between the age and body mass index-matched knee OA and control groups. In the pre-matched knee OA patients, poorer preoperative clinical scores were related to poorer BMD T-scores in the proximal femur and/or lumbar spine. Our study suggests that more attention should be paid to identify and treat osteoporosis in elderly female patients with advanced knee OA undergoing TKA.

Outcomes of the Different Types of Total Knee Arthroplasty with the Identical Femoral Geometry

PURPOSE: There are controversies around the role of the posterior cruciate ligament and the effect of design modifications for high flexion in total knee arthroplasty (TKA). So, we compared the clinical outcomes of the cruciate retaining (CR), posterior stabilized (PS), and high flexion posterior stabilized (F-PS) designs in TKA with identical femoral geometry. MATERIALS AND METHODS: One hundred seventy nine knees with 3 different types of prostheses after a minimum 5-year follow-up were enrolled in this retrospective study: 45 with CR, 40 with PS and 94 with F-PS. The mean ages of these groups were 65.7, 67.2, and 67.5, and the mean durations of follow-up were 8.1, 8.0, and 6.8 years, respectively. We compared the range of motion, functional outcomes, and radiographic measurements at the 2-year follow-up and last follow-up. RESULTS: The maximal flexion angle was significantly lower in the CR group than the F-PS group at the 2-year follow-up. However, there was no significant difference at the last follow-up. Functional outcomes and survival rate of the three groups were similar at the last follow-up. CONCLUSIONS: Three different types of TKAs (CR, PS and F-PS) with identical femoral geometry showed similar mid-term outcomes with regard to the range of motion, functional outcomes and survival rate.

Rotational Alignment of the Femoral Components in Total Knee Arthroplasty: A Modified Gap Technique Using Manual Distraction

PURPOSE: This study was undertaken to introduce a modified gap technique using manual distraction for achieving proper rotational alignment of the femoral components in total knee arthroplasty (TKA) and we compared the accuracy of the rotational alignment of the femoral components in TKAs when using a navigation system with that of another conventional technique. MATERIALS AND METHODS: We randomly used three different methods and implants (group 1: 3degrees external rotation from the posterior condylar axis method, group 2: a modified gap technique using manual distraction and group 3: a navigation system, Orthopilot(R)) in 92 patients. We measured the posterior condylar angles (PCA: the angle between the posterior condylar line and the transepicondylar axis) on computed tomography before and after surgery. RESULTS: The analysis showed no significant differences of the demographic data (age, height, weight, body mass index) and of the mean PCAs for the rotational alignment of the femoral components between the three groups (preoperative PCA: 5.45degrees vs. 5.34degrees vs. 5.24degrees, respectively; postoperative PCA: 1.91degrees vs. 1.17degrees vs. 1.37degrees, respectively, p>0.05). However, the conventional 3degrees external rotation method showed a higher frequency of outliers (p=0.028). CONCLUSION: The modified gap technique using manual distraction showed a higher accuracy of the femoral rotational alignment compared with that of the 3degrees external rotation method by reducing the outliers, and the modified gap technique using manual distraction showed similar results compared with those of the navigation method.

Anatomical Assessment of the Distal Femur and Tibia for Optimal Femoral Rotational Alignment in Total Knee Arthroplasty

PURPOSE: This study aimed 1) to identify the rotational axis of the femur that provides a balanced 90degrees flexion space in TKA, 2) to assess the changes in the flexion space in deep flexion, and 3) to assess the changes in rotational alignment, with using the posterior condylar axis (PCA) as a guide, and as the changes are related to asymmetric cartilage erosion of the posterior condyle. MATERIALS AND METHODS: The axial MR images of the distal femur in knee extension and the coronal images of the distal femur and the entire tibia at 90 and 130degrees were examined in 40 healthy adults. RESULTS: The clinical transepicondylar axis (TEA) provides a balanced 90degrees flexion space on average. The balanced flexion space in 90degrees became an asymmetrical space with relative narrowing of the medial side in 130degrees. Every 1 mm of asymmetrical cartilage erosion between the posterior condyles changed the femoral rotation by approximately 1degrees when using the PCA as a guide. CONCLUSION: This study suggests that the clinical TEA is the rotational reference that provides a balanced flexion space. When using the PCA as a rotational reference, a surgeon should consider the potential change in the rotational angle that is caused by asymmetrical cartilage erosion.

Prevalence of Radiographic Knee Osteoarthritis in Elderly Koreans

PURPOSE: This study was conducted to investigate the epidemiologic characteristics of knee osteoarthritis (OA) in elderly Koreans with respect to its detailed prevalence and association with demographic factors such as gender, age and body mass index (BMI). MATERIALS AND METHODS: Six hundred and ninety six subjects (men 298 and women 398) aged 65 years or older were recruited from an urban population. Radiographic evaluations were conducted using three plain radiographs (weight bearing anteroposterior view, 45 degree of flexion posteroanterior view, and the Merchant view). Radiographic severity was determined using the Kellgren-Lawrence (K/L) grading scale and radiographic OA was defined as K/L grade 2 or higher. Overall prevalence of OA was analyzed with regard to gender, age and BMI using multivariate logistic regression. RESULTS: The overall prevalence of knee OA in the study cohort was 38.1%. Women had the much higher prevalence of knee OA than men (53.8% vs. 17.1%). Female gender, obesity and ageing were associated with the risk of knee OA, but a female gender was found to be the strongest predictor for knee OA. CONCLUSION: This study documents that knee OA is highly prevalent among Korean elderly, and that elderly Korean women are at much greater risk of development of knee OA. It is hoped that our findings provide information that aids the creation of national health policies that better target the prevention and treatment of knee OA.

Patient Perspectives on Currently Controversial Issues in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To examined the level of patient knowledge and their perspectives about the controversial issues in total knee arthroplasty (TKA), and to evaluate the effect of a relevant explanation about the issues on the patient preferences for their particular option. MATERIALS AND METHODS: One hundred patients who visited our clinic and decided to undergo TKA were asked to complete a questionnaire asking about their knowledge and preference for 4 controversial issues: 1) surgical timing of the bilateral TKAs, 2) use of computer assisted surgery, 3) use of minimal invasive surgery, and 4) use of ceramic femoral component. The patients completed the same questionnaire after the advantages and disadvantages of each option had been explained using an explanatory document designed based upon what was documented in the literature. RESULTS: The patients were not well-informed about the issues and received their information through a non-professional source. The patients tended to prefer new options with claimed promises before an explanation. The patients preferred the options with safety, accuracy, and proven evidence after an explanation. Male patients tended to prefer simultaneous TKAs more than female patients. Younger patients preferred ceramic femoral component claimed to have better longevity more than older patients did. CONCLUSION: This study demonstrates that patients' knowledge of the current controversial issues is very limited, and that patient preferences would be significantly changed if they were given an explanation from a physician. Balanced information should be given to patients in order for them to reach a fair decision.

Rigid Stepped Plate (RSP) for the Internal Fixation of the High Tibial Osteotomy / 대한정형외과연구학회지

PURPOSE: To compare the fixation power of the newly devised RSP (rigid stepped plate) with the L-plate by mechanical study and to prove the efficacy of the RSP. MATERIALS AND METHODS: Lateral closing wedge proximal tibial osteotomy was performed on the 10-monthsold porcine tibiae, which were fixed by 15 L-plates and 15 RSP's. Each group of 5 pairs of the specimen were applied to the Instron apparatus and loaded by compression, valgus, and varus bending. The fixation power was compared by the stiffness of each construct. RESULTS: Specimen fixed by the RSP's showed larger stiffness than those fixed by the L-plate. Even though the difference was not statistically significant in compression (p=0.465), it was statistically significant in valgus (p=0.047) and varus (p=0.009) bending. CONCLUSION: The RSP can be applied with minimal skin incision, will provide firm initial fixation to the osteotomy site, and seems to enable early range of motion exercise. It will improve the outcome of proximal tibial osteotomy by preventing excessive soft tissue dissection and complications resulting from long-term immobilization of the knee joint.

Evaluation of Chondrogenesis in Collagen/Chitosan/Glycosaminoglycan Scaffolds for Cartilage Tissue Engineering / 대한정형외과연구학회지

PURPOSE: The scaffold is essential for cartilage tissue engineering. Collagen, chitosan, or glycosaminoglycan( GAG) has separately been proposed as in vitro scaffolds. However, the influence of collagen:chitosanchondroitin sulfate(Col:Chi-CS) composites on cell behavior has not yet been thoroughly examined. Therefore, the aim of this study is to develop a novel Col:Chi-CS blended scaffold that binds covalently with CS for cartilage tissue engineering. MATERIALS AND METHODS: The behavior of rabbit chondrocytes seeded in vitro into collagen/chitosan/GAG scaffolds with different chitosan contents (collagen:chitosan ratios of 20:1, 5:1, and 1.25:1) was investigated. The porous scaffolds containing collagen and chitosan were fabricated by using a freeze drying technique and crosslinked using 1-ethyl-3-(3-dimethyl aminopropyl)carbodiimide(EDC) in the presence of CS. The physicochemical/ mechanical properties of scaffolds were determined by analyzing scanning electron microscopy, compression modulus, immobilized GAG content, and water-binding capacity. Rabbit chondrocytes seeded onto these scaffolds were cultured for 1, 3, 7, and 14 days. The cell proliferation rate was evaluated with 3H-thymidine uptake and total GAG content assay was done via DMB assay using ELISA method. For the histological assessment of extracellular matrix, staining with safranin-O/fast green and immunohistochemistry were used. RESULTS: Scanning electron microscope(SEM) views of the scaffolds showed that all three had interconnected pores of mean diameter 164, 353, and 567 micrometer at collagen:chitosan ratios of 20:1, 5:1, and 1.25:1. GAG was covalently bound onto these scaffolds at 6.4%(w/w) in all three cases, i.e., regardless of chitosan content. However, increased chitosan content resulted in enhanced mechanical properties and increased pore size. Biochemical analysis of these scaffolds showed that proliferation rate and GAG synthesis increased with time, and this became most significant in the collagen:chitosan(20:1)-CS scaffold on day 14. The histology of the cell-seeded constructs showed a significantly higher percentage of cells with spherical morphology, which is specific to mature chondrocyte, especially in the collagen:chitosan(20:1)-CS scaffold at each time point. This finding was consistent with the observation that the pericellular matrix was stained positive for proteoglycans and type II collagen on day 14. CONCLUSION: The novel collagen:chitosan(20:1)-CS scaffold seems to be a useful carrier material for cartilage tissue engineering.

Anatomical Assessment of Distal Femur for Optimal Femoral Component Rotational Alignment in TKA / 대한정형외과학회잡지

PURPOSE: We evaluated the relationship among the various rotational reference axes of femoral component in TKA, and the potential change in rotational alignment when a posterior condylar axis (PCA) was used as a reference for different cartilage erosions between the medial and lateral posterior femoral condyles. MATERIALS AND METHODS: The study subjects included twenty male and twenty female volunteers. Axial MR image of the distal femur were used to measure the angles among the clinical transepicondylar axis (cTEA), surgical transepicondylar axis (sTEA), the PCA, and the AP axis. We then evaluated the difference in the amount of rotation between a normal and osteoarthritic model when the PCA was used as a rotational reference. RESULTS: The mean angle between cTEA and PCA was 5.4 degrees, and it was significantly greater in the female (6.5 degrees) than in the male group (4.3 degrees). The cTEA demonstrated a perpendicular relationship with the AP axis in both groups. The average angles between cTEA and sTEA were 3.2 degrees in the male group and 3.8 degrees in the female group. When we assumed complete erosion of the cartilage on the medial posterior condyle with preservation on the lateral side, the angles between the cTEA and PCA decreased by an average of 1.9 degrees in both groups. CONCLUSION: This study suggests that the two transepicondylar axes, which demonstrated greater than 3 degrees in angle-difference, should be defined clearly in scientific reports and in their application as rotational references in TKA. Some significant gender differences in the rotational profile were noted. When the PCA is used as a rotational reference, potential errors caused by the different amounts of cartilage erosion between the medial and lateral posterior condyles should be considered.

Short Term Clinical Results of Anatomical Reconstruction in the Posterolateral Corner of the Knee using Achilles Tendon Allograft / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the short term clinical results of the new anatomical reconstruction including 3 major posterolateral structures of the knee using a split Achilles allograft. MATERIALS AND METHODS: Eleven knees with posterolateral rotary instability underwent new anatomical posterolateral reconstruction between January 2002 and June 2003. The clinical results were assessed using the Lysholm score and Tegner activity level scales and physical examinations including posterolateral drawer test, dial tests at 30 and 90 degrees of knee flexion, varus stress tests at 0 and 30 degrees of knee flexion. RESULTS: Follow-up averaged 26 months (range, 12 to 29 months). The mean preoperative Lysholm score was 38.6 and at the time of latest follow-up, the mean score was improved to 72.5. The mean preoperative Tegner activity level was improved from 1.6 points to 3.3. Ten out of 11 patients showed negative conversion of the posterolateral drawer test and varus stress test at 30 degrees of flexion postoperatively. All patients, who showed positive signs on the external rotation-dial test at 30 degrees of knee flexion preoperatively, improved postoperatively. In eight patients, preoperative positive signs of varus stress tests at 0 degrees of knee flexion and the external rotation-dial test at 90 degrees of knee flexion disappeared postoperatively. CONCLUSION: This study suggests that the new anatomical reconstruction of posterolateral corner of knee is a reliable method providing excellent stability and satisfactory short term clinical results.

Effects of Tissue Transglutaminase on Human Chondrocytes Adhesion to Degenerated Articular Cartilage / 대한정형외과연구학회지

PURPOSE: The purpose of this study was to evaluate the effect of tissue transglutaminase(tTG) on chondrocyte adhesion to degenerated cartilage in vitro. MATERIALS AND METHODS: Human cartilage explant and chondrocytes were harvested from patients who underwent knee replacement arthroplasties for osteoarthritis. The articular cartilage surface was cut into a disc. Immunohistochemical methods was performed to detect the presence of fibronectin in articular surface. Human chondrocytes were transferred onto degenerated cartilage discs. To evaluate the effect of tTG involvement, tTG was added to the cell suspension or coated onto degenerated cartilage surface. The surface-attached cells were quantitated using the MTS assay. RESULTS: Fibronectin(FN) increased the surface of degenerated cartilage than normal cartilage. The addition of 100 and 1000 mug/ml of tTG to the cell suspension enhanced the cell adhesion to degenerated cartilages. On occasion of the involvement of 40 mug/ml of tTG, the surface coated with tTG showed an increase in the adhesion of cell as compared to the addition of tTG to the cell suspensions. CONCLUSION: The involvement of tTG to FN-exposed degenerated cartilage enhanced the chondrocyte adhesion. These findings may be applied to developing a novel tool of intraarticular injection using chondrocytes for osteoarthritis treatment.

Osteoid Osteoma and Osteoblastoma of the Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze the clinical and radiological findings, and the results of the surgical treatment of osteoid osteomas and osteoblastomas of the spine. SUMMARY OF LITERATURE REVIEW: With the development of new imaging techniques, earlier diagnoses have been reported. However, a few reports of unexpected misdiagnosis, and postoperative results, have also been published. MATERIALS AND METHODS: Between January 1980 and September 2002, twelve patients were diagnosed with an osteoid osteoma or osteoblastoma of the spine, and were surgically treated. The average preoperative symptom-duration and follow-up period were 20 and 33 months, with ranges from 6weeks to 96 months, and 4 to 120 months, respectively. All the patients were younger than 30 years old, with the majority being of growing age, and underwent at least a bone scan, CT or MRI, as part of the diagnostic procedures. RESULTS: The most common symptom was pain at the lesion, with 2 torticollis and 4 scoliosis observed as combined spine deformities, respectively. Neurological abnormalities were seen more often in the osteoblastomas (80%) than in the osteoid osteomas (43%). From the radiological findings, a CT scan was a more effective procedure than any of the other diagnostic modalities in differentiating an osteosclerotic bony lesion and a nidus. In three out of the five MRI, 2 cases were misdiagnosed as infections and the other as a malignant tumor, with no significant abnormal findings in the simple roentgenogram. A wide excision was performed in all patients, and a fusion, with a bone graft, was also performed in 8. There were no postoperative spinal instabilities or complications. CONCLUSION: In a differential diagnosis, careful history taking for pain, and a physical examination for spine deformity, are required. Without any clinical information, these tumors can be misdiagnosed as malignant tumors, or other infectious diseases, in a MRI. With regard to the surgical treatment, there were no cases of recurrence reported due to the wide excision, but a fusion, both with or without instrumentation, can be considered to prevent postoperative spine instability.

Diagnostic Criteria to Differentiate Medial Meniscal Injury from Degenerative Changes on 99mTc-MDP Knee SPECT in Patients with Chronic Knee Pain / 대한핵의학회잡지

PURPOSE: In patients with chronic knee pain, the diagnostic performance of 99mTc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake is increased in medial compartment. MATERIALS AND METHODS: A total of 49 knee SPECT of the patients with chronic (more than 3 months) knee pain, which showed increased 99mTc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion I, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion II, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid, posterior, and diffuse patterns were diagnosed as MMI. In Criterion III, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. RESULTS: The sensitivity and specificity were 93% and 14% in Criterion I, 89% and 38% in Criterion II, and 75% and 67% in Criterion III, respectively. Criterion III had significantly improved diagnostic performance, especially, specificity. CONCLUSION: In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain.

Long Term Follow-up Results of Total Knee Arthroplasty

PURPOSE: We purpose to analyse the clinical and radiologic results of total knee arthroplasty and long term survival rate and to assess the cause of failure. MATERIALS AND METHODS: We retrospectively investigated 156 TKAs(110 patients) from January 1985 to March 1992 followed up for more than 10 year. These series of 110 patients included 20 men and 90 women, the mean follow-up period was 12 years 3 months(range 10~18 years). In primary diagnosis, there were Degenerative Arthritis (DA) 105 knees, Rheumatoid Arthritis(RA) 45 knees, others 6 knees. Of 156 knees, there were 139 Cruciate-Retaining type(CR), and 17 Posterior-Stabilized type(PS). Both femoral and tibial component were fixed with cement in 71 knees, 15 knees were fixed without cement, and only one component was fixed with cement in 70 knees(Hybrid). Press Fit Condylar(PFC) prosthesis were 133, Miller Galante(MG) were 16, and others 7. 16 cases of patella were preserved and 140 knees were resurfaced. The clinical outcome was evaluated according to the HSS and American Knee Society scoring system and radiologic analysis was made by tibiofemoral angle and radiolucent line by American Knee Sociey system. Results: The HSS score was improved from 51.7 to 86.4 and ROM was improved from 101.3 degrees to 111.7 degrees. The last ROM was improved in DA group than RA, and HSS score of PFC prosthesis was higher than Miller-Galante. The failure were seven(5.3%) in PFC, but seven(43.8%) in MG. The survival rate was 93.0% after 10 years, and 88.8% after 14 years when the endpoint was defined as revision arthroplasty. The arthroplasty fails due to wear, aseptic loosening and deep infection and patellofemoral complication. CONCLUSION: The total knee arthroplasty is a safe, durable, and predictable procedure and has a long survivorship if we select the proper prosthesis.

The Effects of Transglutaminase on Perichondrocyte in Alginate Culture / 대한정형외과연구학회지

PURPOSE: To investigate the effects of transglutaminase in the environment of extracellular matrix on perichondrocyte in alginate culture. MATERIALS AND METHODS: Perichondrocyte cells were isolated from articular cartilage of New Zealand white rabbits by enzymatic digestion and maintained in monolayer culture. After 7 days, the cells were trypsinized and cultured in an alginate bead system. Four groups of the alginate beads were prepared as follow: containing 1 mg/ml of transglutaminase, 10 microgram/ml of fibronectin, mixture of 1mg/ml of TGase and 10 microgram/ml of fibronectin and only perichondrocytes as a control group. Cell proliferation was measure by [Methyl-3H] Thymidine uptake, and proteoglycan synthesis was measure by [35S] Sulfate uptake. The gene expression of integrin-alpha5, integrin-beta1 and type II collagen was analyzed by reverse transcription-polymerase chain reaction. Safranin-O staining was utilized for histological assessment of proteoglycan in extracellular matrix. One-way ANOVA was used to analyze the results statistically. RESULTS: Mixture of transglutaminase and fibronectin exhibited high synthesis rates of proteoglycan and active cell proliferation compared with other groups. The gene expression of type II collagen did not show significant difference between groups. The gene expression of integrin-alpha5 was down-regulated in all groups with time. The gene expression of integrin-beta1 was not down-regulated with time only in mixture of transglutaminase and fibronectin. Histological staining of the secretions by Safranin-O staining was in agreement with the data of proteoglycan synthesis, and Safranin-O staining showed that more cell-to-cell aggregates is developed in the mixture of transglutaminase and fibronectin. CONCLUSION: Mixture of transglutaminase and fibronectin can stimulate chondrocyte proliferation and proteoglycan synthesis, and integrin seems to modulate such interactions.

Treatment of Osteochondral Defects with Perichondrial Cells Embedded in Alginate Beads in Rabbit / 대한정형외과연구학회지

PURPOSE: The objective of this study was to investigate the use of cultured rib perichondrial cells embedded in alginate bead on healing in a rabbit osteochondral defect model. The degree of articular cartilage repair was evaluated histologically, histomorphometrically, and biochemical characteristics of the neocartilage. MATERIALS AND METHODS: A single defect, 3.5 mm wide by 3 mm deep, was created in the weight bearing area of the medial femoral chondyle in thirty New Zealand rabbits. The right defect filled with two alginate beads embedded with rabbit rib perichondrial cells, the left defect was empty as the control. The animals were killed at 1, 3, and 12 months, and the repair tissues were examined histologically, and histomorphometric differences were evaluated by an image analysis system. The defects also were examined biochemically for the glycosaminoglycan (GAG) and type II collagen to compare the results with normal articular cartilage. RESULTS: The attachment of repair tissue with the surrounding host tissue was incomplete, many specimens exhibited degenerative changes in adjacent tissue over a post transplant time period. Histomorphometric results showed that the repair groups (0.24+/-0.11 mm, -26.97 (25.62 mm) was decreased in surface roughness, and depression than controls (0.32+/-0.06 mm, -48.73 (32.59 mm) at 12 months. Repair area, repair area ratio, and repair thickness of the repair groups (6.89+/-2.1 mm2, 39.5+/-19.5%, 0.11 (0.01 mm) were increased than controls (2.65+/-2.35 mm2, 2.85+/-2%, 0.09+/-0.04 mm) at 12 months. After 12 months, the content of GAGs of neocartilage (36.45 microgram/mg) was similar to those of normal artilcular cartilage (36.74 microgram/mg), the percentage of type II collagen of the neocartilage increased up to 95%. CONCLUSION: Transplanted rib perichondrial cells were seen to proliferate to fill the osteochodral defect with neocartilage. Histomorphometric analysis should allow a more quantitative described the degree of articular cartilage repair.

Hypertrophy of the Patellar Tendon induced by Local Injection of TGF-beta1 in Mature Rats / 대한정형외과연구학회지

PURPOSE: The effects of local injection of TGF-beta1 on the normal patellar tendon and the characteristics of remaining tendon after the partial resection of hypertrophic one were investigated. MATERIALS AND METHODS: TGF-beta1 was injected into the right patellar tendon of mature rats weekly for 3 weeks. Histological study, biomechanical analysis and the transmission electron microscopic evaluation were done. Half of hypertrophic tendon was resected at 4 weeks after the last injection and the same analyses were RESULTS: TGF-beta1 treated tendon increased in cross sectional area but decreased significantly in maximum tensile stress. The hypertrophic tissue was mainly composed of small collagen fibrils. After the partial resection of hypertrophic tendon, there was no significant difference in maximum tensile stress between remaining and control tendons. There were relatively larger collagen fibrils in the remaining tendon tissue than in non-resected hypertrophic one. CONCLUSION: Local injection of TGF-beta1 induced the hypertrophy of normal tendon. After the partial resection of hypertrophic tendon, the remaining one showed the more similar biomechanical properties to normal one.

The Management of Bone Defects in Revision Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Bone defects in revision TKA were classified according to AORI (Anderson Orthopedic Research Institute) system and results of the treatment are reported according to this classification. MATERIALS AND METHODS: The results of 24 revision TKAs operated from Mar. 1991 to Apr. 1999 were analysed. Fourteen knees had type 1 tibial defects, four knees had type 2 and six knees had type 3. On the femoral side, twelve knees had type 1, four knees had type 2 and seven knees had type 3 defects. Cement and chip bone grafts were mainly used to fill bone defects in type 1, wedges or blocks in type 2 and structural allograft combined with the other methods in type 3. Results were evaluated using the knee and functional scores of the American knee society. RESULTS: The analysis of the results according to the method of treatment- cement filling, chip bone graft, structural bone graft, wedge or blocks and custom made prosthesis- revealed improvements of knee scores in all groups except for custom made prosthesis. CONCLUSION: Satisfactory clinical results were obtained for the management of bone defects according to the AORI classification system in revision total knee arthroplasty.

Tibial Tunnel Changes after Arthroscopic ACL Reconstruction using Autogenous Bone-Patellar Tendon-Bone

PURPOSE: We analysed radiographic changes of bone tunnels after anterior cruciate ligament(ACL) reconstruction and evaluated the correlation between measurements and clinical variable. MATERIALS AND METHODS: Fifty patients were examined retrospectively. The interval between surgery and examination ranged from 12 to 48 months with a mean of 18 months. We measured the area and width of tibial tunnel from the radiographs of anteroposterior(AP) and lateral views of the knee after arthroscopic ACL reconstruction using computer program "Image-Pro ExpressRfi". The proximal, middle, distal one third of tibial tunnel area and maximum diameter of tibial tunnel were measured on AP and lateral radiographs. Each measurements were done on immediate postoperative, and postoperative 3, 6, 9, 12, 24, 36 months. RESULTS: The size of tibial tunnel was larger on lateral than AP radiograph. The proximal part was found to be the largest and the size decreased as it moved distally. The area of proximal one third was increased from postoperative 3 months and that of distal one third was decreased from postoperative 3 months. The shape of tibial tunnel area on the last follow-up was cylinder type in 33(66%) and 17(34%) on AP and lateral radiograph, mallet type 8(16%) and 4(8%), reverse bottle type 5(10%) and 11(22%), reverse triangle type 4(8%) and 18(36%) respectively. CONCLUSIONS: The tibial tunnel change was not correlated with clinical variable such as Lysholm score.