Results of Surgical Treatment in Combined PCL and PL Instability of the Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the functional results, activity status after surgical treatment in combined PCL and PL instability of the knee. MATERIALS AND METHODS: Fifteen patients with combined PCL and PL injury were diagnosed and treated. PCL injury was treated by using tibial inlay method with arthroscopy and PL injury was treated by using repair (acute 4 cases) and reconstruction (chronic 11 cases, Warren method) and followed more than 2 years with average follow-up period of 27.3 months (24-38). Mean age was 39 years (17-67) at operation. Radiologic evaluation was done by simple X-ray, stress view and MRI. Functional evaluation of Lysholm score and Tegner activity score was used. RESULTS: Average Lysholm and Tegner activity score was 43 and 1.5 preoperatively and was improved to 85 and 4.0 postoperatively. Varus laxity was improved from 9.3 mm to 4.0 mm and posterior translation was improved from 18.4 mm to 5.6 mm in stress view. The PCL and PL instability of the knee were improved in all cases. Postoperative improvement of functional and activity score were determined by absence of combined injury not by age or delayed time for operation. Complications were limitation of motion (3 cases), lateral instability (4 cases), osteoarthritic change (4 cases) and quadriceps atrophy (15 cases, severe 4 cases). CONCLUSION: PCL reconstruction using tibial inlay method and PL reconstruction using warren method (chronic cases) and repair (acute cases) improved function, activity and stability in PCL and posterolateral instability.

Osteoinduction Using Recombinant Bone Morphogenetic Protein-7 Gene / 대한정형외과학회잡지

PURPOSE: The aim of this study was to develop recombinant human Bone Morphogenetic Protein-7 (BMP7)-stable cells and recombinant human BMP7 adenoviruses (AdBMP7) for osteoinduction and osteoregeneration in musculoskeletal diseases. MATERIALS AND METHODS: The human BMP7 cDNA was amplified from a human osteosarcoma cell line, U2OS using a reverse transcription-polymerase chain reaction and cloned into a eukaryotic expression vector. The BMP7-stable HEK293 cells (HEK293/BMP7) were prepared by transfecting the recombinant BMP7 plasmid vector. The recombinant human BMP7 adenovirus (AdBMP7) was constructed using the AdEasy vector system. The BMP7 expression levels in HEK293/BMP7 and AdBMP7 were measured by activity staining for alkaline phosphatase in mouse C2C12 promyoblast cells. The BMP7-stable HEK293 cells, AdBMP7 itself, or AdBMP7-transduced human fibroblasts were injected into the subcutaneous tissues and the calf muscles of immunocompromised mice. The amount of ectopic bone formation was evaluated by radiographic and histological analyses. RESULTS: Ectopic bone formation was observed after injecting the BMP7-stable HEK293 cells with either the AdBMP7 itself or AdBMP7-transduced human fibroblasts into the subcutaneous tissues and calf muscles of immunocompromised mice. CONCLUSION: These results showed that HEK293/BMP7 cells and AdBMP7 have a significant potential for bone formation and the regeneration of various bone diseases.

Total Knee Arthroplasty / 영남의대학술지

Total knee arthroplasty has become a common procedure for treatment of severe osteoarthritis, rheumatoid arthritis and post-traumatic arthritis. In the past, failure of total knee arthroplasty was commonly attributable to aseptic loosening, often associated with component malalignment, soft tissue imbalance. With improved surgical instrumentation and soft tissue balancing techiniques, failure secondary to mechanical loosening has been minimal. But surgeons are still dissatisfied with implant malalignment. Correct tibiofemoral alignment seems to be particularly important since it is generally agreed that axial deviation and imprecise implantation may lead to loosening of the implant component. Navigation systems and robotic techniques could potentially solve problems of imprecision in traditional total knee arthroplasty. It is expected that the success rate and longevity of total knee arthroplasty will be improved during the twenty first century.

Effect of the Hyaluronic Acid on Osteoarthritis of the Knee

PURPOSE: The Purpose was to evaulate the efficacy of sodium hyaluronate (HA) according to the degree of osteoarthritis, body mass index and tibiofemoral alignment. MATERIALS AND METHODS: 53 of 73 patients who had osteoarthritis of the knee were underwent intraarticular injection weekly for 5 weeks with hyaluronic acid (HA, hyruan(R), MW:1MDa) and 20 of 73 patients with placebo (normal saline). The patients were followed for 27 weeks. Results were evaluated with visual analogue scale for pain, Lequesne algofunctional index for functional severity and Tegner activity score for activity. The degree of severity of osteoarthrtis of knee was stratified by Kellgren classification. RESULTS: In the group treated with HA, the patients classified as Kellgren classification II and III showed much better improvement in efficacy for pain, function and activity compared with group IV. In the femorotibial alignment, neutral and valgus alignment group showed better results than varus group. There is no statistical significance in the knee pain and function between normal and overweight group. Best symptomatic improvement according to the subjective symptom revealed at 3 week in 25 patients (47.2%). Placebo treated patients had slight pain and improved functional perfomance but less effect in compared with HA treated patients. CONCLUSION: Intraarticular administration of HA relieve the symptom of osteoarthritis and improve the function of knee joint. Especially, the patients classified with Kellgren classification II, III and valgus, neutral tibiofemoral alignmen groups showed much better improvement than grade IV and varus group.