Long-term Results of Partial Release Versus Nonrelease of the Posterior Cruciate Ligament at Cruciate-Retaining Total Knee Arthroplasty: Minimum 15-Year Follow-up.

The goal of this study was to compare the clinical and radiologic results of posterior cruciate ligament (PCL) partial release and PCL nonrelease in performing cruciate-retaining total knee arthroplasty (CR-TKA) for a long-term follow-up period of greater than 15 years. A total of 224 patients underwent CR-TKA in our hospital from June 1996 to April 2002 with greater than 15 years of follow-up. We divided the subjects into 2 groups based on release of the PCL. Group 1 was the PCL partial release group (88 cases), and group 2 was the PCL nonrelease group (136 cases). The mean follow-up period was 16.8 years (range, 15.5-19.5 years). We compared the clinical results by measuring the Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score preoperatively and at the last follow-up. For radiologic results, the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System was used and stress radiographs were obtained at the last follow-up to evaluate PCL function. There was no statistically meaningful difference in radiologic and clinical results between the 2 groups. Radiolucent lines were found for 13 patients radiologically (6 in group 1 and 7 in group 2). No instability as a result of PCL insufficiency required revision surgery on stress radiography at the last follow-up. If an appropriate procedure is performed according to PCL function intraoperatively, CR-TKA can produce a satisfactory result on long-term follow-up. [Orthopedics. 2022;45(4):233-238.].

Reconstruction With Achilles Tendon Allograft Using the Keyhole Technique for Chronic Triceps Insufficiency After Total Elbow Arthroplasty.

Total elbow arthroplasty (TEA) is associated with a relatively high incidence of chronic triceps insufficiency, but there is difficulty in treatment. This case series describes reconstruction with Achilles allografts using the keyhole technique in patients with postoperative chronic triceps insufficiency. Fourteen patients who underwent reconstruction for triceps insufficiency after TEA were included in the study. During this procedure, a keyhole-shaped osteotomy was performed on the proximal olecranon, and a fragment of the calcaneal allograft was shaped into a bone plug to fit the olecranon. The clinical outcomes were assessed in all patients 12 months after reconstruction and at last follow-up (range, 13-54 months). After 12 months, patients had a mean Mayo Elbow Performance Score of 84.3 (range, 75-100), and all achieved a marked improvement compared with before reconstruction (mean, 42.7; range, 20-75). Seven, 4, and 3 patients achieved excellent, good, and fair outcomes, respectively. The mean extension peak torque of the operated-on arm was 34.91 Nm (range, 16.3-63.9 Nm), and the percentage of extension peak torque of the operated-on arm to the opposite arm was from 14.5% preoperative to 76.2% 12 months postoperative. This case series suggests that triceps reconstruction with an Achilles tendon using the keyhole technique is a useful treatment option for triceps insufficiency after TEA. [Orthopedics. 2021;44(4):e498-e502.].

Outcomes of Wedge Wing in the Lag Screw for Unstable Intertrochanteric Fractures in Elderly Patients.

PURPOSE: To evaluate clinical-functional and radiologic outcomes of elderly patients with an unstable intertrochanteric femur fracture treated with a wedge wing in the lag screw. MATERIALS AND METHODS: Forty-eight patients treated with the Dyna Locking Trochanteric nail (DLT nail) to resolve an unstable intertrochanteric femur fracture were reviewed retrospectively. Based on AO/OTA classification, Fracture 31-A2 (34 cases) and 31-A3 (14 cases) were included in the analysis. We measured the femoral neck-shaft angle, tip-apex distance (TAD), Cleveland index, sliding distance of the lag screw, and time to the fracture union. The Harris Hip Score and Paker and Palmer's mobility score for clinical evaluation were used. RESULTS: The mean follow-up period was 21.4 months (range, 12-34 months). The postoperative state of reduction was good in 28 cases and acceptable in 20 cases. The mean TAD was 20.5 mm. The position of the lag screw was center-center in 30 cases and center-inferior in 18 cases. The mean sliding distance of the lag screw was 3.4 mm at the last follow-up. The mean union time was 4.5 months. Two cases had complications which included a cut-out (1 case) and non-union (1 case). The mean Harris Hip Score was 86.5±8.3 (range, 76-90). Walking ability in 34 of the cases (70.8%) at last follow-up was similar to that prior to fracture. CONCLUSION: Functional and radiological outcomes are satisfactory using the DLT nail in the treatment of elderly patients with unstable intertrochanteric fractures; however, wedge wing in the lag screw does not prevent implant-related complications.

Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study.

BACKGROUND: Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction and internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older. METHODS: Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit. RESULTS: The ORIF and TEA groups showed a mean arc of flexion-extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups. CONCLUSIONS: In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.

Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study

Background@#Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older. @*Methods@#Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit. @*Results@#The ORIF and TEA groups showed a mean arc of flexion–extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups. @*Conclusions@#In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.

Clinical and radiological results of cruciate-retaining total knee arthroplasty with the NexGen®-CR system: comparison of patellar resurfacing versus retention with more than 14 years of follow-up.

BACKGROUND: The purpose of this study is to analyze clinical and radiological outcomes of patients (with a minimum of 14 years of follow-up) who underwent cruciate-retaining (CR) total knee arthroplasty (TKA) using a NexGen®-CR, comparing a patellar resurfacing group with a patellar retention group. METHODS: From June 1996 to April 2002, 116 cases of TKA using a NexGen®-CR who had at least 14 years of follow-up were enrolled in this study. Among them, 68 cases had patellar resurfacing and 48 had patellar retention. The average follow-up period was 14.8 years (14.1-18.7). Clinical scores and range of motion (ROM) were evaluated preoperatively and at the last follow-up in all patients. The Hospital for Special Surgery (HSS) score, Knee Society Score (KSS), Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) score, and a new patellar score were assessed. Radiological evaluations are done by analyzing the tibiofemoral angle, loosening, and a radiolucent line on the radiograph by American Knee Society Roentgen Graphic Evaluation. RESULTS: The average HSS score of both the patellar resurfacing group and retention group increased from 42.3 and 41.2 preoperatively to 90.2 and 90.8 at the last follow-up, respectively. The KSS, WOMAC score, patellar score, and knee joint ROM also improved significantly in both groups. However, there were no significant differences in clinical results between the two groups. On the radiological evaluation, the tibiofemoral angle in both groups had improved from varus 7.8° and 7.2° preoperative to valgus 4.9° and 4.8°, respectively. The average angles of α, ß, γ, and δ were 94.1°, 90.4°, 3.2°, and 87.8° in the patellar resurfacing group and 94.4°, 89.8°, 3.3°, and 88.1° in the patellar retention group, respectively. A radiolucent line shown on radiograph was noted in a total of seven cases, three in the patellar resurfacing group and four in the patellar retention group. In the patellar resurfacing group, among the seven zones on the tibia radiograph, all cases were located at the medial side of tibia and two cases were in zone 1 and one case in zone 2, and in the patellar retention group, three cases were in zone 1 and 1 case was in zone 2, also located on the same side. CONCLUSIONS: We achieved satisfactory clinical and radiological outcomes on long-term follow-up when performing TKAs with a NexGen®-CR. There was no significant difference in clinical or radiological results between the patellar resurfacing and retention groups in our study.

Anti-inflammatory effects of isoketocharbroic acid from brown alga, Sargassum micracanthum.

During our on-going screening program designed to isolate natural compounds from marine environments, we isolated isoketochabrolic acid (IKCA) from Sargassum micracanthum, an important brown algae distributed in Jeju Island, Korea. Furthermore, we evaluated the inhibitory effects of IKCA on nitric oxide (NO) production in lipopolysaccharide (LPS)-triggered macrophages. IKCA strongly inhibited NO production, with an IC50 value of 58.31 µM. Subsequent studies demonstrated that IKCA potently and concentration-dependently reduced prostaglandin E2 (PGE2), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1ß, and IL-6 cytokine production. In conclusion, to the best of our knowledge, this is the first study to show that IKCA isolated from S. micracanthum has a potent anti-inflammatory activity. Therefore, IKCA might be useful as an anti-inflammatory health supplement or functional cosmetics.

Inhibitory effects of Fortunella japonica var. margarita and Citrus sunki essential oils on nitric oxide production and skin pathogens.

A number of essential oils from citrus peels are claimed to have biological activities. Citrus peel, called 'Jin-Pi', is used in traditional medicine for digestion, severe cold, and fever. However, the antibacterial activities against skin pathogens and anti-inflammatory effects of the essential oils of Citrus sunki (JinGyul) and Fortunella japonica var. margarita (GumGyul) have not yet been described. Therefore, in this study, the essential oils of the citrus species C. sunki (CSE) and F. japonica var. margarita (FJE), both native to the island of Jeju, Korea, were examined for their anti-inflammatory and antimicrobial activities against skin pathogens. Four human skin pathogenic microorganisms, Staphylococcus epidermidis CCARM 3709, Propionibacterium acnes CCARM 0081, Malassezia furfur KCCM 12679, and Candida albicans KCCM 11282, were studied. CSE and FJE exhibited strong antimicrobial activity against most of the pathogenic bacteria and yeast strains that were tested. Interestingly, CSE and FJE even showed antimicrobial activity against antibiotic-resistant S. epidermidis CCARM 3710, S. epidermidis CCARM 3711, P. acnes CCARM9009, and P. acnes CCARM9010 strains. In addition, CSE and FJE reduced the lipopolysaccharide (LPS)-induced secretion of nitric oxide (NO) in RAW 264.7 cells, indicating that they have anti-inflammatory effects. We also analysed the chemical composition of the oils by gas chromatography-mass spectrometry (GC-MS) and identified several major components, including dl-limonene (68.18%) and beta-myrcene (4.36%) for CSE, and dl-limonene (61.58%) and carvone (6.36%) for FJE. Taken together, these findings indicate that CSE and FJE have great potential to be used in human skin health applications.

Chemical composition, antioxidant, anti-elastase, and anti-inflammatory activities of Illicium anisatum essential oil.

The essential oil of air-dried Illicium anisatum (Illiciaceae), obtained by hydrodistillation was analyzed by gas chromatography-mass spectrometry (GC-MS). Fifty-two components were identified in the essential oil and the main component was eucalyptol (21.8 %). The antioxidant and anti-elastase activities of the essential oil were also investigated; the essential oil exhibited moderate DPPH scavenging and anti-elastase activities. To clarify the mechanism of the anti-inflammatory activities of I. anisatum essential oil (IAE), we evaluated whether it could modulate the production of nitric oxide (NO) and prostaglandin E2 (PGE2) by activated macrophages. The results indicate that IAE is an effective inhibitor of LPS-induced NO and PGE2 production in RAW 264.7 cells. These inhibitory activities were accompanied by dose-dependent decreases in the expression of iNOS and COX-2 proteins and iNOS and COX-2 mRNA. In order to determine whether IAE can be safely applied to human skin, the cytotoxic effects of IAE were determined by colorimetric MTT assays in human dermal fibroblast and keratinocyte HaCaT cells. IAE exhibited low cytotoxicity at 100 microg mL-1. Based on these results, we suggest that IAE may be considered an anti-aging and anti-inflammatory candidate for cosmetic materials, but additional in vitro and in vivo tests have to be performed to prove its safety and efficacy.

Biological activities of Korean Citrus obovoides and Citrus natsudaidai essential oils against acne-inducing bacteria.

This study was designed to analyze the chemical composition of Citrus obovoides (Geumgamja) and Citrus natsudaidai (Cheonyahagyul) oils and to test their biological activities. These citrus essential oils were obtained by steam distillation of fruits collected from Jeju Island, Korea, and were analyzed using gas chromatograph (GC)-flame ionization detectors (FID) and GC-MS. Limonene and gamma-terpinene were the major components of the two citrus species. To evaluate in vitro anti-acne activity, they were tested against Propionibacterium acnes and Staphylococcus epidermidis, which are involved in acne. The Geumgamja and Cheonyahagyul oils exhibited antibacterial activity against both P. acnes and S. epidermidis. Their effects on DPPH radical scavenging, superoxide anion radical scavenging, and nitric oxide radical were also assessed. Cheonyahagyul and Geumgamja exhibited only superoxide anion radical-scavenging activity. To assess their potential usefulness in future cosmetic product applications, the cytotoxic effects of the two oils were determined by colorimetric MTT assays using two animal cell lines: normal human fibroblasts and HaCaT cells. They exhibited low cytotoxicity at 0.1 microl/ml in both cell lines. In addition, they reduced P. acnes-induced secretion of interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF-alpha) in THP-1 cells, an indication of anti-inflammatory effects. Therefore, based on these results, we suggest that Geumgamja and Cheonyahagyul essential oils are attractive acne-mitigating candidates for topical application.

Elaeocarpus sylvestris modulates gamma-ray-induced immunosuppression in mice: implications in radioprotection.

The study investigated the potential of Elaeocarpus sylvestris var. ellipticus (E.S.), which contains 1,2,3,4,6-penta-O-galloyl-beta-D-glucose (PGG), to protect mice from radiation injury by single whole-body irradiation (WBI) in vivo. The results from the present study demonstrate that the E.S. extract significantly improved the rate and duration of survival beyond that of untreated, irradiated control mice. The counts of endogenous colony forming units (CFU) increased in E.S.-treated mice, indicating that E.S. induced the regeneration of hematopoietic cells. E.S. treatment also accelerated the proliferation and recovery of lymphocytes and granulocytes, compared with those levels in untreated, irradiated controls. These results suggest that E.S. extract increases the survival time of mammals exposed to ionizing radiation by intensifying the victims' hematopoietic repair capacities. Therefore, it is concluded that the E.S. extract may be an effective agent of protection from radiation-induced injuries.

Chemical composition and biological activities of essential oils extracted from Korean endemic citrus species.

The aim of this study was to analyze the chemical composition of 14 kinds of citrus oils and to test their biological activities. Citrus essential oils were obtained by steam distillation from immature fruits collected from Jeju Island and were analyzed using gas chromatograph (GC)- flame ionization detectors (FID) and GC-MS. Limonene (55.4% to 91.7%), myrcene (2.1% to 32.1%), alpha-pinene (0.6% to 1.6%) and linalool (0.4% to 6.9%) were the major components in most citrus species. To evaluate in vitro antibacterial activity, all essential oils were tested against Propionibacterium acnes and Staphylococcus epidermidis. Nine out of fourteen citrus oils exhibited antibacterial activity against P. acnes, but not against S. epidermidis. The effects of the citrus oils on DPPH radical scavenging, superoxide radical anion scavenging, nitric oxide radical, and cytotoxicity were also assessed. Three essential citrus oils, Joadeung, Dongjunggyul, and Bujiwha, exhibited potent inhibitory effects on nitric oxide production. Two essential oils, Dongjunggyul and Joadeung, showed potent free radical scavenging activities in the DPPH assay. For future applications in cosmetic products, we also performed MTT assays in a human dermal fibroblast cell line. The majority of the essential oils showed no cytotoxicity. The results indicate that citrus essential oils can be useful natural agents for cosmetic application.

Cytoprotective effect of phloroglucinol on oxidative stress induced cell damage via catalase activation.

We investigated the cytoprotective effect of phloroglucinol, which was isolated from Ecklonia cava (brown alga), against oxidative stress induced cell damage in Chinese hamster lung fibroblast (V79-4) cells. Phloroglucinol was found to scavenge 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical, hydrogen peroxide (H(2)O(2)), hydroxy radical, intracellular reactive oxygen species (ROS), and thus prevented lipid peroxidation. As a result, phloroglucinol reduced H(2)O(2) induced apoptotic cells formation in V79-4 cells. In addition, phloroglucinol inhibited cell damage induced by serum starvation and radiation through scavenging ROS. Phloroglucinol increased the catalase activity and its protein expression. In addition, catalase inhibitor abolished the protective effect of phloroglucinol from H(2)O(2) induced cell damage. Furthermore, phloroglucinol increased phosphorylation of extracellular signal regulated kinase (ERK). Taken together, the results suggest that phloroglucinol protects V79-4 cells against oxidative damage by enhancing the cellular catalase activity and modulating ERK signal pathway.

Triphlorethol-A from Ecklonia cava protects V79-4 lung fibroblast against hydrogen peroxide induced cell damage.

In the present study, triphlorethol-A, a phlorotannin, was isolated from Ecklonia cava and its antioxidant properties were investigated. Triphlorethol-A was found to scavenge intracellular reactive oxygen species (ROS) and 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical, and thus prevented lipid peroxidation. The radical scavenging activity of triphlorethol-A protected the Chinese hamster lung fibroblast (V79-4) cells exposed to hydrogen peroxide (H2O2) against cell death, via the activation of ERK protein. Furthermore, triphlorethol-A reduced the apoptotic cells formation induced by H2O2. Triphlorethol-A increased the activities of cellular antioxidant enzymes like, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). Hence, from the present study, it is suggestive that triphlorethol-A protects V79-4 cells against H2O2 damage by enhancing the cellular antioxidative activity.