Prevention of arthrofibrosis by monoclonal antibody against vascular endothelial growth factor: a novel use of bevacizumab in rabbits.

BACKGROUND: Prevention of arthrofibrosis by different drugs and surgical techniques is an essential issue in modern orthopedics. HYPOTHESIS: Intra-articular injection of bevacizumab can reduce arthrofibrosis on the rabbit's stifle joint model. MATERIALS AND METHODS: Arthrofibrosis was induced in the right stifle joint of thirty male New Zealand white rabbits by removing the cortical bone of the medial femoral condyle under general anesthesia. The rabbits were randomly divided into three equal groups. The control group received intra-articular injection of saline; the one-injection group received a single dose of bevacizumab (2.5mg/kg), and the two-injection group received two intra-articular injections; the operation day and 14 days later. Forty-five days after surgery, animals were sacrificed. The severity of fibrosis was assessed based on the range of motion of the joint, a macroscopic adhesion score, and histopathologic variables such as the number of fibroblasts and of inflammatory cells, collagenous matrix deposition, synovial hyperplasia, granulation tissue formation, vascular proliferation, and presence of giant cells. RESULTS: Although no statistically significant differences were found between the range of motion (P=0.222) and the macroscopic evaluation (P=0.067) of the control group and the one-injection group, all microscopic variables regarding the prevention of arthrofibrosis were significantly superior in the one-injection group except granulation tissue (P=0.347). Compared to the one-injection group, the two-injection group had better results not only in terms of macroscopic evaluation (P=0.001 for range of motion and 0.012 for visual adhesion score) but also in most of the histopathologic variables especially the number of fibroblasts (P=0.002), vascularity (P=0.028) and collagenous matrix deposition (P=0.039). CONCLUSION: A single intra-articular injection of bevacizumab was effective for prevention of microscopically detected arthrofibrosis in the rabbit. Compared to single injection, two injections of bevacizumab improved the clinical outcome. LEVEL OF EVIDENCE: Level II.

Biologic resurfacing of the patella with quadriceps tendon flap: a rabbit study.

In this experimental study, 10 rabbits underwent arthrotomy with exposure of the patellar bone (group A), 10 rabbits underwent arthrotomy of the right knee without touching the patella (group B), and 10 rabbits comprised the control group (group C), which was included only for evaluation of functional scoring activities. A 2-mm thick flap of quadriceps tendon reflected downward to cover the patellar bone denuded of cartilage, which resulted in formation of hyaline cartilage in 87% of cases in group A and 89% in group B, incomplete differentiation of the mesenchymal tissue in 7% in group A and 9% in group B, and fibrous tissue or bone formation in 6% in group A and 2% in group B. In group A, 22% of formed cartilage had a regular surface, 22% had superficial horizontal lamination, 44% had fissuring, and 12% showed severe disruption. In group B, these values were 56%, 33%, 11%, and 0%, respectively. In group A, normal cellularity was noted in 33% of cases, slight hypocellularity in 67%, and no moderate hypocellularity. In group B, these values were 56%, 33%, and 11%, respectively. This procedure should be considered in young patients with loss of articular cartilage for whom other procedures or patellectomy are unsuitable solutions.

Osteochondritis dissecans of the weight-bearing surface of the medial femoral condyle in adults.

Osteochondritis dissecans (OD) is a syndrome that can be characterized as a non-infectious disturbance of enchondral ossification or as a post-traumatic event. OD occurs in the joint cartilage and physis of long bones, as well as in the talus. The medial femoral condyle is the most commonly affected site. OD of the weight-bearing, inferocentral portion of medial femoral condyle is an uncommon, but still challenging issue in knee surgery. This study reports one surgeon's experience in the treatment of OD of the weight-bearing surface of the medial femoral condyle in adult patients. A total of 29 knees in 28 patients with OD were reviewed as the basis of this study. Four patients were women and 24 were men. The average age was 29.5 years. Patients were observed for an average of 2 years after surgery. Medial joint line tenderness, anterior knee pain, stiffness and locking were the major complaints in 60% of cases. Arthroscopic excision of loose bodies with or without drilling of the crater and fixation of the lesions with 2 K-wires, with or without bone grafting, was undertaken for the patients. In our study, the clinical outcome was excellent in 11 patients, good in 13, fair in four and poor in one. On subjective questioning, all patients reported marked improvement and satisfaction with the surgery.

Short-term intravenous antibiotic treatment of acute hematogenous bone and joint infection in children: a prospective randomized trial.

Thirty-three cases of acute hematogenous bone or joint infection in children were randomly treated with short-term (7 days for joint infection, 10 days for bone infection) or long-term (14 days and 21 days, respectively) intravenous antibiotics after surgical drainage. The treatment outcome was measured through a detailed scoring system that included the ability to eradicate infection, the functional status of the limb, and the radiographic appearance of the bone and joint. The results were similar in both groups, showing the added benefit of a shorter hospital stay for children with blood-borne musculoskeletal infection. The use of this scoring system in choosing the route of antibiotic administration is recommended.