Faster bone union progression and less sclerosis at the osteotomy margin after medial opening-wedge high tibial osteotomy using highly porous ß-tricalcium phosphate granules versus allogeneic bone chips: A matched case-control study.

BACKGROUND: This study compared bone union progression using highly porous (80% porosity) ß-tricalcium phosphate (ß-TCP) granules or allogeneic bone chips in the gap created by medial opening-wedge high tibial osteotomy (MOWHTO). METHODS: The study population consisted of 54 patients who received MOWHTO with locking plate fixation: 27 patients using highly porous ß-TCP granules, and 27 age- and sex-matched patients using allogeneic bone chips. Bone union progression was evaluated 1, 3, 6, and 12 months postoperatively. The presence of radiographic sclerosis at the osteotomy margin was also assessed. RESULTS: Among all patients, the highest degree of bone union observed 12 months postoperatively was grade 4. As postoperative time passed, bone union progression of highly porous ß-TCP granules increased linearly and was statistically significant compared with that of cancellous allogeneic bone chips (P = 0.014). The presence of radiographic sclerosis at the osteotomy margin was significantly less common in the ß-TCP group than in the allograft group (P = 0.003) and was the strongest predictor of delayed progress of bone union (odds ratio = 6.16, P = 0.006). CONCLUSIONS: Patients who underwent MOWHTO using highly porous ß-TCP granules had faster new bone remodeling, less radiographic sclerosis at the osteotomy margin, and no inferior clinical outcome compared with allogeneic bone chips, as determined at the 1-year follow up. The presence of radiographic sclerosis at the osteotomy margin in patients undergoing MOWHTO using allogeneic bone or synthetic bone substitute may indicate delayed progress of bone union.

Neuroprotective effects of Liriope platyphylla extract against hydrogen peroxide-induced cytotoxicity in human neuroblastoma SH-SY5Y cells.

BACKGROUND: Oxidative stress is involved in neuronal cell death and mitochondrial dysfunction in neurodegenerative diseases. Liriope platyphylla (LP) has been suggested to have anti-inflammation, anti-bacterial, and anti-cancer effects. However, whether LP exerts neuroprotective effects on neuronal cells is unknown. METHODS: The present study was performed to investigate the neuroprotective effects of LP extract (LPE) against hydrogen peroxide (H2O2)-induced injury in human neuroblastoma cells SH-SY5Y. To test neuroprotective effects of LPE, we performed cell viability assay, flow cytometry analysis and western blot analysis. In addition, mitochondrial membrane potential (MMP) and oxidative stress were performed to evaluate the anti-apoptotic and anti-oxidant effects. RESULTS: LPE pretreatment conferred significant protection against the H2O2-induced decrease of SH-SY5Y cell viability. H2O2-induced increases of intracellular oxidative stress and mitochondrial dysfunction were attenuated by LPE pretreatment. Therefore, LPE pretreatment prevented SH-SY5Y cell injury. Treatment with H2O2 significantly induced poly(ADP ribose) polymerase (PARP) and caspase-3 cleavage, which was blocked by LPE. We found that p38 activation was involved in the neuroprotective effects of LPE. CONCLUSIONS: Current findings suggest that LPE exerts neuroprotective effects against H2O2-induced apoptotic cell death by modulating p38 activation in SH-SY5Y cells. Therefore, LPE has potential anti-apoptotic effects that may be neuroprotective in neurodegenerative diseases and aging-related dementia.

Long-term results of arthroscopic reshaping for symptomatic discoid lateral meniscus in children.

PURPOSE: To assess the long-term clinical and radiographic results of arthroscopic reshaping with or without peripheral meniscus repair for the treatment of symptomatic discoid lateral meniscus in children. METHODS: This study included 38 children (48 knees) who underwent arthroscopic surgery for symptomatic discoid lateral meniscus. The mean age at operation was 9.9 years (range, 4 to 15 years), and the mean follow-up period was 10.1 years (range, 8 to 14 years). Arthroscopic partial meniscectomy was performed in 22 knees (group A); partial meniscectomy with repair, in 18 knees (group B); and subtotal meniscectomy, in 8 knees (group C). Clinical and radiographic results were evaluated preoperatively and at the final follow-up. RESULTS: According to the scale of Ikeuchi, 94% of cases showed excellent or good results clinically. At the final follow-up, the median Tegner activity level was 7 (range, 4 to 10). The mean Lysholm knee score improved from 74.9 ± 10.6 to 97.6 ± 4.0, and the mean Hospital for Special Surgery score improved from 80.8 ± 8.9 to 97.8 ± 3.6 (P < .0001). At the final follow-up, radiographic evaluation showed the development of minor osteophytes in the lateral compartment of 18 knees and moderate joint space narrowing with spur formation in 1 knee. In addition, degenerative changes were observed in 23% of cases in group A, 39% of cases in group B, and 88% of cases in group C. Group C showed significantly greater progression of degenerative changes than group A or B. CONCLUSIONS: Arthroscopic reshaping for symptomatic discoid lateral meniscus in children led to satisfactory clinical outcomes after a mean of 10.1 years. However, progressive degenerative changes appeared in 40% of the patients. The subtotal meniscectomy group had significantly increased degenerative changes compared with partial meniscectomy with or without repair. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

The influence of diabetes mellitus on clinical and structural outcomes after arthroscopic rotator cuff repair.

BACKGROUND: The clinical effect of sustained hyperglycemia on tendon-to-bone healing after rotator cuff repair has not been well characterized. PURPOSE: To compare the clinical and structural outcomes between diabetic and nondiabetic patients after arthroscopic rotator cuff repair and to determine the effect of a diabetic phenotype on tendon-to-bone healing. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study retrospectively evaluated a total of 335 shoulders that were available for magnetic resonance imaging (MRI) evaluation at least 6 months after arthroscopic rotator cuff repair using the suture-bridge technique with a minimum follow-up of 1 year. Only patients who had medium- to large-sized tears with supraspinatus of fatty infiltration <2 and no or mild atrophy were enrolled in this study. There were 271 nondiabetic patients (group A) and 64 diabetic patients (group B). The mean age at the time of operation for groups A and B was 57.7 and 58.2 years, respectively, and the mean duration of follow-up after surgery was 27.8 and 24.8 months, respectively. RESULTS: At the last follow-up, there were no statistically significant differences between the 2 groups with regard to pain at rest and during motion (P = .212 and .336, respectively). Both groups reported statistically significant improvement in Constant and Shoulder Rating Scale of the University of California at Los Angeles scores (P = .323 and .241, respectively), but there was no statistically significant difference between the 2 groups. In assessing the repair integrity with postoperative MRI scans, 39 of 271 cases in group A (14.4%) and 23 of 64 cases in group B (35.9%) had retears, and the difference between the 2 groups was statistically significant (P < .001). In analyzing the retear rates according to the severity of sustained hyperglycemia in group B, retear was found in 16 of 37 (43.2%) uncontrolled diabetic patients with poor glycemic control (≥7.0% of preoperative serum glycosylated hemoglobin [HbA1c] levels) and in 7 of 27 (25.9%) controlled diabetic patients (<7.0%) (P < .001). CONCLUSION: Pain, range of motion, and function all significantly improved after arthroscopic rotator cuff repair using the suture-bridge technique, regardless of the presence of diabetes. However, sustained hyperglycemia increased the possibility of anatomic failure at the repaired cuff. In diabetic patients, an effective glycemic control was associated with better rate of healing after rotator cuff repair.

Application of dynamic indocyanine green perfusion imaging for evaluation of vasoactive effect of acupuncture: a preliminary follow-up study on normal healthy volunteers.

BACKGROUND: Even though acupuncture has long been used for alleviating symptoms related to vascular insufficiency, the clinical effect of acupuncture on peripheral circulation has not been fully confirmed. In this study, we investigated whether a near-infrared optical imaging-based method can be used to evaluate the efficacy of the acupuncture procedure to induce changes in peripheral tissue perfusion. METHODS: Two normal, healthy controls were treated with acupuncture on two acupoints (LI-4 and SI-3) three times within 1 week. At the first and third visits, participants were examined using indocyanine green (ICG) perfusion imaging before and 10 minutes after the acupuncture procedure. Blood perfusion of the hands was determined after intravenous bolus injection of ICG and dynamic analysis of the fluorescence signals by near-infrared imaging system. RESULTS: The blood perfusion rates of the hands were markedly increased immediately after acupuncture at the first trial in both cases. The baseline perfusion rates of the hands measured at the third visit were higher compared to the original basal level in one case; there was no difference in baseline perfusion rates of both hands in another case. In both cases, there was no acute effect of acupuncture on hand perfusion at the third trial. CONCLUSIONS: These results collectively suggest a potential of the ICG perfusion imaging as an effective evaluation tool to validate the vasoactive effect of acupuncture.