Calcitonin delays the progress of early-stage mechanically induced osteoarthritis. In vivo, prospective study.

BACKGROUND/RATIONALE: Introducing new or testing existing drugs in an attempt to modify the progress of osteoarthritis (OA) is of paramount importance. QUESTIONS/PURPOSES: This study aims to determine the effect exerted by Calcitonin on the progress of early-stage osteoarthritic lesions. METHODS: We used 18, skeletally mature, white, female, New Zealand rabbits. OA was operatively induced in the right knee of each animal by the complete dissection of the anterior cruciate ligament, complete medial meniscectomy and partial dissection of the medial collateral ligament. Postoperatively, animals were divided into two groups. Starting on the ninth postoperative day and daily thereafter, group A animals (n = 9) received 10 IU oculus dexter (o.d.) of synthetic Calcitonin IntraMuscularly (I.M.); group B animals (n = 9) received equal volume of saline o.d. Three animals from each group were sacrificed at 1, 2 and 3 months following treatment's initiation. The extent and the grade of OA were assessed macroscopically, histologically and by radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)-scans. The Osteoarthritis Research Society International (OARSI) score, incorporating histological and macroscopic information, was calculated for each knee. RESULTS: Osteoarthritic changes in group A animals were less severe and progressed less rapidly when compared with those of group B animals (sham). This difference was statistically significant in the first and second month (P = 0.05), but not in the third month (P = 0.513). CONCLUSIONS: I.M. administration of Calcitonin seems to delay the progress of early-stage osteoarthritic lesions induced by mechanical instability in a rabbit experimental model.

Brachial plexus palsy secondary to birth injuries.

We describe the long-term results in ten patients with obstetric brachial plexus palsy of anterior shoulder release combined with transfer of teres major and latissimus dorsi posteriorly and laterally to allow them to act as external rotators. Eight patients had a lesion of the superior trunk and two some involvement of the entire brachial plexus. The mean age at operation was six years, and the mean follow-up was 30 years. Before operation, the patients were unable actively to rotate the arm externally beyond neutral, although this movement was passively normal. All showed decreased strength of the external rotator, but had normal strength of the internal rotator muscles. Radiologically, no severe bony changes were seen in the glenohumeral joint. No clinically detectable improvement of active abduction was noted in any patient. The mean active external rotation after operation was 36.5 degrees. This was maintained for a mean of ten years, and then deteriorated in eight patients. At the latest follow-up the mean active external rotation was 10.5 degrees. The early satisfactory results of the procedure were not maintained. In the long term there was loss of active external rotation, possibly because of gradual degeneration of the transferred muscles, contracture of the surrounding soft tissues and degenerative changes in the glenohumeral joint.

Patellofemoral arthritis due to localize nodular synovitis (LNS).

We present the case of a 38-year-old female patient who had suffered from a progressively increasing anterior pain in her right knee for almost 10 years. She decided to seek medical advice when the pain became intolerable, not permitting her to perform normal everyday activities. The clinical examination showed evidence of patellofemoral arthritis, but the MRI that followed, apart from confirming the original diagnosis as an "Outerbridge" grade III osteoarthritic lesion, revealed an unidentifiable tumor located in the lateral part of the right patellofemoral joint, that appeared to be like a type of "reactive synovitis". The articular degeneration was treated with arthroscopic saving, followed by complete excision of the tumor and anteromedial tibial tubercle transfer under direct vision. The excised tumor was histologically categorized as a "localized type of nodular synovitis" otherwise known as "giant cell" tumor of synovial origin. The patient has fully recoreved from surgery and 3 years post-operatively she has fully returned to everyday normal activities noting only occasional slight discomfort.

Unusual displacement of the femoral head in anterior traumatic dislocation of the hip. A case report.

An unusual case of anterior traumatic hip dislocation which occurred in a thirty-three-year-old man is described. The femur had a 90 degree anterior rotation while the femoral head was exactly at the same level as when normal. The best term suited for this type of dislocation is "intermediate" or "inguinal" because the femoral head was dislocated anteriorly but remained at the normal level.