Arthroscopy of the hip for patients with mild to moderate developmental dysplasia of the hip and femoroacetabular impingement: Outcomes following hip arthroscopy for treatment of chondrolabral damage.

The purpose of this study was to determine patient-reported outcomes of patients with mild to moderate developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) undergoing arthroscopy of the hip in the treatment of chondrolabral pathology. A total of 28 patients with a centre-edge angle between 15° and 19° were identified from an institutional database. Their mean age was 34 years (18 to 53), with 12 female and 16 male patients. All underwent labral treatment and concomitant correction of FAI. There were nine reoperations, with two patients requiring revision arthroscopy, two requiring periacetabular osteotomy and five needing total hip arthroplasty. Patients who required further major surgery were more likely to be older, male, and to have more severe DDH with a larger alpha angle and decreased joint space. At a mean follow-up of 42 months (24 to 89), the mean modified Harris hip score improved from 59 (20 to 98) to 82 (45 to 100; p < 0.001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 30 (1 to 61) to 16 (0 to 43; p < 0.001). Median patient satisfaction was 9.0/10 (1 to 10). Patients reported excellent improvement in function following arthroscopy of the hip. This study shows that with proper patient selection, arthroscopy of the hip can be successful in the young patient with mild to moderate DDH and FAI.

[Microfracture and specific rehabilitation for treating osteoarthritis of the knee. Indications, surgical technique, and rehabilitation protocol]. / Die spezifische Rehabilitation nach Mikrofrakturierung bei Arthrose des Kniegelenkes. Mikrofrakturierung und spezifische Rehabilitation zur Behandlung von Arthrose des Kniegelenks. Indikationsstellung, operative Technik und Rehabilitationsprotokoll.

Treatment of osteoarthritis in young and middle-aged patients, in whom joint replacement is usually not appropriate, is a challenge to orthopaedic surgeons. Arthroscopic techniques can help control patients' symptoms. In particular, the microfracture procedure combined with management of the joint volume and a specific rehabilitation protocol shows good results in patients with osteoarthritis and cartilage defects by resurfacing the defect with a combination of types I and II cartilaginous tissue. Microfracture is a single-staged arthroscopic procedure that can be combined with any other arthroscopic treatment for osteoarthritis of the knee. With an appropriate rehabilitation protocol and techniques for controlling the joint volume, these treatments are very effective for pain relief and functional improvement. The described technique is our choice for initial surgical treatment of osteoarthritis of the knee.

Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up.

Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the hip for femoroacetabular impingement and met the inclusion criteria for this study. Patients with bilateral hip arthroscopy, avascular necrosis and previous hip surgery were excluded. Ten patients refused to participate leaving 112 in the study. There were 62 women and 50 men. The mean age of the patients was 40.6 yrs (95% confidence interval (CI) 37.7 to 43.5). At arthroscopy, 23 patients underwent osteoplasty only for cam impingement, three underwent rim trimming only for pincer impingement, and 86 underwent both procedures for mixed-type impingement. The mean follow-up was 2.3 years (2.0 to 2.9). The mean modified Harris hip score (HHS) improved from 58 to 84 (mean difference = 24 (95% CI 19 to 28)) and the median patient satisfaction was 9 (1 to 10). Ten patients underwent total hip replacement at a mean of 16 months (8 to 26) after arthroscopy. The predictors of a better outcome were the pre-operative modified HHS (p = 0.018), joint space narrowing >or= 2 mm (p = 0.005), and repair of labral pathology instead of debridement (p = 0.032). Hip arthroscopy for femoroacetabular impingement, accompanied by suitable rehabilitation, gives a good short-term outcome and high patient satisfaction.

Anterior cruciate ligament injury incidence among male and female professional alpine skiers.

A retrospective review of anterior cruciate ligament injuries among professional alpine skiers was performed to compare sex-related differences in injury incidence. We screened 7155 ski patrollers or instructors (4537 men and 2618 women) for knee injuries before each ski season between 1991 and 1997. Screening involved a ski history questionnaire, a knee injury history questionnaire, and a knee physical examination. Any patient with an equivocal Lachman or pivot shift test was evaluated by KT-1000 arthrometry and excluded from the study if the manual maximum side-to-side difference was 3 mm or more. Thus, the study population was limited to subjects with intact anterior cruciate ligaments. Skiers injured during the study were identified through mandatory workers' compensation claims. Each injured skier was reevaluated using an injury questionnaire and physical examination. The men skied an average of 110 days per year (499,070 skier-days) and the women skied an average of 87 days per year (227,766 skier-days). Thirty-one skiing-related anterior cruciate ligament injuries were diagnosed, 21 in men and 10 in women. The incidence of ACL disruption was 4.2 injuries per 100,000 skier-days in men and 4.4 injuries per 100,000 skier-days in women. These data suggest that the incidences of anterior cruciate ligament injuries among male and female professional alpine skiers are similar.

[The microfracture technic in the management of complete cartilage defects in the knee joint]. / Die Technik der Mikrofrakturierung zur Behandlung von kompletten Knorpeldefekten im Kniegelenk.

Full thickness defects of the articular cartilage rarely heal spontaneously. While some patients do not develop clinically significant problems from chondral defects, most eventually develop degenerative changes associated with the cartilage damage over time. Techniques to treat chondral defects include abrasion, drilling, tissue autografts, allografts, and cell transplantation. The senior author has developed a procedure referred to as the "microfracture." This technique enhances chondral resurfacing by providing a suitable environment for tissue regeneration and by taking advantage of the body's own healing potential. This technique has now been used in more than 1400 patients. Specially designed awls are used to make multiple perforations, or "microfractures", into the subchondral bone plate. The perforations are made as close together as necessary, but not so close that one breaks into another. Consequently, the microfracture holes are approximately three to four millimeters apart (or 3 to 4 holes per square centimeter). Importantly, the integrity of the subchondral bone plate is maintained. The released marrow elements form a "super clot" which provides an enriched environment for tissue regeneration. Follow up with long term results of more than 8 years have been positive and very encouraging.

Reconstruction of the anterior cruciate ligament in patients who are at least forty years old. A long-term follow-up and outcome study.

The long-term results were reviewed for seventy-two patients (seventy-five knees) who had had a bone-patellar ligament-bone intra-articular reconstruction of the anterior cruciate ligament between August 1984 and May 1992. The mean age of the patients at the time of the operation was forty-five years (range, forty to sixty years). Three patients had a bilateral procedure. The primary mechanisms of injury were accidents that occurred during skiing (thirty-two knees), tennis (fourteen knees), and soccer (five knees). We analyzed the responses to subjective questionnaires, the functional results, and the objective clinical data. The clinical examination included assessment of the range of motion, performance of Lachman and pivot-shift tests, and measurements with use of a KT-1000 arthrometer. All knees were evaluated with use of three common rating scales: that of Lysholm and Gillquist; that of The Hospital for Special Surgery, as modified by Insall et al.; and the International Knee Ligament Standard Evaluation Form. At the latest follow-up evaluation, at a mean of fifty-five months (range, twenty-six to 117 months), three patients reported pain or swelling. No patient reported giving-way or symptoms related to the patellofemoral joint. The mean range of extension was -12 to 6 degrees, compared with -8 to 42 degrees preoperatively, and the mean range of flexion was 112 to 150 degrees, compared with 52 to 154 degrees preoperatively. Flexion was limited to 112 degrees in one patient, but this was 5 degrees greater than that of the uninvolved knee. Sixty knees (80 per cent) had a negative pivot-shift test, and ten knees (13 per cent) had a grade of 1+. On testing with the KT-1000 device at maximum manual pressure, the mean difference between the injured and uninjured knees was found to have improved by 5.1 millimeters, from 6.4 millimeters preoperatively to 1.4 millimeters postoperatively (p < 0.01). The grade on the International Knee Ligament Standard Evaluation Form improved markedly; seventy-two knees (96 per cent) had a grade of C or D preoperatively, whereas seventy knees (93 per cent) had a grade of A or B postoperatively. The Hospital for Special Surgery score improved from a mean of 69 points preoperatively to a mean of 92 points postoperatively (p < 0.01). The mean score according to the scale of Lysholm and Gillquist increased from a mean of 63 points preoperatively to a mean of 94 points postoperatively (p < 0.01). All patients indicated that they were pleased with the result of the procedure. Bicycling was resumed at a mean of four months; jogging, at a mean of nine months; skiing, at a mean of ten months; and tennis, at a mean of twelve months.

Calsensin: a novel calcium-binding protein expressed in a subset of peripheral leech neurons fasciculating in a single axon tract.

The mAb lan3-6 recognizes a cytosolic antigen which is selectively expressed in the growth cones and axons of a small subset of peripheral sensory neurons fasciculating in a single tract common to all hirudinid leeches. We have used this antibody to clone a novel EF-hand calcium-binding protein, calsensin, by screening an expression vector library. A full-length clone of 1.1 kb identified by the antibody was isolated and sequenced. In situ hybridizations with calsensin probes and antibody staining using new polyclonal antisera generated against calsensin sequence demonstrate that calsensin indeed corresponds to the lan3-6 antigen. Calsensin consists of 83 residues with a calculated molecular mass of 9.1 kD that contains two helix-loop-helix domains. The calcium-binding domains are likely to be functional in vivo since a fusion protein derived from the calsensin clone binds 45Ca2+ in vitro. Immunoaffinity purification experiments with the lan3-6 antibody shows that a large 200,000 M(r) protein selectively copurifies with calsensin in two different leech species. These results suggest that calsensin may be functioning as a trigger protein which interacts with the larger protein. These data are consistent with the hypothesis that calsensin may mediate calcium-dependent signal transduction events in the growth cones and axons of this small group of sensory neurons which fasciculate in a single axon tract.

Zinc supplementation selectively decreases fetal hepatocyte DNA synthesis and insulin-like growth factor II gene expression in primary culture.

Zinc is important for normal cell growth and differentiation, DNA synthesis, and gene expression. IGF-II is a fetal growth and differentiation factor whose regulation is largely unknown. To assess the effect of zinc (Zn) on fetal hepatocyte IGF-II expression and DNA synthesis, primary cultures of ovine fetal hepatocytes were studied in serum-free medium containing 1 mumol/L Zn or supplemented to 10 or 50 mumol/L Zn. Fetal hepatocyte DNA synthesis, Zn and protein content, IGF-II mRNA, and IGF binding protein production were measured. Zn concentration in medium increased slightly in unsupplemented dishes, from 1 to 1.5 mumol/L; however, Zn concentration declined by 4 and 8 mumol/L over 24 h in culture medium supplemented to contain either 10 or 50 mumol/L Zn (p < 0.05). Zn content of cell pellets increased 155 and 204% after 24 h in supplemented cultures compared with unsupplemented controls, demonstrating uptake of Zn by the liver cells. Media Zn supplementation to 10 and 50 mumol/L decreased 3H-thymidine incorporation of cells in culture by 11 and 13%, respectively, compared with 1 mumol/L Zn (p = 0.001). Addition of Zn caused a progressive 2- to 3-fold decline in the nuclear labeling index of fetal hepatocytes, whereas the labeling index of nonhepatocytes increased almost 2-fold at 50 mumol/L compared with 1 mumol/L Zn. Associated with decreased hepatocyte DNA synthesis, IGF-II mRNA abundance declined by almost 30%. IGF binding protein content of conditioned medium did not change with added Zn.(ABSTRACT TRUNCATED AT 250 WORDS)

Selective pathway choice of a single central axonal fascicle by a subset of peripheral neurons during leech development.

In the CNS of leech, the central projections of peripheral sensory neurons segregate into three distinct axonal tracts during early development. We have previously shown that a subset of these neurons, recognized by the monoclonal antibody lan 4-2, projects axons into only one of these fascicles (Johansen et al., 1992, Neuron 8, 599). Here we report on a developmental and biochemical characterization of another fascicle-specific antigen labeled by the monoclonal antibody lan 3-6. By immunocytochemistry and double labelings we demonstrate that the lan 3-6 epitope is expressed only by a small subgroup of the peripheral neurons in Macrobdella embryos. The axons of these neurons selectively fasciculate in the CNS, but to only one of the three lan 3-2-positive tracts, which is different from the previously described lan 4-2-positive tract. These observations support the existence of a hierarchy of guidance cues mediating specific tract formation in this system. A biochemical analysis of the antigen suggests that it is likely to be a glycosylated protein with a molecular weight of approximately 200 kDa. Thus, the restricted expression of the lan 3-6 antigen and its biochemical properties are consistent with the hypothesis that this antigen may be playing a role in axonal guidance.