Validation of a histologic scoring system for the examination of quality of tendon graft to bone tunnel healing in anterior cruciate ligament reconstruction.

OBJECTIVE: To develop and validate a histologic scoring system for the assessment of tendon graft to bone tunnel healing in anterior cruciate ligament (ACL) reconstruction. STUDY DESIGN: The scoring system, tendon-bone tunnel healing (TBTH) score, comprised 5 items on graft status,fiber type and interface connectivity, evaluated on either a 5- or 6-point scale. Two observers were trained to use the scoring system, examining 15 blinded histologic slides from an ongoing study. Afterward, an independent validation dataset consisting of 89 blinded histologic slides from the same study of different time points, tunnel positions and bone tunnels were scored for validity and reliability. Interrater and intrarater reliabilities were calculated. The sum was validated by the time-dependent change of healing. RESULTS: Both the intrarater and interrater reliabilities of the scoring system were high, with weighted K of 0.90-0.99 (all p < 0.001) and 0.84-0.94 (all p < 0.001), respectively, for different items. The sum of score increased significantly with time at different segments of both tunnels (all p < 0.05), consistent with the process of tunnel healing. CONCLUSION: TBTH score is a reliable, valid measure for evaluating the histologic outcome of tendon graft to bone tunnel healing in ACL reconstruction.

Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction.

BACKGROUND: Tunnel widening after anterior cruciate ligament (ACL) reconstruction (ACLR) is commonly reported without a clear understanding of the mechanism. This study aimed to quantify the spatiotemporal change of the newly formed bone mass, bone tunnel diameter, and area along both bone tunnels using micro-computed tomography (microCT) and correlated the result with histology. METHODS: ACLR was performed in 24 rabbits. At baseline and weeks 2, 6, and 12, the juxta-articular, middle, and exit segments of both tunnels were harvested for microCT and histological evaluation. RESULTS: microCT and histology revealed significant bone tunnel and graft-bone tunnel healing, respectively, only at week 6 after reconstruction. Despite this, the mean tunnel diameter and area remained relatively unchanged with time. The newly formed bone mass [new bone volume/total bone volume (BV/TV) ratio] and its bone mineral density (BMD) were both higher, whereas the mean tunnel diameter and area were significantly smaller at the femoral tunnel compared to those at the tibial tunnel at weeks 6 and 12 and at week 12, respectively. These were consistent with histological findings, which showed inferior graft remodeling and integration at the tibial tunnel at weeks 6 and 12. The BV/TV increased, whereas the mean tunnel diameter and area decreased toward the exit segment of both tunnels. However, whereas better histological healing occurred at the femoral exit segment, poorer graft remodeling and Sharpey's fiber formation occurred at the tibial exit segment. CONCLUSIONS: Poor healing was observed during the initial 6 weeks, particularly that of the tibia, after ACLR. Bone resorption was rapid during healing, resulting in unchanged tunnel diameter and area with time.

Neurilemmoma of the first branch of the lateral plantar nerve causing tarsal tunnel syndrome.

In this article, the authors report a case of tarsal tunnel syndrome caused by neurilemmoma of the first branch of the lateral plantar nerve, with symptom resolved after excision. A 42-year-old man presented with left medial heel pain radiating to the lateral sole for 6 months. On examination, there was positive Tinel sign over the medial heel with pain radiating to the lateral sole. Ultrasonography and magnetic resonance imaging confirmed the presence of a 1-cm neurogenic tumor inside the tarsal tunnel. Intraoperatively, a 1-cm neurilemmoma was found at the first branch of the lateral plantar nerve inside the tarsal tunnel. The lesion was excised completely with preservation of its fascicle. The symptom resolved completely after the operation.

Arthroscopic resection of volar ganglion of the wrist: A new technique.

We evaluated a new arthroscopic technique for treating volar ganglion of the wrist. Arthroscopic resection of volar wrist ganglion was performed under local anesthesia to the portal sites. Arthroscopic instruments were introduced dorsally, and the intra-articular lesion at the interval between the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments was debrided under direct view. Mucinous content of the ganglion was evacuated using suction, but the ganglion sac was not removed. The technique was successful in 5 cases between August 1997 and November 1998, with an average surgery time of 55 minutes. No complications or recurrence occurred at a mean follow-up of 16.4 months. This is the first report of arthroscopic decompression of volar wrist ganglions and provides new insight into the etiology of these lesions.