Effect of Bone Morphogenetic Protein-2 Combined With Microfracture for Osteochondral Defect of the Talus in a Rabbit Model.

BACKGROUND: Osteochondral defects of the talus can be effectively treated using microfracture, which is technically safe, accessible, and affordable. However, fibrous tissue and fibrocartilage comprise the majority of tissue repairs resulting from these procedures. These tissue types lack the mechanical characteristics of native hyaline cartilage and might significantly contribute to the decline in long-term outcomes. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) has been shown to promote matrix synthesis and increase cartilage formation, thus enhancing chondrogenesis in vitro. PURPOSE: This study aimed to evaluate the treatment ability of combining rhBMP-2 with microfracture in rabbit talus osteochondral defect. STUDY DESIGN: Controlled laboratory study. METHODS: A full-thickness chondral defect (3 × 3 × 2 mm) was constructed in the center talar dome of 24 New Zealand White male rabbits, which were then divided into 4 groups of 6. Each group received the appropriate treatment: group 1 (control; no treatment of defect), group 2 (microfracture treatment), group 3 (rhBMP-2/hydroxyapatite treatment), and group 4 (microfracture combined with rhBMP-2/hydroxyapatite treatment). Animals were sacrificed at 2, 4, and 6 weeks postoperatively. The International Cartilage Regeneration & Joint Preservation Society macroscopic score, which considers the degree of defect repair, the integration to the border zone, and the macroscopic appearance, was used to assess the repaired tissue's macroscopic appearance. Subchondral bone regeneration in defects was analyzed using micro-computed tomography, and the histological findings were graded using a modified version of the Wakitani scoring system for osteochondral repair. RESULTS: At 2, 4, and 6 weeks, micro-computed tomography analysis revealed that groups 3 and 4 exhibited subchondral bone healing that was more significantly improved compared with groups 1. No sample showed excessive bone growth from the subchondral bone area. According to macroscopic and histological results, group 4 showed higher-quality cartilage and more accelerated cartilage regeneration than the other groups over time. CONCLUSION: These findings show that osteochondral defect repair in a rabbit talus model could be effectively accelerated and improved by combining rhBMP-2 with microfracture. CLINICAL RELEVANCE: Using rhBMP-2 in combination with microfracture may enhance the repair of talar osteochondral lesions.

Simultaneous laparoscopic and arthroscopic excision of a huge juxta-articular ganglionic cyst compressing the sciatic nerve: A case report.

BACKGROUND: A large ganglionic cyst extending from the hip joint to the intrapelvic cavity through the sciatic notch is a rare space-occupying lesion associated with compressive lower-extremity neuropathy. A cyst in the pelvic cavity compressing the intrapelvic-sciatic nerve is easily missed in the diagnostic process because it usually presents as atypical symptoms of an extraperitoneal-intrapelvic tumor. We present a case of a huge ganglionic cyst that was successfully excised laparoscopically and endoscopically by a gynecologist and an orthopedic surgeon. CASE SUMMARY: A 52-year-old woman visited our hospital complaining of pain and numbness in her left buttock while sitting. The pain began 3 years ago and worsened, while the numbness in the left lower extremity lasted 1 mo. She was diagnosed and unsuccessfully treated at several tertiary referral centers many years ago. Magnetic resonance imaging revealed a suspected paralabral cyst (5 cm × 5 cm × 4.6 cm) in the left hip joint, extending to the pelvic cavity through the greater sciatic notch. The CA-125 and CA19-9 tumor marker levels were within normal limits. However, the cyst was compressing the sciatic nerve. Accordingly, endoscopic and laparoscopic neural decompression and mass excision were performed simultaneously. A laparoscopic examination revealed a tennis-ball-sized cyst filled with gelatinous liquid, stretching deep into the hip joint. An excisional biopsy performed in the pelvic cavity and deep gluteal space confirmed the accumulation of ganglionic cysts from the hip joint into the extrapelvic intraperitoneal cavity. CONCLUSION: Intra- or extra- sciatic nerve-compressing lesion should be considered in cases of sitting pain radiating down the ipsilateral lower extremity. This large juxta-articular ganglionic cyst was successfully treated simultaneously using laparoscopy and arthroscopy.