Current status of second-look arthroscopy after meniscal allograft transplantation: review of the literature.

INTRODUCTION: Clinical assessments do not accurately reflect the status of meniscal transplants and cannot evaluate the graft condition itself and joint preservation effects of meniscal allograft transplantation correctly. The purpose of this review was to assess the need and to ascertain the indication and the role of second-look arthroscopy for objective evaluation after MAT. MATERIALS AND METHODS: We performed a literature search to identify all published clinical studies on MAT with the following medical subject heading (MeSH) terms: "meniscus," "meniscal transplant," "transplantation and allograft," "meniscal and transplant." Include in the review are studies with at least 6 months clinical, radiological, and/or histological follow-up in human subjects. Evaluation method of MAT was reviewed with an aim to describe the frequency of second-look arthroscopy, its feasibility, patient compliance, purposes, and results. RESULTS: We identified 15 clinical studies that satisfied our inclusion and exclusion criteria. Only two studies always performed second-look arthroscopies. Most of the second-look arthroscopy was conducted mainly for the objective evaluation of meniscal allograft transplantation but, in several studies, arthroscopy was performed to treatment of other knee problem. CONCLUSIONS: Although second-look arthroscopy has inevitably ethical issues, especially for asymptomatic and well-functioning knees, in this review, it could be a more dependable method available to detect meniscal healing if performed for certain indications such as a symptomatic patient with a magnetic resonance image indicating abnormalities.

Osteonecrosis of the Femoral Head in the Setting of a Complex Acetabulum Fracture without Hip Dislocation Treated Surgically Using Ilio-inguinal Approach: A Case Report.

Osteonecrosis in isolated fractures of the acetabulum without dislocation of hip seems to be a known complication, but to our knowledge it has not been reported adequately. The causative nature of post-traumatic femoral head osteonecrosis has not been studied critically. The pathophysiology of osteonecrosis in this case also eludes us. Striking evidence points towards the intra-operative blood loss and low mean arterial pressure possibly leading to hypo-perfusion of femoral head leading to osteonecrosis. Fractures of the acetabulum pose a difficult problem for the patient and the surgeon because of possible complications. Thus any surgeon involved in surgery for fractures of the acetabulum should be aware of the possibility of this potential complication. Here is a 61-year male, who sustained a complex fracture of the acetabulum without hip dislocation, subsequently was treated surgically with internal fixation using an anterior approach, 10 months after surgery patient developed osteonecrosis of the femoral head.

Measurement of Capsular Thickness in Magnetic Resonance Arthrography in Idiopathic Adhesive Capsulitis of Hip.

PURPOSE: The clinical suspicion of idiopathic adhesive capsulitis of the hip (IACH) involves restricted range of motion and normal hip radiographs. The purpose of this study was to delineate the characteristic findings observed on magnetic resonance arthrography (MRA) by identifying the anatomical structures involved and their significance on clinical presentation of restricted range of motion. MATERIALS AND METHODS: We retrospectively evaluated MRA's of 46 hips (44 patients) who suffered hip pain from September 2006 to August 2012 in our hospital. Of those, 10 cases (8 patients) with clinical suspicion of IACH were compared to 20 normal hip cases (control group). To identify anatomical evidence of adhesive capsulitis in the MRA's of the IACH group, capsular thickness was measured superiorly, inferiorly, anteriorly and posteriorly, and compared to that of the randomly selected control group. RESULTS: Comparison of the MRA findings of the control group to that of the IACH group showed that there was a statistically significant increase in the mean thickness of the joint capsule superiorly and posteriorly (P<0.01), while comparison of examination findings revealed a statistically significant decrease in the mean range of motion (flexion 122.5°±5.5°/abduction 28.0°±2.8°/adduction 26.5°±2.4°/external rotation 30.5°±3.8°/internal rotation 25.5°±2.4°) in the IACH group. CONCLUSION: A change in the capsular thickness on MRA is a common finding in IACH patients with the increase more evident in the posterior and superior capsules than the anterior and inferior capsules.

Effect of lipopolysaccharide (LPS) on mouse model of steroid-induced avascular necrosis in the femoral head (ANFH).

Avascular necrosis of the femoral head (ANFH) is commonly observed in patients treated with excessive glucocorticoid (GC). Single administration of lipopolysaccharide (LPS) has shown to induce immune stimulatory factors. However, the effect of repeated administration of LPS on GC-induced ANFH has not been studied. Thus, the purpose of this study was (i) to examine the cytokine profile induced by repeated LPS administrations and (ii) to test the effect of repeated LPS treatments on GC-induced ANFH. A mouse necrosis model of ANFH was designed by chronic GC administration with co-treatment of LPS. Mice body weights in the LPS/prednisolone (PDN) co-treated group were lower than that of the untreated control group, but spleen weights were greater than the control group. The levels of IL-6, TNFα, and IL-33 in the liver and spleen of the LPS/PDN group were lower than the untreated control group, whereas TNFα level in the femoral head of the LPS/PDN group increased. Collectively, the effect of repeated LPS on the pathogenesis of GC-induced ANFH was associated with the TNFα level in the femoral head, but the pathogenesis did not correspond to cytokine levels in immune tissues.