Inhibition of TGF-ß-induced collagen production in rabbit flexor tendon with mannose-6-phosphate in vitro.

The flexor tendon affects postoperative range of motion in the hand. Transforming growth factor-beta (TGF-ß) is a key cytokine in the adhesion formation between the flexor tendon and its surrounding fibro-osseous sheath. The purpose of this study was to examine the inhibition of TGF-ß-induced collagen-I production in rabbit flexor tendons with mannose-6-phosphate in vitro. Sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes from rabbit flexor tendons were isolated and each was supplemented with TGF-ß along with increasing doses of mannose-6-phosphate. The enzyme-linked immunosorbent assay (ELISA) and reverse-transcription polymerase chain reaction (RT-PCR) measured collagen-I production. The luciferase assay measured TGF-ß bioactivity. Results were compared with TGF-ß alone and unsupplemented controls. TGF-ß-induced collagen-I production was downregulated significantly with the addition of mannose-6-phosphate in a dose-dependent manner in all 3 cells cultures. The mannose-6-phosphate also reduced TGF-ß bioactivity. The study shows that mannose-6-phosphate was effective in TGF-ß inhibition in cultured flexor tendon cells. The findings presented here encourage further experiments that use the agents to modulate TGF-ß levels and reduce adhesion formation after flexor tendon repair.

Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft.

PURPOSE: The purpose of this study was to analyze the clinical outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone autograft versus allograft. METHODS: Between May 2000 and June 2004, 172 patients undergoing arthroscopic bone-patellar tendon-bone ACL reconstruction were prospectively randomized into autograft (n = 86) or allograft (n = 86) groups. The senior surgeon performed all operations using the same surgical technique. Each fixation was performed by means of an interference screw. Patients were evaluated preoperatively and postoperatively at follow-up. Of the patients, 156 (76 in the autograft group and 80 in the allograft group) were available for full evaluation. Evaluations included a detailed history, physical examination, functional knee ligament testing, KT-2000 arthrometer testing (MEDmetric, San Diego, CA), Harner's vertical jump and Daniel's 1-leg hop tests, Lysholm score, Tegner score, International Knee Documentation Committee standard evaluation form, Cincinnati knee score, and radiograph. RESULTS: Demographic data were comparable between groups. The mean follow-up was 5.6 years for both groups. There were no statistically significant differences according to evaluations of outcome between the 2 groups except that patients in the allograft group had a shorter operation time and longer fever time postoperatively compared with the autograft group. The postoperative infection rates were 0% and 1.25% for the autograft group and allograft group, respectively. There was a significant difference (P < .05) in the development of osteoarthritis between the operated knee in comparison to the contralateral knee according to radiographs. However, no significant difference was found between the 2 groups at the final follow-up examination (P > .05). CONCLUSIONS: Both groups of patients achieved almost the same satisfactory outcomes after a mean of 5.6 years of follow-up. Allograft is a reasonable alternative to autograft for ACL reconstruction. LEVEL OF EVIDENCE: Level II, prospective comparative study.

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft.

OBJECTIVE: To analyze the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with irradiated bone-patellar tendon-bone (BPTB) allograft compared with non-irradiated allograft and autograft. METHODS: All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 mrad of irradiation prior to distribution. A total of 68 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into one of the two groups (autograft and irradiated allograft groups). The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months of follow-up (ranging from 24 to 47 months), patients were evaluated by the same observer according to objective and subjective clinical evaluations. RESULTS: Of these patients, 65 (autograft 33, irradiated allograft 32) were available for full evaluation. When the irradiated allograft group was compared to the autograft group at the 31-month follow-up by the Lachman test, the anterior drawer test (ADT), the pivot shift test, and KT-2000 arthrometer test, statistically significant differences were found. Most importantly, 87.8% of patients in the autograft group and just only 31.3% in the irradiated allograft group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Documentation Committee (IKDC), functional and subjective evaluations, and activity level testing, no statistically significant differences were found between the two groups. Besides, patients in the irradiated allograft group had a shorter operation time and a longer duration of postoperative fever. When the patients had a fever, the laboratory examinations of all patients were almost normal. Blood routine was normal, the values of erythrocyte sedimentation rate (ESR) were 5~16 mm/h and the contents of C reactive protein (CRP) were 3-10 mg/L. CONCLUSION: We conclude that the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate using the gamma irradiation as a secondary sterilizing method.

99Tcm-DISIDA hepatobiliary imaging in evaluating gallbladder function in patients with spinal cord injury.

BACKGROUND: Spinal cord injury (SCI) is associated with increased prevalence of gallstones and acute acalculous cholecystitis. A possible explanation for the increased prevalence of gallstones in SCI patients is decreased gallbladder motility causing gallbladder stasis. In this study, we investigated gallbladder function in patients with SCI. METHODS: Eighteen normal controls, 16 trauma controls and 46 SCI patients were included in this study. Gallbladder function was measured by technium 99m-labeled imino-diacetic acid analogue ((99)Tc(m)-DISIDA) hepatobiliary imaging and represented by filling fraction (FF) and ejection fraction (EF). The data from SCI patients were analyzed according to old versus young, female versus male, heavy versus light body weight, ASIA A & B versus ASIA C & D classification, high- versus low-level injury, and long versus short injury duration. RESULTS: Fifty-two percent of SCI patients had abnormal FF and 59% had abnormal EF. Significantly decreased FF and EF values were found in SCI patients, especially in female patients with severe and high-level injuries. CONCLUSION: Quantitative (99)Tc(m)-DISIDA cholescintigraphy showed that SCI can significantly impair gallbladder function.

Effects of chitosan on cell proliferation and collagen production of tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes.

OBJECTIVE: To study the proliferation and collagen production of tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes; and the effects of chitosan on cell proliferation and collagen production in the 3 cell types of rabbit flexor tendon. METHODS: Three cell lines of tendon sheath, epitenon, and endotenon were isolated from rabbit flexor tendon and cultured. Cell culture media was added with chitosan. The cell number and production of collagens I, II, and III were measured and compared with those cultured without chitosan. The expression of type I collagen in tendon sheath fibroblasts was determined by quantitative analysis of reverse-transcription polymerase chain reaction. RESULTS: All 3 cell lines produced collagens I, II, and III. Adding chitosan to cell media resulted in a significant decrease in cell number in all 3 cell lines. In addition, there was a significant decrease in collagens I, II, and III production in all 3 cell lines as well as the expression levels of type I collagen in tendon sheath fibroblasts (P<0.05). CONCLUSIONS: Chitosan can inhibit cell proliferation and collagen production of the tendon sheath, epitenon, and endotenon, and may provide a promising approach to obviating tendon adhesion formation clinically.

Spinal cord injury and cholelithiasis.

BACKGROUND: Spinal cord injury (SCI) is found to be related to increased prevalence of gallstones and acute acalculous cholecystitis. In this study we assessed the prevalence of cholelithiasis in male patients with SCI and the correlation of cholelithiasis with age and weight of patients, level of injury, as well as severity and duration of SCI. METHODS: One hundred male SCI patients (58 patients rated ASIA A or B and 42 rated ASIA C or D) aged more than 20 years (average 46.5 years) suffered from a spinal cord injury for more than one year. One hundred male volunteers served as controls without SCI and biliary diseases(age range 20-68 years; average 42.6 years). The two groups were subjected to ultrasonography of the gallbladder and biliary tract. RESULTS: The prevalence of cholelithiasis in the group of SCI patients and the control group was 26% and 10% respectively. Significant differences in the prevalence of cholelithiasis were found between the normal controls and SCI patients and between high and low-level injury (P<0.01). But the differences were not statistically significant when correlating the presence of cholelithiasis with the age and weight of the patients, the duration of SCI, and the severity of spinal lesion(P>0.05). CONCLUSIONS: SCI represents a major risk factor for the development of cholelithiasis,especially in patients with high-level injury. Cholelithiasis in SCI patients is not related to their age and weight, the severity of spinal lesion, and the duration of spinal cord injury.