High tibial osteotomy accelerates lateral compartment osteoarthritis in discoid meniscus patients.

PURPOSE: The valgus high tibial osteotomy (HTO) in patients with medial osteoarthritis and discoid lateral meniscus can result in increased load on the lateral compartment and hence a higher chances of tear. This may accelerate the progression of osteoarthritis on lateral compartment. We, therefore, carried out the case control study with a hypothesis that an HTO would accelerate the progression of osteoarthritis (OA) on lateral compartment in patients with complete discoid meniscus. METHODS: The records of all patients with open wedge HTO from 2008 to 2012 were evaluated for complete lateral discoid meniscus. The patient who had a valgus HTO with or without partial meniscectomy for medial compartmental OA was included for this study. Cases to control were chosen to match age, body mass index (BMI), pre-operative osteoarthritis grade, and deformity angles in ratio 1:2. Patient's records were studied for demographic data, clinical examination records, and pre-operative knee functional scores and radiological scores and were compared with post-operative data. RESULTS: Thirty-six patients out of 674 patients, who underwent an HTO, consisted of discoid meniscus group. 72 patients were chosen as control group. Four patients showed progression of OA on the lateral compartment in discoid group compared to none in control group. Although control groups showed a little bit better functional outcomes, there were no statistical differences between two groups (n.s.). CONCLUSION: The high tibial osteotomy could result in accelerated lateral compartment osteoarthritis in patients with complete discoid meniscus, and the procedure should be used with caution in such patients. LEVEL OF EVIDENCE: IV.

Bone Marrow Aspirate Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence.

Objective To critically evaluate the current basic science, translational, and clinical data regarding bone marrow aspirate concentrate (BMAC) in the setting of focal cartilage defects of the knee and describe clinical indications and future research questions surrounding the clinical utility of BMAC for treatment of these lesions. Design A literature search was performed using the PubMed and Ovid MEDLINE databases for studies in English (1980-2017) using keywords, including ["bone marrow aspirate" and "cartilage"], ["mesenchymal stem cells" and "cartilage"], and ["bone marrow aspirate" and "mesenchymal stem cells" and "orthopedics"]. A total of 1832 articles were reviewed by 2 independent authors and additional literature found through scanning references of cited articles. Results BMAC has demonstrated promising results in the clinical application for repair of chondral defects as an adjuvant procedure or as an independent management technique. A subcomponent of BMAC, bone marrow derived-mesenchymal stem cells (MSCs) possess the ability to differentiate into cells important for osteogenesis and chondrogenesis. Modulation of paracrine signaling is perhaps the most important function of BM-MSCs in this setting. In an effort to increase the cellular yield, authors have shown the ability to expand BM-MSCs in culture while maintaining phenotype. Conclusions Translational studies have demonstrated good clinical efficacy of BMAC both concomitant with cartilage restoration procedures, at defined time points after surgery, and as isolated injections. Early clinical data suggests BMAC may help stimulate a more robust hyaline cartilage repair tissue response. Numerous questions remain regarding BMAC usage, including cell source, cell expansion, optimal pathology, and injection timing and quantity.

Congenital cartilaginous rest of the neck in a boy.

Congenital cartilaginous rest of the neck is a rarely encountered entity that requires surgical excision. In this case report, we describe a 12-year-old boy with asymptomatic congenital cartilaginous rest of the neck. We also discuss the associated congenital malformations that dermatologists must be aware of when caring for patients with this disease.

Congenital Medial Meniscus Hypoplasia.

An 18-year-old man with no prior surgical history presented with left knee pain after sustaining a basketball injury and was diagnosed with transient patellar dislocation. Magnetic resonance imaging was ordered to further assess the extent of injury.

Double PCL sign does not always indicate a bucket-handle tear of medial meniscus.

The discoid medial meniscus is an extremely rare anomaly. Bilateral discoid medial menisci are much more rare but intermittently reported. We report the first case of bilateral discoid medial menisci with positive double PCL sign, which typically indicates a bucket-handle tear of medial meniscus. A literature review was also conducted on bilateral discoid medial menisci.

Comparison of Outcome After Use of Extra-Luminal Rings and Intra-Luminal Stents for Treatment of Tracheal Collapse in Dogs.

OBJECTIVE: To report short- and long-term complications and outcomes of dogs treated for tracheal collapse secondary to chondromalacia with extra-luminal rings (ELR) or intra-luminal stents (ILS). STUDY DESIGN: Retrospective cohort. SAMPLE POPULATION: Dogs with naturally occurring tracheal collapse (n = 103). METHODS: Medical records (2002-2012) of dogs diagnosed with tracheal collapse that had treatment with ELR (n = 73) or ILS (30) were reviewed. Demographic information, procedural information, complications, survival time, and subjective outcomes were recorded. Follow-up periods were defined as <730 days (short-term) and >730 days (long-term). RESULTS: Ninety-two percent of dogs undergoing ELR and 100% of dogs undergoing ILS survived to hospital discharge. ELR dogs were significantly younger (P = .009) and significantly fewer had main-stem bronchial collapse (P < .001). After accounting for effects of age and presence of main-stem bronchial collapse, there was no significant difference in median survival time between groups. Dogs with main-stem bronchial collapse (regardless of treatment type) had a shorter survival time than dogs without main-stem bronchial collapse. Major complications occurred in ELR (42%) and ILS dogs (43%). CONCLUSIONS: Both ELR and ILS are associated with high complication rates. Younger dogs and dogs without main-stem bronchial collapse had a longer survival time, regardless of treatment.

Two unusual presentations of focal fibrocartilaginous dysplasia.

Focal fibrocartilaginous dysplasia (FFCD) is an uncommon, yet well documented, cause of long-bone angular deformities in children. We report two unusual cases of FFCD involving the tibia: one within the proximal tibia inducing genu valgum and one apparent FFCD lesion of the distal tibia that generated a varus deformity of the distal tibia. To our knowledge, this is the first reported case of FFCD in the distal tibia. Each lesion led to an angular deformity that required surgical management.

Lung transplantation for Williams-Campbell syndrome with a probable familial association.

Williams-Campbell syndrome is a rare disorder characterized by deficiency of subsegmental bronchial cartilage and development of airway collapse and bronchiectasis that may subsequently progress to respiratory failure and death. There are only 2 published reports suggesting a familial association, and only one report of lung transplantation being used as a therapeutic modality. Due to postoperative airway complications, transplantation has not been recommended for this disease. We report the first lung transplant with prolonged survival, approaching 10 years, in a patient with Williams-Campbell syndrome, and provide further evidence to support a familial association.

Discoid meniscus associated with agenesis of the anterior cruciate ligament in an 8-year-old child.

Among the congenital anomalies involving the lateral compartment of the knee, the combination of both a discoid meniscus and agenesis of the anterior cruciate ligament (ACL) is extremely rare and probably underestimated due to the presence of a meniscofemoral ligament often mistaken for an intact ACL. The therapeutic management of such abnormalities is not univocal and highly depends on their clinical impact. We report on the observations of an 8-year-old boy presenting with a cystic formation on a lateral discoid meniscus associated with agenesis of the ACL and the presence of an anterior lateral meniscofemoral ligament.

Review of discoid meniscus.

Discoid lateral meniscus is an intra-articular knee disorder that typically presents in children and adolescents. The natural history depends on the type of anomaly and the nature and presence of symptoms. Management of this disorder should be directed toward resolution of the symptoms while preserving meniscal tissue and function. Modern surgical techniques make suturing and preservation of meniscal tissue feasible. In the present article, the clinical manifestations, diagnostic criteria and practical management considerations are reviewed.

Discoid medial meniscus: report of four cases and literature review.

INTRODUCTION: Discoid medial meniscus is a rare abnormality, with incidence estimated at 0.12%. The present study describes this congenital abnormality anatomically and reports clinical results in four symptomatic cases managed by surgery. MATERIALS AND METHOD: A retrospective study included three patients (2 female, 1 male), one of whom had bilateral pathology. Mean age at consultation was 18.5 years (range, 13 to 28 yrs). Presenting symptoms were knee pain, associated with acute locking (1 case) or recurrent effusion (1 case). Plain X-rays were normal. MRI found discoid medial meniscus in all four cases, with intrameniscal hypersignal on T2-weighted sequences. RESULTS: Arthroscopy confirmed the discoid abnormality of the medial menisci. Meniscal tear was systematically associated: horizontal in two cases and vertical in the other two. Three cases showed insertion defect of the anterior horn of the discoid medial meniscus. All two cases were managed by meniscoplasty, removing the central part of the meniscus and sparing its peripheral part. Meniscal repair was associated in one case. Subjective results were assessed by KOOS score. At a mean 23 months' follow-up (range, 7 to 54 months), mean KOOS score was 82.7 (range, 77.6 to 86.4): 88 ± 5 for pain, 89 ± 8 for other symptoms, 98 ± 1 for function, 69 ± 17 for sports activity, and 69 ± 16 for quality of life. CONCLUSION: Symptomatic discoid medial meniscus is frequently associated with bone insertion abnormality of the anterior horn. Meniscal tear is consistently present and revelatory, indicating meniscal tissue fragility, as in the lateral meniscus. Meniscoplasty, possibly with associated meniscal repair if the remaining meniscal wall is unstable, provides satisfactory but imperfect results while avoiding total meniscectomy, which would be disabling in this age group.

Vascular rings and slings: interesting vascular anomalies.

INTRODUCTION: A vascular ring refers to encirclement of the trachea and oesophagus by an abnormal combination of derivatives of the aortic arch system. These malformations can cause variable degrees of compression of the oesophagus, trachea or both. Symptoms can range from no effect to severe stridor, dyspnoea and/or dysphagia. METHOD AND RESULTS: This study presents a case series of six patients treated over a six-year period (2003-2009), illustrating the features of four different types of vascular ring; these types are discussed in detail. The clinical presentation, radiology, and microlaryngoscopy and bronchoscopy findings are also discussed. CONCLUSION: The management of children with vascular rings requires a high index of clinical suspicion to ensure prompt diagnosis. As many of these children present with airway symptoms, the paediatric otolaryngologist plays a key role in identifying and assessing their anatomical anomalies.

Fetal MR imaging of Kniest dysplasia.

We present a case of Kniest dysplasia, a rare form of the type II collagenopathies, with prenatal MRI. Sonography revealed only short limbs in the fetus. Fetal MRI findings included enlarged hyaline cartilaginous structures with abnormally high T2 signal intensity, delayed ossification of the pubic and ischial bones, and platyspondyly. By delineating the cartilaginous abnormalities, fetal MRI can contribute to the prenatal diagnosis of chondrodysplasias.

Chondrodysplastic calves in Northeast Victoria.

Outbreaks of chondrodysplasia in calves occur sporadically every 10-15 years, particularly following prolonged drought conditions, throughout Northeastern Victoria and the Southern Tablelands of New South Wales, Australia. An outbreak spanning 2 calving seasons (2003-2004) involving numerous losses through stillbirth, perinatal loss, and poor growth was investigated. Investigations of 4 representative cases are presented here with a definition of the gross and histopathologic defects and an overview of epidemiologic data gathered from affected farms. Calves showed variable disproportionate dwarfism without arthrogryposis. Long bones were shortened and showed axial rotation. Articular surfaces were distorted with misshapen weight-bearing surfaces associated with variable thickness of articular cartilage. Physes were distorted and variable in thickness with occasional foci of complete closure. The major histologic abnormality in the physes was disorderly development of the zones of cartilage hypertrophy, with reduced number and irregular arrangement of hypertrophic chondrocytes; similar less severe changes were present in the zones of cartilage proliferation. Histochemical staining of the cartilage matrix was variable in intensity, and there was evidence of abnormal resorption of cartilage matrix at the level of the primary spongiosa. Osteoid formation and subsequent bone remodelling seemed unaffected, and diaphyseal cortical bone appeared normal at the gross and light microscopic level. No infectious agents were identified, and other known causes for chondrodysplasia in calves were excluded. The most likely cause for the syndrome was considered to be congenital manganese deficiency. Further surveys of tissue and blood manganese levels from cows and calves with and without clinical signs from the region are planned.

Congenital cartilaginous rests of the neck (wattles).

BACKGROUND: Congenital cartilaginous rests of the neck (wattles) are very rare, probably branchiogenic malformations. OBJECTIVE: To discuss the clinical and histologic features and the therapy of wattles. METHODS: We report a 4-year-old patient with symmetric exophytic nodules of the neck that had been present since birth. RESULTS: The two lesions, 0.5 3 0.5 cm, were removed. The histopathologic examination confirmed ectopic cartilaginous tissue. CONCLUSION: Wattles must be excised, including their cartilaginous core, after having sonographically excluded fistulae or sinuses.

Infantile cartilaginous hamartoma of the rib. A case report.

BACKGROUND: Infantile cartilaginous hamartoma of the rib is a rare condition occurring in newborn infants, with an incidence of 1 in 3,000 (0.03%) among primary bone tumor cases. Reports of this condition so far have presented the clinical, radiologic and histopathologic features. To the best of our knowledge, reports of the cytopathologic features have not been documented. In the present case report, clinical, radiologic and cytopathologic features and differential diagnosis are enumerated. CASE: A 1-month-old, male infant presented with a chest wall mass with a clinical diagnosis of osteochondroma. On fine needle aspiration cytology, a diagnosis of infantile cartilaginous hamartoma of the rib was suggested; it was supplemented by the clinical history and radiologic findings. CONCLUSION: Although rare, this condition ought to be kept in mind while dealing with infantile chest wall masses to avoid an erroneous diagnosis of malignancy, owing to its ominous cytopathologic features.

Lung transplantation for Williams-Campbell syndrome.

Williams-Campbell syndrome is a rare disorder characterized by a deficiency of cartilage in subsegmental bronchi leading to distal airway collapse and bronchiectasis. We report the first case of lung transplantation in a patient with end-stage lung disease secondary to Williams-Campbell syndrome. Although the patient did not have proximal airway collapse prior to transplantation, his posttransplant course was complicated by the development of bronchomalacia of the right and left mainstem bronchi. The patient experienced recurrent pulmonary infections and died of bacterial pneumonia 1 year after transplantation. Autopsy revealed cartilage deficiency in both right and left mainstem bronchi. A hypothesis may be made that a combination of proximal cartilage deficiency and posttransplant airway ischemia led to the development of bronchomalacia after lung transplantation. Thus, in contrast to previous reports, the cartilage deficiency in Williams-Campbell syndrome can involve both proximal and distal airways. Consequently, bilateral sequential lung transplantation may not be an effective therapeutic option in patients with this syndrome.

[An adult case of Williams-Campbell syndrome associated with pulmonary hypertension and a severe decrease in ventilatory response].

Williams-Campbell syndrome is a unique form of bronchiectasis caused by a congenital defect in bronchial cartilage, and is rare in Japan. A 34-year-old man was admitted to our hospital with a fever, and a productive cough. Arterial blood gas analysis revealed severe type II-respiratory failure. Many thin-walled cystic shadows (5-60 mm in diameter) were present in the entire lung field. Pulmonary function tests revealed obstructive impairment. Bronchograms demonstrated cystic bronchiectasis, with ballooning on inspiration and collapse on expiration, characteristic of Williams-Campbell syndrome. Despite severe hypoxia, he did not suffer from dyspnea. We examined ventilatory response to hypercapnea (HCVR) and hypoxia (HVR), and both HCVR and HVR were abnormal. In addition, the mean pulmonary artery pressure was 26 mmHg, indicating pulmonary hypertension.

Congenital cartilaginous rests of the neck.

We describe a case of congenital cartilaginous rests of the neck arising on the suprasternal midline area of the neck in a Korean infant. The lesion was characterized by discrete nodules of mature elastic cartilage in the lower dermis or superficial subcutaneous soft tissue and multiple vellus hair follicles in the overlying skin.