Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Obtaining well-balanced soft tissues is important to achieve natural knee kinematics after total knee arthroplasty (TKA). In conventional procedures, soft tissue balance is evaluated with spacer blocks or lamina spreaders. However, the evaluation depends on the surgeons' experience and is not quantitative. This study aims to measure the mechanical properties of knee soft tissue with a new ligament balancer and to determine the optimal distraction force for evaluating tibiofemoral joint gaps in TKA. METHODS: This study included 30 consecutive patients with medial knee osteoarthritis who were scheduled to undergo posterior stabilized TKA. The mean age of patients was 73 ± 9.6 years at the time of surgery, and the mean hip-knee-ankle angle was 13.1 ± 6.5° in varus. After distal femoral and proximal tibial resections, the tibiofemoral joint gaps under several distraction forces were measured in extension and at 90° flexion. The load-displacement curves in extension and flexion were drawn with these data, and the stability range, which was defined as the shift range from the toe region to the linear region in the curves, was calculated. RESULTS: The stability ranges were 160 Newtons (N) in extension and 140 N in flexion. CONCLUSIONS: These displacement forces were considered optimal for evaluating tibiofemoral joint gaps during surgery and ensuring knee stability after TKA.

DOI： 10.1272/jnms.JNMS.2021_88-519

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BACKGROUND: This study sought to assess the efficacy of a deep-tissue thermal therapy system with a resonant cavity applicator (DTT-RCA), which safely heats deep joint tissue for treating osteoarthritis (OA) of the knee. METHODS: Two groups of participants were recruited. The DTT-RCA group comprised 20 knees. Kellgren-Lawrence (K-L) grade was I and II in 8 knees (DTT-RCA I/II group) [mean age 73.3 years (standard deviation 11.4) ], III and VI in 12 knees (DTT-RCA III/IV group) [75.4 (8.6) years]. The control group comprised 13 knees [68.2 (10.8) years]. K-L grade was I in 7 knees and II in 6 knees. This group received exercise therapy. The DTT-RCA I/II group and the control group were imaged by MRI T2 mapping at baseline and 6 months to determine the area of cartilage degeneration. RESULTS: Visual Analogue Scale improved only in the DTT-RCA I/II post-intervention (p < 0.01). Japanese Orthopedic Association knee rating scores (DTT-RCA I/II: p < 0.01, control group: p < 0.01), the Japanese Knee Osteoarthritis Measure (DTT-RCA I/II: p < 0.05, control: p < 0.01), and the Knee injury and Osteoarthritis Outcome Score (DTT-RCA I/II: p < 0.01, DTT-RCA III/IV: p < 0.05, control: p < 0.01) post-intervention. The magnitude of change did not differ significantly between the three groups. The area of cartilage degeneration did not change significantly post-intervention in the DTT-RCA I/II group, not even relative to the control group. CONCLUSIONS: This was the first study to test a DTT-RCA system in patients with knee OA. The system reduced the clinical symptoms of knee OA and could potentially be effective for conservative therapy.

DOI： 10.1272/jnms.JNMS.2021_88-505

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Open wedge high tibial osteotomy (OWHTO) is an effective treatment option for young and middle-aged active patients with medial unicompartmental knee osteoarthritis (OA). In addition, particulated cartilage implantation has been developed as a simple procedure for cartilage regeneration. Thus, to improve the OWHTO outcomes, a single-stage, simultaneous bilateral knee arthroscopic particulated cartilage implantation with OWHTO was performed. CASE PRESENTATION: A 60-year-old male patient presented with severe bilateral knee pain, with grade 2 varus knee OA of the Kellgren-Lawrence classification. Primary arthroscopic evaluations based on the International Cartilage Repair Society grading system showed grade 3c articular cartilage defects of 1.5 cm in diameter at the center of the bilateral medial femoral condyles. Following bilateral OWHTO, the healthy cartilage tissue was harvested from the lateral wall of the unilateral femoral intercondylar notch and minced with the cartilage processor. Then, subchondral drillings and cartilage fragment implantations into the bilateral defects were performed arthroscopically. One year postsurgery, second-look arthroscopy findings revealed that the defects were filled with cartilage-like tissues. The maturation process of the regenerated tissues was confirmed with T2 mapping magnetic resonance imaging during the 3-year follow-up period. The patient could walk without a cane, and all Knee Injury and Osteoarthritis Outcome Score parameters were improved without any correction loss in 3 years. CONCLUSIONS: This is the first report to evaluate the maturation process of the implanted particulated cartilage tissue with T2 mapping magnetic resonance imaging for 3 years. The effect of chondral resurfacing procedure with OWHTO remains unclear; however, the implantation of arthroscopic particulated cartilage fragments is a single-stage and less-invasive procedure. This treatment could regenerate cartilage-like tissue in the present case. Therefore, this additional procedure could potentially improve the long-term outcomes of OWHTO.

DOI： 10.1186/s12891-021-04368-5

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DOI： 10.1272/jnms.JNMS.2021_88-418.

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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INTRODUCTION: Rotator cuff tear with delamination is considered a risk factor for postoperative retear. The purpose of this study was to compare clinical outcomes between three repair procedures for large or massive rotator cuff tears with delamination: conventional en masse suture bridge (EMSB), double-layer suture bridge (DLSB), and the combination of DLSB with modified Debyere-Patte (DLSB + DP). METHODS: 53 shoulders of 52 patients who had massive rotator cuff tears with delamination were categorized into three groups: EMSB (18 shoulders), DLSB (24 shoulders), and DLSB + DP (11 shoulders). The mean postoperative follow-up period was 34.6 months. Pre- and postoperative evaluations included a range of motion (ROM), Constant scores, global fatty degeneration (GFDI), and tendon integrity according to Sugaya's classification by magnetic resonance images (MRI). RESULTS: In all groups, ROM significantly improved after the procedures. Mean constant scores significantly improved: from 45.5 to 77.4 after EMSB, from 45.5 to 87.6 after DLSB, and from 46.3 to 88.0 after DLSB + DP. Significant differences were noted in postoperative Constant scores (p = 0.018: DLSB vs. EMSB, and p = 0.045: DLSB + DP vs. EMSB). The Constant pain scores were better for DLSB + DP than for EMSB (p = 0.012). Global fatty degeneration index (GFDI) with DLSB + DP was significantly higher than that for either EMSB or DLSB, indicating significant preoperative fatty degeneration for DLSB + DP. Retear occurred in 27.8% of the EMSB group, 12.5% of the DLSB group, and 9.1% of the DLSB + DP group. DISCUSSION: Comparisons of the three groups demonstrated that DLSB and DLSB + DP achieved better clinical outcomes than EMSB for the repair of large or massive rotator cuff tears. DLSB + DP is useful for massive rotator cuff tears with severe fatty degeneration or for cases where the presence of excessive tension is anticipated when repairing the torn cuff.

DOI： 10.1051/sicotj/2021039

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OBJECTIVES: Intra-articular injection of hyaluronic acid (IAHA) has been used for the treatment of knee osteoarthritis (OA), but its effectiveness remains controversial. This study analyzed knee OA over time by magnetic resonance imaging (MRI) T1ρ mapping to objectively evaluate whether long-term repeated administration of IAHA influences cartilage degeneration. METHODS: Sixty knees of 60 patients [58.3 ± 12.5 years (mean ± standard deviation)] who had multiple T1ρ mapping images were retrospectively analyzed. We calculated the T1ρ values of the medial femorotibial cartilage and classified changes in degenerative areas over time into 3 groups: Improvement, No Change, and Deterioration. RESULTS: Average time between 2 MRI scans was 7.6 ± 1.2 months. The number of IAHA administrations was 15.5 ± 21.3, 8.39 ± 7.19, and 5.80 ± 7.49 in the Improvement, No Change, and Deterioration groups, respectively. Body mass index and number of IAHA administrations were significant factors causing change in the area of degeneration (p < .05) independent of age, sex, Kellgren-Lawrence grade, and posterior horn meniscus tears. CONCLUSION: Cartilage degeneration may be improved with a higher number of administrations of IAHA, based on T1ρ mapping results. This highlights the possibility of increased treatment effectiveness of IAHA for knee OA with repeated administrations.

DOI： 10.1080/14397595.2020.1830483

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Posterior cruciate ligament (PCL) resection during posterior-stabilized total knee arthroplasty (PS-TKA) has been reported to preferentially increase the tibiofemoral joint gap in flexion compared with extension. However, previous assessments of the joint gaps have been performed after bone resection and medial soft tissue release. Thus, these procedural steps may have the potential to influence soft tissue balance. In native knees, soft tissue laxity is generally greater in the lateral compartment than in the medial compartment both with the knee in extension and in flexion. Some surgeons may retain this natural soft tissue balance with less aggressive medial release during TKA. We performed this study to evaluate the impact of the PCL resection on the extension and flexion gaps in the absence of bone resection or medial soft tissue release. Tibiofemoral joint gaps for 41 patients (10 males and 31 females) in full extension and at 90 degrees of flexion both before and after the resections of both the anterior cruciate ligament (ACL) and PCL were assessed using a ligament tensioner device. The statistical analyze was performed using the Mann-Whitney U test. The results showed that medial gap in extension and flexion were 6.7 ± 1.0 and 7.3 ± 0.9 mm, and lateral gap in extension and flexion were 7.6 ± 1.1 and 8.4 ± 1.6 mm, respectively. Thus, physiological tibiofemoral gaps just after knee arthrotomy were trapezoidal and asymmetric shape with the significantly wider gaps in lateral and flexion, compared with the medial and extension, respectively (p < 0.05). However, the increases of the gaps with the ACL and PCL resections were less than 1 mm under the existence of medial soft tissues. As the medial collateral ligament is the primary restraint for the valgus instability, it was also considered to prevent the increase of the flexion gap although the PCL-which is the secondary restraint for the valgus instability-was resected. This finding is critically important for orthopedic surgeons applying PS-TKA implants, particularly for preserving soft tissues to achieve natural knee kinematics postoperatively.

DOI： 10.1055/s-0040-1713810

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Language：Japanese   Publisher：日本医科大学医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04260&link_issn=&doc_id=20200710390007&doc_link_id=10.1272%2Fmanms.16.164&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.16.164&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2020_87-202

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Language：Japanese   Publisher：(株)南江堂  

<文献概要>はじめに 人工膝関節全置換術(TKA)は除痛や膝関節機能の再獲得に優れた手術であり,本邦では年間約8万例の初回TKAが施行されている.一方,TKA後の拘縮膝は生活の質(QOL)を低下させるため,追加手術の適応となることがある.そこで,TKA後の拘縮膝に対する治療戦略を紹介する.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04037&link_issn=&doc_id=20200527600039&doc_link_id=10.15106%2Fj_besei77_210&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_besei77_210&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

当院で2017〜2018年に内側開大型高位脛骨骨切り術を行った28例31膝を対象とし、術前後の膝アライメント変化と矯正角との関連性について検討した。その結果、有意な相関は認められなかった。

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Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2020_87-504

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00167-018-5319-2

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Other Link： http://link.springer.com/article/10.1007/s00167-018-5319-2/fulltext.html

Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Publishing type：Research paper (scientific journal)   Publisher：Hindawi Limited  

An ergonomic upright body posture is maintained by the alignment of the spine, pelvis, and lower extremities, and the muscle strength of body trunk and lower extremities. The posture varies with age because of the degenerative changes in the involved structures and the weakening of the muscles. The compensatory mechanisms underlying these changes have recently been evaluated, and the loss of lumbar lordosis results in spinal kyphosis, pelvic retroversion, hip extension, knee flexion, and ankle dorsiflexion. These mechanisms are referred to as the hip–spine and knee–spine syndromes. The spine, hip, and knee are anatomically connected, and the pain and discomfort of the lower back, hip, and knee frequently arise due to degenerative changes of these structures. Thus, these mechanisms are considered as the knee–hip–spine syndrome. Spinal fusion, total hip arthroplasty, and total knee arthroplasty are the surgical procedures for severe degeneration, and their clinical outcomes for the affected sites are promising. However, despite surgeries, other structures may degenerate and result in complications, such as proximal junctional kyphosis and hip dislocation, following spinal fusion. Therefore, it is necessary to evaluate each patient under specific conditions and to treat each section while considering associations between the target structure and entire body. The purpose of this article is to introduce postural maintenance, variations with age, and improvements with surgical interventions of spine, hip, and knee as the knee–hip–spine syndrome.

DOI： 10.1155/2019/8484938

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Other Link： http://downloads.hindawi.com/journals/aorth/2019/8484938.xml

Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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Language：Japanese   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J04037&link_issn=&doc_id=20190617600047&doc_link_id=10.15106%2Fj_besei75_202&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_besei75_202&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1272/manms.15.24

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Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2018_85-50

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Femoral rotational alignment is considered an essential factor for total knee arthroplasty because malrotation of femoral components results in poor outcomes. To obtain proper alignment, we developed a superimposable computed tomography (CT) scan-based template to intraoperatively determine the accurate surgical epicondylar axis (SEA), and evaluated the effectiveness of this CT template. METHODS: In the experimental group (n=55), three serial slices of CT images, including medial and lateral epicondyles, were merged into a single image, and SEA was overlaid. SEA was traced onto an image of an assumed distal femoral resection level; this combined image was then printed out onto a transparent film as a CT template. Following a distal femoral resection in TKA, SEA was duplicated onto the femoral surface. Thereafter, the posterior condyle was resected parallel to this SEA. In the control group (n=53), posterior condyles were resected at three degrees of the external rotation from the posterior condylar line (PCL). A posterior condylar angle (PCA) between PCL of the femoral component and SEA was postoperatively evaluated. Positive values indicated external rotation of the femoral component from the SEA. RESULTS: In the experimental group, PCA was 0.01°±1.61°, and three cases were considered as outliers (greater than three degrees or less than -3 degrees). Conversely, in the control group, PCA was 0.10°±2.4°, and 12 cases were considered as outliers. Consequently, dispersion of PCA data was significantly smaller in the experimental group (P=0.004). CONCLUSIONS: The CT template accurately determined intraoperative SEA.

DOI： 10.1016/j.knee.2017.11.009

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Treatment of multiligament knee injuries, especially in adolescent patients, is challenging for orthopedic surgeons. Repair of collateral ligaments and reconstruction of cruciate ligaments are usually performed, however, ligament reconstruction with transphyseal or physeal-sparing techniques may lead to physeal damage and growth disturbances in skeletally immature patients. We present a case report on performing bicruciate ligament sutures arthroscopically in an adolescent patient.
Patient and Methods: The patient was a 14-year-old boy, who was diagnosed with injuries to the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament. Single-stage arthro-scopic primary suturing of the anterior and posterior cruciate ligaments and open medial collateral ligament suturing were performed 7 days after the injury.
Results and Discussion: The patient returned to routine activities, including high-level competitive sports, at 8 months post-surgery, and currently, 8.5 years after surgery, remains without complications. Suture repair was able to minimize the size of the bone tunnels and to re-establish knee stability with native tissues. Therefore, the application of sutures may be a useful option for repairing multiligament knee injuries, particularly in adolescent patients.

DOI： 10.1272/jnms.84.301

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Metal-on-metal had been proposed as an optimal articulation in THRs, however, many monoblock prostheses have been recalled in the USA because of significant high rates of early failure. Metal-on-metal prostheses had been implanted in our institution, and this is a case history of a single patient, in whom metal-on-metal THRs with different femoral sizes of heads were implanted. A 57-year-old female patient underwent bilateral total hip replacements with metal-on-metal prostheses using metal-polyethylene "sandwich'' liners 9 years ago on the right side and 7 years ago on the left side respectively. The only difference in both sides was the femoral head diameter of 28 mm in right and 34 mm in left. Seven years after the left surgery, the acetabular liner was dissociated, however, metallosis was not detected. Although the larger femoral head was thought to increase hip joint stability, it dictated a reduction in polyethylene thickness in this prosthesis design, and it was 4 mm in the left hip. Recently, metal-on-metal articulations are thought not to be optimal for hip joint bearing surface, however, this clinical failure was due to the polyethylene thickness and quality.

DOI： 10.1007/s10856-015-5383-9

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

Background: Cells from the bone marrow are considered important during the rotator cuff repair process, but the kinetics of bone marrow-derived cells in this process is unknown. Purpose: To analyze the kinetics of bone marrow cells during the rotator cuff repair process, to review whether or not they are histologically involved in rotator cuff healing, and to analyze the biomechanics of the repaired tissues.
Methods: Bone marrow chimeric rats that express green fluorescent protein (GFP) only in bone marrow-and circulation-derived cells were created. Bilateral supraspinatus tendons were separated from the greater tuberosity of the humeral head to produce a rotator cuff transection model. Drilling into the bone marrow was performed in the greater tuberosity of the right humerus and the supraspinatus tendon was repaired (drilling group), while the supraspinatus tendon was repaired on the left shoulder without drilling (control group). We examined the histology of the rotator cuff, the ultimate force-to-failure, and the proportion of GFP-positive cells in the repaired rotator cuff at 2, 4 and 8 weeks after surgery.
Results: Mesenchymal cells were observed in the repaired rotator cuff at 2 weeks in both groups. There were more GFP-positive cells in the drilling group than the control group at 2, 4 and 8 weeks. The ultimate force-to-failure was significantly higher in the drilling group than the control group at 4 and 8 weeks.
Conclusion: Bone marrow-derived cells passed through holes drilled in the humerus footprint, infiltrated the repaired rotator cuff and contributed to postsurgical rotator cuff healing. Level of evidence: Basic Science Study, in-vivo Animal Model. (C) 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.

DOI： 10.1016/j.jse.2012.02.007

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER  

Objective: The objective of this study was to evaluate whether light-emitting diodes (LEDs) could be effective in a noninvasive, therapeutic device for the treatment of osteoarthritic (OA) knee joints.
Design: Five weeks following the anterior cruciate ligament transection (ACLT) of mature New Zealand White rabbits, the animal knees were exposed to LED stimulation at intervals of 10 min/day, 5 days/week for 5 weeks in the experimental group (n = 7). The device used high intensity red and infrared (IR) LEDs with a total amount of energy delivered to the skin of 2.4 J/cm(2). Animals were sacrificed at 9 weeks postoperatively. Femoral surface gross morphology was evaluated with a modified Outerbridge classification and mRNA expression of catabolic and anabolic markers from femoral condyle cartilage and synovial tissue was assessed using RT-PCR. A control group was harvested 9 weeks following untreated ACLT.
Results: Gross morphometry of the control group showed four Grade II, two Grade III and one Grade IV (average 2.6) condyles macroscopically. The experimental group showed two Grade I and five Grade II (average 1.7) (Table 1). mRNA expression of aggrecan in the cartilage showed no difference between the groups, however type II collagen expression increased in the experimental group compared with control. TNF-alpha expression was significantly decreased in the experimental group compared to control.
Conclusions: There was general preservation of the articular surface and decreased levels of inflammation in the osteoarthritic joints with the application of LED therapy. This may provide potential application as a noninvasive treatment. (C) 2011 Published by Elsevier Masson SAS.

DOI： 10.1016/j.biopha.2011.02.011

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MARY ANN LIEBERT, INC  

Objective: To achieve osteochondral regeneration utilizing transplantation of cartilage-lineage cells and adequate scaffolds, it is essential to characterize the behavior of transplanted cells in the repair process. The objectives of this study were to elucidate the survival of mesenchymal cells (MCs). In a polylactic acid (PLA) scaffold and assess the possibility of MC/PLA constructs for osteochondral repair.
Design: Bone marrow from mature male rabbits was cultured for 2 weeks, and fibroblast-like MCs, which contain mesenchymal stem cells (MSCs), were obtained. A cell/scaffold construct was prepared with one million MCs and a biodegradable PLA core using a rotator device. One week after culturing, the construct was transplanted into an osteochondral defect in the medial femoral condyle of female rabbits and the healing process examined histologically. To examine the survivability of transplanted MCs, the male-derived sex-determining region Y (SRY) gene was assessed as a marker of MCs in the defect by polymerase chain reaction (PCR).
Results: In the groups of defects without any treatment, and the transplantation of PLA without cells, the defects were not repaired with hyaline cartilage. The cartilaginous matrix by safranin O staining and type II collagen by immunohistochemical staining were recognized, however the PLA matrix was still present in the defects at 24 weeks after transplantation of the construct. During the time passage, transplanted MCs numbers decreased from 7.8 x 105 at 1 week, to 3.5 x 105 at 4 weeks, and to 3.8 x 104 at 12 weeks. Transplanted MCs were not detectable at 24 weeks.
Conclusions: MCs contribute to the osteochondral repair expressing the cartilaginous matrix, however the number of MCs were decreasing with time (i.e. 24 weeks). These results could be essential for achieving cartilage regeneration by cell transplantation strategies with growth factors and/or gene therapy.

DOI： 10.1089/ten.tec.2008.0487

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Osteoarthritis is a degenerative disorder resulting from breakdown of articular cartilage. Previous work has shown bone morphogenic protein-7 has a potential protective effect on cartilage during the development of osteoarthritis. The purpose of this study was to determine whether bone morphogenic protein-7 could decrease the amount of cartilage degradation in preexisting osteoarthritis. The rabbit ACLT model was used as a model of osteoarthritis. Bone morphogenic protein-7 was delivered via Alzet osmotic pump to the joint 4 weeks after anterior cruciate ligament transection; thus cartilage injury was preexisting. The experimental group showed less cartilage degradation than the controls, with an average Outerbridge score of 1.9 versus 2.6 for the controls. Histomorphometry showed a trend toward less cartilage degradation in the bone morphogenic protein-7 group when compared with controls. Semiquantitative real-time polymerase chain reaction showed a considerably greater expression of aggrecan in the bone morphogenic protein-7-treated cartilage when compared with controls and less expression of matrix metalloproteinase-3 and matrix metalloproteinase-13, important catabolic mediators. The synovial tissue of the experimental group also showed considerably less expression of matrix metalloproteinase-3, matrix metalloproteinase-13, and aggrecanase. These results indicate bone morphogenic protein-7 may reduce degradation of articular cartilage in osteoarthritis.

DOI： 10.1007/s11999-008-0569-9

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS LTD  

Female athletes have a significantly higher rate of anterior cruciate ligament (ACL) injury than their male counterparts. Sex steroid hormones are considered to have an influence as risk factors for female ACL injuries. We hypothesized that estrogen and progesterone have specific and synergistic influences on the composition of extracellular matrix in ACL. By ovariectomy (OVX) followed by subcutaneous estradiol (E2) and/or progesterone (P4) replacement, 40 female rats were divided into 5 groups: E2, P4, combined E2 and P4 (EP), OVX control, and sham group. After 30 days, using undecalcified sections of knee joints in conjunction with immunofluorescence staining of estrogen receptor and (ER and ER), collagen types 1 and 3, and cartilage oligomeric matrix protein (COMP), the immunoreactivities of these proteins in two distinct parts of ACL, proximal and middle portions, were compared semiquantitatively among experimental groups. By E2 replacement, the expressions of ER in ACL fibroblasts were elevated compared to the OVX group. At the proximal portion, the immunoreactivities of type 1 collagen by E2 replacement, type 3 collagen by P4 replacement, and COMP by E2 or P4 replacement were significantly reduced. At the middle portion, the immunoreactivity of type 3 collagen was significantly elevated by E2 replacement. However, no differences were observed between the sham and OVX groups. These findings suggest that ACL is ER-dependent and that ovarian hormones alter ligament tissue composition, especially at the proximal portion. Female hormonal influences are partly involved in the biological properties of ACL.

DOI： 10.1080/03008200802531287

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-LISS  

Circulation-derived cells play a crucial role in the healing processes of tissue. In early phases of tendon healing processes, circulation-derived cells temporarily exist in the wounded area to initiate the healing process and decrease in number with time. We assumed that a delay of time-dependent decrease in circulation-derived cells could improve the healing of tendons. In this study, we injected platelet-rich plasma (PRP) containing various kinds of growth factors into the wounded area of the patellar tendon, and compared the effects on activation of circulation-derived cells and enhancement of tendon healing with a control group (no PRP injection). To follow the circulation-derived cells, we used a green fluorescent protein (GFP) chimeric rat expressing GFP in the circulating cells and bone marrow cells. In the PRP group, the numbers of GFP-positive cells and heat-shock protein (HSP47; collagen-specific molecular chaperone)-positive cells were significantly higher than in the control group at 3 and 7 days after injury. At the same time, the immunoreactivity for types I and III collagen was higher in the PRP group than in the control group at early phase of tendon healing. These findings suggest that locally injected PRP is useful as an activator of circulation-derived cells for enhancement of the initial tendon healing process.

DOI： 10.1002/jcp.21368

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-LISS  

The healing of an injured musculoskeletal system requires an influx of mesenchymal cells that can differentiate into osteoblasts, fibroblasts, chondroblasts, and skeletal myoblasts. However, whether these mesenchymal cells arise from the circulation (bone marrow) or the injured tissues themselves has been controversial. To reveal the spatiotemporal characteristics of the reparative mesenchymal cells, we investigated the healing process after patellar tendon injury using two types of green fluorescent protein (GFP) chimeric rats; one expressing GFP in the circulating cells, and the other expressing it in the patellar tendon. We analyzed the behavior of GFP-positive cells after experimental tendon injury in both chimeric rats to clarify the origin of reparative cells. At 24 h after the injury, the wound contained circulation-derived cells but not tendon-derived cells. Tendon-derived cells first appeared in the wounded area at 3 days after the injury, and had significantly increased in number with time and had maintained a high level of proliferative activity until 7 days after the injury, whereas the circulation-derived cells had decreased in number and had been replaced by the tendon-derived cells. These findings suggest that circulation-derived and tendon-derived cells contribute to the healing of tendons in different periods as part of a biphasic process.

DOI： 10.1002/jcp.20876

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC HISTOCHEMISTRY & CYTOCHEMISTRY  

It has been suggested that the degradation of the articular cartilage and osteoarthritis (OA) are associated with gender and the estrogen hormone. Although many investigators have reported the presence of the estrogen receptors (ERs) alpha and beta in the articular cartilage, the localization of these receptors and the difference in their in vivo expression have not yet been clearly demonstrated. We performed immunofluorescence staining of ER alpha and ER beta to elucidate the localization of the ERs and to note the effects of gender and the aging process on these receptors. The results revealed that ER alpha and ER beta were expressed in the articular cartilage and subchondral bone layers of adult rats of both sexes. We also observed the high expression of these receptors in immature rats. In contrast, their expression levels decreased in an ovariectomised model, as a simulation of postmenopause, and in aged female rats. Therefore, this study suggests the direct effects of estrogen and ER expression on articular surface metabolism.

DOI： 10.1267/ahc.06015

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE PUBLICATIONS INC  

Background: The behavior of host and graft cells during the healing process after autologous tendon graft has not been elucidated.
Hypothesis: Host cells will integrate into the bone-tendon interface and contribute to cellular repopulation of the graft.
Study Design: Controlled laboratory study.
Methods: Twelve-week-old, genetically identical, female green fluorescent protein transgenic rats (n = 20) and wild-type rats (n = 20) were used. The rats were divided into 2 experimental groups. In group A, the Achilles tendons of wild-type rats were harvested and transplanted into the transcondylar femoral bone tunnels of green fluorescent protein rats. In group B, the Achilles tendons of green fluorescent protein rats were transplanted into a transcondylar femoral bone tunnel of wild-type rats. Immediately after transplantation (time zero) and at 1, 2, and 4 weeks after the transplantation, distal femoral epiphyses were harvested and cut into 14-mu m serial sagittal frozen sections. The sections were examined with a confocal laser-scanning microscope to quantify green fluorescent protein-positive cell survival.
Results: At time zero, only host cells in group A and only graft cells in group B demonstrated green fluorescent protein signals. At 1 week in group A, many green fluorescent protein-positive cells were found in the graft. In group B, a few green fluorescent protein-positive cells were found in the graft. At 2 and 4 weeks in group A, many green fluorescent protein-positive cells were detected in the graft, but green fluorescent protein-positive cells had disappeared completely in group B.
Conclusion: Host cells, rather than graft cells, contribute to repair of the bone-tendon interface and the remodeling of grafts after simulated autologous tendon graft.

DOI： 10.1177/0363546505277140

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：HISTOCHEMICAL SOC INC  

To elucidate the behavior of autologously transplanted mesenchymal cells in osteochondral defects, we followed transplanted cells using green fluorescent protein (GFP) transgenic rats, in which all cells express GFP signals in their cytoplasm and nuclei as transplantation donors. Bone marrow-derived mesenchymal cells, which contain mesenchymal stem cells (MSCs), were obtained from transgenic rats. Then, dense mesenchymal cell masses created by hanging-drop culture were transplanted and fixed with fibrin glue into osteochondral defects of wild-type rats. At 24 weeks after surgery, the defects were repaired with hyaline-like cartilage and subchondral bone. GFP positive cells, indicating transplanted mesenchymal-derived cells, were observed in the regenerated tissues for 24 weeks although GFP positive cells decreased in number with time. Because GFP causes no immunological rejection and requires no chemicals for visualization, transplantation between transgenic and wild-type rats can be regarded as a simulation of autologous transplantation, and the survivability of transplanted cells are able to be followed easily and reliably. Thus, the behavior of transplanted mesenchymal cells was able to be elucidated in vivo by this strategy, and the results could be essential in future tissue engineering for the regeneration of osteochondral defects with original hyaline cartilage and subchondral bone.

DOI： 10.1369/jhc.4A6280.2005

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO LTD  

Objective: The fate of transplanted cells used in tissue engineering strategies should be followed. With this aim in view, the survival of transplanted bone-marrow-derived mesenchymal cells within osteochondral defects was determined using transgenic rats to simulate autologous transplantation.
Design: An autologous transplantation model was simulated using transgenic rats - whose transgenes produce no foreign proteins - as donors, and wild-type rats as recipients. Dense masses of mesenchymal cells were prepared from the transgenic rats using the hanging-drop culture technique. These cell masses were then transplanted into osteochondral defects created within the medial femoral condyle of wild-type rats, wherein they are affixed with fibrin glue. The course of repair was assessed histologically. The survival of the transplanted cells was ascertained by in situ hybridization of the transgenes.
Results: Twenty-four weeks after transplantation, the defects were repaired with hyaline-like cartilage, which was thicker than normal, and with subchondral bone. Using the in situ hybridization technique, cells derived from the transplanted ones were detected within both the cartilaginous and the subchondral bone layers.
Conclusion: Using this simulated autologous transplantation model, the survival of transplanted mesenchymal cells was monitored in vivo. The findings indicate that the transplanted mesenchymal cells contributed to the repair of the osteochondral defects. (C) 2004 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.joca.2004.06.014

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-LISS  

Transplantation of osteochondral autograft is widely used as a therapeutic strategy for the defect of articular cartilage. In the repair process, although underlying subchondral bone becomes necrotic and then is followed by bone reconstruction, the fate of graft and host cells during remodeling of underlying subchondral bone has not been elucidated. The objectives of this study were to establish a method to follow graft and host cells after transplantation of osteochondral autograft, and to elucidate the fate of both graft and host cells during remodeling of underlying subchondral bone. For these purposes, autologous transplantation models employing transgenic rats and wild-type rats, which were genetically identical to each other except for transgenes, were used. Two transplantation models were designed so that either the graft or the host cells had transgenes. Model I: transgenic rats were the donor, and wild-type rats were the recipient; model II: conversely, wild-type rats were the donor, and transgenic rats were the recipient. The grafted bone marrow cells and osteocytes in the trabeculae survived in the graft at 3 weeks after transplantation. Invasion of the host bone marrow cells into the graft was also found. Thus, bone marrow cells in the host as well as both bone marrow cells and osteocytes in the graft could potentially participate in the remodeling of underlying subchondral bone. Furthermore, the interface between graft and host was consisted with both graft and host derived cells. Since new bone formation was found in this space, both graft and host cells could have the potential to contribute to remodeling of underlying subchondral bone. The two models of the transplantations using the transgenic rats were found to be beneficial in following graft cells as well as host cells and in understanding their function on healing after autologous transplantation. (C) 2002 Wiley-Liss, Inc.

DOI： 10.1002/jemt.10112

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

Supracondylar or condylar femoral fractures require extended treatment and often result in loss of knee range of motion. We present 3 cases in which femoral fractures and preexisring painful knees secondary to osteoarthritis were treated using total knee arthroplasty with a stemmed femoral implant. The patients were all women aged 83, 84. and 87 years old. All fractures united within 3 months, and the patients could walk with 1 cane within 2 months. Primary total knee arthroplasty should be considered as a treatment for supracondylar/condylar femoral fractures in osteoarthritic knees.

DOI： 10.1054/arth.2001.22273

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BACKGROUND: In order to restore the neutral limb alignment in total knee arthroplasty (TKA), surgical procedure usually starts with removing osteophytes in varus osteoarthritic knees, however, that the exact influence on alignment correction is unknown. The purpose of this study was to define the influence of osteophyte removal alone on limb alignment correction in the coronal plane in TKA for varus knee. METHODS: Fifteen medial osteoarthritic knees with varus malalignment scheduled for TKA were included in this study. After registration of a navigation system, each knee was tested at maximum extension, and at 30, 40 and 60 degrees of flexion before and after osteophyte removal. External loads of 10 N-m valgus torque at each angle and in both states were applied. Subsequently, the widths of the resected osteophytes were measured. RESULTS: The average pre-operative hip-knee-ankle angle was -14.2 degrees. The average width of osteophytes was 7.6 mm in femur and 5.3 mm in tibia, respectively. Angle corrections after osteophyte removal were 3.4 degrees at maximum extension, 3.4 degrees at 30 degrees flexion and 3.6 degrees at 60 degrees flexion; and at all angles, the difference was significant. There was positive correlation between the widths of osteophytes and the degree of angle correction at 30 degrees. CONCLUSION: Correlation was found at 30 degrees of knee flexion between the widths of osteophytes and the degree of angle correction in the coronal plane in TKA. We found the degree of angle correction per 1mm width of osteophyte removal to be 0.4 degrees.

DOI： 10.1272/jnms.JNMS.2020_87-503

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BACKGROUND: Total knee arthroplasty (TKA) aims to correct the rotation as well as the alignment and the articulation of the osteoarthritic knee. In this study, we hypothesized that TKA affects hip rotational movement, in addition to improving knee kinematics. The objective was to evaluate the variation in lower extremity alignment and hip rotational range of motion (ROM) with TKA. METHODS: A total of 53 knees among 47 patients with primary varus knee osteoarthritis who were scheduled for primary TKA in our institute were enrolled. Hip rotational ROM was measured in the supine position with 90° flexion of the hip and knee before and 3 weeks after TKA. Variations in tibial axis alignment compared to femoral axis alignment by bone resections were also examined as changes in the joint lines of the distal femur and the proximal tibia using plain radiography and computed tomography. RESULTS: The average internal and sum of the internal and external hip rotational ROM increased significantly; however, the external hip rotational ROM was not significantly changed after TKA. The imaging findings also showed that the axis of the lower leg externally rotated 2.5° with a 4° external rotation of the distal femur and a 6.5° correction of the varus deformity. CONCLUSION: TKA was proven to vary the neutral position of hip rotational movement and to increase hip rotational range of motion.

DOI： 10.1272/jnms.JNMS.2020_87-401

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Language：Japanese   Publisher：東日本整形災害外科学会  

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DOI： 10.11551/jsjd.35.109

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Language：Japanese   Publisher：Japanese Society for Joint Diseases  

&lt;p&gt;&lt;b&gt;Objective&lt;/b&gt;: In total knee arthroplasty (TKA), it is important to reconstruct the knee alignment precisely to have satisfactory outcomes in terms of function, desensitization, and durability. In the coronal and axial plane, there is vast literature concerning alignment. However, the proper alignment in the sagittal plane and its clinical impact on function and outcome has not been studied to any great extent. Although the posterior tibia slope (PTS) has been proven to be important in TKA, and used when cutting the proximal tibia, it is difficult to measure PTS intraoperatively, and also it differs between normal and degenerative knees.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;: We focused on the articular capsule insertion on the tibia, which is more detectable intraoperatively. We defined the posterior capsule slope (PCS) as a new index, and evaluated and compared it with PTS in 51 autopsied knees. We measured the angle between the anterior cortex of the tibia, as one of the axes, and the line connecting the anterior edge and the posterior edge of the medial tibia plateau, and defined it as PTS. We also measured the angle between the anterior cortex of the tibia and the line connecting the anterior edge and the posterior edge of the capsule insertion point and defined it as PCS. We compared the data between PTS and PCS in terms of gender, side and whether there was the presence, or not, of degenerative change.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results&lt;/b&gt;: There was a strong correlation between PTS and PCS, though there were no statistically significant difference between the two parameters. This was the same in all groups.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusion&lt;/b&gt;: PCS may be useful for reconstructing the proper sagittal alignment in TKA.&lt;/p&gt;

DOI： 10.11551/jsjd.35.109

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Language：Japanese   Publisher：The Japanese Association for the Surgery of Trauma  

A 69-year-old female suffered a fall in her home, and was consequently admitted with traumatic subarachnoid hemorrhage, left chest pneumoderma, left hemopneumothorax, left clavicle fracture, and left flail chest, including fractures of left 2nd to 10th ribs. Surgical fixations of the left ribs and clavicle were performed 8 days after admission because of the marked displacement of the 3rd rib segment into the thoracic cavity. Ventilator use was discontinued 1 day after the operation ; however, the subsequent respiratory function remained stable.&lt;br&gt; Because the surgical procedure using a rib fixation plate could be performed without the need for drills or screws, or thoracotomy, it is a technically safe method. Surgical fixation for flail chest with rib plates is thought to be a promising treatment, with early ventilator weaning.

DOI： 10.11382/jjast.28.332

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DOI： 10.11382/jjast.28.332

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：FEDERATION AMER SOC EXP BIOL  

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Chondromyxoid fibroma (CMF) is a benign bone tumor. However, it is sometimes difficult to distinguish this tumor from chondrosarcoma. We report a rare case arising from the proximal fibula, presenting multimodality imaging features. An 18-year-old man presented with a 2-year history of gradually increasing pain and swelling in his left knee. Radiograph showed an area of osteolysis with lobulation. Magnetic resonance (MR) imaging demonstrated that almost the whole lesion was enhanced with Gd-DTPA. Scintigraphy examination with (99m)Tc-biphosphonate showed strong accumulation in the periphery. On Ga-67-citrate scintigraphy, there was a little uptake. Thallium-201 scintigraphy showed strong accumulation of the whole lesion in early and late scans. The tumor was diagnosed as CMF by open biopsy. It is important that CMF is correctly distinguished from other tumors because this may be histologically overdiagnosed as chondrosarcoma. Contrast-enhanced MR imaging and thallium-201 scintigraphy may be useful to distinguish CMF from benign bone tumors or chondrosarcoma.

DOI： 10.1007/s12149-007-0102-3

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Language：Japanese   Publisher：京都府医学振興会  

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