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Ching-Jen Wang

Publications and source records attributed to Ching-Jen Wang.

At least 55 records · Page 3Linked to original sources
PubMed2003

Reducing the "killer turn" in posterior cruciate ligament reconstruction.

PURPOSE: Graft abrasion caused by sharp graft angulation at the graft-tunnel margin of the proximal tibia (the "killer turn") may cause graft failure after posterior cruciate ligament (PCL) reconstruction using the traditional anteromedial route tibial tunnel. One method to reduce the graft angulation is to use the anterolateral route tibial tunnel. However, less acute graft angulation may increase joint translation because of a decrease in graft compressive force. The purpose of this study was to compare the graft angulation and joint translation between anteromedial and anterolateral route tibial tunnels. TYPE OF STUDY: Biomechanical study. METHODS: Twelve above-the-knee amputation specimens were used in this study. Anteromedial and anterolateral tibial tunnels were made at the desired locations, and the same femoral tunnel was used. Graft angulation was measured by inserting a malleable pin into the tibial and femoral tunnels. Measurements of graft angulation were performed with the knee in extension and in 90 degrees of flexion. The joint translation was measured by the posterior translation of the tibia on the femur at 90 degrees of flexion with a 15-lb posterior force applied to the anterior proximal tibia after PCL reconstruction through the respective tunnels. RESULTS: The difference in graft angulation between anterolateral and anteromedial route tibial tunnels was statistically significant (P <.001); however, the difference in joint translation showed no statistical significance between the 2 tunnel routes. CONCLUSIONS: The anterolateral route tibial tunnel significantly reduced the sharp graft angulation ("killer turn") at the graft tunnel margin of the proximal tibia, but it did not increase the joint translation as compared with the traditional anteromedial route tibial tunnel. The anterolateral route tibial tunnel is thought to be a better choice when arthroscopic PCL reconstruction is performed with the tunnel technique.

Aged↗
PubMed2003

Acute popliteal artery occlusion after arthroscopic posterior cruciate ligament reconstruction.

Arthroscopic posterior cruciate ligament reconstruction may carry certain risks of complications, including injury to the neurovascular structures in the popliteal region. Acute occlusion of the popliteal artery, a limb-threatening complication, was reported after total knee arthroplasty. We report a case of acute popliteal artery occlusion after arthroscopic posterior cruciate ligament reconstruction. The possible causes included underlying artherosclerosis, the use of pneumatic tourniquet, surgical manipulation, and arterial spasm. Early diagnosis and prompt surgical treatment are the keys to success in the treatment of this limb-threatening complication. Spontaneous resolution of the thrombus such as is reported in this case is exceptional.

Anticoagulants↗
PubMed2003

Polyethylene-induced pes anserinus bursitis mimicking an infected total knee arthroplasty: a case report and review of the literature.

Polyethylene-induced pes anserinus bursitis after total knee arthroplasty (TKA) with the clinical manifestations mimicking an infected TKA is a very rare occurrence. We report such a case in a 74-year-old woman. She developed recurrent draining papules on the anterolateral aspect of the knee because of polyethylene-induced chronic pes anserinus bursitis 8 years after TKA. The diagnosis was established with a sinography study and confirmed by histopathologic examination of the surgical specimen. The symptoms were resolved after surgical excision of the lesion. Pes anserinus bursitis should be included in the differential diagnosis in knees with a draining sinus after TKA, and sinogram is considered the best method to establish the diagnosis.

Aged↗
PubMed2003

Arthroscopically assisted osteosynthesis for tibial plateau fractures.

BACKGROUND: Options for management of tibial plateau fracture are numerous, and the outcome depends on several factors. With the inherent advantages of arthroscopy, the results of tibial plateau fracture have been greatly improved. METHODS: Thirty-one patients were treated with arthroscopically assisted reduction for tibial plateau fracture, with an average follow-up period of 3 years. Evaluations were performed with the Hospital for Special Surgery knee score clinically, and with the Ahlbäck scale for osteoarthritis radiographically. RESULTS: Eighty percent of cases were Schatzker type II, III, or IV, and over half (52%) of the patients had concomitant intra-articular lesions. Twenty-nine patients (93.5%) had satisfactory results according to the Hospital for Special Surgery knee score, and only one patient developed degenerative arthritis during the period of follow-up. CONCLUSION: The arthroscopically assisted reduction of tibial plateau fracture is a safe and promising procedure. The results are comparable to traditional methods of open reduction.

Adult↗
PubMed2003

Infection after intramedullary nailing of the femur.

BACKGROUND: The management of infection after intramedullary nailing of the femoral shaft fracture remains a challenge to orthopedic surgeons. The dilemma confronting surgeons concerns the removal or retention of the nail in the presence of infection. METHODS: The authors treated 23 infections after intramedullary nailing for femoral fractures. All fractures were unhealed at presentation. All patients were followed for at least 1 year after the infection. Acute infection occurred in 13 patients, subacute infection in 5, and chronic infection in 5. The patients were divided into two groups on the basis of the method of the initial treatment. In group I (12 patients), the intramedullary nails were retained, and there were 11 men and 1 woman, with an average age of 36 years (range, 15-55 years). In group II (11 patients), the nails were removed at the time of debridement and the fractures were stabilized with external fixation, and there were nine men and two women, with an average age of 44 years (range, 25-69 years). RESULTS: In group I, all fractures healed within an average period of 9 months (range, 5-15 months) after surgical debridement. There was no recurrence of infection at an average follow-up of 25 months (range, 12-76 months). In group II, seven fractures healed within an average of 10 months (range, 4-24 months) after treatment. At an average follow-up of 33.8 months (range, 12-79 months), infected nonunion was noted in two patients. More complications occurred in group II patients in comparison with group I patients. Limited range of motion of the knee joint was usually encountered if a fracture was stabilized with external fixation for a prolonged period of time. CONCLUSION: Retention of the intramedullary nail is performed if the fixation is stable and the infection is under control. External fixation is most suitable for uncontrollable osteomyelitis or infected nonunion. Staged bone grafting is usually necessary when a bone defect is present.

Adolescent↗
PubMed2003

Shock wave application enhances pertussis toxin protein-sensitive bone formation of segmental femoral defect in rats.

UNLABELLED: Extracorporeal shock waves (ESWs) elicit a dose-dependent effect on the healing of segmental femoral defects in rats. After ESW treatment, the segmental defect underwent progressive mesenchymal aggregation, endochondral ossification, and hard callus formation. Along with the intensive bone formation, there was a persistent increase in TGF-beta1 and BMP-2 expression. Pretreatment with pertussis toxin reduced ESW-promoted callus formation and gap healing, which presumably suggests that Gi proteins mediate osteogenic signaling. INTRODUCTION: Extracorporeal shock waves (ESWs) have previously been used to promote bone repair. In our previous report, we found that ESWs promoted osteogenic differentiation of mesenchymal cells through membrane perturbation and activation of Ras protein. In this report, we show that ESWs elicit a dose-dependent effect on the healing of segmental defects and that Gi proteins play an important role in mediating ESW stimulation. MATERIALS AND METHODS: Rats with segmental femoral defects were subjected to ESW treatment at different energy flux densities (EFD) and impulses. Bone mass (mineral density and calcium content), osteogenic activities (bone alkaline phosphatase activity and osteocalcin content), and immunohistochemistry were assessed. RESULTS: An optimal ESW energy (500 impulses at 0.16 mJ/mm2 EFD) stimulated complete bone healing without complications. ESW-augmented healing was characterized by significant increases (p < 0.01) in callus size, bone mineral density, and bone tissue formation. With exposure to ESW, alkaline phosphatase activity and osteocalcin production in calluses were found to be significantly enhanced (p < 0.05). After ESW treatment, the histological changes we noted included progressive mesenchymal aggregation, endochondral ossification, and hard callus formation. Intensive bone formation was associated with a persistent increase in transforming growth factor-beta 1 (TGF-beta1) and bone morphogenetic protein-2 (BMP-2) expression, suggesting both growth factors were active in ESW-promoted bone formation. We also found that pertussis toxin, an inhibitor of membrane-bound Gi proteins, significantly reduced (p < 0.01) ESW promotion of callus formation and fracture healing. CONCLUSION: ESW treatments enhanced bone formation and the healing of segmental femoral defects in rats. It also seems likely that TGF-beta1 and BMP-2 are important osteogenic factors for ESW promotion of fracture healing, presumably through Gi protein-mediated osteogenic signaling.

Absorptiometry, Photon↗
PubMed2003

The effect of alendronate on bone mineral density in the distal part of the femur and proximal part of the tibia after total knee arthroplasty.

BACKGROUND: Bone mineral density around the knee is related to the mechanical properties of bone. Alendronate has been shown to be effective for the treatment of osteoporosis and for reducing the rate of osteoporotic fractures. The purpose of the present study was to investigate the effect of alendronate on bone mineral density in the distal part of the femur and proximal part of the tibia after total knee arthroplasty in women. METHODS: Ninety-six women with an average age of seventy years who were undergoing total knee arthroplasty were randomly divided into two groups. Patients in the study group received oral alendronate at a dose of 10 mg/day for six months, whereas patients in the control group did not. The bone mineral density in the distal part of the femur and proximal part of the tibia was determined preoperatively and at six and twelve months postoperatively. RESULTS: In the control group, the bone mineral density showed significant decreases of 13.8% (p < 0.001) and 7.8% (p = 0.003) in the distal part of the femur and of 6.5% (p = 0.002) and 3.6% (p = 0.141) in the proximal part of the tibia at six and twelve months, respectively. In the study group, however, the bone mineral density showed significant increases of 10.0% (p = 0.010) and 1.9% (p = 0.049) in the distal part of the femur and of 9.4% (p < 0.001) and 5.4% (p = 0.032) in the proximal part of the tibia at six and twelve months, respectively. The overall differences in bone mineral density between the study and control groups were significant (p = 0.011 for the proximal part of the tibia, and p = 0.033 for the distal part of the femur). CONCLUSIONS: We found significant postoperative decreases in bone mineral density in the distal part of the femur and proximal part of the tibia in women who had undergone total knee arthroplasty. Oral administration of alendronate for six months postoperatively significantly improved the bone mineral density. While the clinical benefits of alendronate after total knee arthroplasty remain unproven and the duration of follow-up in the present study was quite short, the improvement in bone mineral density may have a clinically important effect on prosthetic fixation and the rate of periprosthetic fractures after total knee arthroplasty.

Absorptiometry, Photon↗
PubMed2003

Hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis: a preliminary report.

BACKGROUND: Hyperbaric oxygen (HBO) has been proven to enhance bone and soft tissue healing in ischemic tissue in vitro and in vivo studies. Although only a few reports have been proven using controlled studies, this treatment modality remains encouraging for chronic refractory osteomyelitis. In this retrospective study, we reported the clinical results of HBO therapy for chronic refractory osteomyelitis. METHODS: From January through August 2000, 14 patients with chronic refractory osteomyelitis of the tibias treated with HBO were available for follow-up examination. According to the Cierny-Mader classification, all patients were classified as type III or IV osteomyelitis. Adequate debridement and parenteral antibiotic treatment in conjunction with HBO therapy at 2.5 atmospheres absolute for 120 minutes, and 5 days per week regimen was used in all patients. The patients were followed-up for an average of 15 months after completion of HBO therapy. RESULTS: The most common infecting microorganism was Staphylococcus aureus. Mixed infections were usually found in patients with open fractures. The average number of operations before HBO therapy was 5.4 including soft tissue reconstruction in 11 patients. The average number of HBO treatments was 33.6 times. There were no HBO related complications. No recurrence of infection was noted in 11 patients, which resulted in a success rate of 79%. CONCLUSIONS: Hyperbaric oxygen therapy is effective and safe for chronic refractory osteomyelitis provided that patients had received appropriate medical and surgical management.

Adult↗
PubMed2003

Surgical correction of postradiation spinal deformity.

BACKGROUND: Radiation to the juxtaspinal area in children with malignant tumors induces the appearance of a postradiation spinal deformity (PRSD) with drastic progression during the growth spurt, so surgical correction is mandatory. Methods of surgical treatment depend on the age of the patient, and the type and size of the spinal deformity. METHODS: A long-term retrospective survey of 6 patients receiving surgical management of kyphoscoliosis was conducted. The original tumors were 3 Wilms' tumors, 2 neuroblastomas, and 1 lymphoma. The mean length of time for tumor excision and subsequent radiation was 2.2 years. The total radiation dose averaged 3566 rad. The mean age at initial presentation was 6.1 years and that at spinal correction was 11.8 years. Single posterior surgery was performed in 3 cases, while the other 3 required anteroposterior correction due to severe deformity and scar contracture. RESULTS: The curves of PRSD were concave toward the side irradiated, and the kyphotic component was more severely involved than was the scoliotic component. Four patients had favorable correction without curve progression. However, in the other 2 younger patients, due to thinness of their back, rigid angulation of the spine, poor bony stock, and medical comorbidity, spinal instrumentation was rather difficult. Postoperative pseudarthrosis and subsequent rod protrusion occurred with progressive kyphosis. CONCLUSIONS: PRSDs consist of uncommon developmental vertebral anomalies, of which curved patterns occur in any combination, but most severely involve the presence of collapsing kyphosis and soft tissue contracture. Surgical correction may be less effective, especially if the children are skinny and have low bone stocks.

Child↗
PubMed2003

An overview of shock wave therapy in musculoskeletal disorders.

Shock waves are high-energy acoustic waves generated under water with high voltage explosion and vaporization. Shock wave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shock wave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce neovascularization, improve blood supply and tissue regeneration. The application of shock wave therapy in certain musculoskeletal disorders has been around for approximately 15 years, and the success rate in non-union of long bone fracture, calcifying tendonitis of the shoulder, lateral epicondylitis of the elbow and proximal plantar fasciitis ranged from 65% to 91%. The complications are low and negligible. Recently, shock wave therapy was extended to treat other conditions including avascular necrosis of femoral head, patellar tendonitis (jumper's knee), osteochondritis dessicans and non-calcifying tendonitis of the shoulder. Shock wave therapy is a novel therapeutic modality without the need of surgery and surgical risks as well as surgical pain. It is convenient and cost-effective. The exact mechanism of shock wave therapy remains unknown. Based on the results of animal studies in our laboratory, it appears that the mechanism of shock waves first stimulates the early expression of angiogenesis-related growth factors including eNOS (endothelial nitric oxide synthase), VEGF (vessel endothelial growth factor) and PCNA (proliferating cell nuclear antigen), then induces the ingrowth of neovascularization that improves blood supply and increases cell proliferation and eventual tissue regeneration to repair tendon or bone tissues. The rise of angiogenic markers occurred in as early as one week and only lasted for approximately 8 weeks, whereas the neovascularization was first noted in 4 weeks and persisted for 12 weeks or longer along with cell proliferation. These findings support the clinical observation that the effect of shock wave therapy appears to be dose-dependent and symptom improvement with time. Additional information including the cellular and molecular changes after shock wave therapy are needed for further clarification on the mechanism of shock wave therapy in musculoskeletal system.

Animals↗
PubMed2003

Simultaneous patellar fracture and patellar tendon avulsion following arthroscopic anterior cruciate ligament reconstruction: a case report and literature review.

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using the middle third of the patellar tendon is an effective method for treating ACL insufficiency. Donor site morbidities are usually mild. This article presents a case of simultaneous patellar fracture and patellar tendon avulsion that occurred 8 weeks after this operation. Such a case has rarely been reported. Theoretically, an accelerated rehabilitation protocol after ACL reconstruction may increase patellar stress and the potential for patellar fracture. However, it is still very important because complications such as arthrofibrosis, muscle atrophy, and patellofemoral pain may outweigh the chance of patellar fracture if adequate rehabilitation is not performed.

Adult↗
PubMed2002

Traumatic spinal subdural hematoma with spontaneous resolution.

STUDY DESIGN: A case report with a literature review is presented. OBJECTIVE: To describe and review the clinical presentations, characteristic findings from imaging studies, and treatment of traumatic spinal subdural hematoma. SUMMARY OF BACKGROUND DATA: Traumatic spinal subdural hematoma is uncommon, and only eight cases have been reported in the literature. Concomitant intracranial and spinal subdural hematoma in the same patient has not been well studied. METHODS: A case of concomitant spinal and intracranial subdural hematoma is reported as well as a review of the literature. RESULTS: Including our patient, we found that five of the nine patients with traumatic spinal subdural hematoma also had intracranial hematoma. We hypothesize that the mechanism of traumatic spinal subdural hematoma may be associated with intracranial events. Recognition of blood products in magnetic resonance imaging scans is important to distinguish spinal subdural hematoma from other spinal lesions. It is generally agreed that prompt laminectomy with evacuation of hematoma should be performed before irreversible damage to the spinal cord occurs. However, including our patient, three of the nine reported cases with thoracic or lumbar subdural hematoma resolved spontaneously with conservative treatment. CONCLUSIONS: This 12-year-old boy illustrated the rapid spontaneous resolution of traumatic subdural hematoma in both left hemisphere and lumbar spine with conservative treatment. This report suggests a possible role of conservative management for traumatic lumbar subdural hematoma, especially when the patients already have neurologic recovery.

Accidental Falls↗
PubMed2002

The thermal and mechanical anti-hyperalgesic effects of pre- versus post-intrathecal treatment with lamotrigine in a rat model of inflammatory pain.

UNLABELLED: Intrathecal (IT) lamotrigine, a sodium channel blocker which suppresses neuronal release of glutamate, has been shown to produce a long-lasting antihyperalgesic effect in the neuropathic pain models. In the present study, we examined the anti-hyperalgesic effects of pre- versus post-treatment of IT lamotrigine in an animal inflammatory pain model, the inflamed knee joint model of the rat. Thermal and mechanical antinociception was assessed in rats using a modified Hargreaves box and von Frey hairs. Induction of tonic persistent inflammatory pain was induced by intra-articular injection (i.a.) of a carrageenan-kaolin mixture (CK) into the right knee-joint. Rats were randomly assigned to the groups receiving IT lamotrigine in distinct doses of 5, 50 or 100 ug either pre- (10 min before CK injection) or post-inflammation induction (4 h or 23 h). We observed that CK injection resulted in a significant thermal and mechanical hyperalgesia throughout a 24-h observation period. Pre-treatment with IT lamotrigine revealed a time and dose-dependent suppression of thermal and mechanical hyperalgesia, whereas the post-treatment with IT lamotrigine only showed an effect for mechanical nociception. CONCLUSION: IT Lamotrigine is antihyperalgesic at a dose larger than 50 ug in the early phase of inflammatory pain model. It reverses tactile allodynia but not thermal hyperalgesia when given after the inflammation induction.

Analgesics↗
PubMed2002

Superoxide mediates shock wave induction of ERK-dependent osteogenic transcription factor (CBFA1) and mesenchymal cell differentiation toward osteoprogenitors.

Extracorporeal shock wave (ESW) is an alternative non-invasive method for the promotion of bone growth and tendon repair. In an animal model, we have reported that ESW promoted bone marrow osteoprogenitor growth through transforming growth factor-beta1 induction. We have further explored the mechanism for the ESW promotion of osteogenesis. Results showed that an optimal ESW treatment at 0.16 mJ/mm(2) for 500 impulses rapidly induced a higher O(2)(-) and ONOO(-) production associated with a decrease of nitric oxide level in 1 h, and induced a higher transforming growth factor-beta1 production in 24 h, and a higher colony-forming units-osteoprogenitor formation in 12 days. The colony-forming units-osteoprogenitor colonies revealed positive staining of bone alkaline phosphatase and turned into bone nodules in 21 days. Early scavenging of O(2)(-) but not Ca(2+), H(2)O(2), or prostaglandin E(2) suppressed osteoprogenitor cell growth and maturation. Scavenging of O(2)(-) by superoxide dismutase raised the nitric oxide level back to the basal level and suppressed ESW-promoted osteoprogenitor cell growth, whereas inhibition of ONOO(-) by urate or NO by N-nitro-l-arginine methyl ester did not affect ESW promotion of osteogenesis, indicating that O(2)(-) acted as an early signal for ESW-induced cell growth. Further studies demonstrated that ESW induced ERK activation, and blockage of O(2)(-) production or inhibition of tyrosine kinase, but not protein kinase A and C inhibitors, suppressed ESW-induced ERK activation. In support that O(2)(-) mediated the ESW-induced ERK activation and osteogenic differentiation, we further demonstrated that scavenging of O(2)(-) by superoxide dismutase and inhibition of ERK activation by PD98059 decreased specific osteogenic transcription factor, core binding factor A1 activation, and decreased osteocalcin expression. Taken together, we showed that ESW-induced O(2)(-) production followed by tyrosine kinase-mediated ERK activation and core binding factor A1 activation resulted in osteogenic cell growth and maturation. Thus, an appropriate modulation of redox reaction by ESW may have some positive effect on the bone regeneration.

Animals↗
PubMed2002

Pathomechanism of shock wave injuries on femoral artery, vein and nerve. An experimental study in dogs.

PURPOSE: To study the pathomechanism of shock wave injuries to the femoral artery, vein and nerve in dogs. MATERIALS AND METHODS: High-energy shock wave (0.47 mJ/mm(2) energy flux density) were applied to the right femoral artery, vein and nerve in nine mongrels, and the left side was used as control. Macroscopic examinations including structure integrity, edema, discolouration and extravasation; and microscopic examinations including detachment of the intima layer, disruption of the medium layer, capillary congestion, neutrophil margination and extravasation of the outer layer and the surrounding tissues were performed in 2 h, and in 4 days, respectively, after shock wave application. RESULTS: The most serious injuries included disruption of the medium layer with separation from the adventitia layer of the femoral artery. The injuries to the femoral vein and nerve predominantly involved the outer adventitia layer and the surrounding tissues. Mild nerve bundle swelling was noted in most cases. There were capillary congestion, neutrophil margination and extravasation indicative of inflammatory tissue reaction after shock wave application. CONCLUSION: High-energy shock waves caused serious injuries to the femoral artery, vein and nerve, especially the femoral artery and inflammatory reaction to the surrounding tissues.

Animals↗
PubMed2002

Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee.

PURPOSE: To evaluate the clinical outcome and the incidence of degenerative changes in 25 patients with 25 knees undergoing surgical reconstruction for combined posterior cruciate ligament (PCL) and posterolateral instabilities of the knee with 2-5-year follow-up. MATERIALS AND METHODS: This series included 16 men and 9 women with an average age of 28 years. The average time from injury to surgery was 10 (range 2-24) months, and the average follow-up time was 40 (range 32-60) months. The mechanisms of injury were 88% due to trauma, and 12% sports related. Arthroscopic single bundle posterior cruciate reconstruction and reconstruction of the posterolateral structures were performed in all cases. Clinical evaluations included functional assessment, ligament laxity and radiograph of the knee. The results were correlated with the duration of injury, the severity of ligament laxity and the follow-up time. RESULTS: The overall results were 68% satisfactory (28% excellent and 40% good) and 32% unsatisfactory (20% fair and 12% poor). Despite functional improvement, complete restoration of ligament stability was observed in only 44% of the knees, while 36% of the knees showed mild (<5 mm), and 20% moderate (5-10 mm) ligament laxity. There was no correlation of the clinical outcome with the duration from injury to surgery. The incidence of degenerative changes of the affected knee was 44%, and the rate correlated with the severity of ligament laxity, the duration from injury to surgery and the length of follow-up time. CONCLUSION: Despite the functional improvement, the currently devised surgical techniques only have modest success in restoration of ligament stability in knees with combined PCL and posterolateral instabilities. Further improvement in surgical technique including a dynamic reconstruction of the popliteus tendon complex seems necessary. The rate of degenerative changes of the affected knee appeared proportional to the duration of injury, the severity of ligament laxity and the length of follow-up time. The results of this study led us to recommend early surgical reconstruction for knees with combined posterior cruciate and posterolateral instabilities.

Adolescent↗
PubMed2002

Multiple ganglion cysts of the knee.

Only solitary ganglion cysts within the knee have been reported. Multiple ganglion cysts within the same knee have not been reported. The author describes a patient with 2 ganglion cysts, one in the anterior cruciate ligament and one in the lateral meniscus of the same knee. Surgery was performed because of recurrent pain and functional disability.

Adult↗