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PubMedDate not supplied

Gene therapy and tissue engineering in orthopaedic surgery.

A new biologic era of orthopaedic surgery has been initiated by basic scientific advances that have resulted in the development of gene therapy and tissue engineering approaches for treating musculoskeletal disorders. The terminology, fundamental concepts, and current research in this burgeoning field must be understood by practicing orthopaedic surgeons. Different gene therapy approaches, multiple gene vectors, a multitude of cytokines, a growing list of potential scaffolds, and putative stem cells are being studied. Gene therapy and tissue engineering applications for bone healing, articular disorders, intervertebral disk pathology, and skeletal muscle injuries are being explored. Innovative methodologies that ensure patient safety can potentially lead to many new treatment strategies for musculoskeletal conditions.

Animals↗
PubMed1994

Adhesive lesions of the talocrural joint.

Iatrogenic and posttraumatic adhesive lesions of the ankle joint are rather common, although infrequently reported, clinical entities. Ankle arthroscopy has proved to be a valuable asset in the assessment and treatment of recalcitrant symptomatic cases of both localized adhesions and adhesive capsulitis. This article intends to broaden the reader's understanding of the clinical presentation and intra-articular derangements of these lesions.

Ankle Joint↗
PubMed1997

New laminoplasty after thoracic and lumbar laminectomy.

We report the development of a new laminoplasty for the thoracic and lumbar spine. In this method, after two or three laminae are subjected to en bloc laminectomy using a surgical air drill, median longitudinal incisions are made in the laminae from the ventral side with a microsurgical saw and then the resected laminae are put back in place, like pitching a tent. Because fixation is accomplished with silk thread, magnetic resonance imaging is unaffected. In 39 cases in which this method was used, the spinal canal was adequately enlarged and bony union was also satisfactory starting after a mean of 4.3 months. This method is useful as a form of anatomical repair after laminectomy. Because it preserves the posterior element, it helps to prevent shrinkage of the laminectomy membrane mass and postoperative spinal column deformity.

Adolescent↗
PubMed1994

Predicting palmar radio-carpal ligament disruption in fractures of the distal articular surface of the radius involving the palmar cortex.

12 adult cadaver wrists were dissected to identify the regions of origin of the four palmar radio-carpal ligaments. A non-dimensionalized value, called the radio-carpal ligament ratio (RLR), was defined as the width of ligament origin from the radius divided by the length of the capitate. Both values were measured directly from radiographs of the cadaver specimens. The RLRs for the four palmar radio-carpal ligaments were found to be statistically consistent. We applied the RLR concept retrospectively to 20 wrists with intraarticular distal radius fractures requiring open reduction. It was found that those fracture patterns in which the fracture fragment ratios (FFR: widths of the fracture fragments divided by the length of the capitate) were outside the limits of corresponding RLRs had clear intra-operative evidence of palmar radio-carpal ligament disruption, while those with FFRs within the limits of corresponding RLRs were noted to have no ligament disruption.

Adult↗
PubMed1991

[Results after surgical stabilization of the ruptured shoulder joint. Combination procedure versus Bosworth screw].

From 1979 to 1989, 46 patients were operated on for luxation of the acromioclavicular joint (Tossy III) in the department of trauma surgery of the Krankenhaus der Barmherzigen Brüder, Eisenstadt. During the first few years, a combination of traction strapping and Boswoth screws was applied (22 patients) Owing to the high incidence of joint trauma and resulting functional deficit, this procedure was abandoned in favour of fixation with the Bosworth screw alone, combined with transosseous refixation of the joint capsule. The incidence of postoperative complications was approximately equal for both procedures (a total of 3 infections which healed completely, 7 secondary dislocations on removal of the screws, 5 cases of broken or migratory screws). Radiological and clinical follow-up examinations were performed on 36 out of 46 patients up to 93 months postoperatively. In 14 cases, the radiological examination revealed moderate to pronounced signs of arthrosis; the combined procedure was followed by a significantly higher rate of arthrosis. A significant correlation was also found between residual displacement and the occurrence of arthrosis. In cases where only Bosworth screws were used, more joint diastases occurred. In the opinion of the authors, unsatisfactory results are likely to be due to faulty operational technique rather than to the method itself. In general, better reductional results were achieved with the combined method. With reference to the restoration of joint function, however, significantly better results were achieved with exclusively extra-articular stabilization.

Acromioclavicular Joint↗
PubMed2003

[Performance of an open low-field MR unit in routine examination of knee lesions and comparison with high field systems].

The purpose of this study was to analyze the diagnostic value of a low-field open MR system in the diagnosis of knee lesions and to compare it with that of high-field MR systems. In 139 knees,arthroscopic investigations were used as the gold standard to calculate sensitivity, specificity, predictive values and accuracy of the low-field open MR system. Figures for high field systems were taken from the literature. The values for the open MR system relative to arthroscopy were as follows: sensitivity 66%,specificity 95%,positive predictive value 64%,negative predictive value 92%, and accuracy 82%. The corresponding values taken from 10 relevant publications for highfield systems were: sensitivity 81%, specificity 90%, accuracy 90%. A lower diagnostic performance has to be expected using open low field MR units for knee lesions in comparison to high field units. Sedative drugs can make it possible for claustrophobic patients to be investigated in high-field units. The use of open low-field scanners may still be indicated in very adipose patients who do not fit into closed units.

Adolescent↗
PubMed2006

The repair response to osteochondral implant types in a rabbit model.

Current treatments for damaged articular cartilage (i.e., shaving the articular surface, perforation or abrasion of the subchondral bone, and resurfacing with periosteal and perichondrial resurfacing) often produce fibrocartilage, or hyaline-appearing repair that is not sustained over time (Henche 1967, Ligament and Articular Cartilage Injuries. Springer-Verlag, New York, NY, pp. 157-164; Insall 1974, Clin. Orthop. 101: 61-67; Mitchell and Shepard 1976, J. Bone Joint Surg. [Am.] 58: 230-233; O'Driscoll et al. 1986, J. Bone Joint Surg. [Am.] 68: 1017-1035; 1989, Trans. Orthop. Res. Soc. 14: 145; Kim et al. 1991, J. Bone Joint Surg. [Am.] 73: 1301-1315). Autologous chondrocyte transplantation, although promising, requires two surgeries, has site-dependent and patient age limitations, and has unknown long-term donor site morbidity (Brittberg et al. 1994, N Engl. J. Med. 331: 889-895; Minas 2003, Orthopedics 26: 945-947; Peterson et al. 2003, J. Bone Joint Surg. Am. 85-A(Suppl. 2): S17-S24). Osteochondral allografts remain a widely used method of articular resurfacing to delay arthritic progression. The present study compared the histological response to four types of osteochondral implants in a rabbit model: autograft, frozen, freeze-dried, and fresh implants. Specimens implanted in the femoral groove were harvested at 6 and 12 weeks. Results showed similar restoration of the joint surface regardless of implant type, with a trend toward better repair at the later timepoint. As has been observed in other studies (Frenkel et al. 1997, J. Bone Joint Surg. 79B: 281-286; Toolan et al. 1998, J. Biomed. Mater. Res. 41: 244-250), each group in this study had at least one specimen in which a healthy-appearing surface on the implant was not well-integrated with host tissues. Although the differences were not statistically significant, freeze-dried implants at both timepoints had the best histological scores. The osteochondral grafts tested successfully restored the gross joint surface and congruity. At 12 weeks, no significant differences were observed between the various allografts and autologous osteochondral grafts.

Animals↗
PubMed1993

Sagittal-plane mobility of the cat cervical spine.

The present study was conducted to evaluate the nature of sagittal-plane motion across cervical vertebral joints and to identify the centers of rotation for each joint in anaesthetized cats X-rayed in a range of head-neck postures. Relative positions of adjacent pairs of vertebrae were assessed by constructing transparent templates for each vertebra that could be overlaid onto different X-rays, and then by digitizing the locations of three markers attached at a distance from each template. The finite centers of rotation for each joint were estimated using a rigid-body method. The errors associated with the estimates were quantified further by using a method in which the positions of digitized markers were fitted to concentric circles using a least-squares approach. The center of rotation between the skull and C1 was located at the cranial articular facets between the two bones. The center of rotation between C1 and C2 was situated near the tip of the odontoid process close to the site of attachment of the transverse ligaments. Centers of rotation for the other cervical vertebral joints were located in the region of the intervertebral disc. A similar range of values was obtained for centers of rotation when extended or flexed postures were used for the calculations, suggesting that the centers of rotation may not move markedly throughout a range of sagittal-plane rotations of approximately 90 degrees at the skull-C1 joint and about 15-30 degrees at the other cervical joints. These results showed that all cervical joints rotated during sagittal-plane motion. A minimal representation of the musculoskeletal mechanics of the feline neck probably requires multiple segments, each corresponding to a single vertebral bone.

Animals↗
PubMed1986

[Fractures and dislocation fractures of the wrist joint].

Most carpal fractures are based on the same injury mechanism. In most cases the injury is caused by a fall on the dorsiflexed hand, which is raised as a protective measure, and less frequently by a fall on the clenched fist. The latter leads to passive palmar flexion, pronation and radial inclination of the hand; in the former, the hand is passively superextended by the impact, supinated, and brought into ulnar inclination. The instability caused by injury to various articular structures has four developmental stages. The bones or syndesmoses that are involved depend on the stage and quantitative relationship between the three above-mentioned moments of force. If the lateral ligament of the wrist is slack, scaphoid fractures occur; in the last stage of superextension, fractures of the capitate bone occur. With increasing ulnar inclination, perilunar dislocations or fracture-dislocations and triquetrum fractures occur in the third stage and dislocations of the semilunar bone in the fourth stage. In addition, compression and avulsion of the 1st, 4th or 5th metacarpal bones cause fractures of the trapezium and the hamate bone. To avoid unpleasant late sequels, scaphoid fractures with diastasis due to soft tissue interposition or non-reducible dislocated scaphoid fractures must be treated surgically. Vertical oblique fractures and scaphoid fractures with small proximal fragments are relatively good indications for operation. Perilunar instability and dislocations, particularly De Quervain's fracture-dislocations, must be treated operatively because reduction of the scaphoid bone requires a different approach than correcting alignment in the carpus and because soft tissue interpositions are always present, even though they may not be evident in the X-ray pictures. Fracture-dislocations in the distal carpal row also require operation, preferably percutaneous internal fixation using K-wire and fluoroscopy. Immobilization is accomplished by a below-elbow cast with a dorsal plaster splint up to the interdigital webs and from the palmar to the proximal crease. The thumb is only embedded in trapezium fractures; fractures requiring fist or above-elbow casts are indications for operation.

Adolescent↗
PubMedDate not supplied

Histologic, histochemical, and ultrastructural studies of the hip joint capsule and ligamentum teres in congenital dislocation of the hip.

The histology, histochemistry, and ultrastructure were investigated in 12 ligamentum teres and 11 hip joint capsule biopsies obtained at open reduction of 9 patients with congenital dislocation of the hip (CDH) and of 2 normal hips. The ages of the patients ranged from 2 months to 4 years and 2 months. In the joint capsule of the dislocated hips, the cells were irregularly distributed, had different shapes, and appeared to be in different stages of functional activity. The collagen fiber bundles were thicker than in the normal capsule, distributed and of varied thickness. The collagen fibrils in the younger patients were thinner than in the normal hip and their diameter increased slightly with age. In the ligamentum teres of the dislocated hips the elastic fibers were thicker and more numerous than in the normal hip, whereas the cells and collagen fibrils showed changes similar to those observed in the capsule. Fibrocartilaginous metaplasia was found in both the capsule and the ligamentum teres in areas compressed by the femoral head. The morphologic and histochemical changes observed in the joint capsule in CDH appeared to be secondary to the mechanical stresses caused by the dislocation.

Cartilage, Articular↗
PubMed2005

Arthroscopic findings of the hip in new onset hip pain in adolescents with previous Legg-Calve-Perthes disease.

Nine adolescent patients with new onset hip pain and previous Legg-Calve-Perthes disease (LCPD) were evaluated by hip arthroscopy. Eight of the nine patients had previous hip surgery for their LCPD and a pain-free interval averaging over 5 years. Hip arthroscopy was performed in the supine position on a fracture table using a distention distraction technique. Eight of the nine hips had intra-articular abnormalities including; four tears of the ligamentum teres, three femoral head osteochondritis dissecans, two labral tears, two hips with significant synovitis and three hips with other femoral head abnormalities. Seven of the eight hips improved following their arthroscopic treatment and the patients returned to their before-pain activities including sports. Three patients have required subsequent surgery. The abnormal mechanics from residual femoral head deformity may increase the risk of developing a variety of painful lesions. Hip arthroscopy is a safe way to evaluate and treat these intra-articular abnormalities.

Adolescent↗
PubMed1982

Knee arthrography for the preoperative evaluation of juxta-articular masses.

Knee arthrography was performed on twenty-one patients with osseous and extraosseous masses about the knee. Twelve patients had arthrographic abnormalities. Joint involvement was accurately delineated in nine of the ten cases where it was present. Three other patients had small suprapatellar bursae with superior flattening, characteristic of noncommunicating suprapatellar synovial cysts. Fluoroscopic spot radiographs and conventional radiographs after injection of contrast material adequately defined the synovial recesses. Tomograms were needed whenever articular cartilage invasion was a possibility. The arthrographic findings were useful in planning the operative approach in all cases except for the one case where the arthrogram did not detect the intra-articular invasion.

Adult↗
PubMed1993

A two-dimensional dynamic model of the human knee joint.

A two-dimensional dynamic model of the knee joint was incorporated into a four-segment, eight-muscle model of the human body to determine the muscle, ligament, and articular contact forces transmitted at the knee as humans stand up from a static squatting position. Our optimal control model predicted peak tibiofemoral contact forces as high as 8 times body weight. Furthermore, ligament forces, especially those in the anterior-cruciate, were nearly body weight as knee flexion approached 90 degrees. Ligament and tibiofemoral contact loads were dominated by the forces exerted by muscles during the movement.

Biomechanical Phenomena↗
PubMed2006

Is the body-coil at 3 Tesla feasible for the MRI evaluation of the painful knee? A comparative study.

The purpose of this study was to compare the in-built body coil of the 3.0-Tesla (T) scanner with a dedicated surface coil of a 1.5 T system regarding knee imaging. We performed an intraindividual prospective clinical trial on 17 patients with knee pain using magnetic resonance imaging (MRI) at 1.5 and 3.0 T systems equipped with identical gradient systems. Proton-density-weighted turbo spin echo sequences with the same spatial resolution and comparable contrast parameters were used. A quantitative measurement of signal to noise ratio (SNR), relative contrast (RC) and contrast to noise ratio (CNR) between muscle and bone marrow was performed, followed by a qualitative assessment of anatomic/pathologic structures and the extent of artefacts. At 3.0 T, 30 lesions (91%) compared to 33 lesions at 1.5 T were detected. The SNR/CNR/RC were moderately reduced at 3.0 T versus 1.5 T (muscle 42 vs 47 and bone 83 vs 112/46 vs 69/0.33 vs 0.43). Motion artefacts from the pulsating popliteal artery were significantly increased at 3.0 T. A visible and measurable signal loss occurred at 3.0 T using the built-in body coil compared with the dedicated 1.5 T knee coil, but nearly all clinically important information could be obtained.

Adult↗
PubMed2001

Imaging of osteochondral injuries.

Acute injuries can produce fragments consisting of cartilage alone or cartilage and underlying bone. A purely cartilaginous fragment creates no direct radiographic abnormalities, whereas one containing calcified cartilage and bone appears as a radiodensity. The advent and refinement of MR imaging have led to the detection of occult injuries of subchondral bone and cartilage that can escape identification on routine radiographic analysis. The available data appear to indicate a substantial role for MR imaging in the analysis of lesion stability in cases of osteochondritis dissecans; however, further studies are required to determine its advantages over other methods, in particular, arthroscopy. Indirect evidence of cartilage abnormality on MR images relates to the identification of fluid at the interface between the fragment and the parent bone. The MR imaging technique influences dramatically whether such fluid is identified. MR arthrography employing the intra-articular injection of gadolinium compounds can be advantageous in the delineation of the chondral surface and in the detection of intraarticular bodies. Optimally, MR imaging would allow direct analysis of the cartilage surface, and specific imaging sequences that are most suited to this analysis are still evolving.

Arthrography↗