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1.
Ronny Lorentzon H. Alfredson Christer Hildingsson 《Knee surgery, sports traumatology, arthroscopy》1998,6(4):202-208
Twenty-six consecutive patients (19 men and 7 women) with a mean age of 31.5 years (range 19–52 years) who suffered from
an isolated full-thickness cartilage defect of the patella (area ranged from 0.75 to 20.0 cm2) and disabling knee pain were treated with autologous periosteal transplantation (without any chondrocytes). The duration
of symptoms was 59 months (range 11–144 months). During the first 5 postoperative days all patients were treated with continuous
passive motion (CPM). This was followed by active motion, slowly progressive strength training, and slowly progressive weight-bearing.
After a mean follow-up of 42 months (range 24–76 months), 17 patients (65%) were graded as excellent (were painfree), 8 patients
(31%) as good (had pain with strenous knee-loading activities), and 1 patient as poor (had pain at rest). Twenty-two patients
(85%) had returned to their previous occupation. Twelve patients (46%) had resumed sports or recreational activities at their
former level. Repeated magnetic resonance imaging (MRI) investigations showed progressive, and finally complete, filling of
the articular defects. Biopsies taken in five randomly selected cases showed hyaline-like cartilage. Patients with full-thickness
cartilage defects of the patella and disabling knee pain can be treated with autologous periosteal transplantation (without
any chondrocytes), followed by CPM, and slowly progressive strength training and weight-bearing. We believe this is a good
method to accomplish regeneration of articular cartilage and satisfactory clinical results.
Received: 25 March 1998 Accepted: 14 April 1998 相似文献
2.
Lisbeth Brax Olofsson Olle Svensson Ronny Lorentzon Inger Lindström Håkan Alfredson 《Knee surgery, sports traumatology, arthroscopy》2007,15(5):560-563
Autologous periosteal transplantation (without chondrocyte cell transplantation) for treating traumatic articular cartilage
defects of the patella gives pain relief in uncontrolled clinical studies. To study the whole transplanted area macroscopically
and microscopically, animal studies are motivated. In this pilot study, we reproduce the surgical technique for periosteum
transplantation on human patella to a rabbit model. A full-thickness cartilage defect of the whole patella was created in
eight adult female rabbits. The defect was treated with autologous periosteal transplantation. After surgery, the rabbits
were allowed free activity. This is the difference compared to the treatment in humans, where our group uses CPM for 5 days
and non-weight-bearing for 12 weeks. After 21 weeks, there was a diffuse synovitis in all transplanted knees, and in five
of eight knees there were signs of osteoarthritis in the patello-femoral joint. Histologically, in three animals, small islands
of hyaline cartilage surrounded by fibrocartilage were seen in the transplanted area. In the other five animals, fibrocartilage
was the predominant tissue. In contrast to previous experimental studies using a rabbit model, we did not achieve hyaline
cartilage resurfacing. 相似文献
3.
We have carried out a prospective randomised, single blind clinical trial to investigate the effect of continuous passive motion on range of knee flexion, lack of extension, pain levels and analgesic use after total knee replacement surgery. 85 subjects were randomly allocated to control or study group. All subjects followed the existing rehabilitation protocol, which permits immediate active range of motion exercises and mobilisation with the study group using continuous passive motion for 1 h, twice a day. Outcome measures employed were range of motion, pain assessed on a visual analogue scale and analgesic use according to the WHO ladder. Blinded evaluation was carried out preoperatively, at time of discharge from hospital, 6 weeks, 6 and 12 months postoperation. No significant difference was observed between groups at all time intervals for each outcome variable using Wilcoxon Rank sum tests. The results substantiate previous findings that short duration continuous passive motion following total knee arthroplasty does not influence outcome of range of motion or reported pain. 相似文献
4.
The use of continuous passive motion after arthroscopically assisted anterior cruciate ligament reconstruction: help or hindrance? 总被引:1,自引:1,他引:0
G. E. Witherow S. R. Bollen L. A. Pinczewski 《Knee surgery, sports traumatology, arthroscopy》1993,1(2):68-70
One hundred and eight patients having undergone arthroscopic anterior cruciate replacement and having had continuous passive motion (CPM) as part of their immediate post-operative regime were prospectively compared with 108 patients having an identical operative procedure but not receiving CPM. All patients were operated on by the same surgeon, and the two groups were well matched for age, weight and associated injuries and procedures. These not receiving CPM required significantly less analgesia (P-0.0001), had less blood loss measured in the drains (P=0.001) and had a shorter hospital stay (P=0.0001). At review 6 months after surgery, there was no significant difference between the two groups in the range of movement of the operated leg compared to the normal leg. 相似文献
5.
Niels B. Kock José M. H. Smolders Job L. C. van Susante Pieter Buma Albert van Kampen Nico Verdonschot 《Knee surgery, sports traumatology, arthroscopy》2008,16(5):461-468
Osteochondral transplantation is a successful treatment for full-thickness cartilage defects, which without treatment would
lead to early osteoarthritis. Restoration of surface congruency and stability of the reconstruction may be jeopardized by
early mobilization. To investigate the biomechanical effectiveness of osteochondral transplantation, we performed a standardized
osteochondral transplantation in eight intact human cadaver knees, using three cylindrical plugs on a full-thickness cartilage
defect, bottomed on one condyle, unbottomed on the contralateral condyle. Surface pressure measurements with Tekscan pressure
transducers were performed after five conditions. In the presence of a defect the border contact pressure of the articular
cartilage defect significantly increased to 192% as compared to the initially intact joint surface. This was partially restored
with osteochondral transplantation (mosaicplasty), as the rim stress subsequently decreased to 135% of the preoperative value.
Following weight bearing motion two out of eight unbottomed mosaicplasties showed subsidence of the plugs according to Tekscan
measurements. This study demonstrates that a three-plug mosaicplasty is effective in restoring the increased border contact
pressure of a cartilage defect, which may postpone the development of early osteoarthritis. Unbottomed mosaicplasties may
be more susceptible for subsidence below flush level after (unintended) weight bearing motion. 相似文献