Arthroscopic meniscal repair: a comparative study between three different surgical techniques

The purpose of this prospective study was to evaluate and compare the results of arthroscopic meniscal repair using three different techniques. Between January 2002 and March 2004, 57 patients who met the inclusion criteria underwent an arthroscopic meniscal repair. The outside-in technique was used in 17 patients (group A), the inside-out in 20 patients (group B), while the rest of the 20 patients (group C) were managed by the all-inside technique using the Mitek RapidLoc soft tissue anchor (Mitek Surgical Products, Westwood, MA, USA). Anterior cruciate ligament (ACL) reconstruction was performed in 29 patients (51%). The criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. The minimum follow-up was one year for all groups. The mean follow-up was 23 months for group A, 22 months for group B, and 22 months for group C. All meniscal repairs were considered healed according to our criteria in group A, while 19 out of 20 repairs (95%) healed in group B. Finally 7 of 20 repairs (35%) were considered failures in group C and this difference was statistically significant in comparison with other groups. The time required for meniscal repair averaged 38.5 min for group A, 18.1 min for group B, and 13.6 min for group C. Operation time for meniscal repair in group A was statistically longer in comparison with other groups. There were no significant differences among the three groups concerning complications. According to our results, arhtroscopic meniscal repair with the inside-out technique seems to be superior in comparison with the other methods because it offers a high rate of meniscus healing without prolonged operation time.Presented at the 11th ESSKA 2000 Congress, Athens, Greece, 2004     

Prospective comparative study between two different fixation techniques in meniscal allograft transplantation

Purpose

To compare the functional and radiographic results between two different horn fixation techniques for meniscal allograft transplant.

Methods

This is a prospective study of 88 meniscal allograft transplants with a mean 5-year follow-up. Forty transplants were performed on the medial compartment and 48 on the lateral compartment. The same surgeon performed all surgeries. Thirty-three grafts were fixed only with sutures (Group A) and 55 only with bony fixation (Group B). Both groups were comparable in terms of age, laterality, time since meniscectomy and preoperative functional and radiographic status. Functional assessment was done with Lysholm and Tegner scores and the Visual Analogical Scale for pain. Joint space narrowing was evaluated in the Rosenberg view.

Results

There was a significant improvement in Lysholm, Tegner and VAS scores without differences between Group A and Group B (n.s.). Radiographic evaluation did not show any joint space narrowing (n.s.). No differences in the comparison of all the variables of the two compartments were found. There were complications in 33.3 % of patients in Group A that including 7 graft tears (21.4 %) and in which there was an allograft failure rate of 9 %. Group B showed complications in 16.4 % of the patients and included 4 graft tears (7.3 %, n.s.) with an allograft failure rate of 3.6 %.

Conclusions

Meniscal allograft transplantation with either technique provided good functional and radiographic results at mid-term follow-up. Both graft fixation methods showed no differences relative to functional and radiographic results. There was a considerably higher rate of complications in transplantations performed with the only-suture technique than those with bony fixation, although the difference was not statistically significant with the numbers available. The results suggest that similar functional results should be expected whether the meniscal graft includes bone plugs or not. However, graft tears seem to happen more frequently if the MAT is performed without bony fixation.

Level of evidence

Prospective comparative study, Level II.     

腰交感神经节切除术手术方式的临床对比研究

目的 比较研究腹腔镜与开腹行腰交感神经节切除术的手术及术后并发症等情况.方法 2002年6月～2006年5月,采用腹腔镜腰交感神经节切除术(VALLS)治疗Buerger's病21例,在手术时间、出血量及术后并发症等方面与同期27例开腹手术进行对比.结果 VALLS组174±14.84min,明显高于开腹组132±32.81min(P＜0.05).VALLS组出血量为70±29.2ml,明显少于开腹组117±15.7ml(P＜0.05).VALLS组术后住院时间为3.7±1.3天,明显少于开腹组7.3±1.9天(P＜0.05).两组手术术后并发症发生率无明显差异,但并发症组成并不相同.两组手术的术后效果无明显差异.结论 腹腔镜腰交感神经节切除是治疗Buerger's病的安全、有效的手术方法,手术创伤小,并发症少,术后恢复快,值得临床推广.     

MR腮腺管成像不同序列的比较研究

目的：探讨几种MR成像序列对显示腮腺、导管的优劣以及对腮腺疾病导管系统的变化进行观察。方法：对25例健康志愿者和10例腮腺疾病患者进行腮腺区域常规MRI扫描后,利用IR-FSE、3DFRFSE-XL3DCUBET2WI3种序列进行腮腺管水成像,对得到的图像进行后处理,然后对其各自显示腮腺导管及其分支的效果进行评比。结果：IR-FSE显示健康正常志愿者腮腺导管22例,3D-FRFSEXL为25例,3D-CUBE-T2WI为24例,3种序列显示腮腺疾病患者导管的例数分别为8侧、10例、8例。IR-FSE、3D-FRFSE—XL背景组织较少,IR-FSE可显示主导管和二级导管,3D-FRFSEXI。经重建后可显示主导管、二级导管和三级导管且导管显示平滑,图像信噪比高,3D-T2W1经重建后可显示主导管和二级导管,且可显示腮腺导管腺体的关系以及腮腺病变侵及腮腺、导管的范围。结论：三种序列均能较好地显示腮腺导管,但各自有优势,对腮腺疾病的诊断具有重要意义。     

核心蛋白聚糖对骨性关节炎中软骨修复作用的形态学研究

目的 利用形态学方法,初步探讨核心蛋白聚糖(decorin,DCN)对骨性关节炎中软骨修复的作用.方法 选取SD大鼠制作骨关节炎模型,将DCN和转化生长因子(TGF)注射进关节腔,通过大体观察和组织学观察,利用国际软骨修复协会(International Cartilage Repair Society,ICRS)评分...     

Surgical repair of the distal biceps brachii tendon: a comparative study of three surgical fixation techniques

Purpose  

Several fixation techniques exist to repair the distal biceps brachii tendon. We aimed to evaluate the clinical and functional outcomes after distal biceps tendon repair using three different fixation techniques.     

Magnetic resonance imaging of cartilage and cartilage repair

Magnetic resonance (MR) imaging of articular cartilage has assumed increased importance because of the prevalence of cartilage injury and degeneration, as well as the development of new surgical and pharmacological techniques to treat damaged cartilage. This article will review relevant aspects of the structure and biochemistry of cartilage that are important for understanding MR imaging of cartilage, describe optimal MR pulse sequences for its evaluation, and review the role of experimental quantitative MR techniques. These MR aspects are applied to clinical scenarios, including traumatic chondral injury, osteoarthritis, inflammatory arthritis, and cartilage repair procedures.     

Quantitative cartilage volume measurement using MRI: comparison of different evaluation techniques

This study was aimed to investigate the accuracy and time saving of MRI Argus application in the assessment of cartilage volume in osteoarthritic knees. Twelve knees of patients suffering from osteoarthritis were scanned with a 1.5 T MRI using a 3D gradient echo sequence with selective water excitation. Cartilage volume of the tibial and patellar compartment was determined with a validated multiprocessing computer system (Octane Duo, Silicon Graphics, Mountain View, Calif., USA). The calculated cartilage volumes were compared to the results acquired by the Argus (Siemens Inc., Erlangen, Germany) application software using the MRI data sets. Compared to the multiprocessing computer system a time saving of at least 30 min for cartilage volume determination was achieved. The mean differences of Argus versus the multiprocessing computer system were 4.26±0.84 and 7.80±0.87% for the medial and lateral tibial plateau and 5.94±0.59% for the patella (no statistical significant difference; P>0.05). The applied Argus software can be used for fast and accurate determination of cartilage volume in the knee joint.The authors certify that there is no actual or potential conflict of interest in relation to this article     

Lateral clavicle fracture with coracoclavicular ligament injury: a biomechanical study of 4 different repair techniques

Purpose

To investigate the biomechanical performance of four different methods used for coracoclavicular (CC) ligament reconstruction in a lateral clavicle fracture repair.

Methods

Native displacement, translation, and rotation at the acromioclavicular joint of 24 fresh-frozen cadaveric shoulders were tested. A reproducible fracture in the lateral third of the clavicle was created by dissecting both CC ligaments. Each specimen was then repaired with plate fixation of the fracture and the following CC repair technique: (1) Cortical button. (2) Suture anchor and plate button. (3) Suture anchor no plate button, and (4) Suture around coracoid. All reconstructed specimens were then re-tested for displacement, translation, and load to failure, and compared to their native results. Groups 1 and 3 were investigated for rotational load.

Results

There was no difference in load to failure between the repaired groups (p: ns). Group 1 showed less superior and anterior translations (p?<?0.05). Group 2 showed significantly less superior translation (p?=?0.003), but no significance with anterior and posterior translations to the native joint. Group 3 showed less superior and posterior translations (p?=?0.005 and p?=?0.039). Anterior and posterior translations were increased in group 4 (p?<?0.05).

Conclusion

The biomechanical analyses did not show any significance in load to failure or displacement after cyclic loading among the study groups. All repairs were effective in preventing superior translation. Groups 1 and 2 demonstrated increased horizontal stability compared to the native state. All 4 methods are clinically viable options for CC ligament repair.

     

A biomechanical analysis of meniscal repair techniques

BACKGROUND: Various methods are available for repair of meniscal tears: a biodegradable meniscal implant without sutures (Biofix meniscus arrow), a suture anchor device (T-fix), and horizontal and vertical mattress sutures. HYPOTHESIS: There is no difference in repair strength or mode of failure among the techniques compared. STUDY DESIGN: Controlled laboratory study. METHODS: Reproducible tears were created in bovine menisci and repaired with each of the techniques. Residual displacement of the tear immediately after repair and the resistance to displacement under load applied perpendicular to the tear were measured and compared. RESULTS: The residual displacement after repair was highest in the Biofix arrow group (0.70 mm) and lowest in the vertical mattress suture group (0.21 mm). The ultimate strength of repair was strongest for the vertical sutures (202 +/- 7 N) and lowest for the arrow and T-fix (95.9 +/- 8 N and 99.4 +/- 8 N, respectively). The force required to generate 2 mm of tear displacement was greatest for the vertical sutures (143 N) and least for the arrow (43.6 N). CONCLUSIONS: Suture techniques were stronger at all levels of testing. CLINICAL RELEVANCE: Knowledge of biomechanical characteristics aids the surgeon in choosing the appropriate technique for each situation.     

Magnetization transfer analysis of cartilage repair tissue: a preliminary study

Purpose To evaluate the magnetization transfer ratio (MTR) after two different cartilage repair procedures, and to compare these data with the MTR of normal cartilage.Design and patients Twenty-seven patients with a proven cartilage defect were recruited: 13 were treated with autologous chondrocyte implantation (ACI) and 14 were treated with the microfracture technique (MFR). All patients underwent MRI examinations with MT-sequences before the surgical treatment, after 12 months (26 patients) and after 24 months (11 patients). Eleven patients received a complete follow-up study at all three time points (five of the ACI group and six of the MFR group). All images were transferred to a workstation to calculate MTR images. For every MT image set, different ROIs were delineated by two radiologists. Means were calculated per ROI type in the different time frames and in both groups of cartilage repair. The data were analyzed with unpaired t- and ANOVA tests, and by calculating Pearson’s correlation coefficient.Results No significant differences were found in the MTR of fatty bone marrow, muscle and normal cartilage in the different time frames. There was a significant but small difference between the MTR of normal cartilage and the cartilage repair area after 12 months for both procedures. After 24 months, the MTR of ACI repaired cartilage (0.31±0.07) was not significantly different from normal cartilage MTR (0.34±0.05). The MTR of MFR repaired cartilage (0.28±0.02), still showed a significant difference from normal cartilage.Conclusion The differences between damaged and repaired cartilage MTR are too small to enable MT-imaging to be a useful tool for postoperative follow-up of cartilage repair procedures. There is, however, an evolution towards normal MTR-values in the cartilage repair tissue (especially after ACI repair).     

A comparative study based on dosimetric properties of different sugars.

Measurements of free radical densities in sugar by electron spin resonance (ESR) constitute a useful method for determining the dose received in the case of accidental irradiation because this material retains its radiation history. The aim of this work is to establish methods for practical dose assessment of people involved in ionising irradiation accidents, using two types of sugar: sucrose and dextrose. In this regard, practical considerations of sample preparation, grain size, ESR spectrum and spurious mechanical-induced ESR signal are discussed. Also presented are results for signal reproducibility, radiation response, signal stability and low-dose values. Studies on irradiated samples were carried out to explain the complex spectra derived from different paramagnetic species.     

Proteoglycan fragments in anterior cruciate ligament reconstructed knees: a comparative study of two different surgical techniques

Proteoglycan fragments (PF) as chondroitin sulphate were monitored and compared in two groups of patients who had anterior cruciate ligament reconstruction with either patellar tendon (PT) or quadruple semitendinosus tendon (ST) autografts. There were 20 ST and 21 PT reconstructions. No difference existed between the groups in terms of associated lesion and time from injury to surgery. Synovial sample was collected at 6 weeks, 3 months and 18 months after the operation. No difference was noted between the groups at 18 months in terms of activity level and functional scores. Both groups demonstrated a sudden increase of PF at 6 weeks with respect to preoperative quantities (p<0.0001). A significant decrease occurred in the PT group at 3 months (p<0.008). Even at 18 months, it was significantly below the preoperative values (p<0.004). However, the decrease in ST cases relative to 6 weeks was insignificant at 3 months and quantities did not drop below the preoperative levels at 18 month (p=0.79). These results confirm again a gradual decrease of PF values in PT-reconstructed knees depending on time and surgery. Reconstruction with quadruple ST does not seem to have the same effect until 18 months postoperatively. Achievement of almost the same level of activity and function in both groups does not necessarily reflect the molecular status.     

几种影像方法对脊柱转移瘤诊断的比较

目的 :分析 93例脊柱转移瘤的MRI、ECT、SCT、X线平片征象 ,以提高脊柱转移瘤的早期诊断率。方法 :回顾性分析 93例经手术病理或随访证实的脊柱转移瘤的MRI、ECT、SCT、X线平片表现。结果 :93例脊柱转移瘤共发现2 79个椎骨异常、184处椎管受累、12 0处椎旁软组织肿块、12 0处椎体病理性骨折。MRIT1 WI表现为低信号 73 .3 %( 198/2 70 ) ,T2 WI表现为高信号 62 .2 %( 168/2 70 ) ,FS T2 WI表现为高信号 85 .2 %( 2 3 0 /2 70 ) ;ECT检出的 2 61处病灶表现为多处放射性浓聚或单发放射性浓聚 ;CT检出 184处病灶表现为局限性或大片骨质破坏 ;X线平片检出的 92处表现为骨质破坏。结论 :MRI及ECT敏感性高于SCT和X线平片 ,MRI、SCT、X线平片特异性高于ECT ;MRI是诊断脊柱转移瘤一种高敏感性和特异性的方法 ,优于ECT、SCT、X线平片 ;脊柱转移瘤首选ECT并结合X线检查 ,必要时SCT或 /和MRI检查。     

高感度数字化全脊柱摄影的对照研究

目的 探讨选择高感度数字化(DR)全脊柱摄影的临床应用及其X射线辐射防护价值。方法 选取90例脊柱侧凸患者按感度等分成S200、S400和S800 3组摄取正侧位全脊柱片。以S400组作为对照组计算,并比较3组不同感度曝光所产生的照射剂量(mGy)、曝光量(mAs);盲式评判3组不同感度全脊柱片影像质量。结果 当感度升至800时其照射剂量均值和曝光量均值约为对照组S400的43%和41%,两组差异有统计学意义(t=4.573、8.038,P<0.05);当感度设置为200时其照射剂量均值和曝光量均值约为对照组S400的187%和178%,两组差异有统计学意义(t=-5.624、-4.052,P<0.05)。感度为200、400时,其正位、侧位影像质量均为优或良,优良率均为100%;感度为800时,其正位、侧位影像质量仍以优、良为主,优良率分别为100%和97%,侧位出现1例中等级影像。结论 对以观察椎体及大范围的脊柱主体形态为主要诊治目的的DR全脊柱摄影可适宜地选择感度S800进行拍摄。     

Basic science of articular cartilage repair

As the ability to understand the peculiarities of successful healing of articular cartilage defects moves forward, it becomes clear that this complex orthopaedic problem soon will be successfully addressed. A multidisciplinary approach, combining clinical experience, cogent biomaterial designs, new cell biologic processes, biomechanical assessment, and modern molecular biology, clearly is leading toward clinically acceptable, viable, and consistent articular cartilage regeneration.