Isolated ACL versus multiple knee ligament injury: associations with patient characteristics,cartilage status,and meniscal tears identified during ACL reconstruction

Objectives: The objectives of this study were to determine (1) if patients undergoing reconstruction of an isolated anterior cruciate ligament (ACL) tear had different characteristics (age, gender, body mass index [BMI]) than patients undergoing ACL reconstruction (ACLR) with multiple knee ligament (MKL) tears and (2) whether there was a difference in prevalence of articular cartilage injury and meniscus tears between these two groups.

Methods: Patients undergoing primary ACLR between February 2005 and June 2013 were identified through an ACLR registry. Patients were grouped by whether they had an isolated ACL tear or an ACL tear associated with another knee ligament tear. The study cohort was analyzed to identify differences in patient characteristics and cartilage/meniscus injury patterns between the groups.

Results: Of the 21,377 ACLR cases enrolled in the registry during the study period, 2.5% (n = 549) had MKL tears. The MKL group had more males (73.2% vs. 62.8%, p < 0.001) than the isolated ACL group. The MKL group also had a higher percentage of patients with a BMI greater than 30 (31.1% vs. 22.7%, p = 0.0002). When adjusting for these variables, any articular cartilage injury was equal in the two groups (OR = 1.01, CI 0.82–1.25, p = 0.922), while medial femoral condyle injury was less common in the MKL group (OR = 0.73, CI = 0.56–0.07, p = 0.28). The likelihood of any meniscus tear was lower in the MKL group (OR = 0.56, CI = 0.47–0.67, p < 0.001) as was the likelihood of medial meniscus tears (OR = 0.53, CI = 0.44–0.65, p < 0.001).

Conclusions: When comparing patients with MKL tears versus isolated ACL tears at ACLR, there was a higher percentage of males and patients with BMI over 30 in the MKL group. Medial femoral condyle articular cartilage injury, any meniscus tear, and medial meniscus tears were less common in patients with MKL injury compared to patients with isolated ACL tears.     

骨软骨栓液相线跟踪法处理方案研究

关节软骨的长期保存是临床上软骨移植得以广泛开展的技术保证。液相线跟踪法作为一种新型的玻璃化保存方法,是一种很有价值的关节软骨低温保存技术。本研究从数值分析的角度指出了应用现有液相线跟踪法方案处理骨软骨栓存在的不足,并以避免软骨细胞在处理过程中遭受冰晶损伤为目标,提出了 软骨直径6 mm、厚1 mm的骨软骨栓的液相线跟踪法处理方案,方案共13步,包括降温提高浓度、升温降低浓度两个过程,共计耗时1012 min。为减少处理时间,采取尽可能降低载入浓度、强化传质过程等措施显得十分有必要。     

咀嚼负荷对幼兔髁突软骨细胞BrdU标记影响的研究

目的 探讨咀嚼负荷对幼兔髁突软骨发育及软骨细胞中BrdU标记的影响。方法 出生10 d龄的32只幼兔,随机分为喂食固体硬饲料组和喂食粉末软饲料组。连续2周每天每只腹腔注射BrdU （50 mg/kg）,在2、4、6、8周时每组处死4只幼兔,HE观察组织形态学变化测量软硬组髁突厚度变化,免疫组化检测BrdU表达。结果 髁突软骨前部厚度硬食组明显高于软食组,在中部无明显差异,髁突软骨后部厚度软食组高于硬食组。BrdU免疫组化染色显示,发育期髁突软骨各层及软骨下骨骨髓腔内均有BrdU阳性标记,前部的增殖层表达最显著。第2周,硬食组在前、中、后3个部位的BrdU阳性率都高于软食组;第6周,软食组的中、后部位的阳性率高于硬食组;第8周,软硬组均检测不到阳性细胞。结论 软食组在低咀嚼力刺激下,幼兔髁突软骨细胞增殖启动较慢。适当的咀嚼压力能促进髁突软骨细胞的增殖,同时幼兔发育期的髁突生长还受到基因等内环境因素影响。     

Effects of growth factors and glucosamine on porcine mandibular condylar cartilage cells and hyaline cartilage cells for tissue engineering applications

Temporomandibular joint (TMJ) condylar cartilage is a distinct cartilage that has both fibrocartilaginous and hyaline-like character, with a thin proliferative zone that separates the fibrocartilaginous fibrous zone at the surface from the hyaline-like mature and hypertrophic zones below. In this study, we compared the effects of insulin-like growth factor-I (IGF-I), basic fibroblast growth factor (bFGF), transforming growth factor beta1 (TGF-β1), and glucosamine sulphate on porcine TMJ condylar cartilage and ankle cartilage cells in monolayer culture. In general, TMJ condylar cartilage cells proliferated faster than ankle cartilage cells, while ankle cells produced significantly greater amounts of glycosaminoglycans (GAGs) and collagen than TMJ condylar cartilage cells. IGF-I and bFGF were potent stimulators of TMJ cell proliferation, while no signals statistically outperformed controls for ankle cell proliferation. IGF-I was the most effective signal for GAG production with ankle cells, and the most potent upregulator of collagen synthesis for both cell types. Glucosamine sulphate promoted cell proliferation and biosynthesis at specific concentrations and outperformed growth factors in certain instances. In conclusion, hyaline cartilage cells had lower cell numbers and superior biosynthesis compared to TMJ condylar cartilage cells, and we have found IGF-I at 100 ng/mL and glucosamine sulphate at 100 μg/mL to be the most effective signals for these cells under the prescribed conditions.     

关节镜下微骨折术治疗膝关节软骨缺损临床疗效观察

目的比较关节镜下关节清理术结合软骨缺损区微骨折术与关节清理灌洗术治疗膝关节软骨全层缺损的临床疗效.方法对2002年1月～2004年10月的膝关节全层软骨缺损患者,分别行膝关节镜下关节清理术结合软骨缺损区微骨折术(29例)和关节清理灌洗术(22例),根据临床症状及Tegner运动评级判定疗效,随访观察6～24个月.结果关节清理术结合软骨缺损区微骨折术总有效率89.7%,关节清理灌洗术总有效率59.1%,组间比较有统计学差异(P＜0.05).结论关节镜下关节清理术结合软骨缺损区微骨折术治疗膝关节软骨缺损的疗效优于关节清理灌洗术.     

Y形自体耳甲软骨移植整复双侧唇裂鼻畸形的临床评价

目的:对Y形自体耳甲软骨移植整复双侧唇裂鼻畸形的临床治疗效果进行评价.方法:以笔者医院收治的16例双侧唇裂鼻畸形患者为研究对象,保留耳轮脚等耳廓支撑结构,切取C形自体耳甲软骨制备成Y形软骨支架植入鼻小柱,重塑鼻翼软骨支撑结构和鼻尖外形,并利用三维激光扫描技术评价手术治疗效果.结果:术后对16例双侧唇裂鼻畸形患者进行1～...     

羌活胜湿汤治疗膝关节软骨Ⅰ级损伤38例

[目的]观察羌活胜湿汤治疗膝关节软骨Ⅰ级损伤疗效。[方法]使用羌活胜湿汤治疗膝关节软骨Ⅰ级损伤38例2,0d后进行疗效判定。[结果]痊愈29例,显效,1例,有效8例,总有效率100.00%。[结论]膝关节软骨Ⅰ级损伤尽早使用羌活胜湿汤进行治疗,效果满意。     

不同浓度医用臭氧对实验大鼠膝关节组织结构安全性评价

目的 观察不同浓度医用臭氧对实验大鼠膝关节软骨组织的病理变化影响,以评估对正常软骨、滑膜组织的氧化应激程度.方法 32只实验大鼠随机分为A、B、C、D4组,每组各10只随机选择一侧膝关节腔内注射医用臭氧气体.A组为浓度10 mg/L,B组为30 mg/L,C组浓度为50 mg/L,D组浓度为80 mg/L,4组分别注射1ml气体.注射医用臭氧后2d、2周、4周后分别对膝关节软骨、滑膜取活组织行病理学光镜检查,对侧膝关节软骨取活组织作空白对照组.结果 与空白对照组比较,病理光镜下显示,关节内注射10 mg/L医用臭氧2d、2周、4周后软骨、滑膜组织未见明显异常.50 mg/L浓度的医用臭氧对软骨、滑膜的氧化作用比30mg/L的稍强,80 mg/L浓度的医用臭氧氧化作用要强许多,软骨在注射80 mg/L浓度的医用臭氧后2周后出现不同程度的病理改变,并且4周后软骨出现组织结构破坏.结论 当医用臭氧浓度达到50 mg/L以上时,开始对软骨、滑膜细胞产生损伤,80 mg/L浓度的医用臭氧出现组织结构破坏.提示在临床应用中30 mg/L的医用臭氧浓度是安全的.     

壳聚糖/磷酸甘油复合自体间充质干细胞修复关节软骨缺损的实验研究

目的探讨壳聚糖/磷酸甘油(C/GP)复合自体间充质干细胞(MSCs)对兔关节软骨缺损的修复作用。方法选择3个月龄新西兰大耳白兔18只,双下肢髁关节面上共制作3个直径3mm、深3mm的全层软骨缺损,自左到右为:C/GP复合自体MSCs组(A组),C/GP组(B组),空白对照组(C组)。分别于术后4、8、12周各处死6只,应用大体观察、组织学观察及组织学评分评估缺损软骨的修复情况。结果A组术后12周,组织切片显示新生组织中可见大量类透明软骨细胞出现,修复组织和周围软骨整合良好。A组各个时间点组织学评分均高于其他2组(P<0.05)。结论C/GP复合自体MSCs可促进对兔关节软骨缺损的修复。