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To determine the magnetic resonance imaging (MRI) findings after mosaicplasty (MOS) for knee subchondral insufficiency fracture (SIFK), and to analyze the relationship between MRI findings and clinical outcomes. We retrospectively reviewed the cases of consecutive patients who underwent MOS for SIFK with/without high tibial osteotomy (HTO) between January 1998 and December 2015. The MRI findings at 12 months after the surgery were assessed by the modified magnetic resonance observation of cartilage repair tissue (MOCART) score to determine the degree of bone marrow edema (BME), plug union, and plug necrosis. The clinical outcomes were assessed by Lysholm score to clarify the minimal clinically important difference (MCID) and patient acceptable symptom state analysis. In total, 58 patients (17 men and 41 women) were enrolled in this study. Among them, 30 knees were treated by MOS alone and 28 knees were treated by MOS with HTO. The MOCART scores of patients who received MOS alone were significantly lower in BME score (P =.0060), plug union score (P =.0216), and in plug necrosis score (P =.0326) than patients who received MOS with HTO. BME lesion was less likely to persist among elderly (odds ratio 1.20, P =.0248) and female (OR 41.8, P =.0118) patients. The MCID of Lysholm score was 6.6 in MOS alone and 8.4 in MOS with HTO cases, but there were no significant association between MRI findings and the postoperative Lysholm score. The MOS with HTO cases had better MOCART scores with less BME, better plug union, and less plug necrosis compared with MOS alone cases. Female and older patients had better resolution of BME, but there was no significant correlation between MRI findings and the postoperative Lysholm score. All cases in both groups showed improvement of Lysholm score exceeding MCID; thus, MOS may be effective as a joint preserving surgery for SIFK. Level IV, clinical case series. [ABSTRACT FROM AUTHOR]

Background: We previously reported that early alendronate administration accelerated bone formation and improved the quality of repaired cartilage in the donor site in rabbits. To investigate whether alendronate administration has effects in humans similar to those observed in rabbits.Methods: The study cohort included 35 patients over the age of 12-years old who underwent mosaicplasty without osteoporotic therapy from March 2011 to October 2012. The donor sites were medial or lateral in the patellofemoral joint. Placebo (P) or Bonalon containing 35 mg of alendronate (A) was administered orally every week for 8 weeks. The cohort comprised 15 male and 20 female, including 14 right and 21 left knees. The mean age at the time of surgery was 57.1 years. Bone formation was examined using computer tomography and lateral knee radiography, and cartilage formation was examined using magnetic resonance imaging (MRI), second-look assessment, and intraoperative acoustic evaluation. The clinical outcomes were assessed using the Japanese Orthopaedic Association knee score and visual analog scale (VAS). Bone and cartilage formation in the donor site and clinical outcomes were assessed at 3, 6, and 12 months after mosaicplasty.Results: The ratio of TRAP-5b in group A was significantly smaller than that in group P at 2 and 8 weeks after mosaicplasty. The extent of bone formation in the donor sites in group A was significantly greater than that in group P at 3 and 6 months after mosaicplasty. Cartilage formation did not differ significantly between the two groups as determined by MRI, macroscopic assessment, and intraoperative acoustic evaluation. Clinical outcomes did not differ significantly between the two groups, and no negative clinical outcomes were observed.Conclusion: Early alendronate administration accelerated bone formation but not cartilage formation in the mosaicplasty donor site in humans. [ABSTRACT FROM AUTHOR]

• Many pitfalls are present for interpreting the BNP value. • Renal dysfunction, age, female sex, atrial fibrillation, inflammation, overestimate BNP level. • Hyperthyroidism, use of sacubitril/valsartan, and macro-proBNPemia also overestimate BNP. • Obesity, immediately after acute coronary syndrome onset, and pericardial effusion underestimate BNP value. • Cardiologists should note the pitfalls of interpretation of BNP. B-type (or brain) natriuretic peptide (BNP) is synthesized in cardiac myocytes and released constitutively into the circulation. Pressure/volume overload, neurohumoral factors, cytokines, and ischemia enhance BNP gene expression, and then precursor proBNP is produced. It has been thought that proBNP is cleaved into active BNP molecule and inactive marker molecule NT-proBNP intracellularly by processing enzyme furin, and they are released into the circulation. However, recent studies have shown that considerable amount of uncleaved proBNP circulates in the blood. The commercially available BNP assay kits consist of two antibodies that sandwich the BNP molecule. Therefore, if proBNP is present, BNP assay kit cross-reacts to proBNP and measures it as BNP. Therefore, it should be noted that the current BNP value is proBNP plus BNP. BNP and NT-proBNP have been established as a biomarker for heart failure patients presenting dyspnea. But many pitfalls are present for interpreting the BNP value. For example, the presence of renal dysfunction, age, female sex, atrial fibrillation, inflammation, hyperthyroidism, use of sacubitril/valsartan, and macro-proBNPemia overestimate BNP value, whereas the presence of obesity, immediately after acute coronary syndrome onset, and pericardial effusion underestimate BNP value. In the management for heart failure patients, BNP plays an important role. Therefore, clinicians should note the pitfall of interpretation of BNP and we describe the mechanism involved. [Display omitted] [ABSTRACT FROM AUTHOR]

Mineralization of cartilage is a key step in the development and growth of bone. A mineralization experiment conducted with rates reveals that the enzyme m-Calpain, a Ca2+ -dependent neutral cysteine proteinase, controls the mineralization of cartilages by degrading proteoglycan during development of the cells. The amount of m-Calpain and its activity in pelleted cultures of rat growth plate chondrocytes increases as the chondrocytes differentiate into the hypertrophic cells and mineralization takes place. In the presence of m-Calpain inhibitors matrix mineralization is suppressed.

This study was aimed at investigating the use of ultrasound parameters obtained non-invasively through soft tissue (ST) to evaluate degeneration in cartilage and subchondral bone (SB) in the human knee. We developed a 3-D ultrasound system and introduced the ratio parameters Rcb and RcbT to suppress the attenuation effect in the ST or in both the ST and cartilage. As reference measurements, the grade for cartilage by visual judgment (Gsum) and ultrasound parameters for the cartilage and the SB were directly evaluated under arthroscopy. Rcb correlated significantly with Gsum (rs = -0.63) and with the corresponding parameter obtained directly under arthroscopy (r = 0.55). RcbT also correlated significantly with Gsum (rs = -0.46) but was not superior to Rcb. Rcb is considered to be an efficient parameter that reflects the total degeneration in both the cartilage and SB, including the information on cartilage thickness. [ABSTRACT FROM AUTHOR]

• SGLT2 inhibitors prevent heart failure in T2DM. • Dapagliflozin improves the outcomes of HFrEF irrespective of the presence of DM. • Cardioprotective mechanisms of SGLT2 inhibitors are currently being discussed. • Ongoing studies will broaden the clinical importance of SGLT2 inhibitors. Despite recent developments in various therapies, heart failure remains a leading cause of morbidity and mortality worldwide. New pharmacological approaches are therefore needed to improve the outcomes of patients with heart failure. Diabetes mellitus is an important risk factor for heart failure, but until recently there had been no evidence that hypoglycemic agents prevent heart failure. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have now been shown to prevent cardiovascular events, especially hospitalization for heart failure, in three large randomized clinical trials: EMPA-REG OUTCOME, the CANVAS program, and the DECLARE-TIMI58 trial. It is expected, therefore, that SGLT2 inhibitors will be useful therapeutic agents for the treatment of heart failure. The DAPA-HF trial recently demonstrated that dapagliflozin significantly reduces cardiovascular death and hospitalization for heart failure in patients with heart failure with reduced ejection fraction (HFrEF). Importantly, these benefits of dapagliflozin were similarly observed in patients with or without diabetes, suggesting the drug's efficacy is independent of glycemic reduction. The results of that study highlight the significance of SGLT2 inhibition as a novel therapeutic approach to treating HFrEF, irrespective of the presence or absence of diabetes. Findings of the DAPA-HF trial may also challenge current assumptions about the mechanisms underlying the cardioprotective action of SGLT2 inhibitors. It is anticipated that ongoing clinical trials, mainly using dapagliflozin and empagliflozin, will provide further insight into the clinical importance of these drugs for the treatment of heart failure, including heart failure with preserved ejection fraction (HFpEF), and also the mechanisms underlying those clinical benefits. [ABSTRACT FROM AUTHOR]

Highlights • ANP and BNP are secreted by the heart and act as cardiac hormones. • Human ANP has three molecular forms: α-ANP, β-ANP, and proANP (or γ-ANP). • ProANP and β-ANP are minor forms but are increased in patients with heart failure. • ProBNP is secreted by the heart and is increased in patients with heart failure. • MiR30-GALNTs-dependent O -glycosylation contributes to the secretion of proBNP. Abstract The natriuretic peptide family consists of three biologically active peptides: atrial natriuretic peptide (ANP), brain (or B-type) natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). Among these, ANP and BNP are secreted by the heart and act as cardiac hormones. Both ANP and BNP preferentially bind to natriuretic peptide receptor-A (NPR-A or guanylyl cyslase-A) and exert similar effects through increases in intracellular cyclic guanosine monophosphate (cGMP) within target tissues. Expression and secretion of ANP and BNP are stimulated by various factors and are regulated via multiple signaling pathways. Human ANP has three molecular forms, α-ANP, β-ANP, and proANP (or γ-ANP), with proANP predominating in healthy atrial tissue. During secretion proANP is proteolytically processed by corin, resulting in secretion of bioactive α-ANP into the peripheral circulation. ProANP and β-ANP are minor forms in the circulation but are increased in patients with heart failure. The human BNP precursor proBNP is proteolytically processed to BNP 1-32 and N-terminal proBNP (NT-proBNP) within ventricular myocytes. Uncleaved proBNP as well as mature BNP 1-32 and NT-proBNP is secreted from the heart, and its secretion is increased in patients with heart failure. Mature BNP, its metabolites including BNP 3-32 , BNP 4-32 , and BNP 5-32 , and proBNP are all detected as immunoreactive-BNP by the current BNP assay system. We recently developed an assay system that specifically detects human proBNP. Using this assay system, we observed that miR30-GALNTs-dependent O -glycosylation in the N-terminal region of proBNP contributes to regulation of the processing and secretion of proBNP from the heart. [ABSTRACT FROM AUTHOR]

Background: There have been some reports of high tibial osteotomy combined with osteochondral autograft transfer for osteonecrosis of the medial femoral condyle of the knee. However, few of them have focused on the deep knee flexion needed to sit straight in the Japanese style.Purpose: To evaluate the clinical outcomes and the knee flexion of HTO combined with OAT for osteonecrosis of the medial femoral condyle of the knee, especially the ability to sit straight in the Japanese style.Methods: Between 1998 and 2012, valgus HTO combined with OAT was performed in 23 patients for stage IV osteonecrosis according to Koshino's radiological classification of the medial femoral condyle. The follow-up period was more than 2 years in all cases. The mean age at the time of the surgery was 65.8 years, and the mean follow-up period was 72.2 months. The function of the knee and the ability to sitting straight in the Japanese style were examined. Twenty-one knees were examined with second-look arthroscopy to assess the recipient and donor sites.Results: The JOA scale and IKDC subjective scores were significantly improved. Twelve patients were able to sit straight in the Japanese style after the surgery, compared to 3 patients who were able to do so before surgery. On second-look arthroscopy of 21 knees, the average ICRS score was 10.5 points. No patient needed additional surgery except for removal of the implants.Conclusion: Valgus HTO combined with OAT is one treatment option for osteonecrosis of the medial femoral condyle with osteoarthritis. In the present study, many of the patients regained good knee function, and 50% of the patients were able to sit straight in the Japanese style after surgery, which is a higher rate than after total knee arthroplasty and unilateral knee arthroplasty. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify ultrasound parameters reflecting subchondral porosity (Po), subchondral plate thickness (Tpl) and bone volume fraction at the trabecular bone region (BV/TVTb). Sixteen osteoarthritic human lateral femoral condyles were evaluated ex vivo using a 15-MHz pulsed-echo ultrasound 3-D scanning system. The cartilage-subchondral bone (C-B) surface region (layer 1) and inner subchondral bone region (layer 2) were analyzed; we newly introduced entropy (ENT) and correlation (COR) of ultrasound texture parameters of the parallel (x) or perpendicular (z) direction to the C-B interface for this analysis. Po, Tpl and BV/TVTb were evaluated as reference measurements using micro-computed tomography. ENTL1x (ENT of layer 1, x-direction) and ENTL1z were significantly correlated with Po (both r values = 0.58), CORL2x with Tpl (r = -0.73) and CORL2z with BV/TVTb (r = -0.66). These are efficient indicators of the characteristics of osteoarthritis-related subchondral bone; the other texture parameters were not significant. [ABSTRACT FROM AUTHOR]

B-type natriuretic peptide (BNP) is a cardiac hormone widely used as a biomarker for heart failure. Here, we present the first report of extremely high levels of immunoreactive BNP caused by formation of macro-proBNP. A 70-year-old woman with left ventricular hypertrophy and normal systolic function presented with extremely high plasma levels of BNP (35,374 pg/ml) and N-terminal proBNP (NT-proBNP; 30,600 pg/ml). Our recently developed proBNP immunoassay showed that nearly 100% of her immunoreactive BNP was proBNP. Polyethylene glycol precipitation tests reported extremely low BNP recovery (1.3%), while protein G addition tests also reported a remarkably low BNP fraction (3.3%). Gel filtration chromatography with normal elution buffer combined with BNP immunoassays showed a BNP peak with a retention time slightly shorter than that of IgG. With acidic elution buffer (pH 3.0), however this peak disappeared and a new BNP peak consistent with glycosylated human proBNP appeared. These results suggest that in this case most BNP immunoreactivity consisted of macro-proBNP, which is an immune complex composed of proBNP and an anti-proBNP autoantibody. Gel filtration chromatography combined with NT-proBNP immunoassays revealed that the NT-proBNP assay cross-reacts with both the proBNP-IgG complex and proBNP. In addition, with acidic buffer, a new large peak appeared with a retention time the same as that of glycosylated NT-proBNP. These results suggest spuriously high levels of BNP and NT-proBNP are caused by macro-proBNP. Macro-NT-proBNP is not detected by the currently available NT-proBNP assay system. [ABSTRACT FROM AUTHOR]

Purpose: To present the surgical technique, clinical outcomes, and poor prognostic factors of arthroscopic retrograde osteochondral autograft transfer of the tibial plateau.Methods: Twelve patients (6 men, 6 women; mean age, 38.7 years) with tibial plateau osteochondral lesions underwent surgery. The primary diseases were osteonecrosis in 4 cases, cartilage injuries in 6, and postfractures of the tibial plateau in 2. Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee score and the Japanese Orthopaedic Association score. The International Cartilage Repair Society score was recorded in 7 cases who underwent second-look arthroscopies postoperatively. Statistical analyses were performed to identify prognostic factors associated with the clinical outcomes.Results: The mean International Knee Documentation Committee and Japanese Orthopaedic Association scores were both significantly improved from 39.0 (range, 13.0-57.1) to 72.4 (range, 33.3-100) (P = .0022) and from 65.8 (range, 30.0-85.0) to 85.8 (range, 50.0-100) (P = .0022 < .05), respectively. In 2 cases, secondary operations were performed because of knee pain (1 varus osteotomy of the femur and 1 total knee replacement). The mean International Cartilage Repair Society scores were significantly worse in the 2 cases who required a secondary operation (3.5; abnormal) than in the 5 cases who did not (10.6; nearly normal). The secondary operation rate was significantly higher in cases with lesion size ≥400 mm2 than in those <400 mm2 (Fisher's exact test; P = .046).Conclusions: Most clinical scores improved significantly postoperatively. The results indicate that arthroscopic retrograde osteochondral autograft transfer is an effective procedure to achieve sufficient cartilage congruity for osteochondral lesions of the tibial plateau <400 mm2 in size.Level Of Evidence: Level IV, therapeutic case series. [ABSTRACT FROM AUTHOR]

Background: We previously developed a surface-controlled water-dispersible form of curcumin and named it Theracurmin (Theracurmin; Theravalues, Tokyo, Japan). The area under the blood concentration-time curve of Theracurmin in humans was 27-fold higher than that of curcumin powder. We determined the clinical effects of orally administered Theracurmin in patients with knee osteoarthritis during 8 weeks of treatment. Methods: Fifty patients with knee osteoarthritis of Kellgren-Lawrence grade II or III and who were aged more than 40 years were enrolled in this randomized, double-blind, placebo-controlled, prospective clinical study. Placebo or Theracurmin containing 180 mg/day of curcumin was administered orally every day for 8 weeks. To monitor adverse events, blood biochemistry analyses were performed before and after 8 weeks of each intervention. The patients' knee symptoms were evaluated at 0, 2, 4, 6, and 8 weeks by the Japanese Knee Osteoarthritis Measure, the knee pain visual analog scale (VAS), the knee scoring system of the Japanese Orthopedic Association, and the need for nonsteroidal anti-inflammatory drugs. Results: At 8 weeks after treatment initiation, knee pain VAS scores were significantly lower in the Theracurmin group than in the placebo group, except in the patients with initial VAS scores of 0.15 or less. Theracurmin lowered the celecoxib dependence significantly more than placebo. No major side effects were observed with Theracurmin treatment. Conclusion: Theracurmin shows modest potential for the treatment of human knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Abstract: We examined the relative motion of femoral and tibial total knee arthroplasty components and the difference between 2 different tibial inserts (9 flat types and 7 dish types) in patients sitting in very deep flexion. X-ray, fluoroscopic examination, and computed tomography were used to analyze liftoff, and rotation. During seiza-style sitting, one knee (11%) with the flat insert lifted off on the medial side and 5 knees (71%) with the dish-type insert showed liftoff. The tibial internal rotation angles were 17.2° ± 4.1° (flat type) and 11.7° ± 3.1° (dish type) (P < .05). The flat type showed less liftoff at the medial side and more internal rotation. For very deep flexion, components that tolerate larger rotational freedom are favorable. [Copyright &y& Elsevier]

Purpose: For successful autologous osteochondral transplantation, it is important that the cartilage in an implanted plug provide histologic replacement of damaged cartilage with cartilage that is structurally and mechanically normal. The purpose of this study was to investigate whether the press-fit technique reconstructs the normal hyaline cartilage and provides acoustic stiffness equal to that of normal intact cartilage. Methods: In 36 rabbits an osteochondral plug, 6 mm in diameter, was removed from the right patellar groove and grafted into a recipient hole, 5 mm in diameter, in the left patellar groove. Specimens at 2, 4, 8, 12, 24, and 52 weeks postoperatively were assessed by macroscopic and histologic observation and by use of an ultrasonic system. The ultrasonic acoustic stiffness, acoustic surface irregularity, and acoustic thickness of the implanted cartilage were examined and compared with normal intact cartilage. Results: The gross appearance of the implanted cartilage was glossy, maintained good surface smoothness, and survived well throughout the observation period. The cartilage recovered histologic features of hyaline cartilage. The acoustic stiffness decreased up to 12 weeks and then increased at 24 and 52 weeks after surgery. The acoustic stiffness at 8 or 12 weeks was significantly lower (acoustically softer) than that of control cartilage (P < .001). The acoustic stiffness at 52 weeks was equal to that of the control. The difference in acoustic surface irregularity was not significant. The acoustic thickness at 8 weeks was higher (acoustically thicker) than that of the control (P < .01). Conclusions: Although the reason acoustically soft cartilage in plugs becomes acoustically stiff and whether the histology of the implanted cartilage had recovered completely remain unclear, the acoustic stiffness recovered to normal control values by 52 weeks postoperatively. Clinical Relevance: Postoperative care for up to 12 weeks should be taken after autologous osteochondral transplantation. [ABSTRACT FROM AUTHOR]

Abstract: An 80-year-old man presented to our clinic with a chief complaint about pain and stiffness in the right knee. His history was significant for osteomyelitis of the right femur 64 years ago. Examination revealed a range of motion from 30° hyperextension to 0° extension. A rotating-hinge total knee arthroplasty was performed. Four years later, the patient ambulates painlessly with 1 cane. He has no extensor lag, and his range of motion is 0° to 15°. [Copyright &y& Elsevier]

Purpose: To assess bone tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons fixed with a round cannulated interference (RCI) screw in the femur. Methods: A consecutive series of 30 ACL reconstructions performed with hamstring tendons fixed with an RCI screw in the femur and with staples via Leeds-Keio ligament in the tibia was retrospectively reviewed. The clinical outcome was evaluated through the Lysholm score. Anterior instability was tested by Telos-SE (Telos Japan, Tokyo, Japan) measurement. The location and angle of each femoral and tibial tunnel were measured with the use of plain radiographs, and bone tunnel enlargement greater than 2 mm detected any time 3, 6, 12, and 24 months postoperatively was defined as positive. Each factor (location and angle of the tunnels, sex, affected side, age, Lysholm score, and Telos-SE measurement) was compared between enlarged and nonenlarged groups. Results: Positive enlargement of the bone tunnel (>2.0 mm) was observed in 36.7% (11 of 30) on the femoral side and 33.3% (10 of 30) on the tibial side, and in 6 knees of both sides. Half of patients (15 of 30) had an enlarged tunnel on the femoral or the tibial side until 1 year postoperatively. In most cases, enlargement reached maximum at 6 months postoperatively. Female patients tended to have an enlarged tunnel, especially on the femoral side (P < .05). Tunnel enlargement was not correlated with location and angle of the tunnels. Moreover, no difference was found in Lysholm score and Telos-SE measurement between enlarged and nonenlarged groups, although the nonenlarged group tended to exhibit higher Lysholm score and lesser instability. Conclusions: Bone tunnel enlargement of the femoral or tibial side was observed in half of patients (6 in both sides, 5 only in the femur, and 4 only in the tibia) after ACL reconstruction was performed with a hamstring tendon fixed with an RCI screw. Female patients had a greater chance for enlargement of the femoral tunnel than did males. This enlargement had no significant impact on patient activity and on anterior instability of the knee 1 year after surgery. Level Of Evidence: Level IV, Therapeutic case series. [ABSTRACT FROM AUTHOR]

We aimed to quantitatively investigate the relationship between amplitude-based pulse-echo ultrasound parameters and early degeneration of the knee articular cartilage. Twenty samples from six human femoral condyles judged as grade 0 or 1 according to International Cartilage Repair Society grading were assessed using a 15-MHz pulsed-ultrasound 3-D scanning system ex vivo. Surface roughness (Rq), average collagen content (A1) and collagen orientation (A12) in the superficial zone of the cartilage were measured via laser microscopy and Fourier transform infrared imaging spectroscopy. Multiple regression analysis with a linear mixed-effects model (LMM) revealed that a time-domain reflection coefficient at the cartilage surface (Rc) had a significant coefficient of determination with Rq and A12 (RLMMm2=0.79); however, Rc did not correlate with A1. Concerning the collagen characteristic in the superficial zone, Rc was found to be a sensitive indicator reflecting collagen disorganization, not collagen content, for the early degeneration samples. [ABSTRACT FROM AUTHOR]

Abstract: We report the case of a 28-year-old woman who underwent osteochondral grafting and anterior cruciate ligament (ACL) reconstruction for treatment of a massive cartilage defect in a knee joint with ACL deficit. Arthroscopy showed a full-thickness degenerative cartilage defect measuring 22 × 35 mm in the weight-bearing area of the medial femoral condyle, a totally resected lateral meniscus, and a loosened ACL. Therefore we performed osteochondral autograft transplantation and ACL reconstruction. Osteochondral plugs were harvested from a donor site in the patellofemoral joint of the contralateral knee and grafted into the recipient site in a “skipping” manner. Arthroscopic examination 1 year after surgery showed good preservation of the grafts and satisfactory bridging of the gaps between the plugs with fibrocartilage-like tissue. A recent follow-up examination, performed 36 months after surgery, has shown an excellent result, with a Lysholm score of 100, an International Knee Documentation Committee score of 95.4, and full range of knee motion with no symptoms. Plain radiographs at that time showed preservation of the medial joint space on the weighted anteroposterior view. No osteoarthritic changes were evident in the patellofemoral joint. [Copyright &y& Elsevier]

Abstract: Autogenous osteochondral grafts have recently become popular for use in small, isolated, contained articular cartilage defects. We treated a 26-year-old man who had a cartilage defect measuring 10 × 20 mm in the anteromedial area of the right talus. We performed multiple osteochondral grafting of the lesion with medial malleolar osteotomy from a donor site in the ipsilateral knee joint. Two years after the operation, the patient’s ankle pain recurred and the bony lesion in the talus also became osteolytic. Because we believed that only the cartilaginous portions of the osteochondral plugs grafted 2 years previously were fully fixed and viable, and that recurrence had occurred at the bony portions, at reoperation we performed curettage of the bony lesions and grafted iliac bone into the lesions with fenestration of the inferomedial ankle joint cartilage, not grafted plug cartilage. Therefore, probably because of overuse, the bony lesion in the talus had recurred 2 years after the first operation, but the grafted hyaline cartilage had survived. Autogenous osteochondral grafting into the talus, unlike the knee joint, should be done with care to ensure there is no sclerotic bone surrounding the lesion in patients with long-standing symptoms and recurrence of bony lesions. [Copyright &y& Elsevier]

Abstract: As a preclinical study, we evaluated the ability of hydroxyapatite and titanium on zirconia (HTOZ) to bond to bone under load-bearing conditions in animal experiments. HTOZ, HA, and Ti on Co–Cr alloy (HTOC) and Ti on Co–Cr alloy (TOC) were implanted into the weight-bearing portion of the femoral condyles of nine beagle dogs. Femurs were extracted 4, 12, and 52 weeks after implantation and examined mechanically by pullout testing, and histologically by toluidine blue staining, SEM, and calculation of the affinity index. The interfacial shear strengths (mean±SD) of the HTOZ, HTOC, and TOC groups were 4.42±0.453, 3.90±0.903, and 4.08±0.790MPa at 4 weeks; 6.82±2.64, 6.00±1.88, and 6.63±1.63MPa at 12 weeks; and 13.98±1.94, 11.95±1.51, and 10.78±0.83MPa at 52 weeks. There were no significant differences in the interfacial shear strengths between the three groups at any time. Affinity indices (mean±SD) obtained from SEM images of the HTOZ, HTOC, and TOC groups were 49.6±6.52%, 43.3±10.43%, and 23.7±3.95% at 4 weeks; 55.0±6.72%, 51.5±3.07%, and 28.6±4.09% at 12 weeks; and 59.1±6.73%, 63.0±6.40%, and 34.3±6.72% at 52 weeks. HA-coated implants (HTOZ, HTOC) had significantly higher affinity indices than non-HA-coated implants (TOC) at all times. HTOZ has the ability to bond to bone equivalent to HTOC and TOC. HTOZ is an excellent material for components of cementless joint prostheses. [Copyright &y& Elsevier]

Abstract: Low-intensity pulsed ultrasound (LIPUS) has been shown to accelerate fracture healing, but the precise mechanism is still unknown. We used aggregate chondrocyte culture system to analyze LIPUS-induced effects on chondrocytes. First, Northern analyses revealed that LIPUS maintained higher expression levels of type II collagen and aggrecan mRNA and delayed the appearance of type X collagen mRNA expression. We also showed that DNA content was increased and that alkaline phosphatase activity was maintained low by daily treatment. Moreover, LIPUS significantly promoted transforming growth factor (TGF)-β1 mRNA expression and the protein production at 2 h and 12 h after the treatment, respectively. Furthermore, recombinant TGF-β1 protein mimicked the LIPUS effect and anti-TGF-β1 neutralizing antibody reversed all these changes induced by the LIPUS treatment. These results indicate that LIPUS promotes the proliferation and retains the differentiation state of chondrocytes in the aggregate culture and that TGF-β1 plays an important role in mediating the LIPUS effects in chondrocytes. (E-mail: smukai@kyotolan.hosp.go.jp) [Copyright &y& Elsevier]

A domino osteochondral autograft transplantation enables the treatment of larger lesions compared to typical osteochondral autograft transplantation. Herein, we describe a case of steroid-induced knee osteonecrosis combined with osteonecrosis of the femoral head in which the knee was treated with domino osteochondral autograft transplantation. 4 Conclusion We reported a case in which we performed a domino osteochondral autograft transplantation using the resected femoral head as the donor for steroid-induced osteonecrosis of the knee that developed simultaneously with osteonecrosis of the hip. Since the necrotic lesion plus bone defect was larger in her left knee than in her right knee, we planned to operate on her left knee and right hip simultaneously so that we could use the resected femoral head as a donor site for the left knee surgery. [Extracted from the article]