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Background: We previously developed a surface-controlled water-dispersible form of curcumin that we called Theracurmin®. The area under the blood concentration-time curve (AUC) of Theracurmin in humans was 27-fold higher than that of curcumin powder. Previously, we reported on the anti-inflammatory effects of Theracurmin for knee osteoarthritis. Hypothesis/Purpose: We determined the clinical effects of orally administered Theracurmin in patients with knee osteoarthritis over a 6-month period. Study Design: Open prospective study. Methods: Fifty patients Kellgren-Lawrence grade II, III, or IV knee osteoarthritis who were above 40 years old were enrolled in this clinical study. Theracurmin containing 180 mg/day of curcumin was administered orally every day for 6 months. To monitor for adverse events, blood biochemistry analyses were performed before and after 6 months of each intervention. The patients' knee symptoms were evaluated at 0, 1, 2, 3, 4, 5, and 6 months based on the Japanese Knee Osteoarthritis Measure, the knee pain visual analog scale, and the knee scoring system of the Japanese Orthopedic Association. Results: Five cases dropped out during the study, but no cases dropped out because of major problems. No major side effects were observed with Theracurmin treatment, including the blood biochemistry analysis results. The effective group included 34 cases (75.6%), while the not-effective group included 11 cases. Conclusion: This study demonstrates the safety and good efficacy of Theracurmin for various types of knee osteoarthritis. Theracurmin shows great potential for the treatment of human knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Background: Plug protuberance occasionally occurs in osteochondral autologous transplantation (OAT). The incongruity of plugs results in poor clinical outcomes, especially in cases of protuberance. However, a surgical procedure to deal with this problem has not been reported. Purpose/Hypothesis: The purpose was to evaluate the efficacy and safety of cartilage resection of elevated plugs, with the hypothesis that patients whose elevated plugs were resected and leveled would achieve clinical outcomes equivalent to those of patients with flush plugs. Study Design: Cohort study; Level of evidence, 3. Methods: Cases (group P) included 22 patients who underwent OAT of the knee and whose plugs showed protuberance greater than 1 mm that was resected with a scalpel to obtain smooth congruity, while controls (group C) included 22 background-matched patients who did not require plug resection. The International Knee Documentation Committee (IKDC) subjective score, IKDC objective grade, and Japanese Orthopaedic Association score for knee osteoarthritis (JOA knee score) were used preoperatively and at the final follow-up (mean ± SD, 49.3 ± 18.1 months). International Cartilage Repair Society (ICRS) Cartilage Repair Assessment was used to evaluate lesion healing during the second-look arthroscopy. Results: IKDC subjective scores of group C (82.5 ± 11.8) and group P (82.1± 15.1) showed no difference at the final follow-up. On postoperative IKDC objective grading, 86% of group C and 82% of group P patients were graded as “nearly normal” or better (P = .639). The mean JOA knee scores of group C (90.9 ± 8.9) and group P (90.1 ± 9.5) did not differ significantly (P = .647). Nine second-look arthroscopies were performed in group C versus 8 in group P, and all patients had plugs that were graded as “nearly normal” or better by the ICRS Cartilage Repair Assessment. Larger plugs tended to be used in those patients who required resection. Conclusion: Resection of the elevated plug surface did not negatively affect patient outcomes in the midterm follow-up period. [ABSTRACT FROM AUTHOR]

Background: It has been reported that the short-term results of mosaicplasty are good, but there have been no reports of the serial cartilage changes in the recipient sites and their mirror sites for mosaicplasty. Purpose: To examine the serial changes in cartilage in the recipient sites and their mirror sites using second-look imaging. Study Design: Case series; Level of evidence, 4. Methods: A total of 33 patients (37 knees, 40 sites) underwent mosaicplasty and second-look arthroscopy at a single institution over a 7-year period. There were 14 men and 19 women (12 right knees and 25 left knees). The recipient sites were the patella (n = 3), trochlea (n = 7), medial femoral condyle (n = 21), and lateral femoral condyle (n = 9). The mean patient age at surgery was 38.3 years; the mean period from mosaicplasty to second-look arthroscopy was 15.4 months; and the mean follow-up period was 34.9 months (range, 24-65 months). The results of second-look arthroscopy at the recipient site were categorized as cartilage with a smooth surface (group S) and fibrillation or an irregular surface (group I), and results of second-look arthroscopy at the mirror site were categorized as worse (group W), improved (group E), and unchanged (group U). Results: There were 30 sites in group S, 10 sites in group I, 3 sites in group W, 4 sites in group E, and 33 sites in group U. The age at operation was significantly greater in group S than in group I. There was a significant correlation between group S and groups E and U. The clinical outcome was significantly worse in group W when compared with groups E and U. Conclusion: If a smooth surface was seen in the recipient site during second-look arthroscopy, the cartilage degeneration in its mirror site did not become worse after mosaicplasty. [ABSTRACT FROM AUTHOR]

Background: In response to socioeconomic pressure to cut budgets in medicine, single-use surgical instruments are often reprocessed despite potential biological hazard. Purpose: To evaluate the quality and contaminants of reprocessed shaver blades. Hypothesis: Reprocessed shaver blades have mechanical damage and chemical contamination. Study Design: Controlled laboratory study. Methods: Seven blades and 3 abraders were reprocessed 1 time or 3 times and then were assessed. In the first part of the study, structural damage on the blades after 3 reprocessings was compared to that after 1 reprocessing using optical microscopy. In the second part, surface damage was observed using optical microscopy and scanning electron microscopy; elemental and chemical analyses of contaminants found by the microscopy were performed using scanning electron microscopy/energy dispersive x-ray spectroscopy, scanning Auger microscopy, and Fourier transform infrared spectroscopy. Results: Optical microscopic examination revealed abrasion on the surface of the inner blade and cracks on the inner tube after 1 reprocessing. These changes were more evident after 3 reprocessings. Scanning electron microscopy/energy dispersive x-ray spectroscopy of the inner cutter of the blade reprocessed once showed contaminants containing calcium, carbon, oxygen, and silicon, and Fourier transform infrared spectroscopy demonstrated biological protein consisting mainly of collagen, some type of salts, and polycarbonate used in plastic molding. Scanning electron microscopy/energy dispersive x-ray spectroscopy of the inner cutter of the reprocessed abrader revealed contaminants containing carbon, calcium, phosphorous, and oxygen, and Fourier transform infrared spectroscopy showed H2O, hydroxyapatite, and hydroxyl proteins. Scanning Auger microscopy showed that the tin-nickel plating on the moving blade and abrader was missing in some locations. Conclusion: This is the first study to evaluate both mechanical damage and chemical contaminants containing collagen, hydroxyapatite, and salts on the reprocessed arthroscopic shaver blades. Clinical Relevance: Surgeons should keep in mind that mechanical damage and chemical contamination are found on reprocessed arthroscopic blades. [ABSTRACT FROM AUTHOR]

Background: Autologous osteochondral mosaicplasty for osteochondritis dissecans of the capitellum is being used increasingly in adolescent patients. Little research has been published on the material properties of living human cartilage of the elbow and knee. Hypothesis: The cartilage of the osteochondritis dissecans lesion is detected as degenerated by ultrasound. The material properties of the cartilage of the intact part of.the elbow are not different from those of the intact knee except in thickness. Study Design: Descriptive laboratory study. Methods: The authors studied 10 young male athletes with osteochondritis dissecans of the capitellum who underwent mosaicplasty. An acoustic probe was used for measurement, and the wavelet transform method was used. Three parameters were used: signal intensity (index of cartilage stiffness), signal duration (index of roughness), and signal interval (index of thickness). Results: The cartilage of the osteochondritis dissecans lesion had lower signal intensity than did the intact part of the capitellum. The cartilage of the radial head opposite the capitellum had significantly lower signal intensity and higher signal duration than did other sites. The signal intensity of the radial head was significantly higher in early-stage patients than in late-stage patients, although the macroscopic view was almost all intact. The signal intensity of the plug was decreased significantly after grafting. Conclusion: The osteochondritis dissecans lesion had lower signal intensity than did the intact part of the capitellum. Although the macroscopic view looked intact, the radial head cartilage was degenerated as measured acoustically. Clinical Relevance: Not only the cartilage of the capitellum but the cartilage of the radial head are acoustically degenerated in osteochondritis dissecans patients. Plugs might be damaged in the transplanting procedure, and further follow-up is necessary. [ABSTRACT FROM AUTHOR]

Background: There are growing concerns about thermal chondroplasty using radiofrequency energy to treat partial-thickness cartilage defects. However, most studies emphasize effects on chondrocyte viability, and other factors such as mechanical properties are less studied. Hypothesis: Radiofrequency energy may cause significant effects on articular cartilage other than chondrocyte viability. Study Design: Controlled laboratory study. Methods; Human osteoarthritic cartilage samples were obtained from total knee arthroplasty, and monopolar radiofrequency energy was applied using commercially available equipment. Material properties (compressive stiffness, surface roughness, and thickness) just before and after thermal treatment were determined using ultrasound. A series of biochemical analyses were also performed after explant culture of the samples. Results: The cartilage surface became smoother by radiofrequency energy, whereas cartilage stiffness or thickness was not altered significantly. Collagen fibrils, especially in the superficial layers, were converted to denatured form, whereas proteoglycan contents released in the media as well as retained in the tissue remained unchanged. The concentrations of matrix metalloproteinases (MMP-1 and MMP-2) were reduced remarkably. Conclusion: Radiofrequency energy is able to create a smooth cartilage surface and reduce catabolic enzymes at the cost of collagen denaturation and chondrocyte death in the superficial layers. The stiffness of the cartilage is not changed at time zero. Clinical Relevance: Further animal as well as clinical studies will be necessary to fully evaluate the long-term effects of radiofrequency energy. [ABSTRACT FROM AUTHOR]

This article focuses on a study related to cervical spinal cord injury in sumo wrestling. Sumo has long been a traditional sport in Japan. But the first World Sumo Championship was held only as recently as 1992, when the International Sumo Federation was established. Since then, the World Sumo Championships have been held in Japan, Germany, and Brazil. In the present case a 19-year-old collegiate sumo wrestler, 166 cm tall and weighing 78 kg, had been practicing sumo for 10 years. During an intercollegiate sumo championship on October 31, 1999, he competed with an opponent whose weight was 120 kg.

Focuses on a study which examined a treatment for end-stage osteochondritis dissecans lesions of the humeral capitellum. Details of a case report about a boy suffering from pain in his right elbow; Information on osteochondritis dissecans of an elbow; History of the patient; Description of surgical treatments for osteochondritis.

Presents the case of a recurrent throwing fracture of the humerus experienced by a baseball player. Clinical profile of the player; Risk factors associated with humerus fractures; Possible causes of recurrent fracture.

Background: Cartilage and subchondral bone have recently been considered an osteochondral unit. The treatment of osteo-chondral lesions is still challenging, but better subchondral bone repair may result in higher quality repaired cartilage.Hypotheses: Alendronate accelerates bone formation in osteochondral defects and affects the quality of the repaired cartilage.Study Design: Controlled laboratory study.Methods: Osteochondral defects were made on the left trochleas of 50 rabbits, which were assigned to 1 of 3 groups: control, ALN (weekly subcutaneous injection of 0.14 mg/mL alendronate), and ALN-S (alendronate injection in the first 8 weeks only). They were evaluated at 4, 8, 24, and 52 weeks. Bone repair was evaluated with microcomputed tomography and histologic evaluation. Cartilage repair was evaluated with ultrasound and histologic analyses.Results: At 4 weeks, the defects were filled, and cartilage-like repair tissue was observed in the ALN group, whereas the defects were incompletely filled in the control group. Alendronate treatment enhanced early bone formation and mineralization in the osteochondral defect for the first 8 weeks. The continuous injection of alendronate for 24 weeks resulted in delayed bone remodeling, but the rabbits in the ALN-S group showed good integrity of the subchondral bone plate, without delayed remodeling. At 52 weeks, the ALN-S group had a columnar arrangement of chondrocytes that had less fibrillation and looked superior to those in the ALN and control groups. Ultrasound analysis showed better quality of repaired cartilage of the ALN and ALN-S group than the control group.Conclusion: Alendronate accelerated bone formation without inhibiting its mineralization but thereafter inhibited bone remodeling in an osteochondral defect. The withdrawal of alendronate at 8 weeks avoided the delayed remodeling and showed better sub-chondral bone repair. At 52 weeks, better subchondral bone repair resulted in better cartilage quality.Clinical Relevance: Alendronate administered in the early period accelerates bone formation and improves the quality of the repaired cartilage. [ABSTRACT FROM PUBLISHER]