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Background: The behavior of host and graft cells during the healing process after autologous tendon graft has not been elucidated., Hypothesis: Host cells will integrate into the bone-tendon interface and contribute to cellular repopulation of the graft., Study Design: Controlled laboratory study., Methods: Twelve-week-old, genetically identical, female green fluorescent protein transgenic rats (n = 20) and wild-type rats (n = 20) were used. The rats were divided into 2 experimental groups. In group A, the Achilles tendons of wild-type rats were harvested and transplanted into the transcondylar femoral bone tunnels of green fluorescent protein rats. In group B, the Achilles tendons of green fluorescent protein rats were transplanted into a transcondylar femoral bone tunnel of wild-type rats. Immediately after transplantation (time zero) and at 1, 2, and 4 weeks after the transplantation, distal femoral epiphyses were harvested and cut into 14-mum serial sagittal frozen sections. The sections were examined with a confocal laser-scanning microscope to quantify green fluorescent protein-positive cell survival., Results: At time zero, only host cells in group A and only graft cells in group B demonstrated green fluorescent protein signals. At 1 week in group A, many green fluorescent protein-positive cells were found in the graft. In group B, a few green fluorescent protein-positive cells were found in the graft. At 2 and 4 weeks in group A, many green fluorescent protein-positive cells were detected in the graft, but green fluorescent protein-positive cells had disappeared completely in group B., Conclusion: Host cells, rather than graft cells, contribute to repair of the bone-tendon interface and the remodeling of grafts after simulated autologous tendon graft.

Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) was used for the measurement of relative proteoglycan depletion of articular cartilage in the patellofemoral (PF) joint following a proprietary protocol, which was compared with the X-ray images, proton density weighted MR images (PDWI) and arthroscopic findings. The study examined 30 knees. The ages ranged from 16 to 74 (average 40.3) years. The Gd-DTPA2–containing contrast medium was used in a single dose. The subjects were made to exercise the knee joint for 10 min; and MR images were taken 2 h after intravenous injection of contrast medium. T1-calculated images were produced and the region of interest (ROI) was set as follows. (1) ROI1: entire articular cartilage in a slice through the center of the patella. (2) ROI2: low signal region in T1-calculated images, which were set in a blind fashion by two observers. (3) ROI3: articular cartilage on one side that includes ROI2 where low signal region were detected (medial or lateral). ROI3 was set to examine the contrast of ROI2 with surrounding articular cartilage. The average T1 values of ROI1 was 393.5±33.6 ms for radiographic grade 0 and 361.3±11.1 ms for grade I, which showed a significant difference ( P=0.036). The T1 value of ROI2 was 351.6±28.2 ms for grade I, 361.9±38.3 ms for grade II, 362.1±67.7 ms for grade III, and 297.8±54.1 ms for grade IV according to arthroscopic Outerbridge classification. All cases, that demonstrated decrease of T1 values on dGEMRIC (ROI2), showed abnormal arthroscopic or direct viewing findings. The ratio (ROI3/ROI2) in cases of only slight damage classified as Outerbridge grade I (6 cases) was an average of 1.04±0.02 and was 1.0 or greater in all cases, thereby indicating well-defined contrast with the surrounding cartilage. The diagnosis of damage in articular cartilage was possible in all 16 cases with radiographic K–L grade I on dGEMRIC, while the intensity changes were not found in 10 of 16 cases on PDWI. The dGEMRIC with a single-dose would be useful on a diagnosis of the area demonstrating early relative proteoglycan depletion in the articular cartilage of the PF joint prior to any discernible changes in the subchondral bone on X-ray images and exceeds to plain MR images for examining deterioration of articular cartilage. [ABSTRACT FROM AUTHOR]

Abstract: A 52 year-old woman suffered bilateral femoral shaft fractures when she was 5 years old and they were treated surgically. She had been able to walk without pain and giving way throughout her young and adult life, however, when she came to us with a 1-year history of the right knee pain, she could walk only 10 m continuously. The right knee revealed valgus deformity with complete lateral patellar dislocation. The femoro–tibial angle was 154° and arthritic change was seen in the femorotibial joint. Surfaces of both the patella and the femur were degraded. Twenty-two degrees of rotational deformity was also found internally in the involved side. Varus osteotomy with external rotation of the distal fragment and lateral retinacular release combined with reefing of vastus medialis muscle were performed. Twenty-four months after surgery, knee score and functional score were, respectively, 85/100 and 71/100, using knee society clinical rating system and there was no pain associating patella incongruity. [Copyright &y& Elsevier]

We describe a case of popliteofibular ligament (PFL) injury, successfully treated with a new anatomic reconstruction technique looping the biceps femoris tendon (BT). The anterior half of the BT was split longitudinally from the fibular insertion, cut at the proximal end and left attached at the insertion. The proximal end of the BT was looped back in a slit made in the popliteal tendon (PT) at the original anatomical insertion site of the PFL, and passed through the tunnel from the posterior and the baseball suture was tightened on the anterior cortex of fibular head. [ABSTRACT FROM AUTHOR]

Abstract: We describe a new double-bundle reconstruction method for ruptured anterior cruciate ligament using a posteromedial portal technique. Reconstruction materials are semitendinosus tendon (STT) and gracilis tendon (GT). STT is used as the substitute for the anteromedial bundle (AMB) and fixed to the tunnels produced on the tibia and the femur. GT is used as the substitute for the posterolateral bundle (PLB) and fixed to the tunnels on the tibia and the femur. This femoral tunnel for the PLB is created through a posteromedial portal. These procedures are performed using the inside-out technique. The posteromedial portal provides an accurate access to the femoral attachment of the PLB. This surgical technique can avoid overlapping of the 2 femoral tunnels and destruction of the posterior cortex of the lateral condyle on the femur during the preparation of the PLB. Our technique does not need another tibial tunnel for the PLB; the 1 tibial tunnel enables double-bundle reconstruction and prevents tibial tunnel expansion. [Copyright &y& Elsevier]