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Background: We hypothesized that preoperative pelvic morphology may affect postoperative anterior coverage and postoperative clinical range of motion (ROM) leading to postoperative pincer type femoroacetabular impingement (FAI). The aim of this study was to evaluate the relationships between preoperative bone morphology and postoperative ROMs to prevent postoperative FAI after periacetabular osteotomy. Methods: Sixty-eight patients (71 hips) with hip dysplasia participated in this study and underwent curved PAO. The acetabular fragment was usually moved only by lateral rotation of the acetabulum, without intraoperative anterior or posterior rotation. The pre- and postoperative three-dimensional center-edge (CE) angles were measured and compared to the postoperative ROM. Results: Preoperative medial anterior CE angle was significantly associated with postoperative anterior CE angle, and the correlation coefficient of medial anterior CE and postoperative anterior CE was higher than the coefficient of preoperative anterior CE and postoperative anterior CE (preoperative anterior CE, rr = 0.27, p = 0.020; preoperative medial anterior CE, rr = 0.54, p < 0.001). Femoral anteversion correlated with postoperative internal rotation angle at 90° flexion (r = 0.32, p = 0.021). In multiple linear regressions, postoperative internal rotation angle at 90° flexion angle was significantly affected by both medial CE angle through the medial one fourth of femoral head and femoral anteversion. Conclusions: Preoperative medial anterior acetabular coverage was associated with postoperative anterior acetabular coverage. Further, the combination with preoperative medial anterior acetabular coverage and femoral anteversion can predict postoperative internal rotation at 90° flexion. Therefore, the direction of acetabular reorientation should be carefully considered when the patients have high preoperative medial anterior CE angle and small femoral anteversion. [ABSTRACT FROM AUTHOR]

Background: Vascular CD34+ cells in anterior cruciate ligament (ACL) tissue have the potential for high proliferation and multilineage differentiation that can accelerate tendon-bone healing. While patient characteristics, such as age, can affect tendon-bone healing, the influence of elapsed time after injury on the healing process is unclear. Hypothesis: Cells obtained during the early phase after injury will exhibit a greater tendon-bone healing potential compared with chronic phase counterparts when applied to an immunodeficient rat model of ACL reconstruction. Study Design: Controlled laboratory study. Methods: Adult human ACL-ruptured tissue was harvested from patients undergoing arthroscopic primary ACL reconstruction and classified into 2 groups based on the time elapsed between injury and surgery: (1) early group (≤3 months from injury) and (2) chronic group (>3 months from injury). In addition, 76 ten-week-old female immunodeficient rats underwent ACL reconstruction, followed by intracapsular administration of one of the following: (1) ACL-derived cells from the early group (n = 5), (2) ACL-derived cells from the chronic group (n = 5), or (3) phosphate-buffered saline (PBS) only (n = 5). During the 8 weeks after surgery, histological (weeks 2, 4, 8), immunohistochemical (week 2), radiographic (weeks 0, 2, 4, 8), and biomechanical (week 8) analyses were performed to evaluate tendon-bone healing. Results: In the early group, the histological evaluation showed early healing, induction of endochondral ossification–like integration, and mature bone ingrowth. Micro–computed tomography showed that the tibial bone tunnels at week 4 and week 8 were significantly reduced in the early group compared with those in the chronic group and PBS group (P < .05). Moreover, biomechanical tensile strength was significantly greater in the early group than in the other groups (P < .05). An accelerated healing potential in the early group was further demonstrated by the enhancement of intrinsic angiogenesis/osteogenesis and human-derived vasculogenesis/osteogenesis. Conclusion: Compared with human ACL-derived cells obtained during the chronic phase, cells obtained during the early phase after injury have a greater tendon-bone healing potential when used in an immunodeficient rat model of ACL reconstruction. Clinical Relevance: During ACL reconstruction surgery, transplanting ACL remnant tissue in the early phase after injury could accelerate and enhance tendon-bone healing. [ABSTRACT FROM AUTHOR]

Background: The anterior cruciate ligament (ACL) does not heal spontaneously after injury, and ACL patients of different ages respond differently to treatment. Although ACL-derived CD34-positive cells contribute to bone-tendon healing after ACL reconstruction, the relationship between the healing potential of ACL-derived cells and a patient's age is unknown. Hypothesis: ACL-derived cells from young patients will have a greater effect on the maturation of bone-tendon integration in an immunodeficient rat model of ACL reconstruction compared with cells derived from older patients. Study Design: Controlled laboratory study. Methods: Sixty 10-week-old female immunodeficient rats underwent ACL reconstruction (using the autologous flexor digitorum longus tendon as a graft) followed by intracapsular administration of ACL-derived cells from patients aged 10 to 19 years (younger group) or patients aged 30 to 39 years (older group), or they were given phosphate-buffered saline (PBS; PBS group). Histologic, radiographic, and biomechanical examinations were performed 2 to 8 weeks after surgery. In addition, intrinsic and human cell– derived angiogenesis and osteogenesis were examined by immunohistochemistry. Results: In the younger group, histologic assessment demonstrated early bone-tendon healing, which induced endochondral ossification-like integration. Micro–computed tomography showed a statistically significant reduction in the area of tibial bone tunnel in the younger group (week 4, 20.0% ± 11.2% reduction; week 8, 25.7% ± 5.6% reduction) compared with the older group (week 4, 1.8% ± 3.0% reduction; week 8, 4.0% ± 5.9% reduction) and the PBS group (week 4, -0.5% ± 3.2% reduction; week 8, 3.3% ± 5.2% reduction) (week 4, P<.05; week 8, P<.01). Failure loads during tensile testing demonstrated a significantly higher ultimate load to failure in the younger group (17.52 ± 4.01 N) compared with the older (8.05 ± 2.91 N) and PBS (7.01 ± 3.16 N) groups (P<.05), and isolectin B4 and rat osteocalcin immunostaining indicated enhanced intrinsic angiogenesis and osteogenesis in the younger group. There was no statistically significant difference in the results of radiographic and biomechanical examinations between the older and PBS groups. Double immunohistochemistry for human-specific endothelial cell and osteoblast markers demonstrated a greater ability of differentiation into endothelial cells and osteoblasts in the younger group. Conclusion: ACL-derived cells from younger patients enhanced early bone-tendon healing in an immunodeficient rat model of ACL reconstruction. Clinical Relevance: Surgeons should consider a patient's age when performing ACL reconstruction with remnant preservation or ruptured tissue incorporation, as this can predict healing ability. [ABSTRACT FROM AUTHOR]

The article presents research which examined the age-related differences in cells derived from the anterior cruciate ligament (ACL). Topics covered include the description of ACL tissues in adolescent and younger patients as well as collection of ACL remnants from 28 patients. Also mentioned is the need for surgeons to consider the age of patients when assessing healing potential of those with ACL injuries.

The article presents a study which investigated the ideal matching patterns of articular surface profiles of donor and recipient sites for autogenous osteochondral grafting of the femur of the knee through the use of three-dimensional laser scanning technique. It claims that the grafting method is broadly used as treatment for focal osteochondral defects. In the study, the FastSCAN Cobra three-dimensional (3D) laser scanner from Polhemus was used to profile the knee.

Background: It has been recently reported that human anterior cruciate ligament (ACL) ruptured tissue contains abundant vascular stem cells that contribute to tendon-bone healing in an immunodeficient rat model of ACL reconstruction.Hypothesis: Autologous ruptured ACL tissue has an effect on the maturation of bone-tendon integration in anterior cruciate ligament reconstruction.Study Design: Controlled laboratory study.Methods: Twenty healthy adult beagle dogs underwent bilateral ACL reconstruction using the ipsilateral flexor digitorum superficialis tendon and were divided into 2 groups: right knee (a tissue-treated group) and left knee (a control group). The tissue-treated group received autologous ruptured ACL tissue, which was obtained 2 days after resection and sutured to the tibial side of the graft. Histological, radiographic, and biomechanical assessments were performed. In addition, immunohistochemical staining was performed to assess angiogenesis and osteogenesis.Results: Histological assessment and staining for osteoblasts and endothelial cells at week 2 demonstrated early healing, inducing endochondral ossification-like integration with enhanced angiogenesis and osteogenesis in the tissue-treated group’s grafts. Computed tomography at week 4 showed a significantly smaller tibial bone tunnel in the tissue-treated group (tissue, 19.0 ± 4.4 mm2; control, 42.6 ± 4.7 mm2; P = .009, n = 5). Furthermore, biomechanical testing of force during loading to ultimate failure at week 4 demonstrated a significantly higher strength in the tissue-treated group (tissue, 66.4 ± 10.1 N; control, 30.5 ± 10.3 N; P = .009, n = 5).Conclusion: In the present study, the authors elucidated that transplantation of ACL-ruptured tissue, which was sutured to the tibial side of the graft, contributed to early tendon-bone healing in a canine model of ACL reconstruction.Clinical Relevance: Anterior cruciate ligament ruptured tissue has a therapeutic potential in promoting an appropriate environment for tendon-to-bone healing in bone tunnels of ACL reconstruction. [ABSTRACT FROM PUBLISHER]

Objective Autophagy, an evolutionarily conserved process for the bulk degradation of cytoplasmic components, serves as a cell survival mechanism. The purpose of this study was to elucidate the role of autophagy in human chondrocytes and pathophysiology of osteoarthritis (OA). Methods Autophagy in articular cartilage and primary chondrocytes was assessed using antibodies for the autophagy markers light chain 3 and beclin 1. The states of autophagy under catabolic and nutritional stresses were examined. We also examined the effects of inhibition or induction of autophagy under stimulation with interleukin-1β. Autophagy was inhibited by small interfering RNA targeting ATG5, and autophagy was induced by rapamycin. The effects of inhibition or induction of autophagy were examined by real-time polymerase chain reaction for aggrecan, COL2A1, MMP13, and ADAMTS5 messenger RNA. To further examine the mechanism of autophagy regulation in OA human chondrocytes, we investigated whether autophagy modulates apoptosis and reactive oxygen species (ROS). Results Autophagy was increased in OA chondrocytes and cartilage. Catabolic and nutritional stresses increased autophagy. In addition, the inhibition of autophagy caused OA-like gene expression changes, while the induction of autophagy prevented them. Furthermore, the inhibition of autophagy increased the amount of cleaved poly(ADP-ribose) polymerase and cleaved caspase 9, while the induction of autophagy inhibited these increases. ROS activity was also decreased by induction of autophagy. Conclusion These observations suggested that increased autophagy is an adaptive response to protect cells from stresses, and that autophagy regulates OA-like gene expression changes through the modulation of apoptosis and ROS. Further studies about autophagy in chondrocytes will provide novel insights into the pathophysiology of OA. [ABSTRACT FROM AUTHOR]

Only a few cases of double-layered meniscus have been described in the English literature. We report two cases of bilateral double-layered lateral meniscus, where an additional semicircular meniscus was observed over the normal lateral meniscus. One of the patients exhibited a bucket-handle tear with a double-layered meniscus. To our knowledge, this abnormality is extremely rare and the incidence of double layered meniscus with bucket-handle tear has not been previously reported. [ABSTRACT FROM AUTHOR]

Background: A reamer irrigator aspirator (RIA) can be used to harvest substantial amounts of autologous bone and debride the intramedullary canal. Clinical experience using reamer irrigator aspirators in Japan is very limited. The applicability of the reamer irrigator aspirator head with a minimum diameter of 12 mm for Japanese people is often questioned as the Japanese are smaller than Americans and Europeans. There are no reports of complications in Japanese patients. This study aimed to retrospectively review clinical cases and describe reamer irrigator aspirator use in Japanese patients.Methods: All patients for whom a reamer irrigator aspirator was used during surgery at our hospital between January 2014 and September 2018 were included. The patients' clinical and radiographic data were retrospectively reviewed.Results: Data of 40 patients (42 cases) were collected. The reamer irrigator aspirator was used for bone graft harvesting in 32 cases, intramedullary debridement and irrigation in 9 cases, and reaming for exchange nailing in 1 case. The diameter of the reamer irrigator aspirator reamer head was 12 mm in 22 cases (53.7%), 12.5 mm in 4 cases (9.8%), 13 mm in 9 cases (22.0%), 13.5 mm in 1 case (2.4%), 14.0 mm in 1 case (2.4%), 14.5 mm in 1 case (2.4%), and 15 mm in 4 cases (9.8%). Mean intraoperative bleeding volume was 1158.6 mL (range, 100-3800 mL). We experienced no difficulty inserting the reamer irrigator aspirator into the intramedullary canals and no cases of insertion-related intraoperative fracture. Five cortical perforations (11.9%) were observed on postoperative computed tomography scans, although no patient was symptomatic. One case (2.4%) of postoperative femur fracture occurred.Conclusions: Reamer irrigator aspirators can be used in Japanese patients. Smaller reamer head sizes were mainly used in our experience. We should manage complications as in previous reports from Western countries. [ABSTRACT FROM AUTHOR]

Background: The Summit cementless stem has been used as a device to occupy the proximal medullary canal space in total hip arthroplasty (THA). The purpose of this study was to evaluate the mid-term clinical and radiographic results of the Summit stem and the differences in the results as a function of medullary cavity shape.Methods: This study analyzed the 90 consecutive patients who underwent THA by using the Summit cementless stem. The minimum clinical and radiographic follow-up period for the patients was 5 years (mean, 5.5 years; range, 5.0-7.1 years). The radiographic and Harris hip scores (HHS) were evaluated across the three Dorr type classifications of femoral bone.Results: The postoperative HHSs were significantly higher than the preoperative HHS scores (p < 0.05). No significant differences in preoperative and postoperative HHSs were found among the three Dorr types. Stress shielding was observed in 58 hips. Spot welds and cortical hypertrophy were observed in various zones in 53 and 11 hips, respectively. No significant difference in the number of occurrences of cortical hypertrophy was found among the three Dorr types. However, the number of occurrences of severe stress shielding in Dorr type C was higher than that in Dorr type B. The number of occurrences of spot welds in Dorr type C was lower than that in both Dorr types A and B.Conclusions: Mid-term clinical results were good regardless of the medullary cavity shape. However, severe stress shielding in Dorr type C was more frequently than that in Dorr type B. Therefore, attention should be paid to the types of medullary cavity shapes for Summit stem use. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to clarify the influence of the posterior condylar offset (PCO) on intraoperative soft tissue balance including the joint component gap and varus ligament balance measured by an offset-type tensor during posterior-stabilized (PS) total knee arthroplasty (TKA).Methods: In this study, 35 patients with osteoarthritis of the knee underwent PS TKA. Intraoperative soft tissue balance including the joint component gap and varus/valgus ligament balance were assessed at 0°, 10°, 45°, 90°, and 135° of flexion with an offset-type tensor that could be used with the femoral component placement and patellofemoral joint reduction. The correlations between the postoperative PCO and the intraoperative soft tissue balance parameters were assessed using simple regression analysis.Results: The joint component gap at 0° extension was inversely correlated with the PCO (R = -0.41, p < 0.05). The joint component gap of 10°-0° was positively correlated with the PCO (R = 0.35, p < 0.05). No other soft tissue balance parameters were correlated with the PCO.Conclusions: A larger PCO was confirmed to reduce joint component gap in extension but not always in flexion in PS TKA. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess radiolucent lines (RLLs) and to determine their effect on clinical outcomes of the newly introduced cementless mobile-bearing total knee arthroplasty (TKA) system. This was prospective, multicentre study. Seventy-eight patients with knee osteoarthritis who underwent primary TKA were enrolled. Patient-reported outcome measures (PROMs) and radiographic assessments were evaluated at preoperative baseline and at 6 weeks, 1 year, and 2 years after surgery. KOOS, PKIP, 2011KSS, EQ-5D-3L and SKO improved from preoperative baseline to all postoperative timepoints, with no loosening of components. No RLLs were detected at 6 weeks after surgery. However, RLLs ≥ 1 mm developed in 2.8% of the patients for the femur and 9.7% for the tibia at 1 year after surgery, and values were 5.7% and 10.9%, respectively, at 2 years after surgery. RLL incidence was not correlated with PROMs. Age, sex, body mass index, range of motion knee flexion, posterior cruciate ligament treatment and β angle did not impact the occurrence of RLLs. There were no intraoperative complications, revisions or reoperations. This TKA system improved PROMs and showed less incidence of RLLs compared to the previous reported TKA without implant-related complications., (© 2024. The Author(s).)

Background: Data of vitamin D sufficiency in Asian patients with osteoporotic fragility hip fractures are limited. This study aimed to obtain data from the Japanese population., Methods: Patients aged 60 years or older with hip fractures were prospectively enrolled. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured. Levels were compared between patients receiving and not receiving treatment for osteoporosis, those with and without previous contralateral hip fractures, and those with femoral neck versus trochanteric fractures. Sex-based differences were also assessed. The serum levels in patients younger than 60 years with extremity fractures were assessed, and differences between elderly and younger patients were evaluated. The individual correlation between 25(OH)D levels and the ultraviolet (UV) index and age was analyzed in elderly patients with hip fractures., Results: The data of 360 patients (aged 84.7 ± 8.2 years), comprising 80 men and 280 women, were analyzed. The mean 25(OH)D level was 16.5 ± 7.2 ng/mL. The prevalence of vitamin D insufficiency (25(OH)D <30 ng/mL) and deficiency (25(OH)D <20 ng/mL) was 93.9% and 71.7%, respectively. A significant difference was noted in the prevalence of vitamin D deficiency between patients with and without previous contralateral hip fractures. Age and 25(OH)D levels were found to be correlated, with no correlation between the UV index and the 25(OH)D levels. The 25(OH)D level in the younger population ( n = 123) was 20.7 ± 8.6 ng/mL, which was significantly higher than that of the elderly., Conclusion: Perennial vitamin D insufficiency is prevalent in elderly Japanese patients with hip fractures.

Background: Whereas clinical studies have revealed a number of important risk factors for postoperative infection following total knee arthroplasty (TKA), it is unclear which factor influences clinical results. A multicenter study was therefore performed by reviewing 51 patients with deep infection after TKA and seeking for the factors related to clinical outcomes., Methods: Fifty-one deep infections after TKA were treated from 2000 to 2011 at the multicenter including a university or three arthroplasty centers. Among them, two clinical outcome measures including retention of prosthesis at initial treatment and functional prosthetic knee were assessed for several factors such as age, sex, primary diagnosis, onset time after primary TKA, type of hospital where the primary TKA was performed and the organism's resistance to methicillin using the logistic regression analysis model., Results: Among the factors, type of hospital where the primary TKA was performed and onset time after primary TKA had higher multivariable-adjusted odds ratios (ORs) for retention of primary prosthesis (ORs 35.21 and 11.69, respectively.). The cases which primary surgery were performed in arthroplasty centers had higher multivariable-adjusted ORs for functional prosthetic knee (OR 4.9). Thirty-one infection cases with non-methicillin-resistant organisms were all able to keep functional prosthetic knee after the operation, whereas 13 out of 20 infection cases with methicillin-resistant organisms lost their knee function after the operation., Conclusions: Onset time after primary TKA, type of hospital where the primary surgery was performed and the organism's resistance to methicillin are important factors influencing the clinical outcomes after infected TKA., Level of Evidence: Level 3. Retrospective comparative study., (Copyright © 2015 Elsevier B.V. All rights reserved.)