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We report our case of ligament reconstruction for treatment of proximal tibiofibular joint disorder using a semitendinosus tendon graft. A 21-year-old male college soccer player with no remarkable history of injury had been suffering from pain at the lateral aspect of the left knee when playing soccer. At another hospital, the patient was diagnosed with a lateral meniscus injury and cartilage injury of the external condyle of the tibia and underwent partial resection of the meniscus and bone drilling. However, his symptoms continued, and he was referred to our institution. Instability of the left proximal tibiofibular joint and pain were noted during weight-bearing dorsiflexion of the ankle. We diagnosed the case as a proximal tibiofibular joint disorder and surgically treated it by dissecting the proximal portion of the semitendinosus tendon, creating one transfibular and two transtibial tunnels, and then reconstructing the proximal tibiofibular ligament using the harvested semitendinosus tendon graft. The patient was allowed to run at postoperative 2 months, with no pain occurring while squatting at postoperative 3 months, subsequently resuming soccer at postoperative 8 months. The proximal tibiofibular joint disorder is a relatively rare pathology, and diagnosis and conservative treatment are often difficult. Although various surgical treatments are known, the clinical outcome of our case has been successful after reconstructing the anterior and posterior proximal tibiofibular ligaments using a semitendinosus tendon graft.

Abstract To our knowledge, this is the first case of synovial osteochondromatosis in a patient presenting with a double patella-like condition. The true duplication of the patella, which is called double patella, is extremely rare. In our case, the operative and histopathological findings showed that the double patella-like condition was secondarily induced by synovial osteochondromatosis. Synovial osteochondromatosis should be considered as a differential diagnosis for congenital double patella.

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-µm 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. Keywords: ligament; transplantation; anterior cruciate ligament (ACL); transgenic animal; green fluorescent protein (GFP), Fixed into bone tunnels, autologous hamstring tendon grafts, which are reported to be superior to bone-patellar tendon-bone grafts in terms of donor site morbidity, (4,6) have been widely used for [...]

The healing of an injured musculoskeletal system requires an influx of mesenchymal cells that can differentiate into osteoblasts, fibroblasts, chondroblasts, and skeletal myoblasts. However, whether these mesenchymal cells arise from the circulation (bone marrow) or the injured tissues themselves has been controversial. To reveal the spatiotemporal characteristics of the reparative mesenchymal cells, we investigated the healing process after patellar tendon injury using two types of green fluorescent protein (GFP) chimeric rats; one expressing GFP in the circulating cells, and the other expressing it in the patellar tendon. We analyzed the behavior of GFP-positive cells after experimental tendon injury in both chimeric rats to clarify the origin of reparative cells. At 24 h after the injury, the wound contained circulation-derived cells but not tendon-derived cells. Tendon-derived cells first appeared in the wounded area at 3 days after the injury, and had significantly increased in number with time and had maintained a high level of proliferative activity until 7 days after the injury, whereas the circulation-derived cells had decreased in number and had been replaced by the tendon-derived cells. These findings suggest that circulation-derived and tendon-derived cells contribute to the healing of tendons in different periods as part of a biphasic process. J. Cell. Physiol. 210: 684–691, 2007. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]