Interest in localized and early stage treatment technologies for joint conditions such as osteoarthritis is growing rapidly. It has therefore become important to develop objective measures capable of characterizing the earliest (non-visible) changes associated with degeneration to aid treatment procedures. In addition to assessing tissue before treatment, it is further important to develop an effective, non-destructive means of monitoring post-treatment tissue healing, and of providing the high-quality data needed for trials of developing treatment methods. To investigate its ability to detect the early stages of degeneration in cartilage-on-bone, diffuse reflectance near infrared spectroscopy was applied to normal and osteoarthritic joints. A discriminating function was developed to relate absorbance peaks of interest and track degradation around focal osteoarthritic defects. The function could distinguish between normal and degraded tissue (100% separation of normal tissue from that within 25 mm of a defect) and between different stages of osteoarthritic progression (p < 0.05). This technique allows simple, practical and non-destructive assessment of component-level properties over the full depth of the tissue. It has the potential to increase our understanding of the underlying etiologic and pathogenic processes in early stage degeneration, to assist classification and the development of new treatment methods.
Anterior Cruciate Ligament (ACL) rupture is a common sporting injury that frequently affects young, athletic patients. Apart from the functional problems of instability, patients with ACL deficient knees also develop osteoarthritis. Although this is frequently cited as an indication for ACL reconstruction, the relationship between ACL rupture, reconstruction and the instigation and progression of articular cartilage degenerative change is controversial.The purpose of this paper is to review the published literature with regards ACL rupture and the multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction.There is no evidence in the published literature to support the view that ACL reconstruction prevents osteoarthritis, although it may prevent further meniscal damage. It must be recognised that this conclusion is based on the current literature which has substantial methodological limitations.
Within antero-medial gonarthrosis (AMG) of the knee, there is a spectrum of damage seen in the functionally intact anterior cruciate ligament (ACL). Our aim was to correlate the degree of ACL damage to the geographical extent and degree of cartilage loss on the tibial plateau. Ninety tibial plateaus resected during unicompartmental arthroplasty were photographed and digitally mapped. The ACL damage was graded (0: normal, 1: synovium loss, 2: longitudinal splits), and dimensions of full thickness cartilage loss and damage recorded. The percentage of full thickness loss in patients with a normal ACL was compared to those with a damaged, but functionally intact ligament. All specimens showed similar elliptical loss of cartilage in the antero-medial part of the tibial plateau. A total of 45(50%) patients had a macroscopically normal ACL, 21(23%) had synovial loss, and 24(27%) had longitudinal splits. An increase in the area of cartilage damage was seen with progressive ACL damage (p < 0.001). The area of macroscopically normal cartilage found posteriorly did not change. This study demonstrates that phenotypic distribution of cartilage damage in AMG is highly reproducible with a pattern of increasing cartilage erosion associated with increasing ACL damage.
ObjectivesSurgical marking during tendon surgery is often used for technical
and teaching purposes. This study investigates the effect of a gentian
violet ink marker pen, a common surgical marker, on the viability
of the tissue and cells of tendon.MethodsIn vitro cell and tissue methods were used to
test the viability of human hamstring explants and the migrating
tenocytes in the presence of the gentian violet ink.ResultsThe outcome of this study was that a constituent of the surgical
marker pen causes cell and tissue death in culture, implying the
same would occur in vivo.ConclusionsThis is a cause for concern when marking tendon during surgical
procedures, as it may compromise healing and repair and potentially
contribute to a poor outcome. The authors suggest that an alternative
surgical marking procedure should be found, or that all marker pens
should undergo testing on human tendon tissue in vitro prior
to use.
Medial clavicle fractures are uncommon, accounting for approximately 5 percent of all clavicle fractures. Vascular injuries are uncommon but are recognised as either an immediate complication due to transection of the vessel by the displaced fracture, or as a late complication, secondary to compression from abundant callus formation. We present an unusual case of positional venous insufficiency in the upper limb as an immediate complication of a closed, minimally displaced clavicle fracture, with secondary subclavian venous thrombosis formation eleven days following the injury.
Femoral fractures following anterior cruciate ligament (ACL) reconstruction are rare. These injuries often are related to increased stresses at the femoral tunnel. Hamstring tendon autograft is often used for ACL reconstruction, and transfemoral fixation is one of many graft fixation techniques with few reported complications. This article reports an atraumatic transverse supracondylar femoral fracture occurring through the transfemoral fixation tract following hamstring ACL reconstruction in a 38-year-old woman. [J Knee Surg. 2009;22:364-366.]
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