In 52 patients we compared the accuracy of standard anteroposterior (AP) radiography, mortise radiography and MRI with arthroscopy of the ankle for the diagnosis of a tear of the tibiofibular syndesmosis. In comparison with arthroscopy, the sensitivity, specificity and accuracy were 44.1%, 100% and 63.5% for standard AP radiography and 58.3%, 100% and 71.2% for mortise radiography. For MRI they were 100%, 93.1% and 96.2% for a tear of the anterior inferior tibiofibular ligament and 100%, 100% and 100% for a tear of the posterior inferior tibiofibular ligament. Standard AP and mortise radiography did not always provide a correct diagnosis. MRI was useful although there were two-false positive cases. We suggest that arthroscopy of the ankle is indispensable for the accurate diagnosis of a tear of the tibiofibular syndesmosis.

No abstract

We present a new surgical technique of anterior cruciate ligament (ACL) augmentation using autogenous hamstring tendons or allogenic fascia lata under arthroscopy for patients in whom considerable ACL remnants with mechanoreceptors are preserved. We review the clinical results of 40 patients who underwent this ACL augmentation, as assessed by manual instability tests, KT-2000 knee arthrometer, Lysholm and Gillquist score, joint position sense and magnetic resonance imaging (MRI), and compare them with those of ACL reconstruction. The side-to-side differences of anterior displacement measured by the KT-2000 knee arthrometer at 30 lbs, an average of 5.3 +/- 2.6 mm preoperatively, was significantly improved to an average of 0.7 +/- 1.8 mm in the augmentation group, while an average of 6.0 +/- 2.4 mm was improved to 1.8 +/- 2.1 mm in the reconstruction group. There was no statistically significant difference between the preoperative values in the two groups, but the postoperative values of the augmentation group were significantly less than those of the reconstruction group. The ratio of anterior terminal stiffness of the augmentation group was 1.2 +/- 1.8, and that of the ACL reconstruction group was 0.7 +/- 0.4. This was a statistically significant difference (P < 0.05). Thus, as for the KT-2000 knee arthrometer, the ACL augmentation group showed significantly better anteroposterior stability and terminal stiffness than the ACL reconstruction group. The final inaccuracy of joint position sense of the augmentation group was 0.7 degrees +/- 0.7 degrees, while that of the reconstruction group was 1.7 degrees +/- 1.2 degrees indicating a significant difference (P < 0.05). This study demonstrates that ACL augmentation, which can preserve ACL remnants with mechanoreceptors, is superior to ACL reconstruction from the viewpoint of position sense and joint stability.

No abstract

The effects of hyaluronic acid (HA) on the proliferation and chondroitin sulfate (CS) synthesis of chondrocytes embedded in collagen gels were examined. Articular cartilage was isolated from the humerus, femur, and tibia of 21 10-week-old Japanese white rabbits. Chondrocytes isolated by collagenase digestion were embedded in type I collagen gels and cultured in Dulbecco's modified Eagle's medium (DMEM) with various doses of HA for 4 weeks. Histological and biochemical evaluations were performed at postculture weeks 1, 2, 3, and 4. For biochemical evaluations, isomers such as chondroitin 6-sulfate (delta(di)-6S) and chondroitin 4-sulfate (delta(di)-4S) synthesized by cultured chondrocytes were determined by high performance liquid chromatography (HPLC) combined with fluorometry. Morphological and histological studies demonstrated that HA-treated chondrocytes in collagen gel proliferated profusely while maintaining their phenotype. At postculture week 4, 0.1 mg/ml of HA induced an eightfold increase in cell counts compared with HA pretreatment values, or 1.5-fold more than control group. Synthesis of delta(di)-6S (delta(di)-6S content/cell) in groups treated with 0.01 and 0.1 mg/ml of HA significantly increased, while gel accumulation rates in groups treated with 0.1 and 1.0 mg/ml of HA scored significantly higher values than other groups. In collagen gel culture, HA enhanced the proliferation and delta(di)-6S synthesis of chondrocytes while maintaining their phenotype. In clinical application, since the supply of autologous chondrocytes for transplantation is not unlimited, the HA-treated culture method may be useful for increasing the number of chondrocytes and thus improving the quality of implants.

MR imaging with use of both criteria is highly accurate for the diagnosis of tibiofibular syndesmotic disruption.

The proposed system has several advantages, including anatomical reconstruction with normal stability and range of motion restored, the need for only a small incision during the reconstruction, and sufficient strength at the tendon graft-bone tunnel junction, in comparison with the tension strength of the lateral ligaments of the ankle.

We have clarified the diagnostic value of stress X-P, US, and MR imaging in diagnosis of ATFL injury. We obtained satisfactory results with US and MR imaging.