Search

Background: The structural properties of a tendon autograft deteriorate during the remodeling phase after anterior cruciate ligament (ACL) reconstruction. Hypothesis: A local application of autologous synovium-derived cells cultured in medium supplemented with transforming growth factor β (TGFβ) may inhibit the deterioration of structural properties of the tendon graft after ACL reconstruction. Study Design: Controlled laboratory study. Methods: Fifty-two mature sheep were used. In each animal, the right knee underwent ACL reconstruction using the semitendinosus tendon autograft; then, the animals were divided into 5 groups of 10. No additional treatments were applied in group 1, whereas fibrin sealant was applied around the graft in group 2. In group 3, autologous synovium-derived cells cultured in standard medium were applied around the graft with fibrin sealant, whereas autologous synovium-derived cells cultured in TGFβ-supplemented medium were applied with fibrin sealant in group 4. In group 5, fibrin sealant containing 20 ng of TGFβ was applied around the graft. Each animal was sacrificed at 12 weeks after the surgery. In each group, 7 and 3 sheep were used for biomechanical and histologic evaluations, respectively. The remaining 2 sheep were used to confirm whether the applied cells infiltrated the graft at 1 week after surgery. Results: Confocal microscope observations showed that the applied cells that were labeled before implantation infiltrated into the superficial portion of the graft at 1 week. Biomechanically, the maximum load and the stiffness of groups 4 and 5 were significantly greater than those of groups 1, 2, and 3. Histologically, necrotic lesions were observed in the core portion of the midsubstance in groups 1 and 2. In groups 3, 4, and 5, no necrotic lesions were found in the midsubstance. Conclusion: A local application of autologous synovium-derived cells cultured in TGFβ-supplemented medium or a fibrin sealant containing TGFβ significantly inhibits the natural deterioration of the structural properties of the tendon graft after ACL reconstruction. Clinical Relevance: Administration of autologous synovium-derived cells cultured in TGFβ-supplemented medium or TGFβ and fibrin glue alone can be a potential cell-based therapy to prevent graft deterioration after transplantation or accelerate mechanical restoration of the deteriorated graft.

肩腱板断裂における腱板修復術は，術後の疼痛が比較的強く，持続することが多い．持続する疼痛は，術後リハビリテーションでの可動域訓練を妨げ，肩関節拘縮を引き起こすだけでなく，複合性局所疼痛症候群（complex regional pain syndrome：以下CRPS）などの合併症を引き起こす．私たちは鏡視下腱板修復術の疼痛コントロールに，持続斜角筋ブロック（continuous scalene block：以下SB）を16例，関節内注射（joint injection：以下JI）を16例に行い，術後除痛効果について比較・検討した．術後疼痛（visual analog scale：以下VAS）は，SB群が，JI群に比べて術後3，4，5日で有意に低値であった．術後挙上角度はSB群が，JI群に比べて術後2週で有意に高値であった．また，術後ジクロフェナク坐薬を使用した症例数はSB群が，JI群に比べて有意に少なかった．両群とも合併症は認めなかった．持続斜角筋ブロックは関節内注射に比べて疼痛が軽減され，鎮痛剤の使用が減り，術後早期の可動域が良好であった．鏡視下腱板修復術において，持続斜角筋ブロックは有用な除痛法と思われた．

Purpose: The purpose of this study was to clarify femoral and tibial tunnel angles in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Methods: A prospective study was performed in 50 consecutive patients who underwent anatomic double-bundle ACL reconstruction via hamstring tendon grafts for chronic ACL deficiency in the unilateral knee. For this procedure, 2 hamstring tendon grafts were secured with EndoButtons (Smith & Nephew Endoscopy, Andover, MA) on the femur and with 2 staples on the tibia. Each patient underwent radiologic examination 1 year after surgery. Results: The tibial tunnel angles of the posterolateral bundle averaged 40.7° in the anteroposterior view and 35.4° in the lateral view. The tibial tunnel angles of the anteromedial bundle averaged 15.6° in the anteroposterior view and 41.4° in the lateral view. The femoral tunnel angles of the posterolateral bundle averaged 44.0° in the anteroposterior view and 52.0° in the lateral view. The femoral tunnel angles of the anteromedial bundle averaged 18.0° in the anteroposterior view and 49.8° in the lateral view. Conclusions: The given data will be useful for surgeons to evaluate the tunnel positions and standardization postoperatively in anatomic double-bundle reconstruction. Level of Evidence: Level II, development of diagnostic criteria on the basis of consecutive patients with universally applied reference gold standard.

OBJECTIVE: The aim of this study was to analyze the efficacy of adalimumab (ADA) in patients with rheumatoid arthritis treated with or without methotrexate (MTX) and determine impact of the MTX dose. METHODS: Pearson's product-moment correlation coefficient was used to assess the correlations between the improvement in the Disease Activity Score (DAS) 28- erythrocyte sedimentation rate (ESR) score and the MTX dose in patients receiving treatment with MTX at a dose of 8 mg/week. PATIENTS: ADA therapy was initiated in 68 rheumatoid arthritis patients between July 2008 and June 2013. The mean MTX dose was 9.6 ± 2.6 mg/week, and the patients were followed for 24 weeks. RESULTS: The mean DAS28-ESR scores at baseline and week 24 were 4.6 ± 1.3 and 2.7 ± 1.2 in the 60 patients treated with MTX and 4.5 ± 1.0 and 4.2 ± 1.5 in the eight patients treated without MTX, respectively. Clinical remission was achieved in 48% and 25% of the patients, respectively, by week 24. Moreover, 90.0% of the patients taking MTX continued to receive ADA until week 24, while 50.0% of the patients not taking MTX continued to receive ADA until week 24. Among the 35 patients receiving MTX at a dose of >8 mg/week, the DAS28-ESR scores decreased rapidly from 4.4 ± 1.2 at baseline to 3.2 ± 1.1 at week 4 and further decreased to 2.4 ± 1.0 at week 24. Meanwhile, clinical remission was achieved in 57% of the patients receiving MTX at a dose of >8 mg/week and 36% of those receiving MTX at a dose of ≤8 mg/week. A significant correlation was noted between the improvement in the DAS-ESR score and the MTX dose. CONCLUSION: In this study population, enhanced clinical efficacy of ADA was achieved in combination with the administration of a sufficient dose of MTX, determined to be >8 mg/week.

We report two cases of one-stage correction of rotational deformities of the lower extremity. Case 1 was a 75-year-old woman with extra-articular rotational deformity of the femur and osteoarthritis of the hip joint. The femoral deformity occurred due to malunion of the femoral fracture at age 20. Corrective osteotomy of the femur and total hip arthroplasty were performed simultaneously. External rotational deformity of 50°, which was determined by preoperative computed tomography, was corrected with angulatory deformity of 22° at the apex of the angulatory deformity. The osteotomy site was fixed with Cannulok® interlocking hip prosthesis. Case 2 was a 16-year-old girl with Kniest syndrome. She had an external rotational deformity of the hip secondary to severe osteoarthritis. Derotational osteotomy of the femur at the mid-shaft was performed. The distal segment was internally rotated by 60° so that the foot progression angle was brought into normal range. The osteotomy was fixed with interlocking nailing. This patient developed delayed union at the osteotomy site, which was successfully treated with ultrasonic therapy. Both cases have had a satisfactory outcome without major complications.

The study evaluated biological reaction of four types of novel double network gels in muscle and subcutaneous tissues, using implantation tests according to the international guideline. The implantation tests demonstrated that, although poly (2-acrylamide-2-metyl-propane sulfonic acid)/poly (N,N′-dimetyl acrylamide) (PAMPS/PDMAAm) gel induced a mild inflammation at 1 week, the degree of the inflammation significantly decreased into the same degree as that of the negative control at 4 and 6 weeks. This gel has a potential to be applied as artificial cartilage. In addition, Cellulose/Gelatin gel showed the same degree of inflammation as that of the negative control at 1 week, and then, showed a gradually absorbable property at 4 and 6 weeks. This gel has a potential to be applied as an absorbable implant. The PAMPS/polyacrylamide and Cellulose/PDMAAm gels induced a significant inflammation at each week. These DN gels are difficult to be applied as clinical implants in the current situation.

A tissue-cultured tendon matrix infiltrated with cultured fibroblasts can be regarded as an ideal tissue-engineered tendon model. To clarify the role of TGF-beta in a tissue-cultured tendon matrix during ex vivo cellular infiltration, the present ex vivo study was conducted to test the following hypothesis that antibody neutralization of TGF-beta enhances weakening of the collagen fascicles of the patellar tendon matrix in response to ex vivo fibroblast infiltration. In skeletally mature female rabbits, fibroblasts were isolated from the right patellar tendons using an explant culture technique, and the left patellar tendons underwent multiple freeze/thaw treatment with liquid nitrogen to obtain an acellular tendon matrix. Each acellular tendon was placed in a collagen gel containing cultured fibroblasts and then incubated with or without anti-TGF-beta1 antibody for 6 weeks. We found that antibody neutralization of TGF-beta enhanced the decrease in the tensile strength and tensile modulus of the collagen fascicles of the patellar tendon matrix in response to ex vivo fibroblast infiltration. The present study indicates a possibility that TGF-beta may have a role in suppressing the material deterioration of the fascicles in the tendon during ex vivo cellular infiltration.

expansion with proliferation medium. Osteogenic assay Cells (n1.0x105) were cultured in 6-well plates in osteogenic medium suppremented with BMP4 (100ng/ ml) and stained for alkaline phosphatase (ALP) at day 7. As well, cells were also cultured as pellets for 21 days in osteogenic medium and evaluated with a micro-CT and stained with von Kossa for assessment of mineralization. Chondrogenic assay Cells (n2.5x105) were placed in a 15ml conical tube, centrifuged at 600g, and cultured in chondrogenic medium (Lonza) supplementted with TGF-3 (10ng/ml). Pellets were assessed macroscopically at day 14, and stained with Alcian blue/nuclear fast red. Adipogenic assay Cells (n1.0x105) were cultured in 6-well plates for 14 days in adipogenic medium and stained for Oil Red O. Reverse Transcription Polymerase Chain Reaction (RT-PCR) Differentiation potential of these cells were confirmed by RT-PCR using osteogenic (osteocalcin and type 1 collagen), chondrogenic (Sox9 and type 2 collegen), and adipogenic (lipoprotein lipase (LPL) and Peroxisome proliferator activated receptor (PPAR))-related markers. Results: Immunohistochemical staining Tissues showed more positive staining for CD34 and CD146 in the ruptured site than in the mid-substance. Flow cytometry analysis The percentage of CD34CD45 and CD146 CD45 cells were significantly higher in the ruptured site compared to the mid-substance (CD34CD45 cells: reptured site, 44.3%, mid-substance, 8.3%; CD146CD45 cells: reptured site, 6.5%, mid-substance, 0.5%) (p0.01). Proliferation potential CD34 and CD146 cells from the ruptured site showed high expansion potential, however, those from the mid-substance did not expand well. Based on these results, we used those from the ruptured site for multilineage differentiation assay. Osteogenesis Cultured CD34 and