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The use of autogenous bone patellar tendon bone graft (BTB) has been well established in anterior cruciate ligament (ACL) reconstruction.A round shaped drill hole at the femur and tibia is commonly used for ACL reconstruction. BTB is on the other hard rectangularly shaped. Therefore, a gap fwms between BTB and bone tunnels. In this study, we attempted rectangular bone tunnel (RBT) for ACL reconstruction. Between 1996 and 1997, RBT for ACL reconstruction was carried out in 43 patients (22 males, 21 females). It suggests that RBT has two advantages, RBT is effective for preventing tunnel enlargement of the tibia, and reproduction of graft rotation is possible by RBT.

A 73-year-old woman presented with rapidly destructive changes of the knee joint due to calcium pyrophoshate dihydrate crystal deposition disease. The patient was complaining of pain and swelling of the left knee joint. She became progressively limited in movement and got around using crutches with difficulty. Radiographs showed osteoarthritic changes and chondrocalcinosis in the knees, shoulders, and hips. On X-ray, the left knee showed destructive changes affecting the medial femoral condyle and tibial plateau on June sixth, 1996. On July forth the destructive change was more marked and on August eighth gross destruction had occurred. Investigations showed a normal erythrocyte sedimentation rate (ESR), serum calcium, and alkaline phosphate. The serological test for syphilis was negative and no increase in rheumatoid factor was found. Deep pain sensation was normal and there were no abnormal neurological signs. We performed total joint replacement with bone graft of the left knee joint. At the operation, calcium pyrophosphate dihydrate crystals were found in the meniscus. After the operation, the left knee joint was stable and painless.

Shoulder arthrography is a simple diagnostic technique used in shoulder disorders. However shoulder arthrography has been forgotten recently because of development of CT and MRI. We experimented with a new technique of shoulder arthrography using 10% urografin.We used the technique in cases with rotator cuff tears, recurrent dislocation and intra-capsular lesions.Contrast medium of 45% urografin is usually used for single contrast arthrography, or double contrast arthrography.The low density contrast medium of 10% urografin evaluated in this study was made by using 3ml of 60% urografin and 15ml of 0.5% xylocain.We evaluated the low density medium in comparison to the usual contrast agent in coses with rotator cuff tears, recurrent dislocations and intra-capsular lesions.We concluded that low density single contrast arthrography (using 10% urografin ) was useful for diagnosing shoulder disease.

In the treatment of the medial compartment osteoarthritic knee, lateral wedged insoles are prescribed very frequently, but the degree of hardness of the insole is usually determined based on the physician's experience alone. The purpose of this study is to determine the effect of differences in the hardness of wedged insoles on the thrust of the knee and on the center of force of the foot on an osteoarthritic knee.We investigated 25 subjects with normal knees demonstrating lateral thrust and wedges of varying hardness were used. We used accelerometric techniques to evaluate the lateral thrust of the knee while walking. We also simultaneously evaluated the center of force of the foot by using the F-scan system.When compared with no insole, the first acceleration peak did not reduce significantly with the use by using an insole made of soft material, but was significantly reduced with an insole made of hard material of used. The center of force of the foot had also was not significantly shifted laterally with an insole of soft material, but was found to have significantly shifted laterally with an insole of made hard material.

Anterior cruciate ligament (ACL) reconstruction with bone patellar tendon bone can usually be secured with interference screws on the femur and tibia. Its strength depends on bone quality, size of the tunnel and screw, and direction of forces. Infrequently, patella alta, which results in a longer tendinous component of the graft construct, can result in a construct mismatch, leading to a large portion of the tibial bone plug extruding from the tibial tunnel, requiring graft fixation with a suture/screw and post technique. For treatment we prefer to use tying sutures over a post technique. However in the first few weeks after reconstruction, the weakest link in the reconstructed ligament system is the site of fixation. This study investigated initial graft fixation strengths of various methods of bone fixation. Fixation was performed using three suture methods with no. 5 Ethibond. An Instron material testing system was used and loading rates at 50mm/minutes until failure was performed. Statistically significant differences were noted for load to failure and elongation. Group 1 specimens' mean maximum load to failure was 439 N, whereas the load to failure for group 2 specimens' was 555 N. In our model, figure-of-eight sutures (group 2) was stronger than simple double suture technique (group 1). Our study has several important limitations. However, these results confirm the hypothesis that this technique avoids the potential pitfalls of interference screw fixation. We used tying sutures over a post with satisfactory clinical results.

Interleukin-10 (IL-10) is a cytokine that plays a major role in suppressing the inflammatory response, particularly cell-mediated immunity that is characteristic of the TH1 response. The purpose of this study was to determine whether local infusion of IL-10 could mitigate the suppression of bone ingrowth associated with polyethylene wear particles. Drug test chambers were implanted in the proximal tibia of 20 mature New Zealand White rabbits. The DTC provided a continuous 1 x 1 x 5-mm canal for tissue ingrowth. After a 6-week period for osseointegration, the DTC was then connected to an osmotic diffusion pump. IL-10 at doses of 0.1-100 ng/mL (0.25 microL/h) was infused with or without ultra-high molecular weight polyethylene particles (0.5 +/- 0.2 microm diameter, 10(12) particles/mL) present in the chamber for a 3- or 6-week period. The tissue in the chamber was harvested after each treatment; sections were stained with hematoxylin and eosin for morphometric analysis. Osteoclast-like cells were identified by immunohistochemical staining using a monoclonal antibody directed against the alpha chain of the vitronectin receptor, CD51. Osteoblasts were identified using alkaline phosphatase staining. In dose-response studies, infusion of 1 ng/mL IL-10 yielded the greatest bone ingrowth in the presence of particles. The addition of polyethylene particles evoked a marked foreign body reaction and fibrosis; bone ingrowth was significantly suppressed (p = 0.0003). Bone ingrowth was increased by over 48% with infusion of IL-10 for the final 3 weeks of a 6-week ultra-high molecular weight polyethylene particle exposure compared with particles alone (p = 0.027). IL-10 is a cytokine that plays a major role in suppressing the inflammatory response, especially cell-mediated immunity that is characteristic of the TH1 response. Local infusion of immune-modulating cytokines such as IL-10 may prove to be useful in abating particle-induced periprosthetic osteolysis.

Van der Hoeve syndrome is a disorder that is characterized by loss of hearing, fragility of bones and blue sclera.We report on a patient with this disease. He is an 18 year-old male with blue sclera hearing loss, and a history of thirteen fractures by th age of fifiteen years.Two other memebers of his family had blue sclera, but no signs of bone fragility. The patient had not had any fractures after the age of sixteen years.It is important that these patients receive appropriate care in helping them in their daily life.

Whether non-steroidal anti-inflammatory drug (NSAID)-induced suppression of bone ingrowth is due to cyclooxygenase-1 (COX-1) inhibition, cyclooxygenase-2 (COX-2) inhibition, or through a yet unidentified pathway is unknown. In this study, the effects of a non-specific COX-1 and COX-2 inhibitor, versus a specific COX-2 inhibitor on bone ingrowth and tissue differentiation are examined in vivo. Harvest chambers were implanted unilaterally in the tibiae of eight mature, New Zealand white rabbits. After a 6-week period for osseointegration of the chamber, the following oral treatments were given for 4 weeks each, followed by a harvest in each case: drinking water with no NSAID (control 1), Naproxen sodium--a COX-1 and COX-2 non-specific inhibitor at a dose of 110 mg/kg/day in the drinking water, drinking water with no NSAID (control 2), and Rofecoxib-a COX-2 inhibitor at a dose of 12.5 mg/day inserted directly into the rabbit's mouth. Harvested specimens were snap frozen, cut into serial 6 microm sections and stained with hematoxylin and eosin for general morphological characterization, and alkaline phosphatase (osteoblast marker). Sections were also processed for immunoperoxidase staining using monoclonal antibodies to identify cells expressing the vitronectin receptor (osteoclast-like cells). With drinking water alone, the percentage of bone ingrowth averaged 24.8 +/- 2.9% and 29.9 +/- 4.5% respectively. Naproxen sodium in the drinking water and oral Rofecoxib decreased bone ingrowth significantly (15.9 +/- 3.3%. p = 0.031 and 18.5 +/- 2+/-4%, p = 0.035 compared to drinking water respectively). Both Naproxen sodium (p = 0.026) and Rofecoxib (p = 0.02) decreased the number of CD51 positive osteoclast-like cells per section compared with drinking water alone. Rofecoxib decreased the area of osteoblasts per section area (p = 0.014) compared to controls, although the value for Naproxen sodium did not reach statistical significance. The results of the present study suggest that bone formation is suppressed by oral administration of an NSAID which contains a COX-2 inhibitor. COX-2 inhibitors currently taken for arthritis and other conditions may potentially delay fracture healing and bone ingrowth.