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We experienced 2 patients with osteochondral defects of the medial femoral condyle who underwent autogenous osteochondral graft. In the first case, surgery was performed for osteonecrosis with two large osteochondral pegs transfer. The second case was treated using the mosaicplasty technique for osteochondritis dissecans. Grafts were taken from the non-weightbearing edges of the femoral condyles at the level of the patellofemoral joint. The secondary examination after surgery revealed that the lesions treated by autogenous grafts were covered with cartilage-like tissue. The duration of follow-up was 4 years in the first case and 1.5 in the second respectively. No clinical symptoms were seen. These results suggest that autogenous osteochondral bone graft seems to be a useful method in the treatment of osteochondral bone defect of the knee, although additional follow-up is required.

41 discoid lateral menisci (DLM) in 34 adults over 20 years of age were operated arthroscopically from 1994 to 2000. They complained of knee pain, lack of extension, hydrarthrosis, etc. 29 knees (71%) were not associated with specific injuries, and in 30 knees (73%) more than 4 weeks had passed since the symptoms occurred. Excluding 9 worn menisci in 6 patients, DLM were classified as incomplete (69%) or complete (31%). Evaluation of articular cartilage was rated on the basis of the Fujisawa classification system, and there were more degenative changes on the lateral compartment than the medial. 19 knees (46%) underwent total menisectomy, 10 knees (24%) subtotal menisectomy, and 12 knees (29%) partial menisectomy. From preoperative radiographs of 34 DLM in 28 patients, 18 DLM (52%) were diagnosed as osteoarthritis.26 DLM in 14 patients were surveyed by interview or telephone. The average duration of follow-up was 40.3 months (8-82 months). Evaluation of clinical results was rated on the basis of the modified Amako classification system postoperatively, and 22 knees (72%) had either A (excellent) or B (good) ratings. Though we investigated the factors for unsatisfactory clinical results, degeneration of cartilage on the lateral seemed to reflect clinical results.

We reviewed ninety-two patients who were more than forty years old when they underwent arthroscopic meniscectomy. Their mean age was 56.7 years (range: 40 to 80 years). These patients were evaluated using the Japanese Orthopaedic Association Score for meniscus injuries. There was no correlation between age, grade of osteoarthritis on preoperative radiograghs, grade of articular cartilage degeneration, and surgical results. Arthroscopic meniscectomy was proven to be an effective procedure for patients over the age of 40.

We present two cases of osteochondritis dissecans of the lateral femoral condyle after the meniscectomy of the discoid lateral meniscus. The first case was a 13-year-old boy who underwent subtotal excision of the right discoid lateral meniscus two years ago. The second case was a 8-year-old girl who underwent subtotal excision of the right discoid lateral meniscus three years ago. In both cases, radiographs showed obvious translucent lesion on the posterior part of the lateral femoral condyle. Arthroscopy showed that there was early separation of the lesion by palpation with a probe in the first case, but no evident softness and swelling of the articular surface in the second case. At surgery, arthroscopic fixation with absorbable pins (PDS) were performed for both cases. At four months after the arthroscopic fixation, radiographs showed good union in both cases and there were no clinical symptoms. Arthroscopic fixation for osteochondritis dissecans of the knee is minimally invasive and effective to ensure the healing of lesions.

As previously reported, MRI is found to be useful in the evaluation of meniscal and cruciate ligament injuries. But at our institute, however, due to frequent in consistencies between MRI and arthroscopic findings, we investigated problem knees by MRI and compared the findings with those using arthroscopy subsequently performed. 28 cases with medial and lateral meniscus, and 31 cases with anterior and posterior crucial ligament were examined. The field strength of MRI was 1.0 Tesla, and images were meared by the T2 weighted gradient echo method. Sensitivity for medial meniscus, lateral meniscus, anterior cruciate ligament, and posterior cruciate ligament was 60, 38, 33, and 20 percent respectively, specificity was 78, 90, 91, and 89 percent respectively, and accuracy was 75, 75, 74, and 77 percent respectively. These values are lower compared with other reports. Diagnoses of meniscal and cruciate ligament injuries from magnetic resonance imaging of the knee at our institute are not confidential. For improvement, the scanning and imaging methods, must be changed and a new sophisticated MRI scanner is desirable.

Seventeen hips in sixteen patients who had osteonecrosis of the femoral head were treated using the transtrochanteric rotational osteotomy. One deep infection and two postoperative intertrochanteric fractures occurred and they were managed with salvage operations such as arthrodesis and femoral endoprosthesis. Out of the remaining fourteen hips, eight had neither hip pain nor progressive collapse of the femoral head. The other six hips, four of which showed progressive collapse, had moderate or severe pain. Preoperative intact area ratio of the posterior part of the femoral head on a lateral X-ray and postoperative intact area ratio of the weight-bearing part on an anteroposterior X-ray were found to be significantly associated with postoperative collapse of the femoral head.

We reviewed 23 patients with MRSA infections in the Department of Orthopaedic Surgery. Decubitus infections should be treated with MC flap even if MRSA is positive. We did not find on effective treatment for osteomyelitis. For patients who have renal dysfunction, ABK should be used carefully.

We used the CDI claw technique for treating delayed neurologic deficits following vertebral fractures in 2 osteoporotic patients.Neurologic deficits improved using posterior fusion without decompression. It was suggested that the neurologic deficit was mainly due to instability. Posterior long fusion without bone grafting may possibly produce late complications, so patients should be chosen carefully.

We studied 34 severe osteoarthritic knees in 25 patients who underwent high tibial osteotomy (HTO). The mean age of the patients in the study group was 68.9 years at the time of surgery and the mean duration of follow-up was 6.6 years. Out of 25 patients 15 (60%) were farmers and of these 25, four patients underwent total knee replacement (TKR) on the other side. 88% of patients achieved good or excellent clinical results, and 3 out of 4 patients who had both HTO and TKR achieved good results on the HTO side.These results suggested that HTO is a suitable operation for patients with severe osteoarthritic knees and also for those in higher age groups, particularly if they wish to continue active work post-operatively.

The authors report a case of common peroneal mononeuropathy caused by an intraneural ganglion which presented acutely in a 58-year-old man. On admission, the patient had drop foot and numbness in the lateral leg and dorsal foot. At exploration, the peroneal nerve was found to be enlarged by cystic formation intimately related to the nerve trunk. A pedicle was found connecting the ganglion with the posterior aspect of the knee joint. One year three months after the cyst resection operation, done using a surgical microscope, there was almost complete return of function in the nerve. In this case the intraneural ganglion may have arisen from the neighbouring joint.

Cervical laminoplasty by Miyazaki's method has been performed for twenty-nine patients with myelopathy due to spondylosis and ossification of posterior longitudunal ligament in cervical spine, we preserved nuchal ligament and deep muscles for fourteen patients.The average age at surgery was 62.8 years old and the average follow-up period 2.0 years.The clinical results were evaluated using J. O. A. score and recovery rates of Hirabayashi's method. The preoparative average was 9.1 points, and it was improved up to 13.0 points postoperatively. The average recovery rate was 50.0%. Radiologically, change of alignment of the cervical spine occurred in neary half of the cases after operation, but the degree was generally slight. Mobility of the cervical spine was reduced to 60% of preoparative range. The postoperative nuchal pain and stiffness were decreased by preservation of the nuchal ligament and deep muscles.Cervical laminoplasty by Miyazaki's method is a useful procedure for treatment of the cervical myelopathy.

Nine patients with complete acromioclavicular dislocation were treated with Leeds-Keio synthetic ligament, supplemented with a temporary fixation of the acromioclavicular joint. Seven patients were re-examined over an average of two years after the operation. The functional results were excellent in four patients, good in two and fair in one. However, we observed roentgenographic changes of the clavicle and the coracoid process, including subluxation of the acromioclavicular joint, erosion and circular sclerosis of the clavicle, and bone atrophy of the coracoid process by the Leeds-Keio synthetic ligament. Indication for the reconstruction of the coracoclavicular ligament using the Leeds-Keio synthetic ligament should be considered prudently.

Since 1981, the Kodama-Yamamoto Knee Prostheses have been used in our hispital.We studied forty-nine knees in thirty-six patients whom we had been able to follow up for at least one year. Thirty knees in twenty-three patients were osteoarthritis, and nineteen in thirteen were rheumatoid arthritis. The average age of the patients in the study group was 66.7 years at the time of surgery. The average follow-up period was 3.0 years.There were thirty-four knees with a patellar replacement and fifteen without. Forty-three knees (87.8%) could obtain good or excellent clinical results, but the postoperative average flexion range of knee was 88.7°, which was not a satisfactory result. Furthermore clinical results were studied between the group of patellar replacement and the one without it. In the group of rheumatoid arthritis, some cases without patellar replacement complained of peripatellar pain postoperatively. No complication of patellar replacement was found in our study. The clinical results were good and stable in the group of patellar replacement.Therefore we recommend the patellar replacement for total knee prosthesis, especially in rheumatoid arthritic patients.

We reviewed the early results of 23 cementless total hip replacement both clinically and radiologically.Clinically the average JOA score was 50.2 before surgery and improved to 81.6 after surgery. Especially pain score and walking ability score improved well.On follow-up X-ray examination radiopaque line around the stem was frequently seen in zone 1 (13 hips) and zone 4 (8 hips). On the acetabular side radiopaque line appeared in only 4 hips with bone transplantation.These results suggest that the cup is sufficiently anchored to the acetabulum but there are some mechanical problems in the stem of this cementless system.

In twenty-five cases operated for cervical myelpathy above sixty years old, we examined some factors influencing on the postoperative results. But there was no good correlation between these factors and recovery of symptoms.A clinical study of computed tomographic myelography with metrizamide was perfomed in 11 patients operated for cervical myelopathy. The compression ratio at the maximam compression level in CTM was not correlated with surgical results. The patients in whom the compression ratio at the maximum compression level increased in the postoperative CTM, showed clinically good postoperative results.

Twenty-six patients with a cubital tunnel syndrome who underwent operative treatment were followed clinically and electrophysiologically for a mean period of 27 months. The MCV at forearm was well correlated with a preoperative clinical condition, and the cases with unsatis factory results showed poor recovery of the MCV at cubital tunnel after 4 months postoperatively. But it was difficult to predict the results through the assessment of the electromyogram before and early after operation. From a clinical point of view, the patients with osteoarthritis of the elbow joint tend to have a poor prognosis.

We reviewed 644 patients who had been examined by myelography retrospectively. The incidence of side effect was lower with iotrolan and iohexol than with metrizamide. But confusion, tremor or convulsion occurred in 3 of 189 patients examined with iotrolan, all being investigated for cervical region by lumbar puncture.We concluded that iotrolan and iohexol were safe agents for myelography.

The case of a seven-year-old boy with acute osteomyelitis of the distal femoral epiphysis is reported. Acute hematogenous osteomyelitis begins commonly in the metaphysis and in children the epiphyseal plate bars the spread to the epiphysis and the adjacent joint. Epiphyseal osteomyelitis is very rare, frequently spreading into the adjacent joint and being more latent than metaphysial osteomyelitis.

Fourty-six trochanteric femoral fractures operated with Ender pinnig were reviewed and investigated. The postoperative gait function was relatively good nevertheless some cases suffered radiological deformities. Loss or decrease of gait function is mainly due to high risk and complications of aging, but the technical failure of operators and the essential difficulty of Ender pinnig can not be neglected also.

Rapidly Destructive coxarthrosis (RDC) has been reported these twenty years by a lot of authors. According to some papers, clinical findings of RDC has not changed so much and histopathological findings are now in consistent with femoral head necrosis, but X-ray findings of RDC at its initial stage and late stage are not in total accord. We experienced two cases that seemed to be RDC in the last six years. It might be said that nature of RDC is avasculan necrosis occurring with proliferation of sinovium at early stage and besides mechanical and immunological factors, bone fragments and crystals freed from exposed subchondral bone might accelerate joint damage by interacting with sinovium and causing release of destructive factors as well as synovial proliferation. In addition, we studied two cases of osteoradionecrosis that reached similar advanced stage clinically and radiologically to that of RDC.

Osteomalacia is caused by distal renal tubular acidosis (distal RTA). And, secondary distal RTA is attended with autoimmunodisease. Recently, a lot of reports suggest that autoimmunodisease should be accompanied with HTLV-I infection. We report one case, a patient with Sjogren syndrome, distal RTA, osteomalacia, and positive HTLV-I antibody. We suggest sequence of these events.

From January 1978 to July 1983, we treated 95 cases of intracapsular and extracapsular femoral neck fracfures. Seventy-seven cases were followed. Of these, 34 cases were intracapsular femoral neck fractures, and 43 cases were extracapsular. The types of intracapsular and extracapsular femoral neck fractures were classified by Graden's and Evans' criteria.Conservative treatment, large pin fixation, and Ender's nail were adopted for extracapsular fractures. Large pin fixation, multiple pinning, and femoral head prosthesis were used for intracapsular fractures.Good results were obtained in the stable types of Evans, and Garden's types I and II by the previous methods. But, the prognosis was not good in the unstable type of Evans and Garden's types III and IV fractures because of occurrences of deformity and non-union or late segmental collapse.