Hidetaka Murakami

Regeneration of ring-shaped lateral meniscus after partial resection of discoid meniscus with anterior cruciate ligament reconstruction

INTRODUCTION The ring-shaped lateral meniscus is very rare. Although it is essentially known as a congenital anomaly, a central tear in an incomplete discoid meniscus or an old bucket-handle tear in a meniscus may be easily mistaken for a ring-shaped meniscus. We experienced a ring-shaped lateral meniscus that regenerated after partial resection of a discoid meniscus together with anterior cruciate ligament (ACL) reconstruction. PRESENTATION OF CASE A 37-year-old female patient still experienced unrelenting knee pain 6 months after ACL reconstruction and partial meniscectomy of a discoid lateral meniscus. A repeat arthroscopy was performed. The lateral tibial plateau was covered in the form of a ring by meniscus-like tissue. The meniscus-like tissue appeared to have regenerated inward toward the center from the stump after the partial meniscectomy and was connected from the anterior to posterior horn, forming an interhorn bridge. Partial meniscectomy was repeated. Histologically, the regenerated tissue was not meniscal, but comprised mature fibrocartilage; macroscopically; however, it was very similar to meniscal tissue. Two years after the initial operation, the patient had no complaints and experienced full return of function. DISCUSSION The reason for such regeneration is unknown, but may have been attributed to the specific intra-articular environment that developed after the ACL reconstruction. CONCLUSION This is the first report of regenerative development of a ring-shaped lateral meniscus. When a ring-shaped lateral meniscus is diagnosed, we must accurately determine whether it is a true congenital anomaly in consideration of the present case.

An All-Inside Repair for Full Radial Posterior Lateral Meniscus Tears

There is controversy about the treatment for unstable full radial posterior lateral meniscus tears, particularly that involving the posterior root. Some surgeons have advocated repairing these types of meniscus tears using various techniques, but their methods are somewhat technical. We developed the technique for an all-inside repair for full radial posterior lateral meniscus tears using the Meniscal Viper (Arthrex, Naples, FL). A doubled thread is passed through 1 edge of the radial tear by the Meniscal Viper and is kept in place without tying the knot. The Meniscal Viper is used again to set a new thread, repeating the same procedure to another edge of the tear. At this step, 2 doubled threads are passed through each stump of the tear, and both a loop end and 2 free ends of each thread are located outside of the joint. Then, 2 doubled threads pass the third thread into its own loop, pulling it out. Finally, the third thread becomes the mattress suture over the radial tear site and is fastened by sliding knot techniques. This procedure makes it easy to strictly, smoothly, and less invasively shorten the gap by drawing each stump of the meniscus in the direction of the circumference.

Clinical Studies of Expansive Laminoplasty for Ossification of the Posterior Longitudinal Ligament of the Cervical Spine.

We investigated the clinical results of 39 patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent expansive laminoplasty by sagittal splitting of the spinous process (Kurokawa’s method), from January 1995 to October 2000. The mean age was 62 (42 to 75) years. The operative results were evaluated according to the Japanese Orthopaedic Association (JOA) score, after a mean follow-up period of 38 (12 to 77) months. The mean JOA score was 7.82 points before surgery and 12.73 points after surgery. The overall mean recovery rate by JOA score was 52.5%. The patients were divided into two groups; Group 1 consisting of 8 patients with spinal canal stenosis due to OPLL or ossification of the ligamentum flavum etc. at the thoracic and/or lumbar level, and Group 2 consisting of 31 patients without stenosis. The mean JOA score of Group 1 was 6.75 points before surgery and 10.94 points after surgery, while the score of Group 2 was 8.10 points before surgery and 13.20 points after surgery, with no significant difference in the score before surgery between the two groups. However, the JOA score after surgery was significantly lower in patients with spinal canal stenosis at the thoracic and/or lumbar level of Group 1, than the patients without stenosis in Group 2.

Examination of Emergency Orthopaedic Patients at a Major Regional Hospital

We report the realities of our emergency medical treatment, and define problems associated with being a regional hospital. The method of presentation, cause of injury, and the principal complaint were collected and examined. Targeted patients included 5, 992 in total examined mainly by the orthopaedics department. They accounted for 11.9% of 50, 273 patients cases who were sent to our hospital for emergencies.According to our data, 12% of 5, 992 patients required admission to hospital. This number comprises 65% of the total yearly orthopaedics inpatients. We also found 33% of the patients come from the suburbs of Kurume city, reflecting the role of the hospital works well as the major regional hospital.However these are times when the second or the third emergency patients are not treated adequately. This implies, the first (the most urgent) patients are treated urgently white less urgent patients are not treated as well. We suggest adjustment to our medical systems. In the near future we have to examine our hospitals function as well as the needs of the community.After doing this, we may have to adjust our medical care systems.

Results of Treatment for Fracture of Extremities and Trunk with Hemopneumothrax.

We report on the usefulness and safety of thoracodrainage for patients with traumatic hemopneumothorax who had fractures of the extremities and trunk. Traffic accident was the most common cause of hemopneumothorax. 20 in 47 patients (42.6%) had multiple bone fractures, and so orthopedic operations were conducted on 23 patients (48.9%). A thoracic drain was inserted for 42 patients (89.3%) including 1 patient who underwent thoracodrainage in both lungs. The outcome of all the patients was satisfactory.