Ho Jong Ra

Comparison of second-look arthroscopic findings and clinical results according to the amount of preserved remnant in anterior cruciate ligament reconstruction.

BACKGROUND Although ACL reconstruction is prevalent, the most effective method for ACL reconstruction still remains controversial. The purpose of this study was to evaluate the effect of the preserved remnant in ACL reconstruction on graft morphology at second-look arthroscopy and clinical outcomes. METHODS 66 consecutive patients who underwent a second-look arthroscopy after a remnant-preserving ACL reconstruction were enrolled. The patients were divided into two groups according to whether the remnant ACL fibers could be preserved by over 50% (Group I) or not (Group II). The Lysholm score, IKDC subjective score, Tegner activity score, pivot-shift test, and KT-2000 arthrometric findings were evaluated preoperatively and just prior to the second-look arthroscopy to assess clinical outcomes. At second-look arthroscopy, graft morphology was evaluated using hypertrophy rate and synovialization. RESULTS At second-look arthroscopy, the hypertrophy rate of Group I (42.1%) was higher than Group II (25.1%), which was statistically significant (p=0.002). In graft synovialization, there was a statistically significant difference between the two groups (p<0.001). The IKDC subjective score improved from 42.9, 43.1 to 77.8, 75.0 for Group I and Group II, respectively (p=0.025). For the Lysholm score, Group I and Group II improved from 55.4 and 55.7 to 87.8 and 84.9 (p=0.031). There was also a significant difference between the pivot shift tests between the groups (p=0.039). Other clinical tests showed no statistically significant differences. CONCLUSION Preserving the remnant ACL tissue during ACL reconstruction could have a positive effect on graft hypertrophy, synovialization and clinical outcomes. LEVEL OF EVIDENCE III, retrospective comparative study.

Pullout Fixation of Posterior Medial Meniscus Root Tears: Correlation Between Meniscus Extrusion and Midterm Clinical Results

Background: Medial meniscus posterior root tears (MMPRTs) lead to extrusion of the meniscus during weightbearing as well as loss of the ability of the meniscus to generate hoop stress. This loss of load-sharing ability leads to progressive arthritic changes. However, there have been no studies that correlate the correction of meniscus extrusion with clinical outcomes. Hypothesis: Decreased meniscus extrusion is associated with better clinical and radiographic outcomes compared with increased meniscus extrusion after MMPRT pullout fixation. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 39 patients who underwent MMPRT pullout fixation and had been observed for more than 5 years were recruited for this study. The mean follow-up period was 69.8 months. Participants were categorized into 2 groups according to the direction of meniscus extrusion: group A (increased extrusion; 23 patients) and group B (decreased extrusion; 16 patients). Meniscus extrusion was assessed in the coronal plane on magnetic resonance imaging preoperatively and at 1 year postoperatively. The postoperative clinical outcomes (Lysholm and International Knee Documentation Committee [IKDC] scores) and radiographic results (Kellgren-Lawrence [K-L] grade and medial joint space) were compared between groups. Results: Meniscus extrusion in group A increased significantly from a mean (±SD) of 3.5 ± 0.9 mm preoperatively to 5.1 ± 1.4 mm at 1 year postoperatively (P < .001), whereas in group B, it decreased significantly from 4.1 ± 1.3 mm preoperatively to 3.5 ± 1.4 mm at 1 year postoperatively (P < .001). The K-L arthritis grade (0/1/2/3/4) significantly progressed in group A (from 2/12/9/0/0 preoperatively to 0/1/14/8/0 postoperatively, respectively; P = .009) but not in group B (from 1/11/4/0/0 preoperatively to 0/6/8/2/0 postoperatively, respectively; P = .274). The mean final Lysholm and IKDC scores in group B (88.1 ± 12.1 and 79.0 ± 11.4, respectively) were significantly better than those in group A (81.0 ± 9.0 and 71.1 ± 7.8, respectively) (P < .05). There was less medial joint space narrowing at final follow-up in group B (0.6 ± 0.8 mm) than in group A (1.1 ± 0.6 mm) (P = .015). Progression of the K-L arthritis grade was seen in 50% (8/16) of the patients in group B compared with 87% (20/23) of the patients in group A (P = .027). Conclusion: The current study demonstrates that in patients with MMPRTs, pullout fixation leads to favorable midterm outcomes, regardless of meniscus extrusion at 1-year follow-up. However, patients with decreased meniscus extrusion at postoperative 1 year have more favorable clinical scores and radiographic findings at midterm follow-up than those with increased extrusion at 1 year. This study indicates that one of the main goals of the repair of MMPRTs is to reduce meniscus extrusion as much as possible.

Comparison of the ceiling effect in the Lysholm score and the IKDC subjective score for assessing functional outcome after ACL reconstruction

BACKGROUND To compare the ceiling effect of the Lysholm and IKDC subjective scores for assessing functional outcome after ACL reconstruction and evaluated the correlation with the one-leg hop test. METHODS A total of 134 patients who underwent ACL reconstruction between 2007 and 2011 were enrolled in this study. All patients fulfilled the postoperative 6- and 12-month evaluations. The ceiling effect of the Lysholm and IKDC subjective scores was assessed, and the correlations between two scales and one-leg hop test were analysed. RESULTS For the entire sample, the ceiling effect for the Lysholm score was 14.9% and 30.6% at 6 and 12 months postoperatively. The values for the IKDC subjective score were 5.2% and 17.2%, respectively. In all subjects, the correlation coefficients [95% confidence intervals] between the IKDC subjective score and one-leg hop test at 6 and 12months (r=0.492, [0.34 to 0.62]; r=0.296, [0.12 to 0.46]) were higher than those for the Lysholm score (r=0.355, [0.18 to 0.51]; r=0.241, [0.06 to 0.41]), respectively.(p<0.05). CONCLUSION With regard to evaluating ACL reconstruction outcomes in patients, no significant difference between the IKDC subjective and the Lysholm scores exists in terms of the amount of ceiling effect and the correlation with the LSI. However, the concern that the ceiling effect of the Lysholm score was greater than the IKDC subjective score, should be addressed in assessing the patients functional status postoperatively. LEVEL OF EVIDENCE III, retrospective comparative study.

Corrigendum to: Effects of salmon DNA fraction in vitro and in a monosodium iodoacetate-induced osteoarthritis rat model

[This corrects the article on p. 163 in vol. 22, PMID: 29520169.].

Effects of salmon DNA fraction in vitro and in a monosodium iodoacetate-induced osteoarthritis rat model

PRF001 is a fragmented DNA polymer extracted from the testes of salmon. The purpose of this study was to assess the anti-inflammatory effect of PRF001 in vitro as well as the protective effect of PRF001 intake against arthritis in a rat model. In vitro, cell survival and inflammatory markers after H2O2 treatment to induce cell damage were investigated in CHON-001 cells treated with different concentrations of PRF001. In vivo, osteoarthritis was induced by intra-articular injection of monosodium iodoacetate (MIA) into the knee joints of rats. After consumption of PRF001 (10, 50, or 100 mg/kg) for 4 weeks, inflammatory mediators and cytokines in articular cartilage were investigated. In vitro, the levels of inflammatory markers, IL-1β, TNF-α, COX-2, iNOS, and PGE2, were significantly suppressed by PRF001 treatment. In vivo, the inflammatory mediators and cytokines, IL-1β, p-Erk1/2, NF-κB, TNF-α, COX-2, and PGE2, as well as MMP3 and MMP7, which have catabolic activity in chondrocytes, were decreased in the MIA-induced osteoarthritic rats following intake of PRF001. Histological analysis revealed that PRF001 had a protective effect on the articular cartilage. Altogether, these results demonstrated that the anti-inflammatory property of PRF001 contributes to its protective effects in osteoarthritis through deregulating IL-1β, TNF-α, and subsequent signals, such as p-Erk1/2, NF-κB, COX-2, PGE2, and MMPs.