In Suk Oh

Regeneration of hyaline cartilage by cell-mediated gene therapy using transforming growth factor β1-producing fibroblasts

Transforming growth factor beta (TGF-beta) has been considered as a candidate for gene therapy of orthopedic diseases. The possible application of cell-mediated TGF-beta gene therapy as a new treatment regimen for degenerative arthritis was investigated. In this study, fibroblasts expressing active TGF-beta 1 were injected into the knee joints of rabbits with artificially made cartilage defects to evaluate the feasibility of this therapy for orthopedic diseases. Two to 3 weeks after the injection there was evidence of cartilage regeneration, and at 4 to 6 weeks the cartilage defect was completely filled with newly grown hyaline cartilage. Histological analyses of the regenerated cartilage suggested that it was well integrated with the adjacent normal cartilage at the sides of the defect and that the newly formed tissue was indeed hyaline cartilage. Our findings suggest that cell-mediated TGF-beta 1 gene therapy may be a novel treatment for orthopedic diseases in which hyaline cartilage damage has occurred.

New modified technique of osteotomy for hallux valgus

Purpose. To improve the technique of osteotomy for hallux valgus (bunion). Methods. 38 cases of a new modified osteotomy procedure for hallux valgus were performed for 22 patients (21 women and one man). During a 3-year (range, 2–5 years) follow-up, the patients underwent physical examination; and their American Orthopedic Foot and Ankle Society hallux-metatarso-phalangeal-interphalangeal scale scores and standard foot radiographic measurements were recorded. Results. 20 of the 22 patients (38 cases) had no pain, achieved good cosmesis, and were completely satisfied with the results of the operation. The remaining 2 patients had occasional mild discomfort. The mean hallux-metatarso-phalangeal-interphalangeal scale score was 93 points (range, 78–100 points). The mean preoperative and postoperative metatarsophalangeal angles were 34 degrees and 11 degrees, respectively. The mean postoperative reduction of the inter-metatarsal angle and metatarsophalangeal angle were 6 degrees and 23 degrees, respectively. Conclusion. The new technique of osteotomy achieved even greater stability and accurate correction of the deformity in our 38 cases. Furthermore, it was more effective than conventional ‘chevron’ osteotomy in terms of correction of the deformity. Therefore, it should be used more widely.

Clinical and radiological results after modified distal metatarsal osteotomy for hallux valgus.

Background: The chevron osteotomy is an acceptable method for correction of mild and moderate hallux valgus, but can result in instability at the osteotomy site. The purpose of this study was to present clinical and radiological results with our modified technique of osteotomy. Materials and Methods: We performed a modified technique of distal osteotomy of the first metatarsal on 77 feet of 46 patients with symptomatic hallux valgus; followed up for an average of 52 months. Results: All of the patients experienced satisfactory pain relief and acceptable cosmesis. The mean postoperative reduction in the intermetatarsal angle was 6.5 degrees and of the metatarsophalangeal angle was 23.0 degrees. There was no loss of correction and there was no discrepancy in preoperative and postoperative lengths of the first metatarsal during the followup period. Conclusion: We found our modified distal metatarsal osteotomy to be an effective method of correcting hallux valgus.

Modified Technique of Distal Metatarsal Osteotomy for Hallux Valgus

Osteotomy of the first metatarsal accompanied by medial eminence removal and soft-tissue reconstruction is the procedure generally performed to correct symptomatic hallux valgus, but the choice of operation is difficult and failed hallux valgus correction has been reported.3 Corless1 reported a modification of the technique described by Mitchell et al.4 in which the osteotomy was V-shaped to provide greater stability. However, the conventional chevron osteotomy is not always stable and sometimes requires internal fixation with wires or passage of a heavy suture through offset drill holes.6,7 Malunion also has been reported at the osteotomy site.5 Johnson et al.2 reported excellent relief of pain and cosmetic correction with the modified chevron osteotomy technique in 26 feet (18 patients). The modified chevron osteotomy seems to produce anatomic correction similar to that of our technique and has better stability at the osteotomy site; however, it does not prevent dorsal angulation or medial or lateral tilting or shortening. Trnka et al.5 reported intraoperative instability in four of 46 chevron osteotomies. We have further modified the technique to provide even greater stability at the osteotomy site. Our modified technique prevents dorsal angulation as well as medial and lateral tilting and shortening at the osteotomy site because of the rectangular anatomical end-to-end contact of the dorsal metatarsal cortex of the osteotomy site. For this reason, we believe that our modified technique achieves a more stable result at the osteotomy site, and a more accurate correction is possible.