Kazushi Hirohata

The osteogenetic potential of fracture haematoma. Subperiosteal and intramuscular transplantation of the haematoma

We studied the precise role of the fracture haematoma in healing by the experimental transplantation of the haematoma at two days and four days after fracture of the rat femur to subperiosteal and intramuscular sites. We used bone marrow and peripheral blood haematomas for control experiments. The transplanted two-day fracture haematoma produced new bone by endochondral ossification at the subperiosteal site, but not at the intramuscular site. Four-day fracture haematoma produced new bone formation at both subperiosteal and intramuscular sites. These results suggest that fracture haematoma has an inherent osteogenetic potential.

Meniscal repair using fibrin sealant and endothelial cell growth factor An experimental study in dogs

The effect of fibrin sealant and endothelial cell growth factor on the healing of defects of the avascular portion of canine menisci was investigated in 30 menisci of 15 adult mongrel dogs. The defects were treated in one of three ways: Group 1, the defect was left empty; Group 2, the defect was filled with fibrin sealant; and Group 3, the defect was filled with fibrin sealant and endothelial cell growth factor. The healing process was evaluated macroscopically and histologically at intervals of 1, 2, 6, 12, and 24 weeks. The average percentage of each defect that was filled with connective tissue was 5% in Group 1, 76.6% in Group 2, and 89.4% in Group 3. In the early phase of this repair, the extrinsic pannus-like tissue that contained many capillary vessels extended from the meniscosynovial junction into the defect. Sub sequently, organized fibrous connective tissue was formed, which had changed to cartilaginous tissue at 12 to 24 weeks. The combination of fibrin sealant and endothelial cell growth factor enhanced the neovascu larization and formation of granulation tissue, which accounted for the increased healing level in the avas cular portion of the meniscus.

Role of the fibula in weight-bearing.

To investigate the weight-bearing function of the fibula, weight-loading experiments were performed on autopsy specimens. With the ankle joint in neutral position, the weight distribution to the fibula amounted to 6.4%. With dorsiflexion of the ankle joint, the weight on the fibula increased. With plantar flexion of the ankle joint, the weight on the fibula decreased. Lateral and posterior loading of the tibia produced increased weight on the fibula. With eversion of the ankle joint, the weight on the fibula increased. The weight-bearing function increased with augmentation of the tibiofibular articular angle. These characteristics of the fibular weight-bearing function should be considered carefully in the treatment of the knee joint or the fibula.

Light and electron microscopic study of remodeling and maturation process in autogenous graft for anterior cruciate ligament reconstruction

We evaluated the remodeling process of autogenous patellar tendon graft for anterior cruciate ligament (ACL) reconstruction by means of light microscopic (LM) and electron microscopic (EM) examinations from the biopsy specimens obtained at the time of second-look arthroscopy. Twenty-one patients were examined at various times postoperatively (from 6 weeks to 15 months, mean 9.5 months), and the results were correlated with the morphology of normal patellar tendon and normal ACL. Our study showed that the graft was revascularized in the early postoperative period, fibroblastic remodeling took place, and the graft obtained gross similarity to the original ACL on their arthroscopic and LM appearances at approximately 1 year postoperatively. However, EM study showed that at both approximately 6 months and 1 year postoperatively the grafts consisted equally of active fibroblasts with a higher cytoplasm-to-nucleus ratio compared with normal ACL. Collagen fibrils of these grafts were of uniformly small diameter compared with normal patellar tendon and ACL. Our results with ultrastructural study suggest that the grafts were still immature even at 1 year postoperatively.

Knee Arthroscopy Using Local Anesthetic

The purpose of this study was to examine the effectiveness and safety of local anesthetics (a mixture of lidocaine and bupivacaine) in knee arthroscopy. Local anesthetic agents were shown to be effective and safe, based on chart review and measurement of blood levels of the anesthetic drugs.

Long-term results of synovectomy in rheumatoid patients.

Seventy-eight knees in fifty-five rheumatoid patients were evaluated clinically and radiographically at an average of 14.1 years (range, ten to twenty-three years) after synovectomy. The functional result was excellent in seventeen, satisfactory in thirty-one, unsatisfactory in eighteen, and poor in twelve knees. Pain and recurrent effusions were significantly reduced after synovectomy, but the range of motion of the knee remained unchanged. Radiographs demonstrated progressive changes of degenerative joint disease but apparent arrest of inflammatory disease changes in about 67 per cent of the knees. We believe that synovectomy of the knee is a good treatment alternative for selected patients with early stage-I rheumatoid arthritis that has proved resistant to standard medical therapy.

Arthritis presumably caused by Chlamydia in Reiter syndrome. Case report with electron microscopic studies.

* No benefits in any ftrm have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study. 1School of Allied Medical Sciences. Kobe University. 7-chome Tomogaoka. Sumaku. Kobe 654. Japan. Please address reprint requests to Dr. Ishikawa. been identified’ . In recent years, it has been suggested that Chlamydia organisms may trigger Reiter syndrome in the susceptible host . Using electron microscopy. we have identified Chlamydia in the synovial tissue of a patient with Reiter syndrome.

Osteochondritis dissecans of the shoulder in a tennis player.

Osteochondritis dissecans is a rare cause of shoulder pain. In reviewing the literature of the past 60 years, we found only four cases involving the articular surface of the humeral head. 2,8,13,16 All theories as to the etiology of this disease have been open to criticism on the ground of validity. In general, these theories may be divided into those pointing to a traumatic origin and those pointing to a nontraumatic origin. Although a number of authors have suggested the possibility of nontraumatic theories3,6 11,18 centering around a bland embolism occluding the arteries supplying the articular plate, more recent studies accept the traumatic theories as more reasonable. 7,9,12,17 This report describes the case of a male who developed osteochondritis dissecans of the humeral head after playing tennis. The case in this study had a clinical course strongly suggestive of a traumatic origin for this disease.

Dumbbell-shaped spinal extradural hemangioma.

SummaryA case of recurrent extradural cavernous hemangioma is presented. In contrast to secondary extension of a vertebral hemangioma to the epidural space, pure epidural hemangioma is rare. The location of this case was at the level of the 7th thoracic vertebra, and the tumor showed unusual dumbbell-like growth through an intervertebral foramen. The rarity of these lesions, as well as their clinical and radiological features, the diagnostic procedure, and the treatment are discussed.ZusammenfassungEs wird über einen Fall eines rezidivierenden extraduralen kavernösen Hämangioms berichtet. Im Gegensatz zu der sekundären Ausbreitung eines Wirbelhämangioms in den epiduralen Raum hinein ist ein reines epidurales Hämangiom selten. Die Lokalisation in diesem Fall war in Höhe Th7, und der Tumor zeigte ein ungewöhnliches hantelartiges Wachstum durch ein Foramen intervertebrale. Die Seltenheit, das klinische und radiologische Bild, das diagnostische Vorgehen und die Behandlung dieser Läsionen wird diskutiert.

Diagnosis of recurrent traumatic anterior subluxation of the shoulder.

Recurrent traumatic anterior subluxation of the shoulder has been infrequently documented. Subluxations have usually been included in reports of recurrent dislocation of the shoulder. There has also been confusion between traumatic and atraumatic subluxation. The authors diagnosed 45 cases of recurrent traumatic anterior subluxation of the shoulder at Kobe University Hospital during an eight-year period. Most patients were injured during sports activities. Patients complained of severe pain with episodes of locking when the shoulder was in abduction, external rotation, and hyperextension. Reduction could be accomplished by the patient. Arthrography demonstrates leaking of contrast medium on the anteroposterior view, and a detached labrum is noted on the posterior tangential view. Arthroscopy reveals Bankart lesions consisting of a ruptured capsule, detached labrum, and erosion of glenoid cartilage. Thirty-five of the patients underwent surgery, including Bankart and Putti-Platt reconstructions. Symptoms were relieved in all patients.