Masao Ishimura

Arthroscopic meniscal repair using fibrin glue. Part I: Experimental study

An experimental study of rabbit menisci was carried out to evaluate the healing-promoting properties of fibrin glue and fibrin glue-containing marrow cells. A full-thickness defect, 1.5 mm in diameter, was made within the avascular portion of the meniscus and left empty in 20 menisci (C group), filled with fibrin glue in 20 menisci (F group), and filled with fibrin glue-containing marrow cells in 20 menisci (M group). Measurements of the remaining defects and histological examinations were performed 1, 3, 6, and 12 weeks after each procedure. Overall, the remaining defects in the F group and, particularly, in the M group were significantly smaller than those in the C group at the various time points. Furthermore, the results of histological study showed earlier mature healing of the defects in the M group than of those in the F group. Our results suggest that fibrin glue, especially in a preparation containing marrow cells, may enhance meniscal healing.

Arthroscopic meniscal repair with fibrin glue

Abstract Since 1984 we have arthroscopically repaired 40 meniscal tears in 32 patients using fibrin glue in our operative technique. This technique was reported initially in 1985 (Ishimura M, Samma M, Habata T, Fujisawa Y. The use of fibrin glue for fresh knee injury. Cent Jpn Orthop Traumat 1985; 28: 1404-8), with a more detailed study published in 1987 [Ishimura M, Samma M, Fujisawa Y, et al. Arthroscopic repair of the meniscus tears with fibrin glue. Arthroscopy (Jpn) 1987; 12:31-6]. During the follow-up period, which ranged from 10 months to 6 years and 7 months (mean: 3 years and 8 months), only two patients complained of meniscal symptoms and underwent arthroscopic partial meniscectomy. Twenty patients with 25 repairs underwent repeat arthroscopy at an average of 5.7 months (range: 2 months-1 year and 2 months) after the initial repair. Twenty repairs were rated as good, four as fair, and one as poor by arthroscopic evaluation criteria. At present, the most appropriate use of this arthroscopic meniscal gluing technique is in tears in the posterior segment, which are difficult to suture without arthrotomy. Even a long tear with a stable reduced position can be expected to show good healing. When reduction of the tear is not stable, additional sutures should be used

Arthroscopic meniscal repair using fibrin glue. Part II: Clinical applications

Since 1984 we have arthroscopically repaired meniscal tears using a purified fibrin glue. This article describes clinical application of a fibrin-based glue to arthroscopic meniscal repair and a long-term follow-up study of 61 repaired menisci in 40 patients (average follow-up, 8 years; range, 5.1 to 11.4 years). Of these patients, 6 complained of recurrent meniscal symptoms and received partial meniscectomy. According to stepwise logistic regression analysis, the factors most strongly correlated with recurrent symptoms were insufficiency of the associated anterior cruciate ligament, repairs of fresh tears, and repairs requiring supplementary meniscal sutures (P < .05).

Marrow cell culture on poly-L-lactic acid fabrics

Bone marrow cells from rat femurs were cultured in Eagle Minimum Essential Medium containing 15% fetal calf serum until confluence. After the cells were trypsinized, they were subcultured on fabrics made of biodegradable poly-L-lactic acid for 2 weeks in the medium containing fetal calf serum, ascorbic acid phosphate, beta-glycerophosphate, and with and without dexamethasone. In the presence of dexamethasone, the fabrics showed many mineralized nodules together with cuboidal shaped cells that had osteoblastic activity, as evidenced by high alkaline phosphatase activity and the appearance of osteocalcin messenger ribonucleic acid. However, in the absence of dexamethasone, nodules did not form and many fibroblastic cells appeared with no evidence of osteoblastic activity. These results indicate the possibility of making a hybrid ligament substitute having an in vitro prefabricated bone anchor.

Chondromatosis within a meniscal cyst of the knee

A 32-year-old man complained of left gonalgia for 2 years and noticed a soft part tumor on the lateral side of his left knee. Roentgenograms showed some small calcified shadows at the same site of the tumor. Arthroscopy revealed a lateral meniscus to be an incomplete discoid with degenerative tears. At the operation, a multilocular soft part tumor was noticed in continuity with the lateral meniscus macroscopically. Small, loose bodies and gelatinous fluid were found in the cavity of the tumor. Histologically loose bodies were chondroma and the soft part tumor was meniscal cyst. The meniscal cyst wall contained hyaline cartilagenous tissue. Therefore it was thought that chondroma originated from the cyst wall.