Ove Engkvist

Results from resection of the distal end of the ulna after fractures of the lower end of the radius.

Pain, impaired mobility and weakness in the wrist are common complications after fractures of the lower end of the radius. When these symptoms persist, resection of the distal end of the ulna has been the surgical treatment of choice. 24 patients who had undergone this procedure were reviewed. 50% stated they were not improved by the operation. Of 11 patients with degenerative changes in the distal radio-ulnar joint on preoperative X-ray, 8 stated they were helped by the operation, while of 13 patients without any signs of arthrosis in the distal radio-ulnar joint, only 4 experienced relief of their discomfort. A more discriminating approach to the treatment of the sequelae of fractures to the lower end of the radius is required. Resection of the distal end of the ulna is probably only indicated when the distal radio-ulnar joint shows sings of arthrosis.

The Cartilaginous Potential of the Perichondrium in Rabbit Ear and Rib

In an experimental study the cartilaginous protential of the rabbit ear perichondrium has been compared with that of the rib in vivo and in vitro. Perichondrium was transferred as free autologous grafts to the subcutaneous tissue on the scalp and as loose bodies into the knee joint. The presence of cartilage in the grafts was examined after six weeks. In vitro explants of rabbit perichondrium from the ear and the rib were maintained in an organ culture system. The presence of cartilage was analyzed after one to three weeks. Rabbit perichondrium from the rib appeared to have a greater cartilaginous potential than that from the ear both in vivo and in vitro. Chondrogenesis in perichondrium was demonstrated in vitro.

Reconstruction of Patellar Articular Cartilage with Free Autologous Perichondrial Grafts: An Experimental Study in Dogs

The cartilaginous potential of the perichondrium has earlier been utilized to reconstruct articular cartilage in unloaded joints in adult rabbits. The present work in adult dogs has been performed to find out if the perichondrium can be used for the same purpose in joints subjected to pressure. In 13 knee joints the articular cartilage of the patella was excised completely and the resected surface was covered with an autologous perichondrial graft taken from the rib cartilage. After 3 weeks of immobilization the dogs were allowed to run freely until sacrifice 2 to 17 months later. In all 13 cases regeneration of cartilage took place. Within 8 months the regenerated cartilage showed no or only very slight degenerative signs but from 12 months and later such changes were common. In control cases where the resected surface was left without any graft no cartilage at all was found. Conclusively cartilage formation from grafted rib perichondrium is achieved in the knee joints of adult dogs, but it does not resist considerable pressure forces.

Reconstruction of Articular Cartilage with Free Autologous Perichondrial Grafts

An experimental study in adult rabbits has been performed to find out whether the cartilage forming capacity of the perichondrium could be utilized in reconstruction of articular cartilage. The normal articular cartilage of the glenoid surface of the humero-scapular joint was completely removed. Auricular perichondrium was grafted to cover the exposed bony surface with the active chondrogenic layer of the perichondrial graft facing the joint cavity. The joint was not immobilized but the operated limb was amputated at wrist level to avoid weight bearing. The animals were sacrificed at different time intervals ranging from 1 to 17 weeks. In 12 out of 14 grafted rabbits regeneration of cartilage occurred. In 6 of 10 control cases where no perichondrium was grafted to cover the resected surface no cartilage was found. In the other 4, only small areas of mature cartilage were seen, probably remnants of the original articular cartilage.

Corrective Osteotomy of Malunited Fracture of the Distal end of the Radius

Thirty-nine patients with painful impaired forearm rotation and reduced grip strength after malunited fracture of the distal radius were treated with corrective osteotomy of the distal radius, bone grafting and internal fixation and followed for an average of 1.5 years. All patients stated that they were improved by the procedure. At follow-up 36 patients were graded as excellent or good, implying no pain, moderate limitation of motion and grip strength not less than 70% of the uninjured hand. Two patients were graded as fair and one as poor. It is concluded that surgical correction of the deformity is a good procedure when treating disabilities in the distal radio ulnar joint following malunited fractures of the distal end of the radius.

Reconstruction of articular cartilage using autologous perichondrial grafts. A preliminary report.

In a pilot study of grown-up rabbits perichondrium from the ear was grafted to the joint surface of cavitas glenoidalis from which the normal articular cartilage had been resected. in all cases regeneration of new cartilage occurred. Five clinical cases of arthritis are reported in which, following removal of the degenerated cartilage and grafting of rib perichondrium, articular cartilage regeneration took place

Formation of Cartilage from RIB Perichondrium Grafted to an Articular Defect in the Femur Condyle of the Rabbit

In immature and adult rabbits perichondrium from the rib was autologously grafted to a surgically created defect of the articular surface of the femur condyles exposing the subchondral bone. After one week of immobilization the animals were allowed to move freely until sacrifice after 7 and 13 weeks. In all grafted cases newly formed cartilage of a hyalin appearance filled the defect. Using the technique of intraarticular administration of tritiated thymidine, mitotic activity was found in the superficial zone of the regenerated cartilage indicating that the proliferation of cells is initiated from the perichondrium. In control cases where no graft covered the defect no cartilage was found.

Perichondrial Wrist Arthroplasty in Rheumatoid Patients

A new method is proposed for reconstruction of the wrist joint in rheumatoid arthritis. Perichondrial arthroplasty done in four patients with severe deformity of the wrist from rheumatoid arthritis gave functionally improved results. In one case biopsy of the reconstructed joint showed newly formed cartilaginous tissue four months after initial surgery.

Perichondrial arthroplasty using fibrin glue and early mobilization. An experimental study.

An experimental study was performed in rabbits to find out whether fibrin glue, used to simplify the procedure for graft fixation in perichondrial arthroplasty, would also allow earlier mobilization of the grafted joint, thereby reducing the risk for postoperative stiffness of the joint. The results indicate the possibility of reducing the time used for postoperative fixation from three weeks originally to one week, and still achieve the same results regarding graft healing and cartilage regeneration. Immediate post-operative mobilization caused loosening of the graft and endangered the results.

Joint Cartilage Formation Induced by Silastic Sheet Spacer

In an experimental study in rabbits the effect on articular cartilage regeneration from subchondral bone induced by a temporary interposed silicone rubber sheet has been analyzed. The normal articular cartilage of the medial condyle of the femur was resected and the subchondral bone surface covered by a 2 mm thick Silastic sheet which was removed after 2 months. At that time cartilaginous tissue of a hyalin appearance was found to cover the resected surface. As early as one month after removal of the sheet this cartilage showed obvious signs of degeneration and a few months later no regenerating cartilage was left. It is concluded that in this study there is no experimental evidence supporting the idea that temporary interposition of a silicone rubber sheet is beneficial in the treatment of degenerative arthritis.