Seok-Jung Kim

Agreements between different methods of gap balance estimation in cruciate-retaining total knee arthroplasty

The authors investigated the agreements between three different methods of estimating gap balance in cruciate-retaining (CR) total knee arthroplasty (TKA) with the use of a subvastus approach. One hundred consecutive CR TKAs were prospectively included in this study. After completing soft tissue release and bone cutting for CR TKA, flexion-extension gap balance was assessed using a distractor, spacer blocks, and trial components. Levels of agreement between the estimation techniques used were substantial. All three techniques were reliable in the assessment of gap balance. But, observations made during this study suggest that if more than one estimation technique is applied during CR TKA, the incidence of undetected gap imbalance can be reduced.

Novel repair technique for articular cartilage defect using a fibrin and hyaluronic acid mixture

We evaluated the cartilage repair potential of a hyaluronic acid and fibrin mixture when transplanted into cartilage defects. Circular, articular, cartilage defects 4-mm in diameter were made in the trochlear region in 21 New Zealand white rabbits divided into three groups. The seven rabbits in the control group underwent microfracture (M group), the seven rabbits in the experimental group underwent microfracture with subsequent injection of hyaluronic acid mixed with fibrin (MH group), and seven rabbits in the other experimental group underwent microfracture followed by injection of bone marrow concentrate and hyaluronic acid mixed with fibrin (MBH group). At week 12 following surgery, the cartilage was observed and histologically compared in the three groups. The surface of the newly generated cartilage was very smooth and even, and we noticed that the entire area was completely regenerated in both experimental groups. The control group showed incomplete and irregular cartilage formation in the defect. In histologic scoring, comparison of the MBH group (M= 2.333) and the M group (M= 9.000) differed significantly (P= 0.046). Therefore, injection of a mixture of bone marrow concentrate, hyaluronic acid and fibrin to treat articular cartilage defects of the knee appears to be an effective method of cartilage regeneration.

Treatment of osteonecrosis of the femoral head using autologous cultured osteoblasts: a case report

IntroductionOsteonecrosis of the femoral head is a progressive disease that leads to femoral head collapse and osteoarthritis. Our goal in treating osteonecrosis is to preserve, not to replace, the femoral head.Case presentationWe present the case of a patient with bilateral osteonecrosis of the femoral head treated with autologous cultured osteoblast injection.ConclusionAlthough our experience is limited to one patient, autologous cultured osteoblast transplantation appears to be effective for treating the osteonecrosis of femoral head.

Autologous chondrocyte implantation for rheumatoid arthritis of the knee: a case report

IntroductionAlthough pharmacologic treatment remains the mainstay for treating rheumatoid arthritis, there is an increasing need for a method that biologically regenerates arthritic knee lesions as patient longevity continually increases.Case presentationWe treated rheumatoid arthritis of the right knee in a 35-year-old female Korean patient using autologous chondrocyte implantation. Twelve months after surgery, the patient could walk without pain.ConclusionAutologous chondrocyte implantation appears to be effective for treating rheumatoid arthritis of the knee.

Gel ACI (GACI): Articular Cartilage Repair Technique

As articular cartilage has only limited ability to regenerate, various treatment options have been developed during the past several decades to treat symptomatic articular cartilage injuries [1, 2]. Among these treatment options available, autologous chondrocyte implantation (ACI), an advanced, cell-based, biologic technology, has become a standard technique used to repair symptomatic, full-thickness, chondral injuries [2]. The traditional ACI technique involves injection of cultured autologous chondrocyte cells into the prepared cartilage defect covered by a periosteal flap. This was the first generation of ACI. However, complications such as periosteal hypertrophy and, less commonly, calcification and delamination have been encountered when periosteum is used as a cover material [3]. Furthermore, improvements in tissue engineering have resulted in a new generation of ACI techniques in which cells are combined with bioactive resorbable biomaterials such as a bilayer type I/III collagen membranes, hyaluronan polymer, and copolymers of polylactin and polyglactin [3]. However, all these techniques require open arthrotomy for the second stage of cell implantation, which has associated patient morbidity and complications [4].

Cartilage Regeneration Using a Fibrin and Autologous Cultured Chondrocytes Mixture in a Canine Model

Background: Various surgical methods have been designed to avoid the necessity of using periosteum, i.e. an operative weak point of autologous chondrocyte implantation (ACI) which is a representative method for treating articular cartilage injury. This study was performed in the attempt to develop a simple, injectable type of ACI to in order facilitate the surgical process. Methods: Seven of 10 dogs were used for the injectable type ACI using fibrin, while the remaining three dogs were used for implantation according to the previous surgical method using periosteum. The left knee of each dog was incised in order to expose the medial femoral condyle, and a circular defect was then made to 5mm in diameter on the articular cartilage of the exposed medial femoral condyle so that chondrocyte implantation using periosteum and the injectable chondrocyte implantation using fibrin glue could both be performed. At week 12 following surgery, the cartilage was observed and compared histologically with normal articular cartilage. Results: The surface of the cartilage newly generated at week 12 was very smooth and even, and it was also seen that the entire area was completely regenerated. Through the histological evaluation, IHC test, and electron microscope pictures, it was verified that collagen type II was normally expressed and that the ultrastructure of the regenerated tissue showed the normal cartilage properties. Conclusion: Gel-type ACI using fibrinfor articular cartilage defects of the knee, appears to be an effective method for the regeneration and growth of cartilage and also has many potential surgical advantages.

Mesenchymal Stem Cell Induced Chondrogenesis (MCIC

In 1743 William Hunter [1] stated, ‘an ulcerated cartilage is a troublesome problem and once destroyed, it never repairs’. This statement holds true even today, in spite of new advances in the field of tissue engineering. Cartilage injuries are common in the knee joint and if untreated can become symptomatic and progressively lead to premature arthritis [2] (Ref Wong et al.). Galen observed and wrote about premature arthritis in athletes.

Autologous Collagen-Induced Chondrogenesis (ACIC™)

Articular cartilage defects in the knee joint are commonly seen in today’s clinical practice [1]. They were recognised early on by the likes of Galen and William Hunter, though we have begun to effectively diagnose and treat them only in the last few decades [2, 3].