Shinro Takai

Behavior of Transplanted Bone Marrow-derived GFP Mesenchymal Cells in Osteochondral Defect as a Simulation of Autologous Transplantation

To elucidate the behavior of autologously transplanted mesenchymal cells in osteochondral defects, we followed transplanted cells using green fluorescent protein (GFP) transgenic rats, in which all cells express GFP signals in their cytoplasm and nuclei as transplantation donors. Bone marrow-derived mesenchymal cells, which contain mesenchymal stem cells (MSCs), were obtained from transgenic rats. Then, dense mesenchymal cell masses created by hanging-drop culture were transplanted and fixed with fibrin glue into osteochondral defects of wild-type rats. At 24 weeks after surgery, the defects were repaired with hyaline-like cartilage and subchondral bone. GFP positive cells, indicating transplanted mesenchymal-derived cells, were observed in the regenerated tissues for 24 weeks although GFP positive cells decreased in number with time. Because GFP causes no immunological rejection and requires no chemicals for visualization, transplantation between transgenic and wild-type rats can be regarded as a simulation of autologous transplantation, and the survivability of transplanted cells are able to be followed easily and reliably. Thus, the behavior of transplanted mesenchymal cells was able to be elucidated in vivo by this strategy, and the results could be essential in future tissue engineering for the regeneration of osteochondral defects with original hyaline cartilage and subchondral bone.

Development of Novel Ultrasonic Bone Densitometry Using Acoustic Parameters of Cancellous Bone for Fast and Slow Waves

A novel ultrasonic bone densitometer, prototype LD-100, has been developed to overcome problems inherent in an ultrasonic method and to obtain bone mass density in the unit of mg/cm3 and bone elasticity in the unit of GPa with a spatial resolution comparable to that of the peripheral quantitative computed tomography (pQCT) system. Bone mass density and bone elasticity are evaluated using ultrasonic parameters based on fast and slow waves in cancellous bone using a modeling of ultrasonic wave propagation path. A good reproducibility of measured values and two-dimensional (2D) imaging of bone density and bone quality are realized by two scannings with an automatic measurement algorithm.

Role of the superior shoulder capsule in passive stability of the glenohumeral joint

BACKGROUND The shoulder capsule is the main static stabilizer of the glenohumeral joint. However, few studies specifically address the function of the superior shoulder capsule, which is usually damaged in patients with complete rotator cuff tears. Therefore, the purpose of this study was to determine the biomechanical contribution of the superior shoulder capsule to passive stability of the glenohumeral joint. METHODS Seven cadaveric shoulders were tested with a custom testing system. Glenohumeral translations, subacromial contact pressure, and glenohumeral external and internal rotations were quantified at 5°, 30°, and 60° of glenohumeral abduction. Data were compared among 3 conditions: (1) intact superior capsule, (2) after detaching the superior capsule from the greater tuberosity (tear model), and (3) after complete removal of the superior capsule from the greater tuberosity to the superior glenoid (defect model). RESULTS A tear of the superior capsule significantly (P < .05) increased anterior and inferior translations compared with those in the intact capsule. Creation of a superior capsular defect significantly (P < .05) increased glenohumeral translation in all directions, subacromial contact pressure at 30° of glenohumeral abduction, and external and internal rotations compared with those of the intact capsule. CONCLUSION The superior shoulder capsule plays an important role in passive stability of the glenohumeral joint. A tear in the superior capsule at the greater tuberosity, which may be seen with partial rotator cuff tears, increased anterior and inferior translations. A defect in the superior capsule, seen in massive cuff tears, increased glenohumeral translations in all directions.

Measurement of joint gap load in patella everted and reset position during total knee arthroplasty

An original tensor system was developed to directly measure the load between femoral trial component and tibial cut surface in vivo in both patella everted and reset positions during total knee arthroplasty (TKA). We used this system during posterior-stabilized (PS) and cruciate-retaining (CR) TKA. In PS-TKA, there was no significant difference between the loads in extension in patella everted position and reset position. In flexion, however, there was significant increase of load in patella reset position compared to in everted position. In CR-TKA, there was no significant difference between the loads in patella everted position and in patella reset position in either extension or flexion. It was found that the effect of patella position on joint gap load was different between PS-TKA and CR-TKA. It is important to be aware that, when performing PS-KA, the load in flexion gap will increase, in other words, flexion gap distance will decrease by resetting the patella.

Molecular hydrogen protects chondrocytes from oxidative stress and indirectly alters gene expressions through reducing peroxynitrite derived from nitric oxide

BackgroundMolecular hydrogen (H2) functions as an extensive protector against oxidative stress, inflammation and allergic reaction in various biological models and clinical tests; however, its essential mechanisms remain unknown. H2directly reacts with the strong reactive nitrogen species peroxynitrite (ONOO-) as well as hydroxyl radicals (•OH), but not with nitric oxide radical (NO•). We hypothesized that one of the H2functions is caused by reducing cellular ONOO-, which is generated by the rapid reaction of NO• with superoxides (•O2-). To verify this hypothesis, we examined whether H2could restore cytotoxicity and transcriptional alterations induced by ONOO-derived from NO• in chondrocytes.MethodsWe treated cultured chondrocytes from porcine hindlimb cartilage or from rat meniscus fibrecartilage with a donor of NO•, S-nitroso-N-acetylpenicillamine (SNAP) in the presence or absence of H2. Chondrocyte viability was determined using a LIVE/DEAD Viability/Cytotoxicity Kit. Gene expressions of the matrix proteins of cartilage and the matrix metalloproteinases were analyzed by reverse transcriptase-coupled real-time PCR method.ResultsSNAP treatment increased the levels of nitrated proteins. H2decreased the levels of the nitrated proteins, and suppressed chondrocyte death. It is known that the matrix proteins of cartilage (including aggrecan and type II collagen) and matrix metalloproteinases (such as MMP3 and MMP13) are down- and up-regulated by ONOO-, respectively. H2restoratively increased the gene expressions of aggrecan and type II collagen in the presence of H2. Conversely, the gene expressions of MMP3 and MMP13 were restoratively down-regulated with H2. Thus, H2acted to restore transcriptional alterations induced by ONOO-.ConclusionsThese results imply that one of the functions of H2exhibits cytoprotective effects and transcriptional alterations through reducing ONOO-. Moreover, novel pharmacological strategies aimed at selective removal of ONOO-may represent a powerful method for preventive and therapeutic use of H2for joint diseases.

Pseudotumor and deep venous thrombosis due to crevice corrosion of the head-neck junction in metal-on-polyethylene total hip arthroplasty

After the implantation of metal-on-metal hip prostheses, pseudotumors or soft-tissue reactions—so-called adverse local tissue reactions (ALTRs)—have frequently been reported [1–7]. However, there are limited reports on the development of a pseudotumor due to crevice corrosion after insertion of a metal-on-polyethylene hip prosthesis. Here we describe a case of pseudotumor and deep venous thrombosis (DVT) causing persistent left hip pain as a result of crevice corrosion of the head–neck junction that required revision surgery in a metal-on-polyethylene hip prosthesis.

SLAP repair with arthroscopic decompression of spinoglenoid cyst.

Introduction: A spinoglenoid cyst with suprascapular nerve disorders is highly associated with superior labrum anterior posterior (SLAP) lesion. Conservative or surgical treatment is applied to relieve pain and neurological symptoms. The purpose of this study was to evaluate clinical outcomes of patients treated by arthroscopic surgery for SLAP lesion with a spinoglenoid cyst. Methods: The subjects of this study were six patients with SLAP lesion with a spinoglenoid cyst who underwent arthroscopic surgery. There was one female and five males with a mean age of 48.5 years. SLAP lesion was found in all the patients at arthroscopy. A small tear of the rotator cuff was found in the two patients. The SLAP lesion was repaired using suture anchors, and the rotator cuff tears were repaired by suture-bridge fixation. The spinoglenoid cyst was decompressed through the torn labrum in three patients, and through the released superior to posterior portion of the capsule in the other three patients. Results: All patients showed excellent improvement in pain and muscle strength at the final follow-up examination. The mean Constant score was improved from 60.5 points preoperatively to 97.2 points postoperatively. The mean visual analog scale (VAS) score decreased from 4.5 on the day of the surgery to 2.5 within one week postoperatively. Postoperative MRI showed disappearance or reduction of the spinoglenoid cyst in four and two patients, respectively. There were no complications from the surgical intervention and in the postoperative period. Discussion: The patients treated by decompression through the released capsule obtained pain relief at an early period after the surgery. Arthroscopic treatment for a spinoglenoid cyst can provide a satisfactory clinical outcome. Arthroscopic decompression of a spinoglenoid cyst through the released capsule is recommended for a safe and reliable procedure for patients with suprascapular nerve disorders.

Transduction of Anti–Cell Death Protein FNK Suppresses Graft Degeneration After Autologous Cylindrical Osteochondral Transplantation

This study shows that artificial super antiapoptotic FNK protein fused with a protein transduction domain (PTD-FNK) maintains the quality of osteochondral transplant by preventing chondrocyte death. Cylindrical osteochondral grafts were obtained from enhanced green fluorescent protein (EGFP)-expressing transgenic rats, in which living chondrocytes express green fluorescence, and submerged into medium containing PTD-FNK, followed by transplantation into cartilage defects of wild-type rats by impact insertion simulating autologous transplantation. The tissues were histologically evaluated by hematoxylineosin and Safranin-O staining. At 1 week, chondrocyte alignment was normal in the PTD-FNK treatment group, whereas all grafts without PTD-FNK treatment showed mixed cluster cell distribution. At 4 weeks, all grafts with PTD-FNK treatment showed almost normal matrix, whereas two grafts without PTD-FNK treatment showed fibrocartilage. Notably, all grafts with PTD-FNK retained high intensity of Safranin-O staining, but all grafts without PTD-FNK largely lost Safranin-O staining. PTD-FNK significantly suppressed a decrease in the survival rate and the density of EGFP-positive cells at 1 and 2 weeks, and this tendency continued at 4 weeks. The results of terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP)-nick end-labeling staining showed that PTD-FNK inhibited cell death, indicating that PTD-FNK protects chondrocyte death and suppresses graft degeneration.

Influence of the Medial Knee Structures on Valgus and Rotatory Stability in Total Knee Arthroplasty

BACKGROUND Precise biomechanical knowledge of individual components of the MCL is critical for proper MCL release during TKA. This study was to define the influences of the deep MCL and the POL on valgus and rotatory stability in TKA using cadaveric knees. METHODS This study used six fresh-frozen cadaveric knees. All TKA procedures were performed using a cruciate-retaining TKA with a CT-free navigation system. We did a sequential sectioning on each knee, S1; femoral arthroplasty only, S2; medial half tibial resection with spacer, S3; anterior cruciate ligament cut, S4; tibial arthroplasty, S5; release of the dMCL, S6; release of the POL. The navigation system monitored motion after application of 10 N-m valgus loads and 5 N-m internal and external rotation torques to the tibia at 0°, 20°, 30°, 60°, and 90° of knee flexion for each sequence. RESULTS There were no significant differences in medial gaps. Internal rotation angles significantly increased after S2 at 0°, 20°, and 30°, and after S6 at 90° compared with those after S1. External rotation angles significantly increased after S3 at 0°, S4 at 60°, S5 at 0°, 30° and 90°, and after S6 at 30°, 60° compared with those after S1. CONCLUSION Significant increases of rotatory instability were seen on release of the dMCL, and then further increased after release of the POL. Surgical approach of retaining the dMCL and POL has a possibility to improve the outcome after primary TKA.

Transverse Ultrasound Assessment of the Displacement of the Median Nerve in the Carpal Tunnel during Wrist and Finger Motion in Healthy Volunteers

PURPOSE The purpose of this study was to investigate the displacement of the median nerve in the carpal tunnel during finger motion at varied wrist positions using transverse ultrasound in healthy volunteers, in order to clarify the appropriate position of a wrist splint in treating carpal tunnel syndrome. METHODS Fifty wrists of 25 asymptomatic volunteers were evaluated by transverse ultrasound. The location of the median nerve in the carpal tunnel was examined at 5 wrist positions (neutral, 60° dorsiflexion, 60° palmar flexion, 40° ulnar flexion, 10° radial flexion) with all 5 fingers in full extension, all 5 fingers in full flexion, and isolated thumb in full flexion, respectively. RESULTS The median nerve was located significantly (p<0.05) more dorsally at the wrist dorsal flexion position, more ulnopalmarly at the wrist palmar flexion position, more radially at the wrist radial flexion position, and more radially at the wrist ulnar flexion position than at the wrist neutral position in all 5 fingers at full extension. The median nerve moved the most significantly dorsally among all wrist positions during finger motion at the wrist dorsal flexion position (p<0.05). Conversely, the median nerve moved the most significantly ulnopalmarly at the wrist palmar flexion position with all 5 fingers in full flexion among all wrist positions during finger motion (p<0.05). This latter wrist and finger position induced significant displacement of the median nerve toward the transverse carpal ligament, and compressed it between the flexor tendons and the transverse carpal ligament. CONCLUSIONS This study showed that there is a significant relationship between the median nerve displacement in the carpal tunnel and the motion of the wrist and fingers. This finding suggests that the compression or the shearing stress of the median nerve caused by the movement of the flexor tendons is reduced in the wrist dorsal flexion position compared with other wrist positions. This wrist dorsal flexion position could be the appropriate position for a wrist splint in the treatment for carpal tunnel syndrome. This ultrasound information provides further knowledge and understanding of the biomechanics and pathophysiology of the carpal tunnel. It could also help in the accurate analysis and assessment of diagnostic images and treatment for carpal tunnel syndrome.