Taiichi Matsumoto

Cylindrical Costal Osteochondral Autograft for Reconstruction of Large Defects of the Capitellum Due to Osteochondritis Dissecans

BACKGROUND There is a need to clarify the usefulness of and problems associated with cylindrical costal osteochondral autograft for reconstruction of large defects of the capitellum due to osteochondritis dissecans. METHODS Twenty-six patients with advanced osteochondritis dissecans of the humeral capitellum were treated with use of cylindrical costal osteochondral autograft. All were males with elbow pain and full-thickness articular cartilage lesions of ≥15 mm in diameter. Clinical, radiographic, and magnetic resonance imaging outcomes were evaluated at a mean follow-up of thirty-six months (range, twenty-four to fifty-one months). RESULTS All patients had rapid functional improvement after treatment with costal osteochondral autograft and returned to their former activities, including sports. Five patients needed additional minor surgical procedures, including screw removal, loose body removal, and shaving of protruded articular cartilage. Mean elbow function, assessed with use of the clinical rating system of Timmerman and Andrews, was 111 points preoperatively and improved to 180 points at the time of follow-up and to 190 points after the five patients underwent the additional operations. Mean elbow motion was 126° of flexion with 16° of extension loss preoperatively and improved to 133° of flexion with 3° of extension loss at the time of follow-up. Osseous union of the graft on radiographs was obtained within three months in all patients. Revascularization of the graft depicted on T1-weighted magnetic resonance imaging and congruity of the reconstructed articular surface depicted on T2-weighted or short tau inversion recovery imaging were assessed at twelve and twenty-four months postoperatively. Functional recovery was good, and all patients were satisfied with the final outcomes. CONCLUSIONS Cylindrical costal osteochondral autograft was useful for the treatment of advanced osteochondritis dissecans of the humeral capitellum. Functional recovery was rapid after surgery. Additional operations were performed for five of the twenty-six patients, whereas the remaining patients showed essentially full recovery within a year. All patients were satisfied with the results at the time of short-term follow-up.

Two-stage reconstruction for the hypoplastic thumb.

A 2-year-old boy with grade 3 hypoplastic thumb (Blauths classification) underwent reconstruction in two stages. Stage 1 was an abductor digiti quinti musculocutaneous flap, first web space widening, and insertion of a silicone rod to prepare for a flexor pollicis longus transfer. Stage 2 (6 months later) was a vascularized second toe proximal interphalangeal joint transfer for carpometacarpal joint replacement, plus tendon transfers for thumb flexion, extension, and adduction. Three years following the procedures, the thumb had an open physis by x-ray film and was functioning well. Pollicization is the traditional procedure for this degree of thumb hypoplasia, but the two-stage reconstruction is an alternative for patients in cultures where the presence of five fingers is important.

Comparison between partial ulnar and intercostal nerve transfers for reconstructing elbow flexion in patients with upper brachial plexus injuries

Background There have been several reports that partial ulnar transfer (PUNT) is preferable for reconstructing elbow flexion in patients with upper brachial plexus injuries (BPIs) compared with intercostal nerve transfer (ICNT). The purpose of this study was to compare the recovery of elbow flexion between patients subjected to PUNT and patients subjected to ICNT. Methods Sixteen patients (13 men and three women) with BPIs for whom PUNT (eight patients) or ICNT (eight patients) had been performed to restore elbow flexion function were studied. The time required in obtaining M1, M3 (Medical Research Council scale grades recovery) for elbow flexion and a full range of elbow joint movement against gravity with the wrist and fingers extended maximally and the outcomes of a manual muscle test (MMT) for elbow flexion were examined in both groups. Results There were no significant differences between the PUNT and ICNT groups in terms of the age of patients at the time of surgery or the interval between injury and surgery. There were significantly more injured nerve roots in the ICNT group (mean 3.6) than in the PUNT group (mean 2.1) (P = 0.0006). The times required to obtain grades M1 and M3 in elbow flexion were significantly shorter in the PUNT group than in the ICNT group (P = 0.04 for M1 and P = 0.002 for M3). However, there was no significant difference between the two groups in the time required to obtain full flexion of the elbow joint with maximally extended fingers and wrist or in the final MMT scores for elbow flexion. Conclusions PUNT is technically easy, not associated with significant complications, and provides rapid recovery of the elbow flexion. However, separation of elbow flexion from finger and wrist motions needed more time in the PUNT group than in the ICNT group. Although the final mean MMT score for elbow flexion in the PUNT group was greater than in the ICNT group, no statistically significant difference was found between the two groups.

Reconstruction of a phalangeal bone using a vascularised metacarpal bone graft nourished by a dorsal metacarpal artery.

SUMMARY We report on a patient with an infected nonunion of the left little-finger phalanges following a gunshot injury. The defect was treated by transplanting a partial fifth metacarpus, vascularised by the fourth dorsal metacarpal vessels. Bone union was obtained 6 months after surgery and no signs of infection were found at the site of the nonunion. Although the range of the interphalangeal joints of the finger was limited, the patient was satisfied because the preserved little finger had a metacarpophalangeal (MP) joint with unrestricted motion.

Basic fibroblast growth factor promotes nerve regeneration in a C--ion-implanted silicon chamber

We reported previously that a silicone tube whose inner surface has been implanted with negatively charged carbon ions (C-) enables a nerve to regenerate across a 15-mm inter-stump gap. In this study, we investigated whether a C- -ion-implanted tube pretreated with basic fibroblast growth factor promotes peripheral nerve regeneration. The C- -ion-implanted tube significantly accelerated nerve regeneration, and this effect was enhanced by basic fibroblast growth factor.

Successful storage of peripheral nerve before transplantation using green tea polyphenol : An experimental study in rats

Green tea polyphenol is known to act as a buffer, reducing biological responses to oxidative stress. Several effects of polyphenol have been reported, such as protection of tissue from ischemia, antineoplasmic and anti-inflammatory effects, and suppression of arteriosclerosis. In this study, we investigated whether peripheral nerve segments could be kept viable in a polyphenol solution for 1 month. Sciatic nerve segments, 20 mm long, were harvested from Lewis rats and treated in three different ways before transplanting to recipient Lewis rats to bridge sciatic nerve gaps created by removal of 15-mm-long nerve segments. Group F: nerve segments were transplanted immediately after harvesting. Group P: nerve segments were transplanted after they had been stored in Dulbeccos Modified Eagles Medium (DMEM) containing polyphenol for 7 days at 4 degrees C and then in DMEM for 21 days at 4 degrees C. Group M: nerve segments were stored in DMEM solution alone for 28 days at 4 degrees C. Viability of the nerve segments was assessed by vital staining (calcein-AM/ethidium homodimer), by electron microscopy and by genomic studies before transplantation. Nerve regeneration was evaluated using electrophysiological and morphological studies 12 and 24 weeks after transplantation. Neural cell viability of the preserved nerve segments was confirmed in group P, in which the nerve regeneration was similar to that in group F and superior to that in group M. Peripheral nerve segments can be successfully preserved for 1 month using green tea polyphenol.

Rat nerve regeneration through a silicone chamber implanted with negative carbon ions.

We investigated whether a tube with its inner surface implanted with negatively-charged carbon ions (C(-) ions) would enable axons to extend over a distance greater than 10 mm. The tube was found to support nerves regenerating across a 15-mm-long inter-stump gap. Silicone treated with C(-) ions showed increased hydrophilic properties and cellular affinity, and axon regeneration was promoted with this increased biocompatibility.

Optimal conditions for peripheral nerve storage in green tea polyphenol: an experimental study in animals

Our previous study demonstrated successful peripheral nerve storage for 1 month using polyphenol solution. We here report two studies to solve residual problems in using polyphenols as a storage solution for peripheral nerves. Study 1 was designed to determine the optimal concentration of the polyphenol solution and the optimal immersion period for nerve storage. Rat sciatic nerve segments were immersed in polyphenol solution at three different concentrations (2.5, 1.0, and 0.5 mg/ml) for three different periods (1, 7, and 26 days). Electrophysiological and morphological studies demonstrated that nerve regeneration from nerve segments that had been immersed in 1mg/ml polyphenol solution for 1 week and in Dulbeccos modified Eagles medium (DMEM) for the subsequent 3 weeks was superior to the regeneration in other treatment groups. In study 2, the permeability of nerve tissue to polyphenol solution was investigated using canine sciatic nerve segments stored in 1.0mg/ml polyphenol solution for 1 week and in DMEM for the subsequent 3 weeks. Electron microscopy revealed that the Schwann cell structure within 500-700 microm of the perineurium was preserved, but cells deeper than 500-700 microm were badly damaged or had disappeared. The infiltration limit for polyphenol solution into neural tissue is inferred to be 500-700 microm.

Successful storage of peripheral nerves using University of Wisconsin solution with polyphenol

We have previously reported that green tea polyphenol can preserve peripheral nerve segments for up to 1 month. In this study, we investigated the effect on peripheral nerve preservation of adding polyphenol to the conventional University of Wisconsin solution (UW solution), which has been widely used for organ storage. Twenty millimeter-long sciatic nerve segments, harvested from Lewis rats, were immersed in UW solution containing polyphenol (1 mg/mL) for 1 week and then in UW solution alone at 4 degrees C for 3 additional weeks before transplantation into recipient Lewis rats. Neural cell viability of the preserved nerve segments was confirmed by vital staining (calcein-AM/ethidium homodimer), electron microscopy, and genomic studies. Morphologically, nerve regeneration was similar to that of fresh isografts and superior to that of grafts stored with UW solution alone. Moreover, the electrophysiological results were equal to those of fresh isografts. Polyphenol has the potential to be used for peripheral nerve storage and could be useful for routine peripheral nerve banking.

Cylindrical Costal Osteochondral Autograft for Reconstruction of Large Defects of the Capitellum Due to Osteochondritis Dissecans: Surgical Technique

Introduction We describe our technique of cylindrical costal osteochondral autograft for elbows with advanced osteochondritis dissecans. Step 1 Prepare and Position the Patient Mark the ipsilateral (fifth or sixth) rib. Step 2 Excise/Debride the Lesion and Create a Cylindrical Hole Debride necrotic fibrous tissue completely. Step 3 Elevate the Costal Osteochondral Junction Elevate the graft carefully from the periosteum and perichondrium to avoid damage to the pleura. Step 4 Prepare the Osteochondral Autograft Shape the harvested osteochondral junction like a cone about 18 mm in height, including a 5-mm-high cartilage cap. Step 5 Place the Graft into the Defect and Close After packing the grafts, shape and contour the cartilage surface to fit the radial head using a scalpel. Step 6 Postoperative Treatment Most patients are able to perform normal daily activities in a few days or a week, but they are not allowed to play sports for three months. Results Between 2006 and 2010, we performed this operation in forty-three patients with severe osteochondritis dissecans of the humeral capitellum, and twenty-six cases were followed for more than twenty-four months12. What to Watch For IndicationsContraindicationsPitfalls & Challenges.