Yoshiyuki Fujisawa

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 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).

Avulsion of the Cartilaginous Femoral Origin of the Anterior Cruciate Ligament in a Three-year-old Child: A Case Report with a Thirteen-year Follow-up

Rupture of the anterior cruciate ligament is rarely seen in children because the ligament is stronger than the physes during childhood, meaning that trauma to the knee will more likely result in a physeal fracture1-3. DeLee and Curtis, in 1983, reported only three cases of midsubstance rupture of the anterior cruciate ligament in their study of 388 knee ligament injuries in children4. Although some recent studies have demonstrated an increasing prevalence of midsubstance rupture of the anterior cruciate ligament in children and adolescents, most of those ruptures occurred during puberty or adolescence5-7. Conversely, osteochondral avulsion fractures of the tibial origin of the anterior cruciate ligament in children are relatively common8-11. Injuries that stress the anterior cruciate ligament most often result in an osteochondral avulsion fracture of the tibial eminence. Although there have been many studies of osteochondral avulsion fracture of the tibial eminence in children, only four cases of osteochondral avulsion fracture of the femoral origin of the anterior cruciate ligament have been reported12-15. It is also known that cartilaginous avulsion fractures of the tibial eminence can occur but are very rare16,17. Furthermore, a review of the orthopaedic literature revealed only one report of an isolated cartilaginous avulsion fracture of the femoral origin18. That fracture occurred in a three-year-old boy, but the duration of follow-up was only ten weeks. Therefore, we are aware of no reports regarding the long-term effects of cartilaginous avulsion fractures of the femoral origin of the anterior cruciate ligament. It is known that residual anterior laxity occurs after an osteochondral fracture of the tibial eminence19-21. Growth disturbance is also a concern. Mylle et al. reported on the premature …

Glomus tumor of the lateral aspect of the knee joint

BackgroundWe report a rare case of glomus tumor that occurred in the lateral joint of the knee. A 54‐year‐old man was referred to us with a 3‐year history of lateral pain in the left knee and the diagnosis of lateral meniscus injury. Physical examination revealed a small trigger point localized just on the lateral joint space. Magnetic resonance imaging (MRI) showed a very small round mass in the subcutaneous tissue at the level of the lateral joint space.TreatmentExcisional biopsy was performed, and the histology was characteristic of a glomus tumor. The patient was asymptomatic immediately after the operation. At the 3-year follow‐up after the operation, no recurrence was seen.

Relationship Between Meniscal Degeneration and Element Contents

The purpose of this study is to investigate the relationship between meniscal degeneration and element contents. The contents of elements (calcium, phosphorus, sulfur, and magnesium) in the menisci from 17 patients with osteoarthritis (OA) of the knee, 6 with rheumatoid arthritis (RA), and 2 who underwent the surgical operation for malignant tumors (control) were analyzed by inductively coupled plasma-atomic emission spectrometry, and the menisci were divided into four stages (Stage 0–3) of histological degeneration.The calcium contents of the menisci were 0.26±0.16 in Stage 0, 0.50±0.37 in Stage 1, and 0.69±0.66 in Stage 2, respectively (the values represent mg elements/g dry tissue). They increased with the progression of the stage. This tendency was found in the menisci with OA, but was not clear in those with RA. The calcium content in the control group was 0.17±0.09 mg/g. There was no significant relationship between the stage of degeneration and the contents of phosphorus, sulfur, or magnesium. The calcium content of the meniscus might indicate the degree of meniscal degeneration.

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.

Arthroscopic meniscal repair with fibrin glue

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.

How to diagnose isolated articular cartilage lesions of the knee in a consulting room

In order to clinically diagnose articular cartilage lesions of the knee in a medical examination, 121 knees (117 cases) with isolated lesions were investigated. Lesions of the patella (PAT), facies patellaris (F-PAT), lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP) were found in 15, 10, 9, 57, 24, and 6 knees, respectively. The lesions often occurred in athletes, but many cases with lesions did not have a history of trauma. Giving way, pain in maximal flexion, pain after exercise, and pseudolocking were relatively common symptoms. Atrophy of the thigh on the involved side was not severe. Mild limitations in both extension and flexion were often found. Hydrarthrosis was frequent in cases with F-PAT, LFC, and MFC lesions. Valgus alignment was found in LTP lesions, while varus alignment was found in MFC and MTP lesions. Findings of fibrillation in PAT, flaps, deep defects, and softening in F-PAT and MFC, deep defects in LFC, and softening and fissuring in LTP were often seen during arthroscopy. Cartilage lesions such as softening were also thought to be related to the symptoms. Increases in joint fluid may suggest lesions in F-PAT, LFC or MFC where deep and wide lesions often occur. Cases with valgus alignment may have LTP lesions and those with varus alignment may have MFC or MTP lesions.

Important points regarding high tibial osteotomy for asymptomatic bowleg correction in younger patients

Osteotomies are generally performed for osteoarthritis and osteonecrosis. The corrective osteotomy technique is adapted to correct lower limb deformities caused by trauma, infections and congenital diseases such as Blount’s disease, rickets and skeletal dysplasia. Previous literature has discussed the surgical procedure, period and technique of osteotomies to correct these deformities.1, 2, 3 As we mainly treat knee-joint deformities at our hospital, we occasionally encounter younger patients who wish to undergo cosmetic corrective surgical treatment for bowlegs. They have no pain or functional disorder in their knees, and therefore could live an ordinary life without surgical treatment. However, most cannot live an active social life because of mental trauma and psychiatric disorders. From the patient’s appearance, it is impossible to notice these factors and understand their true suffering. Generally, cosmetic corrective surgery is not performed for asymptomatic bowlegs. Doctors hesitate to perform cosmetic operations, as post-operative complications and patient satisfaction cannot be guaranteed. However, we chose to perform cosmetic high tibial osteotomy (HTO) in specific cases. Personality disorders, especially in younger patients, are associated with poor cosmetic surgery outcomes.4, 5, 6, 7, 8 However, by supporting the patient’s physical and mental condition before the operation, we obtained good clinical results both physically and mentally. HTO is a useful tool for physical conditions that include mental factors. Given the availability of cosmetic knee osteotomy techniques to correct lower limb deformities in younger patients, we report on surgical planning and several important technical points.

Pathological changes resembling bone cyst of the lateral tibial plateau following arthroscopic partial meniscectomy for lateral discoid meniscus in a boy

We encountered a rare case displaying pathological changes resembling bone cyst of the lateral tibial subchondral bone following arthroscopic partial meniscectomy for discoid lateral meniscus in a boy. Differentiating between bone tumor and osteochondritis dissecans was difficult. Moreover, since an epiphyseal line was remained, deciding on the appropriate medical treatment was also troublesome. However, we selected operative therapy. As the result, an excellent clinical outcome was obtained without damaging the epiphyseal line. We report the analysis of mechanisms causing of this pathological change and the treatments used, with some references to the literature.