Cartilage-like phenomenon in the anterior cruciate ligamenta

OBJECTIVE

To detect histological characteristic of anterior cruciate ligament (ACL) and medial collateral ligament (MCL).

METHODS

In each of 20 skeletally mature male mongrels and 4 men, the ACL and MCL were examined by standard hematoxylin-eosin procedure and toluidine blue staining for histologic observation.

RESULTS

The fibroblasts in medial collateral are elongated to spindle shape and aligned in a row between the bundles of collagenous fibers. Toluidine blue staining is negative. The anterior cruciate ligament demonstrated more heterogenous cell types and arrangement. It had three major cell forms: spindle, round and ovoid type, which were shorter but greater than the cells in medial collateral ligament. Toluidine blue staining was positive in anterior cruciate ligament. Most cells in anterior cruciate ligament were enclosed within lacunae.

CONCLUSION

This study suggests that the ACL has different histological characteristics from MCL, and is more cartilage-like in nature.

Expression of collagen type I, II and III in loose body of osteoarthritis

The expression of collagen type I, II, and III was investigated to evaluate phenotypic change in chondrocytes in loose bodies related to osteoarthritis. We assessed collagen type I, II, and III production in loose bodies from knee joints of ten osteoarthritic patients, using an immunohistochemical method with monoclonal antibodies. Collagen type III expression was identified in all ten loose bodies and was mainly located in cartilage, including chondrocytes and matrices, as well as in a layer of fibroid tissue on the surface. No positive signal for collagen type III was observed in necrotic osteocytes. There was weakly positive staining for collagen type I in chondrocytes. No positive staining for collagen type II could be seen in the cartilage of loose bodies. Cartilage from the non-osteoarthritic knee joints of four people was negative for the expression of collagen type I and III, and positive for the expression of collagen type II. Collagen type I and III expression suggested the dedifferentiation status of chondrocytes in loose bodies.

[Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft fixed with interference screw]

OBJECTIVES

To evaluate the optimal position of bony tunnel, the firmness of tendon graft fixation and the effectiveness of postoperative function recovery in an arthroscopic approach for the minimally invasive reconstruction of anterior cruciate ligament (ACL).

METHODS

In a single arthroscopic approach, the ACL was reconstructed by the bone-tendon-bone compound patellar tendon autograft with the fixation of an interference screw.

RESULTS

ACL reconstruction was performed in 49 patients, of whom 20 were followed up for over one year (average 1 year and 5 months). Among the 20 patients, 13 were rated as excellent, 5 good, and 2 fair. The excellent and good rate went up to 90%. Reconstructed ACLs were reevaluated arthroscopically in 9 patients, in whom, 6 had good remodeling of ACLs.

CONCLUSIONS

Our results indicated that this method has the advantages of less injury, optimal positioning of bone tunnel, firm graft fixation, and early rehabilitation. Compound bone-tendon-bone autograft allows firm fixation and biologic healing with good shape and tension remodeling.

[Experimental study of incompetency of deep vein of lower limb]

OBJECTIVE

The purpose of this study was to find the best material for valvular wrapping operation of deep vein of lower limb and to study the diagnostic value of colored Ultrasonic-Doppler for valvular incompetency of the deep vein and the function of the popliteal valve.

METHODS

Strips of autogenous saphenous vein, autogenous fascia lata and pieces of polytetrafluroethylene artificial vessel were used respectively as the wrapping material for narrowing the valve in 30 dogs. The results of three different wrapping material were obtained by colored Ultrasonic-Doppler and transpopliteal venography in 78 patients. The hemokinetics of the popliteal valve was examined in 20 normal persons.

RESULTS

In the saphenous vein and fascia lata groups, diffuse fibrosis and marked narrowing of the femoral vein were found, while in the group of artificial vein graft, the graft was intact without prominent fibrosis and narrowing of the vein. In comparing with the result of venography, the accuracy of diagnosis by colored Ultrasonic-Doppler was 91.86%. The femoral and popliteal venous valves closed at the same time when holding the breath, but the popliteal venous valve opened more widely than the femoral venous valve when the calf muscles of the leg contracted.

CONCLUSION

It was suggested that the graft was the best material for valvular wrapping operation, and colored Ultrasonic-Doppler was an important and non-invasive method for the diagnosis of incompetency of deep vein. The popliteal venous valve was the important barrier for protection of the function of deep vein.

[Deep venous incompetence of legs: experimental studies]

OBJECTIVE

To seek best wrapping materials of valvular wrapping operation of deep veins in the lower limbs and to understand the value of diagnostic value of duplex scanning for incompetence of the deep veins and the function of the popliteal valve.

METHODS

Strips of the autogenous saphenous vein, autogenous fascia lata and PEFE graft were used respectively as the material for valve constriction. The results were compared of duplex scanning and trans-popliteal venography.

RESULTS

In the saphenous vein and fascia lata groups, diffuse fibrosis and marked narrowing of the femoral vein were found, whereas in the vascular graft group the graft was intact without prominent fibrosis and narrowing of the vein. The accurate rates of duplex scanning and trans-popliteal venography were 91.86%. at the same time the thigh and popliteal valve was closed when held breath.

CONCLUSIONS

Vascular graft is the best constriction material. Duplex scanning is a important method. Popliteal valve is an important barrier for protecting the function of the deep vein.

[Reconstruction of anterior cruciate ligament using bone-patellar tendon-prepatellar periosteum free graft with impacting bone technique]

In order to make full and effective use of patellar tendon (middle one-third) during reconstruction of anterior cruciate ligament, we designed bone-patellar tendon-tendon of quadriceps femoris free graft with impacting bone technique and 38 cases were treated by this method. Follow-up for 2 years and 7 months showed that the clinical results were good. The exellent and good rate was 89.7%. Clinical results indicated that the fixation of this reconstructive method was firm and grafts in the joint cavity were patellar tendon tissue. The anterior medial rotatory instability of the knee joint could be corrected with the same graft that have enough length. The experience of acute rupture of anterior cruciate ligament and the rupture of anterior cruciate ligament combined with injury of meniscus were reported.

[Influence of human bone morphogenetic protein (hBMP) on the articular cartilage pieces cultured in vitro]

To understand the influence of hBMP on the articular cartilage, we investigated the expression of osteocalcin (BGP) and hBMP, and calcium deposit in cartilage matrix induced by hBMP. Under the inducing of hBMP, chondrocytes in cartilage pieces begun to express BGP and hBMP. The hBMP promoted calcium deposition in the cartilage matrix, hBMP made some chondrocytes further differentiat into osteoblast-like cells. We consider that these osteoblast-like cells might be other source of osteoblasts in endochondral osteogenesis.

Chemical carcinogens and antigens contribute to cutaneous tumor promotion by depleting epidermal Langerhans cells

Epidermal Langerhans cells (LC) are an integral component of the skin immune system as they initiate immune responses to a variety of antigens, including tumor antigens. When skin is exposed to carcinogenic doses of ultraviolet-B irradiation, chemical carcinogens or tumor promoters there is a significant reduction of LC density. This causes the skin to be immunocompromised and provides an opportunity for aberrant cells to escape immune detection and develop into tumors. Consequently LC depletion is a key event associated with the pathogenesis of skin cancer. We propose that LC depletion contributes to tumor promotion and therefore any agents that reduce LC number, e.g. the contact sensitizing antigen 2,4,6-trinitrochlorobenzene (TNCB), may also contribute to tumor promotion. This proposal was evaluated in cutaneous carcinogenesis by treating mouse skin with a tumor initiating dose of the carcinogen 7,12-dimethylbenz[a]anthracene (DMBA) followed by a tumor promoter. The initiating dose of DMBA did not cause LC depletion or tumor development. However, if the DMBA-treated skin was then exposed to a concentration of TNCB that caused LC depletion, skin tumors developed. This is analogous to the classical initiator/promoter system with an LC-depleting dose of TNCB contributing to tumor promotion. Further, this promotion effect was independent of the commencement time of the promoter application, as 2% TNCB applied either 1 or 12 weeks after DMBA initiation induced tumor development. Analysis of the association of LC depletion with immunosuppression and tumor promotion, showed that these events were linked, irrespective of the agent that caused the depletion. It is therefore concluded that LC depletion and local immunosuppression are important aspects of tumor promotion in cutaneous carcinogenesis and non-carcinogenic agents may have tumor promoter activities.

[Clinical treatment of post-thrombotic deep veins of lower limbs]

From 1989 to 1995, 213 patients with chronic post-thrombotic syndrome of the deep veins of lower limbs were treated. The surgical approaches consisted of establishment of temporary distal arteriovenous fistula for iliac and iliofemoral occlusion, and bypass of suitable length of autogenous vein with temporary distal arteriovenous fistula. Those who were not candidates for surgery were treated continuously by conservative methods with periodical short-term thrombolysis. A mean follow-up of 37.3 months the cure rate and the effective rate were 50.9% and 83.5% respectively. The authors suggest that different methods may be used in different patients, and the temporary distal arteriovenous fistula is a new approach of the posthrombotic legs.

[An experimental study on the relationship between BMP's activity and its carrier]

To find out the relationship between human bone morphogenetic protein's activity and its carrier and to document the clinical application of BMP, we investigated six kinds of BMP carrier's influence upon hBMP's osteogenic activity with small sample size at first. Then three kinds of carriers selected from the six, added with the seventh carrier, were investigated with large sample size. The result showed that the compound of hBMP and hDDBM had best osteogenic ability. The human bone matrix had been formerly demineralized and extracted without hBMP. The hDDBM showed porous structure under SEM, its mean pore's diameter was 127 +/- 34 microns. It was demonstrated that the function of demineralized bone matrix extracted without BMP (i.e. DDBM) was related not only to its pore's diameter, but to the fibrolike matter in it as well. With the method of BMP bioassay, BMP was composited with carrier, then the compound was injected into the calf of mouse. This made BMP's bioassay become simple and reliable.

Chemical carcinogens and antigens induce immune suppression via Langerhans' cell depletion

The ability of the chemical carcinogen dimethylbenz(a)anthracene (DMBA) to deplete Langerhans' cells (LC) from murine skin is crucial to the development of antigen-specific suppression. This depletion is a consequence of the LC recognizing the DMBA as antigenic and migrating to the draining lymph nodes to attempt to elicit T-cell activation. This depletion also occurred following exposure to high doses of the contact sensitizers 2,4-dinitrofluorobenzene (DNFB), 2,4,6-trinitrochlorobenzene (TNCB) and fluorescein isothiocyanate (FITC). However, LC depletion was not significant at lower doses, even though these doses were sufficient to induce strong contact sensitivity responses. Application of the contact sensitizer, DNFB, through skin depleted of LC (by pretreatment with either the carcinogen DMBA or the antigen TNCB) failed to induce contact sensitivity. This immune non-responsiveness was antigen specific, and could be transferred by spleen cells to naive mice, which were unable to respond to DNFB. Mouse skin treated with doses of TNCB, that did not cause LC depletion but still induced a normal contact hypersensitivity, retained its ability to initiate a normal immune response to DNFB. Together these findings demonstrate that carcinogens share some properties with antigens as they both cause LC depletion and interact with the immune system. Furthermore, it is this LC depletion, rather than carcinogen treatment, that is a critical factor which leaves the skin immunologically compromised and favours the induction of antigen-specific suppression.

Processing of complex antigens and simple hapten-like molecules by epidermal Langerhans cells

Langerhans cells (LCs) are antigen-presenting cells of the skin that trap small contact-sensitizing molecules and induce cutaneous hypersensitivity. LCs can present larger molecules but the mechanisms of processing have required investigation. A system combining in vitro culture of antigen with epidermal cells in the presence of inhibitors, followed by fixation and transfer of these antigen/drug-treated epidermal cells to naive mice, was developed to investigate the steps of antigen processing. Langerhans cells undertake similar, but not identical, pathways for the processing of simple and complex molecules. Complex molecules such as trinitrophenyl conjugated to ovalbumin (TNP-OVA) were internalized and modification required a chloroquine-sensitive proteolysis step and a cycloheximide-sensitive protein synthesis step. This modified product was actively recycled to the cell membrane as presentation was inhibited by blocking receptor translocation with either monensin or cytochalasin B. Small contact sensitizers such as trinitrophenyl did not undergo modification but required internalization and presentation was also inhibited by blocking receptor translocation.