[Missing Floating Mass in the Ascending Aorta;Report of a Case]

A 65-year-old man, with a history of hypertension, presented with dizziness and emesis and was admitted to a local hospital. He was a moderate smoker, but he did not take any hormone-based medication. Magnetic resonance imaging showed scattered cerebral infarction in the bilateral cerebral hemisphere and right cerebellar hemisphere. There were no abnormal findings in Holter monitor and echography of heart, carotid artery, and leg vein and then, antiplatelet therapy was initiated. After that, both computed tomography and magnetic resonance imaging demonstrated a floating pedunculated mass in the ascending aorta measuring 10×8×14 mm. He was admitted to our hospital 15 days after the symptom onset. Laboratory tests including immunological and coagulation studies were within normal. Computed tomography showed on the second day of the admission that the mass spontaneously disappeared, thus canceling the schedule of surgery. He received an oral anticoagulant and discharged uneventfully. During a follow-up period of 6 months, there is no recurrence of the thrombus in the aorta and thromboembolic events.

The Efficacy and Safety of Highly-Bioavailable Curcumin for Treating Knee Osteoarthritis: A 6-Month Open-Labeled Prospective Study

Background

We previously developed a surface-controlled water-dispersible form of curcumin that we called Theracurmin^®. The area under the blood concentration-time curve (AUC) of Theracurmin in humans was 27-fold higher than that of curcumin powder. Previously, we reported on the anti-inflammatory effects of Theracurmin for knee osteoarthritis.

Hypothesis/Purpose

We determined the clinical effects of orally administered Theracurmin in patients with knee osteoarthritis over a 6-month period.

Study Design

Open prospective study.

Methods

Fifty patients Kellgren-Lawrence grade II, III, or IV knee osteoarthritis who were above 40 years old were enrolled in this clinical study. Theracurmin containing 180 mg/day of curcumin was administered orally every day for 6 months. To monitor for adverse events, blood biochemistry analyses were performed before and after 6 months of each intervention. The patients' knee symptoms were evaluated at 0, 1, 2, 3, 4, 5, and 6 months based on the Japanese Knee Osteoarthritis Measure, the knee pain visual analog scale, and the knee scoring system of the Japanese Orthopedic Association.

Results

Five cases dropped out during the study, but no cases dropped out because of major problems. No major side effects were observed with Theracurmin treatment, including the blood biochemistry analysis results. The effective group included 34 cases (75.6%), while the not-effective group included 11 cases.

Conclusion

This study demonstrates the safety and good efficacy of Theracurmin for various types of knee osteoarthritis. Theracurmin shows great potential for the treatment of human knee osteoarthritis.

[Rapid Expansion of Distal Aortic Arch Aneurysm with the Short Elephant Trunk;Report of a Case]

A 78-year-old female patient was introduced to our hospital with chief complaint of massive hemoptysis. She had a history of total arch replacement using a short elephant trunk for acute Stanford type A aortic dissection 3 years before. A contrast-enhanced computed tomography (CT) revealed kinking of the short elephant trunk and distal aortic arch aneurysm which caused aortobronchial fistula. She was treated by emergency thoracic endovascular aortic repair and long-term administration of antibiotics. Three years later, distal aortic arch aneurysm disappeared by CT and there was no recurrence of hemoptysis. This is the aortic aneurysm was considered to be caused by the short elephant trunk.

[Surgical Results for Left Ventricular Thrombus Formation after Myocardial Infarction]

We aimed to review the surgical results of left ventricular restoration for left ventricular thrombus after myocardial infarction. A retrospective study was conducted on 5 patients who underwent thrombus removal and left ventricular restoration for left ventricular thrombus after myocardial infarction. Two patients were in an acute phase of myocardial infarction, and 3 in a chronic phase. Cerebral infarction occurred in 3 patients preoperatively. Median observational period was 1.0 year. Left ventricular thrombus removal with septal anterior ventricular exclusion technique was performed. Concomitant procedure included 3 coronary artery bypass graftings and 1 left ventricular apex ablation. There was no perioperative bleeding event. The 30-day mortality occurred in 1 patient. There has been no systemic embolic complication, left ventricular dysfunction, nor recurrence of left ventricular thrombus during the observational period. The postoperative left ventricular volume reduced in 3 of the 4 survivors. The left ventricular ejection fraction increased postoperatively in 3 of the 4 survivors. In conclusion, the septal anterior ventricular exclusion technique is an effective method for controlling perioperative bleeding, removing left ventricular thrombus completely, and preventing a recurrence of left ventricular thrombus and systemic embolism. This procedure also contributed to reducing the left ventricular volume, resulting in the improvement of the left ventricular function.

Surgical Technique and Clinical Outcomes of Osteochondral Autograft Transplantation for Large Osteonecrotic Lesions of the Femoral Condyle With Residual Normal Cartilage: The Eyeglass Technique

Background:

Osteochondral autograft transplantation (OAT) is usually performed for a defect that is <400 mm² because of the limitations of autografts.

Purpose:

To present the surgical technique and clinical outcomes of OAT using the eyeglass technique for large osteonecrotic lesions of the femoral condyle (LOFs) (>400 mm²) with residual normal cartilage.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Cases (group 1) included 15 patients (18 knees) who underwent OAT using the eyeglass technique for LOFs with residual normal cartilage, while controls (group 2) included 11 patients (11 knees) who underwent OAT using the standard technique for small osteonecrotic lesions of the femoral condyle (≤400 mm²). Clinical outcomes were evaluated preoperatively and at the final follow-up (group 1, 56 months; group 2, 48 months) according to the International Knee Documentation Committee (IKDC) objective grade, the IKDC subjective score, and the Japanese Orthopaedic Association (JOA) score.

Results:

The mean lesion size was 685 mm² in group 1 and 230 mm² in group 2. Patients in group 1 had postoperative scores equivalent to those in group 2. The postoperative IKDC subjective scores in group 1 (mean, 86.9) and group 2 (mean, 87.0) showed no significant difference at the final follow-up (P = .653). For postoperative IKDC objective grades, 83.3% of group 1 and 81.8% of group 2 were graded as “nearly normal” or better, and no significant intergroup difference was found for the IKDC objective grade (P = .989). Also, no significant intergroup difference was found for the postoperative JOA score (group 1, 93.9; group 2, 81.4; P = .480). Nine second-look arthroscopic procedures were performed in group 1 compared with 4 in group 2, and all patients had plugs that were graded as “nearly normal” or better by the International Cartilage Repair Society classification system.

Conclusion:

The postoperative results of patients who underwent OAT using the eyeglass technique for large osteonecrotic lesions (>400 mm²) were equivalent to the results of patients who underwent OAT using the standard technique for small osteonecrotic lesions (≤400 mm²).

The interference with transapical transcatheter aortic valve implantation by the anterior chordae tendineae preserved at previous mitral valve replacement

Preserved anterior chordae tendineae is a possible risk factor for disturbing delivery of a transcatheter heart valve. Inserting a sheath just below the aortic valve for delivery of the transcatheter heart valve might be proposed as an alternative to avoid the chordae tendineae.

[Mediastinal Hematoma after Intravenous Thrombolytic Therapy for Cerebral Infarction in a Patient with a History of Total Aortic Arch Replacement]

An 80-year-old male patient with a history of total arch replacement for thoracic aortic aneurysm 5 years before was introduced to our hospital with a chief complaint of chest pain. Tissue plasminogen activator (t-PA) had been administrated because of acute brain infarction. A contrast-enhanced computed tomography (CT) scan demonstrated a large hematoma in the posterior mediastinum extending from the level of distal aortic arch to the descending aorta together with left pleural effusion. On the next day after admission, CT scan revealed that the hematoma became smaller. This is a rare case of a posterior mediastinal hematoma caused by t-PA with a history of total aortic arch replacement.

Valve-sparing partial root repair for aortic dissection limited to the right coronary sinus of Valsalva

BACKGROUND AND AIM OF THE STUDY

To reveal a technical feasibility and safety of valve-sparing partial aortic root repair for spontaneous aortic dissection limited to the right coronary sinus of Valsalva.

METHODS

A 68-year-old woman presented with chest pain. Twelve-lead electrocardiogram revealed atrioventricular dissociation and ST-segment elevation on II, III, and aVF. Enhanced computed tomography images showed aortic dissection limited to the right-coronary sinus and the other non-dilated sinuses of Valsalva. Localized aortic dissection was repaired by valve-sparing partial aortic root repair using a trimmed U-shaped Dacron graft and a felt strip, and the right coronary artery was revascularized by coronary artery bypass grafting using saphenous vein graft.

RESULTS

The patient was discharged on postoperative day 12 with no complications.

CONCLUSION

Valve-sparing partial aortic root repair with the patch and coronary artery bypass grafting for aortic dissection limited to the right coronary sinus of Valsalva were technically feasible and safe.

The clinical outcomes and the ability to sit straight in the Japanese style following high tibial osteotomy combined with osteochondral autologous transfer for osteonecrosis of the medial femoral condyle

BACKGROUND

There have been some reports of high tibial osteotomy combined with osteochondral autograft transfer for osteonecrosis of the medial femoral condyle of the knee. However, few of them have focused on the deep knee flexion needed to sit straight in the Japanese style.

PURPOSE

To evaluate the clinical outcomes and the knee flexion of HTO combined with OAT for osteonecrosis of the medial femoral condyle of the knee, especially the ability to sit straight in the Japanese style.

METHODS

Between 1998 and 2012, valgus HTO combined with OAT was performed in 23 patients for stage IV osteonecrosis according to Koshino's radiological classification of the medial femoral condyle. The follow-up period was more than 2 years in all cases. The mean age at the time of the surgery was 65.8 years, and the mean follow-up period was 72.2 months. The function of the knee and the ability to sitting straight in the Japanese style were examined. Twenty-one knees were examined with second-look arthroscopy to assess the recipient and donor sites.

RESULTS

The JOA scale and IKDC subjective scores were significantly improved. Twelve patients were able to sit straight in the Japanese style after the surgery, compared to 3 patients who were able to do so before surgery. On second-look arthroscopy of 21 knees, the average ICRS score was 10.5 points. No patient needed additional surgery except for removal of the implants.

CONCLUSION

Valgus HTO combined with OAT is one treatment option for osteonecrosis of the medial femoral condyle with osteoarthritis. In the present study, many of the patients regained good knee function, and 50% of the patients were able to sit straight in the Japanese style after surgery, which is a higher rate than after total knee arthroplasty and unilateral knee arthroplasty.

Ultrasound Parameters for Human Osteoarthritic Subchondral Bone ex Vivo: Comparison with Micro-Computed Tomography Parameters

The aim of this study was to identify ultrasound parameters reflecting subchondral porosity (P_o), subchondral plate thickness (T_pl) and bone volume fraction at the trabecular bone region (BV/TV_Tb). Sixteen osteoarthritic human lateral femoral condyles were evaluated ex vivo using a 15-MHz pulsed-echo ultrasound 3-D scanning system. The cartilage-subchondral bone (C-B) surface region (layer 1) and inner subchondral bone region (layer 2) were analyzed; we newly introduced entropy (ENT) and correlation (COR) of ultrasound texture parameters of the parallel (x) or perpendicular (z) direction to the C-B interface for this analysis. P_o, T_pl and BV/TV_Tb were evaluated as reference measurements using micro-computed tomography. ENT_L1x (ENT of layer 1, x-direction) and ENT_L1z were significantly correlated with P_o (both r values = 0.58), COR_L2x with T_pl (r = -0.73) and COR_L2z with BV/TV_Tb (r = -0.66). These are efficient indicators of the characteristics of osteoarthritis-related subchondral bone; the other texture parameters were not significant.

[Acute Aortic Insufficiency due to the Avulsion of Aortic Valve Commissure;Report of a Case]

A 61-year-old man with a history of hypertension and cerebral infarction, presented to a clinic with sudden dyspnea at rest. He was diagnosed with heart failure and referred to our hospital. Echocardiography and three-dimensional computed tomography showed acute heart failure and aortic insufficiency due to avulsion of the aortic valve commissure between the right coronary cusp and the non-coronary cusp. He had no symptoms such as fever or infection and no history of rheumatic disease. He underwent intima fixation of the avulsed commissure and aortic valve replacement using a tissue valve because acute left heart failure was refractory to medical treatment. Postoperative echocardiography demonstrated good left ventricular contraction without any aortic regurgitation. He was discharged on the 35th postoperative day.

Adventitial Wrap Technique for Acute Type A Aortic Dissection

We describe a simple and reproducible technique to achieve complete and immediate hemostasis of the distal anastomosis in total arch replacement with the frozen elephant trunk technique. The adventitia was left seamlessly 1.0 cm longer than the level of the suture line. The adventitial remnant covered most of the distal anastomosis line tightly while the distal anastomosis was completed with continuous sutures. The adventitia was thin and tough, making it suitable to cover the suture line. This technique can contribute to eliminating bleeding from the distal anastomosis independent of unreliable blood coagulability during aortic surgery for acute aortic dissection.

Resection-Induced Leveling of Elevated Plug Cartilage in Osteochondral Autologous Transplantation of the Knee Achieves Acceptable Clinical Results

BACKGROUND

Plug protuberance occasionally occurs in osteochondral autologous transplantation (OAT). The incongruity of plugs results in poor clinical outcomes, especially in cases of protuberance. However, a surgical procedure to deal with this problem has not been reported. Purpose/Hypothesis: The purpose was to evaluate the efficacy and safety of cartilage resection of elevated plugs, with the hypothesis that patients whose elevated plugs were resected and leveled would achieve clinical outcomes equivalent to those of patients with flush plugs.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Cases (group P) included 22 patients who underwent OAT of the knee and whose plugs showed protuberance greater than 1 mm that was resected with a scalpel to obtain smooth congruity, while controls (group C) included 22 background-matched patients who did not require plug resection. The International Knee Documentation Committee (IKDC) subjective score, IKDC objective grade, and Japanese Orthopaedic Association score for knee osteoarthritis (JOA knee score) were used preoperatively and at the final follow-up (mean ± SD, 49.3 ± 18.1 months). International Cartilage Repair Society (ICRS) Cartilage Repair Assessment was used to evaluate lesion healing during the second-look arthroscopy.

RESULTS

IKDC subjective scores of group C (82.5 ± 11.8) and group P (82.1± 15.1) showed no difference at the final follow-up. On postoperative IKDC objective grading, 86% of group C and 82% of group P patients were graded as "nearly normal" or better ( P = .639). The mean JOA knee scores of group C (90.9 ± 8.9) and group P (90.1 ± 9.5) did not differ significantly ( P = .647). Nine second-look arthroscopies were performed in group C versus 8 in group P, and all patients had plugs that were graded as "nearly normal" or better by the ICRS Cartilage Repair Assessment. Larger plugs tended to be used in those patients who required resection.

CONCLUSION

Resection of the elevated plug surface did not negatively affect patient outcomes in the midterm follow-up period.

Osteochondral autograft transplantation for isolated patellofemoral osteoarthritis

BACKGROUND

The purpose of this retrospective study was to evaluate clinical outcomes of osteochondral autograft transplantation (OAT) for isolated patellofemoral (PF) osteoarthritis (OA).

METHODS

OAT was performed in seven patients (six men, one woman; mean age, 61.1years) with isolated PF OA. The mean duration of follow up was 46.9months (range, 24-84months). Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee (IKDC) objective score and the knee scoring system of the Japanese Orthopaedic Association (JOA) score. The International Cartilage Repair Society (ICRS) score was recorded in three cases that underwent second-look arthroscopies postoperatively. For morphological evaluation, the Kellgren and Lawrence (KL) classification and the modified magnetic resonance observation of cartilage repair tissue (MOCART) score were used.

RESULTS

The mean IKDC and JOA scores were both significantly improved. The percentage of normal and nearly normal on the IKDC score was increased from 28.6% (2/7) to 85.7% (6/7) (P=0.05). The mean JOA score was improved from 80.0 (range, 65.0-85.0) to 95.0 (range, 90.0-100) (P=0.0008). The mean ICRS scores were 10.3 (nearly normal) in the three cases that underwent second-look arthroscopies postoperatively. Regarding KL classification, the grade was unchanged in five cases (two cases in grade 1, three cases in grade 2) and improved in two cases (from grade 3 to 2, from grade 4 to 3). The mean modified MOCART score was 67.9 (range, 60.0-75) at 12-month follow up. There were no complications, and satisfaction was obtained in all cases. The study design was case series: level IV.

CONCLUSIONS

All clinical scores improved significantly postoperatively. Osteochondral plugs were transplanted perpendicular to the articular surface to obtain good congruity of the repaired articular surface. In this way, OAT is an effective procedure to prevent progression of isolated PF OA.

Radiological Changes in the Cervical Spine in Freshman Collegiate Sumo Wrestlers

BACKGROUND

Sumo has long been a traditional sport in Japan and is rapidly attracting enthusiasts abroad. Sumo wrestling entails a risk of impact to the cervical spine during an initial charge. Few reports are available in the English-language literature regarding radiological changes in the cervical spine in sumo wrestlers.

PURPOSE

To examine radiological changes in the cervical spine in freshmen collegiate sumo wrestlers.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 53 freshmen sumo wrestlers (age, 18-19 years) who belonged to the Japan Sumo Federation underwent routine radiographic examination of the cervical spine and completed questionnaires on cervical symptoms.

RESULTS

Of the 53 wrestlers, 81% showed loss of lordosis, 45% showed osteophyte formation (mainly at C3-C4), 11% showed disc space narrowing (mainly at C5-C6), and 51% showed narrowing of the cervical nerve root foramina (mainly at C3-C4). Fifty-one percent had some cervical symptoms. A correlation was found between deformity of the cervical bodies (such as intervertebral disc ballooning) and cervical symptoms, but no correlation was found between cervical degenerative changes and cervical symptoms.

CONCLUSION

Our data suggest that loss of lordosis, osteophyte formation, and narrowing of the cervical nerve root foramina at C3-C4 were frequently present in freshmen wrestlers and may be due to the axial load incurred prior to their collegiate careers.

Clinical Outcomes of Donor Sites After Osteochondral Graft Harvest From Healthy Knees

Background:

The use of autologous osteochondral grafts has become popular in the treatment of small, isolated, well-contained articular cartilage defects. However, donor site morbidity is a problem, and few reports are available of donor site morbidity after mosaicplasty.

Purpose:

To examine the clinical outcomes of donor sites after osteochondral grafts from healthy knees.

Study Design:

Case series; Level of evidence, 4.

Methods:

Between September 1997 and September 2011, there were 40 patients (40 knees; 32 men, 8 women; 31 right knees, 9 left knees) with asymptomatic osteochondral graft donor sites used for autologous transfer; all had a follow-up period of >2 years. The mean patient age at surgery was 21.0 years (range, 12-58 years). The recipient sites included the elbow (n = 28), contralateral knee (n = 5), and ankle (n = 7). The mean diameter of the grafted plugs was 7.5 mm (range, 4.5-9 mm), and the mean number of grafted plugs was 2.2 (range, 1-3). At a mean follow-up of 43.1 months (range, 24-177 months), knee symptoms, return to sport, ability to sit straight in Japanese style, and radiological changes of the patellofemoral joint were evaluated. Whether operative age, follow-up period, and diameter or number of the grafted plugs were risk factors was analyzed statistically. Significance was defined as P < .05.

Results:

Thirty-four patients had no knee symptoms, and 4 patients had occasional mild knee pain. Two patients underwent reoperation for arthrofibrosis and not for cartilage defect. Twenty-seven patients had complete return to sports, and 32 patients could sit straight; donor site morbidity was not the cause of failure to return to sports or inability to sit straight. The radiological changes became worse in 3 patients, and the risk factor for degenerative change was older operative age.

Conclusion:

When osteochondral plugs were obtained from healthy knees, 34 patients (85%) were asymptomatic at follow-up. No donor site defects required surgical intervention due to persistent symptoms.

Relationships Between Quantitative Pulse-Echo Ultrasound Parameters from the Superficial Zone of the Human Articular Cartilage and Changes in Surface Roughness, Collagen Content or Collagen Orientation Caused by Early Degeneration

We aimed to quantitatively investigate the relationship between amplitude-based pulse-echo ultrasound parameters and early degeneration of the knee articular cartilage. Twenty samples from six human femoral condyles judged as grade 0 or 1 according to International Cartilage Repair Society grading were assessed using a 15-MHz pulsed-ultrasound 3-D scanning system ex vivo. Surface roughness (R_q), average collagen content (A₁) and collagen orientation (A₁₂) in the superficial zone of the cartilage were measured via laser microscopy and Fourier transform infrared imaging spectroscopy. Multiple regression analysis with a linear mixed-effects model (LMM) revealed that a time-domain reflection coefficient at the cartilage surface (R_c) had a significant coefficient of determination with R_q and A₁₂ (R_LMMm²=0.79); however, R_c did not correlate with A₁. Concerning the collagen characteristic in the superficial zone, R_c was found to be a sensitive indicator reflecting collagen disorganization, not collagen content, for the early degeneration samples.

Surgical Technique and Clinical Outcomes of Retrograde Osteochondral Autograft Transfer for Osteochondral Lesions of the Tibial Plateau

PURPOSE

To present the surgical technique, clinical outcomes, and poor prognostic factors of arthroscopic retrograde osteochondral autograft transfer of the tibial plateau.

METHODS

Twelve patients (6 men, 6 women; mean age, 38.7 years) with tibial plateau osteochondral lesions underwent surgery. The primary diseases were osteonecrosis in 4 cases, cartilage injuries in 6, and postfractures of the tibial plateau in 2. Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee score and the Japanese Orthopaedic Association score. The International Cartilage Repair Society score was recorded in 7 cases who underwent second-look arthroscopies postoperatively. Statistical analyses were performed to identify prognostic factors associated with the clinical outcomes.

RESULTS

The mean International Knee Documentation Committee and Japanese Orthopaedic Association scores were both significantly improved from 39.0 (range, 13.0-57.1) to 72.4 (range, 33.3-100) (P = .0022) and from 65.8 (range, 30.0-85.0) to 85.8 (range, 50.0-100) (P = .0022 < .05), respectively. In 2 cases, secondary operations were performed because of knee pain (1 varus osteotomy of the femur and 1 total knee replacement). The mean International Cartilage Repair Society scores were significantly worse in the 2 cases who required a secondary operation (3.5; abnormal) than in the 5 cases who did not (10.6; nearly normal). The secondary operation rate was significantly higher in cases with lesion size ≥400 mm² than in those <400 mm² (Fisher's exact test; P = .046).

CONCLUSIONS

Most clinical scores improved significantly postoperatively. The results indicate that arthroscopic retrograde osteochondral autograft transfer is an effective procedure to achieve sufficient cartilage congruity for osteochondral lesions of the tibial plateau <400 mm² in size.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Donor Left-Sided Heptectomy by Use of the Real-Time Moving Windows Method With 8-Centimeter Transverse Skin Incision

BACKGROUND

In this study, we demonstrated our new device for open donor liver surgery with left-sided heptectomy by use of the real-time moving windows (RTMW) method with 8-cm transverse skin incision for living donors from the viewpoints of cosmetic, economic, and safety procedures.

METHODS

After the upper abdominal 8-cm transverse skin incision was made, the subcutaneous area was exfoliated and the reverse T-shaped-abdominal incision was made, as in open surgery. After that, the 2 Kent hooks for the upper region and the 2 surgical arms for the lower region were placed. The operative fields of hepatic vein, hepatic hilus, and common hepatic artery were explored, respectively, by use of the RTMW method with the use of the 4 surgical hooks. Hepatic parenchymal dissection was carried out with the use of CUSA and laparosonic coagulating shears. Manipulations of 3 hepatic vessels and the hepatic duct were done by the usual procedure of open surgery.

RESULTS

This operative procedure could be performed without laparoscopic techniques. The operative time was 7 hours, without blood transfusion. The operative course was uneventful, and the patient was discharged on postoperative day 11.

CONCLUSIONS

Our RTMW method for donor left-sided hepatectomy is considered to be a useful operative procedure from the viewpoints of donor safety, cosmetic advantage, and cost performance.

Serial Changes of the Cartilage in Recipient Sites and Their Mirror Sites on Second-Look Imaging After Mosaicplasty

BACKGROUND

It has been reported that the short-term results of mosaicplasty are good, but there have been no reports of the serial cartilage changes in the recipient sites and their mirror sites for mosaicplasty.

PURPOSE

To examine the serial changes in cartilage in the recipient sites and their mirror sites using second-look imaging.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 33 patients (37 knees, 40 sites) underwent mosaicplasty and second-look arthroscopy at a single institution over a 7-year period. There were 14 men and 19 women (12 right knees and 25 left knees). The recipient sites were the patella (n = 3), trochlea (n = 7), medial femoral condyle (n = 21), and lateral femoral condyle (n = 9). The mean patient age at surgery was 38.3 years; the mean period from mosaicplasty to second-look arthroscopy was 15.4 months; and the mean follow-up period was 34.9 months (range, 24-65 months). The results of second-look arthroscopy at the recipient site were categorized as cartilage with a smooth surface (group S) and fibrillation or an irregular surface (group I), and results of second-look arthroscopy at the mirror site were categorized as worse (group W), improved (group E), and unchanged (group U).

RESULTS

There were 30 sites in group S, 10 sites in group I, 3 sites in group W, 4 sites in group E, and 33 sites in group U. The age at operation was significantly greater in group S than in group I. There was a significant correlation between group S and groups E and U. The clinical outcome was significantly worse in group W when compared with groups E and U.

CONCLUSION

If a smooth surface was seen in the recipient site during second-look arthroscopy, the cartilage degeneration in its mirror site did not become worse after mosaicplasty.

Patch Repair for a Subepicardial Aneurysm With an Approach From Inside the Heart

We present a case of subepicardial aneurysm that developed as a complication of acute myocardial infarction. Although the patient had stable hemodynamics, the diameter of the aneurysm tended to increase over time; thus, an operation was performed. We thought that approaching the aneurysm from outside the heart would injure the papillary muscle or distort the left ventricle and exacerbate mitral regurgitation. Therefore, we performed patch repair using bovine pericardium and approached the aneurysm from inside the heart. This is the first case report of a subepicardial aneurysm that was approached and repaired from inside the heart.