Massive and irreparable rotator cuff tear treatment by arthroscopic partial repair with long head of the biceps tendon augmentation provides better healing and functional results than partial repair only

BACKGROUND

The aim of this study was to compare the clinical and radiologic outcomes of 2 treatment methods for massive and irreparable rotator cuff tears (RCTs): partial repair (PR) and PR with long head of the biceps tendon (LHBT) augmentation. Biceps tendon augmentation is believed to promote better healing at the bone-tendon junction, leading to improved clinical and radiologic outcomes.

METHODS

This retrospective comparative study included patients with chronic, massive and irreparable RCTs involving both the supraspinatus (SSP) and infraspinatus muscles. Only patients with failure of nonoperative treatment and at least 1 year of follow-up between 2013 and 2018 were analyzed. The patients were divided into 2 groups based on the chosen treatment method. Irreparability was defined intraoperatively as the inability to achieve sustainable repair of the SSP after complete release, typically corresponding to a Goutallier classification of stage ≥ 3 and Patte classification of stage 3. The clinical assessment protocol involved measurements of range of motion and shoulder strength, as well as the Constant-Murley score (CMS) and Simple Shoulder Test score. Radiologic assessment comprised measurements of the acromiohumeral distance, Hamada classification, Sugaya classification, and Goutallier classification of both the SSP and infraspinatus.

RESULTS

The study included data from 60 patients (30 in each group) with a mean age of 62.5 years and a mean follow-up period of 34.5 months. The retear rate was 43.3% for PR with LHBT augmentation and 73.3% for PR alone (P = .036). During the final examination, statistically significant differences in favor of PR with LHBT augmentation were observed for the CMS (76.2 ± 10.9 vs. 70.9 ± 11.5, P = .034), Sugaya classification (3.5 ± 1.1 vs. 4.1 ± 0.9, P = .035), and acromiohumeral distance (5.8 ± 2 mm vs. 4.7 ± 1.3 mm, P = .021). There were no significant differences between the groups in range of motion, shoulder strength, Hamada classification, Simple Shoulder Test score, and postoperative Goutallier stage.

CONCLUSION

PR with LHBT augmentation for patients with irreparable, massive RCTs provides a lower retear rate and better humeral head centralization, as well as improved results measured by the CMS, compared with PR alone.

Handball players have superior shoulder proprioception: a prospective controlled study

BACKGROUND

Proper proprioceptive and neuromuscular control is crucial for the overhead athlete's performance. The aim of the present study was to evaluate the shoulder joint position sense (JPS) levels in overhead throwing athletes. The secondary aim was to confront the proprioceptive abilities with glenohumeral adaptive changes and pathologies among athletes.

METHODS

Ninety professional handball players and 32 healthy volunteers were recruited. JPS levels were measured by an electronic goniometer and expressed as values of an active reproduction of the joint position (ARJP) and as error of ARJP (EARJP) in 3 different reference positions for each movement (abduction and flexion at 60°, 90°, and 120°; internal [IR] and external rotation [ER] at 30°, 45°, and 60°).

RESULTS

Side-to-side differences revealed significantly better values of EARJP for the throwing shoulders in abduction at 90° and 120°, flexion at 90° and 120°, IR at 60°, and ER at 30° and 60° compared with the nonthrowing shoulders. Handball players showed significantly better proprioceptive levels in their throwing shoulder compared to the dominant shoulder of the control group in abduction at 90° (P = .037) and 120° (P = .001), flexion at 120° (P = .035), IR at 60° (P = .045), and in ER at 60° (P = .012).

DISCUSSION

Handball players present superior shoulder JPS in their dominant throwing shoulder at high range of motion angles when compared to a nonathlete population and to their own nondominant shoulder.

Isometric Shoulder Testing Using a Forcemeter Is a Reliable Method of Strength Evaluation

Isometric strength testing using a digital dynamometer is reliable for muscle function evaluation. It allows us to objectify manual strength assessment measurement. We tested intra- and inter-observer reliability of a user-friendly efficient digital dynamometer-the Forcemeter-equipped with a computer program to monitor the measurements and to store the data. Abduction, forward flexion, and external and internal rotation of both shoulders were tested three times in 20 healthy volunteers with no record of shoulder trauma. Isometric contracture was recorded in newtons. The first and the third test were carried out by Examiner A (intra-rater reliability); the second test, by Examiner B (inter-rater reliability). Good reliability was shown for intra-class correlation coefficient (ICC) values which mean moderate to high correlations (r = 0.66-0.93) for both examiners. Moderate to high correlations (r = 0.72-0.91) were found for comparisons between the results obtained by Examiner A.

Validity and Reliability of Inertial Measurement Units in Active Range of Motion Assessment in the Hip Joint

Measuring joint range of motion has traditionally occurred with a universal goniometer, inclinometer, or expensive laboratory systems. The popularity of the inertial measurement unit (IMU) is growing, enabling the small and even single portable device to measure the range of motion. Until now, they were not used to assess hip joint range of motion. Our study aimed to check the validity of IMUs in assessing hip range of motion and compare them to other measurement devices-universal goniometer and inclinometer. Twenty participants completed three hip movements (flexion in standing and prone internal and external rotation) on both hips. Two testers independently assessed each movement with a goniometer, digital inclinometer, and IMU at different time points. To assess the agreement of active hip ROM between devices, Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis were used. Furthermore, inter-rater and intra-rater reliability were also assessed by using ICC and Bland-Altman analysis. Limits of agreement (LOA) were calculated using Bland-Altman plots. The IMU demonstrated good to excellent validity (ICC: 0.87-0.99) compared to the goniometer and digital inclinometer, with LOAs < 9°, across all tested movements. Intra-rater reliability was excellent for all devices (ICC: 0.87-0.99) with LOAs < 7°. However, inter-rater reliability was moderate for flexion (ICC: 0.58-0.59, LOAs < 22.4) and poor for rotations (ICC: -0.33-0.04, LOAs < 7.8°). The present study shows that a single inertial measurement unit (RSQ Motion, RSQ Technologies, Poznan, Poland) could be successfully used to assess the active hip range of motion in healthy subjects, comparable to other methods accuracy.

Shoulder Range of Motion Measurement Using Inertial Measurement Unit-Concurrent Validity and Reliability

This study aimed to evaluate the reliability of the RSQ Motion sensor and its validity against the Propriometer and electronic goniometer in measuring the active range of motion (ROM) of the shoulder. The study included 15 volunteers (mean age 24.73 ± 3.31) without any clinical symptoms with no history of trauma, disease, or surgery to the upper limb. Four movements were tested: flexion, abduction, external and internal rotation. Validation was assessed in the full range of active shoulder motion. Reliability was revised in full active ROM, a fixed angle of 90 degrees for flexion and abduction, and 45 degrees for internal and external rotation. Each participant was assessed three times: on the first day by both testers and on the second day only by one of the testers. Goniometer and RSQ Motion sensors showed moderate to excellent correlation for all tested movements (ICC 0.61-0.97, LOA < 23 degrees). Analysis of inter-rater reliability showed good to excellent agreement between both testers (ICC 0.74-0.97, LOA 13-35 degrees). Analysis of intra-rater reliability showed moderate to a good agreement (ICC 0.7-0.88, LOA 22-37 degrees). The shoulder internal and external rotation measurement with RSQ Motion sensors is valid and reliable. There is a high level of inter-rater and intra-rater reliability for the RSQ Motion sensors and Propriometer.

Shoulder Range of Motion Measurement Using Inertial Measurement Unit-Validation with a Robot Arm

The invention of inertial measurement units allowed the construction of sensors suitable for human motion tracking that are more affordable than expensive optical motion capture systems, but there are a few factors influencing their accuracy, such as the calibration methods and the fusion algorithms used to translate sensor readings into angles. The main purpose of this study was to test the accuracy of a single RSQ Motion sensor in comparison to a highly precise industrial robot. The secondary objectives were to test how the type of sensor calibration affects its accuracy and whether the time and magnitude of the tested angle have an impact on the sensor's accuracy. We performed sensor tests for nine repetitions of nine static angles made by the robot arm in eleven series. The chosen robot movements mimicked shoulder movements in a range of motion test (flexion, abduction, and rotation). The RSQ Motion sensor appeared to be very accurate, with a root-mean-square error below 0.15°. Furthermore, we found a moderate-to-strong correlation between the sensor error and the magnitude of the measured angle but only for the sensor calibrated with the gyroscope and accelerometer readings. Although the high accuracy of the RSQ Motion sensors was demonstrated in this paper, they require further study on human subjects and comparisons to the other devices known as the gold standards in orthopedics.

Shoulder arthropathy secondary to syringomyelia: systematic review

Purpose

The purpose of this study was to collect and evaluate clinical and radiological evidence on shoulder neuroarthropathy (NA) in syringomyelia (SM) that may support the management and treatment of patients with this condition.

Materials and methods

This systematic review is based on the analysis of reports available in PubMed, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials using the following keywords: syringomyelia, neuroarthropathy, Charcot joint and shoulder degeneration. Thirty-nine publications were found presenting case reports or case series meeting our criteria. Pooled data included a group of 65 patients and 71 shoulders with NA secondary to SM.

Results

The most commonly reported symptoms were range of motion (ROM) limitation, weakness, swelling, pain and dissociated sensory loss. NA is usually monolateral and concerns only the shoulder. The average active shoulder ROM was flexion -59.2° (s.d. 37.9), internal rotation -29.8° (s.d. 22.6) and external rotation -21.1° (s.d. 23.6). Most of the patients (75%) presented with complete or nearly complete proximal humerus degeneration, while the degree of glenoid preservation varied. Fifty-two neuroarthropathic shoulders were treated conservatively with physiotherapy, anti-inflammatory medication and splinting. Eighteen patients were treated by surgical intervention.

Conclusion

Shoulder NA due to SM is a devastating and progressive condition, and its course is often unpredictable. Patients with unexplained shoulder degeneration should be evaluated for SM, especially if there are additional neurological symptoms. Conservative treatment usually reduces shoulder pain without improving ROM. For select patients, shoulder arthroplasty may be a better option for restoring function.

Shoulder arthropathy secondary to syringomyelia: case series of 10 patients

PURPOSE

Neuroarthropathy is a progressive joint degeneration secondary to neurological diseases. In the upper extremity, the shoulder is the most exposed, and it is mainly caused by syringomyelia. This condition is rare; therefore, the literature has documented only a few case reports or case series of small groups of patients.

METHODS

We collected data about patients with shoulder arthropathy due to syringomyelia who were treated in our two institutes and collected among members of the Polish Shoulder and Elbow Society. Our analysis was based on epidemiological data, symptoms, and clinical examinations. We also examined the results of diagnostic tests, including-spinal cord MRI and shoulder X-ray, and treatment methods and their effectiveness.

RESULTS

The examined group included 10 women with an average age of 63 years. Of these, nine patients reported pain, seven reported-swelling, and nine reported-weakness. In every patient, diagnosis was confirmed by X-ray of the shoulder with joint degeneration and MRI of the spinal cord with syrinx. Two patients were operated with reverse shoulder arthroplasty; the first one had excellent result-significant active range of motion improvement and reduction of symptoms, and the second one had a good result-pain relief and moderate range of motion improvement. Other patients were conservatively treated, resulting in total or partial symptoms relief but without significant range of motion improvement.

CONCLUSION

Charcot shoulder secondary to syringomyelia was mainly manifested by range of motion limitation, swelling, and pain. Both conservative and surgical treatments could be a good solution. However, if reverse arthroplasty is technically possible, it seems to be the most promising treatment for recovering function.

Synovial plica of the elbow and its clinical relevance

A synovial plica (fold) is normal anatomic finding, and occurs in 86–100% of cases; however, symptomatic plica is much less common (7.2–8.7% of all elbow arthroscopies).

Synovial plica syndrome is a painful elbow condition related to symptomatic synovial plica.

Synovial plica syndrome is diagnosed by clinical examination (lateral elbow pain) commonly accompanied by local tenderness, pain at terminal extension and/or painful snapping.

Synovial plica syndrome may be mimicked by other elbow conditions, commonly tennis elbow, loose bodies, and degenerative arthritis.

Magnetic resonance imaging or ultrasound scan may support diagnosis in correlation with clinical findings, but symptomatic plica may also be diagnosed as unexpected during elbow arthroscopy.

The arthroscopic resection is effective and safe if conservative treatment fails.

Cite this article: EFORT Open Rev 2020;5:549-557. DOI: 10.1302/2058-5241.5.200027

Shoulder proprioception following reverse total shoulder arthroplasty

Joint replacement affects the proprioception, as shown in knees, elbows, and shoulder studies.

AIM

The aim was to evaluate shoulder joint position sense (JPS) following reverse total shoulder arthroplasty (rTSA) for patients with cuff arthropathy.

METHODS

Twenty-nine patients that underwent unilateral rTSA (19 females, 10 males) and 31 healthy volunteers evaluated for JPS of shoulder using a dedicated high accuracy electronic goniometer. Error of active reproduction of joint position (EARJP) was assessed at the following reference positions: 30°, 60°, 90°, and 120° for forward flexion and abduction and 15°, 30°, and 45° for internal and external rotation in rTSA, contralateral non-operated, and control shoulders.

RESULTS

Results of EPRJP for rTSA, contralateral, and control (respectively) are as follows:Forward flexion: 30° = (8.0 ± 5.7, 9.8 ± 6.1, and 4.9 ± 3.0), 60° = (5.0 ± 2.8, 5.9 ± 2.7, and 5.1 ± 3.2), 90° = (3.1 ± 1.6, 5.5 ± 2.6, and 3.2 ± 1.4), and 120° = (3.4 ± 2.1, 5.6 ± 4.0, and 3.5 ± 1.7)Abduction: 30° = (5.2 ± 2.5, 9.1 ± 6.1, and 4.6 ± 2.3), 60° = (5.2 ± 3.6, 6.6 ± 4.1, and 5.3 ± 3.1), 90° = (3.8 ± 2.0; 7.4 ± 5.5, and 4.1 ± 1.9), and 120° = (5.3 ± 2.9, 7.7 ± 5.3, and 4.2 ± 1.9)Internal rotation: 15° = (4.3 ± 3.1, 6.2 ± 4.4, and 2.8 ± 1.2), 30° = (3.2 ± 1.9, 4.5 ± 2.3, and 3.3 ± 1.4), and 45° = (3.5 ± 2.0, 4.1 ± 1.8, and 2.8 ± 1.0)External rotation: 15° = (3.0 ± 1.7, 4.2 ± 2.2, and 3.6 ± 1.4) and 30° = (3.1 ± 1.5, 3.8 ± 2.6, and 3.4 ± 1.6)The results showed significantly better JPS (lower EPRJP) in shoulders following rTSA and normal control shoulders comparing with the patient's contralateral shoulder. The explanation can be that rTSA improves joint kinematics and stability, which allows better muscular performance and proprioception feedback.

CONCLUSION

Shoulders following rTSA show JPS superior to non-operated contralateral shoulders and comparable with healthy population shoulders. It seems that rTSA restores shoulder proprioception.

Reliability of humeral head measurements performed using two- and three-dimensional computed tomography in patients with shoulder instability

Purpose

The aim of the study was to compare two measurement methods of humeral head defects in patients with shoulder instability. Intra- and inter-observer reliability of humeral head parameters were performed with the use of 2D and 3D computed tomography.

Methods

The study group was composed of one hundred humeral heads measured with the use of preoperative 2D and 3D computed tomography by three independent observers (two experienced and one inexperienced). All observers repeated measurements after 1 week. The intra-class correlation coefficient (ICC) and the minimal detectable change with 95% confidence (MDC₉₅%) were used for statistical analysis of diagnostic agreement.

Results

For 3D inter-observer reliability, ICC values were “excellent” for all parameters and MDC₉₅% values were “excellent” or “reasonable.” All intra-observer ICC and MDC₉₅% values for 3D were “excellent” for experienced and inexperienced observers. For 2D-CT, ICC values were usually “good” or “moderate” with MDC₉₅% values higher than 10 or 30%.

Conclusions

Three-dimensional CT measurements are more reliable than 2D for humeral head and Hill-Sachs lesion assessment. This study showed that 2D measurements, even performed by experienced observers (orthopaedic surgeons), are burdened with errors. The 3D reconstruction decreased the risk of error by eliminating inaccuracy in setting the plane of the measurements.

Bilateral shoulder proprioception deficit in unilateral anterior shoulder instability

HYPOTHESIS AND BACKGROUND

Proprioception is an important element of shoulder dynamic stability. It has been shown to be affected in cases of capsular or labral injuries of the glenohumeral joint. Therefore, this study was conducted to investigate bilateral shoulder proprioception by active reproduction of joint position both in patients with post-traumatic recurrent unilateral shoulder instability and in normal healthy volunteers.

METHODS

We compared 41 patients, comprising 11 female and 30 male patients with an average age of 25.6 years (range, 18-39 years), with post-traumatic unilateral anterior shoulder instability with a control group of 27 healthy volunteers with no history of shoulder problems and with normal shoulder function during examination. All patients were examined using a high-accuracy computer-controlled electronic goniometer (Propriometer). The error of active reproduction of joint position (EARJP) was measured in abduction, flexion, external rotation, and internal rotation in both shoulders.

RESULTS

We observed a significant deficit in the EARJP in the unstable shoulders within the instability group. Surprisingly, similar results were recorded for the contralateral, unaffected shoulders within this group of patients compared with the control group. Joint acuity increased with higher elevation of the arm position.

CONCLUSION

Unilateral shoulder injuries, resulting in instability, affect proprioception in both shoulders, as demonstrated by an increased EARJP. This is the first report of unilateral shoulder instability coexisting with inferior proprioception in both shoulders.

Prospective outcome assessment of arthroscopic arthrolysis for traumatic and degenerative elbow contracture

BACKGROUND

The purpose of this study was to evaluate the efficacy of arthroscopic elbow release for both traumatic and degenerative contractures from intraoperative recording through the recovery time until final follow-up.

METHODS

The study is based on 54 consecutive patients with extrinsic elbow contracture (traumatic in 31 and degenerative in 23) treated with arthroscopic arthrolysis by a single surgeon in 2011-2015. Range of motion (ROM) and the Mayo Elbow Performance Score (MEPS) were recorded preoperatively; intraoperatively; following release; and in the 1st, 3rd, 8th, 12th, and 26th weeks and at 2 years postoperatively.

RESULTS

Significant improvements were noted in extension, flexion, and range of motion, measured both intraoperatively and at all follow-up visits. The greatest improvement in the range of motion was achieved at the time of surgery (from 89° ± 28° to 131° ± 14°, P < .001); it then decreased at 1 week to 103° ± 22° (P < .001) and slowly recovered to reach 124° ± 22° after 2 years. This was better than the preoperative value (P < .001) but worse than the intraoperative value (P = .002). A similar pattern was observed in both traumatic and degenerative contractures. The MEPS improved from 73 ± 12 preoperatively to 93 ± 14 at the final evaluation (P < .001). The ROM and MEPS results at every follow-up were comparable for both traumatic and degenerative contractures. ROM improved regardless of the severity of contracture.

CONCLUSIONS

Arthroscopic elbow arthrolysis was similarly efficient in ROM restoration in both traumatic and degenerative contractures and regardless of the severity of contracture. After early deterioration, the achieved gain slowly recovers over a period of 6 months but may not recover to the ranges achieved during arthroscopy.

Directional asymmetry of upper limbs in a medieval population from Poland: A combination of linear and geometric morphometrics

OBJECTIVES

Degrees of upper-limb bilateral asymmetry reflect habitual behavior and activity levels throughout life in human populations. The shoulder joint facilitates a wide range of combined motions due to the simultaneous motion of all three bones: clavicle, scapula, and humerus. Accordingly, we used three-dimensional geometric morphometrics to analyze shape differences in the glenoid cavity and linear morphometrics to obtain the degree of directional asymmetry in a medieval population.

METHODS

To calculate directional asymmetry, clavicles, humeri, and scapulae from 100 individuals (50 females, 50 males) were measured. Landmarks and semilandmarks were placed within a three-dimensional reconstruction of the glenoid cavity for analysis of shape differences between sides of the body within sexes.

RESULTS

Linear morphometrics showed significant directional asymmetry in both sexes in all bones. Geometric morphometrics revealed significant shape differences of the glenoid cavity between sides of the body in females but not in males. Both indicators of directional asymmetry (%DA and %AA) did not show significant differences between sexes. PLS analysis revealed a significant correlation between glenoid shape and two humeral head diameters only in females on the left side of the body.

CONCLUSIONS

The studied population, perhaps due to a high level of activity, exhibited slightly greater upper-limb bone bilateral asymmetry than other agricultural populations. Results suggest that the upper limbs were involved in similar activity patterns in both sexes but were characterized by different habitual behaviors. To obtain comprehensive results, studies should be based on sophisticated methods such as geometric morphometrics as well as standard measurements. Am. J. Hum. Biol. 28:817-824, 2016. © 2016Wiley Periodicals, Inc.

Problems of the glenohumeral joint in overhead sports - literature review. Part II - pathology and pathophysiology

In throwing sports shoulder is exposed to enormous and often repetitive overloads. Some sports (contact sports) are also connected with direct trauma. We are thus dealing with traumatic injuries, overload and degenerative damage. The article discusses the most frequent injuries of the shoulder characteristic for throwing sports. These are mainly disorders of arm rotation, internal impingement, lesion of the labrum (SLAP) and rotator cuff tears (PASTA).

Shoulder problems in overhead sports. Part I - biomechanics of throwing

The article discusses the biomechanical processes that occur during an overhead throw. This activity is highly specialized and requires full and proper function from the shoulder joint. It consists of active and passive stabilization and synchronous work of the accelerating and decelerating muscles. The process of the overhead throw can be divided into several phases that differ from each other in biomechanical parameters and involvement of specific muscles.

Elbow joint position sense after total elbow arthroplasty

BACKGROUND

Multiple human experiments have shown that articular lesions can have a negative effect on proprioception. The influence of total elbow arthroplasty on joint position sense has not been reported so far. The purpose of the study was to evaluate proprioception, defined as a joint position sense, after total elbow arthroplasty.

METHODS

The study included 16 patients with unilateral semiconstrained linked total elbow arthroplasty and 21 healthy volunteers. The evaluation included measurement of active and passive reproduction of joint position sense of both elbows after surgery and the control groups. Reference angles included extension to 50° and 70° and flexion to 110°. We also assessed function of the elbow in arthroplasty group using the Mayo Elbow Performance Score, the Disability of the Arm, Shoulder and Hand score, and a visual analog scale for pain level.

RESULTS

The average value of error of passive reproduction of joint position for elbows after arthroplasty was significantly inferior for all evaluated positions compared with the contralateral elbow and with the control group, respectively, at 110° flexion: 4.3°, 2.7°, and 3.2°; at 70° extension: 4.9°, 2.9°, and 2.7°; and at 50° extension: 6.3°, 3.8°, and 3.8°. The average value of error of active reproduction of joint position for the arthroplasty group was also significantly inferior, respectively, at 110° flexion: 3.5°, 1.9° and 2°; and at 50° extension: 4.4°, 3.3°, and 3°.

CONCLUSION

Proprioception in elbows that undergo total arthroplasty is significantly inferior compared with the contralateral site of the patient and in the healthy control group.

The outcome of open elbow arthrolysis: comparison of four different approaches based on one hundred cases

PURPOSE

The aim of this study was to evaluate the results of elbow arthrolysis according to the surgical approach, durability after arthrolysis and the severity of contracture.

METHODS

The study includes a cohort of 100 consecutive patients treated in our institution between 1986 and 2008. The indication for surgery was loss of mobility. This was the result of fractures, dislocation, simultaneous fracture/dislocation or other non-traumatic causes. All patients underwent open elbow release via one of four approaches (42 lateral, 44 medial, six combined medial-lateral and eight posterior). They were clinically evaluated at a minimum of 24 months after arthrolysis.

RESULTS

The average ranges of elbow extension, flexion and arc of motion had increased significantly at the follow up, respectively, by 20°, 16° and 36°. No significant difference was found with regard to surgical approach. However, we noticed significant deterioration of intra-operative average extension and arc of motion (AOM) over the follow up period, respectively, by 13° and 14°. The number of patients with AOM of 100° or more increased from three patients preoperatively to 28 postoperatively.

CONCLUSIONS

Open elbow arthrolysis is a successful method of treatment of elbow contracture. Results are durable, but there is some postoperative deterioration of extension gained during surgery. We may anticipate that at the final stage we shall obtain an average of 86% of intra-operative arc of motion. Patients with the most severe contractures have the best gains.

Clinical and functional evaluation of patients after total elbow arthroplasty

BACKGROUND

The operation of the total elbow arthroplasty (TEA) is recommended in case of advanced joint destruction. At present both in our country and abroad, the number of elbow arthroplasties performed per year is increasing. Surgical procedures are difficult, and postoperative complications may arise. The aim of this study is to evaluate the function of the elbow and the clinical status of patients after having undergone TEA.

MATERIAL/METHODS

Our research is based on 18 patients who had undergone total elbow arthroplasty. The average patient age was 60. The follow-up time varied from 8-108 months. Postoperative assessment included the evaluation of the range of motion and grip strength using a dynamometer. Functional evaluation was carried out using Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) and the SECEC Elbow Score (SES). We had also assessed the pain level (VAS), postoperative complications and patient satisfaction. The study included X-rays of the elbow for the evaluation of prosthesis integrity and possible signs of implant loosening.

RESULTS

The increase of the range of motion was seen among all patients. The amplitude of flexion and extension increased by an average of 25.3° (p<0.02). The results of all questionnaires of functional assessment showed a significant improvement comparing to results before surgery: DASH - 82.6 (±24.6) vs. 116.7 (±24.2), SECEC - 39.3 (±8.5) vs. 27.9 (±9.2), MEPS - 65 (±23.3) vs. 35.8 (±16.9). The VAS pain decreased from 10.9 (±3) to 5.3 (±4). In the postoperative period, 4 patients experienced inflammation, 2 patients had a loosening of prosthesis, and 6 needed a revision of the prosthesis. 94.4% patients were satisfied with the treatment.

CONCLUSIONS

Total elbow arthroplasty effectively improves the clinical status of the patient by reducing pain, increasing range of motion and improving many activities of daily life.

[Latissimus dorsi transfer for treatment of irreparable rotator cuff lesions]

The paper presents results of treatment of irreparable rotator cuff lesions by means of latissimus dorsi transfer. Material consists of 10 patients treated in our center in 2003-2006. 9 male and 1 female patients were operated. The av. age was 56.3 (27-65). Follow-up period was 15.3 months on average. Evaluation included following measurements: range of motion, pain, UCLA score. 4 patients were evaluated also by ultrasound imaging and EMG. Average increase of active flexion was 70 degrees, active abducion--71 degrees, active external rotation--23 degrees. Pain was significantly diminshed in all patients. The result of treatment in our study group are similar to that presented in literature. Based on this paper latissimus dorsi transfer can be recommended as a technique for traetment of irreparable rotator cuff

Scaffold-aided repair of articular cartilage studied by MRI

OBJECTIVE

The objective of the study was to evaluate the ability of the noninvasive magnetic resonance techniques to monitor the scaffold-aided process of articular cartilage repair.

MATERIALS AND METHODS

Defects of 4 mm in diameter and 3 mm in depth were created in right knees of 30 adolescent white New Zealand rabbits. Fourteen rabbits were implanted with poly(lactide-co-glycolic acid) (PLGA) scaffold trimmed to match the size and the shape of the defect (PLGA+ group). No procedure was applied to the remaining 16 animals (PLGA- group). Animals were sacrificed sequentially at 4, 12, and 24 weeks after the surgery and magnetic resonance T (2)-weighted images (400 MHz) of the dissected bone plugs at eight different echo times were taken to derive T (2) relaxation time. The images and the T (2) time dependencies versus the tissue depth were statistically analyzed. Histological results of bone plugs were evaluated using semiquantitative histological scales.

RESULTS

The results obtained for PLGA repair tissue were evaluated versus the PLGA- group and the healthy tissue harvested from the opposite knee (reference group), and compared with histological results (hematoxylin and eosin staining). The magnetic resonance images and T (2) relaxation time profiles taken 4 weeks after surgery for both the PLGA- and PLGA+ group did not reveal the tissue reconstruction. After 12 weeks of treatment T (2) time dependence indicates a slight reconstruction for PLGA+ group. The T (2) time dependence obtained for PLGA+ samples taken after 24 weeks of treatment resembled the one observed for the healthy cartilage, indicating tissue reconstruction in the form of fibrous cartilage. The tissue reconstruction was not observed for PLGA- samples.

CONCLUSION

The study revealed correlation between magnetic resonance and histology data, indicating the potential value of using MRI and spatial variation of T (2) as the noninvasive tools to evaluate the process of articular cartilage repair. It also suggested, that the PLGA scaffold-aided treatment could help to restore the proper architecture of collagen fibrils.

[Application of microscopic MR for evaluation of cartilage repair]

Magnetic resonance imaging is gold standard for noninvasive evaluation of articular cartilage damage and has been also used for monitoring cartilage repair. The aim of this study was to find correlation between histological microscopy and microscopic MR in evaluation of the repair of osteochondral defects in articular cartilage. Study was based animal model (rabbit). The cartilage repair process was evaluated histology and micro MR. Most of the defects were filled with fibrocartilage and fibrous tissue formed. Both methods were equally efficient to show repair tissue thickness, subchondral bone reconstruction and disintegration. Result of observation by both histological and MR microscopy and showed good correlation. Micro MR is promising evaluation tool for cartilage repair monitoring. Results of micro MR correlate well with standard microscopy.

[Wrist arthroscopy]

Wrist arthroscopy has found its place in surgeons armamentarium. Since its introduction the value of wrist arthroscopy has been developing. Current indications for wrist arthroscopy include three groups: diagnostic, evaluation (staging) and therapeutic. Arthroscopy allows for establishing correct diagnosis, including possibility for dynamic testing and probing of examined tissues. Some wrist disorders can be staged and qualified for appropriate operative procedure. Number of therapeutic possibilities have been presented by many authors to be performed by arthroscopic technique in wrist. Our material included 41 wrist arthroscopies. 17 arthroscopies were diagnostic, 4 staging and 20 therapeutic. Arthroscopic interventions included: TFCC repair, debridement, synovectomy, ganglion removal. Ultimate value of wrist arthroscopy remains to be established by more long term scientific update. Wrist arthroscopy is attractive instrument in diagnosis and treatment of different wrist disorders. However its application must be based on detailed knowledge of anatomy, pathology and thorough clinical examination including imaging.

Instability of the distal radioulnar joint (DRUJ): a description of the problem and own experience

Introduction. The distal radioulnar joint (DRUJ) is important for rotation of the forearm and stability of the ulnar wrist. Any DRUJ injury can cause limitation of the range of motion, decreased strength, pain, and instability. This paper deals with DRUJ instability, and reviews treatment methods and outcome. Disturbances in DRUJ stability result from bone damage, TFCC and ligament injuries, and/or other soft tissue deficiencies (capsule, tendon). Instability due to injury may be acute or chronic in nature. Most acute cases are best treated conservatively. Chronic problems resulting in disability may require surgical treatment. Material and methods. We studied 7 patients (age 23-55) with DRUJ instability, operated in our Department between 2000 and 2004. The patients were qualified for surgery based on a clinical examination supported by imaging techniques. All were traumatic cases, and three had a history of distal radius fracture. Different operative procedures were used due to the variety of clinical presentations: extraarticular ligament reconstruction acc. to Bunnel-Boys, anatomic ligament reconstruction with PL acc. to Adams, restabilization of TFCC, retinacular reconstruction, and capsular duplication. Results. Pain was significantly decreased in all patients. The range of motion postoperatively did not differ compared to preoperative findings. DRUJ stability was restored in all cases. Conclusions. DRUJ instability can result in significant disability. In such cases surgical treatment restores stability and decreases symptoms. Return to preinjury activities is possible following treatment.

Instability of the rheumatoid wrist: patterns and treatment

Pathology of the wrist is frequent in rheumatoid arthritis. The proper treatment leading to improvement in function and symptoms relief is of a big importance. The classification based on natural pattern of the disease is presented including three types: ankylotic, arthritic changes with artrodesis and instability leading to wrist collapse. It the third type it is important to add partial or total arthrodesis to the common synovectomy and ulnar head resection.

Treatment of injury of the triangular fibrocartilage complex (TFCC)

Background. The triangular fibrocartilage complex (TFCC) supplies stability and cushioning for proper wrist function. TFCC lesions, a common cause of ulnar-sided wrist pain, can be traumatic (Palmer I) or degenerative (Palmer II) in nature. Clinical assessment is basic for making the diagnosis, but imaging may be helpful. Conservative treatment is the best choice for most acute cases. If the symptoms persist, however, operative treatment has a better prognosis for pain relief. Wrist arthroscopy has a major role to play in the diagnosis and treatment of TFCC lesions. Material and methods. 29 patients were operated in the Hand Surgery Department in Poznań due to TFCC lesions. 16 patients were qualified as Palmer type I (9 sport injuries, 7 sprains). while 13 patients had Palmer type II secondary to distal radial fractures. All patients suffered ulnar wrist pain and were positive on provocation tests. The indication for surgery was a lack of response to conservative treatment. Different operative procedures were used, depending on the type of lesion: arthroscopic debridement, open or arthroscopic restabilization of the TFCC, ulnar shortening, or partial resection of the ulnar head (Wafer). Rehabilitation was introduced following a period of immobilization. Results. Wrist pain was significantly diminished or disappeared after surgical treatment and rehabilitation. Conclusions. Good functional result and pain relief can be expected following surgical treatment of TFCC injuries.

Articular cartilage repair by means of biodegradable scaffolds

INTRODUCTION

Articular cartilage has a limited capacity for self-repair; untreated injuries of cartilage may lead to osteoarthritis. In severe cases the only choice a total joint replacement, may be inadequate in young patients. This problem demands new effective methods to reconstruct articular cartilage. The aim of this study was to evaluate the application of collagen matrix for the reconstruction of articular cartilage.

MATERIALS AND METHODS

A group of 28 rabbits had a defect penetrating into the subchondral constructed and either filled with collagen scaffold (group I) or remained empty (group II). The results were observed after 4 and 12 weeks. Macroscopic and microscopic evaluations were performed.

RESULTS

In the first group we observed the presence of hyalinelike cartilage resembling normal articular cartilage. In the second group fibrous tissue dominated. The surface of regenerated tissue was smooth, intact, and the defect completely filled with regenerated tissue, showing good structural integrity. In the second group, superficial irregularities, disorders of structural integrity, and necrotic features were noticed.

CONCLUSIONS

This study showed better results of articular cartilage reconstruction by means of a biodegradable scaffold.

Scapholunate instability: Natural history, diagnostics, and therapeutic algorithm

Scapholunate joint takes approximately 80% of axial and rotational wrist load. Lesion of scaphoid ligaments leads to its instability especially in dorsal flexion and ulnar deviation mechanism. Increase of scapholunate gap can be found in 19% of patient with wrist injury, 2 of them needs surgical intervention because of severe instability. In 2002 to 2005 in Traumatology, Orthopedics and Hand Surgery Department at Poznan University of Medical Sciences 36 patients were treated due to painful wrist of unknown etiology. Diagnostic possibilities, the value of some imaging methods used in scapholunate instability (SLI) were described. Clinical examination with use of provocational tests, classical X-ray, both static and stress, MRI with contrast, dynamic fluoroscopy were and arthroscopy taken under scope. This paper describes also approach to treatment possibilities of SLI including capsulodesis, static and dynamic stabilization with ligaments and partial or total arthrodesis.

Evaluation of Cartilage Reconstruction by Means of Autologous Chondrocyte Versus Periosteal Graft Transplantation: An Animal Study

BACKGROUND

Autologous chondrocyte transplantation (ACT) has been shown to heal cartilage defects under experimental and clinical conditions. However, the evaluation of successful transplantation still remains arbitrary and further research is required to establish objective criteria of treatment. The aim of the present study was to evaluate the criteria of successful ACT and to compare the results with those obtained following periosteal grafting (PG).

MATERIALS AND METHODS

Articular cartilage specimens were taken from the distal femur of 30 adolescent New Zealand rabbits and chondrocytes were obtained by collagenase digestion. The chondrocytes were identified by a functional assay, based on estimating procollagen type II mRNA by reverse-transcribed polymerase chain reaction. The cells cultured in vitro were transplanted under a periosteal flap into a full thickness defect (ICRS III(0)). The quality of the repaired tissue was evaluated macroscopically according to a modified scale of Brittberg et al, and microscopically according to O'Driscoll et al. For comparative purposes animals treated with PG were used.

RESULTS

Cultured chondrocytes expressed procollagen type II and, upon transplantation into the defect, produced hyaline cartilage. To evaluate the results of transplantation, two categories of criteria were adopted-macroscopic analysis and microscopic examination. By all adopted criteria the results were significantly better in the ACT group (P < .05) than in the PG group.

CONCLUSION

Prior to transplantation, assays for specialized functions of chondrocytes required semiquantitative evaluation of macroscopic and microscopic appearance of the repaired tissue, showing the benefit of autologous chondrocyte versus periosteal graft transplantation.

[Value of collagen scaffolds in surgical reconstruction of articular cartilage]

Articular cartilage has a very limited capacity for regeneration and the untreated injuries of this tissue may lead to osteoarthritis. The aim of this study was to evaluate the application of collagen scaffolds in surgical reconstruction of articular cartilage. A group of 28 rabbits was used in the study. A defect penetrating into the subchondral bone was made. The animals were divided into 2 groups: group 1- defects filled with collagen scaffold, group II the defects remained empty. The results were evaluated at 4 a 12 weeks. Macroscopic and microscopic evaluation was performed. On gross examination of the group I complete filling of the defect with regenerated tissue was observed. This tissue had smooth surface and was completely integrated with the surrounding cartilage. In the group II the surface of the newly formed tissue showed large irregularities. The defect was partially filled and incompletely integrated with the residual cartilage. Microscopic results indicate presence of hyaline-like cartilage resembling normal articular cartilage in group I. Regenerate was more stable and remained stable with longer follow-up. Group II revealed mostly fibrous tissue in regenerate. Thickness was inadequate with visible surface irregularities and loss in tissue integrity. This study proved better results of reconstruction of articular cartilage by means of biodegradable scaffold.

[Value of osteo-chondral paste autologous transplantation in experimental cartilage defects reconstruction. Part III--Microscopic analysis of reconstructed cartilage thickness and surface regularity]

INTRODUCTION

A limited ability of the cartilage to heal after trauma was the reason to start research on new methods concerning better cartilage reconstruction. The aim of the study was evaluation of repair tissue thickness and surface regularity after osteochondral paste transplantation.

MATERIAL AND METHODS

Full thickness defect (IV(o)--ICRS scale) on distal rabbit femur joint surface was made. Three groups were specified: A--defect with paste graft (cartilage and contiguous bone collected from joint surface, crushed into homogenous paste; B--defect with the paste graft covered with periosteum; C--defect left unfilled. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale.

RESULTS

Newly formed tissue was well integrated with surrounding cartilage in group A (paste graft). That trait of repair tissue in group A was much better than in other groups, especially in late observations. Structural integrity of tissue filling the defect was similar to integrity of normal cartilage in groups A and C, but tissue formed in group C didn't represent a hyaline-like cartilage character. In all the examined groups reconstruction of subchondral bone exhibited similar rate. 12 weeks from the procedure, around 80% of subchondral bone was rebuilt. The obtained results indicate, that osteochondral paste autologous transplantation in cartilage defects treatment effects with forming well integrated (structurally and with surrounding cartilage) cartilage tissue, of almost complete subchondral bone rebuilding.

[Value of autologous chondrocyte transplantation in experimental cartilage defects reconstruction. Part II: Microscopic analysis of reconstructed cartilage structural integrity and surface regularity]

Experimental and clinical tests proved that cultured, autologous chondrocytes retain their properties and have ability to reconstruct hyaline-like cartilage, which represents chemical composition and biomechanical characteristics similar to normal hyaline cartilage. The aim of this part of the study was microscopic evaluation of repair tissue structural integrity and surface regularity after autologous chondrocyte transplantation.

MATERIAL AND METHODS

Repair of partial thickness cartilage defect (ICRS III(o) grade) on distal femur joint surface was evaluated (25 adolescent rabbits). Procedures were performed in two groups: I--autologous chondrocyte transplantation under periosteal flap, II--periosteal graft. Chondrocytes were isolated from the cartilage specimens by enzymatic digestion and cultured in vitro. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale.

RESULTS

In group I, 4 weeks after the procedure surface of the reconstructed tissue was irregular. 8- and 12-week observation found the surface regular and plain, and repair tissue exhibited complete structural integrity. In group II, in all follow-up periods regenerate surface was irregular, there was many fissures and cracks in graft tissue, and in several cases--regenerate disintegration.

CONCLUSION

Obtained results indicate, that hyaline-like cartilage reconstructed after autologous chondrocyte transplantation was characterized by regular, plain surface and complete structural integrity.

Proprioception in pathophysiology and treatment of shoulder instability

Shoulder is a complicated anatomical and functional structure. It's normal function depends on stability and neuromuscular control. Static stabilization relies mostly on capsulolabral complex, whereas dynamic stabilizers consist of scapulo-thoracic and glenohumeral muscles. Function of static and dynamic stabilizer is coordinated by neuromuscular control. This is based on proprioceptors, central nervous system, and muscles. Any injury resulting in mechanical and dynamic deficit will lead to shoulder dysfunction. Restoration of joint proprioception and neuromuscular control seems to be an essential part of treatment in shoulder instability.

Pre- and postoperative principles of rehabilitation in arthroscopic treatment of painfull shoulder

Pain of the shoulder is becoming a serious clinical problem. A proper diagnosis, surgical, physiotherapycal, pharmacological and psychological treatment allow to achieve the best result. This shoulder's problem is very common in young, working people, who expect a quick and effective treatment. One of the procedures in the treatment of the painful shoulder is arthroscopy combined with physiotherapy. The very important part of the exercise program is the preparation of the injured extremity for surgical procedure. The time of the immobilization and the beginning of the exercises is being given by the surgeon. Generally it is important to start the exercises as soon as possible and to make it painless if it possible. One of the most effective methods is PNF (Proprioceptive Neuromuscular Fascilitation). It allows for the early beginning of the exercises by using proper patterns and techniques.

The reconstruction of inveterate rotator cuff lesions and lesions of the glenoid labrum of the shoulder with open and arthroscopic techniques

Background. The purpose of the paper is to present the treatment results of patients with injured rotator cuff, based on 6 months study, major limb dysfunction and severe pain. <br /> Material and methods. Study is based on 14 patients, who underwent arthroscopic and open surgery of the shoulder. After arthroscopic repair of coexisting injuries and curbed mobility of the rotator cuff, open method was employed to reinsert rotator cuff with decompression of subacromial space. After the surgery, the arm was immobilised using orthosis with about 20-30 degrees abduction. Limited exercises of mobility range was started in the 4rd week after the surgery, increasing slightly the intensity and character of the exercises. External rotation movement was introduced in the third month after the surgery. <br /> Results. The decrease of pain score has been observed from 6.28 points before surgery to 1.87 points after the treatment. The UCLA score increased after the surgery by about 26 points. In Simple Shoulder Test the score of positive answers increased from 2.2 to 7.6 after surgery. Results of the treatment were lack off pain and restored stability of the shoulder. <br /> Conclusions. Decreased pain and better mobility seem to prove the efficacy of treatment of inveterate massive rotator cuff lesions.

Impingement and rotator cuff lesion an arthroscopic treatment

There has been dynamic increase in arthroscopic treatment of shoulder diseases. This paper presents etiology, classification and symptoms of the rotator cuff disease. Indications and arthroscopic treatment have been also described. <br />

Arthroscopy surgery of atraumatic instability of the shoulder

BACKGROUND

[corrected] Atraumatic shoulder instability makes roughly 4% of all instability cases. Subluxation or dislocation may either have no actual cause or be the result of minor accident. Because of its multi-directional character and coexisting disturbances, atraumatic instability is a serious therapeutic issue. The basics of the treatment are strengthening the shoulder stabilizing muscles and exercises aimed at optimising nerve-muscle control.

MATERIAL AND METHODS

6 patients - 10 shoulders, who suffered non-traumatic multi-directional shoulder instability were operated on at our Dept. Lack of positive results after at least 6 months' rehabilitation was the direct indication for surgery, along with night and activity related pain. Three patients from the above mentioned group suffered additionally single sided idiopathic instability. Arthroscopy was carried from three portals: two front and one back. During the surgery we observed high capsule laxity, generally hypoplastic labrum, and partial cartilage loss within the humeral head. Non-absorbing sutures - Ethiobond 2, anchors, and screws we used to stabilize the capsule and labrum. After inserting the scope we made 3-4 anchors and sutures of capsule and labrum at the anterior and posterior aspect of the glenoid. The next thing to do was to apply sutures closing rotator intervals. Remaining, non-sutured parts of the capsule, were thermally shrunk.

RESULTS

The observation covers period from six months to two years after the surgery. The decrease of pain score has been observed from 4 points before surgery to 0.33 points after the treatment. The UCLA score increased after the surgery by about 13 points. In Simple Shoulder Test the score of positive answers increased from 7 to 11. Results of the treatment were lack off pain and restored stability of the shoulder. There was stronger patients' motivation to exercise in order to strengthen the muscles and muscle coordination.

CONCLUSIONS

Arthroscopic stabilization of shoulder joint is a encouraging method in atraumatic instability of the shoulder. In case of any failure, the method doesn't exclude the option of open-surgery methods.

Arthroscopic treatment of traumatic shoulder instability

Background. Traumatic shoulder instability is a common sequel following first shoulder dislocation, especially in young population (< 30 y.a). Shoulder arthroscopy is getting more and more popular among orthopaedic community. Efficacy of arthroscopic treatment of shoulder instability approaches that of conventional operative techniques. <br /> Aim. The purpose of the study was the analysis of arthroscopic treatment of traumatic shoulder instability. <br /> Material and methods. Study was based on 22 patients, 24 shoulders were operated. Capsulolabral complex has been stabilized arthroscopically in all patients. <br /> Functional was assessed by means of ASES, UCLA and SST scores. Function was improved significantly. There has been no recurrence of instability in follow-up period. <br /> Conclusions. We have proved good efficacy of arthroscopic techniques in treatment of the instability. <br /> Joint stability was restored with decreased invasiveness of operation (better cosmesis, easier rehabilitation).

Magnetic resonance artfrography of the shoulder

Background. There is constant increase in number of patients seeking medical help due to shoulder diseases. Imaging techniques may facilitate making the diagnosis and decide about the treatment modality, including decision on operative treatment. Magnetic resonance is widely accepted for imaging of soft tissue lesions of the shoulder. <br /> Material and Methods. This study was based on material of 26 patients with shoulder pain and dysfunction with diagnostic difficulties or postoperative monitoring. Standard MR was performed first, followed by direct arthrography in MR. <br /> Results. MR arthrography of the shoulder revealed more labral and capsule (ligament) as well as SLAP lesions than standard MR. Arthrography enabled better visualization of degree of rotator cuff lesion. There was more III and IV grade lesions shown in the cuff. <br /> Conclusions. MR arthrography enabled better assessment of rotator cuff lesions and better visualization of capsulo-labral complex lesions.

[The value of autologous osteochondral paste for in-vitro treatment of damage to articular cartilage. Part I. Macroscopic and microscopic assessment of the regenerated articular surface]

The limited ability of articular cartilage to regenerate after trauma has been the main reason for research of new repair techniques. The aim of this paper was to assess in in-vitro conditions the value of autologous osteochondral of pulp--macroscopic analysis of the regenerated articular surface and microscopic assessment of the dominant tissue in the regenerate. The experimental model consisted of a full-depth cartilage defect of the articular surface of the distal femur in rabbits. The animals were subdivided into 3 groups: group A--with defect with osteochondral of pulp, group B--with defects filled with osteochondral of pulp covered by periosteum, group C--defect untreated. After observation periods of 4, 8 and 12 weeks the regenerates were assessed using the Brittberg and O'Driscoll scale. In the overall macroscopic assessment group A prevailed because of the best defect filling. Microscopic assessment showed that in group A the defect had been filled with cartilage very similar to hyaline cartilage (hyaline--like cartilage). Basing on the result of the experiment, we assume that osteochondral of pulp has chondrogenic properties.

[Value of autologous chondrocyte transplantation in the reconstruction of experimental cartilage defects. Part I. Extent of defect, macroscopic appearance of reconstructed articular surface and microscopic analysis of predominant tissue]

Articular cartilage defect is one of the main reasons of osteoarthritis. Currently, tissue engineering techniques are the methods concerning better cartilage reconstruction. The aim of this part of the study was macroscopic evaluation of degree of defect feeling, macroscopic appearance of repair tissue and microscopic analysis of predominant tissue after autologous chondrocytes transplantation. Repair of partial thickness cartilage defect on distal part of femur was evaluated (25 adolescent rabbits). Procedures were performed in II groups: I--autologous chondrocytes transplantation under periosteal flap, II--periosteal graft. Chondrocytes were isolated from the cartilage specimens by enzymatic digestion and cultured in vitro. The regenerates were inspected 4, 8 and 12 weeks after the operation. Macroscopic analysis in group I, in most cases revealed filling of the defect with tissue resembling surrounding cartilage. In group II the defect was partially filled, and there was many fissures and cracks in all regenerates. In microscopic analysis in group I, after 4 and 8 weeks following the transplantation the tissue similar to juvenile hyaline cartilage predominated. After 12 weeks it resembled mature hyaline cartilage. In group II, in all cases fibrous cartilage was observed after 4, 8, 12 weeks. Obtained results indicate, that macroscopic and microscopic characteristics of repair tissue after autologous chondrocytes transplantation more closely resembled hyaline cartilage, than in periosteal graft group. 12 weeks after autologous chondrocytes transplantation the repair tissue reached maturity, and demonstrated microscopic characteristics of hyaline-like cartilage. The method of autologous chondrocytes transplantation provides potential for clinical application.

[Value of autologous transplantation of osteo-chondral paste in reconstruction of experimental cartilage defects. Part II. Microscopic analysis of integration with surrounding cartilage, structural integrity and subchondral bone reconstruction in repair tissue]

INTRODUCTION

A limited ability of the cartilage to heal after trauma was the reason to start research on new methods concerning better cartilage reconstruction. The aim of the study was evaluation of repair tissue integration with surrounding cartilage, its structural integrity and subchondral bone reconstruction after osteo-chondral paste transplantation.

MATERIAL AND METHODS

Full thickness defect (IV degree--ICRS scale) on distal rabbit femur joint surface was made. Three groups were specified: A--defect with paste graft (cartilage and contiguous bone collected from joint surface, crushed into homogenous paste; B--defect with the paste graft covered with periosteum; C--defect left unfilled. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale.

RESULTS

Newly formed tissue was well integrated with surrounding cartilage in group A (paste graft). That trade of repair tissue in group A was much better than in other groups, especially in late observations. Structural integrity of tissue filling the defect was similar to integrity of normal cartilage in groups A and C, but tissue formed in group C didn't represent a hyaline-like cartilage character. In all the examined groups reconstruction of subchondral bone exhibited similar rate. 12 weeks from the procedure, around 80% of subchondral bone was rebuilt. The obtained results indicate, that osteo-chondral paste autologous transplantation in cartilage defects treatment effects with forming well integrated (structurally and with surrounding cartilage) cartilage tissue, of almost complete subchondral bone rebuilding.

The reconstruction of defects in articular cartilage using autologous chondrocytes

A defect was artificially created on the joint surface of the distal ends of both femoral bones in 30 rabbits. After digestion of the cartilage fragment, the resulting cells were cultured in vitro and multiplied. The multiplied autologous chondrocytes were implanted at the point of the defect under a periosteum patch in the right knee (group I). The defect in the left knee was covered with periosteum alone (group II). The regenerates obtained in this way were evaluated at 4, 8, and 12 weeks after surgery, macroscopically for even coverage of the surface of the defect and the quantity of regenerate in proportion to the surrounding healthy tissue, microscopically with H + E stain for the nature of the prevalent tissue, integration with the environment, the presence of necrosis, the formation of isogenous groups of cells, and the formation of cracks.<br /> In the macroscopic evaluations at weeks 4, 8, and 12, the presence of regenerate was discovered in group I in approximately the same quantities as in the surrounding cartilage. The group II joints were found to have less satisfactory repair of the lesion.<br /> In the microscopic evaluation, group I was found histologically to have cartilage tissue well integrated with the environment and chondrocytes forming isogenous groups of cells. In group II most of the joints were found to have incomplete or no integration with the surrounding tissue, with necrosis and cracking.<br /> The reconstruction of defects in articular cartilage using autologous chondrocytes and periosteum produced a regenerate macroscopically similar to the surrounding articular cartilage. The results obtained by regeneration of articular cartilage using autologous chondrocyte grafts and periosteum were superior to those obtained with isolated periosteum grafts.

The experimental reconstruction of articular cartilage using autogenous periosteal and perichondreal implants

Injured cartilage has a limited capacity to heal itself. Untreated damage leads to secondary osteoarthritis. There is a need to find a way to reconstruct cartilage in order to prevent secondary osteoarthritis. The aim this study was to evaluate and compare the chondrogenic potential of three different cell materials: perichonrdrial grafts, periosteal grafts and bone marrow in situ. The mesenchemal cells contained in these materials can differentiate in the joint environment into chondrocytes and rebuild articular cartilage.<br /> Forty nine (49) White New Zealand rabbits were used in our experiment. An osteochondrial (full-thickness) defect was created in the joint surface of both ends of the femoral bone. The animals were divided according to the procedure used:<br /> I - cartilage reconstruction by periosteal grat,<br /> II - cartilage reconstruction by perichondrial graft,<br /> III - no graft.<br /> The joint was not immobilized after surgery. Follow-up exams were performed at 4, 8, and 12 weeks. The results were evaluated macroscopically and microscopically.<br /> The results pointed to the chondrogenic potential of periosteum and perichondrium after grafting to cartilage defects. On gross examination the articular surface was found to be reconstructed. Microscopic examination revealed regeneration, with the formation of hyaline-like cartilage. Regenerating tissue was also found in the group without grafts. The structure resembled normal articular cartilage; however, neither the joint surface nor the subchondrial bone were fully reconstructed. No qualitative or quantitative differences were found between the groups treated with periosteal and perichondral grafts.<br /> Our study confirmed that grafts of periosteum or perichondrium have chondrogenic potential, i.e. the ability to generate cartilage tissue whose features are similar to those of the hyaline chondrial tissue in the joint. Both materials have similar chondrogenic potential. The chondrogenic properties of perichondrium and perisostem produce better results in the various categories in comparison to those of bone marrow.

[Free vascularized joint transfer during surgery for hypoplastic thumb]

Hypoplasia and aplasia of the thumb constitute approximately 11% of congenital disorders of the upper extremity. Surgical treatment depends on type of disorder in Blauth classification used in our Department. Soft tissue procedures and pollicisations are performed most often. Microsurgical transplantation of interphalangeal joint from the toe is an alternative. This paper describes a case of microsurgical treatment in 20 years old patient with hypoplastic thumb. Two months after surgery the range of motion in transplanted joint was between 20 and 75 degrees.