PURPOSE: High Outerbridge grade lesions of the articular cartilage have been associated with poor outcomes of high tibial osteotomy (HTO). However, there has been no report on the efficacy of HTO in the presence of kissing lesions. The purpose of this study was to compare clinical and radiographic outcomes of HTO between kissing lesion and non-kissing lesion groups. MATERIALS AND METHODS: Of the patients with medial compartment osteoarthritis and varus deformity treated with HTO between 2007 and 2012, 21 cases with kissing lesions and 22 cases without kissing lesions were selected. Clinical outcomes were assessed using the Lysholm knee scoring scale score, visual analogue scale score, Hospital for Special Surgery score, Western Ontario and McMaster Universities score, and Tegner activity score. Radiographic outcomes were assessed using the femoral-tibial angle, mechanical axis deviation, medial proximal tibial angle, posterior tibial slope angle, and joint space width. RESULTS: Clinical outcomes were improved in both groups from the postoperative assessment to the final follow-up, which showed no statistically significant difference between groups at the final follow-up. No statistically significant differences were observed with regard to radiographic assessment. CONCLUSIONS: Since both groups showed favorable short-term clinical and radiographic outcomes, HTO might be an alternative treatment option for degenerative osteoarthritis with kissing lesions in relatively young patients.
Cartilage, Articular ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Joints ; Knee ; Lysholm Knee Score ; Ontario ; Osteoarthritis ; Osteotomy

Osteochondroma is the most common benign bone tumor around the metaphysis. Usually, it is originated from the peripheral area of metaphysis-physis junction due to mutation of physeal chondrocyte. This 1-year and 3-month-old boy presented with a mallet deformity. Radiographs showed an abnormal mass on the distal part of the middle phalanx. It was connected to the articular cartilage which was not associated with the physis. Operative and pathologic findings showed typical osteochondroma. After excision of the osteochondroma with sparing of the extensor tendon and immobilization for 6 weeks with a full extension splint, the pseudomallet deformity disappeared.
Cartilage, Articular ; Chondrocytes ; Congenital Abnormalities ; Finger Phalanges ; Fingers ; Humans ; Immobilization ; Infant ; Osteochondroma ; Splints ; Tendons

OBJECTIVETo study the clinical effects of self-invented cartilage-perichondrium autografting for the repair of articular cartilage defects, so as to reconstruct the joint surface.

METHODSAmong total 11 patients with hand injuries from Oct. 2005 to Oct. 2009, 7 patients were male and 4 patients were female, ranging in age from 17 to 50 years, with an average of 29 years. All the patients had serious injuries of finger joint and were treated with cartilage-perichondrium autografting. After the operation, function exercises were performed, and composite scores of joints at hand were used to evaluate therapeutic effects.

RESULTSAll the patients were followed-up from 1 to 4 years with an average of 24 months. The operation of all the patients were successful, and there were no infection. The mean score was (41.0 +/- 0.63) in 2 years after operation. Eight patients got an excellent result (> 38 scores), 2 good (from 35 to 38 scores) and 1 bad (< 30 scores).

CONCLUSIONThe cartilage-perichondrium autografting method is effective to reconstruct the defects of articular cartilage, and decrease the disablement rate of hand injuries.

Adolescent ; Adult ; Arthroscopy ; methods ; Cartilage ; transplantation ; Cartilage Diseases ; genetics ; Cartilage, Articular ; abnormalities ; Chondrocytes ; transplantation ; Female ; Humans ; Knee ; abnormalities ; Male ; Middle Aged ; Transplantation, Autologous ; methods ; Treatment Outcome ; Wound Healing ; physiology ; Young Adult

BACKGROUND: Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. METHODS: Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calve-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications. RESULTS: Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7degrees to a mean of 115.0degrees at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons. CONCLUSIONS: Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.
Acetabulum/surgery ; Adolescent ; Adult ; Cartilage, Articular/surgery ; Child ; Female ; Femur Head/surgery ; Hip Dislocation/surgery ; Hip Joint/abnormalities/*surgery ; Humans ; Male ; Osteotomy/methods ; Treatment Outcome ; Young Adult

PURPOSE: To provide information on the thickness of the patella in Korean adults and to provide a standard for the selection of a proper patella implant in total knee arthroplasty. MATERIALS AND METHODS: From October 2002 to June 2004, the patellar thickness was measured by MRI in 165 knees. The mean age of the patients was 29 years (20-39 years). Patients with either patellar fractures or deformities were excluded. Of the knees included in this study, 54 knees had meniscal injuries, 53 had cruciate ligament injuries, 24 had knee contusions, and 17 had other disorders. The remaining 17 knees were normal. The measurements were taken in the axial and sagittal images of the MRI scans. The maximum distance in millimeter between the anterior cortex of the patella and the surface of the articular cartilage was measured to the first decimal place. The relationship between the patellar thickness and gender, weight and height was also analyzed. RESULTS: The average patellar thickness on the axial image was 23.8 (SD 1.4) mm in males and 21.7 (SD 1.4) mm in females. The measurement estimated in the axial image was not significantly different from that in the sagittal image. The patellar thickness in males was significantly thicker than in females (p<0.01). There was a significant correlation between the patellar thickness and both the body weight and height (p<0.01). CONCLUSION: The average patellar thickness in Korean adults was 23.8 mm in males and 21.7 mm in females. The patella was thicker in males than in females. Moreover, the patellar thickness was proportional to the height and weight of each individual.
Adult* ; Arthroplasty ; Body Weight ; Cartilage, Articular ; Congenital Abnormalities ; Contusions ; Female ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Male ; Patella

PURPOSE: To measure the amount of type II collagen with western blotting method and to verify its relations with the clinical, radiological and second look arthroscopic findings in patients who were treated with microfracture surgery. MATERIALS AND METHODS: From October 1997 to December 2000, second look arthroscopies and biopsies were performed in 21 knees of 20 patients at 1 year after surgery. Their mean age at the time of operation was 62.7 years(range, 44-77years) and mean follow-up period were 1 year 3months(range, 10-30 months). 21 cases were classified into 3 groups (Group I >70%, Group II 20-70%, Group III < 20% of normal control) according to the result of western blotting of type II collagen. We analyzed the relationship of western blotting of type II collagen with clinical, radiological, extent of regenerated articular cartilage, patient's age, weight and preoperative varus deformity. RESULTS: Average amounts of type II collagen were 44% of those in control group. The amounts of type II collagen formation had positive correlation with extent of regenerated cartilage and preoperative varus deformity but no correlation with clinical score, joint space widening, patient's weight and age. CONCLUSION: The results of this study provide the rationale to select the osteoarthritic patients indicated for microfracture surgery.
Arthroscopy ; Biopsy ; Blotting, Western* ; Cartilage ; Cartilage, Articular ; Collagen Type II* ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Joints ; Knee ; Osteoarthritis

PURPOSE: To evaluate the characteristic MR findings of hemophilic arthropathy of the knee. MATERIALS & METHOD: Seven knees in six patients with hemophilia (five hemophilia A and one hemophilia B) were retrospectively studied with MR images and plain radiographs. Patients were aged between 2 and 20 years (mean, 11) and all had a clinical history of repeated hemarthrosis. MR images of the knee were analyzed with respect to intra- andextra-articular hemorrhage, the state of synovial tissue, articular cartilage, bone, menisci, and ligaments. RESULTS: Synovial hypertrophy and articular cartilage destruction were revealed in all seven knees ; pannus wasfound in four, and was seen as low signal intensity on T1-weighted image and high signal intensity on T2-weighted images. All five instances of synovial hypertrophy and pannus were enhanced. Joint effusion, presented in five ofseven knees, demonstrated slightly low signal intensity on T1-weighted image and high signal intensity on T2-weighted images, and was associated with peripheral low signal intensity of hemosiderin. Subchondral and marginal erosion was seen in six cases, patellar deformity in three, meniscal damage in four and cruciate ligament damage in one case. CONCLUSION: MR is superior to plain radiography in demonstrating chronic repeated hemarthrosis (manifested as thick intra-articular effusion), hemosiderin, synovial hypertrophy, erosion ordestruction of articular cartilage and bone, and meniscal or cruciate ligament injury of hemophilic arthropathy ofthe knee. MR is therefore thought to be a useful imaging study for accurate evaluation of hemophilic arthropathyof the knee.
Cartilage, Articular ; Congenital Abnormalities ; Hemarthrosis ; Hemophilia A ; Hemorrhage ; Hemosiderin ; Humans ; Hypertrophy ; Joints ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Radiography* ; Sulindac

High tibial osteotomy is a satisfactory surgical method of treatment for knees with unicompartmental osteoarthritis and angular deformity. This procedure has been found to reiieve pain, improve function and delay the progress of the condition by realigning the joint and thereby shifting the line of weight-bearing to the compartment with preserved articular cartilage. We reviewed clinically and radiologically the long-term results of the high tibial osteotomy performed on 17 medially osteoarthritic knees in 15 patients at Seoul National University Hospital from October 1980 to June 1989. We excluded the cases whose medical records were not complete or the follow-up was less than 5 years. There were 14 females and 1 male, and the average age of the patients were 59 years(range, 50 to 67 years), and the mean follow-up period was 7.3 years(range, 5 to 13.1 years). The clinical results were evaluated using Insall knee-rating scale. Excellent or good result was obtained in 14 knees(82%) at 2- and 5-year follow-up and in 13 knees(76%) at the final follow-up evaluation. Preoperative mean varus angle was 6.6 degrees. Postoperative corrected tibiofemoral angle decreased with time; immediate postoperative and final follow-up valgus angles were 10.2 and 8.5 degrees respectively. The clinical results based on the valgus angle achieved immediately after operation was 75 points(below valgus 10 degrees), 84 points(valgus 10 to 14 degrees), and 76 points(above valgus 15 degrees). Preoperative radiologic stage of osteoarthritis was evaluated using modified Ahlback classification(range, stage I to IV). The knee rating score at the final follow-up was 82 points in grade I(5 knees), 80 points in grade II(6 knees), 77 points in grade III(5 knees) and 72 points in grade IV(1 knee) degenerative arthritis. This study revealed that the best results were seen in knees with preoperative grade I or II degenerative arthritis and with 10 to 14 degrees of valgus immediately after osteotomy. Although there were some deterioration of clinical results and loss of correction with time after osteotomy, we concluded that appropriate selection of patients and careful surgical technique will provide good to excellent long-term results of high tibial osteotomy.
Cartilage, Articular ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Male ; Medical Records ; Methods ; Osteoarthritis ; Osteotomy ; Seoul ; Weight-Bearing

An evaluation of the acetabular cartilage was performed grossly and histologically in a patient who had a bipolar hemiarthroploasty, which had served satisfactorily for 2 years until the femoral prosthetic head had been separated from the acetabular assembly due to creep deformation of the inner bearing polyethylene cup. This study indicates that the double-bearing bipolar prosthesis dose not necessarily have an advantage over the classical single-piece prosthesis in the prevention of acetabular cartilage wear.
Acetabulum/abnormalities* ; Cartilage, Articular/abnormalities* ; Hip Joint/abnormalities ; Hip Prosthesis* ; Human ; Male ; Middle Age ; Postoperative Complications/etiology* ; Prosthesis Failure

Since 1856, Mayer13) coined the term “osteotomy” for a tibial resection for an angular deformity, various shapes and designs of osteotomies in long bone or pelvis have been popularized to treat the malunion, osteoarthritis of hip and knee, bow leg, L.C.P., or C.D.H. etc. The purpose of corrective osteotomy for tibia is so different from that of upper extremity because it must be restored the weight bearing alignment, and equalize or minimize the leg length discrepancy. We respectively reviewed 14 cases with various angular deformities on tibia who were treated at Dept. of Orthopaedic Surgery, Catholic Medical College from Jan. 1976 to Dec. 1984. The results obtained were as follows: 1. Causes of angular or rotational deformities of tibia were malunion in 11, bow leg in 2 and partial closure of distal tibial epiphysis in l. 2. Ten cases of tibial deformities exceeded over the 10° of medial or lateral angulation and 15° of anterior or posterior bowing were corrected for normal weight-bearing alignment in lower leg. And a rotational deformity may be so disabling to walk as to require surgery. So four cases of tibial angular deformities combined with more than 20° of external rotation and 5° of internal rotation were corrected for normal good looking walks. 3. The maximum length that can be gained by an opening wedge osteotomy was near the point of maximum angluation, but it could be changed by the cause of deformity and patient's age. We've done 4 cases of opening and 10 cases of closing wedge osteotomy. 4. Angular deformity in one plane due to fracture in children under 10 years of age may be corrected spontaneously by growth, but deformities due to bow leg or epiphyseal injury cann't be expected any spontaneous correction of deformity by growth. So three cases of tibial deformities due to bow leg or epiphyseal injury in children were corrected in earlier after recognition of that deformities because of possible damage to articular cartilage and the combined rotational deformities. 5. A slight deformity if the angulation involves near a joint, knee or ankle could be seriously disabling and so must be correctcd earlier. 6. Functional results of the corrective wedge osteotomy in angular and rotational deformities of tibia were excellent, good, fair in 4, 7 and 3, respectively.
Ankle ; Cartilage, Articular ; Child ; Congenital Abnormalities ; Epiphyses ; Genu Varum ; Humans ; Knee ; Knee Joint ; Leg ; Numismatics ; Osteoarthritis, Hip ; Osteotomy ; Pelvis ; Tibia ; Upper Extremity ; Weight-Bearing