OBJECTIVETo investigate the prosthesis selection, precaution and curative effect of total knee replacement in severe gonarthrosis.

METHODSFrom January 1996 to July 2009, 50 patients (58 knees) with severe gonarthrosis underwent total knee replacement, included 12 males and 38 females, aged from 46 to 80 years with an average age of 66.5 years old. Six artificial hinged knee joints, 37 general knee joints and 15 ScorpioNRG knee joints were used according to the deformity of the knees. Fifty patients (58 knees) were followed up and evaluated with the HSS (the Hospital for Special Surgery Knee Score) scoring system.

RESULTSThe duration of follow-up ranged from 6 months to 8 years (means 62 months). According to the HSS scoring system, the mean preoperative score was (38.6 +/- 8.76) points, and the postoperative score was (86.50 +/- 9.45) points. The clinical effect was excellent in 20 cases (23 knees), good in 28 cases (32 knees),and acceptable in 2 cases (3 knees).

CONCLUSIONStable and functional recovery knee joint without deformities and pains could be obtained after total knee replacement by carefully chosing of prosthetic replacements according to the different degrees of joint deformity of severe gonarthrosis.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Joint Deformities, Acquired ; surgery ; Knee Joint ; pathology ; Male ; Middle Aged ; Osteoarthritis, Knee ; pathology ; surgery

OBJECTIVETo trace the pathological changes of the cultured autologous chondrocytes mass after implanted in cartilage defects and investigate the pathophysiological mechanisms of the antologous chondrocytes mass transplantation in the repair of cartilage defects.

METHODSTwenty-four New Zealand white rabbits of 4 to 6 month-old and weighing more than 3.0 kg (female and male was unrestricted) were randomly divided into experiment group and the control group. For 12 rabbits of experiment group, the cartilage defects were repaired with the autologous chondrocytes mass and sealed with one piece of periosteum. Firstly, cartilage tissue of 10 to 30 mg was obtained from the shoulder of the rabbits after anaesthetized by 1 mg/kg 20% sumianxin. Then, chondrocytes were isolated from the cartilage tissue with 0.2% type II collagenase digestion and were cultured in DMEM/F-12 supplemented with 20% fetal bovine serum (FBS), 50 microg/ml ascorbic acid-2-phosphate, 0.4 mM proline, 5 microg/ml insulin and 1 mM non-essential amino acids (NEAA) in flasks in vitro. The cells were harvested until a thin film of the cells covered the bottom of the flask could be seen with naked eyes. Then the film was collected with a curled glass stick and formed a solid mass. On this time, the animal was anaesthetized again and the full-thickness cartilage square defect of 4.0 mm x 6.0 mm was fabricated in the patellar grove of distal femur, and then the cellular mass was transplanted into the defect covered by one piece of periosteum which obtained from the upper anterior of tibia and sealed with the femoral condyles. For 12 rabbits of the control group, the defects were sealed with one piece of periosteum only. The animals were sacrificed in the 1st, 3rd, 6th and 12th weeks after the operation respectively. The histologic sections were stained with safranin O-fast green, hematoxylin-eosin (H&E) and picric acid-Sirius red and immunostained for type II collagen and aggrecan.

RESULTSIn the 1st week, the transplanted cells oriented to articular surface differentiated to matured hyaline chondrocytes and excrete large amount cartilage matrix. In the 3rd week, the trend was more obvious and the periosteum was union to the cell mass. In the 12th week, the defects were repaired with hyaline-like cartilage tissue, and in the 24th week, the repair tissue turned to matured hyaline cartilage. In the control group, the defects were repaired with fibrocartilage tissues.

CONCLUSIONIt was evidenced that the defects were repaired by the autologous chondrocytes mass transplantation. The procedure was gradual and initialed from up toward joint to down to the deep of the defect.

Animals ; Cartilage, Articular ; pathology ; surgery ; Chondrocytes ; transplantation ; Female ; Knee Joint ; pathology ; surgery ; Male ; Rabbits ; Transplantation, Autologous

Aged, 80 and over ; Chondroma ; pathology ; surgery ; Female ; Humans ; Knee Joint ; pathology ; Synovial Membrane ; pathology

Adipose Tissue ; pathology ; Adult ; Arthroscopy ; methods ; Female ; Humans ; Joint Diseases ; diagnosis ; pathology ; surgery ; Knee Joint ; pathology ; Male ; Middle Aged

BACKGROUND: We analyzed the clinical and radiologic results of patients with spontaneous osteonecrosis of the knee treated by minimally invasive medial unicompartmental arthroplasty using Oxford Uni. METHODS: We reviewed 22 knees in 21 patients which were treated for spontaneous osteonecrosis between 2002 and 2006. Patients included one male and 20 females. The mean age was 70.8 years (range, 53 to 82 years). The mean follow-up period was 70.3 months (range, 48 to 93 months). The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee score and the range of motion of the knee preoperatively and at the final follow-up. Preoperative plain radiographs and magnetic resonance images were analyzed to determine the size and stage of osteonecrotic lesions. RESULTS: The mean HSS knee score was 64.3 (range, 54 to 75) preoperatively and 92.0 (range, 71 to 100) at the final follow-up. The mean preoperative flexion contracture was 8.9degrees (range, 0 to 15degrees) and 0.2degrees (range, 0 to 5degrees) at the final follow-up. The mean further flexion increased from 138.6degrees (range, 100 to 145degrees) preoperatively to 145.6degrees (range, 140 to 150degrees) at the final follow-up. Active full flexion was possible within 2 months of the operation. The squatting position was possible in 16 patients (84.2%) out of 19, except one case of bronchiectasis and one case of spine fracture. The cross-leg posture was possible in 19 patients (90.5%) out of 21. The mean tibiofemoral angle was improved from varus 0.98degrees to valgus 3.22degrees. Meniscal bearing dislocation occurred in 2 cases and femoral component loosening occurred in 1 case. CONCLUSIONS: Unicompartmental knee arthroplasty using Oxford Uni could be an alternative treatment option in spontaneous osteonecrosis of the knee.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Female ; Humans ; Joint Diseases/pathology/*surgery ; *Knee Joint/pathology ; Male ; Middle Aged ; Osteonecrosis/*surgery ; Retrospective Studies

BACKGROUNDDetermination of the proper orientation of the knee articular surface is required both for correction of knee malalignment by osteotomy and for correct component alignment in knee arthroplasty. We sought to determine whether the patients' sex and lower extremity alignment (hip-knee-ankle angle) affects proper knee realignment in osteotomy or component alignment in total knee arthroplasty.

METHODSWe examined 199 healthy adult knees with malalignment of < 5° to determine the mechanical medial distal femoral angle, mechanical medial proximal tibial angle, surgical transepicondylar axis angle, and discrepancies between bone-cut orientations of osteotomy or total knee arthroplasty and the joint line of the distal femoral condyles, posterior femoral condyles and proximal tibial plateaus, using a three-dimensional computed tomography model.

RESULTSThe mean mechanical medial distal femoral angle and mean mechanical medial proximal tibial angle were (94.4 ± 1.9)° and (87.6 ± 1.8)° respectively for women and (93.8 ± 2.0)° and (87.1 ± 1.4)° respectively for men. The surgical transepicondylar axis angle was (2.9 ± 1.6)° for women and (3.2 ± 1.7)° for men. Independent of sex, the hip-knee-ankle angle was closely related to the mechanical medial distal femoral angle and mechanical medial proximal tibial angle, but not to the surgical transepicondylar axis angle. A slightly more valgus alignment of the knee and a more valgus angulation of the distal femoral joint line were found in women, whereas a more varus angulation of the proximal tibial joint line was found in men. Sex had the greatest effect on knee joint line orientation when the lower extremity was valgus in alignment.

CONCLUSIONSA more valgus femoral joint line can be expected in women and in persons with valgus lower extremity alignment; a more varus tibial joint line can be found in men and in persons with varus lower extremity alignment.

Adult ; Arthroplasty, Replacement, Knee ; Bone Malalignment ; pathology ; surgery ; Female ; Humans ; Knee Joint ; pathology ; surgery ; Lower Extremity ; pathology ; surgery ; Male ; Middle Aged ; Sex Factors

BACKGROUNDThere is a strong need for quick noninvasive diagnostic technique that can give a valid estimate of the status of the cartilage reliably, discriminating intact cartilage from various grades of impaired cartilage. The goal of this study was to assess the incidence of knee cartilage injuries and compare the accuracy of two-dimension spin echo (2D SE) and fast spin echo (FSE) (conventional MRI), three-dimensional spoiled gradient echo (3D SPGR), three-dimensional fast imaging employing steady state acquisition (3D FIESTA) MR imaging sequences with surgical examination of the articular cartilage.

METHODSOne hundred and thirty-eight knees with history of knee trauma received conventional MRI, 3D SPGR and 3D FIESTA MRI examination before surgery, and surgical examination of articular cartilage was used as reference standard. A modified version of the Noyes classification system was applied for the evaluation of the lateral femoral condyle (LFC), medial femoral condyle (MFC), lateral tibial plateau (LTP), medial tibial plateau (MTP), trochlea and patella. The incidence and distributions of different injured grades at different articular surfaces of knee were assessed. A series of assessment indeces of 3D SPGR, 3D FIESTA, and the combination of the conventional MRI and 3D SPGR imaging were calculated.

RESULTSThe incidence of cartilage defects (grade 2 to 4) was 22% (183/828), according to surgical examination. Grade 3 and 4 lesions were absent at the medial tibial plateau. The rates of exact match between the grading results of different MRI procedures and surgical examination were 49% of 3D SPGR, 61% of 3D FIESTA, and 82% of the combination of 3D SPGR and conventional MRI. Also, the combination of 3D SPGR and conventional MR imaging provided the highest sensitivity, specificity, accuracy, positive and negative predictive values, at 71%, 97%, 90%, 90% and 90%, respectively.

CONCLUSIONSFor all the articular surfaces of the traumatic knees, about one fifth (22%) were cartilage defects. Both 3D SPGR and 3D FIESTA imaging performed similarly in detecting cartilage lesions of the knee. The increased accuracy in chondral assessment can be achieved by combining 3D SPGR and conventional MRI within a reasonable time.

Adult ; Cartilage, Articular ; injuries ; pathology ; surgery ; Female ; Humans ; Knee Injuries ; pathology ; surgery ; Knee Joint ; pathology ; surgery ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged

The purpose of this study was to investigate the frequency of the meniscal flounce on MR imaging in patients who underwent arthroscopy or open surgery due to symptoms related to internal derangement of the knee, and to investigate associated findings in patients with meniscal flounce by comparing and analyzing the findings from MR imaging and surgery. MR images obtained from 116 knees before surgery were reviewed retrospectively. Seven medial menisci showed buckled, wavy flounce on sagittal MR images. None of the lateral menisci showed flounce. We reviewed the surgical records of all seven patients and the videotapes of six of the patients undergoing arthroscopy or open surgery. The frequency of flounce on sagittal MR images was 6.0% in the medial meniscus and was completely absent in the lateral meniscus. On coronal MR images, the truncated appearance of the affected meniscus was demonstrated in five patients, and a valgus deformity was seen in three patients. Five patients showed a moderate to large amount of joint effusion. On MR imaging and in surgery, ligament injuries were found in six patients (six medial collateral ligament injuries, five anterior cruciate ligament injuries, and two posterior cruciate ligament injuries). Non-specific synovitis was found in the one remaining patient. In the surgery of all seven patients, no tears were found at the meniscus itself showing flounce. In conclusion, the meniscal flounce seen on sagittal MR imaging can be a rare appearance of a transient distortion of a normal meniscus due to a valgus deformity caused by a MCL tear and/or due to an external rotation induced by cruciate ligament injury or positioning of knee joint within the magnet. The meniscal flounce should be interpreted carefully because it frequently appears truncated on the coronal scan and can simulate a meniscal tear.
Arthroscopy ; Human ; Knee Joint/surgery* ; Magnetic Resonance Imaging ; Menisci, Tibial/pathology*

OBJECTIVETo investigate the effect of rupture and reconstruction of the posterior cruciate ligament (PCL) on the degeneration of rabbit knee joint.

METHODSThirty-three mature New Zealand white rabbits were divided into 3 groups. In experiment group I, the PCL of the right knees in 21 rabbits were resected, the contralateral joints as control group, in which only a medial arthrotomy was performed. In experiment group II, the PCL of the right knees in 12 rabbits were immediately reconstructed after PCL were resected. In experiment group I and control group the rabbits were respectively killed 6, 12 and 26 weeks after the operation. In experiment group II the rabbits were respectively killed 12, 26 weeks after the operation. The methods of ink staining, histology, immunohistochemistry and SEM were used to analyze the changes of articular cartilage of the joints.

RESULTSIn experiment group I, the knee joints had obvious degeneration of articular cartilage at 26 weeks. The quantitative analysis of the results of the ink staining method showed the degeneration of knee articular cartilage was more serious at 26 weeks than that at 26 weeks in control group. Histological results demonstrated: the large area of fibrosis of cartilage could be seen in the medial condyle at 26 weeks; the fibrosis was deep into the deep layer of cartilage and the number of cells decreased; the average Mankin's score was 7.7. At 26 weeks, type I and III collagen were detected in fibrotic cartilage, while the staining of type II collagen was slight. In experiment group I, the injuries of cartilage in medial condyle could be seen at every stage through SEM, while the surface of cartilage demonstrated disorder in control group through SEM. In experiment group II, only a few specimens had mild injuries of cartilage, the degeneration of cartilage in medial condyle and trochlea were slighter at 26 weeks than that in experiment group I.

CONCLUSIONSPCL rupture can result in articular cartilage degeneration, which develops as time goes on. The degeneration of articular cartilage is more serious in medial compartment and patellofemoral joint than those in other positions. Immediate reconstruction of PCL can effectively prevent articular cartilage degeneration.

Animals ; Cartilage, Articular ; pathology ; Disease Models, Animal ; Knee Injuries ; pathology ; surgery ; Knee Joint ; pathology ; Orthopedic Procedures ; Posterior Cruciate Ligament ; injuries ; surgery ; Rabbits ; Rupture

BACKGROUNDExtension loss caused by anterior cruciate ligament (ACL) remnants nodule was usually reported by case reports. There is no systematic report analyzing ACL remnants nodule. The purpose of this study was to investigate the characteristics of extension loss caused by remnants of ACL after injury.

METHODSFrom June 2008 to December 2011, ACL remnants were observed by arthroscopy in 1012 cases with ACL injuries at the time of primary reconstruction. ACL remnants nodules were recorded. The time of extension loss occurrence caused by ACL remnants nodule, associated symptom and sign, magnetic resonance imaging (MRI), and arthroscopic findings were observed. Histological examination was performed on the lesion resected.

RESULTSTwenty-four cases with ACL remnants nodules were found by arthroscopy. Among them extension loss caused by remnants of ACL happened in 19 cases (male 13; female 6). The average extension loss were 9.1° (range, 5° - 20°). The average time from injury to operation was 8.9 weeks (range, 3 - 26 weeks). The remnants of ACL depressed in the inter-condylar notch were found on MRI in 15 cases with extension loss. The rupture locations of ACL were all close to the upper insertion of ACL. The microscopic examination of the resected remnants of ACL revealed disorganized fibrous connective tissue and tissue of ACL ligament.

CONCLUSIONSAmong 1012 ACL injury cases, 24 ACL remnants nodules were found with arthroscopy and 19 nodules could cause knee extension loss. ACL remnants nodule should be paid attention to as a potential cause of extension loss.

Adolescent ; Adult ; Anterior Cruciate Ligament ; pathology ; surgery ; Arthroscopy ; Female ; Humans ; Knee Joint ; pathology ; surgery ; Male ; Middle Aged ; Young Adult