A review of 100 consecutive patients who underwent knee arthroscopy within 1 month of Magnetic Resonance Imaging (MRI) of the knee took place to assess the role of Magnetic Resonance Imaging in regard to assessment of intra articular pathology. The study period was from 15th April 1998 to 19th September 2000. The study compared the MRI report with the operative findings of one surgeon documented with average of 20 photos per patient. The enclosed tables document the sensitivity and specificity in regard to articular cartilage of the patella, trochlearand medial femoral condyle. Medial meniscal and lateral meniscal pathology was reviewed as was anterior cruciate ligament. The study would suggest that whilst MRI is useful for assessment of meniscal pathology it is not highly accurate for assessment of articular surface lesions and anterior cruciate ligament pathology

Monolayer expansion of human articular chondrocytes (HAC) is known to result in progressive dedifferentiation and loss of stable cartilage formation capacity in vivo. For optimal outcome of chondrocyte based repair strategies, HAC capable of ectopic cartilage formation may be required. Thus, the aim of this study was to establish appropriate quality control measures capable to predict the ectopic cartilage formation capacity of HAC from culture supernatants. This strategy would avoid the waste of cells for quality control purposes, in order to improve cell therapy and tissue-engineering approaches for the repair of joint surface lesions. Standardized medium supernatants (n=5) of freshly isolated HAC and chondrocytes expanded for 2 (PD2) or 6 population doublings (PD6) were screened for 15 distinct interleukins, 8 MMPs and 11 miscellaneous soluble factors by a multiplexed immunoassay. Cartilage differentiation markers like COMP and YKL-40 were determined by ELISA. Corresponding HAC were subcutaneously transplanted into SCID-mice and their capacity to form stable ectopic cartilage was examined histologically 4 weeks later. While freshly isolated chondrocytes generated stable ectopic cartilage positive for collagen type II, none of the PD6 transplants formed cartilaginous matrix. Loss of ectopic stable cartilage formation capacity between PD0 and PD6 correlated with a drop of MMP3 secretion to < 10% of initial levels, while changes for other investigated molecules were not predictive. Chondrocytes from donors with low MMP3 levels (< 10%) at PD2 failed to regenerate ectopic cartilage at PD2, indicating that MMP3 levels of cultured chondrocytes, independent of the number of cell doublings and the time in culture, predicted ectopic cartilage formation. In conclusion, loss of stable ectopic cartilage formation capacity in the course of HAC dedifferentiation can be predicted by determination of relative MMP3 levels demonstrating that standardized culture supernatants can be used for quality control of chondrocytes dedicated for cell therapeutic approaches

Purpose. The hip region is the second most common site for tuberculosis following the spine in children. The aim is to describe the variable radiological patterns of presentation and their resemblance to pyogenic infection, tumours and other benign conditions of bone in children. Methods. The clinical and radiological records of 29 children aged 10 months–13 years with confirmed tuberculosis of the hip region seen between 1990 and 2011 were reviewed retrospectively. Clinical features were pain, limp and flexion, adduction contractures. Abscesses and sinuses were seen in 4 children. The ESR ranged between 7–110 mm/hr. Mantoux was positive in 20 children. All cases were histologically confirmed. Treatment involved biopsy, currettage of bone defects, limited synovectomy and adductor tenotomy. Patients were immobilised for 4 weeks on a spica cast or traction. Antituberculous treatment was administered for 9–12 months. Results. Radiologically 9 lesions were extra-articular and 20 involved the joint synovium and articular surface. Extra-articular lesions were seen in the pubis, greater and lesser trochanter, ilium, proximal femur and peri-acetabular regions. Intra-articular lesions were seen in the femoral head, neck and acetabulum. Dislocations and subluxations occurred in 8 patients; various lesions mimicked pyogenic arthritis, idiopathic chondrolysis, chondrobastoma, Perthes disease, eosinophilic granuloma and osteoid osteoma. Follow up ranged between 8 months and 5 years. Good range of movement was seen in 20 children. Nine children had flexion adduction contractures, four of these had ankylosed hips and five required abduction extension osteotomies. Other changes seen were coxa vara (2) coxa magna (1) and avascular necrosis (3). Conclusion. The variable radiological picture of tuberculosis of the hip region can mimic various osteoarticular conditions in children. Biopsy is essential and should be taken from the bony lesion and not the synovium alone. NO DISCLOSURES

Introduction: Revision surgery for stem loosening and peri-implant bone loss of variable extent is a major challenge for orthopedic surgeons. Our strategy has been to use cementless straight stems of rectangular cross-section for revisions. To ascertain the value of this implant we analyzed the results at a minimum follow-up of 10 years. Material and Method: Between October 1991 and end 1998, 125 patients (134 hips) underwent revision surgery. Of these, 39 were males and 86 were females. Sixty-seven of the original implants were cemented and as many were cementless. Cementless revision stems (SLR; Plus Orthopedics, Aarau, Switzerland) size 3 to 11 (180 to 223 mm in length) were used for revisions. Patient age at the time of surgery was 37.8 to 89.3 (mean, 71.0) years. Fifty patients (53 hips) died post revision 0.0 to 13.5 (mean, 6.8) years. Their implants had been followed-up radiographically for 0.0 to 9.2 (mean, 3.6) years. At the time of revision these patients had been 48.9 to 89.3 (mean, 76.7) years old. One of them had undergone stem revision for aseptic loosening one year post surgery. Another 6 were revised 1.4 to 13.9 years post surgery, 5 for low grade infection and 1 for peri-implant fracture. Seven patients refused to present for follow-up because of advanced age and poor cooperation. Eight were contacted by telephone. These 15 patients were not re-operated. Five patients were altogether lost to follow-up, thus leaving a total of 53 hips (49 patients) for analysis at a follow-up time of at least 10 years. The follow-up time was 10.0 to 16.1 (mean, 11.6) years. For radiographic follow-ups monitor-guided a.-p. and axial radiographs were recorded. These were analyzed by Gruen zones. Results: All stems were properly aligned along the long femoral axis, except in 1 patient, who had sustained a peri-implant fracture during a fall with axial stem subsidence responding to conservative treatment. In 38 patients peri-implant bone apposition was detected in all 7 Gruen zones. This was combined with bone resorption in other zones in 2 patients. Four patients presented with osteolytic lesions. In one of them with metal-on-metal articulating surfaces, the lesion extended to several segments and will necessitate revision. All other stems were stable. None of them was at risk. Conclusion: This analysis showed that the SLR revision stem performs well for an intermediate follow-up time of at least 10 years

The purpose of this study is to demonstrate the validity of the autologous chondrocytes transplantation (A.C.T.) technique implemented over the last 6 years in the treatment of osteochondral lesions of the talus. Our case study included 22 patients (12 males and 10 females), with an average age of 27 years affected by osteochondral lesions of the talus surface. All lesions were > 1.5 cm2, monofocal, and post-traumatic in origin. The first 9 patients received ACT (Genzyme technique) and the remaining 13 patients received ACT with an arthroscopic technique. In 6 of the patients, the cartilage harvested from the detached osteochondral fragment was used for culturing, avoiding the first step arthroscopy in the knee. Before surgery, all patients were assessed clinically, radiographically, and using MRIs. For clinical evaluation patients were assessed using the American Foot & Ankle Society 100 point score. Before surgery the mean score was 48.4 points. 11 patients underwent second-look arthroscopy at one year during which a biopsy was harvested for histologic analysis of the reconstructed cartilage. Of these, 9 patients (Genzyme technique) also had hardware removed. The mean follow-up of the 22 patients was 36 months. At follow-up, all patients but one were satisfied with their results. With regards to the clinical results evaluated using the American Foot and Ankle Society score, an average of 90.5 was obtained at 24 months, while at 36 months the average score (19 patients) was 94.0 (range 54–100). During follow-up arthroscopy, 4 patients had mild fibrosis and 1 patient required regularization of flap overgrowth causing pain. The clinical and histological results have confirmed the validity of the surgical technique utilized with no subjective nor objective complications. An improvement of the symptoms and of articular function has also been observed: laboratory data confirmed the histological appearance of the newly formed hyaline cartilage in all cases evaluated. Immunohistochemistry showed a positive staining for collagen type II located in the extracellular matrix and in the chondrocytes in the healthy and transplanted cartilage biopsies. All the specimens studied were also positive for proteoglycans expression as was the Alcian blue reaction, which highlighted the presence of these fundamental components of a cartilaginous matrix

Objectives

The objectives of this study were: 1) to examine osteophyte formation, subchondral bone advance, and bone marrow lesions (BMLs) in osteoarthritis (OA)-prone Hartley guinea pigs; and 2) to assess the disease-modifying activity of an orally administered phosphocitrate ‘analogue’, Carolinas Molecule-01 (CM-01).