Management of Knee Cartilage Defects with the Autologous Matrix-Induced Chondrogenesis (AMIC) Technique

The arthroscopic findings of knee articular cartilage lesions are reported to be as high as 60%, although only a fragment of these are considered to be symptomatic. Such lesions are believed to accelerate the onset of arthritis. Long-term results of the microfracture technique for chondral and osteochondral defects of the knee cartilage are not satisfactory. The autologous matrix induced chondrogenesis (AMIC) technique offers a promising alternative as an effective cartilage repair procedure in the knee resulting in stable clinical results and with a wide range of indications. An extensive literature review has been performed aiming at providing the rationale behind AMIC, to report clinical results of AMIC and to compare AMIC with other chondrogenesis techniques. Finally, we comment on the appropriate surgical technique and its indications, since the number of one-step arthroscopic procedure proposals is steadily increasing

Detection of O-Linked-N-Acetylglucosamine Modification and Its Associated Enzymes in Human Degenerated Intervertebral Discs

Study DesignHuman herniated discs were obtained from discectomy specimens for the immunohistochemical detection of O-GlcNAc and O-GlcNAcase (OGA)/O-GlcNAc transferase (OGT).PurposeThis study aimed to quantify the extent of O-GlcNAcylation and its associated enzymes (OGT/OGA) in human degenerated intervertebral discs.Overview of LiteratureThe O-GlcNAcylation of nuclear, cytoplasmic, and mitochondrial proteins as well as the effects of such post-translational modifications are currently the focus of extensive research. O-GlcNAcylation is believed to contribute to the etiology of chronic illnesses by acting as a nutrient and stress sensor in the cellular environment. Mature intervertebral disc cells are chondrocyte-like cells, and O-GlcNAc has been shown to promote chondrocyte apoptosis in vitro. We believe that O-GlcNAcylation is a key regulator of disc degeneration.MethodsFifty-six specimens were fixed for 24 hours in a 10% solution of neutral-buffered formaldehyde, dehydrated, and embedded in paraffin. Tissue slices (4-µm-thick) were used for hematoxylin-eosin staining and immunohistochemistry.ResultsWe found that O-GlcNAcylation of cytoplasmic proteins was less than that of nuclear proteins in both single cells and cell clusters. Cytoplasmic O-GlcNAcylation occurs subsequent to nuclear O-GlcNAcylation and is directly proportional to disc degeneration. OGT and O-GlcNAc expression levels were identical in all specimens examined.ConclusionsO-GlcNAc and OGA/OGT expression is shown to correlate for the first time with intervertebral disc cell degeneration. Increasing disc degeneration is associated with increasing O-GlcNAcylation in both nuclear and cytoplasmic proteins in human disc cells

Surgical Implications of the Arterial Anatomy around the Knee: A Cadaveric Pictorial Essay

We completed an anatomic cadaver study in order to examine the arterial supply around the knee and to create useful images regarding the arterial surgical anatomy around the knee. A total of four unmatched fresh-frozen cadaveric knees were utilized. There was no medical history of osteoporosis, bony or soft-tissue injury or surgery in any of the knees. The femoral arteries were cannulated with a large catheter at the proximal aspect of the cadavers, and liquid latex in different colours was injected. Τhe specimens were then placed into a bath of 8.0% sodium hypochlorite to complete debridement of the soft tissues to various degrees. The specimens were checked every 15 to 30 min until adequate debridement occurred, and photographs were taken during each stage of this process. Sodium hypochlorite, among others, chemically debrides the vessel walls leaving the casts of the vessel lumens filled with solid coloured latex in order to illustrate the vascular supply pattern to the structures of interest. Knowing the probability of where these arteries should be located adds to the knowledge that surgeons have at their disposal when performing procedures involving arthroscopy, arthroplasty and osteotomies, which can help decrease unnecessary damage to the arteries

A magnetic resonance imaging anatomical study of the intervertrebal space in the cervical, thoracic and lumbar spine

The aim of the present study was to measure in detail and document normal intervertebral space dimensions (front height, middle height, rear height, anteroposterior diameter) in mid-sagittal MR T2W images. In addition, intervertebral space relationships were expressed as imaging indices and results were correlated with clinical applications. 500 MRIs (cervical, thoracic and lumbar), provided by a single center, were retrospectively reviewed. Exclusion criteria were scoliosis, discs with Pfirrmann’s degeneration stage III or higher, any disc protrusion/herniation, Schmorl’s nodes, Modic changes, presence of congenital abnormalities, previous or recent vertebral fractures, tumors and previous spinal surgery. Our final sample consisted of 40 cervical spine MRIs, 20 thoracic spine MRIs and 51 lumbar MRIs. Results were categorized per spinal region. Furthermore, we prospectively studied the effect of added weight on disc height by applying 10% of body weight in a backpack in 10 normal subjects-volunteers (age range 18-28 years). An MRI was performed in the morning as baseline reference and another one was performed after applying the added weight for 6 hours of normal volunteer activity. Body height and disc height measurements were performed in both MRIs. Intervertebral space measurements per spinal region were recorded and compared with measurements from other published studies. Disc height and diameter were statistically compared per spinal level and variation of intervertebral space dimensions was analysed. Furthermore, we expressed height variation of every intervertebral space as a percentage of its adjacent space with the use of primary equations. In our prospective volunteer study, diurnal variation of disc height and diameter was highlighted for every intervertebral disc. Our results can be used as baseline reference and our aim was to create database values. They were also correlated with preoperative templating of surgical implants for current surgical techniques aiming at restoring the degenerated intervertebral disc as well as with perioperative distraction limitations.Στόχος της παρούσας μελέτης ήταν η μέτρηση και καταγραφή των διαστάσεων του φυσιολογικού μεσοσπονδυλίου διαστήματος (πρόσθιο μεσαίο, οπίσθιο ύψος και προσθιοπίσθια διάμετρος) σε μέσες οβελιαίες τομές Τ2 ακολουθίας σε μαγνητική τομογραφία (MRI). Επιπλέον, οι σχέσεις των μεσοσπονδυλίων διαστημάτων εκφράστηκαν μέσω απεικονιστικών δεικτών (disc height index – DHI και μέσο ύψος) και τα αποτελέσματα της μελέτης συσχετίστηκαν με κλινικές εφαρμογές. Από μια βάση δεδομένων ακτινολογικού κέντρου, συγκεντρώθηκαν και αξιολογήθηκαν αναδρομικά συνολικά 500 MRI αυχενικής (ΑΜΣΣ), θωρακικής (ΘΜΣΣ) και οσφυϊκής μοίρας (ΟΜΣΣ). Ως κριτήρια αποκλεισμού χρησιμοποιήθηκαν: η ύπαρξη σκολίωσης, μεσοσπονδύλιοι δίσκοι με εκφύλιση κατά Pfirrmann σταδίου ΙΙΙ ή μεγαλύτερη, οποιαδήποτε μορφής δισκοκήλη, η ύπαρξη όζων του Schmorl, η εμφάνιση αλλαγών τύπου Modic, η παρουσία συγγενών ανωμαλιών, προηγούμενα σπονδυλικά κατάγματα, η παρουσία όγκων και προηγούμενες χειρουργικές επεμβάσεις. Από αυτές επελέγησαν 40 MRI ΑΜΣΣ, 20 MRI ΘΜΣΣ και 51 MRI ΟΜΣΣ για να πραγματοποιηθούν οι μετρήσεις. Τα αποτελέσματα κατηγοριοποιήθηκαν ανά μοίρα της σπονδυλικής στήλη. Παράλληλα, μελετήθηκε προοπτικά η επίδραση συγκεκριμένου βάρους σε σακίδιο ράχης (10% του σωματικού βάρους) από 10 υγιείς εθελοντές (ηλικιακό εύρος 18-28 έτη). Πραγματοποιήθηκε πρωινή MRI χωρίς την επίδραση βάρους ως αναφορά και απογευματινή MRI ύστερα από 6ωρη εφαρμογή του βάρους με φυσιολογική δραστηριότητα των εθελοντών. Μετρήθηκε το ανάστημα και οι διαστάσεις κάθε μεσοσπονδύλιου διαστήματος σε όλη τη σπονδυλική στήλη προ και μετά της εφαρμογής του βάρους. Καταγράφηκαν οι διαστάσεις κάθε μεσοσπονδυλίου διαστήματος για κάθε μοίρα ξεχωριστά και έγινε σύγκριση των τιμών αυτών με άλλες καταγεγραμμένες μετρήσεις στη βιβλιογραφία. Συγκρίθηκαν τα ύψη και η διάμετρος των διαστημάτων μεταξύ τους και αναδείχθηκαν οι στατιστικά σημαντικές σχέσεις, δηλαδή καταγράφηκε η μεταβολή των διαστάσεων του μεσοσπονδύλιου δίσκου ανά επίπεδο. Επιπρόσθετα, έγινε προσπάθεια διαμόρφωσης εξισώσεων πρόβλεψης διακύμανσης του φυσιολογικού ύψους του μεσοσπονδύλιου διαστήματος με βάση τις διαστάσεις του γειτονικού του διαστήματος. Σε ότι αφορά την προοπτική μελέτη των υγιών εθελοντών, αναδείχθηκε η ημερήσια μεταβολή του μεσοσπονδύλιου ύψους και διαμέτρου σε κάθε επίπεδο. Τα αποτελέσματα της παρούσας μελέτης δημιουργούν μια βάση δεδομένων για μελλοντική αναφορά. Συσχετίστηκαν με την προεγχειρητική επιλογή χειρουργικών εμφυτευμάτων για την αναστήλωση του εκφυλισμένου διαστήματος αλλά και με τα όρια της διεγχειρητικής διάτασης του διαστήματος

A Tumor-Like Lump in the Palm Caused by an Inconspicuous-for 75 Years-Bullet

Case. An unusual case of a foreign body in the hand is described here. Excision of a tumor-like soft tissue mass revealed a 75-year-old World War II bullet fragment of which patient was unaware. Conclusion. Differential diagnosis of hand lumps and inflammatory reaction must always include retained foreign bodies even after a very long period of posttraumatic quiescence or patient’s inability to provide a relative injury case history

Does Intra-Wound Vancomycin Powder Affect the Action of Intra-Articular Tranexamic Acid in Total Joint Replacement?

The intra-articular use of tranexamic acid (TXA) has contributed to reduced blood loss in total joint arthroplasty (TJA). The purpose of this study is to assess the efficacy of simultaneously topical use of tranexamic acid and vancomycin powder within the TJA space. From 2016 to 2017, 219 consecutive total hip arthroplasties (THAs) and 272 total knee arthroplasties (TKAs) were performed in a tertiary care center, with a group of patients receiving intra-articular TXA and vancomycin, compared to patients receiving only TXA and to a control group that did not receive anything. Haemoglobin and hematocrit were measured preoperatively, on the first and third days. Transfusions and adverse events were recorded. Haemoglobin and hematocrit dropped significantly in all THA and TKA groups till the third day postoperatively, with a major reduction in the control group, compared to the other two treatment groups. Infections and thromboembolic events were similar in either group of the TJAs. In conclusion, the topical use of tranexamic acid mixed with the vancomycin powder within the joint space after the TJAs of the hip and knee did not alter the anti-fibrinolytic effect of TXA

Scrotal Apocrine Adenocarcinoma with Pagetoid Phenomenon and Inguinal Lymph Node Metastases.

We report a case of scrotal apocrine adenocarcinoma in a 72-year-old Caucasian male which was initially presented as a reddish superficial lesion which in time became an ulcerated nodule. The initial pathological examination showed an apocrine adenocarcinoma with pagetoid phenomenon. The tumor recurred after four months and then excision biopsy showed tumor with pagetoid phenomenon which reached all the surgical margins. Three months later an ulcerated nodule in the scrotum and greatly enlarged ipsilateral inguinal lymph nodes were noticed. The final pathological examination showed multiple separated malignant foci, some with overlying pagetoid phenomenon and inguinal lymph node metastases. Immunohistochemistry showed positivity for Gross Cystic Disease Fluid Protein-15 (GCDFP-15), androgen receptors, and score 3+ for the Human Epidermal growth factor Receptor-2 (HER2). The aggressive behavior of the present tumor goes along with previous reports showing that HER2 high score cases exhibit a worse prognosis

Surgical and Radiological Anatomy of the Medial Patellofemoral Ligament: A Magnetic Resonance Imaging and Cadaveric Study

The purpose of this study was to compare the measurement of several anatomical features of the medial patellofemoral ligament (MPFL) between magnetic resonance imaging (MRI) and by direct fashion during dissection. We hypothesized that the measurements between these two techniques would agree. MRI of 30 fresh-frozen cadaveric knees was followed by dissection. MPFL patella and femoral attachment were evaluated; their shape, length, and width were measured; and measurements were compared. MRI was deemed unreliable for the determination of several of the aforementioned anatomical features. Important findings include: (a) observations on MPFL attachment at medial patella side and attachment to quadriceps were identical between dissection and MRI; (b) average width at patella insertion was significantly different between the two methods (p = 0.002); and (c) an attachment to the quadriceps tendon was present in 20/30 specimens and d. detailed measurements of a thin, non-linear, and three-dimensional structure, such as the MPFL, cannot be performed on MRI, due to technical difficulties. This anatomical radiological study highlights the shape, anatomical measurements (length and width), and attachment of the MPFL using a relatively large cadaveric sample and suggests that MRI is not reliable for detailed imaging of its three-dimensional anatomy