The Microfracture Technique for the Treatment of Full-Thickness Articular Cartilage Lesions of the Knee: Midterm Results

Purpose: The purpose of this study was to determine the effectiveness of the microfracture technique in the treatment of full-thickness articular cartilage lesions of the knee. Methods: In this study the midterm results of 90 patients (47 women and 43 men) with focal full-thickness articular cartilage lesions who had been managed with the microfracture technique are presented. The mean age of our patients was 34.5 years (range, 20 to 58), and 51 right and 39 left knees were treated. All of the articular lesions involved medial femoral condyles. Results: On the basis of follow-Lip at a mean of 68 months (range, 24 to 108 months), mean improvements in Lysholm knee scores (from 54.2 to 84.6 points), Tegner activity scale scores (from 2.6 to 5.2 points), and Oxford knee interrogation scores (from 23,1 to 44.8 points) were observed (P < .0001). Moreover, there was a strong and significant correlation between functional results and age Younger than 35 years, size of defect less than 2 cm(2), non-weight-bearing surface, and body mass index lower than 25 kg/m(2), respectively (P < .001). Conclusions: According to our midterm results, the microfracture technique is quite effective with regard to the improvement of daily activities with a favorable impact on pain relief and better functional results. Furthermore, we found that there was a correlation between functional results and age, size of defect, location of defect, and body mass index as prognostic parameters. Level of Evidence: Level IV, therapeutic case series

High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis

In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39-76) years. For the clinical evaluation of the patients Hospital of Special Surgery (HSS) score, American Knee Society and Oxford knee scores, and for the radiological assessment mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), femorotibial angle and Insall-Salvati index were basically taken into consideration. Our patients were followed up for an average of 34 (range 18-60) months. In the last assessments of our cases, mean improvements detected in HSS scores, Oxford knee scores, knee and functional scores of Knee Society were 26.72, 19.18, 49.9, and 30 points, respectively. The radiological examinations revealed that their mechanical axes on the average passed 5.09 mm laterally achieving an average of 6.5 degrees genu valgum, and a mean Insall-Salvati index of 1.09. As complications, superficial wound infection in two patients (3%), implant infections in one patient (1.5%), deep vein thrombosis in two patients (3%), peroperative lateral tibial plateau fracture in one patient (1.5%), and postoperative lateral tibial plateau fracture due to a falling down were encountered. According to the results obtained, postoperative pain resolves promptly and a significant degree of improvement of knee functions of the patients are achieved. Therefore, we believe that high tibial osteotomy with a Puddu plate is a valuable alternative to total knee arthroplasty in cases with varus gonarthrosis. Although early results are satisfactory, long-term follow-up studies are required especially in the middle aged and elderly patient populations

Genetic association of interleukin-2, interleukin-4, interleukin-6, transforming growth factor-, tumour necrosis factor- and blood concentrations of calcineurin inhibitors in Turkish renal transplant patients

Cytokines are essential for the control of the immune response as most of the immunosuppressive drugs target cytokine production or their action. The calcineurin inhibitors (CNIs) cyclosporine (CsA) and tacrolimus are immunosuppressive drugs widely used after renal transplantation to prevent allograft rejection. They are characterized by large interindividual variability in their pharmacokinetics; therefore, monitoring their blood concentrations is important to predict their optimal dosage following transplantation. Calcineurin inhibitors inhibit the phosphatase activity of calcineurin, thereby suppressing the production of other cytokines such as transforming growth factor (TGF-), tumour necrosis factor- (TNF-), interleukin (IL)-6, IL-2, and IL-4. The aim of this study was to investigate the relationship between polymorphisms of cytokines and blood concentrations of CNIs in renal transplant patients. The study included 53 CsA-treated renal transplant patients and 37 tacrolimus-treated renal transplant patients. Cytokine polymorphisms were analysed using polymerase chain reaction (PCR) sequence-specific primers with the cytokine CTS-PCR-sequence-specific primers Tray Kit; University of Heidelberg. Blood concentrations of CNIs were determined with Cloned Enzyme Donor Immunoassay (CEDIA) method. Patients with TC genotype of TGF- at codon 10 had lower CsA blood concentrations than the TT and CC genotypes (P=0.005) at 1month in CsA treatment group. The ratio of blood concentration/dose of CsA for patients with TGF-1-codon 10 TC genotype was lower than for patients with TT, CC genotypes, and the dose given to these patients was higher in the first month (P=0.046). The ratio of blood concentration/dose of CsA for patients with IL-2-330 GG genotype was higher than for patients with GT, TT genotypes, and the dose given to these patients was lower at first month and sixth months (P=0.043, P=0.035 respectively). The tacrolimus blood concentrations were significantly higher in patients with the genotype GG of IL-2-330 (P=0.012) at the third month. Patients who had the TC genotype TGF- codon 10 had lower CsA blood concentrations and this group had higher acute rejection (P=0.033). These results suggest that the genotyping for TGF--codon 10, IL-2-330 and IL-6-174 polymorphisms may help individualized immunosuppressive dosage regiments

Arthroscopic treatment of symptomatic type D medial plica

We aimed to review the results of subtotal arthroscopic resection of symptomatic type D medial plica. We retrospectively evaluated 23 knees with symptomatic type D medial plica in 22 patients without other intra-articular pathology. All patients complained of chronic knee pain that had not been alleviated by medical treatment or physical therapy. In only three (13%) of the patients studied was the plica diagnosed pre-operatively with magnetic resonance imaging. The type D medial plicae in our series were classified as fenestrated (14 knees), torn (5 knees), or reduplicated (4 knees). Fibrotic changes in the plicae and degenerative changes on the medial femoral condyle were found in 16 knees Patellofemoral chondromalacia was present in three knees Arthroscopic partial resection was performed in all patients. Comparative Lysholm Knee Scale scores before and after surgery revealed a significant clinical improvement (pre-operative status, 67.19 ± 8.05 vs. post-operative status, 90.57 ± 9.80; P < 0.001). Type D medial plica should be considered as a possible cause of chronic knee pain. Arthroscopic partial resection of the plicae in symptomatic patients gives satisfactory results