Medial Meniscus Root Tear: Current Update Review

This chapter mainly focuses on medial meniscus posterior root tear which is the point of attention nowadays because it is the common degeneration process and can lead to early-onset osteoarthritis of the knee without treatment. The biomechanics of the medial meniscus root tear is similar to total meniscectomy. Hence, early detection and diagnosis will lead to better outcome. Most cases with medial meniscus root tear also have degenerative change of the knee. Meniscal extrusion is a common finding in magnetic resonance imaging (MRI) which represent impairing of hoop stress function of the meniscus. Patient selection and understanding of the natural history of the disease is a particularly important. Options for the treatment including conservative treatment, surgical treatment such as partial meniscectomy, meniscus root repair, or reduction of meniscal extrusion. Outcome of these treatments are variable depending on the condition of the patients. Long term outcome of surgical treatment revealed lower rate of knee replacement compared with conservative treatment

Therapeutic potential and pharmacological activities of Atractylodes lancea (Thunb.) DC.

The rhizome of Atractylodes lancea (A. lancea) (Thunb.) DC. (AL) is extensively used in Chinese, Thai, and Japanese traditional medicines as crude extracts/decoctions or a component in various herbal formulations. Various pharmacological activities of AL and its major constituents have been demonstrated in vitro, ex vivo, and in animal models. Results from the toxicity studies in animal models suggest safety profile of AL and its active constituents. Despite extensive use with positive impression in many diseases, there has not been a clinical study that can conclusively support its efficacy and safety profile in human. This review comprehensively summarizes current information on the pharmacological activities of AL and their active constituents including anticancer, anti-inflammatory, antimicrobial and antipyretic activities, as well as activities on central nervous, cardiovascular, and gastrointestinal systems

Antiinflammatory effects of essential oil from the leaves of Cinnamomum cassia and cinnamaldehyde on lipopolysaccharide-stimulated J774A.1 cells

Cassia oil (CO) from different parts of Cinnamomum cassia have different active components. Very few pharmacological properties of cassia leaf oil have been reported. This study investigated and compared effects of cassia leaf oil and cinnamaldehyde on lipopolysaccharide (LPS)-activated J774A.1 cells. Volatile compositions in cassia leaf oil were identified by gas chromatography-mass spectrometry (MS)/MS. Effects of CO and cinnamaldehyde on LPS-activated J774A.1 cells were investigated by determining nitric oxide (NO) production using Griess reaction assay; expression of pro-inflammatory cytokines, enzymes involve in inflammatory mediators; antiinflammatory cytokines, and iron exporter ferroportin1 (Fpn1) using reverse transcription-polymerase chain reaction; and production of tumor necrosis factor (TNF-α) and interleukin (IL)-10 using ELISA. The main component of CO was cinnamaldehyde. Both oils at 1-20 μg/ml markedly inhibited NO production in LPS-activated J774A.1 cells with IC 50 value of 6.1 ± 0.25 and 9.97 ± 0.35 μg/ml, respectively. They similarly inhibited mRNA expression of pro-inflammatory cytokines and chemokines. These mediators included TNF-α, IL-1β, IL-6, monocyte chemoattractant protein-1, and macrophage inflammatory protein-1α in LPS-activated cells. They also significantly decreased expression of inducible enzymes inducible nitric oxide synthase, cyclooxygenase-2, microsomal prostaglandin-E synthase-1. In the opposite way, they increased mRNA expression and the production of antiinflammatory cytokines IL-10 and transforming growth factor-β. In addition, they promoted the expression of Fpn1. These results demonstrated that inhibitory effects of cassia leaf oil from C. cassia mainly came from cinnamaldehyde. This compound not only inhibited inflammatory mediators but also activated antiinflammatory mediators in LPS-activated J774A.1 cells. It may also have an effect on iron regulatory proteins in activated macrophages

Arthroscopic Synthetic Augmentation in Acute Partial Injury of the Anterior Cruciate Ligament

Acute partial injury of the anterior cruciate ligament (ACL) is a challenging condition without a standard treatment. Although ACL reconstruction provided a better outcome previously, recent studies have shown that preserving the ACL stump yields promising results in terms of better vascularization, proprioception, and ligamentization. ACL augmentation is becoming more popular. Therefore, we propose a technique to augment an acute partial ACL injury with synthetic suture material to stabilize the unstable cruciate ligament. The suture material acts as a structural tie for ACL healing without any need for external immobilization. This technique is beneficial in preserving the natural ACL stump and autograft, creating a narrow bone tunnel, and providing a good cosmetic outcome

Arthroscopic Medial Meniscus Root Repair With Soft Suture Anchor Without Posterior Portal Technique

Medial meniscal root injury is known to cause an increase in tibiofemoral contact pressure and results in early osteoarthritis. There have been many reports on meniscal root repairing techniques, which can be categorized into 2 groups. One is transosseous suture, and the other is anchor suture repair. Both techniques show improvement in not only clinical performance, but also radiographic finding. However, the meniscal root repair procedure must be performed by experienced physicians. Most techniques require a posteromedial portal, which takes time and may even complicate the procedure. The technique proposed in this study provides a simple procedure in which no posteromedial portal is required and a soft anchor suture, a commonly used suture in glenolabral repair, is used. The use of this suture, instead of the conventional anchor suture, is believed to lessen possible injury to the cartilage and results in easier revision surgery

Arthroscopic Coracoclavicular Ligament Stabilization Using Coracoid Cortical Suspension in Acute Acromioclavicular Joint Injury; Precision of Drill Tunnel

Acute acromioclavicular joint separation is a common injury of the shoulder. There are several methods for treating this condition; however, there is no gold standard established. Herein, we propose an arthroscopic method for the treatment of acute acromioclavicular joint separation using a simple cortical suspension device at the coracoid base via a transclavicular–transcoracoidal tunnel and tieing the suture at the clavicle. This method has the advantages of making a precision drilling tunnel using small implants and small stab incisions, with better cosmetic results and less implant irritation

Joint distraction for the treatment of knee osteoarthritis

Knee osteoarthritis (OA) is a common degenerative joint disease characterized by cartilage destruction and changes in subchondral bone. Treatment options for end-stage OA are limited, with joint replacement and high tibial osteotomy as the common procedures. High tibial osteotomy may be preferable to joint replacement in the young active patient, malaligned knee, and limited to medial compartment OA. However, both procedures may lead to complications and have durability concerns in young patients. Fortunately, joint distraction (JD) has emerged as a joint-preserving treatment for end-stage OA. The reversal of tissue degeneration observed with JD could be the result of one or more proposed mechanisms, such as partial unloading, synovial fluid pressure oscillation, mechanical and biochemical changes in subchondral bone, or adhesion and chondrogenic commitment of joint-derived mesenchymal stem cells. The procedure involves the use of an external fixator to unload the cartilage and underlying bone for a short time period. In addition, new implantable knee devices, which create unloading instead of distraction and do not require removal, have also been developed. There is a lack of standardization for the JD technique which results in significant variation of implant type, duration of treatment, and rehabilitation. Nevertheless, clinical studies demonstrate long-term pain relief and improved patient outcomes. Interestingly, the increase in joint space width following treatment indicates that cartilage repair occurred throughout and after the distraction period. Although JD appears to be an effective therapeutic choice, the rate of complications remains high, with pin-tract infection being the most common

Capability of Ophthalmology Residents to Detect Glaucoma Using High-Dynamic-Range Concept versus Color Optic Disc Photography

Background. Assessment of color disc photograph (C-DP) is affected by image quality, which decreases the ability to detect glaucoma. High-dynamic-range (HDR) imaging provides a greater range of luminosity. Therefore, the objective of this study was to evaluate the capability of ophthalmology residents to detect glaucoma using HDR-concept disc photography (HDR-DP) compared to C-DP. Design. Cross-sectional study. Methods. Twenty subjects were classified by 3 glaucoma specialists as either glaucoma, glaucoma suspect, or control. All C-DPs were converted to HDR-DPs and randomly presented and assessed by 10 first-year ophthalmology residents. Sensitivity and specificity of glaucoma detection were compared. Results. The mean ± SD of averaged retinal nerve fiber layer (RNFL) thickness was 74.0 ± 6.1 μm, 100.2 ± 9.6 μm, and 105.8 ± 17.2 μm for glaucoma, glaucoma suspect, and controls, respectively. The diagnostic sensitivity of HDR-DP was higher than that of C-DP (87% versus 68%, mean difference: 19.0, 95% CI: 4.91 to 33.1; p=0.014). Regarding diagnostic specificity, HDR-DP and C-DP yielded 46% and 75% (mean difference: 29.0, 95% CI: 13.4 to 44.6; p=0.002). Conclusions. HDR-DP statistically increased diagnostic sensitivity but not specificity. HDR-DP may be a screening tool for nonexpert ophthalmologists

Cortical suspensory button fixation has superior biomechanical properties to knotless anchor suture in anterior cruciate ligament repair: a biomechanical study

Abstract The purpose of our biomechanical study was to assess load-to-failure, stiffness, gap formation following cyclic loading, and the failure mechanism for anterior cruciate ligament (ACL) repair comparing the cortical suspensory button and knotless anchor suture. Eight Thiel’s embalmed paired cadaveric knees from four cadavers were dissected. The specimens were assigned to undergo ACL repair either with cortical suspensory button or with knotless anchor suture. The Instron machine replicates cyclic loading and then determines the gap formation. Traction was applied until failure. The load-to-failure, stiffness, and modes of failure in both groups were recorded. The load-to-failure, stiffness, and gap formation were compared between the two groups using the student's t-test. The mean load-to-failure in the cortical suspensory button group was significantly higher than the knotless anchor suture group (212.96 ± 54.57 vs 44.57 ± 20.80, p value < 0.01). No statistically significant difference was found regarding gap formation following cyclic loading and stiffness between the cortical suspensory button group and the knotless anchor suture group. This biomechanical study showed a higher load-to-failure for the ACL repair with cortical suspensory button compared to ACL repair with knotless anchor suture, while no statistically significant difference was found regarding the gap formation following cyclic loading and the stiffness. The load-to-failure in both cortical suspensory button and knotless anchor suture are below regular daily activity load. Thus, an internal brace or external support is recommended during rehabilitation