佐粧 孝久

60歳以上に対する鏡視下手術について疾患別、術式別にJOAスコア、満足度調査、後にTKAとなる症例の割合を調べた。その結果、外側型変形性膝関節症、半月板切除術、特発性膝関節血症については、保存療法が奏功しない場合に鏡視下手術を積極的に勧めてもよいと考えられた。内側型変形性膝関節症や膝骨壊死については、再手術の可能性、年齢を考慮して手術を施行する必要があると考えられた。(著者抄録)

Small peptides including the Arg-Gly-Asp (RGD) motif have been used in studies on cell-extracellular matrix (ECM) attachment due to their ability to disturb integrin-mediated attachment on the cell surface. As another biological action of RGD peptides, several reports have shown that RGD peptides are incorporated into cytoplasm and induce apoptosis by direct activation of caspase-3. This study evaluated the effect of RGD peptides on chondrocytes and synovial cells and studied the involvement of caspases. Chondrocytes and synovial cells were isolated and cultured from the knee joints of New Zealand White rabbits. Cells were incubated in serum-free medium with peptides (RGD, RGDS, GRGDSP, GRGDNP, RGES), and the survival rates were evaluated. The rate of apoptotic cells was measured by flow cytometry in cells treated with RGDS, GRGDSP, and RGES. Caspase-3, -8 and -9 activity was measured in cells treated with RGDS and GRGDSP. Osteochondral explants harvested from rabbits were also incubated with RGD peptides (RGDS, GRGDSP, and GRGDNP), and the survival rate of chondrocytes was evaluated. The survival rate of cultured chondrocytes was significantly decreased in the GRGDSP- and GRGDNP-treated groups. The survival rate of synovial cells was significantly decreased with four of the RGD peptides (RGD, RGDS, GRGDSP, and GRGDNP) at 5 mM, and in the RGDS- and GRGDSP-treated groups at 1 mM. Flow cytometric assay revealed increases of apoptotic chondrocytes with GRGDSP and increases of apoptotic synovial cells with RGDS and GRGDSP. Caspase-3 was activated in chondrocytes treated with GRGDSP and it was also activated in synovial cells treated with RGDS and GRGDSP. Caspases-8 and -9 were not activated in chondrocytes or in synovial cells. The survival rate of chondrocytes in explants decreased in the superficial layer with all three RGD peptides (RGDS, GRGDSP, and GRGDNP) and in the middle layer with GRGDSP. RGD peptides induced apoptosis in cultured chondrocytes as well as in cells in cartilage explants and synovial cells, presumably through direct activation of caspase-3.

Objective: The purpose of this study was to develop a new technique of gene transfer utilizing radial shock waves. The effects of radial shock waves on gene transfer in rabbit chondrocytes were examined by varying the parameters of exposure conditions in vitro. Methods: Chondrocytes were obtained from New Zealand white rabbits and cultured in a monolayer. A luciferase-encoding gene expression vector, or vector alone, was added to chondrocyte cell suspensions, and the cells were then exposed to radial shock waves. Parameters such as pressure amplitude, number of pulses, frequency, and DNA concentration were varied, and luciferase activity was measured 48 h after transfection. Transfection efficiency of radial shock waves was compared with the FuGENE6 transfection method using a green fluorescence protein (GFP)-encoding gene vector by fluorescent-activated cell sorter (FACS) analysis. Results: Radial shock wave exposure significantly increased luciferase activity over 140-fold as compared to the control under the optimal exposure conditions. Both pressure amplitude and number of pulses were relevant to transfection efficiency and cell viability, but frequency was not. Transfection efficiency increased in a dose-dependent manner with DNA concentration. FACS analysis showed 4.74% of GFP-encoding gene using radial shock waves. FuGENE6 transfection was almost similar in transfection efficiency to radial shock wave. Conclusion: In spite of certain degree of cell disruption, radial shock waves significantly augmented reporter gene transfection in rabbit chondrocytes in vitro. Radial shock waves may potentially contribute to the treatment of the cartilage morbidities by enhancing the potency of tissue healing and gene transfection of growth factors. (c) 2007 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Irregularly described contour of the femur and the tibia on magnetic resonance (MR) imaging is commonly seen in osteoarthritic (OA) knees. The aim of this study is to examine the relationship between irregularity of contour of medial femoral condyle (tentatively named I-index) and severity of OA. Twenty-six medial-type OA knees with a mean age of 63.8 were studied. All patients had undergone MR imaging to measure the I-index using image analysis software, and its relationship to Lysholm score was examined. The I-index negatively correlated with Lysholm score (r = -0.55, p < 0.01). The I-index for each Kellgren and Lawrence grade was significantly different. We have concluded that the I-index is a potent indicator to objectively describe the severity of OA especially for the advanced stage OA.

Objective: Although there have been several reports on the use of extracorporeal shock wave therapy (ESWT), the efficacy of ESWT for knee osteoarthritis (OA) has not been clarified. The aim of this study is to investigate the effect of ESWT on OA in a rat knee model. Methods: The rats were divided into three groups: (1) control, (2) OA, and (3) ESWT (knee OA + shock wave therapy). Behavioral analysis consisted of measuring the duration of walking on a treadmill. The expression of calcitonin gene-related peptide (CGRP) in dorsal root ganglion (DRG) neurons innervating the knee using immunohistochemistry was examined in the three groups at their peak time point on the treadmill. Results: Walking duration was significantly extended 4, 7 and 14 days after ESWT in rats with knee OA (peak time point: 4 days), again decreasing by days 21 and 28. Immunohistochemical studies revealed that the OA group had significantly higher percentages of CGRP positive neurons in the DRG than were found in the control group. In addition, ESWT reduced the ratio of CGRP positive DRG neurons in the OA model. Conclusion: The improvement in walking ability and the reduction of CGRP positive neurons in DRG indicates that ESWT is a useful treatment for knee OA. (C) 2007 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Many studies have reported successful outcomes less than 10 years after anterior cruciate ligament (ACL) reconstruction. However, longer-term outcomes have not been analyzed. We assessd outcomes 24 years after anterior cruciate ligament reconstruction with iliotibial tract and compared them with shorter-term results in the same patients. Between 1979 and 1981, 45 patients underwent combined intra- and extra-articular ACL reconstruction with iliotibial tract. Follow-up evaluations of these patients were performed at 6, 13, and 24 years after surgery, which included manual and instrumental laxity testing, functional assessments, and radiography. Twenty-six (60%) patients of the original ACL reconstruction cohort participated in all three follow-up assessments. Three patients had undergone meniscectomy prior to ACL reconstruction and 18 underwent meniscectomy together with ACL reconstruction. Eleven patients underwent subsequent meniscectomy. The mean Lysholm score was 96.2, 93.8, and 87.8 at 6-, 13-, and 24-year follow-up, respectively. A significant decrease in mean Lysholm score was found between 13- and 24-year follow-up. The mean KT-1000 side-to-side difference was 3.5 mm at 24-year follow-up. Overall knee laxity did not change significantly during the follow-up period. At 24-year follow-up, 17 (71%) patients had moderate or severe degenerative changes on radiographs although about 50% of the patients participated in regular sports activities and no patient required regular clinical intervention.

The aim of this study was to evaluate the qualitative change in reparative cartilage after autologous chondrocyte implantation (ACI). Ten knees of 10 patients were studied. The signal intensities of reparative and normal cartilage were evaluated by fat-suppressed three-dimensional spoiled-gradient recalled (FS 3D-SPGR) MR imaging. The signal intensity (SI) index (signal intensity of reparative cartilage divided by that of normal cartilage) was defined and the change in SI index was investigated. Histological and biochemical evaluation was done at the second look arthroscopy. The SI index was at its lowest level immediately after ACI and increased with time to 9 months thereafter. After 9-12 months, the SI index settled to almost level and was maintained at that value for at least 2-3 years postoperatively. The average of the SI indexes after 12 months to the last examination was 74.2 ± 4.6 (range 64.2-82.8), which means signal intensity of reparative cartilage was maintained at a value lower than that of normal cartilage. The total ICRS score was 11.6 ± 2.3 points (mean ± SD), The GAG concentration was 107.9 ± 17.0 μg/mg (mean ± SD) in normal cartilage and 65.9 ± 9.4 μg/mg in reparative cartilage. The quality of reparative cartilage as hyaline cartilage was inferior to that of normal cartilage. In the present study, the time course change in the SI index indicates that the major maturation process of implanted chondrocytes neared completion in 9-12 months. Minor changes, such as matrix remodeling with reorganization of the collagen fibers in reparative cartilage, may continue, but an almost identical condition seemed to be maintained during the first 2-3 years of follow-up. SI index does not always reflect all properties of reparative cartilage but may be a useful parameter for noninvasive evaluation. Copyright © 2005 Cognizant Comm. Corp.

1)家兎関節軟骨欠損に対し骨膜移植を施行した際,HA投与群は生食投与群に比較し24週まで良好な修復をする傾向が見られた. 2)特にsurface regularity及びintegrationの2項目では良好な修復を示した(P<0.05). 3)骨膜移植をしない軟骨欠損のみにHA及び生食を投与した群はいずれも修復が不良であった. 4)12週での修復軟骨の生化学的分析でHA投与群と生食投与群で有意な差は認められず,ただし正常関節軟骨とはいくぶん異なった性質の修復軟骨が形成されていた. 5)Area healed(%)ではHA群と生食群では有意差は無く,HA群の方が修復が抑えられているということは無かった

当科での腸脛靱帯を用いた前十字靱帯再建術,10年以上の長期成績を報告した.著者等の術式ではLachmanやAnterior drower signが陽性のままであったものも見られたが,回旋不安定性に対しては長期にわたり充分な制動効果があり,膝機能判定基準による評価も満足すべき結果であった