Although bone morphogenetic protein 2 (BMP-2) has been FDA-approved for spinal fusion for decades, its disadvantages of promoting osteoclast-based bone resorption and suboptimal carrier (absorbable collagen sponge) leading to premature release of the protein limit its clinical applications. Our recent study showed an excellent effect on bone regeneration when BMP-2 and zoledronic acid (ZA) were co-delivered based on a calcium sulphate/hydroxyapatite (CaS/HA) scaffold in a rat critical-size femoral defect model. Therefore, the aim of this study was to evaluate whether local application of BMP-2 and ZA released from a CaS/HA scaffold is favorable for spinal fusion. We hypothesized that CaS/HA mediated controlled co-delivery of rhBMP-2 and ZA could show an improved effect in spinal fusion over BMP-2 alone. 120, 8-week-old male Wistar rats (protocol no. 25-5131/474/38) were randomly divided into six groups in this study (CaS/HA, CaS/HA + BMP-2, CaS/HA + systemic ZA, CaS/HA + local ZA, CaS/HA + BMP-2 + systemic ZA, CaS/HA + BMP-2 + local ZA). A posterolateral spinal fusion at L4 to L5 was performed bilaterally by implanting group-dependent scaffolds. At 3 weeks and 6 weeks, 10 animals per group were euthanized for µCT, histological staining, or mechanical testing. µCT and histological results showed that the CaS/HA + BMP-2 + local ZA group significantly promoted bone regeneration than other treated groups. Biomechanical testing showed breaking force in CaS/HA + BMP + local ZA group was significantly higher than other groups at 6 weeks. In conclusion, the CaS/HA-based biomaterial functionalized with bioactive molecules rhBMP-2 and ZA enhanced bone formation and concomitant spinal fusion outcome

Acknowledgements: Many thanks to Ulrike Heide, Anna-Maria Placht (assistance with surgeries) as well as Suzanne Manthey & Annett Wenke (histology).

A novel EP4 selective agonist (KMN-159) was developed [1] and has been proven that it can act as an osteopromotive factor to repair critical-size femoral bone defects in rats at a dose-dependent manner [2]. Based on its osteopromotive properties, we hypothesized that KMN-159 could also aid in bone formation for spinal fusion. Therefore, the aim of this study was to investigate its spinal fusion effect in a dorsolateral spinal fusion model in rats. This study was performed on 192, 10-week-old male Wistar rats. The rats were randomized into 8 groups (n = 12 per group): 1) SHAM (negative control), 2) MCM (scaffold only), 3) MCM + 20 µg BMP-2 (positive control), 4-8) MCM + 0.2, 2, 20, 200 or 2000 µg KMN-159. A posterolateral intertransverse process spinal fusion at L4 to L5 was performed bilaterally by implanting group dependent scaffolds (see above) or left empty in the SHAM group (protocol no. 25-5131/474/38). Animals were euthanized after 3 weeks and 6 weeks for µCT and biomechanical testing analysis. The results showed that KMN-159 promoted new bone formation in a dose-dependent manner at 3 weeks and 6 weeks as verified by µCT. The biomechanical testing showed that the dose of 20, 200 and 2000 µg KMN-159 groups obtained comparable strength with BMP-2 group, which higher than SHAM, MCM and lower doses of 0.2 and 2 µg KMN-159 groups. In conclusion, KMN-159 could be a potential replacement of BMP-2 as a novel osteopromotive factor for spinal fusion.

Acknowledgements: We are grateful to Ulrike Heide, Anna-Maria Placht (assistance with surgeries) as well as Suzanne Manthey & Annett Wenke (histology).

Introduction: When we have operate children’s knee in habitual luxation of the patella we noted, that iliotibial band have branch going to patella and to patella tendon.

It is important to the etiopathology of the patella luxation, but in valgus of the knee and in hyperpresion of the patella syndrome too.

Material and Method: In years 2000–2007 we have performed surgical iliotibial band release In 70 children, 28 boys and 42 girls.

In 19 children contracture of the iliotibial band were one-sided, in 51 children contracture were both-sided.

Patients were divided in to groups with various pre-operative symptoms:

valgus of the knee – 40 patients (74 legs),

In all cases we performed surgically release of the iliotibial band. The incision was 5–10 cm over the joint space on the lateral side of the femur. The fasciotomy of the fascia lata and iliotibial band we make in “Z” shape. During operation we flex and extend the knee to be sure all fibres are released.

Findings: We have check late result (3 – 36 month postoperatively) in 45 patients (77 legs).

We estimate:

27 patients from group of valgus deformity of the knee

The valgus angle preoperatively reaches 12 to 35 (on average 16 for right leg and 16,5 for left). Postoperatively angle improve in all patients. Knee angle change from 5 to 20 degree (on average 8,4 for Wright leg, 8,3 for left).

In group with patella subluxation we have check 23 legs. In 11 patents (18 legs) the angle improve. The 3 patients (5 leg) later has full reconstruction of patello-femoral joint with patella tendon transposition. In patient with post inflammatory deformation the angle improve from 15 to 7 degree, but after next 34 month reaches again 20 degree and patient had osteotomy of the femur.

Conclusions:

iliotibial band release show us good result in correction the axis of the knee, first even during operation