Background: After inside out suture for lateral meniscal tear, the popliteal hiatus is closed. So that procedure is not anatomical. From 2003 we have done all inside anatomical meniscal suture without any implants. This procedure preserves popliteal hiatus.

Objective: To introduce the procedure of anatomical all inside lateral meniscal suture and evaluate post operative results.

Material and Method: From 2003 till 2008, we have done all inside lateral meniscal suture in 43 cases. Twenty eight were male and 15 were female. The age at operation was 9 to 42 (mean: 22). Simple meniscal tear were 21 cases, meniscal tear with ACL injury 17 cases, discoid meniscal tear 4cases, and loose meniscus 1 case. Three portals (lateral infra-patellar, medial infra-patellar, and mid para-patellar) were needed. For suturing torn meniscus, we always use spinal needle that was curved by operative surgeon, and sometimes use Caspari suture punch. After rasping torn part, through medial portal the curved spinal needle within non-absorbable thread was pierced to free margin side of lateral meniscus to be passes through torn part toward tibial side of popliteal hiatus. From mid para-patellar view, tip of spinal needle and thread were seen in popliteal hiatus. And only thread was picked up by punch forceps through lateral portal. This end was passed over lateral meniscus. Finally sliding knot was done. Forty cases were followed. Mean follow up period was 1 year and 11 months. The second look arthroscopy was done in 27 cases, 3 months to29 months (mean: 11 months) after meniscal suture.

Results: There were no complications during and after operation. The second look arthroscopy showed complete union in 16 cases, incomplete union in 7 cases and failure in 4 cases. Among the other cases, physical examination revealed failure in one case. Total success rate was 87.5%. This procedure is only the way for anatomical repair of torn lateral meniscus and post operative results are good.

We reviewed 75 patients (57 men and 18 women), who had undergone tension-band laminoplasty for cervical spondylotic myelopathy (42 patients) or compression myelopathy due to ossification of the posterior longitudinal ligament (33 patients) and had been followed for more than ten years. Clinical and functional results were estimated using the Japanese Orthopaedic Association score. The rate of recovery and the level of postoperative axial neck pain were also recorded. The pre- and post-operative alignment of the cervical spine (Ishihara curve index indicating lordosis of the cervical spine) and the range of movement (ROM) of the cervical spine were also measured.

The mean rate of recovery of the Japanese Orthopaedic Association score at final follow-up was 52.1% (sd 24.6) and significant axial pain was reported by 19 patients (25.3%). Axial pain was reported more frequently in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p = 0.027). A kyphotic deformity was not seen post-operatively in any patient. The mean ROM decreased post-operatively from 32.8° (sd 12.3) to 16.2° (sd 12.3) (p < 0.001). The mean ROM ratio was 46.9% (sd 28.1) for all the patients. The mean ROM ratio was lower in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p < 0.001). Compared to those with cervical spondylotic myelopathy, patients with ossification of the posterior longitudinal ligament had less ROM and more post-operative axial neck pain.

The purpose of this study was to evaluate trabecular bone response, at fifty-two week follow-up, to four different synthetic graft materials (CaSO4 and CaSO4 – HA/TCP composites) as compared to autograft in a canine defect model. The group with the highest HA/ TCP proportion had the greatest amount of residual graft material and total mineralized material. Increasing the proportion of HA/TCP reduces the rate of dissolution, and appears to have little effect on bone formation at long term follow-up. This study further suggests that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications.

The purpose of this study was to evaluate trabecular bone response to four synthetic graft materials (CaSO4 and CaSO4 – HA/TCP composites) as compared to autograft in a canine defect model, at long term follow-up.

Both 85% CaSO4 – 15% HA/TCP and 65% CaSO4 – 15% HA/TCP showed bone formation similar to autograft. The group with the highest proportion of HA/TCP lasted longer than the other formulations. The results suggest that increased HA/TCP proportions reduce the rates of dissolution, without compromising bone formation in the current model.

Results suggests that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications.

In this REB-approved RCT, bilateral humeral and femoral cylindrical defects were filled with one of four types of pellets with varying proportions of CaSO4 – HA/TCP, autograft bone, or left unfilled. After sacrifice at six, twelve, twenty-six or fifty-two weeks, defect sites were evaluated histologically for tissue and inflammatory response, area fractions of residual graft material, and bone ingrowth in the defects.

The area of the defect occupied by residual graft material in the group with the highest percentage of HA/TCP was greater than in other composite groups (p< 0.0001). This group contained the greatest amount of total mineralized material (graft material + bone) (p< 0.03. The extent of new bone formation increased from twelve to twenty-six weeks (p< 0.0001). Both 85% CaSO4 – 15% HA/TCP and 65% CaSO4 – 15% HA/TCP showed bone formation similar to autograft.

Funding: Research grant from Stryker Howmedica, Matwah, NJ.

The purpose of this study was to evaluate trabecular bone response to four different synthetic graft materials (CaSO₄ and CaSO₄ – HA/TCP composites) as compared to autograft in a canine defect model. The group with the highest HA/TCP proportion (and the lowest CaSO4 proportion) had the greatest amount of residual graft material and total mineralized material (p< 0.05). Increasing the proportion of HA/TCP reduces the rate of dissolution, and appears to have little effect on bone formation. This study suggests that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications.

Calcium sulfates and phosphates have become popular clinically for use as bone graft substitutes, however, their in-vivo performance has not been well characterized. The purpose of this study was to evaluate trabecular bone response to four synthetic graft materials (CaSO₄ and CaSO₄ – HA/TCP composites) as compared to autograft in a canine defect model.

Both 100% CaSO₄ and the 3 CaSO₄– HA/TCP formulations showed good bone formation. The group with the highest proportion of HA/TCP lasted longer than the other formulations, suggesting increased HA/TCP proportions reduce the rates of dissolution, without compromising bone formation in the current model.

Results suggests that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications.

In this REB-approved RCT, bilateral humeral and femoral cylindrical defects were filled with one of four types of pellets with varying proportions of CaSO₄ – HA/TCP, autograft bone, or left unfilled. After sacrifice at six or twelve weeks, defect sites were evaluated histologically for tissue and inflammatory response, area fractions of residual graft material, and bone ingrowth in the defects.

The area of the defect occupied by residual graft material in the group with the highest percentage of HA/TCP was greater than in other composite groups (p< 0.0006). At twelve weeks, this group contained more total mineralized material (graft material + bone) (p< 0.005). The extent of new bone formation was not different among the composite groups at either time-point, but all showed more bone formation than the empty defect.

Funding: This study was funded by a research grant from Stryker Howmedica, Matwah, NJ.

Introduction and Aims: Calcium sulfates and phosphates have become popular as bone graft substitutes, however, their in-vivo performance has not been well characterised. The purpose of this study was to evaluate trabecular bone response to four synthetic graft materials (CaSO4 and CaSO4 – HA/TCP composites) as compared to autograft in a canine defect model.

Method: In this REB-approved RCT, bilateral humeral and femoral cylindrical defects were filled with one of four types of pellets with varying proportions of CaSO4 – HA/TCP, autograft bone, or left unfilled. After sacrifice at six or 12 weeks, defect sites were evaluated histologically for tissue and inflammatory response, area fractions of residual graft material, and bone ingrowth in the defects.

Results: The area of the defect occupied by residual graft material in the group with the highest percentage of HA/TCP was greater than in other composite groups (p< 0.0006). At 12 weeks, this group contained more total mineralised material (graft material + bone) (p< 0.005). The extent of new bone formation was not different among the composite groups at either time-point, but all showed more bone formation than the empty defect. Both 100% CaSO4 and the 3 CaSO4 – HA/TCP formulations showed good bone formation.

Conclusion: The group with the highest proportion of HA/TCP lasted longest, suggesting increased HA/TCP proportions reduce the rates of dissolution, without compromising bone formation in this model. Results suggest that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications.

The tension of a repaired rotator cuff was evaluated in nineteen patients who had a repair of a full thickness rotator cuff tear. The tension of the repaired cuff was measured at the operation using a simple spring scale. The tension was evaluated regarding the size of the tear, the duration of the symptom, the presence of trauma, and the post-operative results using a UCLA score. The average of the tension at the arm in 0, 30, and 60 degree elevations were 39.2±18.4N, 23.5±17.2N, and 14.2±13.4N respectively. The average tension of the patient who suffered from a trauma was 20.3±15.8N, whereas the one in the patients who had no history of trauma was 35.0 ±18.0N. The slight positive relation, not statistically significant, was found between the tension and the size of the tear. We could not find a significant relation between the tension and the range of motion or the muscle power in this study. The UCLA score was significantly higher in those patients who had less tension of a repaired rotator cuff. We have to be careful not to put too much tension on the rotator cuff when we repair it. Too much tension might damage the muscles and musclotendious units of the rotator cuff or fail to unite the cuff to the bone, resulting in dysfunction of the rotator cuff postoperatively. Then, how much is "too much"? Only a few papers have described the details of the tension of a repaired cuff. Our results show that the lower the UCLA score in patients with a higher tension of the repaired cuff. These results suggest that the tension of the repaired cuff, indeed, changes the results of a rotator cuff repair.