Development Of Degenerative Changes Research Articles

Changes in Segmental Intervertebral Motion Adjacent to Cervical Arthrodesis: A Prospective Study

Prospective, observational. Quantify the changes in intervertebral motion adjacent to cervical arthrodesis over time. One of the frequently acknowledged sequelae following anterior cervical fusion is the development of adjacent segment disease. It has been argued that a spine fusion transfers stress to adjacent levels and results in increased compensatory motion. However, there are conflicting reports as to whether this actually occurs, and most of these are in vitro or retrospective clinical studies. Patients undergoing anterior cervical discectomy and fusion underwent a preoperative dynamic fluoroscopic study, followed by imaging at regular intervals after surgery. Imaging data were analyzed by a validated software system. Relative motion between adjacent vertebrae was then calculated, and changes in motion cephalad to the fusion followed over time. Twenty-one patients were analyzed. Mean follow-up was 13 months (10-22 months). Intervertebral motion adjacent to the fusion changed by more than 4 degrees in 4 of the 21 patients. However, on average, there was no difference between preoperative and postoperative motion for shear, flexion-extension, or vertical displacement at the anterior or posterior disc space. Although there was some individual variation, at a mean of 13 months following surgery, there was no significant change in the average junctional intervertebral motion. If fusion is going to affect adjacent motion, it appears that this does not consistently occur in the first 1 to 2 years following surgery. Additionally, there was no observable relationship between motion and development of degenerative changes during this time.

Runner’s hip: the possible association between running and the development of degenerative acetabular labral tears (SS-96)

Runner’s hip: the possible association between running and the development of degenerative acetabular labral tears (SS-96)

Runner’s hip: the possible association between running and the development of degenerative acetabular labral tears (SS-35)

Runner’s hip: the possible association between running and the development of degenerative acetabular labral tears (SS-35)

Degenerative Disease In Lumbar Spine Of Military Parachuting Instructors

Parachuting, be it static line or skydiving, places enormous stresses on the human spine. It is, therefore, important to determine the prevalence and severity of degenerative changes in the lumbar...

Surgery for postarthrodesis adjacent-cervical segment degeneration.

Anterior cervical decompression and fusion has gained popularity because of its applicability to a variety of cervical spine disorders. The authors of long-term follow-up studies have demonstrated the development of degenerative changes in segments adjacent to fusion. So-called adjacent-segment disease causes symptomatic deterioration in up to 25% of the patients who have undergone anterior cervical decompression and fusion for cervical spondylotic myelopathy. The causes of this condition are debated in the literature. The authors provide a review of the available literature on the pathogenesis, prevention, and treatment of postarthrodesis adjacent-segment degenerative disease.

Short-term evaluation of collagen meniscus implants by MRI and morphological analysis

Meniscectomy can lead to degenerative joint changes in the knee. Collagen meniscus implantation is a tissue engineering technique designed to stimulate regeneration of meniscal tissue in case of irreparable tears or previous meniscectomy. The implant is composed of type I collagen derived from bovine Achilles tendon and enriched with glycosaminoglycans. Previous clinical trials demonstrated satisfactory medium-term results in patients who received a collagen meniscus implant (CMI). In this study, CMI structure was analysed by light microscopy and scanning electronic microscopy (SEM). The same morphological studies were performed on two implant biopsies, obtained from two patients who underwent a second arthroscopic look six months after implantation. The evolution of the implant was also investigated by magnetic resonance imaging, 6 and 12 months postoperatively. CMI presented a multilamellar structure, with inner lacunae allowing tissue ingrowth. The lamellae were made of collagen fibrils, randomly oriented and preserving the typical 64-nm period. At second arthroscopic look, the implant appeared in continuity to the native residual meniscus and parameniscus, and showed good consistency and stability at probing. The biopsy specimens demonstrated invasion of the scaffold by connective tissue and blood vessels. The newly synthesised collagen fibrils were clearly distinguishable from the scaffold ones. No phagocytomacrophagic cells nor inflammatory reactions were observed inside the implant. MRI findings confirmed CMI biocompatibility and highlighted the evolution of the integration process with time. The data achieved in this study support the hypothesis that CMI stimulates regeneration of meniscal-like tissue, which could prevent the development of degenerative changes after meniscectomy.

Unbiased evaluation of the arthroscopic extra-articular technique for Bankart repair: a clinical and radiographic study with a 2- to 5-year follow-up

This study performed an unbiased reexamination of patients who at least 2 years previously had undergone an arthroscopic extra-articular Bankart repair and prospectively evaluated the development of degenerative changes in the shoulder. Two unbiased observers who had never seen the patients before and had in no way been involved in the treatment of the patients were given unlimited access to the patients' files, surgical reports, and radiographs. Of the 80 patients 72 (90%) attended the follow-up 42.5 months (24-66) after the index procedure. Failures in terms of stability (redislocations and subluxations) were recorded in 14% of the patients. The Rowe score was 97 points (51-100), the Constant score was 94 (56-100) in injured shoulders and 97 points (80-100) in noninjured shoulders (P = 0.002). A return to the preinjury level of activity was recorded in 73% of the patients. There was a significant increase in degenerative changes between the pre- and postoperative radiographic assessments (P < 0.0001). At 2- to 5-year follow-up therefore the extra-articular arthroscopic Bankart repair resulted in stable and well-functioning shoulders in a high percentage of patients. However, the signs of radiographic degenerative changes increased between the preoperative assessments and the 2- to 5-year follow-up.

Minimum 10-Year Results of Sugioka??s Osteotomy for Femoral Head Osteonecrosis

Sugioka's transtrochanteric rotational osteotomy was performed on 14 hips (12 patients) before 1987 for avascular necrosis of the femoral head involving a large part of the weight-bearing area. Three hips required a secondary total hip arthroplasty within 5 years after the osteotomy. The remaining 11 hips were examined at a mean of 13.2 years after surgery (range, 10-17.7 years). The clinical and radiologic results were related to the preoperative radiographic stage of the disease. In the hips with less than 2 mm of collapse, highly satisfactory results were maintained more than 15 years after surgery, with minimal development of degenerative changes. In hips with 2 mm or more of collapse or with acetabular changes, the results tended to deteriorate gradually during the long course of observation but were fairly acceptable. This study shows the osteotomy can enable hip joints to survive and function well for more than 10 years with proper patient selection and operative procedure.

Biomechanical evaluation of the elbow following radial head fracture: Comparison of open reduction and internal fixation vs. excision, silastic replacement, and non-operative management

Thirty-six fractures of the radial head were evaluated following treatment with four different techniques: open reduction and internal fixation (ORIF), excision, silastic replacement, and non-operative management. Clinical assessment included calculation of the Clinical Performance Index based on parameters for motion, stability, pain, and daily function, as well as radiographic evaluation for fracture type (Mason) and the development of degenerative changes. Further assessment included isometric strength measurements for elbow flexion, extension, pronation, supination, and grip. Range of motion and strength measurements were similar, except for grip strength, which was significantly better for ORIF patients compared to excision or silastic replacement groups. Patients with ORIF had the best clinical scores with minimal radiographic changes. When possible, ORIF of displaced radial head fractures appears to provide the best functional result.

Degenerative change in the cervical spine and load-carrying on the head.

To evaluate the relationship between load-carrying on the head and the development of degenerative change in the cervical spine. A case-control study was performed with 35 individuals who had carried loads on their head (carriers) and 35 persons who never had carrier loads on their head (non-carriers). A scoring system was utilized for the assessment of the degenerative change in the cervical spine at the C3/C4, C4/C5, C5/C6 and C6/C7 levels on lateral cervical spine radiography. A total score was calculated by summing the scores for the single segments. In 31 of the 35 (88.6%) carriers degenerative change was found in the cervical spine, but only in 8 of the 35 (22.9%) non-carriers (P < 0.01). The total score and the scores for segments C4/5, C5/C6 anc C6/C7 were significantly higher for the carriers than the non-carriers. It is concluded that the axial strain of load-carrying on the head exacerbates degenerative change in the cervical spine.

Acutely repaired proximal anterior cruciate ligament ruptures in sheep - by augmentation improved stability and reduction of cartilage damage.

The aim of this study was to evaluate the healing capacity of proximal anterior cruciate ligament (ACL) ruptures following primary repair with and without a bioresorbable augmentation. The ACL was transected at the femoral origin in the right knee joint of 24 sheep. The ACL was repaired in eight sheep (group B) without, and in eight sheep (group C) with a bioresorbable augmentation. Eight sheep without repair served as a control (group A). No immobilization was performed in any group. The sheep were sacrificed 13 weeks post-operatively. Macroscopically, all repaired ACLs were healed. The augmentation device was broken in all cases, but not completely degraded. In group A, none of the transected ACLs had healed. The anterior drawer under a load of 50 N was significantly lower in group C than in group A (p<0.01). No significant difference was seen between groups B and A. The distribution and extent of chondromalacia (CM) in the operated knees depended on the type of operative treatment (p<0.01). Groups A and B showed significantly more CM in the operated knee than in the non-operated knee (each p<0.05). Proximal ACL ruptures can heal in sheep after both non-augmented and augmented ACL repair with free-functional rehabilitation. However, augmented repair leads to significantly better stability of the knee joint compared to transected controls and better limits the development of degenerative changes.

Discussion: Age-related changes in the human mandibular condyle: A morphologic, radiologic, and histologic study

Purpose : This study determined the osteoarthrotic changes in the human mandibular condyle in relation to aging and the loss of dental occlusal contacts. Materials and Methods : Thirty-four condyles obtained at autopsy were studied morphologically, radiologically, and histologically. Results : With advancing age, the articular surface of the mandibular condyle morphologically showed severe degenerative changes. The condyles with these changes tended to be from the side of the mandible with minimal areas of occlusal contact. Radiographically, an irregularity of the cortical bone plate was most commonly seen in the fifth and sixth decades, whereas a polygonal or flattened structure was mainly observed after the seventh decade. Conclusion : The histologic findings suggest that a decrease in the cellular components with advancing age may play a critical role in the development of degenerative changes.

Age-related changes in the human mandibular condyle: A morphologic, radiologic, and histologic study

Purpose: This study determined the osteoarthrotic changes in the human mandibular condyle in relation to aging and the loss of dental occlusal contacts. Materials and Methods: Thirty-four condyles obtained at autopsy were studied morphologically, radiologically, and histologically. Results: With advancing age, the articular surface of the mandibular condyle morphologically showed severe degenerative changes. The condyles with these changes tended to be from the side of the mandible with minimal areas of occlusal contact. Radiographically, an irregularity of the cortical bone plate was most commonly seen in the fifth and sixth decades, whereas a polygonal or flattened structure was mainly observed after the seventh decade. Conclusion: The histologic findings suggest that a decrease in the cellular components with advancing age may play a critical role in the development of degenerative changes.

Neck injuries from rear impact road traffic accidents: prognosis in persons seeking compensation

We studied the natural history and prognostic factors in 100 patients who had sustained neck sprains in rear impact road traffic accidents, and who had all originally been seen for medicolegal reports. They were seen for clinical and radiological review at a mean of 8 years after injury. The detailed medicolegal reports from the early years were available on all patients, and were used to supplement the information obtained at review. Of the patients, 50 per cent had significant pain at 8 months, decreasing to 22 per cent at 2 years and 18 per cent at 3 years. At review, 45 per cent were free of pain, and 14 per cent had significant pain. Front seat position, pain within 12 h of injury, past history of neck pain and degenerative changes on radiographs were associated with a longer duration of significant pain ( P < 0.05). Early onset of pain was also associated with a worse level of pain at review. The timing of compensation was not associated with improvement in symptoms. The injury had not accelerated the development of degenerative changes.

Principles and decision making in meniscal surgery

This article provides a review of the basic science and clinical information available to the orthopedist on which a systematic approach to meniscal surgery can be based. Attitudes toward the meniscus have changed dramatically in the last 50 years. Laboratory investigations show that the menisci participate in many important functions, including tibiofemoral load transmission, shock absorption, lubrication, and passive stabilization of the knee joint. Histologic/structural analyses reveal the menisci to be annular structures, with the ability to transmit and properly distribute load over the tibial plateau, primarily facilitated by the circumferential collagen fibers in the peripheral third of the meniscus, in conjunction with their strong bony attachments at the anterior and posterior horns. Biologic studies demonstrate that meniscal healing can occur through two pathways: an intrinsic ability of the meniscal fibrochondrocyte to migrate, proliferate, and synthesize matrix (provided they are given the proper environment), and extrinsic stimulation through neovascularization (when the meniscal injury occurs in the vascular periphery). This review makes it clear that the menisci are essential components of the normal knee, and that techniques intended to preserve the menisci are both possible and mandatory. As evidence has accumulated from both animal and clinical studies of the frequent development of degenerative changes following meniscectomy, surgeons have become increasingly aggressive in their efforts to conserve as much meniscal tissue as possible. Current approaches to treatment of meniscal tears are based on a thorough understanding of meniscal structure, biology, and function, as well as familiarity with the basic principles of meniscal repair and resection. To synthesize these principles, the article concludes with an algorithm intended to guide surgeons in decision making when faced with a variety of meniscal lesions in different clinical situations.

Arthroscopic partial meniscectomy: A long-term follow-up

A follow-up study was conducted to clarify the clinical and radiological long-term consequences of arthroscopic meniscus resection. One hundred thirty-six patients who had unilateral arthroscopic resection of an isolated meniscal tear attended for an interview and a physical and radiological examination. Follow-up averaged 8.5 years, with a range of 7.9–11.6 years. The reoperation rate was as high as 22.8%, but was the lowest in the bucket handle tear group (13%). Pain after exercise was less frequent among patients treated for a bucket handle tear compared to other lesions. Fifty-three percent of the patients had at least one of the Fairbanks changes in the operated knee and only 22% in the control knees. The radiographic result was not influenced by the type of meniscus lesion nor were high age or intraoperatively described cartilage damage factors of significance. Malalignment <4° of valgus and >10° of valgus was found to be a significant risk factor for the development of degenerative changes following meniscus resection.

Effects of SL-1010 (sodium hyaluronate with high molecular weight) on experimental osteoarthritis induced by intra-articularly applied papain in guinea pigs

Effects of SL-1010 on the experimental osteoarthritis (OA) produced by intra-articular injection of papain, proteolytic enzyme, in the knee joint of the guinea pigs were histologically and biochemically investigated. In addition, experimental conditions to produce OA in guinea pig knee joint were also examined, since papain-induced OA has been mainly studied in rabbits. Six weeks after intra-articular injection of papain (1%, 0.1 ml), there were inflammatory reactions of the synovial membrane, degenerative changes in chondrocytes and the matrix of the articular cartilage, a decrease in the Safranin-O staining intensity and lowering of sulfated glycosaminoglycan. Electronmicroscopic observations revealed that the amorphous layer had disappeared and large bundles of unit collagen fibers and larger collagen fibers had appeared in the cartilage matrix. In the OA model, SL-1010 reduced the inflammatory reactions of the synovial membrane, inhibited development of degenerative changes in chondrocytes and the matrix of the articular cartilage and recovered the Safranin-O staining intensity. The sulfated glycosaminoglycan contents in the cartilage was significantly increased in the SL-1010-treated group, compared with the control group. The electromicroscopically observed charges in the papain-injected knee joint of the control group were rarely detected in the SL-1010-treated group. These results suggest that SL-1010 inhibits degenerative changes in the chondrocytes and the matrix probably by reducing synovial inflammation and protection of the cartilage in the OA model of guinea pigs.

Morpho-tribo-mechanical characteristics of the articular cartilage in animals under conditions of hypokinesis.

The influence of activity upon the structure and properties of articular cartilage has been examined in two populations of fur-bearing animals. Morphological changes in cartilage of the caged animals were noted. Friction was mentioned in a vibrotribometer and it was noted that the caged animals exhibited a lower friction coefficient than the free-moving animals. In both cases the friction initially increased with age, reaching a maximum after about three years. It is concluded that prolonged hypokinesis associated with a cage-breeding regime acts like a mechanical stress factor which stimulates the development of degenerative changes in cartilage.

Running and Degenerative Osteoarthritis of the Hip: A Morphobiomechanic Study

The Authors studied the possible development of degenerative changes in 60 hips of 30 ex-distance runners and ex-long-jumpers who had competed ata national level and had given up competitive sport at least 25 years previously. Careful clinical and radiological examination was carried out with particular attention to certain radiographic parameters. The Authors conclude that intensive, long-term sports activity contributes in no way to degenerative hip disease, and that the origin of so-called primary degenerative arthritis of the hip must be sought in morphological changes seen in hip radiographs which may be evaluated by linear and angular parameters. They suggest that the continuous joint movement might have delayed the occurrence of a degenerative process which would inevitably have arisen due to mechanical changes within the joint.

Meniscal transplantation in the human knee: A preliminary report

Meniscectomy can result in degenerative disease, with younger patients developing problems in middle age (1). In addition, loss of a major portion of a medial meniscus may increase instability in an anterior cruciate deficient knee (2). For these two reasons, it is theoretically desirable to transplant menisci in selected patients. In this paper, six patients who underwent allograft transplantation of a meniscus (four medial and two lateral) are presented to demonstrate the apparent success of the operative procedure. Follow-up extends from 24 to 44 months. June 1986 to March 1988. All patients are free of episodes of locking. Four have undergone arthroscopy, which demonstrated healing of the meniscus and no evidence of shrinkage. KT 1,000 values returned to normal in four cases, with concomitant reconstruction of the anterior cruciate ligament (ACL). It is hoped that meniscal transplantation will offset the development of degenerative changes; however, this supposition will remain unproven for decades. Meniscal transplantation seemed to improve stability in the knees undergoing ACL reconstruction. Arthroscopy performed after transplantation revealed that healing does indeed occur. There was no evidence of rejection, confirming the feeling that meniscal tissue is “immunologically privileged”. Meniscal transplantation is offered as an adjunct to other reconstructive procedures in cases of meniscal deficient knees.