Medial Tears Research Articles

Repair Integrity and Clinical Outcome Following Arthroscopic Rotator Cuff Repair: A Prospective Comparison of Medium Tears Versus Large and Massive Tears (SS-51)

Repair Integrity and Clinical Outcome Following Arthroscopic Rotator Cuff Repair: A Prospective Comparison of Medium Tears Versus Large and Massive Tears (SS-51)

The Effect of Rotator Cuff Tear Size on Shoulder Strength and Range of Motion

Prospective cohort study. To determine the effect of rotator cuff tear size on shoulder strength and range of motion. Patients with rotator cuff pathology typically present with weakness and motion loss in various motions. The extent to which the presence of a rotator cuff tear and the size of the tear affect strength and range of motion is not well understood. Sixty-one patients scheduled for surgery, with a diagnosis of a rotator cuff tear and/or subacromial impingement, underwent examination for shoulder pain, function, range of motion, and strength. The extent of rotator cuff pathology was documented during subsequent surgery (presence of tear, tear size, tear thickness). There were 10 massive tears, 15 large tears, 13 medium tears, 12 small tears, and 11 rotator cuffs without a tear. Patients had marked weakness in abduction strength at 90 degrees and 10 degrees of abduction, in external rotation strength at 90 degrees, and in the "full can test" (all, P<.0001). Marked range of motion losses in shoulder flexion and external rotation at 0 degrees and 90 degrees abduction (all, P<.001) were also observed. Abduction strength deficit at 10 degrees was affected by rotator cuff tear size (P<.0001). Twenty of 25 patients with large or massive tears had deficits greater than 50%, compared with only 1 of 11 patients with no tear, 2 of 12 patients with a small tear, and 5 of 13 patients with a medium tear (P<.0001). Other strength and range of motion deficits or indices of pain and function were unaffected by tear size. Weakness of greater than 50% relative to the contralateral side in shoulder abduction at 10 degrees of abduction was indicative of a large or massive rotator cuff tear.

関節外に腫りゅうを呈した内側半月ガングリオンの１症例

This is a case report of a ganglion due to medial meniscus tear. A 79-year-old female presented a painfull swelling of the right knee. A soft tumor was found in the medial side. The soft tumor manifested a cystic image connected to the medial meniscus on MRI. We performed arthroscopy and found a medial meniscus horizontal tear that was connected to the cystic lesion. We performed partial menisectomy plus open tumor resection. Surgical outcome was good. Six months after resection, there was no recurrence.

Long term evaluation of disease progression through the quantitative magnetic resonance imaging of symptomatic knee osteoarthritis patients: correlation with clinical symptoms and radiographic changes

The objective of this study was to further explore the cartilage volume changes in knee osteoarthritis (OA) over time using quantitative magnetic resonance imaging (qMRI). These were correlated with demographic, clinical, and radiological data to better identify the disease risk features. We selected 107 patients from a large trial (n = 1,232) evaluating the effect of a bisphosphonate on OA knees. The MRI acquisitions of the knee were done at baseline, 12, and 24 months. Cartilage volume from the global, medial, and lateral compartments was quantified. The changes were contrasted with clinical data and other MRI anatomical features. Knee OA cartilage volume losses were statistically significant compared to baseline values: -3.7 ± 3.0% for global cartilage and -5.5 ± 4.3% for the medial compartment at 12 months, and -5.7 ± 4.4% and -8.3 ± 6.5%, respectively, at 24 months. Three different populations were identified according to cartilage volume loss: fast (n = 11; -13.2%), intermediate (n = 48; -7.2%), and slow (n = 48; -2.3%) progressors. The predictors of fast progressors were the presence of severe meniscal extrusion (p = 0.001), severe medial tear (p = 0.005), medial and/or lateral bone edema (p = 0.03), high body mass index (p < 0.05, fast versus slow), weight (p < 0.05, fast versus slow) and age (p < 0.05 fast versus slow). The loss of cartilage volume was also slightly associated with less knee pain. No association was found with other Western Ontario McMaster Osteoarthritis Index (WOMAC) scores, joint space width, or urine biomarker levels. Meniscal damage and bone edema are closely associated with more cartilage volume loss. These data confirm the significant advantage of qMRI for reliably measuring knee structural changes at as early as 12 months, and for identifying risk factors associated with OA progression.

Pain &amp; Motion Recovery Patterns After Rotator Cuff Repair According to Tear Size

Purpose: The purpose of this study was to evaluate the recovery patterns of pain and motion as well as final outcomes after rotator cuff repair according to tear size. Materials and Methods: Sixty-one patients of rotator cuff repair (29 small to medium tear; group I, 32 large to massive tear; group II) through July 2000 to July 2003 were evaluated. Visual analogue scale (VAS) for pain, range of motion (ROM) and motion fraction (MF) between glenohumeral and scapulothoracic joint were checked serially 2, 6 and 12 months after operation. Final outcomes were accessed by ASES, SST, and UCLA score. Results: Regardless of tear size, final outcomes were similar. But, recovery patterns of night pain were different from ROM and MF. In group I, night pain shown rapid initial recovery compared to more slow and gradual recovery pattern of group II. ROM and MF shown similar recovery patterns. MF recovery were gained after 12 months in group I, and 6 months in group II. Conclusion: After careful evaluation of recovery patterns of pain, ROM and MF according to tear size, appropriate rehabilitation protocol could be applied to assist normal functional recovery.

Treatment of shoulder instability caused by medial glenohumeral ligament rupture with thermal capsulorrhaphy

A three-year-old, male springer spaniel had chronic left forelimb lameness with a medial glenohumeral ligament tear and articular cartilage damage diagnosed on arthroscopy. The animal failed to respond to conservative therapy of rest and an intra-articular injection of methylprednisolone. The use of thermal capsulorrhaphy using bipolar radiofrequency bought about a return of joint stability and resolution of the lameness.

회전근 개 파열의 관절경적 치료 시 관절된 관절와 상완관절의 동반 변화 -파열의 정도에 따른 차이-

Purpose: To identify associated findings in glenohumeral joint in rotator cuff tear and evaluate its clinical significance, we examined minor and major changes during arthroscopic or mini open repair. Materials & Methods: We reviewed 66 patients of rotator cuff tear treated from March, 2001 to January, 2004. Of 38 cases of small to medium tear, average age was 53 years old and involved in dominant arm in 27 cases. Of 28 cases of large to massive tear, average age was 58 years old and involved in dominant arm in 26 cases. Minor and major associated changes of the glenohumeral joint were evaluated in the tendon of biceps long head, biceps pulley, cartilage of the glenoid and humeral head, labrum and synovium. Results: Minor changes in biceps tendon were in 35% of cases, biceps pulley in 18%, cartilage of humeral head in 27%, cartilage of glenoid in 18%, labrum in 38%, and synovium in 42%. Major changes in biceps tendon were in 6% of cases, biceps pulley in 35%, arthritis of humeral head in 3%, arthritis of glenoid in 2%, labrum in 6%, and synovium in 21 %. Major changes in biceps tendon were 5% in Group I and 7% in Group Ⅱ(p>0.05) and in biceps pulley, 18% and 57% in each (P

Prospective evaluation of the effect of rotator cuff integrity on patient outcomes following arthroscopic rotator cuff repair (SS-75)

Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but 70% to 90% retear rates by ultrasound. This study prospectively evaluates postoperative cuff integrity, as assessed by MRI, and patient outcomes following arthroscopic RCR. Methods: Fifty-two consecutive patients after arthroscopic RCR by a single surgeon were prospectively enrolled for evaluation preoperatively and at one year follow-up, including a postoperative MRI. Any tendon defect was graded a retear, even if smaller than the original tear. Results: Thirty-two patients had completed the arthroscopic RCR protocol and were evaluated. Overall ASES scores improved from 46 to 77, and Constant scores from 52 to71 (P < .05). Strength in forward elevation and external rotation improved significantly, from 5.9 to 9.8 lb, and 9.4 to 13.3 lb (P < .05). The average preoperative tear size was 3.1 cm; 15 tears were <3 cm and 17 >3 m. 47% of the rotator cuffs were intact by MRI. Of tears <3 cm, 80% were intact at follow-up; of tears >3 cm, 18% were intact at follow-up. 13% of massive tears (≥5 cm) were intact by MRI. There was a trend to better scores with an intact cuff (Constant 80, ASES 90, P = .06) than with a retear (Constant 72, ASES 78). Patients with intact cuffs had significantly greater strength of elevation (P < .005) and strength in external rotation (P < .02). Conclusion: Arthroscopic RCR yields excellent clinical outcomes which are better if the tendon is intact at follow-up. Repairs of small and medium tears of the rotator cuff have a high rate of cuff integrity (80%) while the large and massive tears have a higher retear rate. It should be noted that these results evaluate early arthroscopic methods. As techniques continue to evolve, e.g., current use of a double row of anchors, it is hoped that security of repairs of larger tears will improve.

The causes and mechanisms of meniscal injuries in the sporting and non-sporting environment in an unselected population

The aim of this study was to establish the aetiology and circumstances of meniscal injuries in the general adult population. We studied a group of patients who underwent arthroscopy under the care of the same surgeon between 1991 and 1998 (1236 patients). The study group included 392 patients, aged 18 to 60 years, with no previous knee injury, surgery or arthritis, with normal X-rays and meniscal injuries proven at arthroscopy. No professional athletes were included in the study group. The patients with Sports injuries (mean age 33 years) accounted for 32.4% of cases. The patients with Non-sporting injuries (mean age 41 years) accounted for 38.8% of tears. 71.9% of these happened in activities of daily living (and half of this group sustained their tear by squatting or ascent from this position). Patients without identifiable injury (mean age 43 years) represented 28.8% of cases. Male:Female ratio was 4:1. Medial tears accounted for two thirds of cases. This type of study, not undertaken since the advent of MRI or arthroscopy, shows that in the general population, two thirds of meniscal tears occurred in the absence of sporting activities, frequently within the ambit of every day activities and in the absence of the classic injury mechanism. Ascent from a squat is a common mechanism of injury not widely described or emphasised.

鏡視下けん板修復術の短期成績

Purpose: The purpose of this study was to evaluate the outcome of rotator cuff tears repaired arthroscopically. Methods: Twenty patients underwent arthroscopical rotator cuff repair since 2002. The mean follow-up period was 7.5 months. (range: 3M to 16M) Shoulder functions were assessed before operation and after operation by means of JOA shoulder scoring system. Results: Nine patients had small tears, five had medium tears, two had large tears and four had partial tears. The average score was 58.2 points, before operation and 88.4 points after operation. Conclusions: Arthroscopic rotator cuff repair provides good results.

Results of Arthroscopic All-Inside Sutures in Medial Meniscus with Concomitant Anterior Cruciate Ligament Reconstruction

Purpose: To evaluate the clinical results of arthroscopic all-inside suture using 2 posteromedial portals for medial meniscus posterior horn (MMPH) tears by second-look arthroscopy in patients received concurrent anterior cruciate ligament (ACL) reconstruction. Materials and Methods: From May 1997 to June 2001, 78 MMPH tears were treated with arthroscopic all-inside sutures with concurrent anterior cruciate ligament (ACL) reconstruction. Among these 39 patients were availablefor follow-up evaluation by second-look arthroscopy. All MMPH tears were repaired using the arthroscopic all-inside suture technique using 2 posteromedial portals. Second-look arthroscopy was performed on average 19 months (range 6 to 40 month) after the ACL reconstruction and meniscal repair. Meniscus healing status was defined and classified. According to the Henning classification, they were divided into complete healing, incomplete healing, and failure. Tear size, type and location were analyzed and compared with healing category. We determined clinical criterias for success in meniscal status as; (1) no positive among 4 clinical objective parameters: joint line pain and tenderness, locking or catching, recurrent effusions, and positive McMurry test; and (2) complete healing of all-inside sutured meniscus during second-look arthroscopy. Results: Of 39 knees assessed by second-look arthroscopy, 32 (82.1%) showed complete healing, 6 (15.4%) incomplete healing without any positive findings of clinical symptoms. Furthermore, all in the incompletely healed group showed complete healing of the posterior horn, which was sutured by allinside suture, whereas incomplete healing was observed at the junctional areas between all-inside and inside-out sutures, mainly at the posteromedial corner. So the overall success rate was 97.4% (38/39) for all-inside suture healing. The one (2.6%) patient with clinical failure revealed a retear of the repaired site, and subsequent subtotal menisectomy was performed. KT-2000 arthrometry showed that sagittal knee laxity was less than 2 mm (Average 1.5 mm, SD 0.72) in all reconstructed knees. The average knee scores, Lysholm knee score and HSS score, at final follow up were 95.5 and 96.5, respectively. As expected, small, longitudinal, and more peripheral (red-red zone) tears resulted in a higher healing outcome. Conclusion: Accurate repair with arthroscopic all-inside vertical suture using a suture hook, resulted in a high healing rate even in large and complex vertical tears. Arthroscopic all-inside meniscal suturing may be an optimal treatment for medial meniscus posterior horn tear greater than 1 cm during concurrent anterior cruciate ligament reconstruction.

All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear

Up to two thirds of patients with anterior cruciate ligament rupture have a combined medial meniscus posterior horn tear. Researchers have proven the importance of repairing this tear to enhance stability after anterior cruciate ligament reconstruction. However, repairing the meniscal tear can be sometimes cumbersome and difficult or even impossible in certain circumstances, especially in places such as the posterior horn of the medial meniscus. We devised a simple and easy method of all-inside suturing of medial meniscus posterior horn tears using a 2-posteromedial portal system. Furthermore, with a modification of our technique, a clinician can not only suture single but also double longitudinal medial meniscus posterior horn tears.

The use of a balloon angioplasty model of arterial injury to compare the thrombogenicity of dietary anhydrous milkfat, fish oil and hydrogenated coconut oil in pigs

Three groups each of 16 pigs were fed for 70 days on a diet containing one of three test fats/oils (anhydrous milkfat, fish oil (MaxEPA TM) or hydrogenated coconut oil) at a level of 100 g/kg. On day 70, a balloon catheter was inserted under anaesthesia into each femoral artery and inflated to 620.5 kPa for five 30 sec intervals. One h after angioplasty, while still anaesthetised, the pigs were killed by exsanguination. The injured segments of femoral artery were perfused in vivo with 0.9% saline and 10% neutral buffered formalin before being harvested. Thrombus size was determined by the counts of technetium-99m-labelled platelets in the injured arteries and by morphometry of the thrombus area in microscopic sections. Of 91 arteries subjected to angioplasty, mural thrombi were seen macroscopically in all nine arteries that had deep injury with exposure of the tunica media, as well as in 19 of the remaining 82 arteries (23%) in which there was no evidence of a medial tear. Many small platelet-rich thrombi, attached to the denuded endothelium, were also detected microscopically. There was no statistically significant effect of diet on either thrombus area or platelet deposition at sites of arterial injury. Failure to show significant differences may have been due to the large within-group variation in thrombus size, a factor which may limit the use of this model in studies aimed at detecting differences in thrombogenicity between different dietary fats and oils.

All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison

Purpose: The goal of the study was to compare the results of all-arthroscopic rotator cuff repair with those of our mini-open rotator cuff repair. Type of Study: Retrospective outcome study. Methods: Sixty-four shoulders (58 patients) were identified; 35 in the all-arthroscopic group and 29 in the mini-open group. Average follow-up for all patients was 44.6 months, with a minimum of 24 months. The all-arthroscopic group included 3 small tears (< 1 cm), 24 medium-size tears (1 to 3 cm), and 9 large tears (3 to 5 cm). The mini-open group included 2 small tears, 9 medium tears, and 18 large tears. All patients in both groups underwent arthroscopic assessment with arthroscopic subacromial decompression. None underwent formal acromioclavicular joint resection. Four of the all-arthroscopic and 11 of the mini-open patients underwent coplaning of the acromioclavicular joint. Anchors were the primary method of arthroscopic fixation, with an average of 1.5 anchors per case. Results: The average final follow-up UCLA score for the arthroscopic group was 32.6 and for the mini-open group was 31.4, and the average final follow-up ASES score for the arthroscopic group was 91.7 and for the mini-open group was 90.0. No patients in the arthroscopic group developed fibrous ankylosis, whereas 4 patients in the mini-open group developed the condition (14%). No anchor-related complications were noted. Shoulders in the all-arthroscopic group showed greater motion at 6 and 12 weeks postoperatively and slightly better motion at final review. However, final motion difference was not statistically significant. Overall, 4 patients (6.3%) demonstrated some tenderness in the acromioclavicular joint on palpation, but none had clinical symptoms requiring treatment. Conclusions: All-arthroscopic cuff repair provides comparable outcomes and complication rates to arthroscopic decompression with mini-open repair. The lower incidence of fibrous ankylosis favors the all-arthroscopic technique. A trend for better early motion was also noted in the all-arthroscopic group. Analysis of variance shows no measurable outcome difference between tear sizes.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 234–238

鏡視下けん板修復術の短期成績

We present the results of arthroscopic rotator cuff repair in seven patients (five men and two women). The average age of patients at the time of operation was 57.3 years (range, 49 to 72 years). All of the patients were followed up for at least 6 months (average, 8 months, range 6 to 15 month). We found medium (1 to 3cm) tears in three shoulders and large (3 to 5 cm) tears in four. Six glenohumeral joints had intra-articular lesions. Crescent-shaped tears were repaired in a direct tendon-to-bone fashion with suture anchors, and U-shaped tears were repaired by using margin convergence with side-to-side sutures to converger the free margin of the rotator cuff tear to the prepared bone bed. The shoulders were evaluated using the Japanese Orthopedic Association (JOA) score. The total JOA score of all the patients improved from 61 to 88.7 points. The JOA score showed improvement in the postoperative scores for pain, function, and range of motion. Arthroscopic rotator cuff repair produced satisfactory results. The arthroscopic method has the advantages of glenohumeral joint inspection, treatment of intra-articular lesions, smaller incision, no deltoid detachment, less soft-tissue dissection, less pain, and more rapid rehabilitation.

LCL INJURY WITH A BICEPS FEMORIS RUPTURE?

HISTORY: A 20 year old female college freshman soccer forward sustained a right knee injury after a one-on-one breakaway. She was dribbling into the penalty box to shoot with her left foot when the keeper slid out onto her planted right leg hyperextending her knee. She felt a stretching and a “snap”. She was examined on the field by the trainer, ice was applied, and she was then sent to the emergency department. In the emergency department, she complained of numbness and tingling in her leg, foot, and toes. X-rays were completed and were negative, she was placed in a knee immobilizer and she was instructed to follow up Sunday morning in the Sports Medicine Injury Clinic for further evaluation at which point I became involved in the case. PHYSICAL EXAMINATION: Inspection at the Injury Clinic revealed varus malalignment of the bilateral lower extremities. 1+ effusion of the left knee with general swelling in the posterior aspect of the knee and at the proximal head of the fibula. Ecchymosis was noted along the posterior lateral aspect of the knee. There was tenderness along the lateral joint line, over the head of the fibula, and posteriorly. Her ROM was diminished to 75 degrees of flexion due to swelling and tenderness. She had a positive anterior drawer, negative posterior drawer, and a 2+ Lachmans without a discernible endpoint. Varus stressing revealed 30 degrees of opening with no end point. Valgus stress of the knee was intact. McMurray's and Apley's testing were not performed due to patients discomfort. She had 2+ dorsalis pedis and posterior tibialis pulses with decreased sensation along the anterior tibia and dorsum of the foot(photos will be presented). DIFFERENTIAL DIAGNOSIS: Traumatic rupture of the ACL and LCL with a lateral meniscal tear Occult Fibular head fracture and superficial peroneal nerve injury TESTS AND RESULTS: Right Knee Complete Series Radiographs: Negative with no evidence of fracture. Right Knee Magnetic Resonance Imaging: Grade III LCL tear, Grade I MCL sprain, severe interstitial or complete disruption of the ACL, partial tear of the PCL, no medial or lateral tear of the meniscus identified, bone contusion of the medial femoral condyle, and possible biceps femoris tendon disruption (photos will be presented). FINAL WORKING DIAGNOSIS: Rupture of the ACL and LCL with biceps femoris tendon rupture Partial PCL tear with a MCL grade I sprain Superficial peroneal nerve injury. TREATMENT AND OUTCOMES: Passive ROM with a hinge brace and non-weight bearing prior to surgery Surgical repair of the lateral complex with a arthroscopic repair of the ACL and surgical release of the impinged peroneal nerve (intraoperative photos will be presented).

ELBOW INJURY - GYMNASTICS

HISTORY: A 16 year old level 10 gymnast sustained an injury to her left elbow while practicing. She was performing a handstand and hyperextended her left elbow, noting a “popping” feeling and immediate pain. Her preliminary diagnosis was an elbow sprain and she was instructed to do range of motion exercises. She attempted to practice and was noted by her coach to have a swollen left forearm and fingers 10 days later. At that time she complained of mild pain at the elbow, some hand grip weakness and decreassed range of motion in all directions, including pronation and supination of the left elbow and forearm. She denied numbness or tingling. PHYSICAL EXAMINATION: Examination revealed significant swelling of the medial aspect of the left elbow, as well as minimal swelling of the left forearm, hand and fingers. There was also a 5 cm × 10 cm area of ecchymosis located at the medial aspect of the left elbow. She had decreased range of motion, from 5 to 80 degrees in flexion and extension, compared to -10 to 120 degrees on the right, and 45 degrees in both pronation and supination. She had 3+ laxity to valgus stress as well. Tenderness, although mild, was elicited along the medial border of the proximal ulna. Strength was decreased in the left hand and wrist with normal strength in flexion and extension of the elbow. Radial and brachial pulses were equal and symmetrical bilaterally. Her extremities were well perfused. DIFFERENTIAL DIAGNOSIS: Avulsion fracture medial apophysis Medial collateral ligament sprain Muscle/tendon tear, medial flexor group Acute elbow subluxation Osteochondral fracture of capitellum Compartment syndrome TEST AND RESULTS: RADIOGRAPHS: Bilateral elbow anterior-posterior and lateral radiographs: no obvious fractures of left radius or ulna questionable increased space between left distal medial apophysis and capitellum compared to right closed growth plates Magnetic Resonance Imaging – left elbow complete tear medial collateral ligament partial tear common flexor tendon FINAL WORKING DIAGNOSIS: Left medial collateral ligament tear Partial tear, medial flexor tendon group TREATMENT AND OUTCOMES: Physical Therapy Anti-inflammatory medication Elbow extension splint Referral to orthopedic surgery

MR imaging of meniscal cysts: incidence, location, and clinical significance.

The purpose of this study was to determine the incidence of medial versus lateral meniscal cysts as seen on MR imaging. A total of 2572 knee MR imaging reports were retrospectively reviewed for the presence of meniscal tears and cysts. Two musculoskeletal radiologists reviewed all images with reported cysts. The type and location of meniscal tear and the presence and location of meniscal cysts were recorded. A total of 1402 meniscal tears were reported in 2572 MR examinations (922 [66%] of 1402 in the medial compartment; 480 [34%] of 1402 in the lateral compartment). Meniscal cysts were present in 109 (4%) of 2572 knees. Of the 109 cysts, 72 (66%) were in the medial compartment, and 37 (34%) were in the lateral compartment. Meniscal cysts were found in association with 72 (7.8%) of the 922 medial meniscal tears and 37 (7.7%) of the 480 lateral meniscal tears. Meniscal cysts showed direct contact with an adjacent meniscal tear in 107 (98%) of 109 cases, with the tear showing a horizontal component in 96 (90%) of 107 cases. Meniscal cysts occur almost twice as often in the medial compartment as in the lateral compartment. Medial and lateral tears occur with the same frequency. These findings, when viewed in the context of the historical literature on meniscal cysts, suggest that MR imaging detects a greater number of medial meniscal cysts than physical examination or arthroscopy, and that MR imaging can have an important impact on surgical treatment of patients.

Delayed re-endothelialization and T-cell infiltration following intracoronary radiation therapy in the porcine model

Purpose: To evaluate the late induction of apoptosis following intracoronary radiation (IR) and the effects of IR on inflammatory cells. Methods and Materials: Porcine coronaries were injured by balloon overstretch followed by either 0 or 15 Gy of 192Ir prescribed to 2 mm from the center of the source. Swine were euthanized at 3, 7, and 14 days posttreatment, and arteries were stained for markers of smooth muscle cells (SMCs α-actin), T cells (CD3), macrophages, endothelial cells, and apoptotic nuclei (terminal uridine nick end labeling, TUNEL). Intimal area (IA) and IA corrected for medial fracture length (IA/FL) were quantified by digital image analysis, which was also used to quantify the distribution of immunostain-positive cells in the adventitia, media, and neointima, respectively. Results: IA/FL was significantly reduced following treatment with 15 Gy, in association with decreased SMC density. Following injury and IR, TUNEL- and CD3-positive cell density increased significantly, and density of macrophages was increased in the adventitia and neointima. Staining for endothelial cells revealed a delay of re-endothelialization after radiation treatment. Conclusion: Increased T-cell infiltration at the medial tear following IR, perhaps due to incomplete re-endothelialization, may indicate incomplete healing. The elevated apoptosis of these infiltrating T cells may indicate a mechanism for the resolution of inflammation.

Differential remodeling after balloon overstretch injury and either β- or γ-intracoronary radiation of porcine coronary arteries

Background: Restenosis is a consequence of both neointimal hyperplasia and vessel remodeling. Prior studies have shown that intracoronary radiation (IR) prevents neointima accumulation, but its contribution to vessel remodeling is unknown. The purpose of this study was to evaluate the effect of IR on differential vascular remodeling after balloon angioplasty in porcine coronary arteries. Methods: A total of 20 juvenile swine (30 coronary arteries) were subjected to overstretch balloon injury (BI) followed by IR with either β- or γ-radiation ( 90Y or 192Ir). After 2 weeks following treatment, serial tissue sections were perfusion fixed and stained by hematoxylin and eosin (H&E), Verhoeff von Giesson (VVG), or Masson Trichrome. Adventitial area (AA), lumen area (LA), vessel area (VA), intimal area (IA), and IA corrected for medial fracture length (IA/FL) were quantified by digital image analysis. The vessel circumference was divided into two regions containing (1) the undisrupted region (UReg) with the undisrupted arc of media and internal elastic lamina (IEL) and (2) the disrupted region (DReg) with the disrupted arc between the medial tears. Quantitative regional analysis was performed by (1) measuring the IEL to define the UReg, (2) calculating the area of the UReg with the perimeter value derived from measurement of the IEL, and (3) calculating the DReg as follows: LA+IA−UReg. Immunohistochemical smooth muscle cell α-actin and Masson Trichrome were quantified by digital image analysis. Results: The IA/FL was significantly smaller following treatment with 90Y or 192Ir vs. control ( P<.01). A smaller AA was obtained following IR with both β- and γ-sources vs. control ( P<.01). The UReg calculation was smaller in the irradiated arteries as compared to control (β: 2.3±0.4 mm 2, γ: 2.1±0.5 mm 2, P<.01 vs. control; control: 3.6±0.7 mm 2). In contrast, the DReg was increased following IR, as demonstrated by the FL and the calculated area of the injured segment (control: 2.7±0.5 mm 2; β: 5.5±1.1 mm 2, γ: 5.5±1.1 mm 2, P<.01 vs. control). Adventitial α-actin positive cell density (CD) was decreased after IR; however, the collagen density was similar. In contrast, the neointimal collagen density in the injured segment was significantly decreased following IR. Conclusion: We consider that the global arterial remodeling after IR is a heterogeneous process that includes the absence of retraction in an UReg and a positive remodeling in the DReg as shown in the porcine coronary model. These changes in adventitia and neointima appear to contribute to differential vascular remodeling caused by IR in injured vessels.