Perichondrial arthroplasty in a canine elbow model: comparison of vascularized and nonvascularized techniques

Pedunculated Synovium Grafts in Articular Cartilage Defects in Rabbits

A rabbit model was used to assess the nature of healing tissues in hyaline cartilage defects and to compare the healing in defects treated with pedunculated synovium grafts to those in defects without synovial grafting. Both knees of 28 1-year-old rabbits were operated. A 3 x 2-mm cartilage defect that exposed cancellous bone was created in the non-weight-bearing area of each medial femoral condyle. Each right-knee defect was covered with a pedunculated synovial graft obtained from the same joint, and the left-knee defects were left uncovered as controls. Groups of rabbits were sacrificed at 3, 6, 12, and 24 weeks postsurgery. Sections from each knee were stained with hematoxylin-eosin and safranin O-fast green staining, and were immunohistochemically stained for type II collagen. The healing at each site was histologically scored, and the intensity of staining for type II collagen was graded. At 12 and 24 weeks, statistical comparisons of histological scores revealed significantly more hyaline cartilage tissue in the synovium-grafted defects. At 24 weeks, these same defects showed significantly more type II collagen. Thus, pedunculated synovium transplantation appears to hold promise as a method for repairing hyaline cartilage defects.

Reconstruction of the distal radius facet by a free vascularized osteochondral autograft: anatomic study and report of a patient

PURPOSE

Large chondral defects of the distal radius after fractures present a reconstructive challenge. The purpose of this study was to present the anatomic findings from a cadaver of a vascularized osteochondral autograft taken from the third metatarsal appropriate for reconstructing the distal radius articular facet. A patient is presented in whom 70% of the scaphoid fossa was reconstructed with this technique.

METHODS

The base of the third metatarsal was studied in the feet of 20 cadavers. The size and shape of the cartilage were measured. Additionally vessel distribution was recorded and the diameters of vascular foramina were measured with Juch's method.

RESULTS

The base of the third metatarsal is pear shaped and is wider dorsally than plantarly. It averages 19.2 mm long on its main axis. Its cartilaginous surface is minimally concave or flat and it is slanted slightly proximal-dorsal to distal-plantar and proximal-peroneal to distal-tibial. Nutrient foramina were found in every case in the dorsum and on both sides of the proximal shaft. At least 1 nutrient vessel could be tracked back to the dorsalis pedis in every dissected specimen.

CONCLUSIONS

The anatomic features of the base of the third metatarsal make it a potential vascularized autograft to consider for osteochondral defects of the distal radius.

Surgical alternatives for elbow arthritis in the young adult

Most surgeons agree that total elbow arthroplasty is best avoided or deferred in patients younger than 60 years of age, although, at times, there may be no reasonable alternative. Other reconstructive options are available that may provide years of useful function, even if they are sometimes considered a surgical bridge to allow the patient to achieve the age at which implant arthroplasty would be appropriate. The patient and surgeon must have a clear understanding of the expectations and limitations of any proposed procedure. The key to success in reconstructive elbow surgery is the choice of the option that best addresses the articular pathology and the needs and desires of the specific patient.