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Yanggu, South Korea

Koh Y.-G.,Yonsei Sarang Hospital | Choi Y.-J.,Yonsei Sarang Hospital
Knee | Year: 2012

Purpose: The aim of the study was to determine if isolated mesenchymal stem cells (MSCs) derived from the infrapatellar fat pad could effectively improve clinical results when percutaneously injected into arthritic knees. Level of evidence: Therapeutic case-control study; Level III. Methods: Twenty five stem cell injections combined with arthroscopic debridement were administered to patients with knee OA. A mean of 1.89×106 stem cells were prepared with approximately 3.0mL of platelet-rich plasma (PRP) and injected in the selected knees of patients in the study group. Results: The mean Lysholm, Tegner activity scale, and VAS scores of patients in the study group improved significantly by the last follow-up visit. No major adverse events related to the injections were observed during the treatment and follow-up periods. The results were compared between the study and control groups, in which the patients had undergone arthroscopic debridement and PRP injection without stem cells. Although the preoperative mean Lysholm, Tegner activity scale, and VAS scores of the study group were significantly poorer than those of the control group, the clinical results at the last follow-up visit were similar and not significantly different between the two groups. Conclusions: The short-term results of our study are encouraging and demonstrate that infrapatellar fat pad-derived MSC therapy with intraarticular injections is safe, and provides assistance in reducing pain and improving function in patients with knee OA. © 2012 .


Koh Y.-G.,Center for Stem Cell and Arthritis Research | Jo S.-B.,Center for Stem Cell and Arthritis Research | Kwon O.-R.,Center for Stem Cell and Arthritis Research | Suh D.-S.,Center for Stem Cell and Arthritis Research | And 3 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: The purpose of this study was to evaluate the clinical and imaging results of patients who received intra-articular injections of autologous mesenchymal stem cells for the treatment of knee osteoarthritis. Methods: The study group comprised 18 patients (6 men and 12 women), among whom the mean age was 54.6 years (range, 41 to 69 years). In each patient the adipose synovium was harvested from the inner side of the infrapatellar fat pad by skin incision extension at the arthroscopic lateral portal site after the patient underwent arthroscopic debridement. After stem cells were isolated, a mean of 1.18 × 106 stem cells (range, 0.3 × 106 to 2.7 × 106 stem cells) were prepared with approximately 3.0 mL of platelet-rich plasma (with a mean of 1.28 × 106 platelets per microliter) and injected into the selected knees of patients. Clinical outcome was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index, the Lysholm score, and the visual analog scale (VAS) for grading knee pain. We also compared magnetic resonance imaging (MRI) data collected both preoperatively and at the final follow-up. Results: Western Ontario and McMaster Universities Osteoarthritis Index scores decreased significantly (P <.001) from 49.9 points preoperatively to 30.3 points at the final follow-up (mean follow-up, 24.3 months; range, 24 to 26 months). Lysholm scores also improved significantly (P <.001) by the last follow-up visit, increasing from a mean preoperative value of 40.1 points to 73.4 points by the end of the study. Likewise, changes in VAS scores throughout the follow-up period were also significant (P =.005); the mean VAS score decreased from 4.8 preoperatively to 2.0 at the last follow-up visit. Radiography showed that, at the final follow-up point, the whole-organ MRI score had significantly improved from 60.0 points to 48.3 points (P <.001). Particularly notable was the change in cartilage whole-organ MRI score, which improved from 28.3 points to 21.7 points (P <.001). Further analysis showed that improvements in clinical and MRI results were positively related to the number of stem cells injected. Conclusions: The results of our study are encouraging and show that intra-articular injection of infrapatellar fat pad-derived mesenchymal stem cells is effective for reducing pain and improving knee function in patients being treated for knee osteoarthritis. Level of Evidence: Level IV, therapeutic case series. © 2013 by the Arthroscopy Association of North America.


Park J.-H.,Yonsei Sarang Hospital | Kang K.-C.,CHA Medical University | Kang K.-C.,Kyung Hee University | Shin D.-E.,CHA Medical University | And 3 more authors.
Osteoporosis International | Year: 2014

Summary: The progression of fractured vertebral collapse is not rare after a conservative treatment of vertebral compression fracture (VCF). Teriparatide has been shown to directly stimulate bone formation and improve bone density, but there is a lack of evidence regarding its use in fracture management. Conservative treatment with short-term teriparatide is effective for decreasing the progression of fractured vertebral body collapse. Introduction: Few studies have reported on the prevention of collapsed vertebral body progression after osteoporotic VCF. Teriparatide rapidly enhances bone formation and increases bone strength. This study evaluated preventive effects of short-term teriparatide on the progression of vertebral body collapse after osteoporotic VCF. Methods: Radiographs of 68 women with single-level osteoporotic VCF at thoracolumbar junction (T11-L2) were reviewed. Among them, 32 patients were treated conservatively with teriparatide (minimum 3 months) (group I), and 36 were treated with antiresorptive (group II). We measured kyphosis and wedge angle of the fractured vertebral body, and ratios of anterior, middle, and posterior heights of the collapsed body to posterior height of a normal upper vertebra were determined. The degree of collapse progression was compared between two groups. Results: The progression of fractured vertebral body collapse was shown in both groups, but the degree of progression was significantly lower in group I than in group II. At the last follow-up, mean increments of kyphosis and wedge angle were significantly lower in group I (4.0°±4.2° and 3.6°±3.6°) than in group II (6.8°±4.1° and 5.8°±3.5°) (p=0.032 and p=0.037). Decrement percentages of anterior and middle border height were significantly lower in group I (9.6±10.3 and 7.4±7.5%) than in group II (18.1±9.7 and 13.8±12.2%) (p=0.001 and p=0.025), but not in posterior height (p=0.086). Conclusions: In female patients with single-level osteoporotic VCF at the thoracolumbar junction, short-term teriparatide treatment did not prevent but did decrease the progression of fractured vertebral body collapse. © International Osteoporosis Foundation and National Osteoporosis Foundation 2013.


Kim Y.S.,Yonsei Sarang Hospital | Park E.H.,Yonsei Sarang Hospital | Kim Y.C.,Yonsei Sarang Hospital | Koh Y.G.,Yonsei University | Lee J.W.,Yonsei University
American Journal of Sports Medicine | Year: 2012

Background: Identifying factors associated with the clinical outcomes of the osteochondral autograft transfer system would be helpful for treating patients with an osteochondral lesion of the talus. Purpose: To investigate the clinical and second-look arthroscopic results of the osteochondral autograft transfer system and to identify the prognostic factors associated with this procedure. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively evaluated 52 ankles that underwent osteochondral autograft transfer for a medial osteochondral lesion of the talus. Second-look arthroscopies were performed at a mean of 13.1 months postoperatively. Clinical outcomes were evaluated according to a visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Tegner activity scale. Statistical analyses were performed to identify various prognostic factors associated with the clinical outcomes. Results: The mean VAS, AOFAS, and Tegner activity scale scores were all significantly improved from 6.9 6 0.9 to 3.3 6 1.4 (VAS), from 67.4±4.9 to 82.6±7.8 (AOFAS), and from 3.0±0.8 to 3.9±0.9 (Tegner; P<.05). Regarding overall patient satisfaction with the operation, 49 (95%) patients reported good to excellent results. Prognostic factors including the patients age, sex, body mass index, duration of symptoms, defect size and depth, location of osteochondral lesion of the talus, and the existence of a subchondral cyst did not significantly influence clinical outcomes (P <.05), except for body mass index on the Tegner activity scale score (P = .021). Significant differences were observed among clinical outcomes for second-look arthroscopy according to the presence of soft tissue impingement and uncovered areas around the graft (P>05). The VAS and AOFAS score at the last follow-up were significantly worse when the articular surface of the tibial plafond at the malleolar osteotomy site was uneven (P = .031 and .012, respectively). Conclusion: This study showed that the articular surface of the tibial plafond at the malleolar osteotomy site, soft tissue impingement, and uncovered areas around the graft were important factors affecting the clinical outcomes, as observed through secondlook arthroscopy. Therefore, surgeons should restore the articular surface accurately after the osteotomy, and more caution should be taken to avoid soft tissue impingement and uncovered areas around the graft when performing osteochondral autograft transfer. © 2012 The Author(s).


Kim Y.S.,Yonsei Sarang Hospital | Park E.H.,Yonsei Sarang Hospital | Lee H.J.,Yonsei Sarang Hospital | Koh Y.G.,Yonsei Sarang Hospital | Lee J.W.,Yonsei University
American Journal of Sports Medicine | Year: 2012

Background: Osteochondral defects of the first metatarsal head can deteriorate to osteoarthritis of the first metatarsophalangeal joint if left untreated. Treatment options for osteochondral defects of the first metatarsal head vary widely. Purpose: To compare the clinical outcomes of the osteochondral autograft transfer system with those of subchondral drilling for the treatment of osteochondral defects of the first metatarsal head. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively evaluated 24 cases of osteochondral defects of the first metatarsal head treated operatively; 14 patients underwent subchondral drilling (group A), while 10 were treated with the osteochondral autograft transfer system (group B). The association of variables of osteochondral defects with clinical outcomes was assessed in each group. Clinical outcomes were evaluated according to a visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, and the Roles and Maudsley score. The Tegner activity scale and an activity rating scale were used to determine the activity levels. Results: The mean VAS score in both groups was significantly improved (from 6.9 ± 0.9 to 3.9±1.3 in group A and from 7.4±0.8 to 3.4±1.2 in group B; P<.05). No difference was noted between the 2 groups at final follow-up (P = .651). The mean AOFAS score in both groups was significantly improved (from 62.9±5.8 to 73.2±8.2 in group A and from 65.0±4.1 to 81.5±5.8 in group B; P<.05). There was a significant difference in mean AOFAS score between the 2 groups at final follow-up (P = .032). Large defect size (≥50 mm 2) and the existence of a subchondral cyst were significant predictors of unsatisfactory clinical outcomes in group A (P = .047 and P = .019, respectively). Multivariate analyses showed a defect size larger than 50 mm2 was associated with significantly worse outcomes on the last follow-up VAS and AOFAS scores in group A (P = .005 for VAS and P = .006 for AOFAS). There was no association of defect size and subchondral cyst with clinical outcomes in group B (P > .05). No association was found between location of the defect area and clinical outcome in either group. Conclusion: For osteochondral defects larger than 50 mm 2 or when a subchondral cyst exists, the osteochondral autograft transfer system could potentially be used as a treatment of choice for osteochondral defects of the first metatarsal head to restore functionality of the metatarsophalangeal joint. © 2012 The Author(s).

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