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Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

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World Journal of Orthopedics 2017年第5期8卷 379-384页

作者： Matthew Lacey joseph lamplot Kempland C Walley joseph P De Angelis Arun J Ramappa Department of Orthopaedic Surgery Harvard Medical School Beth Israel Deaconess Medical Center

AIM To describe an approach to anterior cruciate ligament(ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary(IM) femoral *** Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware(locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL's anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft's outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are

关键词： Anteromedial drilling Intramedullary femoral nail Anterior cruciate ligament reconstruction Retained hardware

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BMP signaling in mesenchymal stem cell differentiation and bone formation

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Journal of Biomedical Science and Engineering 2013年第8期6卷 32-52页

作者： Maureen Beederman joseph D. lamplot Guoxin Nan Jinhua Wang Xing Liu Liangjun Yin Ruidong Li Wei Shui Hongyu Zhang Stephanie H. Kim Wenwen Zhang Jiye Zhang Yuhan Kong Sahitya Denduluri Mary Rose Rogers Abdullah Pratt Rex C. Haydon Hue H. Luu Jovito Angeles Lewis L. Shi Tong-Chuan He Molecular Oncology Laboratory Department of Orthopaedic Surgery The University of Chicago Medical Center Chicago USA Molecular Oncology Laboratory Department of Orthopaedic Surgery The University of Chicago Medical Center Chicago USA The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine Designated by the Chinese Ministry of Education Chongqing Medical University Chongqing China Molecular Oncology Laboratory Department of Orthopaedic Surgery The University of Chicago Medical Center Chicago USA The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine Designated by the Chinese Ministry of Education Chongqing Medical University Chongqing China Molecular Oncology Laboratory Department of Orthopaedic Surgery The University of Chicago Medical Center Chicago USA Stem Cell Biology and Therapy Laboratory of the Key Laboratory for Pediatrics Co-Designated by Chinese Ministry of Education The Children’s Hospital of Chongqing Medical University Chongqing China Molecular Oncology Laboratory Department of Orthopaedic Surgery The University of Chicago Medical Center Chicago USA Stem Cell Biology and Therapy Laboratory of the Key Laboratory for Pediatrics Co-Designated by Chinese Ministry of Education The Children’s Hospital of Chongqing Medical University Chongqing China The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine Designated by the Chinese Ministry of Education Chongqing Medical University Chongqing China

Bone morphogenetic proteins (BMPs) are members of the TGF-β superfamily and have diverse functions during development and organogenesis. BMPs play a major role in skeletal development and bone formation, and disruptions in BMP signaling cause a variety of skeletal and extraskeletal anomalies. Several knockout models have provided insight into the mechanisms responsible for these phenotypes. Proper bone formation requires the differentiation of osteoblasts from mesenchymal stem cell (MSC) precursors, a process mediated in part by BMP signaling. Multiple BMPs, including BMP2, BMP6, BMP7 and BMP9, promote osteoblastic differentiation of MSCs both in vitro and in vivo. BMP9 is one of the most osteogenic BMPs, yet it is a poorly characterized member of the BMP family. Several studies demonstrate that the mechanisms controlling BMP9-mediated osteogenesis differ from other osteogenic BMPs, but little is known about these specific mechanisms. Several pathways critical to BMP9-mediated osteogenesis are also important in the differentiation of other cell lineages, including adipocytes and chondrocytes. BMP9 has also demonstrated translational promise in spinal fusion and bone fracture repair. This review will summarize our current knowledge of BMP-mediated osteogenesis, with a focus on BMP9, by presenting recently completed work which may help us to further elucidate these pathways.

关键词： BMP BMP9 Bone Regeneration IGF Osteogenesis TGF-β Wnt Signal Transduction Mesenchymal Stem Cells MSCs

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