Early graft failure after meniscus allograft transplantation： an unusual cause of using all-inside meniscal repair device

Meniscal allograft transplantation （MAT） may offer .an attractive alternative to restore the normal biomechanical structure of knees. The mean early failure rate （≤2 years） of MAT is approximately 10%.1-3 A successful outcome of MAT depends on the ligamentous stability of knee, limb alignment, graft types, and graft fixation methodsY Graft fixations include the meniscal horns and the peripheral rim. Techniques for fixation of the peripheral rim include sutures or a meniscal repair device such as FasT-Fix （Smith ＆ Nephew Inc, Andover, MA, USA）. Here we present an unusual case of early graft failure using FasT-Fix sutured to the peripheral rim of the graft.

Current role in facial allograft transplantation:what have we learned?

Face transplant(FT)has evolved enormously in the last 10 years since the successful completion of the first facial transplant.This procedure has become a new reconstructive option for complex facial deformities to restore the anatomy of patients with severely disfigured faces.The authors review the literature and discuss the main surgical,immunological,and ethical aspects as well as the results described in patients undergoing FT.To date there have been more than thirty FT worldwide.The main indication was post-traumatic deformity.In all cases a standard immunosuppression was performed with three drugs,although acute rejection episodes were observed,that could be controlled with conventional immunosuppressive regimen.Overall,functional and aesthetic results have been excellent at short-term and high satisfaction rate exceeded initial expectations,although long-term data are still scarce.Major complications were opportunistic infections.Five deaths that occurred have reopened the ethical debate about the potential complications and concerns of providing informed consent to recipients.Continuous progresses in microsurgical techniques and preoperative planning have promoted the evolution from partial to full FT.All these are on the basis of accurate and careful selection of well-motivated candidates.The next challenge will be getting new immunosuppressive treatment strategies.Although clinical experience has demonstrated the FT viability,it is still considered an experimental procedure in which we have much to learn to define its true role in the current reconstructive surgery and resolve major technical,medical and ethical problems involved.

Discoid meniscus:Treatment considerations and updates

A discoid meniscus is a morphological abnormality wherein the meniscus loses its normal‘C’shape.Although most patients are asymptomatic,patients might still present with symptoms such as locking,pain,swelling,or giving way.Magnetic resonance imaging is usually needed for confirmation of diagnosis.Based on a constellation of factors,including clinical and radiological,different approaches are chosen for the management of discoid meniscus.The purpose of this review is to outline the treatment of discoid meniscus,starting from conservative approach,to the different surgical options for this condition.The PubMed and Google Scholar databases were used for this review.Studies discussing the treatment of discoid meniscus from 2018 to 2023 were searched.Initially there were 369 studies retrieved,and after removal of studies using the exclusion criteria,26 studies were included in this review.Factors such as stability,presence of tear,and morphology can help with surgical planning.Many approaches have been used to treat discoid meniscus,where the choice is tailored for each patient individually.Postoperatively,factors that may positively impact patient outcomes include male sex,body mass index<18.5,age at symptom onset<25 years,and duration of symptoms<24 months.The conventional approach is partial meniscectomy with or without repair;however,recently,there has been an increased emphasis on discoid-preserving techniques such as meniscoplasty,meniscopexy,and meniscal allograft transplantation.

Osseous Rosai-Dorfman disease of tibia in children:A case report

BACKGROUND Rosai-Dorfman disease(RDD),or sinus histiocytosis with massive lymphadenopathy,is a benign histiocytic disorder.Extranodal involvement is common,occurring in>40%of patients,but bone involvement occurs in<10%of cases.In addition,primary bone RDD is extremely rare.The majority of patients are adolescents and young adults,and the mean age at onset is 20-years-old.CASE SUMMARY We report an 8-year-old Chinese girl who presented to our hospital with an insidious onset of swelling and pain in the middle shaft of her right tibia for 4 mo.We performed total surgical resection of the right tibia lesion and allograft transplantation.A good prognosis was confirmed at the 6 mo follow-up.Pain and swelling symptoms were totally relieved,range of motion of her right knee and ankle returned to normal,and there was no clinical evidence of lesion recurrence at last follow up.Our case is the second reported case of osseous RDD without lymphadenopathy in the shaft of the tibia of a child.CONCLUSION Extranodal RDD is a rare disease and can be misdiagnosed easily.Lesion resection and allograft transplantation are an option to treat extranodal RDD in children with good short term result.Pediatric orthopedist should be aware of this rare disease,especially extranodal involvement.

A proteomic analysis of allograft rejection in rats after liver transplantation

In order to understand the allograft rejection in orthotopic liver transplantation (OLT), an allograft re- jection rat model was established and studied by proteomic approach. The protein expression profiles of liver tissues were acquired by fluorescence two-dimensional difference gel electrophoresis (2D DIGE) that incorporated a pooled internal standard and reverse fluorescent labeling method. The expression levels of 27 protein spots showed significant changes in acute rejection rats. Among these spots, 19 were identified with peptide mass fingerprinting using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) after tryptic in-gel digestion. The results of the present paper could be helpful for our better understanding of allograft rejection in organ transplantation.

Macroscopic and Histological Evaluations of Meniscal AIIograft Transplantation Using Gamma Irradiated Meniscus： A Comparative in Vivo Animal Study

Background：Many studies suggest that the gamma irradiation decreases allograft strength in a dose-dependent manner.However,no study has demonstrated that this decrease in strength translates into higher failure rate in meniscal allograft transplantation （MAT）.The aim of this study was to investigate the effects of gamma irradiation on macroscopic and histological alterations of transplanted meniscal tissue and joint cartilage after MAT.Methods：Medial total meniscectomies were performed on the right knees of 60 New Zealand white rabbits.All meniscal allografts were divided into three groups （20 in each group） and then sterilized with 0 Mrad,1.5 Mrad,or 2.5 Mrad of gamma irradiation.For each group,5 menisci were randomly chosen for scanning electron microscopic （SEM） analysis and the remaining 15 were prepared for MAT surgeries.Forty-five right knees received MAT surgeries （0 Mrad group,1.5 Mrad group,2.5 Mrad group,15 in each group）,whereas the remaining 15 only received medial meniscectomy （Meni group）.The left knees of the Meni group were chosen as the Sham group （n =15）.All the rabbits were sacrificed at week 24 postoperatively.Cartilage of the medial compartment of each group was evaluated macroscopically using the International Cartilage Repair Society （ICRS） score and then histologically using the Mankin score based on the Masson Trichrome staining.Results：The SEM analysis confirmed that the meniscal collagen fibers would be significantly damaged as the dose of gamma irradiation increased.At week 24,the overall scores of macroscopic evaluations of the transplanted meniscal tissue showed no significant differences among the three groups receiving MAT surgeries,except for 2 in the 2.5 Mrad group presented partial radial tears at midbody.The ICRS scores and the Mankin scores showed the lowest in the Sham group and the highest in the Meni group （P 〈 0.05）.For the three groups receiving MAT surgeries,the 2.5 Mrad group showed significant higher ICRS scores and Mankin scores than both the 0 Mrad group and the 1.5 Mrad group （P 〈 0.05）.Whereas the 1.5 Mrad group presented similar results to the 0 Mrad group concerning both the ICRS scores and the Mankin scores.Conclusions：The current in vivo animal study proved that although the meniscal collagen fibers were damaged after gamma irradiation,the failure rate of MAT surgeries might not significantly increase if the irradiation dose was 〈1.5 Mrad for New Zealand white rabbits.

Interleukin-1 receptor antagonist eye drops promoting high-risk corneal allografts survival in rats

Background Immune rejection is the main reason of grafts failure after corneal transplantation. This study was to determine whether interlerkin-1 receptor antagonist (IL-1ra) eye drops could prolong corneal allografts survival in high-risk corneal orthotopic allotransplantation in rat model and to study the effect of IL-1ra on the expression of CD 1-positive cells in the grafts Methods For all experiments, the Sprague-Dawley (SD) rats' corneas were transplanted into Wistar rats' eyes High-risk transplants included those that had been sutured into Wistar recipient beds with corneal neovascularization induced by placement of three interrupted sutures in the host cornea 7 days earlier All the animals were divided, in a masked fashion, into three treatment groups and one control group Each treatment group received IL-1ra eye drops of different concentrations (1 mg/ml, 3 mg/ml, or 5 mg/ml, respectively) four times a day for 30 days The control group received 0 9% normal saline (NS) eye drops in the same way as the treatment groups All allografts were evaluated for signs of rejection from the first day after surgery Ten days later, corneal specimens were processed to examine the expression of CD 1-positive cells and histopathological changes Results The survival time of the transplants was 5 80±0 79, 5 89±1 05, 6 78±0 83, and 9 00±2 36 days respectively in the control or three treatment groups Compared with the control group, 1 mg/ml IL-1ra eye drop did not prolong the survival time of the allografts ( t =0 210, P >0 05) However, 3 mg/ml and 5 mg/ml IL-1ra eye drop did prolong the survival time of the grafts ( t ≥2.627, P <0 05), with the latter showing more obvious effect Immunohistochemical examinations showed a significant decrease in inflammatory cell and CD 1-positive cell infiltration in IL-1ra treated groups compared with the control group Conclusions IL-1ra can promote corneal allograft survival in a dose-dependant manner by reducing the infiltration of CD 1-positive cells in high-risk corneal transplantation