Retrospective review. Evaluation of the impact of diabetes on lumbar spine surgery. Characteristics of diabetes that increase the risk of postoperative complications and poor surgical outcomes after lumbar spine surgery remain unclear. The demographic and clinical data of diabetic and nondiabetic patients, 50 years or older, undergoing lumbar spine surgery were reviewed. Japanese Orthopaedic Association and visual analogue scale scores for low back pain, leg pain, and numbness were assessed as perioperative outcomes. Analysis of covariance was used for comparison of perioperative outcomes to adjust for differences between the groups, and a proportional odds model was used to compute the odds ratio of poor improvement in each outcome. Forty-one patients with diabetes were compared with 124 patients without diabetes. Visual analogue scale scores of final low back pain was higher for patients with than without diabetes (29.3 vs. 17.9, P = 0.013). Complications were similar in patients with and without diabetes except for nonunion after fusion surgery (20% vs. 3%, P = 0.095). When stratified by surgical procedure, final low back pain was significantly higher for patients with diabetes who underwent fusion surgery (39.1 vs. 17.4, P = 0.001). Patients with glycosylated hemoglobin of 6.5% or more displayed a 2-fold increase only in the odds ratio (OR) of poor improvement of low back pain (OR = 2.37; 95% confidence interval [CI], 0.99-5.70). Patients having diabetes for 20 years or more were more likely to experience poor improvement of low back pain and leg numbness (OR = 4.95; 95% CI, 1.69-14.5 and OR = 2.80; 95% CI, 0.98-7.94, respectively). Insulin use was associated with an increased OR for poor improvement of leg numbness (OR = 4.49; 95% CI, 1.24-16.3). Longstanding diabetes, poor glycemic control, and insulin use might be associated with poor postoperative improvement.

To investigate the efficacy of the transplantation of autologous bone marrow-derived mesenchymal stem cells (BMSCs) under arthroscopy with microfracture (MFX) compared with microfracture alone. Eleven patients with a symptomatic articular cartilage defect of the knee were included in the study. They were randomized to receive BMSCs with MFX (cell-T group, n=7) or MFX alone (control group, n=4). Clinical results were evaluated using International Knee Documentation committee (IKDC) knee evaluation questionnaires and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before and 48 weeks after surgery. Quantitative and qualitative assessments of repair tissue were carried out at 48 weeks by T2 mapping of magnetic resonance images (MRIs) and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system with follow-up MRI. No significant differences between preoperative and postoperative IKDC and KOOS were observed in the cell-T or control group. However, forty-eight weeks after surgery, the cell-T group showed a trend for a greater KOOS QOL score compared with the control group (79.4 vs. 39.1, respectively; P=0.07). The T2 value did not differ significantly between the two groups, but the mean MOCART score was significantly higher in the cell-T group than in the control group (P=0.02). Compared with MFX alone, BMSC transplantation with MFX resulted in better postoperative healing of the cartilage and subchondral bone as determined by the MOCART score. Clinically, BMSC transplantation with MFX gave a higher KOOS QOL score after 48 weeks.

Background: Although arthroscopic meniscal reshaping for discoid lateral meniscus (DLM) has better outcomes than total or subtotal meniscectomy, degenerative changes on radiographs are still seen in some patients with meniscal reshaping. Purpose: To assess the risk factors associated with knee joint degeneration after reshaping surgery for juvenile DLM. Study Design: Case-control study; Level of evidence, 3. Methods: Forty patients (45 knees) with a mean age of 12.0 years who underwent arthroscopic meniscal reshaping for DLM were enrolled at a mean of 39.6 months after surgery. For all patients, meniscal saucerization was performed first. Then, if the residual meniscus was unstable, stabilization was provided with suture fixation. At final follow-up, we obtained radiographs to assess degenerative changes to the knee joint using the classification by Tapper and Hoover. Residual meniscal width and meniscal extrusion (defined as a relative percentage of extrusion [RPE]) were measured with magnetic resonance imaging (MRI). Then, the correlation between radiographic evidence of degenerative changes (Tapper and Hoover grade), residual meniscal width, and RPE were assessed with Pearson and Spearman correlation analyses. Logistic regression analysis was used to examine whether preoperative characteristics correlated with degeneration and residual meniscal width. Results: The mean residual meniscal width was 4.6 mm (range, 3.8-6.0 mm), and the mean ± SD RPE was 25.5% ± 21.8% at the final follow-up. There were 28 knees with Tapper and Hoover grade 0, 10 knees with grade 1, and 7 knees with grade 2. The residual meniscal width and RPE were significantly correlated with Tapper and Hoover grade (ρ = −0.489, P = .0007; ρ = 0.414, P = .005, respectively). The residual meniscal width was also significantly correlated with RPE ( r = −0.416, P = .004). The receiver operating characteristic curve showed that a 5.0-mm residual meniscal width was the cutoff value leading to evidence of degeneration. Multiple logistic regression analysis showed that an anterocentral shift on preoperative MRI was a risk factor for degeneration (odds ratio, 27.2; 95% CI, 1.1-360.5; P = .012) and residual meniscal width less than 5.0 mm (odds ratio, 20.9; 95% CI, 1.5-281; P = .022). Conclusion: Smaller meniscal width and greater severity of meniscal extrusion correlated with knee joint degeneration. An anterocentral shift on preoperative MRI was a risk factor for degenerative changes and smaller residual meniscal width.