We evaluated 46 patients who had undergone anterior cruciate ligament (ACL) reconstruction using patellar tendons augmented with woven polyester. The mean follow-up was a minimum of 5 years. Lysholm scores improved 35.4 pts. to 94.6 pts. on average postoperatively, and 84.8% of the patients were satisfied with the results of surgery. The mean injured-to-uninjured difference in KT-1000 arthrometer measurements was 1.6 mm. The postoperative range of motion was 148.8°on average. The mean loss of thigh circumference was 0.9 cm, and the mean isokinetic quadriceps and hamstrings muscle strength measurements of the injured side were 89.5% and 97.8% of those of the unijured side, respectively. There were no significant complications, such as chronic synovitis or effusion, infection or rupture of the grafts during the follow-up period. We conluded that the use of woven polyester as augmentation could improve the long-term prognosis of ACL reconstruction.

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We performed 28 arthroscopic capsulo-synovectomies on 17 patients with rheumatoid knees. The results were assessed using the clinical and subjective criteria of Aritomi and criteria of the Japanese Orthopaedic Association. Nineteen knees were radiographically Larsen grade I, 7 were grade II, and 2 were grade III. Surgical techniques were divided into two steps, as follows. First step: Total synovectomy was perfomed in the posterior capsule with multiportal approach. Second step: Total synovectomy and capsulectomy were perfomed in the anterior capsule. The postoperative follow-up period ranged from 1 year to 4 years, 8 months (mean 2 years, 6 months) . Results were good or excellent in 71.4% of this series. The recurrence rate of synovitis was only 21%. Total score and pain score based on JOA criteria improved after operation and a significant difference was recognized (P<0.01) . Reduction of pain and morbidity continued for 3 years. Range of motion of the knee deteriorated in 5 knees and improved in 20 knees, and remained stationary in 2 knees, except for 1 knee which shifted to TKA. The mean improvement in overall ROM was approximately 13°. Larsen grade advanced 28.6% radiographically after operation. Arthroscopic capsulosynovectomy is comparable to open synovectomy in rate of recurrence and reduction of pain, and is equivalent to conventional arthroscopic synovectomy in range of motion. In conclusion, arthroscopic capsulo-synovectomy is essentially an alternative procedure for treating rheumatoid knees.

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Results of late synovectomy of the knee in 16 patients (21 joints) with rheumatoid arthritis treated at our hospital between 1971 and 1991 were evaluated. Relief of pain was obtained in 18 of 19 joints. Two joints were subsequently treated by total knee replacement due to progression of the joint destruction. At the time of follow-up, 90% of the patients were satisfied with the surgical results. There is controversy concerning the usefulness of knee synovectomy in patients with rheumatoid arthritis. However the results of this study indicate that late knee synovectomy, including joint debridement, is useful even in patients with bony destruction unless large bony defect or malalignment of the lower extremity is present.

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To clarify the relationship between joint destruction of the lower extremities and HLA-DRB1 genes in rheumatoid arthritis (RA), we compared DRB1 gene frequencies of 80 RA patients who had undergone lower extremity joint replacement and 298 who had not. Among the 378 RA patients, 327 had adult-onset RA (onset age between 16 and 59 years) and 51 had elderly-onset RA (onset age above 60 years) . Adult-onset RA patients were classified into three disease subsets based on extensiveness of joint destruction on plain radiograms: 190 patients with least erosive subsets (LES), 101 with more erosive subsets (MES), and 36 with most erosive subset with mutilating disease (MUD) . HLA-DRB1 genes were deter-mined using polymerase chain reaction and sequence specific oligonucleotide methods.
HLA-DRB1* 0405 gene expression was somewhat higher in RA patients with joint replacement than in those without it, but not significantly. This may be influenced by the disease severity of RA, because almost all patients with joint replacement had a severer RA disease subset (MES and MUD) . Therefore, we compared the DRB1 gene frequencies of RA patients with joint replacement and RA patients without it who belonged to MES or MUD. DRB1* 0101 gene expression was somewhat higher, but not significantly, in RA patients with joint replacement than in patients with MES or MUD without joint replacement. DRB1* 0405 gene expression was somewhat lower in RA with joint replacement, but not significantly.

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Myasthenia gravis (MG) is sometimes associated with other autoimmune diseases, such as RA, SLE, and thyroiditis. On the other hand, there have also been reports of autoimmune diseases occurring after thymectomy for MG. We report a 51-year-old male with acute destructive monoarthritis of the right wrist joint 15 years after thymectomy for MG. Radiographic examination showed destructive change of the wrist joint 2 months after the onset of arthritis and a moderate level of anti-acetylcholine receptor antibody (19nM/l) . Antibodies against collagen diseases including RA were negative. Histological examination showed RA-like synovitis. We suspect this unusual arthritis may be caused by an immunolo-gical imbalance associated with MG and thymectomy. The patient has had no symptoms one year after synovectomy.

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We recently performed surgical treatment for pseudopodagra. A 55-year-old male who was suffering from pain in his right big toe for 3 months visited our hospital. Systemic chondrocalcinosis was observed in the left big toe, from which a calcified mass had already been resected, and in the bilateral knees, bilateral wrists, the right Achilles tendon, and the left heel. The patient was initially treated with nonsteroidal anti-inflammatory drugs (NSAID), which did not completely alleviate symptoms. Therefore we resected the calcified mass from his first metatarsophalangeal (MTP) joint and did a synovectomy of his first MTP joint. The specimens obtained from the MTP joint were examined by light microscopy, compensated polarized light microscopy, and then by scanning electron microscopy. Results showed that the calcified crystals were deposits of calcium pyrophosphate dehydrate. We concluded that surgical treatment should be done in the case of repeated attacks, and it is necessary to resect not only crystals but also the surrounding tissue of the affected area.

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A case of proliferative synovitis involving the right hip in a 30-year-old woman was reported. Although the patient had a history of CDH, she did not suffer from pain until 2 years ago when she started to have pain in the right hip and bloody synovial fluid was aspirated. Since then, the patient's symptoms were intermittent until recently when they became so aggravated she was admitted to our hospital for further examination. Laboratory findings showed no evidence of bleeding tendency or any other hematopoietic disorders. MRI findings revealed a soft tissue tumor and hematoma mass in the joint. The diagnosis of proliferative synovitis was confirmed histologically in synovial specimens taken at synovectomy. The patient's condition is being monitored by follow-up MRI examination every 6 months.

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