La Valoración del Análisis de la Marcha en la Planificación de la Osteotomía Alta de Tibia

El objetivo de este trabajo ha sido el de valorar una nueva metódica clínica y biomecánica de los pacientes que presentan un genu varo y tratados quirúrgicamente mediante osteotomía tibial alta. De acuerdo a la metódica de Andriacchi e Insall y de nuestra pequeña experiencia hemos aplicado el estudio mediante "gait analysis" a estos pacientes preoperatoriamente. El cálculo preoperatorio del "momento adductor" parece ser discriminativo con respecto a los pacientes que tendrán un buen o mal resultado debido a la recidiva de la deformidad, dolor, etc. Tomando como referencia los resultados de estos estudios sugerimos algunas indicaciones pre y postoperatorias con referencia a la rehabilitación y la orientación quirúrgica más adecuada según el valor del momento adductor (alto o bajo) que presenten este tipo de pacientes.The purpose of this study has been to assess a new clinical and biomechanical approach of genu varum patients treated by high tibial osteotomy. According to Andriacchi, Insall, and their awn small experienc e the author s apply gait analysis to study the genu varum of patients pre-operatively. The assessment during preoperative gait of the adductor moment (high or low value s with respec t to the normal) seems to be discriminant in define patien that are goint to have good or bad results due to the recurrence of the pathology: pain, varus deformity, etc. Starting from the results the studies the authors suggest some indications in the pre and postoperative with reference to rehabilitation and surgical orientation taking in account the high or low level of preoperative the adductor moment

Effect of two different preparations of platelet-rich plasma on synoviocytes

To analyse the modifications induced by two different platelet-rich plasma (PRP) preparations on osteoarthritis (OA) synoviocytes, by documenting changes in gene expression of factors involved in joint physiopathology.OA synoviocytes were cultured for 7 days in medium with different concentrations of either P-PRP (a pure platelet concentrate without leucocytes but with a limited number of platelets), L-PRP (a higher platelet concentrate containing leucocytes) or platelet-poor plasma (PPP). Gene expression of interleukin (IL)-1beta, IL-6, IL-8/CXCL8, tumour necrosis factor alpha, IL-10, IL-4, IL-13, metalloproteinase-13, tissue inhibitor of metalloproteinase (TIMP)-1, (TIMP)-3, (TIMP)-4, vascular endothelial growth factor, transforming growth factor beta1, fibroblast growth factor (FGF)-2, hepatocyte growth factor (HGF), hyaluronic acid (HA) synthases (HAS)-1, (HAS)-2, and (HAS)-3 was analysed by RT-PCR. HA production was determined in culture supernatants by ELISA.IL-1β, IL-8 and FGF-2 were significantly induced by L-PRP compared to both P-PRP and PPP; HGF was down-modulated by L-PRP versus both P-PRP and PPP, and an inverse dose-response influence was shown for all preparations. Expression level of TIMP-4 was lower in the presence of L-PRP compared with P-PRP. HA production and HAS gene expression did not seem to be modulated by PRP.L-PRP is able to sustain the up-regulation of proinflammatory factors, (IL-1beta, IL-8 and FGF-2), together with a down-modulation of HGF and TIMP-4 expression, two factors that have been recognized as anti-catabolic mediators in cartilage, thus supporting the need to further optimize the PRP preparations to be applied in clinical practice

Inspired by nature

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Tissue engineering for total meniscal substitution : Animal study in sheep model

Objective: The aim of the study was to investigate the use of a novel hyaluronic acid/polycaprolactone material for meniscal tissue engineering and to evaluate the tissue regeneration after the augmentation of the implant with expanded autologous chondrocytes. Two different surgical implantation techniques in a sheep model were evaluated. Methods: Twenty-four skeletally mature sheep were treated with total medial meniscus replacements, while two meniscectomies served as empty controls. The animals were divided into two groups: cell-free scaffold and scaffold seeded with autologous chondrocytes. Two different surgical techniques were compared: in 12 animals, the implant was sutured to the capsule and to the meniscal ligament; in the other 12 animals, also a transtibial fixation of the horns was used. The animals were euthanized after 4 months. The specimens were assessed by gross inspection and histology. Results: All implants showed excellent capsular ingrowth at the periphery. Macroscopically, no difference was observed between cell-seeded and cell-free groups. Better implant appearance and integrity was observed in the group without transosseous horns fixation. Using the latter implantation technique, lower joint degeneration was observed in the cell-seeded group with respect to cell-free implants. The histological analysis indicated cellular infiltration and vascularization throughout the implanted constructs. Cartilaginous tissue formation was significantly more frequent in the cell-seeded constructs. Conclusion: The current study supports the potential of a novel HYAFF/polycaprolactone scaffold for total meniscal substitution. Seeding of the scaffolds with autologous chondrocytes provides some benefit in the extent of fibrocartilaginous tissue repair

17)脊椎々間板手術症例の検討 : とくに椎間板障害例における手術適応について(第399回千葉医学会整形外科例会,第8回千葉整形外科災害外科臨床懇談会,千葉県労災指定医集談会)

<p>Data are expressed as medians and interquartile ranges; comparisons among time points, as determined by Friedman-ANOVA test, and between L-PRP and HA treatments, as determined by the Mann-Whitney U test, are not significant. w = week, m = month</p

A multilayer biomaterial for osteochondral regeneration shows superiority vs microfractures for the treatment of osteochondral lesions in a multicentre randomized trial at 2 years

Purpose: The increasing awareness on the role of subchondral bone in the etiopathology of articular surface lesions led to the development of osteochondral scaffolds. While safety and promising results have been suggested, there are no trials proving the real potential of the osteochondral regenerative approach. Aim was to assess the benefit provided by a nanostructured collagen-hydroxyapatite (coll-HA) multilayer scaffold for the treatment of chondral and osteochondral knee lesions. Methods: In this multicentre randomized controlled clinical trial, 100 patients affected by symptomatic chondral and osteochondral lesions were treated and evaluated for up to 2 years (51 study group and 49 control group). A biomimetic coll-HA scaffold was studied, and bone marrow stimulation (BMS) was used as reference intervention. Primary efficacy measurement was IKDC subjective score at 2 years. Secondary efficacy measurements were: KOOS, IKDC Knee Examination Form, Tegner and VAS Pain scores evaluated at 6, 12 and 24 months. Tissue regeneration was evaluated with MRI MOCART scoring system at 6, 12 and 24 months. An external independent agency was involved to ensure data correctness and objectiveness. Results: A statistically significant improvement of all clinical scores was obtained from basal evaluation to 2-year follow-up in both groups, although no overall statistically significant differences were detected between the two treatments. Conversely, the subgroup of patients affected by deep osteochondral lesions (i.e. Outerbridge grade IV and OCD) showed a statistically significant better IKDC subjective outcome (+12.4 points, p = 0.036) in the coll-HA group. Statistically significant better results were also found for another challenging group: sport active patients (+16.0, p = 0.027). Severe adverse events related to treatment were documented only in three patients in the coll-HA group and in one in the BMS group. The MOCART score showed no statistical difference between the two groups. Conclusions: This study highlighted the safety and potential of a biomimetic implant. While no statistically significant differences were found compared to BMS for chondral lesions, this procedure can be considered a suitable option for the treatment of osteochondral lesions

A HYPOTHESIS OF ETIOLOGY OF ATRAUMATIC ACL INJURIES

Atraumatic ACL injury has become more and more frequent especially in sport population. The causes which determine the ACL rupture, have not been identified and the possible relationship between proprioception and subjective function has not been adequately studied. Several authors (Schutte et al. 1987, Schultz et al. 1984) have found the mechanoreceptors in the cruciate ligament, and such receptors formed by muscle spindles, receptors in tendons and in skin determine a complex system for knee joint proprioception. Our starting hypothesis is that a possible cause of ACL lesion could be due to temporary inhibition of the muscular control following an alteration of the propioceptive joint control. The purpose of this study was to verify by a kinesiologic procedure if some stimulation of the subtalus joint could induce an inadequate recruitment of muscle fibers activation