scholarly journals Augmentation Strategies following the Microfracture Technique for Repair of Focal Chondral Defects

Cartilage ◽  
2010 ◽  
Vol 1 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Eric J. Strauss ◽  
Joseph U. Barker ◽  
James S. Kercher ◽  
Brian J. Cole ◽  
Kai Mithoefer
Keyword(s):  
Treatment Options ◽  
Operative Management ◽  
Biomechanical Properties ◽  
Clinical Results ◽  
Symptomatic Improvement ◽  
Comprehensive Overview ◽  
Chondral Lesions ◽  
Repair Tissue ◽  
Chondral Defects ◽  
Augmentation Techniques

The operative management of focal chondral lesions continues to be problematic for the treating orthopedic surgeon secondary to the limited regenerative capacity of articular cartilage. Although many treatment options are currently available, none fulfills the criteria for an ideal repair solution, including a hyaline repair tissue that completely fills the defect and integrates well with the surrounding normal cartilage. The microfracture technique is an often-utilized, first-line treatment modality for chondral lesions within the knee, resulting in the formation of a fibrocartilaginous repair tissue with inferior biochemical and biomechanical properties compared to normal hyaline cartilage. Although symptomatic improvement has been shown in the short term, concerns about the durability and longevity of the fibrocartilaginous repair have been raised. In response, a number of strategies and techniques for augmentation of the first-generation microfracture procedure have been introduced in an effort to improve repair tissue characteristics and reduce long-term deterioration. Recent experimental approaches utilize modern tissue-engineering technologies including local supplementation of chondrogenic growth factors, hyaluronic acid, or cytokine modulation. Other second-generation microfracture-based techniques use different types of scaffold-guided in situ chondroinduction. The current article presents a comprehensive overview of both the experimental and early clinical results of these developing microfracture augmentation techniques.

Patellar Tendinopathy in Athletes

2000 ◽  
Vol 28 (3) ◽  
pp. 392-397 ◽  
Author(s):  
Alfredo Schiavone Panni ◽  
Mario Tartarone ◽  
Nicola Maffulli
Keyword(s):  
Operative Management ◽  
Clinical Results ◽  
Symptomatic Improvement ◽  
Rehabilitation Program ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Patellar Tendinopathy ◽  
Mucoid Degeneration ◽  
Tendon Tissue ◽  
Antiinflammatory Drugs

We report the results of nonoperative and operative management of patellar tendinopathy in 42 athletes with Blazina stage 2 (26 patients) or stage 3 (16 patients) patellar tendinopathy. All patients were initially managed nonoperatively with nonsteroidal antiinflammatory drugs, physical therapy, and a progressive rehabilitation program based on isometric exercises, stretching, and eccentric exercises. After 6 months, 33 patients showed symptomatic improvement and were able to resume their sports. In nine patients with Blazina stage 3 tendinopathy, nonoperative measures failed, and surgery was performed. Operative treatment consisted of removal of the degenerated areas of the tendon, multiple longitudinal tenotomies, and drilling of the lower pole of the patella at the site of tendon attachment. Histologic examination of the excised tendon tissue showed areas of necrosis and mucoid degeneration, and alterations of the bone-tendon junction. After a mean follow-up of 4.8 years, clinical results were excellent or good in all patients. In the group treated nonoperatively, results were better in the patients who had stage 2 tendinopathy than in those with stage 3.

scholarly journals Clinical Results of A Novel Arthroscopic Microfracture Technique For Chondral Lesions of The Lunate

2020 ◽  
Author(s):  
Bulent Ozcelik ◽  
Tugrul Yildirim
Keyword(s):  
Clinical Results ◽  
Chondral Defect ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Chondral Lesions ◽  
Chondral Defects ◽  
Ulnar Impaction ◽  
Significant Difference ◽  
Drilling Technique ◽  
Ulnar Impaction Syndrome

Abstract PurposeChondral lesions of the lunate are one of the causes of ulnar-sided pain, but there has been little interest to date in treating them. In this paper, we describe a modification of the subchondral drilling technique in which an 18-gauge (G) needle was used as a sleeve to guide a K-wire to the lunate chondral defect.MethodsEleven patients (nine women, two men) who had undergone a simultaneous arthroscopic wafer procedure and lunate microfracture between 2014 and 2017 were retrospectively reviewed. After completion of the arthroscopic wafer procedure, an 18G needle was placed into the joint via the 6R portal and the needle tip was inserted into the subchondral bone. A 0.8-mm K-wire was then advanced through the needle and the lunate was drilled to a 2–3-mm depth. It is possible to safely drill remaining areas by only changing the direction of the needle. ResultsEight patients met inclusion criteria. There was no significant difference between the preoperative and postoperative wrist range of motion (p>0.05). Grip strength was significantly improved postoperatively (p<0.05). According to the Mayo wrist scoring system, six and one patients had excellent and good results, respectively.ConclusionArthroscopic lunate microfracture is an effective treatment for chondral defects of the lunate in the setting of ulnar impaction syndrome, and using a needle as a sleeve can ease manipulation and increase accuracy. Level of Evidence: IV

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

scholarly journals The Evolution and Role of the Bursal Acromial Reconstruction

2021 ◽  
Vol 1 (2) ◽  
pp. 263502542110013
Author(s):  
Daniel M. Curtis ◽  
W. Michael Pullen ◽  
Kevin Helenius ◽  
Michael T. Freehill
Keyword(s):  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Treatment Options ◽  
Clinical Problem ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Promising Alternative ◽  
Diagnostic Arthroscopy ◽  
Superior Capsular Reconstruction

Background: Massive, irreparable rotator cuff tears (RCTs) remain a challenging clinical problem with numerous described treatment options. Bursal acromial reconstruction (BAR) represents a promising and evolving technique for a subset of patients with irreparable RCTs. Indications: BAR is indicated for patients with massive, irreparable RCTs with a primary complaint of pain, well-compensated shoulder function, and minimal radiographic degenerative changes of the glenohumeral joint as an alternative to reverse total shoulder arthroplasty or superior capsular reconstruction. Technique Description: Positioning per surgeon preference and diagnostic arthroscopy is performed. Subacromial decompression with a minimal and gentle acromioplasty is performed, followed by assessment of RCT repairability. If the tear is deemed irreparable, acromial measurements in the medial-lateral and anterior-posterior dimensions are obtained. Two pieces of acellular dermal allograft are cut to the acromial dimensions and affixed together using fibrin glue. The reactive side (facing the acromion), medial, and anterior sides of the graft are labeled. Two suture tapes are passed through the corners of the graft and self-locked and run diagonally in a cruciate configuration using an antegrade suture passer. Medial and lateral #2 fiberwire sutures are placed in a luggage-tag configuration. Neviaser (posterior), middle, and anterior acromioclavicular joint portals are created for medial sided suture passage. Medial graft sutures are shuttled through the respective medial portals and the graft is pulled into the subacromial space. The lateral sutures are then removed from percutaneous posterolateral, middle lateral, and anterolateral portals along the acromial edge. Medial sutures are retrieved using a suture grasper subcutaneously on top of the acromion through the percutaneous lateral portals. The sutures are tied through the lateral portals, starting with the medial-lateral sutures, and the knots are buried. Postoperatively, patients are progressed through passive, active-assisted, and active range of motion between weeks 2 and 6 and strengthening is progressed at 6 weeks. Results: Clinical results are lacking in the literature, but anecdotal results in our institution have demonstrated promising early outcomes. Discussion/Conclusion: BAR represents a promising alternative in the array of surgical options for treatment of irreparable RCTs.

scholarly journals Human Mesenchymal Stromal Cells Enhance Cartilage Healing in a Murine Joint Surface Injury Model

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1999
Author(s):  
Jade Perry ◽  
Anke J. Roelofs ◽  
Claire Mennan ◽  
Helen S. McCarthy ◽  
Alison Richmond ◽  
...  
Keyword(s):  
Mesenchymal Stromal Cells ◽  
Cartilage Repair ◽  
Stromal Cells ◽  
Fluorescent Protein ◽  
Joint Surface ◽  
Human Umbilical Cord ◽  
Repair Tissue ◽  
Adult Mice ◽  
Chondral Defects ◽  
Repair Mechanisms

Human umbilical cord (hUC)- or bone marrow (hBM)-derived mesenchymal stromal cells (MSCs) were evaluated as an allogeneic source of cells for cartilage repair. We aimed to determine if they could enhance healing of chondral defects with or without the recruitment of endogenous cells. hMSCs were applied into a focal joint surface injury in knees of adult mice expressing tdTomato fluorescent protein in cells descending from Gdf5-expressing embryonic joint interzone cells. Three experimental groups were used: (i) hUC-MSCs, (ii) hBM-MSCs and (iii) PBS (vehicle) without cells. Cartilage repair was assessed after 8 weeks and tdTomato-expressing cells were detected by immunostaining. Plasma levels of pro-inflammatory mediators and other markers were measured by electrochemiluminescence. Both hUC-MSC (n = 14, p = 0.009) and hBM-MSC (n = 13, p = 0.006) treatment groups had significantly improved cartilage repair compared to controls (n = 18). While hMSCs were not detectable in the repair tissue at 8 weeks post-implantation, increased endogenous Gdf5-lineage cells were detected in repair tissue of hUC-MSC-treated mice. This xenogeneic study indicates that hMSCs enhance intrinsic cartilage repair mechanisms in mice. Hence, hMSCs, particularly the more proliferative hUC-MSCs, could represent an attractive allogeneic cell population for treating patients with chondral defects and perhaps prevent the onset and progression of osteoarthritis.

The non-operative management of bony mallet injuries

2021 ◽  
pp. 175319342199298
Author(s):  
Ryan W. Trickett ◽  
James Brock ◽  
David J. Shewring
Keyword(s):  
Fragment Size ◽  
Visual Analogue Score ◽  
Operative Management ◽  
Clinical Results ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Custom Made ◽  
Evaluation Measure ◽  
Non Operative Management ◽  
Extensor Lag

Over a 4-year period, 218 mallet fractures in 211 adult patients were treated using a custom-made thermoplastic splint. Clinical results were collected prospectively, including the visual analogue score for pain, the range of motion and extensor lag, and the Patient Evaluation Measure (PEM). The joints were congruent in 168 and subluxed in 50. There were no differences in range of movement, extensor lag or PEM associated with articular subluxation or the size of the articular fragment. Pre-existing joint degeneration did not influence outcome. Non-surgical treatment demonstrates predictably good outcomes regardless of fragment size or subluxation in most patients and should be considered when discussing treatment for patients with bony mallet fractures. Level of evidence: III

scholarly journals Non-Surgical Management and Post-Surgical Rehabilitation of Carpal Tunnel Syndrome: An Algorithmic Approach and Practical Guideline

2020 ◽  
Vol 11 (3) ◽  
Author(s):  
Mahshid Nazarieh ◽  
Azadeh Hakakzadeh ◽  
Shima Ghannadi ◽  
Faezeh Maleklou ◽  
Zahra Tavakol ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Surgical Management ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Treatment Options ◽  
Operative Management ◽  
Functional Improvement ◽  
Therapeutic Effects ◽  
Multiple Treatment ◽  
Tunnel Syndrome

: One of the most common forms of entrapment neuropathy is Carpal Tunnel Syndrome (CTS). There are various treatment options for CTS. However, there are no clear and structured guidelines. This review classified the existing treatments and developed an algorithm to help physicians to choose the best option for their patients. Treatment options were summarized in three sections: non-surgical management of CTS, post-operative management of CTS, and practical open carpal tunnel release post-op protocol. The physicians can prescribe multiple treatment options to CTS patients. Corticosteroid in oral or injectable form has strong evidence in pain control and functional improvement in the short term. Shockwave therapy and nocturnal wrist splints display moderate therapeutic effects. Post carpal tunnel release rehabilitation can be started a few days after the operation.

scholarly journals RETROSPECTIVE EVALUATION OF SUCCESS OF IMPLANT SUPPORTED PROSTHESIS: EARLY RESULTS

2020 ◽  
Vol 7 (12) ◽  
pp. 189-198
Author(s):  
Zeynep Başağaoğlu Demirekin ◽  
Yavuz Findik ◽  
S. Süha Turkaslan ◽  
Timuçin Baykul ◽  
Merve Erken
Keyword(s):  
Treatment Options ◽  
Clinical Results ◽  
Long Term Results ◽  
Retrospective Evaluation ◽  
Early Results ◽  
Single Crown ◽  
Long Term Follow Up ◽  
Implant Therapy

Introduction: The interpretation of clinical results of dental implant supported prosthesis treatment is very crucial to be able to make a comparison between different implant systems and treatment options and furthermore to benefit the experiences of the other clinicians. However, the clinical outcomes of these studies should be reported in an objective way and be independent from the system used and also be prepared in accordance with certain criteria and standards that have been accepted scientifically world-wide for being reliable and describing long-term results. Aim: Three-hundred and eighty-two consecutive NTA implants were performed on ninety-nine patients. The implants used in 2016 and the constructed restorations were retrospectively analyzed. In addition, the effect of the experience of clinician was evaluated related with the success of the implant therapy. Materials and Method: This retrospective study was conducted in the Department of Prosthodontics Süleyman Demirel University. Three-hundred and eighty-two consecutive NTA implants were performed on ninety-nine patients. The implants used in 2016 and the constructed restorations were retrospectively analyzed. Results: The implants were followed for at least 2 years. In total, 239 implants were inserted. It was found in 143 mandibles. Prosthetic restorations were determined to be partial prosthetics (219), single crown (81) and overdenture prosthetics (64). During the evaluation period, 6 implants failed before prosthetic treatment, ten decementations, six retentive screw loosening and five porcelain chipping were detected. Discussion and Conclusions: The early results of our study are consistent with the results of other studies. However, long-term follow-up is required for more accurate assessments.

A Systematic Review of the Tensile Biomechanical Properties of the Neonatal Brachial Plexus

2021 ◽  
Author(s):  
Virginia Orozco ◽  
Rachel Magee ◽  
Sriram Balasubramanian ◽  
Anita Singh
Keyword(s):  
Brachial Plexus ◽  
Biomechanical Properties ◽  
Large Animal ◽  
Comprehensive Overview ◽  
Related Factors ◽  
Large Animal Models ◽  
Biomechanical Responses ◽  
Biomechanical Parameters ◽  
Injury Outcomes

Abstract Brachial plexus birth injury has a reported incidence of 1 to 4 per 1000 live births. During complicated deliveries, neonatal, maternal, and other birth-related factors can cause over-stretching or avulsion of the neonatal brachial plexus leading to injury. Understanding biomechanical responses of the neonate brachial plexus when subjected to stretch can offer insight into the injury outcomes while guiding the development of preventative maneuvers that can help reduce the occurrence of neonatal brachial plexus injuries. This review article aims to offer a comprehensive overview of existing literature reporting biomechanical responses of the brachial plexus, in both adults and neonates, when subjected to stretch. Despite the discrepancies in the reported biomechanical properties of the brachial plexus, the studies confirm the loading rate and loading direction dependency of the brachial plexus tissue. Future studies, possibly in vivo, that utilize clinically-relevant neonatal large animal models can provide translational failure values of the biomechanical parameters for the neonatal brachial plexus when subjected to stretch.

scholarly journals Cost-effectiveness analysis (CEA) of IMRT plus C12 boost vs IMRT only in adenoid cystic carcinoma (ACC) of the head and neck

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
A D Jensen ◽  
Jürgen Debus
Keyword(s):  
Cost Effectiveness ◽  
Local Control ◽  
Recurrent Disease ◽  
Treatment Options ◽  
Combined Treatment ◽  
Intensity Modulated Radiotherapy ◽  
Experimental Treatment ◽  
Clinical Results ◽  
Particle Therapy ◽  
Combination Regimen

Abstract Background Particle therapy provides steep dose gradients to facilitate dose escalation in challenging anatomical sites which has been shown not only to improve local control but also overall survival in patients with ACC. Cost-effectiveness of intensity-modulated radiotherapy (IMRT) plus carbon ion (C12) boost vs IMRT alone was performed in order to objectivise and substantiate more widespread use of this technology in ACC. Methods Patients with pathologically confirmed ACC received a combination regimen of IMRT plus C12 boost. Patients presenting outside C12 treatment slots received IMRT only. Clinical results were published; economic analysis on patient-level data was carried out from a healthcare purchaser’s perspective based on costs of healthcare utilization. Cost histories were generated from resource use recorded in individual patient charts and adjusted for censoring using the Lin I method. Cost-effectiveness was measured as incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed regarding potentially differing management of recurrent disease. Results The experimental treatment increased overall costs by € 18,076 (€13,416 – €22,922) at a mean survival benefit of 0.86 years. Despite improved local control, following costs were also increased in the experimental treatment. The ICER was estimated to 26,863 €/LY. After accounting for different management of recurrent disease in the two cohorts, the ICER was calculated to 20,638 €/LY. Conclusion The combined treatment (IMRT+C12 boost) substantially increased initial and overall treatment cost. In view of limited treatment options in ACC, costs may be acceptable though. Investigations into quality of life measures may support further decisions in the future.

Sign in / Sign up

Export Citation Format

Share Document