Microfracture for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Survey of International Cartilage Regeneration & Joint Preservation Society

Cartilage ◽  
2020 ◽  
pp. 194760352095450
Author(s):  
Jesus Medina ◽  
Ignacio Garcia-Mansilla ◽  
Peter D. Fabricant ◽  
Thomas J. Kremen ◽  
Seth L. Sherman ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Regional Differences ◽  
Current Practice ◽  
Cartilage Regeneration ◽  
Postoperative Management ◽  
Cartilage Lesions ◽  
Significant Difference ◽  
Rehabilitation Protocols ◽  
Joint Repair ◽  
Vertical Walls

Objective The purpose of this study was to describe the current practice trends for managing symptomatic cartilage lesions of the knee with microfracture among ICRS (International Cartilage Regeneration & Joint Repair Society) members. Design A 42-item electronic questionnaire was sent to all ICRS members, which explored indications, surgical technique, postoperative management, and outcomes of the microfracture procedure for the treatment of symptomatic, full thickness chondral and osteochondral defects of the knee. Responses were compared between surgeons from different regions and years of practice. Results A total of 385 surgeons answered the questionnaire. There was a significant difference noted in the use of microfracture among surgeons by region ( P < 0.001). There was no association between the number of years in practice and the self-reported proportion of microfracture cases performed ( P = 0.37). Fifty-eight subjects (15%) indicated that they do not perform microfracture at all. Regarding indication for surgery, 56% of surgeons would limit their indication of microfracture to lesions measuring 2 cm2 or less. Half of the surgeons reported no upper age or body mass index limit. Regarding surgical technique, 90% of surgeons would recommend a formal debridement of the calcified layer and 91% believe it is important to create stable vertical walls. Overall, 47% of surgeons use biologic augmentation, with no significant difference between regions ( P = 0.35) or years of practice ( P = 0.67). Rehabilitation protocols varied widely among surgeons. Conclusions Indications, operative technique, and rehabilitation protocols utilized for patients undergoing microfracture procedures vary widely among ICRS members. Regional differences and resources likely contribute to these practice pattern variations.

Autologous Oxygen-Releasing Nano-Biomimetic Scaffold with Chondrocytes Promotes Joint Repair After Trauma

2022 ◽  
Vol 12 (3) ◽  
pp. 602-608
Author(s):  
Wuping Yao ◽  
Yuji Li ◽  
Zhi Liu ◽  
Liuyi Yao ◽  
Rui Liang ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Composite Scaffold ◽  
Control Group ◽  
Tunel Staining ◽  
Osteochondral Fracture ◽  
Patellar Cartilage ◽  
Significant Difference ◽  
Biomimetic Scaffold ◽  
Joint Repair ◽  
Osteochondral Fractures

Our study assesses the role of a scaffold constructed by co-culture of autologous oxygen-releasing biomimetic scaffold (AONS) and chondrocytes in joint repair after trauma. A composite scaffold structure was used and a scaffold constructed of AONS and chondrocytes was transplanted into SD rats to create models of patellar cartilage fracture and hip osteochondral fracture, respectively followed by analysis of cell proliferation by immunofluorescence method, osteogenesis-related gene expression by RT-PCR, chondrocytes apoptosis by TUNEL staining. The blank control group and AONS composite chondrocytes have significant differences in apoptosis and cell proliferation of two fracture types (P <0.05). The autologous oxygen-releasing nanometers at 4 and 8 weeks showed a significant difference in the number of PCNA and TUNEL cells between biomimetic scaffold and chondrocytes in two groups (P < 0.05). The AONS and chondrocytes were effective for two types of fractures at 1, 4 and 8 weeks. The expression of various markers of intrachondral osteogenesis was decreased and the markers of hip osteochondral fracture were increased significantly (P < 0.05). Joint recovery was better than patellar cartilage fractures. The AONS composite chondrocyte scaffold promotes repair of patellar cartilage fractures and hip osteochondral fractures with a better effect on hip osteochondral fractures.

Comparison of a new hydro-surgical technique to traditional methods for the preparation of full-thickness skin grafts from canine cadaveric skin and report of a single clinical case

2012 ◽  
Vol 25 (01) ◽  
pp. 42-48 ◽  
Author(s):  
S. C. Ralphs ◽  
G Coronado ◽  
D. C. Sweet ◽  
J. Ward ◽  
C. P. Bloch ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Skin Graft ◽  
Clinical Case ◽  
Subcutaneous Tissue ◽  
Skin Grafts ◽  
Full Thickness ◽  
Preparation Methods ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Significant Difference

SummaryObjective: To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts.Study design: Ex vivo experimental study and a single clinical case report.Sample population: Four canine cadavers and a single clinical case.Methods: Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample.Results: The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens.Clinical significance: The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.Presented at the ACVS symposium during the resident seminar, Seattle, Washington,USA on October 22, 2010.

scholarly journals Surgery of cholesteatoma: Surgical technique and cholesteatoma recurrences

2004 ◽  
Vol 51 (1) ◽  
pp. 103-107
Author(s):  
Nenad Arsovic ◽  
Radomir Radulovic ◽  
Snezana Jesic ◽  
S. Krejovic-Trivic ◽  
P. Stankovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Complete Removal ◽  
Initial Surgery ◽  
Group I ◽  
Number Of Patients ◽  
Significant Difference ◽  
Diffuse Form ◽  
Surgical Failure

Past experience with open and closed techniques of tympanoplasty in surgery of cholesteatoma has shown that recurring illness is one of the major causes of surgical failure. The literature has reported varying trend of surgical treatment of cholesteatoma. The objective of the study was to analyze the significance of surgical technique in relation to the incidence and most frequent localization of recurrent cholesteatoma. Our study analyzed 120 patients operated on for cholesteatoma. The patients were divided into two groups, group I (45) with recurring disease and group II (75) without any recurring condition, which were followed up three years. Statistical analysis was carried out by modified t-test. The largest number of patients was re-operated in the first two years from the initial surgery (50%), In the majority of patients (50%), recurrent cholesteatoma was most commonly localized (stage I) in attic (20%) and much rarely in mesotympanum (11,9%). Stage III recurrent cholesteatoma was verified in 35% of patients, most frequently diffuse form (13,4%). The involvement of attic by all three stages of disease accounted for over 60%. The analysis of the used techniques of surgical treatment in both groups revealed significant difference. Open techniques of tympanoplasty were used in 60% of patients with no recurrence. Closed techniques were used more frequently in patients with recurring disease, i.e. in over 90% of cases. Recurrent cholesteatoma develops, in the majority of cases, during the first two years after the surgical intervention. Attic is the most common localization of cholesteatoma. More frequent utilization of open technique of tympanoplasty for surgery of cholesteatoma significantly reduces the incidence of recurring condition. The indications for CWD technique are the initial spread of cholesteatoma, possibility of complete removal of cholesteatoma and postoperative follow-up of patients.

A Standardized Approach to Cesarean Surgical Technique and Its Effect on Operative Time and Surgical Morbidity

2018 ◽  
Vol 36 (03) ◽  
pp. 277-284 ◽  
Author(s):  
M. Pallister ◽  
J. Ballas ◽  
J. Kohn ◽  
C. S. Eppes ◽  
M. Belfort ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Operative Time ◽  
Retrospective Chart Review ◽  
Surgical Morbidity ◽  
Entire Cohort ◽  
Cesarean Deliveries ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact ◽  
Academic Year

Objective To evaluate the impact of a standardized surgical technique for primary cesarean deliveries (CDs) on operative time and surgical morbidity. Materials and Methods Two-year retrospective chart review of primary CD performed around the implementation of a standardized CD surgical technique. The primary outcome was total operative time (TOT). Secondary outcomes included incision-to-delivery time (ITDT), surgical site infection, blood loss, and maternal and fetal injuries. Results When comparing pre- versus postimplementation surgical times, there was no significant difference in TOT (76.5 vs. 75.9 minutes, respectively; p = 0.42) or ITDT (9.8 vs. 8.8 minutes, respectively; p = 0.06) when the entire cohort was analyzed. Subgroup analysis of CD performed early versus late in an academic year among the pre- and postimplementation groups showed no significant difference in TOT (79.3 early vs. 73.8 minutes late; p = 0.10) or ITDT (10.8 early vs. 8.8 minutes late; p = 0.06) within the preimplementation group. In the postimplementation group, however, there was significant decrease in TOT (80.5 early vs. 71.3 minutes late; p = 0.02) and ITDT (10.6 early vs. 6.8 minutes late; p < 0.01). Secondary outcomes were similar for both groups. Conclusion A standardized surgical technique combined with surgical experience can decrease TOT and ITDT in primary CD without increasing maternal morbidity.

scholarly journals Circumcision: postoperative complications that required reoperation

2018 ◽  
Vol 16 (3) ◽  
Author(s):  
Carolina Talini ◽  
Letícia Alves Antunes ◽  
Bruna Cecília Neves de Carvalho ◽  
Karin Lucilda Schultz ◽  
Maria Helena Camargo Peralta Del Valle ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Technique ◽  
Medical Records ◽  
Statistical Significance ◽  
Postoperative Outcome ◽  
Conventional Technique ◽  
Significant Difference ◽  
Operative Complications ◽  
Classic Technique ◽  
The Difference

ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients’ age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients’ age did not influence in complications.

scholarly journals Texture analysis on diffusion tensor imaging: discriminating glioblastoma from single brain metastasis

2018 ◽  
Vol 60 (3) ◽  
pp. 356-366 ◽  
Author(s):  
Karoline Skogen ◽  
Anselm Schulz ◽  
Eirik Helseth ◽  
Balaji Ganeshan ◽  
Johann Baptist Dormagen ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Brain Metastasis ◽  
Diagnostic Accuracy ◽  
Texture Analysis ◽  
Diffusion Tensor ◽  
Statistical Parameter ◽  
Postoperative Management ◽  
Peritumoral Edema ◽  
Significant Difference ◽  
Single Brain Metastasis

Background Texture analysis has been done on several radiological modalities to stage, differentiate, and predict prognosis in many oncologic tumors. Purpose To determine the diagnostic accuracy of discriminating glioblastoma (GBM) from single brain metastasis (MET) by assessing the heterogeneity of both the solid tumor and the peritumoral edema with magnetic resonance imaging (MRI) texture analysis (MRTA). Material and Methods Preoperative MRI examinations done on a 3-T scanner of 43 patients were included: 22 GBM and 21 MET. MRTA was performed on diffusion tensor imaging (DTI) in a representative region of interest (ROI). The MRTA was assessed using a commercially available research software program (TexRAD) which applies a filtration histogram technique for characterizing tumor and peritumoral heterogeneity. The filtration step selectively filters and extracts texture features at different anatomical scales varying from 2 mm (fine) to 6 mm (coarse). Heterogeneity quantification was obtained by the statistical parameter entropy. A threshold value to differentiate GBM from MET with sensitivity and specificity was calculated by receiver operating characteristic (ROC) analysis. Results Quantifying the heterogeneity of the solid part of the tumor showed no significant difference between GBM and MET. However, the heterogeneity of the GBMs peritumoral edema was significantly higher than the edema surrounding MET, differentiating them with a sensitivity of 80% and specificity of 90%. Conclusion Assessing the peritumoral heterogeneity can increase the radiological diagnostic accuracy when discriminating GBM and MET. This will facilitate the medical staging and optimize the planning for surgical resection of the tumor and postoperative management.

The distribution of microvilli over the villous surface of the normal human term placenta is homogenous

1995 ◽  
Vol 7 (5) ◽  
pp. 1269 ◽  
Author(s):  
AL Karimu ◽  
GJ Burton
Keyword(s):  
Regional Differences ◽  
Amplification Factor ◽  
Ultrastructural Examination ◽  
Human Term Placenta ◽  
Term Placenta ◽  
Intervillous Space ◽  
Normal Term ◽  
Significant Difference ◽  
Villous Surface ◽  
Normal Human

The study was carried out to estimate stereologically whether regional differences exist in the distribution of microvilli between vasculo-syncytial (VSM) and non-vasculo-syncytial (non-VSM) areas of the villous surface in normal term placenta. In ten placentae a normal lobe was perfusion-fixed at a pressure of 60 mm Hg, and the intervillous space was perfused at 10 mm Hg. The tissue was routinely processed for ultrastructural examination. Stereological estimates relating to the length and diameter of microvilli, and to the villous surface amplification factor in adjacent but contrasting (VSM and non-VSM) regions, were obtained. A paired 't' test showed no significant difference in the villous surface amplification factor between the two regions (5.18 +/- 0.54 and 5.22 +/- 0.54 respectively, mean +/- s.e.m. P > 0.05). In addition, there were no significant differences between the length and diameter of microvilli in both regions (P > 0.05 in both). The results confirm that the normal term placenta has a continuous and even covering of microvilli over the syncytium.

scholarly journals Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

2019 ◽  
Vol 12 (S 01) ◽  
pp. S70-S74
Author(s):  
Lucas M. Harrison ◽  
Spencer R. Anderson ◽  
Sunishka M. Wimalawansa
Keyword(s):  
External Fixation ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Postoperative Management ◽  
Active Motion ◽  
Early Motion ◽  
Right Hand ◽  
Rehabilitation Protocols ◽  
Hand Amputation ◽  
Hand Replantation

Abstract Introduction We review the benefits of early motion protocols following replantation of a total right hand amputation at 1 and 2 years after replantation, and provide recommendations for postoperative management. Materials and Methods Replantation of the entire right hand in zone-4 was performed and supported by rigid external fixation spanning the forearm and hand. An early active “place-and-hold” motion protocol was initiated within the first 3 postoperative days. Metacarpophalangeal joint extensors were tethered by the pins, limiting full excursion. This resulted in stiffness and extensor adhesions that required a staged extensor tenolysis; however, all joints remained supple. The early motion protocol prevented the need for significant flexor tenolysis and joint releases. Results Early motion rehabilitation protocols can produce very successful results in complex replantation. The enhanced stability afforded by external fixation of the wrist allowed us to perform aggressive early rehabilitation. Conclusion This case highlights the benefits of early active motion (limiting the need for complex joint and flexor tendon releases) and demonstrates the degree of extensor adhesions caused by even minor extensor tendon tethering. This aggressive rehabilitation approach can produce excellent range of motion, and likely limit the need for secondary tenolysis and joint release procedures.

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