The long-term post-operative electromyographic evaluation of patients who have undergone carpal tunnel decompression

Producción CientíficaWe present the electromyographic (EMG) results ten years after open decompression of the median nerve at the wrist and compare them with the clinical and functional outcomes as judged by Levine's Questionnaire. This retrospective study evaluated 115 patients who had undergone carpal tunnel decompression at a mean of 10.47 years (9.24 to 11.36) previously. A positive EMG diagnosis was found in 77 patients (67%), including those who were asymptomatic at ten years. It is necessary to include both clinical and functional results as well as electromyographic testing in the long-term evaluation of patients who have undergone carpal tunnel decompression particularly in those in whom revision surgery is being considered. In doubtful cases or when there are differing outcomes, self-administered scales such as Levine's Questionnaire should prevail over EMG results when deciding on the need for revision surgery

Prótesis total de rodilla sobre osteotomía tibial

El objetivo del estudio es conocer las dificultades técnicas de la colocación de una prótesis total sobre una rodilla tratada previamente con una osteotomía tibial y su influencia en el resultado final. Para ello se ha realizado un estudio comparativo entre estos casos (16 rodillas) y un grupo control (116 rodillas). La evaluación clínica, funcional y radiológica de las rodillas se realizó según el sistema de puntuación de la sociedad americana de rodilla. En los casos con osteotomía tibial previa la mejoría clínica fue menor, con una mayor proporción de malos resultados y con una colocación más defectuosa del componente tibial.The aim of this study is to know weather a previous tibial osteotomy has influence in placing a total knee arthroplasty as well as its influence in the outcome of these cases. Therefore, we have done a comparative study between knees with previous osteotomy (16 knees) and a control group (116 knees). Functional, clinical and radiological evaluation was done according to American Knee Society score system. The improvement in cases with a previous tibial osteotomy was less than in the control group. In addititon, this cases showed an increase of bad results and, furthermore, a more frequent deficient placing of the tibial component

Luxación traumática de la rodilla

La luxación traumática de la rodilla es la lesión poco frecuente que se asocia a grandes lesiones cápsuloligamentosas y que a menudo afecta a estructuras neurológicas y vasculares. La lesión vascular es la complicación más importante. Todos los autores coinciden en que el diagnóstico precoz y tratamiento urgente de las lesiones de la arteria poplítea son esenciales. Sin embargo, no existe el mismo acuerdo en cuanto al tratamiento de las lesiones cápsuloligamentosas. Algunos autores publican buenos resultados con tratamientos no quirúrgicos, aunque otros consideran que el mejor tratamiento es la reparación completa de las lesiones ligamentosas. Hemos tratado en nuestro hospital siete casos de luxación traumática de rodilla en los últimos 20 años. Presentamos el tratamiento realizado, sus complicaciones y resultados.Traumatic knee dislocation is an uncommon injury associated with extensive soft tissue damage and often neurovascular involvement. Vascular injury is the most serious complication. There is genera agreement that early diagnosis and immediate treatment of popliteal artery disruption is essential. However there is no consensus about treatment of capsular and ligamentous injuries. Some authors reported good results advocated the repair of all ligaments in the best method. Seven traumatic knee dislocations have been treated in our hospital for last 20 years. Initial treatment, complications and results are presented

Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus

Producción CientíficaThe current trend in hallux valgus surgery is directed toward percutaneous procedures. However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients who had undergone a percutaneous distal retrocapital osteotomy of the first metatarsal, and had been followed up for ten years. METHODS: We carried out a clinical and radiological evaluation of 115 feet ten years after surgery. RESULTS: The AOFAS scale results in the tenth postoperative year remained significantly favourable compared to their corresponding values in the preoperative period, yielding an improvement of 42.2 points overall on average. In relation to radiological findings, the mean hallux angle was maintained below 20 °, with a mean intermetatarsal angle of 8.1 °. CONCLUSION: Percutaneous retrocapital metatarsal osteotomy for treatment of mild to moderate hallux valgus is effective in the long term, with the advantages of a minimally invasive procedure

Artrodesis de rodilla por fracaso de la artroplatsia total

Veintiuna artrodesis de rodilla fueron realizadas en nuestro Servicio en los últimos 20 años. Se realiza un estudio retrospectivo con un seguimiento medio de 10 años. Las razones para la artrodesis fueron en 12 ocasiones (57%) infección de la artroplastia total, y en los 9 casos restantes (43%) aflojamiento aséptico. La artrodesis se realizó mediante fijación externa en un solo plano en 11 casos (52%), en biplano se colocó en 7 (33%), 2 casos con placas a compresión (9,5%) y el caso restante mediante un clavo intramedular (5%). La fusión después del procedimiento inicial se obtuvo solamente en 12 pacientes (57%) y añadiendo procedimientos adicionales totalizamos 19 rodillas fusionadas (90%). Las complicaciones encontradas fueron: 9 pseudoartrosis, 2 infecciones en el trayecto de las fichas, 2 roturas del material de fijación, una infección persistente que llevó a la amputación, y una parálisis del nervio ciático poplíteo externo.A total of 21 knee arthrodesis performed in the last 20 years was reviewed with an average follow-up of 10 years. Arthrodesis was performed following deep infection in 12 cases (57%) and aseptic loosening of the prostheses in the remaining 9 cases. TH artrodesis were performed using one-plane external fixation in 11 cases, two-planes external fixation in 7, compression plates in 2, intramedular nailing in only 12 patients. Using additional procedures we obtained 19 fused knees (90 %). The complications in this series were: Psuedarthrosis (9 cases), infection of the fixator pins (2 cases), infection of the fixator pins (2 cases), and broken osteosybrtesis components (2 cases), severe deep infection with final amputation of the limb (1 case), and CPE injury (1 case)

Influence of HLA Matching on the Efficacy of Allogeneic Mesenchymal Stromal Cell Therapies for Osteoarthritis and Degenerative Disc Disease

Producción CientíficaThe necessity for more effective therapies for chronic osteoarticular diseases has led to the development of treatments based on mesenchymal stem cells (MSCs), the natural precursors of musculoskeletal tissue. Treatments with autologous MSCs yielded excellent results, with nearly 70% improvement of pain and disability in osteoarthritis and degenerative disc disease. Using allogeneic MSCs is logistically more convenient and would widen the pool of eligible patients, but potential immune rejection should be considered. In this context, MSCs are purportedly immune evasive and better tolerated than other cell types. Methods We used samples collected during the performance of 2 randomized clinical trials using allogeneic bone marrow MSCs for treatment of osteoarthritis (NCT01586312) and degenerative disc disease (NCT01860417). Serum samples were used to determine anti-HLA antibodies, whereas either blood or MSC samples were used for HLA typing of recipients and donors, respectively. Algofunctional indexes were used as indicators of clinical evolution, and the correlation between the number of donor-host HLA mismatches and the efficacy of treatment was determined. Results Immune response was weak and transient, with reactivity decaying during the first year. Consistently, better donor-recipient HLA matching did not enhance efficacy. Conclusions This lack of reactivity is presumably due to the cooperation of 2 factors, (1) downregulation of the host immune responses by the transplanted MSCs and (2) effective insulation of these cells inside the articular cavity or the intervertebral disc, respectively. Interestingly, better HLA matching did not enhance efficacy. These observations have medical relevance as they support the clinical use of allogeneic cells, at least as a single-dose administration. Multiple-dose applications will require further research to exclude possible sensitization.Red de Terapia Celular of the Instituto de Salud Carlos III (RD16/0011/0003) and Centro en Red de Medicina Regenerativa de Castilla y Leó

Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results

Producción CientíficaSurgical treatment options for medial compartment osteoarthritis of the knee include high tibial osteotomy, total knee arthroplasty or unicompartmental knee arthroplasty (UKA), depending on the patient's age, level of physical activity and the degree of deformity. METHODS:In this study, we evaluated the long-term results of patients who underwent the Oxford cemented meniscal-bearing unicondylar knee prosthesis through a minimally invasive approach including a clinical, functional and radiographic assessment. RESULTS:Favourable clinical and radiological outcomes were registered overall at ten years after surgery. Overall results of UKA according to the American Knee Society (AKS) using Insall's criteria showed an excellent or good outcome for 492 knees (96.28 %), fair for 11 (2.15 %) and poor for eight (1.57 %) in the post-operative long term. CONCLUSIONS:We believe that with appropriate surgical technique, patient selection, prosthetic design and specific training, surgeons should achieve good outcomes with the added advantages of a minimally invasive approach. High volume for this technique is important in our opinio

An elastin-like recombinamer-based bioactive hydrogel embedded with mesenchymal stromal cells as an injectable scaffold for osteochondral repair

The aim of this study was to evaluate injectable, in situ cross-linkable elastin-like recombinamers (ELRs) for osteochondral repair. Both the ELR-based hydrogel alone and the ELR-based hydrogel embedded with rabbit mesenchymal stromal cells (rMSCs) were tested for the regeneration of critical subchondral defects in 10 New Zealand rabbits. Thus, cylindrical osteochondral defects were filled with an aqueous solution of ELRs and the animals sacrificed at 4 months for histological and gross evaluation of features of biomaterial performance, including integration, cellular infiltration, surrounding matrix quality and the new matrix in the defects. Although both approaches helped cartilage regeneration, the results suggest that the specific composition of the rMSC-containing hydrogel permitted adequate bone regeneration, whereas the ELR-based hydrogel alone led to an excellent regeneration of hyaline cartilage. In conclusion, the ELR cross-linker solution can be easily delivered and forms a stable well-integrated hydrogel that supports infiltration and de novo matrix synthesisThis project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 642687. The authors are grateful for the funding from the European Commission (NMP-2014-646075), the Spanish Government (PCIN-2015-010, MAT2015-68901-R, MAT2016-78903-R, MAT2016-79435-R), Junta de Castilla y León (VA015U16) and Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León. The authors also wish to thank Maria Victoria Saez Velasco for her important contribution to cell culture experimentsS

The young patient and the medial unicompartmental knee replacement

Purpose:Younger patients with unicompartmental degenerative knee joint diseases present a therapeutic dilemma. The purpose of this study is to evaluate the long-term results of theOxfordphase III unicompartmental knee replacement through a minimally invasive approach in the young patient.Methods:We have studied a total of 51 patients (59 interventions) who underwent the Oxford Phase III Unicompartmental Knee Replacement. A clinical, radiographical and functional evaluation was performed twelve years after intervention.Results:According to the American Knee Society Score using Insall's criteria overall results of unicompartmental knee arthroplasty showed an excellent or good outcome for 53 knees (96.36%), fair for 1 (1.81 %) and poor for 1 (1.81%) in the postoperative long term. The survival rate of the implants was close to 95% at follow-up.Conclusions: twelve years follow-up results of UKA through a minimally invasive exposure in young patients demonstrate predictably good outcomes

Rhizarthrosis fourth grade of eaton with hyperextension of themetacarpophalangeal joint

Producción CientíficaRestoration of thumb function with a painfree, stable, and mobile joint with preserved strength are the main goals of treatment of painful arthritis of the thumb. We present our clinical experience in surgical treatment of this disease, in its highest degree of affectation. PRESENTATION OF CASE:A 57-year-old woman presents with a 2-year history of worsening pain at the base of her right, dominant, trapezial-metacarpal (TM) joint. Her thumb metacarpophalangeal (MCP) joint hyperextends 30° with lateral pinch. Radiographs demonstrate Eaton stage IV degenerative changes of her TM joint and no arthritis of her thumb MCP joint. She was successfully treated with a modified Burton-Pellegrini arthroplasty and sesamoidesis to the metacarpal head. DISCUSSION:In cases of advanced rhizarthrosis conventional surgery does not serve to correct deformities of the metacarpophalangeal joint that may affect to the postsurgical outcomes. CONCLUSION:rhizarthrosis management must be carried out in a global way. When a surgical treatment is planned, all deformities must be taken into account