Fat Tissue’s Graft in Osteoarthritis Treatment: Indications, Preparations, and Results

Osteoarthritis (OA) represents one of the most common causes of joint pain and disability with related changes in bone morphology. In last years, this pathology is steadily increasing due to the continuous increase in the average life expectancy and the rate of active population. In recent years, there have been many conservative treatments for symptomatic gonarthrosis in order to reduce pain and delay or avoid the implantation of a knee prosthesis. The most studied and used was infiltrating treatment. Our group has been paying attention to regenerative medicine for many years, focusing on the characteristics of adipose tissue and the presence of multipotent mesenchymal cells, particularly in the vascular stromal area. Mesenchymal stem cells (MSCs) of adipose tissue can commit toward the chondrogenic, osteogenic, adipogenic, myogenic, and neurogenic lineages. Our group has continued the studies in this field by submitting this to treatment patients with grade II–III arthrosis according to the scale of Kellgren-Lawrence or patients with IV degree of such scale inoperable for internal reasons. To date, with a 4-year follow-up, our results are satisfactory in terms of pain reduction, improvement in joint function, and recovery of daily and sports activities

Arthroscopic guided biopsy and radiofrequency thermoablation of a benign neoplasm of the tibial spines area: a treatment option

<p>Abstract</p> <p>Background</p> <p>Lesions located in the area of the tibial spines are rare. In most cases, treatment follows histological diagnosis, but when imaging and clinical data are considered to be "very" characteristic for benign lesions, such as chondroblastoma or osteoid osteoma, treatment may be performed without biopsy. Traditional curettage requires opening the joint, which presents a high risk of contamination of the joint itself and surrounding structures, such as the popliteal area, with possible contamination of the neurovascular bundle when performing curettage with the posterior approach. In this case, the re-excision of a local recurrence would be extremely difficult.</p> <p>Results</p> <p>We describe a technique using arthroscopic guidance for radiofrequency thermoablation of a benign lesion in the tibial spines area. We report on an illustrative case. The patient so treated, reported immediate relief from the pain, and after two weeks, was free of pain. The biopsy performed before the treatment confirmed the radiological diagnosis of chondroblastoma. At one year of follow-up, the patient is without pain, with a 0-130°range of motion, has no activity limitations and is apparently free of disease.</p> <p>Conclusion</p> <p>This technique allows a radiofrequency thermoablation of a lesion in the tibial spines area and in the posterior tibial surface to be performed without opening the joint, monitoring the tibial plateau surface, probably decreasing the risk of cartilage damage. Unfortunately, in the case presented, the high pressure from the arthroscopy's pump broke the tibial plateau surface creating a communication to the tibial tunnel used for thermoablation.</p

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR &lt; 60 mL/min/1.73 m2) or eGFR reduction &gt; 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR &lt; 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR &gt; 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Pre-operative planning in anterior cruciate ligament reconstruction revision surgery

Primary reconstructions of the anterior cruciate ligament are common and increasing in number, a trend inevitably paralleled by an increase in the number of revision procedures. Failure of primary ACL reconstruction can appear as objective residual laxity, subjective instability, severe and persistent postoperative stiffness and/or pain, or infection. Revision surgery is a complex procedure, in which the expected clinical outcome is inferior to that which can be expected from primary reconstruction, and patients have a 5.4% risk of undergoing a second revision after five years. This type of procedure demands correct and exhaustive preoperative planning so as ensure optimal treatment of accompanying lesions and of any complications arising during surgery. It is important to know, in detail, the patient’s clinical history (when the primary surgery was performed and the technique used, the cause of the recurrence, the degree of functional recovery, etc.), to perform a thorough clinical examination (to evaluate alignment, gait cycle, skin color, the trophic condition of the muscles, joint laxity), and to have available the results of a detailed and specific imaging study and also of blood tests, in order to exclude the presence of an infection

1. Fat Tissue’s Graft in Osteoarthritis Treatment: Indications, Preparations and Results. Osteoarthritis Biomarkers and Treatments

Osteoarthritis (OA) represents one of the most common causes of joint pain and disability with related changes in bone morphology. In last years, this pathology is steadily increasing due to the continuous increase in the average life expectancy and the rate of active population. In recent years, there have been many conservative treatments for symptomatic gonarthrosis in order to reduce pain and delay or avoid the implantation of a knee prosthesis. The most studied and used was infiltrating treatment. Our group has been paying attention to regenerative medicine for many years, focusing on the characteristics of adipose tissue and the presence of multipotent mesenchymal cells, particularly in the vascular stromal area. Mesenchymal stem cells (MSCs) of adipose tissue can commit toward the chondrogenic, osteogenic, adipogenic, myogenic, and neurogenic lineages. Our group has continued the studies in this field by submitting this to treatment patients with grade II–III arthrosis according to the scale of Kellgren-Lawrence or patients with IV degree of such scale inoperable for internal reasons. To date, with a 4-year follow-up, our results are satisfactory in terms of pain reduction, improvement in joint function, and recovery of daily and sports activities

Femoral Fixation With Curve Cross-Pin System in Arthroscopic Posterior Cruciate Ligament Reconstruction

Posterior cruciate ligament (PCL) ruptures account for 1% to 44% of all acute ligament injuries of the knee. In this paper we wanted to try out a system for femural fixation. Hamstring tendons are harvested and standard tibial tunnel is prepared using the transtibial PCL guide; by identifying the PCL footprint, the femoral half tunnel 27 to 30 mm with in-out technique is performed. The femoral rod of a curve cross-pin system is inserted into the anterolateral access within the femoral half tunnel. The guide block is placed 2.5 cm anterior (in a coronal plane) and 2.5 cm proximal to the lateral epicondyle. The arc attachment is assembled and the bone stock assessed with the bone gauge pin in contact with the cortex of the medial femoral condyle. Then the first sleeve over trocar is assembled, and the graft is passed through the tunnel and fixed on the femur with the pins and on the tibia with interferential screw. After biomechanical studies we obtained a maximum load at 930.95 N and maximum stiffness at 58.92 N/mm

Percutaneous fat transfer to treat knee osteoarthritis symptoms. Preliminary results

This study aims to evaluate the safety and efficacy of autologous aspirated and purified fat tissue injected percutaneously into the knee joint for the treatment of symptomatic osteoarthritis (OA). Methods  We reviewed 30 patients, who received an autologous percutaneous fat injection for the treatment of knee OA, from January 2012 to March 2015. Mean patients' age was 63.3 ± 5.3 years (range, 50-80 years). Body mass index was 25.1 ± 1.7. Clinical evaluation was based on pain visual analog scale (VAS) and WOMAC score for functional and subjective assessment. We also noted the adverse reactions and the consumption of nonsteroidal anti-inflammatory drugs in the posttreatment period. Results  All patients reported improvements with respect to pain: average VAS was 7.7 ± 1.2 at baseline, 5.2 ± 0.2 at 1-month follow-up, and 4.3 ± 1 at 3-month follow-up. A slight deterioration (5.0 ± 1.1) was evidenced at 1 year. Total WOMAC score was 89.9 ± 1.7 at baseline, 66.3 ± 1 at 1 month, 68.6 ± 1.7 at 3 months, and 73.2 ± 1.8 at 12 months of follow-up. Conclusion  Our preliminary findings suggest that autologous percutaneous fat injections are a valid treatment option for knee OA. Level of Evidence  Level IV, therapeutic case series

Coastal inundation risk assessment due to subsidence and sea level rise in a Mediterranean alluvial plain (Volturno coastal plain - southern Italy)

Interdisciplinary studies of the last years highlight that the Italian coasts are significantly subject to retreat and to inundation by sea ingression due to natural and anthropic causes. In this study, the effects of future relative sea level have been evaluated for the Volturno River Plain, one of the widest coastal plain in southern Italy. The plain is characterized by high economical and ecological value, for the presence of farm activities, tourist structures and wetland protected zones. The study area is potentially prone to coastal flooding due to its very low topography and because it is affected by a severe subsidence, which emphasize the local effect of sea level rise due to the ongoing climate changes.In accordance with the guidelines of the MEDFLOOD project, the areas prone to inundation in the years 2065 and 2100 have been evaluated by comparing the future topographical information and expected relative sea level scenarios. The local Vertical Ground Displacements have been derived by PS-InSAR processing data whilst the mean values of the scenarios RCP 2.6 and RCP 8.5 provided by the IPCC (2014) have been used as future sea level projections in 2065 and 2100. The PS-InSar data elaboration shows that the area affected by subsidence corresponds to 35% of the Volturno plain and that the annual rate of the phenomenon ranges between -1 and -25 mm/yr.The inundation analysis, based on the classification of the areas in four hazard classes, indicates that in 2065 the zones located below the sea level will increase approximately of 50% respect to the present conditions, while between 2065 and 2100 the increase can be at least of 60% (IPCC, RCP 8.5 scenarios). Considering the socio-economical and ecological exposure, evaluated following the EUROSION project guidelines, the coastal flooding risk maps have been produced. Almost 8.2 km2 and 14.4 km2 of the investigated area has to be considered subject to very high marine inundation risk in 2065 and 2100, respectively

Wind Direction Data from a Coastal HF Radar System in the Gulf of Naples (Central Mediterranean Sea)

Results on the accuracy of SeaSonde High Frequency (HF) radar wind direction measurements in the Gulf of Naples (Southern Tyrrhenian Sea, Central Mediterranean Sea) are here presented. The investigation was carried out for a winter period (2 February–6 March) and for one summer month (August) of the reference year 2009. HF radar measurements were compared with in situ recordings from a weather station and with model data, with the aim of resolving both small scale and large scale dynamics. The analysis of the overall performance of the HF radar system in the Gulf of Naples shows that the data are reliable when the wind speed exceeds a 5 m/s threshold. Despite such a limitation, this study confirms the potentialities of these systems as monitoring platforms in coastal areas and suggests further efforts towards their improvement