Hamstring autograft size importance in anterior cruciate ligament repair surgery

Graft size in hamstring autograft anterior cruciate ligament (ACL) surgery is an important factor directly related to failure. Most of the evidence in the field suggests that the size of the graft in hamstring autograft ACL reconstruction matters when the surgeon is trying to avoid failures.The exact graft diameter needed to avoid failures is not absolutely clear and could depend on other factors, but newer studies suggest than even increases of 0.5 mm up to a graft size of 10 mm are beneficial for the patient. There is still no evidence to recommend the use of grafts > 10 mm.Several methods - e.g. folding the graft in more strands that are simple and reproducible have been published lately to address the problem of having an insufficient graft size when performing an ACL reconstruction. Due to the evidence presented, we think it is necessary for the surgeon to have them in his or her arsenal before performing an ACL reconstruction.There are obviously other factors that should be considered, especially age. Therefore, a larger graft size should not be taken as the only goal in ACL reconstruction.No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article

On the development of advanced methodologies to assist on the diagnosis of human articulations pathologies : a biomechanical approach

The main purpose of this investigation is to present a preliminary study on the development of advanced methodologies to assist on the diagnosis of human articulations pathologies. In this process, a biomechanical approach is considered to characterize the patellofemoral joint. The present research work involves two distinct scientific domains, respectively, engineering and health sciences, and arises as a result of an association between the Mechanical Engineering Department of the University of Minho and a Portuguese company of medical consulting, ESPMEN. The correlation of both of these areas takes part of the highest biomedical engineer’s research interests and professional ambitions. One area where this kind of approach is essential is in the understanding of patellofemoral disorders, due to their ambiguous definition, multifactorial aetiology and common thread with and impact on nearly all knee conditions. Thus, the present project represents an appealing challenge to all the involved parts. This paper describes the patellofemoral (PF) problems, from their physiopathology to epidemiology, focusing their critical question: the diagnosis, but from a conclusive perspective of resolution. Actually, since the majority of the PF cases are recurrently misdiagnosed, there is in fact an urgent need of standardization of the physical examination methods. The biomechanical approach should prospectively culminate in the development of a standard assessment methodology that could precisely diagnose the PF pathologies and moreover allow clinicians to apply the most accurate and personalized treatment to each patient.Fundação para a Ciência e a Tecnologia (FCT

Meniscus subluxation retensioning: “autotransplant”

Knee osteoarthritis (OA) is a common condition in the older population and is characterized by several articular dysfunctions with consequent anatomic abnormalities including osteochondral degenerative changes and meniscal extrusion. Meniscal damage with extrusion is one of the strongest identified risk factors for the development and progression of knee OA and represents an important factor in the long-term health of the joint. Meniscal extrusion can alter normal knee biomechanics and dramatically inhibit meniscal function. We present a surgical technique for the treatment of early knee OA in association with an extruded meniscus to restore the meniscal anatomic position and preserve its native physiological function related to cartilage preservation. Meniscal retensioning, or a "meniscal autotransplant," can increase meniscal coverage in the compromised compartment, prevent cartilage degeneration, decrease subchondral bone exposure, and restore the compartmental space and, consequently, can relieve patients' symptoms related to early OA.The experimental work (arthroscopy laboratory) and surgical equipment were financially supported by Arthrex. Video 1 was edited by Arthrex. J.E-M. received support for travel-related expenses and laboratory equipment from Arthrex for this study. R.B. received support for travel-related expenses and laboratory equipment from Arthrex for this study. Full ICMJE author disclosure forms are available for this article online, as supplementary material

Tissue engineering and regenerative medicine strategies in meniscus lesions

Purpose: The aim of this systematic review was to address tissue engineering and regenerative medicine (TERM) strategies applied to the meniscus, specifically (1) clinical applications, indications, results, and pitfalls and (2) the main trends in research assessed by evaluation of preclinical (in vivo) studies. Methods: Three independent reviewers performed a search on PubMed, from 2006 to March 31, 2011, using the term “meniscus” with all of the following terms: “scaffolds,” “constructs,” “cells,” “growth factors,” “implant,” “tissue engineering,” and “regenerative medicine.” Inclusion criteria were English language–written, original clinical research (Level of Evidence I to IV) and preclinical studies of TERM application in knee meniscal lesions. Reference lists and related articles on journal Web sites of selected articles were checked until prepublication for potential studies that could not be identified eventually by our original search. The modified Coleman Methodology score was used for study quality analysis of clinical trials. Results: The PubMed search identified 286 articles (a similar search from 2000 to 2005 identified 161 articles). Non–English-language articles (n 9), Level V publications (n 19), in vitro studies (n 118), and 102 studies not related to the topic were excluded. One reference was identified outside of PubMed. Thirty-eight references that met the inclusion criteria were identified from the original search. On the basis of our prepublication search, 2 other references were included. A total of 9 clinical and 31 preclinical studies were selected for further analysis. Of the clinical trials, 1 was classified as Level I, 2 as Level II, and 6 as Level IV. Eight referred to acellular scaffold implantation for partial meniscal replacement, and one comprised fibrin clot application. The mean modified Coleman Methodology score was 48.0 (SD, 15.7). Of the preclinical studies, 11 original works reported on studies using large animal models whereas 20 research studies used small animals. In these studies the experimental design favored cell-seeded scaffolds or scaffolds enhanced with growth factors (GFs) in attempts to improve tissue healing, as opposed to the plain acellular scaffolds that were predominant in clinical trials. Injection of mesenchymal stem cells and gene therapy are also presented as alternative strategies. Conclusions: Partial meniscal substitution using acellular scaffolds in selected patients with irreparable loss of tissue may be a safe and promising procedure. However, there is only 1 randomized controlled study supporting its application, and globally, many methodologic issues of published trials limit further conclusions. We registered a different trend in preclinical trials, with most considering augmentation of scaffolds by cells and/or GFs, as opposed to the predominantly acellular approach in clinical trials. Different TERM approaches to enhance meniscal repair or regeneration are in preclinical analysis, such as the use of mesenchymal stem cells, gene therapy, and GFs alone or in combination, and thus could be considered in the design of subsequent trials. Level of Evidence: Level IV, systematic review of Level I to IV studies

Academic performance and perceptions of undergraduate medical students in case-based learning compared to other teaching strategies: a systematic review with meta-analysis

Case-based learning (CBL) is a teaching method centered on active student learning that can overcome the limitations of traditional teaching methods used in undergraduate medical education. The aim of this systematic review was to compare the effectiveness of CBL against other teaching methodologies in terms of academic performance and perceptions (intra-individual, interpeer and student–faculty) of undergraduate medical students. Literature searches were performed using PubMed, EMBASE and Web of Science databases up to 28 April 2021. We included studies that quantitatively compared the academic performance and perception outcomes of CBL against other teaching methodologies in undergraduate medical students. The risk of bias was judged using the RoBANS tool and certainty of evidence using the GRADE framework. Meta-analyses were conducted using a random-effects model and reported as standardized mean differences (SMD) with 95% confidence intervals (CI). Of a total of 4470 records, 41 studies comprising 7667 undergraduate medical students fulfilled the eligibility criteria and were included in our systematic review. The CBL group was superior to the other teaching method groups in terms of academic performance measured by exam scores (SMD = 2.37, 95% CI 1.25–3.49, large effect, very low certainty) and interest and motivation (SMD = 0.79, 95% CI 0.13–1.44, moderate effect, very low certainty). Other academic performance or perception outcomes were not statistically different between CBL and other teaching methods when considering the pooled effect. Still, they were often superior in the CBL group for specific subgroups. CBL showed superior academic performance (especially compared to didactic lectures and tutorial-based teaching) and interest and motivation compared to other teaching methods used with undergraduate medical students. However, the certainty of evidence was very low and further studies are warranted before a stronger and more definitive conclusion can be drawn

Medical diagnoses with a Cartographic Oriented Model

The human body is composed of several systems and organs that have a specific and well located position within it. Each organ is usually related to one or more physiological data. There is a subtle spatial interdependency on human’s body structure and behaviour. Because of this, doctors usually execute a spatial analysis when diagnosing a disease in a patient. The doctor has to combine patient’s medical data performing some “implicit” algebraic map operation. Although this is true, most of the models used to analyze, to process and to visualize these data, do not take into account the strong spatial interdependency inherent to human body’s functioning. These models usually treat morphological and physiological data in a full autonomous and isolated way. This happens because they are not “spatially” oriented, and do not interpret the human body as a 3D map, being composed by different parts and layers of information. The possibility of combining these layers using spatial algebraic operations, introduces a new degree of information insight. The main goal of the CHUB (Cartographic Human Body) model is to introduce a cartographic approach to help doctors to analyse, visualize and diagnosis human’s body illnesses

Porto Index Score: validação de novo método de avaliação ecográfica da patelo-femoral

A instabilidade patelo-femoral é uma das mais frequentes causas de consulta do joelho. O diagnóstico e classificação proposta pela escola de Lyon assenta nos achados clínicos e radiológicos incluindo TC (ou mais recentemente RM). A displasia da tróclea, altura da rótula, TA-GT e báscula patelar são classicamente assumidos como factores de risco major. A hipótese deste estudo é que, da avaliação funcional por ecografia é possível aferir uma correlação morfo-funcional pelo menos tão eficaz como pelos protocolos de TC ou RM com um custo significativamente mais baixo

key concepts

Publisher Copyright: © 2021. The author(s) This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.■ Complete access to the posterior medial compartment of the knee may represent a technical challenge during arthroscopy in patients with a tight tibiofemoral joint space. ■ Medial collateral release reduces direct iatrogenic cartilage damage in the medial compartment of the knee through manipulation with instruments. ■ We recommend performing medial collateral release in surgeries that access the posteromedial compartment (e.g. partial meniscectomy for ruptures of the posterior horn of medial meniscus or posterior root repairs) when the patient has a tight tibiofemoral joint space. ■ There are two main techniques to perform medial collateral release: inside-out and outside-in. Regardless of the technique used’ releasing medial ligament structures is a safe and effective method to be used in the diagnosis and treatment of injuries to the medial compartment.publishersversionpublishe

Knee surgery complications related to biomaterials

Recent years have seen a growing interest in biomaterials and use of these materials in the clinical setting is increasing. Despite their advantages, they have also been cited as the source of specific complications and/or fail- ures. Problems such as screw breakage, tunnel enlargement, allergic or foreign body reactions, cyst and abscess formation, or even delayed migration of supposedly biodegradable screws/implants have been reported. This chapter aims to review the basic science and clinical experience with biomaterials currently employed in fixation devices for knee surgery. Information on the clinical implications of biodegradable screws is still limited. Surgeons tend to focus more on the emerging successes of innovations than on the complications and failures (publication bias) of older devices, making it difficult to reliably assess the incidence of such events. More- over, the complexity of possible reactions occurring in the human body cannot be reproduced under controlled laboratory conditions.Neverthe- less, surgeons and patients must be aware of both the advantages and the complications of these devices. Only in this way can informed choices be made, so that both parties are prepared to face and overcome the unde- sired complications, and the improvement of future implants can become a reality