Cartilage repair: Scaffolding

Regenerative scaffold-based procedures have emerged in the last years as a potential therapeutic option for the treatment of chondral and osteochondral lesions. The rationale of using a scaffold is to have a temporary 3D structure of biodegradable polymers for the growth of living cells. The ideal scaffold should reproduce biological and structural properties of the native tissue as close as possible, in order to allow cell infiltration, attachment, proliferation, and differentiation. Other important properties include biocompatibility and biodegradability at suitable time intervals, to support the initial tissue formation and then to be gradually replaced by the regenerating tissue. The use of scaffolds has been introduced into clinical practice to improve the results obtainable with the first-generation cell-based approach, autologous chondrocyte implantation (ACI), by overcoming its drawbacks and simplifying the procedure. ACI techniques were combined with scaffolds, developing matrix-assisted autologous chondrocyte transplantation (MACT). Cells were harvested and cultured in vitro and then seeded on the three-dimensional biomaterial, which favored the redifferentiation processes, better protection, more homogeneous distribution, and easier handling for surgical implantation. Many scaffolds have reached clinical practice, and studies are now being published with good mid- and long-term results, but showing also some limits. Whereas traumatic focal lesions of the femoral condyles were shown to have more chance of benefit from this treatment, other indications have more controversial results, with lower or even poor clinical outcome. Moreover, this approach suffers from a two-step operation, technical difficulties and regulatory restrictions for cell manipulation, and high costs. Thus, after a decade focused on expanding and improving MACT techniques, in more recent years, both researchers and clinicians have been looking for different solutions to regenerate the articular surface

Esporte e atividade física na idade avançada: incidência nas alterações do equilíbrio

Introdução: O presente trabalho foi conduzido com o objetivo de pesquisar os efeitos que o esporte e a atividade física podem exercer nas alterações do equilíbrio estático nas pessoas idosas. Materiais e Métodos: Para o estudo foram recrutadas 30 pessoas saudáveis, de ambos os sexos e de idade entre 65 e 75 anos. Os sujeitos que resultaram capazes preencheram o questionário Minnesota sobre a atividade física praticada e fizeram 6 testes diferentes na plataforma estabilométrica, dependendo das indicações do Smart Balance Master da Neurocom International. Os dados foram submetidos ao teste, de tipo não paramétrico, de Wilcoxon e Mann-Whitney. P < 0,05 foi considerado significativo. Discussão: A análise dos dados não evidenciou diferenças significativas na comparação entre os grupos (0,1 < p< 0,9). Não obstante isso é importante evidenciar que, em quase todas as variáveis examinadas, os valores mostram claras diferenças em favor da população esportiva (nos sujeitos esportivos: redução média SUP= 0,05 ± 0,07cm2 ; redução média X= 0,07 ± 0,06cm; redução média Y= 0,06 ± 0,09cm). Isso nos leva a afirmar que a prática de atividade esportiva, na idade avançada, tem um papel não indiferente nas capacidades de anutenção do equilíbrio estático, se comparada com a atividade físic

Il ruolo dell'acqua nel controllo dei disordini posturali a carico dell'arto superiore ed inferiore

No Abstrac

No Effects of Early Viscosupplementation After Arthroscopic Partial Meniscectomy: A Randomized Controlled Trial

The management of the postoperative period after knee arthroscopic surgery may be challenging because surgical trauma deeply alters the joint microenvironment, causing the release of several catabolic molecules and proinflammatory factors that might slow down functional recovery. The possibility of using hyaluronic acid (HA) to promote postoperative pain relief and expedite functional improvement seems attractive, considering its biological properties

Early Viscosupplementation after Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Background: Hyaluronic acid (HA) has been widely used to treat osteoarthritis given its biological and mechanical properties. Because HA is an "intra-articular" treatment approach that affects the joints, it could be used in the management of acute conditions, such as during the early postsurgical phase, to reduce inflammatory stress and improve articular function. Purpose: The aim of the present double-blind, randomized controlled trial was to evaluate pain control and functional recovery provided by a single injection of HA performed the day after anterior cruciate ligament (ACL) reconstruction. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The study enrolled 60 patients affected by primary, chronic, and symptomatic ACL tear requiring surgical reconstruction. All patients were treated with the same reconstructive technique and rehabilitation protocol. Exclusion criteria were (1) concurrent articular lesion requiring surgical treatment, (2) axial malalignment in the index limb, and (3) functional limitation or pain in the contralateral knee. The day after the procedure, the patients were randomized to receive a single injection of 3 mL HA or 3 mL saline solution after surgical drains were removed. All patients were evaluated at baseline and at 15, 30, 60, and 180 days and 12 months after surgery by use of the following tools: Short Form-36 Health Survey (SF-36), International Knee Documentation Committee (IKDC) subjective score, visual analog scale (VAS) for pain, VAS for general health status, and Tegner score. At each follow-up evaluation, the transpatellar circumference and active and passive range of motion (ROM) of both knees were recorded. Results: No severe adverse events were documented after early viscosupplementation. A significant improvement was documented in both treatment groups. Significant differences were documented in the transpatellar circumference at 60 days and in active ROM at 30 days postoperatively; patients who received HA had better values compared with the placebo group (P =.022 and.027, respectively). No statistically relevant intergroup differences were found in the clinical scores. Conclusion: The study documented no adverse events and had some positive findings in terms of active ROM recovery and transpatellar circumference reduction. However, the early postoperative application of viscosupplementation did not lead to significant improvement in clinical scores after ACL reconstruction. Registration: NCT02630407 (ClinicalTrials.gov identifier)

Implantation of cardioverter-defibrillator: Effects on shoulder function

Abstract BACKGROUND: Subcutaneous almost substituted subpectoral approach of implantable cardioverter-defibrillator (ICD) implantation as a less invasive surgical technique. However, the impact of this change in placement site on procedure-related shoulder impairment is poorly understood. METHODS: Candidates for ICD implantation were prospectively evaluated at baseline, 2-weeks and 3-months after the procedure. Assessment of shoulder function included: Constant Score, Numeric Rating Scale (NRS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) scoring method. The Short Form-36 (SF-36) questionnaire was adopted for quality of life. RESULTS: Fifty consecutive patients were enrolled (21 single-chamber, 5 dual-chamber and 24 biventricular ICD). Significant changes in the short term were observed: physical component summary (regarding SF-36) decreased from 44.5\ub19.1 to 41.8\ub111.4 (p=0.016), patients with NRS >1 increased from 14% to 44% (p<0.001), DASH score increased from 1.29 [interquartile range 0.00-10.34] to 30.60 [interquartile range 12.93-46.34] (p<0.001). Notably, only the shoulder ipsilateral to implantation site presented a decrease in Constant Score (76.00 [interquartile range 61.37-86.87] vs. 95.75 [interquartile range 91.37-98.00]; p<0.001). After three months most of the parameters seemed to have recovered, except for range of motion. Procedure-related increase in pain (i.e. NRS increase 651 point) was the most important independent predictor of shoulder impairment, in terms of Constant Score modification (r=0.570; p<0.001). CONCLUSIONS: ICD implantation is frequently associated with ipsilateral shoulder impairment which tends to recover within 3-months. These data positively compare with the subpectoral approach and should be considered for future research regarding impact of ICD implant on physical well-being and quality of life.Background: Subcutaneous almost substituted subpectoral approach of implantable cardioverter-defibrillator (ICD) implantation as a less invasive surgical technique. However, the impact of this change in placement site on procedure-related shoulder impairment is poorly understood. Methods: Candidates for ICD implantation were prospectively evaluated at baseline, 2-weeks and 3-months after the procedure. Assessment of shoulder function included: Constant Score, Numeric Rating Scale (NRS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) scoring method. The Short Form-36 (SF-36) questionnaire was adopted for quality of life. Results: Fifty consecutive patients were enrolled (21 single-chamber, 5 dual-chamber and 24 biventricular ICD). Significant changes in the short term were observed: physical component summary (regarding SF-36) decreased from 44.5 \ub1 9.1 to 41.8 \ub1 11.4 (p = 0.016), patients with NRS > 1 increased from 14% to 44% (p < 0.001), DASH score increased from 1.29 [interquartile range 0.00-10.34] to 30.60 [interquartile range 12.93-46.34] (p < 0.001). Notably, only the shoulder ipsilateral to implantation site presented a decrease in Constant Score (76.00 [interquartile range 61.37-86.87] vs. 95.75 [interquartile range 91.37-98.00]; p < 0.001). After three months most of the parameters seemed to have recovered, except for range of motion. Procedure-related increase in pain (i.e. NRS increase 65 1 point) was the most important independent predictor of shoulder impairment, in terms of Constant Score modification (r = 0.570; p < 0.001). Conclusions: ICD implantation is frequently associated with ipsilateral shoulder impairment which tends to recover within 3-months. These data positively compare with the subpectoral approach and should be considered for future research regarding impact of ICD implant on physical well-being and quality of life. \ua9 2012 Elsevier Ireland Ltd. All rights reserved