Partial Anterior Cruciate Ligament Ruptures: Advantages by Intraligament Autologous Conditioned Plasma Injection and Healing Response Technique—Midterm Outcome Evaluation

The historical treatment options for partial anterior cruciate ligament (ACL) ruptures were conservative therapy or ACL reconstruction by injured bundle or entire ACL replacement. In awareness of the regenerative potential of biologic agents such as mesenchymal stem cells or platelet rich plasma (PRP), the healing response technique was developed to preserve the injured ACL with belter outcomes lhan ihe conservative therapy. Further improvement of this technique seems to be obtained by the additional application of PRP products. Thus, the aim of this study was to evaluate the midterm outcome after intraligament autologous conditioned plasma (ACP) by a clinical, scoring, and functional performance assessment. 42 patients were evaluated in this study. The failure rate was 9.5%. Outcome evaluation showed good to excellent results. The scores were IKDC subjective 83.2 (SD 14.5), Lysholm 85.5 (SD 15.5), Tegner 4.7 (SD 1.7), and Cincinnati 85.4 (SD 15.5) afler a mean follow-up of 33 months. Clinical examination showed stable Lachman tesl, negative pivot shift phenomenon, and a significant reduction in AP-laxity compared to preoperative status (rolimeter preoperative: 1.9 (SD1.4); postoperative 0.6 (SD1.8), p=0.001) in all patients. Functional performance testing showed no significant differences between the injured and healthy side. Return to sport was achieved after a mean of 5.8 months (SD 3.6) in 71.1% of the included patients. In summary, this new treatment option revealed in midterm follow-up promising results to treat partial ACL lesions with a reduced need for conversion to ACL reconstruction and with a high percentage of return to preinjury sport activity

Biochemische Charakterisierung von mikrokristalliner Zellulose und Besiedelung mit Endothelzellen

Der Gefäßersatz der Koronarien ist die heutzutage am häufigsten durchgeführte herzchirurgische Operation. Das Fehlen von geeignetem natürlichen Material kann durch den Einsatz von künstlich hergestelltem Gefäßersatz abgemildert werden. Diese Studie untersuchte die Verwendung von bakterieller Zellulose (BC), produziert vom Bakterium Acetobacter xylinum, als Material für den künstlichen Gefäßersatz. In seinen Eigenschaften ist es dem Kollagen ähnlich. Dieses Material wurde mit Endothelzellen, welche aus humanen Umbilicalvenen gewonnen wurden, und Glattmuskelzellen, welche aus nicht mehr benötigten Gefäßresten menschlicher Arterien extrahiert wurden, besiedelt. Verschiedene Besiedelungsmethoden wurden durchgeführt, nämlich die statische Besiedelung, ferner die Besiedelung mittels Zentrifuge und die Kolonisation im Bioreactor. Vor jedem Versuch wurde die BC sterilisiert. Statisches Besiedeln sowie der Einsatz der Zentrifuge führten nicht zur Bildung einer konfluenten Schicht aus Endothelzellen, lediglich die Besiedelung im Bioreaktor führte zu einem besseren Ergebnis. Dies wurde mit Proteinassays, histologischer Befundung und dem Einsatz des Rasterelektronenmikroskops bestätigt. Zusammenfassend kann postuliert werden, dass der Einsatz von BC als sinnvolles Gefäßgerüst zur Bildung einer konfluenten Endothelzellschicht fungieren kann und in Zukunft als künstlicher Gefäßersatz dienen kann

Trauma care inside and outside business hours: comparison of process quality and outcome indicators in a German level-1 trauma center

BackgroundOptimal care of multiple trauma patients has to be at a high level around the clock. Trauma care algorithms and guidelines are available, yet it remains unclear if the time of admission to the trauma room affects the quality of care and outcomes. Hence the present study intends to compare the quality of trauma room care of multiple severely injured patients at a level-1 trauma center depending on the time of admission.MethodsA total of 394 multiple trauma patients with an ISS???16 were included into this study (observation period: 52?months). Patients were grouped by the time and date of their admission to the trauma room [business hours (BH): weekdays from 8:00?a.m. to 4:00?p.m. vs. non-business hours (NBH): outside BH]. The study analysed differences in patient demographics, trauma room treatment and outcome.ResultsThe study sample was comparable in all basic characteristics [mean ISS: 32.3???14.3 (BH) vs. 32.6???14.4 (NBH), p?=?0.853; mean age: 40.8???21.0 (BH) vs. 37.7???20.2?years (NBH), p?=?0.278]. Similar values were found for the time needed for single interventions, like arterial access [4.8???3.9?min (BH) vs. 4.9???3.4?min (NBH), p?=?0.496] and quality-assessment parameters, like time until CT [28.5???18.7?min (BH), vs. 27.3???9.5) min (NBH), p?=?0.637]. There was no difference for the 24?h mortality and overall hospital mortality in BH and NBH, with 13.5% vs. 9.1% (p?=?0.206) and, 21.9% vs. 15.4% (p?=?0.144), respectively. The Glasgow Outcome Scale (GOS) comparison revealed no difference [3.7???1.6 (BH) vs. 3.9???1.5 (NBH), p?=?0.305]. In general, the observed demographic, injury severity, care quality and outcome parameters revealed no significant difference between the two time periods BH and NBH.ConclusionsThe study hospital provides multiple trauma patient care at comparable quality irrespective of time of admission to the trauma room. These results might be attributable to the standardization of the treatment process using established principles, algorithms and guidelines as well as to the resources available in a level-1 trauma center

Early functional treatment or trivialization? – current treatment strategies in lateral ligament injuries of the ankle

Introduction: Ankle injuries are common in daily orthopaedic trauma practice, with a high incidence of lateral ligament complex (lat-lig-com) injuries of the ankle joint (AJ). Primarily, these lat-lig-com injuries heal sufficiently, although there is a risk of developing chronic ankle instability. However, there is a lack of knowledge about the clinical application and routine for rehabilitation strategies so as to prevent chronic instability. This study investigates the current rehabilitation concepts in clinical routine after ligament injuries of the AJ. Methods: Rehabilitation protocols, provided by orthopaedic and trauma surgery institutions in German speaking countries, were analysed in terms of weight-bearing, range of motion (ROM), physiotherapy and choice of orthosis. All protocols for operatively and non-operatively (nop) treated ligament ruptures of the AJ were included. Results: 120 of 213 institutions provided protocols of lat-lig-com injuries of the AJ. Regarding the orthosis, the nop-treatment group mainly used ankle braces; in contrast, the operative group preferred the use of an ankle boot. The operative group recommends 6-12 weeks for duration of orthosis in contrast to only 6 weeks in the nop group. Significant differences prevail in ROM, with free ROM in non-operative treatment from the first day after trauma (p<0.001) in contrast to a careful increase in ROM in the first 6 weeks post-operatively. Conclusion: Early functional treatment is clinical standard in rehabilitation after lat-lig-com injuries of the ankle. Regarding current literature the differences of restrictions in ROM and orthosis treatment after lat-lig-com injuries suggest a trivialization of conservative treatment in the first period after trauma compared to post-operative aftercare

Leukocyte-reduced platelet-rich plasma increases proliferation of tenocytes treated with prednisolone: a cell cycle analysis

The purpose of this study was to evaluate the effect of allogenic leukocyte-reduced platelet-rich plasma on human tenocytes after treatment with prednisolone and to develop a standardization of its application for clinical practice. A leukocyte-reduced PRP was produced using the Arthrex Double Syringe (Arthrex, Inc., Naples, FL, USA), in a modified single-spin separation method. Human tenocytes were isolated from discarded rotator cuff segments. Tenocytes were cultured in the presence of PRP and prednisolone, both alone and in combination. Control samples were treated in media containing 2% FCS for 72 h. After 72 h of incubation, cell cycle kinetics of tenocytes were analyzed to assess proliferation. Incubation of the tenocytes with PRP alone for 48 h led to high proliferation rate (10% PRP, 28.0 +/- 10.5%; 20% PRP, 40.9 +/- 3.3%). Incubation in the presence of prednisolone led to a significant decrease of the proliferation rate (5.2 +/- 3.1%; p < 0.05). Treatment with PRP for 48 h significantly increased the proliferation of tenocytes in a dose-dependent manner (10% PRP, 28.0 +/- 10.5%; 20% PRP, 40.9 +/- 3.3%; p < 0.05). The presence of prednisolone resulted in a decreased tenocyte proliferation (5.2 +/- 3.1%; p < 0.05), whereas addition of PRP for 24 and 48 h after prednisolone exposure did not show any compensating effect independent of PRPs concentration (10% PRP, 3.7 +/- 3.0%; 20% PRP, 2.5 +/- 2.5%). However, a significantly increased cell proliferation of tenocytes was evident when PRP was applied 24 h after prednisolone incubation for 48 h (31.0 +/- 3.4 and 34.3 +/- 4.7%). The use of leukocyte-reduced PRP stimulates the proliferation of tenocytes and antagonizes the negative effect of prednisolone 24 h after treatment. Addition of PRP 48 h after treatment with prednisolone has no positive effect on the proliferation rate of tenocytes

A trauma network with centralized and local health care structures: Evaluating the effectiveness of the first certified Trauma Network of the German Society of Trauma Surgery

<div><p>Background</p><p>Trauma is a global burden of disease and one of the main causes of death worldwide. Therefore, many countries around the world have implemented a wide range of different initiatives to minimize mortality rates after trauma. One of these initiatives is the bundling of treatment expertise in trauma centers and the establishment of trauma networks.</p><p>Germany has a decentralized system of trauma care medical centers. Severely injured patients ought to receive adequate treatment in both level I and level II centers. This study investigated the effectiveness of a decentralized network and the question whether level I and level II centers have comparable patient outcome.</p><p>Materials and methods</p><p>In 2009, the first trauma network DGU^® in Germany was certified in the rural area of Eastern Bavaria. All patients admitted to the 25 participating hospitals were prospectively included in this network in the framework of a study sponsored by the German Federal Ministry of Education and Research between March 2012 and February 2014. 2 hospitals were level I centers (maximal care centers), 8 hospitals were level II centers, and 15 hospitals were level III centers. The criterion for study inclusion was an injury severity score (ISS) ≥ 16 for patients´ primarily admitted to a level I or a level II center. Exclusion criteria were transferal to another hospital within 48 h, an unknown revised injury severity classification II score (RISC II), or primary admittance to a level III center (n = 52). 875 patients were included in the study.</p><p>Univariate analyses were used regarding the preclinical and clinical parameters, the primary endpoint mortality rate, and the secondary endpoints length of stay, organ failure, and neurological outcome (GOS). The primary endpoint was additionally evaluated by means of multivariable analysis.</p><p>Results</p><p>Indices for injury severity (GCS, AIS_Head, ISS, and NISS) as well as the predicted probability of death (RISC II) were higher in level I centers than in level II centers.</p><p>No significant differences were found between the mortality rate of the unadjusted analysis [level I: 21.6% (CI: 16.5, 27.9), level II: 18.1% (CI: 14.4, 22.5), p = 0.28] and that of the adjusted analysis [level I SMR: 0.94 (CI: 0.72, 1.21), level II SMR: 1.18 (CI 0.95, 1.48) SMR: expected vs. calculated mortality rate according to RISC II]. Multivariable analysis showed a survival advantage of patients admitted to a level I center with a probability of death of 13% (RISC II). The number need to treat was 10 patients.</p><p>Discussion</p><p>This study showed that a rural trauma network with centralized and local structures may achieve equivalent results with regard to mortality rates to those obtained in level I and level II centers. These results were furthered by a certain preclinical centralization (24/7 air rescue) of patients. The study also showed a survival advantage of patients admitted to a level I center with a probability of death of 13%. Preclinical and initial clinical evaluation with regard to probable mortality rates should be further improved to identify patients who would benefit from admittance to a level I center.</p></div

Early functional rehabilitation after patellar dislocation—What procedures are daily routine in orthopedic surgery?

Introduction: Patellar dislocation and rupture of the medial patellofemoral ligament (MPFL) are frequently seen in daily orthopedic practice. Besides initial non-surgical treatment, surgery and subsequent rehabilitation are crucial for restoring stability in the femoropatellar joint. This study investigated current rehabilitation strategies after patellar dislocation because knowledge on this topic has been severely limited so far. Materials and methods: The current rehabilitation protocols of 42 orthopedic and trauma surgical institutions were analyzed regarding their recommendations on weight bearing, range of motion (ROM), and use of movement devices and orthosis. All protocols for conservative treatment and postoperative rehabilitation after MPFL reconstruction were compared. Descriptive and statistical analyses were carried out when appropriate. Results: The different rehabilitation strategies for conservative and surgical treatment after patellar dislocation showed a tendency towards earlier functional rehabilitation after surgical MPFL reconstruction than after conservative treatment. Both surgical and conservative treatment involved initial restrictions in weight bearing, ROM, and use of movement devices and orthosis at the beginning of rehabilitation. The rehab protocols showed a significant earlier full weight bearing after surgical MPFL reconstruction (p> 0.001). Due to the presence of other parameters for early functional treatment, the absence of an indication for using orthosis (surgical: 44%, conservative: 33%; p = 0.515) or start of unlimited ROM of the knee (surgical: 4.9 weeks, conservative: 5.7 weeks; p = 0.076) showed by trend an earlier functional strategy after MPFL reconstruction than after conservative therapy. Conclusions: Both conservative and surgical treatment after patellar dislocation showed restrictions in the early phase of the rehabilitation. Earlier functional therapy was more common after MPFL reconstruction than after conservative treatment. Further clinical and biomechanical studies on rehabilitation strategies after patellar dislocation are needed to improve patient care and individualized therapy. (C) 2018 Published by Elsevier Ltd

Functional Deficits in the Wrist and Finger Joints of Goalkeepers After 20 Years of Playing Recreational Football

Background Long-term damage in the hip, knee and ankle joints of football players has been thoroughly discussed in the literature. Compared with outfield players, however, goalkeepers sustain injuries to the upper extremities five times more often. There is a lack of studies on long-term functional damage to the wrist and finger joints of football goalkeepers. Hypothesis Repetitive micro-traumas and injuries lead to degenerative diseases in goalkeepers after 20 years of playing recreational soccer. Methods The personal histories, injury histories and clinical examination findings of the wrist and finger joints of 27 goalkeepers were compared with the findings obtained in a control group of outfield players. Results Goalkeepers were significantly more restricted in finger movement (p < 0.05) and experienced more pain and swelling (p < 0.05) as well as higher levels of instability (p < 0.05) in the wrist and finger joints than outfield players. Conclusion Medical history and clinical findings indicate deficits in the hands of soccer goalkeepers and a high prevalence of joint and ligament injuries sustained to the fingers over the course of their sports activity. This necessitates specific strategies in the future to prevent injuries and long-term posttraumatic deficits

11.361 sports injuries in a 15-year survey of a Level I emergency trauma department reveal different severe injury types in the 6 most common team sports

Introduction Severe sports-related injuries are a common affliction treated in Level I trauma departments. Detailed knowledge on injury characteristics from different medical settings is essential to improve the development of injury prevention strategies in different team sports. Methods Team sport injuries were retrospectively analysed in a Level I trauma department registry over 15 years. Injury and treatment data were compared with regard to competition and training exposure. Injury data such as time of visitation, type of injury, multiple injured body regions and immediate hospitalisation helped to define the severity level of each team sports injury. Results At the Level I trauma department, 11.361 sports-related injuries were seen over 15 years, of which 34.0% were sustained during team sports. Soccer injuries were the most common injuries of all team sports (71.4%). The lower extremity was the most affected body region overall, followed by the upper extremity. Head injuries were mainly seen in Ice hockey and American football and concussion additionally frequently in team handball. Slight injuries like sprains or contusions occurred most frequently in all team sports. In soccer and team handball, injuries sustained in competition were significantly more severe (p<0.001) than those sustained in practice. Volleyball and basketball had a trend to higher rate of severe injuries sustained during practice sessions. Conclusion Depending on the specific injury profile of each team sports, injury prevention strategies should address competitive as well as training situations, which may need different strategies

The effect of leukocyte-reduced platelet-rich plasma on the proliferation of autologous adipose-tissue derived mesenchymal stem cells1

Clinical application of platelet-rich plasma (PRP) and stem cells has become more and more important in regenerative medicine during the last decade. However, differences in PRP preparations may contribute to variable PRP compositions with unpredictable effects on a cellular level. In the present study, we modified the centrifugation settings in order to provide a leukocyte-reduced PRP and evaluated the interactions between PRP and adipose-tissue derived mesenchymal stem cells (ASCs). PRP was obtained after modification of three different centrifugation settings and investigated by hemogram analysis, quantification of protein content and growth factor concentration. ASCs were cultured in serum-free alpha-MEM supplemented with autologous 10% or 20% leukocyte-reduced PRP. Cell cycle kinetics of ASCs were analyzed using flow cytometric analyses after 48 hours. Thrombocytes in PRP were concentrated, whereas erythrocytes, and white blood cells (WBC) were reduced, independent of centrifugation settings. Disabling the brake further reduced the number of WBCs. A higher percentage of cells in the S-phase in the presence of 20% PRP in comparison to 10% PRP and 20% fetal calf serum (FCS) advocates the proliferation stimulation of ASCs. These findings clearly demonstrate considerable differences between three PRP separation settings and assist in safeguarding the combination of leukocyte-reduced PRP and stem cells for regenerative therapies