All-arthroscopic AMIC procedure for repair of cartilage defects of the knee

PURPOSE: Bone marrow mesenchymal stem cells were introduced into clinical practice due to their ability to differentiate into many types of cells. Autologous matrix-induced chondrogenesis (AMIC) combines the microfracture method with matrix-based techniques that utilizes a collagen membrane to serve as a scaffold for new bone marrow mesenchymal stem cells, allowing effective reconstruction of even large fragments of a damaged cartilage surface. METHODS: All-arthroscopic technique to repair knee cartilage defects using the AMIC technique, which includes the use of a collagen matrix (porcine collagen type I and III) and fibrin glue—technique presentation. CONCLUSION: This technical note introduces an all-arthroscopic AMIC technique to reconstruct extensive cartilage defects (without bone defects). The technique may be used for treatment of all location of knee cartilage lesions. LEVEL OF EVIDENCE: V

STRATEGY OF VISUAL PROPRIOCEPTIVE CONTROL IN PATIENTS WITH INJURY TO THE ANTERIOR CRUCIATE LIGAMENT OF THE KNEE AND HEALTHY INDIVIDUALS (SOCCER PLAYERS)

Objective: Knee joint dysfunction resulting from injury to the anterior crucial ligament (ACL) is associated not only with mechanical joint instability but also with damage of ligamentous receptors responsible for the joint proprioception. It was found that disturbances of signals from the damaged joint produce disorders in movement perception and position of the analogous joint in the normal limb. This study is aimed at evaluating the control strategy in patients with an injury to the anterior crucial ligament.Design: Cohort study; Level of evidence, 3. Subjects/Patients- 84 men, aged 15 to 55 years (mean age 27 years) were included in this study. Methods- Patients were divided into two groups: those with unilateral injury to the ACL (33 patients) and a control group of healthy volunteers (soccer players; 51 men). Anterior crucial ligament damage was confirmed with arthroscopic knee joint examination in every patient. The way of visual proprioceptive control was assessed with both dynamic (DRT) and static (SRT) Riva tests standing on one leg. Tests were performed with the Delos Postural Proprioceptive System (Delos s.r.l., Corso Lecce, Torino, Italy) in the biomechanical evaluation laboratory at Rehasport Clinic in Poznań. Results: A statistically significant difference for deviations from the averaged axis in SRT (static Riva test) with closed eyes was found between the limb with a damaged ACL and the normal limb in the group of patients with injury to the ACL (p=0.006) and between the limb with a damaged ACL and normal limbs in healthy volunteers (p=0.022). A statistically significant difference for deviations from the averaged axis in SRT with closed eyes was also found between the dominant and non-dominant limb in healthy volunteers (p=0.013). No significant differences in the results of tests with open eyes were noted. Conclusions: The results of systems and their contribution to the visual proprioceptive control suggest an important role of the visual system in compensation of archeproprioceptive system disorders resulting from injury to the ACL. Clinical Relevance: Neurological deficits of proprioceptive perception, associated with injury to the ACL and affecting the balance, may be noted only in the results of tests performed with closed eyes

Similar Outcomes and Satisfaction of the Proprioceptive versus Standard Training on the Knee Function and Proprioception, Following the Anterior Cruciate Ligament Reconstruction

Background: Patients with anterior cruciate ligament (ACL) injuries have poorer proprioception than people without such injuries. The effects of proprioceptive training on knee functionality and proprioceptive improvement after ACL reconstruction is still unclear. Methods: The research material consisted of 40 patients after ACL reconstruction. Of the 40 patients, 20 of them were rehabilitated with a standard program and 20 with additional proprioceptive exercises. The subjective and the objective scores were evaluated. Results: No differences were found between the proprioceptive versus the conservative postoperative rehabilitation in the functional nor in the proprioception outcomes of the operated limbs. Conclusions: There is no advantage to function in doing proprioceptive rehabilitation exercises following the ACL reconstruction, when compared with a traditional strengthening program

Arthroscopic Treatment of Chondral and Osteochondral Defects in the Ankle Using the Autologous Matrix-Induced Chondrogenesis Technique

One of the greatest challenges nowadays facing orthopaedic surgeons around the world is the problem of articular cartilage defects and their treatment. The autologous matrix-induced chondrogenesis technique is based on 2 elements—drilling into bones and matrix application. The purpose of this article is to present the surgical technique of arthroscopic treatment of chondral or osteochondral defects in the ankle using the autologous matrix-induced chondrogenesis technique

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction with autologous hamstring grafts-isokinetic assessment with control group.

OBJECTIVE: The aim of the study was to: 1) evaluate the differences in pre-post operative knee functioning, mechanical stability, isokinetic knee muscle strength in simultaneous arthroscopic patients after having undergone an anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) with hamstring tendons reconstruction, 2) compare the results of ACL/PCL patients with the control group. DESIGN: Controlled Laboratory Study. MATERIALS AND METHODS: Results of 11 ACL/PCL patients had been matched with 22 uninjured control participants (CP). Prior to surgery, and minimum 2 years after it, functional assessment (Lysholm and IKDC 2000), mechanical knee joint stability evaluation (Lachman and "drawer" test) and isokinetic tests (bilateral knee muscle examination) had been performed. Different rehabilitation exercises had been used: isometric, passive exercises, exercises increasing the range of motion and proprioception, strength exercises and specific functional exercises. RESULTS: After arthroscopy no significant differences had been found between the injured and uninjured leg in all isokinetic parameters in ACL/PCL patients. However, ACL/PCL patients had still shown significantly lower values of strength in relative isokinetic knee flexors (p = 0.0065) and extensors (p = 0.0171) compared to the CP. There were no differences between groups regarding absolute isokinetic strength and flexors/extensors ratio. There was statistically significant progress in IKDC 2000 (p = 0.0044) and Lysholm (p = 0.0044) scales prior to (44 and 60 points respectively) and after the reconstruction (61 for IKDC 2000 and 94 points for Lysholm). CONCLUSIONS: Although harvesting tendons of semitendinosus and/or gracilis from the healthy extremity diminishes muscle strength of knee flexors in comparison to the CP, flexor strength had improved. Statistically significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is required for restoring normal muscle strength. Without restoring normal muscle function and strength, surgical intervention alone may not be sufficient enough to ensure expected improvement of the articular function

Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery

Purpose: Chronic Achilles tendon tears, including chronic ruptures with end gap over 6 cm making end-to-end suturing impossible, can be treated with autologous hamstring graft reconstruction. The primary goal of this study was to present the biomechanical and long-term clinical results of recently developed minimally invasive Achilles tendon reconstruction technique. Methods: Minimally invasive Achilles tendon reconstruction was applied to 8 foot and ankle cadaveric specimens as well as 18 patients with chronic Achilles tendon tears. Repaired cadavers were subjected to the biomechanical testing using a cyclic loading protocol. Patients with reconstructed Achilles tendon were subjected to the clinical, functional and isokinetic tests at 12 months after the treatment. Results: All of tested Achilles cadaveric specimens survived 2 loading blocks (250 cycles of 10–100 N load followed by additional 250 cycles of 10–200 N load). With three specimens, it was possible to perform the third cyclic loading block with 20-300 N load and two specimens survived the fourth block with 20–400 N load. Therefore, a mean number of 838 cycles (±178) within the range of 509–1000 was recorded. Two specimens which survived all 1000 cycles were pulled to failure at 25 mm/s rate. The results obtained in the load to failure testing were as follows: 398 N and 608 N of maximum load. The results of functional heel rise endurance test and single leg hop for distance test indicated a decrease in the endurance and strength of the injured limb. However, the results of the weight-bearing lunge tests indicated no tendency for elongation of the Achilles tendon. A comparative analysis of the isokinetic test results for the non-injured and injured limb was revealed no statistically significant differences for every isokinetic test (n. s.), with significant difference for isometric strength parameters (p = 0.0006). Conclusions: The results of the biomechanical tests as well as 1-year extensive functional, clinical and isokinetic results of the minimally invasive technique for chronic Achilles tendon tears are encouraging. Patients returned to their normal physical activity, including sport pre-injury level in most cases. Level of evidence: III

Arthroscopic Matrix-Based Meniscus Repair Surgical Technique With “Goat” Instrument

Human meniscal treatment with an arthroscopic matrix-based meniscal repair technique is a promising procedure. Heretofore, the procedure has required a skilled surgeon with a great amount of experience in knee arthroscopic surgery and meniscal suturing. A surgical technique using a “goat” delivery clamp has been developed. Technique development followed extensive review and the application of earlier arthroscopic matrix-based meniscal repair techniques, along with cadaveric refinement of the proposed arthroscopic technique. The presented technique includes preparation of the meniscus with initial stabilization of the damaged fragments, preparation of the collagen matrix and placement of this matrix into the open jaws of the goat delivery clamp, introduction of the collagen matrix into the knee and placement of this matrix on the meniscus, suturing of the collagen matrix to the meniscus, and bone marrow blood aspirate injection between the collagen matrix and meniscus

Mechanical knee stability in ACL/PCL patients.

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