Inspired by nature

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A HYPOTHESIS OF ETIOLOGY OF ATRAUMATIC ACL INJURIES

Atraumatic ACL injury has become more and more frequent especially in sport population. The causes which determine the ACL rupture, have not been identified and the possible relationship between proprioception and subjective function has not been adequately studied. Several authors (Schutte et al. 1987, Schultz et al. 1984) have found the mechanoreceptors in the cruciate ligament, and such receptors formed by muscle spindles, receptors in tendons and in skin determine a complex system for knee joint proprioception. Our starting hypothesis is that a possible cause of ACL lesion could be due to temporary inhibition of the muscular control following an alteration of the propioceptive joint control. The purpose of this study was to verify by a kinesiologic procedure if some stimulation of the subtalus joint could induce an inadequate recruitment of muscle fibers activation

La Valoración del Análisis de la Marcha en la Planificación de la Osteotomía Alta de Tibia

El objetivo de este trabajo ha sido el de valorar una nueva metódica clínica y biomecánica de los pacientes que presentan un genu varo y tratados quirúrgicamente mediante osteotomía tibial alta. De acuerdo a la metódica de Andriacchi e Insall y de nuestra pequeña experiencia hemos aplicado el estudio mediante "gait analysis" a estos pacientes preoperatoriamente. El cálculo preoperatorio del "momento adductor" parece ser discriminativo con respecto a los pacientes que tendrán un buen o mal resultado debido a la recidiva de la deformidad, dolor, etc. Tomando como referencia los resultados de estos estudios sugerimos algunas indicaciones pre y postoperatorias con referencia a la rehabilitación y la orientación quirúrgica más adecuada según el valor del momento adductor (alto o bajo) que presenten este tipo de pacientes.The purpose of this study has been to assess a new clinical and biomechanical approach of genu varum patients treated by high tibial osteotomy. According to Andriacchi, Insall, and their awn small experienc e the author s apply gait analysis to study the genu varum of patients pre-operatively. The assessment during preoperative gait of the adductor moment (high or low value s with respec t to the normal) seems to be discriminant in define patien that are goint to have good or bad results due to the recurrence of the pathology: pain, varus deformity, etc. Starting from the results the studies the authors suggest some indications in the pre and postoperative with reference to rehabilitation and surgical orientation taking in account the high or low level of preoperative the adductor moment

Effect of two different preparations of platelet-rich plasma on synoviocytes

To analyse the modifications induced by two different platelet-rich plasma (PRP) preparations on osteoarthritis (OA) synoviocytes, by documenting changes in gene expression of factors involved in joint physiopathology.OA synoviocytes were cultured for 7 days in medium with different concentrations of either P-PRP (a pure platelet concentrate without leucocytes but with a limited number of platelets), L-PRP (a higher platelet concentrate containing leucocytes) or platelet-poor plasma (PPP). Gene expression of interleukin (IL)-1beta, IL-6, IL-8/CXCL8, tumour necrosis factor alpha, IL-10, IL-4, IL-13, metalloproteinase-13, tissue inhibitor of metalloproteinase (TIMP)-1, (TIMP)-3, (TIMP)-4, vascular endothelial growth factor, transforming growth factor beta1, fibroblast growth factor (FGF)-2, hepatocyte growth factor (HGF), hyaluronic acid (HA) synthases (HAS)-1, (HAS)-2, and (HAS)-3 was analysed by RT-PCR. HA production was determined in culture supernatants by ELISA.IL-1β, IL-8 and FGF-2 were significantly induced by L-PRP compared to both P-PRP and PPP; HGF was down-modulated by L-PRP versus both P-PRP and PPP, and an inverse dose-response influence was shown for all preparations. Expression level of TIMP-4 was lower in the presence of L-PRP compared with P-PRP. HA production and HAS gene expression did not seem to be modulated by PRP.L-PRP is able to sustain the up-regulation of proinflammatory factors, (IL-1beta, IL-8 and FGF-2), together with a down-modulation of HGF and TIMP-4 expression, two factors that have been recognized as anti-catabolic mediators in cartilage, thus supporting the need to further optimize the PRP preparations to be applied in clinical practice

In Vivo Model of Osteoarthritis to Compare Allogenic Amniotic Epithelial Stem Cells and Autologous Adipose Derived Cells

SIMPLE SUMMARY: An early resolution of osteoarthritis (OA), through minimally invasive orthobiological solutions, would be important to enable a return to daily and sport activities, and delay prosthesis solutions. No study has yet evaluated amniotic epithelial stem cells (AECs) in OA. They could be considered a valid alternative to adipose derived cells, expanded or concentrated, because they differentiate into three lineages and express mesenchymal and embryonic markers, without a tumorigenic phenotype. The innovative aspects of this study are the comparison of three injective orthobiological treatments, the in vivo use of AECs in OA, and the evaluation of structural and inflammatory fronts of OA for up to six months. ABSTRACT: The challenge of osteoarthritis (OA) is to find a minimally invasive orthobiological therapy to contrast OA progression, on inflammatory and structural fronts. The aim of the present study is to compare the effects of an intra-articular injection of three orthobiological treatments, autologous culture expanded adipose-derived mesenchymal stromal cells (ADSCs), autologous stromal vascular fraction (SVF) and allogenic culture expanded amniotic epithelial stem cells (AECs), in an animal model of OA. OA was induced in 24 sheep by bilateral lateral meniscectomy and, at 3 and 6 months post-treatment, the results were analyzed with macroscopy, histology, histomorphometry, and biochemistry. All the three treatments showed better results than control (injection of NaCl), but SVF and AECs showed superiority over ADSCs, because they induced higher cartilage regeneration and lower inflammation. SVF showed better results than AECs at 3 and 6 months. To conclude, SVF seems to be more favorable than the other biological options, because it is easily obtained and rapidly used after harvesting, with good healing potential. AECs cause no discomfort and could be also considered for the treatment of OA joints

PRP Augmentation for ACL Reconstruction

Current research is investigating new methods to enhance tissue healing to speed up recovery time and decrease the risk of failure in Anterior Cruciate Ligament (ACL) reconstructive surgery. Biological augmentation is one of the most exploited strategies, in particular the application of Platelet Rich Plasma (PRP). Aim of the present paper is to systematically review all the preclinical and clinical papers dealing with the application of PRP as a biological enhancer during ACL reconstructive surgery. Thirty-two studies were included in the present review. The analysis of the preclinical evidence revealed that PRP was able to improve the healing potential of the tendinous graft both in terms of histological and biomechanical performance. Looking at the available clinical evidence, results were not univocal. PRP administration proved to be a safe procedure and there were some evidences that it could favor the donor site healing in case of ACL reconstruction with patellar tendon graft and positively contribute to graft maturation over time, whereas the majority of the papers did not show beneficial effects in terms of bony tunnels/graft area integration. Furthermore, PRP augmentation did not provide superior functional results at short term evaluation

Non-inferiority of The Cementless Total TKA Compared to The Cemented TKA, A m-Metanalysis

Objective: Cemented total knee arthroplasty still represents the reference standard in the field of prothesis knee replacement; but since cementless total knee arthroplasties were introduced there have been strong discussions over the years among cemented and non-cemented total knee arthroplasties to establish which gives the best benefits for the patient and for the surgeon. The purpose of this meta-analysis is to systematically analyze the use of cemented and cementless total knee arthroplasties by investigating clinical and radiological outcomes and rate of complications, in order to assess which techniques confers more benefits to the patient and the surgeon. Materials and Methods: The current systematic review has been written in accordance to the Cochrane handbook and the PRISMA statement for reporting of systematic reviews incorporating network. Results: Six randomized controlled trials were finally included in this systematic review. The statistical analysis revealed no significant differences in all clinical scores of interest (Knee Society Score, clinical and functional, Oxford Knee Score, Visual Analogue Score) and a similar revision rate. Conclusion: the results of the current metanalysis suggest the non-inferiority of cementless fixation with respect to cemented total knee arthroplasties in terms of clinical outcomes and survival rates of the implants

Preparation method and growth factor content of platelet concentrate influence the osteogenic differentiation of bone marrow stromal cells

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