Extracorporeal Shock Wave Treatment (ESWT) enhances the in vitro-induced differentiation of human tendon-derived stem/progenitor cells (hTSPCs)

Extracorporeal shock wave therapy (ESWT) is a non-invasive and innovative technology for the management of specific tendinopathies. In order to elucidate the ESWT-mediated clinical benefits, human Tendon-derived Stem/Progenitor cells (hTSPCs) explanted from 5 healthy semitendinosus (ST) and 5 ruptured Achilles (AT) tendons were established. While hTSPCs from the two groups showed similar proliferation rates and stem cell surface marker profiles, we found that the clonogenic potential was maintained only in cells derived from healthy donors. Interestingly, ESWT significantly accelerated hTSPCs differentiation, suggesting that the clinical benefits of ESWT may be ascribed to increased efficiency of tendon repair after injury

Terapia con onde d'urto extracorporee nei disturbi del consolidamento osseo. Basi biologiche e raccomandazioni operative.

Nei disturbi del consolidamento osseo, l'efficacia della chirurgia può essere condizionata da varie complicanze. tra le strategie non chirurgiche, la terapia con onde d'urto extracorporee (ESWT - Extracorporeal Shock Wave Therapy) rimanda al principio fisico della meccanotrasduzione, in base al quale, l'interazione molecolare tra l'impulso acustico e le strutture meccanosensibili delle cellule regola l'espressione genica di determinati fattori di crescita e sostanze pro angiogenetiche. Tali prerogative conferiscono alle onde d'urto il significato traslazionale di terapia rigenerativa la cui efficacia nei trattamenti sull'osso dipende dalla corretta selezione dei pazienti, dal timing, dal rispetto di raccomandazioni operative e successive al trattamento

Hyaluronic acid alone versus hyaluronic acid associated with adelmidrol for intra-articular treatment of knee osteoarthritis: a long-term follow-up

Background: Hyaluronic acid (HA) has been used for many years for intra-articular treatment of knee osteoarthritis with satisfactory results. HA associated with Adelmidrol – an anti-neuroinflammatory compound – have been only recently introduced in orthopedic clinical practice with good preliminary results. Objective: To investigate whether HA associated with Adelmidrol provides better results than HA alone. Methods: Two cohorts of patients with moderate knee osteoarthritis were treated. Cohort 1 received 5 weekly intra-articular injections of HA during 2017 while Cohort 2, 4 weekly intra-articular injections of HA associated with Adelmidrol during 2018. The patients of the two Cohorts were assessed by WOMAC scale, SF-12 questionnaire and PGIC scale at 1 week (T0), 6 months (T1), 1 year (T2), and 2 years (T3) after the end of treatment. All the data were statistically analyzed. A p-value of <0.05 was considered statistically significant. Results: According to the WOMAC Scale Cohort 1 had higher mean scores than Cohort 2 at each follow-up time, with a statistically significant difference between the two cohorts at T3 (p<0.03) for all the WOMAC components, except for Stiffness. WOMAC Total mean score worsened statistically significantly only in Cohort 1, from T1 to T3 (T2 vs T1: p=0.0033; T3 vs T2: p=0.0007). The same happened for WOMAC Physical Function (T2 vs T1: p=0.0146; T3 vs T2: p=0.0046) and WOMAC Pain (T2 vs T1: p=0.0004; T3 vs T2: p=0.0002). WOMAC Stiffness worsened statistically significantly in Cohort 1 from T2 to T3 (T3 vs T2: p=0.0041), while in Cohort 2 no change on WOMAC scale was statistically significant at any time-point, for any components. The mean scores of the SF-12 questionnaire were better in Cohort 2 than in Cohort 1 at each follow-up time for both the Physical and the Mental components, with a statistically significant difference between the two groups for the latter, at T0 (p=0.0001). In both cohorts the mean score of the Physical component decreased from T0 to T3, but the difference was not statistically significant between the two groups (p=0.25). The mean score of the Mental component slightly increased in Cohort 1 and decreased in Cohort 2, without statistically significant differences between the two groups at any time-point. PGIC showed that Cohort 2 scored significantly better than Cohort 1 at T3 (p=0.0336). Conclusions: Overall, HA associated with Adelmidrol gave better long-term results than HA alone

I.S.Mu.L.T. Achilles Tendon Ruptures Guidelines

This work provides easily accessible guidelines for the diagnosis, treatment and rehabilitation of Achilles tendon ruptures. These guidelines could be considered as recommendations for good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care for the individual patient and rationalize the use of resources. This work is divided into two sessions: 1) questions about hot topics; 2) answers to the questions following Evidence Based Medicine principles. Despite the frequency of the pathology andthe high level of satisfaction achieved in treatment of Achilles tendon ruptures, a global consensus is lacking. In fact, there is not a uniform treatment and rehabilitation protocol used for Achilles tendon ruptures

Operative treatment of chronic Achilles tendinopathy

Seventy-six patients with Achilles tendinopathies (n=86) operated between 1980 and 1995 were retrospectively evaluated at an average follow-up of 13 (5–21) years. Total or gross partial ruptures were excluded. Patients' average age at surgery was 38 (18–58) years. The majority of patients were active in competitive or recreational sports. Tendinopathies were classified in peritendinitis, tendinosis, insertional tendinopathies, and mixed forms. The surgical technique depended entirely on the pathology encountered. For 32 cases of peritendinitis, results were excellent in 26, good in four, and poor in two. For eight cases of tendinosis, results were excellent in four and good in four. For 34 cases of insertional tendinopathy, results were excellent in 22, good in four, fair in four, and poor in four. For 12 cases of mixed tendinopathies, results were excellent in ten and good in two. Forty-nine patients (52 cases) were able to return to sport at the desired level