Prevalence of Cervical Canal Stenosis in Patients with Femoral Fracture: A Retrospective Single-Center Study

Introduction: Cervical spine surgery reduces falls and subsequent femoral fractures. Nonetheless, current evidence on the prevalence of cervical cord compression (CCC) and increased signal intensity (ISI) in patients with femoral fractures is limited. We aimed to determine the prevalence of CCC and ISI and characterize the physical status and imaging findings using cervical spine magnetic resonance imaging (MRI) and brain computed tomography (CT) in patients with femoral fractures. Methods: This study included 173 patients (140 women, 33 men) with femoral fractures caused by falling, who underwent both cervical spine MRI and brain CT. CCC cases classified as grade 2 (compression of less than one-third of the spinal cord) or higher were investigated. The ISI of the severely affected intervertebral disc level was evaluated using T2-weighted MRI. Hand grip strength and myelopathic signs were also evaluated. Data analysis was performed using the χ2 test, Fisher's exact test, and Student's t-test. Results: Among the 173 patients, 83 (48.0%) had CCC, 29 (16.8%) had ISI, and 68 (39.3%) had abnormal brain CT findings. There was no ISI in patients in the non-CCC group. The patients' average age in the CCC group was significantly higher than that in the non-CCC group. There was no significant difference in the proportion of myelopathic sign and abnormal brain CT findings between the CCC and non-CCC groups or between the ISI and non-ISI groups. Bilateral hand grip strength was significantly negatively correlated with the stenosis rate (right, p=0.047; left, p=0.0018). Conclusions: In conclusion, our study showed that patients with femoral fractures had a high frequency of cervical canal stenosis and intracranial lesions using cervical spine MRI and brain CT

Characteristics of elongated and ruptured anterior cruciate ligament grafts: An analysis of 21 consecutive revision cases

Background/objective: Anterior cruciate ligament (ACL) reconstructions often fail without graft rupture. The purpose of this study was to compare the characteristics of patients with elongated and ruptured bone-patellar tendon-bone (BTB) grafts that required revision surgery. Methods: Twenty one patients who required revisions of a BTB-reconstructed ACL between 2010 and 2015 were enrolled in this study. All patients were evaluated for bone tunnel position using computed tomography. Tunnel angle was calculated with radiographs. Stability under anaesthesia, and meniscus and cartilage condition were evaluated during the revision surgery. Age at primary surgery, time between primary and revision surgery, activity level, original tunnel position of the graft, and meniscus and cartilage condition were compared between elongated and ruptured grafts. Results: Age at primary surgery was not significantly different between the two groups (p = 0.528). Time between primary and revision surgery as well as activity level were also not significantly different between the two groups (p = 0.010 and p = 0.307, respectively). Femoral bone tunnel position was more proximal (p = 0.003), and radiographic tunnel angle was not significantly different between the two groups (p = 0.029). The rupture group was significantly more unstable on the pivot shift (p < 0.003). Meniscus degeneration, meniscus tear, and cartilage damage were not significantly different between the two groups (p = 0.030, p = 0.311, and p = 0.505, respectively). Conclusion: The location of the original femoral tunnel was more proximal in patients with elongated grafts than in those with ruptured grafts. Different bone tunnel position from native ACL might lead to graft elongation

Hyaluronic acid induces the release of growth factors from platelet-rich plasma

Background/Objective: Platelet-rich plasma (PRP) and hyaluronic acid (HA) injection are both therapeutic options for osteoarthritis and chronic tendinopathy. Although several comparative studies on the two have been published, the effects of mixing PRP and HA are not fully understood. The purpose of this study is to investigate the influence of HA on platelets in PRP by measuring releasing growth factors. Methods: PRP was produced from nine healthy adult volunteers (mean age, 32.8±2.9 years; range, 29–37) with a commercial separation system. HA of weight-average molecular weight of 50–120 kDa was used. PRP group (PRP 1 mL + phosphate buffered saline 0.2 mL) and PRP + HA group (PRP 1 mL + HA 0.2 mL) were incubated at 37°C for 2 hours. The amounts of transforming growth factor β1 (TGF-β1) and platelet-derived growth factor (PDGF-AA) released from the PRP and PRP + HA samples were measured on Day 0, Day 3, and Day 5. In addition, the same growth factors on Day 5 were measured for PRP + high HA group (PRP 1 mL + HA 0.6 mL) with five donors. After collecting all of the samples on Day 5, the remaining gels were observed with Giemsa stain. Statistical analyses were performed using paired t tests to compare the PRP and HA groups at each time point, and a one-way analysis of variance (one-way ANOVA) with Tukey post hoc tests was used to compare the PRP, PRP + HA, and PRP + high HA groups. Results: The TGF-β1 concentrations in the PRP and PRP + HA were 24.3±7.2 μg/mL and 22.4±1.8 μg/mL (p=0.689) on Day 0, 17.2±13.9 μg/mL and 25.4±7.1 μg/mL (p=0.331) on Day 3, and 12.7±10.5 μg/mL and 33.7±8.3 μg/mL (p=0.034) on Day 5. The TGF-β1 concentrations on Day 5 were 24.1±5.2 μg/mL (PRP group), 28.3±2.4 μg/mL (PRP + HA), and 31.9±4.8 μg/mL (PRP + high HA; one-way ANOVA: p=0.003; post hoc PRP vs. PRP + HA: p=0.016). The PDGF-AA concentrations in the PRP and PRP + HA groups were 2.30±1.21 μg/mL and 2.32±0.79 μg/mL (p=0.931) on Day 0, 2.03±0.53 μg/mL and 2.13±0.73 μg/mL (p=0.500) on Day 3, and 1.51±0.40 μg/mL and 2.00±0.52 μg/mL (p=0.003) on Day 5. The PDGF-AA concentrations were 1.48±0.46 μg/mL (PRP group), 1.94±0.57 μg/mL (PRP + HA), and 2.69±0.70 μg/mL (PRP + high HA; one-way ANOVA: p=0.0002; PRP vs. PRP + high HA: p=0.002; PRP + HA vs. PRP + high HA: p=0.011) on Day 5. The PRP showed larger coagulated masses than the PRP + HA. The high concentration HA group had the smallest coagulated mass of all of the group. Conclusion: The levels of growth factors released by PRP on Day 5 were increased by the addition of HA. A mixture of PRP and HA may be a more effective therapy than PRP or HA alone for osteoarthritis and tendinopathy