Cedera Tendon Achilles (Evaluasi, Diagnosis dan Tata Laksana Komprehensif)

Tendon Achilles adalah tendon terbesar dan terkuat pada tubuh manusia. Tendon ini disebut juga triceps surae karena merupakan gabungan tendon gastroknemius dan soleus. Tendon ini melintasi tiga sendi, yaitu lutut, pergelangan kaki, dan subtalar. Cedera tendon Achilles adalah cedera tersering pada atlet. Cedera ini bisa terjadi secara akut atau kronik. Pasien ruptur Achilles umumnya didapatkan pada lelaki dewasa yang aktif berpartisipasi dalam kegiatan olahraga, sebanyak 44-83%. Ruptur Achilles lebih sering terjadi pada laki-laki, dengan perbandingan 7:1 hingga 12:1. Tendon Achilles kiri lebih sering ruptur, kemungkinan karena prevalensi individu dominan tangan kanan lebih tinggi, dan mereka melakukan gerakan melompat dengan kaki kiri. Pada beberapa kasus, pasien tidak menyadari bahwa tendon Achillesnya ruptur, dan datang dengan keluhan ruptur kronik Achilles 4-6 minggu pasca cedera

Defek Kartilago Sendi Lutut (Evaluasi, Diagnosis, dan Tata Laksana Terkini)

Ujung artikulasi sendi diartrodial dilapisi oleh kartilago hialin. Kartilago sendi bersifat hiposeluler, aneural, alimfatik, dan avaskular. jaringan ikat yang unik ini berfungsi sebagai bahan elastis yang bertanggung jawab terhadap ketahanan terhadap gaya tekan, distribusi beban, dan bersama dengan cairan sinovial memungkinkan gerakan tanpa gesekan dari permukaan tulang pembentuk komponen sendi. Kartilago sendi terdiri atas sejumlah kecil sel spesifik, yakni kondrosit, yang terletak di matriks ekstraseluler mengandung air dan makromolekul, termasuk protein kolagen proteoglikan, dan protein nonkolagen

Cytotoxic effect of freeze dried bovine cartilage powder and platelet rich plasma (prp) to mesenchymal stem cell (mscs)

Perbaikan tulang rawan adalah masalah klinis yang menantang karena kerusakan merupakan kondisi yang ireversibel. Banyak penelitian telah dilakukan dengan menggunakan beberapa jenis scaffold alami maupun sintetis. Upaya untuk memperbaiki tulang rawan artikular dengan menggunakan scaffold biasanya memiliki banyak masalah, kekurangan pada struktur fisik dan sifat mekanik yang diperlukan untuk memastikan keefektivan jangka panjang terhadap kerusakan tulang rawan. Selain itu, scaffold sering menyebabkan toksisitas terhadap inang. Oleh karena itu penelitian ini dilakukan secara in vitro untuk menguji efek toksisitas dari scaffold bubuk tulang rawan dan platelet rich plasma (PRP). Penelitian ini dilakukan dengan menggunakan rancangan penelitian eksperimental murni pada 4 kelompok stem cell hewan yang ditambahkan dengan scaffold tulang rawan kering yang diberi platelet rich plasma (PRP). Penelitian ini menggunakan post test only control group design. Hasilnya diproses dengan MTT assay dan spektrofotometer untuk menghitung stem cell yang masih hidup. Tidak ada perbedaan yang signifikan dalam jumlah makrofag antara kelompok kontrol dan scaffold tulang rawan kering beku yang ditambahkan PRP (p=0,128). Dengan hasil ini pada jumlah makrofag antara kelompok kontrol dan scaffold tulang rawan kering beku yang ditambahkan PRP, dapat disimpulkan bahwa biomaterial ini memiliki biokompatibilitas

Graft Tulang & Material Pengganti Tulang (Karaktersitik dan Strategi Aplikasi Klinis)

Sejarah graf tulang telah dimulai sejak zaman kuno, yaitu pada saat bahan-bahan yang digunakan dapat berupa kayu, metal, gading dan material lainnya. Graf tulang sebagai komponen penting ilmu kedokteran modern dimulai lebih kurang 350 tahun yang lalu. Prosedur graf tulang pertama dilakukan oleh dokter dari Belanda pada tahun 1668 yang bernama Jacob van Meekeren. Dokter tersebut melakukan graf tulang pada seorang tentara dengan cedera pada tulang kalvaria, dengan tulang yang diambil dari anjing. Prosedur berjalan sukses dan tulang dapat sembuh, tetapi sayangnya pasien dikucilkan karena memiliki bagian tubuh dari hewan

The role of platelet-rich fibrin facilitates the healing of gastrocnemius muscle defect: a preliminary study on animal model

Background: Scar formation has been a classical issue in the healing of skeletal muscle defect which will results in decrease of strength and function. Platelet-rich plasma (PRP) has been studied to enhance the healing of muscle defect. The disadvantages of it include the risk of immunologic reaction, time-consuming preparation, and lack of scaffold element. Platelet-rich fibrin (PRF) is a new generation of platelet concentrate that provides good source of growth factors and scaffold element necessary for the healing. This study is to provide a fondation of PRF preparation and implantation for the healing of experimental defect of gastrocnemius muscle in an animal model. Purpose: The goal is to provide a fondation of PRF preparation and implantation for the healing of experimental defect of gastrocnemius muscle in an animal model. Methods: Animal Care and Use Committee, Airlangga University approved the study. Twenty New Zealand white rabbits were divided into two groups. In control group, a defect was created in the right gastrocnemius and no implantation was done. In study group, similar defect was created with implantation of PRF. Two and four weeks after surgery, the defect was examined immunohistochemically for the expression of Pax7 protein. Results: The implanted group showed higher IRS score in two and four weeks compared to the control group. Conclusion: The use of PRF facilitates the healing of muscle injury. This study will be used as a fondation for further study on PRF

Correlation between three column concept classification and internal fixation procedure of tibial plateau patients at dr. soetomo hospital

Background: Tibial Plateau Fracture is one of the most common case seen in orthopaedics and the most classification system used is Schaetzker Classification. This classification is using X-ray photograph to classify the fracture and it has limitation to describing a posterior column in tibial plateau fracture since X-ray is a 2D projection. Nowadays surgeon over the world start to using Three Column concept classification because it has a better image of 3D visualization of tibial plateau. Purpose: To know which one classification is more accurate in describing tibial plateau fracture in Dr. Soetomo Hospital period January 2015 until September 2017. Methods: This study is retrospective study, we collected data of patients with Tibial Plateau fracture that has been operated in Dr. Soetomo hospital from January 2015 – September 2017. Results: From the study found 24 patients that match with inclusion criteria. All patients are classified with Schaetzker and Three Column Classification. The most type of fracture based on Schaetzker Classification is Type 2 (7 patients) and based on Three Column Classification is type Three Column (11 patients) and the most action in Three Column type is Internal Fixation with double plate insertion (55 %). Conclusion: Three Column Classification is more accurate to describe type fracture in posterior part than Schaetzker. Three Column Classification is recommended to make easier decision for Tibial Plateau fracture treatment and prevent any loss of correction

The effect of platelet rich plasma on mesenchymal stem cells (mscs) differentiation into chondroblast

Penambahan platelet rich plasma ke kultur mesenchymal stem cell pada media pertumbuhan dan media kondrogenik berpengaruh pada proliferasi dan diferensiasi stem cell menjadi kondroblas belum diketahui efeknya. Penelitian ini bertujuan untuk mengetahui efek platelet rich plasma pada diferensiasi mesenchymal stem cell dan proliferasi menjadi kondroblas pada media invitro. Desain rancangan kelompok kontrol acak post test. Darah diambil dari vena kelinci untuk diproses menjadi platelet rich plasma (PRP). Mesenchymal stem cell (MSC) dipanen dari sumsum tulang kelinci untuk dibudidayakan. Kultur MSC dibagi menjadi tiga kelompok modifikasi. Kelompok pertama adalah kombinasi MSC yang ditambahkan dengan Complete Control Medium (CCM) dan Chondrogenic Differentation Medium (CDM) tanpa PRP sebagai kelompok kontrol. Kelompok kedua memiliki kombinasi yang sama dengan kelompok pertama dengan penambahan PRP 5%. Kelompok ketiga memiliki kombinasi yang sama dengan kelompok pertama dengan penambahan PRP 10%. Hasilnya dievaluasi dalam 21 hari sebagai berikut. Kelompok yang menerima penambahan PRP 5% memiliki peningkatan kondroblas yang signifikan dibandingkan kelompok tanpa penambahan PRP (p = 0,033). Hasil yang sama juga terjadi pada kelompok yang menerima penambahan PRP 10% dibandingkan kelompok tanpa penambahan PRP (p = 0,028). Tidak ada perbedaan yang signifikan antara hitung kedua dan kelompok ketiga (p = 0,203). Ada efek signifikan platelet rich plasma pada diferensiasi mesenchymal stem cell dan proliferasi menjadi kondroblas pada media in vitro

Effects of Balance Exercise and Somatosensory Stimulation on Somatosensory Response in Diabetic Peripheral Neuropathy

Somatosensory dysfunction has become the main problem in diabetic peripheral neuropathy. Balance exercise and somatosensory stimulation are exercises to improve balance and somatosensory responses. However, there is no available sufficient evidence measuring the somatosensory response after practicing balance exercise and somatosensory stimulation. This research aims to investigate the effects of balance exercise and somatosensory stimulation on somatosensory response in diabetic peripheral neuropathy. This was experimental research, 12 type II diabetes with onset > 10 years were enrolled, randomized, and divided into two groups. For three weeks, group 1, an intervention group (N = 6) practiced balance exercise and somatosensory stimulation for five days a week. Group 2, a control group (N = 6) received education for two times in three weeks. The end of the period, the intervention group showed a significant improvement in neuropathy scores (p=0.013). Balance exercise and somatosensory stimulation could improve somatosensory response in diabetic peripheral neuropathy

The effect of decellularization technique on collagen type ii and matrices porosity of cartilage bovine scaffold

Background: Cartilage has limited capacity for self-repair in case of defect. Stem cell based tissue engineering has become an alternative therapy for the treatment of cartilage defect. The use of decellularized cartilage bovine can serve as scaffold to support proliferation dan differentiation of the stem cell. Purpose: This research is to compare the effect of decellularization technique on collagen type II and matrices porosity of cartilage bovine scaffold. Methods: This experimental laboratory research used cartilage bovine scaffold which was decellularized using physical, chemical and enzymatic techniques with different time and concentration variations, then collagen type II measurement was performed by immunohistochemical method and evaluation of porosity size with electron microscopy. Results: In the preparations with the highest concentration and the longest immersion time of 5% SDS for 72 hours, the decellularization process occurs perfectly. The collagen type II content was found to have significantly higher concentrations than the controls and other preparations, and have interconnected porosities in large size. Conclusion: High concentrations of collagen type II and large diameter of porus after decellularization process in cartilage bovine scaffold confirm that this scaffold still has optimum biochemical cues that can be a good mechanical framework and microenvironment stem cell in effort to repair the cartilage defects. This result was expected to become a standard for the deselularization making of cartilage bovine scaffold

Combination effect of core stability exercise and contract relax exercise on hamstring flexibility

Hamstring is a muscle group that often has a reduced flexibility compared to other muscle groups. This hamstring flexibility reduction can lead as a low back pain risk factor. Nowadays, the combination effect of core stability and contract relax exercise on hamstring flexibility is still unclear. The aim of this research was to know about this exercise on hamstring flexibility. This research is experimental with 24 subjects of healthy female students who participated in the exercise program for 4 weeks consisting of 3 times per week. Subjects were randomly assigned to one of three groups: (1) core stability-CS (n = 8) (2) core relax-CR(n = 8), (3) core stability combined contract relax-CS + CR(n = 8). The hamstring flexibility was assessed with sit and reach test using the sit and reaches box. The examinations were conducted by observers twice, prior the training program and 2 days after the last session of exercise. 22 subjects were analyzed (CS,n = 7;CR,n = 8;CS + CR,n = 7). The paired t test analysis of each group showed significant CS (p = 0.03), CR (p = 0.00), CS + CR (p = 0.01) in increasing of result sit and reach test was observed. There was a difference between the three groups by the ANOVA test (p = 0.00). This study shows that combination of core stability and contract relax exercises can increase hamstring flexibility