Showing papers by "Nicola Maffulli published in 2017"
TL;DR: This review outlines the possible molecular events that occur in the first phases of tendinopathy onset, stressing the role of pro-inflammatory cytokines, proteolytic enzymes, growth factors and healing genes in the development of tendon disorders.
Abstract: Pain and functional limitation are frequent in symptomatic tendinopathy. The essential lesion of tendinopathy is a failed healing response. Understanding the cellular and molecular mechanisms involved in a failed healing response during the early stages of pathogenesis of tendinopathy would help to develop new and effective treatments. The role of inflammation in the development of tendon pathologies has been revived during the last few years, in particular during the first phases of tendinopathies, when "early tendinopathy" may not be clinically evident. This review outlines the possible molecular events that occur in the first phases of tendinopathy onset, stressing the role of pro-inflammatory cytokines, proteolytic enzymes, growth factors and healing genes in the development of tendon disorders.
88 citations
TL;DR: The main biological technologies to boost musculoskeletal healing, including bone marrow and subcutaneous fat-derived regenerative products, as well as platelet-rich plasma and conditioned media are described.
Abstract: Regenerative medicine seeks to harness the potential of cell biology for tissue replacement therapies, which will restore lost tissue functionality. Controlling and enhancing tissue healing is not just a matter of cells, but also of molecules and mechanical forces. We first describe the main biological technologies to boost musculoskeletal healing, including bone marrow and subcutaneous fat-derived regenerative products, as well as platelet-rich plasma and conditioned media. We provide some information describing possible mechanisms of action. We performed a literature search up to January 2016 searching for clinical outcomes following the use of cell therapies for sports conditions, tendons, and joints. The safety and efficacy of cell therapies for tendon conditions was examined in nine studies involving undifferentiated and differentiated (skin fibroblasts, tenocytes) cells. A total of 54 studies investigated the effects of mesenchymal stem-cell (MSC) products for joint conditions including anterior cruciate ligament, meniscus, and chondral lesions as well as osteoarthritis. In 22 studies, cellular products were injected intra-articularly, whereas in 32 studies MSC products were implanted during surgical/arthroscopic procedures. The heterogeneity of clinical conditions, cellular products, and approaches for delivery/implantation make comparability difficult. MSC products appear safe in the short- and mid-term, but studies with a long follow-up are scarce. Although the current number of randomized clinical studies is low, stem-cell products may have therapeutic potential. However, these regenerative technologies still need to be optimized.
62 citations
TL;DR: No statistical significant differences were found between conservative and surgical approaches in terms of postoperative osteoarthritis and persistence ofPain, although persistence of pain seemed to occur less frequently in patients undergoing a surgical treatment.
Abstract: Introduction The management of Type III acromioclavicular (AC) dislocations is still controversial. We wished to compare the rate of recurrence and outcome scores of operative versus non-operative treatment of patients with Type III AC dislocations. Source of data A systematic review of the literature was performed by applying the PRISMA guidelines according to the PRISMA checklist and algorithm. A search in Medline, PubMed, Cochrane and CINAHL was performed using combinations of the following keywords: 'dislocation', 'Rockwood', 'type three', 'treatment', 'acromioclavicular' and 'joint'. Areas of agreement Fourteen studies were included, evaluating 646 shoulders. The rate of recurrence in the surgical group was 14%. No statistical significant differences were found between conservative and surgical approaches in terms of postoperative osteoarthritis and persistence of pain, although persistence of pain seemed to occur less frequently in patients undergoing a surgical treatment. Areas of controversy Persistence of pain seemed to occur less frequently in patients undergoing surgery. Growing points Persistence of pain seems to occur less frequently in patients treated surgically for a Type III AC dislocation. Areas timely for developing research There is insufficient evidence to establish the effects of surgical versus conservative treatment on functional outcome of patients with AC dislocation. High-quality randomized controlled clinical trials are needed to establish whether there is a difference in functional outcome.
62 citations
TL;DR: The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible, so minimally invasive treatments provide good functional results and lower complications rate.
Abstract: Background The Achilles tendon, the largest and strongest tendon in the human body, is nevertheless one of the tendons which most commonly undergoes a complete subcutaneous tear. Achilles tendon ruptures are especially common in middle aged men who occasionally participate in sport. Even though Achilles tendon ruptures are frequent, up to 25% of acute injuries are misdiagnosed, and present as chronic injuries. Methods This is a review article about diagnosis and management of chronic Achilles tendon ruptures. Minimally invasive Achilles tendon reconstruction is discussed. Results The optimal surgical procedure is still debated, however, less invasive peroneus brevis reconstruction technique and free hamstring autograft provide good functional results. Conclusion The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible. Wound complications and infections are frequent after open procedures. Minimally invasive treatments provide good functional results and lower complications rate.
53 citations
TL;DR: This work investigated a synthetic three-dimensional (3D) microenvironment able to interact with stem cells and inducing, via coupled biochemical and physical signals, their early commitment toward the tenogenic lineage.
Abstract: At present, injuries or rupture of tendons are treated by surgical repair or conservative approaches with unpredictable clinical outcome. Alternative strategies to repair tendon defects without the undesirable side effects associated with the current options are needed. With this in mind, a tissue engineering approach has gained considerable attention as a promising strategy. Here we investigated a synthetic three-dimensional (3D) microenvironment able to interact with stem cells and inducing, via coupled biochemical and physical signals, their early commitment toward the tenogenic lineage. This multiphase 3D construct consisted of a braided hyaluronate elastic band merged with human bone marrow mesenchymal stem cells (hBMSCs) and poly-lactic-co-glycolic acid microcarriers loaded with human growth differentiation factor 5 (hGDF-5) by means of fibrin hydrogel. The multiphase structure allowed hBMSC culture under cyclic strain within a microenvironment where a controlled amount of hGDF-5 was regularly deliv...
47 citations
TL;DR: A central role of PTX3 in bone homeostasis showing its involvement in osteoblast proliferation, differentiation and function is suggested.
Abstract: Pentraxin 3 (PTX3) is a multifunctional glycoprotein regulating inflammatory response, cell proliferation and migration and deposition and remodelling of the extracellular matrix by a variety of cells. In this study, we investigated the possible role of PTX3 in bone homeostasis. To this end, we compared the expression and function of PTX3 in human osteoblasts of osteoporotic, osteoarthritic patients and young subjects not affected by bone diseases. Immunohistochemical analysis performed on bone head biopsies showed a close association between bone health and the number of osteoblasts expressing PTX3. Noteworthy, the proportion of PTX3-positive osteoblasts resulted to be significantly lower in osteoporotic patients compared with both young patients and osteoarthritic patients of the same age. Ex vivo culture of osteoblasts isolated from the three groups of patients confirmed in vivo observation. Specifically, we observed rare runt-related transcription factor 2 (RUNX2) immunopositive osteoblasts expressing PTX3 in cell cultures derived from osteoporotic patients and western blotting analysis showed 80% reduction of PTX3 in the corresponding culture extracts compared with young and osteoarthritic patients. The treatment of human osteoblast primary cultures derived from young patients with anti-PTX3 antibody dramatically affected osteoblast behaviour. Indeed, they lost the morphological and molecular features typical of mature osteoblasts, acquiring fibroblast-like shape and highly decreasing nuclear factor kappa-B ligand (RANKL) and RUNX2 expression. Also, the inhibition of PTX3 negatively affected osteoblast proliferation and their ability to form cell clusters and microhydroxyapatite crystals. Altogether, these results suggest a central role of PTX3 in bone homeostasis showing its involvement in osteoblast proliferation, differentiation and function.
46 citations
TL;DR: It is demonstrated that hESCs are responsive to tenogenic induction via BMP12/13 in the presence of AA, and the directed in vitro generation of tenocytes from pluripotent stem cells may facilitate the development of novel repair approaches for this difficult to heal tissue.
Abstract: Tendon healing is complex to manage because of the limited regeneration capacity of tendon tissue; stem cell-based tissue engineering approaches may provide alternative healing strategies We sought to determine whether human embryonic stem cells (hESC) could be induced to differentiate into tendon-like cells by the addition of exogenous bone morphogenetic protein (BMP)12 (growth differentiation factor[GDF]7) and BMP13 (GDF6) hESC (SHEF-1) were maintained with or without BMP12/13 supplementation, or supplemented with BMP12/13 and the Smad signaling cascade blocking agent, dorsomorphin Primary rat tenocytes were included as a positive control in immunocytochemistry analysis A tenocyte-like elongated morphology was observed in hESC after 40-days continuous supplementation with BMP12/13 and ascorbic acid (AA) These cells displayed a tenomodulin expression pattern and morphology consistent with that of the primary tenocyte control Analysis of tendon-linked gene transcription in BMP12/13 supplemented hESC demonstrated consistent expression of COL1A2, COL3A1, DCN, TNC, THBS4, and TNMD levels Conversely, when hESCs were cultured in the presence of BMP12/13 and dorsomorphin COL3A1, DCN, and TNC gene expression and tendon matrix formation were inhibited Taken together, we have demonstrated that hESCs are responsive to tenogenic induction via BMP12/13 in the presence of AA The directed in vitro generation of tenocytes from pluripotent stem cells may facilitate the development of novel repair approaches for this difficult to heal tissue
43 citations
TL;DR: All three techniques produced significant functional improvement, and return to sports was possible in most patients, and this study does not demonstrate a clear advantage of one technique over the others.
41 citations
TL;DR: Compared with total ankle replacement, there is some evidence to support TAR to conserve ankle motion and offer improved function and decreased pain with high satisfaction rates, but revision rates for TAR are significantly higher than revise rates for AA.
Abstract: Introduction In advanced stages of ankle osteoarthritis (OA), ankle arthrodesis (AA) or total ankle arthroplasty (TAR) may be necessary. Our purpose is to compare AA and total ankle replacement for the surgical management of end stage ankle OA. Sources of data We conducted a literature search of PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using the terms 'ankle' in combination with 'OA', 'arthrodesis', 'arthroplasty', 'joint fusion', 'joint replacement'. Studies where treatment was exclusively total ankle replacement or AA were excluded. Treatment characteristics and outcome parameters (overall postoperative outcome and complication rate) were reviewed. Areas of agreement When counseling patients who are considering their options with regard to ankle arthritis treatment, surgeons should determine on an individual basis which procedure is more suitable. Areas of controversy TAR has become an accepted treatment for end-stage OA, but revision rates for TAR are significant higher than for AA (odds ratio 2.28 95% confidence interval [CI], 1.63-3.19; P Growing points The results of TAA are gradually improving, but the procedure cannot yet be recommended for the routine management of ankle OA. Areas timely for developing research Although there is some evidence to support TAR to conserve ankle motion and offer improved function and decreased pain with high satisfaction rates, revision rates for TAR are significantly higher than revision rates for AA. Proper patient selection should be better addressed in future studies for successful treatment of end-stage ankle OA. Level of evidence Systematic review, level III.
41 citations
TL;DR: This work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources.
Abstract: Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources. Level of evidence Ia.
39 citations
TL;DR: Moderate evidence suggests that prolotherapy is safe and can help achieve significant symptomatic control in individuals with OA, both in the short term and long term.
Abstract: Introduction
Osteoarthritis (OA) often leads to symptoms such as pain, stiffness and decreased function. OA is treated with a wide range of modalities, both conservatively and surgically. Prolotherapy has been used to treat various musculoskeletal problems and has shown some promise.
Sources of data
Searches of the electronic databases, PubMed, ISI web of science, PEDro and SPORTDiscus, were conducted for all Level 1-4 studies published from inception through to December 2016.
Areas of agreement
Ten studies were evaluated and results show significant improvement in scores for pain, function and range of motion, both in the short term and long term. Patient satisfaction was also high in these patients (82%).
Areas of controversy
Meta-analysis was not possible due to heterogeneity of outcome measures and populations.
Growing points
Moderate evidence suggests that prolotherapy is safe and can help achieve significant symptomatic control in individuals with OA.
Areas for developing research
Future research should focus on larger sample size, standardization of treatment protocol and basic science evidence.
TL;DR: It appears that the use of adipose-derived stem cells is associated with subjective and objective clinical improvements and minimal complication rates, and most of the selected studies present major limitations, and different methods, confounding the results of the review.
Abstract: Introduction To examine the current literature regarding the clinical application of adipose-derived stem cells (ADSCs) for the management of orthopaedic pathologies. Sources of data MEDLINE,SCOPUS, CINAHL and EMBASE (1950 to April 14, 2017) were searched by two independent investigators for articles published in English. Reviews, meta-analyses, expert opinions, case reports, mini case series and editorials were excluded. Furthermore, we excluded animal studies, cadaveric studies and in vitro studies. Areas of agreement ADSCs seem to produce excellent clinical results. However, the length and modalities of follow-up in the different conditions are extremely variable. Nevertheless, it appears that the use of adipose-derived stem cells is associated with subjective and objective clinical improvements and minimal complication rates. Areas of controversy None of the studies identified is a randomized double-blinded trial, and most of the selected studies present major limitations, and different methods, confounding the results of our review. Growing points It is necessary to conduct more and better studies to ascertain whether ADSCs really play a role in orthopaedic surgery with particular attention to ADSCs harvesting method, type of administration and the conditions treated. Areas timely for developing research The current literature regarding the use of ADSCs for orthopaedic pathologies is limited. At present, long-term safety is the biggest challenge of ADSCs based regenerative medicine. Level of evidence Level IV-Study of Level I, II, III, IV.
TL;DR: Intra-articular injections of LMW-HA provide prompt clinical improvement compared to ESWT, which results in more gradual improvement over time, which is effective and safe in patients suffering from non-calcific rotator cuff tendinopathy until 3 months of follow-up.
Abstract: BACKGROUND Rotator cuff tendinopathy is the most common cause of painful shoulder. The treatment is mainly conservative and several therapeutic approaches have been proposed, including NSAIDs, physiotherapy, injections and physical therapies. The aim of the current study was to compare the clinical effectiveness of low molecular weight hyaluronic acid (LMW-HA) injection versus low-energy extracorporeal shock-wave therapy (ESWT) until 3 months of follow-up for the management of painful non-calcific rotator cuff tendinopathies, evaluating also the trend over time between the groups. METHODS A total of 34 patients affected by painful rotator cuff tendinopathy were randomly divided into 2 groups of 17 individuals. The first group (group A; mean age 58.2 years) underwent 3 injections of LMW-HA (Hyalgan®, 500-730 kDa), while in the second group (group B; mean age 58.5 years) the treatment protocol consisted of 4 sessions of low-energy ESWT. Pain level and function were assessed with the DASH and Constant-Murley questionnaires. Parameters were evaluated at baseline (V0), at the end of the treatment (V1) and after 3 months of follow-up (V2). RESULTS Patients of both groups achieved statistically significant improve in pain and function (P<0.0001). Clinical outcome shows a different trend in time between group A and group B for DASH and Constant-Murley questionnaires. CONCLUSIONS LMW-HA and low-energy ESWT are effective and safe in patients suffering from non-calcific rotator cuff tendinopathy until 3 months of follow-up. Intra-articular injections of LMW-HA provide prompt clinical improvement compared to ESWT, which results in more gradual improvement over time.
TL;DR: Genetic profile could explain why some elite soccer players are predisposed to suffer more injuries than others and why they need more time to recover from a particular injury.
Abstract: Damage to skeletal muscle necessitates regeneration to maintain proper muscle form and function. Interindividual differences in injury severity, recovery time, and injury rate could be explained by the presence of single nucleotide polymorphisms (SNPs) in genes involved in the reparation and regeneration of connective tissue . We wished to identify new genetic biomarkers that could help to prevent or minimize the risk of non-contact muscle injuries and are associated with a predisposition to developing muscle injuries. Using allelic discrimination techniques, we analysed 12 SNPs in selected genes from the genomic DNA of 74 elite soccer players. SNPs in the hepatocyte growth factor (HGF) gene showed evidence of a statistically significant association with injury incidence, severity, and recovery time. SNPs in the SOX15 gene showed evidence of a statistically significant association with injury incidence. SNPs in the GEFT and LIF genes showed evidence of a statistically significant association with recovery time. Genetic profile could explain why some elite soccer players are predisposed to suffer more injuries than others and why they need more time to recover from a particular injury. SNPs in HGF genes have an important role as biomarkers of biological processes fragility within muscle injuries related to injury rate, severity, and long recovery time.
TL;DR: Clinical and functional outcomes following surgical repair, percutaneous and open, of the Achilles tendon are significantly improved than following conservative management.
Abstract: Background At present, it is unclear which is the best management for Achilles tendon rupture. Purpose We assess the clinical, functional and imaging outcomes of active patients undergoing 3 different types of management for acute subcutaneous rupture of the Achilles tendon, including conservative cast immobilization, traditional open surgery and percutaneous repair. Methods 26 active patients were managed for a rupture of the Achilles Tendon from January 2007 to March 2008. Anthropometric measurements, Functional assessment, Isometric strength, Ultrasonographic assessment, Patient satisfaction, Working life, Physical activity, Functional score and Complications were recorded retrospectively. Results All 23 (21 men, 2 women) patients were reviewed at a minimum follow-up of 24 months (average 25.7, range 24 to 32 months, SD: 6.3) from the index injury. Thermann scores and patient satisfaction were significantly higher following surgery than conservative management with no significance between open and minimally invasive operated patients. Sensitive disturbances occur in up to 12% of open repairs and 1.8% of patients managed nonsurgically. Conclusions Clinical and functional outcomes following surgical repair, percutaneous and open, of the Achilles tendon are significantly improved than following conservative management. Level of evidence Level III.
TL;DR: In symptomatic patients with patellar tendinopathy, the Royal London Hospital test showed lower sensitivity and higher specificity than manual palpation, both of which should be performed for a correct clinical diagnosis.
Abstract: Purpose To ascertain whether the Royal London Hospital test is reproducible, sensitive, and specific for diagnosis of patellar tendinopathy. Methods Fifteen consecutive athletes with patellar tendinopathy were prospectively enrolled and compared with a control group of 15 non consecutive athletes with Achilles tendinopathy. Two testers examined separately each patient, using manual palpation and the Royal London Hospital test for diagnosis of patellar tendinopathy. High resolution real time ultrasonography was used as standard for diagnosis of tendinopathy and assessment of tendon thickness. Results The palpation test presented significantly higher sensitivity compared to the Royal London Hospital test (98 vs 88%; P=0.01); specificity was 94% for the palpation test and 98% for the Royal London Hospital test (P>0.05). Positive and negative predictive values were 94 and 98% for palpation test, 98 and 89% for the Royal London Hospital test, respectively. The two tests showed good to very good intra-tester and inter-tester agreement. At ultrasonography, pathological patellar tendons were significantly thicker compared to controlateral healthy tendon (P Conclusions In symptomatic patients with patellar tendinopathy, the Royal London Hospital test showed lower sensitivity and higher specificity than manual palpation. Both tests should be performed for a correct clinical diagnosis of patellar tendinopathy. Imaging assessment should be performed as a confirmatory test. Level of evidence III.
TL;DR: There was a high prevalence of hyponatremia in the elderly patients with hip fractures, Hence, serum sodium concentrations should be regularly assessed to prevent occurrence ofHyponatremeia.
Abstract: Objective: This study investigated the prevalence of hyponatremia in elderly patients (≥65 years old) with hip fractures. Subjects and Methods: All records containing clinical and laboratory data on the 334 elderly patients admitted to the San Giovanni di Dio e Ruggi d'Aragona Hospital of Salerno, Italy, with hip fractures during 2014 and 2015, were retrieved from the hospital database. Patients were divided into 4 groups, according to their sex and the type of hip fracture. Sodium serum concentrations were retrieved from the medical records. Hyponatremia was defined as the presence of at least 1 episode of hyponatremia during the hospital stay. Results: Of 334 elderly patients, hyponatremia was found in 64 (19%). The prevalence of hyponatremia was 18% (28/157) for female patients with extracapsular proximal femoral fracture, 22% (17/79) for female patients with intracapsular proximal femoral fracture, 20% (12/60) for male patients with extracapsular proximal femoral fracture, and 18% (7/38) for male patients with intracapsular proximal femoral fracture. Conclusion: There was a high prevalence of hyponatremia in the elderly patients with hip fractures. Hence, serum sodium concentrations should be regularly assessed to prevent occurrence of hyponatremia.
TL;DR: Minimally invasive Achilles tendon stripping seems to be an effective, technically simple, and inexpensive treatment of Achilles tendinopathy.
Abstract: Achilles tendinopathy is a common cause of disability. New nerves fibers grow from the paratenon into the Achilles tendon, and they could play a central role in the development of pain. We report the results of minimally invasive Achilles tendon stripping for Achilles tendinopathy in 47 active patients. The Victorian Institute of Sports Assessment-Achilles questionnaire score improved from 53.8 preoperatively to 85.3 postoperatively ( p
TL;DR: In this work, supercritical emulsion extraction technology is proposed for the fabrication of microcapsules with a core of poly-lactic-co-glycolic acid (PLGA) or polylactic acid (PLA) covered by carboxybetaine-functionalized chitosan (f-chi) and loaded with MAG.
TL;DR: The identification of the various factors that control apoptosis and its mechanisms can help to design new treatments and exert positive effects in the recovery from tendon tears.
Abstract: Introduction Excessive apoptosis has been hypothesized as possible cause of tendinopathy and tear in the tendons of the rotator cuff (RC). Different mechanisms and molecules play a key role in cell regulation. Biological interventions can affect the process of apoptosis to control the tendinopathy process, and may be useful to design new treatments. Source of data We identified basic science, in vitro and in vivo preclinical and clinical studies listed in the Pubmed Google Scholar, CINAHL, Cochrane Central and Embase Biomedical databases in English, Spanish, Italian and French concerning the effects of apoptosis on RC tendons. Areas of agreement The homeostasis between the apoptotic and inflammatory processes is dynamic and controlled by pro- and anti-apoptotic mechanisms and signals, with variable balance in different areas of the RC tendons in human specimens. Areas of controversy Apoptosis can be identified along the whole tendon, not only in the area of the lesion. Therefore, it is not necessary to undertake wide debridement of the torn edges of the tendon when undertaking a repair. Growing points The identification of the various factors that control apoptosis and its mechanisms can help to design new treatments and exert positive effects in the recovery from tendon tears. Areas timely for developing research Further studies are needed to produce clear guidelines to determine how to balance the apoptosis process to reduce the failed healing response found in non-traumatic RC tears.
TL;DR: Allograft reconstruction could be effective, providing that appropriate surgical technique and allograft tensioning are implemented, and level I studies informing surgeons in an evidence-based fashion are informed.
Abstract: We performed a literature search on PubMed, Web of Science, Science Direct/Scopus, Google Scholar, and Google to evaluate results of several techniques to manage disruption of the extensor mechanism after total knee arthroplasty. Different methods to manage extensor mechanism disruption are available at present, with no level I studies informing surgeons in an evidence-based fashion. Primary repair is not indicated. Allograft reconstruction could be effective, providing that appropriate surgical technique and allograft tensioning are implemented.
TL;DR: It is found that male gender, advanced age, normal body mass index, chronic renal failure, and concurrent use of corticosteroids increase the risk of Achilles tendon disorders.
TL;DR: HAPs enhanced viability and proliferation and counteracted apoptosis in tendon derived cells in this study, in a dose-dependent manner.
Abstract: Background Hyaluronic Acid (HA) has been already approved by Food and Drug Administration (FDA) for osteoarthritis (OA), while its use in the treatment of tendinopathy is still debated. The aim of this study was to evaluate the effects of two different HA on human rotator cuff tendon derived cells in terms of cell viability, proliferation and apoptosis. Methods An in vitro model was developed on human tendon derived cells from rotator cuff tears to study the effects of two different HA preparations: Sinovial HL® (High-Low molecular weight) (MW: 80-100 kDa) and KDa Sinovial Forte SF (MW: 800-1200), at various concentrations. Tendon derived cells morphology was evaluated after 0, 7 and 14 d of culture. Viability and proliferation were analyzed after 0, 24, and 48 h of culture and apoptosis occurrence was assessed after 24 h of culture. Results All the HAPs tested here increased viability and proliferation, in a dose-dependent manner and they reduced apoptosis at early stages (24 h) compared to control cells (without HAPs). Conclusions HAPs enhanced viability and proliferation and counteracted apoptosis in tendon derived cells.
TL;DR: There was a statistically significant improvement of all clinical scores after surgery regardless of the procedure performed to reconstruct both PCL and PLC, and standardized methods of functional outcomes assessment are necessary to improve communication on the functional results of the management of PC-PLC.
Abstract: Background Approximately 60% of posterior cruciate ligament (PCL) injury are associated with a posterolateral corner (PLC) tear. Sources of data We performed a systematic review of the literature according to the PRISMA guidelines. The following key words were searched on Medline, Cochrane, EMBASE, Google Scholar, and Ovid: 'posterior cruciate ligament' or 'PCL' with 'posterolateral corner' or 'PLC' and 'chronic'; 'injury'; 'management'; 'reconstruction'; 'outcomes'; 'complications'. Areas of agreement There was a statistically significant improvement of all clinical scores after surgery regardless of the procedure performed to reconstruct both PCL and PLC. Areas of controversy No randomized control trials were identified on the topic. Standardized methods of functional outcomes assessment are necessary to improve communication on the functional results of the management of PC-PLC. Growing points Single stage surgical reconstruction of PCL and PLC is recommended in patients with posterolateral rotatory instability of the knee. Areas timely for developing research Adequately powered randomized trials with appropriate subjective and objective outcome measures are necessary to reach definitive conclusions.
TL;DR: The diagnostic algorithm described is a valid and safe option to diagnose Ramp and hidden lesions are very common ACL rupture associated injuries and a correlation between a longer time from injury than 6 months and a reduced prevalence of these lesions was recorded in the population.
Abstract: Background Anterior cruciate ligament tears (ACL) are associated with meniscal lesions, that could involve the posterior horn of the medial meniscus (PHMM). A variety of techniques has been proposed to better visualise the postero-medial (PM) compartment. The aim of the study is to evaluate the prevalence of longitudinal tears of peripheral attachment of the PHMM during arthroscopic ACL reconstruction, and to describe a diagnostic algorithm. Methods 115 patients who underwent arthroscopic ACL reconstruction were enrolled for the study. An anterior and an intercondylar notch visualisation were ordinarily performed. A postero-medial (PM) portal was performed when the instability of the posterior horn was detected. Statistical significance was assessed by a Chi-squared or Fisher's Exact Test for categorical variables, and by a Mann-Whitney U test for continuous variables. Results We recorded a 9.6% prevalence of lesions of the peripheral attachment of PHMM. Nine ramp lesions and two hidden lesions were diagnosed. Patients treated within 6 months from injury, revealed a statistically significant correlation with a higher prevalence of these lesions. Conclusion Ramp and hidden lesions are very common ACL rupture associated injuries. Our diagnostic algorithm is a valid and safe option to diagnose these kinds of lesions. A correlation between a longer time from injury than 6 months and a reduced prevalence of these lesions was recorded in our population. Level of evidence IV.
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01 Jan 2017
TL;DR: The History of the Tendo Achillis and Its Rupture, and the Anatomy of the Achilles Tendon, and Management of Complications.
Abstract: The History of the Tendo Achillis and Its Rupture.- The Anatomy of the Achilles Tendon.- Biomechanics of the Achilles Tendon.- Imaging of the Achilles Tendon.- Etiology and Epidemiology of Achilles Tendon Problems.- Paratendinopathy of the Achilles Tendon.- Tendinopathy of the Main Body of the Achilles Tendon.- Custom Foot Orthotic Management in Achilles Tendinopathy.- Percutaneous Surgical Management of Achilles Tendinopathy.- Open Surgery for Achilles Tendinopathy.- Flexor Hallucis Longus Augmentation for Insertional or Noninsertional Achilles Tendinopathy.- Generalities of Insertional Tendinopathy.- Insertional Tendinopathy of the Achilles Tendon.- Endoscopic Techniques.- Achilles Tendon Rupture Generalities.- Conservative Management of Acute Achilles Tendon Rupture.- Open Surgery for Achilles Tendon Ruptures.- Chronic Ruptures of the Achilles Tendon.- Fascial Turn-Down Flap Repair of Chronic Achilles Tendon Rupture.- Peroneus Brevis Tendon Transfer for Chronic Achilles Tendon Ruptures.- Free Gracilis Tendon Transfer for Chronic Rupture of the Achilles Tendon.- Chronic Ruptures of the Achilles Tendon: Management with Synthetic Material.- Management of Complications.- The Achilles Tendon, Ankle Equinus, and Athletes.- Achilles Tendon Involvement in Pediatric Conditions.- Medico-Legal Aspects of Achilles Tendon Disorders.- Genes and the Achilles Tendon.
TL;DR: With this procedure, skin healing problems, nerve injuries, infection and prolonged recovery time are minimised, allowing early return to normal activities.
Abstract: Background Plantar fasciopathy presents with pain at the plantar and medial aspect of the heel. If chronic, it can negatively impact on quality of life. Plantar fasciopathy is not always self-limiting, and can be debilitating. Methods Surgical management involves different procedures. We describe a percutaneous plantar fascia release. A minimally invasive access to the plantar tuberosity of the calcaneus is performed, and a small scalpel blade is used to release the fascia. Conclusion With this procedure, skin healing problems, nerve injuries, infection and prolonged recovery time are minimised, allowing early return to normal activities. Level of evidence V.
TL;DR: A surgical technique for patellar and quadriceps tendon reconstruction using ipsilateral hamstring autografts, which provide a secure sound means to manage these challenging injuries.
Abstract: Tears of the patellar and quadriceps tendon are common in the active population, especially in athletes. At present, several techniques for surgical repair and reconstruction are available. When reruptures occur, a reconstruction is mandatory. In the present paper, we describe a surgical technique for patellar and quadriceps tendon reconstruction using ipsilateral hamstring autograft. After routine hamstring tendon harvesting, the tendon ends are prepared using a whip stitch. A transverse tunnel is drilled in the midportion of the patella, the hamstring graft is passed through the patella, and firmly secured to the patellar tunnel openings with sutures. The details of the technique are fully described. Autologous ipsilateral hamstring tendon grafts provide a secure sound means to manage these challenging injuries.
TL;DR: Since the sural nerve can be easily visualised using high-frequency high resolution real time ultrasonography, intraoperative ultrasound can be of assistance during percutaneous repair of Achilles tendon rupture.
TL;DR: Conventional and innovative supercritical technologies for monolithic scaffold production or biopolymer micro/nano devices will be discussed in this chapter.
Abstract: The foundation of tissue engineering for either therapeutic or diagnostic applications is the ability to exploit living cells. Tissue engineering utilizes living cells as engineering materials implanted, seeded or bio-plotted into an artificial structure capable of supporting three-dimensional tissue formation. These structures, typically called scaffolds, are critical, both ex vivo and in vivo, to influence their own microenvironments. Scaffolds can serve the following purposes: allow cell attachment and migration, deliver and retain cells and biochemical factors, enable diffusion of vital cell nutrients or expressed products, exert certain mechanical and biological influences to modify the behaviour of the cell phase. Traditional tissue engineering strategies typically employ a “top-down” approach, in which cells are seeded on a biodegradable three dimensional monolithic polymeric scaffold. More recently they have been updated by a “bottom-up” approach, also known as modular tissue engineering; it is aimed to address the challenge of recreating bio-mimetic structures by designing structural micro-features to build modular tissues, used as building blocks to re-create larger ones. These two different approaches will require scaffolds with given characteristics obtainable by choosing different fabrication technologies. Conventional and innovative supercritical technologies for monolithic scaffold production or biopolymer micro/nano devices will be discussed in this chapter. Some examples of bone and cartilage tissue engineering produced by using modular scaffold will be also discussed, as well as the fabrication of artificial extracellular matrix for spatio-temporally delivery of biological and mechanical signal to address cell fate.