Functional outcomes of bone marrow aspirate concentrate application in osteoarthritis of the knee

Background: Osteoarthritis (OA) of the knee is a very common musculoskeletal disorder. Although total knee replacement is a suitable option in the treatment of severe OA, it has some limitations when performed in the early stage and early age. Bone marrow aspirate concentrate (BMAC), which is rich in mesenchymal stem cells, is promising due to its potentially regenerative and symptomatic effects in many disorders of the musculoskeletal system. This study aims to investigate the efficacy of BMAC in terms of functional recovery in OA of the knee joint.Methods: Total of 52 patients with unilateral symptomatic knee OA but no inflammatory disease, advanced malalignment or instability were enrolled in this study. Bone marrow aspirate was collected from the iliac crest in one session, prepared using a manufactured kit and the patients received intra-articular injections of this BMAC. The mean age of the patients was 59.2±7.4 and the mean follow-up period was 22.1±3.6 months. Functional outcomes of the patients were evaluated using Modified Cincinnati and Tegner Lysholm scoring systems.Results: It was observed that both Lysholm and Cincinnati scores of the patients were statistically significantly higher throughout the follow-up period as compared to the period before the procedure (p=0.0001). There was no statistically significant difference in Lysholm and Cincinnati ratings between gender, side and body mass index groups throughout the follow-up period (p >0.05). It was found that the results of the patients with Kellgren-Lawrence Grade 4 severe joint arthrosis were statistically significantly lower (p <0.05).Conclusions: Considering the functional outcomes of the patients up to two years, it was observed that the application of concentrated bone marrow aspirate provided functional recovery in arthrosis of the knee joint.

The morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter

Background: The anatomy of the proximal femur comprises important landmarks for many orthopedic surgical procedures. However, this area exhibits morphological differences depending on race, gender and age. Besides being the insertion area of the hip flexor muscles, the lesser trochanter is also used as an angular reference in many orthopedic surgical procedures. The aim of this study is to investigate the morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter.Methods: Around 67 dry femur bones (32 left, 35 right) belonging to humans of unknown gender that belong to the Ankara University Medical Faculty, Department of Anatomy were used in this study. The morphologic relationship of the lesser trochanter (TRMI) with the femoral neck (FN) and greater trochanter (TRMJ) was studied and the results were provided in a table.Results: The measured mean lesser trochanter and greater trochanter tip distance was 67.5±4.9mm (60mm-75mm). The angle between the tip of the lesser trochanter and the center of the femoral neck was measured as 35.050±5.060 (290-420) degrees. The distance between the tip of the lesser trochanter and the center of the femoral neck was measured as 15±2.8mm (10mm-20mm).Conclusions: In addition to the angular relationship of the lesser trochanter with the femoral neck, its relationship in terms of distance with the greater trochanter and femoral neck are the anatomic relationships that are noteworthy for the lesser trochanter, which is used as a landmark during orthopedic surgical procedures.

Micro or Nano Does not affect the Functional Outcomes in the Midterm Follow-up

Introduction: Bone marrow stimulation techniques are themost commonly preferred options in the treatment of articularcartilage damage due to many features. Although nanofracturemethod that was developed in order to improve this techniquehas proven efficacy in animal models and in vitro studies,functional outcomes of nanofracture have not been shown inactual patients. In this study, our purpose was to compare theclinical outcomes of nanofracture technique and traditionalmicrofracture technique in the knee joint.Material and Methods: Patients operated using themicrofracture technique as group 1 (n=22) and patientsoperated using the Nanofx (Arthrosurface Inc., Franklin,Massachusetts) technique as group 2 (n=20) were prospectivelyevaluated. Demographic characteristics of the patients, defectsize and localization were recorded. Patients with isolatedcartilage damage who had ICRS Grade 3-4 cartilage lesionand no concomitant pathologies were included in the study.Each surgical procedure was performed by the same surgeonby following the same surgical protocol. Clinical outcomesin the patients were assessed using Modified Cincinnati andTegner-Lysholm scoring systems at months 6, 12, 24, 36 and48.Results: Calculated mean follow-up periods were 50.8±3.1and 51.2±3.2 in groups 1 and 2, respectively. There was nostatistically significant difference between the groups in termsof the defect and demographic characteristics of the patients.In the follow-up of patients using functional scoring, there wasno statistically significant difference in Lysholm (p=0.294)and Cincinnati (p=0.234) scores between the two groups.Conclusion: There was no difference in the mid-term betweenthe functional outcomes of microfracture and nanofracturetechniques in the treatment of cartilage lesions.