ABSTRACT
OBJECTIVE@#To investigate the correlation between the medial meniscal indentation index (MDI) and medial tibiofemoral articular cartilage damage more than 3 degrees in patients aged 40 to 60 years old with suspected or complicated knee osteoarthritis at non-weight-bearing position, and to determine the predictive threshold.@*METHODS@#From June 2016 to June 2020, a total of 308 patients who underwent initial knee arthroscopic exploration for chronic knee pain were collected. The age ranged from 36 to 71 years old with an average of(56.40±1.82) years old, including 105 males and 203 females. And patients with extra-articular malformations (abnormal force lines), a history of trauma, inflammatory arthritis and other specific arthritis were excluded. Finally, 89 eligible cases were obtained, aged from 42 to 60 years old with an average of (59.50±0.71) years old, including 45 males and 44 females. The degree of cartilage damage in the medial compartment of the knee joint was recorded, which was divided into two groups(≥degree 3 and<degree 3) according to Outer-Bridge classification system. The possible risk factors were determined by univariate analysis in the age, gender, affected sides, body mass index (BMI), synovial thickening grade, meniscus injury and MDI of 2 groups. Then, the independent risk factors for cartilage injury of more than grade 3 were determined by further binary Logistic regression analysis. If MDI was taken as an independent risk factor, receiver operating characteristic (ROC) analysis was performed to confirm whether it had diagnostic value for cartilage damage of above degree 3 and calculate the critical value of MDI.@*RESULTS@#A total of 89 eligible patients were obtained. Univariate analysis showed age, BMI, MDI and meniscus injury may be the independent risk factors for cartilage damage of more than 3 degrees, further binary Logistic regression analysis confirmed that MDI[OR=1.66, 95%CI(1.64, 1.69), P=0.01]and BMI [OR=1.58, 95%CI(1.17, 2.15), P=0.03] were independent risk factors for cartilage injury of more than degree 3 in enrolled patients. ROC analysis showed that MDI had more diagnostic value than BMI, and the critical value was 0.355 with a sensitivity of 89.1% and a specificity of 88.2%.@*CONCLUSION@#In doubt or accompanied by 40 to 60 years old patients with knee osteoarthritis, the MDI measured by non-weight-bearing knee MRI has predictive value for cartilage injury of more than degree 3 in medial tibiofemoral joint, and the critical value for diagnosis of cartilage injury of more than degree 3 is 0.355.
Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Osteoarthritis, Knee/surgery , Cartilage, Articular/surgery , Knee Joint/surgery , Meniscus , Menisci, Tibial/surgery , Cartilage Diseases , Magnetic Resonance Imaging/adverse effectsABSTRACT
Knee joint distraction is a new technology for the treatment of knee osteoarthritis in recent years. It could reduce knee pain and improve knee function, which is inseparable from the role of cartilage repair. The mechanism and influencing factors of knee joint distraction in repairing cartilage are the focus of current research. In this paper, the author reviewed literature and found that knee joint distraction could reduce knee joint load and provide a appropriate mechanical environment for cartilage repair, and it is resulting hydrostatic pressure fluctuation in the knee joint not only helps cartilage to absorb nutrients, but also promotes cartilage formation genes and inhibits cartilage matrix degrading enzyme gene expression. In addition, knee joint distraction creates conditions for synovial mesenchymal stem cells to be collected to cartilage injury, and improves ability of synovial mesenchymal stem cells to proliferate and differentiate into a chondrogenic lineage. Knee joint distraction could reduce inflammatory reaction and cartilage injury of knee joint by reducing content of inflammatory factors and inhibiting expression of inflammatory genes. At present, it is known that the factors affect repair of cartilage by knee joint distraction include, increasing weight-bearing activity and height and time of distraction is helpful for cartilage repair, male patients and patients with higher severity of knee osteoarthritis have better cartilage repair effect after knee joint distraction.The better efficacy of cartilage repair on the first year after knee joint distraction predicts a higher long-term survival rate of knee joint distraction with knee preservation. However, the research on the above hot spots is only at the initial stage and further exploration is still needed, in order to better guide clinical application of knee joint distraction.
Subject(s)
Humans , Male , Osteoarthritis, Knee , External Fixators , Knee Joint/surgery , Osteogenesis, Distraction/methods , Cartilage , Cartilage, Articular/surgeryABSTRACT
The aim of this study was to evaluate the effects of mandibular advancement appliance and low level laser therapy (LLLT) with different doses on cellular hypertrophic changes in the mandibular condyle of rats. Forty-eight 8-week-old male Wistar albino rats weighing between 260 and 280 g were randomly divided into four experimental and control groups. Group I was the control group; group II was the mandibular advancement appliance group; group III was the 8 J/cm2 (0.25 W, 20 s) laser irradiation with mandibular advancement appliance group; and group IV was the 10 J/cm2 (0.25 W, 25 s) laser irradiation with mandibular advancement appliance group. Mandibular condyle cartilage and subchondral bone changes with different LLLT dose and mandibular advancement appliance were evaluated by histomorphometrical analysis. Subchondral bone fraction results showed that there were no significant differences between groups (p<0.05). The statistically significant differences found between control group and experimental groups in anterior and posterior cartilage layers thickness (p<0.05) and (p<0.01). Posterior and anterior condylar cartilage layers of rats react differentially to LLLT and mandibular advancement application. Maximum changes in condylar cartilage layers were found in 8 J/cm2 laser irradiation with mandibular appliance group.
El objetivo de este estudio fue evaluar los efectos del aparato de avance mandibular y la terapia con láser de bajo nivel (TLBN) con diferentes dosis sobre los cambios hipertróficos celulares, en el cóndilo mandibular de ratas. Cuarenta y ocho ratas albinas macho Wistar de 8 semanas de edad con un peso de 260 y 280 g se dividieron aleatoriamente en cuatro grupos experimentales y control. El grupo I control; grupo II, dispositivos de avance mandibular; grupo III de irradiación con láser de 8 J / cm2 (0.25 W, 20 s) con el grupo dispositivos de avance mandibular; y grupo IV con irradiación láser de 10 J / cm2 (0,25 W, 25 s) con el grupo de dispositivos de avance mandibular. El cartílago del cóndilo mandibular y los cambios en el hueso subcondral con diferentes dosis de TLBN y dispositivo de avance mandibular, se evaluaron mediante análisis histomorfométrico. Los resultados de la fracción ósea subcondral indicaron que no hubo diferencias significativas entre los grupos (p <0,05). Las diferencias estadísticamente significativas encontradas entre el grupo control y los grupos experimentales, en el grosor del cartílago anterior y posterior (p<0,05) y (p<0,01). Las capas de cartílago condilar posterior y anterior de las ratas reaccionan de manera diferencial a la aplicación de TLBN y avance mandibular. Se encontraron cambios significativos en las capas de cartílago condilar con irradiación láser de 8 J /cm2 con el grupo de dispositivos mandibulares.
Subject(s)
Animals , Male , Rats , Bone and Bones/radiation effects , Cartilage, Articular/radiation effects , Mandibular Advancement/methods , Low-Level Light Therapy/methods , Bone and Bones/surgery , Cartilage, Articular/surgery , Rats, WistarABSTRACT
Introducción: En la actualidad existen diferentes métodos y técnicas de preservación articular. La utilización de una matriz de atelocolágeno combinada con microperforaciones otorga un soporte adecuado para la inducción de la condrogénesis a partir de las células mesenquimales provenientes de la médula ósea. El objetivo de nuestro trabajo es describir la técnica quirúrgica y presentar los resultados de una serie de pacientes con lesiones condrales severas, tratados con microperforaciones asociado a una matriz de atelocolágeno. Material y Método: Se evaluaron los pacientes intervenidos quirúrgicamente por lesión de cartílago grado IV de más de 3 cm2 a los que se le aplicó matriz de atelocolágeno combinado con microperforaciones. El mínimo seguimiento fue de 24 meses. En pacientes con deseje o inestabilidad asociada se realizaron procedimientos combinados en el mismo acto quirúrgico. Describimos la técnica quirúrgica, resultados funcionales pre y postoperatorios con las escalas de Lysholm, IKDC y Escala Visual Análoga (EVA) del dolor fueron. Se realizó una evaluación radiográfica. Analizamos las complicaciones del procedimiento. Resultado: Fueron operados 12 pacientes. A uno se le realizó un reemplazo articular de su rodilla a los 10 meses de la cirugía y fue considerado falla con finalización del seguimiento. Once fueron evaluados clínicamente, nueve hombres y dos mujeres, con una edad promedio de 48 años y seguimiento promedio de 34 meses. Ocho procedimientos en cóndilo interno, 2 en cóndilo externo y 4 en tróclea. La mediana de la escala de IKDC pre/post operatorio fue 41/55 (p 0.016), Lysholm 35/82 (p 0.004) y EVA 9/3 (p 0.002). La evaluación radiológica no evidenció cambios degenerativos. Se registró 1 artrofibrosis post operatoria. Conclusión: En nuestra serie, el tratamiento con atelocolágeno combinado con microperforaciones mejoró la clínica de los pacientes con lesión severa del cartílago articular de rodilla. Tipo de trabajo: Serie de casos Nivel de Evidencia: IV
ntroduction: Different surgical approaches are currently available to treat knee chondral defects. The technique used in this article combines microfractures with the use of an injectable atelocollagen matrix (Cartifillï). The matrix covers the defect and improves the mechanical stability of the blood clot and maintains the chondrogenic progenitor cells and growth factors in the defective area. The aim of our study is to evaluate and describe the results in a series of patients treated with atelocollagen matrix and microfractures. Material and Methods: All patients treated with atelocollagen matrix due to a cartilage lesion with a minimum follow-up of 24 months were evaluated. Patients undergoing associated surgeries (osteotomies, meniscectomies, mosaicplasty, ligament reconstruction) in the same surgical procedure were included in the study. Clinical function was assessed before and after surgery with the International Knee Documentation Committee (IKDC), the Lysholm score and the Visual Analogue Scale (VAS). Radiographic control was requested according to availability. Results: Twelve patients met the inclusion criteria. Three women. Average age of 50 years. Eight applications in medial condyle, 2 in lateral condyle and 4 in trochlea. One post-operative arthrofibrosis was recorded. One of the patients underwent an articular replacement of his knee 10 months after the surgery with finalization of follow-up. The pre / post-operative average was 39/52 (IKDC), 37/76 (Lysholm) and 8.5 / 3.5 (VAS). Conclusion: In our series, atelocollagen matrix combined with microfractures improved the clinical symptoms of patients with severe knee articular cartilage injury. However, a better selection of patients who require this procedure should be applied in future interventions. Type of Study: Case Series. Level of Evidence: IV
Subject(s)
Adult , Middle Aged , Arthroscopy/methods , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Collagen/therapeutic use , Chondrocytes/transplantation , Tissue Engineering/methods , Knee Injuries/surgeryABSTRACT
O objetivo deste estudo foi avaliar o reparo da cartilagem hialina equina, por meio de análises macroscópica (através de videoartroscopia) e histológica (através de fragmentos de biopsia), em defeitos condrais induzidos na tróclea lateral do fêmur tratados pela técnica de microperfurações subcondral associada ou não com administração intra-articular de cartogenina. Foram utilizados seis equinos pesando em média (±DP) 342±1,58 kg, com a idade aproximada de 7,2±1,30 anos e escore corporal de 7,1±0,75, que foram submetidos a videoartroscopia para indução da lesão condral de 1 cm2 na tróclea lateral do fêmur e realização da técnica de microperfuração do osso subcondral de ambos os joelhos. Foram realizadas quatro aplicações semanais com 20 μM de cartogenina intra-articulares em um dos joelhos (grupo tratado) e solução de ringer com lactato na articulação contralateral (grupo controle). Após o período de 60 dias, foram feitas as avaliações macroscópicas, através de videoartroscopias, e histológicas, através de biopsia. Não foram observadas diferenças significativas nos escores macroscópicos e histológicos para reparação condral entre animais dos grupos tratados e não tratados (P>0,05). De modo geral, a porcentagem média de cartilagem hialina no tecido de reparo (17,5%) foi condizente com a literatura internacional usando outros tipos de perfuração condral. Entretanto, não se observaram diferenças estatísticas entre grupos (P>0,05). A terapia com cartogenina, segundo protocolo utilizado, não produziu melhora do processo cicatricial em lesões condrais induzidas e tratadas com microperfurações na tróclea lateral do fêmur em equinos.
The aim of this study was to evaluate the joint cartilage repair by macroscopic (via arthroscopy) and histological (biopsy fragments) analyses in chondral defects induced into equine femoral trochlea treated by microperforation associated with or without intra-articular administration of kartogenin. Six horses weighing 342±1.58 kg (mean ± SD), aged approximately 7.2±1.30 years and with a body condition score of 7.1±0.75, were used. The horses underwent arthroscopy for induction of 1-cm2 chondral lesions in lateral femoral trochlea immediately treated by microperforation of the subchondral bone of both knees. Four weekly intra-articular injections of kartogenin (20μM) in one knee (treated group) and Ringer lactate solution in the contralateral joint (control group) were performed during the postoperative period. After 60 days, macroscopic evaluations were performed by video-arthroscopy, and biopsy samples of the repair tissue were taken for histopathological healing evaluation. No significant change was observed in macroscopic and histological scores for chondral healing between treated and untreated groups (P>0.05). The overall mean percentage of hyaline cartilage in both groups (17.5%) was consistent with other international studies using other types of chondral microperforation; however, no statistical differences were observed between groups (P>0.05). In conclusion, the therapy with kartogenin, according to the used protocol, did not produce any macroscopic and histological healing improvement in induced chondral lesions treated with microperforations in equine femoral trochlea.
Subject(s)
Animals , Cell Self Renewal/physiology , Hyaline Cartilage/surgery , Hyaline Cartilage/pathology , Horses/surgery , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Osteoarthritis/veterinary , Histological Techniques/veterinaryABSTRACT
Antegrade transmalleolar drilling method is one of the options for the treatment of osteochondral lesion of talus (OLT). We present five patients who underwent tibial drilling for treatment of OLT and later developed distal tibial cystic formation induced by cartilage opening or heat necrosis during drilling. Antegrade transmalleolar drilling can be a possible option for the treatment of OLT if the lesion is not easily reachable; however, other viable treatment should be considered due to its possibility of distal tibial pathologic change.
Subject(s)
Adult , Female , Humans , Male , Young Adult , Ankle Joint/surgery , Cartilage, Articular/surgery , Iatrogenic Disease , Musculoskeletal Diseases/etiology , Orthopedic Procedures/adverse effects , Talus/surgery , Tibia/injuriesABSTRACT
El objetivo principal en la reconstrucción de párpados es promover una adecuada protección del globo ocular así como la restitución de sus planos anatómicos. En el caso a presentar, el paciente padecía un carcinoma basocelular en el borde libre del párpado inferior izquierdo, que comprometía su lámina anterior y posterior (figura 1). Para poder obtener una correcta estabilidad se decidió utilizar un injerto de cartílago auricular de espesor parcial con periocondrio para la reconstrucción del tarso (Matsuo, 1987; Friedhofer, 1999 y un colgajo en doble banderín de Laguinge para su cobertura. Se obtuvo la epitelización del injerto en tiempos estándares según la literatura y un buen resultado estético y funcional...
Subject(s)
Humans , Male , Aged , Cartilage, Articular/surgery , Surgical Flaps/surgery , Surgical Flaps/transplantation , Nictitating Membrane/pathology , Eyelid Neoplasms/surgeryABSTRACT
Las lesiones osteocondrales en la rodilla representan un problema frecuente en la práctica médica. Estas llevan a la degeneración del cartílago hialino con la consecuente artrosis, causa importante de dolor y discapacidad. En los últimos años se han desarrollado múltiples técnicas para tratar estas lesiones. El sistema de transferencia osteocondral autólogo (OATS) ha sido descrito para el tratamiento de estos defectos focales en los cóndilos femorales; sin embargo, su aplicación real en la patela es todavía un tema de controversia. Una correcta selección de los pacientes en conjunto con una técnica quirúrgica adecuada son fundamentales para el resultado exitoso de esta cirugía. Nuestro objetivo es describir la técnica quirúrgica y los aspectos involucrados en el sistema de transferencia osteocondral autólogo para lesiones condrales focales de la patela.
Osteochondral injuries in the knee are a common problem in medical practice. These lead to the degeneration of the hyaline cartilage and the consequent osteoarthritis, a major cause of pain and disability. In recent years several techniques have been developed to treat these injuries. The osteochondral autologous transfer system (OATS) has been described for the treatment of these defects on the femoral condyles, however its actual implementation in the patella is not yet clear. Patient selection and adequate surgical technique are fundamental to a successful surgery. Our objective is to describe the surgical technique and aspects involved in the osteochondral autograft transfer system for isolated chondral injuries of the patella.
Subject(s)
Humans , Knee Joint/surgery , Arthroscopy/methods , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Cartilage/transplantation , Osteochondritis/surgery , Patella/surgery , Patella/injuries , Transplantation, Autologous/methodsABSTRACT
Objetivo: Determinar si hay reparación de defectos osteocondrales en cóndilos femorales usando cartílago costal e injerto de cresta iliaca autólogos en ratas blancas. Material y métodos: Se experimentó con 60 ratas blancas de entre 110 y 120 gr. Se formaron dos grupos de 30 especímenes cada uno (control y experimental). Al control solo se le hizo la exceresis del cóndilo femoral medial y al grupo experimental, además, se colocó cartílago costal sobre el defecto con injerto de cresta iliaca interpuesto, ambos autólogos. Los especímenes fueron sacrificados a los 60 días y evaluados microscópicamente. Resultados: Se usó el test de t-student. Hubo diferencia significativa entre los grupos control y experimental, considerando el puntaje total de las cinco variables estudiadas. Así mismo se encontró diferencia significativa con la variable morfología celular; con las variables metacromasia, regularidad de superficie, grosor del cartílago e integración con el cartílago adyacente, no se encontró diferencia significativa. Conclusiones: No hubo reparación de los defectos osteocondrales amplios de los cóndilos femorales.
Objetive: Determine if osteochondral femoral defect will be repaired using costal cartilage and autologous iliac crest graft in rats. Material: We experimented with 60 white rats of 110 and 120 gr. Two groups of 30 specimens (control and experimental). By controlling onIy the exeresis him the medial femoral condyle and the experimental group, in addition, costal cartilage was placed over the defect with iliac crest graft interposed, both autologous. Specimens were sacrificed at 60 days and evaluated microscopically. Results: It was used student's-t test. There was significant difference between the control and experimental groups, considering the total score of the five variables. Also significant differences were found with variable cell morphology, with metachromasia variables, surface regularity, thickness of cartilage and integration with adjacent cartilage, no significant difference was found. Conclusions: There was no repair of large osteochondral defects of the femoral condyles.
Subject(s)
Animals , Rats , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Animal Experimentation , TransplantsABSTRACT
OBJECTIVE: To evaluate the clinical and functional results of autologous trapezoidal plug single-block grafts fixed with absorbable chondral darts in patients with osteochondral knee lesions of varying sizes. METHODS: Twenty-five patients underwent surgery from February 2000 to June 2008. Seventy-two percent of the patients were male, and the mean age was 29 years. RESULTS: The right side (56%) and the medial condyle (92%) were most affected. The lesions had an average area of 5.28 cm², and the mean follow-up was 59 months. All of the variables other than instability showed significant improvements (p<0.05), as shown by the increase in the mean Lysholm score from 55 points preoperatively to 92 points (p<0.001) postoperatively. There was no loosening or collapse of the osteochondral graft. All of the patients had patellofemoral crepitation and pain for an average of six months. CONCLUSION: Autologous trapezoidal plug single-block grafts are a therapeutic option for defects of varying sizes and provide good clinical results and low morbidity at the donor site in the medium term.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Bone Transplantation/methods , Cartilage, Articular/surgery , Cartilage/transplantation , Knee Injuries/surgery , Osteochondritis/surgery , Absorbable Implants , Knee Joint/surgery , Statistics, Nonparametric , Treatment Outcome , Transplantation, Autologous/methodsABSTRACT
Objetivo: presentar la evolución a corto plazo de una serie de pacientes tratados mediante cirugía artroscópica con la técnica de microfracturas para lesiones condrales de acetábulo. Material y Métodos: Se evaluaron 9 pacientes en forma clínica, radiológica y por artroresonancia. Se evaluó, también el tiempo desde el inicio de los síntomas y la cirugía. Los pacientes completaron la escala funcional de WOMAC en el preoperatorio y en la última consulta postoperatoria. También se consultó el grado de satisfacción. Resultados: La escala de Tonnis demostró tres pacientes grado 0, cinco pacientes grado 1 y uno grado 2. No se constató progresión de la artrosis entre el preoperatorio y el último control. El tiempo promedio desde el inicio de los síntomas y la cirugía fue de 17 meses. La artroresonancia mostró la lesión condral en 7 de los 9 pacientes. La escala funcional de WOMAC postoperatoria fue en promedio de 87.3 mejorando en forma significativa de la preoperatoria de 67.3. En cuanto al grado de satisfacción 5 pacientes refirieron estar muy satisfechos, 3 satisfechos y solo un resultado pobre. Conclusión: El tratamiento de las lesiones condrales del acetabulo con microfracturas demostró buenos resultados clínicos y radiológicos con seguimiento mínimo de un año.
Subject(s)
Adult , Young Adult , Acetabulum/surgery , Acetabulum/injuries , Hip Joint/surgery , Arthroscopy/methods , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Follow-Up Studies , Patient Satisfaction , Retrospective Studies , Treatment OutcomeABSTRACT
Introducción: A pesar de los adelantos descriptos en cuanto a patología labral y su resolución artroscópica, no existen seguimientos a largo plazo en cuanto a preferencias sobre reparación/re fijación vs. debridamiento del labrum. El propósito de este trabajo es comparar a corto plazo el resultado obtenido en dos grupos de 10 pacientes cada uno con lesión del labrum de origen traumático. Materiales y métodos: Según criterios de inclusión y exclusión definidos, se seleccionan 20 pacientes con antecedentes de lesión traumática de labrum de cadera tratados por artroscopía. Se los divide en dos grupos de 10. Un grupo A con lesiones fibrilares a los que se les realizo debridamiento clásico y un grupo B con rupturas longitudinales que fueron reinsertadas con arpones biodegradables de 2,3 mm de diámetro. Evaluación y resultados: Los 2 grupos de 10 pacientes fueron evaluados con el score de Harris modificado por Byrd para artroscopía de cadera. Los resultados del grupo A fueron: 2 pacientes con puntaje excelente, 4 pacientes puntaje bueno, 2 pacientes puntaje regular y 2 pacientes con malos resultados. En cuanto al grupo B: 3 pacientes tuvieron puntaje excelente, 5 pacientes puntaje bueno y 2 pacientes puntaje regular. Conclusiones: La resolución de los problemas del labrum retrasa sin duda la llegada de enfermedades degenerativas. Es importante progresar en la técnica quirúrgica y continuar con los seguimientos a largo plazo de los pacientes operados, lo que terminará de delinear cual es el tratamiento a seguir según el tipo de lesión
Subject(s)
Acetabulum/surgery , Acetabulum/injuries , Hip Joint/surgery , Arthroscopy/methods , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Follow-Up Studies , Retrospective Studies , Treatment OutcomeABSTRACT
Comparar los resultados clínicos en pacientes mayores de 50 años con lesiones condrales de rodilla, tratados con radiofrecuencia bipolar o condroplastía mecánica. Métodos: Estudio retrospectivo, descriptivo de una serie consecutiva de 41 pacientes sometidos a una artroscopía de rodilla por diagnóstico clínico e imagenológico de lesión condral. Veintiún hombres y veinte mujeres con un promedio de edad de 60,1 años (50-83) ingresaron al estudio. Evaluamos con puntajes Lysholm e Intemational Knee Documentation Committee (IKDC) postoperatorios. Documentamos lesiones asociadas encontradas y procedimientos realizados. Para el análisis estadístico se utilizó el Test de Wilcoxon y Test T para muestras independientes. Resultados: Seguimiento promedio de 35,9± 15,2 meses. Diecinueve pacientes fueron tratados con radiofrecuencia bipolar y veintidos con condroplastía mecánica. Puntajes postoperatorios promedio: radiofrecuencia bipolar: Lysholm 86,3 e IKDC 83,2, condroplastía mecánica: Lysholm 88,8 e IKDC 79,6. No se encontró diferencia estadísticamente significativa entre los grupos (p>0,05). Conclusión: El tratamiento con radiofrecuencia bipolar y condroplastía mecánica ofrece buenos resultados en pacientes con lesiones condrales de espesor parcial...
Subject(s)
Adult , Middle Aged , Aged, 80 and over , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Cartilage Diseases/surgery , Osteochondritis/surgery , Knee Injuries/surgery , Chondrocytes/pathology , Follow-Up Studies , Radio Waves/therapeutic use , Retrospective Studies , Treatment OutcomeABSTRACT
Introdução: De modo geral, as lesões meniscais vêm sendo tratadas ao longo dos anos pela retirada do menisco. A meniscectomia total ou parcial, a médio e longo prazo, apresenta efeitos deletérios sobre a articulação, acelerando o processo de degeneração da cartilagem articular. Objetivo: O objetivo deste estudo é quantificar as fibras colágenas de meniscos de coelhos submetidos a temperaturas e períodos de preservação variáveis. Métodos: Retirou-se assepticamente 120 meniscos de 30 coelhos (Nova Zelândia), machos, 6/8 meses, 3250g. Os meniscos foram congelados, de 2 a 30 dias, a -7,2ºC (n=60) e -73ºC (n=60). A cada dois dias, de cada temperatura, foram descongelados quatro meniscos que foram encaminhados para o estudo histológico. A descrição morfológica foi feita com os cortes corados por HE e para o estudo morfométrico os cortes foram corados pelo Picrosirius e submetidos à polarização. Resultados: Na análise descritiva das médias percentuais de colágeno foram observadas diferenças maiores e estatisticamente significantes (p<0,001) à temperatura de -73ºC. A análise comparativa das médias percentuais de fibras colágenas ao longo dos períodos de preservação, embora com diferença de valores, apresentaram uma curva simétrica de variação. Também se obervou que a partir do 14ºdia, em ambas as temperaturas, a variação na porcentagem de fibras colágenas em relação aos demais períodos não apresentou significância estatística. Conclusão: Os resultados permitem concluir que a temperatura de -73ºC mostrou médias percentuais de colágeno superiores em todos os períodos observados e que a partir do 14º até o 30º dia de congelamento a quantidade de fibras colágenas permanece estável em ambas as temperaturas.
Subject(s)
Animals , Cartilage, Articular/surgery , Rabbits/physiology , Freezing , AnimalsABSTRACT
BACKGROUND: Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. METHODS: Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calve-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications. RESULTS: Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7degrees to a mean of 115.0degrees at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons. CONCLUSIONS: Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Young Adult , Acetabulum/surgery , Cartilage, Articular/surgery , Femur Head/surgery , Hip Dislocation/surgery , Hip Joint/abnormalities , Osteotomy/methods , Treatment OutcomeSubject(s)
Humans , Cartilage, Articular/anatomy & histology , Cartilage, Articular/surgery , Cartilage, Articular/cytology , Cartilage, Articular/injuries , Transplantation, Autologous , Anti-Inflammatory Agents, Non-Steroidal , Arthroscopy , Bone Transplantation , Chondrocytes/transplantation , Cartilage Diseases/surgery , Cartilage Diseases/therapy , Genetic Therapy , Orthopedic Procedures , Tissue EngineeringABSTRACT
Purpose: Acetabular labral tears are a frecuent cause of hip pain in nonarthritic young patients. We present our experience in the arthroscopic treatment of acetabular labral tears. Material and Methods: This is a retrospective study of45 patients operated by hip arthroscopy between December 2002 and March 2006. We analized the etiology and the location of the labral tears, the presence of associated chondral lesions and clinical short term results. In all the patients we perform the resection of the damaged part of the labrum, in 13 of this cases we perform a resection off the underlying bone deformity. Results: The most frecuent etiology was the femoroacetabular impingement (28 patients), less frecuent are traumatic, displastic and degenerative causes. In 36 patients the lesion was located anterosuperior, in 35 cases chondral lesions of the articular surface were present. The clinical result were excellent and good in 39, poor or fair in 6 patients. Conclusion: In our group the labral tear was the most frecuent cause of hip arthroscopy. Associated chondral lesions are highly frecuent. The main etiology is the femoroacetabular impingement which must be treated simultaneously. With a selective patient selection and an accurate surgical technique good clinical results can be achieved.
La lesión del labrum acetabular es causa frecuente de coxalgia en pacientes jóvenes sin artrosis. En este trabajo se presenta el análisis de sus causas y nuestra experiencia en el tratamiento artroscópico. Material y Métodos: Se analizan retrospectivamente 45 pacientes operados entre Diciembre 2002 y Marzo 2006. Se analiza la etiología, localización de las lesiones, presencia de lesiones condrales asociadas y la evolución clínica. En todos se efectuó la resección parcial del labrum dañado, en 13 se efectuó además la resección artroscópica de la deformidad ósea subyacente. Resultados: La etiología más frecuente fue un pellizcamiento femoroacetabular (28 pacientes), menos frecuente la causa degenerativa, displasia o traumática. En 36 pacientes la lesión del labrum era anterosuperior, 35 presentaban lesiones condrales asociadas. En 13 casos de pellizcamiento se efectuó la resección de la deformidad ósea. Los resultados clínicos fueron excelentes y buenos en 39 pacientes, regulares y malos en 6. Conclusiones: La lesión del labrum es la indicación más frecuente de artroscopia de cadera. Son muy frecuentes las lesiones condrales asociadas. La principal etiología fue el pellizcamiento femoroacetabular el cual idealmente debe ser tratado en forma simultánea. Con una indicación selectiva y adecuada técnica quirúrgica se obtienen resultados clínicos satisfactorios.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Acetabulum/surgery , Arthroscopy/methods , Hip Injuries/surgery , Hip Injuries/etiology , Acetabulum/injuries , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Patient Satisfaction , Postoperative Complications , Retrospective StudiesABSTRACT
PURPOSE: To study the morphology of the articulation of the knee of rabbits after the repairing of the defect osteochondral standardized with resorcina adhesive or metallic synthesis. METHODS: The procedure was to the creation of the defect osteochondral in femoral medial condylus of the knee of 80 rabbits, The animals were distributed in two groups with continuations of 7 and 42 days and submitted to the technique G (resection and retreat of the fragment osteochondral of the femoral medial condylus and relocation with resorcina adhesive), technique S (resection and retreat of the fragment osteochondral of the femoral medial condylus and relocation and metallic synthesis) or technique C (resection and retreat of the fragment osteochondral of the femoral medial condylus, leaving the empty standard defect the control). It was Made clinical study, radiographic, macroscopic and histological in two groups. RESULTS: the resorcina adhesive provokes: necrosis of the fragment osteochondral in 100 percent and 95 percent, degeneration 90 percent and 100 percent, free body in 80 percent and 65 percent respectively in the group I and II; compared with the metallic synthesis that it presented: necrosis in 25 percent and 35 percent, degeneration 25 percent and 35 percent, free body in 35 percent and 10 percent respectively in the group I and II. CONCLUSION: the resorcinol adhesive, related with the necrosis, cartilaginous degeneration and detachment of the fragment osteochondral lives frequently that the metallic synthesis.
OBJETIVO: Estudar a morfologia da articulação do joelho de coelhos após a reparação de um defeito osteocondral padronizado com adesivo de resorcina ou síntese metálica. MÉTODOS: Procedeu-se à criação de um defeito osteocondral em côndilo femoral medial do joelho de 80 coelhos. Os animais foram distribuídos em dois grupos com seguimentos de 7 e 42 dias e submetidos à técnica G (ressecção e retirada do fragmento osteocondral do côndilo femoral medial e recolocação com adesivo de resorcina), técnica S (ressecção e retirada do fragmento osteocondral do côndilo femoral medial e recolocação e síntese metálica) ou técnica C (ressecção e retirada do fragmento osteocondral do côndilo femoral medial, deixando o defeito padrão vazio como controle). Fez-se estudo clínico, radiográfico, macroscópico e histológico nos dois grupos. RESULTADOS: o adesivo de resorcina provoca: necrose do fragmento osteocondral em 100 por cento e 95 por cento, degeneração 90 por cento e 100 por cento, corpo livre em 80 por cento e 65 por cento respectivamente no grupo I e II; comparado com a síntese metálica que apresentou: necrose em 25 por cento e 35 por cento, degeneração 25 por cento e 35 por cento, corpo livre em 35 por cento e 10 por cento respectivamente no grupo I e II. CONCLUSÃO: o adesivo de resorcina, está relacionado com a necrose, degeneração cartilaginosa e despreendimento do fragmento osteocondral com maior freqüência que a síntese metálica.
Subject(s)
Animals , Male , Rabbits , Cartilage, Articular/pathology , Fracture Fixation , Formaldehyde/adverse effects , Gelatin/adverse effects , Knee Injuries , Resorcinols/adverse effects , Tissue Adhesives/adverse effects , Cartilage, Articular/drug effects , Cartilage, Articular/surgery , Drug Combinations , Knee Injuries/pathology , Knee Injuries/surgery , Necrosis , Wound Healing/drug effectsABSTRACT
Introduccion: El mejor tratamiento para las lesiones osteocondrales an se desconoce. Los resultados clinicos con el injerto de condrocitos autologos son favorables (90 por ciento exito a 10 años); sin embargo, su capacidad de regenerar un cartilago hialino adulto continua siendo controversial. La capacidad pluripotencial de las células progenitoras determina probablemente la posibilidad de regenerar al cartilago articular y el hueso subcondral subyacente. El objetivo es establecer si la regeneracion del cartílago es hialina luego de la inoculacion de celulas progenitoras adultas o condrocitos autologos en las lesiones osteocondrales de la rodilla. Materiales y metodos: Se utilizaron 10 conejos en los cuales se creo un defecto osteocondral de ambas rodillas. Luego se los dividio en dos grupos: un grupo control, que no recibio tratamiento (10 rodillas izquierdas) y grupo estudio (10 rodillas derechas), dentro del cual 5 recibieron celulas progenitoras autologas y 5, condrocitos autologos. A los ocho meses de la operacion se sacrifico a los animales previa evaluacion con resonancia magnetica tridimensional. Las piezas fueron evaluadas con tincion de hematoxilina-eosina y con inmunohistoquimica para colageno tipo II. Resultados: Los defectos sin tratamiento presentaron un tejido degenerativo fibrocartilaginoso. Los tratados con lineas celulares demostraron un estimulo regenerativo, pero sin evidenciar un cartílago hialino adulto similar al cartílago nativo adyacente. Las celulas progenitoras demostraron una mejor regeneracion del hueso subcondral. Conclusiones: Los tratamientos con líneas celulas demuestran un estimulo regenerativo en las lesiones osteocondrales; sin embargo, no se logra una cartilago articular hialino similar al nativo. Tal vez sea necesario incorporar a estas terapias otras herramientas de la ingeniería de tejidos, como las matrices tridimimensionales y los factores de crecimiento, que puedan lograr una regeneracion ad integrum del cartílago...
Subject(s)
Animals , Rabbits , Knee Joint/surgery , Cartilage, Articular/surgery , Chondrocytes/transplantation , Osteochondritis/surgery , Transplantation, AutologousABSTRACT
Las lesiones condrales articulares constituyen en la actualidad un verdadero desafio dado el aumento en su incidencia sumado a la nula capacidad regenerativa de los condrocitos y a la ausencia de un tratamiento óptimo. Se han desarrollado múltiples técnicas para tratar estas lesiones, que van desde el aseo articular, la estimulación de la médula ósea, o los transplantes osteocondrales y de condrocitos autólogos que intentan lograr una cobertura del defecto con cartílago hialino. El objetivo de este trabajo es evaluar retrospectivamente la evolución clínica de un grupo de pacientes con lesiones osteocondrales focales de rodilla que fueron sometidos a un injerto osteocondral autógeno (mosaicoplastía) por los autores, entre junio de 1998 a diciembre de 2002, con seguimiento mínimo de 1 año. Se obtuvieron 89 por ciento de buenos y excelentes resultados en un total de 27 pacientes, lo cual avala la utilidad de este procedimiento en el manejo de las lesiones osteocondrales focales de rodilla.