Positive early clinical outcomes of bone marrow aspirate concentrate for osteoarthritis using a novel fenestrated trocar.

BACKGROUND: This study sought to assess early clinical outcomes for knee osteoarthritis (OA) patients undergoing bone marrow aspirate concentrate (BMAC) treatment using a novel closed-end, fenestrated trocar (FT) that does not require centrifugation. METHODS: A prospective cohort of 17 knee OA patients undergoing BMAC treatment with the FT system from March 2018 to March 2019 was retrospectively evaluated. Approximately 10 mL of BMAC was harvested, no centrifugation was performed, and the BMAC was injected into the affected knee. Clinical outcomes were assessed at baseline, six weeks, and 12 weeks. This study has no affiliation with/vested-interest in the FT system. RESULTS: There were significant improvements in nearly all outcomes from baseline to 12 weeks. Specific improvements included Knee Injury and OA Outcome Score (KOOS) activities-of-daily-living (61.1 ± 9.2 [mean ± 95% confidence interval] to 89.3 ± 6, p = 0.001), quality-of-life (32.7 ± 9.3 to 66.1 ± 17.9, p = 0.003), sports/recreation (36.9 ± 10.6 to 72.6 ± 26.3, p = 0.006), and pain (53.8 ± 9.3 to 83 ± 10.2, p = 0.001); Lysholm scores (55.5 ± 8.4 to 77.3 ± 10.5, p = 0.009); and visual analog pain scores (5.68 ± 1.14 to 2.07 ± 1.86, p = 0.003). Individually, at least 75% of patients exhibited improvement in all KOOS categories at six weeks and at least 85% at 12 weeks. CONCLUSIONS: BMAC treatment with an FT system that does not require centrifugation resulted in significant improvements in early pain and function scores for knee OA. The symptomatic improvements in this study were similar to or greater than what has been reported using traditional needles. These data may provide clinicians with comfort in using an FT system and provide motivation for future randomized-controlled trials comparing aspiration techniques.

Immunohistological detection of relaxin binding to anterior cruciate ligaments.

Relaxin, a member of the insulin-like growth factor family, alters collagen metabolism in fibroblasts. It was hypothesized that relaxin interacts with the anterior cruciate ligament (ACL), contributing to its elasticity. Twelve ACL specimens were collected from reconstruction surgeries, sectioned, rinsed, and exposed to rh-relaxin overnight. Polyclonal antirelaxin antibodies, in conjunction with HRP-AEC, localized areas of tissue binding. Controls were used to infer binding specificity. Staining was present in the positive control and all 12 ACL specimens; little or no staining occurred in the negative controls. These data suggest that relaxin binding to the ACL is specific, indicative of a receptor-mediated event.

Bilateral knee and bilateral elbow osteochondritis dissecans.

A 12 1/2-year-old white girl presented with a 3-year history of bilateral knee and bilateral elbow pain. Radiographs showed osteochondritis dissecans (OCD) lesions of both patellas and bilateral intra-articular bodies within the elbows--consistent with previous OCD lesions. After unsuccessful conservative management, an arthroscopy was performed on the right knee; the lesion was removed, and a chondroplasty was performed on the patella. There were no operative complications, and the patient did well postoperatively. At 12-week follow-up, a 2+ effusion was found in the right knee. Locking and pain in the left elbow were treated with arthroscopy/arthrotomy, and the 3 loose osteochondral bodies were removed. The patient regained full, painless range of motion of the left elbow. This is the first report of OCD lesions located on both patellas and elbows in an adolescent.