[Anterior knee pain: a simplified assessment and management algorithm]. / Dolor anterior de rodilla: algoritmo simplificado de estudio y manejo.

Anterior knee pain is a common condition that affects adolescent and young adult patients, being one of the most challenging consultations for a knee surgeon. The large number of distinct diagnoses makes it a peculiar syndrome, the only similarities being the presence of retro or peripatellar pain aggravated by at least one activity that loads the joint in flexion. From a pathophysiological perspective, an overuse injury should be considered, where the structural unit of the tissue is damaged or its capacity for reparative response is exceeded. The diagnosis is clinical. Images should be reserved for a particular group of patients. Early intervention is essential to achieve favorable results. Conservative treatment is the gold standard and it is based on multimodal management validated by international consensus. Based on a categorization by clinic and images, we can have a guide to those etiologies that are susceptible to surgical management. The goal of the intervention is to reduce joint stress. The present review defines a simplified algorithm for the study and management of anterior knee pain.

El dolor anterior de rodilla es una condición que afecta a pacientes adolescentes y adultos jóvenes, siendo una de las consultas más comunes y desafiantes para el cirujano de rodilla. La gran cantidad de diagnósticos diferenciales, lo convierten en un síndrome particular, que solo presentan en común la presencia de dolor retro o peripatelar agravado por al menos una actividad que cargue la articulación en flexión. Desde un punto de vista fisiopatológico, debe considerarse una lesión por sobrecarga, donde la unidad estructural del tejido se encuentra dañada o excedida su capacidad de respuesta reparadora. El diagnóstico es clínico. Las imágenes debiesen reservarse para un grupo particular de pacientes. La intervención precoz es fundamental para lograr resultados favorables. El tratamiento conservador es el estándar de oro y se basa en un manejo multimodal validado por consensos internacionales. Basados en una categorización por clínica e imágenes, podemos tener una guía de aquellos cuadros que son susceptibles de manejo quirúrgico. El objetivo de la intervención es reducir el estrés articular. La presente revisión define un algoritmo simplificado de estudio y manejo en dolor anterior de rodilla.

Dolor anterior de rodilla: algoritmo simplificado de estudio y manejo / Anterior knee pain: a simplified assessment and management algorithm

Resumen: El dolor anterior de rodilla es una condición que afecta a pacientes adolescentes y adultos jóvenes, siendo una de las consultas más comunes y desafiantes para el cirujano de rodilla. La gran cantidad de diagnósticos diferenciales, lo convierten en un síndrome particular, que solo presentan en común la presencia de dolor retro o peripatelar agravado por al menos una actividad que cargue la articulación en flexión. Desde un punto de vista fisiopatológico, debe considerarse una lesión por sobrecarga, donde la unidad estructural del tejido se encuentra dañada o excedida su capacidad de respuesta reparadora. El diagnóstico es clínico. Las imágenes debiesen reservarse para un grupo particular de pacientes. La intervención precoz es fundamental para lograr resultados favorables. El tratamiento conservador es el estándar de oro y se basa en un manejo multimodal validado por consensos internacionales. Basados en una categorización por clínica e imágenes, podemos tener una guía de aquellos cuadros que son susceptibles de manejo quirúrgico. El objetivo de la intervención es reducir el estrés articular. La presente revisión define un algoritmo simplificado de estudio y manejo en dolor anterior de rodilla.

Abstract: Anterior knee pain is a common condition that affects adolescent and young adult patients, being one of the most challenging consultations for a knee surgeon. The large number of distinct diagnoses makes it a peculiar syndrome, the only similarities being the presence of retro or peripatellar pain aggravated by at least one activity that loads the joint in flexion. From a pathophysiological perspective, an overuse injury should be considered, where the structural unit of the tissue is damaged or its capacity for reparative response is exceeded. The diagnosis is clinical. Images should be reserved for a particular group of patients. Early intervention is essential to achieve favorable results. Conservative treatment is the gold standard and it is based on multimodal management validated by international consensus. Based on a categorization by clinic and images, we can have a guide to those etiologies that are susceptible to surgical management. The goal of the intervention is to reduce joint stress. The present review defines a simplified algorithm for the study and management of anterior knee pain.

Evolución clínica y presencia de edema óseo subcondral a los dos años de tratamiento con implante de condrocitos autólogos de alta de densidad en la rodilla / Clinical outcome and subchondral bone edema presence at two-year follow-up after high density autologous chondrocyte implantation treatment in the knee

Antecedentes y objetivo: Recientemente se ha descrito una nueva modalidad de la técnica de implante de condrocitos autólogos sobre membrana de colágeno i/iii llamada HD-ACI (High Density Autologous Chondrocyte Implantation) que está basada en el aumento de la densidad celular. El objetivo de este trabajo fue estudiar la evolución clínica y la incidencia de la aparición de edema óseo en pacientes con lesiones de cartílago en la rodilla tratados con HD-ACI al año y a los 2 años de la intervención. Métodos: Se trata de un estudio retrospectivo en 40 pacientes con lesiones condrales grado iii-iv. Todos los pacientes fueron tratados con HD-ACI con una dosis celular de 5×106 condrocitos/cm2 de lesión. La percepción subjetiva de la mejora de los síntomas/funcionalidad se valoró mediante la escala del Comité Internacional de Documentación de la Rodilla (IKDC, International Knee Documentation Committee). La presencia de edema óseo se evaluó a los 6, 12 y 24 meses de seguimiento por resonancia magnética. Comité Internacional de Documentación de la Rodilla (IKDC) Resultados: Los valores de IKDC mostraron una mejoría significativa a los 12 y 24 meses (p<0,001). La diferencia media de IKDC entre la visita basal y los 12 meses fue de 26,3 puntos y de 31,6 puntos a los 24 meses. El 27,5% de los pacientes presentaron edema óseo subcondral a los 2 años de seguimiento. Conclusiones: HD-ACI es un tratamiento efectivo y seguro que mejora el dolor, la percepción clínica y la funcionalidad de la articulación. No se ha encontrado correlación entre la presencia de edema óseo y la evolución clínica de los pacientes

Background: Recently, a new approach of autologous chondrocyte implantation technique (using as biomaterial a collagen type i/iii membrane) based on increasing cell density called HD-ACI (High Density Autologous Chondrocyte Implantation) has been described. The objective of this paper was to study the clinical outcome and incidence of subchondral bone oedema in patients with cartilage lesions in the knee treated with HD-ACI at 1-2 years of follow-up. Methods: This is a retrospective study performed with forty patients with chondral injuries grade iii-iv. All patients were treated with HD-ACI with a cellular dose of 5×106 chondrocytes /cm2 of lesion. The subjective perception of improvement of symptoms and functionality was measured with the IKDC score (International Knee Documentation Committee). The presence of bone oedema was assessed at 6, 12 and 24 months of follow-up by magnetic resonance imaging. Results: IKDC values showed a significant improvement at 12 and 24 months (P<.001). The mean difference of IKDC between the baseline visit and 12 months was 26.3 points, and 31.6 points at 24 months. Twenty-seven point five percent of the patients presented subchondral bone oedema at 2 years of follow-up. Conclusions: HD-ACI is an effective and safe treatment that improves pain, clinical perception and functionality of the joint. No correlation was found between the presence of bone oedema and the patients' clinical outcome

Clinical outcome and subchondral bone edema presence at two-year follow-up after high density autologous chondrocyte implantation treatment in the knee. / Evolución clínica y presencia de edema óseo subcondral a los dos años de tratamiento con implante de condrocitos autólogos de alta de densidad en la rodilla.

BACKGROUND: Recently, a new approach of autologous chondrocyte implantation technique (using as biomaterial a collagen type i/iii membrane) based on increasing cell density called HD-ACI (High Density Autologous Chondrocyte Implantation) has been described. The objective of this paper was to study the clinical outcome and incidence of subchondral bone oedema in patients with cartilage lesions in the knee treated with HD-ACI at 1-2 years of follow-up. METHODS: This is a retrospective study performed with forty patients with chondral injuries grade iii-iv. All patients were treated with HD-ACI with a cellular dose of 5×106 chondrocytes /cm2 of lesion. The subjective perception of improvement of symptoms and functionality was measured with the IKDC score (International Knee Documentation Committee). The presence of bone oedema was assessed at 6, 12 and 24 months of follow-up by magnetic resonance imaging. RESULTS: IKDC values showed a significant improvement at 12 and 24 months (P<.001). The mean difference of IKDC between the baseline visit and 12 months was 26.3 points, and 31.6 points at 24 months. Twenty-seven point five percent of the patients presented subchondral bone oedema at 2 years of follow-up. CONCLUSIONS: HD-ACI is an effective and safe treatment that improves pain, clinical perception and functionality of the joint. No correlation was found between the presence of bone oedema and the patients' clinical outcome.

Estudio piloto para la reconstrucción del ligamento cruzado anterior (LCA) con cultivos de fibroblastos autólogos sobre membranas de colágeno I/III / Pilot study on the anterior cruciate ligament (ACL) reconstruction with autologous fibroblasts culture on collagen I/III membranes

Objetivo: Utilizar cultivos de fibroblastos sobre membranas de colágeno I/III para tratar la rotura del ligamento cruzado anterior (LCA). Pacientes y métodos: Estudio prospectivo con 100 biopsias de LCA de pacientes con rotura de LCA con las que se realizaron cultivos primarios de fibroblastos. Tras alcanzar 20-30 millones, se transfirieron a membranas de colágeno I/III, donde se determinó su disposición mediante tinción con hematoxilina-eosina y la expresión de los genes colágeno de tipo I (Col-I), colágeno de tipo III (Col-III), tenascina-C y Sox-9 mediante PCR en tiempo real. Resultados: A los 30 días de cultivo existía una correlación negativa entre la edad de los pacientes y la velocidad de crecimiento de los fibroblastos (p=0,003). La histología reveló que las células se disponían entre la malla formada por las fibras de las membranas, expresando Col-I, Col-III, Sox-9 y tenascina-C, características del ligamento. Conclusión: Es posible el establecimiento de cultivos primarios de fibroblastos derivados de LCA tanto in vitro como sobre membranas de colágeno I/III sin que pierdan sus características primarias de células de ligamento (AU)

Objective: To study the possibility on the use of the in vitro cultured on I/III collagen membranes for the treatment of the broken anterior cruciate ligament (ACL). Patients and methodology: Prospective study performed with 100 ACL biopsies from patients with broken ACL, in which primary cultures of fibroblasts were established. When a number of 20-30 million was reached, they were transferred to I/III collagen membranes, where the architecture of the cells was examined by hematoxilin-eosin stained and the expression of the collagen type I (Col-I), collagen type III (Col-III), tenascin-C and Sox-9 genes by real time PCR. Results: A negative correlation between the age of the patients and the growth rate of the fibroblasts after 30 days of setting-up the culture (p=0.003) was observed. The histology revealed that the cells were disposed within the membrane fibers net, where the cells expressed the characteristic proteins of the ligament: Col-I, Col-III, Sox-9 and tenascin-C. Conclusion: It is possible to establish the primary culture of the ACL-derived fibroblasts, both in vitro and onto collagen I/III porcine membranes without losing their primary features of the ligament cells (AU)

[Menisci transplantation and autologous chondrocytes]. / Injerto de menisco y condrocitos autólogos.

We report 66 patients with chondral and osteochondral knee lesions and 3 with ankle lesions in whom, after clinical and radiological examination, arthroscopy was performed to harvest 0.3 or 0.4 g of hyaline cartilage from the knee or ankle to be sent for culture. After culture, autologous chondrocytes were implanted using open surgery. Our statistics show 85-90% of excellent and good results in patients under 50 years of age, including 30 elite athletes who were able to return to sport. The best results in the knee were obtained in the femoral condyle, and in the talus for ankle lesions. In one patient, an ACI in the lateral condyle and a meniscal graft were performed in the same surgery, thus restoring the normal physiology and biomechanics of the joint.

Partially biodegradable polyacrylic-polyester composites for internal bone fracture fixation.

New partially resorbable composite formulations based on components used in surgery were synthesized in rod form (length 15-20 mm, diameter 4 mm). The biostable components were poly(methyl methacrylate) in hydrophobic implants and poly(2-hydroxy ethyl methacrylate) in hydrophilic ones. The biodegradable components were commercially available suture yarn made from poly (alpha-hydroxy esters): polyglycolide, a polyester derived from glycolic acid; and a copolyester of glycolic and lactic acids, polyglactin 910. Biodegradation in phosphate-buffered solution at pH 7.0 and 37 +/- 0.5 degrees C was analysed gravimetrically. There was no measurable loss of mass after treatment for 20-25 d. Composite microstructure was examined by phase-contrast, cross-polarized light microscopy.

Enhancement of bone healing by an exogenous magnetic field and the magnetic vaccine.

We have demonstrated in rabbits that in the absence of a terrestial magnetic field, mammalian bone suffers from calcium depletion. This points to the possibility that the earth's field might be used as a 'magnetic vaccine' for the treatment of consolidation delays in bone healing. The effects, on bone calcification, of magnetic fields produced by electronically generated signals of sine and square waveform, over a range of frequencies from 0-250 kHz, were studied with the aid of a magnetic field generated within a coil containing the bone under test. Suggestions are made for an apparatus suitable for home use, and another which could be introduced into a hospital clinic.