SECEC Research Grant 2008 II: Use of platelet- and leucocyte-rich fibrin (L-PRF) does not affect late rotator cuff tendon healing: a prospective randomized controlled study.

BACKGROUND: Because the retear rate after rotator cuff repairs remains high, methods to improve healing are very much needed. Platelet-rich concentrates have been shown to enhance tenocyte proliferation and promote extracellular matrix synthesis in vitro; however, their clinical benefit remains unclear. We hypothesized that arthroscopic rotator cuff repair with leucocyte- and platelet-rich fibrin (L-PRF) results in better clinical and radiographic outcome at 12 months of follow-up than without L-PRF. METHODS: Thirty-five patients were randomized to receive arthroscopic rotator cuff repair with L-PRF locally applied to the repair site (L-PRF+ group, n = 17) or without L-PRF (L-PRF- group, n = 18). Preoperative and postoperative clinical evaluation included the Subjective Shoulder Value, visual analog score for pain, Simple Shoulder Test, and Constant-Murley score. The anatomic watertight healing, tendon thickness, and tendon quality was evaluated using magnetic resonance arthrography at 12 months of follow-up. RESULTS: No complications were reported in either group. The mean Subjective Shoulder Value, Simple Shoulder Test, and Constant-Murley scores increased from preoperatively to postoperatively, showing no significant differences between the groups. Complete anatomic watertight healing was found in 11 of 17 in the L-PRF+ group and in 11 of 18 in the L-PRP- group (P = .73). The mean postoperative defect size (214 ± 130 mm(2) in the L-PRF+ group vs 161 ± 149 mm(2) in the L-PRF- group; P = .391) and the mean postoperative tendon quality according to Sugaya (L-PRF+ group: 3.0 ± 1.4, L-PRF- group: 3.0 ± 0.9) were similar in both groups at 12 months of follow-up. CONCLUSION: Arthroscopic rotator cuff repair with application of L-PRF yields no beneficial effect in clinical outcome, anatomic healing rate, mean postoperative defect size, and tendon quality at 12 months of follow-up.

Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial.

HYPOTHESIS: We hypothesized that arthroscopic rotator cuff repairs using leukocyte- and platelet-rich fibrin (L-PRF) in a standardized, modified protocol is technically feasible and results in a higher vascularization response and watertight healing rate during early healing. METHODS: Twenty patients with chronic rotator cuff tears were randomly assigned to 2 treatment groups. In the test group (N = 10), L-PRF was added in between the tendon and the bone during arthroscopic rotator cuff repair. The second group served as control (N = 10). They received the same arthroscopic treatment without the use of L-PRF. We used a double-row tension band technique. Clinical examinations including subjective shoulder value, visual analog scale, Constant, and Simple Shoulder Test scores and measurement of the vascularization with power Doppler ultrasonography were made at 6 and 12 weeks. RESULTS: There have been no postoperative complications. At 6 and 12 weeks, there was no significant difference in the clinical scores between the test and the control groups. The mean vascularization index of the surgical tendon-to-bone insertions was always significantly higher in the L-PRF group than in the contralateral healthy shoulders at 6 and 12 weeks (P = .0001). Whereas the L-PRF group showed a higher vascularization compared with the control group at 6 weeks (P = .001), there was no difference after 12 weeks of follow-up (P = .889). Watertight healing was obtained in 89% of the repaired cuffs. DISCUSSION/CONCLUSIONS: Arthroscopic rotator cuff repair with the application of L-PRF is technically feasible and yields higher early vascularization. Increased vascularization may potentially predispose to an increased and earlier cellular response and an increased healing rate.

Percutaneous discectomy on lumbar radiculopathy related to disk herniation: why under CT guidance? An open study of 100 consecutive patients.

The primary objective of this study conducted on 100 patients is to demonstrate that performing CT-guided percutaneous discectomy for herniated disks results in a significant improvement in pain symptoms at several times (D1, D2, D7, 1 month, 3 months, 6 months). This objective assesses the effectiveness and feasibility of this technique under CT guidance in patients presenting documented lower back pain related to disk herniation that has not improved with appropriate medical treatment. The impact of various factors on the effectiveness of discectomy will also be evaluated. At 1 week, we notes a decrease in average VAS respectively of 71% and 67% in patients treated for posterolateral and foraminal herniated disks; the result for posteromedian herniated disks is only 45% in average decrease. At 6 months post op, 79% of lateralized herniated disks have a satisfactory result (≥ 70% decrease in pain as compared to initial pain), whereas post median herniated disks had a satisfactory result in only 50% of cases. Percutaneous fine needle discectomy probe under combined CT and fluoroscopic guidance is a minimally invasive spine surgery which should be considered as an alternative to surgery. This technique presents several advantages: the small diameter of the probe used (maximum 16 G or 1.5mm) allows a cutaneous incision of only a few millimeters, and a trans-canal approach can be possible; it also decreases the risk of ligamentary lesion and does not cause an osseous lesion of the posterior arc or of the adjacent muscular structures.

Dual guidance (CT and fluoroscopy) vertebroplasty: radiation dose to radiologists. How much and where?

OBJECTIVE: The goal of this study was to evaluate the radiation received by the practitioner when performing percutaneous vertebroplasty guided by CT and fluoroscopy for specific anatomical sites: orbits, hands, ankles, and thorax (under lead-lined apron). MATERIALS AND METHODS: Twenty-four vertebroplasties were performed on 18 patients. RESULTS: The anatomical site that was most exposed to radiation was the right hand (0.37 mSv on average). This study demonstrates a significant correlation between the irradiation dose and fluoroscopy duration, reflecting both the quantity of primary-beam radiation and backscattered radiation. The right hand (P = 0.03), left hand (P = 0.02), and the left orbit (P < 0.0001) are the anatomical zones that are the most affected by the combination of these two types of radiation, with cumulative irradiation doses of 0.45, 0.2, and 0.14 mSv, respectively. There was a significant correlation between the patient weight and radiation of the left hand (P = 0.03), the left orbit (P = 0.03), and the thorax (P = 0.02), confirming the major influence of backscattered radiation. CONCLUSIONS: The most irradiated anatomical sites limiting the number of interventions are the left orbit and the right hand.

Computed axial tomography-guided fixation of sacroiliac joint disruption: safety, outcomes, and results at 3-year follow-up.

Secondary to the progress in interventional imaging, new therapeutic options have been developed that decrease potential complications because they are minimally invasive and they decrease patient rehabilitation time. As a diagnostic modality, computed axial tomography (CAT) allows precise evaluation of the degree of sacroiliac reduction that must be performed. Moreover, the use of CAT enables easy positioning of screws across the sacroiliac joint, thus avoiding nerve and vascular damage. We report our clinical experience of 20 patients treated by CAT-guided percutaneous fixation for posttraumatic unilateral sacroiliac disruption, including evaluation of our technique, its safety, and patient outcomes and long-term results. All patients in this study had successful outcomes, which were judged according to how much pain they experienced and how quickly they resumed normal activity after the procedure. Twelve of 16 patients were able to return to work by postoperative month 2. One patient had degenerative sacroiliac joint syndrome (5%), which was confirmed 6 months after surgery by CAT scan. None of the patients showed radiologic or clinical evidence of instability of the sacroiliac joint or screw migration. Postoperative follow-up, performed at 1, 2, and 3 years in our rehabilitation department, showed stable results over time. All pain disappeared, without the need for medication, in 19 patients (95%).