[Treatment of the Shoulder Impingement Syndrome with PRP Injection]. / Lécba impingement syndromu ramena pomocí injekce PRP.

PURPOSE OF THE STUDY This study aimed to explore the effects of new therapeutic procedures in patients with shoulder impingement syndrome. The primary goal of the study was to confirm the hypothesis that the application of the platelet-rich plasma (PRP) in patients with shoulder impingement syndrome will have a positive effect on both the subjective and objective evaluation of their condition. The clinical condition before and after the treatment was evaluated. The secondary goal was to compare the effect achieved by a series of 3 PRP injections and that achieved by treating the impingement syndrome with a standard single depot corticosteroid injection. MATERIAL AND METHODS The randomized prospective blinded study carried out in the period 2013-2015 included 25 patients (Group I), to whom 3 PRP injections were applied in the subacromial (SA) space at a 1-week interval at the outpatient department. The control group of 25 patients (Group II) was treated by a standard single depot corticosteroid injection applied in the SA space. The subjective and objective conditions were evaluated immediately before the treatment, at 6 weeks, 3 months and 6 months after the administration of the injection. The evaluation comprised a physical examination, an evaluation using the Visual Analogue Scale (VAS), ASES (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form) and the Constant score. A part of the study was the statistical processing of the results. RESULTS Both the groups were comparable when assessing the mean age of patients as well as the share of both sexes in the groups; Group I with the mean age of 48.7 years (15 men and 10 women), Group II with the mean age of 50.1 years (16 men and 9 women), but also when assessing the baseline mean VAS score, Constant score and ASES score. In Group I, the baseline mean VAS score improved from 2.96 (range: 1-5; median: 3.0; SD: 0.77) to 2.0 (range: 1-3; median: 2.0; SD: 0.49) at 3 months after the administration and to the mean value of 1.16 (range: 0-2; median: 1.0; SO: 0.67) at 6 months after the last PRP injection. In Group II, the baseline mean VAS score improved from 3.12 (range: 2-5; median: 3.0; SD: 0.82) to the mean value of 2.16 (range: 1-4; median: 2.0; SD: 0.73) at 3 months after the administration of the depot corticosteroid injection and to 1.8 (range: 1-3; median: 2.0; SD: 0.57) at 6 months after the administration. In both the groups of patients, the p-value obtained by the Student s t-test was statistically significant (p < 0.05) when comparing the results of all the three scoring systems before the treatment and 6 months after the treatment. DISCUSSION Although the treatment of musculoskeletal disorders with the concentrate of a platelet-rich plasma (PRP) is a frequently used method, particularly in private medical practice, the scientific literature can offer just a very few studies studying in depth the use of this method of treatment in humane medicine. CONCLUSIONS Based on the results of our study, the hypothesis can be accepted that the concentrate of platelet-rich plasma administered through a series of 3 injections applied in the subacromial space in patients with shoulder impingement syndrome has positive effects on the daily activities of patients as well as on the objective evaluation via the selected scoring systems. Key words:platelet-rich plasma, shoulder impingement syndrome.

In vivo knee rotational stability 2 years after double-bundle and anatomic single-bundle ACL reconstruction.

PURPOSE: The objective of this study was to evaluate knee rotational stability at least 2 years after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction (SB) and double-bundle ACL reconstruction (DB) in comparison with the contralateral healthy knee joint. The Cincinnati, Lysholm and IKDC scores were analysed too. METHODS: There were 40 patients in both groups, the mean follow-up was 27 months. For all measurements, the navigation system OrthoPilot was used. Measurement started with the patient in the standing position in neutral rotation. Then, the patient achieved in 30° knee flexion under weight-bearing maximal external trunk rotation and returned to the neutral position. The same measurement was done for the internal trunk rotation. For the anterior-posterior stability, KT-1000 arthrometer was used. All measurements were repeated three times for each knee joint. RESULTS: After the DB reconstruction, the mean external rotation of the tibia (ER) was 8.2° and the internal rotation (IR) was 10.2°. In the contralateral healthy knee joint, ER was 8.5° (p = 0.597) and IR was 12.1° (p = 0.064). After the SB reconstruction, ER was 9.4° and IR was 13.1°. In the contralateral healthy knee joint, ER was 7.7° (p = 0.066) and IR was 9.8° (p = 0.005). Anterior-posterior translation was to the same extent for both groups. CONCLUSIONS: The DB reconstruction of the ACL restores the rotational stability of the knee joint without any significant difference in comparison to the contralateral healthy knee (p > 0.05). The main finding of this study is that the internal rotational stability of the knee joint after the anatomic SB technique is not sufficient.

[The effect of platelet-rich plasma on graft healing in reconstruction of the anterior cruciate ligament of the knee joint: prospective study]. / Vliv plazmy bohaté na trombocyty (PRP) na hojení stepu pri rekonstrukci LCA kolenního kloubu - prospektivní studie.

PURPOSE OF THE STUDY Growth factors produced by platelets enhance tissue healing. The aim of this study was to confirm or disprove the hypothesis that, in anterior cruciate ligament (ACL) reconstruction, the application of platelet-rich plasma (PRP) into the tibial and femoral tunnels and in the graft enhances graft maturation and graft-bone interface healing and thus improves knee function at 3 and 12 months post-operatively in comparison with the control group. MATERIAL AND METHODS A total of 40 patient had the surgery; 20 underwent single-bundle hamstring reconstruction with PRP application (PRP group) and 20 had the same surgery without PRP addition (control group). A 5 ml amount of PRP was obtained from the patient's peripheral blood. A graft inserted in the bone tunnels was fixed with interference screws and, after intra-articular fluid aspiration, 1 ml of PRP was injected into each tunnel and 3 ml were evenly applied to the intra-articular portion of the graft. The patients were examined by MRI at 3 and 12 months after surgery. The subsidence of swelling in the tunnelsurrounding tissues was taken as a sign of graft-bone interface healing, and increased signal intensity of the graft was considered as a result of its ligamentisation. The knee functional status was evaluated at 3 and 12 post-operative months, using the scoring systems (Cincinnati score, IKDC score). RESULTS Bone swelling was found at 3 post-operative months in 18 of 20 patients in both the PRP and the control group. Graft signal intensity was increased in most patients (19 of the PRP group; 18 control patients; p = 0.949). The Cincinnati score at 3 months had an average value of 72.7 (34-100; SO, 18.7) in the PRP group and 73.4 (42-99; SO, 16.3) in the control group (p = 0.793). The functional score after 12 months improved to 97.5 (75-100; SO, 12.8) in the PRP group and to 95.1 (66-100; SO, 13.1) in the control group; there was no significant difference between the groups (p = 0.885) at either 3 or 12 months. The IKDC score showed similar results. At 12 months bone swelling was recorded in seven out of 20 patients in the PRP group and in nine patients in the control group (p = 0.751). Graft signal intensity was increased in three and four patients of the PRP and control groups, respectively (p = 0.681). There was a statistical difference between the findings at 3 and 12 months within each group, but no difference between the groups. DISCUSSION In ACL reconstruction, the process of tendon graft-to-bone healing has several stages involving inflammation, cell proliferation and graft ligamentisation. At each stage, an important role is played by growth factors produced by thrombocytes, and therefore their potential use in the treatment of injuries to ligaments and tendons has recently come into focus. A number of experimental studies dealing with the effect of platelet-rich plasma on soft tissue healing has been published. Therefore, the method of using PRP to enhance graft healing in ACL reconstruction in humans is still being studied. CONSLUSIONS The use of PRP in ACL reconstruction does not accelerate graft remodelling and bone ingrowth into the tendon. The function scoring results showed a statistically significant improvement in knee function between 3 and 12 months of followup within each group studied but revealed no difference between the groups. The hypothesis postulated above was disproved. Key words: anterior cruciate ligament, platelet-rich plasma, anatomic single-bundle reconstruction.

[The effect of central anatomical single-bundle versus anatomical double-bundle reconstruction of the anterior cruciate ligament on knee stability. a clinical study]. / Vliv centrální anatomické jednosvazkové a anatomické dvojsvazkové rekonstrukce predního zkrízeného vazu na stabilitu kolenního kloubu. Klinická studie.

PURPOSE OF THE STUDY A comparison of the efficacy of central anatomical single-bundle (CASB) reconstruction with that of double-bundle (DB) repair of the anterior cruciate ligament (ACL) in relation to knee stability in anteroposterior translation (APT), internal rotation (IR) and external rotation (ER) of the joint. MATERIAL AND METHODS A total of 40 patients were evaluated; 20 had ACL reconstruction by the CASB technique using hamstrings and 20 underwent DB repair surgery. The average age was 31.3 years, and the group included 22 men and 18 women with 19 right and 21 left knees. The KT-1000 test was used to assess the amount of APT in the knee and rotational deviations were measured by the Rolimeter. In the DB patients, measurements were performed before surgery (on joints with ACL injury), then after reconstruction of the anteromedial (AM) or the posterolateral (PL) bundle and subsequently after repair of both ACL bundles. The CASB patients were assessed before and after graft insertion. RESULTS The average APT value was 18.5 mm for the pre-operative knees and it fell to 8.9 mm after AM bundle reconstruction. However, when the PL bundle was inserted in the first place, the average APT value was 13.1 mm only. The average values recorded after the DB and CASB reconstructions were 6.1 mm and 9.1 mm, respectively. The average IR range of motion in the pre-operative joints was 18.6 degrees. After AM bundle reconstruction it was 13.9 degrees and after PL bundle repair it was 15.3 degrees. In DB reconstruction the average IR value achieved 10.4 degrees, and in CASB repair surgery it was 13.7 degrees. The average ER range of motion in the pre-operative joints was 17.8 degrees. After AM bundle reconstruction it was 14.5 degrees and after PL bundle repair it was 14.9 degrees. In DB reconstruction the average ER value achieved 11.4 degrees, and in CASB repair surgery it was 14.5 degrees. DISCUSSION Rotational stability of the knee after ACL reconstruction is one of the most important factors in restoring physiological kinematics of the joint after ACL injury. Since there are not many studies comparing knee rotational stability after CASB with that after DB reconstructions, the results presented here may contribute to selecting the optimal method of ACL reconstruction. CONCLUSIONS The results show that, in ACL reconstruction, the DB technique provides better stability to the knee, in both APT and rotation, than the CASB method. The latter has the same effect on knee stability as the presence of the AM bundle alone. When the PL bundle is added, knee stability, in both APT and internal/external rotation, is increased in comparison with central single-bundle ACL repair. Key words:anterior cruciate ligament, navigation, central anatomical single-bundle reconstruction, double-bundle reconstruction.

[Tangent sign - a reliable predictor of risk for tendon re-rupture in rotator cuff repair]. / Tangent sign - spolehlivý prediktor rizika reruptury pri rekonstrukci slach svalu rotátorové manzety.

PURPOSE OF THE STUDY: Repair techniques for rotator cuff injury are currently well advanced. However, the risk of re-rupture, particularly when severe damage to the tendons has been repaired, is still high. The causes of failure can be due to the extent of injury, a repair done on a highly degenerated tendon with diminished viability or ischaemic damage to the tendon tissue resulting from suture material. The aim of the study was to ascertain the reliability of the tangent sign, a commonly used indicator of the degree of suprasupinatus muscle atrophy, in the prediction of risk for tendon re-rupture in the post-operative period. MATERIAL AND METHODS: In 2011 the rotator cuff torn tendons were repaired by the method of double-row suture in 37 patients. The surgery was done by an open technique using the deltoid-splitting approach. A pre-operative magnetic resonance image (MRI) of the shoulder was obtained in all patients and each was assessed by a competent independent radiology specialist with a focus on the extent of a tendon lesion and the tangent sign. At 2-year follow-up, the results of repeated MRI were evaluated in view of the state of repaired tendons and, if a re-tear was found, its relation to the original suture and its extent in the sagittal plane were determined. The pre- and post-operative MRI findings were compared to find out how the presence or absence of a tangent sign before surgery relates to the incidence of supraspinatus tendon re-rupture at 2 years after surgery. The results were statistically analysed using Student's t-test and the Chi-square test. RESULTS: Of the 37 shoulders, in the pre-operative period, a tangent sign was identified in 21 (56.8%). The average size of a rotator cuff tear was 29.3 mm for the whole group. For the shoulders with no tangent sign, the average value was 21.8 mm, for those with a tangent sign present, it was 39.6 mm. At 2-year follow-up, no tear was found in the patients in whom preoperative MRI showed no tangent sign while re-tears were recorded in 18 of 21 shoulders (85.7%) with a tangent sign present before surgery. On the average, the re-rupture had 40.8 mm in size and, in all cases, it occurred at the site of tendon re-insertion into the greater tubercle. These results were statistically significant (p < 0.01). DISCUSSION: In repair of injury to the tendons of the rotator cuff muscles, emphasis is currently placed on a thorough pre-operative examination. MRI is an important part of the diagnostic procedure because it provides a detailed image of the muscle as a whole. Although great advances have recently been made in both the diagnostic and surgical techniques, the incidence of tendon re-rupture within a few years of the procedure is still high. CONCLUSION: Our results show that the presence of a tangent sign detected by pre-operative MRI examination of the shoulder can be an important predictor of failure in rotator cuff repair and can also turn attention to the selection of an alternative technique to be used.

Ethanol- and acetonitrile-induced inhibition of water diffusional permeability across bovine red blood cell membrane.

The effect of 0-3% (v/v) ethanol and acetonitrile on water diffusional permeability of bovine and chicken red blood cells (RBCs) was studied using a pulse 1H-T2 NMR technique. Transmembrane water diffusional exchange times, tau exch, of 9.2 +/- 0.46 ms and 18.3 +/- 1.0 ms were determined for bovine and chicken erythrocytes at 27.5 degrees C, respectively. Arrhenius activation energies Ea of water diffusion were 20.4 and 35.8 kJ mol-1. Ethanol, and acetonitrile being 2-fold more effective, markedly increased both tau exch and Ea in bovine RBC as compared to the well-known mercurial inhibitor of water channels, p-chloromercuribenzene sulfonate. Chicken RBCs that have no protein water channels, were found to be completely insensitive for either agent. It was suggested that ethanol and acetonitrile partitioning into the lipid phase of bovine RBC membrane affects the permeability of CHIP28 water channel but not the lipid confined water diffusion. The results suggest that the inhibition of transmembrane movement of water via CHIP28 channels might be involved in the anti-hemolytic action of anaesthetics such as ethanol.

2-O-methyl-D-mannose residues are immunodominant in extracellular polysaccharides of Mucor racemosus and related molds.

In this study, the structure of the immunodominant carbohydrate epitope of the extracellular polysaccharides from mold species belonging to the order Mucorales reactive with rabbit IgG antibodies was elucidated. An exo-alpha-D-mannanase which was able to abolish the antigenicity of these polysaccharides completely was purified and characterized, and the activity was compared with that of an alpha-D-mannosidase. Analysis of the monomeric reaction products after enzymatic treatment revealed the presence of 2-O-methyl-D-mannose residues. This compound is a constituent of the polysaccharides from the mold genera Mucor, Rhizopus, Rhizomucor, Absidia, Syncephalastrum, and Thamnidium, and its occurrence in fungi has not been reported until now. Two mannan fractions which are highly reactive with rabbit IgG were isolated from the extracellular polysaccharides of Mucor racemosus and characterized with ethylation analysis. The role of the newly found 2-O-methyl-D-mannose residues in the immunoreactivity was assessed by specific degradation of these mannans with the exo-alpha-D-mannanase and subsequent ethylation analysis. It was concluded that the immunodominant carbohydrates reactive with rabbit IgG are chains composed of a single terminal non-reducing 2-O-methyl-D-mannose residue, alpha (1-2)-linked to a short sequence of alpha(1-2)-linked D-mannose residues.

Detection of fungal carbohydrate antigens by high-performance immunoaffinity chromatography using a protein A column with covalently linked immunoglobulin G.

Fungal carbohydrate antigens were analysed by high-performance immunoaffinity chromatography (HPIAC) with immunoglobulin G (IgG) antibodies raised against extracellular polysaccharides of Mucor racemosus. The protein A-IgG complex was covalently bound with dimethyl pimelimidate, which enabled the use of strong acidic buffers to release the tightly bound antigens from the column. Prior to pulsed-amperometric detection, an anion-micromembrane suppressor was used to raise the pH of the effluent to above 12 without dilution. The HPIAC system provides a sophisticated method for the rapid and sensitive detection of antigenic oligomeric carbohydrates in biological samples and is proposed as an alternative to quantitative enzyme-linked immunosorbent assay techniques.

Metabolism of arachidonic acid by human epidermal cells depends upon maturational stage.

Synthesis of 12- and/or 15-HETE by human epidermal cells was investigated after separating basal cells from suprabasal epidermal cell layers. We found that the main metabolite of 3H-arachidonic acid (3H-AA), formed by freshly prepared upper epidermal layers (stratum granulosum and spinosum), upon RP-HPLC co-eluted with authentic 3H-12-HETE. A 3H-15-HETE co-eluting peak selectively occurred in chromatograms obtained from supernatants of fractions containing basal cells. Supernatants of freshly prepared suspensions rich in basal keratinocytes appeared to contain 3H-15-HETE as their main 3H-AA metabolite, by far exceeding the recovered amounts of 3H-12-HETE. Moreover, keratinocytes cultured for 1 week or longer were found to produce predominantly a 3H-AA metabolite co-eluting with 3H-15-HETE. In supernatants of cultured cells, little if any 3H-12-HETE was detectable. Cultured human skin fibroblasts were not found to produce relevant amounts of HETE. Genuine tissue rich in basal cells, i.e., cells of hair follicles, were found to form twice as much 3H-15-HETE as 3H-12-HETE (3H-15-HETE/3H-12-HETE-ratio = 1.9 +/- 0.8; n = 7). Apparently, different epidermal layers are able to produce a characteristic pattern of 3H-AA metabolites. 3H-15-HETE generation seems to be a marker for proliferating keratinocytes, whereas 3H-12-HETE formation appears to be typical for differentiating suprabasal epidermal cells. Our results may explain the heretofore varying patterns of AA-metabolites by keratinocytes reported in the literature.