Stem cells for the treatment of early to moderate osteoarthritis of the knee: a systematic review.

PURPOSE: Mesenchymal stem cells (MSCs) present a valuable treatment option for knee osteoarthritis with promising results. The purpose of the present study was to systematically review the clinical and functional outcomes following mesenchymal stem cell application focusing on early to moderate knee osteoarthritis. METHODS: A systematic search was done using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in Pubmed, Scopus, Web of Science, and Cochrane Library databases. All Studies published between 2017 and March 2023 on patients treated with single mesenchymal stem cell injection for Kellgren-Lawrence grade I-III knee osteoarthritis reported on clinical and functional outcomes were included. RESULTS: Twelve articles comprising 539 patients and 576 knees treated with a single intraarticular injection of MSCs for knee osteoarthritis were included in the current systematic review. In eligible studies, the reported outcomes were improved concerning patient-reported outcomes measures, knee function, pain relief, and quality of patient's life. CONCLUSION: Based on high-level evidence studies, single intraarticular injection of MSCs is a safe, reliable, and effective treatment option for Kellgren-Lawrence grade I-III knee osteoarthritis. However, the lack of homogeneity in the included studies and the variance in MSCs sources and preparations should be noted. LEVEL OF EVIDENCE: III.

Arthroscopic Removal of a Free-Floating Bullet From the Hip Joint.

Gunshot injuries and bullet removal are extremely rare indications for hip arthroscopy. We present the case of a 22-year-old male with a free-floating bullet in the hip joint after a gunshot injury. A thorough imaging investigation was used to demonstrate the exact location of the foreign body. The bullet was removed by arthroscopic means under fluoroscopic guidance. The patient has been symptom-free for two years postoperatively. The tips and tricks of the technique are discussed. Hip arthroscopy is a minimally invasive technique to remove a free-floating bullet and avoid potential long-term complications like chondral injury and lead intoxication.

A Rare Case of Quadratus Femoris Muscle Rupture After Yoga Exercises.

We present a case of a female patient with left groin pain after intense yoga exercises. The patient presented abnormal pattern of gait with no swelling over the groin, thigh, or buttock. Magnetic resonance imaging demonstrated a tear of the quadratus femoris muscle with an associated extensive hematoma formation. Patient was treated with a rehabilitation program consisting of nonsteroidal anti-inflammatory drugs and physiotherapy. At the follow-up control, the patient had improved her pain and flexibility of the hip, and gradually she returned to daily activities and yoga exercises. Such an entity is a rare cause of hip pain after exercise and should be kept in mind by the orthopedic surgeon, in cases of gluteal pain after intense physical activity. Moreover, such a condition should be included in the diagnostic algorithm of unknown origin hip pain.

Cyst-like lesion of the acetabular roof - an abnormal finding or an anatomical variant?

Cyst-like lesions are frequently found in the area of the acetabulum on MRI scans. However, their presence is not always abnormal. We report four patients with such lesions found on MRI where, during hip arthroscopy, an area resembling a horseshoe-like extension of the cotyloid fossa was found. Clinicians must be aware that not all cystic acetabular lesions are pathological and may simply represent a normal anatomical or developmental variant of the hip joint. They do not always represent an indication for hip arthroscopic surgery.

The supratrochlear foramen of the humerus and its relation to the medullary canal: a potential surgical application.

BACKGROUND: The supratrochlear foramen of the humerus is located at the septum separating the coronoid from the olecranon fossa. Beyond its anthropologic interest, that trait seems to have clinical significance as well. MATERIAL/METHODS: The supratrochlear foramen was studied in 240 macerated adult humeri. The foramen was recorded in each sex and each side. We attempted to enlighten the likely relation of the foramen with the inferior edge of the medullary canal, as well as that of the dimensions of that canal of humerus and compare it to contralateral humeri without foramen. RESULTS: The medullary canal width at the entry point of a retrograde intramedullary nail was statistically smaller in humeri with foramen than in humeri without it. Furthermore, the medullary canal of the humeri with foramen ends more proximally than the canal of nonforamen humeri. CONCLUSIONS: In cases of humeral fractures of the supratrochlear foramen, the surgeon must keep in mind that it is better to perform an antegrade medullary nailing than a retrograde one; as there is higher chance of a secondary fracture, due to the extreme narrowness of the canal at the distal portion of humeri with the supratrochlear foramen.

Arthroscopic repair of acetabular chondral delamination with fibrin adhesive.

Acetabular chondral delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but disrupted from the subchondral bone. Excision of chondral flaps is the usual procedure for this type of lesion. However, we report 19 consecutive patients in whom the delaminated chondral flap was re-attached to the underlying subchondral bone with fibrin adhesive. We used the modified Harris hip score for assessment of pain and function. Improvement in pain and function was found to be statistically significant six months and one year after surgery. No local or general complications were noted. Three patients underwent further surgery for unrelated reasons. In each, the area of fibrin repair appeared intact and secure. Our results suggest that fibrin is a safe agent to use for acetabular chondral delamination.

Supracondylar process of the humerus: a rare case with compression of the ulnar nerve.

A patient presented with a 6-month history of numbness and pain in the left forearm and hand over the ulnar nerve distribution. Radiographs showed a supracondylar process, which was excised. The ulnar nerve had been compressed. The patient was symptom-free two months postoperatively.

Lumbosacral transitional vertebra causing Bertolotti's syndrome: a case report and review of the literature.

INTRODUCTION: Lumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium. The association of that variant with low back pain and the change in the biomechanical properties of the lumbar spine is called Bertolotti's syndrome. CASE PRESENTATION: We report a case of a 40-year-old male patient with chronic low back pain extending to the left buttock, just above the ipsilateral sacroiliac joint. Radiographic investigation revealed an anomalous enlargement of the left transverse process of the fifth lumbar vertebra forming a pseudarthrosis with the infrajacent ala of the sacrum. CONCLUSION: In young patients with back pain the possibility of Bertolotti's syndrome should always be taken in account.

Arthroscopic treatment of femoroacetabular impingement.

Femoroacetabular impingement is a recently recognized pathological entity. Arthroscopic treatment, as a modern and minimally invasive technique, has become an attractive and promising treatment.

Metastasis of bronchogenic carcinoma to the 5th metacarpal bone: a case report.

BACKGROUND: Metastatic lesions to the hand are very rare and represent 0.1% of all osseous metastases. CASE PRESENTATION: We present a patient with metastasis of bronchogenic carcinoma of the lung to the 5th metacarpal to draw the attention for the potential of such lesions to be developed in this region. Due to the extensive metastasis to the hand the patient was referred to the oncologists. CONCLUSION: The surgeon should be cautious regarding the differential diagnosis, the usual poor prognosis of such patients and the questionable need for reconstructive surgery.

Anatomical variation of co-existence of 4th and 5th short metacarpal bones, sesamoid ossicles and exostoses of ulna and radius in the same hand: a case report.

INTRODUCTION: The anatomical variations of bones in the hand are common. The existence of exostosis and shortening of metacarpal bones has been described in the literature as part of the hereditary multiple exostosis syndrome but no case has been reported with the co-existence of sesamoid ossicles in the same patient. CASE PRESENTATION: We report a case with co-existence of distal ulnar and radial exostoses, 4th and 5th short metacarpals and sesamoid ossicles in the wrist area. CONCLUSION: This variation may help the interpretation of pain or sensory disorders in the hand and wrist areas.

Left common carotid artery arising from the brachiocephalic trunk: a case report.

An abnormal origin of the left common carotid artery from the initial portion of the brachiocephalic trunk was found in the superior mediastinum in a 81-year-old Caucasian male cadaver during dissection practice. We report on the exact morphology of that variant that is appeared in an incidence of 0,2% in the literature. We discuss the relative literature and pay attention on the significance of such a variation for clinicians in its recognition and protection.

Morphological parameters of the superior articular facets of the atlas and potential clinical significance.

BACKGROUND: Although remarkable investigations exist in regard to the morphology of the superior articular facets of the atlas in the literature, only a few data exist concerning the correlation of these facets with the age of the specimens. METHODS: The superior articular facets of the atlas were studied in 86 dried vertebrae. Several non-metric parameters were recorded, like presence of notches, grooves, complete or partial dissociation, rough surfaces as well as their morphology. RESULTS: No notch was found in 37.2% of the superior articular facets. The incidence of notch is decreased as the age progresses. No transverse groove was found in 24.4% and the presence is increased with the age. The incidence of complete and partial dissociations was also found to be age-related. The incidence of rough surfaces, which corresponds to the site of maximum weight bear, was found to be increased in the old age. We classified the shape of the facets into the following types: oval-shaped, kidney-shaped, S-like, triangle, circular and two portioned. CONCLUSIONS: We assume that the increase of incidence of the dissociation, the rough surfaces, the grooves and the decrease of notches could be possibly the result of a restriction of the atlanto-occipital motion in the old age.

Kaplan anastomosis of the ulnar nerve: a case report.

INTRODUCTION: The sensory innervation of the hand is usually unvarying and anomalies in this area are uncommon. CASE PRESENTATION: We report the case of a rare ulnar nerve branch called a Kaplan anastomosis, which anastomosed the dorsal cutaneous branch with the ulnar nerve prior to its bifurcation into the superficial and deep ramus. CONCLUSION: Many authors have reported unusual ulnar nerve branches and knowledge of these anatomical variations is important for the interpretation of pain and sensory loss in the area sustained during injuries or surgical procedures. Our finding is the fourth case of a Kaplan anastomosis to be described in the literature.