Patient-reported outcomes of intra-articular hyaluronic acid for osteoarthritis of the knee: a prospective and multicentric case series.

BACKGROUND: In the present study, patients with symptomatic knee osteoarthritis (OA) were treated with single intra-articular injection of a high molecular weight, non-cross-linked hyaluronic acid (HA), highly concentrated (2%) and associated with sorbitol (4%). The aims of this study were to (1) evaluate clinical outcome after 6 months, (2) evaluate clinical outcomes after 12 months and (3) evaluate clinical outcomes according to OA grade. Hypothesis of the study was that a single intra-articular injection of this HA associated with sorbitol leads to a significant clinical improvement within 6 months in patients with early or moderate knee OA. MATERIALS AND METHODS: A total of 77 patients were enrolled in this prospective multicentric study. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was recorded at baseline and at months 1, 3, 6 and 12 following the intra-articular injection. Moreover, a stratified analysis of all WOMAC items following the OA grade was performed for both groups of patients, one with low (grade I-II according to Kellgren-Lawrence classification) and another with moderate OA grade (grade III according to Kellgren-Lawrence) and the differences between groups were evaluated. RESULTS: Seventy-three patients completed the 12 months follow-up. Pain, stiffness, functional limitation and total scores were significantly reduced at 1, 3 and 6 months (p < 0.05), but not at 12 months. Stratified analysis of all subscores according to OA grade showed that pain, functional limitation and total score decreased at 1, 3, 6 and 12 months (p < 0.05) in both groups. Stiffness was the only item that decreased significantly at 1, 3 and 6 months but not at 12 months in both groups. All subscore values were significantly lower in the group of patients with low OA grade compared to the one with moderate OA grade. No adverse events were reported. CONCLUSION: At 6 months after a single intra-articular injection of a high molecular weight, non-cross-linked HA associated with sorbitol, WOMAC scores decreased significantly. Clinical benefits were observed both in patients with low and in those with moderate OA grade, with better results in the first group.

Spinal hematoma after total knee arthroplasty: a case report.

Spinal anesthesia is a common procedure performed in orthopedic surgery, and it is regarded as secure and safe. Although puncture-related complication of spinal anesthesia has a very low incidence, it would lead to dramatic neurological damage (tetra- or paraplegia). Early diagnosis and surgical decompression are mandatory to promote a better outcome. We present a case of acute spinal hematoma from T11 to L3, triggered by laborious anesthesia puncture after total knee arthroplasty. A prompt surgical decompression within few hours after diagnosis allowed rapid functional recovery and avoided permanent paraplegia.

All-inside repair of meniscal bucket handle tears: a retrospective study at mean 4-years follow-up evaluation.

Bucket-handle tears represent approximately 10% of all meniscal tears. Despite the common treatment is subtotal meniscectomy, repair is technically feasible although complex, and represents a key strategy to avoid severe meniscal tissue loss that could accelerate joint degeneration over time. The aim of this retrospective study was to determine the outcomes of arthroscopically-assisted bucket-handle tear repair, and to identify factors correlating with clinical results. Fifty-four patients affected by meniscal bucket handle tear were included in the present retrospective analysis and evaluated up to mean 4-years follow-up. All patients were treated by arthroscopic-assisted all-inside repair. The primary outcome was considered the need for a re-operation due to failure of meniscal repair. Patients were also evaluated by the following items: KOOS, Lysholm, Tegner, IKDC-subjective and Quadruple-VAS score. Subgroup analysis was performed to identify whether concurrent ACL reconstruction, side of the lesion, age at surgery and time from injury to repair could influence clinical outcome. Ten out 54 patients (18.5%) were considered failed and needed reoperation, mainly within one year from surgery. Overall, there was a significant increase in all clinical scores considered and patients were able to get back to previous sport activity level. Patients with concurrent ACL reconstruction presented a lower risk of failure (p=0.025). Patients with lateral meniscus repair showed better clinical outcome compared to medial meniscus. Timing from injury and age at surgery did not correlated with clinical outcome. Our series showed fair results in bucket handle repair up to middle term evaluation. Concomitant ACL reconstruction was associated with lower failure rate whereas lateral meniscus involvement was associated with higher functional scores at final follow-up evaluation.

Autologous and micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis.

BACKGROUND: Chondral lesions of the knee represent a challenge for the orthopaedic surgeon. Several treatments have been proposed with variable success rate. Recently, new therapeutic approaches, such as the use of mesenchymal stem cells, have shown promising results. The adipose tissue is a good source of these naturally occurring regenerative cells, due to its abundance and easy access. In addition, it can be used to provide cushioning and filling of structural defects. The 1-year safety and outcome of a single intra-articular injection of autologous and micro-fragmented adipose tissue in 30 patients affected by diffuse degenerative chondral lesions was evaluated. METHODS: Micro-fragmented adipose tissue was obtained using a minimal manipulation technique in a closed system. The safety of the procedure was evaluated by recording type and incidence of any adverse event. The clinical outcomes were determined using the KOOS, IKDC-subjective, Tegner Lysholm Knee, and VAS pain scales taken pre-operatively and at 12 months follow-up. A level of at least 10 points of improvement in the scores has been selected as cut-off representing a clinically significant difference. RESULTS: No relevant complications nor clinical worsening were recorded. A total median improvement of 20 points has been observed in IKDC-subjective and total KOOS, and a higher percentage of success was found in VAS pain and Tegner Lysholm Knee, where the total median improvement was 24 and 31 points, respectively. CONCLUSION: The results of this study show the safety and feasibility of using autologous and micro-fragmented adipose tissue in patients affected by diffuse degenerative chondral lesions. The technique is safe, minimally invasive, simple, one-step, with low percentage of complications, and compliant with the regulatory panorama.

A novel technique for combined medial collateral ligament and posterior oblique ligament reconstruction: technical note.

PURPOSE: In the last year, we have performed a new technique for combined medial collateral ligament (MCL) and posterior oblique ligament (POL) reconstruction in chronic setting of anterior cruciate ligament and MCL complex deficiency. Autogenous semitendinosus tendon with the tibial attachment preserved has been used for the medial/posteromedial compartment reconstruction. We describe the operative technique. METHODS: Between January and December 2014, 12 consecutive patients with multiligamentous injuries underwent concomitant MCL/POL using a novel technique. The usefulness of the novel technique is the semitendinosus sling on the semimembranosus tendon and the POL fixation with the knee in full extension. RESULTS: An ideal anteroposterior and rotational stability avoiding the medial compartment over constraint was achieved, in the immediate after surgery, due to the sequence of the bundle fixations and to the semitendinosus sling below the semimembranosus tendon. CONCLUSIONS: This technique is easily reproducible and useful and restores the medial stability immediately after surgery.

Angiomyofibroblastoma and aggressive angiomyxoma: two benign mesenchymal neoplasms of the female genital tract. An immunohistochemical study.

We describe a rare case of angiomyofibroblastoma (AMF) of the vulva and one case of aggressive angiomyxoma (AAM) of the pelvic region and, with the help of an extensive revision of the literature, we attempt to define their histogenesis and peculiar biological behaviour by an immunohistological evaluation. Our results indicate that AAM, which is characterized by the presence of a high content of glycosaminoglycans in the stroma, expresses uniformly vimentin and hyaluronate receptor CD44, and heterogeneously muscle specific actin (MSA) and desmin, while AMF displays a positive reaction for vimentin, desmin and laminin, and only a weak and heterogeneous positivity for CD44. Both AMF and AAM showed no immunohistochemical reactivity for alpha-smooth muscle actin (ASMA), myoglobin, cytokeratin, collagen type IV, CD68 and S-100. The stromal cells of AAM were negative for laminin. These findings support the suggestion of an origin of the two entities by a common myofibroblastic progenitor, which normally occurs in the lower female genital tract and subsequently undergoes a neoplastic transformation. The expression of CD44 by AAM, which has never been reported before, could be responsible for its more aggressive behaviour, because this receptor is able to mediate migration of neoplastic cells on a hyaluronate rich extracellular matrix. It is speculated that the neoplastic cell of the AAM and AMF of the vulva is a specific myofibroblast which probably arises from undifferentiated mesenchymal cells normally occurring in the lower female genital tract.

Plasmacytoma of the thyroid gland.

Solitary plasmacytoma of the thyroid is very rare. Thus far, only 12 cases have been reported in literature. This report describes the clinical and histological features of two additional cases. One patient developed bone metastases 1 month after diagnosis and died 17 months later. The second patient is alive with no evidence of disease, 19 months after diagnosis. At the present time there are insufficient data to assess the prognosis in any single case.

Acute intracranial hypertension syndrome due to ketamine in a patient with delayed radionecrosis simulating an expansive process.

Reported is the case of a delayed cerebral necrosis in a patient with an eosinophil pituitary adenoma who had undergone radiation therapy. Neuroradiological tests were performed in order to verify the possible existence of a lateral sellar extension of the neoplasm. The administration of ketamine before this examination, presumably caused the onset of an acute temporal syndrome. Surgery was performed without delay, and a delayed cerebral necrosis of the right temporal lobe was found.