Stromal Vascular Fraction for Knee Osteoarthritis - An Update.

Orthobiologics never cease to cause popularity within the medical science field, distinctly in regenerative medicine. Recently, adipose tissue has been an object of interest for many researchers and medical experts due to the fact that it represents a novel and potential cell source for tissue engineering and regenerative medicine purposes. Stromal vascular fraction (SVF), for instance, which is an adipose tissue-derivative, has generated optimistic results in many scenarios. Its biological potential can be harnessed and administered into injured tissues, particularly areas in which standard healing is disrupted. This is a typical feature of osteoarthritis (OA), a common degenerative joint disease which is outlined by persistent inflammation and destruction of surrounding tissues. SVF is known to carry a large amount of stem and progenitor cells, which are able to perform self-renewal, differentiation, and proliferation. Furthermore, they also secrete several cytokines and several growth factors, effectively sustaining immune modulatory effects and halting the escalated pro-inflammatory status of OA. Although SVF has shown interesting results throughout the medical community, additional research is still highly desirable in order to further elucidate its potential regarding musculoskeletal disorders, especially OA.

Orthobiologics in the treatment of hip disorders.

Orthobiologics are biological materials that are intended for the regeneration or healing of bone, cartilage and soft tissues. In this review we discuss the use of orthobiologics for hip disorders providing an update. The orthobiologics included in this article are hyaluronic acid, platelet rich plasma, bone marrow, adipose tissue and expanded mesenchymal stem cells. We explain the concepts and definitions of each orthobiological product, and the literature regarding its use in the hip joint. The paucity of guidelines for the production and characterization of the biological products leads to uneven results across the literature. Each biologic therapy has indications and benefits; however, noteworthy are the characterization of the orthobiologics, the application method and outcome analysis for further improvement of each technique.

Bone marrow aspirate clot: A feasible orthobiologic.

Musculoskeletal disorders are one of the major health burdens and a leading source of disability worldwide, affecting both juvenile and elderly populations either as a consequence of ageing or extrinsic factors such as physical injuries. This condition often involves a group of locomotor structures such as the bones, joints and muscles and may therefore cause significant economic and emotional impact. Some pharmacological and non-pharmacological treatments have been considered as potential solutions, however, these alternatives have provided quite limited efficacy due to the short-term effect on pain management and inability to restore damaged tissue. The emergence of novel therapeutic alternatives such as the application of orthobiologics, particularly bone marrow aspirate (BMA) clot, have bestowed medical experts with considerable optimism as evidenced by the significant results found in numerous studies addressed in this manuscript. Although other products have been proposed for the treatment of musculoskeletal injuries, the peculiar interest in BMA, fibrin clot and associated fibrinolytic mechanisms continues to expand. BMA is a rich source of various cellular and molecular components which have demonstrated positive effects on tissue regeneration in many in vitro and in vivo models of musculoskeletal injuries. In addition to being able to undergo self-renewal and differentiation, the hematopoietic and mesenchymal stem cells present in this orthobiologic elicit key immunomodulatory and paracrine roles in inflammatory responses in tissue injury and drive the coagulation cascade towards tissue repair via different mechanisms. Although promising, these complex regenerative mechanisms have not yet been fully elucidated.

Complicações ortopédicas na síndrome de Klippel-Trenaunay / Orthopedic complications in Klippel-Trenaunay syndrom

Introdução: A Síndrome de Klippel-Trenaunay é uma afecção congênita da mesoderme, infrequente, a qual se caracteriza por uma tríade composta por hemangiomas cutâneos, veias varicosas e hipertrofia dos tecidos ósseos e/ou das partes moles; quando combinada com fístulas arteriovenosas passa a ser denominada Klippel-Trenaunay-Weber-Parkes. Relato de caso: Os autores apresentaram um paciente portador da síndrome de Klippel-Trenaunay associada à deformidade angular de joelho, geno valgo, e gonartrose. Discussão: Em virtude da necessidade do diagnóstico precoce dessa afecção, com a finalidade de prevenção de sequelas,foram apresentados os resultados dos exames imagem para avaliação pré-operatória e a metodologia terapêutica adotada. O tratamento consistiu da realização de osteotomia supracondiliana do fêmur, com cunha medial de subtração.

Introduction: The Klippel-Trenaunay syndrome is a mesoderm congenital disorder, infrequent, which is characterized by a triad of cutaneous hemangiomas, varicose veins, bone and soft tissues hypertrophy; when associated with arteriovenous fistulas it is called Klippel-Trenaunay-Weber-Parkes. Case report: The authors presented a case report of a patient with Klippel-Trenaunay syndrome associated to angular deform. The authors presente a case report of a patient with Klippel-Trenaunay syndrome associated to angular deformity of the knee, genu valgus and knee arthritis. Discussion: In view of the need for early diagnosis of this condition, in order to prevent sequelae, are presented the results of the image exams to preoperative evaluation and the methodology adopted therapy. The treatment consisted of supracondylar osteotomy. The treatment consisted of the succed of femur supracondylar osteotomy with medial wedge subtraction.