One-stage cartilage repair using the autologous matrix-induced chondrogenesis combined with simultaneous use of autologous adipose tissue graft and adipose tissue mesenchymal cells technique: clinical results and magnetic resonance imaging evaluation at five-year follow-up.

PURPOSE: To evaluate medium-term outcomes of knee cartilage defects repair by autologous matrix-induced chondrogenesis combined with simultaneous use of autologous adipose tissue graft and adipose tissue mesenchymal cells, defined as LIPO-AMIC technique. METHODS: The LIPO-AMIC technique has been used in ICRS degree III-IV knee defects. Eighteen patients have been prospectively evaluated during two and five years both clinically and by MRI. RESULTS: Patients showed progressive significant improvement of all scores starting early at six months, and further increased values were noted till the last follow-up at 60 months. Mean subjective pre-operative IKDC score of 36.1 significantly increased to 86.4 at 24 months and to 87.2 at 60 months. Mean pre-operative Lysholm score of 44.4 reached 93.5 at two years and 93.5 at five years. MRI examination showed early subchondral lamina regrowth and progressive maturation of repair tissue and filling of defects. The mean total MOCART score showed that a significative improvement from two year follow-up (69.1 points) to last follow-up was 81.9 points (range, 30-100 points, SD 24). Complete filling of the defect at the level of the surrounding cartilage was found in 77.8%. CONCLUSIONS: Adipose tissue can represent ideal source of MSCs since easiness of withdrawal and definite chondrogenic capacity. This study clearly demonstrated the LIPO-AMIC technique to be feasible for treatment of knee cartilage defects and to result in statistically significant progressive clinical, functional and pain improvement in all treated patients better than what reported for the AMIC standard technique, starting very early from the 6-month follow-up and maintaining the good clinical results more durably with stable results at mid-term follow-up.

Current trends in rehabilitation of rotator cuff injuries.

Rehabilitation has a fundamental role in the management of rotator cuff pathology whether the final choice is conservative or surgical treatment. Conservative treatment can give excellent results in cases of rotator cuff tendinopathies without rupture, partial tears less than 50% of the thickness of the tendon, chronic full-thickness tears in elderly patients and irreparable tears. It is an option prior to reconstructive surgery in non-pseudo paralytic cases. When surgery is indicated, adequate postoperative rehabilitation is the best complement to obtain a successful result. No consensus has still been established on the optimal postoperative protocol to follow. No differences were found between delayed, early passive and early active protocols after rotator cuff repair. However, early motion improved the range of motion in the short and mid-term, allowing faster recovery. A 5-phase postoperative rehabilitation protocol is described. Rehabilitation is also an option in specific failed surgical procedures. To choose a therapeutic strategy in these cases, it is reasonable to differentiate between Sugaya type 2 or 3 (tendinopathy of the tendon) and type 4 or 5 (discontinuity/retear). The rehabilitation program should always be tailored to the individual patient.

No difference in return to amateur sports after medial and lateral unicompartmental knee arthroplasty in patients younger than 65 years.

PURPOSE: The aim of this study was to assess the return to amateur sports of patients under 65 years, following medial unicompartmental knee arthroplasty (mUKA) versus lateral unicompartmental knee arthroplasty (lUKA). It was hypothesized that patients younger than 65 years who underwent lateral or medial unicondylar knee replacement will result in similar rates to amateur sports, at a minimum follow-up of 2 years. METHOD: Patients who underwent medial or lateral UKA participated in a 2-year follow-up program, where they were clinically evaluated for their return to amateur sports, using the University of California, Los Angeles (UCLA) activity scale and the High-Activity Arthroplasty Score (HAAS). Furthermore, subgroup analyses by gender and age were performed. Power analysis was performed to ensure sample size considering that lUKA is implanted ten times less frequently than its medial counterpart. RESULTS: There were 85 patients who completed the entire minimum 2-year follow-up of which 73 belonged to the mUKA group and 12 to the lUKA group. No preoperative differences were found between the groups regarding the gender, the affected side, age, and mean follow-up. Both groups showed statistically significant improvement (p < 0.05) in their return to amateur sports in all parameters (UCLA and HAAS). No differences among the two groups were found at T0 and T1 (n.s.). All subgroups showed a statistically significant improvement (p < 0.05) with respect to the preoperative value, except for UCLA for lUKA with less than 60 years and HAAS for males in the lUKA group (n.s.). No differences were found among subgroups both at To and T1 (n.s.). CONCLUSION: Both mUKA and lUKA procedures enabled all young and active patients a certain return to amateur sports 2 years after surgery, regardless of age and gender. UKA, medial or lateral, should always be considered for the treatment of isolated osteoarthritis in young and active patients with high functional demands. LEVEL OF EVIDENCE: Cohort Study, Level of Evidence III. REGISTRATION: Researchregistry6221 - Research Registry www.researchregistry.com .

Biphasic bioresorbable scaffold (TruFit Plug®) for the treatment of osteochondral lesions of talus: 6- to 8-year follow-up.

BACKGROUND: The ideal treatment of osteochondral lesions of the talus (OLT) is debatable. The TruFit plug has been investigated as a potential treatment method for osteochondral defects. This is a biphasic scaffold designed to stimulate cartilage and subchondral bone formation. The purpose of this retrospective study was to investigate the long-term functional and MRI outcomes of the TruFit Plug for the treatment of OLT. METHODS: Twelve consecutive patients treated from March 2007 to April 2009 for OLT were evaluated. Clinical examination included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and the visual analog scale (VAS) for pain. MRI scans were optained pre-treatment and at last follow-up. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. RESULTS: Mean follow-up was 7.5 years (range, 6.5-8.7 years). The average age was of 38.6 years (range, 22-57 years). The sex ratio between males and females was 3:1 (9 males, 3 females). The mean AOFAS score improved from a preoperative score of 47.2±10.7 to 84.4±8 (p<0.05). According to the postoperative AOFAS scores 1 case obtained excellent results, 9 were classified as good, and 2 were fair. VAS score improved from a preoperative value of 6.9±1.4 points to 1.2±1.1 points at last follow-up (p<0.05). The MOCART score for cartilage repair tissue on postoperative MRI averaged 61.1 points (range, 25-85 points). CONCLUSIONS: The long-term results suggest that the technique of Trufit Plug for OLT is safe and demonstrates good post-operative scores including improvement of pain and function, with discordant MRI results. However, randomized controlled clinical trials comparing TruFit Plug with an established treatment method are needed to improve synthetic biphasic implants as therapy for osteochondral lesions. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

In Vitro Validation of a Closed Device Enabling the Purification of the Fluid Portion of Liposuction Aspirates.

BACKGROUND: Adipose tissue harvested through lipoaspiration is widely exploited in plastic and cosmetic surgery, because of its remarkable trophic properties, especially relying on the presence of adipose-derived stem cells. The common procedures for adipose-derived stem cell isolation are mainly based on tissue fractionation and enzymatic digestion, requiring multiple hours of uninterrupted work, unsuitable for direct surgical applications. Recent studies demonstrated the feasibility of isolating adipose stromal cells without the need for enzymatic digestion. These studies reported the processing of the fluid portion of liposuctioned adipose tissue (lipoaspirate fluid), which contains a significant amount of progenitor cells endowed with plastic and trophic features. In this article, the authors introduce a brand new closed device--the MyStem EVO kit--which allows nonenzymatic tissue separation and rapid isolation of lipoaspirate fluid from human liposuctioned adipose tissue. METHODS: Adipose tissue was liposuctioned from 14 donors, split into aliquots, and alternatively processed using either centrifugation or the MyStem EVO kit, to separate fatty and lipoaspirate fluid portions. The samples were analyzed comparatively by flow cytometry, histology, and differentiation assays. Osteoinductive and angioinductive features were analyzed through in vitro co-culture assays. RESULTS: The alternative procedures enabled comparable yields; the kit rapidly isolated lipoaspirate fluid comprising a homogenous cell population with adipose stem cell immunophenotype, bilineage potential, and efficient osteoinductive and angioinductive features. CONCLUSION: MyStem EVO allows the rapid isolation of lipoaspirate fluid with trophic properties within a closed system, and is potentially useful for regenerative medicine applications.