Meniscal Repair with ArthroZheal® an Autologous Bioactive Fibrin Scaffold. A New Technique and Treatment Option.

Injuries of the meniscus often lead to changes in joint biomechanics, which affect the load distribution and contact stresses. The menisci consist of a peripheral vascular region (red zone) and an inner avascular region (white zone). The blood supply plays an important role in the healing of meniscal tears. Surgical treatment of such lesions includes meniscectomy/meniscoplasty and repair, depending on the type of injury, where "meniscoplasty" refers to the treatment modality that occurs under coblation. The application of Autologous Bioactive Matrix (ABM) has been shown to promote healing in such lesions. In addition, a special type of PRF (ArthroZheal®, Vivostat A/S, Allerød, Denmark) has been demonstrated to have healing effects in extracellular matrix synthesis and cell proliferation, as well as regenerative and remodeling effects. This autologous product can be applied directly at the meniscal repair site. We performed a prospective study on meniscus repair with ArthroZheal® alone (plus meniscoplasty) and ArthroZheal® together with an all-inside suturing technique using the STAR AccurFix Meniscal Repair Device system (STAR Sports Medicine, Beijing, China), depending on the type and the site of the lesion. One hundred twenty knees (110 patients) were identified through the use of clinical examination and MRI scan. The study took place between January 2023 and August 2023. Two groups were created: GROUP A was treated only with ArthroZheal®(plus meniscoplasty) and GROUP B was treated with a combination of ArthroZheal® and an all-inside suturing technique (STAR AccurFix). Pre- and postoperative grading was performed with the International Knee Documentation Committee (IKDC) score and the Tegner Activity Level Scale (Tegner Score). The results with both treatment methods were excellent and meniscus restoration has been documented on MRIs conducted 6 months post-op. In 15 patients, 2nd-look arthroscopy was performed through a nanoscope on an outpatient basis, and showed meniscal healing and remodeling. Tegner scores and IKDC scores in both groups showed significant improvement. Meniscal repair should be performed at all costs to maintain meniscal integrity and prevent long-term degenerative changes. New treatment methods include orthobiologics and all-inside suturing techniques. The main idea is to apply an autologous biological scaffold which is able to carry cells into the meniscal lesion and to allow their differentiation, proliferation, and extracellular matrix synthesis to produce a meniscal-like tissue. Our results suggest that the application of autologous ABM (ArthroZheal®) for the treatment of such lesions by means of dry arthroscopy results in better MRI, pain management and functional results at 3 months post-op, and these improvements can persist for up to 6 months.

How Subtalar Kinematics Affects Knee Laxity in Soccer Players After Anterior Cruciate Ligament Injury?

Purpose The goal of the current study was to ascertain whether there is an association between foot pronation and anterior cruciate ligament (ACL) injury in a group of elite professional soccer players. Methods Two groups of soccer players were studied, all of whom played in the Greek Super League. The ACL group included players who had suffered an ACL injury in the last 2 years. The non-ACL group was composed of players who had never suffered an ACL injury. We used a 3D baropodometric laser scanner to measure pronation or overpronation (navicular drop phenomenon) of the subtalar joint and how this affects the subtalar joint while standing. We assessed ACL laxity using the Genourob Rotab. Results ACL-injured patients, regardless of the mechanism of injury, exhibited greater navicular drop values than a randomly selected group of subjects with no history of ACL injury. Conclusion Greater knee joint laxity and subtalar pronation may be associated with an increased risk of ACL injury. Pronation of the foot appears to be a risk factor for ACL injury. These findings should be integrated into future studies to better define how neuromuscular control related to lower extremity biomechanics is associated with ACL injury.

A standardized nutraceutical supplement contributes to pain relief, improves quality of life and regulates inflammation in knee osteoarthritis patients; A randomized clinical trial.

Osteoarthritis (OA) is a degenerative disease of the joints that affects greatly the elderly population and the health care systems and is on the increase due to aging and obesity. Interventions aim at palliative care and pharmaceutical therapies entail serious adverse events. Whereas polyphenols constitute a promising holistic approach in the arsenal of physicians, trials investigating biomarkers and questionnaires are scarce. As such, a randomized controlled trial (RCT) was conducted to evaluate the potency of a standardized polyphenolic supplement in the management of systemic inflammation, oxidative stress, pain and general quality of life (QoL) in patients with osteoarthritis. Sixty subjects were randomized to receive either a polyphenol supplement (curcuma phospholipid, rosemary extract, resveratrol, ascorbic acid), or an active comparator (ascorbic acid) twice, daily for 12 weeks. The group that received the polyphenols exhibited significantly lower symptoms of pain and improved physical function and QoL as it was depicted by validated questionnaires, compared to the control group. Furthermore, post intervention, inflammation was restrained in the polyphenol group. Since systemic inflammation promotes local inflammation, the decrease of pain herein might be attributed to the attenuation of systemic inflammation by the polyphenols.

Arthrozheal®, a Bioactive Fibrin Scaffold for Joint Cartilage, Tendon and Soft Tissue Lesions. Latest Results and Application Perspectives.

Treatment of articular cartilage, tendon and soft tissue damage remains a challenge for the practicing orthopaedic surgeon. Due to the multifactorial aetiology of these lesions, there is a narrow therapeutic window within which they can be treated successfully, thus preventing progression to other musculoskeletal tissues. Recently, a new material that combines platelet-rich fibrin with collagen and is applied as a gel scaffold (ArthroZheal®, Vivostat A/S, Allerød, Denmark) has been shown to provide unique results in these patients. We arthroscopically treated 210 patients (114 knees, 32 hips, 52 shoulders, 12 ankle joints) with ArthroZheal®. The basic idea was to adjust treatment to the individual patient and to repair related and/or contributing problems before or along with treatment of chondral/tendon/ligament injuries. Arthroscopy was our preferred surgical method; the goal was to restore and preserve function, alleviate pain and minimise progression to osteoarthritis. We excluded cases of inflammatory arthropathy, unstable or malaligned joint, "kissing lesions" (bipolar), infection, obesity, massive rotator cuff rupture and multiligament instability. Our results were more than promising. We observed improved mobility in 93%, reduced pain in 95% at 3 months and further improvement at 6 months, with near-normal ROM (97% ) and pain-free status (98%). The MRI at 12 months post application showed cartilage restoration/reformation in 94% of patients, improved cartilage quality (84% )-by 2nd-look arthroscopic confirmationand normal tendon or ligament reconstruction (without stitching of the affected area)(95%). We were concerned about bone marrow oedema and rehab compliance among elderly patients. For successful regeneration of tissue lesions and osteochondral defects, natural gel bioscaffolds, combined with platelet rich fibrin (PRF) with chondroinductive and osteoinductive growth factor stimulators (ArthroZheal®) are required. There is no "gold standard" in the treatment of cartilage defect/tissue lesions or preferred treatment option. Many algorithms are used, which mostly rely on the surface area of the defect/site of lesion and on surgeon experience. An important issue is that rehabilitation depends on the treatment mode used and on the defect/lesion characteristics (classification and qualification). While a return to functional work and sports is possible with all procedures, different lengths of time are needed.

Dietary Interventions with Polyphenols in Osteoarthritis: A Systematic Review Directed from the Preclinical Data to Randomized Clinical Studies.

Osteoarthritis (OA) is the most common form of arthritis and a major cause of limited functionality and thus a decrease in the quality of life of the inflicted. Given the fact that the existing pharmacological treatments lack disease-modifying properties and their use entails significant side effects, nutraceuticals with bioactive compounds constitute an interesting field of research. Polyphenols are plant-derived molecules with established anti-inflammatory and antioxidant properties that have been extensively evaluated in clinical settings and preclinical models in OA. As more knowledge is gained in the research field, an interesting approach in the management of OA is the additive and/or synergistic effects that polyphenols may have in an optimized supplement. Therefore, the aim of this review was to summarize the recent literature regarding the use of combined polyphenols in the management of OA. For that purpose, a PubMed literature survey was conducted with a focus on some preclinical osteoarthritis models and randomized clinical trials on patients with osteoarthritis from 2018 to 2021 which have evaluated the effect of combinations of polyphenol-rich extracts and purified polyphenol constituents. Data indicate that combined polyphenols may be promising for the treatment of osteoarthritis in the future, but more clinical trials with novel approaches in the identification of the in-between relationship of such constituents are needed.

The Accessory Soleus Muscle: A Narrative Review of the Literature.

PURPOSE: Although the accessory soleus muscle is a rare supernumerary muscle of the leg, its presence has been well discussed in the literature. This rare anatomic variation has been described mainly in the anatomic, surgical, and radiology literature. Awareness of the muscle's presence and its clinical presentation can help with diagnosis without surgical exploration. This narrative review summarizes the available data describing the anatomy, clinical presentation, diagnosis, associated pathologies, and treatment options of this accessory muscle. METHODS: A literature review was performed to provide a comprehensive report of the existing data regarding the accessory soleus muscle. PubMed, Heal Link, and Google Scholar were searched for articles in English reporting on the accessory soleus muscle. The search was conducted using the following key words: "soleus muscle" and "accessory soleus muscle". PubMed was searched primarily, and then cross-referenced articles were found via Heal Link and Google Scholar. Results from non-English studies were excluded. RESULTS: A total of 148 articles were reviewed. The majority of the articles was composed of case reports along with a review of the literature. After the initial screening, 33 irrelevant studies, 47 duplicates, and 9 non-English articles were excluded; thus, 59 studies were eligible for analysis. CONCLUSION: Although the accessory soleus muscle is a rare anatomic variation, many cases have been reported in the literature. Nonetheless, the results reported in this literature review are still inconclusive regarding why some patients are symptomatic and others are not, and the recommendation of therapy protocols. Recognizing this anomaly is important in deciding the right diagnosis and planning the appropriate treatment. However, further research is needed to investigate the symptoms' presentations and propose specific treatment protocols.

Safe Popliteal Node Dissection and Utility of Key Anatomical Structures: A Rare Case Series.

Metastasis in popliteal nodes is an extremely rare clinical condition that is scarcely reported in the literature, and popliteal node dissection is an infrequently performed surgical procedure. During the two decades of 2000-2020, 26 patients came to our institution for popliteal node dissection due to metastasis from the primary region to popliteal fossa lymph nodes. We report here that with lymphoscintigraphy, popliteal node dissection is an adequate therapeutic procedure in cases of metastasis to popliteal fossa from acral primary tumors. However, because the frequency of this surgical procedure is typically low, surgeons are often inadequately trained in the proper approach using key anatomical structures to guide them during popliteal node removal. We describe a stepwise surgical approach in the hopes of increasing the surgeon's knowledge, which is pivotal and fundamental for performing successful popliteal lymphadenectomy without hazardous impacts to the patient.

Anatomic variation of the relation between the inferior mesenteric artery and the bifurcation point of abdominal aorta during lower anterior resection: A rare case report.

INTRODUCTION: Identification and ligation of the inferior mesenteric artery (IMA) is a crucial surgical step when performing lower anterior resection (LAR) for rectal cancer. Anatomic variations of the relation between the IMA and the bifurcation point of abdominal aorta (AA) encumber surgical maneuvers and are of great clinical importance. PRESENTATION OF CASE: An unusual anatomic variation of the relation between IMA and the bifurcation point of AA was unexpectedly detected during LAR to a 69-year-old Caucasian female patient. The operation was uneventful. A meticulous review of the recent literature was conducted as well. DISCUSSION: Variations of the mesenteric vascular supply are mainly identified incidentally, during the operation. In particular, variations of IMA are extremely uncommon in the literature. However, such kind of congenital variations, are not as rare as considered and their presence encumbers surgical maneuvers and increases the potentiality of intraoperative injury and hemorrhage. CONCLUSION: Surgeons' deep knowledge and unceasing awareness concerning probable anatomic variations of the relation between the IMA and AA, combined with detailed exposure of the operative field and of the relationship between these adjacent arteries constitute the cornerstone of a safe operation.

Clinical significance of de Garengeot's hernia: A case of acute appendicitis and review of the literature.

INTRODUCTION: The presence of the appendix in a femoral hernia sac is known as de Garengeot's hernia. We report a rare case of an elderly woman with femoral hernia appendicitis and discuss the surgical pitfalls and considerations through a literature review. PRESENTATION OF CASE: An 83-year-old woman presented with fever and right lower quadrant abdominal pain. Clinical examination revealed a femoral hernia. Ultrasonography confirmed bowel was present in the hernia sac. In the operation room, an acutely inflamed appendix was recognized within the sac. The patient underwent appendectomy and hernia repair with sutures. DISCUSSION: Acute appendicitis within a femoral hernia is rare and multiple dilemmas exist regarding its treatment. An incision below the inguinal ligament is a reasonable choice in order to access the hernia sac. A mesh should be placed in non-infectious appendectomy while herniorrhaphy is preferred in cases of appendicitis. CONCLUSION: The presence of the vermiform appendix in a femoral hernia sac is rare but the surgeon should be aware of this clinical entity. Prompt diagnosis and appropriate surgical treatment is the key to avoid complications.