Meniscal scaffold for the treatment of partial meniscal defect-clinical and radiological outcomes in a two-year follow-up.

PURPOSE: The aim of meniscal scaffolds is to fill the defect, allow regeneration of meniscal-like tissues, and to prevent long-term risk of cartilage wear and tear. The aim of this study was to evaluate clinical results after two years and magnetic resonance imaging (MRI) results a year after implantation of a meniscal scaffold. METHODS: Fifteen patients were recruited into a prospective, single-arm, single-center study, and treated with meniscal scaffolds as a result of segmental meniscal defect due to previous partial meniscectomy. Patients were evaluated using functional knee scores used pre-operatively and 6, 12, and 24 months postoperatively. The radiological outcome was assessed using MRI at 12 months by evaluating scaffold size, morphology, and intensity according to the Genovese grading system. Cartilage assessment was completed according to The International Cartilage Repair Society (ICRS) score. RESULTS: All patients completed a follow-up of 24 months. A statistically significant increase in mean levels of all functional scores was present in all patients. On the MRI, all but one of the patients presented an incorporated meniscal implant. In most of the patients (73%), the meniscal implant was a Genovese type III. Type II and III signal intensities were present in all scaffolds when compared with the residual meniscal tissue. A stable cartilage (ICRS) status was observed in 80% of the patients compared with the pre-operative cartilage scores. CONCLUSION: In our case series of patients treated with the meniscal scaffold implant, we observed good clinical results at a two year follow-up. Furthermore, MRI findings suggest that meniscal scaffolds might have a beneficial effect on articular cartilage.

Ischiofemoral Impingement in Children: Imaging With Clinical Correlation.

OBJECTIVE: The purpose of this study is to correlate the MRI finding of quadratus femoris edema in children with established measures of ischiofemoral impingement in adults and to determine their clinical significance. MATERIALS AND METHODS: A case-control retrospective review was performed of MR images of 12 hips of nine children (mean age, 10 years) that showed abnormal signal intensity in the quadratus femoris muscle. The findings were compared with those for 13 hips in 13 control subjects (mean age, 9.8 years). Two musculoskeletal radiologists independently measured the ischiofemoral space, quadratus femoris space, inclination angle, and hamstring tendon area. Quadratus femoris muscle edema, tears, or fatty replacement were assessed visually. Statistical analysis determined inter- and intraobserver variability and statistical differences between the two subject groups. RESULTS: Subjects with abnormal signal in the quadratus femoris muscle had a statistically significantly narrower ischiofemoral space (mean, 11.5 vs 20.7 mm; p < 0.05) and quadratus femoris space (mean, 7.2 vs 14.3 mm, p < 0.05) compared with control subjects. Inclination angles were statistically significantly larger in affected subjects (145.5° vs 138.7°; p < 0.05). No statistically significant difference was found in hamstring tendon area. Four of 12 patient hips had no symptoms or symptoms unrelated to the abnormality. Inter- and intraobserver variability scores were strong for all continuous variables. CONCLUSION: Ischiofemoral impingement is a cause of hip pain in children and should be considered with the combination of quadratus femoris muscle edema and narrowing of ischiofemoral space and quadratus femoris space. Coxa valga may contribute to narrowing of these parameters and predispose to ischiofemoral impingement. The MRI features of ischiofemoral impingement, however, are nonspecific and may be seen in patients with pain localized to that hip or in patients with symptoms unrelated to the abnormality.

Do blood growth factors offer additional benefit in refractory lateral epicondylitis? A prospective, randomized pilot trial of dry needling as a stand-alone procedure versus dry needling and autologous conditioned plasma.

OBJECTIVE: To evaluate whether autologous conditioned plasma offers any therapeutic advantage over ultrasound-guided dry needling as a stand-alone procedure in the treatment of refractory lateral epicondylitis. MATERIALS AND METHODS: Prospective, randomized pilot study of 28 patients (11 men, 17 women, mean age, 49.1  years) with refractory lateral epicondylitis (mean symptom duration, 19.1 months) who underwent either dry needling (n = 13) or dry needling combined with autologous conditioned plasma (ACP) injection (n = 15). Each patient received two separate injections (0 weeks and 1 month) and analysis of visual analogue pain scores (VAS) and Nirschl scores were performed pre-procedure, at 2 months and final evaluation at 6 months. Successful treatment was defined as more than a 25 % reduction in pain scores without re-intervention. Data was analyzed using the Mann-Whitney test and local research ethics committee approval was obtained. RESULTS: At 2 months, the mean VAS improvement was 0.85 (12.3 %) in the dry needling group compared to 2.19 (27.1 %) in the ACP group (p = 0.76) and there was a 5.83-point and 20.3-point Nirschl score improvement respectively (p = 0.72). At the final follow-up of 6 months, the mean VAS improvement was 2.37 (34 %) in the dry needling group compared to 3.92 (48.5 %) in the ACP group (p = 0.74) and there was a 22.5-point and 40-point Nirschl score improvement, respectively (p = 0.82). CONCLUSIONS: There is a trend to greater clinical improvement in the short term for patients treated with additional ACP, however no significant difference between the two treatment groups was demonstrated at each follow-up interval. A larger, multicenter, randomized controlled trial is required to corroborate the results of this pilot study.