Anterior Cruciate Ligament Repair-Here to Stay or History Repeating Itself?

Anterior cruciate ligament (ACL) injuries continue to be a prevalent concern among athletes and individuals with an active lifestyle. Traditionally, the standard of care for ACL tears has involved surgical reconstruction using autograft or allograft. This article aims to provide an overview of the evolving landscape of primary ACL repair, examining the current evidence, surgical techniques, patient selection criteria, outcomes, and potential future directions in this field.

Thermal Imaging for Burn Wound Depth Assessment: A Mixed-Methods Implementation Study.

Background: Implementing innovations emerging from clinical research can be challenging. Thermal imagers provide an accessible diagnostic tool to increase the accuracy of burn wound depth assessment. This mixed-methods implementation study aimed to assess the barriers and facilitators, design implementation strategies, and guide the implementation process of thermal imaging in the outpatient clinic of a burn centre. Methods: This study was conducted between September 2022 and February 2023 in Beverwijk, The Netherlands. Semi-structured interviews with burn physicians guided by the Consolidated Framework for Implementation Research (CFIR) were conducted to identify barriers and facilitators. Based on the barriers, implementation strategies were developed with the CFIR-ERIC Matching Tool, and disseminated to support the uptake of the thermal imager. Subsequently, thermal imaging was implemented in daily practice, and an iterative RE-AIM approach was used to evaluate the implementation process. Results: Common facilitators for the implementation of the thermal imager were the low complexity, the relative advantage above other diagnostic tools, and benefits for patients. Common barriers were physicians' attitude towards and perceived value of the intervention, the low compatibility with the current workflow, and a lack of knowledge about existing evidence. Six implementation strategies were developed: creating a formal implementation blueprint, promoting adaptability, developing educational materials, facilitation, conducting ongoing training, and identifying early adopters. These strategies resulted in the effective implementation of the thermal imager, reflected by a >70% reach among eligible patients, and >80% effectiveness and adoption. Throughout the implementation process, compatibility, and available resources remained barriers, resulting in low ratings on RE-AIM dimensions. Conclusions: This study developed implementation strategies based on the identified CFIR constructs that impacted the implementation of a thermal imager for burn wound assessment in our outpatient clinic. The experiences and findings of this study could be leveraged to guide the implementation of thermal imaging and other innovations in burn care.

Structural characterization of a glycoprotein from white jade snails (Achatina Fulica) and its wound healing activity.

Snail mucus is rich in proteins and polysaccharides, which has been proved to promote wound healing in mice in our previous research. The aim of this study was to investigate the effective component in snail mucus that can exert the wound healing potential and its structural characterization. Here, the glycoprotein from the snail mucus (SM1S) was obtained by DEAE-Sepharose Fast Flow and Sephacryl S-300 columns. The structural characteristics of SM1S were investigated via chromatographic techniques, periodic acid oxidation, FT-IR spectroscopy and NMR spectroscopy. Results showed that SM1S was a glycoprotein with a molecular weight of 3.8 kDa (83.23 %), consists of mannose, glucuronic acid, glucose, galactose, xylose, arabinose, fucose at a ratio of 13.180:4.875:1043.173:7.552:1:3.501:2.058. In addition, the periodic acid oxidation and NMR analysis showed that SM1S contained 1,6-glycosidic bonds, and might also contain 1 â†’ 4 and 1 â†’ 2 glycosidic or 1 â†’ 3 glycosidic bonds. Furthermore, the migration experiment of human skin fibroblasts in vitro suggested that SM1S had a good effect to accelerate the scratch healing of cells. This study suggested that SM1S may be a prospective candidate as a natural wound dressing for the development of snail mucus products.

Fabrication, Properties, and Stability of Oregano Essential Oil and Sodium Alginate-Based Wound-Healing Hydrogels.

The wound dressings fabricated by polymers and oregano essential oil (OEO) can be very effective as a hydrogel. The current study has been focused on fabricating the hydrogel membranes of oregano oil encapsulated as an antibacterial agent into sodium alginate (SA) solution by solvent casting method and then evaluated the antibacterial, antioxidant activity, and physicochemical performance of SA/OEO-based polymeric membranes. The polymeric interactions, surface morphology, water absorption capability, thermal stability, and encapsulation efficiency were investigated by FT-IR, SEM, swelling ratio, DSC, and encapsulation efficiency. The percentage encapsulation efficiency of essential oil was 40.5%. FTIR validated the presence of molecular interaction between individual components. SEM images showed a rough and porous appearance for hydrogel membranes. Moreover, DSC showed that the fabricated membranes were thermally stable. The inclusion of more content OEO decreased swelling ratios. The antioxidant test was carried out by DPPH assay and antibacterial test through disc diffusion method against microbes. The results revealed that membranes containing the highest content of OEO had more excellent antioxidant and antibacterial efficacy. Therefore, the polymeric membranes of sodium alginate loaded with oregano essential oil can be employed as an effective wound-healing candidate.

Determination of the Bioactive Compounds from Echinacea purpurea (L.) Moench Leaves Extracts in Correlation with the Antimicrobial Activity and the In Vitro Wound Healing Potential.

This study aimed at the relationship between antioxidant capacity, antimicrobial activity, and in vitro evaluation of the wound healing effect of the extract obtained from Echinaceae purpureae folium (EPF). This study's objective was to assess the bioactive components (total phenol and flavonoid content) and antioxidant activity of EPF extracts using the DPPH test method. The antioxidant capacity and the quantities of the compounds with antioxidant capacity were evaluated by spectrophotometric methods. Antimicrobial activity has been investigated against various pathogenic microorganisms. The minimum inhibitory concentration was determined by the microdilution method. Additionally, our work used a scratch test to examine the in vitro wound healing effects of EPF extract on NHDF cells. Statistical analysis was used to quantify the rate of migration and proliferation of fibroblast cells within the wound. Microscope pictures of fibroblast cells exposed to various EPF extract dosages were processed to estimate the width of the wound, area of the wound, and cell density inside the wound. The study proved that there was a relationship between the antioxidant, antimicrobial, and wound healing ability of EPF extracts.

Structural study and antimicrobial and wound healing effects of lectin from Solieria filiformis (Kützing) P.W.Gabrielson.

The SfL-1 isoform from the marine red algae Solieria filiformis was produced in recombinant form (rSfL-1) and showed hemagglutinating activity and inhibition similar to native SfL. The analysis of circular dichroism revealed the predominance of ß-strands structures with spectra of ßI-proteins for both lectins, which had Melting Temperature (Tm) between 41 °C and 53 °C. The three-dimensional structure of the rSfL-1 was determined by X-ray crystallography, revealing that it is composed of two ß-barrel domains formed by five antiparallel ß chains linked by a short peptide between the ß-barrels. SfL and rSfL-1 were able to agglutinate strains of Escherichia coli and Staphylococcus aureus and did not show antibacterial activity. However, SfL induced a reduction in E. coli biomass at concentrations from 250 to 125 µg mL-1, whereas rSfL-1 induced reduction in all concentrations tested. Additionally, rSfL-1 at concentrations from 250 to 62.5 µg mL-1, showed a statistically significant reduction in the number of colony-forming units, which was not noticed for SfL. Wound healing assay showed that the treatments with SfL and rSfL-1 act in reducing the inflammatory response and in the activation and proliferation of fibroblasts by a larger and fast deposition of collagen.

Effects of Aging and Immersion on the Healing Property of Asphalt-Aggregate Interface and Relationship to the Healing Potential of Asphalt Mixture.

The self-healing ability of asphalt-aggregate bonding interfaces can maintain the mechanical properties of asphalt mixtures. However, the interface's healing ability will also be affected by moisture and aging. In order to clarify the influence of moisture and aging on the healing ability of a bonding interface, the effects of healing period and temperature on the self-healing level of interfacial strength were measured. The healing master curve of the strength was established. Thereafter, the effects of soaking time, salt solution concentration, and thermal aging on the healing degree of interfacial strength were measured. Based on digital image processing technology and the meso-finite element method, the influence of the interface on the healing performance of the mixture was simulated and analyzed, which was then verified by the beam bend healing test. The results show that the healing index of bonding strength increases with the ascent of healing temperature and period. Healing index gradually decreases with the extension of soaking period, and the higher the concentration of salt in the solution, the worse the healing performance of interfacial strength. After asphalt aging, the healing potential of the interface is weakened. There is a good linear relationship between the healing level of an asphalt-aggregate interface and the level of strength and fracture energy of the mixture. However, the actual healing level of an asphalt mixture is obviously lower than that of the interface, due to the addition of mineral filler. This paper provides a method for predicting the recovery performance of asphalt pavement.

Validity of laser speckle contrast imaging for the prediction of burn wound healing potential.

OBJECTIVE: To assess validity of Laser Speckle Contrast Imaging (LSCI) for the measurement of burn wound healing potential (HP) in a burn centre patient population, based on Laser Doppler Imaging (LDI) as reference standard. METHOD: A single-centre prospective observational cohort study was performed between September-December 2019. A total of 50 burns in 14 patients were included. Imaging and data collection were standardized. Correlation between LSCI and LDI flux values was tested. ROC curves were developed to test the discriminative ability of LSCI between LDI HP categories. RESULTS: Number of adults and children were equal. Mean total body surface area burnt was 5.5%. Main burn causes were scalds (64%) and flame burns (36%). LSCI set-up and imaging duration was 3 min and 10 s, respectively. LSCI was able to discriminate between wounds with early versus delayed HP (<14 versus ≥14 days) with sensitivity 71% and specificity 95% (p < 0.001). For HP ≤21 versus >21 days, similar sensitivity (74%) and specificity (95%) were found (p < 0.001). Correlations between LSCI and LDI flux values were moderate (<14 days) to absent (>21 days). CONCLUSION: LSCI shows good validity for the prediction of burn wound HP. It is a highly feasible, patient and physician friendly tool.

Self-Healing Potential and Phase Evolution Characterization of Ternary Cement Blends.

The autogenous self-healing of cementitious material micro-cracks might lead to the service-life extension of structures. However, most of its aspects are still unknown. This paper investigates the self-healing capacity of ternary cement blends including metakaolin (MK), ground granulated blast-furnace slag (BFS), limestone (LS), and siliceous filler (F). Morphology and healing precipitation patterns were studied through the optical microscopy of artificial micro-cracks, global healing product mass monitoring, and XRD and TGA used to identify and quantify mineral formation. The self-healing potential index is introduced based on the mass measurements. It was found that the formulation containing 10% MK presented the highest healing potential at an early age (<28 days), while the formulations containing 20% BFS with 10% LS/F showed a higher healing potential at an older age (cracked after 28 days of curing). Calcite, C-S-H, and portlandite were found to be the main healing products alongside specific formulation-dependent compounds, and it was observed that the calcite's relative quantity generally increased with time. Finally, the evolution of the self-healing product phases was accurately monitored through XRD and TGA measurements.

A prospective study comparing the FLIR ONE with laser Doppler imaging in the assessment of burn depth by a tertiary burns unit in the United Kingdom.

INTRODUCTION: Laser Doppler imaging (LDI) is the 'gold standard' tool for the assessment of burn depth. However, it is costly. The FLIR ONE is a novel, mobile-attached, thermal imaging camera used to assess burn wound temperature. This study compares the FLIR ONE and LDI in assessing burn depth and predicting healing times. METHODS: Forty-five adult patients with burn wounds, presenting at 1-5 days, were imaged with the FLIR ONE and LDI. Infected, chemical and electrical burns were excluded. Healing potential was determined by comparing wound and normal skin temperature for the FLIR ONE and blood flow changes with the LDI. Healing potential was categorised into wounds healing in less than and over 21 days. Pearson's test was used to determine the correlation between changes in wound temperature and healing potential. RESULTS: Percent total body surface area (%TBSA) was in the range of 0.5-45. FLIR demonstrated a sensitivity of 66.67% and specificity of 76.67% in predicting healing within 21 days, while LDI demonstrated a sensitivity of 93.33% and specificity of 40%. The FLIR ONE showed a significant difference in the mean temperature changes between burns that healed in less than (0.1933 ± 0.3554) and over 21 days (-1 ± 0.4329) (P = 0.04904). Pearson's test showed a significant correlation between the difference in wound and normal skin temperature with healing times (P = 0.04517). CONCLUSION: The inexpensive FLIR ONE shows a significant correlation between changes in wound temperature and healing times. It is useful in predicting healing within 21 days. However, evaporative cooling at the wound surface can lead to overprediction of healing times and overtreatment. LAY SUMMARY: Background Laser Doppler imaging is currently the main tool for burn depth assessment. It works by analysing the blood flow in a burn wound. Based on these findings, it can predict the depth of the burn injury and predict if it will heal in less than or over 21 days. The main problem is that it is costly. The FLIR ONE is a novel, mobile-attached, thermal imaging camera. It can be used to assess burn depth by comparing the temperature of the burn wound to the surrounding normal skin. This information can then be used to predict healing times into less than and over 21 days. The issue being explored The usefulness of the FLIR ONE in assessing burn depth and predicting healing time when compared to the LDI. How was the work conducted? Forty-five adult patients who sustained a burn injury within the last five days were imaged with both the FLIR ONE and LDI. Those with infected, electrical or chemical burns were excluded. Healing potential was determined by comparing the temperature of the burn wound with normal skin for the FLIR ONE and by changes in wound blood flow with the LDI. Healing potential was categorised into wounds healing in less than and over 21 days. The correlation between the temperature changes of the burn wound and healing time was evaluated for the FLIR ONE. What we learned from the study This study was able to demonstrate that the FLIR ONE showed a significant correlation between the temperature difference between the burn wound and normal skin with healing times. When compared with the LDI, the FLIR ONE was useful in predicting if a burn wound will heal in less than 21 days. The FLIR ONE has advantages over the LDI, it is low cost, portable and produces instantaneous images. Ultimately, this developing technology may increase access to higher standard burn care in centres where LDI is not affordable.

Prosopis Plant Chemical Composition and Pharmacological Attributes: Targeting Clinical Studies from Preclinical Evidence.

Members of the Prosopis genus are native to America, Africa and Asia, and have long been used in traditional medicine. The Prosopis species most commonly used for medicinal purposes are P. africana, P. alba, P. cineraria, P. farcta, P. glandulosa, P. juliflora, P. nigra, P. ruscifolia and P. spicigera, which are highly effective in asthma, birth/postpartum pains, callouses, conjunctivitis, diabetes, diarrhea, expectorant, fever, flu, lactation, liver infection, malaria, otitis, pains, pediculosis, rheumatism, scabies, skin inflammations, spasm, stomach ache, bladder and pancreas stone removal. Flour, syrup, and beverages from Prosopis pods have also been potentially used for foods and food supplement formulation in many regions of the world. In addition, various in vitro and in vivo studies have revealed interesting antiplasmodial, antipyretic, anti-inflammatory, antimicrobial, anticancer, antidiabetic and wound healing effects. The phytochemical composition of Prosopis plants, namely their content of C-glycosyl flavones (such as schaftoside, isoschaftoside, vicenin II, vitexin and isovitexin) has been increasingly correlated with the observed biological effects. Thus, given the literature reports, Prosopis plants have positive impact on the human diet and general health. In this sense, the present review provides an in-depth overview of the literature data regarding Prosopis plants' chemical composition, pharmacological and food applications, covering from pre-clinical data to upcoming clinical studies.

A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential.

PURPOSE: Reliable and valid assessment of burn wound depth or healing potential is essential to treatment decision-making, to provide a prognosis, and to compare studies evaluating different treatment modalities. The aim of this review was to critically appraise, compare and summarize the quality of relevant measurement properties of techniques that aim to assess burn wound depth or healing potential. METHODS: A systematic literature search was performed using PubMed, EMBASE and Cochrane Library. Two reviewers independently evaluated the methodological quality of included articles using an adapted version of the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A synthesis of evidence was performed to rate the measurement properties for each technique and to draw an overall conclusion on quality of the techniques. RESULTS: Thirty-six articles were included, evaluating various techniques, classified as (1) laser Doppler techniques; (2) thermography or thermal imaging; (3) other measurement techniques. Strong evidence was found for adequate construct validity of laser Doppler imaging (LDI). Moderate evidence was found for adequate construct validity of thermography, videomicroscopy, and spatial frequency domain imaging (SFDI). Only two studies reported on the measurement property reliability. Furthermore, considerable variation was observed among comparator instruments. CONCLUSIONS: Considering the evidence available, it appears that LDI is currently the most favorable technique; thereby assessing burn wound healing potential. Additional research is needed into thermography, videomicroscopy, and SFDI to evaluate their full potential. Future studies should focus on reliability and measurement error, and provide a precise description of which construct is aimed to measure.

Spectrophotometric intracutaneous analysis for the assessment of burn wounds: A service evaluation of its clinical application in 50 burn wounds.

INTRODUCTION: The assessment of burn depth can be challenging even to the experienced burn clinician. Clinical assessment is most widely used to determine burn depth. Because of this subjective nature, various imaging modalities have been invented. The use of photospectometry as a novel technique in burn wound depth analysis has been previously described but the literature is very limited. METHODOLOGY: We carried out a single blinded non-randomized comparative study of healing potential of 50 burn wounds between tissue spectrophotometry analysis versus clinical evaluation. RESULTS: ScanOSkin™ technology has an overall sensitivity of 75% and specificity of 86% in predicting healing potential of wounds. Analysis of Inter Rater Agreement (IRA) using Kappa calculations showed strengths of agreement varied from fair to moderate in perfusion and burn depth. IRA for assessing pigmentation however, was poor and this was reflected in user feedback. CONCLUSION: There is a potential role for ScanOSkin™ tissue spectrophotometric analysis in burn depth assessment. Future studies comparing several imaging modalities with ScanOSkin®, taking into account costs comparison may be useful for future health resources planning.

Reliability of predictive models for non-operative healing potential of stable juvenile osteochondritis dissecans knee lesions.

BACKGROUND: While juvenile osteochondritis dissecans (JOCD) lesions have greater healing potential than equivalent lesions in adults, only 50% of JOCD lesions demonstrate radiographic healing after six months of non-operative treatment. Two previous studies have produced nomograms to predict a patient's probability of healing with non-operative treatment based on patient and lesion characteristics. The purpose of this study was to determine inter- and intra-observer reliability of the predictive nomograms. METHODS: A consecutive series of 34 skeletally immature patients (40 knees), who underwent non-operative treatment for stable JOCD lesions was retrospectively reviewed. At two time points at least one week apart, two medical students, two orthopaedic surgeons, and a radiologist made measurements of the JOCD lesions. These measurements, along with patient ages and pain type, were used to generate a point value for each lesion based on both nomograms. Intra-class correlations (ICCs) were calculated to determine inter- and intra-rater reliability. RESULTS: We found near perfect intra-rater correlation (ICC) for all raters' individual OCD measurements, as well as total point score for the two nomograms (ICC range, 0.780-0.929). Additionally, there was near perfect inter-rater reliability among raters for total scores and individual components of each nomogram (ICC range, 0.721-0.974). CONCLUSIONS: There is high inter- and intra-rater reliability for both point systems for predicting healing of JOCD lesions. Clinicians should be aware of these as tools to help guide decision making in patients with JOCD lesions.

The healing potential of honey and propolis lotion on septic wounds

Objective: To assess the potential of lotion made from honey and propolis in the treatment of septic wounds in order to determine its effectiveness. Methods: The study area was Osun State, Southwest Nigeria. Fifty patients with septic wounds, aged from 20-60 years, were treated with lotion made from honey and propolis harvested from the Centre for Apicultural Research, Training and Honey Production (CARTHOP) Farm of College of Agriculture, Osun State University, Ejigbo. Honey and powdered propolis were mixed in a ratio of seven to three. The lotion was applied to the wounds three times a day. Results: The wounds of the 80% of the patients showed remarkable signs of improvement at the end of the 4th day; 60% had their wounds completely healed at the end of the 10th day; the remaining 40% healed completely at the end of the 15th day. All healed wounds were without scars or blisters. Conclusions: It can be concluded that the lotion from the honey and propolis has great potential for the treatment and healing of septic wounds. It is recommended that it should be incorporated in the treatment plans of septic wounds and other gangrenous wounds by hospitals in Nigeria.

Healing potential of the transected posterior cruciate ligament of the rabbit / 대한정형외과학회잡지

PURPOSE: This study was undertaken to elucidate the natural healing potential in posterior cruciate ligament (PCL) injury using histological and biomechanical methods. MATERIALS AND METHODS: PCLs of 92 rabbits were cut partially or completely cut on one side. In Group I, 75% of the PCL was cut preserving the synovium partially. In Group II, the PCL and synovium were completely severed. Investigations were performed by gross inspection, histological examination after Hematoxylin-Eosin (HE) staining and tensile stress testing using an Instron. RESULTS: Continuity of the ligaments began to appear at 2 weeks in group I and at 12weeks in group II. Proliferation of fibroblasts and vessels were observed in HE stained ligaments at 6 and 12 weeks in both groups. The ultimate tensile strength in group I was .3% and in group II 33.1% at 12 weeks. CONCLUSION: Although the mechanical properties of the regenerated ligaments were poor, this study demonstrats that the rabbit PCL has healing potential irrespective of the degree of injury.

Magnetic Resonance Imaging on Posterior Cruciate Ligament Injury: Can the PCL hea

PURPOSE: The aim of this study was to elucidate the continiuty of ligament in chronic injury of the pos- terior cruciate ligament(PCL). MATERIALS AND METHODS: Magnetic resonance imaging(MRI#) of twenty-six PCL injury patients with grade II or III laxity and more than 5mm side to side difference on stress radiographs were reviewed in terms of ligamentous continuity and thickness of the ligament at average 7.2 months(range:1-36) after injury. RESULTS: Eighteen PCLs(69%) showed continuity of PCL. When thickness of the ligament in cases without continuity was rated as zero, the average thickness of the PCLs as compared to intact portion of the ligament increased as the time from injury elapsed; 16.4% in 0 2 months group(7 cases), 30.0% in 3- 5 months group(6 cases), 53.8% in 6-8 months group(9 cases) and 80.0% in over 9 months group(4 cases). CONCLUSTION: More than two thirds of PCLs in symptomatic chronic injury showed ligamentous continuity on MRI. The longer the interval from injury was, the thicker the PCL was.