Reverse Shoulder Arthroplasty for Proximal Humeral Fractures: Is the Bigliani-Flatow Stem Suitable for Tuberosity Fixation and Healing?

Background/Objectives: The aim of the study was to investigate the clinical, functional, and radiographic results of patients affected by three- or four-part proximal humeral fractures treated with reverse total shoulder arthroplasty, to investigate whether a prosthetic stem nonspecifically designed for fractures (i.e., the Bigliani-Flatow stem) promotes tuberosities' healing, and to evaluate the impact of tuberosity fixation and healing on the outcomes. Methods: Patients' data such as gender, age, side and dominancy, comorbidities, complications during or after surgery, and time lapse between trauma and surgery were prospectively collected. The type of fixation of the stem, the thickness and type of liner, and whether the tuberosities were fixed or not were also recorded. The Constant score weighted on the contralateral limb, QuickDASH, Oxford Shoulder Score, and Subjective Shoulder Value were collected. Tuberosities' healing was assessed with X-rays (anteroposterior, Grashey, and axillary views). Results: Overall, 34 patients were included, with an average follow-up of 42 months. Tuberosities were reinserted in 24 cases and their healing rate was 83%. The mean values were the following: a Constant score of 64, Oxford Shoulder Score of 39, Subjective Shoulder Value of 71, and QuickDASH score of 27. There were no significant differences in the scores or range of motion between patients with tuberosities healed, reabsorbed, or not reattached. There was a better external rotation in the group with healed tuberosities and a longer duration of surgery to reattach tuberosities. Conclusions: The treatment of proximal humerus fractures with the Bigliani-Flatow stem is associated with good clinical and functional results. The healing rate of the tuberosities was high and comparable, if not even better, than the mean rates reported for the stems dedicated to fractures of the proximal humerus and was, therefore, also appropriate for this indication.

The effects of orthobiologics in the treatment of tendon pathologies: a systematic review of preclinical evidence.

PURPOSE: The aim of this systematic review is to explore the current available knowledge about tendon disorders and orthobiologics derived by preclinical experiments to evaluate their role and efficacy in the different stages and conditions related to the tendon healing processes. METHODS: The systematic review was performed according to the PRISMA guidelines. Different electronic databases (MEDLINE, Web of Science, EMBASE) were searched for studies investigating orthobiologics (PRP and cell-based products from adipose tissue or bone marrow) in animal models or veterinary clinical trials for tendon pathologies (complete/partial tendon ruptures, rotator cuff tears, tendinopathy, enthesis-related injuries). Data regarding the specific product used, the treatment site/pathology, the host and the model were collected. The results were classified into the following categories: histological, biomechanical, molecular and imaging. RESULTS: A large pool of preclinical studies on tendon disorders have been found on platelet-rich plasma (PRP), while data about stromal vascular fraction (SVF) and bone marrow concentrate (BMAC) are still limited and frequently focused on expanded cells, rather than orthobiologics prepared at the point of care. The effect of PRP is related to an acceleration of the healing process, without improvements in the final structure and properties of repaired tendon. Cell-based products have been reported to produce more durable results, but the level of evidence is currently insufficient to draw clear indications. CONCLUSIONS: The preclinical results about orthobiologics applications to tendon pathologies would support the rationale of their clinical use and encourage the performance of clinical trials aimed to confirm these data in human subjects.

Coronal Shear Fractures of the Distal Humerus.

Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.

Relationship Between the Lateral Collateral Ligament of the Elbow and the Kocher Approach: A Cadaver Study.

PURPOSE: The lateral ulnar collateral ligament (LUCL) is considered to be the portion of the lateral collateral ligament playing the most important stabilizing role. Iatrogenic forms of posterolateral rotatory instability have been described. The Kocher approach is a popular approach to the lateral side of the elbow. The aim of this study was to describe the relationship between the LUCL and the Kocher interval. METHODS: The Kocher interval was identified and marked in 20 cadavers. The LUCL was identified and the distance between the LUCL insertion on the tubercle of the cresta supinatoris and the Kocher interval was calculated (TK distance). This distance was considered 0 if the Kocher interval was directly above the tubercle, as a positive value if it was anterior to the tubercle, and as a negative value if it was posterior. Finally, the Kocher interval was sharply opened, and elbow stability was tested using the posterolateral rotatory drawer test. RESULTS: A discrete LUCL was identified in 16 specimens. The mean TK distance was -2.3 ± 4.4 mm (range, -11 to +10). The median TK distance was -3 mm. The posterolateral rotatory drawer test was positive for subluxation after the sharp incision of the Kocher interval in 15 specimens. The median TK distance was significantly higher in the stable group (+2 mm) than in the unstable group (-3 mm). CONCLUSIONS: The LUCL often lies beneath the Kocher interval and is at risk during the Kocher approach. CLINICAL RELEVANCE: Iatrogenic forms of posterolateral rotatory instability could result from this approach.

Outcomes of 188 Proximal Humeral Fractures Treated with a Dedicated External Fixator with Follow-up Ranging from 2 to 12 Years.

BACKGROUND: The treatment of a displaced proximal humeral fracture is still a matter of controversy. Minimally invasive techniques are considered promising options. The purpose of this study was to report outcomes at medium to long-term follow-up after surgical treatment with pins stabilized with an external fixator. METHODS: A total of 235 patients (average age, 64 years [95% confidence interval (CI), 62 to 65 years]) were treated with closed or open reduction and fixation with pins stabilized by an external fixator specifically designed for proximal humeral fractures. The pins were inserted using a "pins-crossing-fracture" or a "pins-bridging-fracture" technique. One hundred and eighty-eight patients had a minimum radiographic and clinical follow-up of 2 years. Outcomes were assessed using the Oxford Shoulder Score (OSS), the subjective shoulder value (SSV), a visual analog scale (VAS) for pain, and, for 155 patients, the Constant score. RESULTS: Eighty-one (43%) of the 188 patients had a 2-part fracture, 60 (32%) had a 3-part fracture, and 47 (25%) had a 4-part fracture. The reduction was performed with percutaneous maneuvers in 120 shoulders or a deltopectoral approach, in 68. The external fixator was applied using a "pins-crossing-fracture" technique in 133 shoulders and using a "pins-bridging-fracture" technique in 55. At last follow-up, mean clinical scores were as follows: OSS, 42.6 (95% CI, 42 to 44); SSV, 85.5 (95% CI, 83 to 88); and VAS for pain, 1 (95% CI, 0.7 to 1.2). The complication rate at 3 months was 16% (37 of 235). The most frequent complication was pin-track infection (19 of 235, 8%). A total of 50 patients had ≥1 complication (50 of 188, 27%) and 6 (3%) underwent revision surgery. More complications were observed with the "pins-crossing-fracture" technique. CONCLUSIONS: In our experience, the use of the external fixator has been a valuable option in the treatment of proximal humeral fractures. The complication and revision rates were acceptable. Most of the complications encountered were manageable without revision surgery. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Does the Harvesting Site Influence the Osteogenic Potential of Mesenchymal Stem Cells?

Total hip arthroplasty (THA) represents one of the commonest surgical procedures in the orthopedic field. Osteointegration of the implant with native bone is essential for an optimal result; thus, the quality of the patient's bone surrounding the implant (i.e., the bone stock) is crucial. However, in some cases, the bone stock is insufficient and needs to be improved with autologous grafts rich in multipotent cells (i.e., from the iliac crest, from the head of the femur, or from the subchondral bone harvested from the acetabulum) or allogenic frozen bone. It is not known if the harvesting site may influence the osteogenic potential of these cells. Thus, our aim was to characterize and compare multipotent cells collected from the bone marrow, acetabular subchondral bone, and trabecular bone on the femoral head with a focus on osteogenic differentiation. The cells from three sources had a fibroblast-like phenotype and expressed surface antigens CD73, CD90, and CD105 and are negative to CD11b, CD34, and CD45. Although all these cells could be induced to differentiate into osteoblasts, chondrocytes, and adipocytes, they displayed different differentiation potentials. In osteogenic differentiation condition, the cells from the acetabulum had the lowest accumulation of calcium deposit while the cells originated from the bone marrow and femur created a considerably increased amount of the deposit. These findings were confirmed by quantitative polymerase chain reaction (qPCR). In chondrogenic and adipogenic conditions, bone marrow cells possessed a predominant differential capacity compared with the others, illustrated by high collagen type II expression together with a cartilage-like lacuna structure and the presence of fat-specific markers, respectively. To our knowledge, this is the first study comparing and demonstrating that the progenitor cells obtained from diverse surgical sites in hip replacement procedure share common characteristics of MSC but differ about plasticity and may provide rational for clinical application in cell therapy and bone grafting. The project number L1033 is registered with ClinicalTrials.gov NCT03369457.

Corrigendum to "Pulsed Electromagnetic Fields Improve Tenogenic Commitment of Umbilical Cord-Derived Mesenchymal Stem Cells: A Potential Strategy for Tendon Repair-An In Vitro Study".

[This corrects the article DOI: 10.1155/2018/9048237.].

Pulsed Electromagnetic Fields Improve Tenogenic Commitment of Umbilical Cord-Derived Mesenchymal Stem Cells: A Potential Strategy for Tendon Repair-An In Vitro Study.

Tendon repair is a challenging procedure in orthopaedics. The use of mesenchymal stem cells (MSCs) and pulsed electromagnetic fields (PEMF) in tendon regeneration is still investigational. In this perspective, MSCs isolated from the human umbilical cord (UC) may represent a possible candidate for tendon tissue engineering. The aim of the study is to evaluate the effect of low-frequency PEMF on tenogenic differentiation of MSCs isolated from the human umbilical cord (UC-MSCs) in vitro. 15 fresh UC samples from women with healthy pregnancies were retrieved at the end of caesarean deliveries. UC samples were manually minced into small fragments (less than 4 mm length) and cultured in MSC expansion medium. Part of the UC-MSCs was subsequently cultured with PEMF and tenogenic growth factors. UC-MSCs were subjected to pulsed electromagnetic fields for 2 h/day, 4 h/day, or 8 h/day. UC-MSCs cultured with FGF-2 and stimulated with PEMF showed a greater production of collagen type I and scleraxis. The prolonged exposure to PEMF was also related to the greatest expression of tenogenic markers. Thus, the exposure to PEMF provides a positive preconditioning biophysical stimulus, which may enhance UC-MSC tenogenic potential.

Large Osteochondral Allografts of the Knee: Surgical Technique and Indications.

Large osteochondral allograft (OCA) transplant has become a valid alternative to restore articular surface in challenging articular lesions in young and active patients, either in primary or in revision procedures. Several studies support the effectiveness and safety of OCA, but costs and graft availability limit their use. The indications are the treatment of symptomatic full-thickness cartilage lesions greater than 3 cm 2 , deep lesions with subchondral damage, or revision procedures when a previous treatment has failed. The goal of the transplant is to restore the articular surface with a biological implant, allow return to daily/sports activities, relieve symptoms, and delay knee arthroplasty. Grafts can be fresh, fresh-frozen, or cryopreserved; these different storage procedures significantly affect cell viability, immunogenicity, and duration of the storage. Dowel and shell technique are the two most commonly used procedures for OCA transplantation. While most cartilage lesions can be treated with the dowel technique, large and/or geometrically irregular lesions should be treated with the shell technique. OCA transplantation for the knee has demonstrated reliable mid- to long-term results in terms of graft survival and patient satisfaction. Best results are reported: in unipolar lesions, in patients younger than 30 years, in traumatic lesions and when the treatment is performed within 12 months from the onset of symptoms.

Two-Stage Treatment of a Large Pelvic Cystic Pseudotumor in a Metal-On-Metal Total Hip Arthroplasty.

The authors report a case of a huge cystic pseudotumor, surrounding a failed metal-on-metal total hip arthroplasty (THA). The cyst surrounded the hip anteriorly, occupied part of the anterior portion of the thigh, and extended to the anterolateral aspect of the abdomen. The case was treated by a two-stage procedure. The first stage consisted of a percutaneous drainage of the fluid content of the cyst (∼1,200 mL). This procedure reduced the risk of tearing the cyst capsule spreading the liquid in the tissues surrounding the THA, and in the abdomen. Thanks to this simple procedure, the second stage treatment consisted of a relatively usual THA revision. The patient recovered completely from the treatment and returned to pain-free full activities of daily living.

Prognostic factors for mortality after hip fracture: Operation within 48 hours is mandatory.

The aim of this study was to assess whether surgery delay and other variables are associated with an increased mortality rate after surgical treatment of hip fractures in the elderly. Patients treated for a proximal femoral fracture at our Orthopaedic Department between 2005 and 2012 were included in this study. A logistic regression was performed to evaluate the relationship between mortality rate at different follow-up times (30 days, six months and one year) and different patient or treatment variables. A total of 1448 consecutive patients with 1558 proximal femoral fractures (55 bilateral) were enrolled in this study (mean age 80.3 years, 75.8% female). The postoperative mortality rate was 4% at 30 days, 14.1% at six months, and 18.8% at one year after surgery. Logistic regression revealed an increased mortality at all the endpoints in patients affected by more than two co-morbidities (respectively OR30-day=2.003, OR6-month=1.8654 and OR1-year=1.5965). Male sex was associated with an increased six-month (OR=1.7158) and one-year (OR=1.9362) mortality. Patients aged under 74 years had a decreased mortality at all endpoints (OR30-day=0.0703, OR6-month=0.2191 and OR1-year=0.2486). In this study, the surgery delay influenced mortality at one-year follow-up: operating within 48hours was associated with a decreased mortality rate (OR=0.7341; p=0.0392). Additionally, the patients who were operated on within 72hours were specifically analysed to understand if the option of 'operating within day 3' was acceptable. In the logistic regression, operating between 48 and 72hours was not reported as a risk factor for mortality, both compared to early surgery (within 48 hours) and to late surgery (after 72hours). This study showed that age, sex and number of co-morbidities influenced both early and late mortality in patients affected by proximal hip fractures. Early surgery influenced late mortality, with a decreased risk in patients operated on within 48hours. The option of operating within day 3 is not a valid alternative.

Non-surgical treatments for the management of early osteoarthritis.

Non-surgical treatments are usually the first choice for the management of knee degeneration, especially in the early osteoarthritis (OA) phase when no clear lesions or combined abnormalities need to be addressed surgically. Early OA may be addressed by a wide range of non-surgical approaches, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as physical therapies and novel biological minimally invasive procedures involving injections of various substances to obtain a clinical improvement and possibly a disease-modifying effect. Numerous pharmaceutical agents are able to provide clinical benefit, but no one has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level. Patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. Among these, exercise is an effective conservative approach, while physical therapies lack literature support. Even though a combination of these therapeutic options might be the most suitable strategy, there is a paucity of studies focusing on combining treatments, which is the most common clinical scenario. Further studies are needed to increase the limited evidence on non-surgical treatments and their combination, to optimize indications, application modalities, and results with particular focus on early OA. In fact, most of the available evidence regards established OA. Increased knowledge about degeneration mechanisms will help to better target the available treatments and develop new biological options, where preliminary results are promising, especially concerning early disease phases. Specific treatments aimed at improving joint homoeostasis, or even counteracting tissue damage by inducing regenerative processes, might be successful in early OA, where tissue loss and anatomical changes are still at very initial stages.

The use of autologous adult, allogenic juvenile, and combined juvenile-adult cartilage fragments for the repair of chondral defects.

PURPOSE: The goal of the study was to evaluate the repair of chondral lesions treated with combined autologous adult/allogenic juvenile cartilage fragments, compared with isolated adult and isolated juvenile cartilage fragments. METHODS: Fifty-eight adult (>16 week old) and five juvenile (<6 week old) New Zealand White female rabbits were used. A large osteochondral defect was created in the center of the femoral trochlea of adult rabbits. The rabbits were divided in four groups: Group 1 = untreated defects (controls); Group 2 = adult cartilage fragments; Group 3 = juvenile cartilage fragments; and Group 4 = adult + juvenile cartilage fragments. Killings were performed at 3 and 6 months. The defects were evaluated with ICRS macroscopic score, modified O'Driscoll score, and Collagen type II immunostaining. RESULTS: At 3 months, Group 4 performed better than Group 1, in terms of modified O'Driscoll score (p = 0.001) and Collagen type II immunostaining (p = 0.015). At 6 months, Group 4 showed higher modified O'Driscoll score (p = 0.003) and Collagen type II immunostaining score (p < 0.001) than Group 1. Histologically, also Group 3 performed better than Group 1 (p = 0.03), and Group 4 performed better than Group 2 (p = 0.004). CONCLUSIONS: Mixing adult and juvenile cartilage fragments improved cartilage repair in a rabbit model. In the clinical setting, a new "one-stage" procedure combining the two cartilage sources can be hypothesized, with the advantages of improved chondral repair and large defect coverage, because of the use of an off-the-shelf juvenile allograft. Further studies on larger animals and clinical trials are required to confirm these results.

Mechanical Stimulation (Pulsed Electromagnetic Fields "PEMF" and Extracorporeal Shock Wave Therapy "ESWT") and Tendon Regeneration: A Possible Alternative.

The pathogenesis of tendon degeneration and tendinopathy is still partially unclear. However, an active role of metalloproteinases (MMP), growth factors, such as vascular endothelial growth factor (VEGF) and a crucial role of inflammatory elements and cytokines was demonstrated. Mechanical stimulation may play a role in regulation of inflammation. In vitro studies demonstrated that both pulsed electromagnetic fields (PEMF) and extracorporeal shock wave therapy (ESWT) increased the expression of pro-inflammatory cytokine such as interleukin (IL-6 and IL-10). Moreover, ESWT increases the expression of growth factors, such as transforming growth factor ß(TGF-ß), (VEGF), and insulin-like growth factor 1 (IGF1), as well as the synthesis of collagen I fibers. These pre-clinical results, in association with several clinical studies, suggest a potential effectiveness of ESWT for tendinopathy treatment. Recently PEMF gained popularity as adjuvant for fracture healing and bone regeneration. Similarly to ESWT, the mechanical stimulation obtained using PEMFs may play a role for treatment of tendinopathy and for tendon regeneration, increasing in vitro TGF-ß production, as well as scleraxis and collagen I gene expression. In this manuscript the rational of mechanical stimulations and the clinical studies on the efficacy of extracorporeal shock wave (ESW) and PEMF will be discussed. However, no clear evidence of a clinical value of ESW and PEMF has been found in literature with regards to the treatment of tendinopathy in human, so further clinical trials are needed to confirm the promising hypotheses concerning the effectiveness of ESWT and PEMF mechanical stimulation.

Design and Testing of the Degree of Shoulder Involvement in Sports (DOSIS) Scale.

BACKGROUND: For athletes affected by shoulder problems, the most important expectation is to resume sporting activities. The ability to return to sport is related to several parameters, including the type and level of sport played. By focusing on these parameters, the Degree of Shoulder Involvement in Sports (DOSIS) scale allows for a better assessment of the involvement of the shoulder in sports. PURPOSE: To design the DOSIS scale and test its psychometric features. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The DOSIS scale was developed as a patient self-administered scale by the Sport Committee of SIGASCOT (Società Italiana del Ginocchio Artroscopia Sport Cartilagine Tecnologie Ortopediche) to score sports activity based on 3 parameters: (1) type of sport, (2) frequency with which the sport is played, and (3) level at which the sport is played. In a subsequent phase, the psychometric features of the DOSIS scale were measured in a cohort of 85 patients who were affected by recurrent anterior shoulder instability and who underwent an open Bristow-Latarjet procedure or an arthroscopic Bankart repair. The content validity, criterion validity, construct validity, responsiveness, and test-retest reliability were measured and compared with the psychometric features of the Tegner activity scale. RESULTS: Neither the DOSIS nor the Tegner activity scale showed floor or ceiling effects, but the DOSIS scale had a different distribution of scores, with a tendency toward a higher percentage of patients with high scores. The test-retest reliability analysis of the DOSIS scale revealed excellent intraobserver reliability (intraclass correlation coefficient = 0.96). Regarding the construct validity, 3 of the 4 hypotheses that we tested were significant. The DOSIS scale showed good criterion validity when compared with the Tegner activity scale (ρ = 0.3, P = .003), and the effect size between the preoperative and postoperative DOSIS scale was 1.1. CONCLUSION: The DOSIS scale showed acceptable psychometric features and seems to be a valid instrument for shoulder assessment in athletes.

PRP and articular cartilage: a clinical update.

The convincing background of the recent studies, investigating the different potentials of platelet-rich plasma, offers the clinician an appealing alternative for the treatment of cartilage lesions and osteoarthritis. Recent evidences in literature have shown that PRP may be helpful both as an adjuvant for surgical treatment of cartilage defects and as a therapeutic tool by intra-articular injection in patients affected by osteoarthritis. In this review, the authors introduce the trophic and anti-inflammatory properties of PRP and the different products of the available platelet concentrates. Then, in a complex scenario made of a great number of clinical variables, they resume the current literature on the PRP applications in cartilage surgery as well as the use of intra-articular PRP injections for the conservative treatment of cartilage degenerative lesions and osteoarthritis in humans, available as both case series and comparative studies. The result of this review confirms the fascinating biological role of PRP, although many aspects yet remain to be clarified and the use of PRP in a clinical setting has to be considered still exploratory.

Bone marrow derived stem cells in joint and bone diseases: a concise review.

Stem cells have huge applications in the field of tissue engineering and regenerative medicine. Their use is currently not restricted to the life-threatening diseases but also extended to disorders involving the structural tissues, which may not jeopardize the patients' life, but certainly influence their quality of life. In fact, a particularly popular line of research is represented by the regeneration of bone and cartilage tissues to treat various orthopaedic disorders. Most of these pioneering research lines that aim to create new treatments for diseases that currently have limited therapies are still in the bench of the researchers. However, in recent years, several clinical trials have been started with satisfactory and encouraging results. This article aims to review the concept of stem cells and their characterization in terms of site of residence, differentiation potential and therapeutic prospective. In fact, while only the bone marrow was initially considered as a "reservoir" of this cell population, later, adipose tissue and muscle tissue have provided a considerable amount of cells available for multiple differentiation. In reality, recently, the so-called "stem cell niche" was identified as the perivascular space, recognizing these cells as almost ubiquitous. In the field of bone and joint diseases, their potential to differentiate into multiple cell lines makes their application ideally immediate through three main modalities: (1) cells selected by withdrawal from bone marrow, subsequent culture in the laboratory, and ultimately transplant at the site of injury; (2) bone marrow aspirate, concentrated and directly implanted into the injury site; (3) systemic mobilization of stem cells and other bone marrow precursors by the use of growth factors. The use of this cell population in joint and bone disease will be addressed and discussed, analysing both the clinical outcomes but also the basic research background, which has justified their use for the treatment of bone, cartilage and meniscus tissues.

A future in our past: the umbilical cord for orthopaedic tissue engineering.

The umbilical cord (UC) has recently been added to the list of potential cell sources for tissue engineering and regenerative medicine purposes. Although the UC is usually discarded after delivery, UC storage in special tissue banks is becoming an increasingly common procedure. Indeed, the capacity of UC cells to be directed toward different phenotypes makes this tissue an ideal cell source for regenerative medicine in orthopedics and in other fields. In this paper, these issues are presented and discussed, together with the potential of this cell source for allogeneic use. This article also looks at the anatomy of the UC from both the macroscopic and the cellular perspective and considers its extraordinary potential for research and clinical applications.

Autologous cartilage fragments in a composite scaffold for one stage osteochondral repair in a goat model.

We propose a culture-free approach to osteochondral repair with minced autologous cartilage fragments loaded onto a scaffold composed of a hyaluronic acid (HA)-derived membrane, platelet-rich fibrin matrix (PRFM) and fibrin glue. The aim of the study was to demonstrate in vitro the outgrowth of chondrocytes from cartilage fragments onto this scaffold and, in vivo, the formation of functional repair tissue in goat osteochondral defects. Two sections were considered: 1) in vitro: minced articular cartilage from goat stifle joints was loaded onto scaffolds, cultured for 1 or 2 months, and then evaluated histologically and immunohistochemically; 2) in vivo: 2 unilateral critically-sized trochlear osteochondral defects were created in 15 adult goats; defects were treated with cartilage fragments embedded in the scaffold (Group 1), with the scaffold alone (Group 2), or untreated (Group 3). Repair processes were evaluated morphologically, histologically, immunohistochemically and biomechanically at 1, 3, 6 and 12 months. We found that in vitro, chondrocytes from cartilage fragments migrated to the scaffold and, at 2 months, matrix positive for collagen type II was observed in the constructs. In vivo, morphological and histological assessment demonstrated that cartilage fragment-loaded scaffolds led to the formation of functional hyaline-like repair tissue. Repair in Group 1 was superior to that of control groups, both histologically and mechanically. Autologous cartilage fragments loaded onto an HA/PRFM/fibrin glue scaffold provided a viable cell source and allowed for an improvement of the repair process of osteochondral defects in a goat model, representing an effective alternative for one-stage repair of osteochondral lesions.

Peroneal tendoscopy.

Peroneal tendoscopy is an innovative technique that allows visualization of the tendons from the myotendinous junction to the peroneal tubercle, together with adjacent anatomic structures such as the recently unveiled vincula. Through a minimally invasive approach, it is possible to diagnose and treat several disorders, such as common tenosynovitis, accessory muscles, hypertrophic bony prominences, and thickened vincula, that can cause pain and tendon catching. Surgical morbidity and postoperative pain are significantly reduced when compared with open procedures. In this paper, the main indications for peroneal tendoscopy are discussed, the available literature is reviewed, and the surgical technique is described. Advantages of this procedure and current limitations are also presented. Anatomic and histological studies were also performed in order to verify: 1) the feasibility of peroneal tendoscopy for evaluation of peroneal tendons, using cadaver specimens; 2) the presence of nervous tissue in cadaver peroneal vincula as well as in tendoscopic vincula biopsies from patients undergoing surgery for chronic lateral ankle pain.