Recent Achievements in the Development of Biomaterials Improved with Platelet Concentrates for Soft and Hard Tissue Engineering Applications.

Platelet concentrates such as platelet-rich plasma, platelet-rich fibrin or concentrated growth factors are cost-effective autologous preparations containing various growth factors, including platelet-derived growth factor, transforming growth factor ß, insulin-like growth factor 1 and vascular endothelial growth factor. For this reason, they are often used in regenerative medicine to treat wounds, nerve damage as well as cartilage and bone defects. Unfortunately, after administration, these preparations release growth factors very quickly, which lose their activity rapidly. As a consequence, this results in the need to repeat the therapy, which is associated with additional pain and discomfort for the patient. Recent research shows that combining platelet concentrates with biomaterials overcomes this problem because growth factors are released in a more sustainable manner. Moreover, this concept fits into the latest trends in tissue engineering, which include biomaterials, bioactive factors and cells. Therefore, this review presents the latest literature reports on the properties of biomaterials enriched with platelet concentrates for applications in skin, nerve, cartilage and bone tissue engineering.

Outcomes of Open Repair Treatment for Acute Versus Chronic Achilles Tendon Ruptures: Long-Term Retrospective Follow-Up of a Minimum 10 Years-A Pilot Study.

The aim of the present study was to compare repaired Achilles tendon (AT) remodelling, whether its function was restored and what effects the surgery had on our patients' gait cycle in a long-term follow-up study. The study population comprised 30 human subjects treated acutely and chronically for AT ruptures, using the same surgical technique in all cases. The study group was divided into two subgroups regarding the age of their AT injury, i.e., how much time elapsed between the injury and when a correct diagnosis was made and when adequate treatment was applied. Following these criteria, persons presenting at less than 4 weeks postinjury were classified as acute rupture (AR) patients and those presenting at more than 4 weeks after injury were grouped as chronic rupture (CR) patients. Both patient groups were operated on using a surgical method favoured at least a decade ago, i.e., open repair through a posteromedial approach. The AT was augmented with a plantaris longus tendon autograft, followed by suturing using the pull-out suture technique. The results were measured using clinical, ultrasonographic (US) and pedobarographic methods. Our ultrasonographic and pedobarographic findings revealed differences between both patient groups, thus indicating that delayed surgery had negative impacts on treatment success, however, with good long-term functional score outcomes in both patient groups. Nevertheless, delayed treatment of AT ruptures did not leave individual gait phases unaffected, as it also affected the plantar surface and balance performance of the affected limb. As per the results, the Achilles tendon manifested decreased capacity following delayed treatment; however, its long-term functional outcomes were favourable, irrespective of whether it was for acute or chronic patients.

Biomimetic biphasic curdlan-based scaffold for osteochondral tissue engineering applications - Characterization and preliminary evaluation of mesenchymal stem cell response in vitro.

Osteochondral defects remain a huge problem in medicine today. Biomimetic bi- or multi-phasic scaffolds constitute a very promising alternative to osteochondral autografts and allografts. In this study, a new curdlan-based scaffold was designed for osteochondral tissue engineering applications. To achieve biomimetic properties, it was enriched with a protein component - whey protein isolate as well as a ceramic ingredient - hydroxyapatite granules. The scaffold was fabricated via a simple and cost-efficient method, which represents a significant advantage. Importantly, this technique allowed generation of a scaffold with two distinct, but integrated phases. Scanning electron microcopy and optical profilometry observations demonstrated that phases of biomaterial possessed different structural properties. The top layer of the biomaterial (mimicking the cartilage) was smoother than the bottom one (mimicking the subchondral bone), which is beneficial from a biological point of view because unlike bone, cartilage is a smooth tissue. Moreover, mechanical testing showed that the top layer of the biomaterial had mechanical properties close to those of natural cartilage. Although the mechanical properties of the bottom layer of scaffold were lower than those of the subchondral bone, it was still higher than in many analogous systems. Most importantly, cell culture experiments indicated that the biomaterial possessed high cytocompatibility towards adipose tissue-derived mesenchymal stem cells and bone marrow-derived mesenchymal stem cells in vitro. Both phases of the scaffold enhanced cell adhesion, proliferation, and chondrogenic differentiation of stem cells (revealing its chondroinductive properties in vitro) as well as osteogenic differentiation of these cells (revealing its osteoinductive properties in vitro). Given all features of the novel curdlan-based scaffold, it is worth noting that it may be considered as promising candidate for osteochondral tissue engineering applications.

Freeze-Dried Curdlan/Whey Protein Isolate-Based Biomaterial as Promising Scaffold for Matrix-Associated Autologous Chondrocyte Transplantation-A Pilot In-Vitro Study.

The purpose of this pilot study was to establish whether a novel freeze-dried curdlan/whey protein isolate-based biomaterial may be taken into consideration as a potential scaffold for matrix-associated autologous chondrocyte transplantation. For this reason, this biomaterial was initially characterized by the visualization of its micro- and macrostructures as well as evaluation of its mechanical stability, and its ability to undergo enzymatic degradation in vitro. Subsequently, the cytocompatibility of the biomaterial towards human chondrocytes (isolated from an orthopaedic patient) was assessed. It was demonstrated that the novel freeze-dried curdlan/whey protein isolate-based biomaterial possessed a porous structure and a Young's modulus close to those of the superficial and middle zones of cartilage. It also exhibited controllable degradability in collagenase II solution over nine weeks. Most importantly, this biomaterial supported the viability and proliferation of human chondrocytes, which maintained their characteristic phenotype. Moreover, quantitative reverse transcription PCR analysis and confocal microscope observations revealed that the biomaterial may protect chondrocytes from dedifferentiation towards fibroblast-like cells during 12-day culture. Thus, in conclusion, this pilot study demonstrated that novel freeze-dried curdlan/whey protein isolate-based biomaterial may be considered as a potential scaffold for matrix-associated autologous chondrocyte transplantation.

Analysis of Difficulties and Complications Following Implantation of Modular Prostheses in Patients with Lower Limb Bone Tumours.

BACKGROUND: The implantation of a modular prosthesis is the most popular method of reconstruction of bone defects in oncological patients. Along with clear-cut benefits associated with this procedure, there is also an increased risk of complications. Common complications include deep infections, aseptic loosening and mechanical implant damage. This study assessed the risk of complications following the implantation of a resection prosthesis in patients with lower limb bone tumours and to evaluate difficulties encountered during the treatment. MATERIAL AND METHODS: A total of 149 patients with lower limb tumours treated at the Department of Oncological Ortho-paedics in Brzozów had resection prostheses implanted in the years 2016 and 2017. We analysed this series and available literature reports with regard to complications of the procedure and those encountered during the treatment. RESULTS: The mean duration of the surgical procedure was 117±45 minutes. Intraoperative complications occurred in 18 cases. Gluteal muscle failure was seen in 34 (43%) of the 74 patients with proximal femoral tumours, and impaired knee extension was noted in 4 (67%) of the 6 patients following resection of the proximal tibia. There were two cases of dislocation following megaprosthetic reconstruction of the hip joint. Impaired wound healing was noted in 7 (5%) patients. Post-operative trophic lesions of the skin were seen in 2 (2%), and peripheral nerve damage in 2 (2%) patients (fibular nerve). Thromboembolic complications were noted in 3 (3%) patients. No aseptic complications, mechanical implant damage or deaths were recorded. CONCLUSIONS: 1. The most frequently encountered complication following the implantation of a modular prosthesis was muscle failure, which was associated with the extent of the procedure. 2. Aseptic loosening and mechanical implant damage were rare and occurred in the early postoperative period.

Stress radiography in the diagnosis and assessment of the outcomes of surgical treatment of chronic anterolateral ankle instability.

BACKGROUND: In about 20-40% of patients, damage to the soft tissues surrounding the ankle leads to recurrent and chronic pain with signs of instability of the talus in the tibiofibular fork. PURPOSE: The aim of the study was to assess the usefulness of stress X-ray images in the diagnosis of long-term outcomes of conservative versus surgical treatment of anterolateral ankle instability. MATERIAL AND METHODS: Thirty patients with chronic ankle instability (CAI) were recruited for the study. The participants were divided into two groups. The first group consisted of 15 non-operatively treated individuals diagnosed with anterior talofibular ligament (ATFL) damage. The second group consisted of 15 patients who had undergone surgical reconstruction of the ATFL. In both groups of patients, the contralateral normal limb was used as a control. In all patients, anteroposterior and lateral view stress radiographs of both ankles were taken using the TELOS Stress Device (GA - III/E, Hungen, Germany). RESULTS: Statistical tests showed that the surgically treated patients had a significantly greater ankle stability compared to the non-surgically treated patients (P = 0.001 for talar tilt angle and P = 0.009 for anterior drawer distance). The results obtained in this study indicate that this method can also be used in postoperative assessment of the function of the reconstructed lateral ankle ligaments. CONCLUSIONS: Stress radiography is a reliable and safe tool for diagnosing CAI. This imaging method is an objective instrument that can be successfully used in postoperative assessment of the function of the reconstructed ATFL.

Assessment of Physical Performance and Early Treatment Outcomes after Implantation of Modular Prostheses of Femoral and Tibial Shaft.

BACKGROUND: Tumours of bone diaphyses often require resection followed by bone reconstruction. The use of modular pro-sthe-ses permits early limb loading and rapid improvement in physical performance. The aim of this study was to evaluate the func-tioning of patients and early treatment outcomes after the implantation of modular prostheses. The analysis covered the correlation between the extent of resection, physical performance and the number of perioperative complications. MATERIAL AND METHODS: 10 patients (5 women and 5 men) with diaphyseal tumours who had modular prostheses implanted were treated at the Orthopaedic Oncology Department in Brzozów between 2014 and 2018. The mean age of the patients was 51.1 years (range: 26-63 years). Functional outcomes were assessed using the MSTS and the Karnofsky scoring system. A VAS was used to evaluate pain intensity. the extent of resection was also analysed, considering bone length and tumour weight. RESULTS: The mean tumour weight was 374g (150-700g). The length of the implants varied from 10 to 25 cm. The mean dura-tion of hospitalisation was 16 days (14-19 days). At 3 months following the surgery, the intensity of pain had decreased from a mean of 6.8 points to 4.2 points (a decrease of 26% from the pre-operative baseline). The MSTS showed improvement of functional performance from a mean of 10.8 points (36%) to 22.9 points (76%). The Karnofsky scores demonstrated an increase in physical performance from 47 to 67 points (20 points on average). Superficial infection of the wound developed in 1 patient. CONCLUSIONS: 1. The treatment of diaphyseal tumours with modular prostheses produces good functional outcomes. 2. The extent of the resection and the size of the implant have an effect on the post-operative physical performance of the patients. 3. Pre-operative evaluation of the weight of the tumour may be helpful in predicting the patient's post-operative functional status. 4. Phy-sical perfor-mance is better after the resection of femoral vs tibial tumours.

Mosaicplasty for the treatment of osteochondritis dissecans following Legg-Calvé-Perthes disease: a case report and literature review.

Legg-Calvé-Perthes disease leads to hip joint deformity. Osteochondritis dissecans following Perthes disease (OCDP) is a less common entity. Treatment options of OCDP are limited. Osteochondral autologous transfer (OATS) is an established method of treatment of full thickness cartilage defects in different locations. This paper presents the case of a 42-year-old patient diagnosed with symptomatic OCDP and treated with lesion fixation using autologous osteochondral grafts via surgical hip dislocation. At the most recent follow-up, 5.5 years after the surgery, the patient did not complain of any pain during rest or activity. He had painless motion with persisting abduction and internal rotation reduction. Harris hip score (HHS) improved from preoperative 62 to 92 points at most recent follow-up. Treatment protocol was discussed in relation to the literature regarding this clinical topic.

Fixation of femoral head fractures with autologous osteochondral transfer (mosaicplasty).

Posterior fracture dislocation of the femoral head is a rare entity usually requiring open reduction and internal fixation. Results of different fixation methods have been reported, including countersinking screws, headless screws, and bioabsorbable implants. Osteochondral autologous transfer (mosaicplasty) is an established method of treatment of full thickness cartilage defects of the knee, ankle, and elbow. At our institution, posterior fracture-dislocations of the femoral head were treated with femoral head fragment fixation using osteochondral autografts through surgical hip dislocation. Osteochondral plugs were harvested from the non-weight-bearing area of the lateral femoral condyle of the knee and used for fixation of the reduced fragment. This article details the technique and its application.

A seven- to 14-year follow-up study of bipolar hip arthroplasty in the treatment of osteonecrosis of the femoral head.

INTRODUCTION: Bipolar hip arthroplasty (BHA) in the treatment of Ficat stage III osteonecrosis of the femoral head (ONFH) has theoretical advantages over total hip replacement (THR) in that it preserves the natural acetabulum and uses an implant that allows better stability and larger range of movement. The purpose of this study was to evaluate the clinical and radiological outcomes of BHA with uncemented ingrowth stems in the treatment of ONFH. MATERIAL AND METHODS: Thirty-nine hips in 34 patients (two women and 32 men) with a mean age at the time of surgery of 45.31 years (range 30-66 years) operated between 1998 and 2005 were examined in a retrospective evaluation. Mean follow-up was 9.5 years (range 3-14 years). Patients were evaluated with the Harris hip score (HHS). Kaplan-Meier survivorship was calculated to examine the revision rate. Radiographic analysis included evaluation of bipolar head migration, radiolucent lines around the stem and osteolysis in the acetabulum and the femur. RESULTS: Evaluation of clinical results revealed an increase in HHS from 28 points preoperatively to 88.6 points at the most recent follow-up. Radiographic evaluation showed bipolar head migration in 3 hips (7.7%). Survival rate of BHA, with revision THR defined as the endpoint, was 92.31% at ten years (CI 95%). All implanted uncemented stems were stable without any radiographic signs of loosening or osteolysis. CONCLUSIONS: The results of the present study show that implantation of BHA with uncemented ingrowth stem in Ficat stage III is still justified.

Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty): preliminary report.

PURPOSE: The purpose of this study was to evaluate clinical and radiological outcomes of autologous osteochondral transfer (OATS) for femoral head osteonecrosis. METHODS: Twenty-one hips in 20 patients (one woman and 19 men), average patients' age at the time of surgery of 35.4 (range 20-56) years, were treated with OATS for osteonecrosis of the femoral head (ONFH). Seven patients at pre-collapse ARCO stages IIA and IIB were treated with OATS alone. Thirteen patients with large pre-collapse ARCO IIC and post-collapse ARCO III and IV were treated with OATS and morselised bone allografts (OATS/allograft). Harris hip score (HHS) was used for clinical evaluation of outcomes; X-rays were performed to examine the evolution of the disease. Kaplan-Meier survival curves were used to determine the failure of the procedures with conversion to THR defined as endpoint. RESULTS: Follow-up of patients treated with OATS alone was 46.14 (range 18-75) months with HHS improvement from a preoperative mean of 42 to 87.85 points at the latest follow-up examination. Only one patient in this group needed a revision operation with THR. The survival for this group of patients was 85.71 % at four years. Follow-up of patients treated with AOTS/allograft was 32.7 (range 7-84) months with HHS improvement from a preoperative mean of 35.2 to 65.7 points at the latest follow-up examination. One patient died six months after the surgery. There were five conversions to THR because of femoral head collapse in this group of patients with survival of 61.54 % at three years. CONCLUSION: The use of osteochondral grafts offers the possibility of successful treatment for ONFH at small and medium pre-collapse stages. The outcomes of large pre-collapse and post-collapse stages were below our expectations. OATS is a time buying procedure for young patients as it may defer total hip replacement.

Comparison of treatment results of acute and late injuries of the lisfranc joint.

OBJECTIVE: A retrospective comparison of treatment difficulties and treatment outcomes in Lisfranc joint injuries with late and early diagnosis. METHODS: The study group consisted of 10 patients diagnosed and treated properly within six months to 20 years of the accident causing the injury (mean six years). The control group consisted of the same number of randomly selected patients with a similar type of injury treated immediately after the accident. Mean follow-up was 13 years in the study group and eight years in the control group. The analysis evaluated the causes of the delay and the foot function at the time of follow up, measured using the AOFAS Midfoot Scale and the Lublin Foot Functional Score. The scores of the patients were analyzed using the non-parametric Mann-Whitney U test and the non-parametric Wilcoxon test. RESULTS: The control group had statistically significantly better scores on both scales. CONCLUSION: The main cause of treatment delay was misdiagnosis by the primary care physician. Level of Evidence III, Retrospective Comparative Study .

The evaluation of knee bone mineral density following open-wedge high tibial osteotomy.

Examinations of bone density changes in selected knee bone ends were evaluated prospectively in a randomized group of 28 patients, aged from 41 to 65 (mean: 55.3 years), who had varus deformations of their mechanic limb axes, mean 8 degrees. The examinations were conducted during the preoperative period, 10 days, 3, 6, and 12 weeks, as well as 6 and 12 months after the procedure. A statistically significant increase in bone density was observed in the medial tibial condyle area, while a statistically insignificant decrease of bone density was noted in the medial femoral condyles. Bone density increased in the lateral tibial condyle area, whereas there were no density changes in the area of the lateral femoral condyles. The research results demonstrate that the relief achieved in ailments after high tibial osteotomies does not directly correspond to the bone density of the affected areas.

The use of ultrasound in the assessment of the glenoid labrum of the glenohumeral joint. Part II: Examples of labral pathologies.

Labral pathologies of the glenohumeral joint are most commonly caused by trauma. The majority of lesions affect the anterior part of labrum, resulting from much higher frequency of anterior shoulder dislocations over posterior ones. Another subgroup of labral lesions, not directly related to joint instability, are SLAP tears. Other findings include degenerative changes of labrum and paralabral cysts. Diagnostic imaging is crucial for making a decision regarding operative treatment. Apart from a standard X-ray examination, the imaging mainly relies on magnetic resonance or computed tomography arthrography. Based on their own experience, the authors propose the use of ultrasound in the assessment of labral tears of the glenohumeral joint. Different signs indicating labral pathology may be discovered and assessed during ultrasound examination. They include permanent displacement of the labrum onto the glenoid, labral instability during dynamic examination, lack of the labrum in the anatomical position, hypoechoic zone at the base of the labrum >2 mm in width, residual or swollen labrum as well as paralabral cyst(s). The most frequent appearance of labral pathology is displacement of the anteroinferior labrum onto the external aspect of the glenoid typically seen after anterior shoulder dislocation. The another most important US feature is labral instability while dynamically examined. The swelling or reduced size of the labrum usually indicates degeneration. This article presents sonographic images of selected labral pathologies.

An analysis of pathomorphic forms and diagnostic difficulties in tarso-metatarsal joint injuries.

Tarso-metatarsal injuries are rare but frequently missed. Due to the large variation in pathomorphic forms of these injuries, great precision is required when carrying out clinical and X-ray diagnostic procedures. The aim of the study was to describe the different forms of Lisfranc joint injuries and analyse the causes of delayed treatment. The treatment results of acute and chronic injuries were compared in 41 patients, with an average follow-up period of 16 years. Statistically significant poorer results were obtained in the group of chronic cases, based on two functional scores - the AOFAS evaluation questionnaire and the Lublin functional questionnaire. The main factor delaying the start of the proper treatment was diagnostic error during initial admission. The best results were achieved after closed reduction and percutaneous Kirschner wire fixation in acute cases.

Results of operative treatment for ulnar neuropathy in patients with a history of fracture of the lateral part of the humeral condyle in childhood.

BACKGROUND: Fractures of the lateral part of the humeral condyle in childhood very often go undetected and are treated incorrectly, giving rise to numerous late complications. The study evaluated the outcomes of treatment of ulnar neuropathy secondary to a fracture of the lateral part of the humeral condyle in childhood. MATERIAL AND METHODS: The study enrolled 12 patients aged 28-58 who had suffered fractures of the elbow at between 2 and 14 years of age. Arthrosis and a valgus deformity of the joint, contractures in flexion and extension of the elbow as well as ulnar neuropathy were observed after an average of about 30 years after the fracture. The patients accepted posttraumatic deformation of the axis and contractures of the elbow. The indication for operative treatment was the presence of signs of ulnar neuropathy. The treatment consisted in anterior transposition of the nerve. Postoperative follow-up lasted from 4 to 23 years. RESULTS AND CONCLUSIONS: The long-term sequelae of these fractures are a valgus deformity of the elbow, arthrosis of the joint and neuropathy of the ulnar nerve. Ulnar nerve transposition relieves the patients from nerve compression symptoms arising at this level.

[The results of primary total knee arthroplasty with bone stock restoration by autologous grafts from resected bony ends]. / Wyniki pierwotnej protezoplastyki kolan z jednoczesnym uzupelnianiem ubytków substancji kostnej przeszczepami z resekowanych konców stawowych.

AIM OF THE STUDY: The aim of the study is the comparison of results of primary total knee arthroplasty with large bone stock deficiencies treated with autologous bone grafts from resected joint ends (both solid and morselized) with the group of patients in whom knee arthroplasty was made without the need of bone grafting. MATERIAL AND METHOD: 342 primary total knee replacements implanted till the end of 2004 at Orthopaedic and Traumatology Department in Lublin were examined. Bone stock defects were treated in 37 knees (35 patients). The necessity of reconstruction resulted from destruction of knee joint surfaces in advanced degenerative osteoarthritic processes or rheumatic disease. Autologous solid bone grafting was used in 22 knees, morselized in 13, meanwhile 2 different required both types of grafts. The medial tibial condyle bone stock defects were the most frequent--26 knees. Control group consists of 39 knees in 33 patients treated in the same period without the need for bone grafting and prostheses were implanted directly on resected surfaces. Preoperative and postoperative knee function was established with Hospital for Special Surgery Score (HSS). The X-rays were analyzed with the special regard for: correctness of implants placing, presence of radiolucence zones both around implants and grafts, and bone grafts healing. RESULTS: The analysis of subsequent X-rays showed bone grafts healing (both solid and morselized) in 21 knees. In 4 knees progressive bone grafts lysis was observed. The remaining knees showed the presence of grafts and lack of evidence of healing in surrounding host bone. No differences were observed in number of intra- and postoperative complications, radiographic knee replacements geometry and long-term clinical results in both groups of patients. CONCLUSIONS: 1) Results of total knee replacements with autologous bone grafting for bone stock reconstruction are comparable with the results of TKR without the need for bone grafting. 2) Natural harvesting of the graft material from resected joint ends and effectiveness of reconstruction increase the value of the method. 3) The durability of early good results need further examination.

[Difficulties and dangers of arthroplasty in valgus knee deformity]. / Trudnosci i niebezpieczenstwa alloplastyki kolan z deformacja koslawa.

In orthopaedic surgeon's opinion arthroplasty in knee joints with valgus deformity is very difficult and risky than in those without deformation or in varus angulation. The authors in the paper analysed deformity morphologies in valgus knees, observed intra-operative problems, as well as obtained results and complications and compare them with those occurred in varus knees. Observations were based on 33 joints (30 persons, 27 females, 3 males), which were operated by primary cemented total knee replacements. The patients' age ranged from 41 to 82 years. The knee function was measured on the base of HSS rating score. The results of HSS obtained before surgery were compared with those from the last control visit. Relaying on surgery reports, analyses of the procedure and the solutions needed to correct the deformity were done. On the basis of X-rays the alignment and positions of the prostheses were evaluated. The results obtained in valgus knees were comparable with TKA in varus knees. The complication rate and necessity of additional steps of the procedure is higher in valgus deformation.