RESUMO
Objective: To assess the effect of PRP on knee articular cartilage content (thickness/volume) and examine the correlation between cartilage changes and clinical outcomes in patients with knee OA. Method: A systematic literature search was performed using the Cochrane methodology in four online databases. Studies were included if they reported on cartilage content with cross-sectional imaging pre- and post-injection. A random-effects model meta-analysis was performed. Correlation with clinical outcomes was evaluated. Results: 14 studies (n â= â1099 patients) from 1452 records met the inclusion criteria: seven RCTs (n â= â688), one prospective (n â= â50), one retrospective (n â= â68), and four case-series (n â= â224). The PRP preparation process and treatment protocol varied widely (follow-up 6-12 months). In meta-analysis, PRP treatment was not associated with a significant increase in cartilage thickness (4 studies, n â= â187, standardized mean difference: Hedges g: 0.079; 95%CI: 0.358 - 0.516; p â= â0.723). Meta-analysis of 3 RCTs (n â= â112) showed no significant difference in the change of overall knee cartilage content with PRP injections compared with no PRP (Hedges' g: 0.217; 95%CI: 0.177 - 0.611; P â= â0.281). Conclusion: The current literature does not support the PRP as chondrogenic in treatment of knee OA. However, there is substantial heterogeneity in the evaluated studies which limits the robustness of any conclusion. An adequately powered RCT, with a standardized PRP regime and standardized high-resolution MRI is needed to definitely define any effect of PRP on knee cartilage content and its relation to clinical outcomes. Until such high-quality evidence becomes available, we recommend that PRP is not administered with the intention of promoting chondrogenesis.
RESUMO
AIMS: To determine whether the radiopaque marker strip, which is woven in surgical swabs, causes measureable wear on metal implants at pressures typically used to wipe off fluid from their surface. MATERIALS AND METHODS: Finger pressure used to wipe a surface was measured and used as a reference pressure for further testing. A tribological wear rig was then used to analyse the wear caused on polished titanium plates by a cobalt chromium pin (the control test), the pin covered by a surgical swab and the pin covered by a radiopaque marker strip. RESULTS: It was found that the cotton part or the radiopaque marker of surgical swabs on polished medical grade titanium plates caused no significant wear. In contrast severe scratching was observed from the cobalt chromium pin on its own. CONCLUSION: To our knowledge, this is the first study in the literature analysing the wear caused by the surgical swabs and radiopaque strip on metal implants. The results suggest that surgical swabs are safe to use on metallic implants at pressures typical of a wiping motion.
Assuntos
Marcadores Fiduciais , Próteses e Implantes , Implantação de Prótese/instrumentação , Fibra de Algodão , Fricção , Dureza , Teste de Materiais , Pressão , TitânioRESUMO
OBJECTIVE: To identify the injury history features reported by patients with anterior cruciate ligament (ACL) injuries and determine whether history may be used to identify patients requiring follow-up appointments from acute trauma services. METHODS: Multisite cross-sectional service evaluation using a survey questionnaire design conducted in the UK. The four injury history features investigated were 'leg giving way at the time of injury', 'inability to continue activity immediately following injury', 'marked effusion' and 'pop (heard or felt) at the time of injury'(LIMP). RESULTS: 194 patients with ACL injury were identified, of which 165 (85.5%) attended an acute trauma service. Data on delay was available for 163 (98.8%) of these patients of which 120 (73.6%) had a follow-up appointment arranged. Patients who had a follow-up appointment arranged waited significantly less time for a correct diagnosis (geometric mean 29 vs 198 days; p<0.001) and to see a specialist consultant (geometric mean 61 vs 328 days; p<0.001). Using a referral threshold of any two of the four LIMP injury history features investigated, 95.8% of patients would have had a follow-up appointment arranged. CONCLUSIONS: Findings support the value of questioning patients on specific injury history features in identifying patients who may have suffered ACL injury. Using a threshold of two or more of the four LIMP history features investigated would have reduced the percentage of patients inappropriately discharged by 22.2%. Evidence presented suggests that this would significantly reduce the time to diagnosis and specialist consultation minimising the chance of secondary complications.