Content of blood cell components, inflammatory cytokines and growth factors in autologous platelet-rich plasma obtained by various methods.

BACKGROUND: The evaluation of the efficacy of platelet-rich plasma (PRP) in clinical practice yields conflicting results and raises numerous controversies. This may be due to different concentrations of biologically active components in PRP obtained with the use of different methods of gravity separation. AIM: To compare the content, repeatability and correlations between biologically active components in PRP obtained with four different commercial systems. METHODS: From a whole blood sample of each of 12 healthy male volunteers, 4 PRP samples were prepared using 4 different commercial kits [Arthrex Autologous Conditioned Plasma (ACP), Mini GPS III, Xerthra, Dr. PRP] in accordance with the instructions provided by the manufacturers. A comparative analysis of blood cell components - 13 selected inflammatory cytokines and 7 growth factors - in the obtained PRP samples was performed using the Kruskal-Wallis test by ranks. The repeatability of results in each method was evaluated by the estimation of the coefficient of variation. The Spearman correlation was used to estimate the relationship between blood cell content and cytokines. RESULTS: Significantly higher concentrations of platelets (PLT), white blood cells (WBC) and red blood cells (RBC) were found in PRP obtained with the use of Mini GPS III than in PRP obtained using other systems. Significant differences in the content of growth factors and cytokines in PRP were found. A positive correlation of the amount of PLT, RBC and WBC with the concentration of most of the growth factors was found but in only three inflammatory cytokines. The obtained correlations between blood cell components and cytokines differed between the systems in terms of statistical significance, which may be due to insufficient sample size. The repeatability of the obtained PLT concentration also varied between protocols with the lowest in Xerthra and the highest in Arthrex ACP. CONCLUSION: Significant differences in the content of biologically active components and their repeatability were found in PRP obtained by various methods, providing new data for further research.

Differences in Accuracy and Radiation Dose in Placement of Iliosacral Screws: Comparison between 3D and 2D Fluoroscopy.

Percutaneous iliosacral screw fixation is a widely accepted method of stabilizing the posterior pelvic ring. Recently developed tools such as 3D-navigated fluoroscopy and computed navigation seem to prevent a surgeon from conducting screw misplacement. The study aimed to comparatively assess the introduction of sacroiliac screw placement using 2D and 3D fluoroscopy in terms of accuracy and radiation exposure. Iliosacral screws were introduced in 37 patients using 2D (group N1) and in 36 patients using 3D fluoroscopy (group N2) techniques. Overall, 61 and 56 screws were introduced in groups N1 and N2, respectively. Screw placement accuracy was assessed using postoperative computed tomography and Smith's scale. Intraoperative radiation exposure was also assessed. No differences were noted between groups in terms of screw positioning accuracy and radiation dose. Both 2D and 3D fluoroscopy provide good visualization for safely placing percutaneous iliosacral joint screws. Using 3D fluoroscopy-based navigation in comparison with 2D fluoroscopy is not advantageous.

The influence of menstrual cycle on the efficiency of stretching.

BACKGROUND: Muscle stretching has been practiced by people for thousands of years. Its effectiveness is well-proven, but the diversity of the obtained results should prompt a search for causative factors. One of the possible explanations can be hormonal fluctuations, which occur during the menstrual cycle. OBJECTIVES: To assess the influence of menstrual cycle on the efficiency of static stretching of hamstrings with special reference to changes in their length. MATERIAL AND METHODS: A total of 534 young women were recruited for the study, but after applying the inclusion criteria, only 48 of them have been accepted. The inclusion criteria for the study comprised a reduced length of the hamstring muscles and a regular menstrual cycle. The whole study included a twofold examination of hamstring length before and after the stretching (3 × 45 s), performed by a physiotherapist. All the measurements were carried out 3 times in individual phases of the menstrual cycle. RESULTS: Statistically significant influence of static stretching upon the length of hamstring muscle was revealed. A change in the passive knee extension (PKE) test was 13.34% (standard deviation (SD) = 10.97), and in active knee extension (AKE) test it was 8.46% (SD = 9.26). Hamstrings length demonstrated no differences in various phases of the menstrual cycle. CONCLUSIONS: Static stretching is an effective tool for the improvement of the length of the hamstring muscle in young women. However, the effectiveness of stretching in healthy women is not influenced by the menstrual cycle phases.

Analysis and comparison of autologous platelet-rich plasma preparation systems used in the treatment of enthesopathies: A preliminary study.

BACKGROUND: Autologous platelet-rich plasma (PRP) injection is an alternative but widely accepted method for the treatment of degenerative changes in tendon attachments known as enthesopathies. The PRP is considered a safe source for high concentrations of the growth factors involved in the healing process. Despite initial promising outcomes, many recent studies report conflicting results for this treatment. This may be due to differences in the concentrations of platelets and growth factors in PRPs obtained using different methods. OBJECTIVES: The aim of this study was to compare PRP preparation systems in terms of morphotic components and selected growth factors to find the most appropriate procedure for the treatment of enthesopathies. MATERIAL AND METHODS: Whole blood samples from 6 healthy male volunteers were collected. Using different commercial kits (Mini GPS III System, Arthrex ACP, and Xerthra, Dr. PRP), 4 PRPs were prepared from the blood of each participant. All samples were analyzed for the content of morphotic components and the following growth factors: transforming growth factor-ß1 (TGF-ß1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and platelet-derived growth factor AA (PDGF-AA). RESULTS: The Mini GPS III produced PRP with the highest concentration of platelets and white blood cells (WBC) compared to the other systems included in the study. Significant differences in the levels of EGF and PDGF-AA were found only between the Mini GPS III and Arthrex ACP. There was positive correlation between the content of platelets and the levels of PDGF-AA and EGF. The red blood cells (RBC) concentration positively correlated with PDGF-AA, EGF and VEGF. CONCLUSIONS: This study showed differences between the morphotic components and levels of selected growth factors in PRP obtained with the different preparation methods. Due to insufficient data, we cannot argue for or against any of the studied protocols for the treatment of enthesopathy. Further studies on a larger population are required to validate our results.

Clinical assessment and comparison of ACL reconstruction using synthetic graft (Neoligaments versus FiberTape).

BACKGROUND: Due to the low potential for primary biological healing of the anterior cruciate ligament (ACL), the most popular approach is currently reconstruction using a graft. Recent research indicates that the technique of strengthening a damaged ligament with synthetic tapes (internal bracing) may be an alternative to reconstructive treatment, especially in cases of partial ACL damage. OBJECTIVES: To compare and evaluate the possibility of using a synthetic graft (Neoligaments or FiberTape) to treat partial lesions of the ACL. MATERIAL AND METHODS: This was a retrospective cohort study. Selected from a pool of 128 patients undergoing primary unilateral intra-articular ACL reconstruction due to partial lesion of the ACL, group I (Neoligaments) and group II (FiberTape) each included 30 patients. Range of motion (ROM), the Lachman test, the anterior drawer test and the pivot-shift test, the Lysholm Knee Scoring Scale, and International Knee Documentation Committee (IKDC) 2000 scale were used for assessment. Follow-up was carried out after 2 years. RESULTS: The knee joint regained anterior stability in both the subjective and objective assessments in all patients in both groups. The subjective results were respectively: in group I, 97.2 ±3.2 points on the Lysholm scale and 93.9 ±6.1 points on the IKDC 2000 scale; in group II, 96.1 ±4.9 points on the Lysholm scale and 93.2 ±6.8 points on the IKDC 2000 scale. Group comparison of the results of the IKDC 2000 scale, Lysholm Scale and ROM obtained postoperatively showed no statistically significant differences between groups. CONCLUSIONS: Reconstruction of partial ACL lesions using a synthetic graft allows regained stability of the knee joint. The results of subjective assessment are comparable with the functional assessment results. The comparison between Neoligaments and FiberTape shows the same functional and objective results, although FiberTape is preferable from an economical perspective.

Treatment results and safety assessment of the LARS system for the reconstruction of the anterior cruciate ligament.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is the prevailing procedure in cases of ACL rupture. OBJECTIVES: To assess the long-term safety of implementing a synthetic ligament with the Ligament Advanced Reinforcement System (LARS) in primary reconstruction of the ACL. MATERIALS AND METHODS: The retrospective analysis involved 403 patients who had undergone ACL reconstruction with the same results in clinical and functional assessments. The patients comprised 2 groups. In group I, a LARS graft was implemented, while in group II, an autograft was used. The Lachman test, anterior drawer test, pivot-shift test, Lysholm scale, IKDC 2000, pain posited to be experienced, the possibility of postoperative complications, the time required to return to work, and revision surgery were all considered and analyzed. RESULTS: The visual analogue scale (VAS) pain score in group I ranged from 37.34 ±8.22 mm on day 3 to 17.21 ±5.45 mm on day 28. In group II, it ranged from 64.72 ±10.20 mm on day 3 (p < 0.05) to 18.67 ±6.57 mm on day 28. The period of time taken to return to office work in group I was 7.04 ±1.82 weeks, and 9.21 ±1.75 weeks in group II (p < 0.05). The time taken to return to physical work in group I was 20.50 ±2.91 weeks, and 21.12 ±3.12 weeks in group II. Postoperative scar and local complications were statistically less prominent in group I. The cost and number of revision surgeries were greater in the first group. CONCLUSIONS: Reconstruction of the ACL using a synthetic graft such as LARS yields similar results to an autograft in a cohort follow-up. Long-term results show a large number of revision surgeries when LARS is used. This method should be used with caution.

A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair.

PURPOSE: The studies comparing the fixation methods being used for the ruptured distal biceps brachii tendon reinsertion show similar outcomes of cortical button and suture anchors usage, however, longer follow-up studies remain necessary. The goal of this study was to compare the clinical and functional three-year outcomes of the cortical button in contrast to the suture anchor fixation. METHODS: A retrospective cohort study comprised of 28 males on average 3 years after surgical reinsertion of the distal biceps brachii tendon with the use of a cortical button (Group I, n = 11) or a suture anchor (Group II, n = 17). The outcomes assessed were range of elbow joint and forearm motion (ROM), arm circumferences, visual analogue scale (VAS), Mayo Elbow Performance Index (MEPI), Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) and forearm flexor and supinator muscle torques measured under isometric and isokinetic conditions. RESULTS: The comparison between the two studied groups revealed no statistically significant differences in ROM (p = 0.24-1.00), circumferences (p = 0.15-0.50), VAS (p = 0.71), MEPI (p = 0.23), Quick DASH (p = 0.61) or in the obtained muscle torque values (p = 0.07-1.00). However, differences in supination ROM between the surgical and non-surgical side were found in both groups (p = 0.01-0.02), and differences in pronation (p = 0.02) were found in Group II. The muscle torque values obtained in the surgical, dominant limb were lower than those in the nonsurgical, nondominant limb. CONCLUSION: The comprehensive comparison of three-year outcomes of cortical button versus suture anchor fixations did not favour one fixation method over the other, and the results justify the clinical usage of both methods.

Surgical Management of Distal Biceps Tendon Anatomical Reinsertion Complications: Iatrogenic Posterior Interosseous Nerve Palsy.

BACKGROUND Although iatrogenic posterior interosseous nerve (PIN) palsy is an uncommon complication of ruptured distal biceps brachii tendon surgical anatomical reinsertion, it is the most severe complication leading to functional limitation. The present study investigated possible types of PIN palsy as a postoperative complication of anatomical distal biceps tendon reinsertion, and aimed to clinically assess patients at 2 years after its surgical treatment. MATERIAL AND METHODS The studied sample comprised 7 male patients diagnosed with an iatrogenic PIN palsies after anatomical reinsertion of the distal biceps tendon, who were referred to the reference center for management of a peripheral nervous system injury. The nerve injury was intraoperatively evaluated. The clinical assessment used the Medical Research Council (MRC) System for motor recovery, and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) was performed before the surgical treatment of the PIN injuries and at 2 years postoperatively. In all studied cases, electromyography was performed preoperatively and postoperatively. RESULTS The comparison of the preoperative (x=1.43±0.53) and postoperative (x=4.71±0.49) results of the motor recovery of the PIN demonstrated a statistically significant improvement (p<0.001). Moreover, the results of functional assessments with the use of the Quick DASH questionnaire significantly improved (p<0.001) postoperatively (x=6.14±6.86) compared to the preoperative evaluations (x=54.29±12.05). CONCLUSIONS The PIN palsies as complications of the surgical anatomical reinsertion of ruptured distal biceps brachii resulted from mechanical nerve compression or direct intraoperative damage. The 2-year outcomes justified the clinical use of surgical management for iatrogenic PIN palsy.

Retrospective Evaluation of Surgical Anatomical Repair of Distal Biceps Brachii Tendon Rupture Using Suture Anchor Fixation.

BACKGROUND To date, no consensus has been reached regarding the preferred fixation method to use in the repair of distal biceps brachii tendon rupture. The aim of this study was to clinically and functionally (Mayo Elbow Performance Index, MEPI) assess the upper limb after surgical anatomic reinsertion of the distal biceps brachii tendon with the use of suture anchor fixation method with regard to postoperative time and limb dominance, and to assess postoperative complications. MATERIAL AND METHODS The sample comprised 18 males (age 52.09±8.89 years) after surgical anatomical distal biceps brachii reinsertion using suture anchor fixation. A comprehensive clinical and functional evaluation and pain assessment were performed. RESULTS In terms of postoperative complications, an isolated case of surgical site sensory disturbances was noted. Circumferences (p-value 0.21-1.00) and ROM (p-value 0.07-1.00) were similar in the operated and nonoperated limbs. The isometric torque (IT) values of muscles flexing and supinating the forearm were comparable in both limbs (p-value 0.14-0.95), but in patients with the operated dominant limb, the mean IT value was not higher than the value obtained in the nonoperated nondominant one. The MEPI indicated good and excellent results (80.00±15.00-90.00±8.66 points), but a detailed individual analysis showed that reported scores were not in line with objectively measured features. CONCLUSIONS The results of the comprehensive retrospective evaluation justify the clinical use of suture anchors fixation method in the surgical anatomical reinsertion of a ruptured distal biceps brachii tendon. The assessment of a patient should always report both subjective and objective measures.

Long-Term Results of Neurectomy Through a Dorsal Approach in the Treatment of Morton's Neuroma.

BACKGROUND: Morton's neuroma, a painful enlargement of the plantar digital nerve between the metatarsal heads, is a common cause of metatarsalgia. The etiology and treatment are still a controversial matter. OBJECTIVES: The objective of this study was to evaluate the long-term follow-up results of neurectomy through a dorsal approach and to identify prognostic factors that can affect the final outcome. MATERIAL AND METHODS: The study included 41 patients who were treated for Morton's neuroma. Their average age was 44 years (range: 25-69 years). The average follow-up time was 7.4 years (range: 5-12 years). Surgery was performed through a dorsal approach. The clinical evaluations, visual analog scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were assessed. RESULTS: The mean preoperative AOFAS score was 39.4 ± 7.84 and the mean postoperative AOFAS score was 83.4 ± 12.1. The mean preoperative VAS scale was 7.04 ± 1.4 and the mean postoperative VAS scale was 1.4 ± 0.8. There were 31 patients (76%) with very good results in the subjective and objective patient assessments; six (15%) had good results; one (2%) had satisfactory results and three (7%) had poor results. Statistically significant differences in the results between single and multiple neuromas were found, depending on the size of the neuromas and the duration of the symptoms. There were no statistically significant differences depending on the time between surgery and assessment, on steroid injections before operation or on the duration of preoperative conservative treatment. CONCLUSIONS: Despite the development of less invasive techniques and very good outcomes in a short period of time, long-term results have shown that neurectomy is still useful in the treatment of Morton's neuroma. The results of the study show that the outcome does not change during the postoperative follow-up period. The best results were achieved in the case of single neuromas larger than 3 mm that were resected within 12 months of the onset of symptoms.

Causes of Secondary Radial Nerve Palsy and Results of Treatment.

BACKGROUND The aim of this study was to analyze the causes that lead to secondary damage of the radial nerve and to discuss the results of reconstructive treatment. MATERIAL AND METHODS The study group consisted of 33 patients treated for radial nerve palsy after humeral fractures. Patients were diagnosed based on clinical examinations, ultrasonography, electromyography, or nerve conduction velocity. During each operation, the location and type of nerve damage were analyzed. During the reconstructive treatment, neurolysis, direct neurorrhaphy, or reconstruction with a sural nerve graft was used. The outcomes were evaluated using the Medical Research Council (MRC) scales and the quick DASH score. RESULTS Secondary radial nerve palsy occurs after open reduction and internal fixation (ORIF) by plate, as well as by closed reduction and internal fixation (CRIF) by nail. In the case of ORIF, it most often occurs when the lateral approach is used, as in the case of CRIF with an insertion interlocking screws. The results of the surgical treatment were statistically significant and depended on the time between nerve injury and revision (reconstruction) surgery, type of damage to the radial nerve, surgery treatment, and type of fixation. Treatment results were not statistically significant, depending on the type of fracture or location of the nerve injury. CONCLUSIONS The potential risk of radial nerve neurotmesis justifies an operative intervention to treat neurological complications after a humeral fracture. Adequate surgical treatment in many of these cases allows for functional recovery of the radial nerve.

Polymers as Carriers of Gentamicin in Traumatology and Orthopedic Surgery - Current State Of Knowledge.

Osteomyelitis in patients undergoing surgery because of injuries and diseases of the musculoskeletal system is a serious clinical, economic and social problem. It is one of the greatest therapeutic challenges in traumatology and orthopedic surgery. To achieve the best results in the treatment of osteomyelitis, surgical debridement and intravenous antibiotic therapy is supported by local antibiotic delivery. Many different substances can be used as drug carriers. In this study we present and compare some polymers used as carriers of gentamicin. Some of them, such as poly(methyl methacrylate), are well known and have been used for 30 years, and others, such as polycaprolactone, polyacrylic acid, polyanhydrides, poly-trimethylene carbonate, polylactide, polyglycolide and poly(trimethylene carbonate), are perspectives for the future. In this study, we have tried to briefly present all of these polymers and compare some of their features. We have concentrated on the pharmacokinetics and bioactivity of such implants, which are important aspects for their potential practical use.

A Retrospective Evaluation of Anatomical Reinsertion of the Distal Biceps Brachii Tendon Using an ACL TightRope® RT with a Titanium Cortical Button and Ultra High Molecular Weight Polyethylene Suture: A Preliminary Report.

BACKGROUND: Various surgical techniques for treating distal biceps brachii tendon injury have been described, and to date there is no consensus regarding the preferred fixation method for the anatomic reinsertion of the ruptured tendon. OBJECTIVES: The aim of the study was to clinically and functionally evaluate the upper limb after surgical anatomic reinsertion of the distal biceps brachii tendon using an ACL TightRope® RT with a titanium cortical button and ultra high molecular weight polyethylene (UHMWPE) suture, and to assess postoperative complications. MATERIAL AND METHODS: The sample comprised 3 patients. Clinical examination (history, measurements of the active range of forearm motion, arm circumference, the maximum isometric forearm supination and flexion muscle torque), pain evaluation (on a visual analogue scale [VAS]) and functional assessment (the Mayo Elbow Performance Index [MEPI] and Quick Disabilities of the Arm, Shoulder and Hand [DASH]) were carried out. Complications were documented. RESULTS: The results of the range of motion measurements, arm circumferences and normalized isometric torque values of the muscle groups being studied were comparable in the involved and uninvolved limbs. The MEPI (x = 95.00 ± 10.42) and Quick DASH (x = 8.66 ± 18.04) scores revealed very good results. The VAS results were close to no pain (x = 3.33 ± 5.77 mm). No complications were noted. CONCLUSIONS: The preliminary comprehensive clinical and functional assessment of the upper limb justify the clinical use of the ACL TightRope® RT with a titanium cortical button and UHMWPE suture in surgical anatomic reinsertion of the distal biceps brachii tendon. The early results with a small sample were encouraging, but studies with a larger number of cases and longer follow-up are needed.