The natural history of alpha angle in the last seventeen centuries.

INTRODUCTION: Hip osteoarthritis is one of the most important and debilitating diseases affecting thousands of people all over the world. On the other hand, femoroacetabular impingement (FAI) is one of the known important causes of hip osteoarthritis. Cam deformity frequently presents in FAI showing an increased alpha angle. Increased alpha angle has been observed among young patients involved in demanding physical activities such as in sports (40-60%), whereas among the non-athletic population, increased alpha angle was observed in 15-20%. Although femoroacetabular pathology has been described over the recent years, it is not possible to determine when the angle increase actually begins prior to diagnosis. The aim of our study is to evaluate the femoral alpha angle in different human femurs in different civilization eras in West Mediterranean area. MATERIALS AND METHODS: Available ancient femurs were selected from the Collection Center belonging to the archeological archives (ancient necropolis) from the fourth, fourteenth and eighteenth centuries. A comparison of the alpha angle was made of the measurements from the different groups accompanied by a sample of present-day femurs from the radiology database of CT scans. Data from 243 femoral bones were collected, 50 of which from the fourth century, 26 from the fourteenth century, 68 from the eighteenth century, and 99 femurs from the 20/twenty-first century. RESULTS: Alpha angles in all historical samples showed pathological values (> 55º) up to a maximum of 11.5% of the cases. Meanwhile, the actual series showed pathological alpha angle in 60.1% of the cases with statistical significant differences. CONCLUSION: The studied femurs of the western Mediterranean region from the fourth, fourteenth and eighteenth centuries showed pathological alpha angles in a smaller proportion than the actual sample. LEVEL OF EVIDENCE: Level III, retrospective studies.

Radiation Exposure from Fluoroscopy during Hip Arthroscopy.

Objective Hip arthroscopy for femoroacetabular impingement treatment is a procedure that is not exempted from complications. The most common complications are related to the arthroscopic portals and the traction system. The use of fluoroscopy helps in hip arthroscopy; however, the radiation exposure is a risk that has not yet been studied. Materials and Methods A retrospective study with 100 arthroscopies was performed. Surgical indication in all cases was femoroacetabular impingement. Surgical times and radiation exposure during the procedure had been recorded and reviewed for the present study. Results A mean of 138.20 cGy cm 2 radiation exposures was observed per patient and procedure for a mean time of radiation exposure of 0.36 minutes. These values are much lower than the values described as being at risk by the nuclear security commissions. Conclusions Radiation exposure in a hip arthroscopy due to femoroacetabular impingement is in margins well below the limits at risk for the patient.

Effects of autologous adipose-derived regenerative stem cells administered at the time of anterior cruciate ligament reconstruction on knee function and graft healing.

PURPOSE: To compare the healing and clinical outcomes of anterior cruciate ligament (ACL) reconstruction between patients with or without intraoperative administration of adipose-derived regenerative stem cells (ADRC). METHODS: Between 2013 and 2014, the outcomes of 20 soccer players undergoing ACL reconstruction using bone-patellar tendon-bone autograft infiltrated with ADRC at the end of the procedure were compared to a historical, matched cohort of 19 soccer players undergoing the same procedure without ADRC. Outcomes were obtained at baseline, and 6 and 12 months postop for IKDC (International Knee Documentation Committee), Lysholm, and Lequesne, and at 2, 4, 6, and 12 months postop for VAS (visual analogue scale) for pain and graft maturation to evaluate the ligamentization process (magnetic resonance imaging (MRI)-based). RESULTS: Both groups significantly improved the IKDC (p < 0.001 in both groups), Lysholm (p < 0.001 in both groups), Lequesne index (p < 0.001 in both groups), VAS for pain (p = 0.002 for the ADRC and p < 0.001 for the control group), and MRI scores (p < 0.001 in both groups) in the 12 months postop compared to baseline scores. However, there were no significant differences in the improvement of the outcomes between groups across time (p > 0.05). All patients returned to sports after surgery, but 8 (40%) patients in the ADRC and 13 (68.4%) patients in the control group had lower Tegner activity score at 12 months postop. CONCLUSIONS: Patients receiving ADRC at the time of ACL reconstruction significantly improved knee function and healing/maturation of the graft at 12 months. However, this improvement was not statistically significant compared to a control group undergoing ACL reconstruction alone.

Magnetic resonance imaging evaluation of patellar tendon graft remodelling after anterior cruciate ligament reconstruction with or without platelet-rich plasma.

PURPOSE: To evaluate the stages of patellar tendon graft remodelling using magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) reconstruction with or without platelet-rich plasma (PRP) injection. METHODS: 98 patients aged 18 to 65 years with complete rupture of the ACL were randomised to undergo reconstruction with the autologous patellar tendon grafts with or without PRP injection. For the PRP group, 8 ml of PRP was obtained in the surgery room and was percutaneously injected into the suprapatellar joint after portal suture. MRI was obtained at months 4, 6, and 12. Remodelling stages of the grafts were classified as hypointense, mildly hyperintense, moderately hyperintense, severely hyperintense, and diffusely hyperintense by a radiologist blinded to treatment allocation. RESULTS: More patients in the PRP group than controls attained higher stages of remodelling at month 4 (p=0.003), month 6 (p=0.0001), and month 12 (p=0.354). CONCLUSION: PRP enabled faster remodelling of patellar tendon grafts.