Arthroscopic Matrix-Based Meniscus Repair Surgical Technique With "Goat" Instrument.

Human meniscal treatment with an arthroscopic matrix-based meniscal repair technique is a promising procedure. Heretofore, the procedure has required a skilled surgeon with a great amount of experience in knee arthroscopic surgery and meniscal suturing. A surgical technique using a "goat" delivery clamp has been developed. Technique development followed extensive review and the application of earlier arthroscopic matrix-based meniscal repair techniques, along with cadaveric refinement of the proposed arthroscopic technique. The presented technique includes preparation of the meniscus with initial stabilization of the damaged fragments, preparation of the collagen matrix and placement of this matrix into the open jaws of the goat delivery clamp, introduction of the collagen matrix into the knee and placement of this matrix on the meniscus, suturing of the collagen matrix to the meniscus, and bone marrow blood aspirate injection between the collagen matrix and meniscus.

Meniscus repair via collagen matrix wrapping and bone marrow injection: clinical and biomolecular study.

PURPOSE: The functional outcomes of arthroscopic matrix-based meniscus repair (AMMR) in patients two and five years after the treatment clearly show that the use of the collagen matrix and bone marrow aspirate creates favorable biological conditions for meniscus healing. This study not only provides ten follow-up results but also investigates biomolecular mechanisms governing the regenerative process. METHODS: Case series was based on data collected from patients who underwent AMMR procedure, starting with preoperatively through two-year and five-year till ten-year follow-up. The outcomes are presented as IKDC and the Lysholm subjective scores as well as the imaging results. Biomolecular investigation of the membranes utilized in the AMMR procedure include DNA content analysis, cell viability and proliferation study of bone marrow and bone marrow concentrate-derived cells, and cytokine array performed on monocytes cultured on the membranes. CONCLUSION: Data collected from patients who underwent AMMR procedure, starting with pre-operatively through two year and five year till ten year follow-up, indicate the possibility for long-term, stable meniscus preservation. Outcomes are manifested with a visible improvement of the IKDC and the Lysholm subjective scores as well as in the imaging results. The type of the meniscal tear or complexity of the knee injury (isolated AMMR vs. AMMR + ACL) did not affect the clinical outcomes. The study highlighted the role of the membrane in facilitating cell adhesion and proliferation. Additionally, several cytokines were selected as potentially crucial products of the membrane vs. monocyte interactions, driving the tissue regeneration and remodeling. Interestingly, thresholds of what constitutes a safe and well-decellularized membrane according to relevant literature have been significantly breached, but ultimately did not elicit detrimental side effects.

"Slipped capital femoral epiphysis in a 25-year-old hypogonadic man with a large cranial chondroma: causality or coincidence? ".

BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a hip disorder frequently occurring in adolescence. In adults it is rare and so far very few cases have been documented. CASE PRESENTATION: This report presents a 25-year-old patient diagnosed with an anterior fossa giant chondroma, hypogonadotropic hypogonadism, and SCFE. The patient underwent surgical and hormonal therapy. His symptoms revealed, and he became a father. CONCLUSIONS: Every patient diagnosed with SCFE in adulthood should undergo endocrinological assessment based on physical examination and laboratory tests.

Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection: Clinical Effectiveness and Survivorship after a Minimum of 5 Years' Follow-Up.

Purpose. To determine the 5-year success rate of the "all-inside" technique of arthroscopic meniscus suture and collagen membrane wrapping along with bone marrow blood injection, to evaluate the progression of degenerative changes and the impact of simultaneous anteriro cruciate ligament (ACL) reconstruction. Methods. Fifty-four consecutive patients with complex meniscal tears were treated with the previously described technique. The subjective scores (International Knee Documentation Committee 2000, Lysholm, EQ-5D-5L) and Barret clinical criteria of meniscal healing were recorded. Magnetic resonance images (MRIs) were assessed at 2 and 5 years postoperatively, using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) criteria. Kaplan-Meier survival analyses were performed in order to assess the survivorship after the index procedure. Thirty-nine patients were divided into 2 groups: group A-isolated meniscus repair and group B-meniscus repair with concurrent ACL reconstruction. Results. Fifty-four patients were treated and 44 were available for analysis. There was a statistically significant improvement in subjective scores and clinical assessment between the preoperative, 2-year follow-up, and 5-year follow-up time points. EQ-5D-5L utility value was 0.9 ± 1 at final follow-up. The WORMS osteoarthritis severity grade had increased from 6.9 ± 5.0 points at the 2-year follow-up to 11.1 ± 9.6 points at the 5-year follow-up (P < 0.001). There was a significant difference between the groups after 60 months. The overall survival rate at final follow-up was 88%. Conclusions. The treatment option evaluated in this study has shown very good mid-term clinical and MRI-based outcomes as well as a favorable survival rate. Simultaneous ACL reconstruction is likely a factor for osteoarthritis progression.

Novel Technique of Achilles Tendon Reconstruction Using Semitendinosus and Gracilis Tendon. Preliminary Report.

BACKGROUND: Achilles tendon ruptures are a common clinical problem. While there are many techniques of Achilles tendon reconstruction, there is little evidence that any of them is clearly superior to the others. The most common techniques rely on augmentation of the plantar tendon, peroneus brevis tendon and flexor hallucis longus tendon. MATERIAL AND METHODS: The article describes a novel procedure for Achilles tendon reconstruction using the hamstring grafts, Endobutton stabilization, collagen membrane and the administration of autologous bone marrow cells to the region of the reconstructed tendon. RESULTS: This technique was used by the author (with the good early results) in so-called "difficult cases" as a "salvage procedure". CONCLUSION: The use of a hamstring autograft is safe and does not further affect the injured foot or induce an autoimmune reaction.

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction with autologous hamstring grafts-isokinetic assessment with control group.

OBJECTIVE: The aim of the study was to: 1) evaluate the differences in pre-post operative knee functioning, mechanical stability, isokinetic knee muscle strength in simultaneous arthroscopic patients after having undergone an anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) with hamstring tendons reconstruction, 2) compare the results of ACL/PCL patients with the control group. DESIGN: Controlled Laboratory Study. MATERIALS AND METHODS: Results of 11 ACL/PCL patients had been matched with 22 uninjured control participants (CP). Prior to surgery, and minimum 2 years after it, functional assessment (Lysholm and IKDC 2000), mechanical knee joint stability evaluation (Lachman and "drawer" test) and isokinetic tests (bilateral knee muscle examination) had been performed. Different rehabilitation exercises had been used: isometric, passive exercises, exercises increasing the range of motion and proprioception, strength exercises and specific functional exercises. RESULTS: After arthroscopy no significant differences had been found between the injured and uninjured leg in all isokinetic parameters in ACL/PCL patients. However, ACL/PCL patients had still shown significantly lower values of strength in relative isokinetic knee flexors (p = 0.0065) and extensors (p = 0.0171) compared to the CP. There were no differences between groups regarding absolute isokinetic strength and flexors/extensors ratio. There was statistically significant progress in IKDC 2000 (p = 0.0044) and Lysholm (p = 0.0044) scales prior to (44 and 60 points respectively) and after the reconstruction (61 for IKDC 2000 and 94 points for Lysholm). CONCLUSIONS: Although harvesting tendons of semitendinosus and/or gracilis from the healthy extremity diminishes muscle strength of knee flexors in comparison to the CP, flexor strength had improved. Statistically significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is required for restoring normal muscle strength. Without restoring normal muscle function and strength, surgical intervention alone may not be sufficient enough to ensure expected improvement of the articular function.

All-arthroscopic AMIC procedure for repair of cartilage defects of the knee.

PURPOSE: Bone marrow mesenchymal stem cells were introduced into clinical practice due to their ability to differentiate into many types of cells. Autologous matrix-induced chondrogenesis (AMIC) combines the microfracture method with matrix-based techniques that utilizes a collagen membrane to serve as a scaffold for new bone marrow mesenchymal stem cells, allowing effective reconstruction of even large fragments of a damaged cartilage surface. METHODS: All-arthroscopic technique to repair knee cartilage defects using the AMIC technique, which includes the use of a collagen matrix (porcine collagen type I and III) and fibrin glue-technique presentation. CONCLUSION: This technical note introduces an all-arthroscopic AMIC technique to reconstruct extensive cartilage defects (without bone defects). The technique may be used for treatment of all location of knee cartilage lesions. LEVEL OF EVIDENCE: V.