Patients treated by magnetic growing rods for early-onset scoliosis reach the expected average growth.

INTRODUCTION: Magnetic controlled growing rods (MCGRs) are one of the most common procedures to treat early-onset scoliosis (EOS). One of the major concerns is that patients treated with MGCR do not reach an adequate height with MGCR. The present study has one of the largest sample sizes of EOS patients treated by MGCR. This study aims to demonstrate the efficacy of the treatment with MGCR in EOS patients, comparing our results with the estimated growth. METHODS: Patients were consecutively enrolled from July 2011 to July 2022. The same surgical equipe performed all the procedures. The mean length of the patients was assessed by X-ray (T2-T12 and T2-S1 distance) by a team of expert radiologists. The estimated growth by Dimeglio was compared with the mean elongation obtained by year. RESULTS: 65 patients were included. 16 patients underwent final surgery. In group 1, patients reached a growth of 3.6 ± 8.7 mm (T2-T12) and 9.6 ± 27.6 mm (T2-S1). In group 2, patients grew 5.4 ± 5.7 mm (T2-T12) and 9 ± 9 mm (T2-S1).81% of the estimated elongation during the treatment was obtained during the first surgery. The difference between Dimeglio's estimated growth and the value obtained by MGCR was -4.3 ± 8.7 mm(T2-T12) and -12.3 ± 12.2 mm (T2-S1) in group 1 (p < 0.001) and -1.1 ± 4.2 mm (T2-T12) and -6.6 ± 6.0 mm (T2-S1) in group 2 (p = 0.001). CONCLUSIONS: MGCR patients reached and overlapped the growth target according to the score by Dimeglio. However, the value of growth tended to reduce over the years. Lastly, obtaining the most significant elongation possible at the first surgery is mandatory, comprising 81% of the total value.

Exploring the association between specific genes and the onset of idiopathic scoliosis: a systematic review.

BACKGROUND: Idiopathic Scoliosis (IS) is the most common spinal deformity in adolescents, accounting for 80% of all spinal deformities. However, the etiology remains uncertain in most cases, being identified as Adolescent Idiopathic Scoliosis (AIS). IS treatments range from observation and sport to bracing or surgery. Several risk factors including sex and familiarity, have been linked with IS. Although there are still many uncertainties regarding the cause of this pathology, several studies report a greater incidence of the defect in families in which at least one other first degree relative is affected. This study systematically reviews the available literature to identify the most significant genes or variants related to the development and onset of IS. METHODS: The research question was formulated using a PIOS approach on the following databases: Medline, Embase, Cinahl, Scopus, Web of Science and Google Scholar. The search was performed from July to August 2021, and articles from the inception of the database to August 2021 were searched. RESULTS: 24 of the 919 initially identified studies were included in the present review. The 24 included studies observed a total of 16,316 cases and 81,567 controls. All the considered studies stated either the affected gene and/or specific SNPs. CHD7, SH2B1, ESR, CALM1, LBX1, MATN1, CHL1, FBN1 and FBN2 genes were associated with IS development. CONCLUSIONS: Although association can be found in some candidate genes the field of research regarding genetic association with the onset of IS still requires more information.

Trends in hospitalization for pediatric hip arthroplasty: an epidemiological Nationwide study in Italy from 2001 to 2015.

BACKGROUND: The epidemiology of Pediatric Hip Arthroplasty (PHA) is unclear. Prevalence of PHA in Europe was reported in Scandinavian registries, but data on this procedure are not described in other countries. Therefore, it is challenging to redact a complete and valid epidemiological report on PHA in Europe. Nevertheless, national health statistics for PHA are helpful for an international audience, as different treatments are reported between countries. Moreover, sharing national statistics and correlating those to other countries' protocols could be helpful to compare outcomes for different procedures internationally. The principal purpose is to evaluate the yearly hospital admission for PHA in Italy. METHODS: Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health. RESULTS: From 2001 to 2015, 770 PHA hospitalizations were performed in Italy, with an incidence of 0.5 procedures for every 100,000 pediatric Italian inhabitants. The average age of patients was 15.2 ± 4.6 years. The mean length of days of hospitalization was 10.9 ± 8.6 days. The majority of patients were male of 15-19 years old age group. A progressive decrease in days of hospitalizations was found during the years of the study. CONCLUSIONS: In Europe, the incidence of hospital admission for PHA is not fully described. There is a lack of consensus on the best type of surgery to perform on young patients. Epidemiological studies are helpful to understand the national variation of a specific surgical procedure and compare them with other countries.

Intramedullary Nailing for Lower Limb Polyostotic Fibrous Dysplasia in Children: A Long-term Follow-up Study.

BACKGROUND: In children, intramedullary nailing (IN) has been proposed as the best treatment when the femur and tibia are totally affected by fibrous dysplasia (FD). However, in younger children IN must be repeated to maintain stabilization of the affected skeletal segment during growth. We report the long-term results in a cohort of patients in whom more than two-thirds of cases had IN repeated during growth. METHODS: Twenty-nine femurs and 14 tibias totally affected by FD were treated by IN in 21 patients with polyostotic FD and McCune-Albright syndrome. Thirteen patients with 35 femoral and tibial deformities had a painful limp whereas 8 presented fractures. The patients had their first IN at a mean age of 9.26±2.68 years (range: 4 to 14 y). IN was repeated during growth in the younger patients, and all the patients underwent a mean of 2.13 femoral and 1.50 tibial IN per limb. The last IN was performed at a mean age of 16.42±1.95 years (range: 11 to 19 y). Titanium elastic nails and adult humeral nails were used in younger children, whereas adult femoral cervicodiaphyseal and interlocking tibial nails were used in older children and adolescents. At the latest follow-up, the patients were evaluated with a clinicoradiographic scale. All the data were statistically analyzed. RESULTS: The mean length of follow-up from the last IN was 6.47±3.10 years (range: 3 to 14 y), and the mean age of the patients at follow-up was 22.85±3.53 years (range: 14 to 29 y) when lower limbs were fully grown in all but 1 patient. Satisfactory long-term results were obtained in about 81% of our patients, while complications occurred in 32.5% of the 43 cases. CONCLUSION: Lower limb IN-that was repeated in younger children during growth-provided satisfactory long-term results in most of our patients, with fracture and deformity prevention and pain control, regardless of the high rate of complications that mainly affected the femoral cases. Missing scheduled follow-ups was the main predictor of a poor result. LEVEL OF EVIDENCE: Level IV-case series.

Trends in hospitalization for paediatric flatfoot: an Italian nationwide study from 2001 to 2016.

BACKGROUND: Flatfoot is a common condition in young patients, but usually resolves by adolescence. This study aimed to estimate annual trend hospitalizations for flatfoot in Italian paediatric population from 2001 to 2016. METHODS: Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper (2001-2016). The yearly number of hospital admission for flatfoot, the percentage of males and females, the average age, the average days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. RESULTS: 109,300 hospitalizations for flatfoot of young patients were performed during this period. 59.3% of patients were male and 40.7% female of the 10-14 years-old age class. The average days of hospitalization stay were 1.73 ± 1.27 days. The data highlights that the burden of flatfoot surgery is growing and affecting the healthcare system. The mean rate of hospital admissions in Italy for flatfoot in the young population was 82.14 for 100,000 inhabitants of the same age class. CONCLUSIONS: The data highlights that the cases of flatfoot surgery increased from 2001 to 2016. The most common treatment was the "Internal Fixation Of Bone Without Fracture Reduction, Tarsals And Metatarsals followed by Subtalar Fusion and Arthroereisis. Further prospective studies on this topic may be conducted to improve the evidence of the results.

Trends in hospitalisation of Subtalar Joint Arthroereisis in Italy from 2009 to 2016.

BACKGROUND: Subtalar Joint Arthroereisis (SJA) is the most used technique for the treatment of flexible flatfoot. Limited data are reported to trends of hospitalisation for SJA. This study aimed to estimate annual admissions and the geographical distribution of SJA in young Italian patients from 2009 to 2016. METHODS: Data of this study were collected from the National Hospital Discharge Reports reported at the Italian Ministry of Health. The yearly number of SJA, sex, age and days of hospitalisation were calculated. Public and Private hospitalisations have been analysed individually. RESULTS: 1.6762 hospitalisations for SJA were performed in Italy during the study period, and the incidence increased from 8.22 to 117.08 (cases/100,000 inhabitants). Men represented the majority of young patients treated by SJA. The mean length of stay was 1.55 ± 0.818 days. CONCLUSIONS: The prevalence of admissions of young patients for SJA increases from 2009 to 2016. The majority of the procedure was performed in public hospitals, but a shorter length of stay was reported in patients treated in private hospitals (p < 0.001). This study highlighted the limits of ICD-9; in fact, difficulties in procedure codification and heterogeneity in diagnosis and procedures performed were reported.

Emerging National Trends in Ankle Prosthesis: A 15-Year Analysis of the Italian National Hospital Discharge Records.

Total ankle replacement (TAR) has gained popularity in recent years becoming the mainstream treatment for conditions like rheumatoid arthritis, posttraumatic arthritis and severe osteochondral lesions of the talus. The aim of the study was to assess the nationwide number of implants performed in a 15-year period (2001-2016) and to identify trends like patients' interregional migratory flows and their accessibility to this procedure. Data for this study were obtained from the Italian National Hospital Discharge records (SDO), obtained from the National Ministry of Health. The selected SDOs were evaluated for demographic data, like the patient's age and gender, for geographical data, including the region of hospitalization and the region of origin of the patient, and for hospitalization data, like the hospital stay length and the principal source of payment. In a 15-year span, a sharp increase in the number of TARs was observed with a 600% growth. The incidence was 0.16 per 100,000 persons in 2001 and increased to 0.915 per 100,000 persons in 2016. Most TAR were performed in northern Italy (73.9%), followed by central Italy (16.7%) and lastly southern Italy (9.4%). The rates of utilization of TAR increased every year from 2001 to 2016, indicating that demand for ankle arthroplasties is growing faster regarding to other procedures performed in Italy. The surgical cost was covered, in the majority of cases, by the National Health System and may play a role in the rising rates of TAR.

Developmental Hip Dysplasia: An Epidemiological Nationwide Study in Italy from 2001 to 2016.

Developmental Dysplasia of the Hip (DDH) includes a broad spectrum of hip abnormalities. DDH requires early diagnosis and treatment; however, no international consensus on screening protocol and treatment is provided in the literature. Epidemiological studies are helpful to understand the national variation of a specific surgical procedure and compare it with that of other countries. Data provided by different countries could allow researchers to provide international guidelines for DDH screening and treatment. Limited data are reported regarding trends of hospitalization for DDH, and no public database is available. The purpose of this study was to estimate annual admissions for DDH in Italian patients from 2001 to 2016, based on the hospitalization reports. Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health. Descriptive statistical analyses were performed. From 2001 to 2016, 3103 hospitalizations for DDH were recorded in Italy, with a mean incidence of 2.33 (per 100,000 young inhabitants). Females of the 0-4 years old group represented the majority of patients hospitalized for DDH.

Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015.

BACKGROUND: Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10-14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed. METHODS: Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. RESULTS: From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%). CONCLUSION: National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy. LEVEL OF EVIDENCE: III.

Trends of anterior cruciate ligament reconstruction in children and young adolescents in Italy show a constant increase in the last 15 years.

PURPOSE: The aim of this 15-year nationwide study was to investigate the trend in ACL reconstructive surgeries in patients younger than 15 years old in Italy, as well as their social and economic impact. MATERIALS AND METHODS: The National Hospital Discharge records (SDO) collected by the Italian Ministry of Health in the 15-year period between 2001 and 2015 were analyzed. This contains anonymous data including patients' age, gender, ICD-9-CM codes for diagnosis and intervention, census region, region of hospitalization, length of the hospitalization, and public or private reimbursement. RESULTS: 1,350 ACL reconstructions were performed in Italy in the population younger than 15 years old, with an incidence rate ranging from 0.16 to 2.04 procedures per 100,000 age-matched individuals. Similarly, the percentage of surgeries in 0-14 year old patients increased with respect to the total number of ACL reconstruction from 0.13% in 2001 to 0.95% in 2015. The age range 10-14 years is the most involved, accounting for 97.3% of surgeries recorded in the study period. The male:female ratio was 1.05 and most of these procedures were performed in the North of Italy (78.3%). CONCLUSION: ACL reconstructions in patients aged 10-14 years are increasing constantly since 2001, and thus, specific actions aimed to define the best management strategy as well as national educational programs to prepare the future surgeons to this new reality are mandatory in the interest of the public health. LEVEL OF EVIDENCE: Level III.

Epidemiology of Paediatric Shoulder Dislocation: A Nationwide Study in Italy from 2001 to 2014.

Limited knowledge is accessible concerning the tendencies of hospitalization for skeletally immature patients with episodes of shoulder dislocation. Our research aim was to evaluate annual hospitalizations for shoulder dislocation in paediatric patients in Italy from 2001 to 2014, on the basis of the official data source as hospitalization reports. The second purpose was to investigate geographical diversification in hospitalization for shoulder dislocation in regions of Italy. The last aim was to make statistical predictions of the number of shoulder dislocation hospitalization volumes and rates in skeletally immature patients based on data from 2001 to 2014. An examination of the National Hospital Discharge records (SDO) kept at the Italian Ministry of Health regarding the 14 years of our study (2001 through 2014) was conducted. These data are anonymous and include patient's age, gender, domicile, region and time of hospitalization, and the kind of reimbursement (public or private). In the 14-year study time, 344 hospitalizations for shoulder dislocation of patients aged 0-14 years took place in Italy. The male/female hospitalization ratio varied from a maximum of 3.0 (2001) to a minimum of 1.1 (2013), with a mean average ratio in the 2001-2014 timespan of 2.0. Almost half of the hospitalizations (49.1%) were performed in the South. The mean incidence of hospitalizations in Italy for shoulder dislocation in patients with less than 14 years was 0.3 for every 100,000 inhabitants in the same class of age. The most common treatment was a closed reduction (60.8%), followed by open stabilization (16.6%) and arthroscopic procedures (13.7%). The present registry study shows a low incidence of hospitalization for shoulder dislocation in young patients. The most common treatment for a shoulder dislocation in paediatric patients is a closed shoulder reduction. Regions from the south and the centre of Italy are marked by an inferior number of operations and a higher number of hospitalization for closed shoulder reduction.

Clinical results and complication rates of lower limb lengthening in paediatric patients using the PRECICE 2 intramedullary magnetic nail: a multicentre study.

Implantable intramedullary nail lengthening devices (e.g., PRECICE 2 system) have been proposed as alternative method to external fixation for lower limb lengthening surgery. The aim of this study was to analyse our outcomes and complications using the PRECICE 2 (P2) nail system and review them in light of the existing literature. A retrospective multicentre study was conducted on patients <18 years, who were treated for limb lengthening using the P2 system. The inclusion criteria were a limb length discrepancy ≥ 30 mm and a follow-up ≥6 months after the end of treatment. A total of 26 (15 males) patients were included, average age was 14.7 ± 2.3 years; 26 nails (21 femur, 5 tibia) were implanted. The average goal lengthening was 49.4 ± 12.4 mm, while average achieved lengthening was 44.4 ± 11.6 mm. Average distraction and consolidation indexes were 11.9 ± 2.1 days/cm and 25.1 ± 8.1 days/cm, respectively. Nail accuracy and reliability were 91.1% and 88.5%, respectively. A total of five problems (joint contractures), one obstacle (femur fracture) and three complications (hip joint subluxation, deep infection and nail running back) were encountered. The P2 nail system is a valid alternative to external fixator for limb lengthening in young patients with no significant angular or rotation deformities. Our study confirms a favourable complication rate and available evidence from literature suggests a lower complication rate than external fixator systems. Nevertheless, surgeons should keep a watchful eye on risk of joint subluxation and mechanical complications with intramedullary lengthening.

Modified Roux-Goldthwait Procedure for Management of Patellar Dislocation in Skeletally Immature Patients with Down Syndrome.

BACKGROUND: Patellar instability is a common problem in Down syndrome patients since their childhood. Several treatment have been proposed, but relapses are frequent and not all surgeries are suitable for growing patients. The aim of the present study is to evaluate the clinical and radiographic outcomes of a modified Roux-Goldthwait technique, for the management of patellar instability in children with Down syndrome at minimum 5-year followup. MATERIALS AND METHODS: 19 patients (23 knees) affected by Down syndrome surgically treated for patellar dislocation, between 2000 and 2012 were included in this study. The mean age of patients was 9.5 years (range 3.7 - 15 years) and had a Dugdale Grade III, IV, and V patellar dislocation. Trochlear groove dysplasia was present in 15 patients. Each patient was clinically evaluated considering relapse rate, pre- and postoperative range of motion (ROM), Kujala score, and modified Lysholm score. Radiographic examination was performed on standard X-ray considering patellar height, trochlear angle, and patellofemoral congruence angle. RESULTS: The mean followup was 134 months (range 62-206 months). No case of relapse of dislocation was registered with an improved ROM (significant for knee extension, P < 0.05). The Kujala score showed significant improvement from a mean preoperative value of 39 ± 6.3 to a mean postoperative value of 92.7 ± 3.4 (P < 0.05) at final followup such as the modified Lysholm score (from mean preoperative 55.6 ± 6.3 to mean postoperative of 94.2 ± 2.6). Radiographs performed at latest followup showed a tendency to normalization of all the parameters considered, with a restored patellofemoral congruence and trochlear groove shape and without signs of osteoarthritis. CONCLUSION: The present study showed that the Roux-Goldthwait procedure is a valid surgical option for the treatment of patellar dislocation in children with Down syndrome.

Magnetically Controlled Growing Rods for the Management of Early-onset Scoliosis: A Preliminary Report.

BACKGROUND: A new method for the management of early-onset scoliosis (EOS) has been recently introduced: it consists of a magnetically controlled growing rod (MCGR) that allows gradual outpatient distractions under control of an external remote device. The aim of the present study is to present a series of 10 patients with EOS managed with MCGR (Ellipse TM MAGEC System, Irvine, CA). METHODS: We implanted MCGR in 10 patients affected by EOS. Scoliosis and kyphosis angles, T1-T12 and T1-S1 length were evaluated preoperatively, postoperatively, and at the last follow-up. A visual analogue scale score was used to evaluate pain during outpatient rod distraction procedures. The mean follow-up is 27 months. All patients attended distractions of the magnetic rod through an external remote control every 3 months. The mean predicted distraction was 3 mm at each lengthening session. RESULTS: The mean Cobb angle value was 64.7±17.4 degrees (range, 45 to 100 degrees) preoperatively and 28.5±13.9 degrees (range, 15 to 59 degrees) at the latest follow-up. The mean T1-S1 length value was 27.1±5.4 cm (range, 16 to 34.8 cm) preoperatively and 32.8±4 cm (range, 26.5 to 39 cm) at the latest follow-up. The mean T1-T12 length value was 16.2±2.7 cm (range, 10 to 19 cm) preoperatively and 20.6±2.9 cm (range, 15.5 to 23.5 cm) at the latest follow-up.The average monthly T1-T12 height increase was 0.8 mm, whereas the average monthly T1-S1 increase was 0.9 mm.Two patients experienced a rod breakage and 1 patient had a pull-out of the apical hooks. CONCLUSIONS: Although implant-related complications could occur, as in all EOS growing rods procedures, MCGR can be effectively used in patients with EOS. This spinal instrumentation can overcome many of the complications related with the traditional growing rods implants. This procedure can be effectively used in outpatient settings, minimizing surgical scarring, surgical site infection, and psychological distress due to multiple surgeries needed in the traditional growing rods system, improving quality of life, and saving health care costs. LEVEL OF EVIDENCE: Level IV.

Characterization of age-related changes of tendon stem cells from adult human tendons.

PURPOSE: The present study evaluated the presence of stem cells in hamstring tendons from adult subjects of different ages. The aim was to isolate, characterize and expand these cells in vitro, and to evaluate whether cell activities are influenced by age. METHODS: Tendon stem cells (TSCs) were isolated through magnetic sorting from the hamstring tendons of six patients. TSC percentage, morphology and clonogenic potential were evaluated, as well as the expression of specific surface markers. TSC multi-potency was also investigated as a function of age, and quantitative polimerase chain reaction was used to evaluate gene expression of TSCs cultured in suitable differentiating media. RESULTS: The presence of easily harvestable stem cell population within adult human hamstring tendons was demonstrated. These cells exhibit features such as clonogenicity, multi-potency and mesenchymal stem cells markers expression. The age-related variations in human TSCs affect the number of isolated cells and their self-renewal potential, while multi-potency assays are not influenced by tendon ageing, even though cells from younger individuals expressed higher levels of osteogenic and adipogenic genes, while chondrogenic genes were highly expressed in cells from older individuals. CONCLUSIONS: These results may open new opportunities to study TSCs to better understand tendon physiology, healing and pathological processes such as tendinopathy and degenerative age-related changes opening new frontiers in the management of tendinopathy and tendon ruptures.

Effect of pulsed electromagnetic fields on human osteoblast cultures.

BACKGROUND AND PURPOSE: Exogenous electromagnetic fields (EMFs) affect bone metabolism, but the mechanisms responsible for this phenomenon are unclear. Pulsed EMFs (PEMFs) can be effective in the management of congenital pseudarthrosis or delayed union or non-union of fractures. We investigated the effects of PEMFs used in clinical practice on human osteoblast cultures. METHODS: Primary osteoblastic cells were isolated from a human femoral head. Cultures were exposed to the PEMF stimulation for 72 hours, 7 and 10 days and compared with a control group of primary osteoblastic cells non-exposed to PEMF. Cell growth and alkaline phosphatase activity were evaluated in the osteoblast cell cultures at each observation time. RESULTS: At each observation time, the differences in cell numbers between PEMF-exposed cells and control group were statistically significant (p < 0.05). The alkaline phosphatase-specific activity of PEMF-exposed osteoblast cultures showed a statistically significant (p < 0.05) increase when compared with the control group after 7 and 10 days of exposure. CONCLUSIONS: The application of PEMF stimulation on human osteoblasts accelerates cellular proliferation when compared with a control group of non-PEMF-exposed cells.

Adhesion and collagen production of human tenocytes seeded on degradable poly(urethane urea).

PURPOSE: The aim of this study was to investigate whether human tenocytes taken from ruptured quadriceps tendon could be seeded on a biodegradable polycaprolactone-based polyurethanes (PU) urea scaffold. Scaffold colonization and collagen production after different culture periods were analyzed to understand whether tenocytes from ruptured tendons are able to colonize these biodegradable scaffolds. METHODS: Human primary tenocyte cultures of ruptured quadriceps tendons were seeded on PU scaffolds. After 3, 10 and 15 days of incubation, the samples were stained with haematoxylin and eosin and were examined under white light microscopy. After 15 and 30 days of incubation, samples were examined under transmission electron microscope. Total collagen accumulation was also evaluated after 15, 30 and 45 days of culture. RESULTS: After 15 and 30 days of culture, tenocyte-seeded scaffolds showed cell colonization and cell accumulation around interconnecting micropores. Tenocyte phenotype was variable. Collagen accumulation in seeded scaffolds demonstrated a progressive increase after 15, 30 and 45 days of culture, while control non-seeded scaffolds show no collagen accumulation. CONCLUSION: These results showed that human tenocytes from ruptured quadriceps tendon can be seeded on polycaprolactone-based PU urea scaffolds and cultured for a long time period (45 days). This study also showed that human tenocytes from ruptured tendons seeded on PU scaffolds are able to penetrate the scaffold showing a progressively higher collagen accumulation after 15, 30 and 45 days of incubation. This study provides the basis to use this PU biodegradable scaffold in vivo as an augmentation for chronic tendon ruptures and in vitro as a scaffold for tissue engineering construct.

Clinical significance of different effects of static and pulsed electromagnetic fields on human osteoclast cultures.

Electromagnetic fields are known to affect the bone metabolism by modifying some relevant physiologic cell parameters of cells, even though the underlying mechanisms are still unclear. The aim of our study was to evaluate the effect of both static magnetic fields (SMFs) of the same intensity of the one generated by spinal metal devices and pulsed electromagnetic fields (PEMFs) of the same intensity used for the management of nonunion on human osteoclasts cell culture. Primary osteoclast cells were isolated from primary human osteoclast precursors and were exposed to SMFs and to PEMFs. Morphology and tartrate-resistant acid phosphatase (TRAP) activity were evaluated in the osteoclast cultures after 7, 10, and 14 days of exposure. The SMF-exposed cells show a more differentiated phenotype and a significantly higher TRAP activity after 7 and 10 days of treatment with respect to a sham control. PEMF-exposed cells have a less-differentiated phenotype after 7 days of exposure compared with the relative sham control, while the TRAP activity shows no statistically significant differences between exposed and control cells at any observation time. Our results indicate that SMFs of the same intensity of the one generated around spinal devices can affect osteoclast differentiation and activity. Aseptic loosening around titanium implants might be due in part to an increased osteoclast activity and differentiation. PEMFs of the same intensity than the one used for the management of nonunions can affect osteoclasts phenotype after 7 days of exposure, while osteoclasts TRAP activity is not affected by this kind of electromagnetic fields.

Effect of pulsed electromagnetic fields on human tenocyte cultures from supraspinatus and quadriceps tendons.

OBJECTIVE: : To investigate the effects of pulsed electromagnetic fields (PEMFs) on human tenocyte cultures and to assess whether PEMFs could represent a viable therapeutic option in tendon pathologies. DESIGN: : Controlled laboratory study in which primary human tenocytes were isolated from healthy supraspinatus and quadriceps tendons and were exposed to the electromagnetic field stimulation. Cell growth and cell cycle were evaluated after 72 hrs, 5 days, and 7 days of continuous PEMF exposure. In quiescent confluent tenocyte culture, an in vitro cut was mechanically produced, and the width of the cell-free zone was measured 12, 24, and 36 hrs after the injury in the presence of PEMF stimulation. Total collagen accumulation was also evaluated after 5, 7, and 14 days of PEMF exposure. RESULTS: : Tenocyte growth analysis, cell cycle analysis, and total collagen accumulation did not show statistically significant differences between exposed and control groups. Exposure to PEMF significantly accelerated cut closure 12 and 24 hrs after the injury. CONCLUSIONS: : PEMFs comparable with the ones used for the management of pseudoarthrosis stimulate closure of an in vitro laceration of a tenocyte monolayer. Our results provide the preliminary in vitro work and the basis to support the study of the in vivo effects of PEMFs on tendinopathies.