ABSTRACT
BACKGROUND: Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated. HYPOTHESIS: We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months. STUDY DESIGN: Prospective case series. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores. RESULTS: Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale (P = 0.03) and WOMAC (P = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months (P < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery. CONCLUSION: PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up. CLINICAL RELEVANCE: This research supports the use of autologous PRP injections for symptomatic DMLs.
Subject(s)
Osteoarthritis, Knee , Platelet-Rich Plasma , Follow-Up Studies , Humans , Hyaluronic Acid , Injections, Intra-Articular , Osteoarthritis, Knee/drug therapy , Osteoarthritis, Knee/therapy , Prospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To report the 5-year clinical efficacy of PRP intra articular injections in knee osteoarthritis (OA) and to investigate the risk factors predictive for treatment failure and poor clinical outcome. METHODS: We retrospectively evaluated 118 patients treated for low to moderate knee OA demonstrated by X-Ray and magnetic resonance imaging (MRI) with autologous PRP injection from 2014 to 2018 with a mean 51.1 ± 14.8 (range 29 to 89) months follow-up. All the patients were evaluated with Lysholm and WOMAC score. The role of Kellgren Lawrence (KL) grade, patello-femoral (PF) degeneration, age, body mass index (BMI), relevant comorbilities, smoking status, gender, previous surgery or conservative measures were analyzed with univariate and multivariate analysis. RESULTS: There was a significant improvement of all outcome measures at final follow-up and high satisfaction rate (79.7%). The overall failure rate was of 15.3% after a mean of 57.7 ± 15.1 (range 33 to 85) months. The BMI and the KL grade were identified as significant independent risk factor related to failure of autologous PRP injection. Patients under 60 reported significantly higher Tegner activity scale (p = 0.032) at final follow-up. Patients with KL grade 3 and patients with PF MRI-KL grade 3 had significantly lower Lysholm scores (p = 0.026 and p = 0.042 respectively) at final assessment. Younger patients with lower BMI and lower grade of radiographic OA had significantly longer therapeutic benefit (p < 0.05). CONCLUSION: Intra articular PRP injections led to a significant clinical improvement in middle-aged adults with a low to moderate knee OA. BMI and high KL grade have been identified as significant risk factors predictive for failure at mid-term follow-up.
Subject(s)
Osteoarthritis, Knee , Platelet-Rich Plasma , Adult , Humans , Hyaluronic Acid/therapeutic use , Injections, Intra-Articular , Middle Aged , Osteoarthritis, Knee/drug therapy , Osteoarthritis, Knee/therapy , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
PURPOSE: The aim of this research is to report the clinical outcome following surgical correction of Haglund's deformity summarising different surgical strategies and comparing clinical outcomes, failures, complications and return to activities of patients underwent open and endoscopic techniques. METHODS: A systematic search of the literature was conducted using eight different databases. Thirty-five studies were included in the systematic review. A total of 1260 ankles of 1147 patients were grouped in accordance with the surgical approach (open, endoscopic, or percutaneous). RESULTS: The overall mean age was 44.8 ± 8.2 (range 14.9-82) years with a mean follow-up of 30.9 ± 17.1 (range 3-132) months. Analysis of clinical outcomes of open and endoscopic techniques demonstrated significant differences of AOFAS (87.1 ± 5.9 versus 90.7 ± 4.2 points; P < 0.001), complications (15.5% versus 4.1%; P < 0.001), failures (6.0% versus 1.2%; P < 0.001), time to return to daily activities (17.2 ± 9.3 versus 6.3 ± 1.0 weeks; P < 0.001) and time to return to sport (20.7 ± 3.3 versus 11.9 ± 0.3 weeks; P < 0.001) in the studies that reported these specific outcome measures. CONCLUSION: Surgical correction of Haglund's deformity provides overall good clinical results and high subjective satisfaction. Endoscopic procedures demonstrated better final AOFAS, a lower rate of complications and failures, and shorter recovery time when compared to open techniques. LEVEL OF EVIDENCE: Level IV.
Subject(s)
Achilles Tendon , Bursitis , Calcaneus , Orthopedic Procedures , Tendinopathy , Achilles Tendon/surgery , Calcaneus/surgery , Child , Child, Preschool , Endoscopy , Humans , Infant , Tendinopathy/surgeryABSTRACT
BACKGROUND: The knowledge of the anatomy and biomechanics of patellar stabilizers is mandatory to achieve good clinical results with surgical reconstructive procedures. Few articles provide clear anatomical and biomechanical picture of medial patello-tibial ligament (MPTL). METHODS: After a systematic review of the literature we selected in vivo or ex vivo studies providing anatomical or biomechanical measurements. We included 7 studies about MPTL anatomy for a total of 96 knees and 4 biomechanical studies. RESULTS: The MPTL is a true ligament and important component of the medial patellar stabilizers, together with the medial patello-femoral ligament (MPFL) and medial patello-meniscal ligament. The contribution of MPTL on restriction forces of the patello-femoral joint is still unclear. Quadriceps, patellar, semitendinous and gracilis tendons are adequate grafts for surgical MPTL reconstruction. CONCLUSIONS: MPTL is a well defined anathomical structure and histologically can be considered a ligament. It plays an important role in patellar stability especially it has a main role on patellar rotation and tilt instead on shift.
Subject(s)
Joint Instability , Patellar Dislocation , Plastic Surgery Procedures , Biomechanical Phenomena , Humans , Joint Instability/surgery , Ligaments, Articular/surgery , Patella/surgery , Patellar Dislocation/surgeryABSTRACT
Few studies provide an analysis of conservative two-stage revision of hip periprosthetic joint infection (PJI) and its impact on final outcome. A conservative revision is defined when soft tissues and bone quality enable the use of primary prosthetic components. Data of patients treated for chronic hip PJI who underwent two-stage revision between 2009 and 2016 and had a minimum of 2 years of follow-up were collected. Oxford Hip Score (OHS), Harris Hip Score (HHS) and radiological and microbiological data were retrieved and analysed. Clinical and functional outcome, survival, mortality, eradication, reinfection and re-revision rates within subgroups of patients with primary components and revision components are reported herein. A total of 148 patients underwent two-stage hip exchange with a mean follow-up of 55.6 ± 23.1 months and a mean age at surgery of 64.3 ± 12.7 years. Forty-four percent of patients underwent conservative revision. The mean HHS significantly improved from 40.6 ± 9.4 points to the final value of 87.8 ± 10.5 points (p = .002), and the mean OHS went from 20.3 ± 3.8 points to 40.3 ± 5. points (p< .001). Patients who were treated with primary components or isolated revision stems in the second stage had a significant reduction in surgical times (p< .001). The mortality rate for all causes of death was 6.8%, the eradication rate was 89.9%, the reinfection rate was 4.7% and the reoperation rate was 7.4% without differences between conservative and non-conservative revisions. Two-stage exchange arthroplasty for total hip arthroplasty (THA) PJI is a good strategy that provides satisfactory results, high eradication rates and no further need for revision. The conservative two-stage revision in patients with adequate bone stock represents a feasible option with good results and survival rates.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Prosthesis-Related Infections/diagnostic imaging , Tomography, X-Ray Computed , Aged , Female , Humans , Male , Middle Aged , Prosthesis-Related Infections/mortality , Prosthesis-Related Infections/therapy , Recurrence , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
PURPOSE: The aim of our work is to evaluate results obtained from a cohort of patients affected by periprosthetic joint infection and treated with a primary cementless stem in a two-stage technique framework. METHODS: Eighty-four patients were evaluated at a mean follow-up of 37.4 months. The main demographic, surgical, clinical, and radiographic data were recorded. A femoral window for stem removal was performed in 33 patients. RESULTS: Statistically significant improvement was noted for both the Harris Hip score and the Oxford Hip score. Postsurgical complications included thigh pain in three patients, subsidence (>2 mm) in one patient, implant dislocation in two patients, cup revision in one patient, implant revision for septic failure in two patients, and stem revision for varus position in one patient. The stem survivorship rate was 96.3%. There were no significant differences between the groups in which a cortical window was created or not. CONCLUSION: Femoral stem revision with primary cementless stems is a viable option in selected patients undergoing two-stage hip revision surgery. Correct indication is a cornerstone of good outcome. The use of a cortical window does not affect the final outcome or implant survivorship rate.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Femur/surgery , Hip Prosthesis/adverse effects , Prosthesis-Related Infections/surgery , Female , Humans , Male , Middle Aged , Prosthesis Design , ReoperationABSTRACT
We report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activity scale (TAS), and Lysholm score. The rate of return to sports and the level of play at final follow-up were recorded. ACL revision was performed with an autologous bone-patellar tendon-bone autograft or a hamstring graft. LET was performed using an extra-articular MacIntosh procedure as modified by Arnold-Coker. Anterior-posterior laxity was significantly reduced at the final clinical assessment (p < 0.0001): 22 patients (91.7%) had a negative pivot shift and 2 (8.3%) had residual glide (+), with significant improvement (p < 0.0001). The mean subjective IKDC and Lysholm score improved from 69.5 ± 11.1 (range: 56-90) to 88.4 ± 8.9 (range: 62.1-100) and from 58.1 ± 11.7 (range: 33-72) to 97.4 ± 3.2 (range: 88-100), respectively, with significant improvement (p < 0.0001) over preoperative values. The overall failure rate was 8.3%. There were no differences between mean preinjury and final TAS scores (p > 0.05). The rate of return to sports at the same level was 91.7% and the mean time to return to sports was 9.2 ± 2.2 months. Mid-term functional outcome after combined extra-articular reconstruction and ACL revision surgery was satisfactory, with a reduction in residual postoperative rotatory instability and degree of pivot shift.
Subject(s)
Bone-Patellar Tendon-Bone Grafting/statistics & numerical data , Reoperation/statistics & numerical data , Soccer/injuries , Tenodesis/statistics & numerical data , Adolescent , Adult , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Hamstring Muscles/transplantation , Humans , Knee Joint/surgery , Lysholm Knee Score , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Surgical options for patellofemoral (PF) disorders include proximal or distal realignment, cartilage restoration techniques, open or arthroscopic lateral retinacular release, and medial soft-tissue reefing. Skeletal immaturity and donor-site morbidity can be of concern in most reconstructive procedures. The Goldthwait procedure with hemi-patellar transfer and medialization combined with arthroscopic lateral retinacular release results in medialization of the PF contact point in flexion and corrects maltracking to prevent recurrent patellar dislocation. This functional procedure is indicated for PF instability and has historically been used in children to accommodate the immaturity of the tibial tubercle and physis. The purpose of surgical correction is to improve PF tracking, reducing the lateralizing forces on the patella with the correction of the Q angle (angle between the quadriceps tendon and patellar tendon). The purpose of this Technical Note was to describe, in detail, arthroscopic lateral retinacular release combined with the modified Goldthwait procedure for recurrent patellar instability.
ABSTRACT
PURPOSE: To report the results of arthroscopic lateral retinacular release without excision of the accessory fragment for treatment of symptomatic bipartite patella with a minimum 2-year follow-up. METHODS: We retrospectively reviewed all cases of symptomatic type III bipartite patella confirmed by radiographs, computed tomography, and magnetic resonance imaging and treated with arthroscopic lateral release from 2005 to 2015. Patients with history of knee fractures or surgery, concomitant meniscal or anterior cruciate ligament (ACL) procedures, and severe arthritic changes of the patellofemoral joint were excluded. Patients were assessed by Kujala score, visual analog scale (VAS), Tegner Activity Scale (TAS), and time to return to sporting activities. RESULTS: Ten patients (11 knees) were clinically reassessed after 69.6 ± 33.3 (range: 25-132; 95% confidence interval [CI]: 47.29-91.99) months from surgery. There was a significant improvement in Kujala (P < .05) and VAS scores (P < .05), and no differences were found between pre- and postoperative TAS scores (P > .05). No complications occurred during the follow-up period. All patients returned to sport after 42.3 ± 11.3 (range: 30-60; 95% CI: 34.71-49.84) days after surgery. CONCLUSIONS: The arthroscopic lateral retinacular release of a symptomatic type III bipartite patella without excision of the accessory fragment allowed early return to sporting activities, with excellent symptom relief. Patients had significantly improved mean Kujala and VAS scores without a decrease in the mean TAS scores. LEVEL OF EVIDENCE: Level IV, case series.