The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis.

OBJECTIVE: The purpose of this meta-analysis was to compare the impact of platelet-rich plasma with that of placebo or dry needling injections on tendinopathy. METHODS: The databases of PubMed, CENTRAL, Scopus, Web of Science, and trial registries, reference lists, and conference abstract books were searched up to December 2014. Adults with tendinopathy in randomized controlled trials were enrolled. The trials compared effect of platelet-rich plasma with that of placebo or dry needling. We used subgroup analysis linked to the anatomical location of the tendinopathy. The primary outcome was pain intensity at two or three and six months after intervention. The secondary outcome was functional disability at three months after treatment. RESULTS: Five trials were included. There was a statistically significant difference in favor of the platelet-rich plasma intervention at the second primary outcome time point (SMD -0.48, 95%CIs -0.86 to -0.10, I(2) = 0%, p = 0.01) and at the secondary outcome time point (SMD -0.47, 95%CIs -0.85 to -0.09, I(2) = 0%, p=0.01). CONCLUSIONS: Platelet-rich plasma did not provide significantly greater clinical benefit versus placebo or dry needling for the treatment of tendinopathy at a six-month follow-up. However, there was a marginal clinical difference in favor of platelet-rich plasma injections on rotator cuff tendinopathy.

The styloid process in a Greek population: an anatomical study with clinical implications.

The study determines the variability of the length of the styloid process in a Greek population and investigates how it is affected by gender and age; it also evaluates the side asymmetry, highlighting clinical implications. One hundred and forty-nine dry adult modern skulls (94 male and 55 female) were divided into subgroups according to their age: 20-39, 40-59 and older than 60 years. The lengths of 262 styloid processes (127 right and 135 left-sided) were measured. The lengths of right-sided styloid processes ranged from 6.4 to 70.2 mm and left-sided styloid processes from 5.2 to 69.0 mm. The processes were classified according to their lengths as short <18 mm, normal 18-33 mm and elongated >33 mm. The majority of the processes were normal (45.8 %), 27.5 % were short and 26.7 % elongated. No statistical significant correlation was established among the lengths of the styloid processes, gender and age. Side asymmetry was found only in the group with elongated styloid processes (right processes were longer, 28.3 %, than the left ones 25.2 %; p = 0.016). Our study contributes to the literature, adding important information about the length of the styloid process and its diversity in the Greek population. It also confirms the existence of an osseous landmark as a starting point for the measurement of the length of the styloid process and proposes a method of measurement for the evaluation of the actual length of the styloid process.

Variable origin and ramification pattern of the lateral femoral cutaneous nerve: a case report and neurosurgical considerations.

Variations in the anatomy of the lateral femoral cutaneous nerve (LFCN) have been reported in the literature. LFCN is vulnerable to injury during several surgical operations, therefore any surgeon intervening in the area should be familiar to its topographic variability. Lesion of the nerve leads to a condition known as "meralgia paresthetica". We present a cadaveric case of a variant LFCN where two LFCN branches were encountered arising from the lumbar plexus. In specific the anterior LFCN branch originated from the femoral nerve, whereas at the level of the inguinal ligament, four nerve branches were present. The existence of multiple LFCN branches could lead to diagnostic confusion in case of "meralgia paresthetica", while if the neurosurgeon is not aware of the potential variability during surgical decompression of the nerve, postoperative complications may occur. The supernumerary LFCN branches could be identified by ultrasound imaging and be used as optimum vascularized grafts for sensory nerve repair.

Gender and Side-to-Side Differences of Femoral Condyles Morphology: Osteometric Data from 360 Caucasian Dried Femori.

The purpose of the present study was to conduct direct measurements in a large sample of dried femori in order to record certain morphometric parameters of the femoral condyles and determine whether there are gender and side differences. Three hundred sixty (Greek) Caucasian dried femori (180 left and 180 right), from 192 males and 168 females, were measured using a digital caliper. The mean age was 67.52 years. The mean bicondylar width of the femur was 8.86 cm ± 0.42 cm in men and 7.85 cm ± 0.30 cm in women (P < 0.01). The relative values for the medial condylar depth were 6.11 cm ± 0.34 cm and 5.59 cm ± 0.29 cm (P < 0.05); for the lateral condylar depth were 6.11 cm ± 0.33 cm and 5.54 cm ± 0.21 cm (P < 0.01); for the intercondylar width were 2.20 cm ± 0.18 cm and 1.87 cm ± 0.10 cm (P < 0.001); for the intercondylar depth were 2.78 cm ± 0.16 cm and 2.37 cm ± 0.12 cm (P < 0.001). No significant side-to-side difference was observed in any parameter. The femoral condyles differences in anatomy between genders might be useful to the design of total knee prostheses. The contralateral healthy side can be safely used for preoperative templating since there were no significant side differences.

Adequacy of semitendinosus tendon alone for anterior cruciate ligament reconstruction graft and prediction of hamstring graft size by evaluating simple anthropometric parameters.

INTRODUCTION: Preoperative identification of patients with inadequate hamstring grafts for anterior cruciate ligament reconstruction is still a subject of interest. PURPOSE: The purpose of this study was to determine whether the semitendinosus tendon length is adequate for four-strand graft harvested by common technique (without bone plug) and whether there is correlation of gracilis and semitendinosus tendon grafts length and diameter of quadrupled graft with anthropometric parameters. MATERIALS AND METHODS: In this retrospective study, 61 patients (45 males, 16 females) undergoing ACL reconstruction using four-strand hamstring autograft tendons were included. Results. The length of semitendinosus tendon, harvested by the common technique, was in 21% of our cases inadequate in order to be used alone as a four-strand graft especially in females (43%). There was moderate correlation between semitendinosus and gracilis graft diameter and patient's height and weight and fair correlation to BMI. We found no statistically important predictor for graft diameter in female patients. CONCLUSIONS: The length of semitendinosus tendon, harvested by common technique, is usually inadequate to be used alone as a four-strand graft especially in females. The most reliable predictor seems to be patient's height in males. In female patients, there is no statistically important predictor.

Rectus abdominis overuse injury in a tennis athlete treated with traumeel.

BACKGROUND: Rectus abdominis injuries are common in tennis players at all levels of competition. Traumeel(®) injection can be used for treatment of muscle strains and hematomas. CASE REPORT: A 21-year-old female tennis athlete was injured on the non-dominant rectus abdominis during the cocking phase of the service motion. She suffered from pain and tenderness. One week later, during a serve, she experienced severe pain on the contralateral side of her abdomen. Conservative treatment was performed by the team physician with rest, ice therapy and analgesics for 20 days, but she had recurrent injuries. The ultrasonography and MRI showed hematoma of the rectus abdominis muscle. She was treated with 2 injections of Traumeel(®) on the 2(nd), 4(th), 6(th) post-traumatic day and received 1 injection on the 10(th) post-traumatic day. She also modified her serve technique. On the fourth post-treatment week the athlete had pain-free function and both the MRI appearance and the size of rectus abdominal muscle were normal. She returned to her sport activities. There is no recurrence of her injury 2 years later. CONCLUSIONS: Rectus abdominis hematoma must be diagnosed early. Traumeel(®) injections are effective, safe and well-tolerated for the treatment of overuse injury of the rectus abdominis following strain.

Efficacy of paracetamol versus diclofenac for Grade II ankle sprains.

BACKGROUND: Ankle sprains are usually treated with the RICE protocol often with nonsteroidal anti-inflammatory drugs (NSAID) for pain reduction. We evaluated the effect of diclofenac, an NSAID, versus paracematol in the reduction of pain and acute edema of severe ankle sprains. MATERIALS AND METHODS: Ninety patients, 18 to 60 years old, with Grade II acute ankle sprains were randomized into two groups. Group A (45 patients) received for the first 10 days diclofenac 75 mg orally twice per day. Group B (45 patients) received paracetamol 500 mg orally three times per day for the same period. We evaluated ankle joint edema with the Figure-of-Eight method and with the volumetric method, as well as pain with the Visual Analogue Scale (VAS) in both groups. RESULTS: The patients had no significant differences concerning their baseline values (p > 0.05). The ankle joint edema was decreased in both groups (p < 0.001) but there was more edema in group A than in group B at the third post-traumatic day with both measurement methods (p = 0.028/0.025). By the tenth post-traumatic day no difference was found. Pain decreased in both groups at the third day and at the tenth day (p < 0.001). CONCLUSION: According to these results, diclofenac and paracetamol had the same effect on pain reduction of ankle sprains but more acute ankle edema was present in patients who were treated with diclofenac than in patients who were treated with paracetamol.

Accessory extensor digiti minimi muscle simulating a soft tissue mass during surgery: a case report.

During a wrist ganglion excision originating at the tendon sheath of the extensor carpi ulnaris muscle, a soft tissue mass was observed just radial and distal to the surgical field. Dissection of the mass revealed an accessory extensor digiti minimi muscle belly which joined the radial extensor digiti minimi tendon. The surgical impact is discussed.

Cytogenetic damage after ischemia and reperfusion.

Tourniquets are often used to provide a bloodless operating field. However, they carry the risk of adverse effects caused by DNA damage from the free radicals generated during postischemic reperfusion of the blood. The aim of this study was to evaluate the cytogenetic damage caused by postischemic reperfusion on peripheral lymphocytes of five women and six men undergoing total knee arthroplasty "bloodless" operation using samples received before, during, immediately, and 1 h after the operations. The sister chromatid exchange assay was applied to peripheral blood lymphocyte cultures and the levels of sister chromatid exchanges were analyzed as a quantitative index of genotoxicity, along with the values of mitotic index and proliferation rate index as qualitative indices of cytotoxicity and cytostaticity, respectively. We observed that postischemic reperfusion induced cytogenetic damages specifically through reperfusion. DNA effects were most pronounced after tourniquet release and declined afterward without returning to preischemic baseline values. Our findings suggest the presence of a functional association between postischemic reperfusion and cytogenetic damage that may have important clinical implications.

Bilateral rectus femoris intramuscular haematoma following simultaneous quadriceps strain in an athlete: a case report.

INTRODUCTION: Bilateral rectus femoris haematoma following a simultaneous strain of the quadriceps muscles is a very rare condition. CASE PRESENTATION: We report the case of a 21-year-old Greek Caucasian female rowing athlete who was injured on both thighs. She complained of pain and inability to walk. Physical examination revealed tenderness over the thighs and restriction of knee movement. The result of a roentgenogram was normal, and there was no evidence of fracture or patella displacement. Magnetic resonance imaging revealed haematoma formation in both the rectus femoris muscles. The diameters of the left and right haematomas within the muscles were 6 cm and 5 cm, respectively. Therapeutic approaches included compression bandages, ice application, rest, elevation, and administration of muscle relaxant drugs. Active stretching and isometric exercises were performed after three days. The patient was able to walk using crutches two days after the initiation of treatment. On the seventh day, she had regained her full ability to walk without crutches. Non-steroidal anti-inflammatory drugs were administered on the fifth day and continued for one week. Six weeks later, she had pain-free function and the result of magnetic resonance imaging was normal. She was able to resume her training programme and two weeks later, she returned to her previous sport activities and competitions. CONCLUSION: There are references in the literature regarding the occurrence of unilateral quadriceps haematomas following strain and bilateral quadriceps tendon rupture in athletes. Simultaneous bilateral rectus femoris haematomas after a muscle strain is a rare condition. It must be diagnosed early. The three phases of treatment are rest, knee mobilization, and restoration of quadriceps function.

Duplication of the inferior vena cava: anatomy, embryology and classification proposal.

A case of a duplicated inferior vena cava (IVC) along with other anatomical vessel variations in a 72-year-old male cadaver is presented. The anomalous vessels involved, besides the IVC, were the left testicular vein and artery, the left suprarenal artery and a superior accessory left renal artery. Based on the gross appearance of the preaortic anastomotic trunk between the left and right IVC as well as on the underlying embryological features, a classification is proposed: incomplete bilateral duplication of the IVC and complete bilateral duplication of the IVC. The latter can be further divided into three types: major, minor and asymmetric.

Study of two cases of high-origin radialartery in humans

Variations in the normal arterial anatomical pattern are very common and among them the high origin of the radial artery is the most frequent variation. We report two cases of a unilateral high-origin radial artery with different variations in each case in the course of the artery, along with a review of the literature. From an embryological point of view, the presence of a radial artery of high origin is established by developmental stage 18 and may be due to a differentiated hemodynamic predominance of the deep arterial segments over the superficial arterial network, chemical factors, foetal position in the uterus, developmental arrest in early stages, and genetic predisposition. Additionally, a high-origin radial artery may complicate medical procedures, leading to misdiagnosis and easier injury. Finally, we discuss the terminology problem we came across reviewing the literature because a number of studies refer to this variant using different terms (AU)

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