CaReS (MACT) versus microfracture in treating symptomatic patellofemoral cartilage defects: a retrospective matched-pair analysis.

BACKGROUND: Treating patellofemoral articular cartilage lesions remains a challenging task in orthopedic surgery. Whereas microfracture and autologous chondrocyte implantation yield good results on femoral condyles, the therapeutic state of the art for treating patellofemoral lesions is yet to be determined. In this study, we compared the CaReS technique, which is a matrix-associated autologous chondrocyte implantation technique, to microfracture for treating patellofemoral articular cartilage lesions. METHODS: Between May 2003 and December 2005, 17 patients with an isolated patellofemoral cartilage defect (International Cartilage Repair Society III/IV) were treated with the CaReS technique at our department. After adjusting for inclusion and exclusion criteria, ten of these patients could be included in this study; ten patients treated with microfracture were chosen as a matched-pair group. Clinical outcome was evaluated 3 years after surgery by the 36-item Short Form Health Survey Questionnaire (SF-36), International Knee Documentation Committee (IKDC) subjective evaluation of the knee, Lysholm Score, and Cincinnati Modified Rating Scale scores. RESULTS: Patients treated with CaReS had statistically significantly improved IKDC, Lysholm, and Cincinnati scores 36 months after surgery compared with preoperatively. When comparing outcome between groups 36 months after surgery, there was no statistically difference in IKDC, Lysholm, and Cincinnati scores. CONCLUSIONS: This is the first trial comparing the CaReS technique and microfracture for treating patellofemoral articular cartilage lesions, and results show that CaReS(®) yields comparable results to microfracture. The small number of patients is a limiting factor of the study, leading to results without statistical significance. A multicentric prospective randomized study comparing the two procedures is desirable.

Clinical and radiological results after implantation of the femoral neck preserving Delfi M hip prosthesis: a case series.

Various types of bone preserving total hip prostheses with a proximal force transmission concept have been developed for younger adults, one of these being the implant "Delfi M®", produced by ESKA until 2009. Since the demand could not meet the expectations, the production was stopped due to economic reasons so that only 31 implants of this type were sold and even less actually implanted. This study followed up 15 Delfi M® prostheses in 12 patients for 3.1 years and represents the only existing valid data about this implant.Demographical, preoperative and postoperative data including clinical scores (HOOS and mHHS) were collected retrospectively. Postoperative X-rays were analyzed by an independent radiologist. One implant had to be exchanged due to an infection and another one due to excessive implant migration. The mHHS and the HOOS scores showed a significant improvement after surgery. In the radiological analysis, there were no signs of radiolucent lines or osteolyses.This trial demonstrates good clinical and radiological midterm results for the Delfi M prosthesis. Limitations of this study are a small sample size and a follow-up time of 3 years at only one timepoint.

Seeding a human tendon matrix with bone marrow aspirates compared to previously isolated hBMSCs--an in vitro study.

Injuries of tendons and ligaments give rise to significant morbidity. Tissue engineering offers promising treatment concepts such as seeding a scaffold with human bone marrow stem cells (hBMSCs) to create high-quality tendon replacement tissue. HBMSCs are usually isolated and cultured prior to seeding. Studies evaluating if previous isolation is superior to seeding with bone marrow aspirates have not been published yet. The aim of this study was to compare these two seeding methods in terms of cell viability, proliferation and differentiation. HBMSCs were harvested from the iliac crest during routine trauma surgery. In group A the scaffold (human achilles tendons) was seeded with bone marrow aspirates, while in group B hBMSCs were isolated, harvested and then seeded. Constructs were stimulated in perfusion bioreactors according to established protocols. Mean cell proliferation was significantly increased (p< 0.05) on tendons seeded with bone marrow aspirates. Cell viability, the concentration of alkaline phosphatase in the perfused media and the synthesis of procollagen - III - polypeptide (PIIIP) were not significantly different when comparing the two groups. The synthesis of procollagen-I-polypeptide (PIP) was significantly increased on tendons seeded with previously isolated hBMSCs p < 0.05). The results indicate that seeding a human tendon matrix scaffold with bone marrow aspirates may be equal to seeding with previously isolated hBMSCs. This new seeding method could facilitate and speed up the tissue engineering process.

Surgical therapy of exocrine pancreatic carcinoma--results at an academic teaching hospital and evaluation of prognostic factors.

BACKGROUND/AIMS: Pancreatic cancer is among the top five cancer related death causes in countries like the US and Germany. Many studies have shown favorable results of pancreatic carcinoma resection at high-volume hospitals. It was the aim of this study to compare the results of pancreatic resection of exocrine pancreatic carcinoma at an academic teaching hospital with those of international centers for pancreatic surgery and to identify prognostic factors for survival. METHODOLOGY: Ninety-eight patients with exocrine pancreatic carcinoma were treated at our hospital, 42 of those underwent a resection. The data was collected from the patient files and statistically analyzed. A complete follow-up was reached. RESULTS: The resection rate was 42.9%, of which 83.3% were R0-resections. Mortality was 2.4%, morbidity 31%. Median survival after R0-resection was 14 months and 57.1% of the patients received adjuvant chemotherapy with gemcitabine. The performed surgical procedure and adjuvant chemotherapy were identified as independent determinants of long-term survival. CONCLUSION: This study shows that morbidity, mortality and survival rates reported in studies from international centers for pancreatic surgery can be reached at an academic teaching hospital as well. Adjuvant chemotherapy prolongs survival.