Clinical, biomechanical and morphological assessment of anterior cruciate ligament Kevlar®-based artificial prosthesis in rabbit model.

BACKGROUND: The aim of this study was to evaluate the clinical, biomechanical and morphological characteristics of a Kevlar®-based prosthetic ligament as a synthetic graft of the anterior cruciate ligament (ACL) in an experimental animal model in rabbits. METHODS: A total of 27 knees of rabbits randomly divided into 3 groups (control, ACL excision and ACL replacement with a Kevlar® prosthesis) were analyzed using clinical, biomechanical and morphological tests at 6, 12 and 18 weeks postprocedure. RESULTS: The mean displacement in mechanical testing was 0.73 ± 0.06 mm, 1.58 ± 0.19 mm and 0.94 ± 0.20 mm for the control, ACL excision and ACL replacement with synthetic prosthesis groups, respectively. The results showed an improvement in the stability of the knee with the use of the Kevlar® synthetic prosthesis in the biomechanical testing (p<0.05) compared with rabbits that underwent ACL excision, in addition to displacements that were larger but comparable to that in the control group (p>0.05), between the replacement group and the control group. The histological study revealed a good morphological adaptation of the synthetic material to the knee. CONCLUSIONS: This study proposes a new animal model for the placement and evaluation of Kevlar®-based synthetic ACL implants. The studied prosthesis showed promising behavior in the clinical and biomechanical tests and in the histological analysis. This study lays the foundation for further basic and clinical studies of artificial ACL prostheses using this material.

[Interosseous electrostimulation in a model of lengthening with external fixation]. / Electroestimulación interósea en un modelo de elongación con fijación externa.

BACKGROUND: A fracture repair involves complex cellular processes. However, despite optimal treatment, some fractures heal slowly or do not repair. These complications support the need for innovative therapies. Electromagnetic stimulation is a non-invasive technology that could have a direct impact on many cellular pathways. OBJECTIVE: To demonstrate the effectiveness of electro-stimulation by alternating current applied during bone elongation to accelerate the consolidation process for 30 days in an animal model. MATERIALS AND METHODS: A device with closed circuit and graduated voltage was designed and kept in contact with the external fixator. Group A was elongated without electro-stimulation and group B was electro-stimulated since the beginning of the distraction. Radiographs were taken at 15 and 30 days post-surgical. Haematoxylin and eosin staining and Masson's trichrome stain were performed. RESULTS: No significant difference were observed in bone density of group A (4.05±3.24, P=0.163). In group B there was a significant difference (61.06±20.17, P=0.03) in bone density. Group A maintained a fibrous tissue repair, with areas of cartilage and bone matrix. Group B had more organised tissue in the stages of bone repair. CONCLUSION: Because there is a significant difference in the growth and callus formation at 15 and 30 days between groups, electro-stimulation could be considered as an adjuvant during bone elongation.

Plantar Fasciitis-A Comparison of Treatment with Intralesional Steroids versus Platelet-Rich Plasma A Randomized, Blinded Study.

BACKGROUND: Many treatment options for plantar fasciitis currently exist, some with great success in pain relief. The objective of our study was to compare the use of intralesional steroids with platelet-rich plasma (PRP), using pain scales and functional evaluation, in patients with plantar fasciitis who did not respond to conservative treatment. METHODS: A controlled, randomized, blinded clinical assay was performed. Patients were assigned to one of the two groups by selecting a sealed envelope. The steroid treatment group received 8 mg of dexamethasone plus 2 mL of lidocaine as a local anesthetic. The PRP treatment group received 3 mL of PRP activated with 0.45 mL of 10% calcium gluconate. All of the patients were evaluated at the beginning of the study, and at 2, 4, 8, 12, and 16 weeks post-treatment with the Visual Analog Scale (VAS), Foot and Ankle Disability Index (FADI), and American Orthopedic Foot and Ankle Society (AOFAS) scale. RESULTS: The right foot was the most frequently affected foot (63%). The average age of the patients was 44.8 years (range, 24-61 years). All scales used (VAS, FADI and AOFAS) showed that the difference was not statistically significant between the two groups. CONCLUSIONS: We can conclude that the use of PRP is an effective treatment method for patients with plantar fasciitis who do not respond to conservative treatment because PRP demonstrates an efficacy equal to that of steroids. However, the cost and the time for preparation the PRP are two of the disadvantages of this treatment.

Implant Composed of Demineralized Bone and Mesenchymal Stem Cells Genetically Modified with AdBMP2/AdBMP7 for the Regeneration of Bone Fractures in Ovis aries.

Adipose-derived mesenchymal stem cells (ADMSCs) are inducible to an osteogenic phenotype by the bone morphogenetic proteins (BMPs). This facilitates the generation of implants for bone tissue regeneration. This study evaluated the in vitro osteogenic differentiation of ADMSCs transduced individually and in combination with adenoviral vectors expressing BMP2 and BMP7. Moreover, the effectiveness of the implant containing ADMSCs transduced with the adenoviral vectors AdBMP2/AdBMP7 and embedded in demineralized bone matrix (DBM) was tested in a model of tibial fracture in sheep. This graft was compared to ewes implanted with untransduced ADMSCs embedded in the same matrix and with injured but untreated animals. In vivo results showed accelerated osteogenesis in the group treated with the AdBMP2/AdBMP7 transduced ADMSC graft, which also showed improved restoration of the normal bone morphology.

Anthropometric landmarks for posterior cruciate ligament reconstruction in anatomical position / Referencias antropométricas para la reconstrucción del ligamento cruzado posterior en posición anatómica

To determine viable anatomical landmarks allowing for accurate femoral and tibial tunnel placement in anatomical position during posterior cruciate ligament (PCL) reconstruction. Ten knees were dissected to analyze femoral and tibial PCL insertion measurements and the features specific to the PCL and its fascicles. The clock hands system was used to measure femoral insertions. The meniscus and anterior cruciate ligament (ACL) were used as landmarks to measure tibial insertions. The PCL and its corresponding fascicle characteristics were determined by its femoral insertion, central portion and tibial insertion. The mean lengths between the central point of the PCL footprint and the articular cartilage border at 12:00 h were 17.23 mm (±3.94) and 17.73 mm (±4.11) for the right and left knees, respectively. The anterior-posterior mean lengths for the PCL were 11.94 mm (±5.08) between the posterior PCL border and the anterior PCL border. The mean lengths were 33.52 mm (±3.49) from the medial border of the lateral meniscus to the lateral PCL border and 32.24 mm (±2.28) from the medial border of the medial meniscus to the medial PCL border. From the anteroposterior viewpoint, the anterolateral fascicle is greater than the posteromedial one in its femoral and tibial insertions and in its central portion. A quantitative data collection summary was conducted with different PCL variables, along with its fascicles and their various femoral and tibial bony landmarks. Various measurements were obtained, indicating the high functionality shared by the PCL fascicles. Lengths reported for insertions are practical landmarks for the locations of femoral and tibial tunnels during posterior cruciate ligament plasty. We must take into account native PCL form to avoid oversizing the graft during reconstruction and to avoid a possible clamping of the graft with the surrounding structures.

El propósito del estudio fue determinar referencias anatómicas viables para la correcta colocación de los túneles femorales y tibiales en posición anatómica durante la reconstrucción del ligamento cruzado posterior (LCP). Se utilizaron 10 rodillas, las cuales fueron disecadas para analizar las mediciones de la inserción femoral y tibial del LCP, sus fascículos y estructuras adyacentes. Se utilizó el sistema de las manecillas del reloj para la medición de las inserciones femorales. Los meniscos y el ligamento cruzado anterior (LCA) fueron utilizados como referencias para la medición de las inserciones tibiales. El LCP y las características de sus fascículos correspondientes fueron determinados por su inserción femoral, porción central e inserción tibial. La media de la longitud entre la porción central de la huella dejada por el LCP y el margen anterior del cartílago femoral a las 12:00 h fue de (±3.94) y 17,73 mm (±4,11) para la rodilla derecha e izquierda, respectivamente. La longitudes del LCP fueron de 11,94 mm (±5,08) entre el margen posterior del LCP y el margen anterior del LCP. La media fue de 33,52 mm (±3,49) desde el margen medial del menisco lateral al margen lateral del LCP y de 32,24 mm (±2,28) del margen medial del menisco medial al margen medial del LCP. Desde el punto de visión anteroposterior, el fascículo anterolateral es mayor que el posteromedial tanto en su inserción femoral como en el punto central e inserción tibial. Se analizó una colección cuantitativa de bases de datos con distintas variables del LCP, así como de sus fascículos y sus inserciones femorales y tibiales. Se obtuvieron varias medidas, indicando la alta funcionalidad compartida por los fascículos del LCP. Las inserciones reportadas son referencias prácticas para la localización de los túneles tibiales y femorales durante la plastía del ligamento cruzado posterior.

Análisis histopatológico del cartílago articular expuesto a metilprednisolona, ropivacaína y ácido hialurónico en un modelo animal de osteoartrosis / Histopathological analysis of the articular cartilage exposed to methylprednisolone, ropivacaine and hyaluronic acid in an animal model of osteoarthrosis

La osteoartrosis es un padecimiento del aparato locomotor con una prevalencia elevada y en crecimiento, paralela al envejecimiento de la población. La infiltración intraarticular de sustancias para aliviar la sintomatología de la osteoartrosis es una práctica común en el consultorio médico de los especialistas que atienden esta enfermedad. Aunque la sintomatología mejora con la infiltración de anestésicos locales, corticoesteroides y suplementos viscosantes, es aún incierto el efecto que estas sustancias tienen sobre la integridad del cartílago articular. Este estudio explora a nivel macroscópico e histológico el efecto de la infiltración de ropivacaína, metilprednisolona y ácido hialurónico sobre el cartílago articular en un modelo de osteoartrosis química en conejos (n=24). Nuestros resultados indican que en los grupos infiltrados con metilprednisolona (n=8) y ropivacaína (n=8) la estructura del cartílago articular presento alteraciones más severas con respecto a su grupo control, además de una disminución importante en la síntesis de matriz extracelular. En el grupo infiltrado con ácido hialurónico (n=8), las alteraciones macroscópicas e histológicas del cartílago articular mejoraron con respecto a su grupo control, presentando una estructura integra y síntesis de matriz extracelular normal.

Osteoarthritis is a musculoskeletal condition with a high prevalence, increasing with the aging of population. The intraarticular infiltration of substances to relieve the symptoms of osteoarthritis is a common practice in medical practice. Although symptoms improved with the infiltration of local anesthetics, corticosteroids and supplements, it is still uncertain what effect these substances have on the integrity of articular cartilage. This study explores the macroscopic and histological effects of infiltration of Ropivacaine, Methylprednisolone and Hyaluronic Acid on articular cartilage in a model of chemical osteoarthritis in rabbits (n=24). Our results indicate that in the infiltrated groups with Methylprednisolone (n=8) and Ropivacaine (n=8) the structure of articular cartilage present more severe alterations with respect to its control group and an important decrease in the synthesis of extracellular matrix. In-group infiltrated with hyaluronic acid (n=8), macroscopic and histological changes of articular cartilage improved with respect to its control group, presenting a normal structure and normal extracellular matrix synthesis.

[Platelet rich plasma versus oral paracetamol for the treatment of early knee osteoarthritis. Preliminary study]. / Plasma rico en plaquetas versus paracetamol oral para el tratamiento de la osteoartrosis temprana de rodilla. Estudio preliminar.

BACKGROUND: in the treatment of early osteoartrosis, analgesics and non-steroidal anti-inflammatory drugs are frequently used to relieve pain. Currently, platelet rich plasma is used as an alternative in the treatment of osteoartrosis. The aim of this study was to evaluate the effect of platelet rich plasma compared to paracetamol as a treatment for patients with knee osteoartrosis grade I. METHODS: we evaluated 42 patients who were randomized into two groups. Group one was treated with 5 mL of platelet rich plasma in two applications, while group two was treated with 1 gr of oral paracetamol every 8 hours for 30 days. Both patient groups received supervised physical rehabilitation during the 6 month observation period. Peripheral blood samples were taken to measure plasma IL-1ß, TNF-a and TGF-ß1 levels at day 0 and at 6 months post-treatment. Clinical evaluation was conducted using the KOOS at the start of the study and for every subsequent month during the study period. RESULTS: the Knee injury and Osteoarthritis Outcome Score (KOOS) for group one at the start of the treatment was measured at 30.1 points, whereas at the end, it was measured at 48.2 points, showing a clinical improvement of 60%. There were no statistically significant differences in IL-1ß and TNF-a levels between groups treated either with platelet rich plasma or paracetamol. CONCLUSIONS: Our patients treated with platelet rich plasma showed a statistically significant increase in the serum levels of TGF-ß1, which was associated with an improvement in the clinical evaluation used (KOOS).

Antecedentes: la osteoartrosis se caracteriza por dolor, rigidez articular y crepitación, con datos radiológicos específicos. El dolor se controla con analgésicos y antiinflamatorios no esteroides. En la actualidad, el plasma rico en plaquetas es una alternativa de tratamiento de esta enfermedad. Objetivo: comparar el efecto del plasma rico en plaquetas versus paracetamol en el tratamiento de pacientes con osteoartrosis de rodilla grado I. Material y métodos: ensayo prospectivo y experimental en el que se estudiaron 42 pacientes que se asignaron al azar a dos grupos. Al grupo 1 (experimental) se le indicaron 5 mL de plasma rico en plaquetas, en dos aplicaciones; el grupo 2 (control) se trató con 1 g de paracetamol oral cada 8 horas durante 30 días. Ambos grupos recibieron terapia física supervisada, con un tiempo de seguimiento total de seis meses. Para determinar las concentraciones de sangre periférica se tomaron muestras de IL-1ß, TNF-a y TGF-ß en plasma el día 0 y a los 6 meses. La valoración clínica se realizó con el Knee injury and Osteoarthritis Outcome Score (KOOS) al inicio y mensualmente durante el estudio. Resultados: los resultados de IL-1ß y TNF-a no mostraron diferencia significativa entre los grupos tratados con plasma rico en plaquetas y paracetamol. La escala KOOS para el grupo 1 al inicio del tratamiento fue de 30.1 puntos y al finalizar el tratamiento 48.2 puntos, con mejoría clínica de 60%. Conclusiones: los pacientes tratados con plasma rico en plaquetas tuvieron un incremento significativo en las concentraciones séricas de TGF-ß1 que se asoció con la mejoría clínica relacionada con el KOOS.

A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study.

BACKGROUND: The objective of this study was to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis. METHODS: The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids. RESULTS: When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study. CONCLUSION: A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids. LEVEL OF EVIDENCE: Level I, therapeutic studies.

Fractura de Colles: correlación anatomo-funcional mediante el esquema de Green y O'Brian / Colles's fracture: anatomo-functional correlationship based upon the Green and O'Brian scale

Objetivo. Comparar los resultados anatómicos con los clínicos en pacientes tratados por fractura de Colles unilateral, según los criterios de Green y O'Brian. Material y métodos. De 30 pacientes con fractura de Colles unilateral tratados de marzo a julio de 1998, se presenta una serie de 19 por llenar criterios de inclusión al no tratarse de fracturas con antecedentes patológicos. Se comparó su estudio clínico y radiográfico inicial y final y los pacientes llenaron un cuestionario de evaluación personal de su resultado. Resultados. Independientemente del tratamiento, que fue cerrado en 17 de los 19 casos, los resultados fueron excelentes en 31 por ciento, buenos en 15 por ciento, regulares en 26 por ciento y malos en 26 por ciento. Asimismo, la correlación se pudo establecer en 52 por ciento (10 casos) y no así en los restantes nueve, ya fuera por un mal resultado radiológico y buen curso clínico o viceversa. Conclusión. No existe regla absoluta entre resultado anatómico y funcional. El mejor resultado funcional se obtiene en los casos que se apegaron estrictamente al programa domiciliario de rehabilitación.

La escoliosis idiopática del adolescente manejada con instrumentación TSRH. Experiencia preliminar en 14 casos / Adolescent idiopatic scoliosis treated by TSRH instrumentation. preliminary report of 14 cases

En el Servicio de Ortopedia y Traumatología del Hospital Universitario "Dr. José E. González" de Monterrey, N.L., de abril de 1993 a noviembre de 1994, se operaron 14 pacientes con diagnóstico de escoliosis idiopática del adolescente, con la Instrumentación Segmentaria TSRH (Texas Scotish Rite Hospital); 10 del sexo femenino y 4 del masculino. La edad promedio fue de 15 años 9 meses. Los patrones de curvas tratadas fueron: King I (5 pacientes), King II (2 pacientes) y King III (7 pacientes). La corrección obtenida fue de un 74 por ciento. Los 14 pacientes tienen una evolución post-operatoria mayor de 12 meses, encontrándose en todos una fusión adecuada, sin pérdida de corrección. El tiempo quirúrgico fue de 4 horas y el sangrado promedio fue de 1,400 cc. En un paciente se tuvo luxación de un gancho laminar lumbar, realizándose una reinserción del mismo y está actualmente sin molestias y sin pérdida de la corrección

Uso del halo cefálico preoperatorio en las deformidades estructuradas de la columna vertebral / Pre-operative halo-traction in treatment of structural spinal deformities. Report of 32 cases

En el departamento de ortopedia del Hospital Universitario de Monterrey, N.L., México, desde enero de 1983 se han aplicado 32 halos cefálicos en pacientes con deformidades de la columna verteral. El objetivo de este trabajo es comentar la técnica empleada en la aplicación del halo; mencionar los casos en que se ha utilizado, así como dar a conocer el alto porcentaje de seguridad en su aplicación y la baja incidencia de complicaciones.

Instrumentación de Harrington con alambrado sublaminar total en escoliosis flexibles / Harrington instrumentation and sublaminar wiring for flexible scoliosis

De marzo de 1984 a noviembre de 1988 en el Servicio de Ortopedia del Hospital Universitario "Dr. José E. González" y del Hospital Regional del ISSSTE de Monterrey, Nuevo León, se trataron quirúrgicamente 25 pacientes con diagnóstico de escoliosis idiopática del adolescente y paralítica por poliomielitis que presentaban curvas torácicas o toracolumbares arriba de 40 grados, que dinámicamente corregían 50%o más. Se practicó instrumentación de Harrington más alambrado sublaminar total; el seguimiento mínimo fue de un año. No hubo complicaciones importantes. La corrección obtenida fue de 62%en promedio.