[Influence of age and duration of neuropathy on effect of the surgical treatment of upper extremity compressive neuropathies]. / Wplyw wieku chorego i czasu trwania neuropatii na wyniki operacyjnego leczenia neuropatii uciskowych konczyny górnej.

Carpal tunnel syndrome and cubital tunnel syndrome are the most common compressive neuropathies of the upper extremity. Many surgical techniques of its treatment have been elaborated. Even though all of techniques turned out to be equally effective, minimal invasive methods are now very willingly applied. In our research, performed on 65 patients, we would like to demonstrate, that duration of the neuropathy has a serious influence on the effect of surgical treatment.

Scaffold-aided repair of articular cartilage studied by MRI.

OBJECTIVE: The objective of the study was to evaluate the ability of the noninvasive magnetic resonance techniques to monitor the scaffold-aided process of articular cartilage repair. MATERIALS AND METHODS: Defects of 4 mm in diameter and 3 mm in depth were created in right knees of 30 adolescent white New Zealand rabbits. Fourteen rabbits were implanted with poly(lactide-co-glycolic acid) (PLGA) scaffold trimmed to match the size and the shape of the defect (PLGA+ group). No procedure was applied to the remaining 16 animals (PLGA- group). Animals were sacrificed sequentially at 4, 12, and 24 weeks after the surgery and magnetic resonance T (2)-weighted images (400 MHz) of the dissected bone plugs at eight different echo times were taken to derive T (2) relaxation time. The images and the T (2) time dependencies versus the tissue depth were statistically analyzed. Histological results of bone plugs were evaluated using semiquantitative histological scales. RESULTS: The results obtained for PLGA repair tissue were evaluated versus the PLGA- group and the healthy tissue harvested from the opposite knee (reference group), and compared with histological results (hematoxylin and eosin staining). The magnetic resonance images and T (2) relaxation time profiles taken 4 weeks after surgery for both the PLGA- and PLGA+ group did not reveal the tissue reconstruction. After 12 weeks of treatment T (2) time dependence indicates a slight reconstruction for PLGA+ group. The T (2) time dependence obtained for PLGA+ samples taken after 24 weeks of treatment resembled the one observed for the healthy cartilage, indicating tissue reconstruction in the form of fibrous cartilage. The tissue reconstruction was not observed for PLGA- samples. CONCLUSION: The study revealed correlation between magnetic resonance and histology data, indicating the potential value of using MRI and spatial variation of T (2) as the noninvasive tools to evaluate the process of articular cartilage repair. It also suggested, that the PLGA scaffold-aided treatment could help to restore the proper architecture of collagen fibrils.

[Latest standards of muscle injury prophylactic activities, treatment and rehabilitation]. / Profilaktyka, leczenie i rehabilitacja uszkodzen miesni--wspólczesne zasady postepowania.

Muscle injury represents the highest proportion of sport-linked contusions. Experimental and clinical studies aim at increasingly detailed recognition of muscle physiology and pathophysiology. It would allow to set up functional standards and permit to minimize risk of contusions associated with sport activities. In cases of such contusions it would restrict its sequele and would abbreviate the duration of treatment. In the study elements of prophylaxis, treatment and rehabilitation of injured muscles will be discussed, based on current scientific results. Review study includes data from studies investigating prophylactic activities, types of teratment and the effects of different rehabilitation strategy. Latest standards from First European Congress of Football Medicine, Munich 2004, were also taken into account. The prophylactic activities should focus on education attempting to popularize the knowledge of the role of warm-up activities which precede proper physical effort, muscle stretching and activities augmenting muscle strength. The treatment of muscle injury is related to the extent of their damage. First actions should be focused on the RICE principle (Rest, Ice, Compression, Elevation). In case of torn tissues, local injections of anesthetics, anti-inflammatory agents and regeneration-promoting agents used to be applied. Application of NSAIDs and anti-thrombotic prophylaxis is sound but due to their side effects it is recommended as frequently as it is counterindicated by physicians. A threshold in the therapy, not always noted by therapeutists, involves rapid mobilization of the injured tissue. This involves mobility exercises starting at 3-5 days post-trauma, with no load at the beginning, but starting at days 4 to 6 asssociated with appropriate loading. The recently conducted studies aim at stimulation of rapid muscle regeneration, inhibition of scar formation in the site of injury and elimination of already existing scars. The latter seems most difficult due to the high risk of the repeated muscle injury in the same site. The rehabilitation following trauma with particular attention paid to proprioceptive training is equally important. The risk of another contusion cannot be reduced to minimum until the pre-contusion proprioception level is achieved in the contused extremity.

[Application of microscopic MR for evaluation of cartilage repair]. / Zastosowanie mikrorezonansu magnetycznego w ocenie doswiadczalnej regeneracji chrzastki stawowej.

Magnetic resonance imaging is gold standard for noninvasive evaluation of articular cartilage damage and has been also used for monitoring cartilage repair. The aim of this study was to find correlation between histological microscopy and microscopic MR in evaluation of the repair of osteochondral defects in articular cartilage. Study was based animal model (rabbit). The cartilage repair process was evaluated histology and micro MR. Most of the defects were filled with fibrocartilage and fibrous tissue formed. Both methods were equally efficient to show repair tissue thickness, subchondral bone reconstruction and disintegration. Result of observation by both histological and MR microscopy and showed good correlation. Micro MR is promising evaluation tool for cartilage repair monitoring. Results of micro MR correlate well with standard microscopy.

[Value of collagen scaffolds in surgical reconstruction of articular cartilage]. / Ocena wartosci matryc kolagenowych w operacyjnej rekonstrukcji chrzastki stawowej.

Articular cartilage has a very limited capacity for regeneration and the untreated injuries of this tissue may lead to osteoarthritis. The aim of this study was to evaluate the application of collagen scaffolds in surgical reconstruction of articular cartilage. A group of 28 rabbits was used in the study. A defect penetrating into the subchondral bone was made. The animals were divided into 2 groups: group 1- defects filled with collagen scaffold, group II the defects remained empty. The results were evaluated at 4 a 12 weeks. Macroscopic and microscopic evaluation was performed. On gross examination of the group I complete filling of the defect with regenerated tissue was observed. This tissue had smooth surface and was completely integrated with the surrounding cartilage. In the group II the surface of the newly formed tissue showed large irregularities. The defect was partially filled and incompletely integrated with the residual cartilage. Microscopic results indicate presence of hyaline-like cartilage resembling normal articular cartilage in group I. Regenerate was more stable and remained stable with longer follow-up. Group II revealed mostly fibrous tissue in regenerate. Thickness was inadequate with visible surface irregularities and loss in tissue integrity. This study proved better results of reconstruction of articular cartilage by means of biodegradable scaffold.

[Value of autologous chondrocyte transplantation in experimental cartilage defects reconstruction. Part IV--Microscopic analysis of repair tissue degenerative changes (cellularity and signs of necrosis)]. / Ocena wartosci przeszczepów autologicznych chondrocytów w doswiadczalnym leczeniu uszkodzen chrzastki stawowej. Czesc IV--Analiza mikroskopowa zmian degeneracyjnych regeneratu (komórkowosci i obecnosci cech martwicy).

UNLABELLED: Articular cartilage cells are immersed in semi-solid matrix and isolated from the rest of the body because of lack of nervous fibres, and blood and lymphatic vessels. Trauma and aging processes result in cartilage ultrastructure disorders. Those changes leads to progressive decreasing of durability and rigidity of cartilage. Research on articular cartilage reconstruction focuses on, among other things, reaching by newly formed tissue optimal amount of vital cells. The aim of this part of the study was microscopic evaluation of repair tissue degenerative changes (cellularity and signs of necrosis). MATERIAL AND METHODS: Repair of partial thickness cartilage defect (III tertiary grade) on distal femur joint surface was evaluated (25 adolescent rabbits). Procedures were performed in two groups: I--autologous chondrocyte transplantation under periosteal flap, II--periosteal graft. Chondrocytes were isolated from the cartilage specimens by enzymatic digestion and cultured in vitro. The follow-up periods were established at 4, 8 and 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale. RESULTS: Repair tissue cellularity. In group I (with chondrocytes), 4 weeks after the procedure tissue of high cellularity was formed, corresponding in amount of cells to the structure of early differentiated hyaline-like cartilage. Amount of cells slightly decreased with time, as it occurs in maturing cartilage. In group II (without chondrocytes), 4 weeks after the procedure the repair tissue was characterized by small amount of cells, which was decreasing with time. Signs of necrosis. In group I, 4, 8 and 12 weeks after the procedure moderate intensity of necrotic signs was observed. In group II, significant intensity of necrosis signs in all observation periods was observed. CONCLUSION: Obtained results indicate, that autologous chondrocyte transplantation in treatment of partial thickness cartilage defects effects with forming tissue of high cellularity, not degenerating with time, much better as compared to untreated defect.

[Value of autologous chondrocyte transplantation in experimental cartilage defects reconstruction. Part II: Microscopic analysis of reconstructed cartilage structural integrity and surface regularity]. / Ocena wartosci przeszczepów autologicznych chondrocytów w doswiadczalnym leczeniu uszkodzen chrzastki stawowej. Czesc II--Analiza mikroskopowa regularnosci powierzchni i integralnosci strukturalnej regeneratu.

UNLABELLED: Experimental and clinical tests proved that cultured, autologous chondrocytes retain their properties and have ability to reconstruct hyaline-like cartilage, which represents chemical composition and biomechanical characteristics similar to normal hyaline cartilage. The aim of this part of the study was microscopic evaluation of repair tissue structural integrity and surface regularity after autologous chondrocyte transplantation. MATERIAL AND METHODS: Repair of partial thickness cartilage defect (ICRS III(o) grade) on distal femur joint surface was evaluated (25 adolescent rabbits). Procedures were performed in two groups: I--autologous chondrocyte transplantation under periosteal flap, II--periosteal graft. Chondrocytes were isolated from the cartilage specimens by enzymatic digestion and cultured in vitro. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale. RESULTS: In group I, 4 weeks after the procedure surface of the reconstructed tissue was irregular. 8- and 12-week observation found the surface regular and plain, and repair tissue exhibited complete structural integrity. In group II, in all follow-up periods regenerate surface was irregular, there was many fissures and cracks in graft tissue, and in several cases--regenerate disintegration. CONCLUSION: Obtained results indicate, that hyaline-like cartilage reconstructed after autologous chondrocyte transplantation was characterized by regular, plain surface and complete structural integrity.

[Value of osteo-chondral paste autologous transplantation in experimental cartilage defects reconstruction. Part III--Microscopic analysis of reconstructed cartilage thickness and surface regularity]. / Wartosc autologicznych przeszczepów miazgi chrzestno-kostnej w doswiadczalnym leczeniu uszkodzen chrzastki stawowej. Czesc III--Ocena mikroskopowa odtworzonej powierzchni stawowej i grubosci tkanki wypelniajacej ubytek.

INTRODUCTION: A limited ability of the cartilage to heal after trauma was the reason to start research on new methods concerning better cartilage reconstruction. The aim of the study was evaluation of repair tissue thickness and surface regularity after osteochondral paste transplantation. MATERIAL AND METHODS: Full thickness defect (IV(o)--ICRS scale) on distal rabbit femur joint surface was made. Three groups were specified: A--defect with paste graft (cartilage and contiguous bone collected from joint surface, crushed into homogenous paste; B--defect with the paste graft covered with periosteum; C--defect left unfilled. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale. RESULTS: Newly formed tissue was well integrated with surrounding cartilage in group A (paste graft). That trait of repair tissue in group A was much better than in other groups, especially in late observations. Structural integrity of tissue filling the defect was similar to integrity of normal cartilage in groups A and C, but tissue formed in group C didn't represent a hyaline-like cartilage character. In all the examined groups reconstruction of subchondral bone exhibited similar rate. 12 weeks from the procedure, around 80% of subchondral bone was rebuilt. The obtained results indicate, that osteochondral paste autologous transplantation in cartilage defects treatment effects with forming well integrated (structurally and with surrounding cartilage) cartilage tissue, of almost complete subchondral bone rebuilding.

[Value of autologous chondrocyte transplantation in experimental cartilage defects reconstruction. Part III--Microscopic analysis of reconstructed cartilage thickness and integration with surrounding tissue]. / Ocena wartosci przeszczepów autologicznych chondrocytów w doswiadczalnym leczeniu uszkodzen chrzastki stawowej. Czesc III--Analiza mikroskopowa grubosci regeneratu i integracji z otaczajaca chrzastka.

UNLABELLED: Lack of cartilage vascularization is the reason of its low regenerative potential. The aim of this part of the study was microscopic evaluation of repair tissue thickness and its integration with surrounding cartilage, after autologous chondrocyte transplantation. MATERIAL AND METHODS: Repair of partial thickness cartilage defect (ICRS III(o) grade) on distal femur joint surface was evaluated (25 adolescent rabbits). Procedures were performed in two groups: I--autologous chondrocyte transplantation under periosteal flap, II--periosteal graft. Chondrocytes were isolated from the cartilage specimens by enzymatic digestion and cultured in vitro. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale. RESULTS: In group I, 8 weeks after the procedure most of defects were filled with the newly formed tissue almost completely. Regenerate thickness after 4 and 12 weeks usually exceeded 1/2 of surrounding cartilage. In group II, 8 weeks after the procedure regenerate thickness amounted to at least 1/2 of surrounding cartilage, but 4- and 12-week observation revealed the decreased repair tissue thickness. In group I, 4 weeks after the procedure regenerative tissue was well integrated with surrounding cartilage, and this trait still gradually increased with time. In group II, there was partial integration or no integration of repair tissue with surrounding cartilage. CONCLUSION: Obtained results indicate, that tissue formed after autologous chondrocyte transplantation with use of periosteal flap was better in its thickness and integration with surrounding cartilage, as compared to tissue formed after use of periosteum alone. Autologous chondrocyte transplantation can not guarantee complete filling of the cartilage defect with the graft tissue and full integration with surrounding cartilage, without three-dimensional scaffold application.

[Value of osteo-chondral paste autologous transplantation in experimental cartilage defects reconstruction. Part IV--Microscopic analysis of cellularity and of traits of necrosis in the defect-filling tissue]. / Wartosc autologicznych przeszczepów miazgi chrzestno-kostnej w doswiadczalnym leczeniu uszkodzen chrzastki stawowej. Czesc IV--ocena mikroskopowa komórkowosci i obecnosci cech martwicy w tkance wypelniajacej ubytek.

INTRODUCTION: Restricted potential of cartilage to regeneration following trauma induced search for new techniques of articular cartilage repair. Present study aimed at defining in experimental conditions of autologous osteochondral paste value by evaluation of cellularity and presence of necrosis in the defect-filling tissue. MATERIAL AND METHODS: Full thickness defect (IV(o)--ICRS scale) on distal rabbit femur joint surface was made. Three groups were specified: A--defect with paste graft (cartilage and contiguous bone collected from joint surface, crushed into homogenous paste; B--defect with the paste graft covered with periosteum; C--defect left unfilled. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale. RESULTS: In evaluation of cellularity in the developed repair tissue, in long-term observations best results were obtained in the group of osteochondral paste (A) and in the group of unfilled defect (C). Following 12 weeks of observation cellularity of the repair tissue in the groups amounted to around 95%, as compared to the surrounding healthy cartilage. In evaluation of necrotic traits in the newly developed tissue, their highest intensity after 4 weeks of observation was noted in the group with periosteum covered osteochondral paste (B), and lower but still significant in the group in which paste alone was applied (A). This resulted from massive dying out of the grafted bone elements, and in the case of group B, also of the periosteal cells in the covering flap and of certain number of chondrocytes composing the graft. The trait was more objectively evaluated in long-term observations, when necrotic foci involved only elements of the proper repair tissue. After 12 weeks of observation degenerative changes showed the least pronounced intensity in the group with the paste alone (A). Following 4 weeks the intensity was least pronounced in the group with the unfilled defect (C), i.a. due to the absence of graft with the decomposing bone elements. However, with elapsing time degenerative lesions intensified in the group, pointing to the low stability of the developed tissue. The results indicated that application of the osteochondral paste in treatment of cartilage defects yields a stable, highly cellular tissue, resistant to time and trauma.

[Graft remodeling following Hertel ACL reconstruction in MR imaging]. / Przebudowa przeszczepu po rekonstrukcji wiezadla krzyzowego przedniego metoda Hertla w obrazie tomografii rezonansu magnetycznego.

MRI and clinical assessment of 21 patients operated on with Hertel method due to knee instability has been presented. Position of the graft in reference to the Blumensaat line has been evaluated in MRI with the use of 3 point scale after mean follow-up of 9-months. Four points scale has been used to grade signal intensity as indicator of graft remodeling. Lysholm scale served for clinical assessment. Mean grade for graft position was 2.3 and for signal intensity 2.7. Better remodeling of the graft correlated positively with its better positioning, but clinical assessment correlated poorly with signal intensity and localization of the graft. Incorrect positioning of the graft hinders its remodeling--ligamentization of the tendon.

[The value of autologous osteochondral paste for in-vitro treatment of damage to articular cartilage. Part I. Macroscopic and microscopic assessment of the regenerated articular surface]. / Wartosc autologicznych przeszczepów miazgi chrzestno-kostnej w doswiadczalnym leczeniu uszkodzen chrzastki stawowej. Czesc I--Ocena makroskopowa odtworzonej powierzchni stawowej i charakter mikroskopowy przewazajacej tkanki.

The limited ability of articular cartilage to regenerate after trauma has been the main reason for research of new repair techniques. The aim of this paper was to assess in in-vitro conditions the value of autologous osteochondral of pulp--macroscopic analysis of the regenerated articular surface and microscopic assessment of the dominant tissue in the regenerate. The experimental model consisted of a full-depth cartilage defect of the articular surface of the distal femur in rabbits. The animals were subdivided into 3 groups: group A--with defect with osteochondral of pulp, group B--with defects filled with osteochondral of pulp covered by periosteum, group C--defect untreated. After observation periods of 4, 8 and 12 weeks the regenerates were assessed using the Brittberg and O'Driscoll scale. In the overall macroscopic assessment group A prevailed because of the best defect filling. Microscopic assessment showed that in group A the defect had been filled with cartilage very similar to hyaline cartilage (hyaline--like cartilage). Basing on the result of the experiment, we assume that osteochondral of pulp has chondrogenic properties.

[Value of autologous chondrocyte transplantation in the reconstruction of experimental cartilage defects. Part I. Extent of defect, macroscopic appearance of reconstructed articular surface and microscopic analysis of predominant tissue]. / Ocena wartosci przeszczepów autologicznych chondrocytów w doswiadczalnym leczeniu uszkodzen chrzastki stawowej. Czesc I--Stopien wypelnienia ubytku i wyglad makroskopowy odtworzonej powierzchni stawowej oraz analiza mikroskopowa przewazajacej tkanki.

Articular cartilage defect is one of the main reasons of osteoarthritis. Currently, tissue engineering techniques are the methods concerning better cartilage reconstruction. The aim of this part of the study was macroscopic evaluation of degree of defect feeling, macroscopic appearance of repair tissue and microscopic analysis of predominant tissue after autologous chondrocytes transplantation. Repair of partial thickness cartilage defect on distal part of femur was evaluated (25 adolescent rabbits). Procedures were performed in II groups: I--autologous chondrocytes transplantation under periosteal flap, II--periosteal graft. Chondrocytes were isolated from the cartilage specimens by enzymatic digestion and cultured in vitro. The regenerates were inspected 4, 8 and 12 weeks after the operation. Macroscopic analysis in group I, in most cases revealed filling of the defect with tissue resembling surrounding cartilage. In group II the defect was partially filled, and there was many fissures and cracks in all regenerates. In microscopic analysis in group I, after 4 and 8 weeks following the transplantation the tissue similar to juvenile hyaline cartilage predominated. After 12 weeks it resembled mature hyaline cartilage. In group II, in all cases fibrous cartilage was observed after 4, 8, 12 weeks. Obtained results indicate, that macroscopic and microscopic characteristics of repair tissue after autologous chondrocytes transplantation more closely resembled hyaline cartilage, than in periosteal graft group. 12 weeks after autologous chondrocytes transplantation the repair tissue reached maturity, and demonstrated microscopic characteristics of hyaline-like cartilage. The method of autologous chondrocytes transplantation provides potential for clinical application.

[Value of autologous transplantation of osteo-chondral paste in reconstruction of experimental cartilage defects. Part II. Microscopic analysis of integration with surrounding cartilage, structural integrity and subchondral bone reconstruction in repair tissue]. / Wartosc autologicznych przeszczepów miazgi chrzestno-kostnej w doswiadczalnym leczeniu uszkodzen chrzastki stawowej. Czesc II--Ocena mikroskopowa integracji z otaczajaca chrzastka, integralnosci strukturalnej tkanki wypelniajacej ubytek oraz rekonstrukcji kosci podchrzestnej.

INTRODUCTION: A limited ability of the cartilage to heal after trauma was the reason to start research on new methods concerning better cartilage reconstruction. The aim of the study was evaluation of repair tissue integration with surrounding cartilage, its structural integrity and subchondral bone reconstruction after osteo-chondral paste transplantation. MATERIAL AND METHODS: Full thickness defect (IV degree--ICRS scale) on distal rabbit femur joint surface was made. Three groups were specified: A--defect with paste graft (cartilage and contiguous bone collected from joint surface, crushed into homogenous paste; B--defect with the paste graft covered with periosteum; C--defect left unfilled. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale. RESULTS: Newly formed tissue was well integrated with surrounding cartilage in group A (paste graft). That trade of repair tissue in group A was much better than in other groups, especially in late observations. Structural integrity of tissue filling the defect was similar to integrity of normal cartilage in groups A and C, but tissue formed in group C didn't represent a hyaline-like cartilage character. In all the examined groups reconstruction of subchondral bone exhibited similar rate. 12 weeks from the procedure, around 80% of subchondral bone was rebuilt. The obtained results indicate, that osteo-chondral paste autologous transplantation in cartilage defects treatment effects with forming well integrated (structurally and with surrounding cartilage) cartilage tissue, of almost complete subchondral bone rebuilding.