A case series utilizing bone marrow aspirate concentrate, cancellous bone autograft, platelet-rich plasma and autologous fibrin for the treatment of femur nonunions.

Aim: To assess the efficacy of a bioregenerative scaffold derived from bone marrow aspirate, cancellous bone autograft, platelet-rich plasma and autologous fibrin in treating supracondylar femur nonunions. Methods & materials: Three patients with nonunions following multiple surgical failures underwent bone stabilization and the application of a novel bioregenerative scaffold. x-rays and subjective scales were collected before surgery and at 6, 12 and 24 months post-surgery. Results: All nonunions exhibited healing with sufficient callus formation, as confirmed radiologically. After 6 months, all patients resumed full weight-bearing walking without pain. Statistical analysis showed improvements in all scales compared with pre-surgical values. Conclusion: This method presents itself as an option for treating supracondylar femur nonunions following multiple surgical failures.

What is this summary about? The objective of this case series study was to evaluate the effectiveness of a new biological autologous scaffold, comprised of stem and blood cells along with blood derivatives, in treating challenging cases of supracondylar femur nonunions.What were the results? Three participants underwent the application of this surgical method and were monitored for a period of 2 years. The therapy was well tolerated and deemed safe. Notably, all three patients experienced significant reductions in pain and improvements in functionality. Within a few months, they were able to walk with full weightbearing without pain, and clear indications of progressing toward bone union were evident by the 6 months.What do the results mean? This study demonstrates that the surgical application of autologous blood, cancellous bone and bone marrow, following the described concept and method, is an effective, safe and enduring treatment for femur nonunions. It markedly diminishes pain, enhances leg function and yields statistically significant improvements in quality of life.

The advantages of using tranexamic acid in anterior cruciate ligament reconstruction: a randomized controlled trial.

OBJECTIVE: The number of participants in sports or some form of recreation globally has led to an increase in the incidence of anterior cruciate ligament (ACL) injuries and the number of surgeries performed. Although it does not belong to risky surgical interventions, this operation is accompanied by complications that slow down post-operative rehabilitation. The objective is to analyze the effects of intra-articular (IA) injection of tranexamic acid (TXA) on the reduction of post-operative drained blood volume, pain intensity, and incidence of hemarthrosis after ACL reconstruction. METHODS: This prospective research included 124 patients undergoing ACL reconstruction surgery, randomly divided into two groups. The TXA group received IA TXA, whereas an equal amount of placebo was administered using the same route in the control group. RESULTS: The research has shown that IA injection of TXA effectively reduces post-operative blood loss (TXA group 71.29 ± 40.76 vs. control group 154.35 ± 81.45), reducing the intensity of post-operative pain (p < 0.001) and the incidence of hemarthrosis. CONCLUSION: The application of TXA significantly reduced post-operative bleeding and pain intensity, which accelerated the post-operative period.

OBJETIVO: El mayor número de participantes en deportes o alguna forma de recreación en todo el mundo ha llevado a un aumento en la incidencia de lesiones del ligamento cruzado anterior (LCA) y de las cirugías realizadas. Aunque no es una intervención quirúrgica de riesgo, esta operación va acompañada de complicaciones que ralentizan la rehabilitación posoperatoria. El objetivo es analizar los efectos de la inyección intraarticular de ácido tranexámico (TXA) sobre la reducción del volumen sanguíneo drenado posoperatorio, la intensidad del dolor y la incidencia de hemartrosis tras la reconstrucción del LCA. MÉTODO: Esta investigación prospectiva incluyó 124 pacientes sometidos a cirugía de reconstrucción del LCA, divididos aleatoriamente en dos grupos: uno recibió TXA intraarticular y otro (grupo de control) una cantidad igual de placebo por la misma vía. RESULTADOS: La investigación ha demostrado que la inyección intraarticular de TXA reduce efectivamente la pérdida de sangre posoperatoria (grupo TXA 71.29 ± 40.76 vs. grupo control 154.35 ± 81.45), reduciendo la intensidad del dolor posoperatorio (p < 0.001) y la incidencia de hemartrosis. CONCLUSIONES: La aplicación de TXA redujo significativamente el sangrado posoperatorio y la intensidad del dolor, lo que aceleró el posoperatorio.

The role of osteoarthritis severity, BMI and age on clinical efficacy of bone marrow aspirate concentrate in the treatment of knee osteoarthritis.

Aim: The aim of this study was to assess whether BMI, severity of knee osteoarthritis, age and gender have any influence on the final clinical results of bone marrow aspirate concentrate injection. Method: A total of 111 study participants with painful knee osteoarthritis and different characteristics concerning before mentioned factors underwent bone marrow aspirate concentrate (BMAC) therapy and were followed up for 1 year. Result: Significant pain and functional improvement were observed in all participant groups. Participants' age and BMI did not influence the clinical outcome, but there was an influence of OA severity, especially among older patients. Conclusion: This study shows that BMAC therapy is effective. Younger patients with milder OA changes could be better candidates for long-lasting and more efficient BMAC therapy. Clinical Trial Registration: NCT03825133 (ClinicalTrials.gov).

How does the increase of body mass and ageing affect sprinter's results in a 100 m run? / ¿Cómo afecta el aumento de la masa corporal y el envejecimiento a los resultados del velocista en una carrera de 100 m?

SUMMARY: The career of a sprinter is analyzed with U. Bolt achievements as an example. The effects of the increase of body mass and ageing are discussed within the framework of the polynomial models for the velocity, muscular isometric force and age. The analysis presented demonstrates the influence of the BM factor in analyzed racing. The nonlinear increase of the BM for 9 kg in the period 2009 - 2017 in was one of the reasons of Bolt's unsuccessful attempt to repeat or confirm the time 9.58 s. Another limiting factor was the fact that due to the age, Bolt was not able to increase isometric muscular force which, after the year of maximal efficiency (2009) decreased.

RESUMEN: La carrera de un velocista se analiza con los logros de U. Bolt como ejemplo. Los efectos del aumento de la masa corporal y el envejecimiento se discuten en el marco de los modelos polinomiales de velocidad, fuerza isométrica muscular y edad. El análisis presentado demuestra la influencia del factor MC en el análisis en las carreras. El aumento no lineal de la MC para 9 kg en el período 2009 - 2017 fue una de las razones del intento fallido de Bolt de repetir o confirmar el tiempo 9,58 s. Otro factor limitante fue el hecho de que debido a la edad, Bolt no fue capaz de aumentar la fuerza muscular isométrica que disminuyó luego del año de máxima eficiencia (2009).

Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis.

Background: In the last decade, regenerative therapies have become one of the leading disease modifying options for treatment of knee osteoarthritis (OA). Still, there is a lack of trials with a direct comparison of different biological treatments. Our aim was to directly compare clinical outcomes of knee injections of Bone Marrow Aspirate Concentrate (BMAC), Platelet-rich Plasma (PRP), or Hyaluronic acid (HA) in the OA treatment. Methods: Patients with knee pain and osteoarthritis KL grade II to IV were randomized to receive a BMAC, PRP, and HA injection in the knee. VAS, WOMAC, KOOS, and IKDC scores were used to establish baseline values at 1, 3, 6, 9, and 12 months. All side effects were reported. Results: A total of 175 patients with a knee osteoarthritis KL grade II-IV were randomized; 111 were treated with BMAC injection, 30 with HA injection, and 34 patients with PRP injection. There were no differences between these groups when considering KL grade, BMI, age, or gender. There were no serious side effects. The mean VAS scores after 3, 7, 14, and 21 days showed significant differences between groups with a drop of VAS in all groups but with a difference in the BMAC group in comparison to other groups (p < 0.001). There were high statistically significant differences between baseline scores and those after 12 months (p < 0.001) in WOMAC, KOOS, KOOS pain, and IKDC scores, and in addition, there were differences between these scores in the BMAC group in comparison with other groups, except for the PRP group in WOMAC and the partial IKDC score. There were no differences between the HA and PRP groups, although PRP showed a higher level of clinical improvement. Conclusions: Bone marrow aspirate concentrate, Leukocyte rich Platelet Rich Plasma, and Hyaluronic acid injections are safe therapeutic options for knee OA and provide positive clinical outcomes after 12 months in comparison with findings preceding the intervention. BMAC could be better in terms of clinical improvements in the treatment of knee OA than PRP and HA up to 12 months. PRP provides better outcomes than HA during the observation period, but these results are not statistically significant. More randomized controlled trials and high quality comparative studies are needed for direct correlative conclusions.

Solitary synovial chondromatosis as a cause of Hoffa's fat pad impingement.

INTRODUCTION: Synovial chondromatosis is a benign disease of synovial membrane usually affecting knee, elbow and shoulder joints. It rarely appears as a solitary formation and exceptionally within Hoffa's fat pad. CASE REPORT: We report a case of solitary synovial chondromatosis within Hoffa's fat pad as a cause of its impingement in a female patient aged 63. At first, the patient had anterior knee pain with limited extension of the knee. Standard radiogram showed only mild patellofemoral osteoarthritic changes. Magnetic resonance of the knee showed ovoid solitary formation within Hoffa's fat pad repressing its superior part between the kneecap and distal femur. Histopathological examination confirmed a case of extra-articular synovial chondromatosis. The tumorous mass was extracted surgically en bloc. CONCLUSIONS: Solitary synovial chondromatosis is an uncommon cause of Hoffa's fat pad impingement and anterior knee pain in elderly female patients and can easily be misinterpreted as a different diagnosis.

Magnetic resonance imaging comparison of lateral collateral ligament and patellar tendon length.

INTRODUCTION: The problem of using patellar tendon auto or allografts for lateral collateral ligament reconstruction results in the occurrence of ligaments mismatch. The length of patellar tendon does not match the lateral collateral ligament. MATERIAL AND METHODS: Out of 151 patients, who formed the study, 102 were men with the mean age of 30 years (18-54) and 49 women, with the mean age of 34 (18-55), and they all underwent magnetic resonance imaging of the knee. Both patellar tendon and lateral collateral ligament were measured using a three-dimensional isovoxel true-fast-imaging with steady-state precession sequence with water excitation and secondary multiplanar reformations. In order to visualize the lateral collateral ligament insertions precisely, sagittal images were reformatted according to the anatomical, oblique ligament position, in anteriorly tilted, paracoronal plane. The length of the patellar tendon was measured from the patellar apex to the tibial tuberosity insertion site. RESULTS: The mean patellar tendon length was 52.88 +/- 7.56 mm (37-75) with a significant difference between men and women. The mean lateral collateral ligament length was 61.21 +/- 5.77 mm (46-80) with a significant difference between genders. The average differences between lateral collateral ligament and patellar tendon length was 8.38 +/- 7.23 mm (-9 to 26) without a significant difference between the genders. In 18 (11.92%) patients, the patellar tendon was longer than the lateral collateral ligament; in 7 patients (4.63%) they were equal; and in 126 patients (83.44%) the patellar tendon was shorter than the lateral collateral ligament. CONCLUSION: The length of patellar tendon does not match the length of lateral collateral ligament. If patellar tendon auto or allograft is used for lateral collateral ligament reconstruction, the lengths of both ligaments must be determined preoperatively in order to avoid intraoperative complications.

Disruption of the knee extensor apparatus complicating anterior cruciate ligament reconstruction.

Disruption of the knee extensor apparatus, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. We made 2215 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 10 patients had fracture of the patella (0.45%), and fore patients had rupture of the patellar tendon (0.18%). The fracture of the patella in two patients was treated nonoperatively and 8 patients was treated with operative reduction and osteosynthesis. Reconstruction of the patellar ligament in four patients with a rupture of patellar tendon (0.18%) was performed by a technique previously published with BTB allograft taken from the local bone bank. The mean Lysholm score was 90 (85-100), and all of them have continued to engage in sporting activities. In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients, who had multifragmentary fractures of the patella. Disruption of the knee extensor apparatus, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment disruption of the knee extensor apparatus after the reconstruction of the anterior cruciate ligament is a operative reconstruction, which allows continuation of the rehabilitation program.

Fracture of the patella after the anterior cruciate ligament reconstruction.

INTRODUCTION: Fracture of the patella, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. MATERIAL AND METHODS: We made 1714 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 7 patients had fracture of the patella (0.42%). The fracture was immediately recognized in the patients with vertical non-displaced patellar fracture and the broken screw osteosynthesis was carried out without changes in the rehabilitation period. One patient was treated non-operatively and patellar fracture in four patients was treated with operative reduction and osteosynthesis. RESULTS: The patients were invited for the check-up 5 years (2-8 years) after surgery on average. The mean Lysholm score was 92 (85-100). All of them continued to engage in sporting activities at the same or greater level after 9 months on average (6-12 months). In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients who had multifragmentary fractures. DISCUSSION AND CONCLUSION: The fracture of patella can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment of the fracture of the patella after the reconstruction of the anterior cruciate ligament is a firm osteosynthesis, which allows healing of the bone and continuation of the rehabilitation program.