Eficacia del trasplante de células madre mesenquimales de lipoaspirado en el tratamiento de lesiones crónicas del manguito rotador. Modelo experimental en ratas / Efficacy of transplantation of lipoaspired mesenchymal stem cells in the treatment of chronic rotator cuff tears. Experimental model in rats

Antecedentes y objetivo: Las roturas del manguito rotador afectan aproximadamente al 30% de la población mayor de 60 años. El tratamiento quirúrgico por vía artroscópica de estas lesiones es el tratamiento de elección, sin embargo, a pesar de las mejoras técnicas de reparación el índice de rerroturas oscila entre el 11 y el 94%. Por ello, los investigadores buscan mejorar el proceso de curación biológica mediante el uso de diferentes alternativas como las células madre mesenquimales (MSC). Nuestro objetivo es evaluar la eficacia de un medicamento de terapia celular elaborado a partir de células madre alogénicas derivadas del tejido adiposo en un modelo de lesión crónica del manguito rotador en ratas. Material y método: Se creó la lesión del supraespinoso en 48 ratas para su posterior sutura a las 4 semanas. A 24 animales se les añadió las MSC en suspensión tras la sutura, y a 24 animales HypoThermosol-FRS® (HTS) como grupo control. En ambos grupos se analizó la histología (escala Åström y Rausing) y la carga máxima, desplazamiento y constante elástica del tendón supraespinoso a los 4 meses de la reparación. Resultados: No se encontraron diferencias estadísticamente significativas en la puntuación histológica comparando los tendones tratados con MSC con respecto a los tendones tratados con HTS (p=0,811) ni tampoco en los resultados de carga máxima (p=0,770), desplazamiento (p=0,852) ni constante elástica (p=0,669) del tendón en ambos grupos. Conclusiones: La adición en suspensión de células derivadas de tejido adiposo a la reparación de una lesión crónica de manguito no mejora las características histológicas ni biomecánicas del tendón suturado.(AU)

Background and aim: Rotator cuff tears emerge in approximately 30% of the population over 60 years of age. Arthroscopic surgical treatment of these lesions is the treatment of choice, however, despite the improved repair techniques, the rate of re-tears ranges between 11 and 94%. Therefore, researchers seek to improve the biological healing process through the use of different alternatives such as mesenchymal stem cells (MSCs). Our objective is to evaluate the efficacy of a Cellular Therapy Drug made from allogeneic stem cells derived from adipose tissue in a rat model of chronic rotator cuff injury. Material and methods: The supraspinatus lesion was created in 48 rats for subsequent suturing at 4 weeks. MSCs in suspension were added to 24 animals after suturing, and HypoThermosol-FRS® (HTS) to 24 animals as a control group. Histology (Åström and Rausing scale) and the maximum load, displacement and elastic constant of the supraspinatus tendon were analyzed in both groups 4 months after the repair. Results: No statistically significant differences were found in the histological score comparing the tendons treated with MSCs with respect to the tendons treated with HTS (P=.811) nor in the results of maximum load (P=.770), displacement (P=.852) or elastic constant (P=.669) of the tendon in both groups. Conclusions: The addition of adipose-derived cells in suspension to the repair of a chronic cuff injury does not improve the histology or biomechanics of the sutured tendon.(AU)

[Translated article] Efficacy of transplantation of lipoaspired mesenchymal stem cells in the treatment of chronic rotator cuff tears. Experimental model in rats / Eficacia del trasplante de células madre mesenquimales de lipoaspirado en el tratamiento de lesiones crónicas del manguito rotador. Modelo experimental en ratas

Antecedentes y objetivo: Las roturas del manguito rotador afectan aproximadamente al 30% de la población mayor de 60 años. El tratamiento quirúrgico por vía artroscópica de estas lesiones es el tratamiento de elección, sin embargo, a pesar de las mejoras técnicas de reparación el índice de rerroturas oscila entre el 11 y el 94%. Por ello, los investigadores buscan mejorar el proceso de curación biológica mediante el uso de diferentes alternativas como las células madre mesenquimales (MSC). Nuestro objetivo es evaluar la eficacia de un medicamento de terapia celular elaborado a partir de células madre alogénicas derivadas del tejido adiposo en un modelo de lesión crónica del manguito rotador en ratas. Material y método: Se creó la lesión del supraespinoso en 48 ratas para su posterior sutura a las 4 semanas. A 24 animales se les añadió las MSC en suspensión tras la sutura, y a 24 animales HypoThermosol-FRS® (HTS) como grupo control. En ambos grupos se analizó la histología (escala Åström y Rausing) y la carga máxima, desplazamiento y constante elástica del tendón supraespinoso a los 4 meses de la reparación. Resultados: No se encontraron diferencias estadísticamente significativas en la puntuación histológica comparando los tendones tratados con MSC con respecto a los tendones tratados con HTS (p=0,811) ni tampoco en los resultados de carga máxima (p=0,770), desplazamiento (p=0,852) ni constante elástica (p=0,669) del tendón en ambos grupos. Conclusiones: La adición en suspensión de células derivadas de tejido adiposo a la reparación de una lesión crónica de manguito no mejora las características histológicas ni biomecánicas del tendón suturado.(AU)

Background and aim: Rotator cuff tears emerge in approximately 30% of the population over 60 years of age. Arthroscopic surgical treatment of these lesions is the treatment of choice, however, despite the improved repair techniques, the rate of re-tears ranges between 11 and 94%. Therefore, researchers seek to improve the biological healing process through the use of different alternatives such as mesenchymal stem cells (MSCs). Our objective is to evaluate the efficacy of a Cellular Therapy Drug made from allogeneic stem cells derived from adipose tissue in a rat model of chronic rotator cuff injury. Material and methods: The supraspinatus lesion was created in 48 rats for subsequent suturing at 4 weeks. MSCs in suspension were added to 24 animals after suturing, and HypoThermosol-FRS® (HTS) to 24 animals as a control group. Histology (Åström and Rausing scale) and the maximum load, displacement and elastic constant of the supraspinatus tendon were analyzed in both groups 4 months after the repair. Results: No statistically significant differences were found in the histological score comparing the tendons treated with MSCs with respect to the tendons treated with HTS (P=.811) nor in the results of maximum load (P=.770), displacement (P=.852) or elastic constant (P=.669) of the tendon in both groups. Conclusions: The addition of adipose-derived cells in suspension to the repair of a chronic cuff injury does not improve the histology or biomechanics of the sutured tendon.(AU)

[Translated article] Efficacy of transplantation of lipoaspired mesenchymal stem cells in the treatment of chronic rotator cuff tears. Experimental model in rats.

BACKGROUND AND AIM: Rotator cuff tears emerge in approximately 30% of the population over 60 years of age. Arthroscopic surgical treatment of these lesions is the treatment of choice, however, despite the improved repair techniques, the rate of re-tears ranges between 11 and 94%. Therefore, researchers seek to improve the biological healing process through the use of different alternatives such as mesenchymal stem cells (MSCs). Our objective is to evaluate the efficacy of a cellular therapy drug made from allogeneic stem cells derived from adipose tissue in a rat model of chronic rotator cuff injury. MATERIAL AND METHODS: The supraspinatus lesion was created in 48 rats for subsequent suturing at 4 weeks. MSCs in suspension were added to 24 animals after suturing, and HypoThermosol-FRS® (HTS) to 24 animals as a control group. Histology (Åström and Rausing scale) and the maximum load, displacement and elastic constant of the supraspinatus tendon were analysed in both groups 4 months after the repair. RESULTS: No statistically significant differences were found in the histological score comparing the tendons treated with MSCs with respect to the tendons treated with HTS (P=0.811) nor in the results of maximum load (P=0.770), displacement (P=0.852) or elastic constant (P=0.669) of the tendon in both groups. CONCLUSIONS: The addition of adipose-derived cells in suspension to the repair of a chronic cuff injury does not improve the histology or biomechanics of the sutured tendon.

Efficacy of transplantation of lipoaspired mesenchymal stem cells in the treatment of chronic rotator cuff tears. Experimental model in rats. / Eficacia del trasplante de células madre mesenquimales de lipoaspirado en el tratamiento de lesiones crónicas del manguito rotador. Modelo experimental en ratas.

BACKGROUND AND AIM: Rotator cuff tears emerge in approximately 30% of the population over 60 years of age. Arthroscopic surgical treatment of these lesions is the treatment of choice, however, despite the improved repair techniques, the rate of re-tears ranges between 11 and 94%. Therefore, researchers seek to improve the biological healing process through the use of different alternatives such as mesenchymal stem cells (MSCs). Our objective is to evaluate the efficacy of a Cellular Therapy Drug made from allogeneic stem cells derived from adipose tissue in a rat model of chronic rotator cuff injury. MATERIAL AND METHODS: The supraspinatus lesion was created in 48 rats for subsequent suturing at 4 weeks. MSCs in suspension were added to 24 animals after suturing, and HypoThermosol-FRS® (HTS) to 24 animals as a control group. Histology (Åström and Rausing scale) and the maximum load, displacement and elastic constant of the supraspinatus tendon were analyzed in both groups 4 months after the repair. RESULTS: No statistically significant differences were found in the histological score comparing the tendons treated with MSCs with respect to the tendons treated with HTS (P=.811) nor in the results of maximum load (P=.770), displacement (P=.852) or elastic constant (P=.669) of the tendon in both groups. CONCLUSIONS: The addition of adipose-derived cells in suspension to the repair of a chronic cuff injury does not improve the histology or biomechanics of the sutured tendon.

¿Es la fibromialgia causa de fracaso de una descompresión subacromial artroscópica? / Is fibromyalgia a cause of arthroscopic subacromial decompression failure?

La descompresión subacromial artroscópica aislada (DSA) es un procedimiento quirúrgico ampliamente utilizado que presenta un elevado porcentaje de éxito. Sin embargo, hasta un 25% de los pacientes puede presentar dolor residual tras la intervención. No está claro si el procesamiento aberrante del dolor, como ocurre en la fibromialgia (FM), podría ejercer un efecto deletéreo en los resultados obtenidos. Para testar esta hipótesis hemos realizado un estudio casos-controles retrospectivo de los pacientes en los que se ha realizado una descompresión subacromial artroscópica como procedimiento quirúrgico único. Material y métodos: Se seleccionaron 26 pacientes con diagnóstico preoperatorio de fibromialgia de una serie de 293 pacientes intervenidos mediante DSA entre 2008-2015. Seis pacientes se perdieron durante el seguimiento. Cada paciente con diagnóstico de fibromialgia fue emparejado con un control (n=20). Los resultados fueron evaluados mediante la escala DASH, Constant, Constant relativo a la edad y sexo (rCS) y la escala visual analógica (EVA). La satisfacción del paciente fue evaluada con una pregunta dicotómica. Se consideró fracaso del procedimiento la presencia de una puntuación superior a 3 en la EVA en el último seguimiento. Resultados: La media de edad de los grupos FM/control fue de 51/48 años, con un seguimiento medio de 36/42 meses respectivamente. Ambos grupos experimentaron una mejoría postoperatoria significativa en las escalas de EVA, DASH y rCS (p<0,001) en comparación con los valores preoperatorios. Los valores medios postoperatorios FM/control fueron Constant 63,5/74 (p=0,07), rCS 82/88 (p=0,18), DASH 38,9/20,7 (p=0,009), EVA 3,8/2,8 (p=0,2). El 85% de los pacientes del grupo control manifestaron estar satisfechos con los resultados de la cirugía frente al 55% del grupo FM (p=0,03). La tasa de fracasos en el grupo FM fue del 60% frente al 30% en el grupo control (p=0,056). Conclusiones: La fibromialgia puede ser considerada como factor pronóstico que condiciona un peor resultado postoperatorio tras DSA. Sin embargo, debido a la mejoría clínica que experimentan estos pacientes frente a su estado preoperatorio, recomendamos realizar este tratamiento quirúrgico cuando exista indicación

Isolated arthroscopic subacromial decompression (IASD) is a widely used surgical procedure with high success rates. However, up to 25% of patients experience residual pain. It is unclear whether aberrant central nervous system processing of pain as described in fibromyalgia (FM) could have a detrimental effect on outcomes. To test this hypothesis, the authors conducted a retrospective case- control study of patients undergoing IASD. Material and methods: Between 2008 and 2015, 26 patients with preoperative diagnosis of fibromyalgia and an IASD procedure were identified. Six patients were lost to follow-up. Each fibromyalgia patient was matched with one control patient (n=20) recruited from the remainder with IASD. Outcomes were assessed by DASH score (Disability Arm Shoulder and Hand), Constant (CS), relative Constant score (rCS) and Visual Analogue Scale (VAS). Patient satisfaction was determined with a single 2-level question. Failure of the IASD was defined as persistent pain (VAS>3) at last follow-up. Results: The average age of the sample was FM/Control group 51/48, with a mean follow-up of 36/42 months respectively. Both groups exhibited significant clinical improvement in the pain VAS, DASH and rCS at final follow-up (P<.001) compared with the preoperative scores. Mean postoperative scores FM/Control group were: Constant 63.5/74 (P=.07), rCS 82/88 (P=.18), DASH 38.9/20.7 (P=.009), VAS 3.8/2.8 (P=.2). Eighty-five percent of patients in the control group were satisfied with the surgery compared with 55% in the FM group (P=.03). Failure of the procedure was 60% in the FM group, and 30% in the control group (P=.056). Conclusions: Fibromyalgia can be considered a prognostic factor of a poor postoperative outcome after an IASD. However the clinical improvement experienced by these patients over their preoperative situation leads us to recommend their surgical treatment when indicated

Is fibromyalgia a cause of arthroscopic subacromial decompression failure? / ¿Es la fibromialgia causa de fracaso de una descompresión subacromial artroscópica?

Isolated arthroscopic subacromial decompression (IASD) is a widely used surgical procedure with high success rates. However, up to 25% of patients experience residual pain. It is unclear whether aberrant central nervous system processing of pain as described in fibromyalgia (FM) could have a detrimental effect on outcomes. To test this hypothesis, the authors conducted a retrospective case- control study of patients undergoing IASD. MATERIAL AND METHODS: Between 2008 and 2015, 26 patients with preoperative diagnosis of fibromyalgia and an IASD procedure were identified. Six patients were lost to follow-up. Each fibromyalgia patient was matched with one control patient (n=20) recruited from the remainder with IASD. Outcomes were assessed by DASH score (Disability Arm Shoulder and Hand), Constant (CS), relative Constant score (rCS) and Visual Analogue Scale (VAS). Patient satisfaction was determined with a single 2-level question. Failure of the IASD was defined as persistent pain (VAS>3) at last follow-up. RESULTS: The average age of the sample was FM/Control group 51/48, with a mean follow-up of 36/42 months respectively. Both groups exhibited significant clinical improvement in the pain VAS, DASH and rCS at final follow-up (P<.001) compared with the preoperative scores. Mean postoperative scores FM/Control group were: Constant 63.5/74 (P=.07), rCS 82/88 (P=.18), DASH 38.9/20.7 (P=.009), VAS 3.8/2.8 (P=.2). Eighty-five percent of patients in the control group were satisfied with the surgery compared with 55% in the FM group (P=.03). Failure of the procedure was 60% in the FM group, and 30% in the control group (P=.056). CONCLUSIONS: Fibromyalgia can be considered a prognostic factor of a poor postoperative outcome after an IASD. However the clinical improvement experienced by these patients over their preoperative situation leads us to recommend their surgical treatment when indicated.

Actividades de vida afectadas en pacientes tras artroplastia total inversa de hombro en el contexto de artropatía de manguito rotador / Patient reported activities after reverse total shoulder arthroplasty in rotator cuff arthropathy patients

Introducción y objetivos. La artroplastia total de hombro inversa en el contexto de la artropatía de manguito rotador mejora la anteversión y abducción existentes, no así las rotaciones. Nuestro objetivo es determinar la repercusión de este hecho en la realización de actividades más cotidianas. Material y métodos. Entre 2009 y 2011 se implantaron 210 artroplastias de hombro en nuestro centro. De ellas, 126 artroplastias totales de hombro inversas por artropatía de manguito rotador. El 88% eran mujeres, con una edad media en el momento de la cirugía de 81 años, encontrándose el 95% laboralmente retirados. El seguimiento medio fue de 53 meses. En cada paciente fue valorada la escala Constant, la escala visual analógica e índice de comorbilidad de Charlson, el balance articular así como la capacidad de realización de 40 actividades cotidianas, divididas según grado de demanda funcional para el hombro en un cuestionario nuevo adaptado a nuestro grupo poblacional. Resultados y discusión. El Constant medio normalizado por edad y sexo fue del 81,2%. EL valor medio de la escala visual analógica e índice de comorbilidad de Charlson medios de 3,56 y 1,69 respectivamente. Mejoría del balance articular en anteversión y abducción, no en rotaciones. Limitación para realizar actividades de baja y alta demanda funcional del 20 y 51% respectivamente, apreciándose mayor limitación en aquellas que implican rotación interna. Conclusión. La artropatía de manguito rotador en el paciente anciano tratada mediante artroplastia total de hombro inversa consigue un adecuado control analgésico y buenos resultados funcionales. Sin embargo, hay que asumir un importante riesgo de limitación en actividades cotidianas de alta demanda y que impliquen rotaciones, sobre todo interna (AU)

Introduction and objective. Reverse total shoulder arthroplasty in rotator cuff arthropathy patients, improves anteversion and abduction, but not rotational, outcomes. The main aim of this study is to determine its repercussions on daily life activities in our patients. Material and methods. Between 2009 and 2011 we implanted 210 shoulder arthroplasties, 126 of them were reverse total shoulder arthroplasty in a rotator cuff arthropathy context. About 88% were women, with a mean age at time of surgery of 81 years, 95% were retired. The mean follow up was 53 months. The Constant scale, Visual Analogue Scale, Charlson Comorbidity Index, range of motion were measured for each patient and whether they could manage 40 daily life activities by means of a new questionnaire, classifying them according toshoulder functional demand. Results and discussion. Mean normalized by sex and age Constant value was 81.2%. Mean Visual Analogue Scale and Charlson Index were 3.56 and 1.69 respectively. Improvement in anteversion and abduction, not in rotational range of motion. Limitation was found in low and high functional demand activities in 20% and 51% respectively, especially those which involved internal rotation. Conclusion. Reverse total shoulder arthroplasty treatment for RCA in the elderly, achieves adequate pain management and good functional outcomes. Nevertheless, an important risk of DLA limitation must be accepted in those which involve internal rotation or shoulder high functional demand (AU)

Patient reported activities after reverse total shoulder arthroplasty in rotator cuff arthropathy patients. / Actividades de vida afectadas en pacientes tras artroplastia total inversa de hombro en el contexto de artropatía de manguito rotador.

INTRODUCTION AND OBJECTIVE: Reverse total shoulder arthroplasty in rotator cuff arthropathy patients, improves anteversion and abduction, but not rotational, outcomes. The main aim of this study is to determine its repercussions on daily life activities in our patients. MATERIAL AND METHODS: Between 2009 and 2011 we implanted 210 shoulder arthroplasties, 126 of them were reverse total shoulder arthroplasty in a rotator cuff arthropathy context. About 88% were women, with a mean age at time of surgery of 81 years, 95% were retired. The mean follow up was 53 months. The Constant scale, Visual Analogue Scale, Charlson Comorbidity Index, range of motion were measured for each patient and whether they could manage 40 daily life activities by means of a new questionnaire, classifying them according toshoulder functional demand. RESULTS AND DISCUSSION: Mean normalized by sex and age Constant value was 81.2%. Mean Visual Analogue Scale and Charlson Index were 3.56 and 1.69 respectively. Improvement in anteversion and abduction, not in rotational range of motion. Limitation was found in low and high functional demand activities in 20% and 51% respectively, especially those which involved internal rotation. CONCLUSION: Reverse total shoulder arthroplasty treatment for RCA in the elderly, achieves adequate pain management and good functional outcomes. Nevertheless, an important risk of DLA limitation must be accepted in those which involve internal rotation or shoulder high functional demand.

Reparación de las lesiones crónicas del manguito rotador mediante diferentes compuestos / Repair of rotator cuff injuries using different composites

Objetivo. La reparación del manguito rotador se acompaña de una elevada tasa de rerrotura. Nuestro objetivo es determinar si el empleo de rhBMP-2 vehiculizada en un transportador híbrido mejora el proceso de reparación en lesiones crónicas del manguito. Material y métodos. Estudio experimental en 62 ratas. A las 4 semanas de la lesión se llevó a cabo una sutura transósea y la asignación aleatoria a uno de los 5 grupos de estudio: 1) grupo control: solo sutura; 2) grupo doble-control: se aplicó además un transportador de alginato-quitina; 3) grupo control-alginato: se añadió rhBMP-2 al alginato; 4) grupo control-quitina: se añadió rhBMP-2 a la quitina, y 5) grupo doble-muestra: se añadió rhBMP-2 a ambos componentes. A los 4 meses se evaluaron los resultados mediante estudios biomecánicos e histológicos. Resultados. En todos los casos se observó una brecha osteotendinosa macroscópicamente a las 4 semanas. La tasa de rerrotura fue del 7,5%, ocurriendo el 20% de ellas en el grupo control-alginato. En la evaluación histológica los mejores resultados se obtuvieron en el grupo doble muestra: 4,5 (3,3-5). La carga máxima soportada fue mayor en el grupo doble muestra 62,9N (59,8-69,4) presentando además una menor rigidez 12,7 (9,7-15,9). Conclusiones. El empleo de la rhBMP-2 vehiculizada en un transportador híbrido de alginato-quitina parece mejorar las características histológicas de la reparación e incrementar las propiedades biomecánicas del tendón en el contexto de una lesión crónica del manguito rotador (AU)

Aim. Rotator cuff repairs have shown a high level of re-ruptures. It is hypothesised that the use of rhBMP-2 in a carrier could improve the biomechanical and histological properties of the repair. Material and methods. Controlled experimental study conducted on 40 rats with section and repair of the supraspinatus tendon and randomisation to one of five groups: Group 1 (control) only suture; Group 2 (double control), suture and alginate-chitin carrier; Group 3 (alginate-control), the rhBMP-2 was added to the alginate; Group 4 (chitin-control) application of the rhBMP-2 to the chitin, and Group 5 (double sample): The two components of the carrier (alginate and chitin) have rhBMP-2. A biomechanical and histological analysis was performed at 4 weeks. Results. A gap was observed in all cases 4 weeks after supraspinatus detachment. The re-rupture rate was 7.5%, with 20% of them in the control-alginate Group. Histologically the best results were obtained in the double sample group: 4.5 (3.3-5.0). Double sample were also able to support higher loads to failure: 62.9N (59.8 to 69.4) with lower rigidity 12.7 (9.7 to 15.9). Conclusions. The use of alginate-chitin carrier with rhBMP-2 improves the biomechanical and histological properties of the repair site in a chronic rotator cuff tear (AU)

Repair of rotator cuff injuries using different composites. / Reparación de las lesiones crónicas del manguito rotador mediante diferentes compuestos.

AIM: Rotator cuff repairs have shown a high level of re-ruptures. It is hypothesised that the use of rhBMP-2 in a carrier could improve the biomechanical and histological properties of the repair. MATERIAL AND METHODS: Controlled experimental study conducted on 40 rats with section and repair of the supraspinatus tendon and randomisation to one of five groups: Group 1 (control) only suture; Group 2 (double control), suture and alginate-chitin carrier; Group 3 (alginate-control), the rhBMP-2 was added to the alginate; Group 4 (chitin-control) application of the rhBMP-2 to the chitin, and Group 5 (double sample): The two components of the carrier (alginate and chitin) have rhBMP-2. A biomechanical and histological analysis was performed at 4 weeks. RESULTS: A gap was observed in all cases 4 weeks after supraspinatus detachment. The re-rupture rate was 7.5%, with 20% of them in the control-alginate Group. Histologically the best results were obtained in the double sample group: 4.5 (3.3-5.0). Double sample were also able to support higher loads to failure: 62.9N (59.8 to 69.4) with lower rigidity 12.7 (9.7 to 15.9). CONCLUSIONS: The use of alginate-chitin carrier with rhBMP-2 improves the biomechanical and histological properties of the repair site in a chronic rotator cuff tear.

Regeneración de defectos osteocondrales a partir de células madre mesenquimales autólogas embebidas en geles de alginato / Osteochondral defect regeneration from autologous mesenchymal stem cells embedded in alginate gels

Objetivo: Evaluar y analizar la capacidad de reparación de células mesenquimales pluripotenciales autólogas embebidas en geles de alginato para favorecer la restauración completa de lesiones osteocondrales generadas en un modelo experimental. Material y método: Se intervinieron 40 rodillas procedentes de 20 conejos albinos machos de raza neozelandesa de 5 meses de edad y un peso de entre 2.500 y 4.500 g. Se seleccionó un grupo control (grupo I, n=10), y en el resto se generó un defecto osteocondral en el área de carga del cóndilo femoral interno, y en función de la reparación efectuada sobre el mismo obtuvimos tres grupos: solo defecto (grupo II, n =10), relleno con alginato (grupo III, n = 10) y relleno con alginato y células (grupo IV, n = 10). Transcurridas ocho semanas, se extraen los cóndilos para su análisis macroscópico (Escala de Moran) e histológico (escalas de O’Driscoll e ICRS). Resultados: Un fallecimiento intraoperatorio (grupo I) y una infección articular (grupo II) supusieron dos pérdidas. El grupo IV obtuvo una mejor reparación osteocondral a nivel macroscópico, con presencia de grupos de condrocitos en la histología y resultados significativos en cuanto a la reparación osteocondral en las escalas utilizadas. Conclusión: El aporte de células mesenquimales en transportadores de alginato demuestra mejores resultados en reparación de lesiones osteocondrales de manera estadísticamente significativa, con mínimas complicaciones en modelos experimentales (AU)

Objective: To evaluate and analyze the ability of autologous mesenchymal stem cells embedded in alginate gels to favor the complete restoration of osteochondral lesions generated in an experimental model. Material and method: 40 knees from 20 male New Zealand albino rabbit breed 5 months old and weighing between 2,500 and 4,500 g were operated. One control group (no defect; group I, n=10) was stablished. In the other groups, an osteochondral defect was generated in the weight bearing area of the medial femoral condyle, and depending on the material aported on it got three groups selected. Group II had only defect (n = 10), group III was filled with alginate (n = 10), and group IV was filled with alginate and cells (n = 10). After eight weeks, the condyles for macroscopic (Moran Scale) and histologic analysis (O'Driscoll and ICRS Scales) are extracted. Results: Intraoperative death (group I) and joint infection (group II) accounted for two losses. Group IV received a better macroscopic level osteochondral repair with chondrocyte groups present in histology and statiscally significant results regarding the osteochondral repair scales used. Conclusion: The contribution of mesenchymal cells in alginate carriers shows better results in restoration of osteochondral lesions with minimal complications in experimental models (AU)

Fracturas de estrés de la espina de la escápula asociadas a lesión del manguito rotador: a propósito de 3 casos y revisión de la literatura / Stress fracture of the scapular spine associated with rotator cuff dysfunction: Report of 3 cases and review of the literature

Las fracturas de estrés de la escápula son extremadamente raras, más aún aquellas que afectan a la espina. Su patogénesis, biomecánica, evolución clínica y tratamiento no están bien establecidos. En este artículo se describen 3 casos en 2 pacientes con lesión asociada del manguito rotador. Durante el seguimiento ninguna de las fracturas consolidó, 2 de ellas precisaron intervención quirúrgica mediante osteosíntesis y aporte de injerto, y la tercera permaneció como seudoartrosis indolora. Los autores proponemos como patogénesis de este tipo particular de fracturas la combinación de 3 factores: un manguito alterado funcionalmente, un incremento en la acción de los músculos con origen e inserción en la espina de la escápula o base del acromion, y cierta fragilidad ósea concomitante. Pensamos que este tipo de fractura es inestable, acompañándose de una ausencia de consolidación, motivo por el que recomendamos su tratamiento quirúrgico (AU)

Scapular spine stress fractures have been scarcely reported in the literature. Their pathomechanics, clinical course and treatment are not well established. We review 3 cases in 2 patients that were associated with cuff dysfunction. On follow-up, none of these fractures progressed to healing. Two of them needed osteosynthesis and bone grafting, and the third one became a painless non-union. The authors propose the combination of 3 factors as a reason for this lesion: a functionally impaired cuff, a greater activation of the muscles with origin and insertion in the spine-acromion and a fragile bone. As we believe that these fractures are unstable, and non-union would be expected, their surgical management is recommended (AU)

[Stress fracture of the scapular spine associated with rotator cuff dysfunction: Report of 3 cases and review of the literature]. / Fracturas de estrés de la espina de la escápula asociadas a lesión del manguito rotador: a propósito de 3 casos y revisión de la literatura.

Scapular spine stress fractures have been scarcely reported in the literature. Their pathomechanics, clinical course and treatment are not well established. We review 3 cases in 2 patients that were associated with cuff dysfunction. On follow-up, none of these fractures progressed to healing. Two of them needed osteosynthesis and bone grafting, and the third one became a painless non-union. The authors propose the combination of 3 factors as a reason for this lesion: a functionally impaired cuff, a greater activation of the muscles with origin and insertion in the spine-acromion and a fragile bone. As we believe that these fractures are unstable, and non-union would be expected, their surgical management is recommended.

Resultados de la reducción abierta y osteosíntesis de fracturas de húmero distal en mayores de 65 años / Results after internal fixation of humerus distal fractures in patients over than 65 years old

Introducción y objetivo. Las fracturas de húmero distal en ancianos asocian mala calidad ósea y gran conminución, lo que teóricamente dificultaría la síntesis de las mismas. Nuestro objetivo es evaluar los resultados radiológicos y funcionales del tratamiento mediante reducción abierta y fijación interna de estas fracturas. Material y métodos. Estudio retrospectivo entre los años 2005-2010 de 26 pacientes tratados mediante reducción abierta y fijación interna. Seguimiento medio de 42 meses. Al finalizar el mismo se realizó una valoración radiográfica (Knirk and Jupiter scale) y funcional mediante las escalas Mayo Elbow Performance Score y Quick-Disabilities of the Arm, Shoulder and Hand Score. La edad media fue de 76,8 años (65-89) siendo el 83% mujeres. Se encontraron 16 pacientes con fractura tipo C y 8 tipo A (según la AO). Todos fueron tratados mediante abordaje posterior. Resultados. La flexión media fue de 118,86° con un déficit de extensión medio de 25°. El 79,1% de los pacientes presentaban un grado 0-1 de artrosis. La media obtenida en las escalas funcionales fue: Quick-Disabilities of the Arm, Shoulder and Hand Score: 19,87; Mayo Elbow Performance Score: 85. Encontramos 2 casos de seudoartrosis: una de húmero distal y otra de la osteotomía del olécranon. Hallamos 2 casos de neuroapraxias cubitales y una radial que se recuperaron sin secuelas. Hubo 3 reintervenciones: 2 retiradas de material y un caso de nueva osteosíntesis. Discusión. El tratamiento con reducción abierta y osteosíntesis con placa para las fracturas tipo A y C de húmero distal en ancianos proporciona unos resultados funcionales satisfactorios para las demandas de este tipo de paciente, lo que altera escasamente la calidad de vida percibida por los mismos (AU)

Introduction and objective. Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Material and methods. Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Results. Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Discussion. Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life (AU)

[Results after internal fixation of humerus distal fractures in patients over than 65 years old]. / Resultados de la reducción abierta y osteosíntesis de fracturas de húmero distal en mayores de 65 años.

INTRODUCTION AND OBJECTIVE: Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. MATERIAL AND METHODS: Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. RESULTS: Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. DISCUSSION: Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life.

Tratamiento comparado de las lesiones del manguito rotador mediante el uso de células madre mesenquimales en combinación con membranas de colágeno tipo I / Rotator cuff injury comparative treatment between isolated mesenchymal stem cells or combined with collagen I membranes

Objetivo: Estudiar, en rata, la rotura completa del tendón del m. supraespinoso (SE) y su reparación mediante una membrana de colágeno tipo I con células mesenquimales pluripotenciales (MSCs). Material y método: Seccionamos unilateralmente el tendón SE, en ratas Sprague-Dawley de nueve meses de edad. Un mes después de la intervención, se realizó una segunda cirugía para reparar el tendón según tres grupos de tratamiento: cirugía convencional usando una sutura (n=30); con membrana de colágeno tipo I sin células (n=30) y con membrana de colágeno tipo I con 1x106 MSCs alogénicas (n=30; grupo MSC-Membrana). La reparación se evaluó al mes (n=30), a los dos2 meses (n=30) y a los nueve meses (n=30) mediante criterios biomecánicos e histológicos. Resultados: Las matrices de colágeno con MSC en los defectos creados mejoraron la resistencia y la rigidez del tendón SE a los tres meses comparado con las otras dos cirugías reparadoras. Ningún tratamiento logró un patrón histológicamente organizado. Conclusión: El tratamiento con MSC es seguro en los desgarros del manguito rotador (AU)

Objective: To study, in a rat model, the supraspinatus tendon (SE) rupture with isolated MSCs or combined with collagen membranes Material and method: A chronic rotator cuff tear injury model was developed by unilaterally detaching the SE tendon of aged Sprague-Dawley rats (9 months). One month post-injury, a second surgery was then performed to repair the tears by: 1. single suture (n=30), 2. suture and type I collagen membranes (n=30) and 3. suture and type I collagen membranes with 1x106 allogeneic MSCs; (n=30). Lesion restoration was evaluated at one month (n=30), two months (n=30) and three months (n=30) post-injury by biomechanical, histological and inmunohistological criterias. Results: All experimental conditions were well tolerated and no adverse effects were observed. Implantation of collagen type I membrane with MSCs into surgically created tendon defects improved strength and stiffness of SE tendon three months after treatment compared with the other two repair surgeries. No treatment achieved a histological organized pattern. Conclusion: The therapeutic use of allogenic MSCs in collagen type I membrane in the rotator cuff tears seems to be the most promising treatment in our experimental model (AU)

Evaluación clínico-ecográfica de la reparación quirúrgica de las roturas del manguito rotador / Clinical and ultrasonographic evaluation of the surgical repair of rotator cuff tears

Objetivo: evaluar la eficacia del tratamiento quirúrgico de las roturas del manguito rotador y analizar la correlación existente entre el estado de la reparación quirúrgica de los tendones afectados y los resultados funcionales obtenidos. Pacientes y metodología: realizamos un estudio retrospectivo de 42 hombros en 39 pacientes, con un seguimiento medio de 15 meses (12-36). La edad media fue de 61 años. Las roturas se clasificaron de acuerdo al grado de retracción del tendón y al número de tendones afectados. Los resultados funcionales se evaluaron con el test de Constant y Murley aislado y ponderado por edad y sexo, realizando un estudio ecográfico postoperatorio para evaluar el estado de la sutura. Resultados: encontramos un 47 % de rerroturas. La puntuación media del grupo completo fue de 76 y 93,6% para el test de Constant aislado y ponderado por edad y sexo respectivamente, siendo para aquellos pacientes que presentaban una rerrotura de 86,7% comparado con el 98,7% que presentaban los tendones íntegros. El descenso de la fuerza fue el parámetro más afectado en el grupo en el que falló la sutura. Conclusión: el 79% de los pacientes con rerroturas se encontraban satisfechos y volverían a intervenirse lo que nos lleva a intentar una reparación quirúrgica incluso ante el potencial fallo de la sutura (AU)

Aim: To evaluate the results of the surgical repair of the rotator cuff tears and to analyze the correlation among the state of the surgical tendons repaired and the functional results obtained. Patients and methodology: We reviewed 42 shoulders in 39 patients being the average follow-up period 15 months. The mean age was 61. The tears were classified according to tendon retraction and the number of affected tendons. The clinical outcome was evaluated with the Constant and Murley system and the relative Constant score. The integrity of the repair was assessed by ultrasound exam. Results: 47% repair failure was observed. The average Constant score for the whole group was 76 being the relative Constant score 93.6%. For those patients with tendon rerupture the mean relative Constant score was 86,7% comparing with the 98,7% which averaged the non-failure group. Out of all the items evaluated, strength was the most affected in the failure group compared to the successful repair group. Conclusion: 79% of the patients with reruptures were subjectively satisfied and would let themselves be operated again, leaving us with the idea that surgical repair should be tried even with the risk of a potential suture failure (AU)