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1.
Einstein (Sao Paulo) ; 18: eAO4739, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553355

RESUMO

OBJECTIVE: To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. METHODS: We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. RESULTS: Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. CONCLUSION: There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Brasil/epidemiologia , Cartilagem Articular/lesões , Criança , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
2.
Orthop Clin North Am ; 50(4): 433-443, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466660

RESUMO

This article serves to provide an overview of molecular and surgical interventions to minimize the progression of posttraumatic arthritis following high-energy intra-articular fractures. The roles of cartilage and the microcellular environment are discussed, as well as the response of the joint and cartilage to injury. Molecular therapies, such as glucocorticoids, mesenchymal stem cells, and bisphosphonates, are presented as potential treatments to prevent progression to posttraumatic arthritis. High-energy intra-articular fractures of the elbow, hip, knee, and ankle are discussed, with emphasis on restoring anatomic alignment, articular reduction, and stability of the joint.


Assuntos
Cartilagem Articular/lesões , Fraturas Intra-Articulares/complicações , Osteoartrite/terapia , Artroplastia , Difosfonatos/uso terapêutico , Progressão da Doença , Glucocorticoides/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico , Transplante de Células-Tronco Mesenquimais , Osteoartrite/etiologia
3.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(3): 296-308, jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1020345

RESUMO

Una significativa cantidad de adultos jóvenes activos sufre lesiones condrales focales. Estas lesiones, si no se tratan, pueden progresar hacia la artrosis, que es una de las principales enfermedades musculoesqueléticas debilitantes y de gran carga económica que afectan a toda sociedad. Pese a los tratamientos quirúrgicos disponibles para la reparación de defectos condrales focales sintomáticos que mejoran la calidad de vida a mediano plazo, hay un mayor riesgo de progresión hacia la artrosis prematura. Los tratamientos biológicos (células madre, bioingeniería tisular) han avanzado a grandes pasos en los últimos años. La bioingeniería es un área que ha progresado en la regeneración de cartílago articular y que potencialmente podría progresar en el terreno de tratamientos articulares, promoviendo la regeneración y evitando la degeneración. Las células madre y los hidrogeles pueden proveer un tejido símil biológico de comportamiento dinámico-funcional equivalente que induce la regeneración tisular al ser degradado y reemplazado gradualmente. El abordaje consiste en colocar un hidrogel precursor o un biomaterial tridimensional impreso dentro del defecto condral por ocupar para inducir la regeneración. Esta revisión se focaliza en el uso actual y futuro de hidrogeles y bioimpresión tridimensional para la regeneración de cartílago articular en el tratamiento de lesiones condrales focales y proporciona datos preliminares de dos estudios piloto en animales. Nivel de Evidencia: V


A significant number of young active adults are affected by focal chondral lesions. These lesions, if left untreated, will progress to osteoarthritis (OA). OA is one of the main debilitating musculoskeletal diseases and leads to a high economic and social burden. Despite surgical cartilage repair for focal chondral lesions, which improve patient-reported outcomes at short- and mid-term, there is a risk of early OA progression. Biological treatments (i.e., stem-cell therapy, bioengineering) have made great progress in the last years. Tissue engineering is an evolving field for articular cartilage repair which could potentially be used for the treatment of focal chondral lesions, promoting regeneration and preventing joint surface degeneration. Stem cells and hydrogels may provide a functional, dynamic and biologically equivalent tissue that promotes tissue regeneration while being gradually degraded and replaced. The standard approach to tissue engineering consists in delivering cells within a hydrogel or a three-dimensional printed biomaterial scaffold into the chondral lesion to induce regeneration. This review focuses on the current and future use of hydrogels and tissue scaffold bioprinting for the treatment of focal chondral lesions, and provides preliminary data from two pilot animal studies. Level of Evidence: V


Assuntos
Humanos , Regeneração , Cartilagem Articular/lesões , Cartilagem Articular/patologia , Hidrogel de Polietilenoglicol-Dimetacrilato/uso terapêutico , Engenharia Tecidual , Polimerização , Bioimpressão
4.
J Biol Regul Homeost Agents ; 33(2 Suppl. 1): 69-77, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31169006

RESUMO

Several techniques and different biological or artificial tissues have been proposed as graft to restore articular defects. However, among the numerous and heterogeneous procedures proposed over time, the current literature findings are not conclusive. The aim of the current study is to evaluate if human costal cartilage can be suitable as graft for restoring articular cartilage defects. Knee articular cartilage and costal cartilage samples were obtained respectively from patients that underwent anterior cruciate ligament reconstruction (samples from notch plasty) or knee joint replacement and ear reconstruction or rhinoplasty through rib graft. The samples were stained with hematoxylin eosin, safranine-O, Gomori paraldehyde-fuchsin and Von Kossa for light microscopy. Immunohistochemistry was performed using anti-collagen I, II, IV and anti-SOX9 antibodies. Furthermore, samples were analyzed by transmission electron microcopy (TEM). In both cartilage, the cells are arranged in quite similar layers and the matrix show the same hyaline appearance: presence of type II collagen and solphated glycosaminoglycans, and absence of type I collagen and SOX-9. The bigger difference between the two hyaline tissues is the presence of perichondrium that surrounds all the specimens of costal cartilage. It consists of two separate layers where the inner one seems to get thinner with aging. The results show that rib cartilage seems to be an adapt tissue as graft for articular cartilage repair from a histological point of view. However, to date its therapeutic potential remains to be clearly defined by animal and clinical studies.


Assuntos
Cartilagem Articular/cirurgia , Cartilagem Costal/transplante , Cartilagem Costal/ultraestrutura , Cartilagem Articular/lesões , Colágeno Tipo I/análise , Humanos , Imuno-Histoquímica , Articulação do Joelho , Microscopia , Microscopia Eletrônica de Transmissão , Costelas , Fatores de Transcrição SOX9/análise
5.
BMC Musculoskelet Disord ; 20(1): 193, 2019 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-31054572

RESUMO

BACKGROUND: Cartilage repair outcomes are compromised in a pro-inflammatory environment; therefore, the mitigation of pro-inflammatory responses is beneficial. Treatment with continuous low-intensity ultrasound (cLIUS) at the resonant frequency of 5 MHz is proposed for the repair of chondral fissures under pro-inflammatory conditions. METHODS: Bovine osteochondral explants, concentrically incised to create chondral fissures, were maintained under cLIUS (14 kPa (5 MHz, 2.5 Vpp), 20 min, 4 times/day) for a period of 28 days in the presence or absence of cytokines, interleukin-6 (IL-6) or tumor necrosis factor (TNF)α. Outcome assessments included histological and immunohistochemical staining of the explants; and the expression of catabolic and anabolic genes by qRT-PCR in bovine chondrocytes. Cell migration was assessed by scratch assays, and by visualizing migrating cells into the hydrogel core of cartilage-hydrogel constructs. RESULTS: Both in the presence and absence of cytokines, higher percent apposition along with closure of fissures were noted in cLIUS-stimulated explants as compared to non-cLIUS-stimulated explants on day 14. On day 28, the percent apposition was not significantly different between unstimulated and cLIUS-stimulated explants exposed to cytokines. As compared to non-cLIUS-stimulated controls, on day 28, cLIUS preserved the distribution of proteoglycans and collagen II in explants despite exposure to cytokines. cLIUS enhanced the cell migration irrespective of cytokine treatment. IL-6 or TNFα-induced increases in MMP13 and ADAMTS4 gene expression was rescued by cLIUS stimulation in chondrocytes. Under cLIUS, TNFα-induced increase in NF-κB expression was suppressed, and the expression of collagen II and TIMP1 genes were upregulated. CONCLUSION: cLIUS repaired chondral fissures, and elicited pro-anabolic and anti-catabolic effects, thus demonstrating the potential of cLIUS in improving cartilage repair outcomes.


Assuntos
Cartilagem Articular/lesões , Interleucina-6/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Terapia por Ultrassom/métodos , Cicatrização/efeitos da radiação , Animais , Cartilagem Articular/citologia , Cartilagem Articular/patologia , Cartilagem Articular/efeitos da radiação , Bovinos , Técnicas de Cultura de Células , Movimento Celular/efeitos da radiação , Sobrevivência Celular/efeitos da radiação , Condrócitos/metabolismo , Osteocondrite/patologia , Osteocondrite/terapia , Cultura Primária de Células
6.
Medicine (Baltimore) ; 98(17): e15361, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027121

RESUMO

Previous research has shown that delays in pediatric anterior cruciate ligament (ACL) reconstruction are associated with increased prevalence of concomitant knee injuries and worse outcomes following surgery. However, few studies have described factors that may contribute to these delays and adverse outcomes. This study seeks to determine the effect of socioeconomic status on clinical outcomes following ACL reconstruction.A retrospective review of patients who underwent primary ACL reconstruction at a tertiary pediatric hospital between 2009 and 2015 was conducted. Variables included chronologic, demographic, and socioeconomic data, and postoperative complications. Socioeconomic status was measured using health insurance type and median household income levels derived from 2009 to 2015 US Census Bureau.A total of 127 patients (69 male, 58 female) were included. The mean age at time of surgery was 15.0 years. Overall, 68 patients had commercial insurance and 59 patients had government-assisted insurance. The mean household median income for patients with commercial insurance was $87,767 compared to $51,366 for patients with government-assisted insurance. Patients with government-assisted insurance plans demonstrated greater delays in time from injury to initial orthopaedic evaluation (P = .0003), injury to magnetic resonance imaging (MRI) examination (P = .021), injury to surgery (P < .0001), initial orthopaedic evaluation to surgery (P = .0036), and injury to return to play clearance, P = .044. Median household income was significantly related to time from injury to MRI examination (P = .0018), injury to surgery (P = .0017), and initial orthopaedic evaluation to surgery (P = .039). Intraoperatively, 81% of patients with government-assisted insurance had concomitant meniscal injuries compared 65% of patients with commercial insurance, P = .036. Postoperatively, 22% of patients with government-assisted insurance were found to have decreased knee range of motion ("stiffness") compared to 9% of patients with commercial insurance, P = .034.Pediatric patients who have government-assisted plans may experience delays in receiving definitive injury management and be at risk for postoperative complications. Our findings suggest a significant discrepancy in time to treatment as well as rates of concomitant knee injuries and postoperative complications between government and commercial insurance types.Level of Evidence: III.


Assuntos
Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Adolescente , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Cartilagem Articular/lesões , Criança , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Classe Social , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/epidemiologia , Lesões do Menisco Tibial/terapia , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
7.
Knee ; 26(3): 647-652, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31031125

RESUMO

BACKGROUND: Chondral delamination with intact articular surface is an under-recognised entity with no previous reports on how it should be managed. The purpose of this article is to increase awareness of this entity and make recommendations for its management. METHODS: We present a small case series of three patients who presented with knee pain and subsequent MRI scans revealed chondral delamination with intact articular surface as the only explanation of symptoms. RESULTS: Two of the lesions were located in the patella and one on the lateral aspect of the medial femoral condyle. All three were treated with bioabsorbable pin fixation. The delaminated area was easily recognised at arthroscopy by its bogginess on probing. All three patients made an excellent recovery and the lesions healed on MRI. CONCLUSION: Chondral delamination with intact articular surface is best managed with bioabsorbable pin fixation so that it can be salvaged in order to optimise patient outcomes and avoid deterioration to a full thickness chondral lesion once the articular surface has separated.


Assuntos
Cartilagem Articular , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Implantes Absorvíveis , Adulto , Artroscopia , Pinos Ortopédicos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino
8.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(2): 343-348, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31016955

RESUMO

After the articular cartilage injury, the metabolic level is increased during the progressive degeneration, the chondrocytes secrete a variety of inflammatory factors, and the original cell phenotype is gradually changed. For a long time, a large number of researchers have done a lot of researches to promote anabolism of chondrocytes and to maintain the stability of chondrocyte phenotype. There are many molecular signaling pathways involved in the process of promoting cartilage repair. This review focuses on the key signaling molecules in articular cartilage repair, such as transforming growth factor-beta and bone morphogenetic protein, and reveals their roles in the process of cartilage injury and repair, so that researchers in related fields can understand the molecular mechanism of cartilage injury and repair widely and deeply. Based on this, they may find promising targets and biological methods for the treatment of cartilage injury.


Assuntos
Cartilagem Articular/crescimento & desenvolvimento , Condrócitos/fisiologia , Regeneração , Transdução de Sinais , Proteínas Morfogenéticas Ósseas/fisiologia , Cartilagem Articular/lesões , Humanos , Fator de Crescimento Transformador beta/fisiologia
9.
Clin Orthop Surg ; 11(1): 21-27, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30838104

RESUMO

Background: We investigated sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) and computed tomography arthrography (CTA), on the basis of arthroscopic findings, to diagnose acetabular labral tears and chondral lesions. Methods: We retrospectively reviewed the results of MRI and subsequent CTA in 36 hips that underwent arthroscopic surgery (33 patients; 17 males [17 hips] and 16 females [19 hips]; average age, 35 years). All patients had positive impingement test results and groin pain. We analyzed sensitivity, specificity, and accuracy of MRI and CTA by comparing with the arthroscopic findings. Interobserver agreement and intraobserver reproducibility of the presence of tears and cartilage lesions on MRI and CTA were calculated using Kappa coefficients. Results: The sensitivity, specificity, and accuracy of MRI for detection of acetabular labral tears by two observers were 60%, 80%, and 64%, respectively, and 65%, 70%, and 69%, respectively. The sensitivity, specificity, and accuracy of CTA for detection of labral tears by both observers were 85%, 90%, and 86%, respectively, and 92%, 80%, and 89%, respectively. However, the sensitivity and specificity of MRI for detection of acetabular chondral lesions by both observers were 36% and 84%, respectively, and 46% and 88%, respectively. The sensitivity and specificity of CTA for detecting acetabular cartilage lesions by both observers were 46% and 72%, respectively, and 64% and 72%, respectively. Intraobserver reproducibility for detection of labral tears and chondral lesions by using MRI was substantial (κ = 0.756 and κ = 0.693, respectively). Interobserver reliability for detection of labral tears and chondral lesions by using MRI was substantial (κ = 0.700 and κ = 0.875, respectively). Intraobserver reproducibility for detection of labral tears and chondral lesions by using CTA was substantial (κ = 0.832 and κ = 0.774, respectively). Interobserver reliability for detection of labral tears and chondral lesions by using CTA was high (κ = 0.886 and κ = 0.596, respectively). Conclusions: This study demonstrated that the accuracy of MRI to detect an acetabular labral tear and a chondral lesion of the hip joint was not sufficient. CTA was reliable in the diagnosis of acetabular labral tears. However, both CTA and MRI were also of limited value to detect chondral lesions.


Assuntos
Artrografia/métodos , Cartilagem Articular/diagnóstico por imagem , Imagem por Ressonância Magnética , Traumatismos dos Tendões/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Artroscopia , Cartilagem Articular/lesões , Feminino , Articulação do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
10.
Knee Surg Sports Traumatol Arthrosc ; 27(6): 1891-1899, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30900033

RESUMO

PURPOSE: To analyse the clinical outcome and survivorship of meniscal allograft transplantation (MAT), performed in a single unit, specifically to assess the impact of concomitant operations and the influence of articular cartilage lesions on outcome. METHOD: A prospective case series analysis of 240 patients undergoing MAT with follow-up greater than 12 months (range 1-10 years) was performed. Group A represented patients with good chondral surfaces (ICRS 0-3A); Group B had good chondral surfaces with concomitant realignment osteotomy. Group C had good chondral surfaces with ACL reconstruction performed at the same time. Groups D and E had bare bone on one or both surfaces respectively. Kaplan-Meier survivorship and PROMS including Lysholm, KOOS, Tegner, and IKDC subjective scores were analysed. RESULTS: Overall survivorship was 96.7% at 1 year, 87% at 5 years and 82.2% at 7 years. Groups A-C (knees without significant chondral damage) had significantly improved survivorship (95% at 5 years) compared to Groups D, E (full-thickness chondral wear) with 77% survivorship at 5 years. Survivorship and PROMS were equivalent between Groups A-C. Groups D and E had similar PROMS to Group A, but did have a higher failure rate. Overall 27% required further operative intervention. CONCLUSIONS: Meniscal transplantation is clinically effective in treating patients with symptomatic meniscal deficiency. Where indicated, the addition of osteotomy or ACL reconstruction achieves results similar to patients undergoing simple meniscal transplantation in stable and normally aligned knees. Survivorship is lower in patients with full-thickness chondral loss and future treatments should, therefore, be directed at improving success in this at-risk group. The results support encouragement for earlier referral of symptomatic patients to a specialist meniscal reconstruction centre before a significant chondral damage is sustained. LEVEL OF EVIDENCE: III.


Assuntos
Aloenxertos , Sobrevivência de Enxerto , Meniscos Tibiais/transplante , Encaminhamento e Consulta , Lesões do Menisco Tibial/cirurgia , Adolescente , Adulto , Reconstrução do Ligamento Cruzado Anterior , Cartilagem Articular/lesões , Cartilagem Articular/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Tempo para o Tratamento , Adulto Jovem
11.
Knee ; 26(3): 673-678, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904326

RESUMO

BACKGROUND: This study aimed to demonstrate the characteristics of the chondral lesion at the medial femoral condyle (MFC) in patients with medial meniscal posterior root tear (MMPRT), and to compare the progression rate of accompanying chondral disease in MMPRT with that in degenerative non-radial tear. METHODS: Thirty-one patients who underwent arthroscopic surgery for MMPRT and 31 controls who underwent arthroscopic surgery for degenerative medial meniscus posterior horn horizontal tear (MMPHT) were included. Accompanying chondral lesions in the MFC were evaluated by magnetic resonance imaging (MRI) at initial diagnosis and from video taken at arthroscopic surgery using the International Cartilage Repair Society (ICRS) classification system. The difference in severity and extent of the chondral lesion between initial diagnosis and surgery was measured. RESULTS: Twenty-five patients with MMPRT (80.6%) and 29 patients (93.5%) with MMPHT had ICRS grade ≥2 chondral injuries at MFC. In the MMPRT and MMPHT groups, the most severely injured areas of the MFC were the far medial compartment (52%) and central compartment (51%), respectively. Comparing MRI and arthroscopy, 12 patients (39%) in the MMPRT group showed progression of chondral disease after a mean of 3.5 months, whereas only three patients (10%) in the MMPHT group showed progression after a mean of 3.1 months. CONCLUSIONS: MFC lesions accompanying MMPRT were located more medially and progressed faster than those with non-root horizontal tear. Earlier intervention such as repair of MMPRT or high tibial osteotomy, if malalignment is present, may be considered in order to prevent the progression of chondral lesion.


Assuntos
Doenças das Cartilagens/etiologia , Cartilagem Articular/lesões , Lesões do Menisco Tibial/cirurgia , Adulto , Artroscopia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
12.
Knee Surg Sports Traumatol Arthrosc ; 27(6): 1847-1872, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30721345

RESUMO

PURPOSE: The purpose of this review is to systematically analyse current literature on the use of allografts in the surgical treatment of foot and ankle disorders in adult patients. Based on this study, we propose evidence-based recommendations. METHODS: The database for PubMed was searched for all published articles. No timeframe restrictions were applied. Clinical studies eligible for inclusion met the following criteria: performed on patients over 18 years old; subject to surgical treatment of foot and ankle disorders; with report on the outcome of the use of allografts; with a report and assessment of pain and function, or equivalent; minimum follow-up of 1 year was required. Two reviewers independently screened and selected studies for full-text analysis from title and abstract. 107 studies were included from 1113 records. Studies were grouped according to surgical indications into ten categories: musculoskeletal tumours (n = 16), chronic ankle instability (n = 15), ankle arthritis (n = 14), osteochondral lesions of the talus (n = 12), Achilles tendon defects (n = 11), other tendon defects (n = 9), fusions (n = 9), fractures (n = 8), hallux rigidus (n = 3) and other indications (n = 10). RESULTS: Most studies displayed evidence level of IV (n = 57) and V (n = 39). There was one level I, one level II and nine level III studies. Most studies reported allografting as a good option (n = 99; 92.5%). Overall complication rate was 17% (n = 202). CONCLUSIONS: Fair evidence (Grade B) was found in favour of the use of allografts in lateral ankle ligament reconstruction or treatment of intra-articular calcaneal fracture. Fair evidence (Grade B) was found against the use of allogeneic MSCs in tibiotalar fusions. LEVEL OF EVIDENCE: V.


Assuntos
Aloenxertos , Articulação do Tornozelo/cirurgia , Transplante Ósseo , Cartilagem/transplante , Pé/cirurgia , Tendões/transplante , Artrite/cirurgia , Artrodese , Neoplasias Ósseas/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Fraturas Ósseas/cirurgia , Hallux Rigidus/cirurgia , Humanos , Instabilidade Articular/cirurgia , Traumatismos dos Tendões/cirurgia
13.
J Knee Surg ; 32(2): 127-133, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30630211

RESUMO

As our patients become more physically active at all ages, the incidence of injuries to articular cartilage is increasing causing significant pain and disability. The intrinsic healing response of articular cartilage is poor because of its limited vascular supply and capacity for chondrocyte division. Nonsurgical management for the focal cartilage lesion is successful in the majority of patients. Those patients who fail conservative management may be candidates for a cartilage reparative or reconstructive procedure. The type of treatment available depends on a multitude of lesion-specific and patient-specific variables. First-line therapies for isolated cartilage lesions have demonstrated good clinical results in the correct patient, but typically repair cartilage with fibrocartilage, which has inferior stiffness, inferior resilience, and poorer wear characteristics. Advances in cell-based cartilage restoration have provided the surgeon a means to address focal cartilage lesions utilizing mesenchymal stem cells, chondrocytes, and biomimetic scaffolds to restore hyaline cartilage.


Assuntos
Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Traumatismos do Joelho/cirurgia , Aloenxertos , Artroplastia Subcondral , Células Cultivadas , Condrócitos/transplante , Desbridamento , Humanos , Traumatismos do Joelho/classificação , Transplante de Células-Tronco Mesenquimais , Transplante Autólogo
14.
J Knee Surg ; 32(1): 9-25, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30562835

RESUMO

The use of intra-articular corticosteroids for traumatic arthritis and osteoarthritis (OA) is common in the horse. The beneficial and deleterious effects of the principal corticosteroids used betamethasone esters (Celestone [Soluspan], methylprednisolone acetate [Depo Medrol], and triamcinolone acetonide [TA] [Vetalog or Kenalog]) have been defined for the horse. While TA has both disease-modifying as well as symptom-modifying effects, methyl prednisolone acetate has deleterious effects on the articular cartilage. Studies in traumatically injured joints show the same rationale (suppression of deleterious mediators associated with inflammation) and positive results from the use of TA in both equine and human patients. Studies in the experimental equine OA model allow for more in-depth knowledge of disease-modifying effects. Recent insights allow us to understand posttraumatic OA as an early consequence of joint injury that may require a more aggressive and proactive treatment approach than commonly applied to date.


Assuntos
Artralgia/tratamento farmacológico , Glucocorticoides/uso terapêutico , Osteoartrite/tratamento farmacológico , Joelho de Quadrúpedes/efeitos dos fármacos , Animais , Artralgia/veterinária , Betametasona/uso terapêutico , Cartilagem Articular/lesões , Quimioterapia Combinada , Cavalos , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Traumatismos do Joelho/terapia , Acetato de Metilprednilosona/uso terapêutico , Osteoartrite/veterinária , Medição da Dor , Joelho de Quadrúpedes/lesões , Sinovite/complicações , Sinovite/terapia , Triancinolona Acetonida/uso terapêutico , Viscossuplementos/uso terapêutico
15.
Knee ; 26(1): 174-184, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30579660

RESUMO

BACKGROUND: CARGEL (Smith & Nephew Inc.), a chitosan-based polymer scaffolding biomaterial, has been used since 2012 for treating articular cartilage lesions. Limited data are available on patient outcomes following CARGEL treatment. This study aimed to describe short-term clinical and radiographic outcomes in a cohort of patients treated with CARGEL and microfracture surgery for articular cartilage defects in the knee. METHODS: A retrospective cohort study was conducted of consecutive patients with articular cartilage defects who had undergone microfracture surgery with CARGEL, or in patellar lesions microfracture and CARGEL plus Chondro-Gide (at SportsClinic Zurich). Study outcomes included reoperations, infections, allergic reactions, pain, swelling, range of motion, and tissue quality and quantity. Ethics approval was obtained from the local ethics committee on 05/09/2017 (Basec. Nr: 2017-01441). RESULTS: A total of 91 participants, with 93 treated lesions, consenting to chart review were included. No participants required reoperation due to complications on the index lesion. Fifteen participants had second-look surgery on the index knee for other reasons, allowing for visual confirmation of cartilage repair. No study participants experienced a post-surgical infection or suffered an allergic reaction. No significant changes in range of motion or T2 values were observed from pre-treatment to post-treatment follow-up. However, significant decreases were found in pain (P < 0.001) and swelling (P < 0.001), along with significant increases in MOCART II scores (P < 0.001). Similar results were found in a subgroup of patients with patellar lesions. CONCLUSIONS: Patients treated with CARGEL experienced few postoperative complications and reported promising reductions in pain and swelling after treatment. LEVEL OF EVIDENCE: IV.


Assuntos
Cartilagem Articular/cirurgia , Fraturas de Estresse/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Patela/lesões , Tecidos Suporte , Adulto , Cartilagem Articular/lesões , Feminino , Seguimentos , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/fisiopatologia , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Patela/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Cirurgia de Second-Look , Transplante Autólogo
16.
Surg Technol Int ; 34: 476-482, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30574679

RESUMO

Few reports in the literature have described the use of an osteochondral allograft for the treatment of articular cartilage damage of the 1st metatarsal phalangeal joint. We present here the clinical outcomes and detailed surgical technique of four cases in which we used a cryopreserved, viable, osteochondral allograft (CVOCA) for full cartilage replacement of the first metatarsal head to address degenerative articular cartilage damage. At 10-22 months of follow-up, patients reported clinical improvement, with VAS pain-scale scores decreasing from an average of 8.0 to 0 post-operatively, and range-of-motion improvement from an average of 4.3 degrees to 58.3 degrees dorsiflexion. Radiographic improvement was also seen, with an increase in average joint space from 1.1mm, 1.5mm, and 2.2mm from medial to lateral on dorsoplantar views pre-operatively, to 3.1mm, 2.8mm, and 3.1mm 15 months post-operatively, respectively. These results suggest that CVOCA is a desirable treatment option for end-stage degenerative joint disease of the first metatarsal phalangeal joint.


Assuntos
Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Hallux/cirurgia , Articulação Metatarsofalângica/cirurgia , Osteoartrite/cirurgia , Aloenxertos , Transplante Ósseo , Cartilagem/transplante , Humanos , Articulação Metatarsofalângica/lesões , Amplitude de Movimento Articular , Transplante Homólogo
18.
Semin Musculoskelet Radiol ; 22(4): 386-397, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30134463

RESUMO

Anterior cruciate ligament (ACL) tears are common injuries that if left untreated can result in chronic instability, cartilage damage, meniscal tears, and ligamentous injuries, eventually leading to early osteoarthritis. ACL reconstruction surgeries are therefore increasingly being performed. Despite the fact that most patients achieve excellent postoperative results, patients can present with recurrent instability and pain. These patients often undergo imaging with radiographs, magnetic resonance imaging, and/or computed tomography. An understanding of the imaging appearance of the normal ACL reconstruction and common causes of failure is therefore essential for the interpreting radiologist. This article reviews surgical techniques for ACL reconstruction, highlighting recent technical advances, the normal imaging appearance after ACL reconstruction, etiologies for reconstruction failure, and the diagnosis of these with the aid of imaging.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Complicações Pós-Operatórias/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Humanos , Período Pós-Operatório
19.
J Pediatr Orthop ; 38(9): e501-e506, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30036288

RESUMO

BACKGROUND: Discoid lateral meniscus (DLM) is a morphologic variant in which concomitant articular cartilage defects lead to poor outcomes. The purpose of this study was to quantify the prognostic ability of history, physical examination, and magnetic resonance imaging (MRI) to identify arthroscopically confirmed articular cartilage injury in pediatric and adolescent DLM patients. METHODS: An analysis of 34 consecutive patients (mean, 12.5 y) who underwent surgical treatment for DLM. Patients were grouped based on arthroscopic findings for the presence or absence of articular cartilage injury. All patients underwent standard preoperative history and physical examination, and MRI of their symptomatic knee. Separate discriminant functional analyses were performed using history (age, sex, symptoms lasting >6 mo, traumatic history), physical examination (presence of clunk, extension block, mechanical symptoms), and MRI findings (chondral injury, meniscal degeneration, meniscal morphology) to determine their sensitivity and specificity in prediction of articular cartilage lesions. RESULTS: The sensitivity and specificity of history alone was 71.4% and 75.0%, respectively; physical examination alone was 64.3% and 60%, respectively; and of MRI findings alone was 60% and 66.7%, respectively. A stepwise discriminant functional analysis found that duration of symptoms and extension block were the optimal contributors with a 78.5% sensitivity and 80% specificity. CONCLUSIONS: Preoperative history had the highest sensitivity and specificity compared with physical examination and MRI findings for predicting articular cartilage injury at the time of DLM surgery. These findings may assist in setting expectations for patients with regard to surgical planning and recovery and also to counsel patients with asymptomatic, incidental DLM which factors may risk chondral injury and warrant early return for evaluation. LEVEL OF EVIDENCE: Level II-retrospective prognostic comparative study.


Assuntos
Cartilagem Articular/lesões , Imagem por Ressonância Magnética , Anamnese , Meniscos Tibiais/cirurgia , Exame Físico , Lesões do Menisco Tibial/diagnóstico , Adolescente , Artroscopia/métodos , Criança , Feminino , Humanos , Artropatias/patologia , Masculino , Meniscos Tibiais/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Avaliação de Sintomas , Lesões do Menisco Tibial/classificação , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/cirurgia
20.
Sports Med Arthrosc Rev ; 26(3): 120-128, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30059446

RESUMO

Articular cartilage injuries in the glenohumeral joint present a unique and difficult problem for the patient and surgeon alike. Various etiologies exist for the development of these cartilage lesions; therefore, treatment options are vast and must be chosen thoughtfully, especially in the young, active patient. Across all treatment modalities, the goal is for the patient to regain lasting function and mobility while decreasing pain.


Assuntos
Cartilagem Articular/lesões , Osteoartrite/diagnóstico por imagem , Articulação do Ombro/lesões , Artroscopia , Humanos , Inflamação , Instabilidade Articular , Osteoartrite/terapia , Osteonecrose , Exame Físico , Dor de Ombro
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