Adjustable bone plate: from bench to operating room.

Background/aim: We have designed an adjustable bone plate (ABP) which allows bone shortening and lengthening after fixation, which is a property not present in any of the plate systems available today. The aim of the current study was to examine the new ABP's segmental bone transfer capability for the treatment of a segmental bone defect in an animal model. Materials and methods: Five sheep had ABPs attached to 10 of their tibias and bone defects of 15 mm in size were created. The pinion mechanism was moved with a manual screwdriver at a rate of 1mm/day for 15 days starting 3 days postoperatively. The animals were euthanized 3 months postoperatively, and the defect site and the transferred segment were evaluated by radiological and histological examination. Results: The radiological results revealed successful transfers of 14.6 ± 1.2 mm of bone segment on all tibia defects without any complications. The histological evaluation showed new bone formation in both the extension and the docking sites. No rupture or breakage was observed within the plates. Conclusion: We have presented the potential of a new generation ABP for use in segmental bone transfer in an animal model as well as for future clinical applications.

Mean femoral cartilage thickness is higher in athletes as compared with sedentary individuals.

PURPOSE: It is unclear how high-intensity physical activity (HIPA) affects the knee joint, specifically the femoral cartilage (FC). Therefore, the aims of this study were to evaluate FC thickness via ultrasound among elite athletes involved in different types of HIPA, and to determine whether there is a correlation between serum cartilage oligomeric matrix protein (sCOMP) and rectus femoris (RF) thickness. METHOD: A total of 132 male individuals participated in this study and were assigned to two groups, the sedentary (n = 43, 23.9 ± 3.7) and athlete groups (n = 89, 22.7 ± 4.6), which did not significantly differ in age. The athletes were elite and performed HIPA during sports such as volleyball (n = 20), soccer (n = 21), basketball (n = 28), and weightlifting (n = 20). RF thickness and three (mid-point) measurements were obtained for each knee. The mean FC thickness for each knee was defined as the sum of the medial, lateral condyles, and intercondylar areas. Blood samples for sCOMP analyses were also obtained. RESULTS: All the measurements of the FC of both knees were significantly higher in the athletes than in the sedentary individuals (p < 0.001 and p = 0.001). The mean right and left FC values were also higher in the athletes (p < 0.001). Multiple linear regression analysis showed that participation in sporting activities was a significant predictor associated with the right and left mean FC thickness (p < 0.001 for both). No significant differences in the sCOMP levels were found between the two groups. CONCLUSION: It was found that the mean FC was higher among athletes than among sedentary individuals. As a result, it is suggested that sports' participation is an independent factor associated with the right and left mean FC thickness. LEVEL OF EVIDENCE: III.

Quadriceps tendon autograft ACL reconstructed subjects overshoot target knee extension angle during active proprioception testing.

PURPOSE: To compare the active joint position sense (JPS), muscle strength, and knee functions in individuals who had anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft, hamstring tendon autograft, tibialis anterior allograft and healthy individuals. It was hypothesized that when compared to an age and gender-matched healthy control group, subjects who were post-ACL reconstruction would display impaired active joint position sense, knee extensor and flexor strength symmetry and knee function at 1 year post-surgery. A secondary hypothesis was that differences would exist between the quadriceps tendon autograft, hamstring tendon autograft and tibialis anterior allograft groups. METHODS: Sixty-seven patients with ACL reconstruction and 20 healthy individuals were included. Active JPS reproduction was measured at 15°, 45° and 75° of knee flexion. International Knee Documentation Committee (IKDC) subjective score and one-leg hop test were used to assess the functional status of the patients. RESULTS: The JPS detection was different at the 15° target angle between groups (F3.86 = 24.56, p < 0.001). A significantly higher proportion of quadriceps tendon autograft group patients failed to identify the 15° active JPS assessment position compared to the other groups (p < 0.0001). The quadriceps index was lower in patients compared to healthy individuals (p < 0.001), while the hamstring index was similar (n.s.). The knee functional outcomes were similar between ACL reconstructed groups and healthy controls (n.s.). CONCLUSION: Knee proprioception deficits and impaired muscle strength were evident among patients at a mean 13.5 months post-ACL reconstruction compared with healthy controls. Patients who underwent ACL reconstruction using a quadriceps tendon autograft may be more likely to actively over-estimate knee position near terminal extension. Physiotherapists may need to focus greater attention on terminal knee extension proprioceptive awareness among this patient group. LEVEL OF EVIDENCE: III.

Injuries Among Recreational Football Players: Results of a Prospective Cohort Study.

OBJECTIVES: To establish the incidence and patterns of football injuries and associated consequences in daily life and labor loss, among public employees. DESIGN: Prospective cohort study. SETTING: Football tournament between public employees in Turkey. PARTICIPANTS: A total of 1821 recreational players from 78 teams. MAIN OUTCOME MEASURES: Injury rates (injuries per 1000 hours of football exposure) during tournament by age group, as well as prevalence, severity, and injury types were recorded. The data regarding the occurrence (eg, location, type, circumstances) and consequences (eg, absenteeism, medical treatment, labor loss) of injuries were collected. RESULTS: Of the 1821 football players registered for participation, 57% (n = 1038) were included in the study with the returned questionnaire forms. In total, 257 matches were played with a total exposure time of 5654 hours. A total of 218 injuries were recorded in 192 players (10.5%), resulting in a mean of 0.85 time-loss injuries per match (38.6 per 1000 hours). Severe injuries constituted 42.6% of all injuries, and 28.9% of all injuries caused the participants to be absent at least 1 day for the next working day. The total labor loss was 1196 days for all injuries. The rate of missing subsequent working day was significantly less for muscle injuries (P < 0.05). CONCLUSIONS: The risk of injury in recreational football players is relatively high causing significant labor loss. The results suggest that prevention programs should consider specific injury characteristics, as there is a greater incidence of muscle and anterior cruciate ligament injuries in this population.

The relationship between quadriceps strength and joint position sense, functional outcome and painful activities in patellofemoral pain syndrome.

PURPOSE: The aim of this study was to investigate how strongly the concentric and eccentric quadriceps strengths were correlated with the joint position sense, functional outcomes and painful activities in patients with patellofemoral pain syndrome (PFPS). METHODS: The study included forty-six women diagnosed with unilateral PFPS. Eccentric and concentric quadriceps strengths were recorded at 60 and 180°/s. Active knee joint position sense (JPS) was measured at 20° and 60° of flexion. Functional levels were determined by using Kujala patellofemoral scores. Pain levels during stair descending and ascending, squatting and prolonged sitting were measured using 0-10 cm visual analogue scale. The relationship of isokinetic quadriceps strength with JPS results, Kujala score and pain levels were evaluated using Spearman's correlation coefficient test. RESULTS: Eccentric and concentric quadriceps strengths were significantly lower on involved side than uninvolved side. JPS results were poorer on the painful knee when compared to uninvolved side. While eccentric strength correlated with both JPS target angles, concentric strength was correlated only with 20°. Both eccentric and concentric strengths were significantly correlated with Kujala scores and pain levels. CONCLUSION: Quadriceps eccentric strength was correlated more to joint position sense than concentric strength. Both eccentric and concentric quadriceps strength related to pain and functional level in PFPS patients.

Effects of boric acid on the healing of Achilles tendons of rats.

PURPOSE: Tendinous lesions are among the most frequent pathologies encountered in sportsmen. The objectives of new treatments are to improve the healing process and reduce the recovery time. Boron plays an important role in the wound repair process by increasing components of extracellular matrix and angiogenesis. This animal study aimed to investigate the effect of boric acid on healing of the Achilles tendon. METHODS: The right Achilles tendons of 40 rats were completely sectioned, and the rats were randomly divided into five groups. Each group consisted of eight rats. Groups 1 and 2 were oral boric acid groups with the doses of 4 and 8 mg/kg/day boric acid, respectively. Group 3 was the local boric acid group (8 mg/kg boric acid intratendinous injection). Group 4 was administered both oral and local boric acid (8 mg/kg/day orally and 8 mg/kg boric acid intratendinous injection), and group 5 was the control group with no boric acid application. At the end of the fourth week, all the rats were killed and histopathological examination of the Achilles tendon repair site was made. RESULTS: Histopathological examination of the tissue sections revealed more properly oriented collagen fibres, more normal cellular distribution of tenocytes and more properly organized vascular bundles in group 1 and group 2, which were the groups administered oral boric acid. Pathological sum scores of groups 1 and 2 were less than those of the other groups, and the differences between the oral boric acid groups (group 1 and group 2) and the other three groups (groups 3, 4 and 5) were statistically significant (p = 0.001). CONCLUSION: As boric acid is safe and toxicity even after very high doses is unusual, oral boric acid may be used as an agent to improve the healing process of tendon injuries. However, biomechanical tests should also be performed to show the effect of boric acid on strength and endurance of the tendon before it can be used in clinical practice.

Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods.

PURPOSE: To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop(®) on the femoral side, and an IS/staple on the tibial side. METHODS: Between 2006 and 2009, at a single institution, 72 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring tendon grafting were retrospectively reviewed. Fixation was performed, and with the EndoButton-Continuous Loop(®) device (Group Ι) in 48 patients (mean age 29.1 ± 7.3 years) with a bioabsorbable IS (Group ΙΙ) in 24 patients (mean age 28.5 ± 8.4 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively. RESULTS: The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (n.s.). Femoral TW at the proximal and middle levels (on both AP and lateral views) in Group ΙΙ was significantly greater than in Group Ι (p < 0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (n.s.). CONCLUSION: Femoral TW is less after EndoButton-Continuous Loop(®) fixation and not reduced after IS fixation. Surgeons should be aware of TW when selecting a fixation device for hamstring graft. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative study, Level III.

The biomechanical and histological effects of platelet-rich plasma on fracture healing.

PURPOSE: Platelet-rich plasma (PRP) includes growth factors and proteins that accelerate and stimulate bone regeneration and tissue recovery. The aim of this study was to evaluate the effects of PRP on fracture healing in terms of biomechanics and histology. METHODS: Seventy female rats were included in this experimental study. They were divided into three groups: Group I (no PRP, n = 30), Group II (PRP added, n = 30) and Group III (control, n = 10). The left femurs of the rats in Groups I and II were osteotomized and fixed by K-wires. Although no additional intervention was performed on Group I rats, PRP was applied to the fracture sites of Group II rats. The remaining ten rats were used as the control group of the biomechanical test (Group III). In the fourth week, nine femurs from Group I and ten femurs from Group II, and in the ninth week, nine femurs from each group were removed, and bone recovery was assessed histologically according to Modified Lane-Sandhu histological scoring criteria. Three-point bending test was applied to femurs for biomechanical evaluation in the ninth week. RESULTS: Histological healing was found to be significantly higher in Group II than in Group I (p < 0.05). Furthermore, biomechanical test results showed that healing quantity and bone strength were significantly better in Group II than in Group I (p < 0.05). CONCLUSION: PRP is a widely studied material in the physiology of fracture healing. The results of this study demonstrated the ameliorative biomechanical effects of PRP on fracture healing, in addition to accelerating the histological union of fractures. In the light of these results, PRP could be a viable alternative to accelerate the healing of fractures, late unions or non-unions. LEVEL OF EVIDENCE: Prospective comparative study, Level II.

Can standing knee radiographs predict chondral lesions in young- and middle-aged population?

PURPOSE: The aim of the study is to investigate the correlation between arthroscopic findings and joint space width on the standing knee radiographs at various flexion degrees in the young- and middle-aged patients with complaints of knee pain. METHODS: Middle-aged patients with complaint of knee pain ongoing more than 6 months and failure in conservative treatment methods were included. Weight-bearing full extension, 30 and 45° of flexion radiographs were obtained. Joint space width was calculated on radiograms. Arthroscopy was performed to evaluate the chondral pathologies. Correlation analysis was performed. RESULTS: Fourty-three patients (18 female, 25 male) with a mean age of 44.6 (20-63) were included. Mean joint space width was 4.87 mm ± 1.45 (2-10) mm in medial and 5.43 mm ± 1.47 (1-9) in lateral on standing extension radiographs. In 30° flexion radiographs, mean joint space width was 4.33 mm ± 1.25 (1.5-7.5) in medial and 5.36 mm ± 1.69 (1-9) in lateral. In 45° flexion radiographs, medial joint space was 4.28 mm ± 1.59 (2-9) in medial and 5.15 mm ± 1.59 (1.5-9) in lateral. In arthroscopic evaluation, one knee had grade 1 (2.3%), three knees had grade 2 (7%), nine knees had grade 3 (20.9%), and twelve knees had grade 4 (27.9%) lesions in the medial compartment. In the lateral compartment, two knees had grade 3 (4.7%) and one knee had grade 4 lesion (2.3%). Radiological data did not correlate with the arthroscopic findings. CONCLUSION: Standing knee radiographs do not correlate with the arthroscopic findings in the middle-aged population with chondral lesions in knee joint. LEVEL OF EVIDENCE: Case series with no comparison group, Level IV.

Comparison of magnetic resonance imaging findings with arthroscopic findings in discoid meniscus.

PURPOSE: It is widely accepted that although valuable in the diagnosis of the discoid meniscus and tears, magnetic resonance imaging (MRI) can be insufficient in determining the type of the tear. This study calculates the sensitivity and specificity of MRI in determining the presence and absence of tears and how these values differ for different types of tears. METHODS: This study is a retrospective review of 10 years of our experience with arthroscopic discoid meniscus treatment between 1999 and 2009. MRI findings were compared with the intraoperative arthroscopic findings in 52 patients with 50 lateral and two medial discoid menisci of which 24 were complete and 28 were incomplete. Tears were classified into six groups: (1) no tear, (2) simple horizontal tear, (3) radial tear, (4) combined horizontal tear, (5) complex tear and (6) longitudinal tear. Sensitivity, specificity, positive and negative predictive values of MRI were calculated for each group separately and for the presence and absence of tears in general. In addition, the effect of age, type of discoid meniscus, and presence and absence of shift on the distribution of tear types were analysed. RESULTS: MRI was found to be 100 % specific and 97.8 % sensitive for determining the presence or absence of a tear with a negative predictive value of 85.7 % and a positive predictive value of 100 %. The specificities were 80 % for simple horizontal, 50 % for radial, 66.7 % for combined horizontal, 55.6 % for complex and 14.3 % for longitudinal tears, whereas the sensitivities were 66.7 % for simple horizontal, 96.9 % for radial, 87.5 % for combined horizontal, 94.6 % for complex and 100 % for longitudinal tears. The presence and absence of shift and type of the discoid were found to affect the distribution of the tear type. CONCLUSIONS: MRI is successful in determining the presence or absence of tears in discoid menisci; however, its ability to determine the tear type is questionable. Complete discoid menisci were found to have tendency towards having a simple horizontal or longitudinal tear, whereas incomplete discoid menisci tend to have radial or combined horizontal tears. Determination of the shift prior to surgery is important since it alters the surgical technique.

Evaluation of posterior tibial slope relationship with common knee pathologies in pediatric and adolescent age groups in the Turkish population.

Anterior cruciate ligament rupture (ACLR), tibial eminence fracture (TEF), and Osgood-Schlatter disease (OSD) have been linked to a steep posterior tibial slope (PTS) in children and adolescents. This study aims to examine and compare these associations. 418 patients aged 8-18, 237 males and 181 females with knee pain between 2010 and 2019 were included and the patients belonged to the Turkish population. They consisted of ACLR (n = 47), TEF (n = 22), OSD (n = 51), and a control group (n = 298). The study and control groups were compared for PTS, sex, and age, with ACLR, TEF, OSD, retrospectively. The ACLR, OSD, and TEF groups had higher PTS values than the control group (P < 0.001). There was no significant difference in ACLR-OSD, ACLR-TEF, and OSD-TEF comparisons (P = 0.22, P = 0.99, and P = 0.99, respectively). PTS increase was linked to ACLR, TEF, and OSD in the multinomial regression analysis, (P < 0.001). Increase in PTS was associated with ACLR, TEF, and OSD for both males and females (independently of other factors; ACLR: P < 0.001, P < 0.001, OR: 1.59, OR: 2.63, TEF: P = 0.001, P < 0.001, OR: 1.98, OR: 1.44; OSD: P = 0.001, P < 0.001, OR: 1.49, OR: 1.28 for males and females respectively). ACLR, TEF, and OSD are associated with increased PTS in the pediatric and adolescent age groups, and there are differences between these pathologies in terms of the amount of PTS increase, age, and sex. Consideration of age and gender in pediatric and adolescent patients with increased PTS may be useful in predicting pathologies associated with increased PTS. Level of evidence: III retrospective comparative study.

What is the effect of the early weight-bearing mobilisation without using any support after endoscopy-assisted Achilles tendon repair?

PURPOSE: The aim of this study was to assess the effect of immediate weight-bearing mobilisation with intensive rehabilitation on muscle strength and lower extremity functional level after endoscopy-assisted Achilles tendon repairs. METHODS: After warming up for 5 min at a self-selected intensity on a stationary bike 32 male patients were tested for bilateral peak concentric isokinetic ankle dorsi- and plantar-flexor torque, passive range of motion for ankle joint, one-leg hop for distance, single-leg vertical jump height, Achilles Tendon Total Rupture Score, and perceived function using the Foot and Ankle Outcome Score (FAOS). A series of paired sample t tests were used to compare side-to-side differences (p < 0.05). RESULTS: There were no significant differences in hop and jump tests, dorsi- and plantar-flexor isokinetic muscle strength, and dorsi- and plantar-flexion range of motion between the affected and unaffected side of the patients. Pain score of FAOS was 95 ± 8, other symptoms score was 92 ± 11, function in daily living score was 95 ± 6, function in sport and recreation was 85 ± 16, and Quality of Life score was 85 ± 12. The mean of the Achilles Tendon Rupture Score was 86. CONCLUSIONS: There was no significant difference in both ankle muscle strength and lower extremity functional level between the endoscopy-assisted repairs and the unaffected sides. The early tolerated weight-bearing mobilisation without cast-brace and/or special shoe at the first day after the surgery may easily provide to return the daily living activities. It improves muscle strength, functional level, and range of motion. Further comprehensive and prospective studies on large patients should be warranted to analyse and compare the clinical and functional results in patients with endoscopy-assisted Achilles tendon repair.

Is there a relationship between tracking ability, joint position sense, and functional level in patellofemoral pain syndrome?

PURPOSE: This prospective cohort study investigated proprioception and motor control changes in patients with patellofemoral pain syndrome (PFPS), and how these changes related to knee function, pain, muscle strength and muscle endurance. METHODS: The study included 43 women diagnosed with unilateral patellofemoral pain syndrome. Thirty-one healthy women were recruited as control group. Peak quadriceps femoris and hamstring muscle isokinetic torques were recorded at 60 and 180°/s. Joint position sense was tested by active reproduction of joint position during horizontal squat performance. Muscle coordination and motor control ability were tested by a multi-joint lower limb tracking-trajectory test. Muscle endurance was tested using a computerized functional squat system. Severity of pain in during stair ascent/descent, squatting, and prolonged sitting with knees 90° flexed were measured using a 10 category modified visual analogue scale. Functional levels of patients were determined using Kujala patellofemoral scores. RESULTS: Active reproduction of joint position did not differ between PFPS and control groups. However, tracking-trajectory error was significantly higher in PFPS group than control subjects. Hamstring and quadriceps peak isokinetic torque and muscle endurance scores were significantly lower in the PFPS group. Kujala patellofemoral score displayed significant relationships with peak isokinetic quadriceps torque, knee pain, and joint position sense scores. Pain during stair descent, sitting, and quadriceps torque at 180°/s explained 57.7 % of the variation in Kujala patellofemoral score. CONCLUSION: Although lower extremity joint position sense did not differ between groups, the PFPS group displayed a target-trajectory muscular coordination deficit, decreased muscular endurance, and decreased muscular strength compared to control group subjects. Pain level directly related to motor control performance while joint position sense scores did not. Knee pain and impaired strength related more to functional performance impairment than joint position sense scores in patients with PFPS.

Proprioception level after endoscopically guided percutaneous Achilles tendon.

PURPOSE: To evaluate ankle function following endoscopically guided percutaneous Achilles tendon repair. The hypothesis of this study was that patients with percutaneous repair of the Achilles tendon would still display impaired involved side ankle proprioception. METHODS: Nineteen male patients with percutaneous Achilles tendon surgery were tested for bilateral ankle active angle reproduction at 10° dorsiflexion and 15° plantar flexion, peak concentric isokinetic ankle dorsiflexor and plantar flexor torque, one-leg hop for distance, and single-leg vertical jump height. Dominant sides of age- and sex-matched 19 healthy controls were evaluated for ankle active angle reproduction at 10° dorsiflexion and 15° plantar flexion, peak concentric isokinetic ankle dorsiflexor and plantar flexor torque. RESULTS: Peak isokinetic torque, one-leg hop for distance, single-leg vertical jump for height and ankle joint position sense at 10° dorsiflexion did not differ between the affected and unaffected side. Ankle joint position sense for active angle replication at 15° plantar flexion revealed a significant side-to-side difference. Joint position sense at 10° dorsiflexion and at 15° plantar flexion at affected side was poor in patients compared with the controls, while joint position sense at 10° dorsiflexion and at 15° plantar flexion at unaffected side was same in patients compared with the controls. CONCLUSIONS: It has revealed a significant difference in joint position sense at plantar flexion of the patients at least 1 year after percutaneous Achilles tendon surgery compared to their unaffected limb. Large prospective longitudinal studies are needed to evaluate therapeutic interventions designed to improve proprioception.

Arthroscopy-assisted reduction versus open reduction in the fixation of medial malleolar fractures.

PURPOSE: Purpose of this case-control study was to evaluate the feasibility and advantages of arthroscopically assisted reduction and internal fixation of isolated medial malleolar fractures and compare the outcomes with conventional open reduction and internal fixation. METHODS: Forty-seven patients with medial malleolar fractures were grouped into two: arthroscopy-assisted group, and conventional open reduction and internal fixation group. Arthroscopic treatment group consisted of 21 patients. The mean age was 34 years (range: 22-49 years). Conventional open reduction and internal fixation group included 26 patients. The mean age was 42 years (range: 22-58 years). According to Herscovici system, 6 fractures in the arthroscopy group were classified as type-B, 13 fractures as type-C, and 2 fractures were classified as type-D. In both groups, fractures were classified according to Herscovici system. Radiological and clinical outcomes were evaluated according to van Dijk classification and Olerud-Molander scoring system, respectively. RESULTS: The mean follow-up period was 26 months (18-52 months) for arthroscopically assisted group and 38 months (24-58 months) for the conventional group. According to van Dijk classification, there was only one patient with Grade 1 osteoarthritic changes in arthroscopically assisted group compared with the conventional group where two patients had Grade 2 and one patient had Grade 1 osteoarthritic changes. Median Olerud Scores were 92.3 (75-100) and 86.3 (70-100) for the arthroscopically assisted group and for the conventional group, respectively. The difference was statistically significant (p = 0.015). CONCLUSIONS: With the use of arthroscopically assisted techniques in fixation of isolated medial malleolar fractures, surgeon can evaluate intra-articular surface and reduction that may be of value in the improvement in clinical outcomes over conventional surgical treatment. LEVEL OF EVIDENCE: Case-control study, Level III.

The Biocompatibility of a New Type of 45S5 Bioactive Graft in a Sheep Model: A Pilot Study.

Background Bone is a dramatically regenerating tissue with the ability to heal after trauma, although intensive surgical management is required to treat considerable damage. In this study, 45S5 bioactive grafts were prepared through the melt-quenched method in compliance with the guidelines on medical product requirements (MDD regulations; 93/42/EEC Annex-II section 3&4 and ISO standardizations; ISO 13485:2016) for bone repair and regeneration. Methodology After preparing the graft/scaffold, it was evaluated for biocompatibility according to the principles of "lSO 10993-6 2015 Biological evaluation of medical devices: Tests for local effects after implantation, Annex D 'Test method for implantation in bone,'" "lSO 10993-2:2005 Biological evaluation of medical devices: Animal welfare requirements," and "lSO 10993-12 2012 Biological evaluation of medical devices sample preparation rules and standards." Defects were created on the tibia of the right hind leg. The defects were filled with 3-mm bioactive granules, and a cylindrical polypropylene biocompatible material was used as a negative control. After 120 days, the sheep were sacrificed, and the tibia were analyzed. Results The results demonstrated the safety of 45S5 bioactive grafts. Histological evaluation showed no signs of pathological changes around the implant area. Hematoxylin and eosin sections demonstrated the presence of a few multinucleated giant cells, macrophages, and non-irritant mild fibrotic changes on the surface of the biomaterial. Conclusions 45S5 bioactive glass was found to be biocompatible in a sheep model, demonstrating its capacity to promote bone consolidation while also justifying its further preclinical application as a bone-bonded material owing to the layer formation of the growing bone mineral.

Investigation into the effect of epidermal growth factor and hyaluronic acid on fracture healing in a rat femoral fracture model.

OBJECTIVE: This study aimed to investigate the role of an exogenous Epidermal Growth Factor and a hyaluronic acid-based scaffold on fracture healing in a rat femoral fracture model Methods: Forty-eight male Wistar-Albino rats, each weighing a mean 392 grams (range= 350-450 grams) and aged 8.2 months (6-9 months), were used for this experimental study. All surgical procedures were performed on the left femur by a single surgeon. An open femoral fracture was created in all rats. The animals were randomly divided into one of the four groups: Control (12), EGF (12), HA (12) and Combined (12). In the 4th and sixth weeks, samples were processed and analyzed using biomechanical and histological methods. RESULTS: Fracture healing was significantly improved in the Combined group compared to the control one, EGF and HA groups in all parameters at both experimental time points. At the fourth and sixth weeks after surgery, fracture healing in the EGF and HA groups was significantly increased at histological evaluation compared to controls. In addition, compared with EGF, HA and Control groups, a significant difference in callus tissue was detected in the Combined group at 4 and 6-week time points in biomechanical features. CONCLUSION: This study has shown that combining local EGF and HA scaffold accelerates bone healing and strengthens the bony callus histologically and biomechanically. Using EGF-HA combined scaffolds may represent a possible future strategy in trauma surgery. LEVEL OF EVIDENCE: N/A.

Consideration of growth factors and bio-scaffolds for treatment of combined grade II MCL and ACL injury.

The literature suggests that a Grade II medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury will heal naturally and not compromise patient outcome following ACL reconstruction. Evidence based on bone-patella tendon-bone autograft use is stronger than evidence supporting anatomically placed soft tissue graft use. Current ACL reconstruction practices make greater use of soft tissue grafts, differing fixation methods, and anatomically lower placement on the inner wall of the lateral femoral condyle. Anatomical graft placement aligns the femoral bone tunnel more directly with valgus knee loading forces. Differences in the soft tissue graft-bone tunnel integration and ligamentization timetable following ACL reconstruction also increase concerns regarding residual Grade II MCL laxity and functional deficiency during accelerated functional rehabilitation. MCL dysfunction may increase susceptibility to early ACL graft slippage, elongation, outright failure, and medial femoral condyle lift-off with valgus knee loading. This concept paper discusses the potential role of growth factors and bio-scaffolds for improving Grade II MCL injury healing and mechanical integrity when the injury occurs in combination with an ACL injury that is reconstructed with a soft tissue graft and an anatomical surgical approach.

Development of femoral trochlear groove in growing rabbit after patellar instability.

PURPOSE: The geometry of an articular surface is an important determinant of joint function. Although the geometry of the trochlear groove is considered to be important in the pathogenesis of patellofemoral joint disorders, the effects of the patella during the development of the femoral trochlear groove are unclear. This animal study aimed to investigate the relationship between the position of the patella and development of femoral trochlear groove in growing rabbits. METHODS: Twenty-four knees of 12 rabbits were included in this study and were divided into two groups. First group consisted of the left knees and was used as the control group to which no surgical procedures were applied. Second group involved the right knees to which medial soft tissue restraints release was applied before 1 month of age. Computed tomographic (CT) evaluation of both knees of each rabbit was made in their first month of age before medial retinacular release and also during post-op 1-year follow-up. CT measurements included both the angle and depth of the femoral trochlear groove from 3 different parts (proximal, middle and distal) of the distal femur, and then these measurements were averaged. RESULTS: Measurements revealed that while in the control group the groove angle decreased 27.4 degrees and the depth increased 0.11 mm, in the operated counterparts groove angle decreased 16.8 degrees and groove depth increased 0.03 mm, which indicated the flattening of the femoral groove in the operated group. These differences were found to be statistically significant (P < 0.05). CONCLUSION: The results indicated that distal femoral groove with inadequate patellar position becomes more flattened and causes predisposition for patellar instability. Consequently, the clinical relevance of this study was that early reconstruction of the patellofemoral joint should be performed in the childhood to prevent the patellofemoral problems that are likely to be encountered in the following years.