Restoration and repair of articular cartilage injuries remain a challenge for orthopaedic surgeons. The standard first-line treatment of articular cartilage lesions is marrow stimulation; however, this procedure can often result in the generation of fibrous repair cartilage rather than the biomechanically superior hyaline cartilage. Marrow stimulation is also often limited to smaller lesions, less than 2 cm
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. Larger lesions may require implantation of a fresh osteochondal allograft, though a short shelf life, size-matched donor requirements, potential challenges of bone healing, limited availability, and the relatively high price limit the wide use of this therapeutic approach. We present a straightforward, single-stage surgical technique of a novel reparative and restorative approach for articular cartilage repair with the implantation of a cryopreserved viable osteochondral allograft (CVOCA). The CVOCA contains full-thickness articular cartilage and a thin layer of subchondral bone, and maintains the intact native cartilage architecture with viable chondrocytes, growth factors, and extracellular matrix proteins to promote articular cartilage repair. We report the results of a retrospective case series of three patients who presented with articular cartilage lesions more than 2 cm
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and were treated with the CVOCA using the presented surgical technique. Patients were followed up to 2 years after implantation of the CVOCA and all three patients had satisfactory outcomes without adverse events. Controlled randomized studies are suggested for evaluation of CVOCA efficacy, safety, and long-term outcomes.
Shape-memory polymers (SMPs) and their medical devices offer improved performance for soft-tissue fixation because of their ability to expand in vivo. Here, we describe the basics of the SMP cycle and the fundamental biomechanics of SMP soft-tissue fixation devices, in particular their effect on graft relaxation after device insertion. A surgical technique for posterior lateral corner reconstruction of the knee is presented that uses several SMP devices to simplify the procedure.
This paper describes a creative, organic approach to business development using a range of techniques to intensify and speed up the idea generation and screening process. It views business development as a cyclical activity which coincides with the annual budget round. All travel agencies are concerned with three business development aims - client retention, persuading clients to buy more at each transaction and to buy more frequently, and to attract new clients. There is no shortage of ideas in the travel trade on how these aims might be met. The large numbers of ideas puts a premium on how to make choices. The paper suggests ways of generating and quickly processing a large number of ideas and roughly matching these to a firm's requirements.
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