Objective: The objective is to evaluate the efficacy of using tibial bone marrow delivered to the chondral-bone interface (CBI) via percutaneous chondral bone interface optimization (PeCaBoo) as a therapy for knee osteoarthritis (OA). Study Design: A series of prospective cases were presented. Participants: Our study included 10 patients with medial or lateral compartment knee OA. Methods: With 1 cc of heparin pre-loaded in the syringe, 5 cc of tibial bone marrow was withdrawn from the proximal tibia. The resultant 6 cc of aspirate in the syringe was injected via PeCaBoo, 2 cc at a time, into the superior CBI and inferior CBI. The remaining 2 cc was injected via needle into the intra-articular joint space. Main Outcome Measurements: Patients had MRIs taken pre-procedure and 3 months post-procedure to measure bone edema and intra-articular matrix thickness. Patient-reported outcomes recorded included the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Numeric Paint Rating Scale (NRS), which were both obtained pre-procedure and post-procedure at 3, 6, and 12 months. Use of non-steroidal anti-inflammatories (NSAIDs) was recorded pre-and post-procedure as well. Results: Our study included 4 males and 6 females, with an average age of 63.5 years. The average follow-up time was 14 months, with a range of 13 -15 months. The mean WOMAC score was 58.2 points pre-procedure and 35.3 points post-procedure (p < 0.01). The mean NRS-Pain score was 8.6 points pre-procedure and 2.8 points post-procedure (p < 0.01). The matrix thickness increased by 14% on average at 3 months postprocedure (p < 0.01). The proportion of patients taking NSAIDs decreased by 60% after the PeCaBoo procedure. The subgroup of patients with tibial edema and knee OA had optimal outcomes. Conclusions: Tibial bone marrow stem cell delivered via PeCaBoo is a novel minimally-invasive treatment for knee OA, with potential to repair cartilage and improve knee pain and function. * Corresponding author. V. Vad et al.2
The aim of the study was to evaluate the outcomes of Arthroscopic ACL Reconstruction using Fixed suspensory device and Adjustable suspensory device for femoral side graft fixation. Material and methods: We conducted a prospective study of sixty two patients with ACL deficient knees treated with arthroscopic ACL reconstruction. Consecutively patients were operated with fixed loop and adjustable loop suspensory devices for femoral side graft fixation and no randomization was done. Results: Functional assessment was performed with VAS score, IKDC score and Lyshom score before and after surgery with ACL reconstruction. The postoperative Lyshom score in fixed loop group and adjustable loop group was 94.23 and 94.32 respectively. The IKDC score in fixed group and adjustable group was 92.03 and 92.16 respectively. VAS in fixed loop group improved from score of 5-3, while in adjustable loop group from score of 4-3. There was significant improvement in stability of knee assessed by Lachman's test, anterior drawer test, and Pivot shiff's test and both methods of fixation provide stability to knee. The complications included; restriction of terminal flexion in 12 patients: 6 in each group. There was no implant breakage in both groups. Conclusion: Arthroscopic ACL reconstruction using fixed loop and adjustable loop suspensory devices are equally effective fixation methods.
INTRODUCTIONTibial eminence fracture is a bony avulsion of the anterior cruciate ligament from its insertion on the anteromedial tibial eminence. 1 These injuries are commonly seen in children aged between 8-14 years and are usually sports related, however in adults these injuries are mainly related to high energy trauma usually road traffic accidents and concomitant injury to the menisci, articular cartilage, and collateral ligaments can also be seen. [2][3][4][5][6][7][8] Meyers and McKeever in 1959 described the severity of the displacement of fracture into 3 types, type I fractures have minimal or no displacement of the fragment, type II fractures have anterior one half avulsion of the eminence, but seated posterior part, and type III fractures have displaced fragment.9 Zaricznyj further modified and divided type III fractures into classes A and B, where type IIIA describes the pathology when the fragment with complete separation is displaced minimally, and type IIIB the pathology when the fragment is twisted or fragmented resulting in rotational malalignment. 10 ABSTRACTBackground: Several techniques of arthroscopic treatment of tibial spine avulsion fractures have been described in the literature. We conducted a study to analyze the results of arthroscopic assisted wire loop technique for treatment of tibial spine avulsion in adults and pediatric patients. Methods: From June 2011 to December 2016, 52 patients with tibial spine fractures were surgically treated with arthroscopic reduction and wire loop fixation. Forty-four patients were adults and eight were in their pediatric age group. The age group ranged from 9 years to 52 years with the mean age of 26.2 years. 28 patients were type 2 and 24 were of type 3 fracture as classified by Myeres and Mckeever's classification. The final analysis was done using clinical tests, radiological evaluation and International Knee Documentation Committee (IKDC) and Lysholm score. Results: At final follow-up, the mean IKDC and Lysholm knee scores were, 92 and 93 respectively. All patients had a complete functional recovery and were able to return to work and to resume their activities. Conclusions: Arthroscopic wire loop fixation is an excellent method for tibial eminence fracture in adults and children which gives excellent results in form of control tension on ACL on each side of avulsed fragment and also gives adequate mechanical strength for early rehabilitation.
Background: Carboplasty is a new minimally invasive technique for knee osteoarthritis (OA) that consists of injecting tibial marrow aspirate into the bone-cartilage interface as well as intra-articularly. Purpose: To compare the clinical and imaging outcomes, as well as the safety, of carboplasty for symptomatic knee OA in a placebo-controlled trial. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The authors conducted a randomized controlled trial to compare carboplasty with placebo for the treatment of symptomatic knee OA. Patients who had failed medical treatment and had bone edema on magnetic resonance imaging (MRI) were randomized in a 1:1 ratio to carboplasty or placebo. The primary outcome of the study was the Numeric Pain Rating Scale (NPRS) for the knee at 1 year (scores range from 0 to 10, with a higher score indicating worse pain). Secondary outcomes were the Knee injury and Osteoarthritis Outcome Score (KOOS), treatment responder rate (based on achieving the minimal clinically important difference of the NPRS), MRI bone edema reduction, and treatment safety. Results: In total, 50 patients (25 carboplasty vs 25 placebo) were enrolled and followed up with for an average of 18 months (range, 14-24 months). The average NPRS at baseline decreased from 7.1 ± 0.9 to 2.9 ± 2.1 ( P < .001) at 1 year in the carboplasty group and from 7.7 ± 0.9 to 4.9 ± 2.2 ( P < .001) in the placebo group. On average, patients after carboplasty improved 60% from their initial NPRS, and patients after placebo improved 37% ( P = .003). Patients had a statistically significantly greater improvement from baseline in all KOOS subscales in the carboplasty group compared with the placebo group ( P < .001). The responder rates were 96% for carboplasty and 76% for placebo ( P = .098). Bone edema was reduced in 72% of patients in the carboplasty group and 44% of patients in the placebo group ( P = .045). Neither group had adverse events related to treatment. Conclusion: Carboplasty resulted in greater pain reduction, a significantly greater improvement in all KOOS subscales, and a similar safety profile compared with placebo in patients with symptomatic knee OA and bone edema. Registration: ISRCTN69838191 (ISRCT Registry).
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