Alberto Combi

Platelet-rich plasma in the treatment of acute hamstring injuries in professional football players

PURPOSE muscle injuries have a high incidence in professional football and are responsible for the largest number of days lost from competition. Several in vitro studies have confirmed the positive role of platelet-rich plasma (PRP) in accelerating recovery and in promoting muscle regeneration, and not fibrosis, in the healing process. This study examines the results of intralesional administration of PRP in the treatment of primary hamstring injuries sustained by players belonging to a major league football club. METHODS twenty-five hamstring injuries (grade 2 according to MRI classification) sustained by professional football players during a 31-months observation period were treated with PRP and analyzed. Sport participation absence (SPA), in days, was considered to correspond to the healing time, and we also considered the re-injury rate, and tissue healing on MRI. The mean follow-up was 36.6 months (range 22-42). RESULTS there were no adverse events. The mean SPA for the treated muscle injuries was 36.76±19.02 days. The re-injury rate was 12%. Tissue healing, evaluated on MRI, was characterized by the presence of excellent repair tissue and a small scar. CONCLUSIONS this study confirmed the safety of PRP in treating hamstring lesions in a large series of professional football players. PRP-treated lesions did not heal more quickly than untreated lesions described in the literature, but they showed a smaller scar and excellent repair tissue. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Total knee replacement in acute and chronic traumatic events.

Total knee replacement (TKR) is a widely used procedure for the treatment of post-traumatic arthritis. This type of solution has also been used recently for the treatment of acute fractures around the knee, particularly in joints that were already arthritic before the trauma. The purpose of this paper is to present our experience with TKR in both acute and chronic traumatic events, highlighting the main problems associated with these conditions and focussing on the indications, principles of technique, tips, tricks and pitfalls of this procedure. The main issues related to post-traumatic arthritis and the problem of TKR in acute fractures are discussed, and our case series of both groups of patients is presented.

MODULUS Stem for Developmental Hip Dysplasia: Long-term Follow-up

Between October 2001 and December 2010, 143 patients with developmental dysplasia underwent hip arthroplasty surgery using a conical stem with modular necks (MODULUS system, Lima Corporate, Villanova di San Daniele del Friuli, Italy). Thirty (21.0%) patients had both hips replaced, for a total of 173 implants. The mean age at the time of surgery was 55 years (range: 22-81 years). The mean follow-up was 87 months (range: 36-146 months); average Harris Hip Score increased from 42 (range: 23-65) preoperatively to 92 (range: 76-100) at the last follow-up. Stem revision was required in two cases. The MODULUS stem showed good long-term clinical and radiographic results, with a Kaplan-Meier survivorship of 97.6% (95% CI: 94.8-100.0%) at 8 years.

Knee replacement in chronic post-traumatic cases

Post-traumatic knee arthritis is a challenging condition. Prosthetic surgery is demanding and the risk of complications is relatively high. Planning is an essential element of this surgery; correct diagnosis (to exclude latent infection) and adequate considerations regarding approach, axis, bone loss, choice of implant and level of constraint are indispensable. There are two main categories of post-traumatic arthritis: extra-articular deformities and articular deformities. Use of an algorithms can support the surgeon’s choice of implant. Correct implant positioning and limb alignment restoration is associated with very good results, similar to those achieved with standard total knee arthroplasty. Cite this article: Benazzo F, Rossi SMP, Combi A, Meena S, Ghiara M. Knee replacement in chronic post-traumatic cases. EFORT Open Rev 2016:1:211-218. DOI: 10.1302/2058-5241.1.000025.

Protesi di ginocchio in acuto

Total knee arthroplasty is a reliable solution not only for the primary arthritic knee but also for severe knee fractures, either affected by osteoarthritis or not, or in case of severe bone loss in young patients. In this paper we present our experience and we suggest different technical solutions related to different segmental bones involved.

Ceramic-Ceramic Bearing in Difficult Hips (Primary and Revision)

The primary goal of total hip arthroplasty (THA) is to provide the patient with end-stage arthritis of the hip with a long-lasting, pain-free, functional hip joint.

Il ruolo del PRP nel trattamento delle lesioni muscolari in atleti di alto livello

Le lesioni dell’apparato muscolo-scheletrico rappresentano una causa importante di assenza dalle competizioni negli gli atleti professionisti. In particolare le lesioni muscolari presentano un’incidenza variabile dal 10 al 55% di tutti i traumi e si rendono complessivamente responsabili della maggior parte dei giorni di assenza dall’attivita sportiva negli atleti professionisti. In ambito muscolare il PRP ha dato buoni risultati in studi in vitro e in modelli animali, mentre nell’uomo si e di fronte ad una carenza di dati a causa delle restrizioni WADA che ne hanno proibito l’utilizzo fino all’anno 2010. Lo scopo del nostro studio e stato quello di valutare l’efficacia del PRP nel trattamento delle lesioni muscolari in atleti di alto livello. Abbiamo trattato 21 pazienti per un totale di 38 lesioni, di cui 35 di II grado e 3 di III grado. Le iniezioni sono state effettuate a distanza di 7-10 giorni l’una dall’altra, monitorando il processo di guarigione tramite Risonanze Magnetiche effettuate prima dell’applicazione, a 14 e 21 giorni dalla prima iniezione. Abbiamo ottenuto un tempo medio di guarigione di 26.74 giorni per le lesioni di II grado e di 36 giorni per le lesioni di III grado; rigenerazione tessutale, diminuzione del dolore dopo la prima applicazione e assenza di cicatrice fibrotica in tutti i casi; recidiva in un caso e seconda lesione nello stesso muscolo ma in sede diversa in 5 casi. Il vantaggio non e stato solamente in termini di tempo di guarigione delle lesione ma anche in termini di qualita del tessuto rigenerato. Il PRP rappresenta quindi una possibile opzione terapeutica per stimolare ed accelerare la guarigione e la rigenerazione del tessuto muscolare. Vista anche la carenza di dati in letteratura, a nostro avviso il suo uso merebbe ulteriori indagini tramite studi multicentrici che potranno fornire maggiori informazioni circa le sue potenzialita.

Cellule staminali mesenchimali da tessuto adiposo per la medicina rigenerativa in campo ortopedico

Il tessuto adiposo costituisce una importante fonte di cellule staminali mesenchimali (ASC), cellule in grado di differenziare in molteplici linee cellulari. Esse sono contenute nella frazione stromale vascolare del tessuto adiposo con il vantaggio di un prelievo meno invasivo e quindi associato a minore morbilita rispetto alle cellule mesenchimali ottenute da midollo osseo. Lo scopo di questo studio e l’isolamento, la caratterizzazione e la differenziazione in senso osteogenico delle cellule staminali mesenchimali ottenute da tessuto adiposo. Dopo aver analizzato i marker di superficie e la vitalita cellulare, e stata studiata la differenziazione delle cellule staminali ottenute e seminate sia su monolayer che su 2 tipi di scaffold, in titanio trabecolare e in materiale biomimetico. Dai dati ottenuti e stato possibile osservare che le ASC su monolayer sono in grado di differenziarsi in senso osteoblastico: producono una matrice extracellulare mineralizzata, esprimono i geni per le proteine dell’osso e sintetizzano fosfatasi alcalina (ALP), collagene di tipo I, Runx2 e osteocalcina. Inoltre le ASC da noi utilizzate sono in grado di aderire, proliferare e differenziare su entrambi i tipi di scaffold, dimo-strando cosi di essere fonte ideale di cellule da poter utilizzare nell’ambito dell’ingegneria tissutale per ripristinare l’anatomia e la funzione del tessuto perso in seguito a malattia, malformazione o traumi.