Arturo Almazán

effect of Angiogenesis-Related cytokines on Rotator cuff Disease: The search for sensitive Biomarkers of early Tendon Degeneration

Background Hallmarks of the pathogenesis of rotator cuff disease (RCD) include an abnormal immune response, angiogenesis, and altered variables of vascularity. Degenerative changes enhance production of pro-inflammatory, anti-inflammatory, and vascular angiogenesis-related cytokines (ARC) that play a pivotal role in the immune response to arthroscopic surgery and participate in the pathogenesis of RCD. The purpose of this study was to evaluate the ARC profile, ie, interleukin (IL): IL-1β, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and angiogenin (ANG), in human peripheral blood serum and correlate this with early degenerative changes in patients with RCD. Methods Blood specimens were obtained from 200 patients with RCD and 200 patients seen in the orthopedic clinic for nonrotator cuff disorders. Angiogenesis imaging assays was performed using power Doppler ultrasound to evaluate variables of vascularity in the rotator cuff tendons. Expression of ARC was measured by commercial Bio-Plex Precision Pro Human Cytokine Assays. Results Baseline concentrations of IL-1β, IL-8, and VEGF was significantly higher in RCD patients than in controls. Significantly higher serum VEGF levels were found in 85% of patients with RCD, and correlated with advanced stage of disease (r = 0.75; P < 0.0005), average microvascular density (r = 0.68, P < 0.005), and visual analog score (r = 0.75, P < 0.0002) in RCD patients. ANG and IL-10 levels were significantly lower in RCD patients versus controls. IL-1β and ANG levels were significantly correlated with degenerative tendon grade in RCD patients. No difference in IL-6 and bFGF levels was observed between RCD patients and controls. Patients with degenerative changes had markedly lower ANG levels compared with controls. Power Doppler ultrasound showed high blood vessel density in patients with tendon rupture. Conclusion The pathogenesis of RCD is associated with an imbalance between pro-inflammatory, anti-inflammatory, and vascular ARC.

Tratamiento artroscópico de la osteoartritis: rodilla y hombro

We discuss the role of arthroscopy in the treatment of knee and shoulder osteoarthritis. The most widely used arthroscopic techniques used in these joints for the treatment of osteoarthritis are arthroscopic lavage, arthroscopic debridement, abrasion arthrosplasty and microfractures. Even though arthroscopic techniques are only useful for a specific group of patients and that the procedure does not modify diseases natural history, it is an accessible therapeutic option.Se discuten las posibles aplicaciones de la cirugia artroscopica para el tratamiento de la osteoartritis de rodilla y hombro. Las tecnicas artroscopicas mas utilizadas para ambas articulaciones son el lavado articular, la limpieza articular, la artroplastia por abrasion y las microfracturas. A pesar de que la artroscopia solo es util en determinados pacientes y no actua como un verdadero modificador de la enfermedad, esta ofrece una opcion terapeutica asequible.

Meniscal repair using the inside-out technique with cross stitch.

The treatment of meniscal tears continues to evolve. A few years ago most tears were treated with total meniscectomy, which evolved to partial meniscectomy and then to meniscal repair. The purpose is to preserve as much of the menisci as possible, to maintain their potential biomechanical properties, and to preserve normal knee function. Different repair techniques have been used many of them involving both vertical and horizontal sutures. We are proposing an inside-out meniscal repair technique with cross-shaped stitches that provides a 4-point fixation construct.

The Effect of Angiogenesis-related Cytokine Profiles on Rotator Cuff Disease: Discovery of New Biomarkers of Early Tendon Degeneration (SS-19)

Introduction Approximately 16% of the general population is believed to have rotator cuff disease (RCD) at a given time. The hallmarks of RCD are pro- or anti-inflammation, abnormal immune response, angiogenesis, and variables of vascularity. The relationship between angiogenesis and early degenerative changes in RCD is attracting increasing attention in orthopaedics today. Avascular zones of tendons are predisposed for degenerative changes and spontaneous rupture in RCD. Degenerative changes enhance production of pro- or anti-inflammatory and vascular angiogenesis-related cytokines (ARC) that play a pivotal role in the immune response to arthroscopic surgery and take part in the pathogenesis of RCD. Abnormalities in ARC network of importance for the clinical signs and symptoms will be focused on. To evaluate the diagnostic performance of serological tests for early degenerative changes in RCD patients: the alterations in endogenous ARC expression (IL-1beta, IL-6, IL-8, IL-10, VEGF, bFGF, ANG) in the blood. Methods The blood specimens were obtained from 200 patients with RCD from Department of Sports Medicine and Arthroscopy. Patients were followed with clinical measures (UCLA, Constant, and WORC). The comparative group consisted of 200 patients seen in the orthopedic clinic for non-tendon related shoulder complaints. The control group consisted of 200 age- and sex-matched healthy controls. Angiogenesis imaging assays was performed using PDUS for evaluation the variables of vascularity of the rotator cuff tendons. Expression ARC were measured by commercial Immunoassay kits Bio-Plex Human Cytokine Assay (Bio-Rad Inc., Hercules, CA, USA) per the manufacturer′s instructions, International Standards of the National Institute for Biological Standards and Control and recommendations of the Expert Committee on Biological Standardization of the WHO for of cytokine measurements. Affinity chromatography yielded ARC (revealed upon Ion-exchange Chromatography on QAE Sephadex) from both control and RCD patients. Results At time of inclusion the concentration of IL-1beta, IL-8, and VEGF was significantly higher in RCD patients than in control. Significantly higher serum VEGF levels were found in 85% RCD patients. VEGF overexpression correlated with advanced stage (r=0.75; p Conclusion This investigation provides the first standardized analytic approach for assessing differences in serum ARC levels of RCD. Our data demonstrated that uncontrolled pathogenesis of RCD is associated with an imbalance between inflammatory, anti-inflammatory and vascular ARC. In RCD patients was a positive correlation between ARC expression and tendon degeneration. The future of ARC in RCD application requires close interactions between the public and private sectors: the government, the pharmaceutical, biotechnology industries, and academia.

Arthroscopic Transarticular Distal Clavicle Resection

Bursal and superior direct arthroscopic distal clavicle resection techniques exist. An indirect transarticular distal clavicle resection (TADCR) technique, in which the bone resection is performed directly through the acromioclavicular joint (ACJ), is presented. With the arthroscope in the lateral portal and viewing at the ACJ, the TADCR begins by inserting a needle into the ACJ to determine the angle of entrance (a 5-mm skin incision directly over the mid portion of the ACJ is made). Then, with a No. 11 blade, a 4- to 5-mm incision, which is just large enough to ensure the pass of the motorized instruments, is made in the mid portion of the superior acromioclavicular ligament (SACL) parallel to its fibers. A radio frequency probe is inserted, and the ACJs soft tissues are excised, taking care not to damage the SACL. Then, the saver is introduced to clean up the soft tissues debris. Finally, a 4.0-mm oval burr is inserted and, with a fan-shaped motion, bone is resected from clavicle and acromion without damaging the superior ligament. The TADCR is an easy technique that produces consistent bone resection, sparing the SACL.