Cecilia Pascual-Garrido

Innovations in Joint Preservation Procedures for the Dysplastic Hip “The Periacetabular Osteotomy”

The Bernese periacetabular osteotomy is an effective treatment for symptomatic developmental dysplasia in the prearthritic young adult hip. Refinements in the periacetabular osteotomy technique and perioperative management have markedly improved the clinical outcomes and recovery in these patients. We will review the clinical presentation of acetabular dysplasia, indications for surgery, perioperative management, and contemporary refinements in technique including refined acetabular reduction, adjunctive hip arthroscopy, femoral head-neck osteochondroplasty, femoral procedures, and rapid recovery protocols. In well-selected patients, this reconstructive osteotomy should be considered safe and effective in alleviating pain and improving hip function in patients with symptomatic acetabular dysplasia.

Current and Novel Injectable Hydrogels to Treat Focal Chondral Lesions: Properties and Applicability†

Focal chondral lesions and early osteoarthritis (OA) are responsible for progressive joint pain and disability in millions of people worldwide, yet there is currently no surgical joint preservation treatment available to fully restore the long term functionality of cartilage. Limitations of current treatments for cartilage defects have prompted the field of cartilage tissue engineering, which seeks to integrate engineering and biological principles to promote the growth of new cartilage to replace damaged tissue. Toward improving cartilage repair, hydrogel design has advanced in recent years to improve their utility. Injectable hydrogels have emerged as a promising scaffold due to their wide range of properties, the ability to encapsulate cells within the material, and their ability to provide cues for cell differentiation. Some of these advances include the development of improved control over in situ gelation (e.g., light), new techniques to process hydrogels (e.g., multi‐layers), and better incorporation of biological signals (e.g., immobilization, controlled release, and tethering). This review summarises the innovative approaches to engineer injectable hydrogels toward cartilage repair.

A Stereolithography-Based 3D Printed Hybrid Scaffold for In Situ Cartilage Defect Repair

Damage to articular cartilage can over time cause degeneration to the tissue surrounding the injury. To address this problem, scaffolds that prevent degeneration and promote neotissue growth are needed. A new hybrid scaffold that combines a stereolithography-based 3D printed support structure with an injectable and photopolymerizable hydrogel for delivering cells to treat focal chondral defects is introduced. In this proof of concept study, the ability to a) infill the support structure with an injectable hydrogel precursor solution, b) incorporate cartilage cells during infilling using a degradable hydrogel that promotes neotissue deposition, and c) minimize damage to the surrounding cartilage when the hybrid scaffold is placed in situ in a focal chondral defect in an osteochondral plug that is cultured under mechanical loading is demonstrated. With the ability to independently control the properties of the structure and the injectable hydrogel, this hybrid scaffold approach holds promise for treating chondral defects.

Trends of hip arthroscopy in the setting of acetabular dysplasia

ABSTRACT Hip arthroscopy is increasingly utilized in the treatment of symptomatic intra-articular hip pathology. Unaddressed development dysplasia of the hip (DDH) is thought to be associated with failure after hip arthroscopy. The aims of this study were (i) to identify the prevalence of previous failed hip arthroscopy in patients undergoing a periactebaular osteotomy (PAO) for the treatment of symptomatic acetabular dysplasia, (ii) report on the temporal trend of failed ipsilateral hip arthroscopy in patients undergoing PAO and (iii) to determine clinical and radiographic characteristics associated with utilization of isolated hip arthroscopy in patients with acetabular dysplasia. We identified 139 patients undergoing PAO who had a history of a prior ipsilateral hip arthroscopy. A comparison group of 1505 patients with a diagnosis of acetabular dysplasia, who underwent PAO alone without any prior ipsilateral surgery during the study period was used. Clinical characteristics, radiographic and intraoperative findings were compared between cohorts. From 2008 to 2015, the rate of previous failed hip arthroscopy in patients undergoing subsequent PAO increased steadily until 2013 with a maximum of 12%. Patients in the study group had mild dysplasia with significantly higher LCEA (17.2° versus 11.3°; Pu2009<u20090.001) and ACEA (15.6° versus 10.8°; Pu2009<u20090.001), a lower acetabular inclination (14.0° versus 19.0°; Pu2009<u20090.001). The findings illustrate a constant increase in the rate of failed hip arthroscopy in the setting of acetabular dysplasia from 2008 till 2013. Female sex and mild dysplasia were associated with use of isolated hip arthroscopy in the setting of acetabular dysplasia.

Acetabular Focal Chondral Lesions Are Not Associated With Worse Outcomes After Periacetabular Osteotomy: A Matched Group Analyses

BACKGROUNDnThe purpose of this study was to assess the outcomes of patients who underwent combined hip arthroscopy and periacetabular osteotomy with acetabular focal chondral defects and compare these outcomes with a group of patients without focal chondral defects.nnnMETHODSnA retrospective review looking at patients who underwent hip arthroscopy and/or periacetabular osteotomy was performed. Minimum 2-year follow-up, Tönnis grade 0-1, and a Beck chondromalacia stages 4-5 were included. Twenty-eight hips met inclusion criteria. These patients were then matched 1:1 and compared.nnnRESULTSnThe average acetabular chondral defect size was 144.3 mm2 ± standard deviation 116.2. Postoperative, modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and University of California Los Angeles scores were similar between groups (Pxa0= .382, Pxa0= .755, Pxa0= .763, respectively). At the last follow-up, Tönnis grade was similar between groups (Pxa0= .552). No association between having a defect and increased risk of failure was noted (hazard ratio 1.35 [95% CI 0.43-4.24], Pxa0= .607).nnnCONCLUSIONnWe found that patients with focal chondral defects did similar to a comparison group of patients without chondral defects.

Does Severity of Acetabular Dysplasia Influence Clinical Outcomes After Periacetabular Osteotomy?—A Case-Control Study

BACKGROUNDnDetailed characterization of factors influencing post-periacetabular osteotomy (PAO) outcome could guide treatment offered.nnnMETHODSnUsing a prospective, multicenter database of PAOs, 61 hips/patients (51 females) with lesser dysplasia (acetabular index < 15° and lateral center-edge angle > 15°) were case-control matched for age, gender, body mass index, Tönnis grade, and joint congruency (Pxa0= .6-.9) with a comparison group of pronounced dysplasia (nxa0= 183), aiming to assess whether severity of acetabular dysplasia has an effect on outcome following PAO and/or the ability to achieve desired acetabular correction.nnnRESULTSnAt 4 ± 1.5 years, no differences in complication or reoperation rates were detected between the groups (Pxa0= .29). Lesser dysplastic hips had inferior Hip Disability and Osteoarthritis Outcome Score, both preoperatively (52 vs 59) and postoperatively (73 vs 78); however, similar improvements were seen. Among the lesser dysplastic hips, those that required a femoral osteochondroplasty at PAO had significantly inferior preoperative Hip Disability and Osteoarthritis Outcome Score (48 ± 18). Increased ability to achieve optimum correction was seen (80% vs 59%, Pxa0= .4) in lesser dysplasia.nnnCONCLUSIONnA PAO is safe and efficacious in the treatment of lesser dysplasia. Further study on the identification of the optimum treatment modality for the mildly dysplastic hips with cam deformity is required.

Proceedings of the signature series symposium “cellular therapies for orthopaedics and musculoskeletal disease proven and unproven therapies—promise, facts and fantasy,” international society for cellular therapies, montreal, canada, may 2, 2018

The Signature Series Symposium Cellular Therapies for Orthopaedics and Musculoskeletal Disease Proven and Unproven Therapies-Promise, Facts and Fantasy was held as a pre-meeting of the 26th International Society for Cellular Therapy (ISCT) annual congress in Montreal, Canada, May 2, 2018. This was the first ISCT program that was entirely dedicated to the advancement of cell-based therapies for musculoskeletal diseases. Cellular therapies in musculoskeletal medicine are a source of great promise and opportunity. They are also the source of public controversy, confusion and misinformation. Patients, clinicians, scientists, industry and government share a commitment to clear communication and responsible development of the field. Therefore, this symposium convened thought leaders from around the world in a forum designed to catalyze communication and collaboration to bring the greatest possible innovation and value to patients with musculoskeletal conditions.

Arthroscopic Management for Acetabular Rim Stress Fracture and Osteochondritis Dissecans in the Athlete With Hip Dysplasia

Intra-articular lesions are common in patients with acetabular hip dysplasia. Rim stress fractures (RSFs) have also been described in patients with acetabular hip dysplasia. This lesion is believed to be a result of an unfused secondary ossification center or a stress fracture that could be caused by repetitive impingement of an abnormal-shaped femoral head-neck junction. In addition, osteochondritis dissecans of the acetabulum is a rare condition that can also result from impingement and has been described in patients with hip dysplasia. Here, we describe an arthroscopic technique for internal fixation of osteochondritis dissecans of the acetabulum and concomitant RSF associated with hip dysplasia in a rhythmic gymnast.