Óscar Mendoza-Lemus

A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study.

Background: The objective of this study was to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis. Methods: The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids. Results: When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study. Conclusion: A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids. Level of Evidence: Level I, therapeutic studies.

Plantar Fasciitis—A Comparison of Treatment with Intralesional Steroids versus Platelet-Rich Plasma

BACKGROUND Many treatment options for plantar fasciitis currently exist, some with great success in pain relief. The objective of our study was to compare the use of intralesional steroids with platelet-rich plasma (PRP), using pain scales and functional evaluation, in patients with plantar fasciitis who did not respond to conservative treatment. METHODS A controlled, randomized, blinded clinical assay was performed. Patients were assigned to one of the two groups by selecting a sealed envelope. The steroid treatment group received 8 mg of dexamethasone plus 2 mL of lidocaine as a local anesthetic. The PRP treatment group received 3 mL of PRP activated with 0.45 mL of 10% calcium gluconate. All of the patients were evaluated at the beginning of the study, and at 2, 4, 8, 12, and 16 weeks post-treatment with the Visual Analog Scale (VAS), Foot and Ankle Disability Index (FADI), and American Orthopedic Foot and Ankle Society (AOFAS) scale. RESULTS The right foot was the most frequently affected foot (63%). The average age of the patients was 44.8 years (range, 24-61 years). All scales used (VAS, FADI and AOFAS) showed that the difference was not statistically significant between the two groups. CONCLUSIONS We can conclude that the use of PRP is an effective treatment method for patients with plantar fasciitis who do not respond to conservative treatment because PRP demonstrates an efficacy equal to that of steroids. However, the cost and the time for preparation the PRP are two of the disadvantages of this treatment.

Anthropometric Landmarks for Posterior Cruciate Ligament Reconstruction in Anatomical Position

El proposito del estudio fue determinar referencias anatomicas viables para la correcta colocacion de los tuneles femorales y tibiales en posicion anatomica durante la reconstruccion del ligamento cruzado posterior (LCP). Se utilizaron 10 rodillas, las cuales fueron disecadas para analizar las mediciones de la insercion femoral y tibial del LCP, sus fasciculos y estructuras adyacentes. Se utilizo el sistema de las manecillas del reloj para la medicion de las inserciones femorales. Los meniscos y el ligamento cruzado anterior (LCA) fueron utilizados como referencias para la medicion de las inserciones tibiales. El LCP y las caracteristicas de sus fasciculos correspondientes fueron determinados por su insercion femoral, porcion central e insercion tibial. La media de la longitud entre la porcion central de la huella dejada por el LCP y el margen anterior del cartilago femoral a las 12:00 h fue de (±3.94) y 17,73 mm (±4,11) para la rodilla derecha e izquierda, respectivamente. La longitudes del LCP fueron de 11,94 mm (±5,08) entre el margen posterior del LCP y el margen anterior del LCP. La media fue de 33,52 mm (±3,49) desde el margen medial del menisco lateral al margen lateral del LCP y de 32,24 mm (±2,28) del margen medial del menisco medial al margen medial del LCP. Desde el punto de vision anteroposterior, el fasciculo anterolateral es mayor que el posteromedial tanto en su insercion femoral como en el punto central e insercion tibial. Se analizo una coleccion cuantitativa de bases de datos con distintas variables del LCP, asi como de sus fasciculos y sus inserciones femorales y tibiales. Se obtuvieron varias medidas, indicando la alta funcionalidad compartida por los fasciculos del LCP. Las inserciones reportadas son referencias practicas para la localizacion de los tuneles tibiales y femorales durante la plastia del ligamento cruzado posterior.

Clinical, biomechanical and morphological assessment of anterior cruciate ligament Kevlar®-based artificial prosthesis in rabbit model

Background The aim of this study was to evaluate the clinical, biomechanical and morphological characteristics of a Kevlar®-based prosthetic ligament as a synthetic graft of the anterior cruciate ligament (ACL) in an experimental animal model in rabbits. Methods A total of 27 knees of rabbits randomly divided into 3 groups (control, ACL excision and ACL replacement with a Kevlar® prosthesis) were analyzed using clinical, biomechanical and morphological tests at 6, 12 and 18 weeks postprocedure. Results The mean displacement in mechanical testing was 0.73 ± 0.06 mm, 1.58 ± 0.19 mm and 0.94 ± 0.20 mm for the control, ACL excision and ACL replacement with synthetic prosthesis groups, respectively. The results showed an improvement in the stability of the knee with the use of the Kevlar® synthetic prosthesis in the biomechanical testing (p<0.05) compared with rabbits that underwent ACL excision, in addition to displacements that were larger but comparable to that in the control group (p>0.05), between the replacement group and the control group. The histological study revealed a good morphological adaptation of the synthetic material to the knee. Conclusions This study proposes a new animal model for the placement and evaluation of Kevlar®-based synthetic ACL implants. The studied prosthesis showed promising behavior in the clinical and biomechanical tests and in the histological analysis. This study lays the foundation for further basic and clinical studies of artificial ACL prostheses using this material.

Electroestimulación interósea en un modelo de elongación con fijación externa

BACKGROUND A fracture repair involves complex cellular processes. However, despite optimal treatment, some fractures heal slowly or do not repair. These complications support the need for innovative therapies. Electromagnetic stimulation is a non-invasive technology that could have a direct impact on many cellular pathways. OBJECTIVE To demonstrate the effectiveness of electro-stimulation by alternating current applied during bone elongation to accelerate the consolidation process for 30 days in an animal model. MATERIALS AND METHODS A device with closed circuit and graduated voltage was designed and kept in contact with the external fixator. Group A was elongated without electro-stimulation and group B was electro-stimulated since the beginning of the distraction. Radiographs were taken at 15 and 30 days post-surgical. Haematoxylin and eosin staining and Massons trichrome stain were performed. RESULTS No significant difference were observed in bone density of group A (4.05±3.24, P=0.163). In group B there was a significant difference (61.06±20.17, P=0.03) in bone density. Group A maintained a fibrous tissue repair, with areas of cartilage and bone matrix. Group B had more organised tissue in the stages of bone repair. CONCLUSION Because there is a significant difference in the growth and callus formation at 15 and 30 days between groups, electro-stimulation could be considered as an adjuvant during bone elongation.