Ps Pastides

Anterior cruciate ligament reconstruction best practice: A review of graft choice

There is much literature about differing grafts used in anterior cruciate ligament (ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear best graft, there are clear differences between the differing graft choices. Surgeons need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements.

Trunnionosis: A pain in the neck

Metal-on-metal (MoM) hip replacements have proven to be a modern day orthopaedic failure. The early enthusiasm and promise of a hard, durable bearing was quickly quashed following the unanticipated wear rates. The release of metal ions into the blood stream has been shown to lead to surrounding soft tissue complications and early failure. The devastating destruction caused has led to a large number of revision procedures and implant extractions. The resulting research into this field has led to a new area of interest; that of the wear at the trunnion of the prosthesis. It had been previously thought that the metal debris was generated solely from the weight bearing articulation, however with the evolution of modularity to aid surgical options, wear at the trunnion is becoming more apparent. The phenomenon of trunnionosis is a rapidly developing area of interest that may contribute to the overall effect of metallosis in MoM replacements but may also lead to the release of metal ions in non MoM hip designs. The aim of this paper is to introduce, explain and summarise the evidence so far in the field of trunnionosis. The evidence for this phenomenon, the type of debris particles generated and a contrast between MoM, non MoM and resurfacing procedures are also presented.

Stem cell therapy for human cartilage defects: A systematic review

OBJECTIVESnThe use of stem cell therapy for the repair of cartilage defects has shown promising results in inxa0vitro and animal studies. However, only a small number of studies have been performed to evaluate the benefits in human subjects. The aim of this study is to systematically review studies that focus on the clinical application of stem cell therapy to treat cartilage defects in human subjects.nnnDESIGNnA literature search was performed, adhering to the PRISMA guidelines, to review any studies using such techniques in humans. Our initial search retrieved 105 articles listed on MEDLINE, EMBASE, Google Scholar, CINHal and SPortDiscus. From these studies, 11 studies meeting the eligibility criteria were selected and formed the basis of our systematic review.nnnRESULTSnThere is limited evidence showing the benefit in humans. The study designs, follow-up methods and criteria reporting and evaluation vary greatly between the studies and are outlined in our systematic review.nnnCONCLUSIONnWith an increasing body of evidence in non-human and inxa0vitro studies, more human trials are required. More high level studies with extensive and robust validated reporting methods should be conducted to evaluate the true effect of such techniques in human cartilage defect repairs.

The Effects of Ageing on Proliferation Potential, Differentiation Potential and Cell Surface Characterisation of Human Mesenchymal Stem Cells

Mesenchymal stem cells (MSCs) have a great capacity for use in regenerative medicine and other clinical applications. However, one question creating curiosity of their use, is how they are affected by ageing. As we now live within an ageing population, the prevalence of age related disorders is increasing, so it is important to investigate how effectively MSCs from older patients can be expanded and differentiated in vitro before their use in autologous cell transplantation. This paper will look at how ageing effects proliferation potential, differentiation potential and cell surface characterisation of human mesenchymal stem cells.

Use of bone marrow derived stem cells in trauma and orthopaedics: A review of current concepts.

There is a considerable amount of interest in the future role of bone marrow-derived stem cells (BMDSCs) and tissue engineering techniques to manage conditions within the musculoskeletal system. Repair of soft tissue and bone defects, in the early stages of injury, may lead to a reduction in progression of symptoms. Furthermore, troublesome soft tissue injuries that are notoriously fraught with problems either in healing or function, could be augmented with such techniques. The aim of this review paper is to look at the advances in such strategies to tackle these problems and assess how BMDSCs, with the aid of growth factors and scaffolds, are being used in vitro, animal and even human models to treat problems within the field of trauma and orthopaedics. There is plenty of evidence that the results are encouraging and thus gaining momentum toward their use in human studies.

An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis.

Total hip arthroplasty (THA) has improved the quality of life of patients with hip arthritis. Orthopedic community is striving for excellence to improve surgical techniques and postoperative care. Despite these efforts, patients continue facing postoperative complications. In particular, patients with rheumatoid arthritis display a higher risk of certain complications such as dislocation, periprosthetic infection, and shorter prosthesis durability. In this review we present the current knowledge of hip arthroplasty in patients with rheumatoid arthritis with more insight into common practices and interventions directed at enhancing recovery of these patients and current shortfalls.

Corrigendum to “An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis”

[This corrects the article DOI: 10.1155/2015/140143.].

The use of the s-quattro dynamic external fixator for the treatment of intra-articular phalangeal fractures: a review of the literature.

Intra-articular phalangeal fractures are a common injury. If left untreated, these injuries can lead to poor functional outcome with severe dehabilitating consequences, especially in younger patients. The S-Quattro external fixator device (Surgicraft®, UK) can be used to treat such injuries. Its use has been widely documented and has shown many advantages in comparison to other conventional treatments. Advantages include reduced operative time, rigid fixation and early range of motion. We present a review of the current literature and use of the S-Quattro serpentine system in the management of intraarticular phalangeal fractures.

Use of ketamine sedation for the management of displaced paediatric forearm fractures

AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fractures of the radius and ulna (moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and post manipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also undertaken. RESULTS During the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate (3), fractures of both radius and ulna (6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthesia, each case performed under ketamine sedation was associated with a saving of £1470, the overall study saving being £14700. CONCLUSION Ketamine procedural sedation in the paediatric population is a safe and cost effective method for the treatment of displaced fractures of the radius and ulna, with high parent satisfaction rates.

Clinical Applications of Stem Cells for Bone Repair

The skeletal system is frequently injured and although most bones heal well, there are many incidences of bony non-unions. These can have significant implications on the patient and on the healthcare service. Current treatment options include osteotomies or bony transport and transplant. Stem cells have been shown to be a viable method of stimulating local bone regeneration, without the associated risks of traditional treatment regimens. They can be used in combination with scaffolds to provide a three-dimensional structure, with growth factors that would allow cell proliferation and differentiation, and gene therapy to modify the gene expression to that of the native tissue. In this chapter, tissue engineering principles are discussed along with the role of mesenchymal stem cells, scaffolds and growth factors.