Stefano Campi

Effect of pulsed electromagnetic fields on human tenocyte cultures from supraspinatus and quadriceps tendons

Objective:To investigate the effects of pulsed electromagnetic fields (PEMFs) on human tenocyte cultures and to assess whether PEMFs could represent a viable therapeutic option in tendon pathologies. Design:Controlled laboratory study in which primary human tenocytes were isolated from healthy supraspinatus and quadriceps tendons and were exposed to the electromagnetic field stimulation. Cell growth and cell cycle were evaluated after 72 hrs, 5 days, and 7 days of continuous PEMF exposure. In quiescent confluent tenocyte culture, an in vitro cut was mechanically produced, and the width of the cell-free zone was measured 12, 24, and 36 hrs after the injury in the presence of PEMF stimulation. Total collagen accumulation was also evaluated after 5, 7, and 14 days of PEMF exposure. Results:Tenocyte growth analysis, cell cycle analysis, and total collagen accumulation did not show statistically significant differences between exposed and control groups. Exposure to PEMF significantly accelerated cut closure 12 and 24 hrs after the injury. Conclusions:PEMFs comparable with the ones used for the management of pseudoarthrosis stimulate closure of an in vitro laceration of a tenocyte monolayer. Our results provide the preliminary in vitro work and the basis to support the study of the in vivo effects of PEMFs on tendinopathies.

Biological Strategies to Enhance Healing of the Avascular Area of the Meniscus

Meniscal injuries in the vascularized peripheral part of the meniscus have a better healing potential than tears in the central avascular zone because meniscal healing principally depends on its vascular supply. Several biological strategies have been proposed to enhance healing of the avascular area of the meniscus: abrasion therapy, fibrin clot, organ culture, cell therapy, and applications of growth factors. However, data are too heterogeneous to achieve definitive conclusions on the use of these techniques for routine management of meniscal lesions. Although most preclinical and clinical studies are very promising, they are still at an experimental stage. More prospective randomised controlled trials are needed to compare the different techniques for clinical results, applicability, and cost-effectiveness.

VEGF, BMP-7, Matrigel(TM), hyaluronic acid, in vitro cultured chondrocytes and trephination for healing of the avascular portion of the meniscus. An experimental study in sheep.

OBJECTIVE To evaluate the effects of VEGF, BMP-7, Matrigel(TM), hyaluronic acid, in vitro cultured chondrocytes and trephination to promote and enhance the healing process of avascular meniscal tears in an animal model. METHODS A longitudinal tear was produced in the inner avascular part of the meniscus of 24 sheeps. Each tear was treated with trephination technique and suture. The animals were divided into 6 groups to receive a different treatment: control (I); VEGF, BMP-7, Matrigel(TM), hyaluronic acid, in vitro cultured chondrocytes. At 8 weeks from surgery, meniscal samples were explanted and analyzed by histology, immunohistochemistry, and histomorphometry. RESULTS At the histological examination, Group IV and VI showed a partial closure of the meniscal lesion, whereas Group I, II, III, and V did not show any evidence of healing. In the group IV, the healed tissue represented the 22.95% of the lesion area. In the group VI, the healed tissue represented the 43.75% of the lesion area. CONCLUSIONS Autologous chondrocytes and BMP-7 associated with trephination and suture techniques enhanced healing process of meniscal tears in the avascular inner third of the meniscus in ovine model.

The architecture of the ipsilateral quadriceps two years after successful anterior cruciate ligament reconstruction with bone–patellar tendon–bone autograft

BACKGROUND We undertook a cross-sectional study to evaluate the pennation angle and muscle thickness of the vastus lateralis muscle in patients undergoing unilateral anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone autograft, and compared these values with the contralateral non-operated limb. METHODS Twenty three consecutive athletic males who underwent ACL reconstruction using the central third of the patellar ligament were evaluated at 25.9±1.5 months. The International Knee Documentation Committee (IKDC) score was administered, and angles of pennation and muscle thickness were measured by ultrasonography. RESULTS There was no significant difference in the pennation angle of the operated leg comparing to the contralateral leg (12.5°±1.81° in the operated leg; 13.25°±2.40° after the test; p=0.117). Quadriceps thickness in the operated leg was significantly decreased in all subjects compared to the contralateral leg (28.4±5.3mm in the operated leg; 32.7±4.85 mm in the contralateral leg; p=0.007). CONCLUSIONS Two years after surgery, there is no difference in pennation angle of the vastus lateralis when compared to the contralateral side in patients undergoing unilateral ACL reconstruction with bone-patellar tendon-bone autograft. There is a significant difference in quadriceps muscle thickness, which was less in the operated side on the operated side in all patients. Further studies are required to study the influence of muscle architecture on clinical outcome after ACL reconstruction surgery, and whether there are differences associated with the use of different grafts. LEVEL OF EVIDENCE Case-control study; level IV.

Unicompartmental knee replacement – Current perspectives

Unicompartmental knee replacement (UKR) is an effective treatment for end-stage, symptomatic unicompartmental osteoarthritis of the knee. However, certain aspects of the procedure are still debated. These areas of discussion include patient selection criteria, implant design and the discrepancy in survival rates between national registries and independent case series. These may contribute in limiting the more widespread acceptance of unicompartmental knee replacement. The aim of this paper is to review the up-to-date evidence on UKR and discuss the most relevant controversies regarding this procedure.

Injuries of the Lateral Collateral Ligament and Posterolateral Corner of the Knee

The lateral collateral ligament (LCL) is a crucial part of the posterolateral corner. Therefore, it can be treated exclusively in the context of the musculoligamentous complex to which it belongs.