Vaibhav Bagaria

The Effect of Platelet-Rich Plasma and Bone Marrow on Murine Posterolateral Lumbar Spine Arthrodesis with Bone Morphogenetic Protein

BACKGROUND Recombinant human bone morphogenetic protein-2 (rhBMP-2) has had limited success in stimulating osteogenesis at the site of posterolateral lumbar spine arthrodesis when used at the currently approved human dose for anterior lumbar interbody arthrodesis. The objective of the present study was to investigate the effect of co-administration of fresh harvested autologous bone marrow aspirate and platelet-rich plasma on rhBMP-2-mediated in vivo murine posterolateral lumbar spine arthrodesis. METHODS Forty adult male mice underwent posterolateral intertransverse process arthrodesis from L4 to L6. In three experimental groups, a collagen sponge was placed on each side, overlaying the decorticated transverse processes. Each collagen sponge was presoaked for fifteen minutes with 31 microg of rhBMP-2 in a 100-microL solution containing either saline solution (n = 10), platelet-rich plasma (n = 10), or donor bone-marrow cells (n = 10). Control mice underwent decortication alone (n = 10). The lumbar spine was harvested four weeks after surgery, and spinal fusion was evaluated on the basis of radiographs, computed tomography, and histological analysis. RESULTS Control mice showed no evidence of spinal fusion. The rate of fusion was radiographically and histologically similar in all three experimental groups. The area, volume, and density of the fusion mass were significantly greater (p < 0.05) for the group treated with rhBMP-2 and bone marrow as compared with the group treated with rhBMP-2 alone. The group treated with rhBMP-2 and platelet-rich plasma had intermediate fusion area and density. Histologically, the spines treated with rhBMP-2 alone consistently showed the presence of cortical bone between the two transverse processes but fewer trabeculae within the fusion mass; bone marrow co-augmentation resulted in more trabeculae within the fusion mass and a thicker cortical perimeter. CONCLUSIONS The present study quantitatively confirmed a synergistic effect of bone marrow cells when added to rhBMP-2 in an in vivo mouse posterolateral lumbar spine fusion model. The volume, area, and density of the fusion mass were significantly increased by augmentation with bone marrow cells.

Arthroscopic removal of intraarticular fragments following fracture dislocation of the hip.

We report here a case of posterior dislocation of hip with fracture of posterior lip of acetabulum, with retained fracture fragments after a successful closed reduction. The fractured fragments were removed by arthroscopy of the hip. The technique of hip arthroscopy used in removing the fragments is discussed.

Computed tomographic evaluation of femoral component rotation in total knee arthroplasty.

Background: Optimal femoral component rotational alignment in total knee arthroplasty (TKA) is crucial to establish a balanced knee reconstruction. Unbalanced knees can lead to instability, patellofemoral problems, persistent pain, stiffness, and generally poorer outcomes including early failure. Intraoperative techniques to achieve this optimal femoral component rotation include the use of the transepicondylar axis (TEA), the posterior-condylar-cut-parallel-to-the-tibial-cut (PCCPTC) technique and the anteroposterior axis technique (Whitesides line). The purpose of this study was to compare the PCCPTC technique to the TEA technique using computed tomography (CT) scans to assess femoral component rotational alignment. Materials and Methods: This study used postoperative CT scans to compare the degree of femoral component rotation obtained with the use of PCCPTC technique and the TEA. The femoral component rotation of 30 TKA was measured on postoperative CT scans the angle of deviation between the two lines radiographic trans-epicondylar axis (rTEA) and femoral prosthesis posterior condylar line (FPPCL) was determined. This angle represented the rotation of the femoral component relative to the true rTEA. Results: The degree of rotation measured 2.67 ± 1.11 degrees in the PCCPTC group and 5.60 ± 1.64 degrees in the TEA group. Conclusion: The use of the TEA technique for determining rotational alignment in TKR results in excessive external rotation of the femoral component compared to the PCCPTC technique.

Functional outcome in tibial spine fracture treated with arthroscopic pull through suture technique

Introduction: Various fixations techniques are available for fixation of tibial spine avulsion fracture. Arthroscopic assisted fixation can be achieved by screw fixation, pull through sutures, and using suture anchors. We conducted a prospective study to analyze the results of arthroscopic assisted pull through suture technique for treatment of tibial spine avulsion. Materials and Methods: Ten patients with displaced tibial spine avulsion fractures without other associated ligament injuries were included in the study. Ten patients (2 female and 8 male) with a mean age of 29.2 years (19-42 years) underwent arthroscopic assisted fixation with pull through suture technique. The postoperative results were analyzed using clinical tests, radiological evaluation and International Knee Documentation Committee (IKDC), Lysholm score and Tegner activity level. Observations and Results: The mean follow-up period was 21.7 months. We evaluated all patients at 18 months after the surgery. Radiographs showed that all fracture healed anatomically at an average duration of 3 months after surgery. At the final follow-up, all patients reported no symptoms of instability, such as giving – way episodes, clinical signs of anterior cruciate ligament deficiency were negative. The mean Lysholm score was 96.9 (range 91-100), mean IKDC score was 87.9 (range 83-93), and all patients achieved their pre injury Tegner activity levels. One patient had postoperative arthrofibrosis with the loss of terminal extension of 5° which responded to arthroscopic adhesiolysis and physiotherapy. We had no case of infection. Conclusion: Arthroscopic suture pull through a technique for tibial spine fracture is a minimally invasive technique with good functional and radiological results with a lesser risk of arthrofibrosis, infection, and need for hardware removal.

Tibial Spine Avulsion Fractures: Current Concepts and Technical Note on Arthroscopic Techniques Used in Management of These Injuries

Avulsion fractures of tibial spine, leading to discontinuity of anterior cruciate ligament fibers has been well described in literature in both pediatric and adult population. These fractures are also called as tibial eminence fractures or ACL avulsion fractures. They represent a variant of anterior cruciate ligament injury. Poncet in 1895 was probably the first person to document these types of injuries and it was only in 1959 that Meyers and McKeever described an account of surgical management of type II injuries of tibial spine. These injuries are commonly seen in children aged between 8-13 years and are usually sports related injuries occurring especially during cycling and skiing [1-3].In adults these injuries are commonly related to high energy trauma usually road traffic accidents [31] and have high incidence of associated injuries. The cause of increased incidence amongst children is hypothesized as being secondary to relative weakness of incompletely ossified tibial eminence compared to native ACL fibres [4].It has also been proposed that injury occurs secondary to greater elasticity of ligaments in young people [5].