Intra-articular

Introduction: Treatment of chondral injuries remains a major issue despite the many advances made in cartilage
repair techniques. Although it has been postulated that the use of marrow stimulation in combination with
cell-based therapy may provide superior outcome, this has yet to be demonstrated. A pilot study was thus
conducted to determine if bone marrow derived mesenchymal stromal cells (BM-MSCs) have modulatory effects on
the repair outcomes of bone marrow stimulation (BMS) techniques.
Methods: Two full-thickness chondral 5 mm diameter defects were created in tandem on the medial condyle of
left stifle joints of 18 Boer caprine (N = 18). Goats were then divided equally into three groups. Simultaneously,
bone marrow aspirates were taken from the iliac crests from the goats in Group 1 and were sent for BM-MSC
isolation and expansion in vitro. Six weeks later, BMS surgery, which involves subchondral drilling at the defect sites,
was performed. After two weeks, the knees in Group 1 were given autologous intra-articular BM-MSCs (N = 6).
In Group 2, although BMS was performed there were no supplementations provided. In Group 3, no intervention
was administered. The caprines were sacrificed after six months. Repairs were evaluated using macroscopic
assessment through the International Cartilage Repair Society (ICRS) scoring, histologic grading by O’Driscoll score,
biochemical assays for glycosaminoglycans (GAGs) and gene expressions for aggrecan, collagen II and Sox9.
Results: Histological and immunohistochemical analyses demonstrated hyaline-like cartilage regeneration in the
transplanted sites particularly in Group 1. In contrast, tissues in Groups 2 and 3 demonstrated mainly fibrocartilage.
The highest ICRS and O’Driscoll scorings was also observed in Group 1, while the lowest score was seen in Group 3.
Similarly, the total GAG/total protein as well as chondrogenic gene levels were expressed in the same order, that
is highest in Group 1 while the lowest in Group three. Significant differences between these 3 groups were
observed (P <0.05).
Conclusions: This study suggests that supplementing intra-articular injections of BM-MSCs following BMS knee
surgery provides superior cartilage repair outcomes.

Background: Distal femur fractures account for less than 1% of all fractures and 4%-6% of all femur fractures. Soft tissue damage, comminution and articular extension makes the treatment difficult and they often result in unsatisfactory outcome and poor knee function. Open fractures further complicate the situation. In our study we compared functional outcome, time of union and complications of open complex distal femoral fractures treated with delayed plating or primary Ilizarov ring fixator. Material and Methods: we retrospectively reviewed 23 cases presented at department of Orthopedics, from January 2011 to January 2017. All skeletally mature patients with AO type C distal femur fractures and up to Gustilo Anderson grade IIIA were included. Pathological fractures, types IIIB and IIIC open fractures and patients with other fractures in the ipsilateral limb were excluded from the study. Patients in group A were treated with delayed plating and in group B with primary Ilizarov. Result: Out of the 23 cases, all cases in both groups showed radiological union between 16-22 weeks. 3 cases of group A showed shortening of >2 cm while Ilizarov group had none. In 5 cases of group A, primary bone grafting done during surgery having severe comminution (C3 type) and in one case secondary bone grafting done after 5 months for delayed union. Out of 12 cases of group A, 5 patients (42%) achieved full flexion. In group B limited knee flexion was seen in all cases with mean flexion at final follow-up of 92°. Conclusion: Delayed fixation with autologous fibular grafting and distal femoral locking plate provides adequate restoration of knee motion and early knee mobilization with high risk of infection. Whereas Ilizarov fixator shows better outcome in terms of infection control, LLD management, lesser number of surgeries, lesser hospital stay, earlier post-op rehabilitation and acceptable knee function.

Conclusion: Intra-articular injection of US-approved viscosupplements is safe and efficacious through 26 weeks in patients with symptomatic knee OA.

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The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue, Springer, Berlin, 1992) and Sheffield (Classification AO des fractures, Springer, Berlin, 1987) circular fixator systems. All tibial plafond fractures healed. Using radiological criteria for assessment of reduction of the articular fragments and the clinical scoring system described by Teeny and Wiss, there were excellent and good restoration of articular structure in 27 cases and good clinical results in 14. This treatment method compares well with previous published series and is to be recommended for this group of difficult fract...

Intra-articular glenohumeral injections are an important part of orthopedic practices for both therapeutic and diagnostic purposes. Forty human cadaver shoulders were injected, 20 anteriorly and 20 posteriorly, to assess the accuracy of injections placed in the glenohumeral joint. After the needle was placed, 1 cc of gadolinium was injected into the joint to determine accuracy of position. The radiographic presence of intra-articular contrast was judged as an accurate injection. The anterior approach had an 80% accuracy rate and .75 positive predictive value. The posterior approach had a 50% accuracy rate and a .67 positive predictive value. Anterior injections produce a higher rate of accuracy than posterior injections.

Objective: To assess the results of patients treated for recurrent anterior shoulder dislocation with glenoid bone deficiency by using the Latarjet procedure. Methods: This is a retrospective study done in the period between April 2014 till February 2016 at the Jordanian Royal Medical Services (JRMS). Thirty patients with recurrent traumatic anterior shoulder dislocation who underwent surgical treatment with modified Latarjet technique were included in the study. Patients were questioned about satisfaction, range of motion and its effect on daily life and were examined for stability and range of motion and complications if present. Result: 21 patients 96.6% were satisfied of the surgery with no experience of redislocation. One patient 3.3% was not satisfied because of axillary nerve injury. Four patients 13.3% had a limitation of external rotation ranging from 5-15 degree. All patients returned to their level of activity at three months except the one with nerve injury fortunately he was improving. Conclusion: The Modified Latarjet procedure is an effective technique for the treatment of recurrent anterior shoulder dislocation particularly associated glenoid bone loss.

Despite being a complex degenerative joint disease, studies on osteoarthritis (OA) suggest that its progression can be reduced by the use of hyaluronic acid (HA) or mesenchymal stem cells (MSC). The present study thus aims to examine the effects of MSC, HA and the combination of HA-MSC in treating OA in rat model. The histological observations using O’Driscoll score indicate that it is the use of HA and MSC independently and not their combination that delays the progression of OA. In conclusion, the preliminary study suggest that the use of either HA or MSCs effectively reduces OA progression better than their combined use.