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Resurfacing versus nonresurfacing the patella in total knee arthroplasty: a critical appraisal of the available evidence
No full text
Resurfacing Versus Non-resurfacing the Patella in Total Knee Arthroplasty: An Appraisal of Available Evidences
No full textThe decision whether to resurface or not
the patella in total knee arthroplasty (TKA) is highly
controversial and surgeons show a wide variety of attitudes
in Europe and in the USA. Surgeons favouring
patellar resurfacing advocate that post-operative knee
pain following TKA is significantly diminished, which
would improve patient-based outcome. On the other
hand, patellar replacement carries a number of potential
complications which may outweigh the benefit of reduced
anterior knee pain. A systematic search of available
evidences comparing the outcome of unresurfaced
versus resurfaced patellae in TKA was therefore conducted.
The purpose of the present paper is providing
orthopaedic surgeons with an updated appraisal of relevant
evidences that may assist them in their decisionmaking
process.
Material and Method: A bibliographic search was
conducted through the most representative databases. We searched for meta-analyses (MA), systematic reviews
(SR) and randomized controlled trials (RCT) comparing
outcome between resurfaced and unresurfaced patellae in
TKA. The following databases were used: Cochrane
Muskuloskeletal Injuries Group Specialized Register, the
Cochrane Register of Controlled Trials, Health Technology
Assessment (HTA), PEDro, Medline, EMBASE,
CINAHL, AMED, DARE, TRIP, The National Research
Register (UK). The search was ended on February 2008.
The search term selected from The National Library of
Medicine’s medical subject heading (MESH) database
were: patella; resurfacing; total knee arthroplasty; TKA;
total knee replacement; TKR. Additionally, the rate of reduced
post-operative anterior knee pain in patients undergoing
patellar resurfacing was compared with the current
rate of complications associated with patellar replacement.
Results: Five MAs, 1 SR and 6 RCTs not included in the
published evidence syntheses were retrieved. All evidence
syntheses would warrant patellar resurfacing in order to
reduce anterior knee pain and the related risk of re-operation.
Conversely, 4 RCTs failed to detect significant differences
using accepted clinical scores at mid- and long-term
follow-up while 2 RCTs did not report significant variations
of the biomechanical performance in vivo between replaced
and un-replaced patellae.
Conclusion: Current evidences would support the decision
to resurface the patella when anterior knee pain and
the related risk of re-operation are used as end-points of
outcome at mid-term follow-up. However, no clinical
differences would be detectable between resurfaced and
unresurfaced patellae at long-term follow-up. In addition,
both patella-replaced and patella-unreplaced TKA
exhibit similar biomechanical behaviour in vivo. The rate
of anterior knee pain improvement in patients undergoing
patellar replacement should be contrasted with the
rate of potential complications related to patellar resurfacing
Possible involvement of nitric oxide in morphine-induced miosis and reduction of intraocular pressure in rabbits.
No full textThe role of μ3 opioid receptors in morphine-induced intraocular pressure (IOP) lowering effect and miosis was evaluated in conscious, dark-adapted New Zealand white (NZW) rabbits using a masked-design study. IOP and pupil diameter (PD) measurements were taken at just before and 0.5, 1, 2, 4, 6 h after monolateral instillation of morphine (10, 50 and 100 μg/30 μl) as compared to vehicle administered in the contralateral eye. Morphine-induced ocular effects were challenged by a pre-treatment with the non-selective opioid receptor antagonist, naloxone (100 μg/30 μl), the nitric oxide synthase inhibitor, Nω-nitro-l-arginine methyl ester (l-NAME, 1%, 30 μl), or the non-selective μ3 opioid receptor inhibitor, reduced l-glutathione (GSH, 1%, 30 μl). Morphine induced a dose-dependent decrease in IOP and PD. Pre-treatment with naloxone totally prevented morphine-induced decrease in IOP and miosis. Ocular administration of l-NAME or GSH alone failed to affect IOP or PD of NZW rabbits. However, pre-treatment with either drugs significantly reduced, but not totally prevented ocular effects of morphine. These results suggest that biochemical mechanisms related to nitric oxide release are involved, at least in part, in morphine effects on the eye. Since the μ3 opioid receptor subtype is able to release nitric oxide and is sensitive to inactivation by GSH, it may be possible that μ3 opioid receptors are involved in morphine-induced miosis and reduction in IOP. © 2006 Elsevier B.V. All rights reserved
Hyaluronan-induced stimulation of corneal wound healing is a pure pharmacological effect
No full textEffects of the COOH-terminal tripeptide α-MSH11-13 on corneal epithelial wound healing: Role of nitric oxide
No full textIt is known that α-melanocyte stimulating hormone (α-MSH) may exert anti-inflammatory effects and facilitate reparative processes in different tissues. The effective message sequence of α-MSH resides in the COOH-terminal tripeptide α-MSH11-13. This study was undertaken to investigate the effects of topical administration of the COOH-terminal tripeptide sequence of α-MSH (α-MSH11-13, KPV) on corneal epithelial wound healing in rabbits and the possible role of nitric oxide (NO) in these effects. The whole corneal epithelium was denuded in both eyes by mechanical abrasion. The area of the corneal epithelial defect was stained with fluorescein, photographed, and then measured before the treatment and every 12 h by a computerized software. The mean epithelial wound area and the mean percent of epithelial defect remaining at each follow-up control were compared between experimental groups. Rabbits were topically treated with KPV 1, 5 or 10 mg/ml (30 μl), two drops four times in a day, for 4 days, starting immediately after corneal abrasion, while control animals received topical phosphate-buffered saline as vehicle. In order to study the role of NO in corneal repair processes, the NO donor, sodium nitroprusside (SP, 10 mg/ml, 30 μl) was administered in both eyes, two drops four times in a day, for 4 days. The effects of KPV or SP were challenged by pre-treatment with the nitric oxide synthase inhibitor, Nω-nitro-l-arginine methyl ester (l-NAME, 10 mg/ml, 30 μl) 30 min prior to KPV or SP instillation. The mean percent epithelial defect remaining each time was significantly smaller in animals treated with KPV or SP in comparison to controls. Sixty hours later, eight out of eight (100%) corneas treated with KPV or SP were completely re-epithelized (P < 0.05) while none of the corneas treated with placebo were re-epithelized. Pre-treatment with l-NAME inhibited the facilitating effect of KPV on corneal epithelial wound healing process and totally prevented the effect of SP. Rabbit corneal epithelial cells (RCE) in culture were exposed for 1, 6 and 24 h to different KPV concentrations (0.1, 1 and 10 μM) in medium containing 15% foetal bovine serum (FBS). Cell viability was stimulated by 1 and 10 μM concentrations of the substance. Thus, KPV may facilitate corneal epithelial wound healing in rabbits with a mechanism that may involve NO disposition in corneal tissue. However, it is not known whether this mechanism is likely to depend on a direct stimulating repairing activity shared by the entire molecule of α-MSH. © 2006 Elsevier Ltd. All rights reserved
Patellar tendon ossification after anterior cruciate ligament reconstruction using bone – patellar tendon – bone autograft
No full textBACKGROUND: Among the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone - patellar tendon - bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature.
CASE PRESENTATION:
We present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological examinations resulted negative.
CONCLUSION:
The surgical removal of the ossifications followed by anti-inflammatory therapy, seems to be useful in order to relieve pain and to prevent relapses. Moreover, a thorough cleaning of the patellar tendon may reveal useful, in order to prevent bone fragments remain inside it and to reduce patellar tendon heterotopic ossification risk
Biomechanical evaluation of different anterior cruciate ligament fixation techniques for hamstring graft
No full textBackground
A number of anterior cruciate ligament (ACL) fixation techniques are currently in use. Slippage or failure of the graft by excessive loading or aggressive rehabilitation may result in an unstable knee. Load and slippage of the ACL graft varies according to the fixation technique used.
Methods
Graft slippage, load to failure, and stiffness were evaluated using an animal model. Six soft tissue ACL fixation techniques and bone cement as a fixation device were tested: group A, Endo Button CL-Bio RCI; group B, Swing Bridge-Evolgate; group C, Rigidfix-Intrafix; group D, Bone Mulch-Washer Lock; group E, Transfix-Retroscrew; group F, Transfix-Deltascrew; group G, Kryptonite bone cement. Maximum failure load, stiffness, and slippage at the 1st and 1000th cycles and mode of failure were evaluated.
Results
The maximum failure load was significantly higher in group B (1030 N) and significantly lower in group E (483 N) than in the others. The stiffness of group B (270 N/mm) was significantly higher than the others. As for the mode of failure, group C showed failure in the femoral side in all tests (four device ruptures and two tendon ruptures on the femoral side). All failures of the other groups occurred on the tibial side except one test in group A. All failures in group G were due to slippage of the tendons.
Conclusion
Load to failure and stiffness was significantly different between the ACL fixation techniques. All but one of the fixation techniques showed sufficient properties for adequate postoperative rehabilitation. Bone cement used as a fixation device in soft tissue grafts did not seem to provide adequate initial fixation suitable for early rehabilitation after ACL reconstruction
Intra-articular tenosynovial giant cell tumor arising from the posterior cruciate ligament.
No full textTenosynovial giant cell tumors originate from the synovial tissue of the joints, tendon sheaths, mucosal bursas, and fibrous tissues adjacent to tendons. The disease presents in localized and diffused forms. Large joints, such as the knee, are not frequently affected. Magnetic resonance imaging has been reported to be the best noninvasive technique to diagnose these tumors. Magnetic resonance imaging diagnosis has to be confirmed by histopathological examination. Few reports exist of tenosynovial giant cell tumors arising from the posterior cruciate ligament. This article describes a case of an 18-year-old man with no history of trauma but with a 2-year history of mild, ongoing, and worsening right knee pain and swelling localized in the popliteal region. Clinical examination of the knee was negative. Magnetic resonance imaging revealed an intra-articular mass measuring 4.8×2.1×2.7 cm in the posterior region of the knee attached to the posterior cruciate ligament. Arthroscopy was performed using the posterior approach through the posterolateral and posteromedial portals. A specimen of the lesion was removed arthroscopically for histopathological examination, and a wide resection of the mass was performed with a shaver and a radiofrequency ablation device. Histopathological examination confirmed the diagnosis of a tenosynovial giant cell tumor. No recurrence had occurred at 2-year follow-up. Magnetic resonance imaging and histopathological examination may help in achieving a correct diagnosis, and arthroscopic excision using a posterior approach may be the treatment of choice by surgeons
Oral Echinacea purpurea extract in low-grade, steroid-dependent, autoimmune idiopathic uveitis: a pilot study.
No full textAIM:
The aim of to test efficacy and safety of Echinacea purpurea (echinacea) extract in the control of low-grade uveitis.
METHODS:
Fifty-one (51) patients with low-grade, steroid dependent, autoimmune uveitis were recruited; posterior uveitis was excluded. The start therapy was represented by topical desamethazone for anterior uveitis and oral prednisone, rapidly tapered, for anterior uveitis with inflammatory scores equal to +2 and in all cases of intermediate uveitis. Best-corrected visual acuity (BCVA) decrease or improvement was defined as a reduction or increase of 2 or more letters seen from the initial BCVA; ETDRS chart was used. Thirty-two (32) patients (21 with anterior uveitis and 11 with intermediate uveitis) received Echinacea (150 mg twice/day) as add-on therapy, whereas 20 patients (10 with anterior uveitis and 9 with intermediate uveitis) were treated with the conventional steroid therapy alone.
RESULTS:
Thirty-one (31) patients showed anterior uveitis and 20 intermediate uveitis. The follow-up duration was 9 months. At the last follow-up, 19/21 patients with anterior uveitis and 9/11 with intermediate uveitis treated with echinacea presented uveitis settled, with a steroid-off time of 209 and 146 days, respectively. BCVA was stable or improved in 19/21 of anterior uveitis and 9/11 of intermediate uveitis. No adverse reactions supposed to be resulting from commercial-grade echinacea were recorded. Patients who did not receive echinacea required a longer treatment period with steroids with a steroid-off time of 121 and 87 days.
CONCLUSIONS:
Systemic echinacea appears safe and effective in the control of low-grade autoimmune idiopathic uveitis
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