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Bulgheroni E.,San Raffaele Hospital | Grassi A.,Istituto Ortopedico Rizzoli | Campagnolo M.,University of Insubria | Bulgheroni P.,University of Insubria | And 2 more authors.
Cartilage | Year: 2016

Purpose: The aim of this study was to compare the effectiveness of 2 different meniscal scaffolds in treating patients with irreparable partial medial meniscal tear and patients complaining of pain in the medial compartment of the knee due to a previous partial medial meniscectomy. Based on previous studies, we hypothesized that both the scaffolds are effective in improving clinical outcomes in these patient populations. Material and Methods: Twenty-eight patients underwent collagen-based medial meniscus implantation (CMI-Menaflex) and 25 with a second-generation scaffold (Actifit). All patients were assessed with Lysholm, Tegner scale, and MRI evaluation—preoperatively, at 6 months, at 12 moths, and followed-up for a minimum of 2 years. Second look arthroscopy and concomitant biopsy were performed in 7 and 12 patients of CMI and Actifit groups, respectively. Results: The CMI group at final follow-up showed improvement in Lysholm score from 58.4 ± 17.3 to 94.5 ± 6.0, while the Actifit group showed improvement from 67.0 ± 15.7 to 90.3 ± 13.1; the improvement was statistically significant in both the groups but intergroup difference was not statistically significant (P = 0.1061). Tegner Activity Scale score improved in both the groups, but intergroup difference was not statistically significant (P = 0.5918). MRI evaluation showed in situ scaffold and no progression of degenerative arthritis in both the groups at final follow-up. Histological evaluation showed more fibrous tissue with blood vessels in the CMI group and the Actift group showed avascular cartilaginous features. Conclusion: Both the scaffolds are effective in improving patients’ symptoms and joint function at short-term follow-up. © 2015, © The Author(s) 2015.

Zaslav K.,Advanced Orthopedic Technologies | McAdams T.,Stanford University | Scopp J.,Peninsula Orthopedic Associates | Theosadakis J.,University of Arizona | And 2 more authors.
Cartilage | Year: 2012

Objective: Articular cartilage injury is common after athletic injury and remains a difficult treatment conundrum both for the surgeon and athlete. Although recent treatments for damage to articular cartilage have been successful in alleviating symptoms, more durable and complete, long-term articular surface restoration remains the unattained goal. In this article, we look at both new ways to prevent damage to articular surfaces as well as new techniques to recreate biomechanically sound and biochemically true articular surfaces once an athlete injures this surface. This goal should include reproducing hyaline cartilage with a well-integrated and flexible subchondral base and the normal zonal variability in the articular matrix. Results: A number of nonoperative interventions have shown early promise in mitigating cartilage symptoms and in preclinical studies have shown evidence of chondroprotection. These include the use of glucosamine, chondroitin, and other neutraceuticals, viscosupplementation with hyaluronic acid, platelet-rich plasma, and pulsed electromagnetic fields. Newer surgical techniques, some already in clinical study, and others on the horizon offer opportunities to improve the surgical restoration of the hyaline matrix often disrupted in athletic injury. These include new scaffolds, single-stage cell techniques, the use of mesenchymal stem cells, and gene therapy. Conclusion: Although many of these treatments are in the preclinical and early clinical study phase, they offer the promise of better options to mitigate the sequelae of athletically induced cartilage. © SAGE Publications 2012.

Gobbi A.,Oasi Bioresearch Foundation | Chaurasia S.,Oasi Bioresearch Foundation | Karnatzikos G.,Oasi Bioresearch Foundation | Nakamura N.,Health Science University
Cartilage | Year: 2015

Objective. To compare the outcome of matrix-induced autologous chondrocyte implantation (MACI) and bone marrow aspirate concentrate (BMAC)–derived multipotent stem cells (MSCs) implantation in patellofemoral chondral lesions, using the same HYAFF11 scaffold. Methods. From January 2005 to December 2010, 37 patients with patellofemoral chondral lesions were prospectively followed up, for a minimum of 3 years; 19 of these patients were treated with MACI and 18 with BMAC. Radiographs, magnetic resonance imaging, and clinical scores (International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, visual analog scale, and Tegner) were collected preoperatively, at 2-year and final follow-up. Five patients of MACI and 6 of the BMAC group underwent second-look arthroscopy; 4 patients of each group consented to a concomitant biopsy. Results. No adverse reactions or postoperative infections were noted. Baseline characteristics were similar in both groups (P > 0.05). Both groups showed significant improvement in all scores, from preoperative to final follow-up (P = 0.001), but there was no significant difference in improvement between the 2 groups, except for the IKDC subjective score (P = 0.015), which favored the BMAC group. Deterioration in MACI and improvement in BMAC group scores were noticed, from 2-year to final follow-up, but was nonsignificant. MACI patients with trochlear lesions showed better results than patellar lesions, while location was not a prognostic factor in the BMAC group. MRI showed complete filling of the defects in 76% of patients in MACI and 81% of patients in BMAC, and histological analysis revealed hyaline-like features. Conclusion. Both techniques are viable and effective for large patellofemoral chondral lesions at minimum 3-year follow-up. © The Author(s) 2014

Gobbi A.,Oasi Bioresearch Foundation | Lad D.,Oasi Bioresearch Foundation | Karnatzikos G.,Oasi Bioresearch Foundation
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015

Purpose: To assess the outcome of intra-articular platelet-rich plasma (PRP) injections into the knee in patients with early stages of osteoarthritis (OA) and to determine whether cyclical dosing would affect the end result. Methods: This is a prospective, randomized study in which 93 patients (119 knees) were followed up for a minimum of 2 years. Fifty knees were randomly selected prior to the first injection, to receive a second cycle at the completion of 1 year. A cycle consisted of three injections, each given at a monthly interval. The outcome was assessed using Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Scale (VAS), Tegner and Marx scoring systems, recorded prior to the first injection and then at 12, 18 and 24 months. Results: There was a significant improvement in all scores over time compared to the pre-treatment value (p < 0.001). At 12 months, both groups showed similar and significant improvement. At 18 months, except for KOOS (Symptoms) and Tegner score, all other parameters showed a significant difference between the two groups in favour of the patients who had received the second cycle (p < 0.001). At 2 years, the scores declined in both groups but remained above the pre-treatment value with no significant difference between the groups despite the patients with two cycles showing higher mean values for all the scores. Conclusion: Intra-articular PRP injections into the knee for symptomatic early stages of OA are a valid treatment option. There is a significant reduction in pain and improvement in function after 12 months, which can be further improved at 18 months by annual repetition of the treatment. Although the beneficial effects are ill sustained at 2 years, the results are encouraging when compared to the pre-treatment function. Level of evidence: II. © 2014, Springer-Verlag Berlin Heidelberg.

Gobbi A.,Oasi Bioresearch Foundation | Malchira S.,Oasi Bioresearch Foundation | Karnatzikos G.,Oasi Bioresearch Foundation
Minerva Ortopedica e Traumatologica | Year: 2011

Aim. The aim of this study was to determine the efficacy of platelet rich plasma (PRP) treatment in active patients with symptomatic pre-arthritic knees and to compare the two groups of patients with or without previous operative intervention. Methods. We prospectively followed up 80 patients with symptomatic prearthritic knees (mean age 47.7 years) for a minimum followup of 12 months. All patients were treated with two intra-articular injections (one monthly) with autologous PRP. Forty patients (S1 group) underwent a previous operative intervention for cartilage lesions whereas 40 patients (S2 group) did not undergo any previous operative intervention. We divided our patients according to previous operative intervention into S1a (cartilage shaving) and S1b (microfracture) subgroups. KOOS, VAS, Tegner, IKDC and MARX scores were collected at pre-treatment evaluation and at 6 and 12 months following treatment. Nonparametric analysis was performed with the Wilcoxon rank test to compare the variations of the scores from pretreatment to 6 and 12 months; non-parametric Mann-Whitney U test was performed to analyse difference in improvement between the Sl and S2 group, S1a and S1b subgroups and between males and females. All reported P-values were two tailed, with an alpha level of 0.05 indicating significance. Results. Patients in both groups showed significant improvement in all the scores at final follow up (P<0.005) and returned to previous activities. There was significant difference in improvement between S1 and S2 group in VAS score, which showed higher reduction in S1 group, in KOOS (Sport) from pre-treatment to 6 month follow up and in KOOS (QOL) from 6 to 12 month follow-up scores, which showed higher improvement in S2 group. There was no significant difference in improvement between S1a and S1b subgroups as well as between males and females. Conclusion. This study shows that PRP treatment is effective both in operated and nonoperated pre-arthritic knees and can act as a preventive agent of OA, by diminishing pain and improving symptoms and quality of life.

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