Objectives

To evaluate the in vitro effects of hyaluronic acid (HA) on adipose-derived stem cells (ASC) in order to consider the possibility of their combined used in the treatment of knee arthrosis.

The most frequent pathogenic organism in arthroplasty infections is Staphylococcus. The immune response impairment is a frequent finding in elderly people. Objective: to investigate the response of some cytokines and the effect of age in an experimental model of osteomyelitis.

Materials and methods. 40 adult male Wistar rats received a stainless steel needle, intramedullarily in the left tibia. Young rats (3 months old) and Old rats (22 months old) were alloted in: Group A: Sterile implant. Group B: Sterile implant + slime producing S. aureus. 9 weeks after surgery, rats were sacrified. Determinations: Cytokines (IL-1b, IL-2, L-4, IL-6, IL-10 and IL-12)(ELISA) in blood (previous to surgery and to sacrifice) and in tibia extract (after sacrifice); the number of bacteria in tibia and implant. The Wilcoxon, Mann-Whitney U test were used (p≤ 0.05 significant).

Results. Infection was detected in all the operated tibias in old rats receiving S.aureus, and in 7/10 of young rats. IL-2 levels increased in blood in the S.aureus group after surgery in old and young rats. Pre and postoperative IL-2 levels in blood were higher in old rats in both groups than in the corresponding groups of young rats. There was a decrease with age in blood of IL-4 (previous and after surgery), and a decrease of IL-1. S.aureus groups increased IL-1 levels in the operated tibia independently of age; increased IL-2 and IL-10 levels in young rats in the operated tibia; increased IL-4, IL-6 and IL-12 in old rats in blood, decreased IL-4 and increased IL-2 and IL-10 in blood in young rats

Conclusions. Significant differences in tibia infection were found with age. Old rats presented differences with young rats in cytokine response in an experimental model of osteomyelitis, showing an immune response impairment associated with old age.

Introduction and purpose: Our aim was to determine a morphometric relation between the long head of the brachial biceps and the bicipital groove with respect to the subscapular tendon, and its repercussion on functional imbalance of the shoulder.

Materials and methods: For this analytical observational crossover study we took a sample of 30 right-handed, sedentary, duly informed male subjects. The morphometric study was carried out with ultrasonography using a cross-section of the long head of the brachial biceps.

Results: In the dominant limb: 1. Bicipital groove (depth 2.6 mm, width 13.4 mm, internal angle 149.8°); 2. Long head of the brachial biceps (area 1.35 mm, internal angle 152.53°, echogenicity 97.95); 3. Subscapular thickness 4.53 mm. In the non-dominant limb: 1. Bicipital groove (depth 2.9 mm, width 12.5 mm, internal angle 145.73°); 2. Long head of the brachial biceps (area 1.07 mm, internal angle 141.32°, echogenicity 112.72); 3. Subscapular thickness 4.12 mm.

Conclusions: The greater the thickness of the subscapular tendon: 1. Bicipital groove (greater width and internal angle, less echogenicity and depth); 2. Long head of the brachial biceps (greater area and internal angle, less echogenicity). Therefore, there is a greater risk of dislocation of the long head of the brachial biceps and functional instability of the shoulder.

Introduction and Objectives: Arthrodesis of the knee is the method that most readily controls septic processes and results in a non-painful, stable knee joint. However, the disadvantages of this technique are shortening of the limb and a loss of joint function.

Materials and Methods: We present here our unit’s experience in the use of the Orthofíx ® transport system on the anterior surface to stabilise this type of arthrodesis. We used radiological techniques to evaluate the alignment and coaptation of the surfaces to be arthodesed. We also assessed functional capacity, postoperative patient satisfaction, rate of repeat arthrodesis, consolidation time, and complications associated with this method.

Results: According to our results, femorotibial arthrodesis with the bone transport system provides all the advantages of monolateral external fixation while allowing compression of the point of arthrodesis, achieving perfect coaptation, and providing extraordinary rigidity to the mounting.

Discussion and Conclusions: As with all other procedures, femorotibial arthrodesis has its complications. The complication directly related to knee arthrodesis is femorotibial non-union, which is correlated with a loss of bone stock, incomplete coaptation, poor alignment of the limb, persistent infection, and inadequate immobilisation. We believe this procedure produces a functional limb with significant relief of pain in most patients.

Introduction and Objectives: The aim of this study is to evaluate the results of the technique described by Ahlgren and Larsson in 1989, presenting our experience with 7 patients.

Materials and Methods: A retrospective study was conducted on the clinical records of 7 adolescents treated in our center beginning in 1991 using the technique described by Ahlgren and Larsson. There were 3 males and 4 females, ranging in age from 13 to 16.5 years (average: 14 years 10 months). All subjects had a history of repeated ankle sprains for 2 to 5 years before surgery. In all cases there was painful instability of the ankle which significantly limited physical activity. In 4 cases, symptoms were present even when walking on level ground. On clinical examination, 3 cases showed significant instability under varus stress, 3 others had moderate instability, and one case had mild instability. Surgical technique was similar in all cases and involved creating a periosteal flap with a distal anterior base, including the fibulotalar and fibulocalcaneal ligaments, which was sutured with tension to the fibula. In 3 cases, this was done with the help of Mitek metal hooks. In 5 of 7 cases, an ossicle of the fibular malleolus visible on the radiographs was removed. Duration of surgery ranged from 30 to 60 minutes, with a mean of 40 minutes. Postoperative immobilisation consisted of a plaster cast used for an average of 45 days, after which time patients progressively returned to normal physical activities. Patients were advised to use an ankle brace. Average follow-up time was 35 months, with a range of 13 to 72 months.

Results: In 5 patients, a subjective improvement in ankle stability was found on examination. Only in one case was there a significant reduction in radiographic instability when the tibiotalar joint was moved from 20° to 8°. One patient developed a superficial infection of the surgical wound which resolved with antibiotic treatment. Two patients suffered sprains within the first year after intervention, but there were no further sprains, and the injuries did not seem to affect the final outcome. However, the outcome of one of these was considered to be only fair due to occasional mild pain which did not limit physical activity. Two cases had poor outcomes due to frequent pain which limited physical activity postoperatively for 2 and 6 years, respectively. However, neither patient had repeat sprains during this period. The remaining 4 cases were considered to have had good results, as the patients were totally asymptomatic and without any limitation of physical activity.

Discussion and Conclusions: This simple, non-aggressive method is an attractive option for use in adolescents. We therefore conclude that more studies are needed to validate its effectiveness.