PURPOSE

Recently, in tissue engineering several methods using stem cells have been developed to repair chondral and osteochondral defects. Most of these methods rely on the use of scaffolds. Studies in the literature have demonstrated, first in animals and then in humans, that the use of mesenchymal stem cells withdrawn by several methods from adipose tissue allows to regenerate hyaline articular cartilage. In fact, it has been cleared that adipose-derived cells have multipotentiality equivalent to bone marrow-derived stem cells and that they can very easily and very quickly be isolated in large amounts enabling their immediate use in operating room for one-step cartilage repair techniques. The purpose of this study is to evaluate the therapeutic effect of adipose-derived stem cells on cartilage repair and present our experience in the treatment of knee cartilage defects by the novel AMIC REPAIR TECHNIQUE AUGMENTED by immersing the collagen scaffold with mesenchymal stem cells withdrawn from adipose tissue of the abdomen.

Introduction: Always more orthopaedic surgeons are nowadays putting all their efforts in improving knee osteochondral defects treatment.

Material and Methods: In order to relieve patient symptoms we have retained of value, among other treatment options in use at our institution, to rely, in older patients, on a new, non biological, method of treating chondral and osteochondral defects and since November 2002 we started using artificial synthetic cartilage implants made of polyvinylalcohol-hydrogel (SaluCartilage™ – Salumedica).

Results: Serial clinical and MRI follow-ups have been conducted. The 65 treated patients have shown significant improvement over preoperative values of 2000 International Knee Documentation Committee Knee Examination Forms. In fact at one year follow-up patients showed an average increase of 24 points over preoperative values of IKDC score, this improvement further raised up at the two year follow-up to a 33 points improvement (range of improvement 14,94 – 68,67) and has been confirmed at the three years evaluation.

Follow-up MRI images revealed normal healing process, without signs of osteolysis or wear. No synovial joint reaction has been observed, but one case of implant’s dislocation occurred.

Conclusions: Based on our mid term results, that have confirmed the short term ones, this study demonstrates that, in middle aged patients, between the fourth and the seventh decade, the use of a non biologic device, the implantation of a polyvinyl alcohol prosthesis in the chondral defect, represents an innovative treatment choice that knee surgeons need to be aware of and prompt to use it in the correct cases. In fact, in our opinion, the “chondral surgeon” must be ready to use different treatments in the different patients. To facilitate the use of Salucartilage ™ implant we suggest the rationale of it’s use with the auspice that surgeon’s experience and round tables will be able to better define the correct indications of each surgical possible solution of chondral defects. The immediate postoperative weight bearing and full regaining of recreational and sport activities are an added advantage of this technique that can be therefore when needed associated to other surgical procedures, such as osteotomies or ACL reconstructions.

Introduction: Based on good results obtained with the hip screw and gamma nail and on newer biomechanical studies, we started treating intertrochanteric fractures with other intramedullary devices: the PFN (Proximal Femoral Nail) and Supernail.

Material and methods: From January 2003 to January 2005 we have treated 100 intertrochanteric fractures, 50 with PFN nail and 50 with Supernail. Fracture type distribution and patient’s age were similar in both groups.

Discussion: To evaluate differences in results we have studied various parameters: blood loss, surgical time and healing process.

Results: We haven’t encountered intra-op complications, nor post-op fractures or fixation devices failure. We, although, had two cases of screw cut-out, one for each implant. About 85% of patients reported good-excellent result.

Conclusions: Both nails have brought to reduction of surgical time, blood loss and intra and post-op complications. Best results are achieved following cautious surgical technique: correct nail’s introduction entry, minimal or no proximal reaming, gentle introduction of the nail and particular attention to proximal screw positioning and length.

Although various treatment options are available, which include shaving, microfractures, abrasion arthroplasty osteochondral allografts and autografts, chondrocyte grafts and unicondylar prostheses, symptomatic articular cartilage defects represent a therapeutic challenge.

Since November 2002, as a non-biological answer to the problem, we started using synthetic cartilage implants made of polyvinyl alcohol- hydrogel (PVA – H) (SaluCartilage). This is a transparent synthetic polymer with a molecular weight of 308,000 daltons and 20% of water content, available in cylindrical shape of various diameters. Following the second part of the OATS technique, under arthroscopic control and by mini-arthrotomy, or completely arthroscopically assisted, the cylindrical implant is inserted, using press-fit technique, into previously punched out and dilatated osteochondral defects.

Our patients, whose mean age was 56 years (range 48–68 years) have been post-operatively reviewed clinically and by serial MRI exams. Patients showed significant improvement over pre-operative values in the IKDC score, with an average increase of 20 points. Follow-up MRI images revealed a normal healing process, without signs of osteolysis or wear.

As complications we had one case of implant dislocation 1 year after surgery and one case of progressive loosening due to osteoarthritic disease, both of which have required a knee prosthesis.

Our experience has led us to emphasise the use of this type of treatment only in cases that fullfil precise indications: (a) Third and fourth degree chondral or osteochondral symptomatic defects; (b) focal unicompartmental defects with 15 mm maximum extent; (c) patient’s age limited from fourth to seventh decade of life; and (d) absence of angular deformities or articular instabilities.

The synthetic cartilage resurfacing technique has the advantages of no donor defect, one short-step surgical procedure, immediate weight-bearing and no extensive rehabilitation programme. Early results of first 15 patients are being presented, expecting a longer observation follow-up study.

Aims: description of results obtained with a single radius TKA design. Matherials and methods: In 1999 we started implanting single-radius TKA design (Scorpio–Osteonics). Between January 1999 and April 2002 we have implanted 211 TKA, 15 bilateral, with 24 months average follow-up (range 3–36 months). This type of prosthesis is based on the concept that the normal knee rotates about a single axis – the transepicondylar axis. This reduces mid-flexion instability, improves patello-femoral tracking and decreases the occurrence of anterior knee pain. Results: Knee Society score has improved to 90 points post-op from 39 points pre-op and function evaluation from 44 to 82 points. We had 128 cases excellent (65.6%), 40 good (20.5%), 24 fair (12.4%) and 3 poor (1.5%). X-ray follow-ups have revealed in 83% of cases knee angulation between 2° from neutral, in 11% a varus deviation between 3° and 5° and in 6% a valgus deviation between 3° and 5°. Radiolucencies have been found in 18 patients (9.23%). Conclusions: Scorpio single-radius prosthesis has permitted a full and early recovery of knee function. Bone cuts, especially the tibial one, are reduced. Anterior knee pain is dramatically reduced and is associated with incremented range of motion and improvement in knee stability, especially in the mid flexion. These short term results are really encouraging, but need to be confirmed by future follow-up studies.