Traditionally, limb reconstruction physiotherapy consisted of face to face group rehabilitation. During the COVID-19 pandemic OP physiotherapy service provision was significantly reduced and delivery methods limited due to staff redeployment, service prioritisation and restriction of footfall within the hospital. A virtual exercise group for acute limb reconstruction patients was set up to maintain contact and clinical support. A small single centre study was performed over two 4 week periods capturing the experience of 35 patients. A patient reported questionnaire was used and revised post-pandemic to gather quantitative and qualitative data about the patients experience of the Limb Reconstruction Physiotherapy Service at each point in time. The qualitative data was analysed using an inductive thematic analysis.Introduction
Materials and Methods
Tendon disease and rupture are common in patients with diabetes and these are exacerbated by poor healing. although nanoscale changes in diabetic tendon are linked to increased strength and stiffness. The resistance to mechanical damage of a tissue may be measured using fatigue testing but this has not been carried out in diabetic tendon, although the toughness of diabetic bone is known to be reduced. The aim of this study was to measure the static fatigue behaviour of tendons from a streptozotocin (STZ)-induced rat model of diabetes, hypothesising that diabetes causes tendon to show lower resistance to mechanical damage than healthy tendon. Diabetic (n=3, 12 weeks post-STZ) and age-matched control (n=3) adult male Sprague Dawley rats were culled, tails harvested and stored at −80ºC. Following defrosting, fascicles (5 per animal) were carefully dissected, mean diameter measured using an optical micrometer and mounted in a Bose Biodynamics test machine using custom grips in a PBS bath. Static fatigue testing at 30 MPa to failure enabled both elastic modulus (initial ramp) and steady state creep rate (gradient at creep curve inflexion) to be measured. Data are reported as median ± interquartile range and pw0.05 using a Mann-Whitney U test was taken as significant.Introduction
Materials and Methods
Platelet-Rich Plasma (PRP), an autologous derivative of whole blood that contains a supraphysiological concentration of platelets and growth factors. Most published studies have investigated the effect of PRP-conditioned media on cell cultures. We are not aware of any study that has investigated whole PRP with its cellular components on human tissue cultures. This study aims to investigate the effect of PRP on cell migration from human Achilles tendon explants, and the subsequent cellular proliferative effects in culture. This is an Purpose
Methods
Total hip arthroplasty (THA) is regarded as one of the most successful surgeries in medicine. However, recent studies have revealed that ideal acetabular cup implantation is achieved less frequently than previously thought, as little as 50% of the time. It is well known that malalignment of the acetabular component in THA may result in dislocation, reduced range of motion, or accelerated wear. This study reports accuracy of a tactile robotic arm system to ream the acetabulum and impact an acetabulur cup compared to manual instrumentation. 12 fresh frozen cadaveric acetabulae were pre-operatively CT scanned and 3D templating was used to plan the center of rotation, and anteversion and inclination of the cup. Each specimen received THA, six prepared manually and six prepared with robotic arm guidance. Tactile, visual, and auditory feedback was provided through robotic guidance as well as navigated guided reaming and cup impaction. The robotic guidance constrained orientation of instruments thus constraining anteversion, inclination, and center of rotation for reaming, trialing, and final cup impaction. Post-operative CT scans were taken of each specimen to determine final cup placement for comparison to the pre-operative plans.INTRODUCTION
METHODS
Platelet Rich Plasma (PRP) has been shown to have positive effect in tendon regeneration in in-vitro and limited in-vivo animal studies. We aim to study PRP use in acute Achilles tendon rupture (ATR) regeneration in a purposely designed clinical trial. This is a prospective double-arm patient-blinded randomized controlled trial. ATR patients were randomized into PRP treatment or control groups. Non-operatively treated patients received PRP or control injection in clinic. In operatively treated patients, PRP gel was applied in the ruptured gap during percutaneous repair. Standard rehabilitation protocol was used and patients were followed up for 24 weeks. ATR, VISA-A and FAOS scores were used as subjective outcome measures. Functional ultrasound Elastography (FUSE) was performed at each follow-up to assess the mechanical properties of tendons. PRP analysis and tendon needle-biopsy were performed to study the histological differences during healing in both groups.Purpose
Methods
Recent gains in knowledge reveal that the ideal acetabular cup position is in a narrower range than previously appreciated and that position is likely different based on femoral component anteversion. For that reason more accurate acetabular cup positioning techniques will be important for contemporary THA. It is well known that malalignment of the acetabular component in THA may result in dislocation, reduced range of motion or accelerated wear. Up to 8% of THA patients have cups malaligned in version by more than ±10° outside of the Lewinnek safe zone. This type of malalignment may result in dislocation of the femoral head and instability of the joint within the first year, requiring reoperation. Reported incidences of reoperation are 1-9% depending on surgical skills and technique. In addition, cup malalignment is becoming increasingly important as adoption of hard on hard bearings increases as the success of large head hard on hard bearings seems to be more sensitive to cup positioning. This study reports the accuracy of a haptic robotic system to ream the acetabulum and impact an acetabular cup compared to manual instrumentation. Six fresh frozen cadaveric acetabula were CT scanned and three-dimensional templating of the center of rotation, anteversion and inclination of the cup was determined pre-operatively. Half of the specimens were prepared with manual instrumentation while half were prepared with robotic guidance. Haptic and visual feedback were provided through robotics and an associated navigation system to guide reaming and impaction of the cup. The robot constrained the orientation and position of the instruments thus constraining the inclination, anteversion and center of rotation of the reamer, trial and the final cup. Post-operative CT's were used to determine the achieved cup placement and compared to the pre-operative plans.Introduction
Methods
Femoro-acetabular impingement (FAI) is a common source of impaired motion of the hip, often attributed to the presence of an aspherical femoral head. However, other types of femoral deformity, including posterior slip, retroversion, and neck enlargement, can also limit hip motion. This study was performed to establish whether the “cam” impinging femur has a single deformity of the head/neck junction or multiple abnormalities. Computer models of 71 femora (28 normal and 43 “cam” impinging) were prepared from CT scans. Morphologic parameters describing the dimensions of the head, neck, and medullary canal were calculated for each specimen. The anteversion angle, alpha angle of Notzli, beta angle of Beaulé, and normalized anterior heads offset were also calculated. Average dimensions were compared between the normal and impinging femora.Introduction
Materials and Methods
The use of platelet-rich concentrate (PRC) to enhance the healing response in tendon repair is currently an area of considerable interest. Activated platelets release a cocktail of growth factors and ECM regulating molecules. Previous work suggests that tenocytes are activated by contact with these clot-derived molecules. Our studies on tenocytes and PRC aim to establish the direct molecular and functional effects of PRC on tenocytes and to support the clinical research on Achilles tendon repair taking place within our group. We hypothesise that applying PRC to human tenocytes in culture will increase proliferation rate and survival by activating relevant signalling pathways. Using a centrifugation method, PRC was extracted from fresh human whole blood. The PRC was immediately clotted and left in medium overnight to release biological factors (at least 95% of presynthesized growth factors are secreted in the first hour of activation)1. Human tenocytes derived from explanted healthy hamstring were used for up to three passages. Cells were treated with varying concentrations of PRC-conditioned medium and assessed for viable cell number (Alamar Blue™ fluorescence) and proliferation (Ziva™ Ultrasensitive BrdU assay) after 72hrs. For western blotting, cells were treated with 10% PRC for 5 or 30 minutes. Antibodies to P-ERK and P-Akt detected the active protein state on the blot, followed by membrane stripping and re-probing with pan antibodies. Quantification was achieved by densitometry using Visionworks software v. 6.7.1.Introduction
Materials and Methods
To audit the routine measurement of Vitamin B12 levels prior to cervical decompressive surgery Retrospective analysis of medical records and pathology results of patients who underwent decompressive cervical surgery for myelopathy over a 6 month period 26 patients were identified from theatre records. 21 out of 26 patients did not have vitamin B12 levels checked prior to their decompressive surgery The reports in the literature of co-existent B12 deficient myelopathy and mechanical compression are a cause for concern. Although the incidence of this is unknown and unlikely to be common, good clinical practice would suggest that we should be routinely monitoring B12 levels in myelopathic patients. We have introduced new standards for routinely checking B12 levels pre-operatively and intend to re-audit the effectiveness of these in six months time.
Although mechanical stabilisation has been a hallmark of orthopaedic surgical management, orthobiologics are now playing an increasing role. Platelet-rich plasma (PRP) is a volume of plasma fraction of autologous blood having platelet concentrations above baseline. The platelet α granules are rich in growth factors that play an essential role in tissue healing, such as transforming growth factor-β, vascular endothelial growth factor, and platelet-derived growth factor. PRP is used in various surgical fields to enhance bone and soft-tissue healing by placing supraphysiological concentrations of autologous platelets at the site of tissue damage. The easily obtainable PRP and its possible beneficial outcome hold promise for new regenerative treatment approaches. The aim of this literature review was to describe the bioactivities of PRP, to elucidate the different techniques for PRP preparation, to review animal and human studies, to evaluate the evidence regarding the use of PRP in trauma and orthopaedic surgery, to clarify risks, and to provide guidance for future research.
