Marco Antônio Percope de Andrade

Knee osteoarthritis (KOA) is a degenerative joint condition characterized by progressive cartilage deterioration and chronic pain, leading to functional im

Elbow dislocation associated with radial head and coronoid fractures is known as terrible triad of the elbow. Despite the improvement in the results of its surgical treatment, complications such as stiffness, osteosynthesis problems, ulnar nerve neuropathy, heterotopic ossification and late arthrosis still occurs. No study so far has showed the clinical repercussion of these complications. This study aims to compare the clinical, functional and radiographic results of patients treated for terrible triad of the elbow in whose there was union of the coronoid process with others in whom the union did not occur. Twenty-five patients who were surgically treated for a terrible triad from March 2007 to December 2012 were retrospectively analyzed. The patients were divided into two groups: C group, comprised of 18 patients with coronoid union and NC group, comprised of 7 patients with nonunion. The groups were compared regarding gender, affected side, coronoid fracture type, coronoid osteosynthesis method, radial head management, follow-up time, time elapsed between fracture and surgery, range of motion, Disabilities of the Arm, Shoulder and Hand Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Index (MEPI) functional scores and number of complications. In total, 19 men and 12 women with mean age of 43 years were enrolled. The mean final flexion and extension arc was 111°. The mean pronation and supination were 68° and 630, respectively. The mean DASH was 12 and the mean MEPI was 86. According to MEPI, 20 patients (80%) had good and excellent results. There was no statistically significant difference in any of the variables in the comparison between C and NC groups. Therefore, it was concluded that the coronoid nonunion does not affect the outcome of patients treated for terrible triad of the elbow.

To describe and standardize a reproducible posterolateral approach to the posterior iliac crest for bone marrow aspirate (BMA) harvesting, based on a palpa

Introduction: This study aimed to evaluate the mechanical resistance to pullout of the lumbar cortical bone trajectory (CBT) screw with and without transfixation of the second cortical in a biomechanical assay in swine vertebrae. Methods: A pullout test was performed in 16 swine vertebrae (L5 and L6) fixed with 32 CBT screws using the same protocol. Of these, 16 were inserted in a monocortical manner according to the original technique and 16 through a modified technique which included the transfixation of the second cortical bone. Results: The average maximum load value for pulling out the inserted screws with the modified technique including the transfixation of the second cortical bone was 140.50 Kgf (± 56.56), while in the original technique it was 95.69 Kgf (± 42.19) (p = 0.004). Conclusion: The biomechanical tests applied to the studied sample showed that the pullout resistance of the CBT screws inserted with the bicortical technique was, on average, 46% higher than the screws inserted according to the original monocortical technique. Level of Evidence II; Experimental study.

Purpose Patients with indication for medial UKA may present with some degree of patellofemoral joint degeneration. The main purpose of this study was to identify the impact of patellofemoral osteoarthritis (PFOA) on the clinical outcomes of medial fixed-bearing UKA. Methods A retrospective cohort study evaluating the clinical outcomes of medial UKA in patients with isolated medial OA, with or without patellofemoral involvement. Data collected included demographic information, pain analog scale scores, range of motion (ROM), KOOS and Oxford Knee Score, and knee radiographs. Results The statistical analysis included 112 patients. The average follow-up was 34.1 months. One patient in the non-PFOA group presented with deep vein thrombosis. No difference was found between groups regarding PROMs, OKS, Pain or KOOS. Postoperative range of motion values in Groups A and B were, respectively, 114.5 ± 2.4 and 112.5 ± 3.6 (p = 0.39). Postoperative Oxford Knee Scale in Groups A and B were, respectively, 40.2 ± 2.0 and 40.5 ± 2.5 (p = 0.86). Pain scale reduction in Groups A and B were, respectively, 5 ± 2.1 and 5.0 ± 2.6 (p = 0.17). Postoperative KOSS values in Groups A and B were, respectively, 80.6 ± 2.5 and 82.5 ± 3.0 (p = 0.45). Conclusion UKA is a good option for medial isolated tibiofemoral osteoarthritis in patients without PFOA (Iwano’s Grade 1) or with asymptomatic PFOA (Iwano’s Grade 2 and 3). Improvements in pain, Oxford Knee Score and KOOS were observed without differences between groups.

Objective: To evaluate the inter- and intraobserver reliability of the Osebold, Maloney, and the Allen and Ferguson methods for evaluating pelvic obliquity in patients diagnosed with adolescent idiopathic scoliosis (AIS).

Knee osteoarthritis (OA) is a chronic articular disease characterized by the progressive degeneration of cartilage and bone tissue, leading to the appearance of subchondral cysts, osteophyte formation, and synovial inflammation. Conventional treatments consist of non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, and glucocorticoids. However, the prolonged use of these drugs causes adverse effects. NSAIDs, for instance, are known to be nephrotoxic, increasing the damage to articular cartilage. New therapies capable of accelerating the process of tissue regeneration and repair are being discussed, such as the use of orthobiologics that are naturally found in the body and obtained through minimally invasive collection and/or laboratory manipulations. Bone marrow aspirate (BMA) and bone marrow aspirate concentrate (BMAC) are both rich in hematopoietic stem cells, mesenchymal stem cells (MSCs), and growth factors (GFs) that can be used in the healing process due to their anabolic and anti-inflammatory effects. The aim of this literature review is to assess the efficacy of BMA and BMAC in the treatment of knee OA based on the favorable results that researchers have obtained with the use of both orthobiologics envisaging an accelerated healing process and the prevention of OA progression.

Bone marrow cellular therapy has undergone a remarkable evolution, significantly impacting the treatment of musculoskeletal disorders. This review traces the historical trajectory from early mythological references to contemporary scientific advancements. The groundbreaking work of Friedenstein in 1968, identifying fibroblast colony-forming cells in bone marrow, laid the foundation for future studies. Caplan’s subsequent identification of mesenchymal stem cells (MSCs) in 1991 highlighted their differentiation potential and immunomodulatory properties, establishing them as key players in regenerative medicine. Contemporary research has focused on refining techniques for isolating and applying bone marrow-derived MSCs. These cells have shown promise in treating conditions like osteonecrosis, osteoarthritis, and tendon injuries thanks to their ability to promote tissue repair, modulate immune responses, and enhance angiogenesis. Clinical studies have demonstrated significant improvements in pain relief, functional recovery, and tissue regeneration. Innovations such as the ACH classification system and advancements in bone marrow aspiration methods have standardized practices, improving the consistency and efficacy of these therapies. Recent clinical trials have validated the therapeutic potential of bone marrow-derived products, highlighting their advantages in both surgical and non-surgical applications. Studies have shown that MSCs can reduce inflammation, support bone healing, and enhance cartilage repair. However, challenges remain, including the need for rigorous characterization of cell populations and standardized reporting in clinical trials. Addressing these issues is crucial for advancing the field and ensuring the reliable application of these therapies. Looking ahead, future research should focus on integrating bone marrow-derived products with other regenerative techniques and exploring non-surgical interventions. The continued innovation and refinement of these therapies hold promise for revolutionizing the treatment of musculoskeletal disorders, offering improved patient outcomes, and advancing the boundaries of medical science.

Purpose The optimal duration of antibiotic therapy for fracture-related infection (FRI) has not been well defined. Our aim was to assess the recurrence rate of infection in patients who underwent six, 12, or 24 weeks of antibiotic therapy following surgical treatment for FRI one year after antibiotic discontinuation. Additionally, complications were monitored. Methods Patients with FRI underwent surgical treatment, and antibiotic therapy was initiated. The patients were divided into groups at the 6th and 12th weeks of antibiotic therapy. The primary endpoint was the recurrence of deep or superficial infection at 90 days and one year after the end of antimicrobial therapy. Results There was no difference in the recurrence of infection 90 days or one year after stopping antibiotic therapy among patients treated for six, 12, or 24 weeks (p = 0.98 and p = 0.19, respectively). The overall recurrence rate of infection 90 days after stopping antibiotic therapy was 4.9% (8/163), and one year after discontinuation of antibiotic therapy was 9.8% (16/163). There was a statistically significant difference in the incidence of adverse effects among the three groups (chi-square; p = 0.01). Adverse effects were more common in the group treated for 24 weeks than in the groups treated for 6 weeks (z score, p = 0.017) or 12 weeks (z score, p = 0.005). Conclusion Antibiotic therapy longer than 6 weeks did not reduce the recurrence of FRI after one year of follow-up. Additionally, antibiotic treatment for 24 weeks increases adverse events such as skin reactions and acute renal failure.