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Falcochio DF, Brunelli JPF, Oliveira RKD, Ruggiero GM. Arthroscopy-assisted Procedures in Hand and Wrist Surgery: An Update. Where Are We So Far? Rev Bras Ortop 2024; 59:e349-e357. [PMID: 38911879 PMCID: PMC11193588 DOI: 10.1055/s-0044-1779336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 06/25/2024] Open
Abstract
Wrist and hand arthroscopy, despite being an old tool, has gained popularity and advanced in assisting in the treatment of various injuries and conditions in the region in recent years. Dorsal, volar, ulnar, and radial accessory portals are used to reach all points of the carpal and hand joints. The minimal tissue damage, lesser injury to the capsule and its mechanoreceptors, the assessment of injuries associated with the reason for surgery, and aesthetically more favorable scars have attracted many doctors and their patients. As a result, there has been an increase in publications and diversifications of arthroscopic techniques. The aim of this update article is to present the advances and the evidence available in the literature to assist readers in their decision on which technique to use in the treatment of wrist and hand conditions.
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Herold C, Lange J, Rennekampff HO, Allert S, Meyer Marcotty M. Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: Long Term Results. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:511-515. [PMID: 35272382 DOI: 10.1055/a-1737-4541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Initial results after autologous fat transfer for treatment of thumb carpometacarpal joint osteoarthritis have been promising. But long-term results have not yet been available. METHODS In a prospective study, 42 patients with thumb carpometacarpal joint osteoarthritis were observed for a mean time of 5 years after autologous fat transfer. Manual liposuction and centrifugation were performed. Pain rating according to numerous analogue pain scale; objective force of pinch grip and fist closure; and Disabilities of the Arm, Shoulder, and Hand questionnaire score (DASH score) before and after treatment were analysed. RESULTS The average pain preoperatively was 8.0 ± 1.6 and 4.0 ± 3.0 after 5 years overall. Force and pinch force of the treated hand improved from 71% and 60% preoperative in comparison to the non-treated hand to 100% and 96%, respectively, 5 years after fat transplantation. There were similar improvements for the parameters strength and DASH score. All improvements were statistically significant. No serious adverse events were observed. CONCLUSIONS Autologous fat transplantation is a real alternative to trapeziectomy even in the long term in basal joint osteoarthritis of the thumb. The low invasiveness of the procedure and early recovery of patients compared with classical procedures such as trapeziectomy, and the superior long-term results compared with classical injection therapy, make this approach feasible as a first-line therapy in basal joint osteoarthritis of the thumb as it offers stable results and warrants a high patient satisfaction rate.
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Affiliation(s)
- Christian Herold
- Plastische und Ästhetische Chirurgie, Medizin im Mühlenviertel, Bremen, Deutschland
- Chirurgische Klinik, Sektion für Plastische und Ästhetische Chirurgie, DIAKO Bremen, Bremen, Deutschland
| | - Janina Lange
- Chirurgische Klinik, Diako Bremen, Bremen, Deutschland
| | - Hans Oliver Rennekampff
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Rhein-Maas Klinikum GmbH, Würselen, Deutschland
| | - Sixtus Allert
- Plastische Chirurgie, Sana Klinikum Hameln-Pyrmont, Hameln, Deutschland
| | - Max Meyer Marcotty
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie / Handchirurgie, Klinikum Lüdenscheid, Lüdenscheid, Deutschland
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de Villeneuve Bargemon JB, Rouveyrol M, Massin V, Jaloux C, Levadoux M. Targeted Partial Arthroscopic Trapeziectomy and Temporary K-Wire Distraction for Basal Joint Arthritis in Young Patients: A Retrospective Study of 39 Thumbs. J Wrist Surg 2023; 12:9-17. [PMID: 36644730 PMCID: PMC9836781 DOI: 10.1055/s-0041-1742204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/09/2021] [Indexed: 01/26/2023]
Abstract
Purpose There is a real need to find less invasive therapeutic options for young patients suffering from osteoarthritis of the first carpometacarpal joint. We wanted to assess the effectiveness of targeted partial arthroscopic trapeziectomy with distraction of the trapeziometacarpal (TM) joint with Kirschner wires (K-wires) in 39 thumbs impacted by TM osteoarthritis. Methods We conducted a retrospective study in which preoperative and postoperative data on pinch strength, grip strength, and pain on a visual analogue scale were collected. Subgroup analysis was performed based on two different K-wire distraction techniques. Only patients suffering from primary osteoarthritis and younger than 70 years were included. Second, we compared the frequency of complications relative to the position of the pins. Results We found a significant improvement in pain ( p = 0.005) and grip strength ( p = 0.0021) as well as an improvement in pinch strength ( p = 0.5704). There was reduction in pain for all Badia levels, which was significant for stages 2 ( p = 0.002) and 3 ( p = 0.032) as well as an overall improvement in grip strength and pinch strength for all Badia levels. Conclusion Partial trapeziectomy with K-wire distraction in young patients suffering from TM osteoarthritis is a simple technique that requires minimal equipment and yields satisfactory outcomes. Conversion to another surgical treatment is still possible if this less invasive technique is unsuccessful. Level of Evidence This is a Level IV study.
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Affiliation(s)
| | - Mathias Rouveyrol
- Department of Hand Surgery and Limb Reconstructive Surgery, Timone Adultes Hospital, Aix Marseille University, Marseille, France
| | - Valentin Massin
- Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique – Hôpitaux de Marseille, Marseille, France
| | - Charlotte Jaloux
- Department of Hand Surgery and Limb Reconstructive Surgery, Timone Adultes Hospital, Aix Marseille University, Marseille, France
| | - M. Levadoux
- Department of Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, France
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Autologous Fat Grafting in the Upper Extremity: Defining New Indications. Plast Reconstr Surg Glob Open 2022; 10:e4469. [PMID: 35999879 PMCID: PMC9390829 DOI: 10.1097/gox.0000000000004469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/03/2022] [Indexed: 11/26/2022]
Abstract
Autologous fat grafting is a commonly used technique in plastic surgery that can also be applied broadly in hand surgery. We present a case series to demonstrate the diverse indications for fat grafting in hand surgery. Methods We retrospectively reviewed cases of fat grafting in the upper extremity in 2020. Cases representing a unique application of fat grafting were identified. Patient data, including demographics, diagnoses, preoperative and postoperative assessments, complications, patient satisfaction, and surgical operative reports, were recorded. Results Five patients representing distinct indications for autologous fat grafting in the upper extremity were identified. Indications included hand rejuvenation (20.0%), burn/scar management (20.0%), tenolysis (20.0%), revision nerve decompression (20.0%), and carpometacarpal joint arthritis (20.0%). Average patient age was 60.4 years (range, 42-71). Average volume of fat injected was 15.2 ml (range, 1-37 ml). No major complications were noted (0.0%). All patients expressed satisfaction with their overall result with good functional outcomes (100%). Conclusions Autologous fat grafting can be applied broadly in hand surgery. Indications for fat grafting in hand surgery include hand rejuvenation, burn/scar management, tenolysis, revision nerve decompression, and thumb carpometacarpal arthritis. Hand surgeons can easily incorporate fat grafting into their daily practice. Current literature supports fat grafting as a viable technique in hand surgery with lower-level studies.
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Effects of Intra-Articular Autologous Adipose Micrograft for the Treatment of Osteoarthritis in Dogs: A Prospective, Randomized, Controlled Study. Animals (Basel) 2022; 12:ani12141844. [PMID: 35883392 PMCID: PMC9311928 DOI: 10.3390/ani12141844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to estimate the safety, feasibility, and efficacy of the intra-articular treatment of autologous microfragmented adipose tissue in dogs with spontaneous osteoarthritis (OA) in comparison with hyaluronic acid (HA), the standard intra-articular treatment. Specifically, it clinically evaluated pain and lameness, the radiographic progression of osteoarthritis, and synovial fluid inflammation. This was a prospective, single-center, parallel-group, randomized, controlled, in vivo clinical study. Participants (n = 40) received either a single intra-articular injection of microfragmented adipose tissue or a single intra-articular injection of HA (1:1). Clinical outcomes were determined using a specialistic clinician assessment obtained by the completion of a specific clinical form based on the Vesseur modified lameness classification system, a pain evaluation using the Visual Analogue Scale (VAS), the measurement of the range of motion (ROM) of the affected joint, limb circumference, and the owners' score evaluation using the Canine Brief Pain Inventory (CBPI) for up to 6 months after the time of injection. Patients underwent a radiographic examination to establish the degree of OA in the affected joint, and synovial fluid samples were collected to assess the biochemical environment of the joint and evaluate and quantify the cellular population and the presence of three specific inflammation biomarkers for up to 60 days. The results of this study suggest that microfragmented autologous adipose tissue is safe and can effectively relieve pain and improve function in dogs with spontaneous articular OA. This one-step procedure is simple, timesaving, cost-effective, minimally invasive, and eliminates the need for complex and time-intensive cell culture processing. Furthermore, the clinical evidence and cytological results suggest better long-term pain control, resulting in an improvement in joint function, compared to HA treatment. The canine spontaneous OA model could play a key role in developing successful treatments for human medicine.
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Karagergou E, Ligomenou T, Chalidis B, Kitridis D, Papadopoulou S, Givissis P. Evaluation of Adipose Cell-Based Therapies for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis. Biomolecules 2022; 12:biom12030473. [PMID: 35327665 PMCID: PMC8946069 DOI: 10.3390/biom12030473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Adipose tissue and its regenerative products which are isolated with enzymatic or mechanical processing of the harvested fat have been studied in a wide range of degenerative diseases, including osteoarthritis of the knee and hip. Intra-articular injection of these products can provide symptomatic relief of pain and postpone surgery. However, their use in the treatment of thumb carpometacarpal joint (CMCJ) osteoarthritis is limited and just a few studies have been published on that topic. For this reason, a review of the literature was performed by a thorough search of eight terms using the Pubmed database. In total, seven human studies met the selection criteria, including case-control studies, case-series and one case report. In all studies, intra-articular injection of autologous fat in osteoarthritic thumb CMCJ provided reduction in pain and improvement in hand function. Grip and pinch strength showed variable results, from no change to significant improvement. Fat-processing techniques were based on centrifugation and mechanical homogenization but biological characterization of the injected cells was not performed in any study. Although the results are encouraging, a uniformly standardized method of fat processing and the conduction of randomized controlled trials in the future could better evaluate the effectiveness of this procedure for thumb CMCJ osteoarthritis.
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Affiliation(s)
- Eleni Karagergou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
- Correspondence: ; Tel.: +30-69-7238-6716
| | - Theodora Ligomenou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
| | - Byron Chalidis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
| | - Sophia Papadopoulou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
| | - Panagiotis Givissis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
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[Minimally invasive procedures in the early stages of trapeziometacarpal joint osteoarthritis : Denervation, arthroscopy and autologous fat transplantation]. DER ORTHOPADE 2022; 51:13-22. [PMID: 35015097 DOI: 10.1007/s00132-021-04198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Resection arthroplasty of the trapezium with or without tendon interposition is the standard procedure in the treatment of advanced, symptomatic thumb carpometacarpal joint osteoarthritis. Treatment recommendation in the early stages without visible or minimal radiographic changes is often difficult, especially when conservative treatment methods have already been exhausted. In these cases, there is the possibility of the minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation. OBJECTIVES Which minimally invasive procedures are available for the treatment of thumb carpometacarpal joint osteoarthritis and how is their value to be assessed? METHODS The minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation for the treatment of thumb carpometacarpal joint osteoarthritis are described and current results from the literature are discussed. RESULTS Good results have been reported with all three procedures. However, the reports are almost exclusively based on retrospective studies with small numbers of patients, which lack control groups, so the results cannot be regarded as definitive. CONCLUSIONS Denervation, arthroscopic procedures and autologous fat transplantation appear to be suitable methods in the early stages of thumb carpometacarpal joint osteoarthritis. Further studies, especially comparative randomised trials that report medium and long-term results, would allow further assessment of these methods.
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Messina JC, Torretta F, Randelli PS. Autologous chondrocyte transplantation in the treatment of thumb CMC joint osteoarthritis. HAND SURGERY & REHABILITATION 2021; 40S:S21-S28. [PMID: 33486105 DOI: 10.1016/j.hansur.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Degenerative thumb carpometacarpal (CMC) joint osteoarthritis is a common disease in women starting at 40-50 years of age. Nevertheless, synovitis and initial cartilage damage start earlier, and then degenerative arthritis develops leading to joint narrowing with progressive exposure of subchondral bone, subluxation, osteophyte formation and joint deformity that can impact the surrounding joints. The aim of this study was to evaluate the outcome of patients treated with autologous chondrocyte transplantation at the thumb CMC joint at early stages. A prospective study on 10 cases of thumb CMC osteoarthritis in 8 patients was done. The thumbs were stage Eaton II (2 cases) and III (8 cases) and were treated by CMC arthroplasty with the implant of autologous chondrocytes by an open or arthroscopic technique. Two patients were treated bilaterally. Preoperatively all patients had persistent pain resistant to various kinds of nonoperative treatments for at least 1 year. Mean preoperative pinch strength was 3.7 Kg pain on VAS was 8, DASH was 55. All patients had limited abduction and flexion at the end range. Ethics committee approval was obtained for this study. Fragments of 3-4 mm of cartilage were harvested by arthroscopy or by an open technique from the wrist or elbow joint. Cartilage cells were sent to the laboratory to be grown on a collagenous biphasic matrix (MACI/Novocart®). After 3 weeks, the chondrocyte augmented scaffold was ready to be implanted in the thumb CMC joint, or frozen for a second operation later. All patients were females aged 42-67 years (mean 52 years). The dominant hand was treated in 6 cases. In 7 cases, the patients were operated with an open technique and in three cases by arthroscopy. Partial trapezium resection and dorsoradial ligament reconstruction was added to stabilize the CMC joint in most cases. Patients were seen in person at 1, 3, and 6, months, 1 year, 2 years, and 5 years after the initial surgery. Patients (nine thumbs) were then reviewed at a mean follow up 8 years (range 4.4-11 years); pain on VAS, Mayo, DASH and PRWE scores were evaluated at follow-up. One patient was lost to follow-up after 2 years. Of those nine hands, seven had an excellent result according to Mayo score, one had a good result. One thumb CMC joint was still painful and was reoperated and converted to arthroplasty after 4.4 years. All patients regained full range of motion. Mean pinch strength increased to 6.25 ± 1.3 Kg, mean DASH score was 7.3 ± 6.7; pain on VAS was 1.0 ± 1.5; these data were statistically significant compared to preoperative values (p < 0.01). Grip strength also increased in all cases, but this was not statistically significant. PRWE was 7.7 ± 6.4. No complications occurred postoperatively. The results obtained are encouraging since the implanted cartilage has lasted a mean of 8 years and up to 11 years. Biological tissue engineering techniques are being developed and could be a new solution to restore normal cartilage in young patients to postpone more aggressive surgical procedures until an older age. In cases of CMC joint instability, a ligament stabilization procedure was added to avoid subsequent damage to the implanted neocartilage. A longer follow-up and a greater number of cases are necessary to definitively establish the usefulness of this procedure, which has the advantage of being completely biological but the disadvantage of being costly.
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Affiliation(s)
- J C Messina
- First Orthopedic Clinic, University of Milan, Gaetano Pini Orthopedic Institute- CTO Orthopedic and Traumatology Centre, Via Gaetano Pini, 9, 20122 Milano MI, Italy.
| | - F Torretta
- Former Head of Hand Surgery Unit - Gaetano Pini Ortohopaedic Institute Milano, MI Italy
| | - P S Randelli
- First Orthopedic Clinic, University of Milan, Gaetano Pini Orthopedic Institute- CTO Orthopedic and Traumatology Centre, Via Gaetano Pini, 9, 20122 Milano MI, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences, University of Milan, Via Gaetano Pini, 9, 20122 Milano MI, Italy
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Froschauer SM, Holzbauer M, Wenny R, Schmidt M, Huemer GM, Kwasny O, Duscher D. Autologous Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis (Liparthroplasty): A Case Series with Two Years of Follow-UP. J Clin Med 2020; 10:jcm10010113. [PMID: 33396314 PMCID: PMC7795524 DOI: 10.3390/jcm10010113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 01/22/2023] Open
Abstract
Adipose-derived mesenchymal stem cell (ASC) therapy is currently a focus of regenerative medicine. Lipoaspirate is rich in ASCs and is evolving into a promising, less-invasive tool to treat thumb carpometacarpal osteoarthritis as compared with common surgical techniques, for example, trapeziectomy or prosthesis implantation. The present study aimed to examine the effect of 1 mL intraarticular lipoaspirate injection (liparthroplasty) in 31 thumb carpometacarpal osteoarthritis patients (27 woman and four men) with a median age of 58 (interquartile range (IQR) of 10) years and Eaton–Littler Stage 2 or 3. Median pain levels assessed via visual analogue scale significantly decreased from 7 (IQR 2) to 4 (IQR 6) after six months (p < 0.0001) and 2 (IQR 5) after two years (p < 0.0001). Median pre-interventional Disabilities of the Arm, Shoulder and Hand (DASH) scores of 59 (IQR 26) significantly reduced to a value of 40 (IQR 43) after six months (p = 0.004) and to 35 (IQR 34) after two years (p < 0.0001). Subjective grip strength showed no significant improvement. However, the time until recurrence of symptoms was measured and a cumulative remission rate of 58% was detected after two years. Satisfaction rates were 68% after six months and 51% after two years. In conclusion, liparthroplasty represents a promising option to reduce pain and functional impairment and to postpone surgery for a certain period of time.
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Affiliation(s)
- Stefan M. Froschauer
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (M.H.); (O.K.)
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria;
- Correspondence: ; Tel.: +43-732-780673992
| | - Matthias Holzbauer
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (M.H.); (O.K.)
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria;
| | - Raphael Wenny
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (R.W.); (G.M.H.); (D.D.)
| | - Manfred Schmidt
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria;
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (R.W.); (G.M.H.); (D.D.)
| | - Georg M. Huemer
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (R.W.); (G.M.H.); (D.D.)
| | - Oskar Kwasny
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (M.H.); (O.K.)
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria;
| | - Dominik Duscher
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (R.W.); (G.M.H.); (D.D.)
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076 Tuebingen, Germany
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Bonetti MA, Rovere G, Fulchignoni C, De Santis V, Ziranu A, Maccauro G, Pataia E. Autologous fat transplantation for the treatment of trapeziometacarpal joint osteoarthritis. Orthop Rev (Pavia) 2020; 12:8666. [PMID: 32913600 PMCID: PMC7459373 DOI: 10.4081/or.2020.8666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Rhizarthrosis is a progressive and disabling pathology affecting the carpometacarpal joint. It’s very common in elderly patients and typically affects postmenopausal women. The diagnosis of rhizarthrosis is mainly made by using different physical examination tests and by evaluating the type of pain and it’s then confirmed by imaging. Over the last few years increasing attention has been devoted to the assessment of new treatment techniques for rhizarthrosis. In this context intra-articular injection of autologous fat grafting for cartilage regeneration has demonstrated promising results in experimental settings as an alternative to open surgery procedures. The aim of this study was therefore to sum up the evidences available so far on autologous fat grafting as an emerging treatment for patients affected by carpometacarpal rizarthrosis. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using “fat grafting”, “fat graft”, “adipose”, “fat transfer” and “lipoaspirate” as search terms. Authors believe autologous fat grafting is an interesting technique, that hand surgeon should keep in mind especially in early stages of rhizarthrosis were pain has not been solved with non-surgical treatment.
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Affiliation(s)
- Mario Alessandri Bonetti
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Camillo Fulchignoni
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Vincenzo De Santis
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giulio Maccauro
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Elisabetta Pataia
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
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Pavarotti GS, Hivernaud V, Brincin M, Roche R, Barreau P, Festy F, Gauthier O. Evaluation of a Single Intra-Articular Injection of Autologous Adipose Tissue for the Treatment of Osteoarthritis: A Prospective Clinical Study in Dogs. Vet Comp Orthop Traumatol 2020; 33:258-266. [PMID: 32316062 DOI: 10.1055/s-0040-1708524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the safety, feasibility and clinical efficacy of a single intra-articular injection of autologous and purified micro-fragmented adipose tissue for the treatment of osteoarthritis (OA) in dogs. STUDY DESIGN Twenty-one client-owned dogs with radiographically confirmed OA were recruited into this prospective study. Lameness and discomfort were evaluated by physical examination at day 0 and then 14, 30, 60 and 180 days after injection. Kinetic data and temporospatial parameters were obtained using a pressure-sensing walkway. Peak vertical force, vertical impulse and percentages of body weight distribution were determined. Owner perception data regarding their own dog's physical activity were also collected using the Canine Brief Pain Inventory. RESULTS Radiographic scores for OA from days 0 to 180 were similar, except in two dogs. No major side effects were noted after injection. Lameness and Canine Brief Pain Inventory scores were significantly lower at all time points compared with day 0. Post-injection results demonstrated gradual improvement of kinetic data up to day 180 compared with pre-treatment values: vertical impulse (>2.25%), peak vertical force (>5.32%) and percentages of body weight distribution (>3.6%). In dogs with elbow OA, gait analysis values significantly increased at all time points compared with day 0. CONCLUSION Regenerative autologous adipose tissue injection therapy is a promising alternative to traditional analgesics treatment in patients with OA, associated with significant reductions in pain and lameness, delayed disease progression and improved quality of life.
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Affiliation(s)
- Greta S Pavarotti
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes Atlantic College of Veterinary Medicine, Nantes, France
| | - Vincent Hivernaud
- Stemcis Cyroi, 2 rue Maxime Rivière, 97490 Ste Clotilde, Ste Clotilde, France
| | - Mélanie Brincin
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes Atlantic College of Veterinary Medicine, Nantes, France
| | - Régis Roche
- Stemcis Cyroi, 2 rue Maxime Rivière, 97490 Ste Clotilde, Ste Clotilde, France
| | - Pierre Barreau
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes Atlantic College of Veterinary Medicine, Nantes, France
| | - Franck Festy
- Stemcis Cyroi, 2 rue Maxime Rivière, 97490 Ste Clotilde, Ste Clotilde, France
| | - Olivier Gauthier
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes Atlantic College of Veterinary Medicine, Nantes, France
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Development of Autologous Platelet-Rich Plasma Mixed-Microfat as an Advanced Therapy Medicinal Product for Intra-Articular Injection of Radio-Carpal Osteoarthritis: From Validation Data to Preliminary Clinical Results. Int J Mol Sci 2019; 20:ijms20051111. [PMID: 30841510 PMCID: PMC6429478 DOI: 10.3390/ijms20051111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
Wrist osteoarthritis (OA) is one of the most common conditions encountered by hand surgeons with limited efficacy of non-surgical treatments. The purpose of this study is to describe the Platelet-Rich Plasma (PRP) mixed-microfat biological characteristics of an experimental Advanced Therapy Medicinal Product (ATMP) needed for clinical trial authorization and describe the clinical results obtained from our first three patients 12 months after treatment (NCT03164122). Biological characterization of microfat, PRP and mixture were analysed in vitro according to validated methods. Patients with stage four OA according to the Kellgren Lawrence classification, with failure to conservative treatment and a persistent daily painful condition >40 mm according to the visual analog scale (VAS) were treated. Microfat-PRP ATMP is a product with high platelet purity, conserved viability of stromal vascular fraction cells, chondrogenic differentiation capacity in vitro and high secretion of IL-1Ra anti-inflammatory cytokine. For patients, the only side effect was pain at the adipose tissue harvesting sites. Potential efficacy was observed with a pain decrease of over 50% (per VAS score) and the achievement of minimal clinically important differences for DASH and PRWE functional scores at one year in all three patients. Microfat-PRP ATMP presented a good safety profile after an injection in wrist OA. Efficacy trials are necessary to assess whether this innovative strategy could delay the necessity to perform non-conservative surgery.
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