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Di Matteo B, Altomare D, Garibaldi R, La Porta A, Manca A, Kon E. Ultrasound-Guided Meniscal Injection of Autologous Growth Factors: A Brief Report. Cartilage 2021; 13:387S-391S. [PMID: 34515536 PMCID: PMC8808951 DOI: 10.1177/19476035211037390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Meniscal degeneration is a common finding even in young patients' knees, and it is regarded as a predictor for the onset of early osteoarthritis (OA). When symptomatic, it represents a challenge since arthroscopic surgery provides unpredictable results: recent evidence has shown that partial meniscectomy is not better than conservative management up to 2 years of follow-up, and the removal of meniscal tissue may accelerate OA progression toward OA. Intra-articular injection of corticosteroids or hyaluronic acid may help in providing temporary symptomatic relief, but no influence should be expected on the quality of the meniscal tissue. Biologic agents have been adopted to treat a variety of degenerative musculoskeletal pathologies, and the use of platelet-derived growth factors (GFs) has become routine. Preclinical studies have documented that platelet-derived GFs may play a beneficial role in stimulating meniscal repair and regeneration by triggering anabolic pathways and stimulating local mesenchymal stem cells from synovium. Furthermore, also mechanical stimulation (e.g., arthroscopic trephination or percutaneous needling) in the red-red or red-white zone may further promote tissue healing. The purpose of the present brief report is to describe the clinical outcomes at 18 months' follow-up in a cohort of patients affected by symptomatic medial meniscus degeneration and treated by percutaneous needling plus intra- and perimeniscal injection of autologous conditioned plasma (ACP). The procedure was shown to be safe and provided significant pain reduction and improvement in subjective scores. This treatment option deserves further investigation in a comparative setting, to establish whether it could offer advantage over isolated intra-articular injections.
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Affiliation(s)
- Berardo Di Matteo
- Department of Biomedical Sciences, Humanitas
University, Milan, Italy,Department of Traumatology, Orthopaedics and
Disaster Surgery, Sechenov First Moscow State Medical University (Sechenov University),
Moscow, Russia,Berardo Di Matteo, Istituto Clinico Humanitas, Via
Manzoni 113, Rozzano, Milano 20089, Italy.
| | - Daniele Altomare
- Department of Biomedical Sciences, Humanitas
University, Milan, Italy,IRCCS Humanitas Research Center, Rozzano
(MI), Italy
| | - Riccardo Garibaldi
- Hôpital du Valais, Service d’Orthopédie et
Traumatologie, Martigny, Switzerland
| | - Agostino La Porta
- Department of Biomedical Sciences, Humanitas
University, Milan, Italy,IRCCS Humanitas Research Center, Rozzano
(MI), Italy
| | - Angelo Manca
- Department of Biomedical Sciences, Humanitas
University, Milan, Italy,IRCCS Humanitas Research Center, Rozzano
(MI), Italy
| | - Elizaveta Kon
- Department of Biomedical Sciences, Humanitas
University, Milan, Italy,IRCCS Humanitas Research Center, Rozzano
(MI), Italy
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Andreani L, Giuntoli M, Addevico F, Aringhieri G, Cosottini M, Marchetti S. The effect of viscosupplementation on early-stage knee osteoarthritis: Clinical evaluation and assessment of cartilage in vivo with 7 T MRI. J Clin Orthop Trauma 2021; 19:53-61. [PMID: 34046300 PMCID: PMC8144354 DOI: 10.1016/j.jcot.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/31/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Viscosupplementation is a well-known strategy for managing early stages knee Osteoarthritis. However, despite its effectiveness in reducing symptoms, it has not yet been found to have an effect on joint cartilage. The aim of this study is to evaluate the clinical efficacy of a new product with gel-like behaviour and its in vivo effects on joint cartilage. METHODS 20 patients were treated by 2 consecutive injections of hyaluronan derivative Hymovis® at one-week interval. Clinical evaluation was performed before the treatment and at each time point during the follow-up using WOMAC and VAS. A 7 T magnet was used for cartilage evaluation at each MRI time point: T2 Relaxation Time (RT), T2∗ RT and cartilage parameters were evaluated before the first injection, after 45 days and at 6 months follow-up. Statistical analysis was obtained for each reported data. RESULTS We report significantly reduction in symptoms with an increase in knee and global activity functions. The T2 RT for lateral tibial compartment and T2∗ RT for Patello-Femoral compartment significantly decreased. A T2 RT reduction was observed in all knee compartments except for the medial tibial one, while a T2∗ RT reduction was observed in all knee compartments. We report an increase in cartilage volume and thickness in most of patients with a reduction of cartilage defects in 9 patients, but we didn't find MRI signals clearly referable to cartilage regeneration. CONCLUSIONS MRI results have confirmed the possibility to employ 7T magnets to evaluate early changes in cartilage structure in vivo. HA VS has provided good clinical outcomes and an improvement in the global assessment of the knee joint, but it doesn't seem to significantly modify the cartilage over the time.
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Affiliation(s)
- Lorenzo Andreani
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Michele Giuntoli
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy,Corresponding author.
| | - Francesco Addevico
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Giacomo Aringhieri
- Radiology Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Mirco Cosottini
- Neuroradiology Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Stefano Marchetti
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
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Akkawi I, Draghetti M, Zmerly H. Degenerative meniscal lesions: Conservative versus surgical management. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021354. [PMID: 35075086 PMCID: PMC8823549 DOI: 10.23750/abm.v92i6.11195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
Degenerative meniscal lesions (DML) typically occur in middle-aged or elderly patients without any history of significant acute trauma. Its prevalence increases with age and are associated with knee osteoarthritis (OA). The most frequent orthopaedic treatment is arthroscopic partial meniscectomy (APM) to relieve pain and functional deficit associated with DML. Nevertheless, several randomised controlled clinical trials recommed against APM as the first-line treatment for managing knee pain in patients affected by DML and no radiographic knee OA that should be reserved for cases of failure after 3 month conservative therapy or earlier in patients with signficant knee mechanical symptoms.
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Affiliation(s)
| | - Maurizio Draghetti
- 1. Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy.
| | - Hassan Zmerly
- 1. Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy.
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Ometti M, Schipani D, Conte P, Pironti P, Salini V. The efficacy of intra-articular HYADD4-G injection in the treatment of femoroacetabular impingement: results at one year follow up. J Drug Assess 2020; 9:159-166. [PMID: 33235816 PMCID: PMC7671711 DOI: 10.1080/21556660.2020.1843860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective Femoroacetabular impingement (FAI) is a condition that has been increasingly recognized as a source of hip pain and a possible risk factor to early development of hip osteoarthritis (OA). To our knowledge, the use of HA in the treatment of femoroacetabular FAI has been investigated only by two studies, both using a high molecular weight HA. The aim of this study was to evaluate the efficacy of two weekly injections of an hexadecylamide derivative of HA (HYADD4-G, HYMOVIS, Fidia Farmaceutici) in FAI. Methods All patients received two weekly intra-articular injections of Hymovis at baseline and after 7 days. Clinical and functional assessments were performed at baseline and was repeated after 1, 3, 6 and 12 months. Functional measures included visual analogue scale (VAS) for pain, Harris Hip score (HHS), Lequesne Index (LI), Tegner activity level scale (TALS) and monthly consumption of nonsteroidal anti-inflammatory drugs (NSAIDs). Results Twenty-one hips (19 patients, 2 bilateral cases) were treated. The variables VAS, HHS as well as Lequesne improved significantly from T0 to T4 (at 12 months) with the best improvement between T0 and T1. At the same time, a reduction in NSAIDs monthly intake was registered. On the other hand, a significant improvement in Tegner scale was not observed. No adverse events were registered. Conclusion This study states that one cycle of HYADD4-G could be a safe and effective treatment in patients with FAI, showing significative results in term of pain control as well as hip functionality and quality of life up to 1 year.
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Affiliation(s)
- Marco Ometti
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Pietro Conte
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Pierluigi Pironti
- Università degli Studi di Milano, Scuola di Specializzazione in Ortopedia e Traumatologia, Milan, Italy
| | - Vincenzo Salini
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute, Milan, Italy
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Berton A, Longo UG, Candela V, Greco F, Martina FM, Quattrocchi CC, Denaro V. Quantitative Evaluation of Meniscal Healing Process of Degenerative Meniscus Lesions Treated with Hyaluronic Acid: A Clinical and MRI Study. J Clin Med 2020; 9:jcm9072280. [PMID: 32709084 PMCID: PMC7408658 DOI: 10.3390/jcm9072280] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose: We aimed to evaluate clinical efficacy and healing effects of conservative management of degenerative meniscus lesions (DMLs) with a hyaluronic acid (HA) hydrogel. Methods: Patients were subjected to two HA injections two weeks apart. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient’s Global Assessment (PtGA) and Clinical Observer Global Assessment (CoGA) of the disease were assessed at baseline, 30, and 60 days after treatment. Short Form (36) Health Survey (SF-36) was assessed at baseline and 60 days after treatment. One year after treatment, patients were called to know whether any of them had undergone arthroscopic partial meniscectomy (APM). All patients underwent magnetic resonance imaging using a 1.5-T Magnetic Resonance Imaging (MRI) scanner (Siemens Aera), which included a T2 mapping pulse sequence with multiple echoes at baseline and 60 days after treatment. Results: 40 patients were enrolled. WOMAC score, physical function subscale, PtGA and CoGA, and SF-36 showed a statistically significant difference between baseline and follow-up. One year after treatment, only one patient had undergone APM. A decrease in the T2 measurement was detected in the posterior horn medial meniscus in 39% of cases in both the red and red–white zone, and in 60% of cases in the white zone; in the posterior horn lateral meniscus in 55% of cases in both the red and white zones, and in 65% of cases in the red–white zone. Only for the latter, there was a statistically significant difference between baseline and posttreatment T2 measurements. Conclusion: This study supports the use of HA in the conservative management of DML as it is clinically effective and enhances meniscus healing as demonstrated by T2 measurements. Moreover, it reduces the need for APM at 1-year follow-up.
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Affiliation(s)
- Alessandra Berton
- Orthopaedic and Trauma Surgery Unit, Campus Bio-Medico University, 00128 Rome, Italy; (A.B.); (V.C.); (V.D.)
| | - Umile Giuseppe Longo
- Orthopaedic and Trauma Surgery Unit, Campus Bio-Medico University, 00128 Rome, Italy; (A.B.); (V.C.); (V.D.)
- Correspondence: ; Tel.: +39-3479330509; Fax: +39-062-2541-1934
| | - Vincenzo Candela
- Orthopaedic and Trauma Surgery Unit, Campus Bio-Medico University, 00128 Rome, Italy; (A.B.); (V.C.); (V.D.)
| | - Federico Greco
- Radiology Unit, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.G.); (F.M.M.); (C.C.Q.)
| | - Francesca Maria Martina
- Radiology Unit, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.G.); (F.M.M.); (C.C.Q.)
| | - Carlo Cosimo Quattrocchi
- Radiology Unit, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.G.); (F.M.M.); (C.C.Q.)
| | - Vincenzo Denaro
- Orthopaedic and Trauma Surgery Unit, Campus Bio-Medico University, 00128 Rome, Italy; (A.B.); (V.C.); (V.D.)
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Resmi R, Parvathy J, John A, Joseph R. Injectable self-crosslinking hydrogels for meniscal repair: A study with oxidized alginate and gelatin. Carbohydr Polym 2020; 234:115902. [DOI: 10.1016/j.carbpol.2020.115902] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/02/2020] [Accepted: 01/20/2020] [Indexed: 12/25/2022]
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