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Vial R, Orrego M, Espinosa J, Besa P, Irarrázaval S. The distance between the fibular collateral ligament tunnel and the common peroneal nerve allows a posterolateral corner reconstruction without neurolysis. Int Orthop 2024; 48:705-709. [PMID: 37792015 DOI: 10.1007/s00264-023-05995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The most popular knee posterolateral corner (PLC) reconstruction techniques describe that a common peroneal nerve (CPN) neurolysis must be done to safely address the posterolateral aspect of the knee. The purpose of this study was to measure the distance between the CPN and the fibular insertion of the FCL in different degrees of knee flexion in cadaveric specimens, to identify if tunnel drilling could be done anatomically and safely without a CPN neurolysis. METHODS Ex vivo experimental analytical study. Ten fresh frozen human knees were dissected leaving FCL and CPN in situ. Shortest distance from the centre of the FCL distal tunnel and CPN was measured (antero-posterior and proximal-distal wire-nerve distances) at 90°, 60°, 30°, and 0° of knee flexion. Measurements between different flexion angles were compared and correlation between knee flexion angle and distance was identified. RESULTS The mean distance between the FCL tunnel and the CPN at 90° were 21.15 ± 6.74 mm posteriorly (95% CI: 16.33-25.97) and 13.01 ± 3.55 mm distally (95% CI: 10.47-15.55). The minimum values were 9.8 mm posteriorly and 8.9 mm, respectively. These distances were smaller at 0° (p ≤ 0.017). At 90° of knee flexion, the mean distance from the fibular tip to the CPN distally was 23.46 ± 4.13 mm (20.51-26.41). CONCLUSION Anatomic localization and orientation of fibular tunnels can be done safely while avoiding nerve neurolysis. Further studies should aim to in vivo measurements and results.
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Affiliation(s)
- Raimundo Vial
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile
| | - Mario Orrego
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile
| | - Julio Espinosa
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile
| | - Pablo Besa
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile
| | - Sebastián Irarrázaval
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile.
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Razavi-Shearer D, Child H, Razavi-Shearer K, Voeller A, Razavi H, Buti M, Tacke F, Terrault N, Zeuzem S, Abbas Z, Aghemo A, Akarca U, Al Masri N, Alalwan A, Blomé MA, Jerkeman A, Aleman S, Kamal H, Alghamdi A, Alghamdi M, Alghamdi S, Al-Hamoudi W, Ali E, Aljumah A, Altraif I, Amarsanaa J, Asselah T, Baatarkhuu O, Babameto A, Ben-Ari Z, Berg T, Biondi M, Braga W, Brandão-Mello C, Brown R, Brunetto M, Cabezas J, Cardoso M, Martins A, Chan H, Cheinquer H, Chen CJ, Yang HI, Chen PJ, Chien CH, Chuang WL, Garza LC, Coco B, Coffin C, Coppola N, Cornberg M, Craxi A, Crespo J, Cuko L, De Ledinghen V, Duberg AS, Etzion O, Ferraz M, Ferreira P, Forns X, Foster G, Fung J, Gaeta G, García-Samaniego J, Genov J, Gheorghe L, Gholam P, Gish R, Glenn J, Hamid S, Hercun J, Hsu YC, Hu CC, Huang JF, Idilman R, Jafri W, Janjua N, Jelev D, Jia J, Kåberg M, Kaita K, Kao JH, Khan A, Kim D, Kondili L, Lagging M, Lampertico P, Lázaro P, Lazarus J, Lee MH, Yang HI, Lim YS, Lobato C, Macedo G, Marinho R, Marotta P, Mendes-Correa M, Méndez-Sánchez N, Navas MC, Ning Q, Örmeci N, Orrego M, Osiowy C, Pan C, Pessoa M, Piracha Z, Pop C, Qureshi H, Raimondo G, Ramji A, Ribeiro S, Ríos-Hincapié C, Rodríguez M, Rosenberg W, Roulot D, Ryder S, Saeed U, Safadi R, Shouval D, Sanai F, Sanchez-Avila J, Santantonio T, Sarrazin C, Seto WK, Seto WK, Simonova M, Tanaka J, Tergast T, Tsendsuren O, Valente C, Villalobos-Salcedo J, Waheed Y, Wong G, Wong V, Yip T, Wong V, Wu JC, Yang HI, Yu ML, Yuen MF, Yurdaydin C, Zuckerman E. Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories. J Hepatol 2024; 80:232-242. [PMID: 38030035 DOI: 10.1016/j.jhep.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND & AIMS Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. METHODS We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. RESULTS After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. CONCLUSIONS We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. IMPACT AND IMPLICATIONS There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.
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Irarrázaval S, Besa P, Fernández T, Fernández F, Donoso R, Tuca MJ, Lira MJ, Orrego M. Tibial tubercle to trochlear groove and the roman arch method for tibial tubercle lateralisation are reliable and distinguish between subjects with and without major patellar instability. J ISAKOS 2024:S2059-7754(24)00006-3. [PMID: 38228271 DOI: 10.1016/j.jisako.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE Patellofemoral (PF) instability recurrence depends on several factors including the relative lateralisation of tibial tubercle (TT) regarding the trochlear groove (TG). TT relative lateralisation quantification has long been a topic of debate. Multiple measuring techniques have been described including TT-trochlear groove (TT-TG), TT-posterior cruciate ligament (TT-PCL) and TT-roman arch (TT-RA), with no clear consensus regarding the most reliable index or pathologic threshold. We set out to determine the normal value range of each index and their association with age, sex and PF instability status. Also, this study aims to determine a reliable pathologic distance threshold to effectively predict patellar dislocation. METHODS Skeletally mature patients up to 45 years of age who presented a CT Scan and an MRI of the same knee between 2014 and 2018 were included and divided into subgroups based on history of PF instability. Three indexes (TT-TG, TT-PCL and TT-RA) were assessed by two independent observers blinded to instability history. ROC curves were performed for each index to obtain the cut point that better predicts instability. Univariate and multivariate models adjusted by age, sex, instability history and type of imaging technique were performed to test the influence of these variables. RESULTS 208 patients were included. Mean age was 27.93 ± 8.48 years, 67.3% were female and 71 patients (34.1%) presented major instability history. Good or excellent inter and intraobserver reliability was found for all three indexes. All indexes presented significantly different distributions between subjects with and without major instability (p < 0.001), except for TT-PCL. Different cut point values differing between imaging modalities were found: 11.4 mm for MRI TT-TG, 17 mm for CT TT-TG, 15.6 mm for MRI TT-RA and 18.2 mm for CT TT-RA. CONCLUSIONS All indexes studied had good or excellent inter and intraobserver reliability. Measurements between imaging techniques (CT and MR) are not interchangeable. Both TT-TG and TT-RA correctly distinguish between subjects with and without major instability, while TT-PCL does not, recommending caution when evaluated on its own. Specific threshold values depending on imaging technique should be considered for surgical decision-making. LEVEL OF EVIDENCE Level IV, Diagnostic Test.
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Affiliation(s)
- Sebastián Irarrázaval
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - Pablo Besa
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile.
| | - Tomás Fernández
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - Francisco Fernández
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - Rodrigo Donoso
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - María Jesús Tuca
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - María Jesús Lira
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - Mario Orrego
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
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Lira MJ, Besa P, Irarrázaval S, Ruz C, Walbaum C, Montecinos C, Amenábar D, Orrego M. Evaluation of the Chilean National Orthopaedic Examination Over 11 Years: Progress and Outcomes of National and International Examinees. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00007. [PMID: 38252551 PMCID: PMC10805422 DOI: 10.5435/jaaosglobal-d-23-00168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/19/2023] [Accepted: 11/26/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION The National Orthopaedics Examination (EMNOT) was initially designed for Chilean orthopaedic program graduates and is now a crucial component of the revalidation process for international orthopaedic surgeons seeking practice in Chile. This study aims to describe participation and performance of EMNOT examinees based on their origin and to analyze the difficulty and discrimination indexes during its first 11 years of implementation. METHODS A retrospective assessment was conducted on all EMNOT results from 2009 to 2019. The study evaluated the participation and performance of examinees according to their origin and examined the difficulty and discrimination indexes of the examination. RESULTS A total of 975 examinees were evaluated, with 41.23% from national resident programs (National Medical Graduates) and 58.77% from international examinees (International Medical Graduates). The number of participating universities increased from 4 in 2009 to 17 in 2019. National Medical Graduates examinees achieved a mean score of 66.52 ± 8.67 (0 to 100 points) while International Medical Graduates examinees scored 55.13 ± 11.42 (P < 0.001). The difficulty and discrimination indexes remained adequate throughout this period. DISCUSSION Over the course of 11 years, the number of EMNOT examinees exhibited notable growth. The examination effectively differentiates between candidates based on their origin and maintains appropriate levels of difficulty and discrimination.
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Affiliation(s)
- María Jesús Lira
- From the Orthopedics Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (Dr. Lira, Dr. Besa, Dr. Irarrázaval, Dr. Ruz, Dr. Walbaum, and Dr. Orrego); the Teaching Committee Chilean Society of Orthopedics (Ms. Montecinos); and the Orthopedics Department, Faculty of Medicine, Universidad de los Andes, Santiago, Chile (Dr. Amenábar)
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Besa P, Vega R, Ledermann G, Calvo C, Angulo M, Lira MJ, Vidal C, Orrego M, Irribarra L, Espinosa J, Vial R, Irarrázaval S. Tibial Cut Accuracy in Mechanically Aligned Total Knee Arthroplasty Using Extensor Hallucis Longus Tendon to Determine Extramedullary Tibial Guide Position. J Knee Surg 2022; 35:1280-1284. [PMID: 33450776 DOI: 10.1055/s-0040-1722625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aimed to determine the tibial cut (TC) accuracy using extensor hallucis longus (EHL) tendon as an anatomical landmark to position the total knee arthroplasty (TKA) extramedullary tibial guide (EMTG), and its impact on the TKA mechanical alignment (MA). We retrospectively studied 96 TKA, performed by a single surgeon, using a femoral tailored intramedullary guide technique. Seventeen were prior to the use of the EHL and 79 used the EHL tendon to position the EMTG. We analyzed preoperative and postoperative standing total lower extremity radiographs to determine the tibial component angle (TCA) and the correction in MA, comparing pre-EHL use and post-EHL technique incorporation. Mean TCA was 88.89 degrees and postoperative MA was neutral in 81% of patients. Pre- and postoperative MAs were not correlated. As a conclusion of this study, using the EHL provides a safe and easy way to determine the position of EMTG.
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Affiliation(s)
- Pablo Besa
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rafael Vega
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gerardo Ledermann
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Calvo
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuela Angulo
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Jesús Lira
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Vidal
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mario Orrego
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Irribarra
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julio Espinosa
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Raimundo Vial
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Irarrázaval
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Orrego M, Besa P, Orrego F, Amenabar D, Vega R, Irribarra L, Espinosa J, Vial R, Phillips V, Irarrázaval S. Medial opening wedge high tibial osteotomy: more than ten years of experience with Puddu plate technique supports its indication. Int Orthop 2020; 44:2021-2026. [PMID: 32474719 DOI: 10.1007/s00264-020-04614-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the short-term and long-term results of patients who underwent a medial opening wedge high tibial osteotomy (MOW-HTO) for unicompartmental medial knee joint osteoarthritis. METHODS A retrospective review was conducted of patients with MOW-HTO using a Puddu plate®, with more than ten year follow-up. The degree of correction, initial chondral damage, number of meniscal lesions, preoperative and 1-year postoperative functional scale scores (IKDC and Lysholm), and arthroplasty conversion rates at the ten year follow-up were registered. We assumed early indication when patients underwent the operation before they were 40 years old and delayed ≥ 40. Functional outcomes were analyzed by adjusting for pre-operative values. Fisher's exact test was used to study the association between the arthroplasty conversion rates and the timing of indication. RESULTS Fifty-five patients were included, 37 of whom were male (67%). Twenty-nine patients had early indications for surgery (53%). All patients completed ten year follow-up. All patients improved IKDC (p < 0.01) and Lysholm (p < 0.01) scores compared to their presurgical scores at the one year post-operative evaluation. We had six minor complications, none requiring revision surgery. We had three conversions to arthroplasty, all in the late indication group, not statistically significant different. Linear regression showed that early indication was associated with a higher IKDC score when adjusting for the Outerbridge chondral damage score, the number of meniscal lesions, and sex (p < 0.01). CONCLUSION All patients improved functional scores one year after surgery. Early indication (i.e., younger than 40 years of age) was independently associated with better functional outcomes than late indication at one year follow-up.
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Affiliation(s)
- M Orrego
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Besa
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Orrego
- School of Medicine, Universidad de Los Andes, Santiago, Chile
| | - D Amenabar
- Departament of Orthopedic Surgery, School of Medicine, Universidad de los Andes, Santiago, Chile
| | - R Vega
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Irribarra
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Espinosa
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Vial
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - V Phillips
- School of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Sebastián Irarrázaval
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Matas J, Orrego M, Amenabar D, Infante C, Tapia-Limonchi R, Cadiz MI, Alcayaga-Miranda F, González PL, Muse E, Khoury M, Figueroa FE, Espinoza F. Umbilical Cord-Derived Mesenchymal Stromal Cells (MSCs) for Knee Osteoarthritis: Repeated MSC Dosing Is Superior to a Single MSC Dose and to Hyaluronic Acid in a Controlled Randomized Phase I/II Trial. Stem Cells Transl Med 2018; 8:215-224. [PMID: 30592390 PMCID: PMC6392367 DOI: 10.1002/sctm.18-0053] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/20/2018] [Indexed: 12/18/2022] Open
Abstract
Knee osteoarthritis (OA) is a leading cause of pain and disability. Although conventional treatments show modest benefits, pilot and phase I/II trials with bone marrow (BM) and adipose‐derived (AD) mesenchymal stromal cells (MSCs) point to the feasibility, safety, and occurrence of clinical and structural improvement in focal or diffuse disease. This study aimed to assess the safety and efficacy of the intra‐articular injection of single or repeated umbilical cord‐derived (UC) MSCs in knee OA. UC‐MSCs were cultured in an International Organization for Standardization 9001:2015 certified Good Manufacturing Practice‐type Laboratory. Patients with symptomatic knee OA were randomized to receive hyaluronic acid at baseline and 6 months (HA, n = 8), single‐dose (20 × 106) UC‐MSC at baseline (MSC‐1, n = 9), or repeated UC‐MSC doses at baseline and 6 months (20 × 106 × 2; MSC‐2, n = 9). Clinical scores and magnetic resonance images (MRIs) were assessed throughout the 12 months follow‐up. No severe adverse events were reported. Only MSC‐treated patients experienced significant pain and function improvements from baseline (p = .001). At 12 months, Western Ontario and Mc Master Universities Arthritis Index (WOMAC‐A; pain subscale) reached significantly lower levels of pain in the MSC‐2‐treated group (1.1 ± 1.3) as compared with the HA group (4.3 ± 3.5; p = .04). Pain Visual Analog scale was significantly lower in the MSC‐2 group versus the HA group (2.4 ± 2.1 vs. 22.1 ± 9.8, p = .03) at 12 months. For total WOMAC, MSC‐2 had lower scores than HA at 12 months (4.2 ± 3.9 vs. 15.2 ± 11, p = .05). No differences in MRI scores were detected. In a phase I/II trial (NCT02580695), repeated UC‐MSC treatment is safe and superior to active comparator in knee OA at 1‐year follow‐up. stem cells translational medicine2019;8:215&224
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Affiliation(s)
- Jose Matas
- Department of Orthopedic Surgery, Universidad de los Andes, Santiago, Chile
| | - Mario Orrego
- Department of Orthopedic Surgery, Universidad de los Andes, Santiago, Chile
| | - Diego Amenabar
- Department of Orthopedic Surgery, Universidad de los Andes, Santiago, Chile
| | | | - Rafael Tapia-Limonchi
- Cells for Cells & Consorcio Regenero, Santiago, Chile.,Program for Translational Research in Cell Therapy, Universidad de los Andes, Santiago, Chile
| | | | - Francisca Alcayaga-Miranda
- Cells for Cells & Consorcio Regenero, Santiago, Chile.,Program for Translational Research in Cell Therapy, Universidad de los Andes, Santiago, Chile.,Laboratory of Nano-Regenerative Medicine, Universidad de los Andes, Santiago, Chile
| | - Paz L González
- Laboratory of Nano-Regenerative Medicine, Universidad de los Andes, Santiago, Chile
| | - Emilio Muse
- Department of Radiology, Clínica Universidad de los Andes, Santiago, Chile
| | - Maroun Khoury
- Cells for Cells & Consorcio Regenero, Santiago, Chile.,Program for Translational Research in Cell Therapy, Universidad de los Andes, Santiago, Chile.,Laboratory of Nano-Regenerative Medicine, Universidad de los Andes, Santiago, Chile
| | - Fernando E Figueroa
- Program for Translational Research in Cell Therapy, Universidad de los Andes, Santiago, Chile.,Laboratory of Nano-Regenerative Medicine, Universidad de los Andes, Santiago, Chile.,Department of Rheumatology, Universidad de los Andes, Santiago, Chile
| | - Francisco Espinoza
- Cells for Cells & Consorcio Regenero, Santiago, Chile.,Program for Translational Research in Cell Therapy, Universidad de los Andes, Santiago, Chile.,Department of Rheumatology, Universidad de los Andes, Santiago, Chile
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Urrutia J, Orrego M, Wright AC, Amenabar D. An assessment of the Chilean National Examination of Orthopaedic Surgery. BMC Med Educ 2016; 16:78. [PMID: 26925852 PMCID: PMC4772443 DOI: 10.1186/s12909-016-0604-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Chilean National Examination of Orthopaedic Surgery (EMNOT) has been administered since 2009. It was developed to determine whether individual residents are meeting minimal knowledge standards at the end of their training programs. METHODS We performed a retrospective evaluation of the EMNOT for all years it has been administered (2009-2015). The test was analyzed for content, taxonomy of questions asked (1: direct recall; 2: diagnosis; 3: evaluation/decision-making), residents' performance, difficulty index and discrimination index. RESULTS During the years of EMNOT administration, the most frequently tested areas have been pediatric orthopaedics (22.9 %), spine (13.8 %), general orthopaedics (13.8 %) and musculoskeletal trauma (9.9 %). A significant increase in questions with images was observed, as well as a significant decrease in the percentage of Type 1 and an increase in Type 3 questions. The Difficulty Index showed a medium level of difficulty for all years the examination has been administered. The Discrimination Index showed good discrimination in 2009, fair discrimination from 2010 through 2012, and excellent discrimination from 2013 through 2015. CONCLUSION The EMNOT has evolved over several years to include better quality questions, better discrimination, and a more representative distribution of questions covering the different orthopaedic sub-specialties. This examination represents an effective instrument for quality assurance of orthopaedic residency programs in Chile.
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Affiliation(s)
- Julio Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
| | - Mario Orrego
- Department of Orthopaedic Surgery, Universidad de Los Andes, Santiago, Chile
| | - Ana C Wright
- Center of Medical Education, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Diego Amenabar
- Department of Orthopaedic Surgery, Universidad de Los Andes, Santiago, Chile
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Figueroa J, Guarachi JP, Matas J, Arnander M, Orrego M. Is computed tomography an accurate and reliable method for measuring total knee arthroplasty component rotation? International Orthopaedics (SICOT) 2015. [DOI: 10.1007/s00264-015-2917-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Orrego M, Matas J, Abusleme S, Guzmán-Venegas R, Amenabar D. Effect of cyclic tension on the biomechanical properties of flexor tendon grafts. Results of an ex-vivo porcine study. Knee 2014; 21:1029-32. [PMID: 25266942 DOI: 10.1016/j.knee.2014.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/03/2014] [Accepted: 08/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Autologous flexor tendons are widely used for anterior cruciate ligament (ACL) reconstruction. Pretension of the graft before fixation has been described as part of the surgical technique, nevertheless there is no consensus on the type and amount to tension needed to increase the stiffness without affecting its biomechanical properties.Our hypothesis is cyclic tension increases flexor tendon stiffness without affecting its ultimate failure at maximum loads (UFML). METHODS Forty-five flexor digitorum profundus tendons harvested from domestic pigs (Sus scrofa domestica) were randomly divided into three groups: E1 (n=15), E2 (n=15) and C (n=15). Groups E1 and E2 were subjected to 50 cyclic loads at a 1 Hz frequency, at 70N and 100N respectively, group C was not intervened. The three groups were then tested for UFML. Cyclic loads and measurements were performed using a Stress-Strain machine (SST 1.0 Kinetecnic). Results were analyzed using GrapgPad statistical software. Groups were compared using Mann-Whitney test with a 95% confidence interval. RESULTS Significant increased stiffness for group E1 (p=0.02) and group E2 ( p<0.01) when compared to group C. The stiffness of group E2 was also significantly higher than E1 (p=0.03). There was a significant reduction on the UFML between group E2 and C (p<0.01), which was not observed when comparing groups E1 and C. CONCLUSION Cyclic loads at 70N result in an increased stiffness of flexor tendons without affecting its ultimate failure at maximum loads. Cyclic loads at higher tensions might cause a deleterious effect on the biomechanical properties of flexor tendon grafts.
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Affiliation(s)
- Mario Orrego
- Department of Orthopedics, Faculty of Medicine, Universidad de los Andes, Santiago, Chile; Knee Surgery Unit, Clínica Dávila, Santiago, Chile; Knee Surgery Unit, Military Hospital, Santiago, Chile
| | - José Matas
- School of Kinesiology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile; Knee Surgery Unit, Clínica Dávila, Santiago, Chile; Knee Surgery Unit, Clínica Meds, Santiago, Chile
| | - Sebastián Abusleme
- Department of Orthopedics, Faculty of Medicine, Universidad de los Andes, Santiago, Chile.
| | | | - Diego Amenabar
- Department of Orthopedics, Faculty of Medicine, Universidad de los Andes, Santiago, Chile; Knee Surgery Unit, Clínica Dávila, Santiago, Chile; Knee Surgery Unit, Military Hospital, Santiago, Chile
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Valenzuela L, Nemtala F, Orrego M, Mardones R, Matas J, Sudy H, Durruty J. Treatment of patellofemoral chondropathy with the Bandi tibial tubercle osteotomy More than 10years follow-up. Knee 2011; 18:94-7. [PMID: 20609588 DOI: 10.1016/j.knee.2010.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 03/22/2010] [Accepted: 03/30/2010] [Indexed: 02/02/2023]
Abstract
Isolated degenerative patellofemoral chondropathy is a prevalent disease. There is still controversy regarding its ideal type of management. A retrospective study was performed to assess the outcomes of 28 patients with a minimum of 10-year follow-up, in whom the Bandi tibial tubercle osteotomy was performed. The Bentley score was applied pre and postoperatively to evaluate the clinical results. Preoperatively, 21 (67%) patients were rated as fair and seven (33%) as poor according to the Bentley functional scale for patellofemoral osteoarthritis. At 5 years of follow-up, one case was rated as excellent, 23 (81%) cases as good, three as fair and one as poor. At 10 years of follow-up no cases were rated as excellent, 17 (61%) cases as good, four (14%) as fair and seven (25%) as poor. The difference in terms of poor results evaluated at five and 10 years after the surgery was statistically significant (p<0.05). We concluded that excellent and good short-term results can be expected with the use of the Bandi tibial tubercle osteotomy in patients with isolated degenerative patellofemoral chondropathy; however, such outcomes tend to deteriorate over the time, especially in patients with advanced chondromalacia, making its indication controversial.
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Affiliation(s)
- Luis Valenzuela
- Department of Orthopaedic Surgery, Hospital Militar de Santiago, Santiago, Chile
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González LA, Orrego M, Ramírez LA, Vásquez G. Primary biliary cirrhosis/autoimmune hepatitis overlap syndrome developing in a patient with systemic lupus erythematosus: a case report and review of the literature. Lupus 2010; 20:108-11. [PMID: 20724352 DOI: 10.1177/0961203310378673] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Biomarkers
- Biopsy
- Comorbidity
- Female
- Hepatitis, Autoimmune/epidemiology
- Hepatitis, Autoimmune/immunology
- Hepatitis, Autoimmune/pathology
- Hepatitis, Autoimmune/physiopathology
- Humans
- Liver/pathology
- Liver Cirrhosis, Biliary/epidemiology
- Liver Cirrhosis, Biliary/immunology
- Liver Cirrhosis, Biliary/pathology
- Liver Cirrhosis, Biliary/physiopathology
- Lupus Erythematosus, Systemic/epidemiology
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/pathology
- Lupus Erythematosus, Systemic/physiopathology
- Middle Aged
- Review Literature as Topic
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Orrego M, Larrain C, Rosales J, Valenzuela L, Matas J, Durruty J, Sudy H, Mardones R. Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel. Arthroscopy 2008; 24:1373-80. [PMID: 19038708 DOI: 10.1016/j.arthro.2008.07.016] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 06/07/2008] [Accepted: 07/16/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine if the use of platelet concentrate (PC) and bone plug (BP) does accelerate the healing process in anterior cruciate ligament (ACL) reconstruction. METHODS One hundred and eight patients requiring ACL reconstruction were prospectively randomized into 4 groups: control (27 patients), PC (26 patients), BP (28 patients), and a combination of PC and BP (27 patients). Magnetic resonance imaging (MRI) studies were carried out at both 3 and 6 months postsurgery. Maturation of the graft was evaluated at the femoral tunnel using MRI maturation criteria defined by a low-intensity signal, absence of osteoligamentous interface, and no widening of the femoral tunnel. RESULTS Three months after surgery, no differences were found among the groups regarding MRI maturation criteria. Six months postsurgery, 78% of the patients in the control group had a low-intensity signal, while in the PC group the low-intensity signal was present in 100% of the patients (P = .036). No statistical differences were observed regarding the osteoligamentous interface between the various groups. Finally, tunnel widening was seen in 11% of the patients of the BP group versus 41% of the patients in the control group (P = .047), but no statistical difference was seen with the other groups. CONCLUSIONS The use of PC had an enhancing effect on the graft maturation process evaluated only by MRI signal intensity, without showing any significant effect in the osteoligamentous interface or tunnel widening evolution. The use of a BP effectively prevented tunnel widening. The BP and PC combination did not show a synergic effect as compared to PC or BP individually. LEVEL OF EVIDENCE Level II, lesser quality randomized controlled trial.
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Affiliation(s)
- Mario Orrego
- Department of Traumatology, Hospital Militar de Santiago, Santiago, Chile.
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Rosales J, Avila E, Orrego M, Cajas AM, Zolezzi A. [Hepatic adenoma rupture as a cause of bleeding in the third trimester of pregnancy: report of a case and review of the literature]. Rev Gastroenterol Peru 2001; 21:312-5. [PMID: 11818993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Anemia and gynecological hemorrhage are common during pregnancy. For this reason an unusual cause of bleeding can pass unnoticed, and a late diagnosis is an important cause of maternal and fetal morbidity and mortality. In this case report we describe the rupture of am hepatic adenoma as cause of abdominal hemorrhage in adolescent pregnant during the labor. The patient didn't have an antecedent of oral contraceptives use; but a has a history of previous spontaneous abortion.
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Affiliation(s)
- J Rosales
- Departamento de Patología, Hospital María Auxiliadora, Peru
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Linossier A, Carvajal P, Donoso E, Orrego M. [Dental fluorosis: quantification of Streptococcus mutans in school children from Mamiña, Chile. A longitudinal study]. Rev Med Chil 1999; 127:1462-8. [PMID: 10835753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND High fluorine concentrations in drinking water are associated with a decrease in the amount of salivary S mutants. Taking into account that clinical dental fluorosis can appear with 1.5 ppm of fluorine in the drinking water, fluorine concentrations in Mamiña is 2.4 ppm. AIM To quantify salivary S mutans in school age children from Mamiña, a zone with a high fluorine content in the drinking water, during one year. MATERIAL AND METHODS During 1997 and 1998, dental health was assessed and salivary samples were obtained from 51 children (27 male) aged 10 +/- 2 years to quantify S mutans. RESULTS Most children studied had more than 10(5) salivary S mutans colony forming units. No changes in the rates of infection or dental health characteristics were observed during the observation year. CONCLUSIONS High fluorine content in the drinking water did not have an effect on salivary S mutans infection in this population.
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Affiliation(s)
- A Linossier
- Departamento de Patología, Facultad de Odontología, Urgencia Hospital Clínico Universidad de Chile.
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