Bone marrow edema and subchondral bone cysts are frequent findings in the various stages of knee osteoarthritis. Typically seen on MRI imaging, once the degenerative process starts, it progresses to severe osteoarthritis and eventually requires knee replacement over time. Herein we report a case of a fifty-four-year-old salesperson who enjoys active sports. He presented with symptomatic right knee osteoarthritis; an MRI scan revealed multiple patellofemoral subchondral bone marrow edema and subchondral cysts with a medial meniscus tear and both medial and patellofemoral cartilage loss together with large baker cyst and synovitis. He failed ultrasoundguided steroid injection but responded dramatically to a single dose of autologous fat-derived expanded mesenchymal stem cells (MSCs) combined with platelet-rich plasma (PRP). He became symptoms-free three months post the therapy. Nine months following the treatment, he remains asymptomatic; a repeat MRI showed a tiny baker cyst and significant reduction of synovitis due to an anti-inflammatory effect of MSCs. A follow-up MRI thirty-three months post-therapy revealed full resolution of both bone marrow edema and multiple subchondral patellofemoral bone cysts. This case represents a successful clinical and radiological outcome following a single expanded mesenchymal stem cell therapy for knee osteoarthritis.
{"title":"Resolution of Patellofemoral Bone Marrow Edema and Subchondral Cysts on MRI Post a Single Autologous Fat-Derived Expanded Mesenchymal Stem Cell Therapy","authors":"H. Mubark","doi":"10.37722/aoasm.2021501","DOIUrl":"https://doi.org/10.37722/aoasm.2021501","url":null,"abstract":"Bone marrow edema and subchondral bone cysts are frequent findings in the various stages of knee osteoarthritis. Typically seen on MRI imaging, once the degenerative process starts, it progresses to severe osteoarthritis and eventually requires knee replacement over time. Herein we report a case of a fifty-four-year-old salesperson who enjoys active sports. He presented with symptomatic right knee osteoarthritis; an MRI scan revealed multiple patellofemoral subchondral bone marrow edema and subchondral cysts with a medial meniscus tear and both medial and patellofemoral cartilage loss together with large baker cyst and synovitis. He failed ultrasoundguided steroid injection but responded dramatically to a single dose of autologous fat-derived expanded mesenchymal stem cells (MSCs) combined with platelet-rich plasma (PRP). He became symptoms-free three months post the therapy. Nine months following the treatment, he remains asymptomatic; a repeat MRI showed a tiny baker cyst and significant reduction of synovitis due to an anti-inflammatory effect of MSCs. A follow-up MRI thirty-three months post-therapy revealed full resolution of both bone marrow edema and multiple subchondral patellofemoral bone cysts. This case represents a successful clinical and radiological outcome following a single expanded mesenchymal stem cell therapy for knee osteoarthritis.","PeriodicalId":7354,"journal":{"name":"Advances in Orthopedics and Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91246440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tendon rupture occurs when sudden forces apply upon the Achilles tendon during vigorous physical activities that involve abrupt pivoting on a foot or fast acceleration. The initial management of Achilles tendon rupture consists of a non-operative approach, but if this fails, operational treatment should take place. This article presents a forty-four-year-old female patient who had a left Achilles tendon rupture during a netball game. Initially was treated conservatively, followed by re-rupturing it spontaneously, which required reconstruction surgery with a tendon transfer. Subsequently, she developed calf muscle weakness and atrophy at the grafted musculoachilles junction. Her manifestations were the inability to perform a single heel raise, impaired recreational activities, and calf muscle wasting and weakness. The Foot & Ankle Disability Index (FADI) score was 74. She elected for a trial of autologous adipose-derived expanded mesenchymal stem cell therapy (MSCs) combined with platelet-rich plasma (PRP). Six months following the treatment, she had a good outcome evidenced by improvement of daily activities, performing heel-raise, and slow running for the first time after several years post reconstruction surgery. Her FADI score rose to 91.3, and six months post-treatment MRI revealed increased signal at the musculo-achilles junction representing a possible healing process. This case suggests successful therapy outcome with a single MSCs and PRP, indicating regenerative therapy could be tried post Achilles rupture surgery when there is calf muscle wasting and weakness.
{"title":"Successful Treatment with Autologous Mesenchymal Stem Cells Therapy for Muscle Wasting Post-Surgical Repair of Achilles Tendon: A Case Report","authors":"H. Mubark","doi":"10.37722/aoasm.2021301","DOIUrl":"https://doi.org/10.37722/aoasm.2021301","url":null,"abstract":"Tendon rupture occurs when sudden forces apply upon the Achilles tendon during vigorous physical activities that involve abrupt pivoting on a foot or fast acceleration. The initial management of Achilles tendon rupture consists of a non-operative approach, but if this fails, operational treatment should take place. This article presents a forty-four-year-old female patient who had a left Achilles tendon rupture during a netball game. Initially was treated conservatively, followed by re-rupturing it spontaneously, which required reconstruction surgery with a tendon transfer. Subsequently, she developed calf muscle weakness and atrophy at the grafted musculoachilles junction. Her manifestations were the inability to perform a single heel raise, impaired recreational activities, and calf muscle wasting and weakness. The Foot & Ankle Disability Index (FADI) score was 74. She elected for a trial of autologous adipose-derived expanded mesenchymal stem cell therapy (MSCs) combined with platelet-rich plasma (PRP). Six months following the treatment, she had a good outcome evidenced by improvement of daily activities, performing heel-raise, and slow running for the first time after several years post reconstruction surgery. Her FADI score rose to 91.3, and six months post-treatment MRI revealed increased signal at the musculo-achilles junction representing a possible healing process. This case suggests successful therapy outcome with a single MSCs and PRP, indicating regenerative therapy could be tried post Achilles rupture surgery when there is calf muscle wasting and weakness.","PeriodicalId":7354,"journal":{"name":"Advances in Orthopedics and Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79368197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Truong, E. Bradley, J. Benito, Jonathan Schneider, Stephen D. Forro, Cindy Ho, F. Stanziola
The purpose of this article is to review the outcomes of surgical fixation of pediatric both bone forearm fractures with intramedullary nailing versus plating in regards to forearm rotation and its effect on athletic performance. The majority of pediatric both bone forearm fractures can be treated nonoperatively with closed reduction and immobilization; however certain displacement parameters will benefit from operative fixation. Controversy exists on whether to fix both bone forearm fractures with intramedullary nailing or with plates and screws. Historically, it has been shown that the decrease in forearm rotation with intramedullary nailing does not affect function when performing activities of daily living, but this does not account for the rotation needed by pediatric athletes to perform specific actions such as shooting a basketball or pitching a baseball. While the more anatomic reduction with plating has led to greater ranges of forearm rotation, there has yet to be a consensus on the preferred treatment in the high demand pediatric athlete. We recommend further research examining the effects of decreased pronosupination on sport-related function in athletes that had undergone surgical intervention for both bone forearm fractures in childhood or adolescence.
{"title":"A Review of Surgical Management Affecting Forearm Rotation after Both Bone Forearm Fracture in the Pediatric Athlete: Plate versus Nail","authors":"P. Truong, E. Bradley, J. Benito, Jonathan Schneider, Stephen D. Forro, Cindy Ho, F. Stanziola","doi":"10.37722/aoasm.20204","DOIUrl":"https://doi.org/10.37722/aoasm.20204","url":null,"abstract":"The purpose of this article is to review the outcomes of surgical fixation of pediatric both bone forearm fractures with intramedullary nailing versus plating in regards to forearm rotation and its effect on athletic performance. The majority of pediatric both bone forearm fractures can be treated nonoperatively with closed reduction and immobilization; however certain displacement parameters will benefit from operative fixation. Controversy exists on whether to fix both bone forearm fractures with intramedullary nailing or with plates and screws. Historically, it has been shown that the decrease in forearm rotation with intramedullary nailing does not affect function when performing activities of daily living, but this does not account for the rotation needed by pediatric athletes to perform specific actions such as shooting a basketball or pitching a baseball. While the more anatomic reduction with plating has led to greater ranges of forearm rotation, there has yet to be a consensus on the preferred treatment in the high demand pediatric athlete. We recommend further research examining the effects of decreased pronosupination on sport-related function in athletes that had undergone surgical intervention for both bone forearm fractures in childhood or adolescence.","PeriodicalId":7354,"journal":{"name":"Advances in Orthopedics and Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88897362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Kay, S. Wolfram, Engel Kerstin, Emmerich Jan, W. Thomas, Casser Hans-Reimund, Marnitz Ulf, S. Ulrich, Michaelis Johannes, Loudovici-Krug Dana
Background: Motor and postural control dysfunctions are hypothesized to be important for the development and clinical course of chronic, non-specific low back pain (cLBP). Objective: Evaluation of the ability of simple, reliable clinical tests to differentiate various aspects motor and postural control between patients with cLBP and healthy controls. Methods: Blinded, cross-sectional control study using clinical tests comparing motor and postural control between patients and healthy controls. Standardized and reliable clinical tests for motor and postural control were applied to patients with cLBPadmitted to different study centers. The quantity of positive findings wascompared to those in healthy controls measured by the same tests. Examiners were blinded regarding patient or control group. Results: We compared the motor and postural control of 46 cLBP patients and 36 healthy controls. Patients with cLBP had significantly more positive pathological tests for movement control (one-leg stance (p 0,006), hip extension, (p<0,001) and breathing pattern (p 0,032)). No significant differences were observed between groups for tests examining postural control. Patients with cLBP had significantly more trigger points in muscles relevant to postural control (pelvic floor; p 0,012). Conclusions: It was found that, in general, cLBP patients have poorer motor and postural control relative to healthy subjects. However, not all patients showed poor motor and postural control. Therefore, MPCD might only be relevant for a subgroup of patients with cLBP. Targeted diagnostic and treatment settings as well as preventive interventions for this subgroup should be the aim of further studies.
{"title":"Motor And Postural Control In Patients With Chronic Nonspecific Low Back Pain: A Blinded And Controlled Cross-Sectional Study Comparing The Quantity Of Motor And Postural Control Disturbances Between Healthy Controls And Patients With Chronic Non-Specific Low Back Pain","authors":"N. Kay, S. Wolfram, Engel Kerstin, Emmerich Jan, W. Thomas, Casser Hans-Reimund, Marnitz Ulf, S. Ulrich, Michaelis Johannes, Loudovici-Krug Dana","doi":"10.37722/aoasm.20205","DOIUrl":"https://doi.org/10.37722/aoasm.20205","url":null,"abstract":"Background: Motor and postural control dysfunctions are hypothesized to be important for the development and clinical course of chronic, non-specific low back pain (cLBP). Objective: Evaluation of the ability of simple, reliable clinical tests to differentiate various aspects motor and postural control between patients with cLBP and healthy controls. Methods: Blinded, cross-sectional control study using clinical tests comparing motor and postural control between patients and healthy controls. Standardized and reliable clinical tests for motor and postural control were applied to patients with cLBPadmitted to different study centers. The quantity of positive findings wascompared to those in healthy controls measured by the same tests. Examiners were blinded regarding patient or control group. Results: We compared the motor and postural control of 46 cLBP patients and 36 healthy controls. Patients with cLBP had significantly more positive pathological tests for movement control (one-leg stance (p 0,006), hip extension, (p<0,001) and breathing pattern (p 0,032)). No significant differences were observed between groups for tests examining postural control. Patients with cLBP had significantly more trigger points in muscles relevant to postural control (pelvic floor; p 0,012). Conclusions: It was found that, in general, cLBP patients have poorer motor and postural control relative to healthy subjects. However, not all patients showed poor motor and postural control. Therefore, MPCD might only be relevant for a subgroup of patients with cLBP. Targeted diagnostic and treatment settings as well as preventive interventions for this subgroup should be the aim of further studies.","PeriodicalId":7354,"journal":{"name":"Advances in Orthopedics and Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73378750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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