Orthopedic Lesions Research Articles

Potential Factors Influencing Complete Functional Recovery in Traumatized Unowned Cats with Orthopedic Lesions-A Cohort Study.

The management of unowned cats is an emerging problem, with public institutions and citizens' concerns regarding their care and arrangement. Little is known regarding the outcome of traumatic orthopedic injuries in these patients. Indeed, complete functional recovery (CFR) should be the goal of treatment for return to their original location or adoption. The aim was to identify clinical factors influencing CFR in traumatized unowned cats with orthopedic lesions. This category of cats referred by the veterinary public service over three years was enrolled. Various clinical variables were retrospectively collected from the medical records and evaluated by nominal logistic analysis. Forty-eight unowned cats were enrolled, with a median estimated age of 24 (1-180) months and a body weight of 3 (0.7-5) kg. Thirty-four (71%) patients reached CFR. Estimated age, body weight, time from trauma to therapeutic intervention, spine involvement, presence of comorbidities, hospitalization time, and the radiographic score results were significantly associated with CFR. A longer time to therapeutic intervention seemed to be associated with a better outcome. Probably, cats severely traumatized did not live long enough to be evaluated and treated. Lighter cats experienced more severe consequences following blunt trauma. Younger and lighter cats bore a higher risk of panleukopenia-related death.

Evaluation of agreement for radiographic lesions and risk for racing in thoroughbred yearling sale repository radiographs.

The veterinary yearling pre-sale repository radiographs have the potential to impact both vendor and prospective purchaser. The primary aim of this study was to determine inter-observer agreement for orthopaedic lesions identified in thoroughbred yearling repository radiographs. A secondary goal was to determine agreement when using a pre-defined risk rating classification. Three experienced specialist equine surgeons (2 ACVS & 1 FANZCVS) interpreted thirty repository radiographs once each for radiographic abnormalities. Each radiographic abnormality was given an associated risk assessment for future racing performance. The use of a pre-defined risk rating grading scale resulted in good to excellent agreement as observers reached a consensus on risk ratings for lesions 97.1% of the time. The highest agreement was for the proximal interphalangeal joint and distal interphalangeal joint, with 99.9 and 98.2% agreement, respectively. The tarsal region was the joint with the highest disagreement with respect to pathology, with observers disagreeing 5.2% of the time. This study found that experienced veterinary surgeons reliably agreed on the absence of lesions but showed disagreement on the specific risk rating of common lesions.

Radiographic measurements of the hind limbs in capuchin monkeys (Sapajus spp.).

Radiographic measurements are a useful tool to assess skeletal health and development in primates. This study aimed to perform radiographic measurements of hind limbs in capuchin monkeys. Twelve Sapajus spp. were used; ten adults and two sub-adults, nine females and three males. The pelvimetry showed that the pelvic inlet area presented mean values of 7.63, 10.23, and 5.43 cm2 for adult males, adult females, and sub-adult females, respectively. The mean inclination angle was 129.45° and the mean values for the mechanical lateral proximal and distal femoral angles were 102.32° and 90.93°, respectively. The mean values for the anatomic lateral proximal and distal femoral angles were 104.59° and 85.98°, respectively. In conclusion, the radiographic measurements proved feasible for hind limb evaluation in Sapajus spp. and can be used for comparison with animals presenting orthopedic lesions.

Determinants for Predicting Polyorganic Functional Changes of the Musculoskeletal System in Children with Various Degrees of Joints Hypermobility

Aim: The aim of the work was to study the presence of determinants for predicting the local structures involvement of the musculoskeletal system against the background of joint hypermobility in children. Materials and Methods: The study involved 446 children aged from four to six years. The study plan includes: copying the data of a comprehensive medical examination; determination of joint hypermobility by goniometry and evaluation according to the criteria of presence and degree of joint hypermobility by the method of C. Carter, J. Wilkinson – in the modification of P. Beighton; application of clinical and physiological methods (functional testing, genealogical analysis) and methods of mathematical data processing. Results: The significance hierarchy of morpho-functional features in relation to the further development of the pathological process in children with one of the main manifestations of undifferentiated connective tissue dysplasia – joint hypermobility – is predicted. Determinants of predicting local involvement of musculoskeletal structures (mobility of the spine in the sagittal plane, muscles endurance of the dorsal torso surface) were determined. Conclusions: Against the background of the study of a wide range of clinical features of several generations’ orthopaedic lesions, the fact of highly-progressing risk of scoliotic disease and flat foot was established.

Autologous conditioned serum in equine and human orthopedic therapy: A systematic review

This systematic review aims to compile and present information of studies evaluating the effectiveness of autologous conditioned serum (ACS) in the healing of tendon, ligament and articular lesions in humans and horses. A systematic search of articles using Medline, PubMed, Embase, Bireme and Google Scholar was conducted up to August 2020. Studies regarding ACS' use in human orthopedic lesions were included if classified as RCTs, cohort and case-controls. All studies regarding this therapy in equine medicine were included given their scarcity. Pre-clinical experimental studies were selected if controlled. A total of 1474 results were found; 126 articles were fully accessed, and 28 studies met the inclusion criteria. In vitro studies failed to demonstrate consistent positive properties and effects, while most clinical trials and observational studies indicated a beneficial response associated with ACS administration. However, RTCs and observational studies presented together mostly an unclear to high risk of bias, with only a few being considered of low risk. In face of the observed inconsistencies, the use of ACS in the treatment of musculoskeletal lesions, although safe, promising and appealing, still cannot be recommended without due caution. Overcoming these incongruences will demand efforts to construct well-designed studies and to regard ACS as an autologous product that encompass a diverse composition.

ORTHOPEDIC MANIFESTATIONS OF CONGENITAL VASCULAR MALFORMATIONS OF THE LOWER EXTREMITIES

The spectrum of orthopedic manifestations of congenital vascular malformations of lower limbs remains insufficiently studied. Objective. To analyze the results of examination of patients with orthopedic manifestations of congenital vascular malformations. Methods. 24 patients with various forms of congenital vascular malformations of the lower extremities were examined. Distribution of patients according to the Hamburg classification of vascular malformations: arteriovenous type — 14 patients; venous — 6; capillary — 2; capillaryvenous — 1; lymphatic — 1 patient. The diagnosis of orthopedicpathology was performed on the basis of clinical examination, X-ray, ultrasound, X-ray densitometry. Results. All patients with congenital vascular malformations were diagnosed with orthopedic pathology: leg length discrepancy (75 %), secondary scoliotic deformity (16 %), knee flexion contracture 40° (8 %), flatfoot (12 %), equinus deformity of the foot (8 %), osteoporosis of the affected limb (16 %), areas of pathological reconstruction of the affected bone (lytic areas) (4 %), hip osteoarthritis of the affected limb (grade 2) (4 %). Leg length discrepancy was observed due to the elongation of the affectedlimb — in 16 patients (67 %), shortening — in 2 (8 %). Leg length discrepancy was in the range of 0.5–6 cm. Elongation of the affected limb < 2 cm was noted in 5 patients (21 %), > 2 cm — in 11 patients (46 %); shortening of the affected limb < 2 cm was observed in one patient (4 %), > 2 cm — in one patient (4 %). Among the patients with leg length discrepancy, 61 % had combinations of several orthopedic manifestations of the disease. Conclusions. Patients with congenital vascular malformations have a wide range of orthopedic pathology, among them the leading is leg length discrepancy (75 %) due to elongation(67 %) or shortening of the affected limb (8 %). Leg length discrepancy is most often observed in patients with arteriovenous type of vascular malformation (67 %), elongation of the lower limb > 2 cm (75 %) significantly predominating in this category. Among patients with a difference in the length of the lower limbs in 61 % of cases, there is a combination with other orthopedic manifestations of the disease. Systematization of orthopedic pathology and development lesions’ classification of the musculoskeletal system taking into account the forms of vascular malformation will improve the diagnosisof the disease and improve the tactics of its orthopedic treatment.

Global Research Trends in Robotic Applications in Spinal Medicine: A Systematic Bibliometric Analysis

We systematically evaluated the global research trends in robotic application on the spine through bibliometric analysis and mapping knowledge domains. A systematic literature search was performed of the PubMed and Web of Science, including the Science Citation Index Expanded, databases. The number, countries, journals, and authors of the publications, total citations, average publication year, and institution sources were analyzed using Microsoft Excel, the Online Analysis Platform of Bibliometrics, and VOSviewer. The hotspots were analyzed and visualized using VOSviewer. We identified a total of 2135 publications. The United States ranked first in the number of publications (n= 824; 38.63%) and frequency of citations (n= 29,075). Northwestern University had the highest number of publications (n= 67) and Harvard University the highest number of citations (n= 4198). The Journal of NeuroEngineering and Rehabilitation published the largest number of reports (n= 73), and the most frequently cited journal was Nature (n= 3844 citations). The research hotspots were divided into 3 categories analyzed by VOSviewer: rehabilitation, basic science, and surgery. According to the average publication year, the most recent hotspot was radiation exposure, and the earliest hotspot was radiosurgery. The number of studies of robotic application on the spine has continued to increase. The United States was the greatest contributor to robotic applications on the spine. Robot-assisted rehabilitation for neurological and orthopedic lesions is still a major research hotspot. The range of robotic applications on the spine has expanded from assisted rehabilitation to assisted rehabilitation and surgery.

Use of integrative medicine in the rehabilitation of feline with bone lesions: case report

A feline, female, of no breed and approximately three years old, suffered multiple traumatic fractures of the left femur and underwent osteosynthesis surgery at the Pet Veterinary Hospital of Universidade Federal Rural do Rio de Janeiro. In the postoperative period, the patient presented local pain, loss of proprioception of the limb and loss of sensation of the distal phalanges. Four weeks after the surgery, acupuncture, moxibustion and flower therapy treatment was started. Over five sessions, the animal improved pain and sensitivity, restoring limb functionality and restoring quality of life. In the present study, the association of different techniques of integrative veterinary medicine seemed to decrease recovery time and facilitate the rehabilitation of orthopedic lesions with peripheral nerve involvement.

NURSE-2 DoF Device for Arm Motion Guidance: Kinematic, Dynamic, and FEM Analysis

Patients with neurological or orthopedic lesions require assistance during therapies with repetitive movements. NURSE (cassiNo-qUeretaro uppeR-limb aSsistive dEvice) is an arm movement aid device for both right- and left-upper limb. The device has a big workspace to conduct physical therapy or training on individuals including kids and elderly individuals, of any age and size. This paper describes the mechanism design of NURSE and presents a numerical procedure for testing the mechanism feasibility that includes a kinematic, dynamic, and FEM (Finite Element Method) analysis. The kinematic demonstrated that a big workspace is available in the device to reproduce therapeutic movements. The dynamic analysis shows that commercial motors for low power consumption can achieve the needed displacement, acceleration, speed, and torque. Finite Element Method showed that the mechanism can afford the upper limb weight with light-bars for a tiny design. This work has led to the construction of a NURSE prototype with a light structure of 2.6 kg fitting into a box of 35 × 45 × 30 cm. The latter facilitates portability as well as rehabilitation at home with a proper follow-up. The prototype presented a repeatability of ±1.3 cm that has been considered satisfactory for a device having components manufactured with 3D rapid prototyping technology.

Falls from height: orthopaedic and psychiatric evaluation.

Background:Fall from a height is one of the major causes of significant trauma with high morbidity and mortality rates. Traumatological damage control is often the primary treatment both for suicide attempt survivors and for accidental fall victims, but management of the hospitalization of psychiatric patients requires more resources than other patients.Methods:Retrospective multidisciplinary study (psychiatric and orthopaedic evaluation) and analysis of psychiatric and trauma characteristics of patients fallen from height admitted to our trauma centre. We analysed patterns of patients after suicidal jumps and accidental falls to look for possible trends that may trigger projects for further improvement of care.Results:205 patients were analysed, 137 were included: 65 suicide attempt survivors and 72 accidental fall victims. Between these two groups there are no differences about the anaesthesiologic acute management or the number of damage control procedures. However, the psychiatric patients stay longer in hospital especially in intensive care unit with prolonged intubation (p< 0.001). Suicide attempt survivors are significant correlated with fractures of feet, but the orthopaedic lesions do not involve an increase of definitive interventions (p< 0.05).Conclusion:We showed that the suicide attempt survivors and accidental victims need the same acute management. The orthopedic definitive surgical procedures are similar between the two groups, but in spite of this patients with psychiatric disorder were associated with a statistically significant increase of care in intensive care unit and hospitalization. Our results allow to create a new multidisciplinary approach for these patients. (www.actabiomedica.it)

Chondrogenic differentiation in vitro of hiPSCs activates pathways engaged in limb development

Human induced pluripotent stem cells (hiPSCs) are a true breakthrough in regenerative medicine with the potential to successfully treat many diseases, including orthopedic lesions, that are unresponsive to current treatments. However, chondrogenic differentiation in vitro is a poorly understood process and more research is needed. In this study, we compared the gene expression profile of chondrocyte-like cells differentiated from hiPSCs via monolayer culture (ChiPS) to the profile of mature chondrocytes and to a line of hiPSCs created by our group (GPCCi001-A). Our results indicate that ChiPS possess features of early chondrocytes. This finding was confirmed by RT-qPCR analysis, which demonstrated that the ALX1, EYA1, HOXB6, HOXC11, HOXD13 and RARB genes were more highly expressed in the ChiPS versus both GPCCi001-A cells and adult chondrocytes. These findings provide a better understanding the processes directing the cell fate of hiPSCs during chondrogenesis in vitro. Moreover, our group has created a potentially unlimited source of early chondrocytes that may prove useful in future clinical practice.

Neuro-orthopedics disorders in intensive care unit (ICU): Perceptions of teams

Objective In intensive care unit (ICU), the frequent association of organ failure, neurological, orthopedic lesions and undernutrition promotes the development of neuro-orthopedic disorders (NOD). They can affect the acute phase management and the functional prognosis of patients. Caregivers (nurses and nursing auxiliaries) have a sentinel role in their early detection. Material/patients and methods We investigated the perception of paramedical and medical teams in 3 surgical ICU in university hospitals in Ile-de-France. Questionnaires were about the impact of the NOD on patient health and on care as well as on the therapeutic or preventive actions carried out. Results In total, 79 questionnaires including: nurses (n = 30, median age = 28.5 [23–49]), nursing auxiliaries (n = 17, median age = 31 [20–56]), doctors (n = 28, median age = 32.5 [24–60]) and physiotherapists (n = 4, median age = 50 [26–53]). Among caregivers, 64% have been working for less than 5 years in ICU and 46.8% consider NOD to be frequently responsible for pain. There is a correlation between age and the perception of NOD responsibility in pain for caregivers (P = 0.04), but not for doctors (P = 0.26). We do not find correlation between the experience in ICU and the perception of NOD responsibility in pain (P = 0.77), nor between the impact of NOD on pain and the tendency to start action against the NOD from caregivers (modification of the positioning P = 0.26 or mobilization by caregivers P = 0.57). Discussion – conclusion The number of responses seems to indicate that ICU teams are interested in NOD. Some results are surprising, with sometimes high variability. Although the methodology (question formulation, subjective declarative data, etc.) induces biases, we may wonder why age seems to influence the perception of the role of NOD in pain, contrary to the experience in ICU or why the pain does not seem to induce modifications of positioning or mobilization by the caregivers. It seems necessary to compare these data with a prospective study to determine the prevalence of NOD in ICU, or even to define a patient profile at risk of developing NOD in ICU.

Applied Induced Pluripotent Stem Cells in Combination With Biomaterials in Bone Tissue Engineering.

Due to increasing of the orthopedic lesions and fractures in the world and limitation of current treatment methods, researchers, and surgeons paid attention to the new treatment ways especially to tissue engineering and regenerative medicine. Innovation in stem cells and biomaterials accelerate during the last decade as two main important parts of the tissue engineering. Recently, induced pluripotent stem cells (iPSCs) introduced as cells with highly proliferation and differentiation potentials that hold great promising features for used in tissue engineering and regenerative medicine. As another main part of tissue engineering, synthetic, and natural polymers have been shown daily grow up in number to increase and improve the grade of biopolymers that could be used as scaffold with or without stem cells for implantation. One of the developed areas of tissue engineering is bone tissue engineering; the aim of this review is present studies were done in the field of bone tissue engineering while used iPSCs in combination with natural and synthetic biomaterials. J. Cell. Biochem. 118: 3034-3042, 2017. © 2017 Wiley Periodicals, Inc.

Prevalence of Tarsal Diseases in Champion Mangalarga Marchador Horses in the Marcha Picada Modality and Its Association With Tarsal Angle

Mangalarga Marchador (MM) is a native Brazilian breed of “gaited” horses. Orthopedic lesions and conformation might affect the sport career of these animals. The aims of this study were to evaluate the tarsal angle and the prevalence of tarsal disease in healthy MM horses that had classified in the top seven positions at the 33rd National Mangalarga Marchador Breed Show in 2014. Fifty horses were included. Horses in category I were presented at hand and aged between 18 and 34 months; horses in category II were presented ridden and aged between 41 and 58 months. The tarsal angle was measured using an arthrogoniometer; lateromedial and dorsopalmar radiographs were taken and analyzed. Of the included horses, 70% had radiographic lesion, the most common disease was osteoarthritis of the distal tarsal joints. Radiographic lesions were detected in 65.38% of the horses in category I and in 75% of those in category II. The mean tarsal angle was 136.5 ± 4.90°, which indicates that high-performance MM horses in marcha picada contests have small tarsal angle. The prevalence of radiographic lesions among horses with tarsal angles ≥140° and ≤139° were compared. Male animals whose tarsal angle was equal to or above 140° were significantly more likely to have radiographic changes in the tarsus (P = .0218). It was concluded that the prevalence of tarsal diseases in MM horses in marcha picada contests is high and that osteoarthitis of the distal interstarsal and tarsometatarsal joints are the most common.

Femoral Fracture Repair in a Ferret (Mustela putorius furo)

Background: Ferrets (Mustela putorius furo) are increasingly popular as pets. They require similar medical and surgical care as small animals, and orthopedic lesions are more and more common. Fracture diagnosis is based on history, orthopedic exam, and diagnostic imaging. The preferred treatment for femur fractures is surgery, which has a favorable outcome in the majority of cases. However, surgical fracture repair in ferrets can be challenging due to the small size of the bones. The objective of thispaper is to report the surgical repair of a femoral fracture in a ferret using an external skeletal fxation system type IA connected to an intramedullary pin (tie-in confguration).Case: An adult ferret was referred to the veterinary hospital after being stepped on. The ferret was diagnosed with an oblique diaphyseal fracture of the left femur and surgery was recommended. Open fracture reduction was performed with a 1 mm in tramedullary pin (Kirschner wire) placed in a retrograde direction into the proximal bone segment. After fracture reduction, the intramedullary pin was inserted into the distal bone segment. The external skeletal fxator type IA was created by the insertionof a 1.5 mm Schanz pin into the distal diaphysis and another, also 1.5 mm, inserted into the proximal metaphysis, both percuta neously. The three pins were connected externally to an aluminum bar with the aid of three staples to form a tie-in system. Rest and restriction of activity were recommended during the frst month after surgery. The ferret recovered well and, at 120 days, orthopedic and radiographic exams showed complete fracture healing. The implant was removed and no functional changesrelated to ambulation were observed.Discussion: The orthopedic knowledge applied to ferrets commonly originates in procedures performed on cats and dogs. Overall,the main objective when dealing with fractures is to stabilize the broken bone to allow early ambulation. Due to the location and type of fracture, an external immobilization was contraindicated in this case. A plate was considered, but the small diameter of the femur and the consequent risk of iatrogenic fractures made this option not feasible. Therefore, the external skeletal fxator in a tie-in confguration was selected. This method permitted control of the forces acting on the fracture site and had the advantage of low cost and ease of application and removal. Nevertheless, the vast musculature that covers the femur could hinder the use ofthe external pins and lead to discomfort. The method has been reported with some changes in ferrets, though with inconclusive results due to lack of follow-up. In the present report, a less rigid method, type I, was used since types II and III have a biplanar confguration and were thus inadequate due to the possible contact between the fxator and the abdominal or inguinal region. The precautions taken during placement of the implant were the same as in cats and dogs since their anatomy follows the same pattern. The implant was rigid, light, and effective, allowing early weight-bearing on the affected limb without discomfort to the patient. As such, the external fxator type IA connected to the intramedullary pin in a tie-in confguration was an effective method for the treatment of the oblique diaphyseal femoral fracture in this ferret. Although it is not the recommended method for this type of fracture in cats and dogs, there were no complications in the ferret, with complete fracture healing and return tofunction of the affected limb. Since there has yet to be a consensus on the recommended procedures in these animals, reports of this nature are important due to the growing number of ferret patients in veterinary practice.Keywords: ferret, osteosynthesis, bone fxation, repair of fractures.

Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review.

Orthopedic injuries commonly affect children during earthquakes, but reports about them are rare. This setting may lead to different standards of care, but guidelines are still missing in this field. A systematic review was performed to: (1) assess type and body distribution of pediatric earthquake-related injuries, treatment performed, length of stay, and complications; and (2) identify starting points to define standards of care. PubMed database was researched for papers (1999-2014 period) in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Inclusion criteria were: English, French, Spanish, or Italian language and data reported about orthopedic lesions in children (≤18 years old). Reviews, letters, commentaries, editorials, and single case reports were excluded. Two independent reviewers selected articles after abstract and full-text reading. Traumatic injuries caused child hospital admissions ranging from 46.9% to 100.0%; 16% to 53% suffered fractures. Lower limbs mostly were involved. Soft-tissue injuries affected 55% of patients. Debridement and external fixation (EF) were the most frequent surgical treatments. Amputation rates varied from 5% to 11%. This study revealed that field hospitals should be prepared to: (1) treat mainly lower extremities fractures in children; and (2) use especially EF techniques. The presence of orthopedic surgeons familiar with pediatric traumatology should be considered.

Orthopedic lesions in tethered cord syndrome: the importance of early diagnosis and treatment on patient outcome.

Many of the patients with tethered cord syndrome (TCS) are admitted because of neurological symptoms, while some are admitted because of their orthopedic, urologic, anorectal, and dermatologic manifestations. Consequently, this study aimed to evaluate the importance of early diagnosis and treatment of tethered cord syndrome on patient outcome. Fourty-three patients who underwent surgery because of tethered cord syndrome from 2006 to 2010 were studied. Many of these cases were referred by orthopedic surgeons. All of the findings were recorded and follow up was done twice (1 and 3 years after surgery). Thirty-seven patients were less than 7 years old and 6 were between 17 to 33 years old. According to clinical and neurological exams, satisfactory results were achieved in both groups. Those with early surgical intervention, especially in their early follow up assessment, had the best results. Seventeen cases were referred by an orthopedic surgeon because of manifestations such as leg weakness and numbness, leg pain and spasticity, pes cavus, claw toes, and leg or foot length discrepancy. Cerebrospinal fluid leakage occurred in 3 cases after surgery and 1 showed pseudomeningocele formation. After one year of follow up, initially the results of the treatment were better in early operated cases, but in later follow up assessment (after 3 years) the results were almost the same in both of the groups.

Métodos de diagnóstico y tratamientos utilizados para la ruptura del ligamento cruzado craneal en perros: encuesta a médicos veterinarios de Chile

The cranial cruciate ligament (CrCL) is an important anatomical structure of the stifle that contributes to joint stability. Tears of the CrCL are frequent orthopaedic lesions in dogs and the diagnosis is based on orthopaedic examination. Despite the large number of surgical methods described, no treatment has been universally accepted in veterinary medicine and the treatment is based on the preferences of the surgeon. With regard to diagnosis and treatment, the aim of the present study was to assess the preferred method in Chile to diagnose and treat the rupture of CrCL in dogs. Out of 307 surveys handed out, 206 questionnaires were obtained and 49 (23%) of them stated that one or more methods were performed to diagnose and treat CrCL rupture in dogs, while twenty one (10, 19%) questionnaires were answered in full. The diagnosis is mainly based on palpation and radiography is the most common complementary method used. Regarding the treatment for the CrCL rupture, the extraarticular surgical technique was the most common method of treatment (90, 47%). In conclusion, we found out that few veterinarians in Chile diagnose and treat CrCL rupture in dogs. The diagnoses for CrCL rupture is mostly performed through palpation of the affected stifle while imaging diagnostic methods are scarcely or not applied. The extraarticular technique is the preferred method to treat CrCL rupture in dogs in Chile.

Cancer Risk Is Not Increased in Patients Treated for Orthopaedic Diseases with Autologous Bone Marrow Cell Concentrate

There is concern that regenerative cell-based therapies could result in increased risk of tumor formation. We investigated the long-term risks for systemic and site-specific cancers in patients who had received autologous bone marrow-derived stromal progenitor cells to treat orthopaedic lesions. A total of 1873 patients were treated from 1990 to 2006 with bone marrow-derived concentrated cells. Patients were monitored for cancer incidence from the date of the first operation (1990) until death, or until December 31, 2011. The mean follow-up time was 12.5 years (range, five to twenty-two years). The average number of colony-forming unit fibroblasts returned to the patients was 483,000 fibroblasts (range, 62,000 to 2,095,000 fibroblasts). The primary outcome was to evaluate with radiographs and/or magnetic resonance imaging the risk of tumorigenesis at the cell therapy treatment sites. The secondary outcome was to evaluate the risk of cancer diagnosed in areas other than the treatment site during the follow-up period. The relative risk of cancer was expressed as the ratio of observed and expected number of cases, that is, the standardized incidence ratio, according to the cancer incidence in the French population. No tumor formation was found at the treatment sites on the 7306 magnetic resonance images and 52,430 radiographs among the 1873 patients. Fifty-three cancers were diagnosed in areas other than the treatment site. On the basis of cancer incidence in the general population during the same period, the expected number of cancers was between ninety-seven and 108 for the same age and sex distribution. The range of the standardized incidence ratio for the follow-up period was between 0.49 and 0.54 (95% confidence interval, 0.30 to 0.80). This study found no increased cancer risk in patients after application of autologous cell-based therapy using bone marrow-derived stromal progenitor cells either at the treatment site or elsewhere in the patients after an average follow-up period of 12.5 years.

Lateral meniscal cyst presenting as Medial Compartment Knee Swelling: A case report and literature review

INTRODUCTIONMeniscal cysts are relatively uncommon orthopaedic lesions usually arising from the meniscus. They present as clinically palpable masses and dull pain. PRESENTATION OF CASEWe report on a 33-year-old male patient who presented clinically with a medial knee swelling that arose from a lateral meniscal cyst. DISCUSSIONNo similar cases were cited in the literature. The cyst was removed surgically with a good result obtained and no recurrence after 12 months. Typically, a clinically palpable mass corresponds to a meniscal cyst arising from the ipsilateral meniscus. CONCLUSIONMagnetic resonance imaging is vital to exclude such anomalies prior to surgical intervention.