This document discusses implant selection considerations for revision total knee replacement (TKR) surgery. It begins by outlining common causes for revision TKR such as aseptic loosening and polyethylene wear. Key challenges in revision TKR are managing bone defects from osteolysis, compromised soft tissues, and restoring proper limb alignment. Implant options discussed include metaphyseal sleeves and stems to provide fixation in bone defect zones, as well as augmentations. Constraint levels from unconstrained to fully constrained implants are reviewed. Clinical cases demonstrate approaches for addressing instability, significant bone loss, and peri-prosthetic fractures in revision TKR.
This document provides an overview of various osteotomies performed around the hip joint for the treatment of developmental dysplasia of the hip (DDH). It describes the indications, techniques, and postoperative management for common osteotomies including the Salter, Steel, Pemberton, Dega, Ganz, Chiari, and shelf osteotomies. The goal of these procedures is to improve hip biomechanics and function by altering the orientation and coverage of the acetabulum to reduce joint reactive forces and improve contact area and femoral head congruency.
Updated HTO vs UniKnee for Postgraduate Orthopaedic Course in Newcastle March...Professor Deiary Kader
This document discusses osteotomy and unicompartmental knee replacement (UKR or "Uni Knee") for the treatment of varus malalignment and osteoarthritis in the knee. It provides details on the surgical techniques, outcomes, advantages, and contraindications of high tibial osteotomy (HTO) and UKR. Non-operative treatments for knee osteoarthritis like weight loss, exercise, and injections are also summarized.
The Taylor spatial frame is a hexapod external fixator that can simultaneously correct six-axis deformities using a virtual hinge mechanism. It consists of two rings connected by six telescopic struts and universal joints. Precise pre-planning is required to calculate deformity, mounting, and frame parameters. It can be used to correct a variety of deformities in the lower and upper extremities, including trauma, Blount's disease, and clubfoot.
Correcting Varus Deformity of the Knee in Total Knee ReplacementVaibhav Bagaria
This document discusses the varus knee, including:
1. Classification of varus knee deformities into intraarticular, metaphyseal, extraarticular, and PAGODA deformity.
2. The sequential approach to correction involves assessing and classifying the deformity, performing a medial release through multiple structures, osteophyte removal, and bone realignment through techniques like shift and resect or pie crusting if needed.
3. Key steps are creating a medial sleeve through layered release of the MCL and other medial structures, complete removal of osteophytes that can impede correction, and balancing flexion and extension gaps.
Templating in total hip replacement involves using preformed templates during preoperative planning to estimate implant size and position. The goals of templating include restoring hip biomechanics, predicting implant size, and recognizing potential difficulties. A standard approach involves assessing radiographs, identifying anatomical landmarks, mechanical references, and optimizing implant position. Careful templating allows surgeons to achieve successful, reproducible results while minimizing complications.
This document outlines details from a seminar on osteotomies around the hip presented by Dr. Vaibhav Gandhi at Gandhi Medical College, Bhopal. It includes definitions of osteotomy procedures, classifications based on anatomic location and indications, as well as overviews and details of specific osteotomies such as the Salter, Pemberton, triple innominate, Ganz, and shelf (Staheli) procedures. Force diagrams and biomechanical principles relating to the hip are also discussed.
This document provides an overview of the history and evolution of total hip arthroplasty. It discusses early techniques from the 1820s through developments in the 1920s-1950s that led to modern total hip replacement designs. It then describes pre-operative planning including patient evaluation, x-ray templating, and considerations for implant selection and alignment. Key implant components like the acetabular cup and femoral stem are also summarized.
This document discusses implant selection considerations for revision total knee replacement (TKR) surgery. It begins by outlining common causes for revision TKR such as aseptic loosening and polyethylene wear. Key challenges in revision TKR are managing bone defects from osteolysis, compromised soft tissues, and restoring proper limb alignment. Implant options discussed include metaphyseal sleeves and stems to provide fixation in bone defect zones, as well as augmentations. Constraint levels from unconstrained to fully constrained implants are reviewed. Clinical cases demonstrate approaches for addressing instability, significant bone loss, and peri-prosthetic fractures in revision TKR.
This document provides an overview of various osteotomies performed around the hip joint for the treatment of developmental dysplasia of the hip (DDH). It describes the indications, techniques, and postoperative management for common osteotomies including the Salter, Steel, Pemberton, Dega, Ganz, Chiari, and shelf osteotomies. The goal of these procedures is to improve hip biomechanics and function by altering the orientation and coverage of the acetabulum to reduce joint reactive forces and improve contact area and femoral head congruency.
Updated HTO vs UniKnee for Postgraduate Orthopaedic Course in Newcastle March...Professor Deiary Kader
This document discusses osteotomy and unicompartmental knee replacement (UKR or "Uni Knee") for the treatment of varus malalignment and osteoarthritis in the knee. It provides details on the surgical techniques, outcomes, advantages, and contraindications of high tibial osteotomy (HTO) and UKR. Non-operative treatments for knee osteoarthritis like weight loss, exercise, and injections are also summarized.
The Taylor spatial frame is a hexapod external fixator that can simultaneously correct six-axis deformities using a virtual hinge mechanism. It consists of two rings connected by six telescopic struts and universal joints. Precise pre-planning is required to calculate deformity, mounting, and frame parameters. It can be used to correct a variety of deformities in the lower and upper extremities, including trauma, Blount's disease, and clubfoot.
Correcting Varus Deformity of the Knee in Total Knee ReplacementVaibhav Bagaria
This document discusses the varus knee, including:
1. Classification of varus knee deformities into intraarticular, metaphyseal, extraarticular, and PAGODA deformity.
2. The sequential approach to correction involves assessing and classifying the deformity, performing a medial release through multiple structures, osteophyte removal, and bone realignment through techniques like shift and resect or pie crusting if needed.
3. Key steps are creating a medial sleeve through layered release of the MCL and other medial structures, complete removal of osteophytes that can impede correction, and balancing flexion and extension gaps.
Templating in total hip replacement involves using preformed templates during preoperative planning to estimate implant size and position. The goals of templating include restoring hip biomechanics, predicting implant size, and recognizing potential difficulties. A standard approach involves assessing radiographs, identifying anatomical landmarks, mechanical references, and optimizing implant position. Careful templating allows surgeons to achieve successful, reproducible results while minimizing complications.
This document outlines details from a seminar on osteotomies around the hip presented by Dr. Vaibhav Gandhi at Gandhi Medical College, Bhopal. It includes definitions of osteotomy procedures, classifications based on anatomic location and indications, as well as overviews and details of specific osteotomies such as the Salter, Pemberton, triple innominate, Ganz, and shelf (Staheli) procedures. Force diagrams and biomechanical principles relating to the hip are also discussed.
This document provides an overview of the history and evolution of total hip arthroplasty. It discusses early techniques from the 1820s through developments in the 1920s-1950s that led to modern total hip replacement designs. It then describes pre-operative planning including patient evaluation, x-ray templating, and considerations for implant selection and alignment. Key implant components like the acetabular cup and femoral stem are also summarized.
This document discusses the history and evolution of total hip arthroplasty (THA) and hip replacement component designs. It outlines key developments from the late 19th century experiments with ivory and tissue replacements, to modern THA pioneered by Professor Charnley in the 1960s using bone cement and low friction materials. Current designs aim to restore normal hip biomechanics and include cemented or cementless femoral and acetabular components with various fixation methods and bearing surfaces to reduce wear. Future advances focus on minimally invasive techniques, computer navigation, and developing more durable and compliant bearing materials to improve implant longevity.
Current trends in ACL surgery include a shift towards anatomical reconstruction techniques that more closely restore the native ACL footprint. While double bundle reconstruction aims to better restore knee rotation, high quality studies show no difference in outcomes compared to single bundle reconstruction. Autograft tissue like hamstring tendon is preferred over allograft for younger patients due to higher failure rates with allograft. Postoperative rehabilitation protocols emphasize early range of motion restoration and return to sport is recommended between 8 to 12 months following surgery accompanied by meeting specific strength and performance benchmarks.
This document provides an outline and introduction for a presentation on the management of periprosthetic fractures. It discusses definition, epidemiology, risk factors, classifications, treatment goals and options, and complications for periprosthetic fractures of the hip, knee, and shoulder. Key points covered include the Vancouver classification system for femoral fractures, surgical treatment approaches depending on the fracture type, and challenges in treating acetabular fractures.
This document discusses the concept and methodology of templating for total hip replacement surgery. It begins by defining templating as a radiographic planning process using templates to estimate implant positioning and identify difficult cases. It then describes the goals of templating as predicting implant size and position to restore hip biomechanics. The document outlines the steps of templating, including identifying anatomical landmarks and mechanical references on radiographs. It emphasizes the importance of restoring leg length, offset, and the center of rotation.
This document discusses aseptic loosening of total hip arthroplasty (THA) components. It notes that while success rates for THA are high, osteolysis and loosening continue to plague surgeons, with failure rates as high as 20% due to these complications. The document then discusses the biological process of osteolysis, sources and rates of particulate debris from different bearing surfaces, modes of wear, and radiographic signs of loosening for cemented and cementless femoral and acetabular components. Treatment options including revision surgery and indications for surgery are also summarized.
This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.
Pemberton's Osteotomy for Acetabular DysplasiaLibin Thomas
This is a slideshow based on the journal- JBJS- ESSENTIAL SURGICAL TECHNIQUES, INDIAN EDITION, OCTOBER 2015, VOL.4, NO. 3, SPECIAL EDITION by Shier- Chieg, Huang, MD, PhD, Ting- Ming Wang, MD, PhD, Kuan- Wen Wu, MD, Ken N. Kuo, MD
Hip resurfacing is an option for young and active patients with hip disease that allows for greater movement and reduced pain compared to traditional hip replacements. It involves reshaping the femoral head and inserting a metal cap, while cementing a metal socket in the pelvis. Hip resurfacing aims to give patients freedom of movement without pain and prevent future hip problems, while also providing an extended treatment option for young patients who may outlive a traditional hip replacement.
Medial patellofemoral ligament reconstruction ---- an update on techniques used. This lecture was taken by me at Trinity Arthroscopy Course, Chandigarh.
This document discusses the surgical anatomy and treatment of varus knee deformities. It describes Maquet's line and how it is medialized in varus knees. It then classifies varus deformities into 5 categories and details the surgical steps to correct it, including: creating a medial sleeve; removing osteophytes; checking and releasing ligaments like PCL, semimembranosus, and superficial MCL if gaps remain tight; and lateralizing the tibial component by shifting and reducing it. The goal is to create symmetrical extension and flexion gaps and restore the mechanical axis.
The document provides an overview of a knee surgeon's elective orthopaedics course on the topic of knees. It includes the surgeon's background and areas of specialty. It also includes sample cases and questions from attendees on topics like evidence-based treatment for osteoarthritis, different types of knee replacements and osteotomies, and principles of knee surgery procedures.
The document discusses graft fixation options in ACL reconstruction. It notes that fixation is the weakest link in the early postoperative period and that tibial fixation carries a greater risk of failure. Interference screws provide the gold standard for fixation but tunnel widening remains a concern. The ideal fixation is strong, stiff, and secure to avoid graft slippage and interference with healing while allowing revision. Aperture fixation and hybrid techniques may improve outcomes over suspensory fixation alone. Rehabilitation must also account for the biomechanical strengths and weaknesses of the fixation method used.
Hip implants are used to replace damaged or diseased hip joints. The document discusses the history and development of hip implants from the 1950s onwards. It describes the key figures like Sir John Charnley who pioneered total hip arthroplasty. The anatomy of the hip joint and biomechanics considerations for implant design are outlined. Different types of femoral and acetabular components including cemented, cementless, and alternative bearing surfaces are explained. Indications, contraindications and risks of hip replacement surgery are also summarized.
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Highly cross-linked polyethylene (XLPE) has been shown to reduce wear rates compared to conventional polyethylene in hip replacements. This reduced wear is associated with lower rates of osteolysis. XLPE appears compatible with large diameter heads, though thin liners may be at increased risk of early failure. Fatigue properties of XLPE are favorable though long-term data is still needed. Ceramic-on-ceramic bearings have the lowest wear rates of any bearing surface but can fracture, though modern designs have low fracture risks. Ceramic generates fewer inflammatory particles than other bearings and may have the best long-term durability without osteolysis. Metal-on-metal bearings are no longer recommended due to high revision rates
Journal club presentation on Shoulder Arthroplasty for Fractures of the Proximal part of the Humerus. Based on review article published in Journal of Bone & Joint Surgery (America)
Indications, Surgical techniques, outcomes are discussed in detail.
This document discusses osteotomies around the hip that are used to treat developmental dysplasia of the hip (DDH). It describes various femoral and pelvic osteotomies, including their objectives, indications, advantages, and disadvantages. For femoral osteotomies, it discusses femoral shortening, derotation, and varus osteotomies. For pelvic osteotomies, it discusses Salter's, Pemberton, Dega, Steel, Sutherland, Tonnis, Ganz, and salvage osteotomies such as Chiari and shelf procedures. The appropriate procedure depends on factors like the patient's age and whether concentric reduction of the hip is possible.
The document discusses posterior malleolus fractures of the ankle. It summarizes that CT scan is important for evaluating these fractures and determining treatment. While fragment size was traditionally used to dictate treatment, the focus should be on restoring joint congruity. A posteromedial surgical approach allows fixation of fractures that extend into the medial malleolus, like Haraguchi type II fractures. This approach provides good outcomes while avoiding complications when used to address complex posterior malleolus fractures.
Use of local antibiotic depot (stimulan)mangalparihar
This document discusses local antibiotic delivery using Stimulan, a synthetic calcium sulfate hemihydrate. It begins by introducing Dr. Mangal Parihar and describing his credentials. It then discusses Stimulan's advantages over traditional calcium sulfate forms, including its purity, pH, and ability to elute antibiotics at high concentrations over an extended period. Studies showing Stimulan's ability to elute antibiotics like moxifloxacin, fusidic acid, and daptomycin at levels above the MIC for pathogens like MRSA are summarized. The document concludes by describing Stimulan's potential benefits for treating bone infections by providing sustained, high local antibiotic levels directly at the site of infection.
The document describes the Modified Broström Procedure for treating unstable ankles. It discusses how ankle instability is graded from I to III based on the amount of instability present. It notes that grade I and some grade II ankles may be treated conservatively through physical therapy and bracing, while grade III typically requires surgical reconstruction. The Modified Broström Procedure is described as restoring stability through anatomic repair of the ligaments while preserving range of motion and the peroneal tendons. It involves attaching the extensor retinaculum to reinforce the repaired ligaments and correct subtalar instability.
CPT is a rare and challenging condition characterized by dysplasia of the tibia leading to anterolateral bowing and risk of pathological fracture. While the exact etiology is unclear, it may involve a defect in the NF1 gene. There is no consensus on treatment, but established methods achieving union rates over 70% include intramedullary rodding, Ilizarov external fixation, and vascularized fibular grafting. The Ilizarov technique and BMP augmentation may further improve outcomes, though long-term results of newer approaches are still unknown. CPT remains difficult to treat and sometimes amputation is considered.
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
This document discusses the history and evolution of total hip arthroplasty (THA) and hip replacement component designs. It outlines key developments from the late 19th century experiments with ivory and tissue replacements, to modern THA pioneered by Professor Charnley in the 1960s using bone cement and low friction materials. Current designs aim to restore normal hip biomechanics and include cemented or cementless femoral and acetabular components with various fixation methods and bearing surfaces to reduce wear. Future advances focus on minimally invasive techniques, computer navigation, and developing more durable and compliant bearing materials to improve implant longevity.
Current trends in ACL surgery include a shift towards anatomical reconstruction techniques that more closely restore the native ACL footprint. While double bundle reconstruction aims to better restore knee rotation, high quality studies show no difference in outcomes compared to single bundle reconstruction. Autograft tissue like hamstring tendon is preferred over allograft for younger patients due to higher failure rates with allograft. Postoperative rehabilitation protocols emphasize early range of motion restoration and return to sport is recommended between 8 to 12 months following surgery accompanied by meeting specific strength and performance benchmarks.
This document provides an outline and introduction for a presentation on the management of periprosthetic fractures. It discusses definition, epidemiology, risk factors, classifications, treatment goals and options, and complications for periprosthetic fractures of the hip, knee, and shoulder. Key points covered include the Vancouver classification system for femoral fractures, surgical treatment approaches depending on the fracture type, and challenges in treating acetabular fractures.
This document discusses the concept and methodology of templating for total hip replacement surgery. It begins by defining templating as a radiographic planning process using templates to estimate implant positioning and identify difficult cases. It then describes the goals of templating as predicting implant size and position to restore hip biomechanics. The document outlines the steps of templating, including identifying anatomical landmarks and mechanical references on radiographs. It emphasizes the importance of restoring leg length, offset, and the center of rotation.
This document discusses aseptic loosening of total hip arthroplasty (THA) components. It notes that while success rates for THA are high, osteolysis and loosening continue to plague surgeons, with failure rates as high as 20% due to these complications. The document then discusses the biological process of osteolysis, sources and rates of particulate debris from different bearing surfaces, modes of wear, and radiographic signs of loosening for cemented and cementless femoral and acetabular components. Treatment options including revision surgery and indications for surgery are also summarized.
This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.
Pemberton's Osteotomy for Acetabular DysplasiaLibin Thomas
This is a slideshow based on the journal- JBJS- ESSENTIAL SURGICAL TECHNIQUES, INDIAN EDITION, OCTOBER 2015, VOL.4, NO. 3, SPECIAL EDITION by Shier- Chieg, Huang, MD, PhD, Ting- Ming Wang, MD, PhD, Kuan- Wen Wu, MD, Ken N. Kuo, MD
Hip resurfacing is an option for young and active patients with hip disease that allows for greater movement and reduced pain compared to traditional hip replacements. It involves reshaping the femoral head and inserting a metal cap, while cementing a metal socket in the pelvis. Hip resurfacing aims to give patients freedom of movement without pain and prevent future hip problems, while also providing an extended treatment option for young patients who may outlive a traditional hip replacement.
Medial patellofemoral ligament reconstruction ---- an update on techniques used. This lecture was taken by me at Trinity Arthroscopy Course, Chandigarh.
This document discusses the surgical anatomy and treatment of varus knee deformities. It describes Maquet's line and how it is medialized in varus knees. It then classifies varus deformities into 5 categories and details the surgical steps to correct it, including: creating a medial sleeve; removing osteophytes; checking and releasing ligaments like PCL, semimembranosus, and superficial MCL if gaps remain tight; and lateralizing the tibial component by shifting and reducing it. The goal is to create symmetrical extension and flexion gaps and restore the mechanical axis.
The document provides an overview of a knee surgeon's elective orthopaedics course on the topic of knees. It includes the surgeon's background and areas of specialty. It also includes sample cases and questions from attendees on topics like evidence-based treatment for osteoarthritis, different types of knee replacements and osteotomies, and principles of knee surgery procedures.
The document discusses graft fixation options in ACL reconstruction. It notes that fixation is the weakest link in the early postoperative period and that tibial fixation carries a greater risk of failure. Interference screws provide the gold standard for fixation but tunnel widening remains a concern. The ideal fixation is strong, stiff, and secure to avoid graft slippage and interference with healing while allowing revision. Aperture fixation and hybrid techniques may improve outcomes over suspensory fixation alone. Rehabilitation must also account for the biomechanical strengths and weaknesses of the fixation method used.
Hip implants are used to replace damaged or diseased hip joints. The document discusses the history and development of hip implants from the 1950s onwards. It describes the key figures like Sir John Charnley who pioneered total hip arthroplasty. The anatomy of the hip joint and biomechanics considerations for implant design are outlined. Different types of femoral and acetabular components including cemented, cementless, and alternative bearing surfaces are explained. Indications, contraindications and risks of hip replacement surgery are also summarized.
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Highly cross-linked polyethylene (XLPE) has been shown to reduce wear rates compared to conventional polyethylene in hip replacements. This reduced wear is associated with lower rates of osteolysis. XLPE appears compatible with large diameter heads, though thin liners may be at increased risk of early failure. Fatigue properties of XLPE are favorable though long-term data is still needed. Ceramic-on-ceramic bearings have the lowest wear rates of any bearing surface but can fracture, though modern designs have low fracture risks. Ceramic generates fewer inflammatory particles than other bearings and may have the best long-term durability without osteolysis. Metal-on-metal bearings are no longer recommended due to high revision rates
Journal club presentation on Shoulder Arthroplasty for Fractures of the Proximal part of the Humerus. Based on review article published in Journal of Bone & Joint Surgery (America)
Indications, Surgical techniques, outcomes are discussed in detail.
This document discusses osteotomies around the hip that are used to treat developmental dysplasia of the hip (DDH). It describes various femoral and pelvic osteotomies, including their objectives, indications, advantages, and disadvantages. For femoral osteotomies, it discusses femoral shortening, derotation, and varus osteotomies. For pelvic osteotomies, it discusses Salter's, Pemberton, Dega, Steel, Sutherland, Tonnis, Ganz, and salvage osteotomies such as Chiari and shelf procedures. The appropriate procedure depends on factors like the patient's age and whether concentric reduction of the hip is possible.
The document discusses posterior malleolus fractures of the ankle. It summarizes that CT scan is important for evaluating these fractures and determining treatment. While fragment size was traditionally used to dictate treatment, the focus should be on restoring joint congruity. A posteromedial surgical approach allows fixation of fractures that extend into the medial malleolus, like Haraguchi type II fractures. This approach provides good outcomes while avoiding complications when used to address complex posterior malleolus fractures.
Use of local antibiotic depot (stimulan)mangalparihar
This document discusses local antibiotic delivery using Stimulan, a synthetic calcium sulfate hemihydrate. It begins by introducing Dr. Mangal Parihar and describing his credentials. It then discusses Stimulan's advantages over traditional calcium sulfate forms, including its purity, pH, and ability to elute antibiotics at high concentrations over an extended period. Studies showing Stimulan's ability to elute antibiotics like moxifloxacin, fusidic acid, and daptomycin at levels above the MIC for pathogens like MRSA are summarized. The document concludes by describing Stimulan's potential benefits for treating bone infections by providing sustained, high local antibiotic levels directly at the site of infection.
The document describes the Modified Broström Procedure for treating unstable ankles. It discusses how ankle instability is graded from I to III based on the amount of instability present. It notes that grade I and some grade II ankles may be treated conservatively through physical therapy and bracing, while grade III typically requires surgical reconstruction. The Modified Broström Procedure is described as restoring stability through anatomic repair of the ligaments while preserving range of motion and the peroneal tendons. It involves attaching the extensor retinaculum to reinforce the repaired ligaments and correct subtalar instability.
CPT is a rare and challenging condition characterized by dysplasia of the tibia leading to anterolateral bowing and risk of pathological fracture. While the exact etiology is unclear, it may involve a defect in the NF1 gene. There is no consensus on treatment, but established methods achieving union rates over 70% include intramedullary rodding, Ilizarov external fixation, and vascularized fibular grafting. The Ilizarov technique and BMP augmentation may further improve outcomes, though long-term results of newer approaches are still unknown. CPT remains difficult to treat and sometimes amputation is considered.
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
This document discusses rotator cuff tears, including their indications, treatment options, and results. It provides an overview of rotator cuff anatomy and function. It describes the various types and classifications of rotator cuff tears and discusses the history and evolution of rotator cuff repair techniques. Treatment options are discussed depending on factors like the patient's age, tear size and chronicity. Expected results are outlined based on the pre-operative tissue quality and repair achieved.
Biocartilage to Treat Osteochondral Defects of the Talus: Case Report and Tec...Jennifer Gerres, DPM
The document describes a case study and technique using BioCartilage to treat a large osteochondral defect of the talus. The key points are:
1) A 24-year old male presented with ankle pain and imaging revealed a 1.2cm x 1.6cm osteochondral defect of the talus.
2) The defect was excised and microdrilled. BioCartilage, a micronized hyaline cartilage allograft, mixed with blood or PRP was used to fill the defect.
3) BioCartilage offers advantages over other techniques like autografts in eliminating donor site morbidity and over ACI in being a single-stage procedure without wait time.
BioPoly - ISAKOS Cartilage Symposium - Shanghai June 2017Vladimir Bobic
This document discusses the BioPoly RS Knee System, a partial resurfacing implant made of a patented composite of UHMWPE and hyaluronic acid. A preliminary registry study on the implant shows:
1) Significant improvements in clinical outcomes like KOOS scores over 2 years for 35 patients, compared to historical microfracture outcomes.
2) One revision was needed due to a subchondral bone disorder, with no other structural or technical failures.
3) Over half of patients had previously failed cartilage repair procedures.
Full thickness rotator cuff: Diagnosis and ManagementSICOTEduDay
1. The document summarizes information from a presentation on rotator cuff injuries, including their etiology, classification, and surgical treatment options.
2. It describes how rotator cuff tears are classified based on their size and provides examples of repair techniques used for different types and shapes of tears.
3. The presentation discusses ongoing research studying rotator cuff injuries, including investigating genetic and epigenetic factors associated with risk and analyzing gene expression changes in injured tendons.
This document discusses periodontal regeneration and the various factors involved. It begins by defining key terminology related to grafting and regeneration. It then discusses the biology and objectives of periodontal regeneration, including the ideal outcome of new attachment formation and factors that can influence outcomes. The document outlines various techniques for periodontal regeneration including non-graft associated approaches involving removal of epithelium and surgical techniques, as well as graft-associated approaches using various graft materials. Requirements for predictable regeneration and assessment methods are also summarized.
Results of Mini-Open Latarjet Procedure in Failed in Arthroscopic Bankart Rep...TheRightDoctors
The document summarizes a study on the mini-open Latarjet procedure for patients with failed arthroscopic Bankart repair for recurrent shoulder instability. 24 patients underwent the mini-open Latarjet procedure and were followed for a minimum of 2 years. Results found satisfactory range of motion, functional outcomes, and low recurrence rates. Complications were minor. The study concludes the mini-open Latarjet is an effective option for challenging cases of recurrent instability after failed soft tissue repair due to significant bone loss.
This document discusses the principles of damage control orthopedics (DCO) for treatment of polytrauma patients. DCO involves a staged approach, with initial temporary stabilization of fractures using external fixation, followed by resuscitation and optimization of the patient. Definitive stabilization is then performed after 4 days once the acute inflammatory response has subsided to minimize additional surgical stress. Femur fractures stabilized with external fixation can be converted to intramedullary nailing within 2-3 weeks once the risk of infection is low. Pelvic and acetabular fractures may also be definitively treated 7-10 days after injury. The goal of DCO is to balance life-saving care of injuries with avoiding lethal complications through additional
This document describes a technique for selectively intruding overerupted molars in adult patients using a combination of selective alveolar corticotomies and a modified full-coverage maxillary splint with nickel-titanium springs. Two case reports are presented where this approach successfully intruded overerupted maxillary molars within 2.5-4 months without side effects. The technique aims to take advantage of the regional acceleratory phenomenon caused by corticotomies to increase orthodontic treatment efficiency for adult patients who require molar intrusion.
This document discusses autologous chondrocyte transplantation (ACT), a treatment for cartilage defects. It covers the stages of ACT healing, indications, prerequisites, investigations, the implantation procedure, and rehabilitation goals. The proliferative, transition, and remodeling stages of healing are described. Advantages include producing hyaline-like cartilage to fill defects of any size. Disadvantages include being more invasive and expensive with a longer recovery than other options.
This document summarizes a surgical technique called L-shaped corticotomy with vascularized bone flap sliding for treating chronic osteomyelitis of the tibia. Some key points:
- Traditional Ilizarov techniques have long treatment times and risks of complications, so this technique aims to shorten treatment.
- It involves radical debridement followed by an L-shaped bone cut preserving blood supply, then sliding the bone flap to increase contact area for healing.
- A study of 34 patients found this technique reduced the external fixation time and index compared to traditional methods, with no major complications.
- By preserving blood supply and increasing contact area, it may promote faster bone formation and healing compared to traditional Il
• Arthroplasty / total knee replacement in Delhi is a surgical intervention in which the worn-out joint surfaces of the femur, tibia and often the kneecap are replaced, as they are a source of disabling pain. Metallic and high-density polyethylene components are placed in place of damaged and painful joint surfaces.
Bobic Vladimir - Partial resurfacing - SICOT Montreal 12th October 2018Vladimir Bobic
This document discusses partial resurfacing implants, specifically the BioPoly implant. It provides details on the BioPoly material which is a combination of UHMWPE and hyaluronic acid. It then summarizes a registry study of 35 patients who received the BioPoly implant with results showing significant improvement in clinical outcomes and one revision. The conclusion is that partial resurfacing implants have limited primary indications but can be useful for failed cartilage repair procedures.
The document discusses the assessment and management of maxillofacial injuries. It begins with the primary assessment of airway, breathing, circulation, disability and exposure. It then covers airway control and management, breathing issues and types of injuries that can cause inadequate ventilation. Circulation and hemorrhagic shock classification is reviewed. Neurological examination and secondary assessment of specific body regions is also outlined. The document focuses on fractures of the mandible, including epidemiology, classification, diagnosis using history, exam and radiographs, and various treatment modalities like closed/open reduction, internal fixation techniques including miniplates, and principles of fracture healing. Multiple case examples are provided to illustrate concepts.
This document discusses ligament function, differences between normal and scarred ligaments, options for ACL reconstruction surgery including graft types and fixation methods, the process of ligamentization after implantation, reasons for reconstruction failure, and the ideal fixation method. It also reviews the literature on outcomes comparing graft types, fixation methods, and surgical techniques for ACL reconstruction.
Ilizarov Methods versus Masquelet’s Technique in Management of Segmental Skel...Abdallah El-Azanki
** PhD Thesis protocol submitted for partial fulfillment of PhD Degree in orthopedic surgery.
**By:
Abdallah Ibrahim Jomaa El Azanki MD, MSc
Faculty of Medicine -- Mansoura University
** Supervisors
Prof. Brakat Sayed Elalfy
Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
Prof. Nabil Ahmed Elmoghazy
Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
Dr. Sallam Ibrahim Fawzy
Assistant Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
High tibial osteotomies are a surgical procedure used to treat unicompartmental osteoarthritis of the knee caused by malalignment. There are several types of high tibial osteotomies including medial opening wedge, lateral closing wedge, medial opening hemicallotasis, and dome osteotomies. Complications can include recurrence of deformity, irritation or failure of implants, nerve palsy, nonunion, infection, or stiffness. Outcomes of high tibial osteotomies are generally good, though some patients may eventually require total knee arthroplasty. High tibial osteotomies can be combined with cartilage restoration procedures, though long-term outcomes of graft survival are mixed.
Guided Growth for Angular Knee Deformities in Nutritional Rickets ChildrenTamer El-Sobky
Nutritional rickets in children is a global health concern. It manifests in generalized skeletal deformities including angular or coronal plane knee deformities. Guided growth surgery is a recognized treatment option for angular knee deformities in general. However, there is insufficient citations on its use in the treatment of angular knee deformities in children with nutritional rickets. Rachitic lower limb deformities can be complex. They are usually multiostotic, multiapex and multiplane and require extensive corrective osteotomies. However osteotomies are fraught with complications and can be technically demanding. In this presentation we present our experience with the use of surgical guided growth as a minimally invasive treatment option to correct angular knee deformities in children with nutritional rickets.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
1. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilage Lesion– what can we do ?
Our Point of View !
Paulo Ribeiro de Oliveira
2. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilage
Tissue that lines the diarthrodial joints, with:
1. Low friction surface
2. Avascular
3. Permeable (water and nutrients)
4. Flexible wear resistant
5. Elasticity
6. Resistance to compressive forces
7. Ability to minimize peak loads transmitted to
the subchondral bone
8. Little regenerative capacity
3. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Constitution :
1. Collagen fibers type II and type IX
(strength and stress resistance)
2. Water 70 - 80%
3. Proteinoglicans or hydrophilic molecules
"aggrecan" (20 to 40% dry weight)
(elasticity and deformability)
4. Chondrocytes (10% dry weight)
5. Other collagens type V, VI, XI small
amounts
Cartilage
4. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
1. Microlesion of cells and matrix with no visible damage to
the cartilage
2. Macrolesion
3. Fractures of articular cartilage and subchondral bone
(osteochondral fractures)
Cartilage
5. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Outerbridge classification:
Grade 0 - Normal cartilage
Grade 1 - Cartilage softened and swollen
Grade 2 - Cracking not reaching the
subchondral bone; less than 1.5 cm
Grade 3 - Cracking reaching the subchondral
bone without exposure; greater than 1.5 cm
Grade 4 - subchondral bone exposure of any
diameter
Cartilage
ICRS Classification:
Normal: grade 0
Almost normal:
Grade 1a- superficial lesions / softening
Grade 1b - 1a and / or fissures or surface cracks
Abnormal:
Grade 2 - length < 50% thickness
Serious injury:
Grade 3 a – extension > 50%
Grade 3 b - to the calcified layer
Grade 3 c - to the surface of the subchondral
bone (without entering)
Grade 3 d - includes blisters
Very serious injury:
Grade 4 a - penetration of the subchondral bone
but not the full diameter of the defect
Grade 4b - penetration across the diameter of the
defect
Several classifications : Outerbridge, ICRS etc
6. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
The primary factor in the development of a cartilage lesion is
undoubtedly the relationship between the size of the lesion and the
load surface, being adversely affected by:
Obesity
Age
Axial misalignment
Family history of osteoarthritis
Overload activities
Cartilage
7. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilage
Treatment
• Individual
• Effective complaints
• Patient expectations
• Age (physiological)
• IMC
• Symptomatology (mechanical pain,
inflammatory or mixed)
• Occupation
• Ability to understand the detailed objectives
and commitment to accept
• Defect
• Localization
• Number of defects
• Size
• Depth
• Defect geometry
• The underlying subchondral space rating
• Lesion contained or not
• Axial deviations
• Instability associated
• Associated injuries (meniscal)
All treatment should be individualized on the basis of these parameters
8. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Conservative treatment
Drugs - NSAIDs
Infiltration - corticosteroids, viscosupplementation, collagen ???
Orthoses
Exercise, weight loss
Activity modification
Cartilage
9. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Microfractures
Microfratures and augmentation
Autologous osteochondral graft
Osteochondral allograft
Matrix autologous chondrocyte implantation
Cartilage
Treatment
10. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Microfractures
❖ Serve to facilitate the repair process with surface repopulation with undifferentiated
mesenchymal cells
❖ Complete filling of the lesion with a stable clot
❖ Overcorrection of axial misalignments
❖ Role of BMP, PGF etc...
Cartilage
Treatment
11. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilage
Treatment
12. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilage
Treatment
13. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
A recent systematic review of twenty-eight studies with >3000 patients found that knee function was consistently improved in
the first twenty-four months after microfracture in the patients studied. After two years, knee function scores remained above
preoperative levels but declined; only 67% to 85% of patients continued to report improvement in the two to five-year time
frame.
It was also noted that shortcomings of the microfracture technique included limited production of hyaline cartilage,
unpredictable repair cartilage volume, and higher failure rates for cell transplantation surgery following failed prior microfracture
compared with patients in whom similar cellular treatments were used as first-line options.
Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-
based systematic analysis. Am J Sports Med. 2009 Oct;37(10):2053-63.
There is growing evidence that modification or augmentation of microfracture may improve the quality of the repair tissue
formed and ultimately the clinical outcome for patients.
At the present time, it is believed that marrow stimulation techniques are best reserved as a first-line option for isolated defects
of <2.5 cm2 on the femoral condyles. Biologic augmentation techniques may broaden these indications and improve longterm
outcomes.
Strauss EJ, Barker JU, Kercher JS, Cole BJ, Mithoefer K. Augmentation strategies following the microfracture technique for repair of focal chondral
defects. Cartilage. 2010 Mar;1(2):145-52.
Cartilage
Microfrature and augmentation
14. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Axial deviations correction
To correct the axial misalignment for a better distribution
of the axial compressive forces
Studies have shown the appearance, after osteotomy, of
fibrocartilage in the medial compartment (Bergenudd H et
al)
This symptons improvement deteriorates with the time
course (Coventry MB et al)
The axial correction should never be by default and should
be performed if necessary in conjunction with
reconstruction techniques
Cartilage
Treatment
15. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Autologous osteochondral graft
It consists in the transplant of osteochondral grafts from a non load zone to
vital areas of the articular surface
Outerbridge HK et al. and Hangody et al. confirmed the validity of this
technique for limited defects correction, highlighting the potential morbidity of
the donor area and the difficult technique of fixation of the graft
Important: early mobilization , without load up to 6-8 weeks
Cartilage
Treatment
16. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Create a sufficiently smooth and sliding
surface of hyaline cartilage or similar
Enabling the delay of joint degeneration
Cartilage
Treatment
Autologous
osteochondral graft
17. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
INDICATIONS
Chondral or osteochondral focal lesions on loading surfaces of the joints
Can be used in astragalus, head of the femur, knee, etc.
Usually below the age of 50
Defects of 1 - 4 cm2
Treatement of associated pathologies: meniscal or ligamentous injuries,
axial deviations correction
Patient compliance to the protocol
Cartilage
18. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Absolute:
Neoplasia, infection, rheumatoid arthritis and
similar pathologies
Absence of a compatible donor zone
〉50 years
Defect 〉8 cm2
Defect deeper than 10mm
Noncompliant patient
Relative:
40 - 50 years
Defect size 4 - 8 cm2
Moderate degenerative changes
Cartilagem
CONTRAINDICATIONS
19. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
TÉCNICA
Arthroscopic
Technically demanding
Miniarthrotomy
Best alternative for
inexperienced
Cartilagem
Tratamento
20. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Pure chondral lesions - the cylinder should be 15 mm
Osteochondral lesions - the cylinder should be 25 mm
Cartilage
Treatment
21. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilagem
Tratamento
22. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cylinder perpendicular to articular surface
Avoid the cylinder sinking; 1 - 2 mm above the adjacent
surface
No load for 3 - 5 weeks
Cartilage
Treatment
23. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
MOSAICPLASTY – RMN 1 YEAR
24. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Bobic ( 1996)
Mosaicplasty in 12 patients with ACL injury: with good or excellent results in 10/12 cases
Wang ( 2002)
Mosaicplasty in 16 patients with 2 to 4 years of follow-up: 80% good or excellent results
Sharp et al ( 2005)
Combined chondrocyte transplantation and mosaicplasty with follow up of 3 years in 13 patients with large lesions:
excellent results in 10/13 patients
Hangody, L. et al. JBJS . Am. 85:25-32, 2003
10 years of follow - up of 831 patients with mosaicplasty: excellent results in 92% in the femoral condyle, 87% in tibial
plate, 79% in patella or trochlear region and 94% in astragalus
Cartilagem
Mosaicplasty
Effect of Impact on Chondrocyte Viability During Insertion of
Human Osteochondral Grafts
BY BORIS H. BORAZJANI et al
Investigation performed at University of California-San Diego, La Jolla, California
Conclusions: Impact insertion of osteochondral grafts generates damaging loads that cause
chondrocyte death, particularly in the superficial zone, mainly as a result of apoptosis mediated by
the activation of caspases.
Clinical Relevance: Chondrocyte death that occurs during impact insertion of osteochondral grafts may lead to compromised
function. Understanding the mechanisms and consequences of such impact loading may provide insights into potential
therapeutic interventions, or lead to changes in the insertion technique, to decrease the cell injury associated with impact
loading.
In conclusion : Osteochondral autograft transfer is
recommended for smaller lesions, lesions in high-
demand athletes, and lesions with associated bone
loss, while microfracture is suited for medium-size
defects with little or no bone loss in lower- demand
patients and they should therefore be reserved for
revision situations.
25. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Osteochondral allograft
Use of cadaver tissue to correct larger defects
Restrictions
Size
Height
Default location
Are factors that influence the adaptation of the graft to the
recipient
Advantages
Ability to fill large defects
Absence of donor morbidity
Cartilage
Treatment
26. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Restrictions
Obtainment difficulties
Rejection
Difficulty in graft incorporation
Diseases transmission
Potential high cost
Technical difficulty in graft conditioning
Cartilage
Treatment
Osteochondral allograft
27. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Graft types
Allograft in culture medium - 91% viability of chondrocytes
after 14 days (Ball, ST et al.).
Cryopreserved allograft - feasibility 77% of chondrocytes to
one year (animal study) deterioration with time (Gole et al.)
Allograft "Fresh Frozen" - The process of freezing at - 80 °
destroys the viability of chondrocytes in all graft (Enneking,
WF et al.)
Cartilage
Treatment
Osteochondral allograft
Most authors concluded that the survival is directly related to the
number of viable cells
Transplantation of Osteochondral Allografts After Cold Storage
BY THEODORE MALININ, MD, H. THOMAS TEMPLE, MD, AND BILL E.
BUCK, MD
Investigation performed at the Department of Orthopaedics and Rehabilitation,
University of Miami School of Medicine, Miami, and the Mannheimer Foundation, Homestead, Florida
Conclusions: Time-dependent loss of chondrocytes in articular cartilage
stored at hypothermia, especially in specimens stored for longer than fifteen
to twenty days, was observed in this study. Cartilage allografts transplanted
into nonhuman primates after twenty-one days of storage underwent more
severe degenerative changes than allografts that had been stored for less
than twenty-one days. These findings suggest caution when transplanting
cartilage stored at hypothermia for over twenty days.
Clinical Relevance: Surgeons who perform fresh osteochondral allograft transplantation should be cognizant of the time-
dependent changes associated with cold storage of these grafts. Full-thickness articular cartilage defects usually do not heal,
presumably because of the limited regeneration capacity of the tissue. The treatment of patients with articular cartilage lesions
is a challenge to orthopaedic surgeons. The problem is magnified by the high frequency of cartilage injury in the knees of
young people and the relatively poor results of arthroplasty in young, active individuals. The results of treating cartilage
defects have been largely disappointing. Shaving, burring, or drilling of these lesions does not predictably result in cartilage
regeneration in humans or in experimental animals. Other treatments have yielded varying outcomes, and each has its
inherent limitations and advantages.
28. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilage
Treatment
❖ Harvesting cartilage tissue from the host with chondrocytes, 14 - 21 days
of growth and redeploy them in joint surface defects (Wakitani S, et al)
❖ Autologous chondrocytes implantation in cartilage defects can be
effectively and reproducibly. We must pay attention to the possibility of the
carrier agents if used may trigger synovial reactions (Brittberg, M et al)
Matrix-assisted autologous
chondrocyte implantation
29. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilage
Treatment
30. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Advantages of the 3rd generation technique
The matrix with chondrocytes is subjected to mechanical stimulation, with
hydrostatic pressure to chondrocytes for a minimum of seven days which
will increase the production of collagen type II, aggrecan and other normal
components of hyaline cartilage
Easy application and adaptation to different sizes and shapes of defects
Cartilage
Treatment
31. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cartilage
Treatament
32. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Cathal J. Moran, MD, FRCS(Orth), Cecilia Pascual-Garrido, MD, Susan Chubinskaya, PhD, Hollis G. Potter, PhD, Russell F. Warren, MD, Brian J. Cole,
MD, MBA, and Scott A. Rodeo, MD
Investigation performed at the Hospital for Special Surgery, New York, NY, and Rush University Medical Center, Chicago, Illinois
Cartilage
33. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Condylar injury
Axial deformity
AP instability
Meniscal injury
Lesion size
« 2-3cm
Microfractures ++
OATS ++
» 2-3 cm
Inactive
Microfractures +-
OATS +-
OCA ++
MACI ++
Active
OCA ++
MACI ++
Cartilage
Treatment- How I Do It
34. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Patellofemoral injury
Misalignment of the knee
extensor apparatus
Lesion size
« a 2-3cm
Inactive
Microfractures ++
MACI/AMPF +-
Active
ACI/AMPF ++
OATS/AMPF +-
OCA/AMPF +-
» a 2-3 cm
Inactive
Microfractures ++
MACI / AMPF +-
Active
OCA/AMPF ++
MACI/AMPF ++
Cartilage
Treatment- How I Do It
35. Paulo Ribeiro de Oliveira
Coordenador da Unidade Funcional do Joelho
Hospital de São João - Porto / F. Medicina do Porto
Thank´s