Chondral Injuries - Current Concepts in Management & Cartilage RegenerationVaibhav Bagaria
Chondral Injuries are one of the technically challenging cases for sports injury surgeons. There are various techniques described including lavage, abrasion chondroplasty, micro fracture, Mosaicplasty, ACI - various generations and newly developed Bioprinting
An overview of management of articular cartilage injuries at various stages. the modalities discussed are PRP, Bone marrow aspirate concentrate, Microfracture, Mosaicplasty and ACI. the pros and cons of each method discussed and compared
-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.
Cartilage Injury in Sports 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'
Chondral Injuries - Current Concepts in Management & Cartilage RegenerationVaibhav Bagaria
Chondral Injuries are one of the technically challenging cases for sports injury surgeons. There are various techniques described including lavage, abrasion chondroplasty, micro fracture, Mosaicplasty, ACI - various generations and newly developed Bioprinting
An overview of management of articular cartilage injuries at various stages. the modalities discussed are PRP, Bone marrow aspirate concentrate, Microfracture, Mosaicplasty and ACI. the pros and cons of each method discussed and compared
-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.
Cartilage Injury in Sports 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'
Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Tissue Engineering,Gene Therapy,Osteoarthritis,Avascular Necrosis,Sickle Cell Disease,Disc Regeneration,PRP,Autologous Chondrocyte Transplantation,BMAC,Spinal cord Injury paraplegia,Autoimmnune disorders,Diabetic foot,Tendinopathies,Wound Healing,,SCAFFOLDS IN STEM CELL THERAPY.Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Articular Cartilage : Repair To Regenerate To Replace Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
il dottor Spoliti Ortopedico illustra come curare con le Cellule mesenchimali, difetto condrale Ricostruzione con Acido Ialuronico e midollo osseo autologo Aspirare Concentrate
Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Tissue Engineering,Gene Therapy,Osteoarthritis,Avascular Necrosis,Sickle Cell Disease,Disc Regeneration,PRP,Autologous Chondrocyte Transplantation,BMAC,Spinal cord Injury paraplegia,Autoimmnune disorders,Diabetic foot,Tendinopathies,Wound Healing,,SCAFFOLDS IN STEM CELL THERAPY.Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Articular Cartilage : Repair To Regenerate To Replace Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
il dottor Spoliti Ortopedico illustra come curare con le Cellule mesenchimali, difetto condrale Ricostruzione con Acido Ialuronico e midollo osseo autologo Aspirare Concentrate
Cartilage is derived (embryologically) from mesenchyme. . Chondroblasts produce the intercellular matrix as well as the collagen fibres. Chondroblasts that become imprisoned within this matrix become chondrocytes. The articular surface of most synovial joints are lined by hyaline cartilage
This includes the basics of open fracture including classifications and treatment.
References are from the latest edition of rockwood and greens fracture in adults.
A variety of autologous biologic products provided by Cellentis, a well-known Biotechnology company working in a close relation to Regenerative and Reconstructive Orthopaedic Department in IASO GENERAL HOSPITAL/Athens/Greece
Δείτε τις τελευταίες τεχνολογικές εξελίξεις στην Αθλητιατρική & τις Αθλητικές κακώσεις. Βλαστοκύτταρα και άλλα σύγχρονα βιολογικά προϊόντα, συνδυάζονται αρμονικά με υπερσύγχρονα φυσιοθεραπευτικά μηχανήματα και τεχνικές με σκοπό την επιτάχυνση της αποκατάστασης των μυικών κακώσεων και τη γρηγορότερη και ασφαλέστερη επάνοδο του αθλητή στην ενεργό δράση.
ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΜΕ ΜΟΝΗ ΔΕΣΜΗ ΣΕ ΑΝΑΤΟΜΙΚΗ ΘΕΣΗ. ...STAVROS ALEVROGIANNIS
(Παρουσίαση σε Διεθνές Συνέδριο Εταιρείας Αρθροσκόπησης & Χειρουργικής Γόνατος της Πολωνίας, POZNAN 2011).
FREE HAND NOVEL ANATOMIC SINGLE BAND TECHNIQUE FOR ACLR
(X/O BUTTON,CONMED,LINVATEC,USA).PRELIMINARY RESULTS.
(POZNAN 2011)
ΠΡΟΓΡΑΜΜΑ ΠΡΟΛΗΨΗΣ ΤΡΑΥΜΑΤΙΣΜΩΝ ΣΕ ΕΠΑΓΓΕΛΜΑΤΙΕΣ ΑΘΛΗΤΕΣ. Π.Α.Ε ΟΛΥΜΠΙΑΚΟΣ- Α...STAVROS ALEVROGIANNIS
Διεθνές Συνέδριο ISOKINETIC υπό την αιγίδα της FIFA/ Bologna/Italy 2011
INNOVATINE INJURY PREVENTION PROGRAM FOR ELITE ATHLETES.
OLYMPIACOS F.C. FOOTBALL ACADEMY –U20 & U17 TEAMS. PRELIMINARY RESULTS
ΠΛΗΡΩΣ ΑΡΘΡΟΣΚΟΠΙΚΗ ΑΠΟΚΑΤΑΣΤΑΣΗ ΧΟΝΔΡΙΝΩΝ ΚΑΙ ΟΣΤΕΟΧΟΝΔΡΙΝΩΝ ΒΛΑΒΩΝ ΓΟΝΑΤΟΣSTAVROS ALEVROGIANNIS
ΠΛΗΡΩΣ ΑΡΘΡΟΣΚΟΠΙΚΗ ΑΠΟΚΑΤΑΣΤΑΣΗ ΧΟΝΔΡΙΝΩΝ ΚΑΙ ΟΣΤΕΟΧΟΝΔΡΙΝΩΝ ΒΛΑΒΩΝ ΓΟΝΑΤΟΣ ΜΕ ΕΜΦΥΤΕΥΣΗ ΚΑΛΛΙΕΡΓΗΜΕΝΩΝ ΧΟΝΔΡΟΣΦΑΙΡΙΔΙΩΝ ( ACT3D). ( Παρουσίαση περιστατικών στο Γερμανικό Ετήσιο Συνέδριο Χειρουργικής Ορθοπαιδικής και Τραυματιολογίας, Βερολίνο, 2008).
FULLY ARTHROSCOPICALLY PERFORMED 3-DIMENSIONAL AUTOLOGOUS CARTILAGE TRANSPLANTATION (ACT3D) FOR MEDIUM TO LARGE FOCAL CHONDRAL DEFECTS AT THE KNEE
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ΠΛΗΡΩΣ ΑΡΘΡΟΣΚΟΠΙΚΗ ΑΠΟΚΑΤΑΣΤΑΣΗ ΧΟΝΔΡΙΝΩΝ ΒΛΑΒΩΝ ΕΠΙΓΟΝΑΤΙΔΟΜΗΡΙΑΙΑΣ ΑΡΘΡΩΣΗΣ ΚΑΙ ΑΣΤΡΑΓΑΛΟΥ
1. FULLY ARTHROSCOPICALLY PERFORMED ACI FOR
CHONDRAL & OSTEOCHONDRAL DEFECTS AT PFJ & TALUS.
PRELIMINARY RESULTS.
S.ALEVROGIANNIS, MD, PhD.
CONSULTANT ORTHOPAEDIC SURGEON
2ND Orth. Dept.251 General Air Force Hospital, Athens/GR.
3. COMMON PROBLEMS IN TREATING
RETRO-PATELLAR & TALAR
CHONDRAL LESIONS
RETRO-PATELLAR LESION POSTEROMEDIAL TALAR LESION
• Difficult surgical procedure
• Often open surgery required
• Major trauma
• Lower limb mal-alignment
• Removal of hardware (2nd operation specially talar chondral injuries)
OFTEN LEAD TO FAIR TO POOR SUBJECTIVE & OBJECTIVE RESULTS
4. AUTOLOGOUS CHONDROCYTE
TRANSPLANTATION (ACT3D) WITH
SPHEROIDS
RELATIVELY NEW TECHNIQUE:
• No scaffold, membrane, periosteum or
growth factors needed
• No fibrin glue or other fixation
• Strictly autologous, no viral transmission
• Minimally invasive technique
(mainly arthroscopically performed)
5. AUTOLOGOUS SPHEROIDS
• Small balls, consisted of 3-dimensional
conglomerats of chondrocytes together with
their matrix
• Diameter about 1mm
• About 2x105 chondrocytes in their de novo
matrix
• 10-70 spheroids/ cm2 of defect
• Grown in the patients own serum
• Cultivated without antibiotics
• Expression of hyaline specific markers:
proteoglycans
collagen type II
S-100, CEP-68
• Suppression of the expression of collagen
type I
• Expression of chondrogenic growth factors:
TGF-β, IGF-1,PDGF,FGF-2
6. Manufacturing of co.don
chondrosphere®
3-4 weeks
Biopsy removal Monolayer cell culture cultivation
2-3 weeks
co.don
3d-cell culture Preparation of Transplantat
chondrosphere®
Spheroid formation
induced by 3D cell-cell-
contacts
induced by matrix synthesis
7. Filling of the defect
Native Native Native Native
20min after application of appr. 30 Defect
spheroids/ cm2 Few days after transplantation
Native Native Native Native
Ddefect Defect
appr. 6 weeks after OP appr. 12 weeks after OP
8. Autologous Chondrocyte Transplantation
Indications: Ideal patient
• Large stage III-IV defects • Age 15-50 years old
• Extensive subchondral • No malalignment
cystic changes • No degenerative joint
• Failed previous surgery disease
• No instability
Grade I Grade II Grade III Grade IV
OUTERBRIDGE CLASSIFICATION
10. RETROPATELLAR LESIONS
( 2 STAGE PROCEDURE)
1ST STAGE:
• Arthroscopic inspection of chondral injury
• Harvest cells from NWB area of knee joint
• Cell cultivation
2ND STAGE:
• Arthroscopic debridement of patellar lesion
• Cells implantation
FULLY ARTHROSCOPICALLY PERFORMED
11. (2ND STAGE)
RETROPATELLAR AUTOLOGOUS
CHONDROCYTE TRANSPLANTATION (ACT3D)
WITH CHONDROSPHERES
12.
13. REHABILITATION PATELLAR AND
TROCHLEAR DEFECTS
WEEK 1 WEEK 2-7 > WEEK 7
MOBILIZATION Brace in extension CPM with restrictions : Free movement
Week 2-3: 0/0/300 (restricted by pain)
Week 4-5: 0/0/600
Week 6-7: 0/0/900
0-14 DAYS WEEK 3 - 4 >WEEK 4
WEIGHT Foot sole contact PWB (up to 50%) Building up FWB
BEARING 3-point –walking 3-point –walking with within 3-6 weeks
with crutches crutches
14. RESULTS
• All the procedures progressed uneventfully.
• Lysholm & Gillquist Score rose from 42.1 to 74.8
1 y.p.o
• IKDC score rose from 56 to 92
• VAS pain significantly reduced from 6.8 to 1.8
• Patient Outcome Function score showed
significantly better performance.
• All MRI scans showed adequate filling of the
defect, with no delamination, no significant BMO
and no hypertrophy of the newly-formed cartilage).
15. OSTEOCHONDRAL LESIONS OF
THE TALUS
• Osteochondral lesions of the talus involve damage or separation of
the cartilage and underlying subchondral bone.
• This lesion may range from a small defect in the talar articular
surface, a subchondral cyst, or a large detached osteochondral
fragment.
• Transchondral fracture
• Osteochondral fracture
• Osteochondritis dissecans
• Talar dome fracture
• Flake fracture
20. MRI Staging
Hepple et al.
• I: Superficial chondral lesion
• II-a: Chondral lesion +
Subchondral compression
fracture + Bone Edema
• II-b: Without bone edema
• III: Separated but nondisplaced
fragment
• IV: Displaced fragment
• V: Subchondral cyst
21. Arthroscopic Staging
Pritsch et al. and Ferkel et al.
A: Smooth, intact, but soft or ballotable
B: Rough surface
C: Fibrillations/ fissures
D: Flap present or bone exposed
E: Loose, nondisplaced fragement
F: Displaced fragment
22. MRI Grading system with
arthroscopic correlation.
Mintz et al., Arthroscopy 2003
• Stage 0: Normal
• Stage I: Hiperintense but intact chondral surface
• Stage II: Chondral fibrillation or fissur
• Stage III: Chondral flap or visible bone
• Stage IV: Nondisplaced fragment
• Stage V: Displaced fragment
23. SURGICAL TREATMENT
OPTIONS
• Traditional treatment of choice in talar OCD is still MFx.
• Concerns as compared to ACI (hyaline-like cartilage,
superior outcomes nature of repair, long-term results).
24. ACI TREATMENT OPTION
Unpopular in ankle joint despite ability to repair defects with hyaline-rich
cartilage, because of:
•Arthrotomy
•Malleolar osteotomy
•Source of morbidity
25. TALAR CHONDRAL DEFECTS-
LITERATURE REWIEW
– medial lesions are most often chronic and not necessarily associated with
specific trauma whereas lateral lesions are almost always traumatic.
– Lateral lesions may be more amenable to internal fixation for acute
injuries
– Lateral lesions have a better prognosis than medial lesions.
– Studies which lump medial and lateral lesions together are difficult to
interpret.
1. Treatment of osteochondral lesions of the talus: a systematic review. Zengerink M, Struijs PA, Tol JL, van
Dijk CN. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):2β8-4ό.
2. Matrix-induced autologous chondrocyte implantation of talus articular defects. Giza E, Sullivan M, Ocel D,et
al. Foot Ankle Int. 2010;31(9):747-53.
3. Comparison of MRI and arthroscopy after autologous chondrocyte implantation in patients with
osteochondral lesion of the talus. Lee KT, Choi YS, Lee YK, et al. Orthopedics. 2010:1-33(8).
4. Autologous chondrocyte implantation of the ankle: a 2- to 5-year follow-up. Nam EK, Ferkel RD, Applegate
GR. Am J Sports Med. 2009;7(2):274-84.
5. Marlovits S. et al. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of
autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical
outcome after 2 years. European Journal of Radiology 2006; 57(1): 16-23.
26. MATERIAL AND METHOD
• 7 patients (avg age 28 years) all recreational athletes
• R(5) and L(2) talus
• Between June 2008 and Feb 2010.
• Lesions location :
medial aspect of the talus (4)
lateral aspect of the left talus (2)
central aspect of the talus (1)
• Avg size measuring : 3.1 cm2 (2.4-3.8)
• All type III- IV (Outerbridge scale).
• All underwent arthroscopy ipsilateral knee (1st stage ACI)
• Avg. F/U 12 months
• Pre-op and post-op evaluation was done using the AOFAS
Score, LYSHOLM & GILLQUIST score, Patient Outcome
Function score and Visual Analogue Pain score.
29. REHAB PROTOCOL
• Antibiotic and thrombosis prophylaxis are given for 48 hours and 3 weeks respectively.
• Hospitalization 2-3 d.
• A gait as close to normal as possible is practiced, as well as stair walking is gained before the patient
is discharged from the hospital.
• CPM (s.d.p through whole hospitalization/6-8 h per day).
• Active ROM exercises post 3rd d.p.o.
• Calibrated brace to allow motion of 15° plantar flexion and 15° dorsal flexion (6 w.p.o).
• P.W.B (20Kgr) with crutches, for the first six weeks.
• Gradual increase is commenced every week until full weight bearing is achieved in week 8 to 10.
• The rehabilitation continues, under the supervision of a physical therapist, with motion and
strength training.
• Once the brace is removed pool exercises can commence.
• As full weight bearing is reached gait training is started along with long distance walking and
bicycling.
• Functional exercises in closed chain are also incorporated in the rehabilitation program.
• Motion and proprioceptive training is continued throughout the rehabilitation, running and
plyometric exercises have to wait for six months.
30. RESULTS
• All the procedures progressed uneventfully.
• We assessed the patient at 6m and 1 y.p.o
• AOFAS score from 32.1 to 91
• Lysholm & Gillquist Score rose from 45.5 to 72.5
• VAS pain significantly reduced from 6.3 to 1.7
• Patient Outcome Function score showed
significantly better performance.
• MRI showed adequate filling of the defect without
significant graft-associated complications for the
same period (no significant bone marrow oedema).
31. 3D- Autologous Chondrocyte
Transplantation
Advantages: Disadvantages:
• Easy use/arthroscopic procedure • Expensive
• Cell-matrix ratio similar to that of the • Needs cartilaginous rim
natural cartilage • Cannot address cystic lesion without an
• Full coverage of the defect additional stage to procedure (bone
• Full integration of the newly produced grafting)
cartilage to the neighboring healthy • Further investigation is necessary to
tissue determine if this theoretical advantage
• Hyaline like cartilage of superior repair tissue results in
improved structural and biomechanical
• Large surface area may be repaired properties, and whether this translates
• Less hospitalization time into better long-term outcomes.
• Less medication needed
• Less pain experienced
• Continuous improvement
• No interruption of everyday lifestyle
• Return to sports without limitations
32. CONCLUSION
• ACT3D for treating talar and retropatellar chondral defects
preliminary results are very promising, can be performed fully
arthroscopically, reduce operative time, avoid patient having multiple
operations
• The whole procedure requires surgeon’s experience and coordinative
team
• Rehabilitation protocol is quicker due to minimal trauma.
• Await medium and long term results
• A greater number of cases and further mid and long term follow-up
has to be studied in order to prove the efficacy of the method.
• As far as we know this is the first publication in the literature
regarding 3nd generation ACI technique fully arthroscopically
performed, concerning retro-patellar & talar chondral lesions, in our
country.