Refixation of the supraspinatus tendon in a rat model—influence of continuous growth factor application on tendon structure

The purpose was to evaluate histological changes of the supraspinatus tendon (SSP) after refixation under continuous growth factor application over 20 days in comparison to the native healing process. In a chronic rat tendon tear model (15 rats/group), a transosseous SSP refixation was performed and growth factors (control, G‐CSF, b‐FGF, combination) were continuously released into the subacromial space by an osmotic pump. Tendon healing was evaluated histologically by a modified MOVIN‐Score, and Collagen I/III content was determined by immunohistology at 6 weeks. A modified MOVIN sum score showed significant lower counts for G‐CSF and b‐FGF in comparison to the control group (p = 0.050/p = 0.027) and the combined group (p = 0.050/p = 0.043). Collagen III was significantly reduced in the combined group compared to the control group (p = 0.028). Collagen I showed no significant differences. The Collagen I/III ratio was nearly doubled for b‐FGF and the combined group compared to the control. At the study endpoint, 33% of pump dislocations were detected. The continuous application of both isolated growth factors (G‐CSF/b‐FGF) achieved improved tendon‐remodeling. However, the continuous application via an osmotic pump showed a relative high dislocation rate when applied in the rat model. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 300–305, 2013     

Organization and financing of home nursing in the European Union

The aim of this study was to provide an overview of the organization and financing of home nursing in the 15 member states in the European Union Home nursing was defined as the nursing care provided at the patients' home by professional home nursing organizations Data were gathered by means of three complementary research methods desk research, postal questionnaire among identified experts and face-to-face interviews with experts The results showed that there are large differences between the countries in the way home nursing care is financed There seems to be a relation between the way of funding and the organizational structure In member states where the organizations receive a fixed budget, based on the number of inhabitants or the demography of the catchment area, home nursing is mainly provided by one type of organization and is freely accessible for the patients In this situation there is little competition among the organizations, and the catchment areas of the regional organizations do not tend to overlap On the other hand, in countries where organizations are reimbursed according to a fee-for-service principle and a referral of a doctor is required, home nursing is provided by different types of organizations and also by independent nurses It seems that fee-for-service reimbursement stimulates competition between providers and a market-oriented home care In addition, a fee-for-service method of funding also has the consequence that mainly technical nursing procedures and some basic care are reimbursed, this leaves little room for nurses to perform preventive and psychosocial activities or to provide more integrated care     

Bone scan appearances following biopsy of bone and bone marrow

The influence of sternal marrow aspiration, iliac crest marrow aspiration, and iliac crest bone biopsy on bone scan appearances was examined. Eighteen patients were scanned a mean of 9.9 days after sternal marrow aspiration with a Salah needle (diameter 1.2 mm). Only one patient had an abnormality at the biopsy site. Bone scans obtained in 9 patients a mean of 10 days after iliac crest trephine marrow biopsy with a Jamshidi needle (diameter 3.5 mm) showed no abnormality at the biopsy site. In 18 patients with metabolic bone disease who had undergone iliac crest bone biopsy with an 8-mm needle, a scan abnormality due to the biopsy was usually present when the interval between the biopsy and the scan was 5 days to 2 months. Patients who were scanned within 3 days of iliac crest bone biopsy or more than 2 months after biopsy had normal scan appearance at the biopsy site.     

Analysis of the effects of high tibial osteotomy on tibial rotation

Purpose

Limited literature reports on internal and external rotation of the distal fragment in the context of valgus open wedge (OW) high tibial osteotomy (HTO). In the authors clinical observation, the distal fragment was always rotated internally in relation to the proximal fragment by the end of the surgical procedure. The purpose was to evaluate the influence of valgus OW-HTO on post-operative tibial torsion.

Study design

Prospective case series.

Methods

Fifty patients (10 female, 40 male; mean age 42.1?±?9.4 years) underwent valgus OW- HTO. The osteotomy was spread and fixed with a locking plate at the posteromedial aspect of the proximal tibia. The osteotomy of the tibial tuberosity was performed either proximally or distally dependent on the patello-femoral findings. Two independent observers measured axial tibial rotation using K-wires placed into the anterior margin of the tibia proximal and distal to the osteotomy.

Results

An overall mean of 4.4?±?2.8° internal rotation of the distal tibia has been shown. In four patients with additional single step double bundle ACL-replacement after harvesting ipsilateral autologous hamstring grafts, the distal tibia rotated internally by 0.1?±?0.3°, accordingly in the other 46 patients by 4.8?±?2.6°.

Conclusions

Valgus OW-HTO produces significant internal axial rotation of the distal tibia. This might be caused by soft tissue tension of the medial hamstrings/soft tissue structures and the location of the lateral tibial hinge.

Clinical relevance

Surgeons have to take into consideration that valgus OW HTO might result in significant 3D changes of the tibia. Higher degrees of internal torsion of the tibia might influence overall gait mechanics and specifically alternate patellofemoral kinematics.

     

牛骨形态发生蛋白对骨质疏松性椎体骨折愈合过程中局部血管内皮生长因子表达的作用

目的:观察骨质疏松性椎体骨折愈合过程中,局部血管内皮生长因子动态表达,探讨牛骨形态发生蛋白促进SD大鼠骨质疏松性椎体骨折愈合的作用机制。方法:实验于2005-07/2006-07在解放军兰州军区总医院骨研所完成。①牛骨形态发生蛋白的制备:青海小牦牛大腿骨,-4℃条件下,粉碎,按Urist改良方法提取。②选择雌性SPF级8个月龄SD大鼠96只,去除双侧卵巢建立骨质疏松模型。随机分为2组:实验组和对照组,每组48只。③术后3个月行L5椎体开窗建立人工骨折模型,实验组置牛骨形态发生蛋白10mg 纤维蛋白复合体;对照组注入等量无血清培养液。④于手术后3,7,10,14,21,28,56,84d每组麻醉状态处死6只,用苏木精-伊红染色、免疫组织化学及定量聚合酶链反应检测骨折愈合不同时间的标本血管内皮生长因子及血管内皮生长因子mRNA的动态表达,阳性信号为胞浆内棕色颗粒。结果:96只SD大鼠全部进入结果分析。①骨折愈合不同时间组织学观察:实验组术后7d纤维骨痂形成,21d新生骨组织与旧骨组织出现融合,56～84d软骨性骨痂已逐渐被骨性骨痂取代,骨折部位髓腔再通,出现成熟板层骨,骨折基本愈合。对照组术后7d未见典型纤维性骨痂;21d新生骨组织大都游离与孤立存在,术后28d骨小梁仅有少部分连结成网状,56～84d部分骨缺损存在,不见成熟板层骨,大部分髓腔不通,骨折愈合延迟。②骨折不同时间血管内皮生长因子免疫组织化学结果:实验组血管内皮生长因子在7d左右可见有阳性表达的细胞,14d有分泌高峰,对应循环数(CT值)最小,两组比值最大。而对照组未见明显分泌高峰。③实时荧光定量聚合酶链反应检测结果:对照组在造模后1,2,4,6,8周时,椎体内的血管内皮生长因子mRNA的表达量明显低于实验组(P<0.01)。结论:牛骨形态发生蛋白可促进大鼠骨质疏松性椎体骨折部位血管内皮生长因子的动态表达,可在受体骨折部位局部促进骨折生长。     

The painful patellofemoral joint. Biomechanics, diagnosis and therapy

New knowledge about the pathophysiology and biomechanics of the patellofemoral joint (PFJ) has led to a better understanding and new treatment options. To recognise the main pathology is the most important and difficult part. This article describes the basic principles of biomechanics (static, passive and active factors) and their influence on the PFJ. Patients are classified into three groups (pain, instability and arthritis). This is achieved by a clinical evaluation and standard X-rays. The instability group is analysed additionally with MRI. The aim of this evaluation is to analyse the biomechanical cause of the instability. Based on a pathophysiological concept a new therapeutic algorithm is introduced.     

Rotator cuff changes in a full thickness tear rat model: verification of the optimal time interval until reconstruction for comparison to the healing process of chronic lesions in humans

Background  

The aim of the study was to develop a standardized rat model for chronic rotator cuff tears. Therefore, a time point of degenerative changes that shows comparable histological changes to the chronic tendon tears in humans had to be determined. The rat shoulder has already been described as a standardized model for investigation of the healing behavior in acute supraspinatus lesions. Little data exist about the possibility of generating a chronic rotator cuff lesion.