RESUMEN
The case presented is that of a 23-year-old man suffering from osteochonditis dissecans (OCD) of the medial femoral condyle, in whom a free piece of cartilage had separated off and there was a large osteochondral defect despite numerous operations. After refixation of the fragment failed, an autologous chondrocyte transplantation (ACT) was performed using the sandwich technique. Three years after the operation the patient is very satisfied with the result. The radiological findings show stable repair of the bony and cartilaginous defect area. This case report shows that ACT is a valid method for the treatment of large osteochondral defects even after several previous failed operations. The low donor site morbidity is an important advantage over other methods, such as transplantation of osteochondral plugs.
Asunto(s)
Condrocitos/trasplante , Fémur/cirugía , Cuerpos Libres Articulares/cirugía , Articulación de la Rodilla/cirugía , Osteocondritis Disecante/cirugía , Terapia Recuperativa , Adulto , Artroscopía , Fémur/patología , Estudios de Seguimiento , Humanos , Cuerpos Libres Articulares/diagnóstico , Articulación de la Rodilla/patología , Imagen por Resonancia Magnética , Masculino , Osteocondritis Disecante/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , ReoperaciónRESUMEN
The subacromial impingement syndrome describes the pathological contact between the rotatory cuff and the acromion. It is only a symptom and not a generic term for the different pathological diseases of the subacromial region. It is the diagnostical aim to verify the pathogenesis of the impingement syndromes and it is essential to differentiate structural versus functional causes. The diagnosis "impingement syndrome" should not have an acromioplastic procedure as general consequence. Because the expression "impingement syndrome" does not show causal approach it should no longer be used as a diagnosis. The term subacromial syndrome, in conjunction with the underlying pathological cause, acquires more therapeutic and prognostic clarity.
Asunto(s)
Síndrome de Abducción Dolorosa del Hombro/diagnóstico , Síndrome de Abducción Dolorosa del Hombro/terapia , Dolor de Hombro/diagnóstico , Dolor de Hombro/terapia , Diagnóstico Diferencial , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en MedicinaRESUMEN
To reduce culture artifacts by conventional repeated passaging and long-term culture in vitro, the isolation of synovial fibroblasts (SFB) was attempted from rheumatoid arthritis (RA) synovial membranes by trypsin/collagenase digest, short-term in vitro adherence (7 days), and negative isolation using magnetobead-coupled anti-CD14 monoclonal antibodies. This method yielded highly enriched SFB (85% prolyl-4-hydroxylase+/74% Thy-1/CD90+ cells; <2% contaminating macrophages; <1% leukocytes/endothelial cells) that, in comparison with conventional fourth-passage RA-SFB, showed a markedly different phenotype and significantly lower proliferation rates upon stimulation with platelet-derived growth factor and IL-1beta. This isolation method is simple and reliable, and may yield cells with features closer to the in vivo configuration of RA-SFB by avoiding extended in vitro culture.