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Browsing by Author "Figueroa, David"

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Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients
(2023) Sánchez, Enrique; Lozano, Beatriz; Zijl, Jacco; Wolterbeek, Nienke; Passarelli, Luis; Janson, Fabio; Verdonk, Peter; Vuylsteke, Kristien; Espregueira, Joao; Valente, Cristina; Figueroa, Francisco; Maestro, Antonio; Figueroa, David; Andrade, Renato
Background: Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries. Hypothesis: The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI. Study design: Cohort study; Level of evidence, 3. Methods: All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed. Results: A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament. Conclusion: The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures.
Aloinjertos óseos y la función del banco de huesos
(2011) Calvo R., Rafael; Figueroa, David; Díaz Ledezma, Claudio; Vaisman, Alex; Figueroa, Francisco
The use of bone grafts is a common practice in musculoskeletal surgery to provide mechanical stability where there is a defect and it allows skeletal reconstruction. Classically auto and allografts have been used. The latter are the choice in large, complex defects. Allografts can be transplanted despite cell death, have osteoconduction and osteoinduction capacity, low antigenicity and biomechanical properties similar to the original bone. They can be obtained from living and death donors. They are stored by cryopreservation and lyophilization in entities called bone banks. This is a reviw about bone allografts and the organization and function of the bone banks.
Anterior cruciate ligament reconstruction in patients over 50 years of age
(Elsevier, 2014) Figueroa, David; Figueroa, Francisco; Calvo, Rafael; Vaisman, Alex; Espinoza, Gonzalo; Gili, Federico
PURPOSE: To describe the clinical outcomes of patients over 50 years of age with following anterior cruciate ligament (ACL)reconstruction for acute rupture. METHODS: A prospective series of patients over the age of 50 years with a diagnosis of ACL rupture who underwent ACL reconstruction was examined. Lysholm and International Knee Documenting Committee (IKDC) subjective scores were assessed preoperatively and at the final follow-up. All associated injuries were documented, and complications were reported. The patients' satisfaction and return to sports were documented. The statistical analyses were preformed with Student's t-tests for independent samples. RESULTS: Fifty patients with a mean age of 52.12 years (50-64) and a mean follow-up period of 53.17 months (36-68) exhibited a mean postoperative Lysholm score of 93.7 (60-100) and IKDC score of 90.96 (57.5-100). Associated injuries occurred in 90% (45) of the patients and included the following: 76% (38) meniscal tears and 36% (18) osteochondral lesions. Complications occurred in 6% (3) of the patients and included the following: 4% (2) ACL re-ruptures and 2% (1) infections. Among all patients, 88% (44) returned to pre-injury sports levels, and 96% (48) were satisfied. CONCLUSIONS: For patients above the age of 50 years, ACL reconstruction appears to be a safe procedure with good to excellent results that are comparable to those for younger patients, and the possibility for returning to pre-injury sports levels for these patients is high.
Anterior cruciate ligament regeneration using mesenchymal stem cells and collagen type I scaffold in a rabbit model
(Springer, 2014) Figueroa, David; Espinosa, Maximiliano; Calvo, Rafael; Scheu, Maximiliano; Vaisman, Alex; Gallegos, Marcela; Conget, Paulette
Purpose: The objective of this study was to determine whether using mesenchymal stem cells (MSC) seeded in a collagen type I scaffold would be sufficient to regenerate the torn anterior cruciate ligament (ACL). Methods: Anterior cruciate ligament transection was performed on both knees in 10 New Zealand rabbits and then repaired with as follows: suture alone (suture-treated group, n = 6), suture associated with collagen type I scaffold (collagen type I scaffold-treated group, n = 8) or suture associated with autologous MSC seeded on collagen type I scaffold (MSC/collagen type I scaffold-treated group, n = 6). At 12-week post-intervention, the animals were killed and the ACLs were characterised macroscopically and histologically. Data of the 3 groups were against normal ACL (normal group, n = 10). Results: Macroscopic observation found that in MSC/collagen type I scaffold group, 33 % of specimens showed a complete ACL regeneration, with a tissue similar to the normal ACL. Regeneration was not observed in the group treated with suture alone or associated with collagen type I scaffold without cells. In the latter, only a reparative attempt at the ends was observed. Histological analysis of the regenerated ACL showed a tissue with organised collagen and peripheric vessels. Conclusions: These results provide evidence that the use of MSC seeded in a collagen type I scaffold in the treatment of ACL injuries is associated with an enhancement of ligament regeneration. This MSC-based technique is a potentially attractive tool for improving the treatment of ACL ruptures.
Arthroscopic Intercondylar Notch Bone Marrow Aspiration During Anterior Cruciate Ligament Reconstruction
(2019) Figueroa, David; Calvo, Rafael; Vaisman, Alejandro; Arellano, Sergio; Figueroa, Francisco; Donoso, Rodrigo; Bernal, Nazira; O'Connell, Luis
Purpose: To categorize and summarize up-to-date anterior cruciate ligament (ACL) research published in Arthroscopy and The American Journal of Sports Medicine and systematically review each subcategory, beginning with ACL anatomy. Methods: After searching for "anterior cruciate ligament" OR "ACL" in Arthroscopy and The American Journal of Sports Medicine from January 2012 through December 2014, we excluded articles more pertinent to ACL augmentation; open growth plates; and meniscal, chondral, or multiligamentous pathology. Studies were subcategorized for data extraction. Results: We included 212 studies that were classified into 8 categories: anatomy; basic science and biomechanics; tunnel position; graft selection; graft fixation; injury risk and rehabilitation; practice patterns and outcomes; and complications. Anatomic risk factors for ACL injury and post-reconstruction graft failure include a narrow intercondylar notch, low native ACL volume, and increased posterior slope. Regarding anatomic footprints, the femoral attachment is 43% of the proximal-to-distal lateral femoral condylar length whereas the posterior border of the tendon is 2.5 mm from the articular margin. The tibial attachment of the ACL is two-fifths of the medial-to-lateral interspinous distance and 15 mm anterior to the posterior cruciate ligament. Anatomic research using radiology and computed tomography to evaluate ACL graft placement shows poor interobserver and intraobserver reliability. Conclusions: With a mind to improving outcomes, surgeons should be aware of anatomic risk factors (stenotic femoral notch, low ligament volume, and increased posterior slope) for ACL graft failure, have a precise understanding of arthroscopic landmarks identifying femoral and tibial footprint locations, and understand that imaging to evaluate graft placement is unreliable. Level of evidence: Level III, systematic review of Level III evidence.
Assessment of Cell Viability of Fresh Osteochondral Allografts in N-Acetylcysteine-Enriched Medium
(Sage, 2018) Calvo, Rafael; Espinosa, Maximiliano; Figueroa, David; Pozo, Luz María; Conget, Paulette
Objective The purpose of this study was to evaluate the effect of N-acetylcysteine (NAC)-enriched storage medium on fresh osteochondral viability at 4°C. Our hypothesis was that the cell viability of chondrocytes obtained from human osteochondral tissue and stored at 4°C significantly improves in the presence of NAC. Design Controlled laboratory study. For this study, 8 samples of femoral condyle osteochondral tissue were obtained from patients undergoing total knee replacement. The samples were stored at either 4°C in phosphate-buffered saline (PBS) or at 3 different concentrations of NAC (NAC 1, 2, and 5 mM). Cell viability was analyzed at time 0 and 4 weeks by flow cytometry. The results of cell viability (median) were analyzed statistically using analysis of variance and Tukey's post hoc test. P values <0.05 were considered statistically significant. Results The viability at time 0 was 95.5% ± 3.7%. At 4 weeks, the cell viability was 56.8% ± 20.1% in the control group (PBS), 83.8% ± 11.9% in the group stored with NAC 1 mM, 73.4% ± 13.6% in the group stored with NAC 2 mM, and 66.4% ± 27.7% in the group stored with NAC 5 mM. A statistically significant difference from the baseline viability (time 0) was observed in the PBS control group ( P = 0.0018) but not in the other groups. A statistically significant difference was observed in the NAC 1 mM group compared with the PBS group ( P = 0.0255). Conclusion The use of NAC at 1 mM concentration improves cell viability after 4 weeks of storage in chondrocytes obtained from human osteochondral tissue.
Cerebral and pulmonary fat embolism after unilateral total knee arthroplasty
(2019) Figueroa, David; Figueroa, Francisco; Calvo, Rafael; Figueroa, María
Fat embolism syndrome is the presence of a fatty embolus in the circulatory system that can manifest itself in multiple ways, ranging from asymptomatic presentation to respiratory failure, neurocognitive deficits, and death. It is a relatively common complication after procedures or conditions such as orthopaedic surgery, severe burns, liver injury, closed-chest cardiac massage, and liposuction. This pathology is relatively common in the field of orthopaedics, especially in long bone fractures and procedures such as total hip replacements. It is typically an exclusion diagnosis, and the management is supportive care. In this report, we present a case of a 63-year-old patient who, during a cemented total knee replacement, presented with fat embolism syndrome with neurological and pulmonary manifestations, and subsequently made a complete recovery at discharge.
Clinical and arthrometric outcomes of an anatomic outside-in single-bundle anterior cruciate ligament reconstruction using a retrodrill
(Elsevier, 2016) Figueroa, David; Calvo, Rafael; Figueroa, Francisco; Paccot, Daniel; Izquierdo, Guillermo; Morales, Nelson
BACKGROUND: The main option to perform an anatomic anterior cruciate ligament (ACL) reconstruction is the anteromedial portal (AMP) technique. It has several reported complications (iatrogenic chondral injury, posterior-wall blowout, short sockets, increased risk of injury to common peroneal nerve). In an attempt to avoid these complications the outside-in (OI) technique was revived with the addition of a retrodrill. The aim of this study is to evaluate the clinical and arthrometric outcomes of a series of anatomical OI single bundle ACL reconstruction using a retrodrill. METHODS: Prospective case series. KT-1000 and Pivot Shift Test were done at 24 months follow-up. International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores preoperatively and at final follow-up. Complications were reported. Statistical analysis was done with t-test. RESULTS: 275 knees of 200 (73%) males and 75 (27%) females were enrolled in the study. Mean age 29.1 years (15-54). Mean follow-up 34.5 months (24-49). Mean preoperatively Lysholm Score 62 (25-95) versus 95 (76-100) at final follow-up (p<0.001) Mean preoperatively IKDC score 60 (26.4-90.8) versus 92 (59.8-100) at final follow-up (p<0.001) Mean Tegner activity Score pre injury 5 versus 5 at final follow-up. (p=0.59) Mean KT-1000 side-to-side difference 2mm (1-6). Pivot Shift test negative in 243 patients (90%); positive in 32 (10%) patients. 13 (5%) ACL re-ruptures. 2 (0.7%) infections. No other complications were reported. CONCLUSION: OI single bundle anatomic ACL reconstruction using a retrodrill is a valid and safe option that avoids the complications reported with the AMP technique.
Clinical and functional outcomes of primary total knee arthroplasty: a South American perspective
(2019) Figueroa, David; Calvo, Rafael; Figueroa, Francisco; Avilés, Carolina; Garín, Alan; Cancino, Jaime
Background. The aim of this study was to report the clinical and functional outcomes as well as complications after primary total knee arthroplasty in a cohort of Chilean patients. Methods. We retrospectively reviewed 191 total knee arthroplasties performed in 182 patients over an 8-year period, with a minimum follow-up of 2 years. The primary outcome measure was the rate of major complications. Secondary outcomes were minor complications, residual symptoms, level of satisfaction, and the Knee Injury and Osteoarthritis Outcome Score. Results. Global complication rate was 15.5%, reintervention rate was 9.2%, and revision rate was 2.5%. Major and minor complications were seen in 9.2% and 5.1% of patients, respectively. Average Knee Injury and Osteoarthritis Outcome Score was 77 points (14-100), and 90% of patients reported satisfaction with the procedure. At 2-year follow-up, 45.8% of patients had some degree of range of motion limitations. Conclusions. Our results show a medium-term follow-up complication rate comparable to those described in the literature. This is the first series to report on the clinical and functional outcomes after primary total knee arthroplasty in a Chilean population.
Clinical outcomes after arthroscopic treatment of knee osteoarthritis
(Elsevier, 2014) Figueroa, David; Calvo, Rafael; Villalón, Ignacio; Meleán, Patricio; Novoa, Felipe; Vaisman, Alex
PURPOSE: The aim of this study was to describe the clinical outcomes of patients with knee osteoarthritis (OA) treated with arthroscopic surgery, documenting the associated injuries and defining the type of treatment selected for OA patients with different symptoms. HYPOTHESIS: Knee arthroscopy is effective for treating patients with symptomatic OA and mechanical symptoms. METHODS: This was a prospective, consecutive series of 100 patients with a clinical and radiological diagnosis of OA who were treated with knee arthroscopy. The average follow-up time was 35.9months (25-71), and the average age was 60.1years (50-83). INCLUSION CRITERIA: >50years of age, a clinical imaging diagnosis of knee OA with an Ahlbäck I-III classification. EXCLUSION CRITERIA: <50years of age, Ahlbäck IV, pathologic lower limb mechanical axis and inflammatory joint diseases. The IKDC and Lysholm scores were assessed before and after surgery. RESULTS: The preoperative average scores were as follows: Lysholm, 56.9±13.5 points (22-71); IKDC, 59.4±21.7 points (45-80). The postoperative average scores were as follows: Lysholm, 86.9 points (22-87); IKDC, 79.5 points (45-100). Regarding the Lysholm scores, 76% were good and excellent results and 24% were moderate (p=0.045). The associated injuries included 48% of chondral and 36% of unstable meniscal injuries. Good or excellent results were observed in 76% of the meniscal injury cases according to the Lysholm scores, while only 84.6% of the cases with unstable chondral lesions had good or excellent results (p=0.035). CONCLUSION: Most patients with knee OA associated with unstable cartilage or meniscal injuries reported good-to-excellent symptomatic results at the short- and mid-term follow-ups. LEVEL OF EVIDENCE: III.
Comparison of Muscular Power Between Dominant and Nondominant Legs in Healthy Young Adults Associated With Single-Leg-Dominant Sports
(2017) Vaisman, Alex; Guiloff, Rodrigo; Rojas, Juan; Delgado, Iris; Figueroa, David; Calvo, Rafael
Background: Achieving a symmetrical power performance (difference <15%) between lower limbs is generally recommended during sports rehabilitation. However, athletes in single-leg-dominant sports, such as professional soccer players, could develop significant asymmetry between their dominant and nondominant legs, such that symmetry does not act as a viable comparison. Purpose: To (1) compare maximal muscular power between the dominant and nondominant legs in healthy young adults, (2) evaluate the effect of a single-leg-dominant sport activity performed at the professional level, and (3) propose a parameter of normality for maximal power difference in the lower limbs of this young adult population. Study Design: Controlled laboratory study. Methods: A total of 78 healthy, male, young adults were divided into 2 groups according to sport activity level. Group 1 consisted of 51 nonathletes (mean ± SD age, 20.8 ± 1.5 ears; weight, 71.9 ± 10.5 kg) who participated in less than 8 hours a week of recreational physical activity with nonspecific training; group 2 consisted of 27 single-leg-dominant professional soccer players (age, 18.4 ± 0.6 years; weight, 70.1 ± 7.5 kg) who specifically trained and competed at their particular activity 8 hours or more a week. For assessment of maximal leg power, both groups completed the single-leg squat jump test. Dominance was determined when participants completed 2 of 3 specific tests with the same extremity. Statistical analysis included the Student t test. Results: No statistical difference was found for maximal power between dominant and nondominant legs for nonathletes (t ¼ –1.01, P ¼ .316) or single-leg-dominant professional soccer players (t ¼ –1.10, P ¼ .281). A majority (95%) of participants studied showed a power difference of less than 15% between their lower extremities. Conclusion: Among young healthy adults, symmetrical power performance is expected between lower extremities independent of the existence of dominance and difference in sport activity level. A less than 15% difference in power seems to be a proper parameter to define symmetrical power performance assessed by vertical single-leg jump tests.
Effect of tendon tensioning: An in vitro study in porcine extensor tendons
(2010) Figueroa, David; Calvo, Rafael; Vaisman, Alex; Meleán, Patricio; Figueroa, Francisco
Graft tensioning is a controversial issue in anterior cruciate ligament reconstruction (ACLR) that has not achieved consensus between peers. The purpose of this study is to determine if after tensioning tendón length and resistance to maximal load changes. We performed an in vitro study with 50 porcine extensors tendons. The first group (P= 25) was tensioned with 80 N (19.97 lb) for 10 min, using an ACL graft preparation board. The second group (C= 25) was used as control and was not tensioned. The average initial (groups P and C) and post tensioning tendon length (group C) were measured; the average initial and post tensioning tendon diameter were measured as well. All samples were fixated in a tube–clamp system connected to a tension sensor. The samples were stressed with continuous and progressive tensión until ultimate failure at maximum load (UFML) occurs. The initial mean length was: P before tensioning= 13.4 mm± 1.4 mm (range 10.5–16.5); P after tensioning= 13.8 mm± 1.4 mm (range 11.5–16.5); C= 13 mm± 1.35 mm (p= 0.005). The mean diameter was: P= 5.6 mm (4.5–6); C= 5.5 mm (range 4.5–6) (p> 0.05). The UFML was: P= 189.7 N (114–336); C= 229.9 N (143–365) (p= 0.029). Tendon tensioning with 80 N for 10 min produced 3% average elongation. These could be beneficial in ACLR since tendon tensioning decreases elongation of the graft after fixation. Regardless, tendón tensioning is not innocuous since it diminishes their resistance when continuously stressed until complete failure occurs
Five-strand hamstring autograft versus quadruple hamstring autograft with graft diameters 8.0 millimeters or more in anterior cruciate ligament reconstruction: clinical outcomes with a minimum 2-year follow-up
(Elsevier, 2017) Calvo, Rafael; Figueroa, David; Figueroa, Francisco; Vaisman, Alex; Schmidt-Hebbel, Andres; Morales, Nelson; Izquierdo, Guillermo
PURPOSE: To compare the outcomes of 2 groups of patients undergoing anterior cruciate ligament (ACL) reconstruction: the first with a quadrupled semitendinosus gracilis (ST-G) autograft larger than 8 mm diameter and the second with a 5-strand ST-G autograft larger than 8 mm due to an insufficient diameter graft harvesting. METHODS: This was a retrospective study with 70 patients divided into 2 groups. Inclusion criteria included ACL ruptures of less than 3 months, ST-G ACL reconstructions, and final (4-strand or 5-strand) graft size larger than 8 mm. Exclusion criteria included multiligament knee injuries, meniscal or chondral pathology, ACL re-ruptures, inflammatory joint disease, or other procedures in the knee. RESULTS: Group A comprised 33 patients with a quadruple ST-G graft, and group B comprised 37 patients with an insufficient graft diameter (<8 mm) in which a 5-strand graft was used. Mean age in group A was 29.7 (range 17-52) years and in group B was 30.6 (range 13-53) years (P = .78). Average follow-up in group A was 32.2 (range 24-48) months and in group B was 30.35 (range 24-48) months (P = .75). Average graft diameter in group A was 8.5 mm (range 8-10) and in group B when the graft was measured as quadruple was 7.2 mm (range 6.5-7.5) and 9.2 mm (range 8-10) when it was converted to 5-strand (P = .00596). Group A had 3 (9%) re-ruptures, and group B had 2 (5.4%) (P = .55). The average postoperative Lysholm score in group A was 93.3 (range 71-100) and in group B was 97.1 (range 80-100) (P = .79). Mean postoperative International Knee Documentation Committee in group A was 91 (range 75.9-100) and in group B was 96.8 (range 82-100) (P = .18). CONCLUSIONS: In our study, the 5-strand hamstring autograft in ACL reconstruction was clinically comparable with the quadruple autograft larger than 8 mm. The differences in re-rupture and clinical outcomes were not statistically significant between the 2 groups, suggesting that it is a valid option when we have a graft of insufficient diameter. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
Graft choice in combined anterior cruciate ligament and medial collateral ligament reconstruction
(2020-04) Figueroa, Francisco; Figueroa, David; Calvo, Rafael; Vaisman, Alex; Espregueira-Mendes, João
There is a concern regarding which grafts should be used in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstructions, with a paucity of recommendations focused on this specific topic.Expert opinions suggest the use of allograft-only reconstructions to limit donor-site morbidity or using at least one allograft and one autograft.When a hamstring tendon autograft is harvested, techniques that maintain both the integrity of the sartorius fascia and the gracilis are recommended because of the role that the ST-G-S (semitendinosus-gracilis-sartorius) complex plays in valgus stability in the setting of an MCL-deficient knee.
Hamstring autograft size importance in anterior cruciate ligament repair surgery
(2018) Figueroa, Francisco; Figueroa, David; Espregueira-Mendes, João
Graft size in hamstring autograft anterior cruciate ligament (ACL) surgery is an important factor directly related to failure. Most of the evidence in the field suggests that the size of the graft in hamstring autograft ACL reconstruction matters when the surgeon is trying to avoid failures.The exact graft diameter needed to avoid failures is not absolutely clear and could depend on other factors, but newer studies suggest than even increases of 0.5 mm up to a graft size of 10 mm are beneficial for the patient. There is still no evidence to recommend the use of grafts > 10 mm.Several methods - e.g. folding the graft in more strands - that are simple and reproducible have been published lately to address the problem of having an insufficient graft size when performing an ACL reconstruction. Due to the evidence presented, we think it is necessary for the surgeon to have them in his or her arsenal before performing an ACL reconstruction.There are obviously other factors that should be considered, especially age. Therefore, a larger graft size should not be taken as the only goal in ACL reconstruction.
High-Grade Patellar Chondral Defects: Promising Results From Management With Osteochondral Autografts
(2020-07) Figueroa, David; Calvo, Rafael; Donoso, Rodrigo; Espinoza, Jaime; Vaisman, Alex; Yañez, Claudio
Background: Patellar chondral defects represent up to 34.6% of defects found during routine arthroscopy. Surgical management has evolved during the past 20 years in an effort to develop techniques to replace hyaline cartilage. Currently, the only technique that achieves this is osteochondral autologous transfer (OAT). Although good and excellent results have often been reported at midterm and long-term follow-up for femoral lesions, little is known about isolated patellar defects. Purpose: To assess clinical and imaging results of patients treated with OAT for high-grade patellar defects. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study on all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at our institution. The study included patients younger than 40 years of age with anterior knee pain and a grade 4 International Cartilage Repair Society patellar chondral defect between 1 and 2.5 cm2. Patients with surgery in other knee compartments, concomitant anterior cruciate ligament ruptures, infection, rheumatoid arthritis, and degenerative lesions were excluded. Six months postoperatively, all patients underwent magnetic resonance imaging (MRI) to allow assessment of graft integrity via the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to evaluate morphologic features and integration. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kujala scores were used to assess functional outcomes at final follow-up. Results: A total of 26 patients who received a patellar OAT were included. Most patients were male (88.4%), and the mean ± SD age was 28.5 ± 9.7 years. Patellar chondral defects had a median size of 180 mm2 (range, 64-250 mm2), and patients received a median of 1 autograft (range, 1-3). Functional outcomes assessed at a minimum of 1 year after surgery showed a mean Kujala score of 90.42 ± 6.7 and a mean WOMAC score of 95 ± 3.6. MRI revealed a median MOCART score of 75 points (range, 20-90 points). Conclusion: To our knowledge, this is the largest series to date regarding isolated patellar OAT. At midterm follow-up, most patients reported good and excellent results regarding symptoms and activity levels. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients.
Intraarticular administration of dexamethasone after mesenchymal stem cells implantation does not improve significantly the treatment of preestablished full-thickness chondral defect in a rabbit model
(Sage Publications, 2013) Espinosa, Maximiliano; Vaisman, Alex; Nazal, Nicolas; Figueroa, David; Gallegos, Marcela; Conget, Paulette
Objective: The aim of this study was to evaluate the contribution to hyaline cartilage regeneration of dexamethasone intraarticular administration after autologous mesenchymal stem cells (MSCs) implantation into a preestablished knee full-thickness chondral defect. Design: Full-thickness chondral defects of 4.5 × 4.5 mm2 were surgically made in both medial femoral condyles of adult male New Zealand rabbits. Two weeks later, autologous ex vivo expanded bone marrow–derived MSCs were embedded in hyaluronic acid and implanted into the chondral defects. Immediately and every week after the intervention, dexamethasone 0.25 mg/kg was intraarticularly administered (MSC/dexa-treated group). Six weeks after MSC transplantation, the animals were euthanized and condyles were characterized molecularly according to aggrecan, collagen type II, and collagen type I gene expression (quantitative reverse transcriptase-polymerase chain reaction) and histologically (hematoxylin–eosin staining). Data of MSC/dexa-treated condyles were compared with untreated, dexa-treated, MSCtreated, or normal unlesioned condyles. Results: The ratio between collagen type II expression versus collagen type I expression in MSC/dexa-treated condyles was higher than one, even though the group mean value was not statistically different from that of untreated defects. Histological changes were observed between MSC/dexa-treated and untreated defects mainly in surface regularity and in hyaline matrix abundance. However, International Cartilage Repair Society score analysis did not support robust differences between those groups. Conclusion: Intraarticular administration of dexamethasone after autologous MSC implantation into a preestablished full-thickness chondral defect does not contribute significantly to the regeneration of a tissue with molecular and histological characteristics identical to hyaline cartilage.
Ligament Lesions: Biologics
(2022) Figueroa, David; Guiloff, Rodrigo; Figueroa, Francisco
In terms of the latest clinical evidence, the use of PRP for ligament injuries remains controversial. There is insufficient evidence to recommend the use of PRP in ACL-R for improving graft maturation and donor site morbidity or improving functional outcomes. The use of PRP injections for the treatment of partial ACL injuries, MCL injuries, and ankle sprains cannot be recommended. Finally, there is no reported clinical evidence of the use of PRP in other knee ligament injuries such as posterior cruciate ligament, lateral collateral ligament, and posterolateral corner
Magnetic Resonance Imaging Evaluation of the Integration and Maturation of Semitendinosus-Gracilis Graft in Anterior Cruciate Ligament Reconstruction Using Autologous Platelet Concentrate
(Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 26, No 10 (October), 2010: pp 1318-1325, 2010) Figueroa, David; Melean, Patricio; Calvo, Rafael; Vaisman, Alex; Zilleruelo, Nicolás; Figueroa, Francisco; Villalón, gnacio
Purpose: To evaluate integration and maturation of semitendinosus-gracilis (STG) grafts in anterior cruciate ligament (ACL) reconstruction with magnetic resonance imaging (MRI) in patients who underwent ACL reconstruction with STG with and without autologous platelet concentrate (APC). Methods: A randomized single–blinded evaluator prospective study was performed in 2 consecutive series of patients who underwent reconstruction over a 14-month period: 30 with APC use (group A) and 20 as control subjects (group B). At 6 months, an MRI evaluation was performed, with observation of the graft’s maturation and presence or absence of synovial fluid at the tunnel-graft interface. To facilitate interpretation, a scoring scale was designed to evaluate graft integration and maturation. Results: Regarding the presence of synovial fluid at the bone-graft interface, the test was negative in 86.84% of patients in group A and 94.74% in group B. A disorganized autograft signal pattern was found in 2.63% in group A and 5.26% in group B. Signal intensity was considered hypointense in 63.16% in group A and 42.11% in group B, isointense in 34.21% in group A and 52.63% in group B, and hyperintense in 0% in both groups. The final mean score was 4.45 points in group A and 4.2 points in group B (P .05). Poor integration was found in 2.63% in group A and 5.26% in group B (P .214). Good integration was found in 97.37% in group A and 94.74% in group B (P .784). Conclusions: In our consecutive series of patients who underwent ACL reconstruction with STG grafts, 1 group with intraoperative APC use versus a control group, followed up by MRI at 6 months after reconstruction, we did not find any statistically significant benefit in the APC group in terms of integration assessment and graft maturation (ligamentization). Level of Evidence: Level III, case-control study
Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up
(2021) Figueroa, David; Figueroa, Francisco; Calvo, Rafael; Gómez, Carlos; Vaisman, Alex
Background: The aim of this study is to report the mid-term follow-up results of a prospective cohort of patients who underwent a polyurethane (PU) meniscal scaffold implantation for post meniscectomy syndrome (PMS), without limb realignment procedures. Methods: Prospective study in patients with PU meniscal scaffolds implanted during 2014e2016. Limb realignment procedures excluded. Clinical outcomes were prospectively evaluated pre-operatively and every year post-operatively using patient-reported outcome scores (KOOS, VAS, Lysholm and IKDC). Postoperative radiologic evaluation was done using 3.0 T magnetic resonance imaging (MRI). Meniscal scaffold extrusion, signal intensity, tibio-femoral cartilage degeneration progression and complications were analyzed. Results: Fourteen patients with an average age of 25.8 years (range: 17e47) received a PU scaffold (8 lateral and 6 medial). Associated procedures were done in all patients, with an osteochondral allograft transplantation (OAT) being the most common. Mean follow up was 51.6 (range: 39e66) months. Postoperative mean clinical outcomes scores showed significantly improved results compared to the preoperative scores. Lysholm scores increased from 62.4 to 80.2 (P ¼ 0.0023), KOOS from 68.9 to 80 (P ¼ 0.0083) and VAS for pain decreased from 5.3 to 3.1 (P ¼ 0.0024). Average post-operative IKDC score was 67.7. There were 8 cases of complete extrusion (>3 mm). The mean extrusion value was 4.0 mm (range: 3e6 mm). Three patients showed signs of a ruptured meniscal scaffold. One patient showed progression of the cartilage degenerative process. Conclusion: The use of a PU scaffold, associated with other surgical procedures in the knee, especially chondral repair, had a significant improvement in clinical outcomes compared to the baseline status, at an average of 51.6 months follow-up in patients suffering from PMS. Although imaging results show a high proportion of implant extrusion, this does not appear to imply a worsening in clinical outcomes in the short term. Level of evidence: IV. Case series

Browsing by Author "Figueroa, David"

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