The Arthroscopic Application of Radiofrequency in Treatment of Articular Cartilage Lesions

Architecting a partial thickness cartilage substitute with mimetic, self-assembling hydrogels

Restoration of partial thickness chondral defects (PTCDs) may be achieved with a synthetic substitute that mimics the discrete mechanical properties of the superficial and transitional chondral layers. Moreover, innate adhesivity of the two components would enable the facile construction and integrity of this bilayered system. Herein, we report a PTCD bilayered substitute formed by triple network (TN) hydrogels that leverage electrostatic charge interactions to achieve mechanical mimicry and self-assembly. TN hydrogels were formed with a polyampholyte 3rd network of five different charge composition (i.e., ratio of cationic and anionic monomers), as well as two crosslink densities. All TN hydrogels exhibited cartilage-like hydration. A single superficial-like chondral layer TN hydrogel, with a somewhat more anionic 3rd network, was identified having mimetic compressive modulus (∼1.8 MPa) and strength (∼13 MPa). Additionally, three transitional-like chondral layer candidates were identified, including two TN hydrogels with a more cationic 3rd network in addition to the TN hydrogel with a 'cationic-only' 3rd network. The adhesivity of the superficial layer and the three transitional layer candidates was found to be robust (∼>100 kPa), wherein the bilayered construct exhibited cohesive rather than adhesive failure.

Advanced Technique of Unilateral Biportal Endoscopy on Revision Surgery for Recurred Herniated Interverbral Disc: A Technical Note

Introduction: Revision surgery in the spine poses considerable challenges due to the presence of scar tissue and structural differences, necessitating careful surgical planning and precise techniques. In this technical note, we focus on lumbar unilateral biportal endoscopy (UBE) for single-level reoperations, outlining principles and methods for handling soft tissue in such cases. Materials and Methods: We reviewed our surgical approach for lumbar reoperations with UBE, emphasizing the importance of meticulous preoperative planning and bone-centered manipulation. Our technique involves utilizing biportal endoscopy for enhanced visualization and employing specific strategies for managing scar tissue, including the "pull-and-cut technique." We present two illustrative cases to demonstrate the application of our method. Results: The described approach yielded successful outcomes in both cases presented. Case 1 involved a posterior interlaminar approach for a recurrent disc at the L4-5 level, while Case 2 utilized a far lateral approach for recurrent disc herniation at the L4-5 level. Both surgeries were completed with relatively short operation time, minimal blood loss, and immediate improvement in symptoms postoperatively. Conclusion: Lumbar UBE offers a promising option for safe and effective reoperation in spinal surgery. Our technique, emphasizing bone-centered manipulation and specific strategies for scar tissue management, provides excellent visibility and enables precise tissue handling. Overall, UBE facilitates relatively simple and safe reoperations, contributing to improved patient outcomes in the challenging field of spinal surgery.

A comprehensive review of hip arthroscopy techniques and outcomes

Transforming the orthopedic landscape, hip arthroscopy pioneers a minimally invasive surgical approach for diagnosing and addressing hip pathologies. With its origins dating back to Burman's 1931 cadaveric study, this groundbreaking technique gained clinical relevance in 1939 through Takagi's report. However, the 1980s marked the actual emergence of hip arthroscopy for treating a wide range of hip disorders. Now, a staple in modern orthopedics, hip arthroscopy empowers patients with previously undiagnosed and untreated hip conditions, enabling them to obtain relief and reclaim their lives. By employing a compact camera and specialized tools, surgeons expertly navigate the hip joint, performing procedures from excising loose bodies and mending labral tears to addressing femoroacetabular impingement and tackling other intricate issues. This innovative approach has dramatically elevated patients' quality of life, allowing them to embrace targeted treatments and resume daily activities without resorting to lifestyle alterations.

Management of chondral and osteochondral lesions of the hip : A comprehensive review

Chondral and osteochondral lesions encompass several acute or chronic defects of the articular cartilage and/or subchondral bone. These lesions can result from several different diseases and injuries, including osteochondritis dissecans, osteochondral defects, osteochondral fractures, subchondral bone osteonecrosis, and insufficiency fractures. As the cartilage has a low capacity for regeneration and self-repair, these lesions can progress to osteoarthritis. This study provides a comprehensive overview of the subject matter that it covers. PubMed, Scopus and Google Scholar were accessed using the following keywords: "chondral lesions/defects of the femoral head", "chondral/cartilage lesions/defects of the acetabulum", "chondral/cartilage lesions/defects of the hip", "osteochondral lesions of the femoral head", "osteochondral lesions of the acetabulum", "osteochondral lesions of the hip", "osteochondritis dissecans," "early osteoarthritis of the hip," and "early stage avascular necrosis". Hip osteochondral injuries can cause significant damage to the articular surface and diminish the quality of life. It can be difficult to treat such injuries, especially in patients who are young and active. Several methods are used to treat chondral and osteochondral injuries of the hip, such as mesenchymal stem cells and cell-based treatment, surgical repair, and microfractures. Realignment of bony anatomy may also be necessary for optimal outcomes. Despite several treatments being successful, there is a lack of head-to-head comparisons and large sample size studies in the current literature. Additional research will be required to provide appropriate clinical recommendations for treating chondral/osteochondral injuries of the hip joint.