Nostra esperienza nella ricostruzione del l c a con utilizzo dei fattori di crescita
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NOSTRA ESPERIENZA NELLA RICOSTRUZIONE DEL L. C. A. CON UTILIZZO DEI FATTORI DI CRESCITA - PowerPoint PPT Presentation


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AZIENDA OSPEDALIERA “OSPEDALE CIVILE DI VIMERCATE” DIVISIONE DI ORTOPEDIA-TRAUMATOLOGIA OSPEDALE DI GIUSSANO - MI - ( Direttore: Dott. Claudio MANZINI ). NOSTRA ESPERIENZA NELLA RICOSTRUZIONE DEL L. C. A. CON UTILIZZO DEI FATTORI DI CRESCITA.

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Nostra esperienza nella ricostruzione del l c a con utilizzo dei fattori di crescita

AZIENDA OSPEDALIERA “OSPEDALE CIVILE DI VIMERCATE”

DIVISIONE DI ORTOPEDIA-TRAUMATOLOGIA

OSPEDALE DI GIUSSANO - MI -

( Direttore: Dott. Claudio MANZINI )

NOSTRA ESPERIENZA NELLA RICOSTRUZIONE DEL L. C. A. CON UTILIZZO DEI FATTORI DI CRESCITA

M. LOVATO - C. MANZINIBologna 04 - 06 ottobre 2006



International Literature

The power of Growth Factors:

tissue revitalizing

recover improvement

pain reduction

A NEW GOAL

The revitalization of the new ligament through the neo-vascularization of the tibial and patellar bone portions


Growth factors
Growth Factors

Platelet Functions

  • Haemostasis

    • Primary haemostasis

    • Secundary haemostasis (coagulation)

  • Inflammation

  • Antimicrobial host defence

  • Stimulation of wound and/or bone healing


Growth Factors

+ Thrombin activation

Platelets in rest

Platelet activated


Our experience
Our Experience

For more than 4 years we have been using GPS II™ platelet derived Growth Factors

in different surgical applications.

For prosthetic correction and in complex cases of pseudoarthrosis.

Since March 2004 we have used them regularly in Anterior Cruciate Ligament reconstruction.


Our experience1
Our Experience

Since 1990 for reconstruction

of the Anterior Cruciate Ligament we have been using the free patellar tendon.

Up until now, we have carried out about 1,500ACL surgical operations

in arthroscopy,

150 of these with Growth Factors.


Our study 120 patients treated
Our Study120 patients treated

  • 2 groups:

    • Control (N=60)

    • With GF (N=60)

  • Age: 17 – 35

  • Professional or agonist sportsman

  • Complete ACL lesion

  • Possible periferical legamentous lesions

  • Absence of 3° or 4° degree chondral malacia

  • Possible meniscal tears

  • Absence of reumathoid complications


Our study
Our Study

  • Control test:

    • clinic visual examination

    • IKDC

    • VAS

    • MRI at 3, 6 and 12 months

“John Lachman docet”


Clinical use
Clinical Use

Just one GF is not sufficient to resolve all the problems linked with the processes of repair


Growth factors1
Growth Factors

1) Plantelet Derived Growth Factor PDGF-ββ

PDGF-aa

PDGF-aβ

2) Trasforming Growth Factor beta TGF- β1

TGF- β2

3) Vascular Endothelial Growth Factor VEGF

4) Epithelial Growth Factor EGF

5) Insuline Growth Factor IGF


Method
Method

GPS II


Method1
Method

Whole Blood

PPP Platelet Poor Plasma

PRP Platelet Rich Plasma

PackedRBC


Method2
Method

Buffy Coat


Prepared Patellar Tendon

Prepared Growth Factors’ Syringe

Infiltration

Ready and Geled Patellar Tendon

Method


Injection of Liquid GF into the Femour

Insertion

Final Intraopetratory Test

Method


Method3
Method

+ Growth Factors


Results
Results

Follow up at 3 months


Results1
Results

Follow up at 6 months


Results

Follow up at 12 months



Results3
Results

  • 50% reduction of post-operational pain (valued with VAS sistem);

  • Quicker articular recovery but above all minor quadricipital hypotrophy.

  • Around third month, on patient treated with GF, MRI pointed out minor fibroblastic invasion and better differentiationof the new ligament than control group.


Results4
Results

Complications

  • In 10 % of cases we found a slight anterior gonalgia and fibrosis of the Hoffa body

  • 2 cases of iperthermya


Costs and benefits analisy

Costs

Single use Kit

Human resource

Benefits

Patient’s

Less pain

Quick recover

Hospital’s

Lower ospitalization

Surgeon’s

Safety procedure

Costs and benefits analisy



Conclusions
Conclusions

Retourn to sport on average 30 days before than control group


Conclusions

We think that this Sistem applied to the surgical reconstruction of ACL, can’t revolutionize the knee surgery,

BUT

it can give us and our patients, a real hope to obtain results nearer to the safe knee!

Moreover, all of it, through a way ethicaly and phisiologicaly sustainable.


Conclusions

We think that this Sistem applied to the surgical reconstruction of ACL, can’t revolutionize the knee surgery,

BUT

it can give us and our patients, a real hope to obtain results nearer to the safe knee!

Moreover, all of it, through a way ethicaly and phisiologicaly sustainable.

A special thank to the Local Organizing Committee.

and

Good work to all !!

Maurizio Lovato e Claudio Manzini

Hospital “C. Borella”, Trauma Center

Giussano – Milano

Italy


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