Electrospun meshes suffer from poor cell infiltration and limited thickness, which restrict their use to thin tissue applications. Herein, we demonstrate two complementary processes to overcome these limitations and achieve elastomeric composites that may be suitable for ligament repair. First, C3H10T1/2 mesenchymal stem cells were incorporated into electrospun meshes using a hybrid electrospinning/electrospraying process. Second, electrospun meshes were rolled and formed into composites with an interpenetrating polyethylene glycol (PEG) hydrogel network. Stiffer composites were formed from poly(lactic-co-glycolic acid) (PLGA) meshes, while softer and more elastic composites were formed from poly(ester-urethane urea) (PEUUR) meshes. As-spun PLGA and PEUUR rolled meshes had tensile moduli of 19.2 ± 1.9 and 0.86 ± 0.34 MPa, respectively, which changed to 11.6 ± 4.8 and 1.05 ± 0.39 MPa with the incorporation of a PEG hydrogel phase. In addition, cyclic tensile testing indicated that PEUUR-based composites deformed elastically to at least 10%. Finally, C3H10T1/2 cells incorporated into electrospun meshes survived the addition of the PEG phase and remained viable for up to 5 days. These results indicate that the fabricated cellularized composites are support cyclic mechanical conditioning, and have potential application in ligament repair.

Introduction: With the increasing demand for total knee arthroplasty (TKA), rapid recovery protocols (RRPs) have been introduced to reduce costs and the length of stay (LOS). Little is known about the effects of RRPs on postoperative knee range of motion (ROM). Methods: We reviewed the medical charts of 323 patients who underwent primary TKA performed by a single orthopaedic surgeon at a university-based orthopaedic tertiary care safety net practice. Of the 323 patients, 129 were treated with a standard recovery protocol (SRP) between January 1, 2012, and December 10, 2013, and 194 with a RRP beginning December 11, 2013. Knee ROM was assessed at the preoperative visit and at scheduled postoperative visits for up to 1 year. Differences in mean LOS between the groups were compared using a Poisson regression with and without adjustment for covariates. Repeated measures analysis of covariance was used to evaluate the effects of recovery protocol, time, and the interaction of recovery protocol by time on flexion and flexion contracture. The probability of achieving flexion ≥120° and having a flexion contracture ≥10° was estimated using the SAS/STAT GLIMMIX procedure with a binary distribution and a logit link. Results: The mean LOS for the RRP and SRP groups was 0.8 and 2.5 days, respectively. RRP was associated with greater flexion at 2, 6, and 12 weeks and a higher probability of attaining flexion ≥120° at 6 and 12 weeks. Patients receiving a RRP had less severe flexion contracture and a lower probability of flexion contracture ≥10° at 2, 6, and 12 weeks. Discussion: During the first 12 weeks after TKA, patients who received a RRP had a markedly greater ROM than patients who received a SRP, suggesting that RRP may allow patients to do a greater variety of activities of daily living during the first 3 postoperative months while reducing health care costs. Level of Evidence: Level III

Purpose: Describe an alternative approach to perform ultrasound-guided injections into the cubital tunnel as a pilot study for cubital tunnel syndrome (CTS) treatment feasibility. Methods: The ulnar nerve was visualized bilaterally on four non-embalmed cadaveric models which were placed in a supine position. To image the cubital tunnel, the subject's elbow was examined in external rotation with the elbow angle at approximately 40° flexion (full elbow extension is considered 0°). The ultrasound transducer was placed transverse to the condylar groove along the medial epicondyle-olecranon axis and the ulnar nerve was identified. Methylene blue 0.35 mL was injected into the ulnar nerve perineural space under ultrasound guidance in a lateral-to-medial approach. Post-injection incisions were made to expose the underlying ulnar nerve and examine the injection sites. Injections were considered accurate if the ulnar nerve perineural space was dyed, and were considered precise if the injection was localized without damaging the ulnar collateral artery. Results: Dissection revealed that the ulnar nerves were covered with dye from the cubital tunnel inlet to outlet. 8-of-8 (100%) injections were accurate; 8-of-8 (100%) injections were precise. Conclusion: This pilot study shows that a lateral-to-medial approach to injecting the cubital tunnel under ultrasound guidance is accurate and precise. The clinical efficacy of such a procedure using corticosteroids should be examined through clinical trials and the results should be compared to other techniques used for treating CTS.