Aim: Management of osteoarthritis (OA) is basically symptomatic. Recently, stem cells (SC) have been used in the search for an optimum treatment. We decided to conduct a controlled clinical trial to determine if a single intra-articular injection of in vivo stimulated bone marrow SC could lead to an improvement in pain management and quality of life in patients with knee OA.Method: This was a prospective, open-label, phase I/II clinical trial to assess the safety and efficacy of a single intra-articular injection of autologous stimulated bone marrow stem cells (BM-SC) in patients with knee OA. Individuals of both genders older than 30 years with confirmed diagnosis of OA who signed informed consent were included in two groups: SC group received in vivo BM stimulation with subcutaneous administration of granulocyte colony stimulating factor (G-CSF). SC were obtained by BM aspiration and administered in a single intra-articular injection. The control group received exclusively oral acetaminophen. Visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were performed at 1 week, 1 month and 6 months in both groups. This trial was registered in ClinialTrials.gov NCT01485198.Results: A total of 61 patients were included. Socio-demographic characteristics, OA grades and initial scores were similar in both groups. The BM-SC group showed significant improvement in knee pain and quality of life during the 6-month follow-up. Conclusion:The study demonstrates feasibility and supports efficacy of a completely ambulatory procedure in treatment of knee OA.

Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versus the use of oral TXA administered in multiple doses pre and postsurgery in patients undergoing total primary knee replacement. We enrolled 92 patients that were randomly divided into two groups: received three doses of aminocaproic acid (2,000 mg per dose) or three doses of oral TXA (1,300 mg per dose). The drugs were administered according to the following schedule: 2 hours before surgery and 6 and 12 hours after surgery. The variables that were analyzed to compare the effectiveness of the hemostatic agents were total blood loss; hidden blood loss; external blood loss; transfusion rate; intraoperative blood loss; decreases in hemoglobin and hematocrit values; surgical drainage output; visual analogue scale; and surgical complications. There were no significant differences between any of the study variables for the group receiving oral aminocaproic acid and the group receiving oral TXA (p > 0.05), with the exception of patients who received TXA, who presented with more adverse events (p = 0.04). Our study showed that the use of oral aminocaproic acid was similar to its counterpart TXA regarding the evaluated parameters. Although patients who received TXA presented an average of 140 mL less blood loss than patients in the ε-ACA group, the difference did not appear to be clinically important, the transfusion rate was very low, and there were no between-group differences in postoperative complications.

Background: One of the most common grafts used to repair anterior cruciate ligament (ACL) rupture is the hamstring tendon (HT) autograft. However, another proposed option to repair the ACL is the quadriceps tendon (QT) autograft. This study aimed to compare the pain and clinical results between patients with ACL injury treated with QT autograft and with HT autograft. Materials and methods: The Ethics and Investigation Committee of our institution approved the study. The patients were randomized into two groups: one group was treated with QT autograft and the other group was treated with HT autograft. The patients were evaluated preoperatively and postoperatively using the Lysholm-Tegner score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and visual analog scale (VAS), at 2 weeks and 1, 3, 6, and 12 months. Results: A total of 28 patients with a primary ACL injury were included in the study. No significant differences in VAS pain, Lysholm knee and Tegner activity scale scores, and IKDC score between the HT and QT groups were observed at any time point. All patients had favorable outcomes and significantly improved evaluation scores. Conclusion: The patients treated with QT autograft had clinical results and post-operative pain similar to those of patients treated with HT autograft for ACL reconstruction.

Lesiones de ligamento cruzado anterior tratadas con autoinjerto de tendón de cuádriceps versus autoinjerto de isquiotibiales: estudio controlado aleatorizado