Background Tendon injuries are one of the most common musculoskeletal conditions in active patients. Platelet rich plasma (PRP) has shown some promise in the treatment of tendon disorders, but little is known as to the mechanisms by which PRP can improve tendon regeneration. PRP contains numerous different growth factors and cytokines which activate various cellular signaling cascades, but it has been difficult to determine precisely which signaling pathways and cellular responses are activated following PRP treatment. Additionally, macrophages play an important role in modulating tendon regeneration, but the influence of PRP on determining whether macrophages assume a proinflammatory or antiinflammatory phenotype remains unknown. Hypothesis/Purpose We used genome wide expression profiling, bioinformatics and protein analysis to determine the cellular pathways activated in fibroblasts treated with PRP. We also evaluated the effect of PRP on macrophage polarization. Study Design Controlled laboratory study. Methods Tendon fibroblasts or macrophages from rats were cultured and treated with either platelet poor plasma (PPP) or PRP. RNA or protein was isolated from cells and analyzed using microarrays, qPCR, immunoblot or bioinformatics techniques. Results Pathway analysis determined that the most highly induced signaling pathways in PRP treated tendon fibroblasts was the TNFα and NFκB pathways. PRP also downregulated the expression of ECM genes and induced the expression of autophagy related genes and reactive oxygen species (ROS) genes and protein markers in tendon fibroblasts. PRP failed to have a major impact on markers of macrophage polarization. Conclusions PRP induces an inflammatory response in tendon fibroblasts which leads to the formation of ROS and activation of oxidative stress pathways. PRP does not appear to significantly modulate macrophage polarization. Clinical Relevance PRP might act by inducing a transient inflammatory event which could then trigger a tissue regeneration response.

In patients with symptomatic FAI and labral tear, intra-articular cortisone injection has limited clinical benefit as a therapeutic modality. However, anaesthetic-only IA injections for patients who may be candidates for hip arthroscopy can be a useful diagnostic tool.

Controversy exists as to the superior graft source for posterior cruciate ligament (PCL) reconstruction. Allogeneic and autogeneic tissue have unique advantages and disadvantages, but little is known about the performance of one versus the other. This study is an evidence-based, systematic literature review comparing clinical and functional outcomes of allograft and autograft PCL reconstruction. A search was conducted via the Cochrane and MEDLINE databases for all relevant studies meeting the following inclusion criteria: (1) English language, (2) human subjects, (3) between the years 1980 and 2011, (4) minimum 24-month follow-up, (5) measures of clinical and functional outcomes, and (6) patients with isolated grade II/III PCL injuries who had failed nonoperative management and were deemed clinically and functionally unstable. Excluded studies were (1) technique articles, (2) case reports, and (3) patients with additional ligamentous or bony injuries. A total of 19 relevant studies were identified (2 direct comparison, 5 allograft, and 12 autograft). No appreciable differences between allograft and autograft PCL reconstruction were identified. A paucity of data exists comparing allogeneic and autogeneic PCL reconstruction, but satisfactory clinical and functional results have been obtained with both graft sources.

Isolated arthroscopic labral debridement for hip labral tears had 45 % combined poor results when strictly defining failure as repeat surgery or abnormal hip rating. Untreated FAI and concomitant chondroplasty were risk factors for inferior outcome. We recommend concomitant treatment for bony impingement lesions and preservation of the labrum whenever possible.

The incidence of ACL tears is rising in the pediatric and adolescent populations as these individuals succumb to traumatic and nontraumatic athletic injuries. Management of this condition in the skeletally immature patient poses a challenge and is controversial. Operative reconstruction carries the concern for damage to the physis with resultant limb length inequality and angular joint deformity but provides stability to the knee and allows return of function in most patients. On the other hand, nonoperative treatment has been shown to carry an increased risk of meniscal and articular cartilage damage and is difficult from a compliance standpoint in this demographic. For the majority of skeletally immature patients, operative treatment is recommended as it has shown good clinical and functional results with minimal risk of growth disturbance. This paper aims to address the natural course of ACL injuries in the skeletally immature patient, treatment options with associated complications, and current preventative strategies.