This study supports early motion as an acceptable form of rehabilitation in both surgically and nonsurgically treated patients with comparable functional results and a low rerupture rate. There appears to be no difference between the 2 groups, suggesting that controlled early motion is the important part of treatment of ruptured Achilles tendon.

In these early results, the anticipated functional gains of RSA over hemiarthroplasty were not realized, suggesting the use of RSA for treatment of proximal humeral fractures should remain guarded. Larger prospective trials are necessary to identify the optimal management of patients in this situation.

The rat thoracic cord clip compression model is a reproducible, clinically relevant spinal cord injury model. This is the first time that the force of clip compression injury in the rat thoracic cord has been correlated with both functional and histologic outcome measures.

No abstract

After spinal cord injury (SCI), a complex cascade of events leads to tissue degeneration and a penumbra of cell death. Neuroprotective molecules to limit tissue loss are promising; however, intravenous delivery is limited by the blood-spinal cord barrier and short systemic half-life. Current local delivery strategies are flawed: bolus injection results in drug dispersion throughout the intrathecal (IT) space, and catheters/pumps are invasive and open to infection. Our laboratory previously developed a hydrogel of hyaluronan (HA) and methylcellulose (MC) (HAMC) that, when injected into the IT space, was safe and, remarkably, had some therapeutic benefit on its own. In order to test this new paradigm of local and sustained delivery, relative to conventional delivery strategies, we tested, for the first time, the in vivo efficacy of HAMC as an IT drug delivery system by delivering a known neuroprotective molecule, erythropoietin (EPO). In vitro studies showed that EPO was released from HAMC within 16 h, with 80% bioactivity maintained. When the material alone was injected in vivo, individual fluorescent labels on HA and MC showed that HA dissolved from the gel within 24 h, whereas the hydrophobically associated MC persisted in the IT space for 4-7 days. Using a clip compression injury model of moderate severity, HAMC with EPO was injected in the IT space and, in order to better understand the potential of this delivery system, compared to the therapeutic effect of both common delivery strategies-IT EPO and intraperitoneal EPO-and a control of IT HAMC alone. IT HAMC delivery of EPO resulted in both reduced cavitation after SCI and a greater number of neurons relative to the other delivery strategies. These data suggest that the localized and sustained release of EPO at the tissue site by HAMC delivery enhances neuroprotection. This new system of IT delivery holds great promise for the safe, efficacious, and local delivery of therapeutic molecules directly to the spinal cord.