Traumatic articular cartilage injuries heal poorly and may predispose patients to the early onset of osteoarthritis. One current treatment relies on surgical delivery of autologous chondrocytes that are prepared, prior to implantation, through ex vivo cell expansion of cartilage biopsy cells. The requirement for cell expansion, however, is both complex and expensive and has proven to be a major hurdle in achieving a widespread adoption of the treatment. This study presents evidence that autologous chondrocyte implantation can be delivered without requiring ex vivo cell expansion. The proposed improvement relies on mechanical fragmentation of cartilage tissue sufficient to mobilize embedded chondrocytes via increased tissue surface area. Our outgrowth study, which was used to demonstrate chondrocyte migration and growth, indicated that fragmented cartilage tissue is a rich source for chondrocyte redistribution. The chondrocytes outgrown into 3-D scaffolds also formed cartilage-like tissue when implanted in SCID mice. Direct treatment of fullthickness chondral defects in goats using cartilage fragments on a resorbable scaffold produced hyaline-like repair tissue at 6 months. Thus, delivery of chondrocytes in the form of cartilage tissue fragments in conjunction with appropriate polymeric scaffolds provides a novel intraoperative approach for cell-based cartilage repair. ß

Osteoarthritis is a debilitating disease that has increased in prevalence across the world due to the aging population. Currently, physicians use a plethora of treatment strategies to try and slow down the progression of the disease, but none have been shown to ubiquitously treat and cure the disease. One of the strategies uses the high molecular weight molecule hyaluronic acid as either an injectable or oral supplement for treatment. Hyaluronic acid (HA) is a relatively new treatment that has shown varied results through several clinical trials. It can be used as a scaffold for engineering new treatments and several new preparations have just been added to the market. A comprehensive search was conducted through several search databases according our inclusion and exclusion criteria. This review included 44 prospective clinical trial investigating the feasibility and efficacy of HA injection for knee, hip, and ankle osteoarthritis. This review will take a closer look at hyaluronic acid and its properties, as well clinical effectiveness and future options.

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Context-Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted.Objective-To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Online-Only Material:The eFigure, eTables 1-3, and the Author Video Interview are available at http://www.jama.com.Author Contributions: Dr Galvagno had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Galvagno, Haut, Millin, Efron, Koenig, Pronovost, Haider. Acquisition of data: Galvagno, Haut, Zafar, Haider. Analysis and interpretation of data: Galvagno, Zafar, Baker, Bowman, Haider. Drafting of the manuscript: Galvagno, Haut, Milllin, Efron, Baker, Bowman, Pronovost, Haider. Critical revision of the manuscript for important intellectual content: Galvagno, Koenig, Baker, Bowman, Pronovost, Haider. Statistical expertise: Galvagno, Zafar, Bowman, Haider.Administrative, technical, or material support: Galvagno, Haut, Efron, Pronovost, Haider. Study supervision: Galvagno, Haut, Haider. Conclusion-Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders. NIH Public AccessTrauma remains the leading cause of death and disability among young people around the world. In the United States, more than 50 million people are injured per year, resulting in approximately 169 000 annual deaths and a lifetime cost of $406 billion. 1,2Over the past several years, significant improvements in survival after trauma have been achieved. One reason for this has been improvements in emergency medical services (EMS) and life-saving transport of trauma patients to a center capable of providing definitive care. The utility of helicopter EMS and its possible effect on outcomes for traumatically injured patients remains the subject of debate. [3][4][5][6][7][8] Because helicopter transport is a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground EMS is warranted.Several studies have used the National Trauma Data Bank (NTDB) to assess outcomes for traumatically injured adultstransportedbyeitheroption. [9][10][11] Although each of these studies concluded that helicopter transport was associated with improved odds of survival, they also reported limitations to their conclusions because of the lack of testing for the assumptions of a regression model, and none was able to account for the differences in how patients were assigned treatments (helicopter or ground transport). Additionally, the high proportio...