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NOSTRA ESPERIENZA NELLA RICOSTRUZIONE DEL L. C. A. CON UTILIZZO DEI FATTORI DI CRESCITA

AZIENDA OSPEDALIERA “OSPEDALE CIVILE DI VIMERCATE” DIVISIONE DI ORTOPEDIA-TRAUMATOLOGIA OSPEDALE DI GIUSSANO - MI - ( Direttore: Dott. Claudio MANZINI ). NOSTRA ESPERIENZA NELLA RICOSTRUZIONE DEL L. C. A. CON UTILIZZO DEI FATTORI DI CRESCITA.

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NOSTRA ESPERIENZA NELLA RICOSTRUZIONE DEL L. C. A. CON UTILIZZO DEI FATTORI DI CRESCITA

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  1. AZIENDA OSPEDALIERA “OSPEDALE CIVILE DI VIMERCATE” DIVISIONE DI ORTOPEDIA-TRAUMATOLOGIA OSPEDALE DI GIUSSANO - MI - ( Direttore: Dott. Claudio MANZINI ) NOSTRA ESPERIENZA NELLA RICOSTRUZIONE DEL L. C. A. CON UTILIZZO DEI FATTORI DI CRESCITA M. LOVATO - C. MANZINIBologna 04 - 06 ottobre 2006

  2. International Literature

  3. International Literature The power of Growth Factors: tissue revitalizing recover improvement pain reduction A NEW GOAL The revitalization of the new ligament through the neo-vascularization of the tibial and patellar bone portions

  4. Growth Factors Platelet Functions • Haemostasis • Primary haemostasis • Secundary haemostasis (coagulation) • Inflammation • Antimicrobial host defence • Stimulation of wound and/or bone healing

  5. Growth Factors + Thrombin activation Platelets in rest Platelet activated

  6. Our Experience For more than 4 years we have been using GPS II™ platelet derived Growth Factors in different surgical applications. For prosthetic correction and in complex cases of pseudoarthrosis. Since March 2004 we have used them regularly in Anterior Cruciate Ligament reconstruction.

  7. Our Experience Since 1990 for reconstruction of the Anterior Cruciate Ligament we have been using the free patellar tendon. Up until now, we have carried out about 1,500ACL surgical operations in arthroscopy, 150 of these with Growth Factors.

  8. Our Study120 patients treated • 2 groups: • Control (N=60) • With GF (N=60) • Age: 17 – 35 • Professional or agonist sportsman • Complete ACL lesion • Possible periferical legamentous lesions • Absence of 3° or 4° degree chondral malacia • Possible meniscal tears • Absence of reumathoid complications

  9. Our Study • Control test: • clinic visual examination • IKDC • VAS • MRI at 3, 6 and 12 months “John Lachman docet”

  10. Clinical Use Just one GF is not sufficient to resolve all the problems linked with the processes of repair

  11. Growth Factors 1) Plantelet Derived Growth Factor PDGF-ββ PDGF-aa PDGF-aβ 2) Trasforming Growth Factor beta TGF- β1 TGF- β2 3) Vascular Endothelial Growth Factor VEGF 4) Epithelial Growth Factor EGF 5) Insuline Growth Factor IGF

  12. Method GPS II

  13. Method Whole Blood PPP Platelet Poor Plasma PRP Platelet Rich Plasma PackedRBC

  14. Method Buffy Coat

  15. Prepared Patellar Tendon Prepared Growth Factors’ Syringe Infiltration Ready and Geled Patellar Tendon Method

  16. Injection of Liquid GF into the Femour Insertion Final Intraopetratory Test Method

  17. Method + Growth Factors

  18. Results Follow up at 3 months

  19. Results Follow up at 6 months

  20. Results Follow up at 12 months

  21. Results

  22. Results • 50% reduction of post-operational pain (valued with VAS sistem); • Quicker articular recovery but above all minor quadricipital hypotrophy. • Around third month, on patient treated with GF, MRI pointed out minor fibroblastic invasion and better differentiationof the new ligament than control group.

  23. Results Complications • In 10 % of cases we found a slight anterior gonalgia and fibrosis of the Hoffa body • 2 cases of iperthermya

  24. Costs Single use Kit Human resource Benefits Patient’s Less pain Quick recover Hospital’s Lower ospitalization Surgeon’s Safety procedure Costs and benefits analisy

  25. Study

  26. Conclusions Retourn to sport on average 30 days before than control group

  27. Conclusions We think that this Sistem applied to the surgical reconstruction of ACL, can’t revolutionize the knee surgery, BUT it can give us and our patients, a real hope to obtain results nearer to the safe knee! Moreover, all of it, through a way ethicaly and phisiologicaly sustainable.

  28. Conclusions We think that this Sistem applied to the surgical reconstruction of ACL, can’t revolutionize the knee surgery, BUT it can give us and our patients, a real hope to obtain results nearer to the safe knee! Moreover, all of it, through a way ethicaly and phisiologicaly sustainable. A special thank to the Local Organizing Committee. and Good work to all !! Maurizio Lovato e Claudio Manzini Hospital “C. Borella”, Trauma Center Giussano – Milano Italy

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