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
AZIENDA OSPEDALIERA OSPEDALE CIVILE DI
VIMERCATE DIVISIONE DI ORTOPEDIA-TRAUMATOLOGIA O
SPEDALE DI GIUSSANO - MI - ( Direttore Dott.
Claudio MANZINI )
M. LOVATO - C. MANZINIBologna 04 - 06
ottobre 2006
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International Literature
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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
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Growth Factors

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

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Growth Factors
Thrombin activation
Platelets in rest
Platelet activated
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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.
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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 1,500 ACL surgical operations in
arthroscopy, 150 of these with Growth Factors.
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Our Study 120 patients treated

• 2 groups
• Control (N60)
• With GF (N60)
• 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

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Our Study

• Control test
• clinic visual examination
• IKDC
• VAS
• MRI at 3, 6 and 12 months

John Lachman docet
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Clinical Use
Just one GF is not sufficient to resolve all the
problems linked with the processes of repair
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Growth Factors
1) Plantelet Derived Growth Factor PDGF-ßß
PDGF-aa PDGF-aß 2) Trasforming Growth
Factor beta TGF- ß1 TGF- ß2 3)
Vascular Endothelial Growth Factor VEGF 4)
Epithelial Growth Factor EGF 5) Insuline Growth
Factor IGF
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Method
GPS II
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Method
Whole Blood
PPP Platelet Poor Plasma
PRP Platelet Rich Plasma
PackedRBC
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Method
Buffy Coat
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Method
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Method
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Method
Growth Factors
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Results
Follow up at 3 months
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Results
Follow up at 6 months
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Results
Follow up at 12 months
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Results
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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 differentiation of the new ligament than
  control group.

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Results

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

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Costs and benefits analisy

• Costs
• Single use Kit
• Human resource

• Benefits
• Patients
• Less pain
• Quick recover
• Hospitals
• Lower ospitalization
• Surgeons
• Safety procedure

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Study
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Conclusions
Retourn to sport on average 30 days before than
control group
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Conclusions
We think that this Sistem applied to the surgical
reconstruction of ACL, cant 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.
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Conclusions
We think that this Sistem applied to the surgical
reconstruction of ACL, cant 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