There are promising results in the use of platelet‐rich plasma (PRP) for musculoskeletal tissue repair. However, the variability in the methodology for its obtaining may cause different and opposing findings in the literature. Particularly, the choice of the anticoagulant is the first definition to be made. In this work, blood was collected with sodium citrate (SC), ethylenediaminetetraacetic acid (EDTA), or anticoagulant citrate dextrose (ACD) solution A, as anticoagulants, prior to PRP obtaining. Hematological analysis and growth factors release quantification were performed, and the effects on mesenchymal stromal cell (MSC) culture, such as cytotoxicity and cell proliferation (evaluated by MTT method) and gene expression, were evaluated. The use of EDTA resulted in higher platelet yield in whole blood; however, it induced an increase in the mean platelet volume (MPV) following the blood centrifugation steps for PRP obtaining. The use of SC and ACD resulted in higher induction of MSC proliferation. On the other hand, PRP obtained in SC presented the higher platelet recovery after the blood first centrifugation step and a minimal change in MSC gene expression. Therefore, we suggest the use of SC as the anticoagulant for PRP obtaining.

An anterior cruciate ligament (ACL) tear is a severe sports injury that often occurs in young athletes. Besides the strong cumulative evidence on noncontact ACL tears, the injury mechanism (especially the contribution of external rotation) is still not well understood. The present work aims to evaluate which knee kinetics result in higher ACL stress and strain. A finite element model of the ACL was developed with a detailed geometry; the two distinct bundles (anteromedial and posterolateral) and the surrounding connective tissue were modelled based on medical anatomic measures and images. The model was validated using computational and cadaveric external data. Sixteen simulations were performed using different combinations of moments and axial loads applied to the knee model as boundary conditions. The results demonstrated that the peak stress (11.00 MPa) and strain (0.048) occurred at the midportion of the anteromedial bundle with the higher values being obtained under a combined knee valgus, flexion, tibial external rotation and high axial load. Anterior load showed low sensitivity in ACL stress and strain peaks. The tibial external rotation showed a higher contribution to the peak ACL stress and strain as compared to internal rotation. These results reinforce the role of axial load and highlight the importance of external rotation on ACL stress and strain, which may be suggestive of the ACL tear mechanism. The role of external rotation is often neglected and should be further explored in future cadaveric and experimental studies. The findings of this study provide data-driven insights to optimize the indications for prevention, diagnosis and treatment of ACL injuries in clinical practice and contribute to raising awareness of the injury mechanism among all relevant stakeholders.

To assess the safety and efficiency of cell therapy for pseudarthrosis. Implant of the bone marrow aspirate was compared to mononuclear cells purified extemporaneously using the Sepax^® equipment. Six patients with nonunion of the tibia or femur were treated. Four received a percutaneous infusion of autologous bone marrow aspirated from the iliac crest, and two received autologous bone marrow mononuclear cells separated from the aspirate with the Sepax^®. The primary fixation method was unchanged, and the nonunion focus was not exposed. Physical examination and radiographies were performed 2, 4 and 6 months after the treatment by the same physician. After consolidation of the fracture the satisfaction of the patients was estimated using the adapted QALY scale. No complications occurred as a result of the referred procedures. Bone consolidation was obtained in all cases within 3 to 24 weeks. The degree of patient satisfaction before and after bone consolidation was assessed, with the average value increasing from two to nine (p=0.0156). We conclude that the proposed method is effective and safe for the treatment of nonunion of long bones regardless of the stabilization method used. Level of Evidence II, Prospective Comparative Study