Purpose: The present study aimed to compare the efficacy and safety of a combined injection of stromal vascular fraction (SVF) and platelet rich plasma (PRP) versus a high molecular weight (HMW) hyaluronic acid (HA) injection in patients with knee osteoarthritis (KOA).Methods: A prospective comparative analysis was conducted for patients with KOA who underwent either a single intra‐articular mechanical SVF combined with PRP injection (Group A) or a single intra‐articular injection of HMW HA (Group B). The Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale (VAS) and the EuroQol EQ‐5D (EQ‐5D‐5L) were assessed at baseline, 3, 6 and 12 months postinjection. PRP was coded according to the DEPA classification.Results: The study included 108 knees from 67 patients (Group A: 31; Group B: 36). The VAS, KOOS total and EQ‐5D‐5L scores significantly improved within each group in every timepoint compared to baseline. The SVF‐PRP group significantly outperformed the HMW‐HA group in VAS, KOOS total and EQ‐5D‐5L scores at 6 months and 12 months follow‐up. The proportion of patients who achieved Minimal Clinically Important Difference (MCID) at 12 months was 87.0% versus 57.4% (p = 0.0003) in KOOS, 74.1% versus 61.1% in VAS (p = 0.152) and 64.8% versus 40.7% (p = 0.005) in EQ‐5D‐5L, for the SVF‐PRP vs HA group, respectively. No serious adverse events were reported in either group. Minor local adverse events were more common in the SVF‐PRP group and spontaneously resolved within days. The implemented PRP was coded as CCA.Conclusion: Both SVF‐PRP and HA injections are safe treatments, with no serious adverse events, and significantly improve pain, function and quality of life in patients with KOA. The SVF‐PRP outperformed the HA group in all three PROMs at 6 months and 12 months follow‐up, and in the proportion of patients who achieved MCID at 12 months postinjection.Level of Evidence: Level II.

The optimal initial graft tension during ACL reconstruction is still a matter of debate. Manual tension is commonly applied to the graft during tibial fixation. However, this has been associated with a greater graft failure rate than that associated with device-assisted tensioning. This study aims to compare the clinical outcomes between the application of manual tension and the use of the ConMed Linvatec SE™ Graft Tensioning System during graft fixation while performing anatomic single-bundle ACL reconstruction. Methods: A prospective comparative study was conducted between September 2015 and May 2017. Sixty-four patients (mean age 29.3 years, range 14–45) with isolated ACL injuries (and who would be subjected to ACL reconstruction with a quadruple hamstring tendon graft) were divided into two groups. In Group A (n = 29), common tension was applied manually to both grafts. In Group B (n = 35), specific tension was applied to the grafts with the use of a tensioner device (ConMed Linvatec SE™ (Stress Equalization) Graft Tensioning System). A total of 60 N was applied to the semitendinosus, and 40 N was applied to the gracilis. Clinical outcomes were assessed at 6, 12, and 24 months. Results: There were no significant differences between the baseline demographic and clinical data among the patients of the two groups (all p > 0.05). The patients were followed up for a minimum of 24 months (mean ± SD). There were no significant differences in the side-to-side anterior knee laxity, the IKDC, the Lysholm Knee, and the Tegner Activity Scale scores for up to 24 months after operation. The pivot shift test was negative in all cases, and no graft failure was reported at a 2-year follow-up. Conclusion: No significant differences were found with respect to postoperative anterior knee laxity, clinical outcomes, activity level, and patient satisfaction between the application of manual tension and the use of the graft-tensioning system during tibial fixation while performing anatomic single-bundle ACL reconstruction with a quadruple hamstring tendon graft. Further high-quality clinical studies are required to elucidate whether device-assisted tension is superior to manual tension.

Background/Objectives: The aim of this study is to describe clavicular morphometric parameters and key bony landmarks relevant to plate-and-screw fixation and ligamentous reconstruction procedures. Methods: Morphometric measurements were performed on 179 adult human clavicles: 84 right and 95 left. Linear measurements were obtained using a Mitutoyo digital caliper (0.01 mm precision). Angular measurements were conducted using ImageJ software (LOCI, University of Wisconsin, Madison, USA). Results: The mean distance between the sternal articular surface and the midpoint of the sternoclavicular curvature was 49.23 ± 8.86 mm. The mean distance between the midpoints of the sternoclavicular and acromioclavicular curvatures was 65.16 ± 12.17 mm. The mean distance between the midpoint of the acromioclavicular curvature and the acromial articular surface was 41.58 ± 4.85 mm. The mean sternoclavicular angle was 153.31 ± 9.53° and the mean acromioclavicular angle was 119.95 ± 10.92°. The average thickness of the narrowest middle part of the clavicle was 11.61 ± 1.77 mm. The mean projection distance from the middle part of the clavicle to the most prominent point of the conoid tubercle was 43.81 ± 6.33 mm. The distances from the middle part of the clavicle to the medial trapezoid line and to the lateral impression of the costoclavicular ligament were 50.10 ± 6.31 mm and 42.29 ± 5.88 mm, respectively. The mean projected clavicular length was 142.76 ± 12.29 mm. Conclusions: In conclusion, these findings offer an anatomical reference that may assist radiological evaluation of clavicular shortening and support orthopaedic surgeons in implant selection and planning of ligament reconstruction procedures.

Purpose: Although platelet‐rich plasma (PRP) and hyaluronic acid (HA) are widely used for knee osteoarthritis (KOA), it remains unclear whether combining them provides greater benefit than HA alone. This study compared the efficacy and safety of three combined injections of PRP and high molecular weight (HMW) HA to three injections of HMW HA alone in patients with KOA. Methods: A prospective comparative analysis was conducted in patients with Kellgren–Lawrence (KL) Grade II–IV KOA who underwent either three intra‐articular PRP‐HA injections (Group A) or three intra‐articular injections of HA (Group B). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and subscales, the visual analogue scale (VAS) and the EuroQuality of Life–5 Dimensions–5 Levels (EQ‐5D‐5L) were assessed at baseline, 3, 6 and 12 months post‐injection. Statistical analysis was applied to compare the outcomes between the two groups. The HA used in both groups had a concentration of 1% (20 mg/2 mL) and a molecular weight of 2.8–3.2 MDa. The PRP used had been previously analysed and classified according to the Dose of injected Platelets, Efficiency of production, Purity of the PRP, Activation of the PRP (DEPA) classification as CCA. Results: The study included 150 knees from 150 patients (Group A: 75 and Group B: 75). The VAS, KOOS total and EQ‐5D‐5L scores significantly improved within each group at every time point compared to baseline ( p < 0.05). The PRP‐HA group achieved significantly superior outcomes than the HMW‐HA group in VAS, KOOS total and EQ‐5D‐5L scores at 6‐ and 12‐month follow‐up post‐injection ( p < 0.05). No serious adverse events were reported in either group. Conclusion: Both PRP‐HA and HA only injections significantly improved pain, function and quality of life in patients with KOA. The PRP‐HA group achieved significantly better outcomes than the HA group in all three patient‐reported outcome measures at 6‐ and 12‐month follow‐up, and in the proportion of patients who achieved Patient Acceptable Symptom State and minimum clinically important difference, especially at 12 months post‐injection. Level of Evidence: Level II.