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Muscle injuries are frequent among athletes and are an ever-growing challenge to medical staff. In order to achieve a quick yet full recovery, there is a continuous search for treatments to improve and accelerate muscle healing. A number of interventions have been proposed. In this chapter, we will cover the basics of muscle healing and discuss emerging therapies with current scientific evidence on their efficacy and safety.

Methacrylated gellan gum hydrogels, obtained either by ionic- (iGGMA) and photo-crosslinking (phGG-MA), have been investigated as potential biomaterials for supporting nucleus pulposus (NP) regeneration and/or repair [1,2]. In previous work, some advantages were attributed to GG-MA hydrogels, such as: (i) the possibility to control endothelial cells infiltration and blood vessel ingrowth’s, (ii) tunable and improved mechanical properties, and (iii) in situ gelation, within seconds to few minutes. In this study, the mechanical and biological performance of these hydrogels was firstly evaluated in vitro. Human intervertebral disc (hIVD) cells obtained from herniated patients were cultured within both hydrogels, for 1 up to 21 days. Dynamic mechanical analysis and biological characterization (calcein-AM staining, ATP and DNA quantification and PCR) were performed after specific times of culturing. A biocompatibility study was also performed in vivo, by subcutaneous implantation of acellular iGG-MA and phGG-MA hydrogels in Lewis rats for the period of 10 and 18 days. Tissue response to the hydrogels implantation was determined by histological analysis (haematoxylin-eosin staining). The in vitro study showed that both cell loading and culturing time do not have an effect on the mechanical properties of the hydrogels. Regarding their biological performance, the iGG-MA and phGG-MA hydrogels showed to be effective on supporting hIVD cells encapsulation and viability up to 21 days of culturing. Human IVD cells were homogeneously distributed within the hydrogels and maintained its round-shape morphology during culturing time. The in vivo biocompatibility study showed that iGG-MA and phGG-MA hydrogels do not elicit any deleterious effect, as denoted by the absence of necrosis and calcification, or acute inflammatory reaction. A thin fibrous capsule was observed around the implanted hydrogels. The results presented in this study indicate that the iGG-MA and phGG-MA hydrogels are stable in vitro and in vivo, support hIVD cells encapsulation and viability, and were found to be well-tolerated and non-cytotoxic in vivo, thus being potential candidates for NP regeneration.

Objectives: Total or partial meniscectomy have been the gold standard for the treatment of degenerated/diseased menisci. Despite meniscal regeneration represents a recent trend in tissue engineering, fundamental studies related to human meniscus biochemistry and biomechanics are still scarce. This work aims to contribute in the knowledge of this tissue aiming future clinical applications namely, the aspects dealing with the cellular phenotypes and density, biomechanics and extracellular matrix composition. Methods: Human tissue was obtained from Clínica Saúde Atlântica by means of surgery or biopsy, in accordance with local ethical committee guidelines. The HMC´s were isolated from different donor (sex and age) explants or using an enzymatic standard protocol. Micro-computed tomography (Micro-CT) of freeze-dried meniscus was carried out. Histological (haematoxylin and eosin - H&E, trichrome stain and toluidine blue stainings) analysis was performed for segmental characterization of ECM and cells density. Dynamic mechanical analysis was carried out for medial, anterior and posterior segments of meniscus (in PBS at pH 7.4). Results and Discussion: Micro-CT analysis revealed that meniscus (freeze-dried) possessed a mean porosity of 53%, a mean pore size and trabeculae thickness of 85 μm and 80 μm, respectively. The cells isolated from meniscus are a mixed population of cells, i.e. fibrochondrocyte-like and MSCs. The histological evaluation has shown that meniscus ECM is composed of collagen-type I. This tissue is fibrocartilagineous in nature and presented a higher cell density in the periphery as compared to meniscus core. Cellular density among the different segments (anterior, medial, posterior) of meniscus was quantified using the H&E 2-D histological images. Conclusions: This study has contributed to improve the knowledge on meniscus biology and mechanical properties. It is believed that these important issues should be considered to develop adequate acellular and cellular strategies for tissue engineer meniscus.

The scientific literature has shown positive results regarding intra-articular injections of hyaluronic acid in osteoarthritic joints. When injecting in the hip joint, the guidance of ultrasound can provide higher injection accuracy and repeatability. However, due to the methodological limitations in the current available literature, its recommendation in the current practice is still controversial. This study shows that ultrasound-guided intra-articular injections of triamcinolone hexacetonide and hyaluronic acid can improve pain, function and quality of life in patients with symptomatic and radiographic hip osteoarthritis. In addition, the administration of triamcinolone hexacetonide and hyaluronic acid to the hip joint in these patients can delay the need for interventional surgery.

Sliding knots can be performed in many situations during an arthroscopic procedure. Their use is possible in quite all conditions w here a tissue should be fixed using a suture as in rotator cuff tear repair or Bankart repair. Many knots are described and performed by arthroscopic surgeons. Aim of this chapter is to describe the principles of sliding knots and create a practical guide for surgeons to learn in an easy way the most famous knots. This guide could help youn g surgeons to learn the basic knots and expert surgeons to learn new techniques. The most famous knots have been described using a step-by-step description and images, to make them more reproducible

Purpose To identify the normal and injured magnetic resonance imaging appearance of the anterolateral ligament (ALL). Methods A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed and Cochrane Library electronic databases were used to search for studies that reported the imaging outcomes of the appearance of the ALL. Two authors performed the searches in duplicate up to April 30, 2018, and interobserver agreement was calculated. The methodologic quality of included articles was assessed using an adaptation of the Arrive methodologic quality scale for clinical studies of radiologic examinations. Results From the original 270 records, a total of 24 studies (κ = 0.94) comprising 2,427 knees in 2,388 patients (mean age, 33.3 years; 66% male patients; 63% with anterior cruciate ligament [ACL] injury) were included. The ALL appeared in 51% to 100% of all assessed knees (71%-100% in ACL-injured knees and 64%-97% in uninjured knees) and was injured in 11% to 79% of ACL-injured knees. Reliability rates varied considerably (0.04-1.0 for intraobserver and 0.143-1.0 for interobserver agreement), and the entire portion of the ligament was often not seen. The tibial insertion was seen in 21% to 96% of cases, followed by the meniscal (range, 0%-100%) and femoral (range, 0%-90%) insertions. The mean methodologic quality score was 5.1 ± 1.8 out of a possible score of 9. Conclusions High variability was found in the identification of normal and injured ALL definition methods and the respective magnetic resonance imaging findings. Reliability rates varied considerably, and the entire portion of the ligament was often not seen. Level of Evidence Level IV, systematic review of Level II to IV studies.

Sports activities are considered favourable for general health; nevertheless, a possible influence of sports practice on the development of early osteoarthritis (OA) is a cause for concern. A higher incidence of OA in knees and ankles of former high-impact sports players than in those of the normal population has been shown and it is still debatable whether the cause is either to be recognized generically in the higher number of injuries or in a joint overload. The possibility to address knee OA in its early phases may be strictly connected to the modification of specific extrinsic or intrinsic factors, related to the patient in order to save the joint from further disease progression; these include sport practice, equipment and load. Non-surgical therapies such as continuative muscles reinforce and training play a strong role in the care of athletes with early OA, particularly if professional. There is an overall agreement on the need of an early restoring of a proper meniscal, ligament and cartilage integrity in order to protect the knee and resume sports safely, whereas alignment is a point still strongly debatable especially for professional athletes. Remaining questions still to be answered are the risks of different sports in relation to one another, although an actual protective effect of low-impact sports, such as walking, swimming or cycling, has been recognized on the appearance or worsening of OA, the effect of continuing or ceasing to practice a sport on the natural history of early OA, and even following appropriate treatment is still unknown., info:eu-repo/semantics/publishedVersion