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Introduction: Therapeutic decisionmaking is a complex process in which multiple variables must be considered. There is a growing trend towards surgical indication, although scientific evidence is not always blunt. Understanding how surgeons make decisions can improve our understanding of treatment variability; Objectives: To expose the demographic situation of osteoarticular injuries in orthopedic surgeons in Uruguay and how they deal with their own injury and identify those variables that influence therapeutic decision-making in the orthopedist. Material and methods: Using the Uruguayan Society of Orthopedics and Traumatology database, residents and surgeons who had at least one osteoarticular injury were identified. Each of the selected ones was interviewed by telephone, obtaining the variables of interest. Results: In a total of 274 residents and Orthopedic surgeons, we include 56 professionals and 69 osteoarticular injuries. We highlight the existence of multiple injuries of controversial treatment, according to current scientific evidence. The surgeon did not always indicate the same treatment to himself, in respect of the one that would indicate a patient with the same injury. Fear of complications, rapid job reimbursement, opinion of an expert colleague, among others were some of the variables found in the therapeutic decision. Conclusions: When the lesion settles on the surgeon itself, a different action was observed with respect to a patient with equal injury. [ABSTRACT FROM AUTHOR]

The practice of any sport is inherently associated with the risk of musculoskeletal lesions. We describe regenerative medicine technologies, including cellular therapies, gene therapies and multimolecular preparations of growth factors and cytokines, which are expected to advance the field of orthopaedics and sports medicine. Gene therapy involves the introduction of genetic information in the injured tissue to help that tissue to heal and, possibly, regenerate. Cell therapies used in clinical practice are based on the transplantation of adult human cells, which can be at different stages of differentiation. Currently, the stromal vascular fraction, containing stem cells and other niche components, has been injected in the articular cartilage of the knee or delivered via arthroscopy. Bone marrow concentrate (BMC) has been used to manage focal chondral defects via arthroscopy with promising clinical results. In addition, purified mesenchymal stem cells (MSCs) have been injected or delivered as an adjuvant to arthroscopic microfractures, and patients have shown improved clinical outcomes. Laboratory-expanded MSCs injected in osteoarthritis moderately improved pain and functional outcomes. MSC treatment in the form of stromal vascular fraction (SVF) or BMC or laboratory expanded adhesive cells (bone marrow and adipose derived stem cells, BM-MSCs and ADSCs) has been proven to be safe. Despite their safety, expensive regulatory complexities required to implement cell-based therapies make these treatments unavailable for most patients. At present, although some results are promising, all biological interventions are experimental, and cost/efficacy has not been demonstrated yet. Moreover, short follow-up in most studies questions the durability of treatments. [ABSTRACT FROM AUTHOR]

Background: The use of autologous platelet gel in orthopedics is effective in accelerating the healing process of osteochondral, muscle, tendon and ligament lesions. The aim of our study was to verify whether the variability in response to infiltration with platelet gel was dependent on the underlying disease treated, sex and age of the patients. During four years, 140 patients have been treated for musculoskeletal injuries by infiltration of gel platelet and lysate platelet obtained from autologous thrombin, with echo-ultrasound guided. The response to treatment was assessed at different time points T0, T1, T2 with respect to pain estimation (VAS), joint mobility (ROM scale) and echo-ultrasound evaluation. This data collection has allowed classifying the response to treated lesions in three categories: NR (no response), PR (partial response), CR (complete response). Results: The data here reported showed that the ability to physical recovery response is evident in tendon injuries, while the large joints injuries gave a poor response. Almost all patients showed a significant pain relief after the first infiltration, but in terms of echo-ultrasound evaluation and tissue repair, only the muscle and tendon injuries showed hyperechoic areas, signs or evidences of repair. Concerning the correlation between response to infiltration with platelet gel and gender/age of the patients, the clinical results appear not influenced by the age and the gender of the patient. Discussion: Our data indicate that, pain relief and ability to physical recovery of muscles, tendons and ligaments depend on tissue repair clearly visible by echo ultrasound evaluation. On the other hand tissue repair seems not occur in the large joints (hip and knee) where arthritis and /or corrosion of articular cartilage cannot be repaired and the only relief is exclusively linked to the reduction of periarticular inflammation (reduction of the inflammatory leakage and signs). [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic decision-making is a complex process in which multiple variables must be considered. There is a growing trend towards surgical indication, although scientific evidence is not always blunt. Understanding how surgeons make decisions can improve our understanding of treatment variability., Objectives: To expose the demographic situation of osteoarticular injuries in orthopedic surgeons in Uruguay and how they deal with their own injury and identify those variables that influence therapeutic decision-making in the orthopedist., Material and Methods: Using the Uruguayan Society of Orthopedics and Traumatology database, residents and surgeons who had at least one osteoarticular injury were identified. Each of the selected ones was interviewed by telephone, obtaining the variables of interest., Results: In a total of 274 residents and Orthopedic surgeons, we include 56 professionals and 69 osteoarticular injuries. We highlight the existence of multiple injuries of controversial treatment, according to current scientific evidence. The surgeon did not always indicate the same treatment to himself, in respect of the one that would indicate a patient with the same injury. Fear of complications, rapid job reimbursement, opinion of an expert colleague, among others were some of the variables found in the therapeutic decision., Conclusions: When the lesion settles on the surgeon itself, a different action was observed with respect to a patient with equal injury.