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The Sports, Ultrasound, Biologics, and Arthroscopy Protocol in the New Era of Orthopaedic Sports Injuries Treatments

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 16-20 | Bernáldez Domínguez Pedro, Dallo Lazzarini Ignacio. DOI: 10.13107/jrs.2021.v01.i01.011

Author: Bernáldez Domínguez Pedro [1], Dallo Lazzarini Ignacio [1]

[1] Department of Orthopaedic Surgery and Sports Medicine, SportMe Medical Center, Unit of Biological Therapies and Ultrasounds, Seville, Spain.

Address of Correspondence
Dr. Bernáldez Domínguez Pedro, MD. PhD
Tabladilla, 2, 41013, Seville, Spain.
E-mail: pedrobernaldez@gmail.com


Abstract

In the new era of sports traumatology, the union of anatomical, biomechanical, and functional knowledge, together with an adequate clinical examination and complemented with ultrasound studies, arthroscopic surgery, and conventional surgery, makes us understand the pathology, in a new and modern way, of the locomotor system, such as the muscle, tendon, ligament, menisci, capsule, synovial membrane, as well as bone and cartilage pathologies. Biological therapies have shown a good result for soft tissue in chronic pathology that can be applied in an ultrasound guided manner to treat tendinopathy of the Achilles, patellar, and quadriceps tendons, also at the elbow and shoulder level. It is striking to highlight the good results of this biological therapy with platelet-rich plasma for degenerative joint diseases in patients with moderate osteoarthritis. In cases in which conservative or biological therapies have not had their effect, we will generally indicate surgery, in most cases arthroscopically if it is joint pathology. This indication will be mandatory, especially in joint instability cases where we will require stabilizing surgery. We emphasize the importance of multidisciplinary teams where there must be a sports doctor, a sports traumatologist, a physiotherapist, a functional trainer, a podiatrist, biomechanics specialist, and other professionals that surround the athlete, such as the nutritionist, the psychologist so that the athlete has comprehensive assistance and is always well cared for. Together, these concepts make a personalized approach named the Sports, Ultrasound, Biologics, and Arthroscopy protocol to improve clinical results, shorten recovery times, and considerably reduce healthcare costs.
Keywords: Sports, Ultrasound, Biologics, Arthroscopy protocol, Sports medicine, Ultrasound-guided therapies, Biological therapies, Arthroscopy.


References:

1. Lind M, Seil R, Dejour D, Becker R, Menetrey J, Ross M. Creation of a specialist core curriculum for the European Society for Sports traumatology, Knee surgery and Arthroscopy (ESSKA). Knee Surg Sports Traumatol Arthrosc 2020;28:3066-79.
2. Centeno C. In: Aldridge K, editor. Orthopedics 2.0: How Regenerative Medicine and Interventional Orthopedics will Change Everything. RHIA; 2018.
3. Daniels EW, Cole D, Jacobs B, Phillips SF. Existing evidence on ultrasound-guided injections in sports medicine. Orthop J Sports Med 2018;6:2325967118756576.
4. Hoeber S, Aly AR, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med 2016;50:392-6.
5. Peck E, Jelsing E, Onishi K. Advanced ultrasound-guided interventions for tendinopathy. Phys Med Rehabil Clin N Am 2016;27:733-48.
6. Domínguez B. Martos AT. El ecógrafo: El fonendo del Traumatólogo: Utilidad diagnostica y terapéutica. Rev S Traum Ort 2017;34:17-26.
7. Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic approaches for the treatment of partial tears of the anterior cruciate ligament: A current concepts review. Orthop J Sports Med 2017;5:2325967116681724.
8. Kon E, Di Matteo B, Delgado D, Cole BJ, Dorotei A, Dragoo JL, et al. Platelet-rich plasma for the treatment of knee osteoarthritis: An expert opinion and proposal for a novel classification and coding system. Expert Opin Biol Ther 2020;20:1447-60.
9. Le AD, Enweze L, DeBaun MR, Dragoo JL. Current clinical recommendations for use of platelet-rich plasma. Curr Rev Musculoskelet Med 2018;11:624-34.
10. Piuzzi NS, Khlopas A, Newman JM, Ng M, Roche M, Husni ME, et al. Bone marrow cellular therapies: Novel therapy for knee osteoarthritis. J Knee Surg 2018;31:22-6.

11. Gobbi A, Whyte GP. Long-term clinical outcomes of one-stage cartilage repair in the knee with hyaluronic acid-based scaffold embedded with mesenchymal stem cells sourced from bone marrow aspirate concentrate. Am J Sports Med 2019;47:1621-8.
12. Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-Step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full-thickness knee cartilage lesions: Results at 2-year follow-up. Cartilage 2011;2:286-99.

13. Dallo I, Morales M, Gobbi A. Platelets and Adipose Stroma Combined for the Treatment of the Arthritic Knee. Arthroscopy Techniques; November 2021.
14. Gobbi A, Dallo I, Rogers C, Striano RD, Mautner K, Bowers R, et al. Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: A multi-centric, international study. Int Orthop 2021;45:1179-88.
15. Jackson RW. A history of arthroscopy. Arthroscopy 2010;26:91-103.
16. Perets I, Rybalko D, Mu BH, Friedman A, Morgenstern DR, Domb BG. Hip Arthroscopy: Extra-articular Procedures. Hip Int 2019;29:346-54.
17. Chloros GD, Shen J, Mahirogullari M, Wiesler ER. Wrist arthroscopy. J Surg Orthop Adv 2007;16:49-61.
18. DiFelice GS, van der List JP. Clinical outcomes of arthroscopic primary repair of proximal anterior cruciate ligament tears are maintained at mid-term follow-up. Arthroscopy 2018;34:1085-93.
19. van der List JP, DiFelice GS. Primary repair of the anterior cruciate ligament: A paradigm shift. Surgeon 2017;15:161-8.

 


How to Cite this article: Pedro BD, Ignacio DL | The Sports, Ultrasound, Biologics, and Arthroscopy Protocol in the New Era of Orthopaedic Sports Injuries Treatments. | Journal of Regenerative Science | Dec 2021; 1(1): 16-20.

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New Trends in Ultrasound-Guided Musculoskeletal Injuries Approaches

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 30-34 | Bernáldez Domínguez Pedro, Dallo Lazzarini Ignacio. DOI: 10.13107/jrs.2021.v01.i01.017

Author: Bernáldez Domínguez Pedro [1], Dallo Lazzarini Ignacio [1]

[1] Department of Orthopaedic Surgery and Sports Medicine, SportMe Medical Center, Unit of Biological Therapies, Seville, Spain.

 

Address of Correspondence
Dr. Bernáldez Domínguez Pedro, MD
Tabladilla, 2, 41013, Seville, Spain.
E-mail: pedrobernaldez@gmail.com


Abstract

The ultrasound not only allows us to diagnose musculoskeletal injuries but is also a fantastic tool to assist us when performing different therapies on the tissues. Multiple studies compare the classic blind versus ultrasound-guided infiltrations, with a significant difference in the results. In this article, we present the different indications for ultrasound-guided therapies, including ultrasound-guided local infiltration, percutaneous needle tenotomy, intracapsular hydrodilatation, hydrodissection, high-volume injection, percutaneous needle scraping and ultrasound-guided surgery (EAS). We describe the techniques, their advantages, and disadvantages, as well as possible complications. These procedures require a good learning curve, but once achieved, it will allow us to use them to obtain good clinical results, and in many cases avoiding the operating room. We have included these therapies in the so-called “SUBA Protocol” that includes the application of the concepts of modern Sports trauma, the use of musculoskeletal Ultrasounds, consider Biological therapies as one more tool in the therapeutic arsenal, and finally, the use of Arthroscopic surgeries, minimally invasive procedures with minor tissue damage.

Keywords: Musculoskeletal ultrasound, Ultrasound-guided therapies, Percutaneous needle tenotomy, Intracapsular hydrodilatation,
Hydrodissection, Percutaneous needle scraping, Ultrasound-guided surgery, SUBA protocol.


References:

1. Domínguez B, Martos TA. El ecógrafo: El fonendo del Traumatólogo: Utilidad diagnostica y terapéutica. Rev S Traum Ort 2017;34:17-26.
2. De Zordo T, Lill SR, Fink C, Feuchtner GM, Jaschke W, Bellmann-Weiler R, et al. Real-time sonoelastography of lateral epicondylitis: Comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol 2009;193:180-5.
3. Nazarian LN. The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. AJR Am J Roentgenol 2008;190:1621-6.
4. Daley EL, Bajaj S, Bisson LJ, Cole BJ. Improving injection accuracy of the elbow, knee, and shoulder: Does injection site and imaging make a difference? A systematic review. Am J Sports Med 2011;39:656-62.
5. Daniels EW, Cole D, Jacobs B, Phillips SF. Existing evidence on ultrasound-guided injections in sports medicine. Orthop J Sports Med 2018;6:2325967118756576.
6. Peck E, Jelsing E, Onishi K. Advanced ultrasound-guided interventions for tendinopathy. Phys Med Rehabil Clin N Am 2016;27:733-48.
7. Hall MM, Rajasekaran S. Ultrasound-guided scraping for chronic patellar tendinopathy: A case presentation. PM R 2016;8:593-6.
8. Patel R, Urits I, Wolf J, Murthy A, Cornett EM, Jones MR, et al. A comprehensive update of adhesive capsulitis and minimally invasive treatment options. Psychopharmacol Bull 2020;50 4 Suppl 1:91-107.
9. Lam KH, Hung CY, Chiang YP, Onishi K, Su DC, Clark TB, et al. Ultrasound-guided nerve hydrodissection for pain management: rationale, methods, current literature, and theoretical mechanisms. J Pain Res 2020;13:1957-68..
10. Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion achilles tendinopathy: A randomized double-blinded prospective study. Am J Sports Med 2017;45:2034-43.

11. Tafti D, Byerly DW. Ultrasound Guided Barbotage. Treasure Island, FL: StatPearls Publishing; 2021.
12. Henning PT, Yang L, Awan T, Lueders D, Pourcho AM. Minimally invasive ultrasound-guided carpal tunnel release: Preliminary clinical results. J Ultrasound Med 2018;37:2699-706.
13. Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, et al. Advances in modern osteotomies around the knee: Report on the association of sports traumatology, arthroscopy, orthopaedic surgery, rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017. J Exp Orthop 2019;6:9.
14. Sabeti-Aschraf M, Lemmerhofer B, Lang S, Schmidt M, Funovics PT, Ziai P, et al. Ultrasound guidance improves the accuracy of the acromioclavicular joint infiltration: A prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2011;19:292-5.
15. Berkoff DJ, Miller LE, Block JE. Clinical utility of ultrasound guidance for intra-articular knee injections: A review. Clin Interv Aging 2012;7:89-95.
16. Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med 2015;49:1042-9.
17. Wu T, Song HX, Dong Y, Li JH. Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: A systematic review and meta-analysis. Semin Arthritis Rheum 2015;45:374-8.
18.Hoeber S, Aly AR, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med 2016;50:392-6.
19. Domínguez MP. Bridging the Gap between Surgical and Conservative Treatment. The SUBA Protocol (Sports, Ultrasound, Biologics, Arthroscopy). TOBI (The Orthobiologic Institute) Conference; 2021.

 


How to Cite this article: Pedro BD, Ignacio DL | New Trends in Ultrasound-Guided Musculoskeletal Injuries Approaches. | Journal of Regenerative Science | Dec 2021; 1(1): 30-34.

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