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Papers by Dr Ignacio Dallo

Research Square (Research Square), Dec 29, 2020

Gels

Platelet- and fibrin-rich orthobiologic products, such as autologous platelet concentrates, have ... more Platelet- and fibrin-rich orthobiologic products, such as autologous platelet concentrates, have been extensively studied and appreciated for their beneficial effects on multiple conditions. Platelet-rich plasma (PRP) and its derivatives, including platelet-rich fibrin (PRF), have demonstrated encouraging outcomes in clinical and laboratory settings, particularly in the treatment of musculoskeletal disorders such as osteoarthritis (OA). Although PRP and PRF have distinct characteristics, they share similar properties. The relative abundance of platelets, peripheral blood cells, and molecular components in these orthobiologic products stimulates numerous biological pathways. These include inflammatory modulation, augmented neovascularization, and the delivery of pro-anabolic stimuli that regulate cell recruitment, proliferation, and differentiation. Furthermore, the fibrinolytic system, which is sometimes overlooked, plays a crucial role in musculoskeletal regenerative medicine by re...

Journal of cartilage & joint preservation, Sep 1, 2021

Abstract Introduction Subchondral bone pathology includes a wide range of pathologies, such as os... more Abstract Introduction Subchondral bone pathology includes a wide range of pathologies, such as osteoarthritis, spontaneous insufficiency fractures, osteonecrosis, transient bone marrow lesions syndromes, and trauma. They show typical magnetic resonance imaging (MRI) findings termed bone marrow lesions (BMLs). However, the etiology and evolution of BMLs in multiple conditions remains unclear. There is still no gold standard treatment protocol in treating BMLs in the knee, and a variety of treatment modalities have been tested in the hope that they might reduce pain and stop disease progression. Objectives To review the treatment options for BMLs of the knee. Methods A literature review was performed that included searches of PubMed, Cochrane, and Medline databases using the following keywords: Bone marrow lesions, sub chondroplasty, bone marrow concentrate, platelet-rich plasma (PRP), subchondral bone augmentation. Results The use of novel biologic techniques to treat BMLs in the knee, such as PRP and Bone Marrow Cells, has yielded promising clinical outcomes. Conclusions Future research of BMLs will be mandatory to address the different pathologies better and determining appropriate treatment strategies. There is still a need for high-quality RCTs studies and systematic reviews in the future to enhance further treatment strategy in preventing or treating BMLs of the knee.

Biologic Orthopedics Journal

To present clinical outcomes in a preliminary patient cohort using a biologic augmentation techni... more To present clinical outcomes in a preliminary patient cohort using a biologic augmentation technique consisting of intra-ligamentous and intra-articular infiltration of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) under arthroscopic visualization for treatment of isolated and acute partial anterior cruciate ligament (ACL) tears. Athletes with an acute symptomatic partial ACL injury with clinical examination findings of increased anterior tibial translation without rotational instability were treated with the biologic augmentation technique. Patients were followed for 2 years postoperatively. The Lysholm Knee Questionnaire, IKDC Objective score, physical examination findings, MRI, and the KT-1000 arthrometer were used to assess clinical outcomes. Five patients were included in the analysis with a median age of 22. All patients were determined to have a healed ACL on MRI 8 months postoperatively. The median Lysholm Score at the final follow-up of 99 was signi...

Stem Cells International

Background. Intra-articular bone marrow concentrate (BMC) and aspirate (BMA) injections have been... more Background. Intra-articular bone marrow concentrate (BMC) and aspirate (BMA) injections have been used with mixed results to treat osteoarthritis (OA). Given the various aspiration and concentration methods available for preparing bone marrow, more data are needed to identify the optimal bone marrow harvesting techniques to treat OA. Methods. This retrospective cohort study examined the effect of using low-volume BMAs harvested using the Marrow Cellution™ (MC) device on 160 patients (262 knees) suffering from pain due to knee OA, KL grades 2-4, that did not respond to conservative treatment. Changes in visual analog scores (VAS) for overall daily activity were examined over a six-month time frame in these patients ( 63.5 ± 0.97 years of age; 48.1% male). In addition, changes in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Patient Global Impression of Change (PGIC scores) were examined over the same time frame in a smaller subset of patients (95 patients ...

European Journal of Orthopaedic Surgery & Traumatology

Purpose The purpose of this prospective randomized clinical trial is to compare the clinical outc... more Purpose The purpose of this prospective randomized clinical trial is to compare the clinical outcomes of three injections of leucocyte-poor platelet-rich plasma (LP-PRP) and hyaluronic acid (HA) to a single dose of autologous microfragmented adipose tissue (AMAT) in patients with mild osteoarthritis at a two-year follow-up. Methods Eighty symptomatic knees in fifty patients (mean age: 62.38 ± 11.88 years) with Kellgren-Lawrence grade 0 to 2 osteoarthritis were non blinded, randomly allocated into two equal groups. Group 1 consisted of 40 knees that received autologous LP-PRP + HA; Group 2 consisted of 40 knees treated with a single dose of AMAT injection. The outcomes were measured by Tegner, Marx, Visual Analogue Scale (VAS) for pain, International Knee Documentation Committee, and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6 (T1), 12 (T2), and 24 (T3) months. Adverse events were recorded at each follow-up timepoint. To assess score differences among subjects of the sam...

ESSKA Instructional Course Lecture Book, 2020

Nowadays there is a growing interest in clinical applications of Biologic therapies specially for... more Nowadays there is a growing interest in clinical applications of Biologic therapies specially for Platelets rich plasma and stem cell therapies; in this chapter many of these applications will be listed from several experts that have extensive basic and clinical experience on its use to enhance healing in a varied number of injuries and pathological states.

Complex Knee Ligament Injuries, 2019

Topics in health record management, 1983

The Patellofemoral Joint, 2021

Research Square (Research Square), Dec 29, 2020

Gels

Journal of cartilage & joint preservation, Sep 1, 2021

Biologic Orthopedics Journal

Stem Cells International

European Journal of Orthopaedic Surgery & Traumatology

ESSKA Instructional Course Lecture Book, 2020

Complex Knee Ligament Injuries, 2019

Topics in health record management, 1983

The Patellofemoral Joint, 2021

Future Trends in Ligament Surgery: The Role of Biology, 2019

There have been numerous treatments developed to address ligament injury, given the functional im... more There have been numerous treatments developed to address ligament injury, given the functional impact of such injury on lifestyle and participa- tion in physical activities at all levels of recre- ational and competitive endeavors. With regard to commonly diagnosed knee injuries, anterior cru- ciate ligament (ACL) insufficiency is a frequently encountered pathology that often requires surgi- cal treatment to restore the desired level of func- tion. Considering that ligament injuries most commonly affect active individuals who tend to be younger, such injuries can lead to substantial alterations in lifestyle, and therapeutic treatments that restore near-anatomic function of damaged ligaments have the potential to overcome some of the shortcomings associated with current methds of reconstruction, particularly in the case of ACL insufficiency. The incidence of complete injury to the posterior cruciate ligament (PCL) is considerably lower than that of the ACL and is estimated to occur at a rate of 2 per 100,000; however, the prevalence of asymptomatic PCL injury is considered to be not ably higher [1]. Injury to collateral ligaments represents a signifi- cant proportion of knee injuries that present to emergency rooms, and high rates of medial and collateral ligament injuries are associated with collegiate sporting activities, with many of these cases involving noncontact competition [2].
Despite advances in sports medicine, there remains controversy in the treatment of ligament injury, particularly when there is functional insuf- ficiency associated with partial ligament injury. For instance, reconstruction of the ACL is the current gold standard treatment for symptomatic ACL insufficiency, irrespective of injury pattern, and high rates of return to sport are expected [3, 4]. Disadvantages of ACL reconstruction include donor site morbidity, inability to restore normal joint kinematics, and an increased incidence of premature degenerative joint changes [5–8].
There are challenges associated with restoring anatomic function in cases of ligament injury, and biologic therapies have great potential to address some of these concerns. Therapeutic interventions that utilize bioactive growth factors and cellular elements may be used to augment ligament repair processes and can be used inconjunction with surgical treatment modalities. These biologic treatments may be a prominent feature of treatment algorithms as these technolo- gies develop and understanding of reparative pro- cesses at the cellular level advances.

Implantation of Mononuclear Cells Sourced from Bone Marrow and Platelet-Derived Growth Factors for the Treatment of Anterior Cruciate Ligament Partial Tears Performed under Arthroscopic Visualization: A Prospective Case Series, 2018

Objectives: To present clinical outcomes of 2 years duration in a prospective case series of a bi... more Objectives: To present clinical outcomes of 2 years duration in a prospective case series of a biologic augmentation technique using intra-ligamentous and intra-articular infiltration of mononuclear cells sourced from bone marrow aspirate concentrate (BMAC) and growth factors derived from platelet-rich plasma (PRP) under arthroscopic visualization for the treatment of isolated and acute partial anterior cruciate ligament (ACL) tears.

Methods: Soccer athletes with an acute symptomatic partial ACL tear who had clinical examination findings of increased anterior tibial translation without rotational instability were treated with biologic augmentation of the injured ligament. Intra-ligamentous infiltration of the ACL followed by intra-articular injection was performed using bone marrow aspirate concentrate and platelet-rich plasma. Patients were followed for 2 years post-operatively with subjective and objective assessment tools. The Lysholm Knee Questionnaire, IKDC Objective score, physical examination findings, MRI, and the KT-1000 arthrometer were used to examine clinical outcome.

Results: Five patients were included in the analysis after undergoing the biologic augmentation treatment of acute partial ACL injury. Median patient age at the time of treatment was 22 years (range 16-30 years). All patients were determined to have a healed ACL on MRI performed 8 months post-operatively. The median Lysholm score at final follow-up of 99 was significantly increased from the median pre-operative score (p=0.042). The objective IKDC score improved in all patients post-operatively, and no clinical examination findings of knee instability were identified at final follow-up. The median side-to-side difference in KT-1000 arthrometer testing was 3 mm pre-operatively and 0 mm at the final 2 year assessment (p=0.038).

Conclusions: The treatment of appropriately indicated symptomatic partial ACL injuries in this study has demonstrated that anatomic or near-anatomic restoration of ligamentous structure and function may be provided by use of a biologic augmentation technique using intra-ligamentous and intra-articular infiltration of mononuclear cells sourced from bone marrow aspirate concentrate and growth factors derived from platelet-rich plasma. This technique is safe, reproducible, performed with minimal technical difficulty, and has led to excellent 2 year clinical outcomes in this prospective case series of patients.

Keywords:
ACL repair, BMAC, PRP, Knee arthroscopy, Biologic augmentation, ACL preservation