Browsing by Author "Nau, Thomas"

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Age-related alterations and senescence of mesenchymal stromal cells: Implications for regenerative treatments of bones and joints
(2021) Nau, Thomas
Abstract: The most common clinical manifestations of age-related musculoskeletal degeneration are osteoarthritis and osteoporosis, and these represent an enormous burden on modern society. Mesenchymal stromal cells (MSCs) have pivotal roles in musculoskeletal tissue development. In adult organisms, MSCs retain their ability to regenerate tissues following bone fractures, articular cartilage injuries, and other traumatic injuries of connective tissue. However, their remarkable regenerative ability appears to be impaired through aging, and in particular in age-related diseases of bones and joints. Here, we review age-related alterations of MSCs in musculoskeletal tissues, and address the underlying mechanisms of aging and senescence of MSCs. Furthermore, we focus on the properties of MSCs in osteoarthritis and osteoporosis, and how their changes contribute to onset and progression of these disorders. Finally, we consider current treatments that exploit the enormous potential of MSCs for tissue regeneration, as well as for innovative cell-free extracellular-vesicle-based and anti-aging treatment approaches.
Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Elbow
(2022) Nau, Thomas
Abstract: Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of synovium that surrounds the joints, tendon sheaths, and bursae. The elbow is rarely affected, making it difficult to establish treatment guidelines. This article relates on a case of a male patient who presented with elbow pain and decreased range of motion. Diagnosis was established with magnetic resonance imaging (MRI) and biopsy, followed by arthroscopic removal and synovectomy. The patient was pain free shortly after surgery and gained free range of motion after six weeks. At the most recent follow-up after six months, he remained clinically well. The most recent MRI did not reveal any recurrence.
Ligament Tissue Engineering: The Anterior Cruciate Ligament
(2021) Nau, Thomas
Abstract: Due to ongoing problems with reconstructive surgery and recent advancements in the field of musculoskeletal tissue engineering, regeneration of ligaments in general and of the anterior cruciate ligament (ACL) in particular has gained an increasing research interest. It is the aim of this chapter to review the current research efforts and highlight promising ligament engineering strategies. The four main components of tissue engineering also apply to several ligament regeneration research efforts. Scaffolds are made of biologic materials, biodegradable polymers, and composite materials. The main cell sources are mesenchymal stem cells and ACL fibroblasts. In addition, growth factors and mechanical stimuli are applied. So far, the regenerated ACL constructs have been tested in few in vivo studies, and the results are encouraging although the real breakthrough has not been achieved thus far. The different strategies reaching from in vitro ACL regeneration in bioreactor systems to bio-enhanced repair and true regeneration are under constant development. We expect considerable progress in the near future that will result in a realistic option for ligament reconstructive surgery soon.
Physeal-Sparing Anterior Cruciate Ligament Reconstruction for Skeletally Immature Patients: All-Epiphyseal Technique Using Quadricep Tendon Autograft
(2021) Nau, Thomas
Abstract: The anterior cruciate ligament (ACL) is a major stabilizing structure of the knee and one of the most common injured structures. The true incidence of ACL injury in children and adolescents is unknown, but recent studies suggest increased ACL injury rates, especially in the sports-participating population. The mechanism of injury, clinical examination, and diagnosis of ACL injury in children is the same as in adults. The main concerns in the management of pediatric ACL injuries are the open physes and the eventual long-term consequences of the ACL deficient knee. The ideal treatment strategy of pediatric ACL injuries is still controversial, because there is still no universal consensus for techniques, graft choices, and postoperative rehabilitation. We present a case of a 12-year-old male patient who underwent ACL reconstruction using an all-inside, physeal-sparing technique with a quadriceps tendon autograft and discuss the current treatment strategies.