Greater socioeconomic deprivation predicts worse functional status two years after orthopaedic surgery, but not magnitude of change from baseline

Background

The purpose of this study was to analyze if Area Deprivation Index (ADI), as a geography-based proxy for socioeconomic status (SES), is associated with differences in patient-reported outcomes (PROs) 2 years after outpatient orthopaedic surgery.

Methods

Patients undergoing outpatient orthopaedic surgery from June 2015 to November 2018 were administered Patient-Reported Outcomes Measurement Information System (PROMIS) and joint-specific surveys at baseline and 2 years postoperatively. ADI was computed from home address. Tests of association were used to characterize 2-year PROs dependence on ADI. This informed covariate selection for multivariable linear regression examined PRO change over 2 years with ADI in the context of other self-reported socioeconomic covariates.

Results

Enrollment was 2117 patients, 1483 (70 %) completed follow-up. Lower SES as measured by home address was associated with lower function and less improvement from baseline at 2 years postoperatively. This trend was most apparent in PROMIS instruments.

Conclusion

SES as approximated by ADI is associated with PROs at 2 years after outpatient orthopaedic surgery for a subset of PROs. ADI should be considered for inclusion in statistical models using an SES-sensitive PRO as an outcome, understanding that model performance may also depend on if a single value or change over time is being estimated.

Molecular signaling pathways in osteoarthritis and biomaterials for cartilage regeneration: a review

Osteoarthritis is a prevalent degenerative joint disease characterized by cartilage degradation, synovial inflammation, and subchondral bone alterations, leading to chronic pain and joint dysfunction. Conventional treatments provide symptomatic relief but fail to halt disease progression. Recent advancements in biomaterials, molecular signaling modulation, and gene-editing technologies offer promising therapeutic strategies. This review explores key molecular pathways implicated in osteoarthritis, including fibroblast growth factor, phosphoinositide 3-kinase/Akt, and bone morphogenetic protein signaling, highlighting their roles in chondrocyte survival, extracellular matrix remodeling, and inflammation. Biomaterial-based interventions such as hydrogels, nanoparticles, and chitosan-based scaffolds have demonstrated potential in enhancing cartilage regeneration and targeted drug delivery. Furthermore, CRISPR/Cas9 gene editing holds promise in modifying osteoarthritis-related genes to restore cartilage integrity. The integration of regenerative biomaterials with precision medicine and molecular therapies represents a novel approach for mitigating osteoarthritis progression. Future research should focus on optimizing biomaterial properties, refining gene-editing efficiency, and developing personalized therapeutic strategies. The convergence of bioengineering and molecular science offers new hope for improving joint function and patient quality of life in osteoarthritis management.

Mid-term failure rates, timing, and mechanisms for osteochondral allograft transplantation in the knee: Characterizing risk factors and identifying modifiable variables

Background

Knee osteochondral allograft transplantation (OCAT) is consistently successful, however, higher failure rates for multisurface and bipolar OCATs persist. Failure mechanisms have involved OCA erosion, delamination, degeneration, fracture, and/or fragmentation, and progression of joint disease, associated with older patient age, higher BMI, male sex, nicotine use, comorbidities, low chondrocyte viability, larger OCA volume, and bipolar OCAT.

Methods

Patient outcomes were prospectively followed after primary knee OCAT and analyzed for failure mechanisms categorized as OCA Cartilage, OCA Bone, Meniscus Allograft, Joint Disease Progression, or Unknown. Cases were included when OCAT was performed >5 years prior; all failure cases were included regardless of final follow-up (FFU) time. Failure and non-failure cohorts, and failure mechanism subcohorts, were compared based on patient sex, age, BMI, nicotine use, concurrent procedures, OCAT surgery type, and adherence.

Results

There were 186 cases in 184 patients (n = 112 males; mean age = 37.1 years; mean BMI = 28.5 kg/m2; mean FFU = 79 months). Initial failure rate was 23.1% (n = 43) with mechanisms attributed to OCA Bone (n = 15; 34.9%), Meniscus (n = 13; 30.2%), Joint Disease Progress (n = 11; 25.6%), OCA Cartilage (n = 2; 4.7%), or Unknown (n = 2; 4.7%). Risk factors included concurrent ligament reconstruction, ipsilateral osteotomy, and tibiofemoral bipolar + OCAT. However, older age and higher BMI, as well as potential barriers for post-operative adherence should be considered during patient selection.

Conclusions

Recent advances have mitigated key risk factors, such that reductions in knee OCAT failure rates with improvements in function, mental health, and quality of life have been more consistently realized.

Level of evidence

2, prospective cohort study.

Therapeutic potential of SOX family transcription factors in osteoarthritis

BACKGROUND

As the worldwide population ages, osteoarthritis has significantly increased. This musculoskeletal condition has become a pressing global health issue and thus, prevention and treatment of osteoarthritis have become the primary focus of domestic and international research. Scholarly investigations of the molecular mechanisms that are related to the occurrence and development of osteoarthritis have shed light on the pathological causes of this condition to a certain extent, providing a foundation for its prevention and treatment. However, further research is necessary to fully understand the critical role of the transcription factor SOX9 in chondrocyte differentiation and the development of osteoarthritis. As a result, there has been widespread interest in SOX transcription factors. While SOX9 has been utilized as a biomarker to indicate the occurrence and prognosis of osteoarthritis, investigations into other members of the SOX family and the development of targeted treatments around SOX9 are still required.

PURPOSE

This article considers the impact of the SOX protein on the development and inhibition of osteoarthritis and highlights the need for therapeutic approaches targeting SOX9, as supported by existing research.

RESULTS

SOX9 can contribute to the process of osteoarthritis through acetylation and ubiquitination modifications. The regulation of the WNT signalling pathway, Nrf2/ARE signalling pathway, NF-κB signalling pathway and SOX9 is implicated in the emergence of osteoarthritis. Non-coding RNA may play a role in the onset and progression of osteoarthritis by modulating various SOX family members, including SOX2, SOX4, SOX5, SOX6, SOX8, SOX9 and SOX11.

CONCLUSION

SOX9 has the capability of mitigating the onset and progression of osteoarthritis through means such as medication therapy, stem cell therapy, recombinant adeno-associated virus (rAAV) vector therapy, physical therapy and other approaches.

Development of a preliminary multivariable model predicting hamstring strain injuries during preseason screening in soccer players: a multidisciplinary approach

OBJECTIVE

Reducing the incidence of hamstring strain injuries (HSIs) is a priority for soccer clubs. However, robust multifactorial predictive models are lacking and potential predictors such as sprint kinematics, performance fatigability, and psychological variables have been overlooked. Thus, the aim of this study was to develop a preliminary parsimonious multifactorial model to predict players at risk of HSI through preseason screening.

MATERIALS AND METHOD

Psychological, physiological, kinematic, performance fatigability and health-related variables were collected for 120 regional and national soccer players during the 2022 preseason. HSIs were prospectively recorded over the entire soccer season. After variable selection, logistic regressions with the Wald backward stepwise method were used to refine the model. The predictive abilities of the model and of the individual variables were determined using the area under the receiver operating characteristic curve (AUC).

RESULTS

Twenty-nine players sustained an HSI during the follow-up period. The final model included eight variables: age, sex, HSI history, knee flexor performance fatigability, sprint performance (best sprint time and maximal theoretical velocity V0), perceived vulnerability to injury, and subjective norms in soccer. While its model was preliminary, it showed good fit indices and strong predictive performance (true positive rate: 79%, AUC = .82). None of the variables evaluated independently demonstrated satisfactory performance in predicting HSI (AUC≤.65).

CONCLUSION

Using a multidisciplinary approach and measurements of only a few variables during preseason screening, the current model tends to demonstrate high accuracy in identifying soccer players at risk of HSI.

All-inside ramp lesion repair via anterior portals and pie-crusting: Excellent outcomes and survivorship at one-year follow-up

Background

Ramp lesions, located in the posterior horn of the medial meniscus, are commonly associated with anterior cruciate ligament (ACL) injuries and contribute to knee instability if untreated. Traditional repair methods use posteromedial portals, but newer approaches, such as the all-inside technique through anterior arthroscopic portals with pie-crusting of the posterior oblique ligament (POL), offer improved access and reduced morbidity. This study aimed to assess the clinical outcomes, return-to-sport rates, and failure rates of this technique compared to established methods.

Materials and methods

A retrospective analysis included 54 patients (mean age: 29.1 years) who underwent ramp lesion repair using the all-inside technique between January 2019 and December 2022. Clinical outcomes were evaluated with the IKDC score, Lysholm score, and Tegner activity scale. Failure was defined as the need for revision surgery.

Results

At a mean follow-up of 30.7 months, patients had a mean IKDC score of 81.5 ± 7.1 and Lysholm score of 94.5 ± 7.4. The Tegner activity scale declined slightly from 7.2 ± 1.2 preoperatively to 6.8 ± 1.3 postoperatively. All patients returned to sport within 9.2 ± 2.5 months, with a failure rate of 12.9 % and an average revision time of 13.1 ± 8.2 months.

Conclusion

The all-inside technique for ramp lesion repair via anterior portals provides excellent clinical outcomes and return-to-sport rates, with failure rates comparable to other methods. This minimally invasive approach offers improved access, reduced morbidity, and a reliable option for managing ramp lesions in ACL-injured patients.

Level of evidence

IV.

Multicomponent body composition of university club sport athletes

BACKGROUND

The body composition of National Collegiate Athletic Association (NCAA) athletes is well documented but no such data exist for university club sports athletes. Additionally, the majority of norms for NCAA athletes were created from individual methods requiring assumptions.

OBJECTIVE

This study used a four-component (4C) model to measure the body composition of university club sports athletes.

METHODS

Data were collected on club athletes participating in baseball, climbing, cycling, figure skating, gymnastics, ice hockey, lacrosse, pickleball, powerlifting, racquetball, rodeo, rugby, soccer, swimming, ultimate, and volleyball. The 4C model consisted of body volume, total body water, and bone mineral content measured by air displacement plethysmography, bioimpedance spectroscopy, and dual-energy x-ray absorptiometry, respectively. Percentile ranks were created for body fat percentage (%BF) and fat-free mass index (FFMI). Mean differences across teams were quantified with Cohen's d.

RESULTS

In total, 225 athletes (137 men, 88 women) completed data collection. Athletes varied in competitive experience (1 to 22 y) and body mass index (16.9 to 36.4 kg·m-2). The density of the FFM was significantly greater than the assumed value of 1.100 g·cm-3 for both men (p = .043) and women (p = .011). The %BF ranged from 4.9% to 35.7% (14.3 ± 5.8% BF) for men and from 15.5% to 42.8% (25.2 ± 6.0% BF) for women. FFMI ranged from 15.6 kg·m-2 to 26.8 kg·m-2 (30.0 kg·m-2 outlier removed) for men and from 14.1 kg·m-2 to 22.6 kg·m-2 for women. Differences across sports in %BF and FFMI were considered large-sized effects (d ≥ 0.80) for both men and women. Weight-sensitive sports (e.g. cycling and climbing) had the lightest athletes and were among the leanest, whereas power athletes (e.g. powerlifting and rugby) were among the heaviest athletes and had the highest FFMI.

CONCLUSIONS

Differences in %BF and FFMI are evident across sports. Due to the small sample size, use caution when interpreting the data as reference values for club sports athletes.

Comparison of combined suprascapular and axillary nerve pulsed radiofrequency and nerve block for the treatment of primary frozen shoulder: a prospective cohort study

OBJECTIVES

To compare the effects of pulsed radiofrequency (PRF) and block of the suprascapular nerve (SSN) and axillary nerve (AN) in patients with primary frozen shoulder (FS).

METHODS

Patients with primary FS received PRF (Group P) or block (Group B). Shoulder pain during rest, activity and sleep was measured by a numerical rating scale (NRS), the Shoulder Pain and Disability Index (SPADI) was used to assess shoulder function and disability, and the passive range of motion (PROM) of the shoulder joint was measured by a digital inclinometer. Assessments were made at baseline and 2 weeks and 1, 3, and 6 months after the procedure.

RESULTS

Of the 74 patients, 63 were eventually included, and a total of 3 patients were lost to follow-up. Finally, 60 patients (30 in each group) completed the final analysis. There was a significant improvement in all outcome measures from baseline to 6 months after the procedure. Compared with those in group B, the NRS scores during activity and sleep in group P decreased more at 6 months after the procedure (p = 0.005 and 0.028). SPADI total scores were lower at 3 and 6 months after the procedure (p = 0.021 and 0.001). At different time after the procedure, most of the parameters of PROM improved more in group P than those in group B (flexion at 3 and 6 months, p = 0.042 and <0.001; abduction at 3 and 6 monthse, p = 0.001 and 0.001; extension at 3 and 6 months, p = 0.038 and 0.007, internal rotation at 6 months, p = 0.015; external rotation at 1, 3, and 6 months, p = 0.002, 0.002, and 0.001, respectively).

CONCLUSIONS

In patients with primary FS who completed both manipulation under anesthesia and intra-articular injections, PRF with SSN and AN appears to provide better pain relief, better PROM recovery, and more shoulder function improvement than nerve block treatment.

Part II. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?

Creatine monohydrate supplementation (CrM) is a safe and effective intervention for improving certain aspects of sport, exercise performance, and health across the lifespan. Despite its evidence-based pedigree, several questions and misconceptions about CrM remain. To initially address some of these concerns, our group published a narrative review in 2021 discussing the scientific evidence as to whether CrM leads to water retention and fat accumulation, is a steroid, causes hair loss, dehydration or muscle cramping, adversely affects renal and liver function, and if CrM is safe and/or effective for children, adolescents, biological females, and older adults. As a follow-up, the purpose of this paper is to evaluate additional questions and misconceptions about CrM. These include but are not limited to: 1. Can CrM provide muscle benefits without exercise? 2. Does the timing of CrM really matter? 3. Does the addition of other compounds with CrM enhance its effectiveness? 4. Does CrM and caffeine oppose each other? 5. Does CrM increase the rates of muscle protein synthesis or breakdown? 6. Is CrM an anti-inflammatory intervention? 7. Can CrM increase recovery following injury, surgery, and/or immobilization? 8. Does CrM cause cancer? 9. Will CrM increase urine production? 10. Does CrM influence blood pressure? 11. Is CrM safe to consume during pregnancy? 12. Does CrM enhance performance in adolescents? 13. Does CrM adversely affect male fertility? 14. Does the brain require a higher dose of CrM than skeletal muscle? 15. Can CrM attenuate symptoms of sleep deprivation? 16. Will CrM reduce the severity of and/or improve recovery from traumatic brain injury? Similar to our 2021 paper, an international team of creatine research experts was formed to perform a narrative review of the literature regarding CrM to formulate evidence-based responses to the aforementioned misconceptions involving CrM.

Efficacy of adipose-derived stem cells and stromal vascular fraction for pain relief in Kellgren-Lawrence grade II-III knee osteoarthritis: A systematic review (2019-2024)

Background

Knee osteoarthritis (KOA) is a common degenerative condition, affecting individuals aged 40 and above. Current therapeutic options often fail to prevent disease progression and provide only short-term pain relief, leading to an increasing interest in regenerative medicine. Adipose-derived mesenchymal stem cells (ADMSCs) and stromal vascular fraction (SVF) have emerged as promising alternatives due to their potential to modulate inflammation and promote tissue repair. However, limited studies compare the efficacy of these two therapies for KOA.

Methods

A systematic review (2019-2024) across PubMed, CINAHL, and Embase included studies on patients aged 40+ with Grade II-III knee osteoarthritis (Kellgren-Lawrence) treated with intra-articular ADMSC and SVF injections. Inclusion criteria followed the SPIDER framework, focusing on pain relief and joint function improvement over ≥3 months, measured via VAS, KOOS, and WOMAC. MeSH terms for KOA and ADMSC/SVF therapies were used, with bias assessed via GRADE.

Results

Ten studies, including three randomized controlled trials and two observational studies, met the criteria, encompassing 452 patients. Results indicate that ADMSC therapies demonstrate prolonged pain relief and enhanced joint function up to 24 months post-treatment, with superior outcomes in cartilage regeneration compared to SVF. SVF provided quicker symptom relief due to its diverse cell composition but plateaued around 12 months. Both treatments had minimal adverse effects, with lipoaspiration-related symptoms being the most common.

Conclusion

ADMSC and SVF stem cell therapies represent promising non-surgical options for managing knee osteoarthritis (KOA) in patients over 40. ADMSC demonstrates higher efficacy in sustaining long-term pain relief and joint health, with significant potential for cartilage regeneration. The chondrogenic properties of ADMSCs make them particularly beneficial for patients younger than 62 years old. Conversely, SVF, with its heterogeneous cell composition, provides rapid paracrine effects, offering early symptom relief and broader applicability for older or obese patients, including those with a Body Mass Index (BMI) over 30.

Pain worsens peripartum after hip arthroscopy for femoroacetabular impingement and may not return to pre-pregnancy improvement

Purpose

To assess hip symptomatology during the perioperative and peripregnancy periods and postoperative outcomes among reproductive age females undergoing arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) and pregnancy complications in females after hip arthroscopy.

Methods

Females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single surgeon were included in the study. Postoperatively, patients were surveyed regarding obstetric history, hip symptomology, and post-surgery pregnancy experiences. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following surgery (Group 2), or pregnant at least once following hip surgery (Group 3). Hip pain intensity was reported on a 10-point Visual Analog Scale (VAS) and hip function was reported using the modified Harris Hip Score (mHHS). Patients self-reported pregnancy outcomes and complications.

Results

85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. Mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9 %), 20 in Group 2 (23.5 %), and 26 in Group 3 (30.6 %). There were no significant inter-group differences in mHHS preoperatively or at final follow-up (p = 0.95). Group 3 subjects reported that both postoperative and post-pregnancy VAS remained significantly lower than the preoperative baseline (p < 0.001). 69.2 % and 73.1 % report worsened hip pain during the third trimester and postpartum, respectively. 57.9 % reported that their hip pain returned to the pre-pregnancy baseline by time of survey completion.

Conclusion

Females of reproductive age with FAIS can expect clinical improvements relative to their baseline after hip arthroscopy regardless of pregnancy timing relative to surgical intervention. A majority of patients who become pregnant post-arthroscopy experience a peripartum recurrence of their symptoms. Most but not all of these patients return to the level of maximal improvement they had initially experienced postoperatively.

Assessing the risk of low energy availability, bone mineral density and psychological strain in endurance athletes

BACKGROUND

Adequate energy intake is crucial for athletic performance and recovery. However, many endurance athletes experience Low Energy Availability (LEA), which, if prolonged, can detrimentally impact both health and performance.

METHODS

A total of 55 endurance athletes (23 females; 45  ±  13 years, 1.64  ±  0.06 m, 64.4  ±  11.4 kg and 32 males; 44  ±  13 years, 1.76  ±  0.18 m, 78.8  ±  9.2 kg) underwent physical assessments and completed questionnaires on dietary habits, training loads, and psychological stress. Dual-Energy X-ray Absorptiometry (DEXA) scans measured bone mineral density (BMD) in the lumbar L1-L4 spine, and body composition. Risk of LEA burnout, and psychological strain were assessed using sport-specific questionnaires.

RESULTS

Seventy-seven percent of female athletes were identified as at risk of LEA by the LEAF-Q. These females had higher body weight and fat percentage than those at low risk of LEA. Male athletes had a higher prevalence of low lumbar BMD (31%) compared to females, associated with older age, and longer training histories. Although only 9% of female athletes had low-BMD, those affected had a history of amenorrhea and were identified as at risk of LEA by the LEAF-Q.

CONCLUSION

A high proportion of endurance athletes had low-BMD and were at risk of LEA. This underscores the need for targeted nutritional strategies to mitigate the risks associated with LEA and promote overall athlete well-being.

Preoperative depression screening using PHQ-2 is associated with worse outcomes after ACL reconstruction

Purpose

To determine how screening positive for depression preoperatively can affect patient reported outcomes after anterior cruciate ligament reconstruction (ACLR).

Methods

Primary ACLR patients between May 2020-September 2022 with a PHQ-2 score prior to their surgery were retrospectively reviewed. Patients older than 13 years of age and with minimum 6-months of follow-up were included for analysis. Patients were categorized as PHQ(+) (PHQ-2 ≥2) or PHQ2(-) (PHQ-2 < 2). Demographics, preoperative and postoperative Patient Reported Outcome Information System (PROMIS) -Physical Function (PF) and Pain Interference (PI) scores, Patient Acceptable Symptomatic State (PASS), surgical clinical outcomes, and complications were collected and compared. Chi-square tests and independent t-tests were used for categorical and continuous variables, respectively.

Results

A total of 127 patients were analyzed, with 32 PHQ2(+) and 95 PHQ2(-). The PHQ2(+) group had a lower proportion responding "yes" to PASS preoperatively (6.5 % vs. 25.3 %, p = 0.03), at 9 months (47.4 % vs. 72.4 %, p = 0.05), and 12 months postoperatively (42.9 % vs 79.5 %, p = 0.009). PHQ2(+) reported worse PROMIS-PI scores preoperatively, at 6 months, and at 9 months. The PHQ2(+) group reported worse PROMIS-PF preoperatively, at 6 months, at and 12 months. The PHQ2(+) group had worse IKDC scores preoperatively at 9 months and at 12 months. Those screening positive for depression also demonstrated a higher incidence of postoperative complications (34.4 % vs. 9.5 %, p = 0.001) and reoperation rates (21.9 % vs. 4.2 %; p = 0.002).

Conclusion

A brief preoperative survey, such as the PHQ-2, can provide prognostic value for patient outcomes after ACLR.

Level of evidence

III-Retrospective cohort study.

One stage total hip arthroplasty and contralateral hip arthroscopy for bilateral femoroacetabular impingement and osteoarthritis: A clinical trial

Introduction

The management of cam morphology of FAI associated with osteoarthritis (OA) is debated. However, current surgical indications are becoming obsolete, and hip arthroscopy spreads in different settings. The present clinical trial evaluated the outcome of one-stage unilateral hip arthroscopy and contralateral total hip arthroplasty (THA) in patients with bilateral cam deformity associated with labral tears and early and advanced OA stages, respectively. The outcomes of interest were patient-reported outcome measures (PROMs) and the rate of complications.

Methods

All patients who underwent one-stage THA and contralateral hip arthroscopic for symptomatic cam deformity were prospectively invited to participate in the present study. Arthroscopies were performed first with patients in a supine position on a traction bed under fluoroscopic control. Three standard portals were used. The intraarticular joint space was inspected, and the peripheral acetabular labral lesions were selectively debrided. Cam bunectomy was performed, and labral tears were debrided and repaired using bio-resorbable anchors. After arthroscopy, patients were positioned in a lateral position, and THA was performed using a minimally invasive posterolateral approach. All patients received uncemented short stems with ceramic heads and vitamin-E augmented polyethylene (GTS, Zimmer Biomet, United States or 3C, Link, Germany).

Results

All 16 patients were men, with a mean age of 41 years ±7.9. The mean length of the follow-up was 4.2 ± 1.3 years (range, 2 to 6). All patients returned to their normal daily activities within one month. PROMs were statistically significantly increased from baseline to the last follow-up in all patients. No patient experienced minor or major complications. One patient required THA five years after arthroscopy for symptomatic and radiographic progression of osteoarthritis. No other patients progressed to THA. No patient underwent revision surgery for failed arthroscopy.

Conclusion

One-stage arthroscopy and contralateral arthroplasty are effective in managing FAI combined with early and mild to severe OA, respectively.

Concomitant hip arthroscopy and periacetabular osteotomy: Systematic review and meta-analysis of contemporary outcomes, survivorship, and complications with comparison to isolated periacetabular osteotomy

Objective

To evaluate outcomes, survivorship, and complication rates among patients who underwent concomitant periacetabular osteotomy (PAO) and hip arthroscopy and compare them to patients undergoing isolated PAO.

Design

Systematic review and meta-analysis.

Setting

Medline, EBSCO host, and Google Scholar databases were searched to identify all studies describing concomitant PAO and HA through May 9, 2023 (PROSPERO study protocol registration: CRD42023426191).

Patients

Patients who underwent concomitant PAO and hip arthroscopy compared to patients who underwent isolated PAO.

Interventions

Randomized controlled trials and cohort studies reporting clinical outcomes after concomitant PAO and hip arthroscopy.

Main outcome measures

Patient-reported outcome measures (PROMs), radiographic outcomes, range of motion scores, complications, re-operations, and survivorship.

Results

Thirteen studies reporting on a total of 697 patients (726 hips) were included. Significant improvements in PROMs and radiographic measures were demonstrated for most included studies. Pooled analyses demonstrated significant improvements in post-operative modified Harris Hip Score (mHHS) (mean difference (MD): 26.97, 95%CI: 30.19 to -23.75; p < 0.00001) and lateral-center edge angle (LCEA; MD: 13.94, 95%CI: 16.95 to -10.93; p < 0.0001) values. Patients undergoing combined procedures experienced 136 complications for 690 hips (19.71 %) with 29 (21.32 %) classified as major. There were 27 re-operations for 614 hips (4.40 %), and post-operative survivorship estimated at minimum 85 % after 3.5 years follow-up. However, for most outcome measures, there were no differences between concomitant procedures and isolated PAO.

Conclusions

Based on the available literature, patients undergoing concomitant PAO and hip arthroscopy experience excellent outcomes. However, there is limited evidence to indicate that performing both procedures result in different outcomes compared to PAO alone.

Older age at anterior cruciate ligament reconstruction associates with a lower systemic inflammation response index after surgery

Purpose

The purpose of this study was to investigate the association of age at anterior cruciate ligament reconstruction (ACLR) with systemic indices of the immune system and inflammation after surgery.

Methods

This study consisted of a retrospective, cohort design. Patients (male and female, ≥18 years) that underwent ACLR at a single academic institution and with complete blood cell (CBC) count data obtained ≥ 1-year after surgery were included. Patients with a documented diagnosis of knee osteoarthritis (OA) before ACLR were excluded, while those with a documented diagnosis of knee OA after ACLR were included in this study. The systemic inflammation response index (SIRI), systemic immune-inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated from the CBC data. Patients (n = 198) were separated into groups based on age at ACLR: (1) 18-29 y (n = 96), (2) 30-39 y (n = 50), or (3) ≥40 y (n = 52).

Results

Subject characteristics (patient sex, height, body mass, and body mass index), follow-up interval, time from ACLR to CBC assessment, and concomitant procedures performed at ACLR were not significantly different between age groups. The PLR, NLR, MLR, and SII were not significantly different between groups, while the SIRI was significantly lower in the 30-39 (p < 0.01) and ≥40 y (p < 0.01) groups compared to the 18-29 y group. An older age at ACLR (i.e., 30-39 y and ≥40 y) was associated with an increased occurrence (11.5 and 12 %, respectively) of a knee OA diagnosis following surgery compared to that in the younger age group (18-29 y, 1.0 %; p = 0.04).

Conclusion

We conclude that an older age at ACLR associated with a lower systemic inflammatory response index at a minimum of 1-year following surger.

Level of evidence

Level III.

Superior capsular reconstruction vs. Latissimus dorsi transfer for posterosuperior irreparable rotator cuff tears without arthritic change: Mid-term Crossover study

Background

Latissimus dorsi transfer (LDT) is a well-known tendon-transfer technique with long-term clinical follow-up results, whereas superior capsular reconstruction (SCR) has recently emerged as a treatment option for posterosuperior irreparable rotator cuff tears (PSIRCTs). However, only a few small short-term comparative studies have evaluated SCR and LDT. We evaluated the clinical and radiological outcomes of SCR and LDT in PSIRCTs without arthritic changes.

Methods

This retrospective clinical comparative study evaluated patients who underwent SCR or LDT for PSIRCTs and had a mid-term (at least 5 years) follow-up. 28 patients in the SCR group and 31 in the LDT group were included. The visual analog scale (VAS) score, patient-reported clinical outcome scores, and active range of motion (aROM) were used for assessing clinical outcomes. The radiologic outcomes including progression of glenohumeral osteoarthritis and graft integrity were evaluated using Hamada grade and Sugaya classification, respectively.

Results

Significant improvements in VAS scores and aROM were observed in both groups. The LDT group reported significant improvements in all patient-reported outcome scores. However, SCR group showed no significant improvement in patient-reported outcome scores except for American Shoulder and Elbow Surgeons score. In radiologic outcomes, AHD was significantly decreased, and the Hamada grade was significantly increased postoperatively in both groups. Moreover, the progression of arthritic change was significantly greater in the LDT group, while the rate of graft retear was markedly higher in the SCR group.

Conclusions

Although both SCR and LDT improved clinical outcomes, LDT was superior to SCR in terms of patient-reported outcome scores. However, progression of osteoarthritis is more common in LDT whereas graft retear is more common in SCR. Therefore, SCR or LDT could be considered as a surgical treatment in PSIRCTs without arthritic changes, but clinical outcomes as well as complications (osteoarthritis and graft re-tear) must be considered.

Level of evidence

Level of evidence, III.

Can intraoperative opioid use in hip and knee arthroplasty be reduced further without negatively affecting pain control: A case controlled study

Background

Whilst forming the backbone of perioperative analgesic regimes in joint replacement surgery, the negative side effect profile of opioids is well known. Common impediments to a smooth running Enhanced Rapid Recovery model of care are often altered cognitive function and postoperative nausea and vomiting (PONV), both related to opioid use.This study focuses on evaluating whether further reductions in intraoperative opioid use during joint arthroplasty can be safely achieved with minimal impact of such reductions on pain control and postoperative outcomes including opioid requirements and the incidence of PONV and ability to mobilise.

Method

Case controlled review of prospectively collected data assessing intraoperative opioid use, postoperative analgesic requirement, incidence of PONV and cognitive status as well as day 0 mobility postoperatively. 50 patients were randomized in the study and control groups.

Results

The study group received statistically significant lower dose of intraoperative opioids equivalent to 24.18 mg of Morphine compared to control group with equivalent to 69.58 mg of Morphine (p < 0.001). There was no statistically significant increase in analgesia requirement postoperatively and no negative influence on PONV or ability to follow immediate postoperative rehabilitative protocols.

Conclusion

Opioid use intraoperatively can be reduced even further without any compromise of postoperative pain control and PONV and may further reduce impediments to efficiency in rapid recovery models of care.

Understanding the structure and mechanics of the sheep calcaneal enthesis: a relevant animal model to design scaffolds for tissue engineering applications

Tendon or enthesis injuries are a worldwide clinical problem. Along the enthesis, collagen fibrils show a progressive loss of anisotropy and an increase in mineralization reaching the bone. This causes gradients of mechanical properties. The design of scaffolds to regenerate these load-bearing tissues requires validation in vivo in relevant large animal models. The sheep tendon of triceps surae muscle is an optimal animal model for this scope with limited knowledge about its structure and mechanics. We decided to investigate in-depth its structure and full-field mechanics. Collagen fibrils morphology was investigated via scanning electron microscopy revealing a marked change in orientation/dimensions passing from the tendon to the enthesis. Backscatter electron images and nanoindentation at the enthesis/bone marked small gradients of mineralization at the mineralized fibrocartilage reaching 27%wt and indentation modulus around 17-30 GPa. The trabecular bone instead had indentation modulus around 15-22 GPa. Mechanical tensile tests with digital image correlation confirmed the typical non-linear behavior of tendons (failure strain = 8.2 ± 1.0 %; failure force = 1369 ± 187 N) with maximum principal strains reaching mean values of εp1 ∼ 7 %. The typical auxetic behavior of tendon was highlighted by the minimum principal strains (εp2 ∼ 5 %), progressively dampened at the enthesis. Histology revealed that this behavior was caused by a local thickening of the epitenon. Cyclic tests showed a force loss of 21 ± 7 % at the last cycle. These findings will be fundamental for biofabrication and clinicians interested in designing the new generation of scaffolds for enthesis regeneration.

Predictors of survey non-response two years after hip arthroscopy: Results from an institutional prospective registry

Purpose

Survey-based studies are inherently subject to non-response bias. A comprehensive understanding of the factors contributing to non-response is important for minimizing attrition bias and ensuring generalizability of results. The purpose of this study was to determine the preoperative factors associated with survey non-response 2 years after hip arthroscopy.

Methods

Patients undergoing hip arthroscopy at a single center between October 2015 and March 2020 were approached for enrollment in a prospective registry. Patients were emailed an electronic survey at baseline and at 1 and 2 years postoperatively. The primary outcome was response to the 2-year postoperative survey. Patients who failed to complete any part of the 2-year postoperative survey after a series of standardized email, text message, and phone call reminders were considered non-responders. Baseline sociodemographics and patient-reported outcomes (PROs) were compared between the groups using Pearson Chi-Squared or Wilcoxon Rank-Sum tests. Logistic regression was used to identify predictors of non-response.

Results

Ninty-nine patients were enrolled and completed the baseline survey. There were 25 non-responders (25 %) at 2 years. Non-responders demonstrated a higher proportion of patients who were male, identified as non-white, and did not respond to the 1-year postoperative survey. There were no differences in baseline PROs between responders and non-responders. When controlling for age and sex, patients who did not identify as white (OR = 4.3, 95 % CI [1.3, 14.4]) and patients who did not respond to the 1-year postoperative survey (OR = 4.5, 95 % CI [1.5, 13.8]) were more likely to be non-responders at 2 years.

Conclusion

Not responding to 1 year postoperative survey and non-white race are independent predictors of non-response at 2 years after hip arthroscopy. Baseline PROs do not differ between responders and non-responders.

Minimum reporting requirements for platelet-rich plasma in biomaterial research

Platelet-rich plasma (PRP) is gaining significant attention in regenerative medicine, offering an abundance of growth factors and bioactive molecules that promote tissue repair and healing. In biomaterial research, PRP is often incorporated into scaffolds to enhance their bioactivity, facilitating cell attachment, proliferation, and differentiation for improved tissue regeneration. However, inconsistencies in outcomes and variability across studies hinder its clinical translation. These challenges are primarily attributed to the lack of standardized reporting criteria for PRP characterization, which limits reproducibility and cross-study comparisons. Accurate characterization of PRP is essential for understanding its biological activity and therapeutic potential. Key parameters include platelet, white blood cell, and red blood cell concentrations. Recent classification systems, such as those proposed by the ISTH Subcommittee on Platelet Physiology, emphasize the importance of these parameters in categorizing PRP types. Establishing minimal reporting requirements helps address variability in PRP studies, ensuring consistency and transparency in the methodology and results. By adopting these standards as mandatory reporting requirements, researchers can reduce variability, enhance the credibility of their findings, and facilitate the development of standardized protocols for PRP-based therapies.

A systematic review and meta-analysis examining alterations in medial meniscus extrusion and clinical outcomes following high tibial osteotomy

Background

Medial meniscal extrusion (MME) is both a contributor to and a consequence of medial knee osteoarthritis (OA), with each condition exacerbating the other.High tibial osteotomy (HTO) realigns varus to valgus to alleviate medial compartment stress.This study conducted a systematic review and meta-analysis to evaluate alterations in medial meniscus extrusion values and clinical outcomes following high tibial osteotomy (HTO).

Methods

Eligible studies were identified through a comprehensive search of databases including PubMed, Scopus, Web of Science, Ovid, Embase, Cochrane Library, and CNKI up to May 13, 2024.The primary goal was to assess the values of medial meniscus extrusion before and after HTO surgery.Secondary objectives were other clinical outcomes such as imaging assessments and clinical functional assessments in medial knee OA patients.All meta-analyses used random effects models, assessing between-study heterogeneity in effect sizes with the I2 statistic and P values.A P value under 0.05 was considered statistically significant.

Results

Eight observational studies were included, involving 316 affected knees from 311 patients.The mean difference(MD) in the change in MME values was 2.78 (95% CI, 2.65 to 2.92; P < 0.0001).The other imaging assessments, HKA angle (MD, 8.82; 95% CI, 8.57 to 9.07; P < 0.0001), WBL ratio (MD, -34.98; 95% CI, -36.03 to -33.93; P < 0.0001), medial proximal tibial angle (MD, -8.61; 95% CI, -9.17 to -8.04; P < 0.0001) and posterior tibial slope angle (MD, -1.19; 95% CI, -2.10 to -0.27; P = 0.011), changed obviously in postoperative period.Post-surgery improvements were noted in clinical assessments, including KOOS (MD, -38.41; 95% CI, -39.28 to -37.55; P < 0.0001), Tegner activity scale (MD, -2.55; 95% CI, -2.74 to -2.37; P < 0.0001), Pain VAS (MD, 5.73; 95% CI, 5.44 to 6.02; P < 0.0001), and WOMAC scores (MD, 36.52; 95% CI, 34.46 to 38.59; P < 0.0001) compared to preoperative values.

Conclusions

This systematic review and meta-analysis demonstrated that HTO effectively reduced MME values in patients with medial knee OA and concurrent MME.Simultaneously, HTO corrected lower limb force lines, significantly enhancing imaging and clinical functional assessments in patients.

Tailoring the therapeutic potential of stem cell spheroid-derived decellularized ECM through post-decellularization BDNF incorporation to enhance brain repair

Decellularized extracellular matrix (dECM) from tissues has significant therapeutic potential but is limited by its rigid molecular composition and reliance on post-decellularization modifications to tailor its functionality. Harsh decellularization processes often result in substantial glycosaminoglycan (GAG) loss, impairing natural growth factor incorporation and necessitating chemical modifications that complicate processing and limit clinical translation. To address these challenges, we developed mesenchymal stem cell (MSC) spheroid-derived three-dimensional (3D) dECM using gentle decellularization techniques. This study demonstrated a crucial advancement-the retention of endogenous GAGs-enabling direct growth factor incorporation without chemical agents. As a proof-of-concept, brain-derived neurotrophic factor (BDNF) was incorporated into the 3D dECM to enhance its therapeutic potential for brain repair. In vitro, BDNF-loaded 3D dECM enabled sustained growth factor release, significantly enhancing the proneuritogenic, neuroprotective, and proangiogenic effects. In a mouse model of traumatic brain injury, the implantation of BDNF-loaded 3D dECM significantly enhanced motor function and facilitated brain repair. These findings highlight the adaptability of MSC spheroid-derived 3D dECM for tissue-specific customization through straightforward and translatable growth factor incorporation, demonstrating its potential as a pro-regenerative biomaterial for advancing regenerative medicine applications.

Characterization of distal biceps tendon and triceps tendon injuries in National Football League players from 2009 to 2022

Purpose

The purpose of this study is to determine the incidence and impact of distal biceps and triceps tendon injuries in the National Football League (NFL) from the 2009-10 to the 2022-23 seasons. This study explores the impact that player and injury characteristics have on injury risk, return-to-play, and player performance.

Methods

Data from the 2009-10 to the 2022-23 NFL seasons were analyzed for players with distal biceps or triceps tendon tears. Return-to-play (RTP) and performance metrics were recorded for each player during the season before and first two post-injury seasons. Data were analyzed to determine statistically significant differences in proportions using chi-square, Fisher's exact, or McNemar tests. Statistical significance was set at p < 0.05.

Results

Fifty tendon ruptures (26 biceps, 24 triceps) were identified. Biceps injuries were more common in defensive players (73.1 %), while triceps injuries predominantly affected offensive players (58.3 %). Significant risk factors for biceps injuries included BMI ≥31 (p = 0.0008) and ≥4 seasons of experience (p = 0.031, OR = 2.7). Triceps injuries were associated with BMI ≥31 (p = 0.01), age ≥26 (p < 0.0001), and ≥4 seasons of experience (p = 0.006). RTP rates were 73.1 % for biceps and 70.8 % for triceps injuries. However, only 52.6 % and 41.2 % of players with biceps and triceps injuries, respectively, returned to pre-injury performance levels. Younger players (<26 years) and those with fewer years of experience (≤4 years) were more likely to achieve prior performance levels.

Conclusion

Distal biceps and triceps tendon injuries are typically season-ending for NFL players. Significant risk factors include BMI ≥31, ≥4 years of NFL experience, and game exposure, with age ≥26 being an additional risk factor for triceps tendon injuries. RTP rates exceed 70 %, indicating a strong potential for athletes to return to the NFL post-injury.

Influence of the functional status of the anterior cruciate ligament on the posterior medial femoral condyle among varus osteoarthritic knees

Background

Morphologic changes in the posterior medial femoral condyle (PMFC) among varus osteoarthritic knees have not been described in the past. The aims of this study were to compare anterior cruciate ligament (ACL) competent and deficient varus osteoarthritic knees during computer-navigation assisted (CAS) total knee arthroplasty (TKA) in terms of their pre-operative deformity, rotation of the posterior condylar axis (PCA) with respect to Whiteside's axis, and prevalence of PMFC hyperplasia or attrition.

Methods

Data pertaining to pre-operative varus deformity, rotation of the PCA with respect to Whiteside's axis, and presence of PMFC hyperplasia or attrition were analyzed for 250 consecutive patients each, with ACL-competent and deficient knees, who underwent CAS TKA for varus osteoarthritis of the knee.

Results

ACL-deficient knees, compared to ACL-competent knees, were associated with greater pre-operative stressed (9.94° ± 6.14° versus 7.29° ± 4.48°, P < 0.001) and corrected (3.62° ± 4.36° versus 2.41° ± 3.08°, P < 0.001) varus deformities, internal rotation of the PCA with respect to Whiteside's axis (4.06° ± 2.32° versus 3.08° ± 2.03°, P < 0.001), and prevalence of PMFC attrition (8.4 % versus 0 %, P < 0.001) and hyperplasia (27.2 % versus 9.6 %, P < 0.001).

Conclusion

Chronic ACL deficiency in varus osteoarthritic knees may result in progression of the coronal deformity, PMFC attrition, increased internal rotation of the PCA with respect to Whiteside's axis, and eventually PMFC hyperplasia. This needs to be borne in mind during TKA to prevent inadvertent placement of the femoral component in inappropriate rotation.

A therapeutic assessment of tranexamic acid on functional recovery after rotator cuff repair surgery: A study of early and mid-term follow-up

Purpose

To perform therapeutic assessment of tranexamic acid on functional recovery after rotator cuff repair surgery in terms of early and mid-term follow up.

Methods

From December 2021 to April 2023, a total of 40 patients with rotator cuff injury were enrolled and randomly assigned to two groups with equal number of patients, and all patients received shoulder arthroscopic surgery before receiving either tranexamic acid or normal saline managements. Patients in the experimental group, group A, treated with 2g tranexamic acid (diluted with normal saline to 20ml) via intra-articular injection, while patients in the control group (group B) received 20ml normal saline management. The whole process was conducted in accordance with randomized double-blind controlled trials. Clinical outcomes were assessed preoperatively and postoperatively via American Shoulder and Elbow Surgeons (ASES) score, a UCLA shoulder rating, a CONSTANT score, and visual analog scale (VAS). Early and mid-term follow-up were performed at 1 week, 1 month, 3 months, and 6 months after surgery.

Results

The ASES score and CONSTANT score at 1 month, 3 months and 6 months after operation in the tranexamic acid group were higher than those in the normal saline group (p < 0.05). Meanwhile, the UCLA score at 3 months and 6 months after operation in the tranexamic acid group was higher than that in the normal saline group (p < 0.05). In addition, the muscle strength score and external rotation value at 6 months after operation in the tranexamic acid group and normal saline group were higher than those in the normal saline group (p < 0.05). There was no significant difference in the VAS score between the two groups at each observation cut-off point (p > 0.05).

Conclusions

Injection of tranexamic acid after rotator cuff repair surgery plays an positive role on the recovery of patients muscle strength and tone as well as shoulder flexibility. Therapeutic assessment demonstrates the favorable clinic efficacy either early or mid-term follow-up.

Mature and inactive microvessels are prominent in areolar synovium of femoroacetabular impingement and hip osteoarthritis patients

Objective

To provide insight into the earliest changes in hip osteoarthritis (OA) pathogenesis. Histopathology of synovium was investigated in patients with femoroacetabular impingement (FAI), FAI with early hip osteoarthritis, and advanced hip osteoarthritis.

Methods

Synovium biopsies were collected from ten FAI, fourteen FAI with early osteoarthritis, and twelve advanced osteoarthritis patients. Histopathological grading allowed assessment of osteoarthritis-associated features. Microvessel density and maturity were determined through immunofluorescent labelling of CD31 and α-smooth muscle actin. Immunohistochemical staining was applied to calculate CD105+ microvessel density, providing insight into microvessel activity.

Results

In all groups, vascularization was prominent, with a mean [95 ​% confidence interval] of 1.64 [1.40, 1.89]. In all three groups, mature microvessel density was greater than immature microvessel density (82.32 [62.92, 101.71] versus 14.84 [9.86, 19.83] microvessels/mm2). Low CD105+ microvessel density across all groups (3.14 [0.92, 5.37] microvessels/mm2) suggests microvessel inactivity. Inflammatory composite scores were significantly greater in the advanced OA (1.08 [0.84, 1.32]) versus the FAI group (0.47 [0.26, 0.68]), and in the advanced OA versus the FAI with early OA group (0.69 [0.49, 0.89]) (p ​< ​0.017).

Conclusion

Synovium from patients with FAI (with and without hip osteoarthritis) demonstrated synovitis and other OA-associated changes. Mature, inactive microvasculature was prominent in all three groups investigated. Histopathological similarities between FAI and hip OA synovium indicate that disordered synovium appears in FAI patients. These findings highlight a potential role of synovial changes in the progression from FAI to hip OA, underscoring the need for early intervention and further investigation into early disease mechanisms.

Combining preoperative expectations and postoperative met expectations to predict patient-reported outcomes after knee surgery

Introduction

Both preoperative expectations and postoperative met expectations can independently influence patient-reported outcomes (PROs), however, their combined effect on PROs is not well understood. This study aimed to determine the prognostic significance of categorizing non-arthroplasty knee surgery patients into clusters based on both preoperative expectations and postoperative met expectations.

Methods

638 patients who underwent non-arthroplasty knee surgery from June 2015 to May 2021 at a single academic institution were analyzed. Patients were grouped based on both preoperative expectations and two-year postoperative met expectations scores using cluster analysis. Four distinct expectations cluster groups were formed: high preoperative-high met expectations (HIGH-HIGH), low preoperative-high met expectations (LOW-HIGH), high preoperative-low met expectations (HIGH-LOW), and low preoperative-low met expectations (LOW-LOW). Socioeconomic data and PROs were compared based on cluster group, and logistic regression was performed to determine the likelihood of achieving a patient-perceived "completely better" status based on cluster group.

Results

Patients with high met expectations, regardless of preoperative expectations, reported better two-year PROs compared to patients with low met expectations. Patients with high preoperative expectations achieved better outcomes only when those expectations were met postoperatively. Low preoperative expectations did not preclude patients from achieving good outcomes, as long as those expectations were met. The HIGH-HIGH group had increased odds of achieving completely better status compared to the LOW-HIGH group (OR = 1.68, p = .02), HIGH-LOW group (OR = 16.69, p < .001), and LOW-LOW group (OR = 5.17, p < .001). The HIGH-LOW group had decreased odds of achieving completely better status compared to the LOW-LOW group (OR = .31, p = .01).

Conclusion

Met expectations may be a stronger predictor of postoperative outcomes than preoperative expectations in non-arthroplasty knee surgery. This study highlights the importance of setting realistic preoperative expectations and focusing on achieving expectations postoperatively. These findings offer valuable insights for clinicians to manage patient expectations effectively based on individual characteristics and expected treatment outcomes.

Tramadol-based multimodal pain protocols after arthroscopic rotator cuff repair are similarly effective as oxycodone-based protocols with fewer morphine milligram equivalents prescribed and lower risk of refills

Background

Tramadol is a synthetic opioid prescribed to control postoperative pain while mitigating the harmful effects of stronger opioids, such as oxycodone. However, it is unknown whether tramadol can serve as an adequate substitute for oxycodone following shoulder surgery. Therefore, the primary purpose of this study was to compare early postoperative pain scores and prescribed narcotic between patients receiving tramadol and oxycodone after arthroscopic rotator cuff repair (ARCR). The secondary purpose was to identify risk factors related to experiencing increased postoperative pain or requiring increased postoperative prescriptions.

Methods

A retrospective cohort study was performed evaluating 58 patients receiving a tramadol-based pain management protocol and 103 patients receiving an oxycodone-based protocol after ARCR. VAS pain scores were obtained preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. The change in VAS score from preoperative to 3-month follow-up was calculated. Total milligram morphine equivalent (MMEs) prescribed, number and timing of refills, and the proportion of patients failing the tramadol protocol who required oxycodone were recorded. Multivariate regression analysis was performed to determine risk factors for having higher postoperative pain scores and requiring an increased number of prescriptions.

Results

The average total number of MMEs prescribed for patients who received oxycodone was over 8 times greater than for patients who received tramadol (993 vs. 120 MMEs). Both groups demonstrated improvements in pain scores at all time points. Patients receiving tramadol had a greater change in VAS score from pre to postoperative at all timepoints. Patients who were prescribed oxycodone received a greater number of refills and were 2.7 times more likely to need a refill within 3 months than those receiving tramadol. Only 4 patients (6.9 %) receiving tramadol required oxycodone within 3 months of surgery.

Conclusion

As part of a multimodal protocol, tramadol provides equivalent pain relief after ARCR compared to oxycodone while requiring fewer MMEs. Patients prescribed oxycodone exhibit a smaller magnitude of improvement in VAS pain and require more refills than those prescribed tramadol. Our findings can be used to improve opioid prescription practices to reduce dependency and over prescription of narcotics.

Impact of infrapatellar fat pad injury severity on subsequent patellofemoral cartilage degeneration following acute ACL tear

Objective

The infrapatellar fat pad (IFP) is important in the homeostasis of the knee joint due to its structural and immune-modulating properties. This study investigates the relationship between IFP injury severity during acute Anterior Cruciate Ligament (ACL) tears, and the future development of Patellofemoral Compartment (PFC) chondrosis.

Methods

Adult participants aged 18-45 years old who were known to have first-time ACL tears between 01/01/2009 and 10/1/2022 were included. Patients with concomitant knee pathologies at the time of injury were excluded from the study. All participants received ACL reconstruction surgery and had follow-up MRIs conducted within two years postoperatively. Preoperative IFP edema levels were assessed alongside both pre-and postoperative PFC. We analyzed the relationship between the initial IFP edema and future PFC progression on subsequent MRI scans.

Results

A total of 69 participants were included in this study. No significant correlation was found between the severity of initial IFP injury and the initial presence of PFC chondrosis (r = -0.04, P = 0.61). However, a significant positive correlation was observed between the severity of initial IFP injury and the future progression of PFC chondrosis (r = 0.44, P < 0.001). Additionally, a significant difference in the progression of PFC chondrosis was noted when comparing grade 1 to grade 2 IFP injuries (P = 0.001). No significant difference in PFC chondrosis development was identified when comparing grade 2 to grade 3 IFP injuries (P = 0.72).

Conclusion

Our study underscores the potential role of the IFP in preserving cartilage homeostasis by establishing a link between the severity of IFP injury and the subsequent development of PFC following ACL injury.

All-inside technique for isolated posterior cruciate ligament tears: Surgical technique and outcomes

Introduction

The aim of this paper is to describe all-inside posterior cruciate ligament (aiPCL) reconstruction surgical technique and to report complications and outcomes in female patients with isolated posterior cruciate ligament (PCL) tears.

Methods

Preoperative and postoperative evaluations included posterior drawer test, dial test at 30o and 90o of knee flexion, Tegner score, and Lysholm score. The mean follow-up was 33.12 months (range 12-74).

Results

Twenty-five female patients with grade II or grade III isolated lesions of the PCL underwent aiPCL reconstruction. The mean age of the patients at the time of surgery was 29.7 ± 12.9 years, while the mean time from injury to surgery was 11 months (range 12-324). No intraoperative/postoperative complications occurred. At the last follow-up, 16 (69.5 %) and 5 (21.5 %) patients had a grade A and B posterior drawer test, respectively, while the dial test (30o and 90o of knee flexion) was negative in all patients. The mean preoperative Lysholm score was 64.08 ± 13.06 points (range 37-85 points), while the mean postoperative Lysholm score was 88.12 ± 13.33 points (range 50-100 points) (p<0.0001). No statistically significant differences were found comparing preoperative and postoperative Tegner score results.

Conclusions

The arthroscopic aiPCL reconstruction seems safe and effective.

Patellofemoral positioning CT protocol has diagnostic ability to differentiate patellar maltracking phenotype

Introduction

Traditional radiographs often fail to capture the dynamic nature of patellar maltracking in patellofemoral pain syndrome (PFPS) and patellar instability, necessitating improved diagnostic protocols. This study aimed to: (1) introduce a CT protocol with scans at three knee positions (45° flexion, extension, and extension with quadriceps contraction), (2) assess how positioning influences patellofemoral indices measured from radiographs and CT, and (3) to evaluate the protocol's ability to classify maltracking phenotypes: dislocator, subluxator, or symptomatic without dislocation/subluxation (Neither).

Methods

Patients who underwent surgery for PFPS from April to December 2022 were retrospectively reviewed. Patellofemoral indices from the three scans within the CT protocol were compared among themselves and with standard radiographs. Patients were grouped by maltracking phenotype, and their patellofemoral indices on radiographs and CT were compared to determine which imaging modality best distinguished the phenotypes. Statistical analyses included bivariate and multivariate logistic regression.

Results

The study included 65 patients (51 females, 14 males) with mean age of 27. Patellofemoral indices measured on CT-45° versus CT-Extended differed significantly (p < 0.05), indicated the influence of knee position. Quadriceps contraction further worsened most indices, highlighting the importance of load-bearing conditions. Radiographs and CT-45° had limited capability to differentiate Dislocator, Subluxator, and Neither, but CT-Extended and CT-Quad showed significant differences among these groups. Multivariate analysis identified four independent predictors of patellar maltracking severity (p < 0.05): (1) Lateral Offset and (2) Insall-Salvati Ratio measured on CT-Extended, as changes in (3) Lateral Offset and (4) Lateral patellofemoral angle (LPFA) between extension and quadriceps contraction.

Conclusions

Radiographs alone cannot reliably distinguish Dislocator, Subluxator, and Neither. A dedicated CT protocol featuring scans in neutral extension and with quadriceps contraction better delineates patellofemoral maltracking phenotypes and offers improved diagnostic accuracy in PFPS. This approach may guide tailored interventions to address distinct underlying mechanics of each phenotype.

Level of evidence

III.

Hyperbaric oxygen therapy as an adjunt treatment for glioma and brain metastasis: a literature review

The incidence and mortality rates of malignant tumors are increasing annually, with gliomas and brain metastases linked to a poor prognosis. Hyperbaric oxygen therapy is a promising treatment modality for both gliomas and brain metastases. It can alleviate tumor hypoxia and enhance radiosensitivity. When combined with other treatments for gliomas, this therapy has the potential to enhance survival rates. This review addresses the progress in research on the use of hyperbaric oxygen therapy combined with radiotherapy. For brain metastases, the combination of hyperbaric oxygen therapy and stereotactic radiosurgery is both feasible and advantagenous. This combination not only offers protection against radiation-induced brain injury but also supports the recovery of neurological and motor functions. The incidence of adverse reactions to hyperbaric oxygen therapy is relatively low, and it is safe and manageable. Future efforts should be made to investigate the mechanisms by which hyperbaric oxygen therapy combined with radiotherapy treats gliomas and brain metastases, optimize protection of the combined treatment against brain injury, minimizing adverse reactions, conducting multidisciplinary research and clinical trials, and training healthcare providers to facilitate broader clinical application.

Strategies for preventing anterior cruciate ligament injuries in athletes: Insights from a scoping review

Background and aims

Anterior cruciate ligament (ACL) injuries significantly impact young athletes, leading to long-term physical, psychological, and socioeconomic consequences. There is an urgent need to develop effective preventive strategies. This scoping review aims to evaluate modifiable and non-modifiable risk factors for ACL injuries and assess existing preventive strategies.

Methods

A comprehensive literature search was performed on November 20, 2024, across databases including Embase, PubMed, Web of Science, Google Scholar, and Cochrane Library. Articles published between 2000 and 2024 focusing on ACL injury prevention were included, while editorial content, non-clinical studies, and non-English publications were excluded.

Results

The search yielded 322 articles, narrowing down to 94 after deduplication. After title screening, 46 studies progressed to full review, ultimately leading to the inclusion of 14 relevant manuscripts. Key findings indicate that ACL injuries result from various factors, with female athletes being 2.2 times more susceptible. Genetic predispositions linked to collagen-related SNPs and biomechanical patterns, such as landing techniques and knee positioning, were identified as significant contributors. Effective preventive programs integrated strength training, neuromuscular training, and advanced technology, including wearable devices and video analysis.

Conclusion

The study reinforces the importance of a personalized, multifaceted approach to ACL injury prevention, focusing on risk stratification and optimizing training strategies alongside technological advancements. Implementing these strategies can significantly mitigate the risk of ACL injuries in high-risk populations.

Clinical characteristics of patients with bone marrow edema syndrome, transient osteoporosis or migratory osteoporosis: a scoping review

Bone marrow edema syndrome (BMES), transient osteoporosis of the hip (TOH), and regional migratory osteoporosis (RMO), along with numerous variants of these terms, are used inconsistently to describe spontaneous pain, typically in the lower extremity, accompanied by bone marrow edema on MRI and/or bone demineralization. In the present review, we aimed to determine whether these designations represent distinct conditions or varying manifestations of a shared pathology. We employed a scoping review methodology, following a preregistered protocol, utilizing a comprehensive systematic search of electronic databases. Eligible publications reported on patients designated with BMES, TOH, RMO, or related terms. A total of 2924 patients, across 561 studies, were included. Data extraction focused on demographics, clinical features and imaging results. Descriptive statistics and meta-analytic methods were used to synthesize the data. Our results show that patients described by terms related to bone marrow edema syndrome, or transient or migratory osteoporosis, displayed similar demographic and clinical profiles. Our findings strongly suggest that these various designations refer to the same clinical entity. Bone marrow edema syndrome appears to be the most suitable term to describe this condition, facilitating a more standardized approach to future diagnosis, management and research.

Assessing joint line obliquity in valgus-producing high tibial osteotomy: A scoping review of the literature

Background

The variance in knee joint line obliquity (KJLO) measurement methods and radiographic techniques may contribute to the controversy on clinical consequences of KJLO after high tibial osteotomy (HTO).

Purpose

To summarize currently used KJLO measurement methods, including their measurement reliability, and the radiographic techniques used in valgus-producing HTO.

Methods

The databases PubMed, Embase, and Web of Science were searched from inception up to May 2023, to identify articles that measured KJLO on radiographs in valgus-producing HTO.

Results

Thirty clinical articles were included. There were five different KJLO measurement methods reported, including joint line orientation angle by femoral condyles (JLOAF), joint line orientation angle by middle knee joint space (JLOAM), joint line orientation angle by tibial plateau (JLOAT), Mikulicz joint line angle (MJLA), and medial proximal tibial angle (MPTA), of which the JLOAT was the most commonly used. KJLO was measured on anteroposterior full-length standing radiographs with either single-leg or double-leg patient stance position, with no standardized bipedal distance on double-leg stance radiographs. Moderate-to-excellent measurement reliability was reported for intraobserver and interobserver MPTA, and good-to-excellent for intraobserver JLOAT and JLOAM and for interobserver JLOAT, JLOAM, and MJLA.

Conclusion

There is no consensus on how to measure KJLO or on which radiographic technique should be used. When measuring joint line orientation angles on anteroposterior full-length double-leg stance radiographs, controlling the bipedal distance with feet together is suggested when possible. Future research is needed to determine the measurement differences between the five KJLO measurement methods and to identify the preferred, ideal one.

SDF-1α/BMP-12 loaded biphasic sustained-release SIS hydrogel/SA microspheres composite for tendon regeneration

Due to the inherent limited regenerative capacity of tendons, rendering countermeasures for tendon injury remains challenging. The pathophysiology of tendon healing is complex and contains three sequential phases including inflammation, proliferation and remodeling. Aiming at the treatment of different stages of tendon injury, in our work, an injectable small intestinal submucosa hydrogel/sodium alginate microspheres (SIS/SA) composite co-encapsulating stromal cell derived factor-1α (SDF-1α) and bone morphogenetic protein-12 (BMP-12) was developed for effective tendon regeneration. BMP-12 was initially embedded into SA microspheres by microfluid method, and then, microspheres were subsequently encapsulated into the SDF-1α loaded SIS hydrogel. The two bioactive molecules were released in a biphasic and controlled manner to facilitate cell recruitment in the early stage and tendon differentiation in the long-time stage, respectively. Meanwhile, with the degradation of hydrogel/microspheres composite, the regeneration process was accelerated through multiple pathways encompassing immune regulation, angiogenesis, and extracellular matrix (ECM) synthesis. The findings of this study present a compelling translational strategy with significant clinical potential for advancing tendon regeneration therapies.

Broken bioabsorbable tibial interference screw post-arthroscopic anterior cruciate ligament reconstruction: A case report

BACKGROUND

Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament (ACL) reconstruction. Their ability to degrade over time and avoid secondary hardware removal makes them advantageous. However, complications such as breakage and intra-articular migration of screws can cause significant clinical issues, including joint pain, swelling, and cartilage damage. Early diagnosis and management are critical in such cases.

CASE SUMMARY

A 26-year-old male presented with knee pain and swelling one year after ACL reconstruction using a hamstring graft and bioabsorbable tibial interference screw. The patient had been engaged in rigorous physical activity as part of military training. Clinical examination revealed mild effusion without instability, and imaging showed screw breakage with intra-articular migration. Therapeutic arthroscopy confirmed intact graft tension, and broken screw fragments were removed successfully. The patient resumed normal activity two weeks after surgery.

CONCLUSION

This case highlights the potential complications associated with bioabsorbable screws, emphasizing the need for meticulous surgical technique, postoperative monitoring, and timely intervention. A comprehensive review of the literature illustrates the mechanisms, risk factors, and preventive strategies associated with screw-related complications.

Tissue-specific composite hydrogel-loaded BMSCs inhibit apoptosis and promote meniscal repair

The meniscus, as a weight-bearing tissue, will accelerate cartilage damage after injury and cause osteoarthritis. Currently, there is enthusiasm for using tissue engineering techniques to bionically fabricate grafts to replace meniscus. However, the high toughness and mechanical strength mediated by the specific arrangement of collagen-I fibers in the meniscus is an intractable challenge. Our study utilized decellularized meniscal extracellular matrix (mECM) in combination with GleMA to form a composite hydrogel for delivery of the BMSCs to regenerate the injured meniscus in situ. mECM has the same composition as the natural meniscus, and its retained bioactive factors can promote the differentiation of BMSCs to fibrocartilage to repair the meniscus and inhibit the meniscus cells' apoptosis. The presence of GelMA allows the hydrogel to adhere firmly to the defect, avoiding the risk of dislodging due to joint movement or gravity. In vitro cell culture, GelMA/mECM-loaded BMSCs retained essential glycosaminoglycans and collagen, and promoted the expression of cartilage markers, while down-regulating the expression of apoptosis-related markers. In a rat meniscal injury model, GelMA/mECM-loaded BMSCs inhibited further damage to the defective meniscus and avoided bone regrowth formation and articular cartilage destruction. In summary, the use of GelMA/mECM to deliver BMSCs for the treatment of meniscal injuries is a very promising strategy to be applied as an alternative treatment option to meniscal bionic graft implantation.

Tibial plateau leveling osteotomy in dogs: Postoperative evaluation and owners' perception

Different studies have already demonstrated the effectiveness of Tibial plateau leveling osteotomy (TPLO) for the treatment of cranial cruciate ligament rupture (CrCLR); however, the course of patient recovery is still not well elucidated. This study aimed to evaluate the postoperative period of dogs undergoing TPLO to identify the recovery pattern and any associated complication. Nineteen TPLO procedures performed over the period of one year were included. Postoperative evaluation included a questionnaire to be answered by the owner and follow-up visits at seven days for suture removal, at 30 to 40 days, and at 60 to 70 days for radiographic assessment of the operated knee. In the evaluation of postoperative ambulation progression, all dogs were using the limb by day seven, and 47.36 % bore weight on the operated limb consistently while walking at that time. Postoperative edema, even if mild, occurred in 89.47 % of patients, and hematoma was observed in 47.36 % of the cases. Two patients (10.52 %) required extended postoperative management of complications; however, all dogs had a positive outcome. This study demonstrated the recovery pattern in 19 TPLO procedures, with 84.2 % of the dogs using the limb during walking by the seventh postoperative day. Early limb use may be associated with better functional recovery. The complications observed were manageable.

Therapeutic potential of microRNA in meniscal repair and regeneration

BACKGROUND

Managing meniscal injuries is challenging due to the complex nature of the tissue and its limited healing capacity. MicroRNAs (miRNAs) are key regulators of cellular processes, making them promising candidates for therapeutic interventions aimed at enhancing meniscal repair. This study explores the potential role of miRNAs in meniscal healing.

METHODS

A comprehensive literature search was conducted in July 2024 using the PubMed (MEDLINE) and EMBASE databases, without any date restrictions. Relevant studies involving the use of miRNAs in meniscal injury or repair were identified, and a narrative review was performed.

RESULTS

The search yielded three in-vitro studies and one animal study, with no clinical studies found. The identified studies suggest that miRNAs may enhance meniscal healing by promoting angiogenesis and reducing inflammation.

CONCLUSIONS

This review underscores the emerging potential of miRNA-based therapies for meniscal repair and regeneration. While progress has been made in understanding the mechanisms of action, several challenges remain before clinical application, including safety concerns, the need for standardized protocols, and the development of clinical-grade miRNA products.

Corticosteroids versus platelet-rich plasma injections for knee osteoarthritis: Where is there more evidence? A systematic review of 60 years of literature

BACKGROUND

Corticosteroid (CS) injections are often recommended by international societies for knee osteoarthritis (OA) treatment, but platelet-rich plasma (PRP) has shown higher safety and efficacy in comparative analyses. Despite this, PRP use is often not endorsed by scientific societies due to perceived insufficient body of evidence. This study aims to quantify clinical data documenting CS and PRP intra-articular injections for knee OA.

METHODS

A systematic review of the literature was conducted on CS and PRP injections for knee OA. The search, performed in March 2024, used PubMed, Cochrane, and Web of Science databases, following PRISMA and Cochrane guidelines. Data collected included publication trends, number of articles, patients evaluated, and study designs documenting CS or PRP injections.

RESULTS

Of 16,979 records, 356 studies were analyzed, covering 24,435 knee OA patients. Both treatments showed an increasing publication trend, with PRP surpassing CS in 2020. The analysis included 9,322 CS patients and 15,113 PRP patients. Among CS studies, there were 103 RCTs with 5,478 patients, 18 comparative studies with 1,095 patients, and 31 case series with 2,749 patients. Among PRP studies, there were 119 RCTs with 6,028 patients, 33 comparative studies with 2,011 patients, and 72 case series with 7,074 patients.

CONCLUSIONS

PRP injections for knee OA have been documented in more studies and in larger patient numbers compared with CS injections. The higher number of high-level trials for PRP, combined with the lower safety and efficacy documented for CS by previous meta-analyses directly comparing the two products, strongly suggests reconsidering current guidelines that favor CS, highlighting PRP's body of evidence and the potential role in the effective and safe treatment of knee OA.

Rotator cuff tendon strain distribution changes from the superior to the inferior tendon attachments with increasing shoulder abduction

Supraspinatus (SSP), infraspinatus (ISP), and subscapularis (SSC) muscles from the rotator cuff (RC) are comprised of anatomical subregions based on muscle fiber alignment and tendon attachments. Previous studies have shown mechanical interactions between the SSP and ISP tendons, with abduction angle influencing these interactions. However, changes in strain distribution originating from the RC muscle subregions, including the SSC, due to differences in abduction angle have not been investigated. Therefore, this study aimed to determine the strain distribution in intact RC cadaveric shoulders with loading from the SSP, ISP, and SSC muscles and their subregions at different abduction angles. Surface strains in the bursal side of the SSP, ISP and SSC tendons of eight fresh frozen cadaveric intact shoulders were obtained by applying tension on these muscles and on their subregions at 25° and 45° glenohumeral abduction using an MTS system. When the SSP muscle or anterior region was loaded, no significant strain differences were observed within the footprint regions at 45° abduction. However, when the posterior region was loaded, strains concentrated on the middle facet as the abduction angle increased. Significantly higher strains were also observed in the inferior portion of the footprint with increasing abduction angle when the ISP or SSC muscles, or their subregions, were loaded. The differences in strain distribution patterns observed between the anterior and posterior regions of the SSP muscle highlight the importance of addressing each region and tendon separately when managing RC tears and repairs.

Partial lateral patellar facetectomy is beneficial for patients with patellofemoral osteoarthritis: A systematic review and meta-analysis

Introduction

Surgical treatment for patellofemoral osteoarthritis (PFOA) consists of soft tissue, bony, and arthroplasty interventions. Partial lateral facetectomy (PLF) is a bone-reducing procedure, commonly done in conjunction with soft tissue and realignment procedures, that has grown in popularity after failure of conservative treatment due to its efficacy and minimally invasive nature. This systematic review and meta-analysis thus seeks to evaluate the efficacy of PLF in the absence of reviews on this topic.

Methods

A systematic review of three databases (PubMed, EMBASE, Scopus) was conducted, identifying studies that evaluated postoperative outcomes of PLF on patients who had PFOA. Pairwise meta-analysis was conducted between preoperative versus postoperative values of a subjective outcome measure (Knee Society Score (KSS)) and radiographic outcome measure (Congruence Angle (CA)). Subgroup analysis was performed on different concomitant procedures aside from PLF to determine their effect on clinical outcomes.

Results

Ten studies were included in this review, with 463 patients and 495 knees and a pooled mean follow-up of 63.2 months and age of 56.3 years. Six studies investigated PLF with lateral release, two with realignment procedures, one with lateral lengthening, and one with both lateral release and realignment. Five studies found significant improvement (p < 0.01) in KSS (34.45; 95%CI: 26.41 to 42.49, and four studies reported significant improvement (p < 0.01) in CA (-10.31; 95%CI: 13.80 to -6.81). Subgroup analysis showed a significant difference in KSS between PLF with lateral release, lateral lengthening, and realignment (p < 0.01) but not for CA (p = 0.65).

Conclusion

PLF is an effective treatment for PFOA using subjective and radiographic outcome measures. Current cohort studies have shown significant improvement in PFOA treatment, even in the context of long-term outcomes and severe PFOA, and provides valuable insight into the use of PLF as a viable minimally invasive surgical option to treat PFOA in addition to other procedures such as lateral retinacular release and realignment procedures.

Application of biodegradable implants in pediatric orthopedics: shifting from absorbable polymers to biodegradable metals

Over the past two decades, advances in pediatric orthopedics and closed reduction combined with percutaneous internal fixation techniques have led to significant growth in pediatric orthopedics surgery. Implants such as Kirschner-wires, cannulated screws and elastic stabilization intramedullary nails are commonly used in these procedures. However, traditional implants made of metal or inert materials are not absorbable, leading to complications that affect treatment outcomes. To address this issue, absorbable materials with excellent mechanical properties, good biocompatibility, and controlled degradation rates have been developed and applied in clinical practice. These materials include absorbable polymers and biodegradable metals. This article provides a comprehensive summary of these resorbable materials from a clinician's perspective. In addition, an in-depth discussion of the feasibility of their clinical applications and related research in pediatric orthopedics is included. We found that the applications of absorbable implants in pediatric orthopedics are shifting from absorbable polymers to biodegradable metals and emphasize that the functional characteristics of resorbable materials must be coordinated and complementary to the treatment in pediatric orthopedics.

Chinese Tuina ameliorates muscle damage by regulating endoplasmic reticulum stress and autophagy in a rat model of skeletal muscle contusion

Chinese Tuina has been used to treat skeletal muscle contusion (SMC) for a long time in China, yet its efficacy and mechanisms remain unclear. Previous studies have shown the vital roles of endoplasmic reticulum (ER) stress and autophagy during injured skeletal muscle recovery, we postulated that Chinese Tuina could expedite the healing of SMC by fine-tuning these processes. In this study, we established a rat model of SMC through weight-dropping and divided the rats into three groups: SMC, SMC+Tuina, and SMC+Tuina+ 3-methyladenine (3-MA) groups, while using untreated normal SD rats as a control. We assessed gait and edema via CatWalk gait analysis and swelling measurements, respectively. Tumor necrosis factor-α (TNF-α) expression was determined by immunohistochemistry (IHC). Morphological and ultrastructural alterations in the damaged muscle tissue were examined using hematoxylin and eosin (HE) staining and transmission electron microscopy (TEM), respectively. Expression of GRP78, LC3B and FAM134b was determined by western blot, and Colocalization of LC3B and FAM134b was examined by immunofluorescence. SMC+Tuina exhibited significantly improved gait and reduced edema. SMC+Tuina showed improvements in morphology and ultrastructure of damaged muscles, as well as decreased expression of TNF-α. Additionally, in SMC+Tuina, expression of GRP78 was downregulated, while expressions of FAM134 and LC3B were upregulated, and colocalization of FAM134 and LC3B was also enhanced. However, autophagy inhibitor 3-MA weakened the aforementioned effects of Chinese Tuina. The obtained results indicated that Chinese Tuina has a positive therapeutic effect in rats with SMC, potentially by promoting autophagy to reduce inflammation and ER stress.

Ligament shear strain stiffening arises from unaligned fibers and is amplified by axial strain

The medial collateral ligament is subject to a combination of shear and tensile loading via passive joint rotation or a combination of joint rotation and valgus loading in the knee. However, empirical characterizations of ligament mechanics usually consider only pure tensile or simple shear loading, and such isolated loading conditions may not fully capture the structure-function relationships under physiological conditions. For example, stretch of off-axis ligament fibers may inherently enhance load transfer and shear resistance within the tissue. Our objectives were to characterize the effects of (1) fiber alignment and (2) axial prestrain on the shear behavior of ligaments. We modeled a medial collateral ligament as an incompressible, hyperelastic material with distributed fibers embedded in a soft and stiff isotropic ground matrix. We used high-throughput, probabilistic finite element modeling to determine changes in shear modulus across a broad range of fiber alignments and axial strains observed in musculoskeletal soft tissues. We then used an experimental technique capable of resolving the loaded shear modulus of human medial collateral ligaments. We found that shear modulus increased dramatically (up to 1.4 MPa) in our soft tissue model when fibers were unaligned, and that this effect was amplified when the axial strain in the soft tissue's shear region was increased. In medial collateral ligaments ex vivo, we found that shear modulus increased by over tenfold on average at an axial prestrain of 9% relative to the unloaded state. These findings uncover an important structure-function relationship in ligaments that is relevant to the complex loading scenarios these tissues undergo in vivo, and thus should be considered for ongoing analyses of ligament mechanics.

The degree of degenerative changes and medial meniscal extrusion of the knee progress with increasing severity of posterior root lesions of the medial meniscus in middle age: A cross-sectional study

BACKGROUND

The aim of this study was to evaluate the relationships between radiologic features and the severity of medial meniscal posterior root (MMPR) lesions.

METHODS

Patients were classified into three groups: Group I, MMPR degeneration (n = 50); Group II, partial MMPR tear (MMPRT; n = 46); and Group III, complete MMPRT (n = 54). Forty-three patients without intra-articular pathologies formed a control group. Knee radiographs were assessed for mechanical femorotibial angle, Kellgren-Lawrence grade and joint space width of the medial compartment. MRIs were assessed for MMPR-related findings, including extent of medial meniscal extrusion (MME), insertional osseous change at the MMPR attachment, cartilage status, subchondral bone marrow lesions, effusion, and osteophytes of the medial compartment.

RESULTS

Varus degree and proportions of Kellgren-Lawrence grade 2 and 3 were higher as the severity of MMPR lesions increased (P < 0.001, respectively). Joint space width decreased as the severity of the MMPR lesion increased (P < 0.001). On MRI, MME, ratio of pathologic MME (>3 mm), the International Cartilage Research Society grade of the medial compartment, the proportions of moderate and high effusion, and proportions of grade 2 and 3 osteophytes increased as the severity of MMPR lesions increased (P < 0.001, respectively). A higher proportion of intraosseous cysts was seen in Group I than in the other groups (P < 0.001).

CONCLUSIONS

The extent of MME and ratio of pathologic MME increased as the severity of MMPR lesions increased. Radiologic features reflecting osteoarthritis worsened as the severity of MMPR lesions increased. On MRI, MMPR degeneration is significantly associated with intraosseous cyst at the MMPR insertion site.

A Di-aptamer-functionalized scaffold promotes bone regeneration by facilitating the selective retention of MSCs and EPCs and then promoting crosstalk between osteogenesis and angiogenesis

The crosstalk between osteogenesis and angiogenesis plays an important role in promoting the formation of a microenvironment that supports bone regeneration. This suggests that the retention of endogenous osteogenic and angiogenic cells in the bone defect area can promote tissue-engineered bone (TEB) osteogenesis and cell-cell interactions. In this study, a Di-Aptamer-functionalized HA/β-TCP (Di-Aptamer-H/T) scaffold was prepared by sequential modification of APTES and sulfo-SMCC and connected with aptamer HM69 and EPC1. We confirmed that aptamers HM69 and EPC1 can specifically identify mesenchymal stem cells (MSCs) and endothelial progenitor cells (EPCs), respectively. This process triggers the expression of adhesion-related genes in these cells and allows these cells to selectively stay coupled to Di-Aptamer-H/T. The osteogenic differentiation ability of MSCs treated with Di-Aptamer-H/T in vitro was significantly increased. Similarly, the ability of Di-Aptamer-H/T-treated EPCs to form blood vessels was also enhanced. Notably, the osteogenic and angiogenic abilities of cocultured MSCs and EPCs treated with the Di-Aptamer-H/T scaffold were significantly better than those of cells cultured individually. In vivo, the results of micro-CT angiography, H&E staining, Masson's staining and histochemical staining further confirmed that Di-Aptamer-H/T formed new bones and vessels more readily than those treated with a single aptamer linked to HA/β-TCP or with HA/β-TCP alone. In brief, our study demonstrated that crosstalk between osteogenesis and angiogenesis is promoted by the Di-Aptamer-H/T scaffold, which serves as a potential treatment strategy for bone defects and can improve outcomes.

Notchplasty in anterior cruciate ligament reconstruction: A systematic review of clinical outcomes

Introduction

Notchplasty is an adjuvant procedure performed during Anterior Cruciate Ligament reconstruction (ACLR) with the purpose of widening the intercondylar notch of the femur. Its use is controversial due to its biomechanical influence on the knee and the potential for increased complications. The purpose of this systematic review is to evaluate the outcomes of patients who underwent ACLR with notchplasty.

Materials and methods

A systematic search of Cochrane, Embase, and Medline was conducted to identify papers evaluating clinical outcomes of patients who underwent ACLR with notchplasty. Inclusion criteria encompassed human studies with a control group, reporting clinical outcomes such as graft failure, graft rupture, range of motion values, and patient-reported outcomes.

Results

A total of 4 studies were included comprising 396 patients (129 with notchplasty, 235 without). No significant differences were reported regarding graft survivability or Lysholm score between those with notchplasty and those without. One study reported significantly reduced rates of revision surgery after ACLR with notchplasty. There were conflicting complication rates between studies regarding chronic synovitis and arthrofibrosis.

Conclusion

Patients who undergo notchplasty during primary ACLR have similar outcome scores and risk of graft failure compared to those who do not undergo notchplasty. Notchplasty patients may also be at a higher risk for loss of extension and chronic synovitis.