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Scanzello CR, Hasty KA, Chung CB, Griffin TM, Willet NJ, Krug H, Chu CQ, Ewart D, Jerban S, Baker JF, Duvall CL, Brunger JM, Burdick JA, Spindler KP, Drissi H. Teaming up to overcome challenges toward translation of new therapeutics for osteoarthritis. J Orthop Res 2024. [PMID: 39103981 DOI: 10.1002/jor.25944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/18/2024] [Accepted: 07/09/2024] [Indexed: 08/07/2024]
Abstract
As a leading global cause of musculoskeletal-related disability, osteoarthritis (OA) represents a public health urgency. Understanding of disease pathogenesis has advanced substantially in the past decade, yet no disease-modifying therapeutics have advanced to the clinic. To address this challenge, the CARE-AP (Cartilage Repair strategies to alleviate Arthritis Pain) collaborative research team was convened to bring together relevant multidisciplinary expertise and perspectives from across the VA research community nationwide. The first CARE-AP Annual Research Symposium took place (virtually) in February 2022 with roughly 90 participants. A number of innovative and therapeutic strategies were discussed, including siRNA approaches coupled with novel nanoparticle-based delivery systems, cellular engineering approaches to develop reparative cells that can probe the joint environment and respond to disease-specific cues, and novel biofabrication techniques to improve tissue engineering and effect "biological joint replacement." In addition, challenges and advances in rehabilitation approaches, imaging outcomes, and clinical studies were presented, which were integrated into a framework of recommendations for running "preclinical trials" to improve successful clinical translation.
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Affiliation(s)
- Carla R Scanzello
- Translational Musculoskeletal Research Center, Corp. Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Karen A Hasty
- Research Service 151, Lt. Col. Luke Weathers, Jr. VA Medical Center, Memphis, Tennessee, USA
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic/University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christine B Chung
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Timothy M Griffin
- Oklahoma City VA Health Care System, Oklahoma City, Oklahoma, USA
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Nick J Willet
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Phil and Penny Knight Campus for Accelerating Scientific Impact, Department of Bioengineering, University of Oregon, Eugene, Oregon, USA
| | - Hollis Krug
- Rheumatology Section, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Division of Rheumatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cong-Qiu Chu
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Division of Arthritis and Rheumatic Diseases, Oregon Health Sciences University, Portland, Oregon, USA
| | - David Ewart
- Rheumatology Section, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Division of Rheumatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Saeed Jerban
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Joshua F Baker
- Translational Musculoskeletal Research Center, Corp. Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Craig L Duvall
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Jonathan M Brunger
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Center for Stem Cell Biology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jason A Burdick
- BioFrontiers Institute and Department of Chemical and Biological Engineering, University of Colorado, Boulder, Colorado, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Sports Medicine, Cleveland Clinic Florida, Coral Springs, Florida, USA
| | - Hicham Drissi
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta VA Medical Center, Decatur, Georgia, USA
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Garcia-Mansilla I, Trivellas M, Singla A, Kelley B, Jones KJ. Quality and Variability of Physical Therapy Protocols Varies Widely for Osteochondral Allograft Transplantation of the Femoral Condyles. Cartilage 2022; 13:19476035221073999. [PMID: 35109692 PMCID: PMC9137295 DOI: 10.1177/19476035221073999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 10/14/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the quality and variability of osteochondral allograft (OCA) transplantation rehabilitation protocols associated with academic orthopedic programs in the United States. DESIGN A systematic review was performed to collect all publicly available online rehabilitation protocols for femoral condyle OCA transplant from US academic orthopedic programs participating in the Electronic Residency Application Service. These protocols were evaluated for inclusion of different rehabilitation components as well as timing of suggested initiation of these activities. RESULTS A total of 22 protocols were included. Although 91% of protocols recommended bracing, wide variation exists in total time of utilization. Median time for full weight bearing (FWB) was 7 weeks (range 4-8). On average, each protocol mentioned 9 (range 2-18) different strengthening exercises. The median time suggested to return to high-impact activities was 9 months (range 8-12). Only 3 protocols (14%) offered criteria of advancement for each phase as well as criteria for discharge. CONCLUSION Very few of the academic orthopedic programs have published online rehabilitation protocols following OCA transplantation. Although there is wide variation between the protocols, it allowed the identification of trends or patterns that are more common. However, there is need for more standardized evidence-based rehabilitation protocols which are easy to understand and follow by patients.
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Affiliation(s)
| | - Myra Trivellas
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amit Singla
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Benjamin Kelley
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, Division of Sports Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Crowley SG, Swindell HW, Saltzman BM, Ahmad CS, Popkin CA, Trofa DP. Rehabilitation Variability Following Femoral Condyle and Patellofemoral Microfracture Surgery of the Knee. Cartilage 2021; 13:1801S-1813S. [PMID: 34151611 PMCID: PMC8808894 DOI: 10.1177/19476035211025818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for microfracture of femoral condyle and patellofemoral lesions of the knee. DESIGN Online postoperative microfracture rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention. RESULTS A total of 18 programs (11.6%) from 155 US academic orthopedic programs' published online protocols and a total of 44 protocols were analyzed. Seventeen protocols (56.7%) recommended immediate postoperative bracing for femoral condyle lesions and 17 (89.5%) recommended immediate postoperative bracing for patellofemoral lesions. The average time to permitting weight-bearing as tolerated (WBAT) was 6.1 weeks (range, 0-8) for femoral condyle lesions and 3.7 weeks (range, 0-8 weeks) for patellofemoral lesions. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. For femoral condyle lesions, 10 protocols (33.3%) recommended functional testing prior to return to sport at an average of 23.3 weeks postoperatively (range, 12-32 weeks). For patellofemoral lesions, 4 protocols (20.0%) recommended functional testing for return to sport at an average of 21.0 weeks postoperatively (range, 12-32 weeks). CONCLUSION A minority of US academic orthopedic programs publish microfracture rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.
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Affiliation(s)
| | - Hasani W. Swindell
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | | | - Christopher S. Ahmad
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - Charles A. Popkin
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - David P. Trofa
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA,David P. Trofa, Department of Orthopedic
Surgery, Columbia University Medical Center, New York, NY 10032, USA.
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Szymański JK, Starzec-Proserpio M, Słabuszewska-Jóźwiak A, Jakiel G. Is PREHAB in Pelvic Floor Surgery Needed? A Topical Review. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E593. [PMID: 33172196 PMCID: PMC7694951 DOI: 10.3390/medicina56110593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/26/2020] [Accepted: 11/04/2020] [Indexed: 12/03/2022]
Abstract
Pelvic organ prolapse and urinary incontinence affect approximately 6-11% and 6-40% of women, respectively. These pathologies could result from a weakness of pelvic floor muscles (PFM) caused by previous deliveries, aging or surgery. It seems reasonable that improving PFM efficacy should positively impact both pelvic floor therapy and surgical outcomes. Nonetheless, the existing data are inconclusive and do not clearly support the positive impact of preoperative pelvic floor muscle training on the improvement of surgical results. The restoration of deteriorated PFM function still constitutes a challenge. Thus, further well-designed prospective studies are warranted to answer the question of whether preoperative PFM training could optimize surgical outcomes and if therapeutic actions should focus on building muscle strength or rather on enhancing muscle performance.
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Affiliation(s)
- Jacek K. Szymański
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 str., 00-004 Warsaw, Poland; (J.K.S.); (A.S.-J.); (G.J.)
| | | | - Aneta Słabuszewska-Jóźwiak
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 str., 00-004 Warsaw, Poland; (J.K.S.); (A.S.-J.); (G.J.)
| | - Grzegorz Jakiel
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 str., 00-004 Warsaw, Poland; (J.K.S.); (A.S.-J.); (G.J.)
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