1
|
Rucinski K, Cook JL, Schweser KM, Crist BD. Short-Term Outcomes After Bipolar Osteochondral Allograft Transplantation (OCAT) in the Ankle. J Foot Ankle Surg 2024; 63:207-213. [PMID: 37972816 DOI: 10.1053/j.jfas.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Treatment options for symptomatic cartilage loss in the ankle are not consistently effective. This study documents initial outcomes for patients undergoing bipolar OCAT in the ankle after advances in tissue preservation, transplantation techniques, and patient management strategies were implemented. Patients were prospectively enrolled into a registry designed to follow outcomes after OCAT in the ankle. Fourteen patients were included for analyses (12 primary OCAT, 2 revision OCAT). Four patients underwent Bipolar OCAT (tibia, talus) and 10 Bipolar+ OCAT (tibia, talus, fibula). Short-term (median follow-up 43, range 13-73 months) success was documented for 13 patients. Radiographic assessments indicated OCA integration and maintenance of joint space in 12 patients. Statistically significant (p < .030) and clinically meaningful improvements in AAOS and VAS pain scores were noted at 3 months, 6 months, 1 year, and 2 years following OCA transplantation when compared to preoperative measures. For patients that were nonadherent to postoperative restriction and rehabilitation protocols, all 1-year postoperative PROs were significantly lower (p < .050) than for patients who were adherent. The successful outcomes documented in 13 of 14 patients in conjunction with significant and clinically meaningful improvements in patient-reported measures of pain and function support OCA transplantation as an appropriate treatment option in indicated patients. These improvements in outcomes were associated with advances in OCA preservation, preimplantation treatment, transplantation techniques, and patient management strategies, suggesting this shift in practice be considered for OCA transplantation in the ankle.
Collapse
Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - James L Cook
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - Kyle M Schweser
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - Brett D Crist
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO.
| |
Collapse
|
2
|
Cook JL, Rucinski K, Crecelius CR, Kfuri M, Stannard JP. Treatment failures (revision or arthroplasty) after knee osteochondral allograft transplantation with minimum two-year follow-up. Knee 2024; 46:128-135. [PMID: 38128151 DOI: 10.1016/j.knee.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Knee osteochondral allograft transplantation (OCAT) has been associated with good short- to mid-term outcomes, however, treatment failures occur more frequently than desired. This study used data from a lifelong outcomes registry to analyze knee OCAT treatment failure rates, variables associated with knee OCAT treatment failures, and outcomes after revision or arthroplasty surgery for knee OCAT treatment failures. METHODS Patient outcomes were followed after knee OCAT performed using standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS®) allografts. The study population consisted of patients undergoing primary OCAT with ≥ 2-year follow-up. For comparisons, the treatment failure population was defined by patients in the study population with documented treatment failure (revision or arthroplasty) with ≥ 2-year follow-up after failure. Functional graft survival was defined as no further need for revision surgery after primary or revision OCAT. RESULTS A total of 262 patients (n = 136 males; 51.9%) were analyzed. SP grafts were used for 59 cases and MOPS grafts were used for 203 cases. Treatment failure was documented in 61 cases (23.3%). MOPS grafts were 3.3 times more likely to be associated with functional graft survival. SP grafts, older patient age, higher BMI, tibiofemoral bipolar OCAT and non-adherence to the postoperative rehabilitation protocol were significantly associated with treatment failure. CONCLUSIONS Knee OCAT resulted in functional graft survival at short- to mid-term follow-up in the majority (70-88%) of cases. In addition, revision of primary OCAT resulted in functional graft survival for at least 2 years after revision surgery in the majority (66%) of patients. LEVEL OF EVIDENCE 2, prospective cohort study.
Collapse
Affiliation(s)
- James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA.
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Cory R Crecelius
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Mauricio Kfuri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| |
Collapse
|
3
|
Reale D, Feltri P, Franceschini M, de Girolamo L, Laver L, Magalon J, Sanchez M, Tischer T, Filardo G. Biological intra-articular augmentation for osteotomy in knee osteoarthritis: strategies and results : A systematic review of the literature from the ESSKA Orthobiologics Initiative. Knee Surg Sports Traumatol Arthrosc 2023; 31:4327-4346. [PMID: 37330935 DOI: 10.1007/s00167-023-07469-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE To assess whether there is evidence supporting the use of augmentation strategies, either cartilage surgical procedures or injective orthobiologic options, to improve the results of osteotomies in knees with osteoarthritis (OA). METHODS A systematic review of the literature was performed on the PubMed, Web of Science and the Cochrane databases in January 2023 on osteotomies around the knee associated with augmentation strategies (either cartilage surgical procedures or injective orthobiologic options), reporting clinical, radiological, or second-look/histological outcomes at any follow-up. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS). RESULTS Out of the 7650 records identified from the databases, 42 articles were included for a total of 3580 patients and 3609 knees treated; 33 articles focused on surgical treatments and 9 on injective treatments performed in association with knee osteotomy. Out of the 17 comparative studies with surgical augmentation, only 1 showed a significant clinical benefit of an augmentation procedure with a regenerative approach. Overall, other studies showed no differences with reparative techniques and even detrimental outcomes with microfractures. Regarding injective procedures, viscosupplementation showed no improvement, while the use of platelet-rich plasma or cell-based products derived from both bone marrow and adipose tissue showed overall positive tissue changes which translated into a clinical benefit. The mean modified CMS score was 60.0 ± 12.1. CONCLUSION There is no evidence to support the effectiveness of cartilage surgical treatments combined with osteotomies in terms of pain relief and functional recovery of patients affected by OA in misaligned joints. Orthobiologic injective treatments targeting the whole joint environment showed promising findings. However, overall the available literature presents a limited quality with only few heterogeneous studies investigating each treatment option. This ORBIT systematic analysis will help surgeons to choose their therapeutic strategy according to the available evidence, and to plan further and better studies to optimize biologic intra-articular osteotomy augmentation. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Davide Reale
- Ortopedia e Traumatologia, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
| | - Marco Franceschini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli-1, 40136, Bologna, Italy.
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
| | - Lior Laver
- Department of Orthopaedics, Hillel Yaffe Medical Center (HYMC), 38100, Hadera, Israel
- Arthrosport Clinic, Tel-Aviv, Israel
- Rappaport Faculty of Medicine, Technion University Hospital, Israel Institute of Technology, 32000, Haifa, Israel
| | - Jeremy Magalon
- Cell Therapy Department, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille (AP-HM), INSERM CIC BT 1409, 13005, Marseille, France
- INSERM, INRA, C2VN, Aix Marseille Univ, 13005, Marseille, France
- SAS Remedex, 13008, Marseille, France
| | - Mikel Sanchez
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
| | - Thomas Tischer
- Department of Orthopaedic Surgery, University of Rostock, 18051, Rostock, Germany
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| |
Collapse
|
4
|
Dhillon J, Kraeutler MJ, Fasulo SM, Belk JW, Scillia AJ, McCulloch PC. Isolated Osteotomy Versus Combined Osteotomy and Cartilage Repair for Osteoarthritis or Focal Chondral Defects of the Medial Compartment of the Knee Joint: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231162030. [PMID: 37179710 PMCID: PMC10170602 DOI: 10.1177/23259671231162030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 05/15/2023] Open
Abstract
Background The extent to which concomitant cartilage repair provides an improvement in clinical outcomes after osteotomy is unclear. Purpose To compare studies reporting clinical outcomes after isolated osteotomy with or without cartilage repair for osteoarthritis (OA) or focal chondral defects (FCDs) of the knee joint. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, Cochrane Library, and Embase databases. The search was done to identify comparative studies that directly compared outcomes between isolated osteotomy-high tibial osteotomy or distal femoral osteotomy-and osteotomy with concomitant cartilage repair for OA or FCDs of the knee joint. Patients were evaluated based on reoperation rate, magnetic resonance observation of cartilage repair tissue score, macroscopic International Cartilage Regeneration & Joint Preservation Society score, and patient-reported outcomes. Results In total, 6 studies-level 2 evidence (n = 2);, level 3 evidence (n = 3);, and level 4 evidence (n = 1)-met the inclusion criteria, including a total of 228 patients undergoing osteotomy alone (group A) and 255 patients undergoing osteotomy with concomitant cartilage repair (group B). The mean patient age was 53.4 and 54.8 years, respectively, and the mean preoperative alignment was 6.6° and 6.7° of varus in groups A and B, respectively. The mean follow-up time was 71.5 months. All studies assessed medial compartment lesions with varus deformity. One study compared osteotomy alone for patients with medial compartment OA versus osteotomy with autologous chondrocyte implantation for patients with FCDs of the medial compartment. Three other studies included a heterogeneous cohort of patients with OA and FCDs in both groups. Only 1 study isolated its comparison to patients with medial compartment OA and 1 study isolated its comparison to patients with FCDs. Conclusion There is limited evidence with substantial heterogeneity between studies on clinical outcomes after osteotomy alone versus osteotomy with cartilage repair for OA or FCDs of the knee joint. At this time, no conclusion can be made regarding the role of additional cartilage procedures in treating medial compartment OA or FCDs. Further studies are needed that isolate specific disease pathology and specific cartilage procedures.
Collapse
Affiliation(s)
- Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Matthew J. Kraeutler
- Houston Methodist Hospital, Houston, Texas, USA
- Matthew J. Kraeutler, MD, Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, 6445 Main Street, Suite 2300, Houston, TX 77030, USA ()
| | - Sydney M. Fasulo
- Saint Joseph’s University Medical Center, Department of Orthopaedic Surgery, Paterson, New Jersey, USA
| | - John W. Belk
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anthony J. Scillia
- Saint Joseph’s University Medical Center, Department of Orthopaedic Surgery, Paterson, New Jersey, USA
- Academy Orthopaedics, Wayne, New Jersey, USA
| | | |
Collapse
|
5
|
Cook JL, Rucinski K, Crecelius CR, Stannard JP. Initial Outcomes After Unicompartmental Tibiofemoral Bipolar Osteochondral and Meniscal Allograft Transplantation in the Knee Using MOPS-Preserved Fresh (Viable) Tissues. Am J Sports Med 2023; 51:596-604. [PMID: 36655742 DOI: 10.1177/03635465221144003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Unicompartmental tibiofemoral bipolar osteochondral allograft transplantation (OCAT) with meniscal allograft transplantation (MAT) has not historically been associated with consistently successful outcomes for treatment of knee articular cartilage defects with meniscal deficiency. HYPOTHESIS Primary OCAT and MAT using fresh tissues will be associated with successful short-term outcomes based on statistically significant and clinically meaningful improvements in pain and function in the majority of patients. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients were prospectively enrolled into a registry for outcomes after OCAT and MAT. Patients included those who underwent primary OCAT and MAT using Missouri Osteochondral Preservation System (MOPS)-preserved allografts for treatment of large bipolar tibiofemoral articular cartilage defects with meniscal deficiency and had a minimum of 2-year follow-up data. RESULTS A total of 76 patients (n = 52 male; 68%) met inclusion criteria (mean follow-up, 52 months). The mean age was 41.1 years (range, 15-69 years), and the mean body mass index was 28.9 (range, 17-46); 48 patients underwent another OCAT in addition to the unicompartmental bipolar tibiofemoral OCAT and MAT; 23 patients (30.3%) were documented to be nonadherent to the prescribed postoperative restriction and rehabilitation protocol. The initial success rate (>2 years) was 77.6%, with 8 patients (10.5%) undergoing revision and 9 (11.8%) converting to arthroplasty. Variables associated with an increased risk for treatment failure (revision or arthroplasty) included ipsilateral osteotomy (P = .046; odds ratio [OR] = 3.3), ipsilateral concurrent procedure (P = .0057; OR = 5.5), and nonadherence (P = .0009; OR = 7.2). None of the patients undergoing revision surgery required arthroplasty at the time of data analysis such that the overall success rate for primary and revision unicompartmental bipolar OCA plus MAT was 88.2%. There were statistically significant (P < .0001) and clinically important improvements for all patient-reported outcomes at each annual follow-up time point. CONCLUSION Unicompartmental tibiofemoral bipolar OCAT and MAT can result in successful short-term outcomes (2-6 years) and satisfaction in the majority of patients (78%). Primary MOPS-preserved OCAT with MAT for treatment of femoral condyle and tibial plateau articular cartilage defects with concurrent meniscal deficiency was associated with statistically significant and clinically meaningful improvements in patient-reported measures of pain and function.
Collapse
Affiliation(s)
- James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Cory R Crecelius
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
6
|
Gelber PE, Ramírez-Bermejo E, Fariñas O. Early Postoperative CT Scan Provides Prognostic Data on Clinical Outcomes of Fresh Osteochondral Transplantation of the Knee. Am J Sports Med 2022; 50:3812-3818. [PMID: 36322380 DOI: 10.1177/03635465221129601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a lack of information regarding the ability of imaging studies to predict clinical outcomes after fresh osteochondral allograft (FOCA) transplantation of the knee. PURPOSE To determine the value of computed tomography (CT) scans to predict the clinical outcome of FOCA transplantation using the assessment computed tomography osteochondral allograft (ACTOCA) score. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We prospectively collected data from all consecutive patients who underwent FOCA transplantation for osteochondral knee lesions at one institution between August 2017 and August 2019. All patients were followed up for a minimum of 2 years. CT scans performed 6 months after surgery were evaluated by a musculoskeletal radiologist using the ACTOCA scoring system. The radiologist was blinded to the patient's medical history. Clinical outcomes were assessed preoperatively and at 12 and 30 months postoperatively using the International Knee Documentation Committee (IKDC) score, the Kujala score, the Tegner activity scale, and the Western Ontario Meniscal Evaluation Tool (WOMET) score. RESULTS A total of 38 cases were included. The ACTOCA score at 6 months after surgery showed a statistically significant correlation with clinical results at 12 and 30 months. The correlation was better at 30 months, showing a high negative correlation with the IKDC score (-0.663) and a moderate negative correlation with the Kujala, WOMET, and Tegner scores (-0.593; -0.547, and -0.593, respectively) (P < .001). CONCLUSION A statistically significant correlation between the mean ACTOCA score on CT scans at 6 months and the clinical results measured by the IKDC, Kujala, WOMET, and Tegner scores at 30 months confirmed the predictive value of the ACTOCA score for use in clinical practice.
Collapse
Affiliation(s)
- Pablo Eduardo Gelber
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.,ICATME-Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Eduard Ramírez-Bermejo
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank, Banc de Sang i Teixits, Barcelona, Spain
| |
Collapse
|
7
|
Tabbaa SM, Bugbee WD, Provencher M, Farr J, Crawford DC. Inconsistent Reporting of Preauthorization Medical Criteria for Osteochondral Allograft Transplantation Surgery. J Bone Joint Surg Am 2022; 104:1841-1853. [PMID: 35984006 DOI: 10.2106/jbjs.21.01191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although osteochondral allograft (OCA) transplantation has been a standard treatment for patients with osteochondral lesions, there is a disagreement in commercial payers' medical criteria regarding the definition of medical suitability and thus authorization for OCA transplantation. The primary goal of this study was to understand where consensus between a committee of experienced cartilage restoration surgeon scientists and payer policies existed and where there was significant disagreement. METHODS U.S. private payers were identified by reviewing health insurance market research literature. Medical criteria were then obtained from publicly available payer medical polices. A literature review was conducted to identify supporting evidence for consensus statements based on private payer medical criteria. The MOCA (Metrics of Osteochondral Allograft) Committee, 30 experienced surgeons and subject-matter experts in OCA transplantation, used a Likert scale of 1 (strongly disagree) to 5 (strongly agree) to rank each statement. The extent of agreement and disagreement among participants was measured for each statement. Consensus was defined as agreement or disagreement of >75%. RESULTS Fifty-seven statements regarding relevant medical criteria for OCA transplantation were included in the survey. All 30 MOCA Committee members completed the survey (100% response rate). Over half of the statements (52.6%) did not reach consensus. Of the remaining 27 statements that reached consensus, respondents agreed or strongly agreed with 16 statements, and disagreed or strongly disagreed with 11 statements. Inconsistent voting was observed for statements related to osteoarthritis, inflammation, and degenerative changes. CONCLUSIONS Commercial payers are not consistent in the medical criteria used to define patient eligibility for authorization of OCA transplantation. In contrast, an expert panel of cartilage surgeons reached a consensus that OCA transplantation was clearly suitable for a variety of specific indications. This study demonstrates the need to standardize medical criteria for cartilage restoration based on the most current literature, as well as in conjunction with experienced cartilage restoration experts. LEVEL OF EVIDENCE Therapeutic Level V . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Suzanne M Tabbaa
- University of California San Francisco, San Francisco, California
| | | | | | - Jack Farr
- Cartilage Restoration Center of Indiana, Greenwood, Indiana
| | | | | | | |
Collapse
|
8
|
Hoorntje A, Kuijer PPFM, Koenraadt KLM, Waterval-Witjes S, Kerkhoffs GMMJ, Mastbergen SC, Marijnissen ACA, Jansen MP, van Geenen RCI. Return to Sport and Work after Randomization for Knee Distraction versus High Tibial Osteotomy: Is There a Difference? J Knee Surg 2022; 35:949-958. [PMID: 33231278 DOI: 10.1055/s-0040-1721027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Knee joint distraction (KJD) is a novel technique for relatively young knee osteoarthritis (OA) patients. With KJD, an external distraction device creates temporary total absence of contact between cartilage surfaces, which results in pain relief and possibly limits the progression of knee OA. Recently, KJD showed similar clinical outcomes compared with high tibial osteotomy (HTO). Yet, no comparative data exist regarding return to sport (RTS) and return to work (RTW) after KJD. Therefore, our aim was to compare RTS and RTW between KJD and HTO. We performed a cross-sectional follow-up study in patients <65 years who previously participated in a randomized controlled trial comparing KJD and HTO. Out of 62 eligible patients, 55 patients responded and 51 completed the questionnaire (16 KJDs and 35 HTOs) at 5-year follow-up. The primary outcome measures were the percentages of RTS and RTW. Secondary outcome measures included time to RTS/RTW, and pre- and postoperative Tegner's (higher is more active), and Work Osteoarthritis or Joint-Replacement Questionnaire (WORQ) scores (higher is better work ability). Patients' baseline characteristics did not differ. Total 1 year after KJD, 79% returned to sport versus 80% after HTO (not significant [n.s.]). RTS <6 months was 73 and 75%, respectively (n.s.). RTW 1 year after KJD was 94 versus 97% after HTO (n.s.), and 91 versus 87% <6 months (n.s.). The median Tegner's score decreased from 5.0 to 3.5 after KJD, and from 5.0 to 3.0 after HTO (n.s.). The mean WORQ score improvement was higher after HTO (16 ± 16) than after KJD (6 ± 13; p = 0.04). Thus, no differences were found for sport and work participation between KJD and HTO in our small, though first ever, cohort. Overall, these findings may support further investigation into KJD as a possible joint-preserving option for challenging "young" knee OA patients. The level of evidence is III.
Collapse
Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - P Paul F M Kuijer
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Suzanne Waterval-Witjes
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports, Amsterdam UMC, Amsterdam, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne C A Marijnissen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mylène P Jansen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| |
Collapse
|
9
|
Cook JL, Stannard JP, Stoker AM, Rucinski K, Crist BD, Cook CR, Crecelius C, Smith MJ, Stucky R. Biologic Joint Restoration: A Translational Research Success Story. MISSOURI MEDICINE 2022; 119:115-121. [PMID: 36036037 PMCID: PMC9339389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Treatment options that result in consistently successful outcomes for young and active patients with joint disorders are needed. This article summarizes two decades of rigorous research using a bedside-to-bench- to-bedside translational approach based on the One Health - One Medicine concept that culminated in successful clinical use of biologic joint restoration options for treatment of knee, hip, ankle, and shoulder problems in this growing patient population.
Collapse
Affiliation(s)
- James L Cook
- William and Kathryn Allen Distinguished Chair in Orthopaedic Surgery; Director, Thompson Laboratory for Regenerative Orthopaedics (TLRO) and Mizzou BioJoint® Center; and Vice Chair, Orthopaedic Research Division, University of Missouri - Columbia, Columbia, Missouri
| | - James P Stannard
- TLRO and Department of Orthopaedic Surgery (DOS), University of Missouri - Columbia, Columbia, Missouri
| | - Aaron M Stoker
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Kylee Rucinski
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Brett D Crist
- TLRO and DOS, University of Missouri - Columbia, Columbia, Missouri
| | - Cristi R Cook
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Cory Crecelius
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | | | - Renee Stucky
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| |
Collapse
|
10
|
Ewing MA, Stannard JP, Cook JL. Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee. J Knee Surg 2021; 34:599-604. [PMID: 33648008 DOI: 10.1055/s-0041-1725176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.
Collapse
Affiliation(s)
- Michael A Ewing
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, Mizzou BioJoint Center, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, Mizzou BioJoint Center, University of Missouri, Columbia, Missouri
| |
Collapse
|
11
|
Crecelius CR, Van Landuyt KJ, Schaal R. Postoperative Management for Articular Cartilage Surgery in the Knee. J Knee Surg 2021; 34:20-29. [PMID: 33111278 DOI: 10.1055/s-0040-1718605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The postoperative rehabilitation team plays a crucial role in optimizing outcomes after articular cartilage surgery. A comprehensive approach to postoperative physical therapy that considers the type of surgery, location in the knee, concurrent procedures, and patient-specific factors is imperative. While postoperative rehabilitation protocols should be specific to the patient and type of surgery performed and include phased rehabilitation goals and activities, the key principles for postoperative rehabilitation apply across the spectrum of articular cartilage surgeries and patients. These key principles consist of preoperative assessments that include physical, mental, and behavioral components critical to recovery; education and counseling with respect to expectations and compliance; and careful monitoring and adjustments throughout the rehabilitation period based on consistent communication among rehabilitation, surgical, and imaging teams to ensure strict patient compliance with restrictions, activities, and timelines to optimize functional outcomes after surgery.
Collapse
Affiliation(s)
- Cory R Crecelius
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri.,University of Missouri Joint Preservation Center, Columbia, Missouri
| | - Karra J Van Landuyt
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri
| | - Robert Schaal
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri
| |
Collapse
|