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O'Sullivan O, Bennett AN, Cameron KL, Crossley K, Driban JB, Ladlow P, Macri E, Schmitt LC, Teyhen DS, Wellsandt E, Whittaker J, Rhon DI. Prevention of Post-Traumatic Osteoarthritis in the Military: Relevance of OPTIKNEE and Osteoarthritis Action Alliance recommendations. BMJ Mil Health 2024:military-2024-002813. [PMID: 39384221 DOI: 10.1136/military-2024-002813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 09/25/2024] [Indexed: 10/11/2024]
Abstract
Musculoskeletal injury (MSKI) is the most common reason for short-term occupational limitation and subsequent medically related early departure from the military. MSKI-related medical discharge/separation occurs when service personnel are unable to perform their roles due to pain or functional limitations associated with long-term conditions, including osteoarthritis (OA). There is a clear link between traumatic knee injuries, such as anterior cruciate ligament or meniscal, and the development of post-traumatic OA (PTOA). Notably, PTOA is the leading cause of disability following combat injury. Primary injury prevention strategies exist within the military, with interventions focused on conditioning, physical health and leadership. However, not every injury can be prevented, and there is a need to develop secondary prevention to mitigate or reduce the risk of PTOA following an MSKI. Two international collaborative groups, OPTIKNEE and OA Action Alliance, recently produced rigorous evidence-based consensus statements for the secondary prevention of OA following a traumatic knee injury, including consensus definitions and clinical and research recommendations. These recommendations focus on patient-centred lifespan interventions to optimise joint health and prevent lost decades of care. This article aims to describe their relevance and applicability to the military population and outline some of the challenges associated with service life that need to be considered for successful integration into military care pathways and research studies.
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Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K L Cameron
- Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, New York, USA
| | - K Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
- Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - J B Driban
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Department for Health, University of Bath, Bath, UK
| | - E Macri
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - L C Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
- OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - D S Teyhen
- Defense Health Agency National Capital Region Medical Directorate, Bethesda, Maryland, USA
| | - E Wellsandt
- Physical Therapy Program, Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - J Whittaker
- Department of Physical Therapy, The University of British Columbia Faculty of Medicine, Vancouver, Washington, Canada
- Arthritis Research, Vancouver, Washington, Canada
| | - D I Rhon
- Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
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Marigi EM, Davies MR, Marx RG, Rodeo SA, Williams RJ. Meniscus Tears in Elite Athletes: Treatment Considerations, Clinical Outcomes, and Return to Play. Curr Rev Musculoskelet Med 2024; 17:313-320. [PMID: 38833135 PMCID: PMC11219605 DOI: 10.1007/s12178-024-09907-w] [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] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE OF REVIEW Management of meniscal injuries in the elite athlete is a difficult problem secondary to the high demands of athletic competition, the need for a timely return to sport, and the desire to maximize performance over time. The purpose of this review is to provide an up-to-date summary on the current literature and trends regarding the management of meniscus injuries with a special consideration for elite athletes. RECENT FINDINGS Historically, partial meniscectomy has been the primary treatment option for meniscus injuries. However, in recent years there has been an increased emphasis on meniscus preservation due to the increased risk of cartilage degeneration over time. Moreover, while partial meniscectomy still provides a quicker return to sport (RTS), recent literature has demonstrated similar rates of RTS and return to pre-injury levels between partial meniscectomy and meniscus repair. In the setting of symptomatic meniscal deficiency, meniscus allograft transplantation has become an increasingly utilized salvage procedure with promising yet variable outcomes on the ability to withstand elite competition. Currently, there is no uniform approach to treating meniscal injuries in elite athletes. Therefore, an individualized approach is required with consideration of the meniscus tear type, location, concomitant injuries, athlete expectations, rehabilitation timeline, and desire to prevent or delay knee osteoarthritis. In athletes with anatomically repairable tears, meniscus repair should be performed given the ability to restore native anatomy, provide high rates of RTS, and mitigate long-term chondral damage. However, partial meniscectomy can be indicated for unrepairable tears.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, USA.
| | - Michael R Davies
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, USA
| | - Robert G Marx
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, USA
| | - Scott A Rodeo
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, USA
| | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, USA
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Anaspure O, Patel S, Baumann AN, Anastasio AT, Walley KC, Kelly JD, Lau BC. Examining the Evidence Regarding Smoking and Patient Outcomes for Isolated Meniscus Pathology: A Comprehensive Systematic Review and Meta-Analysis. Life (Basel) 2024; 14:584. [PMID: 38792605 PMCID: PMC11122235 DOI: 10.3390/life14050584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking's impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies (n = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies (n = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure (p = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking's effect on meniscus treatment is mixed, necessitating further investigation.
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Affiliation(s)
- Omkar Anaspure
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Shiv Patel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Anthony N. Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Albert T. Anastasio
- Department of Orthopedic Surgery, Duke University, Durham, NC 27710, USA; (A.T.A.); (B.C.L.)
| | - Kempland C. Walley
- Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI 48109, USA;
| | - John D. Kelly
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Brian C. Lau
- Department of Orthopedic Surgery, Duke University, Durham, NC 27710, USA; (A.T.A.); (B.C.L.)
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Hrubar YО, Hrubar IY, Hrabyk NМ, Grubar MY, Hrubar YY. INFLUENCE OF CRYOTHERAPY WITH PULSE COMPRESSION ON THE FUNCTIONAL CONDITION OF THE KNEE JOINT AFTER PARTIAL MENISCECTOMY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:182-188. [PMID: 36883508 DOI: 10.36740/wlek202301125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The aim: To study the effect of cryotherapy with adjustable pulse compression in patients after arthroscopic partial meniscectomy on the functional state of the knee joint in the early period of rehabilitation. PATIENTS AND METHODS Materials and methods: A total of 63 patients took part in the research: the experimental group included 32 patients (23 men and 9 women), and the control group - 31 patients (21 men and 10 women). In order to determine the effect on the functional state of the knee joint after arthroscopic partial meniscectomy in the experimental group, cryotherapy with adjustable pulse compression was used with the help of «GIOCO CRYO - 2» system; ice bags were used in the control group. In the research process, the following methods were used: visual analogue point scale, sonography, goniometry and myotonometry. RESULTS Results: It was found that in the experimental group, under the influence of cryotherapy with adjustable pulse compression, there was a progressive decrease in the intensity of the pain syndrome, the accumulation of reactive synovial fluid, a dynamic increase in the amplitude of movements of the operated joint, and an improvement in the muscle tone of the quadriceps femoris (p<0,05-0,001). CONCLUSION Conclusions: Thus, cryotherapy with adjustable pulse compression has shown a positive effect on the functional state of the knee joint in the early period of patients' rehabilitation, after partial meniscectomy and can be recommended for use in clinical practice.
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Affiliation(s)
- Yurii О Hrubar
- HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE
| | - Iryna Ya Hrubar
- TERNOPIL VOLODYMYR HNATIUK NATIONAL PEDAGOGICAL UNIVERSITY, TERNOPIL, UKRAINE
| | - Nadiia М Hrabyk
- TERNOPIL VOLODYMYR HNATIUK NATIONAL PEDAGOGICAL UNIVERSITY, TERNOPIL, UKRAINE
| | - Markiian Yu Grubar
- COMMUNAL NON-PROFIT ENTERPRISE «TERNOPIL UNIVERSITY HOSPITAL» OF TERNOPIL REGIONAL COUNCIL, TERNOPIL, UKRAINE
| | - Yuliana Yu Hrubar
- COMMUNAL NON-PROFIT ENTERPRISE «TERNOPIL UNIVERSITY HOSPITAL» OF TERNOPIL REGIONAL COUNCIL, TERNOPIL, UKRAINE
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Rhon DI, Cook CE. Orthopaedic Injuries of the Knee - Unique considerations in Military Service Members: Part I. J Knee Surg 2022; 35:1047. [PMID: 35896421 DOI: 10.1055/s-0042-1753538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Daniel I Rhon
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Chad E Cook
- Department of Population Health Sciences, Duke University, Durham, North Carolina
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