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Zhang Z, Hu Z, Zhao D, Huang H, Liang Y, Mao B. Arthroscopic surgery is not superior to conservative treatment in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trails. BMC Musculoskelet Disord 2024; 25:712. [PMID: 39237972 PMCID: PMC11375851 DOI: 10.1186/s12891-024-07813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/23/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Studies comparing the effectiveness of arthroscopic knee surgery and conservative treatment on knee osteoarthritis (OA) came up with inconsistent results. Systematic review on this topic still is still lacking. This systematic review and meta-analysis aimed to evaluate the effectiveness of arthroscopic knee surgery on knee OA, compared to conservative treatments. MATERIALS AND METHODS Literature searches were performed in PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published before on 1st July 2024. Studies comparing the effectiveness of arthroscopy and conservative treatments only on knee OA were included. Quality of included studies was evaluated by risk of bias 2 (ROB2). Long-term results in terms of pain relief, functional recovery and patients reported satisfaction were meta-analyzed to evaluate the therapeutic effectiveness. RESULTS Ten studies were included in this review, among which only 1 was considered as low risk of bias. Five studies were involved in meta-analyses and no difference was found in therapeutic effectiveness of arthroscopic surgery and conservative treatment on knee OA, in the evaluation of VAS (p = 0.63), WOMAC (p = 0.38), SF-36 (p = 0.74) and patient satisfaction (p = 0.07). CONCLUSION The evidence does not support the effectiveness of arthroscopic knee surgery compared to conservative treatments in knee OA.
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Affiliation(s)
- Zhong Zhang
- Department of Orthopedics Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Zhengjun Hu
- Department of Orthopedics Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Deng Zhao
- Department of Orthopedics Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Huaqiang Huang
- Department of Orthopedics Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Yijian Liang
- Department of Orthopedics Surgery, The Third People's Hospital of Chengdu, Chengdu, China.
- Third People's hospital of Chengdu, Chengdu, 610000, Sichuan, China.
| | - Beini Mao
- Department of Orthopedics Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen, China.
- Department of Rehabilitation, Shenzhen Hospital, Southern Medical University, Shenzhen, China.
- , No. 1333 Xinhu street, Shenzhen City, 518100, Guangdong, China.
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Migliorini F, Maffulli N, Eschweiler J, Götze C, Hildebrand F, Betsch M. Prognostic factors for the management of chondral defects of the knee and ankle joint: a systematic review. Eur J Trauma Emerg Surg 2022; 49:723-745. [PMID: 36344653 PMCID: PMC10175423 DOI: 10.1007/s00068-022-02155-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
Abstract
Purpose
Different surgical techniques to manage cartilage defects are available, including microfracture (MFx), autologous chondrocyte implantation (ACI), osteoarticular auto- or allograft transplantation (OAT), autologous matrix-induced chondrogenesis (AMIC). This study investigated the patient-related prognostic factors on the clinical outcomes of surgically treated knee and ankle cartilage defects.
Methods
This study followed the PRISMA statement. In May 2022, the following databases were accessed: PubMed, Google Scholar, Embase, and Scopus. All the studies investigating the outcomes of surgical management for knee and/or talus chondral defects were accessed. Only studies performing mesenchymal stem cells transplantation, OAT, MFx, ACI, and AMIC were considered. A multiple linear model regression analysis through the Pearson Product–Moment Correlation Coefficient was used.
Results
Data from 184 articles (8905 procedures) were retrieved. Female sex showed a positive moderate association with visual analogue scale at last follow-up (P = 0.02). Patient age had a negative association with the American Orthopaedic Foot and Ankle Score (P = 0.04) and Lysholm Knee Scoring Scale (P = 0.03). BMI was strongly associated with graft hypertrophy (P = 0.01). Greater values of VAS at baseline negatively correlate with lower values of Tegner Activity Scale at last follow-up (P < 0.0001).
Conclusion
The clinical outcomes were mostly related to the patients’ performance status prior surgery. A greater BMI was associated with greater rate of hypertrophy. Female sex and older age evidenced fair influence, while symptom duration prior to the surgical intervention and cartilage defect size evidenced no association with the surgical outcome. Lesion size and symptom duration did not evidence any association with the surgical outcome.
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Randsborg PH, Årøen A, Owesen C. The Effect of Lesion Size on Pain and Function in Patients Scheduled for Cartilage Surgery of the Knee. Cartilage 2022; 13:19476035221109242. [PMID: 35815409 PMCID: PMC9277437 DOI: 10.1177/19476035221109242] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Despite an increased interest in treatment options for cartilage lesions of the knee, the relationship between lesion characteristics and the symptoms they elicit is not well understood. We evaluated the relationship between lesion characteristics and the patient-reported outcome measures (PROMs) and compared this with symptoms reported by patients scheduled for knee ligament reconstruction and knee arthroplasty. DESIGN Preoperative data, including Lysholm score and The Knee Injury and Osteoarthritis Outcome Score (KOOS), in 90 consecutive patients scheduled for surgery for symptomatic isolated cartilage lesions were prospectively collected. RESULT The patients had a mean age of 33.2 years. There were 62 (69%) males. There was no statistically significant difference in PROMs between patients with cartilage lesions smaller or larger than 2 cm2, except for the KOOS subscale symptoms, with patients with smaller lesions reporting higher scores, 62.8 (95% confidence interval [CI] 58.3-67.3) vs. 51.9 (95% CI 45.5-58.4), P = 0.005. There was a small correlation between lesion size and Lysholm score. However, when adjusted for age, sex, body mass index, and lesion localization, this effect was not statistically significant. The International Cartilage Regeneration & Joint Preservation Society grade did not affect preoperative PROMs. Cartilage patients reported worse preoperative symptoms than patients scheduled for knee ligament reconstruction, and approaching the symptoms reported by patients scheduled for knee arthroplasty. CONCLUSION The size, depth, and location of cartilage lesions have little impact on the symptoms experienced by the patients. Cartilage patients have comparable symptoms to patients scheduled for knee arthroplasty.
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Affiliation(s)
- Per-Henrik Randsborg
- Department of Orthopedic Surgery,
Akershus University Hospital, Lørenskog, Norway,Per-Henrik Randsborg, Department of
Orthopedic Surgery, Akershus University Hospital, Sykehusveien, 1478 Lørenskog,
Norway.
| | - Asbjørn Årøen
- Department of Orthopedic Surgery,
Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine,
University of Oslo, Lørenskog, Norway
| | - Christian Owesen
- Department of Orthopedic Surgery,
Akershus University Hospital, Lørenskog, Norway
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Banitalebi H, Owesen C, Årøen A, Tran HT, Myklebust TÅ, Randsborg PH. Is T2 mapping reliable in evaluation of native and repair cartilage tissue of the knee? J Exp Orthop 2021; 8:34. [PMID: 33913035 PMCID: PMC8081777 DOI: 10.1186/s40634-021-00350-1] [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: 01/27/2021] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the effect of imaging plane and experience of observers on the reliability of T2 mapping of native and repair cartilage tissue of the knee. METHODS Fifteen consecutive patients from two randomised controlled trials (RCTs) were included in this cross-sectional study. Patients with an isolated knee cartilage lesion were randomised to receive either debridement or microfracture (RCT 1) or debridement or autologous chondrocyte implantation (RCT 2). T2 mapping was performed in coronal and sagittal planes two years postoperatively. A musculoskeletal radiologist, a resident of radiology and two orthopaedic surgeons measured the T2 values independently. Intraclass Correlation Coefficient (ICC) with 95% Confidence Intervals was used to calculate the inter- and intraobserver agreement. RESULTS Mean age for the patients was 36.8 ± 11 years, 8 (53%) were men. The overall interobserver agreement varied from poor to good with ICCs in the range of 0.27- 0.76 for native cartilage and 0.00 - 0.90 for repair tissue. The lowest agreement was achieved for evaluations of repair cartilage tissue. The estimated ICCs suggested higher inter- and intraobserver agreement for radiologists. On medial femoral condyles, T2 values were higher for native cartilage on coronal images (p < 0.001) and for repair tissue on sagittal images (p < 0.001). CONCLUSIONS The reliability of T2 mapping of articular cartilage is influenced by the imaging plane and the experience of the observers. This influence may be more profound for repair cartilage tissue. This is important to consider when using T2 mapping to measure outcomes after cartilage repair surgery. TRIAL REGISTRATION ClinicalTrials.gov, NCT02637505 and NCT02636881 , registered December 2015. LEVEL OF EVIDENCE II, based on prospective data from two RCTs.
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Affiliation(s)
- Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Christian Owesen
- Department of Orthopaedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.,Oslo Sports Trauma Research Centre, Oslo, Norway
| | - Asbjørn Årøen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Orthopaedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.,Oslo Sports Trauma Research Centre, Oslo, Norway
| | - Hang Thi Tran
- Department of Diagnostic Imaging, Akershus University Hospital, 1478, Lørenskog, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.,Oslo Sports Trauma Research Centre, Oslo, Norway
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Rajagopal K, Ramesh S, Walter NM, Arora A, Katti DS, Madhuri V. In vivo cartilage regeneration in a multi-layered articular cartilage architecture mimicking scaffold. Bone Joint Res 2020; 9:601-612. [PMID: 33014353 PMCID: PMC7510940 DOI: 10.1302/2046-3758.99.bjr-2019-0210.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIMS Extracellular matrix (ECM) and its architecture have a vital role in articular cartilage (AC) structure and function. We hypothesized that a multi-layered chitosan-gelatin (CG) scaffold that resembles ECM, as well as native collagen architecture of AC, will achieve superior chondrogenesis and AC regeneration. We also compared its in vitro and in vivo outcomes with randomly aligned CG scaffold. METHODS Rabbit bone marrow mesenchymal stem cells (MSCs) were differentiated into the chondrogenic lineage on scaffolds. Quality of in vitro regenerated cartilage was assessed by cell viability, growth, matrix synthesis, and differentiation. Bilateral osteochondral defects were created in 15 four-month-old male New Zealand white rabbits and segregated into three treatment groups with five in each. The groups were: 1) untreated and allogeneic chondrocytes; 2) multi-layered scaffold with and without cells; and 3) randomly aligned scaffold with and without cells. After four months of follow-up, the outcome was assessed using histology and immunostaining. RESULTS In vitro testing showed that the secreted ECM oriented itself along the fibre in multi-layered scaffolds. Both types of CG scaffolds supported cell viability, growth, and matrix synthesis. In vitro chondrogenesis on scaffold showed an around 400-fold increase in collagen type 2 (COL2A1) expression in both CG scaffolds, but the total glycosaminoglycan (GAG)/DNA deposition was 1.39-fold higher in the multi-layered scaffold than the randomly aligned scaffold. In vivo cartilage formation occurred in both multi-layered and randomly aligned scaffolds treated with and without cells, and was shown to be of hyaline phenotype on immunostaining. The defects treated with multi-layered + cells, however, showed significantly thicker cartilage formation than the randomly aligned scaffold. CONCLUSION We demonstrated that MSCs loaded CG scaffold with multi-layered zonal architecture promoted superior hyaline AC regeneration.Cite this article: Bone Joint Res 2020;9(9):601-612.
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Affiliation(s)
- Karthikeyan Rajagopal
- Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India
- Centre for Stem Cell Research (A Unit of inStem, Bengaluru), Christian Medical College, Vellore, India
| | - Sowmya Ramesh
- Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India
- Centre for Stem Cell Research (A Unit of inStem, Bengaluru), Christian Medical College, Vellore, India
| | | | - Aditya Arora
- Department of Biological Sciences & Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India
| | - Dhirendra S. Katti
- Department of Biological Sciences & Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India
| | - Vrisha Madhuri
- Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India
- Centre for Stem Cell Research (A Unit of inStem, Bengaluru), Christian Medical College, Vellore, India
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6
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Everhart JS, Campbell AB, Abouljoud MM, Kirven JC, Flanigan DC. Cost-efficacy of Knee Cartilage Defect Treatments in the United States. Am J Sports Med 2020; 48:242-251. [PMID: 31038980 DOI: 10.1177/0363546519834557] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multiple knee cartilage defect treatments are available in the United States, although the cost-efficacy of these therapies in various clinical scenarios is not well understood. PURPOSE/HYPOTHESIS The purpose was to determine cost-efficacy of cartilage therapies in the United States with available mid- or long-term outcomes data. The authors hypothesized that cartilage treatment strategies currently approved for commercial use in the United States will be cost-effective, as defined by a cost <$50,000 per quality-adjusted life-year over 10 years. STUDY DESIGN Systematic review. METHODS A systematic search was performed for prospective cartilage treatment outcome studies of therapies commercially available in the United States with minimum 5-year follow-up and report of pre- and posttreatment International Knee Documentation Committee subjective scores. Cost-efficacy over 10 years was determined with Markov modeling and consideration of early reoperation or revision surgery for treatment failure. RESULTS Twenty-two studies were included, with available outcomes data on microfracture, osteochondral autograft, osteochondral allograft (OCA), autologous chondrocyte implantation (ACI), and matrix-induced ACI. Mean improvement in International Knee Documentation Committee subjective scores at final follow-up ranged from 17.7 for microfracture of defects >3 cm2 to 36.0 for OCA of bipolar lesions. Failure rates ranged from <5% for osteochondral autograft for defects requiring 1 or 2 plugs to 46% for OCA of bipolar defects. All treatments were cost-effective over 10 years in the baseline model if costs were increased 50% or if failure rates were increased an additional 15%. However, if efficacy was decreased by a minimum clinically important amount, then ACI (periosteal cover) of femoral condylar lesions ($51,379 per quality-adjusted life-year), OCA of bipolar lesions ($66,255) or the patella ($66,975), and microfracture of defects >3 cm2 ($127,782) became cost-ineffective over 10 years. CONCLUSION Currently employed treatments for knee cartilage defects in the United States are cost-effective in most clinically acceptable applications. Microfracture is not a cost-effective initial treatment of defects >3 cm2. OCA transplantation of the patella or bipolar lesions is potentially cost-ineffective and should be used judiciously.
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Affiliation(s)
- Joshua S Everhart
- Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Andrew B Campbell
- Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Moneer M Abouljoud
- Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - J Caid Kirven
- Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - David C Flanigan
- Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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7
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Naylor JP. A critical review of the literature on arthroscopic autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation for acetabular chondral defects. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2017.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Significant acetabular chondral defects are a common clinical finding during hip arthroscopy, for which the current surgical management approach may be falling short. Autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation are two novel cell-regenerative therapies that offer a way to repair acetabular chondral defects. Methods A literature search of Cochrane, CINAHL, AMED and Medline (2007–2017) databases revealed seven relevant articles, but only four involved a hip arthroscopic approach. Results All included studies demonstrated some significant improvements in patient-reported outcomes for autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation. There appears to be a practical advantage in terms of cost and convenience for using one-step autologous matrix-induced chondrogenesis. However, over-reliance on one particular research team and use of small-scale retrospective studies constitutes low-level, non-generalisable evidence. Conclusions The literature does not convincingly support either of these new applications over and above any other currently available treatments. Further research is needed and should involve different centres, longer follow-ups and place a higher emphasis on methodological rigour in order to maximise the trustworthiness of results.
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Affiliation(s)
- John P Naylor
- Senior Physiotherapist, Hull University Teaching Hospitals NHS Trust, Hull, UK
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8
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Nguyen VNB, Miller C, Sunderland J, McGuiness W. Understanding the Hawthorne effect in wound research-A scoping review. Int Wound J 2018; 15:1010-1024. [PMID: 30136375 PMCID: PMC7949616 DOI: 10.1111/iwj.12968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 11/26/2022] Open
Abstract
The Hawthorne Effect (HE) is considered a methodological artefact in research, although its definition and influence on research outcomes lack consensus. This review explored how this term has been mentioned and discussed in the area of wound research. A scoping review was conducted on ProQuest Central, Scopus, EbscoHost, and online databases of indexed wound journals using the methodological framework by Arksey and Malley. A review protocol was applied to detail key terms, truncation and Boolean operators, and inclusion and exclusion criteria. Search findings were reported using PRISMA guidelines. A total of 38 articles reporting primary evidence were identified. Three themes emerged from the review: wound researchers' awareness of HE, the acknowledgement of the existence or otherwise of HE, and the mentioning of HE in passing. These results reflect a lack of attention to and understanding and awareness of the HE in the area of wound research. It is suggested that the HE receives more attention as a methodological concern, and its potential influence is considered and mitigated when planning future studies. Recommendations are provided to minimise the impact of the HE on the rigour of the research and confidence afforded to research findings.
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Affiliation(s)
- Van NB Nguyen
- Alfred Health Clinical SchoolLa Trobe UniversityMelbourneVictoriaAustralia
| | - Charne Miller
- Alfred Health Clinical SchoolLa Trobe UniversityMelbourneVictoriaAustralia
| | - Janine Sunderland
- Alfred Health Clinical SchoolLa Trobe UniversityMelbourneVictoriaAustralia
| | - William McGuiness
- Alfred Health Clinical SchoolLa Trobe UniversityMelbourneVictoriaAustralia
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Ruta DJ, Villarreal AD, Richardson DR. Orthopedic Surgical Options for Joint Cartilage Repair and Restoration. Phys Med Rehabil Clin N Am 2018; 27:1019-1042. [PMID: 27788899 DOI: 10.1016/j.pmr.2016.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The limited natural capacity for articular cartilage to regenerate has led to a continuously broadening array of surgical interventions. Used once patients' symptoms are not relieved by nonoperative management, these share the goals of joint preservation and restoration. Techniques include bone marrow stimulation, whole-tissue transplantation, and cell-based strategies, each with its own variations. Many of these interventions are performed arthroscopically or with extended-portal techniques. Indications, operative techniques, unique benefits, and limitations are presented.
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Affiliation(s)
- David J Ruta
- St. Luke's Department of Orthopedics & Sports Medicine, Duluth, MN, USA.
| | - Arturo D Villarreal
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - David R Richardson
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
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10
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Krill M, Early N, Everhart JS, Flanigan DC. Autologous Chondrocyte Implantation (ACI) for Knee Cartilage Defects. JBJS Rev 2018; 6:e5. [DOI: 10.2106/jbjs.rvw.17.00078] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Simplified Chinese Version of University of California at Los Angeles Activity Score for Arthroplasty and Arthroscopy: Cross-Cultural Adaptation and Validation. J Arthroplasty 2017; 32:2706-2711. [PMID: 28483213 DOI: 10.1016/j.arth.2017.03.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/17/2017] [Accepted: 03/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To translate and cross-culturally adapt the University of California at Los Angeles (UCLA) activity score into a simplified Chinese version (UCLA-C) and evaluate the reliability and validity of the UCLA-C for patients with both knee arthroscopy and total knee arthroplasty. METHODS Cross-cultural adaptation was performed according to the internationally recognized guidelines of the American Academy of Orthopaedic Surgeons Outcome Committee. A total of 200 participants (100 arthroscopy and 100 total knee arthroplasty) were recruited in this study. An intraclass correlation coefficient (ICC) was used to determine reliability. Construct validity was analyzed by evaluating the correlations between UCLA-C and the Tegner activity score, Knee Injury and Osteoarthritis Outcome Score, and the short-form (36) health survey. RESULTS The original version of the UCLA activity score was cross-culturally well adapted and translated into simplified Chinese. UCLA-C was found to have excellent reliability in both arthroscopy (ICC = 0.984, 95% confidence interval 0.976-0.989) and arthroplasty (ICC = 0.946, 95% confidence interval 0.920-0.964). Absolute reliability as evaluated by minimal detectable change was 0.789 and 0.837 for both arthroscopy and arthroplasty groups. Moderate to high correlations between UCLA-C and Tegner activity score (0.799, P < .001); Knee Injury and Osteoarthritis Outcome Score (0.449-0.715, P < .001); and Physical Functioning, Pain, General Health, and Social Functioning (0.549-0.746, P < .001) subdomains of short-form (36) health survey were observed. CONCLUSION UCLA-C was demonstrated to have excellent acceptability, reliability, and validity in both arthroscopy and arthroplasty, and could be recommended for patients in mainland China.
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Flanigan DC, Carey JL, Brophy RH, Graham WC, DiBartola AC, Hamilton D, Nagaraja HN, Lattermann C. Interrater and Intrarater Reliability of Arthroscopic Measurements of Articular Cartilage Defects in the Knee. J Bone Joint Surg Am 2017. [PMID: 28632586 DOI: 10.2106/jbjs.16.01132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cartilage lesions of the knee are difficult to treat. Lesion size is a critical factor in treatment algorithms, and the accurate, reproducible sizing of lesions is important. In this study, we evaluated the interrater and intrarater reliability of, and correlations in relation to, various arthroscopic sizing techniques. METHODS Five lesions were created in each of 10 cadaveric knees (International Cartilage Repair Society grade 3C). Three orthopaedic surgeons used 4 techniques (visualization and use of a 3-mm probe, a simple metal ruler, and a sliding metallic ruler tool) to estimate lesion size. Repeated-measures data were analyzed using a mixed-effect linear model. The differences between observed and gold-standard (plastic mold) values were used as the response. Intraclass and interclass correlation coefficient (ICC) values for intrarater and interrater reliability were computed, as were overall correlation coefficients between measurements and gold standards. RESULTS The mean lesion size was 2.37 cm (range, 0.36 to 6.02 cm). Rater, lesion location and size, and measurement method all affected the cartilage defect measurements. Surgeons underestimated lesion size, and measurements of larger lesions had a higher percentage of error compared with those of smaller lesions. When compared with plastic molds of lesions, 60.5% of surgeon measurements underestimated lesion size. Overall, the correlation between measurements and gold standards was strongest for the simple metal ruler method and weakest for the visualization method. CONCLUSIONS Several factors may influence arthroscopic estimation of cartilage lesion size: the lesion location, measurement tool, surgeon, and defect size itself. The intrarater and interrater reliability was moderate to good using a 3-mm probe, sliding metallic ruler tool, or simple metal ruler and was fair to moderate using visualization only. CLINICAL RELEVANCE There is a need for more accurate methods of determining the size of articular cartilage lesions.
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Affiliation(s)
- David C Flanigan
- 1Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics (D.C.F., W.C.G., and A.C.D.), Division of Biostatistics, College of Public Health (H.N.N.), and Wexner Medical Center (D.C.F. and A.C.D.), The Ohio State University, Columbus, Ohio 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 3Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri 4OrthoCarolina, Pineville, North Carolina 5University of Kentucky, Lexington, Kentucky
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Denisov LN, Tsvetkova ES, Golubev GS, Bugrova OV, Dydykina IS, Dubikov AI, Menshikova LV, Peshekhonova LK, Rebrov AP, Torgashin AN, Trofimov EA, Yakupova SP, Zonova EV, Brewer O, Cooper C, Reginster J, Knyazeva LA. THE EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS AND OSTEOARTHRITIS (ESCEO) ALGORITHM FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS IS APPLICABLE TO RUSSIAN CLINICAL PRACTICE: A CONSENSUS STATEMENT OF LEADING RUSSIAN AND ESCEO OSTEOARTHRITIS EXPERTS. ACTA ACUST UNITED AC 2017. [DOI: 10.14412/1995-4484-2016-641-653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.
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Affiliation(s)
| | | | - G. Sh. Golubev
- Rostov State Medical University, Ministry of Health of Russia
| | - O. V. Bugrova
- Orenburg State Medical University, Ministry of Health of Russia
| | | | - A. I. Dubikov
- Pacific State Medical University, Ministry of Health of Russia
| | | | | | - A. P. Rebrov
- V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia
| | - A. N. Torgashin
- N.N. Priorov Central Research Institute of Traumatology and Orthopedics, Ministry of Health of Russia
| | - E. A. Trofimov
- I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia
| | - S. P. Yakupova
- Kazan State Medical University, Ministry of Health of Russia
| | - E. V. Zonova
- Railway Clinical Hospital at the Novosibirsk-Main Station, OAO «RZhD»
| | - O. Brewer
- Epidemiology, and Health Economics, Centre Hospitalier Universitaire in Sart-Tilman, Universite de Liege
| | - C. Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - J. Reginster
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford
| | - L. A. Knyazeva
- Kursk State Medical University, Ministry of Health of Russia
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14
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Aae TF, Randsborg PH, Breen AB, Visnes H, Vindfeld S, Sivertsen EA, Løken S, Brinchmann J, Hanvold HA, Årøen A. Norwegican Cartilage Project - a study protocol for a double-blinded randomized controlled trial comparing arthroscopic microfracture with arthroscopic debridement in focal cartilage defects in the knee. BMC Musculoskelet Disord 2016; 17:292. [PMID: 27422025 PMCID: PMC4947343 DOI: 10.1186/s12891-016-1156-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/02/2016] [Indexed: 01/30/2023] Open
Abstract
Background Focal lesions to the articular cartilage in the knee might have demolishing consequences to the knee. There exists a wide range of possible surgical procedures targeting these injuries, however no significant differences have been found between these procedures. This may support that the improvement is a result of rehabilitation, and not the surgery itself. Arthroscopic microfracture (MF) treatment has gained popularity, and has become the treatment of choice in patients with knee cartilage defects globally. In this study we want to increase knowledge, both clinical and economic, about arthroscopic microfracture (AF) compared to arthroscopic debridement (AD) and physical rehabilitation both in the short run, and in the long run. Methods/Design To compare arthroscopic microfracture with arthroscopic debridement and physiotherapy for the treatment of focal cartilage lesions in the knee, a long-term, double-blinded, randomized controlled multicenter trial will be conducted. A total of 114 men and non-pregnant women with a symptomatic focal full thickness cartilage lesion in the knee less than 2 cm2 will be included in the study. The two treatment allocations will receive identical rehabilitation, which is made up of 3 phases: accommodation, rehabilitation and return to activity. Follow up is 24 months, where all will be invited to participate in late follow ups after 5 and 10 years. The Knee Injury and Osteoarthritis Outcome Score (KOOS) knee-related quality of life (QoL) subscore is the primary endpoint. Clinical parameters, questionnaires and radiologic modalities (Magnetic Resonance Imaging (MRI) and x-ray) will be used as secondary endpoints. Discussion This is an ongoing multicenter study with a high level of evidence to compare arthroscopic microfracture with arthroscopic debridement and physiotherapy for the treatment of isolated symptomatic full thickness cartilage lesions in the knee joint. Trial registration ClinicalTrials.gov ID: NCT02637505 (December 15, 2015).
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Affiliation(s)
- Tommy Frøseth Aae
- Department of Orthopedic Surgery, Kristiansund Hospital, Kristiansund, Norway.
| | - Per-Henrik Randsborg
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Anne Berg Breen
- Department of Orthopedic Surgery, Ålesund Hospital, Ålesund, Norway
| | - Håvard Visnes
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Søren Vindfeld
- Department of Orthopedic Surgery, Haraldsplass Deaconess Hospital, Deaconess, Norway
| | | | - Sverre Løken
- Department of Orthopedics, Oslo University Hospital, Oslo, Norway
| | - Jan Brinchmann
- Department of Immunology and Norwegian Center for Stem Cell Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Asbjørn Årøen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
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