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Leite CBG, Smith R, Lavoie-Gagne OZ, Görtz S, Lattermann C. Biologic Impact of Anterior Cruciate Ligament Injury and Reconstruction. Clin Sports Med 2024; 43:501-512. [PMID: 38811124 DOI: 10.1016/j.csm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Surgical intervention after anterior cruciate ligament (ACL) tears is typically required because of the limited healing capacity of the ACL. However, mechanical factors and the inflammatory response triggered by the injury and surgery can impact patient outcomes. This review explores key aspects of ACL injury and reconstruction biology, including the inflammatory response, limited spontaneous healing, secondary inflammation after reconstruction, and graft healing processes. Understanding these biologic mechanisms is crucial for developing new treatment strategies and enhancing patient well-being. By shedding light on these aspects, clinicians and researchers can work toward improving quality of life for individuals affected by ACL tears.
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Affiliation(s)
- Chilan B G Leite
- Department of Orthopaedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Richard Smith
- Department of Orthopaedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Ophelie Z Lavoie-Gagne
- Department of Orthopaedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Simon Görtz
- Department of Orthopaedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Christian Lattermann
- Department of Orthopaedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Herger S, Wirth W, Eckstein F, Nüesch C, Egloff C, Mündermann A. Anterior cruciate ligament injury and age affect knee cartilage T2 but not thickness. Osteoarthritis Cartilage 2024:S1063-4584(24)01269-X. [PMID: 38950877 DOI: 10.1016/j.joca.2024.06.014] [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] [Received: 06/23/2023] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To investigate the effect of unilateral anterior cruciate ligament (ACL) injury on cartilage thickness and composition, specifically laminar transverse relaxation time (T2) by magnetic resonance imaging (MRI), in younger and older participants and to compare within-person side differences in these parameters between ACL-injured and healthy controls. DESIGN Quantitative double-echo steady-state 3 Tesla MRI-sequences were acquired in both knees of 85 participants in four groups: 20-30 years: healthy, HEA20-30, n = 24; ACL-injured, ACL20-30, n = 23; 40-60 years: healthy, HEA40-60, n = 24; ACL-injured, ACL40-60, n = 14 (ACL injury 2-10 years prior to study inclusion). Weight-bearing femorotibial cartilages were manually segmented; cartilage T2 and thickness were computed using custom software. Mean and side differences in subregional cartilage thickness, superficial and deep cartilage T2 were compared within and between groups using non-parametric statistics. RESULTS Cartilage thickness did not differ within or between groups. Only the side difference in medial femorotibial cartilage thickness was greater in ACL20-30 than in HEA20-30. Deep zone T2 was longer in the ACL-injured than in the contralateral uninjured knees and than in healthy controls, especially in the lateral compartment. Most ACL-injured participants had side differences in femorotibial deep zone T2 above the threshold derived from controls. CONCLUSION In the ACL-injured knee, early compositional differences in femorotibial cartilage (T2) appear to occur in the deep zone and precede cartilage thickness loss. These results suggest that monitoring laminar T2 after ACL injury may be useful in diagnosing and monitoring early articular cartilage changes.
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Affiliation(s)
- Simon Herger
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Wolfgang Wirth
- Research Program for Musculoskeletal Imaging, Center of Anatomy and Cell Biology, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Felix Eckstein
- Research Program for Musculoskeletal Imaging, Center of Anatomy and Cell Biology, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Corina Nüesch
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Christian Egloff
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland.
| | - Annegret Mündermann
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
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Leite CBG, Merkely G, Charles JF, Lattermann C. From Inflammation to Resolution: Specialized Pro-resolving Mediators in Posttraumatic Osteoarthritis. Curr Osteoporos Rep 2023; 21:758-770. [PMID: 37615856 DOI: 10.1007/s11914-023-00817-3] [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] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW To provide a comprehensive overview of the inflammatory response following anterior cruciate ligament (ACL) injury and to highlight the relationship between specialized pro-resolving mediators (SPMs) and inflammatory joint conditions, emphasizing the therapeutic potential of modulating the post-injury resolution of inflammation to prevent posttraumatic osteoarthritis (PTOA). RECENT FINDINGS The inflammatory response triggered after joint injuries such as ACL tear plays a critical role in posttraumatic osteoarthritis development. Inflammation is a necessary process for tissue healing, but unresolved or overactivated inflammation can lead to chronic diseases. SPMs, a family of lipid molecules derived from essential fatty acids, have emerged as active players in the resolution of inflammation and tissue repair. While their role in other inflammatory conditions has been studied, their relationship with PTOA remains underexplored. Proinflammatory mediators contribute to cartilage degradation and PTOA pathogenesis, while anti-inflammatory and pro-resolving mediators may have chondroprotective effects. Therapies aimed at suppressing inflammation in PTOA have limitations, as inflammation is crucial for tissue healing. SPMs offer a pro-resolving response without causing immunosuppression, making them a promising therapeutic option. The known onset date of PTOA makes it amenable to early interventions, and activating pro-resolving pathways may provide new possibilities for preventing PTOA progression. Harnessing the pro-resolving potential of SPMs may hold promise for preventing PTOA and restoring tissue homeostasis and function after joint injuries.
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Affiliation(s)
- Chilan B G Leite
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 20 Patriot Place Foxboro, Boston, MA, 02035, USA
| | - Gergo Merkely
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 20 Patriot Place Foxboro, Boston, MA, 02035, USA
| | - Julia F Charles
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 20 Patriot Place Foxboro, Boston, MA, 02035, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Christian Lattermann
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 20 Patriot Place Foxboro, Boston, MA, 02035, USA.
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Jacobs CA, Ortiz SF, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Cvetanovich GL, Feeley BT, Frank RM, Jones GL, Kuhn JE, Lansdown DA, Ma CB, Mair SD, Marx RG, McCarty EC, Seidl AJ, Wright RW, Zhang AL, Wolf BR, Hettrich CM. Development and Validation of a Short-Form Version of the Western Ontario Shoulder Instability Scale (Short-WOSI). Am J Sports Med 2023; 51:2850-2857. [PMID: 37584514 DOI: 10.1177/03635465231188975] [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] [Indexed: 08/17/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) have transitioned from primarily being used as research instruments to becoming increasingly used in the clinical setting to assess recovery and inform shared decision-making. However, there is a need to develop validated short-form PROM instruments to decrease patient burden and ease incorporation into clinical practice. PURPOSE To assess the validity and responsiveness of a shortened version of the Western Ontario Shoulder Instability Index (Short-WOSI) when compared with the full WOSI and other shoulder-related PROM instruments. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS This study was a secondary analysis of data collected as part of an institutional review board-approved, multicenter cohort of 1160 patients undergoing surgical stabilization for shoulder instability. The following PROMs were captured preoperatively and 2 years after surgery: WOSI, American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and 36-Item Health Survey (RAND-36). The cohort was split into 2 data sets: a training set to be used in the development of the Short-WOSI (n = 580) and a test set to be used to assess the validity and responsiveness of the Short-WOSI relative to the full WOSI, ASES, SANE, and RAND-36. RESULTS The Short-WOSI demonstrated excellent internal consistency before surgery (Cronbach α = .83) and excellent internal consistency at the 2-year follow-up (Cronbach α = .93). The baseline, 2-year, and pre- to postoperative changes in Short-WOSI and WOSI were closely correlated (r > 0.90), with both demonstrating large effect sizes (Short-WOSI = 1.92, WOSI = 1.81). Neither the Short-WOSI nor the WOSI correlated well with the other PROM instruments before (r = 0.21-0.33) or after (r = 0.25-0.38) surgery. The Short-WOSI, WOSI, and SANE scores were more responsive than ASES and RAND-36 scores. CONCLUSION The 7-item Short-WOSI demonstrated excellent internal consistency and a lack of floor or ceiling effects. The Short-WOSI demonstrated excellent cross-sectional and longitudinal construct validity and was similarly responsive over time as the full WOSI. Neither the Short-WOSI nor WOSI correlated with more general shoulder PROMs, underscoring the advantage of using instability-specific instruments for this population.
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Affiliation(s)
- Cale A Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Shannon F Ortiz
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Julie Y Bishop
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Matthew J Bollier
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Robert H Brophy
- Department of Orthopedics, Washington University Saint Louis, St Louis, Missouri, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Gregory L Cvetanovich
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Grant L Jones
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Scott D Mair
- University of Kentucky Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Carolyn M Hettrich
- North Country Orthopaedics, Clayton, New York, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
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Hutchinson ID, Rodeo SA. The Current Role of Biologics for Meniscus Injury and Treatment. Curr Rev Musculoskelet Med 2022; 15:456-464. [PMID: 35881326 PMCID: PMC9789233 DOI: 10.1007/s12178-022-09778-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW There is little doubt that the consensus has changed to favor preservation of meniscal function where possible. Accordingly, the indications for meniscal repair strategies have been refocused on the long-term interest of knee joint health. The development and refinements in surgical technique have been complemented by biological augmentation strategies to address intrinsic challenges in healing capacity of meniscal tissue, with variable effects. RECENT FINDINGS A contemporary approach to meniscal healing includes adequate surgical fixation, meniscal and synovial tissue stimulation, and management of the intraarticular milieu. Overall, evidence supporting the use of autogenous or allogeneic cell sources remains limited. The use of FDA-approved medications to effect biologically favorable mechanisms during meniscal healing holds promise. Development and characterization of biologics continue to advance with translational research focused on specific growth factors, cell and tissue behaviors in meniscal healing, and joint homeostasis. Although significant strides have been made in laboratory and pre-clinical studies, translation to clinical application remains challenging. Finally, expert consensus and standardization of nomenclature related to orthobiologics for meniscal preservation will be important for the advancement of this field.
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Affiliation(s)
- Ian D. Hutchinson
- grid.239915.50000 0001 2285 8823Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,grid.239915.50000 0001 2285 8823Laboratory for Tissue Engineering, Regeneration & Repair, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Scott A. Rodeo
- grid.239915.50000 0001 2285 8823Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,grid.239915.50000 0001 2285 8823Laboratory for Tissue Engineering, Regeneration & Repair, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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