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Gardashli M, Baron M, Huang C, Kaplan LD, Meng Z, Kouroupis D, Best TM. Mechanical loading and orthobiologic therapies in the treatment of post-traumatic osteoarthritis (PTOA): a comprehensive review. Front Bioeng Biotechnol 2024; 12:1401207. [PMID: 38978717 PMCID: PMC11228341 DOI: 10.3389/fbioe.2024.1401207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/03/2024] [Indexed: 07/10/2024] Open
Abstract
The importance of mechanical loading and its relationship to orthobiologic therapies in the treatment of post-traumatic osteoarthritis (PTOA) is beginning to receive attention. This review explores the current efficacy of orthobiologic interventions, notably platelet-rich plasma (PRP), bone marrow aspirate (BMA), and mesenchymal stem/stromal cells (MSCs), in combating PTOA drawing from a comprehensive review of both preclinical animal models and human clinical studies. This review suggests why mechanical joint loading, such as running, might improve outcomes in PTOA management in conjunction with orthiobiologic administration. Accumulating evidence underscores the influence of mechanical loading on chondrocyte behavior and its pivotal role in PTOA pathogenesis. Dynamic loading has been identified as a key factor for optimal articular cartilage (AC) health and function, offering the potential to slow down or even reverse PTOA progression. We hypothesize that integrating the activation of mechanotransduction pathways with orthobiologic treatment strategies may hold a key to mitigating or even preventing PTOA development. Specific loading patterns incorporating exercise and physical activity for optimal joint health remain to be defined, particularly in the clinical setting following joint trauma.
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Affiliation(s)
- Mahammad Gardashli
- Department of Education, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Max Baron
- Department of Education, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Charles Huang
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Lee D Kaplan
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Zhipeng Meng
- Department of Molecular and Cellular Pharmacology and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Dimitrios Kouroupis
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
- Diabetes Research Institute and Cell Transplant Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
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Zhao H, Li H, Xie X, Tang HY, Liu XX, Wen Y, Xiao X, Ye L, Tang YW, Dai GY, He JN, Chen L, Wang Q, Tang DQ, Pan SN. Dual-energy CT virtual non-calcium: an accurate method for detection of knee osteoarthritis-related edema-like marrow signal intensity. Insights Imaging 2023; 14:74. [PMID: 37121955 PMCID: PMC10149542 DOI: 10.1186/s13244-023-01407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/11/2023] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES To evaluate the performance of a dual-energy computed tomography (DECT) virtual non-calcium (VNCa) technique in the detection of edema-like marrow signal intensity (ELMSI) in patients with knee joint osteoarthritis (OA) compared to magnetic resonance imaging (MRI). METHODS The study received local ethics board approval, and written informed consent was obtained. DECT and MRI were used to examine 28 knees in 24 patients with OA. VNCa images were generated by dual-energy subtraction of calcium. The knee joint was divided into 15 regions for ELMSI grading, performed independently by two musculoskeletal radiologists, with MRI as the reference standard. We also analyzed CT numbers through receiver operating characteristics and calculated cut-off values. RESULTS For the qualitative analysis, we obtained CT sensitivity (Readers 1, 2 = 83.7%, 89.8%), specificity (Readers 1, 2 = 99.5%, 99.5%), positive predictive value (Readers 1, 2 = 95.3%, 95.7%), and negative predictive value (Readers 1, 2 = 97.9%, 98.7%) for ELMSI. The interobserver agreement was excellent (κ = 0.92). The area under the curve for Reader 1 and Reader 2 was 0.961 (95% CI 0.93, 0.99) and 0.992 (95% CI 0.98, 1.00), respectively. CT numbers obtained from the VNCa images were significantly different between regions with and without ELMSI (p < .001). CONCLUSIONS VNCa images have good diagnostic performance for the qualitative and quantitative analysis of knee osteoarthritis-related ELMSI.
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Affiliation(s)
- Heng Zhao
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning, China
| | - Hui Li
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- Department of Radiology, The First People's Hospital of Zhaoqing City, Zhaoqing, China
| | - Xia Xie
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Hai-Yan Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xiao-Xin Liu
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Yi Wen
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xin Xiao
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Lu Ye
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - You-Wei Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Gao-Yue Dai
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Jia-Ni He
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Li Chen
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Qian Wang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - De-Qiu Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
| | - Shi-Nong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning, China.
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Gajardo-Burgos R, Monrroy-Uarac M, Barría-Pailaquilén RM, Norambuena-Noches Y, van Rensburg DCJ, Bascour-Sandoval C, Besomi M. Frequency of Injury and Illness in the Final 4 Weeks before a Trail Running Competition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105431. [PMID: 34069583 PMCID: PMC8160869 DOI: 10.3390/ijerph18105431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
We aimed to (i) determine self-reported injury and illness frequency in trail runners 4 weeks preceding competition; (ii) compare athletes with and without injury/illness by sex, age, body mass index (BMI) and competition distance; (iii) describe mechanism of injury, anatomical region (injury)/organ system (illness) involved, consequences of injury on preparation and self-perception of injury severity; (iv) compare anatomical region (injury) and organ system (illness) by sex. A total of 654 trail runners (age 36.2, IQR 30.6-43.0; 36.9% females) participated in this retrospective cross-sectional study by completing a self-reported questionnaire. Injury and illness frequency rates were 31.3% (n = 205, CI: 27.7-35.0%) and 22.3% (n = 146, CI: 19.1-25.7%), respectively. No significant difference was found between injured vs. non-injured or ill vs. non-ill study participants by sex, age, BMI and competition distance. Regarding injuries, gradual onset (41.6%) and knee (33.2%) were the most indicated mechanism and anatomical region of injury. At least 85.4% of trail runners changed their training following injury and 79% indicated that their injury would affect their competition performance. Regarding illness, the respiratory tract was the most frequent organ system involved (82.9%). Male and female participants reported similar proportions of anatomical regions (injury) and organ systems (illness) affected. These results could help to generate education strategies and appropriate medical support before and during these competitions.
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Affiliation(s)
- Rubén Gajardo-Burgos
- Facultad de Medicina, Instituto de Aparato Locomotor y Rehabilitación, Universidad Austral de Chile, Valdivia 5090000, Chile; (M.M.-U.); (R.M.B.-P.)
- Correspondence: ; Tel.: +56-632293171; Fax: +56-632293727
| | - Manuel Monrroy-Uarac
- Facultad de Medicina, Instituto de Aparato Locomotor y Rehabilitación, Universidad Austral de Chile, Valdivia 5090000, Chile; (M.M.-U.); (R.M.B.-P.)
| | - René Mauricio Barría-Pailaquilén
- Facultad de Medicina, Instituto de Aparato Locomotor y Rehabilitación, Universidad Austral de Chile, Valdivia 5090000, Chile; (M.M.-U.); (R.M.B.-P.)
- Instituto de Enfermería, Universidad Austral de Chile, Valdivia 5090000, Chile
| | | | - Dina Christa Janse van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
- Medical Board Member, International Netball Federation, Manchester M1 5LN, UK
| | - Claudio Bascour-Sandoval
- Departamento de Medicina Interna, Universidad de La Frontera, Temuco 4781218, Chile;
- Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco 4810101, Chile
| | - Manuela Besomi
- Escuela de Kinesiología, Universidad del Desarrollo, Santiago 7610658, Chile;
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Rubin EB, Mazzoli V, Black MS, Young K, Desai AD, Koff MF, Sreedhar A, Kogan F, Safran MR, Vincentini DJ, Knox KA, Yamada T, McCabe A, Majumdar S, Potter HG, Gold GE. Effects of the Competitive Season and Off-Season on Knee Articular Cartilage in Collegiate Basketball Players Using Quantitative MRI: A Multicenter Study. J Magn Reson Imaging 2021; 54:840-851. [PMID: 33763929 DOI: 10.1002/jmri.27610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Injuries to the articular cartilage in the knee are common in jumping athletes, particularly high-level basketball players. Unfortunately, these are often diagnosed at a late stage of the disease process, after tissue loss has already occurred. PURPOSE/HYPOTHESIS To evaluate longitudinal changes in knee articular cartilage and knee function in National Collegiate Athletic Association (NCAA) basketball players and their evolution over the competitive season and off-season. STUDY TYPE Longitudinal, multisite cohort study. POPULATION Thirty-two NCAA Division 1 athletes: 22 basketball players and 10 swimmers. FIELD STRENGTH/SEQUENCE Bilateral magnetic resonance imaging (MRI) using a combined T1ρ and T2 magnetization-prepared angle-modulated portioned k-space spoiled gradient-echo snapshots (MAPSS) sequence at 3T. ASSESSMENT We calculated T2 and T1ρ relaxation times to compare compositional cartilage changes between three timepoints: preseason 1, postseason 1, and preseason 2. Knee Osteoarthritis Outcome Scores (KOOS) were used to assess knee health. STATISTICAL TESTS One-way variance model hypothesis test, general linear model, and chi-squared test. RESULTS In the femoral articular cartilage of all athletes, we saw a global decrease in T2 and T1ρ relaxation times during the competitive season (all P < 0.05) and an increase in T2 and T1ρ relaxation times during the off-season (all P < 0.05). In the basketball players' femoral cartilage, the anterior and central compartments respectively had the highest T2 and T1ρ relaxation times following the competitive season and off-season. The basketball players had significantly lower KOOS measures in every domain compared with the swimmers: Pain (P < 0.05), Symptoms (P < 0.05), Function in Daily Living (P < 0.05), Function in Sport/Recreation (P < 0.05), and Quality of Life (P < 0.05). CONCLUSION Our results indicate that T2 and T1ρ MRI can detect significant seasonal changes in the articular cartilage of basketball players and that there are regional differences in the articular cartilage that are indicative of basketball-specific stress on the femoral cartilage. This study demonstrates the potential of quantitative MRI to monitor global and regional cartilage health in athletes at risk of developing cartilage problems. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 2.
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Affiliation(s)
- Elka B Rubin
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA.,Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Marianne S Black
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Katherine Young
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Arjun D Desai
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Ashwin Sreedhar
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Dominic J Vincentini
- Stanford Department of Athletics, Stanford University, Stanford, California, USA
| | - Katelin A Knox
- Stanford Department of Athletics, Stanford University, Stanford, California, USA
| | - Tomoo Yamada
- Stanford Department of Athletics, Stanford University, Stanford, California, USA
| | - Andrew McCabe
- Santa Clara Department of Athletics, Santa Clara University, Santa Clara, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA
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