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Oputa TJ, Shaw S, Jain N. Continuous suture all-inside meniscal repair technique produces excellent functional outcomes and return to play rates with a low rate of failure. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04061-y. [PMID: 39138667 DOI: 10.1007/s00590-024-04061-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND The all-inside technique is now the most established treatment for meniscal repair, this usually involves a suture-based repair utilising interrupted sutures. A similar technique using continuous sutures can also be used; however there are no studies in the literature appraising this technique. This study aims to review outcomes for patients undergoing meniscal repair using a continuous suture all-inside technique. METHODS We reviewed patients undergoing meniscal repair using a continuous suture all-inside technique over a 5 year period. We recorded demographic details, injury type, surgical procedure, incidence of reoperation, functional outcomes (Tegner-Lysholm and International Knee Documentation Committee (IKDC) score) return to sport and failure of repair. RESULTS Data were collected for 37 patients. Mean age was 25.8 years, 81%, were male, median time to theatre was 169 days, mean follow-up time was 2.9 years. Concurrent ACL ruptures were present in 57%, all underwent ACL reconstruction in the same sitting. The mean Tegner-Lysholm score was 89. Mean IKDC score was 90.2. 78% were able to return to sport. Overall failure rate was 10.81%. Increasing age was associated with a decreased IKDC score (p = 0.02). Tegner-Lysholm score was significantly greater in patients with concurrent ACL injuries (p = 0.03) and patients with lateral meniscal tears (p = 0.04). CONCLUSION In the first study to review outcomes following continuous all-inside suture-based meniscal repair we demonstrate excellent clinical outcomes with IKDC, Tegner-Lysholm, return to play and failure rates comparable to other commonly used techniques. We conclude that this is an acceptable and cost-effective technique.
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Affiliation(s)
- Tobenna Jerris Oputa
- Trauma and Orthopaedics Surgery, Lancashire Teaching Hospitals, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, PR2 9HT, UK.
| | - Sarah Shaw
- Trauma and Orthopaedics Surgery, Northern Care Alliance, Fairfield General Hospital, Rochdale Old, Road Bury, Lancashire, BL9 7TD, UK
| | - Neil Jain
- Trauma and Orthopaedics Surgery, Northern Care Alliance, Fairfield General Hospital, Rochdale Old, Road Bury, Lancashire, BL9 7TD, UK
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Reiter CR, Wyatt PB, O'Neill CN, Satalich JR, O'Connell RS, Vap AR. Increased Age, Operative Time, American Society of Anesthesiologists Classification, Functional Dependency, and Comorbidity Burden Are Risk Factors for Adverse Events After Meniscectomy and Meniscus Repair: 10-Year Analysis of 64,223 Patients. Arthroscopy 2024; 40:1848-1855. [PMID: 37967730 DOI: 10.1016/j.arthro.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To use the National Surgical Quality Improvement Program (NSQIP) database to identify risk factors for 30-day adverse events and hospital readmission following isolated and unilateral meniscectomy or meniscus repair. METHODS A retrospective review of the NSQIP database from the years 2012 to 2021 identified all patients undergoing isolated, unilateral meniscectomy or meniscus repair. Multivariable analyses were performed for each procedure to identify patient characteristics associated with any adverse event (AAE) or unplanned hospital readmission within 30 days of surgery. RESULTS From 2012 to 2021, 59,450 (93%) patients underwent meniscectomy, and 4,773 (7%) patients underwent meniscus repair. Overall adverse event rate was 0.95% after meniscectomy and 1.40% after repair. Risk factors for AAE after meniscectomy included increased age (odds ratio [OR] = 1.010; P = .009), increased operative time (OR = 1.003; P = 0.011), American Society of Anesthesiologists (ASA) class IV (OR = 2.048; P = .045), functional dependency (OR = 3.527; P = .001), and current smoking (OR = 1.308; P = .018). Risk factors for AAE after meniscus repair included age (OR = 1.024; P = .016), operative time (OR = 1.004; P = .038), and bleeding disorders (OR = 7.000; P = .014). ASA class III increased risk of hospital readmission after both procedures (OR = 1.906; P = .008; OR = 4.101; P = .038), and medical comorbidities of heart failure (OR = 3.924; P = .016), hypertension (OR = 1.412; P = .011), and chronic obstructive pulmonary disease (OR = 2.350; P < .001) increased readmission risk after meniscectomy only. CONCLUSIONS Per analysis of the American College of Surgeons (ACS)-NSQIP database, surgical treatment of meniscal tears in the knee has been performed frequently over the past 10 years, with meniscectomies comprising over 90% of cases. Increased age and operative time were associated with a modest risk of adverse events after both meniscectomy and meniscus repair. Increased comorbidity burden, evidenced by ASA class, dependent functional status, current smoking, and systemic medical conditions, such as heart failure, hypertension, chronic obstructive pulmonary disease, and bleeding disorders, greatly increased rates of unfavorable outcomes within 30 days of meniscus surgery. LEVEL OF EVIDENCE Level III, retrospective prognostic comparative investigation.
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Affiliation(s)
- Charles R Reiter
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A..
| | - Phillip B Wyatt
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Conor N O'Neill
- Duke University Health System, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - James R Satalich
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Robert S O'Connell
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Alexander R Vap
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
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Chang B, Schenk RJ. The influence of directional preference on lateral patellar dislocation: a case report. J Man Manip Ther 2023; 31:474-481. [PMID: 37553954 PMCID: PMC10642310 DOI: 10.1080/10669817.2023.2242203] [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] [Received: 07/20/2022] [Accepted: 05/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND There is little consensus on the conservative management of lateral patellar dislocations (LPD). Mechanical diagnosis and therapy (MDT) is an established classification system in the spinal and extremity population. This case report describes the use of MDT in the management and classification of a patient with LPD. CASE DESCRIPTION The patient was a 20-year-old female with a 3-month history of left knee pain precipitated by a lateral patellar dislocation. The patient described pain and a feeling of instability with standing and walking and limitations in work and recreational activities which involve lifting, squatting, and running. Based on the patient's response to repeated end range knee movements, the patient was found to have a directional preference (DP) for knee extension and instruction in performance of knee extension DP exercises was provided. OUTCOMES The patient's knee examination and subsequent intervention included her responses to repeated end range knee movements. Her knee pain was abolished, and strength, function, and motion were fully restored in five visits. A minimal clinically important difference (MCID) was achieved on the Lower Extremity Functional Scale (LEFS). At discharge, the patient was able to independently manage symptoms and perform all work and recreational activities at a pre-injury level and these improvements were maintained at a 9-month follow-up. DISCUSSION There are various management strategies for lateral patellar dislocation. This case demonstrated the use of classifying, subgrouping, and treating a patient with lateral patellar dislocation using the principle of DP. CONCLUSION The patient's outcomes suggest that MDT may be used in the nonoperative management of people with LPD who present with a DP.
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Affiliation(s)
- B Chang
- Rusk Rehabilitation, NYU Langone Health New York, New York, USA
| | - RJ Schenk
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, USA
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4
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Huang L, Zhang S, Wu J, Guo B, Gao T, Shah SZA, Huang B, Li Y, Zhu B, Fan J, Wang L, Xiao Y, Liu W, Tian Y, Fang Z, Lv Y, Xie L, Yao S, Ke G, Huang X, Huang Y, Li Y, Jia Y, Li Z, Feng G, Huo Y, Li W, Zhou Q, Hao J, Hu B, Chen H. Immunity-and-matrix-regulatory cells enhance cartilage regeneration for meniscus injuries: a phase I dose-escalation trial. Signal Transduct Target Ther 2023; 8:417. [PMID: 37907503 PMCID: PMC10618459 DOI: 10.1038/s41392-023-01670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023] Open
Abstract
Immunity-and-matrix-regulatory cells (IMRCs) derived from human embryonic stem cells have unique abilities in modulating immunity and regulating the extracellular matrix, which could be mass-produced with stable biological properties. Despite resemblance to mesenchymal stem cells (MSCs) in terms of self-renew and tri-lineage differentiation, the ability of IMRCs to repair the meniscus and the underlying mechanism remains undetermined. Here, we showed that IMRCs demonstrated stronger immunomodulatory and pro-regenerative potential than umbilical cord MSCs when stimulated by synovial fluid from patients with meniscus injury. Following injection into the knees of rabbits with meniscal injury, IMRCs enhanced endogenous fibrocartilage regeneration. In the dose-escalating phase I clinical trial (NCT03839238) with eighteen patients recruited, we found that intra-articular IMRCs injection in patients was safe over 12 months post-grafting. Furthermore, the effective results of magnetic resonance imaging (MRI) of meniscus repair and knee functional scores suggested that 5 × 107 cells are optimal for meniscus injury treatment. In summary, we present the first report of a phase I clinical trial using IMRCs to treat meniscus injury. Our results demonstrated that intra-articular injection of IMRCs is a safe and effective therapy by providing a permissive niche for cartilage regeneration.
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Affiliation(s)
- Liangjiang Huang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Zhang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Wu
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
| | - Baojie Guo
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Tingting Gao
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Sayed Zulfiqar Ali Shah
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajie Li
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Stem Cell Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqi Fan
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
| | - Liu Wang
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yani Xiao
- Beijing Key Lab for Pre-clinical Safety Evaluation of Drugs, National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control, Beijing, China
| | - Wenjing Liu
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Yao Tian
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Zhengyu Fang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingying Lv
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingfeng Xie
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Yao
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gaotan Ke
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Huang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Huang
- Beijing Key Lab for Pre-clinical Safety Evaluation of Drugs, National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control, Beijing, China
| | - Yujuan Li
- Beijing Zephyrm Biotechnologies Co., Ltd., Beijing, China
| | - Yi Jia
- Beijing Zephyrm Biotechnologies Co., Ltd., Beijing, China
| | - Zhongwen Li
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
| | - Guihai Feng
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yan Huo
- Beijing Key Lab for Pre-clinical Safety Evaluation of Drugs, National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control, Beijing, China
| | - Wei Li
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qi Zhou
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jie Hao
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China.
- University of Chinese Academy of Sciences, Beijing, China.
| | - Baoyang Hu
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China.
- University of Chinese Academy of Sciences, Beijing, China.
| | - Hong Chen
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Stem Cell Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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5
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Melugin HP, Brown JR, Hollenbeck JFM, Fossum BW, Whalen RJ, Ganokroj P, Provencher CMT. Increased Posterior Tibial Slope Increases Force on the Posterior Medial Meniscus Root. Am J Sports Med 2023; 51:3197-3203. [PMID: 37715505 DOI: 10.1177/03635465231195841] [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] [Indexed: 09/17/2023]
Abstract
BACKGROUND Posterior medial meniscus root (PMMR) tears have been associated with increased posterior tibial slope, but this has not been fully evaluated biomechanically. In addition, the effects of knee flexion and rotation on the PMMR are not well understood biomechanically because of technological testing limitations. A novel multiaxial force sensor has made it possible to elucidate answers to these questions. PURPOSE (1) To determine if increased posterior tibial slope results in increased posterior shear force and compression on the PMMR, (2) to evaluate how knee flexion angle affects PMMR forces, and (3) to assess how internal and external rotation affects force at the PMMR. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen cadaveric knees were tested in all combinations of 3 posterior tibial slopes and 4 flexion angles. A multiaxial force sensor was connected to the PMMR and installed below the posterior tibial plateau maintaining anatomic position. The specimen underwent a 500-N compression load followed by a 5-N·m internal torque and a 5-N·m external torque. The magnitude and direction of the forces acting on the PMMR were measured. RESULTS Under joint compression, an increased tibial slope significantly reduced the tension on the PMMR between 5° and 10° (from 13.5 N to 6.4 N), after which it transitioned to a significant increase in PMMR compression, reaching 7.6 N at 15°. Under internal torque, increased tibial slope resulted in 4.7 N of posterior shear at 5° significantly changed to 2.0 N of anterior shear at 10° and then 8.2 N of anterior shear at 15°. Under external torque, increased tibial slope significantly decreased PMMR compression (5°: 8.9 N; 10°: 4.3 N; 15°: 1.1 N). Under joint compression, increased flexion angle significantly increased medial shear forces of the PMMR (0°, 3.8 N; 30°, 6.2 N; 60°, 7.3 N; 90°, 8.4 N). Under internal torque, 90° of flexion significantly increased PMMR tension from 2.3 N to 7.5 N. Under external torque, 30° of flexion significantly increased PMMR compression from 4.7 N to 12.2 N. CONCLUSION An increased posterior tibial slope affects compression and anterior shear forces at the PMMR. An increased flexion angle affects compression, tension, and medial shear forces at the PMMR. CLINICAL RELEVANCE The increase in compression and posterior shear force when the knee is loaded in compression may place the PMMR under increased stress and risk potential failure after repair. This study provides clinicians with information to create safer protocols and improve repair techniques to minimize the forces experienced at the PMMR.
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Affiliation(s)
- Heath P Melugin
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | - Justin R Brown
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Ryan J Whalen
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lemmon EA, Bonnevie ED, Patel JM, Miller LM, Mauck RL. Transient inhibition of meniscus cell migration following acute inflammatory challenge. J Orthop Res 2023; 41:2055-2064. [PMID: 36866823 PMCID: PMC10750267 DOI: 10.1002/jor.25545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Meniscus tears represent a common orthopedic injury that often requires surgery to restore pain-free function. The need for surgical intervention is due, in part, to the inflammatory and catabolic environment that inhibits meniscus healing after injury. In other organ systems, healing is dependent on the migration of cells to the site of injury; however, in the meniscus, it is currently unknown how the microenvironment dictates cell migration in the postinjury inflamed setting. Here, we investigated how inflammatory cytokines alter meniscal fibrochondrocyte (MFC) migration and sensation of microenvironmental stiffness. We further tested whether an FDA approved interleukin-1 receptor antagonist (IL-1Ra; Anakinra) could rescue migratory deficits caused by inflammatory challenge. When cultured in the presence of inflammatory cytokines (tumor necrosis factor-α [TNF-α] or interleukin-1β [IL-1β]) for 1 day, MFC migration was inhibited for 3 days before returning to control levels at Day 7. This migratory deficit was clear in three-dimensional as well, where fewer MFCs exposed to inflammatory cytokines migrated from a living meniscal explant compared with control. Notably, addition of IL-1Ra to MFCs previously exposed to IL-1β restored migration to baseline levels. This study demonstrates that joint inflammation can have negative impacts on meniscus cell migration and mechanosensation, affecting their potential for repair, and that resolution of this inflammation with concurrent anti-inflammatories can reverse these deficits. Future work will apply these findings to mitigate the negative consequences of joint inflammation and promote repair in a clinically relevant meniscus injury model.
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Affiliation(s)
- Elisabeth A. Lemmon
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Edward D. Bonnevie
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Jay M. Patel
- Department of Orthopaedics, Emory University, Decatur, Georgia, USA
| | - Liane M. Miller
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Robert L. Mauck
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
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Nogueira FMF, Martins RP, Nery ECHP, Silva AG. A systematic search and assessment of the quality and characterisation of free mobile applications targeting knee pain. Musculoskeletal Care 2023; 21:212-220. [PMID: 36056759 DOI: 10.1002/msc.1688] [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: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022]
Abstract
Knee pain has an incidence of approximately 25% in adults and its prevalence has been increasing in the last 20 years. The use of smartphones and mobile applications (apps) has also increased in the 'Health and Fitness' field, which might be a useful complement in the rehabilitation process of these patients. However, it is necessary to investigate the quality of these mobile applications. AIM This study aimed to assess free mobile apps targeting knee pain and to characterise and critically analyse the interventions described in them. METHODS A systematic search was performed in the Apple store, Play Store and Microsoft Store. RESULTS A total of 26 applications met the inclusion criteria and were evaluated using the Mobile Apps Rating Scale (MARS), and for their content against guidelines on knee pain intervention. The mean MARS total score was 3.3 (±0.5) and the mean subjective quality score was 2.1 (±0.9) out of a maximum of 5 points each. Most apps combined different types of exercises 88% and included both exercise and pain education (62%). RESULTS These results suggest a need to improve the quality of these apps aiming to create more engagement and improve app usage. Additionally, as health apps may be useful in pain management and be an alternative to complement rehabilitation, the involvement of health professionals is important during the development process of the apps including evidence-based content and progression recommendations.
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Affiliation(s)
| | - Ricardo P Martins
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | | | - Anabela G Silva
- CINTESIS.UA@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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8
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Short S, Tuttle M, Youngman D. A Clinically-Reasoned Approach to Manual Therapy in Sports Physical Therapy. Int J Sports Phys Ther 2023; 18:262-271. [PMID: 36793565 PMCID: PMC9897024 DOI: 10.26603/001c.67936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/03/2022] [Indexed: 02/05/2023] Open
Abstract
Symptom modification techniques have been recently dichotomously labeled as either passive or active therapies. Active therapy such as exercise has been rightfully advocated for while "passive" therapies, mainly manual therapy have been regarded as low value within the physical therapy treatment spectrum. In sporting environments where physical activity and exercise are inherent to the athletic experience, the utilization of exercise-only strategies to manage pain and injury can be challenging when considering the demands and qualities of a sporting career which include chronically high internal and external workloads. Participation may be impacted by pain and its influence on related factors such as training and competition performance, career length, financial earning potential, educational opportunity, social pressures, influence of family, friends, and other key stakeholders of their athletic activity. Though highly polarizing viewpoints regarding different therapies create black and white "sides," a pragmatic gray area regarding manual therapy exists in which proper clinical reasoning can serve to improve athlete pain and injury management. This gray area includes both historic positive reported short-term outcomes and negative historical biomechanical underpinnings that have created unfounded dogma and inappropriate overutilization. Applying symptom modification strategies to safely allow the continuation of sport and exercise requires critical thinking utilizing not only the evidence-base, but also the multi-factorial nature of sports participation and pain management. Given the risks associated with pharmacological pain management, the cost of passive modalities like biophysical agents (electrical stimulation, photobiomodulation, ultrasound, etc), and the indications from the evidence-base when combined with active therapies, manual therapy can be a safe and effective treatment strategy to keep athletes active. Level of Evidence 5.
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9
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Streeter SS, Hebert KA, Bateman LM, Ray GS, Dean RE, Geffken KT, Resnick CT, Austin DC, Bell JE, Sparks MB, Gibbs SL, Samkoe KS, Gitajn IL, Elliott JT, Henderson ER. Current and Future Applications of Fluorescence Guidance in Orthopaedic Surgery. Mol Imaging Biol 2023; 25:46-57. [PMID: 36447084 PMCID: PMC10106269 DOI: 10.1007/s11307-022-01789-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
Fluorescence-guided surgery (FGS) is an evolving field that seeks to identify important anatomic structures or physiologic phenomena with helpful relevance to the execution of surgical procedures. Fluorescence labeling occurs generally via the administration of fluorescent reporters that may be molecularly targeted, enzyme-activated, or untargeted, vascular probes. Fluorescence guidance has substantially changed care strategies in numerous surgical fields; however, investigation and adoption in orthopaedic surgery have lagged. FGS shows the potential for improving patient care in orthopaedics via several applications including disease diagnosis, perfusion-based tissue healing capacity assessment, infection/tumor eradication, and anatomic structure identification. This review highlights current and future applications of fluorescence guidance in orthopaedics and identifies key challenges to translation and potential solutions.
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Affiliation(s)
- Samuel S Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
| | - Kendra A Hebert
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Logan M Bateman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA
| | - Gabrielle S Ray
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Ryan E Dean
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Kurt T Geffken
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Corey T Resnick
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Daniel C Austin
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - John-Erik Bell
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Michael B Sparks
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Summer L Gibbs
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - I Leah Gitajn
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Jonathan Thomas Elliott
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.,Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
| | - Eric R Henderson
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.,Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
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10
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da Silva LA, Thirupathi A, Colares MC, Haupenthal DPDS, Venturini LM, Corrêa MEAB, Silveira GDB, Haupenthal A, do Bomfim FRC, de Andrade TAM, Gu Y, Silveira PCL. The effectiveness of treadmill and swimming exercise in an animal model of osteoarthritis. Front Physiol 2023; 14:1101159. [PMID: 36895628 PMCID: PMC9990173 DOI: 10.3389/fphys.2023.1101159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Introduction: Osteoarthritis (OA) is considered an inflammatory and degenerative joint disease, characterized by loss of hyaline joint cartilage and adjacent bone remodeling with the formation of osteophytes, accompanied by various degrees of functional limitation and reduction in the quality of life of individuals. The objective of this work was to investigate the effects of treatment with physical exercise on the treadmill and swimming in an animal model of osteoarthritis. Methods: Forty-eight male Wistar rats were divided (n=12 per group): Sham (S); Osteoarthritis (OA); Osteoarthritis + Treadmill (OA + T); Osteoarthritis + Swimming (OA + S). The mechanical model of OA was induced by median meniscectomy. Thirty days later, the animals started the physical exercise protocols. Both protocols were performed at moderate intensity. Forty-eight hours after the end of the exercise protocols, all animals were anesthetized and euthanized for histological, molecular, and biochemical parameters analysis. Results: Physical exercise performed on a treadmill was more effective in attenuating the action of pro-inflammatory cytokines (IFN-γ, TNF-α, IL1-β, and IL6) and positively regulating anti-inflammatories such as IL4, IL10, and TGF-β in relation to other groups. Discussion: In addition to maintaining a more balanced oxi-reductive environment within the joint, treadmill exercise provided a more satisfactory morphological outcome regarding the number of chondrocytes in the histological evaluation. As an outcome, better results were found in groups submitted to exercise, mostly treadmill exercise.
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Affiliation(s)
- Leandro Almeida da Silva
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Laboratory of Experimental Phisiopatology, Program of Postgraduate in Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | | | - Mateus Cardoso Colares
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Daniela Pacheco Dos Santos Haupenthal
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Ligia Milanez Venturini
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil.,Programa de Pós Graduação em Ciências da Reabilitação, Universidade Federal de Santa Catarina, Araranguá, SC, Brazil
| | - Maria Eduarda Anastácio Borges Corrêa
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Gustavo de Bem Silveira
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Alessandro Haupenthal
- Programa de Pós Graduação em Ciências da Reabilitação, Universidade Federal de Santa Catarina, Araranguá, SC, Brazil
| | | | | | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Paulo Cesar Lock Silveira
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
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11
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Bachmaier S, Krych AJ, Smith PA, Herbort M, Ritter D, LaPrade RF, Wijdicks CA. Primary Fixation and Cyclic Performance of Single-Stitch All-Inside and Inside-Out Meniscal Devices for Repairing Vertical Longitudinal Meniscal Tears. Am J Sports Med 2022; 50:2705-2713. [PMID: 35787211 DOI: 10.1177/03635465221107086] [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: 01/31/2023]
Abstract
BACKGROUND Primary device fixation and the resistance against gap formation during repetitive loading influence the quality of meniscal repair. There are limited biomechanical data comparing primary tensioning and cyclic behavior of all-inside versus inside-out repair. HYPOTHESIS All-inside devices provide higher initial load on the meniscal repair than inside-out fixation, and stiffer constructs show higher resistance against gap formation during cyclic loading. STUDY DESIGN Controlled laboratory study. METHODS In total, 60 longitudinal bucket-handle tears in human cadaveric menisci were created and repaired with a single stitch and randomly assigned to 4 all-inside groups (TrueSpan, FastFix 360, Stryker AIR, FiberStich) and 2 inside-out groups (suture repair [IO-S], suture tape [IO-ST]). Residual load after repair tensioning (50 N) and relief displacement were measured. Constructs underwent cyclic loading between 2 and 20 N over 500 cycles (0.75 Hz) with cyclic stiffness, gap formation, and final peak elongation measured. Ultimate load and stiffness were analyzed during pull to failure (3.15 mm/s). RESULTS All-inside repair demonstrated significantly higher primary fixation strength than inside-out repair. The significantly highest load (mean ± SD; 20.1 ± 0.9 N; P < .037) and relief displacement (-2.40 ± 0.32 mm; P < .03) were for the knotless soft anchoring FiberStich group. The lowest initial load (9.0 ± 1.5 N; P < .001) and relief displacement (-1.39 ± 0.26 mm; P < .045) were for the IO-S repair group. The final gap formation (500th cycle) of FiberStich (0.75 ± 0.37 mm; P < .02) was significantly smaller than others and that of the IO-S (1.47 ± 0.33 mm; P < .045) significantly larger. The construct stiffness of the FiberStich and IO-ST groups was significantly greater at the end of cyclic testing (16.7 ± 0.80 and 15.5 ± 1.42 N/mm; P < .042, respectively) and ultimate failure testing (23.4 ± 3.6 and 20.6 ± 2.3 N/mm; P < .005). The FastFix 360 (86.4 ± 4.8 N) and Stryker AIR (84.4 ± 4.6 N) groups failed at a significantly lower load than the IO-S group (P < .02) with loss of anchor support. The FiberStich (146.8 ± 23.4 N), TrueSpan (142.0 ± 17.8 N), and IO-ST (139.4 ± 7.3 N) groups failed at significantly higher loads (P < .02) due to suture tearing. CONCLUSION Overall, primary fixation strength of inside-out meniscal repair was significantly lower than all-inside repair in this cadaveric tissue model. Although absolute differences among groups were small, meniscal repairs with higher construct stiffness (IO-ST, FiberStich) demonstrated increased resistance against gap formation and failure load. CLINICAL RELEVANCE Knotless single-stitch all-inside meniscal repair with a soft anchor resulted in less gapping, but the overall clinical significance on healing rates remains unclear.
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Affiliation(s)
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Daniel Ritter
- Department of Orthopedic Research, Arthrex, Munich, Germany
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12
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Tropf JG, Colantonio DF, Tucker CJ, Rhon DI. Epidemiology of Meniscus Injuries in the Military Health System and Predictive Factors for Arthroscopic Surgery. J Knee Surg 2022; 35:1048-1055. [PMID: 35259766 DOI: 10.1055/s-0042-1744189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Meniscus injuries occur at a higher rate in the military than the general population. Appropriate management and rehabilitation of meniscus injuries is important for maintaining readiness. The purpose of this study was to describe the health burden of meniscus injuries in the Military Health System (MHS) to identify the surgical intervention rate for meniscus injuries, and to determine which injury characteristics and demographic variables were associated with the likelihood of surgery after injury. The U.S. Department of Defense Management Analysis and Reporting Tool, a database of health care encounters by military personnel and dependents, was queried for encounters associated with a meniscal injury diagnosis between January 1, 2010, and December 31, 2011. Meniscus injuries were categorized into (1) isolated medial, (2) isolated lateral, (3) combined medial and lateral, and (4) unspecified cohorts. Patients under 18 and over 51 years were excluded, as well as patients without records at least 1 year prior to diagnosis or 2 years after. Relevant surgical procedures were identified with the Current Procedural Terminology (CPT) codes for arthroscopic surgery of the knee, meniscus repair, meniscectomy, and anterior cruciate ligament (ACL) reconstruction. There were 2,969 meniscus injuries meeting inclusion criteria during the study period. There were 1,547 (52.1%) isolated medial meniscus injuries, 530 (17.9%) isolated lateral meniscus injuries, 452 (15.3%) involved both menisci, and 435 (14.7%) were unspecified. The mean age was 35.5 years (standard deviation [SD] = 9.3). An adjacent ligamentous injury occurred in 901 patients (30.3%). The treatment course led to arthroscopic surgery in 52.8% (n = 1,568) of all meniscus injuries. Eighty-five percent (n = 385) of combined medial and lateral tears, 54.9% of medial tears, and 51.6% of lateral tears underwent surgery. Partial meniscectomy was the most common procedure performed while 47.2% (n = 1,401) of tears were not treated surgically. Bilateral meniscus injuries had 4.57 greater odds of undergoing knee arthroscopy (95% confidence interval [CI]: 3.46, 6.04), 2.42 times odds of undergoing a meniscus repair, and 4.59 times odds for undergoing a meniscus debridement (95% CI: 3.62, 5.82). The closed nature of the MHS allows reliable capture of surgical rates for meniscus injuries within the military population. Meniscus injuries are common in the military and impose a significant burden on the MHS. Appropriate management and rehabilitation of this injury is important for maintaining readiness.
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Affiliation(s)
- Jordan G Tropf
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Donald F Colantonio
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Christopher J Tucker
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
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13
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Avila A, Vasavada K, Shankar DS, Petrera M, Jazrawi LM, Strauss EJ. Current Controversies in Arthroscopic Partial Meniscectomy. Curr Rev Musculoskelet Med 2022; 15:336-343. [PMID: 35727503 DOI: 10.1007/s12178-022-09770-7] [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: 05/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Given the continued controversy among orthopedic surgeons regarding the indications and benefits of arthroscopic partial meniscectomy (APM), this review summarizes the current literature, indications, and outcomes of partial meniscectomy to treat symptomatic meniscal tears. RECENT FINDINGS In patients with symptomatic meniscal tears, the location and tear pattern play a vital role in clinical management. Tears in the central white-white zone are less amenable to repair due to poor vascularity. Patients may be indicated for APM or non-surgical intervention depending on the tear pattern and symptoms. Non-surgical management for meniscal pathology includes non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), and intraarticular injections to reduce inflammation and relieve symptoms. There have been several landmark multicenter randomized controlled trials (RCTs) studying the outcomes of APM compared to PT or sham surgery in symptomatic degenerative meniscal tears. These most notably include the 2013 Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial, the 2018 ESCAPE trial, and the sham surgery-controlled Finnish Degenerative Meniscal Lesion Study (FIDELITY), which failed to identify substantial benefits of APM over nonoperative treatment or even placebo surgery. Despite an abundance of literature exploring outcomes of APM for degenerative meniscus tears, there is little consensus among surgeons about the drivers of good outcomes following APM. It is often difficult to determine if the presenting symptoms are secondary to the meniscus pathology or the degenerative disease in patients with concomitant OA. A central tenet of managing meniscal pathology is to preserve tissue whenever possible. Most RCTs show that exercise therapy may be non-inferior to APM in degenerative tears if repair is not possible. Given this evidence, patients who fail nonoperative treatment should be counseled regarding the risks of APM before proceeding to surgical management.
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Affiliation(s)
- Amanda Avila
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA.
| | - Kinjal Vasavada
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Dhruv S Shankar
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Massimo Petrera
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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14
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Jenkins SM, Guzman A, Gardner BB, Bryant SA, Del Sol SR, McGahan P, Chen J. Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations. Curr Rev Musculoskelet Med 2022; 15:170-179. [PMID: 35381974 DOI: 10.1007/s12178-022-09752-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament reconstruction (ACLR) is a common surgical procedure with an estimated 120,000 cases performed in the USA each year. Physical therapy plays a critical role in the successful recovery of both surgically and non-surgically managed patients. Interestingly, ACL rehabilitation protocols vary greatly with little consensus among practitioners. Nonetheless, there has been agreement over the last decade to shift from conservative, standardized length protocols to more accelerated, individualized protocols that vary in length and modalities based on patient-specific findings and preferences. This review summarizes the most recent trends, opinions, and modalities in ACL rehabilitation research, with a specific focus on novel methods to treat the specific psychosocial needs of ACL deficient patients. RECENT FINDINGS We found that new protocols emphasize early weight bearing, open kinetic chain (OKC) exercises, and other alternative modalities such as neuromuscular electrical stimulation and blood flow restriction. We also found a recent trend toward the use of clinical milestones to determine when a patient is ready for the next phase of a "step-up" rehabilitation program. One particularly nascent topic of research is the inclusion of methods to treat the psychosocial impacts of ACL injury, recovery, and the anxiety around return to sport. Rehabilitation strategy has become increasingly patient-dependent, and the new modalities being utilized are accelerating patient recovery. Return to sport is a particularly important factor for many ACLR patients, and recovery has an important psychological component that has only recently been addressed in the literature, with positive preliminary findings.
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Affiliation(s)
- Sarah M Jenkins
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA.
| | - Alvarho Guzman
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Brandon B Gardner
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Stewart A Bryant
- University of Hawaii Orthopaedic Surgery Residency, Honolulu, HI, USA
| | - Shane Rayos Del Sol
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Patrick McGahan
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - James Chen
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
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15
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Strength Level of Professional Elite Soccer Players after the COVID-19 Lockdown Period: A Retrospective Double-Arm Cohort Study. JOURNAL OF SPORTS MEDICINE (HINDAWI PUBLISHING CORPORATION) 2022; 2022:8242210. [PMID: 35252459 PMCID: PMC8892033 DOI: 10.1155/2022/8242210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 01/24/2022] [Indexed: 01/30/2023]
Abstract
Background It is well known that periods of inactivity generate a loss of muscle strength, a fundamental component of sports performance in soccer. However, little information is available on the decrease in strength levels in professional soccer players after the quarantine lockdown that occurred during the COVID-19 pandemic. Aim To compare the isokinetic peak torque profiles of professional soccer players from different teams before and after the quarantine period generated by COVID-19. Methods A retrospective observational study was performed using data collected from two different professional elite-level soccer teams just before and immediately after the COVID-19 quarantine period. One team gave individual instructions to its players for conditioning maintenance at home during the quarantine period, while the other team used regular video calls to maintain the player's conditioning status on home training. The main outcomes were the mean peak torque of knee extensors and flexors, from concentric and eccentric contractions of each playing position. Analysis. A two-way ANOVA analysis was used to compare peak torque before and after the quarantine period and between both teams' strategies, showing a statistically significant reduction in eccentric knee flexor peak torque from the team that did not have remote monitoring. Conclusions Remote monitoring programs are recommended so that athletes are less affected by the deleterious effects of confinement.
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16
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Kouzelis A, Solou K, Panagopoulos A, Kokkalis Z, Gliatis J. Arthroscopic Treatment of a “Bucket-Handle Like Tear” Lesion of the Medial Meniscus. Cureus 2022; 14:e22830. [PMID: 35382175 PMCID: PMC8976876 DOI: 10.7759/cureus.22830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/09/2022] Open
Abstract
Menisci are involved in providing shock absorption, knee stability, and load transfer. Age, tear pattern, location, size and extent, repair time and technique, and patient habits are among various factors that affect meniscal healing. Meniscus repair has become the procedure of choice for the treatment of meniscal tears. However, treatment of meniscal tears in patients over 40 years of age is still debatable. Rare patterns of lesions have been described in the literature. We report a zone 2, partial thickness, “bucket-handle like tear” medial meniscal lesion with two attached ends in a 48-year-old male patient with persistent symptoms after six months of conservative treatment. Arthroscopic excision and debridement were performed. At a six-month follow-up, the patient regained 90% of his functional capacity.
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17
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Alves BMO, Scoz RD, Burigo RL, Ferreira IC, Ramos APS, Mendes JJB, Ferreira LMA, Amorim CF. Association between Concentric and Eccentric Isokinetic Torque and Unilateral Countermovement Jump Variables in Professional Soccer Players. J Funct Morphol Kinesiol 2022; 7:jfmk7010025. [PMID: 35323608 PMCID: PMC8953202 DOI: 10.3390/jfmk7010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Isokinetic tests have been highly valuable to athletic analysis, but their cost and technical operation turn them inaccessible. The purpose of this study was to verify the correlation between unilateral countermovement jump variables and isokinetic data. Thirty-two male professional soccer players were subjected to the isokinetic testing of both knee extensors and flexors in concentric and eccentric muscle contractions. They also executed unilateral countermovement vertical jumps (UCMJ) to compare maximum height, ground reaction force, and impulse power with isokinetic peak torque. Data analysis was conducted through Pearson correlation and linear regression. A high correlation was found between dominant unilateral extensor concentric peak torque and the UCMJ maximum height of the dominant leg. The non-dominant leg jump showed a moderate correlation. No other variable showed statistical significance. Linear regression allowed the generation of two formulae to estimate the peak torque from UCMJ for dominant and non-dominant legs. Although few studies were found to compare our results, leading to more studies being needed, a better understanding of the unilateral countermovement jump may be used in the future as a substitute to the expensive and technically demanding isokinetic testing when it is unavailable, allowing the assessment of lower limb physical asymmetries in athletic or rehabilitation environments.
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Affiliation(s)
- Bruno Mazziotti Oliveira Alves
- Masters and Doctoral Program in Physiotherapy, University City of Sao Paulo (Unicid), Sao Paulo 03071-000, Brazil; (B.M.O.A.); (R.L.B.); (I.C.F.)
- Department of Physical Therapy and Biomechanics, Arsenal Football Club, London N7-7AJ, UK
| | - Robson Dias Scoz
- Masters and Doctoral Program in Physiotherapy, University City of Sao Paulo (Unicid), Sao Paulo 03071-000, Brazil; (B.M.O.A.); (R.L.B.); (I.C.F.)
- Correspondence: (R.D.S.); (C.F.A.)
| | - Ricardo Lima Burigo
- Masters and Doctoral Program in Physiotherapy, University City of Sao Paulo (Unicid), Sao Paulo 03071-000, Brazil; (B.M.O.A.); (R.L.B.); (I.C.F.)
| | - Isabella Christina Ferreira
- Masters and Doctoral Program in Physiotherapy, University City of Sao Paulo (Unicid), Sao Paulo 03071-000, Brazil; (B.M.O.A.); (R.L.B.); (I.C.F.)
| | - Ana Paula Silveira Ramos
- Physiotherapy Department, University of South of Santa Catarina (Unisul), Sao Jose 88137-270, Brazil;
| | - Jose Joao Baltazar Mendes
- Laboratory of Physical and Functional Assessment (LAFF), Interdisciplinary Center of Investigation Egas Monis (CiiEM), Caparica, 2829-511 Setubal, Portugal; (J.J.B.M.); (L.M.A.F.)
| | - Luciano Maia Alves Ferreira
- Laboratory of Physical and Functional Assessment (LAFF), Interdisciplinary Center of Investigation Egas Monis (CiiEM), Caparica, 2829-511 Setubal, Portugal; (J.J.B.M.); (L.M.A.F.)
| | - Cesar Ferreira Amorim
- Masters and Doctoral Program in Physiotherapy, University City of Sao Paulo (Unicid), Sao Paulo 03071-000, Brazil; (B.M.O.A.); (R.L.B.); (I.C.F.)
- Laboratory of Physical and Functional Assessment (LAFF), Interdisciplinary Center of Investigation Egas Monis (CiiEM), Caparica, 2829-511 Setubal, Portugal; (J.J.B.M.); (L.M.A.F.)
- Lab Corinthians R9, Sport Club Corinthians Paulista, Sao Paulo 03828-000, Brazil
- Laboratoire de Recherche BioNR, Université du Quebec, Saguenay, QC G7H-2B1, Canada
- Correspondence: (R.D.S.); (C.F.A.)
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18
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Gonzalez-Leon EA, Hu JC, Athanasiou KA. Yucatan Minipig Knee Meniscus Regional Biomechanics and Biochemical Structure Support its Suitability as a Large Animal Model for Translational Research. Front Bioeng Biotechnol 2022; 10:844416. [PMID: 35265605 PMCID: PMC8899164 DOI: 10.3389/fbioe.2022.844416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Knee meniscus injuries are the most frequent causes of orthopedic surgical procedures in the U.S., motivating tissue engineering attempts and the need for suitable animal models. Despite extensive use in cardiovascular research and the existence of characterization data for the menisci of farm pigs, the farm pig may not be a desirable preclinical model for the meniscus due to rapid weight gain. Minipigs are conducive to in vivo experiments due to their slower growth rate than farm pigs and similarity in weight to humans. However, characterization of minipig knee menisci is lacking. The objective of this study was to extensively characterize structural and functional properties within different regions of both medial and lateral Yucatan minipig knee menisci to inform this model’s suitability as a preclinical model for meniscal therapies. Menisci measured 23.2–24.8 mm in anteroposterior length (33–40 mm for human), 7.7–11.4 mm in width (8.3–14.8 mm for human), and 6.4–8.4 mm in peripheral height (5–7 mm for human). Per wet weight, biochemical evaluation revealed 23.9–31.3% collagen (COL; 22% for human) and 1.20–2.57% glycosaminoglycans (GAG; 0.8% for human). Also, per dry weight, pyridinoline crosslinks (PYR) were 0.12–0.16% (0.12% for human) and, when normalized to collagen content, reached as high as 1.45–1.96 ng/µg. Biomechanical testing revealed circumferential Young’s modulus of 78.4–116.2 MPa (100–300 MPa for human), circumferential ultimate tensile strength (UTS) of 18.2–25.9 MPa (12–18 MPa for human), radial Young’s modulus of 2.5–10.9 MPa (10–30 MPa for human), radial UTS of 2.5–4.2 MPa (1–4 MPa for human), aggregate modulus of 157–287 kPa (100–150 kPa for human), and shear modulus of 91–147 kPa (120 kPa for human). Anisotropy indices ranged from 11.2–49.4 and 6.3–11.2 for tensile stiffness and strength (approximately 10 for human), respectively. Regional differences in mechanical and biochemical properties within the minipig medial meniscus were observed; specifically, GAG, PYR, PYR/COL, radial stiffness, and Young’s modulus anisotropy varied by region. The posterior region of the medial meniscus exhibited the lowest radial stiffness, which is also seen in humans and corresponds to the most prevalent location for meniscal lesions. Overall, similarities between minipig and human menisci support the use of minipigs for meniscus translational research.
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19
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Migliorini F, Cuozzo F, Cipollaro L, Oliva F, Hildebrand F, Maffulli N. Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis. J Orthop Traumatol 2022; 23:8. [PMID: 35129728 PMCID: PMC8821738 DOI: 10.1186/s10195-022-00630-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/25/2022] [Indexed: 01/10/2023] Open
Abstract
Background The efficacy and safety of platelet-rich plasma (PRP) augmentation for arthroscopic meniscal repair is controversial. This meta-analysis compared arthroscopic meniscal repair performed in isolation or augmented with PRP. Methods The present study was conducted according to PRISMA 2020 guidelines. Pubmed, Web of Science, Google Scholar and Embase were accessed in August 2021. All the clinical trials which compared arthroscopic meniscal repair performed in isolation or augmented with PRP were included. Results Eight hundred thirty-seven patients were included: 38% (318 of 837 patients) were women; the mean age of the patients was 35.6 (range, 20.8–64.3) years; the mean follow-up was 26.2 (range, 6–54) months. Similarity was found in analogue scale (VAS) (P = 0.5) and Lysholm (P = 0.9), and International Knee Documentation Committee (IKDC) scores (P = 0.9). Similarity was found in the rate of failure (P = 0.4) and rate of revision (P = 0.07). Conclusion The current published scientific evidence does not support PRP augmentation for arthroscopic meniscal repair.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Francesco Cuozzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Lucio Cipollaro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy.,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke on Trent, England.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
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20
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Championship interseason period did not reduce knee peak moment: A 10-years retrospective study of 467 elite soccer players. BIOMEDICAL HUMAN KINETICS 2022. [DOI: 10.2478/bhk-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: To compare knee moment profiles of professional soccer players from different playing positions before and after an interseason period.
Material and methods: Retrospective study of 467 healthy, professional elite Brazilian soccer players before and after an official championship interseason period during 10-years. Main outcome measures were isokinetic peak moment from knee extensors and flexors from concentric and eccentric contractions. A Two-way ANOVA analysis was used to compare each playing position before and after interseason period.
Results: It was found no statistical difference in Ext.CPT (from p = 0.11 to p = 0.97), Ext.EPT (from p = 0.07 to p = 0.85), Flx. CPT (from p = 0.14 to p = 0.90) or Flx.EPT (from p = 0.10 to p = 0.91) between End-Season and Pre-Season evaluations for all playing positions (from Goalkeepers, Defenders, Backsiders, Midfielders and Forwards).
Conclusions: Isokinetic peak moment did not have significant differences after an interseason period of 4 to 6 weeks, allowing trainers and coaches to focus their pre-season period on other performance concerns than strengthening.
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21
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Blough CL, Bobba CM, DiBartola AC, Everhart JS, Magnussen RA, Kaeding C, Flanigan DC. Biologic Augmentation during Meniscal Repair. J Knee Surg 2021; 36:498-506. [PMID: 34781393 DOI: 10.1055/s-0041-1739198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We reviewed the literature regarding utility of biologic augmentation in meniscal repair. We hypothesized that the addition of biologic augmentation during meniscal repair improves postoperative knee function and reduces risk of repair failure. PubMed and Embase databases were systematically searched. Included studies were clinical studies in humans, published in English, and reported use of biologic augmentation techniques in addition to meniscal repair (including platelet-rich plasma [PRP], fibrin clot, bone marrow stimulation, meniscal wrapping, and bioscaffolds) for treatment of knee meniscal tears. Outcome measures included repair failure, repeat knee arthroscopic surgery, and magnetic resonance imaging), visual analog scale for pain, the International Knee Documentation Committee questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index Lysholm's Knee Scoring Scale, and the Knee Injury and Osteoarthritis Outcome Score. Study quality was assessed using the modified Coleman methodology score. Nineteen studies reported repair of 1,092 menisci including six studies that investigated fibrin clot augmentation, five studies that investigated PRP augmentation, three studies that investigated bone marrow stimulation augmentation, two studies that used meniscal wrapping augmentation, and three studies that used other techniques. The level of evidence ranged from I to IV and mean modified Coleman methodology score was 43 (range: 17-69), with higher scores noted in studies completed in recent years. PRP and bone marrow stimulation augmentation appear to decrease risk of failure in patients undergoing isolated meniscal repair but do not improve knee symptom scores. Fibrin clot and trephination augmentation techniques do not have sufficient evidence to support decreased failure risk at this time. Meniscal wrapping augmentation and scaffold implantation augmentation appear to be an attractive option to meniscectomy in complicated tears that are not candidates for repair alone, but further confirmatory studies are needed to support initial data. Evidence supporting augmentation of meniscal repair is limited at this time but suggests that the highest likelihood for effectiveness of augmentation is in the settings of isolated meniscal repair or meniscal repairs that would normally not be amenable to repair.
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Affiliation(s)
- Christian L Blough
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Alex C DiBartola
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joshua S Everhart
- Sports Medicine, Department of Orthopaedic Surgery, Indiana University, Indianapolis, Indiana
| | - Robert A Magnussen
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio.,Sports Medicine, The Ohio State University, Columbus, Ohio
| | - Christopher Kaeding
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio.,Sports Medicine, The Ohio State University, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio.,Sports Medicine, The Ohio State University, Columbus, Ohio.,Cartilage Restoration Program, The Ohio State University, Columbus, Ohio
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22
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Klarmann GJ, Gaston J, Ho VB. A review of strategies for development of tissue engineered meniscal implants. BIOMATERIALS AND BIOSYSTEMS 2021; 4:100026. [PMID: 36824574 PMCID: PMC9934480 DOI: 10.1016/j.bbiosy.2021.100026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
The meniscus is a key stabilizing tissue of the knee that facilitates proper tracking and movement of the knee joint and absorbs stresses related to physical activity. This review article describes the biology, structure, and functions of the human knee meniscus, common tears and repair approaches, and current research and development approaches using modern methods to fabricate a scaffold or tissue engineered meniscal replacement. Meniscal tears are quite common, often resulting from sports or physical training, though injury can result without specific contact during normal physical activity such as bending or squatting. Meniscal injuries often require surgical intervention to repair, restore basic functionality and relieve pain, and severe damage may warrant reconstruction using allograft transplants or commercial implant devices. Ongoing research is attempting to develop alternative scaffold and tissue engineered devices using modern fabrication techniques including three-dimensional (3D) printing which can fabricate a patient-specific meniscus replacement. An ideal meniscal substitute should have mechanical properties that are close to that of natural human meniscus, and also be easily adapted for surgical procedures and fixation. A better understanding of the organization and structure of the meniscus as well as its potential points of failure will lead to improved design approaches to generate a suitable and functional replacement.
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Affiliation(s)
- George J. Klarmann
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA,Corresponding author at: USU-4D Bio³ Center, 9410 Key West Ave., Rockville, MD 20850, USA.
| | - Joel Gaston
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA
| | - Vincent B. Ho
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA
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23
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Li H, Li P, Yang Z, Gao C, Fu L, Liao Z, Zhao T, Cao F, Chen W, Peng Y, Yuan Z, Sui X, Liu S, Guo Q. Meniscal Regenerative Scaffolds Based on Biopolymers and Polymers: Recent Status and Applications. Front Cell Dev Biol 2021; 9:661802. [PMID: 34327197 PMCID: PMC8313827 DOI: 10.3389/fcell.2021.661802] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022] Open
Abstract
Knee menisci are structurally complex components that preserve appropriate biomechanics of the knee. Meniscal tissue is susceptible to injury and cannot heal spontaneously from most pathologies, especially considering the limited regenerative capacity of the inner avascular region. Conventional clinical treatments span from conservative therapy to meniscus implantation, all with limitations. There have been advances in meniscal tissue engineering and regenerative medicine in terms of potential combinations of polymeric biomaterials, endogenous cells and stimuli, resulting in innovative strategies. Recently, polymeric scaffolds have provided researchers with a powerful instrument to rationally support the requirements for meniscal tissue regeneration, ranging from an ideal architecture to biocompatibility and bioactivity. However, multiple challenges involving the anisotropic structure, sophisticated regenerative process, and challenging healing environment of the meniscus still create barriers to clinical application. Advances in scaffold manufacturing technology, temporal regulation of molecular signaling and investigation of host immunoresponses to scaffolds in tissue engineering provide alternative strategies, and studies have shed light on this field. Accordingly, this review aims to summarize the current polymers used to fabricate meniscal scaffolds and their applications in vivo and in vitro to evaluate their potential utility in meniscal tissue engineering. Recent progress on combinations of two or more types of polymers is described, with a focus on advanced strategies associated with technologies and immune compatibility and tunability. Finally, we discuss the current challenges and future prospects for regenerating injured meniscal tissues.
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Affiliation(s)
- Hao Li
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Pinxue Li
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yang
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Cangjian Gao
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Liwei Fu
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Zhiyao Liao
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Tianyuan Zhao
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Fuyang Cao
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Wei Chen
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Yu Peng
- School of Medicine, Nankai University, Tianjin, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Sui
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Shuyun Liu
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Quanyi Guo
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
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24
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Müller S, Schwenk T, de Wild M, Dimitriou D, Rosso C. Increased Construct Stiffness With Meniscal Repair Sutures and Devices Increases the Risk of Cheese-Wiring During Biomechanical Load-to-Failure Testing. Orthop J Sports Med 2021; 9:23259671211015674. [PMID: 34189149 PMCID: PMC8209834 DOI: 10.1177/23259671211015674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Cheese-wiring, the suture that cuts through the meniscus, is a well-known issue in meniscal repair. So far, contributing factors are neither fully understood nor sufficiently studied. Hypothesis/Purpose: To investigate whether the construct stiffness of repair sutures and devices correlates with suture cut-through (cheese-wiring) during load-to-failure testing. Study Design: Controlled laboratory study. Methods: In 131 porcine menisci, longitudinal bucket-handle tears were repaired using either inside-out sutures (n = 66; No. 0 Ultrabraid, 2-0 Orthocord, 2-0 FiberWire, and 2-0 Ethibond) or all-inside devices (n = 65; FastFix360, Omnispan, and Meniscal Cinch). After cyclic loading, load-to-failure testing was performed. The mode of failure and construct stiffness were recorded. A receiver operating characteristic curve analysis was performed to define the optimal stiffness threshold for predicting meniscal repair failure by cheese-wiring. The 2-tailed t test and analysis of variance were used to test significance. Results: Loss of suture fixation was the most common mode of failure in all specimens (58%), except for the Omnispan, which failed most commonly because of anchor pull-through. The Omnispan demonstrated the highest construct stiffness (30.8 ± 3.5 N/mm), whereas the Meniscal Cinch (18.0 ± 8.8 N/mm) and Ethibond (19.4 ± 7.8 N/mm) demonstrated the lowest construct stiffness. The Omnispan showed significantly higher stiffness compared with the Meniscal Cinch (P < .001) and Ethibond (P = .02), whereas the stiffness of the Meniscal Cinch was significantly lower compared with that of the FiberWire (P = .01), Ultrabraid (P = .04), and FastFix360 (P = .03). While meniscal repair with a high construct stiffness more often failed by cheese-wiring, meniscal repair with a lower stiffness failed by loss of suture fixation, knot slippage, or anchor pull-through. Meniscal repair with a stiffness >26.5 N/mm had a 3.6 times higher risk of failure due to cheese-wiring during load-to-failure testing (95% CI, 1.4-8.2; P < .0001). Conclusion: Meniscal repair using inside-out sutures and all-inside devices with a higher construct stiffness (>26.5 N/mm) was more likely to fail through suture cut-through (cheese-wiring) than that with a lower stiffness (≤26.5 N/mm). Clinical Relevance: This is the first study investigating the impact of construct stiffness on meniscal repair failure by suture cut-through (cheese-wiring).
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Affiliation(s)
- Sebastian Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Tanja Schwenk
- University of Basel, Basel, Switzerland.,Department of Medical Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael de Wild
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Rosso
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Shoulder and Elbow Unit, ARTHRO Medics, Basel, Switzerland
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25
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Milliron EM, Magnussen RA, A Cavendish P, P Quinn J, DiBartola AC, Flanigan DC. Repair of Radial Meniscus Tears Results in Improved Patient-Reported Outcome Scores: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e967-e980. [PMID: 34195666 PMCID: PMC8220631 DOI: 10.1016/j.asmr.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/04/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To quantify healing rates and patient-reported outcome scores following repair of radial meniscus tears. Methods PubMed, Scopus, and Embase databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria included: human subjects with meniscal tears, full-text English language, average follow-up of at 1 year, and publication after the 2000. Exclusion criteria included technical, biomechanical, and cadaveric studies. Study quality was assessed using Coleman Methodology Scores and Methodological Index for Non-Randomized Studies (MINORS) criteria. Results Twelve studies reported on the repair of 243 radial tears in 241 patients. The mean Modified Coleman Methodology Score was 46.8, range 26-60, with a mean level of evidence of 3.5. Arthroscopic techniques were used in all studies, with 1 study using an arthroscopic-assisted 2-tunnel trans-tibial pullout technique. The mean patient age was 32 years (11-71). The mean follow-up was 35 months (12 to 75.6). The average time to surgery was 10.9 months (0.5-22.4). Eight of the 12 studies reported concomitant anterior cruciate ligament (ACL) reconstruction, with 64% having concomitant ACL injury. The most common outcome measure was the Lysholm score, which improved from 47-68.9 preoperatively to 86.4-95.6 postoperatively. Tegner Activity Scale improved from 2.5-3.1 preoperatively to 4.7-6.7 postoperatively. Healing rates were reported via magnetic resonance imaging and second-look arthroscopy. Second-look arthroscopy was performed for a variety of indications, including removal of screw, washers or plates, dissatisfaction with original procedure, partial healing found on magnetic resonance imaging, or desire of the patient to know the true healing status before return to sport. Of those assessed, 62.0% had complete healing, 30.0% partial healing, and 8.0% failure to heal. Conclusions Patient-reported outcomes of radial meniscus repair with and without ACL reconstruction are encouraging, with high patient-reported outcomes reported at final follow-up when compared with preoperative scores. Among all meniscus repairs assessed for healing, the majority demonstrated at least some healing with an overall low rate of failure. Level of Evidence IV; systematic review of level III-IV studies.
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Affiliation(s)
- Eric M Milliron
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Robert A Magnussen
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Sports Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Parker A Cavendish
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - John P Quinn
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Alex C DiBartola
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - David C Flanigan
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Sports Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Cartilage Restoration Program, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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26
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Scoz RD, Alves BMO, Burigo RL, Vieira ER, Ferreira LMA, da Silva RA, Hirata RP, Amorim CF. Strength development according with age and position: a 10-year study of 570 soccer players. BMJ Open Sport Exerc Med 2021; 7:e000927. [PMID: 33754080 PMCID: PMC7938987 DOI: 10.1136/bmjsem-2020-000927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background/aim The purpose of this study was to compare the isokinetic peak torque profiles from the quadriceps and hamstrings muscles during concentric and eccentric contractions in elite Brazilian soccer players across different field positions and age categories. Our hypothesis was that soccer players from different field positions are subjected to different ageing-related effects on their isokinetic peak torque. Methods This is a retrospective study based on professional elite-level soccer players between the years 2009 and 2019. It included 570 adult males who played for at least 5 years on first or second Brazilian divisions. Playing positions were divided as: goalkeepers, defenders, sidebacks, midfielders and forwards. Age categories were also divided as: G1 (17–20 years old), G2 (21–24 years old), G3 (25–28 years old), G4 (29–32 years old) and G5 (33 years old or more). Results The results indicate a moderate effect of age (F(4545)=8.197; p<0.001; η2=0.057) and a small effect of playing position (F(4545)=2.993; p<0.05; η2=0.021) on torque of concentric extensors; mainly from midfielders and goalkeepers with 29 years or more. Conclusions Soccer players from different field positions are subjected to different ageing related effects on their muscular performance during their career special attention should be given to these players to avoid reduction in physical performance.
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Affiliation(s)
| | - Bruno Mazziotti Oliveira Alves
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil.,Physical Therapy Department, Arsenal Football Club, London, UK
| | | | - Edgar Ramos Vieira
- Physical Therapy Department, Florida International University (FIU), Miami, Florida, USA
| | | | | | | | - Cesar Ferreira Amorim
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil.,Physical Therapy Department, Florida International University (FIU), Miami, Florida, USA.,KinesioLab, Instituto Piaget, Silves, Portugal.,Laboratoire de Recherche BioNR, Université du Quebec à Chicoutimi (UQAC), Saguenay, QC, Canada
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27
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Khalifa AA, Mohamed RAE, Abo-Zeid AR, Abd-Elaal AM. Rehabilitation options for patients with an isolated meniscal tear, a narrative review. SPORTS ORTHOPAEDICS AND TRAUMATOLOGY 2020; 36:364-369. [DOI: 10.1016/j.orthtr.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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28
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Burigo RL, Scoz RD, Alves BMDO, da Silva RA, Melo-Silva CA, Vieira ER, Hirata RP, Amorim CF. Concentric and eccentric isokinetic hamstring injury risk among 582 professional elite soccer players: a 10-years retrospective cohort study. BMJ Open Sport Exerc Med 2020; 6:e000868. [PMID: 33304603 PMCID: PMC7705342 DOI: 10.1136/bmjsem-2020-000868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/11/2020] [Accepted: 10/03/2020] [Indexed: 11/03/2022] Open
Abstract
Background/Aim Different authors have tried to correlate the peak isokinetic torque values with the incidence of soccer match injuries. However, due to the wide variety of assessment testing protocols, such an inference becomes difficult. This study aimed to verify the capacity of an isokinetic test to establish injury risk reference values for hamstring strain injuries. Methods A retrospective cohort study based on isokinetic data and clinical records from the last 10 years was conducted in 582 Brazilian elite-professional soccer players, who were subjected to the same isokinetic test protocol, machine, and tester. A Multivariate Logistic Regression Analysis for Complex Data Sampling was used to generate injury risk statistical indexes. Results Multivariate regression analysis of both legs provided important data to identify the cut-off values of Concentric Peak Torque (181.82 Newton/*metres), Concentric Work (236.23 watts) and Concentric Power (130.11 joules). Conclusions The injury risk indexes indicate that an increase of just one Newton unit in CPT (Concentric Peak Torque) and CJ (Concentric Power) above those cut-off values, can reduce the risk of future injuries by 2% and 2.7%, respectively.
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Affiliation(s)
- Ricardo Lima Burigo
- Physical Therapy Department, Universidade Cidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Robson Dias Scoz
- Physical Therapy Department, Universidade Cidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Mazziotti de Oliveira Alves
- Physical Therapy Department, Universidade Cidade de Sao Paulo, Sao Paulo, SP, Brazil.,Physiotherapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Rubens Alexandre da Silva
- Physiotherapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.,Physical Therapy Department, Universite du Quebec, Quebec, Quebec, Canada
| | - Cesar Augusto Melo-Silva
- Physiotherapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.,Faculty of Medicine, Universidade de Brasilia, Brasilia, DF, Brazil
| | - Edgar Ramos Vieira
- Physiotherapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.,Physical Therapy Department, Florida International University, Miami, Florida, USA
| | - Rogerio Pessoto Hirata
- Physiotherapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.,Department of Health Science and Technology, Aalborg Universitet, Aalborg, Denmark
| | - Cesar Ferreira Amorim
- Physical Therapy Department, Universidade Cidade de Sao Paulo, Sao Paulo, SP, Brazil.,Physiotherapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.,Physical Therapy Department, Universite du Quebec, Quebec, Quebec, Canada.,Physical Therapy Department, Florida International University, Miami, Florida, USA
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Krych AJ, LaPrade MD, Hevesi M, Rhodes NG, Johnson AC, Camp CL, Stuart MJ. Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around? Orthop J Sports Med 2020; 8:2325967120961368. [PMID: 33209944 PMCID: PMC7645763 DOI: 10.1177/2325967120961368] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/20/2020] [Indexed: 11/15/2022] Open
Abstract
Background Meniscus root tears are increasingly being recognized. Meniscal extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscal restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated. Purpose To better understand the association between MT ligament competence, medial meniscal extrusion, and medial meniscus posterior root tears (MMPRTs) as well as to determine the progression of meniscal extrusion over time. Study Design Case series; Level of evidence, 4. Methods Serial magnetic resonance imaging (MRI) scans were reviewed for patients who showed evidence of medial meniscal extrusion and MMPRTs on at least 1 of ≥2 available MRI scans. All patients were symptomatic at the time of diagnosis. All MRI scans were analyzed independently by 2 board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscal extrusion, and MMPRTs were recorded for each MRI scan. The time between MRI scans, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated. Results Overall, 27 knees in 26 patients were included in this study, with a total of 63 MRI scans analyzed (21 knees with 2 MRI scans, 3 with 3 MRI scans, and 3 with 4 MRI scans). All patients demonstrated clear medial meniscal extrusion and MT ligament disruption before the subsequent development of MMPRTs (P < .001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT (P < .001). The mean time between initial MRI and the first identification of an MMPRT on later MRI was 1.7 ± 1.6 years. Conclusion In a sample of 27 symptomatic knees with serial MRI scans both before and after an MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscal extrusion before the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscal extrusion represent early and predisposing events contributing to MMPRTs. Therefore, this provides a possible explanation of why meniscal extrusion is not corrected with medial meniscus root repair.
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Affiliation(s)
- Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew D LaPrade
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Adam C Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Haris A, Beng Chye Tan V. Stress response envelopes of intact tibiofemoral joint and knee osteoarthritis. Proc Inst Mech Eng H 2020; 234:1151-1161. [DOI: 10.1177/0954411920944078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine stress envelopes for an intact tibiofemoral joint and to study how they vary with knee loading, external–internal rotation, varus–valgus rotation and cartilage degradation (osteoarthritis) using the finite element method. The envelopes were presented in terms of knee flexion angle. The maximum von Mises stress for all tibiofemoral joint components increased with increasing the axial compressive force magnitude. Menisci exhibited the highest magnitude of maximum von Mises stress as compared to the femoral and tibial cartilages. In a range of flexion angles between 0° and 100°, the medial meniscus exhibited the highest maximum von Mises stress than the lateral meniscus and the stress in medial meniscus tended to increase with increasing the flexion angle. External–internal and varus–valgus rotations changed the stress distribution: higher stress on lateral compartment but lower stress on medial compartment, and conversely. The internal rotation provided more extreme effect than the external rotation. For the knee osteoarthritis, cartilage degradation (early stage) caused maximum von Mises stress to increase on the intact menisci revealing that knee osteoarthritis could also cause meniscal tear. The late osteoarthritis caused the maximum von Mises stress to increase on the calcified cartilage and subchondral bone.
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Affiliation(s)
- Andi Haris
- Department of Mechanical Engineering, National University of Singapore, Singapore
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Kayfan S, Hlis R, Pezeshk P, Shah J, Poh F, McCrum C, Chhabra A. Three-dimensional and 3-Tesla MRI morphometry of knee meniscus in normal and pathologic state. Clin Anat 2020; 34:143-153. [PMID: 32920879 DOI: 10.1002/ca.23679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/11/2020] [Accepted: 09/05/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION To conduct a morphometric analysis of intact and torn menisci using isotropic meniscus plane three-dimensional (3D) reconstructions on 3-Tesla MRI and compare 2D versus 3D MRI for meniscus tear characterization. MATERIALS AND METHODS One hundred thirty three normal menisci from 92 patients (39 male, 53 female), and 38 arthroscopy-proven torn menisci from 36 patients (23 male, 13 female) were evaluated using 3D isotropic multi-planar MRI reconstructions and 2D MRI. Two observers measured the tibial plateau height and area, meniscal height, axial plane cross-sectional areas, and extrusion of intact menisci. Two observers also measured the meniscal tear length, tear area, and residual area of pathological menisci on 2D and 3D MRI. Intraclass correlation coefficients (ICC) were obtained. Institutional Review Board approval was obtained, and the informed consent was waived. RESULTS Medial meniscus (MM) and lateral meniscus (LM) areas were 503.6 ± 85.1 mm2 and 396.6 ± 72.0 mm2 for Observer 1, and 515.8 ± 82.1 mm2 and 408.0 ± 68.3 mm2 for Observer 2 (ICC:0.86, 0.87). In torn menisci, average tear length, area, and residual area were 36.3 ± 13.6 mm, 182.6 ± 139.3 mm2 , and 235.4 ± 140.3 mm2 , respectively for Observer 1, and 38.9 ± 14.7 mm, 181.2 ± 135.6 mm2 , 238.2 ± 140.5 mm2 for Observer 2. In the MM and LM, bucket-handle and complex tears were largest in areas, respectively. ICCs were excellent (0.91-1.0) on 3D MRI and moderate-good (0.57-0.81) on 2D MRI. CONCLUSION Meniscus morphometry on 3D MRI shows moderate to excellent inter-observer reliability and meniscus tear extent is more reliably defined on 3D MRI than 2D MRI. Residual meniscus-area calculation can be performed on 3D MRI.
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Affiliation(s)
- Samar Kayfan
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rocco Hlis
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parham Pezeshk
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jay Shah
- Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Feng Poh
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Medi-Rad Associates Ltd, Radiologic Clinic, Mt Elizabeth Hospital, Singapore, Singapore
| | | | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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Özdemir M, Kavak R. Meniscal Lesions in Geriatric Population: Prevalence and Association with Knee Osteoarthritis. Curr Aging Sci 2020; 12:67-73. [PMID: 31264552 PMCID: PMC6971891 DOI: 10.2174/1874609812666190628112103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study evaluated the prevalence of different types of meniscal lesions among elderly patients with knee pain. Moreover, this study assessed the relationship between meniscal lesions and the presence of radiographic knee osteoarthritis (OA) in the elderly population. METHODS The radiographs and magnetic resonance images of one knee out of 306 patients with knee pain aged 65-89 years were reviewed for knee OA and meniscal lesions. The prevalence of different types of meniscal lesions was calculated, and the relationship between the prevalence of meniscal lesion types and the presence of radiographic knee OA was analyzed. RESULTS Among 306 participants, 274 (89.5%) showed radiographic knee OA. We found one or more meniscal lesion(s) in 93% of the total subjects, in 94% of all patients with knee OA, and in 84% of all patients without knee OA. The prevalence of surgically target, possible-target, and nontarget lesions were 24%, 72%, and 69%, respectively. The prevalence of surgically target lesions was significantly higher in patients with knee OA than in those without it. The most common lesion observed was meniscal extrusion, followed by the horizontal and complex meniscal tears. CONCLUSIONS Our results demonstrated that meniscal damage is considerably prevalent among elderly individuals with knee pain, especially in those with knee OA. The fact that surgically target and possible-target lesions constitute a substantial proportion of these lesions should be considered in the clinical approach to these patients.
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Affiliation(s)
- Meltem Özdemir
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Rasime Kavak
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Ahmed I, Bowes M, Hutchinson CE, Parsons N, Staniszewska S, Price AJ, Metcalfe A. Meniscal tear outcome Study (METRO Study): a study protocol for a multicentre prospective cohort study exploring the factors which affect outcomes in patients with a meniscal tear. BMJ Open 2020; 10:e038681. [PMID: 32660954 PMCID: PMC7359070 DOI: 10.1136/bmjopen-2020-038681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION This study is designed to explore the baseline characteristics of patients under 55 years of age with a meniscal tear, and to describe the relationship between the baseline characteristics and patient-reported outcome measures (PROMs) over 12 months. Research has highlighted the need for a trial to investigate the effectiveness of arthroscopic meniscectomy in younger patients. Before this trial, we need to understand the patient population in greater detail. METHODS AND ANALYSIS This is a multicentre prospective cohort study. Participants aged between 18 and 55 years with an MRI confirmed meniscal tear are eligible for inclusion. Baseline characteristics including age, body mass index, gender, PROMs duration of symptoms and MRI will be collected. The primary outcome measure is the Western Ontario Meniscal Evaluation Tool at 12 months. Secondary outcome measures will include PROMs such as EQ5D, Knee Injury and Osteoarthritis Outcome Score and patient global impression of change score at 3, 6 and 12 months. ETHICS AND DISSEMINATION The study obtained approval from the National Research Ethics Committee West Midlands-Black Country research ethics committee (19/WM/0079) on 12 April 2019. The study is sponsored by the University of Warwick. The results will be disseminated via peer-reviewed publication. TRIAL REGISTRATION NUMBER UHCW R&D Reference: IA428119. University of Warwick Sponsor ID: SC.08/18-19.
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Affiliation(s)
- Imran Ahmed
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
| | | | | | - Nicholas Parsons
- Warwick Medical School, University of Warwick, Coventry, Coventry, UK
| | | | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Favreau H, Pijnenburg L, Seitlinger J, Fioretti F, Keller L, Scipioni D, Adriaensen H, Kuchler-Bopp S, Ehlinger M, Mainard D, Rosset P, Hua G, Gentile L, Benkirane-Jessel N. Osteochondral repair combining therapeutics implant with mesenchymal stem cells spheroids. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 29:102253. [PMID: 32619705 DOI: 10.1016/j.nano.2020.102253] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/05/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022]
Abstract
Functional articular cartilage regeneration remains challenging, and it is essential to restore focal osteochondral defects and prevent secondary osteoarthritis. Combining autologous stem cells with therapeutic medical device, we developed a bi-compartmented implant that could promote both articular cartilage and subchondral bone regeneration. The first compartment based on therapeutic collagen associated with bone morphogenetic protein 2, provides structural support and promotes subchondral bone regeneration. The second compartment contains bone marrow-derived mesenchymal stem cell spheroids to support the regeneration of the articular cartilage. Six-month post-implantation, the regenerated articular cartilage surface was 3 times larger than that of untreated animals, and the regeneration of the osteochondral tissue occurred during the formation of hyaline-like cartilage. Our results demonstrate the positive impact of this combined advanced therapy medicinal product, meeting the needs of promising osteochondral regeneration in critical size articular defects in a large animal model combining not only therapeutic implant but also stem cells.
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Affiliation(s)
- Henri Favreau
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpitaux universitaires de Strasbourg (HUS), Hôpital de Hautepierre, Service de rhumatologie, Service de chirurgie thoracique and Service de chirurgie orthopédique et de traumatologie, Université de Strasbourg, Strasbourg, France
| | - Luc Pijnenburg
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpitaux universitaires de Strasbourg (HUS), Hôpital de Hautepierre, Service de rhumatologie, Service de chirurgie thoracique and Service de chirurgie orthopédique et de traumatologie, Université de Strasbourg, Strasbourg, France
| | - Joseph Seitlinger
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpitaux universitaires de Strasbourg (HUS), Hôpital de Hautepierre, Service de rhumatologie, Service de chirurgie thoracique and Service de chirurgie orthopédique et de traumatologie, Université de Strasbourg, Strasbourg, France
| | - Florence Fioretti
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Laetitia Keller
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Dominique Scipioni
- Hôpital Erasme-Cliniques universitaires de Bruxelles, Université libre de Bruxelles (ULB), CHIREC-Hôpital Delta, Belgique
| | - Hans Adriaensen
- CHRU de Tours, Service de Chirurgie Orthopédique 2, Faculté de Médecine de Tours, and INRA de tours, Université François Rabelais, Tours, France
| | - Sabine Kuchler-Bopp
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Matthieu Ehlinger
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpitaux universitaires de Strasbourg (HUS), Hôpital de Hautepierre, Service de rhumatologie, Service de chirurgie thoracique and Service de chirurgie orthopédique et de traumatologie, Université de Strasbourg, Strasbourg, France
| | - Didier Mainard
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpital central Nancy, Service d'Orthopédie, Nancy, France
| | - Phillippe Rosset
- CHRU de Tours, Service de Chirurgie Orthopédique 2, Faculté de Médecine de Tours, and INRA de tours, Université François Rabelais, Tours, France
| | - Guoqiang Hua
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Luca Gentile
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Nadia Benkirane-Jessel
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France.
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Gudas R, Mačiulaitis J, Staškūnas M, Smailys A. Clinical outcome after treatment of single and multiple cartilage defects by autologous matrix-induced chondrogenesis. J Orthop Surg (Hong Kong) 2020; 27:2309499019851011. [PMID: 31146653 DOI: 10.1177/2309499019851011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Characterized cartilage lesions have a distinct impact on postoperative clinical outcome, which is still being evaluated. The purpose of this study was to assess the postoperative clinical outcome of autologous matrix-induced chondrogenesis (AMIC) for characterized cartilage lesions. METHODS Fifteen patients with articular cartilage (AC) defects of the knee were included in the study. AC defects were characterized intraoperatively by International Cartilage Repair Society score. Grade III-IV AC lesions were treated with AMIC; grade I-II lesions were left untreated. Patients were divided into subgroups and clinically evaluated by subjective autologous matrix-induced chondrogenesis (IKDC) and Tegner scores at median follow-up of 4.5 years. RESULTS Twenty-eight AC defects were diagnosed (1.9/patient). Multiple subgroup had larger diagnosed (7 ± 2.3 cm2, p = 0.022) and untreated (3.1 ± 2.3 cm2, p = 0.012) lesion areas than the single subgroup. Partly treated subgroup had larger untreated defect areas (3.6±2.3 cm2, p = 0.025) than the Treated subgroup. Average subjective IKDC values of total group and individual subgroups improved significantly at follow-up. More patients restored their previous activity levels ( p = 0.026) and had higher incremental subjective IKDC scores ( p = 0.014) in the single subgroup than the multiple subgroup. Diagnosed defect size negatively correlated to subjective IKDC incremental ( r = -0.624, p = 0.023) and postoperative scores ( r = -0.545, p = 0.054) in total group. CONCLUSIONS AMIC can have a clinically relevant outcome for patients with single or multiple knee AC lesions; however, clinical outcome is superior in patients with a single defect per knee. Patients with single defects returned to previous physical activity levels significantly faster than patients with multiple defects. Diagnosed AC defect areas negatively correlate to clinical improvement at follow-up.
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Affiliation(s)
- Rimtautas Gudas
- 1 Orthopaedic and Trauma Department, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.,2 Institute of Sports, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justinas Mačiulaitis
- 2 Institute of Sports, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mantas Staškūnas
- 2 Institute of Sports, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alfredas Smailys
- 1 Orthopaedic and Trauma Department, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
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Twomey-Kozak J, Jayasuriya CT. Meniscus Repair and Regeneration: A Systematic Review from a Basic and Translational Science Perspective. Clin Sports Med 2020; 39:125-163. [PMID: 31767102 DOI: 10.1016/j.csm.2019.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Meniscus injuries are among the most common athletic injuries and result in functional impairment in the knee. Repair is crucial for pain relief and prevention of degenerative joint diseases like osteoarthritis. Current treatments, however, do not produce long-term improvements. Thus, recent research has been investigating new therapeutic options for regenerating injured meniscal tissue. This review comprehensively details the current methodologies being explored in the basic sciences to stimulate better meniscus injury repair. Furthermore, it describes how these preclinical strategies may improve current paradigms of how meniscal injuries are clinically treated through a unique and alternative perspective to traditional clinical methodology.
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Affiliation(s)
- John Twomey-Kozak
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Box G-A1, Providence, RI 02912, USA
| | - Chathuraka T Jayasuriya
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Box G-A1, Providence, RI 02912, USA.
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Majewski-Schrage T, Evans TA, Snyder KR. Identifying Meaningful Patient Outcomes After Lower Extremity Injury, Part 2: Linking Outcomes to the International Classification of Functioning, Disability and Health. J Athl Train 2019; 54:869-880. [PMID: 31386581 DOI: 10.4085/1062-6050-233-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The International Classification of Functioning, Disability and Health (ICF) provides a framework and common language for describing and understanding health that incorporates function and disability, as well as contextual factors. However, whether the meaningful patient outcomes reported by collegiate athletes who have sustained a lower extremity (LE) injury correspond to the ICF model is uncertain. OBJECTIVES To determine if the patient outcomes reported by collegiate athletes after LE injury corresponded with the ICF classification and to identify the most relevant ICF categories and domains. DESIGN Themes and subthemes from the qualitative analysis were linked to the ICF using established linking rules. The frequencies of the linked ICF categories were identified. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty collegiate athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS Semistructured face-to-face interviews and ICF linking process. RESULTS The data from the qualitative interviews were successfully linked to 63 ICF second-level domains (eg, moving around, d455) across all 4 ICF categories: body functions (b), body structures (s), activities and participation (d), and environmental factors (e). The 63 second-level domains corresponded with 20 first-level domains (eg, mobility, d4). CONCLUSIONS The ICF provided a common language for describing health and disability, as all outcomes reported by our collegiate athletes after LE injury were linked with the ICF classification. Athletic trainers should use the results of this study for assessing and monitoring collegiate athletes' health and function after an LE injury.
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Affiliation(s)
| | - Todd A Evans
- Athletic Training Program, University of Northern Iowa, Cedar Falls
| | - Kelli R Snyder
- Athletic Training Program, University of Northern Iowa, Cedar Falls
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Nawasreh ZH, Marmon AR, Logerstedt D, Snyder-Mackler L. THE EFFECT OF TRAINING ON A COMPLIANT SURFACE ON MUSCLE ACTIVATION AND CO-CONTRACTION AFTER ANTERIOR CRUCIATE LIGAMENT INJURY. Int J Sports Phys Ther 2019; 14:3554-3563. [PMID: 31440417 PMCID: PMC6670057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Performing physical activities on compliant surfaces alters joints kinematics by decreasing joint motions. However, the effect of administering a training program on a compliant surface on muscle activities after anterior cruciate ligament (ACL) injury is unknown. HYPOTHESIS/PURPOSE To compare the effects of training on a compliant surface and manual perturbation training on individual muscle activation and muscle co-contraction indexes after an ACL injury. It was hypothesized that patients who received training on the compliant surface would demonstrate higher individual and combined muscle activities compared to the manual group. METHOD Sixteen patients (participated in level I/II sports) who sustained an ACL injury and had not undergone reconstructive surgery participated in this preliminary study. Eight patients received training on a compliant surface (Compliant group) and data of eight patients matched by age and sex from a previous study who received manual perturbation training were used as a control group (Manual group). Patients in both groups completed standard three-dimensional gait motion analysis with surface electromyography (EMG) of several lower extremity muscles during gait. Muscle co-contraction index and individual muscle activations were computed during weight acceptance (WA) and mid-stance (MS) intervals. A 2x2 analysis of variance (ANOVA) was used with an alpha level of p<0.10 to account for the high EMG variability. RESULTS The compliant group significantly increased muscle co-contraction of vastus lateralis-lateral hamstring (VL-LH), vastus medialis-gastrocnemius medialis (VM-MG), and vastus lateralis (VL) muscle activity during WA (p ≤ 0.035) and manual group significantly decreased VM-MG muscle co-contraction during WA (p=0.099) after training. CONCLUSION Administering training on a compliant surface provides different effects on muscle activation compared to manual perturbation training after an ACL injury. Training on a compliant surface caused increased muscle co-contraction indexes and individual muscle activation, while manual perturbation training decreased the VM-MG muscle co-contraction index. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Zakariya H. Nawasreh
- Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Adam R. Marmon
- Department of Physical Therapy, College of Health Sciences, University of Delaware, DE, USA
| | | | - Lynn Snyder-Mackler
- Department of Physical Therapy, College of Health Sciences, University of Delaware, DE, USA
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Preclinical safety study of a combined therapeutic bone wound dressing for osteoarticular regeneration. Nat Commun 2019; 10:2156. [PMID: 31089136 PMCID: PMC6517440 DOI: 10.1038/s41467-019-10165-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/16/2019] [Indexed: 01/01/2023] Open
Abstract
The extended life expectancy and the raise of accidental trauma call for an increase of osteoarticular surgical procedures. Arthroplasty, the main clinical option to treat osteoarticular lesions, has limitations and drawbacks. In this manuscript, we test the preclinical safety of the innovative implant ARTiCAR for the treatment of osteoarticular lesions. Thanks to the combination of two advanced therapy medicinal products, a polymeric nanofibrous bone wound dressing and bone marrow-derived mesenchymal stem cells, the ARTiCAR promotes both subchondral bone and cartilage regeneration. In this work, the ARTiCAR shows 1) the feasibility in treating osteochondral defects in a large animal model, 2) the possibility to monitor non-invasively the healing process and 3) the overall safety in two animal models under GLP preclinical standards. Our data indicate the preclinical safety of ARTiCAR according to the international regulatory guidelines; the ARTiCAR could therefore undergo phase I clinical trial. Arthroplasty is the main clinical option for the treatment of osteoarticular lesions, but has limited efficacy. Here, the authors use a wound dressing with autologous mesenchymal stromal cells, functionalised for local BMP2 delivery, and show feasibility and safety in standardised preclinical tests in animal models, suggesting suitability for use in clinical trials.
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40
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Kramer DE, Kalish LA, Martin DJ, Yen YM, Kocher MS, Micheli LJ, Heyworth BE. Outcomes After the Operative Treatment of Bucket-Handle Meniscal Tears in Children and Adolescents. Orthop J Sports Med 2019; 7:2325967118820305. [PMID: 30729144 PMCID: PMC6350150 DOI: 10.1177/2325967118820305] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Bucket-handle meniscal tears (BHMTs), which we define as vertical
longitudinal tears of the meniscus with displacement of the torn inner
fragment toward the intercondylar notch region, are a well-recognized tear
pattern. Optimizing the management of BHMTs in younger patients is
important, as preserving meniscal tissue may limit future joint
degeneration. Purpose/Hypothesis: The purpose of this study was to review the patient demographics, clinical
presentation, operative details, outcomes, and risk factors for a
reoperation associated with operatively treated BHMTs in a pediatric
population. We hypothesized that the repair of BHMTs in adolescents would
yield a higher reoperation rate than meniscectomy in our population. Study Design: Case-series; Level of evidence, 4. Methods: A departmental database was queried to identify all patients 19 years or
younger who presented with a BHMT and underwent surgery between October 2002
and February 2013. Clinical, radiological, and surgical data were
retrospectively collected, and risk factors for a reoperation and persistent
pain were assessed in all patients with longer than or equal to 6 months of
follow-up. Results: A total of 280 BHMTs were treated arthroscopically by 1 of 8 sports medicine
fellowship–trained surgeons. The mean age at surgery was 15.5 ± 2.5 years
(range, 2.1-19.2 years), and most patients were male (177/280; 63%). Most
injuries occurred during sports (203/248; 82%) and involved the medial
meniscus (157/280; 56%). Concurrent anterior cruciate ligament (ACL) surgery
was performed in 103 cases (37%). Meniscal repair was performed in 181 cases
(65%) and was more common in younger patients (P = .01) and
for the lateral meniscus (P < .001). Among 185 (66%)
cases with longer than or equal to 6 months of adequate follow-up data
(which included 126 meniscal repairs [68%]), a meniscus-related reoperation
occurred in 45 (24%) cases. A reoperation related to the original BHMT
injury or surgery was more common after meniscal repair than after
meniscectomy (40/126 [32%] vs 5/59 [8%], respectively) (P =
.001) and less common with concurrent ACL surgery (P =
.07), although this was not statistically significant. Among patients
injured during sports and with adequate follow-up, all but 1 patient
(176/177; 99%) returned to sports; a slower rate of return was seen in those
undergoing meniscal repair (P = .002) and concurrent ACL
surgery (P < .001). At final follow-up, 170 of 185
patients (92%) were pain free. For the 15 patients with persistent pain at
final follow-up, no identifiable risk factors for persistent pain were
identified. Conclusion: Most BHMTs in younger patients occurred in males and during sports and
affected the medial meniscus. Concurrent ACL surgery was indicated in
approximately one-third of cases and was associated with a lower reoperation
rate and slower return to sports. Two-thirds of patients underwent meniscal
repair, over two-thirds of whom did not require a reoperation during the
study period, despite the high activity levels in this age group.
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Affiliation(s)
- Dennis E Kramer
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie A Kalish
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Martin
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton E Heyworth
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Afzali T, Fangel MV, Vestergaard AS, Rathleff MS, Ehlers LH, Jensen MB. Cost-effectiveness of treatments for non-osteoarthritic knee pain conditions: A systematic review. PLoS One 2018; 13:e0209240. [PMID: 30566527 PMCID: PMC6300294 DOI: 10.1371/journal.pone.0209240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/03/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Knee pain is common in adolescents and adults and is associated with an increased risk of developing knee osteoarthritis. The aim of this systematic review was to gather and appraise the cost-effectiveness of treatment approaches for non-osteoarthritic knee pain conditions. METHOD A systematic review was conducted according to the PRISMA guidelines and registered on PROSPERO (CRD42016050683). The literature search was done in MEDLINE via PubMed, EMBASE, The Cochrane Library, and the National Health Service Economic Evaluation Database. Study selection was carried out by two independent reviewers and data were extracted using a customized extraction form. Study quality was assessed using the Consensus on Health Economic Criteria list. RESULTS Fifteen studies were included. The majority regarded the treatment of anterior cruciate ligament (ACL) injuries, but we also identified studies evaluating other knee pain conditions such as meniscus injuries, cartilage defects, and patellofemoral pain syndrome. Study interventions were categorized as surgical or non-surgical interventions. The surgical interventions included ACL reconstruction, chondrocyte implantation, meniscus scaffold procedure, meniscal allograft transplantation, partial meniscectomy, microfracture, and different types of autografts and allografts. The non-surgical management consisted of physical therapy, rehabilitation, exercise, counselling, bracing, and advice. In general, for ACL injuries surgical management alone or in combination with rehabilitation appeared to be cost-effective. The quality of the economic evaluations was of moderate to high quality. CONCLUSION There was insufficient evidence to give a firm overview of cost-effective interventions for non-osteoarthritic knee pain, but surgical treatment of acute ACL injury appeared cost-effective. There is very little data regarding the cost-effectiveness of non-surgical interventions for non-traumatic knee conditions.
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Affiliation(s)
- Tamana Afzali
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Mia Vicki Fangel
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne Sig Vestergaard
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
| | | | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
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Sullivan JK, Irrgang JJ, Losina E, Safran-Norton C, Collins J, Shrestha S, Selzer F, Bennell K, Bisson L, Chen AT, Dawson CK, Gil AB, Jones MH, Kluczynski MA, Lafferty K, Lange J, Lape EC, Leddy J, Mares AV, Spindler K, Turczyk J, Katz JN. The TeMPO trial (treatment of meniscal tears in osteoarthritis): rationale and design features for a four arm randomized controlled clinical trial. BMC Musculoskelet Disord 2018; 19:429. [PMID: 30501629 PMCID: PMC6271417 DOI: 10.1186/s12891-018-2327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Meniscal tears often accompany knee osteoarthritis, a disabling condition affecting 14 million individuals in the United States. While several randomized controlled trials have compared physical therapy to surgery for individuals with knee pain, meniscal tear, and osteoarthritic changes (determined via radiographs or magnetic resonance imaging), no trial has evaluated the efficacy of physical therapy alone in these subjects. METHODS The Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial is a four-arm multi-center randomized controlled clinical trial designed to establish the comparative efficacy of two in-clinic physical therapy interventions (one focused on strengthening and one containing placebo) and two protocolized home exercise programs. DISCUSSION The goal of this paper is to present the rationale behind TeMPO and describe the study design and implementation strategies, focusing on methodologic and clinical challenges. TRIAL REGISTRATION The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 . on February 14, 2017.
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Affiliation(s)
- James K. Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - James J. Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Clare Safran-Norton
- Department of Rehabilitation Services – Physical and Occupational Therapy, Brigham and Women’s Hospital, Boston, MA USA
| | - Jamie Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
| | - Swastina Shrestha
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Leslie Bisson
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Angela T. Chen
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - Courtney K. Dawson
- Harvard Medical School, Boston, MA USA
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | - Alexandra B. Gil
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Morgan H. Jones
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Melissa A. Kluczynski
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Kathleen Lafferty
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Jeffrey Lange
- Harvard Medical School, Boston, MA USA
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | - Emma C. Lape
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - John Leddy
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Aaron V. Mares
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Kurt Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Jennifer Turczyk
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
- Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA USA
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Nawasreh Z, Failla M, Marmon A, Logerstedt D, Snyder-Mackler L. Comparing the effects of mechanical perturbation training with a compliant surface and manual perturbation training on joints kinematics after ACL-rupture. Gait Posture 2018; 64:43-49. [PMID: 29852358 PMCID: PMC6062476 DOI: 10.1016/j.gaitpost.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/15/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Performing physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown. AIM To compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture. METHODS Sixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training. RESULTS Significant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p < 0.0001), and knee adduction angle at PKE (Manual:-2.00+2.23°, Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01). DISCUSSION Training on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined.
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Affiliation(s)
- Zakariya Nawasreh
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA,Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan
University of Science and Technology, Irbid, Jordan,Corresponding author at: P.O. Box 3030, Irbid, 22110, Jordan., (Z.
Nawasreh)
| | - Mathew Failla
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Adam Marmon
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - David Logerstedt
- University of the Sciences, Department of Physical Therapy, Philadelphia, PA, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA,Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
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Musculoskeletal pain in Primary Care Physiotherapy: Associations with demographic and general health characteristics. Musculoskelet Sci Pract 2018; 35:61-66. [PMID: 29547788 DOI: 10.1016/j.msksp.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Many patients reporting musculoskeletal pain present to Primary Care Physiotherapy with costly comorbid overlapping complaints that remain medically unexplained. These subjective health complaints (SHC) incorporate coexisting multi-site musculoskeletal pain and varied non-musculoskeletal complaints (e.g. anxiety, tiredness). The role of these non-musculoskeletal complaints is acknowledged in spinal musculoskeletal disorders, but less so for peripheral musculoskeletal disorders. OBJECTIVE This cross-sectional study explored the relationships between self-reported musculoskeletal pain sites, non-musculoskeletal complaints and disability among people reporting spinal or peripheral musculoskeletal pain. METHODS Fifty individuals with spinal musculoskeletal pain and fifty with peripheral musculoskeletal pain provided data on disability, number of musculoskeletal pain sites and non-musculoskeletal complaints. Relationships between these variables were examined for each group using Pearson's correlation coefficient and linear regression analysis. RESULTS Participants with spinal musculoskeletal pain recorded significantly more pain sites and non-musculoskeletal complaints than participants with peripheral musculoskeletal pain. However, there was no significant difference in disability between the groups. Non-musculoskeletal complaints were significantly associated with disability (correlation = 0.41, p < 0.01) and number of pain sites (correlation = 0.42, p < 0.01). Number of pain sites and disability were not significantly associated in either group. Participants with spinal musculoskeletal pain reported more tiredness, dizziness, anxiety and sleep problems. Participants reporting dizziness, anxiety, sadness/depression and sleep problems had higher disability. CONCLUSION Further studies must confirm the robustness of these associations, to permit comparisons between clinical and general populations and aid identification of causal factors. Considering SHC within individualised management programmes may improve outcomes.
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Preoperative Diagnosis and Treatment Outcomes of Incarcerated Inferiorly Displaced Flap Tear of the Medial Meniscus: Comparison between Flap Tears with and without Incarcerated Fragment. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5941057. [PMID: 29951538 PMCID: PMC5989300 DOI: 10.1155/2018/5941057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/14/2018] [Accepted: 04/22/2018] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to compare preoperative variables and postoperative outcomes between flap tears with and without incarceration of inferiorly displaced fragments of medial meniscus and find distinct features of incarcerated flap tear of medial meniscus to improve preoperative diagnosis. 79 patients who underwent partial meniscectomy for flap tear of medial meniscus were classified into two groups: group U, usual flap tear without incarcerated fragment; group I, flap tear with incarcerated inferiorly displaced fragment. Patient characteristics and preoperative variables including duration of symptom aggravation were investigated. A comprehensive physical examination including joint line tenderness was performed. Magnetic resonance imaging (MRI) examination was carried out on all patients. Clinical assessments were performed with functional scores including visual analogue scale (VAS), and radiologic evaluation was conducted. Preoperative values and postoperative outcomes measured at the minimum follow-up duration of 2 years were compared between the groups. The groups did not differ significantly regarding postoperative outcomes by functional and radiological evaluations (p > 0.05). In making preoperative diagnosis, sensitivity of diagnosis based solely on MR images was significantly lower in group I (68.8%) than that in group U (90.5%) (p = 0.040). The following clinical features differed significantly between the groups: Patients in group I had higher scores in preoperative VAS (group U = 6.6; group I = 7.7) (p = 0.011) and shorter duration of symptom aggravation (group U = 13.8 weeks; group I = 3.9 weeks) (p < 0.001). Joint line tenderness was positive more distinctly in group I (100%) than in group U (74.6%). If displaced flap tear was properly resected, improved outcomes did not differ regardless of incarceration of flap tear. In diagnosing incarcerated inferiorly displaced flap tear, sensitivity of diagnosis based solely on MR images could be low. Distinguishing clinical findings would be helpful in obtaining a more appropriate diagnosis.
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The Challenge in Using Mesenchymal Stromal Cells for Recellularization of Decellularized Cartilage. Stem Cell Rev Rep 2017; 13:50-67. [PMID: 27826794 DOI: 10.1007/s12015-016-9699-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Some decellularized musculoskeletal extracellular matrices (ECM)s derived from tissues such as bone, tendon and fibrocartilaginous meniscus have already been clinical use for tissue reconstruction. Repair of articular cartilage with its unique zonal ECM architecture and composition is still an unsolved problem, and the question is whether allogenic or xenogeneic decellularized cartilage ECM could serve as a biomimetic scaffold for this purpose.Hence, this survey outlines the present state of preparing decellularized cartilage ECM-derived scaffolds or composites for reconstruction of different cartilage types and of reseeding it particularly with mesenchymal stromal cells (MSCs).The preparation of natural decellularized cartilage ECM scaffolds hampers from the high density of the cartilage ECM and lacking interconnectivity of the rather small natural pores within it: the chondrocytes lacunae. Nevertheless, the reseeding of decellularized ECM scaffolds before implantation provided superior results compared with simply implanting cell-free constructs in several other tissues, but cartilage recellularization remains still challenging. Induced by cartilage ECM-derived scaffolds MSCs underwent chondrogenesis.Major problems to be addressed for the application of cell-free cartilage were discussed such as to maintain ECM structure, natural chemistry, biomechanics and to achieve a homogenous and stable cell recolonization, promote chondrogenic and prevent terminal differentiation (hypertrophy) and induce the deposition of a novel functional ECM. Some promising approaches were proposed including further processing of the decellularized ECM before recellularization of the ECM with MSCs, co-culturing of MSCs with chondrocytes and establishing bioreactor culture e.g. with mechanostimulation, flow perfusion pressure and lowered oxygen tension. Graphical Abstract Synopsis of tissue engineering approaches based on cartilage-derived ECM.
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George SZ, Beneciuk JM, Lentz TA, Wu SS. The Optimal Screening for Prediction of Referral and Outcome (OSPRO) in patients with musculoskeletal pain conditions: a longitudinal validation cohort from the USA. BMJ Open 2017; 7:e015188. [PMID: 28600371 PMCID: PMC5734477 DOI: 10.1136/bmjopen-2016-015188] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/05/2017] [Accepted: 04/27/2017] [Indexed: 11/04/2022] Open
Abstract
PURPOSE There is an increased need for determining which patients with musculoskeletal pain benefit from additional diagnostic testing or psychologically informed intervention. The Optimal Screening for Prediction of Referral and Outcome (OSPRO) cohort studies were designed to develop and validate standard assessment tools for review of systems and yellow flags. This cohort profile paper provides a description of and future plans for the validation cohort. PARTICIPANTS Patients (n=440) with primary complaint of spine, shoulder or knee pain were recruited into the OSPRO validation cohort via a national Orthopaedic Physical Therapy-Investigative Network. Patients were followed up at 4 weeks, 6 months and 12 months for pain, functional status and quality of life outcomes. Healthcare utilisation outcomes were also collected at 6 and 12 months. FINDINGS TO DATE There are no longitudinal findings reported to date from the ongoing OSPRO validation cohort. The previously completed cross-sectional OSPRO development cohort yielded two assessment tools that were investigated in the validation cohort. FUTURE PLANS Follow-up data collection was completed in January 2017. Primary analyses will investigate how accurately the OSPRO review of systems and yellow flag tools predict 12-month pain, functional status, quality of life and healthcare utilisation outcomes. Planned secondary analyses include prediction of pain interference and/or development of chronic pain, investigation of treatment expectation on patient outcomes and analysis of patient satisfaction following an episode of physical therapy. TRIAL REGISTRATION NUMBER The OSPRO validation cohort was not registered.
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Affiliation(s)
- Steven Z George
- Musculoskeletal Research, Duke Clinical Research Institute, Durham, North Carolina, USA
- Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jason M Beneciuk
- Department of Physical Therapy, Brooks—PHHP Research Collaboration, University of Florida, Gainesville, Florida, USA
| | - Trevor A Lentz
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
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Pincus D, Kuhn JE, Sheth U, Rizzone K, Colbenson K, Dwyer T, Karpinos A, Marks PH, Wasserstein D. A Systematic Review and Appraisal of Clinical Practice Guidelines for Musculoskeletal Soft Tissue Injuries and Conditions. Am J Sports Med 2017; 45:1458-1464. [PMID: 28298051 DOI: 10.1177/0363546516667903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are published by several sports medicine institutions. A systematic evaluation can help identify the highest quality CPGs for clinical use and identify any deficiencies that remain. PURPOSE To identify and appraise CPGs relevant to clinical sports medicine professionals. STUDY DESIGN Systematic review. METHODS Predetermined selection criteria were utilized by 2 reviewers who independently identified published CPGs before January 1, 2014. CPGs were excluded if they focused on injured workers, radiological criteria, medical pathology, or the axial skeleton (back/neck). The remaining guidelines were scored by 6 reviewers with different clinical backgrounds using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Scores lower than 50% indicated deficiency. Scores were also stratified by the publishing institution and anatomic location and compared using Kruskal-Wallis tests. The Spearman correlation coefficient was used to assess the range of interobserver agreement between the evaluators. RESULTS Seventeen CPGs met the inclusion criteria. The majority of guidelines pertained to the knee, ankle, or shoulder. Interobserver agreement was strong ( r = 0.548-0.740), and mean total scores between nonsurgical (107.8) and surgical evaluators (109.3) were not statistically different. Overall guideline quality was variable but not deficient for 16 of 17 guidelines (>50%), except regarding clinical "applicability" and "editorial independence." No difference was found between CPGs of the knee, shoulder, foot/ankle, or chronic conditions. However, CPG publishing institutions had significantly different scores; the American Academy of Orthopaedic Surgeons (AAOS) guidelines scored significantly higher (141.4) than the total mean score (108.0). CONCLUSION The overall quality of sports medicine CPGs was variable but generally not deficient, except regarding applicability and editorial independence. Bias through poor editorial independence is a concern. To improve future guideline quality, authors should pay particular attention to these areas and use existing highest quality guidelines, or the AGREE II instrument, as templates. CPGs dedicated to anatomic areas other than the knee, ankle, and shoulder are needed.
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Affiliation(s)
- Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John E Kuhn
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ujash Sheth
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Katie Rizzone
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristi Colbenson
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tim Dwyer
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Karpinos
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul H Marks
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Eitzen I, Grindem H, Nilstad A, Moksnes H, Risberg MA. Quantifying Quadriceps Muscle Strength in Patients With ACL Injury, Focal Cartilage Lesions, and Degenerative Meniscus Tears: Differences and Clinical Implications. Orthop J Sports Med 2016; 4:2325967116667717. [PMID: 27766275 PMCID: PMC5063093 DOI: 10.1177/2325967116667717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Reduced quadriceps strength influences knee function and increases the risk of knee osteoarthritis. Thus, it is of significant clinical relevance to precisely quantify strength deficits in patients with knee injuries. Purpose: To evaluate isokinetic concentric quadriceps muscle strength torque values, assessed both from peak torque and at specific knee flexion joint angles, in patients with anterior cruciate ligament (ACL) injury, focal cartilage lesions, and degenerative meniscus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were synthesized from patients included in 3 previously conducted research projects: 2 prospective cohort studies and 1 randomized controlled trial. At the time of inclusion, all patients were candidates for surgery. Isokinetic concentric quadriceps muscle strength measurements (60 deg/s) were performed at baseline (preoperative status) and after a period of progressive supervised exercise therapy (length of rehabilitation period: 5 weeks for ACL injury, 12 weeks for cartilage lesions and degenerative meniscus). Outcome measures were peak torque and torque at specific knee flexion joint angles from 20° to 70°. All patients had unilateral injuries, and side-to-side deficits were calculated. For comparisons between and within groups, we utilized 1-way analysis of variance and paired t tests, respectively. Results: In total, 250 patients were included. At baseline, cartilage patients had the most severe deficit (39.7% ± 24.3%; P < .001). Corresponding numbers for ACL and degenerative meniscus subjects were 21.7% (±13.2%) and 20.7% (±16.3%), respectively. At retest, there was significant improvement in all groups (P < .001), with remaining deficits of 24.7% (±18.5%) for cartilage, 16.8% (±13.9%) for ACL, and 3.3% (±17.8%) for degenerative meniscus. Peak torque was consistently measured at 60° of knee flexion, whereas the largest mean deficits were measured at 30° at baseline and 70° at retest for the ACL group, at 70° at baseline and retest for the degenerative meniscus group, and at 60° at baseline and at 50° at retest for the cartilage group. Conclusion: This study underlines the importance of including torque at specific knee flexion joint angles from isokinetic assessments to identify the most severe quadriceps muscle strength deficits. Furthermore, it confirms the importance of progressive exercise therapy interventions before potential surgery in patients with knee injuries.
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Affiliation(s)
- Ingrid Eitzen
- Norwegian Research Center for Active Rehabilitation (NAR), Oslo, Norway.; Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Hege Grindem
- Norwegian Research Center for Active Rehabilitation (NAR), Oslo, Norway.; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Agnethe Nilstad
- Norwegian Research Center for Active Rehabilitation (NAR), Oslo, Norway.; Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Håvard Moksnes
- Norwegian Research Center for Active Rehabilitation (NAR), Oslo, Norway.; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - May Arna Risberg
- Norwegian Research Center for Active Rehabilitation (NAR), Oslo, Norway.; Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Fischer S, Kisser A. Single-step scaffold-based cartilage repair in the knee: A systematic review. J Orthop 2016; 13:246-53. [PMID: 27408497 DOI: 10.1016/j.jor.2016.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022] Open
Abstract
Chondral lesions are difficult-to-treat entities that often affect young and active people. Moreover, cartilage has limited intrinsic healing potential. The purpose of this systematic literature review was to analyse whether the single-step scaffold-based cartilage repair in combination with microfracturing (MFx) is more effective and safe in comparison to MFx alone. From the three identified studies, it seems that the single-step scaffold-assisted cartilage repair in combination with MFx leads to similar short- to medium-term (up to five years follow-up) results, compared to MFx alone. All of the studies have shown improvements regarding joint functionality, pain and partly quality of life.
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Affiliation(s)
- Stefan Fischer
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Vienna, Austria
| | - Agnes Kisser
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Vienna, Austria
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