1
|
Milliron E, Beran MC, DiBartola AC. Editorial Commentary: Osteochondral Allograft of the Knee-Diffuse Edema at 6 Months on Magnetic Resonance Imaging Predicts Failure. Arthroscopy 2024:S0749-8063(24)00147-6. [PMID: 38395271 DOI: 10.1016/j.arthro.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Cartilage defects alter natural function of articular cartilage and can predispose patients to further cartilage wear and eventual osteoarthritis. These injuries present a challenging problem with a multitude of treatment options and lack of consensus on when to employ each. Options include conservative measures (limited weightbearing and immobilization), debridement, microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft. Indications may be based on defect size, joint alignment, age, activity level, body mass index, and sex. One option, osteochondral allograft (OCA) transplantation, is typically reserved for large and severe defects or revision. With regard to OCA prognosis, older patients, revision cases, patellar defects, and bipolar lesions confer elevated risk of failure, whereas traumatic or idiopathic cases, unipolar lesions, and short duration of symptoms have reported higher levels of satisfaction. Following surgery, the patient with persistent symptoms can present a conundrum. Recent research shows that in such cases, diffuse edema at 6 months on magnetic resonance imaging often predicts ultimate failure, in which case arthroplasty may be required.
Collapse
Affiliation(s)
- Eric Milliron
- Ohio State University Wexner Medical Center (E.M.); Nationwide Children's Hospital (M.C.B.)
| | - Matthew C Beran
- Ohio State University Wexner Medical Center (E.M.); Nationwide Children's Hospital (M.C.B.)
| | - Alex C DiBartola
- Ohio State University Wexner Medical Center (E.M.); Nationwide Children's Hospital (M.C.B.)
| |
Collapse
|
2
|
Mallory N, Qin C, Gibbs D, Milliron E, Cavendish P, Magnussen RA, Flanigan DC. Horizontal Cleavage Meniscus Tears: Biomechanics, Indications, Techniques, and Outcomes. JBJS Rev 2023; 11:01874474-202308000-00006. [PMID: 37561839 DOI: 10.2106/jbjs.rvw.23.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
» Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have demonstrated that these procedures have an adverse biomechanical effect, while HCT repairs restore the knee's natural biomechanics.» Indications for the surgical repair of HCTs remain disputed, but surgery is generally considered for young, active patients and older patients without significant concomitant osteoarthritis.» Early clinical findings surrounding HCT repair are promising. They suggest that this treatment adequately restores meniscus mechanics, leads to good knee functional outcomes, and results in a high likelihood of return to preinjury activity levels.
Collapse
Affiliation(s)
- Noah Mallory
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Charles Qin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Gibbs
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Eric Milliron
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Parker Cavendish
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
3
|
Blunt KM, Bentkowski BN, Milliron E, Cavendish P, Qin C, Magnussen RA, Stoodley P, Flanigan DC. Influence of Staphylococcus epidermidis on Collagen Crimp Patterns of Soft Tissue Allograft. Am J Sports Med 2023:3635465231181649. [PMID: 37449681 DOI: 10.1177/03635465231181649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Postoperative infections, commonly from Staphylococcus epidermidis, may result in anterior cruciate ligament graft failure and necessitate revision surgery. In biomechanical studies, S. epidermidis has been shown to establish biofilms on tendons and reduce graft strength. PURPOSE/HYPOTHESIS The goal of this study was to determine the effect of bacterial bioburden on the collagen structure of tendon. It was hypothesized that an increase in S. epidermidis biofilm would compromise tendon crimp, a pattern necessary for mechanical integrity, of soft tissue allografts. STUDY DESIGN Controlled laboratory study. METHODS Cultures of S. epidermidis were used to inoculate tibialis anterior cadaveric tendons. Conditions assessed included 5 × 105 colony-forming units or concentrated spent media from culture (no living bacteria). Incubation times of 30 minutes, 3 hours, 6 hours, and 24 hours were utilized. Second-harmonic generation imaging allowed for visualization of collagen autofluorescence. Crimp lengths were determined using ImageJ and compared based on incubation time. RESULTS Incubation time positively correlated with increasing S. epidermidis bioburden. Both fine and coarse crimp patterns lengthened with increasing incubation time. Significant coarse crimp changes were observed after only 30-minute incubations (P < .029), whereas significant fine crimp lengthening occurred after 6 hours (P < .0001). No changes in crimp length were identified after incubation in media lacking living bacteria. CONCLUSION The results of this study demonstrate that exposure to S. epidermidis negatively affects collagen crimp structure. Structural alterations at the collagen fiber level occur within 30 minutes of exposure to media containing S. epidermidis. CLINICAL RELEVANCE Our study highlights the need for antimicrobial precautions to prevent graft colonization and maximize graft mechanical strength.
Collapse
Affiliation(s)
- Koral M Blunt
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Eric Milliron
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Parker Cavendish
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles Qin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Paul Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
| |
Collapse
|
4
|
DiBartola AC, Magnussen RA, Everhart JS, Milliron E, Emery CF, Schiele SE, Harris KM, Schmitt L, Flanigan DC. Athletes and Nonathletes Show No Difference in Symptoms or Function Prior to Knee Surgery, but Those With Chronic Symptoms Show Increased Pain Catastrophizing and Kinesiophobia. Arthroscopy 2023; 39:1028-1034. [PMID: 36872027 DOI: 10.1016/j.arthro.2022.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine whether preoperative psychological status before outpatient knee surgery is influenced by athletic status, symptom chronicity, or prior surgical history. METHODS International Knee Documentation Committee subjective scores (IKDC-S), Tegner Activity Scale scores, and Marx Activity Rating Scale scores were collected. Psychological and pain surveys included the McGill pain scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia 11, Patient Health Questionnaire 9, Perceived Stress Scale, New General Self-Efficacy Scale, and Life Orientation Test-Revised for optimism. Linear regression was used to determine the effects of athlete status, symptom chronicity (>6 months or ≤6 months), and history of prior surgery on preoperative knee function, pain, and psychological status after matching for age, sex, and surgical procedure. RESULTS In total, 497 knee surgery patients (247 athletes, 250 nonathletes) completed a preoperative electronic survey. All patients were age 14 years and older and had knee pathology requiring surgical treatment. Athletes were younger than nonathletes on average (mean [SD], 27.7 [11.4] vs 41.6 [13.5] years; P < .001). The most frequently reported level of play among athletes was intramural or recreational (n = 110, 44.5%). Athletes had higher preoperative IKDC-S scores (mean [SE], 2.5 [1.0] points higher; P = .015) and lower McGill pain scores compared to nonathletes (mean [SE] 2.0 [0.85] points lower; P = .017). After matching for age, sex, athlete status, prior surgery, and procedure type, having chronic symptoms resulted in higher preoperative IKDC-S (P < .001), pain catastrophizing (P < .001), and kinesiophobia scores (P = .044). CONCLUSIONS Athletes demonstrate no difference in symptom/pain and function scores preoperatively when compared to nonathletes of similar age, sex, and knee pathology, as well as no difference in multiple psychological distress outcomes measures. Patients with chronic symptoms have more pain catastrophizing and kinesiophobia, while those who have had prior knee surgeries have slightly higher preoperative McGill pain score. LEVEL OF EVIDENCE Level III, cross-sectional analysis of prospective cohort study data.
Collapse
Affiliation(s)
- Alex C DiBartola
- Department of Orthopaedics, 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; Department of Orthopaedics Sports Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | | | - Eric Milliron
- The Ohio State University College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Charles F Emery
- Department of Psychology, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Steve E Schiele
- Department of Psychology, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kristie M Harris
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University and Jameson Crane Sports Medicine Research Institute, Ohio State University, Columbus, Ohio, U.S.A
| | - David C Flanigan
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A; Department of Orthopaedics 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.
| |
Collapse
|
5
|
Gonzalez RC, Ryskamp DJ, Swinehart SD, Cavendish PA, Milliron E, DiBartola AC, Duerr RA, Flanigan DC, Magnussen RA. Patellofemoral articular cartilage damage is associated with poorer patient-reported outcomes following isolated medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07221-x. [PMID: 36383223 DOI: 10.1007/s00167-022-07221-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of articular cartilage damage on outcomes following medial patellofemoral ligament (MPFL) reconstruction. METHODS Record review identified 160 patients who underwent isolated MPFL reconstruction at a single institution between 2008 and 2016. Patient demographics, patellofemoral articular cartilage status at surgery, and patient anatomical measures from imaging were obtained via chart review. Patients were contacted and outcomes assessed through collection of Norwich Patellar Instability (NPI) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity score as well as an assessment for recurrent patellar dislocation. Outcomes of patients with grade 0-II patellofemoral cartilage damage were compared to those of patients with grade III-IV cartilage damage. RESULTS One hundred twenty-two patients (76%) with a minimum of one year follow-up were contacted at a mean of 4.8 years post-operatively. A total of 63 patients (52%) had grade III or IV patellofemoral chondral damage at the time of surgery. The majority of the defects was on the medial patella (46 patients-72%) and the mean patellar defect size was 2.8 cm2. Among 93 patients who completed patient-reported outcome scores, the 52 with grade III or IV chondral damage reported a significantly poorer KOOS Quality of Life than the 44 patients with grade 0 to II chondral damage (p = 0.041), controlling for patient age, sex, BMI, and anatomical factors. CONCLUSION Patients with grade III or IV articular cartilage damage of the patellofemoral joint at the time of MPFL reconstruction demonstrated poorer KOOS knee-related quality of life than patients without grade III or IV articular cartilage damage at a mean of 4.8 years following isolated MPFL reconstruction. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
| | - David J Ryskamp
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Steven D Swinehart
- Department of Orthopaedics, The Ohio State University, Jameson Crane Institute of Sports Medicine, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
| | - Parker A Cavendish
- Department of Orthopaedics, The Ohio State University, Jameson Crane Institute of Sports Medicine, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
| | - Eric Milliron
- Department of Orthopaedics, The Ohio State University, Jameson Crane Institute of Sports Medicine, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
| | - Alex C DiBartola
- Department of Orthopaedics, The Ohio State University, Jameson Crane Institute of Sports Medicine, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
| | - Robert A Duerr
- Department of Orthopaedics, The Ohio State University, Jameson Crane Institute of Sports Medicine, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Jameson Crane Institute of Sports Medicine, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University, Jameson Crane Institute of Sports Medicine, Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA.
| |
Collapse
|
6
|
Abstract
Traumatic brain injury (TBI) is a common condition with many potential acute and chronic neurological consequences. Standard initial radiographic evaluation includes noncontrast head CT scanning to rapidly evaluate for pathology that might require intervention. The availability of fast, relatively inexpensive CT imaging has fundamentally changed the clinician's ability to noninvasively visualize neuroanatomy. However, in the context of TBI, limitations of head CT without contrast include poor prognostic ability, inability to analyze cerebral perfusion status, and poor visualization of underlying posttraumatic changes to brain parenchyma. Here, the authors review emerging advanced imaging for evaluation of both acute and chronic TBI and include QuickBrain MRI as an initial imaging modality. Dynamic susceptibility-weighted contrast-enhanced perfusion MRI, MR arterial spin labeling, and perfusion CT are reviewed as methods for examining cerebral blood flow following TBI. The authors evaluate MR-based diffusion tensor imaging and functional MRI for prognostication of recovery post-TBI. Finally, MR elastography, MR spectroscopy, and convolutional neural networks are examined as future tools in TBI management. Many imaging technologies are being developed and studied in TBI, and some of these may hold promise in improving the understanding and management of TBI. ABBREVIATIONS ASL = arterial spin labeling; CNN = convolutional neural network; CTP = perfusion CT; DAI = diffuse axonal injury; DMN = default mode network; DOC = disorders of consciousness; DTI = diffusion tensor imaging; FA = fractional anisotropy; fMRI = functional MRI; GCS = Glasgow Coma Scale; MD = mean diffusivity; MRE = MR elastography; MRS = MR spectroscopy; mTBI = mild TBI; NAA = N-acetylaspartate; SWI = susceptibility-weighted imaging; TBI = traumatic brain injury; UHF = ultra-high field.
Collapse
Affiliation(s)
| | - Eric Milliron
- 2The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus; and
| | | | | | | | - Jeffrey Leonard
- 1Department of Neurological Surgery and.,4Division of Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Eric A Sribnick
- 1Department of Neurological Surgery and.,4Division of Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|