Current Reviews in Musculoskeletal Medicine最新文献

Background: Purpose of review Agili-C® (CartiHeal, Smith & Nephew) is an off-the-shelf aragonite-based (inorganic calcium carbonate) scaffold approved for clinical use in 2022 to treat chondral and osteochondral lesions eventually also in the context of mild to moderate knee osteoarthritis (Kellgren-Lawrence 0-3). The successful preclinical studies justified the subsequent clinical trials which reported both clinical and radiological significant improvements over time as well as superiority over standard surgical techniques for cartilage lesions treatment (i.e. microfractures/debridement). The aim of the present review is to summarize the available preclinical and clinical evidence and to report the current indications, surgical techniques and outcomes of this novel and innovative osteochondral scaffold.

Recent findings: A total of six clinical reports, four single cohorts studies and a recent double arm randomized control trial followed by an analysis differentiating between femoral and trochlear lesions, have been published on Agili-C® safety and efficacy. Supported with an excellent safety profile, Agili-C® provided statistically significant clinical benefits at short and medium-term follow up in patients affected by knee joint surface lesions also when presenting in the context of mild to moderate knee osteoarthritis (Kellgren-Lawrence 0-3). Agili-C® (CartiHeal, Smith & Nephew) is an innovative aragonite-based osteochondral scaffold. It is an CE-marked and FDA approved off-the-shelf, cell-free, and cost-effective implant designed to treat knee joint surface lesions in the form of chondral and osteochondral defects. Its indications, supported by consistent clinical evidence, are single or multiple knee joint surface lesions (ICRS grade III or IV), with a total treatable area of 1-7cm², without severe knee OA (Kellgren-Lawrence grade 0-3).

Purpose of review: Reverse total shoulder arthroplasty has become an excellent surgical option for patients suffering from various shoulder pathologies including rotator cuff arthropathy, inflammatory arthritis and proximal humerus fractures. The goals of this operation are to reduce pain, restore function, and allow patients to be able to return to both work and sport. This article provides insight into the return to work and sport of patients who have undergone reverse total shoulder arthroplasty.

Recent findings: Recent literature has demonstrated that patients who have undergone reverse total shoulder arthroplasty demonstrate high rates of return to work and sport. Variations in patient age, sex, work intensity, type of sport and rehabilitation protocols can also play a factor in being able to return to work and sport. Patients who have undergone reverse total shoulder arthroplasty are able to return to work and sport in a timely manner. A structured rehabilitation protocol, appropriate patient selection and excellent communication between surgeon and patient is crucial to achieve a successful return to work and sport.

Purpose of review: The current landscape of treating anterior cruciate ligament (ACL) tears is rapidly evolving with the advent of the bridge-enhanced ACL restoration (BEAR). BEAR is a novel approach to restore the ACL in lieu of conventional reconstruction. BEAR has recently been approved for post-market use by all orthopaedic surgeons for midsubstance or proximal ACL tears. This article provides a review of the indications and outcomes of BEAR, graduating from the Trial 1 stage to the post-market stage, current operative techniques, and the postoperative rehabilitation protocol for BEAR.

Recent findings: Current research demonstrates similar postoperative patient-reported outcome measures and functional outcomes following BEAR compared to ACL reconstruction in clinical trials. Combining all three BEAR trials, there was an aggregate re-tear rate of 15%. Our post-market published BEAR data shows non-inferior short-term postoperative PROMs and functional outcomes as well as zero re-tears. The early- and mid-term results of BEAR show that it is a potential alternative to ACLR for specific patient groups.

Purpose of review: Cartilage injury does not heal spontaneously. The current cell-based cartilage treatments have either demonstrated poor clinical outcomes, require two surgeries, or are costly and logistically challenging. To overcome these challenges, our team has developed a one-stage, two cell-type surgical cell therapy for acute chondral defects. This procedure combines allogeneic mesenchymal stromal cells (MSCs) and autologous chondrons to harness MSCs as signaling cells to stimulate chondrons to promote tissue repair. This procedure has been investigated in clinical trials conducted in both Europe and the United States which are called IMPACT and RECLAIM, respectively. This article provides a review of our preclinical and clinical research which led to the development of this cell therapy.

Recent findings: The combination of allogeneic MSCs and autologous chondrons in preclinical studies have demonstrated to synergistically stimulate cartilage repair, and the combination of cells outperforms either cell-type alone. In clinical trials, the combined cell therapy was safe to use, improved knee function, and demonstrated durable pain reduction. Our single-stage, combined cell therapy of allogeneic MSCs and autologous chondrons is a viable cell therapy for acute articular cartilage defects. We anticipate this combined cell therapy may be a platform cell therapy for a wide range of musculoskeletal repair applications.

Purpose of review: Meniscectomy alters knee function and known to be associated with an increased incidence of knee arthritis. Several methods and materials have been tried to replicate the function of a meniscus. One is a polycarbonate-urethane synthetic medial meniscus implant labeled as NUsurface. It is a non-anchored implant that is meant to replace the native meniscus. This article is intended to give an overview of the NUsurface implant and the experience to date.

Recent findings: The NUsurface implant is not intended to be a substitute for arthroplasty but has indications similar to meniscal allografts. It has had both prospective double armed and single armed prospective studies. Follow up at the 2-year mark has shown the implant can be successful in decreasing patients' pain and improving function. However, the reoperation rate has been high with a little over a 1/3 requiring an additional procedure and 30% requiring implant exchanged. With improved surgical technique and knowledge of contributing anatomic variables, the reoperation rate has been decreased by half. The synthetic medial meniscus implant NUsurface is able to improve the quality of life in select patients that are symptomatic after meniscectomy. The reoperation rate is of concern but it is decreasing as we refine the variables contributing to the high rate.

Purpose of review: Limb alignment correction about the knee joint is crucial for the protection of the meniscus, particularly in the setting of meniscal root repairs and meniscal allograft transplantation. Distal femoral osteotomies and high tibial osteotomies have been described to restore the anatomic alignment to aid in meniscal preservation. This article provides a review of knee alignment and biomechanics, various surgical interventions to correct knee malalignment, and the effect of malalignment on the treatment of meniscal pathology.

Recent findings: Both distal femoral and high tibial corrective osteotomies have been shown to slow the progression of osteoarthritis in the postoperative period. Moreover, corrective osteotomies have resulted in high patient satisfaction and good survival rates at mid- to long-term follow-up in patients with prior varus/valgus malalignment. Ongoing research is aimed to determine the best utilization for concomitant osteotomies in the setting and treatment of meniscal pathology with hopes of decreasing the progression of early-onset osteoarthritis, and ultimately, the conversion to total knee arthroplasty.  Neutral alignment at the level of the knee joint results in optimal force distributions. Corrective valgus and varus osteotomies aim to restore neutral alignment with the goal of ligamentous and meniscal preservation, ideally slowing osteoarthritis progression.

Purpose of review: Atraumatic hip pain in children is one of the most common orthopaedic complaints in this population. This review details the important elements of the pediatric hip physical exam and provides an overview of pertinent clinical exam findings in specific diagnoses of common pediatric hip pathology.

Recent findings: A thorough physical exam is critical for the diagnosis of pediatric hip pathology, as many conditions have exam findings that are very commonly associated with the pathology, if not pathognomonic for the disorder. Additionally, pediatric hip pathology is strongly age-related, so an understanding of typical exam findings and common hip conditions by age can be invaluable in forming a correct diagnosis. Inspection, palpation, range of motion, gait analysis, and provocative tests provide clues about potential diagnoses. Together with history and risk factors, pediatric clinicians can make appropriate diagnosis of pediatric hip disorders.

Purpose of review: Fatty infiltration (FI) of the rotator cuff is a critical determinant of clinical outcomes following rotator cuff injuries and repairs. This review examines the natural history, pathophysiology, imaging evaluation, and treatment strategies for FI, highlighting recent insights into its cellular mechanisms and emerging therapeutic approaches.

Recent findings: Animal models demonstrate that FI begins shortly after tendon injury, progresses with muscle retraction and denervation, and is largely irreversible despite repair. Key cellular drivers include fibroadipogenic progenitor cells (FAPs), influenced by mechanical loading and inflammatory signaling pathways. Clinical studies show that FI is associated with advanced age, female sex, and full-thickness tears. Higher degrees of preoperative FI correlate with poorer functional outcomes and increased re-tear rates. Novel therapeutic targets, including pathways regulating FAP activity, TGF-β, and cell-based therapies, show promise in preclinical studies. Emerging strategies such as leukocyte-poor platelet-rich plasma (PRP) may mitigate FI progression in clinical settings. Fatty infiltration remains a significant barrier to successful rotator cuff repair and functional recovery. While surgical repair may slow FI progression, it is not consistently effective in reversing established muscle degeneration. Improved understanding of the molecular mechanisms driving FI has identified potential therapeutic targets, but their clinical applicability requires further validation. Future advances in regenerative medicine, including cell-based therapies and modulation of fibroadipogenic progenitors, offer hope for mitigating FI and improving long-term outcomes.

Purpose of review: The management of horizontal cleavage meniscus tears (HCT) has evolved in recent years. Historically, HCTs have been treated with partial meniscectomy, but multiple studies have shown the long-term risks of development of arthritic changes in the knee following meniscectomy. These findings have renewed interest in meniscal preservation whenever possible, even in older patients not previously considered for meniscus repair. This article provides an overview of current management of horizontal cleavage meniscus tears and describes modern surgical techniques for repair of HCTs.

Recent findings: Current research studies have continued to emphasize the benefits of meniscal preservation on long-term function. Recent data has demonstrated similar success rates following repair of HCTs compared to repair of other types of meniscus tears. Additionally, multiple recent studies have demonstrated the potential benefit of biologic augmentation in decreasing failure rate after meniscal repair. Modern surgical techniques and biologic augmentation have improved outcomes of meniscal repair. However, consideration of a patient's individual goals, activity level, and expectation are important to achieve a successful outcome regardless of treatment modality. While not every patient is a candidate for meniscal repair, current data has shown it should be considered for a growing number of patients.