{"title":"Lost in quantity: The urgent need for more quality in orthopaedic research.","authors":"Stefano Zaffagnini, Piero Agostinone","doi":"10.1002/ksa.12488","DOIUrl":"https://doi.org/10.1002/ksa.12488","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tayfun Yilmaz, Markus Siegel, Elham Taghizadeh, Andreas Fuchs, Philipp Niemeyer, Hagen Schmal, Kaywan Izadpanah
Purpose: Different cartilage repair techniques are widely used to regenerate cartilage, such as autologous chondrocyte implantation (ACI), osteochondral autograft transfer, microfracturing and minced cartilage. Defect size is a key parameter for selecting the best procedure to repair cartilage. However, the defect's size is not related to the patient's total cartilage surface. This is because assessing the femoral cartilage surface area is time-consuming and therefore unsuitable in the daily clinical routine. It has been proposed that the femur's total cartilage area correlates positively with the transepicondylar distance (TEA).
Methods: The knees of 40 subjects were analysed. Their average age was 30.1 ± 8.6 years. Twenty-four female and 16 male subjects were examined. Their mean body height was 176.2 ± 8.8 cm. MRI scans were performed via 3-Tesla MRI. These data were postprocessed and quantified using the browser-based, customizable SATORI platform (Fraunhofer MEVIS). This software computed the femoral cartilage surface area (FeCA), the patella cartilage surface area (PCA), the TEA and the patella length.
Results: Body height reveals a good correlation (r = 0.722, p < 0.001) with the distal femur's cartilage area surface. However, regression analysis shows only moderate dependence (R2: 0.514). A very good correlation (r = 0.830, p < 0.001) was observed between the TEA distance and the total cartilage surface area of the distal femur. The regression analysis yields a good value (R2: 0.684). The cranio-caudal length of the patella was chosen as a suitably measurable two-dimensional parameter for correlation analysis with the patella's total cartilage surface area. Those results yield a poor correlation (r = 0.577, p < 0.001) between the two parameters, and regression analysis reveals a low value (R2: 0.384).
Conclusion: The TEA is a reliable parameter for estimating the femur's cartilage area using MRI. A simple determination of this parameter allows the estimation of the femur's total cartilage area as well as the surface-corrected defect size (SCDS) in daily routine.
{"title":"The transepicondylar distance is a reliable and easily measured parameter for estimating femoral cartilage surface area using MRI.","authors":"Tayfun Yilmaz, Markus Siegel, Elham Taghizadeh, Andreas Fuchs, Philipp Niemeyer, Hagen Schmal, Kaywan Izadpanah","doi":"10.1002/ksa.12482","DOIUrl":"https://doi.org/10.1002/ksa.12482","url":null,"abstract":"<p><strong>Purpose: </strong>Different cartilage repair techniques are widely used to regenerate cartilage, such as autologous chondrocyte implantation (ACI), osteochondral autograft transfer, microfracturing and minced cartilage. Defect size is a key parameter for selecting the best procedure to repair cartilage. However, the defect's size is not related to the patient's total cartilage surface. This is because assessing the femoral cartilage surface area is time-consuming and therefore unsuitable in the daily clinical routine. It has been proposed that the femur's total cartilage area correlates positively with the transepicondylar distance (TEA).</p><p><strong>Methods: </strong>The knees of 40 subjects were analysed. Their average age was 30.1 ± 8.6 years. Twenty-four female and 16 male subjects were examined. Their mean body height was 176.2 ± 8.8 cm. MRI scans were performed via 3-Tesla MRI. These data were postprocessed and quantified using the browser-based, customizable SATORI platform (Fraunhofer MEVIS). This software computed the femoral cartilage surface area (FeCA), the patella cartilage surface area (PCA), the TEA and the patella length.</p><p><strong>Results: </strong>Body height reveals a good correlation (r = 0.722, p < 0.001) with the distal femur's cartilage area surface. However, regression analysis shows only moderate dependence (R<sup>2</sup>: 0.514). A very good correlation (r = 0.830, p < 0.001) was observed between the TEA distance and the total cartilage surface area of the distal femur. The regression analysis yields a good value (R<sup>2</sup>: 0.684). The cranio-caudal length of the patella was chosen as a suitably measurable two-dimensional parameter for correlation analysis with the patella's total cartilage surface area. Those results yield a poor correlation (r = 0.577, p < 0.001) between the two parameters, and regression analysis reveals a low value (R<sup>2</sup>: 0.384).</p><p><strong>Conclusion: </strong>The TEA is a reliable parameter for estimating the femur's cartilage area using MRI. A simple determination of this parameter allows the estimation of the femur's total cartilage area as well as the surface-corrected defect size (SCDS) in daily routine.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christof Hoffmann, Fatih Göksu, Isabella Klöpfer-Krämer, Julius Watrinet, Philipp Blum, Sven Hungerer, Steffen Schröter, Fabian Stuby, Peter Augat, Julian Fürmetz
Objective: Evaluation of long-leg standing radiographs (LSR) is a standardised procedure for analysis of primary or secondary deformities of the lower limbs. Deep-learning convolutional neural networks (CNN) offer the potential to enhance radiological measurement by increasing reproducibility and accuracy. This study aims to evaluate the measurement accuracy of an automated CNN-based planning tool (mediCAD® 7.0; mediCAD Hectec GmbH) of lower limb deformities.
Methods: In a retrospective single-centre study, 164 pre- and postoperative bilateral LSRs with uni- or bilateral posttraumatic knee arthritis undergoing total knee arthroplasty (TKA) were enroled. Alignment parameters relevant to knee arthroplasty and deformity correction were analysed independently by two observers and a CNN. The intraclass correlation coefficient (ICC) was used to evaluate the accuracy between observers and the CNN, which was further evaluated using absolute deviations, limits of agreement (LoA) and root mean square error (RMSE).
Results: CNN evaluation demonstrated high consistency in measuring leg length (ICC > 0.99) and overall lower limb alignment measures of mechanical tibio-femoral angle (mTFA) (ICC > 0.97; RMSE < 1.1°). The mean absolute difference between angular measurements were low for overall lower limb alignment (mTFA 0.49-0.61°) and high for specific joint angles (aMPFA 3.86-4.50°). Accuracy at specific joint angles like the mechanical proximal tibial angle (MPTA) and the mechanical lateral distal femur angle (mLDFA) varied between lower limbs with deformity, with and without TKA with greatest difference for TKA (ICC 0.22-0.85; RMSE 1.72-3.65°).
Conclusion: Excellent accuracy was observed between manual and automated measurements for overall alignment and leg length, but joint-level metrics need further improvement especially in case of TKA similar to other existing algorithms. Despite the observed deviations, the time-efficient nature of the algorithm improves the efficiency of the preoperative planning process.
{"title":"High accuracy in lower limb alignment analysis using convolutional neural networks, with improvements needed for joint-level metrics.","authors":"Christof Hoffmann, Fatih Göksu, Isabella Klöpfer-Krämer, Julius Watrinet, Philipp Blum, Sven Hungerer, Steffen Schröter, Fabian Stuby, Peter Augat, Julian Fürmetz","doi":"10.1002/ksa.12481","DOIUrl":"https://doi.org/10.1002/ksa.12481","url":null,"abstract":"<p><strong>Objective: </strong>Evaluation of long-leg standing radiographs (LSR) is a standardised procedure for analysis of primary or secondary deformities of the lower limbs. Deep-learning convolutional neural networks (CNN) offer the potential to enhance radiological measurement by increasing reproducibility and accuracy. This study aims to evaluate the measurement accuracy of an automated CNN-based planning tool (mediCAD® 7.0; mediCAD Hectec GmbH) of lower limb deformities.</p><p><strong>Methods: </strong>In a retrospective single-centre study, 164 pre- and postoperative bilateral LSRs with uni- or bilateral posttraumatic knee arthritis undergoing total knee arthroplasty (TKA) were enroled. Alignment parameters relevant to knee arthroplasty and deformity correction were analysed independently by two observers and a CNN. The intraclass correlation coefficient (ICC) was used to evaluate the accuracy between observers and the CNN, which was further evaluated using absolute deviations, limits of agreement (LoA) and root mean square error (RMSE).</p><p><strong>Results: </strong>CNN evaluation demonstrated high consistency in measuring leg length (ICC > 0.99) and overall lower limb alignment measures of mechanical tibio-femoral angle (mTFA) (ICC > 0.97; RMSE < 1.1°). The mean absolute difference between angular measurements were low for overall lower limb alignment (mTFA 0.49-0.61°) and high for specific joint angles (aMPFA 3.86-4.50°). Accuracy at specific joint angles like the mechanical proximal tibial angle (MPTA) and the mechanical lateral distal femur angle (mLDFA) varied between lower limbs with deformity, with and without TKA with greatest difference for TKA (ICC 0.22-0.85; RMSE 1.72-3.65°).</p><p><strong>Conclusion: </strong>Excellent accuracy was observed between manual and automated measurements for overall alignment and leg length, but joint-level metrics need further improvement especially in case of TKA similar to other existing algorithms. Despite the observed deviations, the time-efficient nature of the algorithm improves the efficiency of the preoperative planning process.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cody C Ashy, Mary-Katherine Lynch, Henry B G Baird, John W Xerogeanes, William Pullen, Harris S Slone
Purpose: This study sought to quantify the tunnel widening associated with quadriceps tendon (QT) autograft after anterior cruciate ligament reconstruction (ACLR) and compare it to bone-patellar tendon-bone (BTB) autografts.
Methods: A retrospective review of each ACLR performed at a single academic institution from 2011 to 2021 were reviewed. Subjects with repeat ipsilateral knee magnetic resonance imaging (MRI) studies performed after ACLR were included. Two reviewers independently measured the maximum diameter of the femoral and tibial tunnels 1 cm from the aperture. Tunnel widening was calculated as the difference between the initial drilled diameter and the measured diameters.
Results: Seventy-five patients (38 BTB and 37 QT autografts) were identified including 42 females and 33 males. With respect to graft type (QT vs. BTB), there was no statistically significant difference in median patient age (19.0 (16.0-31.5) years vs. 20.0 (16.8-30.0) years respectively; p = n.s.) or median time to MRI (12.0 [9.0-19.5] months vs. 13.0 [7.0-43.3] months respectively, p = n.s.). Mean tunnel diameter changes or widening was statistically significantly greater for QT autografts than BTB autografts at the tibial tunnel: (0.4 [±0.6] mm] vs. -0.4 [±1.1 mm; p < 0.001). Similarly, the mean tunnel diameter change was also significantly greater at the femoral tunnel for QT compared to BTB. (0.2 [±0.6] mm vs. -0.4 [±0.8] mm; p < 0.001) However, no patients with QT grafts demonstrated tibial or femoral tunnel diameters >12 mm.
Conclusion: Although QT autografts had a statistically significant greater amount of tunnel widening compared to BTB autografts; the mean tibial and femoral net widening of 0.4 mm and 0.2 mm, respectively, does not meet previously reported clinically significant values. Thus, the tunnel widening presented in this study is unlikely to affect clinical outcomes and should not preclude the use of either graft.
Level of evidence: Level III (Retrospective comparative study).
{"title":"All-soft tissue quadriceps tendon autograft and bone-patellar tendon-bone autograft demonstrate no significant ACL tunnel widening: An MRI comparison.","authors":"Cody C Ashy, Mary-Katherine Lynch, Henry B G Baird, John W Xerogeanes, William Pullen, Harris S Slone","doi":"10.1002/ksa.12479","DOIUrl":"https://doi.org/10.1002/ksa.12479","url":null,"abstract":"<p><strong>Purpose: </strong>This study sought to quantify the tunnel widening associated with quadriceps tendon (QT) autograft after anterior cruciate ligament reconstruction (ACLR) and compare it to bone-patellar tendon-bone (BTB) autografts.</p><p><strong>Methods: </strong>A retrospective review of each ACLR performed at a single academic institution from 2011 to 2021 were reviewed. Subjects with repeat ipsilateral knee magnetic resonance imaging (MRI) studies performed after ACLR were included. Two reviewers independently measured the maximum diameter of the femoral and tibial tunnels 1 cm from the aperture. Tunnel widening was calculated as the difference between the initial drilled diameter and the measured diameters.</p><p><strong>Results: </strong>Seventy-five patients (38 BTB and 37 QT autografts) were identified including 42 females and 33 males. With respect to graft type (QT vs. BTB), there was no statistically significant difference in median patient age (19.0 (16.0-31.5) years vs. 20.0 (16.8-30.0) years respectively; p = n.s.) or median time to MRI (12.0 [9.0-19.5] months vs. 13.0 [7.0-43.3] months respectively, p = n.s.). Mean tunnel diameter changes or widening was statistically significantly greater for QT autografts than BTB autografts at the tibial tunnel: (0.4 [±0.6] mm] vs. -0.4 [±1.1 mm; p < 0.001). Similarly, the mean tunnel diameter change was also significantly greater at the femoral tunnel for QT compared to BTB. (0.2 [±0.6] mm vs. -0.4 [±0.8] mm; p < 0.001) However, no patients with QT grafts demonstrated tibial or femoral tunnel diameters >12 mm.</p><p><strong>Conclusion: </strong>Although QT autografts had a statistically significant greater amount of tunnel widening compared to BTB autografts; the mean tibial and femoral net widening of 0.4 mm and 0.2 mm, respectively, does not meet previously reported clinically significant values. Thus, the tunnel widening presented in this study is unlikely to affect clinical outcomes and should not preclude the use of either graft.</p><p><strong>Level of evidence: </strong>Level III (Retrospective comparative study).</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irene Cortés-Pérez, Jose María Desdentado-Guillem, María Soledad Camacho-Delgado, María Del Rocío Ibancos-Losada, Esteban Obrero-Gaitán, Rafael Lomas-Vega
Purpose: Virtual reality-based therapy (VRBT) may be an effective physical therapy complement employed in the rehabilitation of patients with anterior cruciate ligament (ACL) injury. This study aims to assess the effectiveness of VRBT in improving pain, knee function, strength, proprioception, flexion range of motion (ROM), and dynamic balance after ACL injury.
Methods: We conducted this systematic review with meta-analysis following PRISMA criteria. Since inception to June 2024, we searched in PubMed Medline, WOS, SCOPUS, CINAHL and PEDro without publication date and language restrictions. Randomised controlled trials (RCTs), comprising only patients with ACL injury, that assess the effectiveness of VRBT compared to classical interventions on the outcomes of interest were included. PEDro scale was employed to analyze the methodological quality of the RCTs included. Cohen's standardised mean difference (SMD) and its 95% confidence interval (95% CI) was used to calculate the pooled effect in meta-analyses.
Results: Nine RCTs, providing data from 330 participants (26.96 ± 3.11 years, 85% males) were included. The RCTs included showed good methodological quality (PEDro scale = 6.88 points), being, performance and detection biases, the most common biases reported. Meta-analyses showed that VRBT was more effective than classical interventions in reducing pain (SMD = -1.15; 95% CI -1.85 to -0.45; p = 0.001; I2 = 0%), and increasing knee function (SMD = 1.71; 95% CI 0.93 to 2.5; p < 0.001; I2 = 0%), strength (SMD = 0.82; 95% CI 0.4-1.23; p < 0.001; I2 = 0%) and flexion ROM (SMD = 0.7; 95% CI 0.37-1.01; p < 0.001; I2 = 0%). Additionally, VRBT improved postero-medial (SMD = 0.46; 95% CI 0.01-0.9; p = 0.045; I2 = 15.1%) and postero-lateral CoP excursion (SMD = 0.75; 95% CI 0.3-1.21; p = 0.001; I2 = 0%), being effective in improving dynamic balance.
Conclusion: VRBT is an effective physical therapy complement to be included in the ACL's rehabilitation programmes due to reduces pain and increases knee function, strength, ROM and dynamic balance after ACL injury.
Level of evidence: Level II evidence.
目的:在前交叉韧带(ACL)损伤患者的康复治疗中,基于虚拟现实的疗法(VRBT)可能是一种有效的物理疗法辅助手段。本研究旨在评估虚拟现实疗法在改善前交叉韧带损伤后的疼痛、膝关节功能、力量、本体感觉、屈曲运动范围(ROM)和动态平衡方面的效果:我们按照 PRISMA 标准进行了此次系统性回顾和荟萃分析。从开始到 2024 年 6 月,我们在 PubMed Medline、WOS、SCOPUS、CINAHL 和 PEDro 中进行了检索,没有出版日期和语言限制。纳入的随机对照试验(RCT)仅包括前交叉韧带损伤患者,这些试验评估了 VRBT 与传统干预相比对相关结果的有效性。采用PEDro量表对纳入的随机对照试验进行方法学质量分析。在荟萃分析中,采用科恩标准化平均差(SMD)及其95%置信区间(95% CI)来计算汇总效应:共纳入了 9 项研究,提供了 330 名参与者(26.96 ± 3.11 岁,85% 为男性)的数据。所纳入的研究性试验显示出良好的方法学质量(PEDro评分=6.88分),其中最常见的偏差是表现偏差和检测偏差。元分析表明,在减轻疼痛(SMD = -1.15; 95% CI -1.85 to -0.45;P = 0.001;I2 = 0%)、增强膝关节功能(SMD = 1.71; 95% CI 0.93 to 2.5;P 2 = 0%)、力量(SMD = 0.82; 95% CI 0.4-1.23;P 2 = 0%)和屈曲 ROM(SMD = 0.7; 95% CI 0.37-1.01;P 2 = 0%)方面,VRBT 比传统干预更有效。此外,VRBT 改善了后内侧(SMD = 0.46;95% CI 0.01-0.9;p = 0.045;I2 = 15.1%)和后外侧 CoP 偏移(SMD = 0.75;95% CI 0.3-1.21;p = 0.001;I2 = 0%),有效改善了动态平衡:前交叉韧带损伤后,VRBT可减轻疼痛,增强膝关节功能、力量、ROM和动态平衡,是前交叉韧带康复计划中有效的物理疗法补充:二级证据。
{"title":"Virtual reality-based therapy after anterior cruciate ligament injury effectively reduces pain and improves knee function, movement patterns, and dynamic balance: A systematic review and meta-analysis.","authors":"Irene Cortés-Pérez, Jose María Desdentado-Guillem, María Soledad Camacho-Delgado, María Del Rocío Ibancos-Losada, Esteban Obrero-Gaitán, Rafael Lomas-Vega","doi":"10.1002/ksa.12477","DOIUrl":"https://doi.org/10.1002/ksa.12477","url":null,"abstract":"<p><strong>Purpose: </strong>Virtual reality-based therapy (VRBT) may be an effective physical therapy complement employed in the rehabilitation of patients with anterior cruciate ligament (ACL) injury. This study aims to assess the effectiveness of VRBT in improving pain, knee function, strength, proprioception, flexion range of motion (ROM), and dynamic balance after ACL injury.</p><p><strong>Methods: </strong>We conducted this systematic review with meta-analysis following PRISMA criteria. Since inception to June 2024, we searched in PubMed Medline, WOS, SCOPUS, CINAHL and PEDro without publication date and language restrictions. Randomised controlled trials (RCTs), comprising only patients with ACL injury, that assess the effectiveness of VRBT compared to classical interventions on the outcomes of interest were included. PEDro scale was employed to analyze the methodological quality of the RCTs included. Cohen's standardised mean difference (SMD) and its 95% confidence interval (95% CI) was used to calculate the pooled effect in meta-analyses.</p><p><strong>Results: </strong>Nine RCTs, providing data from 330 participants (26.96 ± 3.11 years, 85% males) were included. The RCTs included showed good methodological quality (PEDro scale = 6.88 points), being, performance and detection biases, the most common biases reported. Meta-analyses showed that VRBT was more effective than classical interventions in reducing pain (SMD = -1.15; 95% CI -1.85 to -0.45; p = 0.001; I<sup>2</sup> = 0%), and increasing knee function (SMD = 1.71; 95% CI 0.93 to 2.5; p < 0.001; I<sup>2</sup> = 0%), strength (SMD = 0.82; 95% CI 0.4-1.23; p < 0.001; I<sup>2</sup> = 0%) and flexion ROM (SMD = 0.7; 95% CI 0.37-1.01; p < 0.001; I<sup>2</sup> = 0%). Additionally, VRBT improved postero-medial (SMD = 0.46; 95% CI 0.01-0.9; p = 0.045; I<sup>2</sup> = 15.1%) and postero-lateral CoP excursion (SMD = 0.75; 95% CI 0.3-1.21; p = 0.001; I<sup>2</sup> = 0%), being effective in improving dynamic balance.</p><p><strong>Conclusion: </strong>VRBT is an effective physical therapy complement to be included in the ACL's rehabilitation programmes due to reduces pain and increases knee function, strength, ROM and dynamic balance after ACL injury.</p><p><strong>Level of evidence: </strong>Level II evidence.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yosef Sourugeon, Angelo Boffa, Carlotta Perucca Orfei, Laura de Girolamo, Jeremy Magalon, Mikel Sánchez, Thomas Tischer, Giuseppe Filardo, Lior Laver
Purpose: This systematic review aimed to investigate in animal models the presence of disease-modifying effects driven by non-bone marrow-derived and non-adipose-derived products, with a particular focus on umbilical cord and placenta-derived cell-based therapies for the intra-articular injective treatment of osteoarthritis (OA).
Methods: A systematic review was performed on three electronic databases (PubMed, Web of Science and Embase) according to PRISMA guidelines. The results were synthesised to investigate disease-modifying effects in preclinical animal studies comparing injectable umbilical cord, placenta, and other sources-derived products with OA controls. The risk of bias was assessed using the SYRCLE tool.
Results: A total of 80 studies were included (2314 animals). Cell therapies were most commonly obtained from the umbilical cord in 33 studies and placenta/amniotic tissue in 18. Cell products were xenogeneic in 61 studies and allogeneic in the remaining 19 studies. Overall, 25/27 (92.6%) of studies on umbilical cord-derived products documented better results compared to OA controls in at least one of the following outcomes: macroscopic, histological and/or immunohistochemical findings, with 19/22 of studies (83.4%) show positive results at the cartilage level and 4/6 of studies (66.7%) at the synovial level. Placenta-derived injectable products documented positive results in 13/16 (81.3%) of the studies, 12/15 (80.0%) at the cartilage level, and 2/4 (50.0%) at the synovial level, but 2/16 studies (12.5%) found overall worse results than OA controls. Other sources (embryonic, synovial, peripheral blood, dental pulp, cartilage, meniscus and muscle-derived products) were investigated in fewer preclinical studies. The risk of bias was low in 42% of items, unclear in 49%, and high in 9% of items.
Conclusion: Interest in cell-based injectable therapies for OA treatment is soaring, particularly for alternatives to bone marrow and adipose tissue. While expanded umbilical cord mesenchymal stem cells reported auspicious disease-modifying effects in preventing OA progression in animal models, placenta/amniotic tissue also reported deleterious effects on OA joints. Lower evidence has been found for other cellular sources such as embryonic, synovial, peripheral blood, dental-pulp, cartilage, meniscus, and muscle-derived products.
Level of evidence: Level II.
目的:本系统综述旨在研究非骨髓来源和非脂肪来源产品在动物模型中的疾病调节作用,尤其关注基于脐带和胎盘来源细胞的关节内注射治疗骨关节炎(OA)疗法:根据 PRISMA 指南,在三个电子数据库(PubMed、Web of Science 和 Embase)中进行了系统性综述。综述了临床前动物研究的结果,比较了注射用脐带、胎盘和其他来源产品与OA对照组的疾病调节效果。使用SYRCLE工具对偏倚风险进行了评估:结果:共纳入 80 项研究(2314 只动物)。在33项研究中,细胞疗法最常见的来源是脐带,在18项研究中,细胞疗法最常见的来源是胎盘/羊膜组织。61项研究的细胞产品为异种,其余19项研究的细胞产品为异体。总体而言,25/27(92.6%)项关于脐带衍生产品的研究记录了与 OA 对照组相比在以下至少一项结果上更好的结果:宏观、组织学和/或免疫组化结果,其中 19/22 项研究(83.4%)在软骨水平上显示了积极的结果,4/6 项研究(66.7%)在滑膜水平上显示了积极的结果。在 13/16 项研究(81.3%)中,有 12/15 项研究(80.0%)在软骨水平和 2/4 项研究(50.0%)在滑膜水平发现了阳性结果,但有 2/16 项研究(12.5%)发现总体结果不如 OA 对照组。其他来源(胚胎、滑膜、外周血、牙髓、软骨、半月板和肌肉衍生产品)的临床前研究较少。42%的项目存在低偏倚风险,49%的项目存在不明确偏倚风险,9%的项目存在高偏倚风险:结论:人们对以细胞为基础的注射疗法治疗OA的兴趣与日俱增,尤其是骨髓和脂肪组织的替代品。据报道,扩增的脐带间充质干细胞在防止动物模型中的OA进展方面具有良好的疾病调节作用,但胎盘/羊膜组织对OA关节也有有害影响。其他细胞来源,如胚胎、滑膜、外周血、牙髓、软骨、半月板和肌肉衍生产品的证据较少:证据等级:二级。
{"title":"Cell-based therapies have disease-modifying effects on osteoarthritis in animal models: A systematic review by the ESSKA Orthobiologic Initiative. Part 3: Umbilical cord, placenta, and other sources for cell-based injectable therapies.","authors":"Yosef Sourugeon, Angelo Boffa, Carlotta Perucca Orfei, Laura de Girolamo, Jeremy Magalon, Mikel Sánchez, Thomas Tischer, Giuseppe Filardo, Lior Laver","doi":"10.1002/ksa.12472","DOIUrl":"https://doi.org/10.1002/ksa.12472","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review aimed to investigate in animal models the presence of disease-modifying effects driven by non-bone marrow-derived and non-adipose-derived products, with a particular focus on umbilical cord and placenta-derived cell-based therapies for the intra-articular injective treatment of osteoarthritis (OA).</p><p><strong>Methods: </strong>A systematic review was performed on three electronic databases (PubMed, Web of Science and Embase) according to PRISMA guidelines. The results were synthesised to investigate disease-modifying effects in preclinical animal studies comparing injectable umbilical cord, placenta, and other sources-derived products with OA controls. The risk of bias was assessed using the SYRCLE tool.</p><p><strong>Results: </strong>A total of 80 studies were included (2314 animals). Cell therapies were most commonly obtained from the umbilical cord in 33 studies and placenta/amniotic tissue in 18. Cell products were xenogeneic in 61 studies and allogeneic in the remaining 19 studies. Overall, 25/27 (92.6%) of studies on umbilical cord-derived products documented better results compared to OA controls in at least one of the following outcomes: macroscopic, histological and/or immunohistochemical findings, with 19/22 of studies (83.4%) show positive results at the cartilage level and 4/6 of studies (66.7%) at the synovial level. Placenta-derived injectable products documented positive results in 13/16 (81.3%) of the studies, 12/15 (80.0%) at the cartilage level, and 2/4 (50.0%) at the synovial level, but 2/16 studies (12.5%) found overall worse results than OA controls. Other sources (embryonic, synovial, peripheral blood, dental pulp, cartilage, meniscus and muscle-derived products) were investigated in fewer preclinical studies. The risk of bias was low in 42% of items, unclear in 49%, and high in 9% of items.</p><p><strong>Conclusion: </strong>Interest in cell-based injectable therapies for OA treatment is soaring, particularly for alternatives to bone marrow and adipose tissue. While expanded umbilical cord mesenchymal stem cells reported auspicious disease-modifying effects in preventing OA progression in animal models, placenta/amniotic tissue also reported deleterious effects on OA joints. Lower evidence has been found for other cellular sources such as embryonic, synovial, peripheral blood, dental-pulp, cartilage, meniscus, and muscle-derived products.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luca Tanel, Jean-Marie Fayard, Caroline Mouton, Pierre-Jean Lambrey, Romain Letartre, Nicolas Graveleau, Nicolas Bouguennec, Johannes Barth, Mathieu Thaunat
Purpose: This study aimed to evaluate which preoperative patient, injury or clinical factors were associated with the anterior cruciate ligament (ACL) remnant volume in patients undergoing ACL surgery. It was hypothesized that the main factors determining an insufficient ACL remnant volume at the time of surgery were younger age and longer time to surgery.
Methods: A retrospective analysis from the Francophone Arthroscopic Society's registry was conducted, including 1565 patients with an ACL lesion underdoing a primary ACL surgery (reconstruction or repair) between June 2020 and June 2023. Patients were excluded in case of revision surgery and incomplete data. Preoperative factors-including patient demographics, delay to surgery, preoperative laxity and the presence of meniscal tears or cartilage lesions-were analysed to determine their influence on ACL remnant volume (estimated by the surgeon as the percentage of residual volume). Univariate, multivariate and receiver operating characteristic curve analyses were performed to explore these relationships.
Results: Multivariate analyses demonstrated that younger age (<20 years and 20-30 years compared to ≥40, p = 0.02), higher time from injury to surgery (≥12 months compared to <3 months, p = 0.01) and the presence of a medial (p = 0.01) or a lateral meniscal tear (p = 0.02) were significant predictors of an ACL remnant volume ≤ 50%.
Conclusions: Younger age (under 30 years of age), a time from injury to surgery above 12 months and the presence of medial and lateral meniscal tears are associated with higher odds of observing a smaller ACL remnant volume at the time of the ACL surgery. These factors should be considered when planning ACL remnant preservation techniques.
{"title":"Younger age, longer delay to surgery and meniscal tears are associated with a smaller ACL remnant: An analysis from the registry of the Francophone Arthroscopic Society.","authors":"Luca Tanel, Jean-Marie Fayard, Caroline Mouton, Pierre-Jean Lambrey, Romain Letartre, Nicolas Graveleau, Nicolas Bouguennec, Johannes Barth, Mathieu Thaunat","doi":"10.1002/ksa.12466","DOIUrl":"https://doi.org/10.1002/ksa.12466","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate which preoperative patient, injury or clinical factors were associated with the anterior cruciate ligament (ACL) remnant volume in patients undergoing ACL surgery. It was hypothesized that the main factors determining an insufficient ACL remnant volume at the time of surgery were younger age and longer time to surgery.</p><p><strong>Methods: </strong>A retrospective analysis from the Francophone Arthroscopic Society's registry was conducted, including 1565 patients with an ACL lesion underdoing a primary ACL surgery (reconstruction or repair) between June 2020 and June 2023. Patients were excluded in case of revision surgery and incomplete data. Preoperative factors-including patient demographics, delay to surgery, preoperative laxity and the presence of meniscal tears or cartilage lesions-were analysed to determine their influence on ACL remnant volume (estimated by the surgeon as the percentage of residual volume). Univariate, multivariate and receiver operating characteristic curve analyses were performed to explore these relationships.</p><p><strong>Results: </strong>Multivariate analyses demonstrated that younger age (<20 years and 20-30 years compared to ≥40, p = 0.02), higher time from injury to surgery (≥12 months compared to <3 months, p = 0.01) and the presence of a medial (p = 0.01) or a lateral meniscal tear (p = 0.02) were significant predictors of an ACL remnant volume ≤ 50%.</p><p><strong>Conclusions: </strong>Younger age (under 30 years of age), a time from injury to surgery above 12 months and the presence of medial and lateral meniscal tears are associated with higher odds of observing a smaller ACL remnant volume at the time of the ACL surgery. These factors should be considered when planning ACL remnant preservation techniques.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The quadriceps tendon (QT) has recently gained increasing interest as an anterior cruciate ligament reconstruction (ACLR) graft due to minimally invasive harvesting techniques and low donor site morbidity. QT grafts can be used both with a patella bone block and as complete soft tissue grafts. However, it is unknown whether the QT graft type affects clinical outcomes. This study used data from the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates, knee stability and subjective clinical outcomes in patients who underwent ACLR with QT graft with bone block (QT-B) or soft tissue only (QT-S).
Methods: Patients who underwent primary ACL reconstruction with QT autografts documented in the DKRR were included and divided into the QT-B (n = 925) and QT-S (n = 659) groups. The clinical outcome was evaluated using objective-instrumented knee stability, pivot shift test, knee injury osteoarthritis outcome score (KOOS) and Tegner activity scores for the two cohorts performed at the 1-year follow-up. The overall revision rates were determined as well.
Results: Revision rates at 2 years were equally low in both graft groups at 2.8%. Similarly, post-operative knee laxity was equal at 1.5 (1.4) and 1.6 (1.4) mm side-to-side laxity, respectively. However, QT-B exhibited a reduced post-operative positive pivot shift of 22% compared with 31% for QT-S. Although the subjective outcomes were equal for the KOOS and Tegner activity scale scores at the 1-year follow-up, reduced improvements in KOOS were observed for QT-B compared to QT-S.
Conclusion: ACL with a QT autograft harvested either with a bone block or as a soft tissue graft exhibited comparable revision rates and sagittal knee stability. Furthermore, ACL reconstruction using a QT graft with a bone block achieved better rotational stability with less pivot shift than ACL reconstruction using complete soft tissue QT grafts.
{"title":"No difference in clinical outcome between quadriceps tendon anterior cruciate ligament reconstruction with and without bone block: Results from the Danish Knee Ligament Registry.","authors":"Martin Lind, Torsten Nielsen","doi":"10.1002/ksa.12451","DOIUrl":"https://doi.org/10.1002/ksa.12451","url":null,"abstract":"<p><strong>Purpose: </strong>The quadriceps tendon (QT) has recently gained increasing interest as an anterior cruciate ligament reconstruction (ACLR) graft due to minimally invasive harvesting techniques and low donor site morbidity. QT grafts can be used both with a patella bone block and as complete soft tissue grafts. However, it is unknown whether the QT graft type affects clinical outcomes. This study used data from the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates, knee stability and subjective clinical outcomes in patients who underwent ACLR with QT graft with bone block (QT-B) or soft tissue only (QT-S).</p><p><strong>Methods: </strong>Patients who underwent primary ACL reconstruction with QT autografts documented in the DKRR were included and divided into the QT-B (n = 925) and QT-S (n = 659) groups. The clinical outcome was evaluated using objective-instrumented knee stability, pivot shift test, knee injury osteoarthritis outcome score (KOOS) and Tegner activity scores for the two cohorts performed at the 1-year follow-up. The overall revision rates were determined as well.</p><p><strong>Results: </strong>Revision rates at 2 years were equally low in both graft groups at 2.8%. Similarly, post-operative knee laxity was equal at 1.5 (1.4) and 1.6 (1.4) mm side-to-side laxity, respectively. However, QT-B exhibited a reduced post-operative positive pivot shift of 22% compared with 31% for QT-S. Although the subjective outcomes were equal for the KOOS and Tegner activity scale scores at the 1-year follow-up, reduced improvements in KOOS were observed for QT-B compared to QT-S.</p><p><strong>Conclusion: </strong>ACL with a QT autograft harvested either with a bone block or as a soft tissue graft exhibited comparable revision rates and sagittal knee stability. Furthermore, ACL reconstruction using a QT graft with a bone block achieved better rotational stability with less pivot shift than ACL reconstruction using complete soft tissue QT grafts.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Rindom Krogsgaard, Henrik Palm, Kenneth Obionu, Yvette Astrup, Naja Bjørslev Lange, Tobias Haak, Christian Dippmann
Purpose: To report results following deltoid ligament reconstruction in a large series of patients.
Methods: For consecutive patients who had a medial ankle ligament stabilization 2010-2018 information from their medical files was registered, and they were invited for follow-up in 2021-2022. They answered questions about satisfaction with the treatment and current symptoms, and they completed the Foot and Ankle Measurement (FAAM) questionnaire.
Results: Of the 503 patients, 342 (68%) had a history of trauma to the ankle and 114 (23%) had previous ankle surgery. 67% had other procedures (besides synovectomy) simultaneous to medial ligament reconstruction. 269 patients (54%) responded to the invitation for follow-up. For 182 (71%) of the responders, the operation solved their ankle problems. 163 (63%) were satisfied with the surgery. 192 (71%) would repeat the operation. 173 (67%) had pain in the ankle during the past week, and 86 (50%) of these were not able to run. FAAM ADL-scores were significantly higher than in a mixed group of ankle/foot patients but not normal.
Conclusion: The relatively high degree of satisfaction despite suboptimal clinical results may reflect the complex nature of the deltoid ligament insufficient ankle. It is concluded that repair or reconstruction of the deltoid ligament is only performed in patients reporting ankle instability and with peroperatively demonstrated medial instability and pathology to the ligament.
{"title":"Good rate of satisfaction but suboptimal clinical outcome at long-term follow-up in a large series of patients who had operative stabilization of the deltoid ligament of the ankle.","authors":"Michael Rindom Krogsgaard, Henrik Palm, Kenneth Obionu, Yvette Astrup, Naja Bjørslev Lange, Tobias Haak, Christian Dippmann","doi":"10.1002/ksa.12459","DOIUrl":"https://doi.org/10.1002/ksa.12459","url":null,"abstract":"<p><strong>Purpose: </strong>To report results following deltoid ligament reconstruction in a large series of patients.</p><p><strong>Methods: </strong>For consecutive patients who had a medial ankle ligament stabilization 2010-2018 information from their medical files was registered, and they were invited for follow-up in 2021-2022. They answered questions about satisfaction with the treatment and current symptoms, and they completed the Foot and Ankle Measurement (FAAM) questionnaire.</p><p><strong>Results: </strong>Of the 503 patients, 342 (68%) had a history of trauma to the ankle and 114 (23%) had previous ankle surgery. 67% had other procedures (besides synovectomy) simultaneous to medial ligament reconstruction. 269 patients (54%) responded to the invitation for follow-up. For 182 (71%) of the responders, the operation solved their ankle problems. 163 (63%) were satisfied with the surgery. 192 (71%) would repeat the operation. 173 (67%) had pain in the ankle during the past week, and 86 (50%) of these were not able to run. FAAM ADL-scores were significantly higher than in a mixed group of ankle/foot patients but not normal.</p><p><strong>Conclusion: </strong>The relatively high degree of satisfaction despite suboptimal clinical results may reflect the complex nature of the deltoid ligament insufficient ankle. It is concluded that repair or reconstruction of the deltoid ligament is only performed in patients reporting ankle instability and with peroperatively demonstrated medial instability and pathology to the ligament.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebekah M Kleinsmith, Stephen A Doxey, Haley D Puckett, Fernando A Huyke-Hernández, Arthur J Only, Christopher Y Kweon, Brian P Cunningham
Purpose: This study aims to evaluate clinical and patient-reported outcome measures (PROMs) of patients 40 years and older that underwent anterior cruciate ligament reconstruction (ACLR) and determine the influence of preexisting arthritis and chondral wear on ACLR outcomes. We hypothesized that patients aged 40+ with ACLR would have excellent clinical outcomes and PROMs regardless of preexisting arthritic changes.
Methods: A total of 118 patients were included. Patients aged 40 years and older who underwent ACLR in a single healthcare system between 2009 and 2016 were eligible. Outcomes assessed include Knee Injury and Osteoarthritis Outcome Scores (KOOS), Single Assessment Numeric Evaluation (SANE) scores, intraoperative Outerbridge grading, preoperative Kellgren-Lawrence (KL) grading and postoperative complication rates over a 2-year period.
Results: Average increase in KOOS and SANE scores were 21.2 19.9 and 23.5 31.3, respectively. Patients with Outerbridge grade III and IV lesions in weight-bearing compartments had lower baseline SANE and KOOS scores than those without (47.1 ± 22.0 vs. 64.5 ± 23.6 baseline SANE and 43.1 ± 18.1 vs. 63.5 ± 15.9 baseline KOOS; p = 0.002 and p < 0.001, respectively) with no significant difference in the amount of change in SANE or KOOS scores (p = 0.111 and p = 0.165 respectively). Patients with KL-grade 2+ osteoarthritis experienced similar changes in KOOS and SANE over the 2-year period to their counterparts (p = 0.598 and p = 0.643, respectively).
Conclusion: There is no correlation between preexisting osteoarthritic changes or chondral defects and PROs. KOOS and SANE scores both increased postoperatively. When treating older patients with an ACL tear, surgeons should consider the activity level and desires of the patient as they determine appropriate treatment. Preexisting osteoarthritis does not correlate with patient-reported outcomes for ACLR.
Level of evidence: Level IV.
目的:本研究旨在评估 40 岁及以上接受前交叉韧带重建术(ACLR)患者的临床和患者报告结果指标(PROMs),并确定既往关节炎和软骨磨损对 ACLR 结果的影响。我们假设,40 岁以上接受前交叉韧带重建术的患者无论是否存在关节炎变化,都能获得良好的临床疗效和 PROM:共纳入 118 名患者。方法:共纳入 118 名患者,年龄在 40 岁及以上,2009 年至 2016 年期间在单一医疗系统接受前交叉韧带置换术的患者均符合条件。评估结果包括膝关节损伤和骨关节炎结果评分(KOOS)、单次评估数值评价(SANE)评分、术中Outerbridge分级、术前Kellgren-Lawrence(KL)分级以及2年期间的术后并发症发生率:结果:KOOS和SANE评分的平均增幅分别为21.2 ± $pm $ 19.9和23.5 ± $pm $ 31.3。在负重区有 Outerbridge III 级和 IV 级病变的患者的基线 SANE 和 KOOS 评分低于无病变的患者(基线 SANE 为 47.1 ± 22.0 vs. 64.5 ± 23.6,基线 KOOS 为 43.1 ± 18.1 vs. 63.5 ± 15.9;P = 0.002 和 P 结论:在负重区有 Outerbridge III 级和 IV 级病变的患者的基线 SANE 和 KOOS 评分低于无病变的患者:已有的骨关节病变或软骨缺损与 PROs 之间没有相关性。术后 KOOS 和 SANE 评分均有所提高。在治疗前交叉韧带撕裂的老年患者时,外科医生在确定适当的治疗方法时应考虑患者的活动水平和愿望。已有的骨关节炎与患者报告的前交叉韧带重建结果无关:证据等级:IV 级。
{"title":"Similar two-year improvement in patient-reported outcomes in patients 40 years and older with outerbridge grade III and IV lesions following ACL reconstruction.","authors":"Rebekah M Kleinsmith, Stephen A Doxey, Haley D Puckett, Fernando A Huyke-Hernández, Arthur J Only, Christopher Y Kweon, Brian P Cunningham","doi":"10.1002/ksa.12470","DOIUrl":"https://doi.org/10.1002/ksa.12470","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate clinical and patient-reported outcome measures (PROMs) of patients 40 years and older that underwent anterior cruciate ligament reconstruction (ACLR) and determine the influence of preexisting arthritis and chondral wear on ACLR outcomes. We hypothesized that patients aged 40+ with ACLR would have excellent clinical outcomes and PROMs regardless of preexisting arthritic changes.</p><p><strong>Methods: </strong>A total of 118 patients were included. Patients aged 40 years and older who underwent ACLR in a single healthcare system between 2009 and 2016 were eligible. Outcomes assessed include Knee Injury and Osteoarthritis Outcome Scores (KOOS), Single Assessment Numeric Evaluation (SANE) scores, intraoperative Outerbridge grading, preoperative Kellgren-Lawrence (KL) grading and postoperative complication rates over a 2-year period.</p><p><strong>Results: </strong>Average increase in KOOS and SANE scores were 21.2 <math> <semantics> <mrow><mrow><mo>±</mo></mrow> </mrow> <annotation>$pm $</annotation></semantics> </math> 19.9 and 23.5 <math> <semantics> <mrow><mrow><mo>±</mo></mrow> </mrow> <annotation>$pm $</annotation></semantics> </math> 31.3, respectively. Patients with Outerbridge grade III and IV lesions in weight-bearing compartments had lower baseline SANE and KOOS scores than those without (47.1 ± 22.0 vs. 64.5 ± 23.6 baseline SANE and 43.1 ± 18.1 vs. 63.5 ± 15.9 baseline KOOS; p = 0.002 and p < 0.001, respectively) with no significant difference in the amount of change in SANE or KOOS scores (p = 0.111 and p = 0.165 respectively). Patients with KL-grade 2+ osteoarthritis experienced similar changes in KOOS and SANE over the 2-year period to their counterparts (p = 0.598 and p = 0.643, respectively).</p><p><strong>Conclusion: </strong>There is no correlation between preexisting osteoarthritic changes or chondral defects and PROs. KOOS and SANE scores both increased postoperatively. When treating older patients with an ACL tear, surgeons should consider the activity level and desires of the patient as they determine appropriate treatment. Preexisting osteoarthritis does not correlate with patient-reported outcomes for ACLR.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}