Hss Journal最新文献

In the treatment of osteoarthritis and soft tissue injury, early basic science and clinical data have been promising for the use of autologous blood formulations. This review article explores autologous conditioned serum, alpha-2-macroglobulin, and autologous protein solution, which function via overlapping but distinct mechanisms to reduce inflammation, counteract catabolism, and improve joint homeostasis. The ideal timing and quantity of dosing are largely unknown and may vary based on indication. Additional high-quality clinical trials are necessary to define the efficacy of these interventions on both long-term symptomatic improvement and mitigation of osteoarthritic disease progression.

Background: Cervical disc arthroplasty (CDA) has gained widespread recognition as a motion-preserving alternative to anterior cervical discectomy and fusion for treating degenerative cervical disc disease. Over the past decade, the rate of CDA procedures has increased by a remarkable 654%. However, CDA complications can lead to a repeat procedure or can be converted to fusion.

Purpose: We sought to evaluate the time of onset (early, intermediate, or late) of complications following CDA as well as the progression leading to revision surgeries.

Methods: A retrospective review of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database examined complications across 9 CDA devices from January 1, 2005, to September 30, 2023. Complications were categorized by postoperative time to occurrence: early (<6 months), intermediate (6-18 months), and late (>18 months). The revision procedures were categorized as either a repeat CDA or conversion to fusion.

Results: A total of 688 CDA revision cases were reviewed, with 265 cases (38.5%) reporting revision onset time (median: 12 months, interquartile range: 3-36). Migration was the most frequent complication in both the early (n = 44, 53.0%) and intermediate (n = 25, 32.1%) periods. Subsidence peaked during the intermediate period (11.5%, n = 9), while neck pain and heterotopic ossification (HO) occurred most in the late postoperative phase, at 22.5% (n = 23) and 7.8% (n = 8), respectively. The specific revision type was recorded in 509 of the revision cases; of these, 8 devices were predominantly associated with fusion (>69%), while Mobi-C showed a lower proportion of fusion revisions (16.2%).

Conclusions: This retrospective review of the MAUDE database showed the timing of complications leading to CDA revision. Migration predominated in the early and intermediate phases, while subsidence peaked in the intermediate phase. In the late phase, neck pain, osteolysis, and HO become more prominent. Conversion to fusion was common across most devices. These data provide insight for clinicians to monitor patients after CDA while considering the relative frequencies of reported complications.

Level of evidence: Level IV: retrospective analysis of a prospectively maintained government database.

Background: While much evidence exists on the epidemiology of and prevention strategies for anterior cruciate ligament (ACL) injuries, there is less information on patellar dislocations.

Purpose: We sought to compare the activities of adolescents who underwent a medial patellofemoral ligament reconstruction (MPFLR) to those who underwent an ACL reconstruction (ACLR).

Methods: We conducted a retrospective review of routinely collected preoperative data of adolescent patients who underwent either an MPFLR or ACLR by 1 of 2 fellowship-trained pediatric sports medicine orthopedic surgeons at a single institution between February 1, 2016, and April 15, 2023. A total of 912 patients were identified, and 540 of these met the final inclusion and exclusion criteria. A total of 228 MPFLR participants were successfully matched to 228 ACLR participants based on sex and age within 1 year at the time of surgery. The mean age was 14.8 ± 2.1 years and 53% were female. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Pediatric International Knee Documentation Committee, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, and PROMIS Mobility were collected.

Results: We found that 61% of the MPFLR cohort and 94% of the ACLR cohort sustained their injuries while playing an organized sport. The MPFLR group had significantly lower HSS Pedi-FABS scores than the ACLR group, suggesting that the MPFLR group had lower preoperative athletic activity levels compared to the ACLR group.

Conclusions: In this retrospective study, participation in organized sports was associated with 61% of patellar dislocations. Among girls, dance was the second most common sport participated in at the time of patellar dislocation. This suggests that further investigation into injury prevention strategies for adolescent female dancers is warranted.

Level of evidence: Level III: Retrospective therapeutic study.

This guest editorial gives an overview of the field of regenerative medicine and the special issue.

The possibility of modifying disease through regenerative medicine applications, particularly stem cell therapies, raises ethical and regulatory challenges in orthopedics. This review article provides historical context of stem cell research, ethical issues such as informed consent, therapeutic misconception, and equitable access, emphasizing the responsibilities of providers offering investigational treatments. It also examines the evolving role of the U.S. Food and Drug Administration (FDA) in regulating regenerative therapies through frameworks like the Regenerative Medicine Advanced Therapy (RMAT) designation, and more point-of-care enforcement discretion policies for therapies such as autologous micro-fragmented adipose tissue and bone marrow aspirate concentrate. The authors underscore the importance of innovative therapies to address unmet needs in musculoskeletal healthcare while acknowledging the need for more rigorous basic and clinical research. They call for a continuous refinement of regulatory and ethical standards as regenerative medicine advances.

Adipose-derived cellular therapies, including stromal vascular fraction (SVF) and adipose-derived stem cells (ASCs), have demonstrated increasing therapeutic potential across regenerative medicine applications. This narrative review examines the current evidence supporting the use of SVF and ASCs in 2 primary clinical contexts: osteoarthritis (OA) and chronic wound healing. SVF, a heterogeneous cell population isolated from lipoaspirated fat via enzymatic or mechanical methods, and ASCs, a more homogeneous culture-expanded mesenchymal cell product, both exert regenerative effects through angiogenic, immunomodulatory, and reparative mechanisms. In OA, both cell types have been shown to significantly reduce pain and improve function, with some studies indicating cartilage regeneration on imaging. While ASCs may offer faster symptom relief due to higher purity and dosing, SVF remains a more accessible, minimally manipulated alternative with comparable long-term outcomes. In wound healing, adipose-derived therapies have been associated with accelerated closure of chronic ulcers through enhanced neovascularization, modulation of the inflammatory microenvironment, and promotion of granulation tissue and re-epithelialization. Across both indications, these therapies have shown a good safety profile, with minimal adverse events reported. The review also addresses regulatory distinctions, standardization challenges, and biologic variability, particularly in SVF preparations. Taken together, the evidence suggests the clinical utility of adipose-derived cellular therapies while highlighting the need for further standardization, long-term safety monitoring, and large-scale randomized trials to confirm efficacy and optimize clinical translation.

Nano-sized extracellular vesicles enclosed by a lipid bilayer and secreted by various cell types including mesenchymal stem cells, exosomes act as natural transporters, carrying bioactive molecules such as proteins, lipids, and nucleic acids that mediate intercellular communication. Exosomes influence a range of cellular processes, including immune modulation, tissue repair, and disease progression. Compared to whole-cell therapies, exosomes provide anti-inflammatory, immunosuppressive, and regenerative effects with reduced risks linked to cellular components, such as infusion toxicity, immunogenicity, and tumorigenic phenomena. This article reviews isolation, modification, characterization, and storage techniques, challenges in clinical translation, and innovative engineering strategies to enhance targeting and efficacy. It also examines preliminary evidence suggesting that exosomes may have potential in managing degenerative disorders such as osteoarthritis, intervertebral disc degeneration, osteoporosis, osteonecrosis, and tendinopathy, as well as non-degenerative disorders such as sciatic nerve injury, fractures, and soft tissue trauma.

Background: The formation of a stable fibrin clot plays an important role in early tissue repair. Tranexamic acid (TXA), a potent fibrinolysis inhibitor, prevents fibrin clot dissolution.

Purpose: We sought to test the effect of intra-articular TXA administration on meniscus healing and articular cartilage status in a rabbit model.

Methods: Thirty-two rabbits underwent bilateral knee surgery with creation of a 1.5-mm circular defect in the anterior horn of the lateral meniscus and a 3-mm longitudinal tear with repair in the anterior horn of the medial meniscus. Twelve rabbits were used for an initial TXA dose determination study. Twenty rabbits were then injected with 50 mg/mL of TXA in the left knee while the right knee served as a control. Animals were sacrificed at 2-, 4-, and 8-week timepoints. Eight rabbits underwent biomechanical analysis. Semiquantitative histological analysis compared meniscal healing and articular cartilage between TXA-treated and control knees.

Results: Both circular defects of the lateral meniscus and longitudinal tear injuries of the medial meniscus showed no difference in healing across all timepoints. At 2 weeks post-surgery, TXA-treated knees exhibited reduced tibial articular cartilage structure compared to controls. By week 8, control knees had higher proteoglycan content in all femoral articular cartilage zones compared to TXA-treated knees. Biomechanical analysis was inconclusive.

Conclusion: This rabbit study found that TXA administration did not enhance healing following meniscus repair. Moreover, intra-articular TXA appeared to have exerted an adverse effect on articular cartilage, possibly due to the detrimental effects of persistent blood in a joint. Further studies will be critically important to determine the effect of TXA administration at various time points after surgical repair.