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Role of orthobiologics in managing patellar tendinopathy: A narrative review 矫形生物制剂在治疗髌腱病中的作用:综述。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12099
Sumit Banerjee, Ragulajay Balamarthandapuram Gopalakrishna, Abhay Elhence

Patellar tendinopathy is a relatively common cause of anterior knee pain in athletes. It is predominantly seen in sports involving jumping, running, abrupt change in direction like basketball, volleyball, soccer, sprinting and jumping. The main pathophysiology is considered to be repetitive microtrauma at the inferior pole of patella along with a poor healing response. Although eccentric exercises have shown to be beneficial, the improvement is often slow and may result in a less than satisfactory outcome. There is a growing interest of orthobiologics, mainly platelet-rich plasma (PRP) in multiple chronic musculoskeletal pathologies. This narrative review aimed to analyse the current evidence on the role of orthobiologics in the management of recalcitrant patellar tendinopathy. Multiple studies have shown significant clinical improvement with negligible adverse effects on PRP injection for patellar tendinopathy. Most studies assessed report that the effects of PRP are sustained. However, among all studies evaluated, there is a considerable heterogeneity in terms of PRP composition, number of injections, dosage interval and postinjection rehabilitation protocol, pointing to the need for further research to enable standardisation of PRP therapy. Stem cells too have shown potential to be effective as a treatment modality for chronic patellar tendinopathy, but there is limited data to recommend its use outside of research setting or to enable a meaningful comparison to PRP. There is a promising role of orthobiologics in management of chronic patellar tendinopathy not responding to conventional treatment.

Level of Evidence

Not applicable (narrative review).

髌骨肌腱病是导致运动员膝关节前部疼痛的一个相对常见的原因。主要见于涉及跳跃、奔跑、突然改变方向的运动,如篮球、排球、足球、短跑和跳跃。其主要病理生理学被认为是髌骨下极的重复性微创伤以及不良的愈合反应。虽然偏心运动有一定的疗效,但改善速度往往很慢,可能导致疗效不尽如人意。人们越来越关注骨科生物制剂,主要是富血小板血浆(PRP)在多种慢性肌肉骨骼病症中的应用。本综述旨在分析目前有关骨生物制剂在治疗顽固性髌腱病方面作用的证据。多项研究表明,PRP 注射治疗髌腱病的临床疗效显著,不良反应微乎其微。大多数评估研究报告称,PRP 的效果是持续性的。然而,在所有评估的研究中,PRP 的成分、注射次数、剂量间隔和注射后康复方案都存在相当大的差异,这表明需要进一步研究,以实现 PRP 治疗的标准化。干细胞作为一种治疗慢性髌腱病的方法,也显示出了有效的潜力,但在研究范围之外,建议使用干细胞的数据有限,也无法与 PRP 进行有意义的比较。在治疗对常规治疗无效的慢性髌腱病方面,骨生物制剂具有广阔的前景:证据等级:不适用(叙述性综述)。
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引用次数: 0
Wearable sensor systems measure differences in knee laxity between healthy and affected knees during dynamic exercise activities: A systematic review 可穿戴传感器系统可测量动态运动时健康膝关节和受影响膝关节之间的膝关节松弛差异:系统综述。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12094
Sander C. van Eijck, Marly M. J. Vugts, Rob P. A. Janssen, Iris Hoogendoorn, Keita Ito, Maria C. van der Steen

Purpose

Knee laxity can be experienced as knee instability which may lead to a limitation in the activity of patients. Current methods to determine knee instability are performed in a static setting, which does not always correlate with dynamic knee laxity during activities. Wearables might be able to measure knee laxity in a dynamic setting and could be of added value in the diagnosis and treatment of excessive knee laxity. Therefore, the aim of this systematic review is to provide an overview of the wearables that have been developed and their ability to measure knee laxity during dynamic activities.

Methods

The PRISMA guidelines for systematic reviews were followed. A literature search was conducted in EMBASE, PubMed and Cochrane databases. Included studies assessed patients with knee instability using a non-invasive wearable sensor system during dynamic activity, with comparison to a reference system or healthy knees. Data extraction was performed by two authors via a predefined format. The risk of bias was assessed by The Dutch checklist for diagnostic tests.

Results

A total of 4734 articles were identified. Thirteen studies were included in the review. The studies showed a great variety of patients, sensor systems, reference tests, outcome measures and performed activities. Nine of the included studies were able to measure differences in patients with knee instability, all including a tri-axial accelerometer. Differences were not measurable in all parameters and activities in these studies.

Conclusions

Wearables, including at least a tri-axial accelerometer, seem promising for measuring dynamic knee laxity in the anterior-posterior and mediolateral direction. At this stage, it remains unclear if the measured outcomes completely reflect the knee instability that patients experience in daily life.

Level of Evidence

Level III.

目的:膝关节松弛可表现为膝关节不稳定,可能导致患者活动受限。目前确定膝关节不稳的方法都是在静态环境下进行的,并不总是与活动时膝关节的动态松弛相关联。可穿戴设备或许能在动态环境下测量膝关节松弛程度,从而为膝关节过度松弛的诊断和治疗带来附加价值。因此,本系统综述旨在概述已开发的可穿戴设备及其在动态活动中测量膝关节松弛程度的能力:方法:研究遵循了系统性综述的 PRISMA 指南。在 EMBASE、PubMed 和 Cochrane 数据库中进行了文献检索。纳入的研究使用无创可穿戴传感器系统对动态活动中的膝关节不稳定患者进行了评估,并与参考系统或健康膝关节进行了比较。数据提取由两位作者通过预定义格式完成。根据荷兰诊断测试核对表对偏倚风险进行评估:结果:共发现 4734 篇文章。共有 13 项研究被纳入综述。这些研究显示了患者、传感器系统、参考测试、结果测量和执行活动的多样性。所纳入的研究中有九项能够测量膝关节不稳定患者的差异,所有研究都采用了三轴加速度计。在这些研究中,并非所有参数和活动都能测量出差异:可穿戴设备(至少包括三轴加速度计)似乎有望测量膝关节前后和内外侧方向的动态松弛。现阶段,尚不清楚测量结果是否能完全反映患者在日常生活中的膝关节不稳定性:证据等级:三级。
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引用次数: 0
Role of tourniquet release timing on blood loss and functional outcomes in total knee arthroplasty: Insights from a low- and middle-income country 止血带释放时机对全膝关节置换术失血量和功能预后的影响:来自中低收入国家的启示。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12075
Muhammad Ahmed Ghazni Khan, Mohammad Ahsan Sulaiman, Marij Zahid, Suresh Kumar, Tashfeen Ahmad

Purpose

To identify the effect of releasing a tourniquet before versus after wound closure in total knee arthroplasty (TKA) on blood loss, functional outcome and postoperative complications.

Methodology

A prospective cohort study was conducted including 53 patients from May 2023 to September 2023. All patients underwent unilateral TKA and were divided into two groups based on surgeon preference of deflating tourniquet, Group A consisted of patients in whom the tourniquet was deflated before wound closure for haemostasis and Group B consisted of patients in which tourniquet was deflated after wound closure and compressive dressing. Blood loss was evaluated via intraoperative blood loss (the number of soaked sponges/gauzes, blood in a suction bottle, total output in a suction bottle—irrigation used) and on-field blood loss and calculated blood loss (Using Gross and Meunier's formula). The Functional outcome was evaluated using Knee injury and osteoarthritis score-42 questions. Early postoperative complications and differences in the requirement of blood transfusions were also assessed.

Results

There was a significant difference in intraoperative blood loss between the two groups. The median intraoperative blood loss was 135 mL (interquartile range [IQR]: 90–149) in Group A and 56.2 mL (IQR: 45–68) in Group B (p value: 0.001). However, no difference was found between the groups in calculated blood loss using Gross and Meunier's formula. The median calculated blood loss was 439 mL (IQR: 450–813) in Group A and 508 mL (IQR: 226–671) in group B (p value: 0.981). There was no significant difference between the groups in blood transfusion requirements or functional outcomes.

Conclusion

Based on our results, we conclude that the intraoperative blood loss in TKA is significantly different between the groups but only represents a fraction of true blood loss (23%). The timing of releasing the tourniquet does not affect functional outcomes, blood transfusion and postoperative morbidity; hence, any time can be opted as per surgeon preference.

Level of Evidence

Level II, prospective comparative study.

目的:确定在全膝关节置换术(TKA)中伤口闭合前和闭合后松开止血带对失血量、功能预后和术后并发症的影响:从 2023 年 5 月到 2023 年 9 月,对 53 名患者进行了前瞻性队列研究。所有患者均接受了单侧 TKA 手术,根据外科医生对止血带放气的偏好分为两组,A 组患者在关闭伤口止血前放气,B 组患者在关闭伤口和加压敷料后放气。失血量通过术中失血量(浸湿海绵/纱布的数量、吸引瓶中的血液、吸引瓶中的总输出量--使用的灌流器)、术中失血量和计算失血量(使用 Gross 和 Meunier 的公式)进行评估。功能结果采用膝关节损伤和骨关节炎评分-42 个问题进行评估。此外,还评估了术后早期并发症和输血需求的差异:结果:两组患者术中失血量差异显著。A 组术中失血中位数为 135 毫升(四分位间距 [IQR]:90-149),B 组为 56.2 毫升(四分位间距 [IQR]:45-68)(P 值:0.001)。然而,使用格罗斯和默尼耶公式计算的失血量在两组之间没有差异。A 组计算失血量的中位数为 439 毫升(IQR:450-813),B 组为 508 毫升(IQR:226-671)(P 值:0.981)。两组在输血需求和功能结果方面无明显差异:根据我们的研究结果,我们得出结论:TKA 术中各组间的术中失血量有显著差异,但只占真正失血量的一部分(23%)。释放止血带的时间不会影响功能结果、输血量和术后发病率;因此,可根据外科医生的偏好选择任何时间:二级,前瞻性比较研究。
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引用次数: 0
No difference in postoperative patient satisfaction rates between mechanical and kinematic alignment total knee arthroplasty: A systematic review 机械对位与运动对位全膝关节置换术的术后患者满意度无差异:系统综述。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12101
Zainab-Aqeel Khan, Alexandra Leica, Manuel-Paul Sava, Michael T. Hirschmann
<div> <section> <h3> Purpose</h3> <p>The purpose of this systematic review was to compare patient satisfaction patient-reported outcomes (PROMs) levels after mechanically aligned (MA) and kinematically aligned (KA) total knee arthroplasty (TKA).</p> </section> <section> <h3> Methods</h3> <p>A systematic literature search following PRISMA guidelines was conducted on PubMed, Embase, Medline and Scopus to identify potentially relevant articles for this review, published from the beginning of March 2013 until the end of October 2023. Only articles reporting satisfaction after KA TKA, MA TKA or both were included, which use valid and reliable tools for the evaluation and reporting of satisfaction after TKA. Title, authors, year of publication, study design, level of evidence, follow-up period, patients' demographic data, sample size, type of satisfaction score, postoperative satisfaction score, postoperative alignment, statistical significance, as well as other variables, were extracted for analysis. An Agency for Healthcare Research and Quality's (AHRQ) design-specific scale was used for assessing randomized control trials (RCTs). The nonrandomized control trials were evaluated by using the Joanna Briggs Institute's (JBI) Critical Appraisal Tool. The Newcastle-Ottawa Scale (NOS) was also used to assess cohort studies, while case series were evaluated using the NIH Quality Assessment Tool for Case Series Studies.</p> </section> <section> <h3> Results</h3> <p>The initial search identified 316 studies, of which 178 were considered for screening. Eleven studies completely fulfilled the inclusion criteria, including one RCT, five nonrandomized control trials/quasi-experiments, three case series, and two cohort studies. The total number of patients recruited for MA TKA was 1740. Conversely, 497 patients were enrolled for KA TKA. Five studies used the visual analogue scale (VAS) for assessing postoperative patient satisfaction, four used the Knee Society Score (KSS) 2011 version and two Likert-based types of scores. Overall, the highest mean satisfaction score of KSS 2011 was 31.5 ± 6.6 in the MA group, and 29.8 ± 80 in the KA group in four studies. All of them showed high postoperative patient satisfaction rates for both MA and KA TKA, but with no statistically significant difference between them (<i>p</i> > 0.05).</p> </section> <section> <h3> Conclusion</h3> <p>Both mechanically aligned total knee arthroplasty, as well as kinematically aligned total knee arthroplasty led to high rates of postoperative patient satisfaction, with no statistically signific
目的:本系统性综述旨在比较机械对位(MA)和运动学对位(KA)全膝关节置换术(TKA)后患者满意度的患者报告结果(PROMs)水平:在PubMed、Embase、Medline和Scopus上按照PRISMA指南进行了系统性文献检索,以确定与本综述可能相关的文章,这些文章的发表时间为2013年3月初至2023年10月底。仅纳入了报告 KA TKA、MA TKA 或两者术后满意度的文章,这些文章使用了有效可靠的工具来评估和报告 TKA 术后的满意度。研究人员提取了标题、作者、发表年份、研究设计、证据级别、随访时间、患者人口统计学数据、样本量、满意度评分类型、术后满意度评分、术后对位、统计学意义以及其他变量进行分析。在评估随机对照试验(RCT)时,采用了美国医疗保健研究与质量机构(AHRQ)的设计专用量表。非随机对照试验则采用乔安娜-布里格斯研究所(JBI)的批判性评估工具进行评估。纽卡斯尔-渥太华量表(NOS)也用于评估队列研究,而病例系列研究则使用美国国立卫生研究院病例系列研究质量评估工具进行评估:初步检索发现了 316 项研究,其中 178 项被考虑进行筛选。有 11 项研究完全符合纳入标准,其中包括 1 项随机对照试验、5 项非随机对照试验/准实验、3 项病例系列研究和 2 项队列研究。MA TKA共招募了1740名患者。相反,KA TKA共招募了497名患者。五项研究使用视觉模拟量表(VAS)评估术后患者满意度,四项研究使用膝关节学会评分(KSS)2011版,两项研究使用基于Likert的评分类型。总体而言,在四项研究中,MA 组的 KSS 2011 平均满意度最高,为 31.5 ± 6.6,KA 组为 29.8 ± 80。所有研究均显示,MA 和 KA TKA 术后患者满意度均较高,但两者之间的差异无统计学意义(P > 0.05):结论:机械对位全膝关节置换术和运动学对位全膝关节置换术的术后患者满意度都很高,两者之间没有统计学意义上的显著差异:证据等级:III级,系统综述。
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引用次数: 0
Satellite myoblast and mesenchymal stem cell injections decrease fatty degeneration after rotator cuff tear in rats 注射卫星肌母细胞和间充质干细胞可减少大鼠肩袖撕裂后的脂肪变性。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12087
Tahir Koray Yozgatli, Elif Gelenli Dolanbay, Tunca Cingoz, Ahmet Emre Paksoy, Unal Uslu, Ercument Ovali, Baris Kocaoglu

Purpose

Rotator cuff (RC) tears cause fatty degeneration, aggravated by delayed treatment. Surgical repair alone cannot reverse fatty degeneration. It was aimed to test if local injections of satellite cell-derived myoblasts or satellite myoblasts (SM) from the deltoid region and mesenchymal stem cells (MSCs) from the subcutaneous abdominal fat pad would stimulate myogenesis and decrease adipogenesis in the rat model of fatty degenerated RC tear.

Methods

A standardized RC tear surgery was performed on both shoulders of 24 Wistar albino rats at t = 0, and rats were followed for 8 weeks to create a chronic degeneration model. The animals were randomly divided into repair + SM and MSC (n = 12) or repair only (n = 12) groups. Transosseous repair with or without stem cell-based injection was performed on the right shoulder of all rats on week 8, with additional injections on weeks 9 and 10. The left shoulders were used as control. The animals were followed until week 14 for recovery.

Results

Histological and histomorphometric analyses were performed in week 14. The repair + SM and MSC group had a significantly greater supraspinatus muscle mass than the repair only and control groups. The adipose tissue ratio was significantly lower in the repair + SM and MSC groups versus the repair only and control groups.

Conclusion

Histologically, the repair + SM and MSC group had improved muscle and tendon organization. In treating chronically degenerated RC tear in a rat model, surgical repair combined with injections of SM and MSC improved fatty degeneration, tendon healing and myogenesis.

Level of Evidence

Level III.

目的:肩袖(RC)撕裂会导致脂肪变性,延误治疗会加重病情。单靠手术修复无法逆转脂肪变性。本研究旨在测试在脂肪变性 RC 撕裂的大鼠模型中,局部注射三角肌区域的卫星细胞衍生肌母细胞或卫星肌母细胞(SM)和腹部皮下脂肪垫的间充质干细胞(MSCs)是否会刺激肌生成和减少脂肪生成:方法:在t = 0时对24只Wistar白化大鼠的双肩进行标准化RC撕裂手术,并对大鼠进行为期8周的随访,以建立慢性退变模型。动物被随机分为修复 + SM 和间充质干细胞组(n = 12)或仅修复组(n = 12)。在第8周,对所有大鼠的右肩进行带或不带干细胞注射的经骨修复,并在第9周和第10周进行额外注射。左肩作为对照组。动物随访至第 14 周,以观察恢复情况:结果:第14周进行了组织学和组织形态学分析。修复 + SM 和间充质干细胞组的冈上肌质量明显高于仅修复组和对照组。修复+SM和间充质干细胞组的脂肪组织比率明显低于单纯修复组和对照组:从组织学角度看,修复 + SM 和间充质干细胞组的肌肉和肌腱组织得到了改善。结论:从组织学角度看,修复+SM和间充质干细胞组改善了肌肉和肌腱组织。在治疗大鼠模型中的慢性退行性RC撕裂时,手术修复结合注射SM和间充质干细胞改善了脂肪变性、肌腱愈合和肌生成:证据等级:三级。
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引用次数: 0
Subchondral bone: An emerging target for the treatment of articular surface lesions of the knee 软骨下骨:治疗膝关节表面病变的新目标。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-21 DOI: 10.1002/jeo2.12098
Alessandro Sangiorgio, Luca Andriolo, Wayne Gersoff, Elizaveta Kon, Norimasa Nakamura, Stefan Nehrer, Francesca Vannini, Giuseppe Filardo

Purpose

When dealing with the health status of the knee articular surface, the entire osteochondral unit has gained increasing attention, and in particular the subchondral bone, which plays a key role in the integrity of the osteochondral unit. The aim of this article was to discuss the current evidence on the role of the subchondral bone.

Methods

Experts from different geographical regions were involved in performing a review on highly discussed topics about the subchondral bone, ranging from its etiopathogenetic role in joint degeneration processes to its prognostic role in chondral and osteochondral defects, up to treatment strategies to address both the subchondral bone and the articular surface.

Discussion

Subchondral bone has a central role both from an aetiologic point of view and as a diagnostic tool, and its status was found to be relevant also as a prognostic factor in the follow-up of chondral treatment. Finally, the recognition of its importance in the natural history of these lesions led to consider subchondral bone as a treatment target, with the development of osteochondral scaffolds and procedures to specifically address osteochondral lesions.

Conclusion

Subchondral bone plays a central role in articular surface lesions from different points of view. Several aspects still need to be understood, but a growing interest in subchondral bone is to be expected in the upcoming future towards the optimization of joint preservation strategies.

Level of Evidence

Level V, expert opinion.

目的:在研究膝关节表面的健康状况时,整个骨软骨单元越来越受到关注,尤其是软骨下骨,它在骨软骨单元的完整性中发挥着关键作用。本文旨在讨论软骨下骨作用的现有证据:方法:来自不同地区的专家参与了软骨下骨方面讨论较多的话题的综述,包括软骨下骨在关节退变过程中的病因作用、软骨和骨软骨缺损的预后作用,以及针对软骨下骨和关节面的治疗策略:软骨下骨在病因学角度和诊断工具方面都起着核心作用,而且在软骨治疗的随访过程中,软骨下骨的状况也是一个重要的预后因素。最后,由于认识到软骨下骨在这些病变自然史中的重要性,人们开始将软骨下骨作为治疗目标,并开发了骨软骨支架和专门治疗骨软骨病变的手术:结论:从不同角度看,软骨下骨在关节表面病变中起着核心作用。虽然仍有许多方面需要了解,但预计在不久的将来,人们会对软骨下骨越来越感兴趣,从而优化关节保护策略:证据等级:V 级,专家意见。
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引用次数: 0
Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm 化脓性关节炎和假体周围关节感染微生物鉴定中的多重 PCR:新分子检测诊断算法的应用结果。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-21 DOI: 10.1002/jeo2.12097
Stefano Ghirardelli, Federica Scaggiante, Christina Troi, Pieralberto Valpiana, Giovanni Cristofolini, Giuseppe Aloisi, Bruno Violante, Arcangelo Russo, Sebastian Schaller, Pier F. Indelli

Purpose

Pathogen identification is key in the treatment of septic arthritis (SA) and periprosthetic joint infections (PJI). This study evaluates the outcome of the application of a new, score-based SA and PJI diagnostic algorithm, which includes the execution of molecular testing on synovial fluid.

Methods

A score-based diagnostic algorithm, which includes serologic and synovial fluid markers determination using multiplex PCR (mPCR) and Next Generation Sequencing (NGS) molecular testing, has been applied to a consecutive series of patients with clinically suspected SA or PJI. Patients with a score ≥6 underwent synovial fluid molecular testing, together with traditional culture, to identify the pathogen and its genetically determined antibiotic resistance.

Results

One hundred and seventeen joints in 117 patients (62.5% women; average age 73 years) met the criteria for possible SA/PJI. The affected joint was the knee in 87.5% (joint replacement 66.5%; native joint 21%) and the hip in 12.5% (all replaced joints). 43/117 patients (36.7%) were ultimately diagnosed with SA/PJI. Among the various testing technologies applied, mPCR was the main determinant for pathogen identification in 63%, standard culture in 26%, and mNGS in 11%. Staphylococcus aureus and Enterococcus faecalis were the top two microorganisms identified by mPCR, while Staphylococcus epidermidis was the prevalent organism identified by NGS. mPCR detected the presence/absence of the genetically determined antibiotic resistance of all identified microorganisms. The average timeframe for pathogen identification was 3.13 h for mPCR, 4.5 days for culture, and 3.2 days for NGS.

Conclusions

Molecular diagnostic technologies represent an innovative screening for fast microorganism identification when a joint infection is clinically suspected.

Level of Evidence

Level IV, case series.

目的:病原体鉴定是治疗化脓性关节炎(SA)和假体周围关节感染(PJI)的关键。本研究评估了基于评分的新型化脓性关节炎和假体周围关节感染诊断算法的应用效果,该算法包括对滑膜液进行分子检测:一种基于评分的诊断算法,包括使用多重 PCR (mPCR) 和下一代测序 (NGS) 分子检测进行血清学和滑液标记物测定,已应用于临床疑似 SA 或 PJI 患者的连续系列。评分≥6分的患者接受滑液分子检测和传统培养,以确定病原体及其基因决定的抗生素耐药性:117名患者(62.5%为女性,平均年龄73岁)的117个关节符合SA/PJI的可能标准。87.5%的患者受影响的关节是膝关节(关节置换 66.5%;原生关节 21%),12.5%的患者受影响的关节是髋关节(所有关节均被置换)。43/117 名患者(36.7%)最终被诊断为 SA/PJI。在应用的各种检测技术中,mPCR 是鉴定病原体的主要决定因素,占 63%,标准培养占 26%,mNGS 占 11%。金黄色葡萄球菌和粪肠球菌是 mPCR 鉴定的前两种微生物,而表皮葡萄球菌则是 NGS 鉴定的主要微生物。mPCR 鉴定病原体的平均时间为 3.13 小时,培养为 4.5 天,NGS 为 3.2 天:分子诊断技术是一种创新的筛查方法,可在临床怀疑关节感染时快速鉴定微生物:证据等级:IV 级,病例系列。
{"title":"Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm","authors":"Stefano Ghirardelli,&nbsp;Federica Scaggiante,&nbsp;Christina Troi,&nbsp;Pieralberto Valpiana,&nbsp;Giovanni Cristofolini,&nbsp;Giuseppe Aloisi,&nbsp;Bruno Violante,&nbsp;Arcangelo Russo,&nbsp;Sebastian Schaller,&nbsp;Pier F. Indelli","doi":"10.1002/jeo2.12097","DOIUrl":"10.1002/jeo2.12097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Pathogen identification is key in the treatment of septic arthritis (SA) and periprosthetic joint infections (PJI). This study evaluates the outcome of the application of a new, score-based SA and PJI diagnostic algorithm, which includes the execution of molecular testing on synovial fluid.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A score-based diagnostic algorithm, which includes serologic and synovial fluid markers determination using multiplex PCR (mPCR) and Next Generation Sequencing (NGS) molecular testing, has been applied to a consecutive series of patients with clinically suspected SA or PJI. Patients with a score ≥6 underwent synovial fluid molecular testing, together with traditional culture, to identify the pathogen and its genetically determined antibiotic resistance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and seventeen joints in 117 patients (62.5% women; average age 73 years) met the criteria for possible SA/PJI. The affected joint was the knee in 87.5% (joint replacement 66.5%; native joint 21%) and the hip in 12.5% (all replaced joints). 43/117 patients (36.7%) were ultimately diagnosed with SA/PJI. Among the various testing technologies applied, mPCR was the main determinant for pathogen identification in 63%, standard culture in 26%, and mNGS in 11%. <i>Staphylococcus aureus</i> and <i>Enterococcus faecalis</i> were the top two microorganisms identified by mPCR, while <i>Staphylococcus epidermidis</i> was the prevalent organism identified by NGS. mPCR detected the presence/absence of the genetically determined antibiotic resistance of all identified microorganisms. The average timeframe for pathogen identification was 3.13 h for mPCR, 4.5 days for culture, and 3.2 days for NGS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Molecular diagnostic technologies represent an innovative screening for fast microorganism identification when a joint infection is clinically suspected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11260279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three-dimensional bone morphology is a risk factor for medial postmeniscectomy syndrome: A retrospective cohort study 三维骨形态是内侧腓肠肌切除术后综合征的风险因素:一项回顾性队列研究。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-21 DOI: 10.1002/jeo2.12090
Jonas Grammens, Annemieke Van Haver, Femke Danckaers, Kristien Vuylsteke, Jan Sijbers, Lotem Mahluf, Peter Angele, Elizaveta Kon, Peter Verdonk, MEFISTO WP1 Group

Purpose

The study aims to identify differences in tibiofemoral joint morphology between responders (R group, no pain) to arthroscopic partial medial meniscectomy (APMM) versus medial postmeniscectomy syndrome patients (MPMS group, recurrent pain at 2 years postmeniscectomy) in a clinically neutrally aligned patient population. The second aim was to build a morphology-based predictive algorithm for response to treatment (RTT) in APMM.

Methods

Two patient groups were identified from a large multicentre database of meniscectomy patients at 2 years of follow-up: the R group included 120 patients with a KOOS pain score > 75, and the MPMS group included 120 patients with a KOOS pain score ≤ 75. Statistical shape models (SSMs) of distal femur, proximal tibia and tibiofemoral joint were used to compare knee morphology. Finally, a predictive model was developed to predict RTT, with the SSM-derived morphologic variables as predictors.

Results

No differences were found between the R and MPMS groups for patient age, sex, height, weight or cartilage status. Knees in the MPMS group were significantly smaller, had a wider femoral notch and a smaller medial femoral condyle. A morphology-based predictive model was able to predict MPMS at 2 years follow-up with a sensitivity of 74.9% (95% confidence interval [CI]: 74.4%–75.4%) and a specificity of 81.0% (95% CI: 80.6%–81.5%).

Conclusion

A smaller tibiofemoral joint, a wider intercondylar notch and smaller medial femoral condyle were observed shape variations related to medial postmeniscectomy syndrome. These promising results are a first step towards a knee morphology-based clinical decision support tool for meniscus treatment.

Study Design

Case–control study.

Level of Evidence

Level IIIb.

目的:该研究旨在确定关节镜下内侧半月板部分切除术(APMM)反应者(R组,无疼痛)与内侧半月板切除术后综合征患者(MPMS组,半月板切除术后2年复发疼痛)之间的胫股关节形态学差异。第二个目的是建立基于形态学的 APMM 治疗反应(RTT)预测算法:从随访两年的大型多中心半月板切除术患者数据库中确定了两组患者:R组包括120名KOOS疼痛评分大于75分的患者,MPMS组包括120名KOOS疼痛评分小于75分的患者。股骨远端、胫骨近端和胫股关节的统计形状模型(SSM)用于比较膝关节形态。最后,以 SSM 得出的形态变量为预测因子,建立了一个预测模型来预测 RTT:结果:R组和MPMS组在患者年龄、性别、身高、体重或软骨状况方面均无差异。MPMS组的膝关节明显较小,股骨凹槽较宽,股骨内侧髁较小。基于形态学的预测模型能够预测随访两年的 MPMS,灵敏度为 74.9%(95% 置信区间 [CI]:74.4%-75.4%),特异度为 81.0%(95% 置信区间:80.6%-81.5%):结论:胫股关节变小、髁间凹槽变宽、股骨内侧髁变小是与内侧胫骨切除术后综合征有关的形状变化。这些令人鼓舞的结果是迈向基于膝关节形态的半月板治疗临床决策支持工具的第一步:研究设计:病例对照研究:证据等级:IIIb级。
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引用次数: 0
Comprehensive evaluation of risk factors for aseptic loosening in cemented total knee arthroplasty: A systematic review and meta-analysis 全面评估骨水泥全膝关节置换术中无菌性松动的风险因素:系统回顾和荟萃分析。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-21 DOI: 10.1002/jeo2.12095
Kaiyi Yao, Yao Chen

Purpose

Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta-analysis to reconcile the divergent conclusions observed across studies.

Methods

We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy-four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty-nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design).

Results

Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80−46.77, p < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high-viscosity cement and the utilization of mobile-bearing designs as risk factors for aseptic loosening post-cemented TKA.

Conclusions

Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta-analysis, we believe that higher-level studies are necessary to clearly identify other risk factors.

Level of Evidence

Level III.

目的:无菌性松动是全膝关节置换术(TKA)后最常见的翻修原因。尽管有许多研究探讨了与无菌性松动相关的各种风险因素,但研究结果往往不一致。为了解决这个问题,我们对文献进行了全面的回顾,以确定和分析骨水泥 TKA 中的这些风险因素。此外,我们还进行了一项荟萃分析,以调和各研究中观察到的不同结论:我们检索了从 1996 年到 2024 年的 PubMed、Web of Science 和 Embase,并对纳入文献的质量进行了评估。共纳入74项研究,以评估体重指数(BMI)、糖尿病、高体力活动(HPA)、骨质疏松症、类风湿性关节炎(RA)、骨水泥材料和种植体设计之间的关联。29项研究用于计算六种不同风险因素(体重指数、糖尿病、HPA水平、骨水泥材料、聚乙烯和植入体设计)的相对风险和CIs(使用随机效应理论)以及研究异质性:结果:糖尿病患者发生无菌性松动的几率是非糖尿病患者的八倍(RR = 9.18,95% CI:1.80-46.77,P 结论:接受 TK 的糖尿病患者发生无菌性松动的几率是非糖尿病患者的八倍(RR = 9.18,95% CI:1.80-46.77,P):接受TKA手术的糖尿病患者应就其无菌性松动潜在增加的风险接受咨询。在骨水泥TKA中使用胫骨柄延长和HXLPE可降低无菌性松动的发生率。然而,鉴于纳入荟萃分析的研究数量有限,我们认为有必要进行更高级别的研究,以明确其他风险因素:证据等级:三级。
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引用次数: 0
Limited correlation between physical performance and patient-reported outcomes at 1-year follow-up after anterior cruciate ligament reconstruction 前十字韧带重建术后 1 年随访期间,体能表现与患者报告结果之间的相关性有限。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-07-17 DOI: 10.1002/jeo2.12071
Torsten Grønbech Nielsen, Ulrik Dalgas, Martin Lind
<div> <section> <h3> Purpose</h3> <p>The majority of anterior cruciate ligament reconstruction (ACLr) patients wish to return to sport. Clinical evaluations after ACLr often do not include physical testing, making it difficult to determine the patient's readiness to return to sport. Thus, it would be helpful to identify easily assessable factors associated with physical function in ACLr patients that could inform planning of patients' return to sport. This study sought to evaluate the associations between physical test performance in ACLr patients and known ACL injury risk factors, knee laxity and patient-reported outcomes at 1-year follow-up.</p> </section> <section> <h3> Methods</h3> <p>The cohort included isolated primary ACLr patients operated between 2009 and 2014. Patients were invited to a 1-year visit to clarify their readiness to return to sport. A test battery was performed, including clinical evaluation, patient-reported outcomes and three physical tests, from which the Leg Symmetry Index (LSI) was calculated. Multivariate regression analyses were performed for each of the physical tests, including known risk factors, clinical outcomes and patient-reported outcomes. Laxity <3 mm, pivot shift = 0, Knee Injury and Osteoarthritis Outcome Score (KOOS) sport >75, International Knee Documentation Committee (IKDC) >75.9, and Single Assessment Numeric Evaluation (SANE) >92.7 were applied as cut-off values for good versus poor status.</p> </section> <section> <h3> Results</h3> <p>A total of 480 ACLr patients were included in the study. Laxity <3 mm had a negative impact on the single-hop LSI, whereas a pivot shift = 0 or IKDC >75.9 had a positive impact on the single-hop LSI. Age <20, a pivot shift grade of 0 and KOOSsport >75 were positively associated with the triple-hop LSI. Finally, age <20 and IKDC >75.9 were positively associated with the leg extension strength LSI.</p> </section> <section> <h3> Conclusions</h3> <p>Age, sagittal laxity, pivot shift and patient-reported outcomes were associated with physical test performance 1 year after ACLr. However, the associations were not completely uniform and strong, so information on age, sagittal laxity, pivot shift and patient-reported outcomes cannot replace a return-to-sport functional test battery in determining when it is safe to return to sport after ACLr.</p> </section> <section> <h3> Level of Evidence</h3> <p>Level III.</p> </section>
目的:大多数前十字韧带重建术(ACLr)患者都希望重返运动场。前交叉韧带重建术后的临床评估通常不包括体能测试,因此很难确定患者是否准备好重返运动场。因此,找出与前交叉韧带损伤患者身体功能相关的易于评估的因素将很有帮助,这些因素可为患者重返体育运动的计划提供参考。本研究旨在评估前交叉韧带损伤患者的体能测试表现与已知的前交叉韧带损伤风险因素、膝关节松弛以及随访一年的患者报告结果之间的关联:研究队列包括2009年至2014年期间接受过手术的孤立原发性前交叉韧带损伤患者。邀请患者进行为期1年的随访,以明确他们是否准备好重返运动场。进行了一系列测试,包括临床评估、患者报告结果和三项体能测试,并从中计算出腿部对称指数(LSI)。对每项物理测试进行了多变量回归分析,包括已知风险因素、临床结果和患者报告结果。将松弛度 75、国际膝关节文献委员会(IKDC)>75.9 和单次数字评估(SANE)>92.7 作为良好与不良状态的临界值:研究共纳入了 480 名前交叉韧带损伤患者。松弛度 75.9 对单跳 LSI 有积极影响。年龄 75 与三跳 LSI 呈正相关。最后,年龄 75.9 与腿部伸展力量 LSI 呈正相关:结论:年龄、矢状松弛、枢轴移位和患者报告的结果与前交叉韧带撕裂术后一年的体能测试成绩有关。然而,这些关联并不完全一致和强烈,因此年龄、矢状位松弛、枢轴移位和患者报告结果的信息不能取代重返运动场功能测试,以确定前交叉韧带术后何时重返运动场是安全的:证据等级:三级。
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Journal of Experimental Orthopaedics
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