Sports Medicine and Arthroscopy Review最新文献

Focal articular chondral lesions are a common finding among patients presenting with knee pain, which have been reported with an incidence of up to 60% to 65% during knee arthroscopies. When symptomatic and not responding to conservative treatment measures, cell transplantation techniques can offer a valid treatment solution to regenerate cartilage, due to articular cartilage's very limited self-repair capability. Autologous chondrocyte implantation (ACI) has been used clinically for more than 20 years, with short, medium, and long-term clinical outcomes diffusely reported in the literature. To overcome ACI limitations, other cell transplantation techniques have been considered as treatment modalities for cartilage defect repair. Mesenchymal stem cells induced pluripotent stem cells (iPSC); Scaffold-based cell transplantation techniques such as AMIC and LIPO-AMIC procedures, and allogeneic cell transplantation and allograft cell transplantation have, in recent years, become a successful alternative treatment. This article analyzes clinical data and literature findings on the various cell transplantation cartilage repair techniques from bench and bedside, including all the various options for patients with full-thickness cartilage defects, aiming to outline the past, present, and future of cell therapies for articular cartilage defect repair.

Osteochondral allograft (OCA) transplantation has become a reliable treatment for cartilage defects of the knee, with advancements in recent decades allowing for greater use and effectiveness. This review analyzes the evolution of OCAs through in vitro, translational, and clinical research, highlighting advancements in patient selection, defect characteristics, graft matching, storage, and intraoperative preparation. Looking at long-term clinical outcomes, the success of OCAs is significantly influenced by factors such as age, BMI, defect size, and several other intraoperative and demographic variables. Recent innovations, including orthobiologic augmentation, have augmented graft viability and integration. A number of variations in technique have allowed osteochondral grafts to be used for a wider range of lesions. In addition, emerging alternatives to OCA, technologies such as synthetic scaffolds and decellularized and cryopreserved grafts, show great promise, although more data are needed.

Meniscus allograft transplantation restores knee function and alleviates pain in symptomatic patients with irreparable meniscus loss, particularly in younger individuals without advanced arthritis. Surgical techniques such as bone bridge, bone plug, and all-soft tissue aim to replicate native meniscus root attachments for optimal biomechanical restoration and graft stability. Clinical outcomes and return to sport rates are generally quite favorable, with no clear advantage of one technique over the others. Debate continues about proper methods for tissue processing, sizing, and rehabilitation protocols; ultimately, the choice often relies on the surgeon's preference and graft availability.

Comprehensive studies on the exclusive use of allografts for medial collateral ligament (MCL) and posterolateral corner (PLC) reconstruction are limited. This review assessed clinical and functional outcomes of allograft use for MCL and PLC reconstruction. The PRISMA guidelines were followed. A systematic search of the literature was performed in PubMed, MEDLINE, Web of Science, Cochrane (CENTRAL), and Scopus databases to identify published articles on clinical studies relevant to MCL and LCL reconstruction with the use of allografts. The results of the eligible studies were analyzed in terms of stability and functional outcomes, Lysholm score, objective and subjective International Knee Documentation Committee (IKDC) scores, Tegner activity scale, Cincinnati Knee Rating System, Marx score, complications, and graft failure. Nineteen studies with 547 patients undergoing LCL reconstructions using allografts were analyzed. The most common allograft used was the Achilles tendon. Mean lateral opening improved from 6.21 mm preoperatively to 1.88 mm postoperatively, with IKDC and Lysholm scores increasing significantly (44.02 to 74.78 and 53.44 to 85.68, respectively). The failure rate for LCL/PLC reconstructions was 11.13%, and complications occurred in 19.75%. For MCL reconstructions, 5 studies with 135 patients showed a reduction in medial opening from 9.7 mm to 2.33 mm, with increases in IKDC and Lysholm scores (49.8 to 75.92 and 69.3 to 85.46, respectively). The failure rate was 4.19%, with a 10.93% complication rate. The use of allografts for LCL and PLC reconstruction demonstrated satisfactory outcomes, with stable and functional knees, though there was a relatively high graft failure rate. Similarly, positive results were observed in MCL reconstruction with allografts. Level of Evidence: Level-IV.

Transplantation of fresh osteochondral allografts is a possible biological resurfacing option to substitute massive bone loss and provide proper gliding surfaces for extended and deep osteochondral lesions of weight-bearing articular surfaces. Limited chondrocyte survival and technical difficulties may compromise the efficacy of osteochondral transfers. As experimental data suggest that minimizing the time between graft harvest and implantation may improve chondrocyte survival rate a <48 hours donor to recipient time was used to repair massive osteochondral defects. For optimal graft congruency, a magnetic resonance-based artificial intelligence algorithm was also developed to provide proper technical support. Based on 3 years of experience, increased survival rate of transplanted chondrocytes and improved clinical outcomes were observed.

As the largest intra-articular knee ligament, the posterior cruciate ligament (PCL) is rarely torn in isolation, given the required force to tear it. For high-grade PCL tears unresponsive to conservative treatment or with concomitant ligament tears, the PCL should be reconstructed. Understanding the anatomy and biomechanics of both bundles of the PCL facilitates successful ligament reconstruction. Although various surgical techniques have been studied for either biomechanical or clinical superiority, the selection of the optimal graft in PCL reconstructions remains largely surgeon preference. This review serves to summarize the current understanding of PCL reconstructions with an emphasis on allograft usage and outcomes.

Meniscal damage increases contact stress to the underlying chondral surface, leading to cartilage degeneration. However, meniscal repair is not always feasible, and partial meniscectomy is still the current standard of care for irreparable symptomatic lesions, including failure of primary repair. This approach can lead to the development of early osteoarthritis and irreversible knee damage in the long term. The main goals for treating the post-meniscectomy deficient knee are to allow pain-free daily activities, prevent swelling, and avoid further joint degeneration. The concept of meniscal regeneration has become very appealing. This process requires a scaffold for successful migration and colonization with precursor cells and vessels, leading to the formation of organized new meniscal tissue. Two meniscal scaffolds are available: one is composed of aliphatic polyurethane named Actifit, and the other is based on collagen type I fibers called Collagen Meniscal Implant. Both provide an effective and safe solution for treating symptomatic patients with segmental mid-substance meniscus defects. Recent literature has demonstrated that scaffolds are effective both in mid- and long-term outcomes and significantly improve patient satisfaction and clinical evaluation; therefore, they are suggested for meniscus preservation and long-term knee health.

Objective: The goal of this systematic review is to determine the prevalence of these testing systems in the current rotator cuff literature, determine the most common outcome measurements evaluated with each of these systems, and discuss the benefits and limitations of each of these modalities.

Materials and methods: A PubMed search was conducted to identify studies utilizing either dynamic or static whole shoulder models to assess rotator cuff pathology with or without subsequent repair. For each study, the repair method, the outcomes measured, and the loading forces used were collected. These were then compared between studies using either a dynamic or static model.

Results: A total of 44 studies (34 static, 10 dynamic) were included for analysis. The most common repairs evaluated were superior capsular reconstruction (SCR; static: 35%; dynamic: 40%), no repair (static: 24%; dynamic: 30%), and suture anchor repair (static: 15%; dynamic: 30%). The most common outcome measures for static studies were superior humeral head migration (65%) and glenohumeral contact force (21%), while the most common outcomes in dynamic studies were maximum abduction (50%) and deltoid force at maximum abduction (40%).

Conclusion: Currently, a majority of this research utilizes static models. Understanding the benefits and limitations of these systems is important for researchers hoping to employ these models in their future work.

Recent research underscores the significance of meniscal extrusion in knee osteoarthritis progression. Centralization of the meniscus has emerged as a potential intervention, yet comprehensive literature on this is limited. This systematic review aims to synthesize evidence on meniscus centralization's impact on extrusion and knee biomechanics. A search of PubMed Central and Scopus yielded 14 relevant articles until June 1, 2023. Included were 3 case series, 9 cadaveric studies, and 2 involving animals or patients. Biomechanical effects on both medial and lateral menisci were explored, alongside implications for anterior cruciate ligament reconstruction. Findings suggest centralization may mitigate extrusion and improve knee biomechanics, potentially benefiting clinical outcomes. However, further high-quality studies are warranted to validate these observations and ascertain optimal centralization techniques.