Arthroscopy-The Journal of Arthroscopic and Related Surgery最新文献

Purpose: To characterize the relationship between testosterone replacement therapy (TRT) and anterior cruciate ligament (ACL) injuries.

Methods: A retrospective cohort study using a large insurance database was conducted. Patients who were prescribed TRT for at least 3 months were matched with controls who were not prescribed TRT. Rates of ACL tears were compared between the cohorts. Multiple subgroups were created based on age (<25 years, 25-35, 36-45, 46-55, 56-65, and 65+). Multivariable logistic regressions were performed to determine the association of TRT with ACL tears while accounting for demographic variables and comorbidities.

Results: After matching, there were 160,839 patients in both the TRT cohort and control cohort. The incidence of ACL injuries was 17.8 per 10,000 person-years (95% CI: 16.4-19.2) for patients who were prescribed TRT and 4.9 per 10,000 person-years (95% CI: 4.1-5.7) for controls (p<0.001). Within 2 years of filling a testosterone prescription for at least 3 months, 572 (0.35%) patients experienced an ACL injury compared to only 157 (0.10%) controls during the same follow-up period (OR: 2.77; 95% CI: 2.26-3.42, p<0.001). When stratified by age, all groups except the <25 years of age group demonstrated significantly higher rate of ACL tears (OR 3.91-12.3, p<0.001-0.009). When separated by sex, males on TRT were 3.13 (95% CI: 2.50-3.93, p<0.001) times more likely while females on TRT were 1.94 (95% CI: 1.13-3.41, p=0.018) times more likely to experience an ACL injury compared to controls.

Conclusion: This study found that patients prescribed at least three months of TRT had a significantly higher incidence of ACL injuries compared to controls within a two-year follow-up period.

Level of evidence: Level III, retrospective comparative study.

Purpose: The purposes of this study were to characterize the human bone marrow derived mesenchymal stem cells (BM-MSCs) production of osteoarthritis-relevant cytokines and growth factors as they are purified and multiplied, a process termed culture expansion, and to compare the immunomodulatory potential of BM-MSCs based on source and medium used for culture expansion.

Methods: BM-MSCs were obtained from iliac crest bone marrow aspirates of four healthy donors. These four BM-MSC cell lines underwent four rounds, or "passages," of the institutional culture expansion protocol, using institutional culture media. The secretory molecules known to play a role in OA-related inflammatory immune response, cartilage degradation and patient symptoms, together called the BM-MSC "secretome," were measured at each passage. Three lines of commercially available BM-MSCs from healthy donors underwent culture expansion by the same protocol, using commercial culture media. The commercial BM-MSCs secretome and the institutional BM-MSCs secretome were compared at each passage. Significance was set at p<0.05.

Results: Institutional BM-MSCs produced less IL-6 at passages 3 (237±113 pg/mL) and 4 (237±113 pg/mL) compared to passages 1 (884±97 pg/mL) and 2 (1071±129 pg/mL; p<0.01). Institutional BM-MSCs produced more MIP-3α at passage 4 than at passage 1 (106±41 vs 32±7 pg/mL; p<0.01). Across passages of culture expansion, institutional BM-MSCs grown on institutional medium expressed more IL-6 (P<0.001), IL-10 (P<0.001), IL-1β (P<0.001), TNFα (P=0.004), and VEGF-C (P=0.003) than commercially available BM-MSCs grown on commercial medium.

Conclusion: Culture expansion alters key molecules within the BM-MSC secretome. Additionally, differences in BM-MSC source and culture medium alter the BM-MSC secretome and its immunomodulatory potential.

Purpose: To perform an updated systematic review on the prevalence and morphological characteristics of the anterolateral ligament (ALL) in human cadaveric specimens.

Methods: Medline, Embase, Scopus, and Google Scholar were searched for studies from 2012 to 2024 describing the morphology. Study quality was assessed using CASP checklist and QUACS scale. Heterogeneity was analysed with the I² statistic, funnel plot, and Q-test. Mean effect size and 95% prediction intervals were calculated. Prevalence and anatomical measurements (length, width, thickness) were analysed using mean and standard deviations.

Results: Thirty studies were included. CASP identified three low-quality studies. Twelve studies met the QUACS quality threshold. The prevalence of the ALL was 61.7% (82% North America, 64.9% Europe, 45.8% Asia). The femoral insertion showed variability near the lateral femoral epicondyle and lateral collateral ligament, while the tibial insertion was midway between Gerdy's tubercle and fibular head. Histological analysis revealed 60% of studies identified ligamentous tissue similar to the ACL. The mean ALL length was 39.7 mm, width 5.5 mm, and thickness 1.5 mm, with no significant morphological differences among populations.

Conclusion: This systematic review reveals that the ALL is present in 61.7%, with prevalence rates of 82% in North American studies, 65% in European studies, and 46% in Asian studies. The femoral insertion exhibited substantial variability at/around the lateral femoral epicondyle and LCL, lacking consistency. The tibial insertion was more consistently described as being located about halfway between Gerdy's tubercle and the fibular head. Histological analysis showed that 60% of the included studies identified the ALL as containing ligament-like or ligamentous tissue. The mean length of the ALL was 39.9 mm (range 31-59 mm), the mean width was 5.7 mm (range 2.2-9.0 mm), and the mean thickness was 1.5 mm (range 1.3-2.7 mm). No significant ethnic population differences were observed in the morphological measures.

Purpose: The purpose of this study was to evaluate the clinical outcomes in the use of a synthetic medial meniscus implant in patients symptomatic after medial meniscectomy and not responsive to other treatment methods. and not responded to non-operative treatment.

Methods: This single-arm, multicenter, prospective study enrolled subjects between ages 30-75 with post-meniscectomy pain. Changes from baseline to 24-months were measured in the pain subscale of the knee injury and osteoarthritis outcome score (KOOS) and in KOOS overall (average of all five subscales) in patients that had received a medial meniscus implant. Success was a 20-point improvement at 24-months, reoperation rates, and implant failures were recorded. VAS, IKDC, and WOMET scores were also measured.

Results: Of the 115 treated patients 3 (2.6%) were either lost to follow-up or missed the 24-month visit, 48 (43%) patients had at least one subsequent surgery, 12 (10.7%) had the implant permanently removed. Of the remaining 100 patients, the mean KOOS pain improved 28.4 points at 24 months (P <0.001), and mean KOOS overall improved 28.3 points (P < 0.001). Seventy-six percent of subjects had mean scores for KOOS pain above the minimal clinically important difference (MCID) threshold, and 72% of subjects met or exceeded this threshold for KOOS overall. There were 29 patients (25.9%) who underwent implant exchange. The 24-month clinical outcomes were similar between subjects who had an implant exchange and patients who did not have any subsequent implant procedure (P < 0.2).

Conclusion: The synthetic medial meniscus demonstrates high reoperation and failure rates. Patients who retained the implant or required implant exchange showed significantly improved pain, function, and quality of life at 24-month follow-up in patients symptomatic following partial medial meniscectomy and failed non-operative management. The high reoperation rate is a concern, and further evaluation is needed to determine any contributing factors.

Purpose: To evaluate the available literature on the relationship between knee bony morphology and medial meniscus posterior root tears (MMPRTs) to determine which underlying tibiofemoral morphologic risk factors may predispose the development of MMPRTs.

Methods: Embase, MEDLINE, and PubMed databases were searched to identify all relevant human clinical studies investigating knee morphologic features and MMPRTs. Shape features were compared between control groups and patients with MMPRTs. The methodological index for non-randomized studies (MINORS) instrument was utilized to assess the methodological quality of included studies.

Results: Thirteen level III evidence studies and one level IV evidence study were included in this review (n=2,181), with 895 patients in the MMPRT group and 1,286 in the control group. Tibial morphology features associated with an increased risk for MMPRTs included an increased medial tibial slope (six studies), increased tibial torsion (one study), increased medial meniscal slope (one study), and shallower medial tibial plateau concavity (one study). Varus mechanical alignment was found to increase the risk for MMPRTs (four studies). Femoral morphology features associated with an increased risk for MMPRTs included an A-type intercondylar notch (one study), increased medial femoral condyle (MFC) angle (one study), narrower intercondylar distance (one study), narrower intercondylar notch width (one study), shorter MFC distal offset distance (one study), increased MFC width (one study), increased MFC to medial tibial condyle width ratio (one study), greater distance between the medial tibial eminence and MFC (one study), and smaller femoral offset ratios of both the medial and lateral condyles (one study).

Conclusion: Multiple tibiofemoral shape features, including a steeper slope of the medial tibial plateau, greater varus alignment, and a narrower intercondylar distance and notch width, were found to be predictive factors for MMPRTs.

Level of evidence: Level IV (Systematic review of Level III and IV studies).

A small degree of increased varus laxity in acute anterior cruciate ligament (ACL) disrupted knees can often be felt on initial examination. Why this occurs is not always clear and is usually felt to be related to some degree of fibular collateral ligament (FCL) injury. However, there may be another structure that demands our attention in an ACL-deficient knee with more laxity than isolated ACL injuries, but less laxity than combined ACL and FCL injuries. That structure is the anterolateral complex (ALC), including the anterolateral ligament (ALL), the iliotibial band, and quite importantly, Kaplan's fibers.