Background: Meniscal allograft transplantation (MAT) has been established as a safe, effective treatment for meniscal deficiency. However, questions remain regarding pre- and perioperative factors that affect MAT outcomes.
Purpose: To assess predictive factors for preoperative to postoperative change in Lysholm score (ΔLysholm) and nonfailure reoperations after MAT.
Study design: Systematic review and meta-analysis; Level of evidence, 4.
Methods: The Ovid Medline, Embase, Scopus, and Clinicaltrials.gov databases were systematically searched for studies investigating clinical outcomes after MAT, including Lysholm scores, failure, complications, or reoperations. Study characteristics, predictive factors, and outcomes were extracted. The primary outcomes included ΔLysholm scores and nonfailure reoperations. Nonfailure reoperation was defined as any nonfailure meniscus-related procedure after primary MAT aiming to improve knee function. Failure was defined as conversion to total/unilateral knee arthroplasty, total or subtotal meniscectomy/allograft removal, or revision MAT. Relationships between predictive factors and outcomes were analyzed by meta-analysis or by weighted linear regression. Significant factors were included in a multivariable meta-regression.
Results: Of 2347 screened titles, 154 met inclusion criteria. A total of 11,413 patients and 11,548 transplanted menisci were identified. The estimated pooled ΔLysholm score was 24.2 (SD, 6.08), and the nonfailure reoperation incidence rate was 3.36% (SD, 7.46%). No prognostic factors were significantly associated with differing ΔLysholm scores from meta-analysis. Lateral MATs had greater risk of nonfailure reoperation than medial MATs (ln[RR], -0.74; 95% CI, -1.37 to -0.108; P = .022). From multivariable regression, shorter time between meniscectomy and MAT (P = .007) and older age (P = .02) predicted less favorable cohort ΔLysholm scores. Longer intervals between injury and MAT (P = .039) and bone-bridge graft fixation for medial MAT compared with bone-plug fixation (P < .001) predicted higher risk of nonfailure reoperation.
Conclusion: This systematic review and meta-analysis identified lateral MAT as a significant risk factor for nonfailure reoperation. Older age and shorter time interval between meniscectomy and MAT were significantly associated with less favorable ΔLysholm scores. A longer meniscal injury-MAT time interval and bone-bridge compared with bone-plug fixation technique for medial MAT were significantly associated with higher reoperation risk.
Background: Spin is a form of reporting bias in which study results are presented more favorably than justified by the data. It often appears in abstracts and conclusions, where selective emphasis or misleading interpretation can distort readers' understanding and influence clinical decision-making.
Purpose: To identify the prevalence of spin, a reporting bias in which authors overemphasize beneficial or significant results and underreport weaknesses, in abstracts of systematic reviews and meta-analyses on meniscal allograft transplantation (MAT), as well as to investigate associations between spin and study characteristics.
Study design: Systematic review, Level of evidence, 4.
Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the PubMed, Web of Science, and Medscape databases were searched using the terms "menisc* transplant" OR "menisc* transplantation." Studies were included if they were systematic reviews or meta-analyses published in the English language and in peer-reviewed journals. Studies excluded were case reports, case series, animal or cadaveric studies, studies not published in the English language, and studies without an accessible full text. Data extracted included year of publication, journal, level of evidence, funding, Scopus CiteScore, and Clarivate impact factor. Abstracts were then analyzed for the 15 most common types of spin. Statistical analyses were performed using the Fisher exact test and linear regression with significance set at a P value <.05.
Results: After search screening, 41 studies met the inclusion criteria. Spin was identified in 19 (46.3%) abstracts. Type 3 spin ("Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention") was the most common type of spin, seen in 7 (17.1%) abstracts. Misleading reporting was the most common category of spin, found in 20 (48.8%) abstracts. Studies from earlier years of publication had significantly more spin than studies published more recently (P = .005).
Conclusion: Spin is found in nearly half of abstracts of systematic reviews and meta-analyses investigating MAT, with misleading reporting being the most common modality of spin. Early studies on MAT exhibited a higher prevalence of spin in comparison with more recent investigations. Clinicians should be aware of the presence of spin and exercise judgment before making conclusions from study abstracts without assessing the full text.
Background: Bone grafting is a common and effective treatment for anterior shoulder instability. Graft healing is critical for the success of this procedure; however, few studies have investigated methods to enhance the healing process. Furthermore, suitable animal models are scarce for this type of surgery.
Purpose: To (1) establish an animal model of anterior shoulder instability, and (2) evaluate whether a surgical modification based on an inlay structure (creating a groove on the glenoid and shaping the graft to match it) along with postoperative administration of the bone anabolic agent parathyroid hormone 1-34 (PTH1-34) could accelerate graft healing.
Study design: Controlled laboratory study.
Methods: A rabbit model of anterior shoulder instability was established, and autologous iliac bone grafting was performed. Gross morphological observation, micro-computed tomography imaging and analysis, and histological staining and evaluation were employed to assess whether the inlay-based surgical modification and postoperative intermittent subcutaneous injection of PTH1-34 could enhance graft healing.
Results: The modified inlay technique increased the expression of Runx2 and type I collagen within the graft, accelerated graft integration with the glenoid, promoted more rapid callus remodeling and maturation, and reduced graft resorption. Additionally, for both the modified inlay and classic onlay bone grafting procedures, postoperative intermittent subcutaneous injection of PTH1-34 enhanced osteogenic capacity of the autograft and glenoid, increased new bone volume, and shortened the graft healing time.
Conclusion: We successfully developed an animal model of autologous bone grafting for anterior shoulder instability. Using this model, we demonstrated that the modified inlay bone grafting procedure improves osteogenic ability, shortens healing time, and promotes callus maturation. Intermittent subcutaneous administration of PTH1-34 after surgery further enhanced graft-glenoid healing.
Clinical relevance: The modified inlay technique and postoperative intermittent PTH1-34 administration may improve graft healing rates after bone grafting procedures for anterior shoulder instability.
Platelet-rich plasma (PRP) is a blood-based orthobiologic used to treat a myriad of musculoskeletal conditions. While in vitro and preclinical studies on PRP have been promising, clinical results have been mixed. The heterogeneity in clinical benefits is attributable to both the complexity and variability of PRP as a biologic as well as the diversity of targeted tissues and ailments. Many variables have been proposed to affect PRP's bioactivity and clinical effects, with differing levels of evidence demonstrated for each variable. These variables can be broadly categorized as biological, technical, and abnormality-specific factors. Additionally, insufficient characterization of PRP in clinical studies has been a major limitation in both determining the efficacy of PRP for a given clinical condition and understanding the basic biology of PRP. This review highlights the current landscape of PRP as a treatment of musculoskeletal conditions, including both the regulatory environment and clinical applications, and considers the influence of numerous factors affecting PRP's bioactivity and clinical effects. Emerging technologies that may further enhance the utility of PRP as an orthobiologic are also discussed. Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease.
Background: The incidence of anterior cruciate ligament (ACL) injuries is increasing among the adolescent population, with a peak occurring in the high school age range.
Purpose: To (1) characterize recent epidemiologic trends of ACL injuries and graft failure rates in high school adolescents, and (2) determine variables associated with sustaining a secondary ACL injury.
Study design: Case-control study; Level of evidence, 4.
Methods: A retrospective review was performed for all patients ≤18 years who underwent primary ACL reconstruction (ACLR) between 2015 and 2020. Odds ratios were calculated for baseline patient characteristics and their association with the risk of recurrent tear. Multivariate Cox regression analysis was performed to identify the relationship between recurrent tear and specific categorical variables.
Results: A total of 431 patients were included, with a median follow-up of 64.9 months (range, 24-87 months). Recurrent primary graft failure was experienced in 9% of patients, and 11.1% sustained a contralateral ACL tear. The median time to postoperative graft failure was 14 months (interquartile range, 9-41.5 months). Patients with a secondary ACL injury (eg, graft failure or contralateral ACL injury) were younger than those who did not sustain a subsequent injury (mean age, 15.7 ± 1.8 years [graft failure] and 15.5 ± 1.3 [contralateral ACL injury] vs 16.2 ± 1.5 years, respectively; P = .007). Survival analysis demonstrated that younger age at primary ACLR and earlier time to return to sport (RTS) were significantly associated with an increased rate of secondary ACL injury (P < .05). With respect to combined secondary ACL injuries, as age at primary ACLR increases by 1 year, the rate of secondary ACL injury decreases by 27%. Similarly, for every subsequent 1-month delay in RTS, the risk of secondary ACL injury decreased by 13%.
Conclusion: Younger age and earlier time to RTS after ACL injury are independent risk factors associated with sustaining both primary ACL recurrent tear and contralateral ACL injury in the adolescent patient population. Counseling of adolescent athletes should include physical therapy compliance and allow for adequate healing and time to RTS.
Background: While arthroscopic stabilization for anterior glenohumeral instability is successful in preventing recurrent dislocations, progression to glenohumeral arthritis remains concerning. Age, anchor number, and capsular volume shrinkage have been previously established as risk factors for progression to arthritis in patients who underwent arthroscopic anterior stabilization. However, the rate of and risk factors for arthritis in young populations have not been well characterized.
Purpose: To evaluate the rate of progression to glenohumeral arthritis and identify potential risk factors after arthroscopic anterior stabilization in a young population.
Study design: Cohort study; Level of evidence, 3.
Methods: This study included 287 patients who underwent an index primary arthroscopic anterior shoulder stabilization procedure at a single institution and had a minimum of 4 years of postoperative imaging available over a 12-year period. Patients were excluded if imaging or operative reports were unavailable. The presence of arthritis was defined using radiographic parameters. Kaplan-Meier survival curves were estimated for the development of arthritis and compared by patient characteristics using log-rank tests. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% CIs associated with patient characteristics as predictors of the development of glenohumeral arthritis, adjusted for confounders identified in univariate analyses.
Results: Among the 287 patients, 8% (23/287) developed glenohumeral arthritis. The mean patient age at the time of surgery was 22.7 years (SD, 5.26). The median time from surgery to diagnosis of arthritis was 8 years, and the median follow-up time was 9 years (interquartile range, 6-11). Kaplan-Meier curves revealed differences in time to arthritis among patient groups, with earlier arthritis observed when stratified by age >25 years, use of <3 anchors at index surgery, and undergoing revision surgery after index stabilization. Adjusted for potential confounders in a multivariable Cox regression model, risk factors for the development of glenohumeral arthritis included older age at index surgery (HR per 1-SD increase in years, 1.85 [95% CI, 1.34-2.55]), lower anchor number (HR, 1.54 [95% CI, 1.107-2.14]), and revision surgery (HR, 2.83 [95% CI, 1.150-.95]).
Conclusion: Progression to glenohumeral arthritis after anterior stabilization occurred in 8% of a young patient population. The age and number of anchors used are statistically significant risk factors for progression to arthritis. Additionally, revision surgery was identified as a risk factor, which has not been previously reported in the literature.
Background: The chondrolabral junction (CLJ) plays an important role in maintaining hip dynamics, and there is a paucity in the literature examining the effect of CLJ breakdown on long-term outcomes after hip arthroscopy.
Purpose: To identify patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation rates at 10-year follow-up in patients with severe CLJ breakdown undergoing hip arthroscopy for femoroacetabular impingement.
Study design: Cohort study; Level of evidence, 3.
Methods: PROs were obtained preoperatively and at 10-year follow-up for patients undergoing surgery between January 2012 and June 2014. PROs included the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, and visual analog scale for pain. Clinically significant outcomes included the minimal clinically important difference and Patient Acceptable Symptom State. Patients were categorized as having severe CLJ breakdown if their Beck classification was between 3 and 4 and mild if their classification was 1 to 2. Those with severe breakdown were propensity matched 1:1 to patients who had mild breakdown, controlling for age, sex, and body mass index (BMI). Independent t tests and Fisher exact tests were used to compare PROs and rates of hip arthroscopy revision and total hip arthroplasty conversion between groups, respectively.
Results: In this study, 53 patients with severe CLJ breakdown (25 females; mean ± SD age, 38.6 ± 12.2 years; BMI, 25.9 ± 4.9 kg/m2) were matched successfully 1:1 by age, sex, and BMI to 53 patients with mild CLJ breakdown (27 females; age, 37.8 ± 11.3 years; BMI, 25.9 ± 4.9 kg/m2). Preoperatively, there were no differences in PROs between patients with severe and mild CLJ breakdown. At final 10-year follow-up, PRO scores were also similar between groups. However, at 10 years, patients with severe CLJ breakdown underwent conversion to total hip arthroplasty at significantly higher rates than those with mild breakdown (28.4% vs 5.7%; P = .003).
Conclusion: Patients with severe CLJ junction breakdown undergoing hip arthroscopy for femoroacetabular impingement achieve similar PROs at long-term follow-up but undergo hip arthroplasty significantly more often when compared with patients with mild breakdown.
Background: Clinical outcomes after surgical repair of the distal triceps tendon are scarce and represented in small, heterogeneous case series.
Purpose: To evaluate clinical and cosmetic outcomes after double-row repair in a high-demand athlete population.
Study design: Case series; Level of evidence, 4.
Methods: All patients who participated in regular weight lifting and underwent distal triceps tendon repairs between 2000 and 2021 in 2 centers were retrospectively contacted for informed consent and follow-up examination. Patients who received distal triceps tendon repair in double-row fashion with a minimum follow-up of 24 months were included. The American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Mayo Elbow Performance Score (MEPS; without instability), and Disabilities of the Arm, Shoulder and Hand (DASH) score were surveyed. General satisfaction on a scale from 0 (very unsatisfied) to 10 (very satisfied) was evaluated. In addition, a customized sporting activities questionnaire including subjective strength perception (0%-100%), time to return to sport, sports performance (bench and triceps press), visual analog scale (VAS) pain score, cosmetic results, complications, and failures (rerupture or reoperation) was administered.
Results: A total of 70 patients (all male) with a mean age of 50.9 ± 8.7 years were included in this study. The mean follow-up was 86.9 ± 51.4 months. The postoperative outcome scores were as follows: 97.8 ± 4.8 for the ASES score, 93.6 ± 10.9 for the SANE score, 2.2 ± 5.5 for the DASH score, and 98.1 ± 6.4 points for the MEPS. The median satisfaction score was 10 (IQR, 10-10). Postoperatively, patients subjectively achieved a 94% return of prior strength after a median of 7 months. In bench and triceps press, pre- to postoperative weight loads were a mean of 162.03 ± 53.1 kg to 134.7 ± 52.1 kg (P = .001) and a median of 70 kg (IQR, 50-85 kg) to 60 kg (IQR, 50-60 kg) (P = .001), respectively. The preoperative VAS score was 5.7 ± 2.7 versus 0.2 ± 0.6 postoperatively (P = .001). Overall, 85.7% of patients were satisfied with the cosmetic result. In total, 6 reruptures (8.6%) and 1 infection (1.4%) were observed. All 7 patients underwent surgical revision.
Conclusion: Double-row reconstruction of distal triceps tendon ruptures achieved good clinical and cosmetic results with a low complication rate in this high-demand patient population. Subjectively, maximum strength was regained after a median of 7 months; however, selective triceps strength during bench and triceps press resulted in significantly reduced weight loads postoperatively.
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