Bulletin of the Hospital for Joint Disease (2013)最新文献

Abstract: Limb reconstruction has been an evolving process beginning in the 20th Century with the introduction of modern surgical equipment and materials, to permit the repair of small vessels and nerves. Surgical techniques have also evolved and include vascularized composite allografts that have an important place in current limb reconstruction. The concept was actually conceived centuries ago and has been referred to as the "Miracle of the black leg," an important event in Christian iconography.

Abstract: Management of first-time shoulder dislocations in young active patients presents a significant challenge due to the high likelihood of recurrent anterior shoulder instability. Repeated instability events can result in poor outcomes because each dislocation contributes dose-dependent damage to the glenohumeral joint. Various validated techniques are available for reducing glenohumeral dislocations. For in-season athletes sustaining a shoulder dislocation, management requires balancing a rapid return to play with the heightened risk of recurrent instability. In-season surgical management is typically reserved for athletes experiencing recurrent instability or substantial osseous deficits. When surgical intervention is necessary, the approach is guided by the extent of critical glenoid bone loss and whether the humeral head bone defect engages with the glenoid.

Abstract: Genetics is a burgeoning field within adult reconstructive surgery. Genome-wide sequencing has identified genetic variants found to be associated with not only the development of osteoarthritis but also arthroplasty-related complications, such as aseptic loosening, prosthetic joint infection, arthrofibrosis, and postoperative pain. Examples include newer technology, such as next-generation sequencing, in diagnosing culture-negative prosthetic joint infection. Genetics drives new therapeutic technologies, such as gene therapy, gene-editing, and bacteriophage treatment. Although still rare, a handful of phase 3 clinical trials of gene therapy for osteoarthritis have begun to demonstrate efficacy with low-risk profiles. As the field continues to grow, public and professional buy-in as well as cost present challenges.

Abstract: The knee is a complex joint composed of a combination of osseous, musculotendinous, ligamentous, neurovascular, and intra-articular structures, which must be taken into consideration when performing surgical approaches, whether it be for trauma, replacement, or joint preservation surgery. A wide variety of surgical approaches exist for exposure of the lateral side of the knee, including approaches to the distal femur, knee joint, and proximal tibia. Care must be taken to choose the appropriate approach depending on the procedure being performed to best preserve and protect important neurovascular structures. This review thoroughly describes the most frequently used surgical approaches to the lateral knee. The common themes and anatomical considerations presented in this review, in combination with continued experience, can provide surgeons with familiarity with various ways of accessing the knee joint.

Abstract: In January 2024, New York University Langone Orthopedic Surgery achieved a significant milestone with the first all-women team, from chief residents to interns, at Bellevue Hospital. In a field still dominated by men, only 16% of orthopaedic resident physicians and 6% of practicing orthopaedic surgeons are female, this was no small feat. Although there are many factors that made this historic team possible, it is clear that the earliest female pioneers of orthopaedic surgery were absolutely critical. This paper aims to discuss 5 pioneering women who not only created a path for the now thousands of female orthopaedic surgeons but also left a legacy of significant contributions to the practice of orthopaedics. These trailblazers are as follows: Dr. Marian Frauenthal Sloane, Dr. Ruth Jackson, Dr. Jacquelin Perry, Dr. Claudia Thomas, and Dr. Ericka Lawler.

Background: An isolated medial patellofemoral ligament (MPFL) reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of patellar instability, but there is growing support for performing a tibial tubercle osteotomy (TTO) in patients with an elevated tibial tubercle-trochlear groove distance. The purpose of this study was to evaluate the impact of adding a TTO to MPFLR on patient reported outcomes.

Methods: A retrospective review of patients who underwent MPFLR with or without TTO with a minimum of 12-month follow-up was performed. Patients in both groups were matched based on age, sex, and follow-up time. Recurrent instability (including re-dislocation and subluxation), visual analog scale (VAS) for pain score, Kujala score, and satisfaction were evaluated.

Results: There were 59 patients who underwent MPFLR with concomitant TTO performed at our institution and met our inclusion and exclusion criteria. These patients were then matched to patients undergoing isolated MPFLR based on demographics and follow-up time. The mean age was 25.0, 76.3% were female, and the mean follow-up time was 49 months. There was a significant difference in mean tibial tubercle-trochlear groove distance (19.8 ± 3.9 vs. 14.1 ± 2.8) between groups. There was no significant difference in VAS (1.48 ± 2.0 vs. 1.49 ± 2.1, p = 0.972), satisfaction (86.1% ± 24.2% vs. 81.2% ± 27.9, p = 0.311), or revision surgeries (10.2% vs. 10.2%) between groups.

Conclusion: There was a low complication rate, excellent patient reported outcomes, and a low rate of recurrent patellar instability following TTO and MPFLR with allograft.

Background: Intra-articular (IA) injections of plateletrich plasma (PRP) have been increasingly used in the nonoperative treatment of knee osteoarthritis (OA) but have considerable heterogeneity in both formulation and clinical results. Alpha-2-macroglobulin (A2M) is a large plasma protein found in PRP that inhibits cartilage-degrading enzymes and could be an efficacious OA treatment independently. The purpose of this study was to compare the short-term clinical efficacy of IA injection of A2M-rich PRP concentrate to conventionally prepared PRP and corticosteroids in the management of symptomatic knee OA.

Methods: This double-blinded, randomized, controlled clinical trial was conducted at a single medical center with enrollment from June 2018 to May 2019. Subjects with symptomatic Kellgren-Lawrence (KL) grade 2 or 3 knee OA were randomized to IA injection with A2M, PRP, or methylprednisolone (MP) and followed for 12 weeks post-injection. Knee pain and function were assessed at pre-treatment baseline and at 6-week and 12-week followup with patient-reported outcome (PRO) surveys including the visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner score.

Results: Seventy-five subjects were enrolled in the trial, of whom 68 (90.7%) completed the 12-week follow-up. The majority of subjects (73%) were female with a mean age of 59 years (range: 37 to 75 years). There were no significant differences in age (p = 0.30), sex (p = 0.44), or KL grade (p = 0.73) between treatment groups. By 12 weeks postinjection, the A2M group showed significant improvement in VAS, WOMAC, KOOS, and Tegner (p < 0.05), the PRP group showed no significant improvement in any PROs (p > 0.05), and the MP group showed significant improvement in Lysholm only (p = 0.01). However, the changes in PRO scores between baseline and 12-week follow-up did not significantly differ between the three groups (p > 0.05).

Conclusions: Alpha-2-macroglobulin IA injection shows comparable efficacy to PRP and corticosteroids in the treatment of mild-to-moderate knee OA. Alpha-2-macroglobulin treatment resulted in modest improvement in knee pain and function at 6-week follow-up, albeit inconsistently across PRO measures and to a similar degree as PRP and corticosteroids. Given its non-superior short-term efficacy compared to established IA injections, as well as its increased cost of preparation, A2M may not be a justifiable option for routine treatment of knee OA.

Purpose: The purpose of this study was to compare regimens of eccentric exercise and dry-needling, with and without an ultrasound-guided leukocyte-poor platelet-rich plasma (LP-PRP) injection, in patients with patellar tendinopathy.

Methods: Patients with symptomatic patellar tendinopathy based on physical examination and magnetic resonance imaging and who had failed at least 6 weeks of nonoperative treatment were enrolled and randomized at two centers to receive ultrasound-guided dry-needling (DN) alone or in addition to an injection of LP-PRP coupled with standardized eccentric strengthening exercises. Participants completed patient-reported outcome surveys at baseline and at 3, 6, 9, 12, and 26 weeks post-treatment. The primary outcome measure was the Victorian Institute of Sports Assessment (VISA) score for patellar tendinopathy (VISA-P) at 12 weeks, and secondary measures included the visual analog scale (VAS) for pain, Tegner activity scale, Lysholm knee scale (Lysholm), and Veterans Rand 12-Item Health Survey (VR12) questionnaire at 12 and 26 weeks.

Results: Thirty-one subjects were enrolled in the study (15 DN, 16 LP-PRP). Twenty-three patients were available for follow-up at all time points. There were no statistically significant differences between the two groups at baseline. At 12 weeks post-treatment, both the LP-PRP and DN groups demonstrated statistically significant (p < 0.05) improvements from baseline with respect to Lysholm score (34.5 ± 15.1 and 31.7 ± 18.4), VAS pain scale (-1.58 ± 2.1 and -2.8 ± 1.9, respectively), and VISA score (19.2 ± 15.9 and 28.4 ± 19.4, respectively). At 26 weeks post-treatment both groups demonstrated statistically significant (p < 0.05) improvements in Lysholm score (23.6 ± 23.1 and 24.5 ± 17.3, respectively) and VAS pain score (-1.67 ± 2.3 and -2.18 ± 2.9, respectively). The LP-PRP group failed to show significance for VISA-P score from 0 to 26 weeks, though the DN group did (22.0 ± 14.6). There were no statistically significant differences between the two groups in mean VISA, VAS, Lysholm, or the Short Form Health Survey (SF-12) scores at either the 12 week or 26-week follow-up time points.

Conclusion: The results of the current study demonstrate that both DN and DN plus LP-PRP are effective treatment options in the management of symptomatic patellar tendinopathy, however, LP-PRP did not add any additional improvement over DN alone.

Ankle arthritis is becoming more common and can be pain-ful and debilitating. As the disease progresses, degenera-tive cystic changes may be found in the distal fibula, distal tibia, and talus. After failure of non-operative modalities, arthrodesis is often considered the surgical intervention of choice, but this leaves the patient with reduced range of motion, altered gait, and can negatively impact adjacent joints of the foot. Total ankle arthroplasty has been found to be an effective surgical option for ankle arthritis but is contraindicated in patients with talar collapse. When this is the case, a more personalized approach for preserving ankle motion is necessary. We present the case of a 65-year-old male with severe right ankle arthritis and talar collapse treated with a custom three-dimensionally printed talus and concurrent total ankle replacement with 2-year follow-up.