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  • 1
    Online Resource
    Online Resource
    An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint
    SAGE Publications ; 2020
    In:  Orthopaedic Journal of Sports Medicine Vol. 8, No. 3 ( 2020-03-01), p. 232596712090734-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 8, No. 3 ( 2020-03-01), p. 232596712090734-
    Abstract: Cartilage lesions of the patellofemoral joint constitute a frequent abnormality. Patellofemoral conditions are challenging to treat because of complex biomechanics and morphology. Purpose: To develop a consensus statement on the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint using a modified Delphi technique. Study Design: Consensus statement. Methods: A working group of 4 persons generated a list of statements related to the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint to form the basis of an initial survey for rating by a group of experts. The Metrics of Osteochondral Allografts (MOCA) expert group (composed of 28 high-volume cartilage experts) was surveyed on 3 occasions to establish a consensus on the statements. In addition to assessing agreement for each included statement, experts were invited to propose additional statements for inclusion or to suggest modifications of existing statements with each round. Predefined criteria were used to refine statement lists after each survey round. Statements reaching a consensus in round 3 were included within the final consensus document. Results: A total of 28 experts (100% response rate) completed 3 rounds of surveys. After 3 rounds, 36 statements achieved a consensus, with over 75% agreement and less than 20% disagreement. A consensus was reached in 100.00% of the statements relating to functional anatomy of the patellofemoral joint, 88.24% relating to surgical indications, 100.00% relating to surgical technical aspects, and 100.00% relating to rehabilitation, with an overall consensus of 95.5%. Conclusion: This study established a strong expert consensus document relating to the functional anatomy, surgical indications, donor graft considerations for osteochondral allografts, surgical technical aspects, and rehabilitation concepts for the management of large chondral and osteochondral defects in the patellofemoral joint. Further research is required to clinically validate the established consensus statements and better understand the precise indications for surgery as well as which techniques and graft processing/preparation methods should be used based on patient- and lesion-specific factors.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967120907343
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2706251-X
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  • 2
    Online Resource
    Online Resource
    Association of Sex Mismatch Between Donor and Recipient With Graft Survivorship at 5 Years After Osteochondral Allograft Transplantation
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 3 ( 2022-03), p. 681-688
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 3 ( 2022-03), p. 681-688
    Abstract: Sex mismatch between donor and recipient has been considered a potential contributor to adverse outcomes after solid organ transplantation. However, the influence of sex mismatching in osteochondral allograft (OCA) transplantation has yet to be determined. Purpose: To evaluate whether donor-recipient sex mismatching affects graft survival after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: In this review of prospectively collected data, patients who underwent OCA transplantation between November 2013 and November 2017 by a single surgeon were analyzed. Cumulative survival was assessed via the Kaplan-Meier method using log-rank tests to compare patients with similar donor groups. Multivariable Cox regression analysis adjusted for patient age, graft size, and body mass index was used to evaluate the influence of donor-recipient sex on graft survival. Results: A total of 154 patients were included: 102 (66.2%) who received OCAs from a same-sex donor and 52 (33.8%) who received OCAs from a different-sex donor. At 5-year follow-up, a significantly lower graft survival rate was observed for different-sex donor transplantation in comparison with same-sex donorship (63% vs 92%; P = .01). When correcting for age, graft size, and body mass index, donor-recipient sex-mismatch transplantation demonstrated a 2.9-times greater likelihood to fail at 5 years compared with donor-recipient same-sex transplantation (95% CI, 1.11-7.44; P = .03). A subgroup analysis showed no significant difference in graft survival between the female-to-female and female-to-male groups (91% and 84%, respectively). Conversely, male-to-male transplantation demonstrated a significantly higher cumulative 5-year survival (94%; P = .04), whereas lower survival was found with male-to-female donorship (64%; P = .04). Multivariable Cox regression indicated a 2.6-times higher likelihood of failure for the male-to-female group in comparison with the other groups (95% CI, 1.03-6.69; P = .04). Male-to-male transplantation had a tendency toward decreased likelihood of OCA failure (hazard ratio, 0.33), although without statistical significance (95% CI, 0.11-1.01; P = .052). Conclusion: Mismatch between donor and recipient sex had a negative effect on OCA survival after transplantation, particularly in those cases when male donor tissue was transplanted into a female recipient.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465211068872
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 3
    Online Resource
    Online Resource
    Treatment of post-meniscectomy knee symptoms with medial meniscus replacement results in greater pain reduction and functional improvement than non-surgical care
    Springer Science and Business Media LLC ; 2022
    In:  Knee Surgery, Sports Traumatology, Arthroscopy Vol. 30, No. 4 ( 2022-04), p. 1325-1335
    Details
    In: Knee Surgery, Sports Traumatology, Arthroscopy, Springer Science and Business Media LLC, Vol. 30, No. 4 ( 2022-04), p. 1325-1335
    Abstract: Partial meniscectomy is a common orthopedic procedure intended to improve knee pain and function in patients with irreparable meniscal tears. However, 6–25% of partial meniscectomy patients experience persistent knee pain after surgery. In this randomized controlled trial (RCT) involving subjects with knee pain following partial meniscectomy, it was hypothesized that treatment with a synthetic medial meniscus replacement (MMR) implant provides significantly greater improvements in knee pain and function compared to non-surgical care alone. Methods In this prospective, multicenter RCT, subjects with persistent knee pain following one or more previous partial meniscectomies were randomized to receive either MMR or non-surgical care. This analysis evaluated the 1-year outcomes of this 2-year clinical trial. Patient-reported knee pain, function, and quality of life were measured using nine separate patient-reported outcomes. The primary outcomes were the pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the average of all five KOOS subscales (KOOS Overall). Treatment cessation was defined as permanent device removal in the MMR group and any surgical procedure to the index knee in the non-surgical care group. Results Treated subjects had a median age of 52 years old (range 30–69 years) and one or more previous partial meniscectomies at a median of 34 months (range 5–430 months) before trial entry. Among 127 subjects treated with either MMR ( n  = 61) or non-surgical care ( n  = 66), 11 withdrew from the trial or were lost to follow-up (MMR, n  = 0; non-surgical care, n  = 11). The magnitude of improvement from baseline to 1 year was significantly greater in subjects who received MMR in both primary outcomes of KOOS Pain ( P  = 0.013) and KOOS Overall ( P  = 0.027). Treatment cessation was reported in 14.5% of non-surgical care subjects and only 4.9% of MMR subjects (n.s.). Conclusion Treatment with the synthetic MMR implant resulted in significantly greater improvements in knee pain, function, and quality of life at 1 year of follow-up compared to treatment with non-surgical care alone. Level of evidence I.
    Type of Medium: Online Resource
    ISSN: 0942-2056 , 1433-7347
    URL: Article
    DOI: 10.1007/s00167-021-06573-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1473170-8
    SSG: 31
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  • 4
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    Online Resource
    Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures
    SAGE Publications ; 2021
    In:  CARTILAGE Vol. 13, No. 1_suppl ( 2021-12), p. 473S-495S
    Details
    In: CARTILAGE, SAGE Publications, Vol. 13, No. 1_suppl ( 2021-12), p. 473S-495S
    Abstract: To create a treatment algorithm for focal grade 3 or 4 cartilage defects of the knee using both classic and novel cartilage restoration techniques. Design A comprehensive review of the literature was performed highlighting classic as well as novel cartilage restoration techniques supported by clinical and/or basic science research and currently being employed by orthopedic surgeons. Results There is a high level of evidence to support the treatment of small to medium size lesions ( 〈 2-4 cm 2 ) without subchondral bone involvement with traditional techniques such as marrow stimulation, osteochondral autograft transplant (OAT), or osteochondral allograft transplant (OCA). Newer techniques such as autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate implantation have also been shown to be effective in select studies. If subchondral bone loss is present OAT or OCA should be performed. For large lesions ( 〉 4 cm 2 ), OCA or matrix autologous chondrocyte implantation (MACI) may be performed. OCA is preferred over MACI in the setting of subchondral bone involvement while cell-based modalities such as MACI or particulated juvenile allograft cartilage are preferred in the patellofemoral joint. Conclusions Numerous techniques exist for the orthopedic surgeon treating focal cartilage defects of the knee. Treatment strategies should be based on lesion size, lesion location, subchondral bone involvement, and the level of evidence supporting each technique in the literature.
    Type of Medium: Online Resource
    ISSN: 1947-6035 , 1947-6043
    URL: Article
    DOI: 10.1177/1947603521993219
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2515870-3
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  • 5
    Online Resource
    Online Resource
    Systematic Review of Human Dental Pulp Stem Cells for Cartilage Regeneration
    Mary Ann Liebert Inc ; 2020
    In:  Tissue Engineering Part B: Reviews Vol. 26, No. 1 ( 2020-02-01), p. 1-12
    Details
    In: Tissue Engineering Part B: Reviews, Mary Ann Liebert Inc, Vol. 26, No. 1 ( 2020-02-01), p. 1-12
    Type of Medium: Online Resource
    ISSN: 1937-3368 , 1937-3376
    URL: Article
    DOI: 10.1089/ten.teb.2019.0140
    Language: English
    Publisher: Mary Ann Liebert Inc
    Publication Date: 2020
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  • 6
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    Online Resource
    Macrophage: A Potential Target on Cartilage Regeneration
    Frontiers Media SA ; 2020
    In:  Frontiers in Immunology Vol. 11 ( 2020-2-11)
    Details
    In: Frontiers in Immunology, Frontiers Media SA, Vol. 11 ( 2020-2-11)
    Type of Medium: Online Resource
    ISSN: 1664-3224
    URL: Article
    DOI: 10.3389/fimmu.2020.00111
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2020
    detail.hit.zdb_id: 2606827-8
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  • 7
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    Online Resource
    Osteochondral allograft storage time linked to graft survival
    SAGE Publications ; 2020
    In:  The American Journal of Sports Medicine Vol. 48, No. 13 ( 2020-11), p. 3170-3176
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 48, No. 13 ( 2020-11), p. 3170-3176
    Abstract: Current regulations surrounding the use of osteochondral allografts (OCAs) in the United States require delayed graft release after 14 days to complete infectious disease screening. With a generally accepted expiration time of 28 days in storage, a limited window from 14 to 28 days remains for implantation. Yet, the rates of graft survival and thus optimal time for transplantation within this window remain largely unknown. Hypothesis: OCAs transplanted within 19 to 24 days would have lower failure rates at 5 years than those transplanted at 25 to 27 days. Study Design: Cohort study; Level of evidence, 3. Methods: In this retrospective case series, we analyzed data from patients who underwent OCA transplantation (N = 111) by a single surgeon between February 2014 and December 2016 with at least 2-year follow-up. In total, 56 patients received early transplant grafts (storage time, 19-24 days), and 55 received late transplant grafts (storage time, 25-27 days). Survival analysis with Kaplan-Meier curves was performed using log-rank analysis to compare the groups. Multivariable Cox regression analysis was used to assess the influence of OCA storage duration on graft survival while adjusting for age and defect size. Optimal storage time cutoff associated with graft failure was identified by performing receiver operating characteristic curve analysis and calculating the area under the curve. Results: Patients in the late transplant group had a significantly lower rate of graft survival at 5 years postoperatively (70.4%) as compared with patients in the early transplant group (93.1%; P = .027). When correcting for patient age and defect size, late transplant OCAs demonstrated a 3.4-times greater likelihood of failure versus early transplant OCAs. Receiver operating characteristic analysis suggested that OCA transplantation should ideally occur before 25 days of graft storage. Conclusion: OCA transplantation is a safe and successful treatment option for large osteochondral defects of the knee, with excellent rates of in situ graft survival at 5 years. Prioritizing early transplantation of OCAs to 〈 25 days in storage improves rates of graft survival.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    URL: Article
    DOI: 10.1177/0363546520956311
    DOI: 10.21203/rs.3.rs-279562/v1
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 8
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    Online Resource
    Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 3 ( 2021-03-01), p. 232596712098360-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 3 ( 2021-03-01), p. 232596712098360-
    Abstract: Osteochondral allograft (OCA) transplantation has evolved into a first-line treatment for large chondral and osteochondral defects, aided by advancements in storage protocols and a growing body of clinical evidence supporting successful clinical outcomes and long-term survivorship. Despite the body of literature supporting OCAs, there still remains controversy and debate in the surgical application of OCA, especially where high-level evidence is lacking. Purpose: To develop consensus among an expert group with extensive clinical and scientific experience in OCA, addressing controversies in the treatment of chondral and osteochondral defects with OCA transplantation. Study Design: Consensus statement. Methods: A focus group of clinical experts on OCA cartilage restoration participated in a 3-round modified Delphi process to generate a list of statements and establish consensus. Questions and statements were initially developed on specific topics that lack scientific evidence and lead to debate and controversy in the clinical community. In-person discussion occurred where statements were not agreed on after 2 rounds of voting. After final voting, the percentage of agreement and level of consensus were characterized. A systematic literature review was performed, and the level of evidence and grade were established for each statement. Results: Seventeen statements spanning surgical technique, graft matching, indications, and rehabilitation reached consensus after the final round of voting. Of the 17 statements that reached consensus, 11 received unanimous (100%) agreement, and 6 received strong (80%-99%) agreement. Conclusion: The outcomes of this study led to the establishment of consensus statements that provide guidance on surgical and perioperative management of OCAs. The findings also provided insights on topics requiring more research or high-quality studies to further establish consensus and provide stronger evidence.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967120983604
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 9
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    Regulatory and Ethical Aspects of Orthobiologic Therapies
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 11 ( 2022-11-01), p. 232596712211016-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 11 ( 2022-11-01), p. 232596712211016-
    Abstract: Orthobiologic therapies show significant promise to improve outcomes for patients with musculoskeletal pathology. There are considerable research efforts to develop strategies that seek to modulate the biological environment to promote tissue regeneration and healing and/or provide symptomatic relief. However, the regulatory pathways overseeing the clinical translation of these therapies are complex, with considerable worldwide variation. The introduction of novel biologic treatments into clinical practice raises several ethical dilemmas. In this review, we describe the process for seeking approval for biologic therapies in the United States, Europe, and Japan. We highlight a number of ethical issues raised by the clinical translation of these treatments, including the design of clinical trials, monitoring outcomes, biobanking, “off-label” use, engagement with the public, marketing of unproven therapies, and scientific integrity.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671221101626
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 10
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    Online Resource
    Biologic Association Annual Summit: 2020 Report
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 6 ( 2021-06-01), p. 232596712110156-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 6 ( 2021-06-01), p. 232596712110156-
    Abstract: Interest and research in biologic approaches for tissue healing are exponentially growing for a variety of musculoskeletal conditions. The recent hype concerning musculoskeletal biological therapies (including viscosupplementation, platelet-rich plasma, and cellular therapies, or “stem cells”) is driven by several factors, including demand by patients promising regenerative evidence supported by substantial basic and translational work, as well as commercial endeavors that complicate the scientific and lay understanding of biological therapy outcomes. While significant improvements have been made in the field, further basic and preclinical research and well-designed randomized clinical trials are needed to better elucidate the optimal indications, processing techniques, delivery, and outcome assessment. Furthermore, biologic treatments may have potential devastating complications when proper methods or techniques are ignored. For these reasons, an association comprising several scientific societies, named the Biologic Association (BA), was created to foster coordinated efforts and speak with a unified voice, advocating for the responsible use of biologics in the musculoskeletal environment in clinical practice, spearheading the development of standards for treatment and outcomes assessment, and reporting on the safety and efficacy of biologic interventions. This article will introduce the BA and its purpose, provide a summary of the 2020 first annual Biologic Association Summit, and outline the future strategic plan for the BA.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671211015667
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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