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  • 1
    Online Resource
    Online Resource
    Orthobiologics for the Management of Early Arthritis in the Middle-Aged Athlete
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Sports Medicine and Arthroscopy Review Vol. 30, No. 2 ( 2022-06), p. e9-e16
    Details
    In: Sports Medicine and Arthroscopy Review, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 2 ( 2022-06), p. e9-e16
    Abstract: This article is dedicated to the use of orthobiologic therapies in the management of early osteoarthritis in middle-aged athletes. Understanding a patient’s presenting symptoms, physical examination, imaging results, and goals is of critical importance in applying orthobiologic therapies. The field of orthobiologics is expanding at a rapid pace, and the clinical studies examining the utility of each treatment lag behind the direct-to-consumer marketing that leads to these products being used. Here we provide a review of the available treatments, emerging treatments, and the current literature supporting or refuting their use. Currently studied orthobiologics include autologous and allogenic cell therapies, autologous blood products, hyaluronic acid, gene therapies, Wnt inhibitors, and a variety of systemic treatments.
    Type of Medium: Online Resource
    ISSN: 1062-8592
    URL: Article
    DOI: 10.1097/JSA.0000000000000337
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2059221-8
    SSG: 31
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  • 2
    Online Resource
    Online Resource
    Biomechanics and Microstructural Analysis of the Mouse Knee and Ligaments
    Georg Thieme Verlag KG ; 2018
    In:  The Journal of Knee Surgery Vol. 31, No. 06 ( 2018-07), p. 520-527
    Details
    In: The Journal of Knee Surgery, Georg Thieme Verlag KG, Vol. 31, No. 06 ( 2018-07), p. 520-527
    Abstract: The purpose of this study is to determine the feasibility of using murine models for translational study of knee ligament injury, repair, and reconstruction. To achieve this aim, we provide objective, quantitative data detailing the gross anatomy, biomechanical characteristics, and microscopic structure of knee ligaments of 44 male mice (C57BL6, 12 weeks of age). Biomechanical testing determined the load-to-failure force, stiffness, and the site of ligament failure for the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and the medial and lateral collateral ligaments (MCL and LCL). These data are complemented by histological characterization of each of the knee ligaments. In addition, the osseous morphology of the mouse knee was examined using high-resolution nanofocus computed tomography (CT), while standard micro-CT was employed to measure bone morphometrics of the distal femur and proximal tibia. Collectively, our findings suggest that the gross anatomy of the mouse knee is similar to the human knee despite some minor differences and features unique to the murine knee. The ACL had the highest load to failure (5.60 ± 0.75 N), the MCL (3.33 ± 1.45 N), and the PCL (3.45 ± 0.84 N) were similar, and the LCL (1.44 ± 0.37 N) had the lowest load to failure and stiffness. Murine models provide a unique opportunity to focus on biological processes that impact ligament pathology and healing due to the availability of transgenic strains. Our data support their use as a translational platform for the in vivo study of ligament injury, repair, and reconstruction.
    Type of Medium: Online Resource
    ISSN: 1538-8506 , 1938-2480
    URL: Article
    DOI: 10.1055/s-0037-1604151
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
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  • 3
    Online Resource
    Online Resource
    Anatomy and biomechanics of the rat knee ligaments
    Heighten Science Publications Corporation ; 2023
    In:  Journal of Sports Medicine and Therapy Vol. 8, No. 2 ( 2023-04-27), p. 008-015
    Details
    In: Journal of Sports Medicine and Therapy, Heighten Science Publications Corporation, Vol. 8, No. 2 ( 2023-04-27), p. 008-015
    Abstract: In this study, the authors systematically examined the anatomical and biomechanical properties of the ligaments in the normal rat knee. These biomechanical data will facilitate the use of the rat knee model for future studies of knee ligament injury, repair, and reconstruction. Fifty-six fresh cadaver male Sprague-Dawley rats, aged 16 weeks, were used for this study, with 48 rats for biomechanical testing and 8 for micro-CT and histological evaluation. Our findings suggest that the gross anatomy of the rat knee joint and ligaments is very similar to humans despite some minor differences and features unique to the rat knee. The patella tendon and ACL are the two strongest soft tissue structures in the rat knee joint, with the highest failure force and stiffness, and both play a role in the anterior stability of the knee. In comparison, the failure force and stiffness of the LCL is half of the MCL, suggesting that other structures, such as the popliteal tendon, may play some role in lateral knee stabilization besides the LCL. In addition, our data suggest that anterior knee stability was improved after ACL reconstruction, but was not fully restored to intact ACL function. In conclusion, our study indicates the anatomical and biomechanical properties of the knee joint and ligaments of rat knees. Then we could confirm a reproducible and realistic rat model of knee ligaments like the clinical cases, and provide a basis for the study of knee ligament biology that simulates techniques used in humans.
    Type of Medium: Online Resource
    ISSN: 2573-1726
    URL: Journal
    URL: Article
    DOI: 10.29328/journal.jsmt
    DOI: 10.29328/journal.jsmt.1001065
    Language: Unknown
    Publisher: Heighten Science Publications Corporation
    Publication Date: 2023
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  • 4
    Online Resource
    Online Resource
    Genome-Wide Association Study of Adhesive Capsulitis Suggests Significant Genetic Risk Factors
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Bone and Joint Surgery Vol. 104, No. 21 ( 2022-11-2), p. 1869-1876
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 104, No. 21 ( 2022-11-2), p. 1869-1876
    Abstract: Adhesive capsulitis of the shoulder involves loss of passive range of motion with associated pain and can develop spontaneously, with no obvious injury or inciting event. The pathomechanism of this disorder remains to be elucidated, but known risk factors for adhesive capsulitis include diabetes, female sex, and thyroid dysfunction. Additionally, transcriptional profiling and pedigree analyses have suggested a role for genetics. Identification of elements of genetic risk for adhesive capsulitis using population-based techniques can provide the basis for guiding both the personalized treatment of patients based on their genetic profiles and the development of new treatments by identification of the pathomechanism. Methods: A genome-wide association study (GWAS) was conducted using the U.K. Biobank (a collection of approximately 500,000 patients with genetic data and associated ICD-10 [International Classification of Diseases, 10th Revision] codes), comparing 2,142 patients with the ICD-10 code for adhesive capsulitis (M750) to those without. Separate GWASs were conducted controlling for 2 of the known risk factors of adhesive capsulitis—hypothyroidism and diabetes. Logistic regression analysis was conducted controlling for factors including sex, thyroid dysfunction, diabetes, shoulder dislocation, smoking, and genetics. Results: Three loci of significance were identified: rs34315830 (in WNT7B; odds ratio [OR] = 1.28; 95% confidence interval [CI] , 1.22 to 1.39), rs2965196 (in MAU2; OR = 1.67; 95% CI, 1.39 to 2.00), and rs1912256 (in POU1F1; OR = 1.22; 95% CI, 1.14 to 1.31). These loci retained significance when controlling for thyroid dysfunction and diabetes. The OR for total genetic risk was 5.81 (95% CI, 4.08 to 8.31), compared with 1.70 (95% CI, 1.18 to 2.36) for hypothyroidism and 4.23 (95% CI, 2.32 to 7.05) for diabetes. Conclusions: The total genetic risk associated with adhesive capsulitis was significant and similar to the risks associated with hypothyroidism and diabetes. Identification of WNT7B, POU1F1, and MAU2 implicates the Wnt pathway and cell proliferation response in the pathomechanism of adhesive capsulitis. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.21.01407
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 5
    Online Resource
    Online Resource
    Evaluation of Osseous Incorporation After Osteochondral Allograft Transplantation: Correlation of Computed Tomography Parameters With Patient-Reported Outcomes
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 8 ( 2021-08-01), p. 232596712110226-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 8 ( 2021-08-01), p. 232596712110226-
    Abstract: Studies have reported favorable clinical outcomes after osteochondral allograft (OCA) transplantation to treat osteochondral defects and have demonstrated that healing of the osseous component may be critical to outcomes. However, there is currently no consensus on the optimal modality to evaluate osseous healing. Purpose: To define parameters for OCA healing using computed tomography (CT) and to investigate whether osseous healing identified using CT is correlated with improved pain and function on patient-reported outcomes (PROs) collected closest in time to the postoperative CT scan and at final follow-up. Study Design: Case series; Level of evidence, 4. Methods: Of 118 patients who underwent OCA transplantation for articular cartilage defects of the knee over the 10-year study period, 60 were included in final analysis based on completion of CT scans at 5.8 ± 1.9 months postoperatively and PROs collected preoperatively and postoperatively. CT parameters, including osseous incorporation, bone density, subchondral bone congruency, and cystic changes, were summarized for each patient relative to the cohort. Parameters were assessed for inter- and intrarater reliability as well as for covariation with patient characteristics and surgical variables. Structural equation modeling was used to assess correlation of CT parameters with change in PROs from preoperatively to those collected closest in time to CT acquisition and at the final follow-up. Results: Bone incorporation was the most reliable CT parameter. The summarized scores for CT scans were normally distributed across the study population. Variance in CT parameters was independent of age, sex, body mass index, prior surgery, number of grafts, lesion size, and location. No significant correlation ( P 〉 .12 across all comparisons) was identified for any combination of CT parameter and change in PROs from baseline for outcomes collected either closest to CT acquisition or at the final follow-up (mean, 38.2 ± 19.9 months; range, 11.6-84.9 months). There was a uniformly positive association between change in PROs and host bone density but not graft bone density, independent of patient characteristics and surgical factors. Conclusion: CT parameters were independent of clinical or patient variables within the study population, and osseous incorporation was the most reliable CT parameter. Metrics collected from a single postoperative CT scan was not correlated with clinical outcomes at ≥6-month longitudinal follow-up.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671211022682
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 6
    Online Resource
    Online Resource
    Anticoagulant Usage Following Anterior Cruciate Ligament Reconstruction is Associated with Increased Rate of Manipulation Under Anesthesia
    SAGE Publications ; 2020
    In:  Orthopaedic Journal of Sports Medicine Vol. 8, No. 7_suppl6 ( 2020-07-01), p. 2325967120S0048-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 8, No. 7_suppl6 ( 2020-07-01), p. 2325967120S0048-
    Abstract: Although uncommon, arthrofibrosis following anterior cruciate ligament reconstruction (ACLR) is considered to be a significant and disabling complication for a young, athletic population. In this study, we aimed to determine: (1) the prevalence of manipulation under anesthesia (MUA) for treatment of arthrofibrosis following ACLR (2) whether anticoagulant use following ACLR is associated with an increased risk of MUA. We anticipate that postoperative use of anticoagulants will be associated with an increased risk of subsequent MUA. Methods: A retrospective cohort study was conducted using data collected from the Humana insurance database using the PearlDiver Patient Records Database from 2007-2017. Subjects were identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Patients were initially identified by ACL sprain or tear diagnosis utilizing ICD codes. Patients who underwent a concomitant MCL, PCL or LCL repair or reconstruction were excluded from this analysis. Patients who underwent MUA within one year of ACLR were then identified. Patient demographic characteristics including age, sex, and Charlson Comorbidity Index (CCI) were recorded. In addition, previously identified risk factors for knee stiffness were collected, including history of diabetes mellitus and obesity. Lastly, the time between ACL tear and surgery and ACL reconstruction to MUA were collected and categorized into 2 groups: (1) 〈 4 weeks and (2) 〉 4 weeks. Anticoagulants included in this analysis were warfarin, aspirin, low-molecular-weight heparin, direct factor Xa inhibitors and fondaparinux. Patient demographics, comorbidities, timing to surgery, concomitant meniscal repair, and postoperative complications were analyzed with a logistic multivariate analysis to determine adjusted associations of risk factors of arthrofibrosis. A p-value of 〈 0.05 was used as the cutoff for statistical significance. Results: There were 7,798 patients who met the inclusion criteria for this analysis. 115 (1.5%) patients received a subsequent MUA within one-year, while 7,683 (98.5%) patients did not. Among patients who underwent ACLR, 234 (3.0%) patients were on anticoagulants postoperatively. Patients who were on anticoagulants following ACLR were more likely to require an MUA (OR: 4.626; 95% CI: 2.462-8.093; p 〈 0.001; Table 1). Other risk factors for MUA are listed in Table 1. Conclusion: The key finding of this study was that the use of anticoagulants is associated with increased rates of MUA following ACLR. One potential mechanism for the effect of anticoagulants may be the increased risk of postoperative hematoma. Recurrent hematoma has been suggested as a risk factor for arthrofibrosis requiring MUA following ACLR due to increased vascular micro-permeability that anticoagulants can produce. The presence of blood products in the joint may stimulate the accumulation of inflammatory mediators and subsequent fibrosis, as it is well-established that unresolved inflammation can initiate and propagate scar tissue formation. In conclusion, arthrofibrosis after ACLR is associated with postoperative use of thromboprophylaxis. Healthcare providers should be cognizant of this risk when considering anticoagulant usage in this patient population.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967120S00488
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 7
    Online Resource
    Online Resource
    Stem Cells Genetically Modified With the Developmental Gene MT1-MMP Improve Regeneration of the Supraspinatus Tendon-to-Bone Insertion Site
    SAGE Publications ; 2010
    In:  The American Journal of Sports Medicine Vol. 38, No. 7 ( 2010-07), p. 1429-1437
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 38, No. 7 ( 2010-07), p. 1429-1437
    Abstract: Background: Rotator cuffs heal through a scar tissue interface after repair, which makes them prone to failure. Membrane type 1 matrix metalloproteinase (MT1-MMP) is upregulated during embryogenesis in areas that develop into tendon-bone insertion sites. Hypothesis: Bone marrow-derived stem cells in the presence of the developmental signal from MT1-MMP will drive the healing process toward regeneration and away from scar formation. Study Design: Controlled laboratory study. Methods: Sixty Lewis rats underwent unilateral detachment and repair of the supraspinatus tendon. Thirty animals received mesenchymal stem cells (MSCs) in a fibrin glue carrier, and 30 received adenoviral MT1-MMP (Ad-MT1-MMP)–transduced MSCs. Animals were sacrificed at 2 weeks and 4 weeks and evaluated for the presence of fibrocartilage and collagen fiber organization at the insertion. Biomechanical testing was performed to determine the structural and material properties of the repaired tissue. Statistical analysis was performed with a Wilcoxon rank-sum test with significance set at P = .05. Results: There were no differences between the Ad-MT1-MMP and MSC groups in any outcome variable at 2 weeks. At 4 weeks, the Ad-MT1-MMP group had more fibrocartilage ( P = .05), higher ultimate load to failure ( P = .01), higher ultimate stress to failure ( P = .005), and higher stiffness values ( P = .02) as compared with the MSC group. Conclusion: Mesenchymal stem cells genetically modified to overexpress the developmental gene MT1-MMP can augment rotator cuff healing at 4 weeks by the presence of more fibrocartilage at the insertion and improved biomechanical strength. Clinical Relevance: Biologic augmentation of repaired rotator cuffs with MT1-MMP–transduced MSCs may reduce the incidence of retears. However, further studies are needed to determine if this remains safe and effective in larger models.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546510361235
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 8
    Online Resource
    Online Resource
    International Meniscus Reconstruction Experts Forum (IMREF) 2015 Consensus Statement on the Practice of Meniscal Allograft Transplantation
    SAGE Publications ; 2017
    In:  The American Journal of Sports Medicine Vol. 45, No. 5 ( 2017-04), p. 1195-1205
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 45, No. 5 ( 2017-04), p. 1195-1205
    Abstract: Meniscal allograft transplantation (MAT) has become relatively commonplace in specialized sport medicine practice for the treatment of patients with a symptomatic knee after the loss of a functional meniscus. The technique has evolved since the 1980s, and long-term results continue to improve. However, there still remains significant variation in how MAT is performed, and as such, there remains opportunity for outcome and graft survivorship to be optimized. The purpose of this article was to develop a consensus statement on the practice of MAT from key opinion leaders who are members of the International Meniscus Reconstruction Experts Forum so that a more standardized approach to the indications, surgical technique, and postoperative care could be outlined with the goal of ultimately improving patient outcomes.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546516660064
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 9
    Online Resource
    Online Resource
    Effect of Turf Toe on Foot Contact Pressures in Professional American Football Players
    SAGE Publications ; 2009
    In:  Foot & Ankle International Vol. 30, No. 5 ( 2009-05), p. 405-409
    Details
    In: Foot & Ankle International, SAGE Publications, Vol. 30, No. 5 ( 2009-05), p. 405-409
    Abstract: Background: The relationship between turf toe and plantar foot pressures has not been extensively studied. Two hypotheses were tested in a cohort of professional American football players: first, that a history of turf toe is associated with increased peak hallucal and first metatarsophalangeal (MTP) plantar pressures; second, that decreased range of motion (ROM) of the first MTP correlates with increased peak hallucal and first MTP plantar pressures. Materials and Methods: Forty-four athletes from one National Football League (NFL) team were screened for a history of turf toe during preseason training. Dorsal passive MTP ROM and dynamic plantar pressures were measured in both feet of each player. Anatomical masking was used to assess peak pressure at the first MTP and hallux. Results: First MTP dorsiflexion was significantly lower in halluces with a history of turf toe (40.6 ± 15.1 degrees versus 48.4 ± 12.8 degrees, p = 0.04). Peak hallucal pressures were higher in athletes with turf toe (535 ± 288 kPa versus 414 ± 202 kPa, p = 0.05) even after normalizing for athlete body mass index ( p = 0.0003). Peak MTP pressure was not significantly different between the two groups tested. First MTP dorsiflexion did not correlate with peak hallucal or first MTP pressures. Conclusion: This study showed that turf toe is associated with decreased MTP motion. In addition, increased peak hallucal pressures were found. Further study is warranted to determine whether these pressures correlate with the severity of symptoms or progression of turf toe to first MTP arthritis.
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.3113/FAI-2009-0405
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2129503-7
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  • 10
    Online Resource
    Online Resource
    2011 AOA Symposium: Tissue Engineering and Tissue Regeneration : AOA Critical Issues
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  The Journal of Bone and Joint Surgery-American Volume Vol. 95, No. 15 ( 2013-08), p. e109-1-7
    Details
    In: The Journal of Bone and Joint Surgery-American Volume, Ovid Technologies (Wolters Kluwer Health), Vol. 95, No. 15 ( 2013-08), p. e109-1-7
    Type of Medium: Online Resource
    ISSN: 0021-9355
    URL: Article
    DOI: 10.2106/JBJS.K.01505
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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