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Dai GC, Wang H, Ming Z, Lu PP, Li YJ, Gao YC, Shi L, Cheng Z, Liu XY, Rui YF. Heterotopic mineralization (ossification or calcification) in aged musculoskeletal soft tissues: A new candidate marker for aging. Ageing Res Rev 2024; 95:102215. [PMID: 38325754 DOI: 10.1016/j.arr.2024.102215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
Aging can lead to various disorders in organisms and with the escalating impact of population aging, the incidence of age-related diseases is steadily increasing. As a major risk factor for chronic illnesses in humans, the prevention and postponement of aging have become focal points of research among numerous scientists. Aging biomarkers, which mirror molecular alterations at diverse levels in organs, tissues, and cells, can be used to monitor and evaluate biological changes associated with aging. Currently, aging biomarkers are primarily categorized into physiological traits, imaging characteristics, histological features, cellular-level alterations, and molecular-level changes that encompass the secretion of aging-related factors. However, in the context of the musculoskeletal soft tissue system, aging-related biological indicators primarily involve microscopic parameters at the cellular and molecular levels, resulting in inconvenience and uncertainty in the assessment of musculoskeletal soft tissue aging. To identify convenient and effective indicators, we conducted a comprehensive literature review to investigate the correlation between ectopic mineralization and age-related changes in the musculoskeletal soft tissue system. Here, we introduce the concept of ectopic mineralization as a macroscopic, reliable, and convenient biomarker for musculoskeletal soft tissue aging and present novel targets and strategies for the future management of age-related musculoskeletal soft tissue disorders.
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Affiliation(s)
- Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Hao Wang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Zhang Ming
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Pan-Pan Lu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Ying-Juan Li
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Yu-Cheng Gao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Zhang Cheng
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Xiao-Yu Liu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China.
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Gill VS, Haglin JM, Tummala SV, Iturregui J, Economopoulos KJ, Chhabra A. Meniscectomy Reimbursement and Utilization Are Declining at Different Rates Across the United States. Arthroscopy 2024:S0749-8063(24)00095-1. [PMID: 38336106 DOI: 10.1016/j.arthro.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate how arthroscopic meniscectomy utilization, reimbursement, physician billing practices, and patient populations have changed within the Medicare population from 2013 to 2021 at a national level and regional level. METHODS The Medicare Physician & Other Practitioners database was queried for all episodes of 2-compartment and single-compartment arthroscopic meniscectomy between 2013 and 2021. Utilization per 10,000 beneficiaries and average inflation-adjusted reimbursement were assessed. Physician practice styles, measured through changes in the services billed, and Medicare beneficiary demographic characteristics were extracted each year. The Kruskal-Wallis test was performed to compare regions. RESULTS Between 2013 and 2021, two-compartment meniscectomy utilization per 10,000 Medicare beneficiaries declined by 54.9% and single-compartment meniscectomy utilization declined by 54.2%. Average reimbursement declined by 9.3% and 12.5% for 2-compartment meniscectomy and single-compartment meniscectomy, respectively. In 2021, the South had the highest utilization of both 2-compartment (3.8/10,000) and single-compartment (4.7/10,000) meniscectomies while having the lowest average reimbursement for 2-compartment meniscectomy ($383.02, P < .001). Nationally, the average number of beneficiaries per surgeon performing single-compartment meniscectomy declined by 3.8% whereas the average number of billable services performed per beneficiary increased by 46.6%. The comorbidity risk score of these patients decreased by 8.7%, with the West having the healthiest patients in 2021. CONCLUSIONS Meniscectomy utilization and reimbursement have been declining nationally within the Medicare population. Surgeons in the South performed the most meniscectomies while having among the lowest reimbursement. The practice patterns of surgeons performing meniscectomies have been changing, with surgeons performing nearly 50% more total billable services per beneficiary while performing fewer unique billable services. Additionally, the patient population of surgeons who perform meniscectomy was healthier in 2021 than in 2013. CLINICAL RELEVANCE This study highlights changes in meniscectomy utilization and reimbursement over time in the face of changing evidence of meniscectomy use in elderly patients and new Medicare legislature regarding reimbursement.
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Affiliation(s)
- Vikram S Gill
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A.; Mayo Clinic Alix School of Medicine, Phoenix, Arizona, U.S.A..
| | - Jack M Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Jose Iturregui
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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Gibbs AJ, Gray B, Wallis JA, Taylor NF, Kemp JL, Hunter DJ, Barton CJ. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis Cartilage 2023; 31:1280-1292. [PMID: 37394226 DOI: 10.1016/j.joca.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/13/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Guideline adherence for hip and knee osteoarthritis management is often poor, possibly related to the quality and/or inconsistent recommendations. This systematic review of hip and knee osteoarthritis guidelines aimed to appraise the quality and consistency in recommendations across higher-quality guidelines. METHODS Eight databases, guideline repositories, and professional associations websites were searched on 27/10/2022. Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II tool) (six domains). Higher quality was defined as scoring ≥60% for domains 3 (rigour of development), 6 (editorial independence), plus one other. Consistency in recommendations across higher-quality guidelines was reported descriptively. This review was registered prospectively (CRD42021216154). RESULTS Seven higher-quality and 18 lesser-quality guidelines were included. AGREE II domain scores for higher-quality guidelines were > 60% except for applicability (average 46%). Higher-quality guidelines consistently recommended in favour of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee). Higher quality guidelines consistently recommended against hyaluronic acid (hip) and stem cell (hip and knee) injections. Other pharmacological recommendations in higher-quality guidelines (e.g., paracetamol, intra-articular corticosteroid (hip), hyaluronic acid (knee)) and adjunctive treatments (e.g., acupuncture) were less consistent. Arthroscopy was consistently recommended against in higher-quality guidelines. No higher-quality guidelines considered arthroplasty. CONCLUSION Higher-quality guidelines for hip and knee osteoarthritis consistently recommend clinicians implement exercise, education, and weight management, alongside consideration of Non-Steroidal Anti-Inflammatory Drugs and intra-articular corticosteroid injections (knee). Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence. Future guidelines must prioritise providing implementation guidance, considering consistently low applicability scores.
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Affiliation(s)
- Alison J Gibbs
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Physiotherapy Department, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 312 Victoria, Australia.
| | - Bimbi Gray
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Jason A Wallis
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; School of Public Health & Preventative Medicine, Monash University, Level 4/553 St Kilda Rd, Melbourne 3004, Australia; Physiotherapy Department, Cabrini Health, Malvern, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Joanne L Kemp
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Christian J Barton
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Cai Y, Deng Y, Ou L, Guo Y, Guo Y. Clinical trial of manual therapy in the treatment of chondromalacia patellae. Medicine (Baltimore) 2023; 102:e33945. [PMID: 37327282 PMCID: PMC10270499 DOI: 10.1097/md.0000000000033945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/16/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Chondromalacia patellae (CP) is a common and main cause of knee pain, the prevalence of the disease in the general population is as high as 36.2%, especially in middle-aged patients aged between 30 and 40 years (up to 50%). The use of manual therapy (MT) to dredge the meridians and muscles around the knee joint and stimulate the relevant acupoints can play vital roles in relieving pain and improving function. The purpose of this study is to assess the effectiveness, safety and further comprehensively, completely and multi-dimensionally explain the mechanism and treatment advantages of MT for CP. METHODS A prospective randomized controlled clinical trial design was used to study the efficacy and safety of MT in the treatment of CP. One hundred and twenty cases of CP patients will be recruited and randomly divided into experimental group and control group according to 1:1. The control group: sodium hyaluronate; experimental group: MT added on the basis of the control group. Both groups will receive standard treatment for 4 weeks and followed up for 3 months. And at the same time, pay attention to its efficacy and safety indicators. Observation indicators include: the visual analogue scale pain score; the Western Ontario and McMaster Universities Arthritis Index scores; the Lysholm scores, and Bristol scores, adverse reactions, etc. Data analysis was performed using SPSS 25.0 software. DISCUSSION This study will precisely evaluate the effectiveness and safety of MT in the treatment of CP. The results of this experiment will provide more reliable clinical basis for the selection of MT for patients with CP.
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Affiliation(s)
- Yan Cai
- Hunan University of Chinese Medicine, Changsha, China
- The Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine, Changsha, China
| | - Ying Deng
- Hunan University of Chinese Medicine, Changsha, China
| | - Liang Ou
- The Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine, Changsha, China
| | - Yuxing Guo
- The Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine, Changsha, China
| | - Yanxing Guo
- Hunan University of Chinese Medicine, Changsha, China
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Munn D, Burt J, Gee CW, Mclaren CK, Clarke JV, Hall AJ. Moving orthopaedic procedures out of the operating theatre:Outpatient needle arthroscopy can reduce cost & waste, and increase inpatient capacity compared to conventional knee arthroscopy. Knee 2023; 42:143-152. [PMID: 37001331 DOI: 10.1016/j.knee.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/04/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Needle arthroscopy (NA) is an emerging technique that could streamline pathways, facilitate timely care, and reduce service burden. The primary aim was to assess the practical and economic viability of an outpatient NA service. Secondary aims were to assess the relative costs and benefits compared to a conventional arthroscopy (CA) service. METHODS This service feasibility study was conducted between 2021-2022 in a high-volume national treatment centre. A NA pathway was established for patients with chronic soft tissue pathology or early degenerative knee disease. The pathway was evaluated in terms of: i) cost; ii) efficiency, and iii) waste production, and an assessment was conducted of the patient-related and service-related effects. RESULTS The cost of the NA pathway was £1555.20 per patient, compared to £2,351.53 for CA. Time to management was 45 days for NA versus 180 days for CA. The NA pathway involved two hospital attendances, whereas CA required a minimum of three. NA cases produced 1.4 kg of non-recyclable waste compared to 5.0 kg produced by CA. For every two cases managed by NA instead of CA, capacity for one additional obligate-inpatient procedure was created. CONCLUSIONS The NA pathway offers a technically and economically viable approach for the management of refractory knee symptoms in the context of chronic soft tissue or early degenerative disease. NA placed less demand on hospital resources, produced two-thirds less non-recyclable waste, and is amenable to a one-stop clinic approach. Clinical studies focused on objective and patient-reported outcome measures are required to assess clinical efficacy.
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Affiliation(s)
- D Munn
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - J Burt
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK. https://twitter.com/GJOrthopaedics
| | - C W Gee
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Glasgow, Glasgow, UK. https://twitter.com/ChrisGeeOrtho
| | | | - J V Clarke
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Glasgow, Glasgow, UK
| | - A J Hall
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Edinburgh, Edinburgh, UK. https://twitter.com/andrewhallortho
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Fuchs L, Givon A, Shweiki F, Hovav T. Arthroscopic knee debridement in osteoarthritis in the older age can be satisfactory. J Clin Orthop Trauma 2023; 38:102130. [PMID: 36860995 PMCID: PMC9969278 DOI: 10.1016/j.jcot.2023.102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 01/19/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction Knee arthroscopy is one of the treatments for knee pain. In recent years, the use of knee arthroscopy in the treatment of osteoarthritis was challenged by several randomized-controlled trials, systematic reviews and meta-analyses. However, some design flaws are making the clinical decision harder. This study specifically explores the patient satisfaction from these surgeries to aid in clinical decision. Hypothesis Knee arthroscopy can relieve symptoms and delay further surgical treatment in the older age. Patients & methods Fifty patients accepted participation and were invited to a follow-up examination eight years post knee arthroscopy. All patients were above age 45 and diagnosed with degenerative meniscus tear and osteoarthritis. The patients filled follow-up questionnaires of function (WOMAC, IKDC, SF-12) and pain. The patients were asked to appreciate if they would have repeated the surgery retrospectively. The results were compared to a previous data base. Results Thirty-six patients (72%) reported satisfaction of 8 and above (scale of 0-10) from the surgery and would have repeated it. A higher SF-12 physical score pre-surgery predicted a higher satisfaction rate (p = 0.027). Patients who were more satisfied from the surgery improved post-surgery in all parameters compared with the less-satisfied group (p < 0.001). Patients above the age 60 had similar parameters pre- and post-surgery compared with patients under the age 60 (p > 0.05). Conclusions Patients between the ages 46-78 with degenerative meniscus tear and osteoarthritis felt they benefited from knee arthroscopy in an eight-year follow-up and would repeat the surgery. Our research may help with better patient selection and suggest knee arthroscopy can relive symptoms and delayed further surgical treatment for the older patient with clinical symptoms and signs of meniscus related pain, mild osteoarthritis, and failed conservative treatment. Level of evidence IV.
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Affiliation(s)
- Lee Fuchs
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Assaf Givon
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Fadi Shweiki
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Tavor Hovav
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
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[Mid-term effectiveness of arthroscopy and conservative treatment for symptomatic discoid lateral meniscus in middle-aged and elderly patients]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:6-11. [PMID: 36708108 PMCID: PMC9883643 DOI: 10.7507/1002-1892.202208064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective To compare the mid-term effectiveness of arthroscopy versus conservative treatment on symptomatic discoid lateral meniscus (SDLM) in middle-aged and elderly patients. Methods The clinical data of 118 middle-aged and elderly patients (154 knees) with SDLM who received arthroscopy or conservative treatment between June 2014 and May 2016 were retrospectively analyzed, including 76 patients (96 knees) in the arthroscopy group (group A) and 42 patients (58 knees) in the conservative treatment group (group B). There was no significant difference in age, gender, and body mass index between the two groups (P>0.05). Compared with group B, the symptoms duration in group A was longer, the incidences of discoid lateral meniscus injury and mechanical symptoms were higher, and the visual analogue scale (VAS) score and Lysholm score before treatment were worse, with significant differences (P<0.05). VAS score and Lysholm score before and after treatment were recorded and compared. Results The patients in both groups were followed up 60-74 months, with an average of 66.3 months. The follow-up time of group A and group B was (65.9±3.5) months and (67.0±4.0) months respectively, with no significant difference (t=-1.615, P=0.109). At last follow-up, in either group A or group B, the VAS score and Lysholm score significantly improved when compared with those before treatment (P<0.05). The differences of VAS score and Lysholm score in group A before and after treatment were significantly better than those in group B (P<0.05). Conclusion Arthroscopy and conservative treatment have a satisfactory mid-term effectiveness on SDLM in middle-aged and elderly patients. However, the improvement of symptoms and function of arthroscopy was significantly better than that of conservative treatment. For middle-aged and elderly SDLM patients with invalidated conventional treatment for 6 months, severe clinical symptoms, long duration of symptoms, and combined with mechanical symptoms, arthroscopy should be given priority even if they are complicated with early osteoarthritis.
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O'Connell CD, Duchi S, Onofrillo C, Caballero-Aguilar LM, Trengove A, Doyle SE, Zywicki WJ, Pirogova E, Di Bella C. Within or Without You? A Perspective Comparing In Situ and Ex Situ Tissue Engineering Strategies for Articular Cartilage Repair. Adv Healthc Mater 2022; 11:e2201305. [PMID: 36541723 DOI: 10.1002/adhm.202201305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/21/2022] [Indexed: 11/23/2022]
Abstract
Human articular cartilage has a poor ability to self-repair, meaning small injuries often lead to osteoarthritis, a painful and debilitating condition which is a major contributor to the global burden of disease. Existing clinical strategies generally do not regenerate hyaline type cartilage, motivating research toward tissue engineering solutions. Prospective cartilage tissue engineering therapies can be placed into two broad categories: i) Ex situ strategies, where cartilage tissue constructs are engineered in the lab prior to implantation and ii) in situ strategies, where cells and/or a bioscaffold are delivered to the defect site to stimulate chondral repair directly. While commonalities exist between these two approaches, the core point of distinction-whether chondrogenesis primarily occurs "within" or "without" (outside) the body-can dictate many aspects of the treatment. This difference influences decisions around cell selection, the biomaterials formulation and the surgical implantation procedure, the processes of tissue integration and maturation, as well as, the prospects for regulatory clearance and clinical translation. Here, ex situ and in situ cartilage engineering strategies are compared: Highlighting their respective challenges, opportunities, and prospects on their translational pathways toward long term human cartilage repair.
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Affiliation(s)
- Cathal D O'Connell
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.,Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Serena Duchi
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Carmine Onofrillo
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Lilith M Caballero-Aguilar
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Victoria, 3122, Australia
| | - Anna Trengove
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Stephanie E Doyle
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.,Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Wiktor J Zywicki
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Elena Pirogova
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia
| | - Claudia Di Bella
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
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9
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LUNDBERG M, SØNDERGAARD J, VIBERG B, LOHMANDER LS, THORLUND JB. Declining trends in arthroscopic meniscus surgery and other arthroscopic knee procedures in Denmark: a nationwide register-based study. Acta Orthop 2022; 93:783-793. [PMID: 36173141 PMCID: PMC9521053 DOI: 10.2340/17453674.2022.4803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE A doubling of arthroscopic meniscal procedures was observed in Denmark from 2000 to 2011, but arthroscopic meniscal procedures for degenerative meniscal tears are no longer recommended. We performed an updated investigation of Danish meniscal procedure trends in the private and public healthcare sectors in Denmark from 2006 to 2018, including trends for other arthroscopic knee procedures. PATIENTS AND METHODS We extracted data on the 5 most commonly registered arthroscopic knee procedures (diagnostic arthroscopy, meniscal surgery, anterior cruciate ligament reconstruction, synovectomy, and cartilage resection) from the Danish National Patient Register from January 1, 2006 to December 31, 2018, linked with the Danish Population Statistic Register, to obtain data on age and sex. RESULTS 414,253 arthroscopic knee procedures were registered during 315,290 surgeries on 244,113 individual patients in the study period. For meniscal procedures, the highest incidence was observed in 2010 (319 per 105 persons/year, 95% CI 314-323) and the lowest in 2018 (173 per 105 persons/year, CI 169-176), corresponding to relative decrease of 46% from 2010 to 2018. Remaining arthroscopic procedures also showed declining trends, with lowest incidence for all procedures in 2018. INTERPRETATION A large decrease in the incidence for arthroscopic meniscal procedures was observed from 2010 to 2018, possibly in response to mounting evidence of limited benefit of this procedure for degenerative knee disease. All other investigated arthroscopic knee procedures also declined in the same period.
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Affiliation(s)
- Matilde LUNDBERG
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense
| | - Jens SØNDERGAARD
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense
| | - Bjarke VIBERG
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - L Stefan LOHMANDER
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Jonas B THORLUND
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense
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10
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Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews. Musculoskelet Surg 2022; 107:127-141. [PMID: 36057031 PMCID: PMC10192166 DOI: 10.1007/s12306-022-00760-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Arthroscopic partial meniscectomy (APM) is widely applied for the treatment of degenerative meniscal lesions in middle-aged patients; however, such injury is often associated with mild or moderate osteoarthritis and has been reported by MRI in asymptomatic knees. Previous studies suggested, in most patients, a lack of benefit of surgical approach over conservative treatment, yet many controversies remain in clinical practice. Our aims were to assess the functional and pain scores between exercise therapy and arthroscopic surgery for degenerative meniscal lesions and to evaluate the methodological quality of the most recent systematic reviews (SRs). METHODS Two authors independently searched PubMed and Google Scholar for SRs comparing the outcome (in knee pain and functionality) of arthroscopic treatment and exercise therapy or placebo for degenerative meniscal lesions. The timeframe set was from 2009 to 2019 included. RESULTS A total of 13 SRs were selected. Two reviewers independently assessed the methodological quality of each paper using the AMSTAR 2 tool: seven scored as "moderate," four obtained a "low" grade while the remaining two were evaluated as "critically low." SRs agreed that in middle-aged patients with degenerative meniscal lesions arthroscopic surgery appears to grant no long-term improvement in pain and function over exercise therapy or placebo. CONCLUSIONS Conservative treatment based on physical therapy should be the first-line management. However, most SRs revealed subgroups of patients that fail to improve after conservative treatment and find relief when undergoing surgery. In the future, randomized controlled trials, evidence should be looked for that APM can be successful in case of the unsatisfactory results after physical therapy.
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11
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Lewis E, Merghani K, Robertson I, Mulford J, Prentice B, Mathew R, Van Winden P, Ogden K. The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial. Bone Joint J 2022; 104-B:663-671. [PMID: 35638203 DOI: 10.1302/0301-620x.104b6.bjj-2021-1109.r2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS Platelet-rich plasma (PRP) intra-articular injections may provide a simple and minimally invasive treatment for early-stage knee osteoarthritis (OA). This has led to an increase in its adoption as a treatment for knee OA, although there is uncertainty about its efficacy and benefit. We hypothesized that patients with early-stage symptomatic knee OA who receive multiple PRP injections will have better clinical outcomes than those receiving single PRP or placebo injections. METHODS A double-blinded, randomized placebo-controlled trial was performed with three groups receiving either placebo injections (Normal Saline), one PRP injection followed by two placebo injections, or three PRP injections. Each injection was given one week apart. Outcomes were prospectively collected prior to intervention and then at six weeks, three months, six months, and 12 months post-intervention. Primary outcome measures were Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol five-dimension five-level index (EQ-5D-5L). Secondary outcomes included visual analogue scale for pain and patient subjective assessment of the injections. RESULTS A total of 102 patients were recruited. The follow-up period was 12 months, at intervals of six weeks, 12 weeks, six months, and 12 months. KOOS-Total significantly improved in all groups at these time intervals compared to pre-injection. There was an improvement in EQ-5D-5L index scores in saline and single injection groups, but not in the multiple injection group. Comparison of treatment groups showed no additional beneficial effect of single or multiple PRP injections above that displayed in the saline injection group. Subjective patient satisfaction and recommendation of treatment received demonstrated a similar pattern in all the groups. There was no indication of superiority of either single or multiple PRP injections compared to saline injections. CONCLUSION There is no evidence that single or multiple PRP had any additional beneficial effect compared to saline injection up to 12 months, follow-up after treatment of early stage symptomatic OA of the knee. Cite this article: Bone Joint J 2022;104-B(6):663-671.
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Affiliation(s)
- Emma Lewis
- Launceston General Hospital, Launceston, Australia
| | | | - Iain Robertson
- College of Health and Medicine, University of Tasmania, Launceston, Australia.,Clifford Craig Foundation, Launceston General Hospital, Launceston, Australia
| | | | - Ben Prentice
- Launceston General Hospital, Launceston, Australia
| | | | | | - Kathryn Ogden
- College of Health and Medicine, University of Tasmania, Launceston, Australia.,Clifford Craig Foundation, Launceston General Hospital, Launceston, Australia
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12
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Leopold SS. Editorial: The New AAOS Guidelines on Knee Arthroscopy for Degenerative Meniscus Tears are a Step in the Wrong Direction. Clin Orthop Relat Res 2022; 480:1-3. [PMID: 34870953 PMCID: PMC8673957 DOI: 10.1097/corr.0000000000002068] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S Leopold
- Editor-in-Chief, Clinical Orthopaedics and Related Research® , Philadelphia, PA, USA
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13
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Noorduyn JCA, Teuwen MMH, van de Graaf VA, Willigenburg NW, Schavemaker M, van Dijk R, Scholten-Peeters GGM, Heymans MW, Coppieters MW, Poolman RW. In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery. Knee Surg Sports Traumatol Arthrosc 2022; 30:231-238. [PMID: 33550450 PMCID: PMC8800906 DOI: 10.1007/s00167-021-06468-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Although physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscal tear, 24% still opt for meniscal surgery. The aim was to identify those patients with a degenerative meniscal tear who will undergo surgery following physical therapy. METHODS The data for this study were generated in the physical therapy arm of the ESCAPE trial, a randomized clinical trial investigating the effectiveness of surgery versus physical therapy in patients of 45-70 years old, with a degenerative meniscal tear. At 6 and 24 months patients were divided into two groups: those who did not undergo surgery, and those who did undergo surgery. Two multivariable prognostic models were developed using candidate predictors that were selected from the list of the patients' baseline variables. A multivariable logistic regression analysis was performed with backward Wald selection and a cut-off of p < 0.157. For both models the performance was assessed and corrected for the models' optimism through an internal validation using bootstrapping technique with 500 repetitions. RESULTS At 6 months, 32/153 patients (20.9%) underwent meniscal surgery following physical therapy. Based on the multivariable regression analysis, patients were more likely to opt for meniscal surgery within 6 months when they had worse knee function, lower education level and a better general physical health status at baseline. At 24 months, 43/153 patients (28.1%) underwent meniscal surgery following physical therapy. Patients were more likely to opt for meniscal surgery within 24 months when they had worse knee function and a lower level of education at baseline at baseline. Both models had a low explained variance (16 and 11%, respectively) and an insufficient predictive accuracy. CONCLUSION Not all patients with degenerative meniscal tears experience beneficial results following physical therapy. The non-responders to physical therapy could not accurately be predicted by our prognostic models. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julia C A Noorduyn
- Department of Orthopaedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - M M H Teuwen
- Department of Orthopaedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - V A van de Graaf
- Department of Orthopaedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
- Department of Orthopeadic surgery, Antonius ziekenhuis, Nieuwegein, The Netherlands
| | - N W Willigenburg
- Department of Orthopaedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - M Schavemaker
- Department of Radiology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - R van Dijk
- Department of Radiology, Isala, Zwolle, The Netherlands
| | - G G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - M W Coppieters
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
| | - R W Poolman
- Department of Orthopaedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
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14
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Berg B, Roos EM, Kise NJ, Engebretsen L, Holm I, Risberg MA. Muscle strength and osteoarthritis progression after surgery or exercise for degenerative meniscal tears: Secondary analyses of a randomized trial. Arthritis Care Res (Hoboken) 2021; 74:70-78. [PMID: 34151533 DOI: 10.1002/acr.24736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate muscle strength changes following partial meniscectomy or exercise therapy for degenerative meniscal tears and the relationship between baseline muscle strength and osteoarthritis progression. METHODS Secondary analysis of a randomized trial (n=140 participants). Isokinetic quadriceps and hamstrings strength (peak torque [N·m/kg] and total work [J/kg]) were assessed at baseline, three-, 12-month, and five-year follow-up. Between-group differences were analyzed using intention-to-treat linear mixed models. The relationship between baseline muscle strength and osteoarthritis progression (Kellgren and Lawrence, ≥1 grade increase) were assessed using logistic regression models. RESULTS We found statistically significant between-group differences favoring exercise therapy at three months (quadriceps: -0.30 N·m/kg, 95% CI -0.40, -0.20; hamstrings: -0.10 N·m/kg, 95% CI -0.15, -0.04) and 12 months (quadriceps: -0.13 N·m/kg, 95% CI -0.23, -0.03; hamstrings: -0.08 N·m/kg, 95% CI -0.14, -0.03). At five years, between-group differences were -0.10 N·m/kg (95% CI -0.21 to 0.01) for quadriceps and -0.07 N·m/kg (95% CI -0.13 to -0.01) for hamstrings. Quadriceps muscle weakness at baseline was associated with knee osteoarthritis progression over five years: adjusted odds ratio of 1.40 for every 0.2 N·m/kg decrease (95% CI 1.15 to 1.71). The adjusted odds ratio for hamstrings was 1.14 (95% CI 0.97-1.35) for every 0.1 N·m/kg decrease. CONCLUSION Exercise therapy was effective in improving muscle strength at three and 12-month follow-up compared to partial meniscectomy, but the effect was attenuated at five years. Quadriceps muscle weakness at baseline was associated with higher odds of osteoarthritis progression over five years.
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Affiliation(s)
- Bjørnar Berg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Nina Jullum Kise
- Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway
| | - Lars Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.,Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Inger Holm
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - May Arna Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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15
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Kaken H, Wang S, Zhao W, Asihaer B, Wang L. Arthroscopic Imaging Treatment and Clinical Rehabilitation of Knee Sports Injuries. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article studies the effects of arthroscopic imaging treatment and clinical rehabilitation of knee sports injuries. Arthroscopy was used to perform meniscus trimming and resection for 40 patients with knee sports injuries. The ages of the patients ranged from 20 to 60 years old.
All patients received routine rehabilitation training such as continuous passive motion of the knee joint, biofeedback of the lower limbs, and air pressure therapy of the lower limbs. In addition, the control group was given muscle strength training, and the training began after the patients
received the quadriceps muscle strength test. The removal of the joint cavity and the joint debridement has achieved satisfactory treatment results. In the experiment, the test cases were divided into two groups, and the sensor test platform was used for signal collection. Normal activities
can be resumed 2 weeks after the operation. After a follow-up of 6 to 24 months, the knee joint pain disappeared, the joint was free of swelling, and the knee function was normal up to 93%. Arthroscopic reconstruction of the anterior and posterior cruciate ligament joint repair/reconstruction
of the medial and posterolateral ligament knots is safe and feasible for the treatment of multiple ligament injuries of the knee joint. It has the advantages of less trauma and quick recovery. Early postoperative systemic and standardized rehabilitation exercises can obtain good knee joint
function.
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Affiliation(s)
- Habaxi Kaken
- Department of Joint Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, 830001, China
| | - Shanshan Wang
- Department of Radiology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, 830001, China
| | - Wei Zhao
- Department of Joint Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, 830001, China
| | - Baoerjiang Asihaer
- Department of Joint Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, 830001, China
| | - Li Wang
- Department of Joint Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, 830001, China
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16
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Ardern CL, Paatela T, Mattila V, Taimela S, Järvinen TLN. When taking a step back is a veritable leap forward. Reversing decades of arthroscopy for managing joint pain: five reasons that could explain declining rates of common arthroscopic surgeries. Br J Sports Med 2021; 54:1312-1313. [PMID: 33115728 PMCID: PMC7606570 DOI: 10.1136/bjsports-2020-102981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Clare L Ardern
- Sport & Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.,Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - Teemu Paatela
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Uusimaa, Finland.,Terveystalo Healthcare Services, Helsinki, Uusimaa, Finland
| | - Ville Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Simo Taimela
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Uusimaa, Finland.,Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Teppo L N Järvinen
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Uusimaa, Finland .,Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
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17
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Dolev A, Yaari L, Kittani M, Yassin M, Gbaren M, Feicht E, Shemesh S, Haviv B. Efficacy of Anti-inflammatory Treatment Versus Rescue Analgesia After Arthroscopic Partial Meniscectomy in Nonarthritic Knees: A 3-Arm Controlled Study. Orthop J Sports Med 2021; 9:2325967121991545. [PMID: 33796593 PMCID: PMC7983444 DOI: 10.1177/2325967121991545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background There is currently no consensus regarding the appropriate treatment for postoperative pain after arthroscopic partial meniscectomy (APM). Prescribing a mild non-anti-inflammatory protocol of rescue analgesia may be sufficient to avoid the side effects of opioids or anti-inflammatories. Purpose/Hypothesis The purpose was to compare the efficacy of pain reduction after APM in nonarthritic knees using betamethasone or celecoxib as anti-inflammatory analgesics versus acetaminophen or tramadol as rescue analgesics. The hypothesis was that there is no advantage for anti-inflammatories in achieving postoperative immediate pain relief after APM in nonarthritic knees compared with a simple nonopioid treatment. Study Design Cohort study; Level of evidence, 2. Methods This 3-arm controlled study evaluated postoperative pain levels and analgesic consumption in patients who underwent primary APM (under general anesthesia) at a single institution from December 2018 to December 2019. Patients were prospectively divided into 3 treatment groups: (1) betamethasone injection at the end of the procedure, (2) oral celecoxib prescription, or (3) neither treatment (control). All groups were instructed to take supplementary acetaminophen as needed. Patients were also allowed to take tramadol as needed to evaluate the need for opioids. At postoperative weeks 1, 2, and 3, patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subscale, and results were compared between time points and groups. Results A total of 99 patients were included in the treatment groups: betamethasone group (32 patients), celecoxib group (30 patients), and control group (37 patients). At baseline, there were no statistically significant differences between the groups in age, sex, body mass index, level of activity, comorbidities, or surgical findings. KOOS Pain scores improved at every time point for all 3 groups (P < .001), and no differences in scores were observed among groups. The consumption of acetaminophen or tramadol as rescue analgesia throughout the follow-up period was negligible among groups. Conclusion During the first 3 postoperative weeks after APM in nonarthritic knees, pain was efficiently controlled by betamethasone or celecoxib; however, pain was also efficiently controlled by minimal consumption of acetaminophen with negligible use of tramadol. Therefore, acetaminophen could be prescribed as an effective first-line postoperative analgesic after APM.
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Affiliation(s)
- Amir Dolev
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lee Yaari
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Kittani
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mustafa Yassin
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mahmod Gbaren
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elia Feicht
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Shemesh
- Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Haviv
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Beaufils P, Seil R, Becker R, Karlsson J, Menetrey J. The orthopaedic community does not oppose the non-surgical treatment of degenerative meniscal lesions. Knee Surg Sports Traumatol Arthrosc 2021; 29:329-332. [PMID: 33533960 DOI: 10.1007/s00167-020-06411-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Philippe Beaufils
- ESSKA Consensus Projects Advisor, ESSKA Office Centre Médical, Fondation Norbert Metz, 76, rue d'Eich, L-1460, Luxembourg, Luxembourg.
| | - Romain Seil
- ESSKA Past President, ESSKA Office Centre Médical, Fondation Norbert Metz, 76, rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - Roland Becker
- ESSKA Vice President, ESSKA Office Centre Médical, Fondation Norbert Metz, 76, rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden
| | - Jacques Menetrey
- ESSKA President, ESSKA Office Centre Médical, Fondation Norbert Metz, 76, rue d'Eich, L-1460, Luxembourg, Luxembourg
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19
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Feller JA. Evidence-based medicine at the coal front. ANZ J Surg 2021; 90:1225-1226. [PMID: 33448575 DOI: 10.1111/ans.15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/03/2020] [Indexed: 11/28/2022]
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20
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Xu HH, Li SM, Xu R, Fang L, Xu H, Tong PJ. Predication of the underlying mechanism of Bushenhuoxue formula acting on knee osteoarthritis via network pharmacology-based analyses combined with experimental validation. JOURNAL OF ETHNOPHARMACOLOGY 2020; 263:113217. [PMID: 32763417 DOI: 10.1016/j.jep.2020.113217] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Knee osteoarthritis (KOA) is the most common chronic joint disorder worldwide, which is also a principle consideration for disability. The Bushenhuoxue formula (BSHXF) is a traditional herbal formula which widely applied to the treatment of KOA. However, its pharmacological mechanisms of action have not been clarified. AIMS OF THE STUDY The study aimed to identify the potential targets and mechanisms of BSHXF in the treatment of KOA through pharmacology-based analyses and experimental validation. MATERIALS AND METHODS The TCMSP database was applied to obtain the chemical compounds and targets of BSHXF, while the protein targets in KOA were determined through GeneCards and OMIM databases. The herb-compound-target and protein-protein interaction (PPI) networks were constructed for topological analyses and hub-targets screening. GO and KEGG enrichment analyses were performed on these core nodes to identify the critical biological processes and signaling pathways. Then destabilization of medial meniscus (DMM)-induced C57BL/6J mice model was established to detect the level of apoptosis via TUNEL assessment, while the expressions of CASP3, CASP8 and CASP9 were determined by immunohistochemistry. RESULTS A total of 154 active compounds and 58 targets were predicted. DAVID, ClueGO and Metascape enrichment analyses all proved that BSHXF plays an essential role in regulating apoptosis. Moreover, 3 central nodes of BSHXF are recognized as the active factors involved in the main biological functions, suggesting a potential mechanism of BSHXF for KOA treatment. In vivo experiment revealed that BSHXF significantly inhibited apoptosis and down-regulated the expressions of CASP3, CASP8 and CASP9. CONCLUSION Based on network pharmacology and experimental validation, our study indicated that BSHXF exerted anti-apoptosis effect through inhibiting the expressions of CASP3, CASP8 and CASP9, which could be considered as an effective method for KOA treatment.
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Affiliation(s)
- Hui-Hui Xu
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China.
| | - Suo-Mi Li
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China.
| | - Rui Xu
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China.
| | - Liang Fang
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China.
| | - Hui Xu
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China.
| | - Pei-Jian Tong
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310051, Zhejiang, China; Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China.
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21
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Liu Q, Wu J. A commentary on "Arthroscopic Partial Meniscectomy Combined With Medical Exercise Therapy Versus Isolated Medical Exercise Therapy for Degenerative Meniscal Tear: A Meta-Analysis of Randomized Controlled Trials" (Int J Surg 2020 Jul; 79: 222-232). Int J Surg 2020; 82:229-230. [PMID: 32898665 DOI: 10.1016/j.ijsu.2020.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Qixi Liu
- Department of Nursing, Mindong Hospital of Fujian Medical University, Fujian Province, 355000, China
| | - Jingqing Wu
- Department of Bone and Joint Surgery, Mindong Hospital of Fujian Medical University, Fujian Province, 355000, China.
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22
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Ahmed I, Khatri C, Parsons N, Hutchinson CE, Staniszewska S, Price AJ, Metcalfe A. Meniscal Tear Outcome (METRO) review: a protocol for a systematic review summarising the clinical course and patient experiences of meniscal tears in the current literature. BMJ Open 2020; 10:e036247. [PMID: 32753448 PMCID: PMC7406020 DOI: 10.1136/bmjopen-2019-036247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Meniscal tears are a common knee injury with an incidence of 60 per 100 000. Management of meniscal tears can include either non-operative measures or operative procedures such as arthroscopic partial meniscectomy (APM). Despite substantial research evaluating the effectiveness of APM in the recent past, little is known about the clinical course or the experiences of patients with a meniscal tear. AIM To summarise the short to long-term patterns of variability in outcome in patients with a meniscal tear.To summarise the evidence on patient experiences of meniscal tears. In particular, we will focus on patient experiences of treatment options, treatment pathways and their views of the outcomes used in meniscal tear research. METHODS AND ANALYSIS Two search strategies will be developed to identify citations from EMBASE, MEDLINE, AMED, CENTRAL, Web of Science and Sociofile. The date of our planned search is 14 August 2020. For the quantitative review we will identify studies reporting patient-reported outcome measures in patients after a meniscal tear. The standardised mean change will be used to assess the variation in size of response and summarise the overall response to each treatment option. All studies will undergo quality assessment using either the Cochrane risk of bias or the Newcastle-Ottawa tool.A qualitative systematic review will be used to identify studies reporting views and experiences of patients with a meniscal tear. All studies will be assessed using the Critical Appraisal Skills Programme tool and if sufficient data are present a meta-synthesis will be performed to identify first, second and third-order constructs. ETHICS AND DISSEMINATION Given the nature of this study, no formal ethical approval will be sought. Results from the review will be disseminated at national conferences and will be submitted to a peer-reviewed journal for publication. Lay summaries will be freely available via the study Twitter page. PROSPERO REGISTRATION NUMBER CRD42019122179.
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Affiliation(s)
- Imran Ahmed
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Chetan Khatri
- Trauma and Orthopaedics, --University Hospital Coventry and Warwickshire, Coventry, West Midlands, UK
| | | | | | | | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Osteoarthritis progression after exercise therapy or meniscectomy in patients with degenerative meniscal tears. Osteoarthritis Cartilage 2020; 28:1147. [PMID: 32413466 DOI: 10.1016/j.joca.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 02/02/2023]
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Berg B, Roos EM, Kise NJ, Engebretsen L, Risberg MA. Response to Letter to the Editor: "Osteoarthritis progression after exercise therapy or meniscectomy in patients with degenerative meniscal tears". Osteoarthritis Cartilage 2020; 28:1148-1149. [PMID: 32416222 DOI: 10.1016/j.joca.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 02/02/2023]
Affiliation(s)
- B Berg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - E M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - N J Kise
- Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway.
| | - L Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway; Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.
| | - M A Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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Berg B, Roos EM, Englund M, Kise NJ, Tiulpin A, Saarakkala S, Engebretsen L, Eftang CN, Holm I, Risberg MA. Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial. Osteoarthritis Cartilage 2020; 28:897-906. [PMID: 32184135 DOI: 10.1016/j.joca.2020.01.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear. DESIGN Randomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed. RESULTS The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found. CONCLUSION The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy. TRIAL REGISTRATION www.clinicaltrials.gov (NCT01002794).
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Affiliation(s)
- B Berg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - E M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - M Englund
- Faculty of Medicine, Department of Clinical Sciences, Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden.
| | - N J Kise
- Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway.
| | - A Tiulpin
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - L Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway; Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.
| | - C N Eftang
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway.
| | - I Holm
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - M A Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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Trends in knee arthroscopy utilization: a gap in knowledge translation. Knee Surg Sports Traumatol Arthrosc 2020; 28:439-447. [PMID: 31359100 DOI: 10.1007/s00167-019-05638-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/17/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the longitudinal trends in knee arthroscopy utilization in relation to published negative randomized controlled trials, focusing on annual rates, patient demographics and associated 30-day post-operative complications. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify arthroscopy cases between 2006 and 2016. 30-day post-operative complications were identified, and potential risk factors analysed using univariate and multivariate analyses. RESULTS 68,346 patients underwent knee arthroscopy, of which 47,446 (69.5%) represented partial meniscectomies. The annual procedural rate, as a proportion of all reported cases, increased significantly from 2006 (0.3%) to 2016 (1.6%; p < 0.001), along with a significant increase in average patient age (44.3 ± 15.5 to 48.4 ± 14.5; p < 0.001). Specifically focusing on the meniscectomy cohort, average patient age significantly increased from 47.9 ± 15.1 to 50.7 ± 13.5 (p = 0.001). The overall incidence of complications was 2.0% (n = 1333), with major complications in 0.9% (n = 639) and minor complications in 1.0% (n = 701). Common complications included a return to the operating room (0.5%), deep vein thrombosis/thrombophlebitis (0.4%), and superficial infection (0.2%). Operating time > 90 min, diabetes, steroid use, ASA class 2+, and dialysis-dependency were the predictors of overall complication rates. CONCLUSION Despite the publication of negative trials and new clinical practice guidelines, knee arthroscopy utilization and average patient age continue to increase. Given the high utilization, even low adverse event rates equate to substantial numbers of patients with minor and major complications. The NSQIP data show a gap in knowledge translation to clinical practice and highlight the need for improved clinical guidelines. LEVEL OF EVIDENCE Cohort study; Level III.
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Jiang P, Cui J, Chen Z, Dai Z, Zhang Y, Yi G. Biomechanical study of medial meniscus after posterior horn injury: a finite element analysis. Comput Methods Biomech Biomed Engin 2020; 23:127-137. [PMID: 31931606 DOI: 10.1080/10255842.2019.1702167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We established an effective finite element model of knee joint for observation of stress and displacement of meniscus related changes after medial meniscus injury. Different types of medial meniscus injury can lead to varied meniscus stress and displacement changes. Stress and displacement concentration were found in fissure tip of meniscus tear compared to normal meniscus. The posterior horn injury of medial meniscus may initiate combined injury of medial meniscus posterior horn (MMPH) and that of medial meniscus body, and combined injury of MMPH and that of lateral meniscus anterior horn; fissure expansions regarding horizontal fissure, longitudinal fissure and grip-shaped fissure of MMPH were spotted.
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Affiliation(s)
- Peishi Jiang
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Juncheng Cui
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Zhiwei Chen
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Zhu Dai
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Yangchun Zhang
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Guoliang Yi
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
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Huan X, Jinhe Y, Rongzong Z. Identification of Pivotal Genes and Pathways in Osteoarthritic Degenerative Meniscal Lesions via Bioinformatics Analysis of the GSE52042 Dataset. Med Sci Monit 2019; 25:8891-8904. [PMID: 31758856 PMCID: PMC6884941 DOI: 10.12659/msm.920636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To better understand the process of osteoarthritic degenerative meniscal lesions (DMLs) formation, this study analyzed the dataset GSE52042 using bioinformatics methods to identify the pivotal genes and pathways related to osteoarthritic DMLs. Material/Methods The GSE52042 dataset, comprising diseased meniscus samples and healthier meniscus samples, was downloaded and the differentially-expressed genes (DEGs) were extracted. The reactome pathways assessment and functional analysis were performed using the “ClusterProfiler” package and “ReactomePA” package of Bioconductor. The protein–protein interaction network was constructed, followed by the extraction of hub genes and modules. Results A set of 154 common DEGs, including 64 upregulated DEGs and 90 downregulated DEGs, were obtained. GO analysis suggested that the DEGs primarily participated in positive regulation of the mitotic cell cycle and extracellular matrix organization. Reactome pathway analysis showed that the DEGs were predominantly enriched in TP53, which regulates transcription of genes involved in G2 cell cycle arrest and extracellular matrix organization. The top 10 hub genes were TYMS, AURKA, CENPN, NUSAP1, CENPM, TPX2, CDK1, UBE2C, BIRC5, and CCNB1. The genes in the 2 modules were primarily associated with M Phase and keratan sulfate degradation. Conclusions A series of pivotal genes and reactome pathways were identified elucidate the molecular mechanisms involved in the formation of osteoarthritic DMLs and to discover potential therapeutic targets.
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Affiliation(s)
- Xu Huan
- Department of Joint Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China (mainland)
| | - Ying Jinhe
- Department of Joint Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China (mainland)
| | - Zheng Rongzong
- Department of Joint Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China (mainland)
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Nonoperative Management Prior to Hip Arthroscopy for Femoroacetabular Impingement Syndrome: An Investigation Into the Utilization and Content of Physical Therapy. J Orthop Sports Phys Ther 2019; 49:593-600. [PMID: 31092124 DOI: 10.2519/jospt.2019.8581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There has been a significant increase in surgeries for femoroacetabular impingement syndrome in recent years, but little is known about the use of physical therapy prior to surgery. OBJECTIVES To investigate the use of physical therapy prior to hip arthroscopy for femoroacetabular impingement syndrome, by assessing the number of visits and use of exercise. A secondary objective was to evaluate whether comorbidities prior to surgery were associated with the use of physical therapy. METHODS In this retrospective observational cohort study, eligible participants between the ages of 18 and 50 years undergoing hip arthroscopy between 2004 and 2013 in the Military Health System were included. Patients were categorized based on whether they saw a physical therapist for their hip in the year prior to surgery. For physical therapy patients, dosing variables were identified, including total number of visits and visits that included an exercise therapy procedure code. RESULTS Of 1870 participants, 1106 (59.1%) did not see a physical therapist for their hip prior to surgery. For those who did, the median number of visits was 2. Only 220 (11.8%) had 6 or more unique visits with an exercise therapy procedure code. Exercise was coded in 43.4% to 63.0% of the total visits in each individual course of care (mean, 52.3%). There was an association between substance abuse and exercise utilization. No other comorbidities were associated with physical therapy or exercise therapy utilization. CONCLUSION Physical therapy was not commonly used before undergoing arthroscopic hip surgery by patients seeking care in the Military Health System. Further research is needed to understand the reasons for poor utilization and better define failed nonoperative management. LEVEL OF EVIDENCE Therapy, level 2b. J Orthop Sports Phys Ther 2019;49(8):593-600. Epub 15 May 2019. doi:10.2519/jospt.2019.8581.
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Cancienne JM, Kew ME, Smith MK, Carson EW, Miller MD, Werner BC. The Timing of Corticosteroid Injections Following Simple Knee Arthroscopy Is Associated With Infection Risk. Arthroscopy 2019; 35:1688-1694. [PMID: 31027921 DOI: 10.1016/j.arthro.2019.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/03/2019] [Accepted: 01/09/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine any association between the timing of ipsilateral postoperative corticosteroid injection following simple knee arthroscopy and infection. METHODS Private payer (PP) and Medicare (MC) national insurance databases were queried for patients who underwent simple arthroscopic knee procedures. Patients undergoing concomitant open or more complex procedures with grafts were excluded. Patients who underwent ipsilateral corticosteroid injections within 2, 4, 6, and 8 weeks postoperatively were then identified. Postoperative infection within 90 days after the injection was assessed using International Classification of Diseases, 9th Revision, and Current Procedural Terminology coding and compared using a multivariate binomial logistic regression analysis. RESULTS A total of 5,533 patients were identified, including 725 that received an injection within 2 weeks; 1,236 patients within 4 weeks; 1,716 patients within 6 weeks; and 1,856 patients that received an injection within 8 weeks postoperatively. In both the PP and MC datasets, the rate of infection was significantly higher in the 2-week group compared with the 6- (PP: odds ratio [OR] 3.81, P = .012; MC: OR 9.36, P = .001) and 8-week (PP: OR 8.59, P = .003; MC: OR 7.80, P = .001) groups. The rate of infection was also higher in the 4-week group compared with the 6- (PP: OR 2.54, P = .024; MC: OR 8.91, P = .001) and 8-week (PP: OR 5.64, P = .009; MC: OR 7.80, P = .001) groups. There was no difference in infection rates between the 2- and 4-week groups in either dataset (PP: P = .278; MC: P = .861). CONCLUSIONS There is a significant association between intra-articular knee corticosteroid injections within 4 weeks of surgery and an increased incidence of postoperative infection in both MC and PP patients after knee arthroscopy compared with patients with steroid injections more than 4 weeks postoperatively and matched controls who did not receive injections. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jourdan M Cancienne
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Michelle E Kew
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Marvin K Smith
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Eric W Carson
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A..
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Shriram D, Yamako G, Chosa E, Lee YHD, Subburaj K. Effects of a valgus unloader brace in the medial meniscectomized knee joint: a biomechanical study. J Orthop Surg Res 2019; 14:44. [PMID: 30755226 PMCID: PMC6373038 DOI: 10.1186/s13018-019-1085-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/01/2019] [Indexed: 12/17/2022] Open
Abstract
Background Patients undergoing total or partial arthroscopic meniscectomy for treating traumatic meniscal tears are at greater risk of developing knee osteoarthritis (OA) due to increased mechanical load. The purpose of this study was to evaluate the effects of a valgus unloader brace in the medial meniscectomized knee joint during the gait cycle. Methods A three-dimensional finite element model of the knee joint was developed using the substructures segmented from magnetic resonance images. Experimentally measured forces and moments for one complete gait cycle, without brace and with brace at three different alignment angles (0°, 4°, and 8°), were applied to the finite element model, and the changes in the tibiofemoral contact mechanics were estimated. Results The brace in 0°/4°/8° valgus alignment modes reduced the total contact force in the medial compartment by 16%/46%/82% at opposite toe off and 18%/17%/29% at opposite initial contact events, while it increased the total contact force in the lateral compartment by 31%/81%/110% at opposite toe off and 30%/38%/45% at opposite initial contact events, respectively, when compared to the unbraced meniscectomized knee. Conclusions Increasing the valgus alignment from 0° to 4° and 8° resulted in a greater reduction of contact conditions (total contact force, total contact area, peak contact pressure) in the medial compartment and vice versa in the lateral compartment. This decrease in contact conditions in the medial compartment infers enhanced knee joint function due to a valgus unloader brace, which translates to increased knee-related confidence. Results suggest choosing a higher valgus alignment angle could potentially increase the risk for the onset of osteoarthritis in the lateral compartment, and this computational model could be used in validating the effectiveness of braces on joint health. Electronic supplementary material The online version of this article (10.1186/s13018-019-1085-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duraisamy Shriram
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Go Yamako
- Department of Mechanical Design Systems, Faculty of Engineering, University of Miyazaki, 1-1 Gakuen Kibana-dai-nishi, Miyazaki, 889-2192, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yee Han Dave Lee
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore.
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Thorlund JB, Pihl K, Nissen N, Jørgensen U, Fristed JV, Lohmander LS, Englund M. Conundrum of mechanical knee symptoms: signifying feature of a meniscal tear? Br J Sports Med 2018; 53:299-303. [DOI: 10.1136/bjsports-2018-099431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 02/05/2023]
Abstract
BackgroundMechanical knee symptoms are often considered important in the decision to perform knee arthroscopy on the suspicion of a meniscal tear. We investigated if presence of a meniscal tear at knee arthroscopy in adults is associated with presence of preoperative self-reported mechanical knee symptoms.MethodsWe used data from Knee Arthroscopy Cohort Southern Denmark (KACS). KACS consists of patients aged 18 years or older referred to knee arthroscopy on the suspicion of a meniscal tear at four recruiting hospitals between 1 February 2013 and 31 January 2015. Of 1259 invited patients, 908 (72%) replied to the baseline questionnaire. With 91 patients excluded, the study sample consisted of 641 and 176 patientswithandwithouta meniscal tear confirmed at surgery, respectively. Exposure was meniscal tear as determined by the knee surgeon during arthroscopy. Main outcomes were preoperative mechanical knee symptoms defined as self-reported catching/locking or self-reported inability to straighten knee fully.Results55% of all patients reported symptoms of catching/locking and 47% were unable to straighten their knee fully. Preoperative mechanical symptoms were equally prevalent in patientswithandwithouta meniscal tear (prevalence ratio catching/locking 0.89, 95% CI 0.77 to 1.03, and inability to straighten knee fully, prevalence ratio 1.02, 95% CI 0.84 to 1.23).InterpretationPatient-reported mechanical symptoms were equally common irrespective of presence or absence of a meniscal tear in patients undergoing arthroscopy for suspicion of a meniscal tear. Our findings suggest that mechanical knee symptoms have a limited value when considering indication for meniscal surgery.Trial registration numberNCT01871272; Results.
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The Future of Health Is Self-Production and Co-Creation Based on Apomediative Decision Support. Med Sci (Basel) 2018; 6:medsci6030066. [PMID: 30135365 PMCID: PMC6165271 DOI: 10.3390/medsci6030066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/11/2018] [Accepted: 08/20/2018] [Indexed: 01/14/2023] Open
Abstract
Cultural changes are needed in medicine if the benefits of technological advances are to benefit healthcare users. The Digital Health Manifesto of ‘medical futurist’ doctor Bertalan Meskó and ‘e-patient’ Dave deBronkart, The Patient Will See You Now by Eric Topol and The Patient as CEO by Robin Farmanfarmaian, are among the proliferating warnings of the approaching paradigm shift in medicine, resulting, above all, from technological advances that gives users independent access to exponentially increasing amounts of information about themselves. We question their messages only in suggesting they do not sufficiently shift the focus from ‘patient’ to ‘person’ and consequently fail to recognise the need for the credible, efficient, ethical and independent decision support that can ensure the ‘democratisation of knowledge’ is person empowering, not overpowering. Such decision support can ensure the ‘democratisation of decision,’ leading to higher quality decisions and fully-informed and preference-based consent to health provider actions. The coming paradigm will therefore be characterised by apomediative (‘direct-to-consumer’) decision support tools, engaged with by the person in the community to help them make health production decisions for themselves (including whether to consult a healthcare professional or provider), as well as intermediative (‘direct-from-clinician’) tools, delivered by a health professional in a ‘shared decision making’ or ‘co-creation of health’ process. This vision paper elaborates on the implementation of these preference-sensitive decision support tools through the technique of Multi-Criteria Decision Analysis.
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