Meniscal allograft transplantation improves patient-reported outcomes in both minimal and moderate knee osteoarthritis at 1 and 2 years postoperatively

PURPOSE

Severe cartilage damage and advanced knee osteoarthritis (OA) might be associated with poor outcomes of meniscal allograft transplantation (MAT). The purpose of this prospective follow-up study was to explore MAT survivorship and patient satisfaction among young patients with symptomatic meniscal deficiency and radiological OA of different Kellgren-Lawrence (K-L) grades.

METHODS

Thirty-five consecutive MAT patients were prospectively followed up for 2 years. The lateral meniscus was replaced in 29 patients and the medial meniscus in 6 patients. Outcomes were assessed using the KOOS4 composite score, KOOS subscales, Lysholm knee score, and OA K-L grade progression from weight-bearing knee radiographs. For the outcome analysis, patients were categorized into two groups: 19 in Group A (K-L classification 0-1) and 16 in Group B (K-L classification 2).

RESULTS

In terms of KOOS4 and Lysholm scores, the patients showed a clinically significant improvement from baseline to the 1-year follow-up (22.2 points, 95% CI 16.6-27.8 for KOOS4 and 16.8 points, 95% CI 8.9-24.6 for Lysholm), and the improvement remained at 2 years (20.6 points, 95% CI 13.2-28.1 for KOOS4 and 21.5, 95% CI 12.5-30.7 for Lysholm). At the 6-month follow-up, this improvement was not yet observed. Minor between-group differences were observed in the KOOS4 and Lysholm scores for the K-L 0-1 and K-L 2 OA groups, but the estimates were imprecise with wide confidence intervals. A clinically relevant difference between these two study groups could not be found at any timepoint. The reoperation rate was higher in the K-L 2 group than in the K-L 0-1 group (31% vs. 11%).

CONCLUSIONS

MAT yielded improved patient-reported outcomes and subjective satisfaction at 1 and 2 years postoperatively. The differences from baseline exceeded the minimal clinically important difference (MCID) at all timepoints. The severity of cartilage damage and knee OA in terms of the K-L grade at the time of surgery did not affect the KOOS and Lysholm scores after the MAT procedure. Knee OA progression in terms of K-L grade worsening was not observed in any patients.

LEVEL OF EVIDENCE

III.

Higher Soong grade predicts flexor tendon issues after volar plating of distal radius fractures - a retrospective cohort study

BACKGROUND AND PURPOSE

Soong classification is used to estimate volar locking plate prominence and evaluate the risk for flexor tendon ruptures after surgical treatment of distal radius fractures (DRFs). However, the scientific community has questioned the Soong classification due to lacking evidence. Therefore, this study aimed to evaluate the accuracy of Soong grading as a predictor for flexor tendon issues and plate removal.

PATIENTS AND METHODS

We performed a retrospective single-center review of adult distal radius fracture patients treated with a volar locking plate between 2009 and 2019. In total, 2779 patients were included in the study. The primary outcome was a flexor tendon issue (flexor tendon rupture, tendinitis, or flexor irritation), whereas plate removal was a secondary outcome. Using Soong grade 0 as a reference, we used univariable and multivariable logistic regression to calculate odds ratios (OR) with 95% confidence intervals (CI) for flexor tendon issues and plate removal.

RESULTS

In total, 756 (27%) patients were graded as Soong 0, 1679 (60%) Soong 1, and 344 (12%) Soong 2, respectively. There were 32 (1.2%) patients with flexor tendon issues, of which 4 were flexor tendon ruptures, 8 tendinitises, and 20 flexor irritations. The adjusted OR for flexor tendon issues was 4.4 (CI 1.1-39.7) for Soong grade 1 and 9.7 (CI 2.2-91.1) for Soong grade 2. The plate was removed from 167 (6.0%) patients. Soong grade 1 had a univariable OR of 1.8 (CI 1.2-2.8) for plate removal, and Soong grade 2 had an OR of 3.5. (CI 2.1-5.8), respectively.

CONCLUSION

Flexor tendon ruptures are rare complications after the volar plating of DRFs. A higher Soong grade is a risk factor for flexor tendon issues and plate removal.

TRIAL REGISTRATION

The trial was retrospectively registered.

ISSLS prize in clinical science 2022: accelerated disc degeneration after pubertal growth spurt differentiates adults with low back pain from their asymptomatic peers

PURPOSE

In this prospective observational cohort study, the development of lumbar intervertebral discs (LIVD) on magnetic resonance imaging (MRI) was investigated from childhood to adulthood with emphasis on the possible association of disc degeneration (DD) to low back pain (LBP).

METHODS

In 2021, 89 subjects who were enrolled in 1994 in a longitudinal study with lumbar spine MRI at ages 8, 11 and 18 were invited to participate in a long-term follow-up comprising a clinical examination, selected patient-reported outcome measures and a lumbar spine MRI. We assessed all MRIs (three lowest LIVDs) with the Pfirrmann summary score, and the ratio of signal intensity of nucleus pulposus to signal intensity of cerebrospinal fluid (SINDL). We further analyzed whether disc changes at any age were associated with self-reported LBP at age 34.

RESULTS

Of the 48 subjects in the follow-up, 35 reported LBP at age 34. The Pfirrmann summary score significantly increased with age (p < 0.001). Subjects reporting LBP at age 34 demonstrated statistically significantly higher summary scores at age 18 and 34 compared to asymptomatic subjects (p = 0.004 at age 18, and p = 0.039 at age 34). SINDL significantly decreased with age (p < 0.001 for all levels separately), but no significant differences between subjects with or without LBP at age 34 were noticed.

CONCLUSION

Subjects with LBP at age 34 had more widespread or severe DD already at age 18 compared to those without LBP.

Perioperative platelet rich plasma (PRP) in total hip arthroplasty through the Hardinge approach: protocol to study the effectiveness for gluteus medius healing

Background

Platelet-rich plasma (PRP) has been used to support tendon regeneration mainly in sports medicine. PRP is a concentrate of platelet-rich plasma proteins derived from whole blood by centrifugation to remove erythrocytes and leukocytes. PRP has high amounts of platelets which may promote healing tendons affected by degenerative conditions. These platelets contain growth factors and are known to facilitate the regeneration of injured tendon structures. Total hip arthroplasty (THA) through the Hardinge approach may leave the patient with impaired gait and poor regeneration of the gluteus medius tendon if the tendon is not reattached properly after closure of the surgical wound.

Methods

The study will be a multicenter, double-blinded and randomized study enrolling 90 patients based on power calculations. The efficacy of perioperative PRP treatment will be assessed by subjective and objective outcome variables. The participants will be randomized (sealed envelope) into either a placebo (saline) or a PRP group (1:1). For subjective outcomes, the Oxford Hip Score (OHS) will be collected before surgery and 3 and 12 months after surgery. The objective measures are findings at magnetic resonance imaging and plain radiographs and recorded values of measured strength.

Discussion

We present the perioperative use and the ways to measure the clinical efficacy of PRP. As PRP may have benefits regarding degenerative tendon regeneration, studies on the use of PRP in hip arthroplasty are warranted to facilitate postoperative recovery.

Trial registration

This study has been approved by the ethics committee of the Hospital District of Southwest Finland and approved by the local institutional research board. The study has been registered in ClinicalTrials.gov (NCT02607462).

Physician-prescribed medication use by the Finnish Paralympic and Olympic athletes

OBJECTIVE

Data about medication use by Paralympic athletes (PAs) are limited and no data concerning medication use outside Paralympics exist. The objective of the current study was to compare the use of physician-prescribed medication in PAs and Olympic athletes (OAs).

DESIGN

A cross-sectional comparative study.

SETTING

Finnish PAs and OAs receiving financial support from the Finnish Olympic and Paralympic committee in 2006 and 2009, respectively.

PARTICIPANTS

A total of 92 PAs (response rate, 75.0%; 92 of 123) and 372 OAs (response rate, 91.9%; 372 of 405) participated.

ASSESSMENT OF RISK FACTORS

Age, sex, and type of athlete (PA vs OA) were included as independent covariates in the logistic regression model analysis.

MAIN OUTCOME MEASURES

The use of physician-prescribed medication among athletes during the previous 7 days and 12 months.

RESULTS

Among the PAs, the use of physician-prescribed medicines (48.9% vs 33.3%; adjusted odds ratio, 1.99; 95% confidence interval, 1.13-3.51), painkillers (2.61; 1.18-5.78), oral antibiotics (4.10; 1.30-12.87), and anti-epileptic medicines (37.09; 5.92-232.31) were more common than among the OAs during the previous 7 days. Paralympic athletes had used significantly less asthma medicines than the OAs during the previous 7 days (4.3% vs 11.0%; adjusted odds ratio, 0.30; 95% confidence interval, 0.10-0.96).

CONCLUSIONS

The use of any physician-prescribed medicines, especially those to treat chronic diseases, seems to be more common among the PAs than the OAs. Paralympic athletes use significantly less asthma medicines than OAs.

Asthma medication is increasingly prescribed for finnish olympic athletes--for a reason?

BACKGROUND

Use of asthma medication is common among athletes. In 2009, the World Anti-Doping Committee (WADA) and the International Olympic Committee removed the need to document asthma by lung function tests before the use of inhaled β2-agonists.

METHODS

We assessed the changes in asthma medication use in Finnish Olympic athletes 8 years apart in 2002 (N = 446) and 2009 (N = 372). The athletes filled out a questionnaire on asthma symptoms, diagnosis, and medication.

RESULTS

The use of asthma medication increased from 9.4% in 2002 to 12.6% in 2009 (adjusted odds ratio (OR) = 1.71, 95% confidence interval (CI) 1.08-2.69). Fixed combinations of inhaled long-acting β2-agonists (LABAs) and inhaled corticosteroids (ICSs) were used three times more in 2009 vs. 2002 (OR = 3.38, 95% CI 1.26-9.12). At the same time, no significant changes were observed in the occurrences of physician-diagnosed asthma (13.9% vs. 15.9%) or wheezing (10.3% vs. 10.2%). In 2002, all athletes on asthma medication also had a physician-diagnosed disease, but in 2009, 11.8% of the athletes on medication were lacking it.

CONCLUSIONS

Especially, the use of combination therapy of LABAs and ICSs is increasing among Finnish Olympic athletes. This trend is worrying as it is not based on increasing occurrence of symptoms, asthma diagnoses, or objective lung function measurements. More data, also from other countries, are needed to change recommendations or WADA rules.