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Regenerative Therapy Jun 2024Bone repair via endochondral ossification is a complex process for the critical size reparation of bone defects. Tissue engineering strategies are being developed as... (Review)
Review
Bone repair via endochondral ossification is a complex process for the critical size reparation of bone defects. Tissue engineering strategies are being developed as alternative treatments to autografts or allografts. Most approaches to bone regeneration involve the use of calcium composites. However, exploring calcium-free alternatives in endochondral bone repair has emerged as a promising way to contribute to bone healing. By analyzing researches from the last ten years, this review identifies the potential benefits of such alternatives compared to traditional calcium-based approaches. Understanding the impact of calcium-free alternatives on endochondral bone repair can have profound implications for orthopedic and regenerative medicine. This review evaluates the efficacy of calcium-free alternatives in endochondral bone repair through trials. The findings may guide future research to develop innovative strategies to improve endochondral bone repair without relying on calcium. Exploring alternative approaches may lead to the discovery of novel therapies that improve bone healing outcomes.
PubMed: 38872977
DOI: 10.1016/j.reth.2024.05.017 -
Orthopaedic Journal of Sports Medicine Jun 2024Patellar instability is frequently encountered in patients with Ehlers-Danlos syndrome (EDS). The clinical outcomes of isolated medial patellofemoral ligament...
BACKGROUND
Patellar instability is frequently encountered in patients with Ehlers-Danlos syndrome (EDS). The clinical outcomes of isolated medial patellofemoral ligament reconstruction (MPFLR) for patellar instability in patients with EDS are unknown.
PURPOSE
To evaluate midterm clinical outcomes of isolated MPFLR for patellar instability in patients with EDS and factors affecting these outcomes.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
In a retrospective study, 31 patients (n = 47 knees) with EDS and patellar instability who underwent isolated MPFLR for recurrent patellar instability between 2008 and 2017 and had a minimum 2-year follow-up were identified. Preoperative radiographic images were measured for anatomic risk factors. Clinical outcomes-including postoperative complications-were evaluated. Factors associated with MPFLR failure were identified. Postoperative patient-reported outcomes (PROs)-including the pediatric version of the International Knee Documentation Committee, the Kujala score, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale, the Banff Patellofemoral Instability Instrument 2.0, and the Knee injury and Osteoarthritis Outcome Score-were collected, and factors affecting PRO scores were analyzed.
RESULTS
The mean age of the cohort was 14.9 ± 2 years. At a mean follow-up of 7.2 years, 18 of 47 (38.3%) knees required reoperations, of which 9 of 47 (19.1%) knees required revision stabilization for recurrent patellar instability. Also, 7 of 31 knees (22.6%) with autografts failed compared with 2 of 16 (12.5%) with allografts ( = .69). For autografts, 6 of 17 (35.3%) failures occurred with gracilis, but 0 of 13 (0%) occurred with semitendinosus ( = .02). Compared with patients without failures, patients with failed primary MPFLR were significantly younger ( = .0005) and were able to touch the palm to the floor with their knees extended ( = .03). For radiographic parameters, the patellar height and tilt were significantly higher in the failure group. The postoperative PROs were suboptimal at a mean follow-up of 5.2 years. All but 1 patient were satisfied with the final outcome.
CONCLUSION
At the midterm follow-up, 38.3% of patients with EDS required further surgery after isolated MPFLR for patellar instability; half of these revisions (19.1%) were to address recurrent instability. Recurrent instability after isolated MPFLR was more likely in younger patients and those who could touch the palm to the floor with their knees extended. Postoperative PROs were inferior; nonetheless, patient satisfaction was high.
PubMed: 38845609
DOI: 10.1177/23259671241241096 -
Orthopaedic Journal of Sports Medicine Jun 2024Several approaches to surgical techniques and graft types exist in posterolateral corner (PLC) reconstruction. The literature lacks knowledge regarding outcomes after... (Review)
Review
BACKGROUND
Several approaches to surgical techniques and graft types exist in posterolateral corner (PLC) reconstruction. The literature lacks knowledge regarding outcomes after autograft versus allograft reconstruction for PLC injuries.
PURPOSE
To comprehensively review the current literature on PLC reconstruction and compare outcomes between autograft and allograft tissues.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
The PubMed and Scopus online databases were searched with the terms "PLC,""posterolateral knee,""posterolateral corner," and "reconstruction" in varying combinations. Patient characteristics, graft type, graft failure, surgical techniques, functional outcome scores, and varus laxity on stress radiographs were reviewed and compared between PLC reconstruction with autografts versus allografts.
RESULTS
Included were 22 studies comprising 33 cohorts: 16 autografts (n = 280 knees) and 17 allografts (336 knees). There were 69 isolated PLC reconstructions (58 allografts and 11 autografts) and 493 multiligament reconstructions (269 autografts and 224 allografts). There was no difference in the mean patient age (30.5 vs 33.5 years, respectively; = .11) or mean follow-up (39.5 vs 37.7 months, respectively; = .68) between the autograft and allograft groups. There was no evidence to suggest a difference in graft failures between graft types (pooled mean autograft vs allograft: 0.44 vs 0.41 failures; = .95). There was a significant difference in the mean postoperative Lysholm scores for autografts versus allografts (89.6 vs 85.5, respectively; = .04). There was no difference between the cohorts in preoperative or postoperative International Knee Documentation Committee (IKDC) scores or postoperative varus laxity.
CONCLUSION
Our review and meta-analysis indicated no significant differences in graft failure rates or objective outcomes after PLC reconstruction based on graft type alone. There was a significant difference in postoperative Lysholm scores in favor of the autograft group and no significant difference in IKDC subjective scores.
PubMed: 38840793
DOI: 10.1177/23259671241247542 -
Arthroscopy Techniques May 2024Patellar tendinopathy is an overuse injury of the patella tendon common in jumping sports or activities. Degeneration of the patellar tendon fibers causes microtears in...
Patellar tendinopathy is an overuse injury of the patella tendon common in jumping sports or activities. Degeneration of the patellar tendon fibers causes microtears in the tendon, leading to partial patellar tendon tears. If nonoperative treatment fails and the tears are mild, a debridement of the detached tissue with a patella tendon repair can help to reduce pain, promote healing, and improve function. However, if more than 50% of the patella tendon attachment to the inferior pole of the patella is detached, a debridement with a patellar tendon reconstruction is indicated to restore the strength of the patellar tendon. This reconstruction technique uses gracilis and semitendinosus autografts to surround and reconstruct the patellar tendon. Tunnels are drilled horizontally at the tibial tubercle and through the midpoint of the patella for graft passage. This technique can help to improve patient outcomes and reduce some of the risk of failure associated with performing only the debridement when significant partial patellar tendon tearing is present.
PubMed: 38835451
DOI: 10.1016/j.eats.2024.102931 -
Sultan Qaboos University Medical Journal May 2024This technical note aimed to present a straigthforward method for harvesting quadriceps tendon autografts with the use of a simple vaginal speculum and direct...
The Use of a Simple Vaginal Speculum to Harvest Quadriceps Tendon Autografts for Anterior Cruciate Ligament Reconstruction and Avoid Any Potential Pitfalls during Harvesting Procedure: Technical note.
This technical note aimed to present a straigthforward method for harvesting quadriceps tendon autografts with the use of a simple vaginal speculum and direct visualisation of a scope. Anterior cruciate ligament reconstruction with quadriceps tendon autografts has gained popularity in recent years, with many harvesting techniques that use different harvesting systems available on the market. These techniques vary from transverse to longitudinal skin incisions and from open to minimally invasive approaches and have a learning curve, as with the majority of surgical procedures. The technique proposed in this technical note is minimally invasive, can be easily reproduced by any surgeon irrespective of their experience, has a short learning curve, requires no additional cost or technical support during the procedure and creates a stable working space that allows for freedom of manipulation of surgical instruments and the arthroscope.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Female; Autografts; Tissue and Organ Harvesting; Tendons; Quadriceps Muscle; Transplantation, Autologous; Surgical Instruments
PubMed: 38828237
DOI: 10.18295/squmj.3.2024.016 -
Bioactive Materials Sep 2024Addressing peripheral nerve defects remains a significant challenge in regenerative neurobiology. Autografts emerged as the gold-standard management, however, are...
Addressing peripheral nerve defects remains a significant challenge in regenerative neurobiology. Autografts emerged as the gold-standard management, however, are hindered by limited availability and potential neuroma formation. Numerous recent studies report the potential of wireless electronic system for nerve defects repair. Unfortunately, few has met clinical needs for inadequate electrode precision, poor nerve entrapment and insufficient bioactivity of the matrix material. Herein, we present an advanced wireless electrical nerve stimulator, based on water-responsive self-curling silk membrane with excellent bioabsorbable and biocompatible properties. We constructed a unique bilayer structure with an oriented pre-stretched inner layer and a general silk membrane as outer layer. After wetting, the simultaneous contraction of inner layer and expansion of outer layer achieved controllable super-contraction from 2D flat surface to 3D structural reconfiguration. It enables shape-adaptive wrapping to cover around nerves, overcomes the technical obstacle of preparing electrodes on the inner wall of the conduit, and prevents electrode breakage caused by material expansion in water. The use of fork capacitor-like metal interface increases the contact points between the metal and the regenerating nerve, solving the challenge of inefficient and rough electrical stimulation methods in the past. Newly developed electronic stimulator is effective in restoring 10 mm rat sciatic nerve defects comparable to autologous grafts. The underlying mechanism involves that electric stimulation enhances anterograde mitochondrial transport to match energy demands. This newly introduced device thereby demonstrated the potential as a viable and efficacious alternative to autografts for enhancing peripheral nerve repair and functional recovery.
PubMed: 38827170
DOI: 10.1016/j.bioactmat.2024.05.033 -
Orthopaedic Journal of Sports Medicine May 2024During anterior cruciate ligament (ACL) reconstruction, there are various autograft options. Donor-site morbidity is an important consideration while deciding the type...
BACKGROUND
During anterior cruciate ligament (ACL) reconstruction, there are various autograft options. Donor-site morbidity is an important consideration while deciding the type of the autograft. Gracilis and semitendinosus autografts are commonly used in ACL reconstruction, resulting in weakness of the hamstring muscle.
HYPOTHESIS
We hypothesized that if we preserved the tibial insertion site of the sartorial fascia (SF) during hamstring tendon harvest, there would be better recovery of knee flexor strength.
STUDY DESIGN
Case-control study; Level of evidence, 3.
METHODS
In this retrospective study, 34 patients (aged 20-59 years) underwent ACL reconstruction using hamstring tendon autograft with 2 different incision techniques on the SF. The tibial attachment site of the SF was preserved in 17 patients. The insertion site of the muscle was incised transversely in 17 patients. The follow-up duration was ≥2 years. Patients were recalled to the institute for examination and muscle strength assessment. The results were compared between the groups in terms of flexor and extensor knee isokinetic muscle strength at 60 and 180 deg/s.
RESULTS
There was no statistical difference between the groups in terms of age, sex, or body mass index. When compared with patients whose SF attachment site was incised, patients with a preserved SF tibial insertion were found to have a higher flexion peak torque at the angular speed of 180 deg/s ( < 002). No statistically significant difference was noted at 60 deg/s.
CONCLUSION
During collection of gracilis and semitendinosus autografts, preserving the SF tibial attachment site was associated with better knee flexion peak torque.
PubMed: 38827139
DOI: 10.1177/23259671241248079 -
Injury Jul 2024Atrophic pseudoarthrosis is a serious complication with an incidence of 5-10 % of bone fractures located in the diaphysis of long bones. Standard treatments involve... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Treatment of non-hypertrophic pseudoarthrosis of long bones with a Tissue Engineered Product loaded with autologous bone marrow-derived Mesenchymal Stromal Cells: Results from a phase IIa, prospective, randomized, parallel, pilot clinical trial comparing to iliac crest autograft.
BACKGROUND
Atrophic pseudoarthrosis is a serious complication with an incidence of 5-10 % of bone fractures located in the diaphysis of long bones. Standard treatments involve aggressive surgical procedures and re-interventions requiring the use of autografts from the iliac crest as a source of bone-forming biological activity (Standard of Care, SoC). In this context, regenerative ex vivo expanded osteogenic cell-based medicines could be of interest. Particularly, Mesenchymal Stromal Cells (MSC) offer new prospects to promote bone tissue repair in pseudoarthrosis by providing biological activity in an osteoconductive and osteoinductive environment.
METHODS
We conducted a phase IIa, prospective, randomised, parallel, two-arms, open-label with blinded assessor pilot clinical trial to compare SoC vs. a tissue-engineered product (TEP), composed of autologous bone marrow (BM)-derived MSCs loaded onto allogeneic decellularised, lyophilised spongy bone cubes, in a cohort of 20 patients with non-hypertrophic pseudoarthrosis of long bones. Patients were followed up for 12 months. Radiological bone healing was evaluated by standard X-ray and computed tomography (CT) scanning. Quality of life was measured using the EUROQOL-5D questionnaire.
RESULTS
Ten patients were randomized to TEP and 10 to SoC with iliac crest autograft. Manufacturing of TEP was feasible and reproducibly achieved. TEP implantation in the bone defect was successful in all cases and none of the 36 adverse events (AE) reported were related to the treatment. Efficacy analyses were performed in the Full Analysis Set (FAS) population, which included 17 patients after 3 patients withdrew from the study. The degree of consolidation, estimated by measuring Hounsfield units (HU) on CT, showed no significant differences between the two treatment groups at 12 months post treatment (main efficacy variable) (p = 0.4835) or at 6 months.
CONCLUSIONS
Although only a small number of patients were included in our study, it is notable that no significant differences were observed between the experimental treatment and SoC, thus suggesting TEP as an alternative where autograft is not available or contraindicated.
Topics: Humans; Pseudarthrosis; Male; Female; Pilot Projects; Mesenchymal Stem Cell Transplantation; Middle Aged; Prospective Studies; Ilium; Transplantation, Autologous; Tissue Engineering; Treatment Outcome; Adult; Mesenchymal Stem Cells; Aged; Bone Transplantation; Quality of Life; Autografts
PubMed: 38797000
DOI: 10.1016/j.injury.2024.111596 -
Journal of Clinical Medicine May 2024: Although acute anterior cruciate ligament reconstruction (ACLR) is often avoided because of postoperative joint stiffness, delayed ACLR can lead to a longer recovery...
: Although acute anterior cruciate ligament reconstruction (ACLR) is often avoided because of postoperative joint stiffness, delayed ACLR can lead to a longer recovery time and can have a negative impact on physical function due to detraining. This study aimed to determine the effects of acute ACLR on postoperative outcomes, including muscle strength, performance, and return to sports. : A total of 110 patients who underwent anatomical ACLR using hamstring autografts were included in this study and were divided into three groups: acute (ACLR performed within 2 weeks after ACL injury), 2-6 weeks (ACLR performed between 2 and 6 weeks after injury), and 6-12 weeks (ACLR performed between 6 and 12 weeks after injury). Several parameters were evaluated, including range of motion, knee joint stability, isokinetic knee strength, performance, and return to sports. : No significant differences were found in the range of motion or knee joint stability between the groups. The acute group exhibited significantly greater quadriceps strength at 3 months postoperatively than the other groups ( < 0.05). The single-leg hop test showed that 66.7%, 38.7%, and 33.3% of the patients in the acute, 2-6 weeks, and 6-12 weeks groups, respectively, recovered to an LSI of 90% or greater ( = 0.09, Cramer's V = 0.27). All patients in the acute group were able to return to sports ( = 0.14; Cramer's V = 0.28). : Acute ACLR is advantageous for the early recovery of strength and performance without adverse events. Acute ACLR may shorten the time spent away from sports activities.
PubMed: 38792535
DOI: 10.3390/jcm13102994 -
Journal of Orthopaedics Oct 2024Hypermobility describes the movement of joints beyond normal limits. Whether hypermobility predisposes to patellar instability is yet to be established. We aimed to... (Review)
Review
INTRODUCTION
Hypermobility describes the movement of joints beyond normal limits. Whether hypermobility predisposes to patellar instability is yet to be established. We aimed to determine if joint hypermobility leads to an increased risk of patellar instability, and to evaluate outcomes of treatment for patellar instability in those who exhibit hypermobility.
METHODS
Published and unpublished literature databases were searched to September 7, 2023. Studies comparing prevalence of patellar dislocation/differences in treatment outcomes in patients with and without hypermobility were included.
RESULTS
We identified 18 eligible studies (4,391 patients). The evidence was low in quality. A case series on 82 patients found that there was a relationship between generalised joint laxity and patellar instability. This was corroborated by a study comparing 104 patients with patellar dislocation to 110 patients without. Prevalence of generalised joint laxity was six time higher in the former (64.4% vs 10.9%, p < 0.001).Five studies found surgical intervention aimed at correcting patellar dislocation in patients with idiopathic hypermobility led to satisfactory outcomes. There was conflicting evidence regarding if hypermobile patients have worse outcomes than non-hypermobile patients following medial patellofemoral ligament reconstruction (MPFLR) in two studies. In addition, this procedure had a 19.1% failure rate in patients with Ehlers Danlos Syndrome (EDS), with hypermobility associated with a higher failure rate (p = 0.03). One study showed the type of graft used made no difference in outcome scores or re-dislocation rates (p > 0.5). Another study had 7/31 (22.6%) autografts which failed, compared to 2/16 allografts (12.5%) (p = 0.69).
CONCLUSION
Joint hypermobility is a risk factor for patellar instability. Identification of at-risk groups may aid prevention of dislocations and allow for appropriate treatment. Patients with EDS experience poor outcomes following patellar stabilization surgery, with post-operative monitoring required.
PubMed: 38784948
DOI: 10.1016/j.jor.2024.05.009