Purpose The purpose of this study was to systematically review the basic science evidence for the use of platelet-rich plasma (PRP) in the treatment of pathologic processes of cartilage, both as an ...adjunct to cartilage repair and as a conservative management strategy for osteoarthritis, with the intent of determining the effect of PRP and whether a proof of concept for its use has been established to facilitate further investigation at a clinical level. Methods Using the terms “platelet-rich plasma OR PRP OR autologous conditioned plasma OR ACP AND cartilage OR chondrocytes OR chondrogenesis OR osteoarthritis OR arthritis” we searched EMBASE and PubMed/Medline in April 2012. Two authors performed the search, 3 authors independently assessed the studies for inclusion, and 2 authors extracted the data. Extracted data included cytologic analysis of PRP, study design, and results. Results Twenty-one studies (12 in vitro, 8 in vivo, one in vitro and in vivo) met the inclusion criteria. The effects of PRP in these studies included increasing chondrocyte and mesenchymal stem cell proliferation, proteoglycan deposition, and type II collagen deposition. PRP was also found to increase the cell viability of chondrocytes and the migration and chondrogenic differentiation of mesenchymal stem cells (MSCs) and to inhibit the effect of catabolic cytokines. In vivo, PRP was used as an adjunct to concomitant surgical management, including microfracture surgery and implant, scaffold, and graft insertion. Not all studies concluded that PRP has a positive effect on cartilage repair. Conclusions The current basic science evidence suggests that PRP has several potential effects on cartilage repair and osteoarthritis, and a proof of concept has been established. Well-designed randomized controlled trials (RCTs) are needed to extrapolate this evidence to the clinical setting.
Purpose This study compares retrospective functional and magnetic resonance imaging (MRI) outcomes after arthroscopic bone marrow stimulation (BMS) with and without concentrated bone marrow aspirate ...(cBMA) as a biological adjunct to the surgical treatment of osteochondral lesions (OCLs) of the talus. Methods Twenty-two patients who underwent arthroscopic BMS with cBMA (cBMA/BMS group) for an osteochondral lesion (OCL) of the talus and 12 patients who underwent arthroscopic BMS (BMS alone) for an OCL of the talus were retrospectively reviewed. The Foot and Ankle Outcome Score (FAOS) pain subscale and Short Form 12 general health questionnaire physical component summary score (SF-12 PCS) provided patient-reported outcome scores pre- and postoperatively. MRI scans were assessed postoperatively using the magnetic resonance observation of cartilage repair tissue (MOCART) score. All patients had postoperative MRI performed at the 2-year postoperative visit, and quantitative T2 mapping relaxation time values were assessed in a subset of the cBMA/BMS group. Results The mean FAOS and SF-12 PCS scores improved significantly pre- to post-operatively ( P < .01) at a mean follow-up of 48.3 months (range, 34 to 82 months) for the cBMA/BMS group and 77.3 months (range, 46 to 100 months) for the BMS-alone group. The MOCART score in the cBMA/BMS group was significantly higher than that in the BMS-alone group ( P = .023). Superficial and deep T2 relaxation values in cBMA/BMS patients were higher in repair tissue compared with measurements in adjacent native articular cartilage ( P = .030 and P < .001, respectively). Conclusions BMS is an effective treatment strategy for treatment of OCLs of the talus and results in good medium-term functional outcomes. Arthroscopic BMS with cBMA also results in similar functional outcomes and improved border repair tissue integration, with less evidence of fissuring and fibrillation on MRI. Level of Evidence Level III, retrospective comparative study.
Purpose To perform a systematic review of the basic science literature on the use of platelet-rich plasma (PRP) in tendon models. Methods We searched the PubMed/Medline and Embase databases in June ...2012 using the following parameters: ((tenocytes OR tendon OR tendinitis OR tendinosis OR tendinopathy) AND (platelet rich plasma OR PRP OR autologous conditioned plasma OR ACP)). The inclusion criteria for full-text review were in vivo and in vitro studies examining the effects of PRP on tendons and/or tenocytes. Clinical studies were excluded. Only studies published in peer-reviewed journals that compared PRP directly with a control were included. Data were extracted based on a predefined data sheet, which included information on PRP preparation, study methods, and results. Studies were analyzed for trends, comparing and contrasting the reported effects of PRP. Results The search yielded 31 articles for inclusion in our review. Of the studies, 22 (71%) reported platelet concentrations in the PRP; 6 (19%) reported cytology. Eight in vivo studies found decreased tendon repair time, increased fiber organization, or both with PRP treatment. Eight in vitro studies reported that PRP treatment increased cell proliferation; 7 reported an increase in growth factor expression. Three in vivo studies found increased vascularity, and 4 found increased tensile strength with PRP treatment. Conclusions In the basic science studies evaluated, it appears that PRP confers several potential effects on tendon models compared with a control. However, the literature is inconsistent with regard to reporting the methods of preparation of PRP and in reporting platelet concentrations and cytology. Clinical Relevance Establishing proof of concept for PRP may lead to further high-quality clinical studies in which the appropriate indications can be defined.
Purpose
A literature review of the deltoid ligament was conducted, examining the current literature on anatomy, function, and treatment strategies. In particular, anatomical inconsistencies within ...the literature were evaluated, and detailed anatomical dissections are presented.
Methods
A literature search was conducted on PubMed using keywords relevant to the deltoid ligament in the ankle and medial ankle instability. Primary research articles, as well as appropriate summary articles, were selected for review.
Results
While it is well defined that the deltoid is contiguous and divided into one superficial and one deep portion, the creation of the individual fibres may be artificial. Furthermore, while improvements in imaging techniques and arthroscopy have not led to a consensus on the anatomy of the ligament, they may help improve recognition of deltoid injuries. Once identified, the majority of deltoid injuries can be treated via conservative treatment. However, reparative and reconstructive treatment strategies can also be used for complex acute injuries or chronic medial ankle instability.
Conclusion
Given the continuing evolution of the anatomical understanding of the ligament, the current treatment protocol for deltoid injuries requires further standardization, with an emphasis on proper diagnosis.
The aim of the current work was to study the effect of laser shock peening (LSP) when applied to 2‐mm thick 2024‐T351 aluminium samples containing scratch‐like defects in the form of V‐shaped scribes ...50 to 150 μm deep. The scribes decreased fatigue life to 5% of that of the pristine material. The effect of laser peening on fatigue life was dependent on the specifics of the peen treatment, ranging from further reductions in life to restoration of the fatigue life to 61% of pristine material. Fatigue life was markedly sensitive to near‐surface tensile residual stress, even if a compressive residual stress field was present at greater depth. Fatigue life after peening was also dependent on sample distortion generated during the peening process. Sample distortion modified local stresses generated by externally applied loads, producing additional life changes. Models based on residual stress intensity and crack closure concepts were successfully applied to predict fatigue life recovery.
Background:
Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a ...hook plate for fixation of these fractures.
Methods:
Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles.
Results:
The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 ± 66.0 range 100-300 cycles vs 178.6 ± 95.7 range 24-300 cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens.
Conclusion:
A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base.
Clinical Relevance:
Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.
As healthcare spending continues to rise, price transparency is crucial for patients to calculate a reasonable cost estimate for tests and procedures. Legislative efforts have been successful at ...mandating increased hospital price transparency, including publishing charge description masters (CDMs), but their usefulness in permitting patients to assess the cost for complex procedures is unclear. We sought to determine CDM and diagnosis-related group (DRG) prevalence and evaluate whether these are effective tools for patients to preemptively ascertain the costs for simple and complex tests and procedures.
Cross-sectional analysis of publicly available 2019 CDMs and DRGs from 122 hospitals in the United States, including the top-20 as ranked by the US News & World Report Honor Roll and two top-ranked hospitals per state. We first determined the availability of CDMs and DRGs and then determined the ability to estimate the hospital charge for a three-view knee radiograph and a primary total knee arthroplasty (TKA) using CDM and DRG data.
One hundred fifteen of 122 (94.3%) hospitals published a CDM, and 78 (63.9%) published a DRG. Top-ranked hospitals published DRGs more frequently than those outside of the Honor Roll designation (P = 0.04). The estimated charge for a three-view knee radiograph could be calculated from 113/115 (98.3%) CDMs. The estimated total charge for a primary TKA could not be obtained from any of the available CDMs. By comparison, the estimated charge for a primary TKA could be obtained from 76/78 (97.4%) of the available DRGs.
CDMs are available as currently mandated for most hospitals and generally can be used to identify the charges for simple procedures, but they are ineffective tools for patients to estimate the charges associated with a multifaceted healthcare procedure, such as TKA. Although DRGs are less frequently available, they are a more effective resource for patients to estimate charges.
Purpose To identify potential cysts using magnetic resonance imaging (MRI) after autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLTs) as well as to determine ...the effect of cysts on short-term clinical outcomes. Methods Eighty-nine MRI scans of 37 patients who had AOT for an OLT were evaluated. Radiographic variables examined included cyst presence, cyst location, bone edema, and cartilage integrity. Patient clinical variables recorded and examined for association with the presence of a cyst included gender, age, preoperative lesion size, size and number of osteochondral graft used, symptoms reported, and pre- and postoperative Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) scores measured at final follow-up. Results Twenty-four patients (64.8%) had MRI evidence of cystic change after AOT for an OLT at a mean MRI follow-up time of 15 months after surgery (range 2-54). Patients with presence of a cyst after surgery were older (mean age, 42.7 years) than those without cysts (mean age, 32.7 years) ( P = .041), and among patients with a cyst, older patients more often had involvement of the subchondral plate (57.3 v 36.7 years) ( P < .001). No other variables associated with cyst formation had statistical significance. Mean patient FAOS scores increased from 50 (±19) preoperatively to 87 (±8) postoperatively. Mean SF-12 scores increased from 52 (±18) preoperatively to 85 (±6) postoperatively. Patients not identified as having a cyst had lower SF-12 ( P = .028) and FAOS ( P = .032) preoperative scores and more improvement in SF-12 ( P = .006) and FAOS ( P = .016) scores than patients with cysts. Conclusions Postoperative cyst formation on MRI was found to be a common occurrence after AOT for OLT. Although increasing age was related to increased cyst prevalence, the clinical impact of cyst formation was not found to be significant at short-term follow-up. Continued long-term longitudinal follow-up of postoperative cysts is needed. Level of Evidence Level IV, prognostic case series.
Purpose This study aims to provide an overview of both the open and endoscopic procedures used to treat posterior ankle impingement, as well as an analysis, evaluation, and comparison of their ...outcomes. Methods A systematic literature search of the Medline, Embase (Classic), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases and the Cochrane Database of Clinical and Randomized Controlled Trials was performed. Quality of included studies was assessed by use of the Downs and Black scale. Results After we reviewed 783 studies, 16 trials met the inclusion criteria. Of these trials, 6 reported on open surgical techniques and 10 evaluated endoscopic techniques. The complication rate (15.9% v 7.2%) and time to return to full activity (16.0 weeks v 11.3 weeks) differed between the 2 groups, both favoring endoscopic surgery. Conclusions Although the level of evidence of the included studies is relatively low, it can be concluded that the endoscopic technique is superior to the open procedure. Level of Evidence Level IV, systematic review of Level IV studies.
Autologous osteochondral transplantation restores a cartilage defect with a cylindrical unit of bone and articular cartilage. Previous studies have described poor graft integration at the chondral ...interface and degeneration of the cartilage. This has prompted the investigation of adjuncts to address these concerns, including platelet-rich plasma (PRP), which has the potential to improve chondral interface integration and decrease cartilage degeneration. The purpose of this study was to evaluate the effect of PRP on autologous osteochondral transplantation in a rabbit model.
Bilateral osteochondral defects (2.7 mm in diameter and 5 mm in depth) were created on the femoral condyles of twelve New Zealand White rabbits. Osteochondral grafts were harvested from the ipsilateral femoral condyle and, after randomization, were treated with either PRP or saline solution before implantation into the defect site. The rabbits were killed at three, six, or twelve weeks postoperatively. The osteochondral graft was assessed using the International Cartilage Repair Society (ICRS) macroscopic and modified ICRS histological scoring systems.
Macroscopic assessment revealed no significant difference between the two groups (mean and standard deviation, 11.2 ± 0.9 for the PRP-treated group versus 10.3 ± 0.9 for the control group; p = 0.09). The mean modified ICRS histological score was significantly higher overall and at each time point for the PRP-treated osteochondral transplants compared with the controls (overall mean, 18.2 ± 2.7 versus 13.5 ± 3.3; p = 0.002). Assessing graft integration specifically, the mean score for the PRP-treated group was significantly higher than that for the control group (2.5 ± 0.9 versus 1.6 ± 0.7; p = 0.004). No adverse events occurred as a result of the surgical procedure or PRP.
PRP may improve the integration of an osteochondral graft at the cartilage interface and decrease graft degeneration in an in vivo animal model.
The use of PRP as a biological adjunct to autologous osteochondral transplantation has the clinical potential to enhance graft integration, decrease cartilage degeneration, and improve clinical outcomes of autologous osteochondral transplantation.
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