Faculty Bibliography

BACKGROUND/UNASSIGNED:During the COVID impacted 2020-2021 season of the English soccer league, there was an appreciable number of injuries experienced by players. These injuries, however, have not been quantified against previous seasons to highlight the altered season as a causative factor. METHODS/UNASSIGNED:, with the provided information allowing for the sorting of the data into muscular and ligamentous injuries and skeletal injuries. RESULTS/UNASSIGNED:Overall 226, 260, and 289 muscular and ligamentous injuries were observed across the 2018/2019, 2019/2020, and 2020/2021 seasons, respectively. There were 495 minutes on average played leading up to first injury in the 2020/2021 season, compared with 521 minutes in the 2019/2020 season and 536 minutes in the 2018/2019. There was an average of games played to injury of 5.6 games in the 2020/2021 year, with 6.0 in the 2019/2020 year and 6.1 in the 2018/2019 year. Additionally, there was a significantly shorter time in between games was noted during the COVID-affected season with a mean time of 6.8 days in-between games played during the 2020-2021 season as compared to the previous years of 9.12 and 7.12 days. CONCLUSION/UNASSIGNED:Our study found that there were more injuries and a decreased time to first injury observed during the COVID-impacted 2020-2021 season than the two preceding seasons, perhaps demonstrating a link between fixture congestion and athlete injuries as evidenced by the significantly shorter time between games. It is therefore prudent to retain fixture spacing for athlete recovery even against the backdrop of an overall shortened season.

OBJECTIVE/UNASSIGNED:The purpose of this study was to evaluate the efficacy of osteochondral allograft (OCA) in patients older than 45 years of age, particularly with respect to return to sport. DESIGN/UNASSIGNED:A retrospective review was performed to evaluate patients greater than 45 who underwent an OCA for a symptomatic osteochondral defect of the knee between June 2011 and January 2019. RESULTS/UNASSIGNED:< 0.01). Furthermore, the mean Visual Analogue Scale while playing sport was 3.4 ± 3.2, and the mean Knee Injury and Osteoarthritis Outcome Score was 77.5 ± 12.7 at final follow-up. Overall, 11 patients (78.6%) were able to return to their desired sport. No clinical failures were identified during the follow-up period. CONCLUSION/UNASSIGNED:In our series of patients 45 years and older who were treated with OCA for focal osteochondral injuries of the knee, we found a significant improvement in clinical outcome scores at a midterm follow-up of 37 months with no revision OCA procedures or conversion to any form of knee arthroplasty. In addition, a high percentage of patients were able to return to their preferred level of athletic activity.

PURPOSE/OBJECTIVE:Osteoarthritis (OA) is a debilitating joint disease characterized by progressive loss of articular cartilage. Intra-articular injections are a mainstay of nonoperative treatment, however, there is controversy as to the optimal injectable for these patients. The purpose of the current study is to perform a network meta-analysis of the randomized control trials in the literature to ascertain whether there is a superior injectable nonoperative treatment for knee OA. METHODS:The literature search was conducted based on the PRISMA guidelines. Randomized control trials (RCTs) evaluating intra-articular injectables in osteoarthritic knees were included. Data was extracted and Visual Analogue Scale (VAS) scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, where available were analyzed at 1, 3, 6 and 12 months. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-Score. RESULTS:Seventy-nine RCTs with 8761 patients were included in this review. Intra-articular injectables evaluated included autologous conditioned serum (ACS), bone marrow aspirate concentrate (BMAC), botulinum toxin, corticosteroids (CS), hyaluronic acid (HA), mesenchymal stem cells (MSC), ozone, saline placebo, platelet-rich plasma (PRP), plasma rich in growth factor (PRGF), and stromal vascular fraction (SVF). At 4-6 weeks and 3 months of follow-up, the treatment with the highest P-Score for WOMAC score was high molecular weight (HMW) HA + CS [P-Score = 0.9500 and 8503, respectively]. At 6-months follow-up, the treatment with the highest P-Score for WOMAC score was PRP [P-Score = 0.7676]. At all post-injection time points, the treatment with the highest P-Score for VAS score [P-Score Range = 0.8631-9927] and Womac score at 12 Months [P-Score = 0.9044] was SVF. CONCLUSIONS:The current evidence shows that SVF injections result in the greatest improvement in pain and functional outcomes in patients with knee OA at up to 1 year of follow-up.

SUMMARY:High-energy tibial plateau fractures are associated with knee fracture dislocations and concomitant ligamentous injury. Both bony and ligamentous injuries can require surgical fixation, often requiring a multidisciplinary team and staged treatment. This article and accompanying video describe the workup and treatment of a Moore type 4 tibial plateau rim compression fracture with posterolateral corner and anterior cruciate ligament rupture that underwent open reduction internal fixation of the tibial plateau with posterolateral corner reconstruction and then staged anterior cruciate ligament reconstruction with quad tendon autograft.

Purpose/UNASSIGNED:The purpose of the present review is to systematically review the available literature for failure rates and complications of cartilage restoration of bipolar chondral defects in the patellofemoral (PF) joint to assess the ability to treat these lesions without arthroplasty. Methods/UNASSIGNED:PubMed and MEDLINE databases were queried between 2000 to 2020 using the keywords "osteochondral" and "knee" and "microfracture," "autologous chondrocyte implantation (ACI)," or "transplantation." Patient selection included patients with bipolar chondral lesions of the patellofemoral joint that were treated with cartilage restoration procedures. Treatment of PF joints were reviewed for surgical indications/technique, rates of failure, defect characteristics, and time to failure. For the purposes of this study, failure was defined by each individual author on their respective studies. Results/UNASSIGNED: = 79.0%). Conclusion/UNASSIGNED:From the available data, established cartilage restoration procedures may provide favorable patient-reported function, avoidance of secondary surgery, and joint preservation in at least 80% of patients at short- to mid-term follow-up. Level of Evidence/UNASSIGNED:Level IV, systematic review of Level IV studies.

Purpose/UNASSIGNED:The purpose of the present study is to systematically review the available literature for management of bipolar lesions within the tibiofemoral joint and determine whether tibiofemoral cartilage restoration is an effective treatment modality. Methods/UNASSIGNED:PubMed and MEDLINE databases were queried between 2000 and 2020 using the following keywords: "osteochondral" and "knee" and "microfracture," "autologous chondrocyte implantation (ACI)," or "transplantation." Articles were reviewed for the presence of a bipolar or "kissing" tibiofemoral lesion and reported lesion size, concomitant procedures, failure rates, and time to failure. Results/UNASSIGNED: = 79.1%). Conclusions/UNASSIGNED:Cartilage restoration, through both ACI and OCA, had failure rates between 0% and 44% in patients with bipolar lesions of the tibiofemoral compartment. Although a higher level of evidence is required to prove efficacy, the current study demonstrates midterm survivorship rates between 55% and 100%, which may delay the need for secondary arthroplasty. Level of Evidence/UNASSIGNED:Level IV, systematic review of Level IV studies.

OBJECTIVE:The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. DESIGN/METHODS:A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. RESULTS:= 0.93). CONCLUSIONS:This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

PURPOSE/OBJECTIVE:The purpose of this double-blinded randomized controlled trial was to evaluate the use of intravenous (IV) tranexamic acid (TXA) in patients undergoing primary bone-patella tendon-bone (BTB) ACLR with regard to post-operative hemarthrosis, pain, opioid consumption, quadriceps atrophy and activation. METHODS:A controlled, randomized, double-blinded trial was conducted in 110 patients who underwent ACLR with BTB autograft. Patients were equally randomized to the control and experimental groups. The experimental group received two 1-gram boluses of IV TXA, one prior to tourniquet inflation and one prior to wound closure; the control group did not receive TXA. If a clinically significant hemarthrosis was evident, the knee was aspirated, and the volume of blood (ml) was recorded. Additionally, perioperative blood loss (ml); Visual Analog Scale (VAS) on postoperative days (POD) 1-7 and post-operative weeks (POW) 1, 6 and 12; postoperative opioid consumption POD 1-7; range of motion (ROM) and ability to straight leg raise (SLR) at POW 1, 6, 12; and pre and postoperative thigh circumference ratio (TCR). RESULTS:There was no significant difference in perioperative blood loss between the TXA and control groups (32.5ml v. 35.6ml, p=0.47). The TXA group had 23 knees aspirated; control group had 26 knees aspirated (p=0.56). No significant difference seen in postoperative hemarthrosis volume with IV TXA compared to those without (26.7ml v. 37.3ml, p=0.12). There was no significant difference in VAS score between the two groups (p=0.15), additionally, there was no difference in postoperative opioid consumption (p=0.33). There was no significant difference in ROM or ability to SLR, or post-operative TCR (p > 0.05 for all). CONCLUSION/CONCLUSIONS:IV TXA in patients who undergo ACLR with BTB autograft does not significantly impact perioperative blood loss, postoperative hemarthrosis, or postoperative pain levels. Additionally, no significant differences were seen in early post-operative recovery regarding ROM or quadriceps reactivation.

BACKGROUND:Graft failure following anterior cruciate ligament reconstruction (ACLR) is a devastating complication. Risk factors such as patient characteristics and tunnel positions are well described. The relationship between graft dimension and failure rates has been investigated mainly in soft tissue grafts. Less studied are the effects of patella tendon (PT) dimensions on the risk of graft failure following patella tendon autograft (PTA) reconstructions. PURPOSE/OBJECTIVE:The purpose of the current study was to investigate if patellar tendon thickness measured on preoperative magnetic resonance imaging (MRI) predicts failure after ACLR using PTA. METHODS:This was an institutional review board approved, single-center, retrospective case-control study comparing patients' preoperative patellar tendon thickness between July 2005 and January 2017. Sixteen patients (mean age 21.2 ± 5.0 years) with PTA failure requiring revision surgery were identified and compared to 34 control patients who had undergone primary ACLR with PTA without failure with a minimum of 2-years follow-up. Patients with failure were matched at approximately 1:2 based on age, sex, height, weight, associated meniscus injury, and associated meniscal surgery. Patellar tendon dimensions were measured at the inferior pole of the patella (IPP), tibial tubercle insertion (TT), and longitudinal midpoint (MP) on preoperative axial and sagittal cut MRIs. Interclass correlation coefficeint (ICC) and Bland-Altman analyses were evaluated to determine inter-observer reliability. The two cohorts were compared using independent samples t-tests and analysis of variance. RESULTS:All ACLR failures occurred after a non-contact, pivot type injury. There were no significant differences in age, sex, height, weight, meniscal injury, or meniscal surgery between the two groups. Mean time between primary ACLR and revision was 2.6 ± 2.6 years and mean follow-up time was 3.1 ± 1.0 years in the control group. Patellar tendon length and width were not significantly different between the two groups. The average thickness at both the inferior pole and longitudinal midpoint was significantly higher in the failure group compared to controls (IPP: 5.04 ± 1.1 mm versus 4.33 ± 0.7 mm, p = 0.01; MP: 4.60 ± 0.7 mm versus 4.22 ± 0.5 mm, p = 0.03). Additionally, ICC was high across all measurements, with all values > 0.978. Similarly, all values demonstrated bias of less than ± 0.05. CONCLUSION/CONCLUSIONS:Patella tendon autograft anterior cruciate ligament reconstruction failures had significantly thicker patellar tendons at the inferior pole and longitudinal midpoint of the patella tendon.