A Bedside-to-Bench-to-Bedside Journey to Advance Osteochondral Allograft Transplantation towards Biologic Joint Restoration.

More than 70 million adults in the United States are impacted by osteoarthritis (OA). Symptomatic articular cartilage loss that progresses to debilitating OA is being diagnosed more frequently and earlier in life, such that a growing number of active patients are faced with life-altering healthcare decisions at increasingly younger ages. Joint replacement surgeries, in the form of various artificial arthroplasties, are reliable operations, especially for older (>65 years), more sedentary patients with end-stage OA, but have major limitations for younger, more active patients.

Development and validation of a preclinical canine model for early onset fracture-related infections.

Fracture-related infections (FRIs) are a challenging complication in orthopaedics. Standard of care management for FRIs typically involves prolonged antibiotic therapies, irrigation and debridement (I&D) of the fracture site, and retention of fracture-fixation implants with or without exchange. Unfortunately, this treatment regimen is associated with treatment failure rates of up to 38 %, such that improved preventive and therapeutic interventions are needed.

Midterm Outcomes After Osteochondral Allograft Transplantation in the Knee Using High-Chondrocyte Viability Grafts.

Background: Osteochondral allograft transplantation (OCAT) has become a standard-of-care treatment option for patients with large symptomatic articular defects. Recent advances in allograft science and OCAT protocols have been reported to result in consistently robust outcomes after OCAT in the knee. However, only short-term comparisons have been reported, and analyses are lacking for treatment failure risk factors that account for confounding variables.

Prospective Assessment of Outcomes After Femoral Condyle Osteochondral Allograft Transplantation With Concurrent Meniscus Allograft Transplantation.

Background: Osteochondral allograft transplantation (OCAT) and meniscus allograft transplantation (MAT) have each become more commonly implemented for the treatment of young to middle-aged patients with complex knee pathology. Evidence regarding tibiofemoral OCAT in the setting of concurrent MAT is limited.

Purpose/hypothesis: The purpose of this study was to characterize outcomes for femoral condyle OCAT with concurrent MAT (OCAT+MAT) in the ipsilateral compartment of patients after evidence-based shifts in practice.

Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation.

Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study.

Enrollment in a Behavioral Health Program Positively Impacts 2-Year Cumulative Survival Rates in Osteochondral Allograft Transplant Patients.

Emerging evidence suggests that patients' behavioral health may influence outcomes after osteochondral allograft transplantation (OCAT). A comprehensive behavioral health program (BHP) including preoperative screening and education, and postoperative counseling and support, led by a health behavior psychologist was implemented for patients considering OCAT. We hypothesized that patients undergoing knee OCAT and enrolled in the BHP would have a significantly higher 2-year graft survival rate than those not enrolled.

Donor-recipient age- or sex-mismatched osteochondral allografts do not adversely affect cumulative graft survival rates after transplantation in the knee.

Background: Osteochondral allograft transplantation (OCAT) can be performed without the need for blood-type matching or anti-rejection medications. However, other donor-recipient mismatch variables could influence outcomes. Therefore, it is critical to examine the impacts of sex and age mismatching on functional OCA survival.

Initial Outcomes following Fresh Meniscus Allograft Transplantation in the Knee.

Based on recent evidence-based advances in meniscus allograft transplantation (MAT), fresh (viable) meniscus allografts have potential for mitigating key risk factors associated with MAT failure, and preclinical and clinical data have verified the safety of fresh meniscus allografts as well as possible efficacy advantages compared with fresh-frozen meniscus allografts. The objective of this study was to prospectively assess clinical outcomes for the initial cohort of patients undergoing MAT using fresh meniscus allografts at our center. Patients who were prospectively enrolled in a dedicated registry were included for analyses when they had undergone primary MAT using a fresh meniscus allograft for treatment of medial and/or lateral meniscus deficiency with at least 1-year follow-up data recorded.

Tunnel Overlap Occurs 25% of the Time With Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Root Repair.

Purpose: To assess the risk of socket-tunnel overlap for posterior medial or lateral meniscal root repair combined with anterior cruciate ligament reconstruction (ACLR) using artificial tibias and computed tomography scans for 3-dimensional modeling.

Methods: Artificial tibias (n = 27; n = 3/subgroup) were allocated to groups based on inclination of socket-tunnels (55°, 60°, 65°) created for posterior root of the medial meniscus (MMPR) and lateral meniscus posterior root (LMPR) repair, and ACLR. Three standardized socket-tunnels were created: one for the ACL and one for each posterior meniscal root insertion.

Optimizing Socket-Tunnel Position for Meniscal Allograft Transplantation Combined With ACL Reconstruction: A 3D Model Analysis.

Background: Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and lead to impaired fixation and treatment failure.

Purpose/hypothesis: The purpose of this study was to determine optimal socket-tunnel drilling parameters for medial and lateral MAT with concurrent ACLR using artificial tibias and computed tomography (CT) scans for 3-dimensional (3D) modeling. It was hypothesized that clinically relevant socket tunnels could be created to allow for concurrent medial or lateral MAT and ACLR without significant risk for overlap at varying tunnel guide angles.

Cell-Mediated Immune Responses May Play Roles in Osteochondral Allograft Transplantation Osteointegration Failures.

Prolonged and incomplete osteochondral allograft (OCA) osteointegration is consistently cited as a major mechanism for OCA treatment failure. Subrejection immune responses may play roles in this mode of failure. Preimplantation OCA preparation techniques, including subchondral bone drilling, thorough irrigation, and autogenous bone marrow aspirate concentrate saturation, may dampen immune responses and improve OCA osteointegration.

Accelerated versus Standard Rehabilitation after Meniscus Allograft Transplantation in the Knee.

Meniscus allograft transplantation (MAT) is a proven treatment option for patients with symptomatic irreparable meniscus deficiency. When patients are adherent to prescribed postoperative restriction and rehabilitation protocols, outcomes after MAT are considered good to excellent. However, nonadherence to standard protocols is common and can be associated with undesirable outcomes and patient dissatisfaction.

Treatment failures (revision or arthroplasty) after knee osteochondral allograft transplantation with minimum two-year follow-up.

Background: Knee osteochondral allograft transplantation (OCAT) has been associated with good short- to mid-term outcomes, however, treatment failures occur more frequently than desired. This study used data from a lifelong outcomes registry to analyze knee OCAT treatment failure rates, variables associated with knee OCAT treatment failures, and outcomes after revision or arthroplasty surgery for knee OCAT treatment failures.

Methods: Patient outcomes were followed after knee OCAT performed using standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS®) allografts.

Meniscus Allograft Transplantation With Bone Plugs Using Knotless All-Suture Anchors and Cortical Button Suspensory Fixation.

Meniscus allograft transplantation can be successful for treatment of meniscal deficiency using a number of transplant techniques. In this Technical Note, we describe a double bone plug medial meniscus allograft transplantation technique that uses knotless all-suture anchors with cortical-button suspensory fixation. This technique maintains the reported advantages for bone-plug fixation while mitigating the risk for meniscal root damage, facilitating easier bone plug insertion and seating, expanding tensioning capabilities, and preventing soft-tissue irritation from suture knot stacks.

Making the Case for Hyperosmolar Saline Arthroscopic Irrigation Fluids: A Systematic Review of Basic Science, Translational, and Clinical Evidence.

Commonly used isotonic arthroscopic irrigation fluids, such as normal saline or lactated Ringer's, were initially formulated for intravenous administration so they do not replicate the physiologic properties of healthy synovial fluid. Synovial fluid plays an important role in regulating joint homeostasis such that even transient disruptions in its composition and physiology can be detrimental. Previous studies suggest that hyperosmolar solutions may be a promising alternative to traditional isotonic fluids.

Impacts of Knee Arthroplasty on Activity Level and Knee Function in Young Patients: A Systematic Review.

The annual demand for knee arthroplasty has been steadily rising, particularly in younger patients. The primary objective of this systematic review was to determine the impact of knee arthroplasties on knee function and activity levels in young (≤55 years) patients. A PubMed search from inception (1977) to March 2022 to identify eligible studies produced 640 peer-reviewed studies for consideration.

Using a Markerless Motion Capture System to Identify Preinjury Differences in Functional Assessments.

Functional assessments identify biomechanical issues which may indicate risk for injury and can be used to monitor functional recovery after an injury or surgery. Although the gold standard to assess functional movements is marker-based motion capture systems, these are cost prohibitive and have high participant burden. As such, this study was conducted to determine if a markerless motion capture system could detect preinjury differences in functional movements between those who did and did not experience a noncontact lower extremity injury (NCLEI).

Evaluating the Role and Impact of Health Literacy for Patients Undergoing Knee Surgery.

Health literacy is defined as "the capacity to obtain, process, and understand basic medical information and services and the competence to use such information and services to enhance health." Much of the research regarding health literacy in orthopaedic surgery has focused on readability of educational materials. However, the role of health literacy in patient-reported outcomes is somewhat unknown.

Integrated Care for Comprehensive Management of Patients with Osteoarthritis: Program Development and Implementation.

Treatment of symptomatic osteoarthritis (OA) is often complicated by comorbidities, which put patients at potentially higher risks following operative interventions. Management of these comorbidities is usually separate from orthopaedic care, with patients invited to return to their orthopaedic surgeon once surgical risk factors are better controlled. However, this practice can lead to disjointed care, resulting in uncertainty, mistrust, unmanaged pain, and dissatisfaction for patients.

Fractures and Dislocations on the Playing Field: Which Are Emergent and What to Do?

High-energy injuries, including fractures and dislocations, are occurring with increasing frequency in athletic competitions with the increasing size and speed of players. Common fractures and dislocations will be discussed in this article. We will evaluate emergent versus routine injuries and discuss appropriate treatment at the athletic venue.

Effects of Patient Assessment and Education by an Integrated Care Team on Postoperative Adherence and Failure Rates After Osteochondral Allograft and Meniscal Allograft Transplantation in the Knee.

Background: Patient nonadherence with prescribed rehabilitation protocols is associated with up to 16 times higher likelihood of treatment failure after osteochondral allograft transplantation (OCA) and meniscal allograft transplantation.

Hypothesis: Patients who completed counseling with an orthopaedic health behavior psychologist as part of an evidence-based shift in practice at our institution would have significantly lower rates of nonadherence and surgical treatment failure versus patients who did not participate in counseling.

Study Design: Cohort study; Level of evidence, 2.

Serial ultrasonographic imaging can predict failure after meniscus allograft transplantation.

Introduction: Treatment monitoring after meniscus allograft transplantation (MAT) is challenging. Ultrasonographic (US) imaging has been proposed as a modality that may allow for treatment monitoring after MAT, but has yet to be clinically validated for this purpose. The objective of this study was to assess the capabilities for serial US imaging during the first year after surgery to predict short-term MAT failure.