Local Intraoperative Marrow-Derived Augmentation for Primary Rotator Cuff Repair: An Updated Systematic Review and Meta-analysis of Studies From 2010 to 2022.

Background: Recurrent tears of the rotator cuff pose a substantial problem despite advances in repair technique. Biologic augmentation via marrow stimulation or vented anchors may strengthen the suture-tendon junction and improve healing rates of native tissue, thereby enhancing outcomes of primary surgical repair.

Purpose: To provide a focused systematic review and meta-analysis of local, intraoperative marrow-derived augmentation techniques in clinical primary rotator cuff repair.

Evidence for Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: A Systematic Review of Data From 2010 to 2022.

Background: Biologic healing after rotator cuff repair remains a significant challenge. Injectable biologic augmentation may improve tissue quality at the suture-tendon interface.

Purpose: To investigate the effect of injectable biologic supplementation in rotator cuff repair and to assess the quality and adherence to evolving reporting standards.

Next-Generation Marrow Stimulation Technology for Cartilage Repair: Basic Science to Clinical Application.

»: Given the relatively high prevalence of full-thickness articular cartilage lesions, including in patients who are <40 years of age, and an inability to detect some of these lesions until the time of arthroscopy, there is value in performing a single-stage cartilage procedure such as marrow stimulation (MS).

»: While the positive outcomes of first-generation MS (namely microfracture) have been observed to drop off after 24 months in several studies, improvements have been seen when compared with preoperative conditions for lesions that are 2 to 3 cm2 in size, and MS is considered to be a procedure with technical simplicity, fairly short surgical times, and relatively low morbidity. A recent study showed that autologous chondrocyte implantation (ACI) and osteochondral allograft (OCA) transplantation remain viable treatment options for chondral defects of the knee in the setting of failed MS.

Scientific Developments and Clinical Applications Utilizing Chondrons and Chondrocytes with Matrix for Cartilage Repair.

Injuries to articular cartilage of the knee are increasingly common. The operative management of these focal chondral lesions continues to be problematic for the treating orthopedic surgeon secondary to the limited regenerative capacity of articular cartilage. The pericellular matrix (PCM) is a specialized, thin layer of the extracellular matrix that immediately surrounds chondrocytes forming a unit together called the chondron.

High Prevalence of Superior Labral Anterior-Posterior Tears Associated With Acute Acromioclavicular Joint Separation of All Injury Grades.

Background: Despite the relatively high number of cases of acromioclavicular joint (AC) separation in the athletic population, optimal clinical outcomes are not achieved in every case. Limited data exist regarding the prevalence of intra-articular glenohumeral pathologies (IAPs) associated with acute AC separation of all injury grades.

Purpose: To determine the prevalence of IAPs associated with AC separation, regardless of severity.

Current Applications of Growth Factors for Knee Cartilage Repair and Osteoarthritis Treatment.

Purpose Of Review: The decreased contact area, edge loading, and increased stress in the adjacent area cartilage resulting from chondral defects are believed to predispose this tissue to degenerative changes that have significant economic implications, especially when considering its progression to osteoarthritis of the knee. Growth factors are considered therapeutic possibilities to enhance healing of chondral injuries and modify the progression to degenerative arthritis. Thus, the purposes of this review are to first to summarize important points for defect preparation and recent advances in techniques for marrow stimulation and second, and to identify specific growth factors and cytokines that have the capacity to advance cartilage regeneration and the treatment of osteoarthritis in light of recent laboratory and clinical studies.

Incidence, Degree, and Clinical Effect of Subchondral Bone Overgrowth After Microfracture in the Knee.

Background: Subchondral bone overgrowth has been described with variable frequency after microfracture, but little systematic information is available about the clinical incidence, risk factors, or clinical relevance of this phenomenon.

Hypothesis: Subchondral overgrowth (1) occurs with high incidence and various degrees after microfracture, (2) is associated with risk factors, and (3) affects clinical outcome score and failure rate.

Study Design: Cohort study; Level of evidence, 3.

Cartilage issues in football-today's problems and tomorrow's solutions.

Articular cartilage injury is prevalent in football players and results from chronic joint stress or acute traumatic injuries. Articular cartilage injury can often result in progressive painful impairment of joint function and limit sports participation. Management of articular cartilage injury in athletes aims to return the player to competition, and requires effective and durable joint surface restoration that resembles normal hyaline articular cartilage that can withstand the high joint stresses of football.

Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification.

Background: Owing to the complexity and heterogeneity of muscle injuries, a generally accepted classification system is still lacking.

Aims: To prospectively implement and validate a novel muscle injury classification and to evaluate its predictive value for return to professional football.

Methods: The recently described Munich muscle injury classification was prospectively evaluated in 31 European professional male football teams during the 2011/2012 season.

Clinical outcomes assessment for articular cartilage restoration.

The purpose of this article is to provide an overview and perspective of the available options for clinical outcomes evaluation of articular cartilage repair in the knee. A nonsystematic literature review of reported clinical measures for functional, qualitative, and quantitative structural outcomes evaluation after knee articular cartilage repair was performed. Several outcome scores have been validated for articular cartilage repair in the knee with the International Knee Documentation Committee score, Lysholm score, and Knee injury Osteoarthritis Outcome Score being reported most frequently.

Complex articular cartilage restoration.

Articular cartilage injury and degeneration occurs frequently in athletes and results from the significant chronic joint stress and acute traumatic injuries associated with high-impact sports. These injuries do not heal spontaneously and often lead to progressive painful impairment of joint function and limitation of sports participation. Untreated articular cartilage defects frequently lead to chronic joint degeneration and disability.

Terminology and classification of muscle injuries in sport: the Munich consensus statement.

Objective: To provide a clear terminology and classification of muscle injuries in order to facilitate effective communication among medical practitioners and development of systematic treatment strategies.

Methods: Thirty native English-speaking scientists and team doctors of national and first division professional sports teams were asked to complete a questionnaire on muscle injuries to evaluate the currently used terminology of athletic muscle injury. In addition, a consensus meeting of international sports medicine experts was established to develop practical and scientific definitions of muscle injuries as well as a new and comprehensive classification system.

Current concepts for rehabilitation and return to sport after knee articular cartilage repair in the athlete.

Articular cartilage injury is observed with increasing frequency in both elite and amateur athletes and results from the significant acute and chronic joint stress associated with impact sports. Left untreated, articular cartilage defects can lead to chronic joint degeneration and athletic and functional disability. Treatment of articular cartilage defects in the athletic population presents a therapeutic challenge due to the high mechanical demands of athletic activity.

Return to Sports after Articular Cartilage Repair in the Football (Soccer) Player.

Background: The ability to return to football (soccer) presents a critical aspect for successful treatment of articular cartilage injury in the football (soccer) player.

Methods: Information about sports participation after articular cartilage repair was collected from the literature. Special focus was placed on data in football athletes with information on return rate, timing of return, level of postoperative competition, and the ability to compete in the sport over time.

Evolution and Current Role of Autologous Chondrocyte Implantation for Treatment of Articular Cartilage Defects in the Football (Soccer) Player.

Background: Autologous chondrocyte implantation (ACI) continues to technically evolve, but how the technical innovations affect the ability to participate in high-impact sports such as football is unknown.

Methods: Clinical studies describing athletes treated with first-, second-, or third-generation ACI techniques were reviewed. The technical developments of ACI were evaluated, and the results in athletes and specifically football (soccer) players were analyzed.

Microfracture in Football (Soccer) Players: A Case Series of Professional Athletes and Systematic Review.

Background: Little information is available on the results of microfracture in competitive football (soccer) players. We aimed to evaluate the efficacy of this technique to restore joint function to a level that allows return to this popular high-impact sport.

Methods: This article provides an overview of the basic science and the current published scientific evidence for articular cartilage repair using the microfracture technique in elite football (soccer) athletes.

Guidelines for the Design and Conduct of Clinical Studies in Knee Articular Cartilage Repair: International Cartilage Repair Society Recommendations Based on Current Scientific Evidence and Standards of Clinical Care.

Objective: To summarize current clinical research practice and develop methodological standards for objective scientific evaluation of knee cartilage repair procedures and products.

Design: A comprehensive literature review was performed of high-level original studies providing information relevant for the design of clinical studies on articular cartilage repair in the knee. Analysis of cartilage repair publications and synopses of ongoing trials were used to identify important criteria for the design, reporting, and interpretation of studies in this field.

Articular Cartilage Injury in Athletes.

Articular cartilage lesions in the athletic population are observed with increasing frequency and, due to limited intrinsic healing capacity, can lead to progressive pain and functional limitation over time. If left untreated, isolated cartilage lesions can lead to progressive chondropenia or global cartilage loss over time. A chondropenia curve is described to help predict the outcome of cartilage injury based on different lesion and patient characteristics.

Augmentation Strategies following the Microfracture Technique for Repair of Focal Chondral Defects.

The operative management of focal chondral lesions continues to be problematic for the treating orthopedic surgeon secondary to the limited regenerative capacity of articular cartilage. Although many treatment options are currently available, none fulfills the criteria for an ideal repair solution, including a hyaline repair tissue that completely fills the defect and integrates well with the surrounding normal cartilage. The microfracture technique is an often-utilized, first-line treatment modality for chondral lesions within the knee, resulting in the formation of a fibrocartilaginous repair tissue with inferior biochemical and biomechanical properties compared to normal hyaline cartilage.

Clinical Outcome and Return to Competition after Microfracture in the Athlete's Knee: An Evidence-Based Systematic Review.

Microfracture is frequently used for articular cartilage repair in athletes. This study aimed to define the strength and weaknesses of this minimally invasive cartilage repair technique in the athletic population in an effort to optimize indications, functional outcome, and athletic participation after microfracture in the athlete's knee. A systematic analysis of original studies using microfracture in athletes was performed.

Return to sports participation after articular cartilage repair in the knee: scientific evidence.

Background: Articular cartilage injury in the athlete's knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after articular cartilage repair in the knee.

Hypothesis: Systematic analysis of athletic participation after articular cartilage repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with articular cartilage injury of the knee.

Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis.

Background: Despite the popularity of microfracture as a first-line treatment for articular cartilage defects in the knee, systematic information on its clinical efficacy for articular cartilage repair and long-term improvement of knee function is not available.

Hypothesis: Systematic analysis of the existing clinical literature of microfracture in the knee can improve the understanding of the advantages and limitations of this cartilage repair technique and can help to optimize its indications and clinical outcomes.

Study Design: Systematic review.

Emerging options for treatment of articular cartilage injury in the athlete.

Articular cartilage injury is observed with increasing frequency in both elite and amateur athletes and results from the significant joint stress associated particularly with high-impact sports. The lack of spontaneous healing of these joint surface defects leads to progressive joint pain and mechanical symptoms with resulting functional impairment and limitation of athletic participation. Left untreated, articular cartilage defects can lead to chronic joint degeneration and athletic disability.