Return to Play after Patellar Stabilization.

Purpose Of Review: The purpose of this review is to evaluate the existing literature regarding return to play (RTP) and return to prior performance (RPP) following patellar stabilization surgery. It will also discuss suggested guidelines regarding RTP, and finally, to encourage future patellofemoral instability research to report and publish results of RTP rates using standardized RTP guidelines.

Recent Findings: There is a lack of validation and universal adoption of standardized RTP guidelines.

Subchondroplasty for the treatment of post-traumatic bone marrow lesions of the medial femoral condyle in a pre-clinical canine model.

This study characterizes long-term outcomes associated with subchondroplasty (SCP) treatment for impact-induced subchondral bone marrow lesions (BML) using a validated pre-clinical canine model. With IACUC approval, purpose-bred research hounds (n = 16) underwent arthroscopic impact injury (40N) to both medial femoral condyles. At 3 months, functional assessments, arthroscopy, and MRI were performed and knees (n = 32) were randomly assigned to SCP (3 ml fluoroscopically guided percutaneous injection of AccuFill BSM into BML bone defects) or sham injection (Control).

A Preclinical Model to Study the Influence of Graft Force on the Healing of the Anterior Cruciate Ligament Graft.

The purpose of this study is to establish a small animal anterior cruciate ligament (ACL) reconstruction research model where ACL graft force can be varied to create different graft force patterns with controlled knee motion. Cadaveric ( = 10) and in vivo ( = 10) rat knees underwent ACL resection followed by reconstruction using a soft tissue autograft. Five cadaveric and five in vivo knees received a nonisometric, high-force femoral graft tunnel position.

The Pathobiology of the Meniscus: A Comparison Between the Human and Dog.

Serious knee pain and related disability have an annual prevalence of approximately 25% on those over the age of 55 years. As curative treatments for the common knee problems are not available to date, knee pathologies typically progress and often lead to osteoarthritis (OA). While the roles that the meniscus plays in knee biomechanics are well characterized, biological mechanisms underlying meniscus pathophysiology and roles in knee pain and OA progression are not fully clear.

Mentorship in Orthopedics: A National Survey of Orthopedic Surgery Residents.

Objective: Mentorship is an important component of graduate medical education. It has been associated with numerous benefits including personal development, increased career satisfaction, and reduced stress and burnout. The purpose of this study was to assess orthopedic resident attitudes regarding mentorship and to determine if there were sociodemographic differences.

Reconstruction of the medial patellotibial ligament results in favorable clinical outcomes: a systematic review.

Purpose: The medial patellotibial ligament (MPTL), the medial patellofemoral ligament (MPFL), and the medial patellomeniscal ligament (MPML) support the stability of the patellofemoral joint. The purpose of this systematic review was to report the surgical techniques and clinical outcomes of the repair or reconstruction of the MPTL in isolation or concomitant with the MPFL and/or other procedures.

Methods: A systematic review of the literature was conducted.

Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface.

Background: Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current "anatomic" ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood.

Metabolic Responses of Meniscus to IL-1β.

This article identifies the potential mechanisms of action for meniscal degeneration in response to joint inflammation and potential contributions of the meniscus to the development and progression of osteoarthritis (OA). It was hypothesized that interleukin-1β (IL-1β) stimulation of meniscal explants would result in significant increases in nitric oxide (NO), matrix metalloproteinase (MMP) production and activity, and relevant cytokine production compared with controls. Canine meniscal explants (4 mm) were cultured for 21 days with (IL-1) or without (negative control [NC]) 50 ng/mL rcIL-1β ( = 6/group).

Day of Week and Surgery Location Effects on Stay Length and Cost for Total Joint Arthroplasty: Academic versus Orthopaedic-Specific Hospital.

Demand for total hip (THA) and knee arthroplasties (TKA) is expected to rise sharply by 2030. Increasing demand in conjunction with financial pressure requires the use of cost-effective total joint arthroplasty (TJA) strategies. This study examined the effects that day of week and surgery location [academic (AH) versus orthopaedic-specific (OsH) hospital] have on length of stay (LOS) and cost for primary TJA patients in one multihospital university-based medical center.

Large fresh osteochondral allografts for the hip: growing the evidence.

Introduction: Articular cartilage lesions of the hip are difficult to effectively treat. Osteochondral allograft (OCA) transplantation in the knee has been associated with long-term success, but OCA for the hip has not been extensively studied. Here, we present the clinical and radiological outcomes from a cohort of 10 patients treated with fresh OCA transplants for large osteochondral defects of the femoral head and/or acetabulum.

Current Concepts in Rehabilitation for Traumatic Anterior Shoulder Instability.

Purpose Of Review: The objectives of this review are to evaluate the current evidence-based literature and concepts surrounding rehabilitation in patients with anterior shoulder instability injuries and surgical repair.

Recent Findings: The current literature evidence for shoulder rehabilitation for anterior shoulder instability and labral repair is limited. As a result, there are variations among surgeons and physical therapists in rehabilitation protocols after anterior shoulder instability injuries and repair.

Patellofemoral Cartilage Restoration: Indications, Techniques, and Outcomes of Autologous Chondrocytes Implantation, Matrix-Induced Chondrocyte Implantation, and Particulated Juvenile Allograft Cartilage.

Focal chondral defects are common in the patellofemoral (PF) joint and can significantly impair the quality of life. The autologous chondrocytes implantation (ACI) technique has evolved over the past 20 years: the first-generation technique involves the use of a periosteal patch, the second-generation technique (collagen-cover) uses a type I/III collagen membrane, and the newest third-generation technique seeds and cultivates the collagen membrane with chondrocytes prior to implantation and is referred to as matrix-induced autologous chondrocyte implantation. Particulated juvenile allograft cartilage (PJAC) (DeNovo NT) is minced cartilage allograft from juvenile donors.

Biologic Joint Repair Strategies: The Mizzou BioJoint Story.

Because articular cartilage has very limited healing potential, most symptomatic cartilage injuries eventually result in end-stage osteoarthritis and are treated with artificial joint replacement. Our interdisciplinary, comparative orthopedic research performed by a team of DVMs, MDs, engineers, and basic scientists has yielded marked progress toward effective biologic joint restoration strategies by bringing bench-side ideas to fruition in bedside applications in both canine and human patients. This mini-review summarizes the progress of biologic joint restoration strategies at our center.

Validation of the Missouri Osteochondral Allograft Preservation System for the Maintenance of Osteochondral Allograft Quality During Prolonged Storage.

Background: Fresh osteochondral allografts (OCAs) are limited in availability. The Missouri Osteochondral Allograft Preservation System (MOPS) has been reported to effectively preserve OCAs twice as long as current tissue bank protocols in preclinical studies.

Hypothesis: The viable chondrocyte density (VCD) in OCAs preserved for up to 70 days using the MOPS will not be significantly different from day 0, and the VCD in MOPS-preserved OCAs will be significantly higher than for standard tissue bank preservation.

Comparison of Platelet-Rich Plasma, Stromal Vascular Fraction (SVF), or SVF with an Injectable PLGA Nanofiber Scaffold for the Treatment of Osteochondral Injury in Dogs.

Stromal vascular fraction (SVF) contains a small number of mesenchymal stem cells and has been used as a treatment for osteoarthritis and cartilage injury. Due to limited evidence of successful cartilage regeneration with injected stem cell therapies, there is interest in combining cellular therapies with injectable scaffolding materials to increase intra-articular residence times of stem cells and improve tissue regeneration. However, the safety of intra-articular injection of SVF combined with injectable scaffolds is unestablished.

Effects of Autogenous Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts.

Background: Transplantation of fresh osteochondral allografts (OCAs) is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Because the lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable.

Purpose: To determine if autogenous bone marrow aspirate concentrate (BMC) treatment of large femoral condylar OCAs would be associated with superior radiographic OCA bone integration compared with nontreated allografts during the critical first 6 months after surgery.

Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma to Enhance Osseous Integration Potential for Osteochondral Allografts.

Fresh osteochondral allograft (OCA) transplantation is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Since a lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. This study sought to determine and compare the potential of bone marrow aspirate concentrate (BMC) and leukoreduced platelet rich plasma (PRP) to repopulate the osseous portion of an OCA with cells and deliver osteogenic proteins.

Autologous Chondrocytes and Next-Generation Matrix-Based Autologous Chondrocyte Implantation.

Focal chondral defects of the knee are common and can significantly impair quality of life. The autologous chondrocyte implantation technique has evolved over the past 20 years; the newest third-generation technique is matrix-induced autologous chondrocyte implantation. Physical examination is important to characterize location and source of pain and identify associated injuries.

Osteochondral Autologous Transplantation.

Osteochondral autologous transplantation (OAT) is a treatment strategy for small and medium sized focal articular cartilage defects in the knee. This article reviews the indications, surgical techniques, outcomes, and limitations of OAT for the management of symptomatic chondral and osteochondral lesions in the knee joint.

Medial patellotibial ligament and medial patellomeniscal ligament: anatomy, imaging, biomechanics, and clinical review.

Purpose: The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML.

Methods: A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML.

Results: The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML.