DOCSLIB.ORG

Failure of Bone Marrow Stimulation Techniques

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Failure of Bone Marrow Stimulation Techniques REVIEW ARTICLE Failure of Bone Marrow Stimulation Techniques Rachel M. Frank, MD,* Eric J. Cotter, BS,* Islam Nassar, MBBCh, M.Ch (orth), MBA, MHA,w and Brian Cole, MD, MBA* to prevent further joint deterioration. The limitations in Abstract: Marrow stimulation techniques, including microfracture, intrinsic articular cartilage physiology and regeneration has are among the most commonly performed cartilage restoration led to an influx of research into surgical cartilage restora- procedures for symptomatic chondral defects of the knee. For the tion techniques. vast majority of patients, marrow stimulation results in reduced There are numerous surgical options available for the pain and improved function, providing overall satisfactory out- comes. In some cases, however, marrow stimulation fails, resulting treatment of focal chondral defects, which can be broadly in symptom recurrence and often, the need for repeat surgery. This categorized into 4 groups: palliative options, including review will describe the indications and outcomes of microfracture arthroscopic debridement and lavage; reparative options, as a primary surgical treatment for focal chondral defects of the including microfracture and other bone marrow stimulation knee, identify patient and procedure-specific factors associated with techniques; restorative options including osteochondral poor clinical outcomes, and will discuss treatment options and their autograft transfer (OATS) and autologous chondrocyte respective outcomes for patients with a failed prior microfracture implantation (ACI) procedures; and reconstructive options surgery. including osteochondral allograft transplantation.9 Regard- Key Words: cartilage restoration, microfracture failure, marrow less of the specific technique chosen, the goals of surgical stimulation failure, autologous chondrocyte implantation, osteo- treatment are similar, including the ability to improve joint chondral allograft transplantation function, relieve pain, and allow patients to return to activity or in the case of athletes, return to sport. The appropriate (Sports Med Arthrosc Rev 2017;25:2–9) treatment decision for any given patient presenting with a symptomatic cartilage defect of the knee must be made on a case-by-case basis, and certainly, several defect-specific and ature articular cartilage is relatively avascular and patient-specific factors will aid in clinical decision-making. Maneural, composed of predominantly type II collagen Specifically, the size and location of the lesion, the activity mixed with proteoglycans and relatively few cells. Without level of the patient, the expectations and goals of the patient, vascularity, articular cartilage is dependent on diffusion to prior surgical/treatment history, body mass index, and other obtain nutrients and oxygen, making intrinsic repair of concomitant knee pathologies are all considerations in articular cartilage defects exceedingly difficult in vivo.1 determining which procedure is best for each patient.9 Focal cartilage defects of the knee are relatively common, Bone marrow stimulation techniques were first descri- found in over 60% of patients undergoing arthroscopy of bed by Pridie,10 who demonstrated that drilling subchondral the knee.2,3 It has been estimated that cartilage injuries of bone could stimulate bone marrow substrates to repopulate the knee affect approximately 900,000 Americans annually, articular cartilage defects, a technique that was later termed resulting in >200,000 surgical procedures.4 Regardless of spongialization by Ficat et al.11 Building on the concept of whether the defect is acute, chronic, or degenerative in drilling, Johnson12,13 first described abrasion arthroplasty nature, articular cartilage has not demonstrated quality where one performs multiple tissue debridement including spontaneous healing.5–8 When left untreated, focal chon- surgical penetration through subchondral bone to enhance dral lesions, particularly those involving the weight-bearing bleeding to create a repair response. These early techniques surfaces of the medial or lateral compartments as well as eventually gave rise to microfracture, which was popularized those involving the patellofemoral joint, can result to pain, by Steadman et al14 and is now considered the gold standard effusions, mechanical symptoms, and low levels of function. surgical procedure for small, isolated, articular cartilage For appropriately indicated patients, surgical intervention defects of the knee. Microfracture has gained popularity as for symptomatic cartilage lesions is not only helpful in it is a minimally invasive, single-stage, low-cost, and rela- reducing these symptoms, but also, is needed to restore near tively straightforward surgical procedure (Fig. 1).15 Micro- normal joint mechanics and congruence, and in some cases, fracture and other marrow stimulation techniques induce an influx of marrow substrates to repopulate the cartilage defect by removing the subchondral bone and exposing From the *Department of Orthopaedic Surgery, Rush University 16 Medical Center, Chicago, IL; and wEl-Hadara University Hospital, cancellous bone. This results in clot formation with mar- Alexandria University, Alexandria, Egypt. row elements that is remodeled and organized into a fibro- Disclosure: Brian Cole receives research support from Aesculap/ cartilage plug, comprised primary of type I collagen. B.Braun, Arthrex, Cytori, Medipost, Pssur, Smith & Nephew, Tornier, and Zimmer; is a paid consultant for Arthrex, Regentis, Although fibrocartilage is superior to no cartilage, the long- and Zimmer; receives royalties from Arthrex, DJ Orthopaedics, term efficacy of microfracture has been called into question Elsevier, Saunders/MosbyElsevier, and SLACK Inc; and has stock/ due to the lack of true, articular, hyaline-type cartilage fill- stock options in Carticept and Regentis. The other authors have no ing the void. Fibrocartilage repair tissue lacks many of the conflict of interest to declare. Reprints: Brian Cole, MD, MBA, Rush University Medical Center, intrinsic biochemical and viscoelastic properties of normal 1611 W Harrison St, Suite 300 Chicago, IL 60612. hyaline cartilage. As a result of its biochemical and viscoe- Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved. lastic properties, fibrocartilage is more stiff compared with 2 | www.sportsmedarthro.com Sports Med Arthrosc Rev Volume 25, Number 1, March 2017 Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved. Sports Med Arthrosc Rev Volume 25, Number 1, March 2017 Failure of Bone Marrow Stimulation Techniques FIGURE 1. Intraoperative arthroscopic photographs demonstrating the use of the microfracture procedure to a 1.8 cmÂ1.8 m lesion of the weight-bearing portion of the lateral femoral condyle in a 24-year-old woman. articular hyaline cartilage, which does not afford it the same function was consistently improved in the first 24 months shock absorption and force distribution capabilities seen in after microfracture. Specifically, at 2-year, patient-reported normal hyaline cartilage.10,17–19 The remainder of this outcomes (PROs) were improved compared with pre- review will describe the indications and outcomes of operative scores; however, only 67% to 85% of patients microfracture as a primary surgical treatment for focal continued to report improved outcomes between 2 and 5 chondral defects of the knee, identify patient and procedure- years postoperatively. In a more recent systematic review specific factors associated with poor clinical outcomes, and only of level I and II studies, Goyal et al23 confirmed the will discuss treatment options and their respective outcomes factors described by Mithoefer et al.22 However, Goyal for patients with a failed prior microfracture surgery. et al23 noted progression to osteoarthritis was observed frequently in patients who received microfracture for lesions > 4 cm2 just 5 years after the procedure. Other authors have demonstrated successful outcomes following INDICATIONS AND OUTCOMES microfracture for lesions > 4 cm2; however, that improve- Marrow stimulation techniques, including micro- ment has not been shown to last as long as for smaller fracture, are among the most commonly performed carti- lesions, which may explain why many surgeons reserve the lage restoration procedures in the United States for use of microfracture for isolated lesions < 4 cm2.22,24 symptomatic chondral defects of the knee.20 These techni- Finally, microfracture typically has better outcomes used as ques are indicated for patients with symptomatic, full- a first-line treatment, as opposed to when it is performed as thickness, isolated chondral defects.21 Numerous authors a revision operation.25–27 have nicely delineated which patients may benefit most For patients with symptomatic chondral defects of the from microfracture, while also reporting on possible neg- knee, often, concomitant knee pathology may be present, ative prognostic factors. In a systematic review of 28 studies including meniscal deficiency, coronal or sagittal plane with over 3000 patients, Mithoefer et al22 reported patient malalignment, and/or ligamentous instability.21 Such con- age above 40 years, preoperative symptomatic intervals comitant knee pathology may actually contribute to the <12 months, lesion sizer4cm2 for nonathletes and < 2 development of focal cartilage defects, as any combination of cm2 for athletes, and body mass index < 30 kg/m2 were meniscal deficiency, malalignment, and ligamentous insuffi- associated with better outcomes. Overall
Load more

Recommended publications
  • The Oregon Journal of Orthopaedics
    OJO The Oregon Journal of Orthopaedics Volume II May 2013 JUST WHEN YOU THOUGHT BIOMET KNEE IMPLANTS COULDN’T GET ANY BETTER. THE INDUSTRY’S ONLY LIFETIME KNEE IMPLANT REPLACEMENT WARRANTY† IN THE U.S. This’ll make you feel good. Every Oxford® Partial Knee used with Signature™* technology now comes with Biomet’s Lifetime Knee Implant Replacement Warranty.† It’s the first knee replacement warranty† of its kind in the U.S. – and just one more reason to choose a partial knee from Biomet. Other reasons include a faster recovery with less pain and more natural motion.** And now, the Oxford® is available with Signature™ personalized implant positioning for a solution that’s just for you. Who knew a partial knee could offer so much? ® 800.851.1661 I oxfordknee.com Risk Information: Not all patients are candidates for partial knee replacement. Only your orthopedic surgeon can tell you if you’re a candidate for joint replacement surgery, and if so, which implant is right for your specific needs. You should discuss your condition and treatment options with your surgeon. The Oxford® Meniscal Partial Knee is intended for use in individuals with osteoarthritis or avascular necrosis limited to the medial compartment of the knee and is intended to be implanted with bone cement. Potential risks include, but are not limited to, loosening, dislocation, fracture, wear, and infection, any of which can require additional surgery. For additional information on the Oxford® knee and the Signature™ system, including risks and warnings, talk to your surgeon and see the full patient risk information on oxfordknee.com and http://www.biomet.com/orthopedics/getFile.cfm?id=2287&rt=inline or call 1-800-851-1661.
    [Show full text]
  • Microfracture Surgery Improves Knee Function
    March 2006 • www.rheumatologynews.com Arthritis 19 Microfracture Surgery Improves Knee Function BY DOUG BRUNK the mean Lysholm scores improved from strenuous sports activities, we found they tissue at a level adjacent with normal ar- San Diego Bureau 57 to 87; the Tegner scores improved from increased to 80% in the first 2 years but ticular surface and were firm when pal- 3 to 5; and the subjective evaluation im- then gradually decreased to 55% at final pated with a probe. Biopsies from these S AN D IEGO — Microfracture as a treat- proved from 40/100 to 70/100. At base- follow-up,” Dr. Gobbi added. Changing to same 10 patients showed areas of fi- ment for full thickness chondral lesions line, only three patients scored an A or B a low-risk sport, advancing age of the bromyxoid tissue with differentiation, a provided functional improvement in a on the IKDC, but by final follow-up, 70% study participants, work and family oblig- transition zone with cartilage tissue, and group of professional and recreational of patients scored an A or B. ations, and the influence of degenerative initial hyaline transformation tissue. athletes at 6-year follow-up, but the level Also by final follow-up, activities of dai- joint disease may have contributed to the Candidates should be evaluated by age, of postoperative sports participation de- ly living improved in 65% of patients while decline in postsurgical sports activity. activity level, type of sport, type of injury, clined with time, Dr. Alberto Gobbi re- imaging studies revealed increased de- Second-look arthroscopy performed in expectations, associated pathologies, like- ported at a symposium sponsored by the generative changes in 30% of patients.
    [Show full text]
  • Chicago – USA May 8 – 11, 2015 12 Th World Congress of the International Cartilage Repair Society
    2 015 #ICRS15 Chicago – USA May 8 – 11, 2015 12 th World Congress of the International Cartilage Repair Society Main Programme & Extended Abstracts www.cartilage.org 21 AMA PRA Categorie 1 Credits Diamond Partner Platinum Sponsor Gold Sponsor Silver Sponsors 1 Invited Abstracts 1.1.2 in preshaped plugs 10 lengths in diameters of 7, 9, 11 and 15mm. Chondrofix® Osteochondral Allograft does not have the issue of a Allografts & Autogenous OsteoChondral Technologies waiting time as it is truly off-the-shelf. Chondrofix® is donated hu- J. Farr man tissue that is decellularized; that is, the hyaline cartilage and Greenwood/United States of America cancellous bone are delivered acellular but have mechanical proper- ties that are similar to unprocessed osteochondral tissue. The graft Introduction: Osteochondral grafts have been an important part undergoes a proprietary processing protocol, which includes lipid of the clinician’s armamentarium when treating cartilage lesion for removal, viral inactivation with methylene blue photoactivation and many years. The current issues are: identifying the best applications, terminal sterilization with low temperature low dose gamma irradia- refining the technique and optimizing the use of these tissues. While tion. Chondrofix® is currently available and being actively implanted the algorithm for cartilage restoration will continue to evolve, there in the US, noting there are no published clinical studies on this will remain overlap of the available applications with autograft and unique allograft application. Another acellular approach is frozen allograft continuing to play substantial roles. The amount of availa- osteochondral allograft. The cartilage chondrocytes are not reliably ble tissue for both autograft and allograft is limited, so creative solu- viable upon thawing and thus the matrix is not well-maintained over tions for optimizing tissue use are essential.
    [Show full text]
  • Microfracture of Knee Joint
    Microfracture of Knee Joint Post-op Precautions : The patient will ambulate with crutches for 4 weeks or more after surgery. The physician will base weight- bearing status upon the location of the lesion. Phase I (1 – 5 days post-op) • Wound care: Observe for signs of infection • Gait: WB will vary by the size of the lesion and the location. See physician prescription. The patient will typically be NWB for femoral condyle lesions and TTWB (25%) for patellofemoral lesions. • Modalities: prn for pain and inflammation (ice, IFC) • Brace: Used for patellofemoral lesions locked for WB. • ROM: 0 – 90 degrees o Passive positional stretches for extension and flexion o CPM as prescribed by physician o Ankle AROM Phase II (5 days – 4 weeks post-op) • Wound care: Observe for signs of infection and begin scar management techniques when incision is closed • Gait: o Femoral condyle lesions: Initially NWB; s/p 2 weeks increase to TTWB; s/p week 3 then increase to 25% WB o Patellofemoral lesions: Initially TTWB; At s/p week 1 increase 25% per week o Initiate wt shifting activities as soon as WB status allows • Brace: if used, locked for WB • ROM: o Minimum Goals: • Week 1: 0 – 90 degrees • Week 2: 0 – 105 degrees • Week 3: 0 – 115 degrees • Week 4: 0 – 125 degrees o Stationary bike at 3 to 4 weeks o PROM for flexion with no limits unless painful o Increase / maintain patellar mobility with emphasis on superior glide o Hamstring, gastrocnemius, soleus, and hip flexor stretches • Strengthening: o Multiangle Quad and Hamstring sets o 4 way SLR o Calf raises
    [Show full text]
  • Autologous Chondrocyte Implantation (ACI) for Cartilaginous Defects
    MEDICAL POLICY Knee: Autologous Chondrocyte Implantation (ACI) for Cartilaginous Defects Effective Date: 10/1/2021 Medical Policy Number: 137 Technology Assessment Committee Approved Date: 4/10; 5/12; 7/14; 6/15 Medical Policy Committee Approved Date: 2/11; 2/12; 7/13; 3/16; 4/17; 6/18; 1/19; 2/2020; 8/2020; 9/2021 10/1/2021 Medical Officer Date See Policy CPT/HCPCS CODE section below for any prior authorization requirements SCOPE: Providence Health Plan, Providence Health Assurance, Providence Plan Partners, and Ayin Health Solutions as applicable (referred to individually as “Company” and collectively as “Companies”). APPLIES TO: All lines of business BENEFIT APPLICATION Medicaid Members Oregon: Services requested for Oregon Health Plan (OHP) members follow the OHP Prioritized List and Oregon Administrative Rules (OARs) as the primary resource for coverage determinations. Medical policy criteria below may be applied when there are no criteria available in the OARs and the OHP Prioritized List. POLICY CRITERIA I. Autologous chondrocyte implantation (ACI) may be considered medically necessary and covered for the treatment of single or multiple symptomatic articular cartilage defects of the knee (medial, lateral or trochlear femoral condyle, or patella) when ALL of the following criteria (A. – I.) are met: A. Age 18-55 years (adolescents must have closed growth plates); and B. Body mass index (BMI) of <35; and C. Symptoms from acute or chronic trauma interfere with age-appropriate activities of daily living; and D. Symptoms have failed to improve after 3 months of conservative treatment, including physical therapy, as part of pre-operative planning for surgery; and E.
    [Show full text]
  • Autologous Matrix-Induced Chondrogenesis (AMIC) E
    REVISTA ESPAÑOLA DE ARTROSCOPIA Y CIRUGÍA ARTICULAR Asociación Española de Artroscopia Vol. 28. Issue 1. No. 71. January 2021 ISSN: 2792-2154 (printed) 2792-2162 (online) Monograph: Treatment of chondral ulcers Autologous matrix-induced chondrogenesis (AMIC) E. Sánchez Alepuz1,2,3, J. Part Soriano1,3, I. Peregrin Nevado2,3, J. Zurriaga Carda2,3, J. M. Gómez Alessandri1,3, J. Vicente Díaz2,3, R. Calero Ferrandiz1,3 1 Department of Orthopedic Surgery and Traumatology. Unión de Mutuas. Valencia (Spain) 2 Department of Orthopedic Surgery and Traumatology. IMED Valencia. Burjassot, Valencia (Spain) 3 Grupo de Estudio e Investigación del Cartílago Articular de Valencia (GEICAV) (Spain) Correspondence: Received 8 July 2019 Dr. Joan Part Soriano Accepted 16 October 2020 E-mail: [email protected] Available online: January 2021 ABSTRACT RESUMEN Objective: To analyze the evolution and current status of the au- Condrogénesis inducida por matrices (AMIC) tologous matrix-induced chondrogenesis (AMIC) technique and know its underlying biological principles, as well as the results Objetivo: examinar la evolución y la situación actual de la técni- of its use in treating chondral lesions. ca AMIC y conocer los principios biológicos sobre los que se sus- Method: A literature review is made of the basic science re- tenta, así como los resultados de su utilización en el tratamiento ferred to cartilage injuries, the surgical technique, and clinical de las lesiones condrales. outcomes versus other chondral repair and regeneration tech- Método: se realiza una revisión de la bibliografía sobre la ciencia niques. básica relativa a las lesiones de cartílago, la técnica quirúrgica y Results: According to the published studies, AMIC improves pain los resultados clínicos respecto a otras técnicas de reparación y and the clinical and functional scores, affording better outcomes regeneración condral.
    [Show full text]
  • Osteochondral Allograft/Autograft Transplantation (OAT) Health Technology Assessment
    WA Health Technology Assessment - HTA WASHINGTON STATE HEALTH CARE AUTHORITY Osteochondral Allograft/Autograft Transplantation (OAT) Health Technology Assessment Monday, October 17, 2011 Health Technology Assessment Program 676 Woodland Square Loop SE P.O. Box 42712 Olympia, WA 98504-2712 http://www.hta.hca.wa.gov WA Health Technology Assessment - HTA Osteochondral Allograft/Autograft Transplantation (OAT) Provided by: Spectrum Research, Inc. Prepared by: Andrea C. Skelly, PhD, MPH Erika D. Ecker, BS Jeannette M. Schenk‐Kisser, PhD, MS Barbara C. Leigh, PhD, MPH Annie Raich, MS, MPH With assistance from Robin E. Hashimoto, PhD Jeffrey T. Hermsmeyer, BA WA Health Technology Assessment: OATS (10-17-2011) Page 2 of 168 WA Health Technology Assessment - HTA This technology assessment report is based on research conducted by a contracted technology assessment center, with updates as contracted by the Washington State Health Care Authority. This report is an independent assessment of the technology question(s) described based on accepted methodological principles. The findings and conclusions contained herein are those of the investigators and authors who are responsible for the content. These findings and conclusions may not necessarily represent the views of the HCA/Agency and thus, no statement in this report shall be construed as an official position or policy of the HCA/Agency. The information in this assessment is intended to assist health care decision makers, clinicians, patients and policy makers in making sound evidence‐based decisions that may improve the quality and cost‐ effectiveness of health care services. Information in this report is not a substitute for sound clinical judgment. Those making decisions regarding the provision of health care services should consider this report in a manner similar to any other medical reference, integrating the information with all other pertinent information to make decisions within the context of individual patient circumstances and resource availability.
    [Show full text]
  • Microfracture in the Hip: a Matched-Control Study with Average 3-Year Follow-Up Parth Lodhia1, Chengcheng Gui1, Sivashankar Chandrasekaran1, Carlos Suarez-Ahedo1, S
    Journal of Hip Preservation Surgery Advance Access published December 10, 2015 Journal of Hip Preservation Surgery Vol. 0, No. 0, pp. 1–11 doi: 10.1093/jhps/hnv073 Research article Microfracture in the hip: a matched-control study with average 3-year follow-up Parth Lodhia1, Chengcheng Gui1, Sivashankar Chandrasekaran1, Carlos Suarez-Ahedo1, S. Pavan Vemula1 and Benjamin G. Domb1,2,* 1. Department of Orthopaedics, American Hip Institute, Westmont, IL, USA, 2. Hinsdale Orthopaedics, 1010 Executive Ct, Suite 250, Westmont, IL 60559 *Correspondence to: B. G. Domb, E-mail: [email protected] Downloaded from Submitted 19 December 2014; Revised 17 September 2015; revised version accepted 25 October 2015 ABSTRACT There is a paucity of literature regarding microfracture surgery in the hip. The purpose of this study was to compare http://jhps.oxfordjournals.org/ outcomes in patients undergoing hip arthroscopy predominantly for labral tears with focal full thickness chondral dam- age on the acetabulum or femoral head treated with microfracture and a matched control group that did not have focal full thickness chondral damage. A prospective matched-control study was performed examining four patient-reported outcome (PRO) scores: modified Harris Hip Score (mHHS), non-arthritic hip score, Hip Outcome Score—Activities of Daily Living (HOS-ADL), and Hip Outcome Score—Sports Specific Subscale (HOS-SSS) at minimum 2 years post-operatively between 35 patients undergoing microfracture for chondral defects during hip arthroscopy and 70 pa- tients in a control group that did not have chondral defects. The patients were matched based on gender, age within 7 years, Workman’s compensation claim, labral treatment and acetabular crossover percentage less than or greater than 20.
    [Show full text]
  • Tissue Engineering and the Future of Hip Cartilage, Labrum and Ligamentum Teres Allston J
    Journal of Hip Preservation Surgery Vol. 3, No. 1, pp. 23–29 doi: 10.1093/jhps/hnv051 Advance Access Publication 12 August 2015 Review Article REVIEW ARTICLE Tissue engineering and the future of hip cartilage, labrum and ligamentum teres Allston J. Stubbs1,*, Elizabeth A. Howse2 and Sandeep Mannava1 1. Division of Sports Medicine, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA 2. Department of Emergency Medicine, Kaiser Permanente Walnut Creek Medical Center, 1425 S. Main St, Walnut Creek, CA, 94596, USA *Correspondence to: A. J. Stubbs. E-mail: [email protected] Submitted 30 March 2015; revised version accepted 27 June 2015 ABSTRACT As the field of hip arthroscopy continues to evolve, the biological understanding of orthopaedic tissues, namely articular cartilage, labral fibro-cartilage and the ligamentum teres continues to expand. Similarly, the need for biological solutions for the pre-arthritic and early arthritic hip continues to be a challenge for the sports medicine surgeon and hip arthroscopist. This article outlines existing biological and tissue-engineering technologies, some being used in clinical practice and other technologies being developed, and how these biological and tissue- engineering principals may one day influence the practice of hip arthroscopy. This review of hip literature is specific to emerging biological technologies for the treatment of chondral defects, labral tears and ligamentum teres deficiency. Of note, not all of the technologies described in this article have been approved by the United States Food and Drug Administration and some of the described uses of the approved technologies should be considered ‘off-label’ uses.
    [Show full text]
  • Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions
    Clinical Guidelines DAVID S. LOGERSTEDT, PT, MA • LYNN SNYDER-MACKLER, PT, ScD • RICHARD C. RITTER, DPT • MICHAEL J. AXE, MD Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association J Orthop Sports Phys Ther. 2010:40(6):A1-A35. doi:10.2519/jospt.2010.0304 RECOMMENDATIONS ................................................... A2 INTRODUCTION............................................................ A3 METHODS .................................................................... A3 CLINICAL GUIDELINES: Impairment/Function-Based Diagnosis .................. A7 CLINICAL GUIDELINES: Examinations.......................................................... A13 CLINICAL GUIDELINES: Interventions .......................................................... A25 SUMMARY OF RECOMMENDATIONS ............................. A30 AUTHOR/REVIEWER AFFILIATIONS AND CONTACTS ...... A31 REFERENCES ............................................................. A32 REVIEWERS: Roy D. Altman, MD • Matthew Briggs, DPT • Constance Chu, MD • Anthony Delitto, PT, PhD • Amanda Ferland, DPT Helene Fearon, PT • G. Kelley Fitzgerald, PT, PhD • Joy MacDermid, PT, PhD • James W. Matheson, DPT • Philip McClure, PT, PhD Paul Shekelle, MD, PhD • A. Russell Smith, Jr., PT, EdD • Leslie Torburn, DPT For author, coordinator, and reviewer affiliations, see end of text. ©2010 Orthopaedic
    [Show full text]
  • 2020 Abstracts 04-01-20 Pk
    MID-AMERICA ORTHOPAEDIC ASSOCIATION 38th Annual Meeting April 22-26, 2020 Hyatt Regency Coconut Point Resort Bonita Springs, FL Meeting canceled due to COVID-19 Podium and Poster Abstracts NOTE: Disclosure information is listed at the end of this document. *Denotes presenter MAOA FIRST PLENARY SESSION April 23, 2020 Differentiating Conversion Total Knee Arthroplasty from Primary Total Knee Arthroplasty Abstract ID: Paper 001 Nicholas B. Frisch, M.D., M.B.A. / Rochester, MI *Timothy C. Keating, M.D. / Chicago, IL Tyler E. Calkins, M.D. / Memphis, TN Chris Culvern, M.S. / Chicago, IL Craig J. Della Valle, M.D. / Chicago, IL INTRODUCTION: With the continued push toward increased efficiency and improved clinical outcome pathways, there is a growing need to differentiate routine primary total knee arthroplasty (TKA) from more complex primary TKA procedures. Patients with a previous fracture or corrective osteotomy about the knee often require complex primary, or “conversion,” total knee arthroplasty due to retained hardware, scarred tissue, malalignment, bone loss, and other patient factors. The objective of this study is to compare short-term outcomes and resource utilization of primary and conversion TKA, and to differentiate what previous surgeries or injuries are likely to require conversion TKA. METHODS: Retrospective chart review of 1319 primary TKA performed by a single surgeon at a single institution between 2011 and 2017 identified 130 patients with a history of previous knee surgery to form a ‘conversion’ cohort. One-to-one nearest-neighbor matching was used to identify 130 patients of similar age, ASA BMI, and sex without a history of previous knee surgery for a ‘primary’ cohort.
    [Show full text]
  • Single-/Two-Step Scaffold-Based Cartilage Repair in the Knee and Ankle Joint
    Single-/two-step scaffold-based cartilage repair in the knee and ankle joint Systematic Review 1st Update 2019 Decision Support Document No. 98/1st Update 2019 ISSN online: 1998-0469 Single-/two-step scaffold-based cartilage repair in the knee and ankle joint Systematic Review 1st Update 2019 Vienna, March 2019 Project Team Project leader: Sabine Geiger-Gritsch, Dr. scient.med, Mag. sc.hum, Mag. pharm. Authors: Sarah Wolf, BSc, MSc Katharina Rosian, BSc, MSc Project Support Systematic literature search: Tarquin Mittermayr, BA (Hons), MA External Review: Priv.-Doz. DDr. Christian Albrecht, MBA, Orthopädische Abteilung, Orthopädisches Spital Speising, Vienna Internal Review: Sabine Geiger-Gritsch, Dr. scient.med, Mag. sc.hum, Mag. pharm. Correspondence Sarah Wolf, [email protected] Katharina Rosian, [email protected] This report should be referenced as follows: Wolf S, Rosian K. Single-/two-step scaffold-based cartilage repair in the knee and ankle joint. Decision Support Document No. 98/1st Update 2019. Vienna: Ludwig Boltzmann Institute for Health Technology Assessment. Conflict of interest All authors and the reviewers involved in the production of this report have declared they have no conflicts of interest in relation to the technology assessed according to the Uniform Requirements of Manuscripts Statement of Medical Journal Editors (www.icmje.org). Disclaimer The external reviewers did not co-author the scientific report and do not necessarily all agree with its content. Only the LBI-HTA is responsible for errors or omissions that could persist. The final version and the policy recommendations are under the full responsibility of the LBI-HTA.
    [Show full text]