Medical Concerns in Orthobiologics Procedures.

Orthobiologics have shown immense treatment potential in many medical fields including sports medicine, musculoskeletal disorders, and pain management. As with the case of any medical procedures and treatments, there are potential side effects or caveats that physicians and patients should be cognizant of. Nevertheless, the use of orthobiologics does not seem to have consistent severe side effects and do not have increased risks with transmissible disease, immune-modulated reactions, or oncologic processes.

Novel assessment of leukocyte-rich platelet-rich plasma on functional and patient-reported outcomes in knee osteoarthritis: a pilot study.

Background: Leukocyte-rich platelet-rich plasma (LR-PRP) has demonstrated to be beneficial for patients with knee osteoarthritis (KOA); however, reliable objective end points to accurately assess its therapeutic effects is lacking. Aim: To investigate the efficacy of LR-PRP as assessed by functional and patient-reported outcomes at early time points (6 weeks). Materials & methods: We conducted a prospective cohort study in 12 patients with diagnosed KOA (Kellgren Lawrence score of II-III), who underwent a single ultrasound-guided LR-PRP injection. Results: There was significant improvement in timed up and go, pain and quality of life scales and balance parameters. There were nonsignificant improvements in range of motion and gait parameters. Conclusion: LR-PRP demonstrates efficacy in meaningful end points for functional and patient-reported outcomes at early time points in patients with KOA.

Content Evaluation of Physical Medicine and Rehabilitation Residency Websites.

BACKGROUND: Prospective Physical Medicine and Rehabilitation (PM&R) applicants commonly view residency program websites to make informed decisions about where to submit their applications. To our knowledge, this is the first comprehensive review of the availability and accessibility of online content for PM&R residency programs. OBJECTIVE: To evaluate the comprehensiveness of PM&R residency websites to inform prospective applicants about the information readily available to them and identify deficient areas for program directors to address. DESIGN: Cross-sectional analysis of residency program websites using quantitative and descriptive statistics. SETTING: World Wide Web (Internet). SUBJECTS: 87 PM&R civilian residency program websites listed on the Fellowship and Residency Electronic Interactive Database (FREIDA). MAIN OUTCOME MEASUREMENTS: The presence or absence of 25 predetermined criteria on residency program websites. RESULTS: The individual residency program websites had a mean ± SD of 12.3 ± 4.3 (49.1%) of the 25 criteria sought. The programs ranged from having as few as one to as many as 19 of the 25 criteria. Twenty programs had 9 or fewer criteria, 35 programs had 10 to 14 criteria, 31 programs had 15 to 18 criteria, and one program had 19 criteria available online. No PM&R residency website had all 25 criteria. There was a significant association between a program's Doximity ranking as top 20 or not and the citation of published research projects by faculty on a PM&R website (P = .026), but the other 24 criteria had no significant associations. CONCLUSIONS: Most PM&R residency websites currently do not include comprehensive information about their programs for prospective applicants.

Tendon ruptures: mallet, flexor digitorum profundus.

Mallet injuries are the most common closed tendon injury in the athlete. Flexor digitorum profundus ruptures are rare in baseball, but are common injuries in contact sports. The diagnosis for each condition is based on clinical examination, although radiographs should be evaluated for a possible bony component. Treatment for mallet injury depends on the athlete's goals of competition and understanding of the consequences of any treatment chosen. Gripping, throwing, and catching would be restricted or impossible with the injured finger immobilized. Treatment of FDP ruptures is almost always surgical and requires reattachment of the torn tendon to the distal phalanx.

Postarthroscopic glenohumeral chondrolysis.

Postarthroscopic glenohumeral chondrolysis (PAGCL) is a rare complication in which the articular cartilage of the shoulder undergoes rapid, degenerative changes shortly after arthroscopic surgery. Patients with PAGCL are often young (eg, aged 10 to 40 years) and develop deep shoulder pain with progressive loss of motion that begins months after the initial arthroscopic surgery. PAGCL should be considered in the differential diagnosis in the patient with deep, unexplained shoulder pain following arthroscopic surgery. Although the etiology of PAGCL is not yet fully understood, the pathophysiology is likely multifactorial. Inherent patient factors and risk factors for PAGCL have been identified, but it is unclear how these factors interact. Current surgical practices need to be examined and new practices developed to prevent PAGCL. Proud placement of nonabsorbable suture anchors during surgery to correct instability, as well as the use of thermal devices and intra-articular pain pumps, should be avoided.

Epidemiology of isolated meniscal injury and its effect on performance in athletes from the National Basketball Association.

BACKGROUND: The current incidence and outcomes of meniscal injury have not been quantified in professional athletes. PURPOSE: To describe the incidence, risk, amount of time lost, and effect on performance for isolated meniscal injury in athletes from the National Basketball Association (NBA). Demographic factors predicting the risk of meniscal tears and the effect of injury in return to play were also investigated. STUDY DESIGN: Descriptive epidemiology study. METHODS: A centralized database was queried to identify meniscal injuries occurring in the NBA over 21 seasons. The frequency of injury, time lost, game exposures, and incidence, rate, and risk were calculated. The preinjury and postinjury player efficiency rating (PER) was used to identify changes in player performance. RESULTS: We identified 129 isolated meniscal tears in NBA athletes during a 21-season span. From this number, 77 (59.7%) involved the lateral meniscus and 52 (40.3%) the medial meniscus. Injuries occurred more frequently in games. The lateral meniscus had a statistically significant higher injury rate. Both left and right knees were equally affected. The number of days missed for lateral meniscal tears and medial meniscal tears was 43.8 ± 35.7 days and 40.9 ± 29.7 days, respectively, and was not statistically different. There was a significant inverse relationship between age and rate of lateral meniscal tears, with lateral meniscal tears more likely to occur up to age 30 years; beyond that medial meniscal tears were more common. Players with a body mass index (BMI) greater than 25 had a significantly increased risk of meniscal tears compared with players with a BMI less than 25, specifically with an increased risk of lateral meniscal tears. Twenty-five players (19.4%) did not return to play. For those who did, upon returning to competition, there was no statistical change in PER from their preinjury status, and the mean number of seasons completed was 4.1 ± 3.7 seasons. CONCLUSION: The lateral meniscus is more frequently torn than the medial meniscus, but there was no difference in the amount of playing time lost. Both right and left knees were equally affected. There was an inverse relationship between age and the rate of lateral meniscal tears. Risk of tears was increased in players having a BMI greater than 25. Injury did not negatively affect playing performance.

The distal triceps tendon footprint and a biomechanical analysis of 3 repair techniques.

BACKGROUND: Anatomic repair of tendon ruptures is an important goal of surgical treatment. There are limited data on the triceps brachii insertion, footprint, and anatomic reconstruction of the distal triceps tendon. HYPOTHESIS: An anatomic repair of distal triceps tendon ruptures more closely imitates the preinjury anatomy and may result in a more durable repair. STUDY DESIGN: Descriptive and controlled laboratory studies. METHODS: The triceps tendon footprint was measured in 27 cadaveric elbows, and a distal tendon rupture was created. Elbows were randomly assigned to 1 of 3 repair groups: cruciate repair group, suture anchor group, and anatomic repair group. Biomechanical measurement of load at yield and peak load were measured. Cyclic loading was performed for a total of 1500 cycles and displacement measured. RESULTS: The average bony footprint of the triceps tendon was 466 mm2. Cyclic loading of tendons from the 3 repair types demonstrated that the anatomic repair produced the least amount of displacement when compared with the other repair types (P < .05). Load at yield and peak load were similar for all repair types (P > .05). CONCLUSION: The triceps bony footprint is a large area on the olecranon that should be considered when repairing distal triceps tendon ruptures. Anatomic repair of triceps tendon ruptures demonstrated the most anatomic restoration of distal triceps ruptures and showed statistically significantly less repair-site motion when cyclically loaded. CLINICAL RELEVANCE: Anatomic repair better restores preinjury anatomy compared with other types of repairs and demonstrates less repair-site motion, which may play a role in early postoperative management.

Distal triceps rupture.

Distal triceps rupture is an uncommon injury. It is most often associated with anabolic steroid use, weight lifting, and laceration. Other local and systemic risk factors include local steroid injection, olecranon bursitis, and hyperparathyroidism. Distal triceps rupture is usually caused by a fall on an outstretched hand or a direct blow. Eccentric loading of a contracting triceps has been implicated, particularly in professional athletes. Initial diagnosis may be difficult because a palpable defect is not always present. Pain and swelling may limit the ability to evaluate strength and elbow range of motion. Although plain radiographs are helpful in ruling out other elbow pathology, MRI is used to confirm the diagnosis, classify the injury, and guide management. Incomplete tears with active elbow extension against resistance are managed nonsurgically. Surgical repair is indicated in active persons with complete tears and for incomplete tears with concomitant loss of strength. Good to excellent results have been reported with surgical repair, and very good results have been achieved even for chronic tears.

Extension loss secondary to femoral-sided inverted cyclops lesion after anterior cruciate ligament reconstruction.

Loss of terminal knee extension after anterior cruciate ligament (ACL) reconstruction is problematic. Formation of a fibrous nodule, known as a cyclops lesion, at the site of the ACL graft exiting from the tibial tunnel can impinge at the roof of the intercondylar notch and block terminal knee extension. This article presents a case of an inverted cyclops lesion originating from the femoral tunnel site of the ACL graft, representing a variant of the traditional cyclops lesion. The lesion was identified by clinical examination including prone heel-height difference assessment in combination with magnetic resonance imaging arthrography. The lesion was treated successfully by arthroscopic resection, with rapid resolution of the patient's painful, symptomatic extension loss.

Essex-lopresti injuries.

The Essex-Lopresti injury results from a high energy trauma to the upper extremity causing significant instability to the forearm joint. The radial head is fractured, the interosseous membrane is torn, and the distal radioulnar joint is disrupted. Frequently, the greatest challenge with this specific injury pattern is the diagnosis, because it is often missed in the emergency room. Once the diagnosis has been established, surgical treatment focuses on the elbow (radial head fracture) and the wrist (distal radioulnar joint disruption) to restore forearm length and stability. Chronic or untreated Essex-Lopresti lesions continue to challenge treating physicians and often require salvage or reconstructive procedures to minimize pain and return function.