Donor age has no relevant role in biomechanical properties of allografts used in anterior cruciate ligament (ACL) reconstruction: A systematic review.

PURPOSE: Surgeons generally consider the donor age as a factor that negatively influences the quality of allograft used in anterior cruciate ligament (ACL) reconstruction, however, the available evidence does not clearly support this statement. The purpose of the study was to investigate if donor age influences the biomechanical properties of allografts used in ACL reconstruction. METHODS: A comprehensive literature search was conducted for all relevant articles using MEDLINE (PubMed), Scopus, and Cochrane Collaboration Library, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Studies including the analysis of the correlation between biomechanical properties of the allografts and donor age were selected. The role of donor age was labelled as 'none' if absent, 'higher' or 'lower' if the properties were higher or lower in older specimens with respect to younger. The correlation was defined as 'weak' or 'strong' according to each study definition. RESULTS: No conflicting role of donor age was reported for modulus of elasticity, load to failure, strain, stiffness and displacement. The only parameters where the significant results were consistent were the tensile strength and the stress (low or moderate correlations). When considering the tested samples with a donor's age <65 years, a significant role of age was reported in only four out of 13 groups of graft tested (patellar tendon, fascia lata, anterior tibialis tendon and posterior tibialis tendon). CONCLUSION: The current literature did not allow to state that the donor age negatively influences the biomechanical properties of allografts, making it impossible to identify a clear age cut-off value to exclude them from ACL reconstruction procedures. LEVEL OF EVIDENCE: Level IV, systematic review.

All-Polyethylene Versus Metal-Backed Tibial Components in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: In the literature, there is no evidence suggesting the superiority in clinical performance between all-polyethylene (AP) and metal-backed (MB) tibial implants in total knee arthroplasty. The aim of this study was to systematically review the literature to collect only high-quality studies investigating the differences in terms of clinical and radiostereometric analysis (RSA) outcomes of AP compared to MB implants. METHODS: Only randomized controlled trials (RCTs) reporting either clinical or RSA outcomes have been included. Data sources were Embase, Medline, and the Cochrane Central Register of Controlled Trials. RESULTS: We included eleven RCTs evaluating the outcomes of 1,377 patients. Of the RCTs, 9 of them showed a low risk and 2 showed moderate risk of bias. There was no statistically significant difference in terms of clinical outcomes and survival rate between the AP and MB group; however, a statistically significant lower mean lift-off in the AP group (0.19 mm) compared to the MB group (0.3 mm) was observed on RSA. CONCLUSIONS: The performance of AP total knee arthroplasty in terms of clinical outcomes and 5-year survival was not statistically different when compared to the MB group. However, the RSA showed a statistically significant lower mean lift-off in the AP group.

The 25-year experience of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: the story so far.

This article presents with an evidence based approach, the kinematical rationale, biological evidence and the long term results of the "Over-The-Top" anterior cruciate ligament reconstruction with lateral plasty technique. This surgery was developed more than 25 years ago at the Rizzoli Institute by professor Marcacci and Zaffagnini and it is still widely performed in many orthopedic center worldwide.

Sub-optimal femoral fit in total knee arthroplasty, a systematic review of human femoral data vs off-the-shelf contemporary femoral components.

PURPOSE: The purpose of the current study is to investigate the inadequacy of fit between the human distal femur and the knee implants offerings and describe the available strategies to overcome this issue. METHODS: A systematic research of the literature was performed to identify studies reporting morphologic measures of the distal femur. Studies were excluded if they included unhealthy knees or the morphological analysis did not report the two key dimensions to identify the patient's unique anatomy: AP length and mediolateral (ML) width. Clinically relevant component overhang or underhang was considered when the metal-bone mismatch was > 3 mm as described in the literature. RESULTS: Six studies with anthropometric analysis of 1395 distal femurs met the inclusion criteria. The analysis revealed that by employing the available sizes of four current "state-of-the-art" primary off-the shelf (OTS) femoral implants up to 13-41% would show underhang and 9-27% overhang clinically relevant and the introduction of narrower sizes did not reduce this percentage of underhang but improved the overhang rate of 10-15%. CONCLUSIONS: Whenever an ML/AP mismatch in encountered in the operating room, adaptations are needed, and these bring about deleterious biomechanical and clinical complications. Therefore, this study highlights the need for implants design with multiple ML offerings per AP size, since they provide not only more sizes options but more femoral shapes to match the different ML sizes of the distal femur, compared to designs with single ML offerings for a given femoral AP dimension.

Placenta-Derived Products Demonstrate Good Safety Profile and Overall Satisfactory Outcomes for Treating Knee Osteoarthritis: A Systematic Review of Clinical Evidence.

PURPOSE: To summarize the available evidence regarding the clinical application of placenta-derived products to treat knee osteoarthritis (OA), underlining the differences existing among products, their preparation methods, and the clinical results reported so far. METHODS: A research on PubMed, Cochrane, and Google Scholar databases was performed. The following inclusion criteria for relevant articles were used: (1) randomized controlled trials (RCTs), prospective and retrospective studies, on humans; (2) written in English; (3) published in indexed journals in the last 10 years (2011-2022); and (4) dealing with the use of placenta-derived products for the treatment of knee OA. Exclusion criteria were articles written in other languages; animals or in vitro trials; reviews; and trials analyzing other applications of placenta-derived products not related to knee OA. RESULTS: In total, 16 studies were included in the present systematic review. Five studies investigated placenta-derived products as an augmentation during surgical procedures, whereas 11 studies were focused on the injective approach only. Of these, only 4 were RCTs and were all from the injective approach group. Potential risk of bias was carried out using Cochrane Risk of Bias 2 tool for RCTs and a modified Coleman approach for nonrandomized studies, revealing for both an overall insufficient quality. Clinical outcomes reveal excellent safety profile and notable efficacy, despite the different types of products used and different administration methods adopted. CONCLUSIONS: Placental products showed a good safety profile and overall satisfactory outcomes for the treatment of knee OA. LEVEL OF EVIDENCE: Level IV, systematic review of Level II, III and IV studies.

Survivorship and Reoperation of 324 Consecutive Isolated or Combined Arthroscopic Meniscal Allograft Transplants Using Soft Tissue Fixation.

BACKGROUND: Meniscal allograft transplant (MAT) is an effective treatment for relieving symptoms and improving knee function in patients who experience symptomatic unicompartmental knee pain after a previous meniscectomy. However, the literature contains a paucity of studies assessing the survival rate and prognostic factors of soft tissue MAT. PURPOSE: To report the survivorship of a large, single-center cohort of consecutive patients treated with arthroscopic MAT using soft tissue technique and to investigate variables that could potentially influence failures and outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Consecutive MAT procedures totaling 364 performed in a single institution between June 2004 and April 2019 were screened and assessed for eligibility. Subjective clinical scores (Lysholm score, Tegner activity scale, and visual analog score) were collected preoperatively and at 2, 5, 7, and 10 years of follow-up. Two survival analyses were performed using Kaplan-Meier curves, with surgical failure (defined as any graft revision) and clinical failure (defined as a Lysholm score <65 points) used as endpoints. Univariate analyses were performed using reoperations, surgical failure, clinical failure, and different demographic and surgical characteristics as endpoints. RESULTS: A total of 324 consecutive patients were evaluated at a mean follow-up 5.7 ± 3.0 years. Of these, 189 (58%) underwent an associated surgical procedure. A total of 22 patients (6.8%) were considered to have experienced surgical failure, and no predictors of surgical failure were identified based on the relevant variables. When all patients were considered, a significant improvement in all of the patient-reported outcome measures was present between the preoperative assessment and the last follow-up (P < .001), with no significant decrease over time. Moreover, 70 (21.6%) patients were considered to have experienced clinical failure; the need for concurrent cartilage procedures (odds ratio, 0.16; P = .001) and anterior cruciate ligament (ACL) reconstruction (odds ratio, 0.40; P = .059) were predictors of failure. Finally, a lower survival rate was reported in female patients compared with male patients (49% vs 69%, respectively; P = .007) and in patients who required cartilage surgery (P = .014). In particular, patients who required cartilage surgery showed nearly half the survival rate compared with those with required no cartilage procedures at 10-year follow-up (36.4% vs 71%, respectively; P = .029). CONCLUSION: Female sex and the need to combine MAT with a cartilage procedure or ACL reconstruction could result in an increased rate of clinical failure at midterm follow-up.

Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10 years.

PURPOSE: This study aimed at reporting the long-term second revision rate and subjective clinical outcomes from a cohort of patients who underwent a double-bundle (DB) ACLR first revision with allograft at a single institution. METHODS: The Institutional database was searched according to the following inclusion criteria: (1) patients that underwent DB-ACL first revision with Achilles tendon allograft, (2) surgery performed between January 2000 and December 2012, (3) age at revision ≥ 18 y/o. Patients' general information, history, surgical data, and personal contacts were extracted from charts. An online survey platform was implemented to collect responses via email. The survey questions included: date of surgeries, surgical data, date of graft failure and subsequent second ACL revision surgery, any other surgery of the index knee, contralateral ACLR, KOOS score, and Tegner scores. RESULTS: Eighty-one patients were included in the survival analysis, mean age at revision 32 ± 9.2 y/o, 71 males, mean BMI 24.7 ± 2.7, mean time from ACL to revision 6.8 ± 5.4 years, mean follow-up time 10.7 ± 1.4 years. There were 12 (15%) second ACL revisions during the follow-up period, three females and nine males, at a mean of 4.5 ± 3 years after the index surgery. The overall survival rates were 85% from a second ACL revision and 68% from all reoperations of the index knee. Considering only the successful procedures (61 patients), at final follow-up, the mean values for the KOOS subscales were 84 ± 15.5 for Pain, 88.1 ± 13.6 for Symptoms, 93 ± 11.6 for ADL, 75 ± 24.5 for Sport, and 71 ± 19.6 for Qol. Twenty-nine (48%) patients performed sports activity at the same level as before ACLR failure. CONCLUSIONS: Double-bundle ACL revision with fresh-frozen Achilles allograft yields satisfactory results at long-term follow-up, with an 85% survival rate from a second ACL revision at mean 10 years' follow-up and good patient-reported clinical scores. LEVEL OF EVIDENCE: Level IV.

Conservative vs. Surgical Management for Femoro-Acetabular Impingement: A Systematic Review of Clinical Evidence.

Femoro-acetabular impingement (FAI) syndrome is one of the most studied conditions in sports medicine. Surgical or conservative approaches can be proposed for treating FAI, although the best standard of care is not established yet. Our aim is to provide a comprehensive review of the best treatment for FAI syndrome evaluating differences in outcomes between surgical and non-operative management. A literature search was carried out on the PubMed, EMBASE, Scopus, and PEDro databases, using the following keywords: "femoroacetabular impingement", "FAI", in association with "surgery", "arthroscopy", "surgical" and "conservative", "physiotherapy", "physical therapy", "rehabilitation", "exercise". Only Level I RCTs were included. Four articles were selected for this systematic review. Our analysis showed different therapeutic protocols, follow-up periods, and outcomes; however, three out of the four studies included favored surgery. Our study demonstrates beneficial effects for both arthroscopic treatment and a proper regimen of physical therapy, nevertheless a surgical approach seemed to offer superior short-term results when compared to conservative care only. Further trials with larger sample sizes and longer follow-ups are needed to assess the definitive approach to the FAI condition.

In Vivo Model of Osteoarthritis to Compare Allogenic Amniotic Epithelial Stem Cells and Autologous Adipose Derived Cells.

The challenge of osteoarthritis (OA) is to find a minimally invasive orthobiological therapy to contrast OA progression, on inflammatory and structural fronts. The aim of the present study is to compare the effects of an intra-articular injection of three orthobiological treatments, autologous culture expanded adipose-derived mesenchymal stromal cells (ADSCs), autologous stromal vascular fraction (SVF) and allogenic culture expanded amniotic epithelial stem cells (AECs), in an animal model of OA. OA was induced in 24 sheep by bilateral lateral meniscectomy and, at 3 and 6 months post-treatment, the results were analyzed with macroscopy, histology, histomorphometry, and biochemistry. All the three treatments showed better results than control (injection of NaCl), but SVF and AECs showed superiority over ADSCs, because they induced higher cartilage regeneration and lower inflammation. SVF showed better results than AECs at 3 and 6 months. To conclude, SVF seems to be more favorable than the other biological options, because it is easily obtained and rapidly used after harvesting, with good healing potential. AECs cause no discomfort and could be also considered for the treatment of OA joints.

Anterior Cruciate Ligament Agenesia in a Patient with Ehlers-Danlos Syndrome and Open Physes.

Introduction: The agenesis of the anterior cruciate ligament (ACL) is a rare condition infrequently diagnosed as an isolated malformation. Still, it is linked to systemic disorders such as Ehlers-Danlos syndrome (EDS), an inheritable connective tissue disorder characterized by joint hyperlaxity and increased risk of dislocations and subluxations. The literature on ACL reconstruction in EDS patients is minimal, and ours is the second case report describing the surgical management of an ACL agenesis in a patient with this pathology. Case Presentation: The present case report describes the surgical management of an 11-year-old patient affected by EDS. The particularity of this case is that the young patient presented with complete agenesis of the ACL in the right knee resulting in severe joint instability needing surgical reconstruction. This case represented a challenge for the orthopedic surgeon due to the need to improve joint stability without compromising the bone growth of a young patient with open physes while also dealing with tissues that have reduced mechanical properties due to the patient's disease. The patient was therefore treated with an Achilles tendon allograft through a modified version of the typical ACL reconstructive surgery that excluded the classical tunnel drilling in the tibia and femur. Conclusion: At a 2-year follow-up, this technique proved to be an effective treatment for ACL agenesis in an EDS patient. It could provide a reference for surgeons facing similar cases. The proposed surgical technique, completely extra-epiphyseal, could also be applied to healthy young patients with open physes to avoid future growth disturbances.

High return to sport rate and few re-ruptures at long term in professional footballers after anterior cruciate ligament reconstruction with hamstrings.

PURPOSE: Anterior cruciate ligament (ACL) ruptures are considered high burden injuries in sports with high pivotal activity, especially for professional footballers. A lack of evidence exists about long-term follow up of professional elite athletes who underwent ACL reconstruction. The purpose of the study is to analyze the return to play and the career of professional footballers who underwent ACL reconstruction with hamstrings, to evaluate re-rupture and reoperation at either indexed and contralateral knee, and to assess the long-term clinical subjective outcomes and satisfaction. METHODS: Twenty-eight professional footballers that underwent 33 ACL reconstructions were retrospectively included in the study. All surgical interventions were performed using hamstring tendons graft and an over the top technique. Inclusion criteria were: inability to compete due to joint instability caused by total or subtotal ACL lesion, patients contracted to a professional football team at time of surgery. Exclusion criteria were: multi-ligament reconstruction or concomitant meniscal allograft transplantation. Patients were contacted by phone and a brief questionnaire about surgery was administered. Subsequently, a Lysholm knee scoring scale was obtained. After that, an online research was performed on publicly available websites in order to retrieve information of the patients included after surgery. RESULTS: In all cases, ACL Reconstruction was performed with hamstring tendons using a non-anatomic Double-Bundle technique in 16 cases (49%), an Over-The-Top Single-Bundle technique in 9 cases (27%), and an Over-The-Top Single-Bundle plus Lateral Plasty technique in 8 cases (24%); moreover, a meniscal lesion was present in 20 cases (61%). Three (9%) of the 33 ACL reconstruction failed (2/16 Double-Bundle, 1/9 Single- Bundle, 0/8 Single-Bundle + Lateral Plasty; p = n.s.), with two of them within 12 months from surgery. Other procedures, mainly arthroscopic meniscectomies, were performed in 10 cases (30%). The first official match was played after an average of 8.0 ± 3.6 (4.6-18.2) months in 31 cases (94%). Patients were evaluated after 12.6 ± 3.3 years (6.7-17.5) from the indexed ACL reconstruction. The average Lysholm score was 94.2 ± 8.3. CONCLUSIONS: In our small case-series, professional soccer players were able to return to play at a competitive level with a hamstrings over the top technique. Patients with long careers had a high percentage of reoperation on the contralateral knee. LEVEL OF EVIDENCE: IV.

Long sports career and satisfactory clinical outcomes after Meniscal Allograft Transplantation (MAT) in young professional athletes involved in strenuous sports.

PURPOSE: To assess the return to sport rate of young professional athletes, to analyze their careers in terms of matches played and league participation over a minimum period of 6 years after Meniscal Allograft Transplantation (MAT), as well as to assess the long-term clinical subjective outcomes and satisfaction. METHODS: Thirteen professional athletes (ten soccer and one basketball players, one fencer and one wrestler) with a mean age at surgery of 23.4 ± 4.0 underwent MAT (six medial, seven lateral). The time required to return to sport, post-operative performance level and the number of reoperations were evaluated. At an average follow-up of 9.0 ± 2.8 years, Lysholm, KOOS and Cincinnati scores were administered and collected. RESULTS: Thirteen patients (100%) returned to sports practice after an average period of 11.8 ± 3.8 months. Nine athletes (69%) returned to sports at the same pre-injury level. Overall, 93%, 85%, 62% and 55% were active until the 3rd, the 5th, the 7th and the 9th season after MAT, respectively. Seven patients (54%) underwent a reoperation after MAT, where only two of them (15%) were related to graft problems (one meniscectomy and one graft suture). Of the ten athletes that completed subjective evaluation, the mean Lysholm score was 72 ± 15 (0% "Excellent", 10% "Good", 60% "Fair", 30% "Poor"). Of the athletes with lower scores, one suffered from patellar tendon rupture, one from post-operative infection and one from a previous femoral fracture. The mean Cincinnati knee score was 77 ± 18, while the average KOOS values were 60 ± 34 for sports. CONCLUSION: Meniscal Allograft Transplantation (MAT) in young professional athletes involved in strenuous activities allowed all patients to return to pre-injury sport and in nearly 70% of cases at their pre-injury level. After five seasons following MAT, 85% of patients were still active or playing more than 20-30 matches per season. On the other hand, nearly 50% underwent at least one reoperation and only 70% of patients were rated as "Good", or "Fair" using the Lysholm score. LEVEL OF EVIDENCE: IV.

Psychological factors and trajectories of post-surgical pain: A longitudinal prospective study.

A significant proportion of patients do not experience relief from pain during the early postsurgical period after joint arthroplasty and are at risk for developing chronic pain. The objectives of this study were to identify biopsychosocial factors associated with acute postsurgical pain trajectories and with pain intensity and interference after 1, 3, and 12 months. Two hundred ten patients listed for joint arthroplasty filled a presurgical battery of questionnaires assessing presurgical pain intensity, catastrophizing, emotional distress, state anxiety and depression, self-efficacy, central sensitization, and executive functions. From the day after surgery, they were asked to fill a 7-day diary, including questions about postsurgical pain and postsurgical state catastrophizing. Finally, they provided data about pain intensity and interference after 1, 3, and 12 months. Predictors of acute pain trajectories were investigated using multilevel growth curve analysis. Results showed that central sensitization was a predictor of the intercept of pain trajectories and daily postsurgical catastrophizing was a significant covariate of pain intensity in the acute phase. Analyses of follow-up data showed that central sensitization was a predictor of pain intensity and pain interference at 3 and 12 months, that emotional distress was related with pain intensity and interference at 1 month, and with pain interference at 3 months, and that cognitive flexibility was associated with pain interference at 1 month. Assessment of these factors could enable to identify patients at risk for worse outcomes and to plan targeted treatments to be implemented during the patient's inward stay.

Lateral meniscus allograft transplantation without bone plugs: technique and outcomes.

Once considered a non-fundamental structure, the menisci are now known to provide several functions within the knee, including protection of articular cartilage, load-bearing, shock absorption, joint stability, joint lubrification and joint congruity functions. Meniscal tears are one of the most common lesions in knee orthopedics, and partial or total meniscectomies are commonly performed procedures in orthopedic surgery. Despite meniscectomy is well recognized to lead improvement in clinical outcomes, it has been related to early onset knee osteoarthritis and joint degeneration which are associated with pain and functional limitations. Meniscal allograft transplantation has become a viable option for patients under 55 years old that have undergone total or near total meniscectomy and are in a painful state. This procedure can be performed using bone plugs or without bone plugs. In the bone plugs free technique allograft will be presented as a lateral meniscus with a portion of tibial plateau and is then introduced into the joint through an arthroscopic portal and fixed to the capsule with all-inside stitches. The most important aspect required to obtain good clinical results are graft size, anatomic placement and fixation, because extrusion is the most common complication related to meniscal transplantation. Although a lack of long-term follow-up (FU) studies, it has been demonstrated that lateral meniscus transplantation without bone plugs is a minimal invasive surgical procedure that improves the knee function, increases patient physical activity and reduces pain.

Bone Regeneration in Load-Bearing Segmental Defects, Guided by Biomorphic, Hierarchically Structured Apatitic Scaffold.

The regeneration of load-bearing segmental bone defects remains a significant clinical problem in orthopedics, mainly due to the lack of scaffolds with composition and 3D porous structure effective in guiding and sustaining new bone formation and vascularization in large bone defects. In the present study, biomorphic calcium phosphate bone scaffolds (GreenBone™) featuring osteon-mimicking, hierarchically organized, 3D porous structure and lamellar nano-architecture were implanted in a critical cortical defect in sheep and compared with allograft. Two different types of scaffolds were tested: one made of ion-doped hydroxyapatite/ß-tricalcium-phosphate (GB-1) and other made of undoped hydroxyapatite only (GB-2). X-ray diffraction patterns of GB-1 and GB-2 confirmed that both scaffolds were made of hydroxyapatite, with a minor amount of ß-TCP in GB-1. The chemical composition analysis, obtained by ICP-OES spectrometer, highlighted the carbonation extent and the presence of small amounts of Mg and Sr as doping ions in GB-1. SEM micrographs showed the channel-like wide open porosity of the biomorphic scaffolds and the typical architecture of internal channel walls, characterized by a cell structure mimicking the natural parenchyma of the rattan wood used as a template for the scaffold fabrication. Both GB-1 and GB-2 scaffolds show very similar porosity extent and 3D organization, as also revealed by mercury intrusion porosimetry. Comparing the two scaffolds, GB-1 showed slightly higher fracture strength, as well as improved stability at the stress plateau. In comparison to allograft, at the follow-up time of 6 months, both GB-1 and GB-2 scaffolds showed higher new bone formation and quality of regenerated bone (trabecular thickness, number, and separation). In addition, higher osteoid surface (OS/BS), osteoid thickness (OS.Th), osteoblast surface (Ob.S/BS), vessels/microvessels numbers, as well as substantial osteoclast-mediated implant resorption were observed. The highest values in OS.Th and Ob. S/BS parameters were found in GB-1 scaffold. Finally, Bone Mineralization Index of new bone within scaffolds, as determined by micro-indentation, showed a significantly higher microhardness for GB-1 scaffold in comparison to GB-2. These findings suggested that the biomorphic calcium phosphate scaffolds were able to promote regeneration of load-bearing segmental bone defects in a clinically relevant scenario, which still represents one of the greatest challenges in orthopedics nowadays.

Over-the-top Anterior Cruciate Ligament (ACL) reconstruction plus lateral plasty with hamstrings in high-school athletes: Results at 10 years.

BACKGROUND: Anterior Cruciate Ligament (ACL) injuries have grown in adolescent population in the last decades, and if surgical reconstruction resulted safe in the short term, its impact in the long term is still unclear. The purpose of this study was to assess the long-term risk of failure, the rate of contralateral injury and the clinical reported outcomes in a cohort of high-school athletes after ACL reconstruction. METHODS: 54 consecutive patients (mean age 16.3 ± 1.4 years) underwent ACL reconstruction with a single-bundle plus lateral plasty hamstring technique between May 2006 and July 2009. The number of subsequent ipsilateral reoperations and contralateral ACL reconstruction, Lhysolm, KOOS, VAS for pain and Tegner Activity Level was determined at a minimum follow-up of 10 years. RESULTS: Ipsilateral ACL revision was performed in 8 (3.4%) patients, contralateral ACL reconstruction in 11 (21.1%). The average Lysholm score was 95.1 ± 9.2. The average KOOS was 96.5 ± 6.3 for the Pain subscale, 92.2 ± 9.0 for the Symptom subscale, 99.2 ± 1.8 for the ADL subscale, 94.1 ± 10.1 for the Sport subscale and 91.8 ± 14.5 for the Quality-of-life subscale. The average VAS for pain during activity was 1.7 ± 2.3. 90% returned to sport, 15% decreased the activity level, 61% of patients were still involved in sport, 35% at the same pre-injury level. CONCLUSION: At long-term, single-bundle hamstring ACL-R plus lateral-plasty in a cohort of high school athletes resulted to have a comparable graft failure rate and contralateral ACL injury with other surgical techniques.

Cell-Free Biomimetic Osteochondral Scaffold for the Treatment of Knee Lesions: Clinical and Imaging Results at 10-Year Follow-up.

BACKGROUND: Cell-free devices have been introduced to restore osteochondral defects, avoiding the limitations of cell-based procedures. Among these, an osteochondral scaffold made of type I collagen and hydroxyapatite has been investigated with promising results up to medium-term follow-up. However, the clinical and imaging results over time still need to be documented. PURPOSE: To evaluate the clinical outcome and tissue maturation at long-term follow-up after the implantation of the osteochondral scaffold. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 24 patients (7 women, 17 men; age, 36 ± 9.5 years) underwent surgical implantation of the osteochondral scaffold and were prospectively evaluated before surgery, at 2-, 5-, and 10-year follow-up. The mean defect size was 2.9 ± 1.4 cm2. Patients were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores, and the activity level was documented with the Tegner score. Magnetic resonance imaging (MRI) evaluation involved the use of the magnetic resonance observation of cartilage repair tissue score combined with 5 more variables focused on the bone layer. RESULTS: A statistically significant improvement of all clinical scores was documented from the baseline to the final evaluation. The IKDC subjective score improved from the preoperative level to 2 years (41 ± 13.2 and 77.1 ± 14.6, respectively) (P < .0005), with stable results up to 10 years (77.4 ± 19.4). The IKDC objective score changed from 52% of normal and nearly normal knees before the treatment to 84% at 10 years (P < .0005). Tegner sports activity at the final evaluation (3.8 ± 1.7) was higher compared with the preoperative level (1.6 ± 1.1; P < .05), but it remained significantly lower compared with the preinjury level (5.5 ± 2.6; P < .05). Treatment failed in 1 patient. Persisting graft alterations were observed on MRI scans, although without correlating with the clinical outcome. CONCLUSION: The regenerative potential of this scaffold is limited, as demonstrated by the signal alterations persisting over time on MRI scans. On the other hand, the clinical improvement was significant and stable over time both in terms of subjective and objective outcomes, including activity level, with overall good results.

Cell-Based Therapies for the Treatment of Shoulder and Elbow Tendinopathies: A Scoping Review.

INTRODUCTION: Tendinopathies are a common cause of disability among the general population, and their management is challenging due to the degenerative nature of these disorders. The aim of this paper is to perform a scoping review of the available clinical evidence on the application of cell-based therapies for the management of elbow and rotator cuff tendinopathies, in order to summarize the current application methods and to shed light on the therapeutic potential and current limitations of these biologic approaches. MATERIALS AND METHODS: A scoping review of the literature was performed on the PubMed and Scopus databases using the following inclusion criteria: clinical reports of any level of evidence, written in English, with no time limitation, on the use of cell-based approaches to treat rotator cuff or elbow tendinopathies, including studies on biological augmentation during the surgical procedure. Exclusion criteria were as follows: case reports or mini case series (<5 patients), articles not written in English, and reviews. Relevant data were then extracted and collected in a single database with the consensus of the two observers to be analyzed for the purposes of the present manuscript. RESULTS: Seven papers dealing with rotator cuff tears were included. Four of them investigated the effect of injections, either MSCs alone or in combination with PRP, whereas three studies investigated the use of MSCs in combination with surgery. In all cases, an improvement was found in terms of clinical scores, with even evidence of tendon healing documented at second-look arthroscopy. Six papers dealt with elbow tendinopathies: three studies described the use of MSCs either with or without surgery, reporting significant clinical improvement and three studies analyzed the use of different types of cells (collagen-producing cells and autologous tenocytes) and, even in this case, clinical improvement was reported. CONCLUSION: All the papers included suggested a beneficial role of cell-based approaches to treat common upper limb tendinopathies, with an overall satisfactory safety profile. However, the lack of high-level evidence and the presence of controversial issues, such as interproduct variability, harvest source, and application strategies, do not allow standardization of these novel biologic approaches, whose efficacy needs to be confirmed with properly designed randomized trials.