[The current status and future prospects of mesenchymal stem cell transplantation for the treatment of knee articular cartilage injuries and osteoarthritis].

The prevalence of articular cartilage injuries and osteoarthritis (OA) is high, affecting a wide range of individuals. The self-repair ability of cartilage tissue is poor, and once damaged, it will irreversibly progress to OA. Mesenchymal stem cells (MSCs) play an important role in the field of regenerative medicine and are considered one of the most promising seed cells for cartilage repair and regeneration. In this article, based on the latest clinical research findings from both domestic and international sources, the theoretical basis, treatment goals, significance, sources, characteristics, clinical implementation plans, and efficacy of using MSCs for the treatment of cartilage injuries or osteoarthritis are reviewed. The article also discusses the challenges faced and future directions that need to be addressed in the clinical application of MSCs.

The locked knee.

The acute locked knee is an orthopaedic emergency requiring prompt diagnosis and treatment. It can be classified as acute or chronic. The term 'locked knee' refers to a knee that demonstrates fixed flexion or which has a 'block' to complete extension. Some degree of active or passive extension may be achievable, but not full extension. The most frequent causes of a locked knee are a meniscal tear, rupture of the anterior cruciate ligament or loose bodies. Magnetic resonance imaging is the gold standard in diagnostic imaging. Knee arthroscopy is considered the gold standard in management. This article gives an overview of the presentation, assessment and management of the locked knee for core surgical, acute care common stem and emergency medicine trainees.

Novel use of motor-sparing genicular nerve blocks for knee injuries in the emergency department.

Knee injuries are quite prevalent in the Emergency Department (ED) and often present with severe pain, necessitating effective pain management strategies. Traditional pain management approaches, including opioid medications, may carry undesirable side effects and potential risks, leading to the growing interest in non-opioid alternatives. Nerve blocks have emerged as promising options for targeted pain relief in the ED. Motor-sparing nerve blocks have gained importance due to their ability to provide effective analgesia without compromising motor function [1]. The case series demonstrates the successful use of ultrasound-guided genicular nerve blocks(GNB) in the Emergency Department, providing targeted pain relief without compromising motor function. GNBs offer a valuable alternative to traditional nerve blocks(femoral, fascia iliaca, adductor canal) and opioid-based pain control strategies in the ED. As the evidence base grows, GNBs may become a more established component of ED pain management protocols, enhancing patient outcomes and safety in the management of acute knee injuries. The incorporation of ultrasound-guided motor-sparing nerve blocks in ED pain management protocols may hold great promise in optimising pain control and enhancing patient comfort. Trial Registration: N/A.

Acute sport-related knee injuries.

BACKGROUND: Australia has a high rate of sporting participation. Although this has many benefits, knee injuries are common, particularly in pivoting and contact sports. OBJECTIVE: This article reviews the management of common sport-related knee injuries, including injuries to the collateral and cruciate ligaments, menisci and the extensor mechanism. DISCUSSION: Some sport-related knee injuries can be treated non-operatively with physiotherapy-led rehabilitation. These include the majority of isolated medial collateral ligament, lateral collateral ligament and posterior cruciate ligament injuries. Other knee injuries might require surgical intervention. These include anterior cruciate ligament ruptures in young patients aiming to return to pivoting sports, certain meniscal tears and extensor mechanism disruptions. A multidisciplinary approach to these injuries will facilitate optimal patient care.

Subchondral Insufficiency Fractures of the Knee: A Clinical Narrative Review.

¼ Subchondral insufficiency fractures of the knee (SIFKs) are subchondral plate fractures with a prevalence of 2% to 4% of all knee injuries.¼ Magnetic resonance imaging is the gold standard for evaluating SIFK, while plain radiographs have limited the use in the diagnosis of SIFK.¼ Among patients with SIFK, 50% to 100% have meniscal pathology.¼ Medical therapies and standard treatments traditionally used in the management of knee osteoarthritis differ from recommended management of SIFK patients.¼ Randomized controlled trials and cohort studies with long-term follow-up are needed to determine the optimal rehabilitation protocol, interventional therapy, and prognosis of SIFK patients.

Treatment of Chondral Lesions in the Knee / Tratamento das lesões condrais no joelho

Abstract Articular cartilage injuries are common and lead to early joint deterioration and osteoarthritis. Articular cartilage repair techniques aim at forming a cartilaginous neo-tissue to support the articular load and prevent progressive degeneration. Several techniques are available for this purpose, such as microfracture and chondrocyte transplantation. However, the procedural outcome is often fibrocartilage, which does not have the same mechanical resistance as cartilaginous tissue. Procedures with autologous osteochondral graft have a morbidity risk, and tissue availability limits their use. As such, larger lesions undergo osteochondral transplantation using fresh or frozen grafts. New techniques using minced or particulate cartilage fragments or mesenchymal stem cells are promising. This paper aims to update the procedures for treating chondral lesions of the knee.

Resumo As lesões da cartilagem articular são comuns e levam à deterioração precoce da articulação e ao desenvolvimento da osteoartrite. As técnicas de reparo da cartilagem articular visam a formação de um neo-tecido cartilaginoso capaz de suportar carga articular e evitar a progressão da degeneração. Há várias técnicas disponíveis para esse fim, como a microfratura e o transplante de condrócitos. Entretanto muitas vezes o desfecho do procedimento é a formação de fibrocartilagem, que não possui a mesma resistência mecânica do tecido cartilaginoso. Em outros procedimentos, nos quais é realizado enxerto osteocondral autólogo, há risco de morbidade associada ao procedimento, além da disponibilidade limitada de tecido. Por esse motivo, o transplante osteocondral, utilizando enxertos a fresco ou congelados tem sido utilizado para lesões de maior volume. Por fim, novas técnicas utilizando fragmentos de cartilagem picada ou particulada, assim como o uso de células tronco mesenquimais se apresentam como promissores. O objetivo desse artigo é realizar uma atualização dos procedimentos para tratamento das lesões condrais do joelho.

An isolated rupture of the anterolateral ligament of the knee: A case report.

INTRODUCTION: The anterolateral ligament (ALL) is a controversial ligament in the knee that may play a significant role in knee stability. It is difficult to identify on magnetic resonance imaging (MRI) imaging and is often injured in conjunction with other ligaments, such as the anterior cruciate ligament (ACL) and medial collateral ligament. CASE PRESENTATION: This is a unique case of an isolated ALL tear in a 48-year-old woman who presented with severe left knee pain, swelling, and inability to bear weight during a yoga session. Physical examination showed swelling and tenderness at the lateral aspect of the femoral condyle, with increased pain on varus stress testing. Radiographs revealed normal osseous structures with the absence of traumatic bone lesions. MRI revealed an intact meniscus, cruciate, and collateral ligaments, but a rupture of the ALL at its femoral origin. Diagnosis of isolated ALL rupture of the left knee was made, and the patient was treated conservatively with icing, rest, and non-steroidal anti-inflammatory drugs. Physiotherapy was started 2 weeks post-injury, and return to sports was allowed at the sixth week. Upon last follow-up, the patient had excellent functional outcomes and was satisfied with the treatment. Physical examination showed a stable knee with negative Lachman and pivot shift tests. To the best of the authors' knowledge, this is the first case of isolated ALL rupture to be reported. DISCUSSION: The paper highlights the rarity of isolated ALL injuries and the difficulty in diagnosing them. Conservative treatment can be successful for isolated ALL injuries, with physiotherapy playing an essential role in rehabilitation.In conclusion, isolated ALL injuries are rare and can be challenging to diagnose. Conservative treatment with physiotherapy can lead to successful outcomes. Further research is needed to understand the role of the ALL in knee stability and to determine optimal treatment options.

The Effects of Hydrolyzed Collagen and Collagen Peptide in the Treatment of Superficial Chondral Lesions: An Experimental Study / Os efeitos do colágeno hidrolisado e do peptídeo de colágeno no tratamento de lesões condrais superficiais: Um estudo experimental

Abstract Objective To evaluate the effects of hydrolyzed collagen and collagen peptide in the treatment of superficial chondral lesions in rats. Method This research employed 18 Rattus norvegicus. A single intraarticular infiltration of sodium iodoacetate (2 mg solution) through the patellar ligament induced joint damage in previously anesthetized animals. We divided the animals into three groups: a control group, a collagen peptide group, and a hydrolyzed collagen group. Treatment consisted of oral administration of collagen peptide or hydrolyzed collagen for 30 days. Afterwards, we euthanized the animals and studied the joint chondral changes. We evaluated the results according to the chondrocyte clusters count and a histological evaluation, as per Pritzker et al. Results There was no statistical significance in injury stages between the control, hydrolyzed collagen, and collagen peptide groups (p= 0.11). Regarding scores, there was a statistical significance between the groups treated with hydrolyzed collagen and collagen peptide (p< 0.05), but not in comparison with the control group. Conclusion The proposed treatments of the induced chondral lesion with the oral administration of hydrolyzed collagen or collagen peptides were effective, resulting in lesion stabilization or regression, and warranting further experimental research to understand and improve the primary outcome of this study.

Resumo Objetivo Avaliar os efeitos do colágeno hidrolisado e do peptídeo de colágeno no tratamento de lesões condrais superficiais de ratos. Método Foram utilizados 18 Rattus norvegicus nesta pesquisa. O dano articular foi induzido por uma única infiltração intra-articular de iodoacetato de sódio (solução 2 mg), injetada através do ligamento patelar da articulação dos animais previamente anestesiados. Os animais foram distribuídos em três grupos: grupo controle, grupo peptídeo de colágeno e grupo colágeno hidrolisado. O tratamento foi realizado por 30 dias com a administração via oral do peptídeo de colágeno ou do colágeno hidrolisado. Posteriormente, foi realizada a eutanásia dos experimentos e seguiu-se para o estudo das alterações condrais articulares. Os resultados foram avaliados conforme contagem de condrócitos por cluster e através da avaliação histológica segundo Pritzker et al. Resultados Ao observar os estágios de lesão, não foi observada significância estatística entre os grupos controle, colágeno hidrolisado e peptídeo de colágeno (p= 0,11). Ao observar os escores, houve significância estatística na comparação do grupo tratado com colágeno hidrolisado e o grupo peptídeo colágeno (p< 0,05), porém sem diferença estatística em relação ao grupo controle. Conclusão Os tratamentos propostos da lesão condral induzida com uso de colágeno hidrolisado ou peptídeos de colágeno via oral mostraram-se eficazes, com estabilização ou regressão da lesão apresentada em ratos, merecendo novas pesquisas experimentais com o intuito de compreender e melhorar o desfecho primário deste trabalho.

Revisiting the role of hyperbaric oxygen therapy in knee injuries: Potential benefits and mechanisms.

Knee injury negatively impacts routine activities and quality of life of millions of people every year. Disruption of tendons, ligaments, and articular cartilage are major causes of knee lesions, leading to social and economic losses. Besides the attempts for an optimal recovery of knee function after surgery, the joint healing process is not always adequate given the nature of intra-articular environment. Based on that, different therapeutic methods attempt to improve healing capacity. Hyperbaric oxygen therapy (HBOT) is an innovative biophysical approach that can be used as an adjuvant treatment post-knee surgery, to potentially prevent chronic disorders that commonly follows knee injuries. Given the well-recognized role of HBOT in improving wound healing, further research is necessary to clarify the benefits of HBOT in damaged musculoskeletal tissues, especially knee disorders. Here, we review important mechanisms of action for HBOT-induced healing including the induction of angiogenesis, modulation of inflammation and extracellular matrix components, and activation of parenchyma cells-key events to restore knee function after injury. This review discusses the basic science of the healing process in knee injuries, the role of oxygen during cicatrization, and shed light on the promising actions of HBOT in treating knee disorders, such as tendon, ligament, and cartilage injuries.

Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention.

The Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This guideline focuses on the exercise-based prevention of knee injuries and provides an update on the 2018 guideline, J Orthop Sports Phys Ther. 2018;48(9):A1-A42. doi:10.2519/jospt.2018.0303 J Orthop Sports Phys Ther. 2023;53(1):CPG1-CPG34. doi:10.2519/jospt.2023.0301.

Psychological Aspects of Adolescent Knee Injuries.

Knee injuries are prevalent in pediatric and adolescent athletes, leading to both physical and psychological disturbances following injury. Various preoperative psychological measures of maladaptive beliefs-including kinesiophobia, fear avoidance, and pain catastrophizing-can predict responses to recovery, such as knee function, knee-related quality of life, and return-to-sport. Treatment recommendations for the psychological aspect of adolescent knee injuries can include screening patients to identify those at high risk for poor recovery. These patients can be targeted with psychologically informed media or cognitive-behavioral therapy models aimed at reducing maladaptive beliefs and supporting individualized motivations and recovery goals.

The Impact of Race, Insurance, and Socioeconomic Factors on Pediatric Knee Injuries.

Disparities persist in pediatric sports medicine along the lines of race, ethnicity, insurance status, and other demographic factors. In the context of knee injuries such as anterior cruciate ligament (ACL) ruptures, meniscus tears, and tibial spine fractures, these inequalities affect evaluation, treatment, and outcomes. The long-term effects can be far-reaching, including sports and physical activity participation, comorbid chronic disease, and socio-emotional health. Further research is needed to more concretely identify the etiology of these disparities so that effective, equitable care is provided for all children.

Clinical and Functional Outcome of Meniscal Injuries Treated with Platelet-Rich Plasma: A Single-Center Case Series.

Meniscal injuries are among the most frequently encountered conditions in the knee joint. Therapeutic approaches are diverse and are largely dependent on the extent and location of the injury. The purpose of this study was to describe the clinical and functional outcomes of an intraarticular and percutaneous platelet-rich plasma (PRP) injection regime in patients with stable meniscal injuries. Demographics, the type of tear, affected knee, surgical procedure, type of intervention, follow-up period, and outcomes were recorded in all cases. Patient-reported outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity level scale. Overall patient satisfaction, quality of life, and pain intensity were also assessed. A total of 38 cases (8 females) had sustained a stable meniscal lesion (32 medial, 6 lateral) and met the inclusion criteria. All of them received three intraarticular and percutaneous PRP injections. Patients receiving the PRP injection regime reported clinically (p = 0.000) and functionally (p = 0.000 and p = 0.001) significant improvement in all outcome measures during this interval. All patients reported they were very satisfied or satisfied with the outcome. The results of this study suggest that the treatment of stable meniscal injuries with percutaneous-intraarticular PRP injections can achieve a significant clinical and functional improvement.

Epidemiology, classification and treatment of patella fractures: an observational study of 3194 fractures from the Swedish Fracture Register.

BACKGROUND: Basic epidemiological data on patella fractures derived from large nationwide and multicenter studies are scarce. This observational register study describes patient epidemiology, fracture classification and treatment of patella fractures in adults in a Swedish population. METHODS: We conducted an observational study on data derived from the Swedish Fracture Register (SFR) on all patella fractures classified as non-periprosthetic and non-pathological, registered between 2014 and 2018 in individuals aged ≥ 18years. Epidemiological data on sex, age, side, seasonal variation, trauma mechanism, fracture classification (according to AO/OTA), and treatment were analyzed. RESULTS: 3194 patella fractures were analyzed, occurring at a median age of 67 (range 19-100) years. 64% of all patients were female. Most fractures were caused by low-energy trauma, with 70% due to falling from a standing height. 1796 (56%) of the fractures were transverse compared to 845 (26%) vertical fractures. Most fractures (N=2148, 67%) were treated non-operatively. Operative treatment consisted mainly of Tension Band Wiring (TBW) performed in 774 (24%) patients. CONCLUSIONS: Patella fractures mainly occur in elderly women (> 65 years), commonly caused by low-energy trauma. The main treatment is non-operative (67%), except for transverse (AO/OTA C3) fractures. TBW remains the most used operative treatment of choice. These results may help health care providers, researchers and clinicians better understand the panorama of patella fractures in Sweden.

Meniscus Root Tears: A Clinical Review.

ABSTRACT: Meniscus root tears are important to recognize early given their potentially devastating consequences on joint health. This injury results in the lost ability of the meniscus to transfer axial loads into hoop stress; therefore, it is functionally equivalent to a complete meniscectomy. This causes rapid progression of osteoarthritis and increased need to total knee arthroplasty in a previously healthy joint. Despite these consequences, root tears have only been discussed in the orthopedic literature in the last 10 to 15 years and have not been routinely integrated into nonoperative sports medicine education. It is important for all nonoperative sports medicine providers to properly diagnose and triage this injury early in its course to maximize joint preservation efforts. The goal of this manuscript is to review the anatomy, presentation, natural history, imaging, and treatment options for meniscal root tears.

Meniscus repair: up-to-date advances in stem cell-based therapy.

The meniscus is a semilunar fibrocartilage between the tibia and femur that is essential for the structural and functional integrity of the keen joint. In addition to pain and knee joint dysfunction, meniscus injuries can also lead to degenerative changes of the knee joint such as osteoarthritis, which further affect patient productivity and quality of life. However, with intrinsic avascular property, the tearing meniscus tends to be nonunion and the augmentation of post-injury meniscus repair has long time been a challenge. Stem cell-based therapy with potent regenerative properties has recently attracted much attention in repairing meniscus injuries, among which mesenchymal stem cells were most explored for their easy availability, trilineage differentiation potential, and immunomodulatory properties. Here, we summarize the advances and achievements in stem cell-based therapy for meniscus repair in the last 5 years. We also highlight the obstacles before their successful clinical translation and propose some perspectives for stem cell-based therapy in meniscus repair.

Translation, cross-cultural adaptation, validation and responsiveness in the Brazilian Portuguese version of the Knee Injury and Osteoarthritis Outcome Score (KOOS-BR).

PURPOSE: To carry out the translation, cultural adaptation, and validation in the Brazilian Portuguese version of Knee Osteoarthritis Outcome Score (KOOS-BR) in individuals with knee osteoarthritis (KOA). METHODS: Patients with KOA (n = 136) answered KOOS-BR, Short-Form Health Survey (SF-36) and Numerical Pain Scale (NPS) to access construct validity. KOOS-BR was answered again with an interval of five to eight days. The following were performed: Cronbach's alpha to assess internal consistency, intraclass correction coefficient (ICC2,1) to assess reproducibility, standard error of measurement (SEM) and minimal detectable change (MDC) as error measurements. Dimensionality was tested through confirmatory factor analysis (CFA). Responsiveness was investigated by the correlation between KOOS-BR subscales with global perceived effect (GPE) before and after physical therapy treatment for 6 weeks. Floor and ceiling effects (< 15%) were also assessed. RESULTS: KOOS-BR version showed good test-retest reliability in all KOOS-BR subscales (ICC = 0.77-0.84), with proper internal consistency (α = 0.71-0.94). KOOS-BR showed a moderate direct correlation with physical health domains of SF-36 (r = 0.39-0.68; p < 0.001) and a moderate inverse correlation with pain intensity (r = - 0.51 to - 0.57; p < 0.001). KOOS-BR proved to be responsive, the correlation between the KOOS-BR subscales and GPE before and after treatment ranged from 0.42 to 0.60 (p < 0.001). There was no ceiling and floor effect. CONCLUSION: KOOS-BR is reliable, valid, and responsive in patients with KOA. LEVEL OF EVIDENCE: II.