RESUMEN
OBJECTIVES: The goal of this project was to develop and validate a patient-specific, anatomically correct graft for cartilage restoration using magnetic resonance imaging (MRI) data and 3-dimensional (3D) printing technology. The specific aim was to test the accuracy of a novel method for 3D printing and implanting individualized, anatomically shaped bio-scaffolds to treat cartilage defects in a human cadaveric model. We hypothesized that an individualized, anatomic 3D-printed scaffold designed from MRI data would provide a more optimal fill for a large cartilage defect compared to a generic flat scaffold. METHODS: Four focal cartilage defects (FCDs) were created in paired human cadaver knees, age <40 years, in the weight-bearing surfaces of the medial femoral condyle (MFC), lateral femoral condyle (LFC), patella, and trochlea of each knee. MRIs were obtained, anatomic grafts were designed and 3D printed for the left knee as an experimental group, and generic flat grafts for the right knee as a control group. Grafts were implanted into corresponding defects and fixed using tissue adhesive. Repeat post-implant MRIs were obtained. Graft step-off was measured as the distance in mm between the surface of the graft and the native cartilage surface in a direction perpendicular to the subchondral bone. Graft contour was measured as the gap between the undersurface of the graft and the subchondral bone in a direction perpendicular to the joint surface. RESULTS: Graft step-off was statistically significantly better for the anatomic grafts compared to the generic grafts in the MFC (0.0 â± â0.2 âmm vs. 0.7 â± â0.5 âmm, p â< â0.001), LFC (0.1 â± â0.3 âmm vs. 1.0 â± â0.2 âmm, p â< â0.001), patella (-0.2 â± â0.3 âmm vs. -1.2 â± â0.4 âmm, p â< â0.001), and trochlea (-0.4 â± â0.3 vs. 0.4 â± â0.7, p â= â0.003). Graft contour was statistically significantly better for the anatomic grafts in the LFC (0.0 â± â0.0 âmm vs. 0.2 â± â0.4 âmm, p â= â0.022) and trochlea (0.0 â± â0.0 âmm vs. 1.4 â± â0.7 âmm, p â< â0.001). The anatomic grafts had an observed maximum step-off of -0.9 âmm and a maximum contour mismatch of 0.8 âmm. CONCLUSION: This study validates a process designed to fabricate anatomically accurate cartilage grafts using MRI and 3D printing technology. Anatomic grafts demonstrated superior fit compared to generic flat grafts. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Cadáver , Cartílago Articular , Imagen por Resonancia Magnética , Impresión Tridimensional , Humanos , Imagen por Resonancia Magnética/métodos , Adulto , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/cirugía , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/diagnóstico por imagen , Andamios del Tejido , Masculino , FemeninoRESUMEN
OBJECTIVES: The purpose of this study was to define the rate of preoperative opioid use among patients undergoing hip arthroscopy, ascertain which clinical factors are associated with opioid use, and assess the effect of preoperative opioid usage on preoperative patient-reported outcome (PRO) measures. METHODS: A single institution orthopedic registry was retrospectively analyzed for patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) syndrome with or without labral tear between 2015 and 2022. Patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) in six domains, Numeric Pain Scores (NPS), and Musculoskeletal Outcomes Data Evaluation and Management System expectations domain preoperatively. Patients' charts were reviewed to determine demographic factors and identify any active opioid prescription within 6 weeks before surgery. Bivariate analysis was used to determine associations between preoperative opioid use and baseline PROs. Statistically significant bivariate associations were further tested by multivariate analysis to determine independent predictors. RESULTS: A total of 123 patients were included (age 39.7 â± â12.0 years; 87 females; body mass index 27.4 â± â5.7 kg/m2). There were 21 patients (17%) using opioids preoperatively. Prior orthopedic or other surgery and lower education level were associated with preoperative opioid use. Patients with preoperative opioid use scored statistically significantly worse compared with those without preoperative opioid use on baseline PROMIS Physical Function (38.6 vs 40.5, p â= â0.01), Pain Interference (65.9 vs 60.2, p â= â0.001), Fatigue (60.7 vs 51.6, p â= â0.005), Social Satisfaction (38.2 vs 43.2, p â= â0.007), and Depression (54.2 vs 48.8, p â= â0.01). Preoperative opioid use was also associated with statistically significantly worse preoperative NPS for both the operative hip (6.3 vs 4.6, p â= â0.003) and whole body (3.0 vs 1.4, p â= â0.008). Preoperative opioid use was an independent predictor of worse baseline PROMIS Pain Interference, Fatigue, Social Satisfaction, and NPS for the operative hip. CONCLUSION: Patients using opioids preoperatively had worse baseline PROs for physical function, pain, social satisfaction, and depression than those not using opioids preoperatively. When controlling for confounding variables, preoperative opioid use was independently predictive of worse baseline pain, fatigue, and social satisfaction. LEVEL OF EVIDENCE: Level III, prognostic study.