Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma.

OBJECTIVE: To directly compare clinical and MRI outcomes of multiple intra-articular injections of adipose-derived stromal cells (ASCs) or platelet-rich plasma (PRP) in patients with knee osteoarthritis (OA). DESIGN: We retrospectively compared 24-month outcomes in (1) 27 patients receiving 3-monthly intra-articular injections with a total of 43.8 million ASCs and (2) 23 patients receiving 3-monthly injections of 3-ml preparation of PRP. All patients had Kellgren-Lawrence grade 1, 2, or 3 knee OA with failed conservative medical therapy. The Numeric Pain Rating Scale (NPRS) scores; Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6, 12, and 24 months after the first injection; and the MRI Osteoarthritis Knee Score (MOAKS) at 12 and 24 months were considered as outcomes. RESULTS: No major complications occurred in any patient. Both groups significantly improved in pain NPRS score and KOOS at 6 months. At 12- and 24-month evaluations, the ASC group significantly decreased scores to a greater degree (P < 0.001) than the PRP group. MOAKS scores indicated a decrease in disease progression in the ASC group. CONCLUSION: Both ASCs and PRP were safe and resulted in clinical improvement in patients with knee OA at 6 months; however, at 12 and 24 months, ASCs outperformed leukocyte-poor PRP in clinical and radiological outcomes.

Treatment options for the symptomatic post-meniscectomy knee.

PURPOSE: To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. METHODS: A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. RESULTS: Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-meniscectomy OA. CONCLUSIONS: Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. LEVEL OF EVIDENCE: IV.

Tensor Fasciae Suralis Muscle: Report of a Symptomatic Case With Emphasis on Imaging Findings.

We report a case of a symptomatic tensor fasciae suralis (TFS) muscle in an elite jumper, with a very rare tear in its origin. The TFS muscle must be recognized and differentiated from other pathologic entities in the popliteal region. The magnetic resonance imaging (MRI) and ultrasound (US) can reliably identify this variant and its pathology.

Posterior thigh muscle injuries in elite track and field athletes.

INTRODUCTION: Posterior thigh muscle injuries in athletes are common, and prediction of recovery time would be of value. HYPOTHESIS: Knee active range of motion deficit 48 hours after a unilateral posterior thigh muscle injury correlates with time to full recovery. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred sixty-five track and field athletes with acute, first-time, unilateral posterior thigh muscle injuries were prospectively evaluated regarding knee active range of motion deficit. This was compared with the uninjured side 48 hours after injury. A control group was also examined. Ultrasound was used to image the muscle lesion. All athletes were managed nonoperatively with the same rehabilitation protocol. The "full rehabilitation time" (interval from the injury to full athletic activities) was recorded. RESULTS: Range of motion of the affected leg was decreased in the 165 injured athletes compared with the uninjured side and the control group. Sonography identified abnormalities in 55% (90 of 165) of the injured athletes. The biceps femoris was the most commonly affected muscle (68 of 90 [75%]). The musculotendinous junction (proximal or distal) was involved in 93% (85 of 90) of lesions. Eighty-one percent (133 of 165) of athletes had active range of motion deficit of less than 20 degrees, and had returned to full performance at 2 weeks. In 6 of 165 athletes (3.6%), with active range of motion deficit of more than 30 degrees, recovery time exceeded 6 weeks, with a significant correlation between full rehabilitation time and active range of motion deficit (chi(2) = 152.560; P = .0001). CONCLUSION: Knee active range of motion deficit is an objective and accurate measurement, predicting recovery time in elite athletes.

Reinjury after acute lateral ankle sprains in elite track and field athletes.

BACKGROUND: Lateral ankle sprains can lead to persistent disability in athletes. The authors studied the effect of a lateral ankle sprain on reinjury occurrence in the same region. HYPOTHESIS: There will be no difference in reinjury rate between low-grade (grades I and II) and high-grade (IIIA and IIIB) acute lateral ankle sprains. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 1. METHODS: From 1996 to 2004, the authors managed 202 elite Greek track and field athletes for an acute lateral ankle sprain. Sprains were classified into 4 degrees (I, II, IIIA, and IIIB). The same rehabilitation protocol was prescribed for all the athletes. The rate of a lateral ankle reinjury was recorded in the 24 months following injury. RESULTS: At a follow-up of 24 months, 36 of 202 athletes (17.8%) experienced a second lateral ankle sprain. Of the 79 athletes with a grade I injury, 11 (14%) experienced a recurrence during the study period. Of the 81 athletes with a grade II injury, 23 (29%) experienced a recurrence during the study period. Of the 36 athletes with a grade IIIA injury, 2 (5.6%) experienced a recurrence during the study period. Of the 6 athletes with a grade IIIB injury, none experienced a recurrence during the study period. CONCLUSION: Athletes with a grade I or II lateral ankle sprain are at higher risk of experiencing a reinjury. Low-grade acute lateral ankle sprains result in a higher risk of reinjury than high-grade acute lateral ankle sprains.

Acute lateral ankle sprains in track and field athletes: an expanded classification.

We present a longitudinal observational study on classification of acute lateral ankle ligament injuries in track and field athletes, based on objective criteria. These very common and sometimes troublesome sports injuries are treated functionally, but there is a lack in international literature on predicting the time needed for full recovery. Taking into consideration (1) active range of motion, (2) edema, (3) stress radiographs findings, and (4) full rehabilitation time, we divided grade III sprains in IIIA and IIIB, proposing that these injuries can be classified in four categories (I, II, IIA, IIIB). The range of motion-edema-stress radiographs classification that we propose evaluates the severity of lateral ankle injuries, is an easy and practical method, and predicts full return in athletic activities without residual complaints, if the proper rehabilitation program is executed.