Knee Injury And Osteoarthritis Outcome Score Symptoms Research Articles

Accelerometer-Assisted Physical Activity Outcomes During the First Year of Recovery After Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Pilot Study.

Wearable activity-measurement devices are increasingly popular among the public, but there is little information regarding their use among patients undergoing sports medicine procedures. The purpose of this study was to compare accelerometer-measured data with traditional patient-reported measures and to determine the trajectory of physical activity from before surgery to 1 year after anterior cruciate ligament reconstruction. Adult patients undergoing primary anterior cruciate ligament reconstruction were enrolled in this prospective cohort pilot study. The Tegner activity scale, Marx activity scale, International Physical Activity Questionnaire Short Form (IPAQ-SF), Knee injury and Osteoarthritis Outcome Score (KOOS), and EuroQoL-5D were administered preoperatively and 3, 6, and 12 months postoperatively. At these intervals, each patient was asked to wear an accelerometer for 7 consecutive days. Time spent in moderate-to-vigorous physical activity (MVPA min/wk), metabolic equivalents of physical activity, and average daily steps were calculated from the accelerometer output and correlated with patient-reported measures. Twenty-eight patients were included in this study. Of the 28 patients, 20 remained, and at the 12-month analysis, 18 patients were analyzed. There were significant improvements in Tegner activity scale score, KOOS symptoms, sports/recreation, and quality of life subscales, and IPAQSF MVPA min/wk at final follow-up. All accelerometer-based outcomes had improvements at 3, 6, and 12 months. The accelerometer may be a useful tool for understanding patients' activity levels at different time points during their recovery and for providing tangible targets for patients to achieve at least an average recovery. [Orthopedics. 202x;4x(x):xx-xx.].

Midterm Survivorship and Clinical Outcomes in Fresh Osteochondral Allograft Transplantation for the Treatment of Large Bipolar Lesions of the Knee.

Fresh osteochondral allograft (OCA) transplantation is an established treatment option for patients with chondral or osteochondral lesions of the knee. Predictably positive outcomes are seen in situations of focal or isolated cartilage defects. However, OCA transplantation may also be performed in more complex joint salvage situations in young patients. To evaluate survivorship and outcomes in patients who underwent OCA transplantation for large bipolar lesions of the knee. Case series; Level of evidence, 4. Fresh OCAs were implanted for bipolar chondral lesions in 86 patients (89 knees) between 1983 and 2020. A total of 37 male and 52 female knees with a mean patient age of 37.9 years (range, 14.5-66.0 years) were treated. Surgical indications included degenerative chondral lesions, osteoarthritis, osteochondritis dissecans, traumatic chondral injuries, and previous failed OCAs. The clinical evaluation included the modified Merle d'Aubigné-Postel score, International Knee Documentation Committee (IKDC) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Outcomes were collected during outpatient clinic visits or via mail. The minimum follow-up was 2 years. Additional procedures after OCA transplantation were documented. OCA failure was defined as a reoperation that involved removal of the allograft. There were 81 knees (91.0%) that had undergone previous surgery, with a mean of 3.2 previous procedures (range, 1-11). The mean treated defect surface area was 16.7 cm2. Graft failure occurred in 31 knees (34.8%). Reoperations (including failures) occurred in 46 knees (51.7%). The mean time to failure was 4.8 years. Survivorship of the bipolar OCA was 73.8% at 5 years, 66.6% at 10 years, and 58.9% at 15 years. Among the 58 knees (65.2%) in which the OCA was still in situ, the mean follow-up was 11.3 years (range, 2.1-27.6 years). The mean modified Merle d'Aubigné-Postel score improved from 12.4 to 14.8 points; 64.3% of knees (36/56 with available data) were considered successful with a score ≥15. The mean IKDC pain score improved from 6.3 to 4.0, and the mean IKDC function score improved from 2.9 to 6.2. The KOOS symptoms, pain, activities of daily living, sports/recreation, and quality of life subscores all increased postoperatively by a mean of 19.7, 25.9, 27.1, 35.4, and 36.4, respectively. OCA transplantation is a salvage treatment option for large bipolar cartilage lesions of the knee with acceptable survivorship and significant clinical improvement in a challenging patient population.

Amniotic Tissue Injections Are an Effective Alternative to Corticosteroid Injections for Pain Relief and Function in Patients With Severe Knee Osteoarthritis: A Double-Blind, Randomized, Prospective Study.

The use of corticosteroid injections for short-term pain relief for knee osteoarthritis can have deleterious adverse effects. Amniotic tissue has shown promise in vitro; therefore, this study compared a morcellized injectable amniotic tissue allograft to corticosteroid injection. Eighty-one patients with symptomatic severe knee osteoarthritis (Kellgren-Lawrence grade 3 to 4) were prospectively randomized to either a double-blinded single injection of BioDRestore (Integra LifeSciences; n = 39) or triamcinolone acetonide (n = 42). Knee Injury and Osteoarthritis Outcome Score (KOOS), Single Alpha Numeric Evaluation, visual analog scale (VAS) pain, Lysholm Rating, and Veterans-Rand-12 scales at baseline, 6 weeks, 3, 6, and 12 months were analyzed. No differences were observed in adverse reactions or patient reported outcomes (PROs); however, a notable continued improvement was found in the amnion group from 6 weeks to 1 year for Single Alpha Numeric Evaluation, Lysholm, and KOOS Symptoms, Pain, activities of daily living [ADL], QofL. The minimal clinically important difference (MCID) was met for Lysholm, KOOS ADL, and KOOS pain. Both amnion and steroid injections showed an initial improvement in pain relief and function at 6 weeks; however, more patients in the amniotic tissue group maintained pain relief and function at the 1-year follow-up. The mixed results suggest that amniotic tissue injections may be a safe and effective alternative to corticosteroid injections.

Outcomes Comparison in Anterior Cruciate Ligament Reconstruction Between Hamstring Tendon and Quadriceps Tendon Autograft: A Systematic Review and Meta-Analysis

Introduction and Objectives: Anterior cruciate ligaments (ACL) accounted for the most frequent ligamentous injury. ACL reconstruction (ACLR) when indicated, has been the standard of care to treat instability and to restore functional stability.While hamstring tendon autografts (HT) are commonly used in ACLR, quadriceps tendon autografts (QT) have gained popularity in recent years Thus, this study performed a systematic review and meta-analysis comparing the outcomes of QT to HT for ACLR. Materials and Methods: Comprehensive database searches were performed in two databases, 452 studies were found and 14 studies were included in the study. This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guideline. Included studies will be extracted for characteristics such as author, study year, design, and outcomes. Results: Fourteen studies were included in the study after a comprehensive literature search was done. 2219 patients, 847 were treated with QT and 1372 were treated with HT, functional outcomes such as International Knee Documentation Committee score (IKDC), Cincinnati score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, VAS score, active knee flexion, return to previous activity, and Patient and Observer Scar Assessment Scale(POSAS) were measured, there were differences in KOOS pain score and Symptom score with mean difference of 2.40 (95%CI 0.75 to 4.06, I2=26%, p=0.004), and 4.40 (95%CI 0.81 to 7.89, I2= 60%, p=0.02) respectively. However, there were no significant differences in other functional outcomes and secondary outcomes. Conclusion: This study demonstrates comparable results between ACLR using QT and HT. QT appeared to have better functional outcomes in KOOS pain and KOOS symptoms than in HT

Factors Associated With a Successful Return to Performance After Anterior Cruciate Ligament Reconstruction: A Multiparametric Evaluation in Soccer Players.

Anterior cruciate ligament reconstruction (ACLR) is highly recommended in patients with ACL deficiency who must perform at a high physical level. A combination of functional and psychological outcome measures is necessary to provide a comprehensive evaluation of functional status after successful return to sport after ACLR. To identify factors associated with higher functional outcomes among soccer players who had returned to full sports participation after ACLR. Cohort study; Level of evidence, 3. A total of 168 out of 231 patients who underwent primary unilateral arthroscopic anatomic single-bundle ACLR were available at follow-up. Postoperatively, knee function, generic health outcomes, and psychological impact were assessed using the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, the 12-item Short Form Health Survey (SF-12), and the ACL-Return to Sport after Injury scale. After a mean follow-up of 35.5 ± 22.6 months, 85% of soccer players returned to performance. Midfielder position was associated with a better SF-12 Physical Component Summary (PCS) score (P = .013), IKDC (P = .003), total KOOS (P < .001), KOOS Symptoms (P = .004), KOOS Pain (P = .029), KOOS Activities of Daily Living (ADL) (P = .044), KOOS Sport and Recreation (Sport/Rec) (P = .001), KOOS Quality of Life (QoL) (P < .001), and Lysholm score (P = .008). Playing only on natural grass was associated with lower SF-12 PCS scores (P = .003), total KOOS (P = .001), and KOOS Sport/Rec (P = .011). Playing only on artificial turf was associated with lower Lysholm score (P = .018) and total KOOS (P = .014). The contact mechanism was associated with higher IKDC (P = .044) and KOOS QoL (P = .048), and injury affecting the dominant limb was associated with lower SF-12 Mental Component Summary scores (P = .012). Playing at a nonprofessional level was associated with lower total KOOS (P = .028), KOOS Symptoms (P = .002), KOOS ADL (P = .033), and KOOS Sport/Rec (P = .016). Professional soccer players and the midfielder position are associated with better functional scores upon returning to the sport. A history of noncontact ACL injury and playing on a single type of surface are associated with lower functional outcomes upon returning to the sport. Lower mental health scores can be expected after injury of the dominant limb.

Functional preoperative assessment of coronal knee laxity better predicts postoperative patient outcomes than intraoperative surgeon-defined laxity in total knee arthroplasty.

Intraoperative laxity assessments in total knee arthroplasty (TKA) are subjective, with few studies comparing against standardised preoperative and postoperative assessments. This study compares coronal knee laxity in TKA patients awake and anaesthetised, preprosthesis and postprosthesis implantation, evaluating relationships to patient-reported outcome measures. A retrospective analysis of 49 TKA joints included preoperative and postoperative computed tomography scans, stress radiographsand knee injury and osteoarthritis outcome score (KOOS) questionnaire results preoperatively and 12 months postoperatively. The imaging was used to assess functional laxity (FL) in awake patients, whereas computer navigation measured intraoperative surgical laxity (SL) preimplantation and postimplantation, with patients anaesthetised. Varus and valgus stress states and their difference, joint laxity, were measured. SL was greater than FL in both preimplantation [8.1° (interquartile range, IQR2.0°) and 3.8° (IQR 2.9°), respectively] and postimplantation [3.5° (IQR 2.3°) and 2.5° (IQR 2.7°), respectively]. Preimplantation, SL was more likely than FL to categorise knees as correctable to ±3° of the mechanical axis. Preoperative FL correlated with KOOS Symptoms (r = 0.33, p = .02) and quality of life (QOL) (r = 0.38, p = .01), whereas reducing medial laxity with TKA enhanced postoperative QOL outcomes (p = .02). Functional coronal knee laxity assessment of awake patients is generally lower than intraoperative surgical assessments of anaesthetised patients. Preoperative SL may result in overcorrection of coronal TKA alignment, whereas preoperative FL better predicts postoperative patient outcomes and reflects the patients' native and tolerable knee laxity. Preoperative FL assessment can be used to guide surgical planning. Level II.

Registry-based cohort study comparing percentages of patients reaching PASS for knee function outcomes after revision ACLR compared to primary ACLR

ObjectivesReaching the Patient-Acceptable Symptom State (PASS) threshold for the Knee injury and Osteoarthritis Outcome Score (KOOS) has previously been reported to successfully identify individuals experiencing clinical success after anterior cruciate...

Subjective grade of apprehension during the pivot-shift test reflects patient-reported outcomes more than conventional pivot-shift test grade after ACL reconstruction.

To investigate whether the pivot-shift test reflects patient-reported outcomes 1 year after anterior cruciate ligament (ACL) reconstruction based on a multicentre prospective cohort study. This study included patients who underwent primary ACL reconstruction using the hamstring tendons. The pivot-shift test grades were determined according to the International Knee Documentation Committee (IKDC) form as 0, 1+, 2+ or 3+. In addition, patients' subjective apprehension during the pivot-shift test were classified as 0 (no-apprehension), 1+ (mild-apprehension), 2+ (moderate-apprehension) or 3+ (severe-apprehension). In this study, a positive pivot-shift test was defined as grade 1+ or higher. A total of 837 patients were enroled in this study. One year postoperatively, there was no significant difference in the Knee injury and Osteoarthritis Outcome Score (KOOS), IKDC score, Lysholm knee scale and Tegner activity scale between the positive (118 patients) and negative (719 patients) groups of the conventional IKDC grading of the pivot-shift test. However, when divided into two groups based on the apprehension grading of the pivot-shift test after surgery, the postoperative scores were significantly lower in the apprehension-positive group (114 patients) than those in the apprehension-negative group (723 patients) on the Tegner activity scale and KOOS Symptom, Sports/Rec and Quality of Life subscales. Patients' subjective apprehension during the pivot-shift test after ACL reconstruction was significantly associated with the postoperative Tegner activity scale and three subscales of the KOOS. However, there was no association between the conventional IKDC grading of the pivot-shift test and any patient-reported outcomes postoperatively. Level II.

Poster 267: Relationship Between Sagittal Tibial Tubercle-Trochlear Groove Distance and Outcomes Following Cartilage Restoration for Patellofemoral Articular Cartilage Lesions

Objectives: Increased contact force in the patellofemoral (PF) joint is a known contributor to cartilage damage and pain. A tibial tubercle that is posterior to the trochlear groove may lead to aberrant loading and cartilage wear. The sagittal tibial-tubercle trochlear groove distance (sTT-TG), defined as the distance between the nadir of the trochlear groove and the most anterior aspect of the tibial tubercle, aids in quantifying the degree of risk of acquiring new lesions. However, the relationship between sTT-TG and patient-reported outcomes following surgery has not been assessed. Therefore, the purpose of this study is to assess the association between sTT-TG and post-operative outcomes in patients undergoing cartilage restoration procedures for PF articular cartilage lesions. Methods: A retrospective review of patients who underwent osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI) at a single academic institution from 2010 to 2020 was conducted. Patients were included they underwent OCA or ACI for a high-grade (Outerbridge 3 or 4) articular cartilage lesion located in the patellofemoral joint (unipolar or bipolar), if they were between 18 and 50 years of age at the time of surgery, had magnetic resonance imaging (MRI) available, and had a minimum 2-year clinical follow-up. Demographic data such as age, sex, body mass index (BMI), as well as defect characteristics including size, number, and grade were collected. Before surgery, sTT-TG distance was measured independently on axial T2-weighted MRI sequences by two raters (Rater A and Rater B). Both raters measured the sTT-TG for the entire cohort at two different time points with a two-week time interval between each rater’s initial and follow-up measurements. The Interclass Coefficient (ICC) using a single measure, absolute agreement, two-way mixed effects model was used to test the intra-rater reliability of Rater A and Rater B; mean measures were used to assess the inter-rater reliability for the combined mean of the two rater’s measurements. Patients were surveyed to assess pain and satisfaction on a Visual Analog Scale (VAS) from 0 to 100. Functional outcomes were collected using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The rate of return to sports, complications, and graft failure were also recorded [JT1]. An independent samples t-test was used to compare lesion size between the OCA and ACI group. Linear and logistic regression models accounting for age, sex, BMI, and sTT-TG distance were used to assess the relationship between sTT-TG and PROs. Results: A total of 76 patients, mostly female (61.8%), with a mean age of 31.9 ± 8.3 years, BMI of 26.8, and 60.6 ± 23.6-month follow-up were included. There were 37 (48.7%) patients that underwent OCA transplantation and 39 (51.3%) that underwent ACI. A total of 98 lesions were identified, with the majority (n = 93, 94.9%) being Grade 4. Overall, 54 patients had unipolar lesions and 22 had bipolar lesions. The mean defect size was 2.9 ± 1.4 cm2 and 3.5 ± 2.9 cm2 for the OCA and ACI groups (p = 0.459), respectively, with an overall mean lesion area of 3.2 ± 2.3 cm2. Intra-rater reliability for sTT-TG measurements at each time point was excellent for Rater A (ICC of 0.99 [0.986-0.994] p&lt;0.001) and Rater B (ICC of 0.99 [0.985-0.994]). Inter-rater reliability was excellent (ICC of 0.97 [0.955-.982] p&lt;0.001), with an overall mean sTT-TG of -4.98 ± 4.93 mm (range: -18.9, 5.7). On average, 48.7% (n = 37) of patients returned to sport and of those, 22.4% (n=17) returned to a similar or higher level of sport activity. Mean pain and satisfaction were 26.7 ± 25.1 and 73.8 ± 27.7, respectively. Collectively, the mean KOOS subscores were - KOOS symptoms: 71.4 ± 2.3, KOOS pain: 79.5 ± 2.0, KOOS sport: 60.2 ± 2.8, and KOOS QoL: 52.0 ± 2.6. When controlling for age, sex, BMI, and follow-up, sTT-TG was not predictive of RTS (p=0.706), pain (p=0.698), satisfaction (0.757), or any KOOS subscore (p&gt;0.05). Although, older age was associated with worse satisfaction (-0.819, 95% CI [-1.608,-0.03] and inferior KOOS pain (-0.606, 95% CI [-1.096,-0.116]), KOOS sport (-0.739, 95% CI [-1.445,-0.032]), and KOOS QoL (-0.786, 95% CI [-1.455,-0.117] p&lt;0.05). Conclusions: In this cohort of patients that underwent an OCA or ACI for PF cartilage lesions, sTT-TG was not predictive of post-operative patient reported functional outcomes or complications. These findings suggest that while a more posterior tibial tubercle (negative sTT-TG) may contribute to a higher incidence of cartilage pathology, patients can have favorable short-term outcomes following cartilage restoration with OCA or ACI.

Predictors of Long-term Patient-Reported Outcome Measures After Collagen Meniscal Implant for Partial Meniscal Defects.

Collagen meniscal implant (CMI) is considered an effective procedure for reducing knee pain and improving knee function after previous meniscectomy. Nevertheless, the current knowledge regarding long-term patient reported-outcome measures after CMI is limited. To evaluate clinical outcomes, reoperations, and failures of CMI at a minimum 10-year follow-up. Case series; Level of evidence, 4. Consecutive patients who underwent CMI at a single institution were screened for eligibility. Inclusion criteria for the present study were (1) medial or lateral CMI; (2) isolated or combined procedure with anterior cruciate ligament reconstruction, knee osteotomy, or cartilage treatment; and (3) follow-up between 10 and 15 years. Demographics and surgical details were obtained via chart review. Patients were asked if they were satisfied with the procedure and were evaluated with the Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, and Tegner score at the final follow-up. Cases requiring partial or total scaffold removal for any reason (including scaffold breakage, infection, or surgery for osteoarthritis progression) were considered surgical failure. Survival analysis was performed with Kaplan-Meier curve, and clinical scores were analyzed based on the Patient Acceptable Symptom State (PASS). A total of 92 patients (mean age, 42.2 years were included in the analysis. A significant improvement in all clinical scores was reported between the preoperative evaluation and the last follow-up. A chondropathy with Outerbridge grade ≥3 was associated with significantly overall lower clinical scores, while a timing from meniscectomy to CMI of ≥5 years determined more pain at rest and reduced Quality of Life in the KOOS subscale. No significant difference was found in terms of clinical scores between patients undergoing isolated and combined procedures. At the final follow-up, the mean Lysholm score was 76.3 points. In total, 12 cases (13%) were considered surgical failures. Sixteen patients (17%) did not reach PASS for the Lysholm score, with a total of 28 cases (30%) classified as clinical failures. Overall, 19% (KOOS Pain) and 40% (KOOS Symptoms) of patients did not achieve the PASS in the KOOS subscales. Chondropathy with Outerbridge grade ≥3 was associated with a higher risk of not achieving the PASS in all the KOOS subscales, while age at surgery of ≥45 years resulted in a lower risk of not achieving PASS in the Pain subscale. At the last follow-up, 63% of patients were still involved in sports activity, with 41% at the same or higher level. Finally, 80% of the patients were satisfied with the procedure. Up to 10 years after surgery, around 70% of the patients who underwent CMI reported satisfactory clinical results, with clinical subjective scores still higher compared with the preoperative evaluation. Overall, 30% of cases were considered clinical failures, with 13% considered surgical failures and 17% not meeting the PASS for the Lysholm score. In addition, cartilage status and time from meniscectomy were shown to have a negative impact on the outcomes, while an age ≥45 years was associated with less pain. There was no clinical difference between patients who underwent isolated CMI or combined procedures.

Paper 38: Comparison of Clinical Outcomes and Return to Sport Rates Between Osteochondral Allograft Transplantation and Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Patellofemoral Joint

Objectives: The purpose of this study is to compare clinical outcomes and return to sport (RTS) rates between patients that undergo osteochondral allograft (OCA) transplantation and autologous chondrocyte implantation (ACI), or matrix-induced autologous chondrocyte implantation (MACI), for patellofemoral articular cartilage defects. Methods: A retrospective review of patients who underwent an OCA, ACI, and MACI from 2010 to 2020 with a minimum two-year follow-up was conducted. Patient-reported outcomes (PROs) collected included: Visual Analog Scale for pain and satisfaction, Knee Injury and Osteoarthritis Outcome Score (KOOS), and return to sport (RTS) status. Logistic regression controlling for age, sex, BMI, bone marrow edema, mechanism of injury, lesions size and location was used to identify predictors of worse outcomes. Results: A total of 95 patients with a mean age of 32.1 years (± 10.0) and mean BMI of 26.5 (± 5.9) were included. ACI or MACI was performed in 55 cases (57.9%) and OCA in 40 (42.1%). Satisfaction was not significantly different between groups. VAS pain scores were higher in the OCA group, but did not reach significance. Overall, KOOS pain was significantly poorer in the OCA group than the ACI/MACI group, while KOOS symptoms, KOOS sport, and KOOS QOL subscores were non-significantly different. Overall, RTS rate was 54.3.%, with no significant difference in return between OCA or ACI/MACI groups. Increasing age was associated with lower satisfaction in the OCA group and poorer outcomes in the ACI/MACI group, while larger lesion area was associated with lower satisfaction and poorer outcomes scores in the ACI/MACI group. Conclusions: Clinical outcomes and return to sport rates are similar in patients that undergo OCA or ACI/MACI for patellofemoral articular cartilage defects, except in measures of pain, where patients undergoing OCA may experience more symptoms, particularly in the setting of trochlear defects.

Poster 229: Intra-articular VEGF and MMP-1 Are the Primary Drivers of Worse Baseline KOOS Symptoms and Quality of Life Subscores at Time of Knee Chondroplasty

Objectives: Biomarkers are a topic of interest in orthopaedics in the setting of osteoarthritis and patients undergoing knee arthroscopy for any reason. However, in patients undergoing knee arthroscopy for chondral defects, the influence of cytokines on patient pain and function is not fully understood. The purpose of this study is to investigate the concentrations of synovial inflammatory cytokines in patients undergoing arthroscopic chondroplasty for chondral defects in the knee and correlate those cytokine levels with baseline patient reported outcome measures (PROs) and defect characteristics. We hypothesized that the synovial cytokine environment will correlate with patient symptoms more so than baseline defect characteristics. Methods: Sixty patients 18-50 years old undergoing arthroscopic chondroplasty for knee cartilage defects were enrolled. Patients were assigned preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee International Knee Documentation Committee (IKDC) Subjective Knee Forms. Preoperative magnetic resonance images were used to calculate AMADEUS (Area Measurement And Depth Underlying Structure) scores. All patients received a successful synovial fluid aspiration just prior to initiation the arthroscopic procedure. The number of defects, total defect area, and ICRS grades were recorded based on intraoperative assessment. Patients with concomitant procedures beyond partial meniscectomy were excluded. Multiplex ELISA analyzed aspirations for: PDGF-BB, CCL-5/RANTES, MMP-3, MMP-1, EGF, VEGF, IL-1a, FGF-2, CCL-2, BMP-2, and aggrecan. Univariate correlation testing was used to assess significance between cartilage defect characteristics, PROs, and cytokine concentrations (Figure 1). The Akaike Information Criterion (AIC) was utilized to select the best-fit multivariate regression model using the 4 most significant independent variables for each cytokine (Figure 2). AIC best-fit modeling was repeated for each PRO that had at least two significant cytokine associations on univariate testing (Figure 3). Significance was set at P&lt;0.05. Results: MMP-1 had a positive correlation with number of defects treated ( P=0.016) and negative correlation with KOOS quality of life (QOL) subscores ( P=0.035; R2 =0.173). VEGF was positively correlated with defects treated ( P=0.005) and negatively correlated with KOOS Symptoms scores ( P=0.035; R2 =0.225). The treatment of multiple defects was an independent predictor of elevated IL-1a ( P=0.002, R2 =0.202). CCL-2 was positively correlated with multiple defects ( P=0.012) and negatively with KOOS QOL ( P=0.016, R2 =0.173). Female sex was correlated with higher concentrations of MMP-3 ( P=0.007, R2 =0.144), FGF ( P=0.012, R2 =0.178), and BMP-2 ( P=0.008; R2 = 0.169). BMP-2 was negatively correlated with KOOS Symptom ( P=0.019). The primary driver of preoperative KOOS Symptoms scores on multivariate analysis was VEGF ( P=0.023, R2 =0.120), influencing patient symptoms beyond defect characteristics. Similarly, KOOS QOL was independently correlated with MMP-1 concentration ( P= 0.045, R2 =0.079), more so than ICRS grade (Figure 3). Conclusions: Multivariate regression analysis revealed that elevated MMP-1 was the primary driver of worse preoperative KOOS QOL scores, more so than defect characteristics such as the number of lesions treated. Similarly, worse preoperative KOOS Symptoms scores were more strongly correlated with elevated VEGF concentrations rather than defect ICRS grades. Our study demonstrated that synovial fluid cytokines appear to be the primary drivers of patients’ subjective assessments of their pain and function preoperatively.

Factors Associated with Return to Sport After Anterior Cruciate Ligament Reconstruction: A Focus on Athletes Who Desire Preinjury Level of Sport.

In most previous studies investigating return to preinjury level of sport (RTPS) after anterior cruciate ligament reconstruction (ACLR), whether patients continue aiming for RTPS not only before but also after ACLR was unclear because environmental and social factors were not considered. Herein, we aimed to evaluate factors associated with RTPS among athletes who desired to achieve RTPS even after ACLR, excluding patients who no longer desire this goal owing to environmental and social factors. Ninety-two patients who underwent primary double-bundle ACLR with a minimum 2-year follow-up and desired to achieve RTPS before surgery were retrospectively enrolled. Twelve (13%) patients who no longer desired to achieve RTPS after ACLR owing to environmental and social factors were excluded. Sixty-nine patients were included in the final cohort. At the final follow-up, the patients were split into two groups: those who achieved (R group) or did not achieve (N group) RTPS based on patient self-assessment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores were also determined. The anterior tibial translation in the Lachman test and acceleration and external rotational angular velocity (ERAV) in the pivot shift test were measured at the hardware removal operation. Significant differences were observed for preinjury level of sports between the groups (p < 0.05). The rate of RTPS in competitive athletes was lower than that in recreational athletes (20/46: 43% vs. 16/22: 73%; p =.037). Lysholm score, KOOS symptom, pain, and quality of life showed higher values in the R group than in the N group (p < 0.050). Acceleration was significantly lower in the R group than in the N group (p = 0.028). Competitive level of sports is a risk factor for failure to achieve RTPS. The postoperative functional outcomes in the group that achieved RTPS showed more favorable results. These results provide important information to enable the surgeons to consider the appropriate surgical plan for competitive athletes who desire to achieve RTPS after ACLR.

Meniscal allograft transplantation (MAT) combined with revision ACL reconstruction and lateral extra-articular tenodesis results in significantly improved outcomes, but patient-reported knee function is inferior compared to an isolated MAT.

Meniscal allograft transplantation (MAT) is a valuable option for postmeniscectomy syndrome in young and active patients, which can successfully improve symptoms, function and quality of life. This study aimed to report outcomes and complications in patients treated with isolated MAT or MAT combined with revision anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular tenodesis (LET). In total, 18 patients who were treated with MAT using a soft tissue fixation technique were retrospectively analysed. Patients were allocated into two groups, the isolated MAT group and the MAT plus revision ACLR + LET group (MAT+ group). Both groups were assessed using the following Patient-Reported Outcome Measures (PROMs): Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Tegner Activity Scale, Lysholm score, EuroQol 5-Dimension 5-level (EQ-5D-5L) questionnaire and a patient acceptable symptom state (PASS) statement. The mean follow-up was 3.2 years and the mean age of patients was 29 (±7.6) years. Ten patients were treated with isolated MAT and eight patients were treated with MAT combined with revision ACLR and LET. No complications and no reoperations were reported. In both groups, all PROMs significantly improved postoperatively (p < 0.05), except for the Tegner score in the MAT+ group, which did not reach statistical significance (not significant [n.s.]). No significant difference was found postoperatively in PROMs between the MAT and the MAT+ group; however, differences in the KOOS Symptoms, Sports and Quality-of-life subscales reached the minimal clinically important threshold. Mean values were: IKDC 61.2 (±13.9) versus 64.7 (±23.2), KOOS Total 72.8 (±14.9) versus 68.0 (±16.7), Lysholm score 83.2 (±11) versus 84.2 (±8.7) and EQ-5D-5L 71.8 (±14.9) versus 72.2 (±22.4). Median values for the Tegner Activity Scale were 4 versus 3. PASS statement was negative in 37.5% of the MAT+ group in comparison to 20% of the MAT group (n.s.). In terms of patient-reported outcomes, MAT is an effective and safe procedure, even when combined with revision ACLR + LET. Compared to the preoperative assessment, a significant improvement of the postoperative PROMs can be expected either when MAT is performed isolated or in combination with ACLR + LET. However, clinically important differences between the two groups can be noted in favour of the isolated MAT procedure, especially regarding symptoms and sporting activity. Level III.

Immune Hypersensitivity Is Associated With Higher Graft Failure Rate After Osteochondral Allograft Transplantation of the Knee

To analyze the effects of 1 or more patient-reported allergies on clinical outcomes, in particular graft failure rate, and patient-reported outcomes (PROs) following osteochondral allograft transplantation (OCA) of the knee. Retrospective review of patients who underwent knee OCA from August 2010 to May 2021 with a minimum of 2-year follow-up. Patients were initially divided into 2 cohorts: those with at least 1 allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism, and manipulation under anesthesia/lysis of adhesions (MUA/LOA). PROs assessed, including the visual analog scale (VAS) for pain and satisfaction, the Knee injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates, were compared. In total, 285 patients were included with a mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (P= .008). In a regression analysis controlling for confounding variables, graft failure remained significantly associated with the presence of medication allergies (odds ratio [OR], 3.631; 95% CI, 1.139-11.577; P= .029). Furthermore, an increasing number of allergies were associated with an increased rate of graft failure (OR, 1.644; 95% CI, 1.074-2.515; P= .022). There was no difference in rate of reoperation, complications, infection, and MUA/LOA. Of the 100 patients who completed PROs, there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport. The presence of 1 or more patient-reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, an increasing number of patient-reported allergies were associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain, or return to sport in patients with at least 1 patient-reported allergy and those without allergies. Level III, retrospective cohort study.

Arthroscopic Partial Meniscectomy in Patients With Kellgren-Lawrence Grade 3 Osteoarthritis Shows Clinically Meaningful Improvement in Outcomes

To evaluate patient-reported outcome measures (PROMs) following arthroscopic partial meniscectomy (APM) in patients with Kellgren-Lawrence (KL) grade 3 on preoperative knee radiographs and a symptomatic meniscal tear. This was a retrospective study design using prospectively collected data from a single institution. Patients were included if they had KL grade 3 osteoarthritis on preoperative radiographs of the knee and completed a trial of nonoperative treatment for at least 6 weeks prior to APM. Patients were excluded if they had inflammatory arthritis, incomplete preoperative and/or 1-year postoperative follow-up data, repeat knee arthroscopy, and concomitant ligamentous injury. Statistical analyses used PROMs, preoperatively and up to 2 years postoperatively, to assess improvement utilizing scales with previously established thresholds, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Eighty-two patients met the eligibility criteria (49 women [60%], mean [SD] age, 53.1 [9.3] years). At the 1-year follow-up, most patients achieved MCID: 73% in Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, 66% in KOOS Symptoms, and 78% in KOOS Activities of Daily Living (ADL). These improvements were similar at the 2-year follow-up: 75%, 72%, and 79% in each subscale, respectively. SCB was also demonstrated 1 year postoperatively, with 56%, 73%, and 71% achieving SCB for the KOOS Pain, Symptoms, and ADL subscales, respectively. These results largely persisted at the 2-year follow-up. Visual analog scale scores for pain also improved at 1- and 2-year postoperative periods with mean improvements from baseline of 2.80 and 2.87 points, respectively. Marx Activity Score decreased on average from baseline to 1- and 2-year follow-up. At a minimum of 1-year follow-up, most patients with KL grade 3 and a meniscal tear achieved MCID and SCB in KOOS Pain, KOOS Symptoms, and KOOS ADL, indicating meaningful outcome improvement for these patients. Level IV, therapeutic case series.

Lysholm and KOOS QoL Demonstrate High Responsiveness in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

There have been a large number of patient-reported outcome measures (PROMs) used to assess outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR). The purpose was to determine which PROMs are being commonly used in randomized clinical trials (RCTs) to assess patients undergoing ACLR and to compare the responsiveness between them. It was hypothesized that the International Knee Documentation Committee (IKDC) score would be the most commonly used and responsive PROM among patients undergoing ACLR. Meta-analysis. Level of evidence, 2. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and relevant studies were extracted from the PubMed/MEDLINE and Web of Science databases. The inclusion criteria were English-language RCTs reporting on PROMs after ACLR. For articles meeting our inclusion criteria for responsiveness analysis (≥2 PROMs reported, 1 year minimum follow-up, and reported pre- and postoperative PROM means and standard deviations), the responsiveness between PROMs was compared using effect size (ES) and relative efficiency (RE). A total of 108 articles met the inclusion criteria, comprising 9034 patients (mean age, 29.9 years; mean body mass index, 24.3; mean follow-up time, 36.1 months). There were 34 PROMs identified. The top 3 most commonly reported PROMs were the IKDC (n = 68; 63.0%), Lysholm (n = 65; 60.2%), and Tegner (n = 47; 43.5%) scores. The 2 PROMs with the highest ES were the ACL-Quality of Life (QoL) (3.37) and Knee Injury and Osteoarthritis Outcome Score (KOOS) QoL (2.07) scores. Compared with other PROMs, Lysholm and KOOS QoL scores had the greatest RE values. The Lysholm score had a greater RE than the KOOS Pain (RE, 1.17), KOOS Symptoms (RE, 1.22), KOOS Activities of Daily Living (ADL) (RE, 1.42), KOOS Sport/Recreation (RE, 1.55), KOOS QoL (RE, 1.41), and Tegner (RE, 2.89) scores. KOOS QoL had a greater RE than the IKDC (RE, 1.32), KOOS Pain (RE, 1.60), KOOS Symptoms (RE, 2.12), KOOS ADL (RE, 3.03), KOOS Sport/Recreation (RE, 1.27), and Tegner (RE, 2.06) scores. The IKDC score is the most commonly reported PROM in RCTs after ACLR; however, the Lysholm and KOOS QoL scores demonstrated the highest responsiveness in patients undergoing ACLR compared with other PROMs.

Intra-articular VEGF and MMP-1 are the Primary Drivers of Worse Baseline KOOS Symptoms and Quality of Life Subscores at Time of Knee Chondroplasty

Objectives: Biomarkers are a topic of interest in orthopaedics in the setting of osteoarthritis and patients undergoing knee arthroscopy for any reason. However, in patients undergoing knee arthroscopy for chondral defects, the influence of cytokines on patient pain and function is not fully understood. The purpose of this study is to investigate the concentrations of synovial inflammatory cytokines in patients undergoing arthroscopic chondroplasty for chondral defects in the knee and correlate those cytokine levels with baseline patient reported outcome measures (PRO’s) and defect characteristics. We hypothesized that the synovial cytokine environment will correlate with patient symptoms more so than baseline defect characteristics. Methods: Sixty patients 18-50 years old undergoing arthroscopic chondroplasty for knee cartilage defects were enrolled. Patients were assigned preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee International Knee Documentation Committee (IKDC) Subjective Knee Forms. Preoperative magnetic resonance images were used to calculate AMADEUS (Area Measurement And Depth Underlying Structure) scores.1 All patients received a successful synovial fluid aspiration just prior to initiation the arthroscopic procedure. The number of defects, total defect area, and ICRS grades were recorded based on intraoperative assessment. Patients with concomitant procedures beyond partial meniscectomy were excluded. Multiplex ELISA analyzed aspirations for: PDGF-BB, CCL-5/RANTES, MMP-3, MMP-1, EGF, VEGF, IL-1a, FGF-2, CCL-2, BMP-2, and aggrecan. Univariate correlation testing was used to assess significance between cartilage defect characteristics, PROs, and cytokine concentrations (Figure 1). The Akaike Information Criterion (AIC) was utilized to select the best-fit multivariate regression model using the 4 most significant independent variables for each cytokine (Figure 2). AIC best-fit modeling was repeated for each PRO that had at least two significant cytokine associations on univariate testing (Figure 3). Significance was set at P&lt;0.05. Results: MMP-1 had a positive correlation with number of defects treated (P=0.016) and negative correlation with KOOS quality of life (QOL) subscores (P=0.035; R2 =0.173). VEGF was positively correlated with defects treated (P=0.005) and negatively correlated with KOOS Symptoms scores (P=0.035; R2 =0.225). The treatment of multiple defects was an independent predictor of elevated IL-1a (P=0.002, R2 =0.202). CCL-2 was positively correlated with multiple defects (P=0.012) and negatively with KOOS QOL (P=0.016, R2 =0.173). Female sex was correlated with higher concentrations of MMP-3 (P=0.007, R2 =0.144), FGF (P=0.012, R2 =0.178), and BMP-2 (P=0.008; R2 = 0.169). BMP-2 was negatively correlated with KOOS Symptom (P=0.019). The primary driver of preoperative KOOS Symptoms scores on multivariate analysis was VEGF (P=0.023, R2 =0.120), influencing patient symptoms beyond defect characteristics. Similarly, KOOS QOL was independently correlated with MMP-1 concentration (P= 0.045, R2 =0.079), more so than ICRS grade (Figure 3). Conclusions: Multivariate regression analysis revealed that elevated MMP-1 was the primary driver of worse preoperative KOOS QOL scores, more so than defect characteristics such as the number of lesions treated. Similarly, worse preoperative KOOS Symptoms scores were more strongly correlated with elevated VEGF concentrations rather than defect ICRS grades. Our study demonstrated that synovial fluid cytokines appear to be the primary drivers of patients’ subjective assessments of their pain and function preoperatively.

Responsiveness of Patient-Reported Outcome Measures After Large Knee Articular Cartilage Transplantation: A Systematic Review and Meta-analysis

Background: Cartilage transplantation is commonly used to treat large (>4 cm2) articular cartilage defects of the knee. The 2 most common transplants are osteochondral allograft transplantation and autologous chondrocyte implantation. Several patient-reported outcome measures (PROMs) have been used to determine the efficacy of treatment, but it is unknown which measures are the most effective. Purpose: To report the multiple PROMs used after large knee articular cartilage transplantation surgery and to compare the responsiveness between them. Study Design: Meta-analysis; Level of evidence, 4. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of the PubMed/MEDLINE and Web of Science databases was performed. A total of 181 articles met inclusion criteria. Patient and study characteristics were extracted, including pre- and postoperative means for PROMs. From the articles that met inclusion criteria for responsiveness analysis (2+ PROMs reported, 1-year minimum follow-up, reported pre- and postoperative means and standard deviations; n = 131), the authors compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared with another in ≥10 articles. Results: A total of 10,015 patients (10,093 knees; mean age, 34.8 years; mean body mass index, 26.1) were included in this study. The mean follow-up time was 58.3 months (range, 1.5-247.2 months), imaging findings were reported in 80 articles (44.2%), patient satisfaction was reported in 39 articles (21.5%), and range of motion was reported in 10 articles (5.5%). There were 58 unique PROM instruments identified, with the most used being the International Knee Documentation Committee (IKDC) score (n = 118; 65.2%), followed by Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (n = 58; 32.0%), KOOS Sport and Recreation (n = 58; 32.0%), KOOS Quality of Life (n = 57; 31.5%), KOOS Activities of Daily Living (n = 57; 31.5%), and KOOS Symptoms (n = 57; 31.5%). Overall, IKDC was found to have the greatest effect size (1.68) and the best responsiveness of the other PROMs, which include KOOS Pain (RE, 1.38), KOOS Symptoms (RE, 3.06), KOOS Activities of Daily Living (RE, 1.65), KOOS Sport and Recreation (RE, 1.44), Lysholm (RE, 1.76), and Tegner (RE, 1.56). Conclusion: The IKDC is the most responsive PROM after large knee articular cartilage transplantation surgery. The IKDC score is recommended for assessing outcomes after cartilage transplantation surgery.

Optimal Duration of Physical Therapy Following Total Knee Arthroplasty.

The purpose of this study was to identify patient characteristics associated with engagement and completion of physical therapy (PT) following total knee arthroplasty (TKA) and examine the relationship between number of PT sessions attended and outcomes during the first 12weeks after surgery. Patients underwent unilateral primary TKA by a single surgeon and were advised to complete 17 PT sessions over 6weeks at a hospital-affiliated facility. Analyses examined predictors of PT engagement (attendance of ≥2 sessions) and completion (attendance of 17 ± 1 sessions) within 6weeks and associations between number of PT sessions attended and changes in range of motion (ROM) and Knee Injury and Osteoarthritis Outcome Score (KOOS) values. Patients living <40km were more likely to be engaged in PT than those living ≥40km from the clinic (P < .0001). Among patients who completed PT within 6weeks, 95.0%, 85.1%, and 56.4% achieved flexion of, respectively, ≥90°, ≥100°, and ≥110°. Among engaged patients, the active flexion thresholds of ≥90°, ≥100°, and ≥110° were achieved by, respectively, 94.4%, 82.5%, and 58.1% by 6weeks and by 96.7%, 92.1%, and 84.2% by 12weeks. Improvement in KOOS Symptoms (P = .029), Function in daily living (P = .030) and quality of life (P = .031) linearly decreased as number of PT sessions increased. These results raise the question of whether patients who meet satisfactory outcomes before completing 6weeks of prescribed PT and those who attend more PT sessions than prescribed may be over-utilizing healthcare resources without additional benefit.