JBJS | Platelet-Rich Plasma Differs According to Preparation Method and Human Variability

JBJS | Platelet-Rich Plasma Differs According to Preparation Method and Human Variability
The content and concentrations of platelets, white blood cells, and growth factors for each method of separation differed significantly. All separation techniques resulted in a significant increase in platelet concentration compared with native blood. Platelet and white blood-cell concentrations of the PRP_HP procedure were significantly higher than platelet and white blood-cell concentrations produced by the so-called single-step PRP_LP and the so-called two-step PRP_DS procedures, although significant differences between PRP_LP and PRP_DS were not observed. Comparing the results of the three blood draws with regard to the reliability of platelet number and cell counts, wide variations of intra-individual numbers were observed.

JBJS | Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis

JBJS | Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis
Twenty-three randomized trials and ten prospective cohort studies were identified. There was a lack of consistency in outcome measures across all studies. In six randomized controlled trials (n = 358) and three prospective cohort studies (n = 88), the authors reported visual analog scale (VAS) scores when comparing platelet-rich plasma with a control therapy across injuries to the acromion, rotator cuff, lateral humeral epicondyle, anterior cruciate ligament, patella, tibia, and spine. The use of platelet-rich plasma provided no significant benefit up to (and including) twenty-four months across the randomized trials (standardized mean difference, −0.34; 95% confidence interval [CI], −0.75 to 0.06) or the prospective cohort studies (standardized mean difference, −0.20; 95% CI, −0.64 to 0.23). Both point estimates suggested a small trend favoring platelet-rich plasma, but the associated wide confidence intervals were consistent with nonsignificant effects.

Snowboarders More Injury-Prone Than Skiers: Study

Snowboarders More Injury-Prone Than Skiers: Study
A new study from a Vermont ski resort found that snowboarders get injured slightly more often than skiers, with the most injuries happening in young, inexperienced female snowboarders.

Previous meniscectomy linked with chondral lesions in ACL reconstruction

Previous meniscectomy linked with chondral lesions in ACL reconstruction

Brophy and colleagues used data from the prospective Multicenter ACL Revision Study (MARS) to identify 725 revision ACL surgeries in patients with a mean age of 25 years.

“Knees undergoing ACL reconstruction have been shown to have a high incidence of chondral injuries in studies previously published […], however the risk factors for these lesions in this cohort are not well understood,” Brophy said. “Our hypothesis was that previous partial meniscectomy would be associated with a higher incidence of chondral lesions at the time of revision ACL reconstruction, but that meniscal repair would not be associated with the chondrosis.”

Of the group, there were 421 male patients. The investigators examined the data for Grades II, III and IV chondral lesions. Patients that underwent previous partial meniscal surgery and were undergoing ACL reconstruction had a higher grade of chondral lesions than patients who underwent no meniscal surgery.

“The reason for meniscal repair not being associated with chondrosis are not clear,” Brophy said. “Certainly, differences in underlying injuries to the knee, either at the time of recurring ACL injury, or previous injury to the knee. Although it is certainly a possibility that repair is perhaps somewhat protective, but certainly not to be precluded from association in this study.”

Arthroscopy remains a viable, reliable method for treating lateral epicondylitis

Arthroscopy remains a viable, reliable method for treating lateral epicondylitis

The advantage of arthroscopic evaluation of the elbow for release of the ECRB is that it eliminates a muscle splitting incision. The recovery is quicker, and patients have been shown to return to work and sports in a shorter period of time. Another advantage of the arthroscopic vs. open technique is the ability to see inside the joint and look for associated surgical pathology. Oftentimes, in a typical patient with tennis elbow, the culprit is the thickened annular ligament or a plica of the elbow that would not have been seen if the joint was not entered.

We have found this procedure can be performed by any competent elbow arthroscopist with a short learning curve. The portals are safe. The debridement is straightforward, and there are now 10 years of follow-up results equal to those of open surgery.

Epidural steroid injection returns most professional football players to the field

Epidural steroid injection returns most professional football players to the field

Krych and his team considered the injections successful if athletes returned to play within game conditions with no overtime and no additional surgical procedures. They found 89% of patients were fit to return to play, and the players continued an average of 3 seasons with 10 of the players still on the field. Four players required repeat injection with inability to return to play following a second injection, and three players needed surgery.

“In our hands, epidural steroid injections were an effective therapeutic option for treatment of acute lumbar disk herniation in professional athletes,” Krych said. “They appear to be safe and well-tolerated with minimal side effects. In this small study, risk factors for failure included sequestered disk on MRI as well as presentation of lower extremity weakness. We continue to recommend an individualized treatment approach for our athletes.”

Effects of Single- and Multi-axis Loading Conditions on ACL Strain: an Indication of ACL Injury Mechanism

OASIS: CONCLUSIONS: The combination of anterior shear, abduction and internal rotation along with axial impact generated maximum peak ACL strain. Data indicates that combined multi-planar loading is the most critical loading mechanism in ACL injury.