Differences in the Demographics and Preferred Management of Knee Cartilage Injuries in Soccer Players Across FIFA Centers of Excellence

Cartilage ◽  
2021 ◽  
pp. 194760352110188
Author(s):  
Niv Marom ◽  
Tyler Warner ◽  
Riley J. Williams
Keyword(s):  
Nonoperative Treatment ◽  
Soccer Players ◽  
Continuous Variables ◽  
Knee Cartilage ◽  
Centers Of Excellence ◽  
Bone Marrow Stimulation ◽  
Medical Centers ◽  
Cartilage Restoration ◽  
Cartilage Injuries ◽  
Median Rate

Objective We sought to report on the demographics and epidemiology of knee cartilage injuries and preferred management in soccer players, across FIFA Medical Centers of Excellence (FMCE). Design A descriptive questionnaire focusing on characteristics of knee cartilage injuries and their management in soccer players during the 10-year period prior to the distribution of the questionnaire was sent to all FMCE around the world in September 2019 via an online platform. Voluntary responses from centers were processed and analyzed. Descriptive characteristics were reported using median and interquartile ranges (IQR) for continuous variables and frequencies and percentages (%) for discrete variables. Results A total of 15 centers from 5 continents responded to the questionnaire and reported on a total of 4526 soccer players. Among centers, the median age was 27 years (IQR: 23-38), the median rate of male players was 75% (IQR: 68-90), and the median rate of professional players was 10% (IQR: 5-23). The most common reported etiology for cartilage injury was traumatic (median 40%, IQR: 13-73). The most common nonoperative treatment utilized was physical therapy (median 90%, IQR: 51%-100%) and the most common operative treatment utilized was bone marrow stimulation/micro-fracture (median 40%, IQR: 19-54%). The utilization of other cartilage restoration procedures varied across centers. Conclusions Our findings highlight different tendencies in the management of these injuries across FMCE and emphasize the need for collaborative efforts focusing on establishing consensus guidelines for the optimal management of these challenging injuries in soccer players.

The Clinically Important Difference and Patient Acceptable Symptomatic State for Commonly Used Patient-Reported Outcomes After Knee Cartilage Repair

2020 ◽  
Vol 49 (1) ◽  
pp. 193-199
Author(s):  
Jaskarndip Chahal ◽  
Drew A. Lansdown ◽  
Annabelle Davey ◽  
Aileen M. Davis ◽  
Brian J. Cole
Keyword(s):  
Characteristic Curve ◽  
International Knee Documentation Committee ◽  
Baseline Score ◽  
Limited Information ◽  
Knee Cartilage ◽  
Level Of Evidence ◽  
Clinically Important Difference ◽  
Younger Age ◽  
Cartilage Restoration ◽  
Patient Reported

Background: In patients undergoing cartilage restoration of the knee, limited information is available regarding clinically important difference (CID) and Patient Acceptable Symptomatic State (PASS) estimates for commonly used patient-reported outcome measures (PROMs). Purpose: The objective of this study was to determine the CID and PASS in the population with knee cartilage restoration for the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Form (IKDC) score, and the Lysholm score. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Between 2012 and 2017, patients who underwent a cartilage restoration procedure were prospectively enrolled. Patients completed the KOOS, IKDC, and Lysholm, all of which were scored from 0 to 100, and completed relevant anchor questions at baseline and 1 year postoperatively. Receiver operating characteristic curve analyses were conducted to determine CID and PASS cutoff points. Multivariable regression analyses were performed to determine the effect of age, sex, and baseline score on likelihood of achieving CID and PASS. Results: Of the 113 patients enrolled, 53 (47%) were male, and the mean age was 36 years. The CID values for the PROMs were 10.7 for KOOS Symptoms, 8.3 for KOOS Pain, 8.8 for KOOS Activities of Daily Living (ADL), 30.0 for KOOS Sports and Recreation, 18.8 for KOOS Quality of Life (QOL), 9.2 for IKDC, and 13.0 for Lysholm. The PASS values were 71.5 for KOOS Symptoms, 72.2 for KOOS Pain, 86.8 for KOOS ADL, 43.8 for KOOS Sports and Recreation, 50.0 for KOOS QOL, 62.1 for IKDC, and 70.0 for Lysholm. Patients with higher baseline scores were more likely to achieve PASS for the IKDC (odds ratio, 2.28; P = .03). Baseline score did not have an effect on the likelihood of achieving CID. Younger age was an independent predictor of achieving PASS and CID across all outcomes ( P < .05), but sex did not have such an effect. Conclusion: This study determined CID and PASS values for the KOOS, IKDC, and Lysholm scores among patients treated with knee cartilage restoration. Younger age was a positive prognostic variable, and higher baseline scores implied achieving PASS for the IKDC. The information in this study can be used in designing randomized controlled trials, counseling individual patients as to anticipated outcomes, and conducting responder analyses when evaluating new cartilage technology from a regulatory perspective.

scholarly journals Arthroscopic findings and treatment of maisonneuve fracture complex

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lukas Fraissler ◽  
Georg Mattiassich ◽  
Lars Brunnader ◽  
Lukas A. Holzer
Keyword(s):  
Subchondral Bone ◽  
Ankle Arthroscopy ◽  
High Rate ◽  
Level Of Evidence ◽  
Bone Marrow Stimulation ◽  
International Consensus ◽  
Concomitant Injuries ◽  
Maisonneuve Fracture ◽  
Arthroscopic Findings ◽  
Cartilage Injuries

Abstract Background The Maisonneuve fracture complex (MFC) is a well-known lower leg injury. However, the optimal treatment is still not clear and there is limited data on concomitant injuries of cartilage. Therefore, the aim of our study was to report the incidence of incidental cartilage injuries and their management in arthroscopic treatment of MFC. Patients and methods Between February 2018 and February 2021 all patients presenting with MFC in our department were treated with diagnostic ankle arthroscopy and percutaneous syndesmotic screw or suture-endobutton fixation. In case of instable cartilage, it was debrided and according to the International Consensus Meeting on Cartilage Repair of the Ankle, in grade IV lesions < 10 mm or < 100 mm2 area the subchondral bone was microfractured. Results Eighteen patients, 16 male and two female, with a mean age of 48.1 years, were included. In all cases, instability of the distal tibiofibular articulation was confirmed arthroscopically. Injuries of the cartilage were found in 56% of the cases and in 31% of the patients surgical intervention was required. In three talar and one tibial lesion additional arthroscopic bone marrow stimulation with microfracture of the subchondral bone was performed. Conclusions Ankle arthroscopy is a helpful method to guide fibular reduction and to detect and address associated cartilage injuries. Due to the high rate of chondral lesions, addressing these arthroscopically may contribute to better postoperative results. Level of evidence IV

scholarly journals Prior Bone Marrow Stimulation Surgery Influences Outcomes After Cell-Based Cartilage Restoration: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110353
Author(s):  
Charles J. Cogan ◽  
James Friedman ◽  
Jae You ◽  
Alan L. Zhang ◽  
Brian T. Feeley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Marrow ◽  
Failure Rate ◽  
Meta Analysis ◽  
Failure Rates ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Cartilage Restoration ◽  
History Of ◽  
The Mean

Background: Cell-based cartilage restoration with autologous chondrocyte implantation (ACI) is a safe and effective treatment for symptomatic cartilage lesions. Many patients undergoing ACI have a history of prior surgery, including bone marrow stimulation (BMS). There is mounting evidence that a history of prior BMS may impede healing of the ACI graft. Purpose/Hypothesis: The purpose of this study was to compare the failure rates of primary ACI with ACI after prior BMS. We hypothesized that ACI after BMS would have a significantly higher failure rate (defined as reoperation, conversion to arthroplasty, and/or imaging-based failure) compared with primary ACI. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed by use of PubMed and Embase databases for relevant articles published through October 2, 2020, to identify studies evaluating outcomes and failures rates of ACI after prior BMS in the knee. Results: Included were 11 studies comprising 1479 ACI procedures. The mean age at surgery ranged from 18.3 to 39.1 years, and the mean follow-up ranged from 3 to 20.6 years. All studies reported failure rates. The overall failure rate was significantly higher in the patients who underwent ACI after BMS, at 26.4% compared with 14.8% in the ACI group ( P < .001). Meta-analysis demonstrated an increased risk of failure in patients with a history of prior BMS (log odds ratio = –0.90 [95% confidence interval, –1.38 to –0.42]). Conclusion: This systematic review demonstrated that failure rates were significantly higher for patients treated with ACI after BMS relative to patients undergoing ACI without prior BMS. This finding has important implications when considering the use of BMS for defects that are amenable to cell-based restoration and when determining treatment options after failed BMS. Registration: PROSPERO (CRD42020180387).

Management of Knee Cartilage Injuries in Basketball

2020 ◽  
pp. 379-390
Author(s):  
Hailey P. Huddleston ◽  
Jorge Chahla ◽  
Brian Cole ◽  
Adam B. Yanke
Keyword(s):  
Knee Cartilage ◽  
Cartilage Injuries

Restorative procedures for articular cartilage in the ankle: state-of-the-art review

2019 ◽  
Vol 4 (5) ◽  
pp. 270-284 ◽  
Author(s):  
Yoshiharu Shimozono ◽  
Francesca Vannini ◽  
Richard D Ferkel ◽  
Norimasa Nakamura ◽  
John G Kennedy
Keyword(s):  
Articular Cartilage ◽  
State Of The Art ◽  
Patient Characteristics ◽  
Geographical Differences ◽  
Bone Marrow Stimulation ◽  
Joint Injury ◽  
Fast Pace ◽  
Chondrocyte Implantation ◽  
Articular Cartilage Injury ◽  
Cartilage Injuries

Articular cartilage is a highly specialised connective tissue that serves to lubricate joint surfaces and distribute loads across the joint. Injury to articular cartilage is a significant cause of pain and dysfunction that may eventually lead to osteoarthritis or degenerative arthrosis. Management of these injuries is complicated by the complex architecture and poor vascularity of this tissue. The field of articular cartilage restoration has evolved rapidly over the past several decades and current techniques offer promising results. However, despite the fast pace of progress in the treatment and repair of articular cartilage injury, a clear gold standard in management has yet to emerge. Current techniques for managing cartilage injuries discussed in this review include bone marrow stimulation, osteochondral transplantation, chondrocyte implantation, cell-based transplantation, biological augmentation and scaffold-based therapies. Heterogeneity in study design, including surgical procedures, lesion and patient characteristics, cell collection, biologics preparation protocols and outcome measures limits interpretation of results presented in the literature. Therefore, standardisation across research protocols and collaboration among centres will be necessary. This ‘state-of-the-art review’ presents the indications and techniques for managing ankle articular cartilage lesions, as well as future directions and geographical differences in management.

Lumbar Spondylolysis in Pediatric and Adolescent Soccer Players

2005 ◽  
Vol 33 (11) ◽  
pp. 1688-1693 ◽  
Author(s):  
Georges El Rassi ◽  
Masakazu Takemitsu ◽  
Patarawan Woratanarat ◽  
Suken A. Shah
Keyword(s):  
Back Pain ◽  
Case Series ◽  
Nonoperative Treatment ◽  
Soccer Players ◽  
Fisher Exact Test ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Exact Test ◽  
Lumbar Spondylolysis ◽  
Pain Duration

Background Lumbar spondylolysis in young soccer players has not been studied extensively. Purpose The purpose of this study was to review lumbar spondylolysis in young soccer players, describe the causes, and report the results of nonoperative treatment emphasizing the cessation of activity for 3 months. Study Design Case series; Level of evidence, 4. Methods The authors reviewed 57 child and adolescent soccer players (35 boys and 22 girls) with lumbar spondylolysis who came to their outpatient clinic for back pain evaluation. These patients received different modalities of nonoperative treatment, including cessation of sports and wearing a thoracolumbosacral orthosis. Soccer skills, field position, side of dominant leg, age, initiating event of low back pain, duration of symptoms, and nonoperative treatment were reviewed. Clinical outcome of treatment was assessed by the Steiner-Micheli criteria at the most recent follow-up (minimum 2 years). The Fisher exact test was used to compare all the data. Results Of the patients, 43% noticed that pain started after a high-velocity kick. Thirty-three (58%) of 57 patients had excellent results with no pain during sports, 20 (35%) good, 3 (5%) fair, and 1 (2%) poor. Subjects who ceased playing soccer for 3 months had better results than those who did not comply with this restriction. Conclusion The authors recommend stopping sports for at least 3 months in cases of lumbar spondylolysis in young soccer players who hope to return to their previous level of play without back pain.

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