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Background: A few studies have documented the long-term results of chondrocyte-based procedures for the treatment of patellofemoral cartilage lesions, but specific results are lacking after matrix-assisted autologous chondrocyte transplantation (MACT) for patellar and trochlear lesions. Purpose: To document the clinical results of MACT for the treatment of patellar and trochlear chondral defects at long-term follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 44 patients were prospectively evaluated after MACT for patellofemoral lesions. There were 24 patients affected by patellar lesions, 16 by trochlear lesions, and 4 with both patellar and trochlear defects. Clinical outcomes were analyzed using the International Knee Documentation Committee (IKDC) subjective form, EuroQol visual analog scale, and Tegner score for sport activity level before surgery and at follow-up time points of 5, 10, and a minimum of 15 years (mean final follow-up, 17.6 ± 1.6 years). A Kaplan-Meier survival analysis was performed to examine the survival to failure. Failure was defined as the need for a second surgery because of the persistence of symptoms related to the primary defect. Results: An overall significant improvement was documented from baseline to the last follow-up. The IKDC subjective score improved in the trochlear group from 41.0 ± 13.3 at baseline to 83.9 ± 21.6 at 5 years (P <.005), remaining stable up to the final follow-up (81.3 ± 20.5). In the patellar group, the IKDC subjective score improved from 36.1 ± 14.4 at baseline to 72.3 ± 17.5 at 5 years (P <.005), remaining stable up to the final follow-up (62.0 ± 20.3). Patients with trochlear lesions presented higher IKDC subjective scores compared with those with patellar lesions at 5 (P =.029), 10 (P =.023), and ≥15 years (P =.006) of follow-up. Similar trends were documented for the Tegner score, while no differences were documented for the EuroQol visual analog scale score between patellar and trochlear lesions. There were 4 failures (9.1%) during the follow-up period. The Kaplan-Meier survival analysis did not show statistically significant differences between trochlear and patellar lesions. Conclusion: This hyaluronic acid–based MACT technique offered positive and durable clinical outcomes with a low failure rate at long-term follow-up in patients affected by patellofemoral cartilage lesions. However, trochlear and patellar lesions demonstrated a notable difference in terms of clinical findings and sport activity level, with significantly higher results for patients with trochlear lesions but less satisfactory outcomes for patients with patellar lesions. [ABSTRACT FROM AUTHOR]

Background The two-dimensional (2D) video-analysis of the change of direction (COD) technique has never been used to attempt to predict the risk of ACL injury in female football players. Hypothesis/Purpose The purpose of the present pilot study was to prospectively investigate the biomechanical predictors of ACL injury during a COD task in female football players using both gold standard 3D motion capture and a qualitative scoring system based on 2D video-analysis. Study Design Prospective cohort study Methods Sixteen competitive female football (soccer) players (age 21.4 ± 4.3) performed a series of pre-planned 90° COD tasks. 3D motion data was recorded through 10 stereophotogrammetric cameras and a force platform. 2D frontal and transverse plane joint kinematics were computed through video-analysis from three high-speed cameras. A scoring system based on five criteria was adopted: limb stability, pelvis stability, trunk stability, shock absorption, and movement strategy. The players were prospectively followed for the next two consecutive football seasons and the occurrence of severe knee injuries was registered. Results Four players (25%) experienced an ACL injury. In 3D analysis, ACL-injured players showed greater knee valgus, knee internal rotation, and lower knee flexion (p= 0.017 - 0.029). Lower hip flexion coupled with greater external rotation (p= 0.003 - 0.042), ankle eversion, and contralateral pelvic drop (p<0.001) were also noted. In 2D analysis, ACL-injured players showed greater internal foot rotation, contralateral pelvic drop, lower knee flexion, and contralateral trunk tilt (moderate-to-large effect size). Pelvis stability and trunk stability showed the highest predictive value towards ACL injury. Total score was significantly lower in ACL-injured players with a moderate effect size (d=0.45). Conclusions Both 3D and 2D methodologies depicted biomechanical risk factors and offered predictive insights towards the ACL injury risk. Awareness should rise in women's football regarding the high risk of ACL injury and the strategies to assess and mitigate it. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Background: The role of meniscal lesions and repair in combination with anterior cruciate ligament (ACL) injury and reconstruction has not been extensively investigated in vivo and under weightbearing conditions. Purpose: The purposes of this study were to (1) compare the in vivo knee kinematics between patients with ACL tear and those with combined ACL and medial meniscal tears and (2) investigate kinematic differences between isolated ACL reconstruction and ACL reconstruction plus medial meniscal repair (MR). It was hypothesized that concomitant posterior horn medial meniscal tear and ACL deficiency would affect knee internal-external rotation and anterior-posterior translation but MR would restore these parameters. Study Design: Controlled laboratory study. Methods: Nineteen patients who underwent ACL reconstruction were included: 10 had intact menisci (IM group) and 9 had a medial meniscal injury that was repaired during ACL reconstruction using an all-inside technique (MR group). Preoperatively and 18 months postoperatively, active knee kinematics under weightbearing conditions was evaluated during a single-leg squat using a dynamic biplane x-ray imaging system. The general linear model was used to investigate the differences between group (IM vs MR) and time (preoperative vs follow-up) and their interactions. Results: Tibial internal rotation was higher in the MR group than the IM group both before and after surgery (P =.007). Knee valgus rotation was higher in the MR group preoperatively (P <.001), while no differences were found postoperatively because of an increase of valgus rotation in the IM group, which was significant in the descendant phase (P <.001). Preoperatively, the IM group showed a more medial tibial translation compared with the MR group in the descendant phase (P =.006). Conclusion: When performing a single-leg squat, patients with ACL-deficient knees and a medial meniscal tear demonstrated a more valgus rotation, tibial internal rotation, and lateral tibial translation versus those with intact menisci. After ACL reconstruction and MR, these patients demonstrated significantly higher tibial internal rotation when compared with patients who underwent isolated ACL reconstruction. Clinical Relevance: Surgeons should be aware that MR does not fully restore knee kinematics in vivo and under weightbearing conditions in the context of ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: Meniscal allograft transplant (MAT) is an effective treatment for relieving symptoms and improving knee function in patients who experience symptomatic unicompartmental knee pain after a previous meniscectomy. However, the literature contains a paucity of studies assessing the survival rate and prognostic factors of soft tissue MAT. Purpose: To report the survivorship of a large, single-center cohort of consecutive patients treated with arthroscopic MAT using soft tissue technique and to investigate variables that could potentially influence failures and outcomes. Study design: Case series; Level of evidence, 4. Methods: Consecutive MAT procedures totaling 364 performed in a single institution between June 2004 and April 2019 were screened and assessed for eligibility. Subjective clinical scores (Lysholm score, Tegner activity scale, and visual analog score) were collected preoperatively and at 2, 5, 7, and 10 years of follow-up. Two survival analyses were performed using Kaplan-Meier curves, with surgical failure (defined as any graft revision) and clinical failure (defined as a Lysholm score <65 points) used as endpoints. Univariate analyses were performed using reoperations, surgical failure, clinical failure, and different demographic and surgical characteristics as endpoints. Results: A total of 324 consecutive patients were evaluated at a mean follow-up 5.7 ± 3.0 years. Of these, 189 (58%) underwent an associated surgical procedure. A total of 22 patients (6.8%) were considered to have experienced surgical failure, and no predictors of surgical failure were identified based on the relevant variables. When all patients were considered, a significant improvement in all of the patient-reported outcome measures was present between the preoperative assessment and the last follow-up (P <.001), with no significant decrease over time. Moreover, 70 (21.6%) patients were considered to have experienced clinical failure; the need for concurrent cartilage procedures (odds ratio, 0.16; P =.001) and anterior cruciate ligament (ACL) reconstruction (odds ratio, 0.40; P =.059) were predictors of failure. Finally, a lower survival rate was reported in female patients compared with male patients (49% vs 69%, respectively; P =.007) and in patients who required cartilage surgery (P =.014). In particular, patients who required cartilage surgery showed nearly half the survival rate compared with those with required no cartilage procedures at 10-year follow-up (36.4% vs 71%, respectively; P =.029). Conclusion: Female sex and the need to combine MAT with a cartilage procedure or ACL reconstruction could result in an increased rate of clinical failure at midterm follow-up. [ABSTRACT FROM AUTHOR]

Background: Platelet-rich plasma (PRP) is gaining large interest in clinical practice as a minimally invasive injective treatment for knee osteoarthritis (OA). Different preparation methods are available, and the presence of leukocytes, deemed detrimental in some preclinical studies, is one of the most debated aspects regarding PRP efficacy. Purpose: To compare the safety and effectiveness of leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) for the treatment of knee OA. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 192 patients with symptomatic knee OA (Kellgren-Lawrence grade 1-3) were randomly allocated to 3 weekly injections of LR-PRP or LP-PRP. LP-PRP was obtained with a filter for leukodepletion. LR-PRP and LP-PRP were divided into aliquots of 5 mL, with a mean platelet concentration of 1146.8 × 109/L and 1074.9 × 109/L and a mean leukocyte concentration of 7991.4 × 106/L and 0.1 × 106/L, respectively. Patients were evaluated at baseline and thereafter at 2, 6, and 12 months for the primary outcome, the International Knee Documentation Committee (IKDC) subjective score; and for secondary outcomes, the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, EuroQol–visual analog scale (EQ-VAS), and Tegner score. Results: No differences between groups were observed in terms of absolute values or improvement of the clinical scores across all follow-up intervals. The mean IKDC subjective score at baseline and 12 months improved from 45.6 to 60.7 in the LR-PRP group as compared with 46.8 to 62.9 in the LP-PRP group (P =.626). No severe adverse events were described in either group, although 15 mild adverse events (knee pain or swelling) were reported: 12.2% for LR-PRP and 4.7% for LP-PRP (P =.101). No statistically significant difference was also found between LR-PRP and LP-PRP in terms of failures (7.8% vs 3.5%, P =.331). Conclusion: This double-blind randomized trial showed that 3 intra-articular LR-PRP or LP-PRP injections produced similar clinical improvement in the 12 months of follow-up in patients with symptomatic knee OA. Both treatment groups reported a low number of adverse events, without intergroup differences. The presence of leukocytes did not significantly affect the clinical results of PRP injections. Registration: NCT02923700 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Failure of anterior cruciate ligament (ACL) reconstruction or an injury to the ACL in the contralateral knee represents a devastating event for patients, especially those young and physically active. However, controversies are still present regarding long-term failure rates and risk factors. Purpose: To assess the long-term rate of ipsilateral graft failure and contralateral ACL injuries after ACL reconstruction performed at a single center using the same surgical technique with a hamstring autograft and to investigate the effect of sex, age, and preinjury activity level as predictors of second ACL injuries. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 244 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with a single bundle plus lateral plasty technique using the hamstring tendon between November 2007 and May 2009. The number of subsequent ACL injuries (ipsilateral ACL revision or contralateral ACL reconstruction) was determined at a minimum follow-up of 10 years. Survivorship of either knee and subgroup analysis included sex, age, preoperative Tegner activity level, timing of ACL reconstruction, body mass index, and smoking status. Results: Ipsilateral ACL revision was performed in 8 (3.4%) patients and contralateral ACL reconstruction in 19 (7.8%) patients. Only 1 patient had both ipsilateral and contralateral injuries. No predictors were found for ipsilateral ACL revision, while age <18 years and preoperative Tegner level ≥7 had a higher risk of contralateral ACL reconstruction. The highest rate of a second ACL reconstruction procedure was in young (<18 years) and active (Tegner ≥7) patients, in whom the 10-year survival of either knee was 61.1%. Six years after primary ACL reconstruction, the rate of contralateral ACL reconstruction was significantly higher than that of ipsilateral ACL revision (hazard ratio, 2.4-3.6). Conclusion: In the long term, a second injury to either the ipsilateral or the contralateral knee in young and active populations could reach 40%, with a more than double-fold risk of contralateral ACL reconstruction compared with ipsilateral ACL revision. [ABSTRACT FROM AUTHOR]

Purpose: The main goal of this work was to evaluate the pivot shift test in awake and anesthetized patients by using two different quantitative methodologies and comparing the results with the standard clinical grading, taking advantage of a multicenter international study.Methods: Patients between 16 and 50 years of age undergoing primary unilateral single-bundle anterior cruciate ligament (ACL) reconstruction were considered eligible. The pivot shift test was performed pre-operatively, with the patient awake and again with the patient under general anaesthesia. The pivot shift test was clinically graded as defined by the International Knee Documentation Committee. The instrumented assessment was performed by using two non-invasive acquisition systems; specifically, a system exploiting an inertial sensor and a video-based application developed on a commercial tablet using skin markers. Lateral compartment translation and the tibial acceleration reached during joint reduction were used as quantitative parameters.Results: A total of 103 patients were enrolled in the study. Statistically significant difference was found between the distributions of clinical grade evaluated in awake patients and those under general anaesthesia (P < 0.01). Comparing awake patients to those under general anaesthesia, lower values were found both for tibial acceleration (3.7 ± 1.5 vs 6.0 ± 4.6 m/s2, P < 0.01) and lateral compartment translation of the involved limb (2.2 ± 1.7 vs 3.0 ± 2.2 mm, P < 0.01).Conclusions: This study indicated that significant differences in the grading of the pivot shift test exist between awake and anesthetized patients, regardless of the use of quantitative instruments during the evaluation. Actual clinical assessment reported indeed its weakness, presenting subjective variability and dependence on tester's experience. However, several factors might influence the validity of awake examination such as experience level of examiner and cultural factors, as seen in this international multicenter study.Level Of Evidence: Prospective comparative study, Level II. [ABSTRACT FROM AUTHOR]

Objective: To externally validate a nomogram based on ovarian reserve markers as a tool to optimize the FSH starting dose in IVF/ICSI cycles.Study Design: A two-centres retrospective study including 398 infertile women undergoing their first IVF/ICSI cycle (June 2013-June 2014). IVF data were retrieved from two independent IVF centres in Italy (San Raffaele Hospital, Centre 1; Verona Hospital, Centre 2). A central lab for the routine measurement of AMH and FSH was used for both centres. All women were treated based on physical and hormonal characteristics according to locally adopted protocols. The nomogram was then retrospectively applied to the patients comparing the calculated starting dose to the one actually given.Results: In Centre 1, 64/131 women (48.8%) had an ovarian response below the target. While 45 of these patients were treated with a maximal FSH starting dose (≥225 IU), n=19/131 (14.5%) were treated with a submaximal dose. The vast majority of them (n=17/19) would have received a higher FSH starting dose by using the nomogram. Seventeen patients (n=17/131) had hyper response and about half of them would have been treated with a reduced FSH starting dose according to the nomogram. In Centre 2, 142/267 patients (53.2%) had an ovarian response below the target. While 136 of these were treated with a maximal FSH starting dose (≥225 IU), n=6/267 were treated with a submaximal dose. The majority of them (n=5/6) would have received a higher FSH starting dose. Thirty-two (n=32/267) patients had hyper response and more than half of them would have been treated with a reduced FSH dose.Conclusion: In both Centres, applying the nomogram would have resulted in more appropriate FSH starting doses compared to the the ones actually given based on clinicians choices. The use of an objective algorithm based on patient's age, serum FSH and AMH levels may thus be an effective advice on the selection of the tailored FSH starting dose. Hence, the use of this easily available nomogram could increase the proportion of patients achieving the optimal ovarian response. [ABSTRACT FROM AUTHOR]

Purpose: To compare outcomes of acromioclavicular (AC) joint reconstruction with ligament augmentation and reconstruction system (LARS) ligament in professional and non-professional athletes at 2-year minimum follow-up.Methods: Forty-three patients (men; mean age 30, range 19-54 years) with Rockwood type III to V chronic AC joint dislocations underwent AC joint reconstruction with LARS ligament and standardized rehabilitation. Patients were divided into two groups: professionals (22) and non-professionals (21). Clinical and radiological evaluations were performed preoperatively, at 3- and 24-month follow-up.Results: All clinical (Oxford and Constant) scores and patient satisfaction improved significantly from preoperative to follow-up intervals (p < 0.00001). However, professionals showed nonsignificant improvements from 3- to 24-month follow-up in Constant. Although groups differed preoperatively in Constant (p = 0.037), they were not different in preoperative-to-postoperative differences in clinical scores, postoperative final satisfaction and median time to return to unrestricted activity [4 (interquartiler range 3-5) months to return to full sport in professionals]. Follow-up radiographs revealed an AC joint ratio (clavicle inferior-to-superior translation as ratio of AC joint height) of 0.09 and 0.16 in 8/22 professionals, 0.19 and 0.31 in 9/21 non-professionals, 0.14 and 0.24 in 17/43 overall patients at 3- and 24-month follow-up, respectively. Slight loss of reduction (0.25 < AC joint ratio < 0.50): 21 %. There were no significant clinical-radiographic correlations. Complication: one coracoid fracture at follow-up and one wound infection.Conclusions: AC joint reconstruction with LARS ligament did not reveal differences in clinical outcomes between groups, with 2 % of failures (re-dislocations) at 2-year minimum follow-up. Superior radiological outcomes in professionals were not correlated to clinical results.Level Of Evidence: Therapeutic study-prospective comparative study, Level II. [ABSTRACT FROM AUTHOR]

The article presents a cohort study which examined if patellar and trochlear defects of the knee actually represent various clinical conditions with different healing potentials following cartilage treatment. In the study, 49 patients with full-thickness patellofemoral chondral lesions of the knee were treated with matrix-assisted autologous chondrocyte transplantation (MACT). The results were analyzed using such methods as International Knee Documentation Committee (IKDC) subjective.

The article discusses a follow-up study that was conducted to test the impacts of a lateral collagen meniscus implant (CMI) on knee function and pain in patients over a period of two years. Use of lateral CMI is shown to enhance knee function and reduce pain in most of the patients. The study concludes by demonstrating a reduction in implant size.

A variety of graft sources have been used for ACL reconstruction to improve functions and kinematics in ACL deficient knees. The two most commonly used autogenous grafts are the central third of the patellar tendon and the hamstring tendon constructs. The choice of different grafts and different construct influence the final clinical outcome of ACL reconstruction. The 3 groups, of 25 patients each, were generated by choosing the technique (PT tendon, 4 strand hamstring, and single hamstring plus extraarticular plasty) to utilize and followed for 5 years, with an alternate systematic sampling. Our comparison has shown significant kneeling pain in the patellar tendon with respect to the groups with hamstrings techniques. Single hamstring plus extraarticular plasty achieved subjective score significantly higher with respect to the other two groups as well as for the time to resume sport. The study confirms that patellar tendon and hamstring can be equivalent options for ACL reconstruction. This study demonstrated that a superior outcome as far as subjective clinical findings were concerned, was obtained in group III. Patients in the latter group were also able to return to sports sooner than those in the bone-patellar tendon graft group and the four-strand hamstring group. [ABSTRACT FROM AUTHOR]