Development of Explainable Machine Learning Models to Predict Outcomes After Platelet-Rich Plasma Injections for Knee Osteoarthritis.

Background: Platelet-rich plasma (PRP) has been increasingly used to treat knee osteoarthritis, but its efficacy remains unclear due to the variability of outcomes. Machine learning (ML) can improve the ability to predict responses to PRP treatment by identifying specific baseline characteristics of patients who may have greater clinical improvements.

Purpose: To develop and evaluate an ML model predicting clinical outcomes after PRP injection for knee osteoarthritis.

Adding a Lateral Extra-articular Tenodesis Is Cost-Effective in Primary Anterior Cruciate Ligament Reconstruction: A Markov Analysis.

Purpose: To evaluate the cost-effectiveness of anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) augmentation in athletes with primary anterior cruciate ligament ruptures compared with ACLR alone.

Methods: A Markov chain Monte Carlo model evaluated the outcomes and costs of 1,000 athletes undergoing ACLR with LET (ACLR-LET, iliotibial band) compared with ACLR alone. Costs, utility values, graft failure rates, and transition probabilities were derived from existing literature.

Efficacy and safety of xenograft augmentation in rotator cuff repair: a systematic review and meta-analysis.

Rotator cuff tears are common disorders that can significantly impact patientś shoulder function and quality of life. Incomplete or failed healing is relatively common following repair of large tendon tears. Xenograft materials are increasingly used for augmentation of repairs, but their efficacy and safety remain under debate.

Management of posterior cruciate ligament injuries: an expert consensus from 17 countries.

Background: Posterior cruciate ligament (PCL) injury is a relatively common musculoskeletal condition. However, there is currently a lack of consensus on decision-making, treatment and postoperative management for such injuries.

Objectives: To use the modified Delphi method to reach expert consensus on the management of PCL injury.

Lymphatic dysfunction in lupus contributes to cutaneous photosensitivity and lymph node B cell responses.

Patients with systemic lupus erythematosus (SLE) are photosensitive, developing skin inflammation with even ambient ultraviolet radiation (UVR), and this cutaneous photosensitivity can be associated with UVR-induced flares of systemic disease, which can involve increased autoantibodies and further end-organ injury. Mechanistic insight into the link between the skin responses and autoimmunity is limited. Signals from skin are transmitted directly to the immune system via lymphatic vessels, and here we show evidence for potentiation of UVR-induced lymphatic flow dysfunction in SLE patients and murine models.

Proteomics Reveals Increased Periostin in Synovial Fluid From Canine and Human Anterior Cruciate Ligament Injury.

Posttraumatic osteoarthritis (PTOA) is a common sequela to anterior cruciate ligament (ACL) injury in humans and dogs. Identification of conserved targets between species may hasten biomarker identification and therapeutic development. To identify differentially regulated synovial fluid (SF) proteins in ACL injury, SF samples were collected from knees with ACL injury or control knees (n = 8 per species) in human and dog patients.

Biological impact of meniscus injury on post-traumatic osteoarthritis.

Post-traumatic osteoarthritis (PTOA) is a common and debilitating problem following meniscal injury, which may lead to pain, loss of function, and early joint failure. Over the past 25 years, clinical, laboratory, and translational studies have greatly improved our understanding of PTOA pathogenesis and prevention. Clinical studies have established the benefit of meniscal preservation in preventing PTOA, leading to a significant increase in meniscus repair.

Evaluation of Novel Therapeutic Agents for Modulation of the Inflammatory Response in Rotator Cuff Tendinopathy Utilizing a Mouse Model of Subacromial Impingement.

Background: Rotator cuff disease is prevalent and can cause significant disability. Local subacromial corticosteroid injections (CSIs) have been a mainstay of nonoperative management despite concerns regarding their potential for adverse effects on tendon and muscle tissue. We identified 3 potential molecular targets that could be inhibited by alternative, currently available treatments.

In Pursuit of Quantifying Patient Knee Contact Mechanics: Finite Element Model Validation of Cadaveric Knees in Axially Loaded MRI Scans.

Our long-term objective is to quantify patient-specific changes in contact mechanics after partial meniscectomy (PM) using knee-specific finite element (FE) models created from clinical MR scans under axial load. Before creating patient-specific models, a validation of our workflow and processes is required. The objective of this study was to validate knee-specific FE models of tibiofemoral joint contact mechanics by comparison to direct measurements of contact by electronic pressure sensors.

Remodeling Process of the Tendon Graft After Anterior Cruciate Ligament Reconstruction: Comprehensive Analysis With RNA Sequencing in a Murine Model.

The tendon graft is known to undergo a remodeling process after anterior cruciate ligament (ACL) reconstruction. However, little is known about the transcriptional profile of this process. The aim of the present study is to identify differentially expressed genes inside the remodeling ACL graft in the early phase after ACL reconstruction in our murine model using RNA sequencing (RNAseq).

Novel Noninvasive Imaging Techniques to Assess Structural, Functional, and Material Properties of Tendon, Ligament, and Cartilage: A Narrative Review of Current Concepts.

Background: Novel noninvasive imaging modalities such as quantitative magnetic resonance imaging (qMRI) and shear wave elastography (SWE) allow for assessment of soft tissue microstructure and composition, which ultimately may be associated with functional and material properties.

Purpose: To provide a narrative review of the scientific techniques and clinical applications of qMRI and SWE for the evaluation of soft tissue about the knee and shoulder, including the meniscus, the anterior cruciate ligament (ACL), and the rotator cuff.

Study Design: Review.

Experts Achieve Consensus on a Majority of Statements Regarding Ethics, Transparency, Regulation, and Best Practices for the Use of Orthobiologics.

Purpose: To establish consensus statements via a modified Delphi process about ethics, transparency, regulation, and best practices for the use of orthobiologics in clinical practice for musculoskeletal pathology.

Methods: A consensus process on the regulation of orthobiologics at the provider level was conducted using a modified Delphi technique. Twenty orthopaedic surgeons, sports medicine physicians, or basic scientists participated.

Platelet Concentration Explains Variability in Outcomes of Platelet-Rich Plasma for Lateral Epicondylitis: A High Dose Is Critical for a Positive Response: A Systematic Review and Meta-analysis With Meta-regression.

Background: Randomized controlled trials (RCTs) evaluating the efficacy of platelet-rich plasma (PRP) for the management of lateral epicondylitis (LE) have been characterized by substantial variability in reported outcomes. The source of this heterogeneity is uncertain.

Purpose: To determine the effect of estimated platelet concentration on the efficacy of PRP for the management of LE.

The PIKASO trial (Preventing Injured Knees from Osteoarthritis: Severity Outcomes): Rationale and design features for a randomized controlled trial.

Objective: Given the high burden and increasing prevalence of post-traumatic osteoarthritis (PTOA), identifying clinically beneficial strategies to prevent or delay its onset could improve the quality of life of those at high risk of developing the disease.

Methods: Preventing Injured Knees from OsteoArthritis: Severity Outcomes (PIKASO) is a multicenter blinded, parallel, two-arm randomized controlled trial of 512 individuals aged 18-45 years undergoing anterior cruciate ligament reconstruction (ACLR). This study is designed to evaluate the efficacy of a 12-month intervention of oral metformin vs.

High Rate of Return to Sport for Athletes Undergoing Articular Cartilage Restoration Procedures for the Knee: A Systematic Review of Contemporary Studies.

Background: Continued advancements in cartilage surgery and an accumulating body of evidence warrants a contemporary synthesis of return to sport (RTS) outcomes to provide updated prognostic data and to better understand treatment response.

Purpose: To perform an updated systematic review of RTS in athletes after knee cartilage restoration surgery.

Study Design: Systematic review; Level of evidence, 4.

Editorial Commentary: Suppression of Inflammatory Macrophages Is a Potential Strategy to Improve Rotator Cuff Healing and Has Shown Promise in Preclinical Models.

The pathophysiology of rotator cuff disease is complex, involving intrinsic and extrinsic factors that contribute to mechanical alterations, inflammation, apoptosis, and neovascularization. These changes result in structural and cellular disruptions, including inflammatory cell infiltration and collagen disorganization. Macrophages recently have gained attention as critical mediators of tissue repair and regeneration.

Outcomes of Revision Cartilage Restoration Surgery for Failed Primary Treatment of Chondral or Osteochondral Defects of the Knee: A Systematic Review.

Background: Failure of primary cartilage restoration procedures of the knee that proceed to necessitating revision cartilage procedures represent a challenging clinical scenario with variable outcomes reported in previous literature.

Purpose: To perform a systematic review and meta-analysis of clinical outcomes and adverse events after revision cartilage restoration procedures of the knee for failed primary cartilage procedures.

Study Design: Systematic review and meta-analysis; Level of evidence, 4.

Microfragmented Adipose Tissue Has No Advantage Over Platelet-Rich Plasma and Bone Marrow Aspirate Injections for Symptomatic Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Background: Microfragmented adipose tissue has been proposed for intra-articular treatment of knee osteoarthritis. There are little data comparing the outcomes of treatment between microfragmented adipose tissue and other biological treatments.

Purpose: To perform a systematic review and meta-analysis comparing microfragmented aspirated fat injections to other orthobiologics, hyaluronic acid, and corticosteroid injections for symptomatic knee osteoarthritis.

Skeletal Stem Cells: A Basis for Orthopaedic Pathology and Tissue Repair.

➢ Skeletal stem cells (SSCs) continually replenish mature cell populations to support skeletal homeostasis.➢ SSCs repopulate by self-renewal, have multilineage potential, and are long-lived in vivo.➢ SSCs express specific combinations of cell surface markers that reflect their lineage identity.

Return to Sport in Professional Athletes After Cartilage Restoration Surgery of the Knee: A Systematic Review and Meta-Analysis Demonstrates Gender Inequality and the Need for Improved Reporting.

Objective: To synthesize the literature concerning return to sport (RTS) and related outcomes after cartilage restoration surgery of the knee in professional athletes.

Design: Cochrane, PubMed, and OVID/Medline databases were queried for data pertaining to RTS after knee cartilage surgery in professional athletes. Demographic information, cartilage lesion characteristics, and RTS-specific information were extracted.

Outcomes of orthopaedic surgery in Ehlers-Danlos syndromes: a scoping review.

Background: Patients with Ehlers-Danlos syndromes (EDS) often experience high rates of joint subluxations and dislocations, and associated pain that may require surgical interventions. Orthopaedic surgical management is challenging in this population, and patients will often undergo multiple unsuccessful surgeries. Outcomes data specific to patients with EDS are sparse in the orthopaedic surgery literature.