Vol 1-1 Review Article

Five Key Points on Meniscal Allograft Transplantation

Eric D Haunschild, Ron Gilat, Michael C Fu, Brian J Cole*

Midwest Orthopaedics at Rush, Chicago IL, USA

Meniscus injuries are a common presentation to orthopedic clinics, with hundreds of thousands of meniscectomies and meniscus repairs being performed every year1. As the consequence of osteoarthritis progression has been found to be associated with functional meniscal deficiency, a significant increase in repair surgeries have occurred in recent years2. However, in symptomatic patients with irreparable tears, partial meniscectomy remains the standard of care. Meniscectomy is not harmless and can result in increased contact stress, predisposing the patient to early-onset osteoarthritis1.

In a select group of patients with persistent unicompartmental pain and symptomatic meniscus deficiency, meniscal allograft transplantation (MAT) has emerged as an acceptable surgical procedure aiming to restore function and improve pain. In many patients, MAT can result in long-term improvement, with a recent systematic review demonstrating favorable graft survival and functional outcomes at a minimum ten years after surgery3. These favorable outcomes demonstrate lasting symptomatic improvement and, though unproven at this time, may decrease the progression of osteoarthritis in the knee. The purpose of this article is to review five key points on the indications, pre-operative considerations and surgical preparation, surgical technique, and common concomitant procedures of MAT.

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Vol 1-1 Review Article

Biomechanics of Military Load Carriage and Resulting Musculoskeletal Injury: A Review

Brian D. Fox, Lawrence W. Judge, D. Clark Dickin, Henry Wang*

Biomechanics Laboratory, School of Kinesiology, Ball State University. Muncie, IN, USA

Load carriage is a common activity used in daily tasks for many occupations, so understanding its injury mechanisms, as well as the biomechanical modifications made to gait and posture during load carriage, could reduce injury risk during this activity. The purpose of this review was to compile the most recent literature regarding biomechanical adaptations to load carriage, including its effects on musculoskeletal injury, kinematic, spatiotemporal, and kinetic adaptations, and insights about the future of load carriage research. Researchers found a high degree of injury in personnel who participate in heavy load carriage activities as a part of their job, with lower back and lower extremity injuries being the most common. An observation of several studies that measured kinematic, spatiotemporal, and kinetic adaptations suggest that there may be a threshold in which typical gait kinematics must change to account for the additional load. Not adapting proper mechanisms to deal with increased load carriage forces may lead to lower extremity injury. Future studies should observe how persons untrained in load carriage respond to these loads, and how controlling for variables like speed and cadence affect gait adaptations.

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Vol 1-1 Case Report

Metaphyseal Chondrodysplasia Schmid type - widening the phenotype: Significant variable expression in two familial cases with heterozygous COL10A1 variants

AH Sabir1*, S Mahesh2, RT Freeman3, N Kiely3, A Mageuri4, D Lim5, T Cole5

1Clinical Genetics Registrar, Birmingham Women’s and Children’s Hospital NHS Trust and Birmingham Health Partners, UK

2Foundation Doctor, Royal Wolverhampton Hospital NHS Trust, UK

3Paediatric Orthopaedic Consultant. Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK

4Clinical Genetic Scientist, Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands

5Consultant Clinical Geneticist. Birmingham Women’s and Children’s Hospital NHS Trust and Birmingham Health Partners, UK

Metaphyseal Chondrodysplasia Schmid Type (SMCD) is a rare dominant form of skeletal dysplasia, caused by heterozygous mutations in the COL10A1 (Collagen Type X alpha 1) gene which codes for α1 chains in type X collagen, and typically results in disproportionate short stature. We report two families with the clinical and radiological diagnosis of SMCD seen in our unit over 4 years. In the first family (A), the proband had a possible pathogenic COL10A1 variant (c.133C>T, p.Pro45Ser). However, his father had the same variant without any obvious signs of SMCD, causing uncertainty whether this mutation was pathogenic. In the second family (B), the proband and her affected father had the same variant. Almost at the same time, a large consanguineous family was reported to have segregation of the variant with SMCD phenotypes in that the homozygosity was related to severer phenotypes and the heterozygosity to milder phenotypes. Hence, we were convinced that the variant was pathogenic. The pathogenic variant (p.Pro45Ser) causes a wide phenotypic spectrum of SMCD and even subclinical features. In this report, we highlight attenuated phenotypes of SMCD, and also discuss the latest therapeutic advances in SMCD and its mechanism of action.

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Vol 1-2 Commentary

Commentary: Postoperative Pain Management Strategies in Hip Arthroscopy

Collin LaPorte2, Michael D. Rahl2, Olufemi R. Ayeni3, Travis J. Menge1,2*

1Spectrum Health Medical Group Orthopedics & Sports Medicine, Grand Rapids, MI, USA

2Michigan State University College of Human Medicine, Grand Rapids, MI, USA

3Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada

Hip arthroscopy is a rapidly growing field due to its significant diagnostic and therapeutic value in treating a variety of hip disorders. Due to the lack of standardized protocol for pain management in these patients, adequate control of postoperative pain continues to be challenging. Several techniques have been employed to find a regimen that is effective at reducing postoperative pain, narcotic consumption and cost to the patient and healthcare system. The purpose of this article is to provide a review of important conclusions from the previous paper “Postoperative Pain Management Strategies in Hip Arthroscopy” and report on possible implications of the article.

Recent literature supports the use of a multi-modal approach to managing postoperative pain in patients undergoing hip arthroscopy. When a pre-and postoperative analgesic regimen is used in combination with peripheral nerve block or intraoperative anesthetic injection, patients experience less pain and postoperative narcotic consumption. Postoperative pain scores and opioid consumption are similar between the different techniques. However, postoperative complications are less in those receiving intra-articular (IA) injection or local anesthetic infiltration (LAI) compared to peripheral nerve blocks.

Recent studies suggest that intraoperative techniques such as IA injection or LAI used in conjunction with a pre-and postoperative analgesic regimen may be the safest and most effective multi-modal strategy for reducing postoperative pain in these patients. In addition, omitting the use of peripheral nerve block may lead to decreased anesthesia procedural fees and operating room turnover time, resulting in decreased cost to the patient and increased efficiency of the facility.

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