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AUTOLOGOUS CHONDROCYTE IMPLANTATION: A LONG-TERM FOLLOW- UP. Peterson L, Vasiliadis HS, et al. American Journal of Sports Medicine 2010;38:1117-1124 (published online before print February 24)
Questionnaires with the Lysholm, Tegner-Wallgren, Brittberg-Peterson, modified
Cincinnati (Noyes), and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were sent to 341 patients. Preoperative Lysholm, Tegner-Wallgren, and Brittberg- Peterson scores were also retrieved when possible from patients’ files. The patients were asked to grade their status during the past 10 years as better, worse, or unchanged. Finally, they were asked if they would do the operation again.
There were 224 who replied and were assessed. The mean cartilage lesion size was 5.3 cm2. Ten to 20 years after the implantation (mean, 12.8 years), 74% of the patients reported their status as better or the same as the previous years. There were 92% who were satisfied and would have the ACI again. The Lysholm, Tegner-Wallgren, and Brittberg-Peterson scores were improved compared with the preoperative values. The average Lysholm score improved from 60.3 preoperatively to 69.5 postoperatively, the
Tegner from 7.2 to 8.2, and the Brittberg- Peterson from 59.4 to 40.9. At the final measurement, the KOOS score was on average 74.8 for pain, 63 for symptoms, 81 for activities of daily living (ADL), 41.5 for sports, and 49.3 for quality of life (QOL). The average Noyes score was 5.4. Patients with bipolar lesions had a worse final outcome than patients with multiple unipolar lesions. The presence of meniscal injuries before ACI or history of bone marrow procedures before the implantation did not appear to affect the final outcomes. The age at the time of the operation or the size of lesion did not seem to correlate with the final outcome.
sportEX comment This paper proves that autologous chondrocyte implantation is an effective and durable solution for the treatment of large full- thickness cartilage and osteochondral lesions of the knee joint and that the benefits remain high even 10 to 20 years. However note the other piece of research that suggests that in the short term at least using bone marrow– derived mesenchymal stem cells may be better
ACCURACY OF THE GLENOHUMERAL INJECTION USING THE SUPERIOR APPROACH: A CADAVERIC STUDY OF INJECTION ACCURACY. Kim J-S, Yun JS, et al. American Journal of Physical Medicine and Rehabilitation. 2010;89(9):755-758
Nineteen shoulders from 12 adult cadavers were anatomically dissected after a dye injection had been performed, with cadavers in the supine position. A clinician rated injection confidence scores. The dissectors rated injection accuracy scores and investigated untargeted structures penetrated. The clinician’s confidence scores were the highest in 18 of 19 shoulders. Superior
glenohumeral injections were successful in 18 of 19 (94.7%) shoulders; however, in 3 of these 18 shoulders, the long heads of biceps tendons were penetrated.
sportEX comment
The quoted success rate
is apparently judged to be accurate and clinically useful. If
these had been live patients would the 3 with the penetrated biceps agree?
EFFECTS OF INSPIRATORY MUSCLE TRAINING ON RESPIRATORY FUNCTION AND
REPETITIVE SPRINT
PERFORMANCE IN WHEELCHAIR BASKETBALL PLAYERS. Goosey- Tolfrey V, Foden E. British Journal of Sports Medicine 2010;44:665-668
Sixteen wheelchair athletes were divided into an experimental (IMT; n=8) or placebo (sham-IMT; n=8) group based on selective grouping criteria. Thirty dynamic breaths were performed by the IMT group twice daily at a resistance equivalent to 50% maximum inspiratory pressure (MIP), and 60 slow breaths were performed by the sham-IMT group once a day at 15% MIP for a period of 6 weeks. In the IMT group, both MIP and maximum expiratory pressure (17% and 23%, respectively) were improved. Similar improvements were noted for the sham-IMT group with 23% and 33% from baseline for MIP and maximum expiratory pressure, respectively. There were no significant changes in pulmonary function at rest and any of the performance parameters associated with the repetitive sprint test (sprint and recovery times, peak heart rate and peak blood lactate concentration). Reported experiences of using the IMT training device suggested “less breathlessness” and “less tightness in the chest during the training”.
sportEX comment There is considerable evidence that respiratory muscle training improves pulmonary function, quality of life and exercise performance in the healthy athletic population. Although there was no improvement in sprint performance in this wheelchair group, an improved respiratory muscle function and quality of life were reported by participants which alone makes the inclusion of the training worthwhile.