ABSTRACT
Background: Osteoarthritis is a common cause of pain and disability with an increasing prevalence among the global population (Hunter and Bierma-Zeinstra in Lancet 393(10182):1745-1759, 2019; Zhang and Jordan in Clinics in Geriatric Medicine 26(3):355-369, 2010). Altered immune responses and low-grade systemic inflammation driven by gut dysbiosis are being increasingly recognized as contributing factors to the pathophysiology of OA (Tan et al. in International Journal of Rheumatic Diseases. https://doi.org/10.1111/1756-185X.14123, 2021; Binvignat et al. in Joint, Bone, Spine 88(5):105203, 2021; Ramasamy et al. in Nutrients 13(4):1272, 2021), which increased the interest in the so-called "gut-joint axis". The various microbiota in the gastrointestinal tract is commonly referred to as the gut microbiome. The gut microbiome is affected by age, sex, and immune system activity as well as medications, environment, and diet (Arumugam in Nature. https://doi.org/10.1038/nature09944, 2011). The microbiome is pivotal to maintain host health and contributes to nutrition, host defense, and immune development (Nishida et al. in Clinical Journal of Gastroenterology 11:1-10, 2018). Alterations in this microbiome can induce dysbiosis, which is associated with many human disease states including allergies, autoimmune disease, diabetes, and cancer (Lin and Zhang in BMC Immunology 18(1):2, 2017). A gut-joint axis is proposed as a link involving the gastrointestinal microbiome, the immune response that it induces, and joint health. Results: Emerging evidence has shown that there are specific changes in the microbiome that are associated with osteoarthritis, including increased Firmicutes/Bacteroides ratio, Streptococcus spp. prevalence, and local inflammation (Collins in Osteoarthritis and Cartilage. https://doi.org/10.1016/j.joca.2015.03.014, 2015; Rios in Science and Reports. https://doi.org/10.1038/s41598-019-40601-x, 2019; Schott in JCI insight. https://doi.org/10.1172/jci.insight.95997, 2018; Boer et al. in Nature Communications 10:4881, 2019). Both the innate and adaptive immune systems are affected by the gut microbiome and can become dysregulated in dysbiosis which ultimately triggers events associated with joint OA. Conclusions: The gut is an intriguing and novel target for OA therapy. Dietary modification or supplementation with fiber, probiotics, or prebiotics could provide a positive impact on the gut joint axis.
ABSTRACT
BACKGROUND: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport. PURPOSE: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature, SPORTDiscus, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies on knee OCA. Studies were included if they reported return-to-play data or postsurgical rehabilitation protocols. RESULTS: A total of 62 studies met the inclusion criteria, with a total of 3451 knees in 3355 patients. Concomitant procedures were included in 30 of these studies (48.4%). The most commonly cited rehabilitation protocols included weightbearing restrictions and ROM guidelines in 100% and 90% of studies, respectively. ROM was most commonly initiated within the first postoperative week, with approximately half of studies utilizing continuous passive motion. Progression to weightbearing as tolerated was reported in 60 studies, most commonly at 6 weeks (range, immediately postoperatively to up to 1 year). Of the 62 studies, 37 (59.7%) included an expected timeline for either return to play or return to full activity, most commonly at 6 months (range, 4 months to 1 year). Overall, 13 studies (21.0%) included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. CONCLUSION: There is significant heterogeneity for postoperative rehabilitation guidelines and the return-to-play protocol after OCA of the knee in the literature, as nearly half of the included studies reported use of concomitant procedures. However, current protocols appear to be predominantly time-based without objective criteria or functional assessment. Therefore, the authors recommend the development of objective criteria for patient rehabilitation and return-to-play protocols after OCA of the knee.
