ABSTRACT
Injuries to the musculoskeletal (MSK) system can have a significant impact on an individual's activities of daily living, as this multifunctional unit is associated with physical movement. Treatment of MSK injuries often involves corticosteroid injections, supplements, pharmaceutical agents, and/or surgery. While these approaches have been shown to be effective for some patients over both the short and long term, they can be associated with limited relief, adverse effects, and/or decreases in activities of daily living. An unmet need exists to develop and/or implement more effective treatment approaches for MSK injuries. Treatment options being explored include platelet-rich plasma (PRP) and stem cell injections. This review outlines the current state of research evaluating PRP and stem cell injections in the treatment of various MSK injuries. A literature search was conducted using the PubMed database to identify the relevant published articles related to the use of PRP and/or stem cell injections for the treatment of MSK and cartilage injuries. PRP and stem cell injections have been shown to improve an individual's quality of life (QOL) and are associated with fewer side effects as compared to invasive standards of care in multiple MSK injuries such as plantar fasciitis, Achilles tendinopathy, acute muscle and tendon tears, ligament injuries, chondral and medial collateral ligament (MCL) knee injuries and arthritis, rotator cuff lesions, and avascular femoral necrosis. Specifically, these studies on PRP and stem cell injections suggest that both approaches are associated with a quicker return to activities of daily living while providing longer lasting relief without significant adverse events. The studies reviewed demonstrated PRP and stem cell approaches to be effective and safe for the treatment of certain MSK injuries, but as standardized protocols were not utilized across studies in the discussion of similar injuries, it was therefore difficult to compare their efficacy and safety. As such, further research is warranted to establish standardized research protocols across MSK injury studies to gain further insight into the efficacy, safety, and durability of PRP and stem cell injections.
ABSTRACT
The incidence and prevalence of concussion, a type of mild traumatic brain injury (mTBI), have steadily increased among athletes, both students and professionals, across a wide variety of sports, including, but not limited to, swimming, tennis, football, and boxing. Recent data have demonstrated that sports are one of the leading causes of concussions among student athletes. While the exact mechanism of concussion onset has yet to be fully elucidated, data suggest that the pathophysiology involves rotational acceleration and deceleration of the brain, leading to axon tearing and disturbance in the metabolic cascade of glucose. Concussive events can have debilitating effects on an athlete, including chronic traumatic encephalopathy (gradual degeneration of brain tissue) that is related to personality changes, emotional disorders, and even dementia. Common symptoms associated with concussion include dizziness, nausea, vomiting, and headaches. The physical assessment consists of a combination of tools involving the mental status examination, vital signs, cervical spine exam, eye exam, and neurological testing. The use of osteopathic manipulative medicine (OMM), pharmacotherapy, hyperbaric oxygen therapy (HBOT), aerobic exercise, balance, and/or vestibular therapy are many common treatment approaches for concussion and post-concussion sequelae. This literature review aims to provide insight into concussions, the current treatment options available, and the new developments in concussions per the Amsterdam 2022 International Consensus Statement on Concussion in Sport published in 2023.
ABSTRACT
A concussion is a type of mild traumatic brain injury (mTBI). It is prevalent among athletes across a wide variety of sports. The exact mechanism of a concussion is unknown, but it is currently accepted that the acceleration and deceleration of the brain is the insult causing disturbances in activity. The most common symptoms of concussions include but are not limited to dizziness, nausea, vomiting, and headaches. With repetitive concussive injuries, athletes can experience permanent changes such as chronic traumatic encephalopathy (gradual degeneration of brain tissue), which can lead to personality changes and memory deficits. This literature review aims to provide insight into concussions and the evaluation of physiological changes and long-term sequelae. A comprehensive literature search was performed from April 2012 to April 2022 using PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) and Embase databases. Nineteen articles were finally included in the literature review. The review shows that neuroimaging results demonstrated significant changes in the brain structure and function including alternations in the thalamus, hippocampus, corpus callosum, and the white matter, which can extend beyond the symptom amelioration. In addition, other approaches include brain metabolism, cerebral blood flow, and glucose utilization. Additional techniques include the evaluation of fatigue levels and the alterations in biomarkers, specifically IL-6. These approaches have demonstrated that consequences of concussions, including alternations in brain structure and function, can extend beyond an athlete's report of symptom resolution, and should be taken into consideration for return to play. The physiological changes present after a concussion have the potential to develop into long-term complications such as academic difficulty, cognitive decline, gut microbiome changes, gait changes, and increased risk of lower extremity injury. The findings in the literature review determine that is important to immediately address the symptoms of concussions to expedite treatment and prevent deleterious changes to the brain.
ABSTRACT
BACKGROUND: Femoroacetabular impingement (FAI) is a significant cause of disability in young adults. Hip arthroscopic surgery restores bony congruence and improves function in the majority of patients, but recent evidence indicates that women may experience worse pre- and postoperative function than men. PURPOSE/HYPOTHESIS: The purpose of this study was to identify whether self-reported hip function differed between men and women with symptomatic FAI. The hypothesis was that mean self-reported hip function scores would improve after arthroscopic surgery but that women would report poorer function than men both before and up to 2 years after arthroscopic surgery. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 229 patients (68.4% women; mean [±SD] age, 31.6 ± 10.8 years; mean [±SD] body mass index, 26.8 ± 11.9 kg/m(2)) underwent hip arthroscopic surgery for unilateral symptomatic FAI. All eligible and consenting patients with radiologically and clinically confirmed FAI completed the International Hip Outcome Tool (iHOT-33) and the Hip Outcome Score activities of daily living subscale (HOS-ADL) before hip arthroscopic surgery and at 3, 6, 12, and 24 months after arthroscopic surgery. A linear mixed model for repeated measures was used to test for differences in self-reported hip function between men and women over the study period (P ≤ .05). RESULTS: There were no significant time × sex interactions for either the HOS-ADL (P = .12) or iHOT-33 (P = .64), but both measures showed significant improvements between the preoperative time point and each of the 4 follow-up points (P < .0001); however, self-reported hip function did not improve between 6 and 24 months after arthroscopic surgery (P ≥ .11). Post hoc independent t tests indicated that women reported poorer hip function than did men before surgery (P ≤ .003) both on the HOS-ADL (mean ± standard error of the mean [SEM], 67.4 ± 1.9 [men] vs 60.5 ± 1.3 [women]) and iHOT-33 (mean ± SEM, 38.0 ± 1.9 [men] vs 30.9 ± 1.3 [women]); scores were not different between sexes at any other time point. CONCLUSION: These findings indicate improvements in self-reported hip function in patients with FAI, regardless of sex, until 6 months after hip arthroscopic surgery. Although women reported poorer preoperative function than did men, the differences were not significant 2 years after surgery.
