Retrospective Evaluation of Cryopreserved Human Umbilical Cord Tissue Allografts in the Supplementation of Cartilage Defects Associated with Hip Osteoarthritis.

Background: Osteoarthritis is a chronic disorder that affects the synovial joints by the progressive loss of articular cartilage. In the hip, the largest weight-bearing joint, the deterioration of articular cartilage and acetabular labrum can cause pain, diminishing the quality of life for patients. This study presents changes in reported pain scales from patients who received Wharton's jelly applications to cartilage deterioration in the hip from the observational retrospective repository at Regenative Labs. Methods: Sixty-nine patients were selected based on inclusion criteria with patient-reported pain scales, including the Numeric Pain Rating Scale and the Western Ontario and McMaster University Osteoarthritis Index, collected at the initial application, 30, and 90-day follow-up visits. Thirteen patients received a second allograft application and had additional follow-up visits at 120 and 180 days. Results: Five of the six scales used showed a statistically significant improvement in average scores across the cohort. The greatest improvements were observed in the NPRS with a 31.36% improvement after 90 days and a 44.64% improvement for patients with two applications after 180 days. The minimal clinically important difference (MCID) was also calculated to determine the perceived value of care for each patient with 44.9% of patients exceeding the MCID and 78.3% reporting at least one level of improvement. Conclusions: The positive outcomes for the patients in this cohort suggest WJ to be a promising alternative care option for patients with structural tissue degeneration in the hip refractory to the current standard of care.

Safety and Efficacy of Wharton's Jelly Connective Tissue Allograft for Rotator Cuff Tears: Findings from a Retrospective Observational Study.

With the increasing occurrence of rotator cuff injuries every year, there is a great need for a reliable treatment option. Wharton's Jelly contains several components that can positively impact the replacement and repair of musculoskeletal defects. The overall objective of this study is to evaluate the improvement of patient-reported pain scales after applying Wharton's Jelly (WJ) in rotator cuff defects. Eighty-seven patients with rotator cuff defects who failed at least eight weeks of conservative treatment were selected from the retrospective repository. A total of 2 cc of WJ flowable allograft was applied to the specific affected anatomy, the most common being supraspinatus tendon, biceps tendon insertion, labral tear, and subscapularis tear. No adverse reactions were reported. Statistically significant improvements were found from the initial to Day 90 in all scales. Patient satisfaction was calculated using minimal clinically important differences. No statistically significant differences were found in mean changes between gender, BMI, and age. Scanning electron microscopy images reveal the similarities between the collagen matrix in WJ and the rotator cuff. The significant improvement in patient outcomes coincides with the current literature analyzing WJ applications with other structural defects around the body. WJ is a promising alternative for musculoskeletal defects when the standard of care fails.

PEAK HIP MUSCLE TORQUE MEASUREMENTS ARE INFLUENCED BY SAGITTAL PLANE HIP POSITION.

BACKGROUND: An optimal position for strength testing of the hip musculature has not been identified. However, sagittal plane hip position during testing has been shown to influence hip external rotation strength. HYPOTHESIS/PURPOSE: The purpose of this study was to compare hip extension, external rotation, and abduction isometric torque at positions with differing degrees of hip flexion using a handheld dynamometer. STUDY DESIGN: A cross-sectional laboratory study. METHODS: Twenty-nine healthy and physically active females participated in this study. Peak isometric contractions were measured with a handheld dynamometer secured with a non-elastic strap and then converted to torque using segment lengths. Hip external rotation and extension were tested at 0°, 30°, and 90° of hip flexion. Hip abduction was tested at 0° and 30° of hip flexion and 5° of extension. Testing was randomized and counterbalanced. Repeated measures ANOVAs with Sidak's test for multiple comparisons were used for statistical analysis. Significance was set at p<0.05. RESULTS: Significant main effects were found for hip extension (p<0.001) and external rotation (p<0.027), but not for abduction (p=0.085). Pairwise comparisons showed significant differences between all three testing positions for hip extension torque (0°v30° : p<0.001, 0°v90° : p<0.001, 30°v90°: p=0.002). Extension torque was highest in 90° of flexion (1.43 ± 0.50 Nm/kg*m) and lowest in 0° of flexion (0.83 ± 0.30 Nm/kg*m). Comparisons of hip external rotation torque tested at 0°v90° (p=0.096) and 30°v90° (p=0.080) were not significantly different but did have medium effect sizes. External rotation torque was highest in 90° of flexion (0.29 ± 0.13 Nm/kg*m). CONCLUSIONS: Direct comparisons of torque values of hip extension and external rotation tested at different sagittal plane positions should be cautioned due to differences. Hip extension and external rotation should be measured in consistent sagittal plane positions across examiners and testing sessions. Test position will be dependent upon the goals of strength testing. LEVEL OF EVIDENCE: 2b.