Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine.

Background: There is no consensus among sports medicine surgeons in North America on postoperative rehabilitation strategy after meniscus repair. Various meniscal tear types may necessitate a unique range of motion (ROM) and weightbearing rehabilitation protocol. Purpose: To assess the current landscape of how sports medicine practitioners in the American Orthopedic Society for Sports Medicine (AOSSM) rehabilitate patients after the repair of varying meniscal tears. Study Design: Cross-sectional study. Methods: A survey was distributed to 2973 AOSSM members by email. Participants reviewed arthroscopic images and brief patient history from 6 deidentified cases of meniscus repair-in cases 1 to 3, the tears retained hoop integrity (more stable repair), and in cases 4 to 6, the tear patterns represented a loss of hoop integrity. Cases were shuffled before the presentation. For each case, providers were asked at what postoperative time point they would permit (1) partial weightbearing (PWB), (2) full weightbearing (FWB), (3) full ROM, and (4) ROM allowed immediately after surgery. Results: In total, 451 surveys were completed (15.2% response). The times to PWB and FWB in cases 1 to 3 (median, 0 and 4 weeks, respectively) were significantly lower than those in cases 4 to 6 (median, 4 and 6 weeks, respectively) (P < .001). In tears with retained hoop integrity, the median time to PWB was immediately after surgery, whereas in tears without hoop integrity, the median time to PWB was at 4 weeks postoperatively. Similarly, the median time to FWB in each tear with retained hoop integrity was 4 weeks after surgery, while it was 6 weeks in each tear without hoop integrity. However, regardless of tear type, most providers (67.1%) allowed 0° to 90° of ROM immediately after surgery and allowed full ROM at 6 weeks. Most providers (83.3%) braced the knee after repair regardless of hoop integrity and utilized synovial rasping/trephination with notch microfracture-a much lower proportion of providers utilized biologic augmentation (9%). Conclusion: Sports medicine practitioners in the AOSSM rehabilitated meniscal tears differently based on hoop integrity, with loss of hoop stresses triggering a more conservative approach. A majority braced and utilized in situ adjuncts for biological healing, while a minority added extrinsic biologics.

Mesenchymal stem cells and thermal annular procedures for discogenic pain: a systematic review with pooled analysis.

Aim: Compare the effectiveness of mesenchymal stem cell injection therapies (MSC) and thermal annular procedures for the treatment of discogenic lower back pain. Materials & methods: A systematic review was performed following PRISMA 2020 guidelines. Pooled analysis was performed using patients' pain scores at baseline and at 12 months post-intervention. Results: Effect sizes based on change in pain score from baseline to 12 month follow-up revealed clinically significant improvement in pain score across all interventions. Conclusion: Minimally invasive interventions provide meaningful relief in discogenic back pain, with results suggesting promise for MSC injection therapies as a treatment model.

Efficacy of platelet-rich plasma for sacroiliac joint dysfunction: a qualitative systematic review with pooled analysis.

Aim: We aimed to expound upon previous research examining the effect of platelet rich plasma in the treatment of sacroiliac joint (SIJ) dysfunction and pain. Materials & methods: A systematic review was employed in conjunction with a pooled analysis of the efficacy of platelet-rich plasma (PRP) in SIJ dysfunction and pain. Results: A total of 259 articles were retrieved following database systematic review. As a result, four clinical trials and two case studies were subjected to full text appraisal. The dates of publication ranged from 2015 to 2022. Conclusion: Although a unique modality, there is not enough evidence to support the employment of PRP injections over current steroid standard of care. Further double-blinded, randomized control trials are required to elucidate PRP role in SIJ dysfunction.

Platelet rich plasma is an injection derived from separating blood components in a centrifuge. Injection of platelet rich plasma into the sacroiliac joint has often been touted as highly beneficial for pain and disability, and superior to other modalities. Our systematic review and pooled analysis show that platelet rich plasma injections are beneficial, albeit not to the degree previously reported.