RESUMO
Background: Numerous patient-reported outcome measures (PROMs) have been used in patients with anterior cruciate ligament reconstruction (ACLR), often with overlapping constructs of interest and limited content validity. Inefficient scale application increases burden and diminishes overall usefulness for both the patient and practitioner. Purpose: To isolate specific PROM items across a diverse set of constructs that patients and practitioners perceive as having the greatest value at various stages of recovery and return to sport (RTS) in patients after ACLR. Study Design: Cross-sectional study. Methods: A combined 77 stakeholders participated in this 2-phase mixed-methods investigation. In phase 1, a total of 27 patients and 21 practitioners selected individual PROM items from various constructs that had the greatest utility or importance. In phase 2, the highest rated items were further tested in a head-to-head comparison with 29 stakeholders who attended the 2022 ACL Injury Research Retreat. In addition to the utility assessment, practitioners answered other questions related to importance and timing of PROM assessments. Results: In phase 1, both patients and practitioners shared the same top item in 6 of the 8 (75%) constructs assessed. In phase 2, the construct of psychological burden was rated as "extremely important" by 59% of respondents, followed by physical function (54%), symptoms (35%), and donor site issues (10%). The PROM items of confidence, perceived likelihood of reinjury, and difficulty stopping quickly were rated by a respective 93%, 89%, and 86% of the sample as either "very useful" or "extremely useful." All constructs except donor site issues were rated by most stakeholders to be absolutely necessary to evaluate treatment progress and RTS readiness at the 6-month postoperative time and at RTS. Conclusion: Overall, psychological burden, with specific items related to confidence and reinjury likelihood, were rated as most important and useful by both patients and practitioners. The second most important and useful PROM item was related to higher intensity function (eg, decelerating or jumping/landing activities during sports).
RESUMO
Subchondral bone marrow lesions (BMLs) are areas of disease within subchondral bone that appear as T1 hypointense and T2 hyperintense ill-defined areas of bone marrow on magnetic resonance imaging. The most common bone marrow lesions include subchondral lesions related to osteoarthritis, osteochondral defects, and avascular necrosis. Emerging therapies include autologous biologic therapeutics, in particular mesenchymal stem cells (MSCs), to maintain and improve cartilage health; MSCs have become a potential treatment option for BMLs given the unmet need for disease modification. Active areas in the preclinical research of bone marrow lesions include the paracrine function of MSCs in pathways of angiogenesis and inflammation, and the use of bioactive scaffolds to optimize the environment for implanted MSCs by facilitating chondrogenesis and higher bone volumes. A review of the clinical data demonstrates improvements in pain and functional outcomes when patients with knee osteoarthritis were treated with MSCs, suggesting that BM-MSCs can be a safe and effective treatment for patients with painful knee osteoarthritis with or without bone marrow lesions. Preliminary data examining MSCs in osteochondral defects suggest they can be beneficial as a subchondral injection alone, or as a surgical augmentation. In patients with hip avascular necrosis, those with earlier stage disease have improved outcomes when core decompression is augmented with MSCs, whereas patients in later stages post-collapse have equivalent outcomes with or without MSC treatment. While the evidence for the use of MSCs in conditions with associated bone marrow lesions seems promising, there remains a need for continued investigation into this treatment as a viable treatment option.
RESUMO
BACKGROUND: Investigations into hamstring strain injuries at the elite level exist in sports such as Australian Rules football, rugby, and soccer, but no large-scale study exists on the incidence and circumstances surrounding these injuries in the National Football League (NFL). HYPOTHESIS: Injury rates will vary between different player positions, times in the season, and across different playing situations. STUDY DESIGN: Descriptive epidemiology study. METHODS: Between 1989 and 1998, injury data were prospectively collected by athletic trainers for every NFL team and recorded in the NFL's Injury Surveillance System. Data collected included team, date of injury, activity the player was engaged in at the time of injury, injury severity, position played, mechanism of injury, and history of previous injury. Injury rates were reported in injuries per athlete-exposure (A-E). An athlete-exposure was defined as 1 athlete participating in either 1 practice or 1 game. RESULTS: Over the 10-year study period 1716 hamstring strains were reported for an injury rate (IR) of 0.77 per 1000 A-E. More than half (51.3%) of hamstring strains occurred during the 7-week preseason. The preseason practice IR was significantly elevated compared with the regular-season practice IR (0.82/1000 A-E and 0.18/1000 A-E, respectively). The most commonly injured positions were the defensive secondary, accounting for 23.1% of the injuries; the wide receivers, accounting for 20.8%; and special teams, constituting 13.0% of the injuries in the study. CONCLUSION: Hamstring strains are a considerable cause of disability in football, with the majority of injuries occurring during the short preseason. In particular, the speed position players, such as the wide receivers and defensive secondary, as well as players on the special teams units, are at elevated risk for injury. These positions and situations with a higher risk of injury provide foci for preventative interventions.
