The American Orthopaedic Society for Sports Medicine 2009 Annual Meeting took place July 9 to 12 in Keystone, Colo. This meeting is designed to bring together orthopedic surgeons, physicians, and allied health professionals to identify areas of recent research in the field of sports medicine or related fields of practice. This research was reported through scientific paper presentations, hot topics, updates, question and answer sessions, surgical videos and symposia.
Asheesh Bedi, M.D., of the Hospital for Special Surgery in New York City, reported findings which analyzed the use of a biodegradable scaffold or plug to treat patients with damaged knee cartilage. Although these scaffolds have become increasingly used among knee surgeons, there is a lack of imaging data to adequately assess their biologic incorporation and the quality of the repair tissue. Bedi and colleagues performed cartilage sensitive MRI and T2 mapping on 26 patients who underwent osteochondral autologous transplantation for knee or talus chondral defects, with plug backfilling of donor site lesions. A longitudinal analysis at early follow-up (first six months) showed 75 percent of plugs had a flush morphology and 78 percent demonstrated nearly complete defect fill. Although the plug appearance deteriorated at intermediate follow-up (≈12 months), it markedly improved with longer follow-up (≥16 months), when 70 percent showed flush morphology and 90 percent had nearly complete defect fill. With increasing time after surgery, T2-mapping scores for the superficial and deep cartilage layers of the central and peripheral plug significantly improved. Intermediate postoperative interval to MRI was significantly associated with increased interface resorption, incomplete fill of the defect, and poor plug incorporation. Although subchondral edema was rare, it was significantly associated with a short postoperative interval to MRI.
"What we found was that the plug demonstrated a predictable process of maturation on imaging studies that paralleled the biology of their incorporation," Bedi said in a statement. "With increasing postoperative duration, the repair tissue demonstrated encouraging properties with T2 values that resembled native articular cartilage."
Support for this study was provided by Smith & Nephew.
Timothy F. Tyler, P.T., of the Nicholas Institute of Sports Medicine and Athletic Trauma in New York City, presented the results of a prospective randomized trial designed to assess the efficacy of a novel eccentric wrist extensor exercise to treat chronic lateral epicondylitis, or tennis elbow. A total of 21 patients were randomized into two groups, receiving either standard treatment with isotonic wrist extensor strengthening or eccentric treatment with isolated wrist extensor strengthening. Patients receiving eccentric treatment (three sets of 15 repetitions) were asked to twist a rubber bar with concentric wrist flexion of the uninvolved arm and release the twist with eccentric wrist extension of the involved arm. Patients in both the standard and eccentric groups exhibited similar treatment results, including duration of symptoms (8±3 versus 6±2 months), physical therapy visits (10±2 versus 9±2 visits), and treatment duration (7±0.6 versus 7.2±0.8 weeks). However, significant improvements were noted for patients in the eccentric group in several outcomes, including the disabilities of the arm, shoulder, and hand questionnaire (76 versus 12 percent), the visual analog pain scale (81 versus 22 percent), tenderness (70 versus 4 percent), and wrist and middle finger extension strength (72 versus 11 percent). Based on these favorable results, trial randomization was terminated with 21 of 30 patients having completed the study.
"Our study illustrated that a novel exercise, using an inexpensive rubber bar, may provide a practical and effective means of adding isolated wrist strengthening exercises to a treatment plan," Tyler said in a statement. "Compared to other treatments for tennis elbow such as cortisone injections or topical nitric oxide which require direct medical supervision and often side effects, this treatment is not only cost effective but dosage is not limited by the patient having to come to a clinic."
Gregory Drake, D.O., of the Texas Orthopaedics Hospital in Houston, reported a study which found that returning to sports following a total shoulder arthroplasty (TSA) is feasible for most individuals. At a minimum of one year following TSA, questionnaires were administered to 165 patients, 87 of whom had participated in sports prior to surgery. Following TSA, 94.4 percent of these patients resumed sports participation, 82.7 percent of whom did so more than once weekly. Patients were able to resume sports participation within six months (59.6 percent) or nine months (87 percent) following TSA. Overall, 85.2 percent of these patients reported their performance in sports as excellent or good. Approximately three-quarters (78.8 percent) reported participating in these sports at an intensity similar to that as they had prior to TSA, and 81.4 percent reported participating at greater than 75 percent of the preoperative level. Most patients did not experience pain either during (74 percent) or after (75.6 percent) participating in sports, and 82.6 percent reported using no medication associated with their participation in sports.
In a statement, Drake said that it appeared "that the most likely reason for returning to the same level of participation is dependent on the motivation of the individual. Athletics can be a great motivator for surgery and an even greater one for patients to stick to a rehabilitation schedule."
A number of studies presented at this year's meeting dealt with the impact of sports injuries on the ability of the athlete to continue to play. For example, a study reported by Robert H. Brophy, M.D., of the Washington University School of Medicine in St. Louis, provided evidence that for athletes with knee injuries, anterior cruciate ligament (ACL) reconstruction predicted a longer football career compared with a simple meniscus repair. In another study presented by Ian Byram, M.D., of Vanderbilt Medical Center in Nashville, Tenn., data showed that preseason shoulder strength in baseball pitchers was significantly associated with the likelihood of having a throwing-related injury that required surgery during the season.
AOSSM: Delayed ACL Repair Risky in Children
MONDAY, July 13 (HealthDay News) -- The risks associated with delaying reconstruction of an anterior cruciate ligament (ACL) tear may outweigh the benefits in skeletally immature young people, according to research presented at the annual meeting of the American Orthopaedic Society for Sports Medicine, held July 9 to 12 in Keystone, Colo.
AOSSM: Technique Results in Superior ACL Reconstruction
FRIDAY, July 10 (HealthDay News) -- The anteromedial portal drilling technique results in superior reconstruction of the anterior cruciate ligament (ACL), according to research presented this week at the annual meeting of the American Orthopaedic Society for Sports Medicine, held from July 9 to 12 in Keystone, Colo.
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