Comparative Outcomes of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation with Patellar Realignment for Patellar Instability with Associated Cartilage Defects

Abstract Background: Articular cartilage pathology can stem from a spectrum of etiologies including osteochondritis dissecans, avascular necrosis, degenerative joint disease, and injury resulting from recurrent instability of the patella. Hypothesis/Purpose: The purpose of this study was to identify differences in clinical and functional outcomes in patients treated with either ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and tibia tubercle osteotomy. Study Design: Retrospective Cohort Study Methods: A retrospective review identified patients who underwent autologous chondrocyte implantation (ACI) or osteochondral allograft (OCA) transplantation with concomitant medial patellofemoral ligament (MPFL) reconstruction and tibia tubercle osteotomy (TTO). Outcome measures included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and Short Form Health Survey (SF-12) physical scores, all collected a minimum of 2 years after surgery. Defect location, size, complications, and rate of subsequent surgery were determined. Results: Eighteen patients (11 ACI and 7 OCA) were included in this study to analyze clinical and functional outcomes following surgical correction of 23 chondral defects (ACI n=12, OCA n=10). Defects had comparable baseline characteristics in each group including size measured during index arthroscopy (3.34 cm2 vs 4.03 cm2, P = .351), Outerbridge classification (54.8% grade 4 vs 60.0% grade 4, P = 1.000), and AMADEUS score (47.1 vs 58.6, P = .298). Postoperative outcomes were comparable including revision rate (15.4% vs 10.0%, P=1.000) and 2-year IKDC scores (74.2 vs 51.2, P = .077). However, ACI did have significantly higher 2-year KOOS JR (85.1 vs 63.7, P = .031) and SF-12 scores (54.1 vs 42.6, P = .007) compared to OCA. Conclusion: ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and TTO can be safely performed in an outpatient setting with functional and clinical outcomes being comparable. Functional scores including KOOS JR and SF-12 were shown to be significantly higher at 2-year follow-up in the ACI cohort, however, postoperative IKDC scores, rates of revisions, and clinical evaluations were comparable between cohorts

The Effect of Graft Selection on Patients’ Subjective Readiness to Return to Sport After ACL Reconstruction

Background: Patients who undergo ACL reconstruction with allografts may have an easier functional recovery compared to autograft patients. This is due to decreased donor site morbidity and less muscle atrophy compared to autograft patients. This “easier” recovery may be perceived by patients and may result in a subjective earlier readiness for return to sports. Hypothesis/Purpose: To determine if there is a difference in perceived readiness to return to sport (RTS) in the first year postoperative period between individuals who undergo ACL reconstruction utilizing bone-patellar tendon-bone (BTB) autografts or allografts. Study Design: Prospective Cohort Study, Level II Methods: This was a prospective, observational cohort study for patients aged 14-25 years old undergoing primary ACL reconstruction done either with BTB autograft or allograft. Patients completed questionnaires postoperatively evaluating their perceived ability to perform various activities, and their responses were used to compare subjective ability to RTS. Results: Fifty-nine patients were included in the study. Sixteen patients underwent ACL reconstruction with allograft while 43 patients received autograft. At 3 months those who received autograft reported higher perceived ability to cut (P = .003). At 6-months, patients who received allograft reconstruction reported higher perceived ability to run (P = .033), cut (P = .048), and decelerate (P = .008) as well as a higher overall perceived ability to RTS (P = .032). At all other times, there was no significant difference between cohorts’ subjective readiness to perform activities. Conclusion The results of this study indicate that at times within the first year of recovery following ACL reconstruction, patients who receive allografts and autografts may have significantly different perceived ability to perform activities or RTS. However, while present at various times throughout the first year of recovery, any difference in perceived ability to perform activities or in overall RTS is no longer present at 12 months. This study does not implicate a subjective difference in ability to return to sport or ability to perform sport-like activities between autograft or allograft as being associated with an increased risk for re-injury in the first year following surgery. Key Terms: knee ligament, ACL, allograft, imaging, general sports traum

Latarjet Surgery Leads to Decreased Rates of Subjective Instability Compared to Bankart Repair with Concomitant Remplissage

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects \u3e11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (\u3e15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery. Purpose: To compare rates of recurrent instability, re-operation, revision, and return to play (RTP), as well as patient-reported outcomes including the American Shoulder and Elbow Surgeon Score (ASES), Single Assessment Numeric Evaluation (SANE), and Oxford Shoulder Instability Score (OSI) between Latarjet surgery and arthroscopic labral repair plus remplissage surgery (Remplissage) patients

Ecophysiological Effects of Nitrogen on Soybean [Glycine max (L.) Merr.]

Soybean [Glycine max (L.) Merr.] is a leguminous plant with high nutritional and medicinal value. The goal of this research was to determine the optimal concentration of nitrogen, using Hoagland nutrient solution, which will enhance the productivity of soybeans. The specific objective of the study was to assess the effect of variation of nitrogen concentration on soybean growth and leaf chlorophyll concentrations. Soybeans were grown under three soil nitrogen amendments: low, medium, and high concentration of Hoagland nutrient solution and a control group. Soybeans were grown under controlled environmental conditions in the Biotronette? environmental chamber. Temperature of the environmental chamber was regulated at 27℃ and the photoperiod was set to 10 L: 14D. Soybeans grown in the low treatment group had the highest growth rate (1.03 ± 0.03 cm/day) compared to the control, medium, and high treatment groups. During the first chlorophyll analyses, the control group had the highest total chlorophyll concentration (216.25 ± 4.09 μg/mL/g). During the second chlorophyll analyses, the low treatment group had the highest total chlorophyll concentration (102.81 ± 14.54 μg/mL/g). Although no finding was statistically significant between groups, the low nitrogen treatment conditions had a trend towards producing more favorable physiological outcomes on soybeans

Evaluation of serum calcium differences in hypertensive crises and control patients: A randomly matched case‐control study

Abstract The role of calcium in blood pressure has been widely studied among hypertensive patients; however, no study has explored the role of calcium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum calcium levels between hypertensive crises patients and a 1:1 random matched controls (age‐, sex‐, race‐, diabetes, and body mass index matched). This study is a single‐center, retrospective, chart review, case‐control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented calcium level. The control group patients were required to be 18 years of age or older, have a documented calcium level, and have no diagnosis of hypertensive crises. The primary outcome of the study was to compare the mean serum calcium in patients with hypertensive crises vs patients without hypertensive crises. Five hundred and sixty‐six patients were included in the study: 283 patients in both the case group and control group. The primary outcome results showed that serum calcium concentration was not significantly different between the case group (8.99 ± 0.78 mg/dL) and control group (8.96 ± 0.75 mg/dL) (P = .606). This study found no significant difference in serum calcium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of calcium on blood pressure in hypertensive crises