How do you evaluate your ACL reconstructed patients? The CJSM Podcast.

I have an interest in patient-reported outcome measures (PROMs).  In fact, one of the manuscripts I have published in the pages of CJSM addresses the reliability and validity of a pediatric back pain PROM (the Micheli Functional Scale).

I read with great interest, therefore, work recently published in CJSM on another PROM, the ACL Quality of Life (QOL) questionnaire: Validity, Reliability and Responsiveness of the ACL QOL Measure: A Continuation of its Overall Validation.

When I approached the lead author, Mark Lafave, about doing a possible podcast on this study, he demurred. The person I really needed to talk with was the his mentor, and the developer of the measure 30 years ago: Dr. Nicholas Mohtadi.

Dr. Mohtadi is an orthopaedic surgeon and Director of the Sports Medicine Centre at the University of Calgary, Alberta Canada.  He is a past president of CJSM’s affiliated society, the Canadian Academy of Sport and Exercise Medicine.  He is also on the CJSM editorial board and has been a prolific author in our pages these last 26 years.

He made for a wonderful guest on the podcast.  Check it out, and don’t forget you can see all the CJSM podcasts and sign up for the iTunes feed by going here.

 

CJSM Podcast 12: The Effect of Viscosupplementation in the Treatment of Knee Osteoarthritis

jsm-podcast-bg-1For our 12th podcast, we have invited Dr. Tom Trojian to talk with us about a new CJSM offering, just published ‘On Line First,” for which he is the lead author: “AMSSM Scientific Statement Concerning Viscosupplementation Injections for Knee Osteoarthritis:  Importance for Individual Patient Outcomes.”

Dr. Trojian is a member of our partner society, the American Medical Society for Sports Medicine (AMSSM), and is a professor in the Department of Family, Community & Preventive Medicine at Drexel University College of Medicine, and the director of the Sports Medicine Fellowship program there.

He is also a wonderful guest to have on  the podcast–I learned a great deal from him about not only viscosupplementation in the treatment of knee osteoarthritis, but also the specific study design of a ‘network meta-analysis’ he and his co-authors used to evaluate the clinical importance of this intervention in our patients.

Knee osteoarthritis (OA) is such a common condition–and is one which so many sports medicine clinicians treat as part of their practice–that we find ourselves publishing a great deal of research on the topic.  Just this month, in the November 2015 CJSM, we have three pieces of original research on managing knee OA: i) the relative effectiveness of hip vs. leg strengthening  in treating the problem; ii)  the effect of lower body positive pressure (LBPP)-supported low-load treadmill walking program on knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA);  and iii) a prospective study on the safety and efficacy of intrarticular platelet lysates in early and intermediate knee OA.

T Trojian Screen Shot

Dr. Trojian, ‘in action’ on the podcast.

Check all those studies out.  And check out our newest podcast:  get out those headphones, tune up that iPhone, and listen to what Dr. Trojian has to say on the subject of viscosupplementation in the treatment of knee OA.

Thanks very much for the time you spent with us Tom!

 

Articular Cartilage Pathology: What to do?

A syringe delivering PRP:
A silver bullet for osteoarthritis?

My fall was so busy, I’m finally getting back to doing a sequel of a post I wrote in early October:  Osteoarthritis Part I.

I’m finally writing “Part II.”

The proximal impetus for finally attending to this item on my personal ‘to do’ list?  The new, January 2014 edition of the Clinical Journal of Sports Medicine has a couple of very fine articles on the treatment of articular cartilage pathology. One of the studies, “Treatment of Cartilage Defects of the Knee: Expanding on the Existing Algorithm,” is a general review I hope to post about in the near future.  The study that is in my line of fire today explores the uses of platelet-rich plasma (PRP) in the treatment of osteoarthritis and cartilage defects: “Platelet-rich Plasma in the Management of Articular Cartilage Pathology:  A Systematic Review.”

I found this review to be incredibly helpful.  It begins with an overview of articular cartilage pathology and a reminder of the frustrations in treating a tissue that has a limited inherent healing capacity.   Rarely can articular cartilage repair itself.  And when injury penetrates subchondral bone, underlying marrow cells can be stimulated to provide some repair, but inevitably the fibrocartilage that results is a biomechanically inferior substitute for native, articular hyaline cartilage.

ocd for blog 2

OCD of the medial femoral condyle:
what will this joint look like in 2044?

The review notes the increasing incidence of chondral and osteochondral lesions, something as a pediatric sports medicine specialist I can attest to.  The 10 year old with knee OCD I am treating today:  I often wonder what their knee will be like in 30 years?

The authors note:   “Several treatment modalities are available, including microfracture, autologous chondrocyte transplatation, and autograft and allograft osteochondral transplantation.  However, the reported resulst with these procedures have been variable and are not guaranteed to prevent symptomatic degenerative disease at long-term follow up.”

In other words, the hunt is on for an effective, definitive treatment of articular cartilage injury.  Might PRP be the answer?

The brief answer:  we need to learn much, much more about PRP, and probably about articular cartilage, too.

Let’s start with the limitations.  Read more of this post

Osteoarthritis: Part I

I’ve been an Associate Editor for CJSM now for six months, and so some of you in the blog world may already know a little bit of my background as it has come out over time in my various posts.

For those of you who may be new readers of this blog, I thought for today’s post it was important for me to let you know that I work at Nationwide Children’s Hospital, the pediatric hospital affiliate of Ohio State University, and my specialty is pediatric sports medicine.

So……I don’t manage a lot of osteoarthritis (OA) in my current practice.

ocd of knee jpeg

Adult OCD of the knee,
unstable lesion: destined for osteoarthritis?

However, I didn’t narrow my clinical scope of practice to the younger crowd until 2010, and I have managed my fair share of OA in my career, injecting plenty of knees with hyaluronic acid derivatives, encouraging weight management and low impact exercise…….Now, I suppose I’m more on the end of the spectrum of primary prevention of the disease: if I manage my young patients’ knee osteochondritis dissecans properly, perhaps I can spare them from degenerative joint disease later in life.

I’m not telling anyone reading this something they don’t know already when I write that career paths are varied in modern medicine.  There’ s no telling if I’ll be taking care of kids exclusively in 10 years.  We all have mandates from Certification Boards requiring us to stay abreast of the current medical literature; we’re tested on it every few years now, as Maintenance of Certification is a phenomenon here to stay.  Forces like these make it incumbent that I read and ‘stay on top of’ developments in the world of OA diagnosis and management, even if I am not seeing much of this disease in my current practice.

After all, OA is the leading cause of chronic disability among older adults in the United States.  That’s a disease worth knowing about.

I thought, therefore, that I would share with you a couple of interesting studies that have come out recently on major issues in the world of osteoarthritis.  Both studies were just published within the last month:  the first, “Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee,”  published in the Journal of Bone and Joint Surgery (JBJS), I will discuss in my next blog post.  And the second, “Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis,” published in the Journal of the American Medical Association (JAMA), I will review now.   They are both large, high quality evidence (Level 1) studies which focus on low tech, low cost interventions that have the potential of having major clinical impact.  They are both studies primary care sports/MSK clinicians like myself might be expected to be aware of. Read more of this post

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