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The 20 laboratories and 300 personnel that comprise the HSS Research Institute are subspecialized in research that can improve outcomes and quality of life for people with orthopedic and rheumatic conditions. This week, I discussed new and exciting ways we are looking into the prevention of arthritis after knee ligament injury in several sessions at the American Academy of Orthopaedic Surgeons 2021 annual meeting.

Four bands of connective tissue called ligaments support the knee joint: the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. Ligament damage, such as a tear from a sports injury, makes the knee joint unstable. About half of patients who experience injury to the ACL develop degeneration of cartilage that can lead to knee arthritis over about 15 years. This late effect can be particularly life-altering for young athletes.

HSS research is driven by the fact that we are seeing an increasing number of patients with these problems. Surgery can fix the initial problem of a torn ACL or cartilage and stabilize an injured knee, but we are striving to develop new treatments to prevent post-traumatic arthritis that happens later.

Our researchers have unparalleled access to patient data and tissue samples, making HSS a living laboratory for translating basic research insights into cutting-edge treatments. We’re investigating ways to prevent the development of arthritis after knee ligament injury from three different angles. First, we are analyzing changes at the tissue and cellular level in basic laboratory studies and with use of state-of-the-art quantitative magnetic resonance imaging (MRI) techniques that provide unparalleled information on changes in the microscopic structure of cartilage, going far beyond the diagnostic capability of standard MRIs.

Second, we are conducting biomechanical studies using knees from human cadavers, simulating typical gait and loads on joint surfaces and seeing how injury to ligaments and cartilage damage affects movement of the joint. Simulator technology makes it possible to perform thousands of repetitive movements in a much shorter period than observing changes in patients. The biomechanical studies are being paired with 3D computer modeling, helping us to better understand and predict abnormal stresses on the cartilage that lead to arthritis. There are numerous factors that can lead to post-traumatic arthritis, and our hope is that these models will provide insights into why some patients develop arthritis while others do not.

Third, I am leading a new, multi-institutional clinical research study evaluating the use of platelet-rich plasma (PRP) injections as a potential treatment for reducing the risk of developing knee arthritis after an ACL injury. PRP injections contain platelets concentrated from the patient’s own blood. These platelets provide a rich source of anti-inflammatory chemicals and growth factors known to stimulate repair processes. We want to determine if it can combat the inflammation that is a big culprit behind progressive degeneration in the joint.

We plan to recruit patients with ACL injuries. Patients will be randomly assigned to receive one PRP injection at diagnosis and another during surgery to repair a torn ACL or to receive placebo injections instead and will be followed for two years.

Joint fluid samples will be analyzed over time to look for inflammatory markers by using state-of-the-art laboratory techniques and quantitative MRI techniques that will allow us to detect biochemical changes in cartilage tissue within a year or two, much faster than the development of changes on routine x-rays, which can take up to 15 years. We will combine this information with patients’ symptoms and measures of function, pain and strength.

PRP has great potential, but one of the biggest challenges to date is its variability. As a blood product, the components vary greatly between patients and even on different days from the same patient. To address this issue, we will analyze a small sample of each patient’s PRP in the lab to look for common characteristics that lead to a positive response in warding off the development of arthritis.

We are proud to be leading multiple avenues of research into new ways to prevent knee arthritis in patients with knee ligament injuries.

- Scott A. Rodeo, MD, sports medicine surgeon, Vice Chair of Orthopaedic Research and Co-director of the Orthopaedic Soft Tissue Research Program at HSS

Dr. Williams performed anterior cruciate ligament reconstruction surgery on Dinwiddie’s right knee in January 2021.

Dr. Williams noted, “He looks and feels and moves like the pre-injury Spencer Dinwiddie.”

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Some players worry this change in policy may contribute to an increase in injuries, specifically Tampa Bay Rays’ pitcher Tyler Glasnow, who was recently diagnosed with a partially torn ulnar collateral ligament (UCL).

Dr. Altchek has performed around 1,500 Tommy John operations since 1988, and said this theory is plausible due to the sudden and major adjustment. He noted, “I’d rather have them use the sticky stuff and figure this out in the offseason.”

Dr. Altchek encouraged the MLB to explore alternative options for player health and safety. He said, “We already have an epidemic of elbow injuries. Tyler Glasnow sent a warning shot over the league. A pitcher of his level – saying that he made whatever the sudden changes were, grip pressure or something else – and then immediately developing an elbow problem, is scary. We have a few too many strikeouts, who cares?”

Read the full article at NYDailyNews.com.

Weightlifting and common body-weight exercises can cause a variety of hand and wrist injuries. Maroldi explained, “Oftentimes, tendons or ligaments are overloaded or repetitively strained during certain exercises, leading to tendinitis, tenosynovitis, or ligament sprains or tears.”

Although repetition is a common practice for building muscle, it’s not ideal for hand health. Maroldi noted, “Repetitive stresses from exercise can also lead to ganglion cysts, which most commonly appear on the back of the wrist.”

“Other exercises that involve dynamic movement and loading the wrists, such as snatches and clean and jerks, can lead to ligament tears in the wrist, most commonly the scapholunate ligament (SL ligament),” added Maroldi.

Another watch-out is weight-bearing exercises. “The most common exercises that cause wrist/hand injuries are those that involve weight-bearing or dynamic loading through extended wrists such as pushups and burpees,” said Maroldi.

Maroldi offered tips for avoiding injury during exercise, such as maintaining a neural wrist position. “Neutral wrist position means that the wrist is in slight extension (make a tight fist and the position your wrist is in is your neutral wrist position),” he explained.

Maroldi also advised to avoid overgripping. “Your wrists and hands are constantly working and under tension, and it is therefore not recommended to do specific wrist- or grip-strengthening exercises. Doing wrist curls or repetitive resisted gripping can lead to tendinitis or carpal tunnel syndrome, but training with proper technique, form, and body positioning will strengthen your wrist and grip functionally with less risk of injury,” he said.

Read the full article at Muscleandfitness.com.

In their review, Dr. Carr and Dr. Rodeo evaluate the basic science and clinical evidence for the most commonly used biologic agents for treating common shoulder pathologies (i.e., rotator cuff tears, osteoarthritis, and tendinopathy), to help physicians better understand the terminology for the most commonly used biologic agents; review the current literature on the use of various biologic agents in the treatment of the most common shoulder pathologies; and highlight emerging therapies and potential future applications of biologic agents in the management of these shoulder pathologies.

While the outlook may be positive, Dr. Carr and Dr. Rodeo advised that further laboratory and clinical research is needed, to define optimal formulations, dosing schedules, and approaches for various tissues and injuries. As the safety and efficacy of these approaches are further defined, changes in the regulatory environment at the FDA level may also aid progress.

“Orthopedic surgeons must be well informed when discussing biologic agents with patients," added Dr. Rodeo. "It is paramount that orthopedic surgeons provide leadership in this area and work toward developing practice guidelines and policies for the use of biologic agents. A rigorous approach to the use of 'regenerative medicine' therapies and the maintenance of high clinical and research standards are required to move the field forward."

Read the full article at News-medical.net.