Background Aged asthma patients experience increased morbidity and mortality. Knowledge of the aging effect on airway inflammation and asthma control is limited. Objective To compare airway inflammation and its relationship with asthma control in aged vs. younger patients and determine if differences are asthma-specific or due to “inflamm-aging.” Methods Prospective study of aged (>60 years) and younger (21–40 years) inner-city asthma patients. After a run-in period to control for inhaled corticosteroid use, induced sputum was collected. Aged-matched, non-asthma controls were included to measure age-related inflammatory changes. Results Aged (mean age 67.9±5.1 years, n=35) compared to younger (mean age 30.8±5.9 years, n=37) asthma patients had significantly worse asthma control and lower forced expiratory volume in one-second (FEV1). Aged asthma patients had higher sputum neutrophil number and percent (30.5 ×104/mL and 23.1%) and eosinophils (7.0×104/mL and 3.8%) compared to younger patients (neutrophils, 13.0 ×104/mL [P<0.01] and 6.9% [P<0.01]; eosinophils, 2.0×104/mL [P <0.01] and 1.2% [P<0.01]). Aged asthma patients had higher sputum interleukin-6 (IL-6) (P <0.01) and IL-8 (P =0.01). No significant inflammatory differences between aged and younger controls were observed. In aged asthma patients, elevated sputum IL-6 and MIP3α/CCL20 were significantly associated with decreased asthma control; elevated sputum neutrophils, IL-1β, IL-6 and MIP3α/CCL20 with hospitalization. Conclusions The inflammatory patterns of aged vs. younger asthma patients are associated with increased sputum neutrophils and eosinophils and cytokines related to neutrophil recruitment. Differences in airway inflammation may contribute to diminished asthma control in the aged. Further understanding of asthma pathophysiology in aged patients is needed to improve management of this vulnerable population.

Background: Graft failure after osteochondral allograft transplantation (OCA) of the knee is a devastating outcome, often necessitating subsequent interventions. A comprehensive understanding of the risk factors for failure after OCA of the knee may provide enhanced prognostic data for the knee surgeon and facilitate more informed shared decision-making discussions before surgery. Purpose: To perform a systematic review and meta-analysis of risk factors associated with graft failure after OCA of the knee. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The PubMed, Ovid/MEDLINE, and Cochrane databases were queried in April 2021. Data pertaining to study characteristics and risk factors associated with failure after OCA were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs, while mean differences (MDs) were calculated for continuous data. Qualitative analysis was performed to describe risk factors that were variably reported. Results: A total of 16 studies consisting of 1401 patients were included. The overall pooled prevalence of failure was 18.9% (range, 10%-46%). There were 44 risk factors identified, of which 9 were explored quantitatively. There was strong evidence to support that the presence of bipolar chondral defects (OR, 4.20 [95% CI, 1.17-15.08]; P = .028) and male sex (OR, 2.04 [95% CI, 1.17-3.55]; P = .012) were significant risk factors for failure after OCA. Older age (MD, 5.06 years [95% CI, 1.44-8.70]; P = .006) and greater body mass index (MD, 1.75 kg/m2 [95% CI, 0.48-3.03]; P = .007) at the time of surgery were also significant risk factors for failure after OCA. There was no statistically significant evidence to incontrovertibly support that concomitant procedures, chondral defect size, and defect location were associated with an increased risk of failure after OCA. Conclusion: Bipolar chondral defects, male sex, older age, and greater body mass index were significantly associated with an increased failure rate after OCA of the knee. No statistically significant evidence presently exists to support that chondral defect size and location or concomitant procedures are associated with an increased graft failure rate after OCA of the knee. Additional studies are needed to evaluate these associations.

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Background: Conventional methods are not suitable for difficult to treat osteochondral lesions of the talus (OCLTs). The role of particulated juvenile allograft articular cartilage implantation is not well elucidated for long-term patient outcomes. Methods: Thirteen patients with difficult-to-treat OCLTs underwent arthroscopy-assisted implantation of particulated juvenile articular cartilage graft into defects from 2010 to 2012 by the same surgeon. “Difficult to treat” was defined as having at least 3 of the following features or 2 if both variables described lesion characteristics: (1) lesions size of 107 mm2 or greater, (2) shoulder lesions, (3) patients who failed microfracture, (4) patient aged ≥40 years, or (5) patient body mass index (BMI) >25. Patients were evaluated using physical examination, patient interviews, and outcome score measures. Patients had follow-up at 2 years, 4 years, and between 6 and 10 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery. Results: Patients (age: 46.5 ± 11.8 years, BMI: 28.5 ± 6.1) had, on average, most recent follow-up of 8.0 years (range 72-113 months). Average visual analog scale for pain score decreased for patients by 3.9 points (95% confidence interval [CI] 2.18-5.60), when compared to preoperative assessment. Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscale scores also improved from 46.5 to 80.9 (95% CI 21.35-47.43), and from 18.8 to 57.9 (95% CI 21.05-57.10), respectively. Short Form–36 Health Survey physical component scores showed significant improvement by an average of 45.5 points (95% CI 32.42-58.50). American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores improved from 55.2 to 80.3 (95% CI 12.459-37.741). Conclusion: These results demonstrate positive patient-reported long-term outcomes for a cohort of patients with difficult OCLTs, followed over the course of 6-10 years after treatment with arthroscopy-assisted particulated juvenile articular cartilage implantation. Level of Evidence: Level II, prospective cohort study.

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