Importance. The promising therapeutic potential and regenerative properties of platelet-rich plasma (PRP) have rapidly led to its widespread clinical use in musculoskeletal injury and disease. Although the basic scientific rationale surrounding PRP products is compelling, the clinical application has outpaced the research. Objective. The purpose of this article is to examine the current concepts around the basic science of PRP application, different preparation systems, and clinical application of PRP in disorders in the knee. Evidence Acquisition. A systematic search of PubMed for studies that evaluated the basic science, preparation and clinical application of platelet concentrates was performed. The search used terms, including platelet-rich plasma or PRP preparation, activation, use in the knee, cartilage, ligament, and meniscus. Studies found in the initial search and related studies were reviewed. Results. A comprehensive review of the literature supports the potential use of PRP both nonoperatively and intraoperatively, but highlights the absence of large clinical studies and the lack of standardization between method, product, and clinical efficacy. Conclusions and Relevance. In addition to the call for more randomized, controlled clinical studies to assess the clinical effect of PRP, at this point, it is necessary to investigate PRP product composition and eventually have the ability to tailor the therapeutic product for specific indications.
Background:Isolated tearing and avulsions of the distal biceps femoris sustained during sporting activities are uncommon.Purpose:To systematically review the literature to identify distal biceps femoris tears and avulsions experienced during sporting activities to determine injury prevalence, sporting activities/mechanisms, management, and time to return to sport.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review was conducted investigating studies published between January 1970 and December 2017 that reported on athletes sustaining tears and avulsions of the distal biceps femoris during sporting activity. The review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used the PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE databases. Inclusion criteria were studies reporting on (1) partial or complete tears and avulsions of the distal biceps femoris with documented sporting activity causing injury, (2) injury management (operative vs nonoperative), and (3) patient outcome. Exclusion criteria consisted of studies reporting on (1) distal biceps femoris injuries without tearing, (2) injuries secondary to nonsporting activities (mechanical falls, trauma), (3) concomitant injuries to adjacent structures about the knee, and (4) studies not reporting injury management or patient outcomes. Sporting activities, injury characteristics, management, and time to return to sport were analyzed.Results:A total of 22 athletes with isolated distal biceps femoris tears or avulsions were identified. Injuries were predominantly associated with noncontact knee hyperextension with concurrent hip flexion during soccer or track and field, most commonly isolated to the musculotendinous junction. Injuries were treated surgically in 91% (20/22) of athletes. Mean (±SD) overall time to return to sport was 4.9 ± 3.3 months, and for athletes who underwent operative repair, there were no significant postoperative differences based on injury location (musculotendinous junction vs avulsion, P = .25) or injury severity (partial vs complete injury, P = .13).Conclusion:Isolated distal biceps femoris injuries occurred primarily via noncontact mechanisms. The majority of cases were treated surgically, with successful return to sport at preinjury levels. No significant difference in return to sport was appreciated based on injury location or severity. Further studies are necessary to determine the impact of treatment method.
Background: Isolated distal semitendinosus tears and avulsions sustained during sporting activities are uncommon. Question/Purposes: We sought to systematically review the literature to identify athletes sustaining distal semitendinosus tears and avulsions during sporting activities and to better understand injury mechanisms, management, and return-to-sport timing. Methods: PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE databases were searched from January 1970 to January 2018 using the search terms distal hamstring, semitendinosus, sport, athlete, tear, rupture, and avulsion. Inclusion criteria were studies documenting (1) isolated, complete distal semitendinosus tears and avulsions during sporting activity, (2) injury management, and (3) athlete outcome. Exclusion criteria were studies reporting (1) partial tears, (2) injuries from non-sporting activities, or (3) athlete sustaining injury with concomitant injuries about the knee. Sporting activities, tear location, management strategy, time from injury to surgery, and return-to-sport timing were analyzed. Statistical analysis was used to evaluate return-to-sport timing based on treatment type and tear location. Results: Four studies met the inclusion criteria, comprising a total of 23 cases of complete, isolated distal semitendinosus avulsions or tears. Injuries were sustained predominantly while running or sprinting and most commonly were avulsions off the tibia. Injuries were treated surgically in 70% of cases. Overall time to return to sport was 2.5 ± 1.4 months with athletes treated conservatively returning significantly more quickly (1.5 ± 0.8 months) than athletes undergoing surgery (3.0 ± 1.3 months). Return-to-sport time was significantly shorter in athletes with complete avulsions (2.2 ± 1.3 months) than in those sustaining tears at the musculotendinous junction (3.8 ± 0.8 months). No significant correlation between time to surgery and return-to-sport time was appreciated. Conclusion: Isolated, complete distal semitendinosus tears and avulsions remain infrequently reported during sporting activities and, in this review, occurred predominantly during non-contact activity. Athletes treated conservatively were found to return to sport more quickly, although additional studies are needed to determine the clinical relevance of treatment option, tear location, and concurrent injuries.
Objective: To assess the outcomes of patients who sustained blunt trauma tibia fractures compared with tibia fractures from civilian gunshot injuries when treated with intramedullary fixation. Design: Retrospective chart review. Setting: Level I trauma center. Patients/Participants: Two hundred and seven patients underwent intramedullary nailing for 211 tibia fractures. Methods: A retrospective review of tibia fracture(s) treated with intramedullary fixation with comparison of closed, open, and gunshot wound (GSW) fracture outcomes. Main Outcome Measurements: Outcomes included infection and nonunion. Results: The infection rate in closed and GSW tibia fractures was significantly lower compared with the infection rate of open fractures (1% vs. 9% vs. 20%; P = 0.00005). Significantly lower rates of nonunion in closed fractures compared with open fractures and GSW fractures were appreciated (8% vs. 20% vs. 30%; P = 0.003). There was no difference in infection or nonunion between GSW fractures with small wounds, no exposed bone, and minimal comminution and closed injuries (P = 0.24, P = 0.60). Conversely, there was a significantly higher nonunion rate in GSW fractures with large wounds, exposed tibia, and comminution compared with blunt injuries (P = 0.0014). Conclusions: This study suggests that tibia fractures from civilian GSWs are heterogeneous injuries, and outcomes are dependent on the extent of soft-tissue injury, bone exposure, and bone loss. There are comparable infection rates in all fractures due to civilian GSWs and closed fractures, which are lower than high-grade open fractures. Tibia GSW fractures with exposed bone and comminution have higher complication rates and should be treated accordingly. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.