Sports medicine and arthroscopy session offers wealth of knowledge on controversial topics

ByRachel M. Frank, MD

By Rachel M. Frank, MD

Thursday marked the fourth paper presentation session for Sports Medicine and Arthroscopy, with all papers in this group focusing on the knee. The session was moderated by Peter G. Gerbino, MD of Monteray Joint Replacement and Sports Medicine in Monteray, Calif., and Rick W. Wright, MD, the Dr. Asa C. and Mrs. Dorothy W. Jones Professor in Orthopedic Surgery at Washington University in St. Louis. The moderators provided an engaging atmosphere and asked pertinent questions of the speakers.

The first paper of the session was entitled “Arthroscopic meniscal allograft transplantation in male professional soccer players” and was presented by Giulio Maria Marcheggiani Muccioli, MD of Bologna, Italy. In the well-conducted study, the authors assessed the ability of high level athletes to return to professional soccer at an average 3-year follow-up after arthroscopic meniscal allograft transplantation. This topic is of special interest for me, as our research team is actively involved in studying “return to play” rates following cartilage restoration procedures. Dr. Muccioli’s study found that overall, 11 of the 12 patients returned to play soccer, with 9 patients (75%) at the professional level at the 3-year follow-up period. I found this data to be particularly interesting and encouraging, as meniscal allograft transplantation is not typically aimed at returning patients to elite levels of athletic activity, but instead is thought of as a salvage procedure aimed at reducing pain and improving function. In this cohort of patients, Dr. Muccioli described the procedure not as a salvage procedure, but instead as a “career savage” procedure. I am interested to see if these results can be replicated in larger series and with sports other than soccer. The authors are to be commended for their encouraging outcomes in what is historically a difficult-to-treat patient population.

Rachel M. Frank

Another paper presentation I found particularly interesting and informative was "Analysis of failure and subsequent surgery after unsatisfactory medial patellofemoral ligament reconstruction" presented by Manfred Nelitz, MD, of Oberstdorf, Germany. The authors analyzed a cohort of 19 patients with unsatisfactory medial patellofemoral ligament (MFPL) reconstruction, and ultimately provided reasons for failure based on physical examination findings, imaging findings, copathology (e.g., chondral damage), and clinical outcomes tools (e.g., VAS, IKDC and Kuhala knee function score). Dr. Nelitz reported that a combination of 1) errors in patient selection, 2) technical problems, and 3) failure to consider additional risk factors preoperatively all contributed to unsatisfactory MFPL reconstruction. Specific technical problems that the authors found included over-tensioning of the MPFL and anterior placement of the femoral bone tunnel. Anatomical considerations, such as underlying severe trochlear dysplasia as well as excessive femoral anteversion, were also noted to be risk factors for failed MPFL reconstruction. Dr. Nelitz provided three case examples of failed MPFL reconstruction, offering solutions for addressing the reasons for failure. I found this aspect of his presentation particularly informative.

Other compelling talks included the discussion of allograft vs. autograft in ACL reconstruction, an often-studied but still controversial topic in sports medicine, as well as a randomized control trial, which compared arthroscopic microfracture to autologous chondrocyte implantation in the knee. Overall, the entire session was highly educational, with experts in the field discussing interesting, highly relevant, cutting-edge research in sports medicine.

References:

Muccioli GMM. Paper #451. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

Nelitz M. Paper #453. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

Rachel M. Frank, MD, is a third-year resident at Rush University Medical Center in Chicago.

Disclosure: Frank has no relevant financial disclosures.