Portal de Periódicos da CAPES

ISAKOS Upper Extremity Committee Shoulder Rotator Cuff Consensus, Plus Chondrocyte Implantation and ACL Systematic Reviews

2013; Elsevier BV; Volume: 29; Issue: 11 Linguagem: Inglês

10.1016/j.arthro.2013.08.011

1526-3231

James H. Lubowitz, Matthew T. Provencher, Gary G. Poehling,

Hip disorders and treatments

The leading feature this month highlights the importance of our relationship with ISAKOS. It should be interesting to compare the ISAKOS Rotator Cuff Consensus with the AAOS Rotator Cuff Clinical Practice Guidelines,1Pedowitz R.A. Yamaguchi K. Ahmad C.S. et al.American Academy of Orthopaedic Surgeons. Optimizing the management of rotator cuff problems: Guideline and evidence report.J Bone Joint Surg Am. 2012; 94: 163-167Crossref PubMed Scopus (5) Google Scholar which we thought missed the mark.2Lubowitz J.H. McIntyre L.F. Provencher M.T. Poehling G.G. AAOS Rotator Cuff Clinical Practice Guideline misses the mark.Arthroscopy. 2012; 28: 589-592Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar The Journal is proud to be the Official Journal of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine.3Lubowitz J.H. Provencher M.T. Poehling G.G. The ISAKOS research methods handbook.Arthroscopy. 2011; 27: 449Abstract Full Text Full Text PDF Scopus (5) Google Scholar We encourage ISAKOS committees and leadership to collaborate with the editors of Arthroscopy to promote international arthroscopic and related research scholarship, and the ISAKOS perspective on the rotator cuff, Proceedings of the ISAKOS Upper Extremity Committee Consensus Meeting, is our Current Concepts feature this month.4Arce G. Bak K. Bain G. et al.Management of disorders of the rotator cuff: Proceedings of the ISAKOS Upper Extremity Committee consensus meeting.Arthroscopy. 2013; 29: 1840-1850Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar To quote, “The goal of this article is to consolidate the ISAKOS Upper Extremity Committee's current knowledge on rotator cuff disease and management as well as highlight key unresolved issues.” Thank you to Drs. Arce, Bak, Bain, Calvo, Ejnisman, Di Giacomo, Gutierrez, Guttmann, Itoi, Kibler, Ludvigsen, Mazzocca, Pochini, Savoie, Sugaya, Uribe, Vergara, Willems, Yoo, McNeil, and our own Deputy Editor Provencher. Systematic reviews are frequently the most cited high-impact articles, and your editors love them because they take an evidence-based approach to evaluating clinical questions.5Lubowitz J.H. Poehling G.G. A new year.Arthroscopy. 2008; 24: 2-3Abstract Full Text Full Text PDF Scopus (20) Google Scholar In particular, we prefer systematic reviews on hot topics such as ACL, and there are two ACL reviews in this issue. One is on the timing of surgery by Andernord, Karlsson, Musahl, Bhandari, Fu, and Samuelsson,6Andernord D. Karlsson J. Musahl V. Bhandari M. Fu F.H. Samuelsson K. Timing of surgery of the anterior cruciate ligament.Arthroscopy. 2013; 29: 1863-1871Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar and the other investigates preoperative patient and injury factors of successful rehabilitation after ACL reconstruction with single-bundle techniques. We read with particular interest this systematic review and meta-analysis by de Valk, Moen, Winters, Bakker, Tamminga, and van der Hoeven, “Preoperative patient and injury factors of successful rehabilitation after anterior cruciate ligament reconstruction with single-bundle techniques.”7de Valk E.J. Moen M.H. Winters M. Bakker E.W. Tamminga R. van der Hoeven H. Preoperative patient and injury factors of successful rehabilitation after anterior cruciage ligament reconstruction with single-bundle techniques.Arthroscopy. 2013; 29: 1879-1895Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar As editors, we have anecdotal knowledge of this topic from our own practices and, in this issue of the journal, we can read the published evidence. Today, your editors uniformly practice anatomic single-bundle reconstruction,8Lubowitz J.H. Poehling G.G. Watch your footprint: Anatomic ACL reconstruction.Arthroscopy. 2009; 25: 1059-1060Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar so we are very engrossed in this topic9Lubowitz J.H. Poehling G.G. Understanding ACL research requires patience and persistence.Arthroscopy. 2010; 26: 869-871Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar while we keep a close eye on double-bundle ACL techniques and outcomes literature. Next, Deepak Goyal, Anjali Goyal, Keyhani, Lee, and Hui systematically review the evidence-based status of second- and third-generation autologous chondrocyte implantation (ACI) over first-generation.10Goyal D. Goyal A. Keyhani S. Lee E.H. Hui J.H.P. Evidence-based status of second- and third-generation autologous chondrocyte implantation over first-generation: A systematic review of level I and II studies.Arthroscopy. 2013; 29: 1872-1878Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar From an international perspective this is interesting,11Lubowitz J.H. Poehling G.G. Saving our cells: Advances in tissue engineering for focal cartilage defects.Arthroscopy. 2009; 25: 115-116Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar in keeping with our ISAKOS theme, because different countries regulate ACI according to different laws. Your editors live in the United States, where only first-generation periosteum-based ACI is permitted, and where second- and third-generation collagen membrane–based ACI (C-ACI) and membrane-associated ACI (MACI) have not been approved for clinical use by the U.S. Food and Drug Administration. Platelet-rich plasma (PRP) remains controversial because of conflicting evidence over clinical benefits and basic science research showing that there are so many confounding variables in PRP preparation, indication, and timing, that we are just beginning to collect the data.12Lubowitz J.H. Poehling G.G. Shoulder, hip, knee, and PRP.Arthroscopy. 2010; 26: 141-142Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar In this issue, we share, with notice, a systematic review by the excellent team of Ahmad, Brooks, Kang, Weaver, Nunney, Tytherleigh-Strong, and Rushton, from England, on the effect of PRP on clinical outcomes in lateral epicondylitis.13Ahmad Z. Brooks R. Kang S.-N. et al.The effect of platelet rich plasma on clinical outcomes in lateral epicondylitis.Arthroscopy. 2013; 29: 1851-1862Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar However, we warn our readers that our editorial opinion on PRP research today is that the results of any single study, or even a single systematic review such as this work of Ahmad et al., must be considered preliminary. We need substantial additional study to develop conclusive evidence. PRP also raises FDA issues. In the United States, our understanding is that the approved application of PRP has been limited to injection at a surgical site, such that PRP injection for the nonsurgical treatment of lateral epicondylitis is “off-label.” In addition, private insurance payers have not regularly approved PRP injection for off-label use and may not even approve PRP for “on-label” use. Your Editors' opinion is that autologous growth factors, such as those found in PRP, have great potential to benefit our patients. We are paying attention to biologics with keen interest and appreciate our British colleagues for taking a scientific approach to treating the common, recalcitrant, difficult-to-cure problem of lateral epicondylitis. As clinical researchers search for cures, the use of biologics is something we enjoy imagining, and we enjoy even more seeing our imaginings become realities. In summary, we have an international journal, we pay attention to regional differences, and we are interested in hot clinical topics and controversies. We attempt to stimulate letters to the editor by inviting our international letter writers to provide more information on cartilage generation strategies and their status in your country, as well as the regulatory and reimbursement status of PRP.