Prognostic II.

No abstract

Articular cartilage is the load-bearing tissue found inside all articulating joints of the body. It vastly reduces friction and allows for smooth gliding between contacting surfaces. The structure of articular cartilage matrix and cellular composition is zonal and is important for its mechanical properties. When cartilage becomes injured through trauma or disease, it has poor intrinsic healing capabilities. The spectrum of cartilage injury ranges from isolated areas of the joint to diffuse breakdown and the clinical appearance of osteoarthritis. Current clinical treatment options remain limited in their ability to restore cartilage to its normal functional state. This review focuses on the evolution of biomaterial scaffolds that have been used for functional cartilage tissue engineering. In particular, we highlight recent developments in multiscale biofabrication approaches attempting to recapitulate the complex 3D matrix of native articular cartilage tissue. Additionally, we focus on the application of these methods to engineering each zone of cartilage and engineering full-thickness osteochondral tissues for improved clinical implantation. These methods have shown the potential to control individual cell-to-scaffold interactions and drive progenitor cell differentiation into a chondrocyte lineage. The use of these bioinspired nanoengineered scaffolds hold promise for recreation of structure and function on the whole tissue level and may represent exciting new developments for future clinical applications for cartilage injury and restoration.

Purpose: This study aimed to determine whether PROMIS Physical Function and Pain Interference scores varied at presentation for specialty care by non-trauma hand condition. The secondary aim was to compare PROMIS scores to a reference standard, the QuickDASH, regarding the magnitude and direction of score differentials between diagnoses.Methods: PROMIS Physical Function and Pain Interference scores were analyzed from 1471 consecutive new adult patient clinic visits at a tertiary orthopaedic hand clinic presenting with one of 5 non-trauma hand conditions. A 5-point difference on PROMIS assessments was presumed to be clinically relevant. A random sample of 30 QuickDASH scores from each diagnostic group was evaluated for score differentials between groups. We also measured the correlation between PROMIS and QuickDASH scores.Results: Patients with carpal tunnel syndrome and thumb basal joint arthritis reported worse Physical Function and more Pain Interference, while those with Dupuytren contractures and ganglion cysts reported less pain and better function. For both domains, patients with trigger fingers averaged PROMIS scores between the other groups. Similar differences were observed in QuickDASH scores as patients with carpal tunnel syndrome and thumb arthritis reported clinically worse upper extremity function than patients with ganglion cysts and Dupuytren contracture. A strong correlation was seen between QuickDASH scores with both PROMIS Physical Function scores and Pain Interference scores.Conclusions: PROMIS is sufficiently able to capture differences in self-reported function and pain interference between patients with different hand conditions. PROMIS Physical Function demonstrates construct validity when evaluated against a reference of the QuickDASH across nontrauma hand conditions.

Pediatric PROMIS UE function scores capture impairment from UE fractures but do have a strong positive correlation with pediatric PROMIS Mobility, which assesses lower extremity function. Among children with UE fractures, parent-proxy completion of pediatric PROMIS appears associated with worse scores on most PROMIS domains.