What’s New in Orthopaedic Rehabilitation 2023

Noteworthy findings regarding topics such as platelet-rich plasma injection, botulinum toxin injection, and microinvasive trigger-finger release, among others, are presented in the new JBJS Guest Editorial What’s New in Orthopaedic Rehabilitation. Here, we highlight the 5 most compelling studies, as selected by co-author Donald Kasitinon, MD. 

Hand

In a prospective case series of 60 patients with trigger finger, researchers assessed functional outcomes following ultrasound-guided microinvasive trigger-finger release using an 18-gauge needle with a blade at the tip. Scores for QuickDASH, the numerical rating scale for pain, and the Nirschl scale significantly improved postoperatively. The study authors concluded that this procedure “provides significant functional improvement and full resolution of mechanical symptoms with minimal adverse events”¹. 

Orthobiologics

A randomized controlled trial (RCT) compared platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) for the treatment of knee osteoarthritis in 90 patients. Following a single-dose, intra-articular knee injection, pain and function were assessed up to 24 months postoperatively. Both modalities demonstrated significant improvement and did not differ significantly at any time point, indicating that BMAC is not superior to PRP as a therapeutic agent for knee osteoarthritis². 

A Level I RCT investigated PRP versus microfragmented adipose tissue (MFAT) for the treatment of knee arthritis. Pain and function were evaluated up to 24 months postoperatively among 118 patients who each received a single intra-articular injection of PRP or MFAT. Pain and function significantly improved in both groups, with no significant difference found between the groups. Although the differences were not significant, the adverse event rate was higher with MFAT, whereas the failure rate was higher with PRP³.  

In a prospective study including 30 patients who received PRP for lateral elbow tendinosis, researchers evaluated tendon healing on sequential MRI assessments at 1, 3, 6, 12, 18, and 24 months. MRI scans were rated from 0 (normal tendon) to 3 (worst possible condition). Continuous tendon recovery was demonstrated at each MRI assessment, with the mean MRI score improving from 2.30 pre-treatment to 0.33 at 24 months⁴.  

Sports

A single-center study assessed the efficacy of botulinum toxin injections in 16 patients with chronic exertional compartment syndrome. A total of 11 patients reported initial pain reduction: 4 with partial efficacy and 7 with complete efficacy. However, a recurrence of pain was reported by some patients, particularly those with partial initial efficacy. As noted by Guest Editorial authors Dr. Kasitinon et al., this study indicates that “botulinum toxin may be used for chronic exertional compartment syndrome with moderate efficacy and low risk, but recurrence is expected”⁵. 

What’s New in Orthopaedic Rehabilitation is freely available at JBJS.org. 

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org. 

Recent OrthoBuzz posts include: What’s New in Shoulder and Elbow Surgery, What’s New in Hip Surgery, and What’s New in Osteoporosis and Fragility Fractures. 

References 

1. Colberg RE, Jurado Vélez JA, Garrett WH, Hart K, Fleisig GS. Ultrasound-guided microinvasive trigger finger release technique using an 18-gauge needle with a blade at the tip: a prospective study. PM R. 2022 Aug;14(8):963-70. 
2. Anz AW, Plummer HA, Cohen A, Everts PA, Andrews JR, Hackel JG. Bone marrow aspirate concentrate is equivalent to platelet-rich plasma for the treatment of knee osteoarthritis at 2 years: a prospective randomized trial. Am J Sports Med. 2022 Mar;50(3):618-29. 
3. Zaffagnini S, Andriolo L, Boffa A, Poggi A, Cenacchi A, Busacca M, Kon E, Filardo G, Di Martino A. Microfragmented adipose tissue versus platelet-rich plasma for the treatment of knee osteoarthritis: a prospective randomized controlled trial at 2-year follow-up. Am J Sports Med. 2022 Sep;50(11):2881-92. 
4. Suzuki T, Hayakawa K, Nakane T, Fujita N. Repeated magnetic resonance imaging at 6 follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis. J Shoulder Elbow Surg. 2022 Aug;31(8):1581-7. 
5. Charvin M, Orta C, Davy L, Raumel MA, Petit J, Casillas JM, Gremeaux V, Gouteron A. Botulinum toxin A for chronic exertional compartment syndrome: a retrospective study of 16 upper- and lower-limb cases. Clin J Sport Med. 2022 Jul 1;32(4):e436-40.