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Table 3 Summary of key data and findings of assessed studies

From: Musculoskeletal pathology as an early warning sign of systemic amyloidosis: a systematic review of amyloid deposition and orthopedic surgery

Authors

Total Subjects

Male/ Female

Mean Age (years)

Orthopedic Pathology

Biopsy location

Key Findings

Akasaki et al. [35]

36

16/20

60.8

knee OA

cartilage

Young normal cartilage: 0% amyloid deposits, 0% TTR detected; Aged normal cartilage: 58% amyloid deposits, 83% TTR detected; OA cartilage: 100% amyloid deposits, 100% TTR detected

aus dem Siepen et al. [36]

466

373/93

63.7

CTS and LSS

none

Latency between CTR and diagnosis of systemic amyloidosis was significantly longer in ATTRwt compared to ATTRm (117 ± 179 months vs 66 ± 73 months; p=0.02)

Bishop et al. [15]

82

55/27

70.5

CTS

none

CTS associated with a longer delay in diagnosis (OR: 2.13; 95% CI 1.49–3.03) in 82 patients with AL or ATTR cardiomyopathy

Fernandez Fuertes et al. [37]

147

31/116

58

CTS

TCL, FTS

29 of 147 (19.7%) of patients undergoing CTR had amyloid positive biopsies; 4 patients later developed systemic amyloidosis

Geller et al. [38]

151

137/14

74.7

Distal biceps rupture

none

33.3% [95% CI, 24.7–42.9%] of 111 patients with ATTRwt cardiomyopathy had ruptured distal biceps tendon on exam

Gies et al. [39]

100

60/40

NS

LSS

LF

12 of 100 specimens from LSS and LDH patients contained amyloid; 5 contained very strong TTR presence

Gioeva et al. [14]

1020

351/669

61.8

CTS

TCL

98 biopsies contained TTR amyloid;

70 of 81 patients with DNA sequencing had wildtype TTR gene

Gu et al. [23]

36

16/20

66.4

knee OA

knee synovium

9 of 36 knee OA patients had amyloid positive biopsies;

8 contained TTR amyloid and 1 contained light-chain amyloid

Kyle et al. [40]

35

23/12

71

CTS

TCL, FTS

33 of 35 had TTR amyloid; 2 developed systemic amyloidosis

Nakamichi et al. [41]

108

5/103

56

CTS

TCL, FTS

10 of 108 patients had amyloid deposits, 6 contained TTR amyloid

Niggemeyer et al. [42]

50

14/36

68.4

Hip OA

synovium, cartilage

17 of 50 consecutive patients had amyloid deposits, all contained TTR amyloid

Rubin et al. [27]

313

234/79

66.6

knee and hip OA, rotator cuff

none

THA and TKA significantly more common among ATTR patients with cardiomyopathy (THA: RR 5.61, 95% CI 2.25–4.64; TKA: RR 3.32, 95% CI 2.25–4.64)

Samões et al. [43]

16

3/13

46.1

CTS

TCL

In 16 patients with known ATTRm, 15 patients had CTS that preceded amyloidosis and 14 had amyloid positive biopsies

Scott et al. [44]

35

16/19

72

recurrent CTS

FTS

9 of 35 patients (26%) with recurrent CTS had an amyloid positive biopsy, 7 of which contained TTR

Sekijima et al. [18]

132

40/92

71.8

CTS

FTS

34 of 100 patients with idiopathic CTS had TTR amyloid deposits versus 7 of 32 autopsy controls (OR, 15.8; 95% CI, 3.3–75.7)

Sperry et al. [45]

98

51/47

68.5

CTS

FTS

10 of 98 patients undergoing CTR had an amyloid positive biopsy (7 TTR, 2 light chain); 3 diagnosed with systemic amyloidosis

Stein et al. [46]

108

NS

NS

CTS

TCL

Amyloid deposits were found in 23 of 108 (21%) patients with idiopathic CTS; TTR was identified in 14 of these 23 patients

Sueyoshi et al. [13]

111

56/55

62

CTS, LSS, rotator cuff

FTS, LF, RCT

39 of 111 specimens contained TTR amyloid deposits

Takanashi et al. [25]

232

31/201

73

knee OA

synovium

21 of 232 knee OA patients (9%) had TTR amyloid deposits

Uchihara et al. [47]

25

NS

NS

NS

periarticular F&A

3 of 25 specimens contained TTR amyloid

Westermark et al. [20]

26

13/13

66.5

LSS

LF, bone fragments

21 of 26 specimens contained amyloid deposits; 5 of 15 specimens suitable for immunohistochemistry contained TTR amyloid

Yanagisawa et al. [21]

95

68/27

70.7

LSS

LF

All 95 LF specimens resected from LSS patients contained amyloid deposits; 43 contained TTR amyloid

Yanagisawa et al. [26]

52

17/35

66.6

knee OA

periarticular knee

TTR amyloid deposits were found in specimens from: 18 of 51 menisci, 8 of 27 articular cartilage, and 6 of 34 synovium

Zegri-Reiriz et al. [48]

101

32/69

69

CTS

none, myocardial

Prevalence of cardiac amyloidosis in the cohort was 1.2% (3/233) and 5.5% (3/55) for patients with LVH and bilateral CTS

  1. CI confidence interval, CTS carpal tunnel syndrome, DNA deoxyribonucleic acid, F&A foot and ankle, FTS flexor tenosynovium, LF ligamentum flavum, LDH lumbar disc herniation, LSS lumbar spinal stenosis, LVH left ventricular hypertrophy, NS not specified, OA osteoarthritis, OR odds ratio, RCT rotator cuff tendon, RR relative risk, TCL transverse carpal ligament, THA total hip arthroplasty, TKA total knee arthroplasty