Osteochondral allograft (OCA) transplantation is a clinically and cost-effective option for symptomatic cartilage defects. In 2017 we initiated a program for OCA transplantation for complex chondral and osteochondral defects as a UK tertiary referral centre. To characterise the complications, re-operation rate, graft survivorship and clinical outcomes of knee OCA transplantation.Abstract
Background
Aim
Subtotal or total meniscectomy in the medial or lateral compartment
of the knee results in a high risk of future osteoarthritis. Meniscal
allograft transplantation has been performed for over thirty years
with the scientifically plausible hypothesis that it functions in
a similar way to a native meniscus. It is thought that a meniscal
allograft transplant has a chondroprotective effect, reducing symptoms
and the long-term risk of osteoarthritis. However, this hypothesis has
never been tested in a high-quality study on human participants.
This study aims to address this shortfall by performing a pilot
randomised controlled trial within the context of a comprehensive
cohort study design. Patients will be randomised to receive either meniscal transplant
or a non-operative, personalised knee therapy program. MRIs will
be performed every four months for one year. The primary endpoint
is the mean change in cartilage volume in the weight-bearing area
of the knee at one year post intervention. Secondary outcome measures
include the mean change in cartilage thickness, T2 maps, patient-reported
outcome measures, health economics assessment and complications.Objectives
Methods
To critically evaluate exciting new technology to reconstruct menisci for the treatment of post menisectomy pain and relate results to indication and surgical technique in a non-inventor's general knee practice. We present our early experience of two non-comparative series with different meniscal implants. Series 1: Thirteen patients received a Menaflex implant (Regen Bio, USA). Mean age 30, male/female 11/2, mean length of implant 44mm, mean chondral grade 1.9 (Outerbridge). At 24 months clinical scores showed improvement in 12. Second look arthroscopy in 5 however showed disappointing amounts of regenerative tissue. One patient has been revised. Series 2: Twelve patients received an Actifit implant (Orteq, UK). Mean age 38, male/female 8/4, mean length implant 43 mm, mean chondral grade 1.3. At 12 months all have improved clinical scores. We have performed two second looks, one of these showed excellent integration. However one showed only 50% regeneration. Critical review of the initial implantation shows that there may not have been adequate preparation of the host meniscus tissue.Purpose
Methods
To identify the degree of morphological change achievable following the Bereiter trochleoplasty and to establish whether these results are comparable with functional outcomes. Seventeen consecutive patients (19 knees) with patellar instability secondary to trochlear dysplasia underwent trochleoplasty, of which 12 knees (12 patients) were radiologically evaluated pre- and post surgery using axial CT and MRI imaging. Their mean age at time of surgery was 28.1 years (15 to 44). The mean follow-up was 2.2 years (0.5 to 5). The following four radiological outcomes were used: trochlear depth (TD), transverse patellar shift (TPS), lateral patellar inclination angle (LPIA) and sulcus angle (SA). All knees were assessed post-operatively using MRI. The axial CT images were reformatted which allowed for direct comparison with MRI. Each knee was radiologically evaluated twice by a senior musculoskeletal radiology consultant to increase data accuracy and assess for intra-observer reliability using the intraclass correlation coefficient (ICC). Functional outcomes consisted of the KOOS, Lysholm, Kujala and Tegner scores.Purpose of Study
Methods
Recent advances in understanding of ACL insertional anatomy has led to new concepts of anatomical positioning of tunnels for ACL reconstruction. Femoral tunnel position has been defined in terms of the lateral intercondylar ridge and the bifurcate ridge but these can be difficult to identify at surgery. Measurements of the lateral wall either using C-arm x-ray control or specific arthroscopic rulers have also been advocated. 30 patients undergoing ACL reconstruction before and after introduction of a new anatomical technique of ACL reconstruction were evaluated using 3D CT scan imaging with cut away views of the lateral aspect of the femoral notch and the radiological quadrant grid. In the new technique, with the knee at 90 degrees flexion, the femoral tunnel was centred 50% from deep to shallow as seen from the medial portal (Group A). Group B consisted of patients where the femoral tunnel was drilled through the antero-medial portal and offset from the posterior wall using a 5mm jig.Hypothesis
Method
Focal chondral defects are thought to contribute to the onset of degenerative changes in cartilage and therefore effective treatments of these lesions are aggressively pursued. A number of options such as bone marrow stimulation, osteochondral autograft transplantation, osteochondral allograft transplantation, and autologous chondrocyte implantation exist. Long-term data regarding efficacy and outcome for some of these approaches seem to suggest that there is still a need for a low-cost, effective treatment that leads to a sustained improvement in symptoms and the formation of hyaline cartilage. artilage autologous implantation system (CAIS) is a surgical method in which hyaline cartilage fragments from a non-weight bearing area in the knee joint are collected and then precipitated onto an absorbable filter that is subsequently placed in the focal chondral defect. The clinical outcome of CAIS was compared with microfracture (MFX) in a pilot study. In an IRB approved protocol patients (n=29) were screened with the intention to treat, randomised (2:1, CAIS:MFX) and followed over a 24 month period. To be included in the study the patient may have up to 2 contained focal, unipolar lesions (≤ ICRS grade 3d and ≤ ICRS Grade IVa OCD lesions of femoral condyles and trochlea with a size between 1 and 10 cm2. There were no differences in the demographics between the two treatment groups. We report 24 month patient-reported outcome (PRO) data using the KOOS-scale. The values (mean±SD) for the Sport&Recreation (S&R) and Quality of Life scales are shown in the figures below. We noted that at 12 months after the intervention CAIS differentiated itself from MFX in that the changes in S&R were different (p<0.05, t-test) at 12, 18, and 24 months. QoL data were different at 18 and 24 months. The other KOOS-subscales in CAIS and MFX were not significantly different at any time point. The data suggest that CAIS led to an improvement in clinical outcomes in the second year post-intervention. It is possible that the improvement of symptoms that we measured may be associated with the formation of hyaline cartilage. Study funded by ATRM and DePuyMITEK.
To identify the early functional outcomes, survivorship and complications associated with the Corin Uniglide Unicompartmental Knee Replacement (UKRs) from an independent centre. A prospective consecutive case series of sixty Uniglide UKRs was carried out in fifty-one patients between January 2006 and March 2009. The data collected included:
Primary outcome measures: Pre- and post-operative American Knee Society Score (AKSS), Oxford Knee Scores (OKS), WOMAC Survivorship Secondary outcome measures: X-ray error scores assessing component position Complications No cases were lost to follow-up. Mean follow-up time was 19 months (12 to 36months) and mean age was 66 years (39 to 78 years). Kaplan-Meier Survivorship showed 95% survival at 3 years (CI:6.4). All functional outcomes showed significant improvement p <0.05. There were two revisions within the first year, which were the main complications, secondary to aseptic tibial loosening and collapse of the posteromedial tibia. The x-ray error score identified the most common error as the femoral flexion/extension angle followed by the anterior/posterior fit.Purpose of Study
Methods and Results
