Aims. Osteochondral lesions of the talus (OLT) are a common cause of disability and chronic ankle pain. Many operative treatment strategies have been introduced; however, they have their own disadvantages. Recently lesion repair using autologous cartilage chip has emerged therefore we investigated the efficacy of particulated autologous cartilage transplantation (PACT) in OLT. Methods. We retrospectively analyzed 32 consecutive symptomatic patients with OLT who underwent PACT with minimum one-year follow-up. Standard preoperative radiography and MRI were performed for all patients. Follow-up second-look arthroscopy or MRI was performed with patient consent approximately one-year postoperatively. Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) score and International Cartilage Repair Society (ICRS) grades were used to evaluate the quality of the regenerated cartilage. Clinical outcomes were assessed using the pain visual analogue scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Scale (FAOS). Results. All patients had ICRS grade IV cartilage lesions, except for one (ICRS grade III). The paired MOCART scores significantly improved from 42.5 (SD 1.53) to 63.5 (SD 22.60) (p = 0.025) in ten patients. Seven patients agreed to undergo second-look arthroscopy; 5 patients had grade I (normal) ICRS scores and two patients had grade II (nearly normal) ICRS scores. VAS, FFI, and all subscales of FAOS were significantly improved postoperatively (p ≤ 0.003). Conclusion. PACT significantly improved the clinical, radiological, and morphological outcomes of OLT. We consider this to be a safe and effective surgical method based on the short-term clinical results of this study. Cite this article: Bone Jt Open 2023;4(12):942–947

MACI Cartilage Transplantation has been performed in New Zealand for the last three years for patients with isolated articular cartilage defects who have failed a microfracture technique. Ten patients have undergone this procedure. Patients were evaluated by an independent research assistant preoperatively and at 6, 12 and 24 months. Visual analogue pain score, ICRS score, WOMAC score, KOOS score, IKDC score, Tegner score and SF 36 were collected at all time points. An MRI scan was performed in all patients at 12 months.

So far, ten patients have a minimum of 12 month data, while two have been followed to 12 months. There has been an improvement in visual analogue pain score, ICRS score, WOMAC score, KOOS score, IKDC score and SF 36. No procedures have failed. All MRI scans showed restoration of articular cartilage.

In conclusion, early results are encouraging. The rehabilitation is long, thus 12 month data do not give an accurate outcome measure. Ongoing evaluation is occurring

Introduction: Arthroscopy to debride osteochondral lesions (OCL) of the talus is an accepted procedure with a good outcome in 70–80% of subjects. The minority of subjects that do not do well present a problem. Further arthroscopy and debridement procedures have been assumed to yield poor results and this has been used as justification for cartilage transplantation. The evidence for this is lacking. Methods: In our unit the routine procedure for OCL is arthroscopic debridement. If this fails a further arthroscopic debridement is performed. We identified all subjects who had had a repeat procedure for failed arthroscopic debridement of an OCL by the senior author and reviewed them clinically. The outcome was scored using the AOFAS hind foot and ankle scoring system. Results: Between 1993 and 2002 808 ankle arthroscopies were performed of which 215 were to treat OCLs. Of these 12 had repeat arthroscopies because of a poor outcome. AOFAS scores improved from a mean of 34.8 to 80.5 at a mean follow up of 5.9 years (range 18 months – 11 years). One subject had already undergone a cartilage transplantation procedure because of a poor outcome. The other 11 subjects scored themselves as fair or good and had returned to previous levels of activity, including two professional sportsmen. It was clear by 6 months in all subjects that their symptoms were significantly improved following the second procedure. Conclusions: This is the first series specifically assessing subjects who have had repeat arthroscopic debridement of OCLs of the talus. Our results disprove the assumption that repeat arthroscopic debridement yield poor results. It provides benchmark results at medium term follow up for cartilage transplantation to be compared to

To present our experince in the use of different autologous cartilage transplantation techniques with concomitant procedures. The last 30 months we treated 42 patients with chondral defect at the knee. Their mean age was 34 y.o. and the men to women ratio was 28/14. The defect concerned the medial femoral condyle(20), the lateral femoral condyle (14), the medial facet of the patella (4) while 4 patients demonstrated chodral defects in both femoral condyles. The mean area of the defect was 6.5 cm2 while defects measuring below 2.5 cm2(10) were treated arthroscopically using microfracturing trechnique. 20 cases were treated for chondral defect alone using either MACI or ACT-3D technique for chondrocyte transplantation and in 12 cases there was a combination of cartilage transplantation with alignment correction procedures. Finally a modified rehabilitation protocol was used. All the cases were performed uneventfully. We assesed the patients 12 months post-operatively using the LYSHOLM & GILLQUIST score, FAFA kai Visual Analogue Pain Score. The clinical outcome was excellent, the follow-up using ‘MRI showed adequate filling of the defect without significant bone swelling. Our early results using the method are more than encouraging. The method continues to evolve and is very challenging. As far as we know this the first publication concerning 3rd generation autologous chondrocyte transplantation in both femoral condyles silmutaneously

Chondral injuries of the knee are extremely common and present a unique therapeutic challenge due to the poor intrinsic healing of articular cartilage. These injuries can lead to significant functional impairment. There are several treatment modalities for articular osteochondral defects, one of which is autologous chondrocyte implantation. Our study evaluates the mid to long term functional outcomes in a cohort of 828 patients who have undergone an autologous chondrocyte implantation procedure (either ACI or MACI), identifying retrospectively factors that may influence their outcome. The influence of factors including age, sex, presence of osteoarthritis and size and site of lesion have been assessed individually and with multivariate analysis. All patients were assessed using the Bentley Functional Score, Visual Analogue Score and the Cincinnati Functional Score. Assessment were performed pre-operatively and of their status in 2010. The majority of patients had several interim scores performed at varying intervals. The longest follow-up was 12 years (range 24 to 153 months) with a mean age of 34 years at time of procedure. The mean defect size was 486 mm2 (range 64 to 2075 mm2). The distribution of lesions was 51% Medial Femoral Condyle, 12.5% Lateral Femoral Condyle, 18% Patella (single facet), 5% Patella (Multifacet) and 6% Trochlea. 4% had cartilage transplant to multiple sites. 30% failed following this procedure at a mean time of 72 months. 52% patients stated a marked improvement in their functional outcomes within the first two years. 49% stated an excellent result following their procedure. High failure rate was noted in those with previous cartilage regenerative procedures, transplants occurring on the patella, particularly if involving multifacets. Multiple site cartilage transplantation was also associated with a high failure rate. Autologous chondrocyte implantation is an effective method of decreasing pain and increasing function, however patient selection plays clear role in the success of such procedure

Introduction. Pathophysiology of glenohumeral arthritis differs depending upon type of arthritis. Osteoarthritis. Post-traumatic arthritis. Inflammatory arthritis (i.e. RA). Arthritis of instability. Crystalline arthritis (Milwaukee shoulder, cuff tear arthropathy). Avascular necrosis. Natural history as well as response to treatment are both pathology dependent. Soft-tissue involvement. Rotator cuff tear. Soft tissue contracture. Secondary osseous deformity. Regional osteopenia. Glenoid wear (concentric versus eccentric). Humeral collapse. Surgical options. Joint-sparing techniques. Arthroscopic capsular release/ joint debridement/synovectomy. Open debridement, subscapularis lengthening. Open capsular interposition. Osteotomy. Glenoid. Humeral. Cartilage transplantation. Arthrodesis. Resection arthroplasty. Joint replacement. Unconstrained. Hemiarthroplasty. Total shoulder replacement. Constrained. Joint-sparing Techniques. These techniques are only useful in patients with early changes or who are too young and active for joint replacement. Arthroscopic debridement or capsular release. Young patients. Normal joint alignment. Severe asymmetric capsular contracture (i.e. arthritis of instability). Open debridement. Large humeral osteophytes. Subscapularis lengthening. Open capsular interposition. Lateral edge of anterior capsule sutured to posterior labrum. Less severe degrees of contracture, subscapularis must be repaired anatomically. Osteotomy. Only useful in situations where there is abnormal humeral or glenoid alignment. Glenoid – posterior opening wedge for osteoarthritis in combination with posterior glenoid hypoplasia or increased retroversion. Humeral – most useful for post-fracture deformity (i.e. varus of the surgical neck). Cartilage Transplantation. Very early experience and really only attempted in any numbers in the knee. Chondrocyte transplantation very expensive and tedious. Currently, the most popular techniques involve transplanting plugs or cores of articular cartilage, subchondral bone, and cancellous bone. Autograft- harvest from non-weight-bearing or less weight-bearing area the same or different bone. Lateral femoral condyle. Posterolateral humeral head. Allograft. Early attempts limited by chondrocyte viability after harvest. Improved processing techniques have recently improved chondrocyte survival to 60–70%. Offers the desirable option of being able to preoperatively match radii of curvature of implant to donor site. Arthrodesis. Fortunately, rarely indicated. Patients miss the ability to rotate the humerus. Indications. Brachial plexus injury. Combined deltoid and rotator cuff deficiency. Young heavy labourer. Sepsis. Severe bone loss. Requires functional trapezius and serratus anterior. Resectional Arthroplasty (Jones Procedure). Even more rarely indicated than arthrodesis. Function is better if rotator cuff is attached to proximal humerus. Indications. Sepsis. Failed arthroplasty. Combined deltoid and rotator cuff deficiency. Conclusions. Hemiarthroplasty or total shoulder replacement with unconstrained implants is the surgical treatment of choice in the vast majority of patients with glenohumeral arthritis. Joint-sparing procedures are indicated in young patients with early, less extensive changes. Arthrodesis and resection arthroplasty are rarely indicated, except under unusual circumstances of soft-tissue deficiency, nerve injury, or sepsis. Cartilage transplantation shows promise in very select patients

The aim of this study was to determine whether the clinical outcome of autologous chondrocyte transplantation was dependent on the timing of a high tibial osteotomy in tibio-femoral mal-aligned knees. Between 2000 and 2005, forty-eight patients underwent autologous chondrocyte implantation with HTO performed at varying times relative to the second stage autologous chondrocyte implantation procedure. 24 patients had HTO performed simultaneously with their second stage cartilage transplantation, (the HTO Simultaneous Group). 5 patients had HTO prior to their cartilage procedure, (the HTO pre-ACI Group) and 19 had HTO performed between 1 to 4 years after their second stage cartilage implantation, (the HTO post-ACI Group). There were 29 men and 19 women with a mean age of 37 years (Range 28 to 50) at the time of their second stage procedure. With average follow-up of 72 months we have demonstrated a significant functional benefit in performing the HTO either prior to or simultaneously with the ACI procedure in the mal-aligned knee. The failure rate in the Post-ACI group was 45% compared to the Pre-ACI and Simultaneous group, with failure rates of 20% and 25%, respectively. An HTO performed prior to or simultaneously with an autologous chondrocyte implantation procedure in the mal-aligned knee, provides a significant protective effect by reducing the failure rate by approximately 50%

Chondral injuries of the knee are extremely common and present a unique therapeutic challenge due to the poor intrinsic healing of articular cartilage. These injuries can lead to significant functional impairment. There are several treatment modalities for articular osteochondral defects, one of which is autologous chondrocyte implantation. Our study evaluates the mid to long term functional outcomes in a cohort of 828 patients who have undergone an autologous chondrocyte implantation procedure (either ACI or MACI), identifying retrospectively factors that may influence their outcome. The influence of factors including age, sex, presence of osteoarthritis and size and site of lesion have been assessed individually and with multivariate analysis. All patients were assessed using the Bentley Functional Score, Visual Analogue Score and the Cincinnati Functional Score. Assessment were performed pre-operatively and of their status in 2010. The longest follow-up was 12 years (range 24 to 153 months) with a mean age of 34 years at time of procedure. The mean defect size was 409 mm. 2. (range 64 to 2075 mm. 2. ). The distribution of lesions was 51% Medial Femoral Condyle, 12.5% Lateral Femoral Condyle, 18% Patella (single facet), 5% Patella (Multifacet) and 6% Trochlea. 4% had cartilage transplant to multiple sites. High failure rates were noted in those with previous cartilage regenerative procedures or evidence of early osteoarthritis and those with transplantation to multiple sites. Autologous chondrocyte implantation is an effective method of decreasing pain and increasing function, however patient selection plays clear role in the success of such procedure

Background. An osteochondral defect in the knees of young active patients represents a treatment challenge to the orthopaedic surgeon. Early studies with allogenic cartilage transplantation showed this tissue to be immunologically privileged, showed fresh grafts to maintain hyaline cartilage, and surviving chondrocytes several years after implantation. Methods. Between January 1978 and October 1995 we enrolled 63 patients in a prospective non-randomised study of fresh osteochondral allografts for post-traumatic distal femur defects in our institute. Five international patients who were lost to follow-up were excluded from this study. The indications for the procedure were: patients younger than 50 years of age having unipolar post-traumatic defects, or osteochondritis dissecans larger than three cm in diameter and one cm in depth. Results. Fifty-eight patients, ages 11-48 (mean 28) were followed for 15-32 years (mean 21.8 years). Thirteen of the 58 grafts have subsequently required further surgery, with three having graft removal and ten converted to total knee arthroplasty. Three patients died during the study due to unrelated causes and are included in the survivorship curve. Kaplan-Meier survivorship analysis showed: 91%, 84%, 69%, and 59% graft survival at 10, 15, 20, and 25 years, respectively. Patients with surviving grafts had good function, with a mean modified Hospital for Special Surgery score of an average 86 at 20 years or more following the allograft transplantation surgery. Late osteoarthritic degeneration as was seen on radiographs was associated with lower Hospital for Special Surgery scores representing patients with poorer clinical outcome. Conclusion. The authors confirm the value of fresh osteochondral allograft as a long term solution for articular defect in the knees of young patients. We recommend the use of fresh osteochondral allograft for treatment of large osteochondral defects in the distal femur of young and active patients

To present our preliminary results in fully arthroscopically performed 3-dimensional autologous cartilage transplantation (ACT-3D) for medium to large focal chondral defects at the knee. We treated operatively in our Dept., 35 symptomatic patients between March 2007 and May 2008. The mean age was 32 years old. The mean area of cartilage defect was 6.75cm. 2. (2.2–10cm. 2. ) and all the cases were classified as grade III(16) and IV(18) according to Out-erbrigde scale. 18 of the cartilage lesions were located in the weight-bearing surface of the medial femoral condyle, 8 in the lateral one, 6 in the trochlea area and 2 in the lateral facet of the patella. We performed 15 applications of ACT3D as single procedure. Apart from that, we performed 11 ACL reconstructions combined with the 3D-spheres. Preop. and postoperative evaluation of patients was done using the Modified Cincinatti (MC) Rating System(0–100), the VAS (visual analogue pain score) (0–10), IKDC Knee examination score and Patient Outcome Function score. All the cases were performed uneventfully. No major complications were seen. All cases followed a specialized rehabilitation protocol. In MC Rating System the result rose from 41.5 to 72.5 and in VAS, pain significantly reduced from 6.1 to 1.8 in 12 months time. The Patient Outcome Function score showed 81% better, 18% same and 1% worse results. The follow-up using MRI showed adequate filling of the defect without significant bone swelling. Arthroscopically performed chondrocyte implantation (ACT) is an innovative technique with early results very promising. It’s surgeon demanding, although it’s fast performed technique and well tolerated operation. A greater number of cases and further mid and long term follow-up has to be studied in order to prove the efficacy of the method

Autologous chondrocyte transplantation has become a possible solution for the treatment of chondral knee lesions. Recently an autologous tissue engineered cartilage (Hyalograft C), using biodegradable scaffolds for cell proliferation, was successfully developed. In osteochondritis dissecans (OCD) the lesion also involves subchondral bone. For this reason we began to use a two-step technique: arthroscopic autologous bone grafting followed by autologouos condrocyte Hyalograft C transplantation after 4–6 months. We treated five patients affected by OCD. All the patients were clinically evaluated and analysed according to the International Repair Cartilage Society score at 12 and 24 months. The ICRS score showed highly satisfactory clinical results in all treated patients at 12 and 24 months; CT and MRI evaluation had demonstrated a good articular surface reconstruction with complete bone defect restoration at a short 12-month follow-up period. The autologous chondrocyte transplantation provides highly satisfactory clinical results. This second-generation autologous tissue-engineered cartilage transplantation avoids the use of periosteal flap, simplifies the surgical procedure and permits use of an arthroscopic approach. In association with autologous bone grafting, bone loss can also be restored in order to recreate a perfect articular surface. The preliminary clinical and histological results are encouraging but longer follow-up is required to better evaluate this technique

Purpose: An Osteochondral defect in the knees of young active patients represents a challenge to the orthopedic surgeon. Early studies on allogenic cartilage transplantation showed this tissue to be immunologically privileged, showed fresh grafts to have hyaline cartilage, and surviving chondrocytes present several years after implantation. Method: Since January 1978 until October 1995 we enrolled 72 patients in a prospective non-randomized study of fresh osteochondral allografts in our institute. Ten international patients which were lost to follow-up were excluded. The major indications for the procedure were: patients younger than 60 years of age having post-traumatic unipolar defects larger than three cm in diameter and one cm in depth. Results: Sixty two patients, ages 11–57 (mean 28) were followed for 15–31 years (mean 20.4 years). The etiology for the osteochondral defect was traumatic injury to the knee in 41 patients (66%), Osteochondritis Dissecans in 15 patients (24%), and in six patients (10%) due to other pre-existing conditions. Twenty of the 62 grafts have failed, with five having graft removal and 15 converted to total knee replacement. Three patients died during the course of this study due to unrelated causes. The Kaplan-Meier survivorship analysis showed: 92%, 79%, 56%, and 49% graft survival at 10, 15, 20, and 25 years respectively, (median survival = 23 years). Patients with surviving grafts had good function, with a modified Hospital for Special Surgery score of an average 88 at 20 years or more following the allograft transplantation surgery. Conclusion: Through this long term study the authors confirm the value of fresh osteochondral allografts as a long term solution for large articular defects in the knees of young patients. The improvement of patients’ outcome compared to the previous published results of our earlier studies could be attributed to improved surgical techniques and increasing expertise of the senior authors. We therefore recommend the use of fresh osteochondral allografts for treatment of large osteochondral defects in the distal femur of young and active patients

The Trap Door procedure for avascular necrosis of the femoral head has been reported to give acceptable result (. 1. ). All patients reported here were clinically approaching indication for total hip replacement (THR), and short-term results may therefore be of interest. Material and Method: Thirteen patients (5 men) age 14–48 were operated for avascular necrosis with subchondral collapse (n = 12) or sequel CalvŽ-Legg Perthes disease (n = 1). The hip was dislocated through the anterolateral. The cartilage over the necrotic area was elevated as a ßap with the base towards fovea capitis femoris. The necrotic area was debrided and channels were drilled into well-perfused bone. Autologue bone from the iliac crest was transplanted, overcorrecting the defect slightly. The cartilage ßap was sutured back and the hip relocated. Postoperatively the patients have loaded 15 kg 12 weeks, and then gradually resuming full weight bearing in additionally 6 weeks. Results: Follow up ranges from 3 months to 3.3 years. Postoperative recovery was uneventful. No patient has been reoperated, but two patient are scheduled for THR 19 and 13 months postoperatively. Preoperatively the joint space was mean 4.3 mm (3–5,) at the last follow-up it was 3.9 mm (2,3 Ð 5). The roundness of the femoral head was judged as being better postoperatively than preoperatively Discussion: The TrapDoor procedure may delay or postpone the need for arthroplasty in patients with avascular necrosis of the femoral head. The two patients who will be converted to THR did both have pain and poor range of motion after the procedure, probably indicating that the cartilage/transplanted bone were degenerating

Introduction: Autologous osteochondral transfer is an option for the treatment of articular defects. However, there are concerns about graft integration and the nature of the tissue forming the cartilage-cartilage interface. Chondrocyte viability at graft and recipient edges is stated to be an important determinant of the success of repair. As a tool, water jet (WJ) provides a cold cutting process. The cut is performed using water under high pressure (potential energy) by transforming it into water with high velocity (kinetic energy) using a nozzle. This study evaluates the feasibility of performing selective cutting on the cortical bone and articular cartilage tissue by the use of plain water jetting. Materials and Methods: Fresh full thickness cartilage explants were obtained from the stifle joints of 5 young calves (6–8 months old). Full thickness cartilage explants were removed from the femoral condyles using a scalpel. A specially designed water jet system was used for the study. The intensifier pump allowed pressure variations between 100–700 bars. The nozzle (Ø=0.2mm) was mounted on a gantry with two degrees of freedom. The cutting experiments were performed in displacement control mode, with cartilage held stationary and the nozzle moving at a traverse speed of 1mm/s. To calculate the energy typically required for consistent material removal, 40 cartilage samples were cut at various pressure levels using the water jet. Depths of the cut were measured by a Vernier caliper. Multi- and one-way analyses of variance were computed with cutting depth as dependent variable. In the second part of the study osteochondral cylinders were obtained from the femoral condyles using:. 8 mm diameter Arthrex OATS punch,. 8 mm diameter diamond coated drill punch and. the water jet cutting device. Plugs were then assessed for cell viability along the cut periphery by performing live-dead cell staining and viewing under the confocal laser scanning microscope. Results: There was a significant correlation between pressure and kerf depth (p< 0.001). At a relatively high transverse speed of 1mm/s cartilage was cut smoothly and easily. The typical material removal energy for bovine cartilage is 7,38.109 J/m. 3. Using Equation 1, the resultant kerf depths of multiple jet parameter can be calculated easily. The margin of superficial zone cell death at the curved edge was significantly greater in the OATS punch group (390±18μm) and in the diamond drill group (440±18μm), when compared to the WJ group (10±4 μm). Discussion: The dead at the cutting edge was greatly for WJ cut samples, making it a promising technology for cartilage repair. The results of the present study suggest that water jet cutting has the potential to be developed as an alternative means to prepare the cartilage for patients undergoing cartilage transplantation

Aims

The aim of this retrospective study was to determine if there are differences in short-term clinical outcomes among four different types of matrix-associated autologous chondrocyte transplantation (MACT).