Ouery: Matrix-coupled autologous chondrocyte transplantation (MACT) has become increasingly widespread in the therapy of cartilage defects. The objective of this controlled prospective study was to examine the mid-term results of MACT compared to those of Microfracturing (MF) for the treatment of cartilage defects in the knee joint and to determine possible advantages or disadvantages of the two methods.

Method: In order to compare the two treatment methods, 40 patients with discrete cartilage defects were treated with MACT and 40 with MF between 4/01 – 4/03. As inclusion criterion, the patients had a chondral defect of at least 1.5 cm and as exclusion criterion, there could be no additional cartilage damage in the other areas of the knee. MRI examinations were performed preoperative (T2 gew. TSE-Sequence, fetts. FLASH-3D) and could be repeated after 6 and 12 months. Knee joint function, the activity level and the patient’s quality of life were evaluated in both groups pre- and postoperative using the modified Cincinnati Score and the Tegner Activity Index.

Results: There was significant improvement in the scores used for the study in both the MF group and the MACT group. Comparison of the two groups revealed significantly greater clinical improvement in the MACT patients than in the MF patients (3.8 point increase MACT versus 2.6 point increase MF in the Cincinnati Score). Taking the size extent of the treated cartilage damage into account, there was, however, no relevant difference in defects less than 2,5 qcm.

Conclusion: The study could demonstrate that both methods are successful in treating localized cartilage damage in the knee joint. Comparison of the two forms of therapy showed a greater extent of improvement in the MACT group. However, classification by the size of the defect revealed that this effect was relevant only in larger defects, so that the size of the defect should be a decisive criterion for the selection of therapy.

Query: In the past few years, chevron osteotomy has become more widespread in the treatment of mild Hallux valgus deformities thanks to its low rate of complications and excellent results. The results in moderate to severe deformities are not as convincing, depending on the surgical procedure used. The objective of this study was to examine the influence which the choice of surgical procedure and thus the osteotomy has on the clinical, radiological and pedobarographic results in the forefoot.

Method: In a prospective study, we examined the surgical results of 140 feet treated between August 2004 and March 2005 in our clinic for moderate Hallux-Valgus deformity. In 70 patients, Ludloff osteotomy and in 70 the Scarf osteotomy was selected as the method. The patients underwent pre- and postoperative clinical, radiological and pedobarographic examination. In addition, patient satisfaction was determined using the Kitaoko Forefoot Score. Indication for performance of the osteotomy was a Hallux-Valgus deformity up to an intermetatarsal angle (IMA) of 17°.

Results: The mean preoperative IMA was 14.5 °, the Hallux-Valgus angle (HVA) 31.3°. The IMA could be improved by Scarf osteomy on average by 7.6°, by Ludloff osteotomy by 8.1°. With suitable plantarisation of the 1st metatarsal head, better and more even pressure distribution in the forefoot could be achieved with both surgical procedures and the load peaks reduced overall. The complication rate was somewhat lower overall in the Scarf osteomy.

Conclusion: Both the Scarf osteotomy, and the Ludloff ostetomy enable achieving of good results in moderate deformity. The extent to which one procedure should be preferred over the other could not be determined. Both procedures have advantages as well as disadvantages. Further attention to this area of Hallux-valgus surgery is definitely needed to meet the higher demands of the patients.

Query: The means for treating Osteochondrosis dissecans (OD) of the knee joint in adolescents remains today a matter of controversial discussion. Not only the different treatments, whether purely conservative or one of the various surgical procedures, are rated differently with respect to their benefit, but also the question of the right time to operate is not easy to answer. The objective of this prospective study was to examine the long-term results of a bioabsorbable fixation system in the treatment of OD and to determine possible relationships between the baseline conditions, such as stage of disease, patient’s age, severity or localization and the results in each case.

Method: Between 1995 and 2005, 312 patients aged 7 to 19 years with Osteochondrosis dissecans were treated by means of arthroscopic operation on the knee joint. In 257, fixation using ethipins could be performed, the dissecate had to be removed in 31 patients. An MRT was performed preoperative in all patients, the knee joint function, activity level and patient’s quality of life were evaluated postoperative using the modified Cincinnati Score, the Tegner Activity Index and the Lysholm Score.

Results: 255 of the 312 patients were available to follow-up over a longer period (Ø 7.9 years). The Lysholm Score for all patients 5 years after surgery was 87.6 points, after 10 years 76.5. Classified by baseline stage, it was found that the postoperative course was clearly better in those patients in whom fixation was required. Moreover, an early stage of OD and younger patient age were prognostically favorable factors. The MRT follow-up examination showed re-integrated vital cartilage areas without signs of fixation residuals in patients in whom fixation was performed.

Conclusion: Surgical treatment of Osteochondrosis dissecans brings different results depending on the stage of the disease. Moreover the results depend on patients age, location of the defect, duration of symptoms. If fixation of the dissecate using bioabsorbable pins is successful, the long-term results achieved are good to excellent. Overall, the data obtained justify an early decision for a surgical procedure in the treatment of Osteochondrosis dissecans of the knee joint in children and adolescents.