Objectives

The monitoring of fracture healing is a complex process. Typically, successive radiographs are performed and an emerging calcification of the fracture area is evaluated. The aim of this study was to investigate whether different bone healing patterns can be distinguished using a telemetric instrumented femoral internal plate fixator.

Objectives

Osteochondral injuries, if not treated adequately, often lead to severe osteoarthritis. Possible treatment options include refixation of the fragment or replacement therapies such as Pridie drilling, microfracture or osteochondral grafts, all of which have certain disadvantages. Only refixation of the fragment can produce a smooth and resilient joint surface. The aim of this study was the evaluation of an ultrasound-activated bioresorbable pin for the refixation of osteochondral fragments under physiological conditions.

Introduction: We developed a new treatment option for localized articular cartilage defects: the matrix-induced, autologous chondrocyte transplantation (MACT) in which we seeded autologous chondrocytes on porcine porous matrices of type I/III collagen (Chondro-Gide®, Geistlich Biomaterials, Wolhusen, Switzerland) instead of a periosteum flap.The target of this clinical prospective study was to evaluate the outcome for a follow up period of five years after transplantation.

Methods: Between 1998 and 2001 we treated 38 patients (19 male and 19 female) with localized cartilage defects (Outerbridge grade three to four). Within the follow up time of this study until October 2002 the patients were assessed clinically 3, 6, 12, 18, 24, 36 and 60 month after the transplantation using four different standard rating scales: the Meyers-score, the Tegner/Lysholm-score, the Lysholm/Gilquist-score and the ICRS-score as well as MRI. Results were documented and compared with the pre operatives. Furthermore histological stainings of four patients were assessed.

Results: Mean patient age was 35 years (19 to 58 years). Average defect size was 5,6 qcm, 10 defects localized patellar, 16 femoral medial,3 femoral lateral and 9 combined. Two years after operation 66,7% (n=25) of the patients rated the function of their knee as much better or better than before in the subjective evaluation. After five years the percentage decreased to 57,1% (n=10). Up to a follow-up time of 24 month the clinical outcome of all four scores illustrated an significant improvement. Five years after transplantation two scores still showed significant improvement (Meyers-score: p= 0,02; Lysholm-Gilquist-Score: p=0,02). The other two scores showed improvement which turned out to be non significant (Tegner-Lysholm-Score: p=0,19; ICRS-Score: p=0,06) MRI scanning results after one year could not detect the quality of cartilage defect repair. Histological evaluation of four patients might not identify any association between the quality of the tissue and the clinical outcome

Conclusion: Five years results in two scores (Meyer- and Lysholm-Gilquist-Score) still showing significant improvement imply that MACT has turned out to be an acceptable alternative for the treatment of localized cartilage defects in the knee.