Aims

The objective of this study was to present the outcomes of rotational acetabular osteotomy (RAO) over a 30-year period for osteoarthritis (OA) secondary to dysplasia of the hip in pre- or early-stage OA.

The October 2023 Sports Roundup³⁶⁰ looks at: Extensor mechanism disruption in the treatment of dislocated and multiligament knee injuries; Treatment of knee osteoarthritis with injection of stem cells; Corticosteroid injection plus exercise or exercise alone as adjuvants for patients with plantar fasciitis?; Generalized joint hypermobility and a second ACL injury?; The VISA-A ((sedentary) questionnaire for Achilles tendinopathy?.

Osteoarthritis (OA) of the equine distal interphalangeal joint (DIPJ) is a common cause of lameness. MicroRNAs (miRNAs) from biofluids such as plasma and synovial fluid make promising biomarker and therapeutic candidates. The objectives of this study are (1) Identify differentially expressed (DE) miRNAs in mild and severe equine DIPJ OA synovial fluid samples and (2) Determine the effects of DE miRNAs on equine chondrocytes in monolayer culture. Synovial fluid samples from five horses with mild and twelve horses with severe DIPJ OA were submitted for RNA-sequencing; OA diagnosis was made from MRI T2 mapping, macroscopic and histological evaluation. Transfection of equine chondrocytes (n=3) was performed using the Lipofectamine® RNAiMAX system with a negative control and a miR-92a mimic and inhibitor. qPCR was used to quantify target mRNA genes. RNA-seq showed two miRNAs (miR-16 and miR-92a) were significantly DE (p<0.05). Ingenuity Pathway Analysis (IPA) identified important downstream targets of miR-92a involved in the pathogenesis of osteoarthritis and so this miRNA was used to transfect equine chondrocytes from three donor horses diagnosed with OA. Transfection was successfully demonstrated by a 1000-20000 fold increase in miR-92a expression in the equine chondrocytes. There was a significant (p<0.05) increase in COMP, COL3A1 and Sox9 in the miR-92a mimic treatment and there was no difference in ADAMTS-5 expression between the miR-92 mimic and inhibitor treatment. RNA-seq demonstrated miR-92a was downregulated in severe OA synovial fluid samples which has not previously been reported in horses, however miR-92a is known to play a role in the pathogenesis of OA in other species. Over expression of miR-92a in equine chondrocytes led to significantly increased COMP and Sox9 expression, consistent with a chondrogenic phenotype which has been identified in human and murine chondrocytes

The February 2023 Hip & Pelvis Roundup³⁶⁰ looks at: Total hip arthroplasty or internal fixation for hip fracture?; Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty: a cross-sectional multicentre study; Long-term cognitive trajectory after total joint arthroplasty; Costal cartilage grafting for a large osteochondral lesion of the femoral head; Foley catheters not a problem in the short term; Revision hips still a mortality burden?; How to position implants with a robotic arm; Uncemented stems in hip fracture?

Aims. Rotational acetabular osteotomy (RAO) has been reported to be effective in improving symptoms and preventing osteoarthritis (OA) progression in patients with mild to severe develomental dysplasia of the hip (DDH). However, some patients develop secondary OA even when the preoperative joint space is normal; determining who will progress to OA is difficult. We evaluated whether the preoperative cartilage condition may predict OA progression following surgery using T2 mapping MRI. Methods. We reviewed 61 hips with early-stage OA in 61 patients who underwent RAO for DDH. They underwent preoperative and five-year postoperative radiological analysis of the hip. Those with a joint space narrowing of more than 1 mm were considered to have 'OA progression'. Preoperative assessment of articular cartilage was also performed using 3T MRI with the T2 mapping technique. The region of interest was defined as the weightbearing portion of the acetabulum and femoral head. Results. There were 16 patients with postoperative OA progression. The T2 values of the centre to the anterolateral region of the acetabulum and femoral head in the OA progression cases were significantly higher than those in patients without OA progression. The preoperative T2 values in those regions were positively correlated with the narrowed joint space width. The receiver operating characteristic analysis revealed that the T2 value of the central portion in the acetabulum provided excellent discrimination, with OA progression patients having an area under the curve of 0.858. Furthermore, logistic regression analysis showed T2 values of the centre to the acetabulum’s anterolateral portion as independent predictors of subsequent OA progression (p < 0.001). Conclusion. This was the first study to evaluate the relationship between intra-articular degeneration using T2 mapping MRI and postoperative OA progression. Our findings suggest that preoperative T2 values of the hip can be better prognostic factors for OA progression than radiological measures following RAO. Cite this article: Bone Joint J 2021;103-B(9):1472–1478

Developmental dysplasia of the hip (DDH) is a common risk factor of early osteoarthritis (OA), with insufficient coverage of the femoral head by the acetabulum which leads to excessive cartilage stresses in the hip joint. Knowledge of the molecular health of cartilage using MRI may diagnose and stage chondral disease, but more importantly allows for treatment stratification and prognostication. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a validated MRI technique for detecting early loss of proteoglycan (PG). However, it requires an injection of contrast agent and exercise prior to the scan. MRI techniques such as T1ρ and T2 mapping have also been shown to be sensitive to early biochemical changes in cartilage but can be performed without any contrast injection. In this study we evaluate three quantitative MR techniques (dGEMRIC, T1ρ and T2 mapping) in patients with DDH. Our hypothesis is that both T1ρ and T2 correlate with dGEMRIC, and thus may be effective non-contrast based techniques for biochemical cartilage mapping in DDH hips. Seven informed and consented patients (mean age: 31.1 years) with DDH were enrolled in this IRB approved MRI study before surgery. DDH was defined as a lateral center-edge angle under 25º and acetabular index >13º on the plain x-ray. All subjects underwent two successive MRI sessions at 3T: In the first cartilage T1ρ and T2 mapping were performed. After leaving the scanner the subjects were injected with 0.4ml/kg Dotarem (i.v.), walked for 15min and rested for 25min before returning into the MRI. dGEMRIC (T1post) mapping was initiated approximately 45min after the injection. Image post-processing, registration and cartilage segmentation was performed with Matlab. The joint was subdivided into anterior and posterior regions in the sagittal plane and into lateral, intermediate and medial zones in the transverse plane, resulting in six region of interest (ROIs): antero-lateral, antero-intermediate, antero-medial, postero-lateral, postero-intermediate and postero-medial. The correlation between the dGEMRIC and T1ρ and dGEMRIC and T2 were evaluated using Spearman's Rho and tested for significance. The analysis of all six cartilage ROIs for all subjects resulted in a significant (p < 0 .001) negative correlation (Rho = −0.50) between the dGEMRIC index (T1post) and the T1ρ relaxation time. The dGEMRIC index and T2 correlated positive (Rho = 0.55) and significant (p < 0 .001). Although this pilot study has a small sample size a negative correlation between dGEMRIC and T1ρ was found in patients with DDH. Both methods are known to probe the PG content of cartilage, where a decreased PG content leads to lower dGEMRIC index and an increased T1ρ value. The correlation coefficient was moderate, but significant, which shows that T1ρ mapping as an effective tool to probe the cartilage PG content similar to dGEMRIC. A comparable, but positive correlation was found between dGEMRIC and T2. T2 is sensitive to the cartilage collagen content with a decreased T2 value in degenerated cartilage. In symptomatic DDH, where an onset of OA is assumed, both PG depletion and collagen decay are in progress and can be evaluated using these mapping techniques

Aims. Cardiac magnetic resonance (CMR) was used to assess whether cardiac function or tissue composition was affected in patients with well-functioning metal-on-metal hip resurfacing arthroplasties (MoMHRA) when compared with a group of controls, and to assess if metal ion levels correlated with any of the functional or structural parameters studied. Patients and Methods. In all, 30 participants with no significant cardiac history were enrolled: 20 patients with well-functioning MoMHRA at mean follow-up of 8.3 years post-procedure (ten unilateral, ten bilateral; 17 men, three women) and a case-matched control group of ten non-MoM total hip arthroplasty patients (six men, four women). The mean age of the whole cohort (study group and controls) at the time of surgery was 50.6 years (41.0 to 64.0). Serum levels of cobalt and chromium were measured, and all patients underwent CMR imaging, including cine, T2* measurements, T1 and T2 mapping, late gadolinium enhancement, and strain measurements. Results. None of the MoMHRA patients showed clinically significant cardiac functional abnormality. The MoMHRA patients had larger indexed right and left end diastolic volumes (left ventricular (LV): 74 ml/m. 2. vs 67 ml/m. 2. , p = 0.045; right ventricular: 80 ml/m. 2. vs 71 ml/m. 2. , p = 0.02). There was a small decrease in T2 time in the MoMHRA patients (median 49 ms vs 54 ms; p = 0.0003). Higher metal ion levels were associated with larger LV volumes and with shorter T2 time. Conclusion. Although cardiac function is not clinically adversely affected in patients with well-functioning MoMHRA, modern imaging is able to demonstrate subtle changes in structure and function of the heart. As these changes correlate with systemic ion measurements, they may be consequences of wear debris deposition. Longer, longitudinal studies are necessary to determine whether cardiac function will become affected. . Cite this article: Bone Joint J 2019;101-B:540–546

Anterior cruciate ligament (acl) reconstruction is one of the most commonly performed procedures in orthopedics for acl injury. While literature suggest short-term good-to-excellent functional results, a significant number of long-term studies report unexplained early oa development, regardless type of reconstruction. The present study reports the feasibility analysis and development of a clinical protocol, integrating different methodologies, able to determine which acl reconstruction technique could have the best chance to prevent oa. It gives also clinicians an effective tool to minimize the incidence of early oa. A prospective clinical trial was defined to evaluate clinical outcome, biochemical changes in cartilage, biomechanical parameters and possible development of oa. The most common reconstruction techniques were selected for this study, including hamstring single-bundle, single-bundle with extraarticular tenodesis and anatomical double-bundle. Power analysis was performed in terms of changes at cartilage level measurable by mri with t2 mapping. A sample size of 42 patients with isolated traumatic acl injury were therefore identified, considering a possible 10% to follow-up. Subjects presenting skeletal immaturity, degenerative tear of acl, other potential risk factors of oa and previous knee surgery were excluded. Included patients were randomized and underwent one of the 3 specified reconstruction techniques. The patients were evaluated pre-operatively, intra-operatively and post-operatively at 4 and 18 months of follow-up. Clinical evaluation were performed at each time using subjective scores (koos) and generic health status (sf-12). The activity level were documented (marx) as well as objective function (ikdc). Preliminary results allow to verify kinematic patterns during active tasks, including level walking, stair descending and squatting using dynamic roentgen sterephotogrammetric analysis (rsa) methodology before and after the injured ligament reconstruction. Intra-operative kinematics was also available by using a dedicated navigation system, thus to verify knee laxity at the time of surgery. Additionally, non-invasive assessment was possible both before the reconstruction and during the whole follow-up period by using inertial sensors. Integrating 3d models with kinematic data, estimation of contact areas of stress patterns on cartilage was also possible. The presented integrate protocol allowed to acquired different types of information concerning clinical assessment, biochemical changes in cartilage and biomechanical parameters to identify which acl reconstruction could present the most chondroprotective behavior. Preliminary data showed all the potential of the proposed workflow. The study is on-going and final results will be shortly provided

Objectives. The purpose of this study was to clarify the appearance of the reparative tissue on the articular surface and to analyse the properties of the reparative tissue after hemicallotasis osteotomy (HCO) using MRI T1ρ and T2 mapping. Methods. Coronal T1ρ and T2 mapping and three-dimensional gradient-echo images were obtained from 20 subjects with medial knee osteoarthritis. We set the regions of interest (ROIs) on the full-thickness cartilage of the medial femoral condyle (MFC) and medial tibial plateau (MTP) of the knee and measured the cartilage thickness (mm) and T1ρ and T2 relaxation times (ms). Statistical analysis of time-dependent changes in the cartilage thickness and the T1ρ and T2 relaxation times was performed using one-way analysis of variance, and Scheffe’s test was employed for post hoc multiple comparison. Results. The cartilage-like repair tissue appeared on the cartilage surface of the medial compartment post-operatively, and the cartilage thickness showed a significant increase between the pre-operative and one-year post-operative time points (MFC; p = 0.003, MTP; p < 0.001). The T1ρ values of the cartilage-like repair tissue showed no difference over time, however, the T2 values showed a significant decrease between the pre-operative and one-year post-operative time points (MFC; p = 0.004, MTP; p = 0.040). Conclusion. This study clarified that the fibrocartilage-like repair tissue appeared on the articular surface of the medial compartment after HCO as evidenced by MRI T1ρ and T2 mapping. Cite this article: H. Nishioka, E. Nakamura, J. Hirose, N. Okamoto, S. Yamabe, H. Mizuta. MRI T1ρ and T2 mapping for the assessment of articular cartilage changes in patients with medial knee osteoarthritis after hemicallotasis osteotomy. Bone Joint Res 2016;5:294–300. DOI: 10.1302/2046-3758.57.BJR-2016-0057.R1

Introduction. Successful joint preservation surgery requires the ability to accurately assess the health of the articular cartilage pre-operatively. Traditional radiological methods allow morphological assessment of the cartilage and therefore only identify those with established degeneration. Biophysical properties of cartilage are now being used to identify these changes occurring earlier in the disease processes. Prior literature states that healthy cartilage has a transverse relaxation time of between 15–60 ms (16). Our study aims to establish the correlation and accuracy of MRI with T2 cartilage mapping with observed intra-operative chondral defects. Methods. We routinely request MRI with T2 mapping on all patients with suspected or confirmed femoroacetabular impingement (FAI). A review was performed on all patients who underwent both pre-operative imaging and subsequent hip arthroscopy for FAI over a 24-month period. Using linear regression we correlated intra-operatively observed chondral defects of the femoral head and acetabulum (Outerbridge classification scores) with the pre-operative transverse relaxation times. Statistical analysis of 66 chondral points was undertaken. Results. Results show that there is a significant association between an increase in transverse relaxation time and higher acetabular Outerbridge classification (p = 0.0141). Discussion. This study has identified that MRI with T2 cartilage mapping is an accurate predictor of acetabular cartilage health. Our findings suggest that 3T MRI with T2 cartilage mapping is a useful tool in joint preservation surgery and provides accurate information allowing hip arthroscopists to identify patients who may benefit most from conservative operative intervention

Objectives

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.

Aims

Femoroacetabular Junction Impingement (FAI) describes abnormalities in the shape of the femoral head–neck junction, or abnormalities in the orientation of the acetabulum. In the short term, FAI can give rise to pain and disability, and in the long-term it significantly increases the risk of developing osteoarthritis. The Femoroacetabular Impingement Trial (FAIT) aims to determine whether operative or non-operative intervention is more effective at improving symptoms and preventing the development and progression of osteoarthritis.

Summary Statement. Conventional imaging techniques lack the ability to objectively assess early stages of intervertebral disc degeneration, characterised by glycosaminoglycan loss. This study shows that MRI T2∗ mapping correlates positively with GAG content and that it provides continuous measurements for disc degeneration. Introduction. Early degenerative changes arise in the nucleus pulposus (NP) and are characterised by a loss of glycosaminoglycans (GAG). Early disc degeneration (DD) could possibly be treated with upcoming regenerative therapies (e.g. with stem cells and/or growth factors). In order to evaluate degeneration and treatments, a sensitive diagnostic tool is needed. While conventional magnetic resonance imaging (MRI) and x-ray techniques can detect late stages of DD, these techniques lack the ability to detect early degenerative changes. Recently, T2∗ mapping has been proposed as a new technique to evaluate early IVD degeneration, yet the correlation with GAG content and histological features has not been previously investigated. The objective of this study was to determine the value of T2∗ mapping in diagnosing DD by correlating this technique with the biochemical composition of IVDs. Materials & Methods. Six caprine lumbar spines obtained from an in vivo study and two healthy goat spines from the local abattoir, encompassing a total of 48 IVDs, were examined using sagittal standard T2-weighted and T2∗ mapping MRI protocols at 1.5 Tesla. Regions of interest (ROIs) were drawn on the T2∗ maps, covering the IVD. Based on T2 weighted MRI, discs were morphologically classified using the Pfirrmann score. Histological and macroscopic features were evaluated based on grading scales adapted for goat DD. Finally, GAG content was determined using colorimetric analysis (DMMB assay). Correlations between variables were analysed using Pearson correlation (r) coefficients (parametric data) or Spearman's rho (ρ) coefficients (non-parametric data). Results. The mean GAG content in the NP was 450 μg/mg dry weight (range 20–730 μg/mg dry weight) and the mean histological grade was 2.2 (range 0–6), corresponding with relatively mild disc degeneration. A linear positive correlation was observed between T2∗ and NP GAG content (r = 0.65, p < 0.001). T2∗ in the NP decreased linearly with increasing degeneration as assessed with macroscopic (ρ = 0.33, p < 0.05) and histological (ρ = −0.45, p < 0.05) grading, as well as with the Pfirrmann scoring system (ρ = −0.67, p < 0.001). Discussion. T2∗ mapping is a relatively new MRI technique which allows for measurements on a continuous scale, is acquired in less time than T2 mapping and minimises observer bias compared to grading systems. Although limited by a small sample size (n=48), this study showed a relatively good, linear correlation between T2∗ and GAG content in the NP, suggesting that T2∗ mapping may be an efficient and reliable tool for the objective assessment of proteoglycan content in early DD. Furthermore, with minor software modifications, it can be implemented on a standard 1.5 Tesla clinical MRI scanner. Future research should aim at optimizing the efficiency and user-friendliness of the T2∗ mapping protocol as well as yielding an even stronger correlation between T2∗ mapping and glycosaminoglycan content in human IVD tissue

Introduction: Ideal treatment of osteochondral lesions of the talus (OLT) is still controversial. Aim of this study is to review the 10 years follow-up clinical and MRI results of open field Autologous Chondrocytes Implantation in the treatment of OLT. Methods: From December 1997 to November 1999, 10 patients, age 25.8 +/−6.4 years, affected by OLT, received open field Autologous Chondrocytes Implantation. The mean size of the lesions was 3.1 cm. 2. (2.2 – 4.3). All patients were evaluated clinically (AOFAS score), radiographically and by MRI pre-operatively and at established intervals up to a mean follow-up of 119+/−6.5 months. At the final follow-up MRI T2 mapping evaluation was performed. A bioptic sample was harvested in 5 cases during hardware removal 12 months after implantation. Results: Before surgery the mean score was 37.9 +/−17.8 points, at 24 months it was 93.9 +/−8.5, while at final follow-up it was 92.7 +/−9.9 (p< 0.0005). Bioptic samples showed cartilaginous features at various degrees of remodelling, positivity for collagen type II and for proteoglycans expression. No degenerative changes of the joint at follow-up were found radiographically. MRI showed well-modelled restoration of the articular surface. The regenerated cartilage showed a mean T2 mapping value of 46 msec with no significant difference compared to that of normal hyaline cartilage. Conclusions: The clinical and histological results have confirmed the validity of the technique utilized with a durability of the results over time. T2 mapping was adequate in detecting the quality of the regenerated tissue coherently with the bioptic results

Introduction: Qualitative evaluation of postoperative outcome in cartilage repair techniques is an issue due to morbidity of bioptic second look. T2 mapping is becoming increasingly popular in the knee, providing information about the histological and biochemical contents of healthy or reparative tissue. Nevertheless, little is known about its applicability to the ankle due to thinner cartilage layer. Aim of this study was to investigate the validity of T2 mapping in ankle cartilage characterization. Materials and Methods: 20 healthy volunteers and 30 patients affected by osteochondral lesions of the talus and previously treated by different cartilage repair techniques, were evaluated by T2 mapping. Reparative procedures included microfractures, Autologous Chondrocyte Implantation (open or arthroscopic) and Bone Marrow Derived Cell’s Transplantation. DPFSE with or without fat suppression, T2FSE with or without fat suppression, 3D SPGR and T2-Mapping using a dedicated phased array coil and 1.5 T MR scanner were used as MRI acquisition protocol. MRI results were correlated with clinical score (AOFAS) in the cases who received a cartilage reconstruction treatment. Results: A statistically significant correlation (p< 0.05) was shown between MRI and clinical results. A reduced mean T2 value, suggestive for fibrocartilage features, was shown at repair sites in microfractures, whereas no significative differences with healthy hyaline cartilage mean T2 value, were found in other repair techniques with good to excellent clinical score. Conclusions: T2 mapping demonstrated to be adequate in characterizing cartilage tissue in the ankle. Further studies are required to implement a tool which may over time be a valuable non-invasive alternative to bioptic evaluation

We aim to assess the clinical and radiological outcome following cartilage repair in the knee using the TruFit plug (Smith & Nephew). Eleven active sporting patients underwent cartilage repair using TruFit plugs between February 2006 and August 2007. Postoperatively patients were touch weight bearing for 2 weeks and partial until 4 weeks. Data was collected prospectively, patients underwent clinical review and completed Lysholm, IKDC subjective, Tegner, KOOS and SF-36 scores pre-operatively and at 6 monthly intervals. One patient has been excluded from the analysis as she emigrated and was lost to follow up. The remaining 10 patients (mean age 35 years (21–49)) had defects on the medial femoral condyle (n=6), lateral femoral condyle (n=3), and lateral trochlea (n=1). Patients received one (n=5), two (n=3) or three (n=2) plugs and four were primary procedures, and six revision procedures (1 failed OATS, 5 failed microfracture). Eight implantations were performed arthroscopically and, and two were mini-open. All patients were reviewed at 12 months, five were reviewed at 18 months and four have also been reviewed at 24 months. Statistically significant improvements from mean pre-operative scores are seen at 12 months; Lysholm (48.3 to 71), IKDC Subjective (37.7 to 65.1), Tegner (2.4 to 4.6), SF36 physical (39.5 to 50.3) and all components of KOOS. These improvements are maintained at the latest follow up. MRI evaluation including T2 mapping demonstrates reformation of the subchondral lamina, resorption of the graft and a similar signal from neo-cartilage as that of adjacent native cartilage. TruFit plugs offer an exciting novel solution for cartilage repair in the knee with advantages of low morbidity and rapid recovery without the need for prolonged non-weight bearing. The implant may be suitable for small lesions only and further prospective study is required to establish long-term outcome

Aim: To relate clinical progress following cartilage repair using TruFit plugs with appearance on MRI imaging with a view to determining safe healing in order for patients to return to activity, without needing invasive assessment. Methods: 26 active sporting patients underwent cartilage repair using TruFit CB plugs (Smith & Nephew) for symptomatic chondral defects in the knee between February 2006 and September 2008. The plugs are a biphasic synthetic implant designed to reform both bone and articular cartilage. As part of this prospective series patients underwent MRI at post op time-points of 6, 12, 18 and 24 months. MRI was performed using a 1.5 Tesla scanner and later using a 3T scanner. We report the results of both including T2 cartilage mapping. Results: All 26 patients were improved at latest follow-up when compared to pre-operative scores (mean follow up 15 months (range 6–30 months)). MRI evaluation demonstrates oedema like signal surrounding the plugs at an early stage but by 6 months the oedema resolves and the subchondral lamina is seen to reform. By 12 months the bone part of the plug has similar appearance to host bone and the neo-cartilage shows similar signal to native cartilage on all MRI modalities (1.5T, 3T and T2 mapping). This suggests that the repair tissue contains a high percentage of hyaline like cartilage. In one patient slow clinical improvement was reflected in the MRI appearance. Conclusion: MRI imaging appears to relate to clinical improvement according to KOOS, IKDC, Lysholm, Tegner and SF36 scores. This indicates that MRI is a useful imaging tool for assessing healing, and knowledge of the recovery pattern is important for quantifying healing and for better advising patients on when it may be safe to load repaired areas

Aim: To assess the safety and clinical and radiological outcome of the TruFit CB porous, resorbable scaffold for symptomatic osteochondral and chondral articular defects in the knee. Methods: 11 active sporting patients underwent cartilage repair using TruFit CB plugs (Smith & Nephew) for symptomatic defects on the medial or lateral femoral condyle. All had failed previous treatment (debridement/microfracture) and had persistent symptoms. Postoperatively patients were touch weight bearing for 2 weeks and partial until 4 weeks. Data was collected prospectively. The mean age was 34 (range 19 – 50) and 5 were male. Four lateral femoral condyle defects were treated, all associated with lateral meniscal tears. Four medial defects were associated with ACL injury (1), PCL injury (1) or isolated chondral injury (2). Single plugs were required in 5 (9mm in 3 and 7mm plugs in 2), 2 patients required 2 plugs (9mm and 7mm), and 2 required 3 (2×9mm + 1×7mm). Results: All 11 patients were improved at a mean follow up of 14.5 months (3–21 months) with 4 currently back to full pre-injury level of sport. Subjective IKDC scores improved from 45 pre-op to 79 post-op (p< 0.05), Lysholm from 47 to 71 (p< 0.05), and latest Tegner activity score at 5. MRI evaluation including T2 mapping demonstrates reformation of the subchondral lamina and resorption of the graft. 2nd look arthroscopy was undertaken in 2 showing a well healed and well integrated surface. Conclusion: These preliminary results indicate that TruFit CB plugs offer a potential solution for small focal chondral defects, offering an alternative to microfracture or osteochondral grafting with advantages of low morbidity and rapid recovery without the need for prolonged non-weight bearing