Although the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index was originally developed for the assessment of non-operative treatment, it is commonly used to evaluate patients undergoing either total hip (THR) or total knee replacement (TKR). We assessed the importance of the 17 WOMAC function items from the perspective of 1198 patients who underwent either THR (n = 704) or TKR (n = 494) in order to develop joint-specific short forms. After these patients were administered the WOMAC pre-operatively and at three, six, 12 and 24 months’ follow-up, they were asked to nominate an item of the function scale that was most important to them. The items chosen were significantly different between patients undergoing THR and those undergoing TKR (p < 0.001), and there was a shift in the priorities after surgery in both groups. Setting a threshold for prioritised items of ≥ 5% across all follow-up, eight items were selected for THR and seven for TKR, of which six items were common to both. The items comprising specific WOMAC-THR and TKR function short forms were found to be equally responsive compared with the original WOMAC function form.

Cite this article: Bone Joint J 2013;95-B:239–43.

Autologous matrix-induced chondrogenesis (AMIC) is a new treatment option for full-thickness cartilage defect repair using the well-known microfracturing technique combined with a porcine collagen type I/III matrix implant and partially autologous fibrin sealant.

A retrospective study has being carried out to investigate the objective and subjective clinical outcome of this procedure over a period of up to 2 years after the operation. 18 patients (10 male, 8 female) with localised cartilage defects were treated with AMIC.

The mean age was 37 13 years. Defects treated were localised retropatellar (6), on the medial femoral condyle (7), on the lateral femoral condyle (2) and multiple lesions (3). During the clinical follow-up these patients were evaluated with the help of 3 different scores (IKDC score, Cincinnati score, Lysholm-Gillquist score).

For the collective of 18 patients, one or more years had elapsed since the operation at the time this study was completed. 10 patients were included into the 2-year evaluation. The IKDC Score showed a mean improvement from 28 to 58 out of 100 at 1-year and from 25.5 to 69 out of 100 at 2-years post-operative. The Cincinnati and Lysholm-Gillquist scores showed the same tendency with an improvement of about 40 pecent at 1 year and about 55 percent at 2 years compared to pre-operative value. The improvement in the IKDC Score as well as the Cincinnati and Lysholm-Gillquist suggest that AMIC is a promising alternative in the treatment of local cartilage defects in the knee with good short and possibly mid-term results.

Further follow up will reveal, if the good results are durable and AMIC, as matrix enhanced microfracturing technique can become a valuable, recognised cartilage repair technique.

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.