We attempted to characterise the biological quality
and regenerative potential of chondrocytes in osteochondritis dissecans
(OCD). Dissected fragments from ten patients with
Aims. To explore the efficacy of extracorporeal shockwave therapy (ESWT) in the treatment of osteochondral defect (OCD), and its effects on the levels of transforming growth factor (TGF)-β, bone morphogenetic protein (BMP)-2, -3, -4, -5, and -7 in terms of cartilage and bone regeneration. Methods. The
Abstract. Introduction. Symptomatic osteochondritis dissecans (OCD) and traumatic osteochondral fractures (OCF) are treated with fixation with either metal or bioabsorbable device. We performed a comparative review of patients with
Osteochondritis Dissecans (OCD) is a condition
for which the aetiology remains unknown. It affects subchondral bone
and secondarily its overlying cartilage and is mostly found in the
knee. It can occur in adults, but is generally identified when growth
remains, when it is referred to as juvenile
This study aimed to evaluate the clinical outcomes of paediatric patients who underwent a retrograde drilling treatment for their osteochondritis dissecans (OCD) of the talus. The secondary purpose was to identify factors that are predictive of a failure of the treatment. A retrospective study was done. All patients treated for talar
We describe two cases of osteochondritis dissecans (OCD) affecting both femoral condyles in the same knee. The patients presented with recurrent episodes of pain and swelling, but these were initially thought to be ‘growing pains’. Eventually, a delayed diagnosis of bicondylar
Introduction and purpose: Femoral osteochondritis dissecans (OCD) is a process of unpredictable clinical course and uncertain aetiology (vascular, post-traumatic or microtraumatic). Its prognosis is based on diagnostic imaging (MRI and scintillation scanning) and age (Multicentre EPOS
The purpose of this study was to describe a clinical evaluation of the etiological factors in osteochondritis dissecans (OCD) of the knee from radiographic and arthroscopic findings. Twenty-two knees of 20 patients (16 male and 4 female, 16.1 years old in average at surgery) with symptomatic
To determine if there are osteochondritis dissecans (OCD) lesions of the knee that are so unstable on MRI that they are incapable of healing without operative intervention. A secondary objective was to determine the ability of orthopaedic residents to accurately grade
The purpose of this study is to describe a surgical procedure for unstable osteochondritis dissecans (OCD) of the capitellum and its results. Between 1992 and 1997, 11 elbows of 11 patients with
To assess the use of autogenous osteochondral graft fixation (mosaicplasty) in unstable osteochondritis dissecans (OCD) lesions (Clanton type 2 and 3) of the knee. Eleven patients with x-ray and N4R1 confirmed
Objectives. Surgical treatment is standard for advanced osteochondritis dissecans (OCD) of the humeral capitellum. When cartilage is seen to be separated or completely detached, this fragment fixation is not usually applied. There have been reports of cases in which advanced
The treatment of osteochondritis dissecans (OCD) in children and adolescents is determined by the stability of the lesion and the state of the overlying cartilage. MRI has been advocated as an accurate way of assessing and staging such lesions. Our aim was to determine if MRI scans accurately predicted the subsequent arthroscopic findings in adolescents with
Introduction. Osteochondritis dissecans (OCD) is a localised disorder of subchondral bone and the overlying articular cartilage. The most commonly used classification systems involve arthroscopy and MRI. Aim. To investigate the correlation between arthroscopic and MR findings in patients with
The June 2012 Foot &
Ankle Roundup. 360. looks at: the Achilles tendon Total Rupture Score (ATRS); endoscopic treatment of Haglund’s syndrome; whether it is worth removing metalwork; hyaluronic acid injection; thromboembolic events after fracture fixation in the ankle; whether surgeons are as good as CT scans for
Although osteochondral defects (OCD) following trauma, sport or degenerative diseases occur frequently, healing remains an unresolved clinical problem. These defects seem to appear more often in convex surfaces than in concave ones. In vivo studies have demonstrated the influence of mechanical conditions on osteochondral repair[. 1. ]. However, the influence of the local joint curvature on the mechanical environment as well as the effect of defect fillings on healing remained unknown. We hypothesize that healing of
Purpose of the study: Conservative surgical treatment of osteochondritis dissecans (OCD) in adults raises the problem of integration of the sequestered bone. Mechanical techniques using screw fixation are often insufficient to achieve healing. Adjunction of a biological fixation with osteochondral graft tissue for a mosaicplasty might favour integration of the fragment. The purpose of this study was to assess the short-term outcomes in an initial series using a technique called fixation plus where screw fixation is associated with mosaiplasty. Material and methods: This was a retrospective analysis of eight adults who underwent surgery from 2003 to 2008 for stage IIB or III (Bedouelle)
A prospective case control study analysed clinical and radiographic results in patients operated on with the periosteum autologous chondrocyte implantation (ACI) due to cartilage lesions on the femoral condyles over 10 years ago. 31 out of the 45 patients (3 failures, 9 non-responders, 2 others) were available for a continuous clinical (Lyshom/Tegner, IKDC, KOOS) and radiographic (Kellgren-Lawrence) follow-up at 0, 2, 5, and 10 years after the ACI procedure. The patients were sub-grouped into focal cartilage lesions (FL) – 10, osteochondritis dissecans (OCD) – 12, and cartilage lesions with simultaneous ACL reconstruction (ACL) – 9 subgroups. Lysholm, Tegner, and IKCD subjective scores revealed stable results over the period from 2 to 10 years with a significant improvement toward the pre-operative levels, but the patients had not reached their pre-injury Tegner levels. KOOS profile at 10 years was: Pain 78.6, Symptoms 78.1, Activities of daily living 82.5, Sports 56.9, and Quality of life 55.1. A 10-year IKDC knee examination classified operated knees as: 14 normal, 10 nearly normal, 5 abnormal and 2 severely abnormal. Kellgren-Lawrence scores of 2 and above were found in 10 patients (FL 5,
Purpose: Osteochondritis dissecans (OCD) of the capitellum most commonly affects adolescent pitchers and gymnasts, and presents with pain and mechanical symptoms. Fragment excision is the most commonly employed surgical treatment; however, patients with larger lesions have been reported to have poorer outcomes. It’s not clear whether this is due to increased contact pressures on the surrounding articular surface, or if fragment excision causes instability of the elbow. The purpose of this study was to determine if fragment excision of simulated
Aims: This study aimed to assess the outcome of arthroscopic debridement and removal of loose bodies from the elbows of patients with
Background: Seven cases of osteochondritis dissecans (OCD) of the tarsal navicular bone have been described mainly radiologically. Aims: We report our experience with additional 6 patients which represent the largest series described, and conclude about the treatment modalities in this unique type of
Osteocondritis dissecans (OCD) is a relatively common cause of knee pain. Ideal treatment is still controversial. Aim of this exhibit is to describe the outcomes of 5 different surgical techniques in a series of 63 patients. 63patients (age 22.5±7.4 years) affected by
There is no optimal treatment for osteochondral defects of the talus after failed primary surgical treatment. To treat these patients, a 15-mm diameter metal implant was developed for the medial talar dome. The present study was undertaken to evaluate the clinical effectiveness of the metal implantation technique for osteochondral lesions of the medial talar dome. This is a prospective case series. The inclusion criteria were the combination of a large
PURPOSE. Osteochondral talar defects (OCDs) are sometimes located so far posteriorly that they may not be accessible by anterior arthroscopy, even with the ankle joint in full plantar flexion, because the talar dome is covered by the tibial plafond. It was hypothesized that computed tomography (CT) of the ankle in full plantar flexion could be useful for preoperative planning. The dual purpose of this study was, firstly, to test whether CT of the ankle joint in full plantar flexion is a reliable tool for the preoperative planning of anterior ankle arthroscopy for OCDs, and, secondly, to determine the area of the talar dome that can be reached by anterior ankle arthroscopy. METHODS. In this prospective study, CT-scans with sagittal reconstructions were made of 46 consecutive patients with their affected ankle in full plantar flexion. In the first 20, the distance between the anterior border of the
Introduction: Osteochondral lesions of the Talar Dome(OCD) remain a difficult therapeutic problem. One solution has been to consider using autologous chondrocyte implants. Though initial results of this technique are interesting the donor sites have always been in a normal knee. The presence of knee symptoms subsequently in some patients might be regarded as inevitable. This paper reports on the viabilty of donor material taken from the ankle. Materials: Twenty four patients have been recruited to a pilot study of the viability of obtaining donated chondral material for Matrix Autologous Condrocyte Implantation. There were 14 men and 10 women. Their mean age was 37.3 years (range 17–63). All were complaining of presistent symptoms of pain and some insecurity following previous conventional surgery for treatment of a symptomatic
This scoping review aims to identify patient-related factors associated with a poorer outcome following total ankle arthroplasty (TAA). A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer-based literature search was performed in PubMed, Embase, Cochrane trials, and Web of Science. Two reviewers independently performed title/abstract and full-text screening according to predetermined selection criteria. English-language original research studies reporting patient-related factors associated with a poorer outcome following TAA were included. Outcomes were defined as patient-reported outcome measures (PROMs), perioperative complications, and failure.Aims
Methods
Introduction: Previous studies on ankle arthroscopy have reported the results of treatment in adult patients. To our knowledge there are no studies reporting the out-come in children. Aim: To analyse retrospectively the outcome of ankle arthroscopy in children. Method: Between March 2005 and September 2007, twenty-two children (14 boys and 8 girls) underwent ankle arthroscopy for post-traumatic pathology. Their average age was 13.5 years (range 8.6 to 18). The symptoms were ankle pain (21 out of 22), instability (7) or clicking (6). Indications for arthroscopy were no response to conservative treatment, including physiotherapy, for at least 12 weeks or a grade 3 or 4 osteochondral defect (OCD) on imaging. In five patients radiographs revealed an
Introduction: (OCD) is characterized by bone necrosis and softening of the overlying cartilage, which may separate and displace. It is thought to be secondary to trauma, ischaemia or abnormal epiphyseal ossification. Management remains controversial during the early stages of the disease. Surgery for advanced chondral lesions with loose bodies however remains a challenge. Options that include periosteal graft and autologous chondrocyte transplantation have been used with variable degrees of success. This study investigates the efficacy of these techniques and the use of mesenchymal stem cells to treat advanced chondral lesions found in
Introduction: A number of surgical techniques have been described for the operative treatment of late stage osteochondritis dissecans (OCD) in the knee and ankle that have failed nonoperative management. However, no particular technique has been universally successful. We report the results of a new technique using retrograde drilling combined with the use of a novel collagen based bone void filler to prevent mechanical failure of the joint surface. The purpose of this study was to evaluate the results of this new technique and analyze the efficacy of both collagen Type-1 based osteoinductive bone void fillers Colloss and Colloss E with and without additional bone grafting. Methods: The osteoinductive bone void fillers Colloss (bovine) and Colloss E (equine) are bone inducing collagenous sponges. The osteoinductive properties are due to the interactive release of BMP-2, BMP-7, IGF-1 and TGF-beta from the implant and the surrounding host tissue by osteoclastic and osteoblastic action. All surgeries performed in the present series included retrograde drilling procedures for
Background. Structural and functional outcome of bone graft with first or second generation autologous chondrocyte implantation (ACI) in osteochondral defects has not been reported. Methods. Seventeen patients (mean age of 27±7 years, range 17–40), twelve with osteochondritis dissecans (OD) (ICRS Grade 3 and 4) and five with isolated osteochondral defect (OCD) (ICRS Grade 4) were treated with a combined implantation of a unicortical autologous bone graft with ACI (the Osplug technique). Functional outcome was assessed with Lysholm scores. The repair site was evaluated with the Oswestry Arthroscopy Score (OAS), MOCART score and ICRS II histology score. Formation of subchondral lamina and lateral integration of the bone grafts were evaluated from MRI scans. Results. The mean defect size was 4.5±2.6SD cm. 2. (range 1–9) and depth was 11.3±5SD mm (range 5–18). The pre-operative Lysholm score improved from 45 (IQR 24, range 16–79) to 77 (IQR 28, range 41–100) at 1 year (p-value 0.001) and 70 (IQR 35, range 33–91) at 5 years (p-value 0.009). The mean OAS of the repair site was 6.2 (range 0–9) at a mean of 1.3 years. The mean MOCART score was 61 ± 22SD (range 20–85) at 2.6 ± 1.8SD years. Histology demonstrated generally good integration of the repair cartilage with the underlying bone. Poor lateral integration of the bone graft on the MRI scan and a low OAS were significantly associated with a poor Lysholm score and failure. Conclusion. Osplug technique shows significant improvement of functional outcome for up to 5 years in patients with a high grade OD or
Purpose. To assess the reliability of a biomimetic osteochondral scaffold Maioregen (Finceramica Faenza SpA, Faenza, Italt) as a salvage and joint-preserving procedure in the treatment of late stages of osteonecrosis of the knee. Methods. Nine active patients aged under 65 year presenting with clinical and radiological signs of SPONK were treated with a biomimetic osteochondral scaffold. All patients were clinically evaluated preoperatively and yearly with a minimum follow-up of 2 years. Subjective IKDC and Lysholm Knee Scale were used to assess clinical outcome. Pre-operative and post-operative pain was quantified with VAS scale. Activity level were evaluated pre-operatively and at follow-up according to Tegner Activity Scale. Results. Subjective IKDC (35 ± 14.5 to 75.7 ± 20) and Lysholm Knee Scale (49.7 ± 17.9 to 86.6 ± 12.7) significantly improved from pre-operative evaluation (p < .01). VAS decreased from a mean pre-operative value of 6.3 ± 2.5 to 1.6 ± 2.7 at 2 years follow-up. Tegner Activity Scale doesn't show significant differences between pre-operative values and those obtained at two-year follow up. Two of nine patients returned to be symptomatic after 18 months from the implants and progressed to condylar collapse, despite the joint-preserving treatment, and underwent a total knee arthroplasty. Conclusions. Biomimetic scaffold can be a valid option in surgical treatment of SPONK in young active patients. Use of this surgical technique, originally developed for
Background. Lateral ligament injuries of the ankle are common. They account for up to 50% of all sporting injuries. Recovery times vary, leading to time away from sport and training for the professional athlete. Predicting this time is important for the treating surgeon, the athlete and the rehabilitation team. This can be difficult as associated ankle injuries occurring at the time of the trauma may alter recovery and rehabilitation. Aim. To compare the time to return to training and sports of isolated lateral ligament injuries with more complex injuries of the ankle treated surgically and to evaluate if lateral ligament repair is safe and effective in the professional athlete. Study design: Case series; level of evidence 4. Methods. A consecutive series of professional sportsmen and women were treated operatively for radiologically and clinically confirmed grade III lateral ligament injury between 2005 and 2009. The patients were split into two groups; isolated lateral ligament injuries and those with other associated injuries. The end points studied were the time to return to training in weeks and the time to return to play in weeks. Results. There were 26 ankles in 26 patients. 16 were isolated injuries (Group A) and 10 had associated injuries (Group B). The associated injuries included, osteochondral defects (OCD) (3), deltoid ligament injury (5), syndesmotic injury (1) and deltoid ligament injury combined with an
Isolated osteochondral defects (OCD) of the femoral head remain a challenging issue for the surgeons when trying to balance between a less invasive procedure and the maximum benefit for the patient. We present our experience of the Hemicap partial hip resurfacing system in 12 patients. In ten patiens the defects were identified arthroscopically. Seven of them had concurrent early degeneration of cartilage (OA, Grade I). Three patients had
Recently biodegradable synthetic scaffolds (Trufit plug) have provided novel approach to the management of chondral and osteochondral lesions. The aim of this study was to assess our 2 year experience with the Trufit plug system. 22 patients aged 20 to 50 years old all presenting with knee pain over a 2 year period were diagnosed either by MRI or arthroscopically with an isolated chondral or osteochondral lesion and proceeded to either arthroscopic or mini arthrotomy Trufit plug implantation. In 5 patients plug implantation was undertaken along with ACL reconstruction (3), medial meniscal repair (1) and contralateral knee
Focal chondral defects are thought to contribute to the onset of degenerative changes in cartilage and therefore effective treatments of these lesions are aggressively pursued. A number of options such as bone marrow stimulation, osteochondral autograft transplantation, osteochondral allograft transplantation, and autologous chondrocyte implantation exist. Long-term data regarding efficacy and outcome for some of these approaches seem to suggest that there is still a need for a low-cost, effective treatment that leads to a sustained improvement in symptoms and the formation of hyaline cartilage. artilage autologous implantation system (CAIS) is a surgical method in which hyaline cartilage fragments from a non-weight bearing area in the knee joint are collected and then precipitated onto an absorbable filter that is subsequently placed in the focal chondral defect. The clinical outcome of CAIS was compared with microfracture (MFX) in a pilot study. In an IRB approved protocol patients (n=29) were screened with the intention to treat, randomised (2:1, CAIS:MFX) and followed over a 24 month period. To be included in the study the patient may have up to 2 contained focal, unipolar lesions (≤ ICRS grade 3d and ≤ ICRS Grade IVa
The compressive stiffness of cartilage is primarlly determined by proteoglycan, whereas the tensile properties are determined by collagen fibres. The first alteration in cartilage structure during cartilage degeneration is the decrease in proteoglycan content and increase in interstitial water; consequently, cartilage becomes softer and cartilage stiffness decreases. The pupose of our study was to evaluate arthroscopically the compressive stiffness of cartilage in different areas of living human knee joints. Detection of softening is revealed in vivo by using an indentation instrument (artscan 200). The instrument is composed of a measurement rod joined to the handle; in the distal end of the rod, there is an inclined flat surface with a separate plane –ended cylindrical indenter. During measurement the distal end of the instrument is pressed against the articular surface while the indenter imposes constant deformation on the cartilage. The maximal indenter force, by which the tissue resists the constant deformation, is measured with strain gauge transducers. We performed indenter tests in knees joints in which cartilage was diagnosed as normal; stiffness of articular cartilage was also measured during arthroscopy in knees before ACL reconstruction, in knees with closed chondromalacia (ICRS grade 0–1) and in osteochondral lesions (ICRS
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
Following ankle sprain, there can be many causes of disability including ligament injuries, soft tissue or bony impingement, Peroneal tendon tears, osteochondral defects (OCD), synovitis and Osteoarthritis (OA). Aim: To assess the use of Ankle MRI in clinical decision-making in patients with pain and/or chronic instability following ankle sprains. Method: A retrospective case note review was undertaken for all ankle scopes performed and all Ankle MRI ordered by a single surgeon (AOA) over a three-year period (April 2004 – April 2007). Results: During this period 54 Ankle arthroscopies were performed. 24 had pre op MRI scans (16 ordered by AOA and 8 by others who then referred the patient) and 30 had no MRI. 8 case notes were not available. In 43 of the 46 available notes the patients presented with either chronic ankle pain or instability following ankle sprain. 32 had Anterolateral soft tissue impingement on arthroscopy. Of these 24 had MRI scans with only 3 reporting a soft tissue impingement. 13 patients had lateral ligament reconstruction. All 13 of these patients showed signs of instability on examination under anaesthesia (EUA). Of these 9 had MRI scans with 4 reporting a ligamentous injury. Five other patients had MRI scans that showed a lateral ligament injury but had a normal EUA and did not undergo a ligament reconstruction. 10 patients had moderate to severe OA on arthroscopy of the ankle. Of these 4 had MRI scans with 2 reporting OA changes but 2 reported as
Introduction Osteochondritis Dissecans of the elbow is a rare condition classically affecting teenage males playing throwing sports. The aim of this study was to evaluate the longer term outcome following arthroscopic debridement in patients with osteochondritis of the elbow that had failed conservative management. Methods All clinically, radiologically and arthroscopically proven patients (since 1989) with Osteochondritis Dissecans (OCD) that had failed six months of non-operative management were recalled for clinical, performance indices and radiological review. A 91% follow-up rate was achieved (62% full clinical and radiological follow-up). The group consisted of 29 patients (20 male, nine female) with an average age of 22 years. Patients were mobilised post-operatively as symptoms allowed. Results At an average of 77 months after the operation, the majority of patients had mild or no pain with activities of daily living but with some discomfort during heavy lifting/sports. Only four out of 27 had to give up their preferred sport because of persistent elbow problems. Thirty-eight percent had recurrence of locking or catching, though these symptoms were described as much better than prior to the operation and were not felt severe enough to consider any further intervention. Conclusions We conclude that arthroscopic debridement and removal of loose bodies is a safe and reliable procedure for patients with persistent symptoms from
Full-thickness chondral defects of weight-bearing articular surfaces of the knee are a difficult condition to treat. Our aim is to evaluate the mid- and long-term functional outcome of the treatment of osteochondral defects of the knee with autologous osteochondral transplantation with the OATS technique. Thirty-six patients (37 procedures) were included in this study. Twenty-three patients were male and 13 female with a mean age of 31,9 years (range: 18 to 48 years). The cause of the defect was
Ankle arthroscopy is generally performed through anterior portals and provides good access to the anterior aspect of the ankle joint. However, the structure of the talus and the anatomical confines of the ankle joint limit access to posterior structures via this approach. Developments in the technique of posterior ankle arthroscopy have determined the appropriate site for portals with minimal risk of iatrogenic neurovascular injury. This facilitates treatment of conditions such as flexor hallucis longus (FHL) release, excision of os trigonum for posterior impingement, treatment of retro-calcaneal bursitis and treatment of ankle and subtalar joint pathology. Posterior ankle arthroscopy is a relatively new technique and has recently been adopted by the senior author. This study was performed to explore the benefits and limitations of this procedure and to identify early post operative results. We describe our experience of this technique in treating 9 patients with varied posterior ankle pathology. 2 patients had excision of os trigonum; 2 had FHL release; 1 had both excision of os trigonum and FHL release; 3 had curettage for posterior osteochondral defect (OCD) of the talus; and 1 had resection of Haglund’s deformity. The mean pre-operative AOFAS scores (Ankle-Hindfoot Scale) was 73 (range 47 to 85). The mean post operative AOFAS score at 3 months was 82 (range 75 to 87). 4 patients had recent surgery and await follow up. There were no complications. Two cases exposed the limitations of this procedure: Incomplete resection of (i) a Haglund’s deformity required conversion to an open excision and (ii) a posteromedial
Objectives. Osteochondral ankle defects (OCDs) mainly occur in a young, active population. In 63% of cases the defect is located on the medial talar dome. Arthroscopic debridement and microfracture is considered the primary treatment for defects up to 15 mm. To treat patients with a secondary
Introduction. Osteochondral defects (OCDs) of the talus are treated initially by arthroscopic bone marrow stimulation. For both large and secondary defects, current alternative treatment methods have disadvantages such as donor site morbidity or two-stage surgery. Demineralized bone matrix (DBM) was published for the treatment of OCDs of rabbit knees. Autologous platelet-rich plasma (PRP) may improve the treatment effect of DBM. We previously developed a goat model to investigate new treatment methods for OCDs of the talus. The aim of the current study was to test whether DBM leads to more bone regeneration than control OCDs, and whether PRP improves the effectiveness of DBM. Methods. A standardized 6-mm
Chondral injury has become one of the most difficult problems to solve in orthopaedics. This pathology is very common: Curl et al. founded an incidence of 63% of chondral lesions (2.7 lesions for knee in 31,156 knee arthroscopies) with a 20% rate of lesions of grade IV of Outerbridge. During the past few decades many techniques were developed: with these techniques the lesion is just reparied with the formation of fibro-cartilage tissue with biochemical and bioelastic characteristics very different from the hyaline cartilage tissue. Microfracture technique : This technique, proposed by Steadman et al., utilises hand-drills to create numerous perforations in the subchondral bone at 3–4 mm apart. Indications for this techniques are lesions from 0.5 to 2 cm. 2. with an outlined border in patients with low functional demand. Osteochondral autograft transplantation (OATS, mosaicplasty): Osteochondral autograft transplantation is indicated for isolated lesions from 1 to 3 cm. 2. or in
Introduction &
Aims: To assess the efficacy of periosteal ACI (P-ACI) for articular cartilage lesions of the knee, a study was carried out on patients with minimum 5 year follow up including clinical assessment, second look arthroscopy when indicated clinically and MRI evaluation. Method: Between October 2000 and April 2003 the author carried out P-ACI on 164 patients. Of these 104 patients (106 knees – 145 lesions) could be included in this study. There were 106 single, 35 double and three triple lesions. Seventy-eight lesions were considered traumatic, 63 degenerative and 4
Autologous chondrocyte implant (ACI) is a very effective technique in the treatment of chondral lesions in order to restore normal hyaline cartilage. This technique, reported for the first time by Peterson in 1994, is advised for young or middle-aged. active patients with a single painful chondral injury (3/4 grade of Outerbridge scale), starting from more than 2 cm². New tissue engineering techniques with the use of biomaterial derived from hyaluronic acid (HYAFF matrix) provide ideal support for the culture and proliferation of chondrocytes, allowing at the same time arthroscopic implant. There are many advantages of arthroscopic techniques: easy implant and less pain post-operatively; however, the indications for arthroscopic technique are still restricted: single chondral inury, 2–6 cm² in size and localisation at the femoral condyles. At the Department of Orthopaedic Surgery of the University “ Federico II ” of Naples starting from January 1996 to the present, 29 patients were treated with ACI. Eight patients (six men and two women) had an arthroscopic implant. Median age was 18; in seven patients an
The past ten years have brought plenty of research and technical innovations and also preliminary clinical success in cartilage repair. The common target of all methods utilised is to produce a sufficiently stable quality of cartilage repair or regenerate. However, yet today clinical, radiological and histological results analysing the different techniques are somewhat contradictory. The different lines of clinically applied and basic research have focused on:. 1) Spontaneous natural filling of the defect with fibro-cartilage of variable solidity. - Abrasion chondroplasty, drilling or microfracturing to allow for mobilisation of progenitor cells and mesenchymal stem cells from the cancellous bone into the defect and develop to a hyaline like cartilage. - Stem cell treatment (in vivo or ex vivo theory of potential technique by which stem cells could be brought to a defect to create cartilage; so far no directly linked product available). 2) Transplantation of osteochondral auto grafts (Mosaicplasty, OATS, SDS, patellar graft) or allograft. 3a) Autologous chondrocyte transplantation and periosteal coverage (ACT) to cover bigger surfaces. 3b) Implantation of second and third generation ex vivo products and create less morbidity but without knowing whether the results are as long-lasting as for the originally described technique (chondrocytes cultured on membranes, MACI, in gels, implantation of a stable three-dimensional de novo cartilage disk or even engineered osteochondral grafts, AMIC: autologous membrane induced chondrogenesis). A fair amount of today’s laboratory research is focusing on the culture of the patients own chondrocytes or his own stem cells. Clinically, some methods can be applied in all indications regardless of size, localisation, depth of the lesion up to the age of fifty years and this is valid for lesions in the knee, the shoulder, the talus, the elbow etc. Other methods like AOCT should not be used for lesions over 2cm in diameter because of donor side morbidity. All methods claim to have an 85% outcome success rate. Regarding the histological content of the successful implants or the reformed cartilage, microfracturing produces a cartilage implant containing a fibrocartilage that looks similar to the hyaline like cartilage of ACI at two years. Mosaicplasty plugs provided great care is applied during insertion avoiding damage of the cylinders and cartilage death-a special instrumentation has been developed with ZIMMER, the Soft Delivery System, SDS to avoid force during impaction. They remain hyaline provided they are inserted without being prone or deep sunken and the surface convexity of the femoral condyle is restored and provided they are inserted tightly next to each other. There is agreement that this is more difficult in arthroscopic techniques. One agrees also that results are dependent on the alignment of the limb. If the compartment treated is overloaded, there is less chance for integration. Osteotomy has therefore a solid position in the armamentarium of the cartilage surgeon- up to 50% of our cases get an osteotomy as part of their treatment regardless of which technique is utilised. As complications in autologous osteochondral grafting we may observe destruction of the hyaline cartilage cap, non integration and pseudarthrosis or fractures of the cylinders (of special risk are smokers), especially when grafts are not inserted tightly to each other and there is lack of stability with fluid leakage out of the cartilage caps. Rarely ossification of the cartilage is observed when a thin capped cylinder retrieved in the peripheral zone of the femoral trochlea is implanted in an area of thick cartilage as in the centre of the patella where the cartilage is 5 mm thick. Donor site pathology in mosaicplasty is an issue of concern mainly if more than six plugs are removed from the femoropatellar joint. This alone can create clinical symptoms. Nicotine abuse, probably for all techniques decreases the rate of success of cartilage repair or regeneration and osteotomy healing. Roughly 300 cases have been treated during the last 10 years. The results were reported in 2002. As an alternate single surgery technique to microfracturing and mosaicplasty we adopted the “Autologous membrane induced chondrogenesis” (AMIC) technique proposed by Behrens that we find especially useful in
Cartilage defects of the hip cause significant
pain and may lead to arthritic changes that necessitate hip replacement.
We propose the use of fresh osteochondral allografts as an option
for the treatment of such defects in young patients. Here we present
the results of fresh osteochondral allografts for cartilage defects
in 17 patients in a prospective study. The underlying diagnoses
for the cartilage defects were osteochondritis dissecans in eight
and avascular necrosis in six. Two had Legg-Calve-Perthes and one
a femoral head fracture. Pre-operatively, an MRI was used to determine
the size of the cartilage defect and the femoral head diameter.
All patients underwent surgical hip dislocation with a trochanteric
slide osteotomy for placement of the allograft. The mean age at
surgery was 25.9 years (17 to 44) and mean follow-up was 41.6 months
(3 to 74). The mean Harris hip score was significantly better after
surgery (p <
0.01) and 13 patients had fair to good outcomes.
One patient required a repeat allograft, one patient underwent hip
replacement and two patients are awaiting hip replacement. Fresh
osteochondral allograft is a reasonable treatment option for hip
cartilage defects in young patients. Cite this article:
The treatment of osteochondral lesions and osteoarthritis
remains an ongoing clinical challenge in orthopaedics. This review
examines the current research in the fields of cartilage regeneration,
osteochondral defect treatment, and biological joint resurfacing, and
reports on the results of clinical and pre-clinical studies. We
also report on novel treatment strategies and discuss their potential
promise or pitfalls. Current focus involves the use of a scaffold
providing mechanical support with the addition of chondrocytes or mesenchymal
stem cells (MSCs), or the use of cell homing to differentiate the
organism’s own endogenous cell sources into cartilage. This method
is usually performed with scaffolds that have been coated with a
chemotactic agent or with structures that support the sustained
release of growth factors or other chondroinductive agents. We also
discuss unique methods and designs for cell homing and scaffold
production, and improvements in biological joint resurfacing. There
have been a number of exciting new studies and techniques developed
that aim to repair or restore osteochondral lesions and to treat
larger defects or the entire articular surface. The concept of a
biological total joint replacement appears to have much potential. Cite this article:
We have evaluated the clinical effectiveness
of a metal resurfacing inlay implant for osteochondral defects of
the medial talar dome after failed previous surgical treatment.
We prospectively studied 20 consecutive patients with a mean age
of 38 years (20 to 60), for a mean of three years (2 to 5) post-surgery.
There was statistically significant reduction of pain in each of
four situations (i.e., rest, walking, stair climbing and running;
p ≤ 0.01). The median American Orthopaedic Foot and Ankle Society
ankle-hindfoot score improved from 62 (interquartile range (IQR)
46 to 72) pre-operatively to 87 (IQR 75 to 95) at final follow-up
(p <
0.001). The Foot and Ankle Outcome Score improved on all
subscales (p ≤ 0.03). The mean Short-Form 36 physical component
scale improved from 36 (23 to 50) pre-operatively to 45 (29 to 55)
at final follow-up (p = 0.001); the mental component scale did not
change significantly. On radiographs, progressive degenerative changes
of the opposing tibial plafond were observed in two patients. One
patient required additional surgery for the osteochondral defect.
This study shows that a metal implant is a promising treatment for
osteochondral defects of the medial talar dome after failed previous
surgery. Cite this article:
The management of failed autologous chondrocyte
implantation (ACI) and matrix-assisted autologous chondrocyte implantation
(MACI) for the treatment of symptomatic osteochondral defects in
the knee represents a major challenge. Patients are young, active
and usually unsuitable for prosthetic replacement. This study reports
the results in patients who underwent revision cartilage transplantation
of their original ACI/MACI graft for clinical or graft-related failure.
We assessed 22 patients (12 men and 10 women) with a mean age of
37.4 years (18 to 48) at a mean of 5.4 years (1.3 to 10.9). The
mean period between primary and revision grafting was 46.1 months
(7 to 89). The mean defect size was 446.6 mm2 (150 to
875) and they were located on 11 medial and two lateral femoral condyles,
eight patellae and one trochlea. The mean modified Cincinnati knee score improved from 40.5 (16
to 77) pre-operatively to 64.9 (8 to 94) at their most recent review
(p <
0.001). The visual analogue pain score improved from 6.1
(3 to 9) to 4.7 (0 to 10) (p = 0.042). A total of 14 patients (63%)
reported an ‘excellent’ (n = 6) or ‘good’ (n = 8) clinical outcome,
5 ‘fair’ and one ‘poor’ outcome. Two patients underwent patellofemoral
joint replacement. This study demonstrates that revision cartilage
transplantation after primary ACI and MACI can yield acceptable
functional results and continue to preserve the joint. Cite this article:
We evaluated the histological changes before and after fixation in ten knees of ten patients with osteochondritis dissecans who had undergone fixation of the unstable lesions. There were seven males and three females with a mean age of 15 years (11 to 22). The procedure was performed either using bio-absorbable pins only or in combination with an autologous osteochondral plug. A needle biopsy was done at the time of fixation and at the time of a second-look arthroscopy at a mean of 7.8 months (6 to 9) after surgery. The biopsy specimens at the second-look arthroscopy showed significant improvement in the histological grading score compared with the pre-fixation scores (p <
0.01). In the specimens at the second-look arthroscopy, the extracellular matrix was stained more densely than at the time of fixation, especially in the middle to deep layers of the articular cartilage. Our findings show that articular cartilage regenerates after fixation of an unstable lesion in osteochondritis dissecans.
A total of 11 patients (12 knees) with stable lesions of osteochondritis dissecans of the knee underwent arthroscopic fixation of the fragments using polylactide bioabsorbable pins. The site of the lesion was the medial femoral condyle in ten knees and the lateral femoral condyle in two. The mean age of the patients was 14.8 years (12 to 16). At a mean follow-up of 32.4 months (13 to 38 months) all fragments had MRI evidence of union. One patient developed early transient synovitis, which resolved with non-steroidal anti-inflammatory medication. All patients returned to sporting activities within eight months of operation and did not require a period of immobilisation.
The purpose of this study was to evaluate the
long-term functional and radiological outcomes of arthroscopic removal
of unstable osteochondral lesions with subchondral drilling in the
lateral femoral condyle. We reviewed the outcome of 23 patients
(28 knees) with stage III or IV osteochondritis dissecans lesions
of the lateral femoral condyle at a mean follow-up of 14 years (10
to 19). The functional clinical outcomes were assessed using the Lysholm
score, which improved from a mean of 38.1 ( We found radiological evidence of degenerative changes in the
third or fourth decade of life at a mean of 14 years after arthroscopic
excision of the loose body and subchondral drilling for an unstable
osteochondral lesion of the lateral femoral condyle. Clinical and
functional results were more satisfactory.
Matrix-assisted autologous chondrocyte transplantation (MACT)
has been developed and applied in the clinical practice in the last
decade to overcome most of the disadvantages of the first generation
procedures. The purpose of this systematic review is to document
and analyse the available literature on the results of MACT in the
treatment of chondral and osteochondral lesions of the knee. All studies published in English addressing MACT procedures were
identified, including those that fulfilled the following criteria:
1) level I-IV evidence, 2) measures of functional or clinical outcome,
3) outcome related to cartilage lesions of the knee cartilage.Objectives
Methods
Autologous chondrocyte implantation (ACI) and
mosaicplasty are methods of treating symptomatic articular cartilage
defects in the knee. This study represents the first long-term randomised
comparison of the two techniques in 100 patients at a minimum follow-up
of ten years. The mean age of the patients at the time of surgery was
31.3 years (16 to 49); the mean duration of symptoms pre-operatively
was 7.2 years (9 months to 20 years). The lesions were large with
the mean size for the ACI group being 440.9 mm2 (100
to 1050) and the mosaicplasty group being 399.6 mm2 (100
to 2000). Patients had a mean of 1.5 previous operations (0 to 4)
to the articular cartilage defect. Patients were assessed using
the modified Cincinnati knee score and the Stanmore-Bentley Functional Rating
system. The number of patients whose repair had failed at ten years
was ten of 58 (17%) in the ACI group and 23 of 42 (55%) in the mosaicplasty
group (p <
0.001). The functional outcome of those patients with a surviving graft
was significantly better in patients who underwent ACI compared
with mosaicplasty (p = 0.02).