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.

PURPOSES. Previous studies on patella-femoral morphology have suggested patella maltracking plays an important part in the aetiology but there had been no studies correlating maltracking with articular cartilage change. METHODS. We studied 147 consecutive patients (294 knees) aged between 10 and 63 presenting with anterior knee pain. All underwent MRI tracking scan of their knees as part of the routine investigations. We analysed the prevalence of maltracking with respect to gender, laterality and age groups, as well as patello-femoral articular cartilage changes. RESULTS. 52% of patients were found to have maltracking, of which 75% were bilateral. Furthermore, 66% of patients with maltracking had radiological evidence of patellar articular cartilage changes, corresponding to 61% of 294 knees examined. While majority of these occur at lateral facet, a proportion of medial facet changes (16%) is also seen. More significantly, while 25% of knees from patients with maltracking under the age of 20 are found to have changes on the patella cartilage, this increases to 93% by the age of 50 or above, with step-wise increment per decade of age (p<0.01). CONCLUSION. Our results demonstrate a strong correlation between anterior knee pain symptoms, patella maltracking and changes in patello-femoral joint cartilages of varying severity. This has implications on the management of these patients and would suggest early correction of maltracking is indicated to prevent deterioration in the patello-femoral joint

We attempted to characterise the biological quality and regenerative potential of chondrocytes in osteochondritis dissecans (OCD). Dissected fragments from ten patients with OCD of the knee (mean age 27.8 years (16 to 49)) were harvested at arthroscopy. A sample of cartilage from the intercondylar notch was taken from the same joint and from the notch of ten patients with a traumatic cartilage defect (mean age 31.6 years (19 to 52)). Chondrocytes were extracted and subsequently cultured. Collagen types 1, 2, and 10 mRNA were quantified by polymerase chain reaction. Compared with the notch chondrocytes, cells from the dissecate expressed similar levels of collagen types 1 and 2 mRNA. The level of collagen type 10 message was 50 times lower after cell culture, indicating a loss of hypertrophic cells or genes. The high viability, retained capacity to differentiate and metabolic activity of the extracted cells suggests preservation of the intrinsic repair capability of these dissecates. Molecular analysis indicated a phenotypic modulation of the expanded dissecate chondrocytes towards a normal phenotype. Our findings suggest that cartilage taken from the dissecate can be reasonably used as a cell source for chondrocyte implantation procedures.