Difficulties arise when counselling younger patients on the long-term sequelae of a minor knee chondral defect. This study assesses the natural history of patients with grade 2 Outerbridge chondral injuries of the medial femoral condyle at arthroscopy. We reviewed all arthroscopies performed by one surgeon over 12 years with Outerbridge grade 2 chondral defects. Patients aged 30 to 59 were included. Meniscal injuries found were treated with partial menisectomy. All patients had five-year follow up minimum. Primary outcome measure was further interventions of total or unicondylar arthroplasty or high tibial osteotomy. We analysed 3,344 arthroscopies. Average follow up was 10 years (Range 5–17 years). A total of 357 patients met inclusion criteria of which 86 had isolated medial femoral condyle disease. Average age was 50 at the time of arthroscopy. Average BMI at surgery was 31.7 and average chondral defect area was 450 mm. 2. Isolated MFC chondral disease had a 10.5% intervention rate. Intervention occurred at a mean of 8.5 years post primary arthroscopy. In young patients Outerbridge II chondral injuries affecting ≥2 compartments have a high rate of further intervention within a decade. This information is crucial in counselling young patients on long-term sequelae of benign chondral lesions

Open debridement and Outerbridge and Kashiwagi debridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis. However, the literature contains little information on the long-term survivorship of these procedures. The purpose of this study was to determine the survivorship after elbow debridement techniques until conversion to total elbow arthroplasty and revision surgery. We performed a retrospective chart review of patients who underwent open elbow surgical debridement (open debridement, OK procedure) between 2000 and 2015. Patients were diagnosed with primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients had primary surgery including open debridement (n=142) and OK procedure (n=178), and of these 33 patients required a secondary revision surgery (open debridement, n=14 and OK procedure, n=19). The average follow-up time was 11.5 years (5.5 - 21.5 years). Survivorship was analyzed with Kaplan-Meier curves and Log Rank test. A Cox proportional hazards model was used assess the likelihood of conversion to total elbow arthroplasty or revision surgery while adjusting for covariates (age, gender, diagnosis). Significance was set p<0.05. Kaplan-Meier survival curves showed open debridement was 100.00% at 1 year, 99.25% at 5 years, and 98.49% at 10 years and for OK procedure 100.00% at 1 year, 98.80% at 5 years, 97.97% at 10 years (p=0.87) for conversion to total elbow arthroplasty. There was no difference in survivorship between procedures after adjusting for significant covariates with the cox proportional hazard model. The rate of revision for open debridement and OK procedure was similar at 11.31% rand 11.48% after 10 years respectively. There were higher rates of revision surgery in patients with open debridement (hazard ratio, 4.84 CI 1.29 – 18.17, p = 0.019) compared to OK procedure after adjusting for covariates. We also performed a stratified analysis with radiographic severity as an effect modifier and showed grade 3 arthritis did better with the OK procedure compared to open debridement for survivorship until revision surgery (p=0.05). However, this difference was not found for grade 1 or grade 2 arthritis. This may suggest that performing the OK procedure for more severe grade 3 arthritis could decrease reoperation rates. Further investigations are needed to better understand the indications for each surgical technique. This study is the largest cohort of open debridement and OK procedure with long term follow-up. We showed that open elbow debridement and the OK procedure have excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post traumatic cases. The OK procedure also has lower rates of revision surgery than open debridement, especially with more severe radiographic arthritis

Open debridement and Outerbridge and Kashiwagi debridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis. However, the literature contains little information on the long-term survivorship of these procedures. The purpose of this study was to determine the survivorship after elbow debridement techniques until conversion to total elbow arthroplasty and revision surgery. We performed a retrospective chart review of patients who underwent open elbow surgical debridement (open debridement, OK procedure) between 2000 and 2015. Patients were diagnosed with primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients had primary surgery including open debridement (n=142) and OK procedure (n=178), and of these 33 patients required a secondary revision surgery (open debridement, n=14 and OK procedure, n=19). The average follow-up time was 11.5 years (5.5 - 21.5 years). Survivorship was analyzed with Kaplan-Meier curves and Log Rank test. A Cox proportional hazards model was used assess the likelihood of conversion to total elbow arthroplasty or revision surgery while adjusting for covariates (age, gender, diagnosis). Significance was set p<0.05. Kaplan-Meier survival curves showed open debridement was 100.00% at 1 year, 99.25% at 5 years, and 98.49% at 10 years and for OK procedure 100.00% at 1 year, 98.80% at 5 years, 97.97% at 10 years (p=0.87) for conversion to total elbow arthroplasty. There was no difference in survivorship between procedures after adjusting for significant covariates with the cox proportional hazard model. The rate of revision for open debridement and OK procedure was similar at 11.31% rand 11.48% after 10 years respectively. There were higher rates of revision surgery in patients with open debridement (hazard ratio, 4.84 CI 1.29 - 18.17, p = 0.019) compared to OK procedure after adjusting for covariates. We also performed a stratified analysis with radiographic severity as an effect modifier and showed grade 3 arthritis did better with the OK procedure compared to open debridement for survivorship until revision surgery (p=0.05). However, this difference was not found for grade 1 or grade 2 arthritis. This may suggest that performing the OK procedure for more severe grade 3 arthritis could decrease reoperation rates. Further investigations are needed to better understand the indications for each surgical technique. This study is the largest cohort of open debridement and OK procedure with long term follow-up. We showed that open elbow debridement and the OK procedure have excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post traumatic cases. The OK procedure also has lower rates of revision surgery than open debridement, especially with more severe radiographic arthritis

Introduction. Oriental people habitually adopt formal sitting and squatting postures, the extreme flexion of the knees allowing of this. The influence exercised by pressure and posture are, therefore, found at the posterior side of knee joint. However, we don't have many report about articular cartilage of posterior femoral condyle. Objectives. The purpose of this study was to reveal the accurate prevalence and related factors to the presence of degenerative changing of the articular cartilage of posterior femoral condyle in cadaveric knee joints. Methods. One hundred and thirty two knees from 66 cadavers (42 male knees and 24 female knees, formalin fixed, Japanese anatomical specimens) were included in this study. The average age of the cadavers was 81.4 (56–101) years. Knees were macroscopically evaluated the depth of cartilage degeneration of the patellofemoral joint, medial and lateral femoral condyle, medial and lateral posterior femoral condyle following the Outerbridge's classification. Grading was as follows: Grade 1: normal cartilage or softening and swelling of the cartilage. Grade 2: partial-thickness defect which did not reach the subchondral bone and was less than 1.3 cm in diameter. Grade 3: partial-thickness defect which did not reach the subchondral bone and was more than 1.3 cm in diameter. Grade 4: exposed subchondral bone and visible reactive tissue formation. When there were multiple lesions of different Outerbridge's classification grades, the sizes of the lesions were added up. Lesions with degenerative changes more severe than Outerbridge's classification grade 3 were regarded as OA lesions. Statistical analysis was performed to reveal the correlation between the occurrences of cartilage degeneration of medial and lateral posterior femoral condyle and medial and lateral femoral condyle and gender. Results. The prevalence of OA-positive was 48.5% (64 knees). Analyzing in the prevalence in gender, male was 31% (26 knees) OA-positive, female was 79.2% (38knees) OA-positive. The frequency of OA-positive was significantly higher in females than in males (P < 0.001). The prevalence of OA-positive in posterior condyle was 53.1% (34 knees) in 64 knees of OA-positive. Analyzing in the prevalence in gender, male was 15.4% (4 knees) in 26 knees of OA-positive, female was 78.4% (30knees) in 38 knees of OA-positive. The frequency of OA-positive in posterior condyle was significantly higher in females than in males (P < 0.001). Conclusions. In this study, the prevalence of OA-positive in posterior condyle was evaluated in cadaveric knees. The prevalence of OA-positive in posterior condyle was 53.1% in OA-positive knees, and was significantly correlated with the gender

Aim. Septic arthritis (SA) is considered a medical emergency. The most common etiological agents are glucose consuming bacteria, so we evaluated the clinical utility of synovial fluid (SF) glucose levels and other biochemical parameters for supporting the diagnosis of the disease and their association with a positive bacteria culture and joint destruction. Methods. Adult patients with SA diagnose were enrolled prospectively between July 2018 and October 2019. As control group, adults with knee osteoarthritis, meniscus and/or knee ligaments lesions were enrolled. SF samples were obtained from the joints by arthrocentesis/arthrotomy. Microbiological analyses of SF were performed using Brucella broth blood culture flasks, samples were incubated at 37°C with 5% CO. 2. for 24 hours. Gram stain, chocolate and blood agar were used for the identification and growth of the bacteria. SF glucose levels, pH and leukocyte esterase were measured as biochemical parameters using a glucometer and colorimetric test strips. The Outerbridge classification was used for grading the osteochondral injury. Furthermore, blood samples were collected from patients and control subjects for determining glucose levels. Results. We included 8 subjects with knee ligaments lesions, 6 with meniscus lesions and 5 with osteoarthritis as control group, as well as 20 patients with SA diagnose. The mean age of the patients was 57.8 years with a 65% of male predominance. The most common affected joint was the knee (85%). SF culture was positive in 60% of the cases and the most common etiological agent was Staphylococcus aureus (58.3%). SF glucose levels from patients were lower than the controls (P=0.0018) and showed the lowest concentration in patients with a positive culture (P=0.0004). There was also a difference between blood and SF glucose concentration from the positive culture patients (P<0.0001). Leucocyte esterase presented the highest values in positive culture patients (P=<0.0001) and a more acidic pH was found compared to the control group (P<0.0001). Regarding the osteochondral injury, the lowest concentrations of SF glucose were found in patients with a higher grade in the classification (P = 0.0046). Conclusions. SF glucose and leukocyte esterase concentrations might be a quick and cheap useful parameter for the physician for distinguishing between bacterial infection and not infected joint. In addition, the lowest SF glucose levels might give information about the joint damage due to the disease

Degenerate chondral surfaces can be assessed in many ways, but arthroscopy is often performed without proper categorisation, mapping, zoning or sizing of lesions. Progression of disease in un-resurfaced compartments is well-recognised to occur, but is only one of several failure mechanism in partial knee replacement. A validated ‘Functional Zone’ mapping method was used to document articular surface damage in 250 sequential cases of knee arthroscopy in patients over the age of 40. Size, shape, location and severity of each chondral lesion were noted using the Outerbridge classification. Analysis determined rates of involvement of particular compartments and assessed potential for partial replacement or local treatment and also to consider the risk of future progression. Radiographs including antero-posterior standing, postero-anterior flexion views (Rosenberg), lateral and skyline views were graded (Kellgren and Lawrence) and compared with the arthroscopic findings. Our results showed that out of the 210 knees with Grade 3 or greater damage 13.3% of knees showed ‘isolated’ medial disease of Outerbridge Grade 3 or worse. Isolated lateral disease was noted in 1.4%, patello-femoral disease in 24.3%, bi-compartmental (Medial/PFJ) disease in 30.9% with tibio-femoral and tri-compartmental disease seen in 15.2%. The combination of lateral and patello-femoral disease was seen in 14.8%. Provided that Grade 1 and 2 changes (which were found in other compartments in high percentages) were ignored and ACL status considered, this information seemed to indicate that at the time these procedures were performed, 13.3% of cases were suitable for a medial uni-compartmental device, with sub-analysis of lesion sizes indicating that 17 out of 28 cases (60.7%) were suitable for a localised resurfacing. Lateral uni-compartmental replacement seemed suitable for only 1.4%, patello-femoral replacement in 24.3%, bi-compartmental in 30.9% and total knee replacement in 30%. The mean age for partial resurfacing was 53years and 59 years for total joint replacements. Radiological analysis found that the antero-posterior standing views had only 66% sensitivity and 73% specificity for the presence of Grade 3 changes or worse in the medial compartment in comparison with Rosenberg views having a sensitivity of 73% and a specificity of 83%. Skyline views had a sensitivity of 56% and 100% specificity. This study indicates that a large proportion of cases may be suited to local and limited resurfacing. Cases suitable for Patello-femoral and Bi-compartmental replacements were very common, but with the patella-femoral joint's tendency to be more forgiving in terms of symptoms, meaning that indications for uni-compartmental replacement might well be much higher than the arthroscopic findings suggested. On the other hand, the presence of high levels of Grade 1 and 2 changes in other compartments seems to indicate a need for caution particularly in younger patients. This study also indicates a need for better methods of assessing local cartilage health such as enhanced MRI scanning or spectroscopy

Hill-Sachs and reverse Hill-Sachs lesions come in different shapes and sizes, and their effect on “glenoid track” can vary. Small Hill-Sachs lesions that do not engage can be successfully treated with a Bankart repair alone done arthroscopically or open. Moderate, engaging, Hill-Sachs lesions can be treated either with the addition of remplissage to an arthroscopic Bankart or by adding the triple blocking effect of the Bristow-Latarjet procedure. Surface replacements vary in size from the small hemi-cap type of procedure to an entire humeral head replacement (HHR). These devices can be used as opposed to allograft replacement when the risk of post-reconstruction arthritis is high with the aforementioned more conventional treatment techniques. When 45% or more of the humeral head is involved with the lesion, or Outerbridge stage III and IV changes prevail, a HHR is preferred. An oval shaped HHR is the author's preference, and the long diameter can be used to provide coverage anteriorly or posteriorly and is particularly useful in large Hill-Sachs lesions associated with epilepsy

Septic arthritis is a therapeutic emergency with a high mortality rate (about 11%)(1). Inadequate treatment can cause permanent joint damage. Management of the septic arthritis includes prompt antibiotic treatment as well as joint-decompression and removal of purulent material(2). It is still discussed controversially and there is little evidence which surgical concept is preferable: arthroscopy with lavage and debridement or open arthrotomy with synovectomy(3,4). The aim of the study was to compare efficacy of arthroscopy and arthrotomy in patients with septic gonarthritis. We evaluated 70 consecutive patients who underwent arthroscopy or arthrotomy at our clinic, because of a bacterial monarthritis of the knee between 2002 and 2010. Our primary outcome was the early recurrence of infection (> 3 months after surgery), which made a second surgery necessary. We compared patients who suffered reinfection and those who did not, in regard to the surgery type as well as potential confounders like comorbidity (measured by Charlson comorbidity index), age, body mass index (BMI), Gächter's -, Kellgren and Lawrence - and Outerbridge classification, duration of symptoms and inflammatory parameters. Furthermore we evaluated differences of the confounders between the surgery groups. From the 70 patients 41 were treated arthroscopic and 29 with arthrotomy. In total eight patients (11.4%) had to undergo a second surgery because of early reinfection. The rate was significantly higher in patients treated with arthrotomy (n=6; 20.7%) compared to those treated with arthroscopy (n=2; 4.9%) (p=0.041). Whereas we found no significant influence of potential confounders between the reinfection group and the group where primary eradication was achieved. Patients who underwent arthrotomy were significantly older, had more comorbidities (both p<0.001) and higher grades of osteoarthritis according to Kellgren and Lawrence classification (p=0.023). In order to adjust the study population towards confounders we performed a subgroup analysis on patients of the second and third age percentile. When we repeated our analysis we still found a significant higher reinfection rate in the arthrotomy group (p=0.036). At the same time there were no differences in prevalence of confounders, neither between the two surgery groups, nor between the reinfection and the primary eradication group. Patients with bacterial monarthritis of the knee who were treated with arthroscopy had a significantly lower reinfection rate than those treated with arthrotomy. As arthroscopy is the less invasive and more sufficient method it should be considered the routine treatment according to our data

Background:. Different surgical approaches have been proposed for the treatment of chondral lesions. However surgical management of osteochondral defects of the knee joint involving subchondral bone are still under debate. Purpose:. The aim of this prospective non-randomized uncontrolled clinical investigation is to confirm the effectiveness of a commercially available biomimetic osteochondral scaffold in regenerating cartilage and subchondral bone of severe osteochondral lesions of the knee joint with one step surgery. Methods:. The biomimetic scaffold has a multilayer structure consisting of a combination of type I collagen and type I collagen/hydroxyapatite, mimicking the osteochondral connective tissue of the knee joint. From 2009 to 2011, sixty-one patients affected by grade III or IV osteochondral lesions of the knee, according to Outerbridge Classification, were admitted to three centers and received the biomimetic scaffold. Four-nine patients were evaluated using the International Knee Documentation Committee (IKDC), Tegner and VAS scores, and MRI at 1-, 2- and 3-year follow-ups. Biopsies were carried out in 5 patients at an average time of 19.2 months to histologically evaluate the quality of the newly-formed tissue. Results:. All patients tolerated the surgery well; no major adverse events were observed in the early postoperative period. Clinical evaluation of the 49 patients showed a statistically significant improvement in all scores at 1- 2- and 3-year follow-ups as compared to preoperative baseline scores. Improvement in the scores and functional recovery seemed to reach a plateau after 2 years; no significant improvement was seen between the 2- and the 3-year follow-up. Conclusions:. A synthetic biomimetic scaffold used in one-step surgery for the treatment of severe osteochondral knee lesions significantly improved symptoms and joint function, as demonstrated by subjective and objective scoring system evaluation. Furthermore, the athletic subpopulation exhibited a significantly better outcome than the non-athletic subpopulation

Total knee replacement (TKR) is considered the “gold standard” treatment for advanced osteoarthritis (OA) of the knee with good survivorship and functional outcomes. However up to 20% of patients undergoing TKR may have unicompartmental disease only. Treatment options for medial compartment arthritis can include both unicompartmental knee replacements (UKR) and TKR. While some surgeons favor TKR with a proven track record, others prefer UKR due to more normal joint kinematics, better proprioception and better motion. There is also a higher rate of return to sports amongst patients with UKR compared to TKR. When considering all knee procedures, partial knee replacements account for 7–9%, primary TKRs for 83–88%, and revision knee replacements for 5–8%. Unicompartmental Knee Replacements comprise more than 90% of all partial knee replacement procedures. Proponents of UKR cite as advantages the preservation of normal knee kinematics, lower peri-operative morbidity, blood loss and infection risk compared with TKRs, as well as accelerated patient rehabilitation and recovery. However, partial knee replacements have a higher rate of revision than TKRs. This may be partly because they are inserted in patients with higher expectations, and partly because they are easier to revise. As a result, the volume of UKRs implanted has diminished over time and continues to decline. We compared patient reported outcomes, satisfaction and perception of normality of the knee post-operatively between UKR and TKR. A single unit and single surgeon series of patients were recruited. Data was collated for 68 well-matched patients with more than 24 months follow-up. UKR was undertaken in patients with isolated medial compartment osteoarthritis; stable ACL and less than grade 3 lateral patellar changes of the Outerbridge classification. TKR was undertaken for the rest. The patients were assessed with validated knee scores including the Total Knee Function Questionnaire (TKFQ) which focuses on recreational and sporting outcomes as well as activities of daily living (ADL). Patient satisfaction and perception of knee normality was measured on a visual analogue scale. Thirty-four patients with a TKR and 34 patients with a UKR were analyzed. The average ages in the TKR and UKR groups were 69.25 and 67.26 years, respectively. The patients were well-matched for demographics and had equivalent pre-operative morbidities and scores. The UKR group had better WOMAC (p=0.003), SF36 (physical: p<0.001 mental: p=0.25), Oxford knee (p<0.001) and Knee Society scores (p=0.002, function: p<0.001). The UKR group showed better outcomes in the TKFQ including exercise and sport (p= 0.02), movement and lifestyle (p=0.02) and the ADL (p=0.002). There was, however, no difference in patient satisfaction scores (p=0.41) and perception of how normal the knee felt between the two groups (p=0.99). A UKR procedure confers better functional outcome in terms of recreation and sport compared to TKR procedures. While UKR is an appropriate choice in the elderly yet active patient with unicompartmental knee arthritis, satisfaction is similar to that of patients with a TKR reflecting higher pre-operative expectations. We believe that in appropriate centers, the UKR procedure is associated with excellent outcomes. UKR should have a secure place in the knee arthroplasty armamentarium provided current knowledge regarding patient selection and surgical technique is followed

Chondral damage within the knee commonly occurs during sport following direct trauma or following degeneration through overuse. Radio frequency energy chondroplasty (RFC) can be used as an alternative to mechanical chondroplasty in the arthroscopic treatment of chondral lesions. Current literature supports the theoretical advantage of RFC and purports to in vitro improvements in cartilage structure and function following RFC. We conducted a retrospective study of patients undergoing RFC for isolated chondral lesions in the knee and assessed the short term clinical benefits. Retrospective analysis was completed of operative notes and arthroscopic images of all patients who underwent arthroscopic chondroplasty at the royal Devon and Exeter Hospital between January 2009 and June 2012. Inclusion criteria included 1 to 2 defined chondral lesions, less than 2cm2, of Outerbridge grade II-IV, treated via arthroscopic RFC. Exclusion criteria included diffuse articular cartilage damage, additional pathologies affecting the knee or subsequent further injuries or invasive procedures to the knee. Data was collected via a subjective and objective questionnaire assessing patient outcome. 35 patients met the inclusion criteria, 32 were successfully followed up. Male: female ratio was 16:16, with a mean age of 39.5 (range 19–60). 84% (n=27) of patients experienced a significant reduction in pain (mean reduction of 51%, p < 0.001) lasting until the time of study (median of 21 months, range 9 to 31 months). There was no correlation between change in symptoms and site and grade of chondral lesion. Pre-operative instability symptoms did not significantly improve following RFC. Satisfaction with treatment was in direct correlation with pain relief achieved. Our study appears to support current literature by suggesting short term improvements to pain following the use of RFC on chondral lesions. Greater population size and longer follow-up are required to provide more significant conclusions

Aim. We report the results of a modified Fulkerson technique of antero-medialisation of the tibial tubercle, combined with microfracture or abrasion arthroplasty in patients under 60 with patello-femoral osteoarthritis. Methods. All patients operated between September 1992 and October 2007 were reviewed by an independent observer in clinic or by postal questionnaire, using the Oxford Knee Score, Melbourne Patella Score and a Satisfaction Score. Only patients with Outerbridge Grade 3-4 osteoarthritis of the patello-femoral joint were included. They were assessed pre-operatively with plain x-rays, MRI scans (as well as tracking scans in the last 10 years) and arthroscopically. All patients with tracking scans showed lateral subluxation of the patella. The surgical procedure was a modification of Fulkerson's tibial tubercle osteotomy, with an advancement of 1-1.5cms and a medialisation of 1.5cms. The exposed bone of the patella and trochlea was drilled in the early cases and in the later cases an arthroscopic microfracture or abrasion using a power burr was carried out. Results. Between September 1992 and October 2007, 103 procedures were carried out in 84 patients, 19 patients having staged bilateral procedures. The mean follow-up was 84 months (range 24-204 months). The mean age was 45 (range 26-59) and the female to male ratio was 7.6:1. 70 patients were reviewed (follow-up rate of 82%). The mean Oxford Knee Score was 18.5 pre-operatively (range 3-32) and 34.3 post-operatively (range 11-47). The Melbourne Patella Score was 9.6 pre-operatively (range 3-30) and 20 post-operatively (range 11-30). Patient Satisfaction Scores were excellent (54%), good (29%), fair (8.5%) and poor (8.5%). 4 knees in 3 patients were converted to a patello-femoral arthroplasty, giving a 10 year survival rate of 96.1%. Conclusion. This procedure offers an alternative to patello-femoral arthroplasty for younger patients with isolated patello-femoral arthritis

Purpose. The prevalence of focal chondral lesions reported inthe literature during knee arhroscopy can be as high as 63%. Of these, more than half are either grade III or grade IV lesions (Outerbridge). Full thickness cartilage lesions ranging from 2cm2 to 10cm2 are the most challenging to treat. To goal of this study was to evaluate clinical outcomes of pain, function and quality of life, along with radiological outcomes of cartilage repair using microfracture, autologous minced cartilage and polymeric scaffold. Method. A cohort of thirty-eight patients with Outerbridge grade III or IV cartilage injuries larger than 2cm2 in the knee's femoral condyle, trochlea or patella were prospectively folowed since 2008. They were all treated with microfracture, fresh minced autologous cartilage grafting and a polymeric scaffold technique through mini-arthrotomy of the knee. Autografts and scaffolds were secured to subchondral bone using fibrin glue and tran-sosseous resorbable sutures. Patients were evaluated pre and postoperatively using VAS scores for pain, WOMAC and IKDC scores for knee function and SF-36 questionnaire for quality of life. Clinical evaluations were done by physical examination, and imaging was done using X-Rays, MRI and arthro-CT. Results. Mean follow-up time was14.64.6 months. Mean age was 48.39.3 years old. Pre-op lesions averaged 3.51.5 cm2. VAS pain scores were significantly reduced after surgery (7,62 to 2,52.3, p<. 0001). Improvement in knee function using IKDC score improved from 26,717.5 to 55,415.3, p<. 001). In addition, WOMAC total scores showed significant reduction from 55,520.3 to 27,517.6. SF-36 quality of life Physical Component Summary improved from 26,411.4 to 45,812.3, p<. 01; Mental Component Summary improved from 41,916.8 to 49,411.2, p<. 048). Imaging results indicate sustained cartilage thickness from 6 to 18 months. One patient was an early failure due to scaffold loosening, and two patients had no clinical improvement and no significant cartilage regeneration on MRI and Arthro-CT imaging at 6 months post-op. Conclusion. The combination of microfractures, fresh minced autologous cartilage grafting and polymeric scaffold fixation seems to be an effective treatment option for post-traumatic and focal cartilage lesions of the knee in the short term. A longer-term follow-up to evaluate the sustainability of these results is ongoing. Shortcomings of this study are its short term, the lack of second look arthroscopies and cartilage biopsies to evaluate cartilage microstructure, and the absence of a gold standard treatment for full-thickness cartilage lesions larger than 2cm2 that could be used as a control

Purpose. Traumatic articular cartilage (AC) defects are common in young adults and frequently progresses to osteoarthritis. Matrix-Induced Autologous Chondrocyte Implantation (MACI) is a recent advancement in cartilage resurfacing techniques and is a variant of ACI, which is considered by some surgeons to be the gold standard in AC regeneration. MACI involves embedding cultured chondrocytes into a scaffold that is then surgically implanted into an AC defect. Unfortunately, chondrocytes cultured in a normoxic environment (conventional technique) tend to de-differentiate resulting in decreased collagen II and increased collagen I producing in a fibrocartilagous repair tissue that is biomechanically inferior to AC and incapable of withstanding physiologic loads over prolonged periods. The optimum conditions for maintenance of chondrocyte phenotype remain elusive. Normal oxygen tension within AC is <7%. We hypothesized that hypoxic conditions would induce gene expression and matrix production that more closely characterizes normal articular chondrocytes than that achieved under normoxic conditions when chondrocytes are cultured in a collagen scaffold. Method. Chondrocytes were isolated from Outerbridge grade 0 and 1 AC from four patients undergoing total knee arthroplasty and embedded within 216 bovine collagen I scaffolds. Scaffolds were incubated in hypoxic (3% O2) or normoxic (21% O2) conditions for 1hr, 21hr and 14 days. Gene expression was determined using Q-rt-PCR for col I/II/X, COMP, SOX9, aggrecan and B actin. Matrix production was determined using glycosaminoglycan (GAG) content relative to cell count determined by DNA quantification. Cell viability and location within the matrix was determined by Live/Dead assay and confocal microscopy. Statistical analysis was performed using a two-tailed T-test. Results. Chondrocytes cultured under hypoxic conditions showed an upregulation of all matrix related genes compared to normoxic conditions noted most markedly in col II, COMP and SOX9 expression. There were similar numbers of chondrocytes between hypoxic and normoxic groups (P=0.68) but the chondrocytes in the hypoxic group produced more GAG per cell (P= 0.052). Viable cells were seen throughout the matrix in both groups. Conclusion. Important matrix related genes (col II, COMP, SOX9) were most significantly upregulated in hypoxic conditions compared to normoxic conditions. This was supported by an increase in GAG production per cell in hypoxic conditions. The results indicate that hypoxia induces an upregulation in the production of extracellular matrix components typical of AC with only modest increases in col I (possibly related to the col I based scaffold used in this experiment). These results indicate that hypoxic conditions are important for the maintenance of chondrocyte phenotype even when the cells are cultured in a 3D environment. In conclusion, hypoxic culture conditions should be used to help maintain chondrocyte phenotype even when culturing these cells in a 3D scaffold

Hyaline articular cartilage has been known to be a troublesome tissue to repair once damaged. Since the introduction of autologous chondrocyte implantation (ACI) in 1994, a renewed interest in the field of cartilage repair with new repair techniques and the hope for products that are regenerative have blossomed. This article reviews the basic science structure and function of articular cartilage, and techniques that are presently available to effect repair and their expected outcomes.