Aims. The aim of this study was to evaluate antegrade autologous bone grafting with the preservation of articular cartilage in the treatment of symptomatic osteochondral lesions of the talus with subchondral cysts. Patients and Methods. The study involved seven men and five women; their mean age was 35.9 years (14 to 70). All lesions included full-thickness articular cartilage extending through subchondral bone and were associated with subchondral cysts. Medial lesions were exposed through an oblique medial malleolar osteotomy, and one lateral lesion was exposed by expanding an anterolateral arthroscopic portal. After refreshing the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis. The fragments of cartilage were fixed with 5-0 nylon sutures to the surrounding cartilage. Function was assessed at a mean follow-up of 25.3 months (15 to 50), using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot outcome score. The radiological outcome was assessed using MRI and CT scans. Results. The mean AOFAS score improved from 65.7 (47 to 81) preoperatively to 92 (90 to 100) at final follow-up, with 100% patient satisfaction. The radiolucent area of the cysts almost disappeared on plain radiographs in all patients immediately after surgery, and there were no recurrences at the most recent follow-up. The medial malleolar screws were removed in seven patients, although none had symptoms. At this time, further arthroscopy was undertaken, when it was found that the mean International Cartilage Repair Society (ICRS) arthroscopic score represented near-normal cartilage. Conclusion. Autologous bone grafting with fixation of chondral fragments preserves the original cartilage in the short term, and could be considered in the treatment for adult patients with symptomatic osteochondral defect and subchondral cysts. Cite this article: Bone Joint J 2018;100-B:590–5

Cite this article: Bone Joint Res 2023;12(5):309–310.

We have investigated whether the pattern of subchondral acetabular cyst formation reflects hip pathology and may provide a prognostic indicator for treatment. A single surgeon series of sequential hip arthroscopies was reviewed to identify the most recent 200 cases undertaken on a previously un-operated joint with pre-operative plain radiographs and computed tomography or magnetic resonance scan available for review. Also, serial “non-arthritic hip scores” (NAHS) recorded pre-operatively, at 6 weeks and 3 months post-surgery. The acetabular Lateral Centre Edge Angle, the Acetabular Index, the FEAR index and the Kallgren and Lawrence grade were determined. All images were reviewed by two independent assessors and divided into four groups according to acetabular subchondral cyst distribution. NC - No cysts - 74 cases (mean: 40.1 years), SPC - a Single Peripheral Cyst – 58 cases (mean: 43.1 years), SDC - a Solitary Dome Cyst – 32 cases (mean: 33 years) and MC - Multiple Cysts – 36 cases (mean: 42.7 years). No association was identified between gender and patient reported outcomes. SDC patients were significantly younger than the other three groups (p <0.001). At three months after surgery, the average increase of the NAHS in the four groups was 25.3, 23.5, 4.2 and 4.9 respectively. Acetabular dysplasia was identified in 72% of the SDC group compared to 18%, 16% and 33% in NC, SPC and MC groups. Degenerative change was identified in 86% of the MC group compared to 18%, 40% and 41% of the NC, SPC and SDC groups. The early patient reported outcome following hip arthroscopy was significantly affected by the location and number of acetabular subchondral cysts. A Solitary Dome Cyst is indicative of underling hip dysplasia. Multiple Cysts are indicative of degenerative disease. The majority of patients in these groups have poor three-month outcomes after hip arthroscopy

Osteoarthritis (OA) is the most common disorder of the Sternoclavicular Joint (SCJ). In our case-control study, we evaluated the relationship between clavicular length and OA at the SCJ. CT scans of adults presenting to the Emergency Department of our hospital were examined to look for OA, defined as the presence of osteophytes, subchondral cysts, or cortical sclerosis at the SCJ. Medial-most and lateral-most points of the clavicle were marked on the slices passing through the SC and AC joints respectively. Using x, y, and z-axis coordinates from the DICOM metadata, clavicular length was calculated as the distance between these two points with 3D geometry. Preliminary data of 334 SCJs from 167 patients (64% males, 36% females) with a mean age of 48.5 ± 20.5 years were analysed. Multivariate regression models revealed that age and clavicular length were independent risk factors for OA while gender did not reach statistical significance. A 1mm increase in length was associated with 9% and 7% reduction in the odds of developing OA on the left and the right respectively. Comparing the mean clavicular length using t-test showed a significantly shorter clavicle in the group with OA (145.8 vs 152.7, p=0.0001, left and 144.2 vs 150.3, p=0.0007, right). Our data suggest that the risk of developing OA at the SCJ is higher for shorter clavicles. This could be of clinical relevance in cases of clavicular fracture where clavicular shortening might lead to a higher risk of developing OA. Biomechanical studies are needed to find out the mechanism of this effect

Juvenile Osteochondritis dissecans (JOCD) in humans and subchondral cystic lesions (SCL) in horses (also termed radiolucencies) share similarities: they develop in skeletally immature individuals at the same location in the medial femoral condyle (MFC) and their etiology is only partially understood but trauma is suspected to be involved. JOCD is relatively uncommon in people whereas SCLs arise in 6% of young horses leading to lameness. Ischemic chondronecrosis is speculated to have a role in both osteochondrosis and SCL pathogenesis. We hypothesize that MFC radiolucencies develop very early in life following a focal internal trauma to the osteochondral junction. Our aims were to characterize early MFC radioluciencies in foals from 0 to 2 years old. Distal femurs (n=182) from Thoroughbred horses (n=91, 0–2 years old), presented for post-mortem examination for reasons unrelated to this study, were collected. Radiographs and clinical tomodensitometry were performed to identify lesions defined as a focal delay of ossification. Micro-tomodensitometry (m-CT) and histology was then performed on the MFCs (CT lesions and age-matched subset of controls). Images were constructed in 3D. The thawed condyles, following fixation, were sectioned within the region of interest, determined by CT lesion sites. Hematoxylin eosin phloxin and safran (HEPS) and Martius-Scarlet-Blue (MSB) stains were performed. Histological parameters assessed included presence of chondronecrosis, fibrin, fibroplasia and osteochondral fracture. An additional subset of CT control (lesion-free) MFCs (less 6 months old) were studied to identify early chondronecrosis lesions distant from the osteochondral junction. One MFC in clinical CT triages controls had a small lesion on m-CT and was placed in the lesion group. All m-CT and histologic lesions (n=23) had a focal delay of ossification located in the same site, a weight bearing area on craniomedial condyle. The youngest specimen with lesions was less than 2 months old. On m-CT 3D image analysis, the lesions seemed to progressively move in a craniolateral to caudomedial direction with advancing age and development. Seventy-four percent (n=17/23) of the lesions had bone-cartilage separation (considered to be osteochondral fractures) confirmed by the identification of fibrin/clot on MSB stains, representing an acute focal bleed. Fibroplasia, indicating chronicity, was also identified (74%, n=17/23). In four cases, the chondrocytes in the adjacent cartilage were healthy and no chondronecrosis was identified in any sections in the lesions. Nineteen cases had chondronecrosis and always on the surface adjacent to the bone, at the osteochondral junction. None of the subset of control specimens, less than 6 months old (n=44), had chondronecrosis within the growth cartilage. Early subchondral cystic lesions of the medial femoral condyle may arise secondary to focal internal trauma at the osteochondral junction. The presence of fibrin/clot is compatible with a recent focal bleed in the lesion. Medial femorotibial joint internal forces related to geometry could be the cause of repetitive trauma and lesion progression. In the juvenile horse, and potentially humans, the early diagnosis of MFC lesions and rest during the susceptible period may reduce progression and promote healing by prevention of repetitive trauma, but requires further study

Introduction. Comparative studies examining Fixed-Bearing (FB) and Mobile-Bearing (MB) Total Ankle Replacement (TAR) designs have demonstrated similar results and successful long-term outcomes for both. To date there has been no study directly comparing FB and MB designs of the same prosthesis. We present the first prospective randomised trial comparing patient satisfaction, functional outcomes and radiographic results of the Salto Talaris Fixed-Bearing and the Salto Mobile-Bearing Total Ankle Replacement in the treatment of end-stage ankle arthritis. Methods. A total of 108 adult patients with end-stage ankle arthritis were enrolled in the study between November 2014 and October 2021 with similar demographic comparison. Prospective patient-reported outcomes and standardised weightbearing ankle radiographs were performed preoperatively, at 6 weeks, 6 months and 12 months post-operatively, followed by yearly intervals. All surgeries were performed by a single non-design orthopaedic foot and ankle specialist with experience in over 200 Salto and Salto Talaris TAR prior to the study. Radiographs were examined independently by two clinicians. Complete patient data and radiographs were available for 103 patients with an average follow up of 2 years. Results. Both groups demonstrated statistically significant improvement from preoperative evaluation to most recent follow up with no statistically significant difference between the two groups in all outcome measures. Radiographic incidence of subchondral cyst formation was 8.9% and 38.2% for FB and MB, respectively. Talar subsidence occurred in 2.2% and 5.5% of FB and MB, respectively. Discussion. Our study demonstrates a higher than previously reported rate of cyst formation in the MB TAR and comparatively higher talar subsidence in the MB TAR vs FB however this did not correlate with clinical outcome measures which were favourable for both groups. Conclusion. Fixed-Bearing and Mobile-Bearing Total Ankle Replacement demonstrate comparable favourable

There is some evidence to suggest that outcomes of THA in patients with minimal radiographic osteoarthritis may not be associated with predictable outcomes. The aim of this study was to:. Assess the outcome of patients with hip pain who underwent THA with no or minimal radiographic signs of osteoarthritis,. Identify patient comorbidities and multiplanar imaging findings which are predictive of outcome,. Compare the outcome in these patients to the expected outcome of THA in hip OA. A retrospective review of 107 hips (102 patients, 90F:12M, median age 40.6, IQR 35.1–45.8 years, range 18–73) were included for analysis. Plain radiographs were evaluated using the Tonnis grading scale of hip OA. Outcome measures were all-cause revision; iHOT12; EQ-5D; Oxford Hip Score; UCLA Activity Scale; and whether THA had resulted in the patient's hip pain and function being Better/Same/Worse. The median Oxford Hip Score was 33.3 (IQR 13.9, range 13–48), and 36/107 (33.6%) hips achieved an OHS≥42. There was no association between primary hip diagnosis and post-operative PROMs. A total of 91 of the 102 patients (89.2%, 93 hips) reported that their hip pain and function was Better than prior to THA and would have the surgery again, 7 patients (6.8%, 10 hips) felt the Same, and 4 patients (3.9%, 4 hips) felt Worse and would not have the surgery again. Younger patients undergoing total hip arthroplasty with no or minimal radiographic osteoarthritis had lower postoperative Oxford Hip Scores than the general population; though most felt symptomatically better and knowing what they know now, would have surgery again. Those with chronic pain syndrome or hypermobility were likely to benefit less. Those with subchondral cysts or joint space narrowing on CT imaging were more likely to achieve higher functional scores and satisfaction

It is unclear whether patients with early radiographic osteoarthritis (OA) but severe hip symptoms benefit from total hip replacement (THR). We aimed to assess which factors were associated with successful THR in this patient group. From a consecutive series of 1,935 patients undergoing THR we identified 70 (3.6%) patients with early OA (Kellgren and Lawrence (KL) grades 0-2). These were compared with 200 patients with advanced OA (KL grades 3–4). Outcomes were Oxford Hip Scores (OHS), EQ5D and EQ-VAS scores; compared pre-operatively with one year post-operatively. We investigated which clinical and radiographic (plain x-ray, CT, MRI) features predicted successful THR in the early OA group. Success was defined as reaching a postoperative OHS≥42. The early OA group were significantly younger (61 vs 66 years; P=0.0035). There were no significant differences in body mass index, ASA grade or gender. After adjusting for confounders, the advanced OA group had a significantly greater percentage of possible change (PoPC) in OHS (75.8% versus 50.4%; P<0.0001) and improvement in EQ5D (0.151 versus 0.002; P<0.0001). There were no significant differences in complication, revision or readmission rates. In the early OA group, we identified 16/70 (22.9%) patients who had a ‘successful’ THR. Of those with early OA, 38 patients had pre-operative CT or MRI scans. Patients who had a ‘successful’ THR were significantly more likely to have subchondral cysts on CT/MRI (91.7% versus 57.7%; P=0.0362). The presence of cysts on CT/MRI was associated with a significantly greater PoPC in OHS (61.6% versus 38.2%; P=0.0353). The combination of cysts and joint space width (JSW) <1mm was associated with a PoPC of 68%. Plain radiographs were found to significantly underestimate the narrowest JSW compared to CT/MRI (2.4mm versus 1.0mm; P<0.0001). We advise caution in performing THRs in patients with early OA (KL grades 0-2) on plain radiographs. We advocate pre-operative cross-sectional imaging (CT or MRI) in these patients. In the absence of cysts on cross-sectional imaging, a THR seems unlikely to provide a satisfactory outcome

Summary Statement. OA knee with subchondral cyst formation presented differential microstructure and mechanical competence of trabecular bone. This finding sheds light on the pivot role of subchondral cyst in OA bone pathophysiology. Introduction. Subchondral bone cyst (SBC) is a major radiological finding in knee osteoarthritis (OA), together with joint space narrowing, osteophyte and sclerotic bone formation. There is mounting evidence showing that SBC originates in the same region as bone marrow lesions (BMLs). The presence of subchondral bone cyst (SBCs), in conjunction with BMLs, was associated with the severity of pain, and was able to predict tibial cartilage lolume loss and risk of joint replacement surgery in knee OA patient. It is speculated that the presence of SBCs might increase intraosseous pressure of subchondral bone, and trigger active remodeling and high turnover of surrounding trabecular bone. Yet the exact effect of SBC on the structural and mechanical properties trabecular bone, which provides the support to overlying articular cartilage, remains to be elucidated. Therefore, this study aimed to investiate the microstructure and mechanical competence of trabecular bone of knee OA in presence or absence of SBC. Patients & Methods. A total of 20 postmenopausal women (54–87 years old) with the late-stage of primary knee OA were recruited in this study. Tibial plateau specimens were collected during joint replacement surgery. The samples were grouped for comparison according to presence or absences of SBC in micro-CT images. For micro-CT examination, a cylindrical volume of region of interest (VOI) of 10mm in diameter and 1mm in height was used to cover the trabecular bone region surrounding SBC, and then a cubic VOI of 3.5×3.5×3.5mm. 3. was applied in different anatomic locations of tibial plateau, such as medial, intermediate and lateral part, for the analyses of trabecular bone microstructure. Subsequently, two cylinders of subchondral bone specimens were drilled for each sample with micro-CT guidance from lateral portion of cystic wall along the direction of physiological loading of knee joint. The specimens were processed for micro-CT and mechanical testing using MTS 858 Mini Bionix sequentially. Each specimen was compressed in a longitudinal direction at a speed of 1mm/minute; the ultimate strength and modulus of the specimens were generated. Comparisons of microstructure and mechanical properties of trabecular bone were performed between two groups using student t test. The structure-mechanics relationship was also investigated using Pearson correlation. Results. The bone volume fraction (BV/TV, %) was significantly higher in knee OA specimens in presence of SBC (32±7%) in comparison with those in absence of SBC (16±5%, p<0.001). Meanwhile there were more plate-like trabecular bone surrounding SBC (0.78±0.61) than those without SBC (1.81±0.28, p<0.001), which was indicated by structure model index (0∼3). Furthermore, the trend in conversion of rod-like (close to 3) towards plate-like trabeculae was noticed in different locations of knee OA specimens with SBC formation. Trabecular bone around SBC presented higher modulus (73±22MPa) compared with those without SBC (45±29MPa, p=0.034). The stiffer trabecular bone in presence of SBC correlated with its plate-like morphology (r=0.696, p<0.001) as well as bone volume fraction (r=0.578, p=0.004). Conclusion. Presence of SBC was associated with conversion of trabeculae towards plate-like morphology together with the increase of mechanical competence in advanced knee OA

Radiographs of the shoulders of 84 asymptomatic individuals aged between 40 and 83 years were evaluated to determine changes in 23 specific areas. Two fellowship-trained orthopaedic radiologists graded each area on a scale of 0 to II (normal 0, mild changes I, advanced changes II). Logistic regression analysis indicated age to be a significant predictor of change (p < 0.05) for sclerosis of the medial acromion and lateral clavicle, the presence of subchondral cysts in the acromion, formation of osteophytes at the inferior acromion and clavicle, and narrowing and degeneration of the acromioclavicular joint. Gender was not a significant predictor (p > 0.05) for radiological changes. Student’s t-test determined significance (p < 0.05) between age and the presence of medial acromial and lateral clavicular sclerosis, subchondral acromial cysts, inferior acromial and clavicular osteophytes, and degeneration of the acromioclavicular joint. Radiological analysis in conditions such as subacromial impingement, pathology of the rotator cuff, and acromioclavicular degeneration should be interpreted in the context of the symptoms and normal age-related changes

Introduction. Femoroacetabular impingement(FAI) is a relatively common cause causes of hip pain and dysfunction in active young adults. The concept of FAI was popularized by Ganz et al in early 2000s. Surgical treatment for FAI has been widely employed over the last two decades. The long term outcome of femoroacetabular osteoplasty (FAO) and risk factors for long-term failure of FAO is less studied. The goal of this single surgeon series is to identify the long term outcome of FAO (minimum 10-year follow-up) and risk factors for surgical treatment failure in these patients. Methods. The prospective database on hip joint preservation identified 1,120 patients who have undergone FAO between January 2005-June 2019. Of these 164 patients (178 hips) have a minimum 10-year follow-up (range, 10–14). The database collects detailed information on patient demographics, clinical history, radiographic and cross sectional imaging findings, intraoperative findings (site and size of chondral lesion, labral tear, subchondral cyst, size of cam lesion, etc), and patient outcome using the modified HHS, SF-36, and UCLA activity score. Patients are contacted on an annual basis and the functional outcome instruments administered. Of 1,120 patients, 122 patients have been lost to follow-up. Results. The mean age of patients in the cohort is 34.3±10.4 years and 39.6% of patients are female. FAO resulted in an improvement in mean mHHS (58.2±3.9 to 86.4±3.2) and SF-36(60.4±4 to 85±4.1) in 89% of patients. At the latest follow up 8.1% of patients have undergone THA. The study found that older age, longer preoperative symptomatic period, higher preoperative alpha angle, presence of hip dysplasia and acetabular retroversion, inability to repair acetabular labrum, and full thickness acetabular chondral lesion were associated with higher risk of failure of treatment. Conclusion. Patients with symptomatic FAI who undergo surgery experience pain relief and functional improvement that appears to endure over a decade in the majority. This study on a large cohort with long term follow-up has also identified patients who are at higher risk of failure. The study has also shed light on some interesting findings such as labral tear being very common in patients without hip symptoms and others that will be presented. For any tables or figures, please contact the authors directly

The arterial supply of the talus has been studied extensively in the past. These have been used to improve the understanding of the risk of avascular necrosis in traumatic injuries of the talus. There is, however, poor understanding of the intra-osseous arterial supply of the talus, important in scenarios such as osteochondral lesions of the dome. Previous studies have identified primary sources of arterial supply into the bone, but have not defined distribution of these sources to the subchondral regions. This study aims to map the arterial supply to the surface of the talus. Cadaveric limbs (n=10) were dissected to identify source vessels for each talus. The talus and navicular were removed, together with the source vessels, en bloc. The source vessels were injected with latex and processed using a new, accelerated diaphanisation technique. This quickly rendered tissue transparent, allowing the injected vessels to be visualised. Each talus was then reconstructed using a digital microscribe, allowing a three dimensional virtual model of the bone to be assessed. The terminal points of each vessel were then mapped onto this model, allowing the distribution of each source vessel to be determined. This study will provide quantifiable evidence of areas consistently restricted to single-vessel supply, and those consistently supplied by multiple vessels. These data may help to explain the distribution and mechanisms behind the development of the subchondral cysts of the talus

We reviewed, retrospectively, 13 patients who had undergone open anterograde autologous bone grafting of the talus for symptomatic osteochondral defects of the dome of the talus. The mean age of the seven men and six women was 38.4 years. The defects included the full thickness of articular cartilage, extended through the subchondral plate and were associated with subchondral cysts. Six patients (46%) were clinical failures requiring further surgery. Of the remaining seven, functional outcome results were obtained at a mean of 51.9 months after surgery. The mean outcome scores for the Musculoskeletal Outcomes Data Evaluation and Management System foot and ankle questionnaire and the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale were 87.0 and 84.3, respectively. There was an overall 46.2% patient satisfaction rate. We believe that the technique of autologous bone grafting presented should be used with extreme caution, when considered as the primary treatment for the adult patient with a symptomatic advanced osteochondral defect of the talus

Introduction. Osteonecrosis of the femoral head is a devastating disease in young patients and remains a challenge for clinicians and researchers alike. To increase understanding of the disease and produce effective treatments that preserve a patient's native hip, an animal model that mimics the disease process in humans, including collapse of the femoral head, is essential. Our goal was to create such a bipedal model by surgically inducing osteonecrosis in the femoral heads of chickens. Methods. A lateral approach to the proximal femur was used to access the hip, dislocate the femoral head, and sever the periosteal network of blood vessels. At 4, 8, 12, and 20 weeks after surgery, both the left (experimental) and right (control) femoral heads were harvested from 6 chickens for micro-CT and histological analysis. Results. Hematoxylin and eosin stained sections beginning at 4 weeks demonstrated trabecular bone loss, empty osteocyte lacunae, and new bone formation on existing trabeculae. By 20 weeks, subchondral cyst formation and femoral head collapse was observed. Micro-CT analysis of the operative hips compared to matched controls showed decreased bone volume (18% at 4 weeks, 36% at 8 weeks, 45% at 12 weeks), increased porosity (2.1%, 7.3%, 10.7%), and increased average pore diameter (13%, 18%, 37%). Conclusion. The results indicate that operative disruption of blood supply to the femoral head produces changes consistent with osteonecrosis, including progression to collapse, as seen in human end-stage disease. A successful osteonecrosis model provides the basis to test new therapies, such as bone graft substitutes seeded with stem cells and growth factors

We examined the reliability of radiological findings in predicting segmental instability in 112 patients (56 men, 56 women) with a mean age of 66.5 years (27 to 84) who had degenerative disease of the lumbar spine. They underwent intra-operative biomechanical evaluation using a new measurement system. Biomechanical instability was defined as a segment with a neutral zone > 2 mm/N. Risk factor analysis to predict instability was performed on radiographs (range of segmental movement, disc height), MRI (Thompson grade, Modic type), and on the axial CT appearance of the facet (type, opening, vacuum and the presence of osteophytes, subchondral erosion, cysts and sclerosis) using multivariate logistic regression analysis with a forward stepwise procedure. The facet type was classified as sagittally orientated, coronally orientated, anisotropic or wrapped. Stepwise multivariate regression analysis revealed that facet opening was the strongest predictor for instability (odds ratio 5.022, p = 0.009) followed by spondylolisthesis, MRI grade and subchondral sclerosis. Forward stepwise multivariate logistic regression indicated that spondylolisthesis, MRI grade, facet opening and subchondral sclerosis of the facet were risk factors. Symptoms evaluated by the Short-Form 36 and visual analogue scale showed that patients with an unstable segment were in significantly more pain than those without. Furthermore, the surgical procedures determined using the intra-operative measurement system were effective, suggesting that segmental instability influences the symptoms of lumbar degenerative disease

Introduction: In a photoelasticimetric model Ondrouch suggested a correlation between stress in arthritic joints, microfractures and bone cysts. Other authors believe in a causative role of access of joint ßuid to bone in periarticular osteolysis. In our opinion mechanical stress induced by cartilage defects induces microfractures followed by cystic bone degradation. Materials and Methods: A þnite element analysis using the well described parameters for cancellous and cortical bone as also cartilage was performed. Several typical situations of localized and general cartilage pathologies were calculated in a schematic hip joint situation. Results: A signiþcant impact of cartilage defect size and resulting stress distribution correlating well to cystic lesions of patients with osteoarthritis of the hip could be shown. In localized cartilage defects max. stress was calculated at the rims of the lesions in the subchondral bone. Assuming a situation with an allready preformed cyst either in the acetabulum or the femoral head, further enlargement of the cyst will appear due to a maximal stress at the rims of the lesions. Femoral lesions have a comparable small tendency to grow, thereas acetabular lesions will grow rapidly. Discussion and Conclusion: These þndings þt very well with the clinical observations. Cartilage lesions inducing microfractures by mechanical stress may be able to explain the process of subchondral cyst formation. A process involving osteoclasts and myxomatous cells within the bone marrow seems to be a subsequent mechanism of remodelling and formation of myxomatous cyst content

Purpose: The treatment and prognosis of labral tears secondary to femoroacetabular impingement depends on the severity of the labral injury and whether or not there is concomitant injury and delamination of the adjacent articular cartilage. At present, there is no simple and reproducible technique to determine if there is delamination of the adjacent articular cartilage. We undertook a study to determine if the preoperative presence of a previously undescribed radiographic finding, a “delamination cyst”, correlated with delamination of the articular cartilage at the time of hip arthroscopy. Method: The preoperative radiographs of 125 consecutive hip arthroscopies in which a labral tear was identified intraoperatively were retrospectively reviewed.. In each case an anteroposterior (AP) pelvis and AP, lateral and frog lateral hip radiographs were evaluated for the presence of delamination cysts, perilabral cysts, abnormalities of the femur and acetabulum, as well as arthritic changes. A “delamination cyst” was defined as a subchondral cyst either directly adjacent to a perilabral cyst, or in relation to a subchondral crack in the anterolateral portion of the acetabulum. These findings were then compared and correlated to the intraoperative arthroscopic findings. Results: We identified 16 patients with delamination cysts on radiographs and 15 patients with delamination of the acetabulum on arthroscopy. A strong correlation was found between the preoperative radiographic presence of a delamination cyst and acetabular delamination at the time of arthroscopy – sensitivity of 93.3%, specificity of 98.8%, positive predictive value of 93% and a negative predictive value of 99% (p=0.034). No other radiographic findings were associated with the status of the articular cartilage. Conclusion: A “delamination cyst” is a previously undescribed and novel radiographic sign that can accurately predict preoperatively which patients with labral tears have associated acetabular cartilage delamination or chondral damage. Delamination cysts can be easily identified on plain radiographs without performing any special imaging or invasive infiltrations. Identifying these cysts preoperatively can aid the surgeon in selecting the appropriate surgical procedure and help predict the patient’s prognosis following the planned surgical procedure

The purpose of this study was to validate the usefulness of SPECT/CT as an evaluation method for determining treatment and prognosis for patellofemoral cartilage lesions, based on MRI and arthroscopic findings. From August 2009 to February 2010, SPECT/CT was performed on 80 patients (24 male and 56 female, average 53.3 years old) with chronic anterior knee pain who had no degenerative changes or patellar malalignment on plain radiographs. Radioisotope uptake findings on patellofemoral joint from SPECT/CT were classified into three grades by one nuclear medicine specialist. In the patients who demonstrated poor improvements after conservative treatments, MRI and arthroscopy were performed. Patellofemoral cartilage conditions under arthroscopic finding (ICRS grades) were compared with SPECT/CT grading. In all cases, there were increased uptakes on patellofemoral joints. Eighteen cases showed low uptake (Group 1), 22 cases showed medium uptake (Group 2) and 40 cases high uptake (Group 3). At the follow-up examination after mean 1.7 months, 16 cases of Group 1 (89%), 14 cases of Group 2 (64%) and 28 cases of Groups3 (70%) responded positively to the conservative treatments. For those 22 cases showing poor improvement, MRI and arthroscopy were done. Damage or thinning of patellofemoral cartilage, subchondral cyst, edema and fissuring were observed in every case that underwent MRI. Every arthroscopic case was found that there was patellofemoral cartilage damage. Each of ICRS grade I and grade II was found in 2 cases from Group 1. Two cases of grade II, 4 cases of grade III, and 2 cases of grade IV were found in Group 2. Two cases of grade II, 4 cases of grade III, and 6 cases of grade IV were found in Group 3. There was significant difference in the success rate of conservative treatment between SPECT/CT grade 1 and 2 or 3. And there was significant association between SPECT/CT grade and ICRS grade (P=0.034). SPECT/CT could be a useful modality in determining the treatment and prognosis for patellofemoral cartilage lesions compared with MRI and arthroscopic findings

Purpose. Platelet-derived growth factor-BB (PDGF-BB) is a well characterized wound healing protein known to be chemotactic and mitogenic for cells of mesenchymal origin, including osteoblasts and chondrocytes. Biocompatible scaffolds, combined with growth factors such as PDGF-BB, have potential to stimulate regeneration and repair of osseous and cartilaginous tissues. The purpose of this study was to determine the efficacy and safety of recombinant human PDGF-BB (rhPDGF-BB) combined with a collagen implant to augment healing of osteochondral defects. Method. A single osteochondral defect (8mm x 8mm) was created in the medial femoral condyle of 32 adult goats. Collagen implants(8.5mm x 8mm) hydrated with four doses of rhPDGF-BB (0g, 15g, 75g, 500g) were press-fit into the defect. Defects in four animals were left untreated. All goats were sacrificed 12 weeks postoperatively. Macroscopic evaluation and quantitative CT analyses were performed. Histologic sections were stained with Safranin O/Fast Green and assessed with a modified ODriscoll scoring scale for cartilage and bone repair. Significance was determined by One-Way ANOVA or nonparametric Kruskal-Wallis. Results. Macroscopic evaluation indicated significant improvement of the gross cartilage repair score for the rhPDGF-BB treatment groups compared to the 0g rhPDGF-BB control (500g;0g) and empty defect groups (500,75,15g; Empty). MicroCT analysis indicated a significant increase in trabecular number for the 500g group compared to 0g control, 75g, and Empty groups(p=0.004). Average bone volume reconstitution for the 500g group was increased (58.8%) compared to the 0g control. The total cartilage repair score was significantly improved (p=0.048) in the 500g treatment group (14.30.3) compared to the 0g control group (12.10.4). All rhPDGF-BB treatment groups exhibited increased Safranin-O staining of the matrix compared to the 0g control group, and a significantly decreased incidence(p=0.01) of subchondral cyst formation compared to the empty defect group. Conclusion. The results of this study indicate that rhPDGF-BB, combined with a collagen implant, is safe and improves repair of large osteochondral defects located in a high-load bearing region in a caprine model. Increases in gross scoring and histopathologic cartilage repair score for the rhPDGF-BB treatment groups, in addition to the presence of bony bridging, especially for the 500g rhPDGF-BB treatment group, indicate enhanced reconstitution of the subchondral bone and overlying repair tissue. The cartilage repair score was increased, on average, in the empty defect group relative to the 0g rhPDGF-BB group, however this score may be partially inflated due to collapse of the surrounding native tissue into the defect. Combined with a significant decrease in cyst formation in all rhPDGF-BB treatment groups, these results suggest that rhPDGF-BB, combined with a collagen implant, may have promise as a therapeutic agent for osteochondral defect repair

Aims: To correlate clinical imaging and surgical finding in patients with knee arthritis. In an attempt to identify specific lesions that correlate with the location of clinical pain. Methods: 26 patients and 32 knees were eligible for inclusion in the study. All patients had been admitted for total knee arthroplasty. In all patients an attempt was made to correlate symptoms with radiographic findings and then intraoperative findings. A senior orthopaedic registrar carried out standard knee scores and clinical examinations, radiographs and a radiologist blindly evaluated MRI scans. The integrity of the articular cartilage as well as the menisci and ligaments were all graded. Results: At clinical examination all patients score 70 or higher on a visual analogue scale. In eighteen patients, the maximum site of clinical tenderness was referable to the medial joint line. In seven patients symptoms were on the lateral aspect. Pain was recorded on a line diagram of the knee for analysis. MR images confirmed advanced arthritis with meniscal derangement with extrusion and maceration. Note was made of osteophyte formation, medial collateral ligament laxity and oedema and discrete osteochondral defects. Bone marrow bruising and oedema was also recorded. In nine patients subchondral cysts were identified with extensive associated bone oedema. At surgery, meniscal degeneration was identified in fifteen of twenty-six, meniscal tears were identified in six; the menisci were normal in two patients. Discussion: These results suggest that there is a direct correlation between clinical symptoms and meniscal derangement in severe osteoarthritis. Isolated articular defects and bone marrow oedema did not correlate well with location of pain. Presence of medial collateral oedema correlated well with severity of radiological arthritis and clinical findings. In summary, this study suggests that patients with symptomatic knee arthritis are likely to have meniscal derangement and medial collateral oedema. A greater understanding of the origin of pain in the degenerate knee may assist in the choice of management options for these patients