The technique of Matrix Induced Autologous Chondrocyte Transplantation (MACI) is well established with satisfactory outcomes up to five years in the knee. Fewer series describe the outcomes of this technique in the ankle. We present the functional outcomes of the technique for a single surgeon series in a general hospital setting. Twenty-seven patients, mean age 41, were reviewed at 3.7 (range, 1 to 5) years. Patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hind-foot scale, Tegener activity score and University of California lower extremity activity scale. MRI findings were also reviewed. While most patients report a significant improvement in symptoms with full return to activities of daily living, 36% of those under 40 and 78% of those over 40 reported restricted recreational activity. Of the patients under 40 years of age, 86% were able to run compared with 23% of those over 40. Of patients over 40, 64% continued to have moderate or severe pain. Careful preoperative counselling is required for patients of all ages regarding likely outcomes. In patients over 40 the procedure is unlikely to give good pain relief and alternative options should be considered

It has been reported that the total steroid dose and acute rejection episodes after organ transplantation is one of the risk factors for the development of osteonecrosis of the femoral head (ONFH), and ONFH in steroid-iduced subgroup may progress more aggressively to femoral head collapse requiring total hip arthroplasty. Despite inherent medical co-morbidities of solid organ transplantation patients, most authors recently have reported successful outcomes of THAs in those patients. But there are few comparative studies on the outcome of THAs for ONFH after different organ transplantations. The purpose of this study was to evaluate and compare a single tertiary referral institution's experience of performing primary THAs in kidney transplantation (KT) and liver transplantation (LT) patients with specific focus on the total steroid dose, clinical outcomes, and relationship between ONFH and absence or presence of acute rejection (AR).

Between 1999 and 2010, 4,713 patients underwent organ transplantations (1,957 KT and 2,756 LT) and AR was occurred in 969 patients (20.6%) after transplantation. Among these patients, 131 patients (191 hips) underwent THA for ONFH, and they were retrospectively reviewed. In KT groups, there were 57 men and 36 women with a mean age of 43.7 years. In LT groups, there were 26 men and 13 women with a mean age of 50.4 years. We investigated the dose of steroid administration on both groups, the time period from transplantation to THA, Harris hips score (HHS), visual analogue scale (VAS) and complications. The mean follow up period was 8.1 years (range, 5 to 14 years).

One-hundred and thirty-one (2.8%) patients [93 KT and 38 LT] underwent THA after transplantation. The total steroid dose after transplantations was significantly higher in KT group (10,420 mg) than that in LT group (4,567 mg), but the total steroid dose in the first 2 weeks after transplantation was significantly higher in LT group (3,478 mg) than that in KT group (2,564 mg). Twenty-three (2.4%) patients (19 KT and 4 LT) who underwent THA had an episode of AR. In LT group, the total steroid dose in AR groups was significantly higher than that in non-AR groups, whereas in KT group, there was no significant difference of the total steroid dose between AR group and non-AR group. The rate of THAs for ONFH was similar in both groups (2.4% in AR group, 2.9% in non-AR group). The mean time period from transplantation to THA was 986 days for KT and 1,649 days for LT patients. Both groups showed satisfactory HHS and VAS at final follow up, revealed no differences between the groups.

The rate of THAs for ONFH was three times higher in KT patients than that in LT patients, but it was similar in both AR group and non-AR group. The total steroid dose was also higher in KT patients compared to LT patients. The clinical outcomes of THA were satisfactory with few complications in both KT and LT patients. Therefore, THAs seems to be a good option for the patients with symptomatic steroid-induced ONFH after KT and LT.

Background

Joint replacement surgery has been shown to be successful in post solid organ transplantation patients. However, complication rates, revision rates, and overall mortality can be higher in this population compared to patients who have not undergone solid organ transplantation. Many transplant patients have a decreased life expectancy. Therefore, literature suggests that joint replacement surgery be offered to qualifying patients early on when symptomatic. This study compares the outcomes of patients who have undergone solid organ transplantation as well as a joint replacement to patients that have only undergone joint replacement surgery.

After meniscetomy there is an increased risk of tibiofemoral arthritis. In recent times there has been an increased emphasis on preservation of healthy meniscal tissue. When this cannot be achieved some patients may benefit from allograft transplantation. This aims to restore meniscal function and so limit pain and the development of arthritis. This is an evolving area with controversy surrounding patient selection, tissue harvesting and sterilisation, longterm outcome and overall efficacy.

Twenty-eight patients have undergone 30 meniscal transplants beginning in 2001. All transplants have been performed by the senior author. The mean age at surgery was 37.7 years (range 20–51), there were 16 males and 12 females. At the time of the index operation nine patients underwent additional procedures on the same knee. All patients are scored using recognised knee scoring systems including the Oxford, IKDC and Lysholm scores. All patients are being followed up regularly with clinical assessment and repeat scores.

To date the average follow up is 34.3 months (range 6–84). There have been 12 patients requiring further arthroscopy (three with complete meniscal transplant failure). The average increases in Lysholm, Oxford and IKDC scores were 10.7, 7.6 and 8.6 respectively.

Lack of donors is the current limitation to performing transplants in Brisbane. 61 patients are currently awaiting suitable menisci and in the last 12 months there have been only three donors. A national registry may address this issue but raises problems related to uniform retrieval, storage, sizing and availability. Early results are encouraging with the majority of patients experiencing pain relief and improvement of function over time.

Chondral defects on the patella are a difficult problem in the young active patient and there is no consensus on how to treat these injuries. Fresh osteochondral allografts are a valid option for the treatment of full-thickness osteochondral defects and can be used to restore joint function and reduce pain. The primary purpose of this study was to investigate the clinical and subjective outcomes of a series of patients following fresh osteochondral allograft transplantation for isolated chondral defects of the patella.

A series of 5 patients underwent surgery using an open approach for graft transplantation. A strict protocol for the allograft tissue was followed. Transplant recipients must be aged <60, have a full-thickness, isolated chondral lesion and have failed previous traditional treatments. The fresh allografts are hypothermically stored at 4°C in X-VIVO10 media for up to 30 days to maintain cartilage viability. Pre- and post-operative clinical measures including knee stability, range of motion, and quadriceps girth were completed. Post-operative plain radiographs were completed including weight-bearing AP, lateral and skyline views. Patient-centred outcome measures including the Knee Osteoarthritis Outcome Score (KOOS) and the Knee Society Score (KSS) were gathered a minimum of 1-year post-operative. Descriptive and demographic data were collected for all patients. A paired t-test was employed to determine the difference between the pre-operative and post-operative outcomes.

All patients were female, with a mean age of 27.4 (SD 3.65). Knee ligament stability was similar pre- and post-operatively. Knee ROM assessment of flexion and extension demonstrated a less than 10° increase from pre to post-operative. Quadriceps girth measurements demonstrated a mean change of 0.5 cm from pre- to post-operative for the surgical limb. Post-operative radiographs demonstrated incorporation of the graft in 4/5 cases within 6-months of surgery. One patient developed fragmentation of the graft after 18-months, and one patient had a subsequent trochleoplasty for persistent pain. The mean KOOS domain scores demonstrated significant improvement (p<0.05) as follows: Symptoms pre-op = 28.57, post-op = 55; Pain pre-op 28.89, post-op = 57.22; ADLs pre-op = 48.92, post-op = 66.18; Sports/Recreation pre-op = 6, post-op = 32; and QoL pre-op = 12.5, post-op = 42.5. Mean pre-op surgical versus non-surgical limb KSS scores were 107.4 and 179 respectively. The mean post-op surgical versus non-surgical limb KSS scores were 166 and 200.

Isolated chondral defects of the patella can cause substantial pain, reduced function, and can be challenging to address surgically. This series of 5 cases demonstrated improved function, KOOS and KSS for 4/5 patients. To our knowledge this is a novel biological procedural technique for this problem, which has shown promising results making it a viable treatment option for young active patients with osteochondral defects of the patella.

This paper reports a series of comparative tests in-vitro that examined how lateral meniscectomy and meniscal allografting affected tibio-femoral joint contact pressures. 8 Cadaver knees (age range 81 – 98 years) were loaded in axial compression in an Instron materials testing machine up to 700N for 10 seconds and pressure maps obtained from the lateral compartment using Fuji Prescale film inserted below the meniscus. This was repeated after meniscectomy, then after meniscal allografting with fixation by a bone plug for the insertional ligaments, plus peripheral sutures. Finally, the pressure when the allograft was secured by peripheral sutures alone was measured.

Meniscectomy caused a significant increase in peak contact pressures (p=0.0002). Both of the reconstructive methods reduced the peak contact pressures significantly below that of the meniscectomised knee (p=0.0029 with bone block; p=0.0199 with sutures alone). A significant difference was not found between the peak contact pressures after the reconstructions and that of the intact knee (p=0.1721 with bone block; p=0.0910 with sutures alone). The peak pressures increased slightly when the allografts were converted from bone block to suture-only fixation (p=0.0349).

The principal finding was that both of the meniscal allograft insertion techniques reduced the peak contact pressure significantly below that of the meniscectomised knee, so that it did not then differ significantly from the peak contact pressure in the intact knee. When the two fixation methods were compared, the loss of the bone plug attachment caused a small increase in peak pressure.

This study suggests that meniscal allografting should have a chondroprotective effect and that there is a small advantage from adding bony fixation to suture fixation.

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 OCD of the humeral capitellum progressed to osteoarthritis (Fig), particularly in cases which involved the lateral wall. In these cases, every attempt should be made to reconstruct the lateral wall to avoid osteoarthritis. In this study, we followed up cases with rib osteochondral autograft transplantation technique.

Background

The meniscal deficient knee often exists in the setting of associated pathology including instability, malalignment and chondral injury. Meniscal allograft transplantation (MAT) is established to be a reliable option in restoring function and treating symptoms. The aim of this study was to establish the role of MAT as part of a staged approach to treatment of the previously menisectomised knee.

Purpose

One of the current research topics is the aim to produce tissue engineered osteochondral grafts for future treatment of osteochondral lesions (OCL) of the talus. For the exact anatomic reconstruction, the dimensions of the medial and lateral talar dome must be considered.

Sparse data is available regarding the normal anatomic talar dimensions on standard radiographs of ankle joints [1, 2]. The purpose of this study was to describe normal anatomy of different sections of the talar dome on 3D reconstructions of computertomographic (CT) images.

Articular cartilage repair remains a challenge in orthopedic surgery, as none of the current clinical therapies can regenerate the functional hyaline cartilage tissue. In this study, we proposed a one-step surgery strategy that uses autologous bone marrow mesenchymal stem cells (MSCs) embedded in type II collagen (Col-II) gels to repair the full thickness chondral defects in minipig models. Briefly, 8 mm full thickness chondral defects were created in both knees separately, one knee received Col-II + MSCs transplantation, while the untreated knee served as control. At 1, 3 and 6 months postoperatively, the animals were sacrificed, regenerated tissue was evaluated by magnetic resonance imaging, macro- and microscopic observation, and histological analysis. Results showed that regenerated tissue in Col-II + MSCs transplantation group exhibited significantly better structure compared with that in control group, in terms of cell distribution, smoothness of surface, adjacent tissue integration, Col-II content, structure of calcified layer and subchondral bone. With the regeneration of hyaline-like cartilage tissue, this one step strategy has the potential to be translated into clinical application.

Aims

Disorders of bone integrity carry a high global disease burden, frequently requiring intervention, but there is a paucity of methods capable of noninvasive real-time assessment. Here we show that miniaturized handheld near-infrared spectroscopy (NIRS) scans, operated via a smartphone, can assess structural human bone properties in under three seconds.

Introduction. Meniscus deficiency leads to the development of early arthritis. Total knee replacement may be the only available treatment option in certain situations. However it is generally best avoided in young patients. We hypothesized that a combination of the two procedures, Allograft Meniscal Transplantation (AMT) and Autologous Chondrocyte Implantation (ACI) would be a solution to treat bone-on-bone arthritis in meniscal deficient knees and postpone the need for a total knee replacement (TKR). Materials/Methods. 12 consecutive patients who underwent both ACI and AMT between 1998 and 2005 were followed up prospectively. The patients were assessed by a self-assessed Lysholm score prior to the procedure and yearly thereafter. All operations were performed by the senior author (JBR). ACI procedure was performed according to the standard technique. Frozen meniscal allograft with bone plugs at either ends secured by sutures in the bone tunnels. Post operatively all patients underwent a strict Oscell Rehabilitation protocol. A repeat procedure or progression to a TKR was taken as a failure. Results. Out of the twelve patients only eleven were included as one had died at three months after surgery. Three patients had delayed TKR, and two were heading towards TKR at 8 years. The median pre-operative lysholm score in the remaining six patients rose from 45 to 64 at last follow up. Conclusions. In our small pilot study there was a 19 point increase in the lysholm score. The combination of ACI & AMT could give a good result defer the need for TKR