Single focal grade IV cartilage lesion in the knee has a poor healing capacity. Instead these lesions often progress to severe and generalized osteoarthritis that may result in total knee replacement. Current treatment modalities aim at biological repair and, although theoretically appealing, the newly formed tissue is at the best cartilage-like, often fibrous or fibrocartilaginous. This at the expense of sophisticated laboratory resources, delicate surgery and strict compliance from patients. An alternative may be small implants of biomaterial inserted to replace the damaged cartilage. We investigated the response of the opposing tibia cartilage to a metallic implant inserted at different depth into the surrounding cartilage level. Methods. The medial femoral condyle of both knees of 12 sheep, 70–90kg, 2 year of age and from the same breeder, was operated. A metallic implant with an articulating surface of 316L stainless steel, diameter of 7mm, HA plasma sprayed press-fit peg and a tailored radius and contour to the sheep femoral condyle was placed at the most weight-bearing position. The level of the implant was aimed flush, 0,3 and 0,8 mm below surrounding cartilage. The animals were stabled indoors, allowed to move freely and euthanized after 6 and 12 weeks. Postoperatively the knees were high resolution photographed for macroscopic evaluation. The position and depth of the implant were analysed using a laser scan device. Tibial and femoral condyles specimen were decalcified and slices were prepared for microscopic evaluation. Implant position and cartilage damage was assessed from two independent observers using a macroscopic ICRS score and a modified histologic score according to Mankin. Results. 22 tibia condyles showed a variety of cartilage damage ranging from severe damage down to subchondral bone to an almost pristine condition. There was a strong correlation between implant position and damage to opposing cartilage surface. Mankin score correlated significantly with implant position (p<0.001 regression analysis, r. 2. =.45) as did the ICRS score (p<0.001, regression analysis, r. 2. =.67). Implants sitting proud were associated with poor Mankin score. There was no difference between 6-week and 3-months knees. Conclusion. By precise postoperative measurement we have shown that significant imprecision occur; this has never before been studied. We found a distinct correlation between implant position and cartilage damage. These results suggest that further studies of metallic implants, inserted into cartilage defects with the utmost precision regarding the surrounding cartilage, may be warranted

Background. Femoroacetabular impingement due to a reduced femoral head-neck-offset or excessive acetabular coverage will lead to early cartilage lesions of the hip joint. The purpose of the present study was to analyze the relationship between the extent of bony deformity and the presence and extent of cartilage lesions in femoroacetabular impingement. Methods. On the radiographs of 92 hip joints in 86 patients with a mean age of 36.5 ± 9.2 years who were operated on for with femoroacetabular impingement by surgical hip dislocation, the acetabular index of the weight-bearing zone, the center-edge-angle, the inclination of the acetabulum, the lateral-head-extrusion-index, retroversion signs of the acetabulum, the neck-shaft-angle, asphericity, superior and anterior alpha angles, and superior and anterior offset and offset ratios were assessed and correlated to the presence and extent of chondromalazia. Results. Acetabular chondromalazia was found in 60 hip joints. Full-thickness delamination of the acetabular cartilage was present in 42 of these hips with an average size of 1.1 ± 0.5 cm2. Femoral-sided chondromalazia was found in 9 hip joints. Hip joints with chondromalazia had a lower center-edge-angle (p = 0.014) and anterior offset ratio (p = 0.028) and a higher lateral-head-extrusion-index (p = 0.029). Hip joints with acetabular cartilage delamination had a significantly lower center-edge-angle (p = 0.012) and anterior offset (p = 0.03) and a significantly higher lateral-head-extrusion-index (p = 0.001) and superior (p = 0.006) and anterior alpha angles (p = 0.003). Conclusions. Marked cam-type femoral deformity and lesser coverage of the femoral head are associated with the acetabular cartilage lesions, arousing suspicion to the assumption that a large lateral aperture of the acetabulum abets proximal femora with cam-type deformity to inflict cartilage damage in femoroacetabular impingement

After a severe ankle sprain the incidence of residual complaints, particularly on the medial side of the joint, is high. We studied a consecutive series of 30 patients who had operative repair of acute ruptures of lateral ligaments. During operation, arthroscopy revealed a fresh injury to the articular cartilage in 20 ankles, in 19 at the tip and/or anterior distal part of the medial malleolus as well as on the opposite medial facet of the talus. In six patients, a loose piece of articular cartilage was found. We conclude that in patients with a rupture of one or more of the lateral ankle ligaments after an inversion injury, an impingement occurs between the medial malleolus and the medial facet of the talus. Patients with a lesion of the lateral ankle ligament caused by a high-velocity injury (a faulty landing during jumping or running) had a higher incidence of macroscopic cartilage damage (p < 0.01), medially-located pressure pain (p = 0.06) and medially-located complaints at one-year follow-up (p = 0.02) than those with a low-velocity injury (a stumble)

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

Aims

The aims of this study were to determine the cumulative ten-year survivorship of hips treated for acetabular fractures using surgical hip dislocation and to identify factors predictive of an unfavourable outcome.

Objectives

Osteochondral injuries, if not treated adequately, often lead to severe osteoarthritis. Possible treatment options include refixation of the fragment or replacement therapies such as Pridie drilling, microfracture or osteochondral grafts, all of which have certain disadvantages. Only refixation of the fragment can produce a smooth and resilient joint surface. The aim of this study was the evaluation of an ultrasound-activated bioresorbable pin for the refixation of osteochondral fragments under physiological conditions.

We have compared the results at a mean follow-up of 13 years (11 to 14) of two groups of supination-external rotation type-4 fractures of the ankle, in one of which there was a fracture of the medial malleolus and in the other the medial deltoid ligament had been partially or completely ruptured.

Of 66 patients treated operatively between 1993 and 1997, 36 were available for follow-up. Arthroscopy had been performed in all patients pre-operatively to assess the extent of the intra-articular lesions. The American Orthopaedic Foot and Ankle Society hind-foot score was used for clinical evaluation and showed a significant difference in both the total and the functional scores (p < 0.05), but not in those for pain or alignment, in favour of the group with a damaged deltoid ligament (p < 0.05). The only significant difference between the groups on the short-form 36 quality-of-life score was for bodily pain, again in favour of the group with a damaged deltoid ligament. There was no significant difference between the groups in the subjective visual analogue scores or in the modified Kannus radiological score.

Arthroscopically, there was a significant difference with an increased risk of loose bodies in the group with an intact deltoid ligament (p < 0.005), although there was no significant increased risk of deep cartilage lesions in the two groups.

At a mean follow-up of 13 years after operative treatment of a supination-external rotation type-4 ankle fracture patients with partial or complete rupture of the medial deltoid ligament tended to have a better result than those with a medial malleolar fracture.

Surgical dislocation of the hip in the treatment of acetabular fractures allows the femoral head to be safely displaced from the acetabulum. This permits full intra-articular acetabular and femoral inspection for the evaluation and potential treatment of cartilage lesions of the labrum and femoral head, reduction of the fracture under direct vision and avoidance of intra-articular penetration with hardware. We report 60 patients with selected types of acetabular fracture who were treated using this approach. Six were lost to follow-up and the remaining 54 were available for clinical and radiological review at a mean follow-up of 4.4 years (2 to 9).

Substantial damage to the intra-articular cartilage was found in the anteromedial portion of the femoral head and the posterosuperior aspect of the acetabulum. Labral lesions were predominantly seen in the posterior acetabular area. Anatomical reduction was achieved in 50 hips (93%) which was considerably higher than that seen in previous reports. There were no cases of avascular necrosis. Four patients subsequently required total hip replacement. Good or excellent results were achieved in 44 hips (81.5%). The cumulative eight-year survivorship was 89.0% (95% confidence interval 84.5 to 94.1). Significant predictors of poor outcome were involvement of the acetabular dome and lesions of the femoral cartilage greater than grade 2. The functional mid-term results were better than those of previous reports.

Surgical dislocation of the hip allows accurate reduction and a predictable mid-term outcome in the management of these difficult injuries without the risk of the development of avascular necrosis.