Background. Partial humeral head resurfacing using a stemless implant is a bone-conserving option in treatment of focal chondral defects. We report our experience using the Arthrosurface HemiCAP® device. Methods. This is a retrospective study of patients with focal chondral defects of the humeral head, treated with partial resurfacing arthroplasty, with a minimum follow-up of 2 years. Mean patient age was 45.4 years (range 27–76). Patients were analyzed in 2 groups: those who underwent HemiCAP for an isolated humeral head defect, and those who had HemiCAP combined with biologic resurfacing of concomitant glenoid disease. Results. 39 patients met inclusion criteria, 5 of whom had concomitant biologic glenoid resurfacing. 24 of 34 shoulders (70.6%) with HemiCAP alone demonstrated functional improvement and decreased pain. Mean forward flexion showed some improvement from 131 degrees pre-operatively to 158 degrees post-operatively (p=0.004). Mean Subjective Shoulder Value improved from 35.0% to 83.6% (p< 0.001). ASES score improved from 29.8 to 77.7(p< 0.001). However, follow-up radiographs showed progression of glenoid disease in 20.6%(7 shoulders). 5 shoulders(14.7%) failed and were revised: 3 to total shoulder arthroplasty, 1 to hemiarthroplasty, and 1 patient underwent glenohumeral fusion. 5 (14.7%) had some pain at latest follow-up but were pursuing a course of conservative management. In the group with associated biologic glenoid resurfacing, all 5 patients had ongoing pain and progression of glenohumeral arthritis requiring revision or glenohumeral fusion. Conclusion. While 70% of patients with an isolated humeral head chondral defect had significant improvement in pain and function after HemiCAP, the outcomes were not superior to those published for complete humeral head resurfacing, or for stemmed prostheses. HemiCAP was not successful for patients with concomitant glenoid disease. Results for these patients were inferior to those published for total shoulder arthroplasty, and ultimately all were revised to a stemmed prosthesis or fused

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

Background. Cartilage lesions in chronic lateral ligament deficiency are common with the incidence rates mentioned in the previous literature up to 30%. However, other intra-articular pathologies in the unstable ankle have received little attention. Anterolateral impingement associated with synovitis and scarring is a less recognised feature in the treatment of chronic instability. The aim of our study was to ascertain the incidence of chondral and anterolateral impingement lesions in the symptomatic lateral ligament complex deficiency. Methods. We performed a retrospective study of all consecutive patients who underwent modified Brostrom repair for symptomatic recurrent instability of the ankle. All patients underwent a MRI scan prior to surgery. Arthroscopy was performed in all the patients before lateral ligament reconstruction. Seventy seven patients with 78 ankles were included in the study. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Data was obtained from clinical and radiological records. Arthroscopic findings were recorded in detail during the surgery. Results. The mean age was 29.8 years (Range 18.2–58 yrs). There were 44 females and 34 males in the study. The incidence of chondral lesions were 11.5% (9 out of 78 ankles). The commonest site for chondral defect was the anteromedial talar dome. The incidence of anterolateral impingement which required arthroscopic debridement was 48.7 %(38 ankles). A further 10 ankles revealed non-specific synovitis and scarring which was debrided. The sensitivity and specificity of the MRI scans in the assessment of chondral lesions is 91% and 100%. Conclusion. The incidence of chondral lesions in chronic ankle instability is lower than previously published literature. However, soft tissue impingement lesions have a much higher incidence and require debridement. Arthroscopic examination and debridement of impingement prior to lateral ligament reconstruction of the ankle is quintessential in the management of chronic anterolateral instability

3D printing and Bioprinting technologies are becoming increasingly popular in surgery to provide a solution for the regeneration of healthy tissues. The aim of our project is the regeneration of articular cartilage via bioprinting means, to manage isolated chondral defects. Chrondrogenic hydrogel (chondrogel: GelMa + TGF-b3 and BMP6) was prepared and sterilised in our lab following our standard protocols. Human adipose-derived mesenchymal stem cells were harvested from the infrapatellar fat pad of patients undergoing total knee joint replacements and incorporated in the hydrogel according to our published protocols. The chondrogenic properties of the chondrogel have been tested (histology, immunohistochemistry, PCR, immunofluorescence, gene analysis and 2. nd. harmonic generation microscopy) in vitro and in an ex-vivo model of human articular defect and compared with standard culture systems where the growth factors are added to the media at repeated intervals. The in-vitro analysis showed that the formation of hyaline cartilage pellet was comparable between the two strategies, with a similar metabolic activity of the cells. These results have been confirmed in the ex-vivo model: hyaline-like cartilage was observed within the chondral defect in both the chondrogel group and the control group after 28 days in culture. The use of bioprinting techniques in vivo requires the ability of stem cells to access growth factors directly in the environment they are in, as opposed to in vitro techniques where these factors are provided externally at recurrent intervals. This study showed the successful strategy of incorporating chondrogenic growth factors for the formation of hyaline-like cartilage in vitro and in an ex-vivo model of chondral loss. The incorporation of chondrogenic growth factors in a hydrogel is a possible strategy for articular cartilage regeneration

To evaluate the short-term clinical outcomes of patients treated arthroscopically with chitin-based scaffolding for acetabular chondral defects in conjunction with microfracture compared to microfracture alone. This study is a retrospective analysis of prospectively collected data. A review of charts was performed (2014–2016) on all patients who underwent hip arthroscopy and had microfracture +/− scaffolding for acetabular chondral defects, intraoperative details (lesion size, grade, labral repair/reconstruction) and postoperative complications were recorded with a minimum follow-up of 2 years. Clinical outcomes were assessed by analysing iHOT and HOS scores which were obtained pre-operatively, at six months, one year and two years post-surgery. Plain radiographs were assessed for hip osteoarthritis by Kellgren & Lawrence grading. A total of 60 patients (microfracture=25, scaffolding=35) were included. Patients had a mean age of 36.2 years at the time of the index operation. There were no major adverse events of deep vein 36.2 years at the time of the index operation. There were no major adverse events of deep vein thrombosis, blood vessel or nerve damage, hemarthrosis or device related adverse events in both groups. Two patients were readmitted due to pain as a result of an inflammatory reaction in the scaffolding group. Both treatments of microfracture and scaffolding showed significant improvement in outcome score (iHOT) (p < 0 .001) when compared postoperative to preoperative. Both the arthroscopic treatment of chondral acetabular defects with chitin based scaffolding and microfracture demonstrated significant improvement from their pre-operative outcomes

Introduction. Autologous Chondrocyte Implantation (ACI) is an effective surgical treatment for chondral defects. ACI involves arthrotomy for cell implantation. We describe the development of an intra-articular injection of cultured MSC, progressing from in-vitro analysis, through animal model, clinical and radiological outcome at five years follow up. Materials and Methods. We prospectively investigated sixteen patients with symptomatic ICRS grade III and IV lesions. These patients underwent cartilage repair using cultured mesenchymal stem cell injections and are followed up for five years. Results. Statistically significant clinical improvement was noted by two years and was sustained for five years of the study. At five years, mean Lysholm score was 80, compared to 44 pre-operatively. Symptomatic KOOS improved to 88 from 55. Subjective IKD Calso showed improvement from 42 to 76. On morphological MRI MOCART score was 76 and qualitative MRI showed the mean T2relaxation-times were 28 and 31 for their pair tissue and native cartilage respectively. Discussion. Cultured MSC provides a good number of uncommitted stem cells to the previously prepared chondral defects of the knee by “homing on” phenomenon. Cultured cells, suspended in serum can be delivered by an intra-articular injection. Conclusion. Use of cultured MSC is less invasive, avoids complications associated with arthrotomy, compared to ACI technique. Good clinical results were found to be sustained at five years of follow-up with a regenerate that appears like surrounding native cartilage. The use of Cultured Mesenchymal Stem Cells (MSC) has represented a promising treatment to restore the articular cartilage

Arthroscopic hip procedures have increased dramatically over the last decade as equipment and techniques have improved. Patients who require hip arthroscopy for femoroacetabular impingement on occasion require surgery on the contralateral hip. Previous studies have found that younger age of presentation and lower Charlson comorbidity index have higher risk for requiring surgery on the contralateral hip but have not found correlation to anatomic variables. The purpose of this study is to evaluate the factors that predispose a patient to requiring subsequent hip arthroscopy on the contralateral hip. This is an IRB-approved, single surgeon retrospective cohort study from an academic, tertiary referral centre. A chart review was conducted on 310 primary hip arthroscopy procedures from 2009-2020. We identified 62 cases that went on to have a hip arthroscopy on the contralateral side. The bilateral hip arthroscopy cohort was compared to unilateral cohort for sex, age, BMI, pre-op alpha angle and centre edge angle measured on AP pelvis XRay, femoral torsion, traction time, skin to skin time, Tonnis grade, intra-op labral or chondral defect. A p-value <0.05 was deemed significant. Of the 62 patients that required contralateral hip arthroscopy, the average age was 32.7 compared with 37.8 in the unilateral cohort (p = 0.01) and BMI was lower in the bilateral cohort (26.2) compared to the unilateral cohort (27.6) (p=0.04). The average alpha angle was 76.3. 0. in the bilateral compared to 66. 0. in the unilateral cohort (p = 0.01). Skin to skin time was longer in cases in which a contralateral surgery was performed (106.3 mins vs 86.4 mins) (p=0.01). Interestingly, 50 male patients required contralateral hip arthroscopy compared to 12 female patients (p=0.01). No other variables were statistically significant. In conclusion, this study does re-enforce existing literature by stating that younger patients are more likely to require contralateral hip arthroscopy. This may be due to the fact that these patients require increased range of motion from the hip joint to perform activities such as sports where as older patients may not need the same amount of range of motion to perform their activities. Significantly higher alpha angles were noted in patients requiring contralateral hip arthroscopy, which has not been shown in previous literature. This helps to explain that larger CAM deformities will likely require contralateral hip arthroscopy because these patients likely impinge more during simple activities of daily living. Contralateral hip arthroscopy is also more common in male patients who typically have a larger CAM deformity. In summary, this study will help to risk stratify patients who will likely require contralateral hip arthroscopy and should be a discussion point during pre-operative counseling. That offering early subsequent or simultaneous hip arthroscopy in young male patients with large CAMs should be offered when symptoms are mild

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

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

The parameters to be considered in the selection of a cartilage repair strategy are: the diameter of the chondral defect; the depth of the bone defect; the location of the defect (weight bearing); alignment. A chondral defect less than 3 cm in diameter can be managed by surface treatment such as microfracture, autologous chondrocyte transplantation, mosaicplasty, or periosteal grafting. An osteochondral defect less than 3 cm in diameter and less than 1 cm in depth can be managed by autologous chondrocyte transplantation, mosaicplasty or periosteal grafting. An osteochondral defect greater than 3 cm in diameter and 1 cm in depth is best managed by an osteochondral allograft. If there is an associated knee deformity, then an osteotomy should also be performed with all of the aforementioned procedures. In our series of osteochondral allografts for large post-traumatic knee defects realignment osteotomy is performed about 60% of the time in order to off load the transplant. To correct varus we realign the proximal tibia with an opening wedge osteotomy. To correct valgus, we realign the distal femur with a closing wedge osteotomy. Our results with osteochondral allografts for the large osteochondral defects of the knee have been excellent in 85% of patients at an average follow-up of 10 years. The Kaplan-Meier survivorship at 15 years is 72%. At an average follow-up of 22 years in 58 patients with distal femoral osteochondral allograft, 13 have been revised (22%). The 15-year survivorship was 84%. The results for the hip are early. To date we have performed this procedure on 16 patients. Surgical dislocation of the hip is carried out via a trochanteric osteotomy and the defect defined and trephined out. A press-fit fresh osteochondral allograft is inserted using the trephine technique. We have published our early results on a series of 8 patients with 5 good to excellent results, 1 fair result and 2 failures

Chondral defects of the knee are common and often seen in young and active individuals. A novel single stage arthroscopic technique for the treatment of articular cartilage defects in the knee is described. This involves microfracture and application of concentrated bone marrow aspirate cells (BMAC) with fibrin and Hyaluronic Acid as a gel. After a representative preclinical study, the 5 year results of a prospective clinical study are presented. The pre-clinical study involved two groups of rabbits with standardised lesions treated with microfracture alone and microfracture combined with fibrin/HA/BMAC application. New cartilage from both groups was subjected to staining with H&E for tissue morphology, toluidine blue (collagen) and safranin O (GAG), immunohistochemistry with antibodies for collagen type I and II, and scanning and transmission electron microscopy to analyse the microstructural morphologies. The fibrin/HA/BMAC group scored better than the microfracture group on all tests. A subsequent prospective clinical study patients (n=60) with symptomatic ICRS grade III/IV chondral defects (lesion size 2–8cm2). The surgical procedure involved debridement of the lesion, micro-fracture and application of fibrin/HA/BMAC gel under CO2 insufflation. Patients underwent morphological evaluation with MRI (T2*-mapping and d-GEMRIC scans). Clinical assessment employed the Lysholm, IKDC and KOOS scores while radiological assessment was performed with MOCART score. At 5 years, Lysholm score was 78, compared to 51 pre-operatively (p<0.05). KOOS (symptomatic) improved to 90 from 66 (p<0.05). IKDC (subjective) went to 80 from 39 (p<0.05). The mean T2* relaxation-times for the repair tissue and native cartilage were 26 and 29.9 respectively. Average MOCART score for all lesions was 70. This technique shows encouraging clinical results at 5 year follow-up. The morphological MRI shows good cartilage defect filling and the biochemical MRI suggests hyaline like repair tissue

Background. Magnetic resonance arthrography is the current method of choice for investigating patients with a clinical diagnosis of femoroacetabular impingement prior to performing hip arthroscopy. The aim of our study was to assess the efficacy of this investigation by comparing the findings of MR arthrogram with those found at arthroscopy, with reference to labral tears and chondral damage. Methods. A prospective trial to investigate the sensitivity, specificity, accuracy and predictive value of MRA for diagnosis of labral tears and chondral defects. Over a 25-month period 69 hips undergoing hip arthroscopy were investigated with MRA prior to the definitive operative procedure. MRA findings were compared to the intraoperative findings. Results. In the assessment of labral tears, MRA demonstrated a sensitivity of 81% with a specificity of 51% and an accuracy of 58%. Positive predictive value of MRA was 33% and negative predictive value 90%. For chondral defects MRA demonstrated a sensitivity of 17%, a specificity of 100% and accuracy of 55%. Positive predictive value of MRA was 100% and negative predictive value was 51%. Conclusions. In what the authors believe to be the first UK study to explore both chondral injury and labral tears in a prospective manner and looking specifically at accuracy, it can be seen that the MRA has poor accuracy for both pathologies. Therefore we suggest a moved away from MRA, which is an invasive procedure with associated risks

Introduction. We describe five results of a novel single stage arthroscopic technique for the treatment of articular cartilage defects of the knee. This involves micro drilling and application of Atelo-collagen (Coltrix) and fibrin gel scaffold. Materials and Method. The preclinical study involved two groups of rabbits treated with micro-drilling, and micro-drilling with Atelo-collagen and fibrin gel. New cartilage was subjected to staining with H&E for tissue morphology, toluidine blue (collagen) and safranin O (GAG), immunohistochemistry with antibodies for collagen type I and II, and scanning and transmission electron microscopy to analyse the microstructural morphologies. The micro-drilling with Atelo-collagen, fibrin gel scored better than the micro-drilling alone. Patients (n=30) with symptomatic ICRS grade III/IV chondral defects (lesion size 2–8cm. 2. ) are recruited for this prospective study. The surgical procedure involved micro-drilling and application of Atelo–collagen and fibrin gel under CO. 2. insufflation. Patients underwent morphological evaluation with MRI (T2*-mapping and d-GEMRIC scans). Clinical assessment was done with Lysholm, IKDC and KOOS scores. Radiological assessment was performed with MOCART score. Results. At five years, Lysholm score was 74, compared to 49 pre-operatively (p<0.05). KOOS (symptomatic) improved to 92 from 62 (p<0.05). IKDC (subjective) went to 78 from 40 (p<0.05). The mean T2* relaxation-times for the repair tissue and native cartilage were 26 and 29.9 respectively. Average MOCART score for all lesions was 70. Conclusion. This technique shows encouraging clinical results at five-year follow-up. The morphological MRI shows good cartilage defect filling and the biochemical MRI suggests hyaline like repair tissue

Introduction. We describe a single stage arthroscopic procedure for the treatment of articular cartilage defects in the knee. The novel procedure involves microdrilling and application of atellocollagen and fibrin gel. The aim of the study was to evaluate the clinical outcomes at 4 years. Materials and Methods. A prospective study of 30 patients with symptomatic ICRS grade III/IV chondral defects which were assessed clinically and radiologically. The lesions were located on the MFC, LFC, trochlea or patella, ranging from 2–8cm2. The surgical procedure involved debridement of the lesion, microdrilling and application of atellocollagen and fibrin gel under CO2 insufflation. Patients were clinically assessed using the Lysholm, IKDC and KOOS scores. Radiological assessment used the MOCART score. Results. At 4 year follow-up:. Lysholm score was 80.46 ± 24.7, up from 51.7 ± 27.1 pre-operatively (p < 0.05). KOOS (symptomatic) was 89, up from 66.2 pre-operatively. IKDC (subjective) was 78.6, up from 41 preoperatively. MOCART score for all lesions was 71.3. The mean T2* relaxation-times for the repair tissue and native cartilage were 28.8 and 29.7 respectively. dGEMRIC scan suggests hyaline like repair tissue. Conclusion. Our technique shows encouraging results at 4 year follow-up as assessed by reliable validated scores and qualitative MRI scans

Cartilage is known to have limited intrinsic repair capabilities and cartilage defects can progress to osteoarthritis (OA). OA is a major economic burden of the 21st century, being among the leading causes of disability. The risk of disability from knee OA is as great as that derived from cardiovascular disease; a fact that becomes even more concerning when considering that even isolated cartilage defects can cause pain and disability comparable to that of severe OA. Several cartilage repair procedures are in current clinical application, including microfracture, osteochondral autograft transfer, osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI). Given the economic challenges facing our health care system, it appears prudent to choose procedures that provide the most durable long-term outcome. Comparatively few studies have examined long-term outcomes, an important factor when considering the substantial differences in cost and morbidity among the various treatment options. This study reviews the clinical outcomes of autologous chondrocyte implantation at a minimum of 10 years after treatment of chondral defects of the knee. Mean age at surgery was 36 ± 9 years; mean defect size measured 8.4 ± 5.5cm2. Outcome scores were prospectively collected pre- and postoperatively at the last follow up. We further analyzed potential factors contributing to failure in hopes of refining the indications for this procedure. Conclusions: ACI provided durable outcomes with a survivorship of 71% at 10 years and improved function in 75% of patients with symptomatic cartilage defects of the knee at a minimum of 10 years after surgery. A history of prior marrow stimulation as well as the treatment of very large defects was associated with an increased risk of failure

We describe a novel single stage arthroscopic repair procedure for articular cartilage defect in the knee. The aim of the study was to evaluate the clinical and radiological outcomes at two years. The pre-clinical study involved two groups of New Zealand rabbits, treated with microfracture alone and microfracture combined with fibrin gel and concentrated bone marrow aspirate cells (BMAC) application. New cartilage from both groups was studied with histological staining, immunohistochemistry and electron microscopy. The fibrin gel-BMAC group scored better than the microfracture group on all counts. This is a prospective study of 30 patients with symptomatic ICRS grade III/IV chondral defects, ranging from 2–8 cm. 2. , which were assessed clinically and radiologically. The surgical procedure involved debridement of the lesion, microfracture and arthroscopic application of concentrated BMAC with fibrin gel under CO. 2. insufflation. Patients underwent morphological MRI, quantitative T2*-mapping and d-GEMRIC scan. Clinical assessment was carried out using the Lysholm, IKDC and KOOS scores while radiological assessment used the MOCART score. At 2 year follow-up, Lysholm score was 80.1, as compared to 50.8 pre-operatively (p < 0.05). KOOS (symptomatic) was 92.1, as compared to 65.7 pre-operatively. IKDC (subjective) was 83, up from 39 preoperatively. The mean T2* relaxation-times for the repair tissue and native cartilage were 29.1 and 29.9 respectively. Average MOCART score for all lesions was 72. Our technique shows encouraging clinical and radiological results. The morphological MRI shows good cartilage defect filling and the biochemical MRI (T2*-mapping) suggests hyaline like repair tissue

Trufit resorbable scaffolds, made of semiporous copolymer, are press-fit introduced in chondral defects of articular surfaces in order to promote filling and regeneration of damaged bone and cartilage tissues. In another previous work, we have presented our good and promising results obtanied at 1 yy follow-up. Then, we have had the chance to go on on follow-ups and check patients through second-look arthroscopies and serial MRI's: IKDC score showed 38 points improvement. WOMAC score showed statistically significant pain improvement in 89% of cases and function improvement in 86% of cases. Serial MRI's of the knees showed progressive incorporation of the synthetic plugs and no adverse inflammatory reaction. Second-look arthroscopies showed complete and flush fill of the defects and their resurfacing with hyaline-like tissue under different stages of maturation. Recently, we have been able to check, clinically and by serial MRI's, the first patients operated 24 months ago. Despite the mantainance of clinical very good results, as showed by other authors, MRI images showed a delayed biologic process of incorporation of the plugs. This finding has not to be misinterpreted as an implant failure and the post-op rehabilitation has to be continued in order to give regenerating cartilage time to complete the maturation process

Cartilage repair strategies have been applied successfully to the knee, but only recently and with limited experience to the hip. The indications for these strategies have been well defined for the knee and are defined by the diameter and depth of the defects that are mainly post traumatic and degenerative. Viscosupplementation is an intra-articular therapy that theoretically restores the protective effects of hyaluronic acid. This therapy has been widely used for osteoarthritis of the knee with some early preliminary promising results for osteoarthritis of the hip. Microfracture can be performed arthroscopically or as part of an open procedure. This procedure is indicated for smaller lesions less than 3cm in diameter and 1cm in depth. Widely used in the knee, the results in the hip are limited but promising. The repair tissue is however fibrocartilage. Autologous chondrocyte transplantation can yield hyaline like repair cartilage with good mid- to long-term results in the knee. The indications are chondral defects greater than 3cm in diameter or osteochondral defects less than 1cm in depth. Its use in the hip has been limited with only a few published papers. The procedure requires two stages. The first stage which involves harvesting the cartilage can be done arthroscopically, and the second stage which involves transplantation of the cultured chondrocytes can be done arthroscopically or open. Larger lesions greater than 3cm in diameter and 1cm in depth, can be managed by osteochondral allografts. The published mid- to long-term results for the knee have been encouraging. The results for the hip are early. To date we have performed this procedure on 16 patients. Surgical dislocation of the hip is carried out via a trochanteric osteotomy and the defect defined and trephined out. A press-fit fresh osteochondral allograft is inserted using the trephine technique. We have published our early results on a series of 8 patients with 5 good to excellent results, 1 fair results and 2 failures

The treatment of acute full thickness chondral damage within the knee is a surgical challenge. Frequently used surgical techniques include chondroplasty, micro-fracture and chondrocyte implantation. These procedures give unpredictable functional outcomes and if the formation of neocartilage is achieved it is predominantly composed of type 1 collagen. The TruFit osteochondral plug was designed to provide a scaffold for cell proliferation into full thickness chondral defects. It is a composite polymer composed of polylactide co-glycolide, calcium sulphate and poly-glycolide fibres. It is composed of 2 layers, one with a similar trabecular network to cancellous bone and a superficial layer designed to simulate articular lining. The TruFit bone plug was analysed using micro-computed tomography. Its morphology characteristics, granulometry, mechanical performance and image guided failure were tested as well as numerical modelling to assess the permeability of TruFit. Morphological parameters of the TruFit bone plug compared favourably with those of human tissue. Under load the scaffold exhibited shear bands throughout the composite leading to a failure mechanism similar to cancellous bone. Stress relaxation rates of the scaffolds were greatly decreased under wet conditions, likely due to plasticisation of the scaffold by water. The biomechanical properties of the TruFit bone plugs are a cause for concern. The Scaffolds mechanical performance under load rapidly deteriorates in wet conditions at body temperature (the natural knee environment). This early failure will lead to defects in the articular surface where the plug has been inserted. Clinical data is sparse. This study correlates with work performed by Dockery et al & Spalding et al. These clinical studies have shown that the TruFit implant shows no evidence of bone ingrowth or osteoconductivity. It provides no subchondral support to neocartilage or tissue that was stimulated to form around the defects and surgical sites

Subchondral drillings for articular cartilage defects usually result in fibrocartilage repair, which is inferior biomechanically compared to hyaline cartilage. We postulate that intra-articular injections with autologous marrow-derived stem cells (MSC) and hyaluronic acid (HA) can improve the quality of repair cartilage. We tested this hypothesis in a goat model by creating an articular cartilage defect in the stifle joint and conducted subchondral drillings. The animals were divided into three groups: Group A (control) no injections, Group B (HA) weekly injection of 1 ml sodium hyaluronate for three weeks, Group C (HA+MSC) similar to Group B but with 2 mls autologous MSC in addition to HA. MSC were obtained by bone marrow aspiration, centrifuged, and divided into aliquots, which were cryopreserved. Fifteen animals were equally divided between the groups and sacrificed at 24 weeks after surgery where the joint was harvested and examined macroscopically and histologically. Of the 15 animals, two had died in Group A and one was excluded from Group C due to an infection. In Group A, repair constituted mainly of scar tissue, while in Group B, there was less scar tissue, with small amounts of proteoglycan and collagen II at the osteochondral junction. In contrast, repair cartilage from Group C animals demonstrated almost complete coverage of the defect with evidence of hyaline cartilage regeneration. Histology as assessed by Gill scoring was significantly better in Group C with one-way ANOVA giving an F-statistic of 10.611 with a p-value of 0.004, which was highly significant. Post-operative intra-articular injections of autologous MSC in combination with HA following subchondral drillings into chondral defects resulted in better cartilage repair