The current study aims to ascertain the outcome of ACI with simultaneous transplantation of an autologous bone plug for the restoration of osteoarticular defects in the femoral condyle of the knee (‘Osplug’ technique). Seventeen patients (mean age of 27±7 years), twelve with Osteochondritis dissecans (OD) and five with an osteochondral defect (OCD) was treated with unicortical autologous bone graft combined with ACI (‘Osplug’ technique). Functional outcome was assessed with Lysholm scores obtained for 5 years post-operatively. The repair site was evaluated with the Oswestry Arthroscopy Score (OAS), MOCART MRI score and ICRS II histology score. The mean defect size was 4.5±2.6 SD cm² and mean depth was 11.3±5 SD mm. A significant improvement of Lysholm score from 45 (IQR 24, range 16–79) to 77 (IQR 28, range 41–100) at 1 year (p-value 0.001) and 70 (IQR 35, range 33–91) at 5 years (p-value 0.009). The mean OAS of the repair site was 6.2 (range 0–9) at a mean of 1.3 years. The mean MOCART score was 61 ± 22SD (range 20–85) at 2.6 ± 1.8SD years. Histology demonstrated generally good integration of the repair cartilage with the underlying bone. Poor lateral integration of the bone graft on MRI and low OAS were significantly associated with a poor outcome and failure. The Osplug technique shows significant improvement of functional outcome for up to 5 years. This is the first report describing the association of bone graft integration with functional outcome after such a procedure.
To identify the incidence of sequential slip of the unaffected hips in patients presenting with unilateral SCFE managed with prophylactic fixation or observation. A retrospective review of all unilateral SCFE treated during 1998 to 2012 was undertaken. The study compares the incidence of sequential slip of the initially unaffected hip in patients managed with prophylactic fixation or observation. The study also reports the incidence avascular necrosis, chondrolysis, and metal-work related problem in this group of patients. All patients included in this current work have at least 12 months of follow-up from the index slip. A total of 44 cases had prophylactic fixation of the unaffected hip (mean age 12.6 years,) and 36 patients managed with regular observation (mean age 13.4 years). Sequential slip of the unaffected hip was noted in a total of 10 patients (28 %) managed with regular observation and only in 1 patient (2%) managed with prophylactic fixation. A Fishers exact test showed significantly high incidence of sequential slip in unaffected hips when managed by regular observation (p-value-0.002). There is no evidence of avascular necrosis or chondrolysis in the unaffected hip in both groups, 3 patients had metalwork related problem and one had superficial wound infection in prophylactic fixation group. Simultaneous prophylactic fixation of the unaffected hips significantly reduces the incidence of sequential slip. This is a relatively safe procedure and should be advocated in all cases of unilateral SCFE to avoid potential complications and preserve function of the unaffected hip.
To evaluate the efficacy of bone marrow derived stromal cells (BMSC) for the treatment of non-unions in fractures. An ethically approved single centre randomised control trial recruited 35 patients for treatment of non-unions with BMSC during 2006–2010. Autologous BMSC were culture expanded at the Good Manufacturing Practice (GMP) standard Oscell® laboratory in the hospital. Following Aim
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