Aims

Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions.

Objectives

Meniscal injuries are often associated with an active lifestyle. The damage of meniscal tissue puts young patients at higher risk of undergoing meniscal surgery and, therefore, at higher risk of osteoarthritis. In this study, we undertook proof-of-concept research to develop a cellularized human meniscus by using 3D bioprinting technology.

Objectives

Matrix-assisted autologous chondrocyte transplantation (MACT) has been developed and applied in the clinical practice in the last decade to overcome most of the disadvantages of the first generation procedures. The purpose of this systematic review is to document and analyse the available literature on the results of MACT in the treatment of chondral and osteochondral lesions of the knee.

Osteocondritis dissecans (OCD) is a relatively common cause of knee pain. Ideal treatment is still controversial. Aim of this exhibit is to describe the outcomes of 5 different surgical techniques in a series of 63 patients.

63patients (age 22.5±7.4 years) affected by OCD of the femoral condyle (45 medial and 17 lateral) were treated by either osteochondral autologous transplantation, autologous chondrocyte implantation with bone graft, biomimetic nanostructured osteochondral scaffold (Maioregen) implantation, bone-cartilage paste graft or bone marrow derived cells transplantation “one-step” technique. Patient evaluation included IKDC score, eq-vas score, X-Rays and MRI preoperatively and at follow-up.

Global mean IKDC improved from pre-operative 40.1±14.6 to 77.2±21.3 (p<0.0005) at mean 5.3±4.7 years follow-up, while eq-vas improved from 51.7±17.0 to 83.5±18.3(p<0.0005). No influence of age, size of the lesion, length of follow-up and associated surgeries on the result was found. No differences were found between the results obtained with different surgeries except a slight tendency of better improvement in the result following autologous chondrocyte implantation (p<0.01). Control MRI evidenced a satisfactory repair of cartilaginous layer and subchondral bone.

The techniques described were effective in providing good clinical and radiographic results in the treatment of OCD and confirmed the validity of autologous chondrocyte implantation over time. Newer techniques such as Maioregen implantation and “one-step” base on different rationales, the first relying on the characteristics of the scaffold and the second on the regenerative potential of mesenchymal cells. Both of them have the advantages to be minimally invasive surgeries and to require a single operation.

INTRODUCTION

Osteochondral defects are still a challenge for the orthopaedic surgeon, since most of the current surgical techniques lead to fibrocartilage formation and poor subchondral regeneration, often associated to joint stiffness and/or pain.

Thinking of the ideal osteochondral graft from both the surgical an commercial point of view, it should be an off-the-shelf product; this is the research direction and the explanation for the new biomaterials recently proposed to repair osteochondral defect inducing an “in situ” cartilage regeneration starting from the time of the implantation into the defect site.

For the clinical pilot study we performed, a newly developed nanostructured biomimetic scaffold was used to treat chondral and osteochondral lesions of the knee; its safety and manageability, as much as the surgical procedure reproducibility and the clinical outcome, were evaluated in order to test its intrinsic potential without any cells colture aid.

INTRODUCTION

The menisci play a fundamental biomechanical role in the knee and also help in the maintaining of the articular homeostasis; thus, either a lesion or the complete absence of the menisci can invalidate the physiological function of the knee causing important damages, even at long term. Unfortunately, meniscal tears are often found during the ordinary orthopaedic practice while the regenerative potential of this kind of tissue is very low and limited to its peripheral-vascularized part; this is why the majority of these common arthroscopic findings are not reparable and often the surgeon is almost forced to perform a partial, subtotal or even total meniscectomy, regardless of the well-known consequences of this kind of surgery.

Introduction: In the last years matrix autologous chondrocyte transplantation becomes a possible solution in the treatment of chondral lesions. We develop an arthroscopic procedure for chondrocyte implant on hyaluronian-based scaffold.

Material and methods: Thirty-five patients treated using this technique achieved 3 years follow up. All the patients were clinically evaluated using IKDC score and with MRI or TC scan. In some Patients we performed a second look arthroscopy and histological evaluation.

Results: IKDC objective score improved after 12 months in all patients and the results were confirmed at 24 and 36 months of follow-up. The improving was obtained also according to IKDC subjective score. A second look arthroscopy showed healing of the defect with regenerated cartilage. The histological evaluation has demonstrated in 80% the hyaline type of new cartilage.

Conclusions: This matrix autologous chondrocyte transplantation procedure avoids the use of periosteal flap, simplify the surgical procedure and permit to perform the arthroscopic implant reducing the morbidity of the procedure. The preliminary clinical and histological results at 3 years follow-up are encouraging.

Introduction: Total meniscectomy can cause cartilage degeneration and osteoarthritis. The healing capacity of the meniscus is limited. Bioengineered meniscus can be a valid therapeutic option. Within the framework of the European Project MENISCUS, a pilot animal study was conducted to evaluate surgical technique, critical defect size, implant ingrowth and postoperative mobilization using a meniscus replacement device.

Materials and Method: Six sheep were operated on their right stifle joints. 3 sheep received a total meniscus replacement with a 3D biomaterial fixed with sutures. Additionally, controls without implant were operated. The sheep were sacrificed and evaluated clinically and histologically after 6 weeks.

Results: All implants showed excellent adhesion to the capsule and a good ingrowth at the periphery and the horns. Tissue formation was confirmed histologically.

Conclusions: Tissue ingrowth of the implant was demonstrated. The promising results concerning tissue formation and its meniscus like properties will have to be confirmed in future long-term studies.