To present our preliminary results in fully arthroscopically performed 3-dimensional autologous cartilage transplantation (ACT-3D) for medium to large focal chondral defects at the knee.

We treated operatively in our Dept., 35 symptomatic patients between March 2007 and May 2008. The mean age was 32 years old. The mean area of cartilage defect was 6.75cm² (2.2–10cm²) and all the cases were classified as grade III(16) and IV(18) according to Out-erbrigde scale. 18 of the cartilage lesions were located in the weight-bearing surface of the medial femoral condyle, 8 in the lateral one, 6 in the trochlea area and 2 in the lateral facet of the patella. We performed 15 applications of ACT3D as single procedure. Apart from that, we performed 11 ACL reconstructions combined with the 3D-spheres. Preop. and postoperative evaluation of patients was done using the Modified Cincinatti (MC) Rating System(0–100), the VAS (visual analogue pain score) (0–10), IKDC Knee examination score and Patient Outcome Function score.

All the cases were performed uneventfully. No major complications were seen. All cases followed a specialized rehabilitation protocol. In MC Rating System the result rose from 41.5 to 72.5 and in VAS, pain significantly reduced from 6.1 to 1.8 in 12 months time. The Patient Outcome Function score showed 81% better, 18% same and 1% worse results. The follow-up using MRI showed adequate filling of the defect without significant bone swelling.

Arthroscopically performed chondrocyte implantation (ACT) is an innovative technique with early results very promising. It’s surgeon demanding, although it’s fast performed technique and well tolerated operation. A greater number of cases and further mid and long term follow-up has to be studied in order to prove the efficacy of the method.

To present our experince in the use of different autologous cartilage transplantation techniques with concomitant procedures.

The last 30 months we treated 42 patients with chondral defect at the knee. Their mean age was 34 y.o. and the men to women ratio was 28/14. The defect concerned the medial femoral condyle(20), the lateral femoral condyle (14), the medial facet of the patella (4) while 4 patients demonstrated chodral defects in both femoral condyles. The mean area of the defect was 6.5 cm2 while defects measuring below 2.5 cm2(10) were treated arthroscopically using microfracturing trechnique. 20 cases were treated for chondral defect alone using either MACI or ACT-3D technique for chondrocyte transplantation and in 12 cases there was a combination of cartilage transplantation with alignment correction procedures. Finally a modified rehabilitation protocol was used.

All the cases were performed uneventfully. We assesed the patients 12 months post-operatively using the LYSHOLM & GILLQUIST score, FAFA kai Visual Analogue Pain Score. The clinical outcome was excellent, the follow-up using ‘MRI showed adequate filling of the defect without significant bone swelling.

Our early results using the method are more than encouraging. The method continues to evolve and is very challenging. As far as we know this the first publication concerning 3rd generation autologous chondrocyte transplantation in both femoral condyles silmutaneously

Purpose: To present our experience in using autologous 3D chondrocyte implantation, performed in fully arthroscopical manner, for treatment of cartilage defects, due to osteochondritis descecans in the talus.

Materials and Methods: A total of 12 patients were presented to our clinic with severe ankle pain due to osteochondritis descecans in the right(8) and left(4) talus between June 2008 and June 2009. The lesions were located at the medial aspect of the right talus (7) and the medial aspect of the left talus (4) as well as the central aspect (1) of the right talus, measuring (8) 1×1.5 cm2 and (4) 1.5x1.5 cm2 were classified intraoperatively as Outerbridge IV. They underwent arthroscopy in order to collect cartilage from non-weight bearing area of the talus(1st stage ACI) and then send it for chondrocyte culture. After 6 weeks the cultivated chondrocytes were applied fully arthroscopically as 3D chondrospheres to cover the chondral defects(2nd stage ACI). Pre-op and post-op evaluation was done using the LYSHOLM & GILLQUIST score, Patient Outcome Function score and Visual Analogue Pain score.

Results: The procedures progressed uneventfully. A specialized rehabilitation protocol was followed. We assessed the patient at six months and 1 year post-operatively; the Lysholm & Gillquist Score rose from 45.5 to 72.5, in VAS pain significantly reduced from 6.3 to 1.7 in the 1 year period and the Patient Outcome Function score showed significantly better performance. The follow-up using MRI showed adequate filling of the defect without significant graft-associated complications for the same period. The clinical outcome was excellent.

Conclusions: Our preliminary results of autologous 3D chondrocyte implantation for the treatment of cartilage defects, due to osteochondritis descecans in the talus seems to be more than encouraging. A greater number of cases and further mid and long term follow-up has to be studied in order to prove the efficacy of the method. As far as we know this is the first publication in the literature regarding 3nd generation ACI technique fully arthroscopically performed, concerning the talus, in our country.

The purpose of our study is to report the incidence of osteomyelitis during the last 10 years in our department. Diagnosis, management and follow-up are also discussed.

We carried out a retrospective study on 40 children who were hospitalised in our clinic between the years 1995–2006 suffering from osteomyelitis. There were 29 male and 11 female children with a mean age 6.8 years. A full blood count, CRP, ESR were measured and X-rays and ultrasound were performed in all patients. Blood cultures were also taken. Additionally, bone scan and CT scan were also performed in 6 and 3 children respectively. The lesion involved in 7 cases the tibia, 9 cases the lower end of the femur and the knee joint, 4 cases the head of the femur and the hip, 7 cases the patella, 4 cases the neck of the humerus, 3 cases the lower end of the fibula, 3 cases the 5th finger of the hand, 2 cases the 4th and 5th metatarsal bones and in 1 case the clavicle. All patients were initially commenced to double antibiotic scheme iv. The microorganisms isolated were Staphylococcus Aureus (27 children-67.5%), Pseudomonas Aeruginosa (9 children-22.5%), Streptococcus Pneumoniae (4 children-10%)

The majority of children (80%) were managed conservatively with intravenous and then oral antibiotic therapy. In 8 cases (20%) surgical debridement was performed due to persisting symptoms and/or aggressive radiologic appearance of the lesion. The mean days of hospitalisation were 17.4 days/patient. A 1.2 year mean follow-up was achieved in all the above patients. All children gradually improved and became pain free, while complete bone resolution appeared in the X-Rays.

Staphylococcus aureus remains the most common organism causing acute osteomyelitis. If left untreated the condition can lead to serious sequelae. The optimal approach in uncomplicated cases may be a combination of aspiration for diagnostic purposes and prolonged antibiotic therapy. A patient’s lack of response to antibiotic treatment and evidence of aggressive radiologic features are indications for surgery.

Acute osteomyelitis (OM) and septic arthritis (SA) are two issues of great concern and debate for the pediatric orthopaedic surgeon.

Our purpose is to study the frequency of both diseases in the current years in comparison to the past, as well as other parameters that affect their progress such as time between the onset of the disease and the admission to the hospital, and pathogens that are found in pus and types of therapy.

Three periods were studied: Period A: years 1963–1975, Period B: years 1975–1983, Period C: years 2000–2005. In total, there were 451 patients suffering from OM and SA in Period A, 208 cases in Period B and 95 cases in Period C.

OM is found most often in the femur (A: 34.91%, B: 32.32%, C: 54.54%) and the tibia (A: 43.27%, B: 43.43%, C: 13.63%). SA is found mostly at the knee (A: 17.46%, B: 42.70%, C: 47.76%) and the hip (A: 50%, B: 37.50%, C: 41.79%) joints. A great percentage of patients in Period A (36.80%) are admitted to hospital very late (> 20 days from the onset of the disease); this number falls dramatically in Period C. There is, on the other hand, early admission to hospital (< 3 days) in period C (C: 74.73% versus A: 13.08%). No significant difference among age groups is apparent; 6–11 years of age are the most frequent. Staph. aureus has always been the most usual pathogen found in pus in the majority of cases. A great number of patients in Period A are admitted to hospital being already under antibiotic therapy (60.58%). This percentage falls in Period C (11.57%).

A decrease in the frequency of OM and SA in the recent years is obvious. Most of the patients are admitted early to hospital and due to this event, there is significant improvement concerning the complications from the diseases, in comparison to the past.