scholarly journals Autologe Knorpelzelltransplantation mit Knochenaufbau zur Behandlung osteochondraler Defekte am Knie

2021 ◽  
Author(s):  
Christoph Stotter ◽  
Stefan Nehrer ◽  
Thomas Klestil ◽  
Philippe Reuter
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Knee Injury ◽  
Autologe Chondrozytentransplantation ◽  
Repair Tissue ◽  
Outcome Score ◽  
Autologe Knorpelzelltransplantation ◽  
Entzündliche Gelenkerkrankungen ◽  
Osteochondrale Defekte ◽  
Matrixgestützte Autologe Chondrozytentransplantation

Zusammenfassung Operationsziel Offene Therapie osteochondraler Läsionen des Kniegelenks zur vollständigen Auffüllung knöcherner Defekte und Wiederherstellung der Gelenkfläche. Indikationen Fokale, symptomatische osteochondrale Defekte des Kniegelenks ab einer Knochendefekttiefe von ≥ 5 mm und Größe von ≥ 1,5 cm2. Kontraindikationen Arthrose (> KL Grad 2), „kissing lesions“ (ICRS > Grad 2), Alter > 50 Jahre, unbehandelte Bandinstabilitäten oder Beinachsenfehstellungen zum Nachteil des betroffenen Gelenkkompartiments, fehlendes Defektcontainment, entzündliche Gelenkerkrankungen. Operationstechnik Zweizeitiger Eingriff: Ersteingriff (arthroskopische Knorpelprobenentnahme): Defektevaluierung, Entnahme von Knorpelstücken für die Chondrozytenkultivierung, bei Bedarf Behandlung von Begleitpathologien. Zweiteingriff (offene Defektbehandlung): Arthrotomie, Präparation des knöchernen Defekts, Auffüllung mit autologen Spongiosazylindern aus dem Beckenkamm, Knorpeldefektpräparation (kann größer als knöcherner Defekt sein) und matrixgestützte autologe Chondrozytentransplantation. Weiterbehandlung Ersteingriff: frühfunktionelle Nachbehandlung mit schmerzorientierter Vollbelastung je nach Begleiteingriffen. Zweiteingriff: keine Drainage, funktionelle Kniegelenkorthese in Streckstellung für 1 Woche, danach schrittweise Freigabe der Flexion, Teilbelastung für 6 Wochen, Motorschiene (CPM) ab dem 1. postoperativen Tag. Ergebnisse Seit 2018 sind 8 Patienten (mittleres Alter 29,4 Jahre, Spanne 18 bis 36) mit der beschriebenen Technik behandelt worden. Alle Patienten konnten nach durchschnittlich 12 Monaten nachuntersucht werden. Der Gesamt-KOOS (Knee injury and Osteoarthritis Outcome Score) verbesserte sich im Mittel von 45,8 auf 81,3, und die postoperativen radiologischen Kontrollen zeigten die Einheilung der Spongiosazylinder bei allen Patienten. Der MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) Score ergab 80,4 Punkte.

First-in-Human Pilot Study of Implantation of a Scaffold-Free Tissue-Engineered Construct Generated From Autologous Synovial Mesenchymal Stem Cells for Repair of Knee Chondral Lesions

2018 ◽  
Vol 46 (10) ◽  
pp. 2384-2393 ◽  
Author(s):  
Kazunori Shimomura ◽  
Yukihiko Yasui ◽  
Kota Koizumi ◽  
Ryota Chijimatsu ◽  
David A. Hart ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Femoral Condyle ◽  
Chondral Lesions ◽  
Repair Tissue ◽  
Biopsy Specimens ◽  
Implantation Procedure

Background: Articular cartilage has limited healing capacity, owing in part to poor vascularity and innervation. Once injured, it cannot be repaired, typically leading to high risk for developing osteoarthritis. Thus, cell-based and/or tissue-engineered approaches have been investigated; however, no approach has yet achieved safety and regenerative repair capacity via a simple implantation procedure. Purpose: To assess the safety and efficacy of using a scaffold-free tissue-engineered construct (TEC) derived from autologous synovial membrane mesenchymal stem cells (MSCs) for effective cartilage repair. Study Design: Case series; Level of evidence, 4. Methods: Five patients with symptomatic knee chondral lesions (1.5-3.0 cm2) on the medial femoral condyle, lateral femoral condyle, or femoral groove were included. Synovial MSCs were isolated from arthroscopic biopsy specimens and cultured to develop a TEC that matched the lesion size. The TECs were then implanted into chondral defects without fixation and assessed up to 24 months postoperatively. The primary outcome was the safety of the procedure. Secondary outcomes were self-assessed clinical scores, arthroscopy, tissue biopsy, and magnetic resonance image–based estimation of morphologic and compositional quality of the repair tissue. Results: No adverse events were recorded, and self-assessed clinical scores for pain, symptoms, activities of daily living, sports activity, and quality of life were significantly improved at 24 months after surgery. Secure defect filling was confirmed by second-look arthroscopy and magnetic resonance imaging in all cases. Histology of biopsy specimens indicated repair tissue approaching the composition and structure of hyaline cartilage. Conclusion: Autologous scaffold-free TEC derived from synovial MSCs may be used for regenerative cartilage repair via a sutureless and simple implantation procedure. Registration: 000008266 (UMIN Clinical Trials Registry number).

scholarly journals Resultados a longo prazo de osteotomia varizante femoral distal (OVFD) com cunha de abertura lateral para artrose do compartimento lateral do joelho utilizando navegação computadorizada

2020 ◽  
Author(s):  
Vikram Kandhari ◽  
Darshan Angadi ◽  
Darli Myat ◽  
Brett Fritsch ◽  
David Parker ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Knee Injury ◽  
International Knee Documentation Committee ◽  
International Cartilage Repair Society ◽  
Outcome Score

Resumo Objetivo O objetivo principal do presente estudo foi avaliar os resultados a longo prazo, incluindo a sobrevivência em Osteotomia Varizante Femoral Distal com Cunha de Abertura Lateral (OVFD-CAL) utilizando navegação computadorizada. O objetivo principal do presente estudo foi avaliar os resultados a longo prazo, incluindo a sobrevivência. Métodos Foi realizada uma análise retrospectiva dos dados coletados prospectivamente de pacientes com artrite do compartimento lateral submetidos a OVFD-CAL por navegação de dezembro de 2006 a novembro de 2012. As pontuações International Knee Documentation Committee (IKDC, na sigla em inglês) e Knee Injury and Osteoarthritis Outcome Score (KOOS, na sigla em inglês) foram analisadas para medição de resultados. Conversão para artroplastia durante o acompanhamento foi o ponto final. Resultados Um total de 19 OVFD-CAL foram realizados em 17 pacientes com média de idade de 46,6 ± 6,5 anos formaram a coorte do estudo. O alinhamento coronal foi corrigido a partir de uma média de 7,1° (2–11°) de valgo para uma média de 2,1° (0,5°–3°) de varo. As pontuações do IKDC melhoraram de uma média pré-operatória de 39 para 53 no acompanhamento de médio de longo prazo de 9,1 anos. Os escores do KOOS no acompanhamento a longo prazo foram: dor 71, sintomas 56, atividades da vida diária 82, esportes e recreação 59, qualidade de vida 43. A sobrevivência do OVFD-CAL foi de 78,9% em um acompanhamento de 9,1 anos. Presença de degeneração da cartilagem segundo a Sociedade Internacional de Reparação de Cartilagem (International Cartilage Repair Society [ICRS, na sigla em inglês])≥ grau 2 no compartimento medial do joelho e deformidade pré-operatória em valgo > 7° fortemente correlacionado com a conversão para artroplastia total do joelho (ATJ) no acompanhamento a longo prazo (r – 0,66). Conclusões A OVFD-CAL por navegação computadorizada apresentou resultados clínicos satisfatórios e sobrevida de 79% no acompanhamento a longo prazo. Presença de alterações degenerativas ICRS ≥ grau 2 no compartimento medial do joelho com > 7° de deformidade pré-operatória em valgo afeta negativamente a sobrevivência da OVFD-CAL no acompanhamento de longo prazo.

Magnetic Resonance Imaging to Assess Knee Cartilage Repair Tissue After Microfracture of Chondral Defects

2010 ◽  
Vol 20 (03) ◽  
pp. 228-234 ◽  
Author(s):  
Arun Ramappa ◽  
Thomas Gill ◽  
Catharine Bradford ◽  
Charles Ho ◽  
J. Steadman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Resonance Imaging ◽  
Knee Cartilage ◽  
Repair Tissue ◽  
Chondral Defects

scholarly journals Understanding Magnetic Resonance Imaging of Knee Cartilage Repair: A Focus on Clinical Relevance

Cartilage ◽  
2017 ◽  
Vol 9 (3) ◽  
pp. 223-236 ◽  
Author(s):  
Daichi Hayashi ◽  
Xinning Li ◽  
Akira M. Murakami ◽  
Frank W. Roemer ◽  
Siegfried Trattnig ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Clinical Relevance ◽  
Osteochondral Allograft ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Knee Cartilage ◽  
Ongoing Research ◽  
Repair Tissue

The aims of this review article are (a) to describe the principles of morphologic and compositional magnetic resonance imaging (MRI) techniques relevant for the imaging of knee cartilage repair surgery and their application to longitudinal studies and (b) to illustrate the clinical relevance of pre- and postsurgical MRI with correlation to intraoperative images. First, MRI sequences that can be applied for imaging of cartilage repair tissue in the knee are described, focusing on comparison of 2D and 3D fast spin echo and gradient recalled echo sequences. Imaging features of cartilage repair tissue are then discussed, including conventional (morphologic) MRI and compositional MRI techniques. More specifically, imaging techniques for specific cartilage repair surgery techniques as described above, as well as MRI-based semiquantitative scoring systems for the knee cartilage repair tissue—MR Observation of Cartilage Repair Tissue and Cartilage Repair OA Knee Score—are explained. Then, currently available surgical techniques are reviewed, including marrow stimulation, osteochondral autograft, osteochondral allograft, particulate cartilage allograft, autologous chondrocyte implantation, and others. Finally, ongoing research efforts and future direction of cartilage repair tissue imaging are discussed.

scholarly journals Clinical and Radiographic Outcomes After Fixation of Chondral Fragments of the Knee in 6 Adolescents Using Autologous Bone Pegs

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096305
Author(s):  
Takahiro Ogura ◽  
Hiroki Sakai ◽  
Shigehiro Asai ◽  
Hideaki Fukuda ◽  
Tatsuya Takahashi ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Full Range ◽  
Cartilage Tissue ◽  
Trochlear Groove ◽  
Repair Tissue ◽  
Radiographic Outcomes ◽  
The Mean ◽  
Autologous Bone

Background: Little is known regarding the optimal treatment for displaced, purely chondral fragments in the knee. Purpose: To report the clinical and radiographic outcomes of chondral fragment fixation in adolescents through use of autologous bone pegs. Study Design: Case series; Level of evidence, 4. Methods: This retrospective, single-center study evaluated 6 patients (mean age, 12.9 years) who underwent fixation of chondral fragments (no visualized bone attached) using autologous bone pegs (mean postoperative follow-up, 5.2 years; range, 1.4-10.9 years). The causes were trauma (n = 5) and osteochondritis dissecans (n = 1). Lesions were located in the trochlear groove (lateral, n = 3; medial, n = 2) or posterior part of the lateral femoral condyle (n = 1). The mean lesion size was 3.8 cm2 (range, 0.8-9.0 cm2). Patients were evaluated via physical examination and magnetic resonance imaging (MRI) using magnetic resonance observation of cartilage repair tissue scores. Results: In total, 5 patients successfully returned to sports without restrictions at a mean of 7 months (range, 6-8 months) postoperatively. At the latest follow-up, these 5 patients had full range of motion and no joint effusion. The mean magnetic resonance observation of cartilage repair tissue score was 85 (range, 70-95) at a mean duration of 3 years (range, 1-5 years). One patient experienced failure at 1.3 years postoperatively after a traumatic injury and subsequently underwent removal of the fixed fragment and a drilling procedure. Conclusion: In most adolescents, fixation of chondral fragments with no visualized bony portion using autologous bone pegs provided a satisfactory success rate and good healing of cartilage tissue confirmed on MRI scans.

Combined Bone Marrow Aspirate and Platelet-Rich Plasma for Cartilage Repair: Two-Year Clinical Results

Cartilage ◽  
2019 ◽  
pp. 194760351987632 ◽  
Author(s):  
Kris Hede ◽  
Bjørn B. Christensen ◽  
Jonas Jensen ◽  
Casper B. Foldager ◽  
Martin Lind
Keyword(s):  
Bone Marrow ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Cartilage Repair ◽  
Bone Marrow Aspirate ◽  
Platelet Rich Plasma ◽  
Collagen Scaffold ◽  
Repair Tissue ◽  
Outcome Scores

Purpose To evaluate the clinical and biological outcome of combined bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) on a collagen scaffold for treating cartilage lesions in the knee. Methods and Materials Ten patients (mean age 29.4 years, range 18-36) suffering from large full-thickness cartilage in the knee were treated with BMAC and PRP from January 2015 to December 2016. In a 1-step procedure autologous BMAC and PRP was seeded onto a collagen scaffold and sutured into the debrided defect. Patients were evaluated by clinical outcome scores (IKDC [International Knee Documentation Committee Subjective Knee Form], KOOS [Knee Injury and Osteoarthritis Outcome Score], and pain score using the Numeric Rating Scale [NRS]) preoperatively, after 3 months, and after 1 and 2 years. Second-look arthroscopies were performed ( n = 7) with biopsies of the repair tissue for histology. All patients had magnetic resonance imaging (MRI) preoperatively, after 1 year, and after 2 to 3.5 years with MOCART (magnetic resonance observation of cartilage repair tissue) scores evaluating cartilage repair. Results After 1 year significant improvements were found in IKDC, KOOS symptoms, KOOS ADL (Activities of Daily Living), KOOS QOL (Quality of Life), and pain at activity. At the latest follow-up significant improvements were seen in IKDC, KOOS symptoms, KOOS QOL, pain at rest, and pain at activity. MRI MOCART score for cartilage repair improved significantly from baseline to 1-year follow-up. Histomorphometry of repair tissue demonstrated a mixture of fibrous tissue (58%) and fibrocartilage (40%). Conclusion Treatment of cartilage injuries using combined BMAC and PRP improved subjective clinical outcome scores and pain scores at 1 and 2 years postoperatively. MRI and histology indicated repair tissue inferior to the native hyaline cartilage.

scholarly journals The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas

Cartilage ◽  
2019 ◽  
pp. 194760351986530 ◽  
Author(s):  
Markus M. Schreiner ◽  
Marcus Raudner ◽  
Stefan Marlovits ◽  
Klaus Bohndorf ◽  
Michael Weber ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Cartilage Defect ◽  
Interrater Reliability ◽  
Weighted Kappa ◽  
Kappa Statistics ◽  
Bony Defect ◽  
Knee Score ◽  
Repair Tissue ◽  
Evaluation Sheet

Objective Since the first introduction of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score, significant progress has been made with regard to surgical treatment options for cartilage defects, as well as magnetic resonance imaging (MRI) of such defects. Thus, the aim of this study was to introduce the MOCART 2.0 knee score — an incremental update on the original MOCART score — that incorporates this progression. Materials and Methods The volume of cartilage defect filling is now assessed in 25% increments, with hypertrophic filling of up to 150% receiving the same scoring as complete repair. Integration now assesses only the integration to neighboring native cartilage, and the severity of surface irregularities is assessed in reference to cartilage repair length rather than depth. The signal intensity of the repair tissue differentiates normal signal, minor abnormal, or severely abnormal signal alterations. The assessment of the variables “subchondral lamina,” “adhesions,” and “synovitis” was removed and the points were reallocated to the new variable “bony defect or bony overgrowth.” The variable “subchondral bone” was renamed to “subchondral changes” and assesses minor and severe edema-like marrow signal, as well as subchondral cysts or osteonecrosis-like signal. Overall, a MOCART 2.0 knee score ranging from 0 to 100 points may be reached. Four independent readers (two expert readers and two radiology residents with limited experience) assessed the 3 T MRI examinations of 24 patients, who had undergone cartilage repair of a femoral cartilage defect using the new MOCART 2.0 knee score. One of the expert readers and both inexperienced readers performed two readings, separated by a four-week interval. For the inexperienced readers, the first reading was based on the evaluation sheet only. For the second reading, a newly introduced atlas was used as an additional reference. Intrarater and interrater reliability was assessed using intraclass correlation coefficients (ICCs) and weighted kappa statistics. ICCs were interpreted according to Koo and Li; weighted kappa statistics were interpreted according to the criteria of Landis and Koch. Results The overall intrarater (ICC = 0.88, P < 0.001) as well as the interrater (ICC = 0.84, P < 0.001) reliability of the expert readers was almost perfect. Based on the evaluation sheet of the MOCART 2.0 knee score, the overall interrater reliability of the inexperienced readers was poor (ICC = 0.34, P < 0.019) and improved to moderate (ICC = 0.59, P = 0.001) with the use of the atlas. Conclusions The MOCART 2.0 knee score was updated to account for changes in the past decade and demonstrates almost perfect interrater and intrarater reliability in expert readers. In inexperienced readers, use of the atlas may improve interrater reliability and, thus, increase the comparability of results across studies.

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