Mosaic Osteochondral Autograft Transplantation Versus Bone Marrow Stimulation Technique as a Concomitant Procedure With Opening-Wedge High Tibial Osteotomy for Spontaneous Osteonecrosis of the Medial Femoral Condyle

2018 ◽  
Vol 34 (1) ◽  
pp. 233-240 ◽  
Author(s):  
Ken Kumagai ◽  
Yasushi Akamatsu ◽  
Hideo Kobayashi ◽  
Yoshihiro Kusayama ◽  
Tomoyuki Saito
Keyword(s):  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Tibial Osteotomy ◽  
Bone Marrow Stimulation ◽  
Opening Wedge ◽  
Osteochondral Autograft ◽  
Marrow Stimulation ◽  
Concomitant Procedure ◽  
Wedge High Tibial Osteotomy ◽  
Stimulation Technique

scholarly journals Meniscal and Cartilage Changes on Serial MRI After Medial Opening-Wedge High Tibial Osteotomy

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110479
Author(s):  
Han Gyeol Choi ◽  
Yu Suhn Kang ◽  
Joo Sung Kim ◽  
Han Sang Lee ◽  
Yong Seuk Lee
Keyword(s):  
Tibial Plateau ◽  
Femoral Condyle ◽  
Relaxation Times ◽  
Lateral Compartment ◽  
Tibial Osteotomy ◽  
T2 Relaxation ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Serial Mri

Background: Assessments of the effects of realignment using opening-wedge high tibial osteotomy (OWHTO) on the medial, lateral, and patellofemoral compartments have been limited to cartilage evaluations. Purpose/Hypothesis: The purpose was to evaluate the effects of OWHTO on the meniscus and cartilage of each compartment as a cooperative unit (meniscochondral unit) using serial magnetic resonance imaging (MRI). It was hypothesized that (1) favorable changes in the meniscochondral unit would occur in the medial compartment and (2) that changes in the patellofemoral and lateral compartments would be negligible. Study Design: Case series; Level of evidence, 4. Methods: Included were 36 knees that underwent OWHTO from March 2014 to February 2016 and had postoperative serial MRI. The MRI was performed at 19.9 ± 7.4 and 52.3 ± 8.3 months postoperatively, and the cartilage and meniscal changes were evaluated by highlighting the regions of interest. We evaluated the T2 relaxation times of each cartilage and meniscal area, the cross-sectional area of the menisci, and the extrusion of the medial meniscus (MM). The meniscochondral unit was assessed using subgroup analyses according to the status of the MM. Results: Significant decreases were seen in T2 relaxation times in the medial femoral condyle (MFC) ( P < .001) and medial tibial plateau (MTP) ( P = .050), and significant increases were seen in the lateral femoral condyle (LFC) ( P = .036). The change was more prominent in the MFC compared with the MTP and LFC ( P = .003). No significant changes were observed in the lateral tibial plateau, patella, or trochlear groove. The area of the lateral meniscus (body and posterior horn) was decreased compared with preoperative MRI ( P < .001 for both). The extent of MM extrusion decreased between the preoperative, first follow-up, and second follow-up MRIs ( P < .001). Conclusion: OWHTO affected the medial compartment positively, the lateral compartment negatively, and the patellofemoral compartment negligibly. The effects were more prominent and consistent in the medial than in the lateral compartment.

scholarly journals Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure

Cartilage ◽  
2017 ◽  
Vol 9 (3) ◽  
pp. 248-254 ◽  
Author(s):  
Albert C. Hsu ◽  
Luis E. P. Tirico ◽  
Abraham G. Lin ◽  
Pamela A. Pulido ◽  
William D. Bugbee
Keyword(s):  
High Tibial Osteotomy ◽  
Femoral Condyle ◽  
Case Series ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Tibial Osteotomy ◽  
Opening Wedge

Objective To evaluate the outcome of patients who have undergone simultaneous osteotomy and osteochondral allograft (OCA) transplantation. Our hypothesis is that use of high tibial osteotomy and fresh OCA in a combined procedure is safe and effective without increasing morbidity in comparison to OCA alone. Design A case series of 17 patients underwent tibial osteotomy and simultaneous OCA during a single surgery. Osteotomy was indicated when axial alignment was within the affected compartment. Patients had a minimum of 2 years of follow-up after surgery. The mean graft size was 8.7 cm2, with 82% located on the medial femoral condyle alone and 18% involving the medial femoral condyle and one or more other sites. Data collection included demographics, osteotomy correction, graft site(s) and area, and clinical evaluation. Failure was defined as conversion to arthroplasty. Results Two of 17 patients (12%) failed at a mean of 9.3 years. The remaining 15 patients (88%) had intact allografts with mean survival of 8.1 years (SD 3.3). Five patients (29%) had an additional procedure, all undergoing osteotomy hardware removal. Of those with surviving allografts, mean pain and function scores improved significantly from the preoperative to postoperative assessment and International Knee Documentation Committee total scores improved significantly from 40.9 ± 15.4 preoperative to 75.5 ± 24.0 at latest follow-up ( P = 0.003); 92% of patients were satisfied with the results of the surgery. No postoperative complications occurred. Conclusion Combining high tibial osteotomy and OCA in properly selected patients is safe and effective.

scholarly journals High tibial osteotomy combined with cancellous bone graft and osteochondral autograft transplantation in a patient with massive osteochondral defects in the medial femoral condyle

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668501
Author(s):  
Takehiko Matsushita ◽  
Shu Watanabe ◽  
Daisuke Araki ◽  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
...  
Keyword(s):  
Bone Graft ◽  
High Tibial Osteotomy ◽  
Cancellous Bone ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Tibial Osteotomy ◽  
Osteochondral Defects ◽  
Cancellous Bone Graft ◽  
Osteochondral Autograft ◽  
Osteochondral Autograft Transplantation

Treatment of massive osteochondral defects of the medial femoral condyle is challenging. A 46-year-old man who had a medial femoral condyle fracture on his left knee underwent osteosynthesis in a hospital, but the pain remained and the patient was referred to our hospital 8 months after the surgery. Radiographs showed a varus alignment of the leg, and magnetic resonance image showed a massive necrotic area in the medial femoral condyle. The patient received high tibial osteotomy (HTO) combined with iliac cancellous bone graft and an osteochondral autograft transplantation. Pain and the knee function markedly improved 2 years after the surgery. A second look arthroscopy showed a well-covered bone graft site with cartilaginous tissue and a well-integrated osteochondral plug. HTO combined with cancellous bone autograft and osteochondral autograft transplantation could be an effective treatment for patients presenting with a varus knee deformity associated with massive osteochondral defects in the medial femoral condyle.

scholarly journals OSTEONECROSIS OF THE KNEE

2019 ◽  
Vol 141 (3-4) ◽  
pp. 81-90
Keyword(s):  
Subchondral Bone ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Cartilage Damage ◽  
Core Decompression ◽  
Tibial Osteotomy ◽  
Bone Marrow Stimulation ◽  
Opening Wedge ◽  
Secondary Osteoarthritis ◽  
Artificial Graft

Spontaneous osteonecrosis of the knee (SONK) is the most common type of knee osteonecrosis. It causes subchondral bone damage and in the majority of cases leads to cartilage damage and secondary osteoarthritis. The etiology is commonly explained with two main theories, vascular and traumatic. Vascular theory is based on disrupture of bone blood supply which causes local ischaemia and subchondral bone necrosis. Traumatic theory suggests the development of subchondral insufficiency fractures due to mechanical overload, which causes local oedema, ischaemia and necrosis. SONK typically appears in middle age and older women, with acute onset of sharp pain in the medial femoral condyle without predisposing trauma. Considering that the characteristic radiological signs are not seen on conventional radiography until advanced stage, magnetic resonance imaging is the gold standard in diagnostics. Treatment depends on the size and stage of the osteonecrotic lesion. Small osteonecrotic lesions are usually successfully treated non-operatively, which is based primarily on protected weight bearing and physical therapy. Medium osteonecrotic lesions are treated either non-operatively or operatively, while large osteonecrotic lesions are almost always treated operatively. Most commonly used joint preserving procedures include arthroscopic bone marrow stimulation using microfracture technique, core decompression, osteochondral autologous or homologous transplantation, artificial graft transplantation, and medial opening-wedge high tibial osteotomy. The treatment of choice after subchondral bone collapse is knee arthroplasty.

scholarly journals Intralesional Osteophyte Regrowth Following Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Technique

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 131-138 ◽  
Author(s):  
Marco Kawamura Demange ◽  
Tom Minas ◽  
Arvind von Keudell ◽  
Sonal Sodha ◽  
Tim Bryant ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Previous Treatment ◽  
Control Group ◽  
Collagen Membrane ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Chondrocyte Implantation ◽  
And Control ◽  
Stimulation Technique ◽  
Autologous Chondrocyte

Objective Bone marrow stimulation surgeries are frequent in the treatment of cartilage lesions. Autologous chondrocyte implantation (ACI) may be performed after failed microfracture surgery. Alterations to subchondral bone as intralesional osteophytes are commonly seen after previous microfracture and removed during ACI. There have been no reports on potential recurrence. Our purpose was to evaluate the incidence of intralesional osteophyte development in 2 cohorts: existing intralesional osteophytes and without intralesional osteophytes at the time of ACI. Study Design We identified 87 patients (157 lesions) with intralesional osteophytes among a cohort of 497 ACI patients. Osteophyte regrowth was analyzed on magnetic resonance imaging and categorized as small or large (less or more than 50% of the cartilage thickness). Twenty patients (24 defects) without intralesional osteophytes at the time of ACI acted as control. Results Osteophyte regrowth was observed in 39.5% of lesions (34.4% of small osteophytes and 5.1% of large osteophytes). In subgroup analyses, regrowth was observed in 45.8% of periosteal-covered defects and in 18.9% of collagen membrane–covered defects. Large osteophyte regrowth occurred in less than 5% in either group. Periosteal defects showed a significantly higher incidence for regrowth of small osteophytes. In the control group, intralesional osteophytes developed in 16.7% of the lesions. Conclusions Even though intralesional osteophytes may regrow after removal during ACI, most of them are small. Small osteophyte regrowth occurs almost twice in periosteum-covered ACI. Large osteophytes occur only in 5% of patients. Intralesional osteophyte formation is not significantly different in preexisting intralesional osteophytes and control groups.

Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy

2016 ◽  
Vol 25 (3) ◽  
pp. 779-784 ◽  
Author(s):  
Ken Kumagai ◽  
Yasushi Akamatsu ◽  
Hideo Kobayashi ◽  
Yoshihiro Kusayama ◽  
Tomihisa Koshino ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Factors Affecting ◽  
Wedge High Tibial Osteotomy
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