“DONOR SITE MORBIDITY AFTER THE HARVEST OF MICROVASCULAR FLAPS FROM THE MEDIAL AND LATERAL FEMORAL CONDYLE REGION: OBJECTIVE, RADIOLOGIC AND PATIENT-REPORTED OUTCOME OF A MULTI-CENTER TRIAL”

Background: Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions. Purpose: To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee. Study Design: Case series; Level of evidence, 4. Methods: Data from a prospective OCA transplantation registry were assessed for athletes who underwent knee transplantation for the first time (primary transplant) between June 2015 and March 2018 for injury or overuse-related articular defects. Inclusion criteria were preinjury Tegner level ≥5 and documented type and level of sport (or elite unit active military duty); in addition, patients were required to have a minimum of 1-year follow-up outcomes, including RTS data. Patient characteristics, surgery type, Tegner level, RTS, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures were assessed and compared for statistically significant differences. Results: There were 37 included athletes (mean age, 34 years; range, 15-69 years; mean body mass index, 26.2 kg/m2; range, 18-35 kg/m2) who underwent large single-surface (n = 17), multisurface (n = 4), or bipolar (n = 16) OCA transplantation. The highest preinjury median Tegner level was 9 (mean, 7.9 ± 1.7; range, 5-10). At the final follow-up, 25 patients (68%) had returned to sport; 17 (68%) returned to the same or higher level of sport compared with the highest preinjury level. The median time to RTS was 16 months (range, 7-26 months). Elite unit military, competitive collegiate, and competitive high school athletes returned at a significantly higher proportion ( P < .046) than did recreational athletes. For all patients, the Tegner level at the final follow-up (median, 6; mean, 6.1 ± 2.7; range, 1-10) was significantly lower than that at the highest preinjury level ( P = .007). PROMs were significantly improved at the final follow-up compared with preoperative levels and reached or exceeded clinically meaningful differences. OCA revisions were performed in 2 patients (5%), and failures requiring total knee arthroplasty occurred in 2 patients (5%), all of whom were recreational athletes. Noncompliance was documented in 4 athletes (11%) and was 15.5 times more likely ( P = .049) to be associated with failure or a need for revision than for compliant patients. Conclusion: Large single-surface, multisurface, or bipolar shell OCA knee transplantations in athletes resulted in two-thirds of these patients returning to sport at 16 to 24 months after transplantation. Combined, the revision and failure rates were 10%; thus, 90% of patients were considered to have successful 2- to 4-year outcomes with significant improvements in pain and function, even when patients did not RTS.

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Donor-Site Morbidity and Functional Status following Medial Femoral Condyle Flap Harvest

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000004886 ◽

2018 ◽

Vol 142 (5) ◽

pp. 734e-741e ◽

Cited By ~ 17

Author(s):

Ghassan Mehio ◽

Mohamed Morsy ◽

Cenk Cayci ◽

M. Diya Sabbagh ◽

Alexander Y. Shin ◽

...

Keyword(s):

Functional Status ◽

Femoral Condyle ◽

Donor Site ◽

Donor Site Morbidity ◽

Medial Femoral Condyle

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Scaphoid Nonunion With Poor Prognostic Factors

Hand ◽

10.1177/1558944716661994 ◽

2016 ◽

Vol 12 (2) ◽

pp. 135-139 ◽

Cited By ~ 10

Author(s):

Tahseen Chaudhry ◽

Lauren Uppal ◽

Dominic Power ◽

Michael Craigen ◽

Simon Tan

Keyword(s):

Prognostic Factors ◽

Bone Graft ◽

Femoral Condyle ◽

Donor Site ◽

Donor Site Morbidity ◽

Vascularized Bone Graft ◽

Union Rate ◽

Poor Prognostic Factor ◽

Low Incidence ◽

Vascularized Bone

Background: To report on the results of free medial femoral condyle (MFC) vascularized bone graft for scaphoid nonunions with 1 or more poor prognostic factors. Methods: We have used the free MFC vascularized bone graft for scaphoid nonunions that have 1 or more factors associated with a poor prognosis. These were, a delay in presentation of over 5 years, a proximal pole nonunion, the presence of avascular necrosis (AVN), or previous nonunion surgery. We used this technique on 20 patients over a 4.5-year period. Results: Our overall union rate was 88.5% (17 of 19 patients), with 1 patient failing to attend for follow-up. Our mean union time was 7 months (2-18). All patients had at least 1 poor prognostic factor and over half had 2 or more. Of those with AVN with or without other factors, the union rate was 85% (11 of 13). There were 2 donor site complications that required a further procedure and 2 patients with residual wrist pain that required a scapho-trapezio-trapezoid joint fusion and a radial styloidectomy, respectively. Both nonunions were offered further surgery, and 1 elected to undergo successful revision surgery. Conclusions: Overall, this technique showed good results, in a subgroup of patients that typically have poorer outcomes, with a low incidence of donor site morbidity. Our union rate compares favorably with other techniques for this difficult subset of patients with 1 or more poor prognostic factors, although results are clearly not as good as those of studies using the MFC graft for all scaphoid nonunions. We continue to reserve this technique for nonunions with 1 or more poor prognostic factors, and we believe that this technique should at least be considered in these patients.

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Outcomes of Osteochondral Allograft Transplantation With and Without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546517744202 ◽

2018 ◽

Vol 46 (3) ◽

pp. 573-580 ◽

Cited By ~ 18

Author(s):

Rachel M. Frank ◽

Simon Lee ◽

Eric J. Cotter ◽

Charles P. Hannon ◽

Timothy Leroux ◽

...

Keyword(s):

Femoral Condyle ◽

Lateral Femoral Condyle ◽

Osteochondral Allograft ◽

Failure Rates ◽

Meniscus Allograft Transplantation ◽

Joint Preservation ◽

Allograft Transplantation ◽

Meniscus Allograft ◽

Patient Reported

Background: Osteochondral allograft transplantation (OCA) is often performed with concomitant meniscus allograft transplantation (MAT) as a strategy for knee joint preservation, although to date, the effect of concomitant MAT on outcomes and failure rates after OCA has not been assessed. Purpose: To determine clinical outcomes for patients undergoing OCA with MAT as compared with a matched cohort of patients undergoing isolated OCA. Study Design: Control study; Level of evidence, 3. Methods: Patients who underwent OCA of the medial or lateral femoral condyle without concomitant MAT by a single surgeon were compared with a matched group of patients who underwent OCA with concomitant MAT (ipsilateral compartment). The patients were matched per age, sex, body mass index, and number of previous ipsilateral knee operations ±1. Patient-reported outcomes, complications, reoperations, and survival rates were compared between groups. Results: One hundred patients undergoing OCA (50 isolated, 50 with MAT) with a mean ± SD follow-up of 4.9 ± 2.7 years (minimum, 2 years) were included (age, 31.7 ± 9.8 years; 52% male). Significantly more patients underwent OCA to the medial femoral condyle (n = 59) than the lateral femoral condyle (n = 41, P < .0001). Patients underwent 2.7 ± 1.7 operations on the ipsilateral knee before OCA. There were no significant differences between the groups regarding reoperation rate (n = 18 for OCA with MAT, n = 17 for OCA without MAT, P = .834), time to reoperation (2.2 ± 2.4 years for OCA with MAT, 3.4 ± 2.7 years for OCA without MAT, P = .149), or failure rates (n = 7 [14%] for OCA with MAT, n = 7 [14%] for OCA without MAT, P > .999). There were no significant differences in patient-reported clinical outcome scores between the groups at final follow-up. There was no significant difference in failure rates between patients undergoing medial femoral condyle OCA (n = 12, 15.3%) and lateral femoral condyle OCA (n = 5, 12.2%, P = .665). Conclusion: These results imply that with appropriate surgical indications to address meniscus deficiency in patients otherwise indicated for OCA and despite the added surgical time and complexity of concomitant MAT, outcomes are favorable, with an 86% OCA graft survivorship at 5 years. This information can be used to counsel patients undergoing OCA with concomitant MAT as part of a knee joint preservation strategy.

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Comparison of Weightbearing and Nonweightbearing Juvenile Osteochondritis Dissecans Lesions of the Lateral Femoral Condyle

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211026901 ◽

2021 ◽

Vol 9 (8) ◽

pp. 232596712110269

Author(s):

Liang Zhou ◽

Shawn M. Gee ◽

Philip L. Wilson ◽

Sharon Huang ◽

K. John Wagner ◽

...

Keyword(s):

Osteochondritis Dissecans ◽

Femoral Condyle ◽

International Knee Documentation Committee ◽

Lateral Femoral Condyle ◽

Consecutive Series ◽

Level Of Evidence ◽

Juvenile Osteochondritis Dissecans ◽

Patient Reported ◽

Mri Scans

Background: Repetitive microtrauma may contribute to osteochondritis dissecans (OCD) lesions of the femoral condyle. The effect of differential loading between OCD weightbearing (WB) zones has not been studied. Purpose: To determine whether clinical and radiographic variables differ by WB zone in lateral femoral condyle OCD lesions. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed a consecutive series of patients aged <18 years with lateral femoral condyle OCD lesions presenting at a single institution between 2004 and 2018. Patients with OCD lesions outside of the lateral femoral condyle were excluded. Lesions were localized on radiographs using the Cahill and Berg classification, referencing the Blumensaat line and an extension of the posterior femoral cortex. Progeny bone characteristics evaluated at baseline and 24-month follow-up included ossification, distinct borders from parent bone, and displacement. Baseline lesion dimensions were measured on magnetic resonance imaging (MRI) scans. We evaluated posttreatment pain level, return-to-activity rate, and patient-reported outcome measures (PROMs) including the Pediatric International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Pediatric Functional Activity Brief Scale. Results: A total of 62 lateral femoral condyle OCD lesions (mean follow-up, 24.1 months) presented within the study period: 26 WB lesions and 36 nonweightbearing (NWB) lesions. At presentation, no differences between the lesion types were observed in symptom chronicity or symptomatology. NWB lesions were deeper on MRI scans (sagittal depth, 7.11 vs 5.96 mm; P = .046; coronal depth ratio, 0.05 vs 0.01 mm; P = .003), were more likely to develop progeny bone (69.4% vs 44%; P = .047), and demonstrated higher radiographic healing rates (52.8% vs 24%; P = .025) compared with WB lesions. PROMs at follow-up were available for 25 of 62 patients (40.3%), with no statistically significant differences between cohorts at any time. Return to full activity was observed in 72% of WB and 82.1% of NWB lesions ( P = .378). Conclusion: Lateral femoral condyle OCD lesions of the knee in WB and NWB zones presented similarly at initial evaluation; however, NWB lesions demonstrated higher rates of progeny bone formation and radiographic healing at mean 2-year follow-up.

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Donor site morbidity of vascularized bone grafts from the medial femoral condyle for osseous revascularization

Microsurgery ◽

10.1002/micr.30468 ◽

2020 ◽

Vol 40 (2) ◽

pp. 104-109 ◽

Cited By ~ 1

Author(s):

Victoria Franziska Struckmann ◽

Giuseppe Rusignuolo ◽

Leila Harhaus ◽

Ursula Trinler ◽

Berthold Bickert ◽

...

Keyword(s):

Femoral Condyle ◽

Donor Site ◽

Bone Grafts ◽

Donor Site Morbidity ◽

Medial Femoral Condyle ◽

Vascularized Bone

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Case Report

Hand ◽

10.1177/1558944716658748 ◽

2016 ◽

Vol 11 (4) ◽

pp. NP38-NP40 ◽

Cited By ~ 1

Author(s):

Sanjay Naran ◽

Joseph E. Imbriglia

Keyword(s):

Case Report ◽

Donor Site ◽

Donor Site Morbidity ◽

No Donor ◽

Metacarpophalangeal Joints ◽

Active Function ◽

Patient Reported ◽

Long Term Follow Up

Background: A case is discussed in which a young girl was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits at the age of four. At 39 years of age, she presented incidentally to our clinic and was observed to have a very functional hand with mobile metacarpophalangeal joints in all reconstructed digits. Methods: We present a case report which is discussed in the context of long-term follow-up, and phalangeal growth in the absence of distraction, and a review of the current literature in regards to outcomes for this modality of treatment. Results: We document growth of the transplanted phalanges, despite surgery occurring after the reported optimum age of before 18 months, and the patient not undergoing distraction. The patient reported no donor site morbidity in regards to function or psychosocial impact. Furthermore, we observed active function at the metacarpophalangeal joints of all operated digits. Conclusions: We report the longest follow-up (35 years) following nonvascularized proximal toe phalangeal transfer for short finger type symbrachydactyly. We highlight the long-term functional outcome of nonvascularized toe phalangeal transfers, and present an overview of the current outcome literature for this type of procedure, advocating that nonvascularized toe phalangeal transfers remain a viable treatment option for select cases of symbrachydactyly.

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