All-Arthroscopic Autologous Matrix-Induced Chondrogenesis-Aided Repair of a Patellar Cartilage Defect Using Dry Arthroscopy and a Retraction System

2017 ◽  
Vol 30 (09) ◽  
pp. 925-929 ◽  
Author(s):  
Mariusz Puszkarz ◽  
Lidia Kosmalska ◽  
Martin Wiewiorski ◽  
Boguslaw Sadlik
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Case Series ◽  
Collagen Matrix ◽  
International Knee Documentation Committee ◽  
Level Of Evidence ◽  
Patellar Cartilage ◽  
Radiological Data ◽  
Implantation Techniques

AbstractThe technique of all-arthroscopic autologous matrix-induced chondrogenesis (AMIC)-aided repair of patellar cartilage lesions using a retraction system and dry arthroscopy has been recently described. We report the first clinical and radiological data at a short-term follow-up. Twelve patients underwent AMIC-aided cartilage repair for a patellar lesion. All steps of the procedure were performed arthroscopically, which include the use of an intra-articularly placed retraction plate for distraction of the patellofemoral joint and evacuation of saline solution for collagen matrix insertion and fixation. Clinical assessment performed before surgery and at a mean follow-up time of 38 months (range: 24–70) included the following scores: Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and visual analog scale (VAS). Magnetic resonance imaging was performed at the follow-up examination, including the magnetic resonance observation of cartilage repair tissue (MOCART) score. The mean KOOS and IKDC scores increased significantly (p < 0.01) from 50.3 and 37.4 points preoperatively to 90.1 and 79.4 postoperatively. The VAS score decreased from 7.8 to 2.3 points. Mean MOCART score at follow-up was 58.3 points. Cartilage repair of patellar lesions aided by a retraction system in a dry arthroscopy setup is a promising approach. Further studies are needed to evaluate this procedure and compare it to existing matrix implantation techniques. The level of evidence for the study is 4 (case series).

scholarly journals Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110074
Author(s):  
Jakob Ackermann ◽  
Fabio A. Casari ◽  
Christoph Germann ◽  
Lizzy Weigelt ◽  
Stephan H. Wirth ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Ankle Instability ◽  
Lesion Size ◽  
Lateral Ligament ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

Autologous Osteochondral Mosaicplasty for Centrally and Laterally Located, Advanced Capitellar Osteochondritis Dissecans in Teenage Athletes: Clinical Outcomes, Radiography, and Magnetic Resonance Imaging Findings

2018 ◽  
Vol 46 (8) ◽  
pp. 1943-1951 ◽  
Author(s):  
Tadanao Funakoshi ◽  
Daisuke Momma ◽  
Yuki Matsui ◽  
Tamotsu Kamishima ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Osteochondritis Dissecans ◽  
Case Series ◽  
Return To Play ◽  
Joint Surface ◽  
Resonance Imaging ◽  
Level Of Evidence

Background: Autologous osteochondral mosaicplasty (ie, mosaicplasty) results in satisfactory clinical outcomes and reliable return to play for patients with large or unstable lesions due to osteochondritis dissecans (OCD) of the humeral capitellum. However, the association between the healing of the reconstructed cartilage and clinical outcomes remains unclear. Purpose: To evaluate the efficacy of mosaicplasty in teenage athletes through use of clinical scores and imaging. The secondary purpose was to compare the clinical outcomes with images of centrally and laterally located lesions. Study Design: Case series; Level of evidence, 4. Methods: This study analyzed 22 elbows (all male patients; mean age, 13.5 ± 1.2 years) with capitellar OCD managed with mosaicplasty. Patients were divided into 2 groups according to the location of the lesions: central (10 patients) and lateral (12 patients). Evaluation was performed through use of the clinical rating system of Timmerman and Andrews, plain radiographs, and magnetic resonance imaging (MRI; the cartilage repair monitoring system of Roberts). The mean follow-up period was 27.5 months (range, 24-48 months). Results: Lateral lesions were significantly larger than central lesions (147.1 ± 51.9 mm2 vs 95.5 ± 27.4 mm2, P = .01). No other significant differences were found between central and lateral lesions. Timmerman and Andrews scores for both central and lateral lesions improved significantly from 125.0 ± 30.1 points and 138.3 ± 34.5 points preoperatively to 193.5 ± 11.3 points and 186.7 ± 18.1 points, respectively, at final follow-up ( P < .0001, P < .0001). Radiography identified complete graft incorporation in all cases and the absence of severe osteoarthritic changes or displaced osteochondral fragments. In the lateral group, the radial head ratio at final follow-up (1.83 ± 0.23) was significantly larger than the preoperative findings (1.75 ± 0.14, P = .049). The quality of joint surface reconstruction was found to be acceptable for central and lateral lesions on MRI evaluation. Conclusion: Mosaicplasty resulted in satisfactory clinical outcomes and smooth cartilage surface integrity in teenage athletes with OCD on their return to competition-level sports activities irrespective of lesion location.

Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

2021 ◽  
pp. 036354652110591
Author(s):  
Joo-Hwan Kim ◽  
Dong Jin Ryu ◽  
Sung-Sahn Lee ◽  
Seung Pil Jang ◽  
Jae Sung Park ◽  
...  
Keyword(s):  
Case Series ◽  
Preoperative Assessment ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Valgus Instability

Background: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon’s preference. However, it is still unclear whether transection of sMCL increases valgus laxity. Purpose: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. Study Design: Case series; Level of evidence, 4. Methods: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. Results: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, –3.5°± 2.0°; 6 months, –3.2°± 2.3°; 1 year, –3.1°± 2.3°; 2 years, –2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, –0.1°± 2.1°; 3 months, –0.2°± 2.4°; 6 months, –0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). Conclusion: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.

Osteochondral Transplantation in the Elbow Leads to Good Clinical and Radiologic Long-term Results

2011 ◽  
Vol 39 (12) ◽  
pp. 2619-2625 ◽  
Author(s):  
Stephan Vogt ◽  
Sebastian Siebenlist ◽  
Daniel Hensler ◽  
Lizzy Weigelt ◽  
Patrick Ansah ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Weight Lifting ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
Level Of Evidence

Background: In the long-term follow-up after debridement, microfracture, or drilling of osteochondral lesions in the elbow, subsequent osteoarthritis is a problem. Osteochondral transplantation for these defects has become a more common procedure. However, long-term results are unknown. Purpose: This study was undertaken to evaluate long-term clinical and radiologic outcomes of advanced osteochondral lesions in the elbow treated with osteochondral transplantation. Study Design: Case series; Level of evidence, 4. Methods: The study included 8 patients with osteochondral lesions in the elbow who were treated by autologous osteochondral transplantation between 1996 and 2002. Patients (average age, 17 years) were evaluated pre- and postoperatively by Broberg-Morrey score to assess elbow function and by American Shoulder and Elbow Surgeons (ASES) score for pain analysis. In addition, radiographs (at the first postoperative day, and at 5-year and 10-year follow-up) and magnetic resonance images (8 to 12 weeks postoperatively, and at 5-year and 10-year follow-up) were made to evaluate the joint status. At last follow-up (range, 8-14 years postoperatively), 7 of 8 patients were seen for clinical examination and radiologic analysis. Results: The Broberg-Morrey score increased from an average of 75.9 ± 13.1 to 96.4 ± 2.4 and ASES score significantly improved as follows: worst pain, 7.9 ± 1.1 to 1.6 ± 1.9; rest pain, 3.14 ± 2.7 to 0.6 ± 1.5; weight-lifting pain, 7.6 ± 0.8 to 3.1 ± 1.6; and repetitive movement pain, 5.3 ± 2.4 to 1.6 ± 1.5. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.5° ± 11.6°. At the final follow-up, flexion was free. The mean extension lag was reduced from average 5.4° ± 5.7° to 0°. Radiographs of 2 patients made at final follow-up showed mild signs of osteoarthritis (Kellgren and Lawrence grade I). Postoperative magnetic resonance images showed graft viability in all and a congruent chondral surface in 6 of 7 patients. Conclusion: Clinical long-term results after osteochondral transplantation in the elbow are good to excellent and comparable with midterm results in the literature. Therefore, this technique is a reliable option for satisfactory long-term results regarding treatment of advanced osteochondral lesions in the elbow.

Resection-Induced Leveling of Elevated Plug Cartilage in Osteochondral Autologous Transplantation of the Knee Achieves Acceptable Clinical Results

2017 ◽  
Vol 46 (3) ◽  
pp. 617-622 ◽  
Author(s):  
Kohei Nishitani ◽  
Yasuaki Nakagawa ◽  
Shinichiro Nakamura ◽  
Shogo Mukai ◽  
Shinichi Kuriyama ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Japanese Orthopaedic Association ◽  
Autologous Transplantation ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Second Look ◽  
Osteochondral Autologous Transplantation

Background: Plug protuberance occasionally occurs in osteochondral autologous transplantation (OAT). The incongruity of plugs results in poor clinical outcomes, especially in cases of protuberance. However, a surgical procedure to deal with this problem has not been reported. Purpose/Hypothesis: The purpose was to evaluate the efficacy and safety of cartilage resection of elevated plugs, with the hypothesis that patients whose elevated plugs were resected and leveled would achieve clinical outcomes equivalent to those of patients with flush plugs. Study Design: Cohort study; Level of evidence, 3. Methods: Cases (group P) included 22 patients who underwent OAT of the knee and whose plugs showed protuberance greater than 1 mm that was resected with a scalpel to obtain smooth congruity, while controls (group C) included 22 background-matched patients who did not require plug resection. The International Knee Documentation Committee (IKDC) subjective score, IKDC objective grade, and Japanese Orthopaedic Association score for knee osteoarthritis (JOA knee score) were used preoperatively and at the final follow-up (mean ± SD, 49.3 ± 18.1 months). International Cartilage Repair Society (ICRS) Cartilage Repair Assessment was used to evaluate lesion healing during the second-look arthroscopy. Results: IKDC subjective scores of group C (82.5 ± 11.8) and group P (82.1± 15.1) showed no difference at the final follow-up. On postoperative IKDC objective grading, 86% of group C and 82% of group P patients were graded as “nearly normal” or better ( P = .639). The mean JOA knee scores of group C (90.9 ± 8.9) and group P (90.1 ± 9.5) did not differ significantly ( P = .647). Nine second-look arthroscopies were performed in group C versus 8 in group P, and all patients had plugs that were graded as “nearly normal” or better by the ICRS Cartilage Repair Assessment. Larger plugs tended to be used in those patients who required resection. Conclusion: Resection of the elevated plug surface did not negatively affect patient outcomes in the midterm follow-up period.

scholarly journals Patient-Reported Outcomes After a Modified Albee Procedure

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110281
Author(s):  
Patrick J. Bevan ◽  
Lutul D. Farrow ◽  
Jared Warren ◽  
Perry O. Hooper ◽  
Elisabeth Kroneberger ◽  
...  
Keyword(s):  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
Lateral Wall ◽  
International Knee Documentation Committee ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Level Of Evidence ◽  
Patient Reported

Background: Trochlear dysplasia (TD) is a recognized condition that can become a risk factor for patellofemoral instability. A modified Albee osteotomy procedure using a trapezoidal-shaped wedge to elevate the lateral wall of the trochlea can be used with the goal of preventing further dislocation. However, outcomes studies are lacking, and scores on patient-reported outcome measures (PROMs) are largely unknown. Purpose/Hypothesis: The purpose of this study was to identify PROM scores for the Kujala Anterior Knee Pain Scale (AKPS), International Knee Documentation Committee (IKDC), Activity Rating System (ARS), and 100-point pain visual analog scale (VAS) for patients having undergone the modified Albee osteotomy. The hypothesis was that patients will have acceptable pain and function at mid- to long-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: From 1999 to 2017, a total of 46 consecutive patients (49 knees) underwent a modified Albee procedure by a single surgeon at a single health care system. These 46 patients were contacted and asked to complete the AKPS, IKDC, ARS, and pain VAS. Additional demographic information was obtained via chart review. Frequencies and rates for categorical variables and means and standard deviations for continuous variables of the demographics and PROM scores were calculated. Results: PROM scores were obtained in 28 (30 knees; 61%) of the 46 patients. At minimum follow-up of 82 months, the mean scores were 78.5 ± 18.2 for AKPS, 61.2 ± 11.4 for IKDC, 5.2 ± 5.3 for ARS, and 24.4 ± 28.7 for VAS pain. Notably, only 1 of the 28 patients reported a patellofemoral dislocation since surgery, and this was an isolated incident without further instability. Conclusion: A modified Albee trochlear osteotomy can be a successful adjunctive procedure to prevent recurrent patellar dislocations in patients with mild TD. However, owing to the loss of one-third of patient follow-up scores and the absence of baseline function scores in this study, the procedure deserves further investigation as a way to address a particularly difficult dilemma for a select subset of patients with patellofemoral instability.

scholarly journals Acellular Cartilage Repair Technique Based on Ultrapurified Alginate Gel Implantation for Advanced Capitellar Osteochondritis Dissecans

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198967
Author(s):  
Daisuke Momma ◽  
Tomohiro Onodera ◽  
Daisuke Kawamura ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Osteochondritis Dissecans ◽  
Case Series ◽  
Cartilage Regeneration ◽  
Level Of Evidence ◽  
Bone Marrow Stimulation ◽  
Repair Capacity ◽  
Invasive Approach ◽  
Repair Technique

Background: One of the most important limitations of osteochondral autograft transplant is the adverse effect on donor sites in the knee. Ultrapurified alginate (UPAL) gel is a novel biomaterial that enhances hyaline-like cartilage repair for articular defects. To avoid the need for knee cartilage autografting when treating osteochondritis dissecans (OCD) of the capitellum, we developed a surgical procedure involving a bone marrow stimulation technique (BMST) augmented by implantation of UPAL gel. Hypothesis: BMST augmented by UPAL gel implantation improves the cartilage repair capacity and provides satisfactory clinical outcomes in OCD of the capitellum. Study Design: Case series; Level of evidence, 4. Methods: A total of 5 athletes with advanced capitellar OCD in the dominant elbow underwent BMST augmented by implantation of UPAL gel. The osteochondral defects were filled with UPAL gel after BMST. At a mean follow-up of 97 weeks, all patients were evaluated clinically and radiographically. Results: At final follow-up, all 5 patients had returned to competitive-level sports, and 4 patients were free from elbow pain. The mean Timmerman-Andrews score significantly improved from 100 to 194 points. Radiographically, all patients exhibited graft incorporation and a normal contour of the subchondral cortex. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared, and the signal intensity had returned to normal. Arthroscopic examinations consistently exhibited improvement in the International Cartilage Regeneration and Joint Preservation Society (ICRS) grade of lesions from 3 or 4 to 1 or 2 in 4 patients at 85 weeks postoperatively. Histologic analysis of biopsy specimens revealed an average total ICRS Visual Assessment Scale II histologic score of 1060. Conclusion: The acellular cartilage repair technique using UPAL gel for advanced capitellar OCD provided satisfactory clinical and radiographic results. The present results suggest that this novel technique is a useful, minimally invasive approach for treating cartilaginous lesions in athletes.

scholarly journals Short- to Midterm Clinical and Radiological Outcomes After Matrix-Associated Autologous Chondrocyte Implantation for Chondral Defects in Knees

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098213
Author(s):  
Xuesong Dai ◽  
Jinghua Fang ◽  
Siheng Wang ◽  
Jianyang Luo ◽  
Yan Xiong ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
T2 Mapping ◽  
Case Series ◽  
International Knee Documentation Committee ◽  
Cartilage Defects ◽  
Level Of Evidence ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Matrix-associated autologous chondrocyte implantation (MACI) has been proven to provide favorable short-term results for chondral defects in knees. However, it remains unclear whether the clinical benefits of MACI persist in the longer term. Purpose: The purpose of this prospective study was to evaluate the clinical and radiological outcomes, at short- and midterm follow-up, for patients undergoing MACI for focal chondral defects of the knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 30 consecutive patients (31 knees) were treated using MACI between October 2010 and March 2018. There were 24 male patients and 6 female patients with an average age of 26 years (range, 12-48 years). The areas of the cartilage defect were consistently >2 cm2. All patients underwent MACI for a focal chondral defect of the femoral condyles or trochlea in the knee. These patients had been evaluated for up to 5 years, with an average follow-up of 44 months (range, 6-60 months) postoperatively. The International Knee Documentation Committee (IKDC) score, Lysholm score, and magnetic resonance imaging (MRI) with T2 mapping were used to assess the outcomes. Results: No patients were lost to follow-up. Mean IKDC scores improved from 58.6 (range, 40.2-80.5) to 79.1 (range, 39.1-94.3) at 12 months and up to 88.4 (range, 83.9-100) at 5 years; mean Lysholm scores improved from 67.3 (range, 46-95) to 90.6 (range, 71-100) at 12 months and up to 95.9 (range, 85-100) at 5 years. The MRI with T2 mapping value of the transplanted area was evaluated for 21 knees, which revealed no differences compared with the normal area at 12 months postoperatively. Conclusion: From the first year onward, the clinical outcome scores and MRI with T2 mapping values showed continuous and marked improvement, suggesting that MACI is a valid option for localized cartilage defects in the knee.

scholarly journals MENISCAL REPAIR RESULTS COMPARING MRI, ARTHRO-MRI, AND ARTHRO-CT

2018 ◽  
Vol 26 (3) ◽  
pp. 166-169
Author(s):  
ADRIANO MARQUES DE ALMEIDA ◽  
MARCELO BORDALO RODRIGUES ◽  
MARCIA UCHÔA DE REZENDE ◽  
ANDRÉ PEDRINELLI ◽  
ARNALDO JOSÉ HERNANDEZ
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Case Series ◽  
Meniscal Repair ◽  
Resonance Imaging ◽  
Level Of Evidence ◽  
Meniscal Suture ◽  
Imaging Results ◽  
Magnetic Resonance Imaging Mri

ABSTRACT Objective To clinically and radiologically evaluate patients who received meniscal suture using the outside-in technique, comparing magnetic resonance imaging (MRI), arthro-magnetic resonance imaging (arthro-MRI), and arthro-computed tomography (arthro-CT) to evaluate the healing of meniscal sutures. Methods We evaluated eight patients with an average follow-up of 15 months. The evaluation analyzed clinical parameters using the Lysholm and IKDC scores as well as MRI, arthro-MRI, and arthro-CT imaging. Results At the end of the follow-up period, mean Lysholm score was 89.5 and mean IKDC score was 78.6. In the MRI, signs of meniscal healing were observed in 50% of the cases. The arthro-MRI and arthro-CT showed signs of healing in 75% of cases. There was a positive correlation between arthro-MRI and arthro-CT results in all the cases studied (kappa correlation index=1). Conclusion Meniscal suture using the outside-in technique presented good or excellent results in 87.5% of our patients. The arthro-CT and arthro-MRI showed the same level of accuracy in detecting healing of the sutured region of the meniscus. Level of Evidence IV; Case series.

scholarly journals High-Grade Patellar Chondral Defects: Promising Results From Management With Osteochondral Autografts

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093313
Author(s):  
David Figueroa ◽  
Rafael Calvo Rodriguez ◽  
Rodrigo Donoso ◽  
Jaime Espinoza ◽  
Alex Vaisman ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Young Patients ◽  
Case Series ◽  
High Grade ◽  
Chondral Defects ◽  
Imaging Results

Background: Patellar chondral defects represent up to 34.6% of defects found during routine arthroscopy. Surgical management has evolved during the past 20 years in an effort to develop techniques to replace hyaline cartilage. Currently, the only technique that achieves this is osteochondral autologous transfer (OAT). Although good and excellent results have often been reported at midterm and long-term follow-up for femoral lesions, little is known about isolated patellar defects. Purpose: To assess clinical and imaging results of patients treated with OAT for high-grade patellar defects. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study on all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at our institution. The study included patients younger than 40 years of age with anterior knee pain and a grade 4 International Cartilage Repair Society patellar chondral defect between 1 and 2.5 cm2. Patients with surgery in other knee compartments, concomitant anterior cruciate ligament ruptures, infection, rheumatoid arthritis, and degenerative lesions were excluded. Six months postoperatively, all patients underwent magnetic resonance imaging (MRI) to allow assessment of graft integrity via the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to evaluate morphologic features and integration. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kujala scores were used to assess functional outcomes at final follow-up. Results: A total of 26 patients who received a patellar OAT were included. Most patients were male (88.4%), and the mean ± SD age was 28.5 ± 9.7 years. Patellar chondral defects had a median size of 180 mm2 (range, 64-250 mm2), and patients received a median of 1 autograft (range, 1-3). Functional outcomes assessed at a minimum of 1 year after surgery showed a mean Kujala score of 90.42 ± 6.7 and a mean WOMAC score of 95 ± 3.6. MRI revealed a median MOCART score of 75 points (range, 20-90 points). Conclusion: To our knowledge, this is the largest series to date regarding isolated patellar OAT. At midterm follow-up, most patients reported good and excellent results regarding symptoms and activity levels. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients.

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