scholarly journals Implantation of a Novel Cryopreserved Viable Osteochondral Allograft for Articular Cartilage Repair in the Knee

2017 ◽  
Vol 31 (06) ◽  
pp. 528-535 ◽  
Author(s):  
C. Vangsness ◽  
Geoffrey Higgs ◽  
James Hoffman ◽  
Jack Farr ◽  
Philip Davidson ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Surgical Technique ◽  
Cartilage Repair ◽  
Case Series ◽  
Osteochondral Allograft ◽  
High Price ◽  
Articular Cartilage Repair ◽  
Cartilage Lesions ◽  
Marrow Stimulation ◽  
Articular Cartilage Lesions

AbstractRestoration and repair of articular cartilage injuries remain a challenge for orthopaedic surgeons. The standard first-line treatment of articular cartilage lesions is marrow stimulation; however, this procedure can often result in the generation of fibrous repair cartilage rather than the biomechanically superior hyaline cartilage. Marrow stimulation is also often limited to smaller lesions, less than 2 cm2. Larger lesions may require implantation of a fresh osteochondal allograft, though a short shelf life, size-matched donor requirements, potential challenges of bone healing, limited availability, and the relatively high price limit the wide use of this therapeutic approach. We present a straightforward, single-stage surgical technique of a novel reparative and restorative approach for articular cartilage repair with the implantation of a cryopreserved viable osteochondral allograft (CVOCA). The CVOCA contains full-thickness articular cartilage and a thin layer of subchondral bone, and maintains the intact native cartilage architecture with viable chondrocytes, growth factors, and extracellular matrix proteins to promote articular cartilage repair. We report the results of a retrospective case series of three patients who presented with articular cartilage lesions more than 2 cm2 and were treated with the CVOCA using the presented surgical technique. Patients were followed up to 2 years after implantation of the CVOCA and all three patients had satisfactory outcomes without adverse events. Controlled randomized studies are suggested for evaluation of CVOCA efficacy, safety, and long-term outcomes.

scholarly journals Returning to Work After Articular Cartilage Repair Intervention: A Systematic Review

2020 ◽  
Vol 8 (3) ◽  
pp. 232596712090552 ◽  
Author(s):  
Puwapong Nimkingratana ◽  
Mats Brittberg
Keyword(s):  
Systematic Review ◽  
Articular Cartilage ◽  
General Population ◽  
Return To Work ◽  
Cartilage Repair ◽  
Rate Of Return ◽  
Osteochondral Allograft ◽  
Articular Cartilage Repair ◽  
Surgical Interventions ◽  
Returning To Work

Background: The process of returning to work after cartilage treatment has not been studied in depth, even though a better understanding of potential outcomes could lead to significant benefits for the general population. Purpose: To determine which surgical interventions are most effective in helping patients return to work after cartilage repair and to identify factors that affect the ability to return to work. Study Design: Systematic review; Level of evidence, 4. Methods: This systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in analyzing reports on articular cartilage treatment and return to work published from January 1966 (when the first system of classifying articular cartilage injuries based on the mechanism of injuries and type of lesions was developed) to January 2019. General surgical information and available clinical scores were used to assess outcomes. Results: Only 5 studies describing 283 patients were found to be relevant to our objectives and were therefore included in the analysis. Autologous chondrocyte implantation (ACI) and osteochondral allografts were the only 2 procedures for which information was included regarding patient return to work rates. The mean (overall) return-to-work time after a cartilage repair operation was 4.80 ± 3.02 months. ACI was the most common procedure (3 studies; 227 patients). Return to work after ACI or ACI with high tibial osteotomy (HTO) occurred in almost 100% of cases, whereas the rate of return to work was 51.78% for patients who underwent osteochondral allograft ( P < .01); further, patients who had ACI or ACI+HTO returned to work sooner compared with patients who underwent osteochondral allograft. The Knee injury and Osteoarthritis Outcome Score (KOOS) and Single Assessment Numerical Evaluation (SANE) scores were significantly higher in patients who fully returned to work. No significant difference was found in rates of return to work after ACI related to sex, area of the lesion, or size of the defect. Conclusion: The vast majority of published results on articular cartilage repair do not include data on return to work. Although available data on articular cartilage repair in the general population reveal a high rate of return to work, including those patients treated with ACI, the data do not stratify patients by the type and demand of work. No randomized studies have examined return-to-work rates. Hence, authors should include these data in future studies. A refined definition of work intensity, rather than just return to work, may provide a clearer picture of the relative effectiveness of different surgical interventions. To that end, the authors propose a return to work prognostic score called the Prognostic Cartilage Repair Return to Work Score, or PROCART-RTW score.

Functional Outcome of Knee Articular Cartilage Repair in Adolescent Athletes

2005 ◽  
Vol 33 (8) ◽  
pp. 1147-1153 ◽  
Author(s):  
Kai Mithöfer ◽  
Tom Minas ◽  
Lars Peterson ◽  
Howard Yeon ◽  
Lyle J. Micheli
Keyword(s):  
Articular Cartilage ◽  
Functional Outcome ◽  
Cartilage Repair ◽  
Autologous Chondrocyte Transplantation ◽  
Full Thickness ◽  
Chondrocyte Transplantation ◽  
Adolescent Athletes ◽  
Cartilage Lesions ◽  
Articular Cartilage Lesions ◽  
Autologous Chondrocyte

Background Limited information exists about the treatment of full-thickness articular cartilage lesions of the knee in adolescent athletes. Purpose To evaluate the functional outcome and athletic activity after articular cartilage repair in the knees of adolescent athletes. Study Design Case series; Level of evidence, 4. Methods Twenty adolescent athletes with full-thickness articular cartilage lesions of the knee were treated with autologous chondrocyte transplantation. Functional outcome was evaluated by subjective patient outcome rating, knee activity scores, and level of athletic participation. Results At a mean of 47 months after autologous chondrocyte transplantation, 96% of adolescents reported good or excellent results with significant increases in postoperative Tegner activity scores and Lysholm scores. Ninety-six percent returned to high-impact sports and 60% to an athletic level equal or higher than that before knee injury. Return to preinjury sports correlated with shorter preoperative symptoms and a lower number of prior operations. All adolescents with preoperative symptoms ≤12 months returned to preinjury-level athletics, compared to 33% with preoperative intervals longer than 12 months. Conclusion Treatment of full-thickness articular injuries of the knee in adolescent athletes with autologous chondrocyte transplantation yields a high rate of functional success at a mean follow-up of 47 months. The rate of return to demanding athletic activities is higher in cases in which the preoperative duration of symptoms is 12 months or less.

Guided bone marrow stimulation for articular cartilage repair through a freeze-dried chitosan microparticle approach

Materialia ◽  
2020 ◽  
Vol 9 ◽  
pp. 100609
Author(s):  
Caroline D. Hoemann ◽  
Jessica Guzmán-Morales ◽  
Geneviève Picard ◽  
Gaoping Chen ◽  
Daniel Veilleux ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Articular Cartilage ◽  
Cartilage Repair ◽  
Bone Marrow Stimulation ◽  
Articular Cartilage Repair ◽  
Marrow Stimulation ◽  
Freeze Dried

scholarly journals Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876187 ◽  
Author(s):  
Joseph D. Lamplot ◽  
Kevin A. Schafer ◽  
Matthew J. Matava
Keyword(s):  
Systematic Review ◽  
Articular Cartilage ◽  
Subchondral Bone ◽  
Femoral Condyle ◽  
Osteochondral Allograft ◽  
Inclusion Criteria ◽  
Reconstructive Procedures ◽  
Cartilage Lesions ◽  
Cartilage Restoration ◽  
Articular Cartilage Lesions

Background: Symptomatic articular cartilage lesions of the knee are common and are being treated surgically with increasing frequency. While many studies have reported outcomes following a variety of cartilage restoration procedures, few have investigated outcomes of revision surgery after a failed attempt at cartilage repair or reconstruction. Purpose: To investigate outcomes of revision cartilage restoration procedures for symptomatic articular cartilage lesions of the knee following a previously failed cartilage reconstructive procedure. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed by use of the PubMed, EMBASE, and MEDLINE/Ovid databases for relevant articles published between 1975 and 2017 that evaluated patients undergoing revision cartilage restoration procedure(s) and reported outcomes using validated outcome measures. For studies meeting inclusion criteria, relevant information was extracted. Results: Ten studies met the inclusion criteria. Lesions most commonly occurred in the medial femoral condyle (MFC) (52.8%), with marrow stimulation techniques (MST) the index procedure most frequently performed (70.7%). Three studies demonstrated inferior outcomes of autologous chondrocyte implantation (ACI) following a previous failed cartilage procedure compared with primary ACI. One study comparing osteochondral allograft (OCA) transplant following failed microfracture (MFX) with primary OCA transplant demonstrated similar clinical outcomes and graft survival at midterm follow-up. No studies reported outcomes following osteochondral autograft transfer (OAT) or newer techniques. Conclusion: This systematic review of the literature reporting outcomes following revision articular cartilage restoration procedures (most commonly involving the MFC) demonstrated a high proportion of patients who underwent prior MST. Evidence is sufficient to suggest that caution should be taken in performing ACI in the setting of prior MST, likely secondary to subchondral bone compromise. OCA appears to be a good revision treatment option even if the subchondral bone has been violated from prior surgery or fracture.

A Comparison of Outcomes of Particulated Juvenile Articular Cartilage and Bone Marrow Aspirate Concentrate for Articular Cartilage Lesions of the Talus

2016 ◽  
Vol 10 (4) ◽  
pp. 315-321 ◽  
Author(s):  
Nathan S. Lanham ◽  
John J. Carroll ◽  
Minton T. Cooper ◽  
Venkat Perumal ◽  
Joseph S. Park
Keyword(s):  
Bone Marrow ◽  
Articular Cartilage ◽  
Bone Marrow Aspirate ◽  
Short Form ◽  
Case Series ◽  
Foot And Ankle ◽  
Cartilage Lesions ◽  
Bone Marrow Aspirate Concentrate ◽  
The Mean ◽  
Articular Cartilage Lesions

Background. Articular cartilage lesions of the talus remain a challenging clinical problem because of the lack of natural regeneration and limited treatment options. Microfracture is often the first-line therapy, however lesions larger than 1.5 cm2 have been shown to not do as well with this treatment method. Methods. The objective of this retrospective study was to evaluate the outcomes of iliac crest bone marrow aspirate concentrate/collagen scaffold (ICBMA) and particulated juvenile articular cartilage (PJAC) for larger articular cartilage lesions of the talus. Fifteen patients undergoing ICBMA or PJAC for articular cartilage lesions of the talus from 2010 to 2013 were reviewed. Twelve patients, 6 from each treatment option, were included in the study. American Orthopaedic Foot and Ankle Surgeons (AOFAS), Foot and Ankle Ability Measure (FAAM), and Short Form–12 (SF-12) outcome scores were collected for each patient. Results. The mean age was 34.7 ± 14.8 years for ICBMA and 31.5 ± 7.4 years for PJAC. Lesion size was 2.0 ± 1.1 cm2 for ICBMA and 1.9 ± 0.9 cm2 for PJAC. At a mean follow-up of 25.7 months (range, 12-42 months), the mean AOFAS score was 71.33 for ICBMA and 95.83 for PJAC (  P = .019). The FAAM activities of daily living subscale mean was 77.77 for ICBMA and 97.02 for PJAC (   P = .027). The mean FAAM sports subscale was 45.14 for ICBMA and 86.31 for PJAC (  P = .054). The SF-12 physical health mean was 47.58 for ICBMA and 53.98 for PJAC (  P = .315). The SF-12 mental health mean was 53.25 for ICBMA and 57.8 for PJAC (  P = .315). One patient in treated initially with ICBMA underwent revision fixation for nonunion of their medial malleolar osteotomy, which ultimately resulted in removal of hardware and tibiotalar arthrodesis at 2 years from the index procedure. Conclusion. In the present analysis, PJAC yields better clinical outcomes at 2 years when compared with ICBMA for articular cartilage lesions of the talus that were on average greater than 1.5cm2. Levels of Evidence: Therapeutic, Level IV: Retrospective, Case series

Large fresh osteochondral allografts for the hip: growing the evidence

2017 ◽  
Vol 28 (3) ◽  
pp. 284-290 ◽  
Author(s):  
Lasun O Oladeji ◽  
James L Cook ◽  
James P Stannard ◽  
Brett D Crist
Keyword(s):  
Articular Cartilage ◽  
Femoral Head ◽  
Functional Outcomes ◽  
Survival Rates ◽  
Osteochondral Allograft ◽  
Cartilage Lesions ◽  
Concomitant Procedure ◽  
Institutional Review ◽  
Articular Cartilage Lesions

Introduction: Articular cartilage lesions of the hip are difficult to effectively treat. Osteochondral allograft (OCA) transplantation in the knee has been associated with long-term success, but OCA for the hip has not been extensively studied. Here, we present the clinical and radiological outcomes from a cohort of 10 patients treated with fresh OCA transplants for large osteochondral defects of the femoral head and/or acetabulum. Methods: 10 patients who had undergone osteochondral allograft transplantation of the femoral head and/or acetabulum at our institution between 2013 and 2016 were identified from our Institutional Review Board-approved registry. Hip disability and Osteoarthritis Outcome Score (HOOS) was used to track patient progress. Results: 10 patients with an average clinical follow-up of 1.4 years were included in this study. 4 patients were treated solely with OCA plugs for femoral head defects, while the remaining 6 received femoral OCA plugs and at least 1 concomitant procedure for additional intraarticular pathology. 7 patients (70%) had successful functional outcomes, while 3 (30%) had unsuccessful outcomes and were subsequently converted to total hip arthroplasty (THA) 5 to 29 months after OCA. Conclusions: OCA transplantation can be an effective treatment strategy for young, healthy individuals with articular cartilage lesions of the hip. Smoking, avascular necrosis aetiology, acetabular involvement and concomitant procedures may be risk factors for unsuccessful outcomes necessitating salvage with THA. Long-term clinical studies to refine indications and determine functional outcomes and survival rates are warranted.

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