scholarly journals The Large Focal Isolated Chondral Lesion

2021 ◽  
Author(s):  
Jorge Chahla ◽  
Brady T. Williams ◽  
Adam B. Yanke ◽  
Jack Farr
Keyword(s):  
Surgical Procedures ◽  
Young Patients ◽  
Osteochondral Allograft ◽  
Surgical Approaches ◽  
Arthroscopic Debridement ◽  
Comprehensive Understanding ◽  
First Line ◽  
Algorithmic Approach ◽  
Chondral Lesions ◽  
Chondral Defects

AbstractFocal chondral defects (FCDs) of the knee can be a debilitating condition that can clinically translate into pain and dysfunction in young patients with high activity demands. Both the understanding of the etiology of FCDs and the surgical management of these chondral defects has exponentially grown in recent years. This is reflected by the number of surgical procedures performed for FCDs, which is now approximately 200,000 annually. This fact is also apparent in the wide variety of available surgical approaches to FCDs. Although simple arthroscopic debridement or microfracture are usually the first line of treatment for smaller lesions, chondral lesions that involve a larger area or depth require restorative procedures such as osteochondral allograft transplantation or other cell-based techniques. Given the prevalence of FCDs and the increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This narrative review aims to describe current concepts in the treatment of large FCDs through providing an algorithmic approach to selecting interventions to address these lesions as well as the reported outcomes in the literature.

scholarly journals Arthroscopic bullet removal from the hip joint and concurrent treatment of associated full-thickness chondral defects: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1982967
Author(s):  
Fernando P Ferro ◽  
Felipe S Bessa ◽  
Leandro Ejnisman ◽  
Henrique MC Gurgel ◽  
Alberto T Croci ◽  
...  
Keyword(s):  
Hip Joint ◽  
Weight Bearing ◽  
Osteochondral Allograft ◽  
Concurrent Treatment ◽  
Chondral Lesions ◽  
Chondral Defects ◽  
Arthroscopic Removal ◽  
Fresh Osteochondral Allograft ◽  
Chondrocyte Implantation

The diagnosis of a bullet inside the hip joint is a rare finding. The usual method to treat this condition has been open surgery, with its associated complications and morbidity. The arthroscopic approach has been increasingly utilized for the diagnosis and treatment of several hip conditions, and the number of indications for this technique has been steadily rising. We report the case of a 35-year-old man who suffered a gunshot wound and was operated on for abdominal perforation. He later presented with groin pain that worsened with weight-bearing on his right leg and then underwent arthroscopic removal of a bullet located inside his right hip joint. After a 2-year follow-up, the patient had an excellent clinical outcome, with no radiologic signs of arthritis. The removal of an intra-articular projectile is necessary to avoid complications such as synovitis, osteoarthritis, septic arthritis, and saturnism. The best access to the hip joint remains a topic of debate. Arthroscopy has the advantage of less soft-tissue damage and quicker recovery. The treatment of associated chondral lesions can be done with several techniques, including microfracture, autologous chondrocyte implantation, mosaicplasty, and fresh osteochondral allograft transplantation. There is no consensus as to the best course of treatment for associated chondral lesions in such cases. Hip arthroscopy can be a safe and effective technique for the removal of intra-articular bullets in the hip.

Use of Fresh Osteochondral Allografts in the Patellofemoral Joint

2017 ◽  
Vol 31 (03) ◽  
pp. 227-230 ◽  
Author(s):  
Victor Kremser ◽  
Burak Altintas ◽  
Christian Lattermann
Keyword(s):  
State Of The Art ◽  
Long Term Results ◽  
Osteochondral Allograft ◽  
Surgical Approaches ◽  
High Survival ◽  
Survival Times ◽  
Chondral Defects ◽  
Current State ◽  
Fresh Osteochondral Allograft

AbstractFresh osteochondral allograft (OCA) transplantation has become a mainstay for the treatment of osteochondral defects in the tibiofemoral joint. With excellent outcomes and high survival times, this technology has recently become more interesting for use in the patellofemoral (PF) joint. This review article will point out the historical difficulties that the use of fresh OCA poses. With newer surgical approaches and a better understanding of the mechanical requirements of the PF joint, the use of OCA transplantation has shown increasingly better results. Illustrating the technique for the preparation and implantation of single plug allografts and bulk allografts to the trochlea and patella as well as the analysis of the available literature, we point out the current state of the art as well as potentially achievable long-term results. Finally, we will point out emerging technology seeking to further develop the use of allograft technology in patellofemoral chondral defects.

Osteochondral Allograft Transplantation of the Knee: Analysis of Failures at 5 Years

2017 ◽  
Vol 45 (4) ◽  
pp. 864-874 ◽  
Author(s):  
Rachel M. Frank ◽  
Simon Lee ◽  
David Levy ◽  
Sarah Poland ◽  
Maggie Smith ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Short Form ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Reoperation Rate ◽  
Osteochondral Allograft ◽  
Arthroscopic Debridement ◽  
Level Of Evidence ◽  
Allograft Transplantation

Background: Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, and the need for reoperations is not uncommon. Purpose: To quantify survival for OAT and report findings at reoperations. Study Design: Case series; Level of evidence, 4. Methods: A review of prospectively collected data of 224 consecutive patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years was conducted. The reoperation rate, timing of reoperation, procedure performed, and findings at surgery were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at second-look arthroscopic surgery. Results: A total of 180 patients (mean [±SD] age, 32.7 ± 10.4 years; 52% male) who underwent OAT with a mean follow-up of 5.0 ± 2.7 years met the inclusion criteria (80% follow-up). Of these, 172 patients (96%) underwent a mean of 2.5 ± 1.7 prior surgical procedures on the ipsilateral knee before OAT. Forty-eight percent of OAT procedures were isolated, while 52% were performed with concomitant procedures including meniscus allograft transplantation (MAT) in 65 (36%). Sixty-six patients (37%) underwent a reoperation at a mean of 2.5 ± 2.5 years, with 32% (21/66) undergoing additional reoperations (range, 1-3). Arthroscopic debridement was performed in 91% of patients with initial reoperations, with 83% showing evidence of an intact graft; of these, 9 ultimately progressed to failure at a mean of 4.1 ± 1.9 years. A total of 24 patients (13%) were considered failures at a mean of 3.6 ± 2.6 years after the index OAT procedure because of revision OAT (n = 7), conversion to arthroplasty (n= 12), or appearance of a poorly incorporated allograft at arthroscopic surgery (n = 5). The number of previous surgical procedures was independently predictive of reoperations and failure; body mass index was independently predictive of failure. Excluding the failed patients, statistically and clinically significant improvements were found in the Lysholm score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Short Form–12 physical component summary at final follow-up ( P < .001 for all), with inferior outcomes (albeit overall improved) in patients who underwent a reoperation. Conclusion: In this series, there was a 37% reoperation rate and an 87% allograft survival rate at a mean of 5 years after OAT. The number of previous ipsilateral knee surgical procedures was predictive of reoperations and failure. Of the patients who underwent arthroscopic debridement with an intact graft at the time of arthroscopic surgery, 82% experienced significantly improved outcomes, while 18% ultimately progressed to failure. This information can be used to counsel patients on the implications of a reoperation after OAT.

Treatment of scarring alopecia from trauma and surgical procedures in young patients using follicular unit hair transplantation

2021 ◽  
Author(s):  
Takashi Nuri ◽  
Norihisa Abe ◽  
Aritaka Sakamoto ◽  
Akitoshi Tsushima ◽  
Yoshiaki Kasai ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Young Patients ◽  
Hair Transplantation ◽  
Scarring Alopecia ◽  
Follicular Unit

scholarly journals Sporting participation following the operative management of chondral defects of the knee at mid-term follow up: a systematic review and meta-analysis

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
P. G. Robinson ◽  
T. Williamson ◽  
I. R. Murray ◽  
K. Al-Hourani ◽  
T. O. White
Keyword(s):  
Systematic Review ◽  
Autologous Chondrocyte Implantation ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Osteochondral Allograft ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Abstract Purpose The purpose of this study was to perform a systematic review of the reparticipation in sport at mid-term follow up in athletes who underwent biologic treatment of chondral defects in the knee and compare the rates amongst different biologic procedures. Methods A search of PubMed/Medline and Embase was performed in May 2020 in keeping with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The criteria for inclusion were observational, published research articles studying the outcomes and rates of participation in sport following biologic treatments of the knee with a minimum mean/median follow up of 5 years. Interventions included microfracture, osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral allograft, or platelet rich plasma (PRP) and peripheral blood stem cells (PBSC). A random effects model of head-to-head evidence was used to determine rates of sporting participation following each intervention. Results There were twenty-nine studies which met the inclusion criteria with a total of 1276 patients (67% male, 33% female). The mean age was 32.8 years (13–69, SD 5.7) and the mean follow up was 89 months (SD 42.4). The number of studies reporting OAT was 8 (27.6%), ACI was 6 (20.7%), MACI was 7 (24.1%), microfracture was 5 (17.2%), osteochondral allograft was 4 (13.8%), and one study (3.4%) reported on PRP and PBSC. The overall return to any level of sport was 80%, with 58.6% returning to preinjury levels. PRP and PBSC (100%) and OAT (84.4%) had the highest rates of sporting participation, followed by allograft (83.9%) and ACI (80.7%). The lowest rates of participation were seen following MACI (74%) and microfracture (64.2%). Conclusions High rates of re-participation in sport are sustained for at least 5 years following biologic intervention for chondral injuries in the knee. Where possible, OAT should be considered as the treatment of choice when prolonged participation in sport is a priority for patients. However, MACI may achieve the highest probability of returning to the same pre-injury sporting level. Level of evidence IV

scholarly journals Methotrexate Toxicity: Molecular Mechanisms and Management

2021 ◽  
pp. 204-217
Author(s):  
Riyadh S. Almalki ◽  
Hala Eweis ◽  
Fatemah Kamal ◽  
Dina Kutbi
Keyword(s):  
Side Effects ◽  
Cancer Chemotherapy ◽  
Pulmonary Toxicity ◽  
Molecular Mechanisms ◽  
Hematological Toxicity ◽  
Comprehensive Understanding ◽  
First Line ◽  
Cutaneous Toxicity ◽  
Gi Toxicity ◽  
Line Drug

Methotrexate (MTX) is the most widely used drug in cancer chemotherapy and is considered to be the first-line drug for the treatment of a number of rheumatic and non-rheumatic disorders. The pulmonary toxicity, hepatotoxicity of MTX are two of its major side effects. Other toxicities such as endocrinological toxicity, GI toxicity, cutaneous toxicity, hematological toxicity, fatal malfunction or loss, and malignancy can also occur, but at a significantly lower rate of prevalence. This review aims to provide a comprehensive understanding of the molecular mechanisms of methotrexate toxic effects and Lastly, we discussed the management of this toxicity.

scholarly journals The effect of patient, fracture and surgery on outcomes of high energy neck of femur fractures in patients aged 15–50

2018 ◽  
Vol 29 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Wayne Hoskins ◽  
Johnny Rayner ◽  
Rohan Sheehy ◽  
Harry Claireaux ◽  
Roger Bingham ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Outcome Measures ◽  
Surgical Procedures ◽  
Young Patients ◽  
Significant Risk ◽  
High Energy ◽  
Femoral Neck Fractures ◽  
Secondary Outcome ◽  
Femur Fractures

Introduction: High-energy femoral neck fractures in young patients can be devastating, with the risk of osteonecrosis, nonunion, malunion and lifelong morbidity. The aim of this study is to define the effects of patient, fracture and surgical factors on the outcome of high-energy femoral neck fractures in patients aged from 15 to 50 years. Methods: A retrospective review was conducted of high-energy femoral neck fractures in patients aged 15–50 managed surgically at a Level 1 Trauma Centre, using a prospectively recorded trauma database. Low energy trauma (including falls from <1 m), medical conditions adversely affecting bone density, and pathological fractures were excluded. A clinical and radiological review was performed. The primary outcome measures were the development of osteonecrosis or nonunion leading to total hip arthroplasty (THA). Secondary outcome measures included osteotomy or other surgical procedures, quality of reduction and malunion. Results: 32 patients meeting the inclusion criteria were identified between January 2008 and July 2015. The mean follow-up was 58.5 months (range 980–3,048 days). 3 patients (9.4%) required THA. No other surgical procedures were performed. None of the 29 other patients developed radiologically apparent osteonecrosis. Fracture type, displacement, anatomical reduction and fixation type were not statistically significant risk factors affecting these outcomes. For all patients, an average of 8% loss of femoral neck height and 10% femoral neck offset were seen. Conclusions: At a mean 4.9-year follow-up, the incidence of high-energy femoral neck fractures leading to THA was 9.4%, as a consequence of osteonecrosis or nonunion. Malunion was common.

Leczenie zachowawcze torbieli korzeniowej – opis przypadku

2020 ◽  
Vol 25 (2) ◽  
Author(s):  
Sylwia Kuderewska ◽  
Elżbieta Łuczaj-Cepowicz ◽  
Grażyna Marczuk-Kolada
Keyword(s):  
Conservative Treatment ◽  
Surgical Procedures ◽  
Root Canal ◽  
Young Patients ◽  
Complete Healing ◽  
Radiographic Examination ◽  
Radicular Cyst ◽  
Tooth Crown ◽  
Periapical Lesion ◽  
Radiolucent Lesion

Radicular cyst is the most common odontogenic cyst. This condition can be asomptymatic, it may be accidentally detected on radiographs. Among the treatment methods we distinct conservative, surgical and conservative-surgical procedures. This article presents the case of a 15-year old male patient. He was reported to endodontic treatment of tooth 22 with extensive periapical lesion. Intraoral examination showed a change in the colour of the tooth crown, negative reaction to ethyl chloride, palpable slight excessive growth around the root of the tooth 22 and positive Smreker’s test. The radiographic examination showed the presence of a large 11 x 10 mm diameter radiolucent lesion covering 2/3 of the root lenght of tooth 22. Antiseptic root canal treatment was used. Complete healing of the periapical lesion was observed after 9-months treatment. Conservative treatment of root cysts, especially in young patients, may lead to complete healing of the lesion, which will allow to avoid the need for surgery intervention or at least reduce its extent.

Surgery for urological cancer

2020 ◽  
pp. 175-272
Author(s):  
Suzanne Biers ◽  
Noel Armenakas ◽  
Alastair Lamb ◽  
Stephen Mark ◽  
John Reynard ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Surgical Approaches ◽  
Urological Cancer ◽  
Urological Cancers ◽  
Patient Preparation

This chapter covers various surgical procedures for dealing with different urological cancers. For each method, it takes the reader through diagnosis, indications for the procedure, assessment and staging, patient preparation, and surgical approaches, then closure, and any other potential issues. Each topic is highly illustrated, to aid understanding for unfamiliar procedures.

Other surgical approaches in the management of osteoarthritis

2016 ◽  
Author(s):  
Jonas Bloch Thorlund ◽  
L. Stefan Lohmander
Keyword(s):  
Stem Cells ◽  
Surgical Treatment ◽  
Adverse Events ◽  
Surgical Procedures ◽  
Joint Replacement ◽  
Hip Arthroscopy ◽  
Surgical Techniques ◽  
Risk Of Bias ◽  
Surgical Approaches ◽  
Surgical Treatments

Joint replacement is often considered the surgical treatment for patients with osteoarthritis (OA). However, several other surgical treatments, of which some are more frequently performed, have been advocated for patients with OA in order to relieve symptoms, stall progression, and avoid or postpone joint replacement. This chapter briefly describes the most common procedures such as knee and hip arthroscopy and knee and hip osteotomy. It also reviews the evidence for the efficacy of these treatments compared with non-surgical alternatives, which is frequently insufficient due to lack of controlled low-risk-of-bias studies. The risk of adverse events is also reported when data is available. Some of the more recent surgical techniques such as implantation of chondrocytes or stem cells are also described and discussed but their utility for treating osteoarthritis remains uncertain. There is a great need for continued innovation and development of surgical techniques for managing in particular the earlier stages of osteoarthritis. To reduce the risk of future costly failures, a stepwise introduction of new surgical procedures and devices must be encouraged.

Sign in / Sign up

Export Citation Format

Share Document