scholarly journals Poor outcome after a surgically treated chondral injury on the medial femoral condyle: early evaluation with dGEMRIC and 17-year radiographic and clinical follow-up in 16 knees

2018 ◽  
Vol 89 (4) ◽  
pp. 431-436 ◽  
Author(s):  
Jon Tjörnstrand ◽  
Paul Neuman ◽  
Björn Lundin ◽  
Jonas Svensson ◽  
Leif E Dahlberg ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Early Evaluation ◽  
Poor Outcome ◽  
Chondral Injury

scholarly journals Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988426 ◽  
Author(s):  
John T. Stranix ◽  
Merisa L. Piper ◽  
Said C. Azoury ◽  
Geoffrey Kozak ◽  
Oded Ben-Amotz ◽  
...  
Keyword(s):  
Free Flap ◽  
Femoral Condyle ◽  
Donor Site ◽  
Case Series ◽  
Medial Femoral Condyle ◽  
Flap Reconstruction ◽  
Foot And Ankle ◽  
Osseous Union ◽  
Vascularized Bone

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.

scholarly journals Mosaic arthroplasty of the medial femoral condyle in horses — An experimental study

2014 ◽  
Vol 62 (2) ◽  
pp. 155-168 ◽  
Author(s):  
Gábor Bodó ◽  
Gábor Vásárhelyi ◽  
László Hangody ◽  
László Módis
Keyword(s):  
Hyaline Cartilage ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Medial Femoral Condyle ◽  
The Other ◽  
Bearing Surface ◽  
Femoral Trochlea ◽  
Osteochondral Grafts ◽  
Mosaic Arthroplasty

One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations.

scholarly journals Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Matteo Guzzini ◽  
Cosma Calderaro ◽  
Marco Guidi ◽  
Carolina Civitenga ◽  
Germano Ferri ◽  
...  
Keyword(s):  
Distal Femur ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Donor Site ◽  
Pedicled Flap ◽  
Medial Femoral Condyle ◽  
Full Weight Bearing ◽  
Genicular Artery ◽  
Reconstruction Of Bone Defects

Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too.Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure.Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion.

scholarly journals Fresh Osteochondral Allograft Transplantation for Spontaneous Osteonecrosis of the Knee: A Case Series

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773054 ◽  
Author(s):  
Luís E.P. Tírico ◽  
Samuel A. Early ◽  
Julie C. McCauley ◽  
William D. Bugbee
Keyword(s):  
Conservative Treatment ◽  
Femoral Condyle ◽  
Case Series ◽  
Lesion Size ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Definitive Treatment ◽  
Spontaneous Osteonecrosis ◽  
Fresh Osteochondral Allograft

Background: Spontaneous osteonecrosis of the knee (SONK) is a clinical entity identified by acute knee pain usually associated with joint effusion, with radiographic findings of a radiolucent defect on the weightbearing area of the femoral condyle. Conservative treatment is initially undertaken; however, surgical procedures are often necessary. Historically, surgical options have included core decompression, cartilage repair, high tibial osteotomy, or joint arthroplasty. Few studies in the literature have reported the use of fresh osteochondral allograft (OCA) for the treatment of SONK lesions. Hypothesis: OCA transplantation is an effective treatment for SONK lesions on the medial femoral condyle. Study Design: Case series; Level of evidence, 4. Methods: A case series was analyzed of 7 patients treated with OCA for large SONK lesions of the medial femoral condyle with a minimum 4-year follow-up. All patients experienced failure of at least 6 months of conservative treatment and declined arthroplasty as the form of definitive treatment for medial femoral condyle lesion. All patients underwent OCA of the medial femoral condyle. Mean lesion size was 4.6 cm2 (range, 3.24-6.25 cm2), with a mean condylar width of 41.7 mm (range, 35.4-48.6 mm), resulting in a median proportion (lesion size/condylar width) of 56.8% (range, 32.7%-62.6%). The median surface allograft area was 5.1 cm2 (range, 3.2-6.3 cm2). Results: The median follow-up was 7.1 years (range, 4.5-14.1 years). No patient had additional surgery following OCA transplant; the allograft failure rate was 0%. Subjective outcome scores from the International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, and modified Merle d’Aubigné-Postel scale improved from preoperative assessment to the latest follow-up. All patients were extremely satisfied with the results of the OCA transplant. Conclusion: Fresh OCA transplantation demonstrated excellent efficacy, durability, and satisfaction in this group of patients with isolated stage 2 and 3 SONK lesions who had experienced failure of conservative treatment. Fresh osteochondral allografts are an attractive method for surgical management of selected patients with spontaneous osteonecrosis of the knee.

Return to Sport Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation

2020 ◽  
Vol 48 (8) ◽  
pp. 1945-1952 ◽  
Author(s):  
Joseph N. Liu ◽  
Avinesh Agarwalla ◽  
David R. Christian ◽  
Grant H. Garcia ◽  
Michael L. Redondo ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Femoral Condyle ◽  
Varus Deformity ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Return To Sports ◽  
Tibial Osteotomy ◽  
Allograft Transplantation ◽  
Chondral Defects

Background: Young patients with symptomatic chondral defects in the medial compartment with varus malalignment may undergo opening wedge high tibial osteotomy (HTO) with concomitant osteochondral allograft transplantation (OCA) (HTO + OCA). Although patients have demonstrated favorable outcomes after HTO + OCA, limited information is available regarding return to sporting activities after this procedure. Purpose: To evaluate (1) the timeline to return to sports (RTS), (2) patient satisfaction, and (3) reasons for discontinuing sporting activity after HTO + OCA, and to identify predictive factors of RTS. Study Design: Case series; level of evidence, 4. Methods: Consecutive patients who underwent HTO + OCA for varus deformity and medial femoral condyle focal chondral defects with a minimum 2-year follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire, satisfaction questionnaire, visual analog scale for pain, and Single Assessment Numerical Evaluation. Results: Twenty-eight patients with a mean age of 36.97 ± 7.52 years were included at mean follow-up of 6.63 ± 4.06 years. Fourteen patients (50.0%) required reoperation during the follow-up period, with 3 (10.7%) undergoing knee arthroplasty. Twenty-four patients participated in sports within 3 years before surgery, with 19 patients (79.2%) able to return to at least 1 sport at a mean 11.41 ± 6.42 months postoperatively. However, only 41.7% (n = 10) were able to return to their preoperative level. The most common reasons for sports discontinuation (n = 20; 83.3%) were a desire to prevent further damage to the knee (70.0%), persistent pain (55.0%), persistent swelling (30.0%), and fear (25.0%). Conclusion: In young, active patients with varus deformity and focal medial femoral condyle chondral defects, HTO + OCA enabled 79.2% of patients to RTS by 11.41 ± 6.42 months postoperatively. However, only 41.7% of patients were able to return to their preinjury level or better. It is imperative that patients be appropriately educated to manage postoperative expectations regarding sports participation after HTO + OCA.

Comparison of Clinical Outcome following Cartilage Repair for Patients with Underlying Varus Deformity with or without Additional High Tibial Osteotomy: A Propensity Score–Matched Study Based on the German Cartilage Registry (KnorpelRegister DGOU)

Cartilage ◽  
2020 ◽  
pp. 194760352098234
Author(s):  
Svea Faber ◽  
Peter Angele ◽  
Johannes Zellner ◽  
Gerrit Bode ◽  
Alfred Hochrein ◽  
...  
Keyword(s):  
Propensity Score ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Femoral Condyle ◽  
Varus Deformity ◽  
Medial Femoral Condyle ◽  
Cartilage Defects ◽  
Tibial Osteotomy ◽  
Matched Study

Background Even though realignment procedures have gained popularity as concomitant techniques in cartilage repair approaches with underlying malalignment, the clinical efficacy has not been proven to full extent. Methods Out of 5474 patients from the German Cartilage Registry, 788 patients with focal cartilage defects on the medial femoral condyle having received either no accompanying surgery or high tibial osteotomy (HTO) were identified. After a 1:1 propensity score matching, outcome of 440 patients was evaluated using KOOS (Knee Injury and Osteoarthritis Outcome Score), VAS (visual analogue scale), and satisfaction during the 3-year follow-up. Results Patients having received a concomitant HTO had significantly higher postoperative KOOS values (12 months: 67.26 ± 15.69 vs.75.10 ± 16.12, P = 0.001; 24 months: 67.14 ± 23.85 vs. 77.11 ± 16.50, P = 0.010; 36 months: 74.40 ± 16.57 vs. 81.75 ± 14.22, P = 0.023) and lower pain levels (6 months: 3.43 ± 2.18 vs. 2.89 ± 2.15, P = 0.009; 12 months: 3.64 ± 2.20 vs. 2.17 ± 1.96, P < 0.001; 24 months: 4.20 ± 3.12 vs. 2.94 ± 2.45, P = 0.005; 36 months: 3.20 ± 2.18 vs. 2.02 ± 1.98, P = 0.003). One and 3 years postoperatively, concomitant HTO led to significantly higher satisfaction in patients. These advantages of accompanying HTO were also seen in the group of patients with a varus deformity of 5° or more, in which pain levels without concomitant HTO even increased during the 3-year follow-up. Conclusion The results of the present study underline the importance and safety of concomitant HTO in patients with cartilage defects and varus deformity. HTO should therefore be considered and recommended generously in patients with focal cartilage defects of the medial femoral condyle and varus deformity.

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.

Vascular and Bone Regeneration of the Donor Site After Corticoperiosteal Flap From the Medial Femoral Condyle

Hand ◽  
2020 ◽  
pp. 155894472093029
Author(s):  
Matteo Guzzini ◽  
Domenico Lupariello ◽  
Giuseppe Argento ◽  
Leopoldo Arioli ◽  
Andrea Ferretti
Keyword(s):  
Magnetic Resonance ◽  
Blood Supply ◽  
Upper Limb ◽  
Femoral Condyle ◽  
Donor Site ◽  
Medial Femoral Condyle ◽  
Recipient Site ◽  
Medial Condyle ◽  
Genicular Artery

Background: The aim of this study was to evaluate the morbidity and regeneration of descending genicular artery and bone on the donor site, the medial condyle of the femur, after harvesting the corticoperiosteal flap and to report the clinical, functional, and radiographic outcomes of the treatment of atrophic nonunions of upper limb with corticoperiosteal vascularized flap at 5-year follow-up. Methods: From January 2011 to January 2018, 36 patients (average age of 45.8 years) were enrolled and evaluated with clinical and radiographic follow-up (average time of 66 months). In 20 patients, magnetic resonance angiography was also performed preoperatively and postoperatively to investigate the fate of the descending genicular artery after harvesting the corticoperiosteal flap. Results: Radiographic evaluation demonstrated a success rate of 94.4% (average time of bone healing of 5.2 months). At the recipient site, clinical evaluation showed excellent results in 75% to 80% of cases, and at the donor site, no statistical differences were found between before and after surgery clinical condition. In all patients who underwent magnetic resonance imaging, images showed a complete recovery of the blood supply of the medial femoral condyle. Conclusions: Medial condyle corticoperiosteal flap represents a valid choice for the treatment of upper limb nonunions. This technique brings a very low morbidity on the donor site, with complete restoration of blood supply and bone tissue. The limit of this flap is its low mechanical support, which suggests performing this technique especially for the treatment of upper limb nonunions.

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