scholarly journals Minced Cartilage in Combination with Autologous Bone Grafting for One-Step Osteochondral Defect Reconstruction in an Athlete’s Knee

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Diane Leyder ◽  
Christian Konrads ◽  
Patrick Ziegler ◽  
Stefan Döbele
Keyword(s):  
Bone Grafting ◽  
Time Pressure ◽  
Treatment Plan ◽  
Osteochondral Lesion ◽  
Basketball Player ◽  
Cartilage Defects ◽  
Sports Science ◽  
One Step ◽  
Therapy Option ◽  
Step Therapy

A 17-year-old student athlete suffering from stress-related knee pain asked for help. MRI revealed an unstable osteochondral lesion. Because of time pressure due to the patient’s academic exams and his schedule as a basketball player, an autologous chondrocyte transplantation (ACT) as the standard surgical treatment plan was not accepted by the patient. This was mainly because of its two-step character three weeks in between surgeries. Therefore, a surgical one-step therapy option as alternative treatment to ACT was needed. The patient received simultaneous autologous cancellous bone grafting and minced cartilage procedure in a sandwich technique. After successful rehabilitation, the patient continued his studies of sports science and his active career as a basketball player successfully. Several different procedures are used for the treatment of cartilage defects. The following factors play a significant role: defect size, location, patient age, and sports ambitions. In the case described here, ACT would have been the conventional, but not the ideal option in the perspective of this individual patient because of the two-step surgery and the longer rehabilitation time. Therefore, the minced cartilage method presented a valid alternative, even though long-term data are still missing and prospective studies comparing this procedure with others are needed in the future.

scholarly journals Impact of Early Weightbearing After Ankle Arthroscopy and Bone Marrow Stimulation for Osteochondral Lesions of the Talus

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110298
Author(s):  
Richard M. Danilkowicz ◽  
Nathan L. Grimm ◽  
Gloria X. Zhang ◽  
Thomas A. Lefebvre ◽  
Brian Lau ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Statistical Significance ◽  
Osteochondral Lesion ◽  
Ankle Arthroscopy ◽  
Categorical Variables ◽  
Cartilage Defects ◽  
Osteochondral Lesions ◽  
Bone Marrow Stimulation ◽  
Gold Standard Method ◽  
Marrow Stimulation

Background: Osteochondral lesion of the talus (OLT) may be caused by osteochondritis dissecans, osteochondral fractures, avascular necrosis, or focal arthritic changes. For certain focal cartilage defects, bone marrow stimulation (BMS) has been a widely used technique to restore a fibrocartilage substitute overlying the defect. There are various postoperative weightbearing protocols for this procedure, with no single gold standard method. Purpose: To retrospectively review the outcomes of patients undergoing ankle arthroscopy with concomitant BMS to determine outcomes based on postoperative weightbearing status. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the records of patients who underwent ankle arthroscopy with BMS for OLTs between 2015 and 2018. Patients were placed into 2 cohorts based on postoperative immobilization status: the nonweightbearing (NWB) group and the weightbearing-as-tolerated (WBAT) group. Patient characteristics obtained included age, sex, comorbidities, and etiology of talar pathology. Outcomes included the pain visual analog scale (VAS), range of motion (ROM), complications, time to first weightbearing, and the method and length of immobilization. Patients who were lost to follow-up before 30 days were excluded. The chi-square test was used to compare categorical variables between cohorts, and the t test was used for continuous variables. Results: A total of 69 patients met the inclusion criteria for this study, 18 in the WBAT group and 51 in the NWB group. The mean lesion size was 9.48 × 9.21 mm (range, 3-15 mm × 2-20 mm) for the NWB group and 9.36 × 9.72 mm (range, 5-14 mm × 6-20 mm) for the WBAT group ( P > .05). The VAS scores improved from 4.40 to 0.67 for the WBAT group and from 6.33 to 2.55 for the NWB group, with the difference in final values reaching statistical significance ( P = .0002). Postoperative ROM was not significantly different between the groups. There were 4 repeat operations within the NWB cohort. Conclusion: The surgical management of OLTs can be challenging, and the postoperative weightbearing protocol can be an extra obstacle for the patient to navigate. We found no difference in pain, ROM, or complications when allowing immediate, full WBAT.

Outcome of autologous bone grafting to osteochondral lesion of the talus with subchondral cyst

2017 ◽  
Vol 23 ◽  
pp. 114 ◽  
Author(s):  
M. Sawa ◽  
T. Nakasa ◽  
M. Yoshikawa ◽  
Y. Tsuyuguchi ◽  
N. Adachi
Keyword(s):  
Bone Grafting ◽  
Osteochondral Lesion ◽  
Autologous Bone Grafting ◽  
Subchondral Cyst ◽  
Autologous Bone

scholarly journals Autologous osteochondral transfer for the treatment of full-thickness defects in patients with or without ACL reconstruction. Results with 7 years follow-up

2014 ◽  
Vol 2 (12_suppl4) ◽  
pp. 2325967114S0023
Author(s):  
Juan J. Dere ◽  
Carlos H. Yacuzzi ◽  
Matías Costa Paz
Keyword(s):  
Cruciate Ligament ◽  
Osteochondral Lesion ◽  
Acl Injury ◽  
Cartilage Defects ◽  
Full Thickness ◽  
Chondral Lesions ◽  
Group A ◽  
Group B ◽  
Femoral Condyles

Objectives: The aim of this study was to evaluate the results of autologous osteochondral transfer for the treatment of cartilage defects in 2 groups of patients: The first with an isolated osteochondral injury and the other with associated anterior cruciate ligament (ACL) injury treated in one stage surgery Materials and Methods: We retrospectively evaluated 25 patients with symptomatic focal full-thickness chondral lesions in the femoral condyles during the years 2003-2009, with a minimum of 5 years of follow up. The patients were divided into 2 groups: Group A: 10 patients with associated ACL injury, and Group B: 15 patients with an isolated osteochondral lesion. Clinical outcome was analyzed by Lysholm and IKDC scores. Results: There was an improvement of all scores in both groups. There were no significant differences between the groups in the IKDC (82/84) and Lysholm (87/86) scores. The mean age at the time of assessment for group A was 46 years and 44 for the group B. The mid term follow-up was 96 months for group A and 103 months for group B. Two complications were recorded in group A: 1 infection and 1 arthrofibrosis. 2 complicationsoccurred in group B: 2 arthrofibrosis. Conclusion: The results of the mosaicplasty for the focal full-thickness chondral lesions in the femoral condyles are favorable after 5 years of follow up. There was no difference between the associated or not ACL injury.

Therapy alteration of solid tumors based on FoundationOne comprehensive genome profiling assay.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14742-e14742
Author(s):  
Kirill Karlin ◽  
Abdullah Kahraman ◽  
Alessandra Curioni Fontecedro ◽  
Holger Moch ◽  
Martin Zoche ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Clinical Utility ◽  
Ductal Carcinoma ◽  
Treatment Plan ◽  
Subsequent Treatment ◽  
Unknown Primary ◽  
Tumor Type ◽  
Genome Profiling ◽  
New Therapy ◽  
Therapy Option

e14742 Background: Molecular profiling assays are becoming widely available and provide valuable information on tumor characteristics, which can identify targeted therapies or immunotherapies for cancer patients. However, the clinical utility of such tests remains unclear. Within our institution, we analyzed the clinical utility and subsequent treatment alterations of the FoundationOne Comprehensive Genome Profiling Test (FOne). Methods: We conducted a retrospective cohort review (2017 - 2018) of patients with solid tumors under standard diagnostic care who received FOne testing. We reviewed the therapies that were proposed by FOne and studied whether they led to a therapeutic alteration. Results: 71 patients were identified, of which the majority presented a progressive disease state (80%). Among the cancer types most frequently tested were adenocarcinoma of the colon (14%), prostate (8%), lung (4%), intrahepatic cholangiocarcinoma (8%) and breast invasive ductal carcinoma (4%). In 16 cases (22%), therapies suggested by FOne were approved in patient’s tumor type while in 30 cases (42%) therapies were approved in another tumor type. For an additional 13 cases (18%) only therapies tested in clinical trials were reported. 4 patients (6%) received a new therapy based on the FOne result: cancer of unknown primary (Everolimus due to a TSC1 mutation), cutaneous angiosarcoma (Pembrolizumab due to a high tumor mutational burden (TMB)), gastrointestinal neuroendocrine carcinoma (Ipilimumab and Nivolumab due to an intermediate TMB) and mucinous adenocarcinoma of the appendix (Talazoparib due to an ATM mutation). For 11 cases (15%), a new therapy option was identified by FOne, which due to the current treatment plan might be considered for later use. 3 cases (4%) were evaluated for potential clinical trial enrollment. Note that for an additional 6 patients (8%), the therapies proposed by FOne were already established on the basis of previous testing (e.g. smaller genomic panels, IHC, FISH). Conclusions: Overall, 18 (25%) patients received a new therapy option by FOne after standard of care diagnostics. Therapeutic alterations were observed particularly in patients with a rare or unknown tumor type.

Articular Talar Injuries in Athletes

2007 ◽  
Vol 35 (10) ◽  
pp. 1680-1687 ◽  
Author(s):  
Amol Saxena ◽  
Colin Eakin
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Treatment Plan ◽  
Case Series ◽  
Autogenous Bone ◽  
Osteochondral Lesions ◽  
Return To Sports ◽  
Talar Dome ◽  
High Demand ◽  
Return To Activity

Background The treatment options of talar osteochondral lesions are numerous. Although studies show these treatments have been used with varying success, the ability to return to activity (RTA), including sports after treatment of talar dome injuries, have not been well documented. Hypothesis A treatment plan that uses microfracture for Hepple stage 2 through 4 lesions and autogenous bone grafting for Hepple stage 5 lesions for athletes with articular lesions of the talus will produce a high rate of return to athletic activity. Study Design Case series; Level of evidence, 4. Methods Preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and RTA were assessed prospectively 2 to 8 years after surgery in high-demand (athletic) patients with articular injuries to the talar dome treated according to the above protocol over a 6-year period. Results There were 26 microfracture procedures and 20 bone grafts to the talus. The AOFAS scores for both microfracture (preoperative, 54.6; postoperative, 94.4) and bone graft (preoperative, 46.1; postoperative, 93.4) patients improved significantly. The RTA for the entire group was 17.0 ± 5.3 weeks; for those undergoing microfracture, RTA was 15.1 ± 4.0 weeks; and for bone grafting, it was 19.6 ± 5.9 weeks. The RTA for the bone graft group was significantly slower than that of the microfracture group. Anterolateral lesions had significantly faster RTA and higher postoperative scores compared with other lesion locations. Arthroscopically treated lesions had similar postoperative AOFAS scores to those who had arthrotomy and did not have significantly faster RTA. Forty-four (96%) “excellent/good” AOFAS scores were achieved overall for talar lesions, with the same percentage of return to sport. Conclusions Talar bone grafting required a longer time to return to activity than microfracture in high-demand patients, but both groups had similar postoperative AOFAS scores. When applied to appropriate lesions, both techniques allow athletic patients to return to sports.

scholarly journals Restorasi Resin Komposit Menggunakan Pasak Tapered Self Threading Pada Molar Ketiga Kiri Mandibula

2013 ◽  
Vol 20 (1) ◽  
pp. 58
Author(s):  
Ellen Krisanti ◽  
Tri Endra Untara
Keyword(s):  
Root Canal ◽  
Composite Resin ◽  
Treatment Plan ◽  
Third Molar ◽  
Root Canal Treatment ◽  
Mandibular Third Molar ◽  
Composite Resin Restoration ◽  
Therapy Option ◽  
Root Canal Morphology ◽  
Complex Variation

Morfologi saluran akar gigi molar mandibula ketiga memiliki variasi yang lebih kompleks dibandingkan gigi molar lainnya.   Pada gigi molar ketiga sering dilakukan pencabutan, namun dalam keadaan tertentu gigi molar ketiga dapat dipertahankan. Perawatan saluran akar satu kunjungan merupakan pilihan untuk terapi kasus ini. Tujuan laporan kasus ini untuk memperlihatkan keberhasilan dari perawatan saluran akar satu kunjungan pada gigi molar ketiga nekrosis pulpa disertai restorasi resin komposit dengan pasak tapered self theading. Pasien wanita 20 tahun datang ke RSGM Prof Soedomo FKG UGM dengan keluhan sakit saat pengunyahan pada gigi molar ketiga dan positif pada perkusi. Gambaran radiografis menunjukkan restorasi yang tidak sempurna, terdapat celah antara kavitas dengan restorasi. Rencana perawatan pada kasus ini, perawatan saluran akar satu kunjungan dan resin komposit dengan pasak tapered self threading sebagai restorasi akhir. Kesimpulan dari perawatan saluran akar satu kunjungan memiliki rekontaminasi mikroorganisme yang lebih kecil dibandingkan dengan multi kunjungan sehingga menjamin keberhasilan perawatannya. Restorasi resin komposit secara direkdengan pasak tapered self threadingmerupakan restorasi alternatif pasca perawatan endodontikkarena lebih cepat dan kuat.Composite Resin Restoration Using Tapered Self Threading Poston Left Mandibular Third Molar. Root canal morphology of mandibular third molar has more complex variation than the other molars. In third molar, the extraction teeth are often executed; however, the third molar can be maintained in other conditions. One visit root canal treatment is a therapy option for this case. The purpose of this case report is to show the success of one visit root canal treatment in third molar with pulp necrosis by restoring the composite resin through tapered self-treading post. A 20 year-old female patient who came to the Prof Soedomo RSGM, FKG UGM complained about the pain when chewing food on her third molar and positive in percussion. The radiographs showed that there was an incomplete restoration. There was a gap between cavities with restoration. The treatment plan for this case was one visit root canal treatment and composite resin with tapered self-threading post as final restoration. From the case, it can concluded that one visit root canal treatment results in a smaller chance for microorganism recontamination than the multi-visit in order to ensure the success of the treatment. Direct composite resin restoration with tapered self-threading dowel is an alternative restoration after endodontic treatment because it works out faster and more retentive.

P–474 Psychosocial aspects of fertility preservation options for young cancer patients in the Czech Republic: a qualitative study

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
H Konecna ◽  
K Nováková
Keyword(s):  
Quality Of Life ◽  
Czech Republic ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Time Pressure ◽  
Treatment Plan ◽  
Reproductive Age ◽  
Structured Interviews ◽  
The Czech Republic

Abstract Study question What is the real accessibility of fertility preservation techniques and its perception by patients in the Czech Republic? Summary answer Fertility preservation options are not offered on a routine basis and often are not part of a treatment plan. Patients wish to be adequately informed. What is known already Every year, more than 82.000 people in the Czech Republic develop cancer. The incidence of newly diagnosed cancers in individuals in their reproductive age represents 4.4% of all newly diagnosed oncological diseases. Because the prognosis of treatment in this group of patients is very favourable, the priority in treatment is the emphasis on quality of life after surviving. One of the important parameters of quality of life for many people is the ability to reproduce and the possibility of having a genetic bond to their children. Study design, size, duration This qualitative study was conducted in 2019 and relied on explorative in-depth semi-structured interviews. Participants were chosen through occasional sampling. Participants/materials, setting, methods We interviewed 13 cancer patients/survivors in their reproductive age (aged 21 to 36; 7 females and 6 males); 4 close family members of young cancer patients; and 8 experts from relevant professional fields. Data gathered from semi-structured interviews were analysed by interpretative phenomenological analysis. Main results and the role of chance Cancer was perceived as a threat to life and one’s safety. It causes uncertainty and a feeling of loss of control. It also has a negative impact on a self-concept. Loss of fertility was perceived as a “injury of personality”. The possibility of maintaining fertility has increased the subjectively experienced quality of life. They make decisions under great time pressure, in a mentally demanding situation. They are usually in the early stages of coping with the diagnosis. The main factors that influenced the respondents’ decision were the amount and quality of information, psychological stress and time pressure. Patients and their families are interested in being informed about the risks that the disease and its treatment pose to their reproductive health. They want to be able to decide whether to undergo any of the fertility protection techniques. They want to keep their future open. It is therefore desirable that, within oncofertility, we focus on the process of passing on information and supporting decision-making on issues of fertility and its protection. A tool that could be a good informational platform may be so-called decision aid – a tool used to inform patients about available treatments, along with potential benefits, risks and costs. Limitations, reasons for caution As all qualitative data, our findings cannot be generalized. Selection bias could have occurred because it is likely that those interested and open to sharing participated. Wider implications of the findings: Oncofertility treatment is highly relevant and should be offered and discussed with all patients in their reproductive age. Addressing fertility preservation options should be a part of cancer treatment plan of all these patients. Trial registration number 0

Sign in / Sign up

Export Citation Format

Share Document