Change of Chondral Lesions and Predictive Factors After Medial Open-Wedge High Tibial Osteotomy With a Locked Plate System

2017 ◽  
Vol 45 (7) ◽  
pp. 1615-1621 ◽  
Author(s):  
Kang-Il Kim ◽  
Min-Chul Seo ◽  
Sang-Jun Song ◽  
Dae-Kyung Bae ◽  
Duk-Hyun Kim ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Cartilage Regeneration ◽  
Medial Femoral Condyle ◽  
Open Wedge ◽  
Medial Tibial Plateau ◽  
Locked Plate ◽  
Second Look ◽  
Open Wedge Hto

Background: Although cartilage regeneration after medial open-wedge high tibial osteotomy (HTO) has been described, there is a paucity of reports regarding which factors influence cartilage regeneration. Purpose: To document whether cartilage regeneration occurs in the previously degenerated medial compartment of arthritic knees after medial open-wedge HTO without concomitant cartilage procedures and to assess which predictive factors influence regeneration after HTO. Study Design: Case series; Level of evidence, 4 Methods: From February 2008 to January 2014, 104 consecutive knees were enrolled retrospectively that received medial open-wedge HTO with a medial locked plate system without any additional cartilage regeneration procedures and were followed by second-look arthroscopy for plate removal 2 years after surgery. The mean ± SD age at the time of index HTO was 56.3 ± 5.4 years. Cartilage status was graded at the time of initial HTO and second-look arthroscopy according to the International Cartilage Repair Society grading system, and regenerated articular cartilage was classified by the macroscopic staging system of Koshino et al at the time of second-look arthroscopy. Variables evaluated for possible association with regeneration of articular cartilage included age, sex, body mass index (BMI), American Knee Society score, mechanical tibiofemoral angle, medial proximal tibial angle, amount of correction angle, and degree of arthritis. Results: Per the International Cartilage Repair Society grading system, the lesions in the medial femoral condyle and the medial tibial plateau were improved in 54 knees (51.9%) and 36 knees (34.6%), respectively, at the time of second-look arthroscopy. According to the macroscopic grading system, partial and total regeneration of articular cartilage in the medial femoral condyle and the medial tibial plateau was observed in 75 knees (72%) and 57 knees (55%), respectively. Based on univariable logistic regression tests, regeneration of articular cartilage was associated with a smaller mean preoperative varus mechanical tibiofemoral angle (odds ratio [OR], 0.7; P = .023) and lower BMI (OR, 0.8; P = .026) for the medial femoral condyle and younger age (OR, 0.9; P = .048) and a larger mean correction angle (OR, 1.1; P = .023) for the medial tibial plateau. The mean preoperative knee and function scores were significantly improved at the last follow-up, but no correlation was found between the clinical outcomes and cartilage regeneration. Multiple logistic regression analysis for regeneration of articular cartilage showed lower BMI (OR, 0.7; P = .015) to be a significant predictor for the medial femoral condyle. Conclusion: Regeneration of degenerated articular cartilage in the medial compartment can be expected while correcting a varus deformity in arthritic knees after medial open-wedge HTO with a locked plate system without any additional cartilage regeneration procedures. Moreover, we suggest that medial open-wedge HTO in the medial arthritic knee with varus malalignment should be highly successful in terms of cartilage regeneration, especially for lower BMI patients.

scholarly journals A Case of Spontaneous Osteonecrosis of the Knee with Early and Simultaneous Involvement of the Medial Femoral Condyle and Medial Tibial Plateau

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Shinya Fujita ◽  
Yuji Arai ◽  
Kuniaki Honjo ◽  
Shuji Nakagawa ◽  
Toshikazu Kubo
Keyword(s):  
Rare Case ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Pathological Findings ◽  
Medial Tibial Plateau ◽  
Resonance Imaging ◽  
Ipsilateral Side ◽  
Spontaneous Osteonecrosis ◽  
Progressive Course

Spontaneous osteonecrosis of the knee (SPONK) usually involves a single condyle, most often the medial femoral condyle (MFC). Involvement of the medial tibial plateau (MTP) is less common, occurring in about 2% of knees with SPONK. Early onset SPONK on the ipsilateral side of the medial compartment is very rare, with, to our knowledge, only four cases reported to date. We describe a very rare case of SPONK with early simultaneous development in the MFC and MTP. Serial plain radiographs and magnetic resonance imaging showed that SPONK in both condyles followed a similar progressive course. The pathological findings in these lesions were similar to those observed in subchondral insufficiency fractures.

scholarly journals Biochemical changes in knee articular cartilage of novice half-marathon runners

2019 ◽  
Vol 47 (11) ◽  
pp. 5671-5679 ◽  
Author(s):  
Leiyu Qiu ◽  
Jose Perez ◽  
Christopher Emerson ◽  
Carlos M. Barrera ◽  
Jianping Zhong ◽  
...  
Keyword(s):  
Relaxation Time ◽  
Articular Cartilage ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Biochemical Changes ◽  
Medial Tibial Plateau ◽  
T2 Relaxation Time ◽  
T2 Relaxation ◽  
Marathon Runners ◽  
Limited Region

Objective To evaluate changes in knee articular cartilage of novice half-marathon runners using magnetic resonance imaging T2 relaxation time mapping. Methods Healthy subjects were recruited from local running clubs who met the following inclusion criteria: (i) age 18–45 years; (ii) body mass index less than 30 kg/m2; (iii) had participated in one half-marathon or less (none within the previous 6 months); (iv) run less than 20 km/week; (v) no previous knee injury or surgery; (vi) no knee pain. T2 signals were measured pre- and post-race to evaluate the biochemical changes in articular cartilage after the subjects run a half-marathon. Results A significant increase in the mean ± SD T2 relaxation time was seen in the outer region of the medial tibial plateau (50.1 ± 2.4 versus 54.7 ± 2.6) and there was a significant decrease in T2 relaxation time in the lateral femoral condyle central region (50.2 ± 4.5 versus 45.4 ± 2.9). There were no significant changes in the patella, medial femoral condyle and lateral tibia articular surfaces. Conclusion An increase in T2 relaxation time occurs in the medial tibial plateau of novice half-marathon runners. This limited region of increased T2 values, when compared with complete medial compartment involvement seen in studies of marathon runners, may represent an association between distance run and changes seen in articular cartilage T2 values.

scholarly journals The Effect of Supramalleolar Osteotomy without Marrow Stimulation on Cartilage Regeneration for Medial Compartment Ankle Osteoarthritis: Second-Look Arthroscopic Evaluation of Cartilage Regeneration

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0005
Author(s):  
Jung-Won Lim ◽  
Hong-Geun Jung
Keyword(s):  
Patient Satisfaction ◽  
Articular Cartilage ◽  
Cartilage Regeneration ◽  
Ankle Arthroscopy ◽  
Medial Compartment ◽  
Ankle Osteoarthritis ◽  
Second Look ◽  
The Mean ◽  
Surface Angle ◽  
Articular Cartilage Regeneration

Category: Ankle Arthritis; Ankle; Arthroscopy Introduction/Purpose: The effect of supramalleolar osteotomy (SMO) without an additional bone marrow-stimulating procedure (BMSP) on articular cartilage regeneration in ankle joint still remains unknown. This study aimed to investigate whether SMO yielded favorable clinical and radiologic outcomes, and to evaluate whether the regeneration of articular cartilage could be observed after SMO without BMSP by second-look arthroscopy. Methods: 43 ankles after SMO (mean follow-up: 35.5 months) were retrospectively reviewed. Visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, patient satisfaction were used for functional evaluations. The tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were measured on radiographs, and ankle osteoarthritis was classified by Takakura stage. Among the 43 patients, 31 underwent ankle arthroscopy prior to SMO, and second-look arthroscopy was performed at 1-year postoperatively. Tibiotalar cartilage regeneration was evaluated according to the modified Outerbridge classification for the 29 patients who had undergone SMO without BMSP. Results: The mean VAS score and AOFAS score significantly improved from 6.4 preoperatively to 1.4 postoperatively and from 61.1 preoperatively to 88.4 postoperatively, respectively (P < 0.05). Regarding overall postoperative patient satisfaction, 18 (41.8%) patients reported their satisfaction as excellent, 23 (53.5%) as satisfied. The mean TAS and TLS significantly improved from 83.8° and 94.8° preoperatively to 78.4° and 82.2° postoperatively, respectively (P < 0.05). 23 out of 28 preoperative Takakura stage IIIa cases and 3 out of 7 IIIb cases improved to postoperative stage II. On second-look arthroscopy, cartilage regeneration of the medial compartment of the tibiotalar joint was observed in 26 of 29 patients (89.7%), whereas cartilage deterioration was not observed in any patient. Conclusion: Medial tibio-talar articular cartilage regeneration was observed in most cases (89.7%) of medial compartment ankle osteoarthritis after SMO without BMSP, which was confirmed with second-look arthroscopic evaluation. It also showed satisfactory clinical and radiologic outcomes with high patient satisfaction.

scholarly journals ARTICULAR CARTILAGE THICKNESS OF THE PEDIATRIC KNEE: IMPLICATIONS FOR CARTILAGE IMPLANTATIONS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0018
Author(s):  
Audrey Rustad ◽  
Nicolas G. Anchustegui ◽  
Stockton Troyer ◽  
Cooper Shea ◽  
Aleksei Dingel ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Ct Images ◽  
Cartilage Thickness ◽  
Coronal Plane ◽  
Average Thickness ◽  
Text Figure ◽  
Pediatric Knee ◽  
Femoral Condyles

Background: While access to pediatric tissue for cartilage conditions is limited, recent research on the use of pediatric cartilage tissue for implantation has shown promising results. These pediatric grafts may include bulk osteochondral allografts, morselized cartilage, or cellular manipulation products. The purpose of this study was to evaluate the parameters of cartilage thickness in different regions of the pediatric knee from a larger pediatric knee specimen research database. Methods: CT Scans of 12 skeletally immature knees ranging from ages 7 to 11 were evaluated. Cartilage thickness measurements were taking in the following regions: 1. Femoral Condyles - Cahill Zones 1, 2, 4, and 5 (Fig. 1) on coronal plane CT images, the region of greatest cartilage thickness on medial and lateral femoral condyles using coronal plane CT images, and Cahill Zones A, B, and C on sagittal plane CT images (Fig. 2). 2. Tibial Plateau – the region of greatest cartilage thickness identified on the medial and lateral sides of the tibial plateau using coronal plane CT images (Fig. 1). 3. Patella – the region of greatest cartilage thickness identified on axial and sagittal CT images (Fig. 3 and 4). Results: The cartilage on the medial femoral condyle had an average thickness of 4.86 mm ± 0.61 mm at its thickest point and the cartilage on lateral femoral condyle had an average thickness of 3.71 mm ± 0.52 mm at its thickest point. The cartilage on the medial tibial plateau had an average thickness of 2.80 mm ± 0.26 mm at its thickest point and the cartilage on the lateral tibial plateau had an average thickness of 3.29 mm ± 0.45 mm at its thickets point. The cartilage on the midpoints of Cahill zones 1, 2, 3, and 4 had an average thickness of 2.93 mm ± 0.62 mm, 3.42 mm ± 0.66 mm, 2.81 mm ± 0.46 mm, and 3.30 mm ± 0.73 mm respectively. The cartilage on the midpoints of Cahill zones A, B, and C had an average thickness of 3.81 mm ± 0.68 mm, 4.40 mm ± 0.49 mm, and 3.82 mm ± 0.68 mm respectively. The cartilage at its thickest point on the patella had an average thickness of 4.53 mm ± 0.38 mm from an axial view and 4.40 mm ± 0.49 mm from a sagittal view (Fig. 5 and 6). Conclusion: Pediatric knees demonstrate relatively thick cartilage regions in multiple zone of the knee, compared with adult specimens. Increasing access to and use of this tissue for cartilage grafts, non-manipulated tissue, and manipulated tissue offer significant opportunity to address cartilage loss. Osteochondral allograft procedures may benefit from access to such tissue, with relatively high volume and thickness of normal articular cartilage. [Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text]

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