A Case Series of Successful Repair of Articular Cartilage Fragments in the Knee

2019 ◽  
Vol 47 (11) ◽  
pp. 2589-2595 ◽  
Author(s):  
Jessica L. Churchill ◽  
Aaron J. Krych ◽  
Mark J. Lemos ◽  
Morganne Redd ◽  
Kevin F. Bonner
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Internal Fixation ◽  
Scale Score ◽  
Case Series ◽  
Resonance Imaging ◽  
Patient Reported ◽  
Activity Scale ◽  
Chondral Fracture

Background: It is unclear whether chondral fragments without bone have the potential to heal after fixation. Controversy exists and opinions differ regarding the optimal treatment of chondral defects after pure chondral fracture. Purpose: To determine clinical and radiographic outcomes after internal fixation of traumatic chondral fragments repaired to bone in the knee. Study Design: Case series; Level of evidence, 4. Methods: A retrospective clinical and radiographic evaluation of 10 male patients with a mean age of 14.6 years (range, 10-25 years) at the time of surgery was performed. Eight of 10 patients were skeletally immature. Patients were selected by operating surgeons per the presence of a large displaced pure chondral fragment on magnetic resonance imaging and confirmed on intraoperative inspection. All patients had a diagnosed traumatic displaced pure chondral fracture of the knee (without bone) and underwent internal fixation with minimum 1-year follow-up. Validated patient-reported and surgeon-measured outcomes were collected pre- and postoperatively. All patients were evaluated at a mean 56 months postoperatively. Results: At surgery, the mean defect size that was primarily repaired with the displaced chondral fragment was 1.9 × 2.0 cm. With minimum 1-year follow-up, there were no clinical failures. All 8 patients who had subsequent magnetic resonance imaging follow-up had radiographic evidence of complete healing of the chondral fragment back to bone. At a mean follow-up of 56 months (range, 13-171 months; median, 36 months), patients had a mean International Knee Documentation Committee score of 94.74 (range, 87.4-100), a mean Marx Activity Scale score of 14.4 (range, 8-16), and a mean Tegner Activity Scale score of 7 (range, 5-9). At final follow-up, all patients except 1 returned to sports. Conclusion: The treatment of large traumatic chondral fragments is controversial. In this select series of 10 young patients who underwent primary repair with internal fixation, there were no failures clinically. Patients demonstrated excellent short-term clinical and radiographic results after fixation of these relatively large chondral fragments in the knee.

scholarly journals Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Magnetic Resonance Imaging and Clinical Outcomes at Minimum 2-Year Follow-up

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096008
Author(s):  
Kenneth M. Lin ◽  
Dean Wang ◽  
Alissa J. Burge ◽  
Tyler Warner ◽  
Kristofer J. Jones ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Resonance Imaging ◽  
Short Term ◽  
Patient Reported ◽  
Mri Scans

Background: Fresh osteochondral allograft transplant (OCA) has good outcomes in the knee. However, donor tissue for patellar OCA is limited. Outcomes after nonorthotopic OCA of the patella using more readily available femoral condylar allograft (FCA) tissue have not been previously reported. Purpose: To assess short-term magnetic resonance imaging (MRI) and minimum 2-year clinical outcomes of nonorthotopic patellar OCA using an FCA donor. Study Design: Case series; Level of evidence, 4. Methods: A prospective institutional cartilage registry was reviewed to identify patients treated with patellar OCA using an FCA donor between August 2009 and June 2016. OCA plugs were obtained from the FCA at its trochlear-condylar junction and implanted into the recipient patellar lesion. Early postoperative MRI scans were graded by a blinded musculoskeletal radiologist using the Osteochondral Allograft MRI Scoring System (OCAMRISS). International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), Knee Outcomes Survey–Activities of Daily Living (KOS-ADL), and pain visual analog scale (VAS) scores were collected preoperatively and at minimum 2 years postoperatively, and outcomes were compared using the paired t test. Results: A total of 25 patients were included for clinical outcome analysis and 20 patients for MRI analysis. MRI scans obtained at a mean of 11.4 months (range, 6-22 months) postoperatively showed a mean total OCAMRISS score of 9.0 (range, 7-11); mean bone, cartilage, and ancillary subscores were 2.6, 3.7, and 2.6, respectively. At the latest follow-up (mean, 46.5 months; range, 24-85 months), postoperative improvements were noted in IKDC (from 45.0 to 66.2; P = .0002), KOS-ADL (from 64.3 to 80.4; P = .0012), and VAS (from 5.1 to 3.4; P = .001) scores, with IKDC and KOS-ADL scores above the corresponding previously reported minimal clinically important difference. Conclusion: In this study, patellar OCA using nonorthotopic FCA led to significant short-term improvements in pain and patient-reported outcomes. The majority of nonorthotopic patellar grafts demonstrated full osseous incorporation and good restoration of the articular surface on MRI at short-term follow-up.

Autologous Osteochondral Mosaicplasty for Centrally and Laterally Located, Advanced Capitellar Osteochondritis Dissecans in Teenage Athletes: Clinical Outcomes, Radiography, and Magnetic Resonance Imaging Findings

2018 ◽  
Vol 46 (8) ◽  
pp. 1943-1951 ◽  
Author(s):  
Tadanao Funakoshi ◽  
Daisuke Momma ◽  
Yuki Matsui ◽  
Tamotsu Kamishima ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Osteochondritis Dissecans ◽  
Case Series ◽  
Return To Play ◽  
Joint Surface ◽  
Resonance Imaging ◽  
Level Of Evidence

Background: Autologous osteochondral mosaicplasty (ie, mosaicplasty) results in satisfactory clinical outcomes and reliable return to play for patients with large or unstable lesions due to osteochondritis dissecans (OCD) of the humeral capitellum. However, the association between the healing of the reconstructed cartilage and clinical outcomes remains unclear. Purpose: To evaluate the efficacy of mosaicplasty in teenage athletes through use of clinical scores and imaging. The secondary purpose was to compare the clinical outcomes with images of centrally and laterally located lesions. Study Design: Case series; Level of evidence, 4. Methods: This study analyzed 22 elbows (all male patients; mean age, 13.5 ± 1.2 years) with capitellar OCD managed with mosaicplasty. Patients were divided into 2 groups according to the location of the lesions: central (10 patients) and lateral (12 patients). Evaluation was performed through use of the clinical rating system of Timmerman and Andrews, plain radiographs, and magnetic resonance imaging (MRI; the cartilage repair monitoring system of Roberts). The mean follow-up period was 27.5 months (range, 24-48 months). Results: Lateral lesions were significantly larger than central lesions (147.1 ± 51.9 mm2 vs 95.5 ± 27.4 mm2, P = .01). No other significant differences were found between central and lateral lesions. Timmerman and Andrews scores for both central and lateral lesions improved significantly from 125.0 ± 30.1 points and 138.3 ± 34.5 points preoperatively to 193.5 ± 11.3 points and 186.7 ± 18.1 points, respectively, at final follow-up ( P < .0001, P < .0001). Radiography identified complete graft incorporation in all cases and the absence of severe osteoarthritic changes or displaced osteochondral fragments. In the lateral group, the radial head ratio at final follow-up (1.83 ± 0.23) was significantly larger than the preoperative findings (1.75 ± 0.14, P = .049). The quality of joint surface reconstruction was found to be acceptable for central and lateral lesions on MRI evaluation. Conclusion: Mosaicplasty resulted in satisfactory clinical outcomes and smooth cartilage surface integrity in teenage athletes with OCD on their return to competition-level sports activities irrespective of lesion location.

scholarly journals Therapeutic evaluation of sclerotherapy for limb venous malformations: A case series

2020 ◽  
Vol 35 (9) ◽  
pp. 663-671
Author(s):  
Tenghui Zhan ◽  
Fanggang Cai ◽  
Pingfan Guo ◽  
Yujie Lian ◽  
Hui Zhuang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Doppler Ultrasound ◽  
Clinical Examination ◽  
Clinical Manifestations ◽  
Case Series ◽  
Venous Malformations ◽  
Resonance Imaging ◽  
Percutaneous Sclerotherapy

Objectives To examine three different methods for evaluating the effect of percutaneous sclerotherapy on limb venous malformations in a series of patients with a relatively long follow-up. Method The study was a retrospective study. Results Thirty-eight patients treated with percutaneous sclerotherapy underwent sclerotherapy, with a median number of sessions of 4 (range, 1–10). They were followed up for 1–60 months (average 12.5 months). The kappa between clinical manifestations and Doppler ultrasound was 0.684 ( P < 0.001). The kappa between clinical manifestations and magnetic resonance imaging was 0.217 ( P = 0.006). The kappa between Doppler ultrasound and magnetic resonance imaging was 0.323 ( P < 0.001). The rate of grade IV patients evaluated by clinical manifestations was significantly higher than that by Doppler ultrasound and magnetic resonance imaging. Conclusions Magnetic resonance imaging is the gold standard for VM imaging. Its consistency with clinical examination and Doppler ultrasound is poor, and Doppler ultrasound and clinical examination could be more appropriate for follow-up imaging after sclerotherapy.

scholarly journals Autologous Chondrocyte Implantation to Isolated Patella Cartilage Defects

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 146-154 ◽  
Author(s):  
Arvind von Keudell ◽  
Roger Han ◽  
Tim Bryant ◽  
Tom Minas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Outcome Measures ◽  
Autologous Chondrocyte Implantation ◽  
Tibial Tubercle ◽  
Resonance Imaging ◽  
Patient Reported ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background Autologous chondrocyte implantation (ACI) is a durable treatment for patients with chondral defects. This study presents the comprehensive evaluation of patients with patella defects treated with ACI at medium- to long-term follow-up. Methods Thirty consecutive patients with isolated chondral lesions of the patella were enrolled prospectively. Primary outcome measures were validated patient reported outcome measures and objective magnetic resonance imaging. Results Nineteen of 30 patients underwent tibial tubercle osteotomy (TTO) to correct lateral maltracking in combination with soft tissue balancing. The defect sizes were large, averaging 4.7 ± 2.1 cm2 (range 2.2-30.0 cm2). Pidoriano/Fulkerson classification revealed that 3 defects were type II (lateral), 9 were type III (medial), and 18 were type IV (central/panpatella). Age at the time of surgery was 32 ± 10 years. At follow-up of 2 to 14 years, knee function was rated good to excellent in 25 (83%) patients, fair in 4 (13%) patients, and poor in 1 (3%) patient. Three patients failed treatment after a mean of 75 months (6.25 years). All 3 failures were Workers Compensation (WC) cases. They were older than the non-WC patients, 42 ± 6 years compared with the non-WC 28 ± 9 years ( P = 0.0019). Significant increases in all clinical and health utility outcome scores were seen. Magnetic resonance imaging demonstrated that the fill grade, surface and integrity of the repair tissue correlated with clinical scores. Conclusion ACI to isolated patella defects results in significant functional improvement at a minimum of 24 months, with the results remaining durable at latest follow-up of 15 years. Level of evidence Level 4.

scholarly journals The Influence of Magnetic Resonance Imaging and Adjunct Acupuncture on LongTerm Pain Improvement for Patients with Trigeminal Neuralgia

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Randomized Clinical Trials ◽  
Symptom Improvement ◽  
Resonance Imaging ◽  
Patient Reported ◽  
Pain Improvement

Trigeminal neuralgia is a debilitating disease characterized by neuropathic facial pain which significantly impact on the patient’s quality of life and socioeconomic function. For patients with trigeminal neuralgia, Magnetic Resonance Imaging (MRI) is a routine investigation recommended in recent clinical guidelines but it remains unclear whether its use has any impact on patient-reported clinical outcomes. Acupuncture as an adjunct therapy has been shown to provide short term pain relief but its longer-term benefits remain unknown. The aims of the study are to examine whether the use of MRI and/ or adjunct acupuncture is associated with the long-term pain improvement for trigeminal neuralgia patients, and thus to inform on prognosis of trigeminal neuralgia. Methods: In this retrospective cohort study using data from routine clinical practice, we included all adult patients diagnosed with trigeminal neuralgia and managed at the Pain Management Centre, Singapore General Hospital between 2011 and 2017. Patients who have incomplete clinical data or lost to follow up are excluded. Logistic regression model was used to examine the association between the uses of MRI or adjunct MRI and pain symptom improvement at 6-12 months follow up. Results: Fifty-three patients were identified and included in this study. Neither the use of MRI nor acupuncture was found to be significantly associated with pain improvement for patients with trigeminal neuralgia at 6 to 12 months follow up after the initial diagnosis. Conclusion: The use of MRI or adjunct acupuncture did not seem to be related to long-term pain improvement for patients with trigeminal neuralgia and thus has limited prognostic value. These findings would have to be confirmed by further studies of larger sample size, and ideally with prospective randomized clinical trials.

scholarly journals Infantile Abdominal and Pelvic Lipoblastomas: A Case Series

2019 ◽  
Vol 07 (01) ◽  
pp. e104-e109
Author(s):  
Riccardo Guanà ◽  
Salvatore Garofalo ◽  
Luisa Ferrero ◽  
Maria Grazia Cortese ◽  
Luca Lonati ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Head And Neck ◽  
Case Series ◽  
Fat Cells ◽  
Ovarian Mass ◽  
Resonance Imaging ◽  
Mesenchymal Tumors ◽  
In Infants And Children

Lipoblastomas are rare benign mesenchymal tumors that arise from embryonal fat cells.They are usually discovered in infants and children under 3 years of age, and mostly occur in the trunk (from 10 to 60%, depending on the study) and extremities (from 40 to 45%), while head and neck localizations are rare, with only five cases described to date.We report on three cases of lipoblastomas in infants younger than 4 years, with unusual localizations: one intra-abdominal, discovered during a laparotomy for an intussusception; one pelvic, misdiagnosed as an ovarian mass; and one gluteal with a pelvic extension.All children underwent magnetic resonance imaging as preoperative workup. All tumors were completely resected with free surgical margins and ultrasonographic follow-up was uneventful for all patients.

scholarly journals Prenatal Diagnosis of Galen Vein Aneurysm Using Ultrasonography and Magnetic Resonance Imaging and Perinatal and Long-Term Neurological Outcomes: A Case Series

2017 ◽  
Vol 39 (06) ◽  
pp. 309-314
Author(s):  
Pedro Pires ◽  
Larisse Martins ◽  
Norma Pires ◽  
Heron Werner ◽  
Adilson Ferreira ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Birth Weight ◽  
Prenatal Diagnosis ◽  
Magnetic Resonance ◽  
Gestational Age ◽  
Tertiary Care ◽  
Case Series ◽  
Resonance Imaging ◽  
The Mean

Objective To describe the prenatal diagnosis of Galen vein aneurysm (GVA) based on ultrasonography and magnetic resonance imaging (MRI) in a series of cases, as well as its postnatal outcomes and follow-up until 4 years of age. Methods A retrospective longitudinal study was performed, analyzing a database comprising seven cases of prenatal diagnosis of GVA at two Brazilian institutions from February of 2000 to May of 2012. The following data were evaluated: gestational age at diagnosis, GVA dimensions on ultrasonography, associated fetal changes, findings on fetal echocardiography, gestational age at delivery, type of delivery, birth weight, Apgar score at the 1st and 5th minutes, neonatal outcomes, and survival with follow-up until 4 years of age. Results The mean gestational age ± standard deviation on the prenatal diagnosis of GVA based on ultrasonography was 25 ± 4.9 weeks. The mean length of GVA was 3.2 ± 0.4 cm. The mean gestational age at birth was 37.5 ± 0.7 weeks, and a cesarean section was performed in 85.7% of the cases (6/7). The mean birth weight was 3,070 ± 240.4 g. The total survival rate was 42.8% (4/7), with three neonatal deaths. Of the four survivors, three presented with normal neuropsychomotor development until 4 years of age and only one showed serious neurological sequelae. Ultrasonography and MRI showed similar findings for all seven cases. Conclusions Galen Vein Aneurysm is associated with a high neonatal death rate. Therefore, its prenatal diagnosis is essential for parent counseling and follow-up at tertiary care institutions.

scholarly journals Surgical Fixation of Chondral-Only Fragments of the Knee: A Case Series With a Mean 4-Year Follow-up

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712096139
Author(s):  
Andrew Gudeman ◽  
Dillen Wischmeier ◽  
Jack Farr
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Resonance Imaging ◽  
Outcome Scores ◽  
Surgical Fixation ◽  
The Mean

Background: Chondral-only fragments of the knee have traditionally been treated with excision, with or without cartilage restoration procedures. This is because of the historical assumption that cartilage has limited ability to heal to cancellous or subchondral bone. There is now a growing body of evidence supporting surgical fixation of these fragments. Hypothesis: We hypothesized that surgical fixation of chondral fragments would result in acceptable rates of healing with improvement in clinical outcome scores. Study Design: Case series; Level of evidence, 4. Methods: Data were collected on 15 surgically fixed chondral-only fragments in 14 patients. We retrospectively collected participant demographic information, lesion characteristics, primary mechanism (osteochondritis dissecans vs traumatic shear injury), fixation methods, reoperation information, second-look arthroscopic information, and clinical outcome scores. The mean clinical follow-up was 3.96 years, with a minimum of 1-year follow-up. All patients underwent follow-up magnetic resonance imaging at a mean of 2 years after the index procedure. Results: The mean age of our cohort was 17.7 years. We found an 80% survival rate for fixation of the fragments at a mean 4-year follow-up. There were statistically significant improvements in postoperative Knee injury and Osteoarthritis Outcome Score and Tegner scores compared with preoperative scores. Follow-up magnetic resonance imaging scans showed complete healing in 10 knees, partial healing in 2 knees, and loss of fixation in 3 knees. Second-look arthroscopic surgery of 3 knees for reasons other than fragment symptoms showed healing of the fragment, while arthroscopic surgery of 3 symptomatic knees showed loss of fixation. Conclusion: Surgical fixation of chondral-only lesions showed an 80% success rate with improvements in the KOOS and Tegner scores.

Morning Glory Disc Anomaly Associated with Ipsilateral Optic Nerve and Chiasm Thickening: Three Cases and Review of the Literature

2017 ◽  
Vol 48 (06) ◽  
pp. 463-466 ◽  
Author(s):  
Lorenzo Pinelli ◽  
Matteo Scaramuzzi ◽  
Jessica Galli ◽  
Elisa Fazzi ◽  
Cecilia Parazzini ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Optic Nerve ◽  
Magnetic Resonance ◽  
Case Series ◽  
Morning Glory ◽  
Literature Analysis ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Morning Glory Disc Anomaly

AbstractSeveral extraorbital findings have been described in morning glory disc anomaly (MGDA), including optic pathway abnormalities. We want to emphasize the importance of looking for ipsilateral optic nerve and chiasm thickening in MGDA-affected patients because we think that it may be a relevant common associated finding to date not stressed by anyone. We report three cases of clinically diagnosed unilateral MGDA in which magnetic resonance imaging revealed enlargement of the ipsilateral optic nerve and chiasm. A literature analysis was made and previously reported MGDA cases, and case series were checked, looking for described, or misunderstood similar magnetic resonance imaging findings. Three other cases with very similar prechiasmatic optic nerve and chiasm findings were identified from the literature. Two further cases are discussed as possibly characterized by similar misinterpreted magnetic resonance features. Our study broadens the constellation of intra- and extraorbital findings of MGDA. Though magnetic resonance imaging is not sufficient to determine the neuropathological substrate of this finding, clinicians and radiologists should be aware of the possible association of MGDA with ipsilateral thickening of the optic nerve and chiasm, to properly plan the clinical and imaging follow-up.

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