scholarly journals Clinical and Radiographic Outcomes After Fixation of Chondral Fragments of the Knee in 6 Adolescents Using Autologous Bone Pegs

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096305
Author(s):  
Takahiro Ogura ◽  
Hiroki Sakai ◽  
Shigehiro Asai ◽  
Hideaki Fukuda ◽  
Tatsuya Takahashi ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Full Range ◽  
Cartilage Tissue ◽  
Trochlear Groove ◽  
Repair Tissue ◽  
Radiographic Outcomes ◽  
The Mean ◽  
Autologous Bone

Background: Little is known regarding the optimal treatment for displaced, purely chondral fragments in the knee. Purpose: To report the clinical and radiographic outcomes of chondral fragment fixation in adolescents through use of autologous bone pegs. Study Design: Case series; Level of evidence, 4. Methods: This retrospective, single-center study evaluated 6 patients (mean age, 12.9 years) who underwent fixation of chondral fragments (no visualized bone attached) using autologous bone pegs (mean postoperative follow-up, 5.2 years; range, 1.4-10.9 years). The causes were trauma (n = 5) and osteochondritis dissecans (n = 1). Lesions were located in the trochlear groove (lateral, n = 3; medial, n = 2) or posterior part of the lateral femoral condyle (n = 1). The mean lesion size was 3.8 cm2 (range, 0.8-9.0 cm2). Patients were evaluated via physical examination and magnetic resonance imaging (MRI) using magnetic resonance observation of cartilage repair tissue scores. Results: In total, 5 patients successfully returned to sports without restrictions at a mean of 7 months (range, 6-8 months) postoperatively. At the latest follow-up, these 5 patients had full range of motion and no joint effusion. The mean magnetic resonance observation of cartilage repair tissue score was 85 (range, 70-95) at a mean duration of 3 years (range, 1-5 years). One patient experienced failure at 1.3 years postoperatively after a traumatic injury and subsequently underwent removal of the fixed fragment and a drilling procedure. Conclusion: In most adolescents, fixation of chondral fragments with no visualized bony portion using autologous bone pegs provided a satisfactory success rate and good healing of cartilage tissue confirmed on MRI scans.

scholarly journals Outcomes Following Microfracture for Osteochondral Lesions of the Talus in Female Patients

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Emilie Williamson ◽  
Arianna L. Gianakos ◽  
Eoghan T. Hurley ◽  
John G. Kennedy
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Short Form ◽  
Osteochondral Lesions ◽  
Bone Marrow Stimulation ◽  
Repair Tissue ◽  
Female Patients ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: Microfracture (Mfx) is typically indicated for patients who have symptomatic osteochondral lesions of the talus (OLT) which are smaller in size. However, there is scant literature focusing exclusively on female patients, who may require specific consideration as compared to male counterparts. The purpose of this study was to evaluate the outcomes of Mfx in the treatment of OLT in the females population. Methods: A retrospective analysis comparing patients treated with Mfx for OLT was performed, to include all patients treated between 2007 and 2015. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging (MRI) at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Results: Thirty-one females were included. The mean patient age was 39.6 +- 17.2 years with mean follow-up of 48.4 +- 24.8 months. The mean preoperative and postoperative FAOS score was 53.3 +- 22.9 and 73.2 +- 18.2 (p < 0.001), and the mean preoperative and postoperative SF-12 score was 40.6 +- 11.1 and 56 +- 15.1 (p < 0.001). The final MOCART score was 59.3 +-24.5. Overall, 6 (19.4%) patients required a further surgery, 4 patients (12.9%) were considered failures, 2 (6.5%) patients required a distraction arthroplasty and 2 patients (6.5%) required a repeat bone marrow stimulation. Conclusion: The outcomes following Mfx for OLT in females were good at mid term follow up. However, the final MOCART scores were poor, indicating poor cartilage repair tissue and a poor harbinger for long term outcomes.

scholarly journals Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110074
Author(s):  
Jakob Ackermann ◽  
Fabio A. Casari ◽  
Christoph Germann ◽  
Lizzy Weigelt ◽  
Stephan H. Wirth ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Ankle Instability ◽  
Lesion Size ◽  
Lateral Ligament ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

scholarly journals Arthroscopic Management for the Unstable Inferior Leaf of the Lateral Meniscus Anterior Horn and Associated Cysts through a Direct Inframeniscal Portal: A Retrospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Dongyang Chen ◽  
Qiangqiang Li ◽  
Ye Sun ◽  
Jianghui Qin ◽  
Yao Yao ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Full Range ◽  
Lateral Meniscus ◽  
Clinical Results ◽  
Anterior Horn ◽  
Arthroscopic Management ◽  
The Mean ◽  
Magnetic Resonance Scanning ◽  
One Year

Introduction. To investigate the clinical results of arthroscopic management for the unstable inferior leaf of the lateral meniscus anterior horn and associated cysts through an inframeniscal portal. Methods. From March 2005 to October 2014, 64 patients with an unstable inferior leaf of the lateral meniscus anterior horn and associated cysts underwent arthroscopic management with an inframeniscal portal. The mean age of the patients was 36.9 years (range, 18 to 49 years). The mean follow-up period was 28 months (range, 24 to 44 months). Clinical results were assessed using physical examination, the Lysholm knee score, and postoperative magnetic resonance scanning. Results. The median Lysholm score improved significantly at 1 year after surgery and at final follow-up. Magnetic resonance scanning at least one year after the operation revealed no recurrent meniscal tears or cysts. No reoperations were required after an average follow-up of 28 months. All patients reported significant symptomatic relief after the operation. They had full range of motion at three months and returned to normal activities and sports one year after surgery. Conclusion. The direct inframeniscal portal can provide an effective approach to manage lesions in the anterior horn of the lateral meniscus with predictable clinical outcomes.

scholarly journals Arthroscopic Microfracture Alone or Combined Application of Acellular Scaffold: Which One is More Effective in the Treatment of Osteochondral Lesions of the Talus

2021 ◽  
Author(s):  
Bertan Cengiz ◽  
Ramin Moradi
Keyword(s):  
Cartilage Repair ◽  
Preoperative Assessment ◽  
Single Step ◽  
Osteochondral Lesions ◽  
Repair Tissue ◽  
Combined Application ◽  
Arthroscopic Microfracture ◽  
Significant Difference ◽  
The Mean

Abstract Background: In this study, it was aimed to compare the clinical and radiological outcomes of the single-step arthroscopic microfracture (AMFx) repair procedure and the combined application of AMFx and cell-free scaffold (CFS) in the treatment of talar osteochondral lesions (TOLs).Methods: This retrospective study included patients presenting with a TOL larger than 1.5 cm2 and smaller than 3 cm2 between March 2015 and June 2018 who received arthroscopic treatment and attended follow-up for a period of at least 24 months. Eighteen patients (group 1) had been treated with the AMFx method and 16 patients (group 2) with AMFx + CFS application. American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS), and Tegner Activity Scores. magnetic resonance observation of cartilage repair tissue (MOCART) score was used to assess cartilage repair tissue.Results: The mean patient age was 33.47±8.67 and the mean follow-up time was 32.24±9.33 months. In terms of the two groups, there was no significant difference in terms of age (p=0.984), body mass index (p=0.450), defect size (p = 0.081) and follow-up time (p = 0.484). The median AOFAS score increased in the AMFx group (p<0.001) and in the AMFx+CFS group (p<0.001), from preoperative assessment until follow-up assessment at 12 months. The treatment groups were not superior to each other in terms of clinical scores (p>0.05). The two groups were also similar with respect to the components of the MOCART score.Conclusion: Comparisons revealed that outcomes at the end of 24-month follow-up were similar. Therefore, TOLs appear to benefit similarly from the AMFx and AMFx + CFS techniques.

Combined Bone Marrow Aspirate and Platelet-Rich Plasma for Cartilage Repair: Two-Year Clinical Results

Cartilage ◽  
2019 ◽  
pp. 194760351987632 ◽  
Author(s):  
Kris Hede ◽  
Bjørn B. Christensen ◽  
Jonas Jensen ◽  
Casper B. Foldager ◽  
Martin Lind
Keyword(s):  
Bone Marrow ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Cartilage Repair ◽  
Bone Marrow Aspirate ◽  
Platelet Rich Plasma ◽  
Collagen Scaffold ◽  
Repair Tissue ◽  
Outcome Scores

Purpose To evaluate the clinical and biological outcome of combined bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) on a collagen scaffold for treating cartilage lesions in the knee. Methods and Materials Ten patients (mean age 29.4 years, range 18-36) suffering from large full-thickness cartilage in the knee were treated with BMAC and PRP from January 2015 to December 2016. In a 1-step procedure autologous BMAC and PRP was seeded onto a collagen scaffold and sutured into the debrided defect. Patients were evaluated by clinical outcome scores (IKDC [International Knee Documentation Committee Subjective Knee Form], KOOS [Knee Injury and Osteoarthritis Outcome Score], and pain score using the Numeric Rating Scale [NRS]) preoperatively, after 3 months, and after 1 and 2 years. Second-look arthroscopies were performed ( n = 7) with biopsies of the repair tissue for histology. All patients had magnetic resonance imaging (MRI) preoperatively, after 1 year, and after 2 to 3.5 years with MOCART (magnetic resonance observation of cartilage repair tissue) scores evaluating cartilage repair. Results After 1 year significant improvements were found in IKDC, KOOS symptoms, KOOS ADL (Activities of Daily Living), KOOS QOL (Quality of Life), and pain at activity. At the latest follow-up significant improvements were seen in IKDC, KOOS symptoms, KOOS QOL, pain at rest, and pain at activity. MRI MOCART score for cartilage repair improved significantly from baseline to 1-year follow-up. Histomorphometry of repair tissue demonstrated a mixture of fibrous tissue (58%) and fibrocartilage (40%). Conclusion Treatment of cartilage injuries using combined BMAC and PRP improved subjective clinical outcome scores and pain scores at 1 and 2 years postoperatively. MRI and histology indicated repair tissue inferior to the native hyaline cartilage.

Treatment of Knee Osteochondritis Dissecans With a Cell-Free Biomimetic Osteochondral Scaffold: Clinical and Imaging Findings at Midterm Follow-up

2017 ◽  
Vol 46 (2) ◽  
pp. 314-321 ◽  
Author(s):  
Francesco Perdisa ◽  
Elizaveta Kon ◽  
Andrea Sessa ◽  
Luca Andriolo ◽  
Maurizio Busacca ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Subchondral Bone ◽  
Osteochondritis Dissecans ◽  
Osteochondral Scaffold ◽  
Imaging Results ◽  
The Mean ◽  
Tegner Score ◽  
Over Time

Background: Osteochondritis dissecans (OCD) is a developmental condition of subchondral bone that may result in secondary separation and instability of the overlying articular cartilage, which in turn may lead to degeneration of the overall joint and early osteoarthritis. Biphasic scaffolds have been developed to address defects of the entire osteochondral unit by reproducing the different biological and functional requirements and guiding the growth of both bone and cartilage. Purpose: To evaluate midterm clinical and imaging results after cell-free osteochondral scaffold implantation for the treatment of knee OCD. Study Design: Case series; Level of evidence, 4. Methods: Twenty-seven patients (8 women, 19 men; mean age, 25.5 ± 7.7 years) were treated for knee OCD, with International Cartilage Repair Society (ICRS) grade 3 to 4 lesions with a mean size of 3.4 ± 2.2 cm2 (range, 1.5-12 cm2), and prospectively evaluated for up to 5 years using the ICRS classification system and the Tegner score. Eighteen patients underwent magnetic resonance imaging (MRI) at 24 and 60 months of follow-up, and the graft was evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score for the cartilage layer, while a specific score was used for subchondral bone. Results: All patients significantly improved their clinical scores at each follow-up until their final evaluation. The mean International Knee Documentation Committee (IKDC) subjective score improved from 48.4 ± 17.8 to 82.2 ± 12.2 at 2 years ( P < .0005), and it then remained stable for up to 5 years postoperatively (90.1 ± 12.0). The mean Tegner score increased from 2.4 ± 1.7 preoperatively to 4.4 ± 1.6 at 2 years ( P = .001), with a further increase up to 5.0 ± 1.7 at 5 years of follow-up ( P < .0005 vs preoperatively), reaching almost the preinjury level (5.7 ± 2.2). The MOCART score showed stable results between 24 and 60 months, whereas the subchondral bone status significantly improved over time. No correlation was found between MRI findings and clinical outcomes. Conclusion: This 1-step cell-free scaffold implantation procedure showed good and stable results for up to 60 months of follow-up for the treatment of knee OCD. MRI showed abnormalities, in particular at the subchondral bone level, but there was an overall improvement of features over time. No correlation was found between imaging and clinical findings.

scholarly journals Chondral and Osteochondral Femoral Cartilage Lesions Treated with GelrinC: Significant Improvement of Radiological Outcome Over Time and Zonal Variation of the Repair Tissue Based on T2 Mapping at 24 Months

Cartilage ◽  
2020 ◽  
pp. 194760352092670
Author(s):  
Markus M. Schreiner ◽  
Marcus Raudner ◽  
Pavol Szomolanyi ◽  
Kitty Ohel ◽  
Livnat Ben-Zur ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Osteochondral Lesions ◽  
Resonance Imaging ◽  
Repair Tissue ◽  
Cartilage Lesions ◽  
Femoral Cartilage ◽  
Magnetic Resonance Imaging Mri

Objective To prospectively assess the efficacy of GelrinC in the treatment of chondral and osteochondral femoral cartilage lesions using morphological (Magnetic Resonance Observation of Cartilage Repair Tissue [MOCART]) and quantitative (T2-mapping) magnetic resonance imaging (MRI). Design This study was designed as a prospective single-arm, open label, multicenter study. Morphological magnetic resonance imaging (MRI) for MOCART assessment and T2 mapping was performed 1 week and 6, 12, 18, and 24 months after GelrinC implantation. Evaluation of T2 mapping was based on the assessment of global T2 indices (T2 of the repair tissue [RT] divided by T2 of healthy reference cartilage) and zonal variation. Results Fifty-six (20 female) patients were prospectively enrolled. The mean MOCART score significantly increased from baseline to the 24-month follow-up with 88.8 (95% CI, 85.8-91.9; P < 0.001) for all lesions combined as well as 86.8 (95% CI, 83.0-90.6) for chondral lesions and 94.1 (95% CI, 68.55-100) for osteochondral lesions. Furthermore, based on T2 mapping, significant zonal variation of the RT was observed at 24 months ( P = 0.039), which did not differ significantly from healthy reference cartilage ( P = 0.6). Conclusion Increasing MOCART scores were observed throughout the follow-up period, indicative of maturation of the cartilage repair. Significant zonal variation of the RT at 24 months might indicate the transformation into hyaline cartilage–like RT. Slightly differing morphological outcome between chondral and osteochondral lesions, but similar global and zonal T2 indices at 24 months, support the potential of GelrinC as a treatment option for both lesion types.

No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽  
2021 ◽  
pp. 194760352110219
Author(s):  
Danielle H. Markus ◽  
Anna M. Blaeser ◽  
Eoghan T. Hurley ◽  
Brian J. Mannino ◽  
Kirk A. Campbell ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Lesion Size ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

All-Arthroscopic Autologous Matrix-Induced Chondrogenesis-Aided Repair of a Patellar Cartilage Defect Using Dry Arthroscopy and a Retraction System

2017 ◽  
Vol 30 (09) ◽  
pp. 925-929 ◽  
Author(s):  
Mariusz Puszkarz ◽  
Lidia Kosmalska ◽  
Martin Wiewiorski ◽  
Boguslaw Sadlik
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Case Series ◽  
Collagen Matrix ◽  
International Knee Documentation Committee ◽  
Level Of Evidence ◽  
Patellar Cartilage ◽  
Radiological Data ◽  
Implantation Techniques

AbstractThe technique of all-arthroscopic autologous matrix-induced chondrogenesis (AMIC)-aided repair of patellar cartilage lesions using a retraction system and dry arthroscopy has been recently described. We report the first clinical and radiological data at a short-term follow-up. Twelve patients underwent AMIC-aided cartilage repair for a patellar lesion. All steps of the procedure were performed arthroscopically, which include the use of an intra-articularly placed retraction plate for distraction of the patellofemoral joint and evacuation of saline solution for collagen matrix insertion and fixation. Clinical assessment performed before surgery and at a mean follow-up time of 38 months (range: 24–70) included the following scores: Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and visual analog scale (VAS). Magnetic resonance imaging was performed at the follow-up examination, including the magnetic resonance observation of cartilage repair tissue (MOCART) score. The mean KOOS and IKDC scores increased significantly (p < 0.01) from 50.3 and 37.4 points preoperatively to 90.1 and 79.4 postoperatively. The VAS score decreased from 7.8 to 2.3 points. Mean MOCART score at follow-up was 58.3 points. Cartilage repair of patellar lesions aided by a retraction system in a dry arthroscopy setup is a promising approach. Further studies are needed to evaluate this procedure and compare it to existing matrix implantation techniques. The level of evidence for the study is 4 (case series).

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