scholarly journals Microfracture of subchondral bone leads to persistent subchondral sclerosis and poorer functional outcomes following distraction arthroplasty of the ankle joint while biologic augment may improve recovery times

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005 ◽  
Author(s):  
Arianna Gianakos ◽  
John Kennedy
Keyword(s):  
Subchondral Bone ◽  
Functional Outcomes ◽  
Demographic Data ◽  
Treatment Strategies ◽  
Joint Space ◽  
Additional Treatment ◽  
Biologic Agent ◽  
Distraction Arthroplasty ◽  
Return To Activity

Category: Ankle Arthritis Introduction/Purpose: Treatment of ankle osteoarthritis (OA) continues to remain a challenge. Previous reports have demonstrated the short-term benefits of using joint distraction for the treatment of ankle (OA), however, its efficacy in long term clinical outcomes and its role in preserving the joint space remains controversial. The purpose of this study is to establish whether microfracture or biologics improve the outcomes of ankle distraction. Methods: Records of patients that underwent an ankle distraction procedure between January 2009-December 2013 were retrospectively reviewed. Four groups were identified: Group 1: distraction with no additional treatment, Group 2: distraction with microfracture, Group 3: distraction with microfracture and BMAC/PRP, Group 4: distraction with BMAC/PRP. Demographic data was recorded. Pre-and-postoperative range of motion, Foot and Ankle Outcome Scores (FAOS), complication rate, and return to activity were evaluated. Radiographic images were used to assess the joint space changes pre-operatively and post-operatively. Global comparisons were performed using chi square testing, while individual between-group comparisons were made using robust, resistant regression and Wald tests. Results: Eighty-one patients with a mean age of 47 (range, 37-69) underwent ankle distraction with a mean follow up of 5 years (range, 3-6). All treatment strategies resulted in statistically significant improvements in FAOS (<0.001). Groups that underwent microfracture had a statistically significant decrease in post-operative plantarflexion, dorsiflexion, subtalar inversion and subtalar eversion (p=0.003) as well as an overall decrease in joint space (0.002) with persistence of subchondral bone sclerosis. Patients who underwent distraction with no microfracture treatment resulted in a significant increase in post-operative joint space (p=0.001) and decreased sclerosis in the subchondral bone. Average return to activity was 6 months in patients who received BMAC/PRP with ankle distraction compared to 12 months in patients who were treated with ankle distraction and microfracture (p<0.01). Conclusion: Distraction arthroplasty results in good functional outcomes at medium term follow up. The addition of microfracture seems to create functional outcome deterioration, whereas the addition of a biologic agent either BMAC or PRP appears to benefit earlier return to function. Longer-term studies will be required to see if these effects are sustained.

Spinal artery aneurysms: clinical presentation, radiological findings and outcome

2018 ◽  
Vol 10 (7) ◽  
pp. 644-648 ◽  
Author(s):  
Leonardo Renieri ◽  
Eytan Raz ◽  
Giuseppe Lanzino ◽  
Timo Krings ◽  
Maksim Shapiro ◽  
...  
Keyword(s):  
Back Pain ◽  
Retrospective Review ◽  
Clinical Presentation ◽  
Treated Patient ◽  
Demographic Data ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Imaging Characteristics ◽  
Arterial Aneurysms

Background and purposeSpinal arterial aneurysms are a rare cause of spinal subarachnoid hemorrhage (SAH). We performed a retrospective review of spinal arterial aneurysms not associated with spinal arteriovenus shunts from three institutions in order to better understand the clinical and imaging characteristics of these lesions.Materials and methodsWe performed a retrospective review of spinal arterial aneurysms managed at three North American institutions. For each patient, the following information was collected: demographic data, clinical presentation, comorbidities, imaging findings, and neurological status at the last follow-up. Treatment strategies and outcomes were reported.Results11 patients were included; 7 were women and median age was 60 years. The most common presentation was sudden back pain (81.8%). We found 3 aneurysms on the radiculomedullary artery and 8 along the radiculopial arteries. Of the 3 aneurysms on the radiculomedullary artery, 1 was treated conservatively, 1 was treated with coiling of the aneurysm and sacrifice of the radiculomedullary artery, and 1 was treated with surgical trapping. The 8 aneurysms on the radiculopial artery were treated endovascularly in 4 cases, surgically in 1 case, and conservatively in 3 cases. One surgically treated patient had a spinal subdural hematoma. There were no other complications. Mean clinical follow-up time was 20 months, and 87.5% of patients were functionally independent.ConclusionsSpinal arterial aneurysms are lesions which commonly present with sudden back pain and spinal SAH. Conservative, surgical, and endovascular treatment options are safe and effective. Long term outcomes in these patients are generally good.

scholarly journals The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

2012 ◽  
Vol 18 (4) ◽  
pp. 432-441 ◽  
Author(s):  
Y.K. Ihn ◽  
S.H. Kim ◽  
J.H. Sung ◽  
T-G. Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Additional Treatment ◽  
Stent Insertion ◽  
Supraclinoid Internal Carotid Artery

We report our experience with endovascular treatment and follow-up results of a ruptured blood blister-like aneurysm (BBA) in the supraclinoid internal carotid artery. We performed a retrospective review of ruptured blood blister-like aneurysm patients over a 30-month period. Seven patients (men/women, 2/5; mean age, 45.6 years) with ruptured BBAs were included from two different institutions. The angiographic findings, treatment strategies, and the clinical (modified Rankin Scale) and angiographic outcomes were retrospectively analyzed. All seven BBAs were located in the supraclinoid internal carotid artery. Four of them were ≥ 3 mm in largest diameter. Primary stent-assisted coiling was performed in six out of seven patients, and double stenting was done in one patient. In four patients, the coiling was augmented by overlapping stent insertion. Two patients experienced early re-hemorrhage, including one major fatal SAH. Complementary treatment was required in two patients, including coil embolization and covered-stent placement, respectively. Six of the seven BBAs showed complete or progressive occlusion at the time of late angiographic follow-up. The clinical midterm outcome was good (mRS scores, 0–1) in five patients. Stent-assisted coiling of a ruptured BBA is technically challenging but can be done with good midterm results. However, as early regrowth/re-rupture remains a problem, repeated, short-term angiographic follow-up is required so that additional treatment can be performed as needed.

scholarly journals Clinical Outcomes of Distraction Arthroplasty with Arthroscopic Microfracture for Advanced Stage Ankle Osteoarthritis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Yasunari Ikuta ◽  
Tomoyuki Nakasa ◽  
Yusuke Tsuyuguchi ◽  
Yuki Ota ◽  
Munekazu Kanemitsu ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Joint Space ◽  
Ankle Arthrodesis ◽  
Younger Patients ◽  
Distraction Arthroplasty ◽  
Arthroscopic Microfracture ◽  
Initial Surgery ◽  
Distraction Device ◽  
Active Patients

Category: Ankle Arthritis, Arthroscopy Introduction/Purpose: Ankle trauma is highly implicated in the etiology of osteoarthritis (OA) of the ankle, and posttraumatic ankle OA is often observed in younger patients. In advanced stages, ankle arthrodesis has been considered as a gold standard treatment, and total ankle arthroplasty is also developed over the past decade for older patients. However, the surgical treatment of severe ankle OA for younger, active patients remains challenging. Ankle distraction arthroplasty is an alternative option for treatment of severe ankle OA in younger patients. The distraction device enables joint distraction with ankle motion that induces cartilage repair of the ankle. This study aimed to clarify the clinical outcome of the ankle distraction arthroplasty with arthroscopic microfracture for ankle OA in younger patients. Methods: This retrospective analysis included 7 ankle OA patients who underwent distraction arthroplasty with arthroscopic microfracture, in 5 men and 2 women, with a mean age of 45.9 years (range, 39-62). Range of motion (ROM) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score were evaluated as the clinical outcomes. The talotibial joint space was identified as anterior, center and posterior segment on lateral view. The width of joint space in each segment was measured on pre- and post-operative weight-bearing radiographs. The distraction device was removed at 3 months after initial surgery, and second look arthroscopy was also performed at the same time. The arthroscopic findings were assessed retrospectively. Results: All 7 patients were followed with a mean follow-up period of 4.2 years. One patient who had the worst preoperative AOFAS score of 19 converted to arthroscopic ankle arthrodesis at 2 years after the initial surgery. The mean total ROM and AOFAS score improved from 29.3 to 37.1 (p = 0.028), from 41.7 to 76.1 (p = 0.018), respectively. Weight-bearing radiographs showed a width of ankle joint space with anterior, center and posterior of 1.9 mm, 1.8 mm, 2.0 mm at preoperative status and 2.9 mm, 2.8 mm, 2.9 mm at final follow-up status. Second look arthroscopy revealed that the fibrous cartilage like tissue covered the cartilage defect area at the talotibial joint in all patients. Conclusion: Our findings suggest that the distraction arthroplasty with arthroscopic microfracture could be a useful option for active patients with advanced stage of ankle OA. Good clinical status and the width of joint space had been preserved for a maximum of seven years. Further follow-up was required to elucidate the long-term clinical results.

Central Neurocytoma

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 407-414 ◽  
Author(s):  
Jin Wook Kim ◽  
Dong Gyu Kim ◽  
In Kyeong Kim ◽  
Yong Hwy Kim ◽  
Seung Hong Choi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Central Neurocytoma ◽  
Tumor Control ◽  
Seizure Outcome

Abstract BACKGROUND: A thorough investigation of the long-term outcomes of central neurocytoma (CN) after different treatments is required to establish optimal management strategies. OBJECTIVE We retrospectively reviewed the long-term clinical outcomes of patients with CN according to various treatments and suggest treatment strategies based on 30 years of experience in a single institution. METHODS: Fifty-eight consecutive patients with CN were treated at our institution between 1982 and 2008. Patient demographics, overall survival, local control rates according to multimodal treatments, and functional outcomes were evaluated. The mean clinical and radiological follow-up periods were 119 months (range, 18-304 months) and 98 months (range, 13-245 months), respectively. RESULTS: The initial treatment modality was classified into 4 subgroups: operation only (34 patients), operation followed by radiation therapy (7 patients) or radiosurgery (7 patients), and radiosurgery alone (10 patients). The actuarial overall survival was 91% at 5 years and 88% at 10 years. The actuarial overall survival and local tumor control rate did not differ significantly according to the various treatments and the initial extent of the surgical resection. However, functional outcomes, such as the postoperative seizure outcome at the last follow-up, differed according to the surgical approach. CONCLUSION: The long-term clinical outcomes of CN after multimodal treatment seem to be excellent. Our study suggests that treatment strategies for CN should focus on the patient's quality of life, as well as on tumor control, because of the benign nature of CN.

scholarly journals Functional Analysis of Distraction Arthroplasty in the Treatment of Ankle Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Liang Xiaojun ◽  
Zhao Hong-Mou
Keyword(s):  
Ankle Joint ◽  
Failure Rate ◽  
Functional Outcomes ◽  
Joint Space ◽  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Significant Difference ◽  
And Gender ◽  
American Orthopaedic ◽  
Relative Factors

Category: Ankle Arthritis Introduction/Purpose: Ankle joint distraction arthroplasty (AJDA) is an alternative surgical procedure for the management of moderate to severe ankle osteoarthritis. However, the benefit of this procedure and failure relative factors are still in debate. The purpose of current study was to evaluate the functional outcomes of AJDA in treatment of moderate to severe ankle OA; and to evaluate the relative factors correlated with treatment failure. Methods: Forty-six van Dijk stage II and III ankle osteoarthritis patients were included. Fifteen males and 31 females with a mean age of 54.8 (range, 42-71) years were followed with a mean of 42.8 (range, 24-68) months. The Ankle Osteoarthritis Scale (AOS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score were used for functional outcomes evaluation. The talar tilt (TT) angle and ankle joint space distance (AJSD) were evaluated. The risk ratio (RR) was calculated for each potential failure relative factor. Results: The AOS and AOFAS scores were significantly improved at the last followup time (P＜0.01). The AJSD was improved in 61% of patients, and with a significant improvement compared with the preoperative conditions (P＜0.01). The TT angle and range of motion reached no significant difference. The failure rate was 21.7%. Patients with large TT (>=5°) angle (RR=3.81, 95%CI: 1.28-11.33, P=0.02) and obesity (RR=3.58, 95%CI: 1.30-9.89, P=0.01) were found have positive correlation with failure. No correlation was found between failure and gender, or overweight, or side, or age, or type and stage of OA, or pin infection. Conclusion: Current study confirmed the early functional outcomes of ankle distraction arthroplasty. However, this procedure still has a relatively high failure rate, especially for those obesity patients and the patients with large TT angles.

Effect of Microfracture on Functional Outcomes and Subchondral Sclerosis Following Distraction Arthroplasty of the Ankle Joint

2020 ◽  
Vol 41 (6) ◽  
pp. 631-638
Author(s):  
Arianna L. Gianakos ◽  
R. Sterling Haring ◽  
Yoshiharu Shimozono ◽  
Austin Fragomen ◽  
John G. Kennedy
Keyword(s):  
Ankle Joint ◽  
Demographic Data ◽  
Joint Space ◽  
Ankle Arthrodesis ◽  
Activity Levels ◽  
Level Of Evidence ◽  
Distraction Arthroplasty ◽  
Concentrated Bone Marrow ◽  
Post Traumatic ◽  
End Stage

Background: Treatment for post-traumatic osteoarthritis (PTOA) of the ankle remains challenging. Distraction arthroplasty (DA) is an alternative for patients who are averse to or poor candidates for arthrodesis or joint replacement. The purpose of this study was to examine the role of microfracture (MFX) and concentrated bone marrow aspirate (CBMA) on the outcome of patients undergoing DA for end-stage PTOA of the ankle joint. Methods: Ninety-five patients who underwent DA for the treatment of end stage PTOA from 2009 to 2014 were selected from the hospital ankle registry. Demographic data, functional activity levels, complications, and radiographs taken at 6, 12, 24, and 36 months postoperatively were reviewed. Foot and Ankle Outcome Scores (FAOS) were obtained at the same time intervals. A total of 78 patients were included in this study. Interventions were divided into 4 groups for comparison: DA+MFX (n = 8), DA+MFX+CBMA (n = 35), DA+CBMA (n = 22), and DA alone (n = 13). Results: Patients undergoing DA+MFX or DA+MFX+CBMA had significantly worse motion ( P = .003) when compared with DA alone. Patients undergoing MFX had significantly reduced postoperative joint space and a greater length of time to return to activity when compared to subgroups not using MFX ( P = .01). The use of MFX was associated with significantly lower FAOS scores. Conclusion: The current study showed no benefit from MFX when combined with DA in the treatment of PTOA. CBMA may have helped mitigate the adverse effect of MFX but conferred no benefit when used with DA alone. DA remains a useful alternative to ankle arthrodesis and arthroplasty in patients with PTOA. However, MFX and biologic augmentation using CBMA appeared to have no additional benefit. Level of Evidence: Level III, comparative study.

QOLP-31. QUALITY OF LIFE OF PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA DURING TTFIELDS THERAPY IN ROUTINE CLINICAL CARE: FIRST RESULTS OF THE TIGER STUDY

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi189-vi190
Author(s):  
Oliver Bähr ◽  
Ghazaleh Tabatabai ◽  
Rainer Fietkau ◽  
Roland Goldbrunner ◽  
Martin Glas
Keyword(s):  
Quality Of Life ◽  
Clinical Care ◽  
Demographic Data ◽  
Treatment Compliance ◽  
Additional Treatment ◽  
Phase Iii ◽  
Interdisciplinary Treatment ◽  
Routine Clinical Care

Abstract OBJECTIVE Current interdisciplinary treatment strategies for glioblastoma (GBM) outside clinical trials include maximally safe resection, followed by radiation and chemotherapy. The results of the positive phase III trial EF-14, adding Tumor Treating Fields (TTFields) to temozolomide (TMZ) maintenance therapy, brought an additional treatment method to clinical routine. The TIGER (TTFields In GErmany in Routine Clinical Care) study documents the use of TTFields in routine clinical care with a focus on health-related quality of life (HRQoL) within 4 months after starting therapy, treatment compliance and duration. METHODS This multi-center, prospective, non-interventional study in Germany (NCT03258021) included ndGBM patients eligible for TTFields therapy. Following their consent, patients received a comprehensive introduction to the therapy and baseline demographic data were collected. Information on TTFields therapy decision was evaluated based on a dedicated TTFields questionnaire at baseline in both arms; follow-up information on how patients handle the therapy was collected two months after TTFields treatment start. HRQoL was assessed in patients deciding for TTFields therapy at baseline and at 2 and 4 months using the EORTC-QLQ-C30/BN-20 questionnaires. RESULTS Between August 2017 and November 2019, 710 patients (259 female/451 male) were enrolled at 81 participating centers. The mean age was 58.5 years (range: 19.0-85.0; Cut-off: August 31, 2020). The overall baseline characteristics of the study group reflects a typical GBM population. Of these, 582 (82%) decided to start TTFields; 128 (18%) refused TTFields treatment. HRQoL did not decline during TTFields therapy except for itchy skin, comparable to the EF-14 trial. A detailed analysis of the cohort as well as their reported QoL will be presented. CONCLUSION The TIGER study is the largest non-interventional trial on the use of TTFields in routine clinical care. The use of TTFields in patients with ndGBM did not impair HRQoL during the follow-up period, except for more itchy skin.

scholarly journals Conservative Treatment Versus Repair Deltoid in SER Type IV Equivalent Ankle Fracture

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0000
Author(s):  
Chamnanni Rungprai
Keyword(s):  
Conservative Treatment ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Deltoid Ligament ◽  
Medial Side ◽  
Type Iv ◽  
Sf 36 ◽  
Fibular Fixation ◽  
Return To Activity

Category: Trauma Introduction/Purpose: There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. The purpose of this study was to report clinical and functional outcomes including complications between the two methods. Methods: A prospective, randomized collected data of 41 consecutive patients who were diagnosed with SER type IV equivalence acute ankle fracture and underwent either conservative treatment (20 patients) or deltoid repair (21 patients) between 2015 and 2017. A minimum follow up to be included in the study was 6 months (mean, 13.2 months; range, 6 to 30 months). The primary outcome was visual analogue scale (VAS), Short Form-36 (SF-36); physical and mental component scores, and FAAM; ADL and Sport. Pre- and post-operative SF-36, FAAM, and pain (Visual Analog Scale) were obtained and compared between the two groups using independent t-test. The secondary outcomes were time to return to activity of daily living, sports, work, and complications. Results: There were 41 patients (30 male and 11 female) with mean age of 29.7 years (range, 18-70 years) and mean BMI of 26.7 kg/m2 (range, 18.3-33.6 kg/m2). Both methods demonstrated significant improvement of post-operative functional outcomes (FAAM, SF-36, and VAS (p < 0.05 all)) compared to pre-operative period; however, there was no significant different between the two groups. Functional outcomes between casting and deltoid repair groups were time to return to activity of daily living (10.4 vs 11.7 weeks), works (12.1 vs 12.9 weeks), sport (25.9 vs 23.7 weeks), weight bearing medial clear space (2.9 vs 3.9 mm), and complications included medial side ankle pain (57 vs 15%) and painful scar (0 vs 15%) for cast and deltoid repair respectively. Conclusion: Both casting and deltoid repair were demonstrated significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS in patients with SER IV equivalent ankle fracture. Although there was no significant difference of functional outcome in short term of follow-up, deltoid repair group was better in term of medial side ankle pain and lesser medial clear space widening.

Outcomes Following Posterior and Posterolateral Plating of Distal Fibula Fractures

2018 ◽  
Vol 12 (3) ◽  
pp. 246-252 ◽  
Author(s):  
Danica D. Vance ◽  
Hasani W. Swindell ◽  
Justin K. Greisberg ◽  
James T. Vosseller
Keyword(s):  
Functional Outcomes ◽  
Demographic Data ◽  
Tendon Injury ◽  
Hardware Removal ◽  
Peroneal Tendon ◽  
Ankle Pain ◽  
Distal Fibula ◽  
Lateral Posterior ◽  
Fibular Fixation

Ankle fractures are common orthopaedic injuries often requiring open reduction and internal fixation. A variety of positions for plate placement exist for surgical fixation of distal fibula fractures, including direct lateral, posterior, or posterolateral. Direct lateral is more common, despite evidence that posterior and posterolateral placement is mechanically superior. However, concern for peroneal tendon injury from posterior plating remains. Our study investigates clinical and functional outcomes of patients who underwent operative fixation of distal fibula fractures with posterior or posterolateral plating over a 3-year period. Analyses were performed on 59 patients with at least 2 years of follow-up. Questionnaires were used to obtain demographic data, in addition to information regarding the presence of ankle pain, subsequent hardware removal, and Foot and Ankle Outcome Scores (FAOS). In patients with at least 2 years of follow-up (average 39.6 ± 10.6 months), 37.2% reported ongoing ankle pain; 11 patients underwent hardware removal (18.6%), with 8 patients undergoing removal because of hardware-related pain (13.6%). FAOS scores (n = 51) were as follows: pain (79.9 ± 22.3), activities of daily living (84.2 ± 22.6), symptoms (75.7 ± 23.5), sports (69.4 ± 31.6), and quality of life (58.3 ± 30.5). Posterior and posterolateral plating achieved good clinical and high functional outcomes across our study population. The percentage of hardware removal in our study was either equivalent to, or less than, historical controls for any type of fibular fixation, and removal may be helpful for those patients whose postoperative ankle pain is subjectively related to the hardware. Levels of Evidence: Therapeutic, Level IV: Retrospective

Arthroscopic Lateral Retinacular Release and Modified Elmslie–Trillat Operation Improve Severe Isolated Lateral Patello-Femoral Osteoarthritis

2016 ◽  
Vol 30 (06) ◽  
pp. 514-522 ◽  
Author(s):  
Renn-Chia Lin ◽  
Ko-Huang Lue ◽  
Ko-Hsiu Lu
Keyword(s):  
Bone Remodeling ◽  
Subchondral Bone ◽  
Arthroscopic Surgery ◽  
Joint Space ◽  
Tibial Tubercle ◽  
Lateral Retinacular Release ◽  
The Mean ◽  
Anterior Knee ◽  
Patellar Thickness

AbstractTo evaluate whether arthroscopic lateral retinacular release and the modified Elmslie–Trillat operation improve osteoarthritis (OA) progression and clinical outcomes in patients with severe isolated lateral patello-femoral OA. Nine women (11 knees) and one man (one knee) with isolated late-stage lateral patello-femoral OA underwent surgery. The severity of patello-femoral OA was recorded using the Merchant method, while the level of pain and anterior knee function were scored using the visual analogue scale (VAS) and Kujala knee scores, respectively. The articular cartilage was graded under arthroscopy using the Outerbridge classification. All of the patients underwent the modified Elmslie–Trillat operation after arthroscopic surgery, including lateral retinacular release. Ten patients (12 knees) had a mean 6.45 ± 0.80 mm of medial transfer, 6.02 ± 0.80 mm of anterior transfer of the tibial tubercle, and follow-up of 67.0 months. The mean VAS and Kujala knee scores improved from 8 ± 0.17 preoperatively to 2.33 ± 0.33 on the last follow-up and from 43.08 ± 2.09 to 68.83 ± 2.59, respectively (both p < 0.001). Postoperatively, all had improved subchondral bone remodeling, including cyst resolution, density and trabeculae normalization, and subchondral smoothing in the patello-femoral compartment. The patello-femoral joint space and patellar thickness increased from 0.39 ± 0.16 mm to 1.77 ± 0.18 mm and from 18.28 ± 0.67 mm to 19.60 ± 0.69 mm, respectively (p < 0.001 and p = 0.005). Treatment of severe isolated lateral patello-femoral OA using arthroscopic lateral retinacular release and the modified Elmslie–Trillat operation can improve pain relief, functional outcomes, and subchondral bone remodeling, and also restore the patello-femoral joint space and patellar thickness. Prompt transfer of the tibial tubercle seems to reverse the progress of OA radiographically.

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