scholarly journals The Effect of Containment Type on Clinical Outcome in Osteochondral Lesions of the Talus Treated with Autologous Osteochondral Transplantation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0011
Author(s):  
Yoshiharu Shimozono ◽  
Youichi Yasui ◽  
Joseph Nguyen ◽  
John Kennedy
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Multivariate Regression ◽  
Regression Models ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
Predictors Of Outcome ◽  
Autologous Osteochondral Transplantation ◽  
The Mean

Category: Ankle Introduction/Purpose: Operative management for osteochondral lesions of the talus (OLT) can be broadly divided into reparative techniques, including bone marrow stimulation (BMS), and replacement techniques, including autologous osteochondral transplantation (AOT). Predictors of outcome of BMS have been established as lesion size, containment of the lesion, and previous surgery. Predictors of outcome of AOT or allograft transplantation have been established as body mass index and the requirement for greater than 2 grafts. However, containment of the lesions has not been assessed as a predictor of outcome in patients undergoing AOT to date. Therefore, the purpose of the current study is to clarify the effect of the containment of OLT on clinical and radiological outcomes in patients who underwent AOT procedure for the treatment of OLT. Methods: A retrospective cohort study comparing patients with contained type and uncontained type OLT was undertaken, to include all patients who underwent AOT procedure for the treatment of OLT between 2006 and 2014. Analyses were performed by grouping the patients according to the containment type, location, and both the type of containment and location. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12) preoperatively and at the final follow-up. Magnetic resonance imaging (MRI) at 2 years follow-up was evaluated with modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Comparisons between groups were made with the Man-Whitney U test for continuous variables and the?2 or Fisher exact test for categorical variables. Multivariate regression models were used to evaluate factors affecting postoperative FAOS, SF-12 and MOCART scores. A value of p < 0.05 was considered statistically significant. Results: Ninety-four patients were included, with 31 with a contained type OLT and 63 with an uncontained type OLT. The median follow-up time were 45 months in contained type and 52 months in uncontained type. The mean FAOS and SF-12 improved significantly after surgery in both contained and uncontained lesions (p<0.001). The mean postoperative FAOS in contained type was higher than uncontained type (89.5 vs 80.2, p=0.009), but no significant differences were found between uncontained and contained type in postoperative SF-12 and MOCART score. The multivariate regression models showed that patients with contained type OLT had approximately 10 points better scores in FAOS compared to uncontained type (p=0.006) (Table 1). Patients who had previous microfracture performed worse postoperative FAOS than those who did not (p =0.004). Conclusion: Patients with contained type OLT experienced better clinical outcomes than those with uncontained type OLT following AOT procedure for the treatment of OLT. However, the AOT procedure still provided good clinical and MRI outcomes in both contained type and uncontained type OLT at the mid-term follow-up.

Effect of the Containment Type on Clinical Outcomes in Osteochondral Lesions of the Talus Treated With Autologous Osteochondral Transplantation

2018 ◽  
Vol 46 (9) ◽  
pp. 2096-2102 ◽  
Author(s):  
Yoshiharu Shimozono ◽  
Johanna C.E. Donders ◽  
Youichi Yasui ◽  
Eoghan T. Hurley ◽  
Timothy W. Deyer ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Multivariate Regression ◽  
Regression Models ◽  
Short Form ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Type Group

Background: Uncontained-type osteochondral lesions of the talus (OLTs) have been shown to have inferior clinical outcomes after treatment with bone marrow stimulation. While autologous osteochondral transplantation (AOT) is indicated for larger lesions, no study has reported on the prognostic significance of the containment of OLTs treated with the AOT procedure. Purpose: To clarify the effect of the containment of OLTs on clinical and radiological outcomes in patients who underwent AOT for OLTs. Study Design: Case control study; Level of evidence, 3. Methods: A retrospective cohort study comparing patients with contained-type and uncontained-type OLTs was undertaken to include all patients who underwent AOT for the treatment of OLTs between 2006 and 2014. Analyses were performed by grouping the patients according to the containment type. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and the 12-Item Short Form Health Survey (SF-12) preoperatively and at final follow-up. Magnetic resonance imaging (MRI) at 2 years’ follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Multivariate regression models were used to evaluate factors affecting postoperative FAOS, SF-12, and MOCART scores. Results: Ninety-four patients were included: 31 patients with a contained-type OLT and 63 patients with an uncontained-type OLT. The median patient age was 34 years (interquartile range [IQR], 28-48 years) in the contained-type group and 36 years (IQR, 27-46 years) in the uncontained-type group. The median follow-up time was 45 months (IQR, 38-63 months) in the contained-type group and 52 months (IQR, 40-66 months) in the uncontained-type group. The median FAOS and SF-12 scores improved significantly after surgery in both contained-type and uncontained-type lesions ( P < .001). The median postoperative FAOS score of patients with contained-type OLTs was higher than that of patients with uncontained-type OLTs (91.7 vs 85.0, respectively; P = .009), but no significant differences were found between the contained-type and uncontained-type groups for postoperative SF-12 and MOCART scores. The multivariate regression models showed that patients with contained-type OLTs had an approximately 10-point better score on the FAOS compared with patients with uncontained-type OLTs ( P = .006). There was a nonsignificant trend for the rate of cystic occurrence in uncontained-type OLTs to be higher than that of contained-type OLTs (55.6% vs 38.7%, respectively; P = .125). Conclusion: Patients with contained-type OLTs experienced better clinical outcomes than those with uncontained-type OLTs after AOT for the treatment of OLTs. However, the AOT procedure still provided good clinical and MRI outcomes in both contained-type and uncontained-type OLTs at midterm follow-up.

scholarly journals Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Gender Impact Outcomes?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Arianna L. Gianakos ◽  
Olasunmbo Okedele ◽  
Sean Flynn ◽  
John G. Kennedy ◽  
Christopher W. DiGiovanni
Keyword(s):  
Osteochondral Lesions ◽  
Symptom Duration ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Duration Of Symptoms ◽  
Male And Female ◽  
Female Patients ◽  
Male Patients ◽  
The Mean

Category: Ankle; Arthroscopy Introduction/Purpose: Autologous osteochondral transplantation (AOT) is commonly used in the treatment of osteochondral lesions (OCL) of the talus. There is limited data comparing gender differences in the incidence, presentation, and outcomes following AOT. The purpose of this study is to compare these differences between male and female patients. Methods: Eighty-five consecutive patients who underwent AOT were retrospectively reviewed. Patients were divided into two groups based on gender. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. The mean clinical follow-up was 47.2 months, with mean MRI follow-up of 24.8 months. Results: Fifty-five (65%) males and 30 (35%) females were included. OCL defect size was significantly larger in men (112.8mm2) when compared with women (88.7mm2) (p<0.0001). Male patients had a significantly longer duration of symptoms (p<0.001) and OCLs were more likely traumatic in nature (p=0.0006) when compared with female patients. Mean FAOS improved pre- to postoperatively from 50 to 81(P < .001) with a statistically significant increase in men (p<0.0001). The mean MOCART score was 82.1 and 86.7 in male and female patients, respectively (p<0.0001). Lesion size was negatively correlated with MOCART score (r = -0.36,P = .004). No differences were found in knee donor site morbidity, complication rate, or revision surgery. Conclusion: Our study demonstrates that male patients typically present with talar OCLs that are larger in size, traumatic in nature, and with longer symptom duration when compared with female patients. In addition, male patients had greater improvement in FAOS scores following AOT. Therefore, understanding these differences may influence the management and treatment of talar OCLs in male and female patients.

scholarly journals Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

2021 ◽  
Author(s):  
Quinten G. H. Rikken ◽  
Jari Dahmen ◽  
Sjoerd A. S. Stufkens ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Degenerative Changes ◽  
Osteochondral Lesions ◽  
Ankle Osteoarthritis ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
The Mean

Abstract Purpose The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. Methods A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. Results Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5–13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6–9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6–84.1). 78% (95% CI 69.5–86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1–9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4–3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3–33.2) of ankles. Conclusion Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. Level of evidence Level IV.

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 Mid-term Outcomes of Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0044
Author(s):  
Yoshiharu Shimozono ◽  
Eoghan Hurley ◽  
John Kennedy
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Short Term ◽  
Level Of Evidence ◽  
Quality Of Evidence ◽  
Current Systematic Review

Category: Ankle Introduction/Purpose: Autologous osteochondral transplantation (AOT) is an established treatment for large-sized OLT, typically greater than 107mm2. Several studies have demonstrated favourable outcomes following AOT at short- and mid-term follow-up. However, the majority of the literature on AOT has short-term follow-up and little evidence exists on the mid-term and longer-term follow-up. Additionally, few studies include a large number of patients or have a high level of evidence, limiting the ability to draw broad and meaningful conclusions about the effectiveness of the AOT procedure for the treatment of OLT beyond short-term follow-up. The purpose of the current systematic review was to evaluate the clinical outcomes analysing level and quality of evidence of the AOT procedure in the treatment of OLT at mid-term and long-term follow-up. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in October 2017 based on the PRISMA guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Clinical outcomes, and complications were also evaluated. Results: Eleven studies, with 500 ankles were included at a mean 62.8 months follow-up. There were 3 studies of LOE III, and 8 studies of LOE IV. There were 3 studies of fair quality and 8 studies of poor quality. The weighted mean preoperative AOFAS score was 55.1 ± 6.1, and the postoperative score was 86.2 ± 4.5, with 87.4% of patients being reported as excellent or good results. In total, 54 of the 500 patients (10.8%) had complications. The most common complication was donor site morbidity with 18 patients (3.6%) at final follow-up. Thirty-one patients (6.2%) underwent reoperations, and the authors deemed a total of 5 ankles (1.0%) failures. Only 5 studies (45.5%) used MRI for follow-up evaluation. Conclusion: The current systematic review demonstrated that good clinical and functional outcomes can be expected following AOT procedure for the treatment of OLT, with a failure rate of only 1.0% at 63 months follow-up. MRI and radiographs showed restoration of articular surface as well as a minimal presence of osteoarthritis at mid-term follow-up. However, there is still lack of data from high LOE and QOE studies, and further high quality studies are necessary.

Osteochondral Transplantation in the Elbow Leads to Good Clinical and Radiologic Long-term Results

2011 ◽  
Vol 39 (12) ◽  
pp. 2619-2625 ◽  
Author(s):  
Stephan Vogt ◽  
Sebastian Siebenlist ◽  
Daniel Hensler ◽  
Lizzy Weigelt ◽  
Patrick Ansah ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Weight Lifting ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
Level Of Evidence

Background: In the long-term follow-up after debridement, microfracture, or drilling of osteochondral lesions in the elbow, subsequent osteoarthritis is a problem. Osteochondral transplantation for these defects has become a more common procedure. However, long-term results are unknown. Purpose: This study was undertaken to evaluate long-term clinical and radiologic outcomes of advanced osteochondral lesions in the elbow treated with osteochondral transplantation. Study Design: Case series; Level of evidence, 4. Methods: The study included 8 patients with osteochondral lesions in the elbow who were treated by autologous osteochondral transplantation between 1996 and 2002. Patients (average age, 17 years) were evaluated pre- and postoperatively by Broberg-Morrey score to assess elbow function and by American Shoulder and Elbow Surgeons (ASES) score for pain analysis. In addition, radiographs (at the first postoperative day, and at 5-year and 10-year follow-up) and magnetic resonance images (8 to 12 weeks postoperatively, and at 5-year and 10-year follow-up) were made to evaluate the joint status. At last follow-up (range, 8-14 years postoperatively), 7 of 8 patients were seen for clinical examination and radiologic analysis. Results: The Broberg-Morrey score increased from an average of 75.9 ± 13.1 to 96.4 ± 2.4 and ASES score significantly improved as follows: worst pain, 7.9 ± 1.1 to 1.6 ± 1.9; rest pain, 3.14 ± 2.7 to 0.6 ± 1.5; weight-lifting pain, 7.6 ± 0.8 to 3.1 ± 1.6; and repetitive movement pain, 5.3 ± 2.4 to 1.6 ± 1.5. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.5° ± 11.6°. At the final follow-up, flexion was free. The mean extension lag was reduced from average 5.4° ± 5.7° to 0°. Radiographs of 2 patients made at final follow-up showed mild signs of osteoarthritis (Kellgren and Lawrence grade I). Postoperative magnetic resonance images showed graft viability in all and a congruent chondral surface in 6 of 7 patients. Conclusion: Clinical long-term results after osteochondral transplantation in the elbow are good to excellent and comparable with midterm results in the literature. Therefore, this technique is a reliable option for satisfactory long-term results regarding treatment of advanced osteochondral lesions in the elbow.

scholarly journals Mozaikinė autologinė kremzlės ir kaulo transplantacija gydant kelio sąnario kremzlės pažeidimus

2004 ◽  
Vol 2 (4) ◽  
pp. 0-0
Author(s):  
Rimtautas Gudas ◽  
Romas Jonas Kalesinskas ◽  
Giedrius Bernotavičius ◽  
Eglė Monastyreckienė ◽  
Angelija Valančiūtė ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Clinical Study ◽  
Knee Joint ◽  
Histological Evaluation ◽  
Cartilage Defects ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
The Mean ◽  
Articular Cartilage Defects

Rimtautas Gudas1, Romas Jonas Kalesinskas1, Giedrius Bernotavičius1, Eglė Monastyreckienė2, Angelija Valančiūtė3, Darius Pranys41 Kauno medicinos universiteto klinikųOrtopedijos ir traumatologijos klinikaEivenių g. 2, LT-50009 Kaunasel paštas: [email protected] Kauno medicinos universiteto klinikųRadiologijos klinika3 Kauno medicinos universitetoEmbriologijos ir histologijos katedra4 Kauno medicinos universitetoPatologinės anatomijos klinika Tikslas Mūsų prospektyvaus klinikinio tyrimo tikslas – įvertinti mozaikinės autologinės transplantacijos rezultatus gydant kelio sąnario kremzlės pažeidimus. Ligoniai ir metodai 1998–2002 metais KMU Ortopedijos ir traumatologijos klinikoje atliktos 87 autologinės mozaikinės transplantacijos operacijos esant kelio sąnario kremzlės ir kaulo pažeidimams. Pacientų amžiaus vidurkis operacijų metu buvo 24,74 ± 7,20 metų (14–40 metų). Simptomai vidutiniškai truko 21,32 ± 5,57 mėnesio, o pacientai įvertinti praėjus vidutiniškai 24,4 mėnesio (nuo 12 iki 60 mėnesių) po operacijos. Rezultatai apibendrinti naudojant ICRS (International Cartilage Repair Society) anketą, 13 (15%) atvejų – remiantis kartotinių artroskopijų metu atliktu makroskopiniu įvertinimu, 9 (11%) atvejais – histologiniu tyrimu, 57 (67%) atvejais – BMR ir visais atvejais – rentgeno tyrimais. Visus anketinius įvertinimus atliko nepriklausomas gydytojas ortopedas prieš operacijas ir po operacijų praėjus dvylikai, dvidešimt keturiems, trisdešimt šešiems, keturiasdešimt aštuoniems ir šešiasdešimčiai mėnesių. Nepriklausomi nuo tyrimo gydytojai, radiologas ir patologas, atliko visus BMR ir histomorfologinius įvertinimus. Rezultatai Praėjus vidutiniškai 24,4 mėnesio po mozaikinės transplantacijos, ICRS anketos būdu nustatytas klinikinis rezultatų pagerėjimas (p < 0,05). Funkcinis ir objektyvus įvertinimas pagal ICRS anketą buvo toks: 93% atvejų gauti geri ir labai geri operacinio gydymo rezultatai, kitais atvejais (7%) gydymo rezultatai buvo patenkinami. Kartotinių artroskopijų metu (remiantis ICRS protokolu), po operacijų praėjus vidutiniškai 12,4 mėnesio, 11 (84%) iš 13 atvejų buvo nustatytas geras ir labai geras sąnario kremzlės makroskopinis atsitaisymas. Sąnario kremzlės biopsijos ir histologinis tyrimas buvo atliktas 11% pacientų, ir daugumos jų (remiantis ICRS protokolu) sąnario kremzlės ir pokremzlinio kaulo atitaisymo koeficientas buvo geras. BMR tyrimas parodė, kad 94% pacientų sąnario paviršius atkurtas gerai arba labai gerai. Išvados Mūsų tyrimas parodė, kad po mozaikinės autologinės transplantacijos praėjus vidutiniškai 24,4 mėnesio (nuo 12 iki 60 mėn.) fiziškai aktyvių pacientų, kuriems buvo pažeista kelio sąnario kremzlė, klinikinė ir funkcinė būklė labai pagerėjo. Dauguma pacientų po kremzlės mozaikinės autologinės transplantacijos atgauna prieš pažeidimą buvusį fizinio aktyvumo lygį. Histomorfologinis persodintų transplantatų tyrimas parodė, kad visais tirtais atvejais išsilaikė hialininės kremzlės struktūra ir fibroelastinio audinio intarpai tarp transplantatų. Reikšminiai žodžiai: sąnario kremzlės pažeidimai, mozaikinė transplantacija Mosaic-like autologous osteochondral transplantation for the treatment of knee joint articular cartilage injuries Rimtautas Gudas1, Romas Jonas Kalesinskas1, Giedrius Bernotavičius1, Eglė Monastyreckienė2, Angelija Valančiūtė3, Darius Pranys4 Objective The purpose of this prospective clinical study was to evaluate the outcomes of mosaic type autologous osteochondral transplantation procedure for the treatment of the articular cartilage defects of the knee joint. Patients and methods Between 1998 and 2002, a total of 85 patients underwent an osteochondral autologous transplantation (mosaicplasty) procedure for osteochondral or chondral knee joint injury. The patients were evaluated using the ICRS score, arthroscopically, histologically, with MRI and X-ray examinations. The mean duration of symptoms was 21.32 ± 5.57 months and the mean follow-up was 24.4 months (range, 12 to 60 months). The mean age of the patients during the surgery was 24.74 ± 7.20 years (range, 14 to 40 years). An independent observer performed a follow-up examination after six, twelve, twenty-four, thirty-six and forty-eight months. In 13 (15%) of 85 cases 12.4 months postoperatively, arthroscopy with biopsy for histological evaluation was carried out. A radiologist and a pathologist, both blinded to each patient’s treatment, did the radiological and histological evaluations. Results After 24.4 months all the patients showed a significant clinical improvement (p < 0.05). The cartilage Repair Society (ICRS) score, functional and objective assessment revealed 93% to have excellent or good results after mosaicplasty; 7% were fair 24.4 months (range, 12–60 months) after the operations. The ICRS evaluation showed a significant improvement after the mosaicplasty procedure 24.4 months following operations (p = 0.005). No serious complications were reported. The ICRS for macroscopic evaluation during arthroscopy 12.4 months after mosaicplasty demonstrated excellent or good repair in 11 (84%) of 13 cases. Biopsy specimens were obtained from 9 (69%) of 13 patients, and histological evaluation of repair showed good scores (according to ICRS) for most samples after mosaicplasty. A MRI evaluation demonstrated excellent or good repairs in 94% after mosaicplasty. Conclusions On an average after 24.4 months (range, 12 to 60 months) of follow-up, our clinical study has shown a significant improvement of the clinical status of the physically active patients after the mosaic type autologous osteochondral transplantation for the repair of articular cartilage defects in the knee. Histologically, the osteochondral cylinder transplants retained hyaline cartilage. Keywords: articular cartilage injury, osteochondral mosaic-like transplantation

scholarly journals Mid-Term Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Yoshiharu Shimozono ◽  
James Toale ◽  
Conor Mulvin ◽  
Jari Dahmen ◽  
Gino MMJ Kerkhoffs ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Reoperation Rate ◽  
Osteochondral Lesions ◽  
Long Term Outcomes ◽  
Weighted Mean ◽  
Bone Marrow Stimulation ◽  
The Mean

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Arthroscopic bone marrow stimulation (BMS) is the most common reparative surgical intervention in the treatment of small osteochondral lesions of the talus (OLT). BMS has shown favorable short term clinical outcomes but several recent studies have shown less satisfactory results in the mid- to long-term due to fibrocartilagenous repair tissue deterioration over time following BMS. However, conflicting results with good mid- to long-term outcomes following BMS have been reported. There is still a lack of evidence on the success rates of BMS at mid-term and longer-term follow-up. The purpose of this systematic review was to evaluate the clinical evidence of mid- to long-term outcomes following BMS for the treatment of OLT. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of evidence was decifered using the Modified Coleman methodology score (MCMS). Studies reporting outcomes of BMS for primary ostechndral lesions at a minimum 4-year follow-up were included. Clinical outcomes, radiological outcomes, and reported data were evaluated. Results: Fifteen studies containing 853 patients (858 ankles) were included at a weighted-mean follow-up time of 71.9 (48-141) months. The mean age was 35.3 (24.7-41.9) and the mean lesion size was 110.5mm2 (87-140). Nine studies (60%) used the AOFAS ankle hindfoot score with a weighted-mean postoperative score of 89.9 (78.4-91.8). Six studies showed both pre and post-operative AOFAS scores and showed a weighted-mean improvement of 24.5 (16-38.5). Four studies utilised the VAS score. The weighted-mean postoperative VAS scores were 2.4 (1.8-2.6). Three studies (20%) measured post-opeartive MRI at mid-term using the MOCART score and showed 48% complete filling, 74% complete integration, 76% surface damage, and 78% inhomogeneous repair tissue. Complication rate was 3.2% and reoperation rate was 6% following BMS at mid-term. Conclusion: This systematic review found good clinical outcomes following BMS for primary OLT at mid-term follow-up based on the AOFAS score. The complication rates were relatively low and the data showed a reoperation rate of 6% at mid-term. However, the radiological and MRI outcomes did not show similarly positive results, which may lead to recurrence and reoperation at long-term. Data were variable and numerous aspects largely under-reported in the literature relevant to the systematic review. Further high quality studies, a validated outcome scoring system and further MRI reports are required to accurately assess the success of BMS at mid-term.

scholarly journals One-Step Autologous Minced Cartilage Procedure for the Treatment of Knee Joint Chondral and Osteochondral Lesions: A Series of 27 Patients With 2-Year Follow-up

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985377 ◽  
Author(s):  
Felix Kurt Massen ◽  
Cyril Raphael Inauen ◽  
Laurent Pascale Harder ◽  
Armin Runer ◽  
Stefan Preiss ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Knee Joint ◽  
Large Diameter ◽  
Single Step ◽  
Knee Function ◽  
Area Measurement ◽  
Treatment Modalities ◽  
Osteochondral Lesions ◽  
The Mean

Background:Chondral and osteochondral lesions are being detected with increasing frequency. For large-diameter lesions, cell-based treatment modalities are speculated to result in the best possible outcome.Purpose:To prospectively evaluate the 2-year clinical and radiological results after the treatment of chondral and osteochondral knee joint lesions by a single-step autologous minced cartilage procedure.Study Design:Case series; Level of evidence, 4.Methods:From February 2015 to June 2016, a total of 27 consecutive patients suffering from chondral or osteochondral lesions of the knee joint were treated using a single-step autologous minced cartilage procedure. All patients underwent preoperative and postoperative magnetic resonance imaging for the collection of AMADEUS (Area Measurement and Depth and Underlying Structures) and MOCART (magnetic resonance observation of cartilage repair tissue) scores. Clinical analysis was conducted by a numeric analog scale (NAS) for pain and knee function before the intervention and at 12 and 24 months postoperatively.Results:A total of 12 female and 15 male patients (mean age, 28.7 years) were evaluated for a mean of 28.2 ± 3.8 months. The mean cartilage defect size encountered intraoperatively was 3.1 ± 1.6 cm2. There was a significant decrease in pain from 7.2 ± 1.9 preoperatively to 1.8 ± 1.6 ( P < .001) at 2-year follow-up. Knee function improved from a mean of 7.2 ± 2.0 preoperatively to 2.1 ± 2.3 ( P < .001) at 2 years after surgery. The mean preoperative AMADEUS score was 57.4 ± 21.4. Postoperatively, the mean MOCART score was 40.6 ± 21.1 at 6-month follow-up. No correlation was observed between the clinical data and the MOCART or AMADEUS scores.Conclusion:Overall, the findings of this study demonstrated that patients undergoing a single-step autologous minced cartilage procedure had a satisfactory outcome at 2-year follow-up. As a result, the single-step autologous minced cartilage procedure does represent a possible alternative to standard autologous chondrocyte implantation. Longer follow-up and larger cohorts are required to define the benefits of this procedure.

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