scholarly journals The partial femoral condyle focal resurfacing (HemiCAP-UniCAP) for treatment of full-thickness cartilage defects, systematic review and meta-analysis

2021 ◽  
Vol 87 (1) ◽  
pp. 93-102
Author(s):  
Hany Elbardesy ◽  
Matthew Nagle ◽  
Lydia Simmons ◽  
James Harty
Keyword(s):  
Cartilage Defect ◽  
Revision Rate ◽  
Femoral Condyle ◽  
Meta Analysis ◽  
Long Term Results ◽  
Cartilage Defects ◽  
Aged Patients ◽  
High Revision Rate ◽  
Joint Registry

Knee osteochondral defects are a common problem among people, especially young and active patients. So effective joint preserving surgeries is essential to prevent or even delay the onset of osteoarthritis for these group of patients. This study aims to critically appraise and evaluate the evidence for the results and effectiveness of femoral condyle resurfacing (HemiCAP/ UniCAP) in treatment of patients with focal femoral condyle cartilage defect. Using the search terms : HemiCAP, UniCAP, Episurf, focal, femoral, condyle, inlay and resur-facing, we reviewed the PubMed and EMBASE and the Cochrane Database of Systematic Reviews (CDSR) to find any articles published up to March 2020. The short term follow-up of the HemiCAP shows (6.74 %) revision rate. However, 29.13 % loss of follow up let us consider these results with caution especially if the revision rate progressively increased with time to 19.3 % in 5-7 years with no enough evidence for the long term results except the data from the Australian Joint Registry 2018, where the cumulative revision rate was 40.6 % (33.5, 48.4) at ten years. The UniCAP that used for defect more than 4 cm 2 has a high revision rate (53.66 %) which is considered unacceptable revision rate in com-parison to another similar prosthesis such as Uni-Knee Arthroplasty (UKA). The evidence from published studies and our meta- analysis suggests that partial resurfacing of the femoral condyle (HemiCAP) doesn’t support its usage as a tool to treat the focal cartilage defect in middle- aged patients. The UniCAP as femoral condyle resurfacing has very high revision rate at 5-7 years (53.66 %) which make us recommend against its usage.

scholarly journals Graft-Recipient Anteroposterior Mismatch Does Not Affect the Clinical Outcomes of Osteochondral Allograft Transplantation of the Femoral Condyle

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0015
Author(s):  
Francesca R. Coxe ◽  
Dean Wang ◽  
George Christian Balazs ◽  
Brenda Chang ◽  
Kristofer J. Jones ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Graft Failure ◽  
Femoral Condyle ◽  
Long Term Results ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Allograft Transplantation

Objectives: For the treatment of femoral condyle cartilage defects, anteroposterior (AP) and mediolateral (ML) dimension matching in osteochondral allograft transplantation (OCA) pairs donor and recipient condyles to minimize articular incongruity. This aims to reduce the potential risk of graft failure and improve clinical outcomes. However, size matching restricts the number of compatible osteochondral allografts, which has a number of disadvantages including delayed surgical treatment and prolonged graft storage. Some surgeons match donor-to-recipient exclusively using the ML dimension to ensure that an adequately sized dowel can be harvested, while ignoring AP mismatch. Because a large AP mismatch can lead to radius of curvature differences between graft and host and potential articular incongruity after implantation, this study aimed to evaluate the association between AP mismatch and clinical outcomes of OCA. Methods: A retrospective review of patients treated with OCA for femoral condyle cartilage defects from 2000 to 2015 was conducted. A minimum follow-up of 2 years was required for analysis. Graft characteristics, including AP and ML dimensions, were gathered from vendor-specific allograft offering documents. Patient condyle dimensions were measured from preoperative magnetic resonance imaging (Figure 1). Reoperations and patient responses to validated outcome measures were reviewed. Failure was defined by any partial removal/revision of the allograft or conversion to knee arthroplasty. A multivariable logistic regression model was fitted to examine the association of AP mismatch with OCA failure while adjusting for patient age, sex, number of previous ipsilateral knee surgeries, and number of lesions treated. Results: A total of 69 knees (mean age, 35.7 years) met the inclusion criteria. Mean duration of follow-up was 4 years (range, 2-16 years). The average absolute AP mismatch between graft and patient was 6.7 mm (range, 0-20 mm) (P <0.01). In contrast, the average absolute ML mismatch between graft and patient was 2.3 mm (range, 0-10 mm) (P = 0.33). At final follow-up, 19 knees had failed. There was no significant difference in the average absolute AP mismatch between failures (8.1 mm) and non-failures (6.2 mm) (P = 0.17). Multivariate logistic regression revealed that AP mismatch was not associated with graft failure (P = 0.15) (Table 1). At final follow-up, clinically significant improvements were noted in the pain (52.0 to 73.2) and physical functioning (60.1 to 80.1) subscales of the Short Form-36 (P <0.01 for both), International Knee Documentation Committee subjective form (47.8 to 65.9; P <0.01), and Knee Outcome Survey-Activities of Daily Living (64.2 to 82.0; P <0.01). Conclusion: OCA has consistently shown excellent long-term results in patients, including high-level athletes, with large chondral defects. Widespread use of OCA, however, is limited by the practice of procuring an appropriately sized allograft that matches the recipient hemicondyle in ML and AP dimensions. The results of the present study show no association between the magnitude of graft-patient AP mismatch and OCA failure. Most importantly, patient-reported outcome measures improved significantly over the course of follow-up, despite a wide range of AP mismatch between graft and patient. Our results suggest that AP length matching within the limits measured here is not a contraindication for graft acceptance.

Femoral condyle resurfacing using an inlay metal implant: low revision rate of 266 patients in a 5–10 years follow-up

2021 ◽  
Author(s):  
Panayiotis D. Megaloikonomos ◽  
Christoph Becher ◽  
Johan Van der Stok ◽  
Turlough O’Donnell
Keyword(s):  
Revision Rate ◽  
Femoral Condyle ◽  
Metal Implant

Midterm and Long-term Results of Medial Versus Lateral Meniscal Allograft Transplantation: A Meta-analysis

2017 ◽  
Vol 46 (5) ◽  
pp. 1243-1250 ◽  
Author(s):  
Seong-Il Bin ◽  
Kyung-Wook Nha ◽  
Ji-Young Cheong ◽  
Young-Soo Shin
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Survival Rates ◽  
Long Term Results ◽  
Functional Improvement ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft

Background: It is unclear whether lateral meniscal allograft transplantation (MAT) procedures lead to better clinical outcomes than medial MAT. Hypothesis: The survival rates are similar between medial and lateral MAT, but the clinical outcomes of lateral MAT are better than those of medial MAT at final follow-up. Study Design: Meta-analysis. Methods: In this meta-analysis, we reviewed studies that assessed survival rates in patients who underwent medial or lateral MAT with more than 5 years of follow-up and that used assessments such as pain and Lysholm scores to compare postoperative scores on knee outcome scales. The survival time was considered as the time to conversion to knee arthroplasty and/or subtotal resection of the allograft. Results: A total of 9 studies (including 287 knees undergoing surgery using medial MAT and 407 with lateral MAT) met the inclusion criteria and were analyzed in detail. The proportion of knees in which midterm (5-10 years) survival rates (medial, 97/113; lateral, 108/121; odds ratio [OR] 0.71; 95% CI, 0.31-1.64; P = .42) and long-term (>10 years) survival rates (medial, 303/576; lateral, 456/805; OR 0.78; 95% CI, 0.52-1.17; P = .22) were evaluated did not differ significantly between medial and lateral MAT. In addition, both groups had substantial proportions of knees exhibiting midterm survivorship (85.8% for medial MAT and 89.2% for lateral MAT) but much lower proportions of knees exhibiting long-term survivorship (52.6% for medial MAT and 56.6% for lateral MAT). In contrast, overall pain score (medial, 65.6 points; lateral, 71.3 points; 95% CI, −3.95 to −0.87; P = .002) and Lysholm score (medial, 67.5 points; lateral, 72.0 points; 95% CI, −10.17 to −3.94; P < .00001) were significantly higher for lateral MAT compared with medial MAT. Conclusion: Meta-analysis indicated that 85.8% of medial and 89.2% of lateral meniscal allograft transplants survive at midterm (5-10 years) while 52.6% of medial and 56.6% of lateral meniscal allograft transplants survive long term (>10 years). Patients undergoing lateral meniscal allograft transplantation demonstrated greater pain relief and functional improvement than patients undergoing medial meniscal allograft transplantations.

scholarly journals Clinical Outcomes of ProChondrix® Osteochondral Allograft in the Knee: A Case Series

2021 ◽  
Author(s):  
Michael S. Barnum ◽  
Evan D. Boyd ◽  
Annabelle P. Davey ◽  
Andrew Slauterbeck ◽  
James R. Slauterbeck
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Cartilage Defect ◽  
Femoral Condyle ◽  
Case Series ◽  
Activity Level ◽  
Osteochondral Allograft ◽  
Cartilage Restoration ◽  
Patient Reported

Abstract PurposeFocal articular cartilage injuries are common and may lead to progression of osteoarthritis. The complications associated with traditional treatment strategies have influenced the development of new biotechnologies, such as the ProChondrix® osteochondral allograft. Clinical evidence on the outcomes associated with ProChondrix® osteochondral allografts are limited. Thus, the primary purpose of this study was to evaluate the clinical outcomes following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant.MethodsRetrospective analysis of patients who underwent a cartilage restoration procedure using ProChondrix® osteochondral allograft has been performed. Patients completed patient-reported outcome surveys which included the Knee injury and Osteoarthritis Outcome Score (KOOS), consisting of the 5 subscales of Pain, Symptoms, Activities of Daily Living, Sports and Recreation, and Quality of Life, the Marx Activity Scale, and the visual analog pain scale.ResultsSix patients underwent a cartilage restoration procedure using ProChondrix® between January 2016 and December 2019. Three males and three females were included with a median age of 33.5 years (range 18–48 years). The median follow-up duration was 15 months (range 9–24 months). There were 4 patellar grafts, 1 medial femoral condyle graft, and 1 lateral femoral condyle graft, with a median defect size of 18.5mm (range 13-20mm). At the most recent clinical follow-up, all six patients were pain free and all patients had returned to pre-op activity level.ConclusionTo our knowledge, this is the first study to report the clinical outcome, activity level, and patient orientated outcomes in a case series of patients following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant. Our study demonstrates promising short-term results in patient reported clinical outcome scores.

scholarly journals Intra-articular injection of synovium-derived mesenchymal stem cells and hyaluronic acid promote regeneration of massive cartilage defects in rabbits

2014 ◽  
Vol 2 ◽  
Author(s):  
Vyacheslav Ogay ◽  
Miras Karzhauov ◽  
Ainur Mukhambetova ◽  
Eric Raimagambetov ◽  
Nurlan Batpenov
Keyword(s):  
Stem Cells ◽  
Molecular Weight ◽  
Mesenchymal Stem Cells ◽  
Hyaluronic Acid ◽  
Cartilage Defect ◽  
Femoral Condyle ◽  
Cartilage Regeneration ◽  
Cartilage Defects ◽  
Low Molecular Weight ◽  
Defect Area

Introduction: The purpose of this study was to investigate whether intra-articular injection of synovium-derived mesenchymal stem cells (SD MSCs) with low molecular weight hyaluronic acid (HA) could promote regeneration of massive cartilage in rabbits.Material and methods: The SD MSCs were harvested from the knees of 10 Flemish giant rabbits, expanded in culture, and characterized. A reproducible 4-mm cylindrical defect was created in the intercondylar groove area using a kit for the mosaic chondroplasty of femoral condyle COR (De Puy, Mitek). The defect was made within the cartilage layer without destruction of subchondral bone. Two weeks after the cartilage defect, SD MSCs (2 × 106 cell/0.15 ml) were suspended in 0.5% low molecular weight HA (0.15 ml) and injected into the left knee, and HA solution (0.30 ml) alone was placed into the right knee. Cartilage regeneration in the experimental and control groups were evaluated by macroscopically and histologically at 10, 30, and 60 days.Results: On day 10, after intra-articular injection of SD MSCs, we observed an early process of cartilage regeneration in the defect area. Histological studies revealed that cartilage defect was covered by a thin layer of spindle-shaped undifferentiated cells and proliferated chodroblasts. In contrast, an injection of HA did not induce reparation of cartilage in the defect area. At 30 days, macroscopic observation showed that the size of cartilage defect after SD MSC injection was significantly smaller than after HA injection. Histological score was also better in the MSC- treated intercondylar defect. At 60 days after MSC treatment, cartilage defect was nearly nonexistent and looked similar to an intact cartilage.Conclusion: Thus, intra-articular injection of SD MSCs can adhere to the defect in the intercondylar area, and promote cartilage regeneration in rabbits.

scholarly journals Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Hyojune Kim ◽  
Chul-Ho Kim ◽  
Minsoo Kim ◽  
Wonsun Lee ◽  
In-Ho Jeon ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Revision Rate ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Functional Scores ◽  
Reverse Total Shoulder ◽  
Glenoid Loosening

Abstract Purpose We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. Materials and methods The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. Results Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = − 10.28, 95% CI: − 16.69 to − 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06–0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73–65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07–1.57, P = 0.16). Conclusion A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. Level of evidence: Level IV, Meta-analysis.

HemiCAP Knee Implants: Mid- to Long-Term Results

Cartilage ◽  
2019 ◽  
pp. 194760351989473
Author(s):  
Jens Ole Laursen ◽  
Christian Backer Mogensen ◽  
Helene Skjøt-Arkil
Keyword(s):  
Femoral Condyle ◽  
Survival Rates ◽  
Long Term Results ◽  
Radiographic Examination ◽  
Vas Score ◽  
Radiographic Outcomes ◽  
Potential Risk Factors ◽  
And Function

Purpose The aim of the study was to investigate the long-term outcomes of the Focal Femoral Condyle Resurfacing Prosthesis (HemiCAP) using clinical and radiographic assessments, and to evaluate the revision and survival rates. Methods Clinical evaluation was performed in those not revised and was able to participate. This was a prospective single-center cohort study of HemiCAP patients with 7 to 10 years of clinical and radiographic follow-up. The clinical examination included the Knee Society Score (KSS) and visual analogue scale (VAS) score. The radiographic examination included the Kellgren-Lawrence (KL) grade. Survival was estimated by Kaplan-Meier survival analysis, and potential risk factors for revision was evaluated by a regression analysis. Results Of the 62 patients with 64 HemiCAP prostheses, 37 were HemiCAP condyle, 11 HemiCAP PF, and 16 HemiCAP Wave; 27 (42%) were revised—HemiCAP condyle 17 (42%), HemiCAP PF 4 (36%), HemiCAP Wave 6 (37%), and 1 died. Examinations were performed on 31 patients (86%). When compared with the preoperative data, there were significant increases in the KSS objective (mean = 51.5, standard deviation [SD] = 5.9 vs. mean =94.2, SD = 5.0) and function (mean = 51.0, SD = 6.2 vs. mean = 93.7, SD = 4.8) scores, a decrease in the VAS score (mean = 7.1, SD = 0.7 vs. mean = 2.7, SD = 1.7) and a decrease in the KL lateral score (mean = 1.1, SD = 0.3 vs. mean = 0.6, SD = 0.6). The mean follow-up was 7.3 years (SD 1.4) with minimum 4.2 years and maximum 10.2 years. No failures occurred in the series beyond 5 years. Conclusions As hypothesized, we found good clinical and radiographic outcomes, and for those patients who did not require revisions, there were long-term improvements in disability and function. This suggests that patient selection is a key element to successfully applying these devices in clinical practice.

scholarly journals Cartilage Repair Capacity within a Single Full-Thickness Chondral Defect in a Porcine Autologous Matrix-Induced Chondrogenesis Model Is Affected by the Location within the Defect

Cartilage ◽  
2021 ◽  
pp. 194760352110309
Author(s):  
E. Salonius ◽  
A. Meller ◽  
T. Paatela ◽  
A. Vasara ◽  
J. Puhakka ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Cartilage Defect ◽  
Femoral Condyle ◽  
Cartilage Defects ◽  
Lateral Part ◽  
Type Iii Collagen ◽  
Full Thickness ◽  
Chondral Defect ◽  
Repair Capacity ◽  
Biomaterial Scaffold

Objective Large articular cartilage defects are a challenge to regenerative surgery. Biomaterial scaffolds might provide valuable support for restoration of articulating surface. The performance of a composite biomaterial scaffold was evaluated in a large porcine cartilage defect. Design Cartilage repair capacity of a biomaterial combining recombinant human type III collagen (rhCo) and poly-(l/d)-lactide (PLA) was tested in a porcine model. A full-thickness chondral defect covering the majority of the weightbearing area was inflicted to the medial femoral condyle of the right knee. Spontaneous cartilage repair and nonoperated healthy animals served as controls. The animals were sacrificed after a 4-month follow-up. The repair tissue was evaluated with the International Cartilage Repair Society (ICRS) macroscopic score, ICRS II histological score, and with micro-computed tomography. Additionally, histopathological evaluation of lymph nodes and synovial samples were done for toxicological analyses. Results The lateral half of the cartilage defect in the operated groups showed better filling than the medial half. The mean overall macroscopic score for the rhCo-PLA, spontaneous, and nonoperated groups were 5.96 ± 0.33, 4.63 ± 0.42, and 10.98 ± 0.35, respectively. The overall histological appearance of the specimens was predominantly hyaline cartilage in 3 of 9 samples of the rhCo-PLA group, 2 of 8 of the spontaneous group, and 9 of 9 of the nonoperated group. Conclusions The use of rhCo-PLA scaffold did not differ from spontaneous healing. The repair was affected by the spatial properties within the defect, as the lateral part of the defect showed better repair than the medial part, probably due to different weightbearing conditions.

scholarly journals Collagen-Covered Autologous Chondrocyte Implantation Versus Autologous Matrix-Induced Chondrogenesis: A Randomized Trial Comparing 2 Methods for Repair of Cartilage Defects of the Knee

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986821 ◽  
Author(s):  
Vegard Fossum ◽  
Ann Kristin Hansen ◽  
Tom Wilsgaard ◽  
Gunnar Knutsen
Keyword(s):  
Randomized Controlled Trial ◽  
Autologous Chondrocyte Implantation ◽  
Controlled Trial ◽  
Long Term Results ◽  
Cartilage Defects ◽  
Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background:Autologous matrix-induced chondrogenesis (AMIC) is a single-stage alternative to autologous chondrocyte implantation for treatment of localized cartilage defects of the knee. To our knowledge, no randomized controlled trial exists comparing the 2 methods.Purpose:To evaluate any difference in the outcome of AMIC as compared with collagen-covered autologous chondrocyte implantation (ACI-C).Study Design:Randomized controlled trial; Level of evidence, 2.Methods:A prospective randomized controlled clinical trial was designed to assess any differences in the outcomes between ACI-C and AMIC for the treatment of ≥1 chondral or osteochondral defects of the distal femur and/or patella. The inclusion period was set to 3 years, and the aim was to include 80 patients (40 in each group). Patient inclusion was broad, with few exclusion criteria. The primary outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS) at 2 years as compared with baseline. The secondary outcomes were the number of failures in each group at 2 years and the change in KOOS subscale, Lysholm, and pain visual analog scale (VAS) scores at 2 years as compared with baseline. A 2-sample t test with a significance level of P < .05 was used to compare the change in score from baseline between groups.Results:A total of 41 patients over 3 years were included in the study: 21 in the ACI-C group and 20 in the AMIC group. All the patients had prior surgery to the index knee. At 2-year follow-up, the clinical scores for both groups improved significantly from baseline. No significant differences between groups were seen in the change from baseline for KOOS (AMIC, 18.1; ACI-C, 10.3), any of the KOOS subscales, the Lysholm score (AMIC, 19.7; ACI-C, 17.0), or the VAS pain score (AMIC, 30.6; ACI-C, 19.6). Two patients in the AMIC group had progressed to a total knee replacement by the 2-year follow-up as compared with none in the ACI-C group.Conclusion:At 2-year follow-up, no significant differences were found regarding outcomes between ACI-C and AMIC. Mid- and long-term results will be important.Registration:NCT01458782 ( ClinicalTrials.gov identifier).

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