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Kang DG, Lee DH, Im JH. Osteochondritis dissecans of the metacarpal head in a soldier treated with osteochondral autograft transplantation surgery: A case report. Medicine (Baltimore) 2023; 102:e32563. [PMID: 36701721 PMCID: PMC9857577 DOI: 10.1097/md.0000000000032563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RATIONALE Osteochondral autograft transplantation surgery (OATS) was introduced as a treatment for hand osteochondritis dissecans (OCD), and successful results were reported. However, the cartilage height of the donor plug has not yet been established compared with that of other joints. We present a case using OATS for OCD of the 3rd metacarpal (MCP) head that occurred in a soldier and the findings of magnetic resonance imaging (MRI) images taken at 12 weeks after surgery. PATIENT CONCERNS A 21-year-old male presented with a painful, swollen 3rd MCP joint in the right hand. He was a soldier and right-handed; in addition, he did not recall any traumatic events, nor had he taken any corticosteroid medications before. The patient was excluded from military training and underwent conservative treatment with medication and a brace in a military hospital for 3 months. DIAGNOSIS The patient was diagnosed with OCD due to avascular necrosis of the 3rd MCP head of the right hand through X-ray and MRI. INTERVENTIONS OATS was planned as a surgical treatment. Surgery uncovered a 10 × 10 mm2, isolated cartilage defect of the 3rd MCP head that had an irregular margin and a loose body. Using Arthrex OATS, a 10-mm diameter, 10-mm depth hole was made at the articular defect site, and an 11-mm diameter, 12-length plug was harvested from the left lateral femoral condyle. The donor plug was inserted into the prepared defect site with press-fit fixation. OUTCOMES At the last follow-up, the height of the articular cartilage had subsided with union on MRI 12 weeks after the surgery. However, the patient was asymptomatic with a normal range of motion of the right hand, and he returned to military training. LESSONS Although the joints of the hand are small and non-weight bearing, the level of articular cartilage of the donor plug was subsided in a follow-up MRI in our case. We suggest that the difference in cartilage thickness between the donor and the recipient might have been the cause of subsidence of the articular cartilage, and therefore, it may be helpful to transplant donors with similar thicknesses of articular cartilage.
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Affiliation(s)
- Dong-Geun Kang
- Department of Orthopedic Surgery, Gyeongsang National University, College of Medicine and Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Dong Hyun Lee
- Department of Orthopedic Surgery, Gyeongsang National University, College of Medicine and Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Jin-Hyung Im
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * Correspondence: Jin-Hyung Im, Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea (e-mail: )
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Sheppard WL, Hinckel BB, Arshi A, Sherman SL, Jones KJ. Accurate Reporting of Concomitant Procedures Is Highly Variable in Studies Investigating Knee Cartilage Restoration. Cartilage 2021; 12:333-343. [PMID: 30971096 PMCID: PMC8236649 DOI: 10.1177/1947603519841673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Successful clinical outcomes following cartilage restoration procedures are highly dependent on addressing concomitant pathology. The purpose of this study was to document methods for evaluating concomitant procedures of the knee when performed with articular cartilage restoration techniques, and to review their reported findings in high-impact clinical orthopedic studies. We hypothesized that there are substantial inconsistencies in reporting clinical outcomes associated with concomitant procedures relative to outcomes related to isolated cartilage repair. DESIGN A total of 133 clinical studies on articular cartilage repair of the knee were identified from 6 high-impact orthopedic journals between 2011 and 2017. Studies were included if they were primary research articles reporting clinical outcomes data following surgical treatment of articular cartilage lesions with a minimum sample size of 5 patients. Studies were excluded if they were review articles, meta-analyses, and articles reporting only nonclinical outcomes (e.g., imaging, histology). A full-text review was then used to evaluate details regarding study methodology and reporting on the following variables: primary cartilage repair procedure, and the utilization of concomitant procedures to address additional patient comorbidities, including malalignment, meniscus pathology, and ligamentous instability. Each study was additionally reviewed to document variation in clinical outcomes reporting in patients that had these comorbidities addressed at the time of surgery. RESULTS All studies reported on the type of primary cartilage repair procedure, with autologous chondrocyte implantation (ACI) noted in 43% of studies, microfracture (MF) reported in 16.5%, osteochondral allograft (OCA) in 15%, and osteochondral autograft transplant (OAT) in 8.2%. Regarding concomitant pathology, anterior cruciate ligament (ACL) reconstruction (24.8%) and meniscus repair (23.3%) were the most commonly addressed patient comorbidities. A total of 56 studies (42.1%) excluded patients with malalignment, meniscus injury, and ligamentous instability. For studies that addressed concomitant pathology, 72.7% reported clinical outcomes separately from the cohort treated with only cartilage repair. A total of 16.5% of studies neither excluded nor addressed concomitant pathologies. There was a significant amount of variation in the patient reported outcome scores used among the studies, with the majority of studies reporting International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcomes Score (KOOS) in 47.2% and 43.6% of articles, respectively. CONCLUSIONS In this study on knee cartilage restoration, recognition and management of concomitant pathology is inadequately reported in approximately 28% of studies. Only 30% of articles reported adequate treatment of concomitant ailments while scoring their outcomes using one of a potential 18 different scoring systems. These findings highlight the need for more standardized methods to be applied in future research with regard to inclusion, exclusion, and scoring concomitant pathologies with regard to treatment of cartilage defects in the knee.
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Affiliation(s)
- William L. Sheppard
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Betina B. Hinckel
- Department of Orthopedic Surgery, University of Missouri Health, Columbia, MO, USA
| | - Armin Arshi
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Seth L. Sherman
- Department of Orthopedic Surgery, University of Missouri Health, Columbia, MO, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA,Kristofer J. Jones, Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-143 CHS, Los Angeles, CA 90095-6902, USA. Emails:
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Bushenhuoxue Formula Facilitates Articular Cartilage Repair and Attenuates Matrix Degradation by Activation of TGF- β Signaling Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:2734581. [PMID: 30402118 PMCID: PMC6196996 DOI: 10.1155/2018/2734581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/23/2018] [Indexed: 12/26/2022]
Abstract
Objective To investigate the effect and underlying mechanism of Bushenhuoxue (BSHX) formula on articular cartilage repair. Methods Twenty-four full-thickness cartilage defect rats were divided into two groups: model group and BSHX group (treated with BSHX formula). Macroscopic observation and histopathological study were conducted after 4- and 8-week treatment. Additionally, we also evaluated chondrocyte proliferation, extracellular matrix (ECM) deposition, cartilage degradation, and chondrocyte hypertrophy-related genes expression in chondrogenic ATDC5 cells cultured in BSHX formula-mediated serum. Moreover, we assessed aforementioned genes expression and pSMAD2/3 protein level in Tgfβr2 siRNA transfected chondrogenic ATDC5 cells in order to address whether BSHX formula exerts cartilage repairing effect through TGF-β signaling. Results Neocartilage regeneration promotion effect was observed in cartilage defect rats after BSHX formula treatment, with increases in Col2 and pSMAD2 and decreases in Mmp13 and Runx2. Moreover, cell proliferation, the elevated Col2a1, Aggrecan and pSMAD2/3, reduced Mmp13, Adamts5, Col10a1, and Runx2 expression were also observed in chondrogenic ATDC5 cells cultured in BSHX formula-mediated serum. Besides, the expression alteration of ECM deposition, cartilage degradation, chondrocyte hypertrophy-related genes, and pSMAD2/3 protein levels presented in Tgfβr2 downregulated chondrogenic ATDC5 cells couldn't be adjusted by BSHX formula treatment. Conclusion By activation of TGF-β signaling, BSHX formula can promote articular cartilage repair by accelerating chondrocyte proliferation and maintaining chondrocyte phenotype, upregulate ECM accumulation, and inhibit matrix degradation.
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Ogura T, Bryant T, Mosier BA, Minas T. Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Tibiofemoral Compartment. Am J Sports Med 2018. [PMID: 29533678 DOI: 10.1177/0363546518756977] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treating bipolar chondral lesions in the tibiofemoral (TF) compartment with cartilage repair procedures is challenging, and a suitable treatment remains unclear. PURPOSE To evaluate clinical outcomes after autologous chondrocyte implantation (ACI) for the treatment of bipolar chondral lesions in the TF compartment. STUDY DESIGN Case series; Level of evidence, 4. METHODS We evaluated 57 patients who underwent ACI for the treatment of symptomatic bipolar chondral lesions in the TF compartment by a single surgeon between October 1995 and June 2014. One patient did not return for follow-up. Thus, 56 patients (58 knees) were included with a minimum of 2 years' follow-up. A mean of 3.1 lesions per knee were treated, representing a mean total surface area of 16.1 cm2 (range, 3.2-44.5 cm2) per knee. Bipolar lesions were present in the medial compartment (32 knees) and in the lateral compartment (26 knees). Patients were evaluated with the modified Cincinnati Knee Rating Scale, visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form-36. Patients also answered questions regarding self-rated knee function and satisfaction with the procedure. Standard radiographs were evaluated with the Kellgren-Lawrence grading system. RESULTS The survival rate was 80% at 5 years and 76% at 10 years. A significantly better survival rate was found in patients with the use of a collagen membrane than periosteum (97% vs 61% at 5 years, respectively; P = .0014). Of 46 knees with retained grafts, all functional scores significantly improved postoperatively, with a very high satisfaction rate (91%) at a mean of 8.3 ± 5.1 years (range, 2-20 years) after ACI. At last follow-up, 24 of 46 successful knees were radiographically assessed (mean, 5.5 ± 4.0 years [range, 2.0-18.7 years]) and showed no significant osteoarthritis progression ( P = .3173). Outcomes for 12 patients were considered as failures at a mean of 4.1 years. Of these, 9 patients were converted to partial or total knee arthroplasty at a mean of 4.4 years. Two patients underwent revision ACI at 5 and 17 months. The other 1 patient did not require revision surgery. CONCLUSION Our study showed that ACI for the treatment of bipolar chondral lesions in the TF compartment provided successful clinical outcomes in patients with retained grafts and possibly prevented or delayed osteoarthritis progression at midterm to long-term follow-up. A collagen membrane is more encouraging than periosteum for bipolar lesions in the TF compartment. While addressing the predisposing factors affecting cartilage repair, ACI could be an adequate salvage procedure for bipolar chondral lesions in the TF compartment for the relatively young arthritic patient who wishes to avoid arthroplasty.
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Affiliation(s)
- Takahiro Ogura
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Tim Bryant
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian A Mosier
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Allegheny Health Network, Monroeville, Pennsylvania, USA
| | - Tom Minas
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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van Duijvenbode DC, Jonkers FJ, Könst YE, van Royen BJ, Benink RJ, Hoozemans MJM. Gel-type autologous chondrocyte implantation for cartilage repair in patients with prior ACL reconstruction: A retrospective two year follow-up. Knee 2016; 23:241-5. [PMID: 26826946 DOI: 10.1016/j.knee.2015.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/31/2015] [Accepted: 08/13/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the early patient-reported outcomes of articular cartilage repair in patients with pain due to grade III or IV articular cartilage defects after prior anterior cruciate ligament (ACL) reconstruction. METHODS Nineteen patients underwent a gel-type autologous chondrocyte implantation (GACI) procedure after ACL reconstruction. Median timeframe between ACL reconstruction and GACI procedure was 52 months (range 16 to 369). The average age at chondrocyte implantation was 35 (standard deviation (SD) eight) years and average cumulative articular cartilage defect size was nine (SD four) square centimeter. Outcome was assessed prior to the GACI procedure and two years after GACI using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS Two year post-GACI scores showed a statistically significant improvement of IKDC (13, SD 22, p=.02) and KOOS quality of life (18, SD 27, p=.01) compared to the pre-GACI scores. The other KOOS domains did improve, but not statistically significant. Seven (37%) patients underwent reoperation after the GACI. CONCLUSION Patients with prior ACL reconstruction and suffering from ongoing pain associated with cartilage defects can benefit from cartilage repair with GACI.
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Affiliation(s)
- D C van Duijvenbode
- Center for Orthopedic Research Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
| | - F J Jonkers
- Center for Orthopedic Research Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
| | - Y E Könst
- MOVE Research Institute, Faculty of Behaviourial en Movement Sciences Department of Human Movement Sciences, VU University Amsterdam Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
| | - B J van Royen
- Gemini Hospital Den Helder, Huisduinerweg 3, 1782 GZ Den Helder, The Netherlands.
| | - R J Benink
- Gemini Hospital Den Helder, Huisduinerweg 3, 1782 GZ Den Helder, The Netherlands.
| | - M J M Hoozemans
- Center for Orthopedic Research Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Miller DJ, Smith MV, Matava MJ, Wright RW, Brophy RH. Microfracture and osteochondral autograft transplantation are cost-effective treatments for articular cartilage lesions of the distal femur. Am J Sports Med 2015; 43:2175-81. [PMID: 26159823 DOI: 10.1177/0363546515591261] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multiple techniques have been suggested for the treatment of isolated knee articular cartilage injuries. For smaller lesions (<2-5 cm(2)), microfracture and osteochondral autograft transplantation (OAT) are commonly used options. With an increasing focus on health care efficiency, analyzing the cost-effectiveness of treatment modalities has become increasingly important. PURPOSE/HYPOTHESIS The purpose of this study was to analyze the costs and outcomes of microfracture and OAT to compare their cost-effectiveness. The hypothesis was that microfracture would be more cost-effective. STUDY DESIGN Economic and decision analysis; Level of evidence, 2. METHODS A literature search was performed to identify studies comparing microfracture and OAT for the treatment of articular cartilage lesions of the distal femur in an adult population. Data from these studies including surgical time, failure rates, revision surgeries, outcome scores, and return to athletics were then incorporated into a constructed cost model using standard accounting methodology. The model was based on actual 2013 cost figures (in US dollars) for all procedure, operating room, and instrumentation costs. RESULTS Three studies, with a mean follow-up of 8.7 years, met the inclusion criteria of having evidence level 1 or 2 comparing microfracture and OAT. There was a cumulative 28.6% reoperation rate among patients undergoing microfracture compared with 12.5% among patients undergoing OAT. While both groups demonstrated significant improvements compared with preoperative levels, the only significant differences in any outcome score reported between the 2 procedures were the International Cartilage Repair Society (ICRS) score and patient-reported return to their previous sports activity level. While microfracture had a lower initial cost ($3100), these savings lessened over 1 year ($1843) and 10 years ($996). Microfracture was more cost-effective when comparing Lysholm and Hospital for Special Surgery scores, whereas OAT was more cost-effective when comparing Tegner and ICRS scores. There was a significantly lower cost for return to play in athletes after OAT versus microfracture at 1 year ($11,428 vs $16,953, respectively), 3 years ($12,856 vs $38,000, respectively), and 10 years ($32,141 vs $60,799, respectively). CONCLUSION Published level 1 and 2 clinical studies with a 10-year follow-up demonstrated that the net cost and cost-effectiveness of microfracture and OAT are comparable for the treatment of isolated articular cartilage lesions of the distal femur. CLINICAL RELEVANCE Given similar clinical outcomes, microfracture and OAT are both viable, cost-effective first-line treatment options for these injuries.
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Affiliation(s)
- D Josh Miller
- Northwest Orthopaedic & Sports Medicine, Richland, Washington, USA
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Cognault J, Seurat O, Chaussard C, Ionescu S, Saragaglia D. Return to sports after autogenous osteochondral mosaicplasty of the femoral condyles: 25 cases at a mean follow-up of 9 years. Orthop Traumatol Surg Res 2015; 101:313-7. [PMID: 25817908 DOI: 10.1016/j.otsr.2014.12.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/14/2014] [Accepted: 12/23/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Autogenous osteochondral mosaicplasty is the most common cartilage restoration technique in standard clinical practice. The purpose of this study was to evaluate the return to sports 9 years after mosaicplasty of the femoral condyles. HYPOTHESIS The long-term results of an osteochondral autograft show that patients can regain their pre-injury activity level. MATERIAL AND METHODS This study is based on a series of 25 patients with a mean age of 28.9 years (range, 16-44 years) who had stage 3 or 4 chondral lesions of the femoral condyles (according to the ICRS or ICRS-OCD scores). The origin of the lesion was osteochondritis dissecans (13 knees), osteochondral fracture sequelae (ten knees), or aseptic osteonecrosis (two knees). The average size of the lesion was 2.11 ± 0.9 cm(2). Ten patients (40%) had an associated procedure during the osteochondral autograft. The patients were assessed clinically (IKDC and Lysholm-Tegner scores) and radiographically by a reviewer independent of the team of operators. RESULTS All patients were re-examined at a mean follow-up of 9 years (range, 6-15 years), with 84% satisfied or very satisfied with the procedure. The average IKDC was 74.5 ± 18.5 points. The average Lysholm score was 87.3 ± 11.6 points. The average Tegner score ranged from 6.35 ± 1.53 points prior to surgery to 5.60 ± 1.64 points after surgery (P = 0.001). The average loss was 0.64 points for patients whose presurgery Tegner score was greater than or equal to 7 (P = 0.019) and 0.3 points if lower than 7. The radiologic evaluation of 21 patients showed complete osteointegration of the grafts in 90% of cases. CONCLUSION The results of the femoral condyle mosaic autografts are satisfactory, a mean of 9 years after surgery. The most active patients lowered their activity level while the more sedentary did not have to adapt their lifestyle.
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Affiliation(s)
- J Cognault
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France.
| | - O Seurat
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - C Chaussard
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - S Ionescu
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
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Nosewicz TL, Reilingh ML, Wolny M, van Dijk CN, Duda GN, Schell H. Influence of basal support and early loading on bone cartilage healing in press-fitted osteochondral autografts. Knee Surg Sports Traumatol Arthrosc 2014; 22:1445-51. [PMID: 23479055 DOI: 10.1007/s00167-013-2453-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/18/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE The influence of basal graft support combined to early loading following an osteochondral autograft procedure is unclear. It was hypothesized that bottomed grafts may allow for early mobilization by preventing graft subsidence and leading to better healing. METHODS Osteochondral autografts were press fitted in the femoral condyles of 24 sheep (one graft per animal). In the unbottomed group (n = 12), a gap of 2 mm was created between graft and recipient bone base. In the bottomed group (n = 12), the graft firmly rested on recipient bone. Animals were allowed immediate postoperative weightbearing. Healing times were 3 and 6 months per group (n = 6 per subgroup). After killing, histological and histomorphometric analyses were performed. RESULTS Unbottomed grafts at 3 months showed significantly more graft subsidence (P = 0.024), significantly less mineralized bone (P = 0.028) and significantly worse cartilage and subchondral bone plate healing (P = 0.034) when compared to bottomed grafts. At 6 months, no differences were seen. Compared to the native situation, unbottomed grafts showed significantly more graft subsidence (P = 0.024), whereas bottomed grafts did not. Cystic lesions were seen in both groups. Osteoclasts were closely related to the degree of bone remodelling. CONCLUSION In the animal model, in the case of early loading, bottomed osteochondral autografts have less chance of graft subsidence. Evident subsidence negatively influences the histological healing process. In the osteochondral autograft procedure, full graft support should be aimed for. This may allow for early mobilization, diminish graft subsidence and improve long-term integration.
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Affiliation(s)
- Tomasz L Nosewicz
- Julius Wolff Institute and Center for Musculoskeletal Surgery and Berlin-Brandenburg Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Forum 4, Postbox 24, 13353, Berlin, Germany,
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Niethammer TR, Müller PE, Safi E, Ficklscherer A, Roßbach BP, Jansson V, Pietschmann MF. Early resumption of physical activities leads to inferior clinical outcomes after matrix-based autologous chondrocyte implantation in the knee. Knee Surg Sports Traumatol Arthrosc 2014; 22:1345-52. [PMID: 23839208 DOI: 10.1007/s00167-013-2583-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Matrix-based autologous chondrocyte implantation is a well-established operation procedure for full cartilage defects. When to resume physical activity after matrix-based autologous chondrocyte implantation is controversial. Our hypothesis was that early resumption of physical activity leads to a worse clinical outcome after matrix-based autologous chondrocyte implantation in the knee two years post-operatively. Physical activity is defined as any kind of impact sport. METHODS Forty-four patients with cartilage defects of the knee were treated with matrix-based autologous chondrocyte implantation (Novocart3D). All patients were assessed preoperatively and after a period of 24 months with the University of California Los Angeles (UCLA) Activity score. The return to physical activities or sports after matrix-based autologous chondrocyte implantation was documented. Patients were evaluated using the International Knee Documentation Committee Knee Examination Form and visual analogue scale for pain after 6, 12 and 24 months. RESULTS Fifty-five percent showed an unchanged level of physical activity in the UCLA Activity score post-operatively. About 35% showed a lower level and 10% a higher level of physical activity. The average return to physical activities or sports after matrix-based autologous chondrocyte implantation procedure was 10.2 months. Patients with a later return of sports after 12 months showed significantly better clinical results after two years. In particular, patients who started practicing impact sport after 12 months post-operatively showed significantly better results. CONCLUSION Resuming physical activity including impact sports without waiting at least 12 months after the operation leads to inferior outcomes up to 24 months after matrix-based autologous chondrocyte implantation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Thomas R Niethammer
- Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany,
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Oungoulian SR, Hehir KE, Zhu K, Willis CE, Marinescu AG, Merali N, Ahmad CS, Hung CT, Ateshian GA. Effect of glutaraldehyde fixation on the frictional response of immature bovine articular cartilage explants. J Biomech 2013; 47:694-701. [PMID: 24332617 DOI: 10.1016/j.jbiomech.2013.11.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/19/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
Abstract
This study examined functional properties and biocompatibility of glutaraldehyde-fixed bovine articular cartilage over several weeks of incubation at body temperature to investigate its potential use as a resurfacing material in joint arthroplasty. In the first experiment, treated cartilage disks were fixed using 0.02, 0.20 and 0.60% glutaraldehyde for 24h then incubated, along with an untreated control group, in saline for up to 28d at 37°C. Both the equilibrium compressive and tensile moduli increased nearly twofold in treated samples compared to day 0 control, and remained at that level from day 1 to 28; the equilibrium friction coefficient against glass rose nearly twofold immediately after fixation (day 1) but returned to control values after day 7. Live explants co-cultured with fixed explants showed no quantitative difference in cell viability over 28d. In general, no significant differences were observed between 0.20 and 0.60% groups, so 0.20% was deemed sufficient for complete fixation. In the second experiment, cartilage-on-cartilage frictional measurements were performed under a migrating contact configuration. In the treated group, one explant was fixed using 0.20% glutaraldehyde while the apposing explant was left untreated; in the control group both explants were left untreated. From day 1 to 28, the treated group exhibited either no significant difference or slightly lower friction coefficient than the untreated group. These results suggest that a properly titrated glutaraldehyde treatment can reproduce the desired functional properties of native articular cartilage and maintain these properties for at least 28d at body temperature.
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Affiliation(s)
- Sevan R Oungoulian
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Kristin E Hehir
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Kaicen Zhu
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Callen E Willis
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Anca G Marinescu
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Natasha Merali
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | | | - Clark T Hung
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Gerard A Ateshian
- Department of Mechanical Engineering, Columbia University, New York, NY, USA; Department of Biomedical Engineering, Columbia University, New York, NY, USA.
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Imade S, Kumahashi N, Kuwata S, Kadowaki M, Tanaka T, Takuwa H, Uchio Y. A comparison of patient-reported outcomes and arthroscopic findings between drilling and autologous osteochondral grafting for the treatment of articular cartilage defects combined with anterior cruciate ligament injury. Knee 2013; 20:354-9. [PMID: 22901594 DOI: 10.1016/j.knee.2012.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/22/2012] [Accepted: 07/15/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare the patient-reported outcomes and arthroscopic findings between drilling and autologous osteochondral grafting (AOG) for the treatment of articular cartilage defects combined with anterior cruciate ligament (ACL) injuries. METHODS The subjects were 40 patients who had articular cartilage defects in the weight-bearing part of the medial and lateral femur condyle combined with ACL injuries that were treated by drilling (20 patients) or AOG (20 patients) at the same time as ACL reconstruction was performed. In the drilling group patients, lesions were penetrated with multiple 1.2-mm Kirschner wires, and in the AOG group patients, grafts were made to cartilage defects from one to three osteochondral pegs harvested from the less-weight-bearing periphery of the articular surface of the femoral condyle. The patient-reported outcomes were assessed using the International Knee Documentation Committee (IKDC) subjective knee examination score. Second-look arthroscopy was performed to evaluate the repaired cartilage macroscopically. RESULTS The median follow-up duration was 25 (range, 12-42) months. The IKDC scores were significantly improved from 64.4 to 95.4 points in the drilling group and from 52.3 to 94.3 points in the AOG group, with no difference between the two groups, although there was a difference in the repaired cartilage findings of arthroscopy. CONCLUSION In this study, no differences in IKDC scores were found in patients with a concomitant ACL rupture and an osteochondral lesion treated by drilling or AOG at a minimum follow-up of 1year, regardless of the differences at arthroscopic grading of the ICRS classification. LEVEL OF EVIDENCE Case-control study (LEVEL III).
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Affiliation(s)
- Shinji Imade
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Shimane, Japan.
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Abrams GD, Alentorn-Geli E, Harris JD, Cole BJ. Treatment of a lateral tibial plateau osteochondritis dissecans lesion with subchondral injection of calcium phosphate. Arthrosc Tech 2013; 2:e271-4. [PMID: 24265997 PMCID: PMC3834648 DOI: 10.1016/j.eats.2013.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/05/2013] [Indexed: 02/03/2023] Open
Abstract
Osteochondritis dissecans lesions occur frequently in children and adolescents. Treatment can be challenging and depends on the status of the articular cartilage and subchondral bone. Injection of calcium phosphate bone substitute into the area of subchondral bone edema (Subchondroplasty; Knee Creations, West Chester, PA) may be an option. We present a case of a lateral tibial plateau osteochondritis dissecans lesion treated with subchondral injection of nanocrystalline calcium phosphate. Preoperative magnetic resonance imaging is used to determine the area of subchondral edema, and intraoperative fluoroscopy is used to localize this area with the injection cannula. Calcium phosphate is injected by use of a series of syringes until the appropriate fill is obtained. Treatment of concomitant cartilage defects may also be carried out at this time.
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Affiliation(s)
- Geoffrey D. Abrams
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.,Address correspondence to Geoffrey D. Abrams, M.D., 1611 W Harrison St, Ste 300, Chicago, IL 60612, U.S.A.
| | - Eduard Alentorn-Geli
- Department of Orthopedic Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joshua D. Harris
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J. Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Nosewicz TL, Reilingh ML, van Dijk CN, Duda GN, Schell H. Weightbearing ovine osteochondral defects heal with inadequate subchondral bone plate restoration: implications regarding osteochondral autograft harvesting. Knee Surg Sports Traumatol Arthrosc 2012; 20:1923-30. [PMID: 22186925 PMCID: PMC3445791 DOI: 10.1007/s00167-011-1831-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 12/09/2011] [Indexed: 11/11/2022]
Abstract
PURPOSE It is unknown what causes donor site morbidity following the osteochondral autograft transfer procedure or how donor sites heal. Contact pressure and edge loading at donor sites may play a role in the healing process. It was hypothesized that an artificially created osteochondral defect in a weightbearing area of an ovine femoral condyle will cause osseous bridging of the defect from the upper edges, resulting in incomplete and irregular repair of the subchondral bone plate. METHODS To simulate edge loading, large osteochondral defects were created in the most unfavourable weightbearing area of 24 ovine femoral condyles. After killing at 3 and 6 months, osteochondral defects were histologically and histomorphometrically evaluated with specific attention to subchondral bone healing and subchondral bone plate restoration. RESULTS Osteochondral defect healing showed progressive osseous defect bridging by sclerotic circumferential bone apposition. Unfilled area decreased significantly from 3 to 6 months (P = 0.004), whereas bone content increased (n.s.). Complete but irregular subchondral bone plate restoration occurred in ten animals. In fourteen animals, an incomplete subchondral bone plate was found. Further common findings included cavitary lesion formation, degenerative cartilage changes and cartilage and subchondral bone collapse. CONCLUSIONS Osteochondral defect healing starts with subchondral bone plate restoration. However, after 6 months, incomplete or irregular subchondral bone plate restoration and subsequent failure of osteochondral defect closure is common. Graft harvesting in the osteochondral autograft transfer procedure must be viewed critically, as similar changes are also present in humans. LEVEL OF EVIDENCE Prognostic study, Level III.
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Affiliation(s)
- Tomasz L. Nosewicz
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Forum 4, Postbox 24, 13353 Berlin, Germany ,Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mikel L. Reilingh
- Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - C. Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Georg N. Duda
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Forum 4, Postbox 24, 13353 Berlin, Germany
| | - Hanna Schell
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Forum 4, Postbox 24, 13353 Berlin, Germany
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