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Hoburg A, Niemeyer P, Laute V, Zinser W, Becher C, Kolombe T, Fay J, Pietsch S, Kuźma T, Widuchowski W, Fickert S. Sustained superiority in KOOS subscores after matrix-associated chondrocyte implantation using spheroids compared to microfracture. Knee Surg Sports Traumatol Arthrosc 2022; 31:2482-2493. [PMID: 36269383 DOI: 10.1007/s00167-022-07194-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of matrix-associated autologous chondrocyte implantation (ACI) using spheroids in comparison to arthroscopic microfracture for the treatment of symptomatic cartilage defects of the knee. METHODS In a prospective multicenter-controlled trial, patients aged between 18 and 50 years, with single symptomatic focal cartilage defects between 1 and 4 cm2 (mean 2.6 ± 0.8, median 2.75, range 1.44-5.00) in the knee were randomized to treatment with ACI with spheroids (n = 52) or microfracture (n = 50). Primary clinical outcome was assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS). Analyses were performed in a defined hierarchical manner where outcomes of ACI were first compared to baseline values followed by a comparison to the microfracture group with repeated-measures ANCOVA with a non-inferiority approach. Subgroup analyses were performed to investigate the influence of age and defect size on the overall KOOS. Secondary clinical outcomes were the magnetic resonance observation of cartilage repair tissue (MOCART), modified Lysholm score and International Knee Documentation Committee (IKDC) examination form. Safety data focused on adverse events. Here the 5 years results are presented at which there were 33 observed cases in the ACI group and 30 in the microfracture group. RESULTS The overall KOOS and its five subscores were significantly improved compared to baseline for both the ACI and microfracture group. Non-inferiority of ACI to microfracture was confirmed for the overall KOOS and the subscores, while for the subscores activities of daily living, quality of life and sports and recreation of the threshold for superiority was passed. In the ACI group, a notably more rapid initial improvement of the KOOS was found at three months for the older age group compared to the younger age group and the microfracture group. No other differences were found based on age or defect size. In addition, clinical improvement was found for the MOCART, modified Lysholm and IKDC examination form both the ACI and microfracture group. No safety concern related to either treatment was observed. CONCLUSION This study confirms the safety and efficacy of matrix-associated ACI with spheroids at a mid to long-term follow-up. Non-inferiority of ACI to microfracture was confirmed for the overall KOOS and all subscores, while superiority was reached for the subscores activities of daily living, quality of life and sports and recreation in the ACI group. This underlines the importance of ACI for the young and active patients. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Arnd Hoburg
- Med Center 360 degree Berlin, Kieler Straße 1, 12163, Berlin, Germany.
| | - Philipp Niemeyer
- Department of Orthopedic Surgery and Traumatology, University Hospital, Freiburg, Germany.,OCM Clinic, Munich, Germany
| | - Volker Laute
- Med Center 360 degree Berlin, Kieler Straße 1, 12163, Berlin, Germany
| | - Wolfgang Zinser
- Department of Orthopedic Surgery and Traumatology, St. Vinzenz-Hospital, Dinslaken, Germany
| | - Christoph Becher
- Department of Orthopedic Surgery, Medical University Annastift, Hannover, Germany
| | - Thomas Kolombe
- Traumatology and Reconstructive Surgery, DRK Hospital, Luckenwalde, Germany
| | - Jakob Fay
- Department of Traumatology and Arthroscopic Surgery, Lubinus Clinicum, Kiel, Germany
| | - Stefan Pietsch
- Department of Orthopedic Surgery and Traumatology, Rudolf Elle Hospital, Eisenberg, Germany
| | - Tomasz Kuźma
- Department of Orthopedic Surgery and Traumatology, Center of Sports Medicine, Orthopedic Clinic, Warsaw, Poland
| | | | - Stefan Fickert
- Sporthopaedicum Straubing, Straubing, Germany.,Department of Orthopedic Surgery and Traumatology, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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Bordes M, Sappey-Marinier E, Batailler C, Lustig S, Servien E. Autologous osteochondral transplantation for focal femoral condyle defects: Comparison of mosaicplasty by arthrotomy vs. arthroscopy. Orthop Traumatol Surg Res 2022; 108:103102. [PMID: 34628086 DOI: 10.1016/j.otsr.2021.103102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND While many studies have reported the outcomes of open mosaicplasty, data on arthroscopic mosaicplasty are scarce. Only two cadaver studies have compared arthrotomy and arthroscopy. Moreover, the patello-femoral joint, which is the main donor site, has never been assessed using a specific functional score. The objective of this in vivo study was to compare arthrotomy and arthroscopy for mosaicplasty using both a global functional knee score and a specific score of the patello-femoral joint. HYPOTHESIS The arthroscopic technique results in better functional patello-femoral outcomes. MATERIAL AND METHODS We retrospectively compared two groups of 17 patients who underwent mosaicplasty for focal condylar cartilage defects, at our department between 2009 and 2019. Functional outcomes were assessed using the Kujala score and the Lysholm score, at least 1 year after surgery. The return to sports was assessed using the Tegner score. RESULTS Mean follow-up was 67.4±15.9 months in the arthrotomy group and 45.2±35.1 months in the arthroscopy group (p<0.01). Cartilage defect size was similar in the two groups (arthrotomy: 1.21±0.91cm2; arthroscopy: 0.92±1.23cm2; p=0.052). The mean Kujala score was 85±21.3 in the arthrotomy group and 91.9±13.7 in the arthroscopy group (p=0.064). The mean Lysholm score was 83.9±19.8 with arthrotomy and 89.5±14.9 with arthroscopy (p=0.1). The Kujala score was greater than 95 in 4 (26%) arthrotomy patients and 13 (81%) arthroscopy patients (p=0.003). The Lysholm score was higher than 95 in 4 (26%) arthrotomy patients and 12 (75%) arthroscopy patients (p=0.012). No patient underwent surgical revision for autograft failure. DISCUSSION This is the first clinical study comparing arthrotomy and arthroscopy for mosaicplasty. Clinical outcomes were good with both techniques. The proportion of patients with excellent Lysholm and Kujala functional scores was significantly higher in the arthroscopy group than in the arthrotomy group. This result may be ascribable to decreased donor-site morbidity obtained with arthroscopy. LEVEL OF EVIDENCE IV, retrospective observational comparative study.
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Affiliation(s)
- Maxence Bordes
- Orthopaedics surgery and sports medicine department, FIFA Medical Centre of Excellence, Croix-Rousse hospital, Lyon university hospital, 69004 Lyon, France
| | - Elliot Sappey-Marinier
- Orthopaedics surgery and sports medicine department, FIFA Medical Centre of Excellence, Croix-Rousse hospital, Lyon university hospital, 69004 Lyon, France.
| | - Cécile Batailler
- Orthopaedics surgery and sports medicine department, FIFA Medical Centre of Excellence, Croix-Rousse hospital, Lyon university hospital, 69004 Lyon, France
| | - Sébastien Lustig
- Orthopaedics surgery and sports medicine department, FIFA Medical Centre of Excellence, Croix-Rousse hospital, Lyon university hospital, 69004 Lyon, France; IFSTTAR, LBMC UMR_T9406, Lyon university, Claude Bernard Lyon 1 university, 69622 Lyon, France
| | - Elvire Servien
- Orthopaedics surgery and sports medicine department, FIFA Medical Centre of Excellence, Croix-Rousse hospital, Lyon university hospital, 69004 Lyon, France; LIBM - EA 7424, interuniversity laboratory of biology of mobility, Claude Bernard Lyon 1 university, Lyon, France
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Guzman AJ, Dela Rueda T, Rayos Del Sol SM, Bryant SA, Jenkins S, Gardner B, McGahan PJ, Chen JL. Arthroscopic Osteochondral Autograft Transfer System Procedure of the Lateral Femoral Condyle with Donor-Site Backfill Using Osteochondral Allograft Plug. Arthrosc Tech 2021; 10:e2683-e2689. [PMID: 35004149 PMCID: PMC8719136 DOI: 10.1016/j.eats.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 02/03/2023] Open
Abstract
The osteochondral autograft transfer system (OATS) procedure is at the forefront of cartilage restoration surgeries of the knee, offering superior return to sport rates and long-term functionality. This technique reports an arthroscopic OATS procedure of the lateral femoral condyle with donor-site backfill using an osteochondral allograft plug. Potential complications from unfilled donor site sockets are eliminated through donor site backfill with an allograft plug.
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Affiliation(s)
- Alvarho J. Guzman
- Address correspondence to Alvarho J. Guzman, B.A., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, U.S.A.
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Kizaki K, El-Khechen HA, Yamashita F, Duong A, Simunovic N, Musahl V, Ayeni OR. Arthroscopic versus Open Osteochondral Autograft Transplantation (Mosaicplasty) for Cartilage Damage of the Knee: A Systematic Review. J Knee Surg 2021; 34:94-107. [PMID: 31288271 DOI: 10.1055/s-0039-1692999] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Osteochondral autograft transplantation (OAT) is a surgical option for repairing cartilage damage in knees, and can be performed using open or arthroscopic procedures. The aim of this review was to report clinical outcomes, postoperative complications, defect location, and defect size between open and arthroscopic OATs. Three electronic databases (EMBASE, PUBMED, and MEDLINE) were searched for relevant articles. In regard to eligibility criteria, knee articular damage cases solely treated with OAT were included and cases concomitant with ligament reconstruction, limb realignment, and meniscus repair were excluded. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and descriptive statistics are presented. A total of 24 studies were included with a total sample of 1,139 patients (532 in open OAT vs. 607 in arthroscopic OAT). Defect size in open OAT was three times larger than that of arthroscopic OAT (2.96 ± 0.76 vs. 0.97 ± 0.48 cm2). In terms of defect location, the medial femoral condyle (MFC) was the most common (75.4%), followed by the lateral femoral condyle (LFC; 12.1%), patella (6.7%), and trochlea (5.7%). All of these defect locations were treated with open OAT, whereas arthroscopic OAT treatments were restricted to the MFC and LFC. The clinical outcomes were overall favorable with the modified Hospital for Special Surgery knee scores being 89.6 ± 8.0 (36.1-month follow-up) versus 90.4 ± 6.0 (89.5-month follow-up) and the Lysholm scores being 81.6 ± 8.9 (44.2-month follow-up) and 83.3 ± 7.4 (12.0-month follow-up) between open and arthroscopic OATs, respectively. Fifty-three postoperative complications were observed (39/279 vs. 14/594) and the most common complication was hemarthrosis (13/39 in open, vs. 1/14 in arthroscopic OAT). The overall clinical outcomes were favorable in open and arthroscopic OATs, whereas open OAT allowed for treatment of lesions approximately three times greater in dimension than in arthroscopic OAT. Also, defect location was restricted to MFC and LFC in arthroscopic OAT. The most common complication was hemarthrosis.
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Affiliation(s)
- Kazuha Kizaki
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
| | - Hussein Ali El-Khechen
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
| | - Fumiharu Yamashita
- Kyoto Shimogamo Hospital, Department of Orthopaedic Surgery, Kyoto, Japan
| | - Andrew Duong
- McMaster University, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- McMaster University, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Volker Musahl
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, Pennsylvania
| | - Olufemi R Ayeni
- McMaster University, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
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6
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Roessler PP, Efe T, Wirtz DC, Schildberg FA. Cartilage Regeneration with Cell-free Type 1 Collagen Matrix - Past, Present and Future (Part 1 - Clinical Aspects). ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:607-616. [PMID: 32746491 DOI: 10.1055/a-1200-2765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cartilage regeneration with cell-free matrices has developed from matrix-associated autologous cartilage cell transplantation (MACT) over ten years ago. Adjustments to the legal framework and higher hurdles for cell therapy have led to the procedures being established as an independent alternative to MACT. These procedures, which can be classified as matrix-induced autologous cartilage regeneration (MACR), all rely on the chemotactic stimulus of a cross-linked matrix, which mostly consists of collagens. Given the example of a commercially available type I collagen hydrogel, the state of clinical experience with MACR shall be summarized and an outlook on the development of the method shall be provided. It has been demonstrated in the clinical case series summarized here over the past few years that the use of the matrix is not only safe but also yields good clinical-functional and MR-tomographic results for both small (~ 10 mm) and large (> 10 mm) focal cartilage lesions. Depending on the size of the defect, MACR with a collagen type I matrix plays an important role as an alternative treatment method, in direct competition with both: microfracture and MACT.
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Affiliation(s)
- Philip Peter Roessler
- OPM - Orthopädische Praxisklinik Mayen.,Medical Faculty, Orthopaedics and Trauma Surgery, Rheinische Friedrich-Wilhelms-Universität Bonn
| | - Turgay Efe
- Orthopaedicum Lich.,Medical Faculty, Orthopaedics and Trauma Surgery, Philipps-Universität Marburg
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Jones KJ, Kelley BV, Arshi A, McAllister DR, Fabricant PD. Comparative Effectiveness of Cartilage Repair With Respect to the Minimal Clinically Important Difference. Am J Sports Med 2019; 47:3284-3293. [PMID: 31082325 DOI: 10.1177/0363546518824552] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies demonstrated a 5% increase in cartilage repair procedures annually in the United States. There is currently no consensus regarding a superior technique, nor has there been a comprehensive evaluation of postoperative clinical outcomes with respect to a minimal clinically important difference (MCID). PURPOSE To determine the proportion of available cartilage repair studies that meet or exceed MCID values for clinical outcomes improvement over short-, mid-, and long-term follow-up. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review was performed via the Medline, Scopus, and Cochrane Library databases. Available studies were included that investigated clinical outcomes for microfracture (MFX), osteoarticular transfer system (OATS), osteochondral allograft transplantation, and autologous chondrocyte implantation/matrix-induced autologous chondrocyte implantation (ACI/MACI) for the treatment of symptomatic knee chondral defects. Cohorts were combined on the basis of surgical intervention by performing a meta-analysis that utilized inverse-variance weighting in a DerSimonian-Laird random effects model. Weighted mean improvements in International Knee Documentation Committee (IKDC), Lysholm, and visual analog scale for pain (VAS pain) scores were calculated from preoperative to short- (1-4 years), mid- (5-9 years), and long-term (≥10 years) postoperative follow-up. Mean values were compared with established MCID values per 2-tailed 1-sample Student t tests. RESULTS A total of 89 studies with 3894 unique patients were analyzed after full-text review. MFX met MCID values for all outcome scores at short- and midterm follow-up with the exception of VAS pain in the midterm. OATS met MCID values for all outcome scores at all available time points; however, long-term data were not available for VAS pain. Osteochondral allograft transplantation met MCID values for IKDC at short- and midterm follow-up and for Lysholm at short-term follow-up, although data were not available for other time points or for VAS pain. ACI/MACI met MCID values for all outcome scores (IKDC, Lysholm, and VAS pain) at all time points. CONCLUSION In the age of informed consent, it is important to critically evaluate the clinical outcomes and durability of cartilage surgery with respect to well-established standards of clinical improvement. MFX failed to maintain VAS pain improvements above MCID thresholds with follow-up from 5 to 9 years. All cartilage repair procedures met MCID values at short- and midterm follow-up for IKDC and Lysholm scores; ACI/MACI and OATS additionally met MCID values in the long term, demonstrating extended maintenance of clinical benefits for patients undergoing these surgical interventions as compared with MFX.
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Affiliation(s)
- Kristofer J Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Benjamin V Kelley
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Armin Arshi
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - David R McAllister
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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8
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Rowland R, Colello M, Wyland DJ. Osteochondral Autograft Transfer Procedure: Arthroscopic Technique and Technical Pearls. Arthrosc Tech 2019; 8:e713-e719. [PMID: 31485397 PMCID: PMC6713909 DOI: 10.1016/j.eats.2019.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/03/2019] [Indexed: 02/03/2023] Open
Abstract
The Osteochondral Autograft Transfer System (OATS; Arthrex, Naples, FL) is an excellent option for the treatment of articular cartilage lesions within the knee. Current literature suggests that at early-term to midterm follow-up, patients experience improved function, alleviation of pain, and good satisfaction with acceptable complication rates. Although long-term data are lacking, studies in athletes have shown that the OATS can provide an adequate rate of return to sports. The OATS procedure has traditionally been considered an open procedure. However, with the advancement of arthroscopic techniques, the procedure can now be completed arthroscopically. We discuss this modern operation.
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Affiliation(s)
| | | | - Douglas J. Wyland
- Address correspondence to Douglas J. Wyland, M.D., Steadman Hawkins Clinic of the Carolinas, Greenville Health System, 200 Patewood Dr, Ste C100, Greenville, SC 29615, U.S.A.
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9
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Articular cartilage paste graft for severe osteochondral lesions of the knee: a 10- to 23-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2017; 25:3824-3833. [PMID: 27695904 DOI: 10.1007/s00167-016-4323-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the clinical outcomes of the articular cartilage paste graft procedure at a minimum of 10 years from surgery. It is hypothesized that articular cartilage paste grafting can provide patients with a durable repair of severe full-thickness osteochondral injuries, measured by persistence of procedure-induced benefit and subjective outcome scores at 10 or more years. METHODS Seventy-four patients undergoing paste grafting at a mean age of 45.3 ± 10.8 years (range 13-69 years) were followed up at a mean of 16.8 ± 2.4 years (range 10.6-23.2 years) post-operatively using validated subjective outcome measures; Kaplan-Meier survival analysis was performed to estimate expected population benefit time. RESULTS Kaplan-Meier estimated median benefit time of 19.1 years (mean: 16.6 ± 0.9 years) for all patients undergoing paste grafting. Thirty-one (41.9 %) patients had progressed to arthroplasty at a mean of 9.8 ± 5.6 years (range 0.4-20.6 years). Ninety percent of patients reported that the procedure provided good to excellent pain relief. Median IKDC subjective score increased significantly at most recent follow-up (70.1) compared to preoperative (55.7, p = 0.013). Median WOMAC scores decreased significantly from 26 to 14 (p = 0.001). Median Tegner score increase from 4 to 6 was not found to be significant (ns). VAS pain averaged 23/100 at most recent follow-up. CONCLUSIONS Patients who underwent the paste grafting reported improved pain, function, and activity levels for an expected mean of 16.6 years, and for those who ultimately progressed to knee replacement, surgical treatment including the paste graft was able to delay arthroplasty until a mean age of 60.2 years, an age at which the procedure is commonly performed. Full-thickness articular cartilage loss can be successfully treated, reducing pain, and improving function, using this single-step, inexpensive arthroscopic procedure. LEVEL OF EVIDENCE IV.
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10
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Functional outcomes after patellar autologous osteochondral transplantation. Knee Surg Sports Traumatol Arthrosc 2017; 25:3084-3091. [PMID: 27056692 DOI: 10.1007/s00167-016-4108-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/25/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of the present study was to assess clinical evaluation of patients who underwent autologous osteochondral transplantation of the patella. METHODS This prospective study assessed outcomes of 20 patients who underwent patellar autologous osteochondral transplantation at four time-points: preoperatively, 3 days, 6 months, and 2 years after surgery. The following outcomes were assessed at each time-point: pain (VAS), gait, swelling, trophic status, muscle strength, patellar mobility, and range of motion. The Tegner scale was also applied for each time-point. RESULTS All parameters improved, except for patellar mobility, which did not show any change. Pain score decreased from 7.1 (SD 2.3) to 2.4 (SD 2.6) at the 2-year assessment; limping decreased from 70 % before surgery to 15 % 2 years later; swelling scores decreased from an average of 1.8 (SD 0.8) 3 days after surgery to 0.5 (SD 0.7) at the 2-year assessment; muscle strength increased from 3.9 (SD 0.8) to 4.7 (SD 0.7) points at final follow-up; and the range of motion increased from 84 (SD 16.2) to 132 (SD 10.7) degrees 2 years later. Tegner score before surgery ranged from 0 to 5, and after 2 years, it ranged from 5 to 9. CONCLUSION Autologous osteochondral transplantation for the treatment of patellar chondral lesion was associated with significant improvement in pain, gait, swelling, and range of motion 2 years after surgery, achieving scores similar to uninjured knees. Most of them were able to return to sports activity after 6 months (recreational level) and 2 years (competitive level). LEVEL OF EVIDENCE IV.
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Meric G, Gracitelli GC, McCauley JC, Pulido PA, Chang EY, Chung CB, Bugbee WD. Osteochondral Allograft MRI Scoring System (OCAMRISS) in the Knee: Interobserver Agreement and Clinical Application. Cartilage 2015; 6:142-9. [PMID: 26175859 PMCID: PMC4481388 DOI: 10.1177/1947603515573987] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Osteochondral allograft (OCA) transplantation is a suitable treatment option for large osteochondral defects. Magnetic resonance imaging (MRI) is an objective, reproducible, noninvasive monitoring tool for postoperative assessment after cartilage surgery. OBJECTIVE To correlate Osteochondral Allograft MRI Scoring System (OCAMRISS) in patients undergoing OCA transplantation in the knee with clinical outcomes and determine interobserver agreement of this scoring system. METHODS Fifteen patients underwent OCA transplantation in the knee and received a postoperative MRI. Four examiners read each MRI and completed an OCAMRISS. Interobserver agreement and intraclass correlation coefficients (ICCs) were assessed. Clinical outcomes were evaluated. Correlation between the OCAMRISS and clinical outcomes was calculated using Spearman's correlation coefficients. RESULTS Interobserver agreement on individual features of the OCAMRISS was superior (κ = 0.81-1.0) in 65% of comparisons, substantial (κ = 0.61-0.8) in 14%, moderate (κ = 0.41-0.6) in 18%, and fair (κ = 0.21-0.4) in 3%. Agreement among readers was very strong for the cartilage, bone, ancillary, and total scores with 96% of comparisons having an ICC >0.80. International Knee Documentation Committee (IKDC) function scores were correlated with OCAMRISS cartilage score (ρ = 0.53, P = 0.044) and total score (ρ = 0.67, P = 0.006). The Knee injury and Osteoarthritis Outcome Score (KOOS) sports/recreation subscale was correlated with OCAMRISS ancillary score (ρ = 0.58, P = 0.049) and total score (ρ = 0.64, P = 0.024). No correlation was observed with subchondral bone features of OCAMRISS and any of the outcome scores. CONCLUSIONS The recently described OCAMRISS is a reproducible grading system for in vivo evaluation after osteochondral allograft transplantation.
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Affiliation(s)
- Gokhan Meric
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA,Department of Orthopaedic Surgery, Balikesir University, Balikesir, Turkey
| | - Guilherme C. Gracitelli
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA,Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Julie C. McCauley
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Pamela A. Pulido
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Eric Y. Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA,Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Christine B. Chung
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA,Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - William D. Bugbee
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA,Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
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Uchida S, Utsunomiya H, Taketa T, Sakoda S, Hatakeyama A, Nakamura T, Sakai A. Arthroscopic fragment fixation using hydroxyapatite/poly-L-lactate Acid thread pins for treating elbow osteochondritis dissecans. Am J Sports Med 2015; 43:1057-65. [PMID: 25737319 DOI: 10.1177/0363546515570871] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various procedures, such as arthroscopic debridement, osteochondral transplantation, and bone plug fixation, have been described for the treatment of osteochondritis dissecans (OCD) of the humeral capitellum. However, the use of hydroxyapatite/poly-L-lactate acid (HA/PLLA) thread pins to fix the osteochondral fragment in an OCD lesion is a recent development. HYPOTHESIS Adolescent throwing athletes would return to preinjury levels of function after arthroscopic osteochondral fragment fixation using HA/PLLA thread pins. STUDY DESIGN Case series; Level of evidence, 4. METHODS Enrolled in this prospective cohort study were 18 adolescent baseball players (mean age, 14.2 years; range 12-16, years) with elbow OCD who underwent arthroscopic fragment fixation with HA/PLLA thread pins between 2006 and 2009. All patients were affected on their dominant side. Plain radiographs taken before surgery showed an open physis in 13 patients (72%) and a closed physis in 5 patients (28%). During surgery, the condition of the OCD lesion was evaluated by use of the International Cartilage Research Society (ICRS) classification system; there were 5 grade II, 11 grade III, and 2 grade IV cases. Outcomes were assessed after 3 years (mean, 39 months; range, 36-50 months). Elbow function was measured using the Timmerman and Andrews score and the Mayo Elbow Performance Index. Return to sports activity was assessed as higher than preinjury, same level, lower level, or no return to sports. RESULTS The mean Timmerman and Andrews score improved significantly from 126.6±6.5 to 197.5±1.5, and the mean Mayo Elbow Performance Index improved significantly from 68.0±2.1 to 98.06±0.9 (P=.0001 for both). Mean elbow extension improved significantly from -10°±10.4° to -0.8°±5.2° (P=.006), and mean flexion improved significantly from 123.1°±17.9° to 138.6°±6.1° (P=.001). Three patients had a loss of extension greater than 5°. Five patients returned to a higher level of sports activity, 10 patients returned to the same level, and 2 patients returned to a lower level. A remaining patient did not return to baseball. In one patient, the lesion did not heal, resulting in fragmentation at 1 year after surgery. This patient consequently underwent revision arthroscopy to remove the lesion, and he eventually returned to sports at the same level of activity. CONCLUSION Arthroscopic fragment fixation using HA/PLLA thread pins provides a beneficial clinical outcome to adolescent baseball players with humeral capitellar OCD.
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Affiliation(s)
- Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hajime Utsunomiya
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tomonori Taketa
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinsuke Sakoda
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihisa Hatakeyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshitaka Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Hou H, Zheng K, Wang G, Ikegawa S, Zheng M, Gao X, Qin J, Teng H, Jiang Q. Influence of intra-articular administration of trichostatin a on autologous osteochondral transplantation in a rabbit model. BIOMED RESEARCH INTERNATIONAL 2015; 2015:470934. [PMID: 25866784 PMCID: PMC4381848 DOI: 10.1155/2015/470934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 11/17/2022]
Abstract
Autologous osteochondral transplantation (AOT) is a method for articular cartilage repair. However, several disadvantages of this method have been reported, such as transplanted cartilage degeneration and the lack of a connection between the grafted and adjacent cartilage tissues. To evaluate the effect of intra-articular administration of trichostatin A (TSA) on AOT, we conducted a case control study in a rabbit model. International Cartilage Repair Society (ICRS) macroscopic scores, the modified O'Driscoll histology scores, and real-time PCR were utilized to evaluate the results. At 4 weeks, both macroscopic and histological assessments showed that there was no significant difference between the TSA and control groups. However, the mean macroscopic and histological scores for the TSA-treated group were significantly higher than the scores for the control group at 12 weeks. TSA was shown to directly reduce collagen type II (COL2), aggrecan, matrix metalloproteinase (MMP), and a disintegrin and metalloproteinase domain with thrombospondin motifs 5 (ADAMTS-5) expression and to simultaneously repress the upregulation of MMP-3, MMP-9, and MMP-13 levels induced by interleukin 1β (IL-1β) in chondrocytes. In conclusion, TSA protects AOT grafts from degeneration, which may provide a benefit in the repair of articular cartilage injury.
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Affiliation(s)
- Huacheng Hou
- Medical School of Nanjing University, Hankou Road, Nanjing, Jiangsu 210093, China
- The Center of Diagnosis and Treatment for Joint Disease, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Zhongshan Road, Nanjing, Jiangsu 210008, China
| | - Ke Zheng
- Medical School of Nanjing University, Hankou Road, Nanjing, Jiangsu 210093, China
- The Center of Diagnosis and Treatment for Joint Disease, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Zhongshan Road, Nanjing, Jiangsu 210008, China
| | - Guanghu Wang
- Medical School of Nanjing University, Hankou Road, Nanjing, Jiangsu 210093, China
- The Center of Diagnosis and Treatment for Joint Disease, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Zhongshan Road, Nanjing, Jiangsu 210008, China
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Disease, Center for Genomic Medicine, 4-6-1 Shirokane-dai, Minato-ku, Tokyo 108-8639, Japan
| | - Minghao Zheng
- Orthopaedic Surgery, Centre for Orthopaedic Research, The University of Western Australia (M508), Crawley, WA 6009, Australia
| | - Xiang Gao
- Model Animal Research Center of Nanjing University, Xuefu Road, Nanjing, Jiangsu 210032, China
| | - Jinzhong Qin
- Model Animal Research Center of Nanjing University, Xuefu Road, Nanjing, Jiangsu 210032, China
| | - Huajian Teng
- Medical School of Nanjing University, Hankou Road, Nanjing, Jiangsu 210093, China
- Model Animal Research Center of Nanjing University, Xuefu Road, Nanjing, Jiangsu 210032, China
| | - Qing Jiang
- Medical School of Nanjing University, Hankou Road, Nanjing, Jiangsu 210093, China
- The Center of Diagnosis and Treatment for Joint Disease, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Zhongshan Road, Nanjing, Jiangsu 210008, China
- Model Animal Research Center of Nanjing University, Xuefu Road, Nanjing, Jiangsu 210032, China
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Roessler PP, Pfister B, Gesslein M, Figiel J, Heyse TJ, Colcuc C, Lorbach O, Efe T, Schüttler KF. Short-term follow up after implantation of a cell-free collagen type I matrix for the treatment of large cartilage defects of the knee. INTERNATIONAL ORTHOPAEDICS 2015; 39:2473-9. [PMID: 25676840 DOI: 10.1007/s00264-015-2695-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/26/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE Although there are various new scaffold-based techniques for cartilage regeneration it remains unclear up to which defect size they can be used. The present study reports of a cell-free collagen type I gel matrix for the treatment of large cartilage defects of the knee after a two-year follow-up. METHODS Twenty-eight patients with a mean cartilage defect size of 3.71 ± 1.93 cm² were treated with a cell-free collagen type I gel matrix (CaReS-1S®, Arthro Kinetics AG, Krems/Donau, Austria) via a mini-arthrotomy. Clinical outcome was assessed preoperatively and six weeks as well as six, 12 and 24 months after surgery using various clinical outcome scores (IKDC, Tegner, KOOS, VAS). Cartilage regeneration was evaluated via MRI using the MOCART score. RESULTS Seventeen male and 11 female patients with a mean age of 34.6 years were included in this study. Significant pain reduction (VAS) could be noted after six weeks already. Patient activity (IKDC, Tegner) could be significantly improved from 12 months on and nearly reached reported pre-operative values. All subject categories of the KOOS except for symptom (swelling) showed significant improvements throughout the study. Constant significant improvements of the mean MOCART score were observed from 12 months on. MR images did not yield any signs of infection or synovitis. After 24 months a complete defect filling could be noted in 24 out of 28 cases with a mainly smooth surface, complete integration of the border zone and homogenous structure of the repaired tissue. CONCLUSION Cell-free collagen type I matrices appear to be a safe and suitable treatment option even for large cartilage defects of the knee. Results of this study were comparable to the better-established findings for small cartilage defects. Mid- and long-term results will be needed to see if clinical and MR-tomographic outcome can be maintained beyond 24 months.
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Affiliation(s)
- Philip P Roessler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.,Department of Orthopaedics and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Bernhard Pfister
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Markus Gesslein
- Department of Trauma and Orthopaedic Surgery, Paracelsus Medical University, Nürnberg, Germany
| | - Jens Figiel
- Department of Radiology, University Hospital Marburg, Marburg, Germany
| | - Thomas J Heyse
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Christian Colcuc
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Olaf Lorbach
- Department of Orthopaedic Surgery, Saarland University, Homburg, Saar, Germany
| | - Turgay Efe
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Karl F Schüttler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
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Wondrasch B, Risberg MA, Zak L, Marlovits S, Aldrian S. Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle: a prospective, randomized controlled study presenting MRI-based and clinical outcomes after 5 years. Am J Sports Med 2015; 43:146-53. [PMID: 25378208 DOI: 10.1177/0363546514554910] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term effects of different weightbearing (WB) modalities after matrix-associated autologous chondrocyte implantation (MACI) on changes in knee articular cartilage and clinical outcomes are needed to establish more evidence-based recommendations for postoperative rehabilitation. HYPOTHESIS There will be no differences between accelerated WB compared with delayed WB regarding knee articular cartilage or patient self-reported knee function or activity level 5 years after MACI. Furthermore, significant correlations between magnetic resonance imaging (MRI)-based outcomes and patient-reported outcome measures 5 years postoperatively will exist. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS After MACI, 31 patients (23 male, 8 female) were randomly assigned to the accelerated WB group (AWB group) or to the delayed WB group (DWB group). With the exception of time and increase to full WB, both groups underwent the same rehabilitation program. The AWB group was allowed full WB after 6 weeks and the DWB group after 10 weeks. Assessments were performed 3 months, 2 years, and 5 years postoperatively, but this long-term follow-up study only included changes from 2 to 5 years postoperatively. The magnetic resonance observation of cartilage repair tissue (MOCART) score (primary outcome), the MRI-based variables of bone edema and effusion, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner scale were included. In addition, the association between MRI-based outcomes and the KOOS at 5 years postoperatively was investigated. RESULTS There was a significant decrease in the MOCART score and a significant increase in bone edema 2 and 5 years postoperatively but no significant group differences. The only significant correlation between the MRI-based variables and the KOOS was found for bone edema and the KOOS subscale of pain (r=-0.435, P<.05) at 5-year follow-up. CONCLUSION There were no significant differences in the MRI-based or clinical outcomes between the AWB group and DWB group 5 years after MACI. While the clinical outcomes remained stable, a decline of the MRI-based findings was observed between 2 and 5 years postoperatively. Furthermore, a significant association between bone edema and pain was found. No occurrence of unintended effects was observed.
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Affiliation(s)
- Barbara Wondrasch
- Norwegian Research Center for Active Rehabilitation, Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway Department of Health and Social Sciences, St Poelten University of Applied Sciences, St Poelten, Austria
| | - May-Arna Risberg
- Department of Health and Social Sciences, St Poelten University of Applied Sciences, St Poelten, Austria
| | - Lukas Zak
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Stefan Marlovits
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Silke Aldrian
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
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