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Jiang Z, Clausen JD, Jahn D, Wulsten D, Gladitz LM, Bundkirchen K, Krettek C, Neunaber C. Ex vivo storage of human osteochondral allografts: Long-term analysis over 300 days using a Ringer-based solution. J Orthop Res 2024; 42:1719-1726. [PMID: 38440833 DOI: 10.1002/jor.25821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024]
Abstract
Large osteochondral defects are a major challenge in orthopedics, for which osteochondral allograft (OCA) transplantation is nowadays considered as an option, especially in young patients. However, a major issue with OCA is the need for graft storage, which ensures adequate cartilage integrity over time. The aim of this study was to test how long a Ringer-based storage solution can provide good graft quality after explantation and thus meet the requirements for OCA. For this purpose, human osteochondral allografts of the knee and ankle were analyzed. Live/Dead analysis was performed and glycosaminoglycan, as well as hydroxyproline content, were measured as crucial chondrocyte integrity factors. Furthermore, biomechanical tests focusing on stress relaxation and elastic compression modulus were performed. The critical value of 70% living chondrocytes, which corresponds to a number of 300 cells/mm², was reached after an average of 16 weeks of storage. In addition, a constant cell shrinkage was observed over time. The amount of glycosaminoglycan and hydroxyroline showed a slight and constant decrease over time, but no significant differences when compared from Day 0 to the values at Weeks 40-43. Biomechanical testing also revealed no significant differences at the different time points. Therefore, the results show that the Ringer-based storage solution at 4°C is able to provide a chondrocyte survival of 70% until Week 16. This is comparable to previously published storage solutions. Therefore, the study contributes to the establishment of a Ringer-based osteochondral allograft transplantation system for countries where medium-based storage solution cannot be approved.
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Affiliation(s)
- Zhida Jiang
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Jan-Dierk Clausen
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Denise Jahn
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Dag Wulsten
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Luisa M Gladitz
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Katrin Bundkirchen
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Krettek
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Claudia Neunaber
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
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Husen M, Wang AS, Levy BA, Saris DBF, Stuart MJ, Krych AJ. Influence of Concomitant Meniscal Allograft Transplantation on Midterm Outcomes After Osteochondral Allograft Transplantation: A Comparative Matched-Pair Analysis. Am J Sports Med 2024; 52:1238-1249. [PMID: 38523473 DOI: 10.1177/03635465241234534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Osteochondral allograft transplantation (OCAT) is an accepted knee joint-preserving treatment strategy for focal osteochondral lesions that is often conducted in combination with meniscal allograft transplantation (MAT). Despite its frequent and simultaneous utilization, there remains a lack in the literature reporting on outcomes and failure rates after concomitant procedures. PURPOSE To determine (1) the midterm clinical success rate after OCAT+MAT in comparison with a matched-pair cohort undergoing isolated OCAT, (2) whether patient-specific and procedural variables influence the risk of failure, and (3) patient-reported outcome measures over time. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A single-center matched-pair cohort study was conducted investigating outcomes in patients who underwent OCAT of the medial or lateral femoral condyle with and without MAT between 2004 and 2020. Patients were matched 1:1 by age (±5 years), sex (male or female), body mass index (±5), and grouped Kellgren and Lawrence grade (grades 0-1 or 2-4). The minimum follow-up time was 2 years. Radiographic variables (International Cartilage Regeneration & Joint Preservation Society [ICRS] grade and Kellgren and Lawrence grade) were assessed preoperatively and at follow-up. Subjective patient-reported outcome measures (Lysholm score, Knee injury and Osteoarthritis Outcome Score [KOOS] including subscores, International Knee Documentation Committee [IKDC] score, and visual analog scale score) were collected preoperatively and at follow-up. Clinical failure was defined as revision surgery for graft failure or conversion to total knee arthroplasty. Patient-reported, clinical, and radiographic outcomes were compared between groups. RESULTS In total, 66 patients (33 treated with isolated OCAT, 33 treated with OCAT+MAT; 57.6% male) with a mean age of 26.3 years (range, 18-62 years) were followed for a mean of 5.6 years (minimum, 2 years; range, 24-218 months). The 2 cohorts showed no difference in Kellgren and Lawrence grade postoperatively (P = .59). There was a significantly higher ICRS grade detected at follow-up in the OCAT+MAT group (2.81 ± 1.10) compared with the OCAT group (2.04 ± 0.96) (P < .05). There were no statistically significant differences between the groups regarding reoperation rate (OCAT: n = 6; OCAT+MAT: n = 13; P = .116), time to reoperation (OCAT: 46.67 ± 47.27 months vs OCAT+MAT: 28.08 ± 30.16 months; P = .061), and failure rate (OCAT: n = 4 [12.1%] vs OCAT+MAT: n = 5 [15.2%]; P = .66). In the OCAT+MAT group, an increase of tibial slope by 1° conferred a 1.65-fold increase in the hazard for failure over decreased slope (hazard ratio, 1.65; 95% CI, 1.10-2.50; P < .05). The overall survival rate was 86% at a mean follow-up of 5.6 years. Patient-reported outcome scores were significantly improved at the final follow-up compared with preoperative status. No significant differences were seen between groups with respect to subjective IKDC, Lysholm, Tegner, and KOOS results, except for the KOOS Symptoms subscale score, which was significantly higher in the OCAT+MAT group than in the OCAT group (mean difference, 14.6; P < .05) and did exceed the minimal clinically important difference threshold of 10.7. CONCLUSION Midterm results after isolated OCAT and OCAT+MAT show high rates of healing and sustainable subjective improvement of knee function and quality of life. However, it should be noted that the difference in reoperation rate and time to reoperation between the groups is arguably clinically important and that lack of statistical significance may be because of low power. These results imply that isolated OCAT is an efficient joint-preserving treatment that can be combined with MAT in well-selected patients with meniscal insufficiency without negative influence on global clinical outcomes.
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Affiliation(s)
- Martin Husen
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Allen S Wang
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniël B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, UMC Utrecht, Utrecht, the Netherlands
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Olivos-Meza A, Brittberg M, Martínez-Nava G, Landa-Solis C. Suitable characteristics in the selection of human allogeneic chondrocytes donors to increase the number of viable cells for cartilage repair. Cell Tissue Bank 2023; 24:725-735. [PMID: 36944749 PMCID: PMC10030348 DOI: 10.1007/s10561-023-10074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/21/2023] [Indexed: 03/23/2023]
Abstract
Autologous chondrocyte implantation has shown optimal long-term outcomes in the treatment of cartilage lesions. The challenge for a single-stage approach lies in obtaining sufficient number of cells with high viability. The answer could lie in supplementing or replacing them with allogenic chondrocytes coming from cadaveric donors. In the present work, we aimed to compare the number of viable cells isolated from cartilage of live and cadaveric donors and to determine the suitable characteristics of the best donors. A total of 65 samples from donors aged from 17 to 55 years, either women or men, were enrolled in this study (33 living vs. 32 cadaveric). The mean time of hours from death to processing samples in cadaveric donors was higher compared to live donors (64.3 ± 17.7 vs. 4.6±6.4). The number of isolated chondrocytes per gram of cartilage was higher in cadaveric donors (5.389 × 106 compared to 3.067 × 106 in living donors), whereas the average of cell viability was comparable in both groups (84.16% cadaveric, 87.8% alive). It is possible to obtain viable chondrocytes from cartilage harvested from cadaveric donors, reaching a similar cell number and viability to that obtained from the cartilage of living donors.
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Affiliation(s)
- Anell Olivos-Meza
- Orthopedics and Sports Medicine, Hospital Médica Sur, Mexico, Mexico
| | - Mats Brittberg
- Cartilage Research Unit at University of Gothenburg, Orthopedic Surgeon at Region Halland Orthopaedics at the Kungsbacka Hospital Kungsbacka, Gothenburg, Sweden
| | - Gabriela Martínez-Nava
- Geroscience Laboratory, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Carlos Landa-Solis
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calzada México Xochimilco 289, 14389 Mexico City, ZC Mexico
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Moser LB, Bauer C, Otahal A, Kern D, Dammerer D, Zantop T, Nehrer S. Mincing bovine articular cartilage with commercially available shavers reduces the viability of chondrocytes compared to scalpel mincing. J Exp Orthop 2023; 10:97. [PMID: 37768416 PMCID: PMC10539273 DOI: 10.1186/s40634-023-00661-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE The study aimed to compare the effect of mincing bovine articular cartilage with different shaver blades on chondrocyte viability. METHODS Bovine articular cartilage was harvested either with a scalpel or with three different shaver blades (2.5 mm, 3.5 mm, or 4.2 mm) from a commercially available shaver. The cartilage harvested with a scalpel was then minced into fragments smaller than 1 mm3 with a scalpel. All four conditions were cultivated in a culture medium for seven days. After Day 1 and Day 7, the following measurements were performed: metabolic activity, RNA isolation, and gene expression of anabolic (COL2A1 and ACAN) and catabolic genes (MMP1 and MMP13), live/dead staining and visualization using confocal microscopy, and flow cytometric characterization of minced cartilage chondrocytes. RESULTS Mincing the cartilage with shavers significantly reduced metabolic activity after one and seven days compared to scalpel mincing (p < 0.001). Gene expression of anabolic genes (COL2A1 and ACAN) was reduced, while catabolic genes (MMP1 and MMP13) were increased after day 7 in all shaver conditions. Confocal microscopy showed a thin line of dead cells at the lesion side with viable cells beneath for the scalpel mincing and a higher number of dead cells diffusely distributed in the shaver conditions. After seven days, there was a significant decrease in viable cells in the shaver conditions compared to scalpel mincing (p < 0.05). Flow cytometric characterization revealed fewer intact cells and proportionally more dead cells in all shaver conditions compared to the scalpel mincing. CONCLUSION Mincing bovine articular cartilage with commercially available shavers reduces the viability of chondrocytes compared to scalpel mincing immediately after harvest and after seven days in culture. This suggests that mincing cartilage with a shaver should be considered a matrix rather than a cell therapy. LEVEL OF EVIDENCE Level II therapeutic study.
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Affiliation(s)
- Lukas B Moser
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria.
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500, Krems, Austria.
| | - Christoph Bauer
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Alexander Otahal
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Daniela Kern
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500, Krems, Austria
| | - Thore Zantop
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Sporthopaedicum Straubing, Straubing, Germany
- Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, 3500, Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500, Krems, Austria
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Ead M, Wu K, Jar C, Duke K, Jomha N, Westover L. Mechanical Properties of Fresh, Frozen and Vitrified Articular Cartilage. Ann Biomed Eng 2023; 51:2001-2012. [PMID: 37129781 DOI: 10.1007/s10439-023-03220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
Osteochondral allograft transplantations are typically used to treat focal articular cartilage injuries where the damaged cartilage is replaced with fresh cadaveric donor grafts. Despite the notable success rate of this procedure, it is limited by fresh donor tissue availability which can only be stored for approximately 28 days after harvest. Vitrification, a form of cryopreservation, can extend the storage time of cartilage. Although it has shown to preserve chondrocyte viability, its effect on the mechanical properties of the tissue has not been thoroughly investigated. Therefore, in this study, the mechanical properties of fresh, frozen, and vitrified articular cartilage were evaluated through unconfined compression testing. Results showed that the peak modulus, equilibrium modulus, and relaxation time constants of the vitrified and control samples (tested one day after harvest) were similar and higher than the fresh (tested 21 days after harvest) and frozen samples. This demonstrated that vitrification does not adversely affect the mechanical properties of cartilage and can be used as an alternative to fresh allografts which are limited by storage time. The fresh samples also had inferior mechanical properties compared to the control samples suggesting that vitrified allografts could potentially improve clinical outcomes in addition to increasing donor tissue availability.
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Affiliation(s)
- Maha Ead
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada.
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, Canada
- Sports Medicine Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Chester Jar
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - Kajsa Duke
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - Nadr Jomha
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
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Filho JPAG, Sousa EBD. Treatment of Chondral Lesions in the Knee. Rev Bras Ortop 2023; 58:e551-e556. [PMID: 37663186 PMCID: PMC10468252 DOI: 10.1055/s-0043-1772196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/12/2023] [Indexed: 09/05/2023] Open
Abstract
Articular cartilage injuries are common and lead to early joint deterioration and osteoarthritis. Articular cartilage repair techniques aim at forming a cartilaginous neo-tissue to support the articular load and prevent progressive degeneration. Several techniques are available for this purpose, such as microfracture and chondrocyte transplantation. However, the procedural outcome is often fibrocartilage, which does not have the same mechanical resistance as cartilaginous tissue. Procedures with autologous osteochondral graft have a morbidity risk, and tissue availability limits their use. As such, larger lesions undergo osteochondral transplantation using fresh or frozen grafts. New techniques using minced or particulate cartilage fragments or mesenchymal stem cells are promising. This paper aims to update the procedures for treating chondral lesions of the knee.
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Affiliation(s)
- José Paulo Aramburu Gabbi Filho
- Médico Ortopedista e Traumatologista, Serviço de Traumato-Ortopedia, Hospital Central da Polícia Militar do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Médico Ortopedista e Traumatologista, Serviço de Traumatologia e Ortopedia, Hospital Quinta D'Or, Rio de Janeiro, RJ, Brasil
| | - Eduardo Branco de Sousa
- Ortopedista e Traumatologista, Centro de Cirurgia do Joelho, Divisão de Traumatologia e Ortopedia, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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7
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Mameri ES, Kerzner B, Obioha OA, McCormick JR, Dasari SP, Khan ZA, Fortier LM, Jackson GR, Chahla J. Revision Lateral Femoral Condyle Osteochondral Allograft Transplantation With the Snowman Technique After Failed Previous Oblong Osteochondral Allograft. Arthrosc Tech 2023; 12:e363-e370. [PMID: 37013011 PMCID: PMC10066260 DOI: 10.1016/j.eats.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/06/2022] [Indexed: 04/05/2023] Open
Abstract
Osteochondral allograft transplantation provides components of both cartilage and subchondral bone and can be used in large and multifocal defects where autologous procedures are limited by donor-site morbidity. Osteochondral allograft transplantation is particularly appealing in the management of failed cartilage repair, as larger defects and subchondral bone involvement are often present, and the use of multiple overlapping plugs might be considered. The described technique provides our preoperative workup and reproducible surgical approach for patients who have undergone previous osteochondral transplantation with graft failure and are young, active patients who would not be otherwise suited for a knee arthroplasty procedure.
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Affiliation(s)
- Enzo S. Mameri
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
- Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, RJ, Brazil
| | - Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A. Obioha
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Johnathon R. McCormick
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Suhas P. Dasari
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Luc M. Fortier
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Garrett R. Jackson
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Suite 300, Chicago, IL 60612.
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8
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Orthobiologic Techniques for Surgical Augmentation. Phys Med Rehabil Clin N Am 2023; 34:265-274. [DOI: 10.1016/j.pmr.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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9
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Chua YL, Siang Koh DT, Lee KH. Fresh Femoral Osteochondral Allograft Transplantation Using a Single-Plug Technique for Large Osteochondral Defects of the Knee. Arthrosc Tech 2023; 12:e223-e232. [PMID: 36879860 PMCID: PMC9984732 DOI: 10.1016/j.eats.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/28/2022] [Indexed: 01/20/2023] Open
Abstract
Osteochondral allograft (OCA) transplantation has been used to treat a wide spectrum of cartilage deficiencies in the knee, including spontaneous necrosis of the knee. Studies reporting outcomes after OCA transplantation have shown reliable improvement in pain and return to activities of daily living. We describe a single-plug, press-fit technique for OCA transplantation with concomitant high tibial osteotomy to treat femoral condyle chondral defects in a varus knee. Pearls and pitfalls of this technique are presented; attention should be paid to correction of concomitant joint pathology and malalignment to facilitate osseointegration and survivorship of the allograft plug into host bone. Appropriate surgical timing and prompt allograft implantation help to maximize chondrocyte viability.
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Affiliation(s)
- Yi Ling Chua
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Don Thong Siang Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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10
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Betz VM, Holzgruber M, Simon J, Uhlemann F, Niemeyer P, Müller PE, Niethammer TR. The Effect of Smoking on the Outcome of Matrix-Based Autologous Chondrocyte Implantation: Data from the German Cartilage Registry. J Knee Surg 2023; 36:181-187. [PMID: 34237778 DOI: 10.1055/s-0041-1731456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Smoking is known to have various deleterious effects on health. However, it is not clear whether smoking negatively affects the postoperative outcome following matrix-based autologous cartilage implantation (MACI) in the knee. The purpose of this study was to evaluate the effect of smoking on the outcome of MACI in the knee. A total of 281 patients receiving MACI in the knee between 2015 and 2018 were registered in the German Cartilage Database. The cohort was divided into ex-smokers, smokers, and nonsmokers. Data regarding the Knee Injury and Osteoarthritis Outcome Score (KOOS), the numeric rating scale (NRS) for pain, and satisfaction with the outcome were analyzed and compared. Follow-ups were performed at 6, 12, and 24 months after surgery. Of the 281 patients, 225 (80.1%) were nonsmokers, 43 (15.3%) were smokers, and 13 (4.6%) were ex-smokers. The three groups were comparable with respect to age, sex, body mass index (BMI), height, defect size, the need for additional reconstruction of the subchondral bone defect, number of previous knee surgeries, and defect location. However, nonsmokers had a significantly lower weight as compared with smokers. Besides a significantly lower preoperative NRS of nonsmokers as compared with smokers, there were no significant differences between the three groups with respect to KOOS, NRS, and satisfaction at 6, 12, and 24 months of follow-ups. The present study of data retrieved from the German Cartilage Registry suggests that the smoking status does not influence the outcome of MACI in the knee.
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Affiliation(s)
- Volker M Betz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin Holzgruber
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Johanna Simon
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Felix Uhlemann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Philipp Niemeyer
- Department of Orthopaedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.,Department of Orthopaedic Surgery, Orthopädische Chirurgie München Clinic, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas R Niethammer
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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11
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Burroughs PJ, Kahan JB, Moran J, Gillinov SM, Joo PY, Schneble CA, Moore HG, Grauer JN, Medvecky MJ. Subsequent Surgery Up to 10 Years After Osteochondral Allograft and Osteochondral Autograft: An Analysis of More Than 2000 Patients. Orthop J Sports Med 2022; 10:23259671221139127. [PMID: 36582936 PMCID: PMC9793021 DOI: 10.1177/23259671221139127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Osteochondral allograft transplant (OCA) and osteochondral autograft transfer (OAT) replace damaged cartilage with a plug of bone and overlying articular cartilage; however, limited research is available regarding the survival of these osteoarticular grafting procedures. Hypothesis We hypothesized that patients who underwent OCA would have a higher rate of subsequent surgery over the course of 5 years compared with patients who underwent OAT. Study Design Cohort study; Level of evidence, 3. Methods The PearlDiver Mariner administrative database was used to identify patients 10 to 59 years old who had undergone OCA or OAT between 2010 and 2018. All included patients were assessed for subsequent knee surgeries, defined by the occurrence of a subsequent osteochondral procedure (OCA or OAT) or any type of knee arthroplasty for the duration of the time they were included in the data set (maximum of 10 years). Analyses were performed for the total population and those with allograft versus autograft (compared using the Fisher exact test). The 5-year Kaplan-Meier survival curves for operation-free survival were compared using a Mantel-Cox log-rank test. Results In total, 2598 patients were identified: 1631 patients who underwent OCA (34.5 ± 12.1 years old; 51.6% female) and 967 patients who underwent OAT (32.1 ± 12.9 years old; 51.0% female). Both groups had similarly high rates of subsequent knee surgeries (23.9% vs 21.9%, respectively; P = .249), with no statistical differences in rates of subsequent surgery between groups. Kaplan-Meier survival curves comparing operation-free survival at 5 years indicated no significant difference between the groups (OCA, 88.0% vs OAT, 89.5%; P = .235). Conclusion Both osteochondral grafting procedures carried a relatively high rate of secondary surgery, which increased with time. The 5-year survival analysis revealed similarly high rates of subsequent surgery.
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Affiliation(s)
| | - Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Stephen M. Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
- Stephen M. Gillinov, AB, Department of Orthopaedics and
Rehabilitation, Yale School of Medicine, 367 Cedar Street, New Haven, CT 06511,
USA () (Twitter: @StephenGillinov)
| | - Peter Y. Joo
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Harold G. Moore
- Department of Orthopaedic Surgery, UT Southwestern, Dallas, Texas,
USA
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
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12
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Satisfactory clinical outcomes with autologous matrix-induced chondrogenesis in the treatment of grade IV chondral injuries of the knee. J ISAKOS 2022; 8:86-93. [PMID: 36435431 DOI: 10.1016/j.jisako.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The research aims to evaluate short- and medium-term outcomes of patients treated using autologous matrix-induced chondrogenesis (AMIC) with a hyaluronic acid scaffold (Hyalofast, Anika Therapeutics, MA, USA) in grade IV chondral lesions according to the Outerbridge classification in the knee. METHODS This is a multicentre, non-randomized, retrospective study conducted between 2017 and 2022. To determine the clinical outcome of the patients, the follow-up was done with the subjective International Knee Documentation Committee (IKDC) score, pre-surgery, and with a follow-up at 12, 24, and 32 months. RESULTS Fifty patients (28 female) with a mean age of 45.9 ± 12.7 years were recruited. The mean size of the lesion was 3.5 cm2, and the injuries located in the patella (30%) and trochlear groove (24%) were the most frequent. The total IKDC clinical score significantly increased from baseline to the 32 months of follow-up with a mean difference of 36.4 (95% CI, 29.1-43.7, p < 0.001). Besides, there was a statistically significant improvement in all categories of the IKDC (symptoms, sports activities, function, and activity of daily living) compared between pre-surgery and 24 and 32 months of follow-up. The patients younger than 45 years presented better clinical outcomes than older ones with a difference between medians of 10.40 (95% CI, 1.10-11.50, p = 0.0247), and a negative correlation was found between the 32-month IKDC score and the age. In addition, no statistically significant difference was found when comparing the last results of the IKDC between patients with and without associated surgical procedures or between patients with single and several lesions, neither nor between men and women. The level of satisfaction with the procedure of all the patients, on a score of 1-10, was on average 8 ± 1.5. CONCLUSION Results of this study indicate that patients who underwent the AMIC procedure with hyaluronic acid scaffold for the treatment of grade IV chondral lesions in the knee presented satisfactory results throughout the follow-up. LEVEL OF EVIDENCE Level IV.
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13
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Crowley SG, Pedersen A, Fortney TA, Swindell HW, Saltzman BM, Popkin CA, Trofa DP. Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee. Cartilage 2022; 13:19476035221093071. [PMID: 35762400 PMCID: PMC9247380 DOI: 10.1177/19476035221093071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) of the knee. DESIGN Online postoperative OAT and OCA rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention. RESULTS A total of 16 programs (10.3%) from 155 US academic orthopedic programs published online protocols and a total of 35 protocols were analyzed. Twenty-one protocols (88%) recommended immediate postoperative bracing following OAT and 17 protocols (100%) recommended immediate postoperative bracing following OCA. The average time protocols permitted weight-bearing as tolerated (WBAT) was 5.2 weeks (range = 0-8 weeks) following OAT and 6.2 weeks (range = 0-8 weeks) following OCA. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. Following OAT, 2 protocols (8%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Following OCA, 1 protocol (6%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). CONCLUSION A minority of US academic orthopedic programs publish OAT and OCA rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.
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Affiliation(s)
- Stephen G. Crowley
- Albany Medical Center, Albany, NY,
USA,Stephen G. Crowley, Albany Medical Center,
Albany, NY 12208, USA.
| | | | - Thomas A. Fortney
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | | | | | - Charles A. Popkin
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - David P. Trofa
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
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14
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Tabbaa SM, Guilak F, Sah RL, Bugbee WD. Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature. Am J Sports Med 2022; 50:1702-1716. [PMID: 34310184 DOI: 10.1177/03635465211016832] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Storage procedures and parameters have a significant influence on the health of fresh osteochondral allograft (OCA) cartilage. To date, there is a lack of agreement on the optimal storage conditions for OCAs. PURPOSE To systematically review the literature on (1) experimental designs and reporting of key variables of ex vivo (laboratory) studies, (2) the effects of various storage solutions and conditions on cartilage health ex vivo, and (3) in vivo animal studies and human clinical studies evaluating the effect of fresh OCA storage on osteochondral repair and outcomes. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS A systematic review was performed using the PubMed, Embase, and Cochrane databases. The inclusion criteria were laboratory studies (ex vivo) reporting cartilage health outcomes after prolonged storage (>3 days) of fresh osteochondral or chondral tissue explants and animal studies (in vivo) reporting outcomes of fresh OCA. The inclusion criteria for clinical studies were studies (>5 patients) that analyzed the relationship of storage time or chondrocyte viability at time of implantation to patient outcomes. Frozen, cryopreserved, decellularized, synthetic, or tissue-engineered grafts were excluded. RESULTS A total of 55 peer-reviewed articles met the inclusion criteria. Ex vivo studies reported a spectrum of tissue sources and storage solutions and conditions, although the majority of studies lacked complete reporting of key variables, including storage solution formula and environmental conditions. The effect of various conditions (eg, temperature) and storage solutions on cartilage health were inconsistent. Although 60% of animal models suggest that storage time may influence outcomes and 80% indicate inferior outcomes with frozen OCA as compared with fresh OCA, 75% of clinical studies report no correlation between storage time and outcomes. CONCLUSION Given the variability in experimental designs and lack of reporting across studies, it is still not possible to determine optimal storage conditions, although animal studies suggest that storage time and chondrocyte viability influence osteochondral repair outcomes. A list of recommendations was developed to encourage reporting of key variables, such as media formulation, environmental factors, and methodologies used. High-quality clinical data are needed to investigate the effects of storage and graft health on outcomes.
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Affiliation(s)
- Suzanne M Tabbaa
- University of California, San Francisco, San Francisco, California, USA
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15
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Vivacqua T, Rocha T, Rocha de Faria JL, Prinz R, Mozella A, Guimarães JAM. Aloenxerto osteocondral fresco em uma fratura complexa de Hoffa – Relato de caso. Rev Bras Ortop 2022. [DOI: 10.1055/s-0042-1742599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
ResumoA fratura de Hoffa (FH) é típica do côndilo femoral posterior no plano sagital, com incidência estimada de 0,65% nas fraturas do fêmur. De modo geral, a FH é observada no côndilo femoral lateral em traumatismos de alta energia, com força de carga axial sobre o terço distal do fêmur e o joelho em mais de 90° de flexão. O caso aqui relatado ocorreu em um paciente com FH medial complexa e luxação de joelho após um traumatismo de alta energia. Em dois anos de acompanhamento, a análise radiológica revelou consolidação óssea completa e integração do aloenxerto. O transplante de aloenxerto osteocondral deve ser considerado em casos de FH complexa, e visa restaurar a anatomia superfície articular para evitar o desenvolvimento de osteoartrose pós-traumática precoce em pacientes jovens.
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Affiliation(s)
- Thiago Vivacqua
- Clinical Fellow, Fowler Kennedy Sports Medicine Clinic, 3M Centre, Western University, Richmond Street, Ontario, Canadá
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Tito Rocha
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, Rio de Janeiro, Brasil
| | - José Leonardo Rocha de Faria
- Clinical Fellow, Fowler Kennedy Sports Medicine Clinic, 3M Centre, Western University, Richmond Street, Ontario, Canadá
| | - Rafael Prinz
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Alan Mozella
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, Rio de Janeiro, Brasil
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16
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Garcia-Mansilla I, Trivellas M, Singla A, Kelley B, Jones KJ. Quality and Variability of Physical Therapy Protocols Varies Widely for Osteochondral Allograft Transplantation of the Femoral Condyles. Cartilage 2022; 13:19476035221073999. [PMID: 35109692 PMCID: PMC9137295 DOI: 10.1177/19476035221073999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the quality and variability of osteochondral allograft (OCA) transplantation rehabilitation protocols associated with academic orthopedic programs in the United States. DESIGN A systematic review was performed to collect all publicly available online rehabilitation protocols for femoral condyle OCA transplant from US academic orthopedic programs participating in the Electronic Residency Application Service. These protocols were evaluated for inclusion of different rehabilitation components as well as timing of suggested initiation of these activities. RESULTS A total of 22 protocols were included. Although 91% of protocols recommended bracing, wide variation exists in total time of utilization. Median time for full weight bearing (FWB) was 7 weeks (range 4-8). On average, each protocol mentioned 9 (range 2-18) different strengthening exercises. The median time suggested to return to high-impact activities was 9 months (range 8-12). Only 3 protocols (14%) offered criteria of advancement for each phase as well as criteria for discharge. CONCLUSION Very few of the academic orthopedic programs have published online rehabilitation protocols following OCA transplantation. Although there is wide variation between the protocols, it allowed the identification of trends or patterns that are more common. However, there is need for more standardized evidence-based rehabilitation protocols which are easy to understand and follow by patients.
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Affiliation(s)
- Ignacio Garcia-Mansilla
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina,Ignacio Garcia-Mansilla, Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABD, Argentina.
| | - Myra Trivellas
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amit Singla
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Benjamin Kelley
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, Division of Sports Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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17
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van der Stok J, van Buul GM, Stanclik J, Queally JM, O'Donnell T. Focal articular surface replacement as primary treatment for focal chondral defects of the femoral condyles: A series of 157 cases. Knee 2022; 34:108-117. [PMID: 34890923 DOI: 10.1016/j.knee.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Focal chondral defects (FCDs) of the femoral condyle are common. Treatment has heretofore primarily consisted of non-surgical and biological treatments. Focal articular surface replacement (FASR) is an emerging technique utilizing small implants to essentially fill the FCD. Here we report functional outcome and re-operation rates following FASR as a primary treatment for FCDs of the femoral condyles. METHODS Retrospective analysis of a prospectively collected database including 327 FASR procedures was performed to identify patients who underwent FASR of the femoral condyle with a modular cementless metallic implant (HemiCAPTM) as a primary procedure. Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), SF-36 Health Status Survey (SF-36) and Visual Analog Scale (VAS) were collected before and 6 weeks, 6 months, and 4 years after surgery. Implant revision and re-operation rate were recorded. RESULTS 157 patients were included with a mean follow-up of 9.4 ± 1.3 years (range 7.0 to 11.4 years). The average age was 40.2 ± 5.3 years, 85% involved the medial condyle, and the average defect size was 3.6 ± 0.5 cm2. Primary FASR resulted in functional improvement on the KOOS (+52%), OKS (+69%) and SF-36 (+50%) scores and a reduction in VAS scores (-70%) at 4-year follow-up. Revision rate was 0.64% and the re-operation rate was 11%. CONCLUSION This retrospective case-series supports primary FASR with HemiCAPTM implants as an alternative to biological procedures to treat medium-sized FCDs (2.5-4 cm2) of the femoral condyle, although long-term follow-up is necessary to determine if the clinical outcome and low revision rate can be maintained.
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Affiliation(s)
- Johan van der Stok
- The Centre for Orthopaedics, Beacon Hospital, Bracken Road, Sandyford, Dublin D18 AK67, Ireland.
| | - Gerben M van Buul
- The Centre for Orthopaedics, Beacon Hospital, Bracken Road, Sandyford, Dublin D18 AK67, Ireland; Zuyderland Medical Center, Henri Dunantstraat 5, 6419PC Heerlen, the Netherlands
| | - Jaroslaw Stanclik
- The Centre for Orthopaedics, Beacon Hospital, Bracken Road, Sandyford, Dublin D18 AK67, Ireland
| | - Joseph M Queally
- The Centre for Orthopaedics, Beacon Hospital, Bracken Road, Sandyford, Dublin D18 AK67, Ireland
| | - Turlough O'Donnell
- The Centre for Orthopaedics, Beacon Hospital, Bracken Road, Sandyford, Dublin D18 AK67, Ireland; University College Dublin School of Medicine, Health Sciences Centre, Belfield, Donnybrook, Dublin D04 C7X2, Ireland
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18
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Salzmann GM, Ossendorff R, Gilat R, Cole BJ. Autologous Minced Cartilage Implantation for Treatment of Chondral and Osteochondral Lesions in the Knee Joint: An Overview. Cartilage 2021; 13:1124S-1136S. [PMID: 32715735 PMCID: PMC8808955 DOI: 10.1177/1947603520942952] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cartilage defects in the knee are being diagnosed with increased frequency and are treated with a variety of techniques. The aim of any cartilage repair procedure is to generate the highest tissue quality, which might correlate with improved clinical outcomes, return-to-sport, and long-term durability. Minced cartilage implantation (MCI) is a relatively simple and cost-effective technique to transplant autologous cartilage fragments in a single-step procedure. Minced cartilage has a strong biologic potential since autologous, activated non-dedifferentiated chondrocytes are utilized. It can be used both for small and large cartilage lesions, as well as for osteochondral lesions. As it is purely an autologous and homologous approach, it lacks a significant regulatory oversight process and can be clinically adopted without such limitations. The aim of this narrative review is to provide an overview of the current evidence supporting autologous minced cartilage implantation.
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Affiliation(s)
- Gian M. Salzmann
- Gelenkzentrum Rhein-Main, Wiesbaden,
Germany,Lower Extremity Orthopaedics,
Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland
| | - Robert Ossendorff
- Clinic for Orthopaedics and Trauma
Surgery, University Hospital Bonn, Bonn, Germany,Robert Ossendorff, Clinic for Orthopaedics
and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127,
Germany.
| | - Ron Gilat
- Midwest Orthopaedics at Rush, Rush
University Medical Center, Chicago, IL, USA
| | - Brian J. Cole
- Midwest Orthopaedics at Rush, Rush
University Medical Center, Chicago, IL, USA
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19
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Stark M, Rao S, Gleason B, Jack RA, Tucker B, Hammoud S, Freedman KB. Rehabilitation and Return-to-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211017135. [PMID: 34377714 PMCID: PMC8320585 DOI: 10.1177/23259671211017135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport. Purpose: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature, SPORTDiscus, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies on knee OCA. Studies were included if they reported return-to-play data or postsurgical rehabilitation protocols. Results: A total of 62 studies met the inclusion criteria, with a total of 3451 knees in 3355 patients. Concomitant procedures were included in 30 of these studies (48.4%). The most commonly cited rehabilitation protocols included weightbearing restrictions and ROM guidelines in 100% and 90% of studies, respectively. ROM was most commonly initiated within the first postoperative week, with approximately half of studies utilizing continuous passive motion. Progression to weightbearing as tolerated was reported in 60 studies, most commonly at 6 weeks (range, immediately postoperatively to up to 1 year). Of the 62 studies, 37 (59.7%) included an expected timeline for either return to play or return to full activity, most commonly at 6 months (range, 4 months to 1 year). Overall, 13 studies (21.0%) included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. Conclusion: There is significant heterogeneity for postoperative rehabilitation guidelines and the return-to-play protocol after OCA of the knee in the literature, as nearly half of the included studies reported use of concomitant procedures. However, current protocols appear to be predominantly time-based without objective criteria or functional assessment. Therefore, the authors recommend the development of objective criteria for patient rehabilitation and return-to-play protocols after OCA of the knee.
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Affiliation(s)
- Michael Stark
- Division of Orthopaedic Surgery, Rowan University, Stratford, New Jersey, USA
| | - Somnath Rao
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brendan Gleason
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Bradford Tucker
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sommer Hammoud
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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20
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Schreiner AJ, Stannard JP, Stoker AM, Bozynski CC, Kuroki K, Cook CR, Cook JL. Unicompartmental bipolar osteochondral and meniscal allograft transplantation is effective for treatment of medial compartment gonarthrosis in a canine model. J Orthop Res 2021; 39:1093-1102. [PMID: 32672863 DOI: 10.1002/jor.24801] [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] [Received: 01/16/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
Osteochondral allograft (OCA) transplantation can restore large articular defects in the knee. Bipolar OCA transplantations for partial and whole joint resurfacing often have less favorable results than single-surface transplants. This study was designed to use a large animal model to test the hypothesis that unicompartmental bipolar osteochondral and meniscal allograft transplantation (BioJoint) would be as or more effective for treatment of medial compartment osteoarthritis (OA) compared to standard-of-care nonoperative treatment. OA was induced in one knee of each research hound (n = 8) using a meniscal release model and pretreatment assessments were performed. After 3 months, dogs were randomly assigned to either the control group (n = 4, no surgical intervention, daily nonsteroidal antiinflammatory drugs [NSAIDs]) or the BioJoint group (n = 4). Clinical, radiographic, and arthroscopic assessments were performed longitudinally and histopathology was evaluated at the 6-month endpoint. At study endpoint, functional, pain, and total pressure index measures, as well as radiographic and arthroscopic grading of graft appearance and joint health, demonstrated superior outcomes for BioJoints compared to NSAID controls. Furthermore, histologic assessments showed that osteochondral and meniscal transplants maintain integrity and integrated into host tissues. Clinical significance: The results support the safety and efficacy of unicompartmental bipolar osteochondral and meniscal allograft transplantation in a preclinical model with highly functional outcomes without early OA progression.
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Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Trauma and Reconstructive Surgery, BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Cristi R Cook
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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21
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Yang BW, Brusalis CM, Fabricant PD, Greditzer HG. Articular Cartilage Repair in the Knee: Postoperative Imaging. J Knee Surg 2021; 34:2-10. [PMID: 32898909 DOI: 10.1055/s-0040-1716357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diagnostic and therapeutic advancements have improved clinical outcomes for patients with focal chondral injuries of the knee. An increased number and complexity of surgical treatment options have, in turn, resulted in a commensurate proliferation of patients requiring postoperative evaluation and management. In addition to patient-reported clinical outcomes, magnetic resonance imaging (MRI) offers clinicians with noninvasive, objective data to assist with postoperative clinical decision making. However, successful MRI interpretation in this setting is clinically challenging; it relies upon an understanding of the evolving and procedure-specific nature of normal postoperative imaging. Moreover, further research is required to better elucidate the correlation between MRI findings and long-term clinical outcomes. This article focuses on how specific morphologic features identified on MRI can be utilized to evaluate patients following the most commonly performed cartilage repair surgeries of the knee.
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Affiliation(s)
- Brian W Yang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Harry G Greditzer
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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22
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Huang J, Huang Z, Liang Y, Yuan W, Bian L, Duan L, Rong Z, Xiong J, Wang D, Xia J. 3D printed gelatin/hydroxyapatite scaffolds for stem cell chondrogenic differentiation and articular cartilage repair. Biomater Sci 2021; 9:2620-2630. [DOI: 10.1039/d0bm02103b] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The hUCB-MSC-laden 3D printed gelatin/HAP scaffold effectively repairs knee cartilage defects in a pig model.
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23
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Early S, Tírico LEP, Pulido PA, McCauley JC, Bugbee WD. Long-Term Retrospective Follow-Up of Fresh Osteochondral Allograft Transplantation for Steroid-Associated Osteonecrosis of the Femoral Condyles. Cartilage 2021; 12:24-30. [PMID: 30378446 PMCID: PMC7755967 DOI: 10.1177/1947603518809399] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE No studies currently exist with long-term follow-up of use of osteochondral allografting (OCA) for treatment of steroid-associated osteonecrosis of femoral condyles in young, active patients who wish to avoid total knee arthroplasty (TKA). We evaluate the extent to which fresh osteochondral allografts can (1) prevent or postpone need for prosthetic arthroplasty and (2) maintain long-term clinically meaningful decrease in pain and improvement in function at mean 11-year follow-up. DESIGN Twenty-five patients (33 knees) who underwent OCA transplantation for osteonecrosis of the knee between 1984 and 2013 were evaluated, including 22 females and 11 males with average age of 25 years (range, 16-48 years). Mean total allograft surface area was 10.6 cm2 (range, 4.0-19.0 cm2). Evaluation included International Knee Documentation Committee (IKDC) scores, Knee Society function (KS-F) score, and modified (for the knee) Merle d'Aubigné-Postel (18-point) score. RESULTS OCA survivorship was 90% at 5 years and 82% at 10 years. Twenty-eight of 33 knees (85%) avoided arthroplasty and 25 of 33 knees (73%) avoided other surgical intervention. Mean IKDC pain score improved (P = 0.001) from 7.2 preoperatively to 2.8 at latest follow-up, mean IKDC function score increased (P = 0.005) from 3.3 to 6.5, and mean IKDC total score improved (P = 0.001) from 31.9 to 61.1. Mean KS-F score improved (P = 0.003) from 61.7 to 87.5. Mean modified Merle d'Aubigné-Postel (18-point) score improved (P < 0.001) from 11.4 to 15.1. CONCLUSIONS Our findings suggest that OCA transplantation is a reasonable surgical treatment option for steroid-associated osteonecrosis of the femoral condyles, with durable long-term outcomes.
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Affiliation(s)
- Samuel Early
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Luís E. P. Tírico
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
| | - Pamela A. Pulido
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
| | - Julie C. McCauley
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
| | - William D. Bugbee
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA,William D. Bugbee, Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS 116, La Jolla, CA 92037, USA.
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24
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Stannard JP, Stannard JT, Schreiner AJ. Fresh Osteochondral Allograft Transplants in the Knee: Bipolar and Beyond. J Knee Surg 2020; 33:1172-1179. [PMID: 32688399 DOI: 10.1055/s-0040-1714366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Knee patients who have sustained chondral and osteochondral lesions suffer from debilitating pain, which can ultimately lead to posttraumatic osteoarthritis and whole-joint disease. Older, nonactive patients are traditionally steered toward total knee arthroplasty (TKA), but younger, active patients are not good candidates for TKA based on implant longevity, complications, morbidity, and risk for revision, such that treatment strategies at restoring missing hyaline cartilage and bone are highly desired for this patient population. Over the past four decades, fresh osteochondral allograft (OCA) transplantation has been developed as a treatment method for large (> 2.5 cm2) focal full-thickness articular cartilage lesions. This article documents our own institutional OCA journey since 2016 through enhanced graft preservation techniques (the Missouri Osteochondral Preservation System, or MOPS), technical improvements in surgical techniques, use of bone marrow aspirate concentrate, bioabsorbable pins and nails, and prescribed and monitored patient-specific rehabilitation protocols. Further follow-up with documentation of long-term outcomes will provide insight for continued optimization for future applications for OCA transplantation, potentially including a broader spectrum of patients appropriate for this treatment. Ongoing translational research is necessary to blaze the trail in further optimizing this treatment option for patients.
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Affiliation(s)
- James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James T Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Anna J Schreiner
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
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25
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Schreiner AJ, Stoker AM, Bozynski CC, Kuroki K, Stannard JP, Cook JL. Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment. J Knee Surg 2020; 33:1056-1068. [PMID: 32583400 DOI: 10.1055/s-0040-1712944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.
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Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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26
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Vivacqua TA, Prinz RD, Cavanellas N, Barretto JM, de Sousa EB, Aguiar DP. Protocol for Harvest, Transport and Storage of Human Osteochondral Tissue. Rev Bras Ortop 2020; 55:163-169. [PMID: 32346191 PMCID: PMC7186072 DOI: 10.1055/s-0039-3400522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/22/2019] [Indexed: 11/16/2022] Open
Abstract
Objective
To elaborate a protocol for the harvest, transport, and preservation of human osteochondral tissue for use in tissue banks (TBs).
Methods
Osteochondral fragments measuring 2 cm
3
of 5 corpse donors aged between 15 and 45 years old were analyzed. The samples were stored in cell preservation medium containing: human albumin, Iscove's and vancomycin preserved at 4°C. The concentration of proteoglycans in the extracellular medium was quantified by the use of Safranin-O, while tissue structural analysis was assessed by histological study with hematoxylin-eosin stained slides. The images obtained were analyzed according to the histological scores of Mankin and the score proposed by the OsteoArthritis Research Society International. The samples were analyzed with 0, 15, 30 and 45 days of preservation.
Results
The osteochondral fragments studied showed a progressive decrease in proteoglycan concentration with increased preservation time. After 30 days of preservation, structural changes were identified with discontinuity of the cartilage surface layer. According to the results obtained by the Mankin score, there was a statistically significant difference between 15 and 30 days of tissue preservation.
Conclusion
The protocol described defined knee transport immersed in Lactated Ringer at a controlled temperature of 10° C until its arrival at the TB. After processing, the preservation solution was composed of Iscove's serum-free cell culture medium supplemented with 10% human albumin and 100 μg/ml vancomycin. The tissue was preserved at a temperature of 4°C until the moment of transplantation characterizing the fresh preservation.
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Affiliation(s)
- Thiago Alberto Vivacqua
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Rafael Dantas Prinz
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Naasson Cavanellas
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - João Maurício Barretto
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Eduardo Branco de Sousa
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Diego Pinheiro Aguiar
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
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Ackermann J, Cole BJ, Gomoll AH. Cartilage Restoration in the Patellofemoral Joint: Techniques and Outcomes. OPER TECHN SPORT MED 2019. [DOI: 10.1016/j.otsm.2019.150692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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28
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Gelber PE, Ramírez-Bermejo E, Ibañez M, Grau-Blanes A, Fariñas O, Monllau JC. Fresh Osteochondral Resurfacing of the Patellofemoral Joint. Arthrosc Tech 2019; 8:e1395-e1401. [PMID: 31890513 PMCID: PMC6926379 DOI: 10.1016/j.eats.2019.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/18/2019] [Indexed: 02/03/2023] Open
Abstract
Large osteochondral lesions of the knee in young patients continue to be a challenge for orthopaedic surgeons and the focus of continual research. This is particularly true if the injury is a consequence of a dysplastic trochlea and involves both articular surfaces of the biomechanically complex patellofemoral joint. To obtain a healthy and congruent patellofemoral joint, the use of a bipolar fresh osteochondral allograft transplantation of the patella and trochlea is one of the few options to biologically treat these injuries. This would achieve a replacement of the entire articular surface of the patellofemoral joint with a high number of viable chondrocytes and respect the unique structural characteristics of the cartilage. The aim of this study was to obtain symptomatic and functional improvements while delaying the timing of prosthetic surgery. We present a reproducible although demanding surgical technique to perform a bipolar fresh osteochondral allograft transplantation of the patella and trochlea.
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Affiliation(s)
- Pablo Eduardo Gelber
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain,ICATME–Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain,Address correspondence to Pablo Eduardo Gelber, M.D., Ph.D., Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Quintí 89, 08041 Barcelona, Spain
| | - Eduard Ramírez-Bermejo
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maximiliano Ibañez
- ICATME–Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Grau-Blanes
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank–Banc de Sang i Teixits (O.F.), Barcelona, Spain
| | - Juan Carlos Monllau
- ICATME–Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
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29
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Chahla J, Sweet MC, Okoroha KR, Nwachukwu BU, Hinckel B, Farr J, Yanke AB, Bugbee WD, Cole BJ. Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review. Am J Sports Med 2019; 47:3009-3018. [PMID: 30525887 DOI: 10.1177/0363546518814236] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The initial focus of cartilage restoration algorithms has been on the femur; however, the patellofemoral compartment accounts for 20% to 30% of significant symptomatic chondral pathologies. While patellofemoral compartment treatment involves a completely unique subset of comorbidities, with a comprehensive and thoughtful approach many patients may benefit from osteochondral allograft treatment. PURPOSE To perform a systematic review of clinical outcomes and failure rates after osteochondral allograft transplantation (OCA) of the patellofemoral joint at a minimum 18-month follow-up. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA for patellofemoral joint chondral defects was performed with the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1990 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCA for the treatment of chondral defects in the patellofemoral joint, English language, minimum follow-up of 18 months, minimum study size of 5 patients, and human studies. The methodological quality of each study was assessed with a modified version of the Coleman methodology score. RESULTS The systematic search identified 8 studies with a total of 129 patients. The methods of graft procurement and storage time included fresh (121 patients, 93.8%), and cryopreserved (8 patients, 6.2%) grafts. The mean survival rate was 87.9% at 5 years and 77.2% at 10 years. The following outcome scores showed significant improvement from pre- to postoperative status: modified d'Aubigné-Postel, International Knee Documentation Committee, Knee Society Score-Function, and Lysholm Knee Score. CONCLUSION OCA of the patellofemoral joint results in improved patient-reported outcome measures with high patient satisfaction rates. Five- and 10-year survival rates of 87.9% and 77.2%, respectively, can be expected after this procedure. These findings should be taken with caution, as a high percentage of patellofemoral osteochondral allografts were associated with concomitant procedures; therefore, further research is warranted to determine the effect of isolated osteochondral transplantations.
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Affiliation(s)
- Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
| | - Matthew C Sweet
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | | - Betina Hinckel
- Kaiser Permanente Southern California, San Diego, California, USA
| | - Jack Farr
- Cartilage Restoration Center of Indiana, OrthoIndy, Indianapolis, Indiana, USA
| | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
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30
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Goodfriend B, Essilfie AA, Jones IA, Thomas Vangsness C. Fresh osteochondral grafting in the United States: the current status of tissue banking processing. Cell Tissue Bank 2019; 20:331-337. [PMID: 31214919 DOI: 10.1007/s10561-019-09768-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
The use of musculoskeletal allografts has become increasingly popular among surgeons. The purpose of this review is to highlight the procurment and delievery process of fresh osteochondral allografts in the United States. The four distributors of fresh osteochondral allografts in the United States were contacted. Surveys containing quantitative and qualitative sections concerning the procurement and processing of osteochondral allograft tissue were obtained. Our results showed an average of 13 ± 4.24 years of experience with osteochondral allografts. The average donor age ranged from 13.5 ± 3 to 37.5 ± 5 years, with an average age of 27 ± 2.83 years. All donors were between ages 12 and 45 years old. The percentage of screened donors that were accepted for allograft transplant was consistent at 70-75% for 3 out of the 4 tissue banks. The percentage of grafts that expire without implantation ranged from 20% to 29%. Maximum shipping time varied between 24 and 96 hours. Each tissue bank used its own proprietary storage medium. The time from donor death to the harvest of allograft tissue was < 24 hours. The most commonly requested osteochondral allograft tissue for all banks was the medial femoral condyle. The market share of fresh allografts is as follows: Joint Restoration Foundation (JRF) 59.9%, Muskuloskeletal Transplant Foundation (MTF) 15.3%, LifeNet Health (LN) 14.5%, and Regeneration Technology Incorporated (RTI) 10.2%, with approximately 4700 fresh allografts distributed in 2018. This compiled data from the four tissue banks that supply fresh osteochondral allograft in the United States provides important background information for patients and orthopaedic surgeons.
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Affiliation(s)
- Brett Goodfriend
- Department of Orthopedic Surgery, USC Keck School of Medicine, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90089-9007, USA
| | - Anthony A Essilfie
- Department of Orthopedic Surgery, USC Keck School of Medicine, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90089-9007, USA
| | - Ian A Jones
- School of Medicine, University of California, Irvine, 1001 Health Sciences Rd, Irvine, CA, 92617, USA
| | - C Thomas Vangsness
- Department of Orthopedic Surgery, USC Keck School of Medicine, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90089-9007, USA.
- Department of Orthopaedic Surgery, USC Keck School of Medicine, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90089-9007, USA.
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31
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Tírico LEP, McCauley JC, Pulido PA, Bugbee WD. Osteochondral Allograft Transplantation of the Femoral Condyle Utilizing a Thin Plug Graft Technique. Am J Sports Med 2019; 47:1613-1620. [PMID: 31100008 DOI: 10.1177/0363546519844212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies showed clinical benefit and durable results of osteochondral allograft (OCA) transplantation for the treatment of femoral condyle lesions. However, the majority of these studies are difficult to interpret owing to the mixed results of different techniques and anatomic locations. PURPOSE To evaluate the outcome of OCA transplantation with thin plug grafts for treatment of isolated femoral condyle osteochondral lesions. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study included 187 patients (200 knees) who underwent OCA transplantation for isolated osteochondral lesions on the femoral condyle between 1999 and 2014. For all cases, a thin plug technique was used with commercially available surgical instruments and the minimum amount of bone necessary for fixation. Evaluation included International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and patient satisfaction. Frequency and type of further surgery were assessed. Failure of the allograft was defined as further surgery involving removal of the allograft. RESULTS Mean follow-up was 6.7 years (range, 1.9-16.5 years). The mean age of patients at the time of surgery was 31 years, and 63% were male. The medial femoral condyle was affected in 69% of knees. A single thin plug graft was used in 145 knees (72.5%), and 2 grafts were used in 55 knees (27.5%). Mean allograft area was 6.3 cm2, and graft thickness was 6.5 mm (cartilage and bone combined). Further surgery was required for 52 knees (26%), of which 16 (8% of entire cohort) were defined as allograft failures (4 OCA revisions, 1 arthrosurface, 6 unicompartmental knee arthroplasties, and 5 total knee arthroplasties). Median time to failure was 4.9 years. Survivorship of the allograft was 95.6% at 5 years and 91.2% at 10 years. Among patients with grafts remaining in situ at latest follow-up, clinically meaningful improvement in pain, function, and quality of life was reported. Satisfaction was reported by 89% of patients. CONCLUSION OCA transplantation with a thin plug graft technique is a valuable procedure for the treatment of femoral condyle osteochondral lesions, resulting in significant improvement in clinical scores, high patient satisfaction, and low reoperation and clinical failure rates.
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Affiliation(s)
- Luís E P Tírico
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Pamela A Pulido
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - William D Bugbee
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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32
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Cavendish PA, Everhart JS, Peters NJ, Sommerfeldt MF, Flanigan DC. Osteochondral Allograft Transplantation for Knee Cartilage and Osteochondral Defects. JBJS Rev 2019; 7:e7. [DOI: 10.2106/jbjs.rvw.18.00123] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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33
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Ackermann J, Ogura T, Duerr RA, Mestriner AB, Gomoll AH. Mental Health Has No Predictive Association With Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation of the Knee. Orthop J Sports Med 2018; 6:2325967118812363. [PMID: 30560141 PMCID: PMC6293379 DOI: 10.1177/2325967118812363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient-reported outcome (PRO) measures are progressively utilized as
evaluation tools in preoperative and postoperative assessments in
orthopaedic practice. Identifying the potential utility of psychosocial
factors to predict patient-reported pain and functional outcomes is of
increasing interest to determine which patients will derive the greatest
benefit from surgical treatment. Purpose/Hypothesis: The purpose of this study was to determine potential predictive associations
between the preoperative 12-Item Short Form Health Survey Mental Component
Summary (SF-12 MCS) score, patient characteristics or osteochondral
allograft (OCA) morphology, and PROs in patients who underwent OCA
transplantation. We hypothesized that poor preoperative mental health is
associated with diminished PROs at final follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 67 patients with a mean follow-up of 2.7 ± 1.0 years (range, 2-6
years) with complete preoperative and at least 24-month postoperative SF-12
MCS, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm,
and International Knee Documentation Committee (IKDC) scores were included
in this study. Pearson correlation coefficients and linear regression models
were used to distinguish associations between age, sex, smoking status, body
mass index, workers’ compensation, previous surgery, concomitant surgery,
number of grafts, defect location, total graft size, SF-12 MCS score, and
postoperative PRO scores as well as their improvement from baseline
(delta). Results: The SF-12 MCS showed significant correlation with the KOOS Activities of
Daily Living subscale (P = .015), KOOS Sport/Recreation
subscale (P = .024), and IKDC (P = .039).
In the multivariable linear regression models, the SF-12 MCS had no
predictive association with any PRO measure. Patient sex contributed
significantly to the final regression models of the KOOS Sport/Recreation
(P = .042), Tegner score (P = .024),
and Lysholm score (P = .031). The SF-12 MCS showed no
bivariate correlation with changes in any PRO score (delta)
(P > .05). Conclusion: Preoperative mental health status did not predict perceived functional
outcomes as assessed by PRO measures at final follow-up. Female sex was
negatively correlated with KOOS Sport/Recreation, Tegner, and Lysholm
scores.
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Affiliation(s)
- Jakob Ackermann
- Sports Medicine Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Takahiro Ogura
- Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Robert A Duerr
- Cartilage Repair Center and Center for Regenerative Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Alexandre Barbieri Mestriner
- Cartilage Repair Center and Center for Regenerative Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA.,Universidade Federal de São Paulo, São Paulo, Brazil
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Abstract
Hyaline articular cartilage is critical for the normal functioning of the knee joint. Untreated focal cartilage defects have the potential to rapidly progress to diffuse osteoarthritis. Over the last several decades, a variety of interventions aiming at preserving articular cartilage and preventing osteoarthritis have been investigated. Reparative cartilage procedures, such as microfracture, penetrate the subchondral bone plate in effort to fill focal cartilage defects with marrow elements and stimulate fibrocartilaginous repair. In contrast, restorative cartilage procedures aim to replace the defective articular surface with autologous or allogeneic hyaline cartilage. This review focuses on the preservation of articular cartilage, and discusses the current reparative and restorative surgical techniques available for treating focal cartilage defects.
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35
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Hoburg A, Leitsch JM, Diederichs G, Lehnigk R, Perka C, Becker R, Scheffler S. Treatment of osteochondral defects with a combination of bone grafting and AMIC technique. Arch Orthop Trauma Surg 2018; 138:1117-1126. [PMID: 29766258 DOI: 10.1007/s00402-018-2944-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Osteochondral defects of the knee may cause functional impairment of young and sportively active patients. Different surgical treatment options have been proposed using either one or two step procedures. The aim of the current study was to evaluate mid-term outcomes of combined bone grafting with autologous matrix-associated chondrogenesis (AMIC) for the treatment of large osteochondral defects. MATERIALS AND METHODS 15 Patients with osteochondrosis dissecans of the medial femoral condyle grade III or IV according to ICRS classification were treated with a single step surgical procedure combining bone grafting and the AMIC procedure. Mean defect size was 4.98 cm2 (± 3.02) and patients were examined at 6, 12 weeks, 6 and 12 month and at mean final follow-up of 49 months (36-61). Patients were evaluated using VAS, IKDC, KOOS, Lysholm, Tegner activity scores and psychological and physical health assessed using the SF 12. MRI evaluation was performed at final follow-up using the MOCART score. RESULTS Pain had significantly decreased at final follow-up (7.2 ± 1.4 vs. 2.4 ± 2.6) compared to preoperative baseline. All functional scores had improved significantly throughout the follow-up period (IKDC from 36.6 ± 20.6 vs. 72.2 ± 18.7; KOOS 50.0 ± 18.9 vs. 81.7 ± 13.9; LYSHOLM 39.3 ± 19.5 vs. 79.8 ± 15.1). SF12 evaluation showed a significant increase in physical component summary (PCS) (31.2 ± 11.1 preoperative vs. 46.3 ± 9.9 at final follow-up), while mental component summary (MCS) remained stable (51.8 ± 8.9 vs. 57.3 ± 3.3). MOCART score revealed a mean overall score of 77 ± 15 at final follow-up. Integration to the adjacent cartilage was complete in 79%, incomplete in 21%. Defect filling was complete in 64%, incomplete in 36%. CONCLUSION Significant improvement of knee function and restoration of homogenous cartilage morphology could be achieved with simultaneous AMIC procedure and bone grafting in 2/3 of all patients with large osteochondral lesions at 4 years postoperatively.
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Affiliation(s)
- Arnd Hoburg
- Center for Musculoskeletal Surgery, Charité, Universitaetsmedicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Julia Marcella Leitsch
- Center for Musculoskeletal Surgery, Charité, Universitaetsmedicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Gerd Diederichs
- Department of Radiology, Charité, Universitaetsmedicine Berlin, Berlin, Germany
| | - Rex Lehnigk
- Center for Musculoskeletal Surgery, Charité, Universitaetsmedicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité, Universitaetsmedicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Roland Becker
- Department of Orthopedic Surgery and Traumatology, Hospital Brandenburg, Brandenburg Medical School, Brandenburg/Havel, Germany
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Abstract
Purpose of Review This review provides an overview of well-established and newly developed cartilage repair techniques for cartilage defects in the patellofemoral joint (PFJ). An algorithm will be presented for approaching cartilage defects considering the distinct anatomy of both the patellar and trochlear articular surfaces. Recent Findings Recent studies on cartilage repair in the PFJ have demonstrated improved outcomes in an attempt to delay or obviate the need for arthroplasty, and improve symptoms in young patients. While autologous chondrocyte implantation shows good and excellent outcomes for chondral lesions, osteochondral defects are adequately addressed with osteochondral allograft transplantation. In case of patellar malalignment, concomitant tibial tubercle osteotomy can significantly improve outcomes. Particulated cartilage and bone marrow aspirate concentrate are potential new alternative treatments for cartilage repair, currently in early clinical studies. Summary Due to the frequency of concomitant anatomic abnormalities in the PFJ, a thorough clinical examination combined with careful indication for each procedure in each individual patient combined with meticulous surgical technique is central to achieve satisfying outcomes. Additional comparative studies of cartilage repair procedures, as well as investigation of newer techniques, are needed.
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Clinical Outcomes of Osteochondral Allograft Transplantation for Secondary Treatment of Osteochondritis Dissecans of the Knee in Skeletally Mature Patients. Arthroscopy 2018; 34:1105-1112. [PMID: 29305286 DOI: 10.1016/j.arthro.2017.10.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To report clinical outcomes of osteochondral allograft transplantation (OCA) for skeletally mature patients with osteochondritis dissecans (OCD) lesions of the knee in whom prior surgical intervention has failed, and to describe return-to-sport (RTS) rates and any predictive demographic or preoperative variables associated with a higher likelihood to RTS. METHODS Patients who underwent OCA by a single surgeon (B.J.C.) between October 1, 2002, and November 30, 2014, for a diagnosis of OCD with a minimum of 2 years' follow-up were included. Demographic, surgical history, operative, and postoperative data points including RTS were analyzed for all patients collectively, with subanalysis to identify any demographic and operative variables associated with the ability to RTS. Failure was defined as revision OCA, gross appearance of graft failure on second-look arthroscopy, or conversion to arthroplasty. RESULTS We identified 41 consecutive patients (43 knees), with 37 patients (39 knees, comprising 26 male and 13 female knees) available for clinical follow-up at an average of 7.29 ± 3.30 years. There was significant improvement (P < .05) in all patient-reported outcome scores, with the exception of the Short Form 12 mental subscale (P = .910). Most patients (81.6%) reported being either mostly satisfied or completely satisfied at final follow-up. Of patients self-identifying as athletes preoperatively (n = 22), 18 (81.8%) achieved RTS at an average of 14.0 ± 8.7 months. Athletes with failure to RTS had a significantly greater body mass index (RTS, 24.68 ± 3.67; no RTS, 27.82 ± 0.69; P = .005). Subsequent surgery was performed in 14 patients (35.9%), and primary OCA failed in 2 patients at an average of 6.2 ± 3.8 years. CONCLUSIONS OCA is a successful secondary surgical treatment for OCD of the knee in skeletally mature patients and leads to clinically meaningful improvements in patient-reported outcome scores and high patient satisfaction and RTS rates in low-level athletes at an average of 7.29 years' follow-up. Athletes with failure to RTS were found to have a significantly higher body mass index. Although reoperation may be common after OCA (35.9%), the failure rate is low (5.1%) in this series. LEVEL OF EVIDENCE Level IV, case series.
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Cotter EJ, Frank RM, Wang KC, Cole BJ. Rehabilitation and Return to Play Following Osteochondral Allograft Transplantation in the Knee. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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