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Vannini F, Berveglieri L, Boffa A, Filardo G, Viglione V, Buda R, Giannini S, Faldini C. Hyaluronic scaffold transplantation with bone marrow concentrate for the treatment of osteochondral lesions of the talus: durable results up to a minimum of 10 years. Knee Surg Sports Traumatol Arthrosc 2023; 31:4551-4558. [PMID: 37328684 DOI: 10.1007/s00167-023-07490-0] [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: 02/21/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE The aim of this study was to evaluate the long-term clinical results of the transplantation of a hyaluronic acid membrane augmented with bone marrow aspirate concentrate (BMAC) in an one-step technique for the treatment of patients affected by osteochondral lesions of the talus (OLT). METHODS A total of 101 patients (64 men, 37 women, age 32.9 ± 10.9) were evaluated for a minimum of 10 years of follow-up (151.5 ± 18.4 months) The mean lesion size was 2.2 ± 1.4 cm2, the lesion had a post-traumatic origin in 73 patients, 15 patients previously had an ankle fracture, 22 patients had ankle osteoarthritis. All patients were clinically evaluated at baseline and at 2, 5, and a minimum of 10 years after treatment using the AOFAS score, the NRS for pain, and the Tegner score. A survival analysis was performed to check the survival to failure up to the last follow-up. RESULTS The AOFAS score significantly improved from baseline (59.6 ± 13.9) to the final follow-up (82.3 ± 14.2) (p < 0.0005). A significant reduction in the AOFAS score was found from 2 to 10 years (p < 0.0005). The NRS for pain changed from 7.0 ± 1.3 at baseline to 3.9 ± 2.7 at the final follow-up (p < 0.0005). A significant worsening was documented between 5 years and the final follow-up (p < 0.0005). The Tegner score improved from the preoperative value of 2.0 (range 1-7) to 3.0 (range 1-7) at the final follow-up (p < 0.0005), although it remained lower as compared to the preinjury level of 4.0 (range 1-9) (p < 0.0005). Better results were documented in male and younger patients with smaller lesions, without the previous surgery, and without the previous ankle fractures or osteoarthritis. At the final follow-up, 85 patients considered their general health status "satisfactory" and 84 patients reported feeling "better" than the preoperative condition. Five patients were considered failures and underwent prosthetic ankle replacement or repeated the same surgery. CONCLUSION This one-step technique showed to be an effective procedure for the treatment of OLT, providing a low failure rate and offering durable clinical improvements up to a minimum of 10 years of follow-up. However, this technique demonstrated a small yet significant decrease over the years in terms of pain and function and poor results in terms of sports activity level. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Francesca Vannini
- Clinica Ortopedica E Traumatologica 1, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Luca Berveglieri
- Clinica Ortopedica E Traumatologica 1, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
| | - Angelo Boffa
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Valentina Viglione
- Clinica Ortopedica E Traumatologica 1, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Roberto Buda
- Clinica Ortopedica di Chieti, Ospedale Clinicizzato SS Annunziata di Chieti, Chieti, Italy
| | | | - Cesare Faldini
- Clinica Ortopedica E Traumatologica 1, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy
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Nakagawa Y, Mukai S, Satomi K, Shinya Y, Nakamura R, Takahashi M. Autologous Osteochondral Grafts for Knee Osteochondral Diseases Result in Good Patient-Reported Outcomes in Patients Older Than 60 Years. Arthrosc Sports Med Rehabil 2023; 5:100774. [PMID: 37564902 PMCID: PMC10410132 DOI: 10.1016/j.asmr.2023.100774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 06/15/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose This study aims to examine the clinical autologous osteochondral grafts (AOG) outcomes for knee osteochondral diseases at operative ages >60 years, and to determine whether patients are able to sit straight in Japanese style after AOG. Methods All patients who underwent AOG for knee osteochondral diseases between November 2001 and April 2018 were retrospectively identified. The inclusion criteria were AOG only without osteotomy, operative ages between 60 and 79 years, >2 years of follow-up, and involved femorotibial angle between 169° and 179° (normal alignment). Patients who underwent osteotomy to improve knee alignment and patients with inflammatory diseases such as rheumatoid arthritis were excluded. The patients' knee symptoms and their clinical outcome were evaluated according to the criteria of the knee scoring system of the Japanese Orthopedic Association (JOA), International Knee Documentation Committee (IKDC) subjective score, and the ability of straight sitting in Japanese style. Results This study enrolled 57 cases and 60 knee joints during the study period. The follow-up ratio was 85.1%. Moreover, 14 men and 43 women and 29 right and 31 left knee joints were included in this study. The mean operative age and mean follow-up period were 67.8 years (range 60-76 years) and 81.1 months (range 24-167 months), respectively. In addition, the study involved 30 cases and 32 knee joints (60s group), and 27 cases and 28 knee joints (70s group). Moreover, 34 cases and 36 knee joints had osteonecrosis (ON group), and 23 cases and 24 knee joints had cartilage injury (CI group). The IKDC subjective and JOA scores in both the 60s and 70s groups showed significant differences: 2 years after AOG >at the follow-up period, >at the preoperative period. The scores in both the CI and ON groups showed similar significant differences. Furthermore, 8.3% and 53.5% of the patients could sit straight in Japanese style at the preoperative period and 2 years after AOG, respectively. Conclusion Even if the patient's operative age was >60 years, the AOG only for their knee osteochondral diseases had good clinical outcomes, including the ability to sit straight in Japanese style. Level of Evidence IV, Therapeutic case series Key words: autologous osteochondral grafts, aged patients, clinical outcome, knee joint, straight sitting in Japanese style.
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Affiliation(s)
- Yasuaki Nakagawa
- Clinical Research Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Department of Orthopaedic Surgery, Japan Baptist Medical Foundation, Kyoto, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Kentaro Satomi
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Yuki Shinya
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Ryota Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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Angele P, Zellner J, Schröter S, Flechtenmacher J, Fritz J, Niemeyer P. Biological Reconstruction of Localized Full-Thickness Cartilage Defects of the Knee: A Systematic Review of Level 1 Studies with a Minimum Follow-Up of 5 Years. Cartilage 2022; 13:5-18. [PMID: 36250517 PMCID: PMC9924981 DOI: 10.1177/19476035221129571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the best available mid- to long-term evidence of surgical procedures for the treatment of localized full-thickness cartilage defects of the knee. DESIGN Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of Level 1 randomized clinical trials (RCTs), meta-analyses of RCTs and systematic reviews with a minimum follow-up of 5 years. Data extracted included patient demographics, defect characteristics, clinical and radiological outcomes, as well as treatment failures. RESULTS Six RCTs and 3 Level 1 systematic reviews were included. Two RCTs compared microfracture (MFx) to periosteum-covered autologous chondrocyte implantation (ACI-P), 1 to matrix-associated ACI (M-ACI) and 2 to osteochondral autograft transplantation (OAT). One study compared OAT to collagen membrane covered ACI (ACI-C). The 3 Level 1 systematic reviews/meta-analyses assessed the outcome of MFx, OAT, and various ACI methods in RCTs. OAT showed significantly better outcomes compared with MFx. In the 2 RCTs comparing ACI-P and MFx, no significant differences in clinical outcomes were seen, whereas significantly better outcomes were reported for M-ACI versus MFx in 1 study including patients with larger defects (5 cm2), and for ACI-C versus OAT in terms of Cincinnati Score. Higher failure rates were reported for MFx compared with OAT and for OAT compared with ACI-C, while no significant differences in failure rates were observed for ACI-P compared to MFx. CONCLUSION Restorative cartilage procedures (ACI-C or M-ACI and OAT) are associated with better long-term clinical outcomes including lower complication and failure rates when compared with reparative techniques (MFx). Among the restorative procedures, OAT seems to be inferior to ACI especially in larger defects after longer follow-up periods. LEVEL OF EVIDENCE Level I: Systematic review of Level I studies.
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Affiliation(s)
- Peter Angele
- Sporthopaedicum Regensburg, Regensburg,
Germany,Klinik für Unfall- und
Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg,
Germany,Peter Angele, Sporthopaedicum Regensburg,
Hildegard-von-Bingen-Strasse 1, 93053 Regensburg, Germany.
| | | | - Steffen Schröter
- Abteilung für Unfall- und
Wiederherstellungschirurgie, Jung-Stilling Krankenhaus, Diakonie Klinikum GmbH,
Siegen, Germany
| | | | - Jürgen Fritz
- Orthopädisch Chirurgisches Centrum,
Tübingen, Germany
| | - Philipp Niemeyer
- OCM—Orthopädische Chirurgie München,
München, Germany,Klinik für Orthopädie und
Traumatologie, Universitätsklinikum Freiburg, Freiburg, Germany
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Irem Demir A, Pulatkan A, Ucan V, Yilmaz B, Tahmasebifar A, Tok OE, Tuncay I, Elmali N, Ozturk BY, Uzer G. Comparison of 3 Cell-Free Matrix Scaffolds Used to Treat Osteochondral Lesions in a Rabbit Model. Am J Sports Med 2022; 50:1399-1408. [PMID: 35354059 DOI: 10.1177/03635465221074292] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various cell-free scaffolds are already in use for the treatment of osteochondral defects (OCDs); however, a gold standard material has not yet been defined. PURPOSE This study compared the macroscopic, histological, and scanning electron microscopy (SEM) characteristics of Chondro-Gide (CG), MaioRegen (MA), and poly-d,l-lactide-co-caprolactone (PLCL) cell-free scaffolds enhanced with small-diameter microfractures (SDMs) for OCDs in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS In total, 54 knees from 27 rabbits were used in this study. Three rabbits were sacrificed at the beginning of the study to form an intact cartilage control group (group IC). An OCD model was created at the center of the trochlea, and SDMs were generated in 24 rabbits. Rabbits with OCDs were divided into 4 groups (n = 12 knees per group) according to the cell-free scaffold applied: CG (group CG), MA (group MA), PLCL (group PLCL), and a control group (group SDM). Half of the rabbits were sacrificed at 1 month after treatment, while the other half were sacrificed at 3 months after treatment. Healed cartilage was evaluated macroscopically (using International Cartilage Regeneration & Joint Preservation Society [ICRS] classification criteria) and histopathologically (using modified O'Driscoll scores and collagen staining). Additionally, cell-free scaffold morphologies were compared using SEM analysis. RESULTS ICRS and modified O'Driscoll classification and staining with collagen type 1 and type 2 demonstrated significant differences among groups at both 1 and 3 months after treatment (P < .05). The histological characteristics of the group IC samples were superior to those of all other groups, except group PLCL, at 3 months after treatment (P < .05). In addition, the histological properties of group PLCL samples were superior to those of group SDM samples at both 1 and 3 months after treatment in terms of the modified O'Driscoll scores and type 1 collagen staining (P < .05). Concerning type 2 collagen staining intensity, the groups were ranked from highest to lowest at 3 months after treatment as follows: group PLCL (30.3 ± 2.6) > group MA (26.6 ± 1.2) > group CG (23.3 ± 2.3) > group SDM (18.9 ± 0.9). CONCLUSION OCDs treated with enhanced SDM using cell-free PLCL scaffolds had superior histopathological and microenvironmental properties, more hyaline cartilage, and more type 2 collagen compared with those treated using CG or MA scaffolds. CLINICAL RELEVANCE OCDs treated with PLCL cell-free scaffolds may have superior histopathological properties and contain more type 2 collagen than do OCDs treated with CG or MA cell-free scaffolds.
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Affiliation(s)
- Ahder Irem Demir
- Department of Orthopaedics and Traumatology, Istanbul Beykoz State Hospital, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Bengi Yilmaz
- Department of Biomaterials, University of Health Sciences Turkey, Istanbul, Turkey
| | - Aydin Tahmasebifar
- Department of Biomaterials, University of Health Sciences Turkey, Istanbul, Turkey
| | - Olgu Enis Tok
- Department of Histology and Embryology, Medipol University Medical Faculty Regenerative and Restorative Medicine Research Center, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Nurzat Elmali
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Gokcer Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
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5
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Filardo G, Andriolo L, Angele P, Berruto M, Brittberg M, Condello V, Chubinskaya S, de Girolamo L, Di Martino A, Di Matteo B, Gille J, Gobbi A, Lattermann C, Nakamura N, Nehrer S, Peretti GM, Shabshin N, Verdonk P, Zaslav K, Kon E. Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. A Consensus Statement. Cartilage 2021; 13:1036S-1046S. [PMID: 31941355 PMCID: PMC8808892 DOI: 10.1177/1947603519894729] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To develop patient-focused consensus guidelines on the indications for the use of scaffolds to address chondral and osteochondral femoral condyle lesions. DESIGN The RAND/UCLA Appropriateness Method (RAM) was used to develop patient-specific recommendations by combining the best available scientific evidence with the collective judgement of a panel of experts guided by a core panel and multidisciplinary discussers. A list of specific clinical scenarios was produced regarding adult patients with symptomatic lesions without instability, malalignment, or meniscal deficiency. Each scenario underwent discussion and a 2-round vote on a 9-point Likert-type scale (range 1-3 "inappropriate," 4-6 "uncertain," 7-9 "appropriate"). Scores were pooled to generate expert recommendations. RESULTS Scaffold (chondral vs. osteochondral), patient characteristics (age and sport activity level), and lesion characteristics (etiology, size, and the presence of osteoarthritis [OA]) were considered to define 144 scenarios. The use of scaffold-based procedures was considered appropriate in all cases of chondral or osteochondral lesions when joints are not affected by OA, while OA joints presented more controversial results. The analysis of the evaluated factors showed a different weight in influencing treatment appropriateness: the presence of OA influenced 58.3% of the indications, while etiology, size, and age were discriminating factors in 54.2%, 29.2%, and 16.7% of recommendations, respectively. CONCLUSIONS The consensus identified indications still requiring investigation, but also the convergence of the experts in several scenarios defined appropriate or inappropriate, which could support decision making in the daily clinical practice, guiding the use of scaffold-based procedures for the treatment of chondral and osteochondral knee defects.
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Affiliation(s)
- Giuseppe Filardo
- Applied and Translational Research (ATR)
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Luca Andriolo, Clinica Ortopedica e
Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10,
Bologna 40136, Italy.
| | - Peter Angele
- Clinic for Trauma and Reconstructive
Surgery, University Hospital Regensburg, Regensburg, Bayern, Germany,Sporthopaedicum Regensburg, Regensburg,
Germany
| | - Massimo Berruto
- UOS Knee SURGERY-1st University Clinic
of Orthopaedics, ASST Pini-CTO, Milan, Italy
| | - Mats Brittberg
- Cartilage Research Unit, University of
Gothenburg, Gothenburg, Sweden,Region Halland Orthopaedics, Kungsbacka
Hospital, Kungsbacka, Sweden
| | - Vincenzo Condello
- Joint Preservation and Reconstructive
Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Lombardy,
Italy
| | - Susan Chubinskaya
- Department of Pediatrics, Orthopedic
Surgery & Medicine (Section of Rheumatology), Rush University Medical Center,
Chicago, IL, USA
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory,
IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Berardo Di Matteo
- Department of Biomedical Sciences,
Humanitas University, Rozzano, Milan, Italy,Humanitas Clinical and Research
Center- IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Justus Gille
- Department of Trauma and Orthopaedic
Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck,
Germany
| | - Alberto Gobbi
- Orthopaedic Arthroscopic Surgery
International (OASI) Bioresearch Foundation, Milan, Italy
| | - Christian Lattermann
- Department of Orthopaedic Surgery,
Division of Sports Medicine, Center for Cartilage Repair, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, USA
| | - Norimasa Nakamura
- Institute for Medical Science in
Sports, Osaka Health Science University, Osaka, Japan
| | - Stefan Nehrer
- Center for Regenerative Medicine,
Danube University, Krems an der Donau, Austria
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi,
Milan, Italy,Department of Biomedical Sciences for
Health, University of Milan, Milan, Italy
| | - Nogah Shabshin
- Department of Radiology, Emek Medical
Center, Clalit Healthcare Services, Afula, Israel,Department of Radiology, PennMedicine,
Philadelphia, PA, USA
| | - Peter Verdonk
- ORTHOCA, AZ Monica Hospitals, Antwerp,
Belgium,Aspetar Hospital, Doha, Qatar
| | - Kenneth Zaslav
- Ortho Virginia, Virginia Commonwealth
University, Richmond, VA, USA
| | - Elizaveta Kon
- Department of Biomedical Sciences,
Humanitas University, Rozzano, Milan, Italy,Humanitas Clinical and Research
Center- IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy,Department of Traumatology,
Orthopedics and Disaster Surgery, First Moscow State Medical University of the
Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian
Federation
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6
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Janssen MPF, van der Linden EGM, Boymans TAEJ, Welting TJM, van Rhijn LW, Bulstra SK, Emans PJ. Twenty-Two-Year Outcome of Cartilage Repair Surgery by Perichondrium Transplantation. Cartilage 2021; 13:860S-867S. [PMID: 32929986 PMCID: PMC8739558 DOI: 10.1177/1947603520958146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The main purpose of the present study was to assess the risk for major revision surgery after perichondrium transplantation (PT) at a minimum of 22 years postoperatively and to evaluate the influence of patient characteristics. DESIGN Primary outcome was treatment success or failure. Failure of PT was defined as revision surgery in which the transplant was removed, such as (unicondylar) knee arthroplasty or patellectomy. The functioning of nonfailed patients was evaluated using the International Knee Documentation Committee (IKDC) score. In addition, the influence of patient characteristics was evaluated. RESULTS Ninety knees in 88 patients, aged 16 to 55 years with symptomatic cartilage defects, were treated by PT. Eighty knees in 78 patients were eligible for analysis and 10 patients were lost to follow-up. Twenty-eight knees in 26 patients had undergone major revision surgery. Previous surgery and a longer time of symptoms prior to PT were significantly associated with an increased risk for failure of cartilage repair. Functioning of the remaining 52 patients and influence of patient characteristics was analyzed using their IKDC score. Their median IKDC score was 39.08, but a relatively young age at transplantation was associated with a higher IKDC score. CONCLUSIONS This 22-year follow-up study of PT, with objective outcome parameters next to patient-reported outcome measurements in a unique group of patients, shows that overall 66% was without major revision surgery and patient characteristics also influence long-term outcome of cartilage repair surgery.
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Affiliation(s)
- Maarten P. F. Janssen
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Esther G. M. van der Linden
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Tim A. E. J. Boymans
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Tim J. M. Welting
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Lodewijk W. van Rhijn
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopaedics, University
of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Peter J. Emans
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
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7
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Merkely G, Ackermann J, Gomoll AH. The Role of Hypertension in Cartilage Restoration: Increased Failure Rate After Autologous Chondrocyte Implantation but Not After Osteochondral Allograft Transplantation. Cartilage 2021; 13:1306S-1314S. [PMID: 31965812 PMCID: PMC8808780 DOI: 10.1177/1947603519900792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives. The purpose of this study was to examine whether patients with diagnosed hypertension have an increased risk of graft failure following cartilage repair with either autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA). We hypothesized that hypertension is related to higher ACI and OCA graft failure. Design. Patients who underwent ACI or OCA transplantation between February 2009 and December 2016 were included in this study. Inclusion criteria were (1) at least 2 years' follow-up, (2) available information related to the living habits (smoking and medication status), and (3) available information related to the presence of hypertension, diabetes mellitus, or hyperlipidemia. To identify potential independent risk factors of graft failure, univariate screening was performed and factors with significance at a level of P < 0.1 were entered in multivariate logistic regression models. Results. A total of 368 patients (209 ACI and 159 OCA) were included into our study. In the ACI group, 61 patients' (29.1%) graft failed. Univariate screening identified older age, female gender, defect size, higher prevalence of hypertension, and smoking as a predictor of graft failure. Following, multivariate logistic regression revealed female gender (odds ratio [OR] 1.02, P = 0.048), defect size (OR 1.07, P = 0.035), and hypertension (OR 3.73, P = 0.023) as significant independent risk factors predicting graft failure after ACI. In the OCA group, 29 patients' (18.2%) graft failed and none of the included factors demonstrated to be a potential risk factor for graft failure. Conclusion. Hypertension, defect size, and female gender seem to predict ACI graft failure but not OCA failure.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Traumatology, Semmelweis
University, Budapest, Hungary,Gergo Merkely, Cartilage Repair Center,
Brigham and Women’s Hospital, Harvard Medical School, 850 Boylston Steet # 112,
Chestnut Hill, Boston, MA 02467, USA.
| | - Jakob Ackermann
- Sports Medicine Center, Department of
Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA,Balgrist University Hospital, Zurich,
Switzerland
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8
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Jeuken RM, van Hugten PPW, Roth AK, Timur UT, Boymans TAEJ, van Rhijn LW, Bugbee WD, Emans PJ. A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients. Orthop J Sports Med 2021; 9:23259671211031244. [PMID: 34676269 PMCID: PMC8524698 DOI: 10.1177/23259671211031244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Focal cartilage defects are often debilitating, possess limited potential for
regeneration, are associated with increased risk of osteoarthritis, and are
predictive for total knee arthroplasty. Cartilage repair studies typically
focus on the outcome in younger patients, but a high proportion of treated
patients are 40 to 60 years of age (ie, middle-aged). The reality of current
clinical practice is that the ideal patient for cartilage repair is not the
typical patient. Specific attention to cartilage repair outcomes in
middle-aged patients is warranted. Purpose: To systematically review available literature on knee cartilage repair in
middle-aged patients and include studies comparing results across different
age groups. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane
Library database. Articles were screened for relevance and appraised for
quality. Results: A total of 21 articles (mean Coleman Methodology Score, 64 points) were
included. Two out of 3 bone marrow stimulation (BMS) studies, including 1
using the microfracture technique, revealed inferior clinical outcomes in
middle-aged patients in comparison with younger patients. Nine cell-based
studies were included showing inconsistent comparisons of results across age
groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate
concentrate showed age-independent results at up to 8 years of follow-up. A
negative effect of middle age was reported in 1 study for both ACI and BMS.
Four out of 5 studies on bone-based resurfacing therapies (allografting and
focal knee resurfacing implants [FKRIs]) showed age-independent results up
to 5 years. One study in only middle-aged patients reported better clinical
outcomes for FKRIs when compared with biological repairs. Conclusion: Included studies were heterogeneous and had low methodological quality. BMS
in middle-aged patients seems to only result in short-term improvements.
More research is warranted to elucidate the ameliorating effects of
cell-based therapies on the aging joint homeostasis. Bone-based therapies
seem to be relatively insensitive to aging and may potentially result in
effective joint preservation. Age subanalyses in cohort studies, randomized
clinical trials, and international registries should generate more evidence
for the large but underrepresented (in terms of cartilage repair)
middle-aged population in the literature.
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Affiliation(s)
- Ralph M Jeuken
- Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Alex K Roth
- Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ufuk Tan Timur
- Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - William D Bugbee
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Pieter J Emans
- Maastricht University Medical Center, Maastricht, the Netherlands
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9
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Andriolo L, Reale D, Di Martino A, Boffa A, Zaffagnini S, Filardo G. Cell-Free Scaffolds in Cartilage Knee Surgery: A Systematic Review and Meta-Analysis of Clinical Evidence. Cartilage 2021; 12:277-292. [PMID: 31166117 PMCID: PMC8236653 DOI: 10.1177/1947603519852406] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate current evidence and results of cell-free scaffold techniques for knee chondral lesions. DESIGN A systematic review was conducted on 3 medical electronic databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and the methodological quality was assessed with a modified Coleman Methodology Score. A meta-analysis was performed on the articles reporting results for visual analogue scale (VAS), Lysholm, and International Knee Documentation Committee (IKDC) scores. In order to investigate the clinical results improvement over time of cell-free cartilage scaffold implantation, all scores were reported and analyzed as improvement from basal scores at 1, 2, and ≥3 years' follow-up. RESULTS A total of 23 studies involving 521 patients were included in the qualitative data synthesis. The Coleman score showed an overall poor study quality with the majority of studies reporting results at short-/mid-term follow-up. Sixteen studies were included in the meta-analysis, showing a significant improvement from basal score at 1, 2, and ≥3 years' follow-up. The improvement reached at 1 year remained stable up to the last follow-up for all scores. CONCLUSIONS The current literature suggests that cell-free scaffolds may provide good clinical short-/mid-term results; however, the low evidence of the published studies and their short mean follow-up demand further evidence before more definitive conclusions can be drawn on their real potential over time and on their advantages and disadvantages compared to the cell-based strategies for the treatment of cartilage lesions.
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Affiliation(s)
- Luca Andriolo
- Clinica Ortopedica e Traumatologica 2; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Reale
- Clinica Ortopedica e Traumatologica 2; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Angelo Boffa, Clinica Ortopedica e Traumatologica 2; IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano,1/10, Bologna, 40136, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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10
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Hinz M, Imhoff AB, Schmitt A. [Update on the Operative Treatment of Cartilage Defects]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 159:459-475. [PMID: 33975378 DOI: 10.1055/a-1302-8636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Focal cartilage defects lead to swelling, significant pain and loss of function of the affected joint. Additionally, they are linked to early onset of osteoarthritis. Often young and active patients are especially susceptible due to the high stress placed on their joints. A vast amount of treatment options is available to orthopaedic surgeons to cure cartilage defects of the knee, hip, shoulder, elbow and ankle joints. This article serves to give an overview of these available treatment options and to explain the expected outcomes.
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11
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Andriolo L, Reale D, Di Martino A, De Filippis R, Sessa A, Zaffagnini S, Filardo G. Long-term Results of Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation: A Prospective Follow-up at 15 Years. Am J Sports Med 2020; 48:2994-3001. [PMID: 32936677 DOI: 10.1177/0363546520949849] [Citation(s) in RCA: 16] [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 Matrix-assisted autologous chondrocyte transplantation (MACT) procedures have been developed to overcome some of the limits of first-generation autologous chondrocyte implantation. However, while good autologous chondrocyte implantation results have been documented over time, data are scarce on the long-term MACT results. PURPOSE To evaluate long-term clinical results of a large cohort of patients treated with hyaluronic acid-based MACT for articular cartilage defects of the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS A long-term evaluation of 113 patients was performed (91 men, 22 women; mean ± SD age, 29.0 ± 10.6 years) for 115 knees affected by chondral and osteochondral lesions of the femoral condyles and trochlea. Of these, 61 knees had undergone previous surgery, while other procedures were combined during the same operation in 48 knees. These patients were prospectively evaluated before surgery and at 2, 5, and 10 years after surgery, as well as at a final mean follow-up of 15 years (range, 12-18 years), with various clinical scores: International Knee Documentation Committee (IKDC), EuroQol visual analog scale (EQ-VAS), and Tegner. Both surgical and clinical failures were documented. RESULTS The IKDC subjective score increased from the basal level of 39.9 ± 14.6 (mean ± SD) to 77.3 ± 20.5 (P < .0005) at 2 years; results remained stable up to the 15-year follow-up (76.9 ± 20.5). EQ-VAS and Tegner scores showed a statistically significant improvement up to 10 years, with a further significant improvement at the final follow-up. A failure rate of 15.0% was documented, which increased to 21.7% when clinical failures were also considered. A worse outcome was found for older age (P < .0005), female sex (P = .002), degenerative lesions (P < .0005), longer duration of symptoms (P = .005), and previous surgery (P < .0005). CONCLUSION Arthroscopic MACT offered good and long-lasting results that were stable over time and resulted in a limited number of failures and reinterventions for up to 15 years of follow-up. Several factors were identified as having a prognostic value: a worse outcome could be expected in older patients, female patients, those affected by lesions with a degenerative cause, those having a longer duration of symptoms, and patients who underwent previous surgery.
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Affiliation(s)
- Luca Andriolo
- ‖ Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Reale
- ‖ Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Di Martino
- ‖ Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto De Filippis
- ‖ Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sessa
- Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- ‖ Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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12
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Cell-Free Osteochondral Scaffold for the Treatment of Focal Articular Cartilage Defects in Early Knee OA: 5 Years' Follow-Up Results. J Clin Med 2019; 8:jcm8111978. [PMID: 31739539 PMCID: PMC6912384 DOI: 10.3390/jcm8111978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to investigate the clinical results at five years' follow-up of a tri-layered nanostructured biomimetic osteochondral scaffold used for focal articular cartilage defects in patients meeting the criteria of early osteoarthritis (EOA). The study population comprised 22 patients (mean age: 39 years), prospectively assessed before surgery, at 24 and 60 months' follow-up. Inclusion criteria were: at least two episodes of knee pain for more than 10 days in the last year, Kellgren-Lawrence OA grade 0, I or II and arthroscopic or MRI findings according to the European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA) criteria. Clinical results demonstrated significant improvement in International Knee Documentation Committee (IKDC) subjective and objective scores and in Tegner score, although activity level never reached the pre-injury level. The complication rate of this study was 8.3%. Two patients underwent re-operation (8.3%), while a comprehensive definition of failure (including both surgical and clinical criteria) identified four failed patients (16.6%) at this mid-term follow-up evaluation. The use of a free-cell osteochondral scaffold represented a safe and valid alternative for the treatment of focal articular cartilage defects in the setting of an EOA, and was able to permit a significant clinical improvement and stable outcome with low complication and failure rates.
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Gao Y, Gao J, Li H, Du D, Jin D, Zheng M, Zhang C. Autologous costal chondral transplantation and costa-derived chondrocyte implantation: emerging surgical techniques. Ther Adv Musculoskelet Dis 2019; 11:1759720X19877131. [PMID: 31579403 PMCID: PMC6759717 DOI: 10.1177/1759720x19877131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023] Open
Abstract
It is a great challenge to cure symptomatic lesions and considerable defects of hyaline cartilage due to its complex structure and poor self-repair capacity. If left untreated, unmatured degeneration will cause significant complications. Surgical intervention to repair cartilage may prevent progressive joint degeneration. A series of surgical techniques, including biological augmentation, microfracture and bone marrow stimulation, autologous chondrocyte implantation (ACI), and allogenic and autogenic chondral/osteochondral transplantation, have been used for various indications. However, the limited repairing capacity and the potential pitfalls of these techniques cannot be ignored. Increasing evidence has shown promising outcomes from ACI and cartilage transplantation. Nevertheless, the morbidity of autologous donor sites and limited resource of allogeneic bone have considerably restricted the wide application of these surgical techniques. Costal cartilage, which preserves permanent chondrocytes and the natural osteochondral junction, is an ideal candidate for the restoration of cartilage defects. Several in vitro and in vivo studies have shown good performance of costal cartilage transplantation. Although costal cartilage is a classic donor in plastic and cosmetic surgery, it is rarely used in skeletal cartilage restoration. In this review, we introduce the fundamental properties of costal cartilage and summarize costa-derived chondrocyte implantation and costal chondral/osteochondral transplantation. We will also discuss the pitfalls and pearls of costal cartilage transplantation. Costal chondral/osteochondral transplantation and costa-based chondrocytotherapy might be up-and-coming surgical techniques for recalcitrant cartilage lesions.
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Affiliation(s)
| | - Junjie Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Centre for Orthopaedic Translational Research, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Hengyuan Li
- Department of Orthopaedics, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Dajiang Du
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Dongxu Jin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Minghao Zheng
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
- Institute of Microsurgery on Extremities, Shanghai 200233, China
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14
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Zaffagnini S, Vannini F, Di Martino A, Andriolo L, Sessa A, Perdisa F, Balboni F, Filardo G. Low rate of return to pre-injury sport level in athletes after cartilage surgery: a 10-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2019; 27:2502-2510. [PMID: 30374578 DOI: 10.1007/s00167-018-5255-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Although articular surface is frequently damaged in athletes, results in terms of return to sport and level of activity after cartilage surgery remain rather unpredictable and poorly documented. The aim of this study is to evaluate the clinical outcome in terms of rate and level of return to sport in a group of competitive athletes who underwent matrix-assisted autologous chondrocyte transplantation (MACT), as well as the impact on their athletic career. METHODS Thirty-one male patients (mean age 22.6 ± 6.3 years) p racticing sport at competitive level, affected by focal chondral/osteochondral lesions of the distal femur, were enrolled and treated with arthroscopic hyaluronan-based MACT. Patients were evaluated prospectively at 1-year intervals with the IKDC subjective, Tegner, and EuroQol VAS scores during their pre-operative visit and subsequent follow-ups for up to 10 years. Return to sport in terms of level, time and maintenance of the activity level was documented, together with surgical or clinical failures. RESULTS A marked improvement in all scores was found: IKDC increased from 40.3 ± 13.4 to 81.7 ± 14.4 (p < 0.0005) at 12 months; a further improvement was observed at 2 years (89.5 ± 11.3; p = 0.008), then results were stable for up to 10 years (87.3 ± 13.6). The analysis of return to sport documented that 64.5% of patients were able to return at a competitive level, and 58.1% performed at the same pre-injury level, with activity rates decreasing over time. The rate of patients returning to competitive level was 84% in those without previous surgery (vs. 33% who had undergone previous surgery), 87% for those with traumatic lesions (vs. 33% and 50% for degenerative and OCD lesions, respectively), and 92.3% in younger patients (age < 20 years). Among these factors, multivariate analysis demonstrated that previous surgery was the single most influencing factor for returning to the same sport level (p = 0.010). CONCLUSIONS These long-term results showed that chondrocyte-based regenerative approach has some limitations in terms of sport-related outcomes. The level of high functional knee restoration needed for such high-demanding activity level can be challenging to achieve, especially in patients with a more compromised joint homeostasis. Return to sport rate varies significantly according to specific patient and lesion characteristics and best results are obtained in young patients with traumatic lesions without previous surgery, which should be considered when treating athletes affected by cartilage lesions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - F Vannini
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Di Martino
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - L Andriolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - A Sessa
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - F Perdisa
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - F Balboni
- Laboratorio NABI, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Andriolo L, Reale D, Di Martino A, Zaffagnini S, Vannini F, Ferruzzi A, Filardo G. High Rate of Failure After Matrix-Assisted Autologous Chondrocyte Transplantation in Osteoarthritic Knees at 15 Years of Follow-up. Am J Sports Med 2019; 47:2116-2122. [PMID: 31211592 DOI: 10.1177/0363546519855029] [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 Chondral and osteochondral lesions in osteoarthritic knees of young patients remain challenging for orthopaedic surgeons, due to a combination of high functional demands and limited indications for joint replacement in this population. The possibility of extending the indication of cartilage regenerative procedures to these patients may allow the delay of metal resurfacing. PURPOSE To analyze the potential of a cartilage regenerative approach to provide clinical benefits in young patients with osteoarthritic knees, documenting outcomes in terms of clinical improvement as well as failures, in particular regarding knee replacement, at long-term follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 41 patients (mean ± SD age, 43 ± 9 years) who had cartilage lesions (4 ± 2 cm2) in osteoarthritic knees (Kellgren-Lawrence grade 2 or 3) underwent matrix-assisted autologous chondrocyte transplantation (MACT) as a salvage procedure. Patients were evaluated with International Knee Documentation Committee (IKDC), EuroQol visual analog scale (EQ-VAS), and Tegner scores before surgery; at 1, 2, 5, and 9 years after surgery; and at a final follow-up at a mean of 15 years after surgery (range, 14-18 years). Failures were also recorded. RESULTS An improvement was observed in all scores after surgery, but a progressive worsening over time was noted. The mean ± SD IKDC score improved from 38.6 ± 16.2 to a maximum of 66.0 ± 18.6 at 2 years (P < .0005), with a subsequent deterioration until the final evaluation at 56.2 ± 21.7 (P = .024). A similar trend was confirmed by EQ-VAS scores. Tegner scores improved at all follow-up points but did not reach the preinjury level. Patients who underwent combined surgery obtained significantly lower results. Only 13 patients (32%) had an IKDC score higher than 70. During the follow-up period, 21 patients underwent reoperation (18 with knee replacement) and 3 more patients experienced clinical failure, for a total surgical and clinical failure rate of 59% at 15 years. CONCLUSION The use of cartilage regenerative surgical procedures, such as MACT, as salvage procedures for young, active patients affected by chondral and osteochondral lesions in osteoarthritic knees led to a limited improvement, with the majority of patients experiencing failure at long-term follow-up. Although a minor subpopulation experienced favorable and stable improvement, the use of MACT for such a challenging indication remains questionable until responding patients can be profiled.
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Affiliation(s)
- Luca Andriolo
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Reale
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Di Martino
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Vannini
- I Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Ferruzzi
- I Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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17
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No evidence for combining cartilage treatment and knee osteotomy in osteoarthritic joints: a systematic literature review. Knee Surg Sports Traumatol Arthrosc 2018; 26:3290-3299. [PMID: 29453488 DOI: 10.1007/s00167-018-4871-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/12/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess whether the combination of HTO and cartilage treatment produced an additional clinical benefit compared to HTO alone. The secondary aim was to identify if there was any difference among different cartilage procedures in terms of healing potential and clinical outcome. METHODS A systematic review of the literature was performed on PubMed database by three independent observers according to the following inclusion criteria: clinical reports of any level of evidence, written in the English language, with no time limitation, about HTO associated with cartilage surgical and injective treatment, including surveys reporting clinical, radiological, or second-look outcomes at any follow-up time. RESULTS The database search identified 1956 records: 21 studies were included for the final analysis, for a total of 1068 patients; 10 case series and 11 comparative studies. While overall good results were reported in the case series, the analysis of the comparative studies showed less uniform results. Among the eight studies investigating HTO with cartilage surgical procedures, improved tissue regeneration was found in 5/8 studies, whereas a clinical improvement was reported only in two studies. Three studies on HTO combination with injective treatment showed better tissue regeneration and clinical benefit. CONCLUSIONS Literature presents low-quality studies, with only few heterogeneous comparative papers. While surgical treatments targeting only the cartilage layer did not achieve clinical improvements, injective treatments targeting the overall joint environment showed promising findings. This prompts further research towards the development of treatments able to improve knee osteotomies outcomes. However, until new evidence will prove otherwise, there is no indication for a combined cartilage treatment in routine clinical practice. LEVEL OF EVIDENCE Level IV.
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Use of a Biomimetic Scaffold for the Treatment of Osteochondral Lesions in Early Osteoarthritis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7937089. [PMID: 30515412 PMCID: PMC6236924 DOI: 10.1155/2018/7937089] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/21/2018] [Indexed: 02/03/2023]
Abstract
The aim of this study is to investigate clinical and radiographic outcomes of a biomimetic scaffold for the treatment of osteochondral knee lesions in patients with early OA. Study population was represented by 26 patients with a mean age of 44 years affected by early OA. Inclusion criteria were two episodes of knee pain for more than 10 days in the last year, Kellgren-Lawrence OA grade 0 or I or II, and arthroscopic findings of cartilage defects. Nineteen patients had a previous surgery, 11 of which were revision surgeries of osteochondral unit. All patients were treated with a biomimetic scaffold with a tri-layered structure of type I equine collagen and magnesium-enriched hydroxyapatite. Clinical outcomes were evaluated using the IKDC, Lysholm, VAS, KOOS, and Tegner scores at baseline and at an average follow-up of 35 months. Magnetic resonance imaging (MRI) was performed at follow-up time in 19 patients. Clinical outcomes showed significant improvement in VAS, Lysholm, IKDC subjective score, and KOOS subscales in 69% of the patients. Complication rate of this cases series was 11%, with no surgical failure, although 31% of patients did not reach a significant improvement and were thus considered as clinical failure. MRI analysis showed integration of the scaffold only in 47% of the patients, with partial regeneration of the subchondral bone. No correlation between clinics and radiological images was found. The use of a biomimetic osteochondral scaffold in the setting of an early OA, alone or associated with other procedures, appeared to be a valid and safe option, able to provide good and stable clinical outcomes with high patient's satisfaction and low complication rate.
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Merkely G, Ackermann J, Lattermann C. Articular Cartilage Defects: Incidence, Diagnosis, and Natural History. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Pestka JM, Luu NH, Südkamp NP, Angele P, Spahn G, Zinser W, Niemeyer P. Revision Surgery After Cartilage Repair: Data From the German Cartilage Registry (KnorpelRegister DGOU). Orthop J Sports Med 2018; 6:2325967117752623. [PMID: 29450205 PMCID: PMC5808974 DOI: 10.1177/2325967117752623] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Various operative strategies have been introduced to restore the integrity of articular cartilage when injured. The frequency of revision surgery after cartilage regenerative surgery remains incompletely understood. Purpose/Hypothesis: The purpose of this study was to identify the reasons for revision surgery after cartilage regenerative surgery of the knee. We hypothesized that in a large patient cohort, revision rates would differ from those in the current literature. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 2659 complete data sets from the German Cartilage Registry were available for analyses. In brief, baseline data were provided by the attending physician at the time of index surgery. Follow-up data were collected using a web-based questionnaire inquiring whether patients had needed revision surgery during follow-up, which was defined as the endpoint of the present analysis. Results: A total of 88 patients (3.3%) reported the need for revision surgery as early as 12 months postoperatively. Among the most common causes were arthrofibrosis (n = 27) and infection (n = 10). Female patients showed a significantly greater complication rate (4.5%) when compared with male patients (2.6%; P = .0071). The majority of cartilage lesions were located at the medial femoral condyle (40.2%), with a mean defect size of 3.5 ± 2.1 cm2. Neither the location nor defect size appeared to lead to an increased revision rate, which was greatest after osteochondral autografts (5.2%) and autologous chondrocyte implantation (4.6%). Revision rates did not differ significantly among surgical techniques. Chi-square analysis revealed significant correlations between the number of previous joint surgeries and the need for revision surgery (P = .0203). Multivariate regression analysis further confirmed sex and the number of previous surgeries as variables predicting the need for early revision surgery. Conclusion: The low early revision rates found in this study underline that today’s cartilage repair surgeries are mostly safe. Although invasiveness and techniques differ greatly among the procedures, no differences in revision rates were observed. Specific factors such as sex and the number of previous surgeries seem to influence overall revision rates and were identified as relevant risk factors with regard to patient safety.
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Affiliation(s)
- Jan M Pestka
- Department of Orthopedics and Trauma Surgery, University Medical Center, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Nam H Luu
- Department of Orthopedics and Trauma Surgery, University Medical Center, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopedics and Trauma Surgery, University Medical Center, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Peter Angele
- Department of Traumatology, Regensburg University Hospital, Regensburg, Germany
| | - Gunther Spahn
- Center of Trauma and Orthopaedic Surgery, Jena University Hospital, Eisenach, Germany
| | - Wolfgang Zinser
- Department of Orthopedic Surgery and Traumatology, St Vinzenz Hospital, Dinslaken, Germany
| | - Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, University Medical Center, Albert Ludwigs University of Freiburg, Freiburg, Germany.,OCM Clinic, Munich, Germany
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Albano D, Martinelli N, Bianchi A, Messina C, Malerba F, Sconfienza LM. Clinical and imaging outcome of osteochondral lesions of the talus treated using autologous matrix-induced chondrogenesis technique with a biomimetic scaffold. BMC Musculoskelet Disord 2017; 18:306. [PMID: 28720091 PMCID: PMC5516391 DOI: 10.1186/s12891-017-1679-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/13/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The purpose of our study was to assess the clinical and imaging outcome of autologous matrix-induced chondrogenesis (AMIC) technique consisting of microfractures followed by the filling of osteochondral lesions of the talus (OLTs) with a cell-free biphasic collagen-hydroxyapatite osteochondral scaffold (MaioRegen). METHODS Sixteen patients (eight males, age: 42.6 ± 18.4, range 14-74) with OLT repaired using AMIC technique, with implantation of MaioRegen, were clinically evaluated through the American Orthopedic Foot and Ankle Society Score (AOFAS) and a 10-point Visual Analogue Scale (VAS) pain score after a mean follow-up of 30 ± 16.9 months. The MRI examinations were performed 12 and 24 months after surgery. A paired t-test was applied to compare pre- and post-operative clinical findings (VAS and AOFAS) and Magnetic resonance observation of cartilage repair tissue (MOCART) score changes in the follow-up. To assess the correlation between variation of AOFAS and MOCART scores, the Pearson's correlation coefficient was calculated. RESULTS No complications after surgery were encountered. From pre-operative to post-operative values, there was a significant (P < 0.001) reduction of mean VAS pain score (6.3 ± 0.9,range: 4-8 and 2.9 ± 1.8,range: 0-6, respectively) and increase of AOFAS score (60.2 ± 7.8,range: 50-74 and 77.4 ± 16.2,range: 50-100, respectively). Among 16 patients, six (37%) were not satisfied at the end of follow-up, six (37%) were moderately satisfied and four (25%) were highly satisfied. The treatment was considered failed in five out of 16 patients (31%). Among them, four (25%) required re-interventions with implantation of ankle prostheses, whereas one patient was treated with a further AMIC technique combined with autologous bone graft and platelet-rich plasma. The mean MOCART score was 41.9 ± 14.6 (25-70) 12 months after surgery and 51.9 ± 11.6 (30-70) after 24 months, with a statistically significant increase (P = 0.012). However, no correlation was seen between AOFAS and MOCART changes (r = 0.215, p = 0.609). CONCLUSION The high rates of treatment failure encountered in our study using MaioRegen need to be confirmed by larger studies and should induce the scientific community questioning the reliability of this biomimetic scaffold for the treatment of OLTs.
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Affiliation(s)
- Domenico Albano
- Department of Radiology, Di.Bi.Med, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Nicolò Martinelli
- Department of Foot and Ankle Surgery, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | - Alberto Bianchi
- Department of Foot and Ankle Surgery, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | - Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Francesco Malerba
- Department of Foot and Ankle Surgery, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
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