1
|
Bertelsen Á, Iribar‐Zabala A, Otegi‐Alvaro E, Benito R, López‐Linares K, Macía I. Proof-of-concept of a robotic-driven photogrammetric scanner for intra-operative knee cartilage repair. Healthc Technol Lett 2024; 11:59-66. [PMID: 38638487 PMCID: PMC11022211 DOI: 10.1049/htl2.12054] [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] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 04/20/2024] Open
Abstract
This work presents a proof-of-concept of a robotic-driven intra-operative scanner designed for knee cartilage lesion repair, part of a system for direct in vivo bioprinting. The proposed system is based on a photogrammetric pipeline, which reconstructs the cartilage and lesion surfaces from sets of photographs acquired by a robotic-handled endoscope, and produces 3D grafts for further printing path planning. A validation on a synthetic phantom is presented, showing that, despite the cartilage smooth and featureless surface, the current prototype can accurately reconstruct osteochondral lesions and their surroundings with mean error values of 0.199 ± 0.096 mm but with noticeable concentration on areas with poor lighting or low photographic coverage. The system can also accurately generate grafts for bioprinting, although with a slight tendency to underestimate the actual lesion sizes, producing grafts with coverage errors of -12.2 ± 3.7, -7.9 ± 4.9, and -15.2 ± 3.4% for the medio-lateral, antero-posterior, and craneo-caudal directions, respectively. Improvements in lighting and acquisition for enhancing reconstruction accuracy are planned as future work, as well as integration into a complete bioprinting pipeline and validation with ex vivo phantoms.
Collapse
Affiliation(s)
- Álvaro Bertelsen
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
- eHealth GroupBioengineering areaBiogipuzkoa Health Research InstituteDonostia‐San SebastiánSpain
| | - Amaia Iribar‐Zabala
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
| | - Ekiñe Otegi‐Alvaro
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
| | - Rafael Benito
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
| | - Karen López‐Linares
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
- eHealth GroupBioengineering areaBiogipuzkoa Health Research InstituteDonostia‐San SebastiánSpain
| | - Iván Macía
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
- eHealth GroupBioengineering areaBiogipuzkoa Health Research InstituteDonostia‐San SebastiánSpain
| |
Collapse
|
2
|
Perry J, Kuiper JH, McCarthy HS, Jermin P, Gallacher PD, Tins B, Roberts S. Comparison of Knee Articular Cartilage Defect Size Between Measurements Obtained on Preoperative MRI Versus During Arthrotomy. Orthop J Sports Med 2023; 11:23259671231193380. [PMID: 37693808 PMCID: PMC10483978 DOI: 10.1177/23259671231193380] [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: 03/02/2023] [Accepted: 04/13/2023] [Indexed: 09/12/2023] Open
Abstract
Background Treatment decisions for cartilage defects are often based on lesion size. Magnetic resonance imaging (MRI) is widely used to diagnose cartilage defects noninvasively; however, their size estimated from MRI may differ from defect sizes measured during arthrotomy, especially after debridement to healthy cartilage if undergoing autologous chondrocyte implantation. Purpose/Hypothesis The purpose of this study was to evaluate the reliability of 2 methods to assess knee cartilage defect size on preoperative MRI and determine their accuracy in predicting postdebridement defect sizes recorded during arthrotomy. It was hypothesized that defect size would be predicted more accurately by the total area of abnormal articular cartilage rather than the area of full-thickness cartilage loss as identified on MRI. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods This study included 64 patients (mean age, 41.8 ± 9.6 years) who underwent autologous cell therapy. Each patient received a 3-T MRI at 6.1 ± 3.0 weeks before cell implantation. Three raters, a radiologist, a surgeon, and a scientist, measured (1) the full-thickness cartilage defect area and (2) the total predicted abnormal cartilage area, identified by an abnormal signal on MRI. Interrater reliability was assessed using the intraclass correlation coefficient (ICC). Actual pre- and postdebridement defect sizes were obtained from intraoperative surgical notes. Postdebridement surgical measurements were considered the clinical reference standard and were compared with the radiologist's MRI measurements. Results Eighty-seven defects were assessed, located on the lateral (n = 8) and medial (n = 26) femoral condyle, trochlea (n = 17), and patella (n = 36). The interrater reliability of the cartilage defect measurements on MRI was good to excellent for the full-thickness cartilage defect area (ICC = 0.74) and the total predicted abnormal cartilage area (ICC = 0.78). The median full-thickness cartilage defect area on MRI underestimated the median postdebridement defect area by 78.3%, whereas the total predicted abnormal cartilage area measurement underestimated the postdebridement defect area by 14.3%. Conclusion Measuring the full-thickness cartilage defect area on MRI underestimated the area to treat, whereas measuring the total abnormal area provided a better estimate of the actual defect size for treatment.
Collapse
Affiliation(s)
- Jade Perry
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire, UK
| | - Jan Herman Kuiper
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire, UK
| | - Helen S. McCarthy
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire, UK
| | - Paul Jermin
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire, UK
| | - Peter D. Gallacher
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
| | - Bernhard Tins
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire, UK
| | - Sally Roberts
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire, UK
| |
Collapse
|
3
|
Chen Y, Li Y, Liu W, Wang Z, Li J, Chen C, Zeng G, Shen J, Song W. Comparison of surface microscopy coil and ankle joint special phased array coil magnetic resonance imaging in assessing preoperative osteochondral lesions of the talus. Quant Imaging Med Surg 2023; 13:4973-4983. [PMID: 37581067 PMCID: PMC10423370 DOI: 10.21037/qims-22-1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/16/2023] [Indexed: 08/16/2023]
Abstract
Background Lesion size is a major determinant of treatment strategies and predictor of clinical outcomes for osteochondral lesions of the talus (OLTs). Although magnetic resonance imaging (MRI) has been commonly used in the preoperative evaluation of OLTs, MRI has low reliability and usually overestimates or underestimates lesion size compared with intraoperative assessment. This study aims to determine whether the surface microscopy coil (SMC) can improve the accuracy of assessment of preoperative OLTs compared with conventional coil MRI, ankle joint special phased array coil (ASC). Methods A total of 43 patients diagnosed with OLTs undertook preoperative MRI examination with both SMC and ASC were included in this prospective study from 2019 to 2022. The diameter of the lesion was measured in sagittal plane and coronal plane at its widest point and then the lesion area was calculated. Then MRI measurements were compared with arthroscopy or open-surgery measurements. Results The mean lesion area measured with ASC was significantly greater than that measured intraoperatively (95.07±44.60 vs. 52.74±29.86 mm2, P<0.001), while there was no significant difference between lesion area measured in SMC and intraoperatively (55.28±36.06 vs. 52.74±29.86 mm2, P=0.576). Diameter measured in ASC was significantly greater than that measured intraoperatively in both coronal plane (8.95±2.48 vs. 6.67±1.81, P<0.001) and sagittal plane (13.12±3.76 vs. 9.58±3.98, P<0.001). No significant difference between lesion diameter measured in SMC and intraoperatively in both coronal plane (6.44±2.59 vs. 6.67±1.81, P=0.608) or sagittal plane (10.23±3.69 vs. 9.58±3.98, P=0.194). Compared with surgical assessment, 39 of 43 cases were consistent with SMC assessment while only 26 of 43 cases were consistent with ASC assessment (39/43 vs. 26/43, P=0.002). Conclusions Diameter measured with SMC was much more accurate than ASC MRI. Compared with ASC MRI, the SMC had a much higher concordance rate between preoperative assessment and surgical assessment.
Collapse
Affiliation(s)
- Yanbo Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Li
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenzhou Liu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhihui Wang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiajie Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chen Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Zeng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weidong Song
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Moulton SG, Provencher M, Vidal A, Wiedrick J, Arnold K, Crawford D. Application of 3D Modeling Software to Preoperative MRI for Prediction of Surface Area of Tissue Applied During Osteochondral Allograft Reconstruction of the Knee. Orthop J Sports Med 2023; 11:23259671231153132. [PMID: 36909672 PMCID: PMC9996737 DOI: 10.1177/23259671231153132] [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] [Received: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 03/14/2023] Open
Abstract
Background Preoperative magnetic resonance imaging (MRI) is used to estimate the quantity of tissue provided for fresh osteochondral allograft (FOCA) in the knee. Use of 3-dimensional (3D) MRI modeling software for this purpose may improve defect assessment, providing a more accurate estimate of osteochondral allograft tissue required and eliminating the possibility of acquiring an inadequate quantity of tissue for transplant surgery. Purpose To evaluate the capacity of damage assessment (DA) 3D MRI modeling software to preoperatively estimate the osteochondral allograft surface area used in surgery. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Included were 36 patients who had undergone FOCA surgery to the distal femur. Based on the preoperative MRI scans, the DA software estimated the total surface area of the lesion as well as the surface areas of each subarea of injury: full-thickness cartilage injury (International Cartilage Repair Society [ICRS] grade 4), partial-thickness cartilage injury (ICRS grade 2-3), bone marrow edema, bone loss, and bone cyst. The probability of overestimation of graft tissue areas by the DA software was calculated using a Bayes-moderated proportion, and the relationship between the prediction discrepancy (ie, over- or underestimation) and the magnitude of the DA estimate was assessed using nonparametric local-linear regression. Results The DA total surface area measurement overestimated the actual area of FOCA tissue transplanted 81.6% (95% CI, 67.2%-91.4%) of the time, corresponding to a median overestimation of 3.14 cm2, or 1.78 times the area of FOCA transplanted. The DA software overestimated the area of FOCA transplanted 100% of the time for defect areas measuring >4.52 cm2. For defects <4.21 cm2, the maximum-magnitude underestimation of tissue area was 1.45 cm2 (on a fold scale, 0.63 times the transplanted area); a plausible heuristic is that multiplying small DA-measured areas of injury by a factor of ∼1.5 would yield an overestimation of the tissue area transplanted most of the time. Conclusion The DA 3D modeling software overestimated osteochondral defect size >80% of the time in 36 distal femoral FOCA cases. A policy of consistent but limited overestimation of osteochondral defect size may provide a more reliable basis for predicting the minimum safe amount of allograft tissue to acquire for transplantation.
Collapse
Affiliation(s)
- Samuel G Moulton
- University of California San Francisco, San Francisco, California, USA
| | | | - Armando Vidal
- Oregon Health & Science University, Portland, Oregon, USA
| | - Jack Wiedrick
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kaytee Arnold
- Oregon Health & Science University, Portland, Oregon, USA
| | | |
Collapse
|
6
|
Chahla J, Williams BT, Yanke AB, Farr J. The Large Focal Isolated Chondral Lesion. J Knee Surg 2023; 36:368-381. [PMID: 34507359 DOI: 10.1055/s-0041-1735278] [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
Focal chondral defects (FCDs) of the knee can be a debilitating condition that can clinically translate into pain and dysfunction in young patients with high activity demands. Both the understanding of the etiology of FCDs and the surgical management of these chondral defects has exponentially grown in recent years. This is reflected by the number of surgical procedures performed for FCDs, which is now approximately 200,000 annually. This fact is also apparent in the wide variety of available surgical approaches to FCDs. Although simple arthroscopic debridement or microfracture are usually the first line of treatment for smaller lesions, chondral lesions that involve a larger area or depth require restorative procedures such as osteochondral allograft transplantation or other cell-based techniques. Given the prevalence of FCDs and the increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This narrative review aims to describe current concepts in the treatment of large FCDs through providing an algorithmic approach to selecting interventions to address these lesions as well as the reported outcomes in the literature.
Collapse
Affiliation(s)
- Jorge Chahla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brady T Williams
- Department of Orthopedic Surgery, University of Colorado, Aurora, Colorado
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jack Farr
- Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana
| |
Collapse
|
7
|
O'Malley O, Choudhury A, Biggs A, Humdani AJ, Brown O, Smith TO, Ejindu V, Hing CB. Association between Patellofemoral Anatomy and Chondral Lesions of the Knee in Patellofemoral Instability. J Knee Surg 2023; 36:153-158. [PMID: 34187065 DOI: 10.1055/s-0041-1731351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chondral injury is a serious consequence of patellar dislocation and patellofemoral instability (PFI). There is limited data on the relationship between radiological features such as sulcus angle and patellar height to the presence, location, and severity of chondral lesions. The purpose of this study was to determine the association of anatomical variants in patellofemoral instability with injuries sustained due to patellar dislocation. A cohort of 101 patients who had four or more episodes of dislocation or instability undergoing isolated arthroscopy or arthroscopies at the time of corrective realignment surgery were identified. The prevalence of chondral, ligamentous, and meniscal injuries was determined and correlated to the sulcus angle, tibial tubercle trochlear groove distance, and patellar height on magnetic resonance imaging (MRI) scans. A total of 101 patients was identified. At arthroscopy, the patella demonstrated the highest incidence of chondral injury (68%) followed by the trochlear groove (40%). Lateral meniscal injuries were noted in 6% of patients, medial meniscal injuries in 2%, and anterior cruciate ligament (ACL) injury in 3%. Chondral injuries were graded using the Outerbridge criteria and there was a correlation between more severe chondral injuries and a greater tilt angle (p = 0.05). The occurrence of injury to the lateral meniscus was associated with a higher Insall-Salvati ratio (p = 0.05). More severe chondral injuries are seen in patients with a greater tilt angle.
Collapse
Affiliation(s)
- Olivia O'Malley
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Aliya Choudhury
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Alexandra Biggs
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Alina J Humdani
- St George's Medical School, St George's University London, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Oliver Brown
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Vivian Ejindu
- St George's Medical School, St George's University London, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Caroline B Hing
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| |
Collapse
|
8
|
Naik A, Shanmugasundaram S, Mahadev K, Shetty AA, Kim SJ. Volume index as a new measure of cartilage loss: a retrospective MRI-based study of chondral injury patterns in adult patients with knee pain. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:75-80. [PMID: 34743222 DOI: 10.1007/s00590-021-03158-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/23/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Knee pain is one of the commonest symptoms in patients who attend the Orthopaedic outpatient clinics. Chondral defects result in a painful knee. Incidence of chondral defect is reported to be between 5 and 10% over the age of 40. It is well documented that chondral defects can lead to osteoarthritis. Early detection of these lesions and cartilage repair surgery can delay the onset of osteoarthritis. The purpose of this study is to highlight the incidence, associations and correlations between opposing cartilage defects in patients who present to the knee clinic with pain. METHODS A retrospective analysis was carried out on patients who had Magnetic Resonance Imaging scans for painful knees between June 2017 and May 2019. About 227 consecutive knees were studied for the incidence of chondral defects, number of lesions, grade and size of lesion, geographical location and associated pathology in the knee. RESULTS All the 227 patients had chondral lesions. Most patients had 2-3 lesions (66.1%) with patellar lesions (76.6%) being the commonest followed by medial femoral condyle (59.9%). Significant correlation was found in grade and size between opposing surface lesions in patella-trochlea, Medial Femoral Condyle-Medial Tibial Plateau and Lateral Femoral Condyle-Lateral Tibial Plateau. Females were more predisposed to patella lesions. Significance between age and lesions were established. CONCLUSION Incidence of cartilage defects in the knee is very high. Kissing lesions must be considered when treating cartilage lesions. Volume index could be a promising method to quantify lesions.
Collapse
Affiliation(s)
- Arjun Naik
- Spire Alexandra Hospital & Canterbury Christchurch University, Kent, UK
| | | | | | | | | |
Collapse
|
9
|
O'Connell CD, Duchi S, Onofrillo C, Caballero-Aguilar LM, Trengove A, Doyle SE, Zywicki WJ, Pirogova E, Di Bella C. Within or Without You? A Perspective Comparing In Situ and Ex Situ Tissue Engineering Strategies for Articular Cartilage Repair. Adv Healthc Mater 2022; 11:e2201305. [PMID: 36541723 DOI: 10.1002/adhm.202201305] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/21/2022] [Indexed: 11/23/2022]
Abstract
Human articular cartilage has a poor ability to self-repair, meaning small injuries often lead to osteoarthritis, a painful and debilitating condition which is a major contributor to the global burden of disease. Existing clinical strategies generally do not regenerate hyaline type cartilage, motivating research toward tissue engineering solutions. Prospective cartilage tissue engineering therapies can be placed into two broad categories: i) Ex situ strategies, where cartilage tissue constructs are engineered in the lab prior to implantation and ii) in situ strategies, where cells and/or a bioscaffold are delivered to the defect site to stimulate chondral repair directly. While commonalities exist between these two approaches, the core point of distinction-whether chondrogenesis primarily occurs "within" or "without" (outside) the body-can dictate many aspects of the treatment. This difference influences decisions around cell selection, the biomaterials formulation and the surgical implantation procedure, the processes of tissue integration and maturation, as well as, the prospects for regulatory clearance and clinical translation. Here, ex situ and in situ cartilage engineering strategies are compared: Highlighting their respective challenges, opportunities, and prospects on their translational pathways toward long term human cartilage repair.
Collapse
Affiliation(s)
- Cathal D O'Connell
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.,Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Serena Duchi
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Carmine Onofrillo
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Lilith M Caballero-Aguilar
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Victoria, 3122, Australia
| | - Anna Trengove
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Stephanie E Doyle
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.,Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Wiktor J Zywicki
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Elena Pirogova
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia
| | - Claudia Di Bella
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| |
Collapse
|
10
|
Identifying Consensus and Open Questions around Assessing or Predicting the Quality and Success of Cartilage Repair: A Delphi Study. SURGERIES 2021. [DOI: 10.3390/surgeries2030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A range of surgical techniques have been developed for the repair or regeneration of lesioned cartilage in the human knee and a corresponding array of scoring systems have been created to assess their outcomes. The published literature displays a wide range of opinions regarding the factors that influence the success of surgical cartilage repair and which parameters are the most useful for measuring the quality of the repair at follow-up. Our objective was to provide some clarity to the field by collating items that were agreed upon by a panel of experts to be important in these areas. A modified, three-round Delphi consensus study was carried out consisting of one idea-generating focus-group and two subsequent, self-completed questionnaire rounds. In each round, items were assessed for their importance and level of consensus against pre-determined threshold levels. In total, 31 items reached consensus, including a hierarchy of tissues in the joint based on their importance in cartilage repair, markers of repair cartilage quality and the implications of environmental and patient-related factors. Items were stratified into those that can be employed for predicting the success of cartilage repair and those that could be used for assessing the structural quality of the resulting repair cartilage. Items that did not reach consensus represent areas where dissent remains and could, therefore, be used to guide future clinical and fundamental scientific research.
Collapse
|
11
|
Soellner ST, Welsch GH, Gelse K, Goldmann A, Kleyer A, Schett G, Pachowsky ML. gagCEST imaging at 3 T MRI in patients with articular cartilage lesions of the knee and intraoperative validation. Osteoarthritis Cartilage 2021; 29:1163-1172. [PMID: 33933584 DOI: 10.1016/j.joca.2021.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare glycosaminoglycan chemical exchange saturation transfer (gagCEST) of knee cartilage with intraoperative results for the assessment of early osteoarthritis (OA) and to define gagCEST values for the differentiation between healthy and degenerated cartilage. DESIGN Twenty-one patients with cartilage lesions or moderate OA were examined using 3 T Magnetic Resonance Imaging (MRI). In this prospective study, regions of interest (ROIs) were examined by a sagittal gagCEST analysis and a morphological high-resolution three-dimensional, fat-saturated proton-density space sequence. Cartilage lesions were identified arthroscopically, graded by the International Cartilage Repair Society (ICRS) score in 42 defined ROIs per patient and consecutively compared with mean gagCEST values using analysis of variance and Spearman's rank correlation test. Receiver operating characteristics (ROC) curves were applied to identify gagCEST threshold values to differentiate between the ICRS grades. RESULTS A total of 882 ROIs were examined and graduated in ICRS score 0 (67.3%), 1 (25.2%), 2 (6.2%) and the merged ICRS 3 and 4 (1.0%). gagCEST values decreased with increasing grade of cartilage damage with a negative correlation between gagCEST values and ICRS scores. A gagCEST value threshold of 3.55% was identified to differentiate between ICRS score 0 (normal) and all other grades. CONCLUSIONS gagCEST reflects the content of glycosaminoglycan and might provide a diagnostic tool for the detection of early knee-joint cartilage damage and for the non-invasive subtle differentiation between ICRS grades by MRI even at early stages in clinical practice.
Collapse
Affiliation(s)
- S T Soellner
- Department of Trauma and Orthopaedic Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany.
| | - G H Welsch
- UKE Athleticum, and Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - K Gelse
- Klinikum Traunstein, Traunstein, Germany; Department of Trauma and Orthopaedic Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany; University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany.
| | - A Goldmann
- OCE Orthopaedie Centrum Erlangen, Erlangen, Germany.
| | - A Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany.
| | - G Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany.
| | - M L Pachowsky
- Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3 - Rheumatology and Immunology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany.
| |
Collapse
|
12
|
Osteochondral Grafts Failures. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2019.150712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
13
|
Hartwell MJ, Selley RS, Dayton SR, Ishamuddin SH, Ravi K, Terry MA, Tjong VK. Can preoperative magnetic resonance arthrography accurately predict intraoperative hip labral thickness? J Orthop 2020; 20:131-134. [PMID: 32025136 DOI: 10.1016/j.jor.2020.01.024] [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: 12/23/2019] [Accepted: 01/19/2020] [Indexed: 11/28/2022] Open
Abstract
Objective There is limited literature investigating the reliability of magnetic resonance-based assessments of labral size. The goal of this study was to validate the reliability of magnetic resonance arthrography-based labral size measurements with intra-operative arthroscopic measurements. Methods Patients undergoing hip arthroscopy for femoroacetabular impingement and labral tears were prospectively enrolled. Preoperative magnetic resonance arthrograms were used to determine labral size at the anterior-superior portion (zone 2), mid-superior portion (zone 3), and posterior-superior portion (zone 4). Intra-operative labral widths were measured at the same anatomical zones of the acetabulum using an arthroscopic probe. Mean labral size was determined for each location and a Pearson correlation was used to determine the correlation between imaging-based measurements and intra-operative measurements. Results 117 patients were enrolled with 70% being female, an average age of 39.1 ± 13.3, and an average body mass index was 26.5 ± 5.4. The average labral sizes based on intraoperative measurements were 6.85 mm in zone 2, 7.45 mm in zone 3, and 7.29 mm in zone 4. The average labral sizes based on MRA were 6.95 mm in zone 2, 7.24 mm in zone 3, and 6.71 mm in zone 4. There was a poor correlation between MRA and intraoperative measurements in zones 2 and 3 (zone 2: R = 0.171, p = 0.065; zone 3: R = 0.335, p = 0.00022) and no correlation in zone 4 (R = -0.22, p = 0.82). Conclusion This study demonstrates a poor correlation in labral measurements between magnetic resonance arthrogram imaging and intraoperative measurements, suggesting that this imaging modality may be insufficient in providing accurate measurements of labral size.
Collapse
Affiliation(s)
- Matthew J Hartwell
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Ryan S Selley
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Steven R Dayton
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Sarah H Ishamuddin
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Ksheeraja Ravi
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Michael A Terry
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| |
Collapse
|
14
|
Brinkhof S, Ali Haghnejad A, Ito K, Markenroth Bloch K, Klomp D. Uncompromised MRI of knee cartilage while incorporating sensitive sodium MRI. NMR IN BIOMEDICINE 2019; 32:e4173. [PMID: 31502337 PMCID: PMC6900061 DOI: 10.1002/nbm.4173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 06/10/2023]
Abstract
Sodium imaging is able to assess changes in ion content, linked to glycosaminoglycan content, which is important to guide orthopeadic procedures such as articular cartilage repair. Sodium imaging is ideally performed using double tuned RF coils, to combine high resolution morphological imaging with biochemical information from sodium imaging to assess ion content. The proton image quality of such coils is often harshly degraded, with up to 50% of SNR or severe acceleration loss as compared to single tuned coils. Reasons are that the number of proton receive channels often severely reduced and double tuning will degrade the intrinsic sensitivity of the RF coil on at least one of the nuclei. However, the aim of this work was to implement a double-tuned sodium/proton knee coil setup without deterioration of the proton signal whilst being able to achieve acquisition of high SNR sodium images. A double-tuned knee coil was constructed as a shielded birdcage optimized for sodium and compromised for proton. To exclude any compromise, the proton part of the birdcage is used for transmit only and interfaced to RF amplifiers that can fully mitigate the reduced efficiency. In addition, a 15 channel single tuned proton receiver coil was embedded within the double-resonant birdcage to maintain optimal SNR and acceleration for proton imaging. To validate the efficiency of our coil, the designed coil was compared with the state-of-the-art single-tuned alternative at 7 T. B1+ corrected SNR maps were used to compare both coils on proton performance and g-factor maps were used to compare both coils on acceleration possibilities. The newly constructed double-tuned coil was shown to have comparable proton quality and acceleration possibilities to the single-tuned alternative while also being able to acquire high SNR sodium images.
Collapse
Affiliation(s)
- S. Brinkhof
- Department of RadiologyUniversity Medical Center UtrechtUtrechtNetherlands
| | | | - K. Ito
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, Netherlands
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenNetherlands
| | | | - D.W.J. Klomp
- Department of RadiologyUniversity Medical Center UtrechtUtrechtNetherlands
| |
Collapse
|
15
|
Stewart RC, Nelson BB, Kawcak CE, Freedman JD, Snyder BD, Goodrich LR, Grinstaff MW. Contrast-Enhanced Computed Tomography Scoring System for Distinguishing Early Osteoarthritis Disease States: A Feasibility Study. J Orthop Res 2019; 37:2138-2148. [PMID: 31136003 PMCID: PMC6739126 DOI: 10.1002/jor.24382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
Early detection of osteoarthritis (OA) remains a diagnostic challenge owing to insensitive diagnostic techniques currently available. Herein a new semiquantitative scoring system, based upon contrast-enhanced computed tomographic (CECT) imaging, is described for further refinement of early OA disease staging. Trochlear ridge cartilage defects were surgically created in the femoropatellar joint of an adult horse (ACUC approved protocols). Seven weeks post-surgery, CECT imaging was performed on a clinical scanner after intra-articular injection of a cationic iodinated contrast agent, CA4+, into both injured and control femoropatellar joint compartments. The femoral cartilage surface was densely biopsied, and specimens were assessed for visual (Outerbridge score), functional (equilibrium compressive modulus), and biochemical (glycosaminoglycan content) measures of cartilage quality. Cartilage CECT attenuation was compared with cartilage quality measures using receiver operating characteristic curve analysis to establish attenuation thresholds for distinguishing among cartilage quality levels. CECT imaging identifies macroscopically damaged cartilage regions and in morphologically identical tissue provides moderately sensitive and specific semiquantitative segregation of cartilage quality based upon CECT attenuation, reflecting both glycosaminoglycan content and compressive stiffness of cartilage area under the curve (AUC = 0.83 [95% confidence interval [CI]: 0.72-0.93] for distinguishing poor quality and AUC = 0.76 [95% CI: 0.65-0.90] for distinguishing healthy quality cartilage). A semiquantitative 6-point scoring system-the Osteoarthritis Attenuation and Morphological Assessment (OAMA) score-is proposed as a tool for assessing cartilage quality from CECT images. The OAMA scoring system expands the current disease staging capability of early OA by inclusion of morphological, biochemical, and biomechanical assessments. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2138-2148, 2019.
Collapse
Affiliation(s)
- Rachel C. Stewart
- Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, MA 02215
| | - Brad B. Nelson
- Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Gail Holmes Equine Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO 80523
| | - Chris E. Kawcak
- Gail Holmes Equine Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO 80523
| | - Jonathan D. Freedman
- Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, MA 02215
| | - Brian D. Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, MA 02215,Address correspondence and reprint requests to: Mark W. Grinstaff, Ph.D., Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 590 Commonwealth Ave, Boston MA 02215, Phone: 617-358-3429, ; Brian D. Snyder, M.D., Ph.D., Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 1 Overland Street, RN 115, Boston MA 02215,
| | - Laurie R. Goodrich
- Gail Holmes Equine Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO 80523
| | - Mark W. Grinstaff
- Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Department of Chemistry, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Department of Medicine, Boston University School of Medicine, 715 Albany St. E-113, Boston, MA 02118,Address correspondence and reprint requests to: Mark W. Grinstaff, Ph.D., Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 590 Commonwealth Ave, Boston MA 02215, Phone: 617-358-3429, ; Brian D. Snyder, M.D., Ph.D., Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 1 Overland Street, RN 115, Boston MA 02215,
| |
Collapse
|
16
|
Zikria B, Hafezi-Nejad N, Patten I, Johnson A, Haj-Mirzaian A, Wilckens JH, Ficke JR, Demehri S. Image-Guided Chondrocyte Harvesting for Autologous Chondrocyte Implantation: Initial Feasibility Study with Human Cadaver and Pilot Clinical Experience. JB JS Open Access 2019; 4:e0039. [PMID: 31334460 PMCID: PMC6613850 DOI: 10.2106/jbjs.oa.18.00039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Autologous chondrocyte implantation (ACI), a promising modality for repairing full-thickness cartilage defects, requires 2 consecutive arthroscopic procedures for chondrocyte harvesting and implantation. In the present study, we assessed the feasibility and efficacy of image-guided chondrocyte harvesting as an alternative to arthroscopic biopsy. Methods: We induced full-thickness cartilage defects in 10 human cadaveric knees. Computed tomographic arthrography (CTA) was performed following the intra-articular administration of Omnipaque 350 to measure the diameters of the induced cartilage defects. Subsequently, 2 independent operators conducted CTA-guided chondrocyte harvesting (from the medial and lateral trochlear ridges) in each knee. The time for chondrocyte harvesting, accuracy (distance between the predefined target on CTA and the final insertion site of the needle), and number of needle readjustments were recorded. In the institutional review board-approved clinical study, informed consent was obtained and chondrocyte harvesting was performed both with use of a conventional arthroscopic biopsy method and with use of a needle through an arthroscopy access site in 10 subjects for whom ACI was indicated. The samples were processed and cultured blindly, and the quantity and quality of the samples were determined. Results: CTA measurements of full-thickness cartilage defects showed high to perfect absolute agreement and consistency when compared with direct measurements (overall interclass correlation coefficient, 0.933 to 0.983; p < 0.05). For both operators, image-guided chondrocyte harvesting from the lateral ridge was more accurate (p = 0.007 and 0.040) and faster (p = 0.056 and 0.014) in comparison with harvesting from the medial ridge. In the clinical study, no significant difference was observed for the growth index of samples between the needle-harvest and conventional methods (p = 0.897). Conclusions: CTA can be used for precise measurement of full-thickness cartilage defects. Image-guided chondrocyte harvesting is a viable alternative to traditional arthroscopic biopsy for ACI. Clinical Relevance: We recognize the current pivotal role of arthroscopic biopsy, as a part of ACI, for chondrocyte harvesting as well as for delineating the nature of the lesion. However, on the basis of our results, image-guided chondrocyte retrieval may obviate the need for arthroscopic biopsy in some patients in the future.
Collapse
Affiliation(s)
- Bashir Zikria
- Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland
| | - Nima Hafezi-Nejad
- Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland
| | - Ian Patten
- Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland
| | - Alex Johnson
- Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland
| | - Arya Haj-Mirzaian
- Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland
| | - John H Wilckens
- Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland
| | - James R Ficke
- Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland
| | - Shadpour Demehri
- Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
17
|
Everhart JS, Kirven JC, Abouljoud MM, DiBartola AC, Kaeding CC, Flanigan DC. Effect of Delayed Primary Anterior Cruciate Ligament Reconstruction on Medial Compartment Cartilage and Meniscal Health. Am J Sports Med 2019; 47:1816-1824. [PMID: 31125273 DOI: 10.1177/0363546519849695] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The time required to develop a secondary cartilage or meniscal injury in the medial compartment after anterior cruciate ligament (ACL) injury is not well understood. PURPOSE To determine the association between time delay until ACL reconstruction and the presence of medial compartment Outerbridge grade 3 or 4 chondral injury or medial meniscal tear requiring treatment. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 609 patients underwent primary ACL reconstruction at a single institution at a median 46 days between injury and surgery (61.4% male; mean age, 26.5 years [SD, 11.1]). Chondral status was graded according to Outerbridge criteria at the time of surgery. Multivariate regression analysis was used to assess the relationship between time delay until surgery and medial compartment chondral injury or meniscal injury requiring treatment. Adjustment was performed as needed for patient demographics, sporting activity, and prior knee injuries. Time until surgery had a nonlinear association with medial compartment health and was more effectively described in discrete intervals rather than as a continuous variable. The optimal time intervals to predict medial compartment health were determined by comparison of Bayes information criterion values between fully adjusted regression models. RESULTS After controlling for relevant confounders, delay of surgery >8 weeks had an increased likelihood of a medial meniscal tear requiring partial meniscectomy (adjusted odds ratio [aOR], 2.30; 95% CI, 1.04-5.12; P = .04) and a decreased likelihood of a meniscal tear requiring repair (aOR, 0.50; 95% CI, 0.32-0.76; P = .001). Delay of surgery >5 months had an increased likelihood of a medial Outerbridge grade ≥3 chondral defect (aOR, 3.11; 95% CI, 1.64-5.87; P = .001) or a grade 4 defect (aOR, 3.84; 95% CI, 1.75-8.45; P = .001). CONCLUSION From the time of ACL injury, risk of an irreparable medial meniscal tear found at the time of ACL reconstruction is significantly increased by 8 weeks, and risk of high-grade medial chondral damage is increased by 5 months.
Collapse
Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J Caid Kirven
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Moneer M Abouljoud
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alex C DiBartola
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher C Kaeding
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
18
|
Jones KJ, Sheppard WL, Arshi A, Hinckel BB, Sherman SL. Articular Cartilage Lesion Characteristic Reporting Is Highly Variable in Clinical Outcomes Studies of the Knee. Cartilage 2019; 10:299-304. [PMID: 29405742 PMCID: PMC6585291 DOI: 10.1177/1947603518756464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the degree of standardized evaluation and reporting of cartilage lesion characteristics in high-impact clinical studies for symptomatic lesions of the knee. We hypothesized that there are significant inconsistencies in reporting these metrics across orthopedic literature. DESIGN A total of 113 clinical studies on articular cartilage restoration of the knee were identified from 6 high-impact orthopedic journals between 2011 and 2016. Full-text review was used to evaluate sources for details on study methodology and reporting on the following variables: primary procedure, location, size, grade, and morphology of cartilage lesions. RESULTS All studies reported on the type of primary cartilage procedure and precise lesion location(s). Approximately 99.1% reported lesion morphology (chondral, osteochondral, mixed). For lesion size, 32.7% of articles did not report how size was measured and 11.5% did not report units. The lesion sizing method was variable, as 27.4% used preoperative magnetic resonance imaging to measure/report lesion size, 31.0% used arthroscopy, and 8.8% used both. The majority of studies (83.2%) used area to report size, and 5.3% used diameter. Formal grading was not reported in 17.7% of studies. Only 54.8% of studies reported depth when sizing osteochondral defects. CONCLUSIONS Recent literature on cartilage restoration provides adequate information on surgical technique, lesion location, and morphology. However, there is wide variation and incomplete reporting on lesion size, depth, and grading. Future clinical studies should include these important data in a consistent manner to facilitate comparison among surgical techniques.
Collapse
Affiliation(s)
- Kristofer J. Jones
- Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA,Kristofer J. Jones, Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-143 CHS Los Angeles, CA 90095-6902, USA.
| | - William L. Sheppard
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Armin Arshi
- Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
| | - Betina B. Hinckel
- Department of Orthopedic Surgery, University of Missouri Health, Columbia, MO, USA
| | - Seth L. Sherman
- Department of Orthopedic Surgery, University of Missouri Health, Columbia, MO, USA
| |
Collapse
|
19
|
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]
|
20
|
OSTEOCHONDRAL ALLOGRAFT TRANSPLANTATION for the KNEE: POST-OPERATIVE REHABILITATION. Int J Sports Phys Ther 2019; 14:487-499. [PMID: 31681506 DOI: 10.26603/ijspt20190487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Articular cartilage injuries of the knee are common among young, active patients presenting with knee pain, swelling, and/or mechanical symptoms. These injuries have limited healing potential due to the avascular nature of hyaline cartilage. While several treatment options exist, osteochondral allograft (OCA) transplantation for the knee has been used successfully in primary management of large chondral or osteochondral defects and salvage of previously failed cartilage repair. OCA transplantation potentially yields a natural, matching contour of the native recipient surface anatomy and transplants mature, viable hyaline cartilage to the affected defect. Following OCA transplantation, strict compliance with a rehabilitation protocol is essential to enable optimal recovery. The outlined rehabilitation protocol is informed by the existing literature and incorporates current rehabilitation principles, the science of osteochondral incorporation, and adaptations based on an individual's readiness to progress through subsequent phases. The purpose of this clinical commentary is to discuss the diagnosis, surgical management, and post-operative rehabilitation following OCA transplantation and to assist the physical therapist in returning athletes to full sports participation.
Collapse
|
21
|
Yasui Y, Hannon CP, Fraser EJ, Ackermann J, Boakye L, Ross KA, Duke GL, Shimozono Y, Kennedy JG. Lesion Size Measured on MRI Does Not Accurately Reflect Arthroscopic Measurement in Talar Osteochondral Lesions. Orthop J Sports Med 2019; 7:2325967118825261. [PMID: 30800691 PMCID: PMC6378450 DOI: 10.1177/2325967118825261] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Lesion size is a major determinant of treatment strategy for osteochondral lesions of the talus (OLTs). Although magnetic resonance imaging (MRI) is commonly used in the preoperative evaluation of OLTs, the reliability of the MRI measurement compared with the arthroscopic measurement is unknown. Purpose: To compare preoperative lesion size measured on MRI versus intraoperative lesion size measured during arthroscopy. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We retrospectively reviewed a consecutive series of patients treated with bone marrow stimulation for OLTs. The diameter of the lesion was measured at its widest point in 2 planes, and MRI measurements were compared with those made during arthroscopy using a custom-made graduated probe. Results: A total of 39 patients with 45 OLTs were analyzed. Mean ± SD area measurements on MRI were significantly greater than the equivalent arthroscopic measurements (42.2 ± 30.5 vs 28.6 ± 23.1 mm2, respectively; P = .03). Compared with the arthroscopic measurement, MRI overestimated OLT size in 53.3% (24/45) of ankles and underestimated OLT size in 24.4% (11/45). The mean MRI diameter measurement was significantly greater than the arthroscopic measurement in the coronal plane (MRI diameter vs arthroscopic measurement coronal plane, 6.1 ± 2.6 vs 4.9 ± 2.3 mm, P = .03; sagittal plane, 8.0 ± 3.6 vs 6.3 ± 3.6 mm, P = .05). Further, MRI overestimated coronal diameter in 48.9% (22/45) of ankles and underestimated in 26.7% (12/45) compared with the arthroscopic measurement. Similarly, sagittal plane MRI diameter measurements overestimated lesion size in 46.7% (21/45) of ankles and underestimated lesion size in 28.9% (13/45) compared with the arthroscopic findings. Conclusion: In a majority of lesions, MRI overestimated OLT area and diameter compared with arthroscopy. Surgeons should be aware of the discrepancies that can exist between MRI and arthroscopic measurements, as these data are important in making treatment decisions and educating patients.
Collapse
Affiliation(s)
- Youichi Yasui
- Hospital for Special Surgery, New York, New York, USA.,Teikyo University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan
| | - Charles P Hannon
- Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Rush University Medical Center (C.P.H.), Chicago, Illinois, USA
| | | | | | | | - Keir A Ross
- Hospital for Special Surgery, New York, New York, USA
| | - Gavin L Duke
- East River Medical Imaging, New York, New York, USA
| | | | | |
Collapse
|
22
|
Gersing AS, Feuerriegel G, Holwein C, Suchowierski J, Karampinos DC, Haller B, Baum T, Schwaiger BJ, Kirschke JS, Rummeny EJ, Imhoff AB, Woertler K, Jungmann PM. T2-relaxation time of cartilage repair tissue is associated with bone remodeling after spongiosa-augmented matrix-associated autologous chondrocyte implantation. Osteoarthritis Cartilage 2019; 27:90-98. [PMID: 30248504 DOI: 10.1016/j.joca.2018.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether T2 relaxation time measurements of cartilage repair tissue and structural changes of the knee joint are associated with subchondral bone architecture after spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI). DESIGN Both knees of 25 patients (25.5 ± 7.8y; 10 women) were examined preoperatively and 2.7 years after unilateral spongiosa-augmented MACI with 3T magnetic resonance (MR) imaging. Cartilage composition was assessed using T2 relaxation time measurements, subchondral trabecular bone microstructure was quantified using a 3D phase-cycled balanced steady state free-precision sequence. Structural knee joint changes were assessed using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used for the postoperative description of the area that underwent MACI. Correlations were assessed using Spearman's rank correlation coefficients. RESULTS Hypertrophy of the cartilage repair tissue was found in 2 of 25 patients, both after a MACI procedure at the patella, 21 patients showed congruent filling. In subchondral bone of the cartilage repair compartment, apparent trabecular thickness was significantly higher in compartments with elevated cartilage T2 (n = 17; 0.37 ± 0.05 mm) compared to those showing no difference in cartilage T2 compared to the same compartment in the contralateral knee (n = 8; 0.27 ± 0.05 mm; P = 0.042). Significant correlations were found between the overall progression of WORMS and the ipsilateral vs contralateral ratio of average trabecular thickness (r = 0.48, P = 0.031) and bone fraction (r = 0.57, P = 0.007). CONCLUSIONS After spongiosa-augmented MACI, T2 values of cartilage repair tissue and structural knee joint changes correlated with the quality of the underlying trabecular bone.
Collapse
Affiliation(s)
- A S Gersing
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - G Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - C Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau, Germany.
| | - J Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - D C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - B Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany.
| | - T Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - B J Schwaiger
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - J S Kirschke
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - E J Rummeny
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - A B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - K Woertler
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - P M Jungmann
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland.
| |
Collapse
|
23
|
Michalik R, Pauer T, Brill N, Knobe M, Tingart M, Jahr H, Truhn D, Nebelung S. Quantitative articular cartilage sub-surface defect assessment using optical coherence tomography: An in-vitro study. Ann Anat 2019; 221:125-134. [DOI: 10.1016/j.aanat.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 09/20/2018] [Accepted: 10/01/2018] [Indexed: 12/15/2022]
|
24
|
Erickson BJ, Strickland SM, Gomoll AH. Indications, Techniques, Outcomes for Matrix-Induced Autologous Chondrocyte Implantation (MACI). OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
Gill TJ, Safran M, Mandelbaum B, Huber B, Gambardella R, Xerogeanes J. A Prospective, Blinded, Multicenter Clinical Trial to Compare the Efficacy, Accuracy, and Safety of In-Office Diagnostic Arthroscopy With Magnetic Resonance Imaging and Surgical Diagnostic Arthroscopy. Arthroscopy 2018; 34:2429-2435. [PMID: 29804955 DOI: 10.1016/j.arthro.2018.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/25/2018] [Accepted: 03/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy, accuracy, and safety of in-office diagnostic arthroscopy with magnetic resonance imaging (MRI) and surgical diagnostic arthroscopy. METHODS A prospective, blinded, multicenter, clinical trial was performed on 110 patients, ages 18 to 75 years, who presented with knee pain. The study period was April 2012 to April 2013. Each patient underwent a physical examination, an MRI, in-office diagnostic imaging, and a diagnostic arthroscopic examination in the operating room. The attending physician completed clinical report forms comparing the in-office arthroscopic examination and surgical diagnostic arthroscopy findings on each patient. Two blinded experts, unaffiliated with the clinical care of the study's subjects, reviewed the in-office arthroscopic images and MRI images using the surgical diagnostic arthroscopy images as the "control" group comparison. Patients were consecutive, and no patients were excluded from the study. RESULTS In this study, the accuracy, sensitivity, and specificity of in-office arthroscopy was equivalent to surgical diagnostic arthroscopy and more accurate than MRI. When comparing in-office arthroscopy with surgical diagnostic arthroscopy, all kappa statistics were between 0.766 and 0.902. For MRI compared with surgical diagnostic arthroscopy, kappa values ranged from a low of 0.130 (considered "slight" agreement) to a high of 0.535 (considered "moderate" agreement). The comparison of MRI to in-office arthroscopy showed very similar results as the comparison of MRI with surgical diagnostic arthroscopy, ranging from a low kappa of 0.112 (slight agreement) to a high of 0.546 (moderate agreement). There were no patient-related or device-related complications related to the use of in-office arthroscopy. CONCLUSIONS Needle-based diagnostic imaging that can be used in the office setting is statistically equivalent to surgical diagnostic arthroscopy with regard to the diagnosis of intra-articular, nonligamentous knee joint pathology. In-office diagnostic imaging can provide a more detailed and accurate diagnostic assessment of intra-articular knee pathology than MRI. Based on the study results, in-office diagnostic imaging provides a safe, accurate, real-time, minimally invasive diagnostic modality to evaluate intra-articular pathology without the need for surgical diagnostic arthroscopy or high-cost imaging. LEVEL OF EVIDENCE Level II, comparative prospective trial.
Collapse
Affiliation(s)
- Thomas J Gill
- St. Elizabeth's Medical Center, Boston, Massachusetts, U.S.A..
| | - Marc Safran
- Stanford Medical Center, Stanford, California, U.S.A
| | - Bert Mandelbaum
- Santa Monica Orthopedic Group, Santa Monica, California, U.S.A
| | - Bryan Huber
- Copley Hospital, Morrisville, Vermont, U.S.A
| | | | | |
Collapse
|
26
|
Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Femoral Cartilage Defects. Arthrosc Tech 2018; 7:e791-e795. [PMID: 30167355 PMCID: PMC6111451 DOI: 10.1016/j.eats.2018.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/28/2018] [Indexed: 02/03/2023] Open
Abstract
Fresh osteochondral allograft (OCA) transplantation is a successful single-stage procedure for the treatment of symptomatic cartilage defects of the knee. Although long-term studies reveal reliable improvements in patient-reported outcome scores and graft survival, the limitations of the procedure include graft availability and timely use prior to expiration. To avoid prolonged surgical wait times and progression of lesion size, some surgeons have employed the use of nonorthotopic grafts (e.g., lateral femoral condyle graft for a medial femoral condyle lesion). Additionally, fresh precut OCA cores can be used for smaller symptomatic lesions, thereby precluding surgical delays associated with donor-recipient size matching. We describe our preferred technique for the use of fresh precut OCA cores for the treatment of small osteochondral defects of the knee. The distinct advantages of this technique include single-stage restoration of the articular surface without the donor site morbidity observed with osteochondral autograft transplantation.
Collapse
|
27
|
van Bergen CJA, Baur OL, Murawski CD, Spennacchio P, Carreira DS, Kearns SR, Mitchell AW, Pereira H, Pearce CJ, Calder JDF. Diagnosis: History, Physical Examination, Imaging, and Arthroscopy: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:3S-8S. [PMID: 30215306 DOI: 10.1177/1071100718779393] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Diagnosis: History, Physical Examination, Imaging, and Arthroscopy" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. RESULTS A total of 12 statements on the diagnosis of cartilage injuries of the ankle reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Two achieved unanimous support and 10 reached strong consensus (greater than 75% agreement). All statements reached at least 86% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians in the diagnosis of cartilage injuries of the ankle.
Collapse
Affiliation(s)
| | - Onno L Baur
- 2 Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Christopher D Murawski
- 3 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Stephen R Kearns
- 6 Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Galway, Ireland
| | | | - Helder Pereira
- 8 Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
| | - Christopher J Pearce
- 9 National University Heath System, Division of Foot and Ankle Surgery, Singapore
| | | | | |
Collapse
|
28
|
Pisanu G, Cottino U, Rosso F, Blonna D, Marmotti AG, Bertolo C, Rossi R, Bonasia DE. Large Osteochondral Allografts of the Knee: Surgical Technique and Indications. JOINTS 2018; 6:42-53. [PMID: 29675506 PMCID: PMC5906123 DOI: 10.1055/s-0038-1636925] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Large osteochondral allograft (OCA) transplant has become a valid alternative to restore articular surface in challenging articular lesions in young and active patients, either in primary or in revision procedures. Several studies support the effectiveness and safety of OCA, but costs and graft availability limit their use. The indications are the treatment of symptomatic full-thickness cartilage lesions greater than 3 cm
2
, deep lesions with subchondral damage, or revision procedures when a previous treatment has failed. The goal of the transplant is to restore the articular surface with a biological implant, allow return to daily/sports activities, relieve symptoms, and delay knee arthroplasty. Grafts can be fresh, fresh-frozen, or cryopreserved; these different storage procedures significantly affect cell viability, immunogenicity, and duration of the storage. Dowel and shell technique are the two most commonly used procedures for OCA transplantation. While most cartilage lesions can be treated with the dowel technique, large and/or geometrically irregular lesions should be treated with the shell technique. OCA transplantation for the knee has demonstrated reliable mid- to long-term results in terms of graft survival and patient satisfaction. Best results are reported: in unipolar lesions, in patients younger than 30 years, in traumatic lesions and when the treatment is performed within 12 months from the onset of symptoms.
Collapse
Affiliation(s)
- Gabriele Pisanu
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Umberto Cottino
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Davide Blonna
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | | | - Corrado Bertolo
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Davide E Bonasia
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| |
Collapse
|
29
|
Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR. Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging. Equine Vet J 2018; 50:564-579. [DOI: 10.1111/evj.12808] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins Colorado USA
| | - C. W. McIlwraith
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry and Medicine Boston University Boston Massachusetts USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| |
Collapse
|
30
|
The Benefits of an In-Office Arthroscopy in the Diagnosis of Unresolved Knee Pain. Case Rep Orthop 2018; 2018:6125676. [PMID: 29992071 PMCID: PMC5827882 DOI: 10.1155/2018/6125676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022] Open
Abstract
We report a patient who developed persistent knee pain with mechanical symptoms after an uncomplicated patellofemoral arthroplasty. The etiology of his knee pain remained inconclusive following magnetic resonance imaging due to metallic artifact image distortion. With the use of an in-office needle arthroscopy, an immediate and definitive diagnosis was obtained, preventing an unnecessary surgery for a diagnostic arthroscopy. We discovered a lateral meniscus tear, an anterior cruciate ligament tear, and a medial femoral condyle chondral defect for which the patient underwent arthroscopic partial meniscectomy, ligament reconstruction, and osteochondral allograft transplantation, with resolution of his knee pain.
Collapse
|
31
|
West JA, Amin NH. In-office arthroscopy for the evaluation of chronic knee pain: A case report. SAGE Open Med Case Rep 2017; 5:2050313X17740992. [PMID: 29163952 PMCID: PMC5692121 DOI: 10.1177/2050313x17740992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 10/11/2017] [Indexed: 11/21/2022] Open
Abstract
This is a case report detailing the use of in-office needle arthroscopy (mi-eye 2™) in a patient with chronic knee pain and inconclusive magnetic resonance imaging findings. The patient is a 40-year-old male who presented to our clinic after an extended history of right knee pain along the medial aspect with previous failed treatments. Magnetic resonance imaging without contrast had demonstrated full-thickness chondral fissuring of the lateral patellar facet, mild abnormal signals of the proximal patellar tendon and Hoffa’s fat pad, and intact anterior cruciate ligament and posterior cruciate ligament. The patient was previously treated with an ultrasound-guided injection of 2 cm3 of 1% lidocaine without epinephrine and 1 cm3 of Kenalog-40 and scheduled for follow-up. At follow-up, clinical examination showed antalgic gait, minimal tenderness along medial joint line, medial pain in deep flexion, and no pain when in varus or valgus. Due to continued discomfort with a negative magnetic resonance imaging, in-office diagnostic arthroscopy was performed using mi-eye 2 revealing a tear of the mid-body of the medial meniscus. The patient subsequently underwent arthroscopic repair and is recovering well with complete resolution of medial joint pain. This report highlights the clinical utility of in-office diagnostic arthroscopy in the management of patients with persistent knee pain and negative or equivocal findings on magnetic resonance imaging.
Collapse
|
32
|
van Eck CF, Kingston RS, Crues JV, Kharrazi FD. Magnetic Resonance Imaging for Patellofemoral Chondromalacia: Is There a Role for T2 Mapping? Orthop J Sports Med 2017; 5:2325967117740554. [PMID: 29204454 PMCID: PMC5703110 DOI: 10.1177/2325967117740554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Patellofemoral pain is common, and treatment is guided by the presence and grade of chondromalacia. Purpose: To evaluate and compare the sensitivity and specificity in detecting and grading chondral abnormalities of the patella between proton density fat suppression (PDFS) and T2 mapping magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 2. Methods: A total of 25 patients who underwent MRI of the knee with both a PDFS sequence and T2 mapping and subsequently underwent arthroscopic knee surgery were included. The cartilage surface of the patella was graded on both MRI sequences by 2 independent, blinded radiologists. Cartilage was then graded during arthroscopic surgery by a sports medicine fellowship–trained orthopaedic surgeon. Reliability, sensitivity, specificity, and accuracy were determined for both MRI methods. The findings during arthroscopic surgery were considered the gold standard. Results: Intraobserver and interobserver agreement for both PDFS (98.5% and 89.4%, respectively) and T2 mapping (99.4% and 91.3%, respectively) MRI were excellent. For T2 mapping, the sensitivity (61%) and specificity (64%) were comparable, whereas for PDFS there was a lower sensitivity (37%) but higher specificity (81%) in identifying cartilage abnormalities. This resulted in a similar accuracy for PDFS (59%) and T2 mapping (62%). Conclusion: Both PDFS and T2 mapping MRI were reliable but only moderately accurate in predicting patellar chondromalacia found during knee arthroscopic surgery.
Collapse
Affiliation(s)
| | | | - John V Crues
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California, USA
| | | |
Collapse
|
33
|
Krettek C, Clausen JD, Bruns N, Neunaber C. Partielle und komplette Gelenktransplantation mit frischen osteochondralen Allografts – das FLOCSAT-Konzept. Unfallchirurg 2017; 120:932-949. [DOI: 10.1007/s00113-017-0426-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Soellner ST, Goldmann A, Muelheims D, Welsch GH, Pachowsky ML. Intraoperative validation of quantitative T2 mapping in patients with articular cartilage lesions of the knee. Osteoarthritis Cartilage 2017; 25:1841-1849. [PMID: 28801212 DOI: 10.1016/j.joca.2017.07.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/06/2017] [Accepted: 07/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare T2 relaxation times of knee cartilage with intraoperative results for the assessment of early osteoarthritis (OA) and to define T2 values for the differentiation between healthy and degenerated cartilage. DESIGN Twenty-one patients with cartilage lesions or moderate OA were examined using 3T magnetic resonance imaging (MRI). In this prospective study, a total of 882 regions of interest (ROIs) were examined by a sagittal, multi-echo, spin-echo T2 sequence and a morphological high-resolution three-dimensional, fat-saturated proton-density space sequence. Cartilage lesions were identified arthroscopically, graded by the International Cartilage Repair Society (ICRS) score in 42 defined ROIs per patient and consecutively compared with mean T2 values using analysis of variance and Spearman's rank correlation test. Receiver operating characteristics (ROC) curves were developed to identify threshold T2 values to differentiate between the ICRS grades. RESULTS A total of 882 ROIs were examined and graduated in ICRS score 0 (67.3%), 1 (25.2%), 2 (6.2%) and the merged ICRS 3 and 4 (1.0%). T2 values increased with increasing grade of cartilage damage with a statistically significant positive correlation between T2 values and ICRS scores. A T2 value threshold of 47.6 ms was identified to differentiate between ICRS score 0 (normal) and all other grades (ROC curve analysis). CONCLUSION T2 mapping might provide a diagnostic tool for the detection of early knee-joint cartilage damage and for the non-invasive differentiation between ICRS grades by MRI in clinical practice.
Collapse
Affiliation(s)
- S T Soellner
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - A Goldmann
- OCE Orthopaedie Centrum Erlangen, Germany
| | | | - G H Welsch
- UKE Athleticum, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - M L Pachowsky
- Department of Orthopedic and Trauma Surgery, University Hospital Erlangen, Germany
| |
Collapse
|
35
|
Candela V, Longo UG, Ciuffreda M, Salvatore G, Berton A, Cimmino M, Denaro V. Talar osteochondral size influences outcome after bone marrow stimulation: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
36
|
Hinckel BB, Gomoll AH. Autologous Chondrocytes and Next-Generation Matrix-Based Autologous Chondrocyte Implantation. Clin Sports Med 2017; 36:525-548. [DOI: 10.1016/j.csm.2017.02.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
Flanigan DC, Carey JL, Brophy RH, Graham WC, DiBartola AC, Hamilton D, Nagaraja HN, Lattermann C. Interrater and Intrarater Reliability of Arthroscopic Measurements of Articular Cartilage Defects in the Knee. J Bone Joint Surg Am 2017. [PMID: 28632586 DOI: 10.2106/jbjs.16.01132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cartilage lesions of the knee are difficult to treat. Lesion size is a critical factor in treatment algorithms, and the accurate, reproducible sizing of lesions is important. In this study, we evaluated the interrater and intrarater reliability of, and correlations in relation to, various arthroscopic sizing techniques. METHODS Five lesions were created in each of 10 cadaveric knees (International Cartilage Repair Society grade 3C). Three orthopaedic surgeons used 4 techniques (visualization and use of a 3-mm probe, a simple metal ruler, and a sliding metallic ruler tool) to estimate lesion size. Repeated-measures data were analyzed using a mixed-effect linear model. The differences between observed and gold-standard (plastic mold) values were used as the response. Intraclass and interclass correlation coefficient (ICC) values for intrarater and interrater reliability were computed, as were overall correlation coefficients between measurements and gold standards. RESULTS The mean lesion size was 2.37 cm (range, 0.36 to 6.02 cm). Rater, lesion location and size, and measurement method all affected the cartilage defect measurements. Surgeons underestimated lesion size, and measurements of larger lesions had a higher percentage of error compared with those of smaller lesions. When compared with plastic molds of lesions, 60.5% of surgeon measurements underestimated lesion size. Overall, the correlation between measurements and gold standards was strongest for the simple metal ruler method and weakest for the visualization method. CONCLUSIONS Several factors may influence arthroscopic estimation of cartilage lesion size: the lesion location, measurement tool, surgeon, and defect size itself. The intrarater and interrater reliability was moderate to good using a 3-mm probe, sliding metallic ruler tool, or simple metal ruler and was fair to moderate using visualization only. CLINICAL RELEVANCE There is a need for more accurate methods of determining the size of articular cartilage lesions.
Collapse
Affiliation(s)
- David C Flanigan
- 1Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics (D.C.F., W.C.G., and A.C.D.), Division of Biostatistics, College of Public Health (H.N.N.), and Wexner Medical Center (D.C.F. and A.C.D.), The Ohio State University, Columbus, Ohio 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 3Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri 4OrthoCarolina, Pineville, North Carolina 5University of Kentucky, Lexington, Kentucky
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ, Calder JDF, Takao M, Vannini F, Choi WJ, Lee JW, Stone J, Kennedy JG. Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review. Am J Sports Med 2017; 45:1698-1705. [PMID: 27852595 DOI: 10.1177/0363546516668292] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. PURPOSE To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. STUDY DESIGN Systematic review. METHODS A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes. RESULTS Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QOE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. CONCLUSION An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.
Collapse
Affiliation(s)
| | - Youichi Yasui
- Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Christopher D Murawski
- Hospital for Special Surgery, New York, New York, USA.,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
| | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, Amsterdam, the Netherlands
| | | | - Masato Takao
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | | | - Woo Jin Choi
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - James Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | |
Collapse
|
39
|
Michalik R, Schrading S, Dirrichs T, Prescher A, Kuhl CK, Tingart M, Rath B. New approach for predictive measurement of knee cartilage defects with three-dimensional printing based on CT-arthrography: A feasibility study. J Orthop 2016; 14:95-103. [PMID: 27829733 DOI: 10.1016/j.jor.2016.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim was to prove the possibility of creating an exact module of knee cartilage defects using 3D printing. METHODS Defects were created in cadaver knees. CT-arthrography and 3-Tesla MRI were performed. Based on CTA images a model of the cartilage was created using 3D printing. Defect-sizes in the imaging modalities were compared. RESULTS Estimated lesion area in 3D model differed approximately 5% comparing to the defect sizes in knees. MRI underestimated the defect on average of 12%, whereas the CTA overestimated the defect about 3%. CONCLUSIONS We proved the feasibility of creating an accurate module of knee cartilage.
Collapse
Affiliation(s)
- R Michalik
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - T Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - A Prescher
- Institute of Molecular and Cellular Anatomy, University RWTH Aachen, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - M Tingart
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - B Rath
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
40
|
te Moller NCR, Pitkänen M, Sarin JK, Väänänen S, Liukkonen J, Afara IO, Puhakka PH, Brommer H, Niemelä T, Tulamo RM, Argüelles Capilla D, Töyräs J. Semi-automated International Cartilage Repair Society scoring of equine articular cartilage lesions in optical coherence tomography images. Equine Vet J 2016; 49:552-555. [DOI: 10.1111/evj.12637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/25/2016] [Indexed: 11/27/2022]
Affiliation(s)
- N. C. R. te Moller
- Department of Equine Sciences; Utrecht University; Utrecht the Netherlands
| | - M. Pitkänen
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
| | - J. K. Sarin
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
- Diagnostic Imaging Centre; Kuopio University Hospital; Kuopio Finland
| | - S. Väänänen
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
- Diagnostic Imaging Centre; Kuopio University Hospital; Kuopio Finland
| | - J. Liukkonen
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
| | - I. O. Afara
- Department of Electrical and Computer Engineering; Elizade University; Ondo Nigeria
| | - P. H. Puhakka
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
- Diagnostic Imaging Centre; Kuopio University Hospital; Kuopio Finland
| | - H. Brommer
- Department of Equine Sciences; Utrecht University; Utrecht the Netherlands
| | - T. Niemelä
- Department of Equine and Small Animal Medicine; University of Helsinki; Helsinki Finland
| | - R.-M. Tulamo
- Department of Equine and Small Animal Medicine; University of Helsinki; Helsinki Finland
| | - D. Argüelles Capilla
- Department of Equine and Small Animal Medicine; University of Helsinki; Helsinki Finland
| | - J. Töyräs
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
- Diagnostic Imaging Centre; Kuopio University Hospital; Kuopio Finland
| |
Collapse
|
41
|
Yasui Y, Ross AW, Murawski CD, Kennedy JG. Authors' Reply. Arthroscopy 2016; 32:1491-3. [PMID: 27495854 DOI: 10.1016/j.arthro.2016.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 02/02/2023]
|
42
|
|
43
|
Nicolini AP, Carvalho RT, Dragone B, Lenza M, Cohen M, Ferretti M. Updates in biological therapies for knee injuries: full thickness cartilage defect. Curr Rev Musculoskelet Med 2014; 7:256-62. [PMID: 25012907 PMCID: PMC4596164 DOI: 10.1007/s12178-014-9226-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Full thickness cartilage defect might occur at different ages, but a focal defect is a major concern in the knee of young athletes. It causes impairment and does not heal by itself. Several techniques were described to treat symptomatic full thickness cartilage defect. Recently, several advances were described on the known techniques of microfracture, osteochondral allograft, cell therapy, and others. This article brings an update of current literature on these well-described techniques for full thickness cartilage defect.
Collapse
Affiliation(s)
- Alexandre Pedro Nicolini
- />Division of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - 3 Andar/Bloco A1, Morumbi, 05651-901 São Paulo, SP Brazil
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Rogerio Teixeira Carvalho
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Bruno Dragone
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Mario Lenza
- />Division of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - 3 Andar/Bloco A1, Morumbi, 05651-901 São Paulo, SP Brazil
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Moises Cohen
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Mario Ferretti
- />Division of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - 3 Andar/Bloco A1, Morumbi, 05651-901 São Paulo, SP Brazil
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| |
Collapse
|
44
|
Abstract
OBJECTIVE Patellofemoral instability is common and affects a predominantly young age group. Chondral injury occurs in up to 95%, and includes osteochondral fractures and loose bodies acutely and secondary degenerative changes in recurrent cases. Biomechanical abnormalities, such as trochlear dysplasia, patella alta, and increased tibial tuberosity-trochlear groove distance, predispose to both recurrent dislocations and patellofemoral arthrosis. DESIGN In this article, we review the mechanisms of chondral injury in patellofemoral instability, diagnostic modalities, the distribution of lesions seen in acute and episodic dislocation, and treatments for articular cartilage lesions of the patellofemoral joint. RESULTS Little specific evidence exists for cartilage treatments in patellofemoral instability. In general, the results of reparative and restorative procedures in the patellofemoral joint are inferior to those observed in other compartments of the knee. CONCLUSION Given the increased severity of chondral lesions and progression to osteoarthritis seen with recurrent dislocations, careful consideration should be given to early stabilisation in patients with predisposing factors.
Collapse
Affiliation(s)
- Timothy Lording
- Frankston Hospital, Frankston, Victoria, Australia
- Groupement Hospitalier Nord, Université Lyon 1, Lyon, France
| | | | - Elvire Servien
- Groupement Hospitalier Nord, Université Lyon 1, Lyon, France
| | - Philippe Neyret
- Groupement Hospitalier Nord, Université Lyon 1, Lyon, France
| |
Collapse
|
45
|
|
46
|
Campbell AB, Knopp MV, Kolovich GP, Wei W, Jia G, Siston RA, Flanigan DC. Preoperative MRI underestimates articular cartilage defect size compared with findings at arthroscopic knee surgery. Am J Sports Med 2013; 41:590-5. [PMID: 23324431 DOI: 10.1177/0363546512472044] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is widely used as a preoperative tool to estimate the size of articular cartilage defects to optimize treatment selection. However, the reliability of MRI sizing of cartilage defects is not well understood. Hypothesis/ PURPOSE The purpose of this investigation was to compare the size of knee articular cartilage defects on MRI to arthroscopic visualization after debridement. It was hypothesized that MRI sizing would produce measurements that were no different than those made during arthroscopic knee surgery. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Seventy-seven patients (age [mean ± SD], 38 ± 10.7 years) who met inclusion criteria underwent preoperative knee MRI of at least 1.5 T within 1 year of arthroscopic knee surgery for a high-grade cartilage defect. Postdebridement defect sizes were obtained from intraoperative surgery notes and compared with retrospective MRI estimates. RESULTS Ninety-two total cartilage defects were analyzed with an average of 1.2 high-grade defects per knee and average postdebridement defect area of 2.99 cm(2) per lesion (95% CI, 1.63-2.26 cm(2)). Preoperative MRI analysis estimated a lesion area that was an average of 1.04 cm(2) smaller (95% CI, 0.70-1.39 cm(2); P < .0001). In 74% of the lesions analyzed, defect size was larger on arthroscopic visualization than was estimated by MRI sizing. On average, MRI underestimated the defect area by 70% compared with arthroscopic visualization. CONCLUSION Magnetic resonance imaging underestimates the size of articular cartilage defects compared with final postdebridement size as measured during arthroscopic knee surgery. Thus, before arthroscopic surgery, orthopaedic surgeons should consider treatment strategies that are appropriate for a larger defect than predicted by preoperative MRI.
Collapse
Affiliation(s)
- Andrew B Campbell
- Sports Health & Performance Institute, The Ohio State University Medical Center, Columbus, OH 43221, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.
Collapse
Affiliation(s)
- Marco Demange
- Cartilage Repair Center Department of Orthopaedic Surgery, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Andreas H. Gomoll
- Cartilage Repair Center Department of Orthopaedic Surgery, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| |
Collapse
|