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Soubih HO, Al-Saed AM, Ghazaly SAE, Sobhy MH, Kamel ME, Ebied WF, Haroun HK. Fresh osteochondral allograft transplantation for knee full-thickness articular cartilage lesions using femoral head of living donors: short-term results. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05413-3. [PMID: 39008075 DOI: 10.1007/s00402-024-05413-3] [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: 01/22/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Fresh osteochondral allograft transplantation is a good treatment option of cartilage defects. However, this treatment option is not available in all countries due to limited graft availability and tissue banks limitations. The purpose of this study is to assess the short term functional and imaging outcomes of fresh osteochondral allograft transplantation in the knee using the femoral head of living donors. HYPOTHESIS Fresh osteochondral allografts from the femoral heads of living donors is a valid graft source for management of distal Femur cartilage defects. This technique can improve functional knee scores with good radiological outcomes. STUDY DESIGN Prospective case series. METHODS Fifteen patients with full thickness cartilage defects of the distal femur underwent osteochondral allograft transplantation from the femoral heads of living donors. Grafts were transplanted by both shell and multiple dowels techniques. The average follow up duration was 18.3 months (range, 12-25 months). Patients were evaluated by Lysholm and International Knee Documentation Committee (IKDC) scores, radiography and MR imaging using Osteochondral Allograft MRI Scoring System (OCAMRISS). RESULTS There was a statistically significant improvement (P < 0.001) in both Lysholm and IKDC average scores at 6 months and 12 months postoperative. Postoperative MRI was done at an average 6.8 months (range, 5-11 months) postoperative. The mean total OCAMRISS score was 3.4 (range, 1-7). A second look arthroscopy was done in four patients and showed intact articular cartilage in all three patients. CONCLUSION Femoral head of living donors is a valid new source for fresh osteochondral allograft transplantation of knee osteochondral lesions. Short term results showed improvement in clinical assessment scores. Follow up imaging showed graft incorporation and good MRI scores.
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Affiliation(s)
- Hesham Ossama Soubih
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo Governorate, Egypt.
| | - Ahmed M Al-Saed
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo Governorate, Egypt
| | - Sherif A El Ghazaly
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo Governorate, Egypt
| | - Mohamed H Sobhy
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo Governorate, Egypt
| | - Muhammad Elsayed Kamel
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo Governorate, Egypt
| | - Wessam Fakhry Ebied
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo Governorate, Egypt
| | - Haitham K Haroun
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo Governorate, Egypt
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2
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Chen CP, Weng PW, Lee KT, Chiang LY, Liao WJ, Shaw L. Biphasic Scaffold Loaded With Autologous Cartilage Yields Better Clinical Outcome and Magnetic Resonance Imaging Filling Compared With Marrow Stimulation for Focal Osteochondral Lesions in the Knee. Arthroscopy 2024:S0749-8063(24)00302-5. [PMID: 38719177 DOI: 10.1016/j.arthro.2024.04.016] [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: 11/10/2023] [Revised: 03/31/2024] [Accepted: 04/09/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE To evaluate the effectiveness of marrow stimulation (MS) versus biphasic scaffold loaded with autologous cartilage (scaffold) in treating focal osteochondral lesions of the knee. METHODS In total, 54 patients with symptomatic focal chondral or osteochondral lesion in the knee were randomized to either the scaffold group or the MS group. International Knee Documentation Committee subjective score, the Knee Injury Osteoarthritis Outcome Score, and magnetic resonance imaging (MRI) were assessed preoperatively and at 1 and 2 years after operation to compare treatment outcomes. Biopsy and second-look arthroscopy were performed at 1 year postoperatively for consenting patients. RESULTS There were 27 patients (mean age 31.33 ± 10.95 years) in the scaffold group, and 27 patients (31.74 ± 11.44) in the MS group. The scaffold group and the MS group both included 23 patients with lesions ≤12.5 × 12.5 mm2 mm in size. In addition, each group had 4 patients with lesions between than 12.5 × 12.5 mm2 and ≤12.5 × 25 mm2. Both interventions achieved significant improvement in clinical outcome scores at 2 years. The scaffold group had greater International Knee Documentation Committee score than the MS group at 2 years (93.85 ± 9.55 vs 92.11 ± 9.84) and in the Symptoms/Stiffness and Sport/Recreation subscales of Knee Injury Osteoarthritis Outcome Score at 2 years (96.57 ± 5.97 vs 93.57 ± 6.52, P < .05) and (90.2 ± 17.76 vs 82.8 ± 16.08, P < .05). CONCLUSIONS The use of biphasic scaffold loaded with autologous cartilage in treating focal osteochondral lesions demonstrates superior clinical outcomes and better cartilage refill on magnetic resonance imaging at the 2-year follow-up compared to marrow stimulation. LEVEL OF EVIDENCE Level I, Randomized controlled trial.
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Affiliation(s)
- Chao-Ping Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Pei-Wei Weng
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kun-Tsan Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Liang-Yu Chiang
- Department of Orthopedic Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Jen Liao
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Leo Shaw
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.
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3
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Palhares GM, Vaswani R, Fletcher C, Hinkley P, Rizy M, Strickland SM, Gomoll A. Increased Host Bone Marrow Edema on 6-Month MRI Is a Risk Factor for Osteochondral Allograft Failure. Arthroscopy 2024:S0749-8063(24)00013-6. [PMID: 38242253 DOI: 10.1016/j.arthro.2024.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
PURPOSE To evaluate the presence of host bone marrow edema (BME) surrounding osteochondral allograft (OCA) plugs on routine 6-month postoperative magnetic resonance imaging (MRI) and to determine whether such BME is correlated with subsequent failure. METHODS The present study was approved under our institutional review board-approved database (#2020-2123). We included patients who underwent cartilage repair with OCA for focal chondral and osteochondral defects of the distal femur by 2 senior surgeons between January 2016 and May 2021 with minimum 2-year follow-up. OCA is frequently performed with concomitant procedures, and therefore ligament reconstruction, meniscal surgery, and osteotomy were not exclusion criteria. Failure was defined as (1) poor clinical outcome with graft collapse on follow-up MRI or second-look arthroscopy, (2) primary OCA removal or revision, or (3) conversion to unicompartmental or total knee arthroplasty. Routine MRI scans were performed at 6 ± 2 months postoperatively. All postoperative MRI scans were reviewed from our imaging record by 2 blinded fellowship-trained orthopaedic surgeons. Patients were divided for analyses into 2 groups: BME ≥10 cm3 versus BME <10 cm3. RESULTS Of the 85 patients eligible for the study, 56 patients (30 female, mean age 31.69 ± 11.34 years) had a minimum 2-year follow-up. Nonfailure cases had a mean clinical follow-up of 3.13 ± 0.93 years. The mean time from surgery to failure in our cohort was 1.67 ± 0.91 years. There were 12 (21.4%) patients with BME ≥10 cm³ and 44 (78.6%) patients with BME <10 cm³. No statistically significant differences were found between groups when compared for sex, age, body mass index, OCA size, time to MRI, mean follow-up, number of plugs, graft location, diagnosis, previous surgeries, or concomitant procedures. All OCA failures of the study cohort were in the BME ≥10 cm³ group, representing 50% of this group (P < .001). Kaplan-Meier survival analysis with the log-rank test demonstrated significant difference in survival distributions between groups (P < .001). Patients who ultimately failed had a mean BME volume of 18.49 ± 5.82 cm3, while the nonfailure group had a mean volume of 4.66 ± 4.97 cm3 (P < .001). Cutoff values around 10 cm³ in receiver operating characteristic curve analysis demonstrated 100% sensitivity and close to 90% specificity for OCA failure diagnosis. CONCLUSION Host BME with a volume greater than 10 cm³ on 6-month postoperative MRI is predictive of an increased subsequent failure rate after OCA transplantation with a failure rate of 50%. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
| | - Ravi Vaswani
- Hospital for Special Surgery, New York, New York, U.S.A
| | | | - Paige Hinkley
- Hospital for Special Surgery, New York, New York, U.S.A
| | - Morgan Rizy
- Hospital for Special Surgery, New York, New York, U.S.A
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4
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Ackermann J, Waltenspül M, Merkely G, Germann C, Villefort C, Aufdenblatten C, Fucentese SF. Association of Subchondral Changes With Age and Clinical Outcome in Patients With Osteochondral Fractures in the Knee: MRI Analysis at 1 to 10 Years Postoperatively. Orthop J Sports Med 2022; 10:23259671221113234. [PMID: 35912386 PMCID: PMC9326836 DOI: 10.1177/23259671221113234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Predictive factors influencing outcomes after surgical fixation of osteochondral fractures (OCFs) in the knee, particularly time between injury and surgery, have not been determined. Purpose: To report imaging and clinical outcomes after OCF fixation and to assess the association between clinical scores and patient characteristics, lesion morphology, and appearance on magnetic resonance imaging (MRI) scans. Study Design: Case series; Level of evidence, 4. Methods: We assessed the clinical and imaging outcomes of 19 patients after screw fixation for OCFs in the knee at a minimum follow-up of 1 year. Patient characteristics, lesion morphology, and time from trauma to surgery were reviewed for each patient. At final follow-up, patients completed a 100-point visual analog scale (VAS) for pain, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score (KOOS), and patient satisfaction survey. Postoperative MRI scans were assessed using the MOCART (magnetic resonance observation of cartilage repair tissue), Osteochondral Allograft MRI Scoring System, and bone marrow edema (BME) size. Results: The mean patient age at surgery was 21.3 ± 11.4 years, and the median time from trauma to surgery was 10 days (range, 0-143 days). The refixed OCF fragment failed in 1 (5.3%) patient on the lateral condyle at 15 months postoperatively. The mean follow-up for the remaining 18 patients was 4.7 ± 3.2 years, and postoperative outcomes were as follows: VAS pain score, 9.5 ± 17.9; Tegner score, 4.8 ± 2.3; KOOS–Pain, 85.9 ± 17.6, KOOS-Symptoms, 76.4 ± 16.1; KOOS–Activities of Daily Living, 90.3 ± 19.0; KOOS–Sport, 74.4 ± 25.4; and KOOS–Quality of Life, 55.9 ± 24.7. Overall, 84.2% were satisfied or very satisfied with outcomes. Patient age was significantly associated with KOOS subscale scores and subchondral imaging parameters including BME and presence of subchondral cysts, which in turn were the only imaging variables linked to clinical outcomes (P < .05). Time from injury to surgery was not correlated with clinical or imaging outcomes. Conclusion: Fixation of OCFs yielded acceptable clinical and imaging outcomes at a mean 5-year follow-up with seemingly little influence of delayed surgical treatment. Postoperative subchondral changes were significantly associated with clinical outcomes and were linked to patient age at surgery.
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Affiliation(s)
- Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Clinic for Orthopaedics and Traumatology, Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Germann
- Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Christina Villefort
- Department of Pediatric Surgery, Division of Trauma and Orthopedic Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christoph Aufdenblatten
- Department of Pediatric Surgery, Division of Trauma and Orthopedic Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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5
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Tisano B, Ellis HB, Wyatt C, Wilson PL. Osteochondral Allograft for Unsalvageable Osteochondritis Dissecans in the Skeletally Immature Knee. Orthop J Sports Med 2022; 10:23259671211072515. [PMID: 35178463 PMCID: PMC8844736 DOI: 10.1177/23259671211072515] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background: While an excellent option for osteochondral defects in the adult knee, fresh osteochondral allograft (FOCA) in the skeletally immature adolescent knee has been infrequently studied. Purpose: To compare radiographic and patient-reported outcomes (PROs) in skeletally mature and immature adolescents after FOCA in the knee for treatment of unsalvageable osteochondritis dissecans (OCD). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 34 patients (37 knees) who underwent size-matched FOCA of the knee for unsalvageable OCD lesions. All patients were aged ≤19 years and had a minimum of 12 months of follow-up. Patient characteristics, lesion characteristics, reoperations, and PROs were evaluated and compared between patients with open physes (skeletally immature; n = 20) and those with closed physes (skeletally mature; n = 17). Graft failure was defined as the need for revision osteochondral grafting. Postoperative radiographs were analyzed at 1 year and the final follow-up for graft incorporation and classified as A (complete), B (≥50% healed), or C (<50% healed). Results: The mean patient age was 15.4 years (range, 9.6-17.6 years), and the mean follow-up was 2.1 years (range, 1-5.3 years). The mean graft size was 5.0 cm2 and did not differ significantly between the study groups. Patients with open physes were younger (14.7 vs 16.2 years; P = .002) and more commonly male (80% vs 35%; P = .008). At the 1-year follow-up, 85% of immature patients and 82% of mature patients had radiographic healing grades of A or B. Patients with open physes were more likely to achieve complete radiographic union at 1 year (65% vs 15%; P = .007) and demonstrated better Knee injury and Osteoarthritis Outcome Score (KOOS) Daily Living (96.8 vs 88.5; P = .04) and KOOS Quality of Life (87.0 vs 56.8; P = .01) at the final follow-up. Complications were no different in either group, and graft failure occurred in only 1 skeletally mature patient with a trochlear lesion. Conclusion: FOCA treatment for unsalvageable OCD in the young knee may be expected to yield excellent early results. Despite the presence of open physes and immature epiphyseal osteochondral anatomy, equivalent or improved healing and PRO scores compared with those of skeletally mature patients may be expected.
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Affiliation(s)
- Breann Tisano
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Henry B. Ellis
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Scottish Rite for Children Sports Medicine Campus, Frisco, Texas, USA
| | - Chuck Wyatt
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Philip L. Wilson
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Scottish Rite for Children Sports Medicine Campus, Frisco, Texas, USA
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6
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Ackermann J, Duerr RA, Barbieri Mestriner A, Shah N, Gomoll AH. Effect of Graft-Host Interference Fit on Graft Integration after Osteochondral Allograft Transplantation: A Comparative MRI Analysis of Two Instrumentation Sets. Cartilage 2021; 13:920S-927S. [PMID: 31375032 PMCID: PMC8808806 DOI: 10.1177/1947603519865314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Precise graft-host interference fit is a potentially import factor for the successful incorporation of osteochondral allograft (OCA) transplants for the treatment of symptomatic focal cartilage defects. It was hypothesized that selection of OCA plug instrumentation set has a significant effect on graft integration and morphology after OCA transplantation. METHODS Thirty-one patients who underwent OCA transplantation between July 2013 and July 2016 were identified for this comparative magnetic resonance imaging (MRI) analysis. Patients were stratified into two groups based on the treatment with the Arthrex Allograft OATS Instrument Set or the JRF Ortho Osteochondral Allograft Plug Instrumentation. MRI was obtained at 12 months postoperatively. All grafts were assessed for integration using the Osteochondral Allograft MRI Scoring System (OCAMRISS), host marrow edema size, graft-host interface distance, graft cartilage integrity, cyst size, graft contour and presence of effusion. RESULTS At a mean follow-up of 11.39 ± 1.98 months, 95.5% of all grafts showed osseous integration into the recipient bone with 68.2% presenting without cystic changes of the graft or host-graft junction. No differences were seen in any OCAMRISS subscale besides cartilage signal, which demonstrated minimal differences (P = 0.046). CONCLUSION OCAs show excellent osseous integration at the graft-host junction at 12 months postoperatively. The comparative MRI analysis of two instrumentation sets yielded no significant differences in terms of graft integration, bone marrow edema, or cystic formation. Hence, this study cannot recommend one instrumentation set over the other. Consequently, the individual preference should guide the surgeon's selection of instrumentation for OCA transplantation.
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Affiliation(s)
- Jakob Ackermann
- Sports Medicine Center, Massachusetts
General Hospital, Boston, MA, USA,Jakob Ackermann, Sports Medicine Center,
Department of Orthopaedic Surgery, Massachusetts General Hospital, 175 Cambridge
Street, Sports Medicine Center, Floor 4, Boston, MA 02114, USA.
| | - Robert A. Duerr
- Jameson Crane Sports Medicine Institute,
Ohio State University, Columbus, OH, USA
| | - Alexandre Barbieri Mestriner
- Cartilage Repair Center and Center for
Regenerative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard
University, Boston, MA, USA,Universidade Federal de São Paulo, São
Paulo, Brazil
| | - Nehal Shah
- Brigham and Women’s Hospital, Boston,
MA, USA
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7
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Wang D, Nawabi DH, Krych AJ, Jones KJ, Nguyen J, Elbuluk AM, Farshad-Amacker NA, Potter HG, Williams RJ. Synthetic Biphasic Scaffolds versus Microfracture for Articular Cartilage Defects of the Knee: A Retrospective Comparative Study. Cartilage 2021; 13:1002S-1013S. [PMID: 32046514 PMCID: PMC8808844 DOI: 10.1177/1947603520903418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the results of a biphasic synthetic scaffold (TruFit, Smith & Nephew) to microfracture for the treatment of knee cartilage defects and identify patient- and lesion-specific factors that influence outcomes. DESIGN Prospectively collected data from 132 patients (mean age, 41.8 years; 69% male) with isolated chondral or osteochondral femoral defects treated with biphasic synthetic scaffolds (n = 66) or microfracture (n = 66) were reviewed. Clinical outcomes were evaluated longitudinally over 5 years with the Short Form-36 (SF-36), Activities of Daily Living of the Knee Outcome Survey (KOS-ADL), International Knee Documentation Committee (IKDC), and Marx Activity Scale. Cartilage-sensitive magnetic resonance imaging (MRI) was performed to evaluate osseous integration and cartilage fill in a subgroup of patients. Multivariate regression analysis was used to identify predictors of clinical outcomes within the scaffold group. RESULTS Both groups demonstrated clinically significant improvements in knee clinical scores over 5 years (P < 0.01). There were no significant differences in KOS-ADL and IKDC scores between groups up to 5 years postoperatively. Marx activity level scores in the microfracture group declined over time, while significant improvements in activity level scores were observed in the scaffold group over 5 years (P < 0.01). Good-quality tissue fill and cartilage isointensity were more often observed in the scaffold group compared with the microfracture group, particularly with longer time intervals. Increasing age, high body mass index, prior microfracture, and traumatic etiology were predictors for inferior outcomes in the scaffold group. CONCLUSIONS Activity level and MRI appearance following treatment of cartilage lesions with the biphasic synthetic scaffold were superior to microfracture over time in this nonrandomized, retrospective comparison.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery,
University of California Irvine, Orange, CA, USA,Dean Wang, UC Irvine Health, 101 The City
Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA.
| | - Danyal H. Nawabi
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Aaron J. Krych
- Department of Orthopaedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David
Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Nguyen
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Ameer M. Elbuluk
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | - Riley J. Williams
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
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8
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Markus DH, Blaeser AM, Hurley ET, Mannino BJ, Campbell KA, Jazrawi LM, Alaia MJ, Strauss EJ, Alaia EF. No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts. Cartilage 2021; 13:886S-893S. [PMID: 34078119 PMCID: PMC8808877 DOI: 10.1177/19476035211021911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. DESIGN A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. RESULTS Overall, 52 total patients who underwent OCA with either fresh precut OCA cores (n = 26) and hemi-condylar OCA (n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar (P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle (P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner (P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). CONCLUSIONS This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.
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Affiliation(s)
- Danielle H. Markus
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA,Danielle H. Markus, Department of
Orthopedic Surgery, NYU Langone Health, 333 E 38th Street, New York, NY
10012-1126, USA.
| | - Anna M. Blaeser
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Eoghan T. Hurley
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Brian J. Mannino
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Kirk A. Campbell
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Laith M. Jazrawi
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Michael J. Alaia
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Eric J. Strauss
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Erin F. Alaia
- Department of Radiology, New York
University Langone Health, New York, NY, USA
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9
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Wissman R, Cook C, Cook JL, Okoye M, Rucisnki K, Stannard JP. Initial Validation of a Modified MRI Scoring System for Assessing Outcomes after Single-Surface Osteochondral Shell Allograft Transplantation in the Knee. J Knee Surg 2021; 36:548-554. [PMID: 34781396 DOI: 10.1055/s-0041-1739202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Osteochondral Allograft Magnetic Resonance Imaging Scoring System (OCAMRISS) provides a reproducible method for imaging-based grading for osteochondral allograft (OCA) transplants. However, the OCAMRISS does not account for larger whole-surface OCA shell grafts, and has not been validated for assessing outcomes after shell OCA transplantation. Therefore, the objective of this study was to evaluate a modified OCAMRISS for assessing single-surface shell OCAs in the knee based on strength of correlations for a modified OCAMRISS score with graft success and patient-reported outcomes for pain and function. With institutional review board approval and informed patient consent, patients who underwent large single-surface shell OCA transplantation and magnetic resonance imaging (MRI) exams at 1-year postsurgery were identified from a prospectively enrolled registry. All patients with a minimum of 2 years of clinical follow-up were included in the present study. A modified OCAMRISS, as well as assessment of the percentage of OCA bone incorporation, was used to score each knee. Two radiologists, blinded to patient demographics and outcomes, reviewed all MRIs together to determine a consensus score for each category and %-incorporation for each OCA. Thirteen patients (7 F, 6 M; mean age = 29.8 ± 9.4; mean body mass index = 27.1 ± 5.8); 8 medial femoral condyle, 4 patella, and 1 medial tibial plateau shell OCAs were evaluated. Mean modified OCAMRISS score was 5.2 ± 2.8, range (2-12) and %-integration was 72.7 ± 33.8, range (0-100). Moderate to strong correlations were noted for 1-year modified OCAMRISS total score with final follow-up (FFU) visual analog scale (VAS) pain (r = +0.58) and Single Assessment Numeric Evaluation (SANE) function (r = -0.7) scores, and for 1-year %-incorporation with FFU VAS pain (r = -0.76) and SANE function (r = +0.83) scores. The modified OCAMRISS total score and %-incorporation assessments determined at 1 year following single-surface shell OCA transplantation correlate well with initial patient outcomes and have clinical applicability for monitoring patients after large-shell OCA transplants in the knee.
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Affiliation(s)
- Robert Wissman
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Cristi Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Munachukwudi Okoye
- Department of Graduate Medical Education, School of Medicine, University of Missouri, Columbia, Missouri
| | - Kylee Rucisnki
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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10
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Anderson DE, Bogner EA, Schiffman SR, Rodeo SA, Wiedrick J, Crawford DC. Evaluation of Osseous Incorporation After Osteochondral Allograft Transplantation: Correlation of Computed Tomography Parameters With Patient-Reported Outcomes. Orthop J Sports Med 2021; 9:23259671211022682. [PMID: 34485580 PMCID: PMC8414629 DOI: 10.1177/23259671211022682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Studies have reported favorable clinical outcomes after osteochondral allograft (OCA) transplantation to treat osteochondral defects and have demonstrated that healing of the osseous component may be critical to outcomes. However, there is currently no consensus on the optimal modality to evaluate osseous healing. PURPOSE To define parameters for OCA healing using computed tomography (CT) and to investigate whether osseous healing identified using CT is correlated with improved pain and function on patient-reported outcomes (PROs) collected closest in time to the postoperative CT scan and at final follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS Of 118 patients who underwent OCA transplantation for articular cartilage defects of the knee over the 10-year study period, 60 were included in final analysis based on completion of CT scans at 5.8 ± 1.9 months postoperatively and PROs collected preoperatively and postoperatively. CT parameters, including osseous incorporation, bone density, subchondral bone congruency, and cystic changes, were summarized for each patient relative to the cohort. Parameters were assessed for inter- and intrarater reliability as well as for covariation with patient characteristics and surgical variables. Structural equation modeling was used to assess correlation of CT parameters with change in PROs from preoperatively to those collected closest in time to CT acquisition and at the final follow-up. RESULTS Bone incorporation was the most reliable CT parameter. The summarized scores for CT scans were normally distributed across the study population. Variance in CT parameters was independent of age, sex, body mass index, prior surgery, number of grafts, lesion size, and location. No significant correlation (P > .12 across all comparisons) was identified for any combination of CT parameter and change in PROs from baseline for outcomes collected either closest to CT acquisition or at the final follow-up (mean, 38.2 ± 19.9 months; range, 11.6-84.9 months). There was a uniformly positive association between change in PROs and host bone density but not graft bone density, independent of patient characteristics and surgical factors. CONCLUSION CT parameters were independent of clinical or patient variables within the study population, and osseous incorporation was the most reliable CT parameter. Metrics collected from a single postoperative CT scan was not correlated with clinical outcomes at ≥6-month longitudinal follow-up.
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Affiliation(s)
- Devon E. Anderson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science
University, Portland, Oregon, USA
- Department of Orthopaedics and Rehabilitation, University of
Rochester, Rochester, New York, USA
| | - Eric A. Bogner
- Department of Radiology and Imaging, Hospital for Special
Surgery, New York, New York, USA
| | - Scott R. Schiffman
- Department of Imaging Sciences, University of Rochester, Rochester,
New York, USA
| | - Scott A. Rodeo
- Department of Orthopaedics, Hospital for Special
Surgery, New York, New York, USA
| | - Jack Wiedrick
- Biostatistics Design Program, Oregon Health & Science
University, Portland, Oregon, USA
| | - Dennis C. Crawford
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science
University, Portland, Oregon, USA
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11
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Stark M, Rao S, Gleason B, Jack RA, Tucker B, Hammoud S, Freedman KB. Rehabilitation and Return-to-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211017135. [PMID: 34377714 PMCID: PMC8320585 DOI: 10.1177/23259671211017135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport. Purpose: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature, SPORTDiscus, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies on knee OCA. Studies were included if they reported return-to-play data or postsurgical rehabilitation protocols. Results: A total of 62 studies met the inclusion criteria, with a total of 3451 knees in 3355 patients. Concomitant procedures were included in 30 of these studies (48.4%). The most commonly cited rehabilitation protocols included weightbearing restrictions and ROM guidelines in 100% and 90% of studies, respectively. ROM was most commonly initiated within the first postoperative week, with approximately half of studies utilizing continuous passive motion. Progression to weightbearing as tolerated was reported in 60 studies, most commonly at 6 weeks (range, immediately postoperatively to up to 1 year). Of the 62 studies, 37 (59.7%) included an expected timeline for either return to play or return to full activity, most commonly at 6 months (range, 4 months to 1 year). Overall, 13 studies (21.0%) included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. Conclusion: There is significant heterogeneity for postoperative rehabilitation guidelines and the return-to-play protocol after OCA of the knee in the literature, as nearly half of the included studies reported use of concomitant procedures. However, current protocols appear to be predominantly time-based without objective criteria or functional assessment. Therefore, the authors recommend the development of objective criteria for patient rehabilitation and return-to-play protocols after OCA of the knee.
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Affiliation(s)
- Michael Stark
- Division of Orthopaedic Surgery, Rowan University, Stratford, New Jersey, USA
| | - Somnath Rao
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brendan Gleason
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Bradford Tucker
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sommer Hammoud
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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12
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Gelber PE, Ramírez-Bermejo E, Grau-Blanes A, Gonzalez-Osuna A, Llauger J, Fariñas O. A new computed tomography scoring system to assess osteochondral allograft transplantation for the knee: inter-observer and intra-observer agreement. INTERNATIONAL ORTHOPAEDICS 2021; 45:1191-1197. [PMID: 33416905 DOI: 10.1007/s00264-020-04927-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
AIM OF THE STUDY To describe a new semiquantitative computed tomography (CT) scoring system for multi-feature analysis of cartilage defect repair by osteochondral allografts for the knee and to assess its intra-observer and inter-observer variability. METHOD A semiquantitative assessment CT osteochondral allograft (ACTOCA) scoring system was designed based on fresh osteochondral allograft transplantations for the knee. The system includes five CT features: density relative to host bone, integration at the host-graft junction, surface percentage with a discernible cleft at the host-graft junction, cystic changes, and intra-articular fragments. Inter-observer variability was calculated by three observers blinded to the patient's medical history and treatment. Intra-observer variability was also determined. RESULTS Inter-observer agreement was moderate to substantial for all CT score components and intra-observer agreement was moderate to almost perfect for all CT score components (κ > 0.5, p < 0.05). CONCLUSION The ACTOCA score is a reliable tool to evaluate integration of osteochondral allograft transplantations. It provides an accurate evaluation of bone changes and may help to standardize CT scan reports following osteochondral allograft transplantation for the knee.
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Affiliation(s)
- Pablo Eduardo Gelber
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí, 89 08041, Barcelona, Catalunya, Spain. .,ICATME-Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Eduard Ramírez-Bermejo
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí, 89 08041, Barcelona, Catalunya, Spain
| | - Alex Grau-Blanes
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí, 89 08041, Barcelona, Catalunya, Spain
| | - Aránzazu Gonzalez-Osuna
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí, 89 08041, Barcelona, Catalunya, Spain
| | - Jaume Llauger
- Radiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank, Banc de Sang i Teixits, Barcelona, Spain
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13
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Yang BW, Brusalis CM, Fabricant PD, Greditzer HG. Articular Cartilage Repair in the Knee: Postoperative Imaging. J Knee Surg 2021; 34:2-10. [PMID: 32898909 DOI: 10.1055/s-0040-1716357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diagnostic and therapeutic advancements have improved clinical outcomes for patients with focal chondral injuries of the knee. An increased number and complexity of surgical treatment options have, in turn, resulted in a commensurate proliferation of patients requiring postoperative evaluation and management. In addition to patient-reported clinical outcomes, magnetic resonance imaging (MRI) offers clinicians with noninvasive, objective data to assist with postoperative clinical decision making. However, successful MRI interpretation in this setting is clinically challenging; it relies upon an understanding of the evolving and procedure-specific nature of normal postoperative imaging. Moreover, further research is required to better elucidate the correlation between MRI findings and long-term clinical outcomes. This article focuses on how specific morphologic features identified on MRI can be utilized to evaluate patients following the most commonly performed cartilage repair surgeries of the knee.
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Affiliation(s)
- Brian W Yang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Harry G Greditzer
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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14
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Lin KM, Wang D, Burge AJ, Warner T, Jones KJ, Williams RJ. Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Magnetic Resonance Imaging and Clinical Outcomes at Minimum 2-Year Follow-up. Orthop J Sports Med 2020; 8:2325967120960088. [PMID: 33195717 PMCID: PMC7605000 DOI: 10.1177/2325967120960088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Fresh osteochondral allograft transplant (OCA) has good outcomes in the knee. However, donor tissue for patellar OCA is limited. Outcomes after nonorthotopic OCA of the patella using more readily available femoral condylar allograft (FCA) tissue have not been previously reported. Purpose: To assess short-term magnetic resonance imaging (MRI) and minimum 2-year clinical outcomes of nonorthotopic patellar OCA using an FCA donor. Study Design: Case series; Level of evidence, 4. Methods: A prospective institutional cartilage registry was reviewed to identify patients treated with patellar OCA using an FCA donor between August 2009 and June 2016. OCA plugs were obtained from the FCA at its trochlear-condylar junction and implanted into the recipient patellar lesion. Early postoperative MRI scans were graded by a blinded musculoskeletal radiologist using the Osteochondral Allograft MRI Scoring System (OCAMRISS). International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), Knee Outcomes Survey–Activities of Daily Living (KOS-ADL), and pain visual analog scale (VAS) scores were collected preoperatively and at minimum 2 years postoperatively, and outcomes were compared using the paired t test. Results: A total of 25 patients were included for clinical outcome analysis and 20 patients for MRI analysis. MRI scans obtained at a mean of 11.4 months (range, 6-22 months) postoperatively showed a mean total OCAMRISS score of 9.0 (range, 7-11); mean bone, cartilage, and ancillary subscores were 2.6, 3.7, and 2.6, respectively. At the latest follow-up (mean, 46.5 months; range, 24-85 months), postoperative improvements were noted in IKDC (from 45.0 to 66.2; P = .0002), KOS-ADL (from 64.3 to 80.4; P = .0012), and VAS (from 5.1 to 3.4; P = .001) scores, with IKDC and KOS-ADL scores above the corresponding previously reported minimal clinically important difference. Conclusion: In this study, patellar OCA using nonorthotopic FCA led to significant short-term improvements in pain and patient-reported outcomes. The majority of nonorthotopic patellar grafts demonstrated full osseous incorporation and good restoration of the articular surface on MRI at short-term follow-up.
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Affiliation(s)
- Kenneth M Lin
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Tyler Warner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Kristofer J Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Riley J Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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15
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Mirzayan R, Charles MD, Batech M, Suh BD, DeWitt D. Bipolar Osteochondral Allograft Transplantation of the Patella and Trochlea. Cartilage 2020; 11:431-440. [PMID: 30173540 PMCID: PMC7488947 DOI: 10.1177/1947603518796124] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate clinical, functional, and radiographic outcomes of patients who underwent bipolar osteochondral allograft transplantation (OCAT) of the patellofemoral joint (PFJ). DESIGN Prospectively collected data on 18 knees who underwent fresh osteochondral allograft transplantation of the patella and trochlea by a single surgeon were reviewed. Inclusion criteria were: high-grade chondral lesions of PFJ (5 knees), or recurrent patella dislocations with trochlear dysplasia and chondral injury to the patella and/or trochlea (13 knees). Functional scores were obtained preoperatively and at follow-up appointments included Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Oxford, Cincinnati, Tenger-Lysholm, visual analogue scale (VAS)-pain, and Single Assessment Numeric Evaluation (SANE). Grafts were also evaluated using Osteochondral Allograft MRI Scoring System (OCAMRISS). RESULTS Three patients were lost to follow-up, leaving 4 knees in group 1, and 11 knees in group 2. Average age was 28.9 years (range 16-52 years). The average follow-up was 33.2 months (range 12-64 months). There was significant improvement of KOOS (from 38.7 to 83.1), IKDC (from 28.2 to 76.6), Tegner-Lysholm (from 38.3 to 88.3), Oxford (from 22.7 to 42.9), Cincinnati (from 35.1 to 83.6), VAS (from 71 to 17.9.), and SANE (from 43.3 to 83) (P < 0.0001). The OCAMRISS score for patella was 2.23 and for trochlea 4.69. There were no revisions or conversions to arthroplasty. CONCLUSION Bipolar OCAT of the patella and trochlea provide significant improvement in functional outcomes, relief from pain, activity level, and prevent recurrent instability.
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Affiliation(s)
- Raffy Mirzayan
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, CA, USA,Raffy Mirzayan, Department of Orthopaedic Surgery, Kaiser Permanente Southern California, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91107, USA.
| | - Michael D. Charles
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Michael Batech
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, CA, USA
| | - Brian D. Suh
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, CA, USA
| | - David DeWitt
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, CA, USA
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16
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Carlson MJ, Antkowiak TT, Larsen NJ, Applegate GR, Ferkel RD. Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Pediatric Population: A Minimum 2-Year Follow-up. Am J Sports Med 2020; 48:1989-1998. [PMID: 32510966 DOI: 10.1177/0363546520924800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of osteochondral lesions of the talus (OLTs) in children presents a difficult clinical challenge, with few large series reported. PURPOSE To evaluate functional and radiographic outcomes for children and adolescents undergoing arthroscopic treatment of symptomatic OLT with a minimum follow-up of 2 years. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients were identified who had symptomatic OLT treated arthroscopically with marrow stimulation techniques. Inclusion criteria were age ≤18 years, symptomatic chronic OLT as the surgical indication, failure of nonoperative treatment, and minimum follow-up of 24 months. Outcome measures included Foot Function Index, American Orthopaedic Foot and Ankle Society Hindfoot Score, Tegner Activity Scale, 36-Item Short Form Health Survey (Short Form-36, v 2), visual analog scale, ankle range of motion, and patient satisfaction survey. Weightbearing radiographs were compared with preoperative radiographs via an ankle arthritis classification system. Magnetic resonance imaging (MRI) was used to evaluate postoperative lesion characteristics per the MOCART scale (magnetic resonance observation of cartilage repair tissue). The size, location, lesion stability, traumatic etiology, skeletal maturity, and length of follow-up were recorded and analyzed through univariate logistic regression. RESULTS The study group consisted of 22 patients (11 male, 11 female) with a mean age of 14.4 years (range, 8-18 years) and a mean follow-up of 8.3 years (range, 2-27 years). Of 22 patients, 20 were satisfied with the results from surgery and would recommend it to others. Mean follow-up visual analog scale for pain was reported as 2.2 on a 10-point scale, and mean American Orthopaedic Foot and Ankle Society score at follow-up was 86.6. Mean postoperative Foot Function Index scores for the study group were as follows: pain, 17.1; disability, 16.5; activity, 4.7; and overall, 38.7. Mean Short Form-36 physical component score was 50.7. Postoperative radiographs indicated a van Dijk osteoarthritis grade of 0 in 56%, I in 38%, II in 6%, and III in 0%. Postoperative MRI MOCART scores showed complete filling of the cartilage in 27% of cases, complete graft integration in 22%, and intact repair surface in 22%, with a mean MOCART score of 48.0. No correlation was found between radiographic and MRI findings and clinical outcomes. None of the prognostic factors were significantly associated with patient satisfaction, progression of arthritis, or MOCART scores. CONCLUSION Arthroscopic treatment of symptomatic OLT in adolescent patients (≤18 years) demonstrated high functional outcomes, high clinical satisfaction rates, and minimal radiographic osteoarthritic progression despite low MOCART scores.
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Affiliation(s)
| | | | | | | | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
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17
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18
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Balazs GC, Wang D, Burge AJ, Williams RJ. Fluid imbibition at the bone-cartilage interface is associated with need for early chondroplasty following osteochondral allografting of the knee. J Clin Orthop Trauma 2019; 10:S13-S19. [PMID: 31700203 PMCID: PMC6823826 DOI: 10.1016/j.jcot.2019.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/09/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To determine the clinical significance of fluid imbibition at the bone-cartilage interface seen on postoperative MRI scans after osteochondral grafting of chondral lesions of the knee. METHODS Retrospective review of patients enrolled in a prospective cartilage repair registry. Included patients underwent osteochondral autografting or allografting of the knee, had minimum one year of clinical follow-up, and underwent at least two postoperative MRI scans. The primary outcome was reoperation for arthroscopic debridement and chondroplasty or graft revision. Secondary outcomes included the radiographic fate of fluid imbibition. RESULTS A total of 48 knees in 46 patients were analyzed, with mean 39 months clinical follow-up. Nine patients (19%) had fluid imbibition on at least one postoperative MRI scan, all of whom received allograft. Of these, two (22%) required eventual graft revision, four (45%) underwent arthroscopic chondroplasty but did not require revision, and three (33%) did not require any additional surgery by final follow-up. No demographic or surgical variable was associated with the presence of fluid imbibition. Fluid imbibition was significantly associated with need for chondroplasty (p = 0.05), but not graft revision. CONCLUSIONS Fluid imbibition on postoperative MRI following osteochondral allografting of the knee is associated with the need for arthroscopic chondroplasty, but should not be interpreted as a sign of a failing graft. LEVEL OF EVIDENCE Level IV, Case Series.
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Affiliation(s)
- George C. Balazs
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 620 John Paul Jones Cir, Porsmouth, 23708, VA, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, USA
| | - Alissa J. Burge
- Department of Radiology, Hospital for Special Surgery, New York-NY, USA
| | - Riley J. Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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19
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Effect of Autogenous Bone Marrow Aspirate Treatment on Magnetic Resonance Imaging Integration of Osteochondral Allografts in the Knee: A Matched Comparative Imaging Analysis. Arthroscopy 2019; 35:2436-2444. [PMID: 31395183 DOI: 10.1016/j.arthro.2019.03.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To accurately evaluate the effects of bone marrow aspirate (BMA) augmentation on osteochondral allograft (OCA) integration on early postoperative magnetic resonance imaging (MRI) using the comprehensive Osteochondral Allograft MRI Scoring System (OCAMRISS). METHODS This imaging study compared patients who underwent OCA transplantation with and without BMA augmentation for the treatment of focal osteochondral defects in the knee performed by a single surgeon between July 2013 and July 2017. Patients were excluded if they underwent implantation of premade plugs, had an overlapping OCA configuration ("snowman" technique), or did not undergo MRI at 6 months postoperatively. Patients were matched by lesion location, lesion size, age, and body mass index, as well as whether they underwent previous surgical procedures. Data were analyzed using descriptive statistics, Spearman correlation, the independent t test, the Mann-Whitney U test, and the χ2 test. RESULTS A total of 58 patients (29 per group) were included in this study, with an average age of 36.4 ± 10.1 years and mean body mass index of 28.6 ± 5.1. The mean size of the analyzed OCA plugs was 3.3 ± 1 cm2. At an average imaging follow-up of 5.6 ± 1 months, 86.2% of the grafts had achieved osseous integration at the graft-host junction and 75.9% did not show any cystic changes in the subchondral bone. No difference in any OCAMRISS subscale was seen comparing OCAs with and without BMA augmentation (P > .05). Specifically, osseous integration and subchondral cyst formation were comparable between groups (P = .128 and P = .539, respectively). CONCLUSIONS OCAs showed excellent osseous integration at the graft-host junction on 6-month postoperative MRI. The treatment of OCAs with autogenous BMA did not result in superior imaging outcomes when analyzed using the OCAMRISS. LEVEL OF EVIDENCE Level III, case-control study.
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20
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Ackermann J, Merkely G, Shah N, Gomoll AH. Decreased Graft Thickness Is Associated With Subchondral Cyst Formation After Osteochondral Allograft Transplantation in the Knee. Am J Sports Med 2019; 47:2123-2129. [PMID: 31169995 DOI: 10.1177/0363546519851098] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subchondral changes, specifically cyst formation, are a known finding after osteochondral allograft (OCA) transplantation. PURPOSE/HYPOTHESIS The purpose was to determine potential predictive associations between preoperative patient characteristics or OCA morphology and postoperative OCA appearance as assessed by the osteochondral allograft magnetic resonance imaging scoring system (OCAMRISS) at 6-month follow-up. It was hypothesized that preoperative patient factors or OCA morphology is associated with postoperative OCAMRISS scores. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study evaluated 74 OCAs that were implanted in the femoral condyles of 63 patients for the treatment of symptomatic osteochondral defects in the knee. Postoperative magnetic resonance imaging was obtained at a mean ± SD follow-up of 5.5 ± 1.0 months. A musculoskeletal radiologist scored all grafts according to the OCAMRISS. Point biserial correlation, Mann-Whitney U test, Fisher exact test, and chi-square test were used to distinguish associations between OCAMRISS subscales and age, sex, smoker status, body mass index, previous surgery, concomitant surgery, bone marrow augmentation, graft location, graft size, and bony graft thickness. RESULTS OCA bony thickness showed significant correlation with cystic changes at the graft-host junction (P = .019). Grafts with cystic formation were significantly thinner than grafts without cystic changes (P = .008). The odds ratio for grafts with <5-mm bony thickness demonstrating cystic changes was 4.9 (95% CI, 1.5-16.1; P = .009). Bony graft thickness was not associated with graft integration, but 40% of grafts with a bony thickness >9 mm presented with a residual osseous cleft, as opposed to 11.3% of thinner grafts (P = .1). The augmentation with bone marrow aspirate did not affect osseous graft integration or subchondral cystic formation (P = .375 and P = .458, respectively). CONCLUSION Osteochondral allograft thickness is associated with subchondral cyst formation at short-term follow-up. Thin grafts demonstrate a substantially increased risk of developing subchondral cysts at the graft-host junction after OCA transplantation. Conversely, thicker grafts may negatively affect osseous graft integration. Hence, surgeons should be aware of the potential pitfalls of transplanting thin or thick grafts regarding cystic formation and delay of osseous integration after cartilage resurfacing.
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Affiliation(s)
- Jakob Ackermann
- Sports Medicine Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Nehal Shah
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas H Gomoll
- Hospital for Special Surgery, New York, New York, USA. Presented at the 45th annual meeting of the AOSSM, Boston, Massachusetts, July 2019
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21
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Wang D, Lin KM, Burge AJ, Balazs GC, Williams RJ. Bone Marrow Aspirate Concentrate Does Not Improve Osseous Integration of Osteochondral Allografts for the Treatment of Chondral Defects in the Knee at 6 and 12 Months: A Comparative Magnetic Resonance Imaging Analysis. Am J Sports Med 2019; 47:339-346. [PMID: 30543757 DOI: 10.1177/0363546518813915] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Poor osseous integration after fresh osteochondral allograft transplantation (OCA) may be associated with graft subsidence and subchondral bone collapse after implantation. The augmentation of OCA with bone marrow aspirate concentrate (BMAC) has been hypothesized to improve osseous incorporation of the implanted allograft. PURPOSE To evaluate the effect of autogenous BMAC treatment on osseous integration at the graft-host bony interface after OCA. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review of patients treated with OCA+BMAC or OCA alone for full-thickness chondral defects of the distal femur from March 2015 to December 2016 was conducted. Seventeen knees treated with OCA+BMAC and 16 knees treated with OCA alone underwent magnetic resonance imaging (MRI) in the early postoperative phase (mean, 6 months). Eighteen knees treated with OCA+BMAC and 16 knees treated with OCA alone underwent MRI in the late postoperative phase (mean, 12 months). Bone, cartilage, and ancillary features on MRI were graded using the Osteochondral Allograft MRI Scoring System (OCAMRISS) by a musculoskeletal radiologist blinded to the patient's history and treatment. RESULTS There were no significant differences in the demographics or lesion characteristics between treatment groups in either postoperative phase. In the early postoperative phase, the mean OCAMRISS bone score was 3.0 ± 0.7 and 3.3 ± 0.7 for the OCA+BMAC group and OCA alone group, respectively ( P = .76); 71% (OCA+BMAC) and 81% (OCA alone) of MRI scans demonstrated discernible clefts at the graft-host junction ( P = .69), and 41% (OCA+BMAC) and 25% (OCA alone) of MRI scans demonstrated cystic changes at the graft and graft-host junction ( P = .46). In the late postoperative phase, the mean OCAMRISS bone score was 2.7 ± 0.8 and 2.9 ± 0.8 for the OCA+BMAC group and OCA alone group, respectively ( P = .97); 44% (OCA+BMAC) and 63% (OCA alone) of MRI scans demonstrated discernible clefts at the graft-host junction ( P = .33), and 50% (OCA+BMAC) and 31% (OCA alone) of MRI scans demonstrated the presence of cystic changes at the graft and graft-host junction ( P = .32). The mean OCAMRISS cartilage, ancillary, and total scores were not significantly different between groups in either postoperative phase. CONCLUSION OCA augmented with BMAC was not associated with improved osseous integration; decreased cystic changes; or other bone, cartilage, and ancillary feature changes compared with OCA alone.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Kenneth M Lin
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - George C Balazs
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
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Wang T, Wang DX, Burge AJ, Pais M, Kushwaha B, Rodeo SA, Williams RJ. Clinical and MRI Outcomes of Fresh Osteochondral Allograft Transplantation After Failed Cartilage Repair Surgery in the Knee. J Bone Joint Surg Am 2018; 100:1949-1959. [PMID: 30480599 DOI: 10.2106/jbjs.17.01418] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fresh osteochondral allograft transplantation is an appealing option to address a failed cartilage repair surgical procedure, given the ability to treat large lesions and to address the subchondral osseous changes commonly seen in the revision setting. We hypothesized that osteochondral allograft transplantation after failed cartilage repair would result in low failure rates and improved function and that improved graft incorporation on postoperative magnetic resonance imaging (MRI) would correlate with a superior clinical outcome. METHODS A retrospective review of prospectively collected data was used to identify 43 patients treated with fresh osteochondral allograft transplantation after a previous cartilage repair surgical procedure and having a minimum follow-up of 2 years. Clinical outcomes were evaluated using the Short Form-36 (SF-36) score, International Knee Documentation Committee (IKDC) Subjective Knee Score, Marx Activity Scale, Knee Outcome Survey-Activities of Daily Living (KOS-ADL) Questionnaire, Cincinnati Sports Activity Score, and Cincinnati Overall Symptom Assessment. Postoperative MRI scans were obtained at a mean time of 19.7 months and were independently reviewed by a musculoskeletal radiologist using the Osteochondral Allograft MRI Scoring System (OCAMRISS). RESULTS At a mean 3.5-year follow-up after osteochondral allograft transplantation, significant improvements (p < 0.05) in SF-36 Physical Function, SF-36 Pain, KOS-ADL, IKDC Subjective Knee Score, and Cincinnati Overall Symptom Assessment were seen. Over 90% of grafts remained in situ at the time of the latest follow-up, although 17 knees (40%) underwent reoperation, the majority for arthroscopic debridement or manipulation for stiffness. Body mass index (BMI) of >30 kg/m was associated with worse clinical outcomes. The mean total OCAMRISS score demonstrated poorer allograft integration in patients with graft failure, but the total score did not meaningfully correlate with clinical outcome scores. However, better individual articular cartilage appearance and osseous integration subscores were associated with better clinical outcome scores. CONCLUSIONS Significant improvements in pain and function were seen following fresh osteochondral allograft transplantation after failed cartilage repair, with an overall graft survival rate of >90%. Patients with greater bone and cartilage incorporation on MRI had superior clinical outcomes, although persistent osseous edema was frequently seen. We concluded that osteochondral allograft transplantation is an effective salvage treatment after failed cartilage repair and recommend further evaluation of techniques to optimize graft integration. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tim Wang
- Hospital for Special Surgery, New York, NY
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23
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de Sa D, Fu FH. Fresh Osteochondral Allograft Transplantation Is an Effective Salvage Strategy for Revision of Failed Cartilage Repair: Commentary on an article by Tim Wang, MD, et al.: "Clinical and MRI Outcomes of Fresh Osteochondral Allograft Transplantation After Failed Cartilage Repair Surgery in the Knee". J Bone Joint Surg Am 2018; 100:e145. [PMID: 30480608 DOI: 10.2106/jbjs.18.00805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Darren de Sa
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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24
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Hsu AC, Tirico LEP, Lin AG, Pulido PA, Bugbee WD. Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure. Cartilage 2018; 9:248-254. [PMID: 28530120 PMCID: PMC6042037 DOI: 10.1177/1947603517710307] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate the outcome of patients who have undergone simultaneous osteotomy and osteochondral allograft (OCA) transplantation. Our hypothesis is that use of high tibial osteotomy and fresh OCA in a combined procedure is safe and effective without increasing morbidity in comparison to OCA alone. Design A case series of 17 patients underwent tibial osteotomy and simultaneous OCA during a single surgery. Osteotomy was indicated when axial alignment was within the affected compartment. Patients had a minimum of 2 years of follow-up after surgery. The mean graft size was 8.7 cm2, with 82% located on the medial femoral condyle alone and 18% involving the medial femoral condyle and one or more other sites. Data collection included demographics, osteotomy correction, graft site(s) and area, and clinical evaluation. Failure was defined as conversion to arthroplasty. Results Two of 17 patients (12%) failed at a mean of 9.3 years. The remaining 15 patients (88%) had intact allografts with mean survival of 8.1 years (SD 3.3). Five patients (29%) had an additional procedure, all undergoing osteotomy hardware removal. Of those with surviving allografts, mean pain and function scores improved significantly from the preoperative to postoperative assessment and International Knee Documentation Committee total scores improved significantly from 40.9 ± 15.4 preoperative to 75.5 ± 24.0 at latest follow-up ( P = 0.003); 92% of patients were satisfied with the results of the surgery. No postoperative complications occurred. Conclusion Combining high tibial osteotomy and OCA in properly selected patients is safe and effective.
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Affiliation(s)
| | - Luis E. P. Tirico
- Shiley Center for Orthopaedic Research & Education, Scripps Clinic, La Jolla, CA, USA
| | - Abraham G. Lin
- Department of Orthopaedics, Kaiser Permanente, Downey, CA, USA
| | | | - William D. Bugbee
- Scripps Clinic Torrey Pines, La Jolla, CA, USA,William D. Bugbee, Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, La Jolla, CA 92037, USA.
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25
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Johnson CC, Johnson DJ, Garcia GH, Wang D, Pais M, Degen RM, Burge AJ, Williams RJ. High Short-Term Failure Rate Associated With Decellularized Osteochondral Allograft for Treatment of Knee Cartilage Lesions. Arthroscopy 2017; 33:2219-2227. [PMID: 28967543 DOI: 10.1016/j.arthro.2017.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the short-term clinical and radiographic outcomes following the use of decellularized osteochondral (OC) allograft plugs in the treatment of distal femoral OC lesions. METHODS An Institutional Review Board-approved database with prospectively collected data was used to identify patients treated with the decellularized OC allograft plugs implant. Demographic information, patient-reported outcomes, magnetic resonance imaging (MRI), and the number and type of reoperations were assessed. Failure was defined as revision surgery with removal of the implant. Patients were evaluated pre- and postoperatively using the Short Form-36, Activity of Daily Living Score, International Knee Documentation Committee Subjective Evaluation, Cincinnati Knee Rating System, and Marx Activity Scale. MRIs were evaluated using the OsteoChondral Allograft MRI Scoring System. RESULTS Thirty-four patients were identified, with a mean age of 45 (±11.9) years; 71% were male. Fifteen (44%) patients had undergone prior ipsilateral surgical intervention. Mean defect size was 4 (±1.5) cm2, and median number of allografts per knee was 2 (range, 1-5). Mean follow-up duration was 15.5 months (range, 6-24). Ten patients (29%) required revision surgery with removal of the implant. Implant survivorship was 61% at 2 years. Female gender was independently predictive of failure, with a hazard ratio of 9.4 (95% confidence interval [CI], 2.0-58.9; P = .005). Defect size was also independently predictive of failure, with a hazard ratio of 1.9 per 1 cm2 increase (95% CI, 1.2-3.1; P = .005). MRIs obtained at 1 year postoperatively demonstrated significantly improved osseous integration (P = .0086) and opposing cartilage (P = .019) in the nonfailure group as compared with the failure group. CONCLUSIONS Based on the high short-term failure rate observed in this study, the authors advise that a decellularized OC allograft plugs implant should be used with caution in the treatment of OC lesions of the knee, as similar outcomes have not been noted with other cartilage restoration techniques. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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Affiliation(s)
| | - Daniel J Johnson
- University of Vanderbilt School of Medicine, Nashville, Tennessee, U.S.A
| | | | - Dean Wang
- Hospital for Special Surgery, New York, New York, U.S.A
| | - Mollyann Pais
- Hospital for Special Surgery, New York, New York, U.S.A
| | - Ryan M Degen
- University of Western Ontario, University Hospital, London, Ontario, Canada
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Schreiner MM, Mlynarik V, Zbýň Š, Szomolanyi P, Apprich S, Windhager R, Trattnig S. New Technology in Imaging Cartilage of the Ankle. Cartilage 2017; 8:31-41. [PMID: 27994718 PMCID: PMC5154418 DOI: 10.1177/1947603516632848] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The incidence of osteochondral lesions, as well as osteoarthritis of the ankle joint following osteochondritis dissecans and trauma, has been reappraised in recent years. Consequently, an increasing number of surgical interventions using different cartilage repair techniques is performed in the ankle joint, which has resulted in a growing demand for repetitive and objective assessment of cartilage tissue and its repair. While morphological imaging does enable monitoring of macroscopic changes with increasing precision, it fails to provide information about the ultrastructural composition of cartilage. The significance of molecular changes in cartilage matrix composition, however, is increasingly recognized, as it is assumed that macroscopic cartilage degeneration is preceded by a loss in glycosaminoglycans and a disorganization of the collagen network. Recent advances in biochemical magnetic resonance imaging (MRI) have yielded sequences sensitive to these changes, thus providing invaluable insight into both early cartilage degeneration and maturation of repair tissue, on a molecular level. The aim of this review was to provide a comprehensive overview of these techniques, including water and collagen-sensitive T2/T2* mapping, as well as glycosaminoglycan-sensitive sequences such as delayed gadolinium-enhanced MRI of cartilage dGEMRIC, and sodium imaging, and describe their applications for the ankle joint.
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Affiliation(s)
- Markus M. Schreiner
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Vladimir Mlynarik
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Štefan Zbýň
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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