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Hanna AJ, Campbell MP, Matthews J, Onor G, Perez AR, Tucker B, Freedman KB. Comparable Outcomes Between Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation in the Setting of Patellar Realignment. Arthroscopy 2024:S0749-8063(24)00670-4. [PMID: 39303968 DOI: 10.1016/j.arthro.2024.08.043] [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: 12/19/2023] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE To determine clinical and functional outcomes in patients treated with autologous chondrocyte implantation (ACI) or osteochondral allograft (OCA) transplantation for chondral defects secondary to patellar instability with concomitant medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy (TTO) for patellar realignment. METHODS A retrospective review identified patients who underwent ACI or OCA transplantation with concomitant MPFL reconstruction and TTO. Patients were excluded if they did not have concomitant MPFL reconstruction and TTO, had the presence of other intra-articular pathologies, or failed to complete postoperative subjective outcome evaluations at a minimum of 2 years following surgery. Subjective outcome measures included the Knee injury and Osteoarthritis Outcome Score for Joint Replacement, International Knee Documentation Committee evaluation, and 12-item Short Form Health Survey physical scores, collected a minimum of 2 years after surgery. Defect location, size, complications, and rate of subsequent surgery were determined. RESULTS Eighteen total patients were included in this study. The ACI cohort included 11 patients with 13 total defects that were treated with ACI. The OCA cohort included 7 patients with 10 total defects that were treated with OCA. This was due to a number of patients in either group having multiple cartilage defects. Twenty-three total chondral defects were compared to analyze clinical and functional outcomes following surgical correction (ACI: n = 13, OCA: n = 10). Five defects were noted on the femoral condyle and 18 on the patellar facets/central ridge. Defects were comparable between groups, including size measured during index arthroscopy (ACI = 3.34 cm2 [95% CI, 2.3-4.4 cm2] vs OCA = 4.03 cm2 [95% CI, 3.1-5.0 cm2]; P = .351), Outerbridge classification (ACI = 54.8% grade 4 vs OCA = 60.0% grade 4; P ≥ .999), and Area Measurement and Depth Underlying Structures score (ACI = 47.1 vs OCA = 58.6; P = .298). Postoperative outcomes were comparable, including revision rate (ACI = 15.4% vs OCA = 10.0%; P ≥ .999) and 2-year International Knee Documentation Committee scores (ACI = 74.2 [95% CI, 65.2-83.2] vs OCA = 51.2 [95% CI, 30.3-72.1]; P = .077). ACI did have significantly higher 2-year Knee injury and Osteoarthritis Outcome Score for Joint Replacement (85.1 [95% CI, 76.9-93.3] vs 63.7 [95% CI, 49.1-78.3]; P = .031) and 12-item Short Form Health Survey scores (54.1 [95% CI, 52.0-56.2] vs 42.6 [95% CI, 35.8-49.4]; P = .007) compared to OCA. CONCLUSIONS ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and TTO can be safely performed in an outpatient setting with functional and clinical outcomes being comparable. LEVEL OF EVIDENCE Level III, retrospective case series study.
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Affiliation(s)
- Adeeb J Hanna
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Michael P Campbell
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - John Matthews
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Gabriel Onor
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Andres R Perez
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Bradford Tucker
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kevin B Freedman
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A..
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Mercurio M, Minici R, Spina G, Cofano E, Laganà D, Familiari F, Galasso O, Gasparini G. Clinical and Radiological Outcomes of combined Arthroscopic Microfracture and Mesenchymal Stem Cell Injection Versus Isolated Microfracture for Osteochondral Lesions of the Talus: A Meta-Analysis of Comparative Studies. J Foot Ankle Surg 2024:S1067-2516(24)00210-2. [PMID: 39182822 DOI: 10.1053/j.jfas.2024.08.011] [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: 06/10/2024] [Revised: 08/01/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
We aimed to systematically evaluate the clinical and radiological outcomes reported in comparative studies evaluating combined arthroscopic microfracture and mesenchymal stem cell (MSC) injection versus isolated microfracture for osteochondral lesions of the talus (OLT). A total of 5 studies were included. Demographics, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale score, Foot and Ankle Outcome Scale (FAOS), visual analogue scale (VAS), and Magnetic Resonance Observation of Cartilage Repair Tissue Score (MOCART) were analyzed. A total of 348 patients were evaluated, 171 of whom underwent combined microfracture and MSC injection and 177 of whom underwent isolated microfracture. The frequency-weighted mean ages were 38.9 ± 13.5 and 36.9 ± 11.4 years and the mean follow-up were 36.7 ± 13.3 and 36.2 ± 16.2 months in the combined microfracture and MSC injection and isolated microfracture groups, respectively. The combined microfracture and MSC injection group showed significantly better postoperative AOFAS score (81.5 ± 7.4 vs 68.2 ± 5.1, p < .001), and MOCART score (74.3 ± 16.3 vs 63.9 ± 15.5, p < .001) with differences beyond the minimum clinically important difference. The combination of arthroscopic microfracture and MSC injection significantly improved functionality and radiological outcomes compared to those of isolated microfracture for OLT.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy.
| | - Roberto Minici
- Radiology Unit, Department of Experimental and Clinical Medicine, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100 Catanzaro, Italy
| | - Giovanna Spina
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy
| | - Erminia Cofano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100 Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
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Perez AR, Coladonato C, Hanna AJ, Sabitsky M, Cohen AL, Freedman KB, Cohen SB. Most Patients Older Than 40 Years of Age Who Underwent Meniscal Root Repair Presented With an Effusion, a Positive McMurray Test, and a Positive Hyperflexion Test. Arthrosc Sports Med Rehabil 2024; 6:100949. [PMID: 39421346 PMCID: PMC11480779 DOI: 10.1016/j.asmr.2024.100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/07/2024] [Indexed: 10/19/2024] Open
Abstract
Purpose To analyze the presenting symptoms and clinical examination findings of patients undergoing meniscal root repairs to aid physicians in diagnosing this injury. Methods All patients undergoing isolated arthroscopic meniscal root repair from January 1, 2016, to September 1, 2021, were identified. Patients younger than the age of 40 years were excluded. Clinical notes were reviewed for presenting symptoms and physical examination findings. Preoperative radiographs were graded using the Kellgren-Lawrence (KL) scale for osteoarthritis. Root tears were graded using the radiographic criteria of Chung et al. and articular cartilage injury was graded using a validated system, AMADEUS (mean total Area Measurement And Depth & Underlying Structures). Results In total, 221 patients met inclusion criteria; 65.6% of patients reported that their pain began after an acute injury, with 39.4% of patients reporting a "pop." On examination, an effusion was present in 71% of knees. McMurray test was reported positive in 85.5% and a positive hyperflexion test in 53.8% of knees. In total, 49.5% of knees were graded KL 1. 154 had medial root tears, 10 had lateral root tears, and 24 suffered both root tears. In total, 44.1% of tears occurred at the midsubstance of the root, with 28.0% occurring at the enthesis and 28.0% occurring at the root-posterior horn junction. The mean AMADEUS score was 94.4 ± 11.4. Conclusions Although most patients reported pain began after acute injury, less than one-half reported hearing a "pop." When patients were evaluated, an effusion, positive McMurray test, and positive hyperflexion test were present in most meniscal root tears. Level of Evidence Level IV, diagnostic case series.
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Affiliation(s)
- Andres R. Perez
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Carlo Coladonato
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Adeeb J. Hanna
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Matthew Sabitsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Alexa L. Cohen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
- Massachusetts Institute of Technology, Cambridge, Massachusetts, U.S.A
| | - Kevin B. Freedman
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Steven B. Cohen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
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Tsikopoulos K, Wong J, Mahmoud M, Lampridis V, Liu P, Rippel R, Felstead A. Inter- and Intra-Observer Variability of the AMADEUS Tool for Osteochondral Lesions of the Talus. J Pers Med 2024; 14:749. [PMID: 39064003 PMCID: PMC11278373 DOI: 10.3390/jpm14070749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Managing osteochondral cartilage defects (OCDs) of the talus is a common daily challenge in orthopaedics as they predispose patients to further cartilage damage and progression to osteoarthritis. Therefore, the implementation of a reliable tool to quantify the amount of cartilage damage that is present is of the essence. METHODS We retrospectively identified 15 adult patients diagnosed with uncontained OCDs of the talus measuring <150 mm2, which were treated arthroscopically with bone marrow stimulation. Five independent assessors evaluated the pre-operative MRI scans with the AMADEUS scoring system (i.e., MR-based pre-operative assessment system) and the intra-/inter-observer variability was then calculated by means of the intraclass correlation coefficients (ICC) and Kappa (κ) statistics, respectively. In addition, the correlation between the mean AMADEUS scores and pre-operative self-reported outcomes as measured by the Manchester-Oxford foot questionnaire (MOxFQ) was assessed. RESULTS The mean ICC and the κ statistic were 0.82 (95% CI [0.71, 0.94]) and 0.42 (95% CI [0.25, 0.59]). The Pearson correlation coefficient was found to be r = -0.618 (p = 0.014). CONCLUSIONS The AMADEUS tool, which was originally designed to quantify knee osteochondral defect severity prior to cartilage repair surgery, demonstrated good reliability and moderate inter-observer variability for small OCDs of the talar shoulder. Given the strong negative correlation between the AMADEUS tool and pre-operative clinical scores, this tool could be implemented in clinical practise to reliably quantify the extent of the osteochondral defects of the talus.
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Affiliation(s)
- Konstantinos Tsikopoulos
- Orthopaedic Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (P.L.)
| | - Jenn Wong
- Radiology Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (R.R.)
| | - Moustafa Mahmoud
- Orthopaedic Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (P.L.)
| | - Vasileios Lampridis
- Orthopaedic Department, Liverpool University Hospitals, Liverpool L9 7AL, UK;
| | - Perry Liu
- Orthopaedic Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (P.L.)
| | - Radoslaw Rippel
- Radiology Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (R.R.)
| | - Alisdair Felstead
- Orthopaedic Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (P.L.)
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Baumann-Jungmann PM, Giesler P, Schneider J, Jung M, Karampinos DC, Weidlich D, Gersing AS, Baumann FA, Imhoff AB, Woertler K, Bamberg F, Holwein C. MR imaging after patellar MACI and MPFL reconstruction: a comparison of isolated versus combined procedures. Skeletal Radiol 2024; 53:1319-1332. [PMID: 38240761 DOI: 10.1007/s00256-024-04582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVE To qualitatively and quantitatively evaluate the 2.5-year MRI outcome after Matrix-associated autologous chondrocyte implantation (MACI) at the patella, reconstruction of the medial patellofemoral ligament (MPFL), and combined procedures. METHODS In 66 consecutive patients (age 22.8 ± 6.4years) with MACI at the patella (n = 16), MPFL reconstruction (MPFL; n = 31), or combined procedures (n = 19) 3T MRI was performed 2.5 years after surgery. For morphological MRI evaluation WORMS and MOCART scores were obtained. In addition quantitative cartilage T2 and T1rho relaxation times were acquired. Several clinical scores were obtained. Statistical analyses included descriptive statistics, Mann-Whitney-U-tests and Pearson correlations. RESULTS WORMS scores at follow-up (FU) were significantly worse after combined procedures (8.7 ± 4.9) than after isolated MACI (4.3 ± 3.6, P = 0.005) and after isolated MPFL reconstruction (5.3 ± 5.7, P = 0.004). Bone marrow edema at the patella in the combined group was the only (non-significantly) worsening WORMS parameter from pre- to postoperatively. MOCART scores were significantly worse in the combined group than in the isolated MACI group (57 ± 3 vs 88 ± 9, P < 0.001). Perfect defect filling was achieved in 26% and 69% of cases in the combined and MACI group, respectively (P = 0.031). Global and patellar T2 values were higher in the combined group (Global T2: 34.0 ± 2.8ms) and MACI group (35.5 ± 3.1ms) as compared to the MPFL group (31.1 ± 3.2ms, P < 0.05). T2 values correlated significantly with clinical scores (P < 0.005). Clinical Cincinnati scores were significantly worse in the combined group (P < 0.05). CONCLUSION After combined surgery with patellar MACI and MPFL reconstruction inferior MRI outcomes were observed than after isolated procedures. Therefore, patients with need for combined surgery may be at particular risk for osteoarthritis.
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Affiliation(s)
- Pia M Baumann-Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland.
| | - Paula Giesler
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Julia Schneider
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Weidlich
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Frederic A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Dan Milinkovic D, Schmidt S, Fluegel J, Gebhardt S, Zimmermann F, Balcarek P. Preoperative subjective assessment of disease-specific quality of life significantly influenced the likelihood of achieving the minimal clinically important difference after surgical stabilization for recurrent lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39031883 DOI: 10.1002/ksa.12319] [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: 10/11/2023] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE To evaluate which factors exert a predictive value for not reaching the minimal clinically important difference (MCID) in patients who underwent a tailored operative treatment for recurrent lateral patellar dislocation (RLPD). METHODS A total of 237 patients (male/female 71/166; 22.4 ± 6.8 years) were included. The Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) and subjective rating of knee function and pain (numeric analogue scale [NAS]; 0-10) were used to evaluate patients' outcomes from pre- to postoperatively. Gender, age at the time of surgery, body mass index (BMI), nicotine abuse, psychiatric diseases, cartilage status and pathoanatomic risk factors were evaluated as potential predictors for achieving the MCID using univariate logistic regression analysis. RESULTS The MCID for the BPII 2.0 was calculated at 9.5 points. Although the BPII 2.0 and NAS for knee function and pain improved significantly in the total cohort from pre- to postoperatively (all p < 0.001), 29 patients did not reach the MCID at the final follow-up. The analysis yielded that only the preoperative NAS for function and BPII 2.0 score values were significant predictors for reaching the MCID postoperatively. The optimal threshold was calculated at 7 (NAS function) and 65.2 points (BPII 2.0). Age at the time of surgery should be considered for patients with a preoperative BPII 2.0 score >62.5. CONCLUSION The probability of reaching BPII 2.0 MCID postoperatively depends only on the preoperative BPII 2.0 value and subjective rating of knee function, as well as age at the time of surgery for patients undergoing surgical treatment of RLPD. Here, presented results can assist clinicians in advising and presenting patients with potential outcomes following treatment for this often complex and multifactorial pathology. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Danko Dan Milinkovic
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | | | | | - Sebastian Gebhardt
- Center for Orthopaedics, Trauma Surgery and Rehabilitation, University of Greifswald, Greifswald, Germany
| | - Felix Zimmermann
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Peter Balcarek
- Arcus Sportklinik, Pforzheim, Germany
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medicine Göttingen, Göttingen, Germany
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Vijayvargiya A, Sinha A, Gehlot N, Jena A, Kumar R, Moran K. S-WD-EEMD: A hybrid framework for imbalanced sEMG signal analysis in diagnosis of human knee abnormality. PLoS One 2024; 19:e0301263. [PMID: 38820390 PMCID: PMC11142505 DOI: 10.1371/journal.pone.0301263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/13/2024] [Indexed: 06/02/2024] Open
Abstract
The diagnosis of human knee abnormalities using the surface electromyography (sEMG) signal obtained from lower limb muscles with machine learning is a major problem due to the noisy nature of the sEMG signal and the imbalance in data corresponding to healthy and knee abnormal subjects. To address this challenge, a combination of wavelet decomposition (WD) with ensemble empirical mode decomposition (EEMD) and the Synthetic Minority Oversampling Technique (S-WD-EEMD) is proposed. In this study, a hybrid WD-EEMD is considered for the minimization of noises produced in the sEMG signal during the collection, while the Synthetic Minority Oversampling Technique (SMOTE) is considered to balance the data by increasing the minority class samples during the training of machine learning techniques. The findings indicate that the hybrid WD-EEMD with SMOTE oversampling technique enhances the efficacy of the examined classifiers when employed on the imbalanced sEMG data. The F-Score of the Extra Tree Classifier, when utilizing WD-EEMD signal processing with SMOTE oversampling, is 98.4%, whereas, without the SMOTE oversampling technique, it is 95.1%.
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Affiliation(s)
- Ankit Vijayvargiya
- Insight Science Foundation Ireland Research Centre for Data Analytics, School of Human and Health Performance, Dublin City University, Dublin, Ireland
- Department of Electrical Engineering, Swami Keshvanand Institute of Technology, Management & Gramothan, Jaipur, Rajasthan, India
| | - Aparna Sinha
- Department of Information Technology, Bansthali Vidyapeeth, Radha Kishnpura, Rajasthan, India
| | - Naveen Gehlot
- Department of Electrical Engineering, Malaviya National Institute of Technology, Jaipur, Rajasthan, India
| | - Ashutosh Jena
- Department of Electrical Engineering, Malaviya National Institute of Technology, Jaipur, Rajasthan, India
| | - Rajesh Kumar
- Department of Electrical Engineering, Malaviya National Institute of Technology, Jaipur, Rajasthan, India
| | - Kieran Moran
- Insight Science Foundation Ireland Research Centre for Data Analytics, School of Human and Health Performance, Dublin City University, Dublin, Ireland
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Briem T, Stephan A, Stadelmann VA, Fischer MA, Pfirrmann CWA, Rüdiger HA, Leunig M. Mid-term results of autologous matrix-induced chondrogenesis for large chondral defects in hips with femoroacetabular impingement syndrome. Bone Joint J 2024; 106-B:32-39. [PMID: 38688500 DOI: 10.1302/0301-620x.106b5.bjj-2023-0864.r1] [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: 05/02/2024]
Abstract
Aims The purpose of this study was to evaluate the mid-term outcomes of autologous matrix-induced chondrogenesis (AMIC) for the treatment of larger cartilage lesions and deformity correction in hips suffering from symptomatic femoroacetabular impingement (FAI). Methods This single-centre study focused on a cohort of 24 patients with cam- or pincer-type FAI, full-thickness femoral or acetabular chondral lesions, or osteochondral lesions ≥ 2 cm2, who underwent surgical hip dislocation for FAI correction in combination with AMIC between March 2009 and February 2016. Baseline data were retrospectively obtained from patient files. Mid-term outcomes were prospectively collected at a follow-up in 2020: cartilage repair tissue quality was evaluated by MRI using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Patient-reported outcome measures (PROMs) included the Oxford Hip Score (OHS) and Core Outcome Measure Index (COMI). Clinical examination included range of motion, impingement tests, and pain. Results A total of 12 hips from 11 patients were included (ten males, one female, mean age 26.8 years (SD 5.0), mean follow-up 6.2 years (SD 5.2 months)). The mean postoperative MOCART score was 66.3 (SD 16.3). None of the patients required conversion to total hip arthroplasty. Two patients had anterior impingement. External hip rotation was moderately limited in four patients. There was a correlation between MOCART and follow-up time (rs = -0.61; p = 0.035), but not with initial cartilage damage, age, BMI, or imaging time delay before surgery. PROMs improved significantly: OHS from 37.4 to 42.7 (p = 0.014) and COMI from 4.1 to 1.6 (p = 0.025). There was no correlation between MOCART and PROMs. Conclusion Based on the reported mid-term results, we consider AMIC as an encouraging treatment option for large cartilage lesions of the hip. Nonetheless, the clinical evidence of AMIC in FAI patients remains to be determined, ideally in the context of randomized controlled trials.
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Affiliation(s)
- Tim Briem
- Ortho Clinic Zürich, Zürich, Switzerland
| | - Anika Stephan
- Department of Research and Development, Schulthess Klinik, Zürich, Switzerland
| | | | | | | | - Hannes A Rüdiger
- Department of Hip and Knee Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Michael Leunig
- Department of Hip and Knee Surgery, Schulthess Klinik, Zürich, Switzerland
- Department of Health Sciences and Technology (ETH Zürich), Schulthess Klinik, Zürich, Switzerland
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Perez AR, Coladonato C, Sonnier JH, Saucedo ST, Avendano JP, Corvi J, Campbell M, Tjoumakaris FP, Cohen SB, Ciccotti MC, Freedman KB. Patients With First-Time or Recurrent Patellar Dislocation Have a Similar High Rate and Extent of Articular Cartilage Injury Observed on Magnetic Resonance Imaging. Arthrosc Sports Med Rehabil 2024; 6:100849. [PMID: 38261848 PMCID: PMC10794921 DOI: 10.1016/j.asmr.2023.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/20/2023] [Indexed: 01/25/2024] Open
Abstract
Purpose To use magnetic resonance imaging (MRI) scans to compare the prevalence of articular cartilage damage in patients with a single patellar dislocation versus those with multiple dislocations and to compare the locations and severity of chondral injury between the groups. Methods Patients with patellar dislocation between January 2017 and July 2021 were retrospectively identified. Patients with a documented history of patellar dislocation and an MRI scan of the affected knee were included. Patients with articular cartilage injury prior to the dislocation event were excluded. Articular cartilage injury was graded using a validated system: AMADEUS (Mean Total Area Measurement and Depth & Underlying Structures). Caton-Deschamps Index (CDI) scores and Dejour classifications of trochlear dysplasia were also collected. Data were calculated by performing t tests, Mann-Whitney tests, and χ2 or Fisher Exact tests to calculate P values for categorical data. Results In total, 233 patients were included: 117 with primary dislocations and 116 with recurrent dislocations. Articular cartilage injuries were present in 51 patients with primary dislocations (43.6%) and 68 patients with recurrent dislocations (58.6%, P = .026). On comparison of the groups, the recurrent group contained a significantly larger proportion of female patients (65.5% vs 46.2%, P = .004). There was no difference in lesion size, subchondral bone defect, presence of bone edema, or total AMADEUS score between groups (P = .231). Caton-Deschamps Index scores were not significant when comparing between groups; however, the Dejour classifications showed higher grades in the recurrent group (P = .013 for A-D grading scale and P = .005 for high/low grading scale). Subgroup analysis revealed that when cartilage damage was present, patients from the primary group had significantly more full-thickness lesions (P < .001) and lower AMADEUS scores (P = .016). Conclusions There was a similarly high prevalence of cartilage injury seen on MRI after both a primary patellar dislocation and a recurrent patellar dislocation. Chondral injury primarily affected the medial and lateral patellar facets and the lateral femoral condyle in both the primary and recurrent dislocation groups. However, the primary group showed an increased number of full-thickness lesions. There was no difference in lesion size, subchondral bone defect, presence of bone edema, or total AMADEUS score between the primary and recurrent groups. Level of Evidence Level III, retrospective comparative prognostic investigation.
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Affiliation(s)
- Andres R. Perez
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Carlo Coladonato
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Samuel T. Saucedo
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - John P. Avendano
- Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - John Corvi
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Mike Campbell
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Steven B. Cohen
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
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Heinz T, Oberfeld J, Luetkens KS, Anderson PM, Stratos I, Horas K, Bley TA, Rudert M, Reppenhagen S, Weißenberger M. The AMADEUS score is not a sufficient predictor for functional outcome after autologous chondrocyte implantation (ACI) of the knee: data from the German Cartilage Registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 2023; 143:7097-7105. [PMID: 37639044 PMCID: PMC10635975 DOI: 10.1007/s00402-023-05037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION The AMADEUS (Area Measurement And DEpth and Underlying Structures) score has advanced to a commonly used tool for MRI-based chondral defect severity grading prior to cartilage knee surgery. It was the intention of this study to assess the AMADEUS for a potential correlation with clinical data by patient-reported outcome measures (PROMs). METHODS A total of 51 patients undergoing ACI (autologous chondrocyte implantation) between 2016 and 2022 were found eligible and retrospectively analyzed. All patients were registered in the German Cartilage Registry prior to surgery and follow-up data were collected using the Knee Osteoarthritis Outcome score (KOOS), the International Knee Documentation Committee (IKDC) Form and the numeric rating scale (NRS). Pre-operative MRI images were scored by three raters using the AMADEUS classification system, and an overall AMADEUS score was calculated which was subsequently correlated with pre- and post-operative PROMs. RESULTS Mean patient age was 32.67 ± 8.37 years and mean defect size area 343.04 mm2 ± 139.45 mm2. No correlative capacity of the pre- and postoperative IKDC, KOOS or NRS scores was found with the AMADEUS final score or any of its subscores. From the pre- to postoperative visit, a significant improvement of the PROMs (IKDC: 45.53 ± 21.00 vs. 59.83 ± 17.93, p = 0.04; KOOS Pain: 58.00 ± 16.70 vs. 76.06 ± 19.20, p = 0.03; KOOS ADL: 64.17 ± 18.76 vs. 82.11 ± 16.68, p < 0.01; KOOS Sports: 26.11 ± 18.52 vs. 50.56 ± 23.94, p = 0.01; KOOS QOL: 25.50 ± 14.26 ± 45.28 ± 19.03, p = 0.00) was found. Intraclass correlation coefficients showed an overall good interrater agreement for the AMADEUS total score (ICC = 0.75). CONCLUSIONS Study results suggest no correlative capacity of the AMADEUS with routinely used PROMs in patients undergoing ACI. Therefore, radiographically assessed cartilage defect characteristics poorly translate to pre- and postoperative patient-reported outcome data.
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Affiliation(s)
- Tizian Heinz
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Jan Oberfeld
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Karsten Sebastian Luetkens
- 2Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany
| | - Philip Mark Anderson
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Ioannis Stratos
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Konstantin Horas
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Thorsten Alexander Bley
- 2Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany
| | - Maximilian Rudert
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Stephan Reppenhagen
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Manuel Weißenberger
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany.
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Runer A, Ossendorff R, Öttl F, Stadelmann VA, Schneider S, Preiss S, Salzmann GM, Hax J. Autologous minced cartilage repair for chondral and osteochondral lesions of the knee joint demonstrates good postoperative outcomes and low reoperation rates at minimum five-year follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31:4977-4987. [PMID: 37634136 PMCID: PMC10598129 DOI: 10.1007/s00167-023-07546-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Minced cartilage is a one-step, autologous procedure with promising short-term results. The aim of the present study was to evaluate mid-term results in a patient cohort with chondral and osteochondral lesions in the knee joint treated with minced cartilage. METHODS From 2015 through 2016, a total of 34 consecutive patients were treated with a single-step, autologous minced cartilage for knee chondral and osteochondral lesions. Numeric analogue scale (NAS) for pain and knee function were obtained prior to surgery and at 12, 24 and 60 months postoperatively. Secondary outcomes, including Lysholm score, Tegner activity score, and the International Knee Documentation Committee (IKDC) score, were recorded at final follow-up. MRI examinations of patients with unplanned radiological follow-up were analysed using the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS A total of 28 patients (44.1% females, age at surgery: 29.5 ± 11.5 years) were available at a mean follow-up of 65.5 ± 4.1 months. Mean defect size was 3.5 ± 1.8 cm2. NAS for pain decreased from a median of 7 (range: 2-10) preoperatively to 2 (0-8) postoperatively. NAS knee function improved from a median of 7 (range: 2-10) to 3 (0-7) after five years, respectively. Satisfactory Lysholm (76.5 ± 12.5), IKDC (71.6 ± 14.8) and Tegner activity (4, range 3-9) scores were reported at final follow-up. Of all patients, 21(75%) and 19 (67.9%) reached or exceeded the PASS for the IKDC- and Lysholm score at final follow-up, respectively. The average overall MOCART 2.0 scores for all postoperatively performed MRIs (n = 23) was 62.3 ± 17.4. Four (14.2%) postoperative complications were directly linked to minced cartilage, one (3.5%) of which required revision surgery. CONCLUSION One-step, autologous minced cartilage repair of chondral and osteochondral lesions of the knee without the necessity for subchondral bone treatment demonstrated good patient-reported outcomes, low complication rates, and graft longevity at mid-term follow-up. Minced cartilage represents a viable treatment option to more traditional cartilage repair techniques even in mid-term. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Armin Runer
- Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Robert Ossendorff
- Department for Orthopaedics and Trauma, University Hospital Bonn, Bonn, Germany
| | - Felix Öttl
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Stefan Preiss
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Gian M Salzmann
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Jakob Hax
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
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Johnson EE, Campbell MP, Reddy M, Paul RW, Erickson BJ, Tjoumakaris FP, Freedman KB, Bishop ME. Differences in the Severity and Location of Patellofemoral Cartilage Damage Between Instability Patients With and Without Patella Alta. Orthop J Sports Med 2023; 11:23259671231186823. [PMID: 37533500 PMCID: PMC10392508 DOI: 10.1177/23259671231186823] [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: 03/08/2023] [Accepted: 04/11/2023] [Indexed: 08/04/2023] Open
Abstract
Background Patella alta is a risk factor for recurrent patellar instability. Differences in chondral injury in patients with patellar instability between patella alta and patella norma have not been evaluated. Purpose To analyze whether preoperative cartilage damage differs in severity and location between patellar instability patients with and without patella alta. Study Design Cohort study; Level of evidence, 3. Methods Patients with patellar instability who underwent patellar realignment surgery at a single institution with preoperative magnetic resonance imaging (MRI) scans were included. After measurement of Caton-Deschamps index (CDI) on MRI, patients were divided into patella alta (CDI ≥1.3) and patella norma groups. The area measurement and depth and underlying structures (AMADEUS) score was used to quantify cartilage defect severity on MRI. Results A total of 121 patients were divided into patella alta (n = 50) and patella norma (n = 71) groups. The groups did not differ significantly in sex ratio, age at MRI, body mass index, mean reported number of previous dislocations, or mean interval between first reported dislocation and date of MRI. A total of 34 (68%) of the patella alta group and 44 (62%) of the patella norma group had chondral defects (P = .625) with no significant between-group differences in defect size (P = .419). In both groups, chondral injuries most affected the medial patellar facet (55% in patella alta vs 52% in patella norma), followed by the lateral facet (25% vs 18%), and lateral femoral condyle (10% vs 14%). A smaller proportion of patients had full-thickness defects in the patella alta compared with the patella norma group (60% vs 82%; P = .030). The overall AMADEUS score was higher for the patella alta versus the patella norma group (68.9 vs 62.1; P = .023), indicating superior articular cartilage status. Conclusion Patients with patella alta had less severe cartilage injury after patellar instability, including a lower proportion with full-thickness defects and better overall cartilage grade. The location of injury when present was similar between alta and norma, with most defects affecting the medial facet, lateral facet, and lateral femoral condyle in descending frequency.
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Affiliation(s)
- Emma E. Johnson
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Manoj Reddy
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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McCarthy HS, Tins B, Gallacher PD, Jermin P, Richardson JB, Kuiper JH, Roberts S. Histological and Radiological Assessment of Endogenously Generated Repair Tissue In Vivo Following a Chondral Harvest. Cartilage 2023; 14:48-58. [PMID: 36704827 PMCID: PMC10076898 DOI: 10.1177/19476035221149523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To examine repair tissue formed approximately 15 months after a chondral harvest in the human knee. DESIGN Sixteen individuals (12 males, 4 females, mean age 36 ± 9 years) underwent a chondral harvest in the trochlea as a pre-requisite for autologous chondrocyte implantation (ACI) treatment. The harvest site was assessed via MRI at 14.3 ± 3.2 months and arthroscopy at 15 ± 3.5 months (using the Oswestry Arthroscopy Score [O-AS] and the International Cartilage Repair Society Arthroscopy Score [ICRS-AS]). Core biopsies (1.8 mm diameter, n = 16) of repair tissue obtained at arthroscopy were assessed histologically (using the ICRS II and OsScore histology scores) and examined via immunohistochemistry for the presence of collagen types I and II. RESULTS The mean O-AS and ICRS-AS of the repaired harvest sites were 7.2 ± 3.2 and 10.1 ± 3.5, respectively, with 80.3% ± 26% repair fill depth on MRI. The histological quality of the repair tissue formed was variable, with some hyaline cartilage present in 50% of the biopsies; where this occurred, it was associated with a significantly higher ICRS-AS than those with no hyaline cartilage present (median 11 vs. 7.5, P = 0.049). Collagen types I and II were detected in 12/14 and 10/13 biopsies, respectively. CONCLUSIONS We demonstrate good-quality structural repair tissue formed following cartilage harvest in ACI, suggesting this site can be useful to study endogenous cartilage repair in humans. The trochlea is less commonly affected by osteoarthritis; therefore, location may be critical for spontaneous repair. Understanding the mechanisms and factors influencing this could improve future treatments for cartilage defects.
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Affiliation(s)
- Helen S McCarthy
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
- Centre for Regenerative Medicine Research, School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Bernhard Tins
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
| | - Peter D Gallacher
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
| | - Paul Jermin
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
| | - James B Richardson
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
- Centre for Regenerative Medicine Research, School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Jan Herman Kuiper
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
- Centre for Regenerative Medicine Research, School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Sally Roberts
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
- Centre for Regenerative Medicine Research, School of Pharmacy and Bioengineering, Keele University, Keele, UK
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Heinz T, Meller F, Luetkens KS, Anderson PM, Stratos I, Horas K, Rudert M, Reppenhagen S, Weißenberger M. The AMADEUS score is not a sufficient predictor for functional outcome after high tibial osteotomy. J Exp Orthop 2023; 10:9. [PMID: 36705820 PMCID: PMC9883369 DOI: 10.1186/s40634-023-00575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The Area Measurement And Depth Underlying Structures (AMADEUS) classification system has been proposed as a valuable tool for magnetic resonance (MR)-based grading of preoperatively encountered chondral defects of the knee joint. However, the potential relationship of this novel score with clinical data was yet to determine. It was the primary intention of this study to assess the correlative relationship of the AMADEUS with patient reported outcome scores in patients undergoing medial open-wedge high tibial valgus osteotomy (HTO). Furthermore, the arthroscopic ICRS (International Cartilage Repair Society) grade evaluation was tested for correlation with the AMADEUS classification system. METHODS This retrospective, monocentric study found a total of 70 individuals that were indicated for HTO due to degenerative chondral defects of the medial compartment between 2008 and 2019. A preoperative MR image as well as a pre-osteotomy diagnostic arthroscopy for ICRS grade evaluation was mandatory for all patients. The Knee Osteoarthritis Outcome Score (KOOS) including its five subscale scores (KOOS-ADL, KOOS-QOL, KOOS-Sports, KOOS-Pain, KOOS-Symptoms) was obtained preoperatively and at a mean follow-up of 41.2 ± 26.3 months. Preoperative chondral defects were evaluated using the AMADEUS classification system and the final AMADEUS scores were correlated with the pre- and postoperative KOOS subscale sores. Furthermore, arthroscopic ICRS defect severity was correlated with the AMADEUS classification system. RESULTS There was a statistically significant correlation between the AMADEUS BME (bone marrow edema) subscore and the KOOS Symptoms subscore at the preoperative visit (r = 0.25, p = 0.04). No statistically significant monotonic association between the AMADEUS total score and the AMADEUS grade with pre- and postoperative KOOS subscale scores were found. Intraoperatively obtained ICRS grade did reveal a moderate correlative relation with the AMADEUS total score and the AMADEUS grade (r = 0.28, p = 0.02). CONCLUSIONS The novel AMADEUS classification system largely lacks correlative capacity with patient reported outcome measures in patients undergoing HTO. The MR tomographic appearance of bone marrow edema is the only parameter predictive of the clinical outcome at the preoperative visit.
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Affiliation(s)
- Tizian Heinz
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Felix Meller
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Karsten Sebastian Luetkens
- grid.411760.50000 0001 1378 7891Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany
| | - Philip Mark Anderson
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Ioannis Stratos
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Konstantin Horas
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Maximilian Rudert
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Stephan Reppenhagen
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Manuel Weißenberger
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
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Neubauer M, Moser L, Neugebauer J, Raudner M, Wondrasch B, Führer M, Emprechtinger R, Dammerer D, Ljuhar R, Salzlechner C, Nehrer S. Artificial-Intelligence-Aided Radiographic Diagnostic of Knee Osteoarthritis Leads to a Higher Association of Clinical Findings with Diagnostic Ratings. J Clin Med 2023; 12:jcm12030744. [PMID: 36769394 PMCID: PMC9917552 DOI: 10.3390/jcm12030744] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Radiographic knee osteoarthritis (OA) severity and clinical severity are often dissociated. Artificial intelligence (AI) aid was shown to increase inter-rater reliability in radiographic OA diagnosis. Thus, AI-aided radiographic diagnoses were compared against AI-unaided diagnoses with regard to their correlations with clinical severity. METHODS Seventy-one DICOMs (m/f = 27:42, mean age: 27.86 ± 6.5) (X-ray format) were used for AI analysis (KOALA software, IB Lab GmbH). Subjects were recruited from a physiotherapy trial (MLKOA). At baseline, each subject received (i) a knee X-ray and (ii) an assessment of five main scores (Tegner Scale (TAS); Knee Injury and Osteoarthritis Outcome Score (KOOS); International Physical Activity Questionnaire; Star Excursion Balance Test; Six-Minute Walk Test). Clinical assessments were repeated three times (weeks 6, 12 and 24). Three physicians analyzed the presented X-rays both with and without AI via KL grading. Analyses of the (i) inter-rater reliability (IRR) and (ii) Spearman's Correlation Test for the overall KL score for each individual rater with clinical score were performed. RESULTS We found that AI-aided diagnostic ratings had a higher association with the overall KL score and the KOOS. The amount of improvement due to AI depended on the individual rater. CONCLUSION AI-guided systems can improve the ratings of knee radiographs and show a stronger association with clinical severity. These results were shown to be influenced by individual readers. Thus, AI training amongst physicians might need to be increased. KL might be insufficient as a single tool for knee OA diagnosis.
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Affiliation(s)
- Markus Neubauer
- Danube University Krems, Center for Regenerative Medicine, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Karl Landsteiner University of Health Sciences, Department for Orthopedics and Traumatology, University Hospital Krems, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Lukas Moser
- Danube University Krems, Center for Regenerative Medicine, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Karl Landsteiner University of Health Sciences, Department for Orthopedics and Traumatology, University Hospital Krems, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Johannes Neugebauer
- Danube University Krems, Center for Regenerative Medicine, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Karl Landsteiner University of Health Sciences, Department for Orthopedics and Traumatology, University Hospital Krems, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Marcus Raudner
- Medical University of Vienna, High-Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Währinger-Gürtel 18-20, 1090 Vienna, Austria
| | - Barbara Wondrasch
- Department of Health and Social Sciences, St. Poelten University of Applied Sciences, Campus-Platz 1, 3100 St. Poelten, Austria
| | - Magdalena Führer
- Department of Health and Social Sciences, St. Poelten University of Applied Sciences, Campus-Platz 1, 3100 St. Poelten, Austria
| | - Robert Emprechtinger
- Danube University Krems, Center for Regenerative Medicine, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
| | - Dietmar Dammerer
- Karl Landsteiner University of Health Sciences, Department for Orthopedics and Traumatology, University Hospital Krems, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Richard Ljuhar
- ImageBiopsy Lab GmbH, Zehetnergasse 6/2/2, 1140 Vienna, Austria
| | | | - Stefan Nehrer
- Danube University Krems, Center for Regenerative Medicine, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria
- Karl Landsteiner University of Health Sciences, Department for Orthopedics and Traumatology, University Hospital Krems, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Correspondence:
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Sieroń D, Jabłońska I, Niemiec P, Lukoszek D, Szyluk K, Platzek I, Meusburger H, Delimpasis G, Christe A. Relationship between Outerbridge Scale and Chondropathy Femorotibial Joint in Relation to Gender and Age-The Use of 1.5T and 3.0T MRI Scanners. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111634. [PMID: 36422173 PMCID: PMC9697703 DOI: 10.3390/medicina58111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Background and Objective: Magnetic resonance imaging (MRI) enables the effective evaluation of chondromalacia of the knee joint. Cartilage disease is affected by many factors, including gender, age, and body mass index (BMI). The aim of this study was to check the relationship between the severity of chondromalacia of the femoro-tibial joint and age, gender, and BMI assessed with 1.5T and 3.0T MRI scanners. Materials and Methods: The cross-observational study included 324 patients—159 (49%) females and 165 (51%) males aged 8−87 (45.1 ± 20.9). The BMI of study group was between 14.3 and 47.3 (27.7 ± 5.02). 1.5T and 3.0T MRI scanners were used in the study. The articular cartilage of the knee joint was assessed using the Outerbridge scale. Results: The age of the patients showed a significant correlation with Outerbrige for each compartment of the femorotibial joint (Spearman’s rank correlation rho: 0.69−0.74, p < 0.0001). A higher correlation between BMI and Outerbridge was noted in the femur medial (rho = 0.45, p < 0.001) and the tibia medial (rho = 0.43, p < 0.001) than in the femur lateral (rho = 0.29, p < 0.001) and the tibia lateral compartment (rho = 0.34, p < 0.001). Conclusions: The severity of chondromalacia significantly depends on age and BMI level, regardless of gender.
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Affiliation(s)
- Dominik Sieroń
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
- Correspondence:
| | - Izabella Jabłońska
- Recreation and Treatment Center “Glinik” 1, Wysowa-Zdrój 101 str, 38-316 Wysowa-Zdrój, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752 Katowice, Poland
| | - Dawid Lukoszek
- Dawid Lukoszek Physiotherapy Osteopathy, 42-690 Hanusek, Poland
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940 Piekary Śląskie, Poland
| | - Ivan Platzek
- Department of Radiology, Dresden University Hospital, Fetscherstr. 74, 01307 Dresden, Germany
| | - Hugo Meusburger
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Georgios Delimpasis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Andreas Christe
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
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17
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Yanke AB, Hevesi M, Dandu N, Trasolini NA, Darwish RY, Zavras AG, Cole BJ. After Chondroplasty, Patient Election to Proceed With Cartilage Transplantation Is Closely and Additively Associated With Preoperative AMADEUS (Area Measurement And DEpth Underlying Structure) Grade, Condylar Involvement, Knee Injury and Osteoarthritis Outcome Score Pain Score, and Veterans Rand 12-Item Health Survey Physical Score. Arthrosc Sports Med Rehabil 2022; 4:e1903-e1912. [PMID: 36579045 PMCID: PMC9791869 DOI: 10.1016/j.asmr.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose To identify risk factors for patient election to proceed with cartilage transplant after staging chondroplasty. Methods This study retrospective reviewed patients prospectively enrolled at the time of staging chondroplasty, with early election defined as patient decision to proceed to cartilage transplantation within 6 months of chondroplasty. Cox proportional hazards analysis was used to determine univariate predictors of conversion, and a predictive calculator, the Cartilage Early Return for Transplant score, was formulated using stepwise regression employing the Akaike information criterion. Receiver operator curves and the area under the curve were used to evaluate the predictive ability of the final model on the studied patient population. Results Sixty-five knees (63 patients) were evaluated, with an overall transplant election rate of 27.7% within 6 months after chondroplasty. Based on multivariate results, the final Akaike information criterion-driven Cartilage Early Return for Transplant score employed preoperative Knee Injury and Osteoarthritis Outcome Score Pain Score, Veterans Rand 12-Item Health Survey Physical Score, condylar involvement, and AMADEUS (Area Measurement And DEpth Underlying Structure) score to generate a 0- to 7-point risk-stratification system with a 3% early election to proceed to transplant risk in the 0- to 2-point score group, 33% risk in the 3- to 4-point group, and 79% risk in the 5+-point group (P < .01) and an overall AUC of 0.906 (P < .01). Conclusions Risk of early patient election to pursue cartilage transplantation after chondroplasty is closely and additively associated with preoperative AMADEUS grade, condylar involvement, Knee Injury and Osteoarthritis Outcome Score Pain Score, and Veterans Rand 12-Item Health Survey Physical Score. Clinical Relevance Understanding risk factors for conversion to cartilage transplantation may improve preoperative planning and counseling prior to staging chondroplasty.
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Affiliation(s)
- Adam B. Yanke
- Address correspondence to Adam B. Yanke, M.D., Ph.D., 1611 W. Harrison St., St 300, Chicago, IL 60612.
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18
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Jung M, Ruschke S, Karampinos DC, Holwein C, Baum T, Gersing AS, Bamberg F, Jungmann PM. The Predictive Value of Early Postoperative MRI-Based Bone Marrow Parameters for Mid-Term Outcome after MACI with Autologous Bone Grafting at the Knee. Cartilage 2022; 13:19476035221093061. [PMID: 35993371 PMCID: PMC9393675 DOI: 10.1177/19476035221093061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to longitudinally determine the prognostic value of early postoperative quantitative 3T-MRI (magnetic resonance imaging) parameters of subchondral bone marrow for 2-year clinical and MRI outcome after matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) at the knee. DESIGN Consecutive subjects who received MACI with ABG for treatment of focal osteochondral defects received MRI follow-up 3, 6, 12, and 24 months postoperatively. Quantitative MRI included bone marrow edema-like lesion (BMEL) volume measurements and single-voxel magnetic resonance spectroscopy (MRS; n = 9) of the subchondral bone marrow. At 2-year follow-up, morphological MRI outcome included MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. Clinical outcomes were assessed using Lysholm scores. RESULTS Among a total of 18 subjects (mean age: 28.7 ± 8.4 years, n = 14 males) with defects at the medial or lateral (n = 15 and n = 3, respectively) condyle, mean BMEL volume decreased from 4.9 cm3 at 3 months to 2.0 cm3 at 2-year follow-up (P = 0.040). MRS-based bone marrow water T2 showed a decrease from 20.7 ms at 1-year follow-up to 16.8 ms at 2-year follow-up (P = 0.040). Higher BMEL volume at 6 months correlated with lower 2-year Lysholm (R = -0.616, P = 0.015) and MOCART 2.0 scores (R = -0.567, P = 0.027). Larger early postoperative BMEL volumes at 3 months (R = -0.850, P = 0.007) and 6 months (R = -0.811, P = 0.008) correlated with lower MRS-based unsaturated lipid fractions at 2-year follow-up. Furthermore, patients with early postoperative bony defects showed worse MOCART 2.0 (P = 0.044) and Lysholm scores (P = 0.017) after 24 months. CONCLUSION Low subchondral BMEL volume and optimal restoration of the subchondral bone at early postoperative time points predict better 2-year clinical and MRI outcomes after MACI with ABG.
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Affiliation(s)
- Matthias Jung
- Department of Diagnostic and
Interventional Radiology, Medical Center—University of Freiburg, Faculty of
Medicine, University of Freiburg, Freiburg, Germany
- Matthias Jung, Department of Diagnostic and
Interventional Radiology, Medical Center—University of Freiburg, Faculty of
Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg,
Germany.
| | - Stefan Ruschke
- Department of Diagnostic and
Interventional Radiology, School of Medicine, Technical University of Munich,
Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and
Interventional Radiology, School of Medicine, Technical University of Munich,
Munich, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports
Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich,
Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum
Rechts der Isar, School of Medicine, Technical University of Munich, Munich,
Germany
| | - Alexandra S. Gersing
- Department of Diagnostic and
Interventional Radiology, School of Medicine, Technical University of Munich,
Munich, Germany
- Department of Neuroradiology,
University Hospital, LMU Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and
Interventional Radiology, Medical Center—University of Freiburg, Faculty of
Medicine, University of Freiburg, Freiburg, Germany
| | - Pia M. Jungmann
- Department of Diagnostic and
Interventional Radiology, Medical Center—University of Freiburg, Faculty of
Medicine, University of Freiburg, Freiburg, Germany
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19
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Can the MRI based AMADEUS score accurately assess pre-surgery chondral defect severity according to the ICRS arthroscopic classification system? J Exp Orthop 2022; 9:83. [PMID: 35986190 PMCID: PMC9391552 DOI: 10.1186/s40634-022-00511-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
The AMADEUS (Area Measurement And DEpth and Underlying Structures) scoring and grading system has been proposed for the MRI based evaluation of untreated focal chondral defects around the knee. The clinical practicability, its correlation with arthroscopically assessed grading systems (ICRS – International Cartilage Repair Society) and thereby its clinical value in terms of decision making and guiding prognosis was yet to determine.
Methods
From 2008 to 2019 a total of 89 individuals were indicated for high tibial valgus osteotomy (HTO) due to tibial varus deformity and concomitant chondral defects of the medial compartment of the knee. All patients received a preoperative MRI (1.5 Tesla or 3.0 Tesla) and pre-osteotomy diagnostic arthroscopy. Chondral defects of the medial compartment were scored and graded with the MRI based AMADEUS by three independent raters and compared to arthroscopic defect grading by the ICRS system. Interrater and intrarater reliability as well as correlation analysis with the ICRS classification system were assessed.
Results
Intraclass correlation coefficients for the various subscores of the AMADEUS showed an overall good to excellent interrater agreement (min: 0.26, max: 0.80). Intrarater agreement turned out to be substantially inferior (min: 0.08, max: 0.53). Spearman correlation revealed an overall moderate correlative association of the AMADEUS subscores with the ICRS classification system, apart from the defect area subscore. Sensitivity of the AMADEUS to accurately identify defect severity according to the ICRS was 0.7 (0.69 for 3.0 Tesla MRI, 0.67 for 1.5 Tesla MRI). The mean AMADEUS grade was 2.60 ± 0.81 and the mean ICRS score 2.90 ± 0.63.
Conclusions
Overall, the AMADEUS with all its subscores shows moderate correlation with the arthroscopic chondral grading system according to ICRS. This suggests that chondral defect grading by means of the MRI based AMADEUS is well capable of influencing and guiding treatment decisions. Interrater reliability shows overall good agreement.
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20
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ICRS scores worsen between 2-year short term and 5-year mid-term follow-up after transtibial medial meniscus root repair despite maintained functional outcomes. Knee Surg Sports Traumatol Arthrosc 2022; 30:2235-2243. [PMID: 34652498 DOI: 10.1007/s00167-021-06747-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/14/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the mid-term results of posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and magnetic resonance imaging (MRI). METHODS This was a single-center, retrospective study evaluating patients that had undergone a PMMRT. This was a follow-up to a previously published 2-year outcome study (all original patients were invited to participate). Clinical outcomes included pre- and postoperative International Knee Documentation Committee (IKDC) and Lysholm scores. Root healing, meniscal extrusion, and cartilage degeneration via International Cartilage Repair Society Scale (ICRS) grades were assessed on MRI by two musculoskeletal fellowship-trained radiologists. RESULTS 10 of the original study's 18 patients were able to participate. Mean age and BMI was 48.4 ± 12.0 years and 29.5 ± 4.5, respectively, with mean follow-up 65.5 ± 8.3 months (range 52.0-75.8) (60% female). The IKDC significantly increased from 43 ± 13 preoperatively to 75 ± 16 at 5-year follow-up (p < 0.001). There was no significant change in IKDC score between 2-year and 5-year follow-up [75 ± 16 vs 73 ± 20, (n.s)]. The Lysholm also significantly increased between preoperative and 5-year follow-up (49 ± 7 vs 84 ± 11, p < 0.001). There was no significant change between Lysholm score at 2-year and 5-year follow-up [84.0 ± 11 vs 82 ± 13, (n.s)]. Mean extrusion did not significantly change from the preoperative state to 5-year follow-up [4.80 mm ± 1.9 vs 5.0 mm ± 2.5, (n.s.)]. Extrusion also did not significantly change between 2-and 5-year follow-up [6.1 ± 3.2 mm vs 5.0 mm ± 2.5, (n.s.)]. No patients with > 3 mm of extrusion on preoperative MRI had < 3 mm of extrusion on postoperative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades significantly increased from preoperative to 2-year follow-up (p = 0.038, p = 0.023, respectively). Medial femoral condyle and medial tibial plateau ICRS grades again significantly increased between 2-year and 5-year follow-up (p = 0.014, p = 0.034). CONCLUSION Patients treated with the transtibial suture pullout technique with two locking cinch sutures had maintenance of clinical outcome improvements at 5-year follow-up. However, extrusion was widely prevalent, with worsening progression of femoral and tibial chondral disease. LEVEL OF EVIDENCE Level 4.
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21
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Schagemann JC, Galle L, Gille J, Frydrychowicz A, Welsch G, Salzmann G, Paech A, Mittelstaedt H. Correlation of the Histological ICRS II Score and the 3D MOCART Score for the Analysis of Aged Osteochondral Regenerates in a Large Animal Model. Cartilage 2022; 13:19476035211072254. [PMID: 35176894 PMCID: PMC9137325 DOI: 10.1177/19476035211072254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Reliable outcome measures are essential to predict the success of cartilage repair techniques. Histology is probably the gold standard, but magnetic resonance imaging (MRI) has the potential to decrease the need for invasive histological biopsies. The 3D magnetic resonance observation of cartilage repair tissue (MOCART) score is a reliable yet elaborate tool. Moreover, literature is controversial concerning the correlation of histology and MRI. DESIGN To test the applicability of the International Cartilage Regeneration and Joint Preservation Society (ICRS) II and MOCART 3D score for the evaluation of aged osteochondral regenerates in a large animal model, and to identify correlating histological and MRI parameters. Osteochondral defects in medial femoral condyles of n = 12 adult sheep were reconstructed with biodegradable bilayer implants. About 19.5 months postoperation, n = 10 joints were analyzed with MRI (3D MOCART score). Histological samples were analyzed using the ICRS II score; both pre- and post-training. The intraclass correlation coefficient, the inter-rater reliability, and the 95% confidence interval were calculated. Matching histological and MRI parameters were tested for correlation. RESULTS We found a statistically significant correlation of all histological parameters. MRI parameters reflecting "overall" assessments had very strong inter-rater correlations. Statistically significant strong correlations were found for the MRI parameters defect filling, cartilage interface, bone interface, and surface. For defect overall (MRI) and overall assessment (ICRS II), we found a significant yet mild correlation. CONCLUSIONS The ICRS II and the 3D MOCART score are applicable to aged osteochondral regenerates. Prior training on the scoring systems is essential. Select MRI and histological parameters correlate; however, the only statistically significant correlation was found for overall assessment.
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Affiliation(s)
- J C Schagemann
- Medicine Section, University of Lübeck, Lübeck, Germany.,Christophorus-Kliniken, Coesfeld, Germany
| | - L Galle
- Medicine Section, University of Lübeck, Lübeck, Germany
| | - J Gille
- Medicine Section, University of Lübeck, Lübeck, Germany
| | - A Frydrychowicz
- Department of Radiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - G Welsch
- UKE Athleticum-Center for Athletic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Salzmann
- Gelenkzentrum Rhein-Main, Frankfurt, Germany
| | - A Paech
- Department for Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - H Mittelstaedt
- Department for Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Lübeck, Germany
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22
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Ryu J, Brittberg M, Nam B, Chae J, Kim M, Colon Iban Y, Magneli M, Takahashi E, Khurana B, Bragdon CR. Evaluation of Three-Dimensional Bioprinted Human Cartilage Powder Combined with Micronized Subcutaneous Adipose Tissues for the Repair of Osteochondral Defects in Beagle Dogs. Int J Mol Sci 2022; 23:ijms23052743. [PMID: 35269885 PMCID: PMC8910734 DOI: 10.3390/ijms23052743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 12/04/2022] Open
Abstract
Cartilage lesions are difficult to repair due to low vascular distribution and may progress into osteoarthritis. Despite numerous attempts in the past, there is no proven method to regenerate hyaline cartilage. The purpose of this study was to investigate the ability to use a 3D printed biomatrix to repair a critical size femoral chondral defect using a canine weight-bearing model. The biomatrix was comprised of human costal-derived cartilage powder, micronized adipose tissue, and fibrin glue. Bilateral femoral condyle defects were treated on 12 mature beagles staged 12 weeks apart. Four groups, one control and three experimental, were used. Animals were euthanized at 32 weeks to collect samples. Significant differences between control and experimental groups were found in both regeneration pattern and tissue composition. In results, we observed that the experimental group with the treatment with cartilage powder and adipose tissue alleviated the inflammatory response. Moreover, it was found that the MOCART score was higher, and cartilage repair was more organized than in the other groups, suggesting that a combination of cartilage powder and adipose tissue has the potential to repair cartilage with a similarity to normal cartilage. Microscopically, there was a well-defined cartilage-like structure in which the mid junction below the surface layer was surrounded by a matrix composed of collagen type I, II, and proteoglycans. MRI examination revealed significant reduction of the inflammation level and progression of a cartilage-like growth in the experimental group. This canine study suggests a promising new surgical treatment for cartilage lesions.
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Affiliation(s)
- Jina Ryu
- ROKIT Healthcare Inc., Seoul 08514, Korea; (J.R.); (B.N.); (J.C.); (M.K.)
| | - Mats Brittberg
- Cartilage Research Unit, Joint Restoration Center, University of Gothenburg, 41345 Gothenburg, Sweden;
- Region Halland Orthopaedics, Kungsbaka Hospital, 43440 Kungsbacka, Sweden
| | - Bomi Nam
- ROKIT Healthcare Inc., Seoul 08514, Korea; (J.R.); (B.N.); (J.C.); (M.K.)
| | - Jinyeong Chae
- ROKIT Healthcare Inc., Seoul 08514, Korea; (J.R.); (B.N.); (J.C.); (M.K.)
| | - Minju Kim
- ROKIT Healthcare Inc., Seoul 08514, Korea; (J.R.); (B.N.); (J.C.); (M.K.)
| | - Yhan Colon Iban
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.C.I.); (M.M.); (E.T.)
| | - Martin Magneli
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.C.I.); (M.M.); (E.T.)
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, 18288 Stockholm, Sweden
| | - Eiji Takahashi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.C.I.); (M.M.); (E.T.)
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
- Department of Orthopaedic Surgery, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Bharti Khurana
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Charles R. Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.C.I.); (M.M.); (E.T.)
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
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23
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Jena A, Taneja S, Rana P, Goyal N, Vaish A, Botchu R, Vaishya R. Emerging role of integrated PET-MRI in osteoarthritis. Skeletal Radiol 2021; 50:2349-2363. [PMID: 34185124 DOI: 10.1007/s00256-021-03847-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a common degenerative disorder of the articular cartilage, which is associated with hypertrophic changes in the bone, synovial inflammation, subchondral sclerosis, and joint space narrowing (JSN). Radiography remains the first line of imaging till now. Due to the lack of soft-tissue depiction in radiography, researchers are exploring various imaging techniques to detect OA at an early stage and understand its pathophysiology to restrict its progression and discover disease-modifying agents in OA. As the OA relates to the degradation of articular cartilage and remodeling of the underlying bone, an optimal imaging tool must be sensitive to the bone and soft tissue health. In that line, many non-invasive imaging and minimally invasive techniques have been explored. Out of these, the non-invasive compositional magnetic resonance imaging (MRI) for evaluation of the integrity of articular cartilage and positron emission tomography (PET) scan with fluorodeoxyglucose (FDG) and more specific bone-seeking tracer like sodium fluoride (18F-NaF) for bone cartilage interface are some of the leading areas of ongoing work. Integrated PET-MRI system, a new hybrid modality that combines the virtues of the above two individual modalities, allows detailed imaging of the entire joint, including soft tissue cartilage and bone, and holds great potential to research complex disease processes of OA. This narrative review attempts to signify individual characteristics of MRI, PET, the fusion of these characteristics in PET-MRI, and the ongoing research on PET-MRI as a potential tool to understand the pathophysiology of OA.
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Affiliation(s)
- Amarnath Jena
- PET SUITE (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Sangeeta Taneja
- PET SUITE (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Prerana Rana
- PET SUITE (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India.,Apollo Hospitals Education & Research Foundation, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Nidhi Goyal
- Department of Radiodiagnosis and Imaging, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
| | - Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
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Salzmann GM, Ossendorff R, Gilat R, Cole BJ. Autologous Minced Cartilage Implantation for Treatment of Chondral and Osteochondral Lesions in the Knee Joint: An Overview. Cartilage 2021; 13:1124S-1136S. [PMID: 32715735 PMCID: PMC8808955 DOI: 10.1177/1947603520942952] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cartilage defects in the knee are being diagnosed with increased frequency and are treated with a variety of techniques. The aim of any cartilage repair procedure is to generate the highest tissue quality, which might correlate with improved clinical outcomes, return-to-sport, and long-term durability. Minced cartilage implantation (MCI) is a relatively simple and cost-effective technique to transplant autologous cartilage fragments in a single-step procedure. Minced cartilage has a strong biologic potential since autologous, activated non-dedifferentiated chondrocytes are utilized. It can be used both for small and large cartilage lesions, as well as for osteochondral lesions. As it is purely an autologous and homologous approach, it lacks a significant regulatory oversight process and can be clinically adopted without such limitations. The aim of this narrative review is to provide an overview of the current evidence supporting autologous minced cartilage implantation.
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Affiliation(s)
- Gian M. Salzmann
- Gelenkzentrum Rhein-Main, Wiesbaden,
Germany,Lower Extremity Orthopaedics,
Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland
| | - Robert Ossendorff
- Clinic for Orthopaedics and Trauma
Surgery, University Hospital Bonn, Bonn, Germany,Robert Ossendorff, Clinic for Orthopaedics
and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127,
Germany.
| | - Ron Gilat
- Midwest Orthopaedics at Rush, Rush
University Medical Center, Chicago, IL, USA
| | - Brian J. Cole
- Midwest Orthopaedics at Rush, Rush
University Medical Center, Chicago, IL, USA
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Betzler BK, Bin Muhammad Ridzwan Chew AH, Bin Abd Razak HR. Intra-articular injection of orthobiologics in patients undergoing high tibial osteotomy for knee osteoarthritis is safe and effective - a systematic review. J Exp Orthop 2021; 8:83. [PMID: 34568999 PMCID: PMC8473486 DOI: 10.1186/s40634-021-00387-2] [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: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose To qualitatively evaluate the current evidence reporting outcomes of intra-articular injection of orthobiologics in patients undergoing high tibial osteotomy (HTO) for osteoarthritis of the knee. Methods A systematic search methodology of the PUBMED, EMBASE, and CINAHL databases was conducted in July 2021. The search workflow was in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following inclusion criteria were adopted: clinical trials of any level of evidence, reporting outcomes following intra-articular injection of orthobiologics during high tibial osteotomy for knee osteoarthritis, with a minimum number of 10 patients treated. Duplicate data, studies on implanted orthobiologics and articles not written in English were excluded from this review. Results Eight studies were included in this review, with a total of 585 patients. Outcomes were discussed based on the types of orthobiologics used: (i) Platelet-Rich Plasma (PRP), (ii) Bone Marrow Aspirate Concentrate (BMAC), and (iii) Injected Mesenchymal Stem Cells (MSCs). Two studies utilised PRP, 4 studies utilised BMAC and 4 studies utilised injected MSCs.. Three studies provided Level II evidence and five studies provided Level III evidence. Statistically significant improvements in outcomes were documented in multiple trials, with few patients experiencing adverse events. Conclusion Intra-articular injection of orthobiologics in patients undergoing HTO is safe and effective with good outcomes reported. Due to the lack of high-level evidence, further research is required before this can be considered standard of care. Level of evidence III
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Affiliation(s)
- Brjan Kaiji Betzler
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore
| | | | - Hamid Rahmatullah Bin Abd Razak
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore. .,SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, 20 College Road, Academia Level 4, Singapore, 169865, Singapore.
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Ossendorff R, Walter SG, Salzmann GM. [Patellofemoral cartilage repair]. SPORTVERLETZUNG-SPORTSCHADEN 2021; 35:202-209. [PMID: 34474494 DOI: 10.1055/a-1491-2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Anterior knee pain is a frequent symptom in young athletes. Symptomatic patellofemoral cartilage defects can occur after trauma, especially after patellar dislocation. Numerous cartilage repair methods are currently available. Due to co-pathologies, the outcome after patellofemoral cartilage repair is inferior to the treatment of cartilage defects of the tibiofemoral joint. Adequate addressing of coexisting pathologies is essential for treatment success. This review provides an overview of the different techniques of patellofemoral cartilage repair.
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López-Bravo MD, Zamarrón-Cassinello MD, Touche RL, Muñoz-Plata R, Cuenca-Martínez F, Ramos-Toro M. Psychological Factors Associated with Functional Disability in Patients with Hip and Knee Osteoarthritis. Behav Med 2021; 47:285-295. [PMID: 32910744 DOI: 10.1080/08964289.2020.1813682] [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: 10/23/2022]
Abstract
Several studies have shown an association between psychosocial variables and functional capacity in chronic pain processes such as osteoarthritis. The aim of this study was to test a structural equations model that shows the predictive weight of certain variables such as catastrophizing, self-efficacy and kinesiophobia on functional pain and WOMAC subscales scores of pain and physical function of older patients diagnosed with hip and knee osteoarthritis. We also assessed the specific weight of age in terms of the factors. The study was conducted on a sample of 170 patients (142 women and 28 men mean age, 74.44 years range, 50-96 years). The main variables evaluated were WOMAC subscales scores of pain and physical function, self-efficacy, catastrophizing and kinesiophobia. To assess these variables, we used the Spanish validated version of the Western Ontario and McMaster Universities questionnaire, the Chronic Pain Self-Efficacy Scale, the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia, respectively. We tested a structural equations model (IBM SPSS Amos version 22). The results showed the predominant predictive weight (both direct and indirect) of catastrophizing while simultaneously ruling out the relevance of age as a predictor of WOMAC subscales scores of pain and physical function. This study provides data of interest on the explanatory mechanisms that underlie the direct and inverse relationships between the studied psychological variables.
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Affiliation(s)
- María Dolores López-Bravo
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Dolores Zamarrón-Cassinello
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid Ciudad Universitaria de Cantoblanco, Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Rosa Muñoz-Plata
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mónica Ramos-Toro
- Instituto de Gerontología y Servicios Sociales (INGESS), Madrid, Spain
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Lee SM, Bin SI, Kim JM, Lee BS, Suh KT, Park JG. Meniscal Deficiency Period and High Body Mass Index Are Preoperative Risk Factors for Joint Space Narrowing After Meniscal Allograft Transplantation. Am J Sports Med 2021; 49:693-699. [PMID: 33560864 DOI: 10.1177/0363546520982617] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several studies have reported further reduction in joint space width (JSW) after meniscal allograft transplantation; some contributing postoperative factors are known, although preoperative factors remain unclear. This study is the first to analyze the preoperative risk factors for reduced JSW in patients after lateral meniscal allograft transplantation (LMAT). HYPOTHESIS Poor cartilage status and high preoperative body mass index (BMI) influence the postoperative progression of joint space narrowing. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We retrospectively studied 79 patients after LMAT who were observed for at least 5 years. JSWs on weightbearing flexion posteroanterior radiographs were measured preoperatively and at the 5-year mark. Differences in JSW were divided into more progression and less progression groups. The modified Outerbridge cartilage grades based on magnetic resonance imaging assessments were compared at subtotal/total meniscectomy and at LMAT to determine the difference between time points. Preoperative between-group differences in sex, age, surgical side, follow-up period, weight, height, BMI, and meniscal deficiency period were analyzed. Clinical outcomes were evaluated using the Lysholm score. Data were examined using univariate and multivariate logistic regressions. RESULTS Radiographically, the overall change in JSW from preoperative to follow-up was 0.58 mm (range, -0.23 to 1.83 mm). Reductions in JSW in the more progression and less progression groups were 0.94 ± 0.32 and 0.22 ± 0.21 mm (mean ± SD), respectively. There was no difference in cartilage status between the groups at meniscectomy or LMAT; however, changes between time points were significant on the lateral femoral condyle and lateral tibial plateau. Clinically, there were significant differences in weight, BMI, and meniscal deficiency period between the 2 groups. Postoperative Lysholm scores increased as compared with the preoperative scores, but there was no difference among the postoperative time points. In the univariate logistic regression risk analysis, weight, BMI, meniscal deficiency period, and the difference in cartilage status between time points for the lateral femoral condyle and lateral tibial plateau were identified as significant. In the subsequent multivariate logistic regression, BMI (odds ratio, 1.45; P = .016) and meniscal deficiency period (odds ratio, 1.21; P = .037) were the statistically significant factors. CONCLUSION BMI and meniscal deficiency period were preoperative risk factors for JSW narrowing after LMAT. This suggests that the meniscal deficiency period from meniscectomy to LMAT may be shortened and that proper weight management can lead to successful LMAT.
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Affiliation(s)
- Sang-Min Lee
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Kuen Tak Suh
- Research Institute for Convergence of Biomedical Science and Technology, School of Medicine, Pusan National University, Yangsan, Republic of Korea.,Department of Orthopaedic Surgery, Sehung Hospital, Busan, Republic of Korea
| | - Jun-Gu Park
- Department of Orthopaedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
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Jung M, Karampinos DC, Holwein C, Suchowierski J, Diallo TD, Gersing AS, Bamberg F, Baumann FA, Ruschke S, Jungmann PM. Quantitative 3-T Magnetic Resonance Imaging After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting of the Knee: The Importance of Subchondral Bone Parameters. Am J Sports Med 2021; 49:476-486. [PMID: 33427489 DOI: 10.1177/0363546520980134] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) is an effective surgical treatment for osteochondral defects. Quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as noninvasive biomarkers to assess the biochemical composition of cartilage repair tissue. PURPOSE To evaluate the association of quantitative MRI parameters of cartilage repair tissue and subchondral bone marrow with magnetic resonance morphologic and clinical outcomes after MACI with ABG of the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS Qualitative and quantitative 3 T MRI of the knee was performed in 21 patients (16 male) at 2.5 years after MACI with ABG at the medial (18/21) or lateral (3/21) femoral condyle for the treatment of osteochondral defects. Morphologic MRI sequences were assessed using MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. T2 relaxation time measurements for the assessment of cartilage repair tissue (CRT2) were obtained. Single-voxel magnetic resonance spectroscopy was performed in underlying subchondral bone marrow (BM) and at both central femoral condyles. The presence of pain and Tegner scores were noted. Statistical analyses included Student t tests, correlation analyses, and multivariate regression models. RESULTS The mean defect size was 4.9 ± 1.9 cm2. At a follow-up of 2.5 ± 0.3 years, 9 of 21 patients were asymptomatic. Perfect defect filling was achieved in 66.7% (14/21) of patients. MOCART 2.0 scores (74.1 ± 18.4) did not indicate pain (68.3 ± 19.0 [pain] vs 81.7 ± 15.4 [no pain]; P = .102). However, knee pain was present in 85.7% (6/7) of patients with deep bony defects (odds ratio, 8.0; P = .078). Relative CRT2 was higher in hypertrophic cartilage repair tissue than in repair tissue with normal filling (1.54 ± 0.42 vs 1.13 ± 0.21, respectively; P = .022). The underlying BM edema-like lesion (BMEL) volume was larger in patients with underfilling compared with patients with perfect defect filling (1.87 ± 1.32 vs 0.31 ± 0.51 cm3, respectively; P = .002). Patients with severe pain showed a higher BMEL volume (1.2 ± 1.3 vs 0.2 ± 0.4 cm3, respectively; P = .046) and had a higher BM water fraction (26.0% ± 12.3% vs 8.6% ± 8.1%, respectively; P = .026) than did patients without pain. CONCLUSION Qualitative and quantitative MRI parameters including the presence of subchondral defects, CRT2, BMEL volume, and BM water fraction were correlated with cartilage repair tissue quality and clinical symptoms. Therefore, the integrity of subchondral bone was associated with outcomes after osteochondral transplantation.
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Affiliation(s)
- Matthias Jung
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Joachim Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Frederic A Baumann
- Department of Clinical and Interventional Angiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Ruschke
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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Abstract
Articular cartilage of the knee can be evaluated with high accuracy by magnetic resonance imaging (MRI) in preoperative patients with knee pain, but image quality and reporting are variable. This article discusses the normal MRI appearance of articular cartilage as well as the common MRI abnormalities of knee cartilage that may be considered for operative treatment. This article focuses on a practical approach to preoperative MRI of knee articular cartilage using routine MRI techniques. Current and future directions of knee MRI related to articular cartilage are also discussed.
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Affiliation(s)
| | - Akshay Chaudhari
- Department of Radiology, Stanford University, Stanford, California
| | - Robert D. Boutin
- Department of Radiology, Musculoskeletal Imaging, Stanford University School of Medicine, Stanford, California
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Jungmann PM, Gersing AS, Baumann F, Holwein C, Braun S, Neumann J, Zarnowski J, Hofmann FC, Imhoff AB, Rummeny EJ, Link TM. Cartilage repair surgery prevents progression of knee degeneration. Knee Surg Sports Traumatol Arthrosc 2019; 27:3001-3013. [PMID: 30542744 DOI: 10.1007/s00167-018-5321-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/04/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate, whether cartilage repair surgery for focal osteochondral defects at the knee results in less degenerative changes over 6 years in a MR imaging follow-up than morphologically initially identical defects in non-operated control subjects from the osteoarthritis initiative (OAI). METHODS A total of 32 individuals received baseline and follow-up MRI. In n = 16 patients with cartilage repair [osteochondral autograft transfer system (OATS), n = 12; spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI), n = 4] MRI was performed preoperatively and after 5.7 ± 2.3 year follow-up. Baseline MRIs of non-operated subjects from the OAI were screened for initially identical cartilage defects (n = 16). Morphological knee abnormalities were assessed using WORMS, AMADEUS and MOCART scores. A sagittal 2D MSME sequence was implemented for quantitative cartilage T2 relaxation time measurements in all (0, 2, 4, 6 and 8-years) follow-ups from the OAI and in the postoperative MRI protocol. RESULTS For both groups, focal osteochondral defects were located at the femoral condyle in 8/16 cases (5 medial, 3 lateral) and at the patella in 8/16 cases. At baseline, the mean cartilage defect size ± SD was 1.4 ± 1.3 cm2 for the control group and 1.3 ± 1.2 cm2 for the cartilage repair group (n.s.). WORMS scores were not significantly different between the cartilage repair group and the control group at baseline [mean difference ± SEM (95%CI); 0.5 ± 2.5 (- 4.7, 5.7), n.s.]. During identical follow-up times, the progression of total WORMS scores [19.9 ± 2.3 (15.0, 24.9), P < 0.001] and of cartilage defects scores in the affected (P < 0.001) and in the opposing (P = 0.029) compartment was significantly more severe in non-operated individuals (P < 0.05). In non-operated subjects, T2 values increased continuously from baseline to the 8-year follow-up (P = 0.001). CONCLUSIONS Patients with cartilage repair showed less progression of degenerative MRI changes at 6-year follow-up than a control cohort from the OAI with initially identical osteochondral defects. Patients with focal cartilage defects may profit from cartilage repair surgery since it may prevent progression of early osteoarthritis at the knee joint. LEVEL OF EVIDENCE Prognostic study, Level II.
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Affiliation(s)
- Pia M Jungmann
- Department of Neuroradiology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Frederic Baumann
- Clinical and Interventional Angiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christian Holwein
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- BG Unfallklinik Murnau, Prof.-Küntscher-Strasse 8, 82418, Murnau, Germany
| | - Sepp Braun
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Gelenkpunkt, Sports and Joint Surgery Innsbruck, Olympiastrasse 39, 6020, Innsbruck, Austria
| | - Jan Neumann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Julia Zarnowski
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Felix C Hofmann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Andreas B Imhoff
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas M Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
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Gersing AS, Schwaiger BJ, Wörtler K, Jungmann PM. [Advanced cartilage imaging for detection of cartilage injuries and osteochondral lesions]. Radiologe 2019; 58:422-432. [PMID: 29374314 DOI: 10.1007/s00117-017-0348-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Osteochondral defects represent a main risk factor for osteoarthritis of the ankle. OBJECTIVES The aim of this article is to provide an overview of current optimal clinical cartilage imaging techniques of the foot and ankle and to show typical osteochondral injuries on imaging. MATERIALS AND METHODS A thorough literature search was performed and was supported by personal experience. RESULTS Cartilage imaging of the foot and ankle remains challenging. However, advanced morphological and quantitative magnetic resonance (MR) imaging techniques may provide useful clinical information, for example, concerning cartilage repair surgery. Compared to MRI, MR arthrography (MR-A) and CT arthrography (CT-A) have higher sensitivity with respect to detection of osteochondral defects. Regarding smaller joints of the foot, mainly advanced osteoarthritic changes are detected on conventional radiography; only in rare cases, MR and CT imaging of these smaller joints is of relevance. CONCLUSIONS While at the smaller joints of the foot cartilage imaging only plays a minor role, at the ankle joint cross-sectional cartilage imaging using CT and MRI becomes more and more important for clinicians due to emerging therapeutic options, such as different osteochondral repair techniques.
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Affiliation(s)
- A S Gersing
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - B J Schwaiger
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - K Wörtler
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - P M Jungmann
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland. .,Klinik für Neuroradiologie, UniversitätsSpital Zürich, Universität Zürich, Frauenklinikstrasse 10, 8091, Zürich, Schweiz.
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Massen FK, Inauen CR, Harder LP, Runer A, Preiss S, Salzmann GM. One-Step Autologous Minced Cartilage Procedure for the Treatment of Knee Joint Chondral and Osteochondral Lesions: A Series of 27 Patients With 2-Year Follow-up. Orthop J Sports Med 2019; 7:2325967119853773. [PMID: 31223628 PMCID: PMC6566484 DOI: 10.1177/2325967119853773] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Chondral and osteochondral lesions are being detected with increasing frequency. For large-diameter lesions, cell-based treatment modalities are speculated to result in the best possible outcome. Purpose To prospectively evaluate the 2-year clinical and radiological results after the treatment of chondral and osteochondral knee joint lesions by a single-step autologous minced cartilage procedure. Study Design Case series; Level of evidence, 4. Methods From February 2015 to June 2016, a total of 27 consecutive patients suffering from chondral or osteochondral lesions of the knee joint were treated using a single-step autologous minced cartilage procedure. All patients underwent preoperative and postoperative magnetic resonance imaging for the collection of AMADEUS (Area Measurement and Depth and Underlying Structures) and MOCART (magnetic resonance observation of cartilage repair tissue) scores. Clinical analysis was conducted by a numeric analog scale (NAS) for pain and knee function before the intervention and at 12 and 24 months postoperatively. Results A total of 12 female and 15 male patients (mean age, 28.7 years) were evaluated for a mean of 28.2 ± 3.8 months. The mean cartilage defect size encountered intraoperatively was 3.1 ± 1.6 cm2. There was a significant decrease in pain from 7.2 ± 1.9 preoperatively to 1.8 ± 1.6 (P < .001) at 2-year follow-up. Knee function improved from a mean of 7.2 ± 2.0 preoperatively to 2.1 ± 2.3 (P < .001) at 2 years after surgery. The mean preoperative AMADEUS score was 57.4 ± 21.4. Postoperatively, the mean MOCART score was 40.6 ± 21.1 at 6-month follow-up. No correlation was observed between the clinical data and the MOCART or AMADEUS scores. Conclusion Overall, the findings of this study demonstrated that patients undergoing a single-step autologous minced cartilage procedure had a satisfactory outcome at 2-year follow-up. As a result, the single-step autologous minced cartilage procedure does represent a possible alternative to standard autologous chondrocyte implantation. Longer follow-up and larger cohorts are required to define the benefits of this procedure.
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Affiliation(s)
- Felix Kurt Massen
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Cyril Raphael Inauen
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Laurent Pascale Harder
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Armin Runer
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Stefan Preiss
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Gian Max Salzmann
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
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Runer A, Jungmann P, Welsch G, Kümmel D, Impellizzieri F, Preiss S, Salzmann G. Correlation between the AMADEUS score and preoperative clinical patient-reported outcome measurements (PROMs) in patients undergoing matrix-induced autologous chondrocyte implantation (MACI). J Orthop Surg Res 2019; 14:87. [PMID: 30902098 PMCID: PMC6431008 DOI: 10.1186/s13018-019-1107-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/19/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recently, the AMADEUS (Area Measurement And DEpth Underlying Structures) grading system has been introduced to evaluate and grade osteochondral lesions prior to cartilage surgery. The AMADEUS score has not been connected to clinical data in order to test a potential clincial impact. PURPOSE To examine the correlation between the AMADEUS score and preoperative patient-reported outcome measurements (PROMs). STUDY DESIGN Case series METHODS: Patients treated with matrix-induced autologous chondrocyte implantation (MACI) were included in the study, unless exclusion criteria like BMI > 35, prior extensive meniscectomy or ongoing inflammatory arthritis were present. Preoperative magnetic resonance (MR) examinations were graded according to the standardized AMADEUS protocol. The final AMADEUS score was correlated with preoperative patient-reported outcome measurements (PROMs), including the IKDC (International Knee Documentation Committee), the Lysholm score, the Short-Form-12 (SF-12) score, and the Core Outcome Measures Index (COMI) score. RESULTS A total of 50 patients with a mean age of 33.6 ± 11.5 years, a mean BMI of 25.1 ± 4.9, and a mean defect size of 2.3 ± 1.5 cm2 were included in the study. More severe cartilage defects, indicated by the AMADEUS grade (R = 0.35, p = 0.01) and the AMADEUS score (R = - 0.36, p = 0.01) as well as larger chondral defects (R = 0.32, p = 0.03) show a moderate correlation with the higher COMI scores. No correlative capacity was demonstrated for the AMADEUS score and the IKDC, Lysholm, and Tegner activity scores as well as for its subscales. CONCLUSION There is a moderate correlation of the COMI and the AMADEUS score in patients treated with matrix-induced autologous chondrocyte implantation (MACI). All other patient-reported outcome measurement scores (PROMs) show no evidence of an association to the magnetic resonance-based AMADEUS score. CLINICAL RELEVANCE The clinical and scientific implication of the COMI score as a PROM tool can be recommended when working with the AMADEUS score and patients undergoing MACI.
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Affiliation(s)
- Armin Runer
- Department for Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Schulthess Clinic Zurich, Zurich, Switzerland.
| | - Pia Jungmann
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Götz Welsch
- Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany
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Liu G, Zhang L, Zhou X, Zhang BL, Guo GX, Xu P, Wang GY, Fu SJ. Selection and Investigation of a Primate Model of Spontaneous Degenerative Knee Osteoarthritis, the Cynomolgus Monkey (Macaca Fascicularis). Med Sci Monit 2018; 24:4516-4527. [PMID: 29961076 PMCID: PMC6057266 DOI: 10.12659/msm.908913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim of this study was to identify a primate model of degenerative knee osteoarthritis (KOA) that may be more relevant for research studies on degenerative KOA in humans. MATERIAL AND METHODS Sixteen specific-pathogen-free (SPF) male cynomolgus monkeys (Macaca fascicularis) were divided into group A (n=8), an old group (22.0-25.3 years of age), and group B (n=8), a young group (3.0-5.2 years of age). For each primate, the behavior was observed, knee circumference was measured, knee joint X-rays were performed, and peripheral blood white blood cell (WBC) counts were measured, and the Kellgren and Lawrence (K-L) system was used for the classification of osteoarthritis. An enzyme-linked immunoassay (ELISA) was performed on knee joint fluid to measure levels of interleukin (IL)-1β, transforming growth factor (TGF)-β1, and matrix metalloproteinase (MMP)13. Changes in articular cartilage were evaluated using the Brittberg score and the Mankin histopathology grading score, respectively. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) and Western blot were used to measure the expression of the NOTCH3, JAG1, and ACAN genes in knee cartilage specimens, and the findings in the two groups of primates were compared. RESULTS Seven old aged primates in group A were compared with group B, and showed significant differences in WBC count, synovial fluid IL-1β, TGF-β1, and MMP13 levels, expression levels of the NOTCH3, JAG1, and ACAN genes in knee cartilage specimens, and in the Brittberg and Mankin scores (all, P<0.05). CONCLUSIONS Cynomolgus monkeys (Macaca fascicularis) might be a model for age-related degenerative KOA.
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Affiliation(s)
- Gang Liu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Lei Zhang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Xin Zhou
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Bao L Zhang
- College of Nursing, Affiliated to Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Guang X Guo
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Ping Xu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Guo Y Wang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Shi J Fu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
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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
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Salzmann GM, Calek AK, Preiss S. Second-Generation Autologous Minced Cartilage Repair Technique. Arthrosc Tech 2017; 6:e127-e131. [PMID: 28373950 PMCID: PMC5368339 DOI: 10.1016/j.eats.2016.09.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/09/2016] [Indexed: 02/03/2023] Open
Abstract
Articular cartilage defects at the knee joint are identified and treated with increasing frequency. Autologous chondrocytes may have the strongest potential to generate high-quality repair tissue within the defective region. Autologous chondrocyte implantation is not available in every country. We present a surgical technique where the surgeon can apply autologous chondrocytes in a one-step procedure to treat articular cartilage defects at the knee joint.
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Affiliation(s)
- Gian M. Salzmann
- Address correspondence to Gian M. Salzmann, M.D., Schulthess Clinic, Musculoskeletal Centre, Orthopaedics Lower Extremities, Lengghalde 2, 8008 Zurich, Switzerland.Schulthess ClinicMusculoskeletal CentreOrthopaedics Lower ExtremitiesLengghalde 28008 ZurichSwitzerland
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