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Schneider D, Weber R, Nourkami-Tutdibi N, Bous M, Goedicke-Fritz S, Hans MC, Hein S, Wolf MA, Landgraeber S, Zemlin M, Kaiser E. Ultrasound-guided determination demonstrates influence of age, sex and type of sport on medial femoral condyle cartilage thickness in children and adolescents. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38563657 DOI: 10.1002/ksa.12155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To analyse the reliability of ultrasound-guided measurement of the cartilage thickness at the medial femoral condyle in athletically active children and adolescents before and after mechanical load in relation to age, sex and type of sport. METHODS Three successive measurements were performed in 157 participants (median/min-max age: 13.1/6.0-18.0 years, 106 males) before and after mechanical load by squats at the same site of the medial femoral condyle by defined transducer positioning. Test-retest reliability was examined using Cronbach'sα $\alpha $ calculation. Differences in cartilage thickness were analysed with respect to age, sex and type of practiced sports, respectively. RESULTS Excellent reliability was achieved both before and after mechanical load by 30 squats with a median cartilage thickness of 1.9 mm (range: 0.5-4.8 mm) before and 1.9 mm (0.4-4.6 mm) after mechanical load. Male cartilages were thicker (p < 0.01) before (median: 2.0 mm) and after (2.0 mm) load when compared to female cartilage (before: 1.6 mm; after: 1.7 mm). Median cartilage thickness was about three times higher in karate athletes (before: 2.3 mm; after: 2.4 mm) than in sports shooters (0.7; 0.7 mm). Cartilage thickness in track and field athletes, handball players and soccer players were found to lay in-between. Sport type related thickness changes after mechanical load were not significant. CONCLUSION Medial femoral condyle cartilage thickness in childhood correlates with age, sex and practiced type of sports. Ultrasound is a reliable and simple, pain-free approach to evaluate the cartilage thickness in children and adolescents. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dirk Schneider
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Regine Weber
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
- Center for Gender-Specific Biology and Medicine (CGBM), Saarland University, Homburg/Saar, Germany
| | - Nasenien Nourkami-Tutdibi
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
- Center for Gender-Specific Biology and Medicine (CGBM), Saarland University, Homburg/Saar, Germany
| | - Michelle Bous
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
- Center for Gender-Specific Biology and Medicine (CGBM), Saarland University, Homburg/Saar, Germany
| | - Sybelle Goedicke-Fritz
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
- Center for Gender-Specific Biology and Medicine (CGBM), Saarland University, Homburg/Saar, Germany
| | - Muriel Charlotte Hans
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
- Center for Gender-Specific Biology and Medicine (CGBM), Saarland University, Homburg/Saar, Germany
| | - Steve Hein
- Centre Médical Steinsel, Steinsel, Luxembourg
| | - Milan Anton Wolf
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefan Landgraeber
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Zemlin
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
- Center for Gender-Specific Biology and Medicine (CGBM), Saarland University, Homburg/Saar, Germany
| | - Elisabeth Kaiser
- Department for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
- Center for Gender-Specific Biology and Medicine (CGBM), Saarland University, Homburg/Saar, Germany
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Vahabi A, Biçer EK, Kayıkçı K, Şahin F, Kavaklı K, Tamsel İ, Aydoğdu S. Morphological analysis of patellofemoral joint in haemophilic arthropathy: A case-control study. Haemophilia 2024; 30:531-537. [PMID: 38348604 DOI: 10.1111/hae.14952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Knees affected by haemophilic arthropathy exhibit distinct differences in both bone morphology and soft tissue behaviour. This study aims to analyse the morphological characteristics of the distal femur and patellofemoral joint in patients with haemophilia in comparison to normal healthy population. MATERIAL AND METHODS Study was conducted as pair-matched case-control study with 43 individuals in both the haemophilia group and the control group. Patellar luxation, patellar tilt (PT), length of the patella in both axis (pAP, pML), depth and angle of trochlear sulcus (SD, SA), lateral trochlear inclination (LTI), medial and lateral femoral facet length (mFL, LFL), intercondylar depth (ID), transepicondylar axis (TEA) and lateral condyle length (LCL) were assessed on knee MRI. Correlation between Pettersson score and measured variables were also analysed. RESULTS PT was medial sided in 10 (23.2%) cases in haemophilic group. Mean values of pAP, pML, PT were significantly lower in haemophilia group (p < .001, p: .007, p = .001 respectively). There were no significant changes in SA (p = .628), SD (p = .340), LTI (p = .685), LFL (p = .241) and MFC-LFC (p = .770) whilst mFL was significantly longer in haemophilia group (p = .009). ID (p < .001), TEA (p = .007) and LCL (p = .001) were all shorter in haemophilia group. Pettersson score was inversely correlated with pAP, pML, ID, TEA, LCL, pML/SA and ID/LCL. CONCLUSION Morphological changes in haemophilic arthropathy involve a smaller and medially-tilted patella, narrowed lateral condyle and transepicondylar axis, combined with reduced intercondylar depth. These alterations must keep in mind especially in pre- and intraoperative assessments for arthroplasty procedures.
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Affiliation(s)
- Arman Vahabi
- Department of Orthopedics and Traumatology, Ege University School of Medicine, Izmir, Turkey
| | - Elcil Kaya Biçer
- Department of Orthopedics and Traumatology, Ege University School of Medicine, Izmir, Turkey
| | | | - Fahri Şahin
- Department of Internal Medicine Division of Hematology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Kaan Kavaklı
- Department of Pediatrics Division of Hemato-Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - İpek Tamsel
- Department Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Semih Aydoğdu
- Department of Orthopedics and Traumatology, Ege University School of Medicine, Izmir, Turkey
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Salinas EY, Otarola GA, Kwon H, Wang D, Hu JC, Athanasiou KA. Topographical Characterization of the Young, Healthy Human Femoral Medial Condyle. Cartilage 2023; 14:338-350. [PMID: 36537020 PMCID: PMC10601569 DOI: 10.1177/19476035221141421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The medial femoral condyle of the knee exhibits some of the highest incidences of chondral degeneration. However, a dearth of healthy human tissues has rendered it difficult to ascertain whether cartilage in this compartment possesses properties that predispose it to injuries. Assessment of young, healthy tissue would be most representative of the tissue's intrinsic properties. DESIGN This work examined the topographical differences in tribological, tensile, and compressive properties of young (n = 5, 26.2 ± 5.6 years old), healthy, human medial femoral condyles, obtained from viable allograft specimens. Corresponding to clinical incidences of pathology, it was hypothesized that the lowest mechanical properties would be found in the posterior region of the medial condyle, and that tissue composition would correspond to the established structure-function relationships of cartilage. RESULTS Young's modulus, ultimate tensile strength, aggregate modulus, and shear modulus in the posterior region were 1.0-, 2.8-, 1.1-, and 1.0-fold less than the values in the anterior region, respectively. Surprisingly, although glycosaminoglycan content is thought to correlate with compressive properties, in this study, the aggregate and shear moduli correlated more robustly to the amount of pyridinoline crosslinks per collagen. Also, the coefficient of friction was anisotropic and ranged 0.22-0.26 throughout the condyle. CONCLUSION This work showed that the posteromedial condyle displays lower tensile and compressive properties, which correlate to collagen crosslinks and may play a role in this region's predisposition to injuries. Furthermore, new structure-function relationships may need to be developed to account for the role of collagen crosslinks in compressive properties.
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Affiliation(s)
- Evelia Y. Salinas
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Gaston A. Otarola
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Heenam Kwon
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, CA, USA
- Department of Orthopaedic Surgery, University of California Irvine Health, Orange, CA, USA
| | - Jerry C. Hu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
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Akai S, Iseki T, Kanto R, Iseki T, Onishi S, Nakao Y, Yoshiya S, Tachibana T, Nakayama H. Osteochondral autologous transplantation for large steroid-induced osteonecrosis lesion of the knee in a young patient yielding satisfactory results despite only partial coverage: a case report. J Surg Case Rep 2023; 2023:rjad487. [PMID: 37711846 PMCID: PMC10497884 DOI: 10.1093/jscr/rjad487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 09/16/2023] Open
Abstract
Osteochondral autologous transplantation (OAT) is one of the most common surgical options for osteochondral disorders of the knee. In cases where OAT is performed for steroid-induced osteonecrosis, there are several problems potentially affecting the surgical outcomes such as large chondral damage area and compromised host bone. In addition, steroid administration for a long period of time may lead to extensive lesion, which poses difficulty in obtaining sufficient donor tissue. Those factors affect the prognosis of steroid-induced osteonecrosis resulting in inferior treatment outcomes. We present a young female with a large steroid-induced osteonecrosis lesion repaired only with two osteochondral plugs harvested from the healthy area. The reported case indicates that only partial osteochondral grafting limiting to the weight-bearing area may yield satisfactory outcome when OAT is performed for large steroid-induced osteonecrosis of the knee.
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Affiliation(s)
- Shunsuke Akai
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
| | - Takuya Iseki
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
| | - Shintaro Onishi
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya, Hyogo 662-0957, Japan
| | - Yoshitaka Nakao
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya, Hyogo 662-0957, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya, Hyogo 662-0957, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
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Ozawa J, Kaneguchi A, Ezumi S, Maeno T, Iwazawa J, Minanimoto K, Ikeda A. Effects of hindlimb suspension on development of proximal and distal femur morphological abnormalities in growing rats. J Orthop Res 2023; 41:364-377. [PMID: 35488739 DOI: 10.1002/jor.25352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/07/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Although morphological abnormalities of the femur are known predisposing factors for numerous musculoskeletal disorders, the etiology of these abnormalities is poorly understood. This study aimed to investigate whether femoral morphogenesis is affected by hindlimb suspension (HS) in growing rats. We used 41 four-week-old female rats in this study. In the HS groups, rats were suspended from their tails for 2, 4, and 8 weeks. Age-matched animals were used as controls. We examined morphological indices of the femur using three-dimensional reconstructed images from X-ray computed tomography. The femoral neck anteversion angle (AVA) was higher with growth in the experimental groups and did not differ in control groups. The AVAs in the HS groups were larger than controls at any time point. In the control groups, the trochlear angle (TA) was higher, rotating inward with growth, but did not differ in the HS groups. The TAs in the HS groups were smaller and rotated more outward compared with the control groups at any time point. The height ratios of the medial and lateral condyles (MC/LC), an asymmetry index, were larger in the HS groups compared to controls at any time point. There were strong relationships between proximal (AVA) and distal morphologies, such as the TA (Spearman's coefficient [rs ] = -0.80, p < 0.001) and MC/LC (rs = 0.79, p < 0.001). Our data suggest that sufficient physical activity in early life may protect against morphological femur abnormalities associated with hip and knee joint diseases.
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Affiliation(s)
- Junya Ozawa
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Shun Ezumi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Takuma Maeno
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Jukiya Iwazawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Kengo Minanimoto
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Airi Ikeda
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan.,Department of Judo Therapy, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo, Japan
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Riemer L, Dargel J, Schäferhoff P, Eysel P, Steimel T, Reineck S, Grevenstein D. Femoral condyle configuration and its impact on anterior cruciate ligament reconstruction. Technol Health Care 2023; 31:1607-1617. [PMID: 36970923 PMCID: PMC10578253 DOI: 10.3233/thc-220640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/12/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Rupture of the anterior cruciate ligament (ACL) is one of the most common knee injuries and has substantial impact on knee function. Beside primary ruptures, an increasing number of re-(re-)ruptures occur, representing a therapeutical challenge for the treating surgeon. Several risk factors for re-ruptures have been previously identified, including an increased tibial slope. OBJECTIVE In this study, we investigated the effect of femoral condyle configuration on ACL-ruptures and re-ruptures. METHODS In-vivo magnetic resonance imaging scans of three different groups of patients were compared. Group 1 included patients with an intact ACL on both sides, group 2 included patients with primary, unilateral ACL-rupture, while group 3 included patients with an ACL-re-rupture or re-(re-)rupture. Fourteen different variables were obtained and analyzed regarding their impact on ACL-re-(re-)rupture. RESULTS Overall, 334 knees were investigated. Our data allowed us to define parameters to identify anatomical configurations of bones associated with an increased risk of ACL-re-rupture. Our results show, that patients with ACL-re-rupture show increased radii of the extension facet of the lateral femoral condyle (p< 0.001) as well as of the extension facet of the medial femoral condyle (p< 0.001). CONCLUSION We conclude that a spherical femoral condyle form does influence the clinical outcome after ACL-reconstruction.
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Affiliation(s)
- Lena Riemer
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jens Dargel
- Department for Orthopaedic Surgery, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Peter Schäferhoff
- Department for Orthopaedic Surgery, ATOS MediaPark Klinik, Cologne, Germany
| | - Peer Eysel
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | | | - David Grevenstein
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
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Suo YH, Chen JL, Li QS, Chen X, Xie YP, Gu PF, Li XN, Li YS. Treatment of Hoffa fracture of femoral condyle with anchor combined with auxiliary fixation. J Back Musculoskelet Rehabil 2023; 36:1185-1192. [PMID: 37458023 DOI: 10.3233/bmr-220378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND A Hoffa fracture is an unstable intra-articular break that is generally treated with surgery. OBJECTIVE To evaluate the feasibility and clinical outcomes of using a suture anchor combined with auxiliary fixation for the treatment of a lateral femoral condyle Hoffa fracture. METHODS The study retrospectively reviewed 8 patients (5 males and 3 females) with a lateral femoral condyle Hoffa fracture who had been treated by combining a suture anchor with auxiliary fixation between January 2016 and April 2020. The mean age of patients was 37.5 years (ranging from 23 to 45). According to Letenneur's classification, there were 4 cases of type I, 2 cases of type II, and 2 cases of type III fractures. The clinical outcomes were assessed using Letenneur's functional assessment. RESULTS The follow-up duration ranged between 14-24 months. All patients achieved primary healing of the incision and fracture union, as well as normal flexion and extension of the knee joint, with 7 cases showing excellent outcomes and 1 case showing a good outcome. No postoperative complications, such as fracture displacement, anchor loosening, or fracture malunion, occurred in this series. CONCLUSION Our results indicated that a suture anchor, combined with external fixation, was an effective treatment for a lateral femoral condyle Hoffa fracture. Accordingly, this procedure is worthy of wider clinical application.
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Wu L, Liu C, Jiang B, He L. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. Medicine (Baltimore) 2022; 101:e32104. [PMID: 36550860 PMCID: PMC9771171 DOI: 10.1097/md.0000000000032104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. PATIENT CONCERNS A 15-year-old female student accidentally sprained her right knee while participating in sports activities. The patient felt pain in his right knee and limited movement. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. DIAGNOSIS According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. INTERVENTIONS Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. OUTCOMES The functional and radiographic outcome were satisfactory at 18 months after operation. LESSONS Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical.
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Affiliation(s)
- Liang Wu
- Department of Orthopedic Surgery, First People’s Hospital of Linpin District, Hangzhou, Zhejiang, China
| | - Chao Liu
- Department of General Surgery, Medicine Faculty of Universitas Prima Indonesia, North Sumatra, Indonesia
| | - Bing Jiang
- Department of General Surgery, Daocheng Country People’s Hospital, Sichuan, China
| | - Lijiang He
- Department of Orthopedic Surgery, Second People’s Hospital of Yuhang District, Hangzhou, Zhejiang, China
- * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second People’s Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: )
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Muacevic A, Adler JR, Kumar I, Prakash A, Nagarajan R. Bone Bruise Patterns in Ligamentous Injuries of the Knee With Focus on Anterior Cruciate Ligament. Cureus 2022; 14:e32113. [PMID: 36601188 PMCID: PMC9805383 DOI: 10.7759/cureus.32113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction After sustaining an anterior cruciate ligament (ACL) injury, the bone bruises seen on magnetic resonance imaging (MRI) could reveal plenty of information regarding the loading mechanisms causing injury to the ACL. The current study was conducted to evaluate the common distribution patterns of bone bruises following an ACL injury and understand the loading mechanisms. Methods The knee MRI sequences of the patients operated arthroscopically for an injured ACL between August 2016 to August 2018 were selected for the study. The distribution pattern of the bone bruises was determined using the sagittal and coronal sections of MRI. The pattern of distribution of the bone bruises was categorized and analyzed by two independent observers. Results Twenty-two patients were found to have bone bruises diagnosed in the MRI scans. The mean age of the patients was 27.8 ± 8.7 years. The pattern of a bone bruises in only the lateral femoral and tibial compartments was the most typical pattern observed in this study. The study pattern has a significant anterior distribution of bone bruises on the outer (lateral) compartment of both the femur and tibia as compared to the inner (medial) compartment (p< .05 and p > .05, respectively). The inter-rater reliability between the two observers by Cronbach's Alpha was 93.2%. Conclusion Having the appropriate information regarding the pattern distribution of bone bruises and the concomitant injuries associated with it furthers our knowledge and helps us understand the loading mechanisms of ACL tears. A combination of coup forces acting on the lateral compartment and the contrecoup varus force on the medial compartment of the knee during the primary pivot-shift injury suggests an an involvement of multiplanar loading patterns at the point of sustaining ACL tear.
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Epanomeritakis IE, Lee E, Lu V, Khan W. The Use of Autologous Chondrocyte and Mesenchymal Stem Cell Implants for the Treatment of Focal Chondral Defects in Human Knee Joints-A Systematic Review and Meta-Analysis. Int J Mol Sci 2022; 23:ijms23074065. [PMID: 35409424 PMCID: PMC8999850 DOI: 10.3390/ijms23074065] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 12/16/2022] Open
Abstract
Focal chondral defects of the knee occur commonly in the young, active population due to trauma. Damage can insidiously spread and lead to osteoarthritis with significant functional and socioeconomic consequences. Implants consisting of autologous chondrocytes or mesenchymal stem cells (MSC) seeded onto scaffolds have been suggested as promising therapies to restore these defects. However, the degree of integration between the implant and native cartilage still requires optimization. A PRISMA systematic review and meta-analysis was conducted using five databases (PubMed, MEDLINE, EMBASE, Web of Science, CINAHL) to identify studies that used autologous chondrocyte implants (ACI) or MSC implant therapies to repair chondral defects of the tibiofemoral joint. Data on the integration of the implant-cartilage interface, as well as outcomes of clinical scoring systems, were extracted. Most eligible studies investigated the use of ACI only. Our meta-analysis showed that, across a total of 200 patients, 64% (95% CI (51%, 75%)) achieved complete integration with native cartilage. In addition, a pooled improvement in the mean MOCART integration score was observed during post-operative follow-up (standardized mean difference: 1.16; 95% CI (0.07, 2.24), p = 0.04). All studies showed an improvement in the clinical scores. The use of a collagen-based scaffold was associated with better integration and clinical outcomes. This review demonstrated that cell-seeded scaffolds can achieve good quality integration in most patients, which improves over time and is associated with clinical improvements. A greater number of studies comparing these techniques to traditional cartilage repair methods, with more inclusion of MSC-seeded scaffolds, should allow for a standardized approach to cartilage regeneration to develop.
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Affiliation(s)
| | - Ernest Lee
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (I.E.E.); (E.L.); (V.L.)
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (I.E.E.); (E.L.); (V.L.)
| | - Wasim Khan
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
- Correspondence: ; Tel.: +44-(0)-7791-025554
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Abstract
OBJECTIVE Successful preservation of articular cartilage will increase the availability of osteochondral allografts to treat articular cartilage defects. We compared the effects of 2 methods for storing cartilage tissues using 10-mm diameter osteochondral dowels or femoral condyles at -196°C: (a) storage with a surrounding vitrification solution versus (b) storage without a surrounding vitrification solution. We investigated the effects of 2 additives (chondroitin sulfate and ascorbic acid) for vitrification of articular cartilage. DESIGN Healthy porcine stifle joints (n = 11) from sexually mature pigs were collected from a slaughterhouse within 6 hours after slaughtering. Dimethyl sulfoxide, ethylene glycol, and propylene glycol were permeated into porcine articular cartilage using an optimized 7-hour 3-step cryoprotectant permeation protocol. Chondrocyte viability was assessed by a cell membrane integrity stain and chondrocyte metabolic function was assessed by alamarBlue assay. Femoral condyles after vitrification were assessed by gross morphology for cartilage fractures. RESULTS There were no differences in the chondrocyte viability (~70%) of 10-mm osteochondral dowels after vitrification with or without the surrounding vitrification solution. Chondrocyte viability in porcine femoral condyles was significantly higher after vitrification without the surrounding vitrification solution (~70%) compared to those with the surrounding vitrification solution (8% to 36%). Moreover, articular cartilage fractures were not seen in femoral condyles vitrified without surrounding vitrification solution compared to fractures seen in condyles with surrounding vitrification solution. CONCLUSIONS Vitrification of femoral condyle allografts can be achieved by our optimized approach. Removing the surrounding vitrification solution is advantageous for vitrification outcomes of large size osteochondral allografts.
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Affiliation(s)
- Kezhou Wu
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Orthopedic Surgery, First
Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong,
China
| | - Leila Laouar
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Janet A. W. Elliott
- Department of Chemical and Materials
Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and
Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M. Jomha
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Nadr M. Jomha, 2D2.32 WMC, Division of
Orthopedic Surgery, Department of Surgery, University of Alberta Hospital,
Edmonton, Alberta, Canada T6G 2B7.
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12
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Affiliation(s)
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford, UK
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13
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Huang G, Zhang M, Zhang Y, Wang X, Zhang M, Liu G. Hoffa fracture combined with rotational dislocation of the knee joint: A novel case report. Medicine (Baltimore) 2021; 100:e25253. [PMID: 33832086 PMCID: PMC8036118 DOI: 10.1097/md.0000000000025253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hoffa fracture is a rare fracture confined to the coronal-plane involving femoral condyles. This occurs simultaneously with rotational dislocation of the knee joint is extremely rare. Up to now, there is no valid recommendation for the treatment of the Hoffa fracture. PATIENT CONCERNS A 50-year-old female patient broke her knee joint while skiing, experiencing severe pain in the right knee, which was swollen. She presented limited function of the knee and movement upon arrival in the emergency room. DIAGNOSIS Comminuted Hoffa fracture in the right knee associated with rotational dislocation in the knee joint. INTERVENTIONS We treated the dislocated knee joint through manual reduction initially. During the operation, we used posterolateral approach to expose the fracture fragments, thereafter using headless compression screws and a buttress plate to provide sufficient stability for the fracture. Early postoperative rehabilitation was encouraged. OUTCOMES The patient finally achieved fracture healing three months after operation. In addition, she achieved 0-130° range of function of the knee after four months post-operation, and the patient obtained a satisfactory prognosis after our treatment. LESSONS By using appropriate surgical approach to obtain enough exposure, headless compression screws and the buttress plate provided adequate stability during early active rehabilitation, which resulted in satisfactory results in the treatment of the injury. We reviewed literatures regarding the treatment of Hoffa fracture to demonstrate that our treatment was effective.
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Affiliation(s)
| | | | - Youjia Zhang
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
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14
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Kwak YH, Nam JH, Koh YG, Park BK, Kang KT. Anatomic Differences in the Sagittal Knee Joint Are Associated With ACL Injury: Results From a Skeletally Immature Korean Population. Orthop J Sports Med 2021; 9:2325967121994795. [PMID: 33869647 PMCID: PMC8024458 DOI: 10.1177/2325967121994795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Differences in tibiofemoral articular morphology are associated with risks of anterior cruciate ligament (ACL) injury. Purpose: To determine whether bony and cartilaginous morphological characteristics are related to ACL injury in pediatric patients and to investigate any differences according to sex. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 200 skeletally immature Korean patients from a single institution were included in this study; 100 patients had an ACL injury, and 100 had an intact ACL. Condylar morphology and tibial slopes were evaluated and compared between the groups, and differences between sexes were evaluated in the ACL-injured group. Results: The lateral femoral curvature was significantly greater and the lateral and medial tibial curvatures were significantly smaller in the ACL-injured group than in the intact group (P < .01 for all). In addition, the lateral and medial femoral curvatures as well as the lateral tibial curvature were significantly smaller in female than in male patients (P < .01 for all). Both the medial and lateral tibial slopes were greater in the ACL-injured versus intact group (medial slope, 5.5° vs 5.0°; lateral slope, 3.0° vs 1.3°, respectively); this difference was statistically significant for lateral tibial slope (P = .026). No sex-based differences were found for medial or lateral tibial slope. Conclusion: Femoral and tibial curvatures as well as lateral tibial slope were significantly different between the ACL-injured and ACL-intact patients, and the lateral tibial curvature was significantly smaller in female than in male patients. Medial and lateral tibial slopes were not associated with a significant difference in ACL injury between male and female patients.
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Affiliation(s)
- Yoon Hae Kwak
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Byoung-Kyu Park
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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15
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Abstract
Background The asymmetric medial and lateral condyles of the distal femur and proximal tibia have a direct influence on the biomechanics of knee joint and prostheses design. This study aimed to determine the morphologic data, that is., anteroposterior (AP) and mediolateral (ML) widths, and the radius of curvature (ROC) of the geometric arcs of the distal femur and proximal tibia. Methods One hundred and seventeen adult dry bones (57 femurs and 60 tibias) were studied. Aspect ratios (AP/ML) were calculated. The AP and ML widths were measured using digital Vernier Caliper with a measuring range of 0-150 mm, resolution of 0.01 mm, and accuracy ± 0.02 mm. The geometric arcs of femoral and tibial condyles were divided into three parts namely anterior 1/3rd, distal (femur) or middle (tibia) 1/3rd and posterior 1/3rd and were estimated in the sagittal plane for the femur and transverse plane for tibia using the ROC gauges. Results For the femur, the mean AP length for medial and lateral condyles was 55.62 mm and 57.93 mm, respectively, while the mean ML width was 73.45 mm. For the tibia, the mean AP length for medial condyle (MC) and lateral condyle (LC) was 47.74 mm and 43.46 mm, respectively. The mean aspect ratios for the distal femur and proximal tibia were 1.26 and 1.45, respectively. The mean aspect ratios for MC and LC of the femur were 0.50 and 0.52, respectively, whereas, for tibia, they were 0.61 and 0.71, respectively. The mean ROC for femoral MC - 20.77 mm, 31.42 mm, and 19.68 mm and for LC - 21.48 mm, 64.40 mm and 19.06 mm for the anterior, distal and posterior arcs, respectively. The mean ROC for tibial MC - 22.42 mm, 22.49 mm and 19.94 mm, and LC - 19.92 mm, 21.79 mm and 20.95 mm for the anterior, middle and posterior arcs, respectively. Conclusions The morphologic data accumulated in this study for both the distal femur as well as the proximal tibia would provide guidelines and help the manufacturers of joint prostheses to address the potential for compromised implant fit and re-design and make available ‘anatomic’ knee prostheses appropriate for the local population which would not only improve function but also prolong the longevity of the prostheses.
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Affiliation(s)
- Aditi Chaurasia
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Ankita Tyagi
- Anatomy, All India Institute of Medical Sciences, Bhopal, IND
| | - John A Santoshi
- Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
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16
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Guo JL, Kim YS, Orchard EA, van den Beucken JJ, Jansen JA, Wong ME, Mikos AG. A Rabbit Femoral Condyle Defect Model for Assessment of Osteochondral Tissue Regeneration. Tissue Eng Part C Methods 2020; 26:554-564. [PMID: 33050806 PMCID: PMC7698983 DOI: 10.1089/ten.tec.2020.0261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Osteochondral tissue repair represents a common clinical need, with multiple approaches in tissue engineering and regenerative medicine being investigated for the repair of defects of articular cartilage and subchondral bone. A full thickness rabbit femoral condyle defect is a clinically relevant model of an articulating and load bearing joint surface for the investigation of osteochondral tissue repair by various cell-, biomolecule-, and biomaterial-based implants. In this protocol, we describe the methodology and 1.5- to 2-h surgical procedure for the generation of a reproducible, full thickness defect for construct implantation in the rabbit medial femoral condyle. Furthermore, we describe a step-by-step procedure for osteochondral tissue collection and the assessment of tissue formation using standardized histological, radiological, mechanical, and biochemical analytical techniques. This protocol illustrates the critical steps for reproducibility and minimally invasive surgery as well as applications to evaluate the efficacy of cartilage and bone tissue engineering implants, with emphasis on the usage of histological and radiological measures of tissue growth. Impact statement Although multiple surgical techniques have been developed for the treatment of osteochondral defects, repairing the tissues to their original state remains an unmet need. Such limitations have thus prompted the development of various constructs for osteochondral tissue regeneration. An in vivo model that is both clinically relevant and economically practical is necessary to evaluate the efficacy of different tissue engineered constructs. In this article, we present a full thickness rabbit femoral condyle defect model and describe the analytical techniques to assess the regeneration of osteochondral tissue.
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Affiliation(s)
- Jason L. Guo
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Yu Seon Kim
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - John A. Jansen
- Department of Dentistry-Biomaterials, Radboudumc, Nijmegen, The Netherlands
| | - Mark E. Wong
- Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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17
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Song M, Zhang Z, Yan L, Liu D. [Effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation for large area cartilage injury of femoral condyle of knee]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:330-334. [PMID: 32174078 DOI: 10.7507/1002-1892.201907048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation (OAT) in treatment of large area (4-6 cm 2) cartilage injury of the femoral condyle of knee. Methods Between March 2016 and June 2017, 22 patients of large area cartilage injury of the femoral condyle of knee were treated with arthroscopic microfracture combined with OAT. There were 16 males and 6 females with an average age of 22-60 years (mean, 38.6 years). The cause of injury was traffic accident in 8 cases and sports injuries in 14 cases. The disease duration was 1-6 months (mean, 3.4 months). There were 15 cases of medial femoral condyle injuries and 7 cases of lateral condyle injuries. The area of cartilage defect was 4-6 cm 2 (mean, 4.98 cm 2). According to the International Cartilage Repair Society (ICRS) classification, 9 cases were rated as grade Ⅲ and 13 cases as grade Ⅳ. Eighteen cases were combined with meniscus injuries. Preoperative visual analogue scale (VAS) score was 6.36±1.25 and Lysholm score was 36.00±7.77. Results All incisions healed by first intention. All patients were followed up 2-3 years with an average of 2.3 years. At 2 years after operation, the VAS score was 1.27±0.94 and the Lysholm score was 77.82±6.21, which were significantly improved when compared with those before operation ( t=16.595, P=0.000; t=21.895, P=0.000). At 2 years after operation, MRI showed that the cartilage defect was repaired well. Conclusion Arthroscopic microfracture combined with OAT can be used to treat large area cartilage injury of the femoral condyle of knee, and the good early effectiveness can be obtained.
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Affiliation(s)
- Meng Song
- Department of Orthopedic Surgery and Sports Medicine, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou Liaoning, 121001, P.R.China
| | - Zheng Zhang
- Department of Orthopedic Surgery and Sports Medicine, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou Liaoning, 121001, P.R.China
| | - Lixiang Yan
- Department of Orthopedic Surgery and Sports Medicine, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou Liaoning, 121001, P.R.China
| | - Danping Liu
- Department of Orthopedic Surgery and Sports Medicine, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou Liaoning, 121001, P.R.China
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18
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Elmokhtar A, Rafrafi A, Znagui T, Saadi S, Khezami M, Hamdi M, Nouisri L. [Mid-term results in the treatment of osteochondritis dissecans of the femoral condyles using osteochondral grafting (mosaic arthroplasty)]. Pan Afr Med J 2019; 32:191. [PMID: 31312303 PMCID: PMC6620059 DOI: 10.11604/pamj.2019.32.191.17308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/13/2019] [Indexed: 11/11/2022] Open
Abstract
Several surgical procedures, including mosaic arthroplasty, can be used to treat patients with cartilage loss in the femoral condyles. This study aims to assess mid-term clinical and radiological results as well as the main prognostics elements. We conducted a retrospective epidemiological study over a period of 15 years. During the study period we collected data from 35 workable medical records of patients with osteochondritis dissecans of the femoral condyles treated by mosaic arthroplasty, with an average follow-up of 24 months. The level of complaints as well as preoperative knee function were evaluated and compared with the healthy knee according to the International Cartilage Repair Society (ICRS) score, the International Knee Documentation Committee (IKDC) score and visual analogue scale (VAS). It was less than 60% in 27 patients. During the follow-up period, the results were analyzed according to Hughston's functional and radiological criteria. After an average follow-up of 24 months, algoneurodystrophy was reported in 5 cases with a single case of haemarthrosis. A net ICRS score improvement was observed with a mean increasing from 54% to 74% on the follow-up visit. Most of patients were satisfied or very satisfied (82.9%). The elements of good prognosis recognized in our study included: a mean time between symptom onset and surgery of less of 18 months, having deep lesions with a diameter less than 02 cm and having lesions in the internal condyle. The treatment of cartilage loss is necessarily based on the correction of its direct and indirect causes namely the morphotype, the laxity and meniscus capital. No consensus in the decision-making was reached and no one could confirm the superiority of a technique in relation to the other but we can say that cartilage defect which sizes from 2 to 4 cm² may be the best indication for mosaic arthroplasty.
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Affiliation(s)
- Abdallah Elmokhtar
- Service d'Orthopédie à Hôpital Militaire Principal de Tunis, Tunis, Tunisie
| | - Abderazzak Rafrafi
- Service d'Orthopédie à Hôpital Militaire Principal de Tunis, Tunis, Tunisie
| | - Talel Znagui
- Service d'Orthopédie à Hôpital Militaire Principal de Tunis, Tunis, Tunisie
| | - Saber Saadi
- Service d'Orthopédie à Hôpital Militaire Principal de Tunis, Tunis, Tunisie
| | - Mounira Khezami
- Service d'Orthopédie à Hôpital Militaire Principal de Tunis, Tunis, Tunisie
| | - Mounir Hamdi
- Service d'Orthopédie à Hôpital Militaire Principal de Tunis, Tunis, Tunisie
| | - Lotfi Nouisri
- Service d'Orthopédie à Hôpital Militaire Principal de Tunis, Tunis, Tunisie
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19
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Abstract
BACKGROUND Previous studies showed clinical benefit and durable results of osteochondral allograft (OCA) transplantation for the treatment of femoral condyle lesions. However, the majority of these studies are difficult to interpret owing to the mixed results of different techniques and anatomic locations. PURPOSE To evaluate the outcome of OCA transplantation with thin plug grafts for treatment of isolated femoral condyle osteochondral lesions. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study included 187 patients (200 knees) who underwent OCA transplantation for isolated osteochondral lesions on the femoral condyle between 1999 and 2014. For all cases, a thin plug technique was used with commercially available surgical instruments and the minimum amount of bone necessary for fixation. Evaluation included International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and patient satisfaction. Frequency and type of further surgery were assessed. Failure of the allograft was defined as further surgery involving removal of the allograft. RESULTS Mean follow-up was 6.7 years (range, 1.9-16.5 years). The mean age of patients at the time of surgery was 31 years, and 63% were male. The medial femoral condyle was affected in 69% of knees. A single thin plug graft was used in 145 knees (72.5%), and 2 grafts were used in 55 knees (27.5%). Mean allograft area was 6.3 cm2, and graft thickness was 6.5 mm (cartilage and bone combined). Further surgery was required for 52 knees (26%), of which 16 (8% of entire cohort) were defined as allograft failures (4 OCA revisions, 1 arthrosurface, 6 unicompartmental knee arthroplasties, and 5 total knee arthroplasties). Median time to failure was 4.9 years. Survivorship of the allograft was 95.6% at 5 years and 91.2% at 10 years. Among patients with grafts remaining in situ at latest follow-up, clinically meaningful improvement in pain, function, and quality of life was reported. Satisfaction was reported by 89% of patients. CONCLUSION OCA transplantation with a thin plug graft technique is a valuable procedure for the treatment of femoral condyle osteochondral lesions, resulting in significant improvement in clinical scores, high patient satisfaction, and low reoperation and clinical failure rates.
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Affiliation(s)
- Luís E P Tírico
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Pamela A Pulido
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - William D Bugbee
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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20
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Abstract
Femoral condyle fracture in coronal plane, also known as Hoffa fracture, is a rare fracture. Non-union of Hoffa fracture is even rarer. We present a case of fibrous nonunion of a Hoffa fracture in which the fractured fragment, though not freely movable, led to painful walking. Since the fragment was un-displaced and non-movable we fixed the fractured fragment in situ. Patient regained full range of motion of the knee and was asymptomatic on follow-up.
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Affiliation(s)
- A Soni
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - R Kansay
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - S Gupta
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - A Malhotra
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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21
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Abstract
The fabella is a sesamoid bone that is embedded in the lateral head of the gastrocnemius muscle and often articulates directly with the lateral femoral condyle. It is present in 10-30% of the general population with a higher incidence in Asians. The fabella can lead to various pathologies such as fabella pain syndrome and common fibular nerve palsy. Conservative treatment involves physical therapy or injecting local anesthetics or steroids around this bone. However, if symptoms persist, then a fabellectomy can be performed. Physicians should be aware of the fabella bone and the multiple pathologies associated with it in order to provide the best treatment and management for patients.
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Affiliation(s)
| | | | | | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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22
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Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an effective treatment option for medial compartment osteoarthritis (OA) of the knee. Whether spontaneous osteonecrosis of the knee (SPONK) can be successfully treated with UKA remains controversial. This study evaluated the clinical and radiological results of patients with SPONK who were treated by UKA using Oxford phase III prostheses. METHODS We compared a prospective series of 23 UKA cases operated for SPONK with 235 UKA cases operated for OA. All patients underwent Magnetic Resonance Imaging (MRI) to confirm the diagnosis and exclude any major lesion in the lateral compartment. The stage, condylar ratio, and volume of the necrotic lesion were evaluated. The pre and postoperative Oxford knee scores (OKSs) were compared. RESULTS The mean follow-up was 60 months. No statistical differences in complication rates between the groups were found. The mean OKS improved from 39.48 ± 5.69 to 18.83 ± 3.82 ( p < 0.05). There were no significant differences in the pre and postoperative OKS between the different groups. CONCLUSION SPONK can be successfully treated with UKA, with a favorable short- to mid-term follow-up.
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Affiliation(s)
- Tong Ma
- 1 Department of Orthopaedics, Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yihui Tu
- 1 Department of Orthopaedics, Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huaming Xue
- 1 Department of Orthopaedics, Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Wen
- 1 Department of Orthopaedics, Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiong Mei
- 2 Department of Orthopaedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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23
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Adrian AM, Barrett MF, Werpy NM, Kawcak CE, Chapman PL, Goodrich LR. A comparison of arthroscopy to ultrasonography for identification of pathology of the equine stifle. Equine Vet J 2016; 49:314-321. [PMID: 26582764 DOI: 10.1111/evj.12541] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/12/2015] [Indexed: 11/28/2022]
Abstract
REASONS FOR PERFORMING STUDY To evaluate and compare the diagnostic capability of arthroscopy and ultrasonography for the detection of pathological change in equine stifle joints. Although descriptions of the arthroscopic and ultrasonographic boundaries of the normal femorotibial joint exist, there are few examples in the literature comparing the pathological changes observed with each imaging modality. OBJECTIVES To evaluate and compare arthroscopic and ultrasonographic examinations for characterising pathological change in the stifle joint. To describe how the results of arthroscopic and ultrasonographic examinations may differ in characterising the severity of lesions and to evaluate which lesions are best assessed with each modality. STUDY DESIGN Retrospective review of ultrasonographic and arthroscopic examinations. METHODS The structures of the stifle joint were evaluated and graded for pathological change by scoring arthroscopic and ultrasonographic examinations. The presence and severity of the lesions were then compared between each modality. RESULTS Medial meniscal lesions were detected more often with ultrasonography than with arthroscopy. Conversely, arthroscopy was better for detection of cranial medial meniscotibial ligament (CrMMTL) tearing. Articular cartilage defects were best detected with arthroscopy and periarticular osteophytes of the medial femoral condyle with ultrasonography. Four cases had defects within one of the patellar ligaments, all of which were only characterised with ultrasonography. CONCLUSIONS Ultrasonography and arthroscopy should be combined to best evaluate pathology of the stifle, since each modality has its own limitations depending on the location and type of lesion.
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Affiliation(s)
- A M Adrian
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, USA
| | - M F Barrett
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, USA
| | - N M Werpy
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, USA
| | - C E Kawcak
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, USA.,Orthopaedic Research Center, Colorado State University, Fort Collins, USA
| | - P L Chapman
- Department of Statistics, College of Natural Sciences, Colorado State University, Fort Collins, USA
| | - L R Goodrich
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, USA.,Orthopaedic Research Center, Colorado State University, Fort Collins, USA
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24
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Arokoski MEA, Tiitu V, Jurvelin JS, Korhonen RK, Fick JM. Topographical investigation of changes in depth-wise proteoglycan distribution in rabbit femoral articular cartilage at 4 weeks after transection of the anterior cruciate ligament. J Orthop Res 2015; 33:1278-86. [PMID: 25820864 DOI: 10.1002/jor.22906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/17/2015] [Indexed: 02/04/2023]
Abstract
In this study, we explore topographical changes in proteoglycan distribution from femoral condylar cartilage in early osteoarthritis, acquired from both the lateral and medial condyles of anterior cruciate ligament transected (ACLT) and contralateral (CNTRL) rabbit knee joints, at 4 weeks post operation. Four sites across the cartilage surface in a parasagittal plane were defined across tissue sections taken from femoral condyles, and proteoglycan (PG) content was quantified using digital densitometry. The greatest depth-wise change in PG content due to an ACLT (compared to the CNTRL group) was observed anteriorly (site C) from the most weight-bearing location within the lateral compartment. In the medial compartment, the greatest change was observed in the most weight-bearing location (site B). The depth-wise changes in PG content were observed up to 48% and 28% depth from the tissue surface at these aforementioned sites, respectively (p < 0.05). The smallest depth-wise change in PG content was observed posteriorly (site A) from the most weight-bearing location within both femoral condyles (up to 20% and up to 5% depth from the tissue surface at lateral and medial compartments, respectively). This study gives further insight into how early cartilage deterioration progresses across the parasagittal plane of the femoral condyle.
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Affiliation(s)
- Mikko E A Arokoski
- School of Medicine, University of Eastern Finland, Kuopio, FI-70211, Finland
| | - Virpi Tiitu
- Institute of Biomedicine, Anatomy, University of Eastern Finland, Kuopio, FI-70211, Finland
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, FI-70211, Finland
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, FI-70211, Finland
| | - James M Fick
- Department of Applied Physics, University of Eastern Finland, Kuopio, FI-70211, Finland
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25
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Sasbou Y, Boussaidane M, Lukulunga LU, Azzouz M, Mhammdi Y, Benchebba D, Chagar B. [Lateral condylar fracture of the femur associated with sagittal vertical ipsilateral fracture of the patella]. Pan Afr Med J 2015; 20:218. [PMID: 26113949 PMCID: PMC4470453 DOI: 10.11604/pamj.2015.20.218.6346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 03/02/2015] [Indexed: 11/11/2022] Open
Abstract
Un patient de 24 ans a subit un traumatisme du genou droit suite à un accident de la voie publique occasionnant une fracture simultanée uni condylienne latérale et patellaire verticale. Cette association est exceptionnelle et aucun cas n'as été retrouvé dans la littérature. Un diagnostic précis clinique et radiologique suivi d'une prise en charge précoce et adaptée par une ostéosynthèse interne et une rééducation fonctionnelle ont permis d'obtenir de bons résultats à long terme.
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Affiliation(s)
- Youness Sasbou
- Université Mohammed V, Faculté de Médecine et de Pharmacie, Service de Chirurgie Orthopédique, Hôpital Militaire d'Instruction Mohammed V, 10000 Rabat, Maroc
| | - Mohammed Boussaidane
- Université Mohammed V, Faculté de Médecine et de Pharmacie, Service de Chirurgie Orthopédique, Hôpital Militaire d'Instruction Mohammed V, 10000 Rabat, Maroc
| | - Loubet Unyendje Lukulunga
- Université Mohammed V, Faculté de Médecine et de Pharmacie, Service de Chirurgie Orthopédique, Hôpital Militaire d'Instruction Mohammed V, 10000 Rabat, Maroc
| | - Mohammed Azzouz
- Université Mohammed V, Faculté de Médecine et de Pharmacie, Service de Chirurgie Orthopédique, Hôpital Militaire d'Instruction Mohammed V, 10000 Rabat, Maroc
| | - Youness Mhammdi
- Université Mohammed V, Faculté de Médecine et de Pharmacie, Service de Chirurgie Orthopédique, Hôpital Militaire d'Instruction Mohammed V, 10000 Rabat, Maroc
| | - Driss Benchebba
- Université Mohammed V, Faculté de Médecine et de Pharmacie, Service de Chirurgie Orthopédique, Hôpital Militaire d'Instruction Mohammed V, 10000 Rabat, Maroc
| | - Belkacem Chagar
- Université Mohammed V, Faculté de Médecine et de Pharmacie, Service de Chirurgie Orthopédique, Hôpital Militaire d'Instruction Mohammed V, 10000 Rabat, Maroc
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Kaneko Y, Nozaki T, Yu H, Chang A, Kaneshiro K, Schwarzkopf R, Hara T, Yoshioka H. Normal T2 map profile of the entire femoral cartilage using an angle/layer-dependent approach. J Magn Reson Imaging 2015; 42:1507-16. [PMID: 25917977 DOI: 10.1002/jmri.24936] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 04/14/2015] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To create standard T2 map profiles from the entire femoral cartilage of healthy volunteers in order to assess regional variations using an angular and layer-dependent approach. MATERIALS AND METHODS Twenty healthy knees were evaluated using 3T sagittal images of a T2 mapping sequence. Manual segmentation of the entire femoral cartilage was performed slice-by-slice by two raters using MatLab. Inter- and intrarater reliabilities were calculated using intraclass correlation coefficient (ICC) and Bland-Altman analysis. T2 values were analyzed with respect to specific locations (medial condyle, trochlea, and lateral condyle), angles to B0 , and layers of cartilage (whole, deep, and superficial). RESULTS Inter- and intrarater reliability obtained from the entire femoral cartilage was excellent (ICC = 0.84, 0.86, respectively). The ICCs around the trochlea were lower than those of the medial and lateral condyle. Both the inter- and intrarater Bland-Altman plots indicated larger differences in pixel count are seen as the size of the angular segment becomes larger. T2 values were significantly higher in the superficial layer compared to the deep layer at each femoral compartment (P < 0.001). A magic angle effect was clearly observed, especially within the whole and deep layer over the medial and lateral femoral condyles, except for the superficial layer at the medial condyle. CONCLUSION The normal T2 map profiles of the entire femoral cartilage showed variations in ICCs by location and in T2 values by angles and layers. These profiles can be useful for diagnosis of early cartilage degeneration in a specific angle and layer of each condyle and trochlea.
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Affiliation(s)
- Yasuhito Kaneko
- Department of Radiological Sciences, University of California, Irvine, Orange, California, USA
| | - Taiki Nozaki
- Department of Radiological Sciences, University of California, Irvine, Orange, California, USA
| | - Hon Yu
- Department of Radiological Sciences, University of California, Irvine, Orange, California, USA.,John Tu and Thomas Yuen Center for Functional Onco-Imaging, University of California, Irvine, Orange, California, USA
| | - Andrew Chang
- Department of Radiological Sciences, University of California, Irvine, Orange, California, USA
| | - Kayleigh Kaneshiro
- Department of Radiological Sciences, University of California, Irvine, Orange, California, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
| | - Takeshi Hara
- Department of Intelligent Image Information, Division of Regeneration and Advanced Medical Sciences, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California, Irvine, Orange, California, USA
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Knapik DM, Harrison RK, Siston RA, Agarwal S, Flanigan DC. Impact of lesion location on the progression of osteoarthritis in a rat knee model. J Orthop Res 2015; 33:237-45. [PMID: 25376614 PMCID: PMC4948985 DOI: 10.1002/jor.22762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/06/2014] [Indexed: 02/04/2023]
Abstract
To investigate how surgically created acute full-thickness cartilage defects of similar size and location created on the medial versus lateral femoral condyle influence progression of spontaneous cartilage lesions in a rat model. Full-thickness cartilage defects of 1 mm were surgically created on the medial or lateral femoral condyles on the right leg of 20 rats (n = 10/group). Ten rats served as controls. Spontaneous lesion progression on the ipsilateral and contralateral surfaces was examined using a high-resolution digital camera along with H&E and Safranin-O staining. Chondral defects were scored grossly and histologically. Control femur displayed no cartilage disruption. Surgically treated knees exhibited created and spontaneous cartilage defects with no evidence of healing unless subchondral bone was penetrated. Ipsilateral spontaneous lesions on the lateral condyle were significantly more severe on average (p = 0.009) compared to medial lesions on gross examination. Histological examination found contralateral lesions on the lateral surface following surgically created medial lesions to be more severe (p = 0.057) compared to contralateral lesions. A trend toward more susceptible chondral damage to the lateral condyle was observed following acute lesion creation on either medial or lateral condyles. Mechanisms behind this pattern of spontaneous lesion development are unclear, requring further investigation.
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Affiliation(s)
- Derrick M. Knapik
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio,Cartilage Restoration Program, The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, Ohio
| | - Ryan K. Harrison
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio
| | - Robert A. Siston
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio,Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio
| | - Sudha Agarwal
- Department of Oral Biology, The Ohio State University, Columbus, Ohio
| | - David C. Flanigan
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio,Cartilage Restoration Program, The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, Ohio
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Eismann EA, Pettit RJ, Wall EJ, Myer GD. Management strategies for osteochondritis dissecans of the knee in the skeletally immature athlete. J Orthop Sports Phys Ther 2014; 44:665-79. [PMID: 25098196 DOI: 10.2519/jospt.2014.5140] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS Osteochondritis dissecans (OCD) is a disorder resulting in focal breakdown of the subchondral bone, with potential disruption of the overlying articular cartilage. The femoral condyles of the knee are the most common locations for OCD, and the incidence of OCD appears to be increasing among active children. Juvenile OCD (JOCD) can be distinguished from adult OCD by the presence of open growth plates. Due to a lack of evidence on its early diagnosis, optimal treatment, and long-term course of healing, JOCD presents a unique challenge for the health care team. Approximately 50% to 67% of stable JOCD lesions heal successfully with nonoperative treatment. For unstable lesions and stable lesions that fail nonoperative treatment, a variety of surgical interventions can be utilized to stimulate bony healing and address articular cartilage lesions. It is recommended that rehabilitation of JOCD be tailored to the individual patient, based on the stage and radiographic status of the lesion and the mode of surgery employed when surgically addressed. Although there is a growing body of literature on this condition, the etiology and optimal methods for treatment, rehabilitation, and evaluating outcomes remain inconclusive due to a lack of quality evidence. LEVEL OF EVIDENCE Therapy, level 5.
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Orth P, Meyer HL, Goebel L, Eldracher M, Ong MF, Cucchiarini M, Madry H. Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle. J Orthop Res 2013; 31:1772-9. [PMID: 23813860 DOI: 10.1002/jor.22418] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 06/05/2013] [Indexed: 02/04/2023]
Abstract
Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full-thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type-II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location-independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics, Saarland University, Building 37-38, D-66421, Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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Chen K, Yin L, Cheng L, Li C, Chen C, Yang L. In vivo motion of femoral condyles during weight-bearing flexion after anterior cruciate ligament rupture using biplane radiography. J Sports Sci Med 2013; 12:579-587. [PMID: 24149168 PMCID: PMC3772605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/13/2013] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to investigate in vivo three- dimensional tibiofemoral kinematics and femoral condylar motion in knees with anterior cruciate ligament (ACL) deficiency during a knee bend activity. Ten patients with unilateral ACL rupture were enrolled. Both the injured and contralateral normal knees were imaged using biplane radiography at extension and at 15°, 30°, 60°, 90°, and 120° of flexion. Bilateral knees were next scanned by computed tomography, from which bilateral three-dimensional knee models were created. The in vivo tibiofemoral motion at each flexion position was reproduced through image registration using the knee models and biplane radiographs. A joint coordinate system containing the geometric center axis of the femur was used to measure the tibiofemoral motion. In ACL deficiency, the lateral femoral condyle was located significantly more posteriorly at extension and at 15° (p < 0.05), whereas the medial condylar position was changed only slightly. This constituted greater posterior translation and external rotation of the femur relative to the tibia at extension and at 15° (p < 0.05). Furthermore, ACL deficiency led to a significantly reduced extent of posterior movement of the lateral condyle during flexion from 15° to 60° (p < 0.05). Coupled with an insignificant change in the motion of the medial condyle, the femur moved less posteriorly with reduced extent of external rotation during flexion from 15° to 60° in ACL deficiency (p < 0.05). The medial- lateral and proximal-distal translations of the medial and lateral condyles and the femoral adduction-abduction rotation were insignificantly changed after ACL deficiency. The results demonstrated that ACL deficiency primarily changed the anterior-posterior motion of the lateral condyle, producing not only posterior subluxation at low flexion positions but also reduced extent of posterior movement during flexion from 15° to 60°. Key PointsThree-dimensional tibiofemoral kinematics and femoral condylar motion in ACL-deficient knees during upright weight-bearing flexion were measured using biplane radiography with the geometric center axis.ACL deficiency caused posterior subluxation of the lateral condyle with excess external femoral rotation at early flexion positions.On flexion from 15° to 60°, the lateral condyle moved slightly posteriorly in ACL deficiency leading to reduced extent of external femoral rotation.
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