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Knee And Microfractures

Anirudh K Gowd, Gregory L Cvetanovich, Joseph N Liu, David R Christian, Brandon C Cabarcas, Michael L Redondo, Nikhil N Verma, Adam B Yanke, Brian J Cole
PURPOSE: To provide updated surgical trends of cartilage procedures differentiated by the classic groups of palliative, repair, and restorative modalities. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2010-2016 for the following cartilage procedures: chondroplasty, microfracture, arthroscopic osteochondral autograft or allograft transplantation, open osteochondral autograft or allograft transplantation, and autologous chondrocyte implantation...
November 22, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Jiaju Lu, Xuezhen Shen, Xun Sun, Heyong Yin, Shuhui Yang, Changfeng Lu, Yu Wang, Yifan Liu, Yingqi Huang, Zijin Yang, Xianqi Dong, Chenhao Wang, Quanyi Guo, Lingyun Zhao, Xiaodan Sun, Shibi Lu, Antonios G Mikos, Jiang Peng, Xiumei Wang
Even small cartilage defects could finally degenerate to osteoarthritis if left untreated, owing to the poor self-healing ability of articular cartilage. Stem cell transplantation has been well implemented as a common approach in cartilage tissue engineering but has technical complexity and safety concerns. The stem cell homing-based technique emerged as an alternative promising therapy for cartilage repair to overcome traditional limitations. In this study, we constructed a composite hydrogel scaffold by combining an oriented acellular cartilage matrix (ACM) with a bone marrow homing peptide (BMHP)-functionalized self-assembling peptide (SAP)...
2018: Theranostics
Xavier Armoiry, Ewen Cummins, Martin Connock, Andrew Metcalfe, Pamela Royle, Rhona Johnston, Jeremy Rodrigues, Norman Waugh, Hema Mistry
Chondrosphere (Spherox) is a form of autologous chondrocyte implantation (ACI). It is licensed for repair of symptomatic articular cartilage defects of the femoral condyle and the patella of the knee with defect sizes up to 10 cm2 in adults. In a single technology appraisal (STA) [TA508] undertaken by the National Institute of Health and Care Excellence (NICE), Warwick Evidence was the Evidence Review Group (ERG) invited to independently review the evidence submitted by the manufacturer, Co.Don. The clinical effectiveness data came from their COWISI randomised controlled trial (RCT), which compared Chondrosphere with microfracture (MF)...
November 14, 2018: PharmacoEconomics
Thomas G Baboolal, Alam Khalil-Khan, Anthony A Theodorides, Owen Wall, Elena Jones, Dennis McGonagle
BACKGROUND: Mesenchymal stem cells (MSCs) have emerged as a promising candidate for tissue regeneration and restoration of intra-articular structures such as cartilage, ligaments, and menisci. However, the routine use of MSCs is limited in part by their low numbers and the need for methods and procedures outside of the joint or surgical field. PURPOSE: To demonstrate feasibility of a technique in which minimally manipulated synovial MSCs can be mobilized during knee arthroscopy, thereby showing proof of concept for the future evaluation and clinical use of native joint resident MSCs in single-stage joint repair strategies...
December 2018: American Journal of Sports Medicine
Melanie J Gupte, W Benton Swanson, Jiang Hu, Xiaobing Jin, Haiyun Ma, Zhanpeng Zhang, Zhongning Liu, Kai Feng, Ganjun Feng, Guiyong Xiao, Nan Hatch, Yuji Mishina, Peter X Ma
In the U.S., 30% of adults suffer joint pain, most commonly in the knee, which severely limits mobility and is often attributed to injury of cartilage and underlying bone in the joint. Current treatment methods such as microfracture result in less resilient fibrocartilage with eventual failure; autografting can cause donor site morbidity and poor integration. To overcome drawbacks in treatment, tissue engineers can design cell-instructive biomimetic scaffolds using biocompatible materials as alternate therapies for osteochondral defects...
December 2018: Acta Biomaterialia
Matthew T Wolf, Hong Zhang, Blanka Sharma, Norman A Marcus, Uwe Pietzner, Stefan Fickert, Achim Lueth, G H Robert Albers, Jennifer H Elisseeff
Objective To determine performance and repair kinetics of the ChonDux hydrogel scaffold for treating focal articular cartilage defects in the knee over 24 months. Design This assessor-blinded trial evaluates ChonDux hydrogel scaffold implantation in combination with microfracture in 18 patients across 6 sites. Male and female patients 18 to 65 years of age with full-thickness femoral condyle defects 2 to 4 cm2 in area were enrolled. Eligible patients received ChonDux treatment followed by rehabilitation. Defect volume fill was evaluated after 3, 6 (primary outcome), 12, 18, and 24 months by assessor blinded magnetic resonance imaging (MRI) analysis...
October 3, 2018: Cartilage
Reetadyuti Mukhopadhyay, Nishith Shah, Rohan Vakta, Jaymin Bhatt
PURPOSE: Anterior cruciate ligament (ACL) repair was first described in the mid 1900's. However, due to poorly selected patients led to unsatisfactory early results. We aim to study the outcome of ACL repair in a carefully selected cohort. METHODS: Thirteen consecutive patients of acute Type 1 (proximal ACL avulsion) were treated with arthroscopic ACL repair using a suture pull out technique. At the latest follow-up the patients were evaluated for Lysholm score, KT-1000 measurement and clinical assessment for any laxity...
September 6, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
Onur Başci, Maide Çimşit, Selva Zeren, Yeşim Saglican, Umut Akgün, Bariş Kocaoglu, Gülçin Başdemir, Mustafa Karahan
Purpose: The purpose of this experimental study was to investigate the effect of hyperbaric oxygen (HBO2) therapy combined with microfracture technique in the treatment of cartilage lesions. Methods: Adult Wistar rats (n=44) were divided into six groups. In Groups A, B, C and D, ICRS* (* International Cartilage Repair Society) grade 4 cartilage lesions were made on the femoral sulcus of both knees. Lesions were microfractured on the left knees; the right knees had no further procedure...
July 2018: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Ajaykumar Shanmugaraj, Ryan P Coughlin, Gabriel N Kuper, Seper Ekhtiari, Nicole Simunovic, Volker Musahl, Olufemi R Ayeni
PURPOSE: The patellofemoral (PF) joint contains the thickest articular cartilage in the human body. Chondral lesions to this area are often misdiagnosed and can predispose to secondary osteoarthritis if left untreated. Treatment options range from arthroscopic debridement to cartilage restoration techniques such as microfracture (MFx), autologous chondrocyte implantation (ACI), and osteochondral autograft transplantation. The purpose of this study was to systematically assess the trends in surgical techniques, outcomes, and complications of cartilage restoration of the PF joint...
September 19, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Isabel Andia, Nicola Maffulli
The practice of any sport is inherently associated with the risk of musculoskeletal lesions. We describe regenerative medicine technologies, including cellular therapies, gene therapies and multimolecular preparations of growth factors and cytokines, which are expected to advance the field of orthopaedics and sports medicine. Gene therapy involves the introduction of genetic information in the injured tissue to help that tissue to heal and, possibly, regenerate. Cell therapies used in clinical practice are based on the transplantation of adult human cells, which can be at different stages of differentiation...
August 28, 2018: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Anja Hirschmüller, Wolfgang Schoch, Heiner Baur, Barbara Wondrasch, Lukas Konstantinidis, Nobert P Südkamp, Philipp Niemeyer
INTRODUCTION: Focal cartilage defects are an increasingly relevant clinical problem especially in athletes. Cartilage regenerative surgery (CRS) including microfracture and autologous chondrocyte implantation (ACI) to treat such isolated cartilage defects in the knee joint has been well established in the last two decades. In contradiction to high-level evidence concerning the surgical technique, cell-related issues, and clinical results, the knowledge about the optimal rehabilitation process is still sparse although the importance of optimizing the rehabilitation process has recently led to new research focus in this field...
August 21, 2018: Archives of Orthopaedic and Trauma Surgery
Sung-Sahn Lee, Jin Hwan Ahn, Jun Ho Kim, Bong Soo Kyung, Joon Ho Wang
BACKGROUND: Previous studies have reported various healing rates (0%-100%) as evaluated by second-look arthroscopy after repair of medial meniscal root tears (MMRTs). Such variable results might provoke suspicion of the necessity for repair. Furthermore, the effect of meniscal healing on the clinical outcomes has not been reported. PURPOSE: To more precisely determine the healing rate of MMRTs repaired through the transseptal portal, which could provide objective visualization of the healed meniscus, and to identify the effect of meniscal healing on the clinical and radiological outcomes...
September 2018: American Journal of Sports Medicine
Svend Ulstein, Asbjørn Årøen, Lars Engebretsen, Magnus Forssblad, Stein Håkon Låstad Lygre, Jan Harald Røtterud
Background: The effect of microfracture (MF) or surgical debridement of concomitant full-thickness cartilage lesions in anterior cruciate ligament-reconstructed knees on patient-reported outcomes remains to be determined. Purpose: To evaluate the effect of debridement or MF compared with no surgical treatment of concomitant full-thickness cartilage lesions on patient-reported outcomes 5 years after anterior cruciate ligament reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 2...
August 2018: Orthopaedic Journal of Sports Medicine
Seiju Hayashi, Tomoyuki Nakasa, Masakazu Ishikawa, Atsuo Nakamae, Shigeru Miyaki, Nobuo Adachi
BACKGROUND: The microfracture (MF) technique is an established surgical treatment for cartilage injury. However, the early-phase histological changes in full-thickness cartilage defects (FTCDs) after MF and the concomitant changes in the subchondral bone are still unknown. PURPOSE: To determine the early-phase histological changes in FTCD associated with subchondral bone remodeling after MF in rat model. STUDY DESIGN: Controlled laboratory study...
October 2018: American Journal of Sports Medicine
Rachel M Frank, Frank McCormick, Sam Rosas, Kelms Amoo-Achampong, Brandon Erickson, Bernard R Bach, Brian J Cole
The purpose of this study is to describe the rate of return to the operating room (OR) following microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral autograft transplantation (OATS), and osteochondral allograft (OCA) procedures at 90 days, 1 year, and 2 years. Current Procedural Terminology codes for all patients undergoing MFX, ACI, OATS, and OCA were used to search a prospectively collected, commercially available private payer insurance company database from 2007 to 2011. Within 90 days, 1 year, and 2 years after surgery, the database was searched for the occurrence of these same patients undergoing knee diagnostic arthroscopy with biopsy, lysis of adhesions, synovectomy, arthroscopy for infection or lavage, arthroscopy for removal of loose bodies, chondroplasty, MFX, ACI, OATS, OCA, and/or knee arthroplasty...
June 2018: American Journal of Orthopedics
Rosa S Valtanen, Armin Arshi, Benjamin V Kelley, Peter D Fabricant, Kristofer J Jones
Objective To perform a systematic review of clinical outcomes following microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and osteochondral autograft transplantation system (OATS) to treat articular cartilage lesions in pediatric and adolescent patients. We sought to compare postoperative improvements for each cartilage repair method to minimal clinically important difference (MCID) thresholds. Design MEDLINE, Web of Science, Scopus, and Cochrane Library databases were searched for studies reporting MCID-validated outcome scores in a minimum of 5 patients ≤19 years treated for symptomatic knee chondral lesions with minimum 1-year follow-up...
June 1, 2018: Cartilage
Michaela O'Connor, Anas A Minkara, Robert W Westermann, James Rosneck, T Sean Lynch
Background: The detection and management of chondral injuries of the hip, especially in a younger patient population, may preempt joint degeneration. Although the outcomes of preservation techniques have been well described for other weightbearing joints, such as the knee, evidence for hip joint preservation after procedures such as microfracture and autologous chondrocyte implantation remains in its infancy. Purpose: To evaluate outcomes of joint preservation procedures in the hip, including the success rate and patient-reported outcomes (PROs)...
June 2018: Orthopaedic Journal of Sports Medicine
Eirik Solheim, Janne Hegna, Eivind Inderhaug
Objective To investigate survival of cartilage repair in the knee by microfracture (MFX; n = 119) or mosaicplasty osteochondral autograft transfer (OAT; n = 84). Design For survival analyses, "failure" was defined as the event of a patient reporting a Lysholm score <65 or undergoing an ipsilateral knee replacement. The Kaplan-Meier method was used for construction of a survival functions plot for the event "failure." Log rank (Mantel-Cox) test was used for comparison of survival distributions in the 2 groups...
June 1, 2018: Cartilage
Philipp Niemeyer, Christoph Becher, Peter U Brucker, Matthias Buhs, Stefan Fickert, Kolja Gelse, Daniel Günther, Raphael Kaelin, Peter Kreuz, Jörg Lützner, Stefan Nehrer, Henning Madry, Stefan Marlovits, Julian Mehl, Henning Ott, Matthias Pietschmann, Gunther Spahn, Thomas Tischer, Martin Volz, Markus Walther, Götz Welsch, Johannes Zellner, Wolfgang Zinser, Peter Angele
Surgical principles for treatment of full-thickness cartilage defects of the knee include bone marrow stimulation techniques (i.e. arthroscopic microfracturing) and transplantation techniques (i.e. autologous chondrocyte implantation and osteochondral transplantation). On the basis of increasing scientific evidence, indications for these established therapeutical concepts have been specified and clear recommendations for practical use have been given. Within recent years, matrix-augmented bone marrow stimulation has been established as a new treatment concept for chondral lesions...
October 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Robert Ossendorff, Kilian Franke, Benjamin Erdle, Markus Uhl, Norbert P Südkamp, Gian M Salzmann
PURPOSE: To compare the clinical and radiographical long-term outcome of microfracture (MFX) and first-generation periosteum-covered autologous chondrocyte implantation (ACI-P). METHODS: All subjects (n = 86) who had been treated with knee joint ACI-P or microfracture (n = 76) with a post-operative follow-up of at least ten years were selected. Clinical pre- and post-operative outcomes were analyzed by numeric analog scale (NAS) for pain, Lysholm, Tegner, IKDC, and KOOS score...
June 16, 2018: International Orthopaedics
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