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Cecilia Pascual-Garrido, Jiandong Hao, John Schrock, Omer Mei-Dan, Jorge Chahla
Cartilage lesions in the hip are of high prevalence. Most of these lesions are treated with microfracture. Microfracture has relatively good subjective outcomes for smaller lesions; however, it is limited by the ability to reproduce hyaline cartilage, especially in older patients. For larger chondral defects, we present a technique using juvenile allograft cartilage implantation implanted arthroscopically to treat cartilage lesions in the hip. The purpose of this technical note is to describe the arthroscopic technique for treating chondral lesions in the hip with allograft juvenile cartilage...
August 2016: Arthroscopy Techniques
Darius Moezzi
Knee focal cartilage treatment depends on many variables including lesion size, location, age, and patient activity level. High level of evidence meta-analysis suggests that the osteochondral autograft transfer system is superior to microfracture for larger lesions and osteochondritis dissecans, but cartilage restoration indications must be individualized based on additional variables.
October 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Ryan M Degen, Danielle Tetreault, Greg T Mahony, Riley J Williams
Articular cartilage injuries, and corresponding surgical procedures, are occurring with increasing frequency as identified by a review of recent surgical trends. Concerns have grown in recent years regarding the longevity of results following microfracture, with a shift toward cartilage restoration procedures in recent years. This case report describes 2 cases of acute failure following the use of commercially available osteochondral allograft plugs used for the treatment of osteochondral defects of the distal femur...
October 2016: Cartilage
Tyler Novak, Kateri Fites, Xin Xu, Logan Worke, Aaron Ciesielski, Gert Breur, Corey P Neu
Interest in decellularized tissues has steadily gained as potential solutions for degenerative diseases and traumatic events, replacing sites of missing tissue and providing the relevant biochemistry and microstructure for tissue ingrowth and regeneration. Osteoarthritis, a progressive and debilitating disease, is often initiated with the formation of a focal defect in the otherwise smooth surface of articular cartilage. The use of decellularized cartilage tissue, which maintains the structural complexity of the native extracellular matrix, has the potential to provide a clinically relevant solution to focal defects or large tissue damage, possibly even circumventing or complementing current techniques such as microfracture and mosaicplasty...
September 27, 2016: Tissue Engineering. Part A
Cecilia Pascual-Garrido, Erika Daley, Nikhil N Verma, Brian J Cole
PURPOSE: To compare the results of focal metallic resurfacing with biologic procedures in patients more than 35 years of age with isolated, full thickness defects of the femoral condyle. METHODS: A total of 61 patients met the selection criteria resulting in 30 patients treated with biological procedures, including debridement, microfracture, osteochondral autograft transplantation, osteochondral allograft, and autologous chondrocyte implantation (BIO group), and 32 patients treated with focal metallic resurfacing (CAP group)...
September 20, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Michiel W Pot, Veronica K Gonzales, Pieter Buma, Joanna IntHout, Toin H van Kuppevelt, Rob B M de Vries, Willeke F Daamen
Microfracture surgery may be applied to treat cartilage defects. During the procedure the subchondral bone is penetrated, allowing bone marrow-derived mesenchymal stem cells to migrate towards the defect site and form new cartilage tissue. Microfracture surgery generally results in the formation of mechanically inferior fibrocartilage. As a result, this technique offers only temporary clinical improvement. Tissue engineering and regenerative medicine may improve the outcome of microfracture surgery. Filling the subchondral defect with a biomaterial may provide a template for the formation of new hyaline cartilage tissue...
2016: PeerJ
Michael C Greaser
The incidence of stress fractures in the general athletic population is less than 1%, but may be as high as 15% in runners. Stress fractures of the foot and ankle account for almost half of bone stress injuries in athletes. These injuries occur because of repetitive submaximal stresses on the bone resulting in microfractures, which may coalesce to form complete fractures. Advanced imaging such as MRI and triple-phase bone scans is used to evaluate patients with suspected stress fracture. Low-risk stress fractures are typically treated with rest and protected weight bearing...
October 2016: Orthopedic Clinics of North America
Armin Arshi, Jeremiah R Cohen, Jeffrey C Wang, Sharon L Hame, David R McAllister, Kristofer J Jones
BACKGROUND: Treatment of patellofemoral instability has evolved as our understanding of the relevant pathoanatomy has improved. In light of these developments, current practice patterns and management trends have likely changed to reflect these advancements; however, this has not been evaluated in a formal study. PURPOSE: To determine nationwide patient demographics, surgical trends, and postoperative complications associated with the operative management of patellar instability surgery...
August 2016: Orthopaedic Journal of Sports Medicine
Hakan Sofu, Nizamettin Kockara, Ali Oner, Yalkin Camurcu, Ahmet Issın, Vedat Sahin
PURPOSE: To determine the clinical and radiographic efficacy of hyaluronic acid-based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint. METHODS: Clinical data of 43 patients between 24 and 55 years of age were evaluated. Hyaluronic acid-based cell-free scaffold was applied in combination with microfracture for 19 knees (group 1), whereas microfracture alone was the surgical intervention for 24 knees (group 2)...
September 7, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Jonathan C Riboh, Gregory L Cvetanovich, Brian J Cole, Adam B Yanke
PURPOSE: While numerous randomized controlled trials have compared surgical treatments for cartilage defects of the knee, the comparative efficacy of these treatments is still poorly understood. The goal of this network meta-analysis was to synthesize these randomized data into a comprehensive model allowing pairwise comparisons of all treatment options and treatment rankings based on multiple measures of efficacy. We hypothesized that advanced chondral procedures would have improved outcomes when compared to microfracture...
September 7, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Francesca Vannini, Giuseppe Gianluca Costa, Silvio Caravelli, Gherardo Pagliazzi, Massimiliano Mosca
PURPOSE: ankle injuries make up 15% of all sports injuries and osteochondral lesions of the talus (OLTs) are an increasingly frequent problem in active patients. There exist no widely shared guidelines on OLT treatment in the athletic population. The aim of this paper is to review all the existing literature evidence on the surgical treatment of OLTs in athletes, in order to determine the current state of the art in this specific population, underlining both the limits and the potential of the strategies used...
April 2016: Joints
Pietro Zedde, Sebastiano Cudoni, Giacomo Giachetti, Maria Lucia Manunta, Gerolamo Masala, Antonio Brunetti, Andrea Fabio Manunta
PURPOSE: microfracture, providing direct stimulation of chondrogenic mesenchymal stem cells (MSCs) in the subchondral bone, remains the most frequently used primary cartilage repair technique. However, the newly formed type I collagen-rich fibrocartilaginous tissue has poor biomechanical properties and a tendency to degenerate. To overcome these limitations the nanofracture technique was introduced. Our purpose was to compare subchondral bone remodeling 6 months after microfracture versus nanofracture (subchondral needling) treatment in an ovine model...
April 2016: Joints
Margaret K Boushell, Clark T Hung, Ernst B Hunziker, Eric J Strauss, Helen H Lu
Osteoarthritis (OA) is a degenerative joint condition characterized by painful cartilage lesions that impair joint mobility. Current treatments such as lavage, microfracture, and osteochondral implantation fail to integrate newly formed tissue with host tissues and establish a stable transition to subchondral bone. Similarly, tissue-engineered grafts that facilitate cartilage and bone regeneration are challenged by how to integrate the graft seamlessly with surrounding host cartilage and/or bone. This review centers on current approaches to promote cartilage graft integration...
September 6, 2016: Connective Tissue Research
Liang Gao, Patrick Orth, Lars K H Goebel, Magali Cucchiarini, Henning Madry
Subchondral bone alterations are emerging as considerable clinical problems associated with articular cartilage repair. Their analysis exposes a pattern of variable changes, including intra-lesional osteophytes, residual microfracture holes, peri-hole bone resorption, and subchondral bone cysts. A precise distinction between them is becoming increasingly important. Here, we present a tailored algorithm based on continuous data to analyse subchondral bone changes using micro-CT images, allowing for a clear definition of each entity...
2016: Scientific Reports
Guilherme C Gracitelli, Vinícius Y Moraes, Carlos Es Franciozi, Marcus V Luzo, João Carlos Belloti
BACKGROUND: Cartilage defects of the knee are often debilitating and predispose to osteoarthritis. Microfracture, drilling, mosaicplasty, and allograft transplantation are four surgical treatment options that are increasingly performed worldwide. We set out to examine the relative effects of these different methods. OBJECTIVES: To assess the relative effects (benefits and harms) of different surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults...
September 3, 2016: Cochrane Database of Systematic Reviews
Chadwick John Green, Aswin Beck, David Wood, Ming H Zheng
The use of microfracture in hip arthroscopy is increasing dramatically. However, recent reports raise concerns not only about the lack of evidence to support the clinical use of microfracture, but also about the potential harm caused by violation of the subchondral bone plate. The biology and pathology of the microfracture technique were described based on observations in translational models and the clinical evidence for hip microfracture was reviewed systematically. The clinical outcomes in patients undergoing microfracture were the same as those not undergoing microfracture...
July 2016: Journal of Hip Preservation Surgery
Phu Dinh Nguyen, Tung Dang-Xuan Tran, Huynh Ton-Ngoc Nguyen, Hieu Trung Vu, Phuong Thi-Bich Le, Nhan Lu-Chinh Phan, Ngoc Bich Vu, Ngoc Kim Phan, Phuc Van Pham
: : Osteoarthritis (OA) is a degenerative cartilage disease that is characterized by a local inflammatory reaction. Consequently, many studies have been performed to identify suitable prevention and treatment interventions. In recent years, both arthroscopic microfracture (AM) and stem cell therapy have been used clinically to treat OA. This study aimed to evaluate the clinical effects of AM in the presence and absence of a stromal vascular fraction (SVF) injection in the management of patients with OA...
August 29, 2016: Stem Cells Translational Medicine
U Dasar, S Gursoy, M Akkaya, O Algin, C Isik, M Bozkurt
PURPOSE: To compare the microfracture technique with carbon fibre rod implantation for treatment of knee articular cartilage lesions. METHODS: 10 men and 30 women aged 22 to 56 (mean, 37.4) years underwent microfracture (n=20) or carbon fibre rod implantation (n=20) for International Cartilage Repair Society grade 3 to 4 knee articular cartilage lesions after a mean of 12.2 months of viscosupplementation and physiotherapy. Clinical outcome at 6 and 12 months was assessed using the Tegner-Lysholm score and modified Cincinnati score...
August 2016: Journal of Orthopaedic Surgery
Gregory L Cvetanovich, Jonathan C Riboh, Annemarie K Tilton, Brian J Cole
BACKGROUND: Existing studies of autologous chondrocyte implantation (ACI) in adolescent patients have primarily reported outcomes that have not been validated for cartilage repair and have failed to include measures of general health or health-related quality of life. PURPOSE: This study assesses validated knee-specific functional outcomes and health-related quality of life after ACI in adolescent patients. STUDY DESIGN: Case series; Level of evidence, 4...
August 26, 2016: American Journal of Sports Medicine
Matthew T Brokken, Robert K Schneider, Gregory D Roberts, Shannon P Holmes, Patrick R Gavin, Sarah N Sampson, Kelly D Farnsworth, Linda A Dahlgren
OBJECTIVE: To evaluate the effects of a new microfracture and ligament splitting procedure on ligament healing and to examine the usefulness of magnetic resonance (MR) imaging for monitoring ligament healing over time using a collagenase model of hind limb proximal suspensory desmitis. STUDY DESIGN: Experimental in vivo study. ANIMALS: Healthy adult horses (n=6). METHODS: Horses were free of lameness with normal hind limb proximal suspensory ligaments (PSL)...
October 2016: Veterinary Surgery: VS
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