Patient-specific resurfacing implant knee surgery in subjects with early osteoarthritis results in medial pivot and lateral femoral rollback during flexion: a retrospective pilot study.

PURPOSE: Metallic resurfacing implants have been developed for the treatment of early, small, condylar and trochlear osteoarthritis (OA) lesions. They represent an option for patients who do not fulfill the criteria for unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) or are too old for biological treatment. Although clinical evidence has been collected for different resurfacing types, the in vivo post-operative knee kinematics remain unknown. The present study aims to analyze the knee kinematics in subjects with patient-specific episealer implants. This study hypothesized that patient-specific resurfacing implants would lead to knee kinematics close to healthy knees, resulting in medial pivot and a high degree of femoral rollback during flexion. METHODS: Retrospective study design. Fluoroscopic analysis during unloaded flexion-extension and loaded lunge was conducted at > 12 months post-surgery in ten episealer knees, and compared to ten healthy knees. Pre- and post-operative clinical data of the episealer knees were collected using a visual analog scale (VAS), the EQ 5d Health, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires. RESULTS: A consistent medial pivot was observed in both episealer and healthy knees. Non-significant differences were found in the unloaded (p = 0.15) and loaded (p = 0.51) activities. Although lateral rollback was observed in both groups, it was significantly higher for the episealer knees in both the unloaded (p = 0.02) and loaded (p = 0.01) activities. Coupled axial rotation was significantly higher in the unloaded (p = 0.001) but not in the loaded (p = 0.06) activity in the episealer knees. Improved scores were observed at 1-year post-surgery in the episealer subjects for the VAS (p = 0.001), KOOS (p = 0.001) and EQ Health (p = 0.004). CONCLUSION: At 12 month follow-up, a clear physiological knee kinematics pattern of medial pivot, lateral femoral rollback and coupled axial external femoral rotation during flexion was observed in patients treated with an episealer resurfacing procedure. However, higher femoral rollback and axial external rotation in comparison to healthy knees was observed, suggesting possible post-operative muscle weakness and consequent insufficient stabilization at high flexion.

Acute, isolated and unstable syndesmotic injuries are frequently associated with intra-articular pathologies.

PURPOSE: Although simultaneous arthroscopy for the surgical treatment of acute isolated, unstable syndesmotic injuries has been recommended, little knowledge is present about the actual frequency of intra-articular pathologies for this injury. The aim of this study was to investigate the frequency and severity of intra-articular pathologies detected during arthroscopy and their subsequent treatment in acute isolated, unstable syndesmotic injuries. METHODS: A retrospective chart review of patients treated by arthroscopic-assisted stabilization for acute isolated, syndesmotic instability was performed. The primary outcome parameter was the frequency of intra-articular pathologies. Secondary outcome parameters were the type of syndesmotic lesion (ligamentous/bony), severity of chondral lesions, MRI findings, treatment details, complications and the identification of factors associated with intra-articular pathologies. RESULTS: Twenty-seven patients, 19% female, with a mean age of 37 ± 12 years met the inclusion criteria. 70% suffered isolated ligamentous injuries, the remaining suffered avulsion fractures of the syndesmosis. Chondral lesions occurred in 48% (ICRS grade II: 33%; ICRS grade IV 15%) and intra-articular loose bodies in 11% of patients. Overall, arthroscopy revealed intra-articular pathologies necessitating further treatment in 19% of patients. Neither the type of syndesmotic injury (bony vs. ligamentous; ns) nor the degree of ligamentous instability (West Point IIB vs. III; ns) had a significant influence on the occurrence of chondral lesions. One complication (SSI) occurred. Pre-operative MRI revealed a sensitivity/specificity of 100/79% for chondral lesions and 50/93% for loose bodies. CONCLUSION: Intra-articular pathologies in acute isolated, unstable syndesmotic injuries occur in up to 50% of patients, 19% necessitated additional treatment. Simultaneous arthroscopy, independent of the pre-operative MRI findings, appears reasonable in highly active patients. LEVEL OF EVIDENCE: Level III.

Genetics in Cartilage Lesions: Basic Science and Therapy Approaches.

Cartilage lesions have a multifactorial nature, and genetic factors are their strongest determinants. As biochemical and genetic studies have dramatically progressed over the past decade, the molecular basis of cartilage pathologies has become clearer. Several homeostasis abnormalities within cartilaginous tissue have been found, including various structural changes, differential gene expression patterns, as well as altered epigenetic regulation. However, the efficient treatment of cartilage pathologies represents a substantial challenge. Understanding the complex genetic background pertaining to cartilage pathologies is useful primarily in the context of seeking new pathways leading to disease progression as well as in developing new targeted therapies. A technology utilizing gene transfer to deliver therapeutic genes to the site of injury is quickly becoming an emerging approach in cartilage renewal. The goal of this work is to provide an overview of the genetic basis of chondral lesions and the different approaches of the most recent systems exploiting therapeutic gene transfer in cartilage repair. The integration of tissue engineering with viral gene vectors is a novel and active area of research. However, despite promising preclinical data, this therapeutic concept needs to be supported by the growing body of clinical trials.

[Labral pathologies of the hip joint]. / Labrumpathologie des Hüftgelenkes.

Magnetic resonance imaging (MRI) of the hip joint is performed for the diagnostics of many clinical pathologies. For clarification of pathologies of the hip joint conventional MRI and MR arthrography are used. The use of MRI either with or without the intravenous administration of contrast material is performed to diagnose bone marrow lesions, necrosis of the femoral head, inflammatory and tumorous lesions affecting the hip joint and its components. After the intra-articular administration of a diluted solution of contrast material, which results in distension of the joint, MR arthrography is performed for the diagnosis of intra-articular pathologies, such as lesions of the labrum acetabulare, chondral lesions and free intra-articular bodies. In recent times, MR arthrography is carried out with continuous traction of the limb to be examined because this leads to a distension of the joint and its components and in this way particularly lesions of the labrum with involvement of cartilage can be visualized even better. This article gives an overview of MRI and the accuracy of detecting lesions of the labrum acetabulare and the influence on the therapeutic approach.

Lateral femoral chondral lesions are more frequent when an anterior cruciate ligament tear is concomitant with a lateral femoral notch sign, but do not progress over time.

BACKGROUND: The lateral femoral notch sign (LFNS) is caused by an impact to the lateral femoral condyle during a pivot shift injury and affects 25% to 33% of patients with an anterior cruciate ligament (ACL) rupture. The primary aim of this study was to compare the incidence of chondral lesions 1year after ACL reconstruction, while taking into consideration preoperative chondral damage, in patients with and without a preoperative LFNS. The primary outcome measure was the presence of chondral lesions involving the lateral femoral condyle, confirmed on magnetic resonance imaging (MRI) using the Outerbridge classification, at 1year postoperative. The secondary outcome measures were bone bruise of the lateral femoral condyle confirmed on MRI, the International Knee Documentation Committee (IKDC), Lysholm and Tegner functional scores taken 1year after surgery. METHODS: Sixty patients were included-30 with preoperative LFNS and 30 without-in a retrospective, comparative study of prospectively collected data on patients operated between August 2018 and December 2020. RESULTS: A lateral femoral chondral lesion 1year after surgery was significantly more common in the group with a preoperative LFNS (37% [n=11] versus 13% [n=4] in the group without a preoperative LFNS, p=0.036). Adjusting the statistical analysis for preoperative body mass index (BMI) did not impact these results (adjusted odds ratio [OR]=3.83 [95%CI: 1.03-14.24]; p=0.045). Adjusting for a preoperative lateral femoral chondral lesion had an impact on these results (adjusted OR=0.78 [95%CI: 0.12-5.08]; p=0.793). This indicates that a preoperative LFNS is not significantly and independently associated with a lateral femoral chondral lesion at 1year postoperative when the analysis is adjusted for a preoperative lateral femoral chondral lesion. However, having a preoperative lateral femoral chondral lesion is significantly correlated with the presence of a lateral femoral chondral lesion 1year after the surgery (adjusted OR=63.31 [95%CI: 5.94-674.8]; p=0.001). There were no significant differences in terms of bone bruise on MRI (p=1.0), or for the IKDC (p=0.310), Lysholm (p=0.416) and Tegner (p=0.644) functional scores. The LFNS was still present in 21 out of 30 patients (70%) at 1year postoperative. The preoperative LFNS was significantly smaller in the group without a chondral lesion compared to the group with a chondral lesion 1year after the surgery (median=2.30mm [IQR: 1.40; 3.00] versus 3.10mm [IQR: 2.50; 3.40]; p value=0.045). CONCLUSIONS: Patients with a preoperative LFNS are three times more likely to have a chondral lesion in the notch region 1year after surgery. These chondral lesions are concomitant to the injury and do not progress over time. LEVEL OF EVIDENCE: III.

Incidence of and Risk Factors for Medial Meniscal Lesions at the Time of ACL Reconstruction: An Analysis of 4697 Knees From the SANTI Study Group Database.

BACKGROUND: Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses. PURPOSE: To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model. RESULTS: MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001). CONCLUSION: Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions.

A comprehensive review of hip arthroscopy techniques and outcomes.

Transforming the orthopedic landscape, hip arthroscopy pioneers a minimally invasive surgical approach for diagnosing and addressing hip pathologies. With its origins dating back to Burman's 1931 cadaveric study, this groundbreaking technique gained clinical relevance in 1939 through Takagi's report. However, the 1980s marked the actual emergence of hip arthroscopy for treating a wide range of hip disorders. Now, a staple in modern orthopedics, hip arthroscopy empowers patients with previously undiagnosed and untreated hip conditions, enabling them to obtain relief and reclaim their lives. By employing a compact camera and specialized tools, surgeons expertly navigate the hip joint, performing procedures from excising loose bodies and mending labral tears to addressing femoroacetabular impingement and tackling other intricate issues. This innovative approach has dramatically elevated patients' quality of life, allowing them to embrace targeted treatments and resume daily activities without resorting to lifestyle alterations.

[Treatment of osteochondritis dissecans]. / Therapie der Osteochondrosis dissecans.

Osteochondritis dissecans (OD) is a rare condition with an incidence of 30/100,000. It especially affects male patients aged 10-20 years old. During the staged progression the osteochondral fragments can detach from their base. These can damage the adjacent articular cartilage, which can lead to premature osteoarthritis. Most commonly affected are the knee, ankle and elbow joints. The exact pathogenesis of OD has so far not been clearly confirmed. Several risk factors that can lead to the development of OD are discussed. These include repeated microtrauma and vascularization disorders that can lead to ischemia of the subchondral bone and to a separation of the fragments close to the joint and therefore to the development of free joint bodies. For an adequate clarification patients should undergo a thorough radiological evaluation including X­ray imaging followed by magnetic resonance imaging (MRI) to assess the integrity of the cartilage-bone formation with determination of the OD stage. The assessment is based on criteria of the International Cartilage Repair Society (ICRS). The instability of the cartilage-bone fragment increases with higher stages. Stages I and II with stable cartilage-bone interconnection can be treated conservatively. For stages III and IV, i.e., instability of the OD fragment or the presence of free fragments, surgical treatment should be performed. Primarily, refixation of a free joint body should be carried out depending on the size and vitality of the fragment. In cases of unsuccessful conservative treatment or fixation, a debridement, if necessary in combination with a bone marrow stimulating procedure, can be employed corresponding to the size of the defect. For larger cartilage defects, an osteochondral graft transplantation should be considered. Overall, OD lesions in stages I and II show a good healing tendency under conservative treatment. In cases of incipient unstable OD, refixation can also lead to good clinical and radiological results.

A Multi-Disciplinary MRI Assessment May Optimize the Evaluation of Chondral Lesions in Acute Ankle Fractures: A Prospective Study.

Chondral lesions (CL) in the ankle following acute fractures are frequently overlooked immediately after the injury or diagnosed at a later stage, leading to persistent symptoms despite successful surgery. The literature presents a wide range of discrepancies in the reported incidence of CLs in acute ankle fractures. The objective of this prospective study is to provide a precise assessment of the occurrence of chondral lesions (CLs) in acute ankle fractures through MRI scans conducted immediately after the trauma and prior to scheduled surgery. Furthermore, the study aims to highlight the disparities in the interpretation of these MRI scans, particularly concerning the size and extent of chondral damage, between radiologists and orthopedic surgeons. Over the period of three years, all patients presenting with an unstable ankle fracture that underwent operative treatment were consecutively included in this single-center prospective study. Preoperative MRIs were obtained for all included patients within 10 days of the trauma and were evaluated by a trauma surgeon and a radiologist specialized in musculoskeletal MRI blinded to each other's results. The location of the lesions was documented, as well as their size and ICRS classification. Correlations and kappa coefficients as well as the p-values were calculated. A total of 65 patients were included, with a mean age of 41 years. The evaluation of the orthopedic surgeon showed CLs in 52.3% of patients. CLs occurred mainly on the tibial articular surface (70.6%). Most talar lesions were located laterally (11.2%). The observed CLs were mainly ICRS grade 4. According to the radiologist, 69.2% of the patients presented with CLs. The most common location was the talar dome (48.9%), especially laterally. Most detected CLs were graded ICRS 3a. The correlation between the two observers was weak/fair regarding the detection and classification of CLs and moderate regarding the size of the detected CLs. To enhance the planning of surgical treatment for ankle chondral lesions (CLs), it may be beneficial to conduct an interdisciplinary preoperative assessment of the performed scans. This collaborative approach can optimize the evaluation of ankle CLs and improve overall treatment strategies.

Patellar Cartilage Bossing Causing Patellofemoral Pain After Cartilage Repair With Hyalofast® Scaffold and Bone Marrow Aspirate Concentrate (BMAC).

Chondral lesions of the knee are common orthopedic issues encountered in daily practice. Hyalofast® (Anika Therapeutics, Bedford, Massachusetts) grafting with bone marrow aspirate concentrate (BMAC) has been shown, in numerous studies, to be clinically efficacious in the surgical treatment of these lesions. We describe a case of chondral lesions in the knee initially successfully treated with arthroscopic chondroplasty and Hyalofast® grafting with BMAC, but who subsequently developed patellar cartilage bossing, causing anterior patellofemoral joint pain eight months after surgery. A 48-year-old gentleman underwent arthroscopic chondroplasty and mini-open cartilage repair with Hyalofast® and BMAC after presenting with right knee pain and swelling affecting his ability to participate in sports. His initial recovery was unremarkable, but he subsequently developed anterior knee pain exacerbated by stair climbing and jogging eight months after the initial surgery. Magnetic resonance imaging revealed bossing of the Hyalofast® graft over the central patella, and intraoperative testing confirmed the impingement. The patient's symptoms resolved immediately following arthroscopic debridement. While Hyalofast® grafting and BMAC remain viable options in the treatment of chondral lesions in the knee, the inability to predict the amount of cartilage repair and recovery may result in pain and impingement symptoms, and surgeons should be aware of such possible complications.

Single-stage autologous cartilage repair results in positive patient-reported outcomes for chondral lesions of the knee: a systematic review.

AIM: This article aims to perform a systematic review of the clinical literature regarding the efficacy of single-stage autologous cartilage repair. METHODS: A systematic review of the literature was performed using PubMed, Scopus, Web of Science, and the Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS: Twelve studies were identified; however, due to overlapping patient cohorts, nine studies were included for data extraction and analysis. Six studies applied minced cartilage, while three studies utilized enzymatically processed cartilage. Two authorship groups described single-stage techniques that exclusively utilized cartilage from the debrided lesion rim, while the remaining groups either utilized healthy cartilage or combined healthy cartilage with cartilage debrided from lesion rim. Among the included techniques, scaffold augments were used in four studies, and three studies implemented bone autograft augmentation. When summarizing patient reported outcome measures for the included studies, single-stage autologous cartilage repair demonstrated an average improvement ranging from 18.7 â€‹± â€‹5.3 to 30.0 â€‹± â€‹8.0 amongst the Knee Injury and Osteoarthritis Outcome Scores subsections, 24.3 â€‹± â€‹10.5 for the International Knee Documentation Committee subjective score, and 41.0 â€‹± â€‹10.0 for Visual Analogue Scale-Pain. CONCLUSION: Single-stage autologous cartilage repair is a promising technique with positive clinical data to date. The current study highlights the overall improvement in patient reported outcomes after repair for chondral defects to the knee with average follow-up ranging from 12 to 201 months and also the heterogeneity and variability of the single-stage surgical technique. Further discussion on the standardization of practices for a cost-effective single-stage augmented autologous cartilage technique is needed. In the future, a well-designed randomized controlled trial is needed to explore the efficacy of this therapeutic modality relative to established intervention. LEVEL OF EVIDENCE: Systematic review; Level IV.

Meniscal and Chondral Injury Patterns in Athletes With Anterior Cruciate Ligament Tear.

Anterior cruciate ligament (ACL) tears are a prevalent and debilitating injury among athletes, often accompanied by concurrent meniscal and chondral injuries. This study aimed to present a comprehensive investigation into the patterns and prevalence of meniscal and chondral injuries in athletes with ACL tears. This is a cross-sectional study conducted on 600 athletic patients with ACL tears planned for reconstruction in a duration of five years. A combination of advanced imaging techniques, arthroscopic evaluations, and clinical data was used to provide a comprehensive understanding of the injury profiles of the participant athletes. Those findings were duly recorded and analyzed accordingly. Out of 600 patients, 67% (402) had at least one meniscal or chondral injury while the rest 33% (198) had isolated ACL injuries only. Of the patients, 18% (108) were those who had both meniscal and chondral injuries present. Amongst the 57% (342) of patients who had meniscal injuries, injuries to the medial meniscus, lateral meniscus, and both the meniscus were present in 51% (175), 32% (109), and 17% (58) of patients, respectively. Amongst all associated meniscal injuries (n1 = 404), around 52% (210) tears were present in the body of the meniscus, 31% (125) in the posterior horn, and 17% (69) in the anterior horn. Overall, it was noted that 22.77% (92) of meniscal tears were bucket handle tears of the medial meniscus, 16.08% (65) were complex tears of the posterior horn of the lateral meniscus, and 9.60% (39) were complex tears of the posterior horn of the medial meniscus. Amongst 600 patients, 28% (168) of patients had at least one chondral injury present in association with ACL tear. Further, amongst the total number of chondral lesions reported (n2 =297) in ACL-deficient knees, around 55% (163) of lesions were located on medial femoral condyle, 10% (30) were located on undersurface of patella, 10% (30) were global changes, 7% (20) were on lateral femoral condyle, and 5% (15) were located on medial articulating surface of knee. A total of 61% (181) of chondral lesions were grade II, 21% (62) were grade III, 10%(30) were grade IV, and the least noted were 8% (24) grade I chondral lesions. The study concludes that medial meniscus injury was the most common meniscal injury in ACL-deficient knees and the bucket handle tear of the medial meniscus was the most common type of meniscal tear followed by the complex tear of the posterior horn of the medial meniscus. Further, the study also concludes that the medial femoral condyle is the most common site of chondral lesions in ACL-deficient knees.

Sport Activity and Clinical Outcomes after Hip Arthroscopy with Acetabular Microfractures at a Minimum 2-Year Follow-Up: A Matched-Pair Controlled Study.

Background: Acetabular microfractures for cartilage lesions have been shown to be a safe procedure able to improve patient reported outcomes (PROs). Nevertheless, the return to sport activity rate represents a crucial outcome to be investigated in these young athletic patients. Methods: Patients undergoing acetabular microfracture for full chondral acetabular lesions were compared to a 1:1 matched-pair by age and gender control group undergoing hip arthroscopy without microfractures. Clinical assessment was performed with PROs and participation in sports in terms of type and level of activities was evaluated preoperatively and at 2-years follow-up. Results: A total of 62 patients with an average age of 35.1 ± 8.1 (microfracture group) and 36.4 ± 6.3 (control group) were included. In both groups, the average values of PROs significantly increased from preoperatively to the last follow-up. There was no significant difference between the two groups in the number of patients playing at the amateur and elite level preoperatively and at the last follow-up. Conclusions: Microfractures for the management of full-thickness acetabular chondral defect provides good clinical results at a minimum follow-up of two years, which are not inferior to a matched-pair control group. Patients undergoing this procedure are likely able to return at the same level of sport before surgery.

Autologous Matrix-Induced Chondrogenesis (AMIC) for Focal Chondral Lesions of the Knee: A 2-Year Follow-Up of Clinical, Proprioceptive, and Isokinetic Evaluation.

(1) Background: The autologous matrix-induced chondrogenesis (AMIC) is a bio-orthopedic treatment for articular cartilage damage. It combines microfracture surgery with the application of a collagen membrane. The aim of the present study was to report a medium-term follow-up of patients treated with AMIC for focal chondral lesions. (2) Methods: Fourty-eight patients treated surgically and 21 control participants were enrolled in the study. To evaluate the functional outcomes, the proprioceptive (postural stability, postural priority) and isokinetic (peak value of maximum knee extensor and flexor torque in relation to body mass and the total work) measurements were performed. To evaluate the clinical outcomes, the Lysholm score and the IKDC score were imposed. (3) Results: Compared to the preoperative values, there was significant improvement in the first 2 years after intervention in the functional as well as subjective outcome measures. (4) Conclusions: AMIC showed durable results in aligned knees.

Arthroscopic Treatment of Patellar and Trochlear Cartilage Lesions with Matrix Encapsulated Chondrocyte Implantation versus Microfracture: Quantitative Assessment with MRI T2-Mapping and MOCART at 4-Year Follow-up.

METHODS: Seventeen patients aged 18 to 55 years with symptomatic full-thickness cartilage lesions on either patella or trochlea were treated with matrix autologous chondrocyte implantation (MACI) or microfracture (MF). Both procedures combined with unloading/realigning techniques. Clinical assessment and T2-mapping were evaluated at 48-months. RESULTS: Clinically results from pre-op to 48-months improved significantly in MACI and MF for Lysholm (p = 0.001, p = 0.001), IKDC-S (p = 0.001, p = 0.002), KOOS-P (p = 0.000, p = 0.002), KOOS-DLA (p = 0.002, p = 0.003), KOOS-Sports/Rec (p = 0.000, p = 0.004), KOOS-QoL (p = 0.000, p = 0.003), KOOS-symptoms (p = 0.001, p = 0.020), and Kujala (p = 0.000, p = 0.01), respectively. Tegner was significant between baseline and 48 months only for MACI (p < 0.008) compared with MF (p = 0.25). No significant difference was observed between groups for any score at 3, 12, 24, and 48-months (p > 0.05). T2-mapping values improved significantly over time in MACI compared with MF at 24 months (39.35 vs. 50.44, p = 0.007) and 48 months (36.54 vs. 48.37, p = 0.005). When comparing control values to MACI at 12-m (p = 0.714), 24-m (p = 0.175), and 48-m (p = 0.097), no significant difference was found. MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score comparison gave no statistical difference between groups. CONCLUSIONS: Clinically both techniques improved significantly over time. However, quantitative assessment showed that only newly formed tissue with MACI technique improves significantly since 12-months and maintains stable values compared with native cartilage until 48-month follow-up. MF results were never comparable to those native values. Level of evidence II.

Assessment of the Degree of Osteoarthritis in Aging Male and Female Femoral Condyles: A Cadaveric Study.

OBJECTIVE: Determine if femoral chondral cartilage degeneration on cadaveric knee joints exacerbate differently with aging between the sexes. METHODS: A total of 85 cadaveric femurs were assessed for macroscopic femoral condyle pathology using a scale for gross signs of osteoarthritis. Raters scored specimens and raters' scores were averaged to provide each specimen a Disease Severity Score (DSS). RESULTS: The DSS for the 80+-year-old population was greater than the DSS of the 70- to 79-year-old population (*P < 0.05) and the <70-year-old population (**P < 0.01). Specimens that scored a DSS of 2 and higher were assessed for their specific site of most severe degeneration. The most severe degeneration on the articular cartilage was most regularly on the patellar fossa. The second most degenerated region varied by age and biomechanical alterations. There were no significant changes in DSS between the sexes within the age groups. CONCLUSIONS: No difference was shown between the sexes in the severity or location of degeneration indicating that men and women are likely affected by the same biomechanical changes that spur on osteoarthritis in their eighth decade of life (70s) and later. Lateral femoral degeneration predominates in younger populations. When patients approach their 70s, medial degeneration begins to predominate likely based on an increase in shearing at the knee joint.

Prospective Outcomes of Cryopreserved Osteochondral Allograft for Patellofemoral Cartilage Defects at Minimum 2-Year Follow-up.

OBJECTIVE: To analyze the clinical outcomes, knee function, and activity level of patients after treatment of full-thickness cartilage defects involving the patellofemoral compartment of the knee with cryopreserved osteochondral allograft. DESIGN: Nineteen patients with cartilage defects involving the patellofemoral compartment were treated. The average age was 31 years (range 15-45 years), including 12 females and 7 males. Patients were prospectively followed using validated clinical outcome measures including Veterans RAND 12-item Health Survey (VR-12), International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner activity scale. Graft incorporation was evaluated by magnetic resonance imaging (MRI) or second-look arthroscopy. RESULTS: The cartilage defects included the patella (n = 16) and the femoral trochlea (n = 3). Mean VR-12 scores increased from 31.6 to 46.3 (P < 0.01), mean IKDC increased from 40.0 to 69.7 (P < 0.01), mean KOOS increased from 53.9 to 80.2 (P < 0.01), and mean Tegner scores increased from 3.0 to 4.9 (P < 0.01), at average follow-up of 41.9 months (range 24-62 months). Of the 3 patients who underwent second-look arthroscopy, all demonstrated a well-incorporated graft. Mean MOCART score for the 6 patients with follow-up MRI was 62.5 (range 25-85). The reoperation rate was 21.1% and 2 patients (12.5%) experienced progressive patellofemoral osteoarthritis requiring conversion to patellofemoral arthroplasty. CONCLUSION: Patients with unipolar cartilage defects involving the patellofemoral compartment of the knee can have positive outcomes at minimum 2-year follow-up after surgical treatment with a cryopreserved osteochondral allograft when concomitant pathology is also addressed, but the reoperation rate is high and bipolar cartilage lesions may increase the failure rate.

Does the Presence of Chondral Lesions Negatively Affect Patient-Determined Outcomes After Arthroscopic Rotator Cuff Repair?

BACKGROUND: There are limited data available to guide patients to their prognosis when glenohumeral chondral lesions are found during arthroscopic rotator cuff repair. HYPOTHESIS: The primary hypothesis was that patients with glenohumeral chondral lesions will have inferior outcomes after arthroscopic rotator cuff repair compared with patients without chondral lesions. The secondary hypothesis was that patients with concomitant chondral lesions will have more severe preoperative symptoms compared with those without chondral lesions. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective analysis was performed of patients who underwent arthroscopic rotator cuff repair between 2008 and 2012. We examined the effects of chondral lesions on patient-determined outcomes, which included the Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), and the Shoulder Activity Level (SAL). Shoulders without chondral lesions were compared with shoulders with chondral lesions to determine whether differences in severity of preoperative symptoms as well as postoperative improvements were statistically significant. RESULTS: A total of 281 shoulders were included from 273 patients, with a mean follow-up of 3.7 years. In total, 90 shoulders (32%) had concomitant chondral lesions in the glenohumeral joint. The presence and degree of chondral damage were not associated with the severity of preoperative symptoms or the amount of improvement after arthroscopic rotator cuff repair, as determined by patient outcome scores. Shoulders with bipolar chondral lesions had less postoperative improvement in their outcome scores compared with shoulders with unipolar lesions, with significant differences found in the SST (P = .0005), the SANE (P = .005), and the SAL (P = .04). Regardless of this, the majority of shoulders with bipolar chondral lesions (80%-92%) had postoperative improvements that superseded the minimal clinically important difference of the ASES, WORC, and SANE. CONCLUSION: At a mean 3.7-year follow-up, the presence of chondral damage did not appear to negatively affect the improvement in patient-determined outcomes after arthroscopic rotator cuff repair. However, improvement in outcomes was negatively affected by the presence of bipolar chondral lesions.

Correlation between the AMADEUS score and preoperative clinical patient-reported outcome measurements (PROMs) in patients undergoing matrix-induced autologous chondrocyte implantation (MACI).

BACKGROUND: Recently, the AMADEUS (Area Measurement And DEpth Underlying Structures) grading system has been introduced to evaluate and grade osteochondral lesions prior to cartilage surgery. The AMADEUS score has not been connected to clinical data in order to test a potential clincial impact. PURPOSE: To examine the correlation between the AMADEUS score and preoperative patient-reported outcome measurements (PROMs). STUDY DESIGN: Case series METHODS: Patients treated with matrix-induced autologous chondrocyte implantation (MACI) were included in the study, unless exclusion criteria like BMI > 35, prior extensive meniscectomy or ongoing inflammatory arthritis were present. Preoperative magnetic resonance (MR) examinations were graded according to the standardized AMADEUS protocol. The final AMADEUS score was correlated with preoperative patient-reported outcome measurements (PROMs), including the IKDC (International Knee Documentation Committee), the Lysholm score, the Short-Form-12 (SF-12) score, and the Core Outcome Measures Index (COMI) score. RESULTS: A total of 50 patients with a mean age of 33.6 ± 11.5 years, a mean BMI of 25.1 ± 4.9, and a mean defect size of 2.3 ± 1.5 cm2 were included in the study. More severe cartilage defects, indicated by the AMADEUS grade (R = 0.35, p = 0.01) and the AMADEUS score (R = - 0.36, p = 0.01) as well as larger chondral defects (R = 0.32, p = 0.03) show a moderate correlation with the higher COMI scores. No correlative capacity was demonstrated for the AMADEUS score and the IKDC, Lysholm, and Tegner activity scores as well as for its subscales. CONCLUSION: There is a moderate correlation of the COMI and the AMADEUS score in patients treated with matrix-induced autologous chondrocyte implantation (MACI). All other patient-reported outcome measurement scores (PROMs) show no evidence of an association to the magnetic resonance-based AMADEUS score. CLINICAL RELEVANCE: The clinical and scientific implication of the COMI score as a PROM tool can be recommended when working with the AMADEUS score and patients undergoing MACI.

Autologous Matrix-Induced Chondrogenesis (AMIC) and AMIC Enhanced by Autologous Concentrated Bone Marrow Aspirate (BMAC) Allow for Stable Clinical and Functional Improvements at up to 9 Years Follow-Up: Results from a Randomized Controlled Study.

The aims of the study were to evaluate long-term outcomes after autologous matrix-induced chondrogenesis (AMIC) in the treatment of focal chondral lesions and to assess the possible improvements given by the combination of this technique with bone marrow aspirate concentrate (BMAC). Twenty-four patients (age range 18⁻55 years) affected by focal knee chondral lesions were treated with standard AMIC or AMIC enhanced by BMAC (AMIC+). Pain (Visual Analogue Scale (VAS)) and functional scores (Lysholm, International Knee Documentation Committee (IKDC), Tegner, Knee injury and Osteoarthritis Outcome Score (KOOS)) were collected pre-operatively and then at 6, 12, 24, 60, and 100 months after treatment. Magnetic resonance imaging (MRI) evaluation was performed pre-operatively and at 6, 12, and 24 months follow-ups. Patients treated with AMIC+ showed higher Lysholm scores (p = 0.015) and lower VAS (p = 0.011) in comparison with patients in the standard AMIC group at the 12 months follow-up. Both treatments allowed for functional and pain improvements with respect to pre-operative levels lasting up to 100 months. MRI revealed consistent cartilage repair at 24 months in both groups. This study shows that AMIC and AMIC+ are effective treatments for focal chondral lesions with beneficial effect lasting up to 9 years. AMIC+ allows for faster recovery from injury, and is thus more indicated for patients requiring a prompt return to activity. Level of evidence: II, randomized controlled trial in an explorative cohort.