Autologous Osteochondral Transfer of the Knee Demonstrates Continued High Rates of Return to Sport and Low Rates of Conversion to Arthroplasty at Long-Term Follow-Up: A Systematic Review.

PURPOSE: To perform a systematic review of the literature to evaluate (1) activity level and knee function, (2) reoperation and failure rates, and (3) risk factors for reoperation and failure of autologous osteochondral transfer (AOT) at long-term follow-up. METHODS: A comprehensive review of the long-term outcomes of AOT was performed. Studies reported on activity-based outcomes (Tegner Activity Scale) and clinical outcomes (Lysholm score and International Knee Documentation Committee score). Reoperation and failure rates as defined by the publishing authors were recorded for each study. Modified Coleman Methodology Scores were calculated to assess study methodological quality. RESULTS: Twelve studies with a total of 495 patients and an average age of 32.5 years at the time of surgery and a mean follow-up of 15.1 years (range, 10.4-18.0 years) were included. The mean defect size was 3.2 cm2 (range, 1.9-6.9 cm2). The mean duration of symptoms before surgery was 5.1 years. Return to sport rates ranged from 86% to 100%. Conversion to arthroplasty rates ranged from 0% to 16%. The average preoperative International Knee Documentation Committee scores ranged from 32.9 to 36.8, and the average postoperative International Knee Documentation Committee scores at final follow-up ranged from 66.3 to 77.3. The average preoperative Lysholm scores ranged from 44.5 to 56.0 and the average postoperative Lysholm scores ranged from 70.0 to 96.5. The average preoperative Tegner scores ranged from 2.5 to 3.0, and the average postoperative scores ranged from 4.1 to 7.0. CONCLUSIONS: AOT of the knee resulted in high rates of return to sport with correspondingly low rates of conversion to arthroplasty at long-term follow-up. In addition, AOT demonstrated significant improvements in long-term patient-reported outcomes from baseline. LEVEL OF EVIDENCE: Level IV, systematic review of Level I-IV studies.

Osteogenic differentiation of human bone marrow-derived mesenchymal stem cells is enhanced by an aragonite scaffold.

Bone graft substitutes and bone void fillers are predominantly used to treat bone defects and bone fusion in orthopaedic surgery. Some aragonite-based scaffolds of coralline exoskeleton origin exhibit osteoconductive properties and are described as useful bone repair scaffolds. The purpose of this study was to evaluate the in vitro osteogenic potential of the bone phase of a novel aragonite-based bi-phasic osteochondral scaffold (Agili-C™, CartiHeal Ltd.) using adult human bone marrow-derived mesenchymal stem cells (MSCs). Analyses were performed at several time intervals: 3, 7, 14, 21, 28 and 42 days post-seeding. Osteogenic differentiation was assessed by morphological characterisation using light microscopy after Alizarin red and von Kossa staining, and scanning electron microscopy. The transcript levels of alkaline phosphatase (ALP), runt-related transcription factor 2 (RUNX2), bone gamma-carboxyglutamate (BGLAP), osteonectin (SPARC) and osteopontin (SPP1) were determined by quantitative PCR. Proliferation was assessed by a thymidine incorporation assay and proliferating cell nuclear antigen (PCNA) immunocytochemistry. Our results demonstrate that the bone phase of the bi-phasic aragonite-based scaffold supports osteogenic differentiation and enhanced proliferation of bone marrow-derived MSCs at both the molecular and histological levels. The scaffold was colonized by differentiating MSCs, suggesting its suitability for incorporation into bone voids to accelerate bone healing, remodelling and regeneration. The mechanism of osteogenic differentiation involves scaffold surface modification with de novo production of calcium phosphate deposits, as revealed by energy dispersive spectroscopy (EDS) analyses. This novel coral-based scaffold may promote the rapid formation of high quality bone during the repair of osteochondral lesions.

Does a different dose of gamma irradiation have the same effect on five different types of tendon allografts? - a biomechanical study.

INTRODUCTION: The goals of our study were to evaluate the biomechanical differences between five tendons and the changes in biomechanical properties caused by irradiation. METHODS: Achilles, quadriceps, semitendinosus + gracilis (STG), tibialis anterior (TA) and the peroneus longus (PL) were harvested from 30 donors. Group A contained 50 tendons without gamma irradiation. The groups were irradiated with a dose of 21 kGy (group B 50 tendons) and with a dose of 42 kGy (group C 50 tendons). The grafts were soaked in a radio-protectant solution and frozen at -80 °C. Cyclic loading tests were performed followed by load to failure tests. Young modulus of elasticity, maximum force, strain at tensile strength and strain at rupture were calculated. RESULTS: The Achilles tendons had significantly lower Young modulus than the TA (p = 0.0036) in group A. The Achilles showed significantly lower than PL (p = 0.000042) and TA (p = 0.00142) in group B and C. The quadriceps and the ST (p = 0.0037) provided poorer values than the TA (p = 0.0432) in group C. We found no difference in maximum loads among the tendons in group A. The maximum load of the Achilles and quadriceps showed better results than the PL (p = 0.0016), (p = 0.0018) and the STG (p = 0.0066), (p = 0.0019) in group C. The TA had similar results like the Achilles and quadriceps. DISCUSSION AND CONCLUSIONS: The vulnerability of gamma irradiation of TA was less than Achilles and quadriceps tendons.

Evaluation of biomarkers following autologous osteochondral transplantation in the equine stifle joint - An experimental study.

The purpose of this study was to evaluate changes in biomarker and synovial parameters following autologous osteochondral transplantation (AOT) in the equine stifle joint, to test the hypothesis whether synovial parameters would show significant differences at selected time points following the surgery (at days 3, 14, 60 and 180) compared to baseline level (at day 0). Surgical intervention was performed in both stifles of nine horses (n = 18). The joints were randomly assigned to operated and sham-operated groups. Grafts 8.5 mm in diameter were harvested from the femoropatellar (FP) joint under arthroscopic control and the medial femorotibial (MFT) joints had AOT using mosaicplasty (MP) instrumentation, while the sham FP and sham MFT joints underwent arthroscopy and miniarthrotomy without transplantation, respectively. Synovial fluid (SF) parameters were evaluated at days 4, 14, 60 and 180. Data were analysed by two-way repeated- measures analysis of variance (ANOVA), and P < 0.05 was considered significant. During the first 10-14 days after surgery, lameness of degree 2-3/5 [American Association of Equine Practitioners (AAEP) scores] was present, which disappeared after 60 days. Joints with transplantation showed significant increases in synovial white blood cell count (WBC), total protein (TP), substance P, C1,2C and CS846 epitope concentration at day 3 compared to baseline and shamoperated joints (P < 0.05). These parameters returned to the baseline values by two months after surgery and remained within normal levels at 6 months postoperatively.

Mosaic arthroplasty of the medial femoral condyle in horses - An experimental study.

One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations.

Comparative Effectiveness of Supervised and Home-Based Rehabilitation after Anterior Cruciate Ligament Reconstruction in Competitive Athletes.

Background: After the increasingly common anterior cruciate ligament reconstruction (ACLR) procedure in competitive athletes, rehabilitation is crucial for facilitating a timely return to sports (RTS) and preventing re-injury. This pilot study investigates the patient-reported outcomes of postoperative rehabilitation in competitive athletes, comparing supervised rehabilitation (SVR) and home-based rehabilitation (HBR). Methods: After ACLR, 60 (out of 74 screened) athletes were recruited and equally divided into HBR and SVR groups using non-probability convenience sampling, with each group comprising 15 males and 15 females. The rehabilitation outcomes in the respective groups were evaluated at 8 months using measures (Tegner Activity Scale [TAS], International Knee Documentation Committee subjective knee form [IKDC-SKF], ACL Return to Sport after Injury [ACL-RSI]) and objective parameters (isometric muscle strength, hamstring/quadricep asymmetry). RTS was evaluated at 9 months, with ACL re-injury rates recorded approximately 6 months post-RTS. Results: Both groups exhibited decreased TAS scores (HBR: 8 to 6, SVR: 8 to 7), with the SVR group demonstrating superior postoperative IKDC-SKF scores (81.82 vs. 68.43) and lower ACL-RSI scores (49.46 vs. 55.25). Isometric and isokinetic muscle strength, along with asymmetry values, was higher in the SVR group 8 months post-ACLR (p < 0.05). The SVR group showed a higher RTS rate to the same level (76.6% vs. 53.3%), while the re-injury rate was the same in both the rehabilitation groups (3.3%). Conclusions: Although both rehabilitation approaches yielded comparable outcomes, SVR may demonstrate some superior biomechanical improvements in athletes, resulting in a higher RTS rate. However, the psychological outcomes and re-injury rates did not significantly differ between the groups, emphasizing the need to address individual psychological needs during rehabilitation. Further investigation is recommended with a larger sample size to address the differences of gender among competitive athletes.

A clinical feasibility study to evaluate the safety and efficacy of PEOT/PBT implants for human donor site filling during mosaicplasty.

UNLABELLED: Mosaicplasty has become a well-accepted treatment modality for articular cartilage lesions in the knee. Postoperative bleeding remains potentially concerning. This study evaluates the porous poly(ethylene oxide)terephthalate/poly(butylene terephthalate) (PEOT/PBT) implants used for donor site filling. Empty donor sites were the controls. After 9 months, MRI, macroscopical and histological analysis were carried out. Treated defects did not cause postoperative bleeding. No adverse events or inflammatory response was observed. PEOT/PBT implants were well integrated. Empty controls occasionally showed protrusion of repair tissue at the defect margins. Surface stiffness was minimally improved compared to controls. Existing polymer fragments indicated considerable biodegradation. Histological evaluation of the filled donor sites revealed congruent fibrocartilaginous surface repair with proteoglycan-rich domains and subchondral cancellous bone formation with interspersed fibrous tissue in all implanted sites. The PEOT/PBT implants successfully reduce donor site morbidity and postoperative bleeding after mosaicplasty. LEVEL OF EVIDENCE: II.

Osteochondral allograft transplantation from a living donor.

Treatment of extended and massive osteochondral defects is a real challenge for an orthopaedic practice. Osteochondral allograft transplantation is a possible solution for such lesions. Transplantation of osteochondral allografts has undergone extensive experimental and limited clinical study during recent decades. Graft availability, sizing, technical issues, and viral transmission represent the most problematic points. Because interest in this technique is gaining, more and more countries face the problem of a lack of tissue banks where fresh osteochondral allografts are available. We investigated the advantages of the so-called living donor transplantation of the grafts under programmed surgical conditions. We demonstrate a technique that allows the transplantation of osteochondral allografts without the need for a tissue bank. The radiologic and histologic results regarding the quality of the transplanted cartilage are presented.

Results of ultra-fresh osteochondral allograft transplantation for large cartilage defects in the knee joint.

OBJECTIVES: This study aims to investigate whether ultra-fresh osteochondral allograft (OCA) transplantation was a good therapeutic alternative for the treatment of otherwise challenging, massive osteochondral defects in the knee joint. PATIENTS AND METHODS: Between April 2011 and July 2022, a total of 16 ultra-fresh knee transplantations (9 males, 7 females; median age: 30.2 years; range, 14 to 62 years) having large osteochondral defects on femoral condyles were included. The operations were performed by two surgeons. The condition of the patients were evaluated based on regular follow-up physical examinations, imaging studies and by recording and evaluating clinical scores (modified Cincinnati scores, and 2000 International Knee Documentation Committee [IKDC] scores). RESULTS: The median follow-up was 65±48 (range, 6 months to 12 years). At two years after transplantation, there was a significant improvement in the modified Cincinnati scores (preoperative score of 35.75 increased to 83.75; p<0.001) and also to the IKDC scores (preoperative score of 28.7 increased to 76.3; p<0.001). One patient developed an early septic complication, and another three patients underwent reoperation after the OCA transplantations for non-septic reasons. CONCLUSION: Ultra-fresh OCA transplantation is a good therapeutic alternative for the treatment of otherwise challenging, massive osteochondral defects in the knee joint. Such a shortening of the transplantation time and its positive effect on the better long-term survival of transplanted chondrocytes has not yet been proven; however, the minimizing of transplantation time may create the conditions necessary for successful OCA transplantations many years after the implantation.

Effectiveness of negative pressure wound therapy: Minimum five-year follow-up and review of the literature.

OBJECTIVES: In this study, we aimed to assess the effectiveness of negative pressure wound therapy (NPWT) in a five-year patient cohort and to discuss the results in the light of literature data. PATIENTS AND METHODS: Between January 2012 and December 2016, a total of 74 patients (35 males, 39 females; median age: 60 years; range, 20 to 95 years) who received NPWT were retrospectively analyzed. The patients included 49 orthopedic and traumatology, 12 vascular surgery, and 13 general surgery patients. The efficacy of wound healing, bacterial load, and the impact of comorbidities on wound healing were examined. RESULTS: The distribution of wound types varied very widely. Certain comorbidities affected wound healing. In orthopedic traumatology patients, we observed mainly skin flora infection (57.14%), while in surgical and vascular patients, mixed flora (80%) and in many cases poly-resistant pathogens were present (methicillin-resistant Staphylococcus aureus 24%) A total of 43.3% of wounds were completely closed, while 44.6% of patients had a wound healing. Successful skin grafting was performed in 75% of wounds. CONCLUSION: This technique may be used as widely and as early as possible. However, further large-scale, multi-center, randomized clinical trials are needed worldwide to find a place for this technique in wound care and even in primary care.

Terminology for osteochondral lesions of the ankle: proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

BACKGROUND: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "terminology for osteochondral lesions of the ankle" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS: Forty-three international experts in cartilage repair of the ankle representing 20 countries were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed, and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus, 51%-74%; strong consensus, 75%-99%; unanimous, 100%. RESULTS: A total of 11 statements on terminology and classification reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Definitions are provided for osseous, chondral and osteochondral lesions, as well as bone marrow stimulation and injury chronicity, among others. An osteochondral lesion of the talus can be abbreviated as OLT. CONCLUSIONS: This international consensus derived from leaders in the field will assist clinicians with the appropriate terminology for osteochondral lesions of the ankle.

Paediatric ankle cartilage lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

BACKGROUND: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Pediatric Ankle Cartilage Lesions" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS: Forty-three international experts in cartilage repair of the ankle representing 20 countries convened to participate in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus: 51-74%; strong consensus: 75-99%; unanimous: 100%. RESULTS: A total of 12 statements on paediatric ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Five achieved unanimous support, and seven reached strong consensus (>75% agreement). All statements reached at least 84% agreement. CONCLUSIONS: This international consensus derived from leaders in the field will assist clinicians with the management of paediatric ankle cartilage lesions.

Osteochondral Lesions of the Tibial Plafond and Ankle Instability With Ankle Cartilage Lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

BACKGROUND: An international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to present the consensus statements on osteochondral lesions of the tibial plafond (OLTP) and on ankle instability with ankle cartilage lesions developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS: Forty-three experts in cartilage repair of the ankle were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 4 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held. RESULTS: A total of 11 statements on OLTP reached consensus. Four achieved unanimous support and 7 reached strong consensus (greater than 75% agreement). A total of 8 statements on ankle instability with ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, and seven reached strong consensus (greater than 75% agreement). CONCLUSION: These consensus statements may assist clinicians in the management of these difficult clinical pathologies. LEVEL OF EVIDENCE: Level V, mechanism-based reasoning.

Radiosynoviorthesis in the treatment of posttraumatic joint bleedings of hemophilic patients (concerning hip, knee and ankle joints)-Hungarian experience.

INTRODUCTION: The surgical, arthroscopic synovectomy and radiosynovectomy (radiosynoviorthesis, RSO) all have great practical importance, since they can eliminate the posttraumatic joint bleedings and prevent the further joint destructions in hemophilic patients. The aim of this study was to examine the role of RSO in the prevention of joint bleedings in hemophilic patients. METHODS: 54 out of 684 RSO patients were hemophiliacs. Mean age of the patients was 32 years (range 14-51), therefore this is a relatively young patients' cohort. Radiosynovectomy was performed in 37 patients with hemophilia A and in 17 patients suffering from hemophilia B. Since hemophilia is a sex-linked (x-linked) recessive disorder, all of the patients were male. There was no acquired hemophiliac among the treated patients. RESULTS: The RSO resulted in a 95% decline in bleedings per year and eliminated the incidence of further bleedings in 55% of the treated joints. CONCLUSION: Our findings support the view that radiosynoviorthesis can be considered as the first choice treatment for posttraumatic joint bleedings of hemophilic patients.

Finishing stationary cycling too early after anterior cruciate ligament reconstruction is likely to lead to higher failure.

BACKGROUND: Anterior cruciate ligament injury arises when the knee anterior ligament fibers are stretched, partially torn, or completely torn. Operated patients either end up re-injuring their reconstructed anterior cruciate ligament or majority develop early osteoarthritis regardless of the remarkable improvements of surgical techniques and the widely available rehabilitation best practices. New mechanism theories of non-contact anterior cruciate ligament injury and delayed onset muscle soreness could provide a novel perspective how to respond to this clinical challenge. MAIN BODY: A tri-phasic injury model is proposed for these non-contact injuries. Mechano-energetic microdamage of the proprioceptive sensory nerve terminals is suggested to be the first-phase injury that is followed by a harsher tissue damage in the second phase. The longitudinal dimension is the third phase and that is the equivalent of the repeated bout effect of delayed onset muscle soreness. Current paper puts this longitudinal injury phase into perspective as the phase when the long-term memory consolidation and reconsolidation of this learning related neuronal injury evolves and the phase when the extent of the neuronal regeneration is determined. Reinstating the mitochondrial energy supply and 'breathing capacity' of the injured proprioceptive sensory neurons during this period is emphasized, as avoiding fatigue, overuse, overload and re-injury. CONCLUSIONS: Extended use, minimum up to a year or even longer, of a current rehabilitation technique, namely moderate intensity low resistance stationary cycling, is recommended preferably at the end of the day. This exercise therapeutic strategy should be a supplementation to the currently used rehabilitation best practices as a knee anti-aging maintenance effort.

Does Compression Sensory Axonopathy in the Proximal Tibia Contribute to Noncontact Anterior Cruciate Ligament Injury in a Causative Way?-A New Theory for the Injury Mechanism.

Anterior cruciate ligament injury occurs when the ligament fibers are stretched, partially torn, or completely torn. The authors propose a new injury mechanism for non-contact anterior cruciate ligament injury of the knee. Accordingly, non-contact anterior cruciate ligament injury could not happen without the acute compression microinjury of the entrapped peripheral proprioceptive sensory axons of the proximal tibia. This would occur under an acute stress response when concomitant microcracks-fractures in the proximal tibia evolve due to the same excessive and repetitive compression forces. The primary damage may occur during eccentric contractions of the acceleration and deceleration moments of strenuous or unaccustomed fatiguing exercise bouts. This primary damage is suggested to be an acute compression/crush axonopathy of the proprioceptive sensory neurons in the proximal tibia. As a result, impaired proprioception could lead to injury of the anterior cruciate ligament as a secondary damage, which is suggested to occur during the deceleration phase. Elevated prostaglandin E2, nitric oxide and glutamate may have a critical neuro-modulatory role in the damage signaling in this dichotomous neuronal injury hypothesis that could lead to mechano-energetic failure, lesion and a cascade of inflammatory events. The presynaptic modulation of the primary sensory axons by the fatigued and microdamaged proprioceptive sensory fibers in the proximal tibia induces the activation of N-methyl-D-aspartate receptors in the dorsal horn of the spinal cord, through a process that could have long term relevance due to its contribution to synaptic plasticity. Luteinizing hormone, through interleukin-1ß, stimulates the nerve growth factor-tropomyosin receptor kinase A axis in the ovarian cells and promotes tropomyosin receptor kinase A and nerve growth factor gene expression and prostaglandin E2 release. This luteinizing hormone induced mechanism could further elevate prostaglandin E2 in excess of the levels generated by osteocytes, due to mechanical stress during strenuous athletic moments in the pre-ovulatory phase. This may explain why non-contact anterior cruciate ligament injury is at least three-times more prevalent among female athletes.

A comparison of SanatMetal Sanat Swing and Zimmer NexGen® total knee implants: 10-year postoperative follow-up results.

OBJECTIVES: In this study, we present our 10-year postoperative follow-up results of Sanat Swing® and NexGen® total knee implants. PATIENTS AND METHODS: A total of 189 patients (93 males, 96 females; mean age: 68 years; range, 48 to 86 years) who underwent total knee replacement between January 2008 and September 2010 were retrospectively analyzed. A total of 105 patients (Group A) were implanted a cemented Sanat Swing knee prosthesis and 84 patients (Group B) were implanted a cemented NexGen knee prosthesis. Operation time, range of motion (ROM), pain level, Knee Society Score (KSS), distance of painless walking, and the ability to climb stairs were evaluated between the groups. RESULTS: The mean follow-up was 10.8 (range, 9.8 to 12.3) years. No significant difference was observed in the survival of the prostheses, ROM, pain level, KSS, walking distance, and in the ability to climb stairs between the two groups at 10 years. With an experienced team, the operation time was about 4 to 5 min shorter in the Sanat Swing implantation group. In selected cases, Sanat Swing was superior to the NexGen system; however, there was no statistically significant difference. Complication rates were also low and comparable between both groups. CONCLUSION: Based on the 10 years of follow-up evaluation, Sanat Swing total knee replacement system seems to yield comparable clinical results with the NexGen. Experiences with the operative technique and comparative evaluation, the Sanat Swing system is a safe and reliable alternative for total knee replacement, providing a user-friendly operative technique and shorter operation time.

Segmentation of knee cartilages in MR images with artificial intelligence / Térdporc szegmentálása MR-felvételekbol mesterséges intelligencia segítségével.

Összefoglaló. Bevezetés: A térdízületnek ultrafriss osteochondralis allograft segítségével történo részleges ortopédiai rekonstrukciója képalkotó vizsgálatokon alapuló pontos tervezést igényel, mely folyamatban a morfológia felismerésére képes mesterséges intelligencia nagy segítséget jelenthet. Célkituzés: Jelen kutatásunk célja a porc morfológiájának MR-felvételen történo felismerésére alkalmas mesterséges intelligencia kifejlesztése volt. Módszer: A feladatra legalkalmasabb MR-szekvencia meghatározása és 180 térd-MR-felvétel elkészítése után a mesterséges intelligencia tanításához manuálisan és félautomata szegmentálási módszerrel bejelölt porckontúrokkal tréninghalmazt hoztunk létre. A mély convolutiós neuralis hálózaton alapuló mesterséges intelligenciát ezekkel az adatokkal tanítottuk be. Eredmények: Munkánk eredménye, hogy a mesterséges intelligencia képes a meghatározott szekvenciájú MR-felvételen a porcnak a mutéti tervezéshez szükséges pontosságú bejelölésére, mely az elso lépés a gép által végzett mutéti tervezés felé. Következtetés: A választott technológia - a mesterséges intelligencia - alkalmasnak tunik a porc geometriájával kapcsolatos feladatok megoldására, ami széles köru alkalmazási lehetoséget teremt az ízületi terápiában. Orv Hetil. 2021; 162(9): 352-360. INTRODUCTION: The partial orthopedic reconstruction of the knee joint with an osteochondral allograft requires precise planning based on medical imaging reliant; an artificial intelligence capable of determining the morphology of the cartilage tissue can be of great help in such a planning. OBJECTIVE: We aimed to develop and train an artificial intelligence capable of determining the cartilage morphology in a knee joint based on an MR image. METHOD: After having determined the most appropriate MR sequence to use for this project and having acquired 180 knee MR images, we created the training set for the artificial intelligence by manually and semi-automatically segmenting the contours of the cartilage in the images. We then trained the neural network with this dataset. RESULTS: As a result of our work, the artificial intelligence is capable to determine the morphology of the cartilage tissue in the MR image to a level of accuracy that is sufficient for surgery planning, therefore we have made the first step towards machine-planned surgeries. CONCLUSION: The selected technology - artificial intelligence - seems capable of solving tasks related to cartilage geometry, creating a wide range of application opportunities in joint therapy. Orv Hetil. 2021; 162(9): 352-360.

A randomized comparative evaluation of local infiltration analgesia, extended nerve blocks, and conventional analgesia in pain management after total knee arthroplasty.

OBJECTIVES: The aim of this study was to analyze the postoperative effects of extended nerve blocks and local infiltration analgesia (LIA) on postoperative pain control, muscle weakness, and blood loss after total knee arthroplasty (TKA). PATIENTS AND METHODS: Between February 24th 2020 and July 10th 2020, a total of 161 patients (55 males, 106 females; median age: 69.0 years [IQR 63.0-75.0], range, 41 to 81 years) who underwent primary TKA were randomly allocated into three parallel groups according to their concomitant procedure in a double-blind fashion: (i) those to whom nerve blockade was performed after competition of surgery under the duration of spinal anesthesia (n=50); (ii) those to whom LIA was performed during surgery (n=52), and (iii) control group (n=59). The content of LIA was 10-10 mL of 20 mg lidocaine with 0.01 mg adrenalin and 100 mg ropivacaine, 1 mL (30 mg) ketorolac, and 5 mL (500 mg) tranexamic acid was diluted by 50 mL 0.9% NaCl under aseptic conditions. Outcome parameters were the evaluation of pain until the evening of first postoperative day (24 to 36 h), mobilization, and blood loss within the first three postoperative days. RESULTS: The pain was maximal between 4 and 8 h postoperatively, when the effect of the spinal anesthetic drugs disappeared. During this critical period, tolerable pain (Numerical Rating Scale, NRS ≤3) was observed in 52%, 42%, and 19% of nerve blockade in LIA and control groups, respectively. None of the patients complained of high-intensity pain (NRS >8) in the LIA group, which was a significant difference from the block and control groups (10% and 14%, p<0.008, respectively). There was no significant muscle weakness associated with the use of this extended block. The decrease in hemoglobin level was significantly lower in the LIA group than in the control and block groups (odds ratio [OR]: 0.379, 95% confidence interval [CI]: 0.165-0.874 for nerve blockade vs. LIA, OR: 1.189, 95% CI: 0.491-2.880 for nerve blockade vs. control, OR: 0.319, 95% CI: 0.140-0.727, respectively). The common language effect size for pain in each referred interval in each group and for decrease of hemoglobin between the first and third postoperative days fell between 0.507 and 0.680. CONCLUSION: This study demonstrates that LIA technique offers a fast and safe treatment option for pain relief after TKA. No clinically relevant muscle weakness was observed among groups according to field block applications. Significant advantages were also achieved in blood loss.

Efficacy assessment of radiosynoviorthesis on the progression of radiological osteoarthritic features of hip and ankle joint in patients with osteoarthritis and rheumatoid arthritis.

OBJECTIVE: The study objective was to evaluate the long-term effect of radiosynoviorthesis (RSO) on the progression of radiological and nuclear-medical osteoarthritic features of hip and ankle joint in patients with osteoarthritis and rheumatoid arthritis. PATIENTS AND METHODS: The study included 89 hip joints of 81 patients, of which 48 had osteoarthritis (OA) and 33 had rheumatoid arthritis (RA). In terms of ankle joints, 64 patients were included of which 43 suffered from OA and 21 from RA. The mean follow-up time was 9.2 years for OA and 8.9 years for RA patients. Patients with RA were the active control group. Structural alterations of the hip joints were evaluated following Kellgren-Lawrence score and of ankle joint following Takakura score for both disease entities. For the evaluation of synovitis 2-phase bone scintigraphy was performed. RESULTS: RSO could prevent radiologic status deterioration among 70.6 % of hip osteoarthritic patients and 73.7 % among the hip RA patients. No structural progression was observed in 79.1 % of the treated ankle joints in patients with OA and in 85.7 % of the ankle joints in patients with RA.The scintigraphic response rate for the hip joints of OA patients was 68.6 %, 76.3 % for hip joints of RA patients, 83.1 %, ankle joints of OA patients, and 90.4 % ankle joints of RA patients.The radiographic and scintigraphic RSO response rates were not significantly higher for both joints in RA than OA patients. CONCLUSION: RSO can be a good alternative in the treatment of synovitis and prevention of deterioration of inflammatory and radiographic features even in patients suffering from osteoarthritis and rheumatoid arthritis. RSO may have also a long-term effect to stop or delay progression of both diseases.