Predictors of Functional Outcome After Microfracture Treatment of Cartilage Defects of the Knee.

INTRODUCTION: Microfracture (MFx) is a widely used technique in the treatment of articular cartilage defects of the knee. The objective of this study was to determine the prognostic factors of functional outcomes after MFx treatment of knee cartilage defects ≤ 4 cm2. MATERIALS AND METHODS: Forty-eight patients who were to be treated by MFx for knee cartilage defects ≤ 4 cm2 were prospectively included. The mean follow-up was 5.7 years (3.7-9.5). Demographics, sport practiced, time from diagnosis to surgery and associated lesions were collected. The cartilage defect was graded according to the ICRS classification. The MOCART score was calculated from a one-year MRI. The subjective VAS and IKDC scores were collected preoperatively and at the latest follow-up. Prognostic factors were determined using univariate and multivariate regression analyses incorporating pre-, peri- and postoperative clinical and radiological criteria. The dependent variable was defined as the difference between the pre- and post-operative clinical scores (dIKDC and dVAS). RESULTS: The mean size of the cartilage defect was 1.8 cm2 (0.8-4). At the last follow-up, the VAS and IKDC scores were significantly improved compared to the pre-operative period (p<0.01). The average MOCART score on the one-year MRI was 50 (20-70). Three patients (6 %) who demonstrated filling defects on MRI and debilitating pain required surgical re-intervention. The factors that impacted the functional outcome as reflected by the VAS and IKDC scores were age, BMI, time from diagnosis to surgery, size of the lesion and the MOCART score. CONCLUSION: This study demonstrates that MFx is a successful first-line treatment option for small articular cartilage defects (≤ 4 cm2) of the knee and provides good function and pain relief in the mid-term. The predictors of poor functional outcomes were older age, higher BMI, longer time from diagnosis to surgery, larger lesion size and lower MOCART score.

Salmonella infection after anterior cruciate ligament reconstruction: A case report.

BACKGROUND: Infections after anterior cruciate ligament reconstruction (ACLR) are rare. No cases of Salmonella infection have been described to our knowledge. CASE SUMMARY: We describe a rare case of Salmonella infection in a 23-year-old patient following an ACLR. The patient presented with subacute septic arthritis, 26 d after a hamstring autograft ACLR. The pathogen, Salmonella enterica typhimurium was isolated by bacteriological sampling of the first arthroscopic lavage. Two arthroscopic lavages were required, with intravenous antibiotic therapy for two weeks with cefotaxime and ciprofloxacin, followed by oral antibiotics with amoxicillin and ciprofloxacin for a total duration of three months. This approach treated the infection but two years after the septic arthritis, faced with ongoing knee instability due to graft damage, a revision ACLR with a bone-tendon-bone graft was performed. At the last follow-up, full range of knee motion had been achieved and sports activities resumed. CONCLUSION: Infection after ACLR is rare and requires an early diagnosis and management in order to treat the infection and prevent arthritis-related joint cartilage destruction and damage to the graft.

Determining the change in length of the anterolateral ligament during knee motion: A three-dimensional optoelectronic analysis.

BACKGROUND: The variation of the anterolateral ligament (ALL) length during knee motion is still unclear, and the knee position in which a reconstruction graft should be tensioned remains controversial. The objective of this study was to determine the variation of the ALL length during knee motion using a three-dimensional optoelectronic system. METHODS: Kinematic analyses of 20 cadaveric knees were performed using a Motion Analysis® system. The variability of the measurements made during the five acquisition cycles was studied. Reliability was evaluated by two separate measurement sessions, with complete system reinstallation, using different cadavers and a new operator. The ALL length was analysed from extension to full flexion in three rotational conditions. FINDINGS: When analysing the reliability of the five cycles, 82% of the measurements we found to have an Intra Class Correlation (ICC) >0.85. The reproducibility of inter-sessional measures by different operators and different cadavers was either good (ICC >0.75) or excellent (ICC >0.85). The ALL length was maximum in full internal rotation with the knee at 25° of flexion. INTERPRETATION: This three-dimensional optoelectronic protocol allowed us to analyse the variation of the ALL length during intact knee motion with good reliability and the required accuracy to analyse this variable. The maximal length and highest tension of the ALL was reported at 25° of knee flexion in internal rotation, suggesting this as the optimal position for the knee joint when tensioning an ALL reconstruction.