The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae.

PURPOSE: Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular cartilage of the patella, which results in chronic retropatellar pain. Its aetiology is still unclear but the process is thought to be a due to trauma to superficial chondrocytes resulting in a proteolytic enzymic breakdown of the matrix. Our aim was to assess the effectiveness of autologous chondrocyte implantation on patients with a proven symptomatic retropatellar lesion who had at least one failed conventional marrow-stimulating therapy. METHODS: We performed chondrocyte implantation on 48 patients: 25 received autologous chondrocyte implantation with a type I/III membrane (ACI-C) method (Geistlich Biomaterials, Wolhusen, Switzerland), and 23 received the Matrix-assisted Chondrocyte Implantation (MACI) technique (Genzyme, Kastrup, Denmark). RESULTS: Over a mean follow-up period of 40.3 months, there was a statistically significant improvement in subjective pain scoring using the visual analogue scale (VAS) and objective functional scores using the Modified Cincinnati Rating System (MCS) in both groups. CONCLUSIONS: Chondromalacia patellae lesions responded well to chondrocyte implantation. Better results occurred with MACI than with ACI-C. Excellent and good results were achieved in 40% of ACI-C patients and 57% of MACI patients, but success of chondrocyte implantation was greater with medial/odd-facet lesions. Given that the MACI procedure is technically easier and less time consuming, we consider it to be useful for treating patients with symptomatic chondral defects secondary to chondromalacia patellae.

Acute septic arthritis of the acromioclavicular joint caused by Staphylococcus aureus with marked soft tissue collection towards posterior medial aspect of the AC joint: A rare clinical presentation.

Primary septic arthritis of the Acromioclavicular joint is an unusual disorder and is seldom seen even in an immunocompromised person. We report a case of primary septic arthritis of the acromioclavicular (A-C) joint caused by Staphylococcus aureus. The patient was admitted with pain in the left shoulder, restricted movements and fever. Laboratory parameters showed elevated C-reactive protein, raised erythrocyte sedimentation rate and leukocytosis. Ultrasound revealed a 32 mm collection at the acromioclavicular joint. Patient underwent incision and drainage of abscess. Culture and sensitivity revealed moderate growth of Staphylococcus-aureus. Patient was started on appropriate intravenous antibiotics. Magnetic resonance imaging (MRI) done after 2 weeks revealed marked erosion in the lateral end of clavicle with soft tissue collection along the posteromedial aspect A-C joint. The patient had to undergo repeat drainage of the abscess along with the decompression of lateral end of clavicle. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection.

Autologous chondrocyte implantation in the adolescent knee.

BACKGROUND: Autologous chondrocyte implantation (ACI) has been shown to have favorable results in the treatment of symptomatic chondral and osteochondral lesions. However, there are few reports on the outcomes of this technique in adolescents. PURPOSE: The aim of this study was to assess pain relief and functional outcome in adolescents undergoing ACI. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-five adolescent patients undergoing ACI or matrix-assisted chondrocyte implantation (MACI) were identified from a larger cohort. Four patients were lost to follow-up, leaving 31 patients (24 ACI, 7 MACI). The mean age was 16.3 years (range, 14-18 years) with a mean follow-up of 66.3 months (range, 12-126 months). There were 22 male and 9 female patients. All patients were symptomatic; 30 had isolated lesions and 1 had multiple lesions. Patients were assessed preoperatively and postoperatively using the visual analog scale (VAS) score for pain, the Bentley Functional Rating Score, and the Modified Cincinnati Rating System. At 1 year postoperatively, patients were recalled for a diagnostic biopsy, which was successfully attained in 21 patients. RESULTS: The mean pain scores improved from 5 preoperatively to 1 postoperatively. The Bentley Functional Rating Score improved from 3 to 0, while the Modified Cincinnati Rating System improved from 48 preoperatively to 92 postoperatively with 84% of patients achieving excellent or good results. All postoperative scores exhibited significant improvement from preoperative scores. One patient underwent graft hypertrophy and 1 patient's graft failed and was revised. Biopsy results revealed hyaline cartilage in 24% of cases, mixed fibro/hyaline cartilage in 19%, and fibrocartilage in 57%. CONCLUSION: Results show that, in this particular group who received ACI, patients experienced a reduction in pain and significant improvement in postoperative function after ACI or MACI. The authors believe that ACI is appropriate in the management of carefully selected adolescents with symptomatic chondral and osteochondral defects.

Use of endoprosthetic diaphyseal replacement: a novel approach to management of extensive metastatic tumor of the midshaft radius.

We report the first use of an endoprosthetic diaphyseal replacement after the excision of a midshaft radial tumor. We present a rare case of a solitary midshaft radial metastasis in a 72-year-old gentleman who was treated 8 years earlier for primary renal cell carcinoma by radical nephrectomy. Follow-up for this patient was 25 months after implant insertion and at the latest review was pain-free. Functional scores for the elbow (using the Mayo Elbow Performance Score) and the wrist (using the Mayo Wrist Score) were 80 and 60, respectively, both out of 100. Use of a midshaft radial endoprosthesis provides a good functional outcome and symptom relief after extensive tumor resection, with regard to functional outcome and symptom relief.

Primary intra-osseous liposarcoma of the femur: a case report.

We report a rare case of an intra-osseous liposarcoma of the proximal femur. A 26-year-old man presented with a 6-month history of left groin pain radiating to the knee and an antalgic gait. Radiology showed a predominantly fatty lesion in the medial aspect of the femoral neck extending toward the lesser trochanter; most of the marrow in the femoral neck had been replaced without evidence of an extra-osseous mass; and the posterior cortex had been destroyed. Histological and immunohistochemical analyses of the tumour after open biopsy were indicative of high-grade liposarcomatous malignancy. After exclusion of any other primary tumour foci or metastases on regional and whole-body magnetic resonance images, the diagnosis of a high-grade intra-osseous primary liposarcoma of the proximal femur was made. The patient received 2 preoperative courses of neoadjuvant doxorubicin, cisplatin and methotrexate. After proximal femoral replacement following en bloc excision of the proximal femur, 4 more cycles of adjuvant ifosfamide and etoposide were given. At the 16-month follow-up, he remained independently ambulatory, with no local or distant recurrence. Tissue diagnosis and multimodal imaging, rather than any single radiological investigation, are important in making the diagnosis.