Reoperation Rates After Cartilage Restoration Procedures in the Knee: Analysis of a Large US Commercial Database.

The purpose of this study is to describe the rate of return to the operating room (OR) following microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral autograft transplantation (OATS), and osteochondral allograft (OCA) procedures at 90 days, 1 year, and 2 years. Current Procedural Terminology codes for all patients undergoing MFX, ACI, OATS, and OCA were used to search a prospectively collected, commercially available private payer insurance company database from 2007 to 2011. Within 90 days, 1 year, and 2 years after surgery, the database was searched for the occurrence of these same patients undergoing knee diagnostic arthroscopy with biopsy, lysis of adhesions, synovectomy, arthroscopy for infection or lavage, arthroscopy for removal of loose bodies, chondroplasty, MFX, ACI, OATS, OCA, and/or knee arthroplasty. Descriptive statistical analysis and contingency table analysis were performed. A total of 47,207 cartilage procedures were performed from 2007 to 2011, including 43,576 MFX, 640 ACI, 386 open OATS, 997 arthroscopic OATS, 714 open OCA, and 894 arthroscopic OCA procedures. The weighted average reoperation rates for all procedures were 5.87% at 90 days, 11.94% at 1 year, and 14.90% at 2 years following the index cartilage surgery. At 2 years, patients who underwent MFX, ACI, OATS, OCA had reoperation rates of 14.65%, 29.69%, 8.82%, and 12.22%, respectively. There was a statistically significantly increased risk for ACI return to OR within all intervals (P < .0001); however, MFX had a greater risk factor (P < .0001) for conversion to arthroplasty. There was no difference in failure/revision rates between the restorative treatment options. With a large US commercial insurance database from 2007 to 2011, reparative procedures were favored for chondral injuries, but yielded an increased risk for conversion to arthroplasty. There was no difference in failure/revision rates between the restorative approaches, yet cell-based approaches yielded a significantly increased risk for a return to the OR.

Rotator cuff repair augmentation using a novel polycarbonate polyurethane patch: preliminary results at 12 months' follow-up.

BACKGROUND: Preventing anatomic failure after rotator cuff repair (RCR) remains a challenge. Augmentation with a surgical mesh may permanently reinforce the repair and decrease failure rates. The purpose of this study is to assess the postoperative outcomes of open RCR augmented with a novel reticulated polycarbonate polyurethane patch. MATERIALS AND METHODS: Ten patients with supraspinatus tendon tears underwent open RCR augmented with a polycarbonate polyurethane patch secured in a 6-point fixation construct placed over the repaired tendon. Patients were evaluated with preoperative and postoperative outcome measures, including the Simple Shoulder Test, visual analog pain scale, American Shoulder and Elbow Surgeons shoulder score, Cumulative Activities of Daily Living score, and University of California, Los Angeles shoulder scale, as well as range of motion. Postoperative magnetic resonance imaging was used to evaluate repair status. RESULTS: Patients showed significant improvements in visual analog pain scale, Simple Shoulder Test, and American Shoulder and Elbow Surgeons shoulder scores at both 6 and 12 months postoperatively (P < .05 and P < .01, respectively). The University of California, Los Angeles postoperative score was good to excellent in 7 patients at 6 months and in 8 patients at 12 months. Range of motion in forward flexion, abduction, internal rotation, and external rotation was significantly improved at both 6 and 12 months postoperatively (P < .05 and P < .01, respectively). Magnetic resonance imaging at 12 months showed healing in 90%; one patient had a definitive persistent tear. We found no adverse events associated with the patch, including the absence of fibrosis, mechanical symptoms, or visible subacromial adhesions. DISCUSSION: The polycarbonate polyurethane patch was designed to support tissue in growth and enhance healing as shown by preclinical animal studies. Clinically, the patch is well tolerated and shows promising efficacy, with a 10% retear rate at the 12-month time point.

Tratamiento quirúrgico de la osteocondritis disecante de rodilla / Surgical treatment of osteochondritis dissecans

La OCD (osteocondritis disecante) de rodilla es diagnosticada con mayor frecuencia en pacientes adultos jóvenes. Sin tratamiento, la OCD puede llevar al desarrollo de una artrosis precoz. Este artículo discute la presentación clínica de pacientes con OCD de rodilla, métodos de evaluación, haciendo principal hincapié en el tratamiento quirúrgico. La indicación quirúrgica se basa en la estabilidad de la lesión, la maduración esquelética y los síntomas clínicos. El reestablecimiento de la superficie articular, estimular la vascularización, lograr la fijación y reducción del fragmento osteocondral acompañado de una movilidad articular precoz son los objetiivos primarios cuando se preserva el fragmento osteocondral. Cuando el fragmento no puede ser preservado, el tratamiento se focaliza en la reparación del defecto mediante técnicas de reconstrucción como ser: microfractura, OATS, transplante osteocondral e injerto de condrocitos autólogos.

Tratamiento quirúrgico de la osteocondritis disecante de rodilla / Surgical treatment of osteochondritis dissecans

La OCD (osteocondritis disecante) de rodilla es diagnosticada con mayor frecuencia en pacientes adultos jóvenes. Sin tratamiento, la OCD puede llevar al desarrollo de una artrosis precoz. Este artículo discute la presentación clínica de pacientes con OCD de rodilla, métodos de evaluación, haciendo principal hincapié en el tratamiento quirúrgico. La indicación quirúrgica se basa en la estabilidad de la lesión, la maduración esquelética y los síntomas clínicos. El reestablecimiento de la superficie articular, estimular la vascularización, lograr la fijación y reducción del fragmento osteocondral acompañado de una movilidad articular precoz son los objetiivos primarios cuando se preserva el fragmento osteocondral. Cuando el fragmento no puede ser preservado, el tratamiento se focaliza en la reparación del defecto mediante técnicas de reconstrucción como ser: microfractura, OATS, transplante osteocondral e injerto de condrocitos autólogos.(AU)