Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation Versus Microfracture: A 6-Year Follow-up of a Prospective Randomized Trial.

BACKGROUND: Few randomized controlled trials with a midterm follow-up have compared matrix-assisted autologous chondrocyte transplantation (MACT) with microfracture (MFx) for knee cartilage lesions. PURPOSE: To compare the structural, clinical, and safety outcomes at midterm follow-up of MACT versus MFx for treating symptomatic knee cartilage lesions. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 48 patients aged between 18 and 50 years, with 1- to 4-cm2 International Cartilage Repair Society (ICRS) grade III to IV knee chondral lesions, were randomized in a 1:1 ratio to the MACT and MFx treatment groups. A sequential prospective evaluation was performed using magnetic resonance imaging (MRI) T2 mapping, the MOCART (magnetic resonance observation of cartilage repair tissue) score, second-look arthroscopic surgery, patient-reported outcome measures, the responder rate (based on achieving the minimal clinically important difference for the Knee injury and Osteoarthritis Outcome Score [KOOS] pain and KOOS Sport/Recreation), adverse events, and treatment failure (defined as a reoperation because of symptoms caused by the primary defect and the detachment or absence of >50% of the repaired tissue during revision surgery). RESULTS: Overall, 35 patients (18 MACT and 17 MFx) with a mean chondral lesion size of 1.8 ± 0.8 cm2 (range, 1-4 cm2) were followed up to a mean of 6 years postoperatively (range, 4-9 years). MACT demonstrated significantly better structural outcomes than MFx at 1 to 6 years postoperatively. At final follow-up, the MRI T2 mapping values of the repaired tissue were 37.7 ± 8.5 ms for MACT versus 46.4 ± 8.5 ms for MFx (P = .003), while the MOCART scores were 59.4 ± 17.3 and 42.4 ± 16.3, respectively (P = .006). More than 50% defect filling was seen in 95% of patients at 2 years and 82% at 6 years in the MACT group and in 67% at 2 years and 53% at 6 years in the MFx group. The second-look ICRS scores at 1 year were 10.7 ± 1.3 for MACT and 9.0 ± 1.8 for MFx (P = .001). Both groups showed significant clinical improvements at 6 years postoperatively compared with their preoperative status. Significant differences favoring the MACT group were observed at 2 years on the KOOS Activities of Daily Living (P = .043), at 4 years on all KOOS subscales (except Symptoms; P < .05) and the Tegner scale (P = .008), and at 6 years on the Tegner scale (P = .010). The responder rates at 6 years were 53% and 77% for MFx and MACT, respectively. There were no reported treatment failures after MACT; the failure rate was 8.3% in the MFx group. Neither group had serious adverse events related to treatment. CONCLUSION: Patients who underwent MACT had better structural outcomes than those who underwent MFx at 1 to 6 years postoperatively. Both groups of patients showed significant clinical improvements at final follow-up compared with their preoperative status. MACT showed superiority at 4 years for the majority of the KOOS subscales and for the Tegner scale at 4 to 6 years. The MACT group also had a higher responder rate and lower failure rate at final follow-up. REGISTRATION: NCT01947374 (ClinicalTrials.gov identifier).

[Cartilage repair: cell-based techniques]. / Reparación del cartílago articular: técnicas basadas en cultivos celulares.

INTRODUCTION: The field of cartilage repair continues to advance after cell based and single-stage chondrocyte transplantation technologies. These strategies have been widely used in developed countries, and clinical, histologic and functional outcomes are of special interest. OBJECTIVE: To describe evidence of cartilage repair techniques by means of a literature review. RESULTS AND DISCUSSION: Cartilage restoration through osteochondral allografting or autologous chondrocyte implantation (ACI) had proven efficacy, but technical and biologic limitations to these procedures exist. However, newer second-generation and third-generation cell-based technologies are being developed and tested clinically with purposes of decreasing operative morbidity, the ability to use a single-stage approach, and improve the viability and durability of cartilage repair tissue. These techniques can be used for treatment of important chondral defects in young patients and elite athletes, but well-designed randomized clinical trials should be done to confirm the value of these procedures.

El Instituto Nacional de Ortopedia / The Instituto Nacional de Ortopedia

En este trabajo se presentan algunos aspectos relevantes de la organización y funcionamiento del Instituto Nacional de Ortopedia, destacando los aspectos relativos a la fundación del mismo y concluye con las perspectivas del Instituto para su futuro próximo

Prevención de enfermedades de la columna vertebral / Prevention of diseases of the spine

Las enfermedades de la columna vertebral tienen gran importancia por su alta incidencia y prevalencia. Se ha estimado que durante la vida activa, el 80 por ciento de los seres humanos de los países industrializados presentan lumbalgia. Se revisan alteracciones de la columna vertebral en la infancia, edad adulta y vejez, sus repercusiones incapacientantes y las acciones de prevención primaria, secundaria y terciaria

Enfermedad aguda, enfermedad crónica e invalidez en la infancia en el sector salud del área metropolitana / Acute disease, chronic desease and disabilities in childhood in the health sector of the Metropolitan area

En 1982, se realizó una encuesta en hospitales y servicios pediátricos de la Secretaria de Salubridad y Asistencia, del Instituo Mexicano del Seguro Social, del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado y del Sistema Nacional para el Desarrollo Integral de la Familia, localizados en el área metropolitana del D.F. El estudio comprendió un total de 2,395 casos y señaló que el 39.4% correspondió a problemas agudos, el 32.6% a crónicos y el 24.1% a invalidantes. Estos resultados son proporcionalmente similares a las investigaciones realizadas en 1967, 1970 y 1975 en universos más restringidos. El estudio analiza específicamente los diferentes parametros de los 579 casos clasificados como inválidos