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1.
Foot Ankle Clin ; 27(2): 385-399, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35680295

RESUMO

Osteochondral lesions of the talus are a common result of traumatic ankle injury. Due to the low success rates of nonoperative management, surgical management of osteochondral lesions of the talus (OLTs) has evolved considerably over the past decade as more outcomes research has emerged, new techniques have been described, and we have developed a better understanding of the role of biologics in the treatment algorithm. We describe, in sequence, the surgical management options, including salvage procedures, for failed treatment of OLTs.


Assuntos
Traumatismos do Tornozelo , Cartilagem Articular , Fraturas Intra-Articulares , Tálus , Articulação do Tornozelo/cirurgia , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Humanos , Tálus/patologia , Tálus/cirurgia , Falha de Tratamento , Resultado do Tratamento
2.
J Orthop Surg Res ; 17(1): 311, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690862

RESUMO

BACKGROUND: Some authors secured the membrane during matrix-induced autologous chondrocyte implantation (mACI) with fibrin glue or did not use a formal fixation. The real impact of fibrin glue addition on chondrocytes migration and proliferation has not yet been clarified. This study evaluated the impact of fibrin glue on a chondrocyte loaded collagenic membrane. METHODS: A resorbable collagen I/III porcine derived membrane commonly employed in AMIC was used for all experiments. Chondrocytes from three difference donors were used. At 1-, 2-, 3-, 4-, 6-, and at 8-week the membranes were embedded in Mounting Medium with Dapi (ABCAM, Cambridge, UK). The Dapi contained in the mounting medium ties the DNA of the cell nucleus and emits a blue fluorescence. In this way, the spreading of the cells in the membrane can be easily monitored. The outcomes of interest were to evaluate (1) cell migration and (2) cell proliferation within the porous membrane layer. DAPI/nuclei signals were analysed with fluorescence microscope under a magnification of 100-fold. RESULTS: The no-fibrin group demonstrated greater migration of the cells within the membrane. Although migration resulted higher in the no-fibrin group at every follow-up, this difference was significant only at week 1 (P < 0.001), 2 (P = 0.004), and 3 (P = 0.03). No difference was found at week 3, 6, and 8. The no-fibrin group demonstrated greater proliferation of the chondrocytes within the membrane. These differences were significant at week 4 (P < 0.0001), 6 (P < 0.0001), 8 (P < 0.0001). CONCLUSION: The use of fibrin glue over a resorbable membrane leads to lower in vitro proliferation and migration of chondrocytes.


Assuntos
Cartilagem Articular , Condrócitos , Animais , Cartilagem Articular/cirurgia , Proliferação de Células , Células Cultivadas , Condrócitos/metabolismo , Colágeno/metabolismo , Colágeno/farmacologia , Fibrina , Adesivo Tecidual de Fibrina/metabolismo , Adesivo Tecidual de Fibrina/farmacologia , Suínos
3.
J Orthop Surg Res ; 17(1): 308, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690865

RESUMO

BACKGROUND: This systematic review investigated the efficacy and safety of surgical procedures augmented with cell therapies for chondral defects of the talus. METHODS: The present systematic review was conducted according to the 2020 PRISMA guidelines. PubMed, Google scholar, Embase, and Scopus databases were accessed in March 2022. All the clinical trials investigating surgical procedures for talar chondral defects augmented with cell therapies were accessed. The outcomes of interest were to investigate whether surgical procedures augmented with cell therapies promoted improvement in patients reported outcomes measures (PROMs) with a tolerable rate of complications. RESULTS: Data from 477 procedures were retrieved. At a mean follow-up of 34.8 ± 9.7 months, the Visual Analogic Scale (VAS) improved of 4.4/10 (P = 0.002) and the American Orthopaedic Foot and Ankle Score (AOFAS) of 31.1/100 (P = 0.0001) points. No improvement was found in Tegner score (P = 0.4). Few articles reported data on complications. At last follow-up, the rate of reoperation and failure were 0.06% and 0.03%, respectively. No graft delamination or hypertrophy was observed. CONCLUSION: The current evidence suggests that cell therapies may be effective and safe to enhance surgical procedures for chondral defects of the talus. These results should be considered within the limitations of the present study. The current literature should be enriched with randomized controlled clinical trials with larger population size and longer follow-up.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Tálus , Articulação do Tornozelo/cirurgia , Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Humanos , Tálus/cirurgia , Transplante Autólogo , Resultado do Tratamento
4.
Semin Musculoskelet Radiol ; 26(3): 216-229, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35654091

RESUMO

Focal cartilage lesions are common pathologies at the knee joint that are considered important risk factors for the premature development of osteoarthritis. A wide range of surgical options, including but not limited to marrow stimulation, osteochondral auto- and allografting, and autologous chondrocyte implantation, allows for targeted treatment of focal cartilage defects. Arthroscopy is the standard of reference for the assessment of cartilage integrity and quality before and after repair. However, deep cartilage layers, intrachondral composition, and the subchondral bone are only partially or not at all visualized with arthroscopy. In contrast, magnetic resonance imaging offers noninvasive evaluation of the cartilage repair site, the subchondral bone, and the soft tissues of the joint pre- and postsurgery. Radiologists need to be familiar with the different surgical procedures available and their characteristic postsurgical imaging appearances to assess treatment success and possible complications adequately. We provide an overview of the most commonly performed surgical procedures for cartilage repair at the knee and typical postsurgical imaging characteristics.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Artroscopia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/patologia , Doenças das Cartilagens/cirurgia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Condrócitos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia
5.
Sci Rep ; 12(1): 9328, 2022 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-35661147

RESUMO

Focal chondral defects of the knee are common and their management is challenging. This study investigated the efficacy and safety of Autologous Matrix-Induced Chondrogenesis (AMIC) for focal chondral defects of the knee. A systematic review and meta-analysis was conducted (according to the 2020 PRISMA statement) to investigate the efficacy of AMIC in improving symptoms and to compare AMIC versus microfracture (MFx). In January 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. No time constrain was used for the search. All the clinical trials investigating AMIC and/or those comparing AMIC versus MFx for focal chondral defects of the knee were accessed. Only studies published in peer reviewed journals were considered. Studies which investigated other locations of the defects rather than knee were not eligible, nor those reporting data form mixed locations. Studies which reported data on revision settings, as well as those investigating efficacy on kissing lesions or multiple locations, were not suitable. The mean difference (MD) and odd ratio (OR) effect measure were used for continuous and binary data, respectively. Data from 18 studies (548 patients) were retrieved with a mean follow-up of 39.9 ± 26.5 months. The mean defect size was 3.2 ± 1.0 cm2. The visual analogue scale (VAS) decreased of - 3.9/10 (95% confidence interval (CI) - 4.0874 to -3.7126), the Tegner Activity Scale increased of + 0.8/10 (95% CI 0.6595 to 0.9405). The Lysholm Knee Scoring System increased of + 28.9/100 (95% CI 26.8716 to 29.1284), as did the International Knee Documentation Committee (IKDC) + 33.6/100 (95% CI 32.5800 to 34.6200). At last follow-up no patient showed signs of hypertrophy. 4.3% (9 of 210) of patients underwent revision procedures. The rate of failure was 3.8% (9 of 236). Compared to MFx, AMIC demonstrated lower VAS score (MD: - 1.01; 95% CI - 1.97 to 0.05), greater IKDC (MD: 11.80; 95% CI 6.65 to 16.94), and lower rate of revision (OR: 0.16; 95% CI 0.06 to 0.44). AMIC is effective for focal chondral defects of the knee. Furthermore, AMIC evidenced greater IKDC, along with a lower value of VAS and rate of revision compared to MFx.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Cartilagem Articular/cirurgia , Condrogênese , Humanos , Articulação do Joelho/cirurgia , Transplante Autólogo
6.
J ISAKOS ; 7(1): 39-46, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35543659

RESUMO

This classic discusses the original publication "A method of resurfacing osteoarthritic knee joints" by Dr K.H. Pridie (1959), where this pioneer surgeon described a newly developed method for the treatment of osteoarthritic joint surfaces of the knee, which he named subchondral drilling. This short and concise 11-line publication appeared in the Proceedings of the Congress of the British Orthopaedic Association. It has generated 464 citations since 1959, becoming part of the hundred most-cited publications in knee research. Pridie introduced in clinical experimentation the entity of Marrow Stimulation Techniques to liberate mesenchymal stem cells from cancellous bone. He was aware that the results induced, in terms of quality of the regrown tissue, was limited and "only" fibrocartilage. His idea might have been raised from the work of numerous animal researchers who confirmed repeatedly since 1905 that cartilage needed an osseous perforation to heal. Although the past 60 years brought modifications from the technique described in the original article, the concept of marrow stimulation introduced by Pridie remains the most frequently used in cartilage repair surgery today.


Assuntos
Cartilagem Articular , Procedimentos Ortopédicos , Animais , Medula Óssea/cirurgia , Cartilagem Articular/cirurgia , Fibrocartilagem/cirurgia , Articulação do Joelho/cirurgia , Masculino
7.
J ISAKOS ; 7(2): 67-77, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35543667

RESUMO

Meniscus and cartilage injuries of the knee joint lead to cartilage degeneration and osteoarthritis (OA). The research on biomaterials and artificial implants as substitutes in reconstruction and regeneration has become a main international focus in order to solve clinical problems such as irreparable meniscus injury, postmeniscectomy syndrome, osteochondral lesions and generalised chronic OA. In this review, we provide a summary of biomaterials currently used in clinical practice as well as state-of-the-art tissue engineering strategies and technologies that are developed for articular cartilage and meniscus repair and regeneration. The literature was reviewed over the last 5 years on clinically used meniscus and cartilage repair biomaterials, such as Collagen Meniscal Implant, Actifit, NUsurface, TruFit, Agili-C and MaioRegen. There are clinical advantages for these biomaterials and the application of these treatment options should be considered individually. Standardised evaluation protocols are needed for biological and mechanical assessment and comparison between different scaffolds, and long-term randomised independent clinical trials with large study numbers are needed to provide more insight into the use of these biomaterials. Surgeons should become familiar and stay up to date with evolving repair options to improve their armamentarium for meniscal and cartilage defects.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Menisco , Osteoartrite , Lesões do Menisco Tibial , Materiais Biocompatíveis/uso terapêutico , Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Humanos , Menisco/cirurgia , Lesões do Menisco Tibial/cirurgia
8.
J ISAKOS ; 7(2): 62-66, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35546437

RESUMO

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.


Assuntos
Traumatismos do Tornozelo , Cartilagem Articular , Fraturas Intra-Articulares , Tálus , Tornozelo , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Humanos , Tálus/lesões , Tálus/cirurgia
9.
Foot Ankle Int ; 43(6): 783-789, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35536146

RESUMO

BACKGROUND: Osteochondral lesions of the talus (OLT) treatment is widely debated when the lesion size exceeds 150 mm2. The aim of this study was to assess functional outcome and satisfaction rates of the autologous matrix-related chondrogenesis (AMIC) technique and compare the outcomes for OLTs larger than 150 mm2 that were classified as primary, primary with local tumor-related OLT, or revision cases. METHODS: A total of 77 patients who were operated by AMIC were included. The average age of the population was 39.6 years. The mean body mass index (BMI) was 27.2. Smoker rate was 28.5% of the population. Forty-two patients were primary cases, 14 patients had primary with local tumor-related OLT, and 18 patients were revision cases. Overall and subgroup functional outcomes were evaluated by visual analog scale (VAS) and Foot and Ankle Disability Index (FADI) scores. Satisfaction rates were queried, and failures were recorded. RESULTS: After a median follow-up of 32 months, the score improvement for primary, primary with local tumor-related, and revision group were for VAS, 5.4 ± 0.4, 5.6 ± 0.7, and 3.6 ± 0.8, and for FADI, 46.5 ± 3.8, 45.3 ±6.5, and 26.6 ± 6.7, respectively (P < .001). Intergroup comparison showed greater improvement for the primary OLT group when compared to the revision group (P < .001). The failure rates for the primary, primary with local tumor-related, and revision group were 4.8%, 11.8%, and 38.9%, respectively. CONCLUSION: AMIC procedure provides good functional outcome and satisfactory rates in patients with primary and primary with local tumor-related OLT larger than 150 mm2, but in revision cases, the AMIC success rate was not encouraging as all had advanced OLT operative interventions. LEVEL OF EVIDENCE: Level III, therapeutic retrospective study.


Assuntos
Cartilagem Articular , Fraturas Intra-Articulares , Tálus , Adulto , Cartilagem Articular/cirurgia , Condrogênese , Humanos , Fraturas Intra-Articulares/cirurgia , Imageamento por Ressonância Magnética/métodos , Estudos Retrospectivos , Tálus/patologia , Tálus/cirurgia , Transplante Autólogo/métodos , Resultado do Tratamento
11.
Comput Math Methods Med ; 2022: 7643487, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35529263

RESUMO

The objective of this study was to investigate the application effect of deep learning model combined with different magnetic resonance imaging (MRI) sequences in the evaluation of cartilage injury of knee osteoarthritis (KOA). Specifically, an image superresolution algorithm based on an improved multiscale wide residual network model was proposed and compared with the single-shot multibox detector (SSD) algorithm, superresolution convolutional neural network (SRCNN) algorithm, and enhanced deep superresolution (EDSR) algorithm. Meanwhile, 104 patients with KOA diagnosed with cartilage injury were selected as the research subjects and underwent MRI scans, and the diagnostic performance of different MRI sequences was analyzed using arthroscopic results as the gold standard. It was found that the image reconstructed by the model in this study was clear enough, with minimum noise and artifacts, and the overall quality was better than that processed by other algorithms. Arthroscopic analysis found that grade I and grade II lesions concentrated on patella (26) and femoral trochlear (15). In addition to involving the patella and femoral trochlea, grade III and grade IV lesions gradually developed into the medial and lateral articular cartilage. The 3D-DS-WE sequence was found to be the best sequence for diagnosing KOA injury, with high diagnostic accuracy of over 95% in grade IV lesions. The consistency test showed that the 3D-DESS-WE sequence and T2∗ mapping sequence had a strong consistency with the results of arthroscopy, and the Kappa consistency test values were 0.748 and 0.682, respectively. In conclusion, MRI based on deep learning could clearly show the cartilage lesions of KOA. Of different MRI sequences, 3D-DS-WE sequence and T2∗ mapping sequence showed the best diagnosis results for different degrees of KOA injury.


Assuntos
Cartilagem Articular , Aprendizado Profundo , Traumatismos do Joelho , Osteoartrite do Joelho , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/patologia
12.
Magn Reson Imaging Clin N Am ; 30(2): 227-239, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35512887

RESUMO

Cartilage injuries are common and may predispose to early accelerated osteoarthritis. Magnetic resonance (MR) imaging is critical in the detection and characterization of acute and chronic cartilage injuries. Several surgical approaches including microfracture, osteochondral allografting, autologous osteochondral transfer system, and autologous chondrocyte implantation have been developed to treat cartilage lesions. The goals of these treatments include relief of symptoms, restoration of joint function, and delay of progression of osteoarthritis. Imaging evaluation by MR imaging plays a crucial role in diagnosis and surgical planning as well as monitoring for postoperative complications.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Traumatismos do Joelho , Osteoartrite , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/cirurgia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Condrócitos/transplante , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos
13.
Cartilage ; 13(2): 19476035221098169, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35578752

RESUMO

OBJECTIVE: The objective of this study was to determine whether there are significant differences in terms of indications, techniques, patient variables, and objective and subjective outcome scores as a function of the geographic locale of published studies of knee articular cartilage surgery. METHODS: An electronic database search was performed of clinical studies evaluating knee articular cartilage procedures from 2000 to 2021. Studies were separated into global regions (Europe, Asia, North America, and South America) based on the study country. All cartilage-based treatments in each region were recorded. Patient age and sex, mechanism of injury, cartilage lesion size and location, follow-up time, failure rate, and knee outcome scores utilized were summarized and compared by region. RESULTS: A total of 2,923 studies were analyzed. Eighty level 1 and 2 studies met the inclusion criteria. The majority were from Europe (n = 60), followed by Asia (n = 11), North America (n = 7), and South America (n = 2). The majority of procedures in European and North American studies were cell-based and marrow-stimulation procedures. In Asian studies, the most common procedures were marrow-stimulation, experimental, and biologic procedures as defined by the authors. Asian countries had a higher proportion of females (P < 0.001) and an overall older patient population (P < 0.001). Regional variation was also seen in terms of lesion location, mechanism of injury, and failure rate. CONCLUSION: Most high-level evidence for articular cartilage-based procedures of the knee comes from European countries. These studies vary by patient age and sex, anatomic location, and mechanism of injury. Global variation should be taken into consideration when interpreting and applying studies of knee articular cartilage surgery.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Traumatismos do Joelho , Procedimentos Ortopédicos , Doenças das Cartilagens/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Procedimentos Ortopédicos/métodos
14.
Einstein (Sao Paulo) ; 20: eAO6819, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35544896

RESUMO

OBJECTIVE: Phase 1 clinical trial to determine feasibility, safety, and efficacy of a new advanced cell therapy product for treatment of knee articular cartilage injuries. METHODS: Three participants with knee focal chondral lesions were included, with no signs of osteoarthritis. Chondrocytes were obtained through knee arthroscopy, cultured in collagen membrane for 3 weeks at the laboratory, subjected to tests to release the cell therapy product, and implanted. All patients underwent a specific 3-month rehabilitation protocol, followed by assessments using functional and imaging scales. The main outcome was the incidence of severe adverse events. RESULTS: Three participants were included and completed the 2-year follow-up. There was one severe adverse event, venous thrombosis of distal leg veins, which was no associated with therapy, was treated and left no sequelae. The clinical and radiological scales showed improvement in the three cases. CONCLUSION: The preliminary results, obtained with the described methodology, allow concluding that this product of advanced cell therapy is safe and feasible. ReBEC platform registration number: RBR-6fgy76.


Assuntos
Cartilagem Articular , Traumatismos do Joelho , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Condrócitos , Seguimentos , Hospitais , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Transplante Autólogo
15.
J Biomed Nanotechnol ; 18(2): 504-511, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35484732

RESUMO

Objective: Since the benefits of Nano-material usage have been well documented in orthopedic surgery, this study was conducted to explore the effect of polyvinyl alcohol/nano-hydroxyapatite/polyamide 66 (PVA/n-HA/P66) on repairing of traumatic cartilage defects in rabbit knee joint. Methods: New Zealand white rabbits were used to make a rabbit knee traumatic cartilage defect animal model. All rabbits were randomly located in three groups. Group-A (PVA/n-HA+PA66 implanted in cartilage defects); Group-B (HA nanospheres implanted in cartilage defects)/Gelatin sponge composite scaffold); Group-C (only cartilage defect without implant). The repairment of articular cartilage defects and the general observation were studied by using pathological staining and gene expression of collagen using RT-PCR after 12 weeks. Results: After 12 weeks, we observed a small amount of fibrous tissue growth in group C without soft cell filling. The repaired tissue in group B was stained with immunohistochemical and toluidine blue staining for collagen and type II collagen is positive, but chondrocyte structure is more visible. The relative mRNA expression of type II collagen was higher in group B in comparison to other groups. The results of the Wakitani score were 5.50±2.59 for group A, 8.83±2.79 for group B, 11.50±1.05 for group C. Results showed no significant difference between group B and C; however, significant differences were found in the scoring results between groups A and B, and between-group A and C. Conclusion: This study showed the high effectiveness of PVA/n-HA+PA66 in the treatment of cartilage defects through increasing the expression of type II collagen.


Assuntos
Cartilagem Articular , Animais , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Colágeno/farmacologia , Colágeno Tipo II/genética , Colágeno Tipo II/farmacologia , Modelos Teóricos , Coelhos , Regeneração
16.
Int Orthop ; 46(7): 1539-1545, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35411436

RESUMO

PURPOSE: To determine the correlation between the assessment computed tomography osteochondral allograft (ACTOCA) scoring system and clinical outcomes scores. The hypothesis was that the ACTOCA score would show sufficient correlation to support its use in clinical practice. METHODS: We prospectively collected data from all consecutive patients who underwent cartilage restitution with fresh osteochondral allograft (FOCA) transplantation for osteochondral lesions of the knee and had a minimum follow-up of two years. CT scans were performed at three, six and 24 months post-operatively. A musculoskeletal radiologist blinded to the patients' medical history evaluated the scans using the ACTOCA scoring system. Clinical outcomes collected preoperatively and at three, six and 24 months postoperatively were evaluated using the International Knee Documentation Committee (IKDC), Kujala, the Western Ontario Meniscal Evaluation Tool (WOMET), and the Tegner Activity Scale. RESULTS: The mean total ACTOCA score showed a statistically significant correlation with the clinical outcome. The correlation was optimal at 24 months. We found a high negative correlation with the IKDC, Kujala and Tegner (- 0.737; - 0.757, and - 0.781 respectively), and a moderate negative correlation with WOMET (- 0.566) (p < 0.001). IKDC, Kujala, WOMET, and Tegner scores showed a significant continuous improvement in all scores (p < 0.001). CONCLUSION: The mean total ACTOCA score showed a linear correlation with clinical results in IKDC, Kujala, WOMET, and Tegner scores, being the highest at 24 months post-surgery. This finding supports the use of ACTOCA to standardize CT scan reports following fresh osteochondral allograft transplantation in the knee.


Assuntos
Cartilagem Articular , Fraturas Intra-Articulares , Aloenxertos , Transplante Ósseo/métodos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Tomografia Computadorizada por Raios X
17.
Osteoarthritis Cartilage ; 30(7): 987-997, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35421548

RESUMO

OBJECTIVE: Immediate cartilage structural alterations in the acute phase after an anterior cruciate ligament (ACL) rupture may be a precursor to posttraumatic osteoarthritis (PTOA) development. Our aim was to describe changes in cartilage matrix in the subacute phase of the acutely ACL-injured knee compared to the contralateral uninjured knee. DESIGN: Participants (n = 118) aged 15-40 years with an acute ACL injury were consecutively included in subacute phase after acute ACL-injury and underwent MRI (mean 29 days post trauma) of both knees. Mean T2 relaxation times, T2 spatial coefficient of variation and cartilage thickness were determined for different regions of the tibiofemoral cartilage. Differences between the acutely ACL-injured and uninjured knee were evaluated using Wilcoxon signed-rank test. RESULTS: T2 relaxation time in injured knees was increased in multiple cartilage regions from both medial and lateral compartment compared to contralateral knees, mostly in medial trochlea and posterior tibia (P-value<0.001). In the same sites of injured knees, we observed significantly thinner cartilage. Moreover, injured knees presented shorter T2 relaxation time in superficial cartilage on lateral central femur and trochlea (P-value<0.001), and decreased T2 spatial coefficient of variation in lateral trochlea and load bearing regions of medial-central femoral condyle and central tibia in both compartments. CONCLUSION: Small but statistically significant differences were observed in the subacute phase between ACL-injured and uninjured knee in cartilage T2 relaxation time and cartilage thickness. Future longitudinal observations of the same cohort will allow for better understanding of early development of PTOA. TRIAL REGISTRATION NUMBER: NCT02931084.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Cartilagem Articular , Traumatismos do Joelho , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos
18.
Am J Sports Med ; 50(6): 1635-1643, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35438027

RESUMO

BACKGROUND: Cartilage transplants in the patellofemoral joint have demonstrated lower success rates than in the femoral condyles. This is likely related to the more complex morphology and biomechanics of the joint. While previous studies have evaluated cartilage surface matching and congruence, little work has been done to study the associated subchondral bone congruency in these grafts. PURPOSE: To determine if differences in patellar morphology play a role in the alignment of the donor patellar osteochondral allograft subchondral bone with the native patellar subchondral bone. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 20 (10 Wiberg I and 10 Wiberg II/III) fresh-frozen human patellae were designated as recipients and size-matched to both a Wiberg I and a Wiberg II/III patellar donor. A 16-mm osteochondral allograft transplant to the central ridge of the patella was performed in random order with each matched donor. Transplanted patellae underwent a nano-computed tomography (nano-CT) scan, were digitally reconstructed, and were superimposed on the initial nano-CT scan of the native recipient patella. MATLAB was used to determine the surface height deviation between the native and donor subchondral bone surfaces. DragonFly 3-dimensional imaging software was used to measure subchondral bone step-off heights at the native-donor interface. Differences between matched and unmatched grafts were compared using a 2-way analysis of variance and the Sidak post hoc test. RESULTS: Subchondral bone surface deviation did not differ between Wiberg matched and unmatched allografts. The step-off height was significantly greater in unmatched (1.38 ± 0.49 mm) compared with matched (1.14 ± 0.52 mm) plugs (P = .015). The lateral quadrant step-off differed between matched (0.89 ± 0.43 mm) and unmatched (1.60 ± 0.78 mm) grafts (P = .007). CONCLUSION: While unmatched Wiberg patellar osteochondral allograft implantation did not result in significantly different subchondral bone surface height deviations, there was a significant difference in the circumferential subchondral bone step-off height in the lateral quadrant. Further investigation using finite element analysis modeling will help determine the role of subchondral bone surface on shear and compression force distributions in these areas. CLINICAL RELEVANCE: Given that subchondral bone stiffness and morphology play a role in cartilage health, subchondral bone congruency may play a role in graft survival. Understanding how this congruency plays a role in cartilage force distribution will help surgeons improve the long-term success of osteochondral allograft transplants.


Assuntos
Cartilagem Articular , Fraturas Intra-Articulares , Odonatos , Aloenxertos , Animais , Cartilagem Articular/cirurgia , Fêmur/transplante , Humanos , Patela/cirurgia , Transplante Homólogo
19.
Am J Sports Med ; 50(4): 951-961, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35373606

RESUMO

BACKGROUND: Patients undergoing anterior cruciate ligament reconstruction (ACLR) are at an increased risk for posttraumatic osteoarthritis (PTOA). While we have previously shown that meniscal treatment with ACLR predicts more radiographic PTOA at 2 to 3 years postoperatively, there are a limited number of similar studies that have assessed cartilage directly with magnetic resonance imaging (MRI). HYPOTHESIS: Meniscal repair or partial meniscectomy at the time of ACLR independently predicts more articular cartilage damage on 2- to 3-year postoperative MRI compared with a healthy meniscus or a stable untreated tear. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A consecutive series of patients undergoing ACLR from 1 site within the prospective, nested Multicenter Orthopaedic Outcomes Network (MOON) cohort underwent bilateral knee MRI at 2 to 3 years postoperatively. Patients were aged <36 years without previous knee injuries, were injured while playing sports, and had no history of concomitant ligament surgery or contralateral knee surgery. MRI scans were graded by a board-certified musculoskeletal radiologist using the modified MRI Osteoarthritis Knee Score (MOAKS). A proportional odds logistic regression model was built to predict a MOAKS-based cartilage damage score (CDS) relative to the contralateral control knee for each compartment as well as for the whole knee, pooled by meniscal treatment, while controlling for sex, age, body mass index, baseline Marx activity score, and baseline operative cartilage grade. For analysis, meniscal injuries surgically treated with partial meniscectomy or meniscal repair were grouped together. RESULTS: The cohort included 60 patients (32 female; median age, 18.7 years). Concomitant meniscal treatment at the time of index ACLR was performed in 17 medial menisci (13 meniscal repair and 4 partial meniscectomy) and 27 lateral menisci (3 meniscal repair and 24 partial meniscectomy). Articular cartilage damage was worse in the ipsilateral reconstructed knee (P < .001). A meniscal injury requiring surgical treatment with ACLR predicted a worse CDS for medial meniscal treatment (medial compartment CDS: P = .005; whole joint CDS: P < .001) and lateral meniscal treatment (lateral compartment CDS: P = .038; whole joint CDS: P = .863). Other predictors of a worse relative CDS included age for the medial compartment (P < .001), surgically observed articular cartilage damage for the patellofemoral compartment (P = .048), and body mass index (P = .007) and age (P = .020) for the whole joint. CONCLUSION: A meniscal injury requiring surgical treatment with partial meniscectomy or meniscal repair at the time of ACLR predicted worse articular cartilage damage on MRI at 2 to 3 years after surgery. Further research is required to differentiate between the effects of partial meniscectomy and meniscal repair.


Assuntos
Lesões do Ligamento Cruzado Anterior , Cartilagem Articular , Menisco , Ortopedia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/patologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Cartilagem Articular/cirurgia , Estudos de Coortes , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Menisco/diagnóstico por imagem , Menisco/cirurgia , Estudos Prospectivos
20.
Arthroscopy ; 38(4): 1264-1266, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35369924

RESUMO

Various treatment options exist for patellar chondral lesions, including nonoperative management, marrow stimulation, cell-based strategies, and osteochondral transplantation, yet there is insufficient evidence to recommend one treatment over another. One frequently discussed downside of cell-based strategies, including particulated juvenile allograft cartilage and matrix-induced autologous chondrocyte implantation, is the associated cost. Markov modeling is a tool used for economic modeling of different treatments and may be a viable option to compare cell-based strategies for patellar chondral defects. Too many assumptions carry great risk of drawing a strong conclusion. Further high-quality studies and comparative outcome studies are needed before any definitive cost-effectiveness conclusion is made.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Procedimentos Ortopédicos , Doenças das Cartilagens/cirurgia , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Condrócitos/transplante , Análise Custo-Benefício , Humanos
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