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1.
Medicine (Baltimore) ; 100(12): e24330, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761633

RESUMO

ABSTRACT: This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ±â€Š15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ±â€Š8.1 to 82.1 ±â€Š5.6, the VAS score decreased from 6.9 ±â€Š2.3 to 1.8 ±â€Š1.5, and the SF36 score increased from 48.7 ±â€Š9.4 to 83.5 ±â€Š6.2. TAS increased from 83.3 ±â€Š5.1 to 90.3 ±â€Š6.1, TTS increased from 70.3 ±â€Š6.1 to 82.5 ±â€Š5.4, TT decreased from 12.9 ±â€Š6.1 to 6.9 ±â€Š5.7, and TLS increased from 76.5 ±â€Š4.1 to 81.2 ±â€Š3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.


Assuntos
Articulação do Tornozelo/anormalidades , Ligamentos Colaterais/cirurgia , Osteotomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tálus/lesões , Articulação do Tornozelo/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Desbridamento/efeitos adversos , Desbridamento/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Tálus/cirurgia , Resultado do Tratamento
2.
Arthroscopy ; 37(3): 998-999, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673977

RESUMO

Osteochondral lesions of the talus occur with relatively frequency, often as the sequelae of benign ankle sprains, and are only surpassed by the knee and elbow as more common locations. While microfracture of the talus is the most common first-line surgical treatment performed at the time of ankle arthroscopy, marrow stimulation alone results in fibrocartilaginous repair tissue rather than true hyaline-like articular cartilage. In addition, the benefits of bone marrow stimulation for the treatment of large (>150 mm2), deep (>7 mm), or cystic lesions is limited. Autologous osteochondral transplant has emerged as one such treatment option for large lesions that may address underlying bone loss and reconstitute articular cartilage. The utility of autologous osteochondral transplant also must be interpreted with an understanding of the potential complications, including donor-site morbidity. In addition, it is important to decompress, curettage, and back fill associated cysts with bone graft. When cysts are not treated aggressively, patients may have ongoing bone marrow edema and pain.


Assuntos
Traumatismos do Tornozelo , Cartilagem Articular , Tálus , Traumatismos do Tornozelo/cirurgia , Medula Óssea , Cartilagem Articular/cirurgia , Humanos , Taxa de Sobrevida , Tálus/cirurgia
3.
Bone Joint J ; 103-B(2): 207-212, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517733

RESUMO

The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the surgical treatment of OLTs. Management options are reviewed based on the size of the lesion and include bone marrow stimulation, bone grafting options, drilling techniques, biological preparations, and resurfacing. Although many of these techniques have shown promising results, there remains little high level evidence, and further large scale prospective studies and systematic reviews will be required to identify the optimal form of treatment for these lesions. Cite this article: Bone Joint J 2021;103-B(2):207-212.


Assuntos
Fraturas do Tornozelo/terapia , Cartilagem Articular/lesões , Procedimentos Ortopédicos/métodos , Lesões dos Tecidos Moles/terapia , Tálus/lesões , Algoritmos , Cartilagem Articular/cirurgia , Tomada de Decisão Clínica , Humanos , Guias de Prática Clínica como Assunto , Tálus/cirurgia
4.
Instr Course Lect ; 70: 273-288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438916

RESUMO

Patellofemoral instability is a common pathology especially in the adolescent female population.1,2 Prompt diagnosis and management is critical to prevent future episodes of instability as well as to reduce the risk of cartilaginous injury to the patellofemoral articular surface. Initial management of a first-time patellar dislocation has historically been nonsurgical; however, the presence of intra-articular loose bodies or osseocartilaginous injury may require surgical intervention.3,4 More recent evidence has shown patients with specific risk factors such as skeletal immaturity, an incompetent medial soft-tissue sleeve, family history of patellar dislocation, elevated tibial tubercle to trochlear groove distance, patella alta, and high-grade trochlear dysplasia experience high rates of re-dislocation after initial nonsurgical management.4-9 Based on this, the provider needs to consider these risk factors and the possibility of initial surgical management in these patient populations following a first-time patellar dislocation. Surgical options for management of patellar instability and cartilaginous injury include medial patellofemoral ligament repair, medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, and various cartilaginous repair/restoration procedures. It is important to be knowledgeable about the clinical and anatomic/radiographic risk factors associated with patients presenting with patellar instability, the algorithm for treatment, the indications and surgical technique for medial patellofemoral ligament reconstruction and tibial tubercle osteotomy, and management of cartilaginous injury to the patellofemoral joint.


Assuntos
Cartilagem Articular , Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Adolescente , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Feminino , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamentos Articulares , Luxação Patelar/diagnóstico , Luxação Patelar/etiologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia
5.
Instr Course Lect ; 70: 289-308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438917

RESUMO

Chondral lesions of the patellofemoral joint are common, and when symptomatic they can be difficult to manage. Not only are there various degrees of injury with multiple etiologies, but patellofemoral anatomy is complex and the patient's lower extremity alignment may contribute to the pathology. Treatment depends on the location, size, and depth of the lesion and may require realignment or concomitant stabilizing procedures. Tibial tubercle osteotomy can be performed in isolation or combined with various cartilage-based treatments, including marrow stimulation techniques, autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft. End-stage lesions, failed primary patellofemoral cartilage restoration with diffuse involvement, or isolated primary patellofemoral arthritis may be amenable to treatment with patellofemoral arthroplasty. Recent investigations in properly indicated patients using advanced techniques have shown that management of patellofemoral cartilage disease is now more effective and predictable than in the past.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Artropatias , Articulação Patelofemoral , Cartilagem Articular/cirurgia , Humanos , Osteotomia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia
6.
Instr Course Lect ; 70: 309-318, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438918

RESUMO

Meniscal pathology is one of the most common structural knee issues seen and managed by the orthopaedic surgeon. An ever-evolving armamentarium of management options exists that are geared toward the elimination of symptoms and restoration of normal knee function. A common theme among these management options is to preserve meniscal tissue whenever possible through repair or minimization of meniscal excision, as the literature has shown that the loss of meniscal tissue can significantly alter the distribution of forces and contact stresses on knee articular cartilage, thus predisposing the joint to degenerative osteoarthritis. In the setting of meniscal injuries or insufficiency, various advances in repair techniques, use of meniscal allografts, and use of biologic adjuvants have been reported to help preserve and/or attempt to restore the native kinematic properties of the knee. It is important to explore meniscal function, its associated pathologies, and currently available treatment options that are supported by short-term and long-term clinical data.


Assuntos
Cartilagem Articular , Lesões do Menisco Tibial , Cartilagem Articular/cirurgia , Humanos , Articulação do Joelho/cirurgia , Meniscectomia , Meniscos Tibiais/cirurgia , Lesões do Menisco Tibial/cirurgia
7.
Instr Course Lect ; 70: 319-336, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438919

RESUMO

Joint preservation strategies in young, active patients are a challenge, particularly in those with combined cartilage and meniscal deficiency. Concomitant malalignment and/or ligamentous insufficiency are not uncommon and further add to the complex nature of these patients. In patients who require surgery, a complete treatment strategy must be developed and implemented because unaddressed pathology typically leads to poor outcomes over time. In addition to reconstructive procedures, biologic therapies both as nonsurgical treatments and surgical augments offer promise, but their indications and place in orthopaedics continue to evolve. A comprehensive approach to this difficult patient population, including understanding all underlying pathologies, the natural history of each condition, and the appropriate treatment for each pathology, is necessary for successful joint preservation treatment in the young and active population.


Assuntos
Produtos Biológicos , Cartilagem Articular , Produtos Biológicos/uso terapêutico , Cartilagem Articular/cirurgia , Humanos , Articulação do Joelho/cirurgia , Osteotomia
8.
Instr Course Lect ; 70: 415-432, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438925

RESUMO

Osteochondritis dissecans and cartilage injuries of the knee are among the most challenging clinical entities that pediatric sports medicine specialists encounter. As a weight-bearing joint with significant long-term implications on mobility and overall physical health, the knee also happens to be the most injured or adversely affected joint in preadolescent and adolescent athletes. However, cartilage injuries are unique among other musculoskeletal pathologies in children, in that the healing potential of articular cartilage tissue is limited, and minor injuries or small focal defects can have devastating implications on the lifelong health of the joint. Although the most common form of degenerative joint disease affecting the general population is, of course, osteoarthritis, other conditions such as osteochondritis dissecans or acute, traumatic osteochondral shear injuries can activate their own arthritic pathway, whereby focal injuries precipitate an eventual cascade of diffuse degeneration. Thus, it is important for sports medicine and pediatric orthopaedic specialists alike to understand, diagnose, and initiate early, evidence-based management for cartilage conditions of the knee in pediatric patients. This chapter reviews principles of diagnosis and management of both knee osteochondritis dissecans (a chronic condition of subchondral bone that often secondarily affects the articular cartilage) and acute traumatic cartilage shear injuries. Although the two entities are quite different from an etiologic standpoint, there is significant overlap in technical considerations and treatment principles between these two conditions.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Osteocondrite Dissecante , Adolescente , Osso e Ossos , Cartilagem Articular/cirurgia , Criança , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/etiologia
9.
Sports Med Arthrosc Rev ; 29(1): e1-e8, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395227

RESUMO

Advances in hip preservation surgery have to lead to increased utilization of hip arthroscopy. With this, there has also been a growth in the understanding of various hip conditions, therefore, leading to an increase in hip conditions amenable to arthroscopic intervention. The acetabular hip labrum has been at the forefront of arthroscopic advances in the hip. The labrum is important for hip stability, provision of the suction seal, and joint proprioception. Given the labrum's central role in hip biomechanics, there is increasing emphasis on labral preservation in the form of debridement and repair. In revision settings, advanced techniques such as labral augmentation and reconstruction may play a role in the management of labral pathology. Appropriate management of the hip labrum at the time of surgery can be an important mediator of the outcome. As such, an understanding of the evolving evidence base and surgical indications and techniques are integral to the treatment and management of labral pathology.


Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Artroscopia/métodos , Desbridamento , Acetábulo/diagnóstico por imagem , Cartilagem Articular/cirurgia , Tratamento Conservador , Humanos , Exame Físico , Radiografia
10.
Sports Med Arthrosc Rev ; 29(1): 44-51, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395230

RESUMO

The surgical treatment of femoroacetabular impingement has been shown to have successful early and mid-term clinical outcomes. Despite these favorable clinical outcomes that have been published in the literature, there is a subgroup of patients that present with continued or recurrent symptoms after surgical treatment. Not only has there been an increase in the number of hip arthroscopy procedures, but also there has been a corresponding increase in the number of revision hip arthroscopy and hip preservation surgeries. Previous studies have reported residual deformity to be the most common reason for revision hip arthroscopy. However, chondral, labral, and capsular considerations also are important when addressing patients not only in the primary but also, the revision setting. In this review, we outline the evaluation and treatment of the patient that presents with continued hip and groin pain after undergoing a hip.


Assuntos
Artroscopia , Impacto Femoroacetabular/cirurgia , Artralgia/etiologia , Artroscopia/efeitos adversos , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/patologia , Articulação do Quadril/anatomia & histologia , Articulação do Quadril/patologia , Articulação do Quadril/cirurgia , Humanos , Cápsula Articular/anatomia & histologia , Cápsula Articular/patologia , Cápsula Articular/cirurgia , Instabilidade Articular/etiologia , Complicações Pós-Operatórias , Reoperação , Falha de Tratamento
11.
Am J Sports Med ; 49(2): 476-486, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33427489

RESUMO

BACKGROUND: Matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) is an effective surgical treatment for osteochondral defects. Quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as noninvasive biomarkers to assess the biochemical composition of cartilage repair tissue. PURPOSE: To evaluate the association of quantitative MRI parameters of cartilage repair tissue and subchondral bone marrow with magnetic resonance morphologic and clinical outcomes after MACI with ABG of the knee. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Qualitative and quantitative 3 T MRI of the knee was performed in 21 patients (16 male) at 2.5 years after MACI with ABG at the medial (18/21) or lateral (3/21) femoral condyle for the treatment of osteochondral defects. Morphologic MRI sequences were assessed using MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. T2 relaxation time measurements for the assessment of cartilage repair tissue (CRT2) were obtained. Single-voxel magnetic resonance spectroscopy was performed in underlying subchondral bone marrow (BM) and at both central femoral condyles. The presence of pain and Tegner scores were noted. Statistical analyses included Student t tests, correlation analyses, and multivariate regression models. RESULTS: The mean defect size was 4.9 ± 1.9 cm2. At a follow-up of 2.5 ± 0.3 years, 9 of 21 patients were asymptomatic. Perfect defect filling was achieved in 66.7% (14/21) of patients. MOCART 2.0 scores (74.1 ± 18.4) did not indicate pain (68.3 ± 19.0 [pain] vs 81.7 ± 15.4 [no pain]; P = .102). However, knee pain was present in 85.7% (6/7) of patients with deep bony defects (odds ratio, 8.0; P = .078). Relative CRT2 was higher in hypertrophic cartilage repair tissue than in repair tissue with normal filling (1.54 ± 0.42 vs 1.13 ± 0.21, respectively; P = .022). The underlying BM edema-like lesion (BMEL) volume was larger in patients with underfilling compared with patients with perfect defect filling (1.87 ± 1.32 vs 0.31 ± 0.51 cm3, respectively; P = .002). Patients with severe pain showed a higher BMEL volume (1.2 ± 1.3 vs 0.2 ± 0.4 cm3, respectively; P = .046) and had a higher BM water fraction (26.0% ± 12.3% vs 8.6% ± 8.1%, respectively; P = .026) than did patients without pain. CONCLUSION: Qualitative and quantitative MRI parameters including the presence of subchondral defects, CRT2, BMEL volume, and BM water fraction were correlated with cartilage repair tissue quality and clinical symptoms. Therefore, the integrity of subchondral bone was associated with outcomes after osteochondral transplantation.


Assuntos
Transplante Ósseo , Cartilagem Articular , Condrócitos/transplante , Articulação do Joelho , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Transplante Autólogo
12.
Arthroscopy ; 36(11): 2909-2910, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33172587

RESUMO

Treatment of large articular cartilage defects of the knee is challenging, particularly in young, high-demand patients. Osteochondral allograft (OCA) transplantation is a viable treatment option, providing fully mature articular cartilage during a single operation while avoiding donor site morbidity. Indications are symptomatic, full-thickness articular cartilage defects >3 cm2. Contraindications include a "kissing" lesion of the corresponding articular cartilage surface, uncorrected ligamentous instability, malalignment, peripheral osteophytes, joint-space narrowing, or absence of >50% of the meniscus in the affected compartment. Matching for size and contour is crucial; therefore, we use medial femoral condyle (MFC) allografts for MFC lesions and lateral femoral condyle (LFC) allografts for LFC lesions, and do not recommend LFC grafts for the MFC. Survival rates are 78.7% and 72.8% at 10 and 15 years, respectively.


Assuntos
Cartilagem Articular , Sapatos , Aloenxertos , Cartilagem Articular/cirurgia , Epífises , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia
13.
Arthroscopy ; 36(10): 2611-2613, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33039036

RESUMO

In the past 5 years, arthroscopic labral reconstruction of the hip has rapidly evolved from a salvage procedure used primarily in the setting of multiple failed prior hip surgical procedures to an alternative, and even preferable, primary treatment option for labral pathology and femoroacetabular impingement. As opposed to labral repair, labral reconstruction allows for complete removal of all damaged, pain-generating tissue; optimal correction of underlying bony impingement; and consistent creation of a graft that appropriately restores the fluid hip seal, improves pressurization and stabilization, and decreases contact pressure. Allograft tissue, in particular, allows for accurate and reliable graft length creation and does not rely on native tissue quality. Hips that undergo labral reconstruction have been shown to have positive outcomes at minimum 2-year follow-up, despite the fact that in many cases, these hips have more damage and a poorer preoperative prognosis. Patients report decreased pain, increased function, and greater quality of life after labral reconstruction, and this new evidence suggests that they can resume high-level physical activity as well. Circumferential labral reconstruction is no longer a salvage procedure and is an important tool for the hip arthroscopist; however, it requires high proficiency in hip arthroscopy to perform.


Assuntos
Cartilagem Articular , Impacto Femoroacetabular , Aloenxertos , Artroscopia , Atletas , Cartilagem Articular/cirurgia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril , Humanos , Qualidade de Vida , Volta ao Esporte , Resultado do Tratamento
14.
Arthroscopy ; 36(10): 2708-2709, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33039042

RESUMO

It was thought that the meniscus together with articular cartilage would be among the first tissues to successfully engineer. However, despite extensive research in the field, this path was proven not to be easy. Tissue engineering of musculoskeletal tissues remains promising, and several advancements have further identified the role of biological treatments in meniscus repair and regeneration. To move forward, and advance from being promising to being forthcoming, an important step would be to improve the quality of presented studies. This editorial commentary proposes a checklist of necessary reported data for tissue engineering studies: macroscopic and histologic appearance, tissue composition, mechanical properties, and translational data.


Assuntos
Cartilagem Articular , Menisco , Animais , Cartilagem Articular/cirurgia , Humanos , Menisco/cirurgia , Coelhos , Regeneração , Células-Tronco , Engenharia Tecidual
15.
Acta Chir Orthop Traumatol Cech ; 87(4): 251-258, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32940220

RESUMO

PURPOSE OF THE STUDY This study is a component part of the project focused on cartilage imaging after the treatment of a defect. It aims to compare the evaluation of postoperative status performed by two radiologists with the use of 2D MOCART scoring system and to determine whether this method is a reliable tool for the evaluation of postoperative changes. MATERIAL AND METHODS The study evaluated 78 MRI examinations from 25 patients (one patient had two defects treated), each of whom underwent 3 MRI examinations at 6, 12 and 18 months after surgery. The MRI examinations were performed on Philips Ingenia 3T scanner with 8-channel knee coil, in line with the routine protocol (coronal, sagittal and transversal PD SPAIR, coronal T1, sagittal PD HR, sagittal bFFE). The MRI examinations were evaluated independently by two radiologists using the 2D MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS The raters agreed in a total of 592 of 702 evaluations, therefore the inter-rater reliability is high, namely 84.3%. The highest inter-rater agreement was in assessing subchondral lamina and subchondral bone. Whereas the lowest inter-rater agreement was achieved in assessing effusion. The total score showed a very strong and statistically significant correlation (r = 0.893). In eight out of nine questions there was no statistically significant difference between the raters. A significant difference was seen only in the assessment of repair tissue structure. Excellent reliability of the total score was also confirmed by the intraclass correlation coefficient. DISCUSSION The high degree of agreement in assessing the signal intensity of repair tissue was considered very positive as it is generally viewed as the major pitfall in evaluations. On the contrary, subjective perception was confirmed in the evaluation of tissue homogeneity, especially when comparing homogeneity with the adjacent tissue in close vicinity that could have changed already. Surprisingly, the lowest inter-rater concordance was reported in the evaluation of effusion, where in some cases, its volume was underestimated, when traced back retrospectively. CONCLUSIONS The results of this study confirm that despite certain doubts regarding subjective perception of some of the evaluation criteria the 2D MOCART scoring system is a very good and objective tool to evaluate the effects of surgery. Key words: magnetic resonance imaging , hyaline cartilage, classification.


Assuntos
Cartilagem Articular , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Reprodutibilidade dos Testes , Estudos Retrospectivos
16.
Acta Chir Orthop Traumatol Cech ; 87(3): 167-174, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32773017

RESUMO

PURPOSE OF THE STUDY Damage to hyaline cartilage represents a serious problem due to its limited capacity of regeneration. Currently, there are several treatment options available. The purpose of this study is to evaluate the success rate of treatment of chondral and osteochondral defects of the knee joint using the modified AMIC (Autologous Matrix-Induced Chondrogenesis) technique, combining microfractures of the base and the implantation of the type I collagen-based cell-free implant over a two-year period. MATERIAL AND METHODS The prospective study of the success rate of treatment by the modified AMIC technique included 15 patients (13 men and 2 women) with a defect confirmed by MRI and appropriate indication criteria. The mean age at the time of implantation was 33.4 years (range 19-47 years). The mean size of a treated defect was 3.66 ± 1.71 cm2 (range 2.00-7.05 cm2). The clinical outcomes were monitored through the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and the Tegner activity scale preoperatively and subsequently at 6, 12 and 24 months postoperatively. Control MRI was conducted at 6, 12 and 18 months postoperatively. The MRI finding was evaluated using the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. RESULTS The total KOOS score was 44.69 ± 7.71 preoperatively, while postoperatively it gradually increased up to 80.45 ± 8.97 (p < 0.001) at 24 months. The Lysholm score significantly rise from 43.47 ± 11.87 preoperatively to the mean value of 81.60 ± 13.07 (p < 0.001) at 24 months postoperatively. The preoperative Tegner score was 3.53 ± 1.41. At 24 months, there was a statistically significant increase to 5.40 ± 1.70 (p = 0.003). The mean MOCART score at 18 months postoperatively was 74.67 ± 14.08. At the end of the monitored period, a complete filling of the defect site by tissue was achieved in 73.33% patients. A complete integration with adjacent cartilage was seen in 66.67% patients and homogenous structure of newly formed tissue was reported in 80% of patients. DISCUSSION In recent years, cell-free implants (the so-called scaffolds or carriers) have been used ever more frequently in treating localised cartilage defects. Their main effect should consist in helping the cells penetrate the defect site and support new cartilage tissue formation. In order to improve the efficacy of cell-free implants, a new therapeutic technique was developed, combining the microfractures of the base with the use of cell-free scaffold AMIC (Autologous Matrix-Induced Chondrogenesis). Our modification of the original AMIC technique consists in the use of a type I collagen-based scaffold instead of the original collagen membrane constituted by collagen type I and III. Based on the statistical processing of results, the modified AMIC technique has shown a statistically significant improvement compared to the preoperative values of the KOOS questionnaire and all its sub-groups, the Lysholm core and the Tegner activity scale. These good clinical outcomes correlate with the results obtained by other authors using both the original method and the modified AMIC technique. CONCLUSIONS The modified AMIC technique using the cell-free type I collagen-based implant appears to be a safe, accessible and onestage technique to treat localised chondral and osteochondral defects of the knee joint up to the size of 8 cm2. Key words: hyaline cartilage, chondral defect, AMIC, scaffold, knee.


Assuntos
Cartilagem Articular , Adulto , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Condrogênese , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
17.
Am J Sports Med ; 48(10): 2481-2488, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32736506

RESUMO

BACKGROUND: The molecular mechanism of how femoroacetabular impingement (FAI) morphology leads to hip osteoarthritis (OA) is yet to be determined. The expression and location of inflammation-related molecules during early- and late-stage FAI have not been previously described. Moreover, the characterization of intra-articular inflammation away from the cam deformity as well as the nature of adjacent synovial tissue have also not been extensively reported. HYPOTHESIS: Early-stage FAI has a similar expression of inflammation-related markers in the head-neck and acetabular cartilage but less synovitis than late-stage FAI. STUDY DESIGN: Controlled laboratory study. METHODS: Head-neck cartilage, acetabular cartilage, and synovial samples were obtained from patients undergoing hip preservation surgery for the treatment of symptomatic cam FAI (early FAI group; n = 15) and advanced OA secondary to cam FAI (late FAI group; n = 15). Samples procured from healthy young adult donors served as the control group (n = 7). Cartilage degeneration was assessed by histology, and the expression of inflammation-related proteins (interleukin-1 beta [IL-1ß], matrix metalloproteinase-13 [MMP-13], a disintegrin and metalloproteinase with thrombospondin motifs-4 [ADAMTS-4], type II collagen [COL2], and aggrecan neoepitope [NITEGE]) was measured by immunostaining. Synovial samples in the early and late FAI groups were examined for synovitis and the expression of IL-1ß. RESULTS: Head-neck cartilage in the early FAI group showed significantly more degeneration than the control group and an increased expression of inflammation-related proteins (IL-1ß: 69.7% ± 18.1% vs 20.2% ± 4.9%, respectively; MMP-13: 79.6% ± 12.6% vs 25.3% ± 9.5%; ADAMTS-4: 83.9% ± 12.2% vs 24.3% ± 11.1%; NITEGE: 89.7% ± 7.7% vs 39.8% ± 20.5%) (P < .001). Head-neck and acetabular cartilage in the early and late FAI groups showed a similar degree of degeneration. Moreover, a similar expression of inflammation-related proteins was observed between the early and late FAI groups for head-neck cartilage (IL-1ß: 69.7% ± 18.1% vs 72.5% ± 13.2%; MMP-13: 79.6% ± 12.6% vs 71.4% ± 18.8%; ADAMTS-4: 83.9% ± 12.2% vs 82.6% ± 12.5%; COL2: 93.6% ± 3.9% vs 92.5% ± 5.8%; NITEGE: 89.7% ± 7.7% vs 95.7% ± 4.7%) and acetabular cartilage (IL-1ß: 83.3% ± 24.8% vs 80.7% ± 15.6%; MMP-13: 94.3% ± 9.7% vs 85.2% ± 12.3%; ADAMTS-4: 98.5% ± 2.3% vs 98.4% ± 3.4%; COL2: 99.8% ± 0.7% vs 99.7% ± 1.1%; NITEGE: 96.7% ± 6.7% vs 99.2% ± 2.2%). In contrast, synovitis was minimal with a low expression of IL-1ß in the early FAI group compared with the late FAI group. CONCLUSION: Hip cartilage exhibited an OA phenotype in patients with early-stage FAI, similar to what was observed in hip OA secondary to FAI. Severe synovitis was only evident with late-stage FAI. CLINICAL RELEVANCE: This study supports the concept that early hip impingement is associated with cartilage degeneration and catabolism.


Assuntos
Cartilagem Articular/patologia , Impacto Femoroacetabular/patologia , Inflamação/patologia , Osteoartrite do Quadril , Membrana Sinovial/patologia , Cartilagem Articular/cirurgia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/patologia , Articulação do Quadril/cirurgia , Humanos , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Adulto Jovem
18.
Am J Sports Med ; 48(9): 2242-2251, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32667267

RESUMO

BACKGROUND: There is growing evidence suggesting a link between patellofemoral joint (PFJ) osteoarthritis in anterior cruciate ligament (ACL)-reconstructed knees and altered joint alignment. PURPOSE: To determine whether patellar alignment differs between participants with and without ACL reconstruction (ACLR) and to identify possible associations between patellar alignment and PFJ osteoarthritis features over 3 years. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 37 participants with ACLR (sex, 23 male; mean ± SD age, 28.1 ± 7.4 years) and 20 healthy controls (13 male; 30.4 ± 4.8 years) participated. Patients underwent magnetic resonance imaging: (1) sagittal T2-weighted fat-saturated fast spin echo images to calculate patellar alignment, (2) sagittal 3-dimensional intermediate-weighted fast spin echo Cube sequence for clinical morphological grading (modified Whole-Organ Magnetic Resonance Imaging Score [WORMS]), and (3) sagittal combined T1ρ/T2 mapping sequence for performing voxel-based relaxometry. Patellar alignment of the ACLR knees were assessed at 6 months (baseline). One-way analysis of variance was used to compare patellar alignment among the ACLR (at 6 months), contralateral, and control knees. Within the ACLR group, a logistic regression model was used to identify if patellar alignment measures at baseline were risk factors for worsening of PFJ structural changes over 3 years. Statistical parametric mapping was used to evaluate the longitudinal associations between patellar alignment and cartilage relaxation times at 3 years. RESULTS: When compared with control knees, ACLR knees exhibited a laterally and anteriorly displaced patella (P = .045 and P = .041), less flexion (P = .031), and less lateral spin (P = .012). Furthermore, excessive lateral displacement was a significant predictor of worsening of WORMS (P = .050). Lateral displacement was positively correlated with increased T1ρ and T2 in the patellar and trochlear cartilage at 3 years. Patellar lateral spin revealed similar negative findings. CONCLUSION: Participants with ACLR exhibited a laterally and anteriorly displaced patella, less flexion, and less lateral spin when compared with healthy controls. Excessive patellar lateral displacement was the strongest predictor to the development of PFJ osteoarthritis features longitudinally.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Cartilagem Articular , Tendões dos Músculos Isquiotibiais/transplante , Osteoartrite/fisiopatologia , Patela/fisiopatologia , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Estudos de Coortes , Feminino , Humanos , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Adulto Jovem
19.
Am J Sports Med ; 48(9): 2230-2241, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32667270

RESUMO

BACKGROUND: Matrix-associated autologous chondrocyte implantation (MACI) is a further development of the original autologous chondrocyte implantation periosteal flap technique (ACI-P) for the treatment of articular cartilage defects. PURPOSE: We aimed to establish whether MACI or ACI-P provides superior long-term outcomes in terms of patient satisfaction, clinical assessment, and magnetic resonance imaging (MRI) evaluation. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: A total of 21 patients with cartilage defects at the femoral condyle were randomized to MACI (n = 11) or ACI-P (n = 10) between the years 2004 and 2006. Patients were assessed for subjective International Knee Documentation Committee (IKDC) score, Lysholm and Gillquist score, Tegner Activity Score, and 36-Item Short Form Health Survey (SF-36) preoperatively (T0), at 1 and 2 years postoperatively (T1, T2), and at the final follow-up 8 to 11 years after surgery (T3). Onset of osteoarthritis was determined using the Kellgren-Lawrence score and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and delayed gadolinium-enhanced MRI of cartilage was used to evaluate the cartilage. Adverse events were recorded to assess safety. RESULTS: There were 16 patients (MACI, n = 9; ACI-P, n = 7) who were reassessed on average 9.6 years after surgery (76% follow-up rate). The Lysholm and Gillquist score improved in both groups after surgery and remained elevated but reached statistical significance only in ACI-P at T1 and T2. IKDC scores increased significantly at all postoperative evaluation time points in ACI-P. In MACI, IKDC scores showed a significant increase at T1 and T3 when compared with T0. In the majority of the patients (10/16; MACI, 5/9; ACI-P, 5/7) a complete defect filling was present at the final follow-up as shown by the MOCART score, and 1 patient in the ACI-P group displayed hypertrophy of the repair tissue, which represents 6% of the whole study group and 14.3% of the ACI-P group. Besides higher SF-36 vitality scores in ACI-P at T3, no significant differences were seen in clinical scores and MRI scores between the 2 methods at any time point. Revision rate was 33.3% in MACI and 28.6% in ACI-P at the last follow-up. CONCLUSION: Our long-term results suggest that first- and third-generation ACI methods are equally effective treatments for isolated full-thickness cartilage defects of the knee. With the number of participants available, no significant difference was noted between MACI and ACI-P at any time point. Interpretation of our data has to be performed with caution due to the small sample size, which was further limited by a loss to follow-up of 24%.


Assuntos
Cartilagem Articular , Condrócitos/transplante , Articulação do Joelho/cirurgia , Periósteo/transplante , Cartilagem Articular/cirurgia , Seguimentos , Humanos , Imagem por Ressonância Magnética , Estudos Prospectivos , Transplante Autólogo
20.
Int J Sports Med ; 41(12): 873-878, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32688411

RESUMO

We analyzed the characteristics of 112 consecutive patients who were operatively treated for osteochondral lesions of the talus from August 2014 to April 2019 in our hospital. The patients were divided into three age groups: young-adult (<40 years), middle-age (40-60 years) and old-age (>60 years). The basic clinical features, localization and size of the lesions, Hepple stage, and surgical procedures were compared among groups. Several significant differences were found on the characteristics of osteochondral lesions of the talus among age groups. There were more female patients in the old-age group (p<0.01), and old patients had a longer duration of symptoms (p<0.05). The OLTs in middle- and old-age patients were mostly located in the medial part of the talus with larger depth (p<0.01). Hepple stage 5, the cystic type, was very common in the old-age group (p<0.01). With regard to surgical procedures, more osteochondral autograft transplantations were applied in the old-age group (p<0.01). Female and deep medial talar subchondral cyst is the typical characteristics of patients over 60 years old. Age is an important factor that must be considered when choosing surgery procedure for patients with osteochondral lesions of the talus.


Assuntos
Traumatismos do Tornozelo/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Tálus/lesões , Tálus/cirurgia , Adulto , Fatores Etários , Idoso , Traumatismos do Tornozelo/patologia , Artroscopia , Transplante Ósseo , Cartilagem/transplante , Cartilagem Articular/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tálus/patologia , Transplante Autólogo
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