RESUMO
PURPOSE: To prospectively assess clinical outcomes and regeneration of osteoarthritic cartilage lesions treated with an articular cartilage paste grafting technique. TYPE OF STUDY: Prospective, longitudinal case series. METHODS: We treated 125 patients (136 procedures; 34% female, 66% male; mean age, 46 years; range, 17 to 73 years) with an Outerbridge classification of grade IV lesions with an articular cartilage paste graft. Clinical data were recorded 2 to 12 years from surgery, with 20 of 145 patients lost to follow-up over 12 years (13.7%). Clinical outcomes were captured annually with validated Western Ontario and McMaster Universities Arthritis Index (WOMAC), International Knee Documentation Committee (IKDC), and Tegner subjective questionnaires. Regenerated cartilage biopsy specimens were obtained at second-look arthroscopy from 66 patients and evaluated as to quality and quantity of defect fill by a blinded, independent histopathology reviewer. RESULTS: Preoperative versus postoperative validated pain, functioning, and activity measures improved significantly (P< .001). Clinically, 18 of the 125 patients were considered failures (14.4%), with 10 patients undergoing subsequent joint arthroplasty and 8 who reported worse pain after surgery. Regional histologic variation occurred. Forty-two of 66 biopsy specimens (63.6%) showed strong and consistent evidence of replacement of their articular surface, and 18 of 66 biopsy specimens (27.3%) showed development of areas of cartilage. CONCLUSIONS: Paste grafting is a low-cost, 1-stage arthroscopic treatment for patients with Outerbridge classification grade IV arthritic chondral lesions. The procedure offers excellent, long-lasting, pain relief, restored functioning, and possibility of tissue regeneration for patients with painful chondral lesions in both arthritic and traumatically injured knees. LEVEL OF EVIDENCE: Level IV, case series.
Assuntos
Artroscopia/métodos , Cartilagem Articular/cirurgia , Osteoartrite do Joelho/cirurgia , Extratos de Tecidos/uso terapêutico , Adolescente , Adulto , Idoso , Medula Óssea , Cartilagem Articular/lesões , Cartilagem Articular/patologia , Condrócitos/transplante , Desbridamento , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/reabilitação , Dor/etiologia , Manejo da Dor , Recuperação de Função Fisiológica , Regeneração , Reoperação , Método Simples-Cego , Irrigação Terapêutica , Tíbia/cirurgia , Extratos de Tecidos/administração & dosagem , Transplante Autólogo , Resultado do Tratamento , CicatrizaçãoRESUMO
This review article provides an update on multimodality imaging characteristics of Ewing sarcoma family tumors. Pathology of this tumor and current trends in medical and surgical treatment are briefly discussed.
Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/terapia , Radiologia/métodos , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/terapia , Neoplasias Ósseas/patologia , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Estadiamento de Neoplasias/métodos , Tomografia por Emissão de Pósitrons/métodos , Sarcoma de Ewing/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
We present an unusual case of two synchronous chondroid matrix lesions in the proximal femur of a 16-year-old male. They were incidental findings, which subsequently underwent surgical excision and confirmed the imaging findings of a "kissing" osteochondroma and a periosteal/juxtacortical chondroma. We could not find another report of these findings in the English literature.