Haris Vasiliadis - Academia.edu (original) (raw)

Papers by Haris Vasiliadis

The Cochrane library, Jan 31, 2014

Analysis 2.12. Comparison 2 One-or two-portal endoscopic versus open and mini-open carpal tunnel ... more Analysis 2.12. Comparison 2 One-or two-portal endoscopic versus open and mini-open carpal tunnel release, Outcome 12

The Cochrane library, Mar 28, 2014

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess... more This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of conventional open techniques for carpal tunnel release compared to any other surgical intervention for the treatment of carpal tunnel syndrome. More specifically, to evaluate the relative impact of the open techniques in relieving symptoms, producing functional recovery (return to work and return to daily activities) and reducing complication rates compared to other surgical treatments.

The Foot, Jun 1, 2013

We report a case of a closed subtalar dislocation without any related fractures treated with clos... more We report a case of a closed subtalar dislocation without any related fractures treated with closed reduction and conservative treatment with a cast immobilization. Pure subtalar dislocation without any fractures is extremely rare and hardly reported in the literature. Such injuries are more likely to be open and associated with fractures of the surrounding foot bones such as malleoli, talus or fifth metatarsal fractures. In the examined case, closed reduction was followed by cast immobilization for 3 weeks. Six months post-injury, the patient had a full range of motion without any pain while there were no signs of residual instability or early post-traumatic osteoarthritis. Subjective clinical testing using a valid health instrument revealed an excellent outcome. We discuss in details the mechanism of such an injury and highlight the importance of prompt closed reduction and early mobilization to ensure a satisfactory long term outcome.

European Spine Journal, Apr 6, 2016

Corrections of spinal deformities have been associated with a potential of postoperative vessel-o... more Corrections of spinal deformities have been associated with a potential of postoperative vessel-originating complications. Reports of occlusions of celiac artery seem though to be very rare. We present two cases that developed acute arterial supply impairment and subsequent liver and gastric necrosis due to an occlusion of celiac artery, after a spine deformity correction. In both patients a lateral surgical approach to the superior lumbar spine, lateral placement of cages and then a subsequent posterior fixation were performed. The literature search reveals the report of three similar cases, with potentially different pathogenetic mechanisms and with a different prognosis. This complication is assumed to occur due to a Medial Arcuate Ligament syndrome (MALS) developed postoperatively that leaded to compression of the celiac artery against the Medial Arcuate Ligament. The pathogenesis though remains unclear and two theories are assumed to explain the acute appearance of the syndrome; the alteration of the anatomic relationship between the vessels and the surrounding tissues due to the spine deformity correction and an intraoperative direct or indirect traction injury of the celiac trunk that caused or increased its pressure against the medial arcuate ligament. The spine surgeon should be aware of the possibility of postoperative ischemia of the liver and stomach by occlusion of the celiac artery or its supplying branches. Specifically when a large correction of a kyphotic/kyphoscoliotic spine is planed, the surgeon should be alert for an appearance of a MALS.

The American Journal of Sports Medicine, 2020

Background:An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that... more Background:An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI).Hypothesis:Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty.Study Design:Case series; Level of evidence, 4.Methods:All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires...

British journal of sports medicine, Jan 3, 2016

To compare the efficacy of different injection therapies for plantar fasciopathy (historically kn... more To compare the efficacy of different injection therapies for plantar fasciopathy (historically known as 'plantar fasciitis'). Systematic review and network meta-analysis. Electronic databases (MEDLINE, CENTRAL, Web of Science and Scopus) were searched up to 11 July 2015 for completed studies. We considered randomised trials comparing various injection therapies in adults with plantar fasciopathy. The primary outcome was pain relief. Secondary outcomes included functional disability, composite and health-related outcomes. All outcomes were assessed (1) in the short term (up to 2 months), (2) the intermediate term (2-6 months) and (3) the medium term (more than 6 months to 2 years). Quality assessment was performed using the Cochrane risk of bias tool. We included 22 trials comprising 1216 patients. Dehydrated amniotic membrane injections were significantly superior to corticosteroids in the short term in achieving the primary and composite outcomes (mean difference (MD) in vi...

PloS one, 2015

The Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the tr... more The Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the treatment of Carpal Tunnel Syndrome. There is scepticism regarding the safety of this technique, based on the assumption that this is a rather "blind" procedure and on the high number of severe complications that have been reported in the literature. To evaluate whether there is evidence supporting a higher risk after ECTR in comparison to the conventional open release. We searched MEDLINE (January 1966 to November 2013), EMBASE (January 1980 to November 2013), the Cochrane Neuromuscular Disease Group Specialized Register (November 2013) and CENTRAL (2013, issue 11 in The Cochrane Library). We hand-searched reference lists of included studies. We included all randomized or quasi-randomized controlled trials (e.g. study using alternation, date of birth, or case record number) that compare any ECTR with any OCTR technique. Safety was assessed by the incidence of major, minor and to...

Football Traumatology, 2015

The incidence of the injuries of knee articular cartilage is found to be increasing among athlete... more The incidence of the injuries of knee articular cartilage is found to be increasing among athletes, especially of contact sports like football. It has been shown that foul play is responsible for about 30 % of all injuries and that knee injuries are among the most common injuries and may be career ending.

The Foot, 2013

We report a case of a closed subtalar dislocation without any related fractures treated with clos... more We report a case of a closed subtalar dislocation without any related fractures treated with closed reduction and conservative treatment with a cast immobilization. Pure subtalar dislocation without any fractures is extremely rare and hardly reported in the literature. Such injuries are more likely to be open and associated with fractures of the surrounding foot bones such as malleoli, talus or fifth metatarsal fractures. In the examined case, closed reduction was followed by cast immobilization for 3 weeks. Six months post-injury, the patient had a full range of motion without any pain while there were no signs of residual instability or early post-traumatic osteoarthritis. Subjective clinical testing using a valid health instrument revealed an excellent outcome. We discuss in details the mechanism of such an injury and highlight the importance of prompt closed reduction and early mobilization to ensure a satisfactory long term outcome.

Since 1987, autologous chondrocyte implantation (ACI) has been performed in Gothenburg, Sweden in... more Since 1987, autologous chondrocyte implantation (ACI) has been performed in Gothenburg, Sweden in more than 1600 patients. Out of the first 442 patients operated with ACI, 153 (35%) had patella lesions and 91 (21%) had trochlea lesions. Forty two patients (9.5%) had kissing lesions of the patellofemoral joint. The aim of the study was to evaluate the current clinical status of operated patients. Lysholm and Tegner-Wallgren self-assessment questionnaires were used. The patients were requested to compare their current status to previous states and to report whether they would do the operation again. Concomitant realignment procedures of the patellofemoral joint were also recorded and preoperative scores were also assessed from the medical files. Patients were divided into groups according to the location of lesion. All the groups showed a significant improvement compared with the preoperative assessment. Over 90% of the treated patients were satisfied with the ACI and would have undergone the procedure again. It seems that correcting the coexisting background factors with realignment, stabilizing or unloading procedures is improving the results over time. Despite the initial controversy about the results and indication for ACI in patellofemoral lesions, it is clear that ACI provides a satisfactory result even for the difficult cases with concomitant patellar instability. Our study reveals preservation of the good results and of high level of patients’ activities, even 10 to 20 years after the implantation.

The Patellofemoral Joint, 2014

The patellofemoral pain syndrome (anterior knee pain) is very common in the general population. I... more The patellofemoral pain syndrome (anterior knee pain) is very common in the general population. It is often seen in young people who are very physically active in competitive and recreational sports and more often in teenage girls and young women. However, it is also very frequent in young people sustaining sedentary work (white collars or students). Patellar malalignment and instability with or without articular cartilage lesions in the patellofemoral joint are usually the source of pain. Articular cartilage injuries are very common in this patient group. Hielle et al. found that 17 % of patients having an arthroscopy had an articular cartilage injury located in the patella or trochlea [1]. Nomura et al. also found 35 patients with severe articular cartilage injuries of the patella in 37 patients with a first-time acute patellar dislocation [2].

Patellofemoral Pain, Instability, and Arthritis, 2010

ABSTRACT The total functional stability is dependent on optimal synergic collaboration of the ske... more ABSTRACT The total functional stability is dependent on optimal synergic collaboration of the skeletal, ligamentous and muscular stabilizers, all working together. The skeletal geometry by its own creates a passive stability during knee motion. The geometry of the trochlear groove is of high importance during 0°-30° of flexion (30°-0° of extension) where most of the dislocations occur. The skeletal stability can be affected by patellofemoral dysplasia, where the geometric configuration of the trochlea is primarily not developed. The patella shape usually plays a secondary role even if it is found dysplastic

Revista Colombiana de Anestesiología, 2011

Cochrane Database of Systematic Reviews, 2014

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess... more This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of conventional open techniques for carpal tunnel release compared to any other surgical intervention for the treatment of carpal tunnel syndrome. More specifically, to evaluate the relative impact of the open techniques in relieving symptoms, producing functional recovery (return to work and return to daily activities) and reducing complication rates compared to other surgical treatments.

The Patellofemoral Joint, 2014

Skeletal, ligamentous (passive), and muscular (active) stabilizers of the patella and the knee jo... more Skeletal, ligamentous (passive), and muscular (active) stabilizers of the patella and the knee joint all work together for the stability of the patellofemoral joint (see Fig. 22.1).

Osteoarthritis and Cartilage, 2010

ABSTRACT OBJECTIVE: The purpose of this study is to evaluate the overall improvement of autologou... more ABSTRACT OBJECTIVE: The purpose of this study is to evaluate the overall improvement of autologous chondrocyte implantation (ACI) treated patients at medium and long-term follow-up in terms of clinical assessment and patient's satisfaction. We also aimed to identify possible factors associated with improvement in clinical outcomes and with better or worse functionality and patients' satisfaction. DESIGN: We evaluated 224 patients treated with ACI with periosteum. Lysholm, Tegner-Wallgren and Brittberg scores were assessed pre-operatively, at 3.1 years on average (range 1-8.3) and at 12.8 on average (range 10-20 years) after the surgery. The patients were also asked to grade their satisfaction regarding the current knee function compared with intermediate results and to report whether they would do the operation again. RESULTS: ACI is associated with substantial improvement in all the clinical outcomes, even 10-20 years after the implantation, although a small deterioration was noticed between intermediate and final evaluations. Seventy-three percent of the patients report to be improved or the same compared to previous follow-up, while 93% would do the operation again. CONCLUSIONS: ACI improves the clinical status of operated patients, retaining the benefit over time. Concomitant injuries like meniscal lesions or anterior cruciate ligament deficiencies, if treated, do not seem to alter the effectiveness of the ACI.

Knee Surgery, Sports Traumatology, Arthroscopy, 2010

The aim of our current study is to present the 12.6 years&amp... more The aim of our current study is to present the 12.6 years' follow-up results in patients with cartilage lesions of the patellofemoral joint, treated with autologous chondrocyte implantation (ACI) with the use of periosteum. Ninety-two patients having patella or trochlea lesion participated in this study. Lysholm and Tegner questionnaires were completed 12.6 years (SD 2.3 years) after the surgery. The patients were asked whether they feel better, worse or had not experienced any difference compared to previous years and whether they would undergo the operation again. Complications or subsequent surgeries were also assessed. Median Tegner score was three, improved by one level compared with preoperative values (P = 0.02). Median Lysholm score was 70, improved by nine points (n.s.). Seventy-two percent of the patients were better or unchanged while 93% would undergo the operation again. Patients with no kissing lesions appeared to have a better prognosis. Patients with malalignment or instability that had undergone a realignment procedure had comparable outcomes to the patients that did not need any additional surgery. Realignment procedures increased the incidence of serious complications but they were associated with decreased incidence of periosteal hypertrophy. No association was found between the age of the patients at the time of the ACI or the size per lesion and any of the clinical outcomes. ACI provides a satisfactory outcome for the treatment of cartilage lesions of the patellofemoral joint, even for the cases with concomitant patellar instability. It seems that correcting the coexisting background factors with realignment, stabilizing or unloading procedures, along with the treatment of cartilage lesions, is improving the clinical outcomes over time and decreases the incidence of periosteal hypertrophies although increasing the incidence of serious complications. Our study reveals the good results and the high level of patients' activities (as shown by Tegner score), were preserved 12.6 years after the implantation, in both isolated trochlea and patella lesions and also in multiple and in kissing lesions where an intervention could be considered as a salvage procedure.

Knee Surgery, Sports Traumatology, Arthroscopy, 2011

The Cochrane library, Jan 31, 2014

Analysis 2.12. Comparison 2 One-or two-portal endoscopic versus open and mini-open carpal tunnel ... more Analysis 2.12. Comparison 2 One-or two-portal endoscopic versus open and mini-open carpal tunnel release, Outcome 12

The Cochrane library, Mar 28, 2014

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess... more This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of conventional open techniques for carpal tunnel release compared to any other surgical intervention for the treatment of carpal tunnel syndrome. More specifically, to evaluate the relative impact of the open techniques in relieving symptoms, producing functional recovery (return to work and return to daily activities) and reducing complication rates compared to other surgical treatments.

The Foot, Jun 1, 2013

We report a case of a closed subtalar dislocation without any related fractures treated with clos... more We report a case of a closed subtalar dislocation without any related fractures treated with closed reduction and conservative treatment with a cast immobilization. Pure subtalar dislocation without any fractures is extremely rare and hardly reported in the literature. Such injuries are more likely to be open and associated with fractures of the surrounding foot bones such as malleoli, talus or fifth metatarsal fractures. In the examined case, closed reduction was followed by cast immobilization for 3 weeks. Six months post-injury, the patient had a full range of motion without any pain while there were no signs of residual instability or early post-traumatic osteoarthritis. Subjective clinical testing using a valid health instrument revealed an excellent outcome. We discuss in details the mechanism of such an injury and highlight the importance of prompt closed reduction and early mobilization to ensure a satisfactory long term outcome.

European Spine Journal, Apr 6, 2016

Corrections of spinal deformities have been associated with a potential of postoperative vessel-o... more Corrections of spinal deformities have been associated with a potential of postoperative vessel-originating complications. Reports of occlusions of celiac artery seem though to be very rare. We present two cases that developed acute arterial supply impairment and subsequent liver and gastric necrosis due to an occlusion of celiac artery, after a spine deformity correction. In both patients a lateral surgical approach to the superior lumbar spine, lateral placement of cages and then a subsequent posterior fixation were performed. The literature search reveals the report of three similar cases, with potentially different pathogenetic mechanisms and with a different prognosis. This complication is assumed to occur due to a Medial Arcuate Ligament syndrome (MALS) developed postoperatively that leaded to compression of the celiac artery against the Medial Arcuate Ligament. The pathogenesis though remains unclear and two theories are assumed to explain the acute appearance of the syndrome; the alteration of the anatomic relationship between the vessels and the surrounding tissues due to the spine deformity correction and an intraoperative direct or indirect traction injury of the celiac trunk that caused or increased its pressure against the medial arcuate ligament. The spine surgeon should be aware of the possibility of postoperative ischemia of the liver and stomach by occlusion of the celiac artery or its supplying branches. Specifically when a large correction of a kyphotic/kyphoscoliotic spine is planed, the surgeon should be alert for an appearance of a MALS.

The American Journal of Sports Medicine, 2020

Background:An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that... more Background:An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI).Hypothesis:Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty.Study Design:Case series; Level of evidence, 4.Methods:All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires...

British journal of sports medicine, Jan 3, 2016

To compare the efficacy of different injection therapies for plantar fasciopathy (historically kn... more To compare the efficacy of different injection therapies for plantar fasciopathy (historically known as 'plantar fasciitis'). Systematic review and network meta-analysis. Electronic databases (MEDLINE, CENTRAL, Web of Science and Scopus) were searched up to 11 July 2015 for completed studies. We considered randomised trials comparing various injection therapies in adults with plantar fasciopathy. The primary outcome was pain relief. Secondary outcomes included functional disability, composite and health-related outcomes. All outcomes were assessed (1) in the short term (up to 2 months), (2) the intermediate term (2-6 months) and (3) the medium term (more than 6 months to 2 years). Quality assessment was performed using the Cochrane risk of bias tool. We included 22 trials comprising 1216 patients. Dehydrated amniotic membrane injections were significantly superior to corticosteroids in the short term in achieving the primary and composite outcomes (mean difference (MD) in vi...

PloS one, 2015

The Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the tr... more The Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the treatment of Carpal Tunnel Syndrome. There is scepticism regarding the safety of this technique, based on the assumption that this is a rather "blind" procedure and on the high number of severe complications that have been reported in the literature. To evaluate whether there is evidence supporting a higher risk after ECTR in comparison to the conventional open release. We searched MEDLINE (January 1966 to November 2013), EMBASE (January 1980 to November 2013), the Cochrane Neuromuscular Disease Group Specialized Register (November 2013) and CENTRAL (2013, issue 11 in The Cochrane Library). We hand-searched reference lists of included studies. We included all randomized or quasi-randomized controlled trials (e.g. study using alternation, date of birth, or case record number) that compare any ECTR with any OCTR technique. Safety was assessed by the incidence of major, minor and to...

Football Traumatology, 2015

The incidence of the injuries of knee articular cartilage is found to be increasing among athlete... more The incidence of the injuries of knee articular cartilage is found to be increasing among athletes, especially of contact sports like football. It has been shown that foul play is responsible for about 30 % of all injuries and that knee injuries are among the most common injuries and may be career ending.

The Foot, 2013

We report a case of a closed subtalar dislocation without any related fractures treated with clos... more We report a case of a closed subtalar dislocation without any related fractures treated with closed reduction and conservative treatment with a cast immobilization. Pure subtalar dislocation without any fractures is extremely rare and hardly reported in the literature. Such injuries are more likely to be open and associated with fractures of the surrounding foot bones such as malleoli, talus or fifth metatarsal fractures. In the examined case, closed reduction was followed by cast immobilization for 3 weeks. Six months post-injury, the patient had a full range of motion without any pain while there were no signs of residual instability or early post-traumatic osteoarthritis. Subjective clinical testing using a valid health instrument revealed an excellent outcome. We discuss in details the mechanism of such an injury and highlight the importance of prompt closed reduction and early mobilization to ensure a satisfactory long term outcome.

Since 1987, autologous chondrocyte implantation (ACI) has been performed in Gothenburg, Sweden in... more Since 1987, autologous chondrocyte implantation (ACI) has been performed in Gothenburg, Sweden in more than 1600 patients. Out of the first 442 patients operated with ACI, 153 (35%) had patella lesions and 91 (21%) had trochlea lesions. Forty two patients (9.5%) had kissing lesions of the patellofemoral joint. The aim of the study was to evaluate the current clinical status of operated patients. Lysholm and Tegner-Wallgren self-assessment questionnaires were used. The patients were requested to compare their current status to previous states and to report whether they would do the operation again. Concomitant realignment procedures of the patellofemoral joint were also recorded and preoperative scores were also assessed from the medical files. Patients were divided into groups according to the location of lesion. All the groups showed a significant improvement compared with the preoperative assessment. Over 90% of the treated patients were satisfied with the ACI and would have undergone the procedure again. It seems that correcting the coexisting background factors with realignment, stabilizing or unloading procedures is improving the results over time. Despite the initial controversy about the results and indication for ACI in patellofemoral lesions, it is clear that ACI provides a satisfactory result even for the difficult cases with concomitant patellar instability. Our study reveals preservation of the good results and of high level of patients’ activities, even 10 to 20 years after the implantation.

The Patellofemoral Joint, 2014

The patellofemoral pain syndrome (anterior knee pain) is very common in the general population. I... more The patellofemoral pain syndrome (anterior knee pain) is very common in the general population. It is often seen in young people who are very physically active in competitive and recreational sports and more often in teenage girls and young women. However, it is also very frequent in young people sustaining sedentary work (white collars or students). Patellar malalignment and instability with or without articular cartilage lesions in the patellofemoral joint are usually the source of pain. Articular cartilage injuries are very common in this patient group. Hielle et al. found that 17 % of patients having an arthroscopy had an articular cartilage injury located in the patella or trochlea [1]. Nomura et al. also found 35 patients with severe articular cartilage injuries of the patella in 37 patients with a first-time acute patellar dislocation [2].

Patellofemoral Pain, Instability, and Arthritis, 2010

ABSTRACT The total functional stability is dependent on optimal synergic collaboration of the ske... more ABSTRACT The total functional stability is dependent on optimal synergic collaboration of the skeletal, ligamentous and muscular stabilizers, all working together. The skeletal geometry by its own creates a passive stability during knee motion. The geometry of the trochlear groove is of high importance during 0°-30° of flexion (30°-0° of extension) where most of the dislocations occur. The skeletal stability can be affected by patellofemoral dysplasia, where the geometric configuration of the trochlea is primarily not developed. The patella shape usually plays a secondary role even if it is found dysplastic

Revista Colombiana de Anestesiología, 2011

Cochrane Database of Systematic Reviews, 2014

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess... more This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of conventional open techniques for carpal tunnel release compared to any other surgical intervention for the treatment of carpal tunnel syndrome. More specifically, to evaluate the relative impact of the open techniques in relieving symptoms, producing functional recovery (return to work and return to daily activities) and reducing complication rates compared to other surgical treatments.

The Patellofemoral Joint, 2014

Skeletal, ligamentous (passive), and muscular (active) stabilizers of the patella and the knee jo... more Skeletal, ligamentous (passive), and muscular (active) stabilizers of the patella and the knee joint all work together for the stability of the patellofemoral joint (see Fig. 22.1).

Osteoarthritis and Cartilage, 2010

ABSTRACT OBJECTIVE: The purpose of this study is to evaluate the overall improvement of autologou... more ABSTRACT OBJECTIVE: The purpose of this study is to evaluate the overall improvement of autologous chondrocyte implantation (ACI) treated patients at medium and long-term follow-up in terms of clinical assessment and patient's satisfaction. We also aimed to identify possible factors associated with improvement in clinical outcomes and with better or worse functionality and patients' satisfaction. DESIGN: We evaluated 224 patients treated with ACI with periosteum. Lysholm, Tegner-Wallgren and Brittberg scores were assessed pre-operatively, at 3.1 years on average (range 1-8.3) and at 12.8 on average (range 10-20 years) after the surgery. The patients were also asked to grade their satisfaction regarding the current knee function compared with intermediate results and to report whether they would do the operation again. RESULTS: ACI is associated with substantial improvement in all the clinical outcomes, even 10-20 years after the implantation, although a small deterioration was noticed between intermediate and final evaluations. Seventy-three percent of the patients report to be improved or the same compared to previous follow-up, while 93% would do the operation again. CONCLUSIONS: ACI improves the clinical status of operated patients, retaining the benefit over time. Concomitant injuries like meniscal lesions or anterior cruciate ligament deficiencies, if treated, do not seem to alter the effectiveness of the ACI.

Knee Surgery, Sports Traumatology, Arthroscopy, 2010

The aim of our current study is to present the 12.6 years&amp... more The aim of our current study is to present the 12.6 years' follow-up results in patients with cartilage lesions of the patellofemoral joint, treated with autologous chondrocyte implantation (ACI) with the use of periosteum. Ninety-two patients having patella or trochlea lesion participated in this study. Lysholm and Tegner questionnaires were completed 12.6 years (SD 2.3 years) after the surgery. The patients were asked whether they feel better, worse or had not experienced any difference compared to previous years and whether they would undergo the operation again. Complications or subsequent surgeries were also assessed. Median Tegner score was three, improved by one level compared with preoperative values (P = 0.02). Median Lysholm score was 70, improved by nine points (n.s.). Seventy-two percent of the patients were better or unchanged while 93% would undergo the operation again. Patients with no kissing lesions appeared to have a better prognosis. Patients with malalignment or instability that had undergone a realignment procedure had comparable outcomes to the patients that did not need any additional surgery. Realignment procedures increased the incidence of serious complications but they were associated with decreased incidence of periosteal hypertrophy. No association was found between the age of the patients at the time of the ACI or the size per lesion and any of the clinical outcomes. ACI provides a satisfactory outcome for the treatment of cartilage lesions of the patellofemoral joint, even for the cases with concomitant patellar instability. It seems that correcting the coexisting background factors with realignment, stabilizing or unloading procedures, along with the treatment of cartilage lesions, is improving the clinical outcomes over time and decreases the incidence of periosteal hypertrophies although increasing the incidence of serious complications. Our study reveals the good results and the high level of patients' activities (as shown by Tegner score), were preserved 12.6 years after the implantation, in both isolated trochlea and patella lesions and also in multiple and in kissing lesions where an intervention could be considered as a salvage procedure.

Knee Surgery, Sports Traumatology, Arthroscopy, 2011