A 2-Staged Method for Treatment of Deep Osteochondral Lesions of the Knee Joint (original) (raw)
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Treatment of osteochondral defects of the knee
2009
Arthroscopy is a surgical technique to treat intra-articular lesions that uses minimal incisions and allows that patients have a prompt recovery with few complications, since the intervention is not very aggressive and uses a sophisticated system of micro-optics and micro instrumentation. Hence, arthroscopy became an elective technique for treating intra-articular lesions and is a very important procedure in orthopedics. There have been several advances in arthroscopy, in the design and improvement of equipment, and in the development of techniques, evolving from joint visualization to merely diagnostic purposes to surgical procedures. The present article approaches arthroscopy explaining the different therapeutic possibilities, using this technique to treat osteochondral diseases of the knee.
Technique for Treatment of Osteochondral Defects of the Knee
2015
Background: Articular cartilage lesions have limited capacity for repair. The avascular nature of articular cartilage and the limited stem cell population limit the healing response. In addition, the constant load of articular cartilage, particularly in the knee, creates a challenging mechanical environment for an appropriate healing response. Aim of the work: The work aims evaluate the results of osteochondral autograft in treatment of chondral and osteochondral defects Material and Methods: This prospective study was conducted on twenty patients in Zagazig University in Sharqia between 2011 and 2014. Osteochondral grafts were done for all of the patients either by open technique (13 patients), or by arthroscopic technique (7cases) all of them were proved to have chondral or osteochondral defects of one of the femoral condyles. Results: The study results use Chondral defect scoring system as being simple. The results for subjective score have shown significant improvement of the pa...
[Treatment of focal articular cartilage lesions of the knee with autogenous osteochondral grafts]
PubMed, 2005
Purpose of the study: A chondral/osteochondral defect involving the articular surface of a joint is still a therapeutic problem. Many surgical techniques have been studied in an attempt to restore the damaged articular cartilage. Autogenous osteochondral graft has gained in clinical popularity because of its technical feasibility and cost effectiveness, however, only a few series have been reported in the literature. Material: A retrospective study included 14 patients with 14 knees with focal full thickness articular cartilage defects hospitalised in our department between January 1997 and June 2000. The diagnoses included six knees with osteonecrosis, five knees with osteochondritis dissecans and three knees with traumatic cartilage defect. Methods: All these patients underwent an osteochondral autografts of the knee with 2 years follow-up. The evaluations were based on functional assessments, which included pain, giving way, locking, recurrent effusion, knee scores, functional scores and Lysholm scores. The postoperative values of functional assessments among the three categories of diagnosis were compared statistically using Kruskal-Wallis test. Radiographs of the knees were examined for joint congruence, joint space narrowing and degenerative changes. Results: The study showed good or excellent clinical results in over than 85%. The duration of pain of the knees relief ranged from six to 16 weeks after surgery. Discussion: There was no correlation of the clinical results with the underlying diagnosis, including osteonecrosis, osteochondritis dissecans and traumatic cartilage defect. Improvement in symptoms appeared time-dependent, ranging from 6 to 16 weeks, suggesting that postoperative protection of the graft is warranted. There was no radiographic progression of degenerative changes of the knee on the medium-term follow-up. Conclusion: There was no correlation of the clinical results with the underlying diagnoses. It appears that an osteochondral graft has the potential to prevent or delay the development of degenerative changes of the knee in the medium-term follow-up. Autogenous osteochondral graft is considered as a good method in the treatment of knees with moderately sized articular cartilage defects.
Archives of Orthopaedic and Trauma Surgery, 2005
Introduction: The osteochondral transplantation (OCT) is a well accepted treatment option for focal cartilage lesions in the knee joint, whereas the fate of the transplanted cartilage is still unclear and the clinical outcome is variable. The purpose of this study was to evaluate the histological character of autologous transplanted cartilage and to correlate technical aspects and the patients’ history with the clinical outcome. Material and Methods: The OCT was performed in 27 patients (median age of 32 (22–43) years) with a focal chondral lesion at the medial femoral condyle. We investigated the clinical outcome after a median follow-up of 13.5 (5–28) months using the Lysholm-score and the integration of the transplanted plugs using an MRI-scoring system. Biopsy specimens from representative patients (n=8) were evaluated with histological staining and immunohistochemistry. Results: The median Lysholm-score was 80 (range 45–98). The wide range of the Lysholm-score in clinical outcome did not show significant differences in: follow-up, concomitant injuries, defect size or genesis. The MRI analysis revealed in all cases a regular osseous integration of the subchondral bone, but a failed chondral integration. The congruency of the plugs to the joint surface was often incorrect, however a correlation between the MRI-score and the clinical outcome could not be shown. Histology of the transplanted cartilage revealed small changes in immunohistochemistry after a relatively short-term follow-up, whereas the cartilage has still the typical hyaline character. Often, the surrounding cartilage consists of fibrous and granulation tissue. Conclusion: The congruency of the joint surface can not be restored to the original status, particularly in larger defects with irregular shapes. However, we did not find any aspects which affected the function of the knee joint following OCT. It can be assumed that remaining lesions at the surrounding cartilage could maintain the inflammatory process and therefore maintain the pain and a low knee function. Further investigations are needed to specify the effects of the OCT on the transplanted cartilage and its influence on the later clinical outcome.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
A number of surgical techniques have been described for the operative fixation of an unstable osteochondritis dissecans (OCD) lesion in the knee that has failed appropriate nonoperative management. However, no one technique has been universally successful. We report the results of a new fixation technique for unstable OCD lesions using arthroscopic autogenous osteochondral grafting (mosaicplasty). Methods: Twenty patients with OCD lesions (16 International Cartilage Repair Society [ICRS] OCD type II, 3 ICRS OCD type III, and 1 ICRS OCD type IV) who had failed an appropriate course of nonoperative management underwent autogenous osteochondral grafting. The OCD lesions were assessed arthroscopically and then fixed in situ by using multiple 4.5-mm osteochondral dowel grafts harvested from the edges of the femoral trochlea. The lesion was initially fixed with an osteochondral graft passing through the center of the fragment and then stabilized by using further grafts inserted around its periphery. Results: Preoperative International Knee Documentation Committee scores assessed 5 patients as nearly normal, 8 as abnormal, and 7 as severely abnormal. At the 18-month follow-up, all of the knees were scored as normal. The average preoperative visual analog pain score out of 10 was 8.3, which was reduced to 0.8 at 6 months and to 0 at 1 year after surgery. Serial magnetic resonance imaging scans showed healing of the bony part of the lesion in all of the knees 6 months after surgery and continuous articular cartilage healing at 9 months. Conclusions: Autogenous osteochondral grafting of unstable OCD lesions in the knee is a reliable and minimally invasive technique that provides a stable biologic fixation using autogenous bone graft and has few complications. Level of Evidence: Level IV, therapeutic case series.
International Orthopaedics, 2014
Background: The patella is the largest human sesamoid bone and often sustains chondral injury. There is no consensus on how to treat a full-thickness, symptomatic articular cartilage injury of the patella. We analyzed the clinical and functional outcomes of patients with symptomatic full-thickness patellar chondral lesions treated with autologous osteochondral transplantation and evaluated osteochondral autograft bone-plug integration through magnetic resonance imaging.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004
The purpose of this retrospective analysis was to evaluate the medium-term results of arthroscopic treatment of chondral and osteochondral lesions of the knee with autogenous osteochondral transplantation (AOT). Type of Study: Case series. Methods: Thirty-three skeletally mature patients with symptomatic, full-thickness cartilage lesions of the femoral condyles, between 1 and 2.5 cm in diameter, were treated with arthroscopic AOT. Grafts were harvested from the superior and lateral intercondylar notch and press-fit into holes drilled into the defect. All patients were evaluated both preoperatively and postoperatively with the Lysholm knee score, International Knee Documentation Committee (IKDC) Standard Evaluation Form, and knee joint radiographs. Results: Thirty patients of a mean age of 44.6 years were followed-up for a mean time of 45.1 months. Symptom duration ranged from 1 month to 15 years (median, 9.5 months). The mean Lysholm score significantly improved from 43.6 preoperatively to 87.5 postoperatively (P Ͻ .001). Excellent or good outcome was accomplished in 25 of the patients (83%). Using the IKDC assessment, 26 of the patients (87%) reported their knee as being normal or nearly normal. Repeat arthroscopy with needle biopsy of the graft was performed in 9 patients. Seven of these had complete healing and 2 partial healing. The histologic examination revealed viable chondrocytes and normal hyaline cartilage in the completely healed cases. Congruency of the articular surface was restored in 11 of 12 patients (92%) who underwent magnetic resonance imaging examination. Abnormal marrow signal in the subchondral bone beneath the region of cartilage repair was present in 9 of 12 patients (75%), even 4 years after the procedure. Conclusions: Arthroscopic AOT is an effective and safe method of treating symptomatic full-thickness chondral defects of the femoral condyles in appropriately selected cases. However, further studies with long-term follow-up are needed to determine if the grafted area will maintain structural and functional integrity over time. Level of Evidence: Level IV, therapeutic, case series (no, or historical, control group).
Indian Journal of Orthopaedics, 2010
Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years.
Histological evaluation of internally-fixed osteochondral lesions of the knee
Journal of Bone and Joint Surgery - British Volume, 2009
We evaluated the histological changes before and after fixation in ten knees of ten patients with osteochondritis dissecans who had undergone fixation of the unstable lesions. There were seven males and three females with a mean age of 15 years (11 to 22). The procedure was performed either using bio-absorbable pins only or in combination with an autologous osteochondral plug. A needle biopsy was done at the time of fixation and at the time of a second-look arthroscopy at a mean of 7.8 months (6 to 9) after surgery. The biopsy specimens at the second-look arthroscopy showed significant improvement in the histological grading score compared with the pre-fixation scores (p < 0.01). In the specimens at the second-look arthroscopy, the extracellular matrix was stained more densely than at the time of fixation, especially in the middle to deep layers of the articular cartilage. Our findings show that articular cartilage regenerates after fixation of an unstable lesion in osteochondrit...