Treatment of a Patellar Chondral Defect Using Juvenile Articular Cartilage Allograft Implantation (original) (raw)
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Chondral Defect Repair with Particulated Juvenile Cartilage Allograft
Cartilage, 2011
Objective: This case study of 4 patients followed for at least 2 years was conducted to evaluate a cartilage repair procedure that involves transplanting particulated juvenile allograft cartilage. Design: A multicenter, prospective, single-arm, 25-subject case study was designed to evaluate clinical outcomes such as IKDC and KOOS scores as well as the extent and quality of repair with MRI. In addition, there is an option for the transplants to be biopsied at various time points after implantation (up to 5 years). Currently, 25 patients with 1 or 2 chondral lesions on the femoral condyles and trochlea have been enrolled and treated in the prospective study. Results: The first 4 patients have completed an evaluation at 24 months postoperative follow-up. Improvements in clinical outcomes over the preoperative baseline data have been observed. Conclusions: The present report describes, for the first time, clinical intermediate-term results of a novel cartilage repair procedure that involves transplanting particulated juvenile cartilage tissue allograft into prepared cartilage lesions of the femoral condyles and/or trochlea. Clinical outcome data of 4 patients who have reached the 24-month postimplantation milestone indicate early positive outcomes and suggest that this technique is capable of improving clinical symptoms. MRI data suggest that defect filling is possible and persists to at least 2 years. Continued clinical evaluation of this technique is needed with extended follow-up of all 25 patients in the series.
Orthopaedic Journal of Sports Medicine, 2019
Background:Patellar cartilage defects account for 34.6% of defects found during routine arthroscopy. These defects pose a challenge in orthopaedic surgery because they have been associated with worse outcomes after surgical repair compared with other chondral lesions within the knee.Purpose:To systematically review the literature for evidence on results of osteochondral autologous transplantation (OAT) for the management of isolated patellar cartilage high-grade defects (International Cartilage Repair Society [ICRS] grade 3-4).Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed to find studies that addressed outcomes regarding OAT to treat patellar high-grade cartilage defects (ICRS grade 3-4). Studies addressing patient-reported outcomes, return to sports, or magnetic resonance imaging (MRI) at follow-up after isolated OAT procedures for patellar cartilage defects were included.Results:A total of 5 studies were included i...
Arthroscopy Techniques
Symptomatic articular cartilage injuries are often seen in young active patients and athletes. Magnetic resonance imaging screening examinations have frequently identified such lesions in athletic patients. Patellofemoral chondral defects were previously identified as the most common knee cartilage lesion in high-level athletes. Chondral defects measuring 2 cm 2 or greater and complex cartilage defects involving bone loss are ideally replaced with fresh osteochondral allograft. We describe a technique indicated for patients with symptomatic and recurrent anterior knee pain associated with osteochondral patellar defects including the lateral and medial patellar facets. Patients who have undergone previous interventions, including membrane techniques, microfracture, or autologous chondral transplantation, without clinical benefit are also eligible to undergo osteochondral allograft transplantation for combined medial and lateral patellar cartilage lesions, that is, the osteochondral wide lesion (OWL) technique.
The Current State of Cartilage Transplantation in the Knee
Biomechanica Hungarica, 2009
Articular hyaline cartilage damage is difficult to repair since the chondrocytes often fail to multiply in vivo. Despite many centuries of advances in medical science the repair of damaged articular cartilage tissue remains controversial. This article presents a comprehensive review of the current state of articular cartilage implantation in the knee.
Surgical treatment of articular cartilage defects in the knee: are we winning?
Advances in orthopedics, 2012
Articular cartilage (AC) injury is a common disorder. Numerous techniques have been employed to repair or regenerate the cartilage defects with varying degrees of success. Three commonly performed techniques include bone marrow stimulation, cartilage repair, and cartilage regeneration. This paper focuses on current level of evidence paying particular attention to cartilage regeneration techniques.
The present state of treatments for articular cartilage defects in the knee
Annals of The Royal College of Surgeons of England, 2012
INTRODUCTION Chondral and osteochondral lesions of the knee are notoriously difficult to treat due to the poor healing capacity of articular cartilage and the hostile environment of moving joints, ultimately causing disabling pain and early osteoarthritis. There are many different reconstructive techniques used currently but few are proven to be of value. However, some have been shown to produce a better repair with hyaline-like cartilage rather than fibrocartilage. METHODS A systematic search of all available online databases including PubMed, MEDLINE ® and Embase ™ was undertaken using several keywords. All the multiple treatment options and methods available were considered. These were summarised, and the evidence for and against them was scrutinised. RESULTS A total of 460 articles were identified after cross-referencing the database searches using the keywords. These revealed that autologous and matrix assisted chondrocyte implantation demonstrated both 'good to excellent' histological results and significant improvement in clinical outcomes. CONCLUSIONS Autologous and matrix assisted chondrocyte implantation have been shown to treat symptomatic lesions successfully with significant histological and clinical improvement. There is, however, still a need for further randomised clinical trials, perfecting the type of scaffold and the use of adjuncts such as growth factors. A list of recommendations for treatment and the potential future trends of managing these lesions are given.
Arthroscopy Techniques
Patellar instability is a debilitating condition, and trauma due to the dislocations may severely damage the articular cartilage of the patellofemoral joint. The lack of healing capacity of cartilage makes treatment of such lesions challenging. In young patients, preservation of native bone and cartilage is a priority, and therefore arthroplasty procedures should be avoided even in relatively larger lesions. Fresh osteochondral allografting has been described for these difficult and complex cases, with recent studies showing promising results. In this surgical technique, we describe the use of bipolar osteochondral allografts of the patella and trochlea and patellofemoral joint reconstruction for large bipolar fullthickness cartilage defects due to recurrent dislocation events.
Osteochondral autologous transplantation for treating chondral lesions in the patella
2012
Background: Patellar cartilage defects account for 34.6% of defects found during routine arthroscopy. These defects pose a challenge in orthopaedic surgery because they have been associated with worse outcomes after surgical repair compared with other chondral lesions within the knee. Purpose: To systematically review the literature for evidence on results of osteochondral autologous transplantation (OAT) for the management of isolated patellar cartilage high-grade defects (International Cartilage Repair Society [ICRS] grade 3-4). Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed to find studies that addressed outcomes regarding OAT to treat patellar high-grade cartilage defects (ICRS grade 3-4). Studies addressing patient-reported outcomes, return to sports, or magnetic resonance imaging (MRI) at follow-up after isolated OAT procedures for patellar cartilage defects were included. Results: A total of 5 studies were included in this review. We were not able to perform a meta-analysis as no studies had available data. A total of 102 patients who received an isolated OAT for a patellar chondral defect were included in these 5 studies. All patients showed significant improvement at final follow-up based on the following patient-reported outcome scores: Lysholm, International Knee Documentation Committee, Kujala, Tegner, and 36-Item Short Form Health Survey. We found that 4 studies used MRI during the first postoperative year to assess osteochondral plug integration and positioning. The results demonstrated that most plugs were integrated and correctly positioned when evaluated at follow-up, conducted on average after 12 months. Whether patients were able to return to sports was queried in 2 of the included studies, revealing that patients could return to their previous level in most cases (Tegner score, 5-9 at 2 years after surgery). Conclusion: Results indicate that OAT is a safe and reliable technique to treat patellar high-grade osteochondral defects, allowing for significant improvement in patient-reported outcomes and return to sports.