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Introduction: Differences between tibial and femoral joint surfaces and knee compartments concerning coupled bone and cartilage turnover or bone–cartilage cross talk have not been previously examined, although the mechanical and biological interaction of the mineralized subchondral tissues with articular cartilage is of great importance for advancing osteoarthritis. Materials and methods: Therefore, with the help of immunohistochemistry and real-time polymerase chain reaction (RT-PCR), human knee joint cartilage tissue was investigated for expression of key molecules of the extracellular matrix and cartilage composition (collagen type I and II, aggrecan) plus proteoglycan content (colorimetric analysis). Furthermore, we correlated the results with 3D microcomputed tomography of the underlying subchondral bone (high-resolution micro-CT system). Measurements were performed in dependence of the anatomical site (femoral vs. tibial, medial and lateral each) to identify regional differences during the osteoarthritic process. From an enduring series of 108 patients undergoing implantation of TKA, 34 osteochondral samples with lesions macroscopically classified as ICRS grade 1b (group A) and 34 samples with ICRS grade 3a/3b lesions (group B) were compared with 21 healthy controls. Results: Concerning 3D analysis, the medial femoral condyle and tibia showed the most significant increase in bone volume fraction and a decrease in the trabecular number in group B frequently accompanied by subchondral bone resorption pits and enchondral ossification. Under physiological conditions, tibia plateaus show lower bone volume fraction than the corresponding femoral site and this difference enlarges with advancing OA. Partially even contradictory behavior was observed such as trabecular separation at the lateral tibial and medial plateau in osteochondral OA samples of the same patients. Collagen type II expression levels show faster and varying changes than type I during the OA process, leading to a lower positive or negative correlation with bone microstructural analysis, especially on the tibia plateau. Conclusions: Structural bone and cartilage parameter changes showed varying developments and correlations among each other in the different compartments of the knee. As a clinical conclusion, therapies to postpone or prevent cartilage degeneration by influencing the loss of mineralized bone could be site dependent. [ABSTRACT FROM AUTHOR]

Copyright of SSEM-Journal is the property of Schwiez Zschr Sportmed Sporttraumatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: There have been no data in the literature reporting the influence of sports on the outcome of autologous chondrocyte implantation in chondral defects of the knee. HYPOTHESIS: Sports can improve the result of autologous chondrocyte implantation in postoperative follow-up. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 1997 and 2003, 118 patients with symptomatic isolated chondral lesions of the knee underwent autologous chondrocyte implantation. According to the sports activity level before the start of symptoms, patients were assigned to 2 groups: group II with no or rare sports involvement (1-3 times/month); group I with regular (1-3 times/week) or competitive sports (4-7 times/week). All patients underwent clinical and magnetic resonance imaging evaluation preoperative and 6, 18, and 36 months after autologous chondrocyte implantation. RESULTS: Group I patients showed significantly better results (<.01) in the International Cartilage Repair Society and Cincinnati scores than group II patients. Preoperative evaluation revealed no correlation between the sports activity levels and the clinical scores (P > .05). However, from the sixth month on, correlation was statistically significant, increasing from 6 to 18 months, and from 18 to 36 months postoperatively. CONCLUSION: Physical training improves long-term results after autologous chondrocyte implantation of the knee and should be carried out for at least 2 years after surgery. [ABSTRACT FROM AUTHOR]

Background: There have been limited data in the literature reporting the results of osteochondral autografting for osteochondral lesions of the talus that have failed arthroscopic treatment.Hypothesis: Osteochondral autografting can produce significant clinical improvement and a high rate of healing of osteochondral defects of the talus that have failed arthroscopic treatment.Study Design: Cohort study; Level of evidence, 4.Methods: Between 1998 and 2003, 35 patients (18 men, 17 women) with osteochondral talar lesions for which arthroscopic excision, curettage, and drilling had failed, underwent mosaicplasty with an osteochondral graft harvested from the ipsilateral talar articular facet. A malleolar osteotomy or a tibial wedge osteotomy was used for central or posterior lesions that could not otherwise be reached. The mean age of the patients was 30.9 years, and the mean follow-up was 48.9 months.Results: The American Orthopaedic Foot and Ankle Society Ankle Hindfoot scale score in patients without osteotomy rose by 39 points (P = .0001); with malleolar osteotomy, by 30.1 points (P = .017); with tibial wedge osteotomy, by 34.9 points (P = .0002); and with the posterolateral approach, by 32 points. The Wilcoxon test revealed a significant difference between patients without and with osteotomy (P .027) and between patients with malleolar and tibial wedge osteotomies (P = .046). There were no patients with nonunion or malunion in the osteotomy groups. The score values corresponded with the subjective patient evaluation. The Spearman coefficient of correlation was .89.Conclusion: Osteochondral autografting with tibial wedge osteotomy is a good alternative to malleolar osteotomy in osteochondral talar lesions that have failed arthroscopic treatment and that cannot be reached in spite of a forced plantar flexion of the ankle. Patients with small osteochondral lesions accessible through an anterior approach without additional osteotomy have the best prognostic factors. [ABSTRACT FROM AUTHOR]

Purpose: To describe the magnetic resonance imaging (MRI) signs of technically successful osteochondral plug transfer and to correlate the findings with histology using the Mankin score. Material and Methods: The study was done in a prospective animal experiment: 11 adult black-head sheep underwent surgical treatment with osteochondral plug transfer of a knee joint. The animals were killed 6 months later and MRI of the joints was done immediately. MRI was applied with a 1.5T MR scanner using a spin-echo (SE) T1-weighted, turbo spin-echo (TSE) T2-weighted with spectral fat suppression and a fat-suppressed 3D-spoiled gradient echo (GRE) sequence (manufacturer's acronym: FLASH ® ) (TR 50.0 ms, TE 11.0 ms, flip 35°). After MRI, all knee joints were dissected and a biopsy of the plug and the adjacent cartilage was taken. Classification of the cartilage biopsies was carried out in accordance with a modified Mankin score. Results: Cartilage repairs with a hypointense cartilage signal in the FLASH ® 3D sequence were correlated with poor histological results (lower Mankin score). Histologically, the regions of cartilage with a hypointense signal showed a fibrocartilage-like repair tissue. Hyaline cartilage with well-defined layers had the same signal intensity in the FLASH ® sequence relative to adjacent hyaline cartilage. There were two plugs with a surface defect, graded as Outerbridge grade 1 in MRI and histology. Both had a poor outcome in the histologic Mankin score. Grade 2–4 lesions were not observed in the MRI study nor in the histologic study. Conclusion: MRI is a useful non-invasive tool for evaluating the morphologic status of osteochondral plug transfers. A good postoperative result of the cartilage repair was found histologically if an isointense cartilage signal of the graft was documented in the FLASH ® 3D sequence, and the graft had good congruity with the articular surface without defects. [ABSTRACT FROM AUTHOR]

Background: Studies that compare the effectiveness of different cartilage repair treatments are needed to update treatment algorithms.Hypothesis: Autologous chondrocyte implantation provides greater improvement in overall condition score than does debridement at a minimum of 3 years' follow-up.Study Design: Cohort study; Level of evidence, 3.Methods: Cohorts for debridement and autologous chondrocyte implantation each included 58 Cartilage Repair Registry patients who met study criteria. A retrospective analysis was performed on prospectively collected baseline and follow-up data.Results: Patients in the autologous chondrocyte implantation and debridement groups had similar demographics and chondral lesions at baseline. However, more autologous chondrocyte implantation patients failed a previous debridement or marrow stimulation procedure than did debridement patients. Follow-up outcome assessments were completed by 54 autologous chondrocyte implantation patients and 42 debridement patients. Eighty-one percent of the autologous chondrocyte implantation patients and 60% of the debridement patients reported median improvements of 5 points and 2 points, respectively, in the overall condition score. Autologous chondrocyte implantation patients also reported greater improvements in the median pain and swelling scores than did debridement patients. The treatment failure rate was the same for both autologous chondrocyte implantation and debridement patients. Eighteen autologous chondrocyte implantation patients and 1 debridement patient had at least 1 subsequent operation.Conclusion: Although patients treated with debridement for symptomatic, large, focal, chondral defects of the distal femur had some functional improvement at follow-up, patients who received autologous chondrocyte implantations obtained higher levels of knee function and had greater relief from pain and swelling at 3 years. [ABSTRACT FROM AUTHOR]

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Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Periarticular ossifications of the shoulder after surgery have been described since the beginning of the century. Risk factors and the clinical impact of heterotopic bone formation have been discussed controversially. After open surgery on the shoulder, 131 patients (rotator cuff repair n = 106, acromioplasty n = 25) were included in a retrospective study if pre- and postoperative X-rays were available. The age of the 90 men and 41 women averaged 51 years (range 29–67 years). The minimum follow-up was 2 years. Also, 108 patients were interviewed by questionnaire to estimate the subjective outcome of the procedure (5 patients were reported dead). A clinical examination was carried out on 86 patients using the Constant score for evaluation of the objective outcome. Heterotopic ossifications were found in 35 cases (26.7%), 28 of them after rotator cuff reconstruction and 7 after acromioplasty. A good to excellent result was reported by 89% ( n = 65) of the patients without and by 80% ( n = 28) of the patients with ossifications. The Constant score averaged 69 points and 74 points ( n = 60), respectively. A significant difference between the two collectives could not be calculated. As significant risk factors for the formation of heterotopic bone, the existence of osteoarthritis and the duration and complexity of the procedure could be cited. The appearance of periarticular ossifications after surgery of the shoulder seems to be of minor clinical impact. Severe cases with major functional deficits should and can be prevented by a fast and atraumatic operation technique. [ABSTRACT FROM AUTHOR]