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Purpose: Autologous matrix-induced chondrogenesis (AMIC®) and microfracture are established treatments for focal chondral defects in the knee, but there are little clinical data concerning these procedures over the long term. This study evaluates the outcomes of AMIC® compared to microfracture over 10-year follow-up. Methods: Forty-seven patients were randomized and treated either with MFx (n = 13), sutured AMIC® (n = 17) or glued AMIC® (n = 17) in a prospective, randomized, controlled multicentre trial. The Modified Cincinnati Knee Score, a visual analogue scale for pain and MOCART score were used to assess outcomes over 10 years post-operatively. Results: All treatment arms improved in the first 2 years, but a progressive and significant deterioration in scores was observed in the MFx group, while both AMIC® groups remained stable. MOCART scores were comparable between groups. Conclusion: The AMIC® procedure results in improved patient outcomes in comparison with microfracture up to 10 years following surgery for the repair of focal chondral defects in the knee. ClinicalTrials.gov Identifier: NCT02993510 [ABSTRACT FROM AUTHOR]

Purpose: This retrospective observational cohort analysis aims to address diagnostic and therapeutic challenges in managing osteochondral fractures (OCFs) resulting from acute patella dislocation and ankle sprains in children. Methods: The study includes 15 children treated for OCFs between January 2020 and July 2022. Data were obtained from medical records and analyzed using logistic regression. Results: The diagnostic and treatment algorithm involves detailed history, clinical examination, and imaging, with MRI guiding therapeutic decisions. Arthroscopic or mini open fixation led to successful rehabilitation, with 93% achieving full mobility at 9 months. Age was identified as a slight risk factor for free fragments in MRI, and arthroscopic management correlated with faster recovery at 3 months. Conclusion: This study underscores the importance of immediate diagnosis and minimally invasive intervention for OCFs in children. Timely treatment, guided by a diagnostic algorithm, facilitates joint restoration and prevents degenerative consequences, ensuring a return to regular activities within a year postoperatively. Level of Evidence : IV [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus (OCLT) are common injuries that can be difficult to treat. To date, long-term patient reported outcome measures (PROMs) of patients with particulated juvenile allograft cartilage implantation with or without calcaneal autograft have not been compared. Methods: Thirteen patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of particulated juvenile allograft cartilage (DeNovo NT®) with or without autogenous calcaneal bone grafting by a single surgeon. Calcaneal bone graft use was determined by lesion size > 150 mm2 and/or deeper than 5 mm. Patients were evaluated using physical examination, patient interviews, and PROMs. Results: When comparing patients in regards to calcaneal bone graft implantation, no difference in age, BMI, pre-operative PROMs, or follow-up was noted, however, calcaneal bone graft patients did have a significantly larger lesion size (188.5 ± 50.9 vs. 118.7 ± 29.4 mm2 respectively; p value = 0.027). VAS and FAAM ADL scores during final follow-up improvement did not significantly differ between cohorts. The FAAM Sports score improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.032). The AOFAS score improvement did not differ between cohorts (p value = 0.944), however, the SF-36 PCS improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.038). No intraoperative/perioperative complications were observed with calcaneal bone grafting. Conclusion: While patients followed over the course of ~ 8 years after implantation of particulated juvenile allograft cartilage (DeNovo NT®) with/without autogenous calcaneal bone graft had positive post-operative PROMs, patients without calcaneal bone graft had significantly greater improvement in functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear. Level of Evidence: III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose: Osteochondral defects have a limited capacity to heal and can evolve to an early osteoarthritis. A surgical possibility is the replacement of the affected cartilaginous area with a resurfacing device BioPoly™ RS Partial Resurfacing Knee Implant. The aim of this study was to report the clinical and survival outcomes of the BioPoly™ after a minimum follow-up of 4 years. Methods: This study included all patients who had a BioPoly™ for femoral osteochondral defects greater than 1 cm2 and at least ICRS grade 2. The main outcome was to observe the KOOS and the Tegner activity score were used to assess outcomes preoperatively and at the last follow-up. The secondary outcomes were the VAS for pain, the complications rate post-surgery and survival rate of BioPoly™ at the last FU. Results: Eighteen patients with 44.4% (8/18) of women were included with a mean age of 46.6 years (11.4), a mean body mass index (BMI) of 21.5 (kg/m2) (2.3). The mean follow-up was 6.3 years (1.3). We found a significant difference comparing pre-operative KOOS score and at last follow-up [respectively, 66.56(14.37) vs 84.17(7.656), p < 0.01]. At last follow-up, the Tegner score was different [respectively, 3.05(1.3) vs 3.6(1.3), p < 0.01]. At 5 years, the survival rate was of 94.7%. Conclusions: BioPoly™ is a real alternative for femoral osteochondral defects greater than 1 cm2 and at least ICRS grade 2. It will be interesting to compare this implant to mosaicplasty technic and/or microfracture at 5 years postoperatively regarding clinical outcomes and survival rate. Level of evidence: Therapeutic level III. Prospective cohort study. [ABSTRACT FROM AUTHOR]

Background: Knee pain is one of the commonest symptoms in patients who attend the Orthopaedic outpatient clinics. Chondral defects result in a painful knee. Incidence of chondral defect is reported to be between 5 and 10% over the age of 40. It is well documented that chondral defects can lead to osteoarthritis. Early detection of these lesions and cartilage repair surgery can delay the onset of osteoarthritis. The purpose of this study is to highlight the incidence, associations and correlations between opposing cartilage defects in patients who present to the knee clinic with pain. Methods: A retrospective analysis was carried out on patients who had Magnetic Resonance Imaging scans for painful knees between June 2017 and May 2019. About 227 consecutive knees were studied for the incidence of chondral defects, number of lesions, grade and size of lesion, geographical location and associated pathology in the knee. Results: All the 227 patients had chondral lesions. Most patients had 2–3 lesions (66.1%) with patellar lesions (76.6%) being the commonest followed by medial femoral condyle (59.9%). Significant correlation was found in grade and size between opposing surface lesions in patella-trochlea, Medial Femoral Condyle-Medial Tibial Plateau and Lateral Femoral Condyle-Lateral Tibial Plateau. Females were more predisposed to patella lesions. Significance between age and lesions were established. Conclusion: Incidence of cartilage defects in the knee is very high. Kissing lesions must be considered when treating cartilage lesions. Volume index could be a promising method to quantify lesions. [ABSTRACT FROM AUTHOR]

Introduction: The anatomical dual bundle medial patellofemoral ligament (MPFL) reconstruction technique is one of the surgical techniques used to treat lateral patellar instability. This commonly involves the creation of two patella bone tunnels through which the limbs of the grafts are inserted. The surgical risks include patellar fracture and penetration of patellofemoral articular surface. Thus, an easily reproducible intra-operative guiding parameter is useful to reduce such complications. Purpose: The aim of this study is to demarcate a safe working zone in the axial plane for the patella tunnels. Methods: In this pilot study, we projected patella bone tunnels on the MRI knee images of 201 male patients with intact MPFLs. Two tunnel projections, superior and inferior, are made from the medial to the lateral sides of the patella. The projection of each superior and inferior tunnel is subdivided into three different angles in the axial plane. The tunnel length, thickness of the bone anterior to each tunnel and safety angle are measured. The safety angle refers to the angle between the longitudinal axis of each tunnel and the horizontal plane of the patella. Results: Our current study population consisted of 201 male patients (104 Wiberg type 1, 97 Wiberg type 2, no type 3 or 4). For the superior tunnels, the tunnel lengths are 14.8 mm, 24.3 mm and 27.2 mm. The respective safety angles are 24.9 degrees, 24.5 degrees and 8.8 degrees. The thickness of the bone anterior to the tunnels are 5.9 mm, 2.5 mm and 6.2 mm. For the inferior tunnels, the tunnel lengths are 18.4 mm, 21.9 mm and 34.9 mm. The respective safety angles are 23.5 degrees, 22.5 degrees and 8.5 degrees. The thickness of the bone anterior to the respective tunnels are 5.9 mm, 3.1 mm and 6.0 mm. Conclusion: The proposed safety angle of 8.8 degree for the superior tunnel, and 8.5 degrees for the inferior tunnel is a potentially useful intra-operative guide for the surgeon and can potentially reduce the risks of fracture and articular cartilage injury in patellae with Wiberg 1 and 2 morphologies. Level of evidence: Level II, retrospective study. [ABSTRACT FROM AUTHOR]

Introduction: Osteochondral lesions of the patellofemoral joint (OLPFJ) are defects of the cartilage surface and subchondral bone, which often require surgical treatment. Reparative treatments have shown some limitations in the long-term follow-up. The one-step bone marrow-derived cells transplantation (BMDCT) achieved good to excellent results in the treatment of osteochondral lesions of the femoral condyles. The aim of this study was to report the 48-month clinical and radiological results among 28 patients with OLPFJ treated with the one-step BMDCT technique associated with the anteromedialization tibial tuberosity (AMTT).Materials and methods: Twenty-eight patients from 2010 to 2013 with OLPFJ underwent the BMDCT with the one-step technique associated with the AMTT. Clinical evaluation was performed at 6, 12, 18, 24, 36 and 48 months after surgery using the Kujala PF scale, the IKDC score and the Tegner activity scale. Eighteen lesions were located on patella and ten lesions on trochlea.Results: The preoperative Kujala score improved from 68.2 ± 4.7 to 87.2 ± 1.2 at the mean final follow-up, while the IKDC subjective score improved from 55.1 ± 6.2 to 92.13 ± 5.5. Tegner scale showed an increase from 1.7 ± 1.3 preoperatively to 5.3 ± 2.7 at the final follow-up. MRI analysis at 24-month follow-up showed an overall good filling of the lesions.Discussion and conclusions: The one-step BMDCT associated with the AMTT permitted good clinical results durable over time with a high rate of patients' satisfaction. These results confirm the validity of the one-step technique also in patellofemoral joint. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to comparatively evaluate the effectiveness of intra-articular PRP and HA injections applied as the treatment of Outerbridge grade 2 chondral lesions in patellofemoral joint during arthroscopic ACL reconstruction.Methods: The clinical and radiographic data of 61 patients between 18 and 45 years of age were evaluated. The patients were separated into three groups. Hyaluronic acid injection was applied in 22 knees (Group 1), PRP injection was applied in 18 knees (Group 2), and 21 knees did not have any specific treatment except ACL reconstruction (Group 3). All patients were followed clinically at least for 12 months. Clinical examination of the operated knee, visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the outcome measures. Routine X-ray and MRI were also performed for all patients at 12-month postoperative follow-up visit.Results: Although the mean VAS and Lysholm scores at 3-month follow-up were better in Group 1 and 2 than Group 3, the efficacy of intra-articular PRP on healing process regarding progression of the mean VAS and Lysholm scores through 6- and 12-month follow-ups was significantly better and longer than HA. No statistically significant differences were detected according to Tegner activity scale between the groups at 3 and 6 months; however, Group 2 had better activity level than both Group 1 (p < 0.001) and 3 (p < 0.001) at the end of 12 months after surgery.Conclusion: Intra-articular PRP injection applied as the treatment of concomitant Outerbridge grade 2 chondral lesion in patellofemoral joint during ACL reconstruction revealed better and durable clinical outcomes via decreasing the potentially negative effects of chondral pathology on postoperative healing with respect to HA injection.Level of evidence: III—retrospective comparative study. [ABSTRACT FROM AUTHOR]

Purpose: To present the long-term functional outcomes of revision anterior cruciate ligament (ACL) reconstruction with autograft and factors that influence the outcomes.Methods: Retrospective study of 51 consecutive revision ACL reconstructions performed using autograft under the care of a single surgeon with interference screw fixation. Bone-patellar tendon-bone graft was used in 35 (69%) and hamstring tendons in 16 (31%). The subjective IKDC activity level and Lysholm Knee functional scores were collected at mean follow-up of 9.0 years (range 5.17-14.75 years).Results: Five (9.8%) had re-ruptured and one patient had a total knee replacement. Functional scores were available for 43 patients (84.3%). Twenty-eight had IKDC activity level I or II (65%), level III in 12 (28%) and level IV in 3 (7%). The average Lysholm score was 86.2 ± 12.88, and there is a statistically significant relationship with age (95% CI: − 0.88, − 0.60) (P < 0.05). For each additional 10 years of age, there is a reduction of 5.18 points. No statistically significant effect of sex has been detected. The mean Lysholm score was lower in patients who had partial medial meniscectomy (77.33), although this was not statistically significant (P = 0.06). Regression analysis of the Lysholm score means by chondral damage category adjusted for age, showed that the Grade 3 or 4 group shows a reduction of about 25 points for every 10 years increase in age (95% CI; P = 0.05).Conclusion: Revision ACL reconstruction with autograft affords satisfactory long-term outcomes. Expectations should be carefully managed in patients with increasing age associated with severe chondral damage and previous medial meniscectomy. [ABSTRACT FROM AUTHOR]

The cell quality plays a decisive role in autologous chondrocyte implantation (ACI). Aim of the study was the analysis of in vivo interactions between synovial concentrations of cytokines and cell quality used for ACI. Knee lavage fluids of patients undergoing an ACI were examined for total protein content (TPC) and by ELISA for levels of basic fibroblast growth factor (bFGF), insulin-like growth factor 1, bone morphogenetic proteins 2 and 7 (BMP-2 and BMP-7). Cell quality following amplification for ACI was determined by surface expression of CD44, aggrecan, collagen type II and evaluation of cell characteristics. Data of 17 patients were supplemented by epidemiological parameters and clinical scores (IKDC, Lysholm, pain strength, subjective knee function). CD44 expression was positively associated with TPC and bFGF, and negatively linked to BMP-2 levels ( p < 0.01). In contrast, expression of collagen type II did not show any statistically significant correlations with synovial protein concentrations. TPC was positively associated with intraarticular bFGF levels and pain strength ( p < 0.01), both indicators for osteoarthritis (OA). Correlating with the negative relation of TPC and BMP-2, subjective knee function after 1 year was positively linked to intraarticular BMP-2 concentrations ( p < 0.001). Similarly, expression of collagen type II indicated a favorable clinical result reaching statistical significance in case of pain strength ( p < 0.01). Initially increased bFGF levels and CD44 expression indicated a worse clinical outcome after 1 year (IKDC, Lysholm Scores, pain strength). Surface expression of CD44 on chondrocytes used for ACI was negatively associated with synovial BMP-2 and positively to TPC and bFGF indicating catabolic synovial conditions. These correlations were also reflected by clinical outcome parameters. [ABSTRACT FROM AUTHOR]

Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected. [ABSTRACT FROM AUTHOR]

We present a novel and simple method for single hamstring allograft MCL and PMC reconstruction, which can improve both joint valgus and external rotational stability and maximize utilization of allograft. All patients received arthroscopic evaluation through inferomedial and inferolateral knee incisions to ascertain whether there were intra-articular injuries. An 8-cm-length longitudinal incision was made from 1 cm above adductor tubercle to 5-cm proximal medial tibia joint line. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm below the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm below the medial tibia joint line. A 5- or 6-mm reamer was used to drill the tibia tunnel along with guide pin, and a 6 or 7 mm drill was used to drill the femur tunnel to a depth of 25 or 30 mm until the proximal adductor tubercle. The allograft was harvested from tibia and placed into the tunnel and fixed with absorbable interference screw. All patients performed active rehabilitation exercises after the operation periodically. [ABSTRACT FROM AUTHOR]

Mosaicplasty has become a well-accepted treatment modality for articular cartilage lesions in the knee. Postoperative bleeding remains potentially concerning. This study evaluates the porous poly(ethylene oxide)terephthalate/poly(butylene terephthalate) (PEOT/PBT) implants used for donor site filling. Empty donor sites were the controls. After 9 months, MRI, macroscopical and histological analysis were carried out. Treated defects did not cause postoperative bleeding. No adverse events or inflammatory response was observed. PEOT/PBT implants were well integrated. Empty controls occasionally showed protrusion of repair tissue at the defect margins. Surface stiffness was minimally improved compared to controls. Existing polymer fragments indicated considerable biodegradation. Histological evaluation of the filled donor sites revealed congruent fibrocartilaginous surface repair with proteoglycan-rich domains and subchondral cancellous bone formation with interspersed fibrous tissue in all implanted sites. The PEOT/PBT implants successfully reduce donor site morbidity and postoperative bleeding after mosaicplasty. Level of evidence: II. [ABSTRACT FROM AUTHOR]

A fifteen-year-old boy with an immature skeleton presented to our department having sustained an axial loading-type injury to the elbow. X-ray revealed an unusual pattern of injury to the olecranon. The articular surface of the olecranon had a depression from axial loading of the trochlea of the humerus similar to a die-punch type intra-articular injury seen at the distal radius. A CT scan was arranged which confirmed a bony depression of the olecranon measuring up to 5 mm. Surgery was performed to restore congruency to the joint surface on the basis of this scan, but intra-operatively, we noticed articular cartilage depression of only 1-2 mm with no loose bodies in the joint. The joint surface was left as it was and the approach closed. Six months on from injury, the child was clinically and radiographically normal. We note that CT scan although useful may be misleading in this type of injury and that non-operative management gave an excellent outcome. [ABSTRACT FROM AUTHOR]