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Background: Autologous chondrocyte implantation (ACI) is an established procedure for the treatment of cartilage damage in the knee joint. At present, it is still unclear how previous surgery influences outcome after ACI. Purpose: To evaluate the effect of previous knee surgery related or nonrelated to the treated cartilage defect on clinical outcome after ACI for knee cartilage defects. Study Design: Cohort study; Level of evidence, 3. Methods: An overall 730 patients with ACI who underwent previous unspecific knee surgery, whether related to the defect being currently treated or not, were identified from a cohort of 5961 patients registered in the German Cartilage Registry. Propensity score matching was used to match these patients to 690 patients with analogous characteristics but without previous surgery. Subsequently, 317 patients with previously failed cartilage treatment at the defect site were identified and compared with a matched collective of 254 patients without previous cartilage treatment. In a subgroup analysis, the type of previous cartilage surgery was additionally investigated. Outcome was evaluated by Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, rate of reintervention, and patient satisfaction up to 36 months. A chi-square test was used to compare categorial variables and an unpaired t test to compare continuous variables. Results: Patients with previous knee surgery not related to the cartilage defect showed a lower KOOS at 6 months (68.3 vs 70.8; P = .026), while patients with previous cartilage surgery showed significantly lower KOOS values at all follow-up time points when compared with patients without any previous knee or cartilage surgery (all P < .05). A comparison of KOOS values in patients with previous therapy at the cartilage defect with ACI versus bone marrow stimulation did not show any significant differences at any follow-up. Conclusion: Previously failed cartilage treatment at the defect site represents a negative prognostic factor up to 3 years after ACI. However, this influence appears to be independent of the type of previous treatment at the defect site and applies equally to failed bone marrow stimulation as well as previous ACI. In contrast, a negative effect of previous surgery to the knee unrelated to the cartilage defect could not be shown in the 3-year follow-up.

Objective The aim of this study was to investigate texture features from T2 maps as a marker for distinguishing the maturation of repair tissue after 2 different cartilage repair procedures. Design Seventy-nine patients, after either microfracture (MFX) or matrix-associated chondrocyte transplantation (MACT), were examined on a 3-T magnetic resonance (MR) scanner with morphological and quantitative (T2 mapping) MR sequences 2 years after surgery. Twenty-one texture features from a gray-level co-occurrence matrix (GLCM) were extracted. The texture feature difference between 2 repair types was assessed individually for the femoral condyle and trochlea/anterior condyle using linear regression models. The stability and reproducibility of texture features for focal cartilage were calculated using intra-observer variability and area under curve from receiver operating characteristics. Results There was no statistical significance found between MFX and MACT for T2 values ( P = 0.96). There was, however, found a statistical significance between MFX and MACT in femoral condyle in GLCM features autocorrelation ( P < 0.001), sum of squares ( P = 0.023), sum average ( P = 0.005), sum variance ( P = 0.0048), and sum entropy ( P = 0.05); and in anterior condyle/trochlea homogeneity ( P = 0.02) and dissimilarity ( P < 0.001). Conclusion Texture analysis using GLCM provides a useful extension to T2 mapping for the characterization of cartilage repair tissue by increasing its sensitivity to tissue structure. Some texture features were able to distinguish between repair tissue after different cartilage repair procedures, as repair tissue texture (and hence, probably collagen organization) 24 months after MACT more closely resembled healthy cartilage than did MFX repair tissue.

The working group, “Clinical Tissue Regeneration” of the German Society of Orthopedics and Traumatology (DGOU) issues this paper to update their guidelines. Methods Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available for a particular diagnostic or therapeutic concept, including the grade of recommendation. Besides the scientific evidence, all group members rated the statements to identify possible gaps between literature and current clinical practice. Conclusion In patients with minimal symptoms, OLT progression to ankle osteoarthritis is unlikely. Risk factors for progression are the depth of the lesion on MRI, subchondral cyst formation, and the extent of bone marrow edema. Conservative management is the adaptation of activities to the performance of the ankle joint. A follow-up imaging after 12 months helps not to miss any progression. It is impossible to estimate the probability of success of conservative management from initial symptoms and imaging. Cast immobilization is an option in OLTs in children, with a success rate of approximately 50%, although complete healing, estimated from imaging, is rare. In adults, improvement by conservative management ranges between 45% and 59%. Rest and restrictions for sports activities seem to be more successful than immobilization. Intra-articular injections of hyaluronic acid and platelet-rich plasma can improve pain and functional scores for more than 6 months. If 3 months of conservative management does not improve symptoms, surgery can be recommended.

The goal was to examine gender differences of patient characteristics and outcome after cartilage repair based on a collective of nearly 5,000 patients. Patient characteristics, accompanying therapies, and outcome (Knee Injury and Osteoarthritis Outcome Score [KOOS], reoperations, patient satisfaction) of 4,986 patients of the German cartilage register DGOU were assessed by t test for possible gender differences. P values

Background: Large osteochondral defects of the knee are a challenge for regenerative treatment. While matrix-guided autologous chondrocyte transplantation (MACT) represents a successful treatment for chondral defects, the treatment potential in combination with bone grafting by cancellous bone or bone block augmentation for large and deep osteochondral defects has not been evaluated. Purpose: To evaluate 1- to 3-year clinical outcomes and radiological results on magnetic resonance imaging (MRI) after the treatment of large osteochondral defects of the knee with bone augmentation and MACT. Special emphasis is placed on different methods of bone grafting (cancellous bone grafting or bone block augmentation). Study Design: Case series; Level of evidence, 4. Methods: Fifty-one patients were included. Five patients were lost to follow-up. This left 46 patients (mean age, 28.2 years) with a median follow-up time of 2 years. The 46 patients had 47 deep, large osteochondral defects of the knee joint (1 patient with bilateral defects; mean defect size, 6.7 cm2). The origin of the osteochondral defects was osteochondritis dissecans (n = 34), osteonecrosis (n = 8), or subchondral cysts (n = 5). Depending on the depth, all defects were treated by cancellous bone grafting (defect depth ≤10 mm; n = 16) or bone block augmentation (defect depth >10 mm; n = 31) combined with MACT. Clinical outcomes were followed at 3 months, 6 months, 1 year, 2 years, and 3 years and evaluated using the International Knee Documentation Committee (IKDC) score and Cincinnati score. A magnetic resonance imaging (MRI) evaluation was performed at 1 and 2 years, and the magnetic resonance observation of cartilage repair tissue (MOCART) score with additional specific subchondral bone parameters (bone regeneration, bone signal quality, osteophytes, sclerotic areas, and edema) was analyzed. Results: The clinical outcome scores revealed a significant increase at follow-up (6 months to 3 years) compared with the preclinical results. The median IKDC score increased from 42.6 preoperatively to 75.3 at 1 year, 79.7 at 2 years, and 84.3 at 3 years. The median Cincinnati score significantly increased from 39.8 preoperatively to 72.0 at 1 year, 78.0 at 2 years, and 80.3 at 3 years. The MRI evaluation revealed a MOCART score of 82.6 at 1 year without a deterioration at the later follow-up time point. Especially, the subchondral bone analysis showed successful regeneration. All bone blocks and cancellous bone grafts were integrated in the bony defects, and no chondrocyte transplant failure could be detected throughout the follow-up. Conclusion: Large and deep osteochondral defects of the knee joint can be treated successfully with bone augmentation and MACT. The treatment of shallow bony defects with cancellous bone grafting and deep bony defects with bone block augmentation shows promising results.

Aims and Objectives: This multicentre study was conducted to investigate patients’ expectations on osteotomies around the knee in different health-related domains. It was hypothesized that these expectations are high, yet realistic. Materials and Methods: A total of 264 Patients (age 47y±11) were enrolled from March 2015 until May 2016 in seven specialised departments of orthopaedic surgery in Germany. Data was collected via a standardized questionnaire relating to the expected outcomes of osteotomies around the knee 24 h to 48 h prior to surgery. In addition, KOOS and selfefficacy were assessed. Results: According to the KOOS results all patients suffered from a burden due to their knee impairments; women suffered significantly more than men. All participants had high expectations in all domains concerning the surgical outcome. For patients who had a high work intensity the ability to keep stressful working postures was even more important than for the others (i.e. to kneel, to squat). Furthermore, a lower quality of life was associated with higher importance of improving the ability to walk, to achieve improvements in daily activities and social well-being. Conclusion: Patients’ expectations of osteotomies around the knee are high, and mostly outperform the average results reported in the literature. Detailed patient information giving an overview of the realistic results of osteotomies around the knee seems to be mandatory to prevent patients’ dissatisfaction.

Aims and Objectives: Full thickness cartilage defects may be devastating for the patients. Even though, the surgical options have improved, only limited information for returning to sports. Aim of this study was therefore to compare the functional outcome and the return to sports rate of patients following cartilage regenerative treatment at a minimum follow up of 12 months. Materials and Methods: A total of 50 Patients (32 male, 18 female) undergoing cartilage regeneration using a Matrix-associated chondrocyte transplantation (MACT, Novocart, TETEC, Aesculap) (27 femorotibial, 23 patellofemoral) were evaluated at a minimum follow-up of 12 months. Follow-up was performed using a multifactorial functional analysis including isokinetic strength measurements (BTE-primus), proprioceptive tests (MTF tests), a tapping test and a 3d-motion analysis (myomotion, Noraxon) during single leg squats, bilateral drop jumps and single leg hop tests. Agility was assessed using a lateral speedchase (Globalspeed, Hemsbach). Clinical results were recorded using Tegner and Lysholm score. Results: Patients showed a Lysholm score of 86,3 +/-10,3 and 84,0 +/-13,9 for male and female, respectively. The tegner score was significantly reduced when compared to preoperatively (male 4,72 +/-1,6, female 4,75 +/-1,5). Thigh circumference was reduced by an average of 3,6 cm for male and 4,4 cm for female patients. The tapping test revealed no differences between male and female patients providing a leg symmetry index (LSI) of 102,0 (+/-8,4) with an overall average frequency of 10,14 (+/-1,27). During single leg squat male patients had a significantly lower knee flexion of 55,8 (+/-8,5) of the postoperative leg compared to the non-injured leg (62,2 +/-8,2) whereas the knee abduction was -6.8 (+/-15,1) and -11,8 -11,82 (+/-16,6) for the postoperatively and non-injured leg, respectively. Evaluating the single leg hop, the LSI of distance values was 90,8 (+/-11,9) and for height values 84,0 (+/-16,0) for the male patients. There was a trend towards reduced ROM with regard to knee flexion of the injured leg to the non-injured. Cutting time during lateral speedchase showed a LSI of 98,29 (+/-13,8) and 99,44 (+/-8,2) for male and female patients, respectively. Conclusion: This prospective analysis of patients following cartilage regeneration implicates that the use of a multifactorial “return-to-sports” analysis 12 months postoperatively provides a good correlation to the clinical outcome and scores. At this FU point, Patients following MACT show knee joint function that is close to normal.