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Objective: Intra-lesional bony overgrowth (BO) identified during or following cartilage repair treatment is being frequently described through subjective reports focusing primarily on incidence. Our objective was to quantify the exact volume of intra-lesional BO at 12 months post-cartilage repair treatment, to determine if a correlation exists between the extent of BO and clinical outcomes, and to visualize and characterize the BO.Design: MRI scans were systematically obtained during a randomized clinical trial for cartilage repair (Stanish et al., 2013) that compared two microfracture-based treatments in 78 patients. Semi-automated morphological segmentation of pre-treatment, 1 and 12 months post-treatment scans utilizing a programmed anatomical atlas for all knee bone and cartilage structures permitted three-dimensional reconstruction, quantitative analysis, as well as qualitative characterization and artistic visualization of BO.Results: Limited intra-lesional BO representing only 5.8 ± 5.7% of the original debrided cartilage lesion volume was found in 78 patients with available MRIs at 12 months. The majority (80%) of patients had very little BO (<10%). Most occurrences of BO carried either spotty (56.4%) or planar (6.4%) morphological features, and the remaining balance (37.2%) was qualitatively unobservable by eye. Pre-existing BO recurred at 12 months in the same intra-lesional location in 36% of patients. No statistical correlations were found between BO and clinical outcomes.Conclusions: Intra-lesional BO following microfracture-based treatments may not be as severe as previously believed, its incidence is partly explained by pre-existing conditions, and no relationship to clinical outcomes exists at 12 months. Morphologically, observable BO was categorized as comprising either spotty or planar bone. [ABSTRACT FROM AUTHOR]

Between 1999 and 2002, 16 patients with osteochondral lesions on the central and posterior talar dome underwent osteochondral autografting. A new approach with temporary removal and replacement of a tibia! bone block from the anterior tibial plafond was adopted. Inclusion criteria were joint stability, an age between 18 and 50 years, and osteochondral lesions stages 3 and 4 according to the radiological classification of Loomer, for which previous arthroscopic treatment was not successful. All patients underwent clinical and MRI evaluation after 12, 35 and 59 months. The AOFAS Ankle Hindfoot score improved significantly between the preoperative period and 1 year (p < 0.001), between 1 and 3 years (p < 0.001), but not between 3 and 5 years postoperative (p = 0.37). The score was independent from patients gender (p=0.44) and age. The Spearman coefficient of correlation between clinical outcome and defect size was -0.79 (p = 0.01), indicating that patients with small lesions had the best results. Control radiographs and MRls showed no reduced joint space and good integration of the tibial bone block without incongruency. Osteochondral grafting with temporary removal of a tibial bone block is a successful technique with good midterm results in Osteochondral talar lesions for which arthroscopic excision, curettage and drilling has failed. [ABSTRACT FROM AUTHOR]

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]

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Abstract Background Complex cartilage lesions of the knee including large cartilage defects, kissing lesions, and osteoarthritis (OA) represent a common problem in orthopaedic surgery and a challenging task for the orthopaedic surgeon. As there is only limited data, we performed a prospective clinical study to investigate the benefit of autologous chondrocyte implantation (ACI) for this demanding patient population. Methods Fifty-one patients displaying at least one of the criteria were included in the present retrospective study: (1.) defect size larger than 10 cm2; (2.) multiple lesions; (3.) kissing lesions, cartilage lesions Outerbridge grade III-IV, and/or (4.) mild/moderate osteoarthritis (OA). For outcome measurements, the International Cartilage Society's International Knee Documentation Committee's (IKDC) questionnaire, as well as the Cincinnati, Tegner, Lysholm and Noyes scores were used. Radiographic evaluation for OA was done using the Kellgren score. Results and Discussion Patient's age was 36 years (13-61), defects size 7.25 (3-17.5) cm2, previous surgical procedures 1.94 (0-8), and follow-up 30 (12-63) months. Instruments for outcome measurement indicated significant improvement in activity, working ability, and sports. Mean ICRS grade improved from 3.8 preoperatively to grade 3 postoperatively, Tegner grade 1.4 enhanced to grade 3.39. The Cincinnati score enhanced from 25.65 to 66.33, the Lysholm score from 33.26 to 64.68, the Larson score from 43.59 to 79.31, and Noyes score from 12.5 to 46.67, representing an improvement from Cincinnati grade 3.65 to grade 2.1. Lysholm grade 4 improved to grade 3.33, and Larson grade 3.96 to 2.78 (Table 1), (p < 0.001). Patients with kissing cartilage lesions had similar results as patients with single cartilage lesions. Table 1 Mean scores and grades at surgery (Tx) and at follow-up Tx Follow-up Score Grade Score Grade ICRS 4 3 Tegner 1 3 Noyes 13 47 Cincinnati 26 4 66 2 Lysholm 33 4 65 3 Larson 44 4 79 3 Conclusion Our results suggest that ACI provides mid-term results in patients with complex cartilage lesions of the knee. If long term results will confirm our findings, ACI may be a considered as a valuable tool for the treatment of complex cartilage lesions of the knee.

Die autologe Knorpelzelltransplantation stellt ein mittlerweile etabliertes Verfahren zur Behandlung isolierter Knorpelschäden am Kniegelenk mit zuverlässigen Behandlungsergebnissen dar. Die Erfahrungen bei Patienten mit fortgeschritten Gelenkschäden sind dagegen begrenzt. Gerade bei jungen Patienten mit hohem Aktivitätsgrad ist aber der Erhalt des Kniegelenkes ein wichtiges Behandlungsziel. Die vorliegende Arbeit berichtet über die Ergebnisse der Behandlung posttraumatischer Gelenkschädigungen bei jungen Patienten unter Verwendung der autologen Knorpelzelltransplantation als einem Bestandteil von Komplextherapien. Zwischen Oktober 2005 und Dezember 2007 wurden 21 Patienten im Rahmen einer prospektiven Fall-Kontroll-Studie (EBM Level II) mit einem durchschnittlichen Alter 42,76 (SD 7,19) Jahren in unserer Klinik mittels autologer Knorpelzelltransplantation bei fortgeschrittenen, in der Regel korrespondierenden, posttraumatischen Schädigungen des Kniegelenkes behandelt. Sämtliche Patienten wurden prospektiv erfasst und präoperativ, sowie 6, 12 und 24 Monate postoperativ mittels standardisierter Scoresysteme (IKDC, Lysholm, ICRS) nachuntersucht. Der Anteil der Begleitoperationen in der Untersuchungsgruppe betrug 90,4% (Partielle Meniskusresektion, Umstellungsosteotomie, Meniskustransplantation, u.a.). Als Vergleichsgruppe diente eine Gruppe von 42 Patienten, die während des gleichen Zeitraumes bei isolierter Knorpelschädigung des Kniegelenkes mittels ACT behandelt wurden. In der Untersuchungsgruppe fand sich ein signifikanter Anstieg (p<0,05) des subjektiven IKDC Scores von 48,66 (SD 13,41) auf 60,64 (SD 14,05) nach 6 Monaten, 65,25 (SD 16,60) nach 12 Monaten, sowie 70,78 (SD 13,85) Punkten nach 24 Monaten. 13 von 21 Patienten (61,9%) berichteten über eine Funktionsbesserung des betroffenen Kniegelenkes zum präoperativen Status 24 Monate nach der Operation. Sowohl die IKDC-Werte, als auch der Anteil der gebesserten Patienten lagen zwei Jahre nach erfolgter Behandlung signifikant unter den Werten der Kontrollgruppe (alle p-Werte<0,05; IKDC 80,95 Punkten SD 12,06, Anteil gebesserter Patienten 85,7%). Analoge Signifikanzen fanden sich für die Funktion des Kniegelenkes nach Lysholm. Die vorliegende Arbeit verdeutlicht, dass die zu erwartenden Behandlungsergebnisse nach autologer Knorpelzelltransplantation in Kombination mit anderen kniegelenkserhaltenden Therapieverfahren bei fortgeschrittenen posttraumatischen Veränderungen ungünstiger sind als bei isolierten Knorpelschädigungen des Kniegelenkes. Dennoch rechtfertigen die vorliegenden Zahlen mit einem großen Anteil an Patienten, die eine gebesserte Kniegelenksfunktion zwei Jahre nach Transplantation erreichen bei jungen Patienten ein solches Vorgehen im Sinne eines „Salvage-Verfahrens“. [Copyright &y& Elsevier]