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Background: Repetitive microtrauma may contribute to osteochondritis dissecans (OCD) lesions of the femoral condyle. The effect of differential loading between OCD weightbearing (WB) zones has not been studied. Purpose: To determine whether clinical and radiographic variables differ by WB zone in lateral femoral condyle OCD lesions. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed a consecutive series of patients aged Results: A total of 62 lateral femoral condyle OCD lesions (mean follow-up, 24.1 months) presented within the study period: 26 WB lesions and 36 nonweightbearing (NWB) lesions. At presentation, no differences between the lesion types were observed in symptom chronicity or symptomatology. NWB lesions were deeper on MRI scans (sagittal depth, 7.11 vs 5.96 mm; P = .046; coronal depth ratio, 0.05 vs 0.01 mm; P = .003), were more likely to develop progeny bone (69.4% vs 44%; P = .047), and demonstrated higher radiographic healing rates (52.8% vs 24%; P = .025) compared with WB lesions. PROMs at follow-up were available for 25 of 62 patients (40.3%), with no statistically significant differences between cohorts at any time. Return to full activity was observed in 72% of WB and 82.1% of NWB lesions ( P = .378). Conclusion: Lateral femoral condyle OCD lesions of the knee in WB and NWB zones presented similarly at initial evaluation; however, NWB lesions demonstrated higher rates of progeny bone formation and radiographic healing at mean 2-year follow-up.

Degradation limits the application of magnesium alloys, and evaluation methods for non-traumatic in vivo quantification of implant degradation and bone formation are imperfect. In the present study, a micro-arc-oxidized AZ31 magnesium alloy was used to evaluate the degradation of implants and new bone formation in 60 male New Zealand white rabbits. Degradation was monitored by weighing the implants prior to and following implantation, and by performing micro-computed tomography (CT) scans and histological analysis after 1, 4, 12, 24, 36, and 48 weeks of implantation. The results indicated that the implants underwent slow degradation in the first 4 weeks, with negligible degradation in the first week, followed by significantly increased degradation during weeks 12-24 (P

Background: Fresh osteochondral allografts (OCAs) are limited in availability. The Missouri Osteochondral Allograft Preservation System (MOPS) has been reported to effectively preserve OCAs twice as long as current tissue bank protocols in preclinical studies. Hypothesis: The viable chondrocyte density (VCD) in OCAs preserved for up to 70 days using the MOPS will not be significantly different from day 0, and the VCD in MOPS-preserved OCAs will be significantly higher than for standard tissue bank preservation. Media changes during preservation will significantly improve the VCD. Study Design: Controlled laboratory study. Methods: Femoral condyles harvested from qualified donors (n = 12) were quartered (n = 48), assigned to 1 of 4 treatment groups (tissue bank protocol at 4°C or MOPS at 25°C, with or without media changes), and preserved for 0, 28, 56, or 70 days and assessed for the VCD and histopathological characteristics. In addition, osteochondral explants were created from the femoral condyles of 12 donors (n = 36 explants), assigned to the same groups and time points, and tested for biomechanical properties. Results: MOPS-preserved OCAs maintained the day 0 VCD through 56 days. OCAs stored using current tissue bank protocols had a significantly lower VCD compared with day 0 and the MOPS by day 28. OCA histological and biomechanical properties did not significantly change from day 0 for any group. Conclusion: The MOPS preserved essential OCA viability and quality at significantly higher levels than current tissue bank protocols for at least 56 days after procurement. Clinical Relevance: Improving the viability and duration of OCA preservation provides potential benefits to tissue banks, donor families, surgeons, and patients with respect to tissue use, financial costs, and outcomes.

Articular cartilage lesions of the tibial plateau are an uncommonly encountered clinical entity, and they have been comparatively less well studied than femoral condyle or patellofemoral defects. The management of these lesions is complicated by the challenging geometry, difficult surgical approach, and proximity to important anatomic structures, and thus, treating these lesions by previously established methods, such as osteochondral allograft transplantation or osteochondral autograft transfer, can be a technically challenging endeavor. These lesions remain readily available to undergo microfracture, and this is the preferred method of management in the senior author's practice. Although less technically difficult and less invasive than other techniques, microfracture is currently limited by concerns over the long-term durability of the method. Current research seeks to improve the quality of cartilage fill stimulated by microfracture, and adjunct techniques have become increasingly popular. In this technical report, we present a technique for arthroscopic treatment of an isolated tibial plateau defect with microfracture using a micronized allogeneic cartilage (BioCartilage; Arthrex, Naples, FL) and platelet-rich plasma adjunct.

Focal articular cartilage injuries in the knee are common and can cause severe morbidity and reduced function. The articular cartilage is avascular and has limited ability to heal, and hence, patients with cartilage injuries have increased risk of progressing to osteoarthritis. Most of the cartilage injuries are located on the femoral condyles. Engaging focal cartilage injuries involving the trochlea are challenging because of the morbidity caused by these injuries and the limited treatment options. Osteochondral allograft transplantation is emerging as a promising treatment for full-thickness articular cartilage defects. Recent studies have reported high success rates with the use of osteochondral allografts. This article reports our technique of osteochondral allograft transplantation for the treatment of a focal full-thickness defect of the trochlea.

The purpose of this study was to evaluate the detailed anatomy of the femoral anterior cruciate ligament (ACL) insertion site, with special attention given to the morphology of the mid-substance insertion areas and the fan-like extension fibers. Twenty-three non-paired human cadaver knees were used (7 Males, 16 Females, median age 83, range 69–96). All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in macroscopic tension patterns. The ACL was carefully dissected and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibers. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The area of each bundle, including and excluding the fan-like extension fibers, was measured with Image J software (National Institution of Health). The width and length of the mid-substance insertion sites were also evaluated using same image. The femoral ACL footprint was divided into four regions (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). The measured areas of the mid-substance insertion sites of the AM and PL bundles were 35.5 ± 12.5, and 32.4 ± 13.8 mm2, respectively. Whole width and length of the mid-substance insertion sites were 5.3 ± 1.4, and 15.5 ± 2.9 mm, respectively. The measured areas of the fan-like extensions of the AM and PL bundles were 27 ± 11.5, and 29.5 ± 12.4 mm2, respectively. The femoral ACL footprint was divided into quarters of approximately equal size (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). For clinical relevance, to perform highly reproducible anatomical ACL reconstruction, the presence of the fan-like extension fibers should be taken into consideration.

The purpose of this study was to compare standard knee arthroscopic and MRI findings and measurements for visualization of the femoral condyle articular cartilage. The hypothesis was that certain posterior cartilage defects identified with MRI may not be accessible with routine arthroscopy.Six cadaveric knees were examined by routine arthroscopy through standard inferomedial and inferolateral portals. Suture anchors were inserted into the femoral condyles at 30°, 60°, 90°, and 120° of flexion as markers of the cartilage surface at the most posterior aspect of the condyle that could be accessed at each degree of flexion. Each specimen was then examined with 3-T MRI and gross dissection. Measurements were obtained and compared.During arthroscopy at 90° of knee flexion, only 5.83 mm of the medial femoral condyle and 6.83 mm of the lateral femoral condyle were visualized posterior to the anchor placed at 90° of flexion. These arthroscopic measurements were statistically significant underestimates of the actual amount of cartilage identified posterior to the 90° anchor at gross dissection (medial condyle, 44.20 mm; lateral condyle, 37.50 mm) and MRI (medial, 41.33 mm; lateral, 38.87 mm). This indicates that 85.9% of the medial and 81.8% of the lateral posterior articular cartilage of the femoral condyle seen at MRI were not visualized during arthroscopy.More than 80% of the articular cartilage proximal to the menisci seen at MRI is not visible during routine arthroscopy. This far posterior articular cartilage should be called the hidden zone.

Background The anterior part of the distal femur in trochlear dysplasia has been well investigated; however, to date, posterior morphological characteristics have not been well studied. This study aimed to evaluate whether the posterior femoral condyle in patients with trochlear dysplasia differs from those without trochlear dysplasia. Methods Computed tomography scans of 75 knees with trochlear dysplasia and 55 knees with normal anatomy of the patellofemoral joint were analyzed retrospectively. Three observers assessed the width, length, and height of the posterior condyle between the two groups. The intra-class correlation coefficient was used to evaluate inter-observer reliability. The independent Student's t -test was used to assess the statistical significance of the qualitative variables. Results There was excellent inter-observer reliability (intra-class correlation coefficient 0.91–0.99) for all of the quantitative measurements. There were significant differences between trochlear dysplastic and normal knees. The trochlear dysplasia group had a larger medial posterior condyle and smaller lateral posterior condyle than the control group. Furthermore, proportion of the posterior condyle in the distal femur markedly differed between the two groups: in the trochlear dysplasia group, the medial posterior condyle accounted for a bigger proportion, while the lateral posterior condyle accounted for a smaller proportion. Conclusion Patients with trochlear dysplasia have different posterior femoral condyles compared with those without trochlear dysplasia. Patients with this condition have bigger medial posterior condyles and smaller lateral posterior condyles. A greater amount of attention needs to be paid to this abnormality.

The infrapatellar adipose body (Hoffa's fat pad, IFP) is situated between the patellar tendon, the femoral condyle and the tibial plateau. The IFP consists of lobules of white adipose tissue delimited by thin connective septa. The actual structural functionality of the IFP is debated and should pertain to a cushioning role in the knee joint, providing to distribute and to damp mechanical stresses during articular activity. The present study is aimed to analyze the correlation between histological configuration and mechanical properties of the IFP, compared to other adipose tissues, partially differentiated by composition and conformation. Histological and ultrastructural methods were exploited to analyze the microscopic anatomies of IFP, knee (KSF) and abdominal (ASF) subcutaneous fat tissues. Numerical micro-models of the different tissues were developed by using histo-morphometric data, as the size of adipose lobules, the thickness of the septa and their composition. Numerical analyses made it possible to evaluate the mechanical functionality of the different fat tissues considering the characteristic loading conditions, as compressive and shear actions. The results pointed out the actual mechanical relevance of IFP and KSF, while ASF exhibited different mechanical properties. Furthermore, the contribution of connective septa and adipose lobules to compressive and shear mechanical behavior was elucidated. This preliminary investigation represents the basis for biomechanical interpretation and the definition of more refined model to be developed on the acquisition of additional histological and morphometric data.

An abnormality of femoral anteversion (FA) is often recognized in patients with osteoarthritis of the hip joint (hip OA). And it is considered that rotation abnormality in the knee and the lower leg occurs as compensation, in cases of FA abnormality. The purpose of this study was to assess the magnitude and variability of FA and femoral condyle rotation (FCR) in order to identify the association between FA and FCR in female patients with hip OA who require total hip arthroplasty. A total of 174 hips from 174 hip OA patients undergoing THA were included in this study. All patients were Asian women (average age: 71.1 years). An equilateral correlation was accepted in FA and FCR. It was thought that FA abnormality might be accompanied by morphological rotation abnormalities of the knee joint. Caution is needed in considering femoral anteversion using the posterior condylar line. We must consider FA in patients undergoing THA after having considered the whole leg rotation.

Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture lateral condyle is very rare. This necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Open reduction and internal fixation is the treatment of choice in managing these types of injuries. This should be followed by gradual mobilization of the affected knee joint. Weight bearing can be started once the fracture starts showing signs of union on X-rays. Literature search shows only one case report describing this pattern. The aim of this case report is to highlight the rarity of this injury, to understand the injury mechanism and surgical approach used for these injuries. The knowledge of this combination will help us manage these injuries so that good functional outcome is achieved

Osteochondritis dissecans progresses to osteoarthritis if integration of the fragment is not obtained. The prognosis of osteochondritis dissecans is more severe in adults, as spontaneous integration due to physeal closure does not occur. Hybrid fixation consists in combining screw fixation of the fragment with mosaicplasty through the fragment to promote integration into the native condyle. We describe this technique with reference to 17 patients.

Introduction: Doppler ultrasonography (USG) is the primary modality for diagnosis of superficial venous reflux caused by incompetence of venous valves of the great saphenous vein (GSV) and usually associated with competence of saphenofemoral junction (SFJ). This study is done to know the cutoff value in size of GSV that safely predicts this junction incompetence. Methods: All varicose vein patients during the study period of January–December 2016 were included in the study. The cases underwent Doppler USG of GSV using Siemens Acuson P500 to identify GSV. The diameter of GSV was measured at the level of femoral condyle in standing position and these were compared with SFJ incompetence. Contralateral limbs which were apparently normal were taken as control limbs if there is no evidence of reflux in SFJ. Results: There were 147 patients with 16 cases (9.81%) where bilateral limb was involved making total cases as 163 limbs and controls as 131 limbs. The mean GSV diameter in disease group was 6.05 mm and in control group was 3.19 mm with P < 0.05. Receiver operating characteristic (ROC) curve of size of GSV at the level of knee and prediction of SFJ incompetence had the ideal curve depicting use of some cutoff value. The point with both best sensitivity and specificity lied on 4.95 mm with sensitivity of 82% and specificity of 83%. Conclusion: We recommend 5 mm as the cutoff value for diameter of GSV at the level of femoral condyle which successfully predicts SFJ incompetence.

Objective The objectives of this study were to record the values of Insall-Salvati (IS) index and its modification in dogs classified into four different body weight groups and to determine whether these index values were influenced by sex. Study Design Bilateral mediolateral radiographs of 86 dogs were obtained. The dogs were classified into four different body weight groups: small, medium, large and giant. The patellar length (PL), caudal and cranial patellar ligament lengths (LLca and LLcr), stifle angle and superimposition of the femoral condyles were measured on the radiographs. The IS index and its modification (LLcr:PL) were calculated by dividing LLca or LLcr by the PL respectively. Spearman's correlation test and analysis of variance were used for statistical analyses. Results The sex of the dog and the presence of enthesophytes at the apex of the patella were two influential factors for the IS and LLcr:PL values. The mean IS values were 1.60 ± 0.28 in small dogs, 1.73 ± 0.27 in medium dogs, 1.82 ± 0.21 in large dogs and 1.97 ± 0.13 in giant dogs. The mean LLcr:PL for the same groups were 2.05 ± 0.23, 2.13 ± 0.19, 2.23 ± 0.21 and 2.27 ± 0.16 respectively. Conclusion The reference intervals for the IS index were 1.04 to 2.16 in the small dogs, 1.19 to 2.27 in the medium dogs, 1.40 to 2.24 in the large dogs and 1.71 to 2.23 in the giant dogs. The reference intervals for the LLcr:PL index were 1.59 to 2.51 in the small dogs, 1.75 to 2.51 in the medium dogs, 1.81 to 2.65 in the large dogs and 1.95 to 2.59 in the giant dogs. Dogs with values exceeding these reference intervals have patella alta and those with values below these intervals have patella baja.

The sagittal geometry of the articular surfaces of the femoral condyles, also called J-Curves because of the letter J-shaped profiles, is one of the main factors affecting knee kinematics in the normal knee[1] as well as artificial knee [2]. For example, Clary et al. [2] showed that large changes in the J-curves’ radii cause abrupt changes in the center of rotation, leading to decreased anterior-posterior stability. In literature, the sagittal profile has been described mathematically by different geometric figures, such as arcs, circles, involutes of a circle, and Archimedean and logarithmic spirals [3]. The circular approximation has been often followed in the different concepts of knee implant designs, such as single- radius-, dual-radius-, or multiple-radius-designs. Single-radius-designs have a fixed flexion-extension axis. Dual-radius-designs consist of a larger distal and smaller posterior radius aiming a higher congruence during low flexion (high loading) and lower congruence at high flexion angles (high mobility). Multi-radius-designs try to mimic a physiological roll-glide ratio. However, the description of these circles is usually not standardized. A summary of different measurement methods was given by Nuno and Ahmed [4].Thereby, the radii are very sensitive regarding the length of the fitting arc [5] and position of the sagittal plane [3]. Nuno and Ahmed [3] found that medial and lateral condyles can be adequately described by two-circular arcs and proposed a quantitative description. However, the posterior limits of their arcs were not considered individually, the anterior limits were defined based on soft-tissue measurements (anterior margins of the menisci), and the sagittal plane was positioned at the posterior extreme points, which might be inadequate in arthritic knees.The goal of this study was to automatically analyse the medial and lateral sagittal profiles of the femoral condyles mathematically by two-circular arcs in a standardized and robust fashion.

Background:Osteochondral autograft transplantation (OAT) is usually performed for a defect that is 2because of the limitations of autografts.Purpose:To present the surgical technique and clinical outcomes of OAT using the eyeglass technique for large osteonecrotic lesions of the femoral condyle (LOFs) (>400 mm2) with residual normal cartilage.Study Design:Cohort study; Level of evidence, 3.Methods:Cases (group 1) included 15 patients (18 knees) who underwent OAT using the eyeglass technique for LOFs with residual normal cartilage, while controls (group 2) included 11 patients (11 knees) who underwent OAT using the standard technique for small osteonecrotic lesions of the femoral condyle (≤400 mm2). Clinical outcomes were evaluated preoperatively and at the final follow-up (group 1, 56 months; group 2, 48 months) according to the International Knee Documentation Committee (IKDC) objective grade, the IKDC subjective score, and the Japanese Orthopaedic Association (JOA) score.Results:The mean lesion size was 685 mm2in group 1 and 230 mm2in group 2. Patients in group 1 had postoperative scores equivalent to those in group 2. The postoperative IKDC subjective scores in group 1 (mean, 86.9) and group 2 (mean, 87.0) showed no significant difference at the final follow-up ( P = .653). For postoperative IKDC objective grades, 83.3% of group 1 and 81.8% of group 2 were graded as “nearly normal” or better, and no significant intergroup difference was found for the IKDC objective grade ( P = .989). Also, no significant intergroup difference was found for the postoperative JOA score (group 1, 93.9; group 2, 81.4; P = .480). Nine second-look arthroscopic procedures were performed in group 1 compared with 4 in group 2, and all patients had plugs that were graded as “nearly normal” or better by the International Cartilage Repair Society classification system.Conclusion:The postoperative results of patients who underwent OAT using the eyeglass technique for large osteonecrotic lesions (>400 mm2) were equivalent to the results of patients who underwent OAT using the standard technique for small osteonecrotic lesions (≤400 mm2).

Background Whether the posterior tibial slope (PTS) is associated with the femoral condylar shape has remained unclear. Classical anatomical studies considered the sagittal profiles of femoral condyles to consist of two circles. Recently, an elliptical method was described to simplify the "two circles" model. Our purpose was to analyze the relationship between the PTS and the shape of the sagittal femoral condyle, that is, two circles and two ellipses, using magnetic resonance imaging (MRI) scans. Methods Eighty right knees of healthy subjects were scanned by MRI at full extension. The medial and lateral PTS were measured (mPTS and lPTS). On the distal-most medial and lateral slices, the femoral condylar articular surfaces were best fitted by circles or ellipses, respectively. The radii of the medial and lateral posterior circles and inferior circles (rm and rl , Rm and Rl , respectively), the semi-major axes and the semi-minor axes of the medial and lateral ellipses (am and al , bm and bl , respectively), and the rm /Rm , bm /am , rl /Rl , bl /al ratios were measured and calculated. Results mPTS correlated significantly with the parameters of the medial condyle (all p .05) or the ratios bl /al and rl /Rl (p = .461 and p = .241, respectively). Conclusion The mPTS is associated with the sagittal shape of the medial femoral condyle but the lPTS is not. Both two circles and two ellipses are feasible ways to represent the sagittal femoral condylar shape.

The aim of this study was to evaluate the effects of three different surgical drilling protocols on changes of implant stability parameters and osseointegration performance during the healing period in rabbit femoral condyles. Thirty New Zealand white rabbits were used in this study. Three experimental groups according to different surgical drilling protocols (undersized, standard and oversized preparation) were designed. Measurements of implant stability parameters were performed immediately after implant insertion and then at 1, 2, 4, and 8 weeks after the operation. After the animals were sacrificed, the bone blocks with implant were prepared for histological evaluation and histomorphometric analysis. The results demonstrated that the ISQ values of each group increased gradually through the whole healing period, while the damping factor showed the opposite tendency. The histomorphometric analysis revealed that BIC (bone-implant contact) values gradually increased with time until 8 weeks of healing at each group. In addition, the undersized group has the highest initial BIC (25.16% ± 7.25%) and the lowest values were found in oversized group (9.13% ± 5.89%). Moreover, a higher correlation (R2 = 0. 9817) between ISQ and BIC values in oversized group and moderate correlations between DF and BIC values in undersized group (R2 = 0.823) were demonstrated. The undersized drilling protocol group presented the highest implant stability and BIC values in the whole healing period, while the similar tendency of results was found between standard and oversized drilling protocol groups. These results suggested that undersized drilling protocol is mechanically and biologically beneficial in low-density bone. The modifications of surgical drilling protocols would influence the predictive value of implant stability parameters for osseointegration performance.

Organic-inorganic oligo(ethylene glycol)-polyhedral oligomeric silsesquioxanes (OEGn-POSS) hybrid materials are woven into macroscopically shaped entities by thiol-ene chemistry. The mechanical behavior and interfacial nature of the OEGn-POSS materials are easily tailored by changing the length of OEGn. The nanostructured OEGn-POSS materials exhibited excellent bioactivity to form hydroxyapatite, whose morphology was also dependent on the molecular weight of OEGn. Among them, OEG2-POSS materials enhanced the in vitro differentiation of adipose-derived stem cells to osteoblasts and promoted the in vivo bone formation within a femoral condyle defect site, but they could be limited by the mismatch rates between the degradation and new bone formation. Thus, OEG2-POSS could be practically applied for bone regeneration by optimizing the degradation rate based on its key structural features, which would be of great benefit to bone tissue engineering in the future.

Background:Previous work has demonstrated that patients with cartilage defects of the knee benefit from arthroscopic transplantation of autologous synovial mesenchymal stem cells (MSCs) in terms of magnetic resonance imaging (MRI), qualitative histologic findings, and Lysholm score. However, the effectiveness was limited by the number of cells obtained, so large-sized defects (>500 mm2) were not investigated. The use of MSC aggregates may enable treatment of larger defects by increasing the number of MSCs adhering to the cartilage defect.Purpose:To investigate whether transplantation of aggregates of autologous synovial MSCs with 2-step surgery could promote articular cartilage regeneration in microminipig osteochondral defects.Study Design:Controlled laboratory study.Methods:Synovial MSCs derived from a microminipig were examined for in vitro colony-forming and multidifferentiation abilities. An aggregate of 250,000 synovial MSCs was formed with hanging drop culture, and 16 aggregates (for each defect) were implanted on both osteochondral defects (6 × 6 × 1.5 mm) created in the medial femoral condyle and femoral groove (MSC group). The defects in the contralateral knee were left empty (control group). The knee joints were evaluated at 4 and 12 weeks by macroscopic findings and histology. MRI T1rho mapping images were acquired at 12 weeks. For cell tracking, synovial MSCs were labeled with ferucarbotran before aggregate formation and were observed with MRI at 1 week.Results:Synovial MSCs showed in vitro colony-forming and multidifferentiation abilities. Regenerative cartilage formation was significantly better in the MSC group than in the control group, as indicated by International Cartilage Repair Society score (macro), modified Wakitani score (histology), and T1rho mapping (biochemical MRI) in the medial condyle at 12 weeks. Implanted cells, labeled with ferucarbotran, were observed in the osteochondral defects at 1 week with MRI. No significant difference was noted in the modified Wakitani score at 4 weeks in the medial condyle and at 4 and 12 weeks in the femoral groove.Conclusion:Transplantation of autologous synovial MSC aggregates promoted articular cartilage regeneration at the medial femoral condyle at 12 weeks in microminipigs.Clinical Relevance:Aggregates of autologous synovial MSCs could expand the indications for cartilage repair with synovial MSCs.

Background:Previous studies showed clinical benefit and durable results of osteochondral allograft (OCA) transplantation for the treatment of femoral condyle lesions. However, the majority of these studies are difficult to interpret owing to the mixed results of different techniques and anatomic locations.Purpose:To evaluate the outcome of OCA transplantation with thin plug grafts for treatment of isolated femoral condyle osteochondral lesions.Study Design:Case series; Level of evidence, 4.Methods:This study included 187 patients (200 knees) who underwent OCA transplantation for isolated osteochondral lesions on the femoral condyle between 1999 and 2014. For all cases, a thin plug technique was used with commercially available surgical instruments and the minimum amount of bone necessary for fixation. Evaluation included International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and patient satisfaction. Frequency and type of further surgery were assessed. Failure of the allograft was defined as further surgery involving removal of the allograft.Results:Mean follow-up was 6.7 years (range, 1.9-16.5 years). The mean age of patients at the time of surgery was 31 years, and 63% were male. The medial femoral condyle was affected in 69% of knees. A single thin plug graft was used in 145 knees (72.5%), and 2 grafts were used in 55 knees (27.5%). Mean allograft area was 6.3 cm2, and graft thickness was 6.5 mm (cartilage and bone combined). Further surgery was required for 52 knees (26%), of which 16 (8% of entire cohort) were defined as allograft failures (4 OCA revisions, 1 arthrosurface, 6 unicompartmental knee arthroplasties, and 5 total knee arthroplasties). Median time to failure was 4.9 years. Survivorship of the allograft was 95.6% at 5 years and 91.2% at 10 years. Among patients with grafts remaining in situ at latest follow-up, clinically meaningful improvement in pain, function, and quality of life was reported. Satisfaction was reported by 89% of patients.Conclusion:OCA transplantation with a thin plug graft technique is a valuable procedure for the treatment of femoral condyle osteochondral lesions, resulting in significant improvement in clinical scores, high patient satisfaction, and low reoperation and clinical failure rates.

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Background: The arterial supply to the chondroepiphysis is of paramount importance for proper nutrition and development. Previous animal studies had demonstrated that ischemic necrosis of the chondroepiphysis plays an important role in subsequent development of osteochondritis dissecans (OCD). Previous studies using susceptibility weighted imaging, a magnetic resonance image (MRI) sequence, demonstrated a pattern of disappearance of the arterial system over time at predilection sites for OCD lesions. The purposed of this study is to quantify distribution of the arterial perfusion in different zones of the immature distal femoral chondroepiphysis. Methods: We utilized 5 fresh frozen skeletally immature human cadaver knees (aged 0-6 months). The superficial femoral artery was cannulated proximal to the knee joint and major arteries distal to the knee joint were tied off. For volumetric analysis, comparisons were performed between contrast-enhanced and pre-contrast MRI. Regions of interest were developed to quantify the contrast enhancement in different zones of the chondroepiphysis, excluding the secondary ossification center. (Fig.1) Results: Quantitative MRI analysis demonstrated equivalent enhancement within the medial and lateral condyles in the 5 month and one of the 2 month specimens. The 0 month and 6 month specimens demonstrated greater enhancement in the medial condyle. One of the 2 months specimen demonstrated greater perfusion in the lateral condyle. The distal condyle analysis demonstrated equivalent enhancement in the 0 month, one of the 2 months and the 6 months specimens. The 5 month specimen demonstrated greater enhancement in the lateral distal condyle. The other 2 months specimen demonstrated greater enhancement in the medial distal condyle. The posterior condyle analysis demonstrated greater enhancement in the posterior lateral condyle in one of the 2 month specimen, and the 5 month and the 6 month specimens. The 0 month specimen demonstrated greater enhancement in the medial side. The other 2 month specimen demonstrated equivalent enhancement between medial and lateral side. Analyzing the medial condyle revealed equivalent enhancement in the medial and lateral zone in the 5 month and 6 month specimens. The 0 month specimen demonstrated greater enhancement laterally. Both 2 months specimens demonstrated greater enhancement in the medial side. Conclusion: This study expands the knowledge on the vascularity of the developing distal femoral chondroepiphysis, which may have an impact on our future understanding of OCD etiology, physeal growth, and peri-articular infections. The majority of the specimens demonstrated diminished perfusion in the posterior aspect of the medial femoral condyle when compare to the lateral posterior condyle. This is where the predilected area for the development of OCD lesions is located. Future studies in human and other mammals susceptible to knee OCD, along with the ongoing development of animal models of OCD will benefit from this information.

The fabella syndrome and the Iliotibial band friction syndrome are the most frequent friction syndromes of the knee. The syndrome related to the fabella is relatively rare and more frequent in young athletes, such as high-performance runners. Fabella syndrome has been linked to the increase in tensile forces of the lateral part of the knee, although it is not clear because only some people develop the syndrome. The excessive increase in internal rotation of the knee in competition sports leads to torsional strain on the iliotibial band, with compression of the highly innervated adipose tissue between the iliotibial band and femoral condyle, so Iliotibial band syndrome is a frequent injury among competitive cyclists and long-distance runners. Ultrasonography is a very useful tool in the diagnosis and during the follow-up of the friction syndromes of the knee.

For larger lesions (>2.5-cm2), clinical evidence and practice have shown that fresh osteochondral allograft have good durability, with 88% return to sport and greater than 75% 10-year survival rates for treatment of large femoral condyle lesions. That said, the use of fresh osteochondral allografts in clinical practice is limited by the availability of acceptable donor tissues for eligible patients in a timely fashion. Significant diminution of chondrocyte viability and density occurs during the preservation and storage period. All osteochondral allografts are not equal in performance and outcome. Chondrocyte density and viability are critical for successful transplantation and outcome in the short and long term. This commentary highlights the high failure rates of tissue when it is acellular.

Background: Differences in tibiofemoral articular morphology are associated with risks of anterior cruciate ligament (ACL) injury. Purpose: To determine whether bony and cartilaginous morphological characteristics are related to ACL injury in pediatric patients and to investigate any differences according to sex. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 200 skeletally immature Korean patients from a single institution were included in this study; 100 patients had an ACL injury, and 100 had an intact ACL. Condylar morphology and tibial slopes were evaluated and compared between the groups, and differences between sexes were evaluated in the ACL-injured group. Results: The lateral femoral curvature was significantly greater and the lateral and medial tibial curvatures were significantly smaller in the ACL-injured group than in the intact group ( P < .01 for all). In addition, the lateral and medial femoral curvatures as well as the lateral tibial curvature were significantly smaller in female than in male patients ( P < .01 for all). Both the medial and lateral tibial slopes were greater in the ACL-injured versus intact group (medial slope, 5.5° vs 5.0°; lateral slope, 3.0° vs 1.3°, respectively); this difference was statistically significant for lateral tibial slope ( P = .026). No sex-based differences were found for medial or lateral tibial slope. Conclusion: Femoral and tibial curvatures as well as lateral tibial slope were significantly different between the ACL-injured and ACL-intact patients, and the lateral tibial curvature was significantly smaller in female than in male patients. Medial and lateral tibial slopes were not associated with a significant difference in ACL injury between male and female patients.