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Objective: To study progression of tooth wear quantitatively in a convenient sample of young adults and to assess possible correlations with occlusal conditions. Methods: Twenty-eight dental students participated in a three-year follow up study on tooth wear. Visible wear facets on full arch gypsum casts were assessed using a flatbed scanner and measuring software. Regression analyses were used to assess possible associations between the registered occlusal conditions 'occlusal guidance scheme', 'vertical overbite', 'horizontal overbite', 'depth of sagittal curve', 'canine Angle class relation', 'history of orthodontic treatment', and 'self-reported grinding/clenching' (independent variables) and increase of wear facets (dependent variable). Results: Mean increase in facet surface areas ranged from 1.2 mm2 (premolars, incisors) to 3.4 mm2 (molars); the relative increase ranged from 15% to 23%. Backward regression analysis showed no significant relation for 'group function', 'vertical overbite', 'depth of sagittal curve', 'history of orthodontic treatment' nor 'self-reported clenching. The final multiple linear regression model showed significant associations amongst 'anterior protected articulation' and 'horizontal overbite' and increase of facet surface areas. For all teeth combined, only 'anterior protected articulation' had a significant effect. 'Self reported grinding' did not have a significant effect (p > 0.07). Conclusions: In this study 'anterior protected articulation' and 'horizontal overbite', were significantly associated with the progression of tooth wear. Self reported grinding was not significantly associated with progression of tooth wear. Clinical significance: Occlusal conditions such as anterior protected articulation and horizontal overbite seem to have an effect on the progression of occlusal tooth wear in this convenient sample of young adults. [ABSTRACT FROM AUTHOR]

Fokkinga WA, Le Bell A-M, Kreulen CM, Lassila LVJ, Vallittu PK, Creugers NHJ.Ex vivofracture resistance of direct resin composite complete crowns with and without posts on maxillary premolars.International Endodontic Journal,38, 230–237, 2005.To investigateex vivothe fracture resistance and failure mode of direct resin composite complete crowns with and without various root canal posts made on maxillary premolars.The clinical crowns of 40 human extracted single-rooted maxillary premolars were sectioned at the cemento-enamel junction. The canals were prepared with Gates Glidden drills up to size 4. Thirty samples were provided with standardized post spaces in the palatal canal and all roots were embedded in acrylic. Minimal standardized preparations in the canal entrances were made. Groups of 10 samples were treated with (i) prefabricated metal posts, (ii) prefabricated glass fibre posts, (iii) custom-made glass fibre posts, and (iv) no posts (control). Posts were cemented with resin cement and resin composite complete crowns were made. All specimens were thermocycled (6000×, 5–55 °C). Static load until fracture was applied using a universal loading device (crosshead speed 5 mm min−1) at a loading angle of 30°. Failure modes were categorized as favourable and unfavourable failures.No significant difference was observed between the mean failure loads (group 1: 1386 N, group 2: 1276 N, group 3: 1281 N, and group 4: 1717 N,P > 0.05), nor between frequencies of failure modes (P > 0.05). All failures were fractures of the resin composite crown in combination with tooth material (cohesive failures).Within the limits of this laboratory investigation it is concluded that severely damaged and root filled maxillary premolars, restored with direct resin composite complete crowns without posts have similar fracture resistances and failure modes compared to those with various posts, which suggest that posts are not necessarily required. [ABSTRACT FROM AUTHOR]

Polymerization shrinkage of resin composites may impair restoration longevity. It is hypothesized that layering, rather than bulk, techniques result in less stress in the tooth-restoration complex. The aim of this study was to compare shrinkage stresses for different restorative techniques used for cusp-replacing restorations with direct resin composite. In a 3-D FE model, the dynamic process of shrinkage during polymerization was simulated. Time-dependent parameters (shrinkage, apparent viscosity, Young's modulus, Poisson ratio, and resulting creep), which change during the polymerization process, were implemented. Six different restorative procedures were simulated: a chemically cured bulk technique, a light-cured bulk technique, and 4 light-cured layering techniques. When polymerization shrinkage is considered, a chemically cured composite shows the least resulting stress. The differences seen among various layering build-up techniques were smaller than expected. The results indicate that the stress-bearing locations are the interface and the cervical part of the remaining cusp. [ABSTRACT FROM AUTHOR]

Shortened dental arches consisting of anterior and premolar teeth have been shown to meet oral functional demands. However, the occlusal stability may be at risk as a result of tooth migration. The aim of this nine-year study was to investigate occlusal stability in shortened dental arches as a function over time. Occlusal stability indicators were: 'interdental spacing', 'occlusal contacts of anterior teeth in Intercuspal Position', 'overbite', 'occlusal tooth wear', and 'alveolar bone support'. Subjects with shortened dental arches (n =74) were compared with subjects with complete dental arches (controls, n =72). Repeated-measurement regression analyses were applied to assess age-dependent variables in the controls and to relate the occlusal changes to the period of time since the treatment that led to the shortened dental arches. Compared with complete dental arches, shortened dental arches had similar overbite and occlusal tooth wear. They showed more interdental spacing in the premolar regions, more anterior teeth in occlusal contact, and lower alveolar bone scores. Since the differences remained constant over time, we conclude that shortened dental arches can provide long-term occlusal stability. Occlusal changes were self- limiting, indicating a new occlusal equilibrium. [ABSTRACT FROM AUTHOR]

This paper describes the application technique of direct shaping by occlusion (DSO) for large composite restorations including the entire occlusal surface. For this technique, matrix bands and wedges are inserted without interference with antagonists in the desired occlusion. The final increment of soft-composite resin is shaped by letting the patient occlude on the uncured composite. Due to the nature of the technique, special care has to be taken for moisture control and handling of contamination. The procedure, advantages, and limitations of the technique are discussed. [ABSTRACT FROM AUTHOR]

The integration of dentistry into primary health care is crucial for promoting patient well-being. However, clinical studies in dentistry face challenges, including issues with study design, transparency, and relevance to primary care. Clinical trials in dentistry often focus on specific issues with strict eligibility criteria, limiting the generalizability of findings. Randomized clinical trials (RCTs) face challenges in reflecting real-world conditions and using clinically relevant outcomes. The need for more pragmatic approaches and the inclusion of clinically relevant outcomes (CROs) is discussed, such as tooth loss or implant success. Solutions proposed include well-controlled observational studies, optimized data collection tools, and the integration of artificial intelligence (AI) for predictive modelling, computer-aided diagnostics and automated diagnosis. In this position paper advocates for more efficient trials with a focus on patient-centred outcomes, as well as the adoption of pragmatic study designs reflecting real-world conditions. Collaborative research networks, increased funding, enhanced data retrieval, and open science practices are also recommended. Technology, including intraoral scanners and AI, is highlighted for improving efficiency in dental research. AI is seen as a key tool for participant recruitment, predictive modelling, and outcome evaluation. However, ethical considerations and ongoing validation are emphasized to ensure the reliability and trustworthiness of AI-driven solutions in dental research. In conclusion, the efficient conduct of clinical research in primary care dentistry requires a comprehensive approach, including changes in study design, data collection, and analytical methods. The integration of AI is seen as pivotal in achieving these objectives in a meaningful and efficient way., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

The diagnosis and management of chronic nonspinal osteomyelitis can be challenging, and guidelines regarding the appropriateness of performing percutaneous image-guided biopsies to acquire bone samples for microbiological analysis remain limited. An expert panel convened by the Society of Academic Bone Radiologists developed and endorsed consensus statements on the various indications for percutaneous image-guided biopsies to standardize care and eliminate inconsistencies across institutions. The issued statements pertain to several commonly encountered clinical presentations of chronic osteomyelitis and were supported by a literature review. For most patients, MRI can help guide management and effectively rule out osteomyelitis when performed soon after presentation. Additionally, in the appropriate clinical setting, open wounds such as sinus tracts and ulcers, as well as joint fluid aspirates, can be used for microbiological culture to determine the causative microorganism. If MRI findings are positive, surgery is not needed, and alternative sites for microbiological culture are not available, then percutaneous image-guided biopsies can be performed. The expert panel recommends that antibiotics be avoided or discontinued for an optimal period of 2 weeks prior to a biopsy whenever possible. Patients with extensive necrotic decubitus ulcers or other surgical emergencies should not undergo percutaneous image-guided biopsies but rather should be admitted for surgical debridement and intraoperative cultures. Multidisciplinary discussion and approach are crucial to ensure optimal diagnosis and care of patients diagnosed with chronic osteomyelitis., (© RSNA, 2024.)

Objectives: This study aimed to compare the success and survival rates of metal-ceramic crowns and composite resin restorations applied in root filled teeth that received a glass fiber post., Methods: A prospective, randomized controlled trial, with equivalent parallel groups was designed. Eighty-two teeth were randomly allocated to the metal-ceramic or composite resin groups. Multivariate Cox regression analysis with shared frailty for patients and Kaplan-Meier curves were performed using success and survival rates (p<0.05)., Results: Seventy-five post-retained restorations (34 metal-ceramic crowns and 41 composite restorations) in 62 patients were analyzed. The median follow-up was 8.1 years [IQR 4.0-9.9]. Twenty-seven failures were observed. Twenty-two failures (81.5 %) were observed in the composite resin group, of which six (27.3 %) were not repairable. Five failures (18.5 %) were observed in the metal-ceramic crown group, of which three (66.6 %) were non-repairable. The cumulative success rate at 8 years was 85.0 % for crowns (AFR=1.31 %) and 43.2 % for composite resins (AFR=6.58 %), while the survival rate was 93.8 % for crowns (AFR=0.52 %) and 97.6 % for composite resins (AFR=0.20 %). Considering the success rates, adjusted multivariate Cox regression showed that composite resin had a Hazard Ratio of 5.07 (95 %CI, 1.99-12.89) greater than the metal-ceramic crown. No significant difference in the failure risk was observed when the survival rates were considered (HR=0.38, 95 %CI (0.10 - 1.44), p = 0.156). Co-variables did not affect the success and survival rates (p>0.05)., Conclusions: Metal-ceramic crowns showed a higher success rate than composite restorations. The survival rates were similar, but composite restorations presented a higher need for repairs., Clinical Significance: Post-retained composite restorations may need more reinterventions during the lifecycle, although more preservation of sound tooth structure is expected with a large restoration of resin post-and-core. These aspects have to be discussed with the patient for decision-making planning., Competing Interests: Declaration of competing interest The authors listed in the Title Page declare no conflict of interest regarding the submitted manuscript entitled ‘Crown vs. composite for glass fiber post-retained restorations: an 8-year randomized clinical trial’., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: The treatment of Lisfranc injuries continues to evolve with time. The purpose of this study was to report early outcomes of patients with Lisfranc ligamentous injuries treated with the Arthrex InternalBrace, which has benefits to other previously described techniques., Materials and Methods: We retrospectively identified 15 adult patients with Lisfranc injuries that were treated via open reduction internal fixation with the Arthrex InternalBrace (Naples, Fl). These patients were identified at two separate United States institutions between 2019 and 2022. Demographic data, mechanism of injury, and concomitant foot injuries were recorded. Outcomes were assessed by return-to-work or sport and time to weight-bearing. Secondary complications or revision surgeries were noted., Results: The mean patient age was 35 years. Eight patients had isolated Lisfranc ligamentous injuries and seven had additional intercuneiform instability, which required a supplemental limb of the fixation device. The most common mechanism of injury was a cutting/pivoting maneuver ( n  = 5) followed by fall ( n  = 4). The mean radiographic follow-up time was 7.3 months. The average time to weight-bearing as tolerated was 6.6 weeks (± 2.2). The average time to return-to-work/sport as tolerated was 14.1 weeks (± 3.6). Only two minor complications were noted at follow-up but no major complications or revision surgeries occurred., Conclusions: The outcomes of this case series suggest that the Arthrex InternalBrace is a viable option when performing open reduction and internal fixation of Lisfranc ligamentous injuries. Future prospective studies are needed to directly compare this device with alternative fixation methods., Competing Interests: Conflict of InterestThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Hoskins, Wise, Unangst, and Shaheen have no financial interests. Kreulen, Aynardi, and Giza have previously received funding for research and for general consulting from Arthrex Inc. but no direct funding or incentives were provided for conducting this particular investigation., (© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2024.)

The purpose of root canal posts is to obtain additional retention for build-up restorations of endodontically treated teeth so they can be functionally reconstructed. Due to developments in adhesive dentistry and a lack of clinical evidence, root canal posts are used less and less. Currently, the advice of the European Society of Endodontology is to use a root canal post only in front teeth and premolars in the absence of remaining coronal dentine walls. It is important to avoid additional preparation when placing a root canal post, because this causes (additional) weakness of the tooth. The loss of dental tissue due to preparation cannot be compensated for by placing a post.

Objective: The study aimed to evaluate survival and failure behavior of Direct Composite Restorations (DRC) and Indirect Composite Restorations (ICR) on molars and anterior teeth, in a Randomized Controlled Trial (RCT)., Methods: Patients with generalized severe tooth wear were included, and randomly assigned to one of 2 protocols: (1) DCR: All teeth were restored with directly applied micro-hybrid composite restorations (Clearfil AP-X, Kuraray) for load bearing areas and nano-hybrid composite restorations (IPS Empress Direct, Ivoclar Vivadent) for buccal veneers; (2) ICR: First molars were restored with indirect composite 'tabletop' restorations and maxillary anterior teeth were restored with indirect palatal veneer restorations (Clearfil Estenia C&B, cemented with Panavia F, Kuraray). Remaining teeth were restored directly. Restorations were evaluated after 3 years, focusing on clinical acceptability. Statistical analysis was performed using Kaplan Meier curves, Annual Failure Rates (AFRs), and univariate Cox regression analyses (p < 0.05)., Results: 41 patients (age: 36.6 ± 6.6y) were evaluated after 3 years (40.0 ± 2.2 m). 408 restorations on first molars and palatal veneers on maxillary anterior teeth were part of this RCT, with 220 DCRs and 188 ICRs. No differences in survival between treatment modality for palatal veneers for any failure criteria were found. Tabletop restorations on first molars showed a considerable higher failure rate for ICR compared to DCR (p = 0.026, HR: 3.37, 95%CI = 1.16-9.81)., Significance: In this RCT, directly applied composite restorations showed superior behavior compared to the indirect composite restorations, when used in the molar region., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified., Methods: A retrospective chart review of 649 patients was performed who underwent elective foot and ankle surgery. Six hundred thirty-one patient charts were included in the final analysis. Evaluated were patients who did and did not receive postoperative oral antibiotics in order to identify whether a difference in infection rate or wound healing occurred. The study also evaluated risk factors for developing infection following foot and ankle surgery., Results: The number of infections in patients receiving postoperative oral antibiotics was 6 (3%), while the number of infections in those who did not receive postoperative oral antibiotics was 10 (2%) ( P = .597). The difference of deep versus superficial infections and delays in wound healing between the 2 groups was not statistically significant. Patients who developed infections were older and had a higher prevalence of hypertension, a history of neoplasm, and a greater American Society of Anesthesiologists Classification of Physical Health., Conclusion: This study suggests that routine use of postoperative antibiotics in foot and ankle surgery does not affect wound complications or infection rates. Additionally, patients who are older and those with multiple medical problems may be at higher risk for developing postoperative infection following foot and ankle surgeries., Level of Evidence: Level III, retrospective comparative series.

Syndesmotic instability is a source of significant pain and disability. Both subtle instability and gross diastasis, whether acute or chronic, require stabilization and may benefit from reconstruction with ligamentous augmentation. The use of nonabsorbable suture-tape has emerged as a promising operative strategy, allowing surgeons to anatomically reconstruct the syndesmosis, in particular the anterior inferior tibiofibular ligament. The current work provides a detailed description of the technique and preliminary results of a patient cohort treated using nonabsorbable suture-tape for syndesmotic augmentation. Level of Evidence: Level V, expert opinion.

Background. The aim of this study was to determine the accuracy of ankle arthroscopy as a means for diagnosing syndesmotic reduction or malreduction and to determine anatomical landmarks for diagnosis. Methods. Six matched-pair cadavers (n = 12) with through-knee amputations were studied. Component parts of the syndesmosis and distal 10 cm of the interosseous membrane (IOM) were sectioned in each. The 12 specimens were divided into 2 groups: 6 specimens in the in-situ group fixed with suture button technique and 6 specimens in the malreduced group rigidly held with a 3.5-mm screw. Specimens were randomized to undergo diagnostic arthroscopy by 3 fellowship-trained foot and ankle orthopaedic surgeons in a blinded fashion. Surgeons were asked to determine if the syndesmosis was reduced or malreduced and provide arthroscopic measurements of their findings. Results. Of 36 arthroscopic evaluations, 34 (94%) were correctly diagnosed. Arthroscopic measurement of 3.5 mm diastasis or greater at the anterior aspect of the distal tibiofibular syndesmosis correlated with a posteriorly malreduced fibula. Arthroscopic evaluation of the Anterior inferior tibiofibular ligament (AITFL), IOM, Posterior inferior tibiofibular ligament (PITFL), lateral fibular gutter, and the tibia/fibula relationship were found to be reliable landmarks in determining syndesmotic reduction. An intraclass correlation coefficient (ICC) for interrater reliability of 1.00 was determined for each of these landmarks between 2 surgeons (P < .001). The ICCs between 2 surgeons' measurements and the computed tomography measurements were found to be 0.896 (P value < .001). Conclusions. Ankle arthroscopy is a reliable method to assess syndesmotic relationship when reduced in situ or posteriorly malreduced 10 mm. Levels of Evidence: Level V: Cadaveric.

Level of Evidence: Level V, expert opinion.

Tarsal tunnel syndrome (TTS) is a relatively uncommon compression neuropathy caused by impingement of the tibial nerve or one of the terminal branches. The presence of accessory musculature at the posteromedial aspect of the ankle has been identified as a rare cause of this condition. Despite the rarity of this condition, it must be considered in patients with refractory symptoms consistent with tibial nerve dysfunction. The accurate diagnosis of this condition relies heavily on a detailed history and physical examination, adequate imaging read by both surgeon and trained musculoskeletal radiologist, as well as a high level of suspicion for such pathology. In this case report, we describe a 46-year-old male with history, examination, and imaging all consistent with TTS secondary to accessory musculature. Following excision of an accessory soleus and flexor digitorum accessorius longus, as well as simultaneous tarsal tunnel release, the patient experienced full resolution of his symptoms. This highlights the importance of considering accessory musculature as a potential cause of TTS in patients presenting with tibial compression neuropathy. Levels of Evidence: Level V: Case Report.

Injuries to the Lisfranc complex range from purely ligamentous disruptions to fracture-dislocations of the tarsometatarsal joint. Treatment options include closed/open reduction with percutaneous pinning, open reduction and internal fixation (ORIF), and primary arthrodesis. We present a ligament reinforcement technique utilizing a flexible fixation device for the treatment of ligamentous Lisfranc injuries. Level of Evidence: Level V, expert opinion.

Purpose: The aim of this study was to investigate the biomechanical properties of the InternalBrace for lisfranc injuries., Methods: A Sawbone model was developed comparing screw, suture button and InternalBrace., Results: When loaded in axial tension at 0.5 mm/s, the screw was stiffest (2,240 N/mm), while the InternalBrace (200 N/mm) was stiffer than the suture button (133 N/mm). Cyclic loading with 10,000 cycles of 69 N, 138 N, and 207 N showed the InternalBrace maintained stiffness, but fatigued earlier than the suture button., Conclusion: The mechanical properties of the InternalBrace support clinical use, but further studies are needed regarding early weight bearing., Competing Interests: J.H. has nothing to disclose. K.N. has nothing to disclose. N.H. has nothing to disclose. T.S. has nothing to disclose'. C.K reports the following disclosures: Consultant: Arthrex, Inc., Zimmer, Inc. T.G. has nothing to disclose. B.C. has nothing to disclose. E.G. reports the following disclosures: Consultant for Arthrex, Inc., Zimmer, Inc.; Fellowship and Grant Funding: Arthrex, Inc., Zimmer, Inc., (© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

A select 10-30% of patients with recurrent lateral ankle sprains develop chronic ankle instability (CAI). Patients with chronic ankle instability describe a history of the ankle "giving way" with or without pathological laxity on examination. Evaluation includes history, identification of predisposing risk factors for recurrent sprains, and the combination of clinical tests (eg, laxity tests) with imaging to establish the diagnosis. There are a variety of nonoperative strategies to address chronic ankle instability, which include rehabilitation and taping or bracing to prevent future sprains. Patients who fail conservative treatment are candidates for surgery. The anatomic approaches (eg, modified Broström) are preferred to nonanatomic procedures since they recreate the ankle's biomechanics and natural course of the attenuated ligaments. There is a growing interest in minimally invasive procedures via ankle arthroscopy that also address the associated intra-articular disorders. This article provides a review of chronic lateral ankle instability consisting of relevant anatomy, associated disorders, evaluation, treatment methods, and complications., Level of Evidence: Level V, expert opinion., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Eric Giza, MD, reports Arthrex, Inc., fellowship support. ICMJE forms for all authors are available online., (© The Author(s) 2019.)

The ankle is one of the most commonly injured joints in soccer and represents a significant cost to the healthcare system. The ligaments that stabilize the ankle joint determine its biomechanics-alterations of which result from various soccer-related injuries. Acute sprains are among the most common injury in soccer players and are generally treated conservatively, with emphasis placed on secondary prevention to reduce the risk for future sprains and progression to chronic ankle instability. Repetitive ankle injuries in soccer players may cause chronic ankle instability, which includes both mechanical ligamentous laxity and functional changes. Chronic ankle pathology often requires surgery to repair ligamentous damage and remove soft-tissue or osseous impingement. Proper initial treatment, rehabilitation, and secondary prevention of ankle injuries can limit the amount of time lost from play and avoid negative long-term sequelae (eg, osteochondral lesions, arthritis). On the other hand, high ankle sprains portend a poorer prognosis and a longer recovery. These injuries will typically require surgical stabilization. Impingement-like syndromes of the ankle can undergo an initial trial of conservative treatment; when this fails, however, soccer players respond favorably to arthroscopic debridement of the lesions causing impingement. Finally, other pathologies (eg, stress fractures) are highly encouraged to be treated with surgical stabilization in elite soccer players., Competing Interests: Authors' Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Osteochondral lesions of the talus often occur following ankle sprains and fractures. Operative intervention is typically required because of the diminished intrinsic repair capability of talar articular cartilage. Several techniques have evolved that emphasize replacing the defect with cartilage that closely mimics the biological properties of hyaline articular cartilage. The goals of operative treatment are resolution of symptoms, physiologic healing, and restoration of function while eliminating the need for further intervention. This article describes a novel, single-step technique for the treatment of osteochondral lesions of the talus with the use of particulated autograft cartilage implantation., Levels of Evidence: Level V.

Background: Osteochondral lesions of the talus (OLT) are difficult to treat because of the poor intrinsic healing capability of articular cartilage. Matrix-induced autologous chondrocyte implantation (MACI) has been shown to be a reliable method for treating cartilage lesions that fail to respond to traditional microfracture and debridement. The purpose of this study was to assess 7-year clinical follow-up data of this technique and demonstrate midterm success of this implant., Methods: A prospective investigation of MACI was performed on 10 patients with OLTs who had failed previous arthroscopic treatment. In all, 5 male and 5 female patients were included in the study. Of the 10 patients, 9 were available for 7-year follow-up. Functional and clinical evaluations were done at 7 years postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot evaluation and the Short Form Health Survey (SF-36) and compared with preoperative values., Results: SF-36 data at 7 years showed significant improvements in Physical Functioning (P < .01), Lack of Bodily Pain (P < .1), and Social Functioning (P < .001) compared with preoperative data. The mean AOFAS hindfoot scores of the 9 patients at 7 years was 78.3 ± 18.1 (P = .05) compared with their preoperative mean of 61.8 ± 14.3., Conclusions: MACI provides a stable midterm chondral replacement strategy for osteochondral lesions that fail initial microfracture., Levels of Evidence: Level IV: Prospective case series.