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This Technical Note describes the full arthroscopic one-stage treatment of high-grade osteochondritis dissecans of the humeral capitellum of the elbow joint by means of minced cartilage implantation.

Motion capture analysis (MCA) has the advantage of providing a static and dynamic leg axis analysis without radiation. Nevertheless, there is a lack of evidence regarding the accuracy of this technique. To test whether mechanical femorotibial axis angle (MAA) measurement recorded with a non-invasive MCA system is equal to the gold standard static long-standing full-leg radiographs (LSX) and if the degree of malalignment or other parameters (BMI, body mass, height, age) influence the accuracy, a total of 102 consecutive patients were examined using LSX and MCA. Static as well as all gait motion phases at 3 km/h were analyzed regarding the difference between the two angles. There was no statistical difference for MAA between LSX (MAArad) and MCA (MAAstat) (p = 0.091). There was a strong correlation (rs = 0.858, p < 0.001) between the two methods. The highest accuracy was detected for values of standing MCA. Also, the gait MCA values showed strong correlation with LSX but weaker correlation compared to standing MCA (initial swing rs = 0.549; terminal stance rs = 0.815; p < 0.001). BMI, body mass, and height did not influence the accuracy of MCA. MCA enables frontal alignment analysis with high accuracy and without the side effect of radiation.

Objective Treatment of circumscribed cartilage defects in the first metatarsophalangeal joint (MTP1) using autologous cartilage fragments. Indications Full thickness cartilage defects (ICRS IV) or focal osteoarthritis in combination with hallux rigidus. Contraindications Pre-existing ankylosis of the metatarsophalangeal joint; global osteoarthritis of the joint; advanced osteoarthritis of the sesamoidal articulation; osteonecrotic cysts in the head of the first metatarsal bone. Surgical technique Preparation of the metatarsophalangeal joint. Mobilization of the first metatarsal head. Harvesting of the cartilage fragments from the dorsal rim portion as part of the cheilectomy. Mincing the cartilage fragments with a 3.0 mm shaver in sterile conditions. Augmenting the cartilage fragments with autologous conditioned plasma (ACP). Preparing the defect area and creation of a "contained" defect. Replantation of the resulting minced cartilage mass into the defect of the articular surface on the first metatarsal head. Postoperative management Immobilization of the MTP1 for 48 h. Intensive physiotherapy for 3 months. Full weight bearing after reduced swelling. Results In 2020, 5 patients were treated with the method described and followed up for a period of 1 year. All patients were subjectively satisfied with the result of the operation. There were no relevant surgery-associated complications.

Chondral injuries of the femoral head and their possible progression to osteoarthritis is well known. Regarding focal lesions in young patients, microfracturing or autologous chondrocyte implantation (ACI) are the most frequent used techniques to address them. Although ACI provides the better tissue quality, it is a two-step procedure and needs a lot of resources. Mincing cartilage is an old technique that has become popular again over the last few years, with good short-term results in threatening cartilage lesion in the knee. It seems intriguing to transfer this technique to the hip because you can harvest good-quality cartilage from the cam lesion, and it is a one-step procedure using autologous thrombin and fibrin. This technical note describes the repair of a parafoveal chondral defect using minced cartilage via surgical dislocation of the hip., Technique Video Video 1 Minced cartilage implantation for a cystic defect on the femoral head. Twenty-seven-year-old patient with a parafoveal chondral lesion, patient history (00:06 min), imaging (00:22), intraoperative findings (00:59), preparing of the cartilage defect (01:10), mincing and harvesting of the cartilage with the GraftNet device (Arthrex, Munich, Germany) (01:30), getting a membrane-like structure of the minced cartilage (01:46), implantation of the minced cartilage into the defect (01:58), sealing of the construct with PRP and autologous thrombin (02:16), and postoperative imaging and care (02:28).

ZusammenfassungPatellofemorale Knorpeldefekte sind eine mittlerweile sehr häufige Entität und oft Ursache des vorderen Knieschmerzes beim Sportler. Diese können nach akutem Trauma, insbesondere in Verbindung mit einer Patellaluxation, entstehen. Nichttraumatische Knorpelläsionen sind häufig Folge bestehender Grundpathologien des Patellofemoralgelenks, die jedoch insbesondere bei retropatellaren Knorpeldefekten häufig erst spät symptomatisch werden. Zur Therapie dieser Läsionen steht eine Vielzahl von regenerativen Knorpeltherapieverfahren zur Verfügung. Der Outcome nach Versorgung patellofemoraler Knorpeldefekte ist jedoch den Ergebnissen des Tibiofemoralgelenks oft unterlegen. Von entscheidender Bedeutung für den Therapierfolg ist neben der Wahl der optimalen Knorpelintervention die adäquate Adressierung der Begleitpathologie. In dieser Übersichtsarbeit werden die verschiedenen Techniken der patellofemoralen Knorpeltherapie gegenübergestellt.

Chondral defects of the glenohumeral joint are common but still remain a diagnostic and management challenge. Whereas arthroplasty is a reasonable treatment option in the elderly and low-demand population, joint preservation should be aimed for the remaining patients. For larger defects the current gold standard of treatment is autologous chondrocyte implantation. However, disadvantages such as high cost, the restriction in availability of specialized laboratories, and the 2-stage surgical design need to be accounted for if choosing this option. Showing first good clinical results for the knee joint, minced cartilage implantation is moreover a cost-effective procedure bringing autologous cartilage chips harvested from the defect walls and bringing them into the area of damage in a single-step open or arthroscopic approach. We describe an arthroscopic strategy of this technique to treat chondral defects at the glenohumeral joint., Technique Video Video 1 Dry arthroscopy of a left shoulder with the patient in beach-chair position. 00:13 minutes: Diagnostic arthroscopy through the standard posterior portal in a dry manner. 00:39 minutes: Suggestion of established working portals. 00:52 minutes: Collecting healthy cartilage with a 3-mm shaving device. 01:06: Creating a vertical rim of the chondral defect using a ringed curette. 01:37 minutes: Final measurement of the defect using a probing hook and final drying of the lesion side. 01:47 minutes: Mincing of the collected cartilage fragments on the back table using the 3-mm shaving device. 02:03 minutes: Disconnecting the graft net device and transferring the minced cartilage into a metal bowl. 02:32 minutes: Mixing the cartilage with ACP. 02:43 minutes: Implantation of the ACP-cartilage mixture onto the lesion side. 03:03 minutes: Applying thrombin for initial stability. 03:19 minutes: Adding a mixture of thrombin and ACP for final sealing. (ACP, autologous conditioned plasma)

Cartilage defects in the knee are being diagnosed with increased frequency and are treated with a variety of techniques. The aim of any cartilage repair procedure is to generate the highest tissue quality, which might correlate with improved clinical outcomes, return-to-sport, and long-term durability. Minced cartilage implantation (MCI) is a relatively simple and cost-effective technique to transplant autologous cartilage fragments in a single-step procedure. Minced cartilage has a strong biologic potential since autologous, activated non-dedifferentiated chondrocytes are utilized. It can be used both for small and large cartilage lesions, as well as for osteochondral lesions. As it is purely an autologous and homologous approach, it lacks a significant regulatory oversight process and can be clinically adopted without such limitations. The aim of this narrative review is to provide an overview of the current evidence supporting autologous minced cartilage implantation.

Objective The aim of this systematic review was to analyze the evidence about the efficacy of the several synovial fluid (SF) biomarkers proposed for knee osteoarthritis (OA), categorizing them by both molecular characteristics and clinical use according to the BIPEDs criteria, to provide a comprehensive and structured overview of the current literature. Design A systematic review was performed in May 2020 on PubMed, Cochrane Library, and Embase databases about SF biomarkers in patients with knee OA. The search was limited to articles in the last 20 years on human studies, involving patients with knee OA, reporting SF biomarkers. The evidence for each selected SF biomarker was quantified according to the 6 categories of BIPEDs classification. Results A total of 159 articles were included in the qualitative data synthesis and 201 different SF biomarkers were identified. Among these, several were investigated multiple times in different articles, for a total of 373 analyses. The studies included 13,557 patients with knee OA. The most promising SF biomarkers were C4S, IL-6, IL-8, Leptin, MMP-1/3, TIMP-1, TNF-α, and VEGF. The “burden of disease” and “diagnostic” categories were the most represented with 132 and 106 different biomarkers, respectively. Conclusions The systematic review identified numerous SF biomarkers. However, despite the high number of studies on the plethora of identified molecules, the evidence about the efficacy of each biomarker is supported by limited and often conflicting findings. Further research efforts are needed to improve the understanding of SF biomarkers for a better management of patients with knee OA.

Cartilage tissue has a very limited ability to regenerate. Symptomatic cartilage lesions are currently treated by various cartilage repair techniques. Multiple treatment techniques have been proposed in the last 30 years. Nevertheless, no single technique is accepted as a gold standard. Minced cartilage implantation is a newer technique that has garnered increasing attention. This procedure is attractive because it is autologous, can be performed in a single surgery, and is therefore given it is cost-effective. This narrative review provides an overview of the biological potential of current cartilage regenerative repair techniques with a focus on the translational evidence of minced cartilage implantation.

Knee joint osteoarthritis is a complex immunological and degenerative disease. Current treatment strategies fail to alter its progression. Mesenchymal stromal cell (MSC) therapy for osteoarthritis has been object of research for more than 30 years. The aim of MSC therapy is intended to be holistic, with regeneration of all affected knee joint structures. The paracrine effect of the MSC secretome has been shown to be central for the regenerative capacity of MSCs. Activation of local knee-joint-specific MSCs leads to an immunomodulatory, anti-catabolic, anti-apoptotic and chondrogenic stimulus. Preclinical models have demonstrated the symptom- and disease-modifying effects of MSC therapy. At the bedside, there is evidence that autologous and allogeneic MSC therapy shows significant improvement in symptom-modifying and functional outcome. Despite this, a variety of contradictory clinical outcomes are available in the literature. The effectiveness of MSC therapy is still unclear, although there have been promising results. Regarding the diversity of cell sources, isolation, culture protocols and other factors, a comparison of different studies is difficult. Clinical translation of disease-modifying effects has not yet been shown. This narrative review presents a controversial overview of the current preclinical and clinical studies on MSC therapy in knee joint osteoarthritis.

The aim of this work is to investigate the capability of PRP as an adjuvant therapy to autologous chondrocyte implantation (ACI) in combination with multi-axial load with respect to cartilage regeneration. Articular cartilage shows poor repair capacity and therapies for cartilage defects are still lacking. Well-established operative treatments include ACI, and growing evidence shows the beneficial effects of PRP. Platelets contain numerous growth factors, among them transforming growth factor beta (TGF-β). Dynamic mechanical loading is known to be essential for tissue formation, improving extracellular matrix (ECM) production. For our ACI model monolayer expanded human chondrocytes were seeded into polyurethane scaffolds and embedded in fibrin (hChondro), in PRP-Gel (PRP), or in fibrin with platelet lysate (PL), which was added to the media once a week with a concentration of 50 vol%. The groups were either exposed to static conditions or multi-axial forces in a ball-joint bioreactor for 1 h per day over 2 weeks, mimicking ACI under physiological load. The culture medium was collected and analyzed for glycosaminoglycan (GAG), nitrite and transforming growth factor beta 1 (TGF-β1) content. The cell-scaffold constructs were collected for DNA and GAG quantification; the expression of chondrogenic genes, TGF-β and related receptors, as well as inflammatory genes, were analyzed using qPCR. Loading conditions showed superior chondrogenic differentiation (upregulation of COL2A1, ACAN, COMP and PRG4 expression) than static conditions. PRP and PL groups combined with mechanical loading showed upregulation of COL2A1, ACAN and COMP. The highest amount of total TGF-β1 was quantified in the PL group. Latent TGF-β1 was activated in all loaded groups, while the highest amount was found in the PL group. Load increased TGFBR1/TGFBR2 mRNA ratio, with further increases in response to supplements. In general, loading increased nitrite release into the media. However, over time, the media nitrite content was lower in the PL group compared to the control group. Based on these experiments, we conclude that chondrogenic differentiation is strongest when simulated ACI is performed in combination with dynamic mechanical loading and PRP-gel or PL supplementation. An inflammatory reaction was reduced by PRP and PL, which could be one of the major therapeutic effects. Loading presumably can enhance the action of TGF-β1, which was predominantly activated in loaded PL groups. The combination of load and PRP represents an effective and promising synergy concerning chondrocyte-based cartilage repair.

Anterior knee pain is a frequent symptom in young athletes. Symptomatic patellofemoral cartilage defects can occur after trauma, especially after patellar dislocation. Numerous cartilage repair methods are currently available. Due to co-pathologies, the outcome after patellofemoral cartilage repair is inferior to the treatment of cartilage defects of the tibiofemoral joint. Adequate addressing of coexisting pathologies is essential for treatment success. This review provides an overview of the different techniques of patellofemoral cartilage repair.Patellofemorale Knorpeldefekte sind eine mittlerweile sehr häufige Entität und oft Ursache des vorderen Knieschmerzes beim Sportler. Diese können nach akutem Trauma, insbesondere in Verbindung mit einer Patellaluxation, entstehen. Nichttraumatische Knorpelläsionen sind häufig Folge bestehender Grundpathologien des Patellofemoralgelenks, die jedoch insbesondere bei retropatellaren Knorpeldefekten häufig erst spät symptomatisch werden. Zur Therapie dieser Läsionen steht eine Vielzahl von regenerativen Knorpeltherapieverfahren zur Verfügung. Der Outcome nach Versorgung patellofemoraler Knorpeldefekte ist jedoch den Ergebnissen des Tibiofemoralgelenks oft unterlegen. Von entscheidender Bedeutung für den Therapierfolg ist neben der Wahl der optimalen Knorpelintervention die adäquate Adressierung der Begleitpathologie. In dieser Übersichtsarbeit werden die verschiedenen Techniken der patellofemoralen Knorpeltherapie gegenübergestellt.

Purpose Despite practised for decades, the planning of osteotomy around the knee, commonly using the Mikulicz-Line, is only empirically based, clinical outcome inconsistent and the target angle still controversial. A better target than the angle of frontal-plane static leg alignment might be the external frontal-plane lever arm (EFL) of the knee adduction moment. Hypothetically assessable from frontal-plane-radiograph skeleton dimensions, it might depend on the leg-alignment angle, the hip-centre-to-hip-centre distance, the femur- and tibia-length. Methods The target EFL to achieve a medial compartment force ratio of 50% during level-walking was identified by relating in-vivo-measurement data of knee-internal loads from nine subjects with instrumented prostheses to the same subjects’ EFLs computed from frontal-plane skeleton dimensions. Adduction moments derived from these calculated EFLs were compared to the subjects’ adduction moments measured during gait analysis. Results Highly significant relationships (0.88 ≤ R2 ≤ 0.90) were found for both the peak adduction moment measured during gait analysis and the medial compartment force ratio measured in vivo to EFL calculated from frontal-plane skeleton dimensions. Both correlations exceed the respective correlations with the leg alignment angle, EFL even predicts the adduction moment’s first peak. The guideline EFL for planning osteotomy was identified to 0.349 times the epicondyle distance, hence deducing formulas for individualized target angles and Mikulicz-Line positions based on full-leg radiograph skeleton dimensions. Applied to realistic skeleton geometries, widespread results explain the inconsistency regarding correction recommendations, whereas results for average geometries exactly meet the most-consented “Fujisawa-Point”. Conclusion Osteotomy outcome might be improved by planning re-alignment based on the provided formulas exploiting full-leg-radiograph skeleton dimensions.

In the past few years, autologous chondrocyte implantation has been shown to be the most suitable cartilage reconstructive technique with the best tissue quality. Although this method is part of the standard surgical repertoire in the knee joint, it has so far not been an established method in the ankle because there are no prospective randomized controlled studies to prove a significant advantage over alternative methods of cartilage repair. The methods most frequently used in this context (e.g., marrow stimulation techniques) can, however, at most generate hyaline-like and thus biomechanically inferior regenerates. Minced cartilage implantation, on the other hand, is a relatively simple and cost-effective 1-step procedure with promising biological potential and—at least in the knee joint—satisfactory clinical results. We present an arthroscopic surgical technique by which the surgeon can apply autologous chondrocytes in a 1-step procedure (AutoCart; Arthrex, Munich, Germany) to treat articular cartilage defects in the ankle joint., Technique Video Video 1 Patient history and sagittal magnetic resonance imaging of ankle (20 seconds). Arthroscopy of ankle showing cartilage defect of lateral talar shoulder (30 seconds). Workflow of minced cartilage implantation procedure (49 seconds). Preparation (58 seconds). Autologous conditioned plasma (ACP)–platelet-rich plasma (PRP) production (1 minute 14 seconds). Defect preparation and cartilage harvesting (2 minutes 25 seconds). Necessary parts of technique (3 minutes 8 seconds). Defect filling and transplant fixation (4 minutes 33 seconds).

Treatment of circumscribed cartilage defects in the first metatarsophalangeal joint (MTP1) using autologous cartilage fragments.Full thickness cartilage defects (ICRS IV) or focal osteoarthritis in combination with hallux rigidus.Pre-existing ankylosis of the metatarsophalangeal joint; global osteoarthritis of the joint; advanced osteoarthritis of the sesamoidal articulation; osteonecrotic cysts in the head of the first metatarsal bone.Preparation of the metatarsophalangeal joint. Mobilization of the first metatarsal head. Harvesting of the cartilage fragments from the dorsal rim portion as part of the cheilectomy. Mincing the cartilage fragments with a 3.0 mm shaver in sterile conditions. Augmenting the cartilage fragments with autologous conditioned plasma (ACP). Preparing the defect area and creation of a "contained" defect. Replantation of the resulting minced cartilage mass into the defect of the articular surface on the first metatarsal head.Immobilization of the MTP1 for 48 h. Intensive physiotherapy for 3 months. Full weight bearing after reduced swelling.In 2020, 5 patients were treated with the method described and followed up for a period of 1 year. All patients were subjectively satisfied with the result of the operation. There were no relevant surgery-associated complications.OPERATIONSZIEL: Behandlung von umschriebenen Knorpeldefekten am Metatarsophalangealgelenk‑1 (MTP1) mittels autologen Knorpelfragmenten.Vollschichtige symptomatische Knorpeldefekte (ICRS Grad IV) oder fokale Degeneration bei Hallux rigidus.Allgemeine Kontraindikationen. Bereits bestehende Ankylose des Großzehengrundgelenkes. Globale Arthrose des Gelenkes. Fortgeschrittene Arthrose des Sesambeingleitlagers. Osteonekrosezysten im Kopf des 1. Metatarsale.Präparation des Großzehengrundgelenkes. Mobilisation des Metatarsale I und Entnahme der Knorpelfragmente aus dem später zu resezierenden dorsalen Gelenkanteil im Rahmen der Cheilektomie. Präparation des Defektbereiches und Schaffung eines „contained“ Defektes. Zerkleinern der Knorpelfragmente mit einem 3,0-mm-Shaver außerhalb des Operationsfeldes. Augmentieren der Knorpelfragmente mit autologem konditioniertem Plasma (ACP). Replantation der hieraus entstehenden pastösen Masse in den Knorpeldefekt am Metatarsale-I-Köpfchen.Ruhigstellung des MTP1 für 48 h. Intensive Physiotherapie für 3 Monate. Volle Lastaufnahme nach Abschwellen.Im Jahr 2020 wurden 5 Patienten mit der beschriebenen Methode behandelt und bis zu einem Zeitraum von 1 Jahr nachkontrolliert. Alle Patienten waren mit dem Ergebnis der Operation subjektiv sehr zufrieden. Es gab keine relevanten operationsassoziierten Komplikationen.

Articular cartilage lesions are identified with increasing frequency. Several cartilage repair techniques are available to treat symptomatic cartilage defects. The ultimate goal of any cartilage repair procedure is the prevention of premature osteoarthritis. Autologous chondrocyte implantation provides the best tissue quality. However, 2 operations and a resource-intense culturing process with high regulatory demands are disadvantages of this cartilage repair procedure. Furthermore, cellular dedifferentiation and senescence display further cell culture-associated drawbacks that hamper the procedure. Minced cartilage implantation is a relatively simple and cost-effective one-step procedure with promising biologic potential and satisfying clinical results. We present an arthroscopic surgical technique where the surgeon can apply autologous chondrocytes in a one-step procedure to treat articular cartilage defects at the knee joint.

Background: There is no universally accepted treatment standard for idiopathic toe walking patients (ITW) in the current literature. None of the established methods provide homogenous satisfying results. In our department we treat ITW patients with lower leg orthoses with a circular foot unit for a total of 16 weeks. In this study we reviewed our database to evaluate the success of our treatment protocol for 24 months. Results: 22 patients were included in the study. Age at the beginning of treatment was 7.0 years +/-2.9 (range 2.5-13.1). Percentage of ITW at the beginning of treatment according to the perception of the parents was 89% +/-22.2 (range 50-100). Immediately after the treatment with our device, percentage of ITW dropped to 11% +/-13.2 (range 0-50). After 12 months, 73% of the patients (16/22) walked completely normal or showed ITW less than 10% of the day. After 24 months, 64% of the patients kept a normal gait (14/22). Conclusion: This study provides evidence that the treatment of idiopathic toe walking with lower leg orthoses with a circular foot unit results in satisfying long-term results in two thirds of the patients.

Background There is no universally accepted treatment standard for idiopathic toe walking patients (ITW) in the current literature. None of the established methods provide homogenous satisfying results. In our department we treat ITW patients with lower leg orthoses with a circular foot unit for a total of 16 weeks. In this study we reviewed our database to evaluate the success of our treatment protocol for a 24 months follow up period. Results Twenty-two patients were included in this study. Age at the beginning of treatment was 7.0 years +/− 2.9 (range 2.5-13.1). Percentage of ITW at the beginning of treatment according to the perception of the parents was 89% +/− 22.2 (range 50-100). Immediately after the treatment with our device, percentage of ITW dropped to 11% +/− 13.2 (range 0-50). After 12 months, 73% of the patients (16/22) walked completely normal or showed ITW less than 10% of the day. After 24 months, 64% of the patients kept a normal gait (14/22). Conclusion This study provides evidence that the treatment of idiopathic toe walking with lower leg orthoses with a circular foot unit results in satisfying long-term results in two thirds of the patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04327-0.

Objective Cellular and molecular events occurring in cartilage regions close to injury are poorly investigated, but can possibly compromise the outcome of cell-based cartilage repair. In this study, key functional properties were assessed for cartilage biopsies collected from the central part of traumatic joint lesions ( central) and from regions surrounding the defect ( peripheral). These properties were then correlated with the quality of the initial cartilage biopsy and the inflammatory state of the joint. Design Cartilage samples were collected from knee joints of 42 patients with traumatic knee injuries and analyzed for cell phenotype (by reverse transcriptas-polymerase chain reaction), histological quality, cellularity, cell viability, proliferation capacity, and post-expansion chondrogenic capacity of chondrocytes (in pellet culture). Synovium was also harvested and analyzed for the expression of inflammatory cytokines. Results Cartilage quality and post-expansion chondrogenic capacity were higher in peripheral versus central samples. Differences between these 2 parameters were more pronounced in joints with high inflammatory features characterized by >100-fold difference in the mRNA levels of IL6 and IL8 in the corresponding synovium. Peripheral chondrocytes isolated from good- versus bad-quality biopsies expressed higher levels of collagen II/I and aggrecan/versican and lower levels of MMP13 and ADAMTS5. They also exhibited reduced proliferation and enhanced cartilage-forming capacity. Conclusions Chondrocytes at the periphery of traumatic lesions better maintain properties of healthy cartilage compared to those isolated from the center, even when derived from bad-quality tissues harvested from highly inflamed joints. Future studies are necessary to investigate the change of functional properties of peripheral chondrocytes over time.

Clinical Orthopaedics and Related Research, 478 (4), ISSN:1528-1132, ISSN:0009-921X

Zusammenfassung Einleitung: Die bisher in Deutschland durchgefuhrten Studien bezuglich der Versorgungssituation von Patienten mit osteoporotischer Fraktur beruhen zumeist auf Krankenkassendaten. Es werden daher nur diagnostizierte Erkrankungen erfasst. Ziel der Studie war es, die Dunkelziffer an nicht Osteoporose diagnostizierten Patienten zu erfassen, und die Einleitung von Diagnostik und Therapie nach Fragilitatsfrakturen im Allgemeinen und unter dem Einfluss von Risikofaktoren zu analysieren. Material und Methode: In einer retrospektiven Beobachtungsstudie an orthopadischen und unfallchirurgischen Abteilungen im Rhein-Main-Gebiet wurde eine Analyse der versorgten Frakturen durchgefuhrt. Eingeschlossen wurden Patienten im Alter von > 50 Jahren mit einer ICD verschlusselten Fraktur als Aufnahmediagnose. Die in der Krankenakte enthaltenden Daten wurden nach pravalenten Frakturen, nach fur den Knochen-Stoffwechsel und fur die Knochen-Stabilitat relevanten Grunderkrankungen, einer vorbekannten Osteoporose, durchgefuhrter Diagnostik zur Sicherung oder Widerlegung der Diagnose einer Osteoporose, der Diagnosestellung einer Osteoporose und ggf. erfolgter Therapieeinleitung und - empfehlung nach einem vorliegenden Erhebungsbogen systematisch ausgewertet. Ergebnisse: Insgesamt wurden 2142 Patienten alter als 50 Jahre mit einer Fraktur ausgewertet. 1544 (72,1 %) waren weiblich und 598 (27,9 %) mannlich. Davon wurde bei 1460 (68,2 %) der Patienten die Fraktur als osteoporotisch eingestuft. 80,3 % der Patienten mit osteoporotischer Fraktur waren alter als 70 Jahre. Die Huftfraktur (55,2 %) war die haufigste Frakturlokalisation, gefolgt von der Wirbelkorperfraktur (14 %). Eine pravalente Fraktur gaben 14 % in der Anamnese an. Insgesamt nur bei 29,9 % der Patienten wurde eine Osteoporose als Ursache der Fraktur diagnostiziert. Bei 67,2 % der osteoporotischen Wirbelkorperfrakturen wurde die Osteoporose erkannt, jedoch nur bei 16,3 % der osteoporotischen Huftfrakturen. Zum Zeitpunkt der Entlassung wurden 6,6 % der Patienten mit einem antiosteoporotischen Medikament therapiert und bei 5,1 % wurde diesbezuglich eine Empfehlung im Entlassungsbrief ausgesprochen. Die Ergebnisse dieser Studie zeigen, dass bei 70 % der Patienten die Diagnosestellung einer Osteoporose versaumt und dass 88,3 % der Patienten ohne eine spezifische antiosteoporotische Therapie oder einer Therapieempfehlung aus dem Krankenhaus entlassen wurden. Zusammenfassung: Somit zeigt sich eine deutliche Versorgungslucke zwischen evidenzbasierter Medizin und alltaglicher Praxis. Frakturen bei alteren Menschen fuhren selten zur einer Diagnostik oder Therapie bezuglich Osteoporose. Angesichts der hohen Pravalenz der Osteoporose und der Zunahme der Inzidenz osteoporotischer Frakturen sind Konzepte zur besseren Versorgung gerade dieser Hochrisikopatienten notwendig. Die international zunehmende Etablierung von Fracture Liaison Services (FLS) zeigt in Untersuchungen, dass ein solches Konzept effektiv ist, um ein optimales Osteoporose-Management nach einer Fragilitatsfraktur zu erreichen und sekundare Frakturen zu verhindern. Summary Introduction: Investigations conducted in Germany regarding the care situation of patients with osteoporotic fractures are mostly based on health insurance data. Therefore, only diagnosed diseases are recorded. The aim of the study was to record the unreported number of non-osteoporotic patients and to analyze the initiation of diagnosis and treatment after fragility fractures in general and under the influence of risk factors. Material and method: In a retrospective observational study in orthopedic and trauma surgery departments in the Rhine-Main area an analysis of the treated fractures was conducted. Included were patients aged > 50 years with an ICD encoded fracture as admission diagnosis. The collected information in the medical records were systematically evaluated according to an available questionnaire for prevalent fractures, for underlying bone diseases, for metabolism and bone stability compromising underlying diseases, a known osteoporosis, performed diagnostics to back up or rule out the diagnosis of osteoporosis, initiated therapy and - recommendations. Results: A total of 2142 patients older than 50 years with a fracture were evaluated. 1544 (72.1 %) were female and 598 (27.9 %) were male. Of these, 1460 (68.2 %) of the patients considered the fracture to be osteoporotic. 80.3 % of patients with osteoporotic fracture were older than 70 years. The hip fracture (55.2 %) was the most common fracture localization, followed by the vertebral fracture (14 %). A prevalent fracture was reported in 14 % in the medical history. Overall, only 29.9 % of patients were diagnosed with osteoporosis as the cause of the fracture. Osteoporosis was detected in 67.2 % of osteoporotic vertebral fractures, but only in 16.3 % of osteoporotic hip fractures. At the time of discharge, 6.6 % of patients were treated with an anti-osteoporotic medication and 5.1 % were given recommendation in the discharge letter. The results of this study indicate that 70 % of patients failed to diagnose osteoporosis and that 88.3 % of patients were discharged from the hospital without specific anti-osteoporotic therapy or therapy recommendation. Summary: Thus, there is a clear gap between evidence-based medicine and everyday practice in osteoporosis. Fractures in the elderly rarely lead to a diagnosis or therapy for osteoporosis. Given the high prevalence of osteoporosis and the increase in the incidence of osteoporotic fractures, concepts are needed to better care for these high-risk patients. The increasing international establishment of Fracture Liaison Services (FLS) show in studies that such a concept is effective to achieve optimal osteoporosis management after a fragility fracture and to prevent secondary fractures.

Patient expectations are an issue which is attracting increased interest in outcome research for knee surgery procedures. So far, research into patient expectations has mainly focused on the procedure and postoperative functional improvements. The purpose of this study was to identify patient expectations in the perioperative setting.This was a single-center prospective study. A 17-item questionnaire (ordinal answer scale) about patients' perioperative expectations was developed and completed by patients undergoing elective joint-preserving knee surgery. The study covered a period of 3 months and included all patients consecutively undergoing knee surgery. Subgroup analysis was performed for gender, age and type of insurance.111 consecutive patients completed the questionnaire on admission. Significant preferences for one answer option were found for 13 out of 17 items. Patients considered it "unimportant" whether or not the physician wore a white coat during the consultation and "very important" that the first medical consultation after the patient was discharged from hospital was with the surgeon who had performed their operation. A concise explanation of the surgical procedure using images, talking to the surgeon the day before surgery and immediately after surgery, having their wound personally inspected by the surgeon, and, finally, the availability of the surgeon by phone were regarded as "important". There were no differences in patient responses between the different subgroups.Patients expect a high personal commitment and availability of the surgeon during the entire perioperative setting, starting from the first consultation and continuing during follow-up examinations.Patientenerwartungen sind in der Ergebnisforschung für Knieoperationen von zunehmendem Interesse. Bisher konzentrierte sich die Forschung der Erwartungshaltung hauptsächlich auf Operationen und postoperative Funktionsverbesserungen. Der Zweck dieser Studie bestand darin, die Patientenerwartungen an die perioperativen Rahmenbedingungen zu ermitteln.Prospektive Single-Center-Studie. Ein 17-Punkte-Fragebogen (ordinale Antwortskala) zur perioperativen Patientenerwartung wurde entwickelt und nach entsprechender Bearbeitung durch Patienten, welche sich einer elektiven gelenkerhaltenden Knieoperation unterzogen, ausgewertet. Die Analyse dauerte 3 Monate und umfasste alle Patienten, welche sich in dieser Zeit einer Operation unterzogen. Es wurden Subgruppenanalysen nach Geschlecht, Alter und Art der Versicherung durchgeführt.111 aufeinanderfolgende Patienten füllten den Fragebogen nach der Aufnahme aus. Bei 13 von 17 Elementen wurden signifikante Präferenzen für eine Antwortoption gefunden. Die Patienten hielten es für „unwichtig“, dass der Arzt einen weißen Kittel zur Beratung trug und „sehr wichtig“ war, dass die erste ärztliche Beratung nach der Entlassung aus dem Krankenhaus vom Chirurgen persönlich durchgeführt wurde. Die Erklärung des Operationsvorgangs anhand von Bildern, ein Gespräch mit dem Chirurgen am Tag vor der Operation und direkt nach der Operation, die persönliche Wundkontrolle durch den Chirurgen und schließlich die telefonische Verfügbarkeit des Chirurgen wurden als „wichtig“ angesehen. Beim Vergleich der verschiedenen Untergruppen gab es keine Unterschiede im Antwortverhalten.Die Patienten erwarten ein hohes persönliches Engagement und eine hohe Verfügbarkeit des Chirurgen im gesamten perioperativen Umfeld – von der ersten Konsultation bis zur Nachuntersuchung.

Background:Chondral and osteochondral lesions are being detected with increasing frequency. For large-diameter lesions, cell-based treatment modalities are speculated to result in the best possible outcome.Purpose:To prospectively evaluate the 2-year clinical and radiological results after the treatment of chondral and osteochondral knee joint lesions by a single-step autologous minced cartilage procedure.Study Design:Case series; Level of evidence, 4.Methods:From February 2015 to June 2016, a total of 27 consecutive patients suffering from chondral or osteochondral lesions of the knee joint were treated using a single-step autologous minced cartilage procedure. All patients underwent preoperative and postoperative magnetic resonance imaging for the collection of AMADEUS (Area Measurement and Depth and Underlying Structures) and MOCART (magnetic resonance observation of cartilage repair tissue) scores. Clinical analysis was conducted by a numeric analog scale (NAS) for pain and knee function before the intervention and at 12 and 24 months postoperatively.Results:A total of 12 female and 15 male patients (mean age, 28.7 years) were evaluated for a mean of 28.2 ± 3.8 months. The mean cartilage defect size encountered intraoperatively was 3.1 ± 1.6 cm2. There was a significant decrease in pain from 7.2 ± 1.9 preoperatively to 1.8 ± 1.6 ( P < .001) at 2-year follow-up. Knee function improved from a mean of 7.2 ± 2.0 preoperatively to 2.1 ± 2.3 ( P < .001) at 2 years after surgery. The mean preoperative AMADEUS score was 57.4 ± 21.4. Postoperatively, the mean MOCART score was 40.6 ± 21.1 at 6-month follow-up. No correlation was observed between the clinical data and the MOCART or AMADEUS scores.Conclusion:Overall, the findings of this study demonstrated that patients undergoing a single-step autologous minced cartilage procedure had a satisfactory outcome at 2-year follow-up. As a result, the single-step autologous minced cartilage procedure does represent a possible alternative to standard autologous chondrocyte implantation. Longer follow-up and larger cohorts are required to define the benefits of this procedure.

Objective: Lumican (LUM) is a major extracellular matrix glycoprotein in adult articular cartilage and its expression is known to be upregulated upon cartilage degeneration. LUM is associated with the pathogen-associated molecular pattern (PAMP) activation of the TLR4 signalling cascade, with TLR4 being highly associated with inflammation in rheumatic diseases. However, the main role of the LUM structural molecule in osteoarthritis (OA) remains elusive. The aim of this study was, therefore, to understand the role of LUM during TLR4-mediated activation in OA. Methods: After measuring LUM levels in synovial fluid (SF) of OA patients and lipopolysaccharide (LPS)-induced TLR4 activation, the role of LUM in the expression of pro-inflammatory molecules and cartilage degradation was assessed in vitro and ex vivo in a cartilage explant model. Primary macrophage activation and polarization were studied upon LUM co-stimulation with LPS. Results: We demonstrate that LUM is not only significantly upregulated in SF from OA patients compared to healthy controls, but also that LUM increases lipopolysaccharide (LPS)-induced TLR4 activation. Furthermore, we show that a pathophysiological level of LUM augments the LPS-induced TLR4 activation and expression of downstream pro-inflammatory molecules, resulting in extensive cartilage degradation. LUM co-stimulation with LPS also provided a pro-inflammatory stimulus, upregulating primary macrophage activation and polarization towards the M1-like phenotype. Conclusions: These findings strongly support the role of LUM as a mediator of PAMP-induced TLR4 activation of inflammation, cartilage degradation, and macrophage polarization in the OA joint and potentially other rheumatic diseases. (C) 2019 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Background Recently, the AMADEUS (Area Measurement And DEpth Underlying Structures) grading system has been introduced to evaluate and grade osteochondral lesions prior to cartilage surgery. The AMADEUS score has not been connected to clinical data in order to test a potential clincial impact. Purpose To examine the correlation between the AMADEUS score and preoperative patient-reported outcome measurements (PROMs). Study design Case series Methods Patients treated with matrix-induced autologous chondrocyte implantation (MACI) were included in the study, unless exclusion criteria like BMI > 35, prior extensive meniscectomy or ongoing inflammatory arthritis were present. Preoperative magnetic resonance (MR) examinations were graded according to the standardized AMADEUS protocol. The final AMADEUS score was correlated with preoperative patient-reported outcome measurements (PROMs), including the IKDC (International Knee Documentation Committee), the Lysholm score, the Short-Form-12 (SF-12) score, and the Core Outcome Measures Index (COMI) score. Results A total of 50 patients with a mean age of 33.6 ± 11.5 years, a mean BMI of 25.1 ± 4.9, and a mean defect size of 2.3 ± 1.5 cm2 were included in the study. More severe cartilage defects, indicated by the AMADEUS grade (R = 0.35, p = 0.01) and the AMADEUS score (R = − 0.36, p = 0.01) as well as larger chondral defects (R = 0.32, p = 0.03) show a moderate correlation with the higher COMI scores. No correlative capacity was demonstrated for the AMADEUS score and the IKDC, Lysholm, and Tegner activity scores as well as for its subscales. Conclusion There is a moderate correlation of the COMI and the AMADEUS score in patients treated with matrix-induced autologous chondrocyte implantation (MACI). All other patient-reported outcome measurement scores (PROMs) show no evidence of an association to the magnetic resonance-based AMADEUS score. Clinical relevance The clinical and scientific implication of the COMI score as a PROM tool can be recommended when working with the AMADEUS score and patients undergoing MACI.