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Knee Surgery, Sports Traumatology,... Jun 2024The present study aimed to compare the clinical outcomes and safety at a 1-year follow-up after 5 or 6 weeks of non-weight bearing after a Talar OsteoPeriostic grafting...
PURPOSE
The present study aimed to compare the clinical outcomes and safety at a 1-year follow-up after 5 or 6 weeks of non-weight bearing after a Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for a medial osteochondral lesion of the talus (OLT).
METHODS
A retrospective comparative case-control analysis of prospectively followed patients who underwent a TOPIC procedure with medial malleolus osteotomy was performed. Patients were matched in two groups with either 5 or 6 weeks of non-weight bearing. Clinical outcomes were evaluated using the Numeric Rating Scale (NRS) during walking, rest, running, and stairclimbing. Additionally, the Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were assessed. Moreover, radiology and complications were assessed.
RESULTS
Eleven patients were included in the 5-week non-weight bearing group and 22 in the 6-week non-weight bearing group. No significant differences were found in any of the baseline variables. The NRS during walking in the 5-week group improved by 3.5 points and 4 points for the 6-week group (p = 0.58 at 1-year post-operatively). In addition, all other NRS scores, FAOS subscales and the AOFAS scores improved (all n.s. at 1 year follow-up). No significant differences in radiological (osteotomy union and cyst presence in the graft) were found. Moreover, no significant differences were found in terms of complications and reoperations.
CONCLUSION
No statistical significant differences were found in terms of clinical, radiological and safety outcomes between 5 or 6 weeks of non-weight bearing following a TOPIC for a medial OLT.
LEVEL OF EVIDENCE
Level III, Therapeutic.
PubMed: 38881368
DOI: 10.1002/ksa.12315 -
Arthroscopy : the Journal of... Jun 2024The new radiographic "Windshield Wiper Sign" detects hip instability and an instability-related osteochondral defect of the anterolateral femoral head. It is visible on...
The Hip "Windshield Wiper Sign": An Osteochondral Defect of the Anterolateral Femoral Head, Predicts Instability and Allows Planning of Combined Arthroscopic Cartilage Therapy and Periacetabular Osteotomy.
The new radiographic "Windshield Wiper Sign" detects hip instability and an instability-related osteochondral defect of the anterolateral femoral head. It is visible on plain radiographs, as well as MRI and during arthroscopy, in otherwise considered normal or borderline hips based on the lateral center-edge angle (LCEA). In the last two decades, femoral acetabular impingement syndrome (FAIS) with labral lesions and cartilage lesions were treated with excellent results. Recently the focus shifted to complex cases, revision surgery, and capsular management preventing postoperative hip instability. (Micro-)instability of the hip causes poor outcomes, but preoperatively there has been no Gold Standard for radiographic assessment of hip instability. On plain radiographs we use the LCEA and the anterior center-edge angle (ACEA), we can also use the Femoro-Epiphyseal Acetabular Roof (FEAR) Index and The Gothic Arch Angle (GAA). These signs help detect in which cases arthroscopic surgery alone would provide poor results and a concurrent osteotomy, for example a periacetabular osteotomy (PAO), is needed. We now understand that hip instability in hips otherwise considered normal hips or borderline dysplastic can be detected by the Windshield Wiper Sign. This is important knowledge for concomitant arthroscopic combined with osteotomy, as the need for cartilage therapy can be determined preoperatively.
PubMed: 38880183
DOI: 10.1016/j.arthro.2024.06.003 -
Advanced Materials (Deerfield Beach,... Jun 2024Osteoarthritis is a prevalent disease, characterized by subchondral fractures in its initial stages, which has no precise and specific treatment now. In this study, a...
Osteoarthritis is a prevalent disease, characterized by subchondral fractures in its initial stages, which has no precise and specific treatment now. In this study, a novel multifunctional scaffold was synthesized by photopolymerizing glycidyl methacrylate-modified hyaluronic acid as the matrix in the presence of hollow porous magnetic microspheres based on hydroxyapatite. In vivo subchondral bone repairing results demonstrate that the scaffold's meticulous design has the most suitable properties for subchondral bone repair. The porous structure of inorganic particles within the scaffold facilitates efficient transport of loaded exogenous vascular endothelial growth factor. The FeO nanoparticles assembled in the microspheres could promote the osteogenic differentiation of bone marrow mesenchymal stem cells and accelerate the generation of new bone. These features enable the scaffold to exhibit favorable subchondral bone repair properties and attain high cartilage repair scores. The therapy results prove that the subchondral bone support considerably influences the upper cartilage repair process. Furthermore, magnetic resonance imaging monitoring demonstrates that FeO nanoparticles, which were gradually replaced by new bone during osteochondral defect repair, allow a noninvasive and radiation-free assessment to track the newborn bone during the osteoarthritis repair process. The composite hydrogel scaffold provides a versatile platform for biomedical applications in osteoarthritis treatment. This article is protected by copyright. All rights reserved.
PubMed: 38877353
DOI: 10.1002/adma.202405641 -
The Knee Jun 2024Gel-based autologous chondrocyte implantation (GACI) enables a simpler and more effective delivery of chondrocytes with reproducible three-dimensional structural...
BACKGROUND
Gel-based autologous chondrocyte implantation (GACI) enables a simpler and more effective delivery of chondrocytes with reproducible three-dimensional structural restoration of the articular cartilage surface. There is limited documentation of medium-term outcomes. This study assessed safety and effectiveness of GACI for treatment of cartilage defects of the knee.
METHODS
This multicentric retrospective study was conducted across eight hospitals in India. Patients who had undergone GACI (CARTIGROW®) between 2008 and 2014 for the treatment of focal articular cartilage defects of the knee (mean defect size 4.5 ± 5.8 cm) in limbs with normal alignment were analyzed. Primary outcomes were changes in Lysholm Knee Scoring Scale score, and Knee Outcome Sports Activity Scale (SAS).
RESULTS
A total of 107 patients (110 knee joints) with mean age 31.0 ± 10.5 years were included. The mean follow-up was 9.8 ± 1.5 years (range 7.85-13.43). Majority had osteochondritis dissecans (n = 51; 46.4%). The mean Lysholm Knee Scoring Scale score (81.23 ± 13.21 vs. 51.32 ± 17.89; p < 0.0001) and SAS score (80.93 ± 8.26 vs. 28.11 ± 12.28; p < 0.0001) improved significantly at follow-up as compared to pre-operative. Magnetic Resonance Observation of Cartilage Repair Tissue score in 39 patients at minimum 2 years follow-up was 84.5 ± 4.3. Among 30 patients who were playing sports before treatment, 17 patients (56.7%) could return to the same or higher level of sports post-transplantation. No major intra-operative or post-operative complications were noted. Four patients warranted revision surgery.
CONCLUSION
GACI is an effective treatment option for large focal articular cartilage defects of the knee with a low complication rate and revision rate and significant improvement in functional scores.
PubMed: 38870617
DOI: 10.1016/j.knee.2024.05.006 -
Arthroscopy : the Journal of... Jun 2024
PubMed: 38866377
DOI: 10.1016/j.arthro.2024.06.004 -
Radiology Jun 2024
Topics: Humans; Osteochondritis Dissecans; Magnetic Resonance Imaging; Knee Joint; Male; Cancellous Bone; Female; Adult
PubMed: 38860896
DOI: 10.1148/radiol.240048 -
Frontiers in Surgery 2024To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT).
OBJECTIVE
To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT).
METHODS
This study was divided into two groups: experimental group: robot-assisted retrograde drilling group; control group: arthroscopic microfracture group. A total of 6 OCLT patients who were treated with robot navigation-assisted retrograde drilling and 10 OCLT patients who were treated with arthroscopic microfracture between October 2020 and October 2021 were retrospectively analyzed. There were 11 males and five females, with a mean age of 36 years. The patients were followed up for 6-12 months to compare the changes in the OCLT lesion area by magnetic resonance imaging (MRI), visual analogue scale/score (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) before and after surgery.
RESULTS
All 16 patients were followed up for an average of 8 months, and no complications such as joint infection, nerve injury, or active bleeding occurred during the follow-up period. Only one patient suffered discomfort involving transient postoperative pain in the operative area, but did not experience long-term numbness or chronic pain. Postoperative MRI revealed that none of the patients had severe signs of osteonecrosis, osteolysis or cystic changes of the talus, with lesion areas smaller than those before surgery. The difference was statistically significant (< 0.01). The patients in the experimental group showed a more significant improvement in the last 3 months than in the first 3 months of the follow-up period. At the last follow-up, the VAS score was 3 points in the experimental group and 2.2 points in the control group, and the AOFAS score was 88.6 points in the experimental group and 88 points in the control group, all of which were significantly higher than those before operation, and the differences were statistically significant, but there was no statistically significant difference between the groups.
CONCLUSION
Both robot navigation-assisted retrograde drilling and arthroscopic microfracture for bone marrow stimulation (BMS) to treat OCLT in all patients obtained satisfactory effects in the short term. In addition, the follow-up revealed that with excellent efficacy and few complications, robot navigation-assisted retrograde drilling was safe and minimally invasive, and greatly reduced operative time. Consequently, robot navigation-assisted retrograde drilling for BMS was a safe and effective procedure for the treatment of OCLT.
PubMed: 38859999
DOI: 10.3389/fsurg.2024.1404513 -
Joint Bone Spine Jun 2024
PubMed: 38857873
DOI: 10.1016/j.jbspin.2024.105748 -
The American Journal of Sports Medicine Jul 2024A major limitation of osteochondral allografts (OCA) is the deterioration of cartilage health associated with cell death during prolonged storage. However, little is...
BACKGROUND
A major limitation of osteochondral allografts (OCA) is the deterioration of cartilage health associated with cell death during prolonged storage. However, little is known about the mechanisms that contribute to chondrocyte death during storage.
PURPOSE/HYPOTHESIS
This study aimed to determine whether bioactive lipid metabolites accumulate in the storage media of OCA and whether they are associated with a loss of chondrocyte viability during prolonged storage. It was hypothesized that free fatty acids (FFAs) would accumulate over time in the storage media of OCA and adversely affect cartilage health during storage.
STUDY DESIGN
Controlled laboratory study.
METHODS
A group of 21 (n = 6-8 OCA/treatment group) fresh human hemicondylar OCA tissues and media were analyzed after 7, 28, and 68 days of prolonged cold (4°C) storage. Targeted mass spectrometry analysis was used to quantify bioactive FFAs, as well as primary (lipid hydroperoxide [ROOH]) and secondary (malondialdehyde) lipid oxidation products. Chondrocyte viability was measured using a fluorescence-based live/dead assay and confocal microscopy.
RESULTS
The concentration of all targeted fatty acid metabolites in storage media was significantly increased with increased cold storage time ( < .05). ROOH was significantly higher on day 28 of cold storage. No difference in secondary ROOH products in storage media was observed. Chondrocyte viability significantly declined in both the en face and the vertical cross-sectional analysis with increased cold storage time and inversely correlated with fatty acid metabolites ( < .05).
CONCLUSION
It is well established that elevated levels of certain FFAs and lipid oxidation products can alter cell function and cause cell death via lipotoxicity and other mechanisms. This work is the first to identify elevated levels of FFA metabolites and primary oxidation lipid products in the storage media from clinical OCA. The concentrations of FFA metabolites were measured at levels (>100 µM) known to induce cell death and were directly correlated with chondrocyte viability.
CLINICAL RELEVANCE
These findings provide important targets for understanding why cartilage health declines during cold storage, which can be used to optimize media formulations and improve graft health.
Topics: Humans; Chondrocytes; Cell Death; Fatty Acids, Nonesterified; Cell Survival; Allografts; Adult; Middle Aged; Male; Cartilage, Articular; Female; Lipid Metabolism
PubMed: 38857056
DOI: 10.1177/03635465241252653 -
Small (Weinheim An Der Bergstrasse,... Jun 2024The minimally invasive deployment of scaffolds is a key safety factor for the regeneration of cartilage and bone defects. Osteogenesis relies primarily on cell-matrix...
The minimally invasive deployment of scaffolds is a key safety factor for the regeneration of cartilage and bone defects. Osteogenesis relies primarily on cell-matrix interactions, whereas chondrogenesis relies on cell-cell aggregation. Bone matrix expansion requires osteoconductive scaffold degradation. However, chondrogenic cell aggregation is promoted on the repellent scaffold surface, and minimal scaffold degradation supports the avascular nature of cartilage regeneration. Here, a material satisfying these requirements for osteochondral regeneration is developed by integrating osteoconductive hydroxyapatite (HAp) with a chondroconductive shape memory polymer (SMP). The shape memory function-derived fixity and recovery of the scaffold enabled minimally invasive deployment and expansion to fill irregular defects. The crystalline phases on the SMP surface inhibited cell aggregation by suppressing water penetration and subsequent protein adsorption. However, HAp conjugation SMP (H-SMP) enhanced surface roughness and consequent cell-matrix interactions by limiting cell aggregation using crystal peaks. After mouse subcutaneous implantation, hydrolytic H-SMP accelerated scaffold degradation compared to that by the minimal degradation observed for SMP alone for two months. H-SMP and SMP are found to promote osteogenesis and chondrogenesis, respectively, in vitro and in vivo, including the regeneration of rat osteochondral defects using the binary scaffold form, suggesting that this material is promising for osteochondral regeneration.
PubMed: 38855993
DOI: 10.1002/smll.202401989