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Knee And Microfractures

Andri Maruli Tua Lubis, Troydimas Panjaitan, Charles Hoo
INTRODUCTION: Recurrent patellar dislocation can lead to articular cartilage injury. We report a 21-year old male with left patella instability and articular cartilage defect. PRESENTATION OF CASE: A 21-year-old male presented with left patellar instability and pain. Knee range of motion (ROM) was limited when patella was dislocated (0-20°). The J-sign positive, patellar apprehension test was positive, with medial patella elasticity/patellar glide >2 quadrants...
January 31, 2019: International Journal of Surgery Case Reports
Suzanne Lungwitz, Philipp Niemeyer, Julia Maurer, Jürgen Fritz, D Albrecht, Peter Angele, Stefan Fickert, Kolja Gelse, Wolfgang Zinser, Gunther O Hofmann, Gunter Spahn
PURPOSE: This study was aimed to determine the impact of bioregenerative operations in case of degenerative cartilage lesions within the media knee compartment. MATERIAL AND METHODS: The CartilageRegistry DGOU was founded in 2013. At the deadline August 2016 a total of 1847 patients were included. A total of 23.3% (n = 432) was suffering from a degenerative cartilage lesion in the medial compartment. Follow-up was performed after 6, 12, and 24 months (online evaluation)...
February 8, 2019: Zeitschrift Für Orthopädie und Unfallchirurgie
Gennaro Pipino, Salvatore Risitano, Francesco Alviano, Edward J Wu, Laura Bonsi, Davide Corrado Vaccarisi, Pier Francesco Indelli
Background: Osteochondral knee defects (OCD) are often symptomatic, causing pain and functional impairment even in young and active patients. Regenerative surgical options, aiming to stimulate natural cartilage healing, have been recently used as a first line treatment. In this study, a new hydrogel is investigated in its capacity to regenerate the ultra-structural quality of hyaline cartilage when combined with a classical microfracture technique. Material and methods: Forty-six patients, affected by grade III and IV knee chondropathies, were consecutively treated between 2013 and 2015 with microfractures followed by application of a modern hydrogel in the lesion site...
January 2019: Journal of Clinical Orthopaedics and Trauma
Raffy Mirzayan, Joseph D Cooper, Jorge Chahla
BioCartilage (BC) is dehydrated, minced human hyaline articular cartilage that was developed as an adjunct to microfracture surgery to help stimulate the bone marrow and stem cells to form hyaline-like tissue in full-thickness chondral defects. The minced pieces of BC require a dry environment for application and can easily be disrupted by residual moisture of saline solution in the surrounding tissues. We present a technique of carbon dioxide insufflation during knee arthroscopy as a means of maintaining a dry environment for preparation of the bony bed during BC augmentation of microfracture surgery...
October 2018: Arthroscopy Techniques
Patrick Orth, Liang Gao, Henning Madry
PURPOSE: To systematically review and evaluate novel clinical data following microfracture treatment of knee articular cartilage defects. METHODS: A systematic review was performed by searching PubMed, ScienceDirect, and Cochrane Library databases for clinical trials on microfracture treatment, published between 2013 and 2018. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, study design, pre-, intra-, and postoperative findings were extracted...
January 18, 2019: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Matthias Steinwachs, Nicola Cavalcanti, Santhosh Mauuva Venkatesh Reddy, Clement Werner, Daniel Tschopp, Hema N Choudur
BACKGROUND: CARGEL (Smith & Nephew Inc.), a chitosan-based polymer scaffolding biomaterial, has been used since 2012 for treating articular cartilage lesions. Limited data are available on patient outcomes following CARGEL treatment. This study aimed to describe short-term clinical and radiographic outcomes in a cohort of patients treated with CARGEL and microfracture surgery for articular cartilage defects in the knee. METHODS: A retrospective cohort study was conducted of consecutive patients with articular cartilage defects who had undergone microfracture surgery with CARGEL, or in patellar lesions microfracture and CARGEL plus Chondro-Gide (at SportsClinic Zurich)...
December 19, 2018: Knee
Tamana Afzali, Mia Vicki Fangel, Anne Sig Vestergaard, Michael Skovdal Rathleff, Lars Holger Ehlers, Martin Bach Jensen
INTRODUCTION: Knee pain is common in adolescents and adults and is associated with an increased risk of developing knee osteoarthritis. The aim of this systematic review was to gather and appraise the cost-effectiveness of treatment approaches for non-osteoarthritic knee pain conditions. METHOD: A systematic review was conducted according to the PRISMA guidelines and registered on PROSPERO (CRD42016050683). The literature search was done in MEDLINE via PubMed, EMBASE, The Cochrane Library, and the National Health Service Economic Evaluation Database...
2018: PloS One
Anirudh K Gowd, Gregory L Cvetanovich, Joseph N Liu, David R Christian, Brandon C Cabarcas, Michael L Redondo, Nikhil N Verma, Adam B Yanke, Brian J Cole
PURPOSE: To provide updated surgical trends of cartilage procedures differentiated by the classic groups of palliative, repair, and restorative modalities. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2010-2016 for the following cartilage procedures: chondroplasty, microfracture, arthroscopic osteochondral autograft or allograft transplantation, open osteochondral autograft or allograft transplantation, and autologous chondrocyte implantation...
January 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Jiaju Lu, Xuezhen Shen, Xun Sun, Heyong Yin, Shuhui Yang, Changfeng Lu, Yu Wang, Yifan Liu, Yingqi Huang, Zijin Yang, Xianqi Dong, Chenhao Wang, Quanyi Guo, Lingyun Zhao, Xiaodan Sun, Shibi Lu, Antonios G Mikos, Jiang Peng, Xiumei Wang
Even small cartilage defects could finally degenerate to osteoarthritis if left untreated, owing to the poor self-healing ability of articular cartilage. Stem cell transplantation has been well implemented as a common approach in cartilage tissue engineering but has technical complexity and safety concerns. The stem cell homing-based technique emerged as an alternative promising therapy for cartilage repair to overcome traditional limitations. In this study, we constructed a composite hydrogel scaffold by combining an oriented acellular cartilage matrix (ACM) with a bone marrow homing peptide (BMHP)-functionalized self-assembling peptide (SAP)...
2018: Theranostics
Xavier Armoiry, Ewen Cummins, Martin Connock, Andrew Metcalfe, Pamela Royle, Rhona Johnston, Jeremy Rodrigues, Norman Waugh, Hema Mistry
Chondrosphere (Spherox) is a form of autologous chondrocyte implantation (ACI). It is licensed for repair of symptomatic articular cartilage defects of the femoral condyle and the patella of the knee with defect sizes up to 10 cm2 in adults. In a single technology appraisal (STA) [TA508] undertaken by the National Institute of Health and Care Excellence (NICE), Warwick Evidence was the Evidence Review Group (ERG) invited to independently review the evidence submitted by the manufacturer, Co.Don. The clinical effectiveness data came from their COWISI randomised controlled trial (RCT), which compared Chondrosphere with microfracture (MF)...
November 14, 2018: PharmacoEconomics
Thomas G Baboolal, Alam Khalil-Khan, Anthony A Theodorides, Owen Wall, Elena Jones, Dennis McGonagle
BACKGROUND: Mesenchymal stem cells (MSCs) have emerged as a promising candidate for tissue regeneration and restoration of intra-articular structures such as cartilage, ligaments, and menisci. However, the routine use of MSCs is limited in part by their low numbers and the need for methods and procedures outside of the joint or surgical field. PURPOSE: To demonstrate feasibility of a technique in which minimally manipulated synovial MSCs can be mobilized during knee arthroscopy, thereby showing proof of concept for the future evaluation and clinical use of native joint resident MSCs in single-stage joint repair strategies...
December 2018: American Journal of Sports Medicine
Melanie J Gupte, W Benton Swanson, Jiang Hu, Xiaobing Jin, Haiyun Ma, Zhanpeng Zhang, Zhongning Liu, Kai Feng, Ganjun Feng, Guiyong Xiao, Nan Hatch, Yuji Mishina, Peter X Ma
In the U.S., 30% of adults suffer joint pain, most commonly in the knee, which severely limits mobility and is often attributed to injury of cartilage and underlying bone in the joint. Current treatment methods such as microfracture result in less resilient fibrocartilage with eventual failure; autografting can cause donor site morbidity and poor integration. To overcome drawbacks in treatment, tissue engineers can design cell-instructive biomimetic scaffolds using biocompatible materials as alternate therapies for osteochondral defects...
December 2018: Acta Biomaterialia
Matthew T Wolf, Hong Zhang, Blanka Sharma, Norman A Marcus, Uwe Pietzner, Stefan Fickert, Achim Lueth, G H Robert Albers, Jennifer H Elisseeff
Objective To determine performance and repair kinetics of the ChonDux hydrogel scaffold for treating focal articular cartilage defects in the knee over 24 months. Design This assessor-blinded trial evaluates ChonDux hydrogel scaffold implantation in combination with microfracture in 18 patients across 6 sites. Male and female patients 18 to 65 years of age with full-thickness femoral condyle defects 2 to 4 cm2 in area were enrolled. Eligible patients received ChonDux treatment followed by rehabilitation. Defect volume fill was evaluated after 3, 6 (primary outcome), 12, 18, and 24 months by assessor blinded magnetic resonance imaging (MRI) analysis...
October 3, 2018: Cartilage
Reetadyuti Mukhopadhyay, Nishith Shah, Rohan Vakta, Jaymin Bhatt
PURPOSE: Anterior cruciate ligament (ACL) repair was first described in the mid 1900's. However, due to poorly selected patients led to unsatisfactory early results. We aim to study the outcome of ACL repair in a carefully selected cohort. METHODS: Thirteen consecutive patients of acute Type 1 (proximal ACL avulsion) were treated with arthroscopic ACL repair using a suture pull out technique. At the latest follow-up the patients were evaluated for Lysholm score, KT-1000 measurement and clinical assessment for any laxity...
September 6, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
Onur Başci, Maide Çimşit, Selva Zeren, Yeşim Saglican, Umut Akgün, Bariş Kocaoglu, Gülçin Başdemir, Mustafa Karahan
Purpose: The purpose of this experimental study was to investigate the effect of hyperbaric oxygen (HBO2) therapy combined with microfracture technique in the treatment of cartilage lesions. Methods: Adult Wistar rats (n=44) were divided into six groups. In Groups A, B, C and D, ICRS* (* International Cartilage Repair Society) grade 4 cartilage lesions were made on the femoral sulcus of both knees. Lesions were microfractured on the left knees; the right knees had no further procedure...
July 2018: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Ajaykumar Shanmugaraj, Ryan P Coughlin, Gabriel N Kuper, Seper Ekhtiari, Nicole Simunovic, Volker Musahl, Olufemi R Ayeni
PURPOSE: The patellofemoral (PF) joint contains the thickest articular cartilage in the human body. Chondral lesions to this area are often misdiagnosed and can predispose to secondary osteoarthritis if left untreated. Treatment options range from arthroscopic debridement to cartilage restoration techniques such as microfracture (MFx), autologous chondrocyte implantation (ACI), and osteochondral autograft transplantation. The purpose of this study was to systematically assess the trends in surgical techniques, outcomes, and complications of cartilage restoration of the PF joint...
September 19, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Isabel Andia, Nicola Maffulli
The practice of any sport is inherently associated with the risk of musculoskeletal lesions. We describe regenerative medicine technologies, including cellular therapies, gene therapies and multimolecular preparations of growth factors and cytokines, which are expected to advance the field of orthopaedics and sports medicine. Gene therapy involves the introduction of genetic information in the injured tissue to help that tissue to heal and, possibly, regenerate. Cell therapies used in clinical practice are based on the transplantation of adult human cells, which can be at different stages of differentiation...
August 28, 2018: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Anja Hirschmüller, Wolfgang Schoch, Heiner Baur, Barbara Wondrasch, Lukas Konstantinidis, Nobert P Südkamp, Philipp Niemeyer
INTRODUCTION: Focal cartilage defects are an increasingly relevant clinical problem especially in athletes. Cartilage regenerative surgery (CRS) including microfracture and autologous chondrocyte implantation (ACI) to treat such isolated cartilage defects in the knee joint has been well established in the last two decades. In contradiction to high-level evidence concerning the surgical technique, cell-related issues, and clinical results, the knowledge about the optimal rehabilitation process is still sparse although the importance of optimizing the rehabilitation process has recently led to new research focus in this field...
August 21, 2018: Archives of Orthopaedic and Trauma Surgery
Sung-Sahn Lee, Jin Hwan Ahn, Jun Ho Kim, Bong Soo Kyung, Joon Ho Wang
BACKGROUND: Previous studies have reported various healing rates (0%-100%) as evaluated by second-look arthroscopy after repair of medial meniscal root tears (MMRTs). Such variable results might provoke suspicion of the necessity for repair. Furthermore, the effect of meniscal healing on the clinical outcomes has not been reported. PURPOSE: To more precisely determine the healing rate of MMRTs repaired through the transseptal portal, which could provide objective visualization of the healed meniscus, and to identify the effect of meniscal healing on the clinical and radiological outcomes...
September 2018: American Journal of Sports Medicine
Svend Ulstein, Asbjørn Årøen, Lars Engebretsen, Magnus Forssblad, Stein Håkon Låstad Lygre, Jan Harald Røtterud
Background: The effect of microfracture (MF) or surgical debridement of concomitant full-thickness cartilage lesions in anterior cruciate ligament-reconstructed knees on patient-reported outcomes remains to be determined. Purpose: To evaluate the effect of debridement or MF compared with no surgical treatment of concomitant full-thickness cartilage lesions on patient-reported outcomes 5 years after anterior cruciate ligament reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 2...
August 2018: Orthopaedic Journal of Sports Medicine
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