Autologous osteochondral transplantation using the diamond bone-cutting system (DBCS): 6–12 years’ follow-up of 35 patients with osteochondral defects at the knee joint

Thirty-five patients with severe osteochondral defects were treated by autologous osteochondral transplantation between 1986 and 1992. The majority of patients (27) suffered from osteochondrosis dissecans, while 8 patients presented with posttraumatic osteochondral defects. The grafts were harvested with a diamond bone cutter from the posterior part of the medial or lateral femoral condyle. In 29 patients the lesion was located at the lateral part of the medial femoral condyle, in 3 it was at the lateral femoral condyle, and in 3 at the patella. Twenty-nine patients could be examined at the follow-up between 6 and 12 years later (mean follow up 8.1 years). Using the standard cartilage evaluation form, the transplanted knees of 12 patients were graded as normal (grade I), 14 knees were nearly normal (grade II), while 3 patients presented with an abnormal result (grade III). All 3 of them had a varus malalignment and refused a high tibial correction osteotomy against our advice. No patient was assessed as severely abnormal (grade IV). The majority of patients improved their activity level and the functional status of the joint. Twelve patients developed new radiological signs of osteoarthrosis with a decrease in the radiological score of Kellgren and Lawrence by about one stage. We conclude that autologous osteochondral transplantation with the diamond bone-cutting system is an effective method in the treatment of severe osteochondral defects. Received: 17 April 2000     

Biphasic bioresorbable scaffold (TruFit Plug®) for the treatment of osteochondral lesions of talus: 6- to 8-year follow-up

BackgroundThe ideal treatment of osteochondral lesions of the talus (OLT) is debatable. The TruFit plug has been investigated as a potential treatment method for osteochondral defects. This is a biphasic scaffold designed to stimulate cartilage and subchondral bone formation. The purpose of this retrospective study was to investigate the long-term functional and MRI outcomes of the TruFit Plug for the treatment of OLT.MethodsTwelve consecutive patients treated from March 2007 to April 2009 for OLT were evaluated. Clinical examination included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and the visual analog scale (VAS) for pain. MRI scans were optained pre-treatment and at last follow-up. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation.ResultsMean follow-up was 7.5 years (range, 6.5–8.7 years). The average age was of 38.6 years (range, 22–57 years). The sex ratio between males and females was 3:1 (9 males, 3 females). The mean AOFAS score improved from a preoperative score of 47.2 ± 10.7 to 84.4 ± 8 (p < 0.05). According to the postoperative AOFAS scores 1 case obtained excellent results, 9 were classified as good, and 2 were fair. VAS score improved from a preoperative value of 6.9 ± 1.4 points to 1.2 ± 1.1 points at last follow-up (p < 0.05). The MOCART score for cartilage repair tissue on postoperative MRI averaged 61.1 points (range, 25–85 points).ConclusionsThe long-term results suggest that the technique of Trufit Plug for OLT is safe and demonstrates good post-operative scores including improvement of pain and function, with discordant MRI results. However, randomized controlled clinical trials comparing TruFit Plug with an established treatment method are needed to improve synthetic biphasic implants as therapy for osteochondral lesions.Level of evidence: Retrospective case series, Level IV.     

High tibial osteotomy for the treatment of medial osteoarthritis of the knee with new iBalance system: 2 years of follow-up

Background

A new system for performing open-wedge high tibial osteotomy (HTO), the iBalance HTO System-Arthrex, has been recently developed in order to make the surgery more reproducible and safe. The aim of this study was to determine the short-term outcomes of the iBalance technique in medial compartment osteoarthritis and varus malalignment of the knee.

Methods

Fifteen patients with a mean age of 50.7 years (SD 5.09), affected by symptomatic varus knee, with medial compartment osteoarthritis (1–2 Ahlbäck degree), were treated with iBalance HTO between July 2011 and February 2012 and evaluated retrospectively. Patients were assessed against the following benchmarks: subjective International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and VAS for pain and Tegner scores, along with X-rays and MRI, before surgery and after a 2-year follow-up.

Results

No severe intraoperative complications or implant failures occurred. The mean preoperative scores were as follows: subjective IKDC 66.8 (SD 1.18), KOOS 61.3 (SD 0.86), Vas for pain 8.6 (SD 1.72) and Tegner 4.1 (SD 2.06), while at follow-up the scores were 73.6 (SD 1.01), 88.1 (SD 1.23), 2.9 (SD 2.35) and 3.1 (SD 1.83), respectively. Correction ranged between 3° and 8°. All patients showed complete articular recovery, no loss of correction, no substantial variation in A/P slope and no hardware problems.

Conclusions

iBalance proved to be effective and safe and produced good overall results. Consolidation and osseointegration of the system took place rapidly, while recovery was precocious, comparable with traditional methods and with no severe complications.

Level of evidence

Case series, Level IV.

     

High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up

We reviewed 192 patients (224 knees) to assess the results of HTO in medial gonarthrosis during the period 1982–2008. Median follow-up was about 15 years for 134 females and 58 males. Among the knees, 118 had an average opening wedge for varus angle of 13° and 106 had closing wedges of 11°. Knee Society scoring before osteotomies was 68/200 for opening wedge and 81/200 for closing wedge. Modified Ahlback classification showed preoperative grades I (n = 44), II (78), III (83) and IV (19). Healing delay was 55 days for closing and 70 for opening osteotomy. Twenty-nine knees were still painful. Twenty-eight patients were revised and 19 others had complications. After opening wedge osteotomy, scoring was 101/200 and valgus angle was 2°. After closing wedge osteotomy, scoring was 94/200 and valgus angle was 4°. Global results were as follows: very good, 12%; good, 30%; fair, 31%; and poor, 27%. HTO decreases stresses on medial compartments and widens joint space. The average of 5° mechanical valgus at the time of osteotomy seems to be quite effective at the follow-up for at least ten years. Our indications are opening wedge for grades 1–3 and wide varus angle, until the age of between 65–70. Closing wedge is indicated for medium varus in younger patients.     

A useful combination for the treatment of patellofemoral chondral lesions: realignment procedure plus mesenchymal stem cell—retrospective analysis and clinical results at 48 months of follow-up

European Journal of Orthopaedic Surgery & Traumatology - Osteochondral lesions of the patellofemoral joint (OLPFJ) are defects of the cartilage surface and subchondral bone, which often require...     

Osteochondral transplantation for the treatment of osteochondral defects at the talus with the Diamond twin system® and graft harvesting from the posterior femoral condyles

Background

The aim of this study is to analyze clinical results after osteochondral cylinder transplantation for osteochondral defects at the medial or lateral talar dome using the Diamond twin system (Karl Storz). We hypothesize that grafts harvesting from the posterior femoral condyles are associated with less donor site morbidity than reported by previous studies.

Methods

We have surgically treated 20 patients with an osteochondral defect of the talus by osteochondral transplantation with the Diamond twin system via an osteotomy of the ankle. The osteochondral cylinders were harvested from the posterior aspects of the femoral condyles of the ipsilateral knee. The defects at donor site were filled with a bone substitute of tricalcium phosphate (Synthricer, Karl Storz). The mean age was 25.4 years. After a mean time of 12.6 months, the screws at the medial malleolus were removed and an arthroscopy was performed. The functional outcome was evaluated with the visual analog scale for pain at walking, running, stair climbing, quality of life at the time of implant removal and at a mean follow-up of 25.8 months. Activity was assessed with the Tegner scale. Knee function was evaluated with the Lysholm score.

Results

In one case, the osteochondral cylinder did not heal and an osteochondral fragment was removed arthroscopically. In all other cases, the osteochondral cylinder was stable with surrounding cartilage. The average ICRS Cartilage Repair Assessment was 10.1 points (±1.3). All malleolar osteotomies healed radiologically. In 15 patients, a synovectomy and local debridement of the ankle were performed at second-look arthroscopy. Ankle pain at walking, running and stair climbing as measured by a visual analog scale (10-0) decreased significantly from preoperatively to the first follow-up (mean 12.6 months) and to the second follow-up (mean 25.8 months). The ankle-related quality of life increased significantly from preoperatively to postoperatively. There was no significant change in the Lysholm score. The activity measured with the Tegner activity scale increased significantly from preoperatively to the last follow-up, but only two out of nine patients continued pivoting sports.

Conclusions

Autologous osteochondral grafting with the Diamond twin system is a reliable treatment option for symptomatic osteochondral defects of the talus. After 1 year, the majority of patients had still some complaints. However, after screw removal and second-look arthroscopy, the pain and ankle-related quality of life further improved.

Clinical relevance

The donor site morbidity after graft harvesting from the posterior aspects of the femoral condyles is lower than previously reported.     

Comparison of two different matrix-based autologous chondrocyte transplantation systems: 1 year follow-up results

Purpose  

The treatment of full-thickness cartilage defects of the knee is a common problem in orthopaedic surgery. Autologous chondrocyte transplantation (ACT) is one of the few reliable treatment options of cartilage defects with good long-term outcomes. The improvement of ACT led to the matrix-based ACT (MACT). The purpose of the study was to compare two different commercially available MACT systems.     

Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years

Background  

This study aims to compare radiographic and clinical outcomes of Dynesys and posterior lumbar interbody fusion (PLIF) for the treatment of multisegment disease.     

Comparative results of two different techniques in the treatment of the Morton’s neuroma

We carried out a prospective study with 40 patients diagnosed of interdigital neuroma of the foot and who had undergone surgery over a 9 year period. We analysed the advantages of two surgical techniques (neurectomy and neurolysis). The results were similar in both groups. No recurrence occurred in the group where neurectomy was carried out. There were two cases of clinical recurrence in the group where neurolysis was carried out. We concluded that neurectomy was our preferred technique for its simplicity, the shorter surgical time necessary and the reduced risk of relapse.     

Use of platelet-rich plasma for the treatment of refractory jumper’s knee

The aim of this study was to evaluate the efficacy of multiple platelet-rich plasma (PRP) injections on the healing of chronic refractory patellar tendinopathy after previous classical treatments have failed. We treated 15 patients affected by chronic jumper’s knee, who had failed previous nonsurgical or surgical treatments, with multiple PRP injections and physiotherapy. We also compared the clinical outcome with a homogeneous group of 16 patients primarily treated exclusively with the physiotherapy approach. Multiple PRP injections were performed on three occasions two weeks apart into the site of patellar tendinopathy. Tegner, EQ VAS and pain level were used for clinical evaluation before, at the end of the treatment and at six months follow-up. Complications, functional recovery and patient satisfaction were also recorded. A statistically significant improvement in all scores was observed at the end of the PRP injections in patients with chronic refractory patellar tendinopathy and a further improvement was noted at six months, after physiotherapy was added. Moreover, comparable results were obtained with respect to the less severe cases in the EQ VAS score and pain level evaluation, as in time to recover and patient satisfaction, with an even higher improvement in the sport activity level achieved in the PRP group. The clinical results are encouraging, indicating that PRP injections have the potential to promote the achievement of a satisfactory clinical outcome, even in difficult cases with chronic refractory tendinopathy after previous classical treatments have failed.     

Modified percutaneous needle aponeurotomy for the treatment of dupuytren’s contracture: early results and complications

Background

The purpose of our study was to identify postoperative results and complications using a percutaneous approach to treat Dupuytren''s contracture in a consecutive series of patients.

Methods

A review of all patients with Dupuytren''s contracture treated with percutaneous needle aponeurotomy (NA) from 2008 to 2010 was performed. Patient demographics, digits affected, and disease severity was recorded. Pre-operative total passive extension deficit (TPED) was calculated for each affected digit. TPED in the immediate postoperative period and at the time of most recent follow-up was measured. Treatment-related complications and incidence of disease recurrence were identified. Statistical analysis was performed using paired t-test. (Statistical significance p-value <0.05).

Results

525 digits in 193 hands were treated with NA. 140 patients were male, average age was 65 years. The average preoperative TPED was 41° and the average immediate postoperative TPED was 1° (98% correction) (P=0.0001). The average TPED at 4.5 month follow up was 11 o (73% correction). Complications included infection in 3 patients and one case each of triggering, delayed flexor tendon rupture, complex regional pain syndrome and persistent numbness. Recurrence was observed in 62 digits.

Conclusion

Percutaneous needle aponeurotomy is an effective technique in the treatment of Dupuytren''s contracture. Near complete correction of contracture was achieved and few complications were observed. Longer follow-up is needed to determine if these short-term results are maintained.     

Fracture-dislocations of the elbow joint – strategy for treatment and results

Between January 1993 and December 1996, 41 patients with fracture dislocation of the elbow joint were treated in our department. In 28 patients (median age 46 years, range 15-77 years; 16 male, 12 female), a clinical and radiological follow-up was obtained after median 34 months (range 12-59 months). In addition to the humero-ulnar dislocation, isolated fractures were present in 13 patients and combined fractures in 15 (all with involvement of the radial head). Primary neurological deficits were found in 7 and open fractures in 3 patients. In 7 patients, primary definitive surgical therapy was carried out by open reduction and internal fixation. A two-step surgical management (initial closed reduction and immobilization, 5 patients with external fixator, 7 with plaster; secondary open surgical procedure) was performed in 12 and conservative treatment in 9 patients. According to the Leipzig Elbow Score, taking subjective, clinical and radiological criteria into consideration, 4 patients achieved 'excellent' and 5 patients a 'good' result. Ten patients were scored 'moderate' and 9 'poor'. The rate of secondary complications necessitating revision was 36%. Poor results were primarily caused by extensive initial soft-tissue damage, delayed definitive surgical therapy, and ectopic heterotopic ossification. In contrast, fracture localization and degree of arthrosis were not of significant importance for the final outcome. In fracture dislocations, the goal is a primary definitive surgical treatment aiming for early postoperative physiotherapy.     

Excellent results with the cemented Lubinus SP II 130-mm femoral stem at 10 years of follow-up: 932 hips followed for 5–15 years

Background and purpose

The Lubinus SP II stem is well documented in both orthopedic registries and clinical studies. Worldwide, the most commonly used stem lengths are 150 mm and 170 mm. In 1995, the 130-mm stem was introduced, but no outcome data have been published. We assessed the long-term survival of the Lubinus SP II 130-mm stem in primary total hip arthroplasty.

Patients and methods

In a retrospective cohort study, we evaluated 829 patients with a Lubinus SP II primary total hip arthroplasty (932 hips). The hips were implanted between 1996 and 2001. The primary endpoint was revision for any reason. The mean follow-up period was 10 (5–15) years.

Results

Survival analysis showed an all-cause 10-year survival rate of the stem of 98.7% (95% CI: 99.7–97.7), and all-cause 10-year survival of the total hip arthroplasty was 98.3% (95% CI: 99.3–97.3).

Interpretation

Excellent long-term results can be achieved with the cemented Lubinus SP II with the relatively short 130-mm stem. This stem has potential advantages over its 150-mm and 170-mm siblings such as bone preservation distal to the stem, better proximal filling around the prosthesis, and easier removal.The Lubinus SP II stem is a well-documented prosthesis (Annaratone et al. 2000, Lubinus et al. 2002, Catani et al. 2005, Wierer et al. 2013). The anatomical-shaped SP stem was introduced in 1982 as a monoblock prosthesis, and since 1984 it has been available as the modular SP II system. The anatomical-shaped stem provides a uniform cement mantle surrounding the prosthesis, which reduces the risk of contact between the prosthesis and cortical bone. It has been hypothesized that this more uniform cement mantle improves the survival of the prosthesis (Lubinus et al. 2002). Worldwide, the most commonly used stem lengths are 150 and 170 mm. In 1995, the 130-mm stem was introduced and since its introduction this has been the most frequently used stem in our hospital. This shorter stem has several theoretical advantages, such as preservation of bone stock and possibly a better filling of the proximal femur, subsequently leading to better options for revision. Theoretically, however, the shorter stem has less rotational stability.There is no literature specifically about the SP II 130-mm stem. Reports on 150-mm and 170-mm SP II stems show survival rates ranging from 90% to 98%, with a minimum of 10 years of follow-up (Annaratone et al. 2000, Lubinus et al. 2002, Catani et al. 2005, Makela et al. 2008, Espehaug et al. 2009, Wierer et al. 2013). The Swedish registry data are almost uniformly (> 98%) based on the 150-mm stem (Swedish register database 2013). We hypothesized that the long-term survival of the Lubinus SP II 130-mm stem in primary total hip arthroplasty would be no different from the reported survival of the 150-mm and 170-mm SP II femoral stems. This hypothesis was tested in a retrospective cohort study using revision for any reason as the primary endpoint.