共查询到20条相似文献,搜索用时 16 毫秒
1.
2.
Anterior cruciate reconstruction combined with autologous osteochondral transplantation 总被引:1,自引:0,他引:1
The purpose of this prospective study was to evaluate the results of simultaneous anterior cruciate ligament (ACL) reconstruction and osteochondral autograft transplantation performed in patients suffering an anterior instability associated with symptomatic full-thickness cartilage defects. Our clinical report includes the first 21 patients (six women, 15 men) who have been followed up for 32 months or longer. The average patient age was 29 years (range 22–44 years), and mean time from injury to the combined reconstructive surgery was 10 months (range 4–27 months). The cartilage defects had a mean area of 3.5 cm2 (range 2.0–5.0 cm2). All patients were evaluated according to the IKDC, Lysholm and Tegner scoring scales by an independent observer. A visual analogue scale (VAS) reflecting patient pain was evaluated. Assessment using the IKDC knee scoring scale revealed 81% of the patients with a normal or nearly normal knee joint. There was a significant improvement in subjective discomfort, and the KT-1000 arthrometric evaluation showed a reduction of the ventral tibial translation (5.9 to 1.9 mm). All but two patients had returned to full activities without restriction and were asymptomatic. The results of this study suggest that symptomatic full-thickness articular cartilage defects associated with ACL instability can be effectively treated by performing ACL reconstruction and osteochondral autologous grafts in one procedure. However, only the years which follow will show the long-term outcome of the patients. 相似文献
3.
Byung J. Lee Melissa A. Christino Alan H. Daniels Michael J. Hulstyn Craig P. Eberson 《Knee surgery, sports traumatology, arthroscopy》2013,21(8):1856-1861
Purpose
Patellar dislocations in adolescents may cause osteochondral fractures of the patella. The aim of this study was to review the outcomes of adolescent patients who underwent surgical intervention for patellar osteochondral fracture following patellar dislocation.Methods
Nine patients who underwent surgery for osteochondral fracture of the patella following dislocation were identified retrospectively. Following arthroscopic examination, if the fragment was large enough to support fixation, headless screws or bioabsorbable pins were used. Otherwise, the loose body was excised, and the donor site was managed with a microfracture. Postoperatively, patients were assessed using the International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) outcome measures.Results
The average age of the patients was 14.6 with average follow-up 30.2 months. Four of the nine patients underwent fixation, while five patients underwent removal of loose body with microfracture. The average defect size in the nonfixation group was 1.2 cm2 compared with 3.2 cm2 in the fixation group. The IKDC scores for fixation and nonfixation groups were 63.9 (SD = 18) and 76.1 (SD = 11.7), respectively. The KOOS subscale scores for symptoms, function in sports and recreation, and knee-related quality of life were higher for the nonfixation group when compared to the fixation group.Conclusions
This is the first known series examining surgical outcomes of osteochondral fractures of the patella following patellar dislocations in the adolescent population. While patients without fixation were less symptomatic in this series, this may be attributable to more severe injuries in patients undergoing fracture fixation.Level of evidence
Retrospective case series, Level IV. 相似文献4.
5.
目的对比分析关节镜结合微骨折术与自体骨软骨移植术治疗距骨骨软骨损伤的疗效。方法回顾分析2013年1月-2015年4月宜宾市第一人民医院收治的80例距骨骨软骨损伤患者的治疗情况,根据治疗方法不同分为A组(采取踝关节镜下微骨折术治疗)和B组(采取踝关节镜下自体软骨移植术治疗),每组40例。比较两组患者的踝关节功能、疼痛评分变化,对比分析治疗效果。结果两组患者术后2、6个月疼痛和踝关节功能评分与术前比较,差异均有统计学意义(P0.05);两组的疼痛评分比较,差异无统计学意义P0.05);B组的治疗有效率(97.5%)与A组(80.0%)比较,差异有统计学意义(P0.05);两组患者均未出现相关并发症。结论关节镜结合微骨折术和自体骨软骨移植术治疗距骨软骨损伤均具有较好的临床疗效,均能改善患者的踝关节功能,缓解患者的疼痛症状,并且均有较高的安全性。自体骨软骨移植相较于微骨折术的治疗有效率更佳,值得临床推广。 相似文献
6.
7.
Julia V. Woelfle H. Reichel M. Nelitz 《Knee surgery, sports traumatology, arthroscopy》2013,21(8):1925-1930
Purpose
Osteochondral autologous transplantation (OAT) from the ipsilateral femoral lateral condyle in osteochondritis dissecans (OD) of the talus has shown good clinical results in the past. To further define, indications and limitations of OAT various factors have been discussed which might influence the clinical outcome.Methods
In this study, the clinical outcome of OAT of 32 patients (mean follow-up 29 months) was evaluated by means of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, ankle pain on the visual analogue scale (VAS), and Hospital for Special Surgery (HSS) Patella score. We then analysed the statistical correlation between clinical outcome and various variables such as age, pre-existing osteoarthritis, or size of the lesion.Results
Median AOFAS score was 86 (range 68–100), median ankle pain on VAS was 2.0 (range 0–5.5), and median HSS Patella score was 95 (range 35–100). Advanced age (above 40 years of age) was associated with a significantly lower HSS Patella score (80 vs. 97.5, p = 0.035). None of the other variables (obesity, pre-existing osteoarthritis, size of the lesion, necessity of malleolar osteotomy, localization of the lesion, and number of previous surgeries) influenced the clinical outcome adversely.Conclusions
Osteochondral autologous transplantation in OD of the talus is a safe procedure with good clinical results. As advanced age is associated with higher donor-site morbidity, indication for OAT in older patients should be carefully considered. As none of the other variables affected the clinical outcome of OAT adversely, there is no contraindication for OAT, for example, in osteochondral lesions requiring more than one osteochondral grafts, lateral lesions, patients with BMI >25, pre-existing osteoarthritis, or failed previous surgery.Level of evidence
IV. 相似文献8.
Kock NB Hannink G van Kampen A Verdonschot N van Susante JL Buma P 《Knee surgery, sports traumatology, arthroscopy》2011,19(11):1962-1970
Purpose
The aim of this study was to evaluate subsidence tendency, surface congruency, chondrocyte survival and plug incorporation after osteochondral transplantation in an animal model. The potential benefit of precise seating of the transplanted osteochondral plug on the recipient subchondral host bone (‘bottoming’) on these parameters was assessed in particular. 相似文献9.
T1ρ mapping of articular cartilage grafts after autologous osteochondral transplantation for osteochondral lesions of the talus: A longitudinal evaluation 下载免费PDF全文
Naoki Haraguchi MD Koki Ota MD Naoki Nishida MD Takuma Ozeki MD Takashige Yoshida RT Atsushi Tsutaya RT 《Journal of magnetic resonance imaging : JMRI》2018,48(2):398-403
10.
Dirk Stengel Frank Klufmöller Grit Rademacher Sven Mutze Kai Bauwens Kay Butenschön Julia Seifert Michael Wich Axel Ekkernkamp 《Knee surgery, sports traumatology, arthroscopy》2009,17(5):446-455
During a short period of time, surgical robots had been propagated for automated tunnel placement in anterior cruciate ligament
(ACL) reconstruction. Clinical outcome data are currently unavailable. Between 2000 and 2003, 152 patients underwent ACL replacement
with the assistance of the Computer Assisted Surgical Planning and Robotics system (CASPAR, OrtoMaquet, Germany) at our hospital.
After minimal invasive pin placement in both the tibia and femur, computed tomography was used to register anatomical landmarks
and to plan graft tunnel alignment. The robot was used to drill tibial and femoral tunnels in an outside-in fashion according
to pre-operative planning. There was one procedure-specific Serious Adverse Event (i.e., an intraoperative transection of
the posterior cruciate ligament). After IRB approval, all patients were invited for a follow-up examination. Data from 100
patients (35 women, 65 men, mean age 35 [SD 11] years, median follow-up 61 [range 42–77] months) form the basis of this report.
Side-to-side differences in anterior laxity were measured with the KT-1000 arthrometer. Patient-centered outcomes included
the Lysholm-Score, the lower extremity functional scale (LEFS), and the Short Form 36 (SF36). The mean KT-1000 side-to-side
difference was 0.89 [95% confidence interval (CI) 0.52–1.26] mm. Eight and five patients had a positive Lachman and pivot
shift test, respectively. The Lysholm-Score averaged 86 (95% CI 83–89) points. Excellent, good, fair, and poor outcomes were
reported by 38, 32, 20, and 10 patients. The LEFS averaged 85 (95% CI 82–88) points. The mean SF36 Physical Component Score
was 48.4 (95% CI 46.5–50.3), indicating residual deficits compared to the population norm. All tibial graft tunnels did not
cross the Blumensaat line, but were placed slightly anterior to the optimal center of 42% reported in previous studies. Compared
to literature data, robot-assisted ACL reconstruction with BTB grafts may lead to higher knee stability, but poorer functional
outcomes. The immense additional efforts with the procedure did not pay off in a benefit to patients. 相似文献
11.
L. Zak I. Krusche-Mandl S. Aldrian S. Trattnig S. Marlovits 《Knee surgery, sports traumatology, arthroscopy》2014,22(6):1288-1297
Purpose
Autologous osteochondral transplantation (OCT) is one of the surgical options currently used to treat cartilage defects. It is the only cartilage repair method that leads to a transfer of hyaline cartilage repair tissue. The purpose of this study was to evaluate the magnetic resonance observation of cartilage repair tissue (MOCART) score, the 3D MOCART score and various clinical scores in patients after OCT in knee joints.Methods
Two women and eight men were evaluated 6–9 years (median 7.2 years) after OCT on the femoral condyle of the knee joint. All patients were evaluated by magnetic resonance imaging (MRI) measurement, using a 3.0 T Scanner with different cartilage-specific sequences. Clinical assessment included the knee injury and osteoarthritis outcome score (KOOS), the international knee documentation committee (IKDC) subjective knee form, the Noyes sport activity rating scale and the Tegner activity score. For MRI evaluation, the MOCART score and 3D MOCART score were applied.Results
Clinical long-term results after OCT showed median values of 77 (range 35.7–71.4) for the IKDC; 50 (6.3–100), 66.7 (30.6–97.2), 65 (0–75), 57.1 (35.7–71.4) and 80.9 (30.9–100) for the KOOS subscales (quality of life, pain sports, symptoms and activity of daily living); 61.4 (22.3–86.2) for the Noyes scale; and 3 (0–6) for the Tegner activity score. The median MOCART score was 75 (30–90) after both 1 and 2 years and 57.5 (35–90) after 7 years, as assessed by different cartilage-specific sequences. The 3D MOCART score showed values of 70 (50–85) and 60 (50–80) in the two different isotropic sequences after 7 years.Conclusion
The MOCART and 3D MOCART scores are applicable tools for patient follow-up after OCT. Post-operative follow-up assessments would also benefit from the inclusion of OCT-specific parameters. Long-term results after OCT reflect an impairment in clinical scores in the first 2 years with good results during follow-up. Stable conditions were observed between 2 and 7 years after surgery. The filling of the defects and the cartilage interface appeared good at MRI evaluation after the first 2 years, but cartilage loss was observed between the medium- and long-term follow-ups. Isotropic imaging with multiplanar reconstruction is useful for daily clinical use to assess bony cylinders in cartilage repair, especially in combination with the 3D MOCART.Level of evidence
Retrospective therapeutic study, Level IV. 相似文献12.
Dynamic function after anterior cruciate ligament reconstruction with autologous patellar tendon 总被引:5,自引:0,他引:5
Bush-Joseph CA Hurwitz DE Patel RR Bahrani Y Garretson R Bach BR Andriacchi TP 《The American journal of sports medicine》2001,29(1):36-41
The purpose of this study was to dynamically assess the functional outcome of patients who had undergone successful anterior cruciate ligament reconstruction using an autologous patellar tendon technique and to determine whether their dynamic knee function was related to quadriceps and hamstring muscle strength. The knee kinematics and kinetics of 22 subjects who had undergone anterior cruciate ligament reconstruction (mean age, 27 +/- 11 years) and of 22 age- and sex-matched healthy control subjects were determined during various dynamic activities using a computerized motion analysis and force plate system. The differences in the sagittal plane angles and external moments between the two groups during light (walking), moderate (climbing and descending stairs), and higher-demand (jogging, jog and cut, jog and stop) activities were related to isokinetic strength measurements. Although patients who are asymptomatic and functioning well after anterior cruciate ligament reconstruction can perform normally in light activities, higher-demand activities reveal persistent functional adaptations that require further study. 相似文献
13.
Mark A Taylor Timothy L Norman Nina B Clovis J David Blaha 《Medicine and science in sports and exercise》2002,34(1):70-73
PURPOSE: Blood is a rich source of growth factors that can stimulate fibrocyte migration and help induce neovascular ingrowth. These properties may be able to stimulate a healing response in chronic degeneration of a tendon (tendonosis). The purpose of this study was to assess the biomechanical and histological effects of autologous blood injection on animal tendons. METHODS: New Zealand white rabbit left side patellar tendons were injected with 0.15 cc of autologous blood. We then compared the mechanical properties and histology to the normal right patellar tendon at 6 and 12 wk. RESULTS: At 6 and 12 wk after the injection, there were no differences in the histology compared with normal tendon tissue, and there were no significant changes in tendon stiffness. Biomechanically, the tendons were not damaged at 6 wk after the injection. By 12 wk, tendons that were injected with blood were significantly (P < 0.014) stronger. CONCLUSION: We found that injecting blood directly into normal tendons appears safe. Further evaluation of this technique would appear indicated. 相似文献
14.
15.
16.
17.
Background and objective
The assessment of bone marrow edema-like signal intensity in magnetic resonance imaging (MRI) in patients after osteochondral autograft transplantation (OCT) in the knee joint is a parameter of yet indefinite value. This study determines the prevalence of persistent edema-like signal intensity in OCT patients and evaluates the correlation between edema and morphological imaging findings of the graft and clinical pain symptoms.Materials and methods
In this longitudinal observational study, 10 patients after OCT were followed by MRI prospectively 1 month, 3 months, 6 months, 12 months, and 24 months post-operatively. All MR examinations were performed on a 1.0 T MR unit with the same protocol using a modified scoring system (magnetic resonance observation of cartilage repair tissue—MOCART) for evaluation. Edema-like signal intensity in and beneath the osteochondral graft was assessed in its prevalence and graded using a coronal short tau inversion recovery fast spin echo (STIR-FSE) sequence: grade 1, normal; grade 2, moderate (diameter <2 cm); grade 3, severe (diameter >2 cm). The finding of edema-like signal intensity was correlated with graded parameters describing the morphology of the repair tissue assessed in a sagittal dual FSE sequence including: (a) surface of repair tissue: grade 1, intact; grade 2, damaged. (b) Cartilage interface: grade 1, complete; grade 2, incomplete. (c) Bone interface: grade 1, complete; grade 2, delamination. The finding of edema-like signal intensity was also correlated with the KOOS pain score assessing knee pain after 12 months.Results
Initially, after 1 month the prevalence of edema-like signal intensity was 70% (7/10 patients) and finally after 24 months 60% (6/10 patients). We found no significant relationship between the prevalence and degree of edema-like signal intensity and parameters describing the morphology of the repair tissue. Also the clinical pain score did not show significant correlation with edema.Conclusion
Persistent bone marrow edema-like signal intensity in MRI is frequently found in patients after OCT and may post-operatively continue for years without significant relation to delamination and loss of the graft and knee pain. 相似文献18.
19.
Surgical articular cartilage repair therapies for cartilage defects such as osteochondral autograft transfer, autologous chondrocyte
implantation (ACI) or matrix associated autologous chondrocyte transplantation (MACT) are becoming more common. MRI has become
the method of choice for non-invasive follow-up of patients after cartilage repair surgery. It should be performed with cartilage
sensitive sequences, including fat-suppressed proton density-weighted T2 fast spin-echo (PD/T2-FSE) and three-dimensional
gradient-echo (3D GRE) sequences, which provide good signal-to-noise and contrast-to-noise ratios. A thorough magnetic resonance
(MR)-based assessment of cartilage repair tissue includes evaluations of defect filling, the surface and structure of repair
tissue, the signal intensity of repair tissue and the subchondral bone status. Furthermore, in osteochondral autografts surface
congruity, osseous incorporation and the donor site should be assessed. High spatial resolution is mandatory and can be achieved
either by using a surface coil with a 1.5-T scanner or with a knee coil at 3 T; it is particularly important for assessing
graft morphology and integration. Moreover, MR imaging facilitates assessment of complications including periosteal hypertrophy,
delamination, adhesions, surface incongruence and reactive changes such as effusions and synovitis. Ongoing developments include
isotropic 3D sequences, for improved morphological analysis, and in vivo biochemical imaging such as dGEMRIC, T2 mapping and
diffusion-weighted imaging, which make functional analysis of cartilage possible. 相似文献