Fresh Osteochondral Resurfacing of the Patellofemoral Joint.
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ABSTRACT:
SUBMITTER: Gelber PE
PROVIDER: S-EPMC6926379 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The treatment of articular cartilage lesions in young patients is certainly a complex matter and subject of continuous research, particularly for those located at the patellofemoral joint, given its peculiar biomechanical characteristics. Osteochondral grafts can be of relatively small size when the defect is focal and in an area that allows good stability and consequently the graft's integration. In case of large or multifocal lesions, it is possible to consider an osteochondral transplantation of the entire articular surface of the patella. We present a simple and reproducible technique to perform a patellar fresh osteochondral allograft resurfacing attempting to reduce the symptoms and delay a prosthetic implant in young patients with advanced patellar chondral injuries.
| S-EPMC6020115 | biostudies-literature
Project description:Osteochondritis dissecans (OCD) is a chronic and painful joint condition that can occur from childhood through to adult life. Microtrauma, vascular insufficiency, or abnormal endochondral ossification are the most common causes of OCD. Reconstructive techniques for OCD of the knee are typically necessary when either non-operative or reparative/regenerative operative treatments fail, or when the OCD is irreversible. To analyze the clinical outcomes and failure rates of fresh osteochondral allograft transplantation (FOCA) used as a reconstructive strategy in OCD patients, an in-depth search was carried out on the PubMed, Scopus, and Web of Science databases concerning the existing evidence related to the use of FOCA for OCD patients in the knee joint. A total of 646 studies were found through the search and 2 studies were added after a cross-referenced examination of the articles within the bibliography. Six studies with a total of 303 OCD lesions treated with FOCA, with a mean follow-up of 6.3 years, were included. Although a limited number of low-level evidence studies on this topic are available in previous research, satisfactory clinical results and survival rates of the reconstruction are reported. However, to better define the real advantages of FOCA in the healing process of OCD lesions, comparative studies with different techniques are needed.
| S-EPMC8622509 | biostudies-literature
Project description:IntroductionWe performed a survivorship analysis of patients treated with patellofemoral osteochondral allograft transplantation (OCA) using either a shell or plug technique and identified variables associated with graft failure.MethodsConsecutive patients at two institutions who underwent OCA of the patellofemoral compartment between March 1, 2001 to March 1, 2015, were retrospectively identified at minimum 2 years' follow-up. Demographic information, intraoperative findings, and postoperative data were collected. Patients were divided into two groups on the basis of surgical technique (plug group and shell group). Failure was defined as revision OCA, conversion to arthroplasty, or gross appearance of graft degeneration on second-look arthroscopy. Logistic regression analysis was performed to identify patient- and surgery-specific variables associated with survivorship.ResultsFifty patients were identified (36 women and 14 men; mean age 37.43 ± 8.87 years). Sixteen patients received plug allografts, whereas 34 received shell allografts. Forty percent of patients underwent a concomitant meniscal, ligamentous, malalignment, or chondral procedure. Five patients in the Plug Group (31.3%) underwent reoperation at a mean 1.37 ± 1.34 years, and 28 patients (82.4%) who received Shell OCA underwent reoperation at a mean 1.94 ± 1.92 years. Two patients in the plug group had graft failure at a mean 9.17 ± 0.93 years, whereas 13 patients in the shell group had graft failure at a mean 3.81 ± 2.78 years. Patients with plug allografts demonstrated 100% and 66% survival at 5 and 9.8 years, respectively. For the shell group, survivorship was 65.8% and 37% at 5 and 10.6 years, respectively. Increasing body mass index was associated with failure for the case series overall (odds ratio 1.33, P = .020). Traumatic cause was found to be protective of failure (odds ratio = 0.02, P = .035).ConclusionsPlug OCA of the patellofemoral compartment can be an efficacious procedure with quality mid-term outcomes. Shell OCA led to high failure rates at midterm outcomes. Increasing body mass index may predispose patients to failure, whereas traumatic cause of their lesion was associated with improved outcomes.Level of evidenceLevel IV, Therapeutic case series.
| S-EPMC7120803 | biostudies-literature
Project description:Patellar instability is a debilitating condition, and trauma due to the dislocations may severely damage the articular cartilage of the patellofemoral joint. The lack of healing capacity of cartilage makes treatment of such lesions challenging. In young patients, preservation of native bone and cartilage is a priority, and therefore arthroplasty procedures should be avoided even in relatively larger lesions. Fresh osteochondral allografting has been described for these difficult and complex cases, with recent studies showing promising results. In this surgical technique, we describe the use of bipolar osteochondral allografts of the patella and trochlea and patellofemoral joint reconstruction for large bipolar full-thickness cartilage defects due to recurrent dislocation events.
| S-EPMC6928370 | biostudies-literature
Project description:Chondral defects of the patellofemoral joint remain a difficult-to-treat pathology with limited long-term results. Currently available techniques to treat large or unipolar chondral defects of the patella include autologous chondrocyte implantation and osteochondral allograft transplantation. Despite the recent advances in orthobiologic adjuncts, there is no single gold-standard surgical approach to this difficult-to-treat pathology in patients who are frequently young, active, and demanding on their bodies. We describe a technique for osteochondral allograft transplantation to the patella for an isolated patellar chondral lesion (unipolar).
| S-EPMC6823814 | biostudies-literature
Project description:With increasing shoulder instability events, the likelihood of a bony lesion of the glenoid and/or humeral head rises. Although bone loss of either the glenoid or humeral head may result in recurrent instability, bipolar lesions have been shown, in particular, to result in a negative and additive effect on glenohumeral stability. In the case of a bipolar lesion comprising severe glenoid bone loss and an engaging, "off-track" Hill-Sachs lesion, the bony foundation of the glenohumeral joint is compromised and bony augmentation is necessary. We present our preferred technique, made up of the application of a distal tibia allograft to address the glenoid bone loss and humeral head allograft to address the Hill-Sachs lesion, for the treatment of a severe bipolar lesion in the setting of recurrent anterior shoulder instability after a failed Latarjet procedure.
| S-EPMC5495999 | biostudies-literature
Project description:IntroductionPatellofemoral joint osteoarthritis (OA) is common and leads to pain and disability. However, current classification criteria do not distinguish between patellofemoral and tibiofemoral joint OA. The objective of this study was to provide empirical evidence of the clinical features of patellofemoral joint OA (PFJOA) and to explore the potential for making a confident clinical diagnosis in the community setting.MethodsThis was a population-based cross-sectional study of 745 adults aged ≥ 50 years with knee pain. Information on risk factors and clinical signs and symptoms was gathered by a self-complete questionnaire, and standardised clinical interview and examination. Three radiographic views of the knee were obtained (weight-bearing semi-flexed posteroanterior, supine skyline and lateral) and individuals were classified into four subsets (no radiographic OA, isolated PFJOA, isolated tibiofemoral joint OA, combined patellofemoral/tibiofemoral joint OA) according to two different cut-offs: 'any OA' and 'moderate to severe OA'. A series of binary logistic and multinomial regression functions were performed to compare the clinical features of each subset and their ability in combination to discriminate PFJOA from other subsets.ResultsDistinctive clinical features of moderate to severe isolated PFJOA included a history of dramatic swelling, valgus deformity, markedly reduced quadriceps strength, and pain on patellofemoral joint compression. Mild isolated PFJOA was barely distinguished from no radiographic OA (AUC 0.71, 95% CI 0.66, 0.76) with only difficulty descending stairs and coarse crepitus marginally informative over age, sex and body mass index. Other cardinal signs of knee OA - the presence of effusion, bony enlargement, reduced flexion range of movement, mediolateral instability and varus deformity - were indicators of tibiofemoral joint OA.ConclusionsEarly isolated PFJOA is clinically manifest in symptoms and self-reported functional limitation but has fewer clear clinical signs. More advanced disease is indicated by a small number of simple-to-assess signs and the relative absence of classic signs of knee OA, which are predominantly manifestations of tibiofemoral joint OA. Confident diagnosis of even more advanced PFJOA may be limited in the community setting.
| S-EPMC3446431 | biostudies-literature
Project description:Small-joint arthroscopy has supplanted open procedures because it offers the potential for improvement in joint visualization, reduced scarring, and accelerated recovery. Despite these advantages, arthroscopy of the first metatarsophalangeal joint is not commonly performed and reports of its use are lacking. The reason for this is not clear but may be because of perceived technical complexity and poorly defined indications. In our experience, however, arthroscopy of the first metatarsophalangeal joint is a versatile procedure that facilitates treatment of many different pathologic processes through a minimally invasive approach with few complications. We present our technique for arthroscopic management of osteochondral lesions of the hallux.
| S-EPMC5021517 | biostudies-literature
Project description:BackgroundThe use of particulated articular cartilage for repairing cartilage defects has been well established, but its use is currently limited by the availability and short shelf life of donor cartilage. Vitrification is an ice-free cryopreservation technology at ultralow temperatures for tissue banking. An optimized vitrification protocol has been developed for particulated articular cartilage; however, the equivalency of the long-term clinical efficacy of vitrified particulated articular cartilage compared with fresh articular cartilage has not yet been determined.HypothesisThe repair effect of vitrified particulated cartilage from pigs would be equivalent to or better than that of fresh particulated cartilage stored at 4°C for 21 days.Study designControlled laboratory study.MethodsA total of 19 pigs were randomly divided into 3 experimental groups: fresh particulated cartilage group (n = 8), vitrified particulated cartilage group (n = 8), and negative control group (no particulated cartilage in the defect; n = 3). An additional pig was used as the initial cartilage donor for the first set of surgical procedures. Pigs were euthanized after 6 months to obtain femoral condyles, and the contralateral condyle was used as the positive (no defect) control. Samples were evaluated for gross morphology using the Outerbridge and Osteoarthritis Research Society International (OARSI) scoring systems, histology (safranin O, collagen type I/II, DAPI), and chondrocyte viability using live-dead membrane integrity staining.ResultsThere were no infections after surgery, and all 19 pigs were followed for the duration of the study. The OARSI grades for the fresh and vitrified particulated cartilage groups were 2.44 ± 1.35 and 2.00 ± 0.80, respectively, while the negative control group was graded significantly higher at 4.83 ± 0.29. Analysis of histological and fluorescent staining demonstrated that the fresh and vitrified particulated cartilage groups had equivalent regeneration within cartilage defects, with similar cell viability and densities and expression of proteoglycans and collagen type I/II.ConclusionThe implantation of fresh or vitrified particulated cartilage resulted in the equivalent repair of focal cartilage defects when evaluated at 6 months after surgery.Clinical relevanceThe vitrification of particulated cartilage is a viable option for long-term storage for cartilage tissue banking and could greatly increase the availability of donor tissue for transplantation.
| S-EPMC9630855 | biostudies-literature
Project description:Large post-traumatic osteochondral defects of the proximal tibia in young active patients can be challenging because total or partial arthroplasties are to be avoided. The use of a fresh osteochondral allograft including its meniscus is one of the few options to biologically treat these injuries. Although the use of a fresh allograft is not easily accessible in some places and carries considerable logistical limitations, it is an alternative that provides viable chondrocytes to the defect. The inclusion of the meniscus in the osteochondral graft improves the results but also makes the technique even more demanding. We present a thorough description of this allograft transplantation to make it as reproducible as possible.
| S-EPMC6019868 | biostudies-literature