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Full-Thickness Articular Cartilage Defects of the Trochlea: Management with Autologous Chondrocyte Implantation (SS-80)
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
with a post-op rehab protocol of NWB for a minimum of 4 weeks. Mean post-op Lysholm score was 96 (range 78-100). Subjectively, 7 patients graded themselves as having an excellent outcome, 1 was graded as fair. MRI evaluation of the osteochondral lesion and overlying cartilage was graded as healed in six patients, and of questionable integrity in 2 patients. Conclusions: Osteochondral lesions involving the femoral condyle can be safely and reliably repaired arthroscopically. This is the first report that we are aware of documenting the efficacy of SR-PLLA devices to internally fix an osteochondral lesion. Repeat MRI at a minimum of 2 years post-operatively reveals incorporation of the bioabsorbable nails and healing of the osteochondral fragment.
Stephen Fealy
New York, NY Joshua S. Dines
New York Russell F. Warren
New York Treatment of Full-Thickness Chondral Lesion of the Knee With Microfracture Technique (SS-79) Introduction: This prospective study was designed to evaluate the long-term results of the microfracture technique in a group of 53 patients treated for full thickness chondral lesion of the knee. Methods: 53 patients with Outerbridge IV chondral lesion treated with arthroscopic shaving and microfracture, were evaluated. Patients average age was 38 years and mean follow-up was 49 months (min 24 max 80). Medial Femoral condyle was involved in 70%. No cases of Patellar lesion or tibial lesions were included in this study. 12 patients had undergone previous meniscectomy. Associated malalignement, meniscal lesion and ligament injuries were corrected surgically. Postoperative patients were kept non-weight bearing for 8 weeks with a brace. We performed second look arthroscopy in 10 patients. All patients were evaluated with IKDC, Lysholm, Tegner and subjective evaluation. Special emphasis was given on the time of their return to sports. Results: IKDC: 6 Normal, 30 nearly Normal, 12 abnormal, 5 very abnormal. Lysholm: 16 Excellent, 21 Good, 11 Fair, 5 Poor. Tegner Activity Scale: 80% of these patients decreased their sports level (from 7 to 5). Average subjective evaluation scored 70 /100. Discussion and Conclusion: Microfracture technique is easy and reproducible, with minimal morbidity and does not affect future procedures. We found an improvement in functional parameters of our patients, however long-term results are unpredictable and cannot be advised as a definitive treatment for athletes. In older age group this treatment may help to relieve the symptoms.
Alberto Gobbi
Milan, Italy Sanjeev Mahajan
Milan Full-Thickness Articular Cartilage Defects of the Trochlea: Management with http://www2.us.elsevierhealth.com/inst/serve?art...b&arttype=full&group=Scientific+Program+Abstract (61 of 64) [11/16/2007 9:18:42 AM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
Autologous Chondrocyte Implantation (SS-80) Introduction: Full-thickness articular cartilage defects on the trochlea are difficult to repair due to the high forces in the patellofemoral joint and the complex trochlear topography. This study compares the results of autologous chondrocyte implantation (ACI) in the trochlea to the promising results reported previously for the medial and lateral condyles. Methods: Patients were prospectively followed and evaluated pre-operatively and at a minimum of 4 years using the modified Cincinnati Score. Adverse events, including treatment failures, were collected. Failures were included in the analysis and scored as a “2” with all symptoms present. Patients with patellar or tibial lesions were excluded. Results: 31 out of 38 eligible patients were assessed at 48-60 months (mean 51 months). Mean age 41 years (range: 26-53). 48% on Worker’s Compensation. Twelve patients had single trochlea defects: mean size 5.1cm2. Nineteen patients had multiple lesions: mean size 4.8cm2; mean size of largest lesion 6.6cm2. 94% had failed previous cartilage repair procedures, including 42% who had failed prior marrow stimulation techniques. Based on overall patient score, 77% improved with assessment increasing from a mean of 2.8 (sd: 1.3) to 5.9 (sd: 2.7), p<0.001. Multiple lesions or obesity adversely effected results: 80% with 3 lesions improved, and 82% with body mass index 35 improved. Three treatment failures occurred: 1) delamination of the MFC defect in a patient with 3 defects (trochlea & LFC implants were intact); 2) progressive multi-compartmental OA; and 3) progressive OA secondary to ligamentous instability. Discussion: Outcomes of ACI for the treatment of trochlear defects are similar to those reported previously for the medial and lateral condyles.
Bert R. Mandelbaum, M.D.
Santa Monica, CA Allen F. Anderson, M.D.
Nashville, TN Freddie Fu, M.D.
Pittsburgh, PA Lyle J. Micheli, M.D.
Boston, MA J. Bruce Moseley, M.D.
Houston, TX Christoph Erggelet, M.D.
Feiburg Jon E. Browne, M.D.
Kansas City, MO The Effectiveness of the Use of Electrocautery with Chondroplasty in the Treatment of Chondromalacic Lesions. A Randomized Prospective Study (SS-81) Purpose: To determine the clinical effect of electrocautery with arthroscopic chondroplasty on chondromalacic tissue. Type of Study: A randomized, prospective study Introduction: The use of chondroplasty in the treatment of chondromalacia has been widespread for many years. With the use of cautery as an adjunct to chondroplasty, the cartilaginous surface can be made more even. This http://www2.us.elsevierhealth.com/inst/serve?art...b&arttype=full&group=Scientific+Program+Abstract (62 of 64) [11/16/2007 9:18:42 AM]
with a post-op rehab protocol of NWB for a minimum of 4 weeks. Mean post-op Lysholm score was 96 (range 78-100). Subjectively, 7 patients graded themselves as having an excellent outcome, 1 was graded as fair. MRI evaluation of the osteochondral lesion and overlying cartilage was graded as healed in six patients, and of questionable integrity in 2 patients. Conclusions: Osteochondral lesions involving the femoral condyle can be safely and reliably repaired arthroscopically. This is the first report that we are aware of documenting the efficacy of SR-PLLA devices to internally fix an osteochondral lesion. Repeat MRI at a minimum of 2 years post-operatively reveals incorporation of the bioabsorbable nails and healing of the osteochondral fragment.
Stephen Fealy
New York, NY Joshua S. Dines
New York Russell F. Warren
New York Treatment of Full-Thickness Chondral Lesion of the Knee With Microfracture Technique (SS-79) Introduction: This prospective study was designed to evaluate the long-term results of the microfracture technique in a group of 53 patients treated for full thickness chondral lesion of the knee. Methods: 53 patients with Outerbridge IV chondral lesion treated with arthroscopic shaving and microfracture, were evaluated. Patients average age was 38 years and mean follow-up was 49 months (min 24 max 80). Medial Femoral condyle was involved in 70%. No cases of Patellar lesion or tibial lesions were included in this study. 12 patients had undergone previous meniscectomy. Associated malalignement, meniscal lesion and ligament injuries were corrected surgically. Postoperative patients were kept non-weight bearing for 8 weeks with a brace. We performed second look arthroscopy in 10 patients. All patients were evaluated with IKDC, Lysholm, Tegner and subjective evaluation. Special emphasis was given on the time of their return to sports. Results: IKDC: 6 Normal, 30 nearly Normal, 12 abnormal, 5 very abnormal. Lysholm: 16 Excellent, 21 Good, 11 Fair, 5 Poor. Tegner Activity Scale: 80% of these patients decreased their sports level (from 7 to 5). Average subjective evaluation scored 70 /100. Discussion and Conclusion: Microfracture technique is easy and reproducible, with minimal morbidity and does not affect future procedures. We found an improvement in functional parameters of our patients, however long-term results are unpredictable and cannot be advised as a definitive treatment for athletes. In older age group this treatment may help to relieve the symptoms.
Alberto Gobbi
Milan, Italy Sanjeev Mahajan
Milan Full-Thickness Articular Cartilage Defects of the Trochlea: Management with http://www2.us.elsevierhealth.com/inst/serve?art...b&arttype=full&group=Scientific+Program+Abstract (61 of 64) [11/16/2007 9:18:42 AM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
Autologous Chondrocyte Implantation (SS-80) Introduction: Full-thickness articular cartilage defects on the trochlea are difficult to repair due to the high forces in the patellofemoral joint and the complex trochlear topography. This study compares the results of autologous chondrocyte implantation (ACI) in the trochlea to the promising results reported previously for the medial and lateral condyles. Methods: Patients were prospectively followed and evaluated pre-operatively and at a minimum of 4 years using the modified Cincinnati Score. Adverse events, including treatment failures, were collected. Failures were included in the analysis and scored as a “2” with all symptoms present. Patients with patellar or tibial lesions were excluded. Results: 31 out of 38 eligible patients were assessed at 48-60 months (mean 51 months). Mean age 41 years (range: 26-53). 48% on Worker’s Compensation. Twelve patients had single trochlea defects: mean size 5.1cm2. Nineteen patients had multiple lesions: mean size 4.8cm2; mean size of largest lesion 6.6cm2. 94% had failed previous cartilage repair procedures, including 42% who had failed prior marrow stimulation techniques. Based on overall patient score, 77% improved with assessment increasing from a mean of 2.8 (sd: 1.3) to 5.9 (sd: 2.7), p<0.001. Multiple lesions or obesity adversely effected results: 80% with 3 lesions improved, and 82% with body mass index 35 improved. Three treatment failures occurred: 1) delamination of the MFC defect in a patient with 3 defects (trochlea & LFC implants were intact); 2) progressive multi-compartmental OA; and 3) progressive OA secondary to ligamentous instability. Discussion: Outcomes of ACI for the treatment of trochlear defects are similar to those reported previously for the medial and lateral condyles.
Bert R. Mandelbaum, M.D.
Santa Monica, CA Allen F. Anderson, M.D.
Nashville, TN Freddie Fu, M.D.
Pittsburgh, PA Lyle J. Micheli, M.D.
Boston, MA J. Bruce Moseley, M.D.
Houston, TX Christoph Erggelet, M.D.
Feiburg Jon E. Browne, M.D.
Kansas City, MO The Effectiveness of the Use of Electrocautery with Chondroplasty in the Treatment of Chondromalacic Lesions. A Randomized Prospective Study (SS-81) Purpose: To determine the clinical effect of electrocautery with arthroscopic chondroplasty on chondromalacic tissue. Type of Study: A randomized, prospective study Introduction: The use of chondroplasty in the treatment of chondromalacia has been widespread for many years. With the use of cautery as an adjunct to chondroplasty, the cartilaginous surface can be made more even. This http://www2.us.elsevierhealth.com/inst/serve?art...b&arttype=full&group=Scientific+Program+Abstract (62 of 64) [11/16/2007 9:18:42 AM]