Arthroscopic Treatment for Cartilage Lesions of the Talus / 대한정형외과학회잡지

PURPOSE: To compare clinical results and to evaluate the factors affecting the clinical results after performing arthroscopic chondroplasty, microfracture, and osteochondral autologus transplantation (OAT) due to a chondral defect of the talus. MATERIALS AND METHODS: This study enrolled 35 patients (36 cases) diagnosed with a chondral defect of the talus and who could be followed over 12 months after arthroscopic chondroplasty, microfracture, or OAT between March 1998 and December 2007. The arthroscopic chondroplasties were carried out in 14 cases (13 patients), the microfractures were carried out in 12 cases (12 patients) and OAT was carried out in 10 cases (10 patients). The lesion staging used Berndt and Harty classification on simple radiographs and Anderson's classification on magnetic resonance images. Clinical results were evaluated and compared by measuring VAS and AOFAS scores at the time of operation, before the operation, and at the time of follow up. Clinical evaluation included location, size, and stage of each lesion as well as the age of individual patient. RESULTS: There were 13 medial and 23 lateral lesions. The average size of the chondral defects were 1.9 cm2 (range: 1-4 cm2). According to the classification of Berndt and Harty and Anderson, there were 8 stage II, 21 stage III, and 7 stage IV cases. The average follow up period was 15 months (range: 12-30 months). VAS and AOFAS scores showed significant improvement in all treatment groups. However, clinical results according to the operative methods did not show any differences. Lesion size, stage and location, as well as of age of patient had no significant impact on clinical results. CONCLUSION: We concluded that all three procedures, arthroscopic chondroplasty, microfracture, and OAT, are useful for treating a chondral defect of talus. Location of lesion, size, stage and age of patient did not make a significant difference.

Autologous Chondrocyte Implantation for Treating Chondral Defects of the Femoral Condyle

PURPOSE: We wanted to evaluate the clinical and objective results of autologous chondrocyte implantation (ACI) on a femoral chondral defect of the knee. MATERIALS AND METHODS: We evaluated 14 patients who had been operated on with ACI on the chondral defect of the knee between December 2000 and December 2005. There were 11 males and 3 females with the average age of 33 years (range: 17~44 years) and the mean size of the defect was 5.9 cm2 (range: 2.0~10 cm(2)). Seven cases were due to osteochondritis dissecans, and others were due to traumatic defect. The mean follow-up period was 26 months (range: 12~42 months). Lysholm's and Tegner's scores were used for evaluation. A 2nd look arthroscopic examination and a biopsy were carried out in 6 cases and MRI was done in 3 cases for evaluating cartilage regeneration. RESULTS: The mean Lysholm's and Tegner's scores were improved 60 to 84, and 2.4 to 4.1, respectively. According to the ICRS (International cartilage repair society) assessment, the gross appearance of the regenerated cartilage was graded as the following: 1 normal, 1 nearly normal, 3 abnormal and 1 severely abnormal. MRI demonstrated cartilage regeneration in 2 out of 3 cases. There were 2 cases of graft hypertrophy and 1 case of graft adhesion as complications. CONCLUSION: The clinical results were significantly improved according to Lysholm's and Tegner's scores. However, the gross appearances and histological results gave less satisfactory results. We conclude that a more sophisticated surgical technique and the long term follow-up results are necessary.

The Results of Autologous Chondrocyte Implantation with a Concomitant Injury / 대한정형외과학회잡지

PURPOSE: To evaluate the results of autologous chondrocyte implantation with a concomitant injury. MATERIALS AND METHODS: Sixty-seven chondral defects (39 cases, 36 patients), which were treated with autologous chondrocyte implantation, were analyzed with a minimum follow-up of 2 years. The cases were divided into the following five groups: 4 cases of a single chondral defect (group I), 3 cases of multiple chondral defects (group II), 5 cases of osteochondritis dissecans (group III), 9 cases of a single chondral defect with a concomitant injury (group IV), and 18 cases of multiple chondral defects with a concomitant injury (group V). The clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores and the International Cartilage Repair Society (ICRS) functional evaluation system. Arthroscopic examinations were performed on 12 cases and 21 chondral defects. RESULTS: The mean IKDC subjective score was 39.8 preoperatively, which improved to 64.1 postoperatively, and the IKDC objective score was C in 54% and D in 46%, which improved to A in 74%, B in 23% and C in 3%. The ICRS functional evaluation system was III in 82% of cases, and IV in 18% preoperatively, which improved to I in 15% and II in 85%, postoperatively. At the arthroscopic evaluation, the results of the ICRS system were I in 9%, II in 67%, and III in 24%. There was no significant difference between the single chondral defect and chondral defects with a concomitant injury. CONCLUSION: In the treatment of the multiple chondral defects with a concomitant injury, autologous chondrocyte implantation produced similar excellent clinical results to those of a single chondral defect.

The clinical and radiological results of open wedge high tibial valgus osteotomy: short term results

PURPOSE: The purpose of this study is to evaluate clinical and radiological results of open wedge valgus high tibial osteotomy without bone graft in varus knees with osteoarthritis or chondral defect of medial compartment. MATERIALS AND METHODS: We reviewed 27 cases in 24 patients who underwent open wedge valgus high tibial osteotomy without bone graft in varus knees with osteoarthritis or chondral defect of medial compartment. Patients who had malalignment of femur, varus deformity due to ligamentous injuries, and concomitant autologous chondrocyte implantation or meniscus transplantation were excluded. There were 4 men and 20 women, mean age was 47.3 years old. Minimum follow-up period was 1 year(1 year to 4 year 9 months). we did arthroscopic debridement before the osteotomy in all cases. Results were radiologically evaluated by the joint obliquity, mechanical axis, femorotibial angle, time to bone union, and leg length, and clinically by range of motion, Lysholm scores, and subjective pain scales. RESULTS: The joint obliquity in coronal plane improved varus 9.6 to varus 1.9 degrees. The posterior tibial slope in sagittal plane increased 7.9 to 10.7 degrees. The mechanical axis improved 13.2 to 61.1%. The femorotibial angle improved varus 3.9 to valgus 7.4 degrees. The leg length increased 80.6 to 81.6 cm. The mean plate size was 10.5 mm. The mean period to bone union is 3.9 months(3 to 7 months). Range of motion changed 135.4 to 135.0 degrees. The mean Lysholm knee scores improved 54.6 to 84.3 points. The subjective pain scales improved 50.7 to 85.4 points. CONCLUSION: The open wedge high tibial valgus osteotomy in varus knees with osteoarthritis or chondral defect of medial compartment is useful procedure to reduce pain, to correct mechanical axis, femorotibial angle and joint obliquity in coronal plane, and to obtain bony union without bone graft. But the increase of the posterior tibial slope in sagittal plane and lengthening of tibia may develop.

Autologous Vs Allogenic Chondrocytes Transplantation for Full Thickness Chondral Defects in Rabbit's Patella / 대한정형외과학회잡지

Biologic resurfacing of the damaged joints is an area of great interest and clinical promise because of the limited potential ofdamaged articular cartilage healing. Several methods such as spongiolization. joint dehridement and ahrasion of suhchondral hone. perichondral grafts, and osteochondral grafts have heen used to repair cartilage defects, but the results were not satisfactory. Rccently autologous chondrocyle transplantation with a pcrioslcal patch was paid an altention for its advantage , the regeneration with hyalin cartilage. But it have many disadvantages such as too expensive cost. second staged operation, and technically difficult to isolatc chondrocytes from a small volume of donor site, so we performed that a definecl cartilaee delect in the ribbit patella was treated with transplanta1ion of in virto expanded allogenic chondrocvtes and then compared with an autologous chondrocytes transplantation. Adult rabbits were used to transplant autogenously and allogenously and allogenically harvested and in vitro cultured chondrocytes into patellar chondral lesions that had been made previously 3x 3mmin size , extending down to the calcified zone. Chondrocytes were isolated in the femoral condyle of the opposite knee or othe rabbit knee. And then enzymatic digestion ( collagenase A and DNase I ) was performed for 5 hours room temperature in a spinner bottle and cells were seeded in a 25cm2 culture flask in Dulheccos modified essential medium (DMEM), supplemented with l0% fetal hovine serum (FBS). The culture medium was changed twice weekly. After 14 days of culture, the cells were isolated hy irypsinization and transplanted into previously made chondral defects with an autogenous periosteal patch taken from the medial aspect of tibia. Healing ol' the defects was assessed by gross examination, immunohistochemical stain, and light microscope with hematoxylin-eosin stain at 8, 16, and 24 weeks. Allogenic and autologous chondrocytes transplantation significantly increased the amount of newly tormed repair tissue compared to that found in control knees in which the Jesion was solely covered hy a periosteal patch. The repair tissue, however, had a tendency of incomplete bonding to adjacent cartilage. This study shows that allogenic and autologous articular chondrocytes that have heen expanded for 2 weeks in vitro can stimulate the healing phase of chondral lesion. There is no signilicant diffcrence hetween allogenic and autologous chondrocytes transplantation.