Effect of MRI preoperative quantitative assessment of the range of talus osteochondral injury on surgical selection and medium-to long-term follow-up results / 中国组织工程研究

BACKGROUND:Talus cartilage injury is a common motor system disease.This type of injury will affect the patient's daily life and work ability,and may worsen the condition if left untreated.Surgical treatment is commonly used,but the selection of surgical methods and the evaluation of medium-and long-term follow-up results have always been difficult clinical problems. OBJECTIVE:To explore the influence of T1ρ technique on the range of quantitative evaluation of talus osteochondral injury on the choice of surgical method and the results of medium-and long-term follow-up. METHODS:A total of 154 patients with osteochondral injury of talus admitted to The Second Hospital of Tangshan from January 2019 to August 2022 were retrospectively selected as the study subjects.The lesion site of talus was examined by MRI before operation,and the T1ρ and T2 values of different types were compared.Different surgical methods were selected according to the different T1ρ values.Group A(n=73)was treated with microfracture surgery with T1ρ<45 ms;group B(n=81)was treated with autogenous bone and cartilage transplantation with T1ρ≥45 ms.The general clinical characteristics and curative effects of patients under different surgical methods were compared;the important factors of postoperative recurrence were analyzed by multivariate Logistic regression,and the relationship between T1ρ value and postoperative recurrence was analyzed by restricted cubic spline graph,y=1-1/(1+e-z)regression equation to build a prediction model.The stability of the model was verified by cross-checking method. RESULTS AND CONCLUSION:(1)Classification of talus osteochondral injury in 154 patients(type Ⅰ:36 cases;type Ⅱ:37 cases;type Ⅲ:40 cases;type Ⅳ:41 cases),T1ρ and T2 values of the four groups were statistically significant(P<0.05);pairwise comparison was also statistically significant(all P<0.05).(2)After treatment of 154 patients,7 cases(4.6％)had local swelling,3 cases(2.0％)had pain aggravation,and 5 cases(3.3％)had wound infection.There were 2 cases(1.3％)with poor cartilage healing.(3)After treatment,there were statistically significant differences between groups A and B in terms of American Orthopaedic Foot&Ankle Society score,visual analog scale score,plantar flexor motion range,dorsoextension motion range,subchondral bone marrow edema volume,interleukin-6,interleukin-8,C-reactive protein,procalcitonin,platelet-derived growth factor,transforming growth factor-β1,and efficacy(P<0.05).The total effective rate of group B(90％)was higher than that of group A(85％)(P<0.05).(4)Age(OR=1.589,95％CI:0.305-1.252,P=0.036),interleukin-6(OR=1.737,95％CI:0.974-5.254,P=0.049),interleukin-8(OR=1.385,95％CI:1.066-4.355,P=0.034),C-reactive protein(OR=1.957,95％CI:1.323-2.178,P=0.035),transforming growth factor-β1(OR=1.459,95％CI:0.897-2.455,P=0.038),T1-ρ(OR=1.687,95％CI:0.854-3.321,P=0.026),T2(OR=1.843,95％CI:0.657-2.454,P=0.036),complications(OR=1.719,95％CI:0.654-3.464,P=0.019),and classification of osteochondral injury of talus(OR=3.789,95％CI:1.023-5.897,P=0.028)were independent risk factors for postoperative recurrence.Microfracture surgery(OR=0.751,95％CI:0.321-1.264,P=0.012)and autogenous bone and cartilage grafting(OR=0.649,95％CI:0.246-1.356,P=0.023)were independent protective factors for recurrence after medium-and long-term follow-up.(5)When T1ρ value≤35 ms,the risk of postoperative recurrence decreased rapidly,and when T1ρ value>35 ms,the risk of postoperative recurrence increased rapidly.(6)Further stepwise regression analysis showed that these nine risk factors were most closely associated with postoperative recurrence,and the formula for postoperative recurrence was obtained.The probability of postoperative recurrence was calculated using the regression equation.When P=0.75,the maximum value of Jorden index was 77.728,indicating that the model has a better prediction effect.(7)It is indicated that the quantitative evaluation of T1ρ before operation can effectively guide the selection of surgical methods,improve the success rate of surgery and the quality of life of patients.

Adjustable external fixation traction combined with arthroscopic microfracture for treatment of osteochondral lesions of the talus / 中华创伤骨科杂志

Objective:To investigate the clinical effects of adjustable external fixation traction combined with arthroscopic microfracture in the treatment of osteochondral lesions of the talus (OLT).Methods:A retrospective study was conducted to analyze the data of 27 OLT patients who had been treated at Department of Orthopedics, Beijing Rehabilitation Hospital from May 2017 to March 2022. There were 16 males and 11 females, aged (32.4±7.2) years. Lesion site: 23 medial and 4 lateral cases; Hepple staging: 7 cases at stage Ⅰ, 15 cases at stage Ⅱ, and 5 cases at stage Ⅲ; disease duration: (10.6±3.3) months. All the patients were treated by adjustable external fixation traction combined with arthroscopic microfracture. Recorded were the patients' visual analogue scale (VAS) pain scores and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores at 6 months and 12 months after surgery, levels of interleukin-1 (IL-1), interleukin-6 (IL-6) and tumour necrosis factor- α (TNF- α) at 1 month after surgery, lesion area at 12 months after surgery, and incidence of complications. Results:The follow-up time for this cohort was (16.2±6.7) months. The AOFAS score was (61.52±6.75) points before surgery, (84.15±5.56) points at 6 months after surgery and (95.67±4.30) points at 12 months after surgery. The VAS score was (5.88±1.02) points before surgery, (2.12±0.48) points at 6 months after surgery and (0.66±0.36) points at 12 months after surgery. The two-by-two comparisons between the 3 time points for the above items were statistically significant ( P<0.05). IL-1 was (32.37±6.64) pg/mL, IL-6 (34.04±7.12) pg/mL, and TNF- α (17.89±4.96) ng/L at 1 month after surgery in the 27 patients, all of which were significantly lower than their preoperative levels [(96.63±14.80) pg/mL, (102.33±20.42) pg/mL, and (54.48±9.33) ng/L] ( P<0.05). The lesion area was (28.66±6.52) mm 2 at 12 months after surgery, significantly smaller than the value before surgery [(128.52±11.32) mm 2] ( P<0.05). Infection at the adjustable external fixation needle track occurred in 1 patient and lower limb thrombosis in 2 patients. Conclusion:In the treatment of OLT, adjustable external fixation and traction combined with arthroscopic microfracture can achieve satisfactory results and improve symptoms for the patients.

Treatment of Chondral Lesions in the Knee / Tratamento das lesões condrais no joelho

Abstract Articular cartilage injuries are common and lead to early joint deterioration and osteoarthritis. Articular cartilage repair techniques aim at forming a cartilaginous neo-tissue to support the articular load and prevent progressive degeneration. Several techniques are available for this purpose, such as microfracture and chondrocyte transplantation. However, the procedural outcome is often fibrocartilage, which does not have the same mechanical resistance as cartilaginous tissue. Procedures with autologous osteochondral graft have a morbidity risk, and tissue availability limits their use. As such, larger lesions undergo osteochondral transplantation using fresh or frozen grafts. New techniques using minced or particulate cartilage fragments or mesenchymal stem cells are promising. This paper aims to update the procedures for treating chondral lesions of the knee.

Resumo As lesões da cartilagem articular são comuns e levam à deterioração precoce da articulação e ao desenvolvimento da osteoartrite. As técnicas de reparo da cartilagem articular visam a formação de um neo-tecido cartilaginoso capaz de suportar carga articular e evitar a progressão da degeneração. Há várias técnicas disponíveis para esse fim, como a microfratura e o transplante de condrócitos. Entretanto muitas vezes o desfecho do procedimento é a formação de fibrocartilagem, que não possui a mesma resistência mecânica do tecido cartilaginoso. Em outros procedimentos, nos quais é realizado enxerto osteocondral autólogo, há risco de morbidade associada ao procedimento, além da disponibilidade limitada de tecido. Por esse motivo, o transplante osteocondral, utilizando enxertos a fresco ou congelados tem sido utilizado para lesões de maior volume. Por fim, novas técnicas utilizando fragmentos de cartilagem picada ou particulada, assim como o uso de células tronco mesenquimais se apresentam como promissores. O objetivo desse artigo é realizar uma atualização dos procedimentos para tratamento das lesões condrais do joelho.

Treatment of Hip Wave Lesion Using Reverse Microfracture: A Retrospective Clinical Study / Tratamento da lesão em onda do quadril através da microfratura reversa: Estudo clínico retrospectivo

Abstract Objective The present study aims to evaluate the treatment of hip wave lesion using reverse microfracture, which is a simple and cheap surgical procedure. Methods We retrospectively analyzed 19 patients with acetabular wave lesion treated with reverse microfracture. The patients were assessed by magnetic nuclear resonance imaging (MRI) at the time of diagnosis and 6 months after the surgery and functionally evaluated using the Harris Hip Score (HHS) and the visual analogue scale (VAS) for pain in the preoperative period, and 3 and 6 months after the surgery. Results The statistical data showed a significant improvement in HHS and VAS 6 months after the surgery. Six months after the surgery, the MRI revealed that the area subjected to reverse microfracture presented cartilage with the same visual characteristics observed in areas with no chondral injury. Conclusion We conclude that the reverse microfracture proved to be an effective, reproducible method for the treatment of wave lesion.

Resumo Objetivo Avaliar o tratamento desta lesão, através da microfratura reversa, que é um procedimento simples e sem aumento de insumos na cirurgia. Métodos Foram analisados retrospectivamente 19 pacientes submetidos a tratamento da lesão em onda no acetábulo, através da microfratura reversa. Utilizamos a ressonância nuclear magnética (RNM) no momento do diagnóstico e 6 meses após a cirurgia, avaliação funcional pelo Harris Hip Score (HHS) e escala visual e analógica (EVA) da dor no pré-operatório, e 3 e 6 meses após a cirurgia. Resultadoos dados estatísticos mostraram melhora significativa do HHS e EVA da dor após 6 meses da cirurgia. A RNM após 6 meses da cirurgia mostrou que na área que foi submetida à microfratura reversa, a cartilagem se apresentou com as mesmas características visuais que nas áreas sem lesão condral. Conclusão Concluímos que a microfratura reversa se mostrou eficaz e reprodutível no tratamento da lesão em onda.

Advances in arthroscopic microfracture technique for repairing articular cartilage injuries / 国际外科学杂志

Articular cartilage injury is common in orthopedics. Improper exercises and physical trauma can lead to the injury of cartilage. Since articular cartilage lacks blood supply, once damaged, it is difficult for the cartilage to repair itself. If not treated effectively, cartilage injuries will develop into severe osteoarthritis affecting the whole joint. Arthroscopic microfracture technique can achieve better therapeutic effects than regular joint debridement, with simple procedures, minimal invasion, and low cost. However, the microfracture technique is limited by the patients′ age (under 45 years old) and the size of the cartilage defect area (less than 4 cm 2) Additionally, postoperative patients need to conduct strict and long-term rehabilitation trainings. Generally speaking, the short-term prognosis of microfracture is satisfactory. However, the repair tissue is mainly composed of fibrocartilage, which is inferior to hyaline cartilage because of its poor mechanical properties and anti-wear abilities. Therefore, the long-term effect is controversial. To conclude, arthroscopic microfracture is a recommended method for young patients with small cartilage defect areas, but its exact long-term clinical effects still need to be verified by further research. This paper reviews the operation protocol, clinical efficacy, and the mechanism of arthroscopic microfracture surgery, and aims to provides theoretical basis for its application in clinical treatment.

Injectable Scaffold with Microfracture using the Autologous Matrix-Induced Chondrogenesis (AMIC) Technique: A Prospective Cohort Study

@#Introduction: Autologous matrix-induced chondrogenesis (AMIC) is a one-step surgical cartilage repair procedure involving the insertion of a scaffold into the chondral defect after microfracture. BST-CarGel [Smith and Nephew, Watford, England] is an injectable chitosan-based scaffold which can more easily fill defects with irregular shapes and be used to treat vertical or roof chondral lesions. The study aims to evaluate the clinical outcomes of knee cartilage repair with microfracture surgery and BST-CarGel using the AMIC technique for a minimum of two years. Materials and methods: A prospective study of patients undergoing cartilage repair with microfracture surgery and BST-CarGel at our institution from 2016 to 2019 was performed. Clinical outcomes were determined using the Lysholm Knee Scoring System and Knee Injury and Osteoarthritis Outcome Score (KOOS). These questionnaires were administered before the surgery and at a minimum of two years after surgery. Results: A total of 21 patients were identified and recruited into the study. 31 cartilage defects were seen and treated in 21 knees. These included horizontal lesions (e.g., trochlear, lateral tibial plateau), vertical lesions (e.g., medial femoral condyle, lateral femoral condyle) and inverted lesions (e.g., patella). No complications or reoperations were seen in our study population. For the average duration of follow-up of 42.5±8.55 months, there was an average improvement in Lysholm score of 25.8±18.6 and an average improvement in KOOS score of 22.5±15.0. Conclusion: BST-CarGel with microfracture surgery using the AMIC technique is a safe and effective treatment for cartilage defects in the short to medium term.

Platelet-rich plasma combined with microfracture versus microfracture in the treatment of knee cartilage lesions: A meta-analysis / 中国组织工程研究

OBJECTIVE: A large number of recent studies reported that microfracture combined with platelet-rich plasma has a good effect on osteochondral injury. This study systematically evaluated the clinical effect of arthroscopic platelet-rich plasma combined with microfracture versus microfracture in the treatment of knee cartilage lesions. METHODS: A randomized controlled trial of arthroscopic platelet-rich plasma combined with microfracture in the treatment of knee cartilage lesions was searched in CNKI, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, PubMed, Embase and Cochrane Library. The date was from January 2001 to March 2020. The data were extracted and the quality of the included literature was evaluated, and the Rev-Man5.3 software was used for meta-analysis. RESULTS: (1) A total of seven randomized controlled trials were included, and the modified Jadad scale results showed that the scores of four studies were ≥ 4, which were high-quality literatures, and the scores of three studies were 0.05). CONCLUSION: Platelet-rich plasma combined with microfracture for knee cartilage lesions can reduce the pain in the short and medium terms, enhance the joint function in the medium and long terms, and improve the postoperative experience. However, due to the limited number of included articles, more large-sample and high-quality randomized controlled trials are needed to provide further effective data.

Tratamiento artroscópico en lesión osteocondral subtalar / Arthroscopic treatment of subtalar osteochondral lesion

Las lesiones osteocondrales de la articulación subtalar es una patología infrecuente y de incidencia variable, dado su reporte principalmente como hallazgo en el estudio de dolor crónico de tobillo y ya con cambios degenerativos articulares. La sospecha clínica y el estudio imagenológico dirigido, permiten investigar esas lesiones en estadios iniciales, evitando así el uso de técnicas que no preservan la articulación para su manejo. La artroscopía subtalar es una excelente herramienta tanto diagnóstica como terapéutica para la resolución de dichas lesiones. Dadas las características anatómicas y biomecánicas de la articulación, en estadios iniciales, el manejo mediante sinovectomía y microfracturas es una alternativa con excelentes resultados funcionales. Este trabajo incluye dos casos de lesiones osteocondrales de la faceta posterior de la articulación subtalar manejadas vía artroscópica mediante sinovectomía y microfracturas y su posterior evolución.

Osteochondral lesions in the subtalar joint are an uncommon pathology with a variable incidence, being mainly reported as a finding in chronic ankle pain studies and with already visible degenerative joint changes at time of diagnosis. Clinical suspicion and directed imaging study, allows to investigate these lesions during early stages, thus avoiding the use of invasive techniques with scarce joint preservation. Subtalar arthroscopy is an excellent diagnostic and therapeutic tool for the resolution of these lesions. Given the anatomical and biomechanical characteristics of the joint, in the early stages the management by synovectomy and microfractures is an alternative with excellent functional results. This study includes two cases of osteochondral lesions of the posterior facet of the subtalar joint managed through arthroscopically synovectomy and microfractures and their subsequent evolution.

Outcome of Arthroscopic Bone Marrow Stimulation in Osteochondritis Dissecans of the Talus in a Tertiary Care Hospital

Introduction: Osteochondritis dissecans of the talus is a rarecondition that can create challenges for both the patient andthe treating surgeon. Arthroscopic bone marrow stimulation(i.e. microfracture, drilling) is a well-accepted and proventechnique to allow fibrocartilage differentiation and therebyprovide infill at the site of a cartilage defect in several joints,including the ankle. The aim of our study was to examine therole of arthroscopic bone marrow stimulation techniques as ameans of treatment for osteochondral lesions of the talus.Material and methods: Thirty two ankles were identifiedbetween January 2012 and January 2020 with talus OCD thatunderwent arthroscopic bone marrow stimulation. Each lesionwas classified according to the Berndt and Harty classification.Study patients were evaluated at 6 weeks, 3 months, 6 months,12 months, and annually after surgery. Assessments via avisual analogue scale (VAS) for pain during daily activitiesand sport activity and the American Orthopaedic Foot & AnkleSociety (AOFAS) scoring system were obtained at each visit.Result: There were 25 men and 4 women of average age 35years (range 17–50) and mean body mass index (BMI) 22 kg/m2 (range 20–34) at the time of surgery. Quantitative MRImeasurements on 3D FSPGR Sequence showed that meanarea of the lesions were 0.801 ± 0.505 cm2. Mean AOFASscores improved from 66 points (range 53–77) preoperativelyto 90 points (range 83–100) at final follow-up (p<0.05) andmean Visual Analogue Scale (VAS) scores from 6 points(range 5–8) to 2 points (range 0–5) with p value <0.05 whichis statistically significant.Conclusion: Arthroscopic management of osteochondrallesions of the talus has the advantages of better cosmeticresults, less pain, and less surgical trauma. This techniqueis technically demanding and should be reserved for theexperienced foot and ankle arthroscopist.

Risk of micro-fracture in femoral head after removal of cannulated screws for femoral neck fracture / 中国修复重建外科杂志

Objective: To explore the changes of bone and risk of micro-fracture in femoral head after removal of cannulated screws following femoral neck fracture healing under the impact force of daily stress. Methods: A total of 42 specimens of normal hip joint were collected from 21 adult fresh cadaveric pelvic specimens. Wiberg central-edge (CE) angle, bone mineral density, diameter of femoral head, neck-shaft angle, and anteversion angle of femoral neck were measured. Then, the 3 cannulated screws were implanted according to the AO recommended method and removed to simulate the complete anatomical union of femoral neck fracture. The morphology of screw canal in the femoral head was observed by CT. Finally, the specimens were immobilized vertically within the impact device in an upside-down manner, and the femoral heads were impacted vertically. Every specimen was impacted at 200, 600, and 1 980 N for 20 times with the impacting device. After impact, every specimen was scanned by CT to observe the morphology changes of screw canal in the femoral head. Micro-fractures in the femoral head could be confirmed when there was change in the morphology of screw canal, and statistical software was used to analyze the risk factors associated with micro-fractures. Results: After impact at 200 and 600 N, CT showed that the morphology of screw canal of all specimens did not change significantly compared with the original. After impact at 1 980 N, there were protrusion and narrowing in the screw canal of the 22 femoral head specimens (11 pelvic specimens), showing obvious changes compared with the original screw canal, indicating that there were micro-fractures in the femoral head. The incidence of micro-fracture was 52.38% (11/21). logistic regression results showed that there was correlation between micro-fracture and bone mineral density ( P= 0.039), but no correlation was found with CE angle, diameter of femoral head, neck-shaft angle, and anteversion angle ( P>0.05). Conclusion: The micro-fractures in the femoral head may occur when the femoral head is impacted by daily activities after removal of cannulated screws for femoral neck fractures, and such micro-fractures are associated with decreased bone density of the femoral head.

Effect of microfracture combined with biomimetic hydrogel scaffold on rotator cuff tendon-to-bone healing in rabbits / 中国修复重建外科杂志

Objective: To assess the effect of microfracture and biomimetic hydrogel scaffold on tendon-to-bone healing in a rabbit rotator cuff tear model. Methods: Gelatin and methacrylic anhydride were used to synthesize gelatin methacryloyl (GelMA). Then the GelMA were treated with ultraviolet rays and vacuum freeze-drying method to obtain a biomimetic hydrogel scaffold. The morphology of the scaffold was observed by gross observation and scanning electron microscope. Degradation of the scaffold was determined at different time points. Twenty-four adult New Zealand rabbits, weighting 2.8-3.5 kg and male or female, were surgically created the bilateral acute rotator cuff tear models. One shoulder was treated with microfractures on the footprint and transosseous suture (control group, n=24). The other shoulder was treated with the same way, except for putting the scaffold on the footprint before transosseous suture (experimental group, n=24). The general conditions of rabbits were observed postoperatively. Tendon-to-bone healing was evaluated by gross observation, Micro-CT, HE staining, and bio-mechanical testing at 4 and 8 weeks after operation. Results: The scaffold was white and has a porous structure with pore size of 31.7-89.9 μm, which degraded slowly in PBS solution. The degradation rate was about 95% at 18 days. All the rabbits survived to the completion of the experiment. Micro-CT showed that there was no obvious defect and re-tear at the tendon-to-bone interface in both groups. No difference was found in bone mineral density (BMD), tissue mineral density (TMD), and bone volume/total volume (BV/TV) between the two groups at 4 and 8 weeks postoperatively ( P>0.05). HE staining showed that the fibrous scar tissue was the main component at the tendon-to-bone interface in the control group at 4 and 8 weeks postoperatively; the disorderly arranged mineralized cartilage and fibrocartilage formation were observed at the tendon-to-bone interface in the experimental group at 4 weeks, and the orderly arranged cartilage formation was observed at 8 weeks. Besides, the tendon maturation scores of the experimental group were significantly higher than those of the control group at 4 and 8 weeks ( P0.05); the ultimate load to failure at 8 weeks was significantly higher in the experiment group than in the control group ( t=4.162, P=0.009), and no significant difference was found in stiffness between the two groups at 8 weeks ( t=2.286, P=0.071). Conclusion: Compared with microfracture alone, microfracture combined with biomimetic hydrogel scaffold can enhance tendon-to-bone healing and improve the ultimate load to failure in rabbits.

Effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation for large area cartilage injury of femoral condyle of knee / 中国修复重建外科杂志

Objective: To explore the effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation (OAT) in treatment of large area (4-6 cm 2) cartilage injury of the femoral condyle of knee. Methods: Between March 2016 and June 2017, 22 patients of large area cartilage injury of the femoral condyle of knee were treated with arthroscopic microfracture combined with OAT. There were 16 males and 6 females with an average age of 22-60 years (mean, 38.6 years). The cause of injury was traffic accident in 8 cases and sports injuries in 14 cases. The disease duration was 1-6 months (mean, 3.4 months). There were 15 cases of medial femoral condyle injuries and 7 cases of lateral condyle injuries. The area of cartilage defect was 4-6 cm 2 (mean, 4.98 cm 2). According to the International Cartilage Repair Society (ICRS) classification, 9 cases were rated as grade Ⅲ and 13 cases as grade Ⅳ. Eighteen cases were combined with meniscus injuries. Preoperative visual analogue scale (VAS) score was 6.36±1.25 and Lysholm score was 36.00±7.77. Results: All incisions healed by first intention. All patients were followed up 2-3 years with an average of 2.3 years. At 2 years after operation, the VAS score was 1.27±0.94 and the Lysholm score was 77.82±6.21, which were significantly improved when compared with those before operation ( t=16.595, P=0.000; t=21.895, P=0.000). At 2 years after operation, MRI showed that the cartilage defect was repaired well. Conclusion: Arthroscopic microfracture combined with OAT can be used to treat large area cartilage injury of the femoral condyle of knee, and the good early effectiveness can be obtained.

Micro-fracture therapy combined with intra-articular injection of platelet-rich plasma for small sized osteochondral lesion of the talus / 中国修复重建外科杂志

Objective: To investigate the effectiveness of micro-fracture therapy combined with intra-articular injection of platelet-rich plasma (PRP) in the treatment of small sized osteochondral lesion of the talus (OLT). Methods: Between September 2014 and October 2017, 43 patients with small sized OLT met the inclusive criteria were admitted and randomly divided into micro-fracture group (21 cases) and combined group (22 cases). Patients in the micro-fracture group were treated with micro-fracture therapy, and patients in the combined group were treated with micro-fracture therapy combined with intra-articular injection of PRP. There was no significant difference in gender, age, disease duration, side of OLT, injured position, lesion area, Mintz classification, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score between the two groups ( P>0.05). After treatment, MRI, VAS score, and AOFAS ankle-hind foot score were used to evaluate the recovery of OLT and the ankle function. Results: All incisions healed by first intention, and no complications such as venous thrombosis and ankle joint infection occurred. All patients were followed up 12-18 months after operation, with an average of 15.6 months. The VAS scores and the AOFAS ankle-hind foot scores were significantly improved at 6 and 12 months after operation in the two groups ( P<0.05), and the scores at 12 months were significantly improved when compared with postoperative scores at 6 months ( P<0.05). Compared with the micro-fracture group, the VAS score and the AOFAS ankle-hind foot score were significantly improved in the combined group at 6 and 12 months after operation ( P<0.05). MRI showed that OLT was well filled in both groups at 12 months after operation. Conclusion: Compared with micro- fracture therapy, micro-fracture therapy combined with intra-articular injection of PRP can effectively reduce pain, improve ankle function, and has a good effectiveness in the treatment of small sized OLT.

Failure of articular cartilage repair / 中国组织工程研究

BACKGROUND: Articular cartilage has complex biological characteristics and high durability; therefore, natural degeneration or trauma may lead to irreversible damage of its structure and function. Repair and treatment of articular cartilage injury is an urgent problem in clinic. OBJECTIVE: To report the most common risk factors for failure of articular cartilage repair and their incidence, and to analyze the most important factors influencing the choice of specific surgical treatment for failure of cartilage repair. METHODS: The relevant articles were searched in PubMed and MEDLINE database from 2007 to 2019. The keywords were “articular cartilage, repair, clinic/clinical failure, surgery” in English. Initially, 343 articles were retrieved, and 38 articles were included for final analysis. RESULTS AND CONCLUSION: (1) Microfracture and mosaicplasty have significant failure rates in the early and middle stages after articular cartilage repair, while autologous chondrocyte implantation (ACI) and osteochondral allograft (OCA) transplantation are two effective methods for articular cartilage repair. (2) For the failure of articular cartilage repair, OCA transplantation might be a safe choice in the past. However, a higher re-failure rate of articular cartilage repair has been found in patients undergoing a failed OCA transplantation. For the patients who have failed ACI or matrix-induced ACI, further treatment with ACI or matrix-induced ACI is acceptable. In addition, patients with a history of subchondral bone marrow stimulation have a higher failure rate of ACI. (3) Treatments for cartilage repair failure depend on the type of surgical failure and area and site of cartilage defect. OCA transplantation is the most reliable method for the treatment of cartilage repair failure in subchondral bone marrow stimulation patients. ACI or matrix-induced ACI have shown acceptable therapeutic effect in patients who have suffered cartilage repair failure. When dealing with cartilage repair failure, special attention should be paid to the conditions of subchondral bone.

Micro or Nano Does not affect the Functional Outcomes in the Midterm Follow-up

Introduction: Bone marrow stimulation techniques are themost commonly preferred options in the treatment of articularcartilage damage due to many features. Although nanofracturemethod that was developed in order to improve this techniquehas proven efficacy in animal models and in vitro studies,functional outcomes of nanofracture have not been shown inactual patients. In this study, our purpose was to compare theclinical outcomes of nanofracture technique and traditionalmicrofracture technique in the knee joint.Material and Methods: Patients operated using themicrofracture technique as group 1 (n=22) and patientsoperated using the Nanofx (Arthrosurface Inc., Franklin,Massachusetts) technique as group 2 (n=20) were prospectivelyevaluated. Demographic characteristics of the patients, defectsize and localization were recorded. Patients with isolatedcartilage damage who had ICRS Grade 3-4 cartilage lesionand no concomitant pathologies were included in the study.Each surgical procedure was performed by the same surgeonby following the same surgical protocol. Clinical outcomesin the patients were assessed using Modified Cincinnati andTegner-Lysholm scoring systems at months 6, 12, 24, 36 and48.Results: Calculated mean follow-up periods were 50.8±3.1and 51.2±3.2 in groups 1 and 2, respectively. There was nostatistically significant difference between the groups in termsof the defect and demographic characteristics of the patients.In the follow-up of patients using functional scoring, there wasno statistically significant difference in Lysholm (p=0.294)and Cincinnati (p=0.234) scores between the two groups.Conclusion: There was no difference in the mid-term betweenthe functional outcomes of microfracture and nanofracturetechniques in the treatment of cartilage lesions.

Clinical and Radiological Changes after Microfracture of Knee Chondral Lesions in Middle-Aged Asian Patients

BACKGROUND: Although microfracture is widely accepted as an effective treatment option for knee chondral lesions, little is known about the deterioration of clinical outcomes and radiological progression in middle-aged patients. Therefore, this study was conducted to evaluate the clinical and radiological changes after microfracture of knee chondral lesions in middle-aged Asian patients. METHODS: A total of 71 patients were included in the study. They were between the ages of 40 and 60 years and underwent arthroscopic microfracture for localized full-thickness cartilage defects of the knee from January 2000 to September 2015. The recovery status of chondral lesions was assessed by using the magnetic resonance observation of cartilage repair tissue (MOCART) score in postoperative magnetic resonance imaging (MRI). Clinical and radiological results were reviewed, and survival rate with conversion to arthroplasty or osteotomy as an end point was evaluated. RESULTS: The mean age of the patients at surgery was 51.3 ± 4.7 years (range, 40 to 60 years), and the mean follow-up period was 7.2 ± 2.6 years (range, 1.0 to 17.4 years). The MOCART scores of 32 patients at mean postoperative 2.1 years showed three cases (9%) of full recovery, two cases (7%) of hyperplastic recovery, 23 cases (70%) with more than 50% filling, and four cases (14%) with less than 50% filling. Clinical scores improved significantly at 1 year after surgery (p < 0.05); however, the scores deteriorated over time after postoperative 1 year, and the mean values reached preoperative levels at postoperative 10 years. Significant radiological progression of arthritis (Kellgren-Lawrence grade) was observed at 5 years after surgery. Four patients underwent total knee arthroplasty during follow-up. CONCLUSIONS: Most patients showed more than 50% of defect filling at 2 years after surgery on MRI. Clinical results of microfracture of knee chondral lesion showed the best improvement at postoperative 1 year but gradually worsened thereafter until postoperative 10 years. Radiological progression of arthritis was observed from 5 years after surgery.

Implantación de condrocitos autólogos versus microfracturas para el tratamiento de lesiones del cartílago en la rodilla / Autologous chondrocytes implantation versus microfracture for the treatment of knee cartilage lesions

Resumen: Objetivo: Comparar la eficacia clínica y la seguridad de la terapia de microfracturas (MF) versus implantación de condrocitos autólogos en membrana (MACI) en el manejo de lesiones condrales de rodilla ≥ 3 cm2 y el seguimiento a 12 meses postratamiento. Material y métodos: Se realizó un estudio de cohorte retrospectiva, de Enero de 2016 a Diciembre de 2017. Se incluyeron pacientes con una o varias lesiones condrales en rodilla ≥ 3 cm2 para comparar la terapia MF versus MACI para la reparación de lesión condral. Se realizaron valoraciones clínicas y funcionales previas al tratamiento quirúrgico y 12 meses posteriores, con medición de los arcos de movimiento, escala EVA, Oxford e índice de Lequesne. Resultados: Se incluyeron 12 pacientes en MF y 12 pacientes en MACI. La lesión más frecuente se localizó en la patela en ocho pacientes (67%). Se demostró incremento en los arcos de movimiento, así como mejoría en la comparación entre el nivel basal y en el seguimiento a 12 meses: en EVA, MF mostró 48.4% y MACI 57.5% (p ≤ 0.05); escala de Oxford: MF 32.65% y MACI 51.04% (p ≤ 0.05); índice de Lequesne: MF 40.12% y MACI 50%. Se presentaron dos casos de derrame articular en MACI, que se resolvieron con la realización de artrotomías. Conclusión: En este estudio se demostró mejoría significativa en MACI con alivio del dolor, funcionalidad y arcos de movimiento en comparación con el tratamiento de MF en lesiones ≥ 3 cm2 del cartílago articular de rodilla después de un año de seguimiento.

Abstract: Objective: To compare the clinical efficacy and safety of microfracture therapy (MF) versus implantation of autologous chondrocytes (MACI) in the management of chondral lesions of the knee ≥ 3 cm2 and follow up to 12 months post treatment. Material and methods: A retrospective cohort study was conducted from January 2016 to December 2017. Patients with one or more chondral lesions in knee ≥ 3 cm2 were included to compare MF versus MACI therapy for the repair of chondral lesion. Clinical and functional evaluations were carried out prior to the surgical treatment and 12 months later, with measurement of the range of motion, EVA, Oxford scale and Lequesne index. Results: Twelve patients were included in MF and 12 patients in MACI. The most frequent lesion was located in the Patella in eight patients (67%). It showed an increase in the arcs of motion, as well as improvement in the comparison between baseline and follow-up at 12 months: in EVA, MF demonstrated 48.4% and MACI 57.5% (p ≤ 0.05); Oxford scale: MF 32.65% and MACI 51.04% (p ≤ 0.05); index of Lequesne: MF 40.12% and MACI 50%. Two cases of joint effusion were presented in MACI, which were resolved with the realization of arthrotomies. Conclusion: In this study, significant improvement was demonstrated in MACI with pain relief, functionality, and range of motion compared to the treatment of MF in lesions ≥ 3 cm2 of the articular cartilage of the knee after one year of follow-up.

Effect of micro-fracture and comminution of fat pad on meniscal tear healing under arthroscopy / 中国内镜杂志

Objective To analyze the curative effect of fossa intercondyloidea of micro-fracture and comminution of subcutaneous fat pad on meniscal tear healing under arthroscopy. Methods During the clinical operation, the samples of the micro-fracture and fat pad comminution were attracted to the outside of the joint. The source and properties of cells were identified based on preclinical medicine experiment in vitro. In clinical research, 75 cases of the simple meniscus injury were selected from January 2014 to January 2016 and divided into three groups refer to treatment: Group A, B and C. Different treatments were used in the three groups. Group A - micro-fracture group; Group B - fat pad group; Group C - blank group. All patients' conditions were assessed with Lysholm, VAS score and adverse event (Swelling, anterior knee pain). Results In the preclinical medicine experiment, cells released by micro fracture were fibroblast-like cells which tend to grow more rapidly in vortex shape. Cells released by comminution of fat pad contained a small amount of impurities and necrotic cells and are mostly similar to fibroblast in long spindle shape. Besides, the Human MSC Analysis Kit was used to authenticate two cells which were considered to be as BMSCs and IPFPSCs. In clinical research, all patients received an average of 10 (8 ～ 11) months follow-up visit. No severe complication, such as blood-vessel and nerve injury, infection occurred after operations in the patients followed. Before receiving the treatment, difference in Lysholm, VAS score and general condition of joint of Group A and B, C showed no statistical difference (P > 0.05). Compared with those before operation and after operation in both of four groups, the Lysholm and VAS score were improved (P < 0.05). Besides, there had significantly difference between group A and C, B and C after post treatment in Lysholm and VAS score (P < 0.05), however, group A and B did not. Compared group A and C, the early prevalence of adverse event of group B was higher, but last follow-up show no difference between three groups. Conclusion Combined with basic experimental and clinical studies, our research suggest that micro-fracture and comminution of fat pad have good effect on the repair of meniscus injuries. Nevertheless, it should be concerned that early prevalence of increased swelling amd anterior knee pain of comminution of fat pad.

Arthroscopic Treatment for an Osteochondral Lesion of the Talus / 대한정형외과학회잡지

Ankle injury is one of the most common injuries, and osteochondral lesions of the talus occur in up to 70% of acute ankle sprains or fractures. The number of sports injuries have increased due to the increase in leisure activities, and the development of diagnostic techniques to evaluate the cartilage status leads to a higher prevalence of osteochondral lesions of the talus. Although osteochondral lesions of the talus with no symptoms can be treated conservatively, adult patients are usually treated by surgery because they are more likely to fail after non-surgical management. Recovery to normal cartilage is important, but there has been no surgical treatment established for effective cartilage regeneration. Bone marrow stimulation, such as arthroscopic microfracture, is a commonly used surgical procedure and an effective treatment for lesions that are small or failed after non-operative treatment. In addition, there are treatments, such as osteochondral autograft transplantation, osteochondral allograft transplantation and autologous chondrocyte implantation. The selection of the methods depends on the size and location of the lesion, the presence of subchondral cysts, and the results of previous surgery. Many surgical procedures have shown good results in short and mid-term follow-up studies but the results of long-term follow-up have been unclear. Various treatment methods, such as hyaluronan, platelet-rich plasma, mesenchymal stem cells, and bone marrow aspirate concentrate, have been available recently due to the development of various biological agents.

Treatment of Osteochondral Lesions of the Talus in Athletes / 대한스포츠의학회지

The definition of osteochondral lesion of the talus (OLT) is any defect involving both the articular surface and the subchondral bone of the talus. Many of these lesions are associated with acute ankle injury. Although many classification schemes for OLT have been proposed, Berndt and Harty's 4-staging classification is most commonly used. Stage 4 lesions and symptomatic lesions under grade 3 are usually recommended to surgical treatment. The treatment approach for athletes should be more elaborate due to the need for an early return to play. Several different types of treatment are described for OLTs in athletes, including bone marrow stimulation, osteochondral autograft transfer system, and autogenous chondrocyte implantation. Osteochondral autograft transfer system shows good clinical outcome and has the advantages that could be applied to large defect and recurred lesions, however, it has some disadvantages in terms of the complications related with the donor site and the difficult approach to the medial lesions. Although autogenous chondrocyte implantation has been extensively applied for treating OLTs with successful clinical outcomes, it has some limitations that apply to athletes in terms of the 2-stage and complicated procedure and the insurance issues. Bone marrow stimulation being a simple and cost-effective procedure associated with a low complication rate and low postoperative pain has faster return to play and is recommended the first-line treatment for the OLTs of athletes.