ABSTRACT
Purpose The aims of this paper are to report the rate and risk factors for the failure of the most common cartilage repair technique, and analyze the most important factors that could influence the choice of a specific surgical treatment to revise a failed cartilage repair. Methods A review of the literature was performed focusing on failed cartilage repair and related treatments. Two of the authors independently screened articles. Conflicts about the inclusion of a paper was resolved by further evaluation by the senior author. Review articles, articles written in languages different from/other than English, case reports, and papers that did not evaluate the outcomes of interest were excluded. Full-text version of each included paper was obtained and relevant data were extracted and collected in a database. Results At the end of the screening process, 31 articles were included. Microfractures and mosaicplasty showed a nonnegligible failure rate at short- and midterm. Better results, especially in terms of time to failure or revision, were reported with the use of autologous chondrocyte implantation (ACI) and osteochondral allograft (OCA) transplantation. Regarding the treatment of failed cartilage repair, the use of OCA transplantation in patients with previous failed cartilage repair may be a safe option. The revision of failed OCA transplantation with further OCA seems to have a greater failure rate. Patients with previous failed ACI or matrix-induced autologous chondrocyte implantation (MACI) who underwent further MACI or ACI reported acceptable results. Otherwise, ACI in patients with history of previous subchondral marrow stimulation (SMS) demonstrated a greater failure rate. Conclusion From the analysis of the literature, OCA transplantation seems to be the most reliable treatment of a failed SMS. ACI or MACI showed acceptable results in patients with previously failed MACI or ACI. Level of Evidence Level IV, systematic review of level I-IV studies.
ABSTRACT
BACKGROUND: Anterior cruciate ligament tears (ACL) are associated with meniscal lesions, that could involve the posterior horn of the medial meniscus (PHMM). A variety of techniques has been proposed to better visualise the postero-medial (PM) compartment. The aim of the study is to evaluate the prevalence of longitudinal tears of peripheral attachment of the PHMM during arthroscopic ACL reconstruction, and to describe a diagnostic algorithm. METHODS: 115 patients who underwent arthroscopic ACL reconstruction were enrolled for the study. An anterior and an intercondylar notch visualisation were ordinarily performed. A postero-medial (PM) portal was performed when the instability of the posterior horn was detected. Statistical significance was assessed by a Chi-squared or Fisher's Exact Test for categorical variables, and by a Mann-Whitney U test for continuous variables. RESULTS: We recorded a 9.6% prevalence of lesions of the peripheral attachment of PHMM. Nine ramp lesions and two hidden lesions were diagnosed. Patients treated within 6 months from injury, revealed a statistically significant correlation with a higher prevalence of these lesions. CONCLUSION: Ramp and hidden lesions are very common ACL rupture associated injuries. Our diagnostic algorithm is a valid and safe option to diagnose these kinds of lesions. A correlation between a longer time from injury than 6 months and a reduced prevalence of these lesions was recorded in our population. LEVEL OF EVIDENCE: IV.
