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1.
Eur J Phys Rehabil Med ; 58(3): 462-469, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35148042

ABSTRACT

BACKGROUND: Current prosthetic sockets often provide limited anatomical fit, especially in patients with residual limb volume changes and fluctuations. AIM: To address these issues, Ottobock has developed the Varos Socket, a modular socket that can be adjusted by the user. The aim of this study was to evaluate the potential benefits and acceptance of a newly designed patient-adjustable socket in transfemoral amputees in early phase of prosthetic rehabilitation. DESIGN: A prospective A-B-A pilot study was conducted. SETTING: The setting of the study was an Orthopedic Rehabilitation Clinic. POPULATION: Ten patients with unilateral transfemoral amputation and recent amputation. METHODS: All patients underwent a standard rehabilitation program with physical therapy. The outcome measures included the Comprehensive Lower-limb Amputee Socket Survey (CLASS), Score Comfort Scale (SCS), a Socket Fit Scale, frequency of falls and stumbles, perceived pain, and satisfaction. RESULTS: The total CLASS score and three sub-scores (i.e., stability, suspension, comfort) were significantly higher with Varos socket. Significantly improved comfort and quality of socket fit were observed as measured by the Socket-Comfort-Scale and Socket-Fit-Scale and a trend towards reduced residual limb pain. 87.5% of the patients reported higher satisfaction than with the standard socket. CONCLUSIONS: The results suggest that the Varos socket improved comfort, stability, suspension, appearance, pain, and satisfaction in transfemoral amputees during the early rehabilitation program. A larger study and a longer observation period are warranted to confirm the results of this study. CLINICAL REHABILITATION IMPACT: Quick and easy socket fitting as well as instant adjustability by the patient bear substantial potential to improve and accelerate the rehabilitation process in the early phase after amputation.


Subject(s)
Amputees , Artificial Limbs , Amputation, Surgical/rehabilitation , Amputation Stumps , Amputees/rehabilitation , Humans , Pain , Pilot Projects , Prospective Studies , Prosthesis Design
2.
Arch Orthop Trauma Surg ; 142(6): 1229-1237, 2022 Jun.
Article in English | MEDLINE | ID: mdl-34081194

ABSTRACT

PURPOSE: The aim of the present study was to investigate the potential associations between specific knowledge, resilience and patient-reported outcome measures (PROMS) following primary total hip arthroplasty (THA). METHODS: In a cross-sectional prospective study, consecutive patients following primary THA were included at a rehabilitation center. A novel knowledge score and the validated Connor Davidson Resilience Scale (CD-RISC) were utilized to assess patients' specific knowledge and resilience, respectively. Additionally, patients completed a qualitative questionnaire regarding the information they had received. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as the University of California and Los Angeles Score (UCLA) served as primary outcome measures. Stepwise multiple regression analysis was performed to identify potential predictors of outcome. RESULTS: A total of 103 patients at a mean age of 67.5 years (SD 10.5, 38-88) were included in the analysis at a median of 55.5 days (IQR 43-81) following primary THA. The mean knowledge and resilience scores were 3.8 (SD 1.6, 0-7) and 69.5 (SD 18.5, 0-100), respectively. Forty-seven percent of patients were afraid of harming their prosthesis and these patients had up to 59% worse WOMAC scores (p < 0.001). WOMAC scores on admission to rehabilitation were predicted by resilience and knowledge scores (R2 = 0.106, p = 0.036). UCLA scores at the time of admission were predicted by knowledge scores (R2 = 0.078, p = 0.007). CONCLUSION: The present study demonstrated that patients with a feeling of uncertainty had an inferior short-term functional outcome following primary THA. Moreover, it could be shown that higher specific knowledge and resilience are associated with a better functional outcome according to validated PROMS. While these findings need to be prospectively validated in future studies, specific patient knowledge and resilience may have a direct impact on the outcome of primary THA.


Subject(s)
Arthroplasty, Replacement, Hip , Health Knowledge, Attitudes, Practice , Resilience, Psychological , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Humans , Middle Aged , Prospective Studies , Treatment Outcome
3.
Wien Klin Wochenschr ; 133(11-12): 543-549, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33740126

ABSTRACT

BACKGROUND: A significant percentage of patients have an unfavorable outcome following primary total knee arthroplasty (TKA). This study aimed to evaluate whether specific knowledge about the implant and resilience can influence the functional outcome following TKA. METHODS: A consecutive series of 163 patients following primary TKA at a mean age of 70 years (SD 9.1 years) were included at a regional rehabilitation center between December 2015 and December 2016. Specific patient knowledge (scale 0-7), Connor Davidson Resilience Scale (CD-RISC), Western Ontario and McMaster Universities (WOMAC) score, University of California and Los Angeles (UCLA) score and constitutional parameters were assessed on admission. Pearson's correlation analysis and stepwise linear regression analysis were performed to investigate associations between knowledge, resilience and functional scores. RESULTS: The mean overall knowledge score was 3.5 out of 7 and the mean resilience score was 72.9 out of 100. Mean WOMAC and UCLA scores on admission were 23.8 and 5.5, respectively. Stepwise linear regression analysis identified knowledge and age as significant predictors of WOMAC scores (R2 = 14.3%, p = 0.003). Knowledge and resilience were identified as significant predictors of UCLA scores (R2 = 13.8%, p = 0.013). CONCLUSION: This study highlights the importance of patient-related factors as part of an integral patient care concept in TKA. Although the identified predictors still need to be refined, it could be demonstrated how better patient knowledge might ultimately lead to better functional outcome following TKA. Routinely assessing patients' resilience might be a useful tool to identify patients at risk for low activity levels. LEVEL OF EVIDENCE: III. Patient-reported outcome study.


Subject(s)
Arthroplasty, Replacement, Knee , Osteoarthritis, Knee , Aged , Humans , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Retrospective Studies , Treatment Outcome
4.
Ann Phys Rehabil Med ; 61(5): 278-285, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29753888

ABSTRACT

OBJECTIVE: Microprocessor-controlled knees are generally prescribed and reimbursed for active amputees. Recent studies suggested that this technology could be useful for amputees with moderate activity level. We compared the efficiency of a microprocessor-controlled knee (MPK, Kenevo, Otto Bock) and non-MPKs (NMPKs) in these indications. METHODS: A multi-centric randomized crossover trial was conducted in 16 hospitals from 3 European countries. Participants were randomized to an MPK-NMPK sequence, testing the MPK for 3 months and the NMPK for 1 month, or to an NMPK-MPK sequence, testing the NMPK for 1 month and the MPK for 3 months. Dynamic balance, the main criteria, was assessed with the Timed-Up and Go test (TUG), functional mobility with the Locomotor Capability Index (LCI-5), quality of life with the Medical Outcomes Study Short Form 36 v2 (SF-36v2) and satisfaction with the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0. The occurrence of falls was monitored during the last month of trial. Analysis was by intent-to-treat and per-protocol (PP). RESULTS: We recruited 35 individuals with transfemoral amputation or knee disarticulation (27 males; mean age 65.6years [SD 10.1]). On PP analysis, dynamic balance and functional mobility were improved with the MPK, as shown by a reduced median TUG time (from 21.4s [Q1-Q3 19.3-26.6] to 17.9s [15.4-22.7], P=0.001) and higher mean global LCI-5 (from 40.4 [SD 7.6] to 42.8 [6.2], P=0.02). Median global satisfaction score increased (from 3.9 [Q1-Q3 3.8-4.4] to 4.7 [4.1-4.9], P=0.001) and quality of life was improved for the mental component summary of the SF-36v2 (median score from 53.3 [Q1-Q3 47.8-60.7] to 60.2 [51.6-62.6], P=0.03) and physical component summary but not significantly (mean score from 44.1 [SD 6.3] to 46.3 [7.0], P=0.08). Monitoring of adverse events including falls revealed no differences between both assessed devices. CONCLUSION: This study enhances the level of evidence to argue equal opportunity for all individuals with transfemoral amputation or knee disarticulation, regardless of their mobility grade, to be provided with appropriate prostheses.


Subject(s)
Amputees , Artificial Limbs , Knee , Microcomputers , Patient Satisfaction , Aged , Aged, 80 and over , Amputation, Surgical , Biomechanical Phenomena , Cross-Over Studies , Disarticulation , Female , Humans , Male , Middle Aged , Postural Balance , Quality of Life , Walking
5.
Disabil Rehabil Assist Technol ; 13(2): 157-165, 2018 02.
Article in English | MEDLINE | ID: mdl-28399722

ABSTRACT

PURPOSE: Aim of this pilot study was to assess safety and functioning of a microprocessor-controlled knee prosthesis (MPK) after a short familiarization time and no structured physical therapy. MATERIALS AND METHODS: Five elderly, low-active transfemoral amputees who were fitted with a standard non-microprocessor controlled knee prosthesis (NMPK) performed a baseline measurement consisting of a 3 D gait analysis, functional tests and questionnaires. The first follow-up consisted of the same test procedure and was performed with the MPK after 4 to 6 weeks of familiarization. After being refitted to their standard NMPK again, the subjects undertook the second follow-up which consisted of solely questionnaires 4 weeks later. RESULTS: Questionnaires and functional tests showed an increase in the perception of safety. Moreover, gait analysis revealed more physiologic knee and hip extension/flexion patterns when using the MPK. CONCLUSION: Our results showed that although the Genium with Cenior-Leg ruleset-MPK (GCL-MPK) might help to improve several safety-related outcomes as well as gait biomechanics the functional potential of the GCL-MPK may have been limited without specific training and a sufficient acclimation period. Implications for Rehabilitation Elderly transfemoral amputees are often limited in their activity by safety issues as well as insufficient functioning regarding the non microprocessor-controlled knee prostheses (NMPK), thing that could be eliminated with the use of suitable microprocessor-controlled prostheses (MPK). The safety and functioning of a prototype MPK (GCL-MPK) specifically designed for the needs of older and low-active transfemoral amputees was assessed in this pilot study. The GCL-MPK showed indicators of increased safety and more natural walking patterns in older and low-active transfemoral amputees in comparison to the standard NMPK already after a short acclimatisation time and no structured physical therapy. Regarding functional performance it seems as if providing older and low-active transfemoral amputees with the GCL-MPK alone without prescribing structured prosthesis training might be insufficient to achieve improvements over the standard NMPKs.


Subject(s)
Amputees/rehabilitation , Knee Prosthesis , Microcomputers , Prosthesis Design/instrumentation , Activities of Daily Living , Aged , Artificial Limbs , Biomechanical Phenomena , Cross-Over Studies , Disability Evaluation , Female , Femur , Gait/physiology , Health Status , Humans , Interpersonal Relations , Male , Mental Health , Middle Aged , Physical Therapy Modalities , Pilot Projects , Quality of Life
6.
Foot Ankle Surg ; 23(4): 302-306, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29202992

ABSTRACT

BACKGROUND: The treatment of larger osteochondral lesions of the talus remains an operative challenge. In addition to micro fracturing and osteochondral transplantation one promising strategy could be the operative repair with a cell-free multilayered nano-composite scaffold with the potential to regenerate bone and cartilage in one treatment. METHODS: In this prospective case series four consecutive patients who suffered from a single osteochondral lesion (≥1.5cm2) on the medial talus were enrolled. The repair potential of the implant was assessed using MRI based biochemical, compositional MR sequences (T2 mapping) as well as semi-quantitative morphological analyses (MOCART score) at 18 months follow-up after the surgery. The clinical outcome was determined at 6-, 12-, 18-, and 24 months follow-up by using the Ankle Disability Index and the AOFAS score. RESULTS: At 18 months after the surgery, the clinical outcome was significantly improved compared to the preoperative baseline. Global T2 relaxation times of the repair tissue were significantly increased compared to the healthy control cartilage. CONCLUSIONS: Osteochondral repair with a cell-free, biomimetic scaffold provides good clinical, short-term results. However, biochemical MR imaging provides strong evidence for limited repair tissue quality at 18 months after the implantation. LEVEL OF EVIDENCE: IV.


Subject(s)
Bone Diseases/diagnostic imaging , Bone Diseases/surgery , Cartilage Diseases/diagnostic imaging , Cartilage Diseases/surgery , Nanocomposites/therapeutic use , Talus/diagnostic imaging , Talus/surgery , Tissue Scaffolds , Adolescent , Adult , Biomimetic Materials , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Young Adult
7.
Arch Orthop Trauma Surg ; 137(12): 1699-1705, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28918517

ABSTRACT

PURPOSE: Radial magnetic resonance imaging (MRI) is the most accurate diagnostic tool in assessing cam-type femoroacetabular impingement. Plain radiographs, however, are useful for the initial diagnosis in the daily practice and there is still debate regarding the optimal lateral view. The purpose of this study was to investigate the reliability of detecting cam deformities using the frog-leg view or the 45° Dunn view by comparison with radial MRI. MATERIAL: 66 consecutive hips with plain radiographs (36 with AP and frog-leg views, 30 with AP and 45° Dunn views) and radial MRI were assessed. Alpha angle measurements were obtained both for radiographs and for radial MRI reformats by two investigators. Statistics included frequency analysis, bivariate linear correlation analyses, and cross-table analyses testing the sensitivity and specificity of the radiographic projections for detecting an alpha angle larger than 55°. RESULTS: The intra-class correlation revealed excellent agreement between the two raters [ICC = 0.959, CI (0.943; 0.972)]. 50% (33/66) had the maximum alpha angle in the superior-anterior aspect of the femoral head-neck junction. Cam deformity was found in 40/66 cases (61%) in radial MRI. Pearson correlation demonstrated that the 45° Dunn view was most accurate for the superior-anterior aspect (0.730, p < 0.05). The frog-leg view was best suited for the anterior aspect (0.703, p < 0.05). The sensitivity for detecting cam deformities in the 45° Dunn view was 84 vs 62% in the frog-leg view. CONCLUSION: The frog-leg lateral radiograph does not provide reliable measurements of the alpha angle. This study highlights the importance of the 45° Dunn view for early detection of femoroacetabular cam-type impingement.


Subject(s)
Femoracetabular Impingement/diagnostic imaging , Adult , Aged , Female , Femur Head/diagnostic imaging , Femur Neck/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Radiography , Reproducibility of Results , Sensitivity and Specificity , Young Adult
9.
Knee ; 23(5): 905-10, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27372554

ABSTRACT

UNLABELLED: Wide tumor resections around the proximal tibia (pT) are related to compromised function and high complication rates. This retrospective study aims to present the technique employed as well as functional and surgical outcomes of patients undergoing a Ligament Advanced Reinforcement System (LARS®) reconstruction of the knee extensor apparatus after tumor resection and modular endoprosthetic reconstruction of the proximal tibia. Twenty-five patients who received an artificial ligament after pT resection (11 men and 14 women; mean age, 29years; range 11 to 75years, with a minimum follow-up of 24months) were analyzed regarding the ISOLS failure mode classification. Twenty patients received LARS® during primary surgery, five patients during a revision of a pT modular endoprosthesis. LARS® was available as a band or a tube. The mean extension lag was nine degrees (range, 0 to 30°), the mean flexion was 103° (range, 60 to 130°). The mean extension lag and active flexion in primary implanted LARS were 7.8° and 101° versus secondarily implanted 45° and 115° (p<0.0001; p=0.15). Eleven out of 14 primary implanted LARS® band/tubes (71%) did well with extension lag (0 to 10°). LARS® usage as a band or as a tube showed similar results. The estimated five-year survival of LARS® was 92%. The median survival of LARS® implanted primarily was better than in the case of secondary implantation (p=0.006). Extensor mechanism reconstruction by LARS® band or tube shows excellent function and satisfactory implant survival after primary reconstruction of the extensor mechanism after proximal tibia resection. We experienced no LARS® rupture for only mechanical reasons. LEVEL OF EVIDENCE: Level IV retrospective study.


Subject(s)
Arthroplasty, Replacement, Knee/instrumentation , Bone Neoplasms/surgery , Knee Joint/surgery , Knee/surgery , Ligaments, Articular/surgery , Tibia/surgery , Adolescent , Adult , Aged , Arthroplasty, Replacement, Knee/methods , Child , Female , Humans , Knee/physiopathology , Knee Joint/physiopathology , Male , Middle Aged , Muscle, Skeletal/transplantation , Prostheses and Implants , Prosthesis Failure , Range of Motion, Articular , Plastic Surgery Procedures/instrumentation , Plastic Surgery Procedures/methods , Retrospective Studies , Surgical Flaps , Young Adult
10.
MAGMA ; 29(3): 513-21, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26965509

ABSTRACT

OBJECTIVE: The objective was to establish a gagCEST protocol that would enable robust and reproducible assessment of the glycosaminoglycan (GAG) content in knee cartilage at 7 T within a clinically feasible measurement time. MATERIALS AND METHODS: Ten young healthy volunteers (mean age 26 years, range 24-28, five males, five females) were examined on a 7 T MR system. Informed consent was obtained from all individual participants prior to enrollment into the study. Each volunteer was measured twice for reproducibility assessment. The examined knee was immobilized using a custom-made fixation device. For the gagCEST measurement, a prototype segmented 3-D RF-spoiled gradient-echo sequence with an improved saturation scheme employing adiabatic pulses was used in a scan time of 19 min. The asymmetry of the Z-spectra (MTRasym) in selected regions of interest in knee cartilage was calculated. Differences in MTRasym between different regions were evaluated using ANOVA and the Bonferroni corrected post hoc test. RESULTS: The improvement of the saturation scheme reduced the influence of field inhomogeneities, resulted in more uniform saturation, and allowed for good reproducibility in a reasonable measurement time (19 min), as demonstrated by an intraclass correlation coefficient of 0.77. Improved fixation helped to reduce motion artifacts. Whereas similar MTRasym values were found for weight-bearing and non-weight-bearing femoral cartilage, lower values were observed in the trochlear groove (p = 0.028), patellar (p = 0.015) and tibial cartilage (p < 0.001) when compared to non-weight-bearing femoral cartilage. CONCLUSION: Reasonable reproducibility and sensitivity to regional differences in GAG content suggests that the improved gagCEST protocol might be useful for assessing the biochemical changes in articular cartilage that are associated with early stages of cartilage degeneration.


Subject(s)
Cartilage, Articular/diagnostic imaging , Glycosaminoglycans/chemistry , Knee Joint/diagnostic imaging , Knee/diagnostic imaging , Magnetic Resonance Imaging/methods , Adult , Artifacts , Cartilage, Articular/pathology , Female , Humans , Image Processing, Computer-Assisted/methods , Knee/pathology , Knee Joint/pathology , Male , Motion , Reproducibility of Results , Sensitivity and Specificity
11.
Int Orthop ; 40(3): 625-32, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26803322

ABSTRACT

INTRODUCTION: The treatment of larger osteochondral lesions in the knee is still a clinical challenge. One promising strategy to overcome this problem could be surgical repair by using a cell-free multilayered nano-composite scaffold. METHOD: In this prospective cohort study eight consecutive patients which suffered from a single osteochondral lesion (≥1.5 cm(2)) on the femoral condyle were enrolled. The repair potential of the implant was assessed by using MRI based biochemical MR sequences (T2 mapping) as well as semi-quantitative morphological analyses (MOCART score) at 18 months after the surgery. The clinical outcome was determined at six, 12, 18, and 24 month follow ups by using IKDC, Tegner-Lysholm, and Cincinnati knee scores. RESULTS: Seven out of eight patients showed a complete integration of the scaffold into the border zone and five out of eight patients excellent or good subchondral ossification of the implant at 18 months following implantation. The surface of the repair tissue was found to be intact in all eight patients. T2 mapping data and the zonal T2 index significantly differed in the repair tissue compared to the healthy control cartilage (P < 0.001) which indicates a limited quality of the repair cartilage. The clinical outcome scores consistently improved during the follow up period without reaching statistical significance. CONCLUSIONS: Osteochondral repair by implanting the MaioRegen® scaffold provides a successful osteoconduction and filling of the cartilage defect. However there is evidence for a limited repair cartilage tissue quality at 18 months after the surgery.


Subject(s)
Bone Regeneration , Cartilage Diseases/surgery , Knee Joint/surgery , Nanocomposites/therapeutic use , Tissue Scaffolds , Adolescent , Adult , Cartilage Diseases/pathology , Cartilage, Articular/pathology , Cohort Studies , Female , Femur/pathology , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Treatment Outcome , Wound Healing , Young Adult
12.
Invest Radiol ; 50(4): 246-54, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25436618

ABSTRACT

OBJECTIVES: The goal of cartilage repair techniques such as microfracture (MFX) or matrix-associated autologous chondrocyte transplantation (MACT) is to produce repair tissue (RT) with sufficient glycosaminoglycan (GAG) content. Sodium magnetic resonance imaging (MRI) offers a direct and noninvasive evaluation of the GAG content in native cartilage and RT. In the femoral cartilage, this method was able to distinguish between RTs produced by MFX and MACT having different GAG contents. However, it needs to be clarified whether sodium MRI can be useful for evaluating RT in thin ankle cartilage. Thus, the aims of this 7-T study were (1) to validate our sodium MRI protocol in cadaver ankle samples, (2) to evaluate the sodium corrected signal intensities (cSI) in cartilage of volunteers, (3) and to compare sodium values in RT between patients after MFX and MACT treatment. MATERIALS AND METHODS: Five human cadaver ankle samples as well as ankles of 9 asymptomatic volunteers, 6 MFX patients and 6 MACT patients were measured in this 7-T study. Sodium values from the ankle samples were compared with histochemically evaluated GAG content. In the volunteers, sodium cSI values were calculated in the cartilages of ankle and subtalar joint. In the patients, sodium cSI in RT and reference cartilage were measured, morphological appearance of RT was evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system, and clinical outcome before and after surgery was assessed using the American Orthopaedic Foot and Ankle Society score and Modified Cincinnati Knee Scale. All regions of interest were defined on morphological images and subsequently transferred to the corresponding sodium images. Analysis of variance, t tests, and Pearson correlation coefficients were evaluated. RESULTS: In the patients, significantly lower sodium cSI values were found in RT than in reference cartilage for the MFX (P = 0.007) and MACT patients (P = 0.008). Sodium cSI and MOCART scores in RT did not differ between the MFX and MACT patients (P = 0.185). No significant difference in sodium cSI was found between reference cartilage of the volunteers and the patients (P = 0.355). The patients showed significantly higher American Orthopaedic Foot and Ankle Society and Modified Cincinnati scores after treatment than they did before treatment. In the volunteers, sodium cSI was significantly higher in the tibial cartilage than in the talar cartilage of ankle joint (P = 0.002) and in the talar cartilage than in the calcaneal cartilage of subtalar joint (P < 0.001). Data from the cadaver ankle samples showed a strong linear relationship between the sodium values and the histochemically determined GAG content (r = 0.800; P < 0.001; R = 0.639). CONCLUSIONS: This study demonstrates the feasibility of in vivo quantification of sodium cSI, which can be used for GAG content evaluation in thin cartilages of ankle and subtalar joints at 7 T. A strong correlation observed between the histochemically evaluated GAG content and the sodium values proved the sufficient sensitivity of sodium MRI to changes in the GAG content of cartilages in the ankle. Both MFX and MACT produced RT with lower sodium cSI and, thus, of lower quality compared with reference cartilage in the patients or in the volunteers. Our results suggest that MFX and MACT produce RT with similar GAG content and similar morphological appearance in patients with similar surgery outcome. Sodium MRI at 7 T allows a quantitative evaluation of RT quality in the ankle and may thus be useful in the noninvasive assessment of new cartilage repair procedures.


Subject(s)
Ankle Joint/metabolism , Cartilage, Articular/metabolism , Magnetic Resonance Imaging/methods , Sodium/metabolism , Adult , Ankle Joint/surgery , Cadaver , Cartilage, Articular/surgery , Chondrocytes/metabolism , Cross-Sectional Studies , Feasibility Studies , Female , Humans , Male , Middle Aged , Reproducibility of Results , Transplantation, Autologous , Wound Healing , Young Adult
13.
Int Orthop ; 38(7): 1369-73, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24728266

ABSTRACT

PURPOSE: We report the results of a consecutive series of 12 cases with haemophilic hip arthropathy treated with uncemented total hip arthroplasty (THA). Our hypothesis was that THA results in the haemophilic group would be inferior to those in the nonhaemophilic group. METHODS: The clinical histories of 12 consecutive THAs in eight patients (all men) with hereditary bleeding disorders (haemophilia A and B and von Willebrand disease) were reviewed retrospectively. The results were compared with an age- and sex-matched control group without haemophilia, with special emphasis on bearing surfaces (Metasul metal-on-metal; polyethylene-ceramic articulation). RESULTS: The mean follow-up of the control group was 9.7 (range five to 24) years and was similar to the haemophilia group, with 10.4. Survival in the Metasul haemophilic group was 22.2 % after 18 years, which significantly differed from the Metasul control group (100 % after 24 years). Survival of the polyethylene-ceramic haemophilic group was similar to the control group (100 % after seven years in both groups). CONCLUSIONS: The metal-on-metal bearing surface in patients with haemophilia gave inferior results compared with nonhaemophilic patients. The use of metal-on-metal bearings in haemophilia is debatable.


Subject(s)
Blood Coagulation Disorders, Inherited/complications , Hip Joint/surgery , Hip Prosthesis , Joint Diseases/surgery , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip , Biocompatible Materials , Ceramics , Humans , Joint Diseases/etiology , Male , Metals , Middle Aged , Polyethylene , Prosthesis Design , Retrospective Studies
14.
Am J Sports Med ; 42(6): 1426-32, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24664138

ABSTRACT

BACKGROUND: Matrix-associated autologous chondrocyte transplantation (MACT) has become an established articular cartilage repair technique. It provides good short-term and midterm results; however, long-term results are lacking. PURPOSE: To prospectively assess the clinical outcome after MACT in the knee to report long-term results. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-three subjects (females/males, 22/31; mean age, 32 ± 12 years) were treated between 2000 and 2006 with a hyaluronan-based MACT product and were followed prospectively. The mean body mass index (BMI) was 24.5 ± 3.8 kg/m(2) and the mean defect size was 4.4 ± 1.9 cm(2). Fifty patients had single defects and 3 had multiple defects (41 medial femoral condyle, 6 lateral femoral condyle, 2 patella, 1 tibia). Two patients had 2 defects (medial femoral condyle [MFC]/lateral femoral condyle and tibial/MFC), and in 1 case, multiple defects on the MFC were treated. The patients were stratified into 23 "simple," 22 "complex," and 8 "salvage" cases. Instability or malalignment was treated before or at the time of graft implantation. For 6 patients with small defects (<2 cm(2)), microfracturing was used as first-line treatment before MACT. Clinical assessment was performed once a year with the subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm score, and a modified Cincinnati Knee Rating System. RESULTS: The mean follow-up time was 9.07 ± 2.9 years (range, 5-12 years). Treatment failure occurred in 12 of 53 cases (22.6%) an average of 2.99 ± 1.40 years after surgery. There was 1 failure (4.3%) among the simple cases, 4 failures (18.2%) in complex cases, and 7 failures (87.5%) in salvage cases. Statistically significant increases were observed in all scores at all time points compared with presurgery levels (P < .05). The subjective IKDC score improved from median 40.4 preoperatively to 74.7 at 10-year follow-up (n = 13 patients; P < .05). CONCLUSION: MACT is an excellent surgical therapy for full-thickness cartilage defects of the knee, with good long-term results for simple defects. However, it should not be used in salvage cases.


Subject(s)
Cartilage, Articular/injuries , Chondrocytes/transplantation , Hyaluronic Acid/therapeutic use , Knee Injuries/surgery , Adult , Cartilage, Articular/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Transplantation, Autologous
15.
Int Orthop ; 38(1): 67-72, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24013438

ABSTRACT

PURPOSE: Elevated T2-values of articular cartilage are associated with an increase in cartilage water that results from a damaged collagen matrix, and provide a marker for cartilage damage. We used T2 mapping to analyse the rim of cartilage defects that appeared to be intact on the morphological sequences, to determine whether there are early biochemical changes already present. METHOD: We calculated T2 values for the rim of cartilage defects in 25 patients and compared these values to another area of control cartilage in these patients. RESULTS: A highly significant increase in T2 values of the deep, superficial, and global layer of the rim versus the control cartilage was measured. ANOVA showed a significant correlation of the defect levels with the T2 values of the deep and global zone of the adjacent cartilage tissue, but not with the superficial zone. CONCLUSION: Although cartilage appears to be intact on morphological sequences, T2 mapping can show a loss of structural anisotropy of collagen and the associated increase in cartilage water that indicates the destruction of the adjacent cartilage. Preoperative information about the degree of damage of the collagen matrix will support decision making for cartilage repair.


Subject(s)
Cartilage, Articular/pathology , Magnetic Resonance Imaging/methods , Patella/pathology , Adolescent , Adult , Analysis of Variance , Cartilage, Articular/metabolism , Collagen/metabolism , Female , Humans , Knee Joint/metabolism , Knee Joint/pathology , Male , Middle Aged , Retrospective Studies , Young Adult
16.
Skeletal Radiol ; 42(12): 1657-64, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23990057

ABSTRACT

OBJECTIVE: A novel single-stage approach using arthroscopic microdrilling and atelocollagen/fibrin-gel application is employed for cartilage repair of the knee. The purpose of our study was to investigate the morphological and biochemical MRI outcome after this technique. MATERIALS AND METHODS: A retrospective case series of ten patients (mean age 45 years) with symptomatic chondral defects in the knee who were treated arthroscopically with microdrilling and atelocollagen application was analyzed. All defects were ICRS grade III or IV and the sizes were 2-8 cm(2) intra-operatively. All patients underwent morphological MRI and T2-star mapping at 1.5 T at 1-year follow-up. The magnetic resonance observation of cartilage repair tissue (MOCART) score was assessed. T2* relaxation time values of repair tissue and a healthy native cartilage area was assessed by means of region of interest analysis on the T2* maps. RESULTS: The mean MOCART score at 1-year follow-up was 71.7 ± 21.0 ranging from 25 to 95. The mean T2* relaxation times were 30.6 ± 11.3 ms and 28.8 ± 6.8 ms for the repair tissue and surrounding native cartilage, respectively. The T2* ratio between the repair tissue and native cartilage was 105% ± 30%, indicating repair tissue properties similar to native cartilage. CONCLUSIONS: An arthroscopic single-stage procedure using microdrilling in combination with atelocollagen gel and fibrin-glue can provide satisfactory MRI results at 1-year follow-up, with good cartilage defect filling. The T2* values in the repair tissue achieved similar values compared to normal hyaline cartilage.


Subject(s)
Arthroscopy/methods , Collagen/therapeutic use , Fractures, Cartilage/pathology , Fractures, Cartilage/therapy , Knee Injuries/pathology , Knee Injuries/therapy , Magnetic Resonance Imaging/methods , Adult , Chondrogenesis , Female , Fractures, Cartilage/physiopathology , Humans , Knee Injuries/physiopathology , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Treatment Outcome
17.
Eur J Radiol ; 82(5): 740-4, 2013 May.
Article in English | MEDLINE | ID: mdl-22177325

ABSTRACT

INTRODUCTION: The goal of this in vitro validation study was to investigate the feasibility of biochemical MRI techniques, such as sodium imaging, T2 mapping, fast imaging with steady state precession (FISP), and reversed FISP (PSIF), as potential markers for collagen, glycosaminoglycan and water content in the Achilles tendon. MATERIALS AND METHODS: Five fresh cadaver ankles acquired from a local anatomy department were used in the study. To acquire a sodium signal from the Achilles tendon, a 3D-gradient-echo sequence, optimized for sodium imaging, was used with TE=7.71 ms and TR=17 ms. The T2 relaxation times were obtained using a multi-echo, spin-echo technique with a repetition time (TR) of 1200 ms and six echo times. A 3D, partially balanced, steady-state gradient echo pulse sequence was used to acquire FISP and PSIF images, with TR/TE=6.96/2.46 ms. MRI parameters were correlated with each other, as well as with histologically assessed glycosaminoglycan and water content in cadaver Achilles tendons. RESULTS: The highest relevant Pearson correlation coefficient was found between sodium SNR and glycosaminoglycan content (r=0.71, p=0.007). Relatively high correlation was found between the PSIF signal and T2 values (r=0.51, p=0.036), and between the FISP signal and T2 values (r=0.56, p=0.047). Other correlations were found to be below the moderate level. CONCLUSION: This study demonstrated the feasibility of progressive biochemical MRI methods for the imaging of the AT. A GAG-specific, contrast-free method (sodium imaging), as well as collagen- and water-sensitive methods (T2 mapping, FISP, PSIF), may be used in fast-relaxing tissues, such as tendons, in reasonable scan times.


Subject(s)
Achilles Tendon/anatomy & histology , Achilles Tendon/chemistry , Body Water/chemistry , Collagen/analysis , Glycosaminoglycans/analysis , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy/methods , Cadaver , Feasibility Studies , Female , Humans , Male , Middle Aged , Molecular Imaging/methods , Reproducibility of Results , Sensitivity and Specificity , Statistics as Topic
18.
Int Orthop ; 37(1): 39-43, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23161108

ABSTRACT

PURPOSE: The aim of this study was to assess the stability of the glycosaminoglycan (GAG) content in the long term after matrix-associated autologous chondrocyte transplantation (MACT) with Hyalograft C in the knee over a follow-up period of one year. METHODS: In this cross-sectional evaluation, 11 patients after MACT of the knee consented to delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) measurements. The mean post-operative interval before the first MR examination was 40.6 ± 22.0 months, and the second MR examination was carried out after another 12 months. The Lysholm score was assessed for clinical evaluation. Quantitative T1 measurements after intravenous negatively charged MR contrast agent administration were performed. Global post-contrast T1 of the reference cartilage and the repair tissue and a relative post-contrast T1 value were calculated. RESULTS: The Lysholm score improved significantly from 59.8 ± 12.9 at baseline to 86.1 ± 15.7 at the second visit (p < 0.01). The mean global T1 of the repair tissue (1st visit 581.3 ± 126.4 ms; 2nd visit 684.1 ± 169.9 ms; p = 0.104) and the mean relative T1 value showed stable results over one year (1st visit 0.81 ± 0.28; 2nd visit 0.76 ± 0.32; p = 0.4). CONCLUSIONS: The study demonstrated stable glycosaminoglycan content of the repair tissue after MACT at midterm.


Subject(s)
Cartilage, Articular/surgery , Chondrocytes/transplantation , Glycosaminoglycans/analysis , Hyaluronic Acid/therapeutic use , Knee Joint/surgery , Magnetic Resonance Imaging/methods , Adult , Arthroscopy , Cartilage, Articular/injuries , Contrast Media , Cross-Sectional Studies , Female , Gadolinium , Humans , Male , Transplantation, Autologous , Treatment Outcome
19.
Semin Musculoskelet Radiol ; 16(3): 177-84, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22851322

ABSTRACT

The number of surgical interventions of osteochondral lesions in the talar dome is steadily increasing. The surgical treatment with microfracturing or autologous chondrocyte transplantation has shown good clinical outcome at the midterm follow-up. With the development of advanced MR methods that are relatively specific for ultrastructural components of articular cartilage, compositional or biochemical MR has become possible in addition to the standard morphological evaluation of repair tissue. These quantitative MR techniques allow a monitoring of repair tissue on a molecular level. Using these techniques, the maturation of repair tissue, in particular the glycosaminoglycan content responsible for the biomechanical properties and the organization and content of collagen fibers, can be quantified and compared with normal hyaline cartilage. In addition, the diffusion properties of the repair tissue can also be analyzed by specific MR sequences.


Subject(s)
Cartilage, Articular/pathology , Cartilage, Articular/surgery , Magnetic Resonance Imaging/methods , Postoperative Complications/diagnosis , Talus/pathology , Talus/surgery , Chondrocytes/transplantation , Humans , Postoperative Period , Transplantation, Autologous , Treatment Outcome
20.
Clin Orthop Relat Res ; 470(8): 2274-9, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22487880

ABSTRACT

BACKGROUND: The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN)--so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capital realignment procedure in SCFE treatment we observed that clinical estimation of physeal stability did not always correlate with intraoperative findings at open surgery. This motivated us to perform a systematic comparison of the clinical classification systems with the intraoperative observations. QUESTIONS/PURPOSES: We asked: (1) Is the classification of an acute versus chronic slip based on the duration of symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? (2) Is the stable/unstable classification system based on clinical symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? METHODS: We retrospectively reviewed 82 patients with SCFE treated by open surgery between 1996 and 2009. We classified the clinical stability of all hips using the classifications based on onset of symptoms and on function. We classified intraoperative stability as intact or disrupted. We determined the sensitivity and specificity of two classification systems to determine intraoperative stability. RESULTS: Complete physeal disruption at open surgery was seen in 28 of the 82 hips (34%). With classification as acute, acute-on-chronic, and chronic, the sensitivity for disrupted physes was 82% and the specificity was 44%. With the classification of Loder et al., the values were 39% and 76%, respectively. CONCLUSION: Current clinical classification systems are limited in accurately diagnosing the physeal stability in SCFE. LEVEL OF EVIDENCE: Level III, retrospective diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.


Subject(s)
Intraoperative Complications/diagnosis , Joint Instability/diagnosis , Slipped Capital Femoral Epiphyses/pathology , Acute Disease , Adolescent , Child , Chronic Disease , Female , Hip Joint/diagnostic imaging , Hip Joint/pathology , Hip Joint/physiopathology , Humans , Intraoperative Period , Joint Instability/complications , Joint Instability/physiopathology , Male , Predictive Value of Tests , Radiography , Reproducibility of Results , Retrospective Studies , Slipped Capital Femoral Epiphyses/complications , Slipped Capital Femoral Epiphyses/surgery , Time Factors
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