Comparative study on clinical outcomes in autologous chondrocyte implantation using three-dimensional cultured JACC® with collagen versus periosteum coverings.

This study investigates the efficacy of a collagen membrane as a substitute for autologous periosteum in atelocollagen-assisted autologous chondrocyte implantation (ACI) using J-TEC autologous cultured cartilage (JACC®). Sixty-nine patients with knee joint chondral defects underwent ACI using JACC®-34 with periosteum-covered ACI (P-ACIs) and 35 with collagen-covered ACI (C-ACIs). Clinical outcomes were compared through patient-reported measures, International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) scores at second-look arthroscopy one year postoperatively, and adverse event incidence. Postoperative subjective scores significantly improved up to two years, with no significant differences between P-ACI and C-ACI groups. However, C-ACI exhibited a lower adverse event rate (p = 0.034) and significantly higher ICRS CRA scores (p = 0.0001). Notably, C-ACI outperformed P-ACI in both femoral condyle and trochlea assessments (p = 0.0157 and 0.0005, respectively). While clinical outcomes were comparable, the use of a collagen membrane demonstrated superiority in ICRS CRA during second-look arthroscopy and adverse event occurrence.

Accuracy Verification of Four-Dimensional CT Analysis of Knee Joint Movements: A Pilot Study Using a Knee Joint Model and Motion-Capture System.

Objective This study aimed to use the optical motion-capture method to verify the accuracy of four-dimensional computed tomography (4D-CT) analysis of knee joint movement. Methods One static CT and three 4D-CT examinations of the knee joint model were obtained. The knee joint model was passively moved in the CT gantry during 4D-CT acquisitions. 4D-CT and static CT examinations were matched to perform 3D-3D registration. An optical-motion capture system recorded the position-posture of the knee joint model simultaneously with the 4D-CT acquisitions. Reference axes (X, Y, and Z directions) were defined based on static CT and applied to 4D-CT and the optical-motion capture system. Using the position-posture of the motion capture system as a reference standard, the position-posture measurements using 4D-CT were compared to these values, and the accuracy of the 4D-CT analysis of knee joint movements was quantitatively assessed. Results The position-posture measurements obtained from 4D-CT showed a similar tendency to those obtained from the motion-capture system. In the femorotibial joint, the difference in the spatial orientation between the two measurements was 0.7 mm in the X direction, 0.9 mm in the Y direction, and 2.8 mm in the Z direction. The difference in angle was 1.9° in the varus/valgus direction, 1.1° in the internal/external rotation, and 1.8° in extension/flexion. In the patellofemoral joint, the difference between the two measurements was 0.9 mm in the X direction, 1.3 mm in the Y direction, and 1.2 mm in the Z direction. The difference in angle was 0.9° for varus/valgus, 1.1° for internal/external rotation, and 1.3° for extension/flexion. Conclusions 4D-CT with 3D-3D registration could record the position-posture of knee joint movements with an error of less than 3 mm and less than 2° when compared with the highly accurate optical-motion capture system. Knee joint movement analysis using 4D-CT with 3D-3D registration showed excellent accuracy for in vivo applications.

Dynamic high-resolution ultrasound in the diagnosis of calcaneofibular ligament injury in chronic lateral ankle injury: a comparison with three-dimensional magnetic resonance imaging.

PURPOSE: To date, no gold standard imaging method has been used to assess calcaneofibular ligament (CFL) injuries. Ultrasound (US) has become increasingly important in the assessment of ligaments around the ankle. However, very few reports in the literature have focused on detecting CFL injuries. The objective of this study was to determine the effectiveness of ultrasound in detecting CFL injuries in comparison with magnetic resonance imaging (MRI). METHODS: A retrospective study was conducted in 21 patients with chronic lateral ankle injury, 10 males and 11 females with a mean age of 27.6 ± 14.5 years (range 14-68 years). High-frequency US and three-dimensional (3D) MRI of the affected ankle were performed. Evaluations of the CFL were performed by two orthopedic surgeons experienced in US, while the MRI findings were interpreted by two musculoskeletal radiologists. The US findings were then compared with the MRI findings. RESULTS: US detected CFL injury in 9/21 patients, and these findings were confirmed by the MRI findings. However, one patient with a normal CFL on US was evaluated as laxity on MRI. In this study, US sensitivity and specificity in detecting CFL injuries was 90% (9/10) and 100% (10/10), respectively, with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 91.7% in comparison with MRI. CONCLUSION: With the proper technique and knowledge of the ankle anatomy, high-frequency US proved to be an effective imaging modality in the diagnosis of CFL lesions in chronic lateral ankle injuries. US had a high sensitivity and specificity in the evaluation of the CFL when MRI findings were regarded as the reference standard.

Beta-Tricalcium Phosphate Block for Donor Site Morbidity of the Patella in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft.

PURPOSE: This study aimed to investigate anterior knee symptoms in patients who underwent anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft followed by implantation of a beta-tricalcium phosphate (ß-TCP) block as a bone void filler. MATERIALS AND METHODS: We retrospectively reviewed 84 cases of synthetic bone grafting using a ß-TCP block for the patellar bone defect in ACL reconstruction with a BPTB autograft. Computed tomography of the operated knee was performed immediately after the surgery to evaluate whether the grafted ß-TCP block protruded forward from the anterior surface of the patella. On the basis of the results, the cases were divided into a protrusion group (n=31) and a non-protrusion group (n=53). Anterior knee symptoms at 12 months postoperatively and absorption of the grafted ß-TCP block were compared between the two groups. RESULTS: Except for patellofemoral crepitus, there was no significant difference in anterior knee symptoms between the two groups (p>0.05). The incidence of patellofemoral crepitus was significantly lower in the protrusion group than in the non-protrusion group (p=0.027). The groups showed no significant difference in ß-TCP absorption. CONCLUSIONS: The present study demonstrated that the protrusion of ß-TCP that was used as a bone void filler had no adverse effects.

A large knee osteochondral lesion treated using a combination of osteochondral autograft transfer and second-generation autologous chondrocyte implantation: A case report.

BACKGROUND: Full-thickness knee cartilage defects greater than 4 cm2 are best treated with autologous chondrocyte implantation (ACI). Since the articular cartilage surrounding the site of implantation does not always have the normal thickness desirable for successful engraftment, there may be benefit in combining ACI with osteochondral autograft transfer, which provides immediate restoration of condylar contour and mechanical function. CASE PRESENTATION: A 19 year-old male who sustained a traumatic anterolateral femoral condyle osteochondral fracture underwent arthroscopic knee surgery three months after injury to harvest healthy cartilage to be sent to the Japan Tissue Engineering Co., Ltd. (J-TEC) for cartilage culture. The patient was re-admitted after four weeks to undergo a procedure using the Osteochondral Autograft Transfer System (OATS®) and the J-TEC autologous cultured cartilage (JACC®) system. Three 4.75-mm osteochondral cylindrical cores were harvested from non-weight-bearing areas of the knee and were transplanted to the lateral periphery of the lateral femoral condyle defect. The cultured cartilage was implanted to the remaining defect with a periosteal cover harvested from the anterolateral ridge of the lateral femoral condyle. Continuous passive range of motion exercises and gait retraining were immediately initiated, with strict no weight-bearing precaution on the operated limb. Partial weight-bearing was allowed four weeks after surgery, which was progressed to full weight-bearing after another two weeks. CONCLUSION: ACI must be viewed as a complementary procedure to osteochondral transplantation and this hybrid technique appears to be a promising surgical approach and treatment option for large cartilage lesions, especially in the younger population.

Combined autologous chondrocyte implantation and meniscus reconstruction for large chondral defect in the lateral compartment due to discoid lateral meniscus tear: A case report.

Discoid lateral meniscus tear leads to large chondral defect in the lateral compartment of the knee joint. There are few effective treatments for large chondral defect in both the tibial and femoral sides with severe degenerative lateral meniscus. We have developed a combined autologous chondrocyte implantation and meniscus reconstruction technique using hamstring tendon. This technique allows biological reconstruction and avoids knee arthroplasty.

A new method for tensioning of a chronic tibial bony avulsion of the posterior cruciate ligament as a posteromedial bundle and augmentation by anterolateral bundle reconstruction in a bicruciate ligament injury: A case report.

Multiple ligament injury is associated with high instability; hence, it is necessary to restore stability through application of a reliable treatment strategy. We report our experiences in handling a case of ruptured anterior cruciate ligament (ACL) complicated by chronic bony avulsion of the posterior cruciate ligament (PCL). Favourable results were obtained as a result of ACR reconstruction following a new method for tensioning of the chronic tibial bony avulsion of PCL as a postero-medial bundle and augmentation by PCL anterolateral bundle reconstruction. Favourable posterior stability could be restored through application of this new technique incorporating post-reconstruction PCL reinforcement.