Isolated Osteochondral Autograft Mosaicplasty for In Situ Fixation of Unstable Osteochondritis Dissecans in Skeletally Mature Patients

Background: Injury to Anterior Cruciate Ligament (ACL) commonly occurs in knee injury usually requiring surgical intervention. Use of hamstring autograft for ACL reconstruction (ACLR) is commonly practiced. Many factors govern the selection of graft. Literature lacks studies showing correlation between anthropometric measurements of patients and the size of hamstring tendon graft in ACLR in Nepalese population. This study aimed to correlate anthropometric measurements to diameter and length of graft obtained. Methods: Cross sectional study was carried out from 17th April 2021 to 15th March 2022 and approved by CMC-IRC (Ref: CMC-IRC/078/079-094) and evaluating patients who have undergone surgery in Anthropometric measurements along with thigh length and circumference was measured pre-operatively. Length and diameter of prepared graft was measured intraoperatively before insertion. Forty (n=40) patients of mixed age, sex and ethnicity undergoing Arthroscopic ACLR were included. Statistical analysis was done to find correlation between anthropometric measurements and graft size harvested. Purposive sampling technique was used. Data collection was done in proforma. Data entry was done in Excel and and analysis was done in SPSS version 21. Results: Statistical analyses showed strong positive correlation between patient’s thigh length and graft diameter. Height shows positive correlation with graft length and diameter. Weight shows positive correlation with graft length. There was very low correlation of other variables with graft diameter and length which were statistically insignificant. Conclusions: Positive correlation factors (thigh length, height and weight) can be utilized to anticipate good quality graft and can be used during ACLR.

Background Recently we retrospectively collected clinical data to predict hamstring graft diameter. Prospective data collection will improve and further define prediction of hamstring graft size. Hypothesis Clinical anthropometric data can be used to predict hamstring graft size. Study Design Cohort study (prevalence); Level of evidence, 1. Methods Fifty consecutive patients with anterior cruciate ligament deficiency scheduled for reconstruction using hamstring autograft were prospectively evaluated. Preoperatively we recorded height, weight, body mass index, age, gender, leg length, thigh length, shank length, bilateral thigh circumference, and Tegner score. Intraoperative measurements of both the gracilis and semitendinosus tendons were made, including absolute length before fashioning the graft and final diameter of the quadrupled graft using sizing tubes calibrated to 0.5 mm. Bivariate correlation coefficients (Pearson r) were calculated to identify relationships among clinical data and intraoperatively measured hamstring graft length and diameter. Results Strongest correlations for graft lengths were height and leg length measurements. Shorter persons with shorter leg, thigh, and shank lengths tended to have shorter gracilis and semitendinosus grafts. Likewise, the strongest correlations for graft diameter were weight and thigh circumference. Self-reported activity level and age did not correlate. Gender comparison revealed that women who were shorter, lighter, and had smaller body mass indices were more likely to have smaller graft diameters and shorter graft lengths. Conclusion Patients weighing less than 50 kg, less than 140 cm in height, with less than 37 cm thigh circumference, and with body mass index less than 18 should be considered at high risk for having a quadrupled hamstring graft diameter less than 7 mm. When separated by gender, small graft diameters are most likely in older, short, female subjects with small thigh circumferences or young, skinny, male subjects with small thigh circumferences and low body mass index. Common clinical measurements can be used for preoperative identification of patients at risk for insufficient graft tissue and would be useful for patient counseling and alternative graft source planning.

Background:Young athletes have the highest rates of primary and recurrent anterior cruciate ligament (ACL) tears, and recent research has identified graft diameter as a predictor of graft failure. Newer ACL reconstruction techniques have been developed to increase graft diameter and reduce re-rupture rates. Graft diameter can be modified based upon graft length, number of graft strands/configuration, and native ACL length. While the ACL has been well-studied in adult populations, there is limited research examining the ACL dimensional characteristics in a pediatric population. Appropriate preoperative anatomic dimensions may help surgeons plan for optimal graft length, diameter and bundle arrangementPurpose:To develop MRI-based predictors of native ACL graft length in pediatric populations and enhance preoperative planning to optimize graft length, strand configuration and graft diameter to lower the risk of recurrent ACL injury.Methods:One hundred and ten subjects were included from the STRIDE database (64 females and 46 males, median age 10 years, range 1-13 years). Our exclusion criteria were if the subjects had musculoskeletal diseases or history of knee injury. Using MRIs, researchers evaluated ACL length, sagittal and coronal inclination of the ACL, inclination and width of the intercondylar notch, depth and width of the femoral condyles, and the medial and lateral tibial slopes. Association between measurements, sex, and age were investigated using linear and multivariate regression models.Results:When examining the predictors for ACL length by sex, the best predictor (R⁁2 = 0.65) for female ACL lengths was the depth of the lateral femoral condyle taken in the sagittal view (p<0.001). Other predictors that were statistically significant (p < 0.005) were distal femoral condylar width (R⁁2 = 0.62), age (R⁁2 = 0.52), and coronal notch width (R⁁2 = 0.15). For males, the best predictor (R⁁2 = 0.70) of ACL length was the distal femoral condyle width as viewed coronally (p < 0.001). Other statistically significant predictors (p < 0.005) of male ACL lengths were lateral femoral condyle depth (R⁁2 = 0.62), age (R⁁2 = 0.48), and coronal notch width (R⁁2 = 0.20).Conclusion:When predicting the ACL length in pediatric populations, femoral condylar depth and width, and patient age may be valuable predictors for those undergoing ACL reconstructions. Surgical planning to maximizing graft diameter is contingent upon native ACL graft length, and the use of this information to optimize graft utilization may lower the rates of ACL graft failure in the highest risk pediatric populations.Tables/Figures:Table 1.1.Predictors of ACL LengthFigure 1.2.Figure 1.3.

Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. In the elbow, an OCD is localized most commonly at the humeral capitellum. Teenagers engaged in sports that involve repetitive stress on the elbow are at risk. A high index of suspicion is warranted to prevent delay in the diagnosis. Plain radiographs may disclose the lesion but computed tomography and magnetic resonance imaging are more accurate in the detection of OCD. To determine the best treatment option it is important to differentiate between stable and unstable OCD lesions. Stable lesions can be initially treated nonoperatively with elbow rest or activity modification and physical therapy. Unstable lesions and stable lesions not responding to conservative therapy require a surgical approach. Arthroscopic debridement and microfracturing has become the standard initial procedure for treatment of capitellar OCD. Numerous other surgical options have been reported, including internal fixation of large fragments and osteochondral autograft transfer. The aim of this article is to provide a current concepts review of the etiology, clinical presentation, diagnosis, treatment, and outcomes of elbow OCD.

Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. In the elbow, an OCD is localized most commonly at the humeral capitellum. Teenagers engaged in sports that involve repetitive stress on the elbow are at risk. A high index of suspicion is warranted to prevent delay in the diagnosis. Plain radiographs may disclose the lesion but computed tomography and magnetic resonance imaging are more accurate in the detection of OCD. To determine the best treatment option it is important to differentiate between stable and unstable OCD lesions. Stable lesions can be initially treated nonoperatively, with elbow rest or activity modification and physical therapy. Unstable lesions and stable lesions not responding to conservative therapy require a surgical approach. Arthroscopic debridement and microfracturing has become the standard initial procedure for treatment of capitellar OCD. Numerous other surgical options have been reported, including internal fixation of large fragments and osteochondral autograft transfer. The aim of this chapter is to provide a current concepts review of the aetiology, clinical presentation, diagnosis, treatment, and outcomes of elbow OCD.

Introduction: Preoperative estimation of graft parameters can be useful while using hamstring grafts in knee ligament surgeries. Anthropometric parameters may be an easy way to predict the length and diameter of hamstring tendons. A prospective study was conducted to find the correlation between different anthropometric parameters and activity level of the patient on the length and diameter of the graft. Separate regression equations for males and females were also derived for easy prediction. Methods: Data were obtained from 95 patients who underwent arthroscopic anterior cruciate ligament reconstruction with autologous hamstring tendon graft. Variables studied were age, sex, height, weight, body mass index (BMI), thigh circumference, thigh length, Tegner activity level, diameter (double and quadruple) and length of semitendinosus tendon graft. Results: Height of the patient had strong correlation with graft length (r = 0.41, p < 0.001), double diameter (r = 0.29, p = 0.008) and quadruple diameter (r = 0.3, p = 0.006). Weight of the patients had strong positive correlation with graft length (r = 0.34, p = 0.002) and quadruple diameter (r = 0.34, p = 0.002). Thigh length was found to be positively correlating with graft length (r = 0.43, p < 0.001), double diameter (r = 0.29, p = 0.007) and quadruple diameter of graft (r = 0.34, p = 0.002). BMI and thigh circumference of the patients were not found to correlate with graft size. Male patients were found to have longer semitendinosus graft and larger double and quadruple diameter of the graft. There was no association between the Tegner activity scale and graft size. Regression equations between graft length and quadruple diameter and the anthropometric parameters are also derived. Conclusion: Height, weight and thigh length are useful anthropometric parameters in the prediction of hamstring tendon size. However, the patient’s Tegner activity level was not found to be associated with size of the hamstring tendon.

Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment

Aim: The aim of this study was to find the correlation between different anthropometric parameters of the patient on the length and diameter of the hamstring graft harvested during anterior cruciate ligament (ACL) reconstruction. Materials and Methods: A total of 50 consecutive patients (33 males and 17 females) with ACL deficiency scheduled for reconstruction using hamstring autograft were evaluated prospectively at our institution during the study. Preoperatively, we recorded age, gender, height, weight, and body mass index (BMI). Intraoperative measurements of the final diameter of the graft using sizing tubes calibrated to 1 mm and length of tendon harvested were taken. Correlation coefficient (Pearson’s r) analysis was used. Results: As per the study, height of the patients correlated to graft diameter and length in both Indian men and women (P &lt; 0.001). Although there was no correlation between age, sex, weight, and BMI with graft length and diameter. Conclusion: Anthropometric measurements such as weight, gender, and BMI cannot be used as definitive predictors for the hamstring graft diameter during harvest, but the height of the patients can be taken as a good predictor.

Background/Objectives: The purpose of this study was to preoperatively estimate the four-strand hamstring graft size in a White Caucasian population, using anthropometric data. Methods: This was a prospective study of a consecutive series of fifty patients with anterior cruciate ligament (ACL) rupture, who were scheduled for reconstruction using hamstring autografts; however, one of them was ultimately not enrolled according to the exclusion criteria (49 patients in total). Preoperatively, age, sex, weight, body mass index (BMI), length, and diameter of the contralateral thigh, length of the harvested gracilis/semitendinosus tendons, and length and thickness of the four-stranded graft were recorded. Graft diameter and length were dependent variables, measured via a graft sizer and a ruler, respectively. Quantitative variables were described with mean ± SD (correlated in a pairwise manner with Pearson's r correlation). Qualitative variables were described with an absolute count (relative % percent) per categorical level, and their dependency on any quantitative (dependent) variable was assessed via Student's t-test. Results: The mean lengths of the gracilis and semitendinosus were 25.6 ± 3.2 cm and 28.4 ± 3.3 cm, respectively, and they were positively correlated with the length of the four-strand hamstring graft along with the patients' height and thigh length. Conclusions: The use of anthropometric data can assist in the prediction of the hamstring autograft size, aiding the selection of an appropriate graft type. The four-strand hamstring graft length was related to the gracilis, semitendinosus, and thigh length. The patients' height was related to the graft length and diameter.

BACKGROUND: Osteochondritis dissecans is a localized condition or injury affecting an articular surface that involves separation of a segment of cartilage and subchondral bone. METHODS: This article discusses the etiology, anatomy, evaluation, classification and treatment of osteochondritis dissecans lesions in the knee joint. RESULTS: Osteochondritis dissecans is primarily found in the knee, ankle and elbow joints. Various theories about its etiology have been proposed, but none has been accepted universally or has adequately explained its occurrence. It is believed that repetitive microtrauma may interrupt the tenuous epiphyseal blood supply in the growing child and contribute to the development of osteochondritis dissecans lesions. Patients typically present with vague complaints and a gradual onset of symptoms. The treatment of osteochondritis dissecans is dependent upon age at presentation, fragment size, fragment location and fragment stability. The vast majority of stable lesions in the skeletally immature patient can be successfully treated with nonoperative management. Unstable lesions or those that have failed conservative management may require surgical treatment primarily in the form of drilling with or without mechanical stabilization. Treatment has further evolved with the use of osteochondral autogenous grafts and autologous chondrocyte transplantation. CONCLUSIONS: Well-designed prospective studies with long-term follow-up are necessary to determine the adequacy of these techniques in preventing the development of degenerative arthritis.

Introduction: Semitendinosus, Gracilis and Bone-Patellar Tendon-Bone (BPTB) graft are the most popular grafts for Anterior Cruciate Ligament (ACL) reconstruction. Although bone-to-bone patellar tendon grafting improves knee stability and healing rates, there are drawbacks, including donor site morbidity, patellar tendinopathy, anterior knee pain, flexion contracture, and patellar fracture. The advantages of semitendinosus graft include preservation of bone stock, the ability to triple graft length when needed, and the ability to take Gracilis graft through the same incision if graft diameter is too small. Aim: To predict the semitendinosus graft length and diameter using anthropometric parameters (height, weight, Body Mass Index (BMI), waist circumference, thigh circumference and thigh length). Materials and Methods: This prospective descriptive study was conducted in the Department of Orthopaedics, Malabar Medical College, Calicut, Kerala, India for a period of one year (from October 2021 to October 2022). A total of 50 patients in the age group 15-60 years with ACL insufficiency planned for hamstring autograft reconstruction were examined. A number of preoperative factors, including age, gender, height, weight, BMI, thigh length, thigh circumference and waist circumference were assessed. A 2-tailed test and Pearson correlation was used to identify relationships between outcome variables (semitendinosus graft length and quadrupled tendon diameter) and predictor variables (age, gender, height, weight, BMI, thigh length, thigh circumference and waist circumference). Results: A total of 68% of patients had a semitendinosus graft diameter ≥8 mm, while 32% percent were &lt;8 mm. Compared to males, females had a lower body weight and height and their hamstring grafts were shorter with smaller diameter. Correlation analysis indicated that there was a significant positive relation between height and weight on graft length and diameter (p&lt;0.005). Conclusion: The study concluded that both hamstring diameter and length was related to height and weight of the person. Patients who were taller and heavier might be anticipated to have grafts with longer length and larger diameter. Also, thigh and waist parameters had no impact on hamstring tendon size.

A morphologic, biochemical, and biomechanical assessment of short-term effects of osteochondral autograft plug transfer in an animal model

Background:There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population.Purpose:To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data.Results:A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age (P = .04) and quadriceps thickness on MRI (P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter.Conclusion:Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

Osteochondritis dissecans of the knee

Objectives:Osteochondral allografts are used to treat chondral and osteochondral defects. While prior studies have correlated cell death within the chondral component of osteochondral allografts directly with clinical outcomes, cell death within the subchondral and trabecular bone has not been well characterized. While prior studies have demonstrated a role for apoptosis in chondral cell death in osteochondral allografts, none have examined the role of pyroptosis and necroptosis in osteochondral allografts. These pathways are of particular relevance because persistent inflammation associated with osteochondral allografts on imaging is correlated with poor patient-reported outcomes. We report here a study examining cell death and mechanism in osteochondral allografts.Methods:Fresh human talus allografts were cultured for 14, 28, or 42 days at 4oC in standard clinical media. Osteochondral plugs were taken at the specified time points and fixed in 10% formalin. Cell death was measured in the cartilage, subchondral bone, and trabecular bone with TUNEL staining. The mechanism of cell death was further examined with staining for apoptosis (activated caspase 3), necroptosis (MLKL), and pyroptosis (cleaved gasdermin D). Percentage of cells staining positive was calculated in each zone (cartilage, subchondral bone, trabecular bone). Each time point included 4-5 replicates. Appropriate statistical comparisons were made between groups.Results:Cell death was significantly greater in the trabecular bone and subchondral bone than the cartilage. There was an increase in cell death over time in cartilage as well as subchondral bone. Apoptosis was the most prevalent mechanism of cell death, but necrosis and pyroptosis were present in all areas of bone and cartilage.Conclusions:This study suggests that a component of osteochondral allograft clinical outcomes may be related to viability of the bony component of the allograft. There is significantly greater cell death in the bone versus the cartilage and a significantly greater percentage of the cell death is through pyroptosis, an inflammatory-mediated pathway. Culture media and surgical strategies that limit the effect of inflammatory cell death in the bone component of osteochondral allograft may help to improve postoperative incorporation and control persistent inflammation that can complicate surgical outcomes.