Concomitant Cartilage Lesions Research Articles

Meniscal allograft transplantation: A matched-pair analysis reveals worse sportactivity level but similar clinical improvement and survival in women compared to men.

The aim of this study was to assess how gender might affect the clinical outcome and survival of meniscal allograft transplantation (MAT). A total of 358 patients (23.2% women, 76.8% men) were treated with fresh-frozen nonirradiated allografts implantated arthroscopically using a single- or double-tunnel technique without bone plugs and peripheral suture to the capsule with 'all-inside'stitches. Patients were evaluated at baseline and 2-year follow-up with the Lysholm score, visual analogue scale (VAS) pain, the Knee Osteoarthritis Outcome Score (KOOS) subscalesand Tegner score. Women presented higher body mass index (p < 0.0005), poorer baseline VAS (p = 0.012), Lysholm score (p = 0.005), KOOS symptom (p = 0.034) and KOOS pain (p = 0.030), Tegner score (preinjury and basal, p < 0.0001 and p = 0.002, respectively), a lower number of previous (p = 0.039) and concurrent (p = 0.001) anterior cruciate ligament reconstructionsand a higher number of concurrent procedures (p = 0.032) and distal femoral osteotomies (p = 0.024). Worse results were documented in women at 2 years, with lower Lysholm score(p = 0.024) and Tegner score(p = 0.007)and a lower clinical survival rate (p = 0.03) (67.5% vs.82.2%) in the overall patient cohort. However, the matched-pair analysis only confirmed a lower Tegner score value at 2 years (p = 0.016), while underlying the interplay of sex, ageand concomitant cartilage lesions in determining the clinical outcome. The analysis of this large series of patients affected by postmeniscectomy syndrome and treated with MAT revealed gender differences. While both genders benefited from a significant improvement, the female population presents more often with older age, concomitant cartilage lesionsand a lower activity level, all factors contributing towards a lower clinical success after MAT. Level III, comparative study.

Concomitant full-thickness cartilage lesions do not affect patient-reported outcomes at minimum 10-year follow-up after ACL reconstruction

PurposeTo compare patients with a concomitant full-thickness cartilage lesion and anterior cruciate ligament (ACL) injury to patients with an isolated ACL injury at 10–15 years post ACL reconstruction.MethodsThis is a longitudinal follow-up of a cohort of 89 patients that were identified in the Norwegian National Knee Ligament Registry and included in the index study in 2007. The study group consisted of 30 patients that underwent ACL reconstruction and had a concomitant, isolated full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grade 3–4). Each study patient was matched with two control patients who underwent ACL reconstruction but had no cartilage lesions (ICRS grade 1–4) (n = 59). At a median follow-up of 10.2 years (range 9.9–15.6), 65 patients (74%) completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), which was the main outcome measure, resulting in 23 pairs after matching.ResultsAt a follow-up of 10–15 years after ACL reconstruction, no significant differences in KOOS were found between patients with a concomitant full-thickness cartilage lesion and patients without cartilage lesions. There was also no significant difference between the two groups when comparing the change over time in KOOS scores from preoperative to follow-up. Both groups showed significant improvement in all KOOS subscales from preoperative to follow-up, except for in the Symptoms subscale for the control group. The greatest improvement was in the QoL subscale for the study group.ConclusionACL-reconstructed patients with a full-thickness cartilage lesion did not report worse outcomes at 10–15 years after surgery compared with patients with an isolated ACL injury. Our findings support that there is no long-term negative effect of a concomitant cartilage lesion in an ACL-reconstructed knee. These findings should be considered when discussing treatment and informing about the expected long-term outcome after ACL reconstruction to patients with such combined injuries.Level of evidenceII.

Return to preinjury sports after anterior cruciate ligament reconstruction is predicted by five independent factors

To determine factors that predict return to the same frequency and type of sports participation with similar activity demands as before injury. Individuals 1 to 5years after primary ACL reconstruction completed a comprehensive survey related to sports participation and activity before injury and after surgery. Patient characteristics, injury variables, and surgical variables were extracted from the medical record. Return to preinjury sports (RTPS) was defined as: "Returning to the same or more demanding type of sports participation, at the same or greater frequency with the same or better Marx Activity Score as before injury." Variables were compared between individuals that achieved comprehensive RTPS and those that did not with univariate and multivariate logistic regression models. Two-hundred and fifty-one patients (mean age 26.1years, SD 9.9) completed the survey at an average of 3.4years (SD 1.3) after ACL reconstruction. The overall rate of RTPS was 48.6%. Patients were more likely to RTPS if they were younger than 19years old (OR = 4.07; 95%CI 2.21-7.50; p < 0.01) or if they were competitive athletes (OR = 2.07; 95%CI 1.24-3.46; p = 0.01). Patients were less likely to RTPS if surgery occurred more than 3months after injury (OR = 0.31, 95%CI 0.17-0.58; p < 0.01), if there was a concomitant cartilage lesion (OR = 0.38; 95%CI 0.21-0.70; p < 0.01), and if cartilage surgery was performed (OR = 0.17; 95%CI 0.04-0.80; p = 0.02). Five variables best predicted RTPS including age at time of surgery. Only time from injury to surgery is a potentially modifiable factor to improve RTPS; however, the reasons for which patients delayed surgery may also contribute to them not returning to sports. Regardless, younger patients, those that partake in sports on a competitive level, those that undergo surgery sooner, or do not have a cartilage injury or require cartilage surgery are more likely to return to pre-injury sports participation. III.

Radiofrequency Chondroplasty May Not Have A Long-Lasting Effect in the Treatment of Concomitant Grade II Patellar Cartilage Defects in Humans.

The effect of radiofrequency chondroplasty on cartilage tissue is not well studied. This prospective pilot study investigates the effect of radiofrequency chondroplasty on International Cartilage Repair Society (ICRS) grade II patellar cartilage defects using high-resolution magnetic resonance imaging (MRI) with T2 mapping. Six consecutive patients were treated for ICRS grade II patellar cartilage defects using radiofrequency chondroplasty. Before surgery and at defined follow-ups (2 weeks, 4 and 12 months) a high-resolution morphological 3 Tesla MRI with quantitative T2 mapping was performed. At baseline MRI, global T2 values of cartilage defects were increased (46.8 ms ± 9.7) compared to healthy cartilage (35.2 ms ± 4.5) in the same knee which served as reference. Two weeks after treatment, global T2 values (39.2 ms ± 7.7) of the defect areas decreased. However, global T2 values of the defect areas increased beyond the preoperative levels at 4 months (47.4 ms ± 3.1) and 12 months (51.5 ms ± 5.9), respectively. Zonal T2 mapping revealed that the predominant changes in T2 values occurred at the superficial cartilage layer. T2 mapping appears to be an ideal method to monitor cartilage degeneration after chondroplasty. Based on the small sample size of this pilot study, radiofrequency chondroplasty may cause cartilage damage and may not have a long-lasting effect in the treatment of grade II patellar cartilage defects. In five out of six patients, postoperative cartilage damage was observed on quantitative MRI. This study was therefore terminated before completion. We recommend only addressing the pathology which indicated arthroscopy and leaving concomitant cartilage lesions untreated.

Effect of Concomitant Cartilage Lesions on Patient-Reported Outcome After ACL-Reconstruction-A Nationwide Cohort Study from Norway and Sweden of 8470 Patients With 5-Year Follow-Up

Objectives:To evaluate (1) the effect of concomitant partial-thickness (International Cartilage Repair Society [ICRS] grades 1-2) and full-thickness (ICRS grades 3-4) cartilage lesions on patient-reported outcome 5 years after Anterior Cruciate Ligament Reconstruction (ACLR), and (2) the effect of debridement or microfracture (MF) compared with no treatment of concomitant full-thickness cartilage lesions on patient-reported outcome 5 years after ACLR.Methods:All patients that underwent unilateral primary ACLR registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 through 2008 (n = 15,783) were included the study. At the 5-year follow-up, 8470 (54%) patients completed The Knee Injury and Osteoarthritis Outcome Score (KOOS). A subgroup of all patients with concomitant full-thickness cartilage lesions (n = 644), treated with debridement (n = 129), or MF (n = 164), or no surgical treatment (n = 351) at the time of ACLR, was included in the treatment component of the study. At the 5-year follow-up, 368 (57%) patients completed the KOOS. Linear regression models were used to estimate the effect of concomitant focal cartilage lesions on the patient-reported outcome (KOOS) 5 years after ACLR, and to estimate the effect of surgical debridement or MF of concomitant full-thickness cartilage lesions, on patient-reported outcome 5 years after ACLR.Results:Of the 8470 patients available for follow-up at 5 years, 2248 (27%) had 1 or more concomitant cartilage lesions at the time of ACLR, comprised of 1685 (20%) patients with 1 or more partial-thickness cartilage lesions and 563 (7%) patients with 1 or more full-thickness cartilage lesions. Of the 368 patients available for the 5-year follow-up in the treatment component of the study, 203 (55%) patients received no surgical treatment to their full-thickness cartilage lesion at the time of ACLR, 70 (19%) were treated with debridement and 95 (26%) with MF. In the adjusted analyses, partial-thickness cartilage lesions showed significant associations with inferior KOOS scores at follow-up in all subscales. Full-thickness cartilage lesions were significantly associated with inferior KOOS scores in all subscales, both in the unadjusted and the adjusted analyses. With no treatment of the concomitant cartilage lesion as the reference, no significant effects of debridement or MF were detected in the unadjusted or adjusted regression analyses in any of the KOOS subscales at the 5-year follow-up. However, there was a trend in both the unadjusted and adjusted analyses towards negative effects of MF in the KOOS subscales Sport/Rec and QoL with regression coefficient (β) of -5; 95% CI, -12.3-2.2 and -5.7; 95% CI, -12.5-1.1, respectively.Conclusion:ACL-injured patients with concomitant full-thickness cartilage lesions reported worse outcomes and less improvement than those without cartilage lesions 5 years after ACLR. Compared to leaving concomitant full-thickness cartilage lesions untreated at the time of ACLR, debridement and MF showed no effect on patient-reported outcome at 5-year follow-up.

Effect of Concomitant Cartilage Lesions on Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A Nationwide Cohort Study From Norway and Sweden of 8470 Patients With 5-Year Follow-up.

Background:The effect of concomitant focal cartilage lesions on patient-reported outcomes after anterior cruciate ligament reconstruction (ACLR) remains to be determined.Purpose:To evaluate the effect of concomitant partial-thickness (International Cartilage Repair Society [ICRS] grades 1-2) and full-thickness (ICRS grades 3-4) cartilage lesions on patient-reported outcomes 5 years after ACLR.Study Design:Cohort study; Level of evidence, 2.Methods:All patients who underwent unilateral primary ACLR registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 to 2008 (n = 15,783) were included in the study. At 5-year follow-up, 8470 (54%) patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS). Multivariable linear regression models were used to estimate the effect of concomitant partial-thickness and full-thickness cartilage lesions on patient-reported outcomes (KOOS) 5 years after ACLR.Results:Compared with no concomitant cartilage lesions, both partial-thickness and full-thickness cartilage lesions were indicators of statistically significant adverse effects on the KOOS in the adjusted regression analysis at 5-year follow-up after ACLR.Conclusion:ACL-injured patients with concomitant cartilage lesions reported worse outcomes and less improvement than those without cartilage lesions 5 years after ACLR.

No negative effect on patient-reported outcome of concomitant cartilage lesions 5-9years after ACL reconstruction.

To compare patient-reported outcome 5-9years after anterior cruciate ligament (ACL) reconstruction in patients with and without a concomitant full-thickness [International Cartilage Repair Society (ICRS) grade 3-4] cartilage lesion. This is a prospective follow-up of a cohort of 89 patients that were identified in the Norwegian National Knee Ligament Registry and included in the current study in 2007, consisting of 30 primary ACL-reconstructed patients with a concomitant, isolated full-thickness cartilage lesion (ICRS grade 3 and 4) and 59 matched controls without cartilage lesions (ICRS grade 1-4). At a median follow-up of 6.3years (range 4.9-9.1) after ACL reconstruction, 74 (84%) patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), which was used as the main outcome measure. Secondary outcomes included radiographic evaluation according to the Kellgren-Lawrence criteria of knee osteoarthritis (OA). At follow-up, 5-9years after ACL reconstruction, no statistically significant differences in KOOS were detected between patients with a concomitant full-thickness cartilage lesion and patients without concomitant cartilage lesions. Radiographic knee OA of the affected knee, defined as Kellgren and Lawrence ≥2, was significantly more frequent in subjects without a concomitant cartilage lesion (p=0.016). ACL reconstruction performed in patients with an isolated concomitant full-thickness cartilage lesion restored patient-reported knee function to the same level as ACL reconstruction performed in patients without concomitant cartilage lesions, 5-9years after surgery. This should be considered in the preoperative information given to patients with such combined injuries, in terms of the expected outcome after ACL reconstruction and in the counselling and decision-making on the subject of surgical treatment of the concomitant cartilage lesion. Prognostic; prospective cohort study, Level I.

Effect on Patient-Reported Outcomes of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees

Background: The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)–injured knees is debatable. Purpose: To evaluate the effect of debridement or microfracture (MF) compared with no treatment of concomitant full-thickness (International Cartilage Repair Society [ICRS] grades 3-4) cartilage lesions on patient-reported outcomes after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Six hundred forty-four patients who underwent primary unilateral ACL reconstruction and had a concomitant full-thickness cartilage lesion treated simultaneously by debridement (n = 129) or MF (n = 164), or underwent no treatment (n = 351) of the cartilage lesion, registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 to 2008 were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure patient-reported outcomes. At a mean follow-up of 2.1 ± 0.2 years after surgery, 357 (55%) patients completed the KOOS. Linear regression analyses were used to evaluate the effect of debridement or MF on the KOOS. Results: No significant effects of debridement were detected in the unadjusted or adjusted regression analyses on any of the KOOS subscales at 2-year follow-up. The MF treatment of the cartilage lesions had significant negative effects at 2-year follow-up on the KOOS Sport and Recreation (Sport/Rec) (regression coefficient [β] = −8.9; 95% confidence interval [CI], −15.1 to −1.5) and Knee-Related Quality of Life (QoL) (β = −8.1; 95% CI, −14.1 to −2.1) subscales in the unadjusted analyses. When adjusting for confounders, MF had significant negative effects on the same KOOS subscales of Sport/Rec (β = −8.6; 95% CI, −16.4 to −0.7) and QoL (β = −7.2; 95% CI, −13.6 to −0.8). For the remaining KOOS subscales of Pain, Symptoms, and Activities of Daily Living, there were no significant unadjusted or adjusted effects of MF. Conclusion: MF of concomitant full-thickness cartilage lesions showed adverse effects on patient-reported outcomes at 2-year follow-up after ACL reconstruction. Debridement of concomitant full-thickness cartilage lesions showed neither positive nor negative effects on patient-reported outcomes at 2-year follow-up after ACL reconstruction.

Comparable Maintenance of Tibial Slope in Two High Tibial Osteotomy Techniques

Objectives:High tibial osteotomies (HTO) are commonly performed to correct coronal malalignment in young, active patients who have concomitant cartilage lesions and/or cruciate ligament insufficiency. An unintended change of native tibial slope can negatively affect both the strain on reconstructed cruciate ligaments and the contact forces on cartilage. Therefore, one of the goals when performing an HTO is to minimize any change in posterior tibial slope. This study was designed to determine if there is a time zero difference in the maintenance of native tibial slope when performing valgus producing opening wedge HTOs using two distinct surgical techniques and fixation devices.Methods:Controlled Laboratory Study. Experienced surgeons performed valgus producing opening wedge HTOs in 24 matched paired cadaveric specimens using free hand (FH, n=12) and biplanar cutting jig (Jig, n=12) techniques. Digital fluoroscopy was used to capture anteroposterior and lateral images in all specimens, and the angle of posterior tibial slope (TS) was measured using digital software (NIH image; Bethesda, MD) in a manner blinded for technique and fixation.Results:There was good to excellent intra- and inter-observer reliability with the measurement technique using a Model 3, k, intra-class correlation coefficient (ICC). Both observers’ measurements passed tests for homogeneity (p=0.07, and p=0.12). There was no significant change in the maintenance of tibial slope between JIG and FH groups for observer 1 [JIG = 2.40° (SD = 1.3°) FH= 2.95° (SD=2.89°), p = 0.55] or observer 2 [JIG = 2.32° (SD = 2.5°) FH = 3.14° (SD=3.3°), p = 0.49].Conclusion:When performing a valgus producing opening wedge HTO, neither the cutting jig nor the free hand technique maintained native posterior tibial slope. Both techniques increased posterior tibial slope by an average of 2-3° with no significant difference between the groups. This change in posterior tibial slope is consistent with previously reported values in the literature.

Arthroscopically Assisted Meniscal Allograft Transplantation

Meniscal allograft transplantation (MAT) is performed in the United States in ever-increasing numbers. Various techniques have been described since the initial transplantation was performed more then 20 years ago. Decreased pain and improved knee function are attainable with proper patient selection, identification, and correction of all concomitant malalignment and instability, and intervention earlier in the disease process. This article reviews the indications for MAT and offers a basic treatment algorithm for managing concomitant cartilage lesions, instability, and misalignment. The author’s preferred arthroscopic technique using individual bone plugs for both medial and lateral MAT and fresh-frozen allograft is described. This technique stresses the low morbidity of the approach and the re-establishment of the anatomic bony attachments of the anterior and posterior horns of the meniscus.

Treatment of deep hyalin cartilage defects with autologous perichondrial grafts.

Perichondrial transplantation was performed in 29 patients suffering from a deep chondral lesion with different etiologies. Only those patients with a cartilage lesion in the knee joint were included. Patients were initially and postoperatively examined using the Lysholm- and HSS-Score. In most of the patients (20/29) trauma and the recurrence of osteochondrosis dissecans (6/29) were the cause of the cartilage lesion. Most often the medial femoral condyle (19/29) and, secondly, the lateral femoral condyle (5/29) were involved. In six patients additional therapeutic measures (ACL-plasty, n = 2; high tibial osteotomy because of varus mal-alignment, n = 4) had to be adopted. Follow-up examination was possible in 26/29 patients after a minimum postoperative period of 12 months. All patients exhibited a distinct and significant increase in both the Lysholm and the HSS-score. A follow-up after a minimum of 24 months was possible in 13/29 patients. Even these patients exhibited a distinct and significant improvement. Multiple follow-up examinations in 9/29 patients demonstrated maintenance of the first postoperative results obtained after one postoperative year for a maximum of 49 months in most of the patients. Only in one female patient, implantation of a semi-constrained total knee replacement was necessary because of osteoarthrosis resulting from crystal arthropathy (chondrocalcinosis). It was possible to obtain biopsies from three patients at the time osteosynthetic material was removed. In all cases hyaline-like cartilage was histologically observed. In the treatment of selected patients suffering from a circumscript cartilaginous lesion resulting from trauma or the recurrence of osteochondritis dissecans with a concomitant cartilage lesion but without major signs of osteoarthritis, perichondrial grafting can achieve acceptable clinical results, after a short follow-up period. In order to achieve satisfying results a good selection of patients and additional treatment of other articular disorders, such as ACL-instability or axial mal-alignment, is necessary. Further studies have to be undertaken to evaluate the durability of these results over a longer period of time to see if osteoarthrosis can be avoided.

A partially duplicated discoid lateral meniscus

Partially duplicated discoid lateral meniscus has not been previously reported. We present a case of a partially duplicated discoid lateral meniscus with a peripheral tear of the meniscus and a concomitant cartilage lesion of the lateral femoral condyle. Arthroscopy 1998 Jul-Aug;14(5):518-21