Size Of Cartilage Lesions Research Articles

Early cartilage lesion and 5-year incident joint surgery in knee osteoarthritis patients: a retrospective cohort study

Objectiveto investigate the association between cartilage lesion-related features observed in knee osteoarthritis (OA) patients’ first MRI examination and incident knee surgery within 5 years. Additionally, to assess the predictive value of these features for the incident knee surgery.MethodsWe identified patients diagnosed with knee OA and treated at our institution between January 2015 and January 2018, and retrieved their baseline clinical data and first MRI examination films from the information system. Next, we proceeded to determine joint space narrowing grade, cartilage lesion size grade, cartilage full-thickness loss grade and cartilage lesion sum score for the medial and lateral compartments, respectively. Generalized linear regression models examined the association of these features with 5-year incident knee surgery. Positive and negative predictive values (PPVs and NPVs) were determined referring to 5-year incident knee surgery.ResultsTotally, 878 participants (knees) were found eligible to form the study population. Within the 5 years, surgery was performed on 61 knees. None of the cartilage-related features had been found significantly associated with incident surgery. The results were similar for medial and lateral compartments. The PPVs were low for all the features.ConclusionsAmong symptomatic clinically diagnosed OA knees, cartilage lesions observed in the first MRI examinations were not found to be associated with the occurrence of joint surgery within a 5-year period. All these cartilage-related features appear to have no additional value in predicting 5-year incident joint surgery.

Marrow stimulation procedures for high‐grade cartilage lesions during surgical repair of medial meniscus root tear yielded suboptimal outcomes, whilst small lesions showed surgical eligibility

AbstractPurposeTo investigate the surgical outcomes of arthroscopic pull‐out repair for medial meniscus root tear (MMRT) combined with the marrow stimulation procedures (MSP) for accompanying high‐grade cartilage lesions.MethodsPatients who underwent arthroscopic pull‐out repair for MMRT between 2010 and 2019 were retrospectively reviewed. Patients who had at least 3 years of follow‐up were included and classified into two groups according to whether MSP (microfracture or microdrilling) were performed on cartilage lesions in the medial tibiofemoral joint (group 1, patients with International Cartilage Repair Society [ICRS] grade 0–3a lesions and did not undergo MSP; group 2, patients with ICRS grade 3b–3d lesions and underwent MSP). Comparative analyses, including non‐inferiority trials, were conducted between groups for subjective and objective outcomes. In addition, group 2 was further divided into two subgroups according to cartilage lesion size and compared with group 1 (group S, ≤ 2.0 cm2; group L, > 2.0 cm2).ResultsA total of 94 patients were included (group 1, 68 patients; group 2, 26 patients). There were no significant differences in clinical scores at postoperative 3 years and final follow‐up between groups 1 and 2, but group 2 failed to satisfy the non‐inferiority criteria compared to group 1 overall. In objective outcomes, group 2 did not meet the non‐inferiority criteria for the rate of osteoarthritis progression compared to group 1, and it also showed a significantly higher proportion of high‐grade osteoarthritis at final follow‐up (P = 0.044) and a higher degree of osteoarthritis progression than group 1 (P = 0.03 for pre‐ to postoperative 3 years, and P = 0.006 for pre‐ to final follow‐up). In additional evaluations comparing the subgroups of group 2 and group 1, group S showed relatively favourable results compared to group L in objective outcomes at final follow‐up.ConclusionPatients who underwent arthroscopic pull‐out repair for MMRT combined with MSP for accompanying high‐grade cartilage lesions showed suboptimal outcomes compared to those with no or low‐grade lesions at mid‐term follow‐up. High‐grade cartilage lesions ≤ 2.0 cm2 may be candidates for the surgical repair of MMRT if MSP are performed, but those with larger lesions may require alternative treatment strategies.Level of evidenceIII.

Cartilage lesion size and number of stromal vascular fraction (SVF) cells strongly influenced the SVF implantation outcomes in patients with knee osteoarthritis

PurposeThis study evaluated outcomes in patients with knee osteoarthritis following stromal vascular fraction implantation and assessed the associated prognostic factors.MethodsWe retrospectively evaluated 43 patients who underwent follow-up magnetic resonance imaging 12 months after stromal vascular fraction implantation for knee osteoarthritis. Pain was assessed using the visual analogue scale and measured at baseline and 1-, 3-, 6-, and 12-month follow-up appointments. In addition, cartilage repair was evaluated based on the Magnetic Resonance Observation of Cartilage Repair Tissue scoring system using the magnetic resonance imaging from the 12-month follow-up. Finally, we evaluated the effects of various factors on outcomes following stromal vascular fraction implantation.ResultsCompared to the baseline value, the mean visual analogue scale score significantly and progressively decreased until 12 months post-treatment (P < 0.05 for all, except n.s. between the 1 and 3-month follow-ups). The mean Magnetic Resonance Observation of Cartilage Repair Tissue score was 70.5 ± 11.1. Furthermore, the mean visual analogue scale and Magnetic Resonance Observation of Cartilage Repair Tissue scores significantly correlated 12 months postoperatively (P = 0.002). Additionally, the cartilage lesion size and the number of stromal vascular fraction cells significantly correlated with the 12-month visual analogue scale scores and the Magnetic Resonance Observation of Cartilage Repair Tissue score. Multivariate analyses determined that the cartilage lesion size and the number of stromal vascular fraction cells had a high prognostic significance for unsatisfactory outcomes.ConclusionStromal vascular fraction implantation improved pain and cartilage regeneration for patients with knee osteoarthritis. The cartilage lesion size and the number of stromal vascular fraction cells significantly influenced the postoperative outcomes. Thus, these findings may serve as a basis for preoperative surgical decisions.Level of evidenceIV.

Single-Surgery Co-Implantation of Autologous Primary Articular Chondrocytes with Bone Marrow Cells in the Treatment of Articular Cartilage Lesions: Observations from the Operating Room on Tissue Input and Cell Output.

Single-surgery variants of autologous chondrocyte implantation to repair cartilage are emerging, but practical data on such procedures are scarce. We set out to describe a 1-stage autologous chondrocyte co-implantation procedure and include quantitative characteristics of the biopsy tissues collected and of the cells obtained from those tissues in the operating room. Data concerning patient age, articular cartilage lesion size and location, as well as measurements of cartilage biopsy mass, bone marrow aspirate volume, and the cell yields harvested from those biopsies were intraoperatively collected for 141 patients. The mean patient age was 35.7 ± 9.8 years, and the mean total lesion size was 4.0 ± 3.1 cm2. Cartilage biopsy mass ranged from 0.19 to 2.0 gram and provided a mean yield of 1.23 × 106 chondrocytes/gram. Bone marrow aspirate volume ranged from 7.2 to 62 milliliters and provided a mean yield of 7.18 × 106 mononuclear cells/mL. The cell yields did not correlate with patient age, which ranged from 12 to 57 years. The mean primary chondrocyte supply was 272 thousand per cm2 of lesion, ranging from 10.4 thousand to 1.07 million per cm2. The total cell supply was kept at 9 million cells per cm2 of lesion by adding mononuclear cells to the chondrocytes. The mean tissue processing time was 100 ± 19 minutes, which was frequently used to perform concurrent interventions. Single-surgery co-implantation of clinically relevant numbers of autologous primary articular chondrocytes and bone marrow cells is feasible for a wide range of ages and lesion sizes.

Concentration of synovial fluid biomarkers on the day of anterior cruciate ligament (ACL)-reconstruction predict size and depth of cartilage lesions on 5-year follow-up.

The current investigation evaluated the relationship between the synovial fluid cytokine microenvironment at the time of isolated anterior cruciate ligament (ACL) reconstruction and the presence of subsequent chondral wear and radiologic evidence of osteoarthritis (OA) on cartilage-specific MRI sequences at a minimum of 5-year follow-up. Patients who underwent primary ACL reconstruction with no baseline concomitant cartilage or meniscal defects and had synovial fluid samples obtained at the time of surgery were retrospectively identified. Patients with a minimum of 5years of postoperative follow-up were contacted and asked to complete patient-reported outcome (PRO) measures including Visual Analog Scale (VAS) for pain, Lysholm Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner Activity Scale, along with postoperative magnetic resonance imaging (MRI). The concentration of ten biomarkers that have previously been suggested to play a role in cartilage degradation and inflammation in the joint space was measured. Linear regression controlling for age, sex, and body mass index (BMI) was performed to create a model using the synovial fluid concentrations at the time of surgery to predict postoperative semiquantitative cartilage lesion size and depth on MRI at a minimum of 5years follow up. The patients were comprised of eight males (44.4%) and ten females (55.6%) with a mean age at the time of surgery of 30.8 ± 8.7years (range 18.2-44.5years). The mean follow-up time was 7.8 ± 1.5years post-operatively (range 5.7-9.7years). MCP-1, VEGF, and IL-1Ra were found to have significant associations with the presence of postoperative cartilage wear (p < 0.05). No correlations were demonstrated among the biomarker concentrations at the time of injury with PRO scores at final follow-up (NS). Synovial fluid inflammatory biomarker concentrations at the time of injury can predict progression of early-stage post-traumatic osteoarthritis at a mean of almost 8years post-operatively. Findings from this study may help identify treatment targets to alter the natural history of cartilage loss following anterior cruciate ligament injury. Level III, retrospective cohort study.

Global Variation in Studies of Articular Cartilage Procedures of the Knee: A Systematic Review.

ObjectiveThe objective of this study was to determine whether there are significant differences in terms of indications, techniques, patient variables, and objective and subjective outcome scores as a function of the geographic locale of published studies of knee articular cartilage surgery.MethodsAn electronic database search was performed of clinical studies evaluating knee articular cartilage procedures from 2000 to 2021. Studies were separated into global regions (Europe, Asia, North America, and South America) based on the study country. All cartilage-based treatments in each region were recorded. Patient age and sex, mechanism of injury, cartilage lesion size and location, follow-up time, failure rate, and knee outcome scores utilized were summarized and compared by region.ResultsA total of 2,923 studies were analyzed. Eighty level 1 and 2 studies met the inclusion criteria. The majority were from Europe (n = 60), followed by Asia (n = 11), North America (n = 7), and South America (n = 2). The majority of procedures in European and North American studies were cell-based and marrow-stimulation procedures. In Asian studies, the most common procedures were marrow-stimulation, experimental, and biologic procedures as defined by the authors. Asian countries had a higher proportion of females (P < 0.001) and an overall older patient population (P < 0.001). Regional variation was also seen in terms of lesion location, mechanism of injury, and failure rate.ConclusionMost high-level evidence for articular cartilage-based procedures of the knee comes from European countries. These studies vary by patient age and sex, anatomic location, and mechanism of injury. Global variation should be taken into consideration when interpreting and applying studies of knee articular cartilage surgery.

Lesion size and varus malalignment are the major determinants leading to poorer clinical outcomes after combined microfracture treatment for focal cartilage lesions during anterior cruciate ligament reconstruction.

The purposes of this study were to evaluate the clinical effects of microfracture (MFX) performed for Outerbridge grade 3 or 4 focal cartilage lesion during the same surgery with arthroscopic anterior cruciate ligament (ACL) reconstruction and to analyze the major determinants of these potential effects on the clinical outcome. The clinical and radiographic data of 119 patients were evaluated. The mean follow-up time was 32.6 ± 6months. Isolated arthroscopic ACL reconstruction was performed in 70 patients (Group 1), whereas MFX for Outerbridge grade 3 or 4 chondral lesion during ACL surgery was performed in 49 patients (Group 2). Visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the instruments used as outcome measures to evaluate the clinical status of the patients. Routine X-ray and MRI were also performed for all patients pre-operatively as well as at the latest follow-up visit. Lineer regression analysis was performed to determine major factors predicting the poorer clinical outcome. Clinical outcomes were similar between isolated ACL reconstruction and combined procedure. On the other hand, according to lineer regression analysis, cartilage lesion size > 2 cm2 and > 5 degrees of varus alignment were detected as the major determinants leading to poorer outcomes in combined ACL reconstruction and MFX.Level of evidence: III - Retrospective Comparative Study.

Functional outcome of osteochondral autograft is equivalent in stable knee and in anterior cruciate ligament reconstruction

IntroductionAnterior cruciate ligament (ACL) tears are associated in 10% to 20% of cases with extensive traumatic focal osteochondral damage. Ligament reconstruction may require osteochondral autograft for symptomatic osteochondral lesions. Combined ACL and chondral or osteochondral reconstruction is poorly evaluated in the literature; osteochondral reconstruction in stable knee better documented. The objective of this study was to compare functional results after osteochondral autograft transfer (OAT) for significant symptomatic femoral condyle defect, in stable or stabilised knees (concomitant ACL reconstruction). The hypothesis was that functional results are equivalent in both groups. Material & methodThis was a single-centre retrospective comparative observational study of patients consecutively operated on between 2000 and 2018. Fifty patients met the inclusion criteria and were divided into two groups: Group 1 (OAT+ACL, n=13) and group 2 (OAT on stable knee, n=37). The following criteria were recorded at follow-up: pain (VAS), KOOS, IKDC and Lysholm scores and Hughston radiologic score, and time to return to sport. Mean follow-up was 79.7±60 months in group 1 and 86.4±62 months in group 2. ResultsTen patients were included for analysis in group 1 and 30 in group 2. Cartilage lesion size was comparable between groups: 1.6±1.20 cm2 for group 1 and 2.3±1.3 cm2 for group 2 (ns). One complication (infection with favourable course) was observed in group 2. Sport was resumed at 8.7±2.7 vs. 8.4±3.3 months, respectively. Mean subjective scores were respectively 83.3±7.4 and 75.4±14 for Lysholm, 89.7±7.8 and 89.7±19.6 for KOOS, 78±13.7 and 72.2±12.9 for subjective IKDC, 0.5±0.5 and 0.8±0.9 for pain on VAS and 3 and 3 for radiological Hughston radiologic score, with no significant differences between groups. ConclusionSymptomatic focal osteochondral lesions treated by osteochondral autograft transfer gives the same outcome on stable or stabilised knee. Level of evidenceIV; retrospective study.

Allogeneic umbilical cord blood-derived mesenchymal stem cells combined with high tibial osteotomy: a retrospective study on safety and early results.

Cartilage repair performed as a single-stage procedure is an important advancement in the treatment of full-thickness cartilage injury and has potential for widespread clinical use. To investigate the short-term outcomes and cartilage regeneration after implantation of allogeneic human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in patients who received high tibial osteotomy (HTO) for symptomatic medial knee osteoarthritis. Patients underwent treatment of full-thickness chondral injury in the osteoarthritic knee with HTO and implantation of hUCB-MSCs and were followed prospectively for a minimum of oneyear. Ninety-three patients were followed for a mean 1.7years (range, 1.0-3.5). Median cartilage lesion size was 6.5cm2 (range, 2.0-12.8). Clinical outcomes were examined with patient-reported scoring instruments that consisted of the International Knee Documentation Committee (IKDC) subjective score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), and Hospital for Special Surgery (HSS) score. Cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) cartilage repair assessment grading (CRA) system and the Koshino regeneration staging system in 49 patients who underwent secondlook arthroscopic assessment when their HTO plates were removed. At final follow-up, the median IKDC subjective score had significantly improved from 39.0 to 71.3; the WOMAC score from 44.5 to 11.0; the KSS pain and function scores from 29.8 to 43.2 and 61.0 to 81.2, respectively; and the HSS from 61.6 to 82.7 (p < 0.05). Pre-operative examination showed ICRS grade IV cartilage injury in all knees, and cartilage regeneration at 2nd look arthroscopy showed improvements (8.2% of patients improved to ICRS grade I, 69.3% to grade II, and 22.5% to grade III). Moreover, Koshino stage was B in 24.5% and C in 75.5% of patients (p < 0.05). Allogeneic hUCB-MSC implantation combined with HTO for medial knee osteoarthritis was safe and showed signs of cartilage status improvement. Furthermore, randomized controlled studies with a control group are necessary to determine the real effectiveness and indications of this new combined procedure for patients with osteoarthritis.

The change of joint space width after medial open wedge high tibial osteotomy

Purpose: After medial open wedge high tibial osteotomy (MOWHTO), an increase in the joint space width(JSW) of the medial compartment of the knee joint is commonly observed in clinical practice. Since the JSW is regarded as a surrogate measure for cartilage thickness, it has been suggested that the increment of the medial JSW observed after MOWHTO would have resulted from the cartilage regeneration. However, the association between the change of medial JSW after MOWHTO and cartilage regeneration has not investigated with the second-look arthroscopic examination, which could provide an actual status of the cartilage status. Moreover, the possibility that change in JSW is due to the shift of the weight-bearing axis of the lower limb cannot be excluded. The aim of the present study was to investigate the relevant factors that affect the change of JSW after MOWHTO. It was hypothesized that the change of JSW after MOWHTO would be associated with the change of the weight-bearing condition. Methods: A total of 100 patients who underwent MOWHTO and a following second-look arthroscopic assessment were included in this study. The patients were classified into two groups according to the change of medial JSW between at the time of primary operation(MOWHTO) and at the time of second-look operation: group 1(the patients with increased medial JSW) and group 2 (the patients with maintained or reduced medial JSW). Comparative analysis was performed regarding clinical scores, radiographic parameters, and arthroscopic measurements between the two groups. In addition, for the statistically significant variables, the characteristics of JSW of the knee were further evaluated. Results: There were no differences between the two groups in the preoperative clinical scores as well as the postoperative clinical scores evaluated at the time of second-look operation. Furthermore, there were no significant differences between the two groups regarding the change of cartilage lesion size between the two-time points as well as the cartilage regeneration status. However, the postoperative load-axis deviation and the postoperative medial proximal tibial angle were significantly higher in group 1, suggesting that the increase in medial JSW is possibly related to the postoperative weight-bearing condition. Accordingly, an additional analysis was performed to evaluate whether there were differences in JSW characteristics (medial JSW, lateral JSW, and joint-line convergence angle) according to the position of the postoperative load-axis deviation. The patients were further divided into three groups (group U, under-correction group; group A; acceptable correction group; group O; over-correction group). As a result, there was a statistically significant difference in the postoperative medial JSW and the degree of change in medial JSW, in which the medial JSW increased as the postoperative load-axis deviation located laterally. Medial JSW increased over time in group A and O, whereas it showed a tendency to decrease in group U. On the contrary, there were no differences in lateral JSW and joint-line convergence angle between the groups. Conclusions: The increase in the medial JSW observed after MOWHTO was affected by the postoperative weight-bearing condition, rather than the cartilage regeneration status. Therefore, changes in JSW observed after MOWHTO should not be used as a surrogate measure for cartilage thickness. In addition, for a clinical perspective, it could be recommended to aim the post-operative weight-bearing line to be located at 60-70% of the tibial articular surface from the medial border of the tibia, considering postoperative medial JSW as well as other biomechanical aspects of the knee.

The Effect of Cartilage Lesion in the Lateral Compartment of the Knee on the Surgical Outcome of Medial Open-Wedge High Tibial Osteotomy

The aim of this study was to identify the effect of cartilage lesion in the lateral compartment of the knee on the surgical outcome of medial open-wedge high tibial osteotomy (MOWHTO). A total of 172 consecutive patients who underwent MOWHTO were evaluated retrospectively. Among the patients who underwent second-look arthroscopic assessment, 30 patients with lateral compartment cartilage lesion (group 1: ≥ grade 2 cartilage lesion according to the International Cartilage Repair Society [ICRS] grading system) and 64 patients with normal or near-normal lateral compartment cartilage (group 2: grade 0 or 1 cartilage lesion according to the ICRS grading system) were included in the analysis. Each patient was evaluated for the following variables: clinical scores, radiographic osteoarthritis grade, and comparative measurement under arthroscopy. All clinical scores were similar between the two groups preoperatively and at the time of second-look operation. Group 1 showed a significantly higher osteoarthritis grade in the lateral compartment of the knee on the 30 degree flexed posteroanterior view according to the International Knee Documentation Committee grading system preoperatively (p = 0.005) and at the time of second-look operation (p = 0.002). In regard to the comparative measurement under arthroscopy, the size of cartilage lesion on the medial compartment decreased by time in both groups (p = 0.000), whereas the size of cartilage lesion on the lateral compartment increased by time in both groups (p = 0.004). However, the degree of change in the cartilage lesion size in each compartment of the knee over time did not significantly differ between the two groups. Regarding the cartilage lesion grade in the lateral compartment, there was no statistically significant difference in the frequency of deterioration between the two groups. As a result, the presence of cartilage lesion of ICRS grade 2 or 3 in the lateral compartment of the knee, either subtle or not detected during the preoperative evaluation, would not affect the surgical outcome of MOWHTO. This is a Level IV, therapeutic case series study.

Long-term Clinical Outcomes of One-Stage Cartilage Repair in the Knee With Hyaluronic Acid–Based Scaffold Embedded With Mesenchymal Stem Cells Sourced From Bone Marrow Aspirate Concentrate

Background: Cell-based cartilage repair performed as a single-stage procedure is an important advancement in the treatment of full-thickness cartilage injury and has potential for widespread clinical use. Purpose: To investigate the long-term clinical outcomes of cartilage repair in the knee with a hyaluronic acid–based scaffold embedded with bone marrow aspirate concentrate (HA-BMAC) for the treatment of full-thickness cartilage injury. Study Design: Case series; Level of evidence, 4. Methods: Patients underwent treatment of full-thickness chondral injury in the knee with HA-BMAC and were followed prospectively for a minimum of 6 years. Clinical outcomes were examined with patient-reported scoring instruments that consisted of the Tegner Activity Scale, International Knee Documentation Committee (IKDC) subjective score, visual analog scale, and Knee injury and Osteoarthritis Outcome Score (KOOS). Comparative analysis of pre- and postoperative scores was performed, and the effects of patient age, body mass index, lesion size, number of treated lesions, and concurrent treatment with associated procedures were examined. Results: Twenty-three patients (mean age, 48.5 years) were followed prospectively for a mean 8 years (range, 6-10 years). Median cartilage lesion size was 6.5 cm2 (range, 2-27 cm2). At final follow-up, median Tegner, visual analog scale, and IKDC subjective scores were 4, 0.3, and 85, respectively. Final median KOOS subset scores were as follows: Pain, 94; Symptoms, 89; Activities of Daily Living, 99; Sports/Recreation, 85; and Quality of Life, 85. All scores were significantly increased at final follow-up (P < .001). Comparable median outcome scores were demonstrated after categorization of patients by age, lesion size, treatment of multiple lesions, treatment of multiple knee compartments, and treatment by associated procedures. Rank correlation analysis demonstrated a negative correlation between patient age and final outcome scores of the IKDC, Tegner, and KOOS subsets of Pain, Activities of Daily Living, and Sports/Recreation. No associations were identified between body mass index or lesion size and outcome scores. Conclusion: Repair of full-thickness cartilage injury in the knee with a HA-BMAC provides good to excellent clinical outcomes at long-term follow-up in the treatment of small to large lesions. Cartilage repair with HA-BMAC leads to comparatively successful long-term outcomes in the treatment of small or large lesions, single or multiple lesions, and lesions in 1 or 2 compartments, as well as in cases of associated lesion treatment. While good outcomes can be expected among treated patients >45 years of age, outcomes may be comparatively more successful in younger patients.

The effect of lateral compartment cartilage lesion on outcome of medial open wedge high tibial osteotomy

Purpose: To determine the effect of cartilage lesion of the lateral compartment of the knee on the surgical outcome of medial open wedge high tibial osteotomy (MOHTO) Methods: 152consecutive patients who underwent MOHTO were evaluated retrospectively. Of those patients who underwent second-look arthroscopic assessment with a follow-up period more than 2 years, 22 patients with lateral compartment cartilage lesion (group I), and 54 patients without lateral compartment cartilage lesion (group II) were included in the study. Each patient was evaluated for the following variables: clinical scores (visual analog scale [VAS] score, subjective International Knee Documentation Committee [IKDC] score, Knee injury and Osteoarthritis Outcome score [KOOS], Western Ontario and McMaster universities Osteoarthritis index [WOMAC] score), radiographic grade, comparative measurement under arthroscopy. Results: VAS score, subjective IKDC score, KOOS, WOMAC score were similar between the two groups at 6-month, 12-month, 24-month follow-up. Group I showed significantly higher arthritic grade of lateral compartment of the knee on the 30° flexed postero-anterior view according to the International Knee Documentation Committe grading system at preoperative evaluation (P = 0.003), 12-month (P = 0.04), 24-month follow up (P = 0.005). In regard to comparative measurement under arthroscopy, change in the cartilage lesion size of each compartment of the knee over time did not significantly differ between the two groups. Comparing the regeneration grade of medial compartment cartilage lesion, there was no significant difference between the two groups. Lateral compartment cartilage lesion showed that there was no statistically significant difference in group I between initial-operation and second-look operation while significant deterioration of the grade of cartilage lesion was observed in group II (P = 0.016). Conclusions: The presence of cartilage lesions in the lateral compartment of the knee, which is subtle or not observed in the preoperative evaluation, does not affect the surgical outcome of MOWHTO.

Interrater and Intrarater Reliability of Arthroscopic Measurements of Articular Cartilage Defects in the Knee.

Cartilage lesions of the knee are difficult to treat. Lesion size is a critical factor in treatment algorithms, and the accurate, reproducible sizing of lesions is important. In this study, we evaluated the interrater and intrarater reliability of, and correlations in relation to, various arthroscopic sizing techniques. Five lesions were created in each of 10 cadaveric knees (International Cartilage Repair Society grade 3C). Three orthopaedic surgeons used 4 techniques (visualization and use of a 3-mm probe, a simple metal ruler, and a sliding metallic ruler tool) to estimate lesion size. Repeated-measures data were analyzed using a mixed-effect linear model. The differences between observed and gold-standard (plastic mold) values were used as the response. Intraclass and interclass correlation coefficient (ICC) values for intrarater and interrater reliability were computed, as were overall correlation coefficients between measurements and gold standards. The mean lesion size was 2.37 cm (range, 0.36 to 6.02 cm). Rater, lesion location and size, and measurement method all affected the cartilage defect measurements. Surgeons underestimated lesion size, and measurements of larger lesions had a higher percentage of error compared with those of smaller lesions. When compared with plastic molds of lesions, 60.5% of surgeon measurements underestimated lesion size. Overall, the correlation between measurements and gold standards was strongest for the simple metal ruler method and weakest for the visualization method. Several factors may influence arthroscopic estimation of cartilage lesion size: the lesion location, measurement tool, surgeon, and defect size itself. The intrarater and interrater reliability was moderate to good using a 3-mm probe, sliding metallic ruler tool, or simple metal ruler and was fair to moderate using visualization only. There is a need for more accurate methods of determining the size of articular cartilage lesions.

Magnetic resonance imaging lesions are more severe and cartilage T2 relaxation time measurements are higher in isolated lateral compartment radiographic knee osteoarthritis than in isolated medial compartment disease – data from the Osteoarthritis Initiative

Isolated lateral compartment tibiofemoral radiographic osteoarthritis (IL-ROA) is an understudied form of knee osteoarthritis (OA). The objective of the present study was to characterize Magnetic Resonance Imaging (MRI) abnormalities and MR-T2 relaxation time measurements associated with IL-ROA and with isolated medial compartment ROA (IM-ROA) compared with knees without OA. 200 case subjects with IL-ROA (Kellgren/Lawrence (K/L) grade≥2 and joint space narrowing (JSN)>0 in the lateral compartment but JSN=0 in the medial compartment) were randomly selected from the Osteoarthritis Initiative baseline visit. 200 cases with IM-ROA and 200 controls were frequency matched to the IL-ROA cases. Cases and controls were analyzed for odds of having a subregion with >10% cartilage area affected, with ≥25% bone marrow lesions (BML), with meniscal tear or maceration, and for association with cartilage T2 values. IL-ROA was more strongly associated with ipsilateral MRI knee pathologies than IM-ROA (IL-ROA: OR=135.2 for size of cartilage lesion, 95% CI 42.7-427.4; OR=145.4 for large size BML, 95% CI 41.5-509.5; OR=176 for meniscal tears, 95% CI 59.8-517.7; IM-ROA: OR=28.4 for size of cartilage lesion, 95% CI 14.7-54.7; OR=38.1 for size of BML, 95% CI 12.7-114; OR=37.0 for meniscal tears, 95% CI 12-113.6). Cartilage T2 values were higher in both tibial and medial femoral compartments in IL-ROA, but in IM-ROA were only significantly different from controls in the medial femur. IL-ROA knees show a greater prevalence and severity of MRI lesions and higher cartilage T2 values than IM-ROA knees compared with controls.

Changes in articular cartilage following arthroscopic partial medial meniscectomy.

To examine degenerative changes in all cartilage surfaces of the knee following arthroscopic partial medial meniscectomy. For this prospective cohort study, 14 patients (five female) with a mean age of 47.9±12.9years who had undergone isolated arthroscopic partial medial meniscectomy were evaluated. Cartilage-sensitive magnetic resonance imaging (MRI) scans were acquired from the operated knees before the index operations, as well as at 6, 12, and 24months after surgery. The MRI scans were assessed for the prevalence, severity, and size of cartilage degenerations. The clinical outcome was assessed using the SF-36 physical and mental component score and the International Knee Documentation Committee Knee Evaluation Form and was correlated with radiological findings. There was a significant increase in the severity of cartilage lesions in the medial tibial plateau (P=0.019), as well as a trend towards an increase in the lateral tibial plateau. The size of the cartilage lesions increased significantly in the medial femoral condyle (P=0.005) and lateral femoral condyle (P=0.029), as well as in the patella (P=0.019). Functional outcome scores improved significantly throughout the follow-up period. There was no correlation between cartilage wear and functional outcome. Arthroscopic partial medial meniscectomy is associated with adverse effects on articular cartilage and may lead to an increase in the severity and size of cartilage lesions. Post-operative cartilage wear predominantly affected the medial compartment and also affected the other compartments of the knee. Strategies to reduce subsequent osteoarthritic changes need to involve all compartments of the knee. IV.

Is Magnetic Resonance Imaging Assessment of the Size of Articular Cartilage Defects Accurate?

The purpose of this study was to systematically review the literature relative to the following question: Is preoperative magnetic resonance imaging (MRI) an accurate instrument for the assessment of the size of knee articular cartilage defects compared with arthroscopy? A systematic search was performed in September 2011 using PubMed MEDLINE (from 1966), CINAHL (from 1982), SPORTDiscus (from 1985), SCOPUS (from 1996), and EMBASE (from 1974) databases. Four studies (one study of Level II and three studies of Level III) were identified that met the predetermined inclusion and exclusion criteria. The ability of MRI to preoperatively assess the size of cartilage lesions was highly variable. As a result of inconsistencies between imaging techniques, the methodological variability and shortcomings of the studies, and the limited amount of data available, a meta-analysis was not performed. There is some evidence that MRI is an accurate tool for preoperatively assessing the dimensions of articular cartilage defects. However, because of the heterogeneity of MRI sequences and the paucity of literature related to preoperative sizing, it is not possible to make definitive conclusions regarding the global clinical utility of MRI for guiding the selection of therapeutic strategies.

Age-Associated Cartilage Degeneration of the Canine Humeral Head

The goal of this study was to determine if cartilage lesions of the humeral head in adult dogs are the consequence of osteochondrosis dissecans or degenerative joint disease. A gross and histologic survey was performed of humeral head cartilage lesions of 155 dogs ranging in age from 1 week to 19 years. The humeral head and cartilage lesion size were measured for each dog. Cartilage lesions were classified as fibrillation, fissures, erosion, and/or eburnation. The area of each lesion was multiplied by a severity score (fibrillation and fissures 1, erosion 2, and eburnation 3) to create a combined score for each humeral head. Correlations between this combined lesion score and age, humeral head size, body weight, and body condition score were assessed using a Bonferroni-corrected alpha of .01. Twenty-six humeral heads were also evaluated histologically. Of the 155 dogs, 80 (52%) had gross lesions of the articular cartilage. The presence and severity of the articular cartilage lesions were positively correlated with age, humeral head size, body weight, and body condition score. The average age of dogs with cartilage lesions was 8.8 years, and 77/105 (74%) of adult dogs had cartilage lesions. Fifty dogs were 3 years of age or younger; 3 of those had cartilage lesions, 1 of which was osteochondrosis. These data indicate that cartilage erosion of the caudal humeral head in dogs is a common degenerative lesion acquired in adult large breed dogs; osteochondrosis dissecans does not precede the lesion in the vast majority of cases.

Delay in ACL reconstruction is associated with more severe and painful meniscal and chondral injuries

The goal of our study was to investigate the associations between surgical delay, pain and meniscus, and articular cartilage lesions seen at the time of ACL reconstruction. One hundred and sixty-two consecutive patients who had received ACL reconstruction were recruited. The preoperative International Knee Documentation Committee (IKDC) questionnaires, and cartilage and meniscal lesions seen at the time of surgery were analysed. Patients with surgery within 12 months were less likely to have meniscus injury (59.8/77.4 %, p = 0.032), and the meniscus injury was more likely to be salvageable. (56.3/36.0 %, p = 0.042). Patients with meniscal tear larger than 10 mm had higher pain intensity than tear <10 mm (mean 6.8/8.2, p = 0.007). Patients older than 35 years of age were more likely to suffer from cartilage injury (76.4/39.1 %, p = 0.004). Patients with cartilage lesions had longer surgical delay (mean 18.9/12.1 months, p = 0.033). The presence of meniscal tear increased the risk of cartilage lesions (p = 0.038, OR = 2.14). Patients with cartilage lesions had a greater pain frequency (mean 6.9/7.7, p = 0.048). Moderate correlation was found between the size of cartilage lesion and the frequency of pain (p = 0.013). Increased surgical delay was associated with an increased incidence of meniscus and articular cartilage injuries in patients suffering from ACL tear; also, the meniscus was less likely to be salvageable. The presence of cartilage lesions was associated with an increased frequency of pain. Size of meniscal and cartilage lesions was significantly associated with pain.

Autologous Chondrocyte Implantation

Background: The medium-term results of autologous chondrocyte implantation (ACI) have shown good to excellent outcomes for the majority of patients. However, no long-term results 10 to 20 years after the surgery have been reported. Hypothesis: Autologous chondrocyte implantation provides a durable solution to the treatment of full-thickness cartilage lesions of the knee, maintaining good clinical results even 10 to 20 years after implantation. Study Design: Case series; Level of evidence, 4. Methods: In this uncontrolled study, questionnaires with the Lysholm, Tegner-Wallgren, Brittberg-Peterson, modified Cincinnati (Noyes), and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were sent to 341 patients. Preoperative Lysholm, Tegner-Wallgren, and Brittberg-Peterson scores were also retrieved when possible from patients’ files. The patients were asked to grade their status during the past 10 years as better, worse, or unchanged. Finally, they were asked if they would do the operation again. Results: There were 224 of 341 patients who replied to our posted questionnaires and were assessed. The mean cartilage lesion size was 5.3 cm2. Ten to 20 years after the implantation (mean, 12.8 years), 74% of the patients reported their status as better or the same as the previous years. There were 92% who were satisfied and would have the ACI again. The Lysholm, Tegner-Wallgren, and Brittberg-Peterson scores were improved compared with the preoperative values. The average Lysholm score improved from 60.3 preoperatively to 69.5 postoperatively, the Tegner from 7.2 to 8.2, and the Brittberg-Peterson from 59.4 to 40.9. At the final measurement, the KOOS score was on average 74.8 for pain, 63 for symptoms, 81 for activities of daily living (ADL), 41.5 for sports, and 49.3 for quality of life (QOL). The average Noyes score was 5.4. Patients with bipolar lesions had a worse final outcome than patients with multiple unipolar lesions. The presence of meniscal injuries before ACI or history of bone marrow procedures before the implantation did not appear to affect the final outcomes. The age at the time of the operation or the size of lesion did not seem to correlate with the final outcome. Conclusion: Autologous chondrocyte implantation has emerged as an effective and durable solution for the treatment of large full-thickness cartilage and osteochondral lesions of the knee joint. Our study suggests that the clinical and functional outcomes remain high even 10 to 20 years after the implantation.