Status Of Articular Cartilage Research Articles

Comparison of clinical, imaging and second-look arthroscopic outcomes between varus knee patients with and without preoperative tibial varus deformity after medial opening-wedge high tibial osteotomy

PurposeThis study aimed to compare the regeneration status of articular cartilage, clinical, and radiologic outcomes between varus knee patients with and without preoperative tibial varus deformity (PTVD) after medial opening-wedge high tibial osteotomy (OWHTO) MethodsVarus knee patients who had undergone OWHTO were divided into two groups according to preoperative medial proximal tibial angle (MPTA): a great varus (GV) group (MPTA <85°) and a mild varus (MV) group (85°≤preoperative MPTA <87°). The hip–knee–ankle (HKA) angle, weight-bearing line ratio (WBL%), MPTA, joint line convergence angle and joint line obliquity were measured. Second-look arthroscopy was undertaken 24 months after HTO. The Knee Society (KS) function score and knee score, and Lysholm score were used to evaluate the functional outcomes. All parameters were evaluated preoperatively and 24 months after HTO. ResultsThe GV group had greater varus than the MV group in HKA and WBL% before surgery, but greater valgus after surgery. The arthroscopic probe before HTO revealed the advanced chondral damage in the GV group and lighter chondral damage in the MV group. The regeneration of medial femoral condyle was considerably more frequent in the GV group (72.5%, 45/62) than in the MV group (50.0%, 27/54) (P = 0.030). No significant differences were observed in all functional outcomes preoperatively and 24 months after HTO. ConclusionThe extent of cartilage regeneration in patients without PTVD was inferior to that in those with PTVD, but the functional outcomes were comparable. OWHTO may be a treatment option in a selected subset of varus knee patients without PTVD.

The Principles of Knee Joint Preservation

The 3 primary factors involved with preservation of the knee joint include joint alignment, meniscal status, and ligament stability (in particular that of the anterior cruciate ligament [ACL]). These factors are interdependent and result in knee joint homeostasis when all factors are stable. When a deficiency exists in one of the factors, it will affect the others. For example, the ACL and posterior horn of the medial meniscus both act as restraints to anterior tibial translation. Thus, medial meniscal deficiency increases the risk for failure of ACL reconstruction, and chronic ACL insufficiency increases the risk for medial meniscus tears. Furthermore, all 3 of the factors of joint preservation have an impact on the articular cartilage status of the knee joint. Studies have shown that cartilage-preservation procedures do not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligament deficiency. When evaluating patients with knee cartilage pathology, surgeons should be aware of the various factors involved in knee joint preservation and, if surgery is indicated, all factors should be addressed in order to support a successful result.

Lateral Meniscal Allograft Transplantation Shows a Long-Term Chondroprotective Effect on Quantitative Magnetic Resonance Imaging T2 Mapping at 7-Year Minimum Follow-Up

PurposeThe purpose of this study was to assess the long-term chondroprotective effect of lateral MAT (meniscal allograft transplantation) using quantitative MRI (magnetic resonance imaging) T2 mapping. MethodsIn patients who underwent isolated lateral MAT, quantitative MRI T2 mapping was conducted preoperatively and postoperatively with at minimum follow-up of 7 years to assess the articular cartilage status. On the sagittal section image bisecting the lateral femoral condyle, the weight-bearing portions of the femoral and tibial articular cartilage were divided into three segments each—six segments in total—based on the meniscal coverage area. The regions of interest analysis were performed on the six segments to measure the mean T2 value. Then, the whole layer was divided into deep and superficial layers for further zonal analysis. The longitudinal change in T2 values was statistically analyzed using paired t-tests. Clinical outcome was evaluated using the Lysholm score. ResultsA total of 31 patients were included in the study, with the MRI follow-up period of a minimum follow-up of 7 years (mean 8.9±1.3 years; range, 7.0–11.2 years). The mean T2 value of the whole layer showed significant improvement in all segments of the femoral cartilage and the posterior segment of tibial cartilage. In the zonal analysis, the mean T2 value of the tibial cartilage showed significant improvement in the superficial layer of the mid to posterior portion, while the deep layer remained stable. In contrast, the mean T2 value of the femoral cartilage showed significant improvement in the superficial and deep layers in all segments. The mean Lysholm score significantly improved from 62.6±12.8 to 90.9±10.5 (P < .001). ConclusionThis study suggests that MAT appears to have a long-term chondroprotective effect on the articular cartilage as judged by quantitative T2 mapping. Level of EvidenceLevel Ⅳ, Case series.

The Principles of Knee Joint Preservation: Operative Treatment Strategies.

➤ Joint alignment, meniscal status, and ligament stability are codependent factors involved in knee joint preservation, and any injury or imbalance can impact the knee articular cartilage status and can result in adverse clinical outcomes.➤ Cartilage preservation procedures in the knee will not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligamentous instability.➤ Lower-extremity varus or valgus malalignment is a risk factor for the failure of an anterior cruciate ligament (ACL) reconstruction. It represents an indication for a high tibial osteotomy or distal femoral osteotomy in the setting of failed ACL reconstruction, and may even be considered in patients who have an initial ACL injury and severe malalignment.➤ An elevated posterior tibial slope increases the risk of failure of ACL reconstruction, whereas a decreased posterior tibial slope increases the risk of failure of posterior cruciate ligament reconstruction.

Poster 331: ACL Graft Tear or Contralateral ACL Tear: Which is Worse???

Objectives: Anterior cruciate ligament (ACL) graft tears and contralateral ACL tears are both relatively common following primary ACL reconstruction (ACLR). While some prior studies have combined these injuries as an outcome variable (“subsequent cruciate injury”), there is little prior work comparing the outcomes of these injuries. We hypothesize that patient reported outcome measures (PROMs) and activity level are lower following revision ACLR than following contralateral ACLR. Methods: From a prospective cohort study of 2333 patients who underwent primary, unilateral ACLR, 298 patients were identified who underwent revision ACLR or contralateral ACLR within 5 years of primary ACLR. Following exclusion of 11 patients who had both injuries, 256 patients were eligible for study inclusion, including 124 patients who underwent revision ACLR and 132 patients who underwent contralateral ACLR. Patients were contacted for follow-up at 6 years after the primary ACL reconstruction and PROMs were collected including subjective International Knee Documentation Committee (IKDC) score, Knee Osteoarthritis pain (KOOS-Pain) and knee-related quality of life (KOOS- QOL) subscales, and Marx activity level. Patient demographic and initial injury factors, surgical factors, and PROMs were compared between groups. Multiple regression models were used to determine whether side of subsequent surgery (revision versus contralateral ACLR) was a significant predictor of outcome. Results: Two hundred trenty-three of 256 patients (87%) were contacted and completed PROMs at 6 years following primary ACLR. The median time from primary ACLR to second ACL surgery was lower in the revision group (1.3 years) than the contralateral group (2.0 years, p &lt; 0.001). The revision group also demonstrated a lower incidence of partial lateral meniscectomy and was more likely to have received an allograft for the primary ACLR. There were no significant differences in age, sex, smoking status, pre- operative knee laxity, articular cartilage status at primary ACLR, medial meniscus status at primary ACLR, sport, or pre-operative PROMs between the two groups. At follow-up, the revision ACLR group demonstrated lower Marx activity level and PROMs than the contralateral injury group (Table 1). When controlling for the above factors, the revision ACL group demonstrated a 7.8 point lower IKDC (p&lt;0.001), a 3.2 point lower KOOS-pain (p=0.012), a 10.4 point lower KOOS-QOL (p&lt;0.001), and 2.0 point lower Marx score (p=0.002) than the contralateral ACLR group. Conclusions: Patients who undergo revision ACL R demonstrate with poorer PROMs and lower activity level than those who undergo subsequent revision ACLR. [Table: see text]

Differences in the Severity and Location of Patellofemoral Cartilage Damage Between Instability Patients With and Without Patella Alta.

Patella alta is a risk factor for recurrent patellar instability. Differences in chondral injury in patients with patellar instability between patella alta and patella norma have not been evaluated. To analyze whether preoperative cartilage damage differs in severity and location between patellar instability patients with and without patella alta. Cohort study; Level of evidence, 3. Patients with patellar instability who underwent patellar realignment surgery at a single institution with preoperative magnetic resonance imaging (MRI) scans were included. After measurement of Caton-Deschamps index (CDI) on MRI, patients were divided into patella alta (CDI ≥1.3) and patella norma groups. The area measurement and depth and underlying structures (AMADEUS) score was used to quantify cartilage defect severity on MRI. A total of 121 patients were divided into patella alta (n = 50) and patella norma (n = 71) groups. The groups did not differ significantly in sex ratio, age at MRI, body mass index, mean reported number of previous dislocations, or mean interval between first reported dislocation and date of MRI. A total of 34 (68%) of the patella alta group and 44 (62%) of the patella norma group had chondral defects (P = .625) with no significant between-group differences in defect size (P = .419). In both groups, chondral injuries most affected the medial patellar facet (55% in patella alta vs 52% in patella norma), followed by the lateral facet (25% vs 18%), and lateral femoral condyle (10% vs 14%). A smaller proportion of patients had full-thickness defects in the patella alta compared with the patella norma group (60% vs 82%; P = .030). The overall AMADEUS score was higher for the patella alta versus the patella norma group (68.9 vs 62.1; P = .023), indicating superior articular cartilage status. Patients with patella alta had less severe cartilage injury after patellar instability, including a lower proportion with full-thickness defects and better overall cartilage grade. The location of injury when present was similar between alta and norma, with most defects affecting the medial facet, lateral facet, and lateral femoral condyle in descending frequency.

Paper 04: Differences in the Severity and Location of Patellofemoral Cartilage Damage Between Instability Patients With and Without Patella Alta

Objectives: Patellar instability is estimated to affect approximately 150 out of 100,000 adolescents between the age of 14-18 years old, a rate which is expected to increase over time. Several risk factors have been associated with patellar instability such as younger age, trochlear dysplasia and patella alta. Patella alta is defined as a superiorly-positioned patella, commonly determined using the Caton-Deschamps Index (CDI), with a ratio of 1.3 or greater indicative of patella alta. Patients with patella alta are approximately 2.5-4.0 times more likely to suffer a recurrent patellar dislocation, which is thought to be due to the changes in biomechanics seen in patella alta. Differences in chondral injury in patients with patellar instability between patella alta and patella norma has not been evaluated. Our objective was to retrospectively analyze whether preoperative cartilage damage differs in severity and location between patellar instability patients with and without patella alta. Methods: Patients with patellar instability who underwent patellar realignment surgery at a single institution with a preoperative MRI within 3 months were included. After measurement of CDI on MRI, patients were divided into patella alta (CDI&gt;1.3) and patella norma groups. To quantify cartilage defect severity, the Magnetic Resonance Imaging Score and Classification system (AMADEUS) was utilized by two sports medicine clinical fellows. The AMADEUS score characterizes cartilage defect size, defect depth, presence of subchondral bone defects, and bone marrow edema. The scale is scored 0-100 with 100 indicating no cartilage damage. In patients with multiple cartilage defects on MRI, each defect was characterized and analyzed independently. Continuous variable data were reported as means with standard deviations and categorical data reported as frequencies with percentages. The distribution of data was assessed with the Shapiro-Wilk test. Continuous data were assessed with the Student’s t test and Mann-Whitney U tests as appropriate. Categorical data were assessed with chi-squared analysis. The threshold for significance was set to p &lt; 0.05. Multivariate analysis was conducted with defect depth, bone edema, and AMADEUS score as the dependent variable. All statistical analyses were performed with R Studio (Version 3.6.3, Vienna, Austria). Results: One hundred-twenty-one patients were divided into patella alta (n=50) and patella norma (n=71). The groups did not significantly differ in sex ratio, age at MRI, body mass index (BMI), mean reported number of prior dislocations, or mean interval between first reported dislocation and date of MRI. Thirty-four (68%) of the patella alta group and 44 (62%) of the patella norma group had chondral defects ( P=0.625) with no statistically significant difference in the size of the chondral defects between the groups ( P=0.419). In both groups, chondral injuries most affected the medial patellar facet (55% in patella alta vs. 52% in patella norma), followed by the lateral facet (25% vs 18%), and lateral femoral condyle (10% vs 14%)( P=0.859). The patella alta group had a smaller proportion of patients who had full thickness defects in comparison to the patella norma group (60% vs 82%; P=0.030). The overall AMADEUS score for the patella alta group was higher (68.9 vs. 62.1; P=0.023) compared to the patella norma group, indicating superior articular cartilage status. When looking at a multivariate regression using AMADEUS score as the dependent outcome, female sex shows an increase in AMADEUS score with a beta estimate of 11.96 ( P&lt;0.001). Female sex also shows a higher probability of having no defect associated bone marrow edema (Odds ratio:6.7; P=0.010), and a higher probability of partial-thickness defect rather than full-thickness (Odds ratio:3.9; P=0.004). Age, BMI, interval between dislocation and MRI, and reported number of dislocations were not found to be associated with total AMADEUS score, probability of having defect-associated bone marrow edema, or defect depth. Conclusions: There is a high percentage of cartilage injury in patients with a history of patellar instability with over 60% of patients showing cartilage damage on MRI. Patients with normal patellar height have a higher frequency of full thickness cartilage defects and more severe injury compared to those with patella alta. The location of cartilage injury between alta and norma is similar, with most defects affecting the medial facet, lateral facet, and lateral femoral condyle in descending frequency.

Patellofemoral articular cartilage damage is associated with poorer patient-reported outcomes following isolated medial patellofemoral ligament reconstruction.

The purpose of this study was to investigate the impact of articular cartilage damage on outcomes following medial patellofemoral ligament (MPFL) reconstruction. Record review identified 160 patients who underwent isolated MPFL reconstruction at a single institution between 2008 and 2016. Patient demographics, patellofemoral articular cartilage status at surgery, and patient anatomical measures from imaging were obtained via chart review. Patients were contacted and outcomes assessed through collection of Norwich Patellar Instability (NPI) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity score as well as an assessment for recurrent patellar dislocation. Outcomes of patients with grade 0-II patellofemoral cartilage damage were compared to those of patients with grade III-IV cartilage damage. One hundred twenty-two patients (76%) with a minimum of one year follow-up were contacted at a mean of 4.8years post-operatively. A total of 63 patients (52%) had grade III or IV patellofemoral chondral damage at the time of surgery. The majority of the defects was on the medial patella (46 patients-72%) and the mean patellar defect size was 2.8cm2. Among 93 patients who completed patient-reported outcome scores, the 52 with grade III or IV chondral damage reported a significantly poorer KOOS Quality of Life than the 44 patients with grade 0 to II chondral damage (p = 0.041), controlling for patient age, sex, BMI, and anatomical factors. Patients with grade III or IV articular cartilage damage of the patellofemoral joint at the time of MPFL reconstruction demonstrated poorer KOOS knee-related quality of life than patients without grade III or IV articular cartilage damage at a mean of 4.8years following isolated MPFL reconstruction. Level II.

The Potential of Using an Autogenous Tendon Graft by Injecting Bone Marrow Aspirate in a Rabbit Meniscectomy Model.

Bone marrow aspirate (BMA) is an excellent source of cells and growth factors and has been used successfully for bone, cartilage, and soft-tissue healing. This study aimed to investigate the histological and biomechanical properties of autogenous tendon graft by injecting BMA and its protective effect against degenerative changes in a rabbit model of meniscal defects. Adult white rabbits were divided into untreated, tendon, and tendon + BMA groups, and meniscal defects were created in the knees. The tendon graft and articular cartilage status were evaluated by macroscopic and histological analysis at 4, 12, and 24 weeks postoperatively among the three groups. The tendon graft in the tendon and tendon + BMA groups were used for biomechanical evaluation at 4, 12, and 24 weeks postoperatively. The meniscal covering ratio in the tendon + BMA group was better than that in the tendon and untreated groups at 12 and 24 weeks postoperatively. The matrix around the central portion of cells in the tendon + BMA group was positively stained by safranin O and toluidine blue staining with metachromasia at 24 weeks. The histological score of the tendon graft in the tendon + BMA group was significantly higher than that in the untreated and tendon groups at 12 and 24 weeks postoperatively. In the tendon + BMA group, cartilage erosion was not shown at 4 weeks, developed slowly, and was better preserved at 12 and 24 weeks compared to the untreated and tendon groups. Histological scores for the articular cartilage were significantly better in the tendon + BMA group at 24 weeks. The compressive stress on the tendon graft in the tendon + BMA group was significantly higher than that in the tendon group at 12 weeks postoperatively. Transplantation of autogenous tendon grafts by injecting BMA improved the histologic score of the regenerated meniscal tissue and was more effective than the tendon and untreated group for preventing cartilage degeneration in a rabbit model of massive meniscal defects.

Clinical benefit of high tibial osteotomy combined with the intervention of platelet-rich plasma for severe knee osteoarthritis

PurposeThe objective of present study was to investigate the therapeutic effects of high tibial osteotomy (HTO) combined with platelet-rich plasma (PRP) for severe knee osteoarthritis (KOA).MethodsThis was a double-blinded, randomized, placebo-controlled trial. The participants were randomly divided by computerderived random charts into 3 groups: 24 participants in group A (24 knees) received a treatment option of HTO combined with PRP, 25 participants in group B (25 knees) received a treatment program of HTO combined with hyaluronic acid, and 25 participants in group C (25 knees) received a treatment method of HTO combined with normal saline (NS) (physiological control/placebo). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) were measured preoperatively and at the final follow-up. Status of articular cartilage was assessed according to the International Cartilage Repair Society grade and the presence of newly formed cartilaginous tissue by arthroscopy. MRI was completed of knee joint to measure the cartilaginous thickness.ResultsCompared to Group B and C, the final follow-up results of knee function in Group A were significantly different (P < 0.001), such as the total WOMAC score 18.54 (SD 4.17), the VAS score 1.72 (SD 0.53). Cartilage regeneration of femur and tibia in Group A was observed in all patients. The cartilaginous thickness in Group A were significantly different (P < 0.001), such as the anterior patella femoral region 3.52 (SD 0.47), the anterior meniscal region 1.16 (SD 0.24), the posterior meniscal region 1.24 (SD 0.26) and the posterior condyle region 2.25 (SD 0.31).ConclusionsThe addition of combined PRP to HTO may be a more reasonable choice to relieve knee pain and decelerate the progression of the medial KOA.

Roles of the calcified cartilage layer and its tissue engineering reconstruction in osteoarthritis treatment.

Sandwiched between articular cartilage and subchondral bone, the calcified cartilage layer (CCL) takes on both biomechanical and biochemical functions in joint development and ordinary activities. The formation of CCL is not only unique in articular cartilage but can also be found in the chondro-osseous junction adjacent to the growth plate during adolescence. The formation of CCL is an active process under both cellular regulation and intercellular communication. Abnormal alterations of CCL can be indications of degenerative diseases including osteoarthritis. Owing to the limited self-repair capability of articular cartilage and core status of CCL in microenvironment maintenance, tissue engineering reconstruction of CCL in damaged cartilage can be of great significance. This review focuses on possible tissue engineering reconstruction methods targeting CCL for further OA treatment.

Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy.

To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J2021;103-B(11):1686-1694.

Serial Improvement of Medial Meniscus Extrusion Following Medial Open-Wedge High Tibial Osteotomy Does Not Correlate With Clinical Outcomes and Arthroscopic Articular Cartilage Improvement

To assess serial change up to 2 years in medial meniscus extrusion (MME) following medial open-wedge high tibial osteotomy (MOWHTO) and to determine whether postoperative changes in MME correlated with clinical outcomes and arthroscopic articular cartilage status. This study included 26 patients from December 2016 to March 2018 who underwent MOWHTO for primary medial osteoarthritis with varus malalignment. Second-look arthroscopy with plate removal was performed at postoperative 2 years. MME was consecutively measured using coronal magnetic resonance imaging at preoperative and postoperative 3 months, 6 months, 1.5 years, and 2 years. We also assessed which preoperative parameters could reflect the postoperative changes in MME and evaluated whether postoperative clinical outcomes and arthroscopic articular cartilage improvement would be influenced by the MME changes. Regarding the postoperative serial changes in MME values, significant improvement in MME was noted from postoperative 6 months (P= .003), and thereafter, mean MME was further improved with time until postoperative 2years (P < .001). Regarding the correlation between preoperative parameters and MME changes, preoperative medial proximal tibial angle (MPTA) showed significant correlations in univariate and multivariate analysis (P= .004 and P=.004, respectively). Meanwhile, changes in MME were not correlated with postoperative clinical outcomes or arthroscopic articular cartilage improvement. After MOWHTO, MME improved with time and was significantly correlated with preoperative MPTA. However, the changes in MME after MOWHTO did not reflect postoperative clinical and arthroscopic articular cartilage improvement. IV, case series.

Association between subchondral insufficiency fracture of the knee joint (SIFK) and osteoarthritis of the knee

Purpose: Recently, spontaneous osteonecrosis of the knee joint (SONK) has been discussed to be renamed for a subchondral insufficiency fracture of the knee joint (SIFK), as pathophysiology of SONK has been revealed to be a subchondral insufficiency fracture which is occurred by accumulation of mechanical stress to the subchondral bone due to meniscal extrusion, injury, and tear regardless of the status of articular cartilage. However, it is remained unclear for the pathophysiology and clinical course of SIFK.

Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography

BackgroundEvaluating of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound imaging of the elbow is increasingly being used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children with minimally displaced fractures. The aims of this study were to assess the correlations between ultrasound and arthrography findings for predicting the integrity of the cartilage hinge and to describe the utility of ultrasound in determining the need for pre-treatment.MethodsThirty-nine patients with minimally displaced lateral humeral condyle fractures who underwent ultrasound and arthrography examinations before surgery from May 2018 to December 2019 were included in this study. Ultrasound and arthrography predictors of the cartilage hinge status were independently measured. The ultrasound and arthrography results were compared.ResultsThe mean displacement of the fractures was 3.1 mm (range, 2.0~5.0 mm). Arthrography showed incomplete fractures in 24 patients (61.5%) and complete fractures in 15 patients (38.5%). Ultrasound showed incomplete fractures in 25 patients (64.1%) and complete fractures in 14 patients (35.9%). The ultrasound and arthrography results of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 that were predicted to have an intact articular surface and 13 that were predicted to have an incongruity articular surface. There was no correlation between the displacement and the fracture appearing complete on the ultrasound scan. The Pearson coefficient between ultrasound and arthrography for assessing the integrity of the articular surface was 0.837.ConclusionsUltrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status in children with minimally displaced lateral humeral condyle fractures.Level of evidenceProspective study; level II.

Evaluation of Early Knee Osteoarthritis Using Biomechanical and Biochemical Markers.

Altered cellular mechano-transduction and biochemistry lead to degeneration of articular cartilage in people with knee osteoarthritis. However, the influence of low-moderate exposure to weight-bearing activity such as squatting on cartilage metabolism has not been adequately studied. The current study explored associations between knee adduction moment (KAM) during walking, biochemical markers and daily squat exposure. 3D gait analysis was used to determine external loads acting on the knee as indicators of joint compressive forces whereas biomarkers-Urine type-II-collagen-telopeptide (uCTxII), antioxidant and phospholipase A2 (PLA2) activity reflected on articular cartilage status. Following ethical approval, 66 participants with varying daily squat exposure (non-squatters [n = 21, exposure = 0 min]; activity of daily living [ADL] squatters [n = 16, exposure = 34 min]; occupational squatters [n = 13, exposure = 102 min]) and people with grade 2-3 knee osteoarthritis (n = 16, exposure = 28 min) were evaluated using 3D gait and biomarker analysis. The PLA2 activity was lowest in ADL squatters while occupational squatters demonstrated highest activity (p < 0.05). KAM and urine biomarker were similar among the groups. Moderate-strong positive association was observed between sweat PLA2 activity and age (r = 0.819, p = 0.004), daily squat exposure and biomarker uCTxII (r = 0.604, p = 0.013), antioxidant activity and Right-KAM (r = -0.917, p = 0.001), and Left-KAM (r = -0.767, p = 0.016), in people with knee OA. Healthy people demonstrated weak positive associations between KAM, uCTxII, and BMI. Associations between non-invasive biomechanical and biochemical markers indicate their potential use to identify early knee osteoarthritis. Studies with larger sample size are necessary to support prescription of body weight joint loading activities such as squatting in moderation, to delay functional decline caused by knee OA.

MRI evaluation of knee trauma and its correlation with clinical examination and arthroscopic findings

Knee joint is the largest and complex joint of the body and also most frequently injured joint in sportsmen due to the lack of bony support. The stability of the joint is highly dependent on its supporting ligamentous structures; therefore, injuries of ligaments and menisci are extremely common. MRI has virtually replaced conventional arthrography and other modalities for the evaluation of menisci and cruciate ligaments [3]. Compared with CT scans, MRI provides superior anatomic and pathological status of soft tissues, ligaments, fibro cartilage and articular cartilage. Since the 1980’s, diagnostic arthroscopy has been used frequently to show intra-articular abnormalities with more than 95% accuracy depending on the expertise of the arthroscopist [6]. During arthroscopy, all the internal structures are visualized, the abnormality detected and treated as well. MRI has enormous impact on musculoskeletal imaging and knee is the most frequently imaged joint. It is non- invasive and does not require ionizing radiation. Advantages of MRI include excellent inherent soft tissue contrast, multiplanar imaging capability, lack of patient exposure to radiation, ability to visualize ligaments, tendons, articular cartilages, menisci, para-articular soft tissues and the bone marrow.

Clinical Application Status of Articular Cartilage Regeneration Techniques: Tissue-Engineered Cartilage Brings New Hope.

Hyaline articular cartilage lacks blood vessels, lymphatics, and nerves and is characterised by limited self-repair ability following injury. Traditional techniques of articular cartilage repair and regeneration all have certain limitations. The development of tissue engineering technology has brought hope to the regeneration of articular cartilage. The strategies of tissue-engineered articular cartilage can be divided into three types: “cell-scaffold construct,” cell-free, and scaffold-free. In “cell-scaffold construct” strategies, seed cells can be autologous chondrocytes or stem. Among them, some commercial products with autologous chondrocytes as seed cells, such as BioSeed®-C and CaReS®, have been put on the market and some products are undergoing clinical trials, such as NOVOCART® 3D. The stem cells are mainly pluripotent stem cells and mesenchymal stem cells from different sources. Cell-free strategies that indirectly utilize the repair and regeneration potential of stem cells have also been used in clinical settings, such as TruFit and MaioRegen. Finally, the scaffold-free strategy is also a new development direction, and the short-term repair results of related products, such as NOVOCART® 3D, are encouraging. In this paper, the commonly used techniques of articular cartilage regeneration in surgery are reviewed. By studying different strategies and different seed cells, the clinical application status of tissue-engineered articular cartilage is described in detail.

What Factors Predict Patient Dissatisfaction After Contemporary Medial Opening-Wedge High Tibial Osteotomy?

BackgroundAlthough current advances in surgical techniques have improved outcomes of the medial opening-wedge high tibial osteotomy (MOWHTO), the factors associated with patient dissatisfaction remain unclear. Thus, the purpose of this study is to identify risk factors for patient dissatisfaction following contemporary MOWHTO. MethodsWe retrospectively reviewed prospectively collected data on 140 consecutive MOWHTO patients using an anatomical locking plate with a minimum follow-up of 2 years. Patient demographics, pain Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Kellgren-Lawrence (K-L) grade, activity level, articular cartilage and meniscal status, hip-knee-ankle angle, change in alignment, and postoperative weight-bearing line ratio were recorded. Patients were categorized using the New Knee Society Score into satisfied (satisfaction score ≥20) or dissatisfied (satisfaction score <20) groups. Patient and surgical factors were compared between the groups by the identified predictors. Multiple logistic regression analysis was used to analyze risk factors, including K-L grade IV medial osteoarthritis (OA), preoperative pain Visual Analogue Scale, total Western Ontario and McMaster Universities Osteoarthritis Index score, postoperative hip-knee-ankle angle, change in alignment, and partial meniscectomy. ResultsOf the 140 patients, 24 (17.1%) were dissatisfied with their results. Multiple logistic regression analysis showed that only K-L grade IV medial OA was statistically associated with patient dissatisfaction following MOWHTO (odds ratio 4.911, 95% confidence interval 1.820-13.256, P < .01). ConclusionSevere medial OA was an independent risk factor for dissatisfaction following contemporary MOWHTO using a rigid locking plate. Surgeons should take this into consideration when counseling and choosing surgical options in MOWHTO candidates with severe medial OA. Level of EvidenceLevel III.

Posttraumatic cartilage degradation progresses following anterior cruciate ligament reconstruction: A second-look arthroscopic evaluation

BackgroundSeveral studies have demonstrated that posttraumatic knee osteoarthritis progresses even after anterior cruciate ligament reconstruction. Few reports described zone-specific cartilaginous damages after anterior cruciate ligament reconstruction. This study aimed to compare the status of articular cartilage at anterior cruciate ligament reconstruction with that at second-look arthroscopy. MethodsThis study included 20 patients (20 knees, 10 males and 10 females, mean age 22.4 years, Body mass index 24.4 kg/m2) that underwent arthroscopic anatomic double-bundle anterior cruciate ligament reconstruction and second-look arthroscopy. Mean periods from injury to reconstruction and from reconstruction to second-look arthroscopy were 3.4 and 15.3 months, respectively. Cartilage lesions were evaluated arthroscopically in the 6 articular surfaces and 40 articular subcompartments independently, and these features were graded with the International Cartilage Repair Society articular cartilage injury classification; comparisons were made between the grades at reconstruction and at second-look arthroscopy. Furthermore, clinical outcomes were assessed at reconstruction and at second-look arthroscopy, using the Lysholm knee score, Tegner activity scale, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, side-to-side difference of the KT-2000 arthrometer, and pivot shift test. ResultsEach compartment showed a deteriorated condition at second-look arthroscopy compared with the pre-reconstruction period. A significant worsening of the articular cartilage was noted in all compartments except the lateral tibial plateau and was also observed in the central region of the medial femoral condyle and trochlea after reconstruction. However, each clinical outcome was significantly improved postoperatively. ConclusionsGood cartilage conditions were restored in most subcompartments at second-look arthroscopy. Furthermore, posttraumatic osteoarthritic changes in the patellofemoral and medial compartments progressed even in the early postoperative period, although good knee stability and clinical outcomes were obtained. Care is necessary regarding the progression of osteoarthritis and the appearance of knee symptoms in patients undergoing anterior cruciate ligament reconstruction.