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At least 19 recordsLinked to original sources

PubMed2006

Results of arthroscopic fixation of osteochondritis dissecans lesion of the knee with cylindrical autogenous osteochondral plugs.

BACKGROUND: In situ fixation of unstable lesions of osteochondral dissecans of the knees with cylindrical osteochondral autograft transplantation has been reported to provide excellent results with healing of the osteochondral dissecans fragment. PURPOSE: To evaluate the clinical results and magnetic resonance imaging findings of the osteochondral dissecans of knees treated with in situ fixation of the osteochondral fragments with osteochondral autograft transplantation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve knees (12 patients; mean age, 16.0 years) with osteochondral dissecans lesions were treated with in situ fixation with autogenous osteochondral plugs. The mean lesion size was 2.4 cm(2) (range, 1.0-4.9 cm(2)). The osteochondral dissecans lesions were located on the medial femoral condyle in 10 patients and on the lateral femoral condyle in 2 patients. Seven lesions were located in the weightbearing area. The International Cartilage Repair Society classification in arthroscopic findings was grade II in 1 patient, grade III in 8 patients, and grade IV in 3 patients. All patients were evaluated with the Hughston Rating Scale form with the mean follow-up at 4.5 years (range, 2.8-5.9 years). The interface between the osteochondral fragment and subchondral bone and changes in donor site of the osteochondral graft were evaluated with T2-weighted magnetic resonance image up to 12 months postoperatively. RESULTS: The Hughston Rating Scale scored 8 knees as excellent, 3 as good, and 1 as fair. The interface between the osteochondral fragment and subchondral bone had disappeared on magnetic resonance image by 3 months postoperatively in all cases. No complications arising from the donor site area were observed. Signal intensity of donor site changed from high signal preoperatively to homogeneous surrounding cancellous bone by 1 year postoperatively. CONCLUSION: Biological fixation of the osteochondral dissecans lesion with cylindrical osteochondral autograft provided healing of the osteochondral fragments.

Adolescent↗

PubMed2005

Osteochondral autograft transplantation for osteochondritis dissecans of the elbow in juvenile baseball players: minimum 2-year follow-up.

BACKGROUND: Osteochondral autografts have recently become popular to treat articular cartilage defects, and they are used for unstable osteochondritis dissecans lesions as a means of biological fixation. PURPOSE: To evaluate the clinical results of osteochondral autograft transfer for osteochondritis dissecans of the elbow. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Osteochondral autograft transfer was performed on 18 baseball players (mean age, 13.6 years) with osteochondritis dissecans of the elbow. These included 9 lesions that were grade 3 (separated but in situ) and 9 lesions that were grade 4 (displaced fragment with osteochondral defect) based on magnetic resonance imaging. All patients were evaluated with a scoring system, radiographs, and magnetic resonance imaging, with the mean follow-up at 3.5 years. RESULTS: In patients with grade 3 lesions, the subjective score was increased, but the objective score did not change. Six of 9 patients returned to their previous sports performance levels. One quit baseball because of academic reasons, 1 changed his position, and 1 changed to softball. In patients with grade 4 lesions, both subjective and objective scores were increased significantly. All but 1 patient returned to their previous sports performance levels. In the 3 grade 4 lesions with a wide osteochondral defect, the irregularity of the articular surface remained on magnetic resonance imaging. CONCLUSION: Osteochondral autograft transplantation is a useful treatment for reattachment of the lesion as well as osteochondral resurfacing of elbow osteochondritis dissecans.

Adolescent↗

PubMed2006

The structural properties of an osteochondral cylinder graft-recipient construct on autologous osteochondral transplantation.

PURPOSE: The purpose of this study was to investigate the changes in structural properties of an osteochondral cylinder graft-recipient construct after autologous osteochondral transplantation. METHODS: A full-thickness cylindrical osteochondral defect (5 mm in diameter and 3 mm in depth) was made on the femoral condyle of a mature female Japanese white rabbit using the Osteochondral Autograft Transfer System (OATS; Arthrex, Naples, FL). The defect was repaired with an osteochondral plug (6 mm in diameter and 3 mm in depth) taken from the contralateral femoral condyle using the OATS. The implanted osteochondral grafts were evaluated immediately after surgery and at postoperative weeks 1, 3, 8, and 12. The stiffness of articular cartilage was analyzed using a tactile sensor system (AXIOM, Fukushima, Japan), which measures stiffness based on changes in resonance frequency when a vibrating tactile sensor touches articular cartilage. The specimens were stained with hematoxylin and eosin and serial sections were examined microscopically. RESULTS: The cartilage stiffness of the graft immediately after surgery was 107,695.1 N/m, which was not statistically different from the normal cartilage stiffness (100,027.5 N/m). The stiffness at postoperative weeks 1, 3, 8, and 12 was 95,386.8, 92,899.3, 95,969.8, and 104,683.7 N/m, respectively. The stiffness at postoperative weeks 1, 3, and 8 was significantly lower than the normal cartilage stiffness and the stiffness at postoperative week 12 was the same as normal cartilage. A new bone formation with an increase of bone trabeculae between the osteochondral cylinder graft and the recipient was observed at postoperative weeks 1, 3, and 8. Thereafter, at postoperative week 12, bone trabeculae decreased to the same level as observed in a normal model due to the progress of bone remodeling. CONCLUSIONS: The stiffness of articular cartilage of the osteochondral graft was normal at the time the graft was initially placed and at postoperative week 12. However, the stiffness at postoperative weeks 1, 3, and 8 was lower than the normal cartilage stiffness. CLINICAL RELEVANCE: Care should be taken when planning the rehabilitation program at an early phase after osteochondral transplantation.

Animals↗

PubMed2006

The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus.

BACKGROUND: Mosaic autogenous osteochondral transplantation has been used to treat large osteochondral defects. HYPOTHESIS: There is potential, previously unrecognized donor-site morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of talar osteochondral defect lesions. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifteen patients underwent mosaic osteochondral transplantation to treat a talar osteochondral defect lesion, with 11 patients available for follow-up. A Lysholm knee score was used to assess donor-site morbidity at a mean follow-up of 47 months (range, 7-77 months). Mean age was 29 years (range, 21-44 years). A single surgical team performed the mosaicplasties. Significance was determined using the Student t test. RESULTS: All patients had asymptomatic knees preoperatively. Mean postoperative Lysholm score was 81 (range, 49-100). By Lysholm criteria, 5 rated as excellent, 2 as good, and 4 as poor. No significant difference was detected in terms of the harvest method or the number of grafts obtained from those having an excellent rating versus those having a good/poor rating. Patients rated as good/poor cited knee instability in daily activities as the most common problem. One had knee pain and patellar instability after osteochondral harvest by lateral arthrotomy that required a subsequent lateral retinacular release and tibial tubercle osteotomy. CONCLUSION: This study demonstrates that donor-site morbidity after osteochondral harvest can be significant. In this population, those who experienced a decline in knee function had problems performing activities of daily living. When performing these procedures, the authors recommend that surgeons consider these risks and discuss them with their patients.

Adult↗

PubMed2006

Autologous osteochondral mosaicplasty for capitellar osteochondritis dissecans in teenaged patients.

BACKGROUND: Autologous osteochondral mosaicplasty is a new technique to provide hyaline repair for articular defects. Although recent studies have reported the successful treatment of articular defects in the knee and ankle joints with this surgical procedure, little attention has been given to the surgical efficacy of mosaicplasty in the treatment of osteochondritis dissecans of the humeral capitellum. PURPOSE: To clarify the clinical outcomes of mosaicplasty for teenaged patients with advanced lesions of capitellar osteochondritis dissecans. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eight teenaged patients with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. All patients were baseball players who were affected on the right side, which was also their throwing side. The surgical technique involves obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyles and transplanting them to prepared osteochondral defects. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically. RESULTS: Seven of the 8 patients were free from elbow pain, and the remaining patient had mild pain occasionally. The mean clinical score described by Timmerman and Andrews (a maximum of 200 points) significantly improved from 140 points to 183 points postoperatively. All patients except one had excellent or good clinical results. Radiographically, the graft incorporation and a normal contour of the subchondral cortex were found in all patients. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared and the signal intensity returned to normal. Six of the 8 patients, including all 3 pitchers, returned to competitive-level baseball. CONCLUSION: Mosaicplasty for advanced lesions of capitellar osteochondritis dissecans in teenaged baseball players can provide satisfactory clinical and radiographic results.

Adolescent↗

PubMed2001

Autogenous osteochondral morselised grafts for full thickness osteochondral defects in the knee joints of pigs.

The aim of this study is to firstly ascertain the survival of autogenously grafted morselised cartilage for full thickness osteochondral defects in knee joints of pigs. Secondly, it is to determine the quality of the grafted cartilage that survives and to score to it based on a recognised and tested system of indices and thirdly, to recognise, if any, the potential for reconstitution of the osteochondral junction. Two groups of five pigs were followed up for six and 12 weeks. Similar osteochondral defects were created in the medial condyles of both knees with the right medial femoral condyle defect filled with graft and the left used as control and filled with gel foam. At the end of the study period, an independent pathologist assessed the defects macroscopically and microscopically with an accepted and comparable histological scoring system. Macroscopically, there was better filling of the defect and restoration of bony contour in the grafted group compared to the control. Microscopically, at six weeks, filling of the defect, nature of predominant tissue, matrix staining and nature of cells all showed significantly better histological score than the control using the Mann-Whitney U test at the level of significance of p<0.05. At 12 weeks, in addition to the above, the reconstitution of osteochondral junction also showed a significantly better score. Comparing the test groups at six and 12 weeks, the reconstitution of the osteochondral junction was significantly better at 12 weeks. In conclusion, the autogenous osteochondral morselised graft persisted as mature hyaline cartilage with good histological score at six weeks with significantly better reconstitution of osteochondral junction occurring at 12 weeks. The use of morselised graft allows for the inclusion of bone graft which possibly allows for larger amounts of donor tissue and thus the possibility of treating larger defects. In the human model the donor site would be the non-weight bearing surfaces of the knee such as the intercondylar notch as described by Walgenbach A and Stone KR at the 1997 Annual Meeting of the American Academy of Orthopaedic Surgeons in San Francisco.

Animals↗

PubMed2005

Osteochondral autograft transplantation for osteochondritis dissecans of the capitellum in nonthrowing athletes.

In this report, we present the cases of 3 nonthrowing athletes with osteochondritis dissecans of the capitellum. Preoperatively, they complained of elbow pain during rhythmic gymnastics, table tennis, and basketball, respectively. Magnetic resonance imaging showed a completely separated osteochondral fragment or a full-thickness cartilage defect. All 3 patients were treated with transplantation of an osteochondral autograft harvested from the lateral femoral condyle. They returned fully to their sports activities within 6 months of surgery. The continuity of the cartilage layer between the osteochondral graft and the capitellum was shown on magnetic resonance images taken at 12 months postoperatively. We believe that osteochondral autograft transplantation provides successful results for nonthrowing athletes with end-stage osteochondritis dissecans of the capitellum.

Adolescent↗

PubMed2004

Osteochondral autografts transfer for post-traumatic osteochondral defect of the knee-2 to 5 years follow-up.

The treatment of post-traumatic osteochondral defects of the weight-bearing surface of the knee in young active patients remains a significant challenge. We report the results of an osteochondral autograft transfer (OAT) in 18 patients (mean age 29 years) with post-traumatic focal osteochondral defects of the knee. Sixteen lesions were over the femoral condyle and two were over the tibial plateau. The average size of the lesion was 4.1 cm(2) (from 2.25 to 6 cm(2)), and the subchondral bone involved no more than 1 cm in depth. Osteochondral grafts were harvested from the non-weight-bearing area of the femoral condyle. Ten patients also had concomitant surgical procedures. The average follow-up was 42 months (from 24 to 64 months). All patients were evaluated by Lysholm and Tegner activity scores and plain radiographs. Nine patients had MRI, eight patients had second-look arthroscopy and two had a biopsy. Sixteen patients (89%) had good to excellent results, while two patients with lesion over the tibial surface had fair results. The biopsy revealed survival of hyaline cartilage. For small to medium osteochondral lesion over the femoral condyle of the knee in selected patients, osteochondral autografting yielded promising short to mid-term results.

Adolescent↗

PubMed2001

Autologous osteochondral transplantation using the diamond bone-cutting system (DBCS): 6-12 years' follow-up of 35 patients with osteochondral defects at the knee joint.

Thirty-five patients with severe osteochondral defects were treated by autologous osteochondral transplantation between 1986 and 1992. The majority of patients (27) suffered from osteochondrosis dissecans, while 8 patients presented with posttraumatic osteochondral defects. The grafts were harvested with a diamond bone cutter from the posterior part of the medial or lateral femoral condyle. In 29 patients the lesion was located at the lateral part of the medial femoral condyle, in 3 it was at the lateral femoral condyle, and in 3 at the patella. Twenty-nine patients could be examined at the follow-up between 6 and 12 years later (mean follow up 8.1 years). Using the standard cartilage evaluation form, the transplanted knees of 12 patients were graded as normal (grade I), 14 knees were nearly normal (grade II), while 3 patients presented with an abnormal result (grade III). All 3 of them had a varus malalignment and refused a high tibial correction osteotomy against our advice. No patient was assessed as severely abnormal (grade IV). The majority of patients improved their activity level and the functional status of the joint. Twelve patients developed new radiological signs of osteoarthrosis with a decrease in the radiological score of Kellgren and Lawrence by about one stage. We conclude that autologous osteochondral transplantation with the diamond bone-cutting system is an effective method in the treatment of severe osteochondral defects.

Adult↗

PubMed2005

Management of big osteochondral defects of the knee using osteochondral allografts with the MEGA-OATS technique.

Treatment of osteochondral defects in weight-bearing areas of the knee, especially when they are sizeable and involve considerable subchondral bone loss, is a challenging problem. We report our experience on the use of osteochondral allografts with the MEGA-OATS technique in the management of large osteochondral defects of the knee in young patients. Five patients (3 male and 2 female) were included in this study; their age ranged from 22 to 41 years and the mean size of the defect covered was 30 x 30 mm. They were followed for a minimum of 2.5 years (mean: 32.8 months, range 30-36). An age- and size-matched fresh frozen, non-irradiated distal femoral allograft was used to obtain the donor plug, which was then inserted in the recipient area in a press-fit fashion. Patients' Lysholm knee score increased from 37.8 pre-operatively to 73.8 post-operatively. Tegner activity score increased in all five patients; it improved from a mean of 2 pre-operatively (range 1-3) to 4 post-operatively (range 2-7). Four out of five patients returned to work and three went back to sporting activities. With this technique one can cover sizeable osteochondral defects, and compensate for significant subchondral bone loss, while accurate reconstruction of the curvature of the femoral condyle is allowed. We believe that it is a viable salvage option in young patients with big osteochondral defects of the knee. It offers very satisfactory functional results and does not compromise patients' future options.

Adult↗

PubMed2000

Loose bodies after arthroscopic osteochondral autograft in osteochondritis dissecans of the knee.

We report a case of loose bodies from the donor site as a complication after the osteochondral autograft for the treatment of osteochondritis dissecans. Eight months after surgery, 3 osteochondral loose fragments, having dislodged from the donor sites of the osteochondral autograft, were found in the posteromedial portion, posterolateral portion, and anterior compartment of the knee, respectively. A large osteochondral defect can be treated successfully with arthroscopic autogenous bone graft. When filling the donor site with the recipient bone core, only the cancellous portion should be inserted into the donor socket.

Adult↗

PubMed2005

Reconstruction with an osteochondral autograft for advanced osteochondritis dissecans of the elbow.

UNLABELLED: The treatment of large, advanced osteochondritis dissecans of the elbow is controversial. To ascertain whether better results could be obtained using osteochondral autografts, we retrospectively reviewed the results in 10 young athletes (mean age, 14.3 years; range, 12-17 years) who were followed up for a mean of 25.5 months (range, 18-45 months). After abrasion of the fragments, cylindrical osteochondral bone plugs were transferred from a lateral femoral condyle. They were assessed clinically by the Japanese Orthopaedic Association elbow score and radiologically by radiocapitellar congruity. All patients achieved bony union in 3 months. The average Japanese Orthopaedic Association score was 80.6 points before surgery and improved to 93.8 points at followup. The average percentage of radiocapitellar congruity was 35.7% before surgery and improved to 64.2% at followup. Clinical and radiologic results were excellent in eight patients and poor in two. Poor results may be dependent on preexisting osteoarthritis and technical difficulty related to the location of the lesion. In eight patients, a durable load-bearing elbow was obtained with this procedure, which made hyaline-like cartilage resurfacing with healthy subchondral bony support possible. Osteochondral autograft is a reasonable surgical option for an advanced lesion of osteochondritis dissecans of the elbow, although long-term followup is needed to know whether the early results persist. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗

PubMed2003

Osteochondral autografts for osteochondritis dissecans of the talus.

Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. The mean time of follow-up was 36 months (range, 25-49). The average age at surgery was 22.7 years (range, 19-34). The mean size of defect of OCD was 13.6 mm x 7.2 mm. Two or three osteochondral grafts (6 or 7 mm in diameter and 15-20 mm in length) were harvested from the superomedial margin of the ipsilateral knee. A partial osteotomy of the medial malleolus or osteotomy of the distal lateral tibia was performed for all cases. Being evaluated by the Freiburg ankle score, 16 of 18 ankles (88.8%) had excellent and two (11.8%) had good results. "Second-look" arthroscopy of 16 ankles revealed consistency of the osteochondral grafts and congruity between grafts and native cartilage in 14 (87.5%), and a softening or fissuring of the osteochondral graft in two. Our results showed that this procedure provided an effective treatment for a symptomatic advanced-stage OCD of the talus.

Adult↗

PubMed2005

[Retrograde osteochondral grafting for osteochondral lesion of the talus: a new technique eliminating malleolar osteotomy].

Osteochondral grafting is one of the most effective treatment options for osteochondral lesions of the talus. However, the necessity for a medial malleolar osteotomy is the major drawback of the technique. This report presents a case treated with retrograde osteochondral grafting that eliminated the need for a medial malleolar osteotomy. An osteochondral lesion of the medial talus was detected in a 49-year-old woman. Under arthroscopic guidance, the talus was entered from the sinus tarsi region to establish a tunnel extending to the lesion. An osteochondral graft taken from the ipsilateral knee was inserted into the distal end of the tunnel and was advanced to the joint surface. Postoperative computed tomography scans showed that the graft completely filled the tunnel and provided congruency with the articular surface. Details of this technique are described.

Arthroscopy↗

PubMed1994

Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults.

Fresh osteochondral allografts were used to patch defects in the lateral femoral condyle in 17 patients with osteochondritis dissecans. The patients included 12 males and five females, ages 16 to 46 years. All had previously undergone other procedures including pinning (4), primary removal of osteochondral fragments (16), and abrasion arthroplasty (14). Defects up to 3 cm in diameter were treated with isotopic grafts and fixed with Herbert screws. Larger defects were treated with crescent-shaped grafts fixed with multiple Herbert screws. Follow-up time ranged from two to nine years. Pain, stiffness, swelling, buckling, and locking were ablated in 16 of the 17 patients. No graft collapse has been noted in these individuals. Verification of graft viability was achieved at periods from six weeks to six years, typically at the time of hardware removal. The only failure occurred in an individual with a 3- x 4.5-cm defect who suffered gross fragmentation which left a large crater. Osteochondritis dissecans of the lateral femoral condyle provides an ideal opportunity for evaluating osteochondral grafts. Sixteen of 17 grafts were a success at two to nine years after surgery.

Adolescent↗

PubMed2005

The use of a single osteochondral autograft plug in the treatment of a large osteochondral lesion in the femoral condyle: an experimental study in sheep.

BACKGROUND: The use of osteochondral autograft plugs can be restricted because of limited amount of donor material. HYPOTHESIS: A small osteochondral autograft plug placed in the center of a large defect in a sheep femoral condyle will yield results superior to either an untreated or a bone-grafted defect. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve adult sheep underwent bilateral hindlimb surgery. On 1 limb, a 6-mm circular osteochondral autograft plug was placed in the center of a 10-mm circular defect in the medial femoral condyle. The gap between the plug and the condyle was filled with bone graft. On the contralateral side, the defect was either left untreated or filled with bone graft (control specimens). Animals were studied at 6 and 12 months under gross examination, high-resolution radiography, and histologic evaluation. RESULTS: At 6 months, 4 of 6 plugs healed and showed good maintenance of the joint surface and cartilage viability in the plugs. One plug fractured and resorbed, and 1 plug settled but healed. At 1 year, all 5 plugs healed, 1 having settled slightly (1 animal died earlier). The plug specimens showed better maintenance of the condyle contour at both times, and the central plug had hyaline-appearing cartilage. The control specimens were more irregular, had a fibrocartilage fill, and appeared flatter, although no gross cavitation or collapse was indicated. Composite cartilage scores on histologic evaluation were significantly higher for the plug specimens after 6 months (P = .02) and 1 year (P = .036) compared with controls. CONCLUSION: At 6 months and 1 year, a 6-mm osteochondral plug placed in a 10-mm defect better preserved the articular surface and contour of the condyle compared to untreated or bone-grafted defects. CLINICAL RELEVANCE: Osteochondral autograft plugs may be able to treat larger articular lesions without complete fill of the defect.

Animals↗

PubMed1990

Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients.

Osteochondral lesions (osteochondritis dissecans) of the talus are common articular lesions that are usually traumatic in origin. Clinical management of these lesions is based on whether or not the fragments are attached. We studied the value of MR imaging in determining the stability of the osteochondral fragments. In 13 of 14 patients who had had correlative surgery, we accurately predicted the presence and extent of attachment of the fragment to the talus by performing preoperative MR imaging. The other patient had a false-positive diagnosis of a chondral fragment. All seven partially attached fragments had an irregular high-signal zone on T2-weighted images at the fragment/talar interface. The four unattached fragments had a complete ring of fluid surrounding the lesion. On the basis of these findings, we think MR of the ankle can be used to assess accurately talar osteochondral lesion stability and aid in clinical decision making.

Adolescent↗

PubMed1987

Osteochondritis dissecans and osteochondral fragments managed by Herbert compression screw fixation.

Treatment of osteochondritis dissecans and osteochondral fragments using Herbert compression screw fixation combined with drilling gives satisfactory results. The Herbert screws may be inserted arthroscopically after identifying the lesion. The need for arthrotomy is eliminated in most instances. Management was by drilling and pinning for unseparated lesions and crater preparation with fragment fixation in cases with separated osteochondral fragments. The follow-up period is only four to 28 months. One case required arthrotomy. Ten patients with a four-month to five-year history of knee pain had unseparated lesions. Eight had excellent results with union, one required drilling and removal of sequestrae, and one remains unhealed. Three cases had separated osteochondral fragments. All three appear to have obtained union of the separated fragments without recurrence of separation.

Adolescent↗