Pablo Eduardo Gelber1, Alexandru Mihai Petrica2, Anna Isart3, Raquel Mari-Molina4, Juan Carlos Monllau5. 1. Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041 Barcelona, Spain; ICATME-Hospital Universitari Quirón Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028 Barcelona, Spain. Electronic address: pablogelber@gmail.com. 2. Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041 Barcelona, Spain. 3. ICATME-Hospital Universitari Quirón Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028 Barcelona, Spain. 4. Department of Orthopedic Surgery, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain. 5. ICATME-Hospital Universitari Quirón Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028 Barcelona, Spain; Department of Orthopedic Surgery, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Meniscal scaffolding is thought to provide functional improvement and to prevent cartilage degeneration. Advanced chondral injuries might damage the scaffold structural properties. OBJECTIVE: To evaluate the influence of different degrees of articular chondral injuries on the imaging aspect of a polyurethane meniscal scaffold (Actifit®). METHODS: Fifty-four patients operated on with an Actifit® were studied. The status of the articular cartilage in the involved compartment was classified according to ICRS. The characteristics of the implant were evaluated in MRI with the Genovese score. Functional scores included WOMET, IKDC and Kujala scores. The Genovese score was correlated with the degree of chondral injury and functional results. RESULTS: The mean follow-up was 39 months (range 25-63). Additional procedures were performed in 69.5%. There were 19 patients without chondral injuries and 14 with grade 1, 10 with grade 3 and eight with grade 4 chondral lesions. The morphology and size of the implant on MRI scanning were worse with a higher degree of chondral injury (p=0.023). WOMET, IKDC and Kujala improved from 36.2SD ±7.6, 32.3SD ±13.5 and 39.2SD ±8.1 to 75.8SD ±12.9 (p=0.02), 75.5SD ±15.4 (p=0.03) and 85.6SD ±13.4 (0.042), respectively. There was no relationship between the severity of chondral injury and functional scores. CONCLUSIONS: Patients without chondral injuries showed a better MRI aspect of the polyurethane scaffold in terms of size and morphology. By optimizing biomechanics, in particular the implantation of a meniscal substitute, significant pain relief and functional improvement were observed after a minimum two-year follow-up. LEVEL OF EVIDENCE: Therapeutic case series; level 4.
BACKGROUND: Meniscal scaffolding is thought to provide functional improvement and to prevent cartilage degeneration. Advanced chondral injuries might damage the scaffold structural properties. OBJECTIVE: To evaluate the influence of different degrees of articular chondral injuries on the imaging aspect of a polyurethane meniscal scaffold (Actifit®). METHODS: Fifty-four patients operated on with an Actifit® were studied. The status of the articular cartilage in the involved compartment was classified according to ICRS. The characteristics of the implant were evaluated in MRI with the Genovese score. Functional scores included WOMET, IKDC and Kujala scores. The Genovese score was correlated with the degree of chondral injury and functional results. RESULTS: The mean follow-up was 39 months (range 25-63). Additional procedures were performed in 69.5%. There were 19 patients without chondral injuries and 14 with grade 1, 10 with grade 3 and eight with grade 4 chondral lesions. The morphology and size of the implant on MRI scanning were worse with a higher degree of chondral injury (p=0.023). WOMET, IKDC and Kujala improved from 36.2SD ±7.6, 32.3SD ±13.5 and 39.2SD ±8.1 to 75.8SD ±12.9 (p=0.02), 75.5SD ±15.4 (p=0.03) and 85.6SD ±13.4 (0.042), respectively. There was no relationship between the severity of chondral injury and functional scores. CONCLUSIONS:Patients without chondral injuries showed a better MRI aspect of the polyurethane scaffold in terms of size and morphology. By optimizing biomechanics, in particular the implantation of a meniscal substitute, significant pain relief and functional improvement were observed after a minimum two-year follow-up. LEVEL OF EVIDENCE: Therapeutic case series; level 4.
Authors: G Filardo; E Kon; F Perdisa; A Sessa; A Di Martino; M Busacca; S Zaffagnini; M Marcacci Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-07-09 Impact factor: 4.342
Authors: Darby A Houck; Matthew J Kraeutler; John W Belk; Eric C McCarty; Jonathan T Bravman Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-01-16 Impact factor: 4.342