Arnd Hoburg1, Julia Marcella Leitsch2, Gerd Diederichs3, Rex Lehnigk2, Carsten Perka2, Roland Becker4, Sven Scheffler5. 1. Center for Musculoskeletal Surgery, Charité, Universitaetsmedicine Berlin, Charitéplatz 1, 10117, Berlin, Germany. arnd.hoburg@charite.de. 2. Center for Musculoskeletal Surgery, Charité, Universitaetsmedicine Berlin, Charitéplatz 1, 10117, Berlin, Germany. 3. Department of Radiology, Charité, Universitaetsmedicine Berlin, Berlin, Germany. 4. Department of Orthopedic Surgery and Traumatology, Hospital Brandenburg, Brandenburg Medical School, Brandenburg/Havel, Germany. 5. Sporthopaedicum, Berlin, Germany.
Abstract
INTRODUCTION: Osteochondral defects of the knee may cause functional impairment of young and sportively active patients. Different surgical treatment options have been proposed using either one or two step procedures. The aim of the current study was to evaluate mid-term outcomes of combined bone grafting with autologous matrix-associated chondrogenesis (AMIC) for the treatment of large osteochondral defects. MATERIALS AND METHODS: 15 Patients with osteochondrosis dissecans of the medial femoral condyle grade III or IV according to ICRS classification were treated with a single step surgical procedure combining bone grafting and the AMIC procedure. Mean defect size was 4.98 cm2 (± 3.02) and patients were examined at 6, 12 weeks, 6 and 12 month and at mean final follow-up of 49 months (36-61). Patients were evaluated using VAS, IKDC, KOOS, Lysholm, Tegner activity scores and psychological and physical health assessed using the SF 12. MRI evaluation was performed at final follow-up using the MOCART score. RESULTS: Pain had significantly decreased at final follow-up (7.2 ± 1.4 vs. 2.4 ± 2.6) compared to preoperative baseline. All functional scores had improved significantly throughout the follow-up period (IKDC from 36.6 ± 20.6 vs. 72.2 ± 18.7; KOOS 50.0 ± 18.9 vs. 81.7 ± 13.9; LYSHOLM 39.3 ± 19.5 vs. 79.8 ± 15.1). SF12 evaluation showed a significant increase in physical component summary (PCS) (31.2 ± 11.1 preoperative vs. 46.3 ± 9.9 at final follow-up), while mental component summary (MCS) remained stable (51.8 ± 8.9 vs. 57.3 ± 3.3). MOCART score revealed a mean overall score of 77 ± 15 at final follow-up. Integration to the adjacent cartilage was complete in 79%, incomplete in 21%. Defect filling was complete in 64%, incomplete in 36%. CONCLUSION: Significant improvement of knee function and restoration of homogenous cartilage morphology could be achieved with simultaneous AMIC procedure and bone grafting in 2/3 of all patients with large osteochondral lesions at 4 years postoperatively.
INTRODUCTION:Osteochondral defects of the knee may cause functional impairment of young and sportively active patients. Different surgical treatment options have been proposed using either one or two step procedures. The aim of the current study was to evaluate mid-term outcomes of combined bone grafting with autologous matrix-associated chondrogenesis (AMIC) for the treatment of large osteochondral defects. MATERIALS AND METHODS: 15 Patients with osteochondrosis dissecans of the medial femoral condyle grade III or IV according to ICRS classification were treated with a single step surgical procedure combining bone grafting and the AMIC procedure. Mean defect size was 4.98 cm2 (± 3.02) and patients were examined at 6, 12 weeks, 6 and 12 month and at mean final follow-up of 49 months (36-61). Patients were evaluated using VAS, IKDC, KOOS, Lysholm, Tegner activity scores and psychological and physical health assessed using the SF 12. MRI evaluation was performed at final follow-up using the MOCART score. RESULTS: Pain had significantly decreased at final follow-up (7.2 ± 1.4 vs. 2.4 ± 2.6) compared to preoperative baseline. All functional scores had improved significantly throughout the follow-up period (IKDC from 36.6 ± 20.6 vs. 72.2 ± 18.7; KOOS 50.0 ± 18.9 vs. 81.7 ± 13.9; LYSHOLM 39.3 ± 19.5 vs. 79.8 ± 15.1). SF12 evaluation showed a significant increase in physical component summary (PCS) (31.2 ± 11.1 preoperative vs. 46.3 ± 9.9 at final follow-up), while mental component summary (MCS) remained stable (51.8 ± 8.9 vs. 57.3 ± 3.3). MOCART score revealed a mean overall score of 77 ± 15 at final follow-up. Integration to the adjacent cartilage was complete in 79%, incomplete in 21%. Defect filling was complete in 64%, incomplete in 36%. CONCLUSION: Significant improvement of knee function and restoration of homogenous cartilage morphology could be achieved with simultaneous AMIC procedure and bone grafting in 2/3 of all patients with large osteochondral lesions at 4 years postoperatively.
Authors: Justus Gille; Ellen Reiss; Moritz Freitag; Jan Schagemann; Matthias Steinwachs; Tomasz Piontek; Eric Reiss Journal: Orthop J Sports Med Date: 2021-02-26
Authors: Chengchong Ai; Yee Han Dave Lee; Xuan Hao Tan; Si Heng Sharon Tan; James Hoi Po Hui; James Cho-Hong Goh Journal: J Orthop Translat Date: 2021-10-11 Impact factor: 5.191
Authors: Matthias R Steinwachs; Justus Gille; Martin Volz; Sven Anders; Roland Jakob; Laura De Girolamo; Piero Volpi; Alfredo Schiavone-Panni; Sven Scheffler; Eric Reiss; Udo Wittmann Journal: Cartilage Date: 2019-09-11 Impact factor: 4.634