Concomitant Autologous Chondrocyte Implantation with Osteochondral Grafting for Treatment of a Massive Osteochondral Defect in the Bilateral Knees of a Child

We report the case of a 15-year-old patient who underwent concomitant autologous chondrocyte implantation and osteochondral grafting for the treatment of a massive osteochondritis dissecans defect in the left knee and autologous chondrocyte implantation in the right knee joint. Magnetic resonance imaging showed large osteochondral defects in both the knee joints measuring 8–9 cm2. Both defects were located in the weight-bearing areas of the medial femoral condyles. Therefore, simultaneous autologous chondrocyte implantation (ACI) and osteochondral autograft transplantation (OAT) for the left knee defect and ACI for the right knee joint were performed. Osteochondral plugs were harvested from the patellofemoral joint of the same left knee and grafted into the most dorsal regions of the large osteochondral defect of the left knee. The remaining osteochondral defect was covered with ACI using collagen type I and III membrane and chondrocyte cells. The membrane was implanted into more proximal part of the osteochondral defect of the left knee. Time interval between operations of the left and right knee joints was 6 months. Magnetic resonance imaging at 6 months after each knee surgery showed good preservation of the OAT and ACI grafts. The most recent follow-up examination, performed 12 months after surgeries, has shown excellent results with an International Knee Documentation Committee score of 95.59±4.64 and 96.88±4.69 for the right and left knee joints, respectively, and full range of knee motions with no symptoms. In this clinical case, the combination of ACI and OAT methods in a one-step procedure produced a good reconstruction of the joint surface with excellent clinical outcomes in the both knee joints of the same patient. Autologous osteochondral grafting and autologous chondrocyte implantation can be combined for the treatment of large osteochondral defects of the knee

Joint surfaces pathology treatment with Pridie drilling

This is an article of two homogenic groups treatment comparison, with 25 patients in each. Between 1998 and 2001 twenty-five patients underwent osteochondral or chondral fragment excision with Pridie tunelisations and 25 patients (controls) – osteochondral/chondral fragment excision alone (O-CFE). Average follow-up was 12.4 (range 10–14 months) and 23.6 months (range 22–25 months). All patients were younger than 30 years of age. Patients were evaluated through ICRS and modified HSS scales, arthroscopicaly, histologically and with x-rays. A blinded research assistant performed all follow-up evaluations. Sixteen of 25 (64%) tunelised (Pridie) results were good and 9 (36%) – fair at the time of last follow-up. Twelve of 25 (48%) in O-CFE group results were good and 12 (48%) – fair 23.6 months post operations. Final modified HSS evaluation showed statistically significantly better results in the Pridie group at the 12.4 and 23.6 months (p=0.005). Last follow-up showed deterioration in both groups (p<0.05). At an average 23.6 months follow-up x-rays showed initial osteoarthritis signs in the knees. Consequently, we recommend Pridie tunelisation procedure until final indications of cartilage grafting techniques will be established

The Patello-femoral joint degeneration and the shape of the patella in the population needing an arthroscopic procedure

Background: the main goal of the study was to investigate the prevalence of the articular cartilage defects (ACD) in the patellofemoral (PF) region of the knee joint based on the anatomical shapes of patella and its impact on the level of physical activity in the population needing arthroscopic procedures for all types of pathologies in the knee. Methods: The articular cartilage status of the PF region was obtained from 1098 arthroscopic procedures of the knee joint. The ACD were correlated to Wiberg’s shape of the patella and classified according to the degree, size and depth of the ACD in the PF region using the ICRS (International Cartilage Repair Society) system: group I consisting of patients with Wiberg type I shape (W1), group II—patients with Wiberg type II shape (W2) and group III—patients with Wiberg type III shape (W3). The Tegner physical activity scale was used to evaluate the physical activity of the patients. Results: The mean of ACD size (PF region) in the W3 group was 3.10 ± 0.99 cm2, which was a statistically significantly larger area in comparison with the W1 (1.90 ± 0.63 cm2; p < 0.0000) and W2 (1.95 ± 0.71 cm2; p < 0.0000). The patients from the W3 group (mean 3.10 ± 0.99) were less physically active (<4 Tegner) compared to the W2 group (mean of 4.48 ± 0.88; p = 0.004) and W1 group (mean of 4.55 ± 0.72; p = 0.002). Conclusions: The patients with the Wiberg type III patella shape had a higher incidence and larger size of ACD in the PF of the knee compared to the groups of Wiberg type I and II. Wiberg III patients with a lower level of physical activity had a larger size of ACD in the PF joint