Viabilni i smrznuti transplantat meniska. Rana klinička i radiološka evaluacija

Aim: To perform a clinical and imaging short term evaluation of viable and frozen meniscus allografts. Methods and materials: Between 2005 and 2006, 12 meniscal allograft transplantations were performed in our institution. The study population consisted of 5 men and 7 women with a mean age of 36.4 years (range 17.1-42.5). Six patients received a viable allograft and six a deep-frozen one. All allografts were harvested from donors who died after a short disease. All patients were operated with an open surgical technique (medial or lateral arthrotomy) and soft tissue fixation with secure anterior and posterior horn fixation, performed by one senior surgeon. All patients were scored pre-operatively, at 6 weeks, 3 months, 6 months, 1 and 2 years postoperatively. Three questionnaires were used to score the patients clinically (KOOS, modified HSS and SF-36 questionnaire). Every patient received radiographs pre-operatively and at 6 months and 1 year. Results: Clinically, there was no difference in patient self-reported results through questionnaires or in a questionnaire based on clinical examination. There was no significant progress in joint space narrowing on weight bearing and Rosenberg view radiographs. Conclusion: Our results suggest that there are no clinical significant differences between the viable and the deep frozen subgroup after two years.Cilj: Učiniti ranu kliničku i radiološku evaluaciju vijabilnog i smrznutog transplantata meniska. Metoda i materijali: Tijekom 2005. i 2006. godine, u našoj ustanovi izvedeno je 12 alotransplantacija meniska. U studiju je bilo uključeno 5 muškaraca i 7 žena, s prosječnom dobi od 36,4 godina (raspon od 17,1 do 42,5). U šest pacijenata presađen je vijabilni transplantat, u šest duboko smrznuti transplantat. Svi transplantati su dobiveni od davatelja koji su umrli nakon kratke bolesti. Svi pacijenti operirani su otvorenim kirurškim zahvatom (medijalna ili lateralna artrotomija), uz fiksaciju mekih tkiva i fiksaciju prednjeg i stražnjeg roga. Svi pacijenti su evaluirani preoperativno, te 6 tjedana, 3 mjeseca, 6 mjeseci, jednu i dvije godine nakon operacije. Za kliničku evaluaciju bolesnika korištena su tri upitnika (KOOS, adaptirani HSS i SF-36 upitnik). Svakom pacijentu je učinjena rendgenska slika preoperativno, nakon 6 mjeseci i nakon jedne godine. Rezultati: Klinički, nije bilo razlika između rezultata koje su bolesnici samostalno naveli u upitnicima i onih dobivenih temeljem kliničkog pregleda. Rendgenska slika po Rosenbergu nije pokazala značajni pomak u suženju zglobne pukotine pod opterećenjem. Zaključak: Naši rezultati ukazuju na to da nakon dvije godine ne postoje klinički značajne razlike između transplantacije vijabilnog i duboko smrznutog transplantata

Repair of symptomatic cartilage lesions of the knee: the place of autologous chondrocyte implantation.

An increasing number of patients with cartilage defects of the knee are being treated with autologous chondrocyte implantation (ACI). To date, no clear guidelines exist for the use and indications of this technique. The BVOT and SOBCOT have established a working group to review the clinical results and the cost-effectiveness of the various treatment modalities and particularly of ACI. This group has formulated recommendations and presents a treatment algorithm based on an in-depth review of recent European and American literature, on peer-reviewed opinions of leading investigators in the field and on a comparative analysis of the clinical results and health-economic aspects of current cartilage repair techniques

Load distribution in early osteoarthritis

Total knee replacement is an accepted standard of care for the treatment of advanced knee osteoarthritis with good results in the vast majority of older patients. The use in younger and more active populations, however, remains controversial due to concerns over activity restrictions, implant survival, and patient satisfaction with the procedure. It is in these younger patient populations that alternatives to arthroplasty are increasingly being explored. Historically, osteotomy was utilized to address unicompartmental pain from degeneration and overload, for example, after meniscectomy. Utilization rates of osteotomy have fallen in recent years due to the increasing popularity of partial and total knee arthroplasty. This article explores the indications and outcomes of traditional unloading osteotomy, as well as newer options that are less invasive and offer faster return to function. Level of evidence V