Fresh Osteochondral Resurfacing of the Patellofemoral Joint

Large osteochondral lesions of the knee in young patients continue to be a challenge for orthopaedic surgeons and the focus of continual research. This is particularly true if the injury is a consequence of a dysplastic trochlea and involves both articular surfaces of the biomechanically complex patellofemoral joint. To obtain a healthy and congruent patellofemoral joint, the use of a bipolar fresh osteochondral allograft transplantation of the patella and trochlea is one of the few options to biologically treat these injuries. This would achieve a replacement of the entire articular surface of the patellofemoral joint with a high number of viable chondrocytes and respect the unique structural characteristics of the cartilage. The aim of this study was to obtain symptomatic and functional improvements while delaying the timing of prosthetic surgery. We present a reproducible although demanding surgical technique to perform a bipolar fresh osteochondral allograft transplantation of the patella and trochlea

Valoración de la utilidad de la cirugía reconstructiva de lesiones osteocondrales de la rodilla mediante trasplante de aloinjerto osteocondral fresco

Les lesions del cartílag articular del genoll són una patologia cada vegada més freqüent al nostre entorn en pacients joves i actius, afectant a la vida diària del pacient. El trasplantament osteocondral fresc de genoll, definit per la realització d'un trasplantament en bloc de cartílag i os subcondral adequat per a la mida de la lesió, està indicat per al tractament de lesions osteocondrals majors de 2cm2 en pacients joves. Els estudis d'imatge durant el seguiment postoperatori es realitzen mitjançant Ressonància Magnètica, però els seus resultats no s'han correlacionat significativament amb les puntuacions dels resultats clínics. Respecte a l'avaluació mitjançant Tomografia Computeritzada, destaca la seva major resolució espacial per a l'avaluació d'aspectes ossis, que són claus per a la supervivència d'aloinjerts. No obstant, actualment no existeix cap escala de Tomografia Computaritzada validada per a l'avaluació postoperatòria dels trasplantaments osteocondrals frescos de genoll. Degut a l'absència d'escales de Tomografia Computeritzada validades per al seguiment postoperatori dels aloinjerts osteocondrals frescos de genoll, es considera de gran importància la seva creació i validació per a la realització d'un correcte seguiment postoperatori mitjançant proves d'imatge. A l'estudi 1, es descriu un sistema de puntuació semiquantitatiu per TC per a l'anàlisi multifactorial de la reparació de les lesions osteocondrals del genoll mitjançant aloinjerts osteocondrals i s'avalua la seva variabilitat interobservador i intraobservador. Als resultats, la concordança interobservador va ser moderat a substancial per a tots els components de la puntuació de TC i la concordança intraobservador va ser de moderat a quasi perfecte per a tots els components de la puntuació de TC ([Kappa] > 0,5; p 0,5; p 0.5, p < 0.05), concluding that the ACTOCA score is a reliable tool to evaluate integration of osteochondral allograft transplantations and it provides an accurate evaluation of bone changes and may help to standardize CT scan reports following osteochondral allograft transplantation for the knee. Study 2 determines the correlation between the assessment computed tomography osteochondral allograft (ACTOCA) scoring system and clinical outcomes scores. In the results, the mean total ACTOCA score showed a statistically significant correlation with the clinical outcome. The correlation was optimal at 24 months. We found a high negative correlation with the IKDC, Kujala and Tegner (- 0.737; - 0.757, and - 0.781 respectively), and a moderate negative correlation with WOMET (- 0.566) (p < 0.001). IKDC, Kujala, WOMET, and Tegner scores showed a significant continuous improvement in all scores (p < 0.001). This finding supports the use of ACTOCA to standardize CT scan reports following fresh osteochondral allograft transplantation in the knee. Study 3 determines the value of computed tomography (CT) scans to predict the clinical outcome of FOCA transplantation using the assessment computed tomography osteochondral allograft (ACTOCA) score. In the results, the ACTOCA score at 6 months after surgery showed a statistically significant correlation with clinical results at 12 and 30 months. The correlation was better at 30 months, showing a high negative correlation with the IKDC score (-0.663) and a moderate negative correlation with the Kujala, WOMET, and Tegner scores (-0.593; -0.547, and -0.593, respectively) (P < 0.001)

Fresh Osteochondral and Meniscus Allografting for Post-traumatic Tibial Plateau Defects

Large post-traumatic osteochondral defects of the proximal tibia in young active patients can be challenging because total or partial arthroplasties are to be avoided. The use of a fresh osteochondral allograft including its meniscus is one of the few options to biologically treat these injuries. Although the use of a fresh allograft is not easily accessible in some places and carries considerable logistical limitations, it is an alternative that provides viable chondrocytes to the defect. The inclusion of the meniscus in the osteochondral graft improves the results but also makes the technique even more demanding. We present a thorough description of this allograft transplantation to make it as reproducible as possible

Fresh Osteochondral and Meniscus Allografting for Post-traumatic Tibial Plateau Defects

Altres ajuts: P.G. is the consultant for CONMED, and receives payment for lectures including service on speakers bureaus from CONMED. J.C.M. has grants/grants pending from Spanish Ministerio de Economia, Industria y Competitividad (National Programme for Research Aimed at the Challenges of Society), and receives payment for lectures including service on speakers bureaus from Smith & Nephew.Large post-traumatic osteochondral defects of the proximal tibia in young active patients can be challenging because total or partial arthroplasties are to be avoided. The use of a fresh osteochondral allograft including its meniscus is one of the few options to biologically treat these injuries. Although the use of a fresh allograft is not easily accessible in some places and carries considerable logistical limitations, it is an alternative that provides viable chondrocytes to the defect. The inclusion of the meniscus in the osteochondral graft improves the results but also makes the technique even more demanding. We present a thorough description of this allograft transplantation to make it as reproducible as possible

Fresh osteochondral patellar allograft resurfacing

The treatment of articular cartilage lesions in young patients is certainly a complex matter and subject of continuous research, particularly for those located at the patellofemoral joint, given its peculiar biomechanical characteristics. Osteochondral grafts can be of relatively small size when the defect is focal and in an area that allows good stability and consequently the graft's integration. In case of large or multifocal lesions, it is possible to consider an osteochondral transplantation of the entire articular surface of the patella. We present a simple and reproducible technique to perform a patellar fresh osteochondral allograft resurfacing attempting to reduce the symptoms and delay a prosthetic implant in young patients with advanced patellar chondral injuries

Computerized tomography scan evaluation after fresh osteochondral allograft transplantation of the knee correlates with clinical outcomes

Purpose: To determine the correlation between the assessment computed tomography osteochondral allograft (ACTOCA) scoring system and clinical outcomes scores. The hypothesis was that the ACTOCA score would show sufficient correlation to support its use in clinical practice. Methods: We prospectively collected data from all consecutive patients who underwent cartilage restitution with fresh osteochondral allograft (FOCA) transplantation for osteochondral lesions of the knee and had a minimum follow-up of two years. CT scans were performed at three, six and 24 months post-operatively. A musculoskeletal radiologist blinded to the patients' medical history evaluated the scans using the ACTOCA scoring system. Clinical outcomes collected preoperatively and at three, six and 24 months postoperatively were evaluated using the International Knee Documentation Committee (IKDC), Kujala, the Western Ontario Meniscal Evaluation Tool (WOMET), and the Tegner Activity Scale. Results: The mean total ACTOCA score showed a statistically significant correlation with the clinical outcome. The correlation was optimal at 24 months. We found a high negative correlation with the IKDC, Kujala and Tegner (− 0.737; − 0.757, and − 0.781 respectively), and a moderate negative correlation with WOMET (− 0.566) (p < 0.001). IKDC, Kujala, WOMET, and Tegner scores showed a significant continuous improvement in all scores (p < 0.001). Conclusion: The mean total ACTOCA score showed a linear correlation with clinical results in IKDC, Kujala, WOMET, and Tegner scores, being the highest at 24 months post-surgery. This finding supports the use of ACTOCA to standardize CT scan reports following fresh osteochondral allograft transplantation in the knee

Fresh Osteochondral Patellar Allograft Resurfacing

Altres ajuts: J.C.M. has grants/grants pending from Spanish Ministerio de Economia, Industria y Competitividad (National Programme for Research Aimed at the Challenges of Society), and receives payment for lectures including service on speakers bureaus from Smith & Nephew.The treatment of articular cartilage lesions in young patients is certainly a complex matter and subject of continuous research, particularly for those located at the patellofemoral joint, given its peculiar biomechanical characteristics. Osteochondral grafts can be of relatively small size when the defect is focal and in an area that allows good stability and consequently the graft's integration. In case of large or multifocal lesions, it is possible to consider an osteochondral transplantation of the entire articular surface of the patella. We present a simple and reproducible technique to perform a patellar fresh osteochondral allograft resurfacing attempting to reduce the symptoms and delay a prosthetic implant in young patients with advanced patellar chondral injuries

Fresh Osteochondral Resurfacing of the Patellofemoral Joint

Large osteochondral lesions of the knee in young patients continue to be a challenge for orthopaedic surgeons and the focus of continual research. This is particularly true if the injury is a consequence of a dysplastic trochlea and involves both articular surfaces of the biomechanically complex patellofemoral joint. To obtain a healthy and congruent patellofemoral joint, the use of a bipolar fresh osteochondral allograft transplantation of the patella and trochlea is one of the few options to biologically treat these injuries. This would achieve a replacement of the entire articular surface of the patellofemoral joint with a high number of viable chondrocytes and respect the unique structural characteristics of the cartilage. The aim of this study was to obtain symptomatic and functional improvements while delaying the timing of prosthetic surgery. We present a reproducible although demanding surgical technique to perform a bipolar fresh osteochondral allograft transplantation of the patella and trochlea

Fresh Osteochondral Resurfacing of the Patellofemoral Joint

Large osteochondral lesions of the knee in young patients continue to be a challenge for orthopaedic surgeons and the focus of continual research. This is particularly true if the injury is a consequence of a dysplastic trochlea and involves both articular surfaces of the biomechanically complex patellofemoral joint. To obtain a healthy and congruent patellofemoral joint, the use of a bipolar fresh osteochondral allograft transplantation of the patella and trochlea is one of the few options to biologically treat these injuries. This would achieve a replacement of the entire articular surface of the patellofemoral joint with a high number of viable chondrocytes and respect the unique structural characteristics of the cartilage. The aim of this study was to obtain symptomatic and functional improvements while delaying the timing of prosthetic surgery. We present a reproducible although demanding surgical technique to perform a bipolar fresh osteochondral allograft transplantation of the patella and trochlea