Intra-articular knee injuries in racquet sports. A review of 128 arthroscopies

Matrix-induced autologous chondrocyte implantation (MACI) for chondral defects in the patellofemoral joint

PURPOSE

Both autologous chondrocyte implantation (ACI) and tibial tubercle transfer (TTT) have been used to treat chondral defects in the patellofemoral joint resulting in clinical improvement. Our study investigates the magnetic resonance imaging (MRI) appearance of the matrix-induced autologous chondrocyte implantation (MACI) graft at 5-year follow-up to determine if it provides a durable treatment option in patients with an average age of 42 (standard deviation 11.6).

METHODS

Twenty-three patients were available for follow-up. Nine patients required realignment of the extensor mechanism with lateral release and TTT. The MRI magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used to assess the graft status. Clinical outcomes were assessed at these time periods.

RESULTS

The mean weighted MOCART composite score improved from 2.87 at 3 months to 3.39 at 5 years, indicating an intact appearance in most grafts. Graft height measured >50% of the adjacent native cartilage in 82% of patients. Clinical improvement assessed by the Knee Injury and Osteoarthritis Outcome Score, SF-36 (PCS) and the 6-minute walk test was demonstrated between pre-operative scores and final 5-year follow-up. 91% of patients would undergo MACI again. Correlation between MOCART and clinical scores were low in MACI to the patellofemoral joint. No significant difference was found in outcome between those that required realignment surgery compared with those that did not.

CONCLUSION

Patellofemoral MACI provides a durable graft on MRI assessment at 5 years with resultant clinical improvement. Further work is needed to determine which defect locations may benefit most from this procedure.

LEVEL OF EVIDENCE

IV.

Prevalence of chondral defects in athletes' knees: a systematic review

PURPOSE

To determine the prevalence of full-thickness focal chondral defects in the athlete's knee.

METHODS

We conducted a systematic review of multiple databases, evaluating studies of the prevalence of articular cartilage defects in athletes. Because of the heterogeneity of data, a meta-analysis could not be performed.

RESULTS

Eleven studies were identified for inclusion (931 subjects). All studies were level 4 evidence. Defects were diagnosed via magnetic resonance imaging, arthroscopy, or both. Forty percent of athletes were professionals (NBA and NFL). The overall prevalence of full-thickness focal chondral defects in athletes was 36% (range = 2.4%-75% between all studies). Fourteen percent of athletes were asymptomatic at the time of diagnosis. Patellofemoral defects (37%) were more common than femoral condyle (35%) and tibial plateau defects (25%). Medial condyle defects were more common than lateral (68% vs 32%), and patella defects were more common than trochlea (64% vs 36%). Meniscal tear (47%) was the most common concomitant knee pathological finding, followed by anterior cruciate ligament tear (30%) and then medial collateral ligament or lateral collateral ligament tear (14%).

CONCLUSIONS

Full-thickness focal chondral defects in the knee are more common in athletes than among the general population. More than one-half of asymptomatic athletes have a full-thickness defect. Further study is needed to define more precisely the prevalence of these lesions in this population.

Tennis injuries: occurrence, aetiology, and prevention

A systematic search of published reports was carried out in three electronic databases from 1966 on to identify relevant articles relating to tennis injuries. There were 39 case reports, 49 laboratory studies, 28 descriptive epidemiological studies, and three analytical epidemiological studies. The principal findings of the review were: first, there is a great variation in the reported incidence of tennis injuries; second, most injuries occur in the lower extremities, followed by the upper extremities and then the trunk; third, there have been very few longitudinal cohort studies that investigated the association between risk factors and the occurrence of tennis injuries (odds ratios, risk ratios, hazard ratios); and fourth, there were no randomised controlled trials investigating injury prevention measures in tennis. More methodologically sound studies are needed for a better understanding of risk factors, in order to design useful strategies to prevent tennis injuries.