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Picart B, Papin PE, Steltzlen C, Boisrenoult P, Pujol N. Functional outcome of osteochondral autograft is equivalent in stable knee and in anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2021; 107:102792. [PMID: 33333268 DOI: 10.1016/j.otsr.2020.102792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) tears are associated in 10% to 20% of cases with extensive traumatic focal osteochondral damage. Ligament reconstruction may require osteochondral autograft for symptomatic osteochondral lesions. Combined ACL and chondral or osteochondral reconstruction is poorly evaluated in the literature; osteochondral reconstruction in stable knee better documented. The objective of this study was to compare functional results after osteochondral autograft transfer (OAT) for significant symptomatic femoral condyle defect, in stable or stabilised knees (concomitant ACL reconstruction). The hypothesis was that functional results are equivalent in both groups. MATERIAL & METHOD This was a single-centre retrospective comparative observational study of patients consecutively operated on between 2000 and 2018. Fifty patients met the inclusion criteria and were divided into two groups: Group 1 (OAT+ACL, n=13) and group 2 (OAT on stable knee, n=37). The following criteria were recorded at follow-up: pain (VAS), KOOS, IKDC and Lysholm scores and Hughston radiologic score, and time to return to sport. Mean follow-up was 79.7±60 months in group 1 and 86.4±62 months in group 2. RESULTS Ten patients were included for analysis in group 1 and 30 in group 2. Cartilage lesion size was comparable between groups: 1.6±1.20 cm2 for group 1 and 2.3±1.3 cm2 for group 2 (ns). One complication (infection with favourable course) was observed in group 2. Sport was resumed at 8.7±2.7 vs. 8.4±3.3 months, respectively. Mean subjective scores were respectively 83.3±7.4 and 75.4±14 for Lysholm, 89.7±7.8 and 89.7±19.6 for KOOS, 78±13.7 and 72.2±12.9 for subjective IKDC, 0.5±0.5 and 0.8±0.9 for pain on VAS and 3 and 3 for radiological Hughston radiologic score, with no significant differences between groups. CONCLUSION Symptomatic focal osteochondral lesions treated by osteochondral autograft transfer gives the same outcome on stable or stabilised knee. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Baptiste Picart
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150, Le Chesnay, France
| | - Pierre Emmanuel Papin
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150, Le Chesnay, France
| | - Camille Steltzlen
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150, Le Chesnay, France
| | - Philippe Boisrenoult
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150, Le Chesnay, France
| | - Nicolas Pujol
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150, Le Chesnay, France.
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Thrush C, Porter TJ, Devitt BM. No evidence for the most appropriate postoperative rehabilitation protocol following anterior cruciate ligament reconstruction with concomitant articular cartilage lesions: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26:1065-1073. [PMID: 29511820 DOI: 10.1007/s00167-018-4882-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/28/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) rupture commonly occurs in conjunction with articular cartilage injury. However, there is no consensus on the most appropriate rehabilitation which should be carried out for ACL reconstruction (ACLR) and the surgical management of articular cartilage lesions of the knee. The purpose of this study was to systematically review the literature to investigate the recommended rehabilitation protocol for patients undergoing ACLR with concomitant articular cartilage injury with a view to develop guidelines on the most appropriate treatment. METHODS Two reviewers independently searched five database for randomised controlled trials (RCTs), non-randomised comparative and retrospective cohort studies (CS) describing the management of concomitant ACL rupture and articular cartilage injury and the postoperative rehabilitation regimen. Risk of bias was performed using a modified Downs & Black's checklist. The primary outcome was specific rehabilitation protocols including weight-bearing status, immobilisation, continuous passive motion (CPM), and return to play criteria. Secondary outcomes included patient-reported outcomes. A best evidence synthesis was performed. RESULTS The review yielded six studies which reported on rehabilitation techniques. All studies were of low methodological quality. There was considerable variability in not only the chondral lesion reported but also the treatment techniques utilised and especially the rehabilitation regimes. No consensus was found on weight-bearing status, postoperative immobilisation, the use of CPM, or return to play criteria. Given the quality of the papers, there was no evidence to recommend any specific rehabilitation regime in the postoperative management of concomitant ACLR and articular cartilage lesions. CONCLUSION This systematic review revealed that despite how common concomitant ACL rupture and articular cartilage injury is, there is no evidence to support one, most appropriate rehabilitation protocol. From a clinical perspective, decisions on postoperative rehabilitation for patients undergoing ACLR and treatment of articular cartilage lesions should be made on a case-by-case basis with criteria-based progression until more robust evidence becomes available. A list of specific rehabilitation protocols based on the cartilage restoration technique is provided. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ciaran Thrush
- OrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia
| | - Tabitha J Porter
- OrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia
| | - Brian M Devitt
- OrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia.
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Filardo G, de Caro F, Andriolo L, Kon E, Zaffagnini S, Marcacci M. Do cartilage lesions affect the clinical outcome of anterior cruciate ligament reconstruction? A systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:3061-3075. [PMID: 27043346 DOI: 10.1007/s00167-016-4097-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/15/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To document the available evidence on the influence of cartilage lesions on the results of anterior cruciate ligament (ACL) surgery and their management to optimize the final outcome. METHODS A systematic review was performed on the PubMed database on articles dealing with cartilage lesions detected at the time of ACL reconstruction, by looking both for their influence on the clinical outcome and the results of their treatment. Reports on clinical, radiological, or second-look outcomes at any follow-up were included. Exclusion criteria were preclinical studies, reviews, or studies not reporting clinical, radiological, or second-look outcome after primary ACL reconstruction. RESULTS Thirty-seven studies were included for the final analysis. Twenty-seven focused on the influence of cartilage lesions on clinical outcome after ACL reconstruction in 47,837 patients. In total, 21/27 articles showed a correlation with a poorer outcome in terms of subjective, objective, and radiographic findings. Lesion location and depth influenced final results. Only 9.0 % of these defects were treated in the analysed studies, and only 10 manuscripts of overall low level evaluated the results of combined cartilage-ACL treatments. CONCLUSION The majority of the literature supports the clinical relevance of cartilage lesions which are correlated with a poorer outcome after ACL reconstruction. Nonetheless, a large amount of chondral defects are actually not addressed, also considering the poor evidence for the benefits provided by cartilage treatments. In fact, only a few studies specifically focused on how to manage cartilage lesions found during ACL reconstruction and there is a lack of indications for the most appropriate treatment approach. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Giuseppe Filardo
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Francesca de Caro
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Luca Andriolo
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
| | - Elizaveta Kon
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.,Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Maurilio Marcacci
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
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van Duijvenbode DC, Jonkers FJ, Könst YE, van Royen BJ, Benink RJ, Hoozemans MJM. Gel-type autologous chondrocyte implantation for cartilage repair in patients with prior ACL reconstruction: A retrospective two year follow-up. Knee 2016; 23:241-5. [PMID: 26826946 DOI: 10.1016/j.knee.2015.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/31/2015] [Accepted: 08/13/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the early patient-reported outcomes of articular cartilage repair in patients with pain due to grade III or IV articular cartilage defects after prior anterior cruciate ligament (ACL) reconstruction. METHODS Nineteen patients underwent a gel-type autologous chondrocyte implantation (GACI) procedure after ACL reconstruction. Median timeframe between ACL reconstruction and GACI procedure was 52 months (range 16 to 369). The average age at chondrocyte implantation was 35 (standard deviation (SD) eight) years and average cumulative articular cartilage defect size was nine (SD four) square centimeter. Outcome was assessed prior to the GACI procedure and two years after GACI using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS Two year post-GACI scores showed a statistically significant improvement of IKDC (13, SD 22, p=.02) and KOOS quality of life (18, SD 27, p=.01) compared to the pre-GACI scores. The other KOOS domains did improve, but not statistically significant. Seven (37%) patients underwent reoperation after the GACI. CONCLUSION Patients with prior ACL reconstruction and suffering from ongoing pain associated with cartilage defects can benefit from cartilage repair with GACI.
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Affiliation(s)
- D C van Duijvenbode
- Center for Orthopedic Research Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
| | - F J Jonkers
- Center for Orthopedic Research Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
| | - Y E Könst
- MOVE Research Institute, Faculty of Behaviourial en Movement Sciences Department of Human Movement Sciences, VU University Amsterdam Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
| | - B J van Royen
- Gemini Hospital Den Helder, Huisduinerweg 3, 1782 GZ Den Helder, The Netherlands.
| | - R J Benink
- Gemini Hospital Den Helder, Huisduinerweg 3, 1782 GZ Den Helder, The Netherlands.
| | - M J M Hoozemans
- Center for Orthopedic Research Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Røtterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Årøen A. Effect on Patient-Reported Outcomes of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament-Reconstructed Knees: A Nationwide Cohort Study From Norway and Sweden of 357 Patients With 2-Year Follow-up. Am J Sports Med 2016; 44:337-44. [PMID: 26657851 DOI: 10.1177/0363546515617468] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)-injured knees is debatable. PURPOSE To evaluate the effect of debridement or microfracture (MF) compared with no treatment of concomitant full-thickness (International Cartilage Repair Society [ICRS] grades 3-4) cartilage lesions on patient-reported outcomes after ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Six hundred forty-four patients who underwent primary unilateral ACL reconstruction and had a concomitant full-thickness cartilage lesion treated simultaneously by debridement (n = 129) or MF (n = 164), or underwent no treatment (n = 351) of the cartilage lesion, registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 to 2008 were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure patient-reported outcomes. At a mean follow-up of 2.1 ± 0.2 years after surgery, 357 (55%) patients completed the KOOS. Linear regression analyses were used to evaluate the effect of debridement or MF on the KOOS. RESULTS No significant effects of debridement were detected in the unadjusted or adjusted regression analyses on any of the KOOS subscales at 2-year follow-up. The MF treatment of the cartilage lesions had significant negative effects at 2-year follow-up on the KOOS Sport and Recreation (Sport/Rec) (regression coefficient [β] = -8.9; 95% confidence interval [CI], -15.1 to -1.5) and Knee-Related Quality of Life (QoL) (β = -8.1; 95% CI, -14.1 to -2.1) subscales in the unadjusted analyses. When adjusting for confounders, MF had significant negative effects on the same KOOS subscales of Sport/Rec (β = -8.6; 95% CI, -16.4 to -0.7) and QoL (β = -7.2; 95% CI, -13.6 to -0.8). For the remaining KOOS subscales of Pain, Symptoms, and Activities of Daily Living, there were no significant unadjusted or adjusted effects of MF. CONCLUSION MF of concomitant full-thickness cartilage lesions showed adverse effects on patient-reported outcomes at 2-year follow-up after ACL reconstruction. Debridement of concomitant full-thickness cartilage lesions showed neither positive nor negative effects on patient-reported outcomes at 2-year follow-up after ACL reconstruction.
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Affiliation(s)
- Jan Harald Røtterud
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
| | | | - Magnus Forssblad
- Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Oslo, Norway Department of Orthopedics, Oslo University Hospital, Oslo, Norway Norwegian Cruciate Ligament Register, Bergen, Norway
| | - Asbjørn Årøen
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway Oslo Sports Trauma Research Center, Oslo, Norway
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Tahami SM, Rad SMD. Outcome of ACL Reconstruction and Concomitant Articular Injury Treatment. THE ARCHIVES OF BONE AND JOINT SURGERY 2015; 3:260-263. [PMID: 26550590 PMCID: PMC4628632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/05/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence rate of 16-46%. Good results of ACL reconstruction combined with the treatment of chondral lesions have been published in some studies. METHOD After statistical analysis 30 patients were selected and divided in 2 groups. The first group consisted of 15 patients with isolated ACL tear without any other concomitant injuries and the second group consisted of 15 patients with ACL tear and concomitant high grade (grade 3 or 4 of outerbridge classification) contained articular cartilage injuries during arthroscopy. Group 1 underwent ACL reconstruction and group 2 underwent ACL reconstruction combined with chondroplasty via the drilling or microfracture technique. For each patient the Lysholm knee score questionnaire was completed before surgery, 6 months and 1 year after surgery. RESULTS The mean Lysholm knee score in both groups improves: 9.6 points after 6 months and 16.06 points after 1 year in group 1, 23.26 points after 6 months, 30.66 after 1 year in group 2, which was statistically significant (Pvalue<0.05). CONCLUSION Improvement in the Lysholm knee score in both groups shows that ACL reconstruction with concomitant chondroplasty in high grade chondral injuries has good results with patient satisfaction and improvement in their quality of life.
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Affiliation(s)
- Seyed Mohammad Tahami
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Dhinsa BS, Nawaz SZ, Gallagher KR, Skinner J, Briggs T, Bentley G. Outcome of combined autologous chondrocyte implantation and anterior cruciate ligament reconstruction. Indian J Orthop 2015; 49:155-63. [PMID: 26015603 PMCID: PMC4436480 DOI: 10.4103/0019-5413.152442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Instability of the knee joint, after anterior cruciate ligament (ACL) injury, is contraindication to osteochondral defect repair. This prospective study is to investigate the role of combined autologous chondrocyte implantation (ACI) with ACL reconstruction. MATERIALS AND METHODS Three independent groups of patients with previous ACL injuries undergoing ACI were identified and prospectively followed up. The first group had ACI in combination with ACL reconstruction (combined group); the 2(nd) group consisted of individuals who had an ACI procedure having had a previously successful ACL reconstruction (ACL first group); and the third group included patients who had an ACI procedure to a clinically stable knee with documented nonreconstructed ACL disruption (No ACL group). Their outcomes were assessed using the modified cincinnati rating system, the Bentley functional (BF) rating system (BF) and a visual analog scale (VAS). RESULTS At a mean followup of 64.24 months for the ACL first group, 63 months for combined group and 78.33 months for the No ACL group; 60% of ACL first patients, 72.73% of combined group and 83.33% of the No ACL group felt their outcome was better following surgery. There was no significant difference demonstrated in BF and VAS between the combined and ACL first groups. Results revealed a significant affect of osteochondral defect size on outcome measures. CONCLUSION The study confirms that ACI in combination with ACL reconstruction is a viable option with similar outcomes as those patients who have had the procedures staged.
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Affiliation(s)
- Baljinder S Dhinsa
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom,Address for correspondence: Dr. Baljinder S Dhinsa, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail:
| | - Syed Z Nawaz
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Kieran R Gallagher
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - John Skinner
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Tim Briggs
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - George Bentley
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom
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Imade S, Kumahashi N, Kuwata S, Iwasa J, Uchio Y. Effectiveness and limitations of autologous osteochondral grafting for the treatment of articular cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 2012; 20:160-5. [PMID: 21748393 DOI: 10.1007/s00167-011-1611-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 07/04/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effectiveness and limitations of autologous osteochondral grafting for the treatment of articular cartilage defects in the knee. METHODS The subjects were 40 patients who had undergone autologous osteochondral grafting. Fifteen knees had cartilage defects combined with anterior cruciate ligament tears (ACL group), 15 knees had cartilage defects combined with osteoarthritis (OA group), and 10 knees had cartilage defects combined with osteochondral dissecans (OCD group). From one to five osteochondral pegs were harvested from the less-weight-bearing periphery of the articular surface of the femoral condyle and grafted to cartilage defects. The clinical results were assessed based on the Lysholm score and radiographic and magnetic resonance imaging (MRI) image assessment. RESULTS The median follow-up duration was 24 months (range from 12 to 41 months). The mean Lysholm score following treatment was improved in all groups. The patients who had cartilage defects combined with OA had a significantly poorer prognosis than did those with cartilage defects combined with ACL or OCD. In the OA group, advanced stage and an alignment abnormality were correlated with poor prognosis. Advanced age was correlated with poor prognosis. Other parameters showed no significant difference in prognosis. CONCLUSION Autologous osteochondral grafting was found to be an effective technique for treating relatively young patients who had cartilage defects combined with ACL injury or OCD, but this technique showed limited results in treating cartilage defects based on advanced patient age and degenerative changes in the cartilage. LEVEL OF EVIDENCE Diagnostic studies-investigating a diagnostic test, Level III.
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Affiliation(s)
- Shinji Imade
- Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1, Enya, Izumo, Shimane, 693-8501, Japan.
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Brophy RH, Zeltser D, Wright RW, Flanigan D. Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment. Arthroscopy 2010; 26:112-20. [PMID: 20117635 DOI: 10.1016/j.arthro.2009.09.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 09/02/2009] [Accepted: 09/08/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Articular cartilage injuries commonly occur in conjunction with anterior cruciate ligament (ACL) injury. The exact incidence of this combined injury pattern, as well as the optimal treatment for it, has not been well studied in the literature. The purpose of this study was to systematically review the literature regarding the incidence of concomitant articular cartilage and ACL injury and the results of combined surgical treatment of these injuries. METHODS We performed a systematic review of studies investigating the incidence of articular cartilage injury in conjunction with ACL injury and the results of combined surgical treatment for these injuries. RESULTS On the basis of 5 studies in the literature, the incidence of severe articular cartilage injury in acute ACL tears is between 16% and 46%. On the basis of 3 studies on combined osteochondral autografts and ACL reconstruction and 2 studies on combined autologous chondrocyte implantation and ACL reconstruction, patients can have reasonable short-term outcomes after combined surgery. CONCLUSIONS Articular cartilage injury is often encountered at the time of ACL reconstruction, and combined surgery can result in reasonable outcomes. Additional studies are needed to better define both the incidence of combined injury and the outcome, particularly in the long term, after these procedures.
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Affiliation(s)
- Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
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Comparison of bioabsorbable interference screws and posts for distal fixation in anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2007; 33:123-7. [PMID: 18064457 DOI: 10.1007/s00264-007-0482-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 10/04/2007] [Indexed: 12/13/2022]
Abstract
Comparison of the results of bioabsorbable interference screws and posts for hamstring graft distal fixation in ACL reconstructions are presented. The results of 20 patients with bioabsorbable screws were compared to 22 patients with posts. The assessement was based on Lysholm-Gillquist and Marshall scores and the KT-1000 device. In the study group the points gained were 38.9 in the Lysholm-Gillquist and 12.89 in the Marshall scale. The average KT-1000 difference was 2.46 mm. In the control group the points gained were 32.93 in the Lysholm-Gillquist and 11.47 in the Marshall scale. The average KT-1000 difference was 2.5 mm. There were 14 patients in the study group with interference screw problems; in 2 the implants were removed. (1) There are no differences in outcome using bioabsorbable interference screws and posts for distal fixation of hamstring ACL grafts. (2) The lack of bioabsorbtion with poly L-lactide interference screws is frequent and causes problems.
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