1
|
Bohlen H, Karasavvidis T, Wen D, Wong FKL, Wang D. Early Complication Rates Are Equivalent Between Isolated Cartilage Restoration and Concomitant Cartilage Restoration and Osteotomy of the Knee. Cartilage 2024; 15:94-99. [PMID: 37592438 DOI: 10.1177/19476035231194769] [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] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE Realignment osteotomy performed concomitantly with cartilage restoration typically requires early restricted weightbearing and can add significant morbidity, potentially leading to an increased risk of early perioperative complications. The purpose of this study was to compare the 30-day complication rates after isolated cartilage restoration (ICR) versus concomitant cartilage restoration and osteotomy (CRO) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. DESIGN NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing ICR (autologous chondrocyte implantation, osteochondral autograft transfer, or osteochondral allograft transplantation) and CRO (with concomitant high tibial osteotomy, distal femoral osteotomy, and/or tibial tubercle osteotomy). Complications rates between treatment groups were compared using multivariate logistic regression analyses adjusted for sex, age, steroid use, and respiratory status. RESULTS A total of 773 ICR and 97 CRO surgical procedures were identified. Mean patient ages were 35.9 years for the ICR group and 31.2 years for the CRO group. Operative time was significantly longer in the CRO group (170.8 min) compared with the ICR group (97.8 min). Multivariate analysis demonstrated no significant differences in rates of PE, VTE, and all-cause readmission between the ICR and CRO groups. No events of wound disruption, SSI and reoperation were found in the CRO group, while the ICR group was characterized by low rates of wound disruption, reoperation, and SSI (<1.1%). CONCLUSIONS These findings further support concomitant osteotomy with cartilage restoration when appropriate and aid surgeons in the preoperative counseling of patients undergoing cartilage restoration treatment.
Collapse
Affiliation(s)
- Hunter Bohlen
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
| | | | - Deborah Wen
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
| | - Francis K L Wong
- Department of Orthopaedic Surgery, Sengkang General Hospital, Musculoskeletal Sciences ACP, Singhealth-DukeNUS Graduate Medical School, Sengkang General Hospital, Singapore
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
- Department of Biomedical Engineering, University of California-Irvine, Irvine, CA, USA
| |
Collapse
|
2
|
Choe RH, Kuzemchak BC, Kotsanos GJ, Mirdamadi E, Sherry M, Devoy E, Lowe T, Packer JD, Fisher JP. Designing Biomimetic 3D-Printed Osteochondral Scaffolds for Enhanced Load-Bearing Capacity. Tissue Eng Part A 2024. [PMID: 38481121 DOI: 10.1089/ten.tea.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Osteoarthritis is a debilitating chronic joint disorder that affects millions of people worldwide. Since palliative and surgical treatments cannot completely regenerate hyaline cartilage within the articulating joint, osteochondral (OC) tissue engineering has been explored to heal OC defects. Utilizing computational simulations and three-dimensional (3D) printing, we aimed to build rationale around fabricating OC scaffolds with enhanced biomechanics. First, computational simulations revealed that interfacial fibrils within a bilayer alter OC scaffold deformation patterns by redirecting load-induced stresses toward the top of the cartilage layer. Principal component analysis revealed that scaffolds with 800 μm long fibrils (scaffolds 8A-8H) possessed optimal biomechanical properties to withstand compression and shear forces. While compression testing indicated that OC scaffolds with 800 μm fibrils did not have greater compressive moduli than other scaffolds, interfacial shear tests indicated that scaffold 8H possessed the greatest shear strength. Lastly, failure analysis demonstrated that yielding or buckling models describe interfacial fibril failure depending on fibril slenderness S. Specifically for scaffolds with packing density n = 6 and n = 8, the yielding failure model fits experimental loads with S < 10, while the buckling model fitted scaffolds with S < 10 slenderness. The research presented provides critical insights into designing 3D printed interfacial scaffolds with refined biomechanics toward improving OC tissue engineering outcomes.
Collapse
Affiliation(s)
- Robert H Choe
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, Maryland, USA
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, Maryland, USA
| | - Blake C Kuzemchak
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, Maryland, USA
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, Maryland, USA
| | - George J Kotsanos
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, Maryland, USA
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, Maryland, USA
| | - Eman Mirdamadi
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, Maryland, USA
- Department of Oral and Maxillofacial Surgery, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Mary Sherry
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, Maryland, USA
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, Maryland, USA
| | - Eoin Devoy
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, Maryland, USA
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, Maryland, USA
| | - Tao Lowe
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, Maryland, USA
- Department of Oral and Maxillofacial Surgery, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Jonathan D Packer
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John P Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, Maryland, USA
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, Maryland, USA
| |
Collapse
|
3
|
Breulmann F, Mehl J, Otto A, Lappen S, Siebenlist S, Rab P. [Treatment of osteochondritis dissecans]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:69-82. [PMID: 38189958 DOI: 10.1007/s00132-023-04461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/09/2024]
Abstract
Osteochondritis dissecans (OD) is a rare condition with an incidence of 30/100,000. It especially affects male patients aged 10-20 years old. During the staged progression the osteochondral fragments can detach from their base. These can damage the adjacent articular cartilage, which can lead to premature osteoarthritis. Most commonly affected are the knee, ankle and elbow joints. The exact pathogenesis of OD has so far not been clearly confirmed. Several risk factors that can lead to the development of OD are discussed. These include repeated microtrauma and vascularization disorders that can lead to ischemia of the subchondral bone and to a separation of the fragments close to the joint and therefore to the development of free joint bodies. For an adequate clarification patients should undergo a thorough radiological evaluation including X‑ray imaging followed by magnetic resonance imaging (MRI) to assess the integrity of the cartilage-bone formation with determination of the OD stage. The assessment is based on criteria of the International Cartilage Repair Society (ICRS). The instability of the cartilage-bone fragment increases with higher stages. Stages I and II with stable cartilage-bone interconnection can be treated conservatively. For stages III and IV, i.e., instability of the OD fragment or the presence of free fragments, surgical treatment should be performed. Primarily, refixation of a free joint body should be carried out depending on the size and vitality of the fragment. In cases of unsuccessful conservative treatment or fixation, a debridement, if necessary in combination with a bone marrow stimulating procedure, can be employed corresponding to the size of the defect. For larger cartilage defects, an osteochondral graft transplantation should be considered. Overall, OD lesions in stages I and II show a good healing tendency under conservative treatment. In cases of incipient unstable OD, refixation can also lead to good clinical and radiological results.
Collapse
Affiliation(s)
- Franziska Breulmann
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, 81675, München, Deutschland
| | - Julian Mehl
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, 81675, München, Deutschland
| | - Alexander Otto
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, 81675, München, Deutschland
| | - Sebastian Lappen
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, 81675, München, Deutschland
| | - Sebastian Siebenlist
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, 81675, München, Deutschland.
| | - Peter Rab
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, 81675, München, Deutschland
| |
Collapse
|
4
|
Alasaad HH, Ibrahim J. A case report of an adult with bilateral osteochondritis dissecans of the femoral condyles in both knees. Int J Surg Case Rep 2023; 103:107868. [PMID: 36634502 PMCID: PMC9843273 DOI: 10.1016/j.ijscr.2022.107868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION There are several possible treatment options for the treatment of focal cartilage defects in the knee. Determining the appropriate treatment option to compensate for an osteochondral defect caused by osteochondritis dissecans (OCD) in adults is difficult. This study was conducted to clarify the importance of Autogenous Osteochondral Grafting by a mosaicplasty method in treating OCD, relieving pain, and improving knee function. CASE REPORT Our study is a case report of a young female patient with osteochondritis dissecans in both the medial and lateral femoral condyles of both knees. Three of these were treated with autogenous osteochondral grafting using a mosaicplasty method. The case was done in 2016 and followed up for 5 years, where the functional results were evaluated according to International Knee Documentation Committee (IKDC Questionnaire) and the pain was assessed on a visual analogue scale (VAS). DISCUSSION There were no complications associated with surgery. We observed improvement in knee function according to the IKDC questionnaire from 38 before surgery to 85 after a year of surgery and her pain decreased significantly according to the visual analogue scale (VAS) from 7 before surgery to 1 after a year of surgery and continued until the end of the follow-up period. CONCLUSION Autologous osteochondral grafting with the mosaicplasty method is a good treatment option to treat osteochondritis dissecans (OCD) in the knee, as it helps to relieve pain and improve the functional state of the knee.
Collapse
|
5
|
Chau MM, Tompkins MA. Osteochondritis Dissecans of the Knee in Young Athletes. Clin Sports Med 2022; 41:579-594. [DOI: 10.1016/j.csm.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
6
|
Holwein C, Jungmann P, Suchowierski J, Gersing A, Wörtler K, Brucker P, Angele P, Imhoff A, Vogt S. Sandwich Technique for Large Osteochondral Lesions of the Knee. Cartilage 2022; 13:19476035221102571. [PMID: 35906752 PMCID: PMC9340910 DOI: 10.1177/19476035221102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years. DESIGN Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). RESULTS Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up (P < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant (P = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months (P < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months (P < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up (P < 0.05) but did not correlate with clinical scores or defect filling. CONCLUSION MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients' activity levels remain low, even 2 years after surgery.
Collapse
Affiliation(s)
- C. Holwein
- Orthopädisch-Unfallchirurgisches Zentrum, Alb Fils Kliniken GmbH, Göppingen, Germany,Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,C. Holwein, Rohrbachstraße 11, 73337 Bad Überkingen, Germany.
| | - P.M. Jungmann
- Zentrales Röntgeninstitut Kantonsspital Graubünden, Spital Davos AG, Davos, Switzerland
| | - J. Suchowierski
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - A.S. Gersing
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,Institut für Neuroradiologie, Klinikum der Universität München, München, Germany
| | - K. Wörtler
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - P.U. Brucker
- MVZ ATOS Klinik München, München, Germany,Orthopädie in der Ottostraße, München, Germany
| | - P. Angele
- Klinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany,Sporthopaedicum Regensburg, Regensburg, Germany
| | - A.B. Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - S. Vogt
- Sportorthopädie und arthroskopische Chirurgie, Hessing Stiftung, Augsburg, Germany
| |
Collapse
|
7
|
Ai C, Lee YHD, Tan XH, Tan SHS, Hui JHP, Goh JCH. Osteochondral tissue engineering: Perspectives for clinical application and preclinical development. J Orthop Translat 2021; 30:93-102. [PMID: 34722152 PMCID: PMC8517716 DOI: 10.1016/j.jot.2021.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 01/17/2023] Open
Abstract
The treatment of osteochondral defects (OCD) remains challenging. Among currently available surgical treatments for OCDs, scaffold-based treatments are promising to regenerate the osteochondral unit. However, there is still no consensus regarding the clinical effectiveness of these scaffold-based therapies for OCDs. Previous reviews have described the gradient physiological characteristics of osteochondral tissue and gradient scaffold design for OCD, tissue engineering strategies, biomaterials, and fabrication technologies. However, the discussion on bridging the gap between the clinical need and preclinical research is still limited, on which we focus in the present review, providing an insight into what is currently lacking in tissue engineering methods that failed to yield satisfactory outcomes, and what is needed to further improve these techniques. Currently available surgical treatments for OCDs are firstly summarized, followed by a comprehensive review on experimental animal studies in recent 5 years on osteochondral tissue engineering. The review will then conclude with what is currently lacking in these animal studies and the recommendations that would help enlighten the community in developing more clinically relevant implants. The translational potential of this article This review is attempting to summarize the lessons from clinical and preclinical failures, providing an insight into what is currently lacking in TE methods that failed to yield satisfactory outcomes, and what is needed to further improve these implants.
Collapse
Affiliation(s)
- Chengchong Ai
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Yee Han Dave Lee
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Xuan Hao Tan
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University Health System, Singapore.,NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore.,Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Cho-Hong Goh
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore.,NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore.,Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|