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Ma Y, Lin Q, Wang X, Liu Y, Yu X, Ren Z, Zhang Y, Guo L, Wu X, Zhang X, Li P, Duan W, Wei X. Biomechanical properties of articular cartilage in different regions and sites of the knee joint: acquisition of osteochondral allografts. Cell Tissue Bank 2024; 25:633-648. [PMID: 38319426 PMCID: PMC11143059 DOI: 10.1007/s10561-024-10126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
Osteochondral allograft (OCA) transplantation involves grafting of natural hyaline cartilage and supporting subchondral bone into the cartilage defect area to restore its biomechanical and tissue structure. However, differences in biomechanical properties and donor-host matching may impair the integration of articular cartilage (AC). This study analyzed the biomechanical properties of the AC in different regions of different sites of the knee joint and provided a novel approach to OCA transplantation. Intact stifle joints from skeletally mature pigs were collected from a local abattoir less than 8 h after slaughter. OCAs were collected from different regions of the joints. The patella and the tibial plateau were divided into medial and lateral regions, while the trochlea and femoral condyle were divided into six regions. The OCAs were analyzed and compared for Young's modulus, the compressive modulus, and cartilage thickness. Young's modulus, cartilage thickness, and compressive modulus of OCA were significantly different in different regions of the joints. A negative correlation was observed between Young's modulus and the proportion of the subchondral bone (r = - 0.4241, P < 0.0001). Cartilage thickness was positively correlated with Young's modulus (r = 0.4473, P < 0.0001) and the compressive modulus (r = 0.3678, P < 0.0001). During OCA transplantation, OCAs should be transplanted in the same regions, or at the closest possible regions to maintain consistency of the biomechanical properties and cartilage thickness of the donor and recipient, to ensure smooth integration with the surrounding tissue. A 7 mm depth achieved a higher Young's modulus, and may represent the ideal length.
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Affiliation(s)
- Yongsheng Ma
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Qitai Lin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xueding Wang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Yang Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xiangyang Yu
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Zhiyuan Ren
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Yuanyu Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Li Guo
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xiaogang Wu
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Xiangyu Zhang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Pengcui Li
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Wangping Duan
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China.
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China.
| | - Xiaochun Wei
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
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Alvero AB, Wright-Chisem J, Vogel MJ, Wright-Chisem A, Mather RC, Nho SJ. Treatment of Hip Cartilage Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:95-103. [PMID: 38978203 DOI: 10.1097/jsa.0000000000000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Chondral defects in the athlete's hip are a relatively common occurrence, often presenting with debilitating pain and activity limitation. Preoperative identification of cartilage defects is challenging and there are many different modalities for treatment. Nonsurgical interventions, including activity modification, physical therapy, and injections, play a vital role, especially in less severe cases and as adjuncts to surgical intervention. Treating surgeons must be familiar with the cartilage restoration procedures available, including debridement, microfracture, and various implantation and transplantation options. Safe and effective management of cartilage defects is imperative to an athlete's return to sport. It is also imperative that surgeons are aware of all these various treatment options to determine what modality is best for their patients. This review serves to outline these options, cover the published literature, and provide general guidelines for surgeons when they encounter chondral defects in the office and the operating room.
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Affiliation(s)
- Alexander B Alvero
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL
| | - Joshua Wright-Chisem
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL
| | - Michael J Vogel
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL
| | - Adam Wright-Chisem
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Richard C Mather
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL
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Ma Y, Lin Q, Yang W, Liu Y, Xing Y, Ren Z, Wang X, Zhou R, Wu G, Li P, Duan W, Zhang X, Wei X. High-Speed Centrifugation Efficiently Removes Immunogenic Elements in Osteochondral Allografts. Orthop Surg 2024; 16:675-686. [PMID: 38238250 PMCID: PMC10925494 DOI: 10.1111/os.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES The current clinical pulse lavage technique for flushing fresh osteochondral allografts (OCAs) to remove immunogenic elements from the subchondral bone is ineffective. This study aimed to identify the optimal method for removing immunogenic elements from OCAs. METHODS We examined five methods for the physical removal of immunogenic elements from OCAs from the femoral condyle of porcine knees. We distributed the OCAs randomly into the following seven groups: (1) control, (2) saline, (3) ultrasound, (4) vortex vibration (VV), (5) low-pulse lavage (LPL), (6) high-pulse lavage (HPL), and (7) high-speed centrifugation (HSC). OCAs were evaluated using weight measurement, micro-computed tomography (micro-CT), macroscopic and histological evaluation, DNA quantification, and chondrocyte activity testing. Additionally, the subchondral bone was zoned to assess the bone marrow and nucleated cell contents. One-way ANOVA and paired two-tailed Student's t-test are used for statistical analysis. RESULTS Histological evaluation and DNA quantification showed no significant reduction in marrow elements compared to the control group after the OCAs were treated with saline, ultrasound, or VV treatments; however, there was a significant reduction in marrow elements after LPL, HPL, and HSC treatments. Furthermore, HSC more effectively reduced the marrow elements of OCAs in the middle and deep zones compared with LPL (p < 0.0001) and HPL (p < 0.0001). Macroscopic evaluation revealed a significant reduction in blood, lipid, and marrow elements in the subchondral bone after HSC. Micro-CT, histological analyses, and chondrocyte viability results showed that HSC did not damage the subchondral bone and cartilage; however, LPL and HPL may damage the subchondral bone. CONCLUSION HSC may play an important role in decreasing immunogenicity and therefore potentially increasing the success of OCA transplantation.
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Affiliation(s)
- Yongsheng Ma
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Qitai Lin
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Wenming Yang
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Yang Liu
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Yugang Xing
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Zhiyuan Ren
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Xueding Wang
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Raorao Zhou
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Gaige Wu
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Pengcui Li
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Wangping Duan
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
| | - Xiaoling Zhang
- Department of Orthopedic SurgeryXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xiaochun Wei
- Department of OrthopaedicsSecond Hospital of Shanxi Medical UniversityTaiyuanChina
- Shanxi Key Laboratory of Bone and Soft Tissue Injury RepairTaiyuanChina
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Wang X, Ren Z, Liu Y, Ma Y, Huang L, Song W, Lin Q, Zhang Z, Li P, Wei X, Duan W. Characteristics and Clinical Outcomes After Osteochondral Allograft Transplantation for Treating Articular Cartilage Defects: Systematic Review and Single-Arm Meta-analysis of Studies From 2001 to 2020. Orthop J Sports Med 2023; 11:23259671231199418. [PMID: 37745815 PMCID: PMC10515554 DOI: 10.1177/23259671231199418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results. Purpose To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects. Study Design Systematic review; Level of evidence, 4. Methods We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis. Results In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m2. The mean lesion area was 5.05 cm2, the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm2, and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty. Conclusion The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.
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Affiliation(s)
- Xueding Wang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Zhiyuan Ren
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Yang Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Yongsheng Ma
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Lingan Huang
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Wenjie Song
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Qitai Lin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Zhipeng Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Pengcui Li
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Xiaochun Wei
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Wangping Duan
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
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Stark M, Rao S, Gleason B, Jack RA, Tucker B, Hammoud S, Freedman KB. Rehabilitation and Return-to-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211017135. [PMID: 34377714 PMCID: PMC8320585 DOI: 10.1177/23259671211017135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport. Purpose: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature, SPORTDiscus, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies on knee OCA. Studies were included if they reported return-to-play data or postsurgical rehabilitation protocols. Results: A total of 62 studies met the inclusion criteria, with a total of 3451 knees in 3355 patients. Concomitant procedures were included in 30 of these studies (48.4%). The most commonly cited rehabilitation protocols included weightbearing restrictions and ROM guidelines in 100% and 90% of studies, respectively. ROM was most commonly initiated within the first postoperative week, with approximately half of studies utilizing continuous passive motion. Progression to weightbearing as tolerated was reported in 60 studies, most commonly at 6 weeks (range, immediately postoperatively to up to 1 year). Of the 62 studies, 37 (59.7%) included an expected timeline for either return to play or return to full activity, most commonly at 6 months (range, 4 months to 1 year). Overall, 13 studies (21.0%) included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. Conclusion: There is significant heterogeneity for postoperative rehabilitation guidelines and the return-to-play protocol after OCA of the knee in the literature, as nearly half of the included studies reported use of concomitant procedures. However, current protocols appear to be predominantly time-based without objective criteria or functional assessment. Therefore, the authors recommend the development of objective criteria for patient rehabilitation and return-to-play protocols after OCA of the knee.
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Affiliation(s)
- Michael Stark
- Division of Orthopaedic Surgery, Rowan University, Stratford, New Jersey, USA
| | - Somnath Rao
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brendan Gleason
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Bradford Tucker
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sommer Hammoud
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Hacken BA, LaPrade MD, Stuart MJ, Saris DBF, Camp CL, Krych AJ. Small Cartilage Defect Management. J Knee Surg 2020; 33:1180-1186. [PMID: 32898908 DOI: 10.1055/s-0040-1716359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cartilage defects in the knee are common resulting in significant pain and morbidity over time. These defects can arise in isolation or concurrently with other associated injuries to the knee. The treatment of small (< 2-3 cm2) cartilage deficiencies has changed as our basic science knowledge of tissue healing has improved. Advancements have led to the development of new and more effective treatment modalities. It is important to address any associated knee injuries and limb malalignment. Surgical options are considered when nonoperative treatment fails. The specific procedure depends on individual patient characteristics, lesion size, and location. Debridement/chondroplasty, microfracture, marrow stimulation plus techniques, fixation of unstable osteochondral fragments, osteochondral autograft transfer, and osteochondral allograft transplantation, all have roles in the treatment of small cartilage defects.
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Affiliation(s)
- Brittney A Hacken
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew D LaPrade
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
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Use of a Superolateral Portal and 70° Arthroscope to Optimize Visualization of Patellofemoral Tracking and Osteochondral Lesions in Patients With Recurrent Patellar Instability. Arthrosc Tech 2020; 9:e1731-e1736. [PMID: 33294334 PMCID: PMC7695614 DOI: 10.1016/j.eats.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/18/2020] [Indexed: 02/03/2023] Open
Abstract
Surgical treatment of patellofemoral instability and associated cartilaginous lesions can be technically challenging. Visualization of patellar tracking and underlying osteochondral lesions is paramount to operative success. To treat these conditions effectively, a comprehensive arthroscopic assessment of the patellofemoral joint as well as dynamic visualization of patella tracking must be achieved. Visualization of the patellofemoral joint-in particular, the articular cartilage of the patella and trochlea morphology-can be difficult when using traditional anteromedial or anterolateral portals and a 30° arthroscope lens. The technique described here uses an accessory superolateral portal and a 70° arthroscope to achieve significantly improved visualization of the patellofemoral articulation, in particular the chondral surfaces. This vantage point aids the surgeon in effectively evaluating patellar tracking, trochlea morphology, and importantly, osteochondral lesion location to help guide treatment algorithms in the patellofemoral joint.
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