1
|
Kumagai K, Yamada S, Nejima S, Sotozawa M, Inaba Y. Minimum 5-Year Outcomes of Osteochondral Autograft Transplantation with a Concomitant High Tibial Osteotomy for Spontaneous Osteonecrosis of the Knee with a Large Lesion. Cartilage 2022; 13:19476035221126341. [PMID: 36117434 PMCID: PMC9634997 DOI: 10.1177/19476035221126341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the mid-term clinical outcomes of osteochondral autograft transplantation (OAT) with concomitant high tibial osteotomy (HTO) in spontaneous osteonecrosis of the knee (SONK) with a large lesion. DESIGN A total of 48 knees of 48 consecutive patients with SONK (lesion size ≥4 cm2, no age criteria) who underwent opening wedge HTO and concomitant OAT were retrospectively investigated, and those who were followed up postoperatively for at least 5 years were included in this case series study. Clinical outcomes were evaluated using knee and function scores of Knee Society Score, radiographic outcomes were evaluated using the anatomical femorotibial angle (FTA), and these outcomes were compared between patients aged ≥70 years and <70 years. RESULTS Of the 48 cases, a total of 43 cases were available for review at a minimum of 5 years, and 5 cases were excluded from the analysis. Overall, the mean knee score improved from preoperative 48.8 ± 13.3 to postoperative 87.9 ± 8.6 at 1 year (P < 0.05) and 85.0 ± 10.4 at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). The mean function score also improved from preoperative 60.1 ± 10.9 to postoperative 87.3 ± 12.2 at 1 year (P < 0.05) and 84.2 ± 12.4 at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). The mean standing FTA was corrected significantly from 181.1° ± 2.7° preoperatively to 169.7° ± 2.4° at 1 year (P < 0.05) and 169.4° ± 3.1° at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). There were no significant differences in clinical and radiographic outcomes between patients aged ≥70 years and <70 years. There were 4 cases of lateral hinge fracture around the osteotomy site and 1 case of delayed union. None of the patients underwent revision surgery during the follow-up period (survival rate of 100%). CONCLUSIONS Mid-term clinical outcomes of patients with SONK who underwent HTO and OAT with a relatively large lesion were good.
Collapse
Affiliation(s)
- Ken Kumagai
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Yokohama City University, Yokohama, Japan,Ken Kumagai, Department of Orthopaedic
Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura,
Kanazawa-ku, Yokohama 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| |
Collapse
|
2
|
Kumagai K, Yamada S, Nejima S, Sotozawa M, Inaba Y. Biological Effects of High Tibial Osteotomy on Spontaneous Osteonecrosis of the Knee. Cartilage 2022; 13:19476035221118171. [PMID: 35997249 PMCID: PMC9421024 DOI: 10.1177/19476035221118171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the postoperative status of spontaneous osteonecrosis of the knee (SONK) after high tibial osteotomy (HTO) with concomitant bone marrow stimulation (BMS) using synovial fluid (SF) biomarkers. DESIGN Twenty patients with SONK who underwent opening wedge HTO were enrolled. Paired SF samples from the affected knee were collected at the time of HTO surgery and at the time of plate removal. SF concentrations of interleukin (IL)-6, IL-8, and matrix metalloproteinase (MMP)-13 were measured by enzyme-linked immunosorbent assays. The Knee Society Score (KSS) and hip-knee-ankle (HKA) angle were assessed before and 2 years after HTO. RESULTS The KSS knee and function scores were significantly improved after HTO (mean changes of 33.8 and 29.4, respectively). The mean HKA angle was changed from mechanical varus (-8.6°) to valgus (5.2°). Concentrations of IL-6, IL-8, and MMP-13 were significantly decreased after HTO (mean changes of -73.7%, -32.4%, and -47.9% from preoperative baseline, respectively). Significant correlations were found between lesion size and concentrations of biomarkers, except for preoperative MMP-13. CONCLUSIONS SF levels of biomarkers of inflammation and cartilage degradation were reduced after HTO with a concomitant BMS procedure, suggesting a biological improvement in SONK.
Collapse
Affiliation(s)
- Ken Kumagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan,Ken Kumagai, Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan
| |
Collapse
|
3
|
BALTA O, ŞAHİN K, ZENGİN Ç, EREN MB, ALTINAYAK H, DEMİR O. Severity of subchondral insufficiency knee fracture: is it associated with increasing age, femorotibial angle, and severity of meniscus extrusion? Journal of Health Sciences and Medicine 2022. [DOI: 10.32322/jhsm.1065127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
4
|
Hashimoto S, Terauchi M, Hatayama K, Ohsawa T, Omodaka T, Chikuda H. Medial meniscus extrusion as a predictor for a poor prognosis in patients with spontaneous osteonecrosis of the knee. Knee 2021; 31:164-171. [PMID: 34214956 DOI: 10.1016/j.knee.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/26/2021] [Accepted: 06/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Risk factors for the progression of spontaneous osteonecrosis of the knee (SONK) remain unclear. The purpose of this study was to investigate the association between magnetic resonance imaging (MRI) findings of the meniscus and the prognosis of SONK. METHODS A total of 78 consecutive patients (female 85%; mean age 75.6 ± 7.2 years old) diagnosed with SONK were included. Of these, 30 patients did not receive surgery within 1 year from the onset of SONK (conservative group), while the remaining 48 patients underwent unicompartmental knee arthroplasty due to worsening of symptoms (UKA group). Using MRI findings obtained within 3 months of the onset, we compared the types of meniscus tear and medial meniscus extrusion between the conservative group and UKA group. We performed a receiver operating characteristics (ROC) analysis to estimate the cut-off value. RESULTS Patients in the UKA group showed greater medial meniscus extrusion (absolute value, 4.2 mm ± 1.9 vs. 2.8 mm ± 1.2, P = 0.001; relative percentage of extrusion (RPE), 45.7% ± 21.5 vs. 30.7% ± 12.9, P = 0.001) and a higher prevalence of radial tear (P = 0.021) than those in the conservative group. In the multivariate analysis, RPE remained a relevant independent factor (P = 0.035) for future UKA. An ROC analysis found that the cut-off point of RPE was 33% (sensitivity, 81.2%; specificity, 63.3%). CONCLUSION RPE was a predictor of the prognosis of patients who underwent UKA within 1 year after the onset of SONK. Our results suggest that patients with RPE ≥ 33% are at high risk for progression.
Collapse
Affiliation(s)
- Shogo Hashimoto
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan.
| | - Masanori Terauchi
- Department of Orthopaedic Surgery, Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Kazuhisa Hatayama
- Department of Orthopaedic Surgery, Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Kiryu Orthopedic Hospital, Kiryu, Gunma, Japan
| | - Takuya Omodaka
- Department of Orthopaedic Surgery, Zensyukai Hospital, Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| |
Collapse
|
5
|
Choi HG, Kim JS, Yoo HJ, Jung YS, Lee YS. The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures. Am J Sports Med 2021; 49:1551-1560. [PMID: 33793351 DOI: 10.1177/03635465211002160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. PURPOSE To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). STUDY DESIGN Cohort study; Level of evidence 3. METHODS A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. RESULTS The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia (P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). CONCLUSION OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.
Collapse
Affiliation(s)
- Han Gyeol Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| | - Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| | - You Sun Jung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, Republic of Korea
| |
Collapse
|
6
|
Husain R, Nesbitt J, Tank D, Verastegui MO, Gould ES, Huang M. Spontaneous osteonecrosis of the knee (SONK): The role of MR imaging in predicting clinical outcome. J Orthop 2020; 22:606-611. [PMID: 33311863 DOI: 10.1016/j.jor.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/15/2020] [Indexed: 10/23/2022] Open
Abstract
Background/aim We try to investigate the association between patterns of imaging findings in patients who had a diagnosis of subchondral fracture around the knee, formerly known as SONK and their clinical outcome. Materials and methods We retrospectively identified 43 knees of 37 patients (28 males, 15 females) who had diagnosis of subchondral fractures around the knee. The mean age is 56-year-old (range 17-83). Musculoskeletal fellowship trained radiologist evaluated all 43 knee MRI in: 1)location of marrow edema 2)peri-osseous edema; 3) subchondral fracture line; 4) subchondral articular surface contour; 5)meniscal tear and extrusion; 6)adjacent soft tissue edema; 7) joint effusion. Independent clinical chart review was performed for clinical outcome with follow up time average of 13.3 months (range 0-88 months). Bad outcome was defined as worsening on imaging, continued complaint with surgical management and knee replacement or another episode of SONK. Chi-square analysis and Student's T tests were conducted to test the statistical significance of association between MR findings and outcomes. Statistical significance was set at p = 0.05 level. Results Of 43 knees, 6 patients had another episodes of SONK (14%), 11 patients were not improving or needed injection vs arthroscopy (26%), 4 patients required arthroplasty (9%), 22 patients had no negative outcome (51%). Gender, age, diabetic status, and location of the subchondral fracture show no influence on outcome. Worse outcome group had a significantly higher average BMI (31.7 vs. 28.0, P = 0.02). Positive change of subchondral articular surface contour is the only imaging finding with positive association with worse outcome (80% vs. 39.9%, P = 0.02). Presence of positive findings of above 3), 4), 5) and 6) had higher percentage of bad outcome (77.8%) compared to those with less positive findings (47.2%). Conclusion MR imaging findings may help at identifying SONK patient with potential risk of developing bad outcome.
Collapse
Affiliation(s)
- Rola Husain
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, NY, USA
| | - Jared Nesbitt
- Department of Radiology, Stony Brook Medicine, NY, USA
| | - Dharmesh Tank
- Department of Radiology, Stony Brook Medicine, NY, USA
| | | | | | - Mingqian Huang
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, NY, USA
| |
Collapse
|
7
|
Nishitani K, Nakagawa Y, Matsuda S. Osteochondral Autograft Transplant as a Potential Salvage Procedure for Articular Cartilage Defects of the Lateral Compartment in Lateral Meniscus-Deficient Knees: Results From a Country With Limited Availability of Meniscal Transplant. Orthop J Sports Med 2020; 8:2325967120962753. [PMID: 33225008 PMCID: PMC7653291 DOI: 10.1177/2325967120962753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022] Open
Abstract
Background: The treatment of a meniscus-deficient knee is challenging, especially when
patients are young and active and are not favorable candidates for
prosthetic joint replacement. Hypothesis: We hypothesized that osteochondral autologous transplant (OAT) alone can be
considered a salvage treatment for patients with cartilage damage of the
lateral compartment of the knee, even with lateral meniscal deficiency, if
the knee alignment is close to neutral. Study Design: Case series; Level of evidence, 4. Methods: Patients with lateral meniscal deficiency, whose femorotibial angle was 170°
to 180° and who underwent OAT on the lateral compartment of the knee without
concomitant realignment osteotomy, were retrospectively included in this
study. The International Knee Documentation Committee (IKDC) subjective
score and the Japanese Orthopaedic Association score for knee osteoarthritis
(JOA knee score) were recorded. The International Cartilage Repair Society
(ICRS) cartilage repair assessment was used to evaluate the repaired
cartilage at second-look arthroscopy. Results: The study included 10 patients (mean ± SD age, 31.7 ± 19.7 years; 3 men and 7
women) who had ICRS grade 4 cartilage lesions (mean size, 3.5 ± 1.7
cm2); the mean follow-up was 73.8 ± 42.5 months. From
preoperative assessment to final follow-up, the mean IKDC subjective score
improved significantly from 53.5 ± 10.0 to 85.4 ± 10.1, and the mean JOA
knee score improved significantly from 81.0 ± 8.4 to 95.6 ± 5.3
(P = .004 for both). One patient with a femorotibial
angle of 170° underwent revision distal femoral osteotomy owing to prolonged
symptoms and progression of the valgus deformity, and 2 other patients with
femorotibial angles of 170° and 171° also exhibited progression of valgus
malalignment or low clinical scores postoperatively. Patients with a
favorable femorotibial angle (174°-178°) exhibited relieved symptoms and
preservation of femorotibial angle alignment within 1° of change at
follow-up. At second-look arthroscopy (n = 8 patients), 6 patients had an
ICRS score of nearly normal or normal. Conclusion: In the study patients, for which a meniscal allograft was unavailable, the
OAT procedure was able to relieve the symptoms associated with cartilage
lesions, even with lateral meniscal deficiency, when the femorotibial angle
alignment was close to neutral.
Collapse
Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine,
Kyoto University, Kyoto, Japan
- Kohei Nishitani, MD, PhD, Department of Orthopaedic Surgery,
Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo,
Kyoto 606-8507, Japan (
)
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization
Kyoto Medical Center, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine,
Kyoto University, Kyoto, Japan
| |
Collapse
|
8
|
Yang T, Xue H, Ma T, Wen T, Xue L, Guan M, Tu Y. Lateral Unicompartmental knee arthroplasty for a secondary osteonecrosis of the lateral femoral condyle. A case report. BMC Musculoskelet Disord 2020; 21:585. [PMID: 32867743 PMCID: PMC7461265 DOI: 10.1186/s12891-020-03585-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background Secondary osteonecrosis of the knee is a rare event. There are few reports regarding management of this condition. The aim of the present study is to report treatment outcomes for secondary osteonecrosis of the lateral condyle treated with unicompartmental knee arthroplasty (UKA). Case presentation A 54-year-old woman with idiopathic thrombocytopenic purpura, who received low-dosage corticosteroids, complained of knee pain for 5 years and difficulty walking in the last 5 months. Fixed-bearing lateral UKA was performed under general anesthesia combined with midthigh saphenous nerve block. The patient could walk without ambulation aid shortly after the operation and achieved satisfactory knee joint function at the 6-week follow-up. The knee society score (KSS) increased from 68 to 91. The follow-up period was up to 1 year. There was no pain, loosening, or fracture of the prosthesis at the latest follow-up. Conclusions This case study demonstrates successful management of secondary osteonecrosis of the lateral femoral condyle is possible with a fixed bearing lateral UKA. Early diagnosis, rigorous indication, and appropriate surgical techniques were critical to maximizing prosthesis stability in lateral UKA.
Collapse
Affiliation(s)
- Tao Yang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Huaming Xue
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Tong Ma
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Tao Wen
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Long Xue
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Mengyin Guan
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Yihui Tu
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.
| |
Collapse
|
9
|
Tsukamoto H, Saito H, Saito K, Yoshikawa T, Oba M, Sasaki K, Sato C, Akagawa M, Takahashi Y, Miyakoshi N, Shimada Y. Radiographic deformities of the lower extremity in patients with spontaneous osteonecrosis of the knee. Knee 2020; 27:838-845. [PMID: 32331828 DOI: 10.1016/j.knee.2020.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spontaneous osteonecrosis of the knee (SONK) is one of the acute knee pain disorders arising in elderly patients. The presence of knee varus alignment and the size of necrotic area have been reported as the negative prognostic factors in prior studies. However, no previous study has yet clarified the radiological analysis of the lower extremity in SONK compared with that in osteoarthritis. The purpose of this study was therefore to identify the radiographic findings of the lower extremity in SONK. METHODS Sixty-three knees of Kellgren-Lawrence classification grade 1 or 2 without any trauma treated between April 2012 and March 2014 were enrolled in this study. These knees were divided into two groups according to their magnetic resonance imaging (MRI) findings: SONK group (31 knees) and OA group (32 knees). Using a long leg standing X-ray, femorotibial angle (FTA), mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and joint line convergent angle (JLCA) were compared between groups. Correlation between each parameter and the width ratio (WR) of the necrotic lesion were analyzed. RESULTS FTA, MAD, MPTA and JLCA showed significant differences between the SONK and OA groups. In the SONK group, FTA was positively correlated with WR, and, MAD and MPTA was negatively correlated with WR. CONCLUSIONS Compared with OA, SONK is associated with a significantly larger varus deformity at the proximal tibia, and larger joint play in the coronal plane.
Collapse
Affiliation(s)
- Hiroaki Tsukamoto
- Department of Orthopedic Surgery, Omori Municipal Hospital, Akita, Japan; Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan; Department of Internal Medicine, Tazawako Municipal Hospital, Akita, Japan; Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan.
| | - Hidetomo Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan; Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Kimio Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan; Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Takayuki Yoshikawa
- Department of Orthopedic Surgery, Omori Municipal Hospital, Akita, Japan; Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Masashi Oba
- Department of Orthopedic Surgery, Omori Municipal Hospital, Akita, Japan
| | - Kana Sasaki
- Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Chie Sato
- Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | - Manabu Akagawa
- Akita Sports Arthroscopy Knee Group (ASAK), Akita, Japan
| | | | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
10
|
Pareek A, Parkes CW, Bernard C, Camp CL, Saris DBF, Stuart MJ, Krych AJ. Spontaneous Osteonecrosis/Subchondral Insufficiency Fractures of the Knee: High Rates of Conversion to Surgical Treatment and Arthroplasty. J Bone Joint Surg Am 2020; 102:821-829. [PMID: 32379123 DOI: 10.2106/jbjs.19.00381] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Spontaneous osteonecrosis of the knee has recently been termed subchondral insufficiency fracture of the knee (SIFK) to appropriately recognize the etiology of mechanical overloading of the subchondral bone. The purpose of this study was to assess clinical outcomes of SIFK based on progression to surgical treatment and arthroplasty, and to evaluate the risk factors that increase the progression to arthroplasty. METHODS A retrospective review was performed on patients with a diagnosis of SIFK, as confirmed with use of magnetic resonance images (MRIs). Baseline and final radiographs were reviewed. Baseline MRIs were also reviewed for injury characteristics. Failure was defined as progression to surgical treatment or conversion to arthroplasty. RESULTS Two hundred twenty-three patients (71% female) with a mean age of 65.1 years were included. SIFK affected 154 femora (69%) and 123 tibiae (55%), with medial compartment involvement in 198 knees (89%); 74% of medial menisci had root or radial tears, with a mean extrusion of 3.6 mm. Varus malalignment was identified in 54 (69%) of 78 knees. Seventy-six (34%) of all patients progressed to surgical intervention at 2.7 years, and 66 (30%) underwent arthroplasty at 3.0 years. The rates of conversion to surgical intervention and arthroplasty increased to 47% (37 of 79; p = 0.04) and 37% (29 of 79; p = 0.09), respectively, in patients with >5 years of follow-up. The 10-year survival rate free of arthroplasty for patients with SIFK on the medial femoral condyle (p < 0.01), SIFK on the medial tibial plateau (p < 0.01), medial meniscal extrusion (p = 0.01), varus alignment (p = 0.02), and older age (per year older; p = 0.003) was significantly higher than the survival rates of those without each respective condition. CONCLUSIONS Subchondral insufficiency fractures predominantly involve the medial compartment of the knee and commonly present with medial meniscal root and radial tears. Approximately one-third of patients progressed to total knee arthroplasty. Baseline arthritis, older age, location of the insufficiency fracture on both the medial femoral condyle and medial tibial plateau, meniscal extrusion, and varus malalignment were all associated with progression to arthroplasty. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Ayoosh Pareek
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Chad W Parkes
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher Bernard
- 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
| | - Daniel B F Saris
- 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
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
11
|
Chalmers BP, Mehrotra KG, Sierra RJ, Pagnano MW, Taunton MJ, Abdel MP. Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee. Bone Joint J 2019; 101-B:1356-1361. [PMID: 31674235 DOI: 10.1302/0301-620x.101b11.bjj-2019-0576.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. PATIENTS AND METHODS In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. RESULTS Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. CONCLUSION Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356-1361.
Collapse
Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kapil G Mehrotra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
12
|
Hu D, Huang Z, Zhang W, Lin J, Li W. [Analysis of medial unicompartmental knee arthroplasty for patients with spontaneous osteonecrosis of the knee]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:13-17. [PMID: 30644254 DOI: 10.7507/1002-1892.201805127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To analyse the effectiveness of unicompartmental knee arthroplasty (UKA) for the patients with spontaneous osteonecrosis of the knee (SONK). Methods Between January 2012 and December 2016, 31 patients with SONK was admitted and treated with medial UKA. All patients were examined by both plain radiography and magnetic resonance images. The patients were composed of 5 men and 26 women with an average age of 64.3 years (range, 48-79 years), and with 16 left joints and 15 right joints. The average disease duration was 14.7 months (range, 6-26 months). Preoperative visual analogue scale (VAS) was 6.00±1.15, Hospital for Special Surgery (HSS) score was 55.77±11.03, and knee range of motion (ROM) was (114.68±10.40)°. The imaging examinations showed that all the lesions were located in the medial compartment of the knee joint and there were 19 patients with Aglietti stage Ⅳ and 12 patients with Aglietti stage Ⅴ. Preoperative femorotibial angle (FTA) was (177.39±1.63)° and posterior tibial slope (PTS) was (84.05±1.39)°. Results All the incisions healed by first intention. All patients were followed up 14-46 months (mean, 25 months). At last follow-up, VAS score was 2.06±0.72 and HSS score was 86.45±3.67, which both improved significantly when compared with preoperative scores ( t=22.73, P=0.00; t=-14.72, P=0.00). ROM was (118.06±3.80)° with no significant difference when compared with preoperative ROM ( t=-1.78, P=0.08). The X-ray films showed there was no severe adverse events, such as periprosthetic infection, aseptic loosening, bearing dislocation, and so on. At last follow- up, PTS was (85.30±1.19)° with significant difference compared with preoperative one ( t=-4.07, P=0.00); while FTA was (177.51±1.98)° with no significant difference when compared with preoperative FTA ( t=-0.38, P=0.71). Conclusion UKA may be an optional management for SONK with minimally invasive, bone-preserving, and rapid recovery.
Collapse
Affiliation(s)
- Deqing Hu
- Department of Orthopaedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350005, P.R.China
| | - Zida Huang
- Department of Orthopaedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350005, P.R.China
| | - Wenming Zhang
- Department of Orthopaedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350005,
| | - Jianhua Lin
- Department of Orthopaedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350005, P.R.China
| | - Wenbo Li
- Department of Orthopaedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350005, P.R.China
| |
Collapse
|
13
|
Chalmers BP, Mehrotra KG, Sierra RJ, Pagnano MW, Taunton MJ, Abdel MP. Reliable outcomes and survivorship of unicompartmental knee arthroplasty for isolated compartment osteonecrosis. Bone Joint J 2018; 100-B:450-454. [PMID: 29629588 DOI: 10.1302/0301-620x.100b4.bjj-2017-1041.r2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Primary (or spontaneous) and secondary osteonecrosis of the knee can lead to severe joint degeneration, for which either total or unicompartmental arthroplasty may be considered. However, there are limited studies analyzing outcomes of unicompartmental knee arthroplasties (UKAs) for osteonecrosis involving an isolated compartment of the knee. The aims of this study were to analyze outcomes of UKAs for osteonecrosis with specific focus on 1) survivorship free of any revision or reoperation, 2) risk factors for failure, 3) clinical outcomes, and 4) complications. Patients and Methods A total of 45 patients underwent 46 UKAs for knee osteonecrosis between 2002 and 2014 at our institution (The Mayo Clinic, Rochester, Minnesota). Twenty patients (44%) were female; the mean age of the patients was 66 years, and mean body mass index (BMI) was 31 kg/m2. Of the 46 UKAs, 44 (96%) were medial UKAs, and 35 (76%) were fixed-bearing design. Mean mechanical axis postoperatively was 1.5° varus (0° to 5° varus); 41 UKAs (89%) were performed for primary osteonecrosis. Mean follow-up was five years (2 to 12). Results Survivorship free of any revision in the cohort was 89% (95% CI 77 to 99) and 76% (95% CI 53 to 99) at five and ten years, respectively. In patients undergoing UKA for primary osteonecrosis survivorship free of any revision was 93% (95% CI 83 to 100)at both five and ten years. Secondary osteonecrosis was a significant risk factor for poorer survivorship free of any revision or reoperation (hazard ratio 7.7, p = 0.03). Three medial UKAs (6.5%) were converted to total knee arthroplasties (TKAs): two for lateral compartment degeneration and one for development of lateral osteonecrosis. No implants were revised for loosening, fracture, or wear. Knee Society scores improved from a mean of 60 (44 to 72) preoperatively to a mean of 94 postoperatively (82 to 100) (p < 0.001). There were no surgical complications. Conclusion When done for primary osteonecrosis of the knee, UKA resulted in reliable clinical improvement, minimal complications, and durable estimated implant survivorship free of revision at ten years. UKA done for secondary osteonecrosis was substantially less durable at mid-term follow-up. Progression of knee degeneration, rather than implant failure or loosening, was most common indication for conversion to TKA. Cite this article: Bone Joint J 2018;100-B:450-4.
Collapse
Affiliation(s)
- B P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - K G Mehrotra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - R J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - M W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - M J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| |
Collapse
|
14
|
Bhatnagar N, Sharma S, Gautam VK, Kumar A, Tiwari A. Characteristics, management, and outcomes of spontaneous osteonecrosis of the knee in Indian population. Int Orthop 2018; 42:1499-1508. [PMID: 29552689 DOI: 10.1007/s00264-018-3878-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Spontaneous osteonecrosis of the knee affects the medial femoral condyle in patients above 55 years of age. Many reports and studies are available from western countries. But there is a gross paucity of literature on spontaneous osteonecrosis of the knee (SPONK) in the Indian subcontinent, either it is under-reported or detected at a later stage. The aim of our study was to detect SPONK in Indian population and describe its characteristics, treatment, and outcome. MATERIAL AND METHOD A prospective study was conducted over a period of three years. All patients above 18 years with knee pain at rest and medial condyle tenderness without joint laxity were evaluated with plain radiographs and MRI. Further tests were done if radiological signs of osteonecrosis were present. Various parameters were recoded like Visual Analog Scale (VAS), Knee Society Score (KSS), and MRI Osteoarthritis Knee Score. Conservative treatment consisted of a combination of NSAIDs and bisphosphonates. Decompression with bone grafting was done if there was no improvement or deterioration at three month follow-up. RESULTS Ten patients were diagnosed with SPONK. The mean age was 50 years with male predominance (60%) with the involvement of medial femoral condyle (80%) or left knee (70%). Most cases were in Koshino stage 1. Mean VAS was 6.5 and mean KSS was 59. All clinical parameters showed improvement at one year. DISCUSSION A study with a bigger sample size and longer follow-up is needed to fill the lacunae of literature on this topic from the Indian subcontinent. In spite of the limitations, we did observe that in our population, males were more commonly affected than females, which is contrary to most studies on the subject. Also, the disease had an early age of onset (50 years) in Indian population as compared to Western and East Asian populations. CONCLUSION Combined therapy of NSAIDs and bisphosphonates shows excellent results over a period of one year. Joint-preserving surgeries are effective even in Koshino stage 3 SPONK.
Collapse
Affiliation(s)
- Nishit Bhatnagar
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Siddharth Sharma
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India.
- , Ghaziabad, India.
| | - Virender Kumar Gautam
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Ajeet Kumar
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Anurag Tiwari
- Department of Orthopedics, All India Institute of Medical Sciences, Saket Nagar, Habib Ganj, Bhopal, Madhya Pradesh, 462026, India
| |
Collapse
|
15
|
Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Saito T. Mosaic Osteochondral Autograft Transplantation Versus Bone Marrow Stimulation Technique as a Concomitant Procedure With Opening-Wedge High Tibial Osteotomy for Spontaneous Osteonecrosis of the Medial Femoral Condyle. Arthroscopy 2018; 34:233-40. [PMID: 29102568 DOI: 10.1016/j.arthro.2017.08.244] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effects of osteochondral autograft transplantation (OAT) mosaicplasty as a concomitant procedure with opening-wedge valgus high tibial osteotomy (HTO) for spontaneous osteonecrosis of the medial femoral condyle (MFC) on clinical outcomes and cartilage status in comparison with bone marrow stimulation (BMS) by drilling, and to assess the relation between lesion size and postoperative cartilage status. METHODS Fifty-eight patients with spontaneous osteonecrosis of the MFC were treated with opening-wedge HTO and a concomitant procedure of BMS (28 patients) or OAT (30 patients). Clinical evaluation was carried out using the Knee Society Score at postoperative 2 years. Postoperative status of articular cartilage was assessed by arthroscopy according to the International Cartilage Repair Society (ICRS) grade at the time of plate removal. RESULTS The Knee Society Score objective score and function score were improved at postoperative 2 years compared with preoperative value in both groups, but no significant difference was found between the 2 groups. According to the ICRS overall repair grade, cartilage status was rated as normal or nearly normal (ICRS overall score ≥8) in 41% of the BMS group and 90% of the OAT group. The results suggested that cartilage repair in OAT was significantly better than that in BMS (P = .0015). Furthermore, the BMS group revealed that repair with normal or nearly normal was observed in all less than 4 cm2 of lesion size, whereas the OAT group exhibited that repair with normal or nearly normal was independent of lesion size. CONCLUSIONS This study suggested that OAT is superior to BMS as a concomitant procedure with opening-wedge valgus HTO for spontaneous osteonecrosis of the MFC in the success of cartilage repair. However, clinical outcomes were not significantly different between these 2 procedures. When treating the lesion larger than 4 cm2 by joint-preserving surgery, OAT mosaicplasty is recommended as a concomitant procedure with HTO. LEVEL OF EVIDENCE Level III, therapeutic case-control study.
Collapse
|
16
|
Abstract
Background: Spontaneous osteonecrosis of the knee (SONK) is a clinical entity identified by acute knee pain usually associated with joint effusion, with radiographic findings of a radiolucent defect on the weightbearing area of the femoral condyle. Conservative treatment is initially undertaken; however, surgical procedures are often necessary. Historically, surgical options have included core decompression, cartilage repair, high tibial osteotomy, or joint arthroplasty. Few studies in the literature have reported the use of fresh osteochondral allograft (OCA) for the treatment of SONK lesions. Hypothesis: OCA transplantation is an effective treatment for SONK lesions on the medial femoral condyle. Study Design: Case series; Level of evidence, 4. Methods: A case series was analyzed of 7 patients treated with OCA for large SONK lesions of the medial femoral condyle with a minimum 4-year follow-up. All patients experienced failure of at least 6 months of conservative treatment and declined arthroplasty as the form of definitive treatment for medial femoral condyle lesion. All patients underwent OCA of the medial femoral condyle. Mean lesion size was 4.6 cm2 (range, 3.24-6.25 cm2), with a mean condylar width of 41.7 mm (range, 35.4-48.6 mm), resulting in a median proportion (lesion size/condylar width) of 56.8% (range, 32.7%-62.6%). The median surface allograft area was 5.1 cm2 (range, 3.2-6.3 cm2). Results: The median follow-up was 7.1 years (range, 4.5-14.1 years). No patient had additional surgery following OCA transplant; the allograft failure rate was 0%. Subjective outcome scores from the International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, and modified Merle d’Aubigné-Postel scale improved from preoperative assessment to the latest follow-up. All patients were extremely satisfied with the results of the OCA transplant. Conclusion: Fresh OCA transplantation demonstrated excellent efficacy, durability, and satisfaction in this group of patients with isolated stage 2 and 3 SONK lesions who had experienced failure of conservative treatment. Fresh osteochondral allografts are an attractive method for surgical management of selected patients with spontaneous osteonecrosis of the knee.
Collapse
Affiliation(s)
- Luís E P Tírico
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Samuel A Early
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,University of California San Diego Medical School, La Jolla, California, USA
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - William D Bugbee
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| |
Collapse
|