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Cartilage Repair With or Without Meniscal Transplantation and Osteotomy for Lateral Compartment Chondral Defects of the Knee: Case Series With Minimum 2-Year Follow-up.

Harris JD, Hussey K, Saltzman BM, McCormick FM, Wilson H, Abrams GD, Cole BJ - Orthop J Sports Med (2014)

Bottom Line: Pre- and postoperative outcomes were compared via Student t tests.At follow-up, patients undergoing isolated articular cartilage surgery had a significantly higher KOOS quality of life subscore than did those undergoing articular cartilage surgery and lateral meniscus transplant (P = .039).Otherwise, there were no significant postoperative differences between the isolated and combined surgery groups in any outcome score.

View Article: PubMed Central - PubMed

Affiliation: Center for Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA. ; Center for Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.

ABSTRACT

Background: Treatment decision making for chondral defects in the knee is multifactorial. Articular cartilage pathology, malalignment, and meniscal deficiency must all be addressed to optimize surgical outcomes.

Purpose: To determine whether significant clinical improvements in validated clinical outcome scores are observed at minimum 2-year follow-up after articular cartilage repair of focal articular cartilage defects of the lateral compartment of the knee with or without concurrent distal femoral osteotomy and lateral meniscus transplant.

Study design: Case series; Level of evidence, 4.

Methods: Symptomatic adults who underwent surgical treatment (microfracture, autologous chondrocyte implantation [ACI], osteochondral autograft or allograft) of full-thickness lateral compartment chondral defects of the knee with or without a postmeniscectomy compartment or valgus malalignment by a single surgeon with minimum 2-year follow-up were analyzed. Validated patient-reported and surgeon-measured outcomes were collected pre- and postsurgery. Pre- and postoperative outcomes were compared via Student t tests.

Results: Thirty-five subjects (mean age, 29.6 ± 10.5 years) were analyzed. Patients had been symptomatic for 2.51 ± 3.52 years prior to surgery and had undergone 2.11 ± 1.18 surgeries prior to study enrollment, with a mean duration of follow-up of 3.65 ± 1.71 years. The mean defect size was 4.42 ± 2.06 cm(2). Surgeries included ACI (n = 18), osteochondral allograft (n = 14), osteochondral autograft (n = 2), and microfracture (n = 1). There were 18 subjects who underwent concomitant surgery (14 lateral meniscus transplant, 3 distal femoral osteotomy, and 1 combined). Statistically significant (P < .05) and clinically meaningful improvements were observed at final follow-up in Lysholm, subjective International Knee Documentation Committee (IKDS), Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, Short Form-12 (SF-12) scores, and patient satisfaction. At follow-up, patients undergoing isolated articular cartilage surgery had a significantly higher KOOS quality of life subscore than did those undergoing articular cartilage surgery and lateral meniscus transplant (P = .039). Otherwise, there were no significant postoperative differences between the isolated and combined surgery groups in any outcome score. Five patients underwent 6 reoperations (1 revision osteochondral allograft, 5 chondroplasties). No patient was converted to knee arthroplasty.

Conclusion: In patients with lateral compartment focal chondral defects with or without lateral meniscal deficiency and valgus malalignment, surgical cartilage repair and correction of concomitant pathology can significantly improve clinical outcomes at 2-year follow-up with no significant differences between isolated and combined surgery and a low rate of complications and reoperations.

No MeSH data available.


Related in: MedlinePlus

(A) Mechanical axis anteroposterior (AP) standing radiograph with valgus deformity of the right knee. The mechanical axis (from the center of the femoral head to the center of the talus) passes through the middle of the lateral compartment. The desired correction point for the mechanical axis is to 62% the distance from the most lateral aspect of the lateral compartment (approximately the medial tibial spine). (B) Healed postdistal femoral osteotomy AP standing knee radiograph with lateral distal femoral plate and screw construct.
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fig1-2325967114551528: (A) Mechanical axis anteroposterior (AP) standing radiograph with valgus deformity of the right knee. The mechanical axis (from the center of the femoral head to the center of the talus) passes through the middle of the lateral compartment. The desired correction point for the mechanical axis is to 62% the distance from the most lateral aspect of the lateral compartment (approximately the medial tibial spine). (B) Healed postdistal femoral osteotomy AP standing knee radiograph with lateral distal femoral plate and screw construct.

Mentions: Varus-producing opening wedge distal femoral osteotomy (Figure 1B) was performed for correction of valgus deformity (Figure 1A). Internal fixation was achieved using a low-profile titanium locking plate with 4.5-mm diameter, fully threaded cortical screws proximally and 6.5-mm diameter, fully threaded cancellous screws distally (Femoral Opening Wedge Osteotomy Plate; Arthrex). The opened wedge was packed with local bone graft, demineralized bone matrix (StimuBlast DBM; Arthrex), allograft bone chips, beta–tricalcium phosphate wedges (OSferion [osteoconductive bone graft substitute]; Arthrex), and platelet-rich plasma. Degree of correction was determined preoperatively to unload the lateral compartment to 62% tibial width from the most lateral edge of the lateral compartment (62% width chosen based on valgus-producing high tibial osteotomy for varus malalignment correction literature).9 This corresponds approximately to the medial tibial spine as the desired correction point.


Cartilage Repair With or Without Meniscal Transplantation and Osteotomy for Lateral Compartment Chondral Defects of the Knee: Case Series With Minimum 2-Year Follow-up.

Harris JD, Hussey K, Saltzman BM, McCormick FM, Wilson H, Abrams GD, Cole BJ - Orthop J Sports Med (2014)

(A) Mechanical axis anteroposterior (AP) standing radiograph with valgus deformity of the right knee. The mechanical axis (from the center of the femoral head to the center of the talus) passes through the middle of the lateral compartment. The desired correction point for the mechanical axis is to 62% the distance from the most lateral aspect of the lateral compartment (approximately the medial tibial spine). (B) Healed postdistal femoral osteotomy AP standing knee radiograph with lateral distal femoral plate and screw construct.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555547&req=5

fig1-2325967114551528: (A) Mechanical axis anteroposterior (AP) standing radiograph with valgus deformity of the right knee. The mechanical axis (from the center of the femoral head to the center of the talus) passes through the middle of the lateral compartment. The desired correction point for the mechanical axis is to 62% the distance from the most lateral aspect of the lateral compartment (approximately the medial tibial spine). (B) Healed postdistal femoral osteotomy AP standing knee radiograph with lateral distal femoral plate and screw construct.
Mentions: Varus-producing opening wedge distal femoral osteotomy (Figure 1B) was performed for correction of valgus deformity (Figure 1A). Internal fixation was achieved using a low-profile titanium locking plate with 4.5-mm diameter, fully threaded cortical screws proximally and 6.5-mm diameter, fully threaded cancellous screws distally (Femoral Opening Wedge Osteotomy Plate; Arthrex). The opened wedge was packed with local bone graft, demineralized bone matrix (StimuBlast DBM; Arthrex), allograft bone chips, beta–tricalcium phosphate wedges (OSferion [osteoconductive bone graft substitute]; Arthrex), and platelet-rich plasma. Degree of correction was determined preoperatively to unload the lateral compartment to 62% tibial width from the most lateral edge of the lateral compartment (62% width chosen based on valgus-producing high tibial osteotomy for varus malalignment correction literature).9 This corresponds approximately to the medial tibial spine as the desired correction point.

Bottom Line: Pre- and postoperative outcomes were compared via Student t tests.At follow-up, patients undergoing isolated articular cartilage surgery had a significantly higher KOOS quality of life subscore than did those undergoing articular cartilage surgery and lateral meniscus transplant (P = .039).Otherwise, there were no significant postoperative differences between the isolated and combined surgery groups in any outcome score.

View Article: PubMed Central - PubMed

Affiliation: Center for Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA. ; Center for Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.

ABSTRACT

Background: Treatment decision making for chondral defects in the knee is multifactorial. Articular cartilage pathology, malalignment, and meniscal deficiency must all be addressed to optimize surgical outcomes.

Purpose: To determine whether significant clinical improvements in validated clinical outcome scores are observed at minimum 2-year follow-up after articular cartilage repair of focal articular cartilage defects of the lateral compartment of the knee with or without concurrent distal femoral osteotomy and lateral meniscus transplant.

Study design: Case series; Level of evidence, 4.

Methods: Symptomatic adults who underwent surgical treatment (microfracture, autologous chondrocyte implantation [ACI], osteochondral autograft or allograft) of full-thickness lateral compartment chondral defects of the knee with or without a postmeniscectomy compartment or valgus malalignment by a single surgeon with minimum 2-year follow-up were analyzed. Validated patient-reported and surgeon-measured outcomes were collected pre- and postsurgery. Pre- and postoperative outcomes were compared via Student t tests.

Results: Thirty-five subjects (mean age, 29.6 ± 10.5 years) were analyzed. Patients had been symptomatic for 2.51 ± 3.52 years prior to surgery and had undergone 2.11 ± 1.18 surgeries prior to study enrollment, with a mean duration of follow-up of 3.65 ± 1.71 years. The mean defect size was 4.42 ± 2.06 cm(2). Surgeries included ACI (n = 18), osteochondral allograft (n = 14), osteochondral autograft (n = 2), and microfracture (n = 1). There were 18 subjects who underwent concomitant surgery (14 lateral meniscus transplant, 3 distal femoral osteotomy, and 1 combined). Statistically significant (P < .05) and clinically meaningful improvements were observed at final follow-up in Lysholm, subjective International Knee Documentation Committee (IKDS), Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, Short Form-12 (SF-12) scores, and patient satisfaction. At follow-up, patients undergoing isolated articular cartilage surgery had a significantly higher KOOS quality of life subscore than did those undergoing articular cartilage surgery and lateral meniscus transplant (P = .039). Otherwise, there were no significant postoperative differences between the isolated and combined surgery groups in any outcome score. Five patients underwent 6 reoperations (1 revision osteochondral allograft, 5 chondroplasties). No patient was converted to knee arthroplasty.

Conclusion: In patients with lateral compartment focal chondral defects with or without lateral meniscal deficiency and valgus malalignment, surgical cartilage repair and correction of concomitant pathology can significantly improve clinical outcomes at 2-year follow-up with no significant differences between isolated and combined surgery and a low rate of complications and reoperations.

No MeSH data available.


Related in: MedlinePlus