I.

The aim of the present study is to describe results at long-term follow-up of internal fixation of unstable Osteochondritis Dissecans (OCD) achieved with three different fixation devices in skeletally mature knees. A retrospective cohort study was performed at 5 to 19 years follow-up. Patient-reported questionnaires were collected at the final follow-up. Postoperative X-rays and MRIs were evaluated for healing of the lesion and articular degeneration. An arthroscopic second look was performed in 74.3% of the cases. Failures were reported as reintervention to address the osteochondral lesion or poor functional outcomes at the last follow-up. A total of 39 subjects with a median follow-up of 10.7 years were included. Herbert screws were used in 51.2% of the cases, bioabsorbable nails in 25.7% of the cases and cannulated screws in 23.1% of the cases. No differences were observed in terms of the clinical score (International Knee Documentation Committee (IKDC) p = 0.211; Lysholm p = 0.197), radiographic union (p = 0.102) or radiographic degeneration (p = 0.238) between the three different fixation devices. Arthroscopic second look found complete stability of the lesions in all 29 cases evaluated. The mean postoperative Lysholm score was 83 (range = 33–100) and IKDC score was 79 (range = 39–100). Radiographic union was seen in 74% of the cases. Lack of radiographic union was correlated with worst functional scores. A failure rate of 20.5% was found: four reinterventions were performed, and four patients had poor scores at last follow up. This study shows that internal fixation of condylar OCD in skeletally mature patients provides good long-term clinical results and a high degree of healing regardless of the dimensions of the lesion and type of fixation.

Objectives:Different surgical approaches are currently available to treat knee chondral defects. The technique used in this article combines microfractures with the use of an injectable atelocollagen matrix (Cartifill®). The matrix covers the defect and improves the mechanical stability of the blood clot and maintains the chondrogenic progenitor cells and growth factors in the defective area. The aim of our study is to evaluate and describe the results in a series of patients treated with atelocollagen matrix and microfractures.Methods:All patients treated with atelocollagen matrix due to a cartilage lesion with a minimum follow-up of 24 months were evaluated. Patients undergoing associated surgeries (osteotomies, meniscectomies, mosaicplasty, ligament reconstruction) in the same surgical procedure were included in the study. Clinical function was assessed before and after surgery with the International Knee Documentation Committee (IKDC), the Lysholm score and the Visual Analogue Scale (VAS). Radiographic and magnetic resonance control were requested according to availability.Results:Twelve patients met the inclusion criteria. Three women. Average age of 50 years. Eight applications in medial condyle, 2 in lateral condyle and 4 in trochlea. One post-operative arthrofibrosis was recorded. One of the patients underwent an articular replacement of his knee 10 months after the surgery with finalization of follow-up. The pre / post-operative average was 39/52 (IKDC), 37/76 (Lysholm) and 8.5 / 3.5 (VAS).Conclusion:In our series, atelocollagen matrix combined with microfractures improved the clinical symptoms of patients with severe knee articular cartilage injury. However, a better selection of patients who require this procedure should be applied in future interventions.

<p><strong>Introducción</strong></p><p>El trasplante osteocondral autólogo es una alternativa quirúrgica en lesiones focales del cartílago articular. El objetivo de nuestro trabajo fue evaluar una serie de 62 pacientes tratados con mosaicoplastía de rodilla con 8 años promedio de seguimiento.</p><p><strong>Material y métodos</strong></p><p>Evaluamos retrospectivamente 62 pacientes operados con mosaicoplastía entre el año 2001 y 2014. Se incluyeron pacientes con lesión de cartílago focal de la rodilla a los que se les realizó mosaicoplastía aislada o asociada a otros procedimientos quirúrgicos (reconstrucción de LCA, osteotomía). Con un seguimiento mínimo de 2 años. Se evaluaron con las escalas de Lysholm e IKDC y el grado de artrosis con la escala radiográfica de Kellgren-Lawrence.</p><p><strong>Resultados</strong></p><p>Cuarenta y cinco fueron hombres y 17 mujeres. La edad promedio fue de 36 años. Treinta y cinco en cóndilo interno, 12 cóndilo externo, 12 tróclea y 3 combinadas. Cuarenta y dos fueron mosaicoplastías aisladas y 20 asociados a otro procedimiento. El resultado promedio de la escala de Lysholm al momento de la evaluación fue 80.1 y el IKDC fue 66.7. No encontramos diferencias significativas en la escala de Lysholm e IKDC entre los grupos de mosaicoplastía aislada y asociada a otro procedimiento. En 30 pacientes evaluados con radiografía se observó una inclusión satisfactoria del taco óseo.</p><p><strong>Conclusiones</strong></p><p>Dentro de las opciones quirúrgicas se encuentran las microfracturas, el auto/alo injerto osteocondral y el implante de condrocitos autólogos. Todas estas técnicas han demostrado mejorar el estado clínico en comparación con el estado preoperatorio independientemente de cuál se utilice.</p><p> </p><p>En nuestra serie de pacientes operados con mosaicoplastía encontramos resultados satisfactorios en las evaluaciones clínicas.</p><p>Consideramos que la mosaicoplastía es un procedimiento con alto grado de satisfacción y buenos resultados funcionales en pacientes con lesiones focales del cartílago articular.</p><p> </p><p><strong>Abstract</strong></p><p><strong></strong><br /><strong>Introduction</strong>: Osteochondral autograft transplantation is a surgical alternative for osteochondral defects of the knee. The aim of this study was to analyze a series of 62 patients treated with osteochondral autograft transplantation of the knee and an average follow-up of 8 years.</p><p><strong>Methods</strong>: A total of 62 patients treated with osteochondral autograft transplantation between 2001 and 2014 were evaluated. Patients with focal osteochondral lesions who underwent osteochondral autograft transplantation alone or associated with another procedure and a minimum follow-up of 2 years were included. Lysholm score, IKDC, and Kellgren- Lawrence radiographic scale were used. Forty-five men and 17 women (average age 36 years) were evaluated. Lesions were localized in medial condyle (35), lateral condyle (12), patella (12), and three were combined. Forty-two patients underwent isolated osteochondral autograft transplantation while 20 patients underwent associated surgical procedures.</p><p><br /><strong>Results</strong>: Mean Lysholm score was 80.1 and IKDC score was 66.7. There were no significant differences in the Lysholm and IKDC scores between groups. Radiographic results demonstrated complete graft incorporation in 30 patients. Clinical evaluation revealed satisfactory results.</p><p><br /><strong>Conclusion</strong>: Osteochondral autograft transplantation to treat osteochondral lesions is a procedure with a high clinical satisfaction and good functional results in patients with focal osteochondral lesions.<br /><br /></p><p> </p>