Biological Knee Reconstruction for Combined Malalignment, Meniscal Deficiency, and Articular Cartilage Disease

Harris, Joshua D.; Hussey, Kristen; Wilson, Hillary; Pilz, Kyle; Gupta, Anil Kumar; Gomoll, Andreas H.; Cole, Brian J.

doi:10.1016/j.arthro.2014.04.085

Cited by 19 publications

(33 citation statements)

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“…Substantial evidence for the activation of collagen synthesis and fibrotic remodeling in human OA cartilage has recently been described in at least eight independent genome-wide analysis studies. 12 There is also accumulating evidence from human OA studies for scarring responses in bone, 13,14 meniscus and cartilage, 15 as well as joint capsule and synovium, 16 with similar findings in animal models of OA. [17][18][19] These suggested that fibrotic scarring of joint tissues represents a potentially important drug target for OA therapy.…”

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confidence: 84%

Pirfenidone reduces subchondral bone loss and fibrosis after murine knee cartilage injury

Chan

Luo

et al. 2017

Journal Orthopaedic Research

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Pirfenidone is an anti-inflammatory and anti-fibrotic drug that has shown efficacy in lung and kidney fibrosis. Because inflammation and fibrosis have been linked to the progression of osteoarthritis, we investigated the effects of oral Pirfenidone in a mouse model of cartilage injury, which results in chronic inflammation and joint-wide fibrosis in mice that lack hyaluronan synthase 1 (Has1 ) in comparison to wild-type. Femoral cartilage was surgically injured in wild-type and Has1 mice, and Pirfenidone was administered in food starting after 3 days. At 4 weeks, Pirfenidone reduced the appearance, on micro-computed tomography, of pitting in subchondral bone at, and cortical bone surrounding, the site of cartilage injury. This corresponded with a reduction in fibrotic tissue deposits as observed with gross joint surface photography. Pirfenidone resulted in significant recovery of trabecular bone parameters affected by joint injury in Has1 mice, although the effect in wild-type was less pronounced. Pirfenidone also increased Safranin-O staining of growth plate cartilage after cartilage injury and sham operation in both genotypes. Taken together with the expression of selected extracellular matrix, inflammation, and fibrosis genes, these results indicate that Pirfenidone may confer chondrogenic and bone-protective effects, although the well-known anti-fibrotic effects of Pirfenidone may occur earlier in the wound-healing response than the time point examined in this study. Further investigations to identify the specific cell populations in the joint and signaling pathways that are responsive to Pirfenidone are warranted, as Pirfenidone and other anti-fibrotic drugs may encourage tissue repair and prevent progression of post-traumatic osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:365-376, 2018.

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confidence: 84%

Pirfenidone reduces subchondral bone loss and fibrosis after murine knee cartilage injury

Chan

Luo

et al. 2017

Journal Orthopaedic Research

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“…72% required concomitant procedures, and 44% had Outerbridge III or IV chondral damage. The complication rate was 21% (9). At mean follow-up of 3 (±1.9) years, 9% (4) were surgical failures and 21% (9) were clinical failures.…”

Section: Introductionmentioning

confidence: 93%

“…The complication rate was 21% (9). At mean follow-up of 3 (±1.9) years, 9% (4) were surgical failures and 21% (9) were clinical failures. Half of those patients considered a failure stated they would undergo MAT again.…”

Section: Introductionmentioning

confidence: 93%

The Results of Meniscal Allograft Transplantation Surgery: What is Success?

Searle

Asopa

Coleman

et al. 2020

Preprint

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Background : Meniscal allograft transplantation (MAT) may improve symptoms and function, and limit premature knee degeneration in patients under 50 years with symptomatic meniscal loss. The aim of this retrospective study was to examine patient outcomes after MAT and to explore the potential definitions of ‘success' or ‘failure’. Methods : 60 patients who underwent MAT between 2008-2014, aged 18-50 were identified. Six validated outcome measures for knee pathologies, patient satisfaction and return to sport were incorporated into a questionnaire. Surgical failure (removal of most/all the graft, revision MAT or conversion to arthroplasty), clinical failure (Lysholm <65), complication rates (surgical failure plus repeat arthroscopy for secondary allograft tears) and whether patients would have the procedure again were recorded. Statistical analysis included descriptive statistics, with patient-reported outcome measures reported as median and range. A binomial logistic regression was performed to assess factors contributing to failure. Results : 43 patients (72%) responded, mean age 35.6 (±7.5). 72% required concomitant procedures, and 44% had Outerbridge III or IV chondral damage. The complication rate was 21% (9). At mean follow-up of 3 (±1.9) years, 9% (4) were surgical failures and 21% (9) were clinical failures. Half of those patients considered a failure stated they would undergo MAT again. In the 74% (32) reporting they would undergo MAT again, median KOOS, IKDC and Lysholm scores were 82.1, 62.1 and 88, compared to 62.2, 48.5 and 64 in patients who said they would not. None of the risk factors significantly contributed to surgical or clinical failure, although female gender and number of concomitant procedures were nearly significant. Following MAT, 40% were dissatisfied with type/level of sport achieved, but only 14% would not consider MAT again. Conclusions: None of the risk factors examined were linked to surgical or clinical failure. Whilst less favourable outcomes are seen with Outerbridge Grade IV, these patients should not be excluded from potential MAT. Inability to return to sport is not associated with failure since 73% of these patients would undergo MAT again. The disparity between ‘clinical failure’ and ‘surgical failure’ means these terms may need re-defining using a bespoke MAT scoring system.

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“…There are several limitations to this study. First, as authors have previously described, [24][25][26] it is not uncommon to have concomitant pathology such as meniscal injury or deficiency, ligamentous instability, or malalignment, which is addressed surgically at the time of OCA and is thus difficult to control for. This study is no exception, with 20 (40%) of patients undergoing a concomitant procedure at the time of OCA, which may confound the ability to attribute knee joint preservation and symptom modification or lack thereof directly to the OCA procedure.…”

Section: Limitationsmentioning

confidence: 99%