Medial Femoral Condyle Cartilage Defect Biomechanics

Lacy, Kyle; Cracchiolo, Allison M.; Yu, Stephen; Goitz, Henry T.

doi:10.1177/0363546515613517

Cited by 30 publications

(10 citation statements)

References 40 publications

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“…Ultimately, prolonged wait times are a concern in the young, active patient population that typically requires this procedure, as even small full-thickness lesions experience increased force at the base and periphery of the defect and can possibly progress in size with continued weightbearing. 6 , 7 Fresh OCA cores represent an ideal alternative to standard graft matching for small femoral condyle lesions for myriad reasons. Similar to fresh hemicondylar allografts, these cores provide a mature hyaline cartilage/bone construct with 80% absolute viability in the superficial, middle, and deep chondral layers.…”

Section: Discussionmentioning

confidence: 99%

Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Femoral Cartilage Defects

Jones

Mosich

Williams

2018

Arthroscopy Techniques

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Fresh osteochondral allograft (OCA) transplantation is a successful single-stage procedure for the treatment of symptomatic cartilage defects of the knee. Although long-term studies reveal reliable improvements in patient-reported outcome scores and graft survival, the limitations of the procedure include graft availability and timely use prior to expiration. To avoid prolonged surgical wait times and progression of lesion size, some surgeons have employed the use of nonorthotopic grafts (e.g., lateral femoral condyle graft for a medial femoral condyle lesion). Additionally, fresh precut OCA cores can be used for smaller symptomatic lesions, thereby precluding surgical delays associated with donor-recipient size matching. We describe our preferred technique for the use of fresh precut OCA cores for the treatment of small osteochondral defects of the knee. The distinct advantages of this technique include single-stage restoration of the articular surface without the donor site morbidity observed with osteochondral autograft transplantation.

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Section: Discussionmentioning

confidence: 99%

Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Femoral Cartilage Defects

Jones

Mosich

Williams

2018

Arthroscopy Techniques

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“…55,56 A larger lesion size as risk factor is in accordance with biomechanical studies that have shown that defects larger than 2 cm 2 increase the load on the base of the defect as well as on the rim. 57 This will potentially negatively influence the development of the repair tissue in the defect and the progression of rim cartilage deformation, resulting in the pothole effect as mentioned before. 58 The same biomechanics apply to lesion location as a prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors for the Clinical Outcome after Microfracture Treatment of Chondral and Osteochondral Defects in the Knee Joint: A Systematic Review

et al. 2023

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Objective The objective of this study is to establish which patient and lesion characteristics are related to the clinical outcome after microfracture of cartilage defects in the knee. Study design Systematic review. Methods After preregistration, PubMed, Embase, and Cochrane were searched for studies that analyzed prognostic factors for the outcome of microfracture treatment in the knee. The criteria for inclusion were outcome measured using Patient-Reported Outcome Measures (PROMs), a clinical study with ≥10 participants receiving microfracture, and a minimal follow-up period of 1 year. Results For none of the investigated prognostic factors, effect size reporting was sufficiently homogeneous to conduct a meta-analysis. However, a majority of the included studies identified higher age, larger lesion size, longer preoperative symptom duration, and previous surgery on the ipsilateral knee, especially meniscectomy and anterior cruciate ligament reconstruction, as factors that are reported to be correlated to a less favorable outcome. A lesion location that does not include the trochlea or the patellofemoral joint and is not weightbearing, a nondegenerative mechanism of injury, and a single lesion were reported as factors that predict a favorable outcome. As to gender, body mass index, preoperative activity level, smoking, and concomitant knee surgery, the included articles were inconclusive or no effect was reported. Conclusions Several factors correlated with the clinical result after microfracture treatment. However, the information on the effect sizes of the influence on clinical outcome is incomplete due to poor reporting. Large-scale registries or pooling of homogeneous, well-reported data is needed to work toward prognostic models. That would be an important step toward personalized treatment.

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“…75 , 81 , 82 It has been hypothesized that the treated defect is unable to withstand the detrimental pothole effect. 45 In addition, the subchondral bone (SB) starts thickening and forms cysts due to aging, OA, or chronic cartilage defects. 26 , 72 The standard MF awl causes widespread microarchitecture disturbances in the SB, leading to further sclerosis 27 and cyst formation after MF, 76 with good correlation between the severity of SB changes and poor clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients

Jeuken

Hugten

Roth

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high proportion of treated patients are 40 to 60 years of age (ie, middle-aged). The reality of current clinical practice is that the ideal patient for cartilage repair is not the typical patient. Specific attention to cartilage repair outcomes in middle-aged patients is warranted. Purpose: To systematically review available literature on knee cartilage repair in middle-aged patients and include studies comparing results across different age groups. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane Library database. Articles were screened for relevance and appraised for quality. Results: A total of 21 articles (mean Coleman Methodology Score, 64 points) were included. Two out of 3 bone marrow stimulation (BMS) studies, including 1 using the microfracture technique, revealed inferior clinical outcomes in middle-aged patients in comparison with younger patients. Nine cell-based studies were included showing inconsistent comparisons of results across age groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate concentrate showed age-independent results at up to 8 years of follow-up. A negative effect of middle age was reported in 1 study for both ACI and BMS. Four out of 5 studies on bone-based resurfacing therapies (allografting and focal knee resurfacing implants [FKRIs]) showed age-independent results up to 5 years. One study in only middle-aged patients reported better clinical outcomes for FKRIs when compared with biological repairs. Conclusion: Included studies were heterogeneous and had low methodological quality. BMS in middle-aged patients seems to only result in short-term improvements. More research is warranted to elucidate the ameliorating effects of cell-based therapies on the aging joint homeostasis. Bone-based therapies seem to be relatively insensitive to aging and may potentially result in effective joint preservation. Age subanalyses in cohort studies, randomized clinical trials, and international registries should generate more evidence for the large but underrepresented (in terms of cartilage repair) middle-aged population in the literature.

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Medial Femoral Condyle Cartilage Defect Biomechanics

Cited by 30 publications

References 40 publications

Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Femoral Cartilage Defects

Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Femoral Cartilage Defects

Prognostic Factors for the Clinical Outcome after Microfracture Treatment of Chondral and Osteochondral Defects in the Knee Joint: A Systematic Review

A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients

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