Spontaneous Osteonecrosis of the Knee Treated with Autologous Chondrocyte Implantation, Autologous Bone-Grafting, and Osteotomy

Keudell, Arvind von; Gomoll, Andreas H.; Bryant, Tim; Minas, Tom

doi:10.2106/jbjs.k.00242

Cited by 14 publications

(21 citation statements)

References 26 publications

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“…Techniques to address the underlying diseased subchondral bone altered after MSTs to lessen the risk of failure in conjunction with ACI are being developed, including the removal of sclerotic bone and the ACI “sandwich” technique, 29,51 which may have improved survival rates and functional outcomes in this cohort of patients. The senior author (T.M.)…”

Section: Discussionmentioning

confidence: 99%

A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation

et al. 2017

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Section: Discussionmentioning

confidence: 99%

A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation

et al. 2017

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“…The advanced stages are generally treated more invasively with surgery, such as osteochondral grafts, high tibial osteotomy with or without autogenetic bone grafts, or unicompartmental or total knee arthroplasty, with good clinical results. [ 17 18 19 20 ] Appropriately selected patients may be managed through HTO to preserve the joint. [ 21 ] Although this option is typically reserved for younger, active patients, HTO relieves the affected femoral condyle by shifting the weight-bearing axis laterally.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatment of Spontaneous Osteonecrosis of Medial Tibial Plateau

Yang

Zhao

et al. 2018

Chinese Medical Journal

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Background:In a small proportion of cases, spontaneous osteonecrosis of the knee (SONK) involves the medial tibial plateau (MT). Here, we introduced the clinical characteristics of spontaneous osteonecrosis of the MT and unicompartmental knee arthroplasty (UKA) as the favorable treatment for this situation based on a retrospective case study.Methods:Patients with spontaneous osteonecrosis of the MT, confirmed by magnetic resonance imaging (MRI) at Guangdong Provincial Hospital of Chinese Medicine (China) from March 2015 to June 2016, were included as a case serial and analyzed retrospectively. All patients underwent Oxford Medial UKA. The characteristics of their lesions, corresponding treatment, and results of follow-up were presented. The lesion scores and grade were determined according to the criteria of Ficat and Arlet.Results:In total, 22 patients (5 men, 17 women; mean age, 64.1 years) with spontaneous osteonecrosis of the MT were analyzed. The lesion stages assessment showed that 3 (14%) were Stage II, 10 (45%) were Stage III, 7 (32%) were Stage IV, and 2 (9%) were Stage V. In the sagittal plane, 7 (32%) were in the anterior region (MTa) and 15 (68%) were central (MTc). The lesion volume averaged 2.24 ± 0.79 cm3 (range: 1.57–3.08 cm3). Seventeen patients (77%) had Level III posterior medial meniscus root tears (MMRTs). All the patients underwent UKA. Average follow-up was 30.0 ± 6.4 months with a range of 23.0–38.0 months. The visual analog scale score was 7.78 ± 0.67 before surgery while decreased to 2.22 ± 1.09 at the final follow-up (P < 0.001). The Hospital for Special Surgery scores of pre-/post-surgery were 65.67 ± 5.45 and 84.10 ± 4.20, respectively (P < 0.001).Conclusions:SONK often occurs in the anterior and central tibial plateau due to abnormal stresses. Most of the patients had Level III posterior medial meniscus root tears. MRI is recommended for suspected cases to identify SONK at an early stage. The use of the Oxford Medial UKA for SONK of the MT is reliable both immediately and at follow-up.

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“…Concomitant procedures included combined distal femoral osteotomy (DFO)/TTO in 6 and TTO alone in 1 patient. One patient underwent surgery using the “sandwich technique,” 51 which involved the use of an autologous bone graft for the subchondral bone defect and ACI for the overlying cartilage defect, because this patient had a deep cystic lesion with the osteochondral injury. Ten patients did not require concomitant procedures ( Table 2 ).…”

Section: Methodsmentioning

confidence: 99%

Biological Knee Reconstruction With Concomitant Autologous Chondrocyte Implantation and Meniscal Allograft Transplantation

Ogura

Bryant

Minas

2016

Orthopaedic Journal of Sports Medicine

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Background:Treating articular cartilage defects and meniscal deficiency is challenging. Although some short- to mid-term follow-up studies report good clinical outcomes after concurrent autologous chondrocyte implantation (ACI) and meniscal allograft transplantation (MAT), longer follow-up is needed.Purpose:To evaluate mid- to long-term outcomes after combined ACI with MAT.Study Design:Case series; Level of evidence, 4.Methods:We performed a retrospective review of prospectively gathered data from patients who had undergone ACI with MAT between 1999 and 2013. A single surgeon treated 18 patients for symptomatic full-thickness chondral defects with meniscal deficiency. One patient was lost to follow-up. Thus, 17 patients (18 knees; mean age, 31.7 years) were evaluated over a mean 7.9-year follow-up (range, 2-16 years). A mean 1.8 lesions per knee were treated over a total surface area of 7.6 cm2 (range, 2.3-21 cm2) per knee. Seventeen lateral and 1 medial MATs were performed. Survival was analyzed using the Kaplan-Meier method. The modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale, and Short Form–36 were used to evaluate clinical outcomes. Patients also self-reported knee function and satisfaction. Standard radiographs were scored for Kellgren-Lawrence (K-L) grade.Results:Both 5- and 10-year survival rates were 75%. Outcomes for 6 knees were considered failures. Of the 6 failures, 4 knees were converted to arthroplasty and the other 2 knees underwent biological revision surgery. Of the 12 successfully operated knees, all clinical measures significantly improved postoperatively. Ten patients representing 11 of the 12 knees rated outcomes for their knees as good or excellent, and 1 rated their outcome as fair. Eight patients representing 9 of the 12 knees were satisfied with the procedure. There was no significant osteoarthritis progression based on K-L grading from preoperatively to a mean 5.9 years after surgery. Seven of the 12 knees (58%) required subsequent surgical procedures (5 arthroscopic alone, 2 both arthroscopic and open).Conclusion:Combined ACI with MAT provided significant improvement in 65% of the operated knees over a mid- to long-term follow-up. This procedure can allow patients to retain their biological knees, delay or prevent rapid degeneration to osteoarthritis, and could be recognized as a bridge procedure before artificial knee replacement. However, careful discussion between the patient and surgeon is necessary before surgery to ensure realistic expectations.

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Spontaneous Osteonecrosis of the Knee Treated with Autologous Chondrocyte Implantation, Autologous Bone-Grafting, and Osteotomy

Cited by 14 publications

References 26 publications

A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation

A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation

Clinical Characteristics and Treatment of Spontaneous Osteonecrosis of Medial Tibial Plateau

Biological Knee Reconstruction With Concomitant Autologous Chondrocyte Implantation and Meniscal Allograft Transplantation

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