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Purpose Autologous Matrix-Induced Chondrogenesis (AMIC ® ) utilizing a type I/III collagen membrane was compared with microfracture (MFx) alone in focal cartilage lesions of the knee at one, two and five years. Methods Forty-seven patients (aged 37 ± 10 years, mean defect size 3.6 ± 1.6 cm 2 ) were randomized and treated either with MFx, with sutured or glued AMIC ® in a prospective multicentre clinical trial. Results After improvement for the first two years in all subgroups, a progressive and significant score degradation was observed in the MFx group, while all functional parameters remained stable for least five years in the AMIC ® groups. At two and five years, MRI defect filling was more complete in the AMIC ® groups. No treatment-related adverse events were reported. Conclusions AMIC ® is an effective cartilage repair procedure in the knee resulting in stable clinical results significantly better than the MFx group at five years.

Purpose The increasing awareness on the role of subchondral bone in the etiopathology of articular surface lesions led to the development of osteochondral scaffolds. While safety and promising results have been suggested, there are no trials proving the real potential of the osteochondral regenerative approach. Aim was to assess the benefit provided by a nanostructured collagen–hydroxyapatite (coll-HA) multilayer scaffold for the treatment of chondral and osteochondral knee lesions. Methods In this multicentre randomized controlled clinical trial, 100 patients affected by symptomatic chondral and osteochondral lesions were treated and evaluated for up to 2 years (51 study group and 49 control group). A biomimetic coll-HA scaffold was studied, and bone marrow stimulation (BMS) was used as reference intervention. Primary efficacy measurement was IKDC subjective score at 2 years. Secondary efficacy measurements were: KOOS, IKDC Knee Examination Form, Tegner and VAS Pain scores evaluated at 6, 12 and 24 months. Tissue regeneration was evaluated with MRI MOCART scoring system at 6, 12 and 24 months. An external independent agency was involved to ensure data correctness and objectiveness. Results A statistically significant improvement of all clinical scores was obtained from basal evaluation to 2-year follow-up in both groups, although no overall statistically significant differences were detected between the two treatments. Conversely, the subgroup of patients affected by deep osteochondral lesions (i.e. Outerbridge grade IV and OCD) showed a statistically significant better IKDC subjective outcome (+12.4 points, p  = 0.036) in the coll-HA group. Statistically significant better results were also found for another challenging group: sport active patients (+16.0, p  = 0.027). Severe adverse events related to treatment were documented only in three patients in the coll-HA group and in one in the BMS group. The MOCART score showed no statistical difference between the two groups. Conclusions This study highlighted the safety and potential of a biomimetic implant. While no statistically significant differences were found compared to BMS for chondral lesions, this procedure can be considered a suitable option for the treatment of osteochondral lesions. Level of evidence I.

Several collagen subtypes have been identified in hyaline articular cartilage. The main and most abundant collagens are type II, IX and XI collagens. The minor and less abundant collagens are type III, IV, V, VI, X, XII, XIV, XVI, XXII, and XXVII collagens. All these collagens have been found to play a key role in healthy cartilage, regardless of whether they are more or less abundant. Additionally, an exhaustive evaluation of collagen fibrils in a repaired cartilage tissue after a chondral lesion is necessary to determine the quality of the repaired tissue and even whether or not this repaired tissue is considered hyaline cartilage. Therefore, this review aims to describe in depth all the collagen types found in the normal articular cartilage structure, and based on this, establish the parameters that allow one to consider a repaired cartilage tissue as a hyaline cartilage.

Objectives: To 1) characterize the morphology of rHSLs in the setting of recurrent posterior shoulder instability using advanced three-dimensional (3D) imaging analyses, and 2) compare these metrics to HSLs in patients with anterior instability. Methods: A retrospective review was performed of patients between 2004-2010 who presented with recurrent posterior shoulder instability. Patients with rHSLs were pair-matched in a 1:4 ratio for age, sex, and laterality to those with HSLs. 3D models of unilateral proximal humeri were reconstructed from two-dimensional (2D) CT scans, and width, depth, surface area (SA), and volume of identified rHSLs and HSLs were quantified, along with their location (medial, superior, and inferior extent) and orientation (rHSL/HSL rim (r) and center (c) angle). A Mann-Whitney U test was used to assess the relationship between measured group parameters. Results: A total of 25 rHSLs, including 21 males and 4 females, met inclusion criteria (mean age: 27.9 years, range: 18 - 39 years), and were pair matched to 100 patients with HSLs. Mean rHSL depth, width, SA, and volume were 0.9 mm (range = 0.20-2.1 mm), 9.1 mm (range = 4.0-17.9 mm), 129.1 mm2 (range = 37.9-357.8 mm2), and 366.2 mm3 (range = 54.2-1488.7 mm3), respectively. On average, the medial border of rHSLs extended 18.1 mm (range = 11.5-28.6 mm) from the medial edge of the humeral head cartilage margin. When compared to HSLs, rHSLs were significantly narrower (p < 0.001), shallower (p < 0.001), had a smaller SA (p <0.01), and had a greater angulation relative to the humeral diaphysis (mean rHSL center (c) and rim (r) angle 16.0° and 13.7° greater than HSL, respectively) (p < 0.001) thus involving more of the humeral head cartilage. Conclusions: rHSLs are significantly narrower, shallower, and occupy less surface area than HSLs. Additionally, rHSLs had a greater angle of orientation relative to the humeral diaphysis involving more cartilage surface than HSLs. Appropriate morphological distinction between rHSLs and HSLs is imperative to correctly tailor treatment in the setting of posterior shoulder instability.

Objectives: To evaluate the patient-reported outcomes (PROs), return to activity, and osteochondral healing based upon magnetic resonance imaging (MRI) using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score following arthroscopic layered cancellous autograft bone and morselized allograft cartilage (composite) grafting for osteochondritis dissecans (OCD) of the talus in adolescent patients. Methods: An IRB-approved review of demographic and operative data, imaging, and prospectively collected preoperative and postoperative PROs was accomplished. Consecutive patients treated for talar OCD (indicated for symptomatic, unstable lesions) with arthroscopic debridement, cancellous autografting, and implantation of morselized allograft cartilage (BioCartilage; Arthrex, Naples, FL) grafting (January 2015 - October 2022) with a minimum one year follow up were included. The MOCART 2.0 score was employed to assess postoperative MRIs. Results: The study population consisted of 20 ankles with talar OCD. The average age at presentation was 14.5 ± 2.0 years with an average follow up of 1.7 years ± 10.6 months (range: 1-4.2 years). Postoperatively, 81.3% of athletes reported a return to their preoperative sport after an average of 8.5 ± 3.0 months. There was a statistically significant increase across all five domains of the FAOS from pre- and post-treatment. All lesions demonstrated stable lesion filling with incorporated bony elements below the augmented fibrocartilage surface. A mean MOCART score of 66.7 ± 15.0 reflected appropriate contour and stability of surface fibrocartilage with some signal irregularity of the fibrocartilage matrix. There was no significant correlation between MOCART scores and PROs (P > 0.05). Conclusions: Statistically significant improvement in PROs and high rates of return to sport were achieved following composite grafting to treat unstable talar OCD in adolescent athletes. The authors recommend this technique as an effective strategy for addressing both the osseous and chondral components of the defect with minimal morbidity.

Objectives: To assess the external rotation angle between the transepicondylar axis (TEA) and the posterior condylar axis (PCA) in a Brazilian population, to determine whether the universal use of 3-degrees external rotation of the femoral component is appropriate during total knee arthroplasty (TKA) in this population. Methods: The TEA rotation relative to the PCA was measured in 167 magnetic resonance imaging (MRI) exams using four different methods for the PCA, based on posterior reference points: (A) cartilage references; (B) bony references; (C) lateral posterior reference and medial cartilage reference; and (D) lateral cartilage reference and medial bony reference. The measurements were statistically compared to the traditional 3-degrees external rotation used in TKA instrumentation. An analysis of variance was conducted to assess differences between the measurement methods. Results: Mean TEA external rotation for methods A, B, C, and D was 5.44º ± 2.39º, 4.94º ± 2.10º, 8.56º ± 2º, and 2.33º ± 2º, respectively. All measurement methods showed significant differences compared to the traditional 3-degrees external rotation (p<.0001). Significant differences were also found between all measurement methods (p<.0001), except between methods A and B (p=0.1614). Conclusion: Using cartilage or bony reference points for the PCA, the TEA in the Brazilian population is approximately 5-degrees externally rotated. The traditional 3-degrees femoral component rotation may be insufficient for this population, particularly in valgus knees. This highlights the importance of an individualized approach to achieve optimal component rotational alignment during TKA.

As the old paradigm of cell-based cartilage treatment has shifted to promising cell-free therapy, the role of secretome has been more profound. To provide the best environment for cartilage regeneration is to provide the most optimum condition and composition of the secretome which has to be more chondrogenic. The currently available crude secretome does not specifically provide the necessary condition for cartilage. This topic will discuss the three most recent advancements to improve the efficacy and reliability of the secretome. The first is to yield a secretome with more chondrogenic properties that can be harvested from a novel three-dimensional cell culture using a bovine cartilage scaffold as culture medium. One of the pearls of secretome is the availability for transport and storage. Therefore, freeze-drying the secretome can be seen to improve stability for transport and storage. Lastly, this secretome must be applicable in cartilage problems. An animal study has been conducted to prove the efficacy of this secretome in osteoarthritis model. Histological evaluation shows promising changes after the application.

Objectives: Enchondromas are benign cartilage tissue tumors composed of mature hyaline cartilage. Most enchondromas are discovered incidentally during radiological examinations. Differentiating between low-grade chondrosarcoma and enchondroma can be difficult both clinically, radiologically, and histologically. Malignant tumors can mimic benign tumors. Therefore, it is crucial to accurately diagnose enchondromas, as the treatments for both tumors are very different. We aimed to contribute to a better understanding of the clinical features and treatment challenges of patients diagnosed with enchondroma. Methods: Thirty patients who presented to the Department of Orthopedics and Traumatology at Manisa Celal Bayar University Faculty of Medicine between 2010 and 2023 and were diagnosed with enchondroma in hand after surgical treatment were retrospectively evaluated in our study. The patients were classified according to the Tordai and Takigawa classifications. Results: Nineteen women and 11 men were examined. The lesions were observed in the left hand in 15 patients and in the right hand in 15 patients. The proximal phalanx was the most affected area. Fractures developed in 2 patients during postoperatively, requiring revision surgeries. No wound complications were observed during follow-up, and except for 2 patients who experienced refractures, both clinical and radiological complete healing was observed at the 8-week follow-up. Conclusions: This study aims to understand better the clinical features and treatment challenges of patients diagnosed with enchondroma. We believe that immobilization for at least 4 weeks or implant application would be appropriate to increase stability in patients with intramedullary involvement of more than 50% in the dominant hand. Enchondromas still present many unknowns, more research is necessary to increase knowledge about these tumors. This study provides important data regarding enchondromas and serves as a foundational step for further research and investigation in this area.

Background Many surgical techniques, including microfracture, periosteal and perichondral grafts, chondrocyte transplantation, and osteochondral grafts, have been studied in an attempt to restore damaged articular cartilage. However, there is no consensus regarding the best method to repair isolated articular cartilage defects of the knee. Questions/purposes We compared postoperative functional outcomes, followup MRI appearance, and arthroscopic examination after microfracture (MF), osteochondral autograft transplantation (OAT), or autologous chondrocyte implantation (ACI). Methods We prospectively investigated 30 knees with MF, 22 with OAT, and 18 with ACI. Minimum followup was 3 years (mean, 5 years; range, 3–10 years). We included only patients with isolated cartilage defects and without other knee injuries. The three procedures were compared in terms of function using the Lysholm knee evaluation scale, Tegner activity scale, and Hospital for Special Surgery (HSS) score; modified Outerbridge cartilage grades using MRI; and International Cartilage Repair Society (ICRS) repair grade using arthroscopy. Results All three procedures showed improvement in functional scores. There were no differences in functional scores and postoperative MRI grades among the groups. Arthroscopy at 1 year showed excellent or good results in 80% after MF, 82% after OAT, and 80% after ACI. Our study did not show a clear benefit of either ACI or OAT over MF. Conclusions Owing to a lack of superiority of any one treatment, we believe MF is a reasonable option as a first-line therapy given its ease and affordability relative to ACI or OAT. Level of Evidence Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Treatment strategies for osteochondral defects, for which particulated autologous cartilage transplantation (PACT) is an emerging treatment strategy, aim to restore the structure and function of the hyaline cartilage. Herein, we compared the efficacy of PACT with control or human transforming growth factor-β (rhTGF-β), and clarified the necessity of bone graft (BG) with PACT to treat shallow osteochondral defects in a porcine model. Methods: Two skeletally mature male micropigs received 4 osteochondral defects in each knee. The 16 defects were randomized to (1) empty control, (2) PACT, (3) PACT with BG, or (4) rhTGF-β. Animals were euthanized after 2 months and histomorphometry, immunofluorescence analysis, semiquantitative evaluation (O’Driscoll score), and magnetic resonance observation of cartilage repair tissue (MOCART) score were performed. Results: Hyaline cartilages, glycosaminoglycan synthesis, and collagen type II staining were more abundant in the PACT than in the control and rhTGF-β groups. The O’Driscoll score was significantly different between groups (P < 0.001), with both PACT groups showing superiority (P = 0.002). PACT had the highest score (P = 0.002), with improved restoration of subchondral bone compared with PACT with BG. The MOCART score showed significant differences between groups (P = 0.021); MOCART and O’Driscoll scores showed high correlation (r = 0.847, P < 0.001). Conclusion: Treatment of osteochondral defects with PACT improved tissue quality compared with that with control or rhTGF-β in a porcine model. BG, in addition to PACT, may be unnecessary for shallow osteochondral defects. Clinical Relevance. BG may not be necessary while performing PACT.