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Purpose: Autologous matrix‐induced chondrogenesis (AMIC) showed promising short‐term results comparable to microfracture. This study aims to assess the 19‐year outcomes of AMIC, addressing the lack of long‐term data. Methods: Retrospective cohort of 34 knees treated with AMIC underwent a 19‐year follow‐up. The primary outcome was AMIC survival, considering total knee arthroplasty as a failure event. Survival analysis for factors that were associated with longer survival of the AMIC was also performed. Clinical and radiological outcome scores were analysed for the AMIC group. Results: Twenty‐three knees were available for follow‐up analysis. Of these, 14 (61%) underwent revision surgery for total knee arthroplasty (TKA). The mean time was 13.3 ± 2.5 years (range: 9–17 years). Secondary outcomes showed that increased age at surgery (hazard ratio [HR]: 1.05; p = 0.021) and larger defect size (HR: 1.95; p = 0.018) were risk factors for failure. Concomitant proximal tibial osteotomy (HR: 0.22; p = 0.019) was associated with longer survival. The remaining nine knees (39%) were analysed as a single group. The mean clinical score at follow‐up of 18.6 ± 0.9 SD years was 79.5 ± 19.7 SD for the Lysholm score, 1.8 ± 1.5 SD for the visual analog scale score, 74.2 ± 22.4 SD for the KOOS score and a median of 3 (range: 3–4) for the Tegner activity scale. Conclusions: The mean survival time of 13.3 years indicates the durability of AMIC in properly aligned knees. Nonetheless, despite a 61% conversion to TKA, the knees that persisted until the 19‐year follow‐up remained stable, underscoring the procedure's longevity and consistent clinical outcomes. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The autologous collagen-induced chondrogenesis technique is described, and the results of a 6-year follow-up clinical study using this technique are presented. Methods: 30 patients with International Cartilage Repair Society (ICRS) Grade III/IVa symptomatic chondral defects of the knee treated with enhanced microdrilling using atelocollagen were prospectively examined in this clinical series. The median age of the patients was 39.0 years (range 19–61 years). Patients were followed up to 72 months. Clinical evaluation was performed using functional knee scores and radiologically. Both quantitative and qualitative assessments were performed. Results: Statistically significant and clinically relevant improvement was observed in 2 years and was sustained for the 6 years of the study observation. At 6 years, the mean Lysholm score was 79.7 (SD 6.8) compared to 52.6 (SD 10.7) pre-operatively (p < 0.05). The symptomatic Knee Injury and Osteoarthritis Outcome Score (KOOS) improved from 68.3 (SD 11.4) to 90.2 (SD 4.3) (p < 0.05). The subjective International Knee Documentation Committee (IKDC) also showed improvement from 39.1 (SD 4.1) to 81.6 (SD 7.8) (p < 0.05). The calculated T2* relaxation times were 26.0 (SD 4.2) seconds and 30.3 (SD 6.2) seconds for the repair tissue and native cartilage, respectively. The average magnetic resonance observation of cartilage repair tissue (MOCART) score was 78.5 (SD 9.6) for all lesions. Conclusion: The enhanced microdrilling using atelocollagen is an enhancement of the traditional microfracture method using an off-the-shelf product. When used to treat moderate to severe chondral lesions, this enhancement produces hyaline-like cartilage with a corresponding improvement in symptoms. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: Hip arthroscopy is a safe and reproducible method for treating femoroacetabular impingement (FAI) and has evolved greatly in recent years. But little is known about the influences on the outcome after surgery. The aims of the current study were to elucidate (1) which parameters can be used as a marker for the presence of chondral and labral lesions, (2) the postoperative clinical outcome, and (3) at which time after surgery recovery occurs.Methods: A prospective study was performed with 177 patients who underwent hip arthroscopy because of cam-type FAI. The patients were examined preoperatively as well as 6 weeks and 6 months postoperatively, and their condition was rated according to the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Non-Arthritic Hip Score (NAHS). Statistical analyses were performed to evaluate the influence of independent factors such as "patient age," "pain duration before surgery" on the clinical outcome, and the appearance of chondral or labral defects.Results: The NAHS and WOMAC scores showed a significant enhancement 6 weeks after surgery. Only the NAHS showed a further improvement after 6 months. A positive correlation with the dependent variable "chondral lesion" was evaluated for the independent variables "pain duration before surgery," "preoperative NAHS," and "labrum lesion". Using ROC analysis, the optimal cutoff value of "pain duration before surgery" as a predictor was 9.5 months, for the NAHS 42.5 points. For the dependent variable, "6-month postoperative NAHS" significant correlations for the independent variables "age" and "pain duration before surgery" were revealed with a cutoff value of 55.5 years, respectively, 23.5 months.Conclusions: It was concluded from the results that the date of surgery is relevant for the appearance of chondral defects. Patient age is a further relevant factor for clinical outcome. Recovery after hip arthroscopy takes place mainly in the first 6 weeks after surgery.Level Of Evidence: Therapeutic study, Level III. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies report professional athletes return to play following arthroscopic microfracture of the hip for chondral defects. Our hypothesis is that professional hockey players undergoing arthroscopic microfracture for chondral defects of the hip achieve the same performance they had pre-injury and compared to matched controls. Methods: Seventeen professional hockey players underwent arthroscopic microfracture for an Outerbridge grade IV chondral lesion. Concomitant procedures for labral pathology or FAI were included. Performance data for the full season preceding and following index procedure were analysed, in addition to two matched control players per subject. Data were collected at two points, 2 years apart. Results: Eighty-two per cent (14/17) of players who underwent arthroscopic microfracture returned to play. The year prior to injury for the 14 players who returned was compared to the average of their individual controls. There was no statistical difference between the groups for age, number of seasons in the league, games played, time on ice, points, save percentage, and shots against goal. Post-operatively, there was no statistical difference between the treatment and control groups regarding performance measures. There was a trend towards a decrease in games played and points post-operatively compared with controls. The treatment group decreased 11 games played, while the controls decreased five games. The treatment group also decreased 14 points, while the controls decreased three points for the season. Conclusions: Professional hockey players with a discrete, full-thickness chondral defect of the hip are able to return to elite performance level following an arthroscopic microfracture procedure when compared to pre-injury outcomes and controls. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe the practice of microfracture surgery for knee chondral defects among Canadian orthopedic surgeons. Methods: All orthopedic surgeon members of the Canadian Orthopaedic Association were invited to participate in a survey, designed to explore the microfracture technique used by orthopedic surgeons in the treatment for knee chondral defects The primary outcome measure was an emailed 26-item questionnaire, which explored indications for microfracture surgery, surgical techniques, types of postoperative rehabilitation regimes used and assessment of outcome. In addition, responses were compared between orthopedic surgeons with a sports medicine practice to surgeons with a non-sports medicine practice. Results: The survey response rate was 24.6% (299/1,216), with 131 regularly performing microfracture. 41% of surgeons indicated that they had no upper limit for age at the time of surgery, and 87% indicated no upper limit for body mass index. The majority of respondents (97%) resected cartilage back to a stable margin, while 69% of respondents removed the calcified cartilage layer prior to creating holes. Only 11% of respondents used continuous passive motion (CPM) postoperatively, and 39% did not restrict weight bearing. Sports surgeons were more likely than non-sports surgeons to remove the calcified cartilage layer, use a 45° pick, use CPM and restrict weight bearing postoperatively (all P values < 0.05). Conclusions: This survey on microfracture for knee chondral defects revealed widespread variation among surgeons regarding the indications for surgery, surgical technique, postoperative rehabilitation and assessment of outcome. Sports surgeons demonstrate better evidence-based practice than non-sports surgeons for a few important parameters. Level of evidence: Cross-sectional survey, Level II. [ABSTRACT FROM AUTHOR]

Purpose: Articular resurfacing by treatment of chondral defects may include chondral abrasion, autologous chondrocyte Implantation (ACI), matrix-induced chondrocyte transplantation (MACT) or osteochondral autologous transplantation (OATS). This technical note describes the method of autologous matrix-induced chondrogenesis (AMIC), a one-step procedure combining subchondral microfracture with the fixation of a collagen I/III membrane with fibrin glue or sutures. Methods: This is a technical note on the AMIC procedure and its further development. Results and conclusion: This method is applied primarily in chondral or osteochondral lesions of the knee. Indications and contraindications are provided; the technique is described. The further development of AMIC is described with an increased focus on the subchondral zone and the complex of cartilage and bone, the osteochondral unit, which receives increased attention in cartilage research. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Surgical treatment for chondral defects of the knee in competitive running and jumping athletes remains controversial. This study evaluated the performance outcomes of professional basketball players in the National Basketball Association (NBA) who underwent microfracture. Data from 24 professional basketball players from 1997 to 2006 was obtained and analyzed. NBA player efficiency ratings (PER) were calculated for two seasons before and after injury. A control group of 24 players was used for comparison. Study group and control group demographics including age, NBA experience, and minutes per game demonstrated no statistical difference. Mean time to return to an NBA game was 30.0 weeks from the time of surgery. The first season after returning to competition PER and minutes per game decreased by 3.5 ( P < 0.01) and 4.9 min ( P < 0.05), respectively. The 17 players who continued to play two or more seasons after surgery, the average reduction in their PER and minutes per game was 2.7 ( P > 0.05) and 3.0 min ( P < 0.26), respectively. A multivariant comparison versus controls demonstrated that power rating during the 2 years after surgery decreased by 3.1 ( P < 0.01); while minutes per game decreased by 5.2 ( P < 0.001). Twenty-one percent ( n = 5 of 24) of the players treated with microfracture did not return to competition in an NBA game. On return to competition player performance and minutes per game are diminished. [ABSTRACT FROM AUTHOR]

This prospective, non-randomized study was aimed to evaluate the effects of abrasive arthroplasty and periosteal arthroplasty in the treatment of deep chondral defects of the patella. A total of 30 patients in group A (13 male, 17 female, age: 28.7+/-6.9 years) underwent arthroscopic abrasive arthroplasty. The other patients in group B (n=17, 11 male, 8 female, age 26.8+/-7.0 years) underwent periosteal arthroplasty by an autologous periosteal flap. The maximal diameter of the defects was 31.1+/-6.7 (range 20-45 mm). The Lysholm score and the intensity of pain were evaluated preoperatively and at the time of follow-up (3.1+/-1.1, range 2-5 years). The Tegner activity score was evaluated before onset of the symptoms and at the time of follow-up. The Lysholm score increased significantly in both groups (in group a from 36.1+/-7.1 to 42.5+/-6.6 points and in group B from 42.7+/-2.4 to 67.6+/-7.8 points). The result in group B was significantly better than in group A. In group A the intensity of pain was unchanged, whereas patients from group B reported a significant reduction of pain. The level of physical activity (Tegner score) was 5.5+/-2.1 in group A and 5.5+/-2.1 in group B before onset of the complaints. In follow-up, patients from group B (4.9+/-1.2) had a reduced Tegner score in tendency. The patients in group A had a significantly reduced level of physical activity (2.7+/-0.6). A total of 12 patients from group B had a range of motion lesser than 80 degrees in flexion. These patients underwent joint mobilization and control arthroscopy. During control arthroscopy there was always found a stable periosteal flap. Short-term clinical results with periosteal arthroplasty produced a significant reduction in pain and improved Lysholm score in comparison to abrasive arthroplasty. [ABSTRACT FROM AUTHOR]

The high incidence of chondral defects of the femoral condyles associated with chronic ACL tears is widely recognised. However, treatment is difficult and controversial. This preliminary report presents our experience with arthroscopic osteochondral autograft transplantation in ACL-deficient knees. The series consists of 12 cases of arthroscopic osteochondral autograft transplantation in conjunction with ACL reconstruction using bone-patellar tendon-bone autograft; eight procedures were primary, and four were revisions of failed synthetic grafts. The patients' ages ranged from 22 to 42 years. There were ten male and two female patients. Chondral lesions in this series ranged from 10 to 22 mm in diameter. Donor site was selected prior to notchplasty, and three to five osteochondral cylinders, 5-10 mm in diameter, 10-15 mm long, were harvested. Improved surgical technique, tubular cutting instruments enabling minimal damage to harvested articular cartilage, and press-fit insertion yielded promising uniform results in ten of 12 cases with 2 years' follow-up. This study addresses the important issue of articular cartilage defects in ACL-deficient knees and possible prevention of premature joint degeneration. The aim of arthroscopic osteochondral autograft transplantation is to slow down the development of osteoarthrosis. [ABSTRACT FROM AUTHOR]