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Background: Tibial tuberosity anteromedialization (TTA) is a well-established treatment option for patellofemoral chondral disease that is resistant to nonoperative treatment. However, the prognostic factors of this procedure are unknown. Purpose: To analyze the prognostic factors correlated with the midterm outcomes of TTA for patellofemoral chondral disease and determine the survivorship. Study Design: Case series; Level of evidence, 4. Methods: Indications of TTA for chondral disease included skeletal maturity, age <65 years, 7 points (34.6% of knees) in the multiple regression model was associated with age >45 years (odds ratio [OR], 10.4; 95% CI, 2.0-55.0) and increased femoral anteversion (OR, 7.9; 95% CI, 1.4-44.1). A Kujala score of <80 points (61.5% of knees) was associated with age >45 years (OR, 12.0; 95% CI, 2.6-56.2) and foot pronation (OR, 5.1; 95% CI, 1.3-20.4). Patient satisfaction of <7 of 10 points (32.1% of knees) was associated with positive postoperative patellofemoral crepitus (OR, 3.6; 95% CI, 1.1-11.7). The Kaplan-Meier survivorship of TTA with dissatisfaction (<5/10 points) as an end point was 94% at 43 months, 88% at 77 months, and 77% at 108 months. Conclusion: Overall, good outcomes and survivorship (77% at 108 months) were obtained in this case series. However, 25.6% of the patients would not undergo the surgery again. Increased age, increased femoral anteversion, foot pronation, and postoperative patellofemoral crepitus were identified as negative prognostic factors. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the histological features of erosive hand osteoarthritis (EHOA), which is considered an aggressive subset of hand osteoarthritis (OA) characterized by severe local inflammation and degeneration of the distal and proximal interphalangeal joints. Two patients with EHOA underwent replacement with a cement-free press fit ceramic prosthesis of a proximal interphalangeal joint (PIPJ). Clinical and radiological data were collected and histological examination was performed. Radiological examination with histological correlation showed complete erosion of the articular cartilage with focal presence of peripheral fibrocartilaginous resurfacing, sclerosis, and remodeling of the exposed bone, osteoclastic activity with resorptive lacunae in the subchondral bone and around degenerative fibromyxoid pseudocysts, coarse trabeculation of the cancellous bone, and marginal osteophytes. The synovial membrane showed non-specific mild hypertrophy and mildly cellular fibromyxoid stroma. The histological findings in patients with EHOA suggest a pathogenesis of cartilage resorption from the subchondral bone, via osteoclastic-mediated activity and formation of periarticular reactive fibrocartilaginous proliferation with partial resurfacing of the articular surface. [ABSTRACT FROM AUTHOR]

Purpose: "Early Osteoarthritis (EOA)" has been defined combining clinical, imaging and surgical parameters, with the aim to identify patients in early degenerative phases, who might benefit from the use of available regenerative procedures. Aim of this first clinical trial is to prospectively evaluate the results obtained in a group of patients meeting the inclusion criteria of "EOA" as proposed by the ESSKA Cartilage Committee, and surgically treated with the implantation of a multi-phasic osteochondral scaffold.Methods: 23 patients were prospectively evaluated at 12 and 24 months of follow-up. Etiology of the chondral or osteochondral defect was rated as microtraumatic or degenerative in 18 cases, and traumatic in 5 cases. Patients included were complaining of clinical symptoms like knee pain and affected by chondral and osteochondral lesions located at the femoral condyles or trochlea and MRI findings demonstrating articular cartilage degeneration and/or meniscal degeneration and/or subchondral bone marrow lesions.Results: All patients increased significantly in any clinical score adopted. The IKDC subjective score increased from 42.8 ± 13.8 at basal evaluation to 74.3 ± 17.4 at 12 months' (p < 0.0005), being stable (74.9 ± 20.4) up to the final follow-up of 24 months. Tegner score showed a statistically significant improvement in sports activity from 3.3 ± 2.7 pre-operative to 4.6 ± 2.2 at 12 months (p < 0.005), with a slight improvement to the final evaluation (4.7 ± 2.1; n.s.). However, the activity level was significantly lower than the pre-injury one (6.1 ± 2.6; p = 0.004). A significant difference was shown between patients younger versus older than 40 years, with younger patients had better clinical improvement (76.0 ± 18.6 vs 45.1 ± 38.8 respectively, p = 0.037).Conclusions: The implantation of a multi-phasic osteochondral scaffold represents a good option after failure of conservative management for Early OA patients, where younger age represent an important factor for a better outcome. Longer follow-up is needed to evaluate the benefit over time.Level Of Evidence: IV, case series. [ABSTRACT FROM AUTHOR]

The article evaluates the stability of the initial clinical improvement over time through documenting the imaging evolution of tissue regeneration process using magnetic resonance imaging analysis for up to 5 years. It examines 27 patients treated for knee chondral or osteochondral lesions. It looks at the use of osteochondral scaffold to treat chondral and osteochondral knee defects. Statistical improvement in all clinical scores during the two- and five-year follow-ups is also discussed.

The article presents a study which was carried out to evaluate the potential of a biomimetic osteochondral scaffold for treating osteochondritis dissecans (OCD) by analyzing the results obtained at two-year follow-up. It mentions that 27 consecutive patients who were affected by symptomatic knee OCD of the femoral condyles were employed in the study. It concludes that the biomimetic osteochondral scaffold proved to be a valid treatment option for knee OCD.

The article report the results after 4 years of a series of patients who underwent a one-step repair of osteochondral lesions of the talar dome, as well as the capability of magnetic resonance imaging (MRI) which used a T2-mapping sequence to predict the clinical outcome. It also discusses method and gives various results. It was concluded that the quality of the regenerated tissue detected by MRI T2 mapping directly correlated with the clinical results.

Background: Regenerative techniques, such as autologous chondrocyte implantation (ACI), have emerged as a potential therapeutic option for the treatment of chondral lesions, aiming to recreate a hyaline-like tissue in the damaged articular surface. The clinical application of the regenerative approach is well documented for different types of scaffold but mostly with an evaluation of the clinical outcome at short-term follow-up.Purpose: This study was conducted to analyze the clinical outcome obtained with arthroscopic second-generation ACI up to 7 years’ follow-up, to assess the durability of the results, and understand its real potential over time.Study Design: Case series; Level of evidence, 4.Methods: Sixty-two consecutive patients, 48 men and 14 women with a mean age of 28.1 ± 11.4 years, affected by chondral lesions of the femoral condyles were enrolled and treated with arthroscopic implantation of the bioengineered tissue Hyalograft C. The average size of the defects was 2.5 ± 1.0 cm2. Patients were evaluated with International Knee Documentation Committee (IKDC), EuroQol visual analog scale (EQ-VAS), and Tegner scores every year for 7 years, and a magnetic resonance imaging evaluation was performed.Results: A statistically significant improvement was observed in all scores from the basal evaluation to the 84 months’ follow-up. The IKDC subjective score increased from 39.6 ± 15.0 to 73.6 ± 18.8 at 12 months; a further slight improvement was observed at 24 months’ follow-up (76.5 ± 20.7), and then the results were stable and reached a final 7-year value of 77.3 ± 21.5. Seven cases (11%) failed. A better outcome was obtained in young active men, whereas the worst results were found in degenerative lesions or when previous surgery had been performed. Postoperative magnetic resonance imaging studies in 42 cases revealed a complete filling of the cartilage defect in 57% of the lesions, complete integration of the graft in 62% of cases, intact repair tissue surface in 50%, homogeneous repair tissue structure in 43%, and a graft signal-intensity score that was isointense with the adjacent native cartilage in 43% and 48% of the cases in dual T2–fast spin echo and 3-dimensional gradient echo with fat suppression sequences, respectively.Conclusion: The analysis of this group of homogeneous patients, prospectively evaluated every year for 7 years, shows that this bioengineered approach with the proper indications may offer good and stable clinical results over time. [ABSTRACT FROM PUBLISHER]

Background: In recent years, there has been an increasing interest in and awareness of the importance of subchondral bone, for its role in the pathogenesis of articular surface damage and for the care that should be taken when treating such damage.Purpose: The objective of this pilot clinical study was to test the safety and performance of a newly developed type I collagen-hydroxyapatite nanostructured biomimetic osteochondral scaffold that aims to regenerate cartilage and subchondral bone.Study Design: Case series; Level of evidence, 4.Methods: A multilayer gradient nano-composite scaffold was obtained by nucleating collagen type I fibrils with hydroxyapatite nanoparticles. Thirty patients (9 female, 21 male; mean age, 29.3 years) with knee chondral or osteochondral lesions were treated with scaffold implantation. Lesion size varied from 1.5 cm2 to 6.0 cm2. Twenty-eight patients were followed for 2 years and were clinically evaluated using the International Knee Documentation Committee and Tegner scores. At final follow-up, magnetic resonance imaging evaluation was performed in 24 patients, and they were evaluated with the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score.Results: The Tegner and International Knee Documentation Committee objective and subjective scores improved significantly from the baseline evaluation to the 6-, 12-, and 24-month follow-ups. Further analysis showed a slower recovery but the same results for patients who presented with adverse events, for older patients, for patients who underwent previous surgery, and for those with patellar lesions. In contrast, a faster recovery was observed in active patients. At magnetic resonance imaging evaluation, complete filling of the cartilage and complete integration of the graft was shown in 70% of the lesions. However, the subchondral lamina and bone were considered intact in a minority of cases (7% and 47%, respectively).Conclusion: This open 1-step procedure was used for the treatment of chondral and osteochondral knee defects. The present pilot study highlighted the safety and potential clinical benefit of the graded biomimetic osteochondral scaffold in promoting bone and cartilage tissue restoration by itself and with good clinical and magnetic resonance imaging results at the 2-year follow-up. [ABSTRACT FROM AUTHOR]