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The article presents a study on survival rates after combined osteochondral autologous transfer (OAT) and valgus high tibial osteotomy (HTO) in young and active patients with symptomatic osteochondral defects of the medial femoral condyle and concomitant varus malalignment. It mentions deep osteochondral defects of the medial femoral condyle in young patients that might lead to early osteoarthritis of the knee joint. Results showed combined OAT and valgus HTO can treat the disease.

Background: There are limited data regarding activity after osteochondral transplantation of the talus in orthopaedic publications.Hypothesis: Osteochondral transplantation of the talus is a clinically successful treatment and enables patients to pursue regular and ongoing recreational sporting activities.Study Design: Case series; Level of evidence, 4.Methods: One hundred thirty-one patients were retrospectively analyzed to determine their sporting and recreational activities at an average of 60 ± 28.4 months postoperatively (range, 24-141 months). The clinical evaluation included the Tegner activity scale, the Activity Rating Scale (ARS), and a visual analog scale (VAS) for pain.Results: The VAS illustrated significant preoperative to postoperative improvements (6.3 to 2.7; P < .001). Regarding sporting activity, 96.9% of the patients were engaged in sports during their lifetimes compared with 83.8% the year before surgery and 89.3% at the time of survey. The Tegner score dropped from 5.9 preoperatively to 5.0 after surgery (P = .001), and the ARS decreased from 8.9 preoperatively to 6.8 postoperatively (P = .003). The sports frequency and the duration of activities did not significantly change after surgery: 1.7 ± 2.0 (range, 0-8; P = .053) and 4.2 ± 3.8 hours (range, 0-30 hours; P = .052), respectively. The number of actual reported different sports disciplines was unchanged in comparison to the year before surgery (3.7 ± 2.9; range, 0-12). The top 10 cited sports activities did not change for the lifetime, preoperative, and postoperative periods but illustrated an altered order. Although the overall satisfaction with the surgery was good, 15% of our patients were only partially satisfied, and 14% were not satisfied with the procedure.Conclusion: Patients engage in fewer, less frequent sporting activities when a symptomatic osteochondral lesion (OCL) at the talus is present. Talar osteochondral transplantation shows good clinical midterm results and allows patients to return to sporting activity. However, we found patients modify their postoperative sporting activities, and we noted a reduction of participation in high-impact and contact sports. [ABSTRACT FROM PUBLISHER]

Background: The use of predifferentiated mesenchymal stem cells (MSC) leads to better histological results compared with undifferentiated MSC in sheep. This raises the need for a longer term follow-up study and comparison with a clinically established method.Hypothesis: We hypothesized that chondrogenic in vitro predifferentiation of autologous MSC embedded in a collagen I hydrogel leads to better structural repair of a chronic osteochondral defect in an ovine stifle joint after 1 year. We further hypothesized that resulting histological results would be comparable with those of chondrocyte-seeded matrix-associated autologous chondrocyte transplantation (MACT).Study Design: Controlled laboratory study.Methods: Predifferentiation period of ovine MSC within collagen gel in vitro was defined by assessment of several cellular and molecular biological parameters. For the animal study, 2 osteochondral lesions (7-mm diameter) were created at the medial femoral condyles of the hind legs in 9 sheep. Implantation of MSC gels was performed 6 weeks after defect creation. Thirty-six defects were divided into 4 treatment groups: (1) chondrogenically predifferentiated MSC gels (pre-MSC gels), (2) undifferentiated MSC gels (un-MSC gels), (3) MACT gels, and (4) untreated controls (UC). Histological, immunohistochemical, and radiological evaluations followed after 12 months.Results: After 12 months in vivo, pre-MSC gels showed significantly better histological outcome compared with un-MSC gels and UC. Compared with MACT gels, the overall scores were higher for O’Driscoll and International Cartilage Repair Society (ICRS). The repair tissue of the pre-MSC group showed immunohistochemical detection of interzonal collagen type II staining. Radiological evaluation supported superior bonding of pre-MSC gels to perilesional native cartilage. Compared with previous work by our group, no degradation of the repair tissue between 6 and 12 months in vivo, particularly in pre-MSC gels, was observed.Conclusion: Repair of chronic osteochondral defects with collagen hydrogels composed of chondrogenically predifferentiated MSC shows no signs of degradation after 1 year in vivo. In addition, pre-MSC gels lead to partially superior histological results compared with articular chondrocytes.Clinical Relevance: The results suggest an encouraging method for future treatment of focal osteochondral defects without donor site morbidity by harvesting articular chondrocytes. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the ankle are a common injury after ankle sprains, especially in young and active patients. The Osteochondral Autograft Transfer System (OATS) is the only 1-step surgical technique designed to replace the entire osteochondral unit.Purpose: This study was conducted to evaluate the long-term clinical and radiographic outcomes of the OATS procedure for the talus and compare the results of patients who have had prior surgical interventions with patients for whom OATS represents the primary surgical treatment.Study Design: Case series; Level of evidence, 4.Methods: The authors retrospectively analyzed 26 talus OATS procedures (25 patients) with an average follow-up of 84 months (range, 53-124 months); 9 patients had OATS as a second surgical intervention. The patients completed the American Orthopaedic Foot & Ankle Society (AOFAS) and Tegner scores plus the visual analog scale (VAS) preoperatively and at follow-up. Magnetic resonance imaging examinations were conducted on a 1.5-T whole-body magnet that assessed transplant congruency, adjacent surface of the talus, the corresponding distal tibia, and joint effusion.Results: The authors found significant increases for the AOFAS score (50 to 78 points, P < .01) and the Tegner score (3.1 to 3.7, P < .05) and a significant decrease for the VAS (7.8 to 1.5, P < .01) from preoperative to postoperative. Patients with normal integration or minor incongruity of the transplant on magnetic resonance imaging (81%) had significantly better AOFAS scores (P = .03). Other magnetic resonance imaging criteria did not predict clinical results. Patients for whom OATS represented a second procedure had significantly worse clinical AOFAS and Tegner scores plus a higher VAS.Conclusion: Long-term clinical and magnetic resonance imaging results after osteochondral transplantation are good and patients significantly benefit from this surgery. Magnetic resonance imaging should not be a routine control but appears to be indicated when clinical symptoms persist after osteochondral transplantation. [ABSTRACT FROM AUTHOR]