ICRS 2019 - Conference Calendar
23.1.1 - Clinical study of anatomical ACL reconstruction with adjustable oval shaped bone tunnels: a CT evaluation
Abstract
Purpose
The purpose of this article was to demonstrate an adjustable oval bone tunnel ACLR technique. Aim of this technique was to fit the direction and shape of the footprint and tendon-bone healing passage (TBHP) which was defined as the passage of the normal ACL insertion embedded in the bone as closely as possible.
Methods and Materials
30 fresh-frozen human cadaveric knees were used to do the ACL anatomical insertions research. 20 patients underwent adjustable oval bone tunnel surgery and 20 patients were in round tunnel group. The tunnel of the presented technique was first drilled with a small diameter round drill bit. Then according to the direction and area of the remnant insersion fibers, the major axes of oval tunnels were expanded to theoretical value with a bone file. Major and minor axes, positions of bone apertures, and areas were evaluated on CT scans.
Results
The distance of major axis of oval tunnel apertures were 10.42 ± 0.55 mm and 12.63 ± 0.5 mm respectively. There’re no statistical significance compared with theoretical distance. The distance of minor axis of oval femoral and tibial tunnel apertures were 6.79 ± 0.28 mm and 6.02 ± 0.29 mm respectively. Both of them were longer than theoretical values (P < 0.001). Compared with the round femoral tunnel, the major/minor axis ratio of oval tunnel (1.53) was more close to the cadaveric results (1.83, P < 0.001). The areas of femoral and tibial apertures were 53.12 ± 1.87 mm2 and 54.22 ± 3.21 mm2 respectively. Both of them were smaller than the round tunnel area and lager than theoretical areas (P < 0.001).
Conclusion
We successfully developed the adjustable single oval bone tunnel ACLR technique, which mimic the direction and shape of the tibial and femoral footprints together with the BTHP better than single round tunnel.
23.1.2 - Does Repair of Horizontal Cleavage Meniscus Tears Improve Patient Outcomes? 1 Year Results from Prospective Multi-Center STITCH Trial
- D. Flanigan (Columbus, US)
- A. Krych (Rochester, US)
- A. Anz (Gulf Breeze, US)
- F. Gwathmey (Charlottesville, US)
- J. Larson (Columbus, US)
- G. Loren (Winchester, US)
- M. Lavery (Greenwood, US)
- L. Jazrawi (New York, US)
- S. Faucett (Washington, US)
- L. McIntyre (Sleepy Hollow, US)
- P. Kurzweil (Long Beach, US)
Abstract
Purpose
The study objective was to evaluate 1 year outcomes of Horizontal Cleavage Tear (HCT) repairs including reoperation and patient-reported outcomes (PROs).
Methods and Materials
A Prospective, Non-randomized, Multi-Center Investigation of All Suture-based Repair of Horizontal Meniscal Tears (STITCH) enrolled patients, ages 18-60, with HCTs repaired using circumferential sutures placed with a self-retrieving all-inside suture repair device with or without adjunct all-suture techniques. Patients with grade ≥3 OA, BMI ≥35kg/m2, prior meniscus surgery, instability, malalignment, or tobacco abuse were excluded.
Results
30 patients were enrolled, with the majority male (68%) and an average age of 38.1±11.7years. Tears were predominantly in the medial compartment (68%), extended into Zone 2 or 3 (64%), with an average length of 18.3±5.8mm and an average of 4.9±2.7stitches placed.Three subjects were disqualified for anchor usage, one lost to follow-up, and one dropped out, and one exited due to infection. At the time of this abstract, three patients had not returned for the 1 year visit. Of the remaining 21 patients, two (9.5%) required reoperation of the original meniscus tear. There was significant improvement on all scales measured: IKDC (40.4±20.5, p<0.001), KOOS Pain (31.8±19.0, p<0.001), KOOS Sport (41.9±28.7, p=0.001), KOOS Symptom (29.5±21.6, p<0.001), KOOS ADL (30.3±15.0, p<0.001), KOOS QOL (41.5±27.7, p<0.001), Tegner (1.9±2.7, p=0.003), Lysholm (29.6±24.0, p=0.001). 16/19 (84.2%) and 15/19 (78.9%) of patients met the minimal clinically important difference (MCID) for improvement in IKDC and Lysholm scores, respectively. Age, BMI, length of tear, and tear location were not independent predictors of success, although the study may not be sufficiently powered.
Conclusion
1 year results demonstrate improvement in clinical outcomes and low reoperation rates for patients with circumferential meniscus repair of HCTs. Subjects will be followed for 2 years to assess durability of results.
23.1.3 - Prospective Evaluation of Particulated Juvenile Articular Cartilage Allograft in the Treatment of Osteochondral Lesions of the Talus
Abstract
Purpose
To prospectively evaluate the clinical efficacy of minimally invasive single stage treatment of osteochondral lesions of the talus (OLT) with arthroscopic application of “particulated” juvenile articular cartilage allograft transplantation (PJACAT), also known as DeNovo NT for lesions >1cm2 or failed prior cartilage restoration procedure. Post-operative MRI used to evaluate structural characteristics of the chondral repair non-invasively.
Methods and Materials
A single surgeon series of ankle arthroscopies were evaluated prospectively for treatment of OLT with “particulated” juvenile articular cartilage allograft transplantation (PJACAT) using DeNovo NT. Demographic data and operative variables were recorded. MRI was utilized to determine the size of the lesion pre-and post-operatively, the extent of integration with adjacent articular cartilage, integration with subchondral bone, and the presence of subchondral marrow edema and cystic lesions. Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), Short Form Health Survey (SF-36) version were collected.
Results
18 patients are enrolled with mean follow up of 24.8 months (range 1-44 months). 14 of the 18 patients have at least 24 months follow up. The OLT lesion was medial talar dome in 13 (72.2%) of patients. 5 (27.7%) of the 18 patients had undergone prior OLT treatment, 4 (77.7%) of which were treated with prior microfracture. 2 patients (11%) had symptoms of ankle instability prior to OLT surgical intervention. FAOS, FAAM, and SF-36 surveys markedly improved in every subscale category, with some subscales reaching significance of p < 0.05. Average MOCART score was 55 (range 40-90), with an average OCAMRISS score of 7 (range 4-9).
Conclusion
Our findings confirm clinical efficacy of minimally invasive single-stage treatment of OLT with arthroscopic application of DeNovo NT in patients with lesion size >1cm2 or failed prior cartilage restoration procedure. These findings also demonstrate better correlation of OCAMRISS over MOCART, which appears to be better suited to radiographically evaluate OLT lesions following PJACAT.
23.1.4 - Outcomes and Survival Rate of Collagen Matrix-Based Meniscus Repair: 4- to 8-year Follow-up Study
Abstract
Purpose
To report the MRI and clinical outcomes with survival rate at a minimum 5-year follow-up in a series of patients with complex meniscal tear and treated with a collagen matrix-based meniscus repair.
Methods and Materials
Fifty-four consecutive patients operated on from 2010 to 2011 with the mean follow up 5,92- year (3,56-8,34) were included. We lost to follow up 6 patients so to final analysis was included 48 cases. Functional scores (IKDC, Lysholm) were assessed preoperatively, 2-year, and at the last follow-up. EQ 5D 5L score were assessed at the last follow-up. The state of the meniscus and the total WORMS OA score was also evaluated in MRI.
Results
Forty-eight patients were included to the final analysis. Four meniscus were partly resected to the last follow up - 8,3% failure rate. The functionality of the knees improved from preoperative to 2 –year follow up and were even better at 5-year follow up in all the scores used (P < .001). Thirty-seven patients were examined by MRI 2 and 5 years postoperatively. MRI revealed a non-homogeneous signal without meniscal tear in 2-year follow up in 92% and in 5-year follow up in 81% of the operated menisci. The total WORMS score increased from main 6,89 in 2-year follow up to main 11,1 in 5-year follow up. No progression to the OA level was observed. Sex, age and BMI have no correlation with 2- and 5-year outcomes. The time from injury to the surgery correlated with clinical outcome. The EQ-5D-5L was 0,943.
Conclusion
The 2- and 5-year follow-up data demonstrate this technique is safe with acceptable failure rate and can offer an additional tool to save the meniscus in the patients otherwise scheduled for meniscal removal. The quality of life 5 year after surgery is very good. The procedure protects the knee against the progression of degenerative.
23.1.5 - Improved Osteochondral Allograft Preservation Using Cyclic Hydrostatic Pressure
Abstract
Purpose
Osteochondral allografts (OCA) are currently stored at 4˚C for an average of 24 days after procurement. Chondrocyte viability, believed to be a major determinant of graft performance, deteriorates after 2 weeks under such condition, especially in the superficial zone, and falls below acceptable levels ~28 days. Consequently, the improvement of OCA storage condition to extend chondrocyte viability is critical to potentially improve graft availability. We aimed to improve cell viability and matrix integrity of OCAs during storage by promoting mass transfer with cyclic hydrostatic pressure (HP).
Methods and Materials
Osteochondral (OC) explants (6x8 mm) from bovine humeral head were randomly assigned to one of 4 groups: freshly harvested; stored at 4°C on atmospheric pressure (AP), stored at 37°C on AP (95% humidity, 5% CO2); stored at 37°C on cyclic HP at 0-0.5 MPa, 0.5 Hz (95% humidity, 5% CO2) (Figure 1). Explants were stored for 7, 14, 21 days in Dulbecco's Modified Eagle's Medium and antibiotics. Chondrocyte viability and density were assessed using LIVE/DEAD® staining in the entire tissue section and in the superficial, middle, deep zones using Image J program. In addition, OC explants underwent histological (Safranin-O fast green; Hematoxylin and eosin) and immunohistological (Proliferating cell nuclear antigen (PCNA)) evaluation.
Results
Full-thickness chondrocyte viability was significantly higher at 14 and 21 days in the HP group at 37°C compared to 4°C or 37°C storage at AP alone. Specifically, chondrocyte viability in the superficial zone was markedly improved after HP was applied (Figure 2). A greater amount of sulfated glycosaminoglycan matrix and proliferating cells in 37°C HP group were observed in the superficial zone compared to other storage conditions at 21 days.
Conclusion
OCA stored with cyclic HP at 37˚C maintained higher chondrocyte viability and ECM accumulation than OCA stored at AP at 4˚C or 37˚C.
23.1.6 - Anteromedial Tibial Tubercle Osteotomy improves results of MPFL reconstruction in patients with TT-TG distance of 17-20mm
Abstract
Purpose
To compare the mid-term clinical outcomes of the anteromedialization tibial tubercle osteotomy combined with the medial patellofemoral ligament reconstruction (TTO+MPFLR) versusthe medial patellofemoral ligament reconstruction alone (MPFLRa) for the treatment of recurrent patellar instability (RPI) in patients with TT-TG 17 to 20 mm.
Methods and Materials
From January 2008 to August 2013, patients with RPI and TT-TG 17-20mm were divided into two groups: TTO+MPFLR or MPFLRa. Subjects were evaluated for J sign classification (1 to 4+), patellar glide (1 to 4+), apprehension test, increased femoral anteversion, Caton index, trochlea dysplasia, TT-TG, Kujala, Lysholm, IKDC, and Tegner. Kujala improvement was the primary outcome.
Results
Forty-two patients were evaluated: 18 in the TTO+MPFLR and 24 in the MPFLRa groups. Mean follow-up: 40.86 months (range 24 to 60 months). Demographics between the groups were not different. Preoperatively, there was no statistically significant difference between groups regarding J sign classification, patellar glide, apprehension test, increased femoral anteversion, Caton index, trochlea dysplasia, TT-TG, Kujala, Lysholm, IKDC, and Tegner. Postoperative J sign classification mean results comparing TTO+MPFLR and MPFLRa, respectively: 1, 1.33, p=0.006. Improvement was significantly higher in the TTO+MPFLR group in all scores, except for Tegner. Kujala improvement: 30.27, 23.95, p=0.003, was also clinically significant favoring TTO+MPFLR. Lysholm improvement: 40.5, 36.2, p=0.02. IKDC improvement: 38.59, 31.6, p=0.002. There were no reported recurrent subluxations or dislocations in either group.
Conclusion
TTO+MPFLR resulted in better functional outcome scores and patellar kinematics compared to MPFLRa in the surgical treatment of RPI in patients with TT-TG distance of 17-20mm.
23.1.7 - Tibial tubercle distalization can reduce articular cartilage contact pressures in the patellofemoral joint of patients with patella alta
Abstract
Purpose
Tibial tuberosity distalization with normal patella height increases articular contact pressures; however, it is unknown what is the biomechanical effect of distalization in patients with patella alta. There is concern that distalization in these cases can result in iatrogenic increases in contact pressure. We sought to characterize the effect of distalization on contact pressure in patients with patella alta.
Methods and Materials
High resolution 3T MRI scans of eight patients (1 male, 7 female, mean age 17, range 13-21) being treated for patellar instability were used to create individual multibody dynamic computer simulation models with patella alta (Caton-Deschamps index ≥ 1.3). Dynamic knee squatting was simulated for 3 conditions: the native knee with patella alta; following distalization (Caton-Deschamps index = 1.0); and following distalization combined with patellar tendon tenodesis. Patellofemoral contact pressures and distribution were based on discrete element analysis. Repeated measures comparisons were used to identify significant (p < 0.05) differences between the conditions.
Results
Tuberosity distalization significantly decreased the maximum pressure applied to cartilage at 15°, 20°, 30°, and 35° of flexion, with the decrease more than 20% of the pre-operative pressure. Distalization also significantly increased contact area from 15° to 40° of flexion. Tenodesis had a relatively small influence on the kinematics and pressure, compared to distalization.
Conclusion
Tibial tuberosity distalization is associated with a reduction in peak patella contact pressure at low flexion angles. Distalization may help decrease the risk of patellofemoral arthritis in patients witha alta.
23.1.8 - The Study on the Clinical Effect of Weight-bearing of Fast-Fix Suture Operation under Arthroscopy of Meniscus Tear
Abstract
Purpose
To focus on making a comparison on meniscus healing and knee movement of weight-bearing in early stage of Fast-Fix suture operation(weight-bearing in the 2nd day) and weight-bearing after 6 weeks and draw a conclusion with clinical significance.
Methods and Materials
200 patients with Fast-fix suture operation of pure meniscus tear under knee arthroscopy were collected and divided into group A and group B.The operation was conducted by the same physician and all patients conducted Fast-Fix internal suture. During the operation period: patients in group A wore adjustable support of knee, started weight-bearing in the 2nd day and conducted rehabilitation exercise; patients in group B wore adjustable support of knee and conducted rehabilitation exercise on the bed. After 6 weeks, they started weight-bearing on the ground. The postoperative follow-up time in the group A was 3-24 months(mean: 6 months) and in the group B was 2-22 months(mean: 5 months). After operation, the following indexes were used for observation: 1) Lysholm; 2) IKDC(International Knee Documentation Committee; 3) Postoperative MRI inspection and secondary arthroscopy inspection.
Results
Lysholm: in the group A, it was increased to 92.2 after operation from 45.7 before operation; in the group B, it was increased to 93.5 after operation from 46.3 before operation. IKDS: After operation, 96 patients in the group A got 5.8 months and 97 patients in the group B got 4.3 months to get well to the normal life or movement state before getting injury; MRI inspection and secondary microscopic examination were conducted for trauma or other cases: The group A had 11 patients and the group B had 16 patients.
Conclusion
Pure meniscus tear was conducted under Fast-Fix suture of arthroscopy and after wearing adjustable support, patients could conduct weight-bearing activity in early stage(the 2nd day). Early-stage weight-bearing had no obvious influences on meniscus healing and knee joint movement.
23.1.9 - Severe bone marrow edema following prior marrow stimulation technique is a predictor of autologous chondrocyte implantation failure.
Abstract
Purpose
Autologous chondrocyte implantation (ACI) is a well-established cartilage repair procedure, however, numerous studies have shown higher ACI graft failure rates after prior marrow stimulation techniques (MST). The purpose of this study was to identify which factors may predict decreased graft survival after ACI among patients who underwent prior MST. A secondary aim was to investigate the specificity of these predictors.
Methods and Materials
In this review of prospectively collected data, we analyzed 38 patients who had failed prior MST surgery and subsequently underwent collagen covered ACI (case group). We divided our patient case group to graft failure ACI (n=8, 21%) and successful ACI (n=30, 79%). Fourteen clinical variables were categorized and analyzed to determine predictors for failure of the ACI graft. Preoperative magnetic resonance imaging (MRI) was used to evaluate the severity of subchondral bone marrow edema (BME) graded from I–absent to IV–severe, the presence of subchondral cyst, hypertrophic sclerosis, and intralesional osteophyte. The effects of these MRI findings on the graft survivor were also investigated. Concurrently, a control group, without prior MST was matched to investigate the specificity of the previously determined predictor.
Results
In the case group, the presence of preoperative severe BME was significantly higher in patients with failed ACI as compared to patients with successful ACI (p<0.001). In the control group the presence of severe BME was not significantly different between the failure and successful group (p=0.747). ACI graft failure rate among patients with prior MST and preoperative grade IV BME was 83.7% at 5 years postoperatively resulting a significantly lower survival rate as compared to patients with prior MST and without severe BME (5-year graft failure rate=6.5%) (p < 0.001). Other parameters did not differ significantly.
Conclusion
The presence of grade IV BME after prior MST is a predictive factor for graft failure among patients who then underwent second-generation ACI.