B. Cole (Chicago, US)

Rush Medical College Orthopaedic Surgery

Presenter Of 5 Presentations

Podium Presentation Osteochondral Grafts

16.4.9 - Clinically Significant Outcome Achievement After Osteochondral Allograft Surgery

Presentation Number
16.4.9
Presentation Topic
Osteochondral Grafts
Lecture Time
12:27 - 12:36
Session Name
Session Type
Free Paper Session
Corresponding Author

Abstract

Purpose

Patients undergoing osteochondral allograft transplantation (OCA) for articular cartilage defects have demonstrated significant post-operative improvements in patient-reported outcome scores. The purpose of this study is to examine the achievement of clinically significant outcomes, minimally clinically important difference (MCID), in patients undergoing OCA, and identify factors associated with achievement.

Methods and Materials

A prospectively maintained institutional database was reviewed for all patients who have completed 2-year follow-up after OCA between 2014 and 2017. Achievement of MCID on various PROMs including International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscore were evaluated. Thresholds for MCID achievement were based on previously published literature in OCA patients (IKDC: 9.8; KOOSPain; 16.7). MCID achievement rates were examined across 6 month, 1 year and 2 year follow-up time points, and univariate analysis was utilized to examine the effect of lesion size and demographic factors on achievement rates.

Results

A total of 235 patients (30.0±9.42 years, 53.6% female, BMI 26.6±4.40) were included, with an average lesion size of 3.20±1.17cm2. Achievement rates of MCID at 6-month, 1-year and 2-year time points were 54.07%, 79.31% and 80.95% for IKDC and 42.96%, 56.98% and 61.90% for KOOSPain, respectively. Patients had significantly increased odds of reporting MCID achievement on IKDC at 2 years when compared to 6 months [Odds Ratio: 3.16, p=0.003). Females were more likely than males to report MCID achievement on IKDC (p=0.043). Patients achieving MCID on KOOSPain had lower average BMIs than those failing to achieve MCID (26.1±4.0 vs. 27.5±4.5, p=0.043).

cso_mcid_ikdc_koospain.png

Conclusion

Two years post-operatively after OCA, achievement rates of MCID on function and pain outcome measures exceed 60%. Female patients are more likely to report some benefit in function following MFX than male counterparts, and those with greater preoperative BMIs are less likely to report minimal benefits with respect to pain.

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Extended Abstract (for invited Faculty only) Others

17.1.1 - Management of the Cartilage Defect in the Athlete

Presentation Number
17.1.1
Presentation Topic
Others
Lecture Time
13:00 - 13:30
Session Type
Industry Satellite Symposium
Corresponding Author
Podium Presentation Microfracture/Bone Marrow Stimulation

18.4.10 - Outcomes after Microfracture with Traditional Awl vs. Powerpick

Presentation Number
18.4.10
Presentation Topic
Microfracture/Bone Marrow Stimulation
Lecture Time
15:36 - 15:45
Session Type
Free Paper Session
Corresponding Author

Abstract

Purpose

Microfracture (MFx) has traditionally utilized an awl/mallet technique to stimulate bone marrow healing and growth factor recruitment. A Powerpick drill (Arthrex Inc., Naples, FL, USA) has been introduced as an alternative to traditional methods, although the impact of this new technology on outcomes has yet to be defined. Accordingly, we seek to examine longitudinal outcomes comparing the awl/mallet to the Powerpick technique in MFx surgery.

Methods and Materials

601 patients underwent MFx of the knee at a single institution from 2003-2017. Patient-reported outcome measures (PROMs) consisting of the International Knee Committee Documentation (IKDC) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores were administered at pre-operative, 6 and 12 month timepoints. Operative reports were reviewed for the technique used during MFx surgery, lesion size, and location. Demographic information collected included age, BMI, and surgical history. Student T-tests were performed to analyze differences between groups, as well as across different time points within the same group. MCID achievement utilizing previously established thresholds (IKDC: 11.5) was examined across 6 and 12 months for both groups.

Results

Preoperative, 6 month, and 12 month data was available for a total of 70 patients (32.0±13.1 years, 48.5% female, BMI 26.7±5.3 kg/m2). The average lesion size was 2.27±1.61cm2. No statistically significant differences were found in any preoperative PROMs between the awl and Powerpick groups (p>0.32). Statistically significant improvements in all PROMs were seen at both 6 and 12 in the powerpick group(p<0.027), while improvements were not observed in the awl group until 12 months.screen shot 2019-04-23 at 4.51.13 pm.pngscreen shot 2019-04-23 at 4.51.00 pm.png

Conclusion

Short term data suggest great improvement seen as early as 6 months with respect to sport, MCID, and quality of life when utilizing a Powerpick compared to the traditional awl/mallet microfracture technique. As it was only recently implemented, there is a need to evaluate long-term outcomes in this patient population.

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Extended Abstract (for invited Faculty only) Cartilage /Cell Transplantation

22.0.1 - ACL Isolated Cartilage Lesion – Leave Alone

Presentation Number
22.0.1
Presentation Topic
Cartilage /Cell Transplantation
Lecture Time
09:00 - 09:05
Session Type
Plenary Session
Corresponding Author
Podium Presentation Osteochondral Grafts

23.3.7 - Return to Sport and Work Following Osteochondral Autograft Transplantation

Presentation Number
23.3.7
Presentation Topic
Osteochondral Grafts
Lecture Time
11:24 - 11:33
Session Type
Free Paper Session
Corresponding Author
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

Osteochondral autograft transplantation (OAT) is a commonly performed surgical procedure in those suffering articular cartilage defects; however, limited literature exists with respect to return to sport and work timelines. The purpose of this study was to utilize an institutional cohort with minimum follow-up of 5 years to examine return to sport and work timelines following OAT.

Methods and Materials

A prospectively maintained institutional database was reviewed for all 45 patients undergoing OAT between January 2005 and April 2014 with a minimum follow-up of 5 years. Patients were contacted via phone with regard to pre- and post-operative participation in sport and work. Variables collected include demographics, surgical history, occupation, duty status, satisfaction, and the frequency, intensity and time to return to sports. SANE was also collected at the time of phone follow-up.

Results

A total of 21 patients (33.69±11.27 years, 42.86% right-sided) were contacted at a mean follow-up time of 10.54±2.86 years. Average lesion size was 1.22±0.47 cm2. Fifty percent of patients underwent concomitant procedures; 25% were realignment procedures. The average SANE score at follow-up was 72.11±20.30, with 66.67% of patients being “Satisfied” or “Very Satisfied”. Survivorship to eventual knee replacement was 90.48% at 10.54 years, and 42.9% required subsequent surgery, most commonly cartilage debridement. 76.19% played sports preoperatively, with 81.25% returning to sports successfully at 7.68±3.99 months. Recreational athletes were more likely than competitive athletes to return to their main sport (84.62% vs. 37.5%, p=0.026). Eighty-one percent maintained an occupation preoperatively, with 76.5% returning to work at an average 2.98±3.13 months. Worker’s compensation patients were significantly less likely to return to work successfully, irrespective of duty status (p=0.046).

rts_figure1 oat.png

rts_figure2 oat.png

Conclusion

Following OAT, competitive athletes are less likely to return to their primary sport when compared to recreational athletes. Worker’s compensation patients are also less likely to return to work than those suffering non-worker’s compensation injury.

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Moderator Of 3 Sessions

Regency Special Session
Session Type
Special Session
Date
06.10.2019
Time
09:45 - 10:45
Location
Regency
Georgia Free Paper Session
Session Type
Free Paper Session
Date
06.10.2019
Time
17:00 - 18:30
Location
Georgia
Georgia Instructional Course / Workshop
Session Type
Instructional Course / Workshop
Date
07.10.2019
Time
07:30 - 08:30
Location
Georgia

Meeting Participant of

Lord Byron - ICRS Meeting Room (20) ICRS Committee Meeting
Lord Byron - ICRS Meeting Room (20) ICRS Committee Meeting

ICRS Diamond Partners

Session Type
ICRS Committee Meeting
Date
07.10.2019
Time
11:00 - 12:00
Location
Lord Byron - ICRS Meeting Room (20)