W. Bugbee (La Jolla, US)

Scripps Clinic Medical Group Orthopaedics
William Bugbee is an attending physician at Scripps Clinic; La Jolla and Professor; department of Orthopaedics; university of California; San Diego. His clinical interests are in arthritis surgery of the hip; knee and ankle; joint replacement; osteochondral allograft transplantation and cartilage restoration. Research interests include biologic response to implants; innovation in knee replacement technique and design; Osteochondral transplantation; cartilage tissue engineering and biologic joint repair. For CV please proceed to www.drbugbee.com

Presenter Of 5 Presentations

Podium Presentation Allografts

16.3.4 - An Analysis of Factors that Influence Meniscal Allograft Size Discrepancies Between Patient and Donor Populations

Presentation Topic
Allografts
Date
14.04.2022
Lecture Time
11:51 - 12:00
Room
Potsdam 1
Session Name
Session Type
Free Papers
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

Successful outcomes of meniscal allograft transplantation are dependent on adequate size matching of donor and patient meniscus. The extent that donor pools meet the demands of the patient pool is unknown. The purpose of this study was to analyze the variability in meniscus size and anthropometric data between donors (supply) and patients (demand), and determine the impact on time to match.

Methods and Materials

Lateral and medial meniscal measurements, sex, patient height and weight, and time to match a donor graft were extracted from a tissue supplier database. Distributions of meniscus size for patient and donor pools were analyzed. Body Mass Index (BMI), meniscus area, body mass to meniscus area index (BMMI), and height to meniscus area index (HMI) were compared via chi-square tests and independent samples t-test. The effect of size on time to match was analyzed using ANOVA and post-hoc Tukey test.

Results

The distributions of meniscus sizes were significantly different for meniscus donor and patient populations (Fig1A-D). The lateral meniscus patients showed a higher frequency of larger size meniscus and the medial meniscus patients showed a higher frequency of smaller size meniscus. The lateral meniscus analysis showed significantly greater meniscus area and increased average height in the patient population. The medial meniscus analysis showed significantly smaller meniscus areas in the patient population contributing to an increased BMMI and HMI. The time to match a donor meniscus was affected by the patient meniscus size.

dia1.jpgFigure 1: Distribution of donor (blue) and patient (gray) meniscus sizes.

Conclusion

This analysis demonstrates variations in frequency of meniscus sizes between donor and patient populations. This variation is attributed to significant differences in anthropometric data between patient and donor populations. This work identifies a mismatch between demand and supply. Areas of size mismatch were further substantiated by the longer time period to identify a donor match.

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Podium Presentation Osteoarthritis

18.3.8 - Surgical Management of the Young Degenerative Knee: “Power Ranking” the Options

Presentation Topic
Osteoarthritis
Date
14.04.2022
Lecture Time
15:18 - 15:27
Room
Potsdam 1
Session Type
Free Papers
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

Management of young patients with degenerative joint disease (DJD) of the knee is challenging. The spectrum of surgical options include joint preservation and arthroplasty. Direct clinical comparison of these procedures would be useful. We sought to compare the “treatment effect” of various surgical interventions in young patients with knee DJD.

Methods and Materials

Our institution’s registry identified 283 patients age 30-50 who underwent surgery for DJD of the knee by a single surgeon: 68 TKA, 60 UKA, 96 osteochondral allograft (OCA) transplantation, 35 distal femoral osteotomy (DFO), and 24 high tibial osteotomy (HTO) were included. Knee injury and Osteoarthritis Outcome Scores (KOOS) were captured preoperatively and postoperatively. KOOS subscales include symptoms, pain, activities of daily living, sports and recreation, and quality of life.

Results

Mean follow-up was 5.2 years (range, 2-14 years). Mean age was 42 years. Clinically significant improvements were seen on every KOOS subscale for all treatments (p<0.001) (Table 1.) Largest improvement in symptoms was for UKA (30 points). OCA had the lowest improvement (17 points), but pre and postoperative mean scores were highest. Best pain score improvement was for TKA and UKA (both 29 points). Lowest pain score improvement was for OCA (19 points). ADL scores improved most for TKA (31 points) and least for OCA (18 points). Improvement in sports and recreation was similar for TKA, UKA, OCA, and DFO (34, 33, 35, and 39 respectively and lowest for HTO (17 points). Quality of life improved most for TKA (42 points), followed by HTO (37 points) and UKA (36 points).

table 1. koos change scores.jpg

Conclusion

Arthroplasty had the largest treatment effects for symptoms, pain, and activities of daily living. Osteotomy had the largest treatment effects for sports and recreation (DFO) and quality of life (HTO). OCA had the lowest treatment effects but highest mean KOOS scores.

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Extended Abstract (for invited Faculty only) Please select your topic

19.2.1 - Borders of Joint Preservation

Presentation Topic
Please select your topic
Date
14.04.2022
Lecture Time
16:00 - 16:15
Room
Potsdam 1
Session Type
Special Session
Extended Abstract (for invited Faculty only) Joint Specific Cartilage Repair

23.1.3 - Do We Still Need Osteotomy? Pro

Presentation Topic
Joint Specific Cartilage Repair
Date
15.04.2022
Lecture Time
09:40 - 09:45
Room
Potsdam 1
Session Type
Plenary Session
Poster Osteochondral Grafts

P177 - Do Osteochondral Allograft (OCA) Donor Characteristics Impact Survivorship?

Presentation Topic
Osteochondral Grafts
Date
13.04.2022
Lecture Time
09:30 - 09:30
Room
Exhibition Foyer
Session Name
7.3 - Poster Viewing / Coffee Break / Exhibition
Session Type
Poster Session
Disclosure
S. Tabbaa, JRF Ortho, Consultant; W. Bugbee, JRF Ortho, Consultant

Abstract

Purpose

The impact of donor characteristics on clinical outcomes of OCA transplantation is not well understood. Several studies have reported inconsistent findings when considering storage time for fresh OCA grafts on clinical outcomes. No studies to date have investigated the possibility of donor characteristics impacting clinical outcomes. The purpose of this study was to determine if donor characteristics and graft storage time were associated with graft survivorship.

Methods and Materials

In this cohort study, data were analyzed from patients who underwent primary OCA transplantation of the knee (Table 1). All patients had a minimum 2-year follow-up. Survival rate (grafts remaining in situ) and survivorship were compared between patients who received OCA graft from donors (i) aged > 20 years old or ≤ 20 years old, (ii) with BMI ≤ 30 or with BMI > 30, (iii) of same sex (matched) or different sex (mismatched), (iv) released early (1-14d) or late (15-28d) using chi-square testing and log-rank analysis.

Results

The mean follow-up was 8.0 years. Patients who received OCA grafts from older donors had a significantly lower survival rate of 88.3% (grafts remaining in situ) compared to OCAs from younger donors (96.7%, P = 0.039). The 10-year survivorship (Figure 1) of the OCA was 89.3% for older donor group and 100.0% for younger donor group. Interestingly, OCA survival rate for early release (77.3%) was significantly lower than late-release (94.0%) group (P = 0.002). The 10-year survivorship rate was 85.6% in the early-release and 96.1% in the late-release group. Donor BMI and sex matching did not impact survivorship.

icrs 2021 donor characteristics figure 1.png

icrs 2021 donor characteristics_survivorship figure.png

Conclusion

Donor factors are important variables that have not been previously studied. The findings of this work suggest that donor age can impact survivorship of OCA transplantation. Late-release grafts were also associated with higher graft survivorship.

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Moderator Of 3 Sessions

Potsdam 1 Free Papers
Session Type
Free Papers
Date
14.04.2022
Time
11:15 - 12:45
Room
Potsdam 1
CME Evaluation
Potsdam 1 Plenary Session
Session Type
Plenary Session
Date
15.04.2022
Time
09:30 - 10:30
Room
Potsdam 1
Session Description
Worldwide experts present in a confronted discussion opposing opinions with regard to relevant actual treatment modalities or scientific paradigms. High profile argumentation and evidence-based discussion on "hot" topics of cartilage repair.
Session Learning Objective
  1. Participants will learn how an academic confronted discussion should be performed, based on randomized trials and high-quality GLP GMP studies. Of course the style of argumentation and discussion in high profile experts is a great and interesting experience anyway.
CME Evaluation

Meeting Participant Of

Bellevue Plenary Session
Session Type
Plenary Session
Date
14.04.2022
Time
17:30 - 18:30
Room
Bellevue
Session Description
All ICRS members, present in Berlin are expected to attend the ICRS General Member’s Assembly. Retired Members and Corporate Members have no right to vote but are most welcome to attend. It is of utmost importance that as many members as possible attend this important meeting and take part in decision-making and approval processes of our association.