D. Jones (New Orleans, US)
Ochsner Health Systems Orthopaedic SurgeryPresenter Of 4 Presentations
P080 - Results of Meniscal Transplants Over a 13 Year Study Period
Abstract
Purpose
To identify trends in results for patients who underwent a meniscal transplant performed by a single surgeon based off patient recorded outcomes at measured intervals of 6 weeks, 12 weeks, 6 months, and every year after surgery. In patients status-post meniscectomy, meniscal allografts transplantation (MAT) has been used to restore the normal biomechanics and anatomy of the knee. Numerous studies have shown that this is a viable option to restore this vital, missing tissue. MAT has been previously shown to yield favorable results and provide both improved function and pain in the short- and medium-term basis.
Methods and Materials
The aim of this study is to evaluate patient recorded outcomes in the short-, medium, and long-term basis in patients who underwent MAT performed by a single surgeon utilizing a bone-block technique. From November 2012 through January 2019, 16 isolated MATs were performed by the senior author in previously meniscectomized patients with corresponding compartmental knee pain. Summaries for pain frequency and severity were calculated at measured intervals. Variables were compared over time with a nonparametric repeated measures model.
Results
16 patients with minimum one-year post-operative follow up demonstrated statistically significant improvements in at all time points in seven of nine of standardized outcomes surveys with the exception of MSF-12 and PSF-12 (Fig 1). Median preoperative pain frequency and pain severity scores were 7 and 6.5 respectively, whereas these scores each decreased to 3.5 at one-year follow-up and to 1.5 at two-year follow-up.
Conclusion
Meniscus transplantation in isolation resulted in reliable improvements in knee pain and function at minimum 1-year follow-up, although overall, scores demonstrated best results at the 2-year follow up interval. Our findings agree with preceding studies demonstrating that when done in the correct patient population, MAT (specifically utilizing bone fixation), provides an excellent graft which provides long-term improvements (Fig 2).
P169 - Novel Solution Using Viable Cartilage Allograft for Focal Cartilage Defects
Abstract
Purpose
Viable Cartilage Allograft (VCA) is a cartilage tissue matrix that contains cryopreserved viable allogeneic cartilage fibers mixed with chondrogenic matrix. This study aimed to assess safety and benefits in treating focal knee cartilage defects with VCA. We hypothesized VCA is a safe single stage procedure in isolated chondral defects with results comparable or better than other single stage procedures.
Methods and Materials
Symptomatic International Cartilage Repair Society (ICRS) grade 3/4A lesions of the femoral condyle or patella were implanted with VCA. International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome (KOOS) subscales, Lysholm, Short Form-12 (SF-12), visual analog scale (VAS) and pain frequency levels were assessed. Radiographic and magnetic resonance imaging (MRI) was performed at regular intervals post-operatively.
Results
19 patients were implanted, mean age 28.3 (16-56), mean BMI 27.9 ± 5.6, mean follow-up 24.1 months (range 12.0–36.0 months). Lesions were in either the femoral condyle (n=7) or patella (n=12). Lesion sizes ranged from 1.5-6.0 cm2 (mean defect size was 4.58 cm2). Outcome scores at 6 months increased from pre-operative baseline (POB) and were maintained at 12 months: IKDC (72.2), Lysholm (58.9), KOOS: Pain (75.6), Symptoms (61.1), ADL (83.1), Sports (58.3), and QOL (32.3). MRI imaging at 3-, 6- and 12-month timepoints showed viable preliminary cartilage tissue with no significant bone edema or graft delamination. Second look arthroscopy (2 patients) demonstrated complete fill and incorporation (Brittberg Scores 11/12). Functional scores improved at 24(M): IKDC (84.9), Lysholm (59.5), KOOS: Pain (76.9), Symptoms (64.8), ADLs (79.1), Sports (67.9), QOL (48.8).
Conclusion
VCA is an off-the-shelf, single- stage, conformable allogeneic graft that treats chondral defects with no additional fixation. Pre-clinical and short-term prospective clinical studies show VCA can safely treat chondral defects with potential advantages to existing options.
P181 - Short Term Results After Missouri Osteochondral Preservation System for Symptomatic Chondral Lesions
Abstract
Purpose
The Missouri Osteochondral Preservation System (MOPS) is a novel medium designed to increase the viability of donor tissue cells beyond the typical 14-day period of fresh graft storage (4°C) medium that is the standard of care for osteochondral allografts (OCA). The goal of our study was to assess short term functional outcome measures following treatment of symptomatic chondral lesions treated with MOPS.
Methods and Materials
A retrospective review of 29 patients with symptomatic knee chondral lesions treated with MOPS were evaluated for safety and improvement in functional outcomes. Patient recorded outcome measures were used to evaluate progression over time. Alpha was set at 0.05 for significance.
Results
29 patients were evaluated pre-op and post-op at regular intervals. All patients had a minimum of 1-year post-op follow up. PROM improved at each follow up visit. These trends were maintained at most recent follow up (average 32.4 months) with significant increases compared to pre-operative baseline (POB). Table 1 highlights differences in scores within each modality. Figure 1 shows intra-operative images demonstrating a grade III ICRS lesion on the patealla (A) to the process of preparing the lesion site (B), progressing to the ultimate implantation of the allograft (C).
Conclusion
Our clinical results demonstrate significant increases in functional scores at mean 2 year follow up compared to POB. This short-term follow-up data indicates that patients who received MOPS OCA can expect to gradually improve over a time period of 12 months with maintenance at 24 months as evidenced by multiple modalities of functional scoring. Future long term studies and randomized controlled trials is needed to validate the efficacy and superiority of MOPS compared to the standard of care.
P184 - MACI Case Series with Bone Involvement Requiring Autologous Bone Grafting
Abstract
Purpose
Matrix-induced autologous chondrocyte implantation (MACI) is a regenerative procedure aimed to recreate a hyaline-like repair tissue, restoring a biologically and biomechanically valid articular surface with durable clinical results. The purpose of this study is to assess patient reported outcome measures (PROMS) to characterize and elucidate whether the excellent results with the ACI or CACI (autologous bone graft and a periosteal replacement graft) and autologous bone grafting (ABG) sandwich technique can be demonstrated using the MACI graft in place of the previous ACI or CACI “sandwich” procedures.
Methods and Materials
A retrospective review of a prospective patient series was undertaken. The study population included patients who underwent MACI procedures with bony involvement, bone grafting, sandwich technique with minimum 6-month follow-up. The primary study endpoint was defined as an improvement of pain scores as measured at a minimum of 6M post-operative compared to preoperative value. Secondary endpoints included IKDC, KOOS, Lysholm, and SF-12 scores. All procedures were performed by the senior author, a fellowship-trained sports orthopaedic surgeon. Differences in mean outcomes were assessed using generalized linear mixed model with a Poisson distribution and a random patient effect to account for correlations over time. All P-values were adjusted for multiple comparisons using the Tukey-Kramer method with alpha less than 0.05 considered statistically significant.
Results
8 patients with mean age 28.6 years underwent MACI with bone grafting. Mean follow up was 30.3 months (range 13-51 months). 87.5% of patients had a single defect treated. Table 1 demonstrates PROM at measured intervals of pre-op, 6 months, 12 months, and 24 months post-op with corresponding statistical significance. Statistically significant improvements were noted at 24 months follow up in 8 of 10 outcome measures (Fig 1).
Conclusion
MACI has clinically significant results at mean 2-year post-operative follow up in improving patient reported outcome measures in patients requiring bone grafting.
Presenter Of 4 Presentations
P080 - Results of Meniscal Transplants Over a 13 Year Study Period
Abstract
Purpose
To identify trends in results for patients who underwent a meniscal transplant performed by a single surgeon based off patient recorded outcomes at measured intervals of 6 weeks, 12 weeks, 6 months, and every year after surgery. In patients status-post meniscectomy, meniscal allografts transplantation (MAT) has been used to restore the normal biomechanics and anatomy of the knee. Numerous studies have shown that this is a viable option to restore this vital, missing tissue. MAT has been previously shown to yield favorable results and provide both improved function and pain in the short- and medium-term basis.
Methods and Materials
The aim of this study is to evaluate patient recorded outcomes in the short-, medium, and long-term basis in patients who underwent MAT performed by a single surgeon utilizing a bone-block technique. From November 2012 through January 2019, 16 isolated MATs were performed by the senior author in previously meniscectomized patients with corresponding compartmental knee pain. Summaries for pain frequency and severity were calculated at measured intervals. Variables were compared over time with a nonparametric repeated measures model.
Results
16 patients with minimum one-year post-operative follow up demonstrated statistically significant improvements in at all time points in seven of nine of standardized outcomes surveys with the exception of MSF-12 and PSF-12 (Fig 1). Median preoperative pain frequency and pain severity scores were 7 and 6.5 respectively, whereas these scores each decreased to 3.5 at one-year follow-up and to 1.5 at two-year follow-up.
Conclusion
Meniscus transplantation in isolation resulted in reliable improvements in knee pain and function at minimum 1-year follow-up, although overall, scores demonstrated best results at the 2-year follow up interval. Our findings agree with preceding studies demonstrating that when done in the correct patient population, MAT (specifically utilizing bone fixation), provides an excellent graft which provides long-term improvements (Fig 2).
P169 - Novel Solution Using Viable Cartilage Allograft for Focal Cartilage Defects
Abstract
Purpose
Viable Cartilage Allograft (VCA) is a cartilage tissue matrix that contains cryopreserved viable allogeneic cartilage fibers mixed with chondrogenic matrix. This study aimed to assess safety and benefits in treating focal knee cartilage defects with VCA. We hypothesized VCA is a safe single stage procedure in isolated chondral defects with results comparable or better than other single stage procedures.
Methods and Materials
Symptomatic International Cartilage Repair Society (ICRS) grade 3/4A lesions of the femoral condyle or patella were implanted with VCA. International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome (KOOS) subscales, Lysholm, Short Form-12 (SF-12), visual analog scale (VAS) and pain frequency levels were assessed. Radiographic and magnetic resonance imaging (MRI) was performed at regular intervals post-operatively.
Results
19 patients were implanted, mean age 28.3 (16-56), mean BMI 27.9 ± 5.6, mean follow-up 24.1 months (range 12.0–36.0 months). Lesions were in either the femoral condyle (n=7) or patella (n=12). Lesion sizes ranged from 1.5-6.0 cm2 (mean defect size was 4.58 cm2). Outcome scores at 6 months increased from pre-operative baseline (POB) and were maintained at 12 months: IKDC (72.2), Lysholm (58.9), KOOS: Pain (75.6), Symptoms (61.1), ADL (83.1), Sports (58.3), and QOL (32.3). MRI imaging at 3-, 6- and 12-month timepoints showed viable preliminary cartilage tissue with no significant bone edema or graft delamination. Second look arthroscopy (2 patients) demonstrated complete fill and incorporation (Brittberg Scores 11/12). Functional scores improved at 24(M): IKDC (84.9), Lysholm (59.5), KOOS: Pain (76.9), Symptoms (64.8), ADLs (79.1), Sports (67.9), QOL (48.8).
Conclusion
VCA is an off-the-shelf, single- stage, conformable allogeneic graft that treats chondral defects with no additional fixation. Pre-clinical and short-term prospective clinical studies show VCA can safely treat chondral defects with potential advantages to existing options.
P181 - Short Term Results After Missouri Osteochondral Preservation System for Symptomatic Chondral Lesions
Abstract
Purpose
The Missouri Osteochondral Preservation System (MOPS) is a novel medium designed to increase the viability of donor tissue cells beyond the typical 14-day period of fresh graft storage (4°C) medium that is the standard of care for osteochondral allografts (OCA). The goal of our study was to assess short term functional outcome measures following treatment of symptomatic chondral lesions treated with MOPS.
Methods and Materials
A retrospective review of 29 patients with symptomatic knee chondral lesions treated with MOPS were evaluated for safety and improvement in functional outcomes. Patient recorded outcome measures were used to evaluate progression over time. Alpha was set at 0.05 for significance.
Results
29 patients were evaluated pre-op and post-op at regular intervals. All patients had a minimum of 1-year post-op follow up. PROM improved at each follow up visit. These trends were maintained at most recent follow up (average 32.4 months) with significant increases compared to pre-operative baseline (POB). Table 1 highlights differences in scores within each modality. Figure 1 shows intra-operative images demonstrating a grade III ICRS lesion on the patealla (A) to the process of preparing the lesion site (B), progressing to the ultimate implantation of the allograft (C).
Conclusion
Our clinical results demonstrate significant increases in functional scores at mean 2 year follow up compared to POB. This short-term follow-up data indicates that patients who received MOPS OCA can expect to gradually improve over a time period of 12 months with maintenance at 24 months as evidenced by multiple modalities of functional scoring. Future long term studies and randomized controlled trials is needed to validate the efficacy and superiority of MOPS compared to the standard of care.
P184 - MACI Case Series with Bone Involvement Requiring Autologous Bone Grafting
Abstract
Purpose
Matrix-induced autologous chondrocyte implantation (MACI) is a regenerative procedure aimed to recreate a hyaline-like repair tissue, restoring a biologically and biomechanically valid articular surface with durable clinical results. The purpose of this study is to assess patient reported outcome measures (PROMS) to characterize and elucidate whether the excellent results with the ACI or CACI (autologous bone graft and a periosteal replacement graft) and autologous bone grafting (ABG) sandwich technique can be demonstrated using the MACI graft in place of the previous ACI or CACI “sandwich” procedures.
Methods and Materials
A retrospective review of a prospective patient series was undertaken. The study population included patients who underwent MACI procedures with bony involvement, bone grafting, sandwich technique with minimum 6-month follow-up. The primary study endpoint was defined as an improvement of pain scores as measured at a minimum of 6M post-operative compared to preoperative value. Secondary endpoints included IKDC, KOOS, Lysholm, and SF-12 scores. All procedures were performed by the senior author, a fellowship-trained sports orthopaedic surgeon. Differences in mean outcomes were assessed using generalized linear mixed model with a Poisson distribution and a random patient effect to account for correlations over time. All P-values were adjusted for multiple comparisons using the Tukey-Kramer method with alpha less than 0.05 considered statistically significant.
Results
8 patients with mean age 28.6 years underwent MACI with bone grafting. Mean follow up was 30.3 months (range 13-51 months). 87.5% of patients had a single defect treated. Table 1 demonstrates PROM at measured intervals of pre-op, 6 months, 12 months, and 24 months post-op with corresponding statistical significance. Statistically significant improvements were noted at 24 months follow up in 8 of 10 outcome measures (Fig 1).
Conclusion
MACI has clinically significant results at mean 2-year post-operative follow up in improving patient reported outcome measures in patients requiring bone grafting.