Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft. A preliminary report. (1/9)

Autologous chondrocyte implantation (ACI) is a technique used for the treatment of symptomatic osteochondral defects of the knee. A variation of the original periosteum membrane technique is the matrix-induced autologous chondrocyte implantation (MACI) technique. The MACI membrane consists of a porcine type-I/III collagen bilayer seeded with chondrocytes. Osteochondral defects deeper than 8 to 10 mm usually require bone grafting either before or at the time of transplantation of cartilage. We have used a variation of Peterson's ACI-periosteum sandwich technique using two MACI membranes with bone graft which avoids periosteal harvesting. The procedure is suture-free and requires less operating time and surgical exposure. We performed this MACI-sandwich technique on eight patients, five of whom were assessed at six months and one year post-operatively using the modified Cincinnati knee, the Stanmore functional rating and the visual analogue pain scores. All patients improved within six months with further improvement at one year. The clinical outcome was good or excellent in four after six months and one year. No significant graft-associated complications were observed. Our early results of the MACI-sandwich technique are encouraging although larger medium-term studies are required before there is widespread adoption of the technique.  (+info)

Second-look arthroscopy of cartilage changes of the patellofemoral joint, especially the patella, following acute and recurrent patellar dislocation. (2/9)

OBJECTIVE: The purpose of this study was to clarify some pathogenesis of the cartilage changes of the patellofemoral joint in patellar dislocation knees. METHODS: A first arthroscopy was performed in a total of 60 knees, including 30 knees of acute patellar dislocation (APD) and 30 knees of recurrent patellar dislocation (RPD). At the time of the first arthroscopy, 58 knees sustained open medial patellofemoral ligament repair/reconstruction, and 2 knees had only arthroscopy examination. In APD knees, the second-look arthroscopy was performed 16.7 months after the first arthroscopy, and in RPD knees, 25.2 months after the first arthroscopy. RESULTS: In most APD knees, cracking primarily on the central dome of the patella did not have a remarkable change but in several knees that had a high number of cracking or interlaced cracking, cracking became worse with fibrillation. Osteochondral defect site primarily on the medial facet showed fibrillation and/or ulceration (erosion). In most RPD knees, fissuring primarily on the central dome did not have a remarkable change, and fibrillation and/or erosion mainly on the medial facet also did not have a remarkable change. However, in four knees with the continuation of patellar dislocation, the patellar cartilage changes had definitely worsened. On the other hand, in the first and second-look arthroscopy, most APD and RPD knees had no remarkable cartilage lesions or cartilage changes of the femoro-trochlear aspect. CONCLUSIONS: One of the pathogenesis of fissuring in RPD knees seems to be cracking occurring at the time of APD. Two of the pathogenesis of fibrillation may result from the reparative reaction of the cartilage in osteochondral defect site and the cartilage change due to a high degree of cracking damage mainly on the central dome in APD injury. The continuation of patellar dislocation definitely makes the patellar cartilage lesions worse.  (+info)

Who is the ideal candidate for autologous chondrocyte implantation? (3/9)

We investigated the prognostic indicators for collagen-covered autologous chondrocyte implantation (ACI-C) performed for symptomatic osteochondral defects of the knee. We analysed prospectively 199 patients for up to four years after surgery using the modified Cincinnati score. Arthroscopic assessment and biopsy of the neocartilage was also performed whenever possible. The favourable factors for ACI-C include younger patients with higher pre-operative modified Cincinnati scores, a less than two-year history of symptoms, a single defect, a defect on the trochlea or lateral femoral condyle and patients with fewer than two previous procedures on the index knee. Revision ACI-C in patients with previous ACI and mosaicplasties which had failed produced significantly inferior clinical results. Gender (p = 0.20) and the size of the defect (p = 0.97) did not significantly influence the outcome.  (+info)

The diagnostic value of the Clarke sign in assessing chondromalacia patella. (4/9)

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Chondromalacia patellae treated by warming needle and rehabilitation training. (5/9)

OBJECTIVE: To observe the effect of warming needle combined with rehabilitation training on chondromalacia patellae in a randomized controlled trial. METHODS: The 92 cases were randomly divided into a treatment group treated by warming needle plus rehabilitation training (47 cases) and a control group treated by medication plus rehabilitation training (45 cases), and the therapeutic effect was compared after 20 sessions. RESULTS: The pain was relieved more obviously in the treatment group than in the control group (P < 0.05), and the total effective rate was 91.8% and 71.1% respectively (P < 0.01). CONCLUSION: Warming needle plus rehabilitation training was superior in the therapeutic effect and duration of producing relief of pain to medication plus rehabilitation training in treating chondromalacia patellae.  (+info)

Evaluation of the chondromalacia patella using a microscopy coil: comparison of the two-dimensional fast spin echo techniques and the three-dimensional fast field echo techniques. (6/9)

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The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae. (7/9)

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Maquet III procedure: what remains after initial complications--long-term results. (8/9)

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