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Bert R. Mandelbaum - One of the best experts on this subject based on the ideXlab platform.
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Articular Cartilage Repair in athletes.
Journal of Bone and Joint Surgery American Volume, 2020Co-Authors: Kai Mithoefer, Jason M. Scopp, Bert R. MandelbaumAbstract:Abstract Articular Cartilage lesions in the athletic population commonly occur and result from the significant acute and chronic joint stress associated with high-impact sports. These lesions have poor intrinsic healing capacity, and the persistent defects in the joint surfaces cause pain, swelling, and mechanical symptoms that result in functional impairment and limitation of athletic participation. If untreated, Articular Cartilage lesions can lead to chronic joint degeneration and disability. Several techniques for Articular Cartilage Repair have been recently developed with promising results. However, the significant joint stresses generated in athletes require an effective and durable Cartilage surface restoration that can withstand the high mechanical demands in this population over time.
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return to sports participation after Articular Cartilage Repair in the knee scientific evidence
American Journal of Sports Medicine, 2009Co-Authors: Kai Mithoefer, Karen Hambly, Holly J. Silvers, Stefano Della Villa, Bert R. MandelbaumAbstract:BACKGROUND: Articular Cartilage injury in the athlete's knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after Articular Cartilage Repair in the knee. HYPOTHESIS: Systematic analysis of athletic participation after Articular Cartilage Repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with Articular Cartilage injury of the knee. STUDY DESIGN: Systematic review. METHODS: A comprehensive literature review of original studies was performed to provide information about athletic participation after Articular Cartilage Repair. The athlete's ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time. RESULTS: Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the Cartilage Repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete's age, preoperative duration of symptoms, level of play, lesion size, and Repair tissue morphology. CONCLUSION: Articular Cartilage Repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the clinical decision-making process and for the management of the athlete's postoperative expectations.
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clinical efficacy of the microfracture technique for Articular Cartilage Repair in the knee an evidence based systematic analysis
American Journal of Sports Medicine, 2009Co-Authors: Kai Mithoefer, Timothy Mcadams, Peter C. Kreuz, Riley J Williams, Bert R. MandelbaumAbstract:BackgroundDespite the popularity of microfracture as a first-line treatment for Articular Cartilage defects in the knee, systematic information on its clinical efficacy for Articular Cartilage Repair and long-term improvement of knee function is not available.HypothesisSystematic analysis of the existing clinical literature of microfracture in the knee can improve the understanding of the advantages and limitations of this Cartilage Repair technique and can help to optimize its indications and clinical outcomes.Study DesignSystematic review.MethodsA comprehensive literature search was performed using established search engines (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials) to identify original human studies of Articular Cartilage Repair with microfracture. Modified Coleman Methodology Scores were used to analyze the quality of the existing studies. Clinical efficacy of Articular Cartilage Repair was evaluated by systematic analysis of short- and long-term functional outcome scor...
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Clinical efficacy of the microfracture technique for Articular Cartilage Repair in the knee: An evidence-based systematic analysis
American Journal of Sports Medicine, 2009Co-Authors: Kai Mithoefer, Timothy Mcadams, Peter C. Kreuz, Riley J Williams, Bert R. MandelbaumAbstract:BACKGROUND: Despite the popularity of microfracture as a first-line treatment for Articular Cartilage defects in the knee, systematic information on its clinical efficacy for Articular Cartilage Repair and long-term improvement of knee function is not available. HYPOTHESIS: Systematic analysis of the existing clinical literature of microfracture in the knee can improve the understanding of the advantages and limitations of this Cartilage Repair technique and can help to optimize its indications and clinical outcomes. STUDY DESIGN: Systematic review. METHODS: A comprehensive literature search was performed using established search engines (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials) to identify original human studies of Articular Cartilage Repair with microfracture. Modified Coleman Methodology Scores were used to analyze the quality of the existing studies. Clinical efficacy of Articular Cartilage Repair was evaluated by systematic analysis of short- and long-term functional outcome scores, macroscopic and microscopic Repair Cartilage quality, and findings of postoperative magnetic resonance imaging. RESULTS: Twenty-eight studies describing 3122 patients were included in the review. The average follow-up was 41 months, with only 5 studies reporting follow-up of 5 years or more. Six studies were randomized controlled trials and the mean Coleman Methodology Score was 58 (range, 22-97). Microfracture effectively improved knee function in all studies during the first 24 months after microfracture, but the reports on durability of the initial functional improvement were conflicting. Several factors were identified that affected clinical outcome. Defect fill on magnetic resonance imaging was highly variable and correlated with functional outcome. Macroscopic Repair Cartilage quality positively affected long-term failure rate, while the influence of histologic Repair tissue quality remained inconclusive. CONCLUSION: This systematic analysis shows that microfracture provides effective short-term functional improvement of knee function but insufficient data are available on its long-term results. Shortcomings of the technique include limited hyaline Repair tissue, variable Repair Cartilage volume, and possible functional deterioration. The quality of the currently available data on micro-fracture is still limited by the variability of results and study designs. Further well-designed studies are needed to determine the long-term efficacy of microfracture and to define its specific clinical indications compared to other Cartilage Repair techniques.
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Articular Cartilage Repair in soccer players with autologous chondrocyte transplantation functional outcome and return to competition
American Journal of Sports Medicine, 2005Co-Authors: Kai Mithöfer, Bert R. Mandelbaum, Lars E Peterson, Tom MinasAbstract:BackgroundThe ability of autologous chondrocyte transplantation to produce and maintain an effective Articular Cartilage Repair under high mechanical demands has not been investigated.HypothesisAutologous chondrocyte transplantation provides a reliable and durable Repair of full-thickness knee Articular Cartilage lesions in high-demand athletes.Study DesignCase series; Level of evidence, 4.MethodsA total of 45 soccer players were evaluated 41 ± 4 months after autologous chondrocyte transplantation for their ability to return to soccer, the timing of their return, skill level, and functional outcome rating by the Tegner activity rating scale score and Brittberg score. The factors influencing the return to sport were analyzed.ResultsOf these players, 72% reported good to excellent results, with significant overall improvement of Tegner activity rating scale scores; 33% returned to soccer, including 83% of competitive-level players and 16% of recreational players. Of the returning players, 80% returned to th...
Kai Mithoefer - One of the best experts on this subject based on the ideXlab platform.
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Articular Cartilage Repair in athletes.
Journal of Bone and Joint Surgery American Volume, 2020Co-Authors: Kai Mithoefer, Jason M. Scopp, Bert R. MandelbaumAbstract:Abstract Articular Cartilage lesions in the athletic population commonly occur and result from the significant acute and chronic joint stress associated with high-impact sports. These lesions have poor intrinsic healing capacity, and the persistent defects in the joint surfaces cause pain, swelling, and mechanical symptoms that result in functional impairment and limitation of athletic participation. If untreated, Articular Cartilage lesions can lead to chronic joint degeneration and disability. Several techniques for Articular Cartilage Repair have been recently developed with promising results. However, the significant joint stresses generated in athletes require an effective and durable Cartilage surface restoration that can withstand the high mechanical demands in this population over time.
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current concepts for rehabilitation and return to sport after knee Articular Cartilage Repair in the athlete
Journal of Orthopaedic & Sports Physical Therapy, 2012Co-Authors: Kai Mithoefer, Karen Hambly, Holly J. Silvers, David Logerstedt, Margherita Ricci, Stefano Della VillaAbstract:Synopsis Articular Cartilage injury is observed with increasing frequency in both elite and amateur athletes and results from the significant acute and chronic joint stress associated with impact sports. Left untreated, Articular Cartilage defects can lead to chronic joint degeneration and athletic and functional disability. Treatment of Articular Cartilage defects in the athletic population presents a therapeutic challenge due to the high mechanical demands of athletic activity. Several Articular Cartilage Repair techniques have been shown to successfully restore Articular Cartilage surfaces and allow athletes to return to high-impact sports. Postoperative rehabilitation is a critical component of the treatment process for athletic Articular Cartilage injury and should take into consideration the biology of the Cartilage Repair technique, Cartilage defect characteristics, and each athlete's sport-specific demands to optimize functional outcome. Systematic, stepwise rehabilitation with criteria-based prog...
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return to sports after Articular Cartilage Repair in the football soccer player
Cartilage, 2012Co-Authors: Kai Mithoefer, Stefano Della VillaAbstract:Background: The ability to return to football (soccer) presents a critical aspect for successful treatment of Articular Cartilage injury in the football (soccer) player. Methods: Information about sports participation after Articular Cartilage Repair was collected from the literature. Special focus was placed on data in football athletes with information on return rate, timing of return, level of postoperative competition, and the ability to compete in the sport over time. Results: Twenty studies describing 1,469 athletes including football players with Articular Cartilage injury were reviewed. Average return to sport was 79% without a significant difference in return rate or postoperative level of play between Cartilage Repair techniques. Time to return varied between 7 to 17 months, with the longest time for autologous chondrocyte transplantation (ACI). Advanced sport-specific rehabilitation was able to reduce recovery time. Durability of results was best after ACI, with up to 96% continued sport partic...
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guidelines for the design and conduct of clinical studies in knee Articular Cartilage Repair international Cartilage Repair society recommendations based on current scientific evidence and standards of clinical care
Cartilage, 2011Co-Authors: Kai Mithoefer, Jack Farr, Daniel B.f. Saris, Kenneth Zaslav, Brian J Cole, Jonas Ranstam, Matthew Shive, David W Levine, Wilfried Dalemans, Mats BrittbergAbstract:Objective:To summarize current clinical research practice and develop methodological standards for objective scientific evaluation of knee Cartilage Repair procedures and products.Design:A comprehensive literature review was performed of high-level original studies providing information relevant for the design of clinical studies on Articular Cartilage Repair in the knee. Analysis of Cartilage Repair publications and synopses of ongoing trials were used to identify important criteria for the design, reporting, and interpretation of studies in this field.Results:Current literature reflects the methodological limitations of the scientific evidence available for Articular Cartilage Repair. However, clinical trial databases of ongoing trials document a trend suggesting improved study designs and clinical evaluation methodology. Based on the current scientific information and standards of clinical care, detailed methodological recommendations were developed for the statistical study design, patient recruitment...
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return to sports participation after Articular Cartilage Repair in the knee scientific evidence
American Journal of Sports Medicine, 2009Co-Authors: Kai Mithoefer, Karen Hambly, Holly J. Silvers, Stefano Della Villa, Bert R. MandelbaumAbstract:BACKGROUND: Articular Cartilage injury in the athlete's knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after Articular Cartilage Repair in the knee. HYPOTHESIS: Systematic analysis of athletic participation after Articular Cartilage Repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with Articular Cartilage injury of the knee. STUDY DESIGN: Systematic review. METHODS: A comprehensive literature review of original studies was performed to provide information about athletic participation after Articular Cartilage Repair. The athlete's ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time. RESULTS: Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the Cartilage Repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete's age, preoperative duration of symptoms, level of play, lesion size, and Repair tissue morphology. CONCLUSION: Articular Cartilage Repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the clinical decision-making process and for the management of the athlete's postoperative expectations.
Daniel B.f. Saris - One of the best experts on this subject based on the ideXlab platform.
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a vision on the future of Articular Cartilage Repair
European Cells & Materials, 2014Co-Authors: Magali Cucchiarini, Henning Madry, Daniel B.f. Saris, Farshid Guilak, Martin J Stoddart, Koon M Wong, Peter J RoughleyAbstract:: An AO Foundation (Davos, Switzerland) sponsored workshop "Cell Therapy in Cartilage Repair" from the Symposium "Where Science meets Clinics" (September 5-7, 2013, Davos) gathered leaders from medicine, science, industry, and regulatory organisations to debate the vision of cell therapy in Articular Cartilage Repair and the measures that could be taken to narrow the gap between vision and current practice. Cell-based therapy is already in clinical use to enhance the Repair of Cartilage lesions, with procedures such as microfracture and Articular chondrocyte implantation. However, even though long term follow up is good from a clinical perspective and some of the most rigorous randomised controlled trials in the regenerative medicine/orthopaedics field show beneficial effect, none of these options have proved successful in restoring the original Articular Cartilage structure and functionality in patients so far. With the remarkable recent advances in experimental research in cell biology (new sources for chondrocytes, stem cells), molecular biology (growth factors, genes), biomaterials, biomechanics, and translational science, a combined effort between scientists and clinicians with broad expertise may allow development of an improved cell therapy for Cartilage Repair. This position paper describes the current state of the art in the field to help define a procedure adapted to the clinical situation for upcoming translation in the patient.
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Treatment and Prevention of (Early) Osteoarthritis Using Articular Cartilage Repair—Fact or Fiction? A Systematic Review
Cartilage, 2013Co-Authors: Tommy S. De Windt, Lucienne A. Vonk, Mats Brittberg, Daniel B.f. SarisAbstract:Early osteoarthritis (OA) is increasingly being recognized in patients who wish to remain active while not accepting the limitations of conservative treatment or joint replacement. The aim of this systematic review was to evaluate the existing evidence for treatment of patients with early OA using Articular Cartilage Repair techniques. A systematic search was performed in EMBASE, MEDLINE, and the Cochrane collaboration. Articles were screened for relevance and appraised for quality. Nine articles of generally low methodological quality (mean Coleman score 58) including a total of 502 patients (mean age range = 36-57 years) could be included. In the reports, both radiological and clinical criteria for early OA were applied. Of all patients included in this review, 75% were treated with autologous chondrocyte implantation. Good short-term clinical outcome up to 9 years was shown. Failure rates varied from 8% to 27.3%. The conversion to total knee arthroplasty rate was 2.5% to 6.5%. Although a (randomized controlled) trial in this patient category with long-term follow-up is needed, the literature suggests autologous chondrocyte implantation could provide good short- to mid-term clinical outcome and delay the need for total knee arthroplasty. The use of standardized criteria for early OA and implementation of (randomized) trials with long-term follow-up may allow for further expansion of the research field in Articular Cartilage Repair to the challenging population with (early) OA.
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is magnetic resonance imaging reliable in predicting clinical outcome after Articular Cartilage Repair of the knee a systematic review and meta analysis
American Journal of Sports Medicine, 2013Co-Authors: Tommy S. De Windt, Lucienne A. Vonk, Mats Brittberg, Daniel B.f. Saris, S Marlovits, Siegfried Trattnig, Goetz H WelschAbstract:Background: While MRI can provide a detailed morphological evaluation after Articular Cartilage Repair, its additional value in determining clinical outcome has yet to be determined. Purpose: To evaluate the correlation between MRI and clinical outcome after Cartilage Repair and to identify parameters that are most important in determining clinical outcome. Study Design: Systematic review and meta-analysis. Methods: A systematic search was performed in Embase, MEDLINE, and the Cochrane Collaboration. Articles were screened for relevance and appraised for quality. Guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement were used. Chi-square tests were performed to find variables that could determine correlation between clinical and radiological parameters. Results: A total of 32 articles (total number of patients, 1019) were included. A majority (81%) were case series or cohort studies that used similar standardized MRI techniques. The mean Coleman score was 63 (range, 42-96). For the majority of MRI parameters, limited or no correlation was found. Nine studies (28%) found a correlation between clinical outcome and the composite magnetic resonance observation of Cartilage Repair tissue (MOCART) or Henderson score and 7 (22%) with defect fill. In 5 studies, a weak to moderate correlation was found between clinical outcome and the T2 index (mean Pearson coefficient r = .53). Conclusion: Strong evidence to determine whether morphological MRI is reliable in predicting clinical outcome after Cartilage Repair is lacking. Future research aiming specifically at clinical sensitivity of advanced morphological and biochemical MRI techniques after Articular Cartilage Repair could be of great importance to the field.
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guidelines for the design and conduct of clinical studies in knee Articular Cartilage Repair international Cartilage Repair society recommendations based on current scientific evidence and standards of clinical care
Cartilage, 2011Co-Authors: Kai Mithoefer, Jack Farr, Daniel B.f. Saris, Kenneth Zaslav, Brian J Cole, Jonas Ranstam, Matthew Shive, David W Levine, Wilfried Dalemans, Mats BrittbergAbstract:Objective:To summarize current clinical research practice and develop methodological standards for objective scientific evaluation of knee Cartilage Repair procedures and products.Design:A comprehensive literature review was performed of high-level original studies providing information relevant for the design of clinical studies on Articular Cartilage Repair in the knee. Analysis of Cartilage Repair publications and synopses of ongoing trials were used to identify important criteria for the design, reporting, and interpretation of studies in this field.Results:Current literature reflects the methodological limitations of the scientific evidence available for Articular Cartilage Repair. However, clinical trial databases of ongoing trials document a trend suggesting improved study designs and clinical evaluation methodology. Based on the current scientific information and standards of clinical care, detailed methodological recommendations were developed for the statistical study design, patient recruitment...
Henning Madry - One of the best experts on this subject based on the ideXlab platform.
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Biomaterial-guided delivery of gene vectors for targeted Articular Cartilage Repair.
Nature Reviews Rheumatology, 2018Co-Authors: Magali Cucchiarini, Henning MadryAbstract:Articular Cartilage defects are prevalent and are potentially involved in the initiation of osteoarthritis, yet the lack of efficient therapeutic options to treat Cartilage defects represents a substantial challenge. Molecular treatments that require the delivery of therapeutic gene vectors are often less effective that specific, targeted approaches, and the scientific evidence for acellular biomaterial-assisted procedures is limited. Controlled delivery of gene vectors using biocompatible materials is emerging as a novel strategy for the sustained and tuneable release of gene therapies in a spatiotemporally precise manner, thereby reducing intra-Articular vector spread and possible loss of the therapeutic gene product. Controlled, biomaterial-guided delivery of gene vectors could be used to enhance intrinsic mechanisms of Cartilage Repair while affording protection against potentially damaging host immune responses that might counteract the gene therapy component. This Review provides an overview of advances in gene vector-loaded biomaterials for Articular Cartilage Repair. Such systems enable the sustained release of gene therapies while maintaining transduction efficacy. Strategies that harness these properties are likely to result in improved in situ Cartilage tissue regeneration that could be safely translated into clinical applications in the near future. Gene therapy and tissue engineering strategies for the treatment of Cartilage Repair each pose unique challenges to clinical translation. Could combining the two approaches open new avenues for the treatment of Articular Cartilage defects in patients with osteoarthritis?
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Subchondral drilling for Articular Cartilage Repair: a systematic review of translational research.
Disease Models & Mechanisms, 2018Co-Authors: Lars Goebel, Patrick Orth, Magali Cucchiarini, Henning MadryAbstract:ABSTRACT Articular Cartilage defects may initiate osteoarthritis. Subchondral drilling, a widely applied clinical technique to treat small Cartilage defects, does not yield Cartilage regeneration. Various translational studies aiming to improve the outcome of drilling have been performed; however, a robust systematic analysis of its translational evidence was still lacking. Here, we performed a systematic review of the outcome of subchondral drilling for knee Cartilage Repair in translational animal models. A total of 12 relevant publications studying 198 animals was identified, detailed study characteristics were extracted, and methodological quality and risk of bias were analyzed. Subchondral drilling led to improved Repair outcome compared with defects that were untreated or treated with abrasion arthroplasty for Cartilage Repair in multiple translational models. Within the 12 studies, considerable subchondral bone changes were observed, including subchondral bone cysts and intralesional osteophytes. Furthermore, extensive alterations of the subchondral bone microarchitecture appeared in a temporal pattern in small and large animal models, together with specific topographic aspects of Repair. Moreover, variable technical aspects directly affected the outcomes of osteochondral Repair. The data from this systematic review indicate that subchondral drilling yields improved short-term structural Articular Cartilage Repair compared with spontaneous Repair in multiple small and large animal models. These results have important implications for future investigations aimed at an enhanced translation into clinical settings for the treatment of Cartilage defects, highlighting the importance of considering specific aspects of modifiable variables such as improvements in the design and reporting of preclinical studies, together with the need to better understand the underlying mechanisms of Cartilage Repair following subchondral drilling.
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Hydrogel-Based Controlled Delivery Systems for Articular Cartilage Repair
BioMed Research International, 2016Co-Authors: Ana Rey-rico, Henning Madry, Magali CucchiariniAbstract:Delivery of bioactive factors is a very valuable strategy for Articular Cartilage Repair. Nevertheless, the direct supply of such biomolecules is limited by several factors including rapid degradation, the need for supraphysiological doses, the occurrence of immune and inflammatory responses, and the possibility of dissemination to nontarget sites that may impair their therapeutic action and raise undesired effects. The use of controlled delivery systems has the potential of overcoming these hurdles by promoting the temporal and spatial presentation of such factors in a defined target. Hydrogels are promising materials to develop delivery systems for Cartilage Repair as they can be easily loaded with bioactive molecules controlling their release only where required. This review exposes the most recent technologies on the design of hydrogels as controlled delivery platforms of bioactive molecules for Cartilage Repair.
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Complex and elementary histological scoring systems for Articular Cartilage Repair.
Histology and Histopathology, 2015Co-Authors: Patrick Orth, Henning MadryAbstract:The Repair of Articular Cartilage defects is increasingly moving into the focus of experimental and clinical investigations. Histological analysis is the gold standard for a valid and objective evaluation of cartilaginous Repair tissue and predominantly relies on the use of established scoring systems. In the past three decades, numerous elementary and complex scoring systems have been described and modified, including those of O'Driscoll, Pineda, Wakitani, Sellers and Fortier for entire defects as well as those according to the International Cartilage Repair Society (ICRS-I/II) for osteochondral tissue biopsies. Yet, this coexistence of different grading scales inconsistently addressing diverse parameters may impede comparability between reported study outcomes. Furthermore, validation of these histological scoring systems has only seldom been performed to date. The aim of this review is (1) to give a comprehensive overview and to compare the most important established histological scoring systems for Articular Cartilage Repair, (2) to describe their specific advantages and pitfalls, and (3) to provide valid recommendations for their use in translational and clinical studies of Articular Cartilage Repair.
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New trends in Articular Cartilage Repair
Journal of Experimental Orthopaedics, 2015Co-Authors: Magali Cucchiarini, Christel Henrionnet, Didier Mainard, Astrid Pinzano, Henning MadryAbstract:Damage to the Articular Cartilage is an important, prevalent, and unsolved clinical issue for the orthopaedic surgeon. This review summarizes innovative basic research approaches that may improve the current understanding of Cartilage Repair processes and lead to novel therapeutic options. In this regard, new aspects of Cartilage tissue engineering with a focus on the choice of the best-suited cell source are presented. The importance of non-destructive Cartilage imaging is highlighted with the recent availability of adapted experimental tools such as Second Harmonic Generation (SHG) imaging. Novel insights into Cartilage pathophysiology based on the involvement of the infrapatellar fat pad in osteoarthritis are also described. Also, recombinant adeno-associated viral vectors are discussed as clinically adapted, efficient tools for potential gene-based medicines in a variety of Articular Cartilage disorders. Taken as a whole, such advances in basic research in diverse fields of Articular Cartilage Repair may lead to the development of improved therapies in the clinics for an improved, effective treatment of Cartilage lesions in a close future.
Karen Hambly - One of the best experts on this subject based on the ideXlab platform.
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A systematic review of reporting of rehabilitation in Articular-Cartilage-Repair studies of third-generation autologous chondrocyte implantation in the knee.
Journal of Sport Rehabilitation, 2014Co-Authors: Philip Bright, Karen HamblyAbstract:Context: Autologous chondrocyte implantation (ACI) is a tissue-engineered surgical technique initially developed for Articular Cartilage Repair of isolated chondral lesions of the knee. Third-generation techniques (ACI3) are now available that deliver autologous cultured chondrocytes into the defect using cell scaffolds. The successful outcomes of these techniques have some dependency on presurgical and postsurgical patient rehabilitation. Objectives: To determine if the standard of reporting for rehabilitation has improved in ACI3 studies; previous reviews in this field recommended describing the detail of this rehabilitation and patient compliance as integral elements. Evidence Acquisition: A computerized search was performed in March 2013. Criteria for inclusion were any studies that evaluated or described the process of ACI3 in the knee and subsequent rehabilitation. The modified Coleman Methodology Score (CMS) was used to rate the standard of reporting of rehabilitation and surgical procedures; revie...
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current concepts for rehabilitation and return to sport after knee Articular Cartilage Repair in the athlete
Journal of Orthopaedic & Sports Physical Therapy, 2012Co-Authors: Kai Mithoefer, Karen Hambly, Holly J. Silvers, David Logerstedt, Margherita Ricci, Stefano Della VillaAbstract:Synopsis Articular Cartilage injury is observed with increasing frequency in both elite and amateur athletes and results from the significant acute and chronic joint stress associated with impact sports. Left untreated, Articular Cartilage defects can lead to chronic joint degeneration and athletic and functional disability. Treatment of Articular Cartilage defects in the athletic population presents a therapeutic challenge due to the high mechanical demands of athletic activity. Several Articular Cartilage Repair techniques have been shown to successfully restore Articular Cartilage surfaces and allow athletes to return to high-impact sports. Postoperative rehabilitation is a critical component of the treatment process for athletic Articular Cartilage injury and should take into consideration the biology of the Cartilage Repair technique, Cartilage defect characteristics, and each athlete's sport-specific demands to optimize functional outcome. Systematic, stepwise rehabilitation with criteria-based prog...
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Rehabilitation after Articular Cartilage Repair of the Knee in the Football (Soccer) Player.
Cartilage, 2011Co-Authors: Karen Hambly, Holly J. Silvers, Matthias SteinwachsAbstract:BACKGROUND: Participation in football can put both male and female players at an increased risk for knee osteoarthritis. There is a higher prevalence of focal chondral defects in the knee of athletes compared to nonathletes. The management of chondral defects in the football player is complex and multifactorial. OBJECTIVE: The aim of this study is to provide an overview of the current strategies for rehabilitation after Articular Cartilage Repair of the knee in the football player. DESIGN: A review of current literature and the scientific evidence for rehabilitation after Articular Cartilage Repair of the knee. CONCLUSIONS: Articular Cartilage Repair has been shown to allow return to sport but rehabilitation timescales are lengthy. Successful rehabilitation for a return to football after Articular Cartilage Repair of the knee requires the player to be able to accept the load of the sport. This necessitates a multidisciplinary approach to rehabilitation, especially in the transition from therapy to performance care. It should be recognized that not all players will return to football after Articular Cartilage Repair. The evidence base for rehabilitative practice after Articular Cartilage Repair is increasing but remains sparse in areas.
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The use of the Tegner Activity Scale for Articular Cartilage Repair of the knee: a systematic review.
Knee Surgery Sports Traumatology Arthroscopy, 2010Co-Authors: Karen HamblyAbstract:Purpose The Tegner Activity Scale (TAS) was developed in 1984 and has been widely used in studies on knee populations. The primary objective of this study was to undertake a systematic review on the use of the TAS for Articular Cartilage Repair (ACR) of the knee. Methods A systematic review was conducted using electronic databases (MEDLINE, CINAHL, SPORTDiscus TM , NHS Evidence, ISI Web of Knowledge, AMED, BNI, PEDro and The Cochrane Collaboration of Systematic Reviews) and reference lists from extracted articles. Studies were selected that were published between 1984 and 2009 in which the TAS was reported for patients who had undergone ACR of the knee. Results The search strategy identified 442 citations of which 34 articles met the inclusion criteria. There was a large degree of study heterogeneity especially regarding data reporting a wide variation in the number of participants (range 5‐137), participant age (range 12‐76 years), follow-up time (range 3‐120 months) and male-to-female participant ratio. Where pre- to postoperative TAS change was analysed, 88% of studies demonstrated a significant improvement in postoperative TAS scores. Conclusions In general, TAS data were inconsistently reported and methodological detail was often lacking. Caution is advised in the interpretation of TAS scores following ACR of the knee where there are large ranges in postoperative follow-up times, mixed gender cohorts and wide ranges in participant ages. TAS data should be presented and analysed fully and ideally in a standardised fashion to facilitate the comparison of outcomes between studies.
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return to sports participation after Articular Cartilage Repair in the knee scientific evidence
American Journal of Sports Medicine, 2009Co-Authors: Kai Mithoefer, Karen Hambly, Holly J. Silvers, Stefano Della Villa, Bert R. MandelbaumAbstract:BACKGROUND: Articular Cartilage injury in the athlete's knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after Articular Cartilage Repair in the knee. HYPOTHESIS: Systematic analysis of athletic participation after Articular Cartilage Repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with Articular Cartilage injury of the knee. STUDY DESIGN: Systematic review. METHODS: A comprehensive literature review of original studies was performed to provide information about athletic participation after Articular Cartilage Repair. The athlete's ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time. RESULTS: Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the Cartilage Repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete's age, preoperative duration of symptoms, level of play, lesion size, and Repair tissue morphology. CONCLUSION: Articular Cartilage Repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the clinical decision-making process and for the management of the athlete's postoperative expectations.