The Experts below are selected from a list of 537 Experts worldwide ranked by ideXlab platform
Peter Behrens - One of the best experts on this subject based on the ideXlab platform.
-
Reviewing subchondral Cartilage Surgery: considerations for standardised and outcome predictable Cartilage remodelling
International Orthopaedics, 2013Co-Authors: Jan P Benthien, Peter BehrensAbstract:Purpose The potential of subchondral mesenchymal stem cell stimulation (MSS) for Cartilage repair has led to the widespread use of microfracture as a first line treatment for full thickness articular Cartilage defects. Recent focus on the effects of subchondral bone during Cartilage injury and repair has expanded the understanding of the strengths and limitations in MSS and opened new pathways for potential improvement. Comparative studies have shown that bone marrow access has positive implications for pluripotential cell recruitment, repair quality and quantity, i.e. deeper channels elicited better Cartilage fill, more hyaline Cartilage character with higher type II collagen content and lower type I collagen content compared to shallow marrow access. Methods A subchondral needling procedure using standardised and thin subchondral perforations deep into the subarticular bone marrow making the MSS more consistent with the latest developments in subchondral Cartilage remodelling is proposed. Results As this is a novel method clinical studies have been initiated to evaluate the procedure especially compared to microfracturing. However, the first case studies and follow-ups indicate that specific drills facilitate reaching the subchondral bone marrow while the needle size makes perforation of the subchondral bone easier and more predictable. Clinical results of the first group of patients seem to compare well to microfracturing. Conclusion The authors suggest a new method for a standardised procedure using a new perforating device. Advances in MSS by subchondral bone marrow perforation are discussed. It remains to be determined by clinical studies how this method compares to microfracturing. The subchondral needling offers the surgeon and the investigator a method that facilitates comparison studies because of its defined depth of subchondral penetration and needle size.
-
reviewing subchondral Cartilage Surgery considerations for standardised and outcome predictable Cartilage remodelling a technical note
International Orthopaedics, 2013Co-Authors: Jan P Benthien, Peter BehrensAbstract:Purpose The potential of subchondral mesenchymal stem cell stimulation (MSS) for Cartilage repair has led to the widespread use of microfracture as a first line treatment for full thickness articular Cartilage defects. Recent focus on the effects of subchondral bone during Cartilage injury and repair has expanded the understanding of the strengths and limitations in MSS and opened new pathways for potential improvement. Comparative studies have shown that bone marrow access has positive implications for pluripotential cell recruitment, repair quality and quantity, i.e. deeper channels elicited better Cartilage fill, more hyaline Cartilage character with higher type II collagen content and lower type I collagen content compared to shallow marrow access.
-
We do not have evidence based methods for the treatment of Cartilage defects in the knee
Knee Surgery Sports Traumatology Arthroscopy, 2011Co-Authors: Jan P Benthien, Manuela Schwaninger, Peter BehrensAbstract:Purpose The aim of this study was to perform a systematic review of studies concerning current treatment of chondral defects of the knee. Methods The relevance for evidence based data and for successful surgical treatment of Cartilage defects was evaluated. From 56,098 evaluated studies, 133 studies could be further pursued. These supplied data concerning microfracturing, the osteochondral autograft transplantation system (OATS), the autologous chondrocyte implantation (ACI) and the matrix induced chondrocyte implantation (MACI). The modified Coleman Methodical Score (CMS) and the Level of Evidence (LOE) were applied to evaluate the quality. Results In these studies, a total of 6,920 patients were reviewed with a median of 32 patients per study and a mean follow-up of 24 months. The mean CMS was 58 of 100 points. No study reached 100 points in the CMS. Three studies reached a level above 90. Ten studies were Level I, five studies reached Level II. Seven studies reached Level III, 111 studies Level IV. MRI scans to verify the clinical data were used by only 72 studies. The means in the modified CMS were for the different procedures as follows: ACI 58 points, MACI 57 points, microfracturing 68 points and OATS 50 points. 24 studies applied the Lysholm Score (LS) for clinical evaluation of Cartilage Surgery. All operative procedures yielded comparable improvements of the LS (n.s.) meaning that no operative procedure proved superior. Conclusion As the majority of studies evaluated by this review is insufficient for EBM purposes more coherent studies with LOE of I or II are needed. Co-relating the systems of CMS and LOE and validating the applied scores seems desirable.
Jan P Benthien - One of the best experts on this subject based on the ideXlab platform.
-
microfracture state of the art in Cartilage Surgery
Cartilage, 2018Co-Authors: Florian Frehner, Jan P BenthienAbstract:ObjectiveThis study is a literature review from 2010 to 2014 concerning the quality of evidence in clinical trials about microfracture in attempt to repair articular Cartilage. We have decided to f...
-
Reviewing subchondral Cartilage Surgery: considerations for standardised and outcome predictable Cartilage remodelling
International Orthopaedics, 2013Co-Authors: Jan P Benthien, Peter BehrensAbstract:Purpose The potential of subchondral mesenchymal stem cell stimulation (MSS) for Cartilage repair has led to the widespread use of microfracture as a first line treatment for full thickness articular Cartilage defects. Recent focus on the effects of subchondral bone during Cartilage injury and repair has expanded the understanding of the strengths and limitations in MSS and opened new pathways for potential improvement. Comparative studies have shown that bone marrow access has positive implications for pluripotential cell recruitment, repair quality and quantity, i.e. deeper channels elicited better Cartilage fill, more hyaline Cartilage character with higher type II collagen content and lower type I collagen content compared to shallow marrow access. Methods A subchondral needling procedure using standardised and thin subchondral perforations deep into the subarticular bone marrow making the MSS more consistent with the latest developments in subchondral Cartilage remodelling is proposed. Results As this is a novel method clinical studies have been initiated to evaluate the procedure especially compared to microfracturing. However, the first case studies and follow-ups indicate that specific drills facilitate reaching the subchondral bone marrow while the needle size makes perforation of the subchondral bone easier and more predictable. Clinical results of the first group of patients seem to compare well to microfracturing. Conclusion The authors suggest a new method for a standardised procedure using a new perforating device. Advances in MSS by subchondral bone marrow perforation are discussed. It remains to be determined by clinical studies how this method compares to microfracturing. The subchondral needling offers the surgeon and the investigator a method that facilitates comparison studies because of its defined depth of subchondral penetration and needle size.
-
reviewing subchondral Cartilage Surgery considerations for standardised and outcome predictable Cartilage remodelling a technical note
International Orthopaedics, 2013Co-Authors: Jan P Benthien, Peter BehrensAbstract:Purpose The potential of subchondral mesenchymal stem cell stimulation (MSS) for Cartilage repair has led to the widespread use of microfracture as a first line treatment for full thickness articular Cartilage defects. Recent focus on the effects of subchondral bone during Cartilage injury and repair has expanded the understanding of the strengths and limitations in MSS and opened new pathways for potential improvement. Comparative studies have shown that bone marrow access has positive implications for pluripotential cell recruitment, repair quality and quantity, i.e. deeper channels elicited better Cartilage fill, more hyaline Cartilage character with higher type II collagen content and lower type I collagen content compared to shallow marrow access.
-
We do not have evidence based methods for the treatment of Cartilage defects in the knee
Knee Surgery Sports Traumatology Arthroscopy, 2011Co-Authors: Jan P Benthien, Manuela Schwaninger, Peter BehrensAbstract:Purpose The aim of this study was to perform a systematic review of studies concerning current treatment of chondral defects of the knee. Methods The relevance for evidence based data and for successful surgical treatment of Cartilage defects was evaluated. From 56,098 evaluated studies, 133 studies could be further pursued. These supplied data concerning microfracturing, the osteochondral autograft transplantation system (OATS), the autologous chondrocyte implantation (ACI) and the matrix induced chondrocyte implantation (MACI). The modified Coleman Methodical Score (CMS) and the Level of Evidence (LOE) were applied to evaluate the quality. Results In these studies, a total of 6,920 patients were reviewed with a median of 32 patients per study and a mean follow-up of 24 months. The mean CMS was 58 of 100 points. No study reached 100 points in the CMS. Three studies reached a level above 90. Ten studies were Level I, five studies reached Level II. Seven studies reached Level III, 111 studies Level IV. MRI scans to verify the clinical data were used by only 72 studies. The means in the modified CMS were for the different procedures as follows: ACI 58 points, MACI 57 points, microfracturing 68 points and OATS 50 points. 24 studies applied the Lysholm Score (LS) for clinical evaluation of Cartilage Surgery. All operative procedures yielded comparable improvements of the LS (n.s.) meaning that no operative procedure proved superior. Conclusion As the majority of studies evaluated by this review is insufficient for EBM purposes more coherent studies with LOE of I or II are needed. Co-relating the systems of CMS and LOE and validating the applied scores seems desirable.
David C Flanigan - One of the best experts on this subject based on the ideXlab platform.
-
Symptom Chronicity and Tobacco Use: Differences in Athletic and Nonathletic Candidates for Cartilage Surgery.
Cartilage, 2019Co-Authors: Joshua S. Everhart, Sravya P. Vajapey, James C. Kirven, Moneer M. Abouljoud, Alex C. Dibartola, Brennan Wright, David C FlaniganAbstract:ObjectiveTo determine whether there are differences in symptomatic knee Cartilage defects and rates of tobacco use among age-matched athletes versus nonathletes undergoing initial arthroscopic knee...
-
correlation between magnetic resonance imaging and clinical outcomes after Cartilage repair Surgery in the knee a systematic review and meta analysis
American Journal of Sports Medicine, 2013Co-Authors: Andrew J Blackman, David C Flanigan, Matthew V Smith, Matthew J Matava, Rick W Wright, Robert H BrophyAbstract:Background:Magnetic resonance imaging (MRI) is often used to assess Cartilage after surgical repair. The correlation between MRI and clinical outcomes is not well understood.Hypothesis:Postoperative MRI findings correlate with clinical outcome measures in patients after articular Cartilage Surgery of the knee.Study Design:Meta-analysis.Methods:A systematic review of the literature was performed to identify studies in which MRI and clinical outcomes were correlated after autologous chondrocyte implantation (ACI), osteochondral autograft transfer system (OATS), or microfracture. Studies that reported correlation coefficients (r) for different MRI parameters were then included in a meta-analysis.Results:A total of 26 studies were identified for inclusion in this systematic review, 15 of which were included in the meta-analysis. Most of the studies (n = 19) involved ACI, although studies were available for OATS (n = 5) and microfracture (n = 4). The strongest MRI correlates with clinical outcomes after ACI we...
-
Survival and clinical outcome of isolated high tibial osteotomy and combined biological knee reconstruction.
Knee, 2013Co-Authors: Joshua D Harris, Ryan J. Mcneilan, Robert A. Siston, David C FlaniganAbstract:Abstract Purpose We sought to determine survival and clinical outcomes of high tibial osteotomy (HTO) with or without articular Cartilage Surgery and/or meniscal allograft transplantation in patients with medial compartment chondral pathology, varus malalignment, and/or meniscal deficiency, whether there is any difference in survival or clinical outcome between these patient cohorts, and whether there is any difference between opening- (OWHTO) and closing-wedge (CWHTO) techniques. Methods A systematic review of multiple medical databases was performed using PRISMA guidelines. Study quality was assessed via modified Coleman Methodology Scores (MCMS). Results Sixty-nine studies were included (4557 subjects). MCMS rating was overall poor. Mean follow-up was 7.1 years. Mean subject age was 53 years. Survival of isolated HTO was 92.4%, 84.5%, 77.3%, and 72.3% at 5, 10, 15, and 20 years of follow-up. At 5 years of follow-up, HTO with articular Cartilage Surgery had significantly greater survival (97.7%) than either isolated HTO (92.4%) or HTO with MAT (90.9%). Isolated HTO, HTO with articular Cartilage Surgery, and HTO with MAT all significantly improved subjective and objective clinical outcome scores. At two years of follow-up, survival was significantly greater following OWHTO (98.7%) versus CWHTO (96.7%). However, at all other time points with or without combined articular Cartilage Surgery and/or MAT, there was no significant survival difference between the techniques. Conclusions Survival and clinical outcomes of isolated HTO were excellent at short- and mid-term follow-ups, but deteriorated with time. HTO with concomitant procedures also demonstrated excellent early survival and clinical outcomes that deteriorated with time (up to 10 years).
-
continuous passive motion following Cartilage Surgery does a common protocol exist
The Physician and Sportsmedicine, 2013Co-Authors: Jonathan M. Karnes, Joshua D Harris, Michael J Griesser, David C FlaniganAbstract:AbstractContinuous passive motion (CPM) devices have the potential to improve the histological content as well as the rate and volume of chondrogenesis in repair tissue following chondral injury. However, clinical evidence is lacking to support broad implementation of CPM following Cartilage restoration procedures. We searched PubMed, CINAHL, SPORTDiscus, and Cochrane for such terms as knee, continuous passive motion, CPM, ACI, ACT, autologous chondrocyte implantation, autologous chondrocyte transplantation, microfracture, marrow-stimulation technique, mosaicplasty, osteochondral autograft, and osteochondral allograft. Inclusion criteria were all English-language studies of human subjects, evidence levels I to IV, reporting the use of CPM following Cartilage repair or restoration Surgery in the knee. One hundred and seven studies met inclusion criteria. Sixty-three studies reported the use of CPM following autologous chondrocyte implantation; 28 reported the use of CPM following microfracture; 13 reported...
-
the effect of smoking on ligament and Cartilage Surgery in the knee a systematic review
American Journal of Sports Medicine, 2012Co-Authors: Praveen Kanneganti, Joshua D Harris, Robert H Brophy, Christian Lattermann, James L Carey, David C FlaniganAbstract:Background:The adverse effects of smoking on various health conditions such as cancer, diabetes, and cardiovascular disease have been well documented. Many orthopaedic conditions, such as fracture healing, wound repair, and bone mineral density, have been reported to be adversely affected by smoking. However, no known systematic reviews have investigated the effects of smoking on ligament and Cartilage knee Surgery.Purpose:We hypothesized that smoking would have a negative influence from both a basic science and clinical outcome perspective on these types of knee surgeries.Study Design:Systematic review.Methods:A systematic review of multiple medical databases was performed evaluating clinical and basic science studies to determine the effects of smoking on ligament and Cartilage knee Surgery.Results:Fourteen studies were found for inclusion and analysis. Eight of these studies addressed the relationship between smoking and knee ligaments, and 6 investigated the relationship between smoking and articular ...
Robert H Brophy - One of the best experts on this subject based on the ideXlab platform.
-
Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes
Sports Health: A Multidisciplinary Approach, 2016Co-Authors: Matthew V Smith, Matthew J Matava, Rick W Wright, Jeffrey J. Nepple, Robert H BrophyAbstract:Background:Football puts athletes at risk for knee injuries such meniscus and anterior cruciate ligament (ACL) tears, which are associated with the development of osteoarthritis (OA). Previous knee Surgery, player position, and body mass index (BMI) may be associated with knee OA.Hypothesis:In elite football players undergoing knee magnetic resonance imaging at the National Football League’s Invitational Combine, the prevalence of knee OA is associated with previous knee Surgery and BMI.Study Design:Retrospective cohort.Level of Evidence:Level 4.Methods:A retrospective review was performed of all participants of the National Football League Combine from 2005 to 2009 who underwent magnetic resonance imaging of the knee because of prior knee injury, Surgery, or knee-related symptoms or concerning examination findings. Imaging studies were reviewed for evidence of OA. History of previous knee Surgery—including ACL reconstruction, meniscal procedures, and articular Cartilage Surgery—and position were recorded...
-
microfracture and ability to return to sports after Cartilage Surgery
Operative Techniques in Orthopaedics, 2014Co-Authors: Josh D Miller, Robert H BrophyAbstract:Microfracture is a simple, effective first-line treatment for small articular Cartilage defects in the knee joint. The lesions should be isolated to the articular Cartilage with no loss of bone and have a circumferential shoulder of intact Cartilage. Postoperative rehabilitation involves 4-6 weeks of protected weight bearing and continuous passive motion. Younger, lighter patients with a shorter duration of symptoms have better outcomes after microfracture. Femoral lesions are associated with better outcomes than patellofemoral lesions are. The repair tissue generated by microfracture is fibrous with uncertain durability, especially in more active patients. Athletes can return to sport after articular Cartilage Surgery, but the data regarding this are relatively limited. Optimal indications, rehabilitation, timing of return to sport, and durability of repair deserve further study in the athletic patient population.
-
Articular Cartilage Repair of the Knee in Athletes
Developing Insights in Cartilage Repair, 2013Co-Authors: Robert H BrophyAbstract:Athletes are at an elevated risk for articular Cartilage injury of the knee, especially in pivoting sports such as soccer and basketball. Due to the poor intrinsic healing response of articular Cartilage, these injuries can be debilitating and even career threatening for high level athletes. Athletes often damage their articular Cartilage in conjunction with other pathology such as an anterior cruciate ligament tear or meniscus tear, and these typically need to be addressed at the same time as the articular Cartilage. Fortunately, there are an increasing number of surgical treatment options available to restore the articular Cartilage of the knee. Outcomes data is still relatively limited, especially for athletes, but there is a growing body of evidence that patients can return to sport after articular Cartilage Surgery, although the recovery may be lengthy. Microfracture and autologous chondrocyte implantation, and osteochondral autograft to a lesser degree, have demonstrated fair to good rates of return to sport. Appropriate rehabilitation is essential and the quality of the tissue repair appears to be an important factor influencing return to play. Much of the evidence for return to play is in soccer and American football, with less data for other sports. Although promising, more studies are needed to better define and predict return to play and long term outcomes in athletes after articular Cartilage Surgery in the knee.
-
correlation between magnetic resonance imaging and clinical outcomes after Cartilage repair Surgery in the knee a systematic review and meta analysis
American Journal of Sports Medicine, 2013Co-Authors: Andrew J Blackman, David C Flanigan, Matthew V Smith, Matthew J Matava, Rick W Wright, Robert H BrophyAbstract:Background:Magnetic resonance imaging (MRI) is often used to assess Cartilage after surgical repair. The correlation between MRI and clinical outcomes is not well understood.Hypothesis:Postoperative MRI findings correlate with clinical outcome measures in patients after articular Cartilage Surgery of the knee.Study Design:Meta-analysis.Methods:A systematic review of the literature was performed to identify studies in which MRI and clinical outcomes were correlated after autologous chondrocyte implantation (ACI), osteochondral autograft transfer system (OATS), or microfracture. Studies that reported correlation coefficients (r) for different MRI parameters were then included in a meta-analysis.Results:A total of 26 studies were identified for inclusion in this systematic review, 15 of which were included in the meta-analysis. Most of the studies (n = 19) involved ACI, although studies were available for OATS (n = 5) and microfracture (n = 4). The strongest MRI correlates with clinical outcomes after ACI we...
-
the effect of smoking on ligament and Cartilage Surgery in the knee a systematic review
American Journal of Sports Medicine, 2012Co-Authors: Praveen Kanneganti, Joshua D Harris, Robert H Brophy, Christian Lattermann, James L Carey, David C FlaniganAbstract:Background:The adverse effects of smoking on various health conditions such as cancer, diabetes, and cardiovascular disease have been well documented. Many orthopaedic conditions, such as fracture healing, wound repair, and bone mineral density, have been reported to be adversely affected by smoking. However, no known systematic reviews have investigated the effects of smoking on ligament and Cartilage knee Surgery.Purpose:We hypothesized that smoking would have a negative influence from both a basic science and clinical outcome perspective on these types of knee surgeries.Study Design:Systematic review.Methods:A systematic review of multiple medical databases was performed evaluating clinical and basic science studies to determine the effects of smoking on ligament and Cartilage knee Surgery.Results:Fourteen studies were found for inclusion and analysis. Eight of these studies addressed the relationship between smoking and knee ligaments, and 6 investigated the relationship between smoking and articular ...
Brian J Cole - One of the best experts on this subject based on the ideXlab platform.
-
PROMIS Instruments Correlate Better with Legacy Measures in Knee Cartilage Patients at Post-operative than at Pre-operative Assessment.
Arthroscopy, 2020Co-Authors: Benedict U. Nwachukwu, Nikhil N. Verma, Adam B Yanke, Alexander Beletsky, Neal B. Naveen, Taylor M. Southworth, Kelechi R. Okoroha, Brian Forsythe, Brian J ColeAbstract:Abstract Purpose To define the psychometric properties of the PROMIS Physical Function (PF), Pain Interference (PI) and Depression Computer Adaptive Test (CAT) in patients undergoing knee Cartilage surgeries. Methods The PROMIS PF, PI and Depression CAT were administered preoperatively and at 6 months alongside legacy knee patient-reported outcome measures in patients undergoing knee Cartilage surgeries. Statistical analysis consisted of time-to-completion, psychometric analysis for correlative strengths, absolute and relative floor and ceiling effects, and Cohen’s effect size. Results Our study included 250 patients (57.2% male), averaging 1.87, 1.53, and 1.91 minutes for completion of the PF, PI, and Depression CATs, respectively. Pre-operatively, the PROMIS PF CAT and PI CATs wide ranges of correlation coefficients with respect to function (PF:0.14-0.72, PI:0.29-0.77) and health-related quality of life (HRQoL) PROMs (r=0.64-0.70). At six months, PROMIS PF CAT (r=0.82-0.93) and PI CAT (r=0.77-0.93) both exhibited excellent correlations with respect to legacy function and HRQoL PROMs except for the Marx (r=0.36-0.44). None of the PROMIS instruments exhibited any significant floor or ceiling effects. Conclusion The PROMIS PF, PI, and Depression CATs performed better with respect to legacy PROMs in the postoperative period than the preoperative period. In addition, PROMIS PF and PI measures perform best with respect to the IKDC, and no floor or ceiling effects were identified for PROMIS instruments. PROMIS instruments may be more suited to track outcomes post-operatively than establish preoperative baselines in Cartilage Surgery patients.
-
defining failure in articular Cartilage Surgery
2019Co-Authors: Drew A Lansdown, Kevin C Wang, Brian J ColeAbstract:Articular Cartilage injury remains a challenging condition for orthopedic surgeons to address. While multiple treatment options exist and have reported improvement in patient symptoms, sustained and successful treatment of symptomatic chondral defects remains elusive in many cases. Physicians may define failure in a multitude of ways such as subsequent Surgery, progression to arthroplasty, lack of improvement in outcome measures, lack of hyaline-like repair tissue, or poor appearance on imaging studies. This chapter reviews the current standards for defining treatment failure in order to address the importance of consistent and clear goals for treating Cartilage injuries and understanding the outcome tools currently available.
-
Staging and Practical Issues in Complex Cases
Cartilage Restoration, 2018Co-Authors: David R. Christian, Adam B Yanke, Lucy Oliver-welsh, Brian J ColeAbstract:The management of articular Cartilage defects poses a complex challenge to the orthopedic surgeon. Developing an appropriate treatment plan requires a patient-centered approach with a thorough evaluation of a patient’s clinical history, physical exam, and imaging results. Many factors impact the appropriate treatment such as demographics, patient lifestyle, defect characteristics, and any concomitant pathology such as meniscal deficiency, malalignment, or instability. Once all factors are considered and surgical management is indicated, the chondral defect can be successfully treated with a variety of modalities including debridement, microfracture, autologous chondrocyte implantation, osteochondral autograft transplant, or osteochondral allograft, among others. Concomitant pathology can be managed with either staged or combined procedures, but failure to address these additional pathologies predisposes the patient to treatment failure and symptomatic recurrence. There are several complicated scenarios that occur relatively common: concomitant meniscal deficiency and chondral defect; concomitant malalignment and chondral defect; concomitant ligamentous injury and chondral defect; concomitant malalignment, meniscal deficiency, and chondral defect; and chondral defect with history of failed Cartilage Surgery. When appropriately applied, Cartilage repair and restoration Surgery provide reliably successful outcomes in patients with symptomatic articular Cartilage defects, even in the most complex cases.
-
Reoperation Rates After Cartilage Restoration Procedures in the Knee: Analysis of a Large US Commercial Database.
American journal of orthopedics, 2018Co-Authors: Rachel M. Frank, Brandon J. Erickson, Frank Mccormick, Bernard R. Bach, Samuel Rosas, Kelms Amoo-achampong, Brian J ColeAbstract:: The purpose of this study is to describe the rate of return to the operating room (OR) following microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral autograft transplantation (OATS), and osteochondral allograft (OCA) procedures at 90 days, 1 year, and 2 years. Current Procedural Terminology codes for all patients undergoing MFX, ACI, OATS, and OCA were used to search a prospectively collected, commercially available private payer insurance company database from 2007 to 2011. Within 90 days, 1 year, and 2 years after Surgery, the database was searched for the occurrence of these same patients undergoing knee diagnostic arthroscopy with biopsy, lysis of adhesions, synovectomy, arthroscopy for infection or lavage, arthroscopy for removal of loose bodies, chondroplasty, MFX, ACI, OATS, OCA, and/or knee arthroplasty. Descriptive statistical analysis and contingency table analysis were performed. A total of 47,207 Cartilage procedures were performed from 2007 to 2011, including 43,576 MFX, 640 ACI, 386 open OATS, 997 arthroscopic OATS, 714 open OCA, and 894 arthroscopic OCA procedures. The weighted average reoperation rates for all procedures were 5.87% at 90 days, 11.94% at 1 year, and 14.90% at 2 years following the index Cartilage Surgery. At 2 years, patients who underwent MFX, ACI, OATS, OCA had reoperation rates of 14.65%, 29.69%, 8.82%, and 12.22%, respectively. There was a statistically significantly increased risk for ACI return to OR within all intervals (P < .0001); however, MFX had a greater risk factor (P < .0001) for conversion to arthroplasty. There was no difference in failure/revision rates between the restorative treatment options. With a large US commercial insurance database from 2007 to 2011, reparative procedures were favored for chondral injuries, but yielded an increased risk for conversion to arthroplasty. There was no difference in failure/revision rates between the restorative approaches, yet cell-based approaches yielded a significantly increased risk for a return to the OR.
-
relationship between quantitative mri biomarkers and patient reported outcome measures after Cartilage repair Surgery a systematic review
Orthopaedic Journal of Sports Medicine, 2018Co-Authors: Drew A Lansdown, Kevin C Wang, Eric J Cotter, Annabelle Davey, Brian J ColeAbstract:Background:Treatment of articular Cartilage injuries remains a clinical challenge, and the optimal tools to monitor and predict clinical outcomes are unclear. Quantitative magnetic resonance imaging (qMRI) allows for a noninvasive biochemical evaluation of Cartilage and may offer advantages in monitoring outcomes after Cartilage repair Surgery.Hypothesis:qMRI sequences will correlate with early pain and functional measures.Study Design:Systematic review; Level of evidence, 3.Methods:A PubMed search was performed with the following search terms: knee AND (Cartilage repair OR Cartilage restoration OR Cartilage Surgery) AND (delayed gadolinium-enhanced MRI OR t1-rho OR T2 mapping OR dgemric OR sodium imaging OR quantitative imaging). Studies were included if correlation data were included on quantitative imaging results and patient outcome scores.Results:Fourteen articles were included in the analysis. Eight studies showed a significant relationship between quantitative Cartilage imaging and patient outcome ...