Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-08-2011 | Knee Arthroplasty

Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee

Authors: Christoph Becher, C. Kalbe, H. Thermann, H. H. Paessler, H. Laprell, T. Kaiser, A. Fechner, S. Bartsch, H. Windhagen, S. Ostermeier

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2011

Abstract

Introduction

The purpose of this study was to evaluate the results of a contoured focal articular femoral condyle resurfacing prosthetic in the treatment of full-thickness cartilage and osteochondral defects at the medial femoral condyle of the knee beyond 5 years.

Methods

In a multicenter case series, preoperative and follow-up scores of the Knee Injury and Osteoarthritis Outcome Score (KOOS), SF-36 and Tegner activity scale were evaluated. Standard radiographs were performed to evaluate the progression of osteoarthritis. Patients were also asked to report their satisfaction.

Results

A total of 21 patients were included in this study. The average follow-up was 5.3 years. The average age at the time of resurfacing was 54 years. Average KOOS scores significantly (P ≤ 0.005) improved for pain (51.1 to 77.6), symptoms (57.9 to 79.5), activities of daily living (ADL) (58.8 to 82.4), sports (26.3 to 57.8) and quality of life (QOL) (34.4 to 55.0). The Tegner activity level improved significantly (P ≤ 0.02) from 2.9 to 4. The physical health value of the SF-36 increased by 15.2 to 46.9 compared to the preoperative value. The mental health value almost (51.2) remained unchanged. As many as 16/21 of the patients in this series were satisfied with their outcome and would have the operation again. Radiographic results demonstrated solid fixation, preservation of joint space and no change in the osteoarthritic stage.

Conclusions

The device appears to be an effective reconstructive treatment option for large full-thickness cartilage and osteochondral lesions of the knee in middle-aged patients.

Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468:45–51PubMedCrossRef

Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMedCrossRef

vies-Tuck ML, Wluka AE, Wang Y, Teichtahl AJ, Jones G, Ding C, Cicuttini FM (2008) The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthritis Cartilage 16:337–342CrossRef

Wluka AE, Ding C, Jones G, Cicuttini FM (2005) The clinical correlates of articular cartilage defects in symptomatic knee osteoarthritis: a prospective study. Rheumatology (Oxford) 44:1311–1316CrossRef

Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460PubMedCrossRef

Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18:730–734PubMedCrossRef

Cicuttini F, Ding C, Wluka A, Davis S, Ebeling PR, Jones G (2005) Association of cartilage defects with loss of knee cartilage in healthy, middle-age adults: a prospective study. Arthritis Rheum 52:2033–2039PubMedCrossRef

Jackson DW, Lalor PA, Aberman HM, Simon TM (2001) Spontaneous repair of full-thickness defects of articular cartilage in a goat model. A preliminary study. J Bone Joint Surg Am 83-A:53–64PubMed

Wang Y, Ding C, Wluka AE, Davis S, Ebeling PR, Jones G, Cicuttini FM (2006) Factors affecting progression of knee cartilage defects in normal subjects over 2 years. Rheumatology (Oxford) 45:79–84CrossRef

10.

Browne JE, Anderson AF, Arciero R, Mandelbaum B, Moseley JB, Jr., Micheli LJ, Fu F, Erggelet C (2005) Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects. Clin Orthop Relat Res 237–245

11.

Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 85-A(Suppl 2):25–32PubMed

12.

Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38:1117–1124PubMedCrossRef

13.

Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484PubMedCrossRef

14.

Karataglis D, Green MA, Learmonth DJ (2006) Autologous osteochondral transplantation for the treatment of chondral defects of the knee. Knee 13:32–35PubMedCrossRef

15.

McCulloch PC, Kang RW, Sobhy MH, Hayden JK, Cole BJ (2007) Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle: minimum 2-year follow-up. Am J Sports Med 35:411–420PubMedCrossRef

16.

Asik M, Ciftci F, Sen C, Erdil M, Atalar A (2008) The microfracture technique for the treatment of full-thickness articular cartilage lesions of the knee: midterm results. Arthroscopy 24:1214–1220PubMedCrossRef

17.

Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Sudkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22:1180–1186PubMedCrossRef

18.

Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89:2105–2112PubMedCrossRef

19.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMed

20.

Bekkers JE, de Windt TS, Raijmakers NJ, Dhert WJ, Saris DB (2009) Validation of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthritis Cartilage 17:1434–1439PubMedCrossRef

21.

Hambly K, Griva K (2008) IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients? Am J Sports Med 36:1695–1704PubMedCrossRef

22.

Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRef

23.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res:43–49

24.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedCrossRef

25.

Altman RD, Gold GE (2007) Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 15 (Suppl A):A1–A56

26.

Guermazi A, Hunter DJ, Roemer FW (2009) Plain radiography and magnetic resonance imaging diagnostics in osteoarthritis: validated staging and scoring. J Bone Joint Surg Am 91(Suppl 1):54–62PubMedCrossRef

27.

Paradowski PT, Bergman S, Sunden-Lundius A, Lohmander LS, Roos EM (2006) Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord 7:38

28.

Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, Joseph L, Brown JP, Murray TM, Adachi JD, Hanley DA, Papadimitropoulos E (2000) Canadian normative data for the SF-36 health survey. Canadian Multicentre Osteoporosis Study Research Group. CMAJ 163:265–271PubMed

29.

Briggs KK, Steadman JR, Hay CJ, Hines SL (2009) Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 37:898–901PubMedCrossRef

30.

O’Rourke MR, Gardner JJ, Callaghan JJ, Liu SS, Goetz DD, Vittetoe DA, Sullivan PM, Johnston RC (2005) The John Insall Award: unicompartmental knee replacement: a minimum twenty-one-year followup, end-result study. Clin Orthop Relat Res 440:27–37PubMedCrossRef

31.

Kirker-Head CA, Van S, Ek SW, McCool JC (2006) Safety of, and biological and functional response to, a novel metallic implant for the management of focal full-thickness cartilage defects: preliminary assessment in an animal model out to 1 year. J Orthop Res 24:1095–1108PubMedCrossRef

32.

van Susante JL, Buma P, Schuman L, Homminga GN, van den Berg WB, Veth RP (1999) Resurfacing potential of heterologous chondrocytes suspended in fibrin glue in large full-thickness defects of femoral articular cartilage: an experimental study in the goat. Biomaterials 20:1167–1175PubMedCrossRef

33.

Becher C, Huber R, Thermann H, Paessler HH, Skrbensky G (2008) Effects of a contoured articular prosthetic device on tibiofemoral peak contact pressure: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 16:56–63PubMedCrossRef

34.

Becher C, Huber R, Thermann H, Ezechieli L, Ostermeier S, Wellmann M, von Skrbensky G (2011) Effects of a surface matching articular resurfacing device on tibiofemoral contact pressure: results from continuous dynamic flexion–extension cycles. Arch Orthop Trauma Surg 131:413–419PubMedCrossRef

35.

Niemeyer P, Kostler W, Salzmann GM, Lenz P, Kreuz PC, Sudkamp NP (2010) Autologous chondrocyte implantation for treatment of focal cartilage defects in patients age 40 years and older: a matched-pair analysis with 2-year follow-up. Am J Sports Med

36.

Rosenberger RE, Gomoll AH, Bryant T, Minas T (2008) Repair of large chondral defects of the knee with autologous chondrocyte implantation in patients 45 years or older. Am J Sports Med 36:2336–2344PubMedCrossRef

37.

Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T (2009) Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 37:902–908PubMedCrossRef

38.

Gomoll AH, Farr J, Gillogly SD, Kercher J, Minas T (2010) Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am 92:2470–2490PubMed

39.

Zaslav K, Cole B, Brewster R, DeBerardino T, Farr J, Fowler P, Nissen C (2009) A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med 37:42–55PubMedCrossRef

40.

Wood JJ, Malek MA, Frassica FJ, Polder JA, Mohan AK, Bloom ET, Braun MM, Cote TR (2006) Autologous cultured chondrocytes: adverse events reported to the United States Food and Drug Administration. J Bone Joint Surg Am 88:503–507PubMedCrossRef

41.

Emrani PS, Katz JN, Kessler CL, Reichmann WM, Wright EA, McAlindon TE, Losina E (2008) Joint space narrowing and Kellgren–Lawrence progression in knee osteoarthritis: an analytic literature synthesis. Osteoarthritis Cartilage 16:873–882PubMedCrossRef

Title: Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee
Authors: Christoph Becher
C. Kalbe
H. Thermann
H. H. Paessler
H. Laprell
T. Kaiser
A. Fechner
S. Bartsch
H. Windhagen
S. Ostermeier
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2011
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-011-1323-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2011

An experimental study of COMP (cartilage oligomeric matrix protein) in the rabbit menisci

Relationship between human femorotibial joint configuration and the morphometry of the anterior cruciate ligament

In vitro and in vivo AM and PL tunnel positioning in anatomical double bundle anterior cruciate ligament reconstruction

Arthroscopic rotator cuff repair using a single-row of triple-loaded suture anchors with a modified suture configuration

Diagnosis and treatment of ganglion cysts of the cruciate ligaments

Arthroscopic repair of type II superior labrum anterior posterior (SLAP) lesions in patients over the age of 45 years: a prospective study