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Life
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Focal Chondral Defects
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Focal Chondral Defects

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (28 February 2021) | Viewed by 38670

Special Issue Editors

Dr. Filippo Migliorini

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Guest Editor
Department of Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, Puwelsstrasse 30, 52074 Aachen, Germany
Interests: orthopedics; traumatology; meta-analysis; medical statistics; regenerative medicine; biomechanics
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Nicola Maffulli

E-Mail Website
Co-Guest Editor
1. Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
2. School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
3. Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Fisciano, Italy
Interests: orthopaedic
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Focal chondral defects are a common cause of joint complaints and impairment, affecting negatively the quality of life of patients. Given the poor self-healing capability of the cartilage, isolated chondral and osteochondral defects are a difficult clinical challenge, especially for younger patients, for whom alternatives such as partial or total knee arthroplasty are rarely advised. Focal chondral defects left untreated, or managed sub-optimally, can lead to osteoarthritis over time. Thus, a prompt and effective treatment may be necessary. Despite the progress made in the clinical sciences, no consensus regarding the best treatment for focal chondral defects has been reached. Advances in cell-based and delivery techniques for the repair of focal chondral defects have yielded much interest, a broad range of studies, and applications in orthopaedic surgery. However, the limited capacity of damaged cartilage to regenerate and the potential morbidity associated with implanting or transferring bone and cartilage make regenerative medicine an attractive alternative. The future of managing cartilage defects is supposed to lie in providing biologic solutions through cartilage regeneration and tissue engineering. The purpose of this Special Issue is to investigate current strategies and future perspectives for the management of focal chondral defects of the hip, knee, and ankle.

Dr. Filippo Migliorini
Guest Editor

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Keywords

  • focal chondral defects
  • cartilage healing
  • regenerative medicine

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Published Papers (8 papers)

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Research

17 pages, 8885 KiB  
Communication
Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques
by Christian D. Weber, Filippo Migliorini and Frank Hildebrand
Life 2021, 11(6), 543; https://doi.org/10.3390/life11060543 - 10 Jun 2021
Cited by 3 | Viewed by 4254
Abstract
Large (>3 cm2), focal osteochondral lesions (OCL) may result in poor functional outcomes and early secondary osteoarthritis of the knee. The surgical management of these OCL remains challenging. The treatment strategy must be tailored to various aspects, including lesion-specific (e.g., size, [...] Read more.
Large (>3 cm2), focal osteochondral lesions (OCL) may result in poor functional outcomes and early secondary osteoarthritis of the knee. The surgical management of these OCL remains challenging. The treatment strategy must be tailored to various aspects, including lesion-specific (e.g., size, location, chronicity), joint-specific (e.g., instability, limb alignment, meniscal status), and patient-specific factors (e.g., age, activity level, comorbidities). Simple chondroplasty and bone marrow stimulation (BMS) techniques should be reserved for smaller lesions, as they only realize midterm clinical benefits, related to inferior wear characteristics of the induced fibrocartilage (type I collagen). Therefore, much attention has been focused on surgical restoration with hyaline cartilage (type II collagen), based on chondrocyte transplantation and matrix-assisted autologous chondrocyte implantation (MACI). Limited graft availability, staged procedures (MACI), and high treatment costs are limitations of these techniques. However, acute traumatic OCL of the femoral condyles and patellofemoral joint may also be suitable for preservation by surgical fixation. Early detection of the fragment facilitates primary repair with internal fixation. The surgical repair of the articular surface may offer promising clinical and cost-effective benefits as a first-line therapy but remains under-investigated and potentially under-utilized. As a unique characteristic, the fixation technique allows the anatomic restoration of the hyaline articular surface with native cartilage and the repair of the subchondral bone. In this manuscript, we present a case series of large OCL around the knee that were preserved by surgical fixation. Furthermore, various implants and techniques reported for this procedure are reviewed. Full article
(This article belongs to the Special Issue Focal Chondral Defects)
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9 pages, 257 KiB  
Article
Treatment of Unicompartmental Cartilage Defects of the Knee with Unicompartmental Knee Arthroplasty, Patellofemoral Partial Knee Arthroplasty or Focal Resurfacing
by Bernhard Springer and Friedrich Boettner
Life 2021, 11(5), 394; https://doi.org/10.3390/life11050394 - 27 Apr 2021
Cited by 4 | Viewed by 2292
Abstract
Focal chondral defects are common lesions of the articular cartilage. They are predominantly found on the medial femoral condyle and often progress to osteoarthritis of the knee. Various conservative treatment options are available. The conservative treatment might reduce pain and delay the progress [...] Read more.
Focal chondral defects are common lesions of the articular cartilage. They are predominantly found on the medial femoral condyle and often progress to osteoarthritis of the knee. Various conservative treatment options are available. The conservative treatment might reduce pain and delay the progress of degenerative processes. However, restoration of the articular cartilage cannot be accomplished. If the conservative treatment fails unicompartmental arthroplasty, patellofemoral joint replacement or focal resurfacing are reasonable options to postpone total knee arthroplasty. A careful patient selection before surgery is crucial for all three treatment options. The following overview reports indications and outcomes of medial partial knee replacement, patellofemoral partial knee replacement, and focal resurfacing treatment options for focal chondral defects. Full article
(This article belongs to the Special Issue Focal Chondral Defects)
8 pages, 2061 KiB  
Communication
Isolated Arthroscopic Lateral Retinacular Release for Lateral Patellar Compression Syndrome
by Filippo Migliorini, Christian Lüring, Jörg Eschweiler, Alice Baroncini, Arne Driessen, Filippo Spiezia, Markus Tingart and Nicola Maffulli
Life 2021, 11(4), 295; https://doi.org/10.3390/life11040295 - 30 Mar 2021
Cited by 7 | Viewed by 2964
Abstract
Introduction: Evidence concerning the role of isolated lateral retinacular release (LRR) for lateral patellar compression syndrome (LPCS) dates back at least three decades. Appropriate indications, execution and outcomes still remain unclear and controversial. The present investigation analyzed the midterm result of isolated and [...] Read more.
Introduction: Evidence concerning the role of isolated lateral retinacular release (LRR) for lateral patellar compression syndrome (LPCS) dates back at least three decades. Appropriate indications, execution and outcomes still remain unclear and controversial. The present investigation analyzed the midterm result of isolated and arthroscopic LRR for LPCS in a cohort of patients who underwent such procedure at our institution. Material and methods: Patients undergoing isolated arthroscopic LRR for LPCS were identified retrospectively from our electronic database. All procedures were performed by two experienced surgeons. Patients with bony and/or soft tissues abnormalities, patellofemoral instability, moderate to severe chondral damage were not included. Patients with previous surgeries were not included, as were those who underwent combined interventions. Clinical scores and complications were recorded. Results: 31 patients were recruited in the present investigation. The mean follow-up was 86.0 ± 22.8 months. The mean age of the patients at the index operation was 34.2 ± 13.1 years. A total 55% (17 of 31) were women, and 58% (18 of 31) had involved the right knee. The mean hospitalization length was 3.5 ± 1.4 days. At a mean follow-up of 86.0 ± 22.8 months, the numeric rating scale (NRS) was 1.2 ± 0.8, the Kujala score was 91.3 ± 11.3, the Lysholm score was 93.1 ± 15.0, and the Tegner score was 5.0 ± 1.8. At the latest follow-up, 9 of 31 (29.0%) of patients experienced compilations. One patient (3.2%) had a post-operative hemarthrosis which was managed conservatively. Six patients (19.4%) reported a persistent sensation of instability, without signs of patellar dislocation or subluxation. One patient underwent an arthroscopic meniscectomy, and another patient an anterior cruciate ligament (ACL) reconstruction. Conclusion: isolated arthroscopic lateral retinacular release for lateral patellar compression syndrome is feasible and effective, achieving satisfying results at more than seven years following the procedure. Full article
(This article belongs to the Special Issue Focal Chondral Defects)
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9 pages, 794 KiB  
Communication
Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures for Chondral Defects of the Talar Shoulder: A Five-Year Follow-Up Prospective Cohort Study
by Filippo Migliorini, Jörg Eschweiler, Nicola Maffulli, Hanno Schenker, Arne Driessen, Björn Rath and Markus Tingart
Life 2021, 11(3), 244; https://doi.org/10.3390/life11030244 - 16 Mar 2021
Cited by 17 | Viewed by 3006
Abstract
Introduction: Many procedures are available to manage cartilage defects of the talus, including microfracturing (MFx) and Autologous Matrix Induced Chondrogenesis (AMIC). Whether AMIC or MFx are equivalent for borderline sized defects of the talar shoulder is unclear. Thus, the present study compared the [...] Read more.
Introduction: Many procedures are available to manage cartilage defects of the talus, including microfracturing (MFx) and Autologous Matrix Induced Chondrogenesis (AMIC). Whether AMIC or MFx are equivalent for borderline sized defects of the talar shoulder is unclear. Thus, the present study compared the efficacy of primary isolated AMIC versus MFx for borderline sized focal unipolar chondral defects of the talar shoulder at midterm follow-up. Methods: Patients undergoing primary isolated AMIC or MFx for focal unipolar borderline sized chondral defects of the talar shoulder were recruited prospectively. For those patients who underwent AMIC, a type I/III collagen resorbable membrane was used. The outcomes of interest were: Visual Analogic Scale (VAS), Tegner Activity Scale, American Orthopedic Foot and Ankle Score (AOFAS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Data concerning complication rate and additional procedures were also collected. Results: The mean follow-up was 43.5 months. The mean age of the 70 patients at operation was 32.0 years, with a mean defect size of 2.7 cm2. The mean length of hospitalization was shorter in the MFx cohort (p = 0.01). No difference was found between the two cohorts in terms of length of prior surgery symptoms and follow-up, mean age and BMI, sex and side, and defect size. At a mean follow-up of 43.5 months, the AOFAS (p = 0.03), VAS (p = 0.003), and Tegner (p = 0.01) scores were greater in the AMIC group. No difference was found in the MOCART score (p = 0.08). The AMIC group evidenced lower rates of reoperation (p = 0.008) and failure (p = 0.003). Conclusion: At midterm follow-up, AMIC provides better results compared to MFx. Full article
(This article belongs to the Special Issue Focal Chondral Defects)
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17 pages, 2240 KiB  
Article
Longitudinal T2 Mapping and Texture Feature Analysis in the Detection and Monitoring of Experimental Post-Traumatic Cartilage Degeneration
by Marc Sebastian Huppertz, Justus Schock, Karl Ludger Radke, Daniel Benjamin Abrar, Manuel Post, Christiane Kuhl, Daniel Truhn and Sven Nebelung
Life 2021, 11(3), 201; https://doi.org/10.3390/life11030201 - 5 Mar 2021
Cited by 3 | Viewed by 2319
Abstract
Background: Traumatic cartilage injuries predispose articulating joints to focal cartilage defects and, eventually, posttraumatic osteoarthritis. Current clinical-standard imaging modalities such as morphologic MRI fail to reliably detect cartilage trauma and to monitor associated posttraumatic degenerative changes with oftentimes severe prognostic implications. Quantitative MRI [...] Read more.
Background: Traumatic cartilage injuries predispose articulating joints to focal cartilage defects and, eventually, posttraumatic osteoarthritis. Current clinical-standard imaging modalities such as morphologic MRI fail to reliably detect cartilage trauma and to monitor associated posttraumatic degenerative changes with oftentimes severe prognostic implications. Quantitative MRI techniques such as T2 mapping are promising in detecting and monitoring such changes yet lack sufficient validation in controlled basic research contexts. Material and Methods: 35 macroscopically intact cartilage samples obtained from total joint replacements were exposed to standardized injurious impaction with low (0.49 J, n = 14) or high (0.98 J, n = 14) energy levels and imaged before and immediately, 24 h, and 72 h after impaction by T2 mapping. Contrast, homogeneity, energy, and variance were quantified as features of texture on each T2 map. Unimpacted controls (n = 7) and histologic assessment served as reference. Results: As a function of impaction energy and time, absolute T2 values, contrast, and variance were significantly increased, while homogeneity and energy were significantly decreased. Conclusion: T2 mapping and texture feature analysis are sensitive diagnostic means to detect and monitor traumatic impaction injuries of cartilage and associated posttraumatic degenerative changes and may be used to assess cartilage after trauma to identify “cartilage at risk”. Full article
(This article belongs to the Special Issue Focal Chondral Defects)
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10 pages, 1287 KiB  
Communication
Autologous Matrix-Induced Chondrogenesis (AMIC) and Microfractures for Focal Chondral Defects of the Knee: A Medium-Term Comparative Study
by Filippo Migliorini, Jörg Eschweiler, Nicola Maffulli, Hanno Schenker, Alice Baroncini, Markus Tingart and Björn Rath
Life 2021, 11(3), 183; https://doi.org/10.3390/life11030183 - 25 Feb 2021
Cited by 26 | Viewed by 3306
Abstract
Introduction: The potential of autologous matrix-induced chondrogenesis (AMIC) to restore unipolar focal chondral defects of the knee is promising. However, the outcome compared to microfracturing (MFx) for certain defect sizes (2–3 cm2) is still uncertain. Therefore, the present study compared primary [...] Read more.
Introduction: The potential of autologous matrix-induced chondrogenesis (AMIC) to restore unipolar focal chondral defects of the knee is promising. However, the outcome compared to microfracturing (MFx) for certain defect sizes (2–3 cm2) is still uncertain. Therefore, the present study compared primary isolated AMIC versus MFx in a cohort of patients with borderline sized focal unipolar chondral defects of the knee at midterm follow-up. Methods: Patients with chondral defects of the knee who underwent AMIC or MFx were compared. An arthroscopic approach was used for MFx, and a minimally invasive parapatellar arthrotomy for AMIC. For those patients who underwent AMIC, a collagen membrane was used with fibrin glue. The patients answered independently: Visual Analogic Scale (VAS), Tegner Activity Scale, International Knee Documentation Committee (IKDC), and the Lysholm scores. Results: A total of 83 patients with a mean age of 30.2 and body mass index (BMI) of 26.9 kg/m2 were recruited. Of them, 33.7% (28 of 83) were women, and 55.4% (46 of 83 patients) had defects in the right knee. The mean length of symptoms before surgery was 43.3 months. The mean size of the defect was 2.7 cm2. The mean length of follow-up was 42.1 months. No difference was found in terms of symptoms and follow-up length, mean age and BMI, mean size of defect, sex, and side. The AMIC cohort reported greater IKCD (p > 0.0001), Lysholm (p = 0.002), VAS (p = 0.01), Tegner (p = 0.004) scores. The AMIC cohort reported lower rate of failure (p = 0.005) and revision surgery (p = 0.02). No difference was found in the rate of arthroplasty (p = 0.2). No delamination or hypertrophy were detected. Conclusion: AMIC demonstrated superiority over MFx for focal unipolar chondral defects of the knee. At approximately 40 months follow-up, the IKDC, Lysholm, and VAS scores were greater in the AMIC group. Patients treated with AMIC also demonstrated a higher level of sport activity, and lower rates of failure and revision surgeries. Full article
(This article belongs to the Special Issue Focal Chondral Defects)
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11 pages, 1142 KiB  
Communication
Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial
by Filippo Migliorini, Jörg Eschweiler, Nicola Maffulli, Arne Driessen, Björn Rath, Markus Tingart and Hanno Schenker
Life 2021, 11(2), 141; https://doi.org/10.3390/life11020141 - 13 Feb 2021
Cited by 26 | Viewed by 16436
Abstract
Introduction: Evidence on the management of chondral defects of the patella arises from studies in which the patellofemoral joint was treated together with the femorotibial joint and primary and revision settings. Furthermore, the superiority of Autologous Matrix Induced Chondrogenesis (AMIC) over microfractures (MFx) [...] Read more.
Introduction: Evidence on the management of chondral defects of the patella arises from studies in which the patellofemoral joint was treated together with the femorotibial joint and primary and revision settings. Furthermore, the superiority of Autologous Matrix Induced Chondrogenesis (AMIC) over microfractures (MFx) for patellar chondral defects is uncertain. Therefore, the present study compared primary isolated AMIC versus MFx for focal unipolar chondral defects of the patellar facet joints at midterm follow-up. Methods: Patients undergoing AMIC or isolated MFx surgery for borderline-sized focal unipolar chondral defects of the patellar facet joints were followed at our institution. All surgeries were performed in the same fashion by experienced surgeons. A parapatellar arthrotomy was adopted in all surgeries. The outcomes of interest were: Visual Analogic Scale (VAS), Tegner Activity Scale, International Knee Documentation Committee (IKDC), and the Lysholm scores. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Results: 38 patients were enrolled in the present study: 27 underwent AMIC, and 11 MFx. The mean follow-up was 45.1 months. The mean age of the patients at baseline was 34.5 years. The mean size of the defect was 2.6 cm2. The MFx cohort experienced a shorter length of the hospitalization (P = 0.008). There was no difference in terms of follow-up and previous symptoms duration, mean age, sex, side, defect size, and BMI. At last follow-up, the AMIC cohort reported greater IKDC (P = 0.01), Lysholm (P = 0.009), and Tegner (P = 0.02), along with a low rate of failure (P = 0.02). VAS was lower in the AMIC group (P = 0.002). No difference was found in the MOCART score (P = 0.09), rates of revision (P = 0.06), and arthroplasty (P = 0.2). Conclusion: The AMIC procedure achieves greater IKDC and Lysholm score, and a significant reduction of the VAS score in the management of patellar chondral defects. The Tegner scale demonstrated greater activity after AMIC procedure. Finally, the AMIC group evidenced a lower rate of failure. Similarity was found on MOCART score, rates of revision, and arthroplasty between the two procedures. Full article
(This article belongs to the Special Issue Focal Chondral Defects)
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9 pages, 386 KiB  
Article
AMIC for Focal Osteochondral Defect of the Talar Shoulder
by Christian Götze, Christian Nieder, Hanna Felder and Filippo Migliorini
Life 2020, 10(12), 328; https://doi.org/10.3390/life10120328 - 5 Dec 2020
Cited by 19 | Viewed by 2658
Abstract
Background: The management of a focal osteochondral lesion of the talus (OLT) is challenging. Evidence concerning the role of the autologous matrix-induced chondrogenesis (AMIC) procedure in patients with focal OLT is promising. The purpose of the present study was to investigate clinical outcomes [...] Read more.
Background: The management of a focal osteochondral lesion of the talus (OLT) is challenging. Evidence concerning the role of the autologous matrix-induced chondrogenesis (AMIC) procedure in patients with focal OLT is promising. The purpose of the present study was to investigate clinical outcomes and radiographic findings of the AMIC technique for focal unipolar OLT. Material and Methods: The present study was performed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Twenty-four patients who underwent AMIC for focal OLT were prospectively recruited at our institution. All the surgeries were performed by two experienced surgeons through malleolar osteotomy and autologous cancellous bone grafting. The outcomes of interest were the American orthopedic foot and ankle score (AOFAS), the foot-function index (FFI), and the magnetic resonance observation of cartilage repair tissue (MOCART). Surgical duration, hospitalization length, and complications were also collected. Results: 24 patients were included in the present study. The mean follow-up was 25.17 ± 13.1 months. The mean age of the patients at surgery was 46.75 ± 15.2 years, the mean BMI 26.92 ± 5.7 kg/m2, and 50% (12 of 24) of patients were female. The right ankle was involved in 62.5% (15 of 24) of patients. The mean defect size was 6.95 ± 2.9 mm2. The mean surgical duration was 112 ± 20 min while the mean hospitalization 5.58 ± 1.7 days. At last follow-up, the AOFAS increased by 27.8 points (p < 0.0001), while the FFI reduced by 25.3 points (p < 0.0001) and the MOCART score increased by 28.33 points (p < 0.0001). No complications were observed. Conclusion: The AMIC procedure for focal osteochondral defects of the talar shoulder is feasible and reliable at midterm follow-up. Full article
(This article belongs to the Special Issue Focal Chondral Defects)
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