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Life
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Osteochondral Lesions: Current Knowledge and Future Perspectives
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Osteochondral Lesions: Current Knowledge and Future Perspectives

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: closed (15 August 2023) | Viewed by 9889

Special Issue Editors

Dr. Christian David Weber

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Guest Editor
Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Interests: sports traumatology; articular injuries; osteochondral reconstruction; joint preservation surgery; arthroscopy
Dr. Filippo Migliorini

E-Mail Website
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

Special Issue Information

Dear Colleagues,

Osteochondral lesions (OCLs) have been recognized in both pediatric and adult patients as a challenging entity, presenting either as acute (e.g., traumatic injuries), subacute or even chronic conditions. OCLs are clinically associated with significant morbidity and may impair the quality of life. Scientific investigations have focused on OCLs as the cause of symptomatic joint dysfunction and premature articular degeneration for more than a century, but the exact etiology and ideal management remain unknown.

A broad range of clinical, cadaveric, animal, advanced imaging, biomechanical and genetic studies have been initiated in order to elucidate the etiology of these manifold lesions. With variable involvement of the subchondral bone and cartilaginous layers, osteochondral lesions may affect the articular architecture of any joint of the human body. In clinical and surgical practice, the knee, elbow and ankle are most prevalent, but enarthroses (e.g., shoulder or hip) may also be involved.

The complex osteochondral unit may be harmed by multifactorial effects, including sports-related injuries, chronic overload, local ischemia/osteonecrosis, as well as aberrant endochondral ossification or osteoarthritis. The highest incidence is observed in active adolescents and young adults, and increased risk is observed for multisport athletes. The regenerative potential is limited and proposed to be associated with skeletal maturity, vascular supply, genetic variations, and biomechanical factors.

For unstable symptomatic lesions, a variety of interventions have been applied, including techniques to stimulate subchondral revascularization, promote parent–progeny healing, and restore anatomic joint congruity. Surgical strategies after failed nonoperative treatment involve unstable fragment fixation, bone marrow stimulation, autologous and allograft transplantation, biomaterials, scaffolds, cells, and adjuvant therapies. In the light of a high number of secondary procedures, the diagnostic and therapeutic management of osteochondral lesions warrants current scientific evaluation.

The purpose of this Special Issue is to investigate current epidemiology, established and innovative strategies and future perspectives for the management of osteochondral lesions.

Dr. Christian David Weber
Dr. Filippo Migliorini
Guest Editors

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Keywords

  • osteochondral lesion
  • osteochondral defect
  • osteochondrosis dissecans (OCD)
  • ankle
  • knee
  • elbow
  • shoulder
  • hip

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Published Papers (3 papers)

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Review

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15 pages, 4923 KiB  
Review
Imaging of Cartilage and Chondral Defects: An Overview
by Neha Nischal, Karthikeyan P. Iyengar, Deepak Herlekar and Rajesh Botchu
Life 2023, 13(2), 363; https://doi.org/10.3390/life13020363 - 28 Jan 2023
Cited by 6 | Viewed by 5707
Abstract
A healthy articular cartilage is paramount to joint function. Cartilage defects, whether acute or chronic, are a significant source of morbidity. This review summarizes various imaging modalities used for cartilage assessment. While radiographs are insensitive, they are still widely used to indirectly assess [...] Read more.
A healthy articular cartilage is paramount to joint function. Cartilage defects, whether acute or chronic, are a significant source of morbidity. This review summarizes various imaging modalities used for cartilage assessment. While radiographs are insensitive, they are still widely used to indirectly assess cartilage. Ultrasound has shown promise in the detection of cartilage defects, but its efficacy is limited in many joints due to inadequate visualization. CT arthrography has the potential to assess internal derangements of joints along with cartilage, especially in patients with contraindications to MRI. MRI remains the favored imaging modality to assess cartilage. The conventional imaging techniques are able to assess cartilage abnormalities when cartilage is already damaged. The newer imaging techniques are thus targeted at detecting biochemical and structural changes in cartilage before an actual visible irreversible loss. These include, but are not limited to, T2 and T2* mapping, dGEMRI, T1ρ imaging, gagCEST imaging, sodium MRI and integrated PET with MRI. A brief discussion of the advances in the surgical management of cartilage defects and post-operative imaging assessment is also included. Full article
(This article belongs to the Special Issue Osteochondral Lesions: Current Knowledge and Future Perspectives)
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Other

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10 pages, 3053 KiB  
Case Report
Refixation of a Large Osteochondral Fragment with Magnesium Compression Screws—A Case Report
by Adrian Deichsel, Lucas Klaus Palma Kries, Michael J. Raschke, Christian Peez, Thorben Briese, Johannes Glasbrenner, Elmar Herbst and Christoph Kittl
Life 2023, 13(5), 1179; https://doi.org/10.3390/life13051179 - 12 May 2023
Cited by 1 | Viewed by 1587
Abstract
Introduction: Osteochondrosis dissecans (OCD) is a disease affecting the subchondral bone and the overlying articular cartilage. The etiology is most likely a combination of biological and mechanical factors. The incidence is highest in children >12 years old and it predominantly affects the knee. [...] Read more.
Introduction: Osteochondrosis dissecans (OCD) is a disease affecting the subchondral bone and the overlying articular cartilage. The etiology is most likely a combination of biological and mechanical factors. The incidence is highest in children >12 years old and it predominantly affects the knee. In high-grade OCD lesions, free osteochondral fragments usually are refixed via titanium screws or biodegradable screws or pins. In this case, headless compression screws made from magnesium were used for refixation. Case report: A thirteen-year-old female patient with a two-year history of knee pain was diagnosed with an OCD lesion of the medial femoral condyle. After initial conservative treatment, displacement of the osteochondral fragment occurred. Refixation was performed using two headless magnesium compression screws. At the 6 months follow up, the patient was pain free, and the fragment showed progressive healing while the implants were biodegrading. Discussion: Existing implants for refixation of OCD lesions either require subsequent removal or show less stability and possible inflammatory reactions. The new generation of magnesium screws used in this case did not lead to a gas release, as described for previous magnesium implants, while maintaining stability during continuous biodegradation. Conclusions: The data available to date on magnesium implants for the treatment of OCD are promising. However, the evidence on the magnesium implants in refixation surgery of OCD lesions is still limited. Further research needs to be conducted to provide data on outcomes and possible complications. Full article
(This article belongs to the Special Issue Osteochondral Lesions: Current Knowledge and Future Perspectives)
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12 pages, 662 KiB  
Systematic Review
Fixation of the Membrane during Matrix-Induced Autologous Chondrocyte Implantation in the Knee: A Systematic Review
by Filippo Migliorini, Raju Vaishya, Andreas Bell, Christian D. Weber, Christian Götze and Nicola Maffulli
Life 2022, 12(11), 1718; https://doi.org/10.3390/life12111718 - 27 Oct 2022
Cited by 5 | Viewed by 1653
Abstract
Introduction: It is unclear whether the type of membrane used for matrix-assisted autologous chondrocyte implantation (mACI) influences results. A systematic review was conducted to investigate the midterm results of the three most common types of membrane fixation for mACI. Methods: This systematic review [...] Read more.
Introduction: It is unclear whether the type of membrane used for matrix-assisted autologous chondrocyte implantation (mACI) influences results. A systematic review was conducted to investigate the midterm results of the three most common types of membrane fixation for mACI. Methods: This systematic review was conducted according to the 2020 PRISMA checklist. PubMed, Google Scholar, Embase, and Scopus online databases were accessed in August 2022. All the prospective clinical trials reporting outcomes of mACI in the knee were considered. Studies that describe the modality of membrane fixation (glued, glued, and sutured, no fixation) used for mACI were eligible. Studies that conducted a minimum of 12 months of follow-up were considered. The outcomes of interest were the Tegner Activity Scale and International Knee Documentation Committee (IKDC) score. The rate of failure and revisions were also collected. Results: Data from 26 studies (1539 procedures; 554 of 1539 (36%) were women) were retrieved. The mean follow-up was 42.6 (12 to 84) months. No difference between the groups was found in terms of mean duration of symptoms, age, BMI, gender, and defect size (P > 0.1). No difference was found in terms of the Tegner score (P = 0.3). When no fixation was used, a statistically significant higher IKDC compared to the other groups (P = 0.02) was evidenced. No difference was found in the rate of failure (P = 0.1). The no-fixation group evidenced a statistically significant lower rate of revisions (P = 0.02). Conclusions: No membrane fixation for mACI in the knee scored better than the fastening techniques at the midterm follow-up. Full article
(This article belongs to the Special Issue Osteochondral Lesions: Current Knowledge and Future Perspectives)
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