Juan José Deré

Osteochondral Defects of the Knee treated with Mosaicplasty. Results at Eight Years of Follow-Up

Objectives: There are several surgical options described for osteochondral defects of the knee depending on the size, location and condition of subchondral bone. The main indication for a mosaicplasty procedure is a less than 4 cm2 femoral condyle lesion. The purpose of this study was to analyze a series of patients treated with mosaicplasty with average eight years of follow-up. Methods: We retrospectively evaluated sixty-two patients with osteochondral defects of the knee who underwent a mosaicplasty between 2001 and 2014 with a minimum follow-up of 2 years. Patients were evaluated using the Lysholm score, International Knee Documentation Committee Score (IKDC) and Kellgren-Lawrence radiographic scale. Results: The mean Lysholm score was 80.1 and IKDC was 66.7. Forty-two patients had isolated mosaicplasty and 20 patients presented an associated surgical procedure (osteotomy, ACL reconstruction, meniscectomy). There were no significant differences between the Lysholm and IKDC scores in these two groups. Conclusion: We consider that mosaicplasty is a satisfactory procedure with good functional results in patients with focal articular cartilage lesions of the knee.

Estudio prospectivo randomizado sobre el uso de drenaje vs. no drenaje en artroplastia total de rodilla. [Prospective randomized study on the use of drainage in total knee arthroplasty.]

Introduction The use of drainage in total knee arthroplasty is a widely accepted practice in Orthopedics; however, there is not conclusive evidence about its benefit in the literature. The purpose of this study was to compare two groups of patients in whom primary total knee arthroplasty with and without drainage was performed. Methods Prospective randomized study in which 76 primary total knee arthroplasties were performed; patients were divided into two groups: group A, with drainage, and group B, without drainage. The number of transfusions, the drainage debit, postoperative complications and length of hospital stay were evaluated. Diameter of the thigh, range of motion, hematocrit and hemoglobin were also recorded before and after surgery in both groups. Results No statistically significant differences were found in thigh diameter, range of motion, hematocrit, hemoglobin, number of transfusions, and hospital stay. The number of complications in group B (without drainage) was higher (P = 0.019): two deep infections, two cases of cellulitis, one case of blebs, a hip fracture, a superficial vein thrombosis, a deep venous thrombosis, and one pulmonary thromboembolism. Conclusion Patients without postoperative drainage presented a higher number of complications.

ISAKOS Classification of Meniscal Tears. Intra and Interobserver Reliability.

Objectives: To analyze the intra and interobserverreliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Methods: Thearthroscopic classification of meniscal lesions created by the ISAKOS was used. Thirty one arthroscopic videos, made between June and December 2013,with different meniscal tear characteristics were analyzedby three orthopedic surgeons (two specialists in knee surgery and a fellowship), twice at an interval of 30 days. The Kappa Coefficients (k) was used to assess the intraobserver reliability and intraclass correlation coefficient (ICC) for interobserverreliability. Results: The averageintraobserver reliability was for the first observer 51%, the second 65% and the third 58%, reaching moderate agreement according to the Kappa coefficient used by Landis and Koch. Regarding interobserver reliability, good agreement (ICC = 0.71) was obtained as the intraclass correlation coefficient. The whole results were significantlystatical (p <0.05). Conclusion: While this classification provides a detailed description of meniscal lesions, the intraobserver reliability did not reach the optimum values obtained despite having on average a moderate agreement. However interobserver reliability results showed on average 70% of agreement (good agreement), which can affirm that the agreement and interobserver reliability is acceptable.

Autologous osteochondral transfer for the treatment of full-thickness defects in patients with or without ACL reconstruction. Results with 7 years follow-up

Objectives: The aim of this study was to evaluate the results of autologous osteochondral transfer for the treatment of cartilage defects in 2 groups of patients: The first with an isolated osteochondral injury and the other with associated anterior cruciate ligament (ACL) injury treated in one stage surgery Materials and Methods: We retrospectively evaluated 25 patients with symptomatic focal full-thickness chondral lesions in the femoral condyles during the years 2003-2009, with a minimum of 5 years of follow up. The patients were divided into 2 groups: Group A: 10 patients with associated ACL injury, and Group B: 15 patients with an isolated osteochondral lesion. Clinical outcome was analyzed by Lysholm and IKDC scores. Results: There was an improvement of all scores in both groups. There were no significant differences between the groups in the IKDC (82/84) and Lysholm (87/86) scores. The mean age at the time of assessment for group A was 46 years and 44 for the group B. The mid term follow-up was 96 months for group A and 103 months for group B. Two complications were recorded in group A: 1 infection and 1 arthrofibrosis. 2 complicationsoccurred in group B: 2 arthrofibrosis. Conclusion: The results of the mosaicplasty for the focal full-thickness chondral lesions in the femoral condyles are favorable after 5 years of follow up. There was no difference between the associated or not ACL injury.

High Tibial Valgus Osteotomy and Concomitant Anterior Cruciate Ligament Reconstruction. Which is the most appropriate surgical technique

Introduction: The aim of this study is to evaluate advantages of close vs. open HTO of a group of patients who underwent a one-stage combined operation for chronic ACL rupture and early medial compartment arthritis. Material and Methods: We retrospective evaluated two series of patients operated on for anterior cruciate ligament (ACL) reconstruction combined with high tibial valgus osteotomy (HTO) for chronic anterior knee instability associated with medial tibio femoral osteoarthritis. Close HTO using rigid plate fixation and ACL reconstruction with bone patellar tendon bone graft was performed in Group A (7 patients). An open HTO using Puddu plate and ACL reconstruction with hamstring tendon graft was performed in Group B (9 patients). The mean age in Group A was 41 years old with an average varus of 8 degrees. Mean age in Group B was 42 years old and with 4 degrees of varus. Lysholm Score, HSS and Radiographs were performed. Results: Group A obtained a mean Lysholm score of 94, mean HSS of 91. Group B showed a mean Lysholm score of 83, mean HSS of 87. The mean follow-up was 5 years in both groups. In all cases osteotomies consolidated. Discussion: Technically we found that open HTO with hamstrings had several advantages such as lower risk of peroneal nerve injury, use of one incision, no problems as regards graft length, possibility of fixing the graft in the proximal tibia, maintenance of tibial slope and preservation of bone stock. The Open HTO need of osseous graft, may produce patella baja and the risk of nonunion is higher. This technique is indicated for relaxed medial collateral ligament. As regards the Close HTO there may be possibilities of a peroneal nerve injury, it may decrease the tibial slope, patellar ascent, loss of bone, the need to disrupt either the fibula or proximal tibio-fibular joint and may generate instability in the posterolateral corner and the screws could compromise the tunnels path. The advantages are provision of bone to bone contact with excellent union rates and the potential for full early weight-bearing. Conclusion: In spite of these issues, both procedures relieved pain and restored knee stability and the choice will depend on each particular case.