Efficacy of Genicular Nerve Block in Patients with Osteoarthritis: A Comparative Study with and without Fluoroscopy Assistance.

 To compare the efficacy of fluoroscopy as an auxiliary method in genicular nerve block (GNB) with block guidance by anatomical parameters, without imaging aid, in reducing pain.  A total of 23 patients underwent fluoroscopy-guided or anatomical parameter-based GNBs. We applied the Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC) and the Visual Analog Scale (VAS) for pain at 6 time points (preblock, and after 1 hour, 24 hours, 7 days, 28 days, and 90 days).

Early Results of a Patient-Specific Total Knee Arthroplasty Implant Cast From a 3D-Printed Mold.

Background: The second generation of a custom total knee arthroplasty (TKA) implant cast from a 3D-printed mold was introduced into the market in 2012. The purpose of this retrospective study was to investigate short- to mid-term survivorship and complication rates of this novel implant.

Methods: This study is a retrospective analysis of 314 TKA procedures (264 patients) performed by a single surgeon using a customized TKA from September 2012 to November 2015.

Load Distribution After Serial Resection of the Posterior Horn of the Lateral Meniscus and Subsequent Meniscal Allograft Transplant: A Biomechanical Study.

Background: Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus.

Hypothesis: Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy.

Study Design: Controlled laboratory study.

Short-to Mid-Term Survivorship of a Patient-specific Unicompartmental Knee Arthroplasty Implant Cast from a Three-Dimensional Printed Mold.

The purpose of this study was to determine early survivorship and complication rates associated with the implantation of a new patient-specific unicompartmental knee implant cast from a three-dimensional (3D) printed mold, introduced in 2012. We retrospectively reviewed 92 consecutive patients who underwent unicompartmental knee arthroplasty (UKA) with a patient-specific implant cast from a 3D printed mold between September 2012 and October 2015. The early results of a patient-specific UKA implant were favorable in our cohort, with survivorship free from reoperation of 97% at an average 4.

Etiology of Cartilage Lesions Does Not Affect Clinical Outcomes of Patellofemoral Autologous Chondrocyte Implantation.

Objective: To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years' follow-up.

Methods: A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.

Femoral interference screw insertion significantly increases graft tension in medial patellofemoral ligament reconstruction.

Purpose: This study aimed to quantify the effect of interference screw insertion on MPFL graft tension when securing the femoral attachment after patellar fixation. It was hypothesized that interference screw insertion significantly increases graft tension.

Methods: Ten fresh frozen human cadaveric femurs were utilized to compare graft tension at three different preloading conditions (2 N, 5 N, 10 N) using a tensile testing machine (Admet Inc.

Trochlear Dysplasia Does Not Affect the Outcomes of Patellofemoral Autologous Chondrocyte Implantation.

Purpose: To evaluate the influence of trochlear dysplasia on clinical outcomes after autologous chondrocyte implantation (ACI) for the treatment of large cartilage lesions in the patellofemoral joint (PFJ) with a minimum of 2 years' follow-up.

Methods: We performed a retrospective review of prospectively collected data of all patients submitted to cartilage repair with ACI for focal cartilage defects in the PFJ by a single surgeon. Patient factors, lesion morphology, and preoperative and postoperative patient-reported outcome measures including the Knee Injury and Osteoarthritis Score, Lysholm score, Tegner activity level, and International Knee Documentation Committee Subjective Knee Evaluation Form score were collected.

The Effect of Mechanical Leg Alignment on Cartilage Restoration With and Without Concomitant High Tibial Osteotomy.

Purpose: To assess graft survivorship in patients who underwent autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) for the treatment of focal full-thickness cartilage lesions on the medial femoral condyle with and without concomitant high tibial osteotomy (HTO), depending on the preoperative lower-extremity alignment. A secondary purpose was to retrospectively evaluate associated factors for ACI and OCA graft failures.

Methods: A total of 168 patients who underwent cartilage repair with ACI or OCA with or without HTO for focal chondral defects on the medial femoral condyle by a single surgeon between March 2007 and February 2018 were included.

Prior Surgery Negatively Affects Cell Culture Identity in Patients Undergoing Autologous Chondrocyte Implantation.

Background: Recently, a cell identity assay has been introduced to evaluate the identity of cultured chondrocytes before autologous chondrocyte implantation (ACI), which was shown to be associated with graft survival after ACI.

Purpose: To identify the influence of several patient- and lesion-specific factors on cell identity and viability assays.

Study Design: Cross-sectional study; Level of evidence, 3.

Bone-Plug Versus Soft Tissue Fixation of Medial Meniscal Allograft Transplants: A Biomechanical Study.

Background: It is controversial whether soft tissue fixation only and bone-plug techniques for medial meniscal allograft transplantation provide equivalent fixation and restoration of load distribution. Prior studies on this topic did not re-create the clinical situation with use of size-, side-, and compartment-matched meniscal transplants.

Hypothesis: Both techniques will provide equivalent fixation of the meniscal transplant and restore load distribution and contact pressures similar to those of the native knee.

Increased Chondrocytic Gene Expression Is Associated With Improved Repair Tissue Quality and Graft Survival in Patients After Autologous Chondrocyte Implantation.

Background: Assays to quantitate the quality of autologous chondrocyte implants have recently become available. However, the correlation of the assay score with radiological and clinical outcomes has not been established.

Purpose/hypothesis: The purpose was to assess the influence of cell identity (chondrocyte/synoviocyte gene expression ratio) and viability on patient-reported outcome measures, graft survival, and repair tissue quality.

Effect of Autogenous Bone Marrow Aspirate Treatment on Magnetic Resonance Imaging Integration of Osteochondral Allografts in the Knee: A Matched Comparative Imaging Analysis.

Purpose: To accurately evaluate the effects of bone marrow aspirate (BMA) augmentation on osteochondral allograft (OCA) integration on early postoperative magnetic resonance imaging (MRI) using the comprehensive Osteochondral Allograft MRI Scoring System (OCAMRISS).

Methods: This imaging study compared patients who underwent OCA transplantation with and without BMA augmentation for the treatment of focal osteochondral defects in the knee performed by a single surgeon between July 2013 and July 2017. Patients were excluded if they underwent implantation of premade plugs, had an overlapping OCA configuration ("snowman" technique), or did not undergo MRI at 6 months postoperatively.

Effect of Graft-Host Interference Fit on Graft Integration after Osteochondral Allograft Transplantation: A Comparative MRI Analysis of Two Instrumentation Sets.

Objective: Precise graft-host interference fit is a potentially import factor for the successful incorporation of osteochondral allograft (OCA) transplants for the treatment of symptomatic focal cartilage defects. It was hypothesized that selection of OCA plug instrumentation set has a significant effect on graft integration and morphology after OCA transplantation.

Methods: Thirty-one patients who underwent OCA transplantation between July 2013 and July 2016 were identified for this comparative magnetic resonance imaging (MRI) analysis.

Open Meniscal Allograft Transplantation With Transosseous Suture Fixation of the Meniscal Body Significantly Decreases Meniscal Extrusion Rate Compared With Arthroscopic Technique.

Purpose: To assess and compare meniscal extrusion rates after lateral "bridge-in-slot" meniscal allograft transplantation (MAT) with arthroscopic versus open insertion.

Methods: In this review of prospectively collected data, we analyzed data from patients who underwent arthroscopic or open lateral MAT. Patients who underwent concomitant distal femoral osteotomy, for whom 1-year postoperative magnetic resonance imaging was unavailable, or who underwent open lateral MAT without the use of transosseous sutures were excluded.

Clinical Outcomes after Revision of Autologous Chondrocyte Implantation to Osteochondral Allograft Transplantation for Large Chondral Defects: A Comparative Matched-Group Analysis.

Objective: Osteochondral allograft transplantation (OCA) is a well-established procedure for patients with symptomatic cartilage defects in the knee. Revision to OCA after prior failed cartilage repair has shown similar clinical outcomes as primary OCA; however, most of the failed procedures were arthroscopic procedures for smaller defects. There is no literature investigating the clinical outcomes after OCA for prior failed autologous chondrocyte implantation (ACI) for the treatment of large chondral defects of the knee.

Mental Health Has No Predictive Association With Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation of the Knee.

Background: Patient-reported outcome (PRO) measures are progressively utilized as evaluation tools in preoperative and postoperative assessments in orthopaedic practice. Identifying the potential utility of psychosocial factors to predict patient-reported pain and functional outcomes is of increasing interest to determine which patients will derive the greatest benefit from surgical treatment.

Purpose/hypothesis: The purpose of this study was to determine potential predictive associations between the preoperative 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) score, patient characteristics or osteochondral allograft (OCA) morphology, and PROs in patients who underwent OCA transplantation.

The Minimal Clinically Important Difference and Substantial Clinical Benefit in the Patient-Reported Outcome Measures of Patients Undergoing Osteochondral Allograft Transplantation in the Knee.

Objective: Little is known regarding the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) with regard to the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm score, and Short Form 12 (SF-12) score of patients who undergo osteochondral allograft transplantation (OCA). We aimed to determine the MCID and SCB associated with those patient-reported outcome measures (PROMs) after OCA.

Design: We analyzed the data of 86 consecutive patients who underwent OCA and who completed satisfaction surveys at a minimum of 1 year postoperatively and had at least one repeated PROM.

Safety, Feasibility, and Radiographic Outcomes of the Anterior Meniscal Takedown Technique to Approach Chondral Defects on the Tibia and Posterior Femoral Condyle: A Matched Control Study.

Objective: Takedown of the anterior meniscus to facilitate exposure of the cartilage defects located on the tibial plateau and/or posterior femoral condyle with subsequent reattachment is being performed clinically; however, clinical evidence is lacking to support the safety of this technique. The aim of this study was therefore to investigate whether meniscal extrusion develops after patients undergo meniscus takedown and transosseous refixation during autologous chondrocyte implantation (ACI).

Design: We analyzed data from 124 patients with a mean follow-up of 6.

Minimal Clinically Important Differences and Substantial Clinical Benefit in Patient-Reported Outcome Measures after Autologous Chondrocyte Implantation.

Objective: We sought to determine the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) associated with the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm, and Short Form-12 (SF-12) after autologous chondrocyte implantation (ACI).

Design: Ninety-two patients with satisfaction surveys at a minimum of 2 years postoperatively and at least 1 repeated patient-reported outcome measure (PROM) were analysed. The MCID was determined using 4 anchor-based methods: average change, mean change, minimally detectable change, and the optimal cutoff point for receiver operating characteristic (ROC) curves.

Validation of the Oswestry Risk of Knee Arthroplasty Index (ORKA-1) for Patients Undergoing Autologous Chondrocyte Implantation.

Objective: The purpose of this study was first to externally validate the Oswestry Risk of Knee Arthroplasty index (ORKA-1) by applying it to an autologous chondrocyte implantation (ACI) patient cohort in the United States with a broader definition of failure than only arthroplasty, and second, to determine predictive factors for the risk of ACI failure as defined by the senior author.

Design: A total of 171 patients that underwent ACI were included to validate the ORKA-1 as all factors needed for calculation and outcomes were recorded. For Cox regression analysis, 154 patients were included as they completed preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm, International Knee Documentation Committee (IKDC), and 12-item Shor Form (SF-12) scores.

Preoperative Mental Health Has a Stronger Association with Baseline Self-Assessed Knee Scores than Defect Morphology in Patients Undergoing Cartilage Repair.

Objective: The purpose of this study was to assess potential correlations between the mental component summary of the Short Form-12 (SF-12 MCS), patient characteristics or lesion morphology, and preoperative self-assessed pain and function scores in patients undergoing autologous chondrocyte implantation (ACI).

Design: A total of 290 patients underwent ACI for symptomatic cartilage lesions in the knee. One hundred and seventy-eight patients were included in this study as they completed preoperative SF-12, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores.

Patellofemoral Cartilage Repair.

Purpose Of Review: This review provides an overview of well-established and newly developed cartilage repair techniques for cartilage defects in the patellofemoral joint (PFJ). An algorithm will be presented for approaching cartilage defects considering the distinct anatomy of both the patellar and trochlear articular surfaces.

Recent Findings: Recent studies on cartilage repair in the PFJ have demonstrated improved outcomes in an attempt to delay or obviate the need for arthroplasty, and improve symptoms in young patients.